Acute hypoxaemic respiratory failure after treatment with lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal: long-term outcomes from the REST randomised trial.

INTRODUCTION: Lower tidal volume ventilation, facilitated by veno-venous extracorporeal carbon dioxide removal (vv-ECCO2R), does not improve 90-day mortality in patients with acute hypoxaemic respiratory failure (AHRF). The aim of this analysis was to evaluate the effect of this therapeutic strategy on long-term outcomes. METHODS: This was a prespecified analysis of the REST trial, a UK-wide multicentre randomised clinical trial that compared lower tidal volume ventilation, facilitated by vv-ECCO2R (intervention), with standard care in the treatment of patients with moderate-to-severe AHRF. Mortality to 2 years was assessed, while respiratory function, post-traumatic stress disorder, cognitive function and health-related quality of life were evaluated in survivors at 1 year using standardised questionnaires. RESULTS: Of 412 patients enrolled into the REST trial, 391 (95%) had 2-year mortality outcome data available. There was no difference in the time to death between intervention and standard care (HR 1.08 (0.81, 1.44); log-rank test p=0.61). 161 patients alive at 1 year provided at least one questionnaire response. There was no difference in respiratory function, post-traumatic stress disorder, cognitive dysfunction or health-related quality of life between patients allocated to intervention or standard care. CONCLUSION: Lower-tidal volume ventilation facilitated by vv-ECCO2R does not affect 1-year mortality in patients with moderate-to-severe AHRF. Of the patients who provided questionnaire responses, there was no treatment effect on long-term respiratory function, post-traumatic stress disorder, cognitive dysfunction or health-related quality of life. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02654327.

Hair cortisol as a viable tool for the assessment of an association between environmental noise exposure and chronic stress.

Entrenched in the well-established link between stress and health, noise exposure as a potential contributor to stress-related health effects receives tremendous attention. Indeed, exposure to noise can act as a stressor as evidenced through increased heart rate, blood pressure, adrenaline, epinephrine, and cortisol. Cortisol is secreted from the adrenal glands in response to stressor-induced activation of the hypothalamic-pituitary-adrenal axis. For assessment of environmental noise and stress, repeated sampling in blood, saliva, or urine is necessary to evaluate the association between environmental noise exposure and protracted changes in cortisol. Controlling for the many variables that influence the secretion of cortisol at discrete sampling intervals is challenging. Studies suggest that systemically produced cortisol integrates and remains in hair as it grows, providing a measure that integrates a cortisol response over a longer period, circumventing several limitations associated with multiple sampling. Robust evidence supports the integration of cortisol into hair, yet recent studies call into question the notion that cortisol is retained with growth. The current paper discusses the strengths and limitations of hair cortisol analysis with an emphasis on its utility as a measure of chronic stress in environmental noise studies.

A comparison of self-reported health status and perceptual responses toward environmental noise in rural, suburban, and urban regions in Canada.

Health Canada, in collaboration with Advanis, conducted the Canadian Perspectives on Environmental Noise Survey (CPENS) to investigate expectations and attitudes toward environmental noise in rural and non-rural Canada. The CPENS, a 26-item questionnaire, was completed online by 6647 randomly selected Canadians, age 18 y and older between April and May 2021. The prevalence of reporting their area as often or always calm, quiet, and relaxing was 76.8%, 64%, and 48.4% in rural/remote, suburban, and urban, respectively. A high expectation of quiet was less prevalent yet followed the same pattern: rural/remote (58.2%), suburban (37.4%), and urban (21.8%). Self-reported health status and noise sensitivity were unrelated to geographic region. A high magnitude of non-specific sleep disturbance over the previous 12 months was reported by 7.8% overall; highest among urban dwellers (9.8%), followed by suburban (7.2%) and rural/remote (5.5%) dwellers (p < 0.01). High annoyance toward road traffic noise was 8.5% overall, and significantly higher in urban (10.5%), relative to suburban (7.9%) and rural/remote (6.6%) areas (p < 0.0001). Annoyance toward noise from rail, aircraft, mining, industry, marine activity, construction, wind turbines, and landscaping equipment is reported. The analysis also explores potential differences between Indigenous Peoples of Canada and non-Indigenous Canadians in their attitudes and expectations toward environmental noise.

