Recovery Ventilation Research Articles

Cardiorespiratory failure induced by inhalation of aerosolized fentanyl in anesthetized rats

Intravenous rapid injection of fentanyl causes respiratory depression (severe apneas), leading to sudden death, which constitutes the deadliest drug reaction among overdoses of synthetic opioids. Here we asked whether acute inhalation of overdose fentanyl would also result in similar respiratory failure and death. The anesthetized and spontaneously breathing rats with tracheal cannulation were exposed to aerosolized fentanyl at 100 mg/m3 (FNTH) or 30 mg/m3 (FNTL) for 10 min. Minute ventilation (VE), electromyography (EMG) of the internal and external intercostal muscles and thyroarytenoid muscles (EMGII, EMGEI, and EMGTA), heart rate and arterial blood pressure were recorded. During the exposure, FNTH and FNTL immediately triggered bradypnea (40 % reduction, p < 0.05) with TE prolonged and then gradually decreased VE by 40 % (P < 0.05) after a brief VE recovery. The initial TE prolongation (apneas) were characterized by the cessation of EMGEI activity with enhanced tonic discharges of EMGTA and EMGII. After termination of the exposure, the cardiorespiratory responses to FNTL returned to the baseline values 30 min later, while those to FNTH were greatly exacerbated (P < 0.05), leading to ventilatory and cardiac arrest occurred 16.4 ± 4.7 min and 19.3 ± 4.5 min respectively after the onset of FNTH. The ventilatory arrest was featured by cessation of both EMGEI and EMGII and augmentation of tonic EMGTA. Our results suggest that acute exposure to an overdose of fentanyl aerosol leads to death through initially inducing a brief central and upper airway obstructive apnea as well as chest wall rigidity followed by gradual severe hypoventilation, bradycardia and hypotension, and eventual cardiorespiratory arrest in anesthetized rats.

Initiation of mechanical weaning of ICU patients and investigation of nurses' knowledge and role.

ABSTRACT Introduction: The process of weaning from MV involves a methodical practice, during which certain conditions should be met. Critical care nurses play a key role in the ongoing assessment and monitoring of the patient weaned from MV, using a thorough 'Airway, Breathing and Circulation' approach. Adjusting weaning parameters requires a high level of skill and training, as well as a good knowledge of cardiorespiratory physiology and pathophysiology. The purpose of this study is to investigate the role of ICU nurses and the level of knowledge they possess regarding the process of weaning patients from MV. Materials and Methods: The research was conducted in a sample of 90 employees in the ICU of a General Hospital. A quantitative survey was conducted with a questionnaire, during the time-period July-September 2021. The questionnaire used for data collection consists of 43 questions categorised as follows: a) Demographic data; b) Overview of mechanical ventilation recovery; c) Mechanical ventilation weaning methods and methods; d) Evaluation criteria weaning readiness; e) Spontaneous respiration test, g) Causes of intubation failure; h) Weaning protocols and suppression. Results: Most nurses did not answer all the questions correctly, meaning nurses do not have the required knowledge and skills to successfully manage patient intubation. Two more key findings of this research were: a) protocols can help in the successful intubation of the patient; b) nurses need training in successfully ossifying patients. Conclusions: There is a need for nurses to participate in continuing education programs, as well as a need to create an interdisciplinary team. However, further research on a larger sample of respondents is necessary in order to extract results that can be generalized.

Comparison of five weaning indices in predicting successful weaning from mechanical ventilation

