Ventilator Research Articles

Pnömoni Tanısı İle Hastaneye Yatırılan Çocuk Hastalarda Olası Risk Faktörlerinin Morbidite Üzerine Etkileri

Amaç: Çocukluk çağı pnömonileri, özellikle gelişmekte olan ülkelerde en önemli mortalite ve morbidite nedenidir. Bu çalışmada pnömoni tanısı ile hastaneye yatışı yapılan çocukların demografik özellikleri ve pnömoni gelişiminde önemli risk faktörleri incelenmiş; komplikasyon gelişimi ve prognoz üzerine etkilerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu tek merkezli retrospektif kesitsel çalışmada, Pediatri Servisleri ve Yoğun Bakım Ünitesi (YBÜ) ’ne Ocak 2017- Ocak 2018 tarihleri arasında pnömoni tanısı ile yatırılan hastalar değerlendirildi. Hastaların demografik bulguları, anne sütü alım öyküsü, malnütrisyon varlığı, aşılama durumu, kronik hastalık varlığı, kalabalık yaşam koşulları, pasif sigara içiciliği gibi faktörlerin hastane yatışını ve yatış süresini ne kadar etkilediği, hastalık sonrasında komplikasyon gelişme durumu ve sağkalım bulguları incelendi. Bulgular: Pnömoni tanısı ile yatırılan 289 hastanın %53.3’ü kız olup ortanca yaşları 14 aydı ve hastaların %65.4’ü 2 yaşından küçüktü. Hastaların %19.7’sinde prematüre doğum öyküsü olup %76.1’i >2500 gr doğum ağırlığına sahipti; %15.9’unun postnatal dönemde küvöz bakımı, %6.2’sinin mekanik ventilatör ihtiyacı olmuştu. Hastaların %31.5’inin hiç anne sütü almadığı, %10’unun malnütre olduğu, %18’inin rutin aşılarının eksik olduğu, %26.6’sında pasif sigara maruziyeti, %37’sinde kronik hastalık varlığı saptandı. Başvuruda en sık gözlenen semptomlar öksürük (%86.5) ve ateş (%60) olup ortanca semptom süresi 3 gün idi. Başvuruda en sık saptanan fizik muayene bulguları ise takipne (%68.9) ve retraksiyonlar (%60.9)’di. Radyolojik incelemelerinde %85.8’inde pnömonik infiltrasyon, %3.5’inde lober konsolidasyon, %2.8’inde pnömonik infiltrasyon+plevral effüzyon, %2.1’inde pnömonik infiltrasyon+atelektazi, %1.1’inde lober konsolidasyon+plevral effüzyon ve %0.3’ünde atelektazi saptandı. Hastanede yatışları süresince hastalardan alınan kültürlerin %9’unda mikroorganizma üredi. Hastaların %56,7’si tekli antibiyotik tedavisi, diğerleri kombine antibiyotik tedavileri aldılar. Hastaneye yatış süresi ortanca 9 gün (1-115 gün) olup izlemde hastaların %25.6’sının yoğun bakım ünitesi izlemi gerekti. Pnömoni seyrinde komplikasyon gelişen hasta oranı %13.1 olarak saptandı. Yaş, prematüre doğum öyküsü, düşük doğum ağırlığı, postnatal dönemde küvözde veya mekanik ventilatörde kalma, malnütrisyon varlığı, kronik hastalık varlığı, başvuru muayenelerinde takipne, retraksiyon, ateş, ral-ronküs varlığı, akciğer grafisinde plevral effüzyonla birlikte pnömonik infiltrasyon veya lober konsolidasyon varlığı parametreleri uzamış hastane yatışında, pnömoni seyrinde komplikasyon gelişmesinde, YBÜ yatış gereksiniminde olası risk faktörleri olarak saptandı. Sonuç: Küçük yaş, prematüre doğum öyküsü, düşük doğum ağırlığı, anne sütü almamak, eksik aşılanma ve malnütrisyon çocuklarda pnömoni nedenli hastaneye yatışlar için önemli risk faktörleridir. Yoğun bakım ünitesine yatış gereksinimini, yoğun bakım ünitesinde yatış süresini ve komplikasyon gelişimini etkileyen faktörler ise ek nörolojik ve genetik hastalıkların varlığı ve düşük oksijen saturasyonu olarak belirlenmiştir. Hastalığın seyrini ve prognozunu, komplikasyonlarını ve hastanın hastanede yatış süresini etkileyen olası risk faktörlerinin belirlenip önlenmesi çocukluk çağında pnömonilerin morbiditesini azaltacaktır.

