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American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927862

ABSTRACT

Rationale: The COVID-19 pandemic has renewed interest in the use of inhaled anesthetics for sedation of ventilated critically ill patients. Compared to intravenous sedatives, inhaled anesthetics reduce lung inflammation, time to extubation, and ICU length of stay. However, their impact on cognitive and psychiatric outcomes is less clear. In this systematic review we summarize the impact of inhaled sedatives on cognitive and psychiatric outcomes in ventilated critically ill patients. Methods: We searched MEDLINE, EMBASE, and PsychINFO for studies from 1970 - 2021 that assessed cognitive and psychiatric outcomes in critically ill adult patients sedated with inhaled anesthetics. We included case series, observational, cohort, and randomized controlled trials. Outcome(s) of interest included cognition, anxiety, depression, hallucinations, psychomotor recovery, and PTSD, as well as instruments for assessing these outcomes. Results: We identified a total of twelve studies that examined at least one of our outcomes of interest (16 total outcomes). Four studies were in post cardiac arrest survivors, three in post-operative (non-cardiac) patients, two in post-operative cardiac patients, and three more in mixed medical-surgical patients. Seven studies reported incidence of delirium, two assessed neurologic recovery post cardiac-arrest, and two examined ICU memories. One study reported on each of anxiety, depression, hallucinations, PTSD, psychomotor recovery, and long-term cognitive dysfunction more than 3 months following ICU discharge. Of the seven studies reporting on delirium, only one reported an increase in delirium for those sedated with intravenous sedation compared to volatile. The remaining studies did not report any difference in delirium incidence between modes of sedation. Similarly, no difference between sedation methods were observed for neurologic recovery following cardiac arrest, anxiety, depression, hallucinations, PTSD, psychomotor recovery, or long-term cognitive dysfunction. The most commonly used tool used was the CAM-ICU tool (delirium outcome;3 studies). Five studies used subjective chart review to assess their outcome of interest, or did not report their method of assessment. Conclusions: Few studies examined cognitive and psychiatric outcomes in critically ill adults sedated with volatile anesthetics. As volatile anesthetics offer a promising alternative mode of sedation in the ICU, future studies should incorporate assessment of these important patientcentered outcomes using validated objective tools during and following hospital stay.

2.
Journal of Geophysical Research. Atmospheres ; 126(24), 2021.
Article in English | ProQuest Central | ID: covidwho-1595324

ABSTRACT

Nitrogen oxides (NOx) are air pollutants critical to ozone and fine particle production in the troposphere. Here, we present fuel‐based emission inventories updated to 2018, including for mobile source engines using the Fuel‐based Inventory of Vehicle Emissions (FIVEs) and oil and gas production using the Fuel‐based Oil and Gas (FOG) inventory. The updated FIVE emissions are now consistent with the NEI17 estimates differing within 2% across the contiguous US (CONUS). Tropospheric NO2 columns modeled by the Weather Research and Forecasting with Chemistry model (WRF‐Chem) are compared with those observed by TROPOspheric Monitoring Instrument (TROPOMI) and Ozone Monitoring Instrument (OMI) during the summer of 2018. Modeled NO2 columns show strong temporal and spatial correlations with TROPOMI (OMI), identified with biases of −3% (−21%) over CONUS, and +8% (−6%) over point sources plus urban regions. Taking account of the negative bias (∼20%) in early version of TROPOMI over polluted regions, WRF‐Chem shows good performance with updated FIVE and FOG emissions. Our model tends to under‐predict the tropospheric NO2 columns over background and rural regions (bias of −21% to −3%). Through model sensitivity analyses, we demonstrate the important roles of emissions from soils (11.7% average over CONUS), oil and gas production (4.1%), wildfires (10.6%), and lightning (2.3%) with greater contributions at regional scales. This work provides a roadmap for satellite‐based evaluations for emission updates from various sources.Alternate :Plain Language SummarySatellite observations of tropospheric NO2 columns provide important constraints on air pollutants from space, which have been widely used to validate the performance of atmospheric models. To gain better knowledge of the accuracy of the recently updated fuel‐based emissions inventory, we conducted NO2 assessments between a regional chemical transport model (Weather Research and Forecasting with Chemistry model, WRF‐Chem), with the TROPOspheric Monitoring Instrument (TROPOMI) and Ozone Monitoring Instrument (OMI) over the contiguous United States. We find that model simulation results show strong spatial and temporal correlations with satellite observations across point sources, urban, oil and gas production, and rural regions. With updated emissions, our regional atmospheric model can reconcile with satellite retrievals differing from −3% (TROPOMI) to −21% (OMI) overall. Soils, oil and gas production, wildfires and lightning emissions can play key roles in regional air quality. This work provides an important baseline of a pre‐COVID year by which sharp changes in anthropogenic NOx emissions due to the pandemic can be assessed.

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