One-way Valve Research Articles

Outcomes of outpatient treatment for primary spontaneous pneumothorax using a small-bore portable thoracic drainage device.

There is no consensus regarding the initial intervention for primary spontaneous pneumothorax. We report the outcomes of outpatient treatment for primary spontaneous pneumothorax using a portable thoracic drainage device. Between April 2007 and December 2011, 99 consecutive patients with a first episode of primary spontaneous pneumothorax were indicated for insertion of a portable thoracic drainage device. All patients were treated with a small-bore portable thoracic drainage device that consists of a flexible 9F silicone catheter with one-way valves and a small plastic chamber. Successful treatment was defined as when the pneumothorax was resolved after the insertion of a portable thoracic drainage device solely on an outpatient basis. Demographic data and treatment outcomes were obtained by a retrospective chart review. Ninety-seven patients (98%) with a first primary spontaneous pneumothorax were discharged from the emergency department after insertion of a portable thoracic drainage device. Ninety-three patients (94%) resolved with outpatient treatment. The median duration of portable thoracic drainage device insertion was 4 days (range, 0-33 days). The recurrence rate after treatment with a portable thoracic drainage device was 34% (32/93). There were two infections (2.0%), two instances of hemothoraces (2.0%), and one severe discomfort at the insertion site (1.0%). There were no cases of tension pneumothorax or reexpansion edema. Outpatient treatment for primary spontaneous pneumothorax using a portable thoracic drainage device had a high success rate with few serious complications and an acceptable recurrence rate.

Sound-producing voice prostheses: 150 years of research.

Advanced laryngeal cancer sometimes necessitates the removal of the complete larynx. This procedure involves suturing the trachea to an opening in the neck, the most disturbing consequence of which is the loss of voice. Since 1859, several devices have been developed for voice restoration, based mainly on a vibrating reed element. However, the resulting sound is very monotonous and thus unpleasant. Presently the most successful way of voice restoration is the placement of a one-way shunt valve in the tracheo-esophageal wall, thus preventing aspiration and allowing air to flow from the lungs to the esophagus, where soft tissues start to vibrate for substitute voicing. However, the quality of this voice is often poor. New artificial vocal folds to be placed within the shunt valve have been developed, and a membrane-principle concept appears very promising, owing to the self-cleaning construction and the high voice quality. Future developments will include electronic voice sources. Hopefully these developments will result in a high-quality voice, after 150 years of research.

Quantitative assessment of emphysematous parenchyma using multidetector-row computed tomography in patients scheduled for endobronchial treatment with one-way valves†.

To investigate the role of volume quantitative assessment using multidetector-row computed tomography to select patients scheduled for endobronchial one-way valves treatment. Twenty-five consecutive patients (15 with heterogeneous emphysema and 10 with giant emphysematous bulla) undergoing endobronchial valves treatment were enrolled. All patients were studied pre- and postoperatively with standard pulmonary functional tests and quantitative volume assessment of target lobe and entire lung. Emphysematous parenchyma was obtained applying density thresholds of -1.024/-950 Hounsfield units. Among different subtype of patients, we evaluated: (i) the differences between preoperative versus postoperative data; (ii) the correlation between functional and volumetric quantification changes and (iii) the critical threshold value of volumetric quantification of the target lobe in close association with clinical effects. Among heterogeneous emphysematous and giant emphysematous bulla patients, a significant improvement of flow-expiratory volume in 1 s (from 36.9 ± 15.3 to 43.9 ± 10.4; P = 0.01; and from 35.8 ± 6.0 to 47.5 ± 7.9; P < 0.0001, respectively); and of forced vital capacity (from 41.9 ± 5.9 to 47.3 ± 9.3; P = 0.0009 and from 40.7 ± 5.9 to 48.8 ± 4.9; P = 0.0002, respectively); and a significant reduction of residual volume (from 185 ± 14 to 157 ± 14.7; P = 0.005; and from 196 ± 13.5 to 137 ± 21; P < 0.0001, respectively) and of total lung volume (from 166.7 ± 13 to 137 ± 18 ; P = 0.0003, and from 169 ± 15 to 134 ± 18; P < 0.0001, respectively) were seen after treatment. The volumetric measurements showed a reduction of volume of the treated lobe among heterogeneous emphysematous patients (from 1448 ± 204 to 1076 ± 364; P = 0.0008); and in those with giant emphysematous bulla (from 1668 ± 140 to 864 ± 199; P < 0.0001). The entire lung and target lobe volume changes were inversely correlated with change in forced expiratory volume in 1 s in patients with heterogeneous emphysematous (r = -0.7; P = 0.0006; and r = -0.7; P = 0.0009, respectively) and giant emphysematous bulla (r = -0.8; P = 0.001; and r = -0.7; P = 0.009, respectively). Among patients with heterogenous emphysematous and giant emphysematous bulla, the value of sensitivity and specificity were 66.6 and 83%, respectively (for a volumetric qunatification >1.5239), and of 60 and 100%, respectively (for a volumetric qunatification >1.762). Our study showed that the volumetric quantification adds further informations to the routine evaluation for optimizing the selection of patients scheduled for endobronchial valve treatment.

