Negative Pressure System Research Articles

Novel Technologies in Chronic Wound Care.

In Israel, 20% of wounds do not progress to full healing under treatment with conservative technologies of which 1 to 2% are eventually defined as chronic wounds. Chronic wounds are a complex health burden for patients and pose considerable therapeutic and budgetary burden on health systems. The causes of chronic wounds include systemic and local factors. Initial treatment involves the usual therapeutic means, but as healing does not progress, more advanced therapeutic technologies are used. Undoubtedly, advanced means, such as negative pressure systems, and advanced technologies, such as oxygen systems and micrografts, have vastly improved the treatment of chronic wounds. Our service specializes in treating ulcers and difficult-to-heal wounds while providing a multiprofessional medical response. Herein, we present our experience and protocols in treating chronic wounds using a variety of advanced dressings and technologies.

Experimental investigation on the motion of a single plug and its constituent particles in a horizontal pneumatic pipeline

In this study, the revolution of individual plug constituent particles, the relation between plug length and pressure drop, and the relation between plug velocity and pressure drop were experimentally examined, for a single plug in a negative pressure system, using high-speed video cameras. The horizontal pipeline consists of an 8.8 m long, 30 mm i.d. transparent acrylic tube. The particles used are three kinds of uniform spherical ABS resin particles of 6.0 mm diameter and different densities, and the non-spherical polyethylene pellet of 3.27 mm spherical equivalent diameter. By observing the plug-constituent particles, it was found that more than 65% of spherical particles revolve and about 33–39% of them are forward revolving. Some plug-constituent particles revolve in reverse due to the frictional force between the particles. For non-spherical particles, more than half revolve, although the revolution axis frequently changes and most revolutions are intermittent. Furthermore, a plug begins to be conveyed spontaneously as soon as it is generated, and plug length increases up to a definite length depending on the pressure drop across the plug.

Modern mortuary complex plan in Covid-19 era

The COVID-19 pandemicis the most burning health emergency worldwide now a days and all health professionals are called to give support in the diagnosis, treatment of patients and management of dead bodies affected by this disease. Different modes of transmission of corona virus is well established, however aerosol generating procedure has significant importance for mortuary during autopsy. The risk of infection can be minimized by using standard universal precautions for autopsy dissection procedure, applying high bio-safety levels, using negative pressure and laminar flow system for ventilation, UV irradiation for sterilization, virtual autopsy etc. The aim can be achieved by constructing the mortuary complex in more planned way like area division, ventilation planning, environmental disinfection, individual protection, autopsy procedure, virtual autopsy, preservation and transportation of dead body and waste disposal management. The present manuscript describes in detail about modern mortuary complex during the pandemic era of covid-19.

Treatment of deep peri-implant abscess of the upper spine with a negative wound pressure (NPWT) system (clinical observations)

Treatment of deep peri-implant abscess of the upper spine with a negative wound pressure (NPWT) system (clinical observations)

Treatment of a 5-year-old child with damage to the esophagus: a case report

Diagnosis and treatment of esophageal injuries remain the most difficult problems in pediatric urgent surgery with high mortality rates. Restoration of function in severe multiple-organ disorders associated with the development of mediastinitis and sepsis in children requires a multidisciplinary approach and the search for alternative treatment methods that help close the esophageal defect and prevent inflammation. These methods include a constant negative pressure system.
 Severe polytrauma led to the development of local inflammation and mediastinitis. The formed esophageal fistula with clinical sepsis required multistage surgical treatment and support of several specialists. At the Regional Childrens Clinical Hospital No. 1 in Vladivostok, at the first stage of treatment, the mediastinum and soft tissues of the neck were drained, which made it possible to stop the spread of inflammation and stabilize the patients condition. The effectiveness of the second stage of surgical treatment using the VAС system was noted in the first 48 h, in the form of a significant reduction in local inflammation and elimination of skin maceration. The VAС system provided adequate drainage of the wound cavity and promoted wound cleansing and growth of granulation tissue. Dissociation of the fistula by applying a gastrostomy made it possible to create favorable conditions for the healing of the esophageal defect and ensure adequate enteral nutrition for the patient.
 Damage to the esophagus with the development of mediastinitis and sepsis are critical conditions; therefore, treatment outcomes depend on early diagnosis and timely surgical treatment. A full-fledged surgical treatment in a specialized hospital helps eliminate complications of damage to effectively restore functions and lead to patient recovery.

