Artificial Mechanical Ventilation Research Articles

Diaphragmatic muscle dysfunction associated with artificial mechanical ventilation: a narrative review of the literature

Mechanical ventilation is a respiratory support therapy that can cause diaphragm muscle injury and induce dysfunction, which is associated with prolonged ventilation, weaning failure and mortality. Protecting the diaphragm during ventilation requires the use of tools to monitor diaphragmatic effort. The aim of this review was to address current and relevant elements about the pathophysiology of diaphragmatic function in ventilated patients. For this purpose, a narrative review of the literature available in Google Scholar, Pumed/Medline, regional SciELO, and academic Google was carried out under the terms: diaphragmatic function-diaphragmatic function in ventilated patients/diaphragmatic ultrasound in ventilated patients pathophysiology/ diaphragmatic function and others. Fundamental theoretical contents on the clinic of diaphragmatic muscle dysfunction, its relationship with artificial ventilation and related structures, such as the lung, are addressed. It is concluded that the diaphragm represents the main muscle involved in respiration and diaphragmatic muscle dysfunction represents a frequent complication in critically ill patients. Diaphragmatic ultrasound is a tool that aids decision making on artificial ventilation, potentially reduces the duration of respiratory support and associated complications

Energy efficiency in architecture: Strategies and technologies

Energy efficiency in architecture is a critical consideration in the design and construction of buildings, aiming to reduce energy consumption and minimize environmental impact. This abstract explores various strategies and technologies that can be implemented to enhance energy efficiency in architecture. The importance of energy efficiency in architecture lies in its potential to reduce greenhouse gas emissions, lower energy costs, and create healthier indoor environments. Achieving energy efficiency in architecture involves a combination of passive design strategies, such as orientation, shading, and natural ventilation, as well as active technologies, including high-performance insulation, energy-efficient lighting, and renewable energy systems. Passive design strategies are fundamental to energy-efficient architecture, utilizing the natural elements of sunlight, shade, and airflow to minimize the need for mechanical heating, cooling, and lighting. Proper building orientation, effective shading devices, and strategic placement of windows and openings can maximize natural light and ventilation, reducing the reliance on artificial lighting and mechanical ventilation systems. In addition to passive design strategies, active technologies play a crucial role in enhancing energy efficiency in architecture. High-performance insulation materials, such as aerogel and vacuum insulation panels, can significantly reduce heat loss and gain through building envelopes, improving thermal comfort and reducing energy consumption. Energy-efficient lighting systems, such as light-emitting diodes (LEDs) and daylight harvesting systems, can reduce electricity usage for lighting, while renewable energy systems, such as solar photovoltaic panels and wind turbines, can generate clean energy on-site, further reducing reliance on fossil fuels. Overall, energy efficiency in architecture requires a holistic approach that considers both passive design strategies and active technologies. By incorporating these strategies and technologies into building design and construction, architects and designers can create buildings that are not only environmentally sustainable but also comfortable, healthy, and cost-effective for occupants.

