Breathing Support Research Articles

Proteomic analysis of serum from a MeCP2 patient reveals an arginine biosynthesis pathway affected by the p.Lys254* variant.

This study reports a Chinese male patient with a novel MeCP2 p.Lys254*variant. Upon birth, the patient presented with typical symptoms, such as abnormal electroencephalogram, immature sleep rhythm, hypotonia, feeding difficulties, pulmonary fluid accumulation, horizontal fissures in the lungs, hypoventilation, and heart defects. MeCP2 is a gene located on the X chromosome and the main pathogenic gene responsible for Rett syndrome, which mainly occurs in females. Herein, we identified a male patient with a novel MeCP2 p.Lys254* variant through whole-exome sequencing, although both parents are wild type. Upon birth, the patient presented with typical symptoms, such as abnormal electroencephalogram, immature sleep rhythm, hypotonia, feeding difficulties, pulmonary fluid accumulation, horizontal fissures in the lungs, hypoventilation, and other symptoms. Period of breathing support, but also found that the boy had a heart defect and horizontal fissure in the lungs. Our discovery of a new spontaneous MeCP2 nonsense mutation enriches the understanding of Rett syndrome and provides a reference for its early diagnosis and treatment.

Loaded Words: The Ongoing Evolution of “Support”

Abstract: As frequently referenced in voice studios, “support” (or “breath support”) is a fundamental element of some teachers’ pedagogy. Others eschew the term, believing it to be ambiguous at best and harmful at worst. This article examines how support has been addressed in select pedagogical books and articles over the last fifty years. It presents various definitions for the term, examines potential problems with how it is often used in the voice studio, and considers alternate phrases that may be less “loaded.” It will also highlight some areas of general consensus in the ongoing evolution of the word support.

Addressing data quality issues to assess clinical and epidemiological risk factors for COVID-19 among documented cases in Liberia: a single-centre, retrospective, observational study

IntroductionIdentification of risk factors for severe COVID-19 can help to inform case management in resource-constrained settings. We aimed to rigorously but retroactively address data issues to identify risk factors for...

Elevated hospital floor-based HDU (POPUP-HDU): a new safe alternative to PICU for high-risk neuromuscular and syndromic children undergoing scoliosis surgery.

Children undergoing either posterior spinal fusion (PSF) or index insertion of growing rods for neuromuscular or genetic/syndromic scoliosis may require post-operative care on the paediatric intensive care unit (PICU). Demands on this limited resource result in frequent bed shortage related cancellations. In response, an ad-hoc or 'pop-up' ward-based high-dependency unit (POPUP-HDU) was developed. This converts a ward bed to POP-HDUbed for the required time. This study assesses the safety and efficacy of postoperative management that utilises POPUP-HDU as an alternative to a PICU bed. Retrospective review of 111 consecutive children undergoing posterior surgery for scoliosis between June 2016 and April 2023. The inclusion criteria included a diagnosis of genetic/syndromic or neuromuscular scoliosis; PSF or primary insertion of distraction-based growth rods and requirement for postoperative care in a PICU. We excluded those children that were mandated to go to PICU post-operatively for any reason by the anaesthetic team. 49 patients (mean age 13.0years) were managed on PICU, and 62 (mean age 11.4years) on POPUP-HDU. The groups were matched with respect to body weight, curve magnitude, operative duration, type of fusion procedure performed, the presence of cardiac malformations, the use of home breathing support, the number of operated levels, pelvic instrumentation and intraoperative blood loss. 8 patients in the PICU, and 16 in the POP-HDU groups were readmitted back to PICU following step-down to the hospital ward (p = 0.27). The median PICU length of stay was 1day in the PICU group and less than a day in POPUP-HDU (for those that needed to be subsequently admitted to PICU). The median total length of hospital stay was 10days in the PICU group, and 8days in POPUP-HDU (p < 0.05). 14 patients developed medical complications in the PICU group, compared to 19 in POPUP-HDU. There were no bedshortage cancellations in POPUP-HDU, compared to 23 in PICU. For children with neuromuscular, genetic or syndromic scoliosis undergoing PSF or growth rods that are not deemed suitable for immediate ward-level post-operative care, POPUP-HDU provided a safe alternative to PICU for appropriate patients and was associated with shorter hospital stay and fewer cancellations for lack of PICU beds. Therapeutic Level III.

Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) in the neonatal intensive care unit (NICU): an Australian NICU experience

BackgroundPreterm infants often require non-invasive breathing support while their lungs and control of respiration are still developing. Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) is an emerging technology that allows infants to breathe spontaneously while receiving support breaths proportional to their effort. This study describes the first Australian Neonatal Intensive Care Unit (NICU) experience of NIV-NAVA.MethodsRetrospective cohort study of infants admitted to a major tertiary NICU between October 2017 and April 2021 supported with NIV-NAVA. Infants were divided into three groups based on the indication to initiate NIV-NAVA (post-extubation; apnoea; escalation). Successful application of NIV-NAVA was based on the need for re-intubation within 48 h of application.ResultsThere were 169 NIV-NAVA episodes in 122 infants (82 post-extubation; 21 apnoea; 66 escalation). The median (range) gestational age at birth was 25 + 5 weeks (23 + 1 to 43 + 3 weeks) and median (range) birthweight was 963 g (365–4320 g). At NIV-NAVA application, mean (SD) age was 17 days (18.2), and median (range) weight was 850 g (501–4310 g). Infants did not require intubation within 48 h in 145/169 (85.2%) episodes [72/82 (87.8%) extubation; 21/21 (100%) apnoea; 52/66 (78.8%) escalation).ConclusionNIV-NAVA was successfully integrated for the three main indications (escalation; post-extubation; apnoea). Prospective clinical trials are still required to establish its effectiveness versus other modes of non-invasive support.

Prehospital Use of Ketamine Versus Midazolam for Sedation in Acute Severe Agitation

Objective: Acute severe agitation often requires pharmacologic sedation. While benzodiazepines and antipsychotics are traditional first-line medications for this purpose, recent evidence has shown that prehospital intramuscular (IM) administration of ketamine results in rapid, effective sedation. However, ketamine may be associated with adverse clinical events including a higher intubation rate. The purpose of this study is to compare the efficacy and safety of IM ketamine versus IM midazolam as medications to achieve sedation in the prehospital setting. Methods: This is a retrospective cohort study of agitated patients with an initial Richmond Agitation-Sedation Scale (RASS) score of at least 3, who were sedated and transported by ambulance to Hartford Hospital. The primary endpoint was incidence of endotracheal intubation occurring during transportation and within one hour after arrival to the emergency department (ED). Secondary endpoints included the percentage of patients who achieved an improved RASS score post drug administration, the use of additional sedating agents and the need for airway and breathing support, and differences in adverse events. Results: 66 patients in the ketamine group and 68 patients in the midazolam group met inclusion criteria. While more patients in the midazolam group achieved target RASS score of -1, 0, or 1 post drug administration, patients in the ketamine group had a lower mean RASS score post drug administration. There was no difference in endotracheal intubation rates between the two groups (6.1% versus 2.9%, respectively; p = 0.383). However, upon arrival to the ED, more patients in the ketamine group required additional sedating agents as well as airway or respiratory support Conclusion: Both ketamine and midazolam are relatively safe and efficacious in the prehospital environment. IM ketamine resulted in deeper sedation without increasing intubation rate. However, ED providers receiving patients treated with IM ketamine should prepare for additional sedating agents and airway interventions.