Mechanical Ventilation for Acute Respiratory Distress Syndrome during Extracorporeal Life Support. Research and Practice.

Ventilator-induced lung injury remains a key contributor to the morbidity and mortality of acute respiratory distress syndrome (ARDS). Efforts to minimize this injury are typically limited by the need to preserve adequate gas exchange. In the most severe forms of the syndrome, extracorporeal life support is increasingly being deployed for severe hypoxemia or hypercapnic acidosis refractory to conventional ventilator management strategies. Data from a recent randomized controlled trial, a post hoc analysis of that trial, a meta-analysis, and a large international multicenter observational study suggest that extracorporeal life support, when combined with lower Vt and airway pressures than the current standard of care, may improve outcomes compared with conventional management in patients with the most severe forms of ARDS. These findings raise important questions not only about the optimal ventilation strategies for patients receiving extracorporeal support but also regarding how various mechanisms of lung injury in ARDS may potentially be mitigated by ultra-lung-protective ventilation strategies when gas exchange is sufficiently managed with the extracorporeal circuit. Additional studies are needed to more precisely delineate the best strategies for optimizing invasive mechanical ventilation in this patient population.

Self-reported occupational noise exposure and cardiovascular disease in Canada: Results from the Canadian Health Measures Survey.

Self-reported occupational noise exposure has been associated with impaired hearing, but its relationship with extra-auditory affects remains uncertain. This research assessed the association between self-reported occupational noise exposure and cardiovascular outcomes. Participants (n = 6318, ∼50% male) from the Canadian Health Measures Survey (2012-2015) aged 20-79 years were randomly recruited across Canada. An in-person household interview included basic demographics, perceived stress, diagnosed health conditions, and self-reported exposure to a noisy work environment. Direct physiological assessment in a mobile examination centre permitted the determination of biomarkers/risk factors related to cardiovascular function. Logistic or linear regression models explored the association between self-reported occupational noise exposure and several cardiovascular endpoints after adjusting for confounding variables. After adjustments, there was no evidence for an association between occupational noise and any of the evaluated endpoints, which included but were not limited to blood pressure, heart rate, blood glucose, insulin, lipids, diagnosed hypertension, medication for hypertension, myocardial infarction, stroke, or heart disease. There was no evidence that self-reported occupational noise exposure was associated with evaluated cardiovascular-related biomarkers, or cardiovascular diseases among Canadians aged 20-79 years. This study, and others like it, provides an important contribution to an evidence base that could inform policy related to occupational noise exposure.

High frequency hearing impairment and cardiovascular disease in Canada: Results from the Canadian Health Measures Survey.

Noise-induced stress may precipitate cardiovascular diseases. This research assessed the association between sensorineural bilateral high frequency hearing loss (HFHL), as an indication of excessive noise exposure, and cardiovascular outcomes. Participants (n = 6318, ∼50% male) 20-79 years were recruited through the cross-sectional Canadian Health Measures Survey. Questionnaires included several demographic and health-related variables. Audiometry and blood/urine collection took place in a mobile examination centre. Average thresholds ≥25 dB averaged across 3, 4, and 6 kHz defined HFHL. Logistic or linear regression models explored associations between HFHL and cardiovascular-related risk factors/outcomes. Adjusted models indicated elevated diastolic blood pressure in respondents with normal hearing, X¯ = 72.52 (95% confidence interval: 71.85-73.18) compared to the group with bilateral HFHL, X¯ = 70.28 (95%CI: 69.13-71.43), p < 0.05. Average total cholesterol, high-density lipoprotein, low-density lipoprotein and apolipoprotein A1 were elevated in the normal hearing group (p < 0.05). Insulin, high-sensitivity C-reactive protein, and average resting heart rate were elevated in the group with bilateral HFHL, p < 0.05. A stratified analysis by sex- and age, or history of loud occupational noise exposure, did not change the overall results. Although some findings warrant further exploration, the overall analysis did not provide compelling evidence for an association between HFHL and cardiovascular-related biomarkers, or cardiovascular diseases among Canadians aged 20-79 years.

Prevalence of handheld laser device use, exposure and associated injury.

