Tube Size Research Articles

Risk of Post-Intubation Laryngotracheal Stenosis With Respect to COVID-19 Status in a Large Multicenter Cohort Cross-Sectional Study.

Occurrence of post-intubation laryngotracheal stenosis (LTS) with respect to COVID-19 status. Retrospective cross-sectional inpatient database. Eleven Midwest academic and community hospitals, United States. Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS. None. Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02-1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02-1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36-1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS. The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.

Heat transfer in a vessel-tubes array with a rotating baffle: A rotating frame modeling approach

Conveying heat from one medium to another is more critical when merging these media is banned. Thus, the media should flow individually in separate pipes. This paper explores the exchange of heat between tube bundles enclosed in a circular vessel with a rotating frame. The rotating frame serves to modulate the natural convection to mixed convection. The hot and cold tubes are distributed peripherally while the rotor is centered in the insulated vessel. The study focused on the configuration of the tubes, namely their number, size (r*), and radial position (e*), and how these parameters act with various Rayleigh numbers (Ra = 103 - 105) and rotational speeds (ω* = 0 - 400). The time-dependent equations are discretized and solved using the finite element method with rotating meshes. The outcomes indicate that the augmentation of Nusselt number with the rotational speed and Rayleigh number relies significantly on the radial position, the size as well as the number of hot tubes. The Nusselt number increases by 74.59 % and 9.57 % for Ra = 105 and 103, respectively, when the rotational speed is elevated from 0 to 200, whereas it increases by 308 % when the tube size is reduced from r* = 0.05 to r* = 0.01 at ω* = 200. It is deduced that the size of the tube is the supreme parameter affecting the Nusselt number.

Self-supervised learning of shedding droplet dynamics during steam condensation

Knowledge of condensate shedding droplet dynamics provides important information for the characterization of two-phase heat and mass transfer phenomena. Detecting and segmenting the droplets during shedding requires considerable time and effort if performed manually. Here, we developed a self-supervised deep learning model for segmenting shedding droplets from a variety of dropwise and filmwise condensing surfaces. The model eliminates the need for image annotation by humans in the training step and, therefore, reduces labor significantly. The trained model achieved an average accuracy greater than 0.9 on a new unseen test dataset. After extracting the shedding droplet size and speed, we developed a data-driven model for shedding droplet dynamics based on condensation heat flux and surface properties such as wettability and tube diameter. Our results demonstrate that condensate droplet departure size is both heat flux and tube size dependent and follows different trends based on the condensation mode. The results of this work provide an annotation-free methodology for falling droplet segmentation as well as a statistical understanding of droplet dynamics during condensation.

Force in Cable of Pretensioner Tube—A Possibility of Car Accident Reconstruction

The reconstruction of traffic accidents has grown as an interdisciplinary field, encompassing bodies of research from automotive engineering, traffic and transport engineering, biomechanics, and forensic sciences. In this work, a method is proposed by which the value of the force in the safety belt buckle can be determined provided the belt buckle is equipped with a pretensioning system with a pyrotechnic trigger in the pretensioner tube, PBP—Pyrotechnical Buckle Pretensioner, or PLP—Pyrotechnical Lap Pretensioner type. The anti-return system of the pretensioner mechanism, which prevents the passenger’s body from moving forward, contains a set of balls that block the movement of the piston in the pretensioner tube after its activation. When limiting the movement, the force the human body exerts on the safety belt webbing is transformed into the deformation of the pretensioner tube by the balls of the anti-return system. Depending on the magnitude of the force, the marks left by the balls differ. This is an alternative method for determining the force that occurs in a seatbelt and causes injury to the occupants of a vehicle. The advantage of this method is that the force in the seatbelt buckle cable can be determined relatively quickly and accurately by analyzing the deformations in the pretensioner tube, without a need for expensive laboratory equipment. The limitation of the model resides in the consideration of a static system with rigid bodies. The correlation between the normal force causing the deformation of the tube and the force in the belt buckle cable is obtained by means of a mechanical model that explains the operation of the anti-return system. By comparing the values of the normal force given by the proposed model and the elastoplastic model, a good correlation is found. Finally, a regression curve is determined to help the expert in approximating the force in the buckle cable depending on the deformation size in the pretensioner tube. The value of this force also enables biomechanical or medical specialists to correlate the degree of injury to occupants of a vehicle depending on the force in the seatbelt.