Introduction: Mechanical ventilation is a life-supporting modality used in patients with respiratory failure. Most patients are extubated early but weaning can be prolonged in some. Aim: Comparison of accuracy of prediction of success of a spontaneous breathing trial (SBT) using CORE, CROP, RSBI, RSBI rate and minute ventilation recovery. Methods: This is a prospective observational study. 62 adult patients admitted to Multidisciplinary Intensive Care Unit during April 2012 - January 2013 were studied. All patients, orotracheally intubated and mechanically ventilated for at least 24 hours and ready for weaning were enrolled. The patients underwent SBT using pressure support ventilation (5 – 8 cm H2O), PEEP of 5 - 8 cm H2O, and 40% oxygen. The weaning indices were measured at 30 min and correlated with weaning success. Results: The mean (± SD) age was 49.7 (± 18.3) years. There were 46 male and 16 female patients. The threshold values were as follows: CORE index: ≥ 6, CROP index: ≥ 13, RSBI &lt; 105 b/min/L, RSBI rate ≤ 20%. The sensitivity (%), specificity (%) and AUC of ROC curve were as follows: CORE (96, 66, 0.74), CROP (95, 33, 0.61), RSBI (89, 46, 0.2), RSBI rate (85, 28, 0.52) and minute ventilation recovery (higher than baseline minute ventilation at 25 min of rest on initial ventilator settings after 30 min of SBT) (n = 26) (92.3, 100, 0.93). Conclusion: CORE and RSBI are moderately accurate while CROP and RSBI rate are inaccurate. Minute ventilation recovery predicted weaning failure accurately.

High-rise residential building ventilation in cold climates: A review of ventilation system types and their impact on measured building performance.

Ventilation system performance in high-rise multi-unit residential buildings (MURBs) has a significant impact on resident wellbeing. While the importance of ventilation is well established, it is commonly overlooked since underperformance often goes undetected. This article presents a review and synthesis of ventilation system performance in high-rise MURBs located in cold climates as it relates to the three pillars of sustainability: economic (capital and operational cost), social (airflow control, indoor environmental quality, and occupant behavior and interactions), and ecological (energy and carbon). A meta-analysis revealed previous ventilation system designs generally prioritized economic sustainability, specifically, capital cost. However, priorities have recently shifted toward social and ecological sustainability. While this shift is positive, there is insufficient empirical evidence showing which ventilation system most effectively supports it. The decentralized heat/energy recovery ventilator (HRV/ERV) system shows the potential to improve upon the social and ecological sustainability of previous designs, such as the centralized pressurized corridor system, but the interconnected nature of performance metrics can cause improvements to one to negatively impact others. Therefore, further research is required to enhance ventilation system performance in cold climate, high-rise MURBs, and facilitate decision-making while designing and retrofitting these systems.

In severe COVID-19, high-flow vs. conventional oxygen therapy reduced intubation and time to clinical recovery at 28 d.

Ospina-Tascón GA, Calderón-Tapia LE, García AF, et al. Effect of high-flow oxygen therapy vs conventional oxygen therapy on invasive mechanical ventilation and clinical recovery in patients with severe COVID-19: a randomized clinical trial. JAMA. 2021;326:2161-71. 34874419.

Adoption of Artificial Intelligence (AI)-Based Computerized Tomography (CT) Evaluation of Comprehensive Nursing in the Operation Room in Laparoscopy-Guided Radical Surgery of Colon Cancer.

This research aimed to discuss the application of traditional nonlocal mean (NLM) algorithm-based computerized tomography (CT) images in intervention evaluation of the nursing for patients performing laparoscopy-guided radical surgery of colon cancer. A total of 100 patients who were diagnosed with colon cancer after enteroscopy and performed laparoscopic radical surgery were chosen as the research objects. They were divided into an observation group (comprehensive nursing in operation room) and a control group (routine nursing), each of which included 50 cases. All cases received CT examination. Meanwhile, the improved traditional NLM (INLM) algorithm was proposed, and the effects of image reconstruction were analyzed to improve the quality of CT images. The result showed that structural similarity index measure (SSIM) and figure of merit (FOM) of INLM were obviously higher than those of filtered back projection (FBP) algorithm and NLM algorithm, and the average running time was significantly less than that of FBP algorithm and NLM algorithm (P < 0.05). The operation time and the amount of intraoperative blood loss of patients in the observation group were both less than those of patients in the control group, and differences had statistical significance (P < 0.05). Besides, the time of getting out of bed, ventilation recovery time, postoperative meal time, stomach tube encumbrance time, and catheter encumbrance time of patients in the observation group were all less than those of patients in the control group, and the differences had statistical significance (P < 0.05). In the observation group, there were 3 cases with postoperative complications, and 2 out of them got incision infection while 1 suffered from constipation. In contrast, there were 9 cases with postoperative complications in the control group, 3 of which were patients with incision infection, and 2 suffered from urinary retention while the other 4 suffered from constipation. According to the above results, the INLM algorithm proposed in this research could improve the image reconstruction accuracy of traditional algorithm, shorten the running time, and enhance the overall diagnostic efficiency. The comprehensive nursing in operation room with laparoscopic radical surgery of colon cancer could improve the cure rate and prognosis of patients, so it was worthy of clinical promotion and application.

