Results of Lung Transplantation for Cystic Fibrosis With Selected Donors Over 65 Years Old.

Lung transplantation is limited by the shortage of suitable donors. Many programs have begun to use extended criteria donors. Donors over 65 years old are rarely reported, especially for young cystic fibrosis recipients. This monocentric study was conducted for cystic fibrosis recipients from January 2005 to December 2019, comparing two cohorts according to lung donor age (<65 years or ≥65 years). The primary objective was to assess the survival rate at 3 years using a Cox multivariable model. Of the 356 lung recipients, 326 had donors under 65 years, and 30 had donors over 65 years. Donors' characteristics did not differ significantly in terms of sex, time on mechanical ventilation before retrieval, and partial pressure of arterial oxygen/fraction of inspired oxygen ratio. There were no significant differences in post-operative mechanical ventilation duration and incidence of grade 3 primary graft dysfunction between the two groups. At 1, 3, and 5 years, the percentage of predicted forced expiratory volume in 1 s (p = 0.767) and survival rate did not differ between groups (p = 0.924). The use of lungs from donors over 65 years for cystic fibrosis recipients allows extension of the donor pool without compromising results. Longer follow-up is needed to assess the long-term effects of this practice.

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis.

Rationale: Whether patients with coronavirus disease (COVID-19) may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. Objectives: To estimate the effect of ECMO on 90-day mortality versus IMV only. Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO versus no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 < 80 or PaCO2 ⩾ 60 mm Hg). We controlled for confounding using a multivariable Cox model on the basis of predefined variables. Measurements and Main Results: A total of 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability on Day 7 from the onset of eligibility criteria (87% vs. 83%; risk difference, 4%; 95% confidence interval, 0-9%), which decreased during follow-up (survival on Day 90: 63% vs. 65%; risk difference, -2%; 95% confidence interval, -10 to 5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand and when initiated within the first 4 days of IMV and in patients who are profoundly hypoxemic. Conclusions: In an emulated trial on the basis of a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and regions with ECMO capacities specifically organized to handle high demand.

How physical activity and passion color the passage of time: A response with ultra-trail runners.

The aim of this study was to replicate the results of a lengthening effect caused by physical activity already observed in duration length judgment, using the time passage judgment measure, while exploring the effects of passion types (obsessive vs. harmonious) on time perception. A total of 378 ultra-trail runners responded to an online questionnaire in which the type of passion and the passage of time (PoT) judgments associated with both an ultra-trail context and a non-trail daily context were collected. The results showed that participants systematically judged the time as being dilated in a situation of sports practice, thus extending the results obtained in interval duration judgment studies. This study also showed an influence of the type of passion: higher levels of harmonious passion were related to greater feelings of time dilation, while higher levels of obsessive passion were related to greater feelings of both time contraction and time dilation. Results are discussed in light of the two major factors that influence the PoT referenced in the literature, namely, attention and happiness level.

Gratitude Moderates the Relation between Daily Hassles and Satisfaction with Life in University Students.

Satisfaction with life as a judgmental cognitive process can be negatively influenced by appraisals of daily events such as hassles. Trait-gratitude-a tendency to appraise, recognize and respond to life events through being grateful-is a determinant of mental health and well-being, and has been shown to be related to the positive appraisal of life. The aim of the current study was to investigate the moderating role of trait-gratitude in the relationship between daily hassles and satisfaction with life. In the process of carrying out this study, the French version of the Gratitude Questionnaire (GQ-6) was validated. A total of 328 French undergraduates completed questionnaires measuring gratitude, satisfaction with life, and daily hassles to test the main hypothesis. They also completed optimism, coping strategies, depression, and anxiety questionnaires in order to assess the convergent validity of the French version of the GQ-6. First, the results showed satisfactory psychometric properties of the Gratitude Questionnaire. Second, the results indicated the moderating role of trait-gratitude in the relationship between daily hassles disturbance and satisfaction with life. This study further documents the role of gratitude as a determinant of well-being and provides French-speaking clinicians and researchers with a useful tool to measure grateful disposition.

Regression of Coronary Aneurysms With Intravenous Immunoglobulins and Steroids for COVID-19 Adult Multisystem Inflammatory Syndrome.

A multisystem inflammatory syndrome mimicking Kawasaki disease has been increasingly reported, mainly in children, in the context of coronavirus disease-2019 (COVID-19). We report on the first case of coronary aneurysm resolution after treatment with steroids and intravenous immunoglobulins in an adult patient with multisystem inflammatory syndrome temporally associated with COVID-19. (Level of Difficulty: Beginner.).

Connection of a Renal Replacement Therapy or Plasmapheresis Device to the ECMO Circuit.

