Suction System Research Articles

The disinfection of dental chair suction systems

Krishna Baidya outlines a recent clinical audit initiative at Guys Hospital, London.

Clinical trial to verify the safety of an automatic electric airway suction system: a multicenter prospective randomized study

BackgroundAcute lung injury and respiratory failure in patients in the intensive care unit (ICU) present challenges owing to varied factors. Manual suctioning, which is the current standard, burdens healthcare professionals and poses risks. The Lmeca.A1000 automatic suction device offers an innovative solution to this problem. This study aimed to evaluate the safety of this device.MethodsThis prospective, multicenter, randomized trial compared automatic and manual suction in ICU patients. Mucosal injury and pneumonia were assessed using bronchoscopy and monitoring. Mechanical stability and adverse events were also evaluated.ResultsIn total, 117 critically ill adults were screened: 56 in the experimental group and 53 in the control group completing the study. No significant difference in mucosal injury was found at 3 or 7 days after treatment (p = 0.871, and 0.750). The incidence of VAP over 2 weeks was 5.36% in the experimental group and 1.89% in the control group, not significantly different (p = 0.582). Adverse events occurred in 14.3 and 13.2%, respectively, with no significant difference (p = 0.870). The incidence of clinical trial device malfunction within 3 days of application was 0.03% and within 2 weeks of follow-up was 0.02%.ConclusionsThis study evidenced the non-inferiority of the automatic suction device to the manual method in terms of safety. The adoption of an automated system could alleviate the workload of healthcare professionals while maintaining effective airway management.

Vibration and pressure pulsation elimination in a reciprocating compressor suction system using an acoustic filter

High vibration poses significant safety and operational risks to compressor components. This study presents a thorough investigation of the root causes analysis and corrective actions to resolve vibration-induced failures faced on the suction system of a reciprocating compressor. Excessive pressure pulsations in the suction bottle and strong mechanical coupling between the cylinders and suction bottle due to high cylinder gas forces were identified as the root causes of vibration-induced failure of the suction system. The proposed solutions to eliminate this problem were implemented by splitting the suction bottle into two parts and making one bottle as an acoustic filter (Helmholtz resonator). The acoustic filter was optimized for the suppression of pressure pulsations above its Helmholtz frequency and also for the avoidance of acoustic and mechanical resonance. After applying the proposed solutions, the modified suction system achieved a 14.3-61.1% reduction in vibration and a 75.56% reduction in peak-to-peak pressure pulsation for the compressor operating at 1000 rpm. The processing capacity of the compressor has been increased by 6.82%. An acoustic filter is an effective low-cost technical measure for reduction of pressure pulsation and fluid-induced vibration, which greatly increases the reliability of the entire compressor system.

Small Diameter (7.5 Fr) Single-Use Flexible Ureteroscopy with Direct In-Scope Suction (DISSTM) in Conjunction with Aspiration-Assisted Flexible Access Sheath: A New Hype for Real Stone-Free?

Background: Renal lithiasis continues to represent a great challenge for modern urology in terms of minimally invasive management of lithotripsy procedures. The recent revolution of endoscopes with the miniaturization of instruments and the development of improved disposable ureteroscopes combined with recent suction methods such as suction access sheaths or direct in-scope suction (DISSTM) systems promise to further improve the outcome of renal stone treatment. Methods: Considering this technological advance, this study aims to evaluate the results obtained by combining these methods in three groups: Group 1—Single-use 7.5 Fr flexible ureteroscope with standard access sheath, Group 2—Single-use 7.5 Fr flexible ureteroscope with direct in-scope suction (DISSTM) with standard access sheath, Group 3—Single-use 7.5 Fr flexible ureteroscope with DISSTM with suction access sheath. A total number of 105 consecutive patients were enrolled in the study, divided equally in each group. Several parameters were followed, such as size and location of the stones, operative time, duration of hospitalization, the need for ureteral stent insertion, residual fragments, and subjective evaluation of the lithotripsy environment visualization. Results: The best results were highlighted in Group 3 for almost all evaluated parameters. Significant improvements were indicated in terms of stone-free rates. Conclusions: Additional large studies are needed to support these initial results, but preliminary data indicate a valuable advantage for every urologist who treats urolithiasis.

