Type Of Ventilation Research Articles

Long Term Ventilation in Pediatric Central Apnea: Etiologies and Therapeutic Approach over a Decade.

This retrospective study aimed to analyze the clinical characteristics, ventilatory strategies, and effectiveness of ventilation in pediatric patients with central apneas treated at the Sleep Medicine and Long-Term Ventilation Unit of the Bambino Gesù Children's Hospital in Rome from 2012 to 2022. Among all ventilated patients at our Center from January 2012 to December 2022, we retrospectively included children with a cAHI ≥ 1 events/h on baseline poly(somno)graphic study. Additional parameters assessed included the underlying disease, type of ventilation (non-invasive vs. invasive), age at ventilation onset, ventilation mode, and transcutaneous capnometry parameters. To assess the effectiveness of ventilation on central apneas, we compared the cAHI at baseline and on ventilation. Sixty-seven patients met the inclusion criteria for central apnea (cAHI > 1 events/h). Diagnoses included hypoxic-ischemic encephalopathy, 15 (22.4%); Ondine syndrome, 14 (20.9%); polymalformative syndrome, 10 (14.9%); Prader-Willi syndrome, 8 (11.9%); brain tumor, 6 (9.0%); Down syndrome, 4 (6.0%); ROHHAD syndrome, 2 (3.0%); other infrequent pathologies were, Arnold-Chiari II, primary central apnea, epilepsy, lisosomal diseases, hydrocephalus, myopathy, obesity, Rett Syndrome. Pressure-supported ventilation (PSV) was the most common mode used (45 out 67 patients, 67.2%), followed by pressure-controlled ventilation (PCV) (15 out 67 patients, 22.4%) and continuous positive airway pressure (CPAP) (7 out 67 patients, 10.4%). Statistically significant improvement (p < 0.05) in cAHI was observed in patients with polymalformative syndrome (3.5 vs. 0.3, p = 0.01), hypoxic-ischemic encephalopathy (3.1 vs. 0.1, p = < 0.01), and Prader-Willi syndrome (3.5 vs. 0.1, p = 0.03), while there was no significant improvementn in children with brain tumor (6.2 vs. 1.5, p = 0.21). Central apneas are present in children with various underlying pathologies. Ventilatory strategies tailored to the specific diagnosis and severity of central apneas yield significant improvements in cAHI. PSV was the preferred ventilation mode in this study and there was notable effectiveness across different diagnostic categories. PCV was employed in most severe cases. CPAP was exclusively used in patients with predominantly obstructive sleep apneas.

The Care of Preterm and Term Newborns with Respiratory Conditions: A Systematic Synthesis of Evidence from Low- and Middle-Income Countries.

Neonatal respiratory conditions are leading causes of mortality and morbidity during the neonatal period. This review evaluated 11 management interventions for respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), as well as bronchopulmonary dysplasia (BPD) as a potential complication from respiratory care in low- and middle-income countries (LMICs). Two different methodological approaches were completed: (1) updating outdated reviews and pooling all LMIC studies and (2) re-analysis of LMIC studies from up-to-date reviews. Review updates were conducted between October 2022 and February 2023 and followed systematic methodology. A total of 50 studies were included across four review updates and seven review re-analyses. Findings indicate that bubble CPAP (RR 0.74, 95% CI 0.58 to 0.96) and prophylactic CPAP (RR 0.39, 95% CI 0.26 to 0.57) for RDS reduced the risk of treatment failure compared to other ventilation types or supportive care, respectively. Postnatal corticosteroids reduced BPD assessed as oxygen requirement at 36 weeks' postmenstrual age (RR 0.56, 95% CI 0.41 to 0.77). All other outcomes were found to be non-significant across remaining interventions. Our findings indicate that prophylactic and bubble CPAP may provide some benefit by reducing treatment failure compared to other pressure sources. The safety and efficacy of other management interventions for RDS, AOP, BPD, MAS, and TTN remains uncertain given limited evaluations in LMICs. Future research should conduct adequately powered trials in underrepresented LMIC regions, investigate long-term outcomes, and evaluate cost-effectiveness.