Lung Sonography in Obstetrics during COVID-19.

In the current coronavirus SARS-CoV-2 pandemic, certain patients are becoming seriously ill. Lung pathologies are common, and some patients even go on to develop acute respiratory distress syndrome (ARDS), which requires intubation and artificial respiration of the critically ill patient. Imaging of the lung is absolutely necessary to obtain a diagnosis, assess the course of disease and for treatment. Particularly in gynecology and obstetrics (OBGYN), ultrasound scans of the lung can be a useful additional tool when caring for pregnant patients in the delivery room. As obstetricians use ultrasound imaging a lot in routine clinical practice, in the current pandemic setting, routine prenatal imaging screening could be expanded by the addition of ultrasound scans of the lung. Lung sonography can offer important additional information, particularly in obstetrics where the indications for radiation-emitting imaging are particularly restrictive. If there is a sonographic suspicion of lung involvement, then, depending on the symptoms and the morphological extent of the ultrasound findings, it may be necessary to consider admitting the patient to hospital for close fetal and maternal monitoring.

A Review of Designing Ventilators Using Different Mechanisms

A Review of Designing Ventilators Using Different Mechanisms

Living on Borrowed Breath: Respiratory Distress, Social Breathing, and the Vital Movement of Ventilators.

Based on ethnographic research in a public hospital trauma intensive care unit in Mumbai, India, this article formulates the concept of “social breathing” to analyze how breath is central to values of life at the edges of death. Case studies of emergency resuscitation, intubation, and ventilation each illustrate breathing's sociality, as people and machines move air both materially and immaterially. Amid the hospital's rationing of life support technologies, forms of life that seem to be self‐regulated are better understood as relational movements of breath. Social breathing stands to reshape our understanding of the biopolitics of intensive care by drawing attention to uncertain techniques of the body. These techniques move at the hinge between person and environment, self and other, public and private health care systems, and medicine and machine. Life's valuation at this hinge takes shape through breath moving against its limits. Ultimately, the article argues that it is crucial to understand how ventilators mediate the edges of life and death by tracing the circulations of life support as the movements of life itself. As patients, families, and hospital workers struggle to make and manage breath, we might better grapple with the social relations that emerge as life support shapes life.

Bacterial and fungal isolates from endotracheal tube secretions culture and their antibiogram in patients with ventilator associated pneumonia

The study was undertaken to determine causative bacteria / Fungi and antimicrobial sensitivity pattern of the isolates in patients with VAP. The study was conducted at the Department of Medicine. The duration of the study was two years. A total of 100 VAP cases were studied, sample collected was endotracheal aspirate. More the age, more the patient is prone to VAP but the role sex in occurance of VAP was not statistically significant in our study. VAP was considered when after 48 hours of intubation patient develops Pneumonia, Leukocytosis/ Leukopenia, Fever. Gram negative bacteria were the most common organism causing VAP. Acinetobacter Baumannii was the most notorious bacteria causing VAP contributes to 53% followed by Klebsiella species 16%, Pseudomonas species 15% were the most frequent bacteria causing VAP later followed by coagulase positive Staphylococcus 6%, Escherichia coli 4%, Candida 4% and Enterobacter Cloacae Complex 2%. The antibiotic sensitivity pattern of gram negative bacteria isolated in our study including Pseudomonas species showed that most of them are sensitive to Colistin, Tigecycline, Meropenem and Amikacin followed by other drugs. In case of Gram Positive (Coagulase positive Staphylococcus) is sensitive to vancomycin and very rarely to Linezolid.

As Ventilators Become Crucial in Saving Lives, Repair Roadblocks Remain

Biomedical Safety & Standards 50(12):p 89-92, July 01, 2020. | DOI: 10.1097/01.BMSAS.0000671712.39890.14

Are Brighter Days Ahead? Light and Sound in the Pediatric Intensive Care Unit

PURPOSE. Though intended to heal, Pediatric Intensive Care Unit (PICU) environments are often a source of stress for patients and families. Disturbances in patient sleep quantity and quality are thought to be due to loss of the day/night cycle and continuous light and noise exposure. Environmental disruptions may exacerbate delirium, which is associated with increased ventilator days and mortality in children. ICU sound levels frequently exceed World Health Organization (WHO) recommendations; there are no similar standards for hospital light. Little PICU-specific data exists. The purpose of this study was to describe light and …

Investigation of the Antimicrobial Resistance Wastewater Based on Public Health: is Prospective an Integrated Methodology for Coronavirus (Covid-19) Outbreak Tracking Schemes and Reoccurrence Real-Time Detection