Management of the patient with the open abdomen.

The aim of this study was to outline the management of the patient with the open abdomen. An open abdomen approach is used after damage control laparotomy, to decrease risk for postsurgery intra-abdominal hypertension, if reoperation is likely and after primary abdominal decompression.Temporary abdominal wall closure without negative pressure is associated with higher rates of intra-abdominal infection and evisceration. Negative pressure systems improve fascial closure rates but increase fistula formation. Definitive abdominal wall closure should be considered once oedema has subsided and the patient has stabilized. Delayed abdominal closure after trauma (>24-48 h) is associated with less achievement of fascial closure and more complications. Protective lung ventilation should be employed early, particularly if respiratory compromise is evident. Conservative fluid management and less sedation may decrease delirium and increase definitive abdominal closure rates. Extubation may be performed before definitive abdominal closure in selected patients. Antibiotic therapy should be brief, targeted and guideline concordant. Survival depends on the underlying disease, the closure method and the course of hospitalization. Changes in the treatment of patients with the open abdomen include negative temporary closure, conservative fluid management, early protective lung ventilation, decreased sedation and extubation before abdominal closure in selected patients.

Large eddy simulation of contaminants dispersion in ship isolation room

Objectives Conducting studies on contaminant dispersion during the door-opening process of isolation rooms and quantitatively comparing and evaluating the diffusion characteristics of contaminated air under different negative pressure conditions is of great significance for the design of negative pressure systems for the isolation rooms of ships. Methods Based on the large eddy simulation (LES) method and a combination of tracer gas component transport equations, numerical simulations were conducted to investigate contaminated air dispersion during the door-opening process of isolation rooms. The flow field characteristics and pollutant dispersion process during the dynamic opening of the door under different differential pressure conditions were then compared and analyzed. Results The results show that the sensitivity analysis of mesh resolution and time step with total pollutant diffusion as the evaluation index can ensure the reliability of the LES simulation results. Further analysis shows that under the combination of different differential pressures and door-opening induced flows, there is a significant difference between the magnitude of the fluid velocity peak and the time when the peak appears. Increasing the negative pressure value of the isolation room can reduce the peak of pollutant diffusion and shorten the time for the diffused pollutant to return to the isolation room under the differential pressure. Conclusions The results obtained in this paper can provide guidance for the design of ship isolation rooms.

Knowledge, attitude, and practice of forensic practitioners during COVID-19 pandemic in Arab countries.

COVID-19 pandemic burdens forensic practice worldwide. The experience of crisis management is a lesson learned that guides future preparedness for similar casualties. Thus, the present study takes an in-depth look at the knowledge, attitude, and practice of forensic practitioners during the COVID-19 pandemic in the Arab world. A comprehensive questionnaire was adopted in compliance with optimum international standards for the management of deaths during the pandemic. The survey was electronically distributed in 13 Arab countries. The responses were received from 29 forensic practitioners from 11 countries. Total median knowledge, attitude, and practice scores of respondents constituted 37.9%, 74%, and 36.8% of optimum scores respectively. Regarding knowledge, better scores are related to risk assessment and routes of exposure to Coronavirus, whereas, least scores were related to ventilation and negative pressure system. Most of the participants had a positive attitude, 85.2% were concerned about proper management of COVID-19 deaths, and 77.8% trusted the decisions of their teams. Considering practice, better scores are related to forensic staff competence, whereas, least scores were related to the implementation of ideal safety measures. Participants described the management process as useful (52%), reliable (35%), high quality (21%), and cost-effective (17%), however, they expressed challenges as staff infection, limited resources, and infrastructure issues. This survey guides readjusting of procedures and future preparedness for similar disasters in the Arab world. This research adopted a questionnaire that could be used in initial and periodic assessments in any medicolegal institute worldwide. Also, it could support infrastructure projects and disaster management plans.

