Period Of Ventilation Research Articles

Effects of Variable Ventilation on Gas Exchange in an Experimental Model of Capnoperitoneum: A Randomized Crossover Study.

The rapid advancement of minimally invasive surgical techniques has made laparoscopy a preferred alternative because it reduces postoperative complications. However, inflating the peritoneum with CO2 causes a cranial shift of the diaphragm decreasing lung volume and impairing gas exchange. Additionally, CO2 absorption increases blood CO2 levels, further complicating mechanical ventilation when the lung function is already compromised. Standard interventions such as lung recruitment maneuvers or increasing positive end-expiratory pressures can counteract these effects but also increase lung parenchymal strain and intrathoracic pressure, negatively impacting cardiac output. The application of variability in tidal volume and respiratory rate during mechanical ventilation to mimic natural breathing has shown benefits in various respiratory conditions. Therefore, we aimed to evaluate the short-term benefits of variable ventilation (VV) on gas exchange, respiratory mechanics, and hemodynamics during and after capnoperitoneum, compared to conventional pressure-controlled ventilation (PCV). Eleven anaesthetized rabbits were randomly assigned to PCV or VV. Oxygenation index (Pao2/FiO2), arterial partial pressure of carbon dioxide (Paco2), and respiratory mechanical parameters were assessed after a 15-minute-long ventilation period before, during, and after capnoperitoneum. According to a crossover design, after measurements at the 3 different stages, the ventilation mode was changed, and the entire sequence was repeated. Capnoperitoneum compromised respiratory mechanics, decreased oxygenation, and caused CO2-retention compared to baseline measurements under both ventilation modalities (P < .05, for all). Application of VV resulted in lower Pao2/FiO2 (405. 5 ± 34.1 (mean ± standard deviation [SD]) vs 370. 5 ± 44.9, P < .001) and higher Paco2 (48. 4 ± 5.1 vs 52. 8 ± 6.0 mm Hg, P = .009) values during capnoperitoneum compared to PCV. After abdominal deflation and a lung recruitment maneuver, VV proved more beneficial for CO2 removal than PCV (41. 0 ± 2.3 vs 44. 6 ± 4.3mmHg, P = .027). No significant difference was observed in the respiratory mechanical or hemodynamic parameters between the ventilation modalities under the same conditions. The detrimental effects of capnoperitoneum on gas exchange were more pronounced with VV. However, after the release of capnoperitoneum, VV significantly improved CO2 clearance. Therefore, VV could possibly be considered as an alternative ventilation modality to restore physiological gas exchange after, but not during, capnoperitoneum.

EFFECTIVENESS OF POSITIVE REMINISCENCE GROUP THERAPY ON DEPRESSION, SELF-ESTEEM AND LONELINESS AMONG ELDERS

Background of the studyThe increase in the relative and absolute number of older people in our society has posed a major challenge for both individual and collective levels in the study of aging. It had appeared various contributions, at the individual level, extending the biological perspective of disease and disability with a more positive and comprehensive one, covering the social and behavioral sciences to reduce the risk of adverse events and improve the resilience of the seniors and make changes in their immediate surroundings.At the population level, aging is seen as a challenge that involves, in addition, challenges such as the double burden of disease, increased risk of disability, having to provide adequate care for the aging population, addressing inequalities, economic challenges, and having a different view of aging and old age.Methodology:The study method included quantitative research, Quasi experimental design where Pre and post-test with equivalent control group design, a population comprises all elderly people residing in the selected old age homes, 400 samples chosen for the study, and a purposive sampling methodology was utilized for the study. Three tools were used to evaluate depression, loneliness and self-esteem among elders. Before data collection, the tool was tested and certified by seven professionals. Permission was taken from concern old age homes and consent was taken from elders. Elderly were asked to rate items against depression, self-esteem and loneliness questions followed by positive reminiscencegroup therapy went on for a month and post was conducted after one month. ResultsElderly from experimental group in depression score pretest 14.45 and posttestmean 9.58 and mean difference was 3.304. The obtained t- test value was 21.576 which shows statistical significance at p&lt;0.05. in self esteem score pretest 22.6 and posttest mean 30.26 and mean difference was 7.66. The obtained t- test value was 28.247 which shows statistical significance at p&lt;0.05. in loneliness score pretest 30.73 and posttest mean 20.86 and mean difference was 9.87. The obtained t- test value was 24.717which shows statistical significance at p&lt;0.05.In experimental group, in depression in post test maximum were 110 (55) mild depression, in self esteem maximum 164 (52) moderate self esteem, in loneliness maximum were 105 (52.5) moderate loneliness. In correlation there is weak positive correlation found between depression and self-esteem, Strong Positive correlation found between depression and loneliness and similarly Very strong positive correlation found between self-esteem and Loneliness. ConclusionReminiscence group therapy is an effective therapy for reduction of depression and loneliness and elevation of self-esteem in elderly. Further research and an improvement in methodological quality, such as using qualitative and mixed methods approaches, is recommended to help establish an evidence base and provide better understanding of the effectiveness of group reminiscence therapynical ventilation period of the patients hospitalized in the ICU had a positive effect on physiological responses..