ASSESSMENT OF KNOWLEDGE REGARDING EVIDENCE BASED GUIDELINES ON VAP PREVENTION AMONG NURSES

Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that increases morbidity, mortality, and healthcare costs, particularly in intensive care units (ICUs). In Pakistan, the high prevalence of VAP in ICUs underscores the importance of adherence to evidence-based preventive practices among nursing staff. However, knowledge gaps and inconsistencies in VAP preventive practices remain a challenge, largely due to limited training resources and high patient-to-nurse ratios. Objective: This study aimed to assess the knowledge of ICU nurses on evidence-based guidelines for VAP prevention at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study design was utilized. Data were collected from 140 registered nurses working in the ICU of Sir Ganga Ram Hospital, Lahore, using a structured questionnaire consisting of 17 questions related to VAP prevention guidelines. Convenience sampling was employed to recruit participants who met the inclusion criteria. Data analysis was performed using SPSS, with descriptive statistics applied to summarize findings and identify knowledge gaps. Results: The study revealed varied levels of knowledge among ICU nurses regarding VAP prevention. While the majority demonstrated awareness of core practices, such as semi-recumbent positioning and regular oral care, there were notable gaps in understanding related to the frequency of ventilator circuit changes and the optimal use of suction systems. Approximately 67.9% of nurses were aware of general VAP guidelines, but only 47.1% correctly identified all recommended practices. Additionally, knowledge disparities were observed based on educational background and years of ICU experience.Conclusion: This study highlights critical knowledge gaps among ICU nurses regarding evidence-based VAP prevention practices. The findings underscore the need for targeted educational interventions and standardized training programs to improve adherence to VAP guidelines. Strengthening nurse education on VAP prevention can contribute to reduced infection rates, enhanced patient safety, and better utilization of healthcare resources in Pakistan’s ICUs.

Six-Port Robotic Liver Resection Using Double Bipolar Clamp-Crush Method With Saline Drops: Advancing Safety, Efficiency, and Versatility in Liver Parenchymal Dissection.

Robotic liver resection (RLR) faces challenges in parenchymal dissection due to device limitations, necessitating the development of a safe, efficient, and versatile method for its widespread use. We introduce our six-port RLR approach utilizing the double bipolar clamp-crush method with saline drops to overcome these device limitations. This method, combined with robotic bipolar forceps, maximizes the advantages of RLR by leveraging its multi-joint functionality and facilitates the dissection of strong, fibrotic liver tissue through the use of bipolar energy. The assistant surgeon strategically drops saline solution from an electrocautery system onto the operative field, while simultaneously removing crushed tissue, blood, and excess moisture using an endoscopic suction system through two assistant trocars. This process prevents tissue adhesion to the forceps and carbonization while maintaining a moist environment. Hemostasis is achieved using bipolar or monopolar coagulation under these conditions, with multiple hemostatic devices ensuring safety. In our study, RLR was performed on 16 lesions in 13 patients, including two with cirrhosis and portal hypertension. Median blood loss was 27 mL, and no postoperative complications occurred. The forceps were changed a median of four times due to tissue adherence during liver parenchymal dissection, which prevented tissue adhesion and facilitated efficient hepatic resection. Although further advances in instrumentation technology for RLR are needed, we are confident that our method will lower the barriers for many surgeons to adopt robotic liver resection and contribute to its further widespread use. Our six-port double bipolar clamp-crush method with saline drops shows promise for safe, efficient, and versatile liver parenchymal resection in current RLR practice.

Zero-Intrarenal Pressure Percutaneous Nephrolithotomy for One-Stage Treatment of Non-Acute Infectious Calculous Pyonephrosis: A Strategy to Avert Sepsis.

