Increased sedation requirements in patients receiving extracorporeal membrane oxygenation for respiratory and cardiorespiratory failure

Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are often noted to have increased sedation requirements. However, data related to sedation in this complex group of patients is limited. The aim of our study was to characterise the sedation requirements in adult patients receiving ECMO for cardiorespiratory failure. A retrospective chart review was performed to collect sedation data for 30 consecutive patients who received venovenous or venoarterial ECMO between April 2009 and March 2011. To test for a difference in doses over time we used a regression model. The dose of midazolam received on ECMO support increased by an average of 18 mg per day (95% confidence interval 8, 29 mg, P=0.001), while the dose of morphine increased by 29 mg per day (95% confidence interval 4, 53 mg, P=0.021) The venovenous group received a daily midazolam dose that was 157 mg higher than the venoarterial group (95% confidence interval 53, 261 mg, P=0.005). We did not observe any significant increase in fentanyl doses over time (95% confidence interval 1269, 4337 µg, P=0.94). There is a significant increase in dose requirement for morphine and midazolam during ECMO. Patients on venovenous ECMO received higher sedative doses as compared to patients on venoarterial ECMO. Future research should focus on mechanisms behind these changes and also identify drugs that are most suitable for sedation during ECMO.

ASAP ECMO : antibiotic, sedative and analgesic pharmacokinetics during extracorporeal membrane oxygenation : a multi-centre study to optimise drug therapy during ECMO

BACKGROUND: Given the expanding scope of extracorporeal membrane oxygenation (ECMO) and its variable impact on drug pharmacokinetics as observed in neonatal studies, it is imperative that the effects of the device on the drugs commonly prescribed in the intensive care unit (ICU) are further investigated. Currently, there are no data to confirm the appropriateness of standard drug dosing in adult patients on ECMO. Ineffective drug regimens in these critically ill patients can seriously worsen patient outcomes. This study was designed to describe the pharmacokinetics of the commonly used antibiotic, analgesic and sedative drugs in adult patients receiving ECMO. METHODS: This is a multi-centre, open-label, descriptive pharmacokinetic (PK) study. Eligible patients will be adults treated with ECMO for severe cardiac and/or respiratory failure at five Intensive Care Units in Australia and New Zealand. Patients will receive the study drugs as part of their routine management. Blood samples will be taken from indwelling catheters to investigate plasma concentrations of several antibiotics (ceftriaxone, meropenem, vancomycin, ciprofloxacin, gentamicin, piperacillin-tazobactum, ticarcillin-clavulunate, linezolid, fluconazole, voriconazole, caspofungin, oseltamivir), sedatives and analgesics (midazolam, morphine, fentanyl, propofol, dexmedetomidine, thiopentone). The PK of each drug will be characterised to determine the variability of PK in these patients and to develop dosing guidelines for prescription during ECMO. DISCUSSION: The evidence-based dosing algorithms generated from this analysis can be evaluated in later clinical studies. This knowledge is vitally important for optimising pharmacotherapy in these most severely ill patients to maximise the opportunity for therapeutic success and minimise the risk of therapeutic failure

Catalytic cracking of tars derived from rice hull gasification over goethite and palygorskite

Palygorskite (P), goethite (G), and hydrothermally synthesized goethite (HG) were used as supports for Fe and Ni. The catalytic activity of these materials was investigated involving in P, G and HG (supported Fe and Ni) for catalytic decomposition of biomass tar derived from rice hull gasification. The materials were characterized by X-ray diffraction (XRD), X-ray fluorescence (XRF), and transmission electron microscopy (TEM) with an energy dispersive X-ray (EDS). The catalytic activity of P for removal of tar was significantly better than that of G and HG. However, the activity of G with 6 mass% Ni labeled as Ni6/G (tar conversion 94.6%), which was equal to Fe6Ni6/P (94.4%), was better than Ni6/P (64.4%) and Ni6/HG (46.7%). When the loading of Ni (mass%) was 6 mass% on G, tar conversion had the best value (94.6%) and yield of gaseous products reached 486.9, 167.8 and 22.2 mL/(g·tar) for H2, CO, CH4, respectively. The catalytic activity of goethite supported Ni was better in improving tar conversion and improving increased yield of H2, CO, CH4, which was attributed to the existence of Al/Fe substitution of goethite

Catalytic cracking of tar derived from rice hull gasification over palygorskite-supported Fe and Ni

The catalytic performance of Fe–Ni/PG (PG: palygorskite) catalysts pre-calcined and reduced at 500 ◦C for catalytic decomposition of tar derived through rice hull gasification was investigated. The materials were characterized by using X-ray diffraction, hydrogen temperature reduction, and transmission electron microscopy. The results showed that ferrites with spinel structure ((Fe, Ni)3O4) were formed during preparation of bimetallic systems during calcination and reduction of the precursors (Fe–Ni/PG catalysts) and NiO metal oxide particles were formed over Fe6–Ni9/PG catalyst. The obtained experimental data showed that Fe–Ni/PG catalysts had greater catalytic activity than natural PG. Tar removal using Fe6–Ni9/PG catalyst was as high as Fe10–Ni6/PG catalyst (99.5%). Fe6–Ni9/PG showed greater catalytic activity with greater H2 yield and showed stronger resistance to carbon deposition, attributed to the presence of NiO nanoparticles. Thus, the addition of nickel and iron oxides played an important role in catalytic cracking of rice hull biomass tar.