Anesthesiology and Critical Care Response to COVID-19 in Resource-Limited Settings: Experiences from Nepal.

It is difficult to predict the future course and length of the ongoing COVID-19 pandemic, which has devastated health care systems in low- and middle-income countries. Anesthesiology and critical care services are hard hit because many hospitals have stopped performing elective surgeries, staff and scarce hospital resources have been diverted to manage COVID-19 patients, and several makeshift COVID-19 units had to be set up. Intensive care units are overwhelmed with critically ill patients. In these difficult times, low- and middle-income countries need to improvise, perform indigenous research, adapt international guidelines to suit local needs, and target attainable clinical goals.

Effect of Negative Pressure Therapy on Open Abdomen Treatments. Prospective Randomized Study With Two Commercial Negative Pressure Systems.

Introduction: The use of negative pressure dressings for open abdominal therapy has made a great impact on strategies for open abdominal treatment. Observed intestinal damage and developement of fistula formation raises questions about safety of commonly used systems (AB-Thera). The most common used system uses foils for shielding intestines directly from negative pressure. As an alternative a system with open pore dressing in double layer film was introduced (Suprasorb CNP) and proved to safe in animal studies. We compared the effects of this two systems on patients requiring open abdominal treatment.Materials and methods: Patients with secondary peritonitis in at least two abdominal quadrants were included in this randomized study. Inclusion criteria were secondary peritonitis (ACS), abdominal compartment syndrome, and abdominal trauma combined with ACS and/or contaminated abdomen. Patients with active bleeding and pancreatitis were not included. We examined Mannheim peritonitis Index (MPI), bloodcount, PCT, amount of fluid collected, and morphological changes on the bowel. Data were collected on day 2, 4, 7, 14, 21, and 28. Primary end point was fascial closure. Examination was terminated in case of death and damage to the abdominal organs. Groups were compared using Mann Whitney U-test and chi square test. Trend evaluation was evaluated using an one way repeated measure analysis of variance. P-values below 0.05 was considered significat.Results: Thirty four patients were included between August 2010 and September 2012. There were no significant difference between two groups in MPI, age, and gender. Mean duration of treatment, WBC, CRP, and abdominal closure rate were not significantly different between groups. Suprasorb CNP System collected twice more fluid than AB-Thera and decreased PCT on significantly faster rate than AB-Thera. Four patients died (11%) and four patients developed enteric fistula (11%). Closure rate was achieved in 27 out of 34 Patients (79.5%). Closure rate was not significantly different between groups.Conclusion: The use of both systems proved to be efficient and safe. The application of well-dosed, moderate negative pressure on contaminated areas of the abdomen seems to have a lot of potential and it is worth directing greater research potential in this direction.

Impact of negative pressure system on microbiological air quality in a Central Sterile Supply Department

ObjectiveGuidelines recommend that the cleaning area in a Central Sterile Supply Department (CSSD) maintain a negative pressure of the environmental air, but how much this system can impact the contamination of the air by bioaerosols in the area is not known. The objective of this study was to assess the impact of negative pressure on CSSD by evaluating the microbiological air quality of this sector.MethodsMicrobiological air samples were collected in two CSSD in the same hospital: one with and one without a negative air pressure system. Outdoor air samples were collected as a comparative control. Andersen six‐stage air sampler was used to obtain the microbiological air samples.ResultsThe concentration of bioaerosols in the CSSD without negative pressure was 273.15 and 206.71 CFU/m3, while in the CSSD with negative pressure the concentration of bioaerosols was 116.96 CFU/m3 and 131.10 CFU/m3. The number of isolated colonies in the negative pressure CSSD was significantly lower (P = .01541).ConclusionThe findings showed that the negative pressure system in the CSSD cleaning area contributed to the quantitative reduction in bioaerosols. However, the concentration of bioaerosols was lower than that established in the guideline for indoor air quality of many countries. Therefore, it cannot be concluded that CSSDs which do not have a negative pressure system in their cleaning area offer occupational risk.

Influence of volume of endodontic irrigants used in different irrigation techniques on root canal dentin microhardness.

