CPAP Machines Research Articles

(200) THE RELATIONSHIP BETWEEN STUTTERING PRIAPISM AND OBSTRUCTIVE SLEEP APNEA

Abstract Introduction Priapism is a urologic emergency with devastating long-term consequences if left untreated. Some cases of priapism are recurring, requiring patients to have multiple visits to the emergency room for drainage and possible creation of penile shunts. Priapism has been historically classified into three categories: nonischemic, ischemic, and “stuttering” (also known as “recurrent”). The etiologies and management of patients with stuttering priapism remain somewhat perplexing, with many patients requiring trials of several medications including phosphodiesterase inhibitors and/or anti-androgens or surgery to prevent relapse of their condition. Apart from patients with sickle cell disease and other hematological conditions, most cases of stuttering priapism are idiopathic. The underlying pathophysiological basis for some causes, such as sickle cell disease, is believed to be due to depletion of nitric oxide and resulting dysfunction of cGMP-induced vasodilation of corporal smooth muscle. Objective After analyzing a case series of three cases of stuttering priapism at our institution, we propose a potential mechanism for stuttering priapism in patients with obstructive sleep apnea (OSA). Methods We constructed a case series of three patients with stuttering priapism with OSA at our institution. A thorough query of our institution’s electronic medical record was performed from January 1st, 2023 to January 1st, 2024 through the use of an existing IRB approval. Results A total of three patients were identified with a history of OSA who were treated for stuttering priapism. The mean patient age was 43 years old. Two of the three patients also had a history of hypertension and diabetes. All three patients were not consistently treating their OSA (i.e., inconsistent CPAP use, lack of regular pulmonology follow up). However, patients did report less priapism episodes during periods when they were adherent to their CPAP machine. Interestingly, two of three patients were hypogonadal (with testosterone <150) and the third patient had low-normal testosterone at 344. Conclusions OSA is a risk factor for multiple conditions, such as coronary artery disease, type 2 diabetes, stroke, and cerebrovascular diseases. One hypothesis for the increased risk of a variety of cardiovascular conditions in OSA is due to decreased NO. Oxidative stress due to repetitive hypoxemic episodes in OSA induces apoptosis and dysfunction of endothelial cells, which are responsible for production and regulation of NO. Given that there is low nitric oxide both in patients with sickle cell disease and in those with OSA, we hypothesize that this results in extremely down-regulated PDE5. Thus, through alternative non-nitric oxide pathways, there can be episodic uncontrolled cGMP-induced vasodilation of penile smooth muscle thereby resulting in prolonged erection time. Non-nitric oxide mediated pathways including vasoactive peptide and acetylcholine release have been described in producing erections. Previous studies have also shown that the consistent use of CPAP for more than 12 weeks is associated with improvement or normalization of nitric oxide levels in patients with OSA. In our case series, our patients reported less episodes of priapism when using their CPAP consistently. Disclosure No.

Deep learning-based snore sound analysis for the detection of night-time breathing disorders

Snoring, a prevalent symptom of obstructive sleep apnea, is believed to impact 57% of men and 40% of women in the United States. Night-time breathing disorders present significant challenges to both diagnosis and treatment, impacting millions of individuals worldwide. Traditional methods like CPAP machines and lifestyle changes face barriers such as discomfort, low adherence, and high costs, prompting the need for innovative solutions. This paper presents a novel approach using artificial intelligence, specifically deep learning, to create a snore sound analysis-based alerting system. This system aims to detect sleep disorders by analyzing snore patterns, providing a non-intrusive, cost-effective, and user-friendly alternative to traditional methods. By training models on snore sound characteristics, we've achieved promising results in identifying sleep apnea, showcasing the potential of this system in transforming the detection and management of night-time breathing disorders.