OTUB1 regulates ferroptosis to inhibit myoblast differentiation into myotubes by deubiquitinating P62

As the largest organ in the human body, skeletal muscle is essential for breathing support, movement initiation, and maintenance homeostasis. It has been shown that programmed cell death (PCD), which includes autophagy, apoptosis, and necrosis, is essential for the development of skeletal muscle. A novel form of PCD called ferroptosis is still poorly understood in relation to skeletal muscle. In this study, we observed that the activation of ferroptosis significantly impeded the differentiation of C2C12 myoblasts into myotubes and concurrently suppressed the expression of OTUB1, a crucial deubiquitinating enzyme. OTUB1-silenced C2C12 mouse myoblasts were used to investigate the function of OTUB1 in ferroptosis. The results show that OTUB1 knockdown in vitro significantly increased C2C12 ferroptosis and inhibited myogenesis. Interestingly, the induction of ferroptosis resulting from OTUB1 knockdown was concomitant with the activation of autophagy. Furthermore, OTUB1 interacted with the P62 protein and stabilized its expression by deubiquitinating it, thereby inhibiting autophagy-dependent ferroptosis and promoting myogenesis. All of these findings demonstrate the critical role that OTUB1 plays in controlling ferroptosis, and we suggest that focusing on the OTUB1-P62 axis may be a useful tactic in the treatment and prevention of disorders involving the skeletal muscle.

Evaluation of phrenic nerve stimulation trigger lag and synchronization in different modes of ventilation.

Phrenic nerve stimulation is currently being investigated for the prevention of diaphragm atrophy in patients with mechanically supported breathing. Patients receiving breathing support from mechanical ventilation are at risk of mismatches between respiratory demand and ventilator support. Our objectives were to determine if a novel phrenic nerve stimulation device provided stimulation during inspiration as intended and did not exacerbate any potential discordances. A benchtop electromechanical simulation model was developed to validate phrenic nerve stimulation with simulated breathing. The phrenic nerve stimulation device was evaluated with a mechanical ventilator attached to a breathing simulator. The trigger ratio and time lag between phrenic nerve stimulation and mechanical ventilation was measured for multiple disease and ventilator parameters. For the 1:1 breath trigger ratio test, 99.79% of intended stimulation breaths received stimulation at the correct time. For the 1:4 breath trigger ratio test, 99.72% of intended stimulation breaths received stimulation at the correct time. For trigger lag times for the inspiratory and expiratory phases, the mean inspiratory lag was 36.10 ± 10.50ms and 16.61 ± 3.61ms, respectively. The following discordance scenarios were evaluated in conjunction with simulated phrenic nerve stimulation: asynchrony-false trigger, dyssynchrony-early trigger, dyssynchrony-late trigger, dyssynchrony-early cycling, dyssynchrony-late cycling. Testing demonstrated none of these discordances were exacerbated by the simulated phrenic nerve stimulation. The novel phrenic nerve stimulation device delivered electrical stimulation therapy as intended and did not exacerbate any simulated discordances.

Assessment of vitamin d status among egyptian covid-19 patients

BackgroundThe COVID-19 outbreak has increased awareness of vitamin D's (Vit-D) potential advantages for both prevention and treatment. Adequate vitamin D levels are necessary for health of the immune system, which can help with cellular response and protection against the severity of microbial infection.PurposeTo evaluate Vit-D levels and their association with illness severity in Egyptian COVID-19-infected individuals.MethodsThis case–control investigation was performed at the Alexandria Main University Hospital on 80 subjects divided into 2 groups: 40 COVID-19 patients and 40 healthy persons to measure the Vit-D levels of the Egyptian cohort.ResultsThere was a statistically insignificant difference in the Vit-D serum levels of the studied groups (P = 1.000). The age of the Vit-D insufficient patients was significantly higher than that of Vit-D sufficient patients (P = 0.006). There was a statistically insignificant rise in the CRP level in the Vit-D insufficient patients (P = 0.862) compared to patients with sufficient Vit-D. Also, the D-dimer levels in Vit-D-insufficient patients were considerably higher (P = 0.015). Patients with sufficient Vit-D exhibited significantly lower levels of IL-6 than Vit-D insufficient patients. (P = 0.037). Patients in the Vit-D-insufficient subgroup needed substantially more breathing support than those in the Vit-D-sufficient group (P = 0.020).ConclusionAlthough there was no association between both levels of Vit-D and the COVID-19 infection risk, insufficiency of Vit-D was related to more severe infection.

