The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV). Methods: This is a multicenter, prospective, observational study in consecutive, mechanically ventilated patients with ARDS (as defined by the Berlin criteria) affected with with COVID-19 (confirmed SARS-CoV-2 infection in nasal or pharyngeal swab specimens), admitted to a network of 36 Spanish and Andorran intensive care units (ICUs) between March 12 and June 1, 2020. We examined the clinical features, ventilatory management, and clinical outcomes of COVID-19 ARDS patients, and compared some results with other relevant studies in non-COVID-19 ARDS patients. Results: A total of 742 patients were analysed with complete 28-day outcome data: 128 (17.1%) with mild, 331 (44.6%) with moderate, and 283 (38.1%) with severe ARDS. At baseline, defined as the first day on invasive MV, median (IQR) values were: tidal volume 6.9 (6.3-7.8) ml/kg predicted body weight, positive end-expiratory pressure 12 (11-14) cmH 2 O. Values of respiratory system compliance 35 (27-45) ml/cmH 2 O, plateau pressure 25 (22-29) cmH 2 O, and driving pressure 12 (10-16) cmH 2 O were similar to values from non-COVID-19 ARDS patients observed in other studies. Recruitment maneuvers, prone position and neuromuscular blocking agents were used in 79%, 76% and 72% of patients, respectively. The risk of 28-day mortality was lower in mild ARDS [hazard ratio (RR) 0.56 (95% CI 0.33-0.93), p = 0.026] and moderate ARDS [hazard ratio (RR) 0.69 (95% CI 0.47-0.97), p = 0.035] when compared to severe ARDS. The 28-day mortality was similar to other observational studies in non-COVID-19 ARDS patients. Conclusions: In this large series, COVID-19 ARDS patients have features similar to other causes of ARDS, compliance with lung-protective ventilation was high, and the risk of 28-day mortality increased with the degree of ARDS severity.
Background: We aimed to examine whether using a high fraction of inspired oxygen (FIO 2 ) in the context of an individualised intra-and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. Methods: We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO 2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. Results: We enrolled 740 subjects: 371 in the high FIO 2 group and 369 in the low FIO 2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO 2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59e1.50; P¼0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48e1.25; P¼0.38) and myocardial ischaemia (0.6% [n¼2] vs 0% [n¼0]; P¼0.47) did not differ between groups. Conclusions: An oxygenation strategy using high FIO 2 compared with conventional FIO 2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. Clinical trial registration: NCT02776046.
Elsevier Álvarez, C.; Alcázar-Ortega, M.; Escrivá-Escrivá, G.; ANTONIO GABALDON MARIN (2009)
AbstractThe authors present a methodology to evaluate and quantify the economic parameters (costs and benefits) attached to customer electricity consumption by analyzing the service provided by the different "pieces" of absorbed electricity. The first step of this methodology is to perform a process oriented market segmentation to identify segments according to their flexibility potential. After that, a procedure based on comprehensive simulations to identify and quantify the actual demand that can be managed in the short term is presented and, finally, the required economic analysis is performed. The methodology, which is demonstrated with some applications to the commercial sector, not only helps the customers to integrate in flexible distribution systems but also offers the necessary economical parameters for them to integrate in electricity markets.
En un escenario competitivo y de evolución continua de la educación universitaria, es fundamental ofrecer una herramienta adecuada para el desarrollo y seguimiento de las diferentes competencias que los alumnos adquieren durante su formación. Los sistemas ERPs verticales, a través del uso de software educativos, han favorecido en más de 350 instituciones a nivel mundial la creación de un entorno de colaboración y aprendizaje con múltiples funcionalidades de comunicación entre profesores y alumnos. Estos sistemas de gestión permiten construir procesos de afiliación de largo plazo con la posibilidad de implementar nuevos módulos según las necesidades. Sin embargo, aunque se han hecho avances significativos a través de su aplicación, son todavía muchas las potencialidades que permanecen inexploradas. Este articulo evidencia la necesidad de monitorizar el desarrollo de las competencias específicas y trasversales de los alumnos para, de esta manera, proporcionar un servicio de enseñanza que sea lo más cercano posible a las necesidades particulares de cada alumno. Para conseguir este objetivo, este artículo propone una metodología implementada a través de sistemas ERPs verticales, los cuales favorecen la interacción dinámica entre el alumnado y la Academia, así como la interpretación y comprensión de los resultados obtenidos.
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