Climate change does not affect the seafood quality of a commonly targeted fish.

Climate change can affect marine and estuarine fish via alterations to their distributions, abundances, sizes, physiology and ecological interactions, threatening the provision of ecosystem goods and services. While we have an emerging understanding of such ecological impacts to fish, we know little about the potential influence of climate change on the provision of nutritional seafood to sustain human populations. In particular, the quantity, quality and/or taste of seafood may be altered by future environmental changes with implications for the economic viability of fisheries. In an orthogonal mesocosm experiment, we tested the influence of near-future ocean warming and acidification on the growth, health and seafood quality of a recreationally and commercially important fish, yellowfin bream (Acanthopagrus australis). The growth of yellowfin bream significantly increased under near-future temperature conditions (but not acidification), with little change in health (blood glucose and haematocrit) or tissue biochemistry and nutritional properties (fatty acids, lipids, macro- and micronutrients, moisture, ash and total N). Yellowfin bream appear to be highly resilient to predicted near-future ocean climate change, which might be facilitated by their wide spatio-temporal distribution across habitats and broad diet. Moreover, an increase in growth, but little change in tissue quality, suggests that near-future ocean conditions will benefit fisheries and fishers that target yellowfin bream. The data reiterate the inherent resilience of yellowfin bream as an evolutionary consequence of their euryhaline status in often environmentally challenging habitats and imply their sustainable and viable fisheries into the future. We contend that widely distributed species that span large geographic areas and habitats can be "climate winners" by being resilient to the negative direct impacts of near-future oceanic and estuarine climate change.

Permissive Hypercapnia, Alveolar Recruitment and Low Airway Pressure (PHARLAP): a protocol for a phase 2 trial in patients with acute respiratory distress syndrome.

BACKGROUND: Mechanical ventilation is a life-saving intervention that maintains gas exchange in patients with acute respiratory distress syndrome (ARDS); however, it is associated with high mortality and it may augment, or even initiate, lung injury. An open lung ventilation strategy that combines alveolar recruitment manoeuvres with individually titrated positive end-expiratory pressure (PEEP) and targeting lower tidal volumes, or driving pressures by a permissive approach to hypercapnia, may reduce the lung injury associated with mechanical ventilation. This protocol reports the rationale, study design and analysis plan of the Permissive Hypercapnia, Alveolar Recruitment and Low Airway Pressure (PHARLAP) trial. METHODS AND DESIGN: PHARLAP is a phase 2, international, multicentre, prospective, randomised, controlled, parallel-group clinical trial, which aims to determine if staircase alveolar recruitment and individually titrated PEEP, when combined with permissive hypercapnia and low airway pressures, increases ventilator-free days to Day 28 when compared with conventional mechanical ventilation (Acute Respiratory Distress Syndrome Clinical Network [ARDSNet] strategy) in patients with moderate to severe ARDS. This study will enrol 340 patients. The intervention group will receive daily staircase alveolar recruitment manoeuvres with incremental PEEP to a maximum of 40 cmH2O and peak pressures to a maximum of 55 cmH2O. PEEP will be titrated individually against peripheral oxygen saturation, targeting lower tidal volumes by a permissive approach to hypercapnia. In the control group, patients will receive mechanical ventilation following the ARDSNet-ARMA trial protocol, including PEEP titrated with a PEEP/fraction of inspired oxygen (FiO2) chart. Both groups will receive airway pressures ≤30 cmH2O and tidal volumes of ≤ 6 mL/kg predicted bodyweight or less. The primary outcome is ventilator-free days to Day 28. Secondary outcomes include oxygenation and lung compliance, intensive care unit (ICU) and hospital length of stay, use of rescue therapies for refractory hypoxaemia, rate of barotrauma, mortality (ICU, hospital and at 28, 90 and 180 days), quality of life and a health economic analysis at 6 months. DISCUSSION: The PHARLAP trial will determine whether the intervention strategy is effective in increasing ventilator-free days in patients with ARDS. If the PHARLAP strategy is proven to improve ventilator-free days, it will provide a strong impetus to conduct an international phase 3 trial to determine the effects of this strategy on mortality. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01667146.

Long-term survival of adults with cardiogenic shock after venoarterial extracorporeal membrane oxygenation.

PURPOSE: This study was designed to examine the long-term survival of patients who survived to be weaned from venoarterial extracorporeal membrane oxygenation (VA ECMO) and to determine which factors present at initiation and during ECMO predict long-term survival. We further sought to develop the preliminary long-term outcome after VA ECMO score that would predict patient outcome and to assess its accuracy at various time points. METHODS: We conducted a retrospective, observational cohort study of all patients with cardiogenic shock treated with VA ECMO at the Alfred Hospital, Australia, from January 2007 until February 2013. Overall, 125 patients underwent ECMO, and 104 patients were successfully weaned and formed the study population, with a median follow-up of 21 months (range, 0-84). RESULTS: Survival rates of those weaned from ECMO at 3 months, 12 months, and 2 years were 87%, 79%, and 71%, respectively, corresponding to overall survival rates at 3 months of 90 (72%) of 124; at 12 months, 80 (65%) of 122; and 24 months, 57 (57%) of 100. Ischemic heart disease, higher lactate and higher bilirubin at initiation of VA ECMO, and a longer duration of renal replacement therapy during ECMO were all independently associated with decreased length of survival. Long-term survival was found to be highly related to the number of these risk factors present up to 2 years afterward. CONCLUSION: Good long-term survival can be achieved in patients who have been successfully weaned from VA-ECMO. The factors present at initiation and during ECMO can relate to altered risk of long-term survival.