Regional Anaesthesia with Non Invasive Ventilation and Conscious Sedation: An Alternative to General Anaesthesia in Morbidly Obese Patients with Obstructive Sleep Apnea in Retrograde Intrarenal Surgery

Obstructive sleep apnea(OSA) is a syndrome characterized by obstruction in the upper airway during sleep. OSA patients undergoing procedures under GA are at increased risk for hypoxemia, pneumonia, difficult intubation, atelactasis, myocardial infarction making it a challenge for anesthesiologist. Retrograde intrarenal surgery(RIRS) is normally performed under GA to prevent respiratory embaracement. There are very few studies focusing on Regional anesthesia in RIRS procedure. A Sixty-three-year-old male known case of morbid obesity (BMI- 35 kg/meter square), OSA (on CPAP support at night) presented with left renal pelvis calculus, STOP BANG score (=5) therefore making it a case of difficult airway. Respiratory discomfort improved at 30-35-degree head up due to existing OSA considering the severe OSA and anticipated difficult airway, the surgery was planned under Lumbar subarachnoid block with preparation for management of difficult airway if conversion to GA required. 3 ml of 0.5 percent Bupivacaine heavy and 25 mcg fentanyl injected into subarachnoid space. T6 level block acheived after 3 minutes. The patient was put on his home CPAP machine with 5cm H2O PEEP. The patient was maintained on sponatneous ventilation and monitored using Etco2 at aliquot of 1mg midazolam given to mimic natural sleep pattern. The surgery was uneventful and the risk of induction of GA and difficult intubation was succesfully avoided. Patient with regional anaesthesia who are prone to converted to GA due to multiple risk factors, i.e., OSA with anticipated difficult airway can create a chaotic situation. So as a preliminary step NIV can be used, and along with it, mild sedation can be supplemented to improve acceptance and to avoid asynchrony. In this case NIV was used as a preemptive ventilation strategy even before actual requirement of BiPAP by mimicing the natural sleep pattern and make patient comfortable while a smooth conductance of the procedure.

Modified Mono-Block Device for Treatment of Mild to Moderate Obstructive Sleep Apnea: Case Report and Overview

Obstructive sleep apnea is a prevalent sleep disorder that leads to breathing pauses during sleep, causing symptoms such as tiredness, irritability, and fatigue. Various treatment options are available, including behavioral management, CPAP machines, oral devices, and surgery. The New Modified Mono-Block (MMBA) has demonstrated effectiveness and versatility in treating OSA patients and boasts its advantages over previously used devices. It is essential to seek medical advice if experiencing any symptoms of sleep apnea, and long-term treatment use can significantly improve symptoms and prevent potential complications.

Assessment of the Performance of selected Special Care Newborn Units (SCANUs) in Bangladesh: A cross Sectional Study

Background: Government of Bangladesh initiated the Special Care Newborn Units (SCANU) in 2011 at selected district hospitals followed by its scale up in other districts with support from UNICEF and other partners. The objective of the study was to assess the performance of those SCANUs in Bangladesh. Methods: A cross-sectional study approach was applied for assessment of the performance of SCANU facilities compared to facilities without SCANU. Fifteen facilities with SCANUs and five facilities without SCANUs were selected from eight divisions of the country for the study. The selected SCANU and Non-SCANU facilities were of secondary level hospital with similar patient flow and workload. Quantitative data were collected from direct observation of the 20 facilities and interviews with 678 caregivers using a field-tested questionnaire. Caregivers were mothers of the infants (<59 days old) who were admitted and stayed for at least one day in those hospitals. Analysis was done using Stata version 15.1 and presented in tabular, graphical and numerical measures of central tendency and dispersion. Result: The results of the assessment found that 60% of SCANU facilities had KMC care services and 27% of SCANU facilities had rooming in services and special sick baby ward services but no such services was available in non-SCANU facilities. Equipment in the SCANUs such as resuscitation bag and mask, radiant warmers, phototherapy machines and to a large extent CPAP machines and Oxygen blenders were mostly available and functioning optimally. More than half of the SCANUs still need to have oxygen blenders, CPAP machines and transcutaneous bilirubinometers since they were not found/functional during the assessment. Majority of SCANU facilities 60%-80% reported no stock-outs of critical medications like dexamethasone, ceftriaxone and gentamicin which are critical for management of preterm and sick babies. A web-based online ‘Individual Case Tracking’ system has been developed for online reporting from all SCANUs by the Health Management Information System (HMIS) of the Directorate General of Health Services (DGHS). UNICEF was supporting its linkage to the district health information system (DHIS-2). There was a statistically significant difference between SCANUs and non-SCANUs with respect to the proportions of admissions. SCANUs are acting as referral destination for sick and small newborns as 41%-45% of the admitted newborns were either were born at home or in other facilities. Conclusion: The assessment findings will be helpful for country strategy for improving newborn care through expansion of SCANU expansion throughout the country

Cognitive Functions, Depressive and Anxiety Symptoms After One Year of CPAP Treatment in Obstructive Sleep Apnea.