BACKGROUND: This study assessed the use of and exposure to handheld laser devices by Canadians and the potential associated health risks. DATA AND METHODS: The 2019 Canadian Community Health Survey collected data from 12,397 Canadians on the prevalence of handheld laser exposure or use, and associated eye or skin injuries. RESULTS: In 2019, an estimated 12.4% (95% CI: 11.4% to 13.4%) of Canadians reported using a handheld laser device or being exposed to its beam in the previous year, and those between the ages of 12 and 17 represented 30.5% (95% CI: 26.6% to 34.4%) of users. The highest laser device use or exposure was among those with a university education (13.8%; 95% CI: 11.8% to 15.8%), and a significant trend was found over income categories (p < 0.0001). The highest prevalence of exposure or use involved laser pointers (69.4%; 95% CI: 65.4% to 73.4%), followed by laser toys (38.5%; 95% CI: 34.6% to 42.5%), laser torches (8.2%; 95% CI: 6.1% to 10.4%) and-lastly-search-and-rescue lasers (0.8%E; 95% CI: 0.3% to 1.2%). Overall, 0.7%E (95% CI: 0.2% to 1.2%) of Canadians reported discomfort or injury in the past 12 months. One-quarter (27.9%; 95% CI: 23.8% to 31.9%) of users had a laser beam intentionally directed toward their eyes or skin. Most users did not buy the device (56.3%; 95% CI: 52.1% to 60.5%), while 40.5% (95% CI: 36.2% to 44.7%) purchased it at a Canadian retail store or online (3.8%E; 95% CI: 2.6% to 5.0%). DISCUSSION: The prevalence of handheld laser device use and beam exposure was 12.4% (95% CI: 11.4% to 13.4%), representing approximately 3.9 million Canadians. While the number of reported injuries was low, ongoing surveillance helps assess the effectiveness of current risk management approaches for laser products.

Personal listening device usage among Canadians and audiometric outcomes among 6-29 year olds.

OBJECTIVE: To describe personal listening device (PLD) usage and sociodemographic variables among a nationally representative sample of Canadians and examine audiometric outcomes among a subsample. DESIGN: Audiometry and in-person questionnaires were used to evaluate hearing and PLD usage across age, sex, household income/education level. PLD exposure was quantified using a common occupational noise limit. STUDY SAMPLE: A randomised sample of 10,460 respondents, aged 6-79, with audiometric analysis of a subsample (n = 4807), aged 6-29, tested between 2012 and 2015. RESULTS: Loud PLD usage was reported by19.5% of Canadians. The highest prevalence was among teenagers (44.2%) and young adults (36.3%). Among children, 13.1% of users listened at loud volumes. High PLD usage (equivalent to or above 85 dBA, LEX 40) among 12-19 year olds was double that of 20-29 year olds: 10.2% versus 5.1%E. Five years or more of loud PLD usage was associated with significantly higher mean hearing thresholds compared to less years. No association between loud or high PLD usage and mean thresholds were found. CONCLUSION: The majority used PLDs safely, however a small proportion reported high risk usage which will impact hearing should this pattern persist over many years.

Effect of Lower Tidal Volume Ventilation Facilitated by Extracorporeal Carbon Dioxide Removal vs Standard Care Ventilation on 90-Day Mortality in Patients With Acute Hypoxemic Respiratory Failure: The REST Randomized Clinical Trial.