Enabling speech in ICU patients during mechanical ventilation

Dear Editor, Inability to speak during mechanical ventilation (MV) increases psycho-emotional distress during ICU treatment [1]. Although relevant for all ICU patients, this problem becomes more prominent in patients with a prolonged weaning period. One way to enable speech in tracheotomised patients during the weaning period is to alternate MV with time-limited trials of cuff-deflated spontaneous breathing in combination a speaking valve. However, not all patients tolerate such interruptions of MV [2]. Although not commonly used, MV with deflated cuff in tracheotomised patients may be an alternative approach, and has been provided safely and comfortably in selected groups of non-ICU patients [3]. Its use has been associated with improved swallowing and the possibility to speak [4]. However, in daily clinical ICU practise the use of MV under such conditions is limited by multiple ventilator alarms, as a result of air leakage. Furthermore, optimisation of speech is hampered by loss of airflow during open airway MV. We describe our experiences to improve speech in tracheotomised ICU patients during cuff-deflated MV, in combination with a high flow non-invasive ventilator and a one-way tracheostomy speaking valve. In 2013, 24 patients in our mixed medical-surgical ICU were tracheotomised, using a percutaneous dilatation technique. Five patients were able to wean and speak with progressive periods of spontaneous breathing trials. Five patients were weaned from MV without the ability to speak, one patient died within 2 days after the tracheotomy, and one patient had persistent insufficient air leakage around the cannula, despite reduction in cannula size. Table 1 summarizes the characteristics of the remaining 12 patients. Within 24 h after the tracheotomy procedure air leakage was present after deflation of the cuff. Invasive pressure support ventilation was replaced by a BiPAP mode with a non-invasive ventilator (BiPAP Vision®, Philips, Best, the Netherlands) at equal ventilator settings. A minimum PEEP level of 8 cmH2O was maintained in order to prevent rebreathing of CO2. Furthermore, an increasing level of PEEP has been associated with a prolonged duration and improved quality of speech [5]. In case all expiratory flow passed through the oropharyngeal route, a Passy Muir® speaking valve (Passy Muir Inc., Irvine, USA) was installed in the circuit to enhance speech (Fig. 1). All 12 patients were able to speak in the first day after switching to the BiPAP setting, enabling effective communication with relatives and medical personnel. Quality and duration of speech improved over time. Effective weaning from MV was achieved in all patients by progressive intervals of CPAP. During CPAP the ability to speak was similar to that in the BiPAP mode. Median time from the beginning of speech to the end of MV was 12 ± 6 days. Table 1 Patient characteristics Fig. 1 Ventilator setting; Passy Muir® one-way speaking valve in red circle We conclude that in a selected group of difficult-to-wean tracheotomised ICU patients the ability to speak may effectively be restored by cuff-deflated non-invasive BiPAP ventilation in combination with a one-way speaking valve. We encourage intensive care personnel to develop similar weaning protocols, in an effort to improve well-being of ICU patients.