Purpose: To evaluate the efficacy and safety of a novel zero-intrarenal pressure (IRP) percutaneous nephrolithotomy (PCNL) technique for one-stage treatment of non-acute infectious calculous pyonephrosis. Patients and Methods: This retrospective study analyzed 12 patients (4 males, 8 females; mean age 56.4 years) who underwent zero-IRP PCNL. The technique utilized a double-sheath vacuum suction system, with the outer sheath allowing for gravity irrigation and the inner sheath facilitating continuous suction. Keeping the height of gravity perfusion at the level of the kidney inherently prevented high IRP and achieved zero-IRP PCNL, even when stone fragments obstructed the suction channel. Results: The procedure demonstrated a high initial stone-free rate of 75%, improving to 91.7% after 1 month. The average operative time was 50.7 minutes. The mean hemoglobin drop was 6.1 g/L, managed without transfusions. Complications were minimal, with low-grade fever in two patients. No significant intraoperative or postoperative complications, such as sepsis, were noted. Conclusions: The zero-IRP PCNL technique, characterized by its double-sheath vacuum suction system and zero-pressure gravity perfusion, shows promise in safely and effectively managing non-acute infectious calculous pyonephrosis. Preliminary results are encouraging, but further research with larger sample sizes is essential for broader clinical validation.

Intensive Care Nurses' Performance of Open versus Closed Endotracheal Suction on Critically Ill Patients in Ismailia City.

Endotracheal Tube Suctioning (ETS), which involves either an open or closed suctioning system, is a crucial practice for mechanically ventilated patients. The nursing practice of airway suctioning is inevitable. This study was designed to compare the intensive care nurses' performance of open versus closed endotracheal suction on critically ill patients in Ismailia City. A non-participant structured observational study design was conducted on a convenient sample (N = 63) at intensive care units at a teaching hospital through March and August 2022 to evaluate how nurses practice different procedures in open suctioning compared with the closed suctioning system of Endotracheal Suction (ES) through a 32-item structured checklist. Additionally, authors compared their levels of knowledge in both suctioning systems. Approximately 75% and 65% of the study participants had a satisfactory level of knowledge about the open system compared with the closed system, respectively. The total percentage of patients who achieved a satisfactory level of practice was 72% for the open-system group, compared with 56% for the closed-system group. Overall, there were significant differences between total nurses' performances in the open-system and closed-system systems. Independent sample t-tests revealed a statistically significant correlation between overall nurses' performance in both systems (t = 6.04, p < 0.001). The findings revealed significant differences in nurses' performance between open and closed-system suctioning. The researchers recommend in-service-led training programs to improve nurses' performance, and other studies with larger sample sizes should be supported.

Feasibility study on the heat transfer enhancement of gap flow induced by wasted vibration of linear compressor body

Refrigerators account for 20–30 % of household electricity consumption, with the compressor contributing to 80 % of the total consumption. Therefore, it is essential to increase the compressor efficiency. One approach to enhance compressor performance involves increasing heat dissipation to lower the temperature of the suction system and boost the refrigerant density entering the suction chamber. To achieve that innovatively, we harnessed the waste vibration of the linear compressor body to create a gap flow between the body and the housing, enhancing compressor performance by augmenting heat dissipation. Measurements of gap flow temperature, cylinder surface temperature, and heat flux on the cylinder surface were conducted, varying the RPM, gap size, and the shape of the gap flow path. We also observed variations in the gap flow rate with RPM and stroke. The results revealed that gap temperature and heat flux increased with higher RPM and smaller gap size, and the application of ribs to the gap flow path proved to be more effective in enhancing temperature and heat flux. Additionally, it is anticipated that heat flux will further increase with a longer stroke as the flow rate increases. Therefore, to optimize heat dissipation through gap flow using the waste vibration of the compressor body, it is advantageous to employ a smaller gap size, higher RPM, longer stroke, and apply ribs to the gap flow path. Future research should focus on verifying the effectiveness of increased heat dissipation and improved Energy Efficiency Ratio (EER) through actual compressor experiments.