The study worked with depressive symptoms, anxiety score and cognitive functions in obstructive sleep apnea (OSA) patients treated with CPAP. Eighty-one subjects with OSA and without psychiatric comorbidity were treated with CPAP for one year and completed the following scales and cognitive tests: Trail Making Test, Verbal Fluency Test, d2 Test, Beck Depression Inventory-II and Beck Anxiety Inventory. MINI ruled out psychiatric disorder. At the two months check-up, subjects were re-evaluated for depressive and anxiety symptoms, and after one year of CPAP treatment, subjects repeated cognitive tests and scales. Data about therapy adherence and effectiveness were obtained from the patient's CPAP machines. The study was completed by 59 CPAP adherent patients and eight non-adherent patients. CPAP therapy effectiveness was verified in all patients by decreasing the apnea-hypopnoea index below 5 and/or 10% of baseline values. The adherent patients significantly improved depressive and anxiety symptoms. There was also an improvement in overall performance in the attention test; however, performance in many individual items did not change. The adherent patients also improved verbal fluency and in the Part B of the Trail making test. The non-adherent group significantly increased the number of mistakes made in the d2 test; other results were non-significant. According to our results, OSA patients' mood, anxiety and certain cognitive domains improved during the one-year therapy with CPAP. NCT03866161.

Nursing Professionals’ Role in the Comprehensive Management of Obstructive Sleep Apnoea: A Literature Review

Background: obstructive sleep apnoea is a common and burdensome condition, characterised by obstruction of the airway during sleep at the level of the pharynx, which may occur with symptoms or without any symptoms. The most common place for obstructive sleep apnoea management is in specialised sleep units. Aim: to identify what is known about nurses’ role in comprehensive management of obstructive sleep apnoea, and to determine the effectiveness of nurse-led interventions as well as the cost effectiveness of management of obstructive sleep apnoea in primary care settings. Methods: a scoping review was carried out by searching PubMed/Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ScienceDirect. The study findings were synthesised using a thematic analysis approach. Results: In this review, 12 articles were included, and three key themes emerged, namely the role of nurses in the diagnosis of obstructive sleep apnoea, role of nurses in the follow up and support of obstructive sleep apnoea patients, and role of nurses in the management of obstructive sleep apnoea in primary care and the cost-effectiveness. Conclusion: Nurses can play a critical role in obstructive sleep apnoea. There are many ways in which nurses can contribute, including screening, assessment, diagnosis, promotion of therapy adherence, and following up with patients, including monitoring for any side effects associated with the CPAP machine, such as irritation of the face. Additionally, nurses can provide patient education and coordinate with other health care providers. Nursing interventions such as patient education have been demonstrated to be highly effective in promoting adherence to PAP therapy in both sleep units and primary care settings. Based on the findings of this review, the primary care model is more cost-effective than the sleep unit model in the management of obstructive sleep apnoea patients. The role of nurses in managing Obstructive Sleep Apnoea in both paediatric and adult populations shares similarities, but also includes differences that should be carefully considered and explored. In this review, one article only explored the role of nurses in paediatric OSA care. Thus, there is a need to identify the potential role of nursing in the comprehensive management of paediatric obstructive sleep apnoea, as well as to explore alternative cost-effective approaches that include primary care settings.

Respiratory support for patients with COVID-19: A national survey of respiratory departments in England.