THE EFFECT OF NATURE SOUND AND CULTURAL MUSIC ON PHYSIOLOGICAL RESPONSES DURING MECHANICAL VENTILATION PERIOD IN INTENSIVE CARE UNIT PATIENTS

Objective: This study was carried out to evaluate the effects of nature sound and cultural music (folk song) performed during the mechanical ventilation period of the patients hospitalized in the intensive care surgery department (surgical intensive care unit) on blood pressure, heart rate, respiration, saturation and pain scores.Material and Method: This study was designed as a semi-experimental research with pre-test - post-test control group.Data were collected between October 1, 2019 and March 31, 2020. Three groups were made in the study. During the treatment process, 30 patients were made to listen to nature sounds, 30 to cultural music (instrumental folk songs), while 30 patients were not made to listen to anything and the treatment was applied in this way.In the study, Patient Diagnosis and Evaluation Form,Critical Care Pain Observation Tool, Evaluation Form for the Physiological Conditions of Patientswere used, and Nature Sound and Cultural Music (Turkish Folk Music) were listened in the study. Data were evaluated in SPSS (for Windows 25.0)Results:Considering the total scores according to the Critical Care Pain Observation Tool there was no significant difference before listening to music and 1 hour after listening to music (p&gt;0.05), while there was a statistical difference 2 hours after listening to music (p &lt;0.05). It was determined that the difference was due to the patients listening to folk music. Considering the physiological responses of the patients, while the mean arterial pressure did not change in the group that listened to nature sound and cultural music before and 2 hours after the music, the mean arterial pressure increased in the control group. Conclusion: As a result, it was observed that listening to nature sound and cultural music during the mechanical ventilation period of the patients hospitalized in the ICU had a positive effect on physiological responses.

Reevaluating 30 cmH2O endotracheal tube cuff pressure: risks of airway mucosal damage during prolonged mechanical ventilation.

The optimal endotracheal tube (ETT) cuff pressure remains contentious. In the traditional consideration that the level 30 cmH2O is considered safe, balancing the prevention of reflux aspiration against airway mucosal damage. Whether this pressure level can cause potential damage to the airway mucosa remains to be discussed. Airway mucosa damage and structural changes at 30 cmH2O were examined in patients under general anesthesia and in rabbit mechanical ventilation models. Prior to this, we also interviewed some anesthesiologists about the level of concern about ETT cuff pressure. A total of 634 valid questionnaires suggested that anesthesiologists generally do not pay enough attention to ETT cuff pressure and the average established cuff pressure significantly exceeded 30 cmH2O. Airway mucosa images of 100 general anesthesia patients with different ventilation duration indicated that maintaining the pressure at 30 cmH2O did not cause significant damage to airway mucosa in a short period of time, while it still caused damage to airway mucosa in patients with long-term ventilation, with damage severity increasing with longer ventilation periods. This correlated strongly with postoperative sore throat (R 2 = 0.3884, p < 0.001). In rabbits, 4 h of ventilation at this pressure resulted in significant loss of ciliated epithelium and inflammation. Calculations suggested an effective dose (ED50) to prevent mucosal injury at a cuff pressure of 25.64 cmH2O (95% CI: 19.268-29.367 cmH2O). The currently established cuff pressure of 30 cmH2O is associated with airway mucosal damage in both clinical and animal models. Lowering the safety threshold of cuff pressure may be necessary to mitigate mucosal injury.