Optimization of nanosecond laser drilling strategy on CFRP hole quality

The drilling and cutting of carbon fiber-reinforced epoxy resin matrix composite (CFRP) structural parts is a prerequisite for one-off moulding and assembly connections. However, the thermal ablation effect observed during nanosecond laser hole-making of CFRP results in significant accuracy errors and thermal damage defects in the quality of the holes obtained from the process. To enhance the quality of laser-drilling CFRP holes, a spiral drilling path was employed in this work. The influence of diverse drilling methodologies, encompassing the trajectory of the laser beam, the spacing between scans, and the direction of the suction system's pumping, on the quality of the holes was examined. The impact of these techniques on the precision and integrity of the holes was assessed in terms of their dimensions, the quality factor, the width of the heat-affected zone (HAZ), and the prevalence of microscopic defects. The results demonstrated that when the drilling strategy involves moving the laser beam from the outside to the inside (Scheme I), a scanning spacing of 20 μm, and backward pumping, the optimal micro-hole accuracy and surface morphology, as well as minimal thermal damage defects can be achieved. This study provides a reference for further optimization of the nanosecond laser drilling process.

Gravity- vs Wall Suction-Driven Large-Volume Thoracentesis: A Randomized Controlled Study

Prior studies have found no differences in procedural chest discomfort for patients undergoing manual syringe aspiration or drainage with gravity after thoracentesis. However, whether gravity drainage could protect against chest pain due to the larger negative-pressure gradient generated by wall suction has not been investigated. Does wall suction drainage result in more chest discomfort compared with gravity drainage in patients undergoing large-volume thoracentesis? In this multicenter, single-blinded, randomized controlled trial, patients with large free-flowing effusions of≥ 500mL were assigned at a 1:1 ratio to wall suction or gravity drainage. Wall suction was performed with a suction system attached to the suction tubing and with vacuum pressure adjusted to full vacuum. Gravity drainage was performed with a drainage bag placed 100cm below the catheter insertion site and connected via straight tubing. Patients rated chest discomfort on a 100-mm visual analog scale before, during, and after drainage. The primary outcome was postprocedural chest discomfort at 5 min. Secondary outcomes included measures of postprocedure chest discomfort, breathlessness, procedure time, volume of fluid drained, and complication rates. Of the 228 patients initially randomized, 221 were included in the final analysis. The primary outcome of procedural chest discomfort did not differ significantly between the groups (P= .08), nor did the secondary outcomes of postprocedural discomfort and dyspnea. Similar volumes were drained in both groups, but the procedure duration was longer in the gravity arm by approximately 3 min. No differences in rate of pneumothorax or reexpansion pulmonary edema were noted between the two groups. Thoracentesis via wall suction and gravity drainage results in similar levels of procedural discomfort and dyspnea improvement. ClinicalTrials.gov; No.: NCT05131945; URL: www. gov.

Development and verification of a novel bone collector with automatic size separating function for orthopedics surgery

ABSTRACT Background Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study was to develop a novel bone collector that can be used to collect bone chips/dust of varying sizes without changing current surgical procedures. Research design and methods This collector was designed to connect to a surgical continuous suction system and comprised a plate filter with a 3 mm hole and featured a taper filter with a mesh size of 0.27 mm for the separation and collection of both coarse and fine bone chips/dust. The bone collector was manufactured using nylon 3D printing and plastic injection with biocompatible materials. Results The bone collector functional test revealed high bone chip collection efficiency (93%) with automatic size separation function. Low (3.42%) filtration errors showed that most of the water can be drained smoothly from the bone collector. In clinical usability testing, bone collectors can provide functions demonstrated in in vivo spinal fusion and femoral fracture surgeries with different bone grafting size requirements. Conclusions The novel bone collector has been validated as a viable and effective surgical device, offering surgeons an additional option to enhance patient outcomes.

