Videolaryngoscopy (VL) may improve the success of orotracheal intubation compared with direct laryngoscopy (DL). We performed a systematic search of PubMed, Embase, and CENTRAL databases for studies ...comparing VL and DL for emergency orotracheal intubations outside the operating room. The primary outcome was rate of first-pass intubation, with subgroup analyses by location, device used, clinician experience, and clinical scenario. The secondary outcome was complication rates. Data are presented as odds ratio (95% confidence intervals); P-values. We identified 32 studies with 15 064 emergency intubations. There was no difference in first-pass intubation with VL compared with DL OR=1.28, (0.99–1.65); P=0.06. First-pass intubations were increased with VL compared with DL in the intensive care unit (ICU) 2.02 (1.43–2.85); P<0.001, and similar in the emergency department or pre-hospital setting. First-pass intubations were similar with GlideScope®, but improved with the CMAC® 1.32 (1.08–1.62); P=0.007 compared with DL. There was greater first-pass intubation with VL compared with DL amongst novice/trainee clinicians OR=1.95 (1.45–2.64); P<0.001, but not amongst experienced clinicians or paramedics/nurses. There was no difference in first-pass intubation with VL compared with DL during cardiopulmonary resuscitation or trauma. VL compared with DL was associated with fewer oesophageal intubations OR=0.32 (0.14–0.70); P=0.003, but more arterial hypotension OR=1.49 (1.00–2.23); P=0.05. In summary, VL compared with DL is associated with greater first-pass emergency intubation in the ICU and amongst less experienced clinicians, and reduces oesophageal intubations. However, VL is associated with greater incidence of arterial hypotension. Further trials investigating the utility of VL over DL in specific situations are required.
Tests of a dual-readout fiber calorimeter with SiPM light sensors Antonello, M.; Caccia, M.; Cascella, M. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
08/2018, Letnik:
899, Številka:
C
Journal Article
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In this paper, we describe the first tests of a dual-readout fiber calorimeter in which silicon photomultipliers are used to sense the (scintillation and Čerenkov) light signals. The main challenge ...in this detector is implementing a design that minimizes the optical crosstalk between the two types of fibers, which are located very close to each other and carry light signals that differ in intensity by about a factor of 60. The experimental data, which were obtained with beams of high-energy electrons and muons as well as in lab tests, illustrate to what extent this challenge was met. The Čerenkov light yield, a limiting factor for the energy resolution of this type of calorimeter, was measured to be about twice that of the previously tested configurations based on photomultiplier tubes. The lateral profiles of electromagnetic showers were measured on a scale of millimeters from the shower axis and significant differences were found between the profiles measured with the scintillating and the Čerenkov fibers.
Diamond detector technology, status and perspectives Alexopoulos, A.; Artuso, M.; Bachmair, F. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
04/2019, Letnik:
924, Številka:
C
Journal Article
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Detectors based on Chemical Vapor Deposition (CVD) diamond have been used extensively and successfully in beam conditions/beam loss monitors as the innermost detectors in the highest radiation areas ...of Large Hadron Collider (LHC) experiments. The startup of the LHC in 2015 brought a new milestone where the first polycrystalline CVD (pCVD) diamond pixel modules were installed in an LHC experiment and successfully began operation. The RD42 collaboration at CERN is leading the effort to develop polycrystalline CVD diamond as a material for tracking detectors operating in extreme radiation environments. The status of the RD42 project with emphasis on recent beam test results is presented.
•Successful operation of the first pCVD diamond planar pixel detector in the ATLAS experiment at the LHC.•Demonstration that the average signal pulse height of pCVD diamond detectors irradiated up to 5×014n∕cm2 is independent of the particle flux up to ∼20 MHz/cm2.•Successful fabrication and operation of the first pCVD diamond 3D pixel detector with 50 micron × 50 micron cells read out with CMS pixel electronics with 3 cell × 2 cell ganging into pixels to match the electronics.•Demonstration that in the pCVD diamond 3D pixel device the efficiency for a MIP was 99% when operating with a 1500 e threshold.
Results on radiation tolerance of diamond detectors Venturi, N.; Alexopoulos, A.; Artuso, M. ...
Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment,
04/2019, Letnik:
924, Številka:
C
Journal Article
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In sight of the luminosity increase of the High Luminosity-LHC (HL-LHC), most experiments at the CERN Large Hadron Collider (LHC) are planning upgrades for their innermost layers in the next 5–10 ...years. These upgrades will require more radiation tolerant technologies than exist today. Usage of Chemical Vapor Deposition (CVD) diamond as detector material is one of the potentially interesting technologies for the upgrade. CVD diamond has been used extensively in the beam condition monitors of BaBar, Belle, CDF and all LHC experiments. Measurements of the radiation tolerance of the highest quality polycrystalline CVD material for a range of proton energies, pions and neutrons obtained with this material are presented. In addition, new results on the evolution of various semiconductor parameters as a function of the dose rate are described.
IDEA (Innovative Detector for Electron–positron Accelerators) is a detector concept designed for a future leptonic collider operating as a Higgs factory. It is based on innovative detector ...technologies developed over years of R&D. In September 2018, prototypes of the proposed sub-detectors have been tested for the first time on a beam line at CERN. The preliminary results from this test of a full slice of the IDEA detector and standalone measurements of dual read-out calorimeter prototypes are presented.
Vasodilatory shock is a potentially lethal complication of severe disease in critically ill patients. Currently, catecholamines are the most widely used vasopressor agents to support blood pressure, ...but loss of catecholamine pressor effects is a well-known clinical dilemma. Arginine vasopressin (AVP) has recently been shown to be a potent vasopressor agent to stabilize cardiocirculatory function even in patients with catecholamine-resistant vasodilatory shock.