Neuromuscular electrical stimulation of the respiratory muscles based on breathing modelization in a mouse model of cervical spinal cord injury

High cervical spinal cord injuries (cSCI) induce profound denervation in respiratory muscles leading to hypoventilation that compromises quality of life and increases mortality rate. Neuromuscular electrical stimulation of extra-diaphragmatic respiratory muscles (rNMES) could be a non-invasive approach to improve ventilatory capacity in cSCI. We developed a model of rNMES synchronized with breathing (to avoid breathing pattern alteration) in a murine model of cSCI. A theorical breathing signal was built based on an ordinary differential equation and compared to actual breathing signals during spontaneous breathing at rest obtained by plethysmography in 13 mice (OF1, 8 weeks old) after a C3 hemi-contusion (C3HC) or a laminectomy (LM). The signal was dilated to represent breathing during rNMES under anesthesia. Then, nine mice (6 C3HC and 3 LM) were trained using rNMES or sham-rNMES. The modelized signal matched actual ventilation with a mean squared error of the residuals of 0.016 and a mean r 2 of 83%. rNMES algorithms allowed for intercostal NMES during inspiratory phases only while producing a thoracic expansion and abdominal NMES during expiratory phases only with a duty cycle of 25%. Although C3HC mice decreased tidal volume (Vt) by 17% (0.53 ± 0.11 vs. 0.64 ± 0.11 mL, P = 0.03, n = 6), 10 sessions of rNMES tended to allow for ventilation recovery via an improved Vt in the stimulated C3HC mice ( n = 3) while there was no change in sham-rNMES mice ( n = 3) ( Fig. 1 ). This new model of rNMES could be of great interest to investigate the mechanisms of recovery after NMES in cSCI but also in various other models of respiratory failure.

Peripheral chemoreflex contribution to ventilatory long-term facilitation induced by acute intermittent hypercapnic hypoxia in males and females.

Ventilatory long-term facilitation (vLTF) refers to respiratory neuroplasticity that develops following intermittent hypoxia in both healthy and clinical populations. A sustained hypercapnic background is argued to be required for full vLTF expression in humans. We determined whether acute intermittent hypercapnic hypoxia elicits vLTF during isocapnic-normoxic recovery in healthy males and females. We further assessed whether tonic peripheral chemoreflex drive is necessary and contributes to the expression of vLTF. Following 40min of intermittent hypercapnic hypoxia, minute ventilation was increased throughout 50min of isocapnic-normoxic recovery. Inhibition of peripheral chemoreflex drive with hyperoxia attenuated the magnitude of vLTF. Males and females achieve vLTF through different respiratory recruitment patterns. Ventilatory long-term facilitation (vLTF) refers to respiratory neuroplasticity that manifests as increased minute ventilation ( ) following intermittent hypoxia. In humans, hypercapnia sustained throughout intermittent hypoxia and recovery is considered necessary for vLTF expression. We examined whether acute intermittent hypercapnic hypoxia (IHH) induces vLTF, and if peripheral chemoreflex drive contributes to vLTF throughout isocapnic-normoxic recovery. In 19 individuals (9 females, age: 22±3years; mean±SD), measurements of tidal volume (VT ), breathing frequency (fB ), , and end-tidal gases ( and ), were made at baseline, during IHH and 50min of recovery. Totalling 40min, IHH included 1min intervals of 40s hypercapnic hypoxia (target =50mmHg and =+4mmHg above baseline) and 20s normoxia. During baseline and recovery, dynamic end-tidal forcing maintained resting and and delivered 1min of hyperoxia ( =355±7mmHg) every 5min. The depression in during hyperoxia was considered an index of peripheral chemoreflex drive. Throughout recovery was increased 4.6±3.7lmin-1 from baseline (P<0.01). Hyperoxia depressed at baseline, and augmented depression was evident following IHH (Δ =-0.8±0.9 vs. -1.7±1.3lmin-1 , respectively, P<0.01). The vLTF was similar between sexes (P=0.15), but males had larger increases in VT than females (sex-by-time interaction, P=0.03), and females tended to increase fB (P=0.09). During isocapnic-normoxic recovery following IHH: (1) vLTF is expressed in healthy humans; (2) vLTF expression is attenuated but not abolished with peripheral chemoreflex inhibition by hyperoxia, suggesting a contribution from central nervous pathways in vLTF expression; and (3) males and females develop similar vLTF through different ventilatory recruitment strategies.

