Ventilation Guidelines Research Articles

Adherence to Lung Protective Ventilation in ARDS: A Mixed Methods Study Using Real-Time Continuously Monitored Ventilation Data.

Lung-protective ventilation is a standard intervention for mitigating ventilator-induced lung injury in patients with ARDS. Despite its efficacy, adherence to contemporary evidence-based guidelines remains suboptimal. We aimed to identify factors that affect the adherence of staff to applying lung-protective ventilation guidelines by analyzing real-time, continuously monitored ventilation data over a 5-year longitudinal period. We conducted retrospective cohort and qualitative studies. Subjects with billing code J80 who survived at least 48 h of continuous mandatory ventilation with volume control in critical care settings between January 1, 2018, and December 31, 2022, were eligible. Tidal volume was measured dynamically (1-min resolution) and averaged hourly. The lung-protective ventilation setting studied was ≤ 6 mL/kg predicted body weight. A subgroup analysis was conducted by considering COVID-19 status. Focus groups of critical-care providers were convened to investigate the possible reasons for the non-utilization of lung-protective ventilation. Among 1,055 subjects, 42.4% were on lung-protective ventilation settings at 48 h. Male sex was correlated with lung-protective ventilation (odds ratio [OR] 1.63, 95% CI 1.08-2.47), whereas age ≥ 60 y was associated with no lung-protective ventilation use (OR 0.61, 95% CI 0.39-0.94] in the subjects with non-COVID-19 etiologies. Improved staff adherence was observed in the subjects with COVID-19 early in the pandemic when COVID-19 (OR 1.48, 95% CI 1.07-2.04), male sex (OR 2.42, 95% CI 1.79-3.29), and neuromuscular blocking agent use within 48 h (OR 1.69, 95% CI 1.25-2.29) were correlated with staff placing subjects on lung-protective ventilation. However, lung-protective ventilation use occurred less frequently by staff managing subjects with cancer (OR 0.59, 95% CI 0.35-0.99) and hypertension (OR 0.62, 95% CI 0.45-0.85). Focus groups supported these findings and highlighted the need for an accurate height measurement on unit admission to determine the appropriate target tidal volume. Staff are not yet universally adherent to lung-protective ventilation best practices. Strategies, for example, continuous monitoring, with frequent feedback to clinical teams may help.

Pathophysiology and Prevention of Manual-Ventilation-Induced Lung Injury (MVILI).

Manual ventilation, most commonly with a bag-valve mask, is a form of short-term ventilation used during resuscitative efforts in emergent and out-of-hospital scenarios. However, compared to mechanical ventilation, manual ventilation is an operator-dependent skill that is less well controlled and is highly subject to providing inappropriate ventilation to the patient. This article first reviews recent manual ventilation guidelines set forth by the American Heart Association and European Resuscitation Council for providing appropriate manual ventilation parameters (e.g., tidal volume and respiratory rate) in different patient populations in the setting of cardiopulmonary resuscitation. There is then a brief review of clinical and manikin-based studies that demonstrate healthcare providers routinely hyperventilate patients during manual ventilation, particularly in emergent scenarios. A discussion of the possible mechanisms of injury that can occur during inappropriate manual hyperventilation follows, including adverse hemodynamic alterations and lung injury such as acute barotrauma, gastric regurgitation and aspiration, and the possibility of a subacute, inflammatory-driven lung injury. Together, these injurious processes are described as manual-ventilation-induced lung injury (MVILI). This review concludes with a discussion that highlights recent progress in techniques and technologies for minimizing manual hyperventilation and MVILI, with a particular emphasis on tidal-volume feedback devices.