Indoor radon trends with building code change in two Canadian cities

Radon studies were conducted in two Canadian cities, in Halifax, Nova Scotia, and Winnipeg, Manitoba, to evaluate trends in indoor radon before and after the 2010 National Building Code of Canada was adopted into the legally binding provincial building codes in 2011. Participants were recruited in neighbourhoods characterized by newer housing developments. A postcard campaign in each city offered free radon testing to every house in the target areas, and free testing kits were mailed to study participants. Indoor radon measurements and house questionnaires were completed by 225 eligible participants in Halifax and 171 eligible participants in Winnipeg, using alpha-track radon detectors deployed for three months during the heating season in 2021–2022. Multivariate logistic regression analyses were conducted to evaluate the association between indoor radon and the period of construction, the area in contact with the ground, the number of storeys, the type of heating system, the water source, and the type of ventilation. These analyses were focussed on the detached study houses because the majority of the participants lived in a detached house, and significant associations were identified for the period of construction and the floor where the radon detector was located. An odds ratio of 1.91 (1.04–3.50) for the detached Halifax study houses built after 2011 was associated with having a higher than geometric mean radon concentration (p = 0.033), nearly double the likelihood. There was no evidence of significant change in the indoor radon after 2011 in the detached Winnipeg study houses. A lower likelihood – almost half - for measurement conducted on a main/upper floor compared to in the basement was associated with a radon concentration above the respective geometric mean for each city: an odds ratio of 0.48 (0.27–0.86) for the detached Halifax study houses (p = 0.012), and of 0.45 (0.32–0.64) for the detached Winnipeg study houses (p = 0.022). Radon is the second most important cause of lung cancer, after smoking, and the results of this study support strengthening the radon preventive measures required in new low-rise housing to reduce the associated lung cancer burden in Canada.

Evolution of the oxyhemoglobin dissociation curve in COVID-19 related ARDS patients.

Severe hypoxemia is the leading cause of admission in intensive care (ICU) in patients with COVID-19 related acute respiratory distress syndrome (ARDS). In these patients, several studies reported a left shift of the oxyhemoglobin dissociation curve associated with a lower mortality. However, these results are conflicting, as these studies include few patients and often no control groups. Moreover, the calculation of P50, representing the PaO2 value at which 50% of hemoglobin is saturated, is not corrected for factors known to influence it (pH, PaCO2 or temperature). For all of these reasons, we compared the corrected P50 between ICU patients with severe COVID-19 related ARDS on mechanical ventilation or not, and ARDS from other causes. We investigated the evolution of the corrected P50 during the first 3 days of ICU and its relationship with ICU mortality. We retrospectively calculated the corrected P50 in three groups of patients: intubated and mechanically ventilated COVID-19 related ARDS, non-intubated COVID-19 related ARDS and intubated patients with ARDS due to other infectious causes. The corrected P50 was calculated, on the worst blood gas analysis on days 1 and 3 of ICU admission, by the formula of Hill but modified by Dash et al., controlled for pH, PaCO2 and temperature. We collected ICU mortality. 463 blood gas analysis at days 1 and 3 from 214 ICU COVID-19 related ARDS patients (114 with intubation and 100 without) and 35 ICU patients with ARDS from other causes were analyzed. All patients were severely hypoxemic: PaO2/FiO2 of 76 [58-108] mmHg for intubated COVID-19, 79 [60-108] mmHg for non-intubated COVID-19 and 142 [78-197] mmHg for the third group (p < 0.001). The mortality rate was higher in intubated COVID-19 related ARDS patients (44.7 versus 14 versus 37% in ARDS from other causes; p < 0.001). The corrected P50 was significantly lower in COVID-19 patients, especially in non- intubated patients (21.2 [18.8-25.2] mmHg vs. 25.5 [19.2-30.3] mmHg in intubated patients; compared to ARDS from other causes: 27.2 [23.3-35.4] mmHg; p < 0.001. The corrected P50 does not change over the first 3 days, except for the non intubated COVID-19 related ARDS and is not correlated with ICU mortality (odds ratio = 0.98 [0.95-1.03]; p = 0.51), in contrast of PaO2/FiO2 and ICU gravity scores. The oxyhemoglobin dissociation curve at ICU admission was left shifting in severe COVID-19 related ARDS patients regardless of the type of ventilation. This deviation increases the third day only in non-intubated COVID-19 related ARDS and was not related to the outcome.