No policy for the novel coronavirus 50% of COVID-19 dead have infected with a secondary bacterial infection. The threat of antimicrobial resistance could become a massive source of extra virus and death in our system of healthcare, as coronavirus pneumonia percentages grow far beyond throughput. Exploiting the antimicrobial-resistant gen in sewage for data collection and Analyzing human discharge waste passes via the drainage system to a treatment plant — is one approach scientists can follow for contagious diseases emitted in urine or human feces such as superbug serious long-lasting lung disease “COVID -19. Infections with polymicrobiomics biofilm have emerged as a major epidemiological issue for the reason that biofilm- are highly resistant to both multidrug resistance and immune system. Biofilm -substrate-related polymicrobes-infected artificial breathing machine and feeding tubes; act as a source of respiratory infection and tolerance for multidrug. More such reinforcement and implementation of probiotics are designed to improve the internal structure of gut microbiome and raising concerns of respiratory infections caused by microbial translocation and endocytosis. COVID-19 Patients Prerequisite to be investigated for pathogenic and opportunities infection microbiotia, not so much the COVID-19 .This home message is especially significant for those involved with risky behavior and hospital equipment, in infected people with weak immunity. The scenario whereupon gets more complicated

U-23 A Research Analysis of Human Dignity and Medical Cases from the Perspective of Islam and Western Philosophy

The principle of human dignity is one of the universally accepted principles among nations and peoples, thus it is considered the most important human right. It is a necessary attribute for human being that cannot be separated since first breath in the womb of mother; and it continued even after the death. Hence the man deserves respect and dignity before birth in mother’s womb, in this worldly life and after death too. A person himself, as a bearer of this value of dignity, must respect the dignity of others in all his dealings. It a comparative study between the understanding of human dignity by Western philosophers and the Islamic Shrī’ah. Further there is an attempt to apply the both understandings on modern day medical cases; like abortion without any reason, cloning of human organs, blood transfusion without permission, artificial respiration after death, mercy killing by patient or medical staff, etc.

PEEP ADJUSTMENT UNDER LUNG ULTRASOUND CONTROL IN NEONATES WITH RESPIRATORY DISTRESS SYNDROME. A CLINICAL CASE PRESENTATION

The article describes a clinical case presentation of PEEP adjustment under lung ultrasound control in a newborn with respiratory distress syndrome during artificial respiration. Diagnostic value for B-line reduction and appearance of A-lines as predictors of lung atelectasis opening is demonstrated. The practice of low-volume lung recruitment which is achieved by functional residual capacity increasing rather than raising of inspiratory peak pressure can be considered safer as to the risk of ventilator-associated lung injury and the development of severe air leakage syndrome. In addition, the absence of significant fluctuations in the partial pressure of carbon dioxide is prognostically more positive in terms of reducing cerebral perfusion. Nevertheless, additional evidence based data needs to be collected before any further conclusions can be drawn.

Neuromuscular diseases and Covid-19: Advices from scientific societies and early observations in Italy.

The risk of a severe course of COVID-19 is increased in patients suffering with Neuromuscular disorders (NMD) due to the following comorbidities: muscular weakness of the chest and diaphragm, use of ventilator supports and/or presence of tracheostoma, weak airway clearance, cardiac involvement, rhabdomyolysis, comoribities, steroid and immunosuppressant treatments. NMD display varying levels of disability in people with the same diagnosis, thus it is difficult to give COVID-19 related general recommendations. Present advicess were designed for patients, caregivers, general neurologists and non-specialist medical providers. They address frequently asked questions and basic service requirements and are supported by a series of in-depth references. In this truly unprecedented situation, the clinical management of neuromuscular patients during the COVID-19 epidemics - taking into account the related difficulties (patients who have suspended ERT, difficulty in contacting the doctors, etc.) - we propose to use a telemedicine device, i.e. the AIGkit application (AIGkit app), promoted and developed in 2018 by Fabrizio Seidita on behalf of the Italian Glycogenosis Association (AIG). The app was born to allow patients with Pompe disease to receive as far as possible continuous monitoring of their health. The support of all colleagues of the Italian Association for Myology (AIM) should extend its use to all NMD patients and beyond.

Repurposing factories with robotics in the face of COVID-19.

Can collaborative robots ramp up the production of medical ventilators?

Neutrophilia and NETopathy as Key Pathologic Drivers of Progressive Lung Impairment in Patients With COVID-19.