The Anatomy of a Bokken Strike: Breaking Through Mental Blocks for Whole Body Breath Support

Abstract: This article details a voice training method that stems from a traditional Japanese budo ("way of war")" called Yoshokai Aikido . The method involves safely teaching the use of a bokken ("wooden sword") strike to overcome both the mental blocks that produce under-energized breath support in singing, and the fight-or-flight cascade that causes fear and choking. The article describes the physiology of the respiratory and cognitive mechanics affected by the proper use of a bokken strike, and the philosophy of Yoshokai Aikido that can benefit singers.

Early Breathing in Very Preterm Infants during Deferred Cord Clamping (DCC) Is Related to Gestational Age and Is Not Independently Associated with Important Neonatal Outcomes: A 5-Year Cohort Study.

Deferred cord clamping (DCC) has been associated with reduced mortality in preterm infants, and a period of at least 30 s has been recommended before clamping. However, preterm infants assessed as being in need of resuscitation have often had earlier cord clamping. In this study, we aimed to compare neonatal outcomes for preterm infants undergoing DCC who established early breathing movements compared to those who were not breathing. After a 5 yr recruitment period, we recently completed the ABC study, in which preterm infants <31 weeks undergoing 50 s of DCC who were not breathing by 15 s of age were randomised into two groups: one received intermittent positive pressure ventilation (IPPV) and the other was a standard group, which received no breathing support. The outcomes in the two groups were similar, and for the present analysis, the groups were combined. Infants in the ABC study were compared with the cohort excluded from the original ABC study because they were breathing by 15 s (called the Breathing Before Clamping or BBC group). There were significant differences in demographics between the ABC and BBC groups. Spontaneous preterm labour was more common in the BBC group, and these infants were more likely to be delivered vaginally. Gestational age and birth weight were significantly higher in the BBC group (p < 0.01). Soon after birth, Apgar scores were significantly higher in the BBC group, with a lower base deficit on first obtained blood gas, and a smaller proportion were intubated in the delivery room. Fewer BBC infants were hypothermic (<36.5 °C) on admission. Multivariate regression analysis indicated whether infants were breathing or not at 15 s of age was linked predominantly to gestation. Important neonatal outcomes and a composite of these outcomes (mortality, severe intraventricular haemorrhage, bronchopulmonary dysplasia) were not significantly different between the ABC and BBC groups (odds ratio for the composite outcome was 1.77 CI 0.84-3.76 corrected for gestation). For very preterm infants undergoing DCC, important neonatal outcomes were related to gestational age and not independently associated with early breathing. There was a small group (7% of total) who were deemed compromised at birth and did not undergo DCC. These infants had significantly worse neonatal outcomes.

Impact of COVID-19 in Pregnant Women and Vertical Transmission in Newborns; A Case Series

Objective: To assess the impact of COVID-19 in pregnant women and determine the vertical transmission in newborns.Study Design: Case series. Place and Duration of Study: Department of Gynecology &amp; Obstetric, Combined Military Hospital, Gujranwala Pakistan, from Jun to Sep 2020. Methodology: Forty consecutive pregnant women reported as COVID-19-positive cases were included. After taking clinical and demographic details, the maternal outcome was defined regarding shortness of breath, fever, oxygen saturation and ventilator support. The fetal outcome was defined based on APGAR score, birth weight, and Neonatal Intensive Care Unit admission. For vertical transmission, the neonatal nasopharyngeal swab samples were collected after 24 hours of birth.Result: Forty pregnant women were included in the study with the mean age of 30.05±2.8 years, and mean gestational age of36.08±0.717 weeks. Of the included women, 67.5% underwent C-sections, and 25.0% underwent SVD. As per fetal outcome, most of the babies 80% were normally delivered, while 5% were IUD. Out of all, three neonates were diagnosed with vertical transmission, but none of them developed any complications. Conclusion: Vertical transmissions of COVID-19 among neonates were observed. No critical maternal outcome in terms of maternal severe morbidity or mortality was observed. However, further studies are required on this subject.