PENGARUH PERTUMBUHAN PEMUKIMAN TERHADAP AKTIVITAS PEREKONOMIAN DI KELURAHAN KOYA BARAT

This research aims to identify the factors influencing the growth of settlements and economic activities inKoya Barat Village, Muara Tami District, and the efforts made in the growth of settlements and economic activitiesin Koya Barat Village, Muara Tami District. The quantitative research method and data collection techniquesinvolve questionnaires and documentation. The data analysis uses simple linear regression. The results of theresearch indicate that the factors influencing the growth of settlements and economic activities in Koya BaratVillage, Muara Tami District, show that the level of settlement growth in Koya Barat Village, Muara Tami District,is categorized as high, with 65 respondents or 65%. This includes several factors such as the type of physicalbuilding, building/occupant type, wall type, roof type, ceiling, floor type, door, sanitation, window, ventilation,and ridge. The economic level of the community with a very high economic level is 33 respondents or 33%, anda high economic level is 31 respondents or 31%, which means that the economic level of the community in KoyaBarat Village, Muara Tami District is high, including education level, occupation/livelihood, and householdincome. The efforts made in the growth of settlements and economic activities in Koya Barat Village, Muara TamiDistrict, indicate a significant influence of settlement growth on the economy in Koya Barat Village, Muara TamiDistrict, which means that if settlement growth increases, economic activities will also experience a significantincrease.

Monitoring of urinary nickel and chromium in metal industries workers in Alborz, Iran

Heavy metal contamination from occupational sources is a cause for concern due to its potential accumulation in the environment and the body of living organisms, which leads to long-term toxic effects. There is limited evidence on the concentration of heavy metals in the body fluids of welding workers. This study aimed to measure the concentration of nickel (Ni) and chromium (Cr) as two main toxic heavy metals in the urine samples of welders and determine the potential relationship of various environmental factors on their concentration levels. This study was conducted in Iran in 2022–2023. Eighty-five urine samples were collected from the studied welding workers. Inductively coupled plasma optical emission spectrometry (ICP-OES) was used to measure the concentration of Ni and Cr. Data related to socio-demographic characteristics (education level, income, work experience, age, and body mass index (BMI)), lifestyle profile (consumption of seafood and canned food, smoking, physical activity), type of ventilation and preventive devices at work, and suffering from underlying diseases (cardiovascular and high blood pressure) were collected using valid questionnaires. Ni and Cr were present in 100% of urine samples with mean concentrations of (1.09 ± 0.294) and (11.45 ± 16.751) µg/g creatinine, respectively. A significant correlation was observed between the mean concentration of Ni and Cr with the level of education, income, work experience, age, consumption of seafood and canned food, smoking, type of ventilation and preventive devices, and underlying diseases (p-value < 0.05). Also, there was no significant difference between Ni concentration and physical activity and Cr concentration with BMI. Lifestyle determinants and not using preventive devices are important predictors of urinary heavy metals in welding workers. Therefore, more research is required to determine the adverse effects of long-term exposure to these heavy metals.

High-Flow Oscillatory Ventilation: A Possible Therapeutic Option for Pediatric Patients with Cardiovascular Diseases.

High-flow oscillatory ventilation (HFOV) is a common rescue treatment in infants and children with respiratory failure. This type of ventilation is an effective technique in numerous diseases that affect a child in the postnatal period, such as ARDS, meconium aspiration syndrome (MIS), postnatal pulmonary bleeding and idiopathic pulmonary hypertension (IPH). Although this ventilation technique is commonly recognized as a valuable therapeutic option in the general pediatric population, this is not the same for children with congenital cardiovascular diseases. The key mechanism of oscillatory ventilation is continuous positive pressure administered within the airways via a small tidal volume at high frequency. Tidal volumes are between 1 and 3 mL/kg delivered at 5-15 Hz, equivalent to 300-900 breaths per minute. A few older studies conducted on humans and animals highlight that HFOV may be dangerous for congenital heart patients. According to these evidences, hemodynamic parameters such as blood pressure, wedge pressure, central venous pressure, heart rate and inotrope level can be dangerously changed for patients with congenital heart disease; therefore, oscillatory ventilation should be avoided. Numerous retrospective studies have pointed out how oscillatory ventilation constitutes a valid therapeutic option in children with congenital heart disease. Recently, new evidences have highlighted how hemodynamic parameters are modified in a non-significant way by this type of ventilation, remaining beneficial as in the normal pediatric population. This narrative review aims to describe the mechanisms of oscillatory ventilation and collect all the available evidences to support its use in pediatric patients with congenital heart problems.

