Modification of a domiciliary ventilator to increase FiO2: an off-label modification which may be of value in COVID-19.

Although nasal continuous positive airway pressure or non-invasive ventilation is used to manage some patients with acute lung injury due to COVID-19, such patients also demonstrate increased minute ventilation which makes it hard, if the device is used in line with the manufacturer's instructions, to achieve adequate oxygen delivery. In addition, if a hospital contains many such patients, then it is possible that the oxygen requirements will exceed infrastructure capacity. Here we describe a simple modification of two exemplar ventilators normally used for domiciliary ventilation, which substantially increased the fraction of inspired oxygen (FiO2) delivered.

Correction: The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study.

[This corrects the article DOI: 10.2196/30899.].

The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study.

BACKGROUND: Good nutrition affects children's health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children's eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones. OBJECTIVE: The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices. METHODS: This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project. RESULTS: This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention. CONCLUSIONS: The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30899.

Central venous and bladder pressure reflect transdiaphragmatic pressure during pressure support ventilation.

STUDY OBJECTIVES: To determine whether the change in bladder pressure (Pblad) and central venous pressure (Pcvp) may reflect the changes in esophageal pressure (Pes) and gastric pressure (Pgas) when inspiratory pressure support (IPS) is altered. DESIGN: Prospective clinical study. SETTING: The ICUs of a teaching hospital. PATIENTS: Ten patients currently receiving IPS ventilation via a tracheostomy or an endotracheal tube who already had bladder and central venous catheters in situ. MEASUREMENTS AND RESULTS: Airway pressure, Pes, Pgas, Pcvp, Pblad, and flow were measured at the original IPS setting. IPS then was reduced by 5-cm H(2)O increments until IPS was zero or was at the minimum pressure that could be tolerated by each patient. At each level of IPS, pressures and flow were measured at steady-state breathing. The maximum pressure difference for each pressure during inspiration was calculated. We found that the Delta Pblad correlated closely with the Delta Pgas (r = 0.904) and that the Delta Pes correlated with the Delta Pcvp (r = 0.951). When the Delta Pcvp - Delta Pblad was compared with the transdiaphragmatic pressure for each patient as the IPS was altered, the correlation coefficients varied from 0.952 to 0.999. CONCLUSION: Although absolute values for the Delta Pcvp during mechanical ventilation do not always reflect the Delta Pes, useful information can be obtained from this route. In individual patients, the two sites of measurement followed each other when IPS was changed, enabling a bedside assessment of the response to reducing respiratory support.