In patients under extracorporeal membrane oxygenation (ECMO) support requiring renal replacement therapy or plasmapheresis, connecting such extracorporeal therapy device to the ECMO circuit provides many advantages compared with central venous catheterization. However, high pressures of the ECMO circuit limit the usefulness of this technique. We propose a new approach to connect extracorporeal therapy lines to the ECMO circuit. Inlet line is connected to the oxygenator, and outlet line is connected either to the femoral artery antegrade perfusion cannula in case of venoarterial ECMO or to the lateral vent of the return cannula in case of venovenous ECMO. We report the successful management of 21 patients using this connection, with much longer hemofilter average lifetime than previously reported.

Differential Perceptions of Noninvasive Ventilation in Intensive Care among Medical Caregivers, Patients, and Their Relatives: A Multicenter Prospective Study-The PARVENIR Study.

BACKGROUND: Noninvasive ventilation (NIV) requires a close "partnership" between a conscious patient and the patient's caregivers. Specific perceptions of NIV stakeholders and their impact have been poorly described to date. The objectives of this study were to compare the perceptions of NIV by intensive care unit (ICU) physicians, nurses, patients, and their relatives and to explore factors associated with caregivers' willingness to administer NIV and patients' and relatives' anxiety in relation to NIV. METHODS: This is a prospective, multicenter questionnaire-based study. RESULTS: Three hundred and eleven ICU physicians, 752 nurses, 396 patients, and 145 relatives from 32 ICUs answered the questionnaire. Nurses generally reported more negative feelings and more frequent regrets about providing NIV (median score, 3; interquartile range, [1 to 5] vs. 1 [1 to 5]; P < 0.0001) compared to ICU physicians. Sixty-four percent of ICU physicians and only 32% of nurses reported a high level of willingness to administer NIV, which was independently associated with NIV case-volume and workload. A high NIV session-related level of anxiety was observed in 37% of patients and 45% of relatives. "Dyspnea during NIV," "long NIV session," and "the need to have someone at the bedside" were identified as independent risk factors of high anxiety in patients. CONCLUSIONS: Lack of willingness of caregivers to administer NIV and a high level of anxiety of patients and relatives in relation to NIV are frequent in the ICU. Most factors associated with low willingness to administer NIV by nurses or anxiety in patients and relatives may be amenable to change. Interventional studies are now warranted to evaluate how to reduce these risk factors and therefore contribute to better management of a potentially traumatic experience. (Anesthesiology 2016; 124:1347-59).

Weaker compressions after night shift? The WeCAN manikin study.

To assess whether the quality of chest compressions (CC) differs before and after a night shift. We carried out a cluster randomized study in three Emergency Departments and three ICUs in Paris, France. Physicians were assessed on a control day and immediately following after a night shift. The primary endpoint was the proportion of CC with a depth greater than 50 mm. We analyzed 67 participants. The proportion of CC with a depth greater than 50 mm was similar on a control day and after a night shift [52% in both groups, mean difference of 0 (95% confidence interval: -17 to 17)]. Other indicators of CC quality were unchanged after a night shift, except for the mean depth of CC (51 vs. 48 mm, P=0.01). We report in our sample that the quality of CC after a night shift is not inferior to a control day.

Microcirculatory alterations in traumatic hemorrhagic shock.

OBJECTIVES: Microcirculatory dysfunction has been well reported in clinical studies in septic shock. However, no clinical studies have investigated microcirculatory blood flow behavior in hemorrhagic shock. The main objective of this study was to assess the time course of sublingual microcirculation in traumatic hemorrhagic shock during the first 4 days after trauma. DESIGN: Prospective observational study. SETTING ICU PATIENTS: Eighteen traumatic hemorrhagic shock patients. INTERVENTIONS: The sublingual microcirculation was estimated at the study inclusion after surgical or angiographic embolization to control bleeding (D1), and then three times at 24-hour intervals (D2, D3, and D4). MEASUREMENTS AND MAIN RESULTS: Sublingual microcirculation was impaired for 72 hours despite restoration of the macrovascular circulation after control of bleeding in traumatic hemorrhagic shock patients. Furthermore, we found significantly higher decreases in the microvascular flow index and proportion of perfused vessels in high Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score ≥ 6) compared to low Sequential Organ Failure Assessment score patients at D4 (Sequential Organ Failure Assessment score < 6) without any differences in global hemodynamics between these two groups. Finally, the initial proportion of perfused vessels at D1 appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. CONCLUSIONS: Alterations of microcirculation in traumatic hemorrhagic shock patients result from the interplay among hemorrhage-induced tissue hypoperfusion, trauma injuries, inflammatory response, and subsequent resuscitation interventions. Despite restoration of the macrocirculation, the sublingual microcirculation was impaired for at least 72 hours. The initial proportion of perfused vessels appears to be a good predictor of high Sequential Organ Failure Assessment score at D4. Further studies are required to firmly establish the link between microvascular alterations and organ dysfunction in traumatic hemorrhagic shock patients.

Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults.

PURPOSE: This study was designed to optimize the latest generation venovenous (vv)-extracorporeal membrane oxygenation (ECMO)-circuit configuration and settings based on the evaluation of blood oxygenation and CO2 removal determinants in patients with severe acute respiratory distress syndrome (ARDS) on ultraprotective mechanical ventilation. METHODS: Blood gases and hemodynamic parameters were evaluated after changing one of three ECMO settings, namely, circuit blood flow, FiO(2ECMO) (fraction of inspired oxygen in circuit), or sweep gas flow ventilating the membrane, while leaving the other two parameters at their maximum setting. RESULTS: Ten mechanically ventilated ARDS patients (mean age 44 ± 16 years; 6 males; mean hemoglobin 8.0 ± 1.8 g/dL) on ECMO for a mean of 9.0 ± 3.8 days) receiving femoro-jugular vv-ECMO were evaluated. vv-ECMO blood flow and FiO(2ECMO) determined arterial oxygenation. Decreasing the ECMO flow from its baseline maximum value (5.8 ± 0.8 L/min) to 40% less (2.4 ± 0.3 L/min) significantly decreased mean PaO2 (arterial oxygen tension; 88 ± 24 to 45 ± 9 mm Hg; p < 0.001) and SaO2 (oxygen saturation; 97 ± 2 to 82 ± 10%; p < 0.001). When the ECMO flow/cardiac output was >60%, SaO2 was always >90%. Alternatively, the rate of sweep gas flow through the membrane lung determined blood decarboxylation, while PaCO2 (arterial carbon dioxide tension) was unaffected when the ECMO blood flow and FiO(2ECMO) were reduced to <2.5 L/min and 40%, respectively. In three additional patients evaluated before and after red blood cell transfusion, O2 delivery increased after transfusion, allowing lower ECMO flows to reach adequate SaO2. CONCLUSIONS: For severe ARDS patients receiving femoro-jugular vv-ECMO, blood flow was the main determinant of arterial oxygenation, while CO2 elimination depended on sweep gas flow through the oxygenator. An ECMO flow/cardiac output >60% was constantly associated with adequate blood oxygenation and oxygen transport and delivery.

Cutaneous ear lobe Pco2 at 37°C to evaluate microperfusion in patients with septic shock.

BACKGROUND: Tissue hypercarbia is related to hypoperfusion and microcirculatory disturbances in patients with septic shock. Transcutaneous Pco2 devices using a heated sensor to arterialize the tissue have been used as an alternative method for estimation of Paco2. This study investigates whether a cutaneous sensor attached to an ear lobe and regulated to 37°C could be used to measure cutaneous Pco2 (Pcco2) and evaluate microperfusion in patients with septic shock. METHODS: Fifteen stable patients in an ICU were studied as a control group. Forty-six patients with septic shock who were ventilated were enrolled as the study group. The difference of the gradients between Pcco2 and Paco2 (Pc-aco2) and between Pcco2 and end-tidal Pco2(Pc-etco2) were evaluated for 36 h. Variations of the Pc-aco2 and Pc-etco2 during fluid challenge were compared with microcirculatory skin blood flow (mBFskin) assessed by laser Doppler flowmetry. RESULTS: The baseline levels for Pc-aco2 and Pc-etco2 were significantly higher in the patients with septic shock than in the control group (14.8 [12.6] vs 6 [2.7] mm Hg and 25 [16.3] vs 9 [3.8] mm Hg, P < .0001, respectively). During the following 36 h, the Pc-aco2 and Pc-etco2 for the surviving patients with septic shock decreased significantly compared with the nonsurvivors (P < .01). The evolution of macrohemodynamic parameters showed no differences between survivors and nonsurvivors. At hour 24, a Pc-aco2 > 16 mm Hg and a Pc-etco2 > 26 mm Hg were related to poor outcome. Pc-aco2 and Pc-etco2 variations during fluid challenge were inversely correlated with changes in mBFskin (r² = 0.7). CONCLUSIONS: Ear lobe cutaneous Pco2 at 37°C represents a noninvasive technique to assess tissue Pco2 measurement. Pc-aco2 and Pc-etco2 were related to outcome and provide continuous information on microperfusion in patients with septic shock.