There is an urgent need for new therapeutic strategies to contain the spread of the novel coronavirus disease 2019 (COVID-19) and to curtail its most severe complications. Severely ill patients experience pathologic manifestations of acute respiratory distress syndrome (ARDS), and clinical reports demonstrate striking neutrophilia, elevated levels of multiple cytokines, and an exaggerated inflammatory response in fatal COVID-19. Mechanical respirator devices are the most widely applied therapy for ARDS in COVID-19, yet mechanical ventilation achieves strikingly poor survival. Many patients, who recover, experience impaired cognition or physical disability. In this review, we argue the need to develop therapies aimed at inhibiting neutrophil recruitment, activation, degranulation, and neutrophil extracellular trap (NET) release. Moreover, we suggest that currently available pharmacologic approaches should be tested as treatments for ARDS in COVID-19. In our view, targeting host-mediated immunopathology holds promise to alleviate progressive pathologic complications of ARDS and reduce morbidities and mortalities in severely ill patients with COVID-19.

Mechanical Ventilation During the Coronavirus Disease 2019 Pandemic: Combating the Tsunami of Misinformation From Mainstream and Social Media.

Mechanical Ventilation During the Coronavirus Disease 2019 Pandemic: Combating the Tsunami of Misinformation From Mainstream and Social Media.

Ventilación mecánica simultánea con un solo ventilador a varios pacientes

espanolIntroduccion: La ventilacion mecanica simultanea a varios pacientes con un solo ventilador podria disminuir el deficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. Objetivo: Comunicar los resultados de un ejercicio de ventilacion mecanica con un ventilador en un simulador de pulmon, y simultaneamente en dos y cuatro simuladores. Resultados: No se observaron diferencias estadisticamente significativas entre la presion positiva al final de la espiracion, presion media de la via aerea y presion pico programadas, registradas y medidas, excepto al ventilar simultaneamente cuatro simuladores de pulmon. Conclusiones: La ventilacion mecanica simultanea debe ser instaurada por personal medico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos. EnglishIntroduction: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. Objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. Results: No statistically significant differences were observed between positive end-expiratory pressure, mean airway pressure, and programmed, recorded and measured peak pressure, except when simultaneously ventilating four lung simulators. Conclusions: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.

We'll breathe again [medical ventilators

Throughout the 19th century prototype ventilators appeared, but it was the great polio epidemics of the early 20th century that brought ventilation technology to the fore. In patients whose diaphragm had been paralysed by polio, only an artificial respirator could keep them alive, and in bad outbreaks, thousands might be needed. The first widely available `iron lung' was the brainchild not of a doctor but an industrial hygienist Philip Drinker. In late 2019 and onwards medical ventilators have been used in treatment of acute respiratory distress syndrome from coronovirus induced COVID 19 outbreaks.

In Memoriam: Lionel H. Opie, MD (1933-2020).

In Memoriam: Lionel H. Opie, MD (1933-2020).

