High-intensity Ventilation Research Articles

Nichtinvasive Beatmung bei chronisch obstruktiver Lungenerkrankung mit chronischer respiratorischer Insuffizienz

Due to the steadily increasing number of patients with chronic obstructive pulmonary disease (COPD), the number of those with very advanced stages of the disease is also steadily increasing. Particularly in severe COPD, respiratory insufficiency occurs in the course of the disease, which by affection of the respiratory pump can become clinically evident as respiratory failure with subsequent hypercapnia. In chronic hypercapnic insufficiency non-invasive ventilation via face masks is the treatment of choice; however, an improvement of the mortality and prolonged hospitalization-free survival can only be achieved if the ventilation treatment is initiated with the aim of normocapnia or the maximum possible reduction of the partial pressure of carbon dioxide in arterial blood. This high intensity ventilation is now recommended in national and international guidelines and is the current standard treatment in COPD with chronic hypercapnic respiratory insufficiency.

Does the Efficacy of High Intensity Ventilation in Stable COPD Depend on the Ventilator Model? A Bench-to-Bedside Study

PurposeThe European Task Force for chronic non-invasive ventilation in stable COPD recommends the use of high pressure-support (PS) level to maximize the decrease in PaCO2. It is possible that the ventilator model can influence the need for higher or lower pressure levels.Research QuestionTo determine the differences between ventilators in a bench model with an increased inspiratory demand; and to compare the degree of muscular unloading measured by parasternal electromyogram (EMGpara) provided by the different ventilators in real patients with stable COPD.Patients and MethodsBench: four levels of increasing progressive effort were programmed. The response of nine ventilators to four levels of PS and EPAP of 5 cm H2O was studied. The pressure-time product was determined at 300 and 500 msec (PTP 300/500).Clinical StudyThe ventilators were divided into two groups, based on the result of the bench test. Severe COPD patients with non-invasive ventilation (NIV) were studied, randomly comparing the performance of one ventilator from each group. Muscle unloading was measured by the decrease in EMGpara from its baseline value.ResultsThere were significant differences in PTP 300 and PTP 500 in the bench study. Based on these results, home ventilators were classified into two groups; group 1 included four models with higher PTP 300. Ten COPD patients were recruited for the clinical study. Group 1 ventilators showed greater muscle unloading at the same PS than group 2.ConclusionThe scale of pressure support in NIV for high intensity ventilation may be influenced by the ventilator model.Clinical Trials.govNCT03373175.

A Comparative Study of a Moving Bed Biofilm Reactor and Bio-shaft Technology for a Wastewater Treatment Process: A review

In addition to the primary treatment, biological treatment is used to reduce inorganic and organic components in the wastewater. The separation of biomass from treated wastewater is usually important to meet the effluent disposal requirements, so the MBBR system has been one of the most important modern technologies that use plastic tankers to transport biomass with wastewater, which works in pure biofilm, at low concentrations of suspended solids. However, biological treatment has been developed using the active sludge mixing process with MBBR. Turbo4bio was established as a sustainable and cost-effective solution for wastewater treatment plants in the early 1990s and ran on minimal sludge, and is easy to maintain. This has now evolved into a technology that has proven successful worldwide with trouble-free operation and improved Turbo4bio technology, an advanced high-intensity ventilation system fully enclosed and non-mechanical, ensuring odor-free operation, simple and environmentally friendly operation and long life of domestic and commercial wastewater treatment And the municipality. In this paper, a comparison between MBBR and T4B treatment system was made. As a general review of previous research and experiments, it is possible to reduce the total cost based on building all plant structures to obtain concentrations within the permissible limits of pollutants at the final outlets. It is clear that the use of MBBR has contributed to the realization of simultaneous biological phosphorous and nitrogen removal experiments, which aim to change the more significant methods developed from conventional methods, from the advantages of the Turbo 4 Bioreactor with low cost and high production performance, with less energy consumption and lower operating costs because it does not require Chemicals for processing, cleaning, and disinfection. It only takes small amounts of chlorine, the use of a compressor system for air, and rapid recovery providing high rates of generation of biomass to restore the plant quickly.