Association of systemic corticosteroid use with prognosis of patients with acute exacerbations of chronic obstructive pulmonary disease in the intensive care unit: a propensity score-matched cohort study

BackgroundSystemic corticosteroid has been recommended for the treatment of severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Little is known about the use of systemic corticosteroid in patients admitted to intensive care units (ICU) since most of previous trials excluded these critically ill patients.MethodsWe conducted a matched cohort study based on the Medical Information Mart in Intensive Care-IV database. Patients with AECOPD in ICUs were included. Patients in the exposure group should be intravenously administrated with methylprednisolone or treated with oral prednisone within 24 h after ICU admission. The propensity score matching and multivariable analyses were used to adjust for covariates. The primary outcome was 28-day mortality, and secondary outcomes included ICU mortality, in-hospital mortality, the duration of ICU stay, and mechanical ventilation. Subgroup analyses for the primary outcome were performed according to age, sex, type of corticosteroid, type of ICU admission, type of mechanical ventilation, and co-morbidities/complications.ResultsThe entire cohort and the matched cohort included 763 and 412 patients, respectively. In the matched cohort, the use of systemic corticosteroid had no impact on 28-day mortality (OR: 1.00, 95% CI: 0.61–1.64, P = 1.000). The results kept consistent in all subgroups. Additionally, systemic corticosteroid showed no benefits on ICU mortality, in-hospital mortality, the length of ICU stay, and the duration of mechanical ventilation.ConclusionsThe results of this study do not support routine use of systemic corticosteroid in patients with AECOPD admitted to ICUs.

Effects of mechanical ventilation on neurodevelopment at 12 months in preterm low birth weight pediatric patients: a systematic review.

The objective of this review is to know the existing scientific evidence about the effects of mechanical ventilation (MV) on neurological development in low-birth-weight premature pediatric patients after 12 months of life, taking as background the direct impact that ventilation has on the central nervous system in the newborn during the first days of life. A systematic search was carried out between 2003 and 2024 in the data bases of: PUBMED, Cochrane Library Plus, PEDro, CINAHL, and SciELO, and two investigators scored the articles according to the Newcastle-Ottawa Assessment scale. Were found 129 non-replicated articles, and 10 cohort and cross-sectional studies were selected that performed an assessment of neurodevelopment in the three spheres after 12 months of life in corrected age of premature infants exposed to ventilator support and related the two variables independently. Mechanical ventilation is an independent neurodevelopmental risk factor in low-birth-weight preterm infants. The time of exposure and the type of ventilation were the variables with the most scientific evidence. https://www.crd.york.ac.uk/, Identifier CRD42023446797.

Prognostic nutritional index as a predictor of mortality among patients admitted to ICU with acute exacerbation of chronic obstructive pulmonary disease

BackgroundThe PNI is a metric that may assess the combined impact of the inflammatory process and nutritional condition. It may be beneficial in evaluating the nutritional state of patients with AECOPD.In recent years, it has also been utilized for prognostic assessment of cases admitted to the critical care unit.Aim of the workThe objective of the research was to assess the relationship between PNI and the prognosis for ICU patients with AECOPD.Patients and methodsThis was a prospective cross-sectional observational research carried out in the RICU of Ain Shams University Hospitals from April 2023 to March 2024. The study included 161 AECOPD patients who were admitted to RICU. All patients underwent demographic data collection, special habits and comorbid conditions evaluations, and hematological indices with laboratory markers and ABG. ICU and hospital stay duration, SOFA score, and SAPS II were also documented. The PNI value was computed using the following equation: the formula to calculate the value is 10 times the serum albumin concentration in grams per deciliter plus 0.005 times the total lymphocyte count in cubic millimeters. The main measure of interest was the death rate within 30 days for all causes. Additional measures were the duration of stay in the ICU, the duration of hospitalization, and the rate of MV.ResultsThere was a significant relationship between PNI and type of respiratory failure, mechanical ventilation, fate, hypertension, and diabetes. One hundred five (65.2%) of the patients were extubated and discharged, while 56 (34.8%) of them died. The study also noted a significant positive relationship among PNI and HCT, lymphocytic %, HB, and albumin. However, there was a significant negative relationship between PNI and age, RDW, WBC, neutrophil count, neutrophil %, NLR, CRP, SAPSII, and SOFA. The SAPS II score (with SAPS II mortality) had greater AUROC in predicting mortality than PNI, NLR, and SOFA. The optimal cut-off value for PNI in this study was ≤ 29 with sensitivity 82.14% and specificity 56.19%.ConclusionThe study showed that PNI can be a useful biomarker for AECOPD. PNI with SAPS II scores on admission to ICU were closely correlated to adverse outcomes.

