Pump Failure Research Articles

Assessing in-hospital mortality and predictors in Patients with contrast-induced nephropathy Following primary percutaneous coronary Intervention.

The contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (PCI) it has been reported to be associated with an increased risk of mortality. The study reported the in-hospital mortality among patients who developed CIN after primary PCI. This descriptive cross-sectional study was conducted on a sample of consecutive who developed CIN after primary PCI at a tertiary care cardiac hospital in Karachi, Pakistan. The CIN was defined as either a relative increase of 25% or an absolute increase of 0.5 mg/dL in post -procedure serum creatinine within 72 hours. The in-hospital mortality status was recorded and clinical and demographic predictors of in-hospital mortality were identified with the help of binary logistic regression analysis. In the study sample of 402 patients, 74.1% (298) were male and the mean age of the study sample was 59.4±11.5 years. The in-hospital mortality rate was 9.7% (39). On multivar iable analysis, an increased risk of mortality was found to be independently associated with inferior wall myocardial infarction (IWMI) with right ventricular (RV) infarction, intra-procedure arrhythmias, and pump failure with an adjusted odds ratio of 3.63 [95% CI: 1.31-10.08; p=0.013], 5.53 [95% CI: 1.39-22.06; p=0.015], and 8.94 [95% CI: 3.99-20.02; p<0.001], respectively. In conclusion, there is a high rate of mortality for patients who develop CIN after primary PCI, and the risk of mortality is further aggravated by the presence of IWMI with RV infarction, intra-procedure arrhythmias, and pump failure.

Analysis of Electrical Submersible Pump With 120% Overload Setting Point in the SLN Area

In the SLN field, there has been an increase in the setting point by 120% to optimize fluid production and minimize the production decline previously caused by a setting point of 110%, which resulted in temporary well shutdowns. Wells HFU01 and HFU02 in this area experienced shutdowns, suspected to be caused by overload in the electrical submersible pump. Overloaded pumps were identified through alarms originating from the switchboard on the surface, where the alarms were triggered by three cables connecting the switchboard to the motor of the electrical submersible pump. This study aims to determine the impact of overload setting point on wells HFU01 and HFU02, which have not shown improvement after the overload setting point adjustment. The research methodology involves analyzing pump failures due to overload in the electrical submersible pump in wells HFU01 and HFU02 located in the Sumatera Light North Area, which affects the well production. From this research, it is suspected that the wells that have not shown improvement after the overload setting point change may be caused by worn-out, aged pumps with low efficiency, and pump cavitation issues. Through this research, these issues can be addressed, leading to improved well production and run life of the electrical submersible pump, ultimately reducing pump failures in the wells.

МҰНАЙ КӘСІПШІЛІК ЖАБДЫҚТАРЫНЫҢ СЕНІМДІЛІК СИПАТТАМАЛАРЫН БАҒАЛАУ ЖӘНЕ БЕЛГІСІЗДІК ЖАҒДАЙЫНДА ШЕШІМ ҚАБЫЛДАУ

Abstract. The article is devoted to the results of information analysis and the establishment of the relationship between factors affecting the reliability of oilfield equipment using a fuzzy clustering algorithm. One of the main tasks of oilfield practice is to assess the influence of various factors on the efficiency of field operation and make the right technological decisions. The reliability of estimates and decisions is determined by how reliably the input and output variables and their values are selected. Situations often arise when, given the same data, fundamentally different results are obtained. To find specific expressions of these dependencies and the parameters characterizing them, in particular, methods of statistical data processing are used. As a result of the analysis of the causes of failures of deep-well pumps, factors influencing the efficiency of the pump in the fields under consideration were identified and subjected to fuzzy cluster analysis, which allows us to gain an understanding of the influence of selected factors on efficiency indicators under conditions of uncertainty. A relationship was obtained between the input and output variables, which can be expressed by a fuzzy expression of the IF-THEN rule. Keywords: reliability, liquid flow rate, turnaround time, fuzzy set theory, fuzzy cluster analysis.