Monitoring CO 2 , CO and CH 4 , affected or not by ventilation and anthropogenic activities, in the galleries of the Underground Research Laboratory (URL) of Meuse/Haute-Marne

The alternation between periods of ventilation and non-ventilation of the galleries in the Meuse/Haute-Marne Underground Research Laboratory (URL) within the Callovian–Oxfordian argillaceous rock affects the contents of CO 2 , CO and CH 4 in atmospheric air. Monitoring the evolution of the gas composition in the galleries was conducted over a period of about 4 months. Two models of IR laser spectroscope (Picarro) were used, one to measure CO 2 , CO and CH 4 concentrations and the other to measure CH 4 isotopic compositions. The results show a night and day periodicity with the highest concentrations at night-time and the lowest during the daytime in the URL. Long-term monitoring of these gases at the surface shows the same evolution, but with different amplitudes. Moreover, in the URL, a weekday and weekend or holiday periodicity were superimposed. The concentrations of CO 2 in the galleries are influenced by human activities and ventilation. During working days, the galleries are ventilated, and human activities increase the CO 2 concentrations. Conversely, during weekends and holidays, CO 2 concentrations decrease owing to the cessation of ventilation and human activities, and consumption of CO 2 by concrete carbonation. The data analysis confirms a CH 4 source from the rock and reveals compelling evidence of CO sources that probably originate from rock and/or gallery engineered structure materials. Despite the difficulties in quantifying local sources and sinks of these gases, this study demonstrates the feasibility of obtaining valuable insights into their variability. This study provides information on potential sources and sinks of CO 2 , CO and CH 4 in this context.

Transvenous phrenic nerve stimulation reduces diaphragm injury during controlled mechanical ventilation in a preclinical model of ARDS.

Patients with acute respiratory distress syndrome (ARDS) require periods of deep sedation and mechanical ventilation, leading to diaphragm dysfunction. Our study seeks to determine whether the combination of temporary transvenous diaphragm neurostimulation (TTDN) and mechanical ventilation changes the degree of diaphragm injury and cytokines concentration in a preclinical ARDS model. Moderate ARDS was induced in pigs using oleic acid, followed by ventilation for 12 h post-injury with volume-control at 8 mL/kg, positive end-expiratory pressure (PEEP) 5 cmH2O, respiratory rate and [Formula: see text] set to achieve normal arterial blood gases. Two groups received TTDN: every second breath (MV + TTDN50%, n = 6) or every breath (MV + TTDN100%, n = 6). One group received ventilation only (MV, n = 6). Full-thickness diaphragm and quadricep muscle biopsies were taken at study end. Samples were fixed and stained with hematoxylin and eosin and a point-counting technique was applied to calculate abnormal muscle area fraction. Cytokine concentrations were measured in homogenized tissue using porcine-specific enzyme-linked immunosorbent assay (ELISA) and compared with serum samples. Percentage of abnormal diaphragm tissue was different between MV [8.1% (6.0-8.8)] versus MV + TTDN50% [3.4% (2.1-4.8)], P = 0.010 and MV versus MV + TTDN100% [3.1% (2.5-4.0)], P = 0.005. Percentage of abnormal quadriceps tissue was not different between groups. Cytokine concentration patterns in diaphragm samples were different between all groups (P < 0.001) and the interaction between TTDN application and resultant cytokine concentration pattern was significant (P = 0.025). TTDN, delivered in synchrony with mechanical ventilation, mitigated diaphragm injury, as evidenced by less abnormal tissue in the diaphragm samples, in pigs with oleic acid-induced ARDS and is an exciting tool for lung and diaphragm-protective ventilation.NEW & NOTEWORTHY This study adds to our understanding of applying transvenous diaphragm neurostimulation synchronously with mechanical ventilation by examining its effects on diaphragm muscle injury and cytokine concentration patterns in pigs with acute respiratory distress syndrome (ARDS). We observed that using this therapy for 12 h post lung injury mitigated ventilator-induced diaphragm injury and changed the pattern of cytokine concentration measured in diaphragm tissue. These findings suggest that transvenous diaphragm neurostimulation is an exciting tool for lung and diaphragm protective ventilation.

