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1.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 3261-3264, 2022 Jul.
Article in English | MEDLINE | ID: mdl-36083938

ABSTRACT

We present new results validating the capability of a high-fidelity computational simulator to accurately predict the responses of individual patients with acute respiratory distress syndrome to changes in mechanical ventilator settings. 26 pairs of data-points comprising arterial blood gasses collected before and after changes in inspiratory pressure, PEEP, FiO2, and I:E ratio from six mechanically ventilated patients were used for this study. Parallelized global optimization algorithms running on a high-performance computing cluster were used to match the simulator to each initial data point. Mean absolute percentage errors between the simulator predicted values of PaO2 and PaCO2 and the patient data after changing ventilator parameters were 10.3% and 12.6%, respectively. Decreasing the complexity of the simulator by reducing the number of independent alveolar compartments reduced the accuracy of its predictions. Clinical Relevance- These results provide further evidence that our computational simulator can accurately reproduce patient responses to mechanical ventilation, highlighting its usefulness as a clinical research tool.


Subject(s)
Positive-Pressure Respiration , Respiratory Distress Syndrome , Blood Gas Analysis , Humans , Positive-Pressure Respiration/methods , Respiration, Artificial/methods , Ventilators, Mechanical
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 957-961, 2022 Jul.
Article in English | MEDLINE | ID: mdl-36085701

ABSTRACT

The MASI mechanical ventilator was developed in a state of emergency to meet the demand for ventilators caused by COVID-19. Although it has obtained positive results in its use with patients in intensive care units, not having an optimal quality non-invasive ventilation (NIV) modality prevents it from being used in the early treatment of patients, which has been shown to prevent admission to the ICU and reduce mortality. Therefore, the following study focuses on evaluating MASI's ability to provide NIV using different accessories in order to compare their performance and determine which one would work best with MASI, and under which conditions. To do this, the high-flow nasal cannula, facial mask, and ventilation helmet accessories were tested under different pressure parameter settings. The data was collected using a gas flow analyzer. After that, a statistical analysis of the results was carried out, which showed that the face mask is the best accessory to use for NIV with MASI, and that it performs with optimal accuracy and precision when the peak inspiratory pressure is set at a value lower than 25 cmH20. Clinical Relevance- This study presents an optimization of the non-invasive ventilation (NIV) modality of the MASI me-chanical ventilator by evaluating its performance with different accessories.


Subject(s)
COVID-19 , Noninvasive Ventilation , Humans , Masks , Respiration, Artificial , Ventilators, Mechanical
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 986-990, 2022 Jul.
Article in English | MEDLINE | ID: mdl-36086445

ABSTRACT

More than 500 millions of people were affected by the COVID-19 pandemic and in Peru there is an increasing the high numbers of cumulative cases; as well as the hospitalized people, where more than 20 % require mechanical ventilation. This condition with other respiratory diseases cause patients to remain connected to a mechanical ventilator until they regain the ability to perform this vital function on their own. Some prototypes with characteristics equivalent to a high-end mechanical ventilator have been developed. And therefore, this paper presents the design and simulation of an algorithm for the pressure-controlled pulmonary ventilation mode of the mechanical ventilator. The functional design of the algorithm uses the linear multi compartment mathematical model to simulate the respiratory system. Finally the results respond adequately under multiple scenarios, including variations of the ventilator and pulmonary parameters, where the algorithm presents encouraging results in the mechanical ventilator simulation. Clinical relevance - The algorithm presented in this study will allow to have better knowledge for a treatment and eventual clinical diagnosis in health centers, especially in eventual variants and outbreaks of COVID-19.


Subject(s)
COVID-19 , Algorithms , COVID-19/therapy , Humans , Pandemics , Software , Ventilators, Mechanical
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2022: 422-425, 2022 Jul.
Article in English | MEDLINE | ID: mdl-36086508

ABSTRACT

Weaning from mechanical ventilation in the intensive care unit is a complex and relevant clinical problem. Prolonged mechanical ventilation leads to a variety of medical complications that increase hospital stay and costs, in addition to contributing the morbidity and mortality, affecting long-term quality of life. This work presents a methodology to establish the optimal moment of extubation of a patient connected to a mechanical ventilator, submitted to the T-Tube test. 133 patients are analyzed, classified into two groups: successful group (94 patients) and failed group (39 patients). The behaviour of the respiratory function is characterized through the mean, standard deviation, kurtosis, skewness, interquartile range and coefficient of interval of the respiratory flow time series. To classify these patients, neural networks (NN) and support vector machines (SVM) classifier are used, considering time intervals of the 450s, 600s and 900s. According to the results, the best classification is obtained using the SVM. Clinical Relevance-The paper determines the optimal moment for weaning a patient connected to a mechanical ventilator using machine learning techniques.