A Study on Comparison of Classification Algorithms for Pump Failure Prediction

The reliability of pumps can be compromised by faults, impacting their functionality. Detecting these faults is crucial, and many studies have utilized motor current signals for this purpose. However, as pumps are rotational equipped, vibrations also play a vital role in fault identification. Rising pump failures have led to increased maintenance costs and unavailability, emphasizing the need for cost-effective and dependable machinery operation. This study addresses the imperative challenge of defect classification through the lens of predictive modeling. With a problem statement centered on achieving accurate and efficient identification of defects, this study’s objective is to evaluate the performance of five distinct algorithms: Fine Decision Tree, Medium Decision Tree, Bagged Trees (Ensemble), RUS-Boosted Trees, and Boosted Trees. Leveraging a comprehensive dataset, the study meticulously trained and tested each model, analyzing training accuracy, test accuracy, and Area Under the Curve (AUC) metrics. The results showcase the supremacy of the Fine Decision Tree (91.2% training accuracy, 74% test accuracy, AUC 0.80), the robustness of the Ensemble approach (Bagged Trees with 94.9% training accuracy, 99.9% test accuracy, and AUC 1.00), and the competitiveness of Boosted Trees (89.4% training accuracy, 72.2% test accuracy, AUC 0.79) in defect classification. Notably, Support Vector Machines (SVM), Artificial Neural Networks (ANN), and k-Nearest Neighbors (KNN) exhibited comparatively lower performance. Our study contributes valuable insights into the efficacy of these algorithms, guiding practitioners toward optimal model selection for defect classification scenarios. This research lays a foundation for enhanced decision-making in quality control and predictive maintenance, fostering advancements in the realm of defect prediction and classification.

Diagnosis and management of blunt cardiac injury: What you need to know.

Blunt cardiac injury (BCI) encompasses a wide spectrum, from occult and inconsequential contusion to rapidly fatal cardiac rupture. A small percentage of patients present with abnormal electrocardiogram or shock, but most are initially asymptomatic. The potential for sudden dysrhythmia or cardiac pump failure mandates consideration of the presence of BCI, including appropriate monitoring and management. In this review, we will present what you need to know to diagnose and manage BCI.

Cardiac radiation improves ventricular function in mice and humans with cardiomyopathy.

Rapidly dividing cells are more sensitive to radiation therapy (RT) than quiescent cells. In the failing myocardium, macrophages and fibroblasts mediate collateral tissue injury, leading to progressive myocardial remodeling, fibrosis, and pump failure. Because these cells divide more rapidly than cardiomyocytes, we hypothesized that macrophages and fibroblasts would be more susceptible to lower doses of radiation and that cardiac radiation could therefore attenuate myocardial remodeling. In three independent murine heart failure models, including models of metabolic stress, ischemia, and pressure overload, mice underwent 5 Gy cardiac radiation or sham treatment followed by echocardiography. Immunofluorescence, flow cytometry, and non-invasive PET imaging were employed to evaluate cardiac macrophages and fibroblasts. Serial cardiac magnetic resonance imaging (cMRI) from patients with cardiomyopathy treated with 25 Gy cardiac RT for ventricular tachycardia (VT) was evaluated to determine changes in cardiac function. In murine heart failure models, cardiac radiation significantly increased LV ejection fraction and reduced end-diastolic volume vs. sham. Radiation resulted in reduced mRNA abundance of B-type natriuretic peptide and fibrotic genes, and histological assessment of the LV showed reduced fibrosis. PET and flow cytometry demonstrated reductions in pro-inflammatory macrophages, and immunofluorescence demonstrated reduced proliferation of macrophages and fibroblasts with RT. In patients who were treated with RT for VT, cMRI demonstrated decreases in LV end-diastolic volume and improvements in LV ejection fraction early after treatment. These results suggest that 5 Gy cardiac radiation attenuates cardiac remodeling in mice and humans with heart failure. NIH, ASTRO, AHA, Longer Life Foundation.

