Zoekresultaten

Effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients (CONFIDENCE)

BackgroundFluid therapy is a common intervention in critically ill patients. It is increasingly recognised that deresuscitation is an essential part of fluid therapy and delayed deresuscitation is associated with longer invasive ventilation and length of intensive care unit (ICU) stay. However, optimal timing and rate of deresuscitation remain unclear. Lung ultrasound (LUS) may be used to identify fluid overload. We hypothesise that daily LUS-guided deresuscitation is superior to deresuscitation without LUS in critically ill patients expected to undergo invasive ventilation for more than 24 h in terms of ventilator free-days and being alive at day 28.MethodsThe “effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients” (CONFIDENCE) is a national, multicentre, open-label, randomised controlled trial (RCT) in adult critically ill patients that are expected to be invasively ventilated for at least 24 h. Patients with conditions that preclude a negative fluid balance or LUS examination are excluded. CONFIDENCE will operate in 10 ICUs in the Netherlands and enrol 1000 patients. After hemodynamic stabilisation, patients assigned to the intervention will receive daily LUS with fluid balance recommendations. Subjects in the control arm are deresuscitated at the physician’s discretion without the use of LUS. The primary endpoint is the number of ventilator-free days and being alive at day 28. Secondary endpoints include the duration of invasive ventilation; 28-day mortality; 90-day mortality; ICU, in hospital and total length of stay; cumulative fluid balance on days 1–7 after randomisation and on days 1–7 after start of LUS examination; mean serum lactate on days 1–7; the incidence of reintubations, chest drain placement, atrial fibrillation, kidney injury (KDIGO stadium ≥ 2) and hypernatremia; the use of invasive hemodynamic monitoring, and chest-X-ray; and quality of life at day 28.DiscussionThe CONFIDENCE trial is the first RCT comparing the effect of LUS-guided deresuscitation to routine care in invasively ventilated ICU patients. If proven effective, LUS-guided deresuscitation could improve outcomes in some of the most vulnerable and resource-intensive patients in a manner that is non-invasive, easy to perform, and well-implementable.Trial registrationClinicalTrials.gov NCT05188092. Registered since January 12, 2022

The effect of real-time vibrotactile feedback delivered through an augmented fork on eating rate, satiation, and food intake

Eating rate is a basic determinant of appetite regulation, as people who eat more slowly feel sated earlier and eat less. Without assistance, eating rate is difficult to modify due to its automatic nature. In the current study, participants used an augmented fork that aimed to decelerate their rate of eating. A total of 114 participants were randomly assigned to the Feedback Condition (FC), in which they received vibrotactile feedback from their fork when eating too fast (i.e., taking more than one bite per 10 s), or a Non-Feedback Condition (NFC). Participants in the FC took fewer bites per minute than did those in the NFC. Participants in the FC also had a higher success ratio, indicating that they had significantly more bites outside the designated time interval of 10 s than did participants in the NFC. A slower eating rate, however, did not lead to a significant reduction in the amount of food consumed or level of satiation.These findings indicate that real-time vibrotactile feedback delivered through an augmented fork is capable of reducing eating rate, but there is no evidence from this study that this reduction in eating rate is translated into an increase in satiation or reduction in food consumption. Overall, this study shows that real-time vibrotactile feedback may be a viable tool in interventions that aim to reduce eating rate. The long-term effectiveness of this form of feedback on satiation and food consumption, however, awaits further investigation.

Reducing CO2 emission and disrupting car travel habits through personalized feedback

This paper presents the results of an experimental field study, in which the effects were studied of personalized travel feedback on car owners’ car habits, awareness of the environmental impact of their travel choices, and the intention to switch modes. For a period of six weeks, 349 car owners living in Amsterdam used a smart mobility app that automatically registered all their travel movements. Participants in the experiment group received information about travel distance, time, and CO2 emission. Results show that the feedback did not influence self-reported car habits, intention, and awareness, suggesting that personalized feedback may not be a one-size-fits-all solution to change travel habits.

Move and be moved

Dynamic body feedback is used in dance movement therapy (DMT), with the aim to facilitate emotional expression and a change of emotional state through movement and dance for individuals with psychosocial or psychiatric complaints. It has been demonstrated that moving in a specific way can evoke and regulate related emotions. The current study aimed to investigate the effects of executing a unique set of kinetic movement elements on an individual mover’s experience of happiness. A specific sequence consisting of movement elements that recent studies have related to the feeling of happiness was created and used in a series of conditions. To achieve a more realistic reflection of DMT practice, the study incorporated the interpersonal dimension between the dance movement therapist (DMTh) and the client, and the impact of this interbodily feedback on the emotional state of the client. This quantitative study was conducted in a within-subject design. Five male and 20 female participants (mean age = 20.72) participated in three conditions: a solo executed movement sequence, a movement sequence executed with a DMTh who attuned and mirrored the movements, and a solo executed movement sequence not associated with feelings of happiness. Participants were only informed about the movements and not the feelings that may be provoked by these movements. The effects on individuals were measured using the Positive and Negative Affect Schedule and visual analog scales. Results showed that a specific movement sequence based on movement elements associated with happiness executed with a DMTh can significantly enhance the corresponding affective state. An additional finding of this study indicated that facilitating expressed emotion through movement elements that are not associated with happiness can enhance feelings such as empowerment, pride, and determination, which are experienced as part of positive affect. The results show the impact of specific fullbody movement elements on the emotional state and the support outcome of DMT on emotion regulation.

CO2 reduction through shared mobility: A review of psychological factors for the switch from a private car to shared transport

Switching modalities in a sentence verification task : ERP evidence for embodied language processing

In an event related potential (ERP) experiment using written language materials only, we investigated a potential modulation of the N400 by the modality switch effect. The modality switch effect occurs when a first sentence, describing a fact grounded in one modality, is followed by a second sentence describing a second fact grounded in a different modality. For example, "A cellar is dark" (visual), was preceded by either another visual property "Ham is pink" or by a tactile property "A mitten is soft." We also investigated whether the modality switch effect occurs for false sentences ("A cellar is light"). We found that, for true sentences, the ERP at the critical word "dark" elicited a significantly greater frontal, early N400-like effect (270-370 ms) when there was a modality mismatch than when there was a modality-match. This pattern was not found for the critical word "light" in false sentences. Results similar to the frontal negativity were obtained in a late time window (500-700 ms). The obtained ERP effect is similar to one previously obtained for pictures. We conclude that in this paradigm we obtained fast access to conceptual properties for modality-matched pairs, which leads to embodiment effects similar to those previously obtained with pictorial stimuli.