Analysis of Occupational Safety and Health (K3) Risk Management in the Physics and Chemistry Laboratory of the Medan Occupational Safety and Health Center

The many possible risks associated with laboratory work are unavoidable. This study aimed to determine and analyze hazards, risks, impacts, risk levels and occupational safety and health (OHS) controls in the physics and chemistry laboratories of the Occupational Safety and Health Center (OHS) Medan. This is a qualitative research method with phenomenological approach hazard identification using Task Risk Analysis method using AS/NZS 4360: 2004 semi-quantitative. The tolerable risk threshold in the chemistry lab was 52, priority 3 was 10, and major was 11. The only thing OHS controlled in the physics lab was the air conditioning system. The presence of SOP (work procedures), MSDS (material safety data sheet) documents, OHS signs, supervision, managerial support, and the use of PPE masks, gloves, long-hand lab coats, rubber shoes, and other safety measures were all necessary in chemistry labs. Expanding the space, adding SOP, installing ventilation are all suggested at the physics laboratorium, Adopting ANSI / AIHA Z9.5-2003 ventilation guidelines, changing or replacing processes with safer chemicals, providing OHS training, and wearing coveralls and glasses are all recommended in the chemistry laboratory.

Respiratory Therapist-Driven Mechanical Ventilation Protocol Is Associated With Increased Lung Protective Ventilation.

Mechanical ventilation is a common life-saving procedure but can lead to serious complications, including ARDS and oxygen toxicity. Nonadherence to lung-protective ventilation guidelines is common. We hypothesized that a respiratory therapist-driven mechanical ventilation bundle could increase adherence to lung-protective ventilation and decrease the incidence of pulmonary complications in the ICU. A respiratory therapist-driven protocol was implemented on August 1, 2018, in all adult ICUs of a Midwestern academic tertiary center. The protocol targeted low tidal volume, adequate PEEP, limiting oxygen, adequate breathing frequency, and head of the bed elevation. Adherence to lung-protective guidelines and clinical outcomes were retrospectively observed in adult subjects admitted to the ICU and on ventilation for ≥ 24 h between January 2011 and December 2019. We included 666 subjects; 68.5% were in the pre-intervention group and 31.5% were in the post-intervention group. After adjusting for body mass index and intubation indication, a significant increase in overall adherence to lung-protective ventilation guidelines was observed in the post-intervention period (adjusted odds ratio 2.48, 95% CI 1.73-3.56). Fewer subjects were diagnosed with ARDS in the post-intervention group (adjusted odds ratio 0.22, 95% CI 0.08-0.65) than in the pre-intervention group. There was no difference in the incidence of ventilator-associated pneumonia, ventilator-free days, ICU mortality, or death within 1 month of ICU discharge. A respiratory therapist-driven protocol increased adherence to lung-protective mechanical ventilation guidelines in the ICU and was associated with decreased ARDS incidence.

Carbon dioxide guidelines for indoor air quality: a review.

The importance of building ventilation to protect health has been more widely recognized since the COVID-19 pandemic. Outdoor air ventilation in buildings dilutes indoor-generated air pollutants (including bioaerosols) and reduces resulting occupant exposures. Many countries and organizations have advisory guidelines or mandatory standards for minimum ventilation rates (VRs) to maintain indoor air quality (IAQ). Because directly measuring VRs is often difficult, many IAQ guidelines instead specify indoor concentration limits for carbon dioxide (CO2), using CO2 exhaled by building occupants as an indicator of VR. Although indoor CO2 guidelines are common, the evidence basis for the various CO2 limits has not been clear. To review current indoor CO2 guidelines worldwide and the supportive evidence provided. We identified worldwide CO2-based guidelines for IAQ or ventilation, along with any supportive evidence provided. We excluded occupational guidelines for CO2 levels ≥5000 ppm. Among 43 guidelines identified, 35 set single CO2 concentration limits and eight set multi-tiered limits; 16 mentioned no specific human effect to be controlled, 19 specified only odor dissatisfaction, five specified non-infectious health effects, and three specified airborne infectious disease transmission. The most common indoor CO2 limit was 1000 ppm. Thirteen guidelines specified maximum CO2 limits as extended time-weighted averages, none with evidence linking averaged limits to occupant effects. Of only 18 guidelines citing evidence to support limits set, we found this evidence persuasive for eight. Among these eight guidelines, seven set limits to control odor perception. One provided 17 scientifically-based CO2 limits, for specific example space uses and occupancies, to control long-range COVID-19 transmission indoors. Many current indoor carbon dioxide (CO2) guidelines for indoor air quality specified no adverse effects intended for control. Odor dissatisfaction was the effect mentioned most frequently, few mentioned health, and three mentioned control of infectious disease. Only one CO2 guideline was developed from scientific models to control airborne transmission of COVID-19. Most guidelines provided no supportive evidence for specified limits; few provided persuasive evidence. No scientific basis is apparent for setting one CO2 limit for IAQ across all buildings, setting a CO2 limit for IAQ as an extended time-weighted average, or using any arbitraryone-time CO2 measurement to verify a desired VR.

