Significant Air Leak Research Articles

Early Hospital Discharge on Day Two Post-Robotic Lobectomy with Telehealth Home Monitoring.

Background: Despite the implementation of enhanced recovery programs, the reported average postoperative length of stay after robotic lobectomy remains as 4 days. In this prospective study, we present the outcomes of early discharge (on day 2) with telehealth home monitoring device after robotic lobectomy for lung cancer in selected patients. Methods: All patients with a caregiver were discharged on postoperative day 2 (POD 2) with a telemonitoring device provided they met the specific discharge criteria. Inclusion criteria: <75 years old, stage I-II NSCLC, with caregiver, ECOG 0-2, scheduled for lobectomy, logistic proximity to hospital (<60 km); intra-postoperative exclusion criteria: conversion to open surgery, early complications needing hospital monitoring or redo-operation, difficult pain management, <92 HbO2% saturation on room air or need for O2 supplementation, altered vital or laboratory parameters. Teleconsultations were scheduled as follows: the first one in afternoon of POD2, two on POD3, then once a day until chest tube removal. After discharge, patients recorded their vital signs at least four times a day using the device, which allowed two surgeons to monitor them via a mobile application. In the event of sudden changes in vital signs or the occurrence of adverse events, patients had access to a direct phone line and a dedicated re-hospitalization pathway. The primary outcome was safety, assessed by the occurrence of post-discharge complications or readmissions, as well as feasibility. Secondary outcomes: comparison of safety profile with a matched control group in which the standard of care and the evaluation of resource optimization were maintained and economic evaluation. Results: Between July 2022 and February 2024, 48 patients were enrolled in the present study. Six patients (12.5%) dropped out due to unsatisfied discharge criteria on POD2. Exclusion causes were: significant air leaks (n:2) requiring monitoring and the use of suction device, uncontrolled pain (n:2), atrial fibrillation, and occurrence of cerebral ischemia (n:1 each). The adherence rate to vital signs monitoring by patients was 100%. A mean number of four measurements per day was performed by each patient. During telehealth home monitoring, a total of 71/2163 (1.4%) vital sign measurements violated the established acceptable threshold in 22 (52%) patients. All critical violations were managed at home. During the surveillance period (defined as the time from POD 2 to the day of chest tube removal), a persistent air leak was recorded in one patient requiring readmission to the hospital (on POD 13) and re-intervention with placement of a second thoracic drainage due to unsatisfactory lung expansion. No other postoperative complication occurred nor was there any readmission needed. Compared to the control group, the discharge gain was 2.5 days, with an economic benefit of 528 €/day (55.440 € on the total enrolled population). Conclusions: Our results confirm that the adoption of telehealth home monitoring is feasible and allows a safe discharge on postoperative day two after robotic surgery for stage I-II NSCLC in selected patients. A potential economic benefit (141 days of hospitalizations avoided) for the healthcare system could result from the adoption of this protocol.

Compound disaster characteristics of rock burst and coal spontaneous combustion in island mining face: A case study

The island mining face in coal mines often encounters stress concentration and significant air leakage, elevating the risk of rock burst and spontaneous combustion of residual coal in the goaf. This study centers on the investigation of the 9305 island mining face within a mine situated in Shandong Province, China. Leveraging the features of coal spontaneous combustion and data from microseismic and gas monitoring throughout the mining process, a novel method for calculating safe mining speeds under compound disasters is introduced. The safe mining speed of the 9305 island mining face is stratified, and a prevention and control technology integrating long distance directional drilling for impact-spontaneous combustion compound disasters is proposed. Findings suggest that to mitigate spontaneous combustion of residual coal, considering the seam's spontaneous combustion tendency, the safe mining speed should exceed 3.7 m per day. Accounting for the distribution of microseismic events during coal seam extraction, the safe mining speed is maintained below 4.8 m per day in the unprotected mining area and capped at 8 m per day in the protected zone. Through a comprehensive analysis considering coal seam spontaneous combustion tendency, impact tendency, and time to coal seam oxidation to critical temperature, the safe mining speed for the island mining face ranges from 3.7 m per day to 4.8 m per day in the unprotected area and from 5.14 m per day to 8 m per day in the protected area. The proposed long distance directional drilling 'one hole, multiple purposes' scheme enables an integrated approach encompassing pressure relief before coal seam extraction, water injection during mining, and grouting post-mining. This method effectively prevents and controls the compound disasters of rock burst and coal spontaneous combustion, presenting innovative technical solutions for the safe extraction of coal resources.