A review of heating, ventilation and air conditioning technologies and innovations used in solar-powered net zero energy Solar Decathlon houses

Abstract Innovations in Heating, Ventilation, and Air Conditioning (HVAC) systems are continuously required to provide a better, healthier and more productive and sustainable built environment for building occupants with minimized energy or cost consumption. This paper provides an overview of the HVAC technologies and systems used in 212 solar-powered houses developed through 13 U.S. Department of Energy Solar Decathlon (SD) competitions. Some comments and discussions on the HVAC technologies and systems used in the SD competitions were also provided. The review was carried out based on the information available from the organizer’s project reports and equipment summary, team project manuals, and construction drawings available on the SD official websites as well as the published research papers and textbooks. It was found that 84.9% and 89.6% of the competition teams used heat pumps for space heating and space cooling, respectively, among which air-to-air heat pumps were used by approximately 50% of the competition teams. A wide range of energy technologies such as phase change materials, night-time radiative cooling, evaporative cooling, desiccant dehumidification, and energy/heat recovery ventilators have been used to reduce the electricity consumption of the HVAC systems. Energy/heat recovery ventilators were used by more than 55% of the teams in each competition held after 2005. Phase change materials were also frequently used in the competitions held in Europe. The SD competitions provided an excellent platform to showcase innovations of the HVAC technologies in residential buildings.

Serum Clara Cell Protein (CC16) Levels and Multi-Detector Computed Tomography–Based Volumetric Assessment of Lung Parenchymal Injury in Isolated Blunt Thoracic Trauma Patients: a Prospective Observational Study

Numerous studies have been done for markers of lung injury especially in animal models and it remains relatively unexplored whether these biomarkers clinically correlate with the outcome of patients or with the extent of lung parenchymal injury as deduced by MDCT. This prospective study was conducted to assess the serum level of Clara cell secretory protein (CC16) and volume of the uninvolved lung by MDCT and to ascertain the correlation between levels of CC16 with the volume of the injured lung in the clinical outcome of patients of blunt thoracic trauma. Serum CC16 levels and mean uninvolved lung volumes of both lungs were compared in between groups of eventless recovery, need for mechanical ventilation and mortality with p value < 0.05 considered to be significant. Sixty-two patients of blunt chest trauma, age range from 18 to 60 years, were evaluated in our study. Out of them, 43 (69%) were male. Higher level (more than 100 ng/mL) of serum Clara cell protein was associated with the requirement of ventilator and mortality. Total mean uninvolved lung volume of 1075.71 ± 327.5 and 2329.23 ± 776.01 was significantly associated with the requirement of mechanical ventilation and eventless recovery of patients respectively. A mild negative correlation (− 0.4) between the remaining volume of the lung after injury and serum Clara cell protein levels were also noted. Serum CC16 levels may obviate the need of MDCT in the selected group of patients and thereby avoiding its radiation hazards.