Research on Energy-saving Design for University Library Spaces in Cold Regions

With the popularization of open-shelf reading in university library, the change of use mode leads to the change of space mode, and gradually develops from corridor mode to large-scale and deep composite centralized space organization mode. However, the large and deep open reading space and atrium space in university libraries increasingly rely on artificial lighting, mechanical ventilation and mechanical temperature regulation to meet the comfort needs of space thermal environment. Moreover, the improper control of passive design strategy in the early stage further leads to the reduction of indoor thermal environment comfort and the increase of building energy consumption. In the early stage of architectural design, through reasonable passive space layout design, the use of air conditioning equipment can be greatly reduced, energy consumption can be reduced, and the goal of green development can be achieved. Through extensive collection and analysis of 23 university libraries built in cold climate region, by making a statistical study on the building type, building area, number of floors, building scale and building plane aspect ratio, summarizing and extracts the prototype. Referring to the typical cases in cold climate area, two core groups that reading spatial variable group and atrium spatial variable group are proposed by controlling a single variable, in which each group has four plane layout modes. The dynamic energy consumption simulation software DesignBuilder is used to simulate the annual cooling, heating and lighting load of each group in cold climate region, and the results are converted into energy consumption values for analysis. The final results show that among the four combination modes of reading spatial variable group, the overall energy consumption of compound type is the smallest, and the energy-saving rate is the highest, up to 3.71%. The overall energy consumption of parallel type and surround type is little difference, and the overall energy consumption of surround type is the highest. The energy-saving rate of the four groups of reading modes is as follows: compound type > decentralized type > parallel type > surround type. The total energy consumption of the atrium partial staggered floor group is lower than that of the non staggered floor group. Among the four combination modes of the atrium spatial variable group, the overall energy consumption of the organization form of the atrium partial staggered floor to the south is the smallest, the energy-saving rate is the highest, reaching 5.84%, and the energy-saving rate of the atrium partial staggered floor to the north is the lowest. Therefore, in the preliminary scheme design stage, low-performance spaces such as traffic auxiliary space can be placed at the building boundary to form a buffer zone similar to the transition space, so as to alleviate the negative impact of the external adverse climate environment on the internal space. At the same time, it can be considered to carry out partial staggered floor design of the atrium, and give priority to arranging the atrium on the south side, which is not only conducive to reducing the overall energy consumption of the building and achieving the energy-saving goal, but also enhance the diversification of vertical sections and promote the interest of the internal space of modern university libraries.

Notes on the epidemiology of artificial mechanical ventilation and stroke

Artificial mechanical ventilation in the course of stroke presents a high mortality. Even today, with advanced knowledge in the physiopathology of the neurological event and modern techniques of respiratory support, it continues to be a problem of interest, which invites to reflect on the benefits of ventilation in this field. In Cuba, there is not enough research on the subject, however, mortality due to this cause is high. This phenomenon, which implies high costs and limited functional recovery in survivors, should continue to be studied.

TO CHARACTERISTICS OF THE ETIOLOGICAL STRUCTURE AND ANTIBIOTIC SENSITIVITY PATHOGENSOF INFECTIOUS RESPIRATORY ORGANS IN NEWBORN AFTER ARTIFICIAL PULMONARY VENTILATION

Objective. The study of the etiological structure, properties of pathogens of the Vinnytsia National Medical University named after E. Pirogova, respiratory process in newborns who have underwent artificial mechanical lung ventilation (MLV) and their resistance to antibacterial agents is especially relevant in modern conditions, expands the search for new approaches to pathogens, improves treatment and reduces mortality from this pathology. The purpose of the study - to determine the etiological structure, sensitivity to antibiotics of the leading pathogens of the infectious process of the respiratory system in newborns who were on mechanical ventilation. Materials and methods. In total, the species composition of the leading microorganisms that colonized the airways of 180 newborns treated in the Neonatal Intensive Care Unit (VAITN) of Vinnytsia Regional Children’s Clinical Hospital (VRCCH) was studied in 2020. A total of 285 isolates of microorganisms were isolated. 62 patients who underwent mechanical ventilation were involved in a prospective microbiological study, 86 clinical strains of microorganisms were isolated. The susceptibility of microorganisms to 30 antibacterial agents was determined according to the generally accepted method (order of the Ministry of Health of Ukraine №167; recommendations). Research results. The etiological significance of opportunistic pathogens (Enterobacter cloacae - 29%, Staphylococcus aureus - 24.4%, Pseudomonas aeruginosa - 18.6%, Candida albicans) was proved in patients who were on mechanical ventilation in VAITN VRCCH in 2020 for pneumonia. Clinical strains of S. aureus are sensitive to vancomycin, oxacillin and clindamycin. Conclusions. Pathogens of the respiratory process in newborns who have been on mechanical ventilation, are resistant to a number of antibiotic drugs (cefepime, gentamicin amikacin, piperacillin).

The Way of Severe Nursing of Respiratory System Failure.