Efficacy of bronchoscopic lung volume reduction: a meta-analysis

BackgroundOver the last several years, the morbidity, mortality, and high costs associated with lung volume reduction (LVR) surgery has fuelled the development of different methods for bronchoscopic LVR (BLVR) in patients with emphysema. In this meta-analysis, we sought to study and compare the efficacy of most of these methods.MethodsEligible studies were retrieved from PubMed and Embase for the following BLVR methods: one-way valves, sealants (BioLVR), LVR coils, airway bypass stents, and bronchial thermal vapor ablation. Primary study outcomes included the mean change post-intervention in the lung function tests, the 6-minute walk distance, and the St George’s Respiratory Questionnaire. Secondary outcomes included treatment-related complications.ResultsExcept for the airway bypass stents, all other methods of BLVR showed efficacy in primary outcomes. However, in comparison, the BioLVR method showed the most significant findings and was the least associated with major treatment-related complications. For the BioLVR method, the mean change in forced expiratory volume (in first second) was 0.18 L (95% confidence interval [CI]: 0.09 to 0.26; P<0.001); in 6-minute walk distance was 23.98 m (95% CI: 12.08 to 35.88; P<0.01); and in St George’s Respiratory Questionnaire was -8.88 points (95% CI: −12.12 to −5.64; P<0.001).ConclusionThe preliminary findings of our meta-analysis signify the importance of most methods of BLVR. The magnitude of the effect on selected primary outcomes shows noninfe-riority, if not equivalence, when compared to what is known for surgical LVR.

Biophysical Studies Reveal New Evidence for One-Way Revolution Mechanism of Bacteriophage ϕ29 DNA Packaging Motor

Biophysical Studies Reveal New Evidence for One-Way Revolution Mechanism of Bacteriophage ϕ29 DNA Packaging Motor

A technique of placing cuffed endotracheal tubes through in situ paediatric laryngeal mask airways.

If tracheal intubation is not possible using direct laryngoscopy, one option is to use a laryngeal mask airway (LMA) through which an endotracheal tube (ETT) can be passed. In children, however, the size of an uncuffed ETT that can pass through the lumen of an LMA is sometimes too small for the trachea, resulting in gas leakage around the ETT. Using a cuffed ETT may reduce the gas leak but withdrawal of the LMA is then prevented by the pilot balloon. In this study, the largest sizes of cuffed and uncuffed Mallinckrodt™ ETTs that could pass with ease through various sizes of paediatric Classic™ and ProSeal™ LMAs were documented. For cuffed ETTs, withdrawal of the LMA was made possible by simply cutting off the pilot balloon. The ETT cuff-inflating mechanism was then repaired by passing a 20 or 22 gauge cannula into the cut end of the inflating tubing. The proximal end of the cannula was then connected to a one-way valve or a three-way stopcock. This technique of cutting off the pilot balloon of the cuffed ETT made it possible to use paediatric cuffed ETTs in exchange for the LMAs tested. The task was easy to perform. Subsequent repair of the cuff-inflation tubing was effective and could withstand high pressures. These findings indicate that it is possible to pass cuffed ETTs through paediatric LMA lumens, which can provide ventilation without gas leaks, unlike uncuffed ETTs.

Clinical challenges of persistent pulmonary air-leaks—Case report

Air leaks are a common problem after pulmonary resection and can be a source of significant morbidity and mortality.The authors describe the case of a 68-year-old male patient who presented with a persistent air-leak after pulmonary resection. Watchful waiting, surgical procedures, as well as medical therapy like pleurodesis and implantation of endobronchial one-way valves on the bronchial segments identified using systematic occlusion of the bronchial segments, were all tried unsuccessfully. During that time the patient remained hospitalized with a chest tube.The instillation of methylene blue through the chest tube was used to identify the segments leading to the persistent air-leak; this enabled successful endobronchial valve placement which sufficiently reduced the size of the air-leak so that the chest tube could be removed.Nonsurgical approaches seem promising and, for some patients may be the only treatment option after all conventional treatments have failed or are considered too high risk.

A unidirectional breathing pattern improves breathing efficiency in subjects with severe COPD.

