The COVID–19 pandemic led to local oxygen shortages worldwide. To gain a better understanding of oxygen consumption with different respiratory supportive therapies, we conducted an international multicenter observational study to determine the precise amount of oxygen consumption with high-flow nasal oxygen (HFNO) and with mechanical ventilation. A retrospective observational study was conducted in three intensive care units (ICUs) in the Netherlands and Spain. Patients were classified as HFNO patients or ventilated patients, according to the mode of oxygen supplementation with which a patient started. The primary endpoint was actual oxygen consumption; secondary endpoints were hourly and total oxygen consumption during the first two full calendar days. Of 275 patients, 147 started with HFNO and 128 with mechanical ventilation. Actual oxygen use was 4.9-fold higher in patients who started with HFNO than in patients who started with ventilation (median 14.2 [8.4–18.4] versus 2.9 [1.8–4.1] L/minute; mean difference 5 11.3 [95% CI 11.0–11.6] L/minute; P, 0.01). Hourly and total oxygen consumption were 4.8-fold (P, 0.01) and 4.8-fold (P, 0.01) higher. Actual oxygen consumption, hourly oxygen consumption, and total oxygen consumption are substantially higher in patients that start with HFNO compared with patients that start with mechanical ventilation. This information may help hospitals and ICUs predicting oxygen needs during high-demand periods and could guide decisions regarding the source of distribution of medical oxygen.
MULTIFILE
Abstract Background: 30 to 60% of the acute hospitalized older adults experience functional decline after hospitalization. The first signs of functional decline after discharge can often be observed in the inability to perform mobility tasks, such as raising from a chair or walking. Information how mobility develops over time is scarce. Insight in the course of mobility is needed to prevent and decrease mobility limitations. Objectives: The objectives of this study were to determine (i) the course of mobility of acute hospitalized older adults and (ii) the association between muscle strength and the course of mobility over time controlled for influencing factors. Methods: In a multicenter, prospective, observational cohort study, measurements were taken at admission, discharge, one- and three months post-discharge. Mobility was assessed by the De Morton Mobility Index (DEMMI) and muscle strength by the JAMAR. The longitudinal association between muscle strength and mobility was analysed with a Linear Mixed Model and controlled for potential confounders. Results: 391 older adults were included in the analytic sample with a mean (SD) age of 79.6 (6.7) years. Mobility improved significantly from admission up to three months post-discharge but did not reach normative levels. Muscle strength was associated with the course of mobility (beta=0.64; p<0.01), even after controlling for factors as age, cognitive impairment, fear of falling and depressive symptoms (beta=0.35; p<0.01). Conclusion: Muscle strength is longitudinally associated with mobility. Interventions to improve mobility including muscle strength are warranted, in acute hospitalized older adults.
IntroductionMechanical power of ventilation, a summary parameter reflecting the energy transferred from the ventilator to the respiratory system, has associations with outcomes. INTELLiVENT–Adaptive Support Ventilation is an automated ventilation mode that changes ventilator settings according to algorithms that target a low work–and force of breathing. The study aims to compare mechanical power between automated ventilation by means of INTELLiVENT–Adaptive Support Ventilation and conventional ventilation in critically ill patients.Materials and methodsInternational, multicenter, randomized crossover clinical trial in patients that were expected to need invasive ventilation > 24 hours. Patients were randomly assigned to start with a 3–hour period of automated ventilation or conventional ventilation after which the alternate ventilation mode was selected. The primary outcome was mechanical power in passive and active patients; secondary outcomes included key ventilator settings and ventilatory parameters that affect mechanical power.ResultsA total of 96 patients were randomized. Median mechanical power was not different between automated and conventional ventilation (15.8 [11.5–21.0] versus 16.1 [10.9–22.6] J/min; mean difference –0.44 (95%–CI –1.17 to 0.29) J/min; P = 0.24). Subgroup analyses showed that mechanical power was lower with automated ventilation in passive patients, 16.9 [12.5–22.1] versus 19.0 [14.1–25.0] J/min; mean difference –1.76 (95%–CI –2.47 to –10.34J/min; P < 0.01), and not in active patients (14.6 [11.0–20.3] vs 14.1 [10.1–21.3] J/min; mean difference 0.81 (95%–CI –2.13 to 0.49) J/min; P = 0.23).ConclusionsIn this cohort of unselected critically ill invasively ventilated patients, automated ventilation by means of INTELLiVENT–Adaptive Support Ventilation did not reduce mechanical power. A reduction in mechanical power was only seen in passive patients.Study registrationClinicaltrials.gov (study identifier NCT04827927), April 1, 2021URL of trial registry recordhttps://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1
MULTIFILE