Neutralization and CO2 fixation behavior of alkaline recycled soil using column tests with CO2 ventilation

AbstractColumn tests were conducted to elucidate the pH neutralization and CO2 fixation behavior of alkaline recycled soils permeated with CO2. The ventilation period required for complete CO2 fixation (tEOF) was estimated from the test results of each column. The maximum amount of CO2 captured per gram of dry soil ((mCO2)max) was determined based on the inflow and outflow of CO2 for each specimen. The investigation into the effects of soil density, specimen height, CO2 gas concentration, and flow rate on tEOF and (mCO2)max revealed that tEOF increased with higher dry density (ρd) or specimen height (H), as a denser and larger specimen consumed more CO2 gas. Conversely, tEOF decreased with a higher CO2 gas concentration (C) or flow volume (Q) because a low C or Q resulted in an insufficient CO2 gas supply to match the consumption induced by the reaction. Lower C and Q tended to yield higher (mCO2)max, whereas higher ρd and H resulted in higher (mCO2)max. Furthermore, (mCO2)max increased with tEOF, with a slight reduction in pH after neutralization with increased tEOF. This phenomenon was attributed to the longer ventilation period enabling more Ca to react with the CO2 gas and maintain the equilibrium state of the reaction. Finally, the evaluation of the CO2 consumption rate (CSR) for each column specimen revealed that a higher C and Q resulted in a lower CSR, whereas a higher H resulted in a higher CSR. Additionally, a longer tEOF was associated with a higher CSR, although some variation was observed.

The impact of intravenous metoprolol tartrate on mortality rates in patients with septic shock due to ventilator-associated pneumonia: A randomized clinical trial

Background: Septic shock, particularly due to ventilator-associated pneumonia (VAP), is a significant cause of mortality in critically ill patients. Traditional treatments include antimicrobial therapy, fluid resuscitation, and vasopressors. However, recent interest has emerged in using β-blockers to modulate the hyperadrenergic state seen in sepsis. β-blockers, like metoprolol, may improve cardiac efficiency, reduce myocardial oxygen demand, and ultimately enhance patient outcomes. Objective: This study aimed to assess the impact of administering intravenous metoprolol tartrate on the mortality rates of patients with septic shock due to VAP. Methods: This study employed a randomized clinical trial design within the Intensive Care Units of Alexandria Main University Hospital. A cohort of 100 patients diagnosed with septic shock due to ventilator-associated pneumonia (VAP) participated in the trial. Upon achieving hemodynamic stabilization, participants were randomly assigned to either receive standard care alone or standard care supplemented with intravenous metoprolol. Variables of interest included assessing 28-day mortality rates, duration of ICU stay and mechanical ventilation, reliance on intravenous fluids and vasopressors, acid-base balance, lactate levels, inflammatory markers, and mean arterial pressure (MAP). This comprehensive approach aimed to evaluate the impact of metoprolol on critical outcomes in this patient population. Results: The administration of intravenous metoprolol tartrate resulted in significant clinical benefits, including lower 28-day mortality rates (P = 0.013), shortened durations of ICU stay (P &lt; 0.001), and reduced mechanical ventilation periods (P &lt; 0.001). These outcomes were explained by the observed decreased reliance on intravenous fluids and vasopressors (P &lt; 0.001), improved acid-base balance and lactate levels. The rapid reduction of inflammatory markers (P &lt; 0.001) and the sustained improvement of MAP in the metoprolol group compared to the control group further contributed to the explication of these findings. Conclusion: Intravenous metoprolol tartrate effectively controlled inflammation, optimized hemodynamics, and improved patient outcomes compared to standard care, suggesting it as a beneficial adjunct in the management of septic shock. Trial registration: PACTR202404531355476. Keywords: Metoprolol; septic shock; ventilator-associated pneumonia; beta-blockers; mortality.

Sleep apnea physiological burdens and markers of white matter injury: the Multi-Ethnic Study of Atherosclerosis.