Respiratory failure is the most common clinical symptom, seriously endangering people's health, which is mainly caused by a series of reasons, leading to serious respiratory dysfunction and severe pulmonary respiratory disorders, damaging the pulmonary airway function, and causing disability to maintain normal human gas exchange activities. At present, the main treatment of respiratory failure is to use the ventilator to help patients exchange gas and keep their breathing unobstructed. The nursing method is also around the artificial airway mechanical ventilation. The nursing of patients with respiratory failure is mainly respiratory nursing and psychological nursing. In this paper, the main research is to explore the way of severe nursing of respiratory failure. Before the nursing of respiratory failure, we should carry out nursing detection of the ventilator and test its performance, tightness, pipeline safety, and airway patency. Then carrying on the respiratory failure mechanical ventilation nursing and clarifying its mechanical ventilation nursing process is the main work of intensive care, at the same time, giving consideration to the psychological nursing of respiratory failure and implementing comprehensive nursing. In this paper, 50 patients were selected and divided into group A and group B; group A was given comprehensive nursing, and group B was given general nursing. The experimental results show that a series of situations in group A are more optimistic than those in group B. There was no doubt that the PH value of the two groups changed significantly 6 months after discharge. The pO2 value of group A was higher than that before discharge, while the pCO2 value of group B was unstable and increased. The pO2 value of group A was 55.52 before discharge and 62.36 six months after discharge. The pCO2 value of group A was 54.31 before discharge and 50.61 six months after discharge. The pCO2 value of group B was 55.23 before discharge and 57.34 six months after discharge.

Mechanical ventilation strategies

Any medical emergency resulting in a compromised airway will require emergency airway management, but subsequent continued airway support and artificial mechanical ventilation may also be needed. This article explores some of the common mechanical ventilation strategies and modes used during the COVID-19 pandemic and will discuss why coronary care nurses need to be familiar with these.

Analysis of related factors of carbapenem resistant Klebsiella pneumoniae infection in patients with artificial airway

To analyze the clinical characteristics and related influencing factors of carbapenem resistant Klebsiella pneumoniae (CRKP) in patients with artificial airway and mechanical ventilation in intensive care unit (ICU), and provide theoretical basis for clinical prevention of Klebsiella pneumoniae infection. The clinical data of patients with pulmonary infection of Klebsiella pneumoniae in ICU of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2016 to December 2019 were collected. Compared CRKP pneumonia patients (study group) with carbapenem antibiotic sensitive Klebsiella pneumoniae (CSKP) pneumonia patients (control group), the clinical characteristics [gender, age, acute physiology and chronic health evaluation II (APACHE II), duration of mechanical ventilation, proportion of patients with mechanical ventilation > 10 days, use of antibiotics before detection of Klebsiella pneumoniae, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), albumin, bedridden for more than 1 month before admission, 28-day mortality] were analyzed. The drug resistance rates of Klebsiella pneumoniae in both groups and difference of drug resistance rate of Klebsiella pneumoniae to different antibiotics from 2016 to 2019 were compared. The risk factors of CRKP infection were analyzed by multivariate Logistic regression, and the related drug resistance genes were detected. Compared with the control group, the study group was older [years old: 81.5 (72.0, 86.0) vs. 78.0 (71.0, 80.5)], APACHE II [point: 25.00 (20.00, 34.00) vs. 19.00 (14.00, 23.25)] and proportion of patients with mechanical ventilation > 10 days [63.2% (182/288) vs. 12.8% (10/78)], the use of β-lactamase inhibitor antibiotics before detection of Klebsiella pneumoniae [75.69% (218/288) vs. 30.77% (24/78)], the use of carbapenems [79.86% (230/288) vs. 41.03% (32/78)], the use of more than two kinds of antibiotics [80.90% (233/288) vs. 29.49% (23/78)], proportion of patients staying in bed for more than 1 month before admission [40.97% (118/288) vs. 11.54% (9/78)] and WBC [×109/L: 9.72 (6.41, 14.69) vs. 7.57 (5.84, 12.61)], CRP [mg/L: 74.45 (36.30, 158.88) vs. 39.22 (13.68, 92.51)], PCT [μg/L: 3.87 (0.82, 19.24) vs. 0.51 (0.25, 5.71)], 28-day mortality [21.5% (62/288) vs. 10.3% (8/78)] were higher, albumin [g/L: 24.1 (18.3, 28.6) vs. 30.1 (23.8, 35.1)] was lower, duration of mechanical ventilation [days: 16.5 (9.0, 19.0) vs. 7.0 (5.0, 10.0)] was longer, the proportion of patients with chronic obstructive pulmonary disease [COPD: 35.76% (103/288) vs. 11.54% (9/78)], malignant tumor [18.06% (52/288) vs. 5.13% (4/78)], renal failure [31.94% (92/288) vs. 11.54% (9/78)], shock [51.74% (149/288) vs. 19.23% (15/78)] were higher, and the differences were statistically significant (all P < 0.05). The drug resistance rates of Klebsiella pneumoniae to aztreonam, piperacillin/tazobactam, imipenem and ciprofloxacin were statistically significant (all P < 0.05); the drug resistance rates of Klebsiella pneumoniae to aztreonam and piperacillin/tazobactam were the highest in 2019 (88.17% and 86.02%, respectively), and the lowest in 2016 (70.65% and 57.61%, respectively). The drug resistance rate to imipenem was the highest in 2018 (86.32%), the lowest in 2016 (59.78%); the resistance rate to ciprofloxacin was the highest in 2016 (76.09%), and the lowest in 2018 (53.68%). The resistance rates of ceftetan, amikacin, piperacillin/tazobactam, ceftazidime, ceftriaxone and gentamicin in the study group were significantly higher than those in the control group (82.99% vs. 62.82%, 49.31% vs. 17.95%, 75.69% vs. 60.26%, 81.25% vs. 64.10%, 80.21% vs. 58.97%, 91.32% vs. 60.26%, all P < 0.05). Logistic regression analysis showed that COPD, severe hypoproteinemia, mechanical ventilation time > 10 days and the use of carbapenem antibiotics before detection of Klebsiella pneumoniae were independent risk factors of CRKP infection. Gene detection showed that there were TEM, KPC, AmpC, AAC(3)-II, ant(3")-I, qnrS and other drug resistance genes in CRKP. The detection rate of TEM was the highest (74.00%), and qnrA was the lowest (6.67%). The occurrence of CRKP in ICU patients with artificial airway and mechanical ventilation is related to many factors. It is necessary to shorten the mechanical ventilation time, avoid the nonstandard use of carbapenem antibiotics, and improve the serum albumin level, so as to reduce the incidence of CRKP pneumonia and improve the prognosis of patients.