ANALYSIS OF THE INFLUENCE OF THE DESIGN PARAMETERS OF THE UPPER STAGE LIQUID PROPELLANT ROCKET ENGINE PUMP ON ITS CAVITATION CHARACTERISTICS

Abstract. The phenomenon of cavitation is inherent in all vane machines, the working medium of which is liquid. With a certain combination of input pressure, flow rate, rotor speed, and the gas saturation of the working fluid in the vane machine, cavitation may occur. Cavitation negatively affects the power characteristics of the vane machines. It leads to a drop in the power parameters for the pumps and damage to their flowing parts. And also at times increases the pulsation of pressure at the pump outlet and vibration. This is especially dangerous for LPRE chambers, as the pulsation of pressure leads to the appearance of low-frequency oscillations of the chamber itself. Therefore, it is so important, even at the design stage, to determine the cavitation perfection of the LPRE vane pump and take measures to increase it.When developing the RD861K engine, high demands were placed on the power perfection of the oxidizer pump. The efficiency of the oxidizer pump RD861K should be 5% higher than that of the oxidizer pump RD861 (pump prototype).To increase the efficiency of the oxidizer pump of the RD861K engine, a number of design parameters was changed (compared to the prototype). These works were crowned with success, the required efficiency value was achieved. However, some of the taken measures had a negative impact on the cavitation perfection of the pump.This study is devoted to the analysis of the influence of the design parameters of the RD861K engine pump (which make it possible to increase its efficiency) on its cavitation properties. During the analysis, it was determined how the design parameters affect the nature of the cavitation characteristicof the oxidizer pump RD861K and RD861. It is also established how a concrete design change affects the value of the suction specific speedof the pump. In addition to the above studies, an analysis was made of cavitation characteristics of pumps operating on a gas-containing two-phase liquid. Based on the results of the analysis, the dependence of the decrease in therelativesuction specific speedof the pump on the amount of gas supplied to the inlet to the pump was constructed. The results of this study allow us to estimate the magnitude of cavitation pump failure at the design stage, depending on the design features of its flowing part when working liquid withoutgas and on the gas-liquid two-phase mixture.

Abstract 16189: Using Vectorcardiography to Predict Prognosis in Patients With STEMI and Heart Failure

Introduction: There is an unmet need for a non-invasive and cost-effective surveillance tool for characterizing the severity and progression of heart failure (HF) to guide evidence-based therapies. We hypothesize that changes over time in unique parameters extracted using vectorcardiography (VKG) have the potential to predict clinical outcomes in patients with HF. The pathophysiology of HF involves abnormal remodeling and a loss of cardiomyocytes, which may alter the strength and direction of the net depolarization signal. These subtle changes can be elucidated using VKG and correlated with prognosis. We hypothesize a similar approach can be utilized for patients post-STEMI as the underlying pathophysiology - loss of myocardium - is comparable and could serve as an initial proof-of-concept. Methods: We identified 209 patients discharged from Michigan Medicine between 2016 and 2021 with a diagnosis of acute STEMI. For each patient, a single 12-lead EKG pre-STEMI and &gt;1-week post-STEMI were collected. A set of 60 VKG parameters were derived by analyzing features of the QRS complex. We used LASSO regression analysis incorporating clinical variables and VKG parameters to create a predictive model for the composite outcome of mortality or HF at 90 days post-STEMI. Model accuracy was determined by randomly partitioning the data into five folds and running the logistic regression model on all folds but one. Results: Comorbid diabetes (OR = 3.04, p = 0.06), QTc post-STEMI (OR = 2.44, p &lt;0.05), and P wave onset pre-STEMI (OR = 0.41, p &lt; 0.05) were consistently predictive. A logistic regression with just these variables has a raw accuracy of 80.3% and cross-fold validation accuracy of 79.4%. Future work aims to create one of the largest pre-/post-STEMI ECG databases, with over 1,200 patients, which will be used to corroborate the above results and serve as a tool for other investigators to explore. Conclusions: ECG changes before and after a STEMI event can be used to assess the risk of mortality or HF and help guide management. The composite outcome appears to be dominated by variables that are primarily associated with arrhythmogenic death. Future work will focus on pump failure alone and determine VKG parameter predictiveness in HF specifically.

Nursing care for children with fulminant myocarditis treated with extracorporeal membrane oxygenation.

To summarize the nursing experience of treating pediatric fulminant myocarditis with extracorporeal membrane oxygenation (ECMO). The intensive care unit of our hospital treated 6 children with fulminant myocarditis with ECMO from 2019 to 2022. The main nursing measures included establishing an ECMO rescue team, preparing before initiation of ECMO, management of arterial and venous catheters, enteral nutrition support, reducing the risk of infection aggravation, anticoagulation management, prevention of bleeding and thrombosis, management of ECMO pump failure, and post-ECMO care. One child's family abandoned treatment and left the hospital, while the other 5 children were transferred to the cardiovascular department after stable weaning from ECMO and continued treatment, with good condition, and eventually discharged. Pediatric fulminant myocarditis has a high mortality rate, but detailed evaluation and nursing care can improve the outcome of these patients.