Overzealous application of endodontic irrigants affects the root canal dentin mechanical properties. The effect of volume of endodontic irrigants on the microhardness of root canal dentin has not been studied. This study assessed the effect of volume of endodontic irrigants used in different final irrigation activation techniques on root canal dentin microhardness (RCDM). Sixty human maxillary central incisors were embedded in acrylic resin in Kuttler's endodontic cube to the level of cementoenamel junction. The root samples were randomly divided into 4 experimental groups (n = 15): Group-NI-needle irrigation, Group-PUI-continuous passive ultrasonic irrigation, Group-EndoVac-apical negative pressure system, Group combination- EndoVac + PUI irrigation. Root canals were instrumented up to size 40 (F4). The resin mounted specimens were sectioned longitudinally into two halves and were reassembled in Kuttler's kube to carry out final irrigation activation. A predetermined standardized volume of irrigants was used in each group. The RCDM was measured after root canal instrumentation and after final irrigation using Vicker microhardness tester (coronal, middle, and apical third). The reduction in RCDM values (p < 0.0086) were analyzed using Kruskal Wallis and Mann Whitney-U tests. Reduction in RCDM was observed with all the endodontic irrigating techniques tested. EndoVac and combination irrigation techniques showed maximum reduction in RCDM in all thirds of root canal. It is concluded that the volume of irrigants and agitation plays a role in reducing RCDM. The overall volume of irrigants to cause maximum reduction was 25 ml, beyond which neither volume nor agitation affects RCDM.

Commentary: "Indovation" in retinopathy of prematurity management during COVID-19 times.

The coronavirus disease-2019 (COVID-19) pandemic has caught many of us off-guard and thrust even the most developed of nations into chaos. While the direct implications of the disease have been much talked about, the collateral damage on patients suffering from non-COVID conditions has been equally severe. Retinopathy of prematurity (ROP) is an ocular emergency and any delay in treatment leads to permanent visual loss in a premature child. However, during the COVID-19 pandemic, lesser number of ROP babies got screened with an increasing proportion of them presenting with advanced disease.[1] Despite effective methods of treatment with laser and surgery, many premature neonates lost vision in the initial days of the COVID-19 lockdown due to late presentation.[23] To add to this, the fear of COVID-19 transmission led various doctors to reduce working hours, taking ROP care further away from those in need of it. In these testing times, Nayak et al.[4] have come out with a unique 'indovation' – The virus containment box. The basic concept stems from an incubator where ROP screening and laser are provided through the visualization provided by the slanting wall of the incubator.[5] The authors have described a low-cost setup that may be feasible at the level of a general ophthalmologist. While the authors must be applauded for their effort, a little note of caution is necessary here. Pros and Cons of Barrier Devices Barrier devices have become a commonplace due to the circumstances of the COVID-19 pandemic. Various designs of barrier devices for procedures such as mechanical intubation/resuscitation have been published over the past few months.[6789] Some devices even incorporate a negative pressure system to actively eliminate any aerosols that may be generated during the procedure. However, the impact of aerosols generated by a crying baby may not be completely gauged by the 'eye drop bottle' experiment applied by Nayak et al.[4] An airborne particle counter with a laser diode and photon detector to detect various sizes of airborne particles may be a better option. Simpson et al.[8] utilized the same to test various modifications of barrier devices during simulated intubation. A barrier device with suction to create negative pressure led to a reduction in 0.3, 0.5, 1.0, and 2.5 micron particles but not in the 5.0 micron particles when compared to no device used. On the contrary, a barrier device with no negative pressure actually showed an increase in 1.0, 2.5 and 5.0 micron particle count compared to no device use. The results for 0.3 micron particle size were similar whether any barrier device was used or not. A review of 52 publications describing various barrier devices by Sorbello et al.[9] also concluded that barrier devices may only be effective in limiting large droplet spread and not the aerosolised virus particles. While the aerosol containment barrier device may serve as an adjunct during the COVID-19 pandemic, the importance of adequate personal protective equipment and hand hygiene practices cannot be over stated. They remain our first line of defense in protecting ourselves from the pathogen while providing effective care. Pre-procedure testing before laser/surgery is another way of creating a safe workplace. It is during these procedures that a prolonged exposure is expected. Over the past 6 months, we have been testing all premature infants for COVID-19 by polymerase chain reaction who are to undergo laser/surgery for ROP. From over 100 babies tested, only one has tested positive so far. Thus the overall rate of positivity in neonates appears to be low and this has been substantiated by other studies as well.[10] Adequate availability of personal protective equipment, extensive COVID-19 testing, and an added layer of protection by barrier devices should encourage more and more ROP specialists to continue providing their services safely to prevent an impending pandemic of preventable childhood blindness.