Chest Tube Size Selection: Evaluating Provider Practices, Treatment Efficacy, and Complications in Management of Thoracic Trauma.

The standard for managing traumatic pneumothorax (PTX), hemothorax (HTX), and hemopneumothorax (HPTX) has historically been large-bore (LB) chest tubes (>20-Fr). Previous studies have shown equal efficacy of small-bore (SB) chest tubes (≤19-Fr) in draining PTX and HTX/HPTX. This study aimed to evaluate provider practice patterns, treatment efficacy, and complications related to the selection of chest tube sizes for patients with thoracic trauma. A retrospective chart review was performed on adult patients who underwent tube thoracostomy for traumatic PTX, HTX, or HPTX at a Level 1 Trauma Center from January 2016 to December 2021. Comparison was made between SB and LB thoracostomy tubes. The primary outcome was indication for chest tube placement based on injury pattern. Secondary outcomes included retained hemothorax, insertion-related complications, and duration of chest tube placement. Univariate and multivariate analyses were performed. Three hundred and forty-one patients were included and 297 (87.1%) received LB tubes. No significant differences were found between the groups concerning tube failure and insertion-related complications. LB tubes were more frequently placed in patients with penetrating MOI, higher average ISS, and higher average thoracic AIS. Patients who received LB chest tubes experienced a higher incidence of retained HTX. In patients with thoracic trauma, both SB and LB chest tubes may be used for treatment. SB tubes are typically placed in nonemergent situations, and there is apparent provider bias for LB tubes. A future randomized clinical trial is needed to provide additional data on the usage of SB tubes in emergent situations.

FEATURES OF THE STRUCTURE OF THE EAR TUBE IN THE PRENАTAL PERIOD OF HUMAN DEVELOPMENT

They were irregular in ten cases, rectangular in nine cases, and triangular in three cases. It has been established that the size and shape of the auditory tube in prematurely born children do not have defi nitive dimensions and its location diff ers from that in newborns. The pharyngeal openings of the auditory tubes are at the level of the hard palate and, in newborns, above the level of the hard palate. The tympanic openings from the lower part of the anterior wall of the tympanic cavity in fetuses of the seventh month of intrauterine development move completely to the upper part of it and open into the supratympanic space in fetuses of the tenth month. The identifi ed features are important in improving the technology and adequacy of surgical treatment and manipulations in prematurely born children.The structure and syntony of the auditory tube were studied in 35 human fetuses of the seventh to tenth months of intrauterine development and 11 corpses of newborns. In the fetuses of the seventh month, the shape of the tympanic openings of the auditory tubes was irregular in eight cases, triangular in three cases, and rectangular in eleven cases. The drum holes shift to the top even more. They had an irregular shape in nine cases and a rectangular shape in fi ve. In the tenth month, the tympanic openings of the auditory tubes move to the upper part of the anterior wall of the tympanic cavity and open into the supratympanic space. They had an irregular shape in ten cases, and in six cases we observed a rectangular shape of them. The tympanic openings of the auditory tubes in newborns are located in the upper part of the anterior wall of the tympanic cavity and open into the supratympanic space. They were irregular in ten cases, rectangular in nine cases, and triangular in three cases. It has been established that the size and shape of the auditory tube in prematurely born children do not have defi nitive dimensions and its location diff ers from that in newborns. The pharyngeal openings of the auditory tubes are at the level of the hard palate and, in newborns, above the level of the hard palate. The tympanic openings from the lower part of the anterior wall of the tympanic cavity in fetuses of the seventh month of intrauterine development move completely to the upper part of it and open into the supratympanic space in fetuses of the tenth month. The identifi ed features are important in improving the technology and adequacy of surgical treatment and manipulations in prematurely born children.