Importance: In patients who require mechanical ventilation for acute hypoxemic respiratory failure, further reduction in tidal volumes, compared with conventional low tidal volume ventilation, may improve outcomes. Objective: To determine whether lower tidal volume mechanical ventilation using extracorporeal carbon dioxide removal improves outcomes in patients with acute hypoxemic respiratory failure. Design, Setting, and Participants: This multicenter, randomized, allocation-concealed, open-label, pragmatic clinical trial enrolled 412 adult patients receiving mechanical ventilation for acute hypoxemic respiratory failure, of a planned sample size of 1120, between May 2016 and December 2019 from 51 intensive care units in the UK. Follow-up ended on March 11, 2020. Interventions: Participants were randomized to receive lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal for at least 48 hours (n = 202) or standard care with conventional low tidal volume ventilation (n = 210). Main Outcomes and Measures: The primary outcome was all-cause mortality 90 days after randomization. Prespecified secondary outcomes included ventilator-free days at day 28 and adverse event rates. Results: Among 412 patients who were randomized (mean age, 59 years; 143 [35%] women), 405 (98%) completed the trial. The trial was stopped early because of futility and feasibility following recommendations from the data monitoring and ethics committee. The 90-day mortality rate was 41.5% in the lower tidal volume ventilation with extracorporeal carbon dioxide removal group vs 39.5% in the standard care group (risk ratio, 1.05 [95% CI, 0.83-1.33]; difference, 2.0% [95% CI, -7.6% to 11.5%]; P = .68). There were significantly fewer mean ventilator-free days in the extracorporeal carbon dioxide removal group compared with the standard care group (7.1 [95% CI, 5.9-8.3] vs 9.2 [95% CI, 7.9-10.4] days; mean difference, -2.1 [95% CI, -3.8 to -0.3]; P = .02). Serious adverse events were reported for 62 patients (31%) in the extracorporeal carbon dioxide removal group and 18 (9%) in the standard care group, including intracranial hemorrhage in 9 patients (4.5%) vs 0 (0%) and bleeding at other sites in 6 (3.0%) vs 1 (0.5%) in the extracorporeal carbon dioxide removal group vs the control group. Overall, 21 patients experienced 22 serious adverse events related to the study device. Conclusions and Relevance: Among patients with acute hypoxemic respiratory failure, the use of extracorporeal carbon dioxide removal to facilitate lower tidal volume mechanical ventilation, compared with conventional low tidal volume mechanical ventilation, did not significantly reduce 90-day mortality. However, due to early termination, the study may have been underpowered to detect a clinically important difference. Trial Registration: ClinicalTrials.gov Identifier: NCT02654327.

Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis.

BACKGROUND: Levosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis. METHODS: We conducted a double-blind, randomized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis. Patients were randomly assigned to receive a blinded infusion of levosimendan (at a dose of 0.05 to 0.2 µg per kilogram of body weight per minute) for 24 hours or placebo in addition to standard care. The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28 (scores for each of five systems range from 0 to 4, with higher scores indicating more severe dysfunction; maximum score, 20). Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events. RESULTS: The trial recruited 516 patients; 259 were assigned to receive levosimendan and 257 to receive placebo. There was no significant difference in the mean (±SD) SOFA score between the levosimendan group and the placebo group (6.68±3.96 vs. 6.06±3.89; mean difference, 0.61; 95% confidence interval [CI], -0.07 to 1.29; P=0.053). Mortality at 28 days was 34.5% in the levosimendan group and 30.9% in the placebo group (absolute difference, 3.6 percentage points; 95% CI, -4.5 to 11.7; P=0.43). Among patients requiring ventilation at baseline, those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days (hazard ratio, 0.77; 95% CI, 0.60 to 0.97; P=0.03). More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia (3.1% vs. 0.4%; absolute difference, 2.7 percentage points; 95% CI, 0.1 to 5.3; P=0.04). CONCLUSIONS: The addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia. (Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others; LeoPARDS Current Controlled Trials number, ISRCTN12776039 .).

Prevalence of loud leisure noise activities among a representative sample of Canadians aged 6-79 years.

This population-based study estimates the prevalence of loud leisure noise exposure and hearing protection usage among Canadians, as well as the population potentially at-risk using an occupational limit of 85 dBA, LEX 40 h, which denotes a typical occupational noise limit for a 40 hour work week. A total of 10 460 participants, aged 6-79 years, completed a Canadian Health Measures Survey household questionnaire. Loud leisure noise was defined by vocal effort required while communicating at arm's length except for loud personal listening device (PLD) usage with earbuds/headphones, which included both volume setting and vocal effort. The most prevalent loud leisure noise activities were amplified music, car/home stereo listening, and power tools, with 40% reporting each source, followed by sporting/entertainment (25%), gasoline engines (23%), and loud PLD listening (19.5%). Loud leisure noise was more prevalent among 12-39 year olds and males. Hearing protection usage was uncommon, from 44.2% (firearms) to 20.3% (power tools) and below 3% during amplified music and sporting/entertainment events. Calculations using self-reported duration of loud leisure noise activities estimated that 6.6 × 106 Canadians were in the high cumulative noise exposure category. A large proportion of Canadians would be expected to develop some degree of noise-induced hearing loss should this pattern persist over years.

Prevalence of laser beam exposure and associated injuries.

