Plug Removal Research Articles

Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature.

Juvenile hallux valgus (JHV) is a forefoot deformity that causes pain and functional limitation. Treatment poses a challenge in terms of the optimal technique and timing of intervention. A systematic review of the literature on the use of growth modulation in treating JHV was conducted. The literature review was performed using PubMed and EMBASE searches for articles investigating growth modulation in the treatment of JHV published before December 1st, 2021. Seven articles were included in the final review that matched the inclusion and exclusion criteria. The primary outcomes included the degree of correction of hallux valgus angle and intermetatarsal angle. A qualitative assessment of the articles was done due to the heterogeneity of the growth modulation methods used in these articles. A total of 135 feet from 78 patients were included from the reviewed articles. Growth modulation methods included temporary screw lateral hemiepiphysiodesis of the first metatarsal, lateral drilling hemiepiphysiodesis of the first metatarsal, and a trephine plug removal of the lateral epiphysis followed by cancellous bone graft insertion. The degree of correction of the hallux valgus and intermetatarsal angles were found to be statistically significant in all studies, regardless of the technique. Growth modulation for JHV by lateral hemiepiphysiodesis using minimally invasive techniques produced favourable radiologic outcomes with some evidence of clinical improvement. Larger, prospective and comparative studies with objective clinical outcome measures may further consolidate this surgical approach as a mean to treating this deformity. AlZeedi M, Park JP, Marwan Y, et al. Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature. Strategies Trauma Limb Reconstr 2023;18(1):51-55.

Influence of Soil Plug on the Seismic Response of Bucket Foundations in Liquefiable Seabed

The suction installation process for bucket foundations for offshore wind turbines (OWTs) can cause the formation of soil plug within the bucket, which can affect the seismic performance of the OWT. Therefore, it is important to evaluate the influence of soil plug on the seismic performance of OWT on bucket foundations. In this study, a comprehensive set of high-fidelity solid–fluid coupled dynamic numerical simulations are conducted to analyze the seismic response of bucket foundations with a focus on the influence of soil plug and its potential mitigation. The influence of different bucket models, seabed soil densities, seabed inclination and reinforcement types, as well as soil plug removal techniques, are investigated. The results clearly show that the existence of soil plug has a significant unfavorable influence on the seismic performance of OWT on bucket foundations, especially for wide bucket foundations in mildly inclined seabeds, and should be considered in seismic design. Reinforcement methods, such as the application of an inner compartments, outer wings and inner pile, can improve the seismic performance of OWT on bucket foundations, with the application of an inner compartment being the most effective. Soil plug removal can alleviate the negative influence of soil plug, and should be adopted when possible.

Optimization and Performance Evaluation of Foam Acid Systems for Plugging Removal in Low Pressure Oil and Gas Reservoirs

Foam acidization has unique advantages such as low damage, low filtration, low friction, high efficiency, excellent retardation, and fast liquid discharge rate, which is suitable for stimulation and reconstruction of low-pressure oil and gas reservoirs that have been developed over many years. It is obtained that the main chemical components of downhole plugging materials include vegetable oil, fatty acids and their esters, silicone oil, amide polymers, and additional organic components, as well as non-organic components, elemental sulfur, ferrous sulfide, iron disulfide, silicon dioxide, mineral salts, etc. The performance of foam acid was investigated by experiments, including the effective range of action of active acids, reducing filtration, increasing temperature resistance and high-temperature stability of foam acid deep wells. The new foam acid system is developed and optimized to suitable for low-pressure deep well acidification operations. Experimental evaluation optimized the acid foaming agent and foam stabilizer and developed a new foam acid formulation with foam stability, filter loss reduction, temperature resistance, and easy backflow performance. The experimental condition is that the temperature is 90 °C, the foam quality can reach more than 70% when mixed for more than 30 s, the average half-life is 38.75 min, and the liquid separation rate is 19.90 s/mL. Its suspension is better than that of conventional hydrochloric acid, its corrosion rate is 1.872 g/m2·h, and the flowback rate of foam acid residue reaches 97%. Experimental evaluation has shown that the developed foam acid features high surface activity, stable foam, strong temperature resistance, significant speed and corrosion suppression, and excellent drainage assist performance. Dynamical simulation evaluation of reservoir core foam acidification demonstrated that the foam features long-life, strong suspension capacity, excellent rheology, low filtration, and significant acidization and plug removal effects, and can be used in stimulating the medium-deep, high-temperature, and low-pressure oil and gas reservoirs.

