Inadequate Ventilation Research Articles

Choice of the correct size of endotracheal tube in pediatric patients.

Selection and insertion of an endotracheal tube (ETT) of appropriate size for airway management during general anesthesia in pediatric patients is very important. A very small ETT increases the risk of inadequate ventilation, air leakage, and aspiration, whereas a very large ETT may cause serious complications including airway damage, post-intubation croup, and, in severe cases, subglottic stenosis. Although the pediatric larynx is conical, the narrowest part, the rima glottidis, is cylindrical in the anteroposterior dimension, regardless of development, and the cricoid ring is slightly elliptical. A cuffed ETT reduces the number of endotracheal intubation attempts, and if cuff pressure can be maintained within a safe range, the risk of airway damage may not be greater than that of an ETT without cuff. The age-based formula suggested by Cole (age/4 + 4) has long been used to select the appropriate ETT size in children. Because age-based formulas in children are not always accurate, various alternative methods for estimating the ETT size have been examined and suggested. Chest radiography, ultrasound, and a three-dimensional airway model can be used to determine the appropriate ETT size; however, there are several limitations.

Perioperative Anesthetic Care of Children with Congenital Cystic Adenomatous Malformation: A Report of 3 Cases

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental entity. Symptomatic patients mustundergo thoracic surgery for lobectomy. Perioperative anesthetic management is challenging because it involvesthoracotomy in a young patient that may lead to hemodynamic compromise and inadequate ventilation. We present 3 cases of pediatric patients (6 months - 2 years old) with CCAM who underwent lobectomy.

Rare cause of intraoperative endotracheal cuff deflation.

Dear Editor, Manufacturing defects in endotracheal tubes (ETTs) can lead to cuff leaks, inadequate ventilation, hypoxemia, and risk of aspiration.[1] These defects may go unnoticed during preuse check of tube before intubating[2] and may lead to difficulty in tube exchange during head and neck surgeries or prone positioning. We report a case of trivial leak that went unnoticed until the intraoperative phase with a source of leak being only established after tube exchange. A 39-year-old female (43 kg), undergoing gastric pull-up surgery, was intubated with a 7.5-mm ID cuffed ETT (Portex®, Smiths Medical, Minneapolis, MN, USA) and a pilot balloon was filled with 4 ml of air at which there was no cuff leak. After around 30 min, a leak was visible on the ventilator with 150 ml of difference between the inspired and expired air. On inspection of the pilot balloon, it was found to be deflated. It was again filled with air resulting in correction of leak. As neck incision had been made with the face covered under the drapes with no leak, we decided to continue with the surgery. Thereafter, every 45–60 min, the tube developed a leak that was managed by filling air repeatedly. A syringe was attached at the valve to rule out valve incompetency, but it did not prevent leak and tube was exchanged. The surgery lasted for 5 h and the patient was extubated uneventfully. The tube was dipped in water and cuff did not show any bubbling. Then, the pilot balloon and valve were immersed in water, which showed slight bubbling at the junction of pilot balloon and valve assembly [Figure 1]. The leak was mild and clearly appreciable only when the tube cuff was pressurized by hand. These types of leaks were found in other cases in the same operating room complex as well implying a faulty manufacturing defect in the batch of ETT s.Figure 1: Site of leak in endotracheal tube. (a) Immersion in water showed bubbling. (b) Application of water showed bubble at junction of pilot balloon and one-way valveManufacturing defects in tube can lead to leaks present in the valve, pilot balloon, junction of cuff inflation line and ETT shaft, lumen of tube and the cuff.[3,4] Minute leaks may not be visible and missed during inspection of tube before intubating. These leaks can be hazardous in cases of head and neck surgery and difficult airway. Various methods of minimizing the leak have been described and include throat packing, injecting the cuff inflation line with lignocaine, continuous inflation, and blocking the one-way valve (in case of valve incompetency).[5] These methods are not foolproof and act as temporary measures. If a leak is detected, a plan must be formulated depending upon the surgery, airway, and amount of leak. Manufacturing defects must be reported to the manufacturer and stores department. The tubes of same batch must be inspected thoroughly as they may have the same defect and leak. If a trivial leak is present, it should always be looked for after extubating and immersing the tube in water. Intense vigilance toward monitoring difference in inspired and expired tidal volume can aid in detection of such minuscule defects. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Spinal Backboard-Necessity or Hazard? The IDF Clinical Practice Guidelines and Policy.

