Adverse Events in Intensive Care and Continuing Care Units During Bed-Bath Procedures: The Prospective Observational NURSIng during critical carE (NURSIE) Study.

OBJECTIVES: Standard nursing interventions, especially bed-baths, in ICUs can lead to complications or adverse events defined as a physiologic change that can be life-threatening or that prolongs hospitalization. However, the frequency and type of these adverse events are rarely reported in the literature. The primary objective of our study was to describe the proportion of patients experiencing at least one serious adverse event during bed-bath. The secondary objectives were to determine the incidence of each type of serious adverse event and identify risk factors for these serious adverse events. DESIGN: Prospective multicenter observational study. SETTING: Twenty-four ICUs in France, Belgium, and Luxembourg. PATIENTS: The patients included in this study had been admitted to an ICU for less than 72 hours and required at least one of the following treatments: invasive ventilation, vasopressors, noninvasive ventilation, high-flow oxygen therapy. Serious adverse events were defined as cardiac arrest, accidental extubation, desaturation and/or mucus plugging/inhalation, hypotension and/or arrhythmia and/or agitation requiring therapeutic intervention, acute pain, accidental disconnection or dysfunction of equipment, and patient fall requiring additional assistance. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study included 253 patients from May 1, 2018, to July 31, 2018 in 24 ICUs, representing 1,529 nursing procedures. The mean Simplified Acute Physiology Score II was 54 ± 19. Nursing care was administered by an average of 2 ± 1 caregivers and lasted between 11 and 20 minutes. Of the 253 patients included, 142 (56%) experienced at least one serious adverse event. Of the 1,529 nursing procedures, 295 (19%) were complicated by at least one serious adverse event. In multivariate analysis, the factors associated with serious adverse event were as follows: presence of a specific protocol (p = 0.011); tracheostomy (p = 0.032); administration of opioids (p = 0.007); presence of a physician (p = 0.0004); duration of nursing care between 6 and 10 minutes (p = 0.003), duration of nursing care between 11 and 20 minutes (p = 0.005), duration of nursing care greater than 40 minutes (p = 0.04) with a reference duration of nursing care between 20 and 40 minutes. CONCLUSIONS: Serious adverse events were observed in one-half of patients and concerned one-fifth of nurses, confirming the need for caution. Further studies are needed to test systematic serious adverse event prevention strategies.

Warmer, deeper, and greener mixed layers in the North Atlantic subpolar gyre over the last 50 years.

Shifts in global climate resonate in plankton dynamics, biogeochemical cycles, and marine food webs. We studied these linkages in the North Atlantic subpolar gyre (NASG), which hosts extensive phytoplankton blooms. We show that phytoplankton abundance increased since the 1960s in parallel to a deepening of the mixed layer and a strengthening of winds and heat losses from the ocean, as driven by the low frequency of the North Atlantic Oscillation (NAO). In parallel to these bottom-up processes, the top-down control of phytoplankton by copepods decreased over the same time period in the western NASG, following sea surface temperature changes typical of the Atlantic Multi-decadal Oscillation (AMO). While previous studies have hypothesized that climate-driven warming would facilitate seasonal stratification of surface waters and long-term phytoplankton increase in subpolar regions, here we show that deeper mixed layers in the NASG can be warmer and host a higher phytoplankton biomass. These results emphasize that different modes of climate variability regulate bottom-up (NAO control) and top-down (AMO control) forcing on phytoplankton at decadal timescales. As a consequence, different relationships between phytoplankton, zooplankton, and their physical environment appear subject to the disparate temporal scale of the observations (seasonal, interannual, or decadal). The prediction of phytoplankton response to climate change should be built upon what is learnt from observations at the longest timescales.

Documenting decadal disturbance dynamics reveals archipelago-specific recovery and compositional change on Polynesian reefs.

Coral reefs are declining at an unprecedented rate as a consequence of local and global stressors. Using a 26-year monitoring database, we analyzed the loss and recovery dynamics of coral communities across seven islands and three archipelagos in French Polynesia. Reefs in the Society Islands recovered relatively quickly after disturbances, which was driven by the recovery of corals in the genus Pocillopora (84% of the total recovery). In contrast, reefs in the Tuamotu and Austral archipelagos recovered poorly or not at all. Across archipelagos, predation by crown-of-thorns starfish and destruction by cyclones outweighed the effects of heat stress events on coral mortality. Despite the apparently limited effect of temperature-mediated stressors, the homogenization of coral communities towards dominance of Pocillopora in the Society Archipelago and the failure to fully recover from disturbances in the other two archipelagos concern the resilience of Polynesian coral communities in the face of intensifying climate-driven stressors.

Large impact of Stokes drift on the fate of surface floating debris in the South Indian Basin.

In the open ocean, floating surface debris such as plastics concentrate in five main accumulation zones centered around 30° latitude, far from highly turbulent areas. Using Lagrangian advection of numerical particles by surface currents from ocean model reanalysis, previous studies have shown long-distance connection from the accumulation zones of the South Indian to the South Pacific oceans. An important physical process affecting surface particles but missing in such analyses is wave-induced Stokes drift. Taking into account surface Stokes drift from a wave model reanalysis radically changes the fate of South Indian particles. The convergence region moves from the east to the west of the basin, so particles leak to the South Atlantic rather than the South Pacific. Stokes drift changes the South Indian sensitive balance between Ekman convergence and turbulent diffusion processes, inducing either westward entrainment in the north of the accumulation zone, or eastward entrainment in the south.

Floating marine debris surface drift: convergence and accumulation toward the South Pacific subtropical gyre.

Whatever its origin is, a floating particle at the sea surface is advected by ocean currents. Surface currents could be derived from in situ observations or combined with satellite data. For a better resolution in time and space, we use satellite-derived sea-surface height and wind stress fields with a 1/3 degrees grid from 1993 to 2001 to determine the surface circulation of the South Pacific Ocean. Surface currents are then used to compute the Lagrangian trajectories of floating debris. Results show an accumulation of the debris in the eastern-centre region of the South Pacific subtropical gyre ([120 degrees W; 80 degrees W]-[20 degrees S; 40 degrees S]), resulting from a three-step process: in the first two years, mostly forced by Ekman drift, the debris drift towards the tropical convergence zone ( approximately 30 degrees S). Then they are advected eastward mostly forced by geostrophic currents. They finally reach the eastern-centre region of the South Pacific subtropical gyre from where they could not escape.

Climate-driven basin-scale decadal oscillations of oceanic phytoplankton.

Phytoplankton--the microalgae that populate the upper lit layers of the ocean--fuel the oceanic food web and affect oceanic and atmospheric carbon dioxide levels through photosynthetic carbon fixation. Here, we show that multidecadal changes in global phytoplankton abundances are related to basin-scale oscillations of the physical ocean, specifically the Pacific Decadal Oscillation and the Atlantic Multidecadal Oscillation. This relationship is revealed in approximately 20 years of satellite observations of chlorophyll and sea surface temperature. Interaction between the main pycnocline and the upper ocean seasonal mixed layer is one mechanism behind this correlation. Our findings provide a context for the interpretation of contemporary changes in global phytoplankton and should improve predictions of their future evolution with climate change.