Topography and dimensions of the auditory tube at the end of the fetal period

Introduction. Otitis media in premature newborns and term newborns is a serious problem due to the immaturity of the organs and systems of these children and the difficulty of their adaptation. This often leads to the development of pathological changes in the hearing organ and the need for surgical intervention. The aim - to find out the topographic and anatomical features of the auditory tube at the end of the fetal period to improve technologies and the adequacy of surgical treatment. Material and methods. The study was performed on 35 human fetuses of 231.0-375.0 mm parietococcygeal length (PCL) and 11 neonatal cadavers. In the course of the study the following methods were used: thin dissection of the middle ear and adjacent areas under the control of a binocular loupe; macro- and microscopy; morphometry; macro photography with digital camera "OLIMPUS μ 1000 All-weather 10.0 MPix". Results. It has been established that the size and shape of the auditory tube in premature babies do not have definitive dimensions and its location differs from that in term newborns. The pharyngeal openings of the auditory tubes are located at the level of the hard palate, and in term newborns - above the level of the hard palate. The tympanic openings from the lower part of the anterior wall of the tympanic cavity in fetuses of the seventh month of intrauterine growth completely move to its upper part and open into the supratympanic space in fetuses of the tenth month. Conclusions. The defined features of the development of the auditory tube at the end of the fetal period are important for the improvement of technologies and the adequacy of surgical treatment and manipulations in premature babies and term newborns. The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution indicated in the work. No conflict of interests was declared by the authors.

Tube-based robust reinforcement learning for autonomous maneuver decision for UCAVs

Reinforcement Learning (RL) algorithms enhance intelligence of air combat Autonomous Maneuver Decision (AMD) policy, but they may underperform in target combat environments with disturbances. To enhance the robustness of the AMD strategy learned by RL, this study proposes a Tube-based Robust RL (TRRL) method. First, this study introduces a tube to describe reachable trajectories under disturbances, formulates a method for calculating tubes based on sum-of-squares programming, and proposes the TRRL algorithm that enhances robustness by utilizing tube size as a quantitative indicator. Second, this study introduces offline techniques for regressing the tube size function and establishing a tube library before policy learning, aiming to eliminate complex online tube solving and reduce the computational burden during training. Furthermore, an analysis of the tube library demonstrates that the mitigated AMD strategy achieves greater robustness, as smaller tube sizes correspond to more cautious actions. This finding highlights that TRRL enhances robustness by promoting a conservative policy. To effectively balance aggressiveness and robustness, the proposed TRRL algorithm introduces a “laziness factor” as a weight of robustness. Finally, combat simulations in an environment with disturbances confirm that the AMD policy learned by the TRRL algorithm exhibits superior air combat performance compared to selected robust RL baselines.

Evaluation of field survival and growth to support the restoration of four valuable Miombo tree species

Understanding of right nursery practices is important for the production of high quality seedlings and successful restoration of trees with limited natural regeneration and/or on-farm tree planting. We evaluated the effects of nursery practices on field tree survival and growth in two trials in Morogoro, Tanzania: 1) shading regime, polythene tube size with four Miombo tree species i.e. Albizia harveyi, A. versicolor, Diplorhynchus condylocarpon and Pterocarpus angolensis; and 2) soil mixture and mycorrhizae/rhizobia inoculation with three Miombo tree species i.e. A. versicolor, D. condylocarpon and P. angolensis. There were no significant effects of the shading regime and polythene tube size on the survival, root collar diameter and height for all studied tree species. Almost all P. angolensis trees died after one year but the overall tree survival was good (>80 %) for the other tree species. Tree survival was always higher in nursery soil mixture S5 (0: 0: 1 sand: cow manure: soil) for D. condycarpon and at the early stages for P. angolensis. Mycorrhizae/rhizobia inoculation reduced tree survival of D. condylocarpon but not for other tree species. Interactions of soil mixture and mycorrhizae/rhizobia were only significant for D. condylocarpon and only with soil mixture S6 (1: 2: 3 sand: cow manure: soil). The advantages of medium and large polythene tubes on tree survival and growth in the field are dismissed in favour of small polythene tubes (10 x 10 cm). Nursery forest top soil alone is recommended for P. angolensis and D. condylocarpon. Albizia harveyi and A. versicolor can be grown in any of the soil mixtures tested. Testing the effect of nursery techniques on the field performance of these tree species in dry areas or poor soils, and for enrichment planting is recommended to enhance restoration of Miombo woodland.