Editor's Perspective: The Clinical Exercise Physiologist in the Time of Covid-19

At the time of this writing, the world is amid a pandemic due to the SARS-CoV-2 virus (a new coronavirus) which causes COVID-19 disease. More than 3.5 million are known to have been infected, and it can cause a range in severity of symptoms from asymptomatic (believed to occur in most individuals) to those with mild to severe flulike symptoms to those who end up in intensive care units (ICUs) with severe acute respiratory syndrome requiring artificial respiration support from a ventilator. Those with more severe effects often have chronic comorbid diseases including diabetes, chronic lung disease, cardiovascular disease, hypertension, and obesity. Up to 19% and 29% of those with 1 or >2 of these comorbidities, respectively, end up in ICUs or dying (1).So what are the current and future roles of the clinical exercise physiologist (EP) during the age of COVID-19? Let us begin with current roles. Many clinical EPs in the United States work in exercise rehabilitation programs, primarily cardiac rehabilitation, but some others in diabetes, pulmonary, weight management, or oncology programs. During the COVID-19 pandemic, most programs discontinued “nonessential” services to reduce or eliminate direct patient contact. Because of this, clinical EPs in these programs are currently (April 2020) not seeing patients in the traditional face-to-face encounter. However, many have either begun or extended the use of remote connection with patients. Connections range from as simple as a phone call to texting/messaging regularly to video visits using commercially available products. Other activities include reassessing and updating patient education materials, but in many situations, this has not been enough to keep all staff working full time. Unfortunately, in the United States, some clinical EPs have been furloughed and have resorted to enrolling in their states' unemployment benefits programs.Others have fulfilled supplementary duties within their work environments. Some of the duties might remain within the clinical EP's scope of practice (e.g., asking COVID-19-related symptom questions as door screeners in clinics and hospitals or taking vital signs such as temperature, blood pressure, heart rate, and assessing for dyspnea). Others have learned new skills, including face mask fitting. Additionally, at Henry Ford Hospital in Detroit, some clinical EPs have been deployed to work as research staff in an ongoing study assessing the effect of hydroxychloroquine to prevent SARS-CoV-2 infection in hospitals, first responders, public transportation, and nursing home staff who are at high risk of virus exposure due to their essential vocations.This pandemic has seen clinical EPs in various countries rise to the occasion. They have been, in some cases, recognized for their skill and abilities and used in ways they have never been used previously, but there are some opportunities for clinical EP professional growth as the current pandemic ends. Those working in rehabilitation settings should continue to advocate for the development, use of, and reimbursement for virtual visits, particularly those using telehealth or video visits. Unfortunately, the US Medicare program denied a request for reimbursement for video visits associated with cardiac rehabilitation. Alternatively, in Michigan, Blue Cross is very interested in expanding this technology for their members. Despite the Medicare decision, this might be an unprecedented opportunity, and likely a necessary one, to demonstrate alternative methods to provide supervised exercise programming. This is especially necessary if supervised exercise needs grow to desired levels set forth by the Million Heart Initiative for cardiac rehabilitation (2) and the American Heart Association for those with symptomatic peripheral artery disease (PAD; 3). It has been estimated that current programs in the United States only have capacity for ∼47% of all patients referred to cardiac rehabilitation. If one adds PAD, and especially if other chronic diseases are approved by the US Medicare system for supervised exercise (e.g., cancer and renal rehabilitation), the current system will become quickly overwhelmed. Adding to this is the emerging information that a poor lifestyle leading to comorbidities, such as hypertension, obesity, and diabetes, also leads to an increased risk of severe COVID-19, so supervised exercise programs may become in very high demand.I believe this is a time in history for clinical EPs across the world to rise to the occasion and show the broader allied health community, patients, and lawmakers that we are ready to provide the necessary care to all patients who might benefit from supervised exercise training.

Miniature Transport Respirator Performance Evaluation for Ventilatory Support

In the face of the coronavirus pandemic (COVID-19), in hospital and emergency units, there is low availability of mechanical respirator for patients in need of this support, greatly improving the survival rate. In these situations, there is a need for simpler equipment, easy access, low cost, and fast manufacturing. In this study, a 3D prototype transport respirator was developed using as a model the Takaoka 600 Mini Respirator, national technology from the 1950s. The influence of adjustable parameters of the respirator was evaluated to understand it is functioning: maximum and minimum lung pressure; respirator intake pressure; respiratory rate; inspiratory and expiratory time according to the sensitivity of the mini respirator; and pressure and flow of O₂ line intake. The increase in sensitivity led to an increase in maximum and minimum pulmonary pressure, decreased inspiratory and expiratory time, with margins of 1/1, 1/2, 1/3 inspiratory/expiratory time ratio (I/E ratio). The intake flow of O₂ varied proportionally with the pressure of air intake into the respirator, with its increase leading to an increase in respiratory rate, without major influences on lung pressure and the I/E ratio. The O₂ line intake pressure without major influences on lung pressure, showing and I/E ratio >1 in values below 3.5 kPa x 100. In conclusion, it was possible to obtain a pulmonary ventilator-dependent only on positive O₂ flow, compact and effective for patient transport, and in cases of emergencies with control of maximum pressure and respiratory rate offered to the patient. Among the parameters evaluated for this respirator, an line pressure of O₂ from 3.5 kPa x 100, sensitivity between 3 and 5, a flow of 5 to 15 L/min is recommended.

A Gaussian Model for the Time Development of the Sars-Cov-2 Corona Pandemic Disease. Predictions for Germany Made on 30 March 2020

For Germany, it is predicted that the first wave of the corona pandemic disease reaches its maximum of new infections on 11 April 2020 − 3.4 + 5.4 days with 90% confidence. With a delay of about 7 days the maximum demand on breathing machines in hospitals occurs on 18 April 2020 − 3.4 + 5.4 days. The first pandemic wave ends in Germany end of May 2020. The predictions are based on the assumption of a Gaussian time evolution well justified by the central limit theorem of statistics. The width and the maximum time and thus the duration of this Gaussian distribution are determined from a statistical χ 2 -fit to the observed doubling times before 28 March 2020.