Fatigue Life Analysis of Coiled Tubing in Deep Well Jet Plugging Removal

The coiled tubing plugging has become the main means of plugging in gas Wells in Xinjiang. These Wells are deep and have high pressure, which can easily affect the fatigue life of the operating coiled tubing. In order to improve the life of coiled tubing in high-pressure gas Wells, this paper studies the plugging conditions of coiled tubing in high-pressure ultra-deep Wells. Firstly, the cross section deformation of coiled tubing under high internal pressure is analyzed. Secondly, the factors influencing the fatigue life of coiled tubing and the influence of surface damage on the fatigue life of coiled tubing were studied. Finally, the mechanism of furrow damage caused by coiled tubing and the main measures to reduce furrow damage are analyzed. The following suggestions are made to improve the life of coiled tubing: select the right material and the right size coiled tubing; Use appropriate measures to prevent premature coiled tubing failure and reduce operating costs.

Promotion and inhibition effects of wax on methane hydrate formation and dissociation in water-in-oil emulsions

Clarifying the effect of wax on hydrate formation and dissociation are important for the safe and high-efficient development of deep-water oil and gas fields. In this study, a series of experiments on the effect of wax on hydrate formation and dissociation in water-in-oil emulsions were systematically studied based on the variation analysis of temperature, pressure, torque, oil–water interface area morphology and water droplet size in emulsions. Microscopic images reveal that wax crystals form shell barriers on the oil–water interface, which increases transfer resistance, and the particle focused beam reflectance illustrates that the wax crystals decrease the water droplet size, which increases the oil–water interface area in emulsions. With increasing wax concentration, the hydrate induction time and growth rate show a bimodal shape because of the dual regulation of wax in emulsions, involving the inhibition effect of the transfer barrier layer and the promotion effect of the increasing water–oil interface area. The inhibition effect on hydrate formation was dominant when the wax concentration exceeds 6 wt%, resulting in a rapid decrease in both the growth rate and conversion ratio with increasing wax concentration. Compared with the bimodal shape of hydrate formation, the inhibition effect of wax on hydrate dissociation is the dominant regulation factor. The duration of complete hydrate dissociation by depressurization increased linearly with the increasing wax concentration, which increased the operation difficulty of hydrate plug removal. These experimental results provide valuable references for hydrate risk assessment and optimization of the project design of flow assurance for deep-water oil and gas fields.

Use of Irrigation Device for Duct Dilatation during Sialendoscopy

Continuous irrigation of the duct with isotonic saline is one of the fundamental stages of a successful sialendoscopic procedure. It allows for an adequate luminal distension for the removal of debris and mucous plugs and for the conservative treatment of strictures. This procedure, which commonly involves the use of a medical syringe, can be laborious, and it is often necessary to interrupt irrigation during surgery due to the high resistance to saline. Academic university hospital. We propose the use of an irrigation device which consists of a high-pressure syringe barrel, an ergonomic piston handle, and a gauge used to monitor the inflation and deflation of balloon catheters. The system allows for a simple and safe dilation, ensuring good visualization of the salivary duct lumen during sialendoscopy. The irrigation system described can be widely used to perform a diagnostic or interventional sialendoscopy more effectively than with a typical manual irrigation procedure.

Toric trans-scleral plugs IOL to correct aphakia with significant corneal astigmatism.

To describe the use of toric trans-plugs IOL to correct aphakia with significant corneal astigmatism. Case report and literature review. A 62-year-old man with an history of aphakia in his left eye after a traumatic cataract extraction and significant corneal astigmatism was referred to our clinic. Surgery plan was cataract remnants removal and secondary IOL implantation of toric sutureless trans-scleral plugs fixated IOL (FIL SSF, Soleko, Italy). The postoperative course was uneventful. At 12 months, the IOL was well-centered and the optic alignment remained stable with minimal total astigmatism. The e uncorrected distance visual acuity (UDVA) was 20/25 Snellen while correct distance visual acuity (CDVA) was 20/20 with a manifest refraction of -0.25-50 40° D; the patient was satisfied by the visual outcome. This novel toric trans-scleral plug fixated lens provides valuable outcomes also for astigmatic correction for a comprehensive correction of the aphakia in patients with poor zonular support and high expectations for postoperative visual quality.

A survey of pediatric flexible bronchoscopy in India.