Quality improvement project to improve adherence to lung protective ventilation guidelines

IntroductionLung protective ventilation (LPV) is advocated for all patients requiring mechanical ventilation (MV), for any duration of time, to prevent worsening lung injury. Previous studies proved simple interventions can increase...

Automatic Mechanical Ventilation vs Manual Bag Ventilation During CPR: A Pilot Randomized Controlled Trial

BackgroundThere is insufficient evidence supporting that mechanical ventilation can replace the manual ventilation method during cardiopulmonary resuscitation (CPR). Research QuestionIs using automatic mechanical ventilation feasible and comparable to the manual ventilation method during CPR? Study Design and MethodsThis is a pilot randomized controlled trial comparing automatic mechanical ventilator (MV) and manual bag ventilation (BV) during CPR of out-of-hospital cardiac arrest (OHCA). Patients with medical OHCA arriving at the emergency department were randomly assigned to two groups: an MV group using a mechanical ventilator and a BV group using Ambu-bag. Primary outcome was any return-of-spontaneous circulation (ROSC). Secondary outcomes were changes of arterial blood gas analysis results during CPR. Tidal volume, minute volume, and peak airway pressure were also analyzed. ResultsA total of 60 patients were enrolled and 30 patients were randomly assigned to each group. There were no statistically significant differences in basic characteristics of OHCA patients between the two groups. The rate of any ROSC was 56.7% in the MV group and 43.3% in the BV group, showing no significant (p = 0.439) difference between the two groups. There were no statistically significant differences in changes of PH, PCO2, PO2, HCO3, or lactate level during CPR between the two groups either (p-value: 0.798, 0.249, 0.515, 0.876. and 0.878, respectively). Significantly lower TV (p < 0.001) and minute volume (p = 0.009) were found in the MV group. InterpretationIn this pilot trial, the use of MV instead of BV during CPR was feasible and could serve as a viable alternative. A multicenter RCT is needed to create sufficient evidence for ventilation guideline during CPR.

Guideline-informed reinforcement learning for mechanical ventilation in critical care

Reinforcement Learning (RL) has recently found many applications in the healthcare domain thanks to its natural fit to clinical decision-making and ability to learn optimal decisions from observational data. A key challenge in adopting RL-based solution in clinical practice, however, is the inclusion of existing knowledge in learning a suitable solution. Existing knowledge from e.g. medical guidelines may improve the safety of solutions, produce a better balance between short- and long-term outcomes for patients and increase trust and adoption by clinicians. We present a framework for including knowledge available from medical guidelines in RL. The framework includes components for enforcing safety constraints and an approach that alters the learning signal to better balance short- and long-term outcomes based on these guidelines. We evaluate the framework by extending an existing RL-based mechanical ventilation (MV) approach with clinically established ventilation guidelines. Results from off-policy policy evaluation indicate that our approach has the potential to decrease 90-day mortality while ensuring lung protective ventilation. This framework provides an important stepping stone towards implementations of RL in clinical practice and opens up several avenues for further research.