Effects of training flights of combat jet pilots on parameters of airway function, diffusing capacity and systemic oxidative stress, and their association with flight parameters

BackgroundFighter aircraft pilots are regularly exposed to physiological challenges from high acceleration (Gz) forces, as well as increased breathing pressure and oxygen supply in the support systems. We studied whether effects on the lung and systemic oxidative stress were detectable after real training flights comprising of a wide variety of exposure conditions, and their combinations.MethodsThirty-five pilots of the German Air Force performed 145 flights with the Eurofighter Typhoon. Prior to and after flight lung diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), alveolar volume (VA), and diffusing capacities per volume (KCO, KNO) were assessed. In addition, the fractional concentration of exhaled nitric oxide (FeNO) was determined, and urine samples for the analysis of molecular species related to 8-hydroxy-2’-deoxyguanosine (8-OHdG) were taken. For statistical analysis, mixed ANOVA models were used.ResultsDLNO, DLCO, KNO, KCO and VA were reduced (p < 0.001) after flights, mean ± SD changes being 2.9 ± 5.0, 3.2 ± 5.2, 1.5 ± 3.7, 1.9 ± 3.7 and 1.4 ± 3.1%, respectively, while FeNO decreased by 11.1% and the ratio of 8-OHdG to creatinine increased by 15.7 ± 37.8%. The reductions of DLNO (DLCO) were smaller (p < 0.001) than those of KNO (KCO). In repeated flights on different days, baseline values were restored. Amongst various flight parameters comprising Gz-forces and/or being indicative of positive pressure breathing and oxygenation support, the combination of long flight duration and high altitude appeared to be linked to greater changes in DLNO and DLCO.ConclusionsThe pattern of reductions in diffusing capacities suggests effects arising from atelectasis and increased diffusion barrier, without changes in capillary blood volume. The decrease in exhaled endogenous NO suggests bronchial mucosal irritation and/or local oxidative stress, and the increase in urinary oxidized guanosine species suggests systemic oxidative stress. Although changes were small and not clinically relevant, their presence demonstrated physiological effects of real training flights in a modern 4th generation fighter jet.

Rapid Design of an ICU Ventilator: An Approach Based on Smart Switching of Compressed Air-Oxygen.

Breathing support is provided by regulating volume or pressure of lungs using ventilators. Due to COVID-19 pandemic, there was a sudden shortage of resuscitating devices such as ventilators. Additionally, ventilators being one of the primary critical care devices are also very costly. In order to address this situation, a number of low-cost designs have been proposed, however, many of these lack either an efficient control system or a hardware comparable to a standard ICU ventilator. In this regard, this article presents a comprehensive cost-effective solution that covers all aspects of the ventilator design (named as NED-Vent) such as hardware/pneumatic assembly, electronic design, user interface and control system. The proposed design works on compressed air-oxygen switching via proportional valves to produce basic volume and pressure modes as well as their derivatives such as assist ventilation, intermittent ventilation and spontaneous modes. The NED-Vent also features an interactive single-knob-single-touch user interface along with an automated mechanism for adjusting air-oxygen ratio in breathing gas mixture as an improvement on existing designs. The pressure regulated control is based on two mathematical models of human lungs with dynamic lung parameters estimated using machine learning approach. Additionally, the controller is tuned to optimized stability using Jury's Test and Ziegler-Nichols methods. The obtained results of breath profile are validated for the employed mathematical models (SLSC & SLMC) as well as the tuning methods in compliance with the tolerances provided by international standards.

Pelvic floor status in opera singers. a pilot study using transperineal ultrasound