Obstructive sleep apnea (OSA) is associated with cognitive impairment; however, the underlying mechanisms remain incompletely understood. OSA is characterized by periods of interrupted ventilation ("ventilatory burden (VB)"), leading to hypoxemia ("hypoxic burden (HB)") and/or arousal ("arousal burden (AB)") from sleep. While hypoxemia is considered a key mechanism underlying white matter injury, its measurement has been limited. In our primary analysis, we assessed the association of HB, a quantitative measure of hypoxemia, with white matter hyperintensity volume (WMHv), a marker of small vessel disease, and compared with that of VB and AB (quantitative measures of ventilatory deficit and arousals). Data from participants in the Multi-Ethnic Study of Atherosclerosis with full polysomnograms (PSG) and brain MRI were analyzed. HB was defined as the total area under the oxygen desaturation curve per hour of sleep, while VB was defined as the event-specific area under the ventilation signal and AB was defined as the normalized cumulative duration of all arousals. The primary outcome was WMHv, with other MRI measures considered secondary outcomes. The analysis included PSGs from 587 participants (age: 65.5±8.2 years). In the fully adjusted model, each 1 standard deviation (SD) increase in HB was associated with a 0.09 SD increase in WMHv (p=0.023), after adjusting for demographics, study site, and comorbidities. In contrast, VB, AB, and conventional OSA measures were not associated with outcomes. Hypoxic burden was associated with white matter hyperintensity volume in a racially/ethnically diverse cohort of older individuals with a high prevalence of OSA.

Use of prototype bi-nasal prongs for noninvasive ventilation in foals.

Noninvasive ventilation (NIV) provides effective respiratory support in foals, but face masks are poorly tolerated and associated with hypercapnia. Bi-nasal prongs might be a more effective device interface in foals. To compare bi-nasal prongs and masks for NIV in foals with pharmacologically induced respiratory insufficiency. Six healthy foals. In a randomized cross-over study, sedated foals received NIV delivered by mask or bi-nasal prongs, with the treatment repeated using the alternative device interface after a 3-day rest period. After periods of spontaneous ventilation through the allocated interface, with and without supplementary O2 (T2-T3), foals were subject to 10-minute treatment periods of NIV at different pressure support (5 or 10 cmH2O) and end-expiratory pressure settings (5 or 10 cmH2O), with and without supplementary O2 (T4-T7). Vital signs, arterial blood gases, spirometry, and gas exchange data were measured in the final 2 minutes of each treatment window. Bi-nasal prongs were well tolerated and required less manual positioning or monitoring compared to the mask. Partial pressure of carbon dioxide did not increase during NIV with bi-nasal prongs and was lower than observed with masks (mean difference, 8.2 mmHg [95% confidence interval, 4.1-12.2 mmHg] at T6). Oxygenation and respiratory mechanics were improved in all foals and not different between device interfaces. Nasal prongs were well tolerated, had similar effects on respiratory function, and appeared to ameliorate hypercapnia observed previously during NIV in foals.

Research on an adaptive prediction method for restaurant air quality based on occupancy detection

This study evaluates the impact of personnel on air quality in air-conditioned restaurant environments during winter, summer, and transitional seasons, characterized by the peculiarities of personnel movement, high concentration of personnel in a short period of time, poor ventilation and high personnel density, leading to the accumulation of pollutants that can severely damage personnel health. This study examines carbon dioxide (CO2) and particulate matter (PM) concentrations and proposes an online adaptive model for their prediction.Environmental influence factors are analyzed through correlations of measured data, and appropriate input parameters (time-lagged cumulative number of people) are selected. The Auto-Regressive with Exogenous Inputs (ARX) model is used to predict the change of air quality with the movement and number of people, compared with classical models (LR, DT, SVM, ENS, GPR, NN, VARX). Results show that the ARX model performs excellently in predicting restaurant environments; the effect of different environmental factors on the predictive effectiveness of the model was also explored. When combined with real-time sensor data and AIC-based adaptive optimization, the prediction accuracy is further improved by more than 25 %. The R2 of the ARX model is 0.9549, the MAE is 0.8352 μg/m3 and the MAPE is 3.17 %. The adaptively optimized model can be adapted to different environments, overcoming the problem of poor adaptability of such models. Our results enable effective environmental control strategies in public spaces, contributing to Sustainable Development Goal (SDG) 3: Good Health and Well-being by reducing health risks associated with indoor air pollution.