Prehospital spinal immobilization using a cervical collar and a backboard has been standard practice for suspected spinal cord injuries (SCIs) since the 1960s. Multiple studies have shown that the disadvantages of the spinal backboard outweigh its advantages. This report aims to present a review of the current literature along with the revised IDF protocol regarding patients with suspected SCI. In 2019, the IDF Medical Corps (IDFMC) convened a multidisciplinary expert committee to revise the IDFMC protocols regarding the use of spinal backboards. Prior to convening the committee, a review of the pertinent literature was done by conducting a thorough clinical evaluation in "PubMed" and "Google Scholar" databases to identify recent studies investigating traumatic SCI and the prehospital military use of spinal backboards. There were no documented studies that have managed to prove the efficacy of spinal backboards to prevent exacerbation of spinal injuries during mobilization. Despite being a good tool for extraction from vehicles and combat arenas, more than 11 studies have shown that backboards may even result in adverse outcomes such as pain due to the contact between board and skin, the formation of decubitus ulcers, hypothermia, and inadequate ventilation. In light of the evidence showing the potential harmful effects of the routine use of spinal backboards, the IDF guidelines have been revised and now recommends avoiding the routine use of spinal backboards and using a standard stretcher for transporting potential SCI patients. Current IDF guidelines recommend using a backboard for the extraction of an entrapped patient and for obtunded or unconscious patients with obvious deformity or mechanism for spinal trauma.

Epidemiological profile of work-related Covid-19 in Brazil, 2020-2021

Covid-19 is the newest occupational disease, and its transmission patterns can lead to high rates among workers. This work aims to describe the epidemiological profile of work-related Covid-19 cases in Brazil. Methods: Descriptive study using notifications of work accidents by Covid-19 (B34.2) from 2020 and 2021. Data were collected from the Notifiable Diseases Information System (Sinan). Absolute and relative frequencies of sociodemographic characteristics and occupation groups were presented, and Incidence Rates (IR) per 100,000 workers calculated. Results: In 2020 and 2021, 70,618 cases of work-related Covid-19 were reported, with a mean IR of 37.2 cases per 100,000 workers. Most cases occurred among women (65.1%), brown (36.1%) or white (33.0%), aged between 35-39y (17.4%) and 40-44y (15.4%), with more than 8 years of study (60.2%). The most affected workers were nursing technicians or assistants (25.6%), followed by nurses (10.0%), doctors (5.1%), and administrative agents, assistants or auxiliaries (5.1%). Approximately 70.1% cases progressed clinically to cure, 14.5% to temporary disability and 2.0% to death caused by Covid-19. Conclusions: Covid-19 has driven several physical, social and economic impacts to workers globally. In Brazil, frontline workers, particularly healthcare workers, appear to have a high probability of infection. Lack or misuse of protective equipment, workplaces with person-to-person physical contact, inadequate ventilation, shared eating, and accommodation areas, can be considered the main causes of outbreaks of Covid-19 at work. Despite most cases has progressed to cure, the impacts of long Covid-19 are still unknown and must be further investigated.

Fatal unintentional non-fire related carbon monoxide poisoning: Data from Narrative Verdicts, England and Wales, 1998-2019

Background and Aim: Unintentional non-fire-related (UNFR) carbon monoxide (CO) poisoning continues to cause fatalities. Coroners’ narrative verdicts concerning fatal UNFR CO poisoning in England and Wales, 1998-2019, were collated by the Office for National Statistics. Methods: Search terms related to CO exposure were used to obtain information regarding the circumstances of death. Findings were grouped by location of death, source of CO, and reason or behaviour underlying the exposure. Results: There were 750 deaths (77% male). Annual numbers of deaths decreased over the period studied. Two-thirds (68%) of the deaths occurred in the autumn/winter. Of records with information, 59% of deaths occurred in a dwelling (67% male). Males also predominated in deaths in vehicles (91%) and garages/outbuildings (95%). Of deaths with information, domestic piped gas was the most common source of CO (36%), and the most frequent underlying factor was inadequate ventilation of exhaust gases (39%, 91% male). Conclusion: Despite the decrease in the annual numbers of deaths over the study period, there remains a clear need for measures to raise awareness of the dangers of CO poisoning, especially amongst men working alone in garages/outhouses. Education campaigns and fitting and maintaining CO alarms in high-risk areas should be encouraged. Keywords: carbon monoxide, CO, unintentional poisoning, environmental epidemiology, environmental public health, unintentional death, preventing CO poisoning

Healthy nonobese bitches maintain acceptable spontaneous ventilation during laparoscopic ovariectomies.