Does Earlier Cannulation With Veno-Venous Extracorporeal Membrane Oxygenation in Adult Patients With Acute Respiratory Distress Syndrome Decrease Duration of Artificial Mechanical Ventilation?

Acute respiratory distress syndrome (ARDS) is characterized by an acute, diffuse, inflammatory lung injury, leading to increased alveolar capillary permeability, increased lung weight, and loss of aerated lung tissue (Fan, Brodie, & Slutsky, 2018). Primary treatment for ARDS is artificial mechanical ventilation (AMV) (Wu, Huang, Wu, Wang, & Lin, 2016). Given recent advances in technology, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) to treat severe ARDS is growing rapidly (Combes et al., 2014). This 49-month quantitative, retrospective inpatient EMR chart review compared if cannulation with VV-ECMO up to and including 48 hours of admission and diagnosis in adult patients 30 to 65 years of age diagnosed with ARDS, decreased duration on AMV, as compared to participants who were cannulated after 48 hours of admission and diagnosis with ARDS. A total of 110 participants were identified as receiving VV-ECMO during the study timeframe. Of the 58 participants who met all inclusion criteria, 39 participants were cannulated for VV-ECMO within 48 hours of admission and diagnosis with ARDS, and 19 participants were cannulated with VV-ECMO after 48 hours of admission and diagnosis with ARDS. Data collected identified no statistically significant (p < 0.579) difference in length of days on AMV between participant groups. Further studies are needed to determine if earlier initiation of VV-ECMO in adult patients with ARDS decrease time on AMV. Although the results related to length of time on AMV did not produce statistical significance, the decreased duration of AMV in the participants who were cannulated within 48 hours (21 days vs. 27 days) may support several benefits associated with this participant population including increased knowledge of healthcare providers, decreased lung injury, earlier discharge which decreases hospital and patient cost, ability for patients to communicate sooner, decreased risk of pulmonary infection, decreased length of stay, decreased cost, and improved patient and family satisfaction.