Research on gas–liquid separation characteristics in the helico-axial multiphase pump

Due to the fact that it serves as both a pump and a compressor, the helico-axial multiphase pump is better suited for mixed-transport oil-gas two-phase flow and is frequently used for deep-sea oil extraction. The gas–liquid separation caused by the asynchrony of the gas–liquid two-phase medium is the primary cause of the damage or failure of the helico-axial multiphase pump in the project, resulting in the pump's damage or inability to operate. To investigate the variation of phase separation in the helico-axial multiphase pump under diverse operating conditions, a test system was designed and the theory of fluid flow mechanics was applied. The effects of different flow fields on the energy conversion characteristics of the pump were investigated. The results indicate that the gas–liquid separation position in the impeller occurs near the 2/3 of the airfoil bone line. After the gas–liquid separation, gas mass will be formed, pocket flow will be readily induced, and the gas block-up phenomenon will result in energy loss in the compression unit. Simulations indicate that the static pressure recovery and total pressure loss in a diffuser fluctuate over time. The static pressure recovery efficacy of the diffuser is highest when the imported gas volume fraction is 10% and lowest when the imported gas volume fraction is 60%. On the surface of the impeller blade, perpendicular to the flow direction, the separation phenomenon near the hub side is more severe than that near the rim. Along the flow direction, the pattern of phase separation is comparable.

Effect of Blade Trimming Length on the Performance of Marine Centrifugal Pump

To study the hydrodynamic characteristics of blade trimming length in centrifugal pumps, Delayed Detached Eddy Simulation (DDES) with nonlinear eddy viscosity was utilized to conduct unsteady calculations on the centrifugal pump. A comprehensive examination of the fluid dynamic properties of the centrifugal pump, including external features, flow conditions, and pressure fluctuations, was carried out. By applying the theory of entropy production, the areas of high energy loss within the centrifugal pump were identified, and the correlations between local entropy production, energy loss, and unsteady flow in different areas with varying blade trimming lengths were analyzed. The results indicate that with the increase in blade trimming length, under rated flow conditions, the head decreases by 1.8%, 3.2%, and 5.7% for different blade trimming lengths, respectively, compared to normal impellers. Similarly, the efficiency decreases by 0.5%, 0.8%, and 1.0% for different blade trimming lengths, respectively. Similar trends were observed under other working conditions as well. As the degree of blade trimming increases, the irreversible losses after the failure of the centrifugal pump also increase significantly, indicating that the flow inside the centrifugal pump becomes disorder. Blade trimming leads to a disorderly fluid flow inside the centrifugal pump, causing an increase in the radial force during operation, which in turn leads to an increase in vibration amplitude and affects its operational stability. Blade trimming failure has a significant impact on the frequency and amplitude of pressure pulsation, resulting in abnormal pressure pulsation and abnormal vibration of the centrifugal pump. Therefore, early warning and diagnosis of blade trimming can be achieved through pressure pulsation monitoring.

A case study on the failure analysis of 1 hp house hold electrical submersible pump in Prayagraj India

This paper deals with the failure analysis of a 1 HP household electrical submersible pump in Prayagraj city. The city is surrounded by two rivers i.e. the Ganga and the Yamuna. Therefore, domestic submersible pumps are widely used in the region. Hard water and sand particles cause various problems with the pump. The submersible pump consists of a pump section and a motor section. The failure analysis of the motor section consists of failure of the rotor, stator, cable and other parts. Similarly, the pump section consists of failure of the impeller, diffuser and other parts. Prevention methods for all failed components have also been discussed in this paper. The failure of a submersible pump can be summarized into three major categories i.e. mechanical failure (breakage, corrosion, dislocation and leakage), electrical failure (cable failure, motor failure, and connection severances) and operational failure (high temperature, high pressure and multiphase flow).

Outcomes of Endonasal Dacryocystorhinostomy Performed for Functional Nasolacrimal Obstruction With Delay on Dacryoscintigraphy.