Placement of the feline V-gel Advanced supraglottic airway device and tracheal selectivity during controlled mechanical ventilation: a clinical and tomodensitometric evaluation.

The aims of the study was to assess the placement of the V-gel Advanced (V-gel-A) and to evaluate tracheal selectivity during controlled mechanical ventilation, using CT. In this prospective clinical study, 20 healthy cats undergoing general anaesthesia for an elective procedure underwent four successive CT scans from the nose to the mid-abdomen: at baseline (no device); after the placement of the V-gel-A, after a controlled mechanical ventilation (CMV) period of 5 mins; and after the placement of an endotracheal tube (ETT). Using both a purpose designed position score and a gas score estimating the quantity of gas in different digestive regions, the position of the V-gel-A and presence of gas in the digestive tract at each step were evaluated. Number of attempts and times required to place the V-gel-A and ETT were recorded and compared. The V-gel-A was found to be correctly placed, with position scores of 3/5 in six cats, 4/5 in 13 cats and 5/5 in one cat. Imperfect positioning was due to minor axial rotation or incomplete occlusion of the oesophagus by the tip of the device. The gas scores significantly increased after placement of the V-gel-A compared with baseline and after CMV was initiated. Correct positioning of the device was mostly achieved at the first attempt; no significant difference was found in the time required to place V-gel-A vs ETT, nor in the number of attempts (P >0.05). The V-gel-A was clinically easy to place and use in both spontaneous and controlled ventilation. The device properly fitted the larynx and was never observed to occlude the airway. However, incomplete occlusion of the oesophagus was frequently observed and may lead to a lack of complete tracheal selectivity.

Air pollutant removal performance using a BiLSTM-based demand-controlled ventilation method after tunnel blasting

Efficient tunnel ventilation is essential for ensuring construction safety and protecting personnel health during tunnel construction. This study proposes a demand-controlled ventilation (DCV) method on the basis of deep learning algorithm to both improve pollutant removal efficiency and reduce energy consumption. The DCV method utilizes a two-layer bidirectional long short-term memory algorithm (BiLSTM) to predict pollutant concentrations. The air volume is dynamically adjusted based on the gaseous pollutant removal requirements. The coefficient of ventilation performance (COVP) is proposed to evaluate the performance of two ventilation methods (DCV and constant air-volume ventilation (CAV)) through computational fluid dynamics (CFD) simulations. The results show that the DCV results in a lower maximum average CO concentration and higher removal efficiency in the heading area (372.3 mg/m3) than the CAV does (404.1 mg/m3). The fan's energy consumption of DCV is 64.6% lower than that of CAV during a 1000 s ventilation period. The COVPs for both methods exhibit temporal variation and achieves their maximums (2.25 for DCV and 0.741 for CAV) after reaching the constraint conditions (air volume threshold). The DCV method expedites pollutant elimination, reduces construction waiting period, and minimizes energy consumption, providing a novel application of a deep learning algorithm in construction engineering.

Posttraumatic hydrocephalus as a complication of decompressive craniectomy-same old story, new perspectives.

Decompressive craniectomy (DC) serves as a vital life-saving intervention, demonstrating efficacy in reducing intracranial pressure (ICP). However, its efficacy hinges on meticulous surgical execution, perioperative management, and vigilance toward potential complications. The incidence of complications associated with DC plays a pivotal role in determining its superiority over medical management for patients experiencing intracranial hypertension following traumatic brain injury (TBI). Severe cases often require more intensive therapy, prolonged mechanical ventilation, and vasopressor treatment. Identifying the optimal moment for early extubation and minimizing vasopressor use is crucial to reducing the risk of complications, including PTH. Our study aims to highlight the potential risks associated with prolonged mechanical ventilation and long-term vasopressor administration. The collected data were demographics, the craniectomy size, the distance from the midline of the craniectomy, the presence or absence of hydrocephalus, duration of mechanical ventilation and vasopressor treatment, and outcome at 30 days. Seventy-two patients with a mean age of 44.2 (range 5-83) were included in the study, with a median craniectomy size of 119.3 cm2. In our series, craniectomy areas ranged between 30 and 207.5 cm2 and had a similar decrease in midline shift in all cases. We did not observe any associations between the surface of craniectomy and the complication rate (p = 0.6302). There was no association between craniectomy size and mortality rate or length of hospital stay. The most common complication of decompressive craniectomy in our study group was posttraumatic hydrocephalus, with an incidence of 13.8%. Our results showed that craniectomy size did not independently affect PTH development (p = 0.5125). Still, there was a strong correlation between prolonged time of vasopressor treatment (p = 0.01843), period of mechanical ventilation (p = 0.04928), and the development of PTH. This study suggests that there is no clear correlation between craniectomy size, midline shift reduction, and survival rate. An extended period of vasopressor treatment or mechanical ventilation is linked with the development of posttraumatic hydrocephalus. Further studies on larger series or randomized controlled studies are needed to better define this correlation.

