Zoekresultaten

Report from the DIEM25 launch in Berlin

Inspiration aus Berlin

Broadening the Berlin definition of ARDS to patients receiving high-flow nasal oxygen

BackgroundHigh-flow nasal oxygen (HFNO) is increasingly used in patients with acute hypoxemic respiratory failure. It is uncertain whether a broadened Berlin definition of acute respiratory distress syndrome (ARDS), in which ARDS can be diagnosed in patients who are not receiving ventilation, results in similar groups of patients receiving HFNO as in patients receiving ventilation.MethodsWe applied a broadened definition of ARDS in a multicenter, observational study in adult critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19), wherein the requirement for a minimal level of 5 cm H2O PEEP with ventilation is replaced by a minimal level of airflow rate with HFNO, and compared baseline characteristics and outcomes between patients receiving HFNO and patients receiving ventilation. The primary endpoint was ICU mortality. We also compared outcomes in risk for death groups using the PaO2/FiO2 cutoffs as used successfully in the original definition of ARDS. Secondary endpoints were hospital mortality; mortality on days 28 and 90; need for ventilation within 7 days in patients that started with HFNO; the number of days free from HFNO or ventilation; and ICU and hospital length of stay.ResultsOf 728 included patients, 229 patients started with HFNO and 499 patients with ventilation. All patients fulfilled the broadened Berlin definition of ARDS. Patients receiving HFNO had lower disease severity scores and lower PaO2/FiO2 than patients receiving ventilation. ICU mortality was lower in receiving HFNO (22.7 vs 35.6%; p = 0.001). Using PaO2/FiO2 cutoffs for mild, moderate and severe arterial hypoxemia created groups with an ICU mortality of 16.7%, 22.0%, and 23.5% (p = 0.906) versus 19.1%, 37.9% and 41.4% (p = 0.002), in patients receiving HFNO versus patients receiving ventilation, respectively.ConclusionsUsing a broadened definition of ARDS may facilitate an earlier diagnosis of ARDS in patients receiving HFNO; however, ARDS patients receiving HFNO and ARDS patients receiving ventilation have distinct baseline characteristics and mortality rates.Trial registration: The study is registered at ClinicalTrials.gov (identifier NCT04719182).

The Swamps of Postart

‘Non art is more art than art art’, Allan Kaprow claimed in 1972. He concluded: ‘Artists of the world, drop out! You have nothing to lose but your professions.’ Are we ready to move on? From the 6th until the 9th of June 2024, an international group of art workers gathered at Floating Berlin to explore this question during the Konteksty Postartistic Congress.

Learning experiences from ECEC professionals during an international field visit

International field visits aim to provide transformative learning experiences that stimulate the professional development of staff, but outcomes may vary among programs. In this mixed-methods study, we investigated the transformative learning experiences of Dutch and German professionals (n = 28) from early childhood education and care (ECEC) who participated in a blended intensive exchange program with mutual field visits. Our findings indicate a transformative learning process in which the participants developed an awareness of cultural differences, moved to understanding these differences and, occasionally, to adaptation of new professional beliefs related to the interaction with young children. However, it proved difficult to implement new practices in the own centers after the program. We discuss how international exchange programs may foster transformative learning and the professional development of ECEC staff.