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- Pisani, Luigi, et al.
(författare)
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Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome : a pooled analysis of four observational studies
- 2022
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Ingår i: The Lancet Global Health. - 2214-109X. ; 10:2, s. 227-235
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Tidskriftsartikel (refereegranskat)abstract
- Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding.
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| 3. |
- Ferreira da Silva, Eduardo, et al.
(författare)
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Heavy metal pollution downstream the abandoned Coval da Mó mine (Portugal) and associated effects on epilithic diatom communities
- 2009
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 407:21, s. 5620-5636
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Tidskriftsartikel (refereegranskat)abstract
- This study examined trace-element concentrations in 39 sediment samples collected in the vicinity of the abandoned Coval da Mó mine, and evaluated the anthropogenic contaminant effects and other environmental variables in the taxonomic composition, structure and morphological changes of benthic diatom communities.The results show the existence of extremely high contamination in Pb, Zn and Cd (the mean values exceed the background values 376, 96 and 19 times, respectively) on the first 2.5 km in the water flow direction. Also Co, Cu, Mn and Ni are present in high concentrations. Dilution by relatively uncontaminated sediment reduces metal concentrations downstream, but Zn concentrations increase downstream Fílvida stream, as a result of several factors such as sewage and agriculture.To evaluate the biological effects caused by Pb, Cd and Zn, three sites were selected. In the stressed environment, near the mining area (C232), diatoms were extremely rare, however there was a slight recovery at site C79 located 2 km downstream. Fragilaria capucina var. rumpens, Fragilaria cf. crotonensis and Achnanthidium minutissimum showed abnormal valves which may be related to high levels of metals.Six km downstream, in Fílvida stream (C85), an increase in species richness and diversity was registered while the relative percentage of valve teratologies was lower. In the absence of OM, nutrients and low pH the diatom community patterns must be attributed to the metal concentration at some sites. Considering that community diversity can be affected by abiotic and biotic variables and valve deformations are caused by a small number of variables, basically metals, and acid conditions, we consider the presence of teratologies as an indication of the presence of metals.
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