Research on the technology of uniformly injecting nitrogen into the porous long pipes in the gob of the gob-side entry retaining mining mode with roof cutting and pressure relief

The implementation of the Gob-Side Entry Retaining Mining Mode with Roof Cutting and Pressure Relief (GERRCPR) results in the gob connecting to the retaining roadway, creating an open space that causes significant air leakage and increases the risk of spontaneous combustion. A study was conducted during the implementation of the GERRCPR in the Xiaonan Coal Mine N1-1502 working face to investigate spontaneous combustion characteristics, along with fire prevention and extinguishing measures. To analyze gob airflow, Computational Fluid Dynamics (CFD) was employed to collect data on airflow conditions, O2 concentration, and temperature. Based on this, this study focuses on exploring the effects of nitrogen injection treatment under various rates and positions to optimize parameters for buried pipe nitrogen injection. Results indicated that within the GERRCPR, air leakage in the gob increased, leading to an increase in O2 concentration, expansion of the oxidation zone, and an elevated risk of spontaneous combustion. Air leakage primarily occurred from the retaining roadway and the working face near the intake-air roadway, peaking at a retaining roadway length of 500 m, with a flow rate of 226 m3/min. Following nitrogen injection treatment, the oxidation zone was significantly reduced, with optimal treatment achieved at a nitrogen injection depth of 70 m and a rate of 600 m3/h. Field monitoring data showed that the inertization measure of using porous long pipes, a nitrogen injection spacing of 30 m, and a nitrogen injection rate of 600 m3/h significantly decreased the O2 concentration within the gob. This reduction meets safety production requirements and outperforms the effectiveness of traditional buried-pipe nitrogen injection methods, thereby validating the simulation accuracy. Understanding the laws governing spontaneous coal combustion in the GERRCPR and enacting preventive measures for nitrogen injection can improve safety standards in mining operations. This proactive approach can effectively prevent spontaneous coal combustion accidents, resulting in substantial social benefits.

Mitigating Coal Spontaneous Combustion Risk within Goaf of Gob-Side Entry Retaining by Roof Cutting: Investigation of Air Leakage Characteristics and Effective Plugging Techniques

Relative to conventional coal pillar retention mining technology (the 121 mining method), gob-side entry retaining by cutting roof (the 110 mining method), a non-pillar mining technique, efficiently addresses issues like poor coal resource recovery and significant rock burst damage. Nonetheless, the open-type goaf created by 110 mining techniques suffers from complex and significant air leaks, increasing the likelihood of coal spontaneous combustion (CSC) within the gob area. To address the CSC problem caused by complex air leakage within the goaf of gob-side entry retaining by roof cutting, this study takes the 17202 working face of Dongrong Second Coal Mine as the object of study. Field tests and simulation calculations are conducted to research the features of air leakage and the distribution of the oxidation zone within the goaf. Subsequently, plugging technology with varying plugging lengths is proposed and implemented. The tests and simulations reveal that the airflow migration within the goaf follows an L-shaped pattern, while air leakage primarily originates from gaps found in the gob-side entry retaining wall. The amount of air leaking into the gob-side entry retaining section is 171.59 m3/min, which represents 7.3% of the overall airflow. The maximum oxidation zone within the goaf ranges from 58.7 m to 151.8 m. After the air leakage is blocked, the airflow migration route within the goaf is transformed into a U-shaped distribution, and the maximum oxidation zone range changes from 42.8 m to 80.7 m. Engineering practice demonstrates that after air leakage plugging, the total air leakage volume within the gob-side entry retaining section significantly reduces to 20.59 m3/min, representing only 0.78% of the total airflow volume. This research provides reference on how to prevent the occurrence of CSC in similar mine goafs.