Blade Segment with a 3D Lattice of Diamond Grits Fabricated via an Additive Manufacturing Process

Diamond tools with orderly arrangements of diamond grits have drawn considerable attention in the machining field owing to their outstanding advantages of high sharpness and long service life. This diamond super tool, as well as the manufacturing equipment, has been unavailable to Chinese enterprises for a long time due to patents. In this paper, a diamond blade segment with a 3D lattice of diamond grits was additively manufactured using a new type of cold pressing equipment (AME100). The equipment, designed with a rotary working platform and 16 molding stations, can be used to additively manufacture segments with diamond grits arranged in an orderly fashion, layer by layer; under this additive manufacturing process, at least 216000 pcs of diamond green segments with five orderly arranged grit layers can be produced per month. The microstructure of the segment was observed via SEM and the diamond blade fabricated using these segments was compared to other commercial cutting tools. The experimental results showed that the 3D lattice of diamond grits was formed in the green segment. The filling rate of diamond grits in the lattice could be guaranteed to be above 95%; this is much higher than the 90% filling rate of the automatic array system (ARIX). When used to cut stone, the cutting amount of the blade with segments made by AME100 is two times that of ordinary tools, with the same diamond concentration. When used to dry cut reinforced concrete, its cutting speed is 10% faster than that of ARIX. Under wet cutting conditions, its service life is twice that of ARIX. By applying the machine vision online inspection system and a special needle jig with a negative pressure system, this study developed a piece of additive manufacturing equipment for efficiently fabricating blade segments with a 3D lattice of diamond grits.

Manejo exitoso de fascitis necrotizante con un sistema de presión negativa artesanal

Necrotizing fasciitis is an acute progressive infection that develops severe systemic toxicity. If this is not treated in a timely manner, it leads to a fatal outcome. The treatment with fluids, antibiotics, and debridement is the basis for management; however, negative pressure systems are positioned at a strategic point for treatment, especially in large areas, such as lower limbs. This is the case of a 17-year-old male with no relevant medical history, who developed extensive necrotizing fasciitis in the inguinogenital region after fasciotomies due to compartment syndrome, in whom a handmade negative pressure system was successfully applied.

Application of the damage control principles and the use of a local negative pressure system for the prevention of infectious complications in a patient with traumatic separation of the upper limb and massive damage to soft tissues

The article presents a clinical case of the successful treatment of a patient with traumatic separation of the upper limb and massive damage to the soft tissues of the upper shoulder and chest. The effectiveness of applying the damage control principles and the method of local negative pressure for the prevention of local and systemic infectious complications is emphasized.