General Anesthetic Management of a Patient With Spondyloepiphyseal Dysplasia Congenita Undergoing Palatoplasty Revision

Spondyloepiphyseal dysplasia congenita (SEDC) is a type of short-limbed dwarfism characterized by platyspondylia, delayed metaphyseal ossification, and irregularly shaped bones. Anesthetic issues in patients with SEDC have reportedly included airway stenosis caused by laryngotracheal hypoplasia, ventilation difficulty due to facial hypoplasia, and intubation difficulty attributed to microgenia. Furthermore, atlantoaxial instability can lead to cervical dislocation due to excessive or violent manipulation of the head and neck. We present the case of a 5-year-old girl with SEDC scheduled for palatoplasty revision. Airway difficulties were anticipated because of microgenia and the cervical collar she wore for atlantoaxial instability. However, mask ventilation and video laryngoscopy proved relatively easy. The patient was placed in Trendelenburg position (approximately 10°) without head tilt for surgical access. A combination of formulas based on the patient’s age and height was used to determine tracheal tube size. However, the 4.5-mm oral Ring, Adair, Elwyn (RAE) tube selected resulted in 1-lung intubation when the tube bend was fixed at the lip, requiring further depth adjustment. Successful anesthetic management of this patient with SEDC incorporated several factors, including an individualized airway management plan, use of a video laryngoscope, careful posturing to avoid excessive cervical strain, and appropriate tube sizing and positioning.

Nodal Analysis of Naturally Flowing Wells in Faihaa Oil Field, Yamama Formation

This study focuses on the Yamama Formation, a significant carbonate reservoir in southern Iraq that is one of the most important productive reservoirs in the region. The Formation is characterized by porous limestone interspersed with thin layers of argillaceous and tight limestone. The Yamama reservoir in the Faihaa oil field is divided mainly into four units; YA, YB, YC, and YD. YA and YB units are considered to be the most important oil-bearing subunits due to their good petrophysical properties. The main objective of the study is to determine the optimum production rates of four naturally flowing wells in the Faihaa oil field using the Inflow Performance Relationship and Vertical Lifting Performance curves. The study investigates four critical parameters; tubing size, water cut, reservoir pressure, and wellhead pressure, and their impact on well performance. The study finds that wellhead pressure is the primary determinant of well performance, and deviations from the original tubing size have adverse effects on well performance. An increase in water cut beyond the recommended threshold, coupled with a reduction in reservoir pressure, results in decreasing well performance. The study underscores the importance of careful monitoring and analysis of these parameters to sustain and enhance well performance in the Faihaa oil field, providing valuable insights for well operators and petroleum engineers. The study's findings can be used to optimize well performance and increase oil production rates, with significant implications for the petroleum industry.

Comparison of the Recent ExPreS Score, WEANSNOW Score, and the Parsimonious HACOR Score as the Best Predictor of Weaning: An Externally Validated Prospective Observational Study.

Since weaning failure is multifactorial, comprehensive weaning scores encompassing not only the respiratory component but also nonrespiratory aspects are quintessential for successful weaning prediction. This was a single-center prospective observational study on 128 intensive care unit (ICU) patients undergoing spontaneous breathing trials (SBT). The extubation prediction score (ExPreS), heart rate, acidosis, consciousness, oxygenation, respiratory rate (HACOR), and weaning parameters, endotracheal tube size, arterial blood gas analysis, nutrition, secretions, neuromuscular affecting agents, obstructive airway problems and wakefulness (WEANSNOW) scores were compared for their diagnostic accuracy for successful weaning prediction. Out of 128 patients, 49 (38.3%) patients had weaning failure, and 79 (61.7%) had weaning success. The patients in the weaning failure group had significantly higher APACHE II scores, WEANSNOW scores, HACOR scores, MV days, and significantly lower ExPreS scores as compared to the successful weaning group. Multivariable regression analysis showed that ExPreS score p = 0.015, adjusted OR 0.960, 95% CI (0.929-0.992) and HACOR score p < 0.001, adjusted OR 1.357, 95% CI (1.176-1.567) were independent predictors of weaning failure. The HACOR score had an AUC of 0.830, cut-off ≥5, p < 0.001, sensitivity 76%, specificity 68%, diagnostic accuracy 70% to predict weaning failure. The ExPreS score had an AUC of 0.735, cut-off ≥69, p < 0.001, sensitivity of 70.9%, specificity of 69.4%, and diagnostic accuracy of 70.3% to predict weaning success. Both the HACOR and ExPreS scores were good models for predicting weaning outcomes (model quality 0.76 and 0.64 respectively). The parsimonious HACOR score is comparable to the ExPreS score for the prediction of weaning outcomes in critically ill patients. Nayak G, Chaudhuri S, Ravindranath S, Todur P. Comparison of the Recent ExPreS Score, WEANSNOW Score, and the Parsimonious HACOR Score as the Best Predictor of Weaning: An Externally Validated Prospective Observational Study. Indian J Crit Care Med 2024;28(3):273-279.