Unidirectional breathing (UB), nose-in mouth-out (NMB) or vice versa, is thought to create PEEP, stabilize small airways, and increase expiratory flow and exhaled tidal volume (VT) in patients with expiratory obstructive disorders. However, the exact mechanism providing the benefits of UB remains unknown. Our hypothesis was that the benefits of UB are achieved mainly through reduction of upper airway dead space. Sixteen stable COPD patients requiring oxygen use at home were enrolled in this prospective study at a tertiary health care center. A nasal mask and a mouthpiece were used, each having a removable one-way valve to direct the breathing pattern. Four experimentally defined patterns of spontaneous breathing, NMB, mouth-in nose-out (MNB), nose-in nose-out (NNB), and mouth-in mouth-out (MMB), were compared. Each breathing pattern lasted 5 min followed by a 5-min rest period. A NICO device continuously monitored respiratory parameters. The functional anatomical dead space volume (VD) and expired VT values were determined. Breathing efficiency (BE) was calculated as alveolar VT divided by expired volume. Functional anatomical VD was higher in bidirectional breathing (BB) (overall: 207.4 ± 7.9 mL; MMB: 232.5 ± 72.7 mL; NNB: 182.2 ± 75 mL) compared to UB (overall: 178.1 ± 87.2 mL; NMB: 176.9 ± 91.3 mL; MNB: 179.3 ± 83.2 mL) (P < .001). BE achieved with UB (overall: 76.2 ± 6.5%; NMB: 76.8 ± 6.8%; MNB: 75.6 ± 6.3%) was higher than that with BB (overall: 66.2 ± 0.09%; MMB: 64.3 ± 0.10%; NNB: 68.1 ± 0.08%) (P < .001). The difference in BE between UB and BB was more pronounced with small VT values (UB: 73.8 ± 0.08; BB: 49.4 ± 0.09) than with large VT values (UB: 77.3 ± 0.06; BB: 63.0 ± 0.07) (P < .001). Our data suggest that a reduction in functional anatomic VD may be the underlying mechanism for the benefits associated with UB in COPD patients. (ClinicalTrials.gov registration NCT00784004.).

Cantilever Piezoelectric Micro-Pump Modeling Based on Bond Graph Port

Micro-pump is a fundamental component of micro-fluid machine, which has obtained an extensive use in medical care, bio-engineering, and the other fields. Its application will continuously be expanded. Its structure is different from the conventional mechanical pump as its size and flow limit, thus it is difficult to directly apply traditional method to micro-pump modeling. Firstly, the paper introduces the structure of the cantilever piezoelectric micro-pump, in which its input/output can be seen as two separate one-way valves, and its structure can be simplified for a simple beam model. Secondly, presents a port model based on bond graph port analysis, and selects the basic components in order to understand the micro-fluid characteristics of the micro-pump. Finally, gives the result of simulation to obtain the process of the volume change of micro-pump companying with the input pressure and the displacement of deformable film..

Ambulatory management of large primary spontaneous pneumothorax

To the Editor: In a recent issue of the European Respiratory Journal , Massongo et al. [1] reported the results of a prospective study dealing with ambulatory management of primary spontaneous pneumothorax (PSP) using a pigtail catheter with one-way valve in a series of 60 consecutive patients. The authors reported a success rate of 83%, a 1-year recurrence rate of 17% and full outpatient management in 50% of the patients. However, they included …

Awareness of manufacturing defect of the chest drain bottle

Chest tubes and bottles are some of the simplest devices used in medical practice. A chest drain system involves four components: drain tubing, a valve (underwater or flutter valve), a collection chamber, and an optional suction control device [1]. The classic underwater drainage system requires a bottle connected by tubing. The bottle provides the collection chamber. Fluid and air can egress from the tube. The vacuum produced by inhalation draws fluid into the tubing, but does not allow air to be re-introduced into the pleural cavity. The intrapleural vacuum can be countered by the application of suction to the third bottle, the suction control. In addition to the afferent and efferent tubes, the suction control bottle has a third tube open to air. The depth the tube penetrates below the fluid level determines the degree of suction. The water seal chamber acts as a one-way valve. We wish to share an undesirable situation that we faced concerning a manufacturing defect of a chest tube bottle. The chest drainage system comprised a 2000ml bottle and tube which formed part of a one-piece system. In this particular instance, the chest tube bottle of a patient who had undergone decortication had been planned to be changed in the usual way. We changed the filled bottle but, unfortunately, we failed to notice the defect in its replacement. Soon after, continuous bubbling was seen in the bottle. Until now, we had never come across such a manufacturing defect (Figure 1). None of the other chest drains have had any problem. The defect has since been reported. We therefore conclude that everyone involved in chest tube management should pay attention to checking the tubes and the bottles each time before their use.