Microbiological Profiles after Out-of-Hospital Cardiac Arrest: Exploring the Relationship between Infection, Inflammation, and the Potential Effects of Mechanical Circulatory Support.

Background: Cardiogenic shock (CS) following an out-of-hospital cardiac arrest (OHCA) poses significant management challenges, exacerbated by inflammatory responses and infectious complications. This study investigates the microbiological profiles and impacts of mechanical circulatory support (MCS) on inflammation and infection in OHCA patients. Methods: We retrospectively analyzed microbiological data from various specimens of 372 OHCA patients, who were treated at the Cardiac Arrest Center of the University Hospital of Marburg from January 2018 to December 2022. Clinical outcomes were evaluated to investigate the potential impact of MCS on infection and inflammation. Results: Of the study cohort, 115 patients received MCS. The microbiological analysis revealed a higher incidence of positive blood cultures in the MCS group vs. the non-MCS group (39% vs. 27.7%, p = 0.037), with predominantly Gram-positive bacteria. Patients with positive microbiological findings had longer in-hospital stays and prolonged periods of mechanical ventilation. The levels of inflammatory markers such as C-reactive protein (CRP) and procalcitonin (PCT) differed, suggesting a more pronounced inflammatory response in MCS patients, especially in the later ICU stages. Notably, despite the higher infection rate in the MCS group, the survival rates did not significantly differ in the two groups. Conclusions: MCS appears to influence the microbiological and inflammatory landscape in OHCA patients, increasing the susceptibility to certain infections but not affecting the overall mortality. This study underscores the complexity of managing post-resuscitation care and highlights the need for tailored therapeutic strategies to effectively mitigate infectious and inflammatory complications.

Extended period of ventilation before umbilical cord clamping at birth: A study that mis-interprets and mis-represents the physiology.

Extended period of ventilation before umbilical cord clamping at birth: A study that mis-interprets and mis-represents the physiology.

Comparative efficacy of peptide-based versus standard polymeric enteral nutrition in ICU patients at high nutritional risk: a multicenter randomized controlled trial

Within intensive care units (ICU), the administration of peptide-based formulas (PBF) may confer nutritional advantages for critically ill patients identified with heightened nutritional risk. This investigation aimed to ascertain the efficacy of PBF in comparison to standard polymeric formulas (SPF) among this patient cohort. A double-blind, randomized controlled trial was conducted across three ICUs, encompassing 63 adult patients characterized by elevated modified Nutrition Risk in Critically Ill (mNUTRIC) scores. Enrollment occurred promptly subsequent to ICU admission, with participants allocated to receive either PBF or SPF. Primary outcome was the duration to achieve caloric targets. Secondary outcomes involved the evaluation of mean daily gastric residual volume, mechanical ventilation period, infection rates within the ICU, length of hospitalization, mortality rates, nutritional status and inflammatory markers, specifically serum albumin and interleukin-6 levels. Patients in the PBF group reached their caloric targets more expeditiously compared to the SPF group (2.06 ± 0.43 days versus 2.39 ± 0.79 days; p = 0.03). No significant differences were discernible between the groups regarding gastric residual volume, duration of mechanical ventilation, ICU length of stay, mortality, or infection rates. Both cohorts exhibited minimal adverse effects and were devoid of any instances of abdominal distension. While not reaching statistical significance, the observed trends in albumin and interleukin-6 levels suggest a potential advantage of PBF utilization. The implementation of PBF enabled swifter attainment of caloric goals in ICU patients at high nutritional risk without adversely impacting other clinical parameters. Given its favorable tolerance profile and potential immunomodulatory properties, PBF may be considered a valuable nutritional intervention in this setting.Thai Clinical Trials Registry TCTR20220221006. Registered 21 February 2022, https://www.thaiclinicaltrials.org/show/TCTR20220221006.