Complete Closed-Loop Ventilatory Circuit Delays the Onset of Ventilator-Associated Pneumonia in Mechanically Ventilated Neurological Patients in the ICU: A Single-Center Prospective Preliminary Study

Abstract Background Ventilator-associated pneumonia (VAP) is preventable yet its incidence remains high. We compared conventional ventilator circuit with open suction and dual heated wire circuit (DHWC) with closed suction on the incidence of VAP. Methods This is a single-center, prospective cohort study conducted at a tertiary care hospital in neurological patients admitted to the neuro-intensive care unit (neuro-ICU) and requiring mechanical ventilation (MV) for more than 48 hours. Patients were ventilated using either conventional ventilator circuit with open suction (open group) or DHWC with closed suction (closed group) and were observed for VAP during the first 14 days of MV. The incidence and day of onset of VAP, duration of MV, duration of neuro-ICU and hospital stay, and mortality was noted in each group. Results A total of 63 patients were included (32 in open and 31 in closed group). The incidence of VAP was 9.3% in the open group and 12.9% in the closed group (p = 0.8). All the patients developed late VAP, that is, &gt; 96 hours after intubation. However, as compared to the open group, VAP was observed much later in the closed group (day 7 vs. day 11). Duration of MV, neuro-ICU stay, hospital stay, and mortality did not differ significantly. Conclusion In this study, VAP incidences are similar in both the groups. However, neurological patients requiring MV for a short period might benefit from the usage of DHWC with closed suction system as VAP was seen to occur later in this group. Further, a randomized controlled trial with larger sample size is desired to confirm our findings.

Clinical Efficacy and Safety of an Automatic Closed-Suction System in Mechanically Ventilated Patients with Pneumonia: A Multicenter, Prospective, Randomized, Non-Inferiority, Investigator-Initiated Trial.

Endotracheal suctioning is an essential but labor-intensive procedure, with the risk of serious complications. A brand new automatic closed-suction device was developed to alleviate the workload of healthcare providers and minimize those complications. We evaluated the clinical efficacy and safety of the automatic suction system in mechanically ventilated patients with pneumonia. In this multicenter, randomized, non-inferiority, investigator-initiated trial, mechanically ventilated patients with pneumonia were randomized to the automatic device (intervention) or conventional manual suctioning (control). The primary efficacy outcome was the change in the modified clinical pulmonary infection score (CPIS) in 3 days. Secondary outcomes were the frequency of additional suctioning and the amount of secretion. Safety outcomes included adverse events or complications. A total of 54 participants, less than the pre-determined number of 102, were enrolled. There was no significant difference in the change in the CPIS over 72 h (-0.13 ± 1.58 in the intervention group, -0.58 ± 1.18 in the control group, p = 0.866), but the non-inferiority margin was not satisfied. There were no significant differences in the secondary outcomes and safety outcomes, with a tendency for more patients with improved tracheal mucosal injury in the intervention group. The novel automatic closed-suction system showed comparable efficacy and safety compared with conventional manual suctioning in mechanically ventilated patients with pneumonia.

Badania turbulentnego przepływu płynu w pompach głębinowych w celu poprawy bezpieczeństwa środowiskowego

When the plunger moves downwards, the local hydraulic resistance in the injection system causes a hydraulic force from the bottom upwards, which prevents the plunger from falling freely in the cylinder and is the source of the bending of the pump rod column. For this reason, the plunger takes an eccentric position in the cylinder and presses against it, delaying the plunger fall from the head of the balancer of the rocking machine and disturbing coaxial connection of the stock-discharge valve-plunger. These complications lead to increased wear of the plunger-cylinder pair, breakage of the injection valve cell, broken pump rod column, loss of the plunger stroke, etc. It should be noted, however, that in these tests, the flow factor μ is taken as the hydraulic resistance for determining the pressure loss in the valve assembly, and the valve seat cross-section is calculated. When calculating the friction force in the plunger-pressure valve system, the loss of pressure in it is taken to be equal to the loss of pressure of the valve unit. As is known, the downhole pump suction and injection system is a complex system of local resistance, as it consists of different combinations of elements that strongly affect the overall hydraulic resistance of the unit. It is therefore advisable to adopt the local hydraulic resistance coefficient as the hydraulic resistance of the respective unit. The reliability of downhole pumps in general and their individual components is ensured during their design and manufacture and depends on the design features, the quality of manufacturing of components thereof, assembly of the downhole pump in general and their components, as well as a number of other process indicators.