Forty-eight patients with catecholamine-resistant vasodilatory shock were prospectively randomized to receive a combined infusion of AVP and norepinephrine (NE) or NE infusion alone. In AVP patients, AVP was infused at a constant rate of 4 U/h. Hemodynamic, acid/base, single-organ, and tonometrically derived gastric variables were reported before the study and 1, 12, 24, and 48 hours after study entry. For statistical analysis, a mixed-effects model was used. AVP patients had significantly lower heart rate, NE requirements, and incidence of new-onset tachyarrhythmias than NE patients. Mean arterial pressure, cardiac index, stroke volume index, and left ventricular stroke work index were significantly higher in AVP patients. NE patients developed significantly more new-onset tachyarrhythmias than AVP patients (54.3% versus 8.3%). Gastrointestinal perfusion as assessed by gastric tonometry was better preserved in AVP-treated patients. Total bilirubin concentrations were significantly higher in AVP patients.
The combined infusion of AVP and NE proved to be superior to infusion of NE alone in the treatment of cardiocirculatory failure in catecholamine-resistant vasodilatory shock.
Conventional wisdom in Germany claims pork hocks with sauerkraut and beer. But is it really that simple? In an unbalanced cross-country panel covering 169 nations and time-series records of up to 52 ...years, we analyse drivers behind beer consumption. Based on data gathered from Worldbank and Faostat, we run multivariate panel regressions and test for the explanatory power of three categories of food and six macroeconomic and demographic variables. Indeed, we confirm most clichés of a typical beer drinker being a middle-aged urbanite with a strong desire for pork and potatoes, however, disliking cheese and wine.
We retrospectively investigated the effects of continuous arginine vasopressin (AVP) infusion on systemic hemodynamics, acid/base status, and laboratory variables in patients (mean age mean +/- SD= ...66.3 +/- 10.1 yr) with catecholamine-resistant septic (n = 35) or postcardiotomy shock (n = 25). Hemodynamic and acid/base data were obtained before; 30 min after; and 1, 4, 12, 24, 48, and 72 h after the start of AVP infusion. Laboratory examinations were recorded before and 24, 48, and 72 h after the start of AVP infusion. For statistical analysis, a mixed-effects model was used. The overall intensive care unit mortality was 66.7%. AVP administration caused a significant increase in mean arterial pressure (+29%) and systemic vascular resistance (+56%), accompanied by a significant decrease in heart rate (-24%) and mean pulmonary arterial pressure (-11%) without any change in stroke volume index. Norepinephrine requirements could be reduced by 72% within 72 h. During AVP infusion, a significant increase in liver enzymes and total bilirubin concentration and a significant decrease in platelet count occurred. Arginine vasopressin was effective in reversing systemic hypotension. However, adverse effects on gastrointestinal perfusion and coagulation cannot be excluded.
In this retrospective analysis, the influence of a continuous infusion of an endogenous hormone (arginine vasopressin) on systemic hemodynamics and laboratory variables was assessed in patients with vasodilatory shock unresponsive to conventional therapy. Arginine vasopressin was effective in reversing systemic hypotension. However, adverse effects on gastrointestinal perfusion and coagulation cannot be excluded.
An international team of experts in the field of fluid resuscitation was invited by the ESICM to form a task force to systematically review the evidence concerning fluid administration using basic ...monitoring. The work included a particular emphasis on pre-ICU hospital settings and resource-limited settings. The work focused on four main questions: (1) What is the role of clinical assessment to guide fluid resuscitation in shock? (2) What basic monitoring is required to perform and interpret a fluid challenge? (3) What defines a fluid challenge in terms of fluid type, ranges of volume, and rate of administration? (4) What are the safety endpoints during a fluid challenge? The expert panel found insufficient evidence to provide recommendations according to the GRADE system, and was only able to make recommendations for basic interventions, based on the available evidence and expert opinion. The panel identified significant gaps in the scientific evidence on fluid administration outside the ICU (excluding the operating theater). Globally, scientific communities and health care systems should address these critical gaps in evidence through research on how basic fluid administration in resource-rich and resource-limited settings can be improved for the benefit of patients and societies worldwide.
Summary
We undertook an audit in a rural Ugandan hospital that describes the epidemiology and mortality of 5147 patients admitted to the intensive care unit. The most frequent admission diagnoses ...were postoperative state (including following trauma) (2014/5147; 39.1%), medical conditions (709; 13.8%) and traumatic brain injury (629; 12.2%). Intensive care unit mortality was 27.8%, differing between age groups (p < 0.001). Intensive care unit mortality was highest for neonatal tetanus (29/37; 78.4%) and lowest for foreign body aspiration (4/204; 2.0%). Intensive care unit admission following surgery (333/1431; 23.3%), medical conditions (327/1431; 22.9%) and traumatic brain injury (233/1431; 16.3%) caused the highest number of deaths. Of all deaths in the hospital, (1431/11,357; 12.6%) occurred in the intensive care unit. Although the proportion of hospitalised patients admitted to the intensive care unit increased over time, from 0.7% in 2005/6 to 2.8% in 2013/4 (p < 0.001), overall hospital mortality decreased (2005/6, 4.8%; 2013/14, 4.0%; p < 0.001). The proportion of intensive care patients whose lungs were mechanically ventilated was 18.7% (961/5147). This subgroup of patients did not change over time (2006, 16%; 2015, 18.4%; p = 0.12), but their mortality decreased (2006, 59.5%; 2015, 44.3%; p < 0.001).
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