BackgroundControl of pelvic floor muscles (PFM) is emphasized as important to obtain functional breath support in opera singing, but there is not much research that proves PFM function as part of breath support in classical singing. Transperineal ultrasound is a reliable method for quantification of PFM contraction in urogynecology. Our aim was to establish if transperineal ultrasound can be used for observation of movement of the PFM during singing and to quantify pelvic floor contraction.MethodsCross sectional study of 10 professional opera singers examined with transperineal ultrasound in the supine position at rest and contraction, and standing at rest and during singing. Levator hiatal area was measured in a 3D rendered volume. Levator hiatal anteroposterior (AP) diameter and bladder neck distance from symphysis were measured in 2D images.ResultsThe AP diameter was shortened from supine rest to contraction (15 mm), standing (6 mm) and singing (9 mm), all p < 0.01. The bladder neck had a non-significant descent of 3 mm during singing. The mean proportional change in AP diameter from rest to contraction was 24.2% (moderate to strong contraction) and from rest to singing was 15% (weak to moderate contraction).ConclusionsTransperineal ultrasound can be used to examine the PFM during singing. The classically trained singers had good voluntary PFM contraction and moderate contraction during singing. AP diameter was significantly shortened from supine to upright position, with further shortening during singing, confirming that female opera singers contracted their pelvic floor during singing.

Standards for the care of people with cystic fibrosis (CF); recognising and addressing CF health issues

This is the third in a series of four papers updating the European Cystic Fibrosis Society (ECFS) standards for the care of people with CF. This paper focuses on recognising and addressing CF health issues. The guidance was produced with wide stakeholder engagement, including people from the CF community, using an evidence-based framework. Authors contributed sections, and summary statements which were reviewed by a Delphi consultation.Monitoring and treating airway infection, inflammation and pulmonary exacerbations remains important, despite the widespread availability of CFTR modulators and their accompanying health improvements. Extrapulmonary CF-specific health issues persist, such as diabetes, liver disease, bone disease, stones and other renal issues, and intestinal obstruction. These health issues require multidisciplinary care with input from the relevant specialists. Cancer is more common in people with CF compared to the general population, and requires regular screening. The CF life journey requires mental and emotional adaptation to psychosocial and physical challenges, with support from the CF team and the CF psychologist. This is particularly important when life gets challenging, with disease progression requiring increased treatments, breathing support and potentially transplantation. Planning for end of life remains a necessary aspect of care and should be discussed openly, honestly, with sensitivity and compassion for the person with CF and their family.CF teams should proactively recognise and address CF-specific health issues, and support mental and emotional wellbeing while accompanying people with CF and their families on their life journey.

Investigating the Utility of the SOFA Score and Creating a Modified SOFA Score for Predicting Mortality in the Intensive Care Units in a Tertiary Hospital in Jordan.

The utility of the Sequential Organ Failure Assessment (SOFA) score in predicting mortality in the intensive care unit (ICU) has been demonstrated before, but serial testing in various settings is required to validate and improve the score. This study examined the utility of the SOFA score in predicting mortality in Jordanian ICU patients and aimed to find a modified score that required fewer laboratory tests. A prospective observational study was conducted at Jordan University Hospital (JUH). All adult patients admitted to JUH ICUs between June and December 2020 were included in the study. SOFA scores were measured daily during the whole ICU stay. A modified SOFA score (mSOFA) was constructed from the available laboratory, clinical, and demographic data. The performance of the SOFA, mSOFA, qSOFA, and SIRS in predicting ICU mortality was assessed using the area under the receiver operating characteristic curve (AUROC). 194 patients were followed up. SOFA score (mean ± SD) at admission was significantly higher in non-survivors (7.5 ± 3.9) compared to survivors (2.4 ± 2.2) and performed the best in predicting ICU mortality (AUROC = 0.8756, 95% CI: 0.8117-0.9395) compared to qSOFA (AUROC = 0.746, 95% CI: 0.655-0.836) and SIRS (AUROC = 0.533, 95% CI: 0.425-0.641). The constructed mSOFA included points for the hepatic and CNS SOFA scores, in addition to one point each for the presence of chronic kidney disease or the use of breathing support; it performed as well as the SOFA score in this cohort or better than the SOFA score in a subgroup of patients with heart disease. SOFA score was a good predictor of mortality in a Jordanian ICU population and better than qSOFA, while SIRS could not predict mortality. Furthermore, the proposed mSOFA score which employed fewer laboratory tests could be used after validation from larger studies.