Sample-to-answer lateral flow assay with integrated plasma separation and NT-proBNP detection

Through enabling whole blood detection in point-of-care testing (POCT), sedimentation-based plasma separation promises to enhance the functionality and extend the application range of lateral flow assays (LFAs). To streamline the entire process from the introduction of the blood sample to the generation of quantitative immune-fluorescence results, we combined a simple plasma separation technique, an immunoreaction, and a micropump-driven external suction control system in a polymer channel-based LFA. Our primary objective was to eliminate the reliance on sample-absorbing separation membranes, the use of active separation forces commonly found in POCT, and ultimately allowing finger prick testing. Combining the principle of agglutination of red blood cells with an on-device sedimentation-based separation, our device allows for the efficient and fast separation of plasma from a 25-µL blood volume within a mere 10 min and overcomes limitations such as clogging, analyte adsorption, and blood pre-dilution. To simplify this process, we stored the agglutination agent in a dried state on the test and incorporated a filter trench to initiate sedimentation-based separation. The separated plasma was then moved to the integrated mixing area, initiating the immunoreaction by rehydration of probe-specific fluorophore-conjugated antibodies. The biotinylated immune complex was subsequently trapped in the streptavidin-rich detection zone and quantitatively analyzed using a fluorescence microscope. Normalized to the centrifugation-based separation, our device demonstrated high separation efficiency of 96% and a yield of 7.23 µL (= 72%). Furthermore, we elaborate on its user-friendly nature and demonstrate its proof-of-concept through an all-dried ready-to-go NT-proBNP lateral flow immunoassay with clinical blood samples.Graphical

An Individual Barrier Enclosure Actively Removing Aerosols for Airborne Isolation: A Vacuum Tent.

Aerosol barrier enclosure systems have been designed to prevent airborne contamination, but their safety has been questioned. A vacuum tent was designed with active continuous suctioning to minimize risks of aerosol dispersion. We tested its efficacy, risk of rebreathing, and usability on a bench, in healthy volunteers, and in an ergonomic clinical assessment study. First, a manikin with airway connected to a breathing simulator was placed inside the vacuum tent to generate active breathing, cough, and CO2 production; high-flow nasal cannula (HFNC) was applied in the manikin's nares. Negative pressure was applied in the vacuum tent's apex port using wall suction. Fluorescent microparticles were aerosolized in the vacuum tent for qualitative assessment. To quantify particles inside and around vacuum tent (aerosol retention), an airtight aerosol chamber with aerosolized latex microparticles was used. The vacuum tent was tested on healthy volunteers breathing with and without HFNC. Last, its usability was assessed in 5 subjects by 5 different anesthesiologists for delivery of full anesthesia, including intubation and extubation. The vacuum tent was adjusted until no leak was visualized using fluorescent particles. The efficacy in retaining microparticles was confirmed quantitatively. CO2 accumulation inside the vacuum tent showed an inverse correlation with the suction flow in all conditions (normal breathing and HFNC 30 or 60 L/min) in bench and healthy volunteers. Particle removal efficacy and safe breathing conditions (CO2, temperature) were reached when suctioning was at least 60 L/min or 20 L/min > HFNC flow. Five subjects were successfully intubated and anesthetized without ergonomic difficulties and with minimal interference with workflow and an excellent overall assessment by the anesthesiologists. The vacuum tent effectively minimized aerosol dispersion. Its continuous suction system set at a high suction flow was crucial to avoid the spread of aerosol particles and CO2 rebreathing.