Airway management for a patient with tracheobronchomegaly undergoing lobectomy: a case report

BackgroundTracheobronchomegaly (TBM) is a rare disorder mainly characterized by dilatation and malacia of the trachea and major bronchi with diverticularization. This will be a great challenge for airway management, especially in thoracic surgery requiring one-lung ventilation. Using a laryngeal mask airway and a modified double-lumen Foley catheter (DFC) as a “blocker” may achieve one-lung ventilation. This is the first report introducing this method in a patient with TBM.Case presentationWe present a 64-year-old man with TBM receiving left lower lobectomy. Preoperative chest computed tomography demonstrated a prominent tracheobronchial dilation and deformation with multiple diverticularization. The most commonly used double-lumen tube or bronchial blocker could not match the distorted airways. After general anesthesia induction, a 4# laryngeal mask was inserted, through which the modified DFC was positioned in the left main bronchus with the guidance of a fiberoptic bronchoscope. The DFC balloon was inflated with 10 ml air and lung isolation was achieved without any significant air leak during one-lung or two-lung ventilation. However, the collapse of the non-dependent lung was delayed and finally achieved by low-pressure artificial pneumothorax. The surgery was successful and the patient was extubated soon after the surgery.ConclusionsUsing a laryngeal mask airway with a modified double-lumen Foley catheter acted as a bronchial blocker could be an alternative method to achieve lung isolation.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

Reducing Post-Operative Alveolo-Pleural Fistula by Applying PGA-Sheets (Neoveil) after Major Lung Resection: A Historical Case-Control Study.

Alveolo-pleural fistula remains a serious post-operative complication in lung cancer patients after surgery, which is associated with prolonged hospital stay and higher healthcare costs. The aim of this study is to evaluate the efficacy of a polyglycol acid (PGA)-sheet known as Neoveil in preventing post-operative air-leak in cases of detected intra-operative air-leak after lung resection. Between 11/2021 and 7/2022, a total of 329 non-small cell lung cancer (NSCLC) patients were surgically treated in two institutions. Major lung resections were performed in 251 cases. Among them, 44 patients with significant intra-operative air-leak at surgery were treated by reinforcing staple lines with Neoveil (study group). On the other hand, a historical group (selected by propensity score matched analysis) consisting of 44 lung cancer patients with significant intra-operative air leak treated by methods other than the application of sealant patches were considered as the control group. The presence of prolonged air-leak (primary endpoint), pleural drainage duration, hospital stay, and post-operative complication rates were evaluated. The results showed that prolonged air-leak (>5 days after surgery) was not observed in study group, while this event occurred in four patients (9.1%) in the control group. Additionally, a substantial reduction (despite not statistically significant) in the chest tube removal was noted in the study group with respect to the control group (3.5 vs. 4.5, p = 0.189). In addition, a significant decrease in hospital stay (4 vs. 6 days, p = 0.045) and a reduction in post-operative complications (2 vs. 10, p = 0.015) were observed in the study group when compared with the control group. Therefore, in cases associated with intra-operative air-leak after major lung resection, Neoveil was considered a safer and more effective aerostatic tool and represents a viable option during surgical procedures.

Outcome of Noninvasive Respiratory Support in Pediatric High-Dependency Units for Acute Respiratory Distress.