Subject(s)
Quality of Life , Ventilator Weaning , Humans , Respiration , Respiration, Artificial/methods , Ventilator Weaning/methods , Ventilators, Mechanical
5.
Biomed Eng Online ; 21(1): 62, 2022 Sep 05.
Article in English | MEDLINE | ID: mdl-36064546

ABSTRACT

BACKGROUND: Aerosols and droplets are the transmission routes of many respiratory infectious diseases. The COVID-19 management guidance recommends against the use of nebulized inhalation therapy directly in the emergency room or in an ambulance to prevent possible viral transmission. The three-dimensional printing method was used to develop an aerosol inhalation treatment mask that can potentially prevent aerosol dispersion. We conducted this utility validation study to understand the practicability of this new nebulizer mask system. RESULTS: The fit test confirmed that the filter can efficiently remove small particles. The different locations of the mask had an excellent fit with a high pressure making a proper face seal usability. The full-face mask appeared to optimize filtration with pressure and is an example of materials that perform well for improvised respiratory protection using this design. The filtering effect test confirmed that the contamination of designated locations could be protected when using the mask with filters. As in the clinical safety test, a total of 18 participants (10 [55.6%] females; aged 33.1 ± 0.6 years) were included in the final analysis. There were no significant changes in SPO2, EtCO2, HR, SBP, DBP, and RR at the beginning, 20th, 40th, or 60th minutes of the test (all p >.05). The discomfort of wearing a mask increased slightly after time but remained within the tolerable range. The vision clarity score did not significantly change during the test. The mask also passed the breathability test. CONCLUSION: The results of our study showed that this mask performed adequately in the fit test, the filtering test, and the clinical safety test. The application of a full-face mask with antiviral properties, together with the newly designed shape of a respirator that respects the natural curves of a human face, will facilitate the production of personal protective equipment with a highly efficient filtration system. METHODS: We conducted three independent tests in this validation study: (1) a fit test to calculate the particle number concentration and its association with potential leakage; (2) a filtering effect test to verify the mask's ability to contain aerosol spread; and (3) a clinical safety test to examine the clinical safety, comfortableness, and visual clarity of the mask.


Subject(s)
COVID-19 , Respiratory Tract Infections , COVID-19/prevention & control , Female , Humans , Male , Masks , Respiratory Aerosols and Droplets , Respiratory Tract Infections/prevention & control , Ventilators, Mechanical
6.
Front Public Health ; 10: 972249, 2022.
Article in English | MEDLINE | ID: mdl-36091510

ABSTRACT

Background: Existing anthropometric studies for respirator designs are based on the head and facial dimensions of Americans and Chinese nationals, with no studies for multi-ethnic countries like Malaysia. This study aimed to create head and facial morphological database for Malaysia, specifically to identify morphological differences between genders, ethnicities, and birthplaces, as well as predictors of the dimensions. Design: A cross-sectional study. Setting: Malaysia. Participants: A nation-wide cross-sectional study using a complex survey design with two stage-stratified random sampling was conducted among 3,324 participants, aged 18 years and above who were also participants of the National Health and Morbidity Survey 2020. Primary and secondary outcomes: The study collected data on sociodemographic, measurement of Body Mass Index (BMI) and 10 head and facial dimensions (3 dimensions were measured using direct measurement, and 7 others using Digimizer software for 2-dimension images). Linear regression was performed to determine the association between gender, ethnicity, birthplace, age and BMI and the dimensions. Results: There were significant differences in all the dimensions between sex, birthplace and ethnicity (p < 0.005). Further analysis using linear regression showed sex, ethnicity, birthplace, age and BMI were significant predictors of the dimensions. In comparison to studies from the United States and China, our study population had a wider interpupillary distance and nose breadth for both male and female participants, but smaller bigonial breadth and smaller minimal frontal breadth. Conclusion: These findings could assist in the design and sizing of respirators that will fit Malaysians and possibly other Southeast Asian population.


