First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation

OBJECTIVES: The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support. METHODS: Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients). RESULTS: The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support. CONCLUSIONS: The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.

Quantum entanglement of bound particles under free center of mass dispersion

On the basis of the full analytical solution of the overall unitary dynamics, the time evolution of entanglement is studied in a simple bipartite model system evolving unitarily from a pure initial state. The system consists of two particles in one spatial dimension bound by harmonic forces and having its free center of mass initially localized in space in a minimum uncertainty wavepacket. The existence of such initial states in which the bound particles are not entangled is discussed. Galilean invariance of the system ensures that the dynamics of entanglement between the two particles is independent of the wavepacket mean momentum. In fact, as shown, it is driven by the dispersive center of mass free dynamics, and evolves in a time scale that depends on the interparticle interaction in an essential way.

Magnetic and optical investigation of 40SiO(2)center dot 30Na(2)O center dot 1Al(2)O(3)center dot(29-x) B2O3 center dot xFe(2)O(3) glass matrix

Samples of 40SiO(2)center dot 30Na(2)O center dot 1Al(2)O(3)center dot(29 - x)B2O3 center dot xFe(2)O(3) (mol%), with 0.0 <= x <= 17.5, were prepared by the fusion method and investigated by electron paramagnetic resonance (EPR), optical absorption (OA) and Mossbauer spectroscopy (MS). The EPR spectra of the as-synthesized samples exhibit two well-defined EPR signals around g = 4.27 and g = 2.01 and a visible EPR shoulder around g = 6.4, assigned to isolated Fe3+ ion complexes (g = 4.27 and g = 6.4) and Fe3+-based clusters (g = 2.01). Analyses of both EPR line intensity and line width support the model picture of Fe3+-based clusters built in from two sources of isolated ions, namely Fe2+ and Fe3+; the ferrous ion being used to build in iron-based clusters at lower x-content (below about x = 2.5%) whereas the ferric ion is used to build in iron-based clusters at higher x-content (above about x = 2.5%). The presence of Fe2+ ions incorporated within the glass template is supported by OA data with a strong band around 1100 nm due to the spin-allowed E-5(g)-T-5(2g) transition in an octahedral coordination with oxygen. Additionally, Mossbauer data (isomer shift and quadrupole splitting) confirm incorporation of both Fe2+ and Fe3+ ions within the template, more likely in tetrahedral-like environments. We hypothesize that ferrous ions are incorporated within the glass template as FeO4 complex resulting from replacing silicon in non-bridging oxygen (SiO3O-) sites whereas ferric ions are incorporated as FeO4 complex resulting from replacing silicon in bridging-like oxygen silicate groups (SiO4). (C) 2012 Elsevier Masson SAS. All rights reserved.