Kinetic verification and Comsol modeling of the Diels-Alder reaction of conjugated pentadiene with maleic anhydride in a continuous flow capillary reactor

Synthesis of 3/4-methyltetrahydrophthalic anhydride was carried out by the Diels-Alder reaction in a continuous flow capillary reactor. The efficient liquid–liquid reaction of pentadiene with molten maleic anhydride provided a theoretical basis for replacing the conventional batch reaction process. Different inner diameter sizes of the channel tubes were adjusted in the range of 0.50 ∼ 2.00 mm to find the optimal size to match the strong exothermic reaction. Under the capillary channel size of 0.8 mm, the conversion rate of C5 and MA reached 100 % when nC5: nMA = 1.08:1 at 65 °C for 8 min. The D-A reaction process is accompanied by the autopolymerization of diolefin in the batch reactor. Our results showed that choosing a continuous flow capillary reactor of appropriate size can directly improve the selectivity of the reaction and the quality of the product. The accurate reaction rate constant and activation energy were obtained by establishing a kinetic model, and the effects of temperature, reaction time and pipe diameter were designed using Comsol software.

Establishment and application of temperature–pressure coupling model for opening and closing wells in HTHP gas wells

Switching wells in high-temperature and high-pressure gas wells will affect parameters such as the temperature and pressure of the fluid in the wellbore. Dynamic monitoring of temperature and pressure is difficult, and wellbore temperature, pressure, and fluid physical parameters are coupled to each other. Obtaining them separately will lead to large calculation errors. In order to improve the prediction accuracy of temperature and pressure in high-temperature and high-pressure gas wells, Based on the temperature–pressure coupling algorithm, this study compares the advantages and disadvantages of nine classic algorithms based on the temperature–pressure coupling algorithm, considers the impact of high temperature and high pressure on the temperature and pressure of the gas wellbore fluid, and establishes an unsteady temperature–pressure coupling model for high-temperature and high-pressure gas wells under on–off well conditions. Comparing with the measured data, it is proved that the prediction accuracy of the unsteady temperature–pressure coupling model of high-temperature and high-pressure gas wells meets the construction requirements of switch wells. The established model is used to simulate the temperature and pressure distribution of two high-temperature and high-pressure gas wells under switching conditions. The analysis shows that the distribution of wellbore temperature and pressure under the switch on and off conditions is affected by the gas–water ratio, heat transfer coefficient, tube size, and gas well production. Among them, the gas–water ratio increased by 1.5 times, the wellhead temperature increased by 25%, and the wellhead pressure decreased is 7.68%; When the heat transfer coefficient is increased by 1.5 times, the wellhead temperature drops to 34.38% and the wellhead pressure drops to 2.29%. When the tube size is increased by 1.125 times, the wellhead temperature is reduced by 44.20% and the pressure is increased by 6.09%. When the production of gas well is doubled, the wellhead temperature increases by 40.79% and the wellhead pressure decreases by 2.29%. The results can be used as a basis for the construction of high-temperature and high-pressure gas wells.

Agrooter® - Skillful Natural Tubes to Enhance Soil Productivity and Manage Hydric Stress

Agrooter® is a Hungarian patent created by the first author, tested in several field experiments in Hungary and recently in some African countries. The point of the invention is that small tubes are mixed into the fertile soil, which keeps moisture or air in the soil, depending on their position. In the case of an entirely random distribution of the tubes within the soil, the tubes achieve both advantages. The point of this patent is the carefully designed size and amount of empty tubes fabricated from organic bio-degradable materials and micro-grinded specific minerals. Using these tubes in the plantations helps to avoid hydric stress and increases yield and improves quality. These small particles improve the water budget (significantly decreases water demand) and enhance the soil’s porosity. After the description of the principle of the tubes, including the positive impact of the tubes on micro-biotic life in the soil, technical advice is also presented on the optimum amounts of mixing the tubes into the soil, and ways of planting are illustrated for plant seedlings and tree saplings. Finally, six different plants planted and observed in Hungary demonstrate the usefulness of these effects. The most common feature of these results is that significant improvements are obtained by using the Agrooter® compared to the traditional plantation by using a 50% smaller amount of irrigation water.