To report the demographics and outcomes of endonasal dacryocystorhinostomy (DCR) following dacryoscintigraphy (DSG) performed for a series of patients with functional epiphora. Case series of endonasal DCR outcomes in patients with symptomatic epiphora with no evidence of lacrimal hypersecretion or lacrimal pump failure, minimal regurgitation noted on syringing, and DSG-confirmed delayed drainage. A successful outcome was defined as 80% subjective improvement or resolution of tearing on the operated side. Patient charts, DSG results, and operative records were examined, and data were collected. Relevant literature was reviewed and discussed. The case series included 15 eyes of 10 patients. The mean age was 61.7 years at the time of surgery. Most cases (n=13) had post-sac obstruction, retention, or delay. One patient had pre and post-sac retention. A total of 12 cases had success after endonasal DCR, and 3 cases had failure. Follow-up for all operated patients was over 6 months. There were no reported complications by the surgeon or patients. Patients with functional epiphora confirmed by DSG seem to have a high success rate after endonasal DCR. In patients with symptomatic epiphora with subjective patency on syringing, the use of DSG in decision-making and outcome prediction may be supported. Further studies, including clinic-based tests, to demonstrate functional obstruction are warranted.

Application of Machine Learning Coupled with Stochastic Numerical Analyses for Sizing Hybrid Surge Vessels on Low-Head Pumping Mains

In surge protection, low-head profiles are deemed a challenge in pump failure events since they are prone to severe negative pressure surges that require an uneconomical surge vessel volume. A hybrid surge vessel with a dipping tube can provide required protection with reasonable economic volume. This work presents novel analyses for the hybrid surge vessel and develops a simple model for its optimum sizing using a stochastic numerical approach coupled with machine learning. Practical ranges for correct sizing of vessel components, such as ventilation tube, inlet/outlet air valves, and compression chamber, are presented for optimal protection and performance. The water hammer equations are iteratively solved using the hybrid surge vessel’s revised boundary conditions within the method of characteristics numerical framework to generate 2000 cases representing real pump failures on low-head pipelines. Genetic programming is utilized to develop simple relations for prediction of the hybrid vessel initial and expanded air volumes in addition to the compression chamber volume. Moreover, the developed model presented a classification index for low-head pipelines on which the hybrid vessel would be most economical. The developed model yielded good prediction error statistics. The developed model proves to be more accurate and easier to use than the classical design charts for the low-head pumping mains. The model clearly showed the relation between various hydraulic and pipe parameters, with pipe diameter and static head as the most influencing parameters on compression chamber volume and expanded air volume. The developed model, together with the classification indices, can be used for preliminary surge protection sizing for low-head pipelines.

SAT103 Strategies To Enhance Insulin Pump Backup Plan Delivery: A Quality Improvement Project

Abstract Disclosure: P. Krutilova: None. S. Blount: None. A. Carvalho: None. A. Cedeno: None. K. Jones: None. I. Malik: None. S.A. Maraqa: None. A. Markov: None. A. Martirossian: None. M.C. Petersen: None. R.L. Usala: None. N. Genere: Research Investigator; Self; Fractyl Laboratories. Background: Continuous subcutaneous insulin infusion (“insulin pump”) use is associated with improved glycemic control, greater quality of life, and reduced hypoglycemic events. However, failure to properly identify and respond to insulin pump malfunction can cause adverse events, including diabetic ketoacidosis. Professional society guidelines recommend the use of insulin pump backup plans in the event of pump failure, but plan details are determined by individual clinicians and practices. We identified inconsistent implementation of insulin pump backup plans within our Diabetes Center and undertook a quality improvement project to (1) standardize backup plan documentation and (2) evaluate the extent to which these efforts improve patient confidence in their personalized backup plan. Methods: Retrospective review of the electronic medical record was performed to evaluate whether all necessary components of an insulin pump backup plan [abbreviated as “WIS”, including (1) Written backup plan with dosing, (2) intermediate or long-acting Insulin prescription, and (3) appropriate Supplies], were documented prior to the intervention. Clinician and patient surveys were completed to gather insights into existing backup plan practices. We then developed a ‘Backup Plan’ document with troubleshooting tips and patient-specific dosing of subcutaneous insulin. We assessed several interventions for increasing utilization of the ‘Backup Plan’ using surveys. Results: In a baseline assessment of 89 patients using insulin pumps, 53% had a documented backup plan and 33% had all WIS components. Certified Diabetes Care and Education Specialist (CDCES) visits were the most common source of pump backup plan documentation and CDCES involvement in care was associated with higher likelihood of successful WIS components (53.3% vs. 11.4%, p &amp;lt;0.001). Yet, only 39% of patients had a CDCES visit within the past year. Of 20 patients surveyed, 85% reported confidence in using their backup plan, but only 50% were able to recall specific insulin dosing. Among several interventions, we found that only personalized training for clinicians improved implementation of the ‘Backup Plan’ document, and none of the interventions increased CDCES referral frequency. Barriers to CDCES visits included patient preference, scheduling constraints, and referral order complexity. Conclusion: We identified low rates of insulin pump backup plan documentation in our practice and identified CDCES engagement as a key factor for backup plan implementation. We developed standardized pump backup plan documentation and implemented it using personalized training of clinicians. In the future, we will pilot a multidisciplinary diabetes technology clinic with allocated time for both clinician and CDCES visits and evaluate frequency of successful pump backup plans through retrospective chart review and patient surveys. Presentation: Saturday, June 17, 2023