ObjectiveWe developed a national survey to assess the changes implemented by respiratory departments across England in response to the first wave of the COVID‐19 pandemic.MethodsAn online survey was sent to the respiratory clinical leads in 132 NHS trusts in England. The survey was open between 10 August 2020 and 25 September 2020.ResultsFifty‐three responses (42%) are included in our results.The total number of non‐critical care led Level 2 beds (requiring care for single organ failure—capable of managing continuous positive airways pressure, CPAP) increased by 159% at peak COVID activity from levels prior to COVID‐19. CPAP was used solely in side‐rooms in 9% of sites, and 57% and 31% of sites used CPAP in closed bays and closed wards, respectively.Fifteen sites (28%) reported shortages of non‐vented non‐invasive ventilation (NIV) masks and 12 sites (23%) CPAP machines. There was regional variation.ConclusionsThe number of beds capable of managing patients requiring CPAP increased significantly. We found deviations from previous standards of care, which likely reflects the pressure faced by hospitals in managing patients with COVID‐19. The regional variation in equipment shortages suggests moving resources between regions may have been beneficial.

0674 CPAP Adherence and Response to Cognitive Processing Therapy for PTSD in Veterans with Obstructive Sleep Apnea

Abstract Introduction Cognitive processing therapy (CPT) is a recommended first-line psychotherapy treatment for veterans with PTSD. Veterans with PTSD are at higher risk for sleep disorders including obstructive sleep apnea (OSA), and there is evidence that OSA can exacerbate PTSD and vice versa. Several studies have shown that CPAP use is associated with improvement in PTSD symptoms. CPT is an effective, yet time and resource intensive treatment option, making it critical to identify potential health factors impacting its efficacy. This retrospective chart analysis of veterans diagnosed with OSA and PTSD evaluated the effect of CPAP adherence on response to CPT. Methods Medical records of patients seen in a VA Health Care System were reviewed to identify veterans diagnosed with OSA and PTSD that received between 1-12 sessions of CPT with documented weekly PTSD Checklist for DSM-5 (PCL-5) scores, Patient Health Questionnaire-9 (PHQ-9) scores, and were issued a CPAP machine for OSA. Data collected included demographics, CPAP adherence (mean CPAP use, % days with greater than 4 hrs./night of CPAP use, mean residual apnea hypopnea index, mask leak), and PTSD symptoms (PCL-5 and PHQ-9 scores). For each outcome, we estimated a linear mixed-effects model; models for PCL-5 allowed heterogeneous residual variances for each veteran. Results This study identified 25 veterans receiving CPT for PTSD with access to a CPAP machine for OSA. The median age of patients was 43 years, median BMI was 35.6, and median residual AHI was 2.4. Patients received CPT for a median duration of 11.0 weeks. There was significant improvement in weekly PCL-5 and PHQ-9 scores over the course of CPT (both p < .001). CPAP adherence of at least 4 hrs./night for ≥70% of days did not significantly impact PCL-5 and PHQ-9 scores during CPT. Residual AHI and mask leak were not associated with PTSD symptoms during CPT. Conclusion While CPAP nonadherence appears to be a potential contributing factor to the reduced effectiveness of evidence-based treatments for veterans with PTSD, our study revealed significant improvement in PTSD symptoms during CPT regardless of CPAP adherence. Given the retrospective nature and small sample size of this study, further research is needed to expand on these findings. Support (If Any)

0861 Sleepy in the Mountains

IntroductionCentral sleep apnea (CSA) is a rare disorder caused by a reduction of airflow and ventilatory effort during sleep. CSA is rarely idiopathic and associated with medical conditions including heart failure, opioid medications, treatment emergent and high-altitude periodic breathing. At higher altitudes, hypoxemia induces periodic breathing with periods of deep and rapid breathing alternating with central apnea. Patients with high-altitude periodic breathing experience fragmented sleep, poor sleep quality, excessive daytime sleepiness, morning headaches and witnessed apnea. We discuss a patient with obstructive sleep apnea (OSA) who developed new-onset central sleep apnea after relocating to a higher altitude location. Report of Cases: A 75-year-old male with a history of moderate obstructive sleep apnea well controlled on CPAP for eight years, with no known cardiovascular or pulmonary disease, presented with new-onset excessive daytime sleepiness. He had recently relocated to an area in the Colorado mountains (7000 ft elevation) from his previous home in Los Angeles (sea level). His residual apneahypopnea index (r-AHI) displayed on his CPAP machine increased to 7-14/hr from his normal of 1-2/hr after his relocation. Review of his compliance data revealed his central apnea index was elevated, contributing to his high r-AHI. A one-night nocturnal oximeter was mailed to the patient to use while on CPAP. Data revealed oxygen desaturation to less than 88% for about 2 hours of the night, worse during the early morning hours. The patient was advised to undergo a polysomnography and adaptive servo-ventilation titration if significant central sleep apnea was present. The patient declined due to concern about the COVID-19 pandemic. Supplemental nocturnal oxygen was initiated at 2L/min with normalization of the r-AHI.ConclusionPatients with OSA who experience worsening symptoms or increased r-AHI despite excellent compliance with PAP therapy should be considered for repeat polysomnography or titration study. While it is expected that high-altitude central sleep apnea will improve with acclimatization, nocturnal supplemental oxygen in addition to PAP therapy is indicated for patients with high-altitude central sleep apnea to diminish hypoxemia and improve residual AHI and sleep quality.Support (If Any)