A bronchoscopy is an essential tool in pediatric pulmonology. However, the practices involved in the procedure are variable. To evaluate prevalent practices and variations in pediatric flexible bronchoscopy in India. An online survey was conducted via Google forms between September 2018 and March 2019. We circulated the survey among members of various respiratory societies and personal contacts. Physicians performing pediatric flexible bronchoscopy were requested to respond. The survey had 95 questions in seven domains: demographics, patient preparation, sedation, procedural aspects, monitoring, bronchoscope cleaning, and complications. The survey received 24 complete responses; the respondents were from 14 cities. Pediatric bronchoscopy was done mainly for diagnostic purposes. Most (19, 79%) respondents reported using conscious sedation for the procedure. The preferred regimen for sedation was midazolam plus fentanyl [9 (37.5%)]. Atropine was used routinely by 4 (16%). For topical anesthesia, nebulized lignocaine only, both nebulized and spray as go lignocaine, and spray as go lignocaine only were used by 1 (4.2%), 6 (25%), and 17 (71%) respondents, respectively. The methods of providing oxygen during bronchoscopy were free flow (9, 37.5%), nasal prongs (8, 33.3%), mask (6, 25%), and laryngeal mask airway (1, 4.2%). The common therapeutic procedures included removal of mucus plugs (17, 71%), bronchoscopic intubation (11, 45%), and foreign body removal (10, 41%). The number of aliquots used by respondents for bronchoalveolar lavage varied from 2 to 6, and the volume for each aliquot was also varied (1-2 ml/kg or 5-10 ml). Almost all the respondents reported complication rates of less than 5%. There is a considerable variation in pediatric flexible bronchoscopy practices across the country, highlighting the need to develop a uniform guideline.

Effect Evaluation and Action Mechanism Analysis of "Profile Control + Plugging Removal" after Chemical Flooding.

The existing plugging removal operation in JZ9-3 oilfield has the disadvantages of small amount of plugging remover, fast injection speed, and short construction time. Under the condition of injection well suction profile reversal, plugging remover is difficult to enter the low permeability part and play the role of deep plugging removal. In order to improve the plugging removal effect, this paper used the physical simulation method to carry out the experimental study and mechanism analysis on the effect of water flooding, chemical flooding, and plugging removal measures of the multi-layer system combination model. The results showed that the recovery of general plugging removal after chemical flooding increases by only 0.70%, while the recovery of ‘profile control + plugging removal’ increases by ‘9.34% + 2.59%’, and the amount of produced liquid decreases by more than 40%. It can be seen that the combined operation of profile control and plugging removal has dual effects of plugging and dredging and synergistic effect, which not only expands the swept volume, but also reduces the inefficient and ineffective cycles. On this basis, the optimization design and effect prediction of the target well W4-2 plugging removal scheme were carried out by using the numerical simulation method. Recommended scheme: inorganic gel profile control agent volume 13,243.6 m3, produced by the main agent (Na2O·nSiO2), isolation fluid (Water), and auxiliary agent (CaCl2) through multiple rounds of alternating injection into the reservoir. The plug removal agent (K2S2O8) injection volume is 100 m3, the concentration is 0.8%. The post-implementation ‘Output/Input’ ratio is expected to be 3.7.

Gas-Free Continuously Regenerated Impurity Removal Device for Ion Chromatography.

A gas-free continuously regenerated-anion impurity removal device (CR-ARD) is described for ion chromatography (IC). It is a sandwiched configuration consisting of three channels. The central eluent channel is isolated from two outer regenerant channels by stacked anion exchange membranes (sAEM) and a bipolar membrane (BPM) plus stacked cation exchange membranes (BPM-sCEM), in which the anion exchange side of BPM is facing the central channel. The sAEM side is an anode with respect to the cathode of the BPM-sCEM side. The central channel is packed with strongly basic anion exchange resins in hydroxide form. The application of an electrical voltage to the device causes enhanced water splitting at the interface of BPM to occur and the potential drives the hydroxide ions through the resin phase toward the anode, thereby enabling continuous regeneration of the resin and avoiding any off-line regeneration. Meanwhile, nonhydroxide anionic impurities (basically carbonate) are transported toward the anode through the sAEM. It does not produce gas in the eluent channel, and no degasser is required afterward. It shows a strong ability to remove anionic impurities, as indicated by effective removal of 5 mM CO32- injected sample plug (25 μL, 125 pmol) or continuous removal of 600 μM KNO3 solution at 1 mL/min (10 nmol/s) over 300 min. Much improved peak integration at the gradient mode and a higher signal-to-noise ratio at the isocratic mode can be achieved by CR-ARD. To our knowledge, this is the first account of gas-free CR-ARD.