To determine whether end-tidal CO2 (Petco2), tidal volume (Vt), inspiratory minute volume (V.i), and respiratory rate (RR) remain within reference limits for spontaneously breathing dogs undergoing laparoscopic ovariectomy; characterize changes in these variables over time; and record the proportion of dogs requiring mechanical ventilation on the basis of predetermined criteria. 22 client-owned dogs. Between January and June 2019, dogs were anesthetized for abdominal insufflation (CO2; 10 mm Hg) and laparoscopic ovariectomy. Respiratory variables (Petco2, Vt, V.i, and RR) were recorded at 5 time points: preinsufflation (T2), immediately after insufflation (T3), immediately after first ovary extraction (T4), immediately after second ovary extraction (T5), and after abdominal deflation (T6). Results for variables were assessed to identify differences with reference limits and between time points. At all time points (T2 to T6), Petco2 was within or above the reference limit, Vt was below or within reference limits, and V.i was either within or above reference limits. Significant temporal changes were detected in all recorded parameters. One dog had to be ventilated prior to abdominal insufflation due to inappropriately low Vt (< 6 mL/kg) and was excluded from further analysis. One of the 21 remaining dogs required rescue ventilation. Following insufflation, there was a tendency toward inadequate ventilation over time characterized by increased Petco2. Twenty of 21 dogs maintained Petco2 within tolerance via a mild increase in RR and did not require assisted ventilation. Dogs undergoing short surgeries may not require assisted ventilation. Clinicians are advised to monitor for hypercapnia and be prepared to assist ventilation if required.

SchoolVent pilot ventilation system with indirect adiabatic cooling and high efficiency filtering

Existing schools are badly insulated and often suffer from inadequate ventilation and cold in winter and too high temperatures in summer. Further schools nearby a busy road require high efficiency filtering, which traditionally lead to high pressure drops and installation noise. Current ventilation systems suitable for renovation often require expensive commissioning measurements and lack monitoring facilities during the use phase.With the development of the SchoolVent system we have solved these problems in an energy efficient manner. Core of the system is a balanced ventilation system with heat recovery. The heat exchanger is also used for indirect adiabatic cooling. For filtering a high efficiency and low pressure drop electrostatic filtration system is scaled up to 10.000 m3/hour. With this airflow 5 classrooms can be conditioned. The components have first been tested in the TNO laboratory. After that a pilot has been started on the Montessori Lyceum in Zeist. The main results of the monitoring during 2019/2020 are a heat recovery efficiency between 60 and 75%. With regard to the indoor climate class A of the “PvE Frisse scholen” has been achieved for summer and winter temperature and for CO2 concentration. With regard to filtration depending on the flowrate the specifications of an E10 – E11 filter have been obtained. In the climatized class rooms this lead to a 70 – 96% lower PM2.5 concentration compared to a reference classroom. The system has been further optimized with regard to installation costs and in 2021 another 14 classrooms are equipped with the SchoolVent system.

Differential Tympanic membrane retraction

Aims and objectives: Tympanic membrane retraction occurs due to inadequate ventilation of middle ear cavity. The aim is to evaluate the surgical management of TM retractionits effectiveness and analyse the hearing improvement after surgery. Materials and methods: A retrospective study with 100 patients came to ENT OPD vmkvmch Salem in last 2 years with symptoms of hard of hearing, ear ache, ear block sensation. These patients underwent necessary ENT examination, diagnosed as TMwere selected for study and surgery done for these cases depending upon the grades of TM retraction which included Grommet insertion, Cartilage Tympanoplasty, Cortical Mastoidectomy + cartilage tympanoplasty. They were followed up for1, 3 and 6 months post operatively and evaluated based on hearing assessment after surgery and successful graft uptake. Results: Surgical interventionwas donedepending upon the stage of retraction. Grommet insertion done in stage 1, cartilage tympanoplasty in stage 2whereas stage 3 cortical mastoidectomy +cartilage tympanoplasty done. Hearing improvement seen after 1 month 76%,3 and 6months is 84% and 96%. The success rate in stage 1 retraction is 90 %, stage 2 84% and stage 3 81%.

