Purpose
This study was designed to optimize the latest generation venovenous (vv)-extracorporeal membrane oxygenation (ECMO)-circuit configuration and settings based on the evaluation of blood ...oxygenation and CO
2
removal determinants in patients with severe acute respiratory distress syndrome (ARDS) on ultraprotective mechanical ventilation.
Methods
Blood gases and hemodynamic parameters were evaluated after changing one of three ECMO settings, namely, circuit blood flow, FiO
2ECMO
(fraction of inspired oxygen in circuit), or sweep gas flow ventilating the membrane, while leaving the other two parameters at their maximum setting.
Results
Ten mechanically ventilated ARDS patients (mean age 44 ± 16 years; 6 males; mean hemoglobin 8.0 ± 1.8 g/dL) on ECMO for a mean of 9.0 ± 3.8 days) receiving femoro–jugular vv-ECMO were evaluated. vv-ECMO blood flow and FiO
2ECMO
determined arterial oxygenation. Decreasing the ECMO flow from its baseline maximum value (5.8 ± 0.8 L/min) to 40 % less (2.4 ± 0.3 L/min) significantly decreased mean PaO
2
(arterial oxygen tension; 88 ± 24 to 45 ± 9 mm Hg;
p
< 0.001) and SaO
2
(oxygen saturation; 97 ± 2 to 82 ± 10 %;
p
< 0.001). When the ECMO flow/cardiac output was >60 %, SaO
2
was always >90 %. Alternatively, the rate of sweep gas flow through the membrane lung determined blood decarboxylation, while PaCO
2
(arterial carbon dioxide tension) was unaffected when the ECMO blood flow and FiO
2ECMO
were reduced to <2.5 L/min and 40 %, respectively. In three additional patients evaluated before and after red blood cell transfusion, O
2
delivery increased after transfusion, allowing lower ECMO flows to reach adequate SaO
2
.
Conclusions
For severe ARDS patients receiving femoro–jugular vv-ECMO, blood flow was the main determinant of arterial oxygenation, while CO
2
elimination depended on sweep gas flow through the oxygenator. An ECMO flow/cardiac output >60 % was constantly associated with adequate blood oxygenation and oxygen transport and delivery.
Microcirculatory dysfunction has been well reported in clinical studies in septic shock. However, no clinical studies have investigated microcirculatory blood flow behavior in hemorrhagic shock. The ...main objective of this study was to assess the time course of sublingual microcirculation in traumatic hemorrhagic shock during the first 4 days after trauma.
Prospective observational study.
Eighteen traumatic hemorrhagic shock patients.
The sublingual microcirculation was estimated at the study inclusion after surgical or angiographic embolization to control bleeding (D1), and then three times at 24-hour intervals (D2, D3, and D4).
Sublingual microcirculation was impaired for 72 hours despite restoration of the macrovascular circulation after control of bleeding in traumatic hemorrhagic shock patients. Furthermore, we found significantly higher decreases in the microvascular flow index and proportion of perfused vessels in high Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score ≥ 6) compared to low Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score < 6) without any differences in global hemodynamics between these two groups. Finally, the initial proportion of perfused vessels at D1 appears to be a good predictor of high Sequential Organ Failure Assessment score at D4.
Alterations of microcirculation in traumatic hemorrhagic shock patients result from the interplay among hemorrhage-induced tissue hypoperfusion, trauma injuries, inflammatory response, and subsequent resuscitation interventions. Despite restoration of the macrocirculation, the sublingual microcirculation was impaired for at least 72 hours. The initial proportion of perfused vessels appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Further studies are required to firmly establish the link between microvascular alterations and organ dysfunction in traumatic hemorrhagic shock patients.
The aim of this study was to replicate the results of a lengthening effect caused by physical activity already observed in duration length judgment, using the time passage judgment measure, while ...exploring the effects of passion types (obsessive vs. harmonious) on time perception. A total of 378 ultra-trail runners responded to an online questionnaire in which the type of passion and the passage of time (PoT) judgments associated with both an ultra-trail context and a non-trail daily context were collected. The results showed that participants systematically judged the time as being dilated in a situation of sports practice, thus extending the results obtained in interval duration judgment studies. This study also showed an influence of the type of passion: higher levels of harmonious passion were related to greater feelings of time dilation, while higher levels of obsessive passion were related to greater feelings of both time contraction and time dilation. Results are discussed in light of the two major factors that influence the PoT referenced in the literature, namely, attention and happiness level.
A multisystem inflammatory syndrome mimicking Kawasaki disease has been increasingly reported, mainly in children, in the context of coronavirus disease-2019 (COVID-19). We report on the first case ...of coronary aneurysm resolution after treatment with steroids and intravenous immunoglobulins in an adult patient with multisystem inflammatory syndrome temporally associated with COVID-19. (Level of Difficulty: Beginner.)