Updated Guidelines for Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) accounts for 10% of patients admitted to the intensive care unit and 23% of patients using mechanical ventilation, with a mortality rate of 45% in severe cases. The perception that patients with ARDS are vulnerable to ventilator-induced lung injury has led to lung-protective ventilation strategies. Accordingly, the American Thoracic Society, the European Society of Intensive Care Medicine (ESICM), and the Society of Critical Care Medicine announced ARDS mechanical ventilation guidelines in 2017. Since then, based on the results of newly reported research and data accumulated throughout the coronavirus disease 2019 pandemic, the ESICM announced an amendment to the previous guidelines in 2023. The revised ARDS guidelines discuss extending the ARDS definition and its phenotypes that were not mentioned in the previous guidelines. The new guidelines encompass ventilation strategies, including positive end-expiratory pressure and recruitment maneuvers in patients receiving mechanical ventilation. In addition, various oxygenation devices, such as high-flow nasal cannulated oxygen and continuous positive airway pressure in nonmechanically ventilated patients, are introduced. This review discusses new changes in the diagnosis and treatment of ARDS based on the new ESICM guidelines, providing a supportive background and rationale.

Non-invasive ventilation for people with neuromuscular disorders in Australia and New Zealand: a qualitative study of clinician perspectives.

To explore the experiences of Australian and New Zealand clinicians with respect to care pathways, their awareness and use of non-invasive ventilation guidelines, and their perspectives on delivering quality non-invasive ventilation services to people with neuromuscular disorders. Qualitative study; semi-structured focus groups and individual interviews with Australian and New Zealand clinicians who provide non-invasive ventilation services to people with neuromuscular disorders, recruited from participants at a 2017 sleep medicine conference. Interviews were conducted during 1 October 2017 - 31 May 2018. Major themes identified by an iterative, semantic, and inductive analysis. A total of 28 participants attended the four focus group sessions and five individual interviews; fourteen each from New Zealand and Australia, seventeen women and eleven men, eighteen physicians and ten other clinicians. Two major themes were identified: decision making for current practice, and resource constraints. Participants noted variable use of clinical guidelines and limited training to meet the needs of people with neuromuscular disorders who require non-invasive ventilation. They described a lack of dedicated funding, unstructured care pathways, equipment supply levels that do not meet need, low staff-to-patient ratios and staff shortages, and the inability to deliver quality multidisciplinary care. The need for clinical guidelines and service specifications was highlighted as requisite for reducing variation in clinical care. Systemic factors influence the needs-based provision of non-invasive ventilation for people with neuromuscular disorders. Development of clinical guidelines for Australia and New Zealand, dedicated funding for respiratory services for people with neuromuscular disorders, and specialist clinician training are important for equitable and high quality non-invasive ventilation care.

Shed Roof Air Extractors and Collectors: Design Guidelines for Natural Ventilation in Generic Models

Most of the Brazilian territory is classified as a hot and humid climate, whose natural ventilation is one of the most important passive design strategies. The use of this strategy can be enhanced in the design through the shed roof air collectors or extractors. However, this strategy is not exploited by architecture design, due to the designers’ lack of knowledge about the efficiency of these devices. The article’s aim is to present guidelines for the design of shed roof air extractors and collectors, seeking to help designers to use these devices in buildings. The method is parametric studies, through CFD simulations. For the shed roof air extractors and collectors, the following is recommended: aerodynamic geometries; building with less depth and large air outlet openings. The increase in the number of sheds influences ventilation more than the change in the geometry of the sheds. For extraction, the area of the air outlet openings is the parameter that exerts the greatest influence on ventilation. For collection, the increase in the sizes of the openings of the sheds, without changing other parameters, does not significantly increase the air speed.

Overlooked Impacts of Urban Environments on the Air Quality in Naturally Ventilated Schools Amid the COVID-19 Pandemic