Application of in-situ heat generation plugging removal agents in removing gas hydrate: A numerical study

Under the condition of low temperature and high pressure, natural gas will form solid gas hydrates in oil and gas wellbore and pipeline, resulting in blockage, pressure increase, production reduction, and even shutdown. Methods such as heat preservation, heating, and injection of inhibitors are often used in engineering to avoid the formation of hydrates. The latter, injection of inhibitors, is the most widely used means of hydrate prevention and control at present. A special inhibitor, namely an in-situ heat generation plugging removal agent, has the advantages of both heating and chemical plugging removal and is a kind of hydrate inhibitor with great potential. In this study, a new mathematical model is developed based on hydrate phase equilibrium thermodynamics and decomposition kinetics, which is used to solve the heat and mass transfer problems in the plugging removal process of the gas hydrate by using in-situ heat generation plugging removal agents. Numerical simulation is used to solve the mathematical model, and the plugging removal process and parameter variation of pure in-situ heat generation system (high/medium/low temperature), electrolyte in-situ heat generation system (containing Na+/Mg2+), and alcohol in-situ heat generation system (containing MeOH/DEG) are studied respectively. Based on the experimental results, the quantitative relationship between the plugging removal time, the dosage, and the concentration of the plugging removal agent is calculated and analyzed. Our proposed model is verified through experimental study and the calculated values of the mathematical model are in good agreement with the experimental values under different working conditions. It is concluded that the rapid removal of hydrates and the prevention of secondary formation of hydrates can be achieved by configuring the high-temperature in-situ heat generation plugging removal agents, and the efficiency of plugging removal can be enhanced by adding appropriate concentration of electrolyte and alcohol without changing the heating property of the original plugging removal agent. This study can provide theoretical guidance for the safety of oil and gas flow and the efficient development of hydrate.

PREVENTION OF SAND CLOGGING IN WELLS

A brief analysis of the prevention of sand blockage in wells is considered. One of the most common complications during the operation of wells in Azerbaijani oil fields is sand formation. During sand formation, wells are stopped for a while, their repair takes a long time, and as a result, significant well product losses occur. The sand that comes with the fluid entering the wellbore destroys the equipment and at the same time forms a blockage in the wellbore. The removal of the sand plug requires heavy labor, but sometimes leads to oil losses in many wells and leads to the collapse of rocks in the wellbore zone and the deformation of the production pipeline. The collapse of the bedrock and the prevention of sand congestion are still one of the most pressing issues in the oil industry. Despite numerous scientific studies and mining experiments on the mechanism of sand formation prevention, no universal method has been found to combat sand formation. The collapse of the bedrock and the prevention of sand congestion are still one of the most pressing issues in the oil industry. Keywords: sand plug, well, sand plug removal, well bottom filter, surface filter, well bottom zone

Microbiologic Analysis of Removed Silicone Punctal Plugs in Dry Eye Patients.

This study analyzed the microbiologic results of removing silicone punctal plugs due to uncomfortable symptoms in dry-eye patients. Patients who were diagnosed with dry eye and received silicone punctal plugs—SuperEagle Punctum Plug™ (EagleVision, Denville, NJ, USA) or Parasol Punctum Plug™ (Beaver–Visitec international, Inc., Waltham, MA, USA)—into upper or lower puncta that were removed due to discomfort from January 2018 to June 2020 were enrolled and reviewed retrospectively. Out of the total 58 patients (64 eyes), 19 patients were male and 39 patients were female. Protrusion without granulation (21 patients, 32.8%) was the most common reason for plug removal, followed by protrusion with granuloma (19 patients, 29.7%). The positive rate of bacterial culture was 42.2% and Klebsiella aerogenes was the most common organism identified (18.5%). Vancomycin showed the highest susceptibility of 100% among all the antibiotics, third-generation cephalosporins were the most susceptible (88.5%) among cephalosporines, and levofloxacin was the most susceptible (81.0%) among quinolones. Among the patients who complained of discomfort after insertion of silicone punctal plugs, approximately 42% had a positive result in bacterial culture. Therefore, when removing punctal plugs in such patients, a microbiological examination may be needed for the appropriate selection of antibiotics.