Study of natural ventilation and daylight in a multi-storey residential building to address the problems of COVID-19

Many issues have emerged more clearly than before in multi-storey residential buildings during quarantine and lockdown caused by the global pandemic COVID-19. Among these problems is the deterioration in people’s mental and physical health inside the home caused by quarantine and closure. This deterioration is due to inadequate passive ventilation, natural lighting, and the lack of green open spaces in and around traditional multi-storey residential buildings. Also, one of the most severe problems is the airborne infection transmission from a positive covid-19 person to others due to the lack of control in the entrance of buildings against an infected person. In this paper, we modified the shape of a traditional multi-storey residential building. Using Design-Builder and Autodesk CFD software, we create a simulation to compare the amount of natural ventilation and lighting before and after modifying the building’s shape. This work aims to increase the passive ventilation and daylight inside the building. Also, to achieve the biophilic concept to provide open spaces for each apartment to improve the mental and physical health of the residents. In addition, it protects the building users from infection with the virus. Through this study, we found that passive ventilation and daylight achieved more efficiency in the building that we have modified in its shape, which led to a 38% reduction in energy consumption. In summary, these findings suggest that by modifying the mass of the traditional multi-storey residential building with open green spaces provided for each apartment, the natural connection with the inhabitants of the building was sufficiently provided. Moreover, all this will significantly help improve residents’ mental and physical state, and it will also help prevent the spread of various diseases inside the homes.

Retrospective Analysis of 53 Cases who Developed Colon Fistula

Objective: Colon cancer is among the most common cancers in men and women. Separation of anastomosis after resection is undesirable. There are various risk factors affecting the development of anastomotic leakage. Methods: Fifty-three cases of colon anastomotic leakage were included in the study retrospectively. Demographic characteristics and co-morbidities in these patients were evaluated retrospectively and risk factors were compared with the literature. Results: Additional disease was detected in thirty of fifty-three cases. The most common co-morbidities are diabetes mellitus (DM) and hypertension (HT), while less frequent chronic diseases such as chronic obstructive pulmonary disease (COPD) have been detected. Mortality rate is 11% in patients who develop fistula, and DM and HT usually coexist in mortal cases. Conclusion: Inadequate alveolar ventilation and consequently hypoxia and hypercapnia have negative effects on tissue repair processes in patients with COPD. Changes in the microcirculation and the patient's greater susceptibility to diabetes mellitus (DM)-related infection are risk factors for the development of postoperative fistula. If obesity is present together with DM, the risk of anastomotic leakage may be even higher. Preoperative diastolic pressure is another factor that increases the risk of anastomotic leakage. In conclusion, hypertension, obesity, diabetes, COPD are effective risk factors for anastomotic leakage after colorectal surgery. These risk factors are effective in increased morbidity and mortality. Keywords: colon, cancer, anastomosis, leakage, fistula

Conversion of Existing Room into Green Room

Abstract: Humans are most exposed to indoor air. Half of the body's lifetime intake is house air. Indoor air exposure causes most environmental diseases. Today's environmental challenges are outdoor air quality, energy utilisation, and not duplicate (IAQ). But evidence is accumulating that IAQ causes morbidity and mortality. Creating Indoor unvented biomass cooking causes at least 2,000,000 (mostly women and children) die each year in wealthy countries. IAQ causes allergies, hypersensitivity responses, and airway inflammation, cancers, infections Radon and ETS (Environmental Tobacco Smoking) cause lung cancer, Sick Building Syndrome, inadequate ventilation. Future IAQ and health issues must be prioritised. This project also aims towards a quick composting endeavour to convert kitchen wet waste to compost in as little as 25 to 35 days. Vegetable cuttings, dry and wet leaf twigs, grass clippings, tree trimmings, and other wastes are included in the composting process. Composting comes into play here; organic waste may be recycled and the resulting product can be utilised to improve soil quality and aid plant growth. This can be simply implemented at hotels, colonies, schools, and institutions with readily available wet waste. The compost that is produced is used as manure for plants on the campus of the college. Keywords: Indoor Air Quality (IAQ), Health, Allergy, Indoor environments, Dampness, Ventilation, Kitchen Wet Waste, Composter.