Influence of Building Air Tightness on Energy Consumption of Ventilation System in Nearly Zero Energy Residential Buildings

Building air tightness increased quickly in recent years as nearly zero energy buildings concept gradually drawn more attentions from the industry. Ventilation system plays an important role for the indoor air quality control in residential buildings with good air tightness. The energy consumption of the ventilation system is a significant part of the overall energy consumption of low energy residential building. The influence of the building air tightness on the energy consumption of ventilation system was not addressed sufficiently in previous studies. This paper analyses the quantitative relations between building air tightness, energy recovery efficiency and ventilation system control strategy. A mathematical model of the heating and cooling energy consumption in residential buildings is proposed, which takes building air tightness, energy recovery efficiency and control strategy of ventilation system as major input parameters. Equivalent COP of ventilation energy recovery system is proposed as an energy efficiency index of the ventilation system. It can be used as a criterion to decide the optimal design parameters of nearly zero residential buildings in different climate conditions.

A Novel Spherical Packed Bed Application on Decentralized Heat Recovery Ventilation Units

Decentralized heat recovery ventilation (HRV) systems are assumed as simple solutions to obtain a healthy and comfortable indoor environment. A wall or window mounted compact version of decentralized HRV systems (mono unit) are used for small scale, mostly residential applications. A fan and a heat exchanger are the critical components of this compact system. The flow capacity of these units are down to 10 m3/h, where efficiencies over 90% are commonly declared by the manufacturers. On the other hand, spherical packed beds (SPD) are widely used in the heat transfer applications such as; chemical reactors, grain driers, nuclear reactors, thermal storage in buildings and in solar thermal power plants, due to operational convenience. These systems are operated under steady flow conditions, unlike decentralized HRV systems which are designed for cyclic operation. In this study, heat recovery performance of a spherical packed bed heat exchanger for a decentralized HRV system is investigated. A one dimensional mathematical model for a SPD is obtained and an in-house computer code is developed to solve the transient heat transfer inside the packed bed under cyclic operation conditions. Well known convenient correlations were used for pressure drop calculations. A number of bed and sphere diameters were studied in a wide range. Various flow time and number of cycles were studied for the hot and cold flow to understand the SPD performance for HRV applications. This novel application also has the potential for regenerative heat recovery systems.

Early Inflammatory Response in the Brain and Anesthesia Recovery Time EvaluationAfter Experimental Subarachnoid Hemorrhage.

The main objective was to evaluate, whether the subarachnoid hemorrhage (SAH)-associated early inflammatory response has focal or global character, i.e., whether areas distant to hematoma may be affected by an early inflammatory response. The second objective was to evaluate the association of anesthesia recovery time for basic reflexes/neurological functions with severity of SAH. SAH was induced in rats using an endovascular perforation model. Anesthesia recovery time was evaluated for pain reaction recovery time (spinal level), spontaneous ventilation recovery time (brain stem level), and consciousness recovery time (neocortical level). mRNA expressions of TNFα, IL-1β, IL-6, ICAM-1, and VCAM-1 in areas adjacent and distant to hematoma were evaluated between 2 and 8h after SAH. Serum levels of TNFα, IL-1β, and IL-6 were assessed at 4 and 8h after SAH. Anesthesia recovery time of all selected parameters was associated with severity of SAH. The consciousness recovery time test had the best predictive value, while the spontaneous ventilation recovery time test was able to bring information in the shortest time. The mRNA expressions of pro-inflammatory cytokines were significantly increased in severe SAH groups in both adjacent and distant areas. The inflammatory response in mild/moderate SAH groups was less strong, peaking at 4h after SAH. Serum levels of pro-inflammatory cytokines were ambiguous. Anesthesia recovery time may be useful for bleeding severity prediction in the SAH model; however, further validation is needed. Severe subarachnoid hemorrhage is associated with the strong early inflammatory response, which has a global character, while mild subarachnoid hemorrhage is accompanied by a weaker inflammation.