Development and Application of Well-Test Model after Injection Biological Nanomaterials

Nanomaterials are gradually shining in the petroleum industry and have made great achievements in EOR, pipeline coating, fracturing, and other aspects. In practical application, they have the advantages of long validity period and more environmental friendliness. At the same time, due to the short effective period of conventional plugging removal measures such as acidizing and fracturing, which are not friendly to the environment, nanomaterials are gradually applied to reduce pressure and increase injection of injection wells, and good application results are obtained. In this study, a new biological nanomaterial with long-term injection enhancement characteristics was evaluated. To have a better understanding of the reservoir performance of water injection wells after pressure reduction and injection increase measures, it is necessary to establish the well test model after the step-down and injection increase measures of biological nanomaterials that are taken for water injection wells. In this paper, the influence of the injection amount of bionanomaterials on the permeability is studied, and the rule of the permeability around the injection well with the distance from the bottom of the well is analyzed. On this basis, the flow mathematical model of three zones (inner zone, transition zone, and outer zone) of bionanosolution is established. Then, using the basic principles of fluid mechanics and the Laplace transform principle, a mathematical model of the bottom hole pressure response of water injection wells in the third zone of the bionanosolution reservoir is obtained, and the influence of the key process parameters of the bionanosolution water injection on the bottom hole pressure is analyzed. The established well test interpretation model can be used to calculate the near wellbore permeability, reservoir skin factor, reservoir sweep radius, and reservoir resistance coefficient. Based on application examples, it was determined that the fitting results of the interpretation chart are in good agreement with the field test data, and the reservoir parameters obtained from the interpretation are reasonable and reliable. The findings of this study can help for better understanding of the dynamic change law of reservoir after injection of biological nanomaterials or similar plugging removal measures (the improvement effect varies with the distance from the bottom hole). To the best of our knowledge, it is the first paper on the application of biological nanomaterials in reducing pressure and increasing injection in injection wells.

Characteristics of Porosity and Permeability of Ultra-High Temperature Perforated Damage Zone in Sandstone Targets

Perforating as a widely-applied stimulation technology is becoming incrementally important in unconventional oil/gas development. It can effectively improve deep-lying high-temperature, high-pressure (HTHP), low-porosity, low-permeability reservoirs, eliminate near-wellbore surface pollution, and increase drainage area. Characteristics of damage zone porosity directly reflect perforating performance. To study porosity and permeability of damage zone in sandstone targets, the paper collected sandstone cores from the 3rd section of the Zhuhai Formation to conduct a simulation experiment for HTHP perforation of large-size targets. After the simulation experiment, an automatic scanner was used to find the planar distribution of the porosity and permeability parameters of the 150°C perforation holes in the cores. The study led to two findings. First, the temperature has a minor effect on the hole depth and diameter in a specified scope. The hole depth decreases as the negative pressure increases and the depth decreases as the effective stress increases. Second, a UHP perforated sandstone target is remarkably zone-specific in planar distribution of the hole porosity and permeability. The damage zone can be divided into the fracture zone, the transition zone, the compaction zone and the undisturbed zone. Besides, the zone permeability damage was quantified. These findings can effectively support research on numerical value simulation for HTHP perforation holes. Besides, they can support HTHP well perforating design and improve near-wellbore permeability enhancement and plug removal.

INVESTIGATION OF WELLS IN THE WORKING FUND OF “AZNEFT” PU AND PROPOSAL OF ANTI-SAND MEASURES

INVESTIGATION OF WELLS IN THE WORKING FUND OF “AZNEFT” PU AND PROPOSAL OF ANTI-SAND MEASURES

Study of diffusion coefficients and molecular adsorption laws for the slit-hole coal model under the thermal-gas-liuid coupling effect with hot nitrogen injection

To solve the serious filtering problems of fracturing fluid during active hydraulic fracturing of coalbed methane, which blocks gas migration channels with residual fracturing fluid and results in a rapid decline in coalbed methane production, several preliminary experiment of thermal nitrogen injection was carried out. To explain the process and mechanism of thermal nitrogen injection at the nanoscale, an adsorption and diffusion model was established to study the adsorption and diffusion of methane, water and fracturing fluid during thermal nitrogen injection. The results showed that the self-diffusion coefficient of methane was increased by 23%, 45% and 32%, the self-diffusion coefficient of water molecule was increased by 108%, 185% and 138%, the self-diffusion coefficient of fracturing fluid molecule was increased by 169%, 275% and 181%, and the total number of atoms in the slit hole was decreased by 15%, 25% and 37%, respectively, when hot nitrogen was injected at 2, 4 and 6 Mpa, respectively. This shows that the numbers of methane, water and fracturing fluid molecules in the slit hole were significantly decreased by the thermal and displacement effects of hot nitrogen injection. The self-diffusion coefficient was significantly improved, and the effects of plug removal was remarkable.