Assessment of predictors for difficult intubation and laryngoscopy in adult elective surgical patients at Tikur Anbessa Specialized Hospital, Ethiopia: A cross-sectional study

BackgroundGeneral anesthesia is not without morbidity. One of the well-known life-threatening events associated with general anesthesia is difficult airway which can happen during induction of anesthesia while attempting to insert the endotracheal tube with the aid of a laryngoscope. Difficult intubation, inadequate ventilation, and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. ObjectiveThe main objective of this study was to assess the magnitude and predictors for difficult laryngoscopy and intubation among surgical patients who underwent elective surgery under general anesthesia with endotracheal intubation at Tikur Anbessa Specialized Hospital from February 1 to March 30, 2019. Materials &methodAn institutional based cross sectional study was conducted from February 1 to March 30, 2019 on patients who underwent elective surgery under general anesthesia with endotracheal intubation. Data on socio-demographic characteristics, preanesthetic airway assessment and laryngoscopic view were collected. Data were analyzed by SPSS Version 20.0. Chi- square test, binary logistic regression and multivariate analysis were performed. Tables and texts were used to present data. A p value less than 0.05 was considered as statistically significant. ResultsThe magnitude of difficult laryngoscopy, difficult intubation, and failed intubation were 12.2%, 6.1%, and 0.67%, respectively. Upper Lip Bite Test (ULBT) had a higher sensitivity (90.2%) and negative predictive value of 85.3%. Mallampati had a sensitivity of 45.8% and negative predictive value of 86% in predicting difficult laryngoscopy. Mallampati grade, thyromental distance and ratio of height to thyromental distance (HRTMD) have also showed greater sensitivity (69.6%, 58.3% and 47.8%, respectively) when compared to other tests in predicting difficult intubation. Mallampati class, upper lip bite test (ULBT) and inter-incisor distance (IID) are independent predictors for difficult laryngoscopy (p < 0.05). Furthermore, Mallampati class, Thyromental distance and ratio of height to thyromental distance (HRTMD) are identified as independent predictors of difficult intubation (p < 0.001). Conclusionand recommendation: Mallampati class, Thyromental distance and Ratio of height to Thyromental distance (HRTMD) can predict the probability of difficult endotracheal intubation in adult patients. Whereas, Mallampati class and upper lip bite test (ULBT) predicts higher probability for difficult laryngoscopy.

Risk Mitigation Strategy against SARS-CoV-2 Infection for Healthcare Provider at Harapan Bersama General Hospital, Singkawang, Indonesia

Working in one of the countries with highest number of COVID-19 cases, healthcare providers in Indonesia are at higher risk of contracting COVID-19. Therefore, risk mitigation strategy is crucial to protect the healthcare workers, especially in hospitals with limited resources such as Harapan Bersama General Hospital. This study aims to analyze risk mitigation strategy against SARS-CoV-2 infection for hospital workers in hospital with limited resource. Action Research study was performed through four stages. COVID-19 risk factor identification was carried out among healthcare workers who came in contact with COVID-19 patients between October 2020 and February 2021. Risk mitigation strategies were evaluated using Hospital Readiness Checklist for COVID-19. Implementation of risk mitigation strategies was done using hierarchy of control against infection transmission. Long period of close contact, inadequate PPE, and inadequate ventilation increased the risk of COVID-19 among healthcare workers.