Evaluation of three suction pretreatment systems for the air compressor

Air compressor, as the power source of pneumatic tools, suffers the problems of low efficiency and high failure rate in summer. In this paper, three suction air pretreatment systems are presented, which are characterized by the cold sources: a vapor compression refrigeration unit, a water chilling unit and a combination of water chilling unit with cooling tower. Models for the thermodynamic and economic performance evaluation of the three systems are established and solved. The moisture diffusion coefficient is applied to consider the influence of the moisture condensation and the Marshall and Swift coefficients is introduced to consider the capital change over time. Formula to calculate the efficiency of refrigeration compressor is adopted. Besides, the system total efficiency, percentage of power saving (PPS) and payback period (PBP) are defined as performance indexes. A comparative study with typical meteorological data of hot-dry regions and hot-humid regions is conducted to analyze the superiority of each system under the operation conditions of varied suction air temperature and volume flow. According to the results, optimal spray water flowrate exists for each operation condition and an air–water ratio of 0.8 is recommended. When the suction air temperature decreases, the PBP of each system increases and a sharp increase occurs when the temperature is lower than the air dew point temperature. A suction air temperature of 26 ℃ is suggested. Direct air cooling with an evaporator is preferred when the suction air volume flowrate is smaller than 60 m3/min for hot-humidity regions. The combined system is significantly superior in hot-dry regions. The PBP of the three systems is all longer than 10 months. How to guarantee the usage rate is the key for enterprises to consider the use of suction air pretreatment systems.

Open versus Closed Suctioning Among Mechanically Ventilated Pediatric Patients: A Randomised Control Trial.

To compare the difference in efficacy of closed tracheal suction system (CTSS) to open tracheal suction system (OTSS) in reducing incidence of ventilator associated pneumonia (VAP). Also to evaluate their efficacy in stabilizing cardio-respiratory parameters, reducing mortality and duration of intubation. This study was a single centre, parallel group, open label, randomized controlled study with an equal allocation (1:1) in pediatric patients requiring mechanical ventilation. A specific suction system of CTSS or OTSS was assigned to the two groups based on randomization. All the demographic, clinical, laboratory parameters and treatment outcomeswere noted in the preformed sheet. Total 116 eligible pediatric ventilated patients were studied. Total incidence of VAP was 9 (7.75%) of which 3 occurred in open and 6 in closed suction group. Rate of VAP was similar among both the groups with RR 2.11 (95% CI 0.50-8.9). However, significant number of infection-related ventilator associated condition (IVAC) were found in CTSS (17) compared to OTSS (6) group with RR 3.5 (95% CI 1.3-9.9).SpO2 was better maintained in the CTSS group post-suction (p = 0.001). Incidence of mortality and intubation days were similar between both groups. Incidence of VAP was similar between open and closed suction groups.

Clinical case of treatment of true drowning in fresh water

Drowning is the third leading cause of unintentional injury death worldwide. The largest number of victims of drowning falls on the young able- bodied population.Objective. There are no recent intensive care protocols for drowning, it is relevant to formulate guidelines for the treatment of drowning. Clinical observation. A 25-year-old female patient was taken by an ambulance team to the intensive care unit with a directional diagnosis ‘drowning in fresh water’ of three degree of severity. The patient had got on ventilator with closed aspiration system. Emergency bronchoscopy was performed during which 200 ml of fluid aspirated into the lungs was removed. Respiratory support was determined by stepwise increase of the PEEP level and decrease in FiO2 level taking into account respiratory index. Given the development of a pro-inflammatory mediator response, lactatacidosis, hemolysis, hyperhydration, a high risk of infectious complications, it was decided to start extracorporeal treatment early by continuous veno-venous hemodiafiltration and de-escalation of systemic antibacterial therapy with meropenem by prolonged infusion. Against the background of the ongoing treatment, we managed to achieve target respiratory parameters and stabilize central hemodynamic parameters by the end of the first day, prevent the development of renal damage, correct water-electrolyte and metabolic disorders, and avoid severe septic complications. Vasopressor support was discontinued on the 4th day, and on the 5th day the patient was switched to independent breathing. The patient`s stay in the intensive care unit was 6 days.Conclusions. Stepwise respiratory therapy using closed suction systems and urgent bronchoscopy prevent direct damage to the alveoli and ongoing translocation of fluid into the vascular bed. Prescribing broad-spectrum antibiotics prior to the growth of clinical and laboratory signs of infectious lung lesions allows to reduce the risk of severe septic complications with pulmonary destruction parenchyma. Early onset extracorporeal treatment by CVVHDF allows to correct homeostasis disorders, eliminate hypervolemia, prevent the development of acute renal damage as a result of hemolysis.