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In the past two decades, gratitude has been shown to be closely related to mental health and well-being. However, there is no consensus about its definition, and self-gratitude was hastily dismissed. ...This research aimed to analyze how self-gratitude is considered by laypersons. We conducted three online studies to test the hypothesis according to which self-gratitude is prototypically organized. In Study 1, participants (N = 152) listed the features of self-gratitude: 55 categories emerged from the data processing. In Study 2, participants (N = 146) significantly distinguished the features according to their degree of centrality. In Study 3 (N = 108), the analysis showed that the centrality of features influenced cognition through a recognition task. The results provide preliminary evidence of the internal structure of self-gratitude. Overall, this study showed the lay conceptions, allowing us to define self-gratitude as acknowledgment and appreciation of meaningful benefits involving the self.
Satisfaction with life as a judgmental cognitive process can be negatively influenced by appraisals of daily events such as hassles. Trait-gratitude-a tendency to appraise, recognize and respond to ...life events through being grateful-is a determinant of mental health and well-being, and has been shown to be related to the positive appraisal of life. The aim of the current study was to investigate the moderating role of trait-gratitude in the relationship between daily hassles and satisfaction with life. In the process of carrying out this study, the French version of the Gratitude Questionnaire (GQ-6) was validated. A total of 328 French undergraduates completed questionnaires measuring gratitude, satisfaction with life, and daily hassles to test the main hypothesis. They also completed optimism, coping strategies, depression, and anxiety questionnaires in order to assess the convergent validity of the French version of the GQ-6. First, the results showed satisfactory psychometric properties of the Gratitude Questionnaire. Second, the results indicated the moderating role of trait-gratitude in the relationship between daily hassles disturbance and satisfaction with life. This study further documents the role of gratitude as a determinant of well-being and provides French-speaking clinicians and researchers with a useful tool to measure grateful disposition.
The aim of this study was to replicate the results of a lengthening effect caused by physical activity already observed in duration length judgment, using the time passage judgment measure, while ...exploring the effects of passion types (obsessive vs. harmonious) on time perception. A total of 378 ultra-trail runners responded to an online questionnaire in which the type of passion and the passage of time (PoT) judgments associated with both an ultra-trail context and a non-trail daily context were collected. The results showed that participants systematically judged the time as being dilated in a situation of sports practice, thus extending the results obtained in interval duration judgment studies. This study also showed an influence of the type of passion: higher levels of harmonious passion were related to greater feelings of time dilation, while higher levels of obsessive passion were related to greater feelings of both time contraction and time dilation. Results are discussed in light of the two major factors that influence the PoT referenced in the literature, namely, attention and happiness level.
Lung transplantation is limited by the shortage of suitable donors. Many programs have begun to use extended criteria donors. Donors over 65 years old are rarely reported, especially for young cystic ...fibrosis recipients. This monocentric study was conducted for cystic fibrosis recipients from January 2005 to December 2019, comparing two cohorts according to lung donor age (<65 years or ≥65 years). The primary objective was to assess the survival rate at 3 years using a Cox multivariable model. Of the 356 lung recipients, 326 had donors under 65 years, and 30 had donors over 65 years. Donors' characteristics did not differ significantly in terms of sex, time on mechanical ventilation before retrieval, and partial pressure of arterial oxygen/fraction of inspired oxygen ratio. There were no significant differences in post-operative mechanical ventilation duration and incidence of grade 3 primary graft dysfunction between the two groups. At 1, 3, and 5 years, the percentage of predicted forced expiratory volume in 1 s (
= 0.767) and survival rate did not differ between groups (
= 0.924). The use of lungs from donors over 65 years for cystic fibrosis recipients allows extension of the donor pool without compromising results. Longer follow-up is needed to assess the long-term effects of this practice.
In patients under extracorporeal membrane oxygenation (ECMO) support requiring renal replacement therapy or plasmapheresis, connecting such extracorporeal therapy device to the ECMO circuit provides ...many advantages compared with central venous catheterization. However, high pressures of the ECMO circuit limit the usefulness of this technique. We propose a new approach to connect extracorporeal therapy lines to the ECMO circuit. Inlet line is connected to the oxygenator, and outlet line is connected either to the femoral artery antegrade perfusion cannula in case of venoarterial ECMO or to the lateral vent of the return cannula in case of venovenous ECMO. We report the successful management of 21 patients using this connection, with much longer hemofilter average lifetime than previously reported.
The aim of this study was to replicate the results of a lengthening effect caused by physical activity already observed in duration length judgment, using the time passage judgment measure, while ...exploring the effects of passion types (obsessive vs. harmonious) on time perception. A total of 378 ultra-trail runners responded to an online questionnaire in which the type of passion and the passage of time (PoT) judgments associated with both an ultra-trail context and a non-trail daily context were collected. The results showed that participants systematically judged the time as being dilated in a situation of sports practice, thus extending the results obtained in interval duration judgment studies. This study also showed an influence of the type of passion: higher levels of harmonious passion were related to greater feelings of time dilation, while higher levels of obsessive passion were related to greater feelings of both time contraction and time dilation. Results are discussed in light of the two major factors that influence the PoT referenced in the literature, namely, attention and happiness level.
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