열회수형 환기장치의 결로방지를 위한 지역별 예열코일 용량산정 및 분석

Heat recovery ventilator and energy recovery ventilator (HRVs/ERVs) save energy load in buildings by reusing the heat from exhaust air. However, when HRVs/ERVs are operated in winter season, condensation may occur in heat exchange process causing negative influence not only on occupants but also on the performance of the system; mold and bacteria are developed through condensation causing respiratory diseases to occupants, and frosts may be developed once the condensation meets the air with the temperature under the freezing point causing the efficiency of exchangers to drop dramatically or even the breakdown of the whole system. Many methods to prevent condensation or frost have been suggested however preheating may be the simplest and the most certified method to guarantee the performance of the HRVs/ERVs systems. In this paper, variable factors for sizing the capacity of preheating coils have been verified. Also, the appropriate preheating capacity of HRVs/ERVs for different regions in Korea have been suggested based on the frost threshold temperature and the design procedure for various conditions.

Energy performance of an existing office building in the northern part of Italy: Retrofitting actions and economic assessment

In recent years, the interest of the scientific community towards building energy performance has become more evident in order to meet the National and European Directives. In this context, retrofits that result in improved building energy performance are widely investigated. The paper presents a comparative analysis of two different and complementary strategies to enhance the energy performance of an existing tertiary building located in Bologna, Italy. The first retrofit action is to reduce the heat transfer by transmission (i.e. use of low-emissivity glass) and the second one is to decrease the ventilation losses (i.e. installation of a heat recovery system). Then a third case has been investigated: it contemplates simultaneously both the solutions of windows replacement and installing a ventilation recovery system. Potential energy savings were calculated by means of dynamic simulation assisted by Trnsys energy simulation tool. Finally, an evaluation of the simple payback time and the net present value was performed in order to investigate global cost assessment. The window replacement option in the analyzed building office proved to be absolutely unprofitable, even if it would appear as the first and simplest action to be performed. On the contrary, the installation of a total energy recovery system resulted in sensible reduction of energy consumption and at the same time generated good values of NPV with reference to all the three different analyzed variation of the cost of energy.

Sutureless bioprosthesis may increase postoperative atrial fibrillation after aortic valve replacement

Benefits of sutureless aortic valve replacement (AVR) have been established. Most western centres have reported advantages in reduced cardiopulmonary bypass, cross clamp, ventilation, and postoperative recovery time. It has established a role in moderate to high-risk surgical patients requiring an AVR. However, the incidence of postoperative atrial fibrillation (POAF) in sutureless AVR is less known.

공동주택의 환기시스템별 에너지성능 비교 분석

The purpose of this study was to comparative analyses of energy performance in apartment houses adopted window frame-type natural ventilation, under-floor air distribution ventilation and heat recovery ventilation. As the object of energy simulation, the three type ventilation system with area of was selected in apartment house. As a result, when the ECO2 simulation was performed, the 1st requirement quantity per annual were (CASE1, Natural Ventilation), (CASE2, Under-floor Air Distribution Ventilation) and (CASE3, Heat Recovery Ventilation).

Eastern Mediterranean Sea circulation inferred from the conditions of S1 sapropel deposition

Abstract. Holocene eastern Mediterranean Sea sediments contain an organic-rich sapropel S1 layer that was formed in oxygen-depleted waters. The spatial distribution of this layer revealed that during S1 deposition, deep waters were anoxic below a depth of 1800 m. However, whether this boundary permanently existed from the early to the mid-Holocene has not been examined yet. To answer this question, a multi-proxy approach was applied to a core retrieved close to the 1800 m boundary (at 1780 m). We measured the bulk sediment elemental composition, the stable isotopic composition of the planktonic foraminifer Globigerinoides ruber and the abundance of benthic foraminifera since the last deglaciation. The result indicates that authigenic U and Mo accumulation began around 13–12 cal ka BP, in concert with surface water freshening estimated from the G. ruber δ18O record. The onset of bottom and pore water oxygen depletion occurred prior to S1 deposition inferred from barium enrichment. In the middle of the S1 deposition period, reduced authigenic V, Fe and As contents and the Br/Cl ratio indicated short-term bottom-water re-oxygenation. A sharp Mn peak and maximal abundance for benthic foraminifera marked a total recovery for circulation at approximately 7 cal ka BP. Based on our results and existing data, we suggest that S1 formation within the upper 1780 m of the eastern Mediterranean Sea was preconditioned by reduced ventilation, resulting from excess freshwater inputs due to insolation changes under deglacial conditions that initiated between 15 and 12 cal ka BP within the upper 1780 m. Short-term re-oxygenation in the Levantine Basin is estimated to have affected bottom water at least as deep as 1780 m in response to cooling and/or the reduction of freshwater inputs. We tentatively propose that complete ventilation recovery at the S1 termination was depth-dependent, with earlier oxygenation within the upper 1780 m. Our results provide new constraints on vertical water column structure in the eastern Mediterranean Sea since the last deglaciation.