What should be included in web-based simulation for new nurses?

PurposeThe purpose of this study was to investigate newly graduated nurses' educational needs for web-based simulation (WBS) education. MethodsA cross-sectional descriptive study was conducted with 132 registered nurses, regardless of their career length, working at a hospital in Korea. Data accrued through a self-reported questionnaire asking nurses about their educational needs. Data were analyzed using descriptive statistics, independent t-test ANOVA, and Scheffe test. ResultsAlmost all (96.2%) participants said that new nurses need simulation training, and 90.2% of participants said WBS is necessary. The highest ranked category was fundamental nursing knowledge, followed by fundamental nursing technique. Among 81 items of nursing education needs, top ranked items were cardiopulmonary resuscitation, care of artificial airways, oxygen therapy, and mechanical ventilation, which were mostly in the fundamental-nursing-techniques category. Educational needs significantly differed depending on participants' clinical experience (F = 5.37; p = .006), hospital types (t = −3.48; p = .001), and past experiences as a preceptor (t = 2.71; p = .008). Participants with 4 to 6 years of clinical experience, working in a hospital with more than 300 beds, and with experience as a preceptor, answered that new nurses have high educational needs WBS. ConclusionsWBS for new nurses should include fundamental nursing knowledge and techniques that can apply to clinical practice immediately after learning. Also, emergency nursing care should be included to prioritize adequately and cope with emergency situations. The use of WBS will help new nurses learn and adapt to the clinical setting, which can assist nurses in providing optimal care to patients with confidence.

Status quo and countermeasure analysis of ICU nurses' implementation of airbag pressure monitoring in artificial airway

Objective To investigate the execution rate of airbag pressure monitoring of artificial airway by ICU nurses, and analyze the countermeasures to improve the execution rate of airbag pressure monitoring. Methods From May to June 2017, 15 patients who were admitted to the ICU of this hospital with retained artificial airway and mechanical ventilation time greater than 24 hours were randomly selected.The 418 times of airbag pressure monitoring in 15 patients during mechanical ventilation were recorded, and the implementation of airbag pressure monitoring in nurses at different time points and with different seniority was compared, and the influence of nurses' teaching on airbag pressure monitoring was analyzed. Results Total execution rate of airbag pressure monitoring was 45.93%.The comparison of airbag pressure monitoring implementation rates at different time points within 24 hours showed statistically significant differences (P<0.05). The execution rate in the afternoon was higher than that in the morning, and pre-night shift was higher than that of post-night shift, the difference was statistically significant (P<0.05). The execution rate of nurses within 3 years was higher than that of nurses over 3 years, and the difference was statistically significant(P<0.05). The execution rate of nurses with teaching was higher than that of nurses without teaching, the difference was statistically significant(P<0.05). Conclusions The execution performance of airbag pressure monitoring among ICU nurses is not optimistic.It is necessary to improve their execution performance from training, changing the work flow of nursing, setting an example or improving the nurses' subjective initiative, improving monitoring method, etc. Key words: ICU nurses; Artificial airway; Airbag pressure monitoring; Execution rate

The risk of unfavorable outcomes in critically ill patients during interhospital transportation in Tyumen Region