Influence of Seasons and Sites on Bioaerosols in Indoor Wastewater Treatment Plants and Proposal for Air Quality Indicators

During wastewater treatment, bioaerosols are generated and, can either remain in suspension for several hours or settle on surfaces and workers may be exposed. The presence of pathogens in the air could contribute to an increased frequency of gastrointestinal or respiratory illness amongst workers. Due to harsh winter conditions in Eastern Canada, much of the steps in the wastewater treatment process occur indoors, leading to a greater risk of significant occupational exposure especially if there is inadequate ventilation or a lack of personal protection. This work has used stationary sampling at various indoor wastewater treatment steps in both winter and summer. Bioaerosols were evaluated using both culture and molecular methods along with ventilation characterization. Endotoxins were quantified, as well as total cultivable and Gram-negative bacteria and pathogen indicators using qPCR. This study highlights the presence of potential pathogens at all steps in the treatment process, which may represent a potential occupational hazard. Comparisons between summer and winter data suggest that water temperature is an important factor for microbial activity and suggest that increasing the rate of air changes per hour in summer would be beneficial to reduce the concentration of bioaerosols during this time of the year. The screening, grit/FOGs removal and biofiltration were the most bioaerosols loaded sites. Based on strong correlations, we suggest the reconsideration of exposure limits in WWTPs. Workers should be encouraged to use personal respiratory protection to limit the risk of health problems, especially during long-term work. Implication Statement The work presented herein showcases significant correlations between concentrations of endotoxins, cultivable bacteria, Gram-negative bacteria, and total bacteria by qPCR from air collected in indoor wastewater treatment plants. These correlations lead us to propose new Limit of Exposure values, revisited to fit the Endotoxin exposure limits recommendations. The results can serve as guidelines for future proposals for air quality indicators.

Tubomanometry correlations with patient characteristics and other diagnostic tests of Eustachian tube dysfunction: a cohort study of 432 ears

ObjectivesCurrently, there is no consensus regarding the best protocol for diagnosing Eustachian tube dysfunction (ETD). We aimed to evaluate how patient characteristics affect tubomanometry (TMM) results. If an association between patient characteristics and TMM results exists, this should be considered in TMM interpretation. We also wanted to study if TMM correlates with other diagnostic tools of ETD.MethodsA retrospective chart review was conducted on all patients with TMM results available from November 2011 to October 2020 at a tertiary referral center, including 432 ears from 219 patients. An association between diagnostic tests and patient characteristics was assessed using regression models. Spearman’s rank correlation was used to analyze correlations between diagnostic tests.ResultsNone of the studied patient characteristics (age, gender, body mass index, smoking, sinonasal disease) was associated with TMM results except for pollen allergy (OR 1.74, 95% CI 1.15–2.63, P = 0.009). TMM results correlated with Valsalva maneuver performance (P < 0.001, ρ = 0.31) and otomicroscopic signs of inadequate middle ear ventilation (P < 0.001, ρ = 0.28). The Eustachian tube dysfunction questionnaire-7 (ETDQ-7) score did not correlate with any diagnostic method.ConclusionsTMM results are unaffected by patient characteristics other than pollen allergy. Thus, TMM may be used in ETD diagnostics in a wide variety of patients with straightforward interpretation. TMM correlates with other diagnostic tests studied but not with ETDQ-7. ETDQ-7 does not seem to correlate with other diagnostic tests and appears nonspecific in ETD diagnostics.

An overview of indoor air pollution in the Malaysian kindergarten environment

Abstract The components of indoor air determine the quality of the indoor environment, which affects the health and well-being of inhabitants. Exposure to high levels of indoor air pollution in a kindergarten environment has a detrimental influence on children’s learning performance and increases the risk of respiratory problems that could lead to absenteeism. This paper explores and summarises the literature on indoor air pollution in kindergartens in the Malaysian environment. A review was done by analyzing papers taken from four electronic databases: Scopus, Science Direct, PubMed and Google Scholar. Information on indoor pollution levels and determinants sources were extracted from 17 studies. The most investigated pollutants were carbon dioxide (CO2), particulate matter (PM2.5 and PM10), volatile organic compounds (VOCs), carbon monoxide (CO), fungi and bacteria. Inadequate ventilation systems and overcrowded classrooms all contributed to excessive CO2 levels. Indoor PM2.5 sources are generated from cooking activities while cleaning, opening windows and movement activities of children were the primary sources of coarse particles. High concentrations of VOCs are emitted from a wide variety of indoor sources. Mobile vehicles and the proximity of kindergartens to busy roads were key contributors to higher CO concentrations. The findings highlight the importance of interventions to improve indoor air pollution in kindergarten premises in various settings.

