Background
Duration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) affects outcome in acute respiratory distress syndrome (ARDS). In coronavirus disease 2019 (COVID-19) related ARDS, the role of pre-ECMO IMV duration is unclear. This single-centre, retrospective study included critically ill adults treated with ECMO due to severe COVID-19-related ARDS between 01/2020 and 05/2021. The primary objective was to determine whether duration of IMV prior to ECMO cannulation influenced ICU mortality.
Results
During the study period, 101 patients (mean age 56 [SD ± 10] years; 70 [69%] men; median RESP score 2 [IQR 1–4]) were treated with ECMO for COVID-19. Sixty patients (59%) survived to ICU discharge. Median ICU length of stay was 31 [IQR 20.7–51] days, median ECMO duration was 16.4 [IQR 8.7–27.7] days, and median time from intubation to ECMO start was 7.7 [IQR 3.6–12.5] days. Fifty-three (52%) patients had a pre-ECMO IMV duration of > 7 days. Pre-ECMO IMV duration had no effect on survival (p = 0.95). No significant difference in survival was found when patients with a pre-ECMO IMV duration of < 7 days (< 10 days) were compared to ≥ 7 days (≥ 10 days) (p = 0.59 and p = 1.0).
Conclusions
The role of prolonged pre-ECMO IMV duration as a contraindication for ECMO in patients with COVID-19-related ARDS should be scrutinised. Evaluation for ECMO should be assessed on an individual and patient-centred basis.
Time-resolved high-resolution soft x-ray spectra from gas-puff injected Ar impurity ions have been investigated for neutral beam heated and ohmically heated discharges in the TEXTOR tokamak. The experimental spectra show systematic deviations from corona model calculations for the line intensities of the forbidden He-like lines x, y, z and the Li-and Be-like dielectronic satellite spectra: theoretical corona model calculations predict intensities significantly too low. High-intensity Li-like inner-shell excited satellites correlate with the neutral beam injection. The discrepancies could also be observed in the stationary phase of an inductively heated discharge. In the heating phase the discrepancies are even larger. We propose charge-exchange processes between the neutral atoms and the impurity ions as an explanation of the experimental findings. Good agreement with the experimental observations can then be obtained without the need for invoking large (anomalous) diffusion coefficients. A self-consistent coupling of the population kinetics of the neutrals and the impurity ions, also taking into account charge-exchange processes from excited states of hydrogen/deuterium permit the determination of the neutral fraction and of the electron lifetime on the sole basis of impurity spectra analysis. Independent Monte Carlo simulations of neutral gas transport also provides the ionization degree in the centre and the electron lifetime. These calculations are also in good agreement with the spectroscopic results.
A high-resolution x-ray polarimeter has been installed at the torus experiment for technology oriented research ͑TEXTOR-94͒. The instrument consists of two spectrometers in Johann geometry, utilizing the dependence of Bragg reflection on the polarization. The dispersion plane of the so-called horizontal spectrometer coincides with the midplane of the tokamak, whereas the dispersion plane of the so-called vertical spectrometer lies perpendicular to the midplane of the tokamak. Both spectrometers operate with cylindrically bent quartz crystals of dimensions 153 mmϫ38 mmϫ0.7 mm with a 2d spacing of 4.9130 Å. The radii of curvature of the horizontal and vertical spectrometer crystals are 3820 mm and 4630 mm, respectively. The detectors are multiwire proportional counters having a large entrance window of 180 mmϫ90 mm, with a high count rate capability of up to 2.5ϫ10 5 photons/s, and a spatial resolution of 0.4-0.65 mm, depending on the count rate. The unique data acquisition system makes it possible to record up to 8192 spectra per TEXTOR-94 discharge to study fast events and impurity transport. The instruments are sensitive to spurious amounts of argon in hydrogen or deuterium discharges and aim for x-ray polarization measurements and other core plasma diagnostics like electron temperature, ion temperature, plasma rotation, impurity transport, and relative abundance of Ar 15ϩ /Ar 16ϩ . The first measurements of toroidal rotation speed, ion and electron temperatures show a very good agreement with charge exchange recombination spectroscopy ͑XRS͒ and electron cyclotron emission ͑ECE͒ diagnostics available at TEXTOR-94. The measured values of the ratio Ar 15ϩ /Ar 16ϩ are higher than that predicted from coronal equilibrium. The ratio depends strongly upon the electron density both for ohmic and neutral beam injection cases. This suggests that the charge state distribution is also dependent on diffusion and charge exchange processes in the plasmas.
Spectroscopic and photophysical properties of two p-phenylenevinylene (PV) trimers, 2,5-substituted diheptyl-(p-phenylenevinylene) and di-[(2-ethylhexyl)oxy]-(p-phenylenevinylene), were studied using absorption spectroscopy, fluorescence and laser flash photolysis. The change from alkyl to alkyloxy groups red-shifts the absorption and fluorescence bands. The rate of internal conversion is independent of the substitution, whereas alkyloxy substitution increases the S 1 , T 1 intersystem crossing rate by an order of magnitude. The relevance for the behaviour of conjugated PPV polymers is discussed. For diheptyl-PV, a sample having ca. 3% of the cis-configuration was also studied. Comparison between the all-trans and the cis-contaminated samples revealed no significant differences in their photophysical properties.
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