Study of indications, associated comorbid condi-tions and outcome of patients requiring Bilevel type of Non Inva-sive Positive Pressure Ventilation in a tertiary care hospital

BiLevel non-invasive positive pressure ventilation (BiPAP) is the most utilised supportive treatment in the world of medicine for respiratory failure. COPD is the most common indication for its use. We in-vestigated the indications and effects of comorbidities on BiPAP outcomes because there have been few studies on it. It is a descriptive, observational, cross-sectional study conducted over period of 12 months, wherein 60 patients fulfilling the inclusion criteria for the requirement of BiPAP were includ-ed in the study and evaluated. The indications, associated comorbid conditions and the outcomes of NIV therapy were studied. COPD exacerbation with Type II Respiratory failure was the most common indication (71.4%), followed by asthma [near fatal/severe] (21.4%). Success with BiPAP in COPD was 67.6% . In COPD patients with co-morbidities, success came down to 47.4%. Pneumonia, ILD &amp; Cardiogenic Pulmonary Edema (CPE) had success rates of 0%, 16.7% and 66.7% respectively with BiPAP therapy,with higher mortality rates for pneumonia and ILD. Comorbidities were present in 51.7% of patients and Hypertension (35%) and Diabetes Mellitus (21.7%) were the most common. In patients who had co-morbidities, the mean hospital stay was 12 days, which was higher than the mean hospital stay of 9.3 days in patient with no co-morbidities. The presence of co-morbidities was associated with higher failures with BiPAP (51.6%) comapred to ones with no co-morbidities (13.8%) (p value &lt;0.05). Higher respiratory rate (&gt;28/min), lower ABG pO2, pCO2 and bicarbonate levels and higher blood glucose and total leucocyte counts were associated with higher BiPAP failures and mortality. The conclusion was that the most common indication of BiPAP was a COPD exacerbation with type II respiratory failure and presence of comorbidities led to a poorer outcome with prolonged hospital stay. ABG parameters, blood glucose levels and total leucocyte counts has an effect on NIV outcome and mortality.

Performance and PV benefits analysis of multi-source renewable energy systems for different types of buildings on university campus

Due to the large campus area and high personnel density, universities experience significant building energy consumption. The comprehensive utilization of renewable energy can greatly alleviate energy consumption in higher education institutions. To explore the application prospects of renewable energy systems in universities, this study takes a university in Wuhan as a case example, investigating the performance and potential of various types of Photovoltaic-assisted Heating, Ventilation, and Air Conditioning (PV-HVAC) systems. First, the building load was calculated using DeST software. Subsequently, the potential for solar energy application on campus was assessed using a combination of QGIS, Labelme, and Python. Moreover, three types of PV-HVAC systems were designed for five categories of buildings based on their distinct characteristics, and TRNSYS software was utilized for performance simulation and analysis. The results indicate that the annual performance coefficients of the three systems are 3.8, 3.2, and 4.5, with corresponding annual energy self-sufficiency rates of 114 %, 72 %, and 32 %, respectively. Finally, the overall energy self-sufficiency rate of the PV-HVAC system across the campus is 65 %. This research provides valuable insights for achieving nearly zero-energy HVAC systems in university campuses.