Noninvasive respiratory support (NRS) is widely used in pediatric ICUs (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDUs), identify predictors of NRS failure, quantify adverse events, and assess outcomes. We included infants and children (> 7 d to < 13 y old) admitted to PHDU in 2 tertiary hospitals for acute respiratory distress over a 19-month period. Collected data included diagnosis, type and duration of NRS, adverse events, and the need for PICU transfer or invasive ventilation. Two hundred and ninety-nine children were included, with a median age of 7 (interquartile range [IQR] 3-25) months and a median weight of 6.1 (IQR 4.3-10.5) kg. Bronchiolitis (37.5%), pneumonia (34.1%), and asthma (12.7%) were the most frequent diagnoses. Median NRS duration was 2 (IQR 1-3) d. At baseline, median SpO2 was 96% (IQR 90-99); median pH was 7.36 (IQR 7.31-7.41), and median PCO2 was 44 (IQR 36-53) mm Hg. Overall, 234 (78.3%) children were successfully managed in PHDU, whereas 65 (21.7%) required transfer to PICU. Thirty-eight (12.7%) needed invasive ventilation on a median time of 43.5 (IQR 13.5-108.0) h. On multivariable analysis, maximum FIO2 > 0.5 (odds ratio 4.49 [95% CI 1.36-14.9], P = .01) and PEEP > 7 cm H2O (odds ratio 3.37 [95% CI 1.49-7.61], P = .004) were predictors for NRS failure. Significant apnea, cardiopulmonary resuscitation, and air leak syndrome were reported in 0.3, 0.7, and 0.7% children, respectively. In our cohort, we found NRS in PHDU safe and effective; however, maximum FIO2 > 0.5 post treatment and PEEP > 7 cm H2O were associated with NRS failure.

Efficacy and safety of early chest tube removal after selective pulmonary resection with high-output drainage: A systematic review and meta-analysis.

There is controversy over the drainage threshold for removal of chest tubes in the absence of significant air leakage after selective pulmonary resection. A comprehensive search of online databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, Ovid, Elsevier, Ebsco, and Wiley) and clinical trial registries (WHO-ICTRP and ClinicalTrials.gov) was performed to investigate the efficacy and safety of early chest tube removal with high-output drainage. Primary outcome (postoperative hospital day) and secondary outcomes (30-day complications, rate of thoracentesis, and chest tube placement) were extracted and synthesized. Subgroup analysis, meta-regression, and sensitivity analysis were used to explore the potential heterogeneity. Study quality was assessed with the Newcastle-Ottawa Scale, and evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment by the online GRADEpro Guideline Development Tool. Six cohort studies with a total of 1262 patients were included in the final analysis. The postoperative hospital stay in the high-output group was significantly shorter than in the conventional treatment group (weighted mean difference: -1.34 [-2.34 to -0.34] day, P = .009). While there was no significant difference between 2 groups in 30-day complications (relative ratio [RR]: 0.92 [0.77-1.11], P = .38), the rate of thoracentesis (RR: 1.93 [0.63-5.88], P = .25) and the rate of chest tube placement (RR: 1.00 [0.37-2.70], P = .99). According to the sensitivity analysis, the relative impacts of the 2 groups had already stabilized. Subgroup analysis revealed that postoperative hospital stay was modified by Newcastle-Ottawa Scale score. The online GRADEpro Guideline Development Tool presented very low quality of evidence for the available data. This meta-analysis revealed that it is feasible and safe to remove a chest tube with high-output drainage after pulmonary resection for selected patients.

Case Reports of Acquired and Reversible Tracheomegaly

Dilation of the trachea, or tracheomegaly, is a rare phenomenon that can occur under a variety of disease processes and categorized into either congenital or acquired. In acquired cases, causes range from excessive tracheal wall pressure from prolonged intubation and cuff hyperinflation to inflammatory respiratory pathologies such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and cystic fibrosis. However, due to the low number of reported cases, the nature of these acquired processes is unclear. We present two cases that developed tracheomegaly of unknown etiology, one of which was reversible. Patients with factors predisposing them to tracheomalacia during intubation can experience significant air leaks with difficulty ventilating the patient and that could represent increasing tracheomegaly. Changing the cuff location intermittently during prolonged intubations may prevent tracheomegaly from occurring or may diminish its’ extent once it does occur. To the best of our knowledge, the reversibility of this relatively rare disorder has not been previously reported.