The objective : assessment of the risk of unfavorable outcomes in critically ill patients based on the experience of interhospital transportation in Tyumen Region. Methods . The results of 338 patients’ transportation from hospitals of the Tyumen Region for 4 months of 2018 were studied. To assure the group homogeneity, exclusion criteria were used (in order to assess changes in hemodynamic parameters, patients with upcoming or recently performed cardiac surgery, those who had acute myocardial infarction in the last 6 months, were excluded from the study, as well as children under 14 years old, whose hemodynamic parameters depended on the age). Results . Interhospital evacuation of patients at night was statistically significantly associated with lower systolic blood pressure, lower Glasgow coma score, and more often required artificial pulmonary mechanical ventilation (APV) on the way. Conclusions . The severity of the condition of patients undergoing interhospital transfer is closely associated with the state of three systems: respiratory, cardiovascular and central nervous systems. With unfavorable assessment of functions of these systems, the risk of deterioration of the patient's condition during evacuation can accelerate. Tests of these systems’ functions should be the basis of the scales aimed to assess the transportation risk. It was found that impaired consciousness and the need for sedation correlated with condition severity (r = 0.46; p = 0.03) and the need for artificial pulmonary ventilation (r = 0.55; p = 0.05), and if the decision on APV was not made in due time it could serve as a signal to start mechanical ventilation during transportation. Interhospital evacuation at night often requires APV, which in the absence of the timely decision about the patient’s intubation can lead to a deterioration of the condition directly associated with transportation (t = 2.19; p = 0.03) and the increased risk of critical incidents.

Airway Management and Ventilator-Associated Events.

Airway management techniques are aimed at reducing complications associated with artificial airways and mechanical ventilation, such as retained secretions. The impact of airway management techniques on ventilator-associated events (VAEs) varies considerably by modality. Closed-suction techniques are generally recommended but have limited, if any, impact on VAEs. Normal saline instillation during suctioning is not recommended. Devices designed specifically to remove biofilm from the inside of endotracheal tubes appear to be safe, but their role in VAE prevention is uncertain. Subglottic secretion clearance by artificial cough maneuvers is promising, but more research is needed to assess its clinical feasibility. Continuous cuff-pressure management appears to be effective in reducing microaspiration of subglottic secretions.

The optimization of light-wells with integrating daylight and stack natural ventilation systems in deep-plan residential buildings: A case study of Tehran

Simultaneous access to fresh air and daylight is one of the main problems in deep-plan buildings, causing increasing energy consumption for artificial lighting and mechanical ventilation. The proper design of light-wells as an integrated system to simultaneously provide daylighting and natural ventilation is the main topic of this research. In this study, a pattern for horizontal and vertical cross-sectional form of light-wells has been suggested for better daylighting and stack natural ventilation performance in connected rooms to light-wells. This suggested pattern of light-well can be used in future projects, located in different places with similar climatic conditions. Furthermore, daylighting and natural ventilation performance in different types of light-wells have been evaluated. The main tool of this research is computer simulation using Energy-Plus, Design Builder and Daysim simulation programs. Results show that the square light-well with 4 × 4 m minimum dimensions and the rectangular light well with 3 × 4 m dimensions can provide adequate ventilation rate and annual illuminance to the rooms connected to the light-well, up to 4 floors under the roof. Nevertheless, the air velocity and airflow pattern inside these rooms are not desirable for cooling by natural ventilation trough the light-well. Also, the quality of ventilated air in rooms connected to light-wells is low because the inlet air to upper floors comes from the outlet air from the lower floor. Considering these results, a revised light-well has been suggested for better daylighting and stack natural ventilation performance with some changes in the horizontal and vertical cross-sectional form.

Effect of suctioning order on suctioning effect of artificial airway mechanical ventilation

Objective To investigate the effect of suctioning order on suctioning in patients with artificial airway ventilation. Methods A total of 92 patients with mechanical ventilator in the First Affiliated Hospital of Harbin Medical University who were recruited from January 2016 to April 2015 were divided into observation group (n=46) and control group (n=46) by random number table method. The suction order for patients in the observation group was from oral nasal cavity to trachea, while the order was adverse in the control group. Nurse workload, suction effect, SaO2, PaCO2, mucosal injury and ventilator associated pneumonia incidence of two groups were compared. Results The time of suction, duration of suction and ventilation, as well as hospital stays of observation group were less than those of the control group (P 0.05) . After suction, the SaO2 of the observation group was higher than that of the control group, PaCO2 was lower than that of the control group (P<0.05) . The incidence of mucosal injury and ventilator-associated pneumonia in the experimental group were 8.70%, 6.52% compared with 17.39% and 23.91% in the control group (P<0.05) . Conclusions Suction with order from oral and nasal cavity to trachea can effectively reduce the risk of ventilator associated pneumonia, reduce the workload of nurses, improve patients′ comfort while suctioning, it is worth for clinical promotion. Key words: Respiration, artificial; Pneumonia, ventilator-ssociated; Suction; Order; Mucosal injury; Comfort