The density, form, and dimensions of urban morphology are important for healthy living conditions in cities, especially if they are related to the climate and air pollution. Morphology and environmental conditions determine the relationship between open and built space, the width of street spaces, the aerodynamic characteristics of wind currents, albedo, and the retention of pollutants, as well as determining the radiative exchange with the atmosphere. Studies on the COVID-19 pandemic have focused on the assumption of a possible relationship between the spread of the SARS-CoV-2 virus and the presence and concentration of airborne particulate matter (PM10 and PM2.5). This paper focuses on the research of indoor air quality (IAQ) in two schools with naturally ventilated classrooms in Ljubljana, Slovenia. The presence of particulate matter (PM2.5 and PM10) and the concentration of CO2 were studied, along with other microclimatic conditions, e.g., ambient temperature, relative humidity, air pressure, and wind conditions. These were compared and assessed via analysis of variance (ANOVA) and Duncan’s post hoc test. The main concern was to see how effective different ventilation strategies are, as well as how the openings in the classroom impact the concentrations of CO2 relative to the concentrations of PM2.5 and PM10 particles as a side effect of these ventilation strategies. The inconsistent application of recommended COVID-19 ventilation strategies suggests that IAQ in naturally ventilated classrooms is highly determined by individual perceptions of indoor air quality. The results also suggest that the IAQ is significantly affected by the schools’ urban environment; however, this is not considered within the national COVID-19 ventilation recommendations. Future ventilation guidelines for pandemics should also include the urban environment as a risk factor for inadequate IAQ, instead of focusing solely on pathogen characteristics.

Pilot Evaluation of Possible Airborne Transmission in a Geriatric Care Facility Using Carbon Dioxide Tracer Gas: Case Study

Although several COVID-19 outbreaks have occurred in older adult care facilities throughout Japan, no field studies focusing on airborne infections within these settings have been reported. Countermeasures against airborne infection not only consider the air change rate (ACR) in a room but also the airflow in and between rooms. However, a specific method has not yet been established by Japanese public health centers or infectious disease-related organizations. In April 2021, 59 COVID-19 cases were reported in an older adult care facility in Miyagi, Japan, and airborne transmission was suspected. The objective of this study was to simultaneously reproduce the ACR and aerosol advection in this facility using the carbon dioxide (CO2) tracer gas method to elucidate the specific location and cause of the outbreak. These findings will guide our recommendations to the facility to prevent recurrence. In August 2021, CO2 sensors were placed in 5 rooms where airborne infection was suspected, and the CO2 concentration was intentionally increased using dry ice, which was subsequently removed. The ACR was then estimated by applying the Seidel equation to the time-series changes in the CO2 concentration due to ventilation. By installing multiple sensors outside the room, advection outside the room was monitored simultaneously. Aerosol advection was verified using computer simulations. Although the windows were closed at the time of the outbreak, we conducted experiments under open-window conditions to quantify the effects of window opening. The ACR values at the time of the outbreak were estimated to be 2.0 to 6.8 h-1 in the rooms of the facility. A low-cost intervention of opening windows improved the ventilation frequency by a factor of 2.2 to 5.7. Ventilation depended significantly on the window-opening conditions (P values ranging from .001 to .03 for all rooms). Aerosol advection was detected from the private room to the day room in agreement with the simulation results. Considering that the individual who initiated the infection was in the private room on the day of infection, and several residents, who later became secondarily infected, were gathered in the day room, it was postulated that the infectious aerosol was transmitted by this air current. The present results suggest that secondary infections can occur owing to aerosol advection driven by large-scale flow, even when the building design adheres to the ventilation guidelines established in Japan. Moreover, the CO2 tracer gas method facilitates the visualization of areas at a high risk of airborne infection and demonstrates the effectiveness of window opening, which contributes to improved facility operations and recurrence prevention.

Model-based analysis and optimization of pressure-controlled ventilation of COPD patients in relation to BMI

Abstract This article presents an approach for model-based and personalized determination of inspiratory pressure and inspiratory time in pressure-controlled ventilation. Lung mechanics are strongly dependent on weight and affected by lung diseases such as COPD. Based on a simplified model of the lung with weight- and COPD-specific parameter selection and consideration of ventilation guidelines, the appropriate inspiratory pressure values are calculated. The results illustrate the effect of BMI on the computed optimal pressure-volume ratio. The findings provide a first step towards individualized decision support systems taking into account additional effects like BMI and specific lung diseases.