Assessing effectiveness and comfortability of a two-layer cloth mask with a high-efficiency particulate air (HEPA) insert to mitigate COVID-19 transmission

A face mask is essential personal protective equipment to mitigate the spread of COVID-19. While a cloth mask has the least ability to prevent the passage of infectious respiratory droplets through it compared to surgical and N95 masks, the surgical mask does not fit snugly and causes significant air leakage. The synthetic fibers in the latter reduce comfortability and are an allergen for facial eczema. Moreover, the N95 mask causes CO2 inhalation and reduces heat transfer in the nose. Therefore, the objective of the present work is to improve the effectiveness of a two-layer cloth mask by introducing an intermediate, high-efficiency particulate air (HEPA) filter layer. A significant volume of impacted droplets penetrates through a single-layer cloth mask, ejecting secondary droplets from the rear side. However, a two-layer cloth mask prevents this ejection. Despite slowing down the liquid penetration, capillary imbibition through cloth due to its hydrophilicity causes the transport of the liquid into the second layer, resulting in a thin-liquid layer at the mask's rear-side surface and contaminating it. Conversely, the HEPA filter inserted in the cloth mask prevents the imbibition, making the second cloth layer free of contamination. We attribute the impedance to the imbibition by the intermediate HEPA filter layer to its hydrophobic characteristics. We experimentally and analytically assess the role of wettability on capillary imbibition. The breathability measurements of masks show that the HEPA inserted in the cloth mask does not reduce its breathability compared to that of the surgical mask.

Air Leakage and Adherence to Continuous Positive Airway Pressure Therapy in Patients with Moderate to Severe Obstruction Sleep Apnoea: A Cross Sectional Study

This multicentre study aimed to evaluate the air leakage following a palatal surgery and its effect on CPAP adherence in OSA patients. The data on air leakage and adherence were objectively obtained and evaluated from the recorded CPAP therapy data. Forty patients were divided into two groups: surgery (18 patients) and non-surgery (22 patients). The mean air leakage level was 7.62±8.14% and 12.62±13.81% and mean adherence was 51.44±35.27% and 60.03±27.04% for surgery and non-surgery, respectively. There was no significant difference in CPAP adherence (p=0.389) but for mean air leakage it was significantly higher in non-surgery (p&lt;0.01). The occurrence of significant air leakage during CPAP therapy was not associated with surgery (p=0.436). There was no association between poor CPAP adherence and surgery (p=0.622). In terms of impact of palatal surgery, it did not cause significant leakage with no significant association to poor adherence.

LEFT UPPER LOBE ATELECTASIS WITH PNEUMOTHORAX THREE YEARS AFTER BRONCHOSCOPIC LUNG VOLUME REDUCTION SURGERY

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchoscopic lung volume reduction surgery (BLVRS) is a minimally invasive treatment option for severe emphysema with hyperinflation and air trapping. The one-way valves are designed to induce lobar atelectasis. The most common complication is pneumothorax, which usually develops within 72 hours after BLVRS. We present a case of delayed atelectasis with a large left pneumothorax, 3 years after left upper lobe (LUL) BLVRS with three Zypher® valves. CASE PRESENTATION: A 64 year-old-female with a past medical history of severe emphysema on oxygen presented to a local hospital with dyspnea. Chest radiography revealed a large left pneumothorax. CT chest also showed complete LUL atelectasis. Of note in 2018, the patient underwent LUL BLVRS without interval development of atelectasis. Given the new findings, a chest tube was placed. She was transferred to our hospital for interventional pulmonary consultation after 6 days of conservative management for persistent air leak. Bronchoscopy revealed three Zypher® valves occluding the LUL and lingula. Balloon occlusion of the left main stem resulted in air leak cessation. Subsegmental occlusion of the left lower lobe superior segment revealed no change, but there was significant air leak reduction after anteromedial segment occlusion. A 5 mm Spiration® valve was then deployed, causing the air leak in the pleurovac to switch from continuous to intermittent. Over the next 48 hours, the air leak resolved with near resolution of the pneumothorax. Chest tube was removed, and the patient was discharged home after 24 hour observation. DISCUSSION: BLVRS is a minimally invasive treatment option for emphysema with hyperinflation and air trapping. Endobronchial valves are placed in a target lobe after fissure integrity confirmation. The goal is to cause deflation and subsequent atelectasis of the target lobe. However, 30-40% of patient do not develop immediate lobar atelectasis. The exact mechanism behind such a delay is not clear. It has been postulated by Nabil Jarad, et al., that a breach in fissure integrity prior to valve placement could account for lack of immediate atelectasis. Alternatively, there may have been a paravalvular leak accounting for the lack of response initially. We present a case of delayed left upper lobar atelectasis with pneumothorax, 3 years after BLVRS with appropriately placed Zypher® valves. The patient was managed with balloon occlusion bronchoscopy with Spiration® valve placement instead of Zypher® valve removal. CONCLUSIONS: The possibility of delayed lobar atelectasis with pneumothorax after BLVRS is something that interventionists should consider discussing with patients who do not develop lobar atelectasis after BLVRS with appropriately placed endobronchial valves. The risk of pneumothorax has been described to be the highest in the first 72 hours post-procedure, but as seen with our patient, it can still happen after 3 years. REFERENCE #1: Creber P, Bendall O, Jarad N. Delayed Response to Endobronchial Emphysema Valve Insertion. Clin Respirat Med. 2018; 1(1): 1003. REFERENCE #2: Franzen D, Straub G, Freitag L. Complications after bronchoscopic lung volume reduction. J Thorac Dis. 2018;10(Suppl 23):S2811-S2815. doi:10.21037/jtd.2018.06.66. REFERENCE #3: Shah PL, Herth FJF. Current status of bronchoscopic lung volume reduction with endobronchial valvesThorax 2014;69:280-286. DISCLOSURES: No relevant relationships by Muhammad Arif, source=Web Response No relevant relationships by MAYKEL IRANDOST, source=Web Response No relevant relationships by Abid Khokar, source=Web Response No relevant relationships by Jonathan Munoz, source=Web Response no disclosure submitted for Ali Saeed; No relevant relationships by Andrew Talon, source=Web Response