Mechanical pump complication after HeartMate 3 implantation.

With the improvement in postoperative complications and long-term survival post LVAD, continuing to improve clinical outcomes will require efforts to decrease long-term complications. The purpose of this study is to describe the incidence of mechanical pump failure requiring surgery, which we define as pump failure secondary to either outflow graft compression, outflow graft obstruction, or pump thrombosis requiring surgical intervention. 141 consecutive adult patients who underwent HeartMate3 Implantation using the "cut-then-sew" implantation technique between September 2015 and September 2021 were included in our study. The primary outcome measure was mechanical pump complication (outflow graft obstruction and or pump thrombosis) requiring surgical intervention. Secondary outcome measures included incidence of bleeding, stroke, renal failure, length of stay, and overall survival. Median follow up was 27.3 months. Eleven (7.8%) of patients developed mechanical pump complications. Six patients developed outflow graft obstruction. Five patients developed acute pump thrombosis. Median time to a mechanical complication was 828 days. Of the 11 patients who underwent surgery, 10 patients (90%) survived to discharge. Overall survival at 1, 3, and 5 years was 82.9%, 69.1% and 55.2% respectively for the entire cohort. The mechanical pump complication rate of 7.8% which is quite high may be related to duration of follow up, as the median time to mechanical complication was 828 days. This study highlights an important late complication that occurs post LVAD implantation.

Machine learning applications in predictive maintenance: Enhancing efficiency across the oil and gas industry

The oil and gas industry faces constant pressure to enhance operational efficiency, reduce costs, and minimize equipment downtime. Machine learning (ML) applications in predictive maintenance have emerged as a transformative approach to achieving these goals. This review explores the role of machine learning in predictive maintenance, highlighting its potential to revolutionize maintenance strategies and improve asset management across the industry. Predictive maintenance leverages advanced algorithms to analyze historical and real-time data from equipment and sensors, enabling the identification of patterns and anomalies that precede equipment failures. By utilizing techniques such as supervised learning, unsupervised learning, and reinforcement learning, organizations can forecast equipment malfunctions and schedule maintenance activities proactively, thereby reducing unexpected downtimes and extending asset lifecycles. The implementation of ML in predictive maintenance provides several key benefits. Firstly, it enhances operational efficiency by optimizing maintenance schedules and minimizing unplanned outages, which are critical in the capital-intensive oil and gas sector. Secondly, it enables cost savings through more efficient resource allocation and reduced labor costs associated with reactive maintenance strategies. Thirdly, machine learning algorithms can continuously learn from new data, refining their predictive capabilities and improving accuracy over time. Several case studies illustrate the successful application of machine learning in predictive maintenance within the oil and gas industry. For example, ML models have been employed to predict pump failures, optimize drilling operations, and improve pipeline integrity monitoring. These applications not only lead to significant financial savings but also enhance safety by reducing the risk of catastrophic failures. In conclusion, machine learning applications in predictive maintenance represent a crucial advancement for the oil and gas industry. By harnessing the power of data-driven insights, organizations can enhance operational efficiency, reduce costs, and ultimately drive sustainable growth. This review emphasizes the transformative potential of machine learning in predictive maintenance, establishing it as a key strategy for success in the ever-evolving oil and gas landscape.