Ambulatory management of primary spontaneous pneumothorax: the good is (not always) the enemy of the better (evidence)

Pneumothorax is defined as the presence of air in the pleural cavity. A pneumothorax might occur spontaneously in patients without underlying lung disease (primary spontaneous pneumothorax (PSP)) or in patients with an underlying lung disease (secondary spontaneous pneumothorax), most commonly chronic obstructive pulmonary disease. The underlying cause of spontaneous pneumothorax is likely to be the rupture of “emphysema-like changes” (small bullae or blebs) on the pleural surface, which allows air from the lung into the pleural space. Smoking, male sex and height are the major risk factors for the development of a PSP. There is evidence of a pleural inflammatory reaction in patients with PSP, involving an increase in eosinophils and neutrophils as well as elevated inflammatory cytokines compared with blood levels [1]. From an epidemiological point of view, PSP remains a significant health problem, with an annual incidence of 18–28 per 100 000 in males and 1.2–6.0 per 100 000 in females [2, 3]. Primary therapeutic goals for PSP include removal of air from the pleural space and prevention of recurrences. Air evacuation may be achieved by simple manual needle aspiration, by a small bore tube or a conventional chest tube, the tubes being attached to a one-way valve or to a water-seal device, with or without active suctioning [4]. The treatment of PSP would lend itself well to ambulatory management, since patients are usually young, without relevant comorbidities, and the condition itself caries a low morbidity and mortality [5]. Furthermore, outpatient-orientated treatment rather than hospitalisation might be favoured by many patients and would substantially reduce health-cost expenses. Unfortunately, however, the adherence to recommendations of outpatient management of patients with PSP in clinical practice is rather low [5, 6]. The lack …

Exceptional Heterogeneous Elasticity and One-Way Valve Mechanism of the PHi29 Head-Tail Connector

The bacteriophage Φ29 DNA packaging motor, comprising ATPase, pRNA and head-tail connector, transports viral DNA inside the prohead against a maximum pressure of ∼60 atm. Two recently discussed transport models, push-and-roll (Yu et al. 2010) and one-way-revolution (Zhao et al. 2013), propose that the ATPase pushes the DNA directly into the procapsid; additionally, the latter model postulates that the connector acts as a one-way valve and restricts DNA leakage by specific loop interactions (residues N229-N246). Here, we focus on the connector's role in translocation and how it affects DNA conformation. Specifically, how such a one-way valve withstands the large pressure difference and how the connector loop-residues affect the function. To address these questions, we performed equilibrium and force-probe molecular dynamics simulations of the connector with and without DNA. We observe that the connector deforms DNA, which untwists, over-twists and compresses. Remarkably, comparison of the obtained DNA compression with FRET-FCS measurements of the T4 bacteriophage motor (Ray et al. 2010), revealed to be common characteristic of the head-tail bacteriophages. Further, the Young's modulus of the connector central region is comparable to that of structural proteins like collagen, and the obtained heterogonous connector stiffness resembles composite materials. These exceptional elastic properties enable the connector to withstand both longitudinal and lateral pressure generated by the packed DNA and the procapsid, respectively. Furthermore, pushing the DNA into the procapsid requires less force than pulling it out. Upon three loop-residue mutations (K234A.K235A.R237A), the required forces for pushing and pulling become similar, which supports the residues' essential role in the one-way-valve function. Our results corroborate the connector's one-way valve function, whereas rotation and/or revolution motions of DNA proposed in both models remain open for future investigation.