Long-term non-invasive ventilation in patients with chronic obstructive pulmonary disease (COPD): 2021 Canadian Thoracic Society Clinical Practice Guideline update

BACKGROUND: Chronic hypercapnic respiratory failure is common in advanced chronic obstructive pulmonary disease (COPD) and it is associated with adverse outcomes such as repeat hospitalization and death. Long-term non-invasive ventilation (NIV) has been used with uncertain efficacy in this condition, but recent clinical trials suggest possible survival benefit and reduced hospitalization under specific circumstances with this therapy. METHODS: The purpose of this guideline update is to assess current evidence regarding long-term NIV in the treatment of chronic hypercapnic respiratory failure specifically related to advanced COPD. A representative multidisciplinary panel of expert clinicians undertook a formal clinical practice guideline development process. Four key clinical questions were defined according to the Patient/problem, Intervention, Comparison, Outcome (PICO) approach. The panel performed a systematic literature review, assessed and graded the relevant evidence and made evidence-based recommendations. RESULTS: There is supportive evidence for the use of long-term NIV to improve survival in patients with stable COPD with significant chronic hypercapnic respiratory failure. The use of this therapy may also lead to reduced hospital readmission rates when applied to patients who were recently hospitalized for an acute hypercapnic exacerbation and in whom the elevated partial pressure of carbon dioxide in arterial blood (PaCO2) persists 2 to 4 weeks after the index hospitalization. Studies demonstrating benefit of long-term NIV targeted very selected patient populations and used very specific methodology, both of which are likely key elements for NIV success. Although there is no evidence from clinical trials directly comparing high-intensity versus low-intensity NIV, most successful clinical trials have used the former ventilation strategy. Therefore, when opting for long-term NIV in patients with COPD and chronic hypercapnic respiratory failure, we suggest using high-intensity ventilation (sufficient inspiratory pressures to meaningfully reduce PaCO2). We found no evidence to support the use of volume-assured pressure ventilation over standard pressure preset ventilation, which is currently the preferred mode. CONCLUSIONS: This 2021 guideline update represents an important shift from the previous recommendation against the use of long-term NIV in most patients with COPD and chronic hypercapnia, toward its suggested use. Based on the reported survival and hospital readmission rate benefits, we suggest long-term NIV in highly selected patients with COPD and chronic hypercapnic respiratory failure along with the use of specific and closely monitored ventilatory strategies.

Improving thermal response of lightweight timber building envelopes during cooling season in three European locations

In recent years the use of wood based products in building industry has expanded. Although lightweight timber constructions essentially decrease environmental impact of a building, their consequential low thermal mass can lead to overheating during summer. Therefore, the purpose of this paper was to investigate various examples of enhanced lightweight constructions from the thermal response point of view. Several improvements were investigated (e.g. clay boards, wood wool thermal insulation, Phase Change Materials, etc.) and compared with the performance of a conventional thermally insulated high mass wall. Finite element model was created and dynamic thermal performance of enhanced lightweight external walls was analysed in three different European locations: Helsinki (Finland), Vienna (Austria) and Madrid (Spain). Certain enhancements resulted in lower internal surface temperature of constructions up to 1 °C, depending on location. In addition, it was shown that in order to further improve thermal performance, application of high intensity ventilation is necessary, which additionally lowered the internal surface temperature up to 8 °C. It was shown that enhanced and naturally cooled lightweight constructions are more suitable for locations with milder summer temperatures (Northern, Central Europe), rather than for hot climates (Mediterranean). It was concluded that the application of lightweight constructions should be thoughtful in order to achieve adequate thermal response of buildings. However, in lightweight buildings the integration of materials characterised by high thermal mass, high thermal effusivity and low environmental impact should be encouraged.

P227 Home NIV in COPD: A Real Life Study

IntroductionHome NIV in selected patients with stable hypercapnic COPD has been shown to reduce hospital admissions. Randomised studies have produced conflicting evidence on its effect on quality of life and...

Compartmental chest wall volume changes during volitional hyperpnoea with constant tidal volume in healthy individuals

Prolonged high-intensity ventilation is associated with the development of rapid shallow breathing with decreased end-inspiratory volumes of all chest wall compartments. During respiratory muscle endurance training using normocapnic hyperpnoea, tidal volume (VT) is normally kept constant. The aim of this study was to investigate possible changes in muscle recruitment during constant-VT hyperpnoea, to assess potential mechanisms related to rapid shallow breathing. Ten healthy subjects performed 1h of normocapnic hyperpnoea at 70% of maximal voluntary ventilation. Chest wall volume changes were assessed by optoelectronic plethysmography. End-inspiratory (1.08±0.18 versus 0.96±0.27 l, p=0.017) and end-expiratory volumes (−0.13±0.15 versus −0.31±0.19 l, p=0.007) of the pulmonary ribcage decreased significantly and lung function and respiratory muscle strength were reduced (all p<0.05). Since with forced, constant VT only the inspiratory rib cage muscles were unable to sustain end-inspiratory volume of their compartment, inspiratory rib cage muscles are the most likely candidate responsible for the development of rapid shallow breathing.