Subject(s)
Ethnicity , Respiratory Protective Devices , Cross-Sectional Studies , Equipment Design , Face/anatomy & histology , Female , Humans , Malaysia , Male , United States , Ventilators, Mechanical
7.
Article in English | MEDLINE | ID: mdl-36141723

ABSTRACT

Hospitalization of a child in the paediatric intensive care unit (PICU) is extremely stressful, both for the child and for his or her family. The purpose of this study was to gain deeper insight into the stressful experiences of parents of children hospitalized in the PICU. This study included 96 parents. The data were collected using a translated and standardized scale "The Parental Stressor Scale: Paediatric Intensive Care Unit (PSS: PICU)". This study confirms high exposure of parents to numerous PICU stressors. The most intense PICU stressor for parents was child's breathing depending on the ventilator (4.22 ± 1.17), and the least intense was child's demanding behaviour (1.17 ± 0.33). A significant positive correlation between the level of parents' perceived stress and the number of their children was recorded (r = 0.240, p = 0.02), while there was no significant correlation between the level of stress and other sociodemographic variables. A significantly higher level of stress was experienced by parents with primary school education (p = 0.032) and parents who are not healthcare professionals (p < 0.01). It is necessary to establish a system that will enable continuous assessment of parents' stress levels and timely prevention of stressful experiences for parents in the PICU.


Subject(s)
Hospitalization , Intensive Care Units, Pediatric , Child , Family , Female , Humans , Male , Risk , Stress, Psychological , Ventilators, Mechanical
8.
Clin Chest Med ; 43(3): 499-509, 2022 09.
Article in English | MEDLINE | ID: mdl-36116817

ABSTRACT

The ventilatory care of patients with acute respiratory distress syndrome (ARDS) is evolving as our understanding of physiologic mechanisms of respiratory failure improves. Despite several decades of research, the mortality rate for ARDS remains high. Over the years, we continue to expand strategies to identify and mitigate ventilator-induced lung injury. This now includes a greater understanding of the benefits and harms associated with spontaneous breathing.


Subject(s)
Respiratory Distress Syndrome , Ventilator-Induced Lung Injury , Humans , Respiration, Artificial , Respiratory Distress Syndrome/therapy , Ventilator-Induced Lung Injury/prevention & control , Ventilators, Mechanical/adverse effects
9.
Clin Chest Med ; 43(3): 511-518, 2022 09.
Article in English | MEDLINE | ID: mdl-36116818

ABSTRACT

Patient-ventilator asynchrony develops when the ventilator output does not match the efforts of the patient and contributes to excess work of breathing, lung injury, and mortality. Asynchronies are categorized as trigger (breath initiation), flow (delivery of the breath), and cycle (transition from inspiration to expiration). Clinicians should be skilled at ventilator waveform analysis to detect patient-ventilator asynchronies and make informed ventilator adjustments. Ventilator overdrive suppresses respiratory drive and reduces asynchrony, while other adjustments specific to the asynchrony are also useful.


Subject(s)
Respiratory Mechanics , Ventilators, Mechanical , Humans
10.
Skelet Muscle ; 12(1): 21, 2022 09 09.
Article in English | MEDLINE | ID: mdl-36085166

ABSTRACT

BACKGROUND: In intensive care units (ICU), mechanical ventilation (MV) is commonly applied to save patients' lives. However, ventilator-induced diaphragm dysfunction (VIDD) can complicate treatment by hindering weaning in critically ill patients and worsening outcomes. The goal of this study was to identify potential genes involved in the endogenous protective mechanism against VIDD. METHODS: Twelve adult male rabbits were assigned to either an MV group or a control group under the same anesthetic conditions. Immunostaining and quantitative morphometry were used to assess diaphragm atrophy, while RNA-seq was used to investigate molecular differences between the groups. Additionally, core module and hub genes were analyzed using WGCNA, and co-differentially expressed hub genes were subsequently discovered by overlapping the differentially expressed genes (DEGs) with the hub genes from WGCNA. The identified genes were validated by western blotting (WB) and quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: After a VIDD model was successfully built, 1276 DEGs were found between the MV and control groups. The turquoise and yellow modules were identified as the core modules, and Trim63, Fbxo32, Uchl1, Tmprss13, and Cst3 were identified as the five co-differentially expressed hub genes. After the two atrophy-related genes (Trim63 and Fbxo32) were excluded, the levels of the remaining three genes/proteins (Uchl1/UCHL1, Tmprss13/TMPRSS13, and Cst3/CST3) were found to be significantly elevated in the MV group (P < 0.05), suggesting the existence of a potential antiproteasomal, antiapoptotic, and antiautophagic mechanism against diaphragm dysfunction. CONCLUSION: The current research helps to reveal a potentially important endogenous protective mechanism that could serve as a novel therapeutic target against VIDD.


