Purpose: To evaluate whether intraoperative ventilation using lower driving pressure decreases the risk of nonhome discharge.
Methods: We conducted a historical cohort study of patients aged ≥ 60 yr who were living at home before undergoing elective, noncardiothoracic surgery at two tertiary healthcare networks in Massachusetts between 2007 and 2018. We assessed the association of the median driving pressure during intraoperative mechanical ventilation with nonhome discharge using multivariable logistic regression analysis, adjusted for patient and procedural factors. Contingent on the primary association, we assessed effect modification by patients' baseline risk and mediation by postoperative respiratory failure.
Results: Of 87,407 included patients, 12,584 (14.4%) experienced nonhome discharge. In adjusted analyses, a lower driving pressure was associated with a lower risk of nonhome discharge (adjusted odds ratio [aOR], 0.88; 95% confidence interval [CI], 0.83 to 0.93, per 10 cm HO decrease; P < 0.001). This association was magnified in patients with a high baseline risk (aOR, 0.77; 95% CI, 0.73 to 0.81, per 10 cm HO decrease, P-for-interaction < 0.001). The findings were confirmed in 19,518 patients matched for their baseline respiratory system compliance (aOR, 0.90; 95% CI, 0.81 to 1.00; P = 0.04 for low [< 15 cm HO] vs high [≥ 15 cm HO] driving pressures). A lower risk of respiratory failure mediated the association of a low driving pressure with nonhome discharge (20.8%; 95% CI, 15.0 to 56.8; P < 0.001).
Conclusions: Intraoperative ventilation maintaining lower driving pressure was associated with a lower risk of nonhome discharge, which can be partially explained by lowered rates of postoperative respiratory failure. Future randomized controlled trials should target driving pressure as a potential intervention to decrease nonhome discharge.
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http://dx.doi.org/10.1007/s12630-022-02378-y | DOI Listing |
ChemSusChem
January 2025
Nanyang Technological University - Jurong Campus: Nanyang Technological University, School of Materials Science and Engineering, Block N4.1, 50 Nanyang Avenue, 639798, Singapore, SINGAPORE.
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Since its inception in 2014, Cyrene has emerged as a promising biobased solvent derived from renewable cellulose waste, offering a sustainable alternative to conventional toxic solvents. However, experimental data on its thermodynamic and transport properties remain scarce. This study addresses this critical gap by employing state-of-the-art molecular dynamics simulations.
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King Fahd University of Petroleum & Minerals, Dhahran, 31261, Saudi Arabia.
Climate change policies are driving the oil and gas industry to explore CO injection for carbon dioxide storage in reservoirs. In the United States, a substantial portion of oil production relies on CO-enhanced-oil-recovery (CO-EOR), demonstrating a growing interest in using CO to address various production challenges like condensate mitigation, pressure maintenance, and enhancing productivity in tight reservoirs. CO injection introduces gases like natural gas and N, either pre-existing or as impurities in the injected CO gas.
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School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia 30322, United States.
Increasing demand for high-purity fine chemicals and a drive for process intensification of large-scale separations have driven significant work on the development of highly engineered porous materials with promise for sorption-based separations. While sorptive separations in porous materials offer energy-efficient alternatives to longstanding thermal-based methods, the particulate nature of many of these sorbents has sometimes limited their large-scale deployment in high-throughput applications such as gas separations, for which the necessary high feed flow rates and gas velocities accrue prohibitive operational costs. These processability limitations have been historically addressed through powder shaping methods aimed at the fabrication of structured sorbent contactors based on pellets, beads or monoliths, commonly obtained as extrudates.
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Ciencias Agrogenómicas, Escuela Nacional de Estudios Superiores Unidad León, Universidad Nacional Autónoma de México, León, Guanajuato, México.
Mezcal, a traditional Mexican alcoholic beverage, has been a vital source of livelihood for indigenous and rural communities for centuries. However, increasing international demand is exerting pressure on natural resources and encouraging intensive agricultural practices. This study investigates the impact of management practices (wild, traditional, and conventional) and environmental factors on the microbial communities associated with Agave angustifolia, a key species in mezcal production.
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