Anisotropic Janus Si nanopillar arrays as a microfluidic one-way valve for gas–liquid separation

In this paper, we demonstrate a facile strategy for the fabrication of a one-way valve for microfluidic (MF) systems. The micro-valve was fabricated by embedding arrays of Janus Si elliptical pillars (Si-EPAs) with anisotropic wettability into a MF channel fabricated in poly(dimethylsiloxane) (PDMS). Two sides of the Janus pillar are functionalized with molecules with distinct surface energies. The ability of the Janus pillar array to act as a valve was proved by investigating the flow behaviour of water in a T-shaped microchannel at different flow rates and pressures. In addition, the one-way valve was used to achieve gas-liquid separation. We believe that the Janus Si-EPAs modified by specific surface functionalization provide a new strategy to control the flow and motion of fluids in MF channels.

Improvised arrangement of aerosol delivery to the ventilator dependent patient.

Sir, The patients supported by invasive mechanical ventilation (IMV) often require aerosol therapy for bronchodilators and inhaled corticosteroids. Mucolytics, antibiotics and other medications can also be given by this method.[1] Aerosol therapy is indicated in these patients for management of asthma, bronchospasm, increased airway resistance, intrinsic positive end-expiratory pressure, difficult to wean, and ventilator dependent patients. Aerosol therapy helps in reducing work of breathing by decreasing pulmonary dynamic hyperinflation and resistance of the respiratory system.[2] Effective delivery of aerosol to the lungs depends on formulation of drug, aerosol generator, and technique of administration. Various devices are used to generate aerosol, but pressurized metered-dose inhaler (pMDI) and nebulizers are the most commonly used in patients supported by IMV. The commonly used nebulizers are the jet and the ultrasonic devices. Vibrating mesh nebulizers and intratracheal nebulizing catheters are newer aerosol generating devices. These devices are connected to the inspiratory limb of the ventilator circuit by specific adaptors attached to the artificial airway. Several ventilator parameters also affect the effective delivery of aerosol to the patient. pMDI require a specific adaptor, a spacer and synchronization with ventilator for effective delivery of aerosol. If properly administered pMDI and nebulizers are equally effective in delivery of aerosol therapy to the mechanically ventilated patients although using nebulizers is the common practice. Jet nebulizers use a jet of compressed air or oxygen, while ultrasonic nebulizers use piezo-electric crystals vibrations to produce aerosol. New vibrating mesh nebulizers use a vibrating mesh or plate with multiple apertures to generate aerosol. Jet nebulizers are cost-effective and easy to use and adding a reservoir between jet nebulizer and endotracheal tube increases aerosol delivery. Some new generation ventilators have an in-built mechanism for supporting the jet or ultrasonic nebulizers. These ventilators synchronize inspiratory flow and volume to activate the jet nebulizer intermittently during inspiration.[3] Over a period of time, these compatible jet nebulizers tend to be damaged or lost. Many ventilators are not compatible with jet nebulizers or newer aerosol therapy devices. In these situations, often a jet nebulizer operated by compressed oxygen from wall system or cylinder, is attached to the inspiratory limb of breathing circuit. A minimum flow of 6-8 L is required to generate the aerosol. The volume added by this method can affect ventilator parameters and can be very harmful, especially to the pediatric patients who have small lung volumes. Self-inflating manual resuscitator is a breathing system that uses nonrebreathing unidirectional valves. A pressure limiting device is present near inspiratory valve to prevent barotrauma in all infant/child and some adult manual resuscitators. There is a connection port to attach a reservoir bag at the bag inlet.[4] In this improvized arrangement, a T-adaptor with jet nebulizer assembly is attached to the above mentioned connection port [Figure 1]. A one-way valve [Direction, Figure 1] is attached to the free end of the T-adaptor to prevent aerosol loss and direct airflow to the bag inlet when it is re-expanding. Presence of resuscitation bag next to the jet nebulizer and addition of 3-4 mL of normal saline to the drug can help in effective delivery of aerosol. The tidal and minute volumes can be controlled manually to deliver aerosol safely to the ventilator dependent patients where compatible aerosol device is not available. Figure 1 Improvized arrangement

Study of thermal properties, toxicity emissions and rebreathing avoidance as exogenous stressors of sudden infant dead syndrome in baby mattresses. Design recommendations