SEDLine Monitored Sedation and Recovery for Postoperative Ventilated Recipients of Living Donor Liver Transplantation: A Randomized Controlled Trial

Background: Monitoring of adequacy of sedation and careful drug selection can minimize the risks of over sedation and side effects. We evaluate the safety and efficiency of patient state index (PSI) versus Ramsay sedation scale (RSS) on postoperative sedation for living donor liver transplantation (LDLT) recipients. Methods: Sixty postoperative mechanically ventilated LDLT recipients sedated with desflurane were randomly allocated to either R group (Ramsay group n=30), where sedation assessed using clinical assessment with the RSS, or S group (SEDline group n=30) where sedation assessed with PSI to target sedation depth (50-75). Memorization of five words, Trieger's dot (TT), digit symbol substitution tests (DSST) were recorded. Transesophageal Doppler (TED) parameters were recorded. Duration of mechanical ventilation, postoperative side effects and cost, were recorded. Results: Mean values of time from cessation of desflurane to eye opening (min), hand squeezing (min), verbal command (min) and to extubation were statistically significant, shorter in S group than R group (p<0.001). Five words recall, TT and DSST were better in S group. Patients required norepinephrine were lower in S group than R group (10 (33.3%) vs. 23 (76.7%) P=0.001). Duration of ventilation was shorter in S group than R group (6.83 ± 2.00 vs. 8.26 ± 1.68 hour, P=0.004). Systemic vascular resistance (SVR) and mean blood pressure (MBP) were better preserved in S compared to R group at all measuring points (SVR, MBP after 2hrs sedation 915.73 ± 194.31 vs. 669.20 ± 119.82 dyn.sec.cm-5, P<0.001 and 78.03 ± 6.242 vs. 65.13 ± 67.58 mmHg, P<0.001, respectively). Postoperative drowsiness, nausea and vomiting were lower in S compared to R group (P=0.000). Conclusion: Sedation guided with PSI preserved better haemodynamics, enhanced recovery and rapid ventilation weaning at a lower cost compared to RSS monitoring. PSI-augmented sedation monitoring markedly reduced the total dose of sedative used to achieve the same level of clinical sedation without any measurable adverse effects.

Achieving Net Zero with a 649,848-square-foot Industrial Complex

ABSTRCTThe following is a comprehensive review of what works when designing for net zero. Typically, it is very difficult or nearly impossible to re-commission an existing historical heavy use industrial complex with a 1222-ton refrigeration plant to a net zero energy standard.The subject is a 649,848-sq.-ft. warehouse and office complex in Edison, New Jersey. The energy reduction plan consisted of a solar project consisting of 17,745 solar panels, along with an energy reduction plan consisting of a 20,000 cfm; a BPE energy recovery ventilation (ERV) system; high-speed doors for refrigerated and freezer areas; controls for a 1,222-ton refrigeration plant; and additional energy reduction measures that were engineered by Haglid Engineering & Associates, Inc. This energy reduction plan resulted in the building being successfully retrofitted to become a power producing facility on peak summer days. This subject industrial complex was also nominated for an EBie award.The project was able to achieve a net zero ...