Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study

Contains fulltext : 218568.pdf (publisher's version ) (Open Access)BACKGROUND: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. METHODS: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 >/= 0.60 during hyperoxemia). RESULTS: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). CONCLUSIONS: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. TRIAL REGISTRATION: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

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The Sense-City equipment project: 9M¤ for prototyping and validation of nanosensors for sustainable cities

While today’s galloping urbanization weighs heavily on both People and Environment, the massive instrumentation of urban spaces appears a landmark toward sustainability. Because of their high sensitivity, the wide range of their observables, their energetic self-sufficiency and their low cost, nanosensors appear particularly well suited to urban metrology. A 8 years, 9 M¤ equipment project funded by the French ‘Programme d’Investissement d’Avenir’ starting in 2012, Sense-City project offers high-quality facilities for prototyping and performance assessment of urban nanosensors. Sense-City is built around four programs, environmental monitoring, structural health monitoring, energy performances monitoring and people exposure monitoring. We present the activities of the consortium partners along these lines, the complementarity of our skills enabling the design of decision-support tools based on innovative sensors, precise modeling as well as data management and visualization. We also discuss the shortcomings of evaluating the performances of sensors only in lab conditions or directly in real, urban conditions. As a solution, Sense-City will provide an environment of intermediate complexity for the testing of environmental sensors, a realistic urban test space in climatic conditions, both far more complex than clean rooms and far more controllable than actual cities

The Sense-City equipment project: 9M¤ for prototyping and validation of nanosensors for sustainable cities

While today’s galloping urbanization weighs heavily on both People and Environment, the massive instrumentation of urban spaces appears a landmark toward sustainability. Because of their high sensitivity, the wide range of their observables, their energetic self-sufficiency and their low cost, nanosensors appear particularly well suited to urban metrology. A 8 years, 9 M¤ equipment project funded by the French ‘Programme d’Investissement d’Avenir’ starting in 2012, Sense-City project offers high-quality facilities for prototyping and performance assessment of urban nanosensors. Sense-City is built around four programs, environmental monitoring, structural health monitoring, energy performances monitoring and people exposure monitoring. We present the activities of the consortium partners along these lines, the complementarity of our skills enabling the design of decision-support tools based on innovative sensors, precise modeling as well as data management and visualization. We also discuss the shortcomings of evaluating the performances of sensors only in lab conditions or directly in real, urban conditions. As a solution, Sense-City will provide an environment of intermediate complexity for the testing of environmental sensors, a realistic urban test space in climatic conditions, both far more complex than clean rooms and far more controllable than actual cities

The Sense-City equipment project: 9M¤ for prototyping and validation of nanosensors for sustainable cities

While today’s galloping urbanization weighs heavily on both People and Environment, the massive instrumentation of urban spaces appears a landmark toward sustainability. Because of their high sensitivity, the wide range of their observables, their energetic self-sufficiency and their low cost, nanosensors appear particularly well suited to urban metrology. A 8 years, 9 M¤ equipment project funded by the French ‘Programme d’Investissement d’Avenir’ starting in 2012, Sense-City project offers high-quality facilities for prototyping and performance assessment of urban nanosensors. Sense-City is built around four programs, environmental monitoring, structural health monitoring, energy performances monitoring and people exposure monitoring. We present the activities of the consortium partners along these lines, the complementarity of our skills enabling the design of decision-support tools based on innovative sensors, precise modeling as well as data management and visualization. We also discuss the shortcomings of evaluating the performances of sensors only in lab conditions or directly in real, urban conditions. As a solution, Sense-City will provide an environment of intermediate complexity for the testing of environmental sensors, a realistic urban test space in climatic conditions, both far more complex than clean rooms and far more controllable than actual cities

The Sense-City equipment project: 9M¤ for prototyping and validation of nanosensors for sustainable cities