Effect of erythropoietin on SOFA score, Glasgow Coma Scale and mortality in traumatic brain injury patients: a randomized-double-blind controlled trial.

Recent studies suggest that erythropoietin has an anti-inflammatory effect on the central nervous system. The authors aimed to investigate the effect of erythropoietin on Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) scores, and the mortality rate of traumatic brain injury (TBI) patients. Sixty-eight patients with available inclusion criteria were randomly allocated to the control or intervention groups. In the intervention group, erythropoietin (4000 units) was administrated on days 1, 3, and 5. In the control group, normal saline on the same days was used. The primary outcomes were the GCS and SOFA score changes during the intervention. The secondary outcomes were the ventilation period during the first 2 weeks and the 3-month mortality rate. Erythropoietin administration significantly affected SOFA score over time (P=0.008), but no significant effect on the GCS, and duration of ventilation between the two groups was observed. Finally, erythropoietin had no significant effect on the three-month mortality (23.5% vs. 38.2% in the erythropoietin and control group, respectively). However, the mortality rate in the intervention group was lower than in the control group. Our finding showed that erythropoietin administration in TBI may improve SOFA score. Therefore, erythropoietin may have beneficial effects on early morbidity and clinical improvement in TBI patients.

Increase of the indoor concentration of volatile organic compounds after the use of incense and scented candle in studio apartments determined using passive sampling

Burning incenses and scented candles may provide harmful chemicals. Although many studies have evaluated volatile organic chemicals emitted by their use and related health risks, extension of our understanding for guiding appropriate use under various use conditions is necessary. In this study, emission characteristics of commercial incenses and scented candles were evaluated in a laboratory chamber using real-time measurement and the time-weighted average exposure concentrations of monoaromatic compounds and monoterpenes were assessed using passive samplers while volunteers living in a studio apartment use them. After burning incense, the average levels of benzene increased from 1.4 to 100 μg m−3. The presence of a wood core in commercial incense products was the main cause of high benzene emission by burning them although the increase in benzene was also influenced by factors such as the brand of the products, the number of incense sticks burned, the duration of each burning session, and ventilation period. Electrical warming of scented candles increased the levels of monoterpenes by factors of 16–30 on average. Considering the emission characteristics found in this study, exposure to benzene and monoterpenes could be mitigated by cautious use of those products in residential areas.

Evaluation of cooling energy saving and ventilation renovations in office buildings by combining bioclimatic design strategies with CFD-BEM coupled simulation

Bioclimatic design knowledge and measures, including passive techniques and natural ventilation cooling, are urgently for building renovation to mitigate global warming. The performance of indoor airflow, energy, economic, and environmental aspects has been researched separately. However, developing a comprehensive framework to investigate bioclimatic strategies under the impact of climate change is challenging. This study aims to integrate bioclimatic design strategies with a coupled simulation approach using Fluent and EnergyPlus to evaluate retrofitting techniques for a single-room office in a university building in a hot summer and cold winter climate. A bioclimatic analysis was conducted to recommend cost-effective passive cooling strategies, including natural ventilation and window shading systems. Two passive measures, changing window types and furniture layouts, were included in renovation packages. Results indicated that the empty model is not valid compared to the fully furnished model when calculating room air change per hour (ACH). Natural ventilation was the most cost-effective strategy to mitigate climate change, with a net present value (NPV) ranging from USD 135.09 to 402.81 over 30 years. However, a higher ACH did not ensure a longer natural ventilation period. By changing the top-hung window to a vertical sash and implementing a movable furniture layout, can achieve better ventilation efficiency. The installation of window vertical shadings had the highest annual emission savings by 2080, while it performed negative economic viability in both the present and the 2050 climates. This research demonstrated how combining bioclimatic measures with a co-simulation approach can offer a thorough evaluation of building energy retrofitting. The results could support architectural and engineering design by integrating bioclimate measures to identify the most effective strategies.