0773 When CPAPs are in Short Supply: A Review of Other FDA Approved OSA Interventions

Abstract Introduction The CPAP recall of 2021 has highlighted an inherent problem that occurs when a field of medicine is overly dependent on a single class of medical devices to treat a condition. The global shortage of CPAP devices has led to numerous individuals with OSA being unable to obtain a CPAP machine to treat their condition, including those with severe OSA. CPAP is well known to be efficacious in treating OSA, but has limited effectiveness, particularly for mild-to-moderate cases. It has been reported that there are nearly 200 different medical devices approved by the FDA to treat OSA. The goal of this project was to search the FDA databases to investigate the number of devices currently on file with the FDA. A secondary goal was to examine the range of FDA product categories for the treatment of OSA. Methods An FDA database (AccessGUDID; https://accessgudid.nlm.nih.gov) with a release date of December 1, 2021 was searched for devices that are approved for the treatment of sleep apnea. The text string “sleep apnea” was used for the search. Diagnostic devices, duplicate versions of the same treatment devices, and device accessories were excluded from the total counts. The FDA classifies medical devices into three categories (I, II, III), with a higher classification level indicating greater risk to patients. Results The FDA AccessGUDID database search returned 166 results, which resulted in 72 unique devices across 10 product code categories. 9 of the 10 product codes in the FDA database were class II (medium risk) and 1/10 was classified as III (high risk). 65 of the devices were reported to be in commercial distribution at the time of the search and 7 were not. Conclusion This analysis found that a relatively large number of FDA-approved devices exist for the treatment of OSA across a range of product categories. The field is encouraged to develop a better understanding of which subgroups of OSA patients could benefit from alternative forms of treatment in an effort to diversify treatment options and reduce the field’s reliance on a single type of device, particularly for patients with mild-to-moderate OSA. Support (If Any) VA IIR 16-277

Use of CPAP Machines in the Perioperative Setting in Ambulatory Surgical Centers.

IntroductionObstructive sleep apnea is a common sleep-related breathing disorder that is associated with significant perioperative complications. In 2012 and 2017, Society of Ambulatory Anesthesia and Society of Anesthesia and Sleep Medicine published consensus statements for the selection of patients with OSA scheduled for ambulatory surgery. Despite these recommendations, the need for a CPAP device in the immediate postoperative period at ambulatory surgical centers remains controversial because these ambulatory patients are healthier and have fewer complications. This study aims to investigate the compliance rate with this recommendation among busy ASCs.MethodsWe created a survey to investigate if ASCs require patients to bring their CPAP devices to the facility. The survey measured compliance rates of ASCs to SAMBA’s recommended guidelines of having CPAP machines available.ResultsThe survey had a response rate of 60.9% encompassing 408,147 cases among 1946 providers. Of the facilities that responded, only 59.7% of them required their patients to bring their CPAP devices on the day of surgery. Out of the 67 facilities that responded, only 25.37% reported using a CPAP machine postoperatively within the past 2 years, with the highest CPAP usage at one facility being 20 times in that 2-year period.DiscussionThis would mean that 40.3% of ASCs that did respond do not have access to a CPAP device on-site and may possibly lack the proper equipment needed to handle these complications. The frequency and fatality rate associated with postoperative respiratory complications requiring a CPAP device are still inconclusive, making the need for CPAP devices during perioperative management controversial. Studies further in-depth are therefore necessary to assess postoperative complications that require the use of a CPAP device to determine the urgency of ASCs implementing SAMBA’s recommendations.