Staging Korean Haenyeos in Celine Song’s Endlings: Diasporic Subjectivity Torn between Ethnic Lineage and Metatheatrical Satire

In March 2020, haenyeos—Korean female sea divers who make their living by harvesting seafood without any breathing support apparatus—debuted on the New York stage in Celine Song’s play Endlings at New York Theatre Workshop. The play’s title indicates that being a haenyeo is a disappearing way of life that the younger generation will not learn or follow. The play comprises two distinct segments and locations: the first act tells the stories of three haenyeos on Man-Jae, an island near South Korea’s Jeju Island, while the second part focuses on Ha Young, who is trying to succeed as a playwright on the island of Manhattan in New York. Mourning the extinction of a pursuit that has existed for hundreds or even thousands of years, the first part of the play pays heartwarming tribute to the haenyeos. In the second part, however, the play juxtaposes the stories of the haenyeos with the topics of immigration, real estate, and the survival of a millennial Korean Canadian playwright, abruptly turning into a cynical metatheatrical satire about the white/other binary racial paradigm and the politics of representation. The issue of authenticity looms too large, reducing the grand, resilient spirit of the haenyeos to a mere theatrical device, and the play ends up missing the rare opportunity to tell a powerful story of the haenyeos.

The feasibility of using mouthpiece ventilation in the intensive care unit for post-extubation breathing support after acute tetraplegia

Study designA prospective cohort of patients with acute tetraplegia.ObjectivesThis study aimed to determine the feasibility of using mouthpiece ventilation (MPV) in the intensive care unit (ICU) for patients who are extubated after suffering an acute cervical spinal cord injury (CSCI).SettingICU, Princess Alexandra Hospital, Brisbane Australia.MethodsNew admissions to ICU in the 14 months between April 2017 and June 2018 with a CSCI who underwent intubation were assessed for inclusion. MPV was provided to consenting participants (who were deemed likely to be able to maintain ventilation on their own) at the time of extubation and was utilised in addition to standard care while participants were awake. MPV settings, usage, and support hours to educate and facilitate MPV were collected. Feedback from participants and clinical staff was gathered throughout the study. Pre- and post-extubation measures of forced vital capacity (FVC), the frequency of endotracheal suction of sputum, and gas exchange using ventilation-perfusion ratios were recorded along with the incidence of reintubation.ResultsFourteen participated in utilising MPV with 16 episodes of extubation. The average time per participant to have MPV titrated and bedside data collected was 178 minutes. Data from 16 episodes of extubation have been included. Three of the 14 participants failed initial extubation. Feedback from participants and clinicians has been positive and constructive, enabling MPV settings to be adapted to the person with acute CSCI during this pilot study.ConclusionMPV is feasible to use post-extubation for people with CSCI in ICU. Pressure control mode MPV was deemed the most suitable for newly extubated acute CSCI patients. Intensive clinical support is required initially to provide education prior to MPV, and at the time of extubation for both patient and treating clinicians. Both report it to be a useful adjunct to ICU treatment.

An optimal internal model proportional integral controller to improve pressure tracking profile of artificial ventilator.

Mechanical ventilator (MV) is a breathing support medical equipment used during medical surgery or in an intensive care unit (ICU) for critical patients to reduce the breathing work of the patient under ventilation. In this work, a piston-driven mechanical ventilator is studied. Such types of ventilators are generally used as anaesthesia ventilators with volume-controlled modes. A modern ventilator can operate in different modes, such as volume control, pressure control, or both. Pressure-controlled mode may be better suited for some cases, such as patients undergoing laparoscopic surgery, as compared to volume-controlled mode because it may increase compliance during pneumoperitoneum, enhance oxygenation, and lower the stress response postoperatively. The pressure profile of a PCV must exactly track the pressure profile of a patient under ventilation to avoid ventilator-induced diaphragmatic dysfunction. Therefore, an optimal internal model control base proportional integral (IMC-PI) controller is proposed. The optimum parameter of the filter component of the IMC-PI controller is found by an enhanced class topper optimization (ECTO) algorithm. The performance of the proposed controller is analyzed in different scenarios and compared with existing results. Graphical Abstract Optimal internal model proportional integral controller for human respiratory ventilator.