BACKGROUND: An increasing number of consumer laser products are available to Canadians, many being purchased from online retailers. Of particular concern are high-powered, handheld laser devices. This study was conducted to assess the impact of this influx of laser products on the number of laser-associated injuries in Canada. DATA AND METHODS: The rapid response component of the 2014 Canadian Community Health Survey collected data from 19,765 Canadians on the prevalence of laser product exposure and usage, the type of laser product used, and the incidence of eye or skin injuries. RESULTS: Approximately half of Canadians (48.1%) reported using or being exposed to a laser product in the previous 12 months. The highest laser product usage or exposure was among those with university education (58.6%) and those with higher income categories (p ⟨ 0.0001). The highest prevalence of exposure or usage involved laser scanners (38.7%), laser pointers (11.1%) and lasers for entertainment (9.7%). Overall, about 1% of Canadians reported discomfort or injury involving a laser product in the past 12 months. Over half the injuries (59.1%) occurred to the eyes. Most of the injuries (74.9%) resulted from someone else's use of the device. The majority of the reported injuries were caused by lasers for cosmetic treatment or laser pointers. DISCUSSION: Despite the prevalence of laser product usage and exposure among Canadians, a low percentage of respondents reported injuries. This is likely because most laser devices are low-powered and typically do not represent a hazard. Nonetheless, efforts to increase awareness of laser product risks may be beneficial given the findings of this study.

Prevalence of Hearing Loss Among a Representative Sample of Canadian Children and Adolescents, 3 to 19 Years of Age.

OBJECTIVES: There are no nationally representative hearing loss (HL) prevalence data available for Canadian youth using direct measurements. The present study objectives were to estimate national prevalence of HL using audiometric pure-tone thresholds (0.5 to 8 kHz) and or distortion product otoacoustic emissions (DPOAEs) for children and adolescents, aged 3 to 19 years. DESIGN: This cross-sectional population-based study presents findings from the 2012/2013 Canadian Health Measures Survey, entailing an in-person household interview and hearing measurements conducted in a mobile examination clinic. The initial study sample included 2591 participants, aged 3 to 19 years, representing 6.5 million Canadians (3.3 million males). After exclusions, subsamples consisted of 2434 participants, aged 3 to 19 years and 1879 participants, aged 6 to 19 years, with valid audiometric results. Eligible participants underwent otoscopic examination, tympanometry, DPOAE, and audiometry. HL was defined as a pure-tone average >20 dB for 6- to 18-year olds and ≥26 dB for 19-year olds, for one or more of the following: four-frequency (0.5, 1, 2, and 4 kHz) pure-tone average, high-frequency (3, 4, 6, and 8 kHz) pure-tone average, and low-frequency (0.5, 1, and 2 kHz) pure-tone average. Mild HL was defined as >20 to 40 dB (6- to 18-year olds) and ≥26 to 40 dB (19-year olds). Moderate or worse HL was defined as >40 dB (6- to 19-year olds). HL in 3- to 5-year olds (n = 555) was defined as absent DPOAEs as audiometry was not conducted. Self-reported HL was evaluated using the Health Utilities Index Mark 3 hearing questions. RESULTS: The primary study outcome indicates that 7.7% of Canadian youth, aged 6 to 19, had any HL, for one or more pure-tone average. Four-frequency pure-tone average and high-frequency pure-tone average HL prevalence was 4.7 and 6.0%, respectively, whereas 5.8% had a low-frequency pure-tone average HL. Significantly more children/adolescents had unilateral HL. Mild HL was significantly more common than moderate or worse HL for each pure-tone average. Among Canadians, aged 6 to 19, less than 2.2% had sensorineural HL. Among Canadians, aged 3 to 19, less than 3.5% had conductive HL. Absent DPOAEs were found in 7.1% of 3- to 5-year olds, and in 3.4% of 6- to 19-year olds. Among participants eligible for the hearing evaluation and excluding missing data cases (n = 2575), 17.0% had excessive or impacted pus/wax in one or both ears. Self-reported HL in Canadians, aged 6 to 19, was 0.6 E% and 65.3% (aged 3 to 19) reported never having had their hearing tested. E indicates that a high sampling variability is associated with the estimate (coefficient of variation between 16.6% and 33.3%) and should be interpreted with caution. CONCLUSIONS: This study provides the first estimates of audiometrically measured HL prevalence among Canadian children and adolescents. A larger proportion of youth have measured HL than was previously reported using self-report surveys, indicating that screening using self-report or proxy may not be effective in identifying individuals with mild HL. Results may underestimate the true prevalence of HL due to the large number excluded and the presentation of impacted or excessive earwax or pus, precluding an accurate or complete hearing evaluation. The majority of 3- to 5-year olds with absent DPOAEs likely had conductive HL. Nonetheless, this type of HL which can be asymptomatic, may become permanent if left untreated. Future research will benefit from analyses, which includes the slight HL category, for which there is growing support, and from studies that identify factors contributing to HL in this population.