Effect of preparation method of palygorskite-supported Fe and Ni catalysts on catalytic cracking of biomass tar

In this study, the effect of catalyst preparation and additive precursors on the catalytic decomposition of biomass using palygorskite-supported Fe and Ni catalysts was investigated. The catalysts were characterized by X-ray diffraction (XRD) and transmission electron microscopy (TEM). It is concluded that the most active additive precursor was Fe(NO3)3·9H2O. As for the catalyst preparation method, co-precipitation had superiority over incipient wetness impregnation at low Fe loadings.

Characterization and catalytic performance of Fe3Ni8/palygorskite for catalytic cracking of benzene

Catalytic decomposition is a very attractive way to convert tar components into H2, CO and other useful chemicals. The performance of Fe3Ni8/PG (palygorskite, PG) reduced in hydrogen at different temperatures for the catalytic decomposition of benzene has been assessed. Benzene was used as the model biomass tar. The effects of calcination atmosphere, temperatures and benzene concentration on catalytic cracking of benzene were measured. The results of XRD (X-Ray Diffraction), TEM (Transmission Electron Microscope), TPR (Temperature Program Reduction), TPSR (Temperature Program Surface Reduction), TC (Total Carbon), the reactivity component and reaction mechanism over Fe3Ni8/PG for catalytic cracking of benzene are discussed. The results showed particles of awaruite (Fe, Ni) about 2–30 nm were found on the surface of palygorskite by TEM when the calcination temperature was 600 °C. Particles with size smaller than 30 nm were obtained on all prepared Fe3Ni8/PG catalysts as shown by XRD. The nanoparticles proved to be the reactive component for catalytic cracking of benzene and the increase of active particle size caused the decrease in the reactivity of Fe3Ni8/PG. Fe3Ni8/PG annealed in hydrogen at 600 °C was proved to have the best reactivity in experiments (45% hydrogen yield). High concentration benzene (448 g/m3) accelerated the formation of carbon deposition. However, iron oxide decreases carbon deposition and increases the stability of catalyst for catalytic cracking of benzene. The application of Fe3Ni8/PG catalysts was proved a very effective catalyst for the catalytic cracking of benzene.

Catalytic conversion of gases via cation-exchangable alumino-silicate materials

A process for catalytic conversion and/or adsorption of gases inclusive of NOx, SOx, CO2, CO, dioxins and PAHs and combinations thereof wherein said gases may contain particulates which include contacting one or more of such gases with an alumino-silicate material having: a primarily tetrahedrally co-ordinated aluminium as established by the fact that the 27 A1 Magic Angle Spinning (MAS) provides a single peak at 55-58 ppm (FWHM ~23 ppm) relative to Al(H 2 0) 6 3 and (ii) a cation exchange capacity of at least 1 meq 100 in aqueous solution at room temperature.

Recent advances in catalytic/biocatalytic conversion of greenhouse methane and carbon dioxide to methanol and other oxygenates

Methane gas has been identified as the most destructive greenhouse gas (Liu et al., 2004). It was reported that the global warming potential of methane per molecule relative to CO2 is approximately 23 on a 100-year timescale or 62 over a 20-year period (IPCC, 2001). Methane has high C-H bond energy of about 439 kJ/mol and other higher alkanes (or saturated hydrocarbons) also have a very strong C-C and C-H bonds, thus making their molecules to have no empty orbitals of low energy or filled orbitals of high energy that could readily participate in chemical reactions as is the case with unsaturated hydrocarbons such as olefins and alkynes (Crabtree, 1994; Labinger & Bercaw, 2002)...

Asymmetrically decorated, doped porous graphene as an effective membrane for hydrogen isotope separation

We propose a new route to hydrogen isotope separation which exploits the quantum sieving effect in the context of transmission through asymmetrically decorated, doped porous graphenes. Selectivities of D2 over H2 as well as rate constants are calculated based on ab initio interaction potentials for passage through pure and nitrogen functionalized porous graphene. One-sided dressing of the membrane with metal provides the critical asymmetry needed for an energetically favorable pathway.

Desalination by a solar thermal membrane distillation process

A solar thermal membrane distillation pilot plant was operated for over 70 days in field conditions. The pilot plant incorporated a single spiral wound permeate gap membrane distillation style of module. All energy used to operate the unit was supplied by solar hot water collectors and photovoltaic panels. The process was able to produce a distillate stream of product water with a conductivity less than 10 µS/cm. Feed water concentration varied from 2,400 µS/cm to 106,000 µS/cm. The process is expected to find application in the production of drinking water for remote island and arid regions without the consumption of electrical energy.