While today’s galloping urbanization weighs heavily on both People and Environment, the massive instrumentation of urban spaces appears a landmark toward sustainability. Because of their high sensitivity, the wide range of their observables, their energetic self-sufficiency and their low cost, nanosensors appear particularly well suited to urban metrology. A 8 years, 9 M¤ equipment project funded by the French ‘Programme d’Investissement d’Avenir’ starting in 2012, Sense-City project offers high-quality facilities for prototyping and performance assessment of urban nanosensors. Sense-City is built around four programs, environmental monitoring, structural health monitoring, energy performances monitoring and people exposure monitoring. We present the activities of the consortium partners along these lines, the complementarity of our skills enabling the design of decision-support tools based on innovative sensors, precise modeling as well as data management and visualization. We also discuss the shortcomings of evaluating the performances of sensors only in lab conditions or directly in real, urban conditions. As a solution, Sense-City will provide an environment of intermediate complexity for the testing of environmental sensors, a realistic urban test space in climatic conditions, both far more complex than clean rooms and far more controllable than actual cities

The Sense-City equipment project: 9M¤ for prototyping and validation of nanosensors for sustainable cities

While today’s galloping urbanization weighs heavily on both People and Environment, the massive instrumentation of urban spaces appears a landmark toward sustainability. Because of their high sensitivity, the wide range of their observables, their energetic self-sufficiency and their low cost, nanosensors appear particularly well suited to urban metrology. A 8 years, 9 M¤ equipment project funded by the French ‘Programme d’Investissement d’Avenir’ starting in 2012, Sense-City project offers high-quality facilities for prototyping and performance assessment of urban nanosensors. Sense-City is built around four programs, environmental monitoring, structural health monitoring, energy performances monitoring and people exposure monitoring. We present the activities of the consortium partners along these lines, the complementarity of our skills enabling the design of decision-support tools based on innovative sensors, precise modeling as well as data management and visualization. We also discuss the shortcomings of evaluating the performances of sensors only in lab conditions or directly in real, urban conditions. As a solution, Sense-City will provide an environment of intermediate complexity for the testing of environmental sensors, a realistic urban test space in climatic conditions, both far more complex than clean rooms and far more controllable than actual cities

Rapid rEcognition of COrticosteRoiD resistant or sensitive Sepsis (RECORDS): study protocol for a multicentre, placebo-controlled, biomarker-guided, adaptive Bayesian design basket trial

International audienceIntroduction: Corticosteroids affect variably survival in sepsis trials, suggesting heterogeneity in patients’ response to corticosteroids. The RECORDS (Rapid rEcognition of COrticosteRoiD resistant or sensitive Sepsis) trial aimed at defining endotypes associated with adults with sepsis responsiveness to corticosteroids.Methods and analysis: RECORDS, a multicentre, placebo-controlled, biomarker-guided, adaptive Bayesian design basket trial, will randomly assign to a biomarker stratum 1800 adults with community-acquired pneumonia, vasopressor-dependent sepsis, septic shock or acute respiratory distress syndrome. In each stratum, patients will be randomly assigned to receive a 7-day course of hydrocortisone and fludrocortisone or their placebos. Patients with COVID-19 will be treated with a 10-day standard course of dexamethasone and randomised to fludrocortisone or its placebo. Primary outcome will be 90-day death or persistent organ dysfunction. Large simulation study will be performed across a range of plausible scenarios to foresee power to detect a 5%–10% absolute difference with corticosteroids. We will assess subset-by-treatment interaction by estimating in a Bayesian framework two quantities: (1) measure of influence, relying on the value of the estimation of corticosteroids’ effect in each subset, and (2) measure of interaction.Ethics and dissemination: The protocol was approved by the Ethics Committee ( Comité de Protection des Personnes, Dijon, France), on 6 April 2020. Trial results will be disseminated at scientific conferences and results will be published in peer-reviewed journals.Trial registration number ClinicalTrials.gov Registry ( NCT04280497 )