Optimizing gas production with innovative approach to evaporative halite precipitation and liquid loading management

The article discusses two issues that affect the productivity of gas wells: halite precipitation and liquid loading. Halite precipitation occurs when salt crystals form in the well, while liquid loading happens when liquids build up in the well, reducing gas production. Accurate prediction of these issues is essential to mitigate them effectively. While liquid loading can be managing by reducing the size of tubing, halite precipitation is more challenging to predict and manage. The existing approaches have not sufficiently validated, and the current halite management measures are not cost-effective. The article reports on a study that aims to develop a model using halite envelope to predict the onset of halite precipitation in a gas field in Oman. The study simulated halite envelopes for thirty different gas wells known to have experienced halite precipitation problems. The results showed that there is significant variation in the size and shape of halite envelopes in different wells, making it infeasible to construct a single envelope for the entire field. However, grouping halite envelopes based on inflow resistance and constructing a model for each group proved to be a powerful tool for halite prediction. The study also investigated the use of velocity string (VS) technology as a new approach to managing halite precipitation. The study simulated halite envelopes for a few wells with different sizes of VS installed, estimating the timing of halite precipitation reoccurrence. The results showed that the effectiveness of VS as a halite remedial technique depends mainly on the rock quality and the time of installation. Additionally, the study assessed the impact of installing VS on liquid loading and the synergy between halite management and de-liquefaction by using VS. The results showed that the synergy between halite management and de-liquefaction using VS depends mainly on rock quality and the size of the installed VS.

National survey on management of spontaneous pneumothorax from emergency department to specialised treatment: room for improvement

ABSTRACT Introduction Spontaneous pneumothorax (SP) affects both young, otherwise healthy individuals and older persons with known underlying pulmonary disease. Initial management possibilities are evolving and range from observation to chest tube insertion. SP guidelines suggest an individualized approach based on multiple factors such as symptoms, size of pneumothorax, comorbidity and patient preference. Aim With this Danish national survey we aimed to map organization of care including involved specialties, treatment choice, training, and follow-up plans to identify aspects, and optimization of spontaneous pneumothorax management. Method A survey developed by the national interest group for pleural medicine was sent to all departments of emergency medicine, thoracic surgery, respiratory medicine, and to relevant departments of abdominal or orthopaedic surgery. Results The response rate was 75 % (47 of 65). Overall, 21% of responding departments had no guideline for SP management, which was provided by multiple specialties with marked heterogeneity in choice of treatment including tube size, management during admission, and referral procedure to follow-up. Few departments required procedure training, and nearly all of the responders called for improvements in management of pneumothorax. Conclusion This survey suggests that SP management and care is delivered heterogeneously across Danish hospitals with marked difference between respiratory physicians, emergency physicians, general surgeons and thoracic surgeons. It is therefore likely that management is sub-optimal. There is a need for a common Danish SP guideline to ensure optimal treatment across involved specialties.

Prehospital Use of Waveform Capnography in Intubated Neonates

Introduction Routine continuous monitoring of endotracheal tube placement with waveform capnography is considered standard of care in the prehospital setting. However, maintaining this standard in neonatal patients remains a challenge due to low tidal volumes that do not tolerate the additional dead space ETCO2 attachments add. Additionally, continuous ETCO2 can increase the risk of ETT dislodgement or kinking because of the weight and size of the capnography attachments relative to the patient and tube size. We hypothesize that there is a gap in care of intubated neonates when compared to adults in the prehospital setting in terms of continuous monitoring of ETT placement. Methods Data were obtained from a single air medical agency. Through a retrospective chart review, records of intubated neonates (<28 days), children (≥28 days–12 years), adolescents (13–18 years), and adults (aged ≥18 years) were analyzed. Records were available from 11/21/13–1/21/22. The number of intubation attempts, whether an intubation was successful, and the use of capnography were recorded in RedCap. Statistical analysis was performed in Microsoft Excel via Chi Square Goodness of Fit Tests. Results During the study period, 674 intubation attempts were identified, and 28 charts were excluded due to missing patient age. Continuous waveform ETCO2 monitoring was used on 62%, 94%, 95%, and 97% of successfully intubated neonates, children, adolescents, and adults, respectively. There was a statistically significant difference between use of continuous waveform capnography in adults and neonates (p-value = 0.013). There was also a statistically significant difference between use of continuous waveform capnography in intubated neonates, children, and adolescents (p-value = 0.049). Conclusion Continuous ETCO2 monitoring is underutilized in intubated neonates compared to children, adolescents, and adults in the prehospital setting in this study population. This suggests a gap in the standard of care provided to neonates. Additional studies are needed to determine if these results are consistent around the industry and if there is a higher rate of undetected tube displacement in neonates who are transported without waveform capnography.