Occupant’s behavior investigation related to the building openings in a rural pavilion: A case study of a bioclimatic designed building in a hot semi-arid climate

This study targets the building openings management as a sustainable, passive, cost-effective technique in a rural context with limited budget. Ensuring health and well-being and promoting energy-saving in building operation phase based on natural ventilation and sun management in interaction with the building design. The study utilizes thermo-aeraulic simulation through TRNSYS software, exploring the effects of altered seasonal day and night ventilation and vertical shading management. The findings highlight the significant impact of night natural cross ventilation on energy saving during June and September. Conversely, for July and August, early morning cross ventilation proves to be a more effective option for refreshing the indoor environment. During the cold season, minimizing or avoiding natural ventilation, especially cross ventilation, is advised; in addition, the mandatory overhangs on the south side and the vertical adjustable blinds enhance the energy saving inside the building. With a humidity interval ratio of 30 % to 70 % and two different set-point temperature ranges of 18 °C-28 °C and 20 °C-26 °C respectively, the annual thermal loads per square meter for two of the simulated scenarios are optimal, measuring 22.28 kWh/m2 and 22.85 kWh/m2 compared to 56 kWh/m2, respectively. These results can be further optimized by altering both types of ventilation mentioned earlier.

Evaluating building-level parameters for lower-temperature heating readiness: A sampling-based approach to addressing the heterogeneity of Dutch housing stock

The Dutch government aims to eliminate natural gas for residential heating in 1.5 million homes by 2030. One strategy is connecting existing dwellings to lower-temperature district heating (DH) systems, although these dwellings might require energy renovations. The heterogeneous dwelling stock causes varying renovation needs that complicate the energy transition. The present study addresses this issue by assessing the building-level parameters affecting the readiness of the Dutch terraced-intermediate and apartment types for lower-temperature heating (LTH) supplied by DH systems. A sampling-based approach was employed to capture variability within these dwelling types, addressing the limitations of archetype-based methods. The findings suggest a sample size of 1300 to represent the variations in these dwelling types. Parametric simulations and machine learning methods were used to identify significant building-level parameters for medium-temperature (MT: 70/50 °C) and low-temperature (LT: 55/35 °C) supply levels. These include heating setpoints (desired indoor temperature) and ventilation-related parameters (ventilation system type and air infiltration rate), followed by fabric-related parameters (roof, glazing, wall, ground, and door insulation) and geometric properties (orientation, compactness ratio, and window-to-wall ratio). Additionally, radiator oversizing also impacts LTH readiness. These results broadly apply to the studied dwelling types, although feature importance varies by supply temperature and dwelling type. The findings can guide stakeholders in assessing current conditions and prioritising renovation measures, aiding the development of targeted renovation solutions. Encompassing the representative variations within studied dwelling types enhances the robustness of the results. However, incorporating more refined data could improve the accuracy of the findings, better supporting the energy transition of these dwellings.

Analysis of condensation phenomena according to the type of energy recovery ventilator—Simulation and experiments

Ventilation plays a crucial role in maintaining indoor air quality. Energy recovery ventilators (ERVs) have emerged as a solution to balance ventilation needs and energy consumption in buildings. However, ERVs can encounter condensation issues in extreme outdoor conditions, impacting their performance and indoor air quality. In this study, we investigate occurrence conditions and ratios of condensation in ERVs through dynamic simulations and experimental tests using different heat exchanger types: plastic-based plate, membrane-based plate, and rotary. The simulation results show that condensation ratios vary depending on the heat exchanger type and seasonal conditions, with higher latent effectiveness playing a significant role in reducing condensation. Notably, we demonstrate that rotary ERVs rarely exhibit the generation of condensation. The simulation results are validated through experimental tests, ensuring reliable condensation predictions in ERVs. Our findings underline the importance of selecting appropriate type of ERV to mitigate condensation and enhance indoor comfort while promoting energy efficiency. The proposed simulation methodology will provide valuable insights into estimating condensation ratios in ERVs under diverse climatic conditions.

Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study.

Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ± 13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.