Airborne transmission of the Delta variant of SARS-CoV-2 in an auditorium

The Delta variant of SARS-CoV-2 has inflicted heavy burdens on healthcare systems globally, although direct evidence on the quantity of exhaled viral shedding from Delta cases is lacking. The literature remains inconclusive on whether existing public health guidance, based on earlier evidence of COVID-19, should respond differently to more infectious viral strains. This paper describes a study on an outbreak of the Delta variant of COVID-19 in an auditorium, where one person contracted the virus from three asymptomatic index cases sitting in a different row. Field inspections were conducted on the configuration of seating, building and ventilation systems. Numerical simulation was conducted to retrospectively assess the exhaled viral emission, decay, airborne dispersion, with a modified Wells-Riley equation used to calculate the inhalation exposure and disease infection risks at the seat level. Results support the airborne disease transmission. The viral emission rate for Delta cases was estimated at 31 quanta per hour, 30 times higher than those of the original variant. The high quantity of viral plume exhaled by delta cases can create a high risk zone nearby, which, for a mixing ventilation system, cannot be easily mitigated by raising mixing rates or introducing fresh air supply. Such risks can be reduced by wearing an N95 respirator, less so for social distancing. A displacement ventilation system, through which the air is supplied at the floor and returned from the ceiling, can reduce risks compared with a mixing system. The study has implications for ventilation guidelines and hygiene practices in light of more infectious viral strains of COVID-19.

Positive pressure ventilation at birth

ObjectiveTo review the current state of the art of positive pressure ventilation (PPV) during resuscitation FindingsThe frequency of PPV during delivery room resuscitation varies across settings and gestational age subgroups. Goal targets and parameters for delivery room PPV remain undefined. The T-piece resuscitator provides the most consistent pressures during PPV and may improve clinical outcomes. The laryngeal mask may be an important alternative interface for PPV, but more data are needed to identify the optimal role of the supraglottic airway during PPV. No objective monitors of PPV have conclusively demonstrated improved outcomes to date. ConclusionMore information, including real-world data from population-based studies, is needed to provide data-driven guidelines for positive pressure ventilation during neonatal transition after birth.

Comparison of Indoor Radon Reduction Effects Based on Apartment Housing Ventilation Methods

A lack of ventilation in multi-unit dwellings can affect human health adversely owing to accumulated radon gases; therefore, developing immediate and effective methods to reduce radon gas in indoor living environments is urgently needed. Therefore, this study conducted a basic research study to develop ventilation guidelines for radon through assessments of various ventilation strategies on indoor radon concentration in multiple-unit dwellings, a typical residential type in Korea. Radon measurement was conducted in November 2020 using RAD 7 Radon Detector (Durridge Co., Billerica, MA, USA) for living rooms and rooms of an apartment located in Uijeongbu, Gyeonggi-do, Korea. The radon reduction effect according to the ventilation conditions per hour was compared and evaluated by performing seven natural ventilation scenarios through opening and closing windows leading to the outside and three types of mechanical ventilation with high, middle, and low operating intensity. The concentration ratio (Cr) was estimated to present the indoor radon increase/decrease ratio. Among the natural ventilation scenarios, Case 3 had the highest radon reduction rate in the living room and Case 1 in the room, and Case 2 using natural ventilation equipment showed the lowest reduction rate in both the room and the living room. When ventilated by mechanical ventilation conditions, the radon reduction rate (Pr) was 70% or less under all conditions. Under the natural ventilation measurement condition, when every doors and windows was opened, it showed an effective ventilation in a short time. With high mechanical ventilation, the radon reduction effect in a relatively large space was better. Additionally, with middle and low mechanical ventilation, the reduction effect seems to be good in a relatively narrow space.

Systematic summary and analysis of Chinese HVAC guidelines coping with COVID-19.