A study of the utility and safety of bronchoscopy in mechanically ventilated COVID19 ARDS: Transgressing the conventional guidelines

Background: Bronchoscopy has been done sparingly in COVID19 patients due to the risk of aerosol generation. We describe a study on targeted bronchoscopy in mechanically ventilated (MV) COVID-19 patients outlining the procedural, clinical, utilitarian and safety aspects. Methods: Bedside bronchoscopy was performed in suspected or confirmed COVID-19 cases on MV for specific indications. Demographic, clinical, bronchoscopic and laboratory findings were analysed. Results: 98 procedures were performed on 61 patients, mean age 62.1 years, 51 (83.6%) males. 42 patients (69%) had at least 1 co-morbidity. Major indications were new radiographic infiltrates with clinical deterioration, increased endotracheal tube (ETT) secretions and haemorrhagic secretions/hemoptysis. Common findings were copious secretions in 87 (88.8%), purulent in 61%, mucoid in 18%, haemorrhagic in 7% and frothy in 14% cases. On the management front, antibiotics were changed in 31 (31.6%) cases based on bronchoscopic findings. Other significant changes included reduction/stopping steroids and anticoagulation and ETT repositioning. The incidence of bacterial superinfection was high (54% culture positivity), a significant number (94%) with multi-drug resistant organisms. Fungi were seen in 7 cases (7.1%). Pneumocystis jiroveci was not seen and cytology did not show any viral inclusions. Therapeutic mucus plug removal was done in 30 cases (30.6%), and hemoptysis control in 4% cases. The procedures were safe and none of the HCW developed any COVID19 disease. Conclusion: Bronchoscopy in critically ill MV COVID-19 patients contributes on both diagnostic and therapeutic fronts and impacts management decisions. With adequate precautions and standard protocols, it is safe for both HCW and patients.

Results from a multicentre evaluation of plug use for left ventricular assist device explantation.

OBJECTIVESMyocardial recovery allows for left ventricular assist device (LVAD) explantations after long-term support. Several surgical approaches, including interventional decommissioning, off-pump explantation using a custom-made plug and complete LVAD removal through redo sternotomy, have been described. We present the results from an evaluation of the long-term follow-up of patients who received a titanium sintered plug after LVAD explantation. METHODSWe performed a retrospective, European, multicentre analysis of patients who received a titanium sintered plug to seal the apical fixation ring after LVAD explantation. Data were collected from a questionnaire that included demographics, procedural details and follow-up information.RESULTSOut of 54 contacted centres in 12 countries (n = 179 patients), a total of 68 patients were successfully included in the study. The median follow-up was 34 months (interquartile range: 17–58.5 months); 57 (84%) patients had >1-year follow-up. At the time of the last follow-up, 55 (81%) patients were alive, with a Kaplan–Meier 1-year survival of 90.1% (95% confidence interval: 84.0–98.1%) and a 5-year survival of 80.0% (95% confidence interval: 68.4–92.9%). One patient (1.5%) developed a plug infection originating from an infected part of the incorporated driveline and, after complete removal, is currently in good condition. No postoperative stroke has been reported after plug implantation.CONCLUSIONSIn this European multicentre study, the use of a custom-made titanium plug to close the apical fixation ring after LVAD explantation resulted in a low incidence of plug-related complications. With the volume of patients undergoing LVAD explantations after myocardial recovery increasing, the plug has evolved as a simple alternative to more invasive device explantation procedures or decommissioning with a high risk for infection of the remaining system or stroke.

Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review.

Flexible bronchoscopy (FB) has become a standard of care for the triad of inspection, sampling, and treatment in critical care patients. It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit (ICU). Less is known about its role outside the ICU, particularly in the intermediate care unit (IMCU), a specialized environment, where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided. In the IMCU, the leading indications for a diagnostic work-up are: To visualize airway system/obstructions, perform investigations to detect respiratory infections, and identify potential sources of hemoptysis. The main procedures for therapeutic purposes are secretion aspiration, mucus plug removal to solve atelectasis (total or lobar), and blood aspiration during hemoptysis. The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients. Serious adverse events related to FB are relatively uncommon, but they may be due to lack of expertise or appropriate precautions. Finally, nowadays, during dramatic recent coronavirus disease 2019 (COVID-19) pandemic, the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined. Hence, we provide a concise review on the role of FB in an IMCU setting, focusing on its indications, technical aspects and complications.