History, evolution, and graphic analyses of mechanical insufflation exsufflation for treatment of neurological disorders

In individuals with ventilatory pump failure (VPF) prophylactic, mechanically assisted airway clearance (ACT) by means of Mechanical Insufflation Exsufflation (MIE), is an important mitigation strategy to prevent respiratory infection, decompensation, and ultimately acute respiratory failure (ARF). VPF secondary to respiratory muscle dysfunction is a significant risk factor in neuromuscular disorders, spinal cord injury, chest wall disease, and may occur in some instances of morbid obesity. In the intensive care unit (ICU), MIE has been shown to help avoid the need for tracheostomy tube placement and improve the success rate of extubation from mechanical ventilation, especially when MIE is used in combination with continuous noninvasive ventilatory support (CNVS). Globally, clinicians are recognizing that initial titration of the settings and ongoing management of MIE can be guided by the flow and pressure waveforms that are a feature of at least one widely available MIE device.

Postprandial hypotension as a predictor of respiratory failure in patients with foodborne botulinum intoxication – a case-control study in outbreak investigation

ObjectivesBotulism is a rare syndrome characterized by acute, flaccid paralysis with possible involvement of respiratory muscle-producing pump failure requiring mechanical ventilation. A predominance of autonomic involvement can occur. MethodsWe enrolled patients affected by foodborne botulism during an outbreak. All patients underwent the detection of the toxin in stool specimens, and 24-hour ambulatory blood pressure monitoring (ABPM). A blinded expert operator analyzed ABPM data for the diagnosis of hypertension and postprandial hypotension (PPH). ResultsTwenty male patients met the inclusion and exclusion criteria. Thirty-four healthy subjects matched for sex and age were enrolled as a control group. PPH was significantly more frequent in the botulin group than in healthy subjects (40% vs 2.9%, P <0.0001). At the logistic regression, the probability that patients affected by botulinum could require ventilation was increased by 733% (adjusted odds ratio: 8.33) when PPH is encountered. ConclusionsThe likelihood of resorting to ventilation in subjects with botulinum intoxication was seven times greater in patients presenting PPH. These results could allow the prompt identification of patients at high risk for requiring ventilation.

Pacing-induced cardiomyopathy in patients with preserved ejection fraction undergoing permanent cardiac pacemaker placement.

Chronic right-ventricular (RV) pacing can worsen heart failure in patients with a low ejection fraction (EF), but little is known about pacing-induced cardiomyopathy (PICM) in patients with preserved EF. We aimed to investigate risk factors of PICM in these patients during long-term follow-up. The prospective registry at Chosun University Hospital, South Korea, included de novo patients with preserved EF undergoing transvenous permanent pacemaker (PPM) implantation for atrioventricular blockage from 2017 to 2021. Patients with EF ≥ 50% and expected ventricular pacing ≥ 40% were included. Composite outcomes were cardiac death (pump failure), hospitalization because of heart failure, PICM, and biventricular pacing (BVP) upgrade. A total of 168 patients (69 men, 76.3 ± 10.4 years) were included. During three years of follow-up, one patient died, 14 were hospitalized, 16 suffered PICM, and two underwent BVP upgrade. PICM were associated with reduced global longitudinal strain (GLS), prolonged paced QRS duration (pQRSd) and diastolic variables (E/e', LAVI). Cox regression analysis identified pQRSd (hazard ratio [HR], 1.111; 95% confidence interval [CI], 1.011-1.222; P = 0.03) and reduced GLS (HR, 1.569; 95% CI, 1.163-2.118; P = 0.003) as independent predictors of PICM. GLS showed high predictive accuracy for PICM, with an area under the curve of 0.84 (95% CI 0.779-0.894; P < 0.001) [GLS -12.0, 62.5% sensitivity, and 86.1% specificity]. RV pacing increased the risk of PICM in patients with preserved EF. Reduced GLS and prolonged pQRSd could help identify individuals at high risk of PICM even with preserved EF.