Bioclimatic Design Approach in Dayak Traditional Longhouse

The bioclimatic building design is essential for a building to adapt to local climates and to provide comfort for the inhabitants while encouraging energy saver features. Comfort inside the house can be achieved with less dependence on artificial lighting and mechanical ventilation, and the application of eco-friendly materials. Wood and bamboo are examples of eco-friendly materials which are excellent in absorbing heat and allowing natural ventilation thus giving comfort to the occupants. These materials are widely used in the construction of Dayak traditional longhouses in Sarawak, Malaysia. Therefore, a study has been conducted to assess the presence of bioclimatic building design approach in the Dayak traditional longhouse. In the study, observation and photo analysis were carried out at selected traditional longhouses in Sarawak. This study found that traditional longhouses practice bioclimatic building design. The traditional longhouse with its passive design for lighting and ventilation and materials contribute to its natural adaptation to the hot and humid weather conditions in the tropical climate. The findings are expected to generate ideas for bioclimatic building design for other modern houses in a tropical climate. In conclusion, the Dayak traditional longhouse in Sarawak, Malaysia is a good example of bioclimatic building design of the past.

Clinical effectiveness study on artificial airway sequential mechanical ventilation patients withdraw machine pull out

Objective On patients with mechanical ventilation spontaneous breathing trial (SBT) success, out of breath machine smoothly pulled out after endotracheal intubation for active airway moist sequential therapy of clinical new method and new technology. Methods Between January 2013 and May 2014 respiratory endotracheal intubation implementation of mechanical ventilation with intensive medicine successful withdraw machine pulled out of 135 patients with tracheal intubation, they were divided into group A(68 cases) and group B(67 cases) by random digits table method. The patients in group A were treated with buoy type oxygen device, group B with active airway moist heat treatment unit. The breathing rate, PaO2, SpO2, heart rate, Clinical Pulmonary Infection Score(CPIS) were measured after 72 h of pull out endotracheal intubation in two groups. Sputum viscosity was evaluated by Airway Secretions Score before pull out endotracheal intubation and after 24, 48, 72 h of pull out endotracheal intubation in two groups. Results There were no significant differences between two groups in gender, age, clinical diagnosis, mechanical ventilation time, acute physiology and chronic health evaluation system Ⅱ rating etc (P >0.05). The breathing rate, heart rate and CPIS score respectively (20.94±0.89), (80.79±4.67) times/min and (7.13±2.54) points after 72 h of pull out endotracheal intubation in group B, and (24.12±0.97), (86.32±5.12) times/min and (8.79±3.56) points in group A, and there were significant differences(t=5.113, 7.298, 5.597, all P 0.05). After 24, 48 and 72 h of pull out endotracheal intubation, group B of patients with sputum viscosity was suitable in group A (Z=-2.684,-2.870,-2.771, all P < 0.01). Conclusions Mechanical ventilation in patients with ventilator buoy type oxygen device for the pull out after endotracheal intubation success does not favor the sputum drainage, improve patients with dyspnea and hypoxemia is not obvious. By positive airway plus temperature humidity to sequential therapy is helpful to correct hypoxemia, improve the patients' respiratory function, reduce the breathing difficulties, reduce sputum viscosity, promote the airway drainage unblocked, shortening the time of lung infection. Key words: Ventilators, mechanical; Airway management; Ventilator weaning; Intubation; Intratracheal

Venovenous extracorporeal membrane oxygenation for acute respiratory failure : A clinical review from an international group of experts.

Despite expensive life-sustaining interventions delivered in the ICU, mortality and morbidity in patients with acute respiratory failure (ARF) remain unacceptably high. Extracorporeal membrane oxygenation (ECMO) has emerged as a promising intervention that may provide more efficacious supportive care to these patients. Improvements in technology have made ECMO safer and easier to use, allowing for the potential of more widespread application in patients with ARF. A greater appreciation of the complications associated with the placement of an artificial airway and mechanical ventilation has led clinicians and researchers to seek viable alternatives to providing supportive care in these patients. Thus, this review will summarize the current knowledge regarding the use of venovenous (VV)-ECMO for ARF and describe some of the recent controversies in the field, such as mechanical ventilation, anticoagulation and transfusion therapy, and ethical concerns in patients supported with VV-ECMO.