155. Safer way for vertebroplasty under fluid mechanics theory

BACKGROUND CONTEXT Osteoporotic vertebral fractures (OVF) are a hallmark of osteoporosis and are the most prevalent fracture. PURPOSE Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of OVF. However, the matter of which surgical approach should be selected remains controversial. This study aimed to find a safer and better way for patients treated with cement augmentation technique through fluid dynamics theory to prevent cement leakage. STUDY DESIGN/SETTING Randomized controlled trials and biomechanics analysis PATIENT SAMPLE In vitro, 36 standardized osteoporotic porcine vertebrae body series (T10-L3) were developed. In vivo, from January 2015 to December 2018, 68 patients with OVF were randomly assigned to the unilateral puncture group (n=36) or the bilateral group (n=32). OUTCOME MEASURES In vitro, specimens were imaged with plain radiology, mounted on the testing apparatus, and histologic examination. In vivo, these patients underwent percutaneous injection of PMMA into posterior pedicle by the unilateral or bilateral puncture approach. Visual analogue scale (VAS) and the Quality of Life were recorded on presentation, at 1 week, 3, 6, and 12 months after operation. The cement leakage was measured by x-ray and computed tomography scan. METHODS Two different cement augmentation techniques were assessed with polymethyl methacrylate (PMMA) under unilateral vertebroplasty and bilateral vertebroplasty with continuous negative pressure to the contralateral side of the vertebral body. RESULTS The leakage rate was significantly lower in the continuous-negative pressure system than unilateral puncture approach. Excellent cross-filling of bone cement, better stress-resist power, better digitation of cement under histology examination were in negative pressure group. As for patient follow-up data showed there were no significant differences in VAS and QUALEFFO between two groups after PVP between two groups at 3, 6, and 12 months after operation. The cement leakage was higher in the unilateral puncture group than in the bilateral group. CONCLUSIONS Cement injection combined with continuous negative pressure system to the contralateral side of the vertebral body is a simple approach to minimize the risk for leakage. It offers surgeon a more secure and effective way to perform augmentation technique and reduces the likelihood of cement leakage and pulmonary embolism. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Current strategies for the control of COVID-19 in South Korea1

This study sheds light on the current strategies for control of coronavirus-19 (COVID-19) in South Korea in terms of the current status of the 2019 novel coronavirus infection, role of the government, infrastructures preparation, people’s responses, etc. The South Korean government organized a response team in the early stages of the COVID-19 infection to quickly disclose information related to the infection and information regarding those in close contact with infected persons and to carry out a wide range of COVID-19 tests. The South Korean government established and operated a system for sending disaster text messages since 2003. If a virus infection occurs, this system can find all information of confirmed cases such as the infected area, age, gender, close contacts, and route of transmission through GPS tracking of cell phones, CCTV tracking, credit card usage details, and interviews to make it transparent to the people throughout the whole country. South Korea introduced the world’s first “Drive Thru” and “Walking Thru” system to carry out rapid virus testing and hospitalize confirmed cases of COVID-19 at national designated hospitals where the negative pressure system is deployed. Nevertheless, South Korea did not implement a full-scale denied entry for all countries around the world and tried to block the transmission of virus by testing all suspected cases and people who were in close contact with them. In addition, the government managed the supply and sale of masks to allow the entire nation to purchase two masks every week, and most Koreans wore masks without panic and participated in the social distancing campaign.

Smoke evacuation, is it important for prevention of COVID-19?

Smoke evacuation, is it important for prevention of COVID-19?

Impact of acclimatization system on zootechnical performance and thermal comfort in young broiler chickens

Regulating room temperature of poultry houses is frequently difficult for breeders; nevertheless, it is very important that housing provides a comfortable thermal environment for chicks. Therefore, the objective of this work was to compare environmental aspects of two rearing systems in broiler chicks aged 1 to 21 days, as well as batch productivity throughout the production cycle (1-42 days). The experimental design was randomized blocks, with two types of shed: one with a positive pressure system and one with negative pressure system. The average weights at 7, 14, and 21 days were measured, as was final slaughter weight and feed conversion. We found a higher internal temperature in the negative pressure system at 7, 14, and 21 days, and maintaining the birds within the temperature considered ideal for thermal comfort at their ages. Regarding relative humidity, only at 14 days was there a difference between the systems, in which the negative pressure system maintained better humidity than did the positive pressure system. Both systems maintained litter temperature within the recommended range for the chicks’ ages; however, there were differences between the systems on days 7 and 21. Litter moisture showed a difference only at 14 days of age; however, both systems were within the optimal range. Ammonia concentrations in the poultry houses showed no differences between the two types of treatment. There was also no significant difference between the acclimatization systems for drinking water temperature and water consumption. The average weight of the 7-day-old chicks differed between the acclimatization systems, with higher weights in the negative pressure system than in the positive pressure system. We measured higher average slaughter weight and lower feed conversion in broiler chicks raised in the negative pressure system. We conclude that the negative pressure system enhanced the productive performance of chickens and improved thermal comfort.