Subject(s)
Diaphragm , Ventilators, Mechanical , Animals , Atrophy , Intensive Care Units , Male , Rabbits , Respiration, Artificial/adverse effects
11.
J Investig Med High Impact Case Rep ; 10: 23247096221121412, 2022.
Article in English | MEDLINE | ID: mdl-36121295

ABSTRACT

Bronchoscopy can be used to resolve respiratory failure caused by tenacious mucus plugs. However, emergent bronchoscopy to resolve mucus plugging is not always available in small rural hospitals around the country. We present a case in which increasing the positive end-expiratory pressure settings on the ventilator resulted in immediate improvement in patient oxygenation and imaging findings during a respiratory emergency caused by mucus plugging.


Subject(s)
Pulmonary Atelectasis , Respiratory Insufficiency , Humans , Mucus , Positive-Pressure Respiration/adverse effects , Positive-Pressure Respiration/methods , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Ventilators, Mechanical/adverse effects
13.
Contrast Media Mol Imaging ; 2022: 6005914, 2022.
Article in English | MEDLINE | ID: mdl-36017026

ABSTRACT

A stroke is a sudden onset cerebral blood circulation disorder. It occurs in patients with cerebrovascular disease due to various predisposing factors causing stenosis, occlusion, or rupture of intracerebral arteries, which, in turn, causes acute cerebral blood circulation disturbance and clinically manifests as symptoms and signs of excessive or permanent cerebral dysfunction. It can cause serious harm to patients' physical and mental health. This study aimed to evaluate the effect of Breathe-Link breathing trainers on lung function and the ability to perform activities of daily living in patients with stroke. Sixty patients with stroke were randomly divided into two groups. One group was set as the control group and received routine breathing training. The experimental group received a Breathe-Link trainer based on regular training, with rehabilitation training for 12 weeks as the time node. Respiratory muscle strength, respiratory velocity, respiratory capacity, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and rate in the first second (FEV1/FVC) were used to evaluate the respiratory function of patients, and the Barthel index was used to evaluate the ability to perform activities of daily living. Improvements in respiratory function and daily living ability were compared between the two groups. After 12 weeks of training, respiratory muscle strength, respiratory velocity, respiratory volume, FVC, FEV1, FEV1/FVC, and Barthel index of patients in the two groups improved compared with those before training (P < 0.05), and the improvement in the treatment group was better than that in the control group (P < 0.05). Breathe-Link breathing trainers can improve lung function and the ability to perform activities of daily living in patients with stroke, and its effect is acceptable. It can be recommended for clinical use.


Subject(s)
Quality of Life , Stroke , Activities of Daily Living , Breathing Exercises , Humans , Lung , Stroke/therapy , Ventilators, Mechanical
14.
BMC Pediatr ; 22(1): 507, 2022 08 25.
Article in English | MEDLINE | ID: mdl-36008853

ABSTRACT

BACKGROUND: Rehabilitation of patients with high cervical spinal cord injury (CSCI) to improve activities of daily living (ADL) is challenging due to severe paralysis. In addition, pediatric patients with CSCI are rare, and literature describing ADL changes as the patient grows are limited. In this case report, we present the long-term change in ADL over time in a girl with severe high CSCI from an injury during infancy. CASE PRESENTATION: A 2 years and 6 months old girl, who was injured in a traffic accident, was diagnosed with C3 CSCI, resulting in complete quadriplegia and respiratory paralysis below C3. Thus, she was managed with a ventilator. Rehabilitation for quadriplegia, respiratory dysfunction, and autonomic neuropathy was started on the fifth day after the injury while she was in the intensive care unit. Six months after the injury, the patient was transferred to a hospital. Thereafter, she was discharged with nursing and care guidance provided to her family and environmental changes at home. Afterwards, she continued to acquire skills through writing training using a mouse stick, computer operation training, and electric wheelchair operation training, which enabled her to improve her ADL despite her severe disability. In terms of education, she was able to go through a regular elementary school, a regular junior high school, and then to a senior high school of a support school. CONCLUSIONS: We believe that training that utilizes current technology and changes in the environment that are appropriate for daily life are important for improving the ADL of children with severe CSCI.