WHEN SHOULD CANNABIS CROSS YOUR MIND? A CASE REPORT OF ANAPHYLACTIC SHOCK INDUCED BY MARIJUANA-TOMATO CROSS REACTIVITY

TOPIC: Allergy and Airway TYPE: Medical Student/Resident Case Reports INTRODUCTION: With the increased prevalence of recreational and medical marijuana use throughout the United States, patients with severe food allergies are particularly vulnerable to severe and devastating allergic reactions from its use. Nonspecific lipid transfer proteins, which can be found on the Cannabis sativa leaf, are also found on a variety of fruits and legumes, providing a mechanism for cross-reactivity in those susceptible to certain food allergies. CASE PRESENTATION: We present a case of a 35-year-old female with a past medical history of OSA on CPAP, hypertension, and anxiety with complaints of shortness of breath and wheezing. The night prior, she attested to having a glass of wine and smoking half of a marijuana joint. Shortly after she smoked, she began to complain of an itchy throat and an itching sensation throughout her body. She perceived the symptoms as only mild and went to bed with her CPAP machine, hoping that her symptoms would resolve spontaneously. Hours later, she suddenly woke up with severe dyspnea and respiratory distress, prompting her to call EMS. Initial vitals were BP 120/62, HR 75, RR 28, and SpO2 98% on non-rebreather mask. Her chemistry profile was unremarkable with normal renal and liver indices. EKG showed normal sinus rhythm with a ventricular rate of 86 bpm. Her listed allergies included angioedema to Lisinopril, urticaria to aromatic oils, and hives to tomatoes. Family history was non-contributory. Chest X-ray showed no acute pulmonary findings. On physical exam, she was in severe respiratory distress and barely able to complete any sentences. There were no adventitious sounds on auscultation of her lung fields, although severe upper airway stridor was appreciated. Diffuse urticaria was also noted over her extremities. She required urgent endotracheal intubation and mechanical ventilation for severe respiratory distress and upper airway edema, attributed to severe anaphylaxis. At the time, the precipitating agent that caused her to clinically deteriorate was unclear. Two doses of epinephrine IM, benadryl 50 mg IV, and Solumedrol 125 mg IV were administered. Within 24 hours, the patient's airway edema markedly improved and she passed a leak test prior to extubation. She was successfully discharged home the following day on a steroid taper and H2 inhibitor. DISCUSSION: Review of literature demonstrates a well established cross reactivity between the cannabis sativa leaf and multiple plant-food allergens, including tomatoes, peaches, and apples (1). Patients who are sensitized to non-specific lipid transfer proteins, found on the surface of these and other fruits, may develop a cross-reaction when marijuana is ingested, leading to a wide range of allergic reactions (2). CONCLUSIONS: A thorough history, physical, and review of potential cross-reactions between a patient's known allergies & recently ingested foods or substances is imperative to an accurate diagnosis. REFERENCE #1: Decuyper, I. I., Van Gasse, A. L., Cop, N., Sabato, V., Faber, M. A., Mertens, C., ... & Ebo, D. G. (2017). Cannabis sativa allergy: looking through the fog. Allergy, 72(2), 201-206. REFERENCE #2: Azofra, J., Berroa, F., Gastaminza, G., Saiz, N., Gamboa, P. M., Vela, C., ... & Goikoetxea, M. J. (2016). Lipid transfer protein syndrome in a non-Mediterranean area. International archives of allergy and immunology, 169(3), 181-188. DISCLOSURES: No relevant relationships by Maie Abdullah, source=Web Response no disclosure on file for Bhavinkumr Dalal; No relevant relationships by Kareem Ebeid, source=Web Response

Repurposing CPAP machines as stripped-down ventilators

The worldwide shortage of medical-grade ventilators is a well-known issue, that has become one of the central topics during the COVID-19 pandemic. Given that these machines are expensive and have long lead times, one approach is to vacate them for patients in critical conditions while patients with mild to moderate symptoms are treated with stripped-down ventilators. We propose a mass-producible solution that can create such ventilators with minimum effort. The central part is a module that can be attached to CPAP machines and repurpose them as low-pressure ventilators. Here, we describe the concept and first measurements which underline the potential of our solution. Our approach may serve as a starting point for open-access ventilator technologies.

Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda

BackgroundNeonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes.MethodsA pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests.ResultsNCUs were run by a median of 1 nurse [interquartile range (IQR):1–2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77–155] to 137 [IQR: 79–184]. Availability of advanced equipment improved (syringe pumps: 57–100 %, vital sign monitors: 51–100 % and CPAP machine: 14–100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001).ConclusionsThe ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.

Integrated Activity Cpap and Bipap Machine for Sleep Apnea

Sleep apnea is a disorder that patients experience during sleep because of pauses in breath. The breath pauses usually remain for seconds to minutes and they might happen some times during night and it causes loud choking or snorting sounds when breathing is resumed. As it disturbs normal sleep, patients affected might feel sleepiness or tired in case of day time. In order to cure sleep apnea disorder, the breathing assistants like CPAP and BiPAP machines are used. CPAP devices are the best for treatment of OSA and can monitor during sleep and BiPAP is suggested for patients who are suffering with both OSA and CSA. The lack of treatment for both OSA and CSA might lead to heart attack, stroke, diabetes, heart failure, and irregular heartbeat. The overview of our project is to get people know the awareness of sleep apnea disorder and make the low-cost integrated CPAP and BiPAP machine as single non-invasive method working model.

Noise-reducing Insert for NICU Incubator

Premature infants in the Neonatal Intensive Care Unit (NICU) are at risk for hearing impairment, cognitive development abnormalities, and intraventricular hemorrhaging due to high noise levels. Nearly 400,000 infants are admitted into the NICU in the United States each year, and this number continues to increase. Up to 10% of these preterm infants are diagnosed with hearing impairment in comparison to only .1% for the general pediatric population. Noises from the CPAP machine and other life-sustaining devices along with external human noise in the NICU, sound levels average around 62 dB and can reach up to 120 dB. However, the American Academy of Pediatrics recommends noise levels should be lower than 45 dB. Existing incubators on the market do not address this noise issue. The designed solution is to create an adjustable foam insert that can be fitted to any incubator and used for sound absorption. The foam would line the edges of the incubator to reduce resonance and allow for neonatologists still to have full vision of the inside of the incubator. Additionally, the design contains a bottom piece that perfectly fits a Z-flow device so that the infants can be positioned for maximum health. This design was modeled in Solidworks, and various geometries were tested to improve the design’s effectiveness. Two foams were tested, and a statistical t-test was used to determine which foam had better noise reduction. In comparison to having no foam present in the chamber, the noise level was reduced by over 15 dB. The combination of this foam along with a multi-channel Active Noise Control system would significantly reduce noise levels to below the acceptable limit. This system would consist of one reference microphone that picks up noise, two error microphones to sense residual noise, and two loudspeakers to generate the “anti-noise” signal. Ultimately, this foam insert was found to reduce noise levels so that they are under the recommended limit given by the American Academy of Pediatrics.