Sterilization Central: HVAC and Infection Prevention Considerations in Sterile Processing Departments.

Sterilization Central: HVAC and Infection Prevention Considerations in Sterile Processing Departments.

Surgical outcomes for pediatric congenital lung malformation: 13years' experience.

BackgroundCongenital lung malformations (CLM) are a gamut of lesions that originate throughout the embryonic period and manifest in the neonatal or sporadically in the prenatal period, characteristically might stay well for some time, to be found inadvertently or to present with complications. In the 13 years from Jan. 2003 to Dec. 2015, this prospective cohort study included consecutive pediatric patients under 12 years old, who presented either emergently or electively with any variety of CLM. The lesions encompassed in this assortment were congenital lobar emphysema (CLE), congenital pulmonary airway malformation (CPAM), bronchogenic cysts (BC), and bronchopulmonary sequestration (BPS).ResultsSixty-eight pediatric patients with CLM were operated at our institution; 18 CPAMs, 22 CLEs, 19 BPSs (17 intralobar and 2 extralobar), and 9 patients with BCs. The patients’ age ranged from 1 to 54 months (mean age of 10.73 ± 9.73 months), with overall male gender predominance (61.76%). Both CLE and CPAM had a male predominance, while BC and BPS had equivocal gender distribution. CLE patients had the earliest presentation at 2.89 ± 1.5 months and congenital cystic adenomatoid malformations (CCAM) had the latest presentation at 21.78 ± 15.6 months (F = 15.27, p < 0.0001). Lobectomy was the commonest procedure performed. Fifty-nine lobectomies were performed (21 LUL, 15 RLL, 14 LLL, 8 RUL, and 1 middle lobectomy). Six cystectomies were performed for BC. Twenty-three cases (33.8%) had postoperative complications that were mainly significant or prolonged air leak (13.24%), pneumonia (5.88%), 3 cases of hemothorax (4.4%), pulmonary atelectasis in 2 patients (2.94%), 1 patient developed effusion (1.47%), and there were 2 mortalities.ConclusionsCLM must be in mind in the differential diagnoses of any case with repeated infection, respiratory distress, or radiological abnormalities. Surgery in the form of lobectomy or lesser resection is generally safe.Electronic supplementary materialThe online version of this article (10.1007/s12055-020-00977-2) contains supplementary material, which is available to authorized users.