Percutaneous Treatment of Massive Pneumoperitoneum Following Reintubation After Coronary Artery Bypass Surgery

The aim of this study is to present a percutaneous treatment option for a patient with massive pneumoperitoneum following intubation after coronary artery bypass surgery. After coronary artery bypass surgery, a 74-year-old woman had prolonged endotracheal intubation due to hypoxia associated with pneumonia. On postoperative day seven, she was reintubated with inadequate ventilation leading to hypercapnia due to blockage of the endotracheal tube. Shortly after intubation, the patient was hypotensive, tachycardic, and hypoxic. The breath sound was absent on the right hemithorax, and the abdomen was distended. The chest x-ray showed a right-sided tension pneumothorax. A chest tube was placed on suction to the right hemithorax immediately. The computed tomography scan showed a massive pneumoperitoneum without free fluid in the abdomen. Air evacuation from the peritoneum was performed using a 7 French percutaneous venous catheter and 50 cc syringe. As a practical technique to see air bubbles puffing out from the peritoneal cavity, we connected the sterile water-filled syringe to the line upwards. After the air evacuation, the abdomen was softened and non-distended. Arterial blood gas sample and peak airway pressure became normal. To avoid unnecessary surgical procedures, we need to recognize whether pneumoperitoneum is surgical or not. In non-surgical pneumoperitoneum, the less invasive air evacuation techniques may be faster, more practical, and as effective as placing an intraperitoneal tube or laparoscopy. The percutaneous drainage techniques should be tried as a first-line treatment in pneumoperitoneum without symptoms and signs of peritonitis.

Fatal Unintentional Non-Fire Related Carbon Monoxide Poisoning: Data from Narrative Verdicts in England and Wales, 1998-2019.

Unintentional non-fire related (UNFR) carbon monoxide (CO) poisoning continues to cause fatalities. The narrative verdicts from coroners concerning fatal UNFR CO poisoning in England and Wales, 1998–2019, were collated by the Office for National Statistics. Search terms related to CO exposure were used to obtain information regarding the circumstances of death. Findings were grouped by the location of death, the source of CO, and the reason or behaviour underlying the exposure. There were 750 deaths (77% male). The annual number of deaths decreased over the period studied. Two thirds (68%) of the deaths occurred in the autumn or winter. From the records with information, 59% of deaths occurred within a dwelling (67% male). Males also predominated deaths within vehicles (91%) and garages or outbuildings (95%). From the deaths with information, domestic piped gas was the most common source of CO (36%) and the most frequent underlying factor was inadequate ventilation of exhaust gases (39%, 91% male). Despite the decrease in the annual number of deaths over the study period, there remains a clear need for measures that raise awareness of the dangers of CO poisoning, especially amongst men working alone in garages or outbuildings. Education campaigns and fitting and maintaining CO alarms in high-risk areas should be encouraged.

Prevalence of Hoarseness in Primary Health Care and Hospitals—Associations With Different Work Tasks and Environmental Factors Among Nurses

The voice is one of the most essential tools necessary for nurses achieve high care satisfaction and safety. Research on hoarseness has mainly focused on professional speakers, like teachers. The aim of this study was to determine the current prevalence of hoarseness among six subgroups of nurses (registered nurses, primary care nurses, pediatric nurses, laboratory nurses, dental nurses, and midwives) and also to identify potential environmental risk factors in their working environment. The health data was collected in collaboration with two health care professional trade unions. The findings are based on 15,553 returned health questionnaires which were statistically analyzed. The 1-year prevalence of hoarseness among all participating nurses was 30.2 % in this data, but the variation between different occupational subgroups was significant; ranging from 25 % for laboratory nurses to 38 % for midwives. These findings were in line with perceived environmental problems and the differences between the sub-groups were not explained by the participants suffering from asthma, sinusitis, rhinitis, or common respiratory infections; there were no explanatory differences in the prevalence's of the above-mentioned diseases. The variation in prevalence of hoarseness between the different occupational subgroups was significant and the prevalence was found to be in line with perceived environmental problems. The most common problems were stuffiness, dry air, and inadequate ventilation. In addition, both a perceived "sewer odor" and "smell of mold or cellar" in one's own working environment were also found to be significant risk factors for hoarseness. Based on this study, the current indoor air problems in Finnish health care facilities can be verified and are a source of risk to nurses' voices.