Tanning equipment use: 2014 Canadian Community Health Survey.

BACKGROUND: Tanning equipment use is related to the early onset of cancer, with the risk increasing as the duration and repetition of exposure increase. In 2009, the International Agency for Research on Cancer classified tanning equipment use as carcinogenic to humans, and according to the World Health Organization, the risk of skin melanoma increases significantly when use begins before age 35. DATA AND METHODS: The rapid response component of the 2014 Canadian Community Health Survey collected data on the use of tanning equipment in the previous 12 months, including reasons for use, frequency/duration of use, precautions taken, and adverse reactions or injuries. This analysis examines the prevalence of self-reported indoor tanning in a nationally representative sample of Canadians aged 12 or older in the 10 provinces. RESULTS: In 2014, 4.5% of Canadians (an estimated 1.35 million) reported that they had used tanning equipment in the past year; 70.3% of them were female, and just over half of female users were aged 18 to 34. The prevalence of indoor tanning was highest among people with some postsecondary education and among those in higher income households (trend p-value ⟨ 0.0001). Most users reported fewer than 10 sessions in the past year. The most common reason (62.0%) was to develop a "protective" base tan. INTERPRETATION: Females made up the majority of tanning equipment users, particularly at ages 18 to 34. Efforts to increase awareness of the risks may be beneficial, given the high percentage of users who believed that indoor tanning offers some level of skin protection from future sun exposure.

Chronic noise exposure in the spontaneously hypertensive rat.

INTRODUCTION: Epidemiological studies have suggested an association between the relative risk for developing cardiovascular disease (CVD) and long-term exposure to elevated levels of transportation noise. The contention is that this association is largely owing to an increase in stress-related biomarkers that are thought to be associated with CVD. Animal models have demonstrated that acute noise exposure is capable of triggering a stress response; however, similar studies using chronic noise models are less common. MATERIALS AND METHODS: The current study assessed the effects of intermittent daily exposure to broadband 80 kHz bandwidth noise of 87.3 dBA for a period of 21 consecutive days in spontaneously hypertensive rats. RESULTS: Twenty-one days of exposure to noise significantly reduced body weight relative to the sham and unhandled control groups; however, noise had no statistically significant impact on plasma adrenocorticotropic hormone (or adrenal gland weights). Noise was associated with a significant, albeit modest, increase in both corticosterone and aldosterone concentrations following the 21 days of exposure. Interleukin 1 and interleukin 6 levels were unchanged in the noise group, whereas both tumour necrosis factor alpha and C-reactive protein were significantly reduced in noise exposed rats. Tail blood sampling for corticosterone throughout the exposure period showed no appreciable difference between the noise and sham exposed animals, largely due to the sizeable variation for each group as well as the observed fluctuations over time. DISCUSSION: The current pilot study provides only modest support that chronic noise may promote stress-related biological and/or developmental effects. More research is required to verify the current findings and resolve some of the unexpected observations.

Aspirin therapy in patients with acute respiratory distress syndrome (ARDS) is associated with reduced intensive care unit mortality: a prospective analysis.

INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a common clinical syndrome with high mortality and long-term morbidity. To date there is no effective pharmacological therapy. Aspirin therapy has recently been shown to reduce the risk of developing ARDS, but the effect of aspirin on established ARDS is unknown. METHODS: In a single large regional medical and surgical ICU between December 2010 and July 2012, all patients with ARDS were prospectively identified and demographic, clinical, and laboratory variables were recorded retrospectively. Aspirin usage, both pre-hospital and during intensive care unit (ICU) stay, was included. The primary outcome was ICU mortality. We used univariate and multivariate logistic regression analyses to assess the impact of these variables on ICU mortality. RESULTS: In total, 202 patients with ARDS were included; 56 (28%) of these received aspirin either pre-hospital, in the ICU, or both. Using multivariate logistic regression analysis, aspirin therapy, given either before or during hospital stay, was associated with a reduction in ICU mortality (odds ratio (OR) 0.38 (0.15 to 0.96) P = 0.04). Additional factors that predicted ICU mortality for patients with ARDS were vasopressor use (OR 2.09 (1.05 to 4.18) P = 0.04) and APACHE II score (OR 1.07 (1.02 to 1.13) P = 0.01). There was no effect upon ICU length of stay or hospital mortality. CONCLUSION: Aspirin therapy was associated with a reduced risk of ICU mortality. These data are the first to demonstrate a potential protective role for aspirin in patients with ARDS. Clinical trials to evaluate the role of aspirin as a pharmacological intervention for ARDS are needed.

Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013 Canadian Health Measures Survey.

BACKGROUND: In Canada, population-level estimates of hearing loss have been based on self-reported data, yielding estimates of 4% or 5%. Self-reported hearing difficulties may result in underestimates of hearing loss, particularly among people with mild loss and among older adults. DATA AND METHODS: The 2012/2013 Canadian Health Measures Survey (cycle 3) collected audiometric and self-reported data to estimate the prevalence of hearing loss and limitations in a population-based sample of Canadians aged 20 to 79. Weighted frequencies and cross-tabulations were used to calculate measured and self-reported hearing levels by sociodemographic characteristics. All estimates were weighted at the person-level to represent the population. RESULTS: Based on a pure-tone average of four frequencies that are important in speech, 19.2% of Canadians aged 20 to 79 had measured hearing loss in at least one ear; 35.4% had high-frequency hearing loss. These levels exceeded the self-reported estimate of hearing difficulty--3.7%--derived from responses to questions from the Health Utilities Index Mark 3. The prevalence of measured hearing loss rose with age from no more than 10% among people younger than 50 to 65% at ages 70 to 79. Men were more likely than women to have a hearing loss, a difference that emerged around age 60. Canadians with low household income and/or educational attainment were more likely than those in higher income/education households to have a hearing loss. INTERPRETATION: This analysis presents the first population-based audiometric data on the prevalence of hearing loss among the adult household population of Canada, and highlights the disparity between measured and self-reported outcomes.

Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review.

Acute respiratory distress syndrome (ARDS) continues to have significant mortality and morbidity. The only intervention proven to reduce mortality is the use of lung-protective mechanical ventilation strategies, although such a strategy may lead to problematic hypercapnia. Extracorporeal carbon dioxide removal (ECCO2R) devices allow uncoupling of ventilation from oxygenation, thereby removing carbon dioxide and facilitating lower tidal volume ventilation. We performed a systematic review to assess efficacy, complication rates, and utility of ECCO2R devices. We included randomised controlled trials (RCTs), case-control studies and case series with 10 or more patients. We searched MEDLINE, Embase, LILACS (Literatura Latino Americana em Ciências da Saúde), and ISI Web of Science, in addition to grey literature and clinical trials registries. Data were independently extracted by two reviewers against predefined criteria and agreement was reached by consensus. Outcomes of interest included mortality, intensive care and hospital lengths of stay, respiratory parameters and complications. The review included 14 studies with 495 patients (two RCTs and 12 observational studies). Arteriovenous ECCO2R was used in seven studies, and venovenous ECCO2R in seven studies. Available evidence suggests no mortality benefit to ECCO2R, although post hoc analysis of data from the most recent RCT showed an improvement in ventilator-free days in more severe ARDS. Organ failure-free days or ICU stay have not been shown to decrease with ECCOvR. Carbon dioxide removal was widely demonstrated as feasible, facilitating the use of lower tidal volume ventilation. Complication rates varied greatly across the included studies, representing technological advances. There was a general paucity of high-quality data and significant variation in both practice and technology used among studies, which confounded analysis. ECCO2R is a rapidly evolving technology and is an efficacious treatment to enable protective lung ventilation. Evidence for a positive effect on mortality and other important clinical outcomes is lacking. Rapid technological advances have led to major changes in these devices and together with variation in study design have limited applicability of analysis. Further well-designed adequately powered RCTs are needed.