The Impact of Ventilation System Type on the Microclimate of Boar's Pen and Their Clinical Triad Parameters

The purpose of the study was the impact of different types of ventilation systems in boar`s pen on the microclimate and their physiological parameters. The control group of boars was kept in a house with a transverse ventilation system, and the animals of the experimental group were kept in a geothermal air supply. It was found that, regardless of the season, transverse ventilation provides a significantly higher air velocity and relative humidity: in Winter - 0.15 m s–1 and 5.4%; in Spring - 0.35 m s–1 and 5.3%; in Summer - 0.41 m s–1 and 0.7%; in Autumn - 0.28 m s–1 and 8.1%. Maintaining a stable temperature by the normative values in the boar housing was due to geothermal ventilation, regardless of the season, especially the "basement effect" was observed in the summer months, where the air temperature was cooled to 4.5°C (P &amp;lt; 0.001), compared to the transverse ventilation system. Compared with the boars in the experimental group, under the influence of the temperature increase in Summer, the boars in the control group increased significantly the respiratory rate to 50.9 ppm (P &amp;lt; 0.001) and heartbeat rate of 45.7 ppm (P &amp;lt; 0.001). An increase in rectal temperature in boars at elevated ambient temperature under both air ventilation systems was not found. The obtained results make it possible to introduce the use of cost-effective geothermal air supply technology in pig farms to harmonize the physiological parameters of boars to meet their biological needs, even in closed housing to improve their welfare.

Efficacy of home healthcare on the management of tracheostomy patients.

To evaluated the home healthcare efficacy in managing tracheostomy patients at King Abdulaziz Medical City under the Ministry of National Guard Health Affairs. Home healthcare is care provided to patients in the convenience of their homes to ensure high-quality care based on healthcare providers' supervision. This retrospective cohort study utilizing a non-probability consecutive sampling technique, including all available tracheal patients with no exclusion criteria, was carried out in Riyadh, Saudi Arabia, between January 2019 and June 2022. The collected data included patient demographic variables and respiratory settings (ventilation type, daily ventilation need, tracheostomy duration, and ventilator settings). The outcomes included mortality rate and therapeutic outcomes of tracheal management. Of the 183 patients in the study, the most common type of respiratory-related infection was pneumonia (53%). Unlike respiratory-related causes, The mortality rate of patients admitted to the intensive care unit that was unrelated to respiratory causes was statistically significant (57%) (p=0.003). The mortality rate of patients who used aerosol tracheal collars (34%) was markedly higher than mechanically ventilated patients (57%) (p=0.004). The mortality rate following discharge from HHC was 40%, and was higher among patients aged >70 years (47%) (p=0.04). Pneumonia was associated with the majority of ventilator-related infections and resulted in hospital readmissions. Ensuring proper practices and caregiver education is crucial to decrease the incidence of ventilator-related infections.

Serial paired arterial and jugular venous point-of-care values in dogs undergoing manual basic life support.

To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time. Experimental study. Small animal research facility. Twenty-four purpose-bred research dogs. Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (T0), at 3minutes (T3), and at 6minutes (T6) into BLS. The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pao2, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (P<0.03). By T6, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous Po2, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from T0 (P<0.05). Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical role of POC testing during CPR.

Characterising indoor air quality in private vehicle cabins under unprecedented traffic conditions during COVID-19 lockdown

Air pollution negatively impacts human health, yet it is rarely studied inside vehicles. This study aimed to characterise indoor air quality (IAQ) in vehicle cabins, focusing on the concentrations of key pollutants and the influence of various factors on IAQ including vehicle-specific characteristics (self-pollution), traffic intensity, ventilation type, and enclosed spaces like parking garages. It addressed a significant literature gap by using real-world driving data, a multipollutant approach, real-time monitoring, and a detailed log of influencing factors. Additionally, part of the study was conducted during the COVID-19 lockdown, providing an unprecedented opportunity to gather real-world data with reduced traffic emissions. Forty trips were conducted with four diesel vehicles of different ages and emission standards. Concentrations of VOCs, CO, CO₂, NO₂, SO₂, O₃, and PM₁, PM₂.₅, PM₁₀, and TSP were monitored, alongside detailed logbook entries. This study evidenced the formation of O₃ inside vehicle cabins under conditions of high NO₂ and/or VOC concentrations and direct sunlight, a phenomenon not previously reported. Results also showed that IAQ inside vehicle cabins depended largely on vehicle-specific factors, the surrounding environment, and indoor-outdoor air exchange. CO, NO₂, SO₂, and PM levels varied mainly with the external environment and air exchange, while CO₂ levels were influenced primarily by ventilation settings. The concentrations of certain pollutants exceeded reference levels for indoor environments, potentially posing health risks to occupants. Further research is needed to study the pioneer evidence of O3 formation and to develop a comprehensive health risk assessment, thereby contributing to developing specific IAQ guidelines for vehicles.