Dysphagia following prolonged mechanical ventilation and tracheostomy in critical ill patients. results of edisval study pilot phase

Available data shows that dysphagia and swallowing disorder rate secondary to artificial airway and prolonged mechanical ventilation in critical tracheostomized patients is high (50-83%), nevertheless it real incidence is not yet well established. Dysphagia is directly related to bronchial aspirations and respiratory infections. The rate of respiratory infections on tracheostomized patients is also very high (Some series next 100%). The re-establishment of airway using speaking valves allow the rehabilitation and post-recovery of those disorders, as well as deglutition and phonatory system rehabilitation. The aim of EDISVAL Study is to determine the usefulness of speaking valve in preventing respiratory nosocomial infections in critical tracheostomized patients diagnosed of dysphagia secondary to artificial airway, for what it was done a screening test of dysphagia to the critical tracheostomized patients.

Current insights in brain protection for the sick newborn infant

This paper presents an overview of the modern antenatal and postnatal strategies in brain protection for both preterm and term born infants. It is known, that the two most common causes of neonatal brain injury are prematurity and hypoxic-ischemic encephalopathy (HIE) in the term born infant. Approximately one in nine babies is born before term. Nowadays these preterm born infants more often survive the neonatal period due to developments in treatment options in the last decades. They are however at a high risk for developing brain damage and neurodevelopmental impairment later in life. Approximately 40 % of survivors develop long-term intellectual or physical impairment, including cerebral palsy (CP). Term born infants born after perinatal asphyxia may also survive with a variety of neurocognitive disorders due to brain damage as a result from the hypoxic ischemic encephalopathy (HIE). Untreated, the sequelae of moderate to severe HIE includes a 60 to 65 % risk of mental retardation, CP, hydrocephalus, seizures, or death. The main goal in neonatal care for these surviving but vulnerable infants is to preserve brain function and prevent further brain damage, in order to improve neurocognitive outcome and the subsequent quality of life. In preterm brain protection antenatal strategies besides educating and supporting pregnant women regarding life style and healthy food intake, centralization of care for extreme preterm born infants, fetal monitoring in high risk pregnancies, administration of antenatal steroids for lung maturity, the use of intravenous magnesium sulfate administration to mothers just before preterm delivery are of great importance. In the postnatal strategies setting optimal oxygen saturation, the avoidance of prolonged artificial mechanical ventilation, hypoglycemia, hypocapnia electrolytic imbalances, hyperbilirubinemia, blood pressure shifts, stress and pain, inflammation, necrotizing enterocolitis as well as adequate feeding strongly predict neurocognitive outcome. In the term asphyxiated infants the brain experiences a cascade of problems occurring after energy failure which in fact are the basis of neuroprotective strategies. These strategies consist of anti-oxidative, anti-inflammatory, anti-excitatoxic and anti-apoptotic agents, and in the future possibly neurogenetic approaches, including stem cell therapy. In antenatal strategies prevention of asphyxia starts at promoting a healthy pregnancy and of an early recognition of fetal, placental or perinatal risk factors for hypoxia. Recent experimental trials have shown a possible beneficial effect of antenatal administration of the anti-oxidative agent allopurinol in a HIE. In postnatal strategies two methods to achieve therapeutic hypothermia were evaluated in newborn infants with HIE: whole body cooling and selective head cooling with mild systemic hypothermia with the conclusion: hypothermia should be instituted in term infants with moderate-to-severe hypoxic ischemic encephalopathy if identified before six hours of age. Monitoring of brain activity by means of amplitude integrated electroencephalography to identify infants with HIE is promising. Potential agents with either anti-oxidative, anti-inflammatory, anti-excitatoxic or anti-apoptotic capacities are currently being investigated in various phases of research.