Validating a Safe Built Environment in High Risk Areas Using Air Sampling Methodologies

<h3>Background</h3> Construction inside of a hospital environment creates risks by increasing the amount of airborne mold in the environment, posing significant health risks to immunocompromised patient populations. Despite implementing construction risk control measures, the completed built environment may have built environment issues that could allow for mold contamination in the high risk patient area. During hospital expansion construction a new OR region and new Stem Cell Transplant unit were built. Prior to opening these new areas, IPC created an extensive air sampling plan utilizing two air sampling methodologies as due diligence to assure a safe built environment for future high risk patient use. <h3>Methods</h3> An air sampling protocol was developed for the two high risk built environments. Particulate and viable air samples were collected by a third party and sent for lab processing. All results were reviewed by IPC; any mold growth was considered a failed test. <h3>Results</h3> Air sample results were reviewed by IPC. Following multiple iterations of failed testing, problem solving and retesting, significant issues with the built environment were identified; in the OR, air balance issues and window installation; in the stem cell unit, a penetration in HEPA filter bank, air balance issues and a patio overlook door with significant air leaks. Once all issues were corrected and final air samples were negative for mold, the built environment was considered safe for patient use. <h3>Conclusions</h3> Presence of mold can create major patient safety risks if not identified and corrected prior to operational use. Conducting targeted and intentional air sampling in these environments can be a reliable mechanism to identify and correct prior to any patient impact. The air sampling methodologies described here in as an important step in ensuring a new built high risk environment is safe and ready for patients.

1264 Innovation and Ingenuity to Improve Treatment Efficacy of Non-Invasive Positive Pressure Ventilation

Abstract Introduction Use of chronic non-invasive-positive-pressure ventilation (NIPPV) in individuals with neuromuscular disease allows for increased independence and mobility in this population. Optimal mask fit is imperative due to the chronic and extensive device use. Commonly cited side effects of improper mask fit include air leak, dermatitis, skin breakdown, nasal discomfort, and claustrophobia. Report of Case This is a case report of a 46-year-old female with rigid spine muscular dystrophy leading to chronic hypercarbic respiratory failure secondary to neuromuscular weakness and thoracic cage abnormalities. The patient is dependent on continuous use of NIPPV with a PLV 100 device (Philips Respironics; discontinued model). The patient prefers this model because of its unique ventilation delivery mode, which allows her to pause breaths to speak. The patient developed a significant air leak with her nasal mask and was unable to be fitted properly with commercially available nasal masks. In order to minimize her air leak her husband used an innovative approach using 3D printing technology. He created a 3D print of her facial and nose features and then used this to print a 3D mask. Additionally he 3D printed silicone nose clips, that reinforced the seal on the outside of her nose. The patient had a significant decrease in her air leak and subjectively reported improved comfort with use of the 3D printed mask. Conclusion This represents a case where application of ingenuity and innovative technology improved treatment efficacy and compliance with NIPPV. The combination of 3D custom fit mask (currently available from a limited number of vendors), with custom fit nasal clips may possibly be applied to a wider category of patients with similar complaints of nasal discomfort and frequent air leaks.

Awake Neonatal Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is used in patients with acute respiratory failure that is not responsive to conventional management. The practice of awake ECMO has become an area of interest but with limited data and experience. Most reported experience comes from adult and pediatric populations. Traditional management of these patients still includes mechanical ventilator support and often requires the use of sedatives for provision of safe care. We present a series of eight neonates who were electively extubated while on ECMO, with expanded discussion of two representative cases. We discuss the rationale for extubation and outcomes. The greatest benefit of this management was seen in patients with significant air leak, and in no reported case did we experience any adverse effects or complications as a direct result of extubation while on ECMO. In conclusion, in our experience, awake neonatal ECMO appears safe and effective and may offer significant advantages over traditional management in certain clinical scenarios. Prospective comparison trials are warranted to further investigate the clinical benefits and risks of awake neonatal ECMO.

