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      Increased Longevity of a Novel Gas Exchanger System for Low-Flow Veno-Venous Extracorporeal CO 2 Removal in Acute Hypercapnic Respiratory Failure


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          Low-flow veno-venous extracorporeal CO 2 removal (ECCO 2R) is an adjunctive therapy to support lung protective ventilation or maintain spontaneous breathing in hypercapnic respiratory failure. Low-flow ECCO 2R is less invasive compared to higher flow systems, while potentially compromising efficiency and membrane lifetime. To counteract this shortcoming, a high-longevity system has recently been developed. Our hypotheses were that the novel membrane system provides runtimes up to 120 h, and CO 2 removal remains constant throughout membrane system lifetime.


          Seventy patients with pH ≤ 7.25 and/or PaCO 2 ≥9 kPa exceeding lung protective ventilation limits, or experiencing respiratory exhaustion during spontaneous breathing, were treated with the high-longevity ProLUNG system or in a control group using the original gas exchanger. Treatment parameters, gas exchanger runtime, and sweep-gas VCO 2 were recorded across 9,806 treatment-hours and retrospectively analyzed.


          25/33 and 23/37 patients were mechanically ventilated as opposed to awake spontaneously breathing in both groups. The high-longevity system increased gas exchanger runtime from 29 ± 16 to 48 ± 36 h in ventilated and from 22 ± 14 to 31 ± 31 h in awake patients ( p < 0.0001), with longer runtime in the former ( p < 0.01). VCO 2 remained constant at 86 ± 34 mL/min ( p = 0.11). Overall, PaCO 2 decreased from 9.1 ± 2.0 to 7.9 ± 1.9 kPa within 1 h ( p < 0.001). Tidal volume could be maintained at 5.4 ± 1.8 versus 5.7 ± 2.2 mL/kg at 120 h ( p = 0.60), and peak airway pressure could be reduced from 31.1 ± 5.1 to 27.5 ± 6.8 mbar ( p < 0.01).


          Using a high-longevity gas exchanger system, membrane lifetime in low-flow ECCO 2R could be extended in comparison to previous systems but remained below 120 h, especially in spontaneously breathing patients. Extracorporeal VCO 2 remained constant throughout gas exchanger system runtime and was consistent with removal of approximately 50% of expected CO 2 production, enabling lung protective ventilation despite hypercapnic respiratory failure.

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          Fitting Linear Mixed-Effects Models Using lme4

          Maximum likelihood or restricted maximum likelihood (REML) estimates of the parameters in linear mixed-effects models can be determined using the lmer function in the lme4 package for R. As for most model-fitting functions in R, the model is described in an lmer call by a formula, in this case including both fixed- and random-effects terms. The formula and data together determine a numerical representation of the model from which the profiled deviance or the profiled REML criterion can be evaluated as a function of some of the model parameters. The appropriate criterion is optimized, using one of the constrained optimization functions in R, to provide the parameter estimates. We describe the structure of the model, the steps in evaluating the profiled deviance or REML criterion, and the structure of classes or types that represents such a model. Sufficient detail is included to allow specialization of these structures by users who wish to write functions to fit specialized linear mixed models, such as models incorporating pedigrees or smoothing splines, that are not easily expressible in the formula language used by lmer. Journal of Statistical Software, 67 (1) ISSN:1548-7660
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            Random effects structure for confirmatory hypothesis testing: Keep it maximal.

            Linear mixed-effects models (LMEMs) have become increasingly prominent in psycholinguistics and related areas. However, many researchers do not seem to appreciate how random effects structures affect the generalizability of an analysis. Here, we argue that researchers using LMEMs for confirmatory hypothesis testing should minimally adhere to the standards that have been in place for many decades. Through theoretical arguments and Monte Carlo simulation, we show that LMEMs generalize best when they include the maximal random effects structure justified by the design. The generalization performance of LMEMs including data-driven random effects structures strongly depends upon modeling criteria and sample size, yielding reasonable results on moderately-sized samples when conservative criteria are used, but with little or no power advantage over maximal models. Finally, random-intercepts-only LMEMs used on within-subjects and/or within-items data from populations where subjects and/or items vary in their sensitivity to experimental manipulations always generalize worse than separate F 1 and F 2 tests, and in many cases, even worse than F 1 alone. Maximal LMEMs should be the 'gold standard' for confirmatory hypothesis testing in psycholinguistics and beyond.
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              Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.

              Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).

                Author and article information

                Blood Purif
                Blood Purif
                Blood Purification
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                April 2023
                2 November 2022
                2 November 2022
                : 52
                : 3
                : 275-284
                Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
                Author notes
                *Matthias Peter Hilty, matthias.hilty@ 123456usz.ch

                M.P.H. and M.M. are joint senior authors.

                Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                : 8 February 2022
                : 15 July 2022
                : 2023
                Page count
                Figures: 3, Tables: 1, References: 31, Pages: 10
                This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
                Research Article

                extracorporeal circulation,extracorporeal co2 removal,respiratory failure,lung protective ventilation,acute respiratory distress syndrome,chronic obstructive pulmonary disease,respiratory acidosis


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