The postdoc candidate, Giuliana Scuderi, will strengthen the connection between the research group Biobased Buildings (BB), (collaboration between Avans University of Applied Sciences and HZ University of Applied Sciences (HZ), and the Civil Engineering bachelor programme (CE) of HZ. The proposed research aims at deepening the knowledge about the mechanical properties of biobased materials for the application in the structural and infrastructural sectors. The research is relevant for the professional field, which is looking for safe and sustainable alternatives to traditional building materials (such as lignin asphalt, biobased panels for bridge constructions, etc.). The study of the mechanical behaviour of traditional materials (such as concrete and steel) is already part of the CE curriculum, but the ambition of this postdoc is that also BB principles are applied and visible. Therefore, from the first year of the programme, the postdoc will develop a biobased material science line and will facilitate applied research experiences for students, in collaboration with engineering and architectural companies, material producers and governmental bodies. Consequently, a new generation of environmentally sensitive civil engineers could be trained, as the labour market requires. The subject is broad and relevant for the future of our built environment, with possible connections with other fields of study, such as Architecture, Engineering, Economics and Chemistry. The project is also relevant for the National Science Agenda (NWA), being a crossover between the routes “Materialen – Made in Holland” and “Circulaire economie en grondstoffenefficiëntie”. The final products will be ready-to-use guidelines for the applications of biobased materials, a portfolio of applications and examples, and a new continuous learning line about biobased material science within the CE curriculum. The postdoc will be mentored and supervised by the Lector of the research group and by the study programme coordinator. The personnel policy and job function series of HZ facilitates the development opportunity.
Recent research by the renowned Royal Institution of Chartered Surveyors (RICS) shows that more than 2/3 of all CO2 is emitted during the building process and less than 1/3 during use to heat the building and the tap water. Lightweight, local and biobased materials such as biocomposites to replace concrete and fossil based cladding are in the framework of climate change, a necessity for future building. Using plant fiber in polymer composites is especially interesting for construction since natural fibers exhibit comparative good mechanical properties with small specific weight, which defines the potential for lightweight constructions. The use of renewable resources, will affect the ecosystem favorably and the production costs of construction materials could also decrease. However, one disadvantage of natural fibers in plastics is their hydrophilic properties. In construction the materials need to meet special requirements like the resistance against fluctuating weather conditions (Ticoalu et al., 2010). In contrast to synthetic fibers, the natural ones are more moisture- and UV-radiation-sensitive. That may lead to degradation of these materials and a decreasing in quality of products. (Lopez et al., 2006; Mokhothu und John, 2017) Tanatex and NPSP have approached CoE BBE/Avans to assist in a study where fibres impregnated with the (modified) Tanatex products will be used for reinforcement of thermoset biopolymers. The influence of the different Tanatex products on the moisture absorption of natural/cellulosic fibers and the adhesion on the fibers on main composite matrix will be measured. The effect of Tantex products can optimize the bonding reaction between the resin and the fibers in the (bio) composite and result to improved strength and physico-chemical properties of the biocomposite materials. (word count: 270)
To decrease the environmental impact caused by the construction sector, biobased materials need to be further developed to allow better integration and acceptance in the market. Mycelium composites are innovative products, with intrinsic properties which rise the attention of architects, designers and industrial companies. Until now, research has focused on the mechanical properties of mycelium products. The aim has been improving their mechanical strength, to achieve wider application in the construction sector. Alongside this, to introduce mycelium composites to a wider market, the aesthetic experience of the public also needs to be considered. In the context of this proposal, it is argued that users of biobased products can shift their attitudes towards their surroundings by adjusting to the visual aesthetics within their environment or products they surround themselves with (Hekkert, 1997). This can be further attributed to colours which can be experienced as warm or cold, aggressive or inviting, leading to experiences that may include pleasure or displeasure indicating the future success of the bio based product. Mycelium composites can be used as building materials, but also as interior design materials, therefore visible to its user. It is to determine the appropriate methodologies to confer colour to mycelium composites that the companies Impershield and Dorable came together to form the consortium for the present project. The investigated ways are: 1. Through the preliminary colouring of fibres and their use as substrate for mycelium growth 2. The surface treatment of the final product. The Centre of Expertise BioBased Economy (CoEBBE) and the Centre of Applied Research for Art and Design (CARADT) will be guiding the research through their experience with mycelium composites. This project will lay the basis to enhance visual appearance of mycelium composites, with the utilization of natural pigments, natural paints and coatings.