Numerical investigations of airflow patterns on a longwall face

To thoroughly understand the ventilation flow characteristics on a longwall face, six computational fluid dynamics (CFD) models representing six consecutive longwall operating scenarios were developed. Key features of the longwall equipment and an immediate goaf were embedded into the models to obtain a realistic ventilation flow field. The occurrence of flow separation at both intersections of maingate/tailgate and face were revealed by the model results. Control measures are therefore suggested to minimise the potential accumulation of hazardous gas and dust within the flow separation zones. Significant air leakage to the goaf would occur if maingate curtain were not used. The impact of shearer position and its cutting direction on face ventilation was regional, indicating the stability of face ventilation system. These new insights into the complex longwall ventilation flow patterns will eventually be beneficial to the hazardous gas and dust management at longwall faces of underground coal mines. [Received: May 16, 2018; Accepted: August 9, 2018]

UNIQUE CASE OF ENDOBRONCHIAL VALVE IN TB BRONCHOPLEURAL FISTULA

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: A bronchopleural fistula (BPF) is a pathological connection between bronchial tree and the pleural space. BPF is a well-known complication of pulmonary tuberculosis (PTB). Endobronchial valve (EbV) are conventionally used to treat persistent air leaks (PAL) in the setting of non-surgical bronchopleural fistula. EbV are not routinely used in BPF secondary to active PTB. We describe a unique case where EbV was used to treat BPF secondary to active cavitatory pulmonary tuberculosis CASE PRESENTATION: A 30-year-old Spanish-speaking female, emigrated from Honduras 5 years ago presented to the emergency department with worsening productive cough and anorexia for two months. On admission patient was noted to be in respiratory distress and saturating 88% on room air. She once cachectic had poor inspiratory effort and bilateral rhonchorous breath sounds. Chest imaging was significant for bilateral upper lobe thick walled cavitatory lesions. Mycobacterium tuberculosis without rifampin resistance was detected, and patient was started on antituberculous therapy. On day 7 patient developed acute respiratory distress secondary to large right-side pneumothorax requiring chest tube placement. Patient required mechanical ventilation for hypercarbic respiratory failure, felt secondary to significant air leak. Bronchoscopy with balloon occlusion was performed, BPF with air leak was identified in right upper lobe with complete disappearance of air leak on occlusion of all three segments of right upper lobe (RUL). On day14 patient underwent endobronchial valve placement with complete occlusion of RUL. The hypercapnia, hypoxia improved, and patient stabilized clinically. Unfortunately, patient had complicated ICU course with failure to thrive and venous thromboembolism. On day 35 family requested terminal extubation and comfort care. DISCUSSION: There is very limited literature on utility and safety of EbV in patients with BPF and PAL secondary to active cavitatory PTB. Since their first description in 2005 by Snell (1), EbV have been in use for more than a decade now. The main indication of EbV is non-surgical management of BPF and PAL. PAL have been associated with significant morbidity, mortality and prolonged hospital stay(2). There is recent literature in multidrug resistant tuberculosis where EbV was used safely to treat cavernous tuberculosis with improved cavity closure and bacteriological conversion (3). In our patient the main reason for EbV placement was to improve minute ventilation and hypercapnia secondary to PAL. Endobronchial valve placement stabilized the clinical status in our patient without any associated adverse events. CONCLUSIONS: We need more literature and randomized controlled trials to evaluate safety and long-term complications of EbV in pulmonary tuberculosis associated BPF. Our case highlights that EbV could be a safe option for BPF in patients with active pulmonary tuberculosis. Reference #1: Snell, G., Holsworth, L., Fowler, S., Eriksson, L., Reed, A., Daniels, F.. (2005) Occlusion of a broncho-cutaneous fistula with endobronchial one-way valves. Ann Thorac Surg 80: 1930–1932. Reference #2: Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest. 2005;128:3955–65. Reference #3: Denis Krasnov, Yana Petrova, Sergei Skluev, Irina Felker, Vladimir Krasnov, Nikolay Grischenko. Endobronchial valve in complex treatment of patients with destructive pulmonary TB/HIV co-infection.European Respiratory Journal 2016 48: PA775; https://doi.org/10.1183/13993003.congress-2016.PA775 DISCLOSURES: No relevant relationships by Sean Dikdan, source=Web Response No relevant relationships by Boyd Hehn, source=Web Response No relevant relationships by MRINALINI VENKATA SUBRAMANI, source=Web Response