DIFFUSE ALVEOLAR HEMORRHAGE DUE TO EOSINOPHILIC PNEUMONIA

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Eosinophilic Pneumonia commonly presents with fever, dry cough, and dyspnea.1 In this case, we present a patient with diffuse alveolar hemorrhage due to eosinophilic pneumonia. CASE PRESENTATION: A 65 y.o. female former healthcare worker with past medical history of obstructive sleep apnea on continuous positive airway pressure with 2 liters per minute of oxygen at night, gastroesophageal reflux disease, and previous exposure to tuberculosis 25 years ago at a health care facility with previously positive purified protein derivative (PPD) and no treatment, mild intermittent asthma, and regular marijuana use who presented with the chief complaint of hemoptysis and dyspnea. Patient states that she was having a dry cough for over a month. A week prior to presentation she developed drenching night sweats, fever, and hemoptysis. She did not have any family history as she was adopted. Social history was positive for alcohol use of 2-4 beers a month, no tobacco use, and smoking marijuana daily via pipe. She denied any recent travel, sick contacts, history of rheumatologic disorders, Raynaud’s phenomenon, joint pain, or hematuria. For her hobby, she would paint silk and was not using respirator protection. She also reported exposure to Jacquard dye set concentration where she accidentally put the dye set in her CPAP machine in place of distilled water. A computed tomography scan done on admission showed diffuse nodular opacities with ground glass opacities and mediastinal lymphadenopathy. Due to previously positive PPD, the patient had 3 acid fast smears done which were negative. Further infectious workup was also negative. Sedimentation rate and C-Reactive protein were elevated. Additional autoimmune workup was also negative. The patient underwent a bronchoscopy which showed diffuse alveolar hemorrhage while fungal, acid fast, and bronchial cultures were negative. She then underwent an open lung biopsy, and pathology confirmed eosinophilic pneumonia in a subacute setting. Patient was started on 60 mg prednisone for 3 weeks, and then 40 mg for a week, and then further tapered. She had complete resolution of her symptoms following initiation of prednisone. DISCUSSION: Eosinophilic Pneumonia is a rare lung disease that involves activation of alveolar macrophages which release cytokines that recruit eosinophils to the lung parenchyma.1 Patients commonly present with fever, dry cough, and dyspnea.1 It can present as acute, subacute, or chronic and is generally brought on by an offending agent such as smoking or an infection.1 Rarely, eosinophilic pneumonia can cause damage and inflammation to the alveoli themselves which may cause alveolar hemorrhage.2,3 This case has two potential causes in the patient’s daily marijuana smoking along with her silk painting and exposure of dyeset in her CPAP machine. CONCLUSIONS: This is an unusual documented case of eosinophilic pneumonia causing alveolar hemorrhage. Reference #1: De Giacomi, Federica; Vassallo, Robert; Yi, Eunhee S; Ryu, Jay H. Acute Eosinophilic Pneumonia: Causes, Diagnosis, and Management Reference #2: Rothenberg M, Hogan S. The eosinophil. Annu Rev Immunol 24: 147-174, 2006 Reference #3: Hogan SP, Rosenberg HF, Moqbel R, et al. Eosinophils: biological properties and role in health and disease. Clin Exp Allergy 38: 709-750, 2008. DISCLOSURES: No relevant relationships by Brian Dykstra, source=Web Response No relevant relationships by Adam Ladzinski, source=Web Response No relevant relationships by Aditya Mehta, source=Web Response

C-L Psychiatry Vital in Assessing Patients Before, After Bariatric Surgery

C-L Psychiatry Vital in Assessing Patients Before, After Bariatric Surgery

CPAP Added to Oxygen Administration Avoid Intubation in Acute Respiratory Distress in COVID-19 Pneumonia. Case Report.

It was recently described that COVID-19 pneumonia patients had an atypical form of the ARDS syndrome and required gentle ventilation. We report here on benefits of CPAP treatment in a patient with COVID-19 pneumonia. A 63-year-old patient of African origin presented to the emergency room with COVID-19 pneumonia. Fever had started 5 days before her admission. On day 4, rapid clinical deterioration associated to a high respiratory rate and increased oxygen requirements was noted. The patient was working in an intensive care unit and refused to be intubated. Oxygen was administered at a rate of 15 litres per minute via a Boussignac valve, which initially restored normal oxygen saturation, but this treatment was poorly tolerated and the patient withdrew it after 2 h. A CPAP set at a pressure of 8 cm of water (Goodknight®) was then introduced with better tolerance, allowing the patient to wear it almost continuously for more than 38 h. The patient also benefited from the administration of methypredinsolone 40 mg. Concerning tolerance, a substantial advantage was noted for CPAP machine compared to the Boussignac valve with in addition, a clear decrease in respiratory rate. We would like to encourage the use of CPAP, better tolerated for extended hours with lower oxygen flows, in patients with COVID-19 pneumonia, where acute respiratory distress all too often leads to patient intubation and the genesis of deleterious lung lesions.