Heating, Ventilation, and Air-Conditioning (HVAC) system that is almost indispensable service system of modern buildings is recognized as the most important engineering control measure against pandemics. However, the effectiveness of HVAC systems has been questioned on their ability to control airborne transmission. After the outbreak of COVID-19, China has controlled the spread within a relatively short period. Considering the large population, high population density, busy transportation and the overall underdeveloped economy, China’s control measures may have some implications to other countries, especially those with limited resources. This paper intends to provide a systematic summary of Chinese ventilation guidelines issued to cope with COVID-19 transmission. The following three aspects are the main focus of these guidelines: (1) general operation and management schemes of various types of HVAC systems, (2) operation and management schemes of HVAC system in typical types of buildings, and (3) design schemes of HVAC system of makeshift hospitals. In addition, some important differences in HVAC guidelines between China and other countries/institutions are identified and compared, and the possible reasons are discussed. Further discussions are made on the following topics, including the required fresh air supply, the extended operation time, the use of auxiliary equipment, the limited capacity of existing systems, and the use of personalized systems.

Quantifying the Impact of Ultraviolet Subtype C in Reducing Airborne Pathogen Transmission and Improving Energy Efficiency in Healthy Buildings: A Kahn–Mariita Equivalent Ventilation Model

There is growing evidence that viruses responsible for pandemics, such as Middle East respiratory syndrome and severe acute respiratory syndrome, are mainly spread through aerosols. Recommendations have been introduced to reduce the transmission risks of virulent airborne viral particles by increasing ventilation rates, expressed in air changes per hour (ACHs), effectively improving the dilution of pathogens via mechanical ventilation. However, infrastructural and operational costs associated with upgrades of building heating, ventilation, and air conditioning systems make these solutions expensive. It is well documented that Ultraviolet Subtype C (UVC) disinfection can help lower exposure risks by inactivating viruses and the performance of such solutions can translate into equivalent ventilation. Here, we present the first framework to extract the optimal UVC requirements to improve facility management yet ensuring compliance with ventilation guidelines at lower energy costs. The Kahn–Mariita (KM) model considers the air quality of shared enclosed spaces over time by supplementing the existing mechanical ventilation with localized UVC air treatment and includes variables such as room size, occupancy, existing ventilation, and target equivalent ACH. For example, the model applied to a conference room shows that a UVC chamber with recirculation rates of 160 m3/h increases ventilation from an ACH 3 to 7.9 and reduces the room’s reset time from 46 to &amp;lt;10 min with as little as 1 W. Recirculation rates of 30 m3/h however offer no benefits beyond 200 mW, with an eACH of 3.9 and reset time of 31 min. The first finding is that single-pass disinfection is not an appropriate metric of performance, i.e., low recirculation rates increase single-pass disinfection, and, however, only treats a portion of the space volume within a given time, limiting the overall performance. Conversely, higher recirculation rates decrease single-pass disinfection but treat larger portions of air, potentially multiple times, and are therefore expected to lower the transmission risk faster. The second result is that for fixed amounts of recirculating air flow, increasing UVC power helps with diminishing return, while for a fixed UVC power, increasing the recirculating air flow will always help. This dynamic is particularly important toward optimizing solutions, given the constraints system engineers must work with, and particularly to design for end-user benefits such as increased occupancy, in-dwelling time, or reduction of shared-space reset time.

Stochastic Modelling of Respiratory System Elastance for Mechanically Ventilated Respiratory Failure Patients.

While lung protective mechanical ventilation (MV) guidelines have been developed to avoid ventilator-induced lung injury (VILI), a one-size-fits-all approach cannot benefit every individual patient. Hence, there is significant need for the ability to provide patient-specific MV settings to ensure safety, and optimise patient care. Model-based approaches enable patient-specific care by identifying time-varying patient-specific parameters, such as respiratory elastance, Ers, to capture inter- and intra-patient variability. However, patient-specific parameters evolve with time, as a function of disease progression and patient condition, making predicting their future values crucial for recommending patient-specific MV settings. This study employs stochastic modelling to predict future Ers values using retrospective patient data to develop and validate a model indicating future intra-patient variability of Ers. Cross validation results show stochastic modelling can predict future elastance ranges with 92.59 and 68.56% of predicted values within the 5–95% and the 25–75% range, respectively. This range can be used to ensure patients receive adequate minute ventilation should elastance rise and minimise the risk of VILI should elastance fall. The results show the potential for model-based protocols using stochastic model prediction of future Ers values to provide safe and patient-specific MV. These results warrant further investigation to validate its clinical utility.