Introduction Sudden Infant Death Syndrome (SIDS) is the highest cause of death in the post- neonatal period. According to the Triple Risk Model (Kinney et al., 2009), SIDS results when three factors simultaneously influence the infant: (a) an underlying vulnerability in the infant, (b) a critical developmental period, and (c) an exogenous stressor. Considering exogenous stressor evidences, the objectives were: to determine the thermal behavior of current baby mattresses, to test improvements reached by new materials, to confirm the viability to design harmfulness mattresses according to Oeko-tex, to confirm that rebreathing of exhaled air is above the safety threshold concluding with a design criteria including the properties mentioned above. Materials and methods Thermal test It was used a thermal mannequin ST-2 made by Measurement Technology Northwest. Test specimens were: (1) spring mat.-foam-textile cover sewed. (2) Fiber mat.-foam 3d textile. (3) PU mat. core low density PU-PVC cover. (4) PU Mat. core with low density PU. (5) Babykeeper®mat. core. (6) Babykeeper®mat. core-3D foam textile. (7) Babykeeper®mat. core-Smart textile. Toxicity and Rebreathing test Oekotex test was performed by AITEX following label standards. To study rebreathing avoidance an infant mannequin was simulated as a head box which was placed with its open face on the mattress and connected with tubing to a gas reservoir filled with 5% CO2. Also it was used 50 cc syringe with two one-way valves which simulates infant breathing. Finally a CO2 analyzer was placed in the head box (tested by Bar-Yishay Phd). Both tests were executed to confirm liability of new materials: spec. 2 and 7. Results Thermal Test Results (Test Specimen (Temperature average last 30 min, Thermal Resistance Rt (C m2/W)): 1: (38.4oC, 3.2) 2: (40.1oC, 3.34) 3: (38.4oC, 3.2) 4: (38.1oC, 3.17) 5: (37.2oC, 3.1) 6: (38.5oC, 3.20) 7: (38.3oC, 3.19) Oekotex: Not toxic class1; and Rebreathing results (specimen (Max CO2(%),Time to reach plateau (sec)): Fiber core with 3D Foam (4.36 ± 0.11, 324 ± 1.4) Babykeeper®mat. (3.35 ± 0.14, 298 ± 19) In this sense both systems had a significantly faster rate of CO2 elimination (4–5 min) compared to 15–18.7 min. for other mattresses (P Conclusion As a conclusion design recommendation are: RT Acknowledgements Authors give thanks to IBV and AITEX for collaboration during laboratory test.

Clinical challenges of persistent pulmonary air-leaks—Case report

Air leaks are a common problem after pulmonary resection and can be a source of significant morbidity and mortality.The authors describe the case of a 68-year-old male patient who presented with a persistent air-leak after pulmonary resection. Watchful waiting, surgical procedures, as well as medical therapy like pleurodesis and implantation of endobronchial one-way valves on the bronchial segments identified using systematic occlusion of the bronchial segments, were all tried unsuccessfully. During that time the patient remained hospitalized with a chest tube.The instillation of methylene blue through the chest tube was used to identify the segments leading to the persistent air-leak; this enabled successful endobronchial valve placement which sufficiently reduced the size of the air-leak so that the chest tube could be removed.Nonsurgical approaches seem promising and, for some patients may be the only treatment option after all conventional treatments have failed or are considered too high risk.

S121 Assessment of interlobarcollateral ventilation prior to endobronchial valves treatment for severe emphysema

Bronchoscopic lung volume reduction (BVLR) with one-way endobronchial valves are employed to reduce hyperinflation to improve symptoms and lung function. The clinical benefits of Zephyr (PulmonX) valves in achieving target...

Benigne subkutane Emphysembildung durch einen Falten-Blasebalg-Mechanismus der ersten Zwischenfingerfalte

We report 2 cases of subcutaneous emphysema after stab wounds of the first interdigital space. The first diagnosis of a gas gangrene was not confirmed. We hypothese an air incorporation caused by a bellows mechanism. An escape of the air may not be possible due to an one-way valve mechanism. The aim of this report is to describe criteria to distinguish benign emphysema from emphysema caused by infection.