Development of A Neural Boosted Model and JSL Code to Identify “Clean” or “Not Clean” Wells - A West Texas Sperry and Oklahoma Woodford Fractured Wells Coiled Tubing Cleaning Case Study

In a previous study, wellbore cleaning coefficient (WCC) correlations for cleaned wellbores out of debris and bridge plug remnants were developed for three conventional coiled tubing sizes (2.375”, 2.625”, and 2.875”). The following key performance indicators (KPIs): (1) slick water density ( ) ρ f , (2) slick water viscosity ( ) µ f , (3) hydraulic diameter c t (d - d ) between casing inner diameter (dc ) and coil tubing outer diameter (dt ), (4) average annular velocity ( ) v and (5) cleaning pressure gradient ∆P across a measured depth (MD) were employed in the empirical models. The models addressed operational conditions under which fractured wells will be identified as whether “clean” or “not clean”. In this study, the database from 150 wells, in the Spraberry formation in West Texas, was used to develop a predictive model to identify status of cleaned fractured wells: whether “clean” or “not clean”? About 70% of the data (99 wells) was used for training and about 30% (51 wells) for validation. 14 wells from the liquids-rich shale Woodford formation (Oklahoma) were utilized for testing. Six predictive modeling tools were designed to validate the derived empirical correlations. These tools are (1) Fit Stepwise, (2) Neural Boosted, (3) Boosted Tree, (4) Decision Tree (Partition), (5) Generalized Regression Lasso, and K-Nearest Neighbors. In the predictive models, independent variables are the annular velocity (AV), the Reynolds’ Number (Re), the Euler’s Number (Eu), and the coiled tubing roughness to internal radius ratio (ε/D). The dependent variable is well status; “clean” or “not clean”. Jump Scripting Language (JSL) code was used to develop user-friendly software. The software would be utilized to identify the fractured wellbore status, whether “clean” or “not clean”. Operators would be able to use the code to identify working conditions for which completed fractured wells are “clean” out of fracturing debris and remnants of bridge plugs or “not clean”. Input parameters to the code are AV, Re, Eu, and ε/D

Reduction in drain-related adverse events using the barbed suture method for chest tube wound closure.

A chest tube is usually placed in patients undergoing general thoracic surgery. Although the barbed suture method has been introduced for chest tube wound closure, its superiority to the conventional suture methods for drain management remains unclear. The study aimed to determine whether the barbed suture method could reduce drain-related adverse events compared to the conventional method. We retrospectively reviewed the medical records of patients who underwent general thoracic surgery between January 2021 and December 2022, 1year before and after the introduction of the barbed suture method at our institution. Patients who underwent the barbed suture or conventional method were included. Univariate and multivariate analyses of drain-related adverse events were performed. Of the 250 participants, 110 and 140 underwent the barbed suture method and conventional suture method, respectively. The univariate analysis showed that a higher body mass index, preoperative malignant diagnosis, lobectomy, longer operative time, larger tube size, longer chest drainage duration, surgical complications, and conventional method were risk factors for drain-related adverse events. The multivariate analysis showed that the barbed suture method was a protective factor against drain-related adverse events (odds ratio 0.267; 95% confidence interval 0.103-0.691; P = 0.007). The barbed suture method could reduce drain-related adverse events compared to the conventional method. Therefore, it might be a potential standard method for chest tube wound closure in patients undergoing general thoracic surgery.