Subject(s)
Cervical Cord , Spinal Cord Injuries , Activities of Daily Living , Cervical Cord/injuries , Female , Humans , Quadriplegia/etiology , Spinal Cord Injuries/complications , Spinal Cord Injuries/therapy , Ventilators, Mechanical/adverse effects
17.
Medicine (Baltimore) ; 101(32): e29940, 2022 Aug 12.
Article in English | MEDLINE | ID: mdl-35960117

ABSTRACT

OBJECTIVE: To investigate the efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). METHODS: This study is a retrospective clinical study. Seventy-two NRDS neonates were selected as the subjects from November 2019 to November 2020, and divided into observation group (40 cases, HFOV treatment) and control group (32 cases, conventional mechanical ventilation treatment). All cases were treated with PS and comprehensive treatment. The therapeutic effect, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), Percentage of inhaled oxygen concentration (FiO2), mean arterialpressure, oxygenation index (OI), and complications were compared in the 2 groups. RESULTS: The total effective rate of the observation group was 90.0%, significantly higher than that of the control group. After treatment, the observation group has higher PaO2 levels and lower levels of PaCO2, mean arterial pressure, FiO2, and OI than the control group. There was no significant difference in the incidence of complications between the 2 groups. CONCLUSION: HFOV combined with PS has a significant effect on NRDS, which can improve the arterial blood gas index without increasing the incidence of complications.


Subject(s)
High-Frequency Ventilation , Pulmonary Surfactants , Respiratory Distress Syndrome, Newborn , Humans , Infant, Newborn , Oxygen/therapeutic use , Pulmonary Surfactants/therapeutic use , Respiratory Distress Syndrome, Newborn/drug therapy , Retrospective Studies , Ventilators, Mechanical
18.
PLoS One ; 17(8): e0273173, 2022.
Article in English | MEDLINE | ID: mdl-35976965

ABSTRACT

BACKGROUND: Increased and decreased diaphragm thickness during mechanical ventilation is associated with poor outcomes. Some types of patient-ventilator asynchrony theoretically cause myotrauma of the diaphragm. However, the effects of double cycling on structural changes in the diaphragm have not been previously evaluated. Hence, this study aimed to investigate the relationship between double cycling during the early phase of mechanical ventilation and changes in diaphragm thickness, and the involvement of inspiratory effort in the occurrence of double cycling. METHODS: We evaluated adult patients receiving invasive mechanical ventilation for more than 48 h. The end-expiratory diaphragm thickness (Tdiee) was assessed via ultrasonography on days 1, 2, 3, 5 and 7 after the initiation of mechanical ventilation. Then, the maximum rate of change from day 1 (ΔTdiee%) was evaluated. Concurrently, we recorded esophageal pressure and airway pressure on days 1, 2 and 3 for 1 h during spontaneous breathing. Then, the waveforms were retrospectively analyzed to calculate the incidence of double cycling (double cycling index) and inspiratory esophageal pressure swing (ΔPes). Finally, the correlation between double cycling index as well as ΔPes and ΔTdiee% was investigated using linear regression models. RESULTS: In total, 19 patients with a median age of 69 (interquartile range: 65-78) years were enrolled in this study, and all received pressure assist-control ventilation. The Tdiee increased by more than 10% from baseline in nine patients, decreased by more than 10% in nine and remained unchanged in one. The double cycling indexes on days 1, 2 and 3 were 2.2%, 1.3% and 4.5%, respectively. There was a linear correlation between the double cycling index on day 3 and ΔTdiee% (R2 = 0.446, p = 0.002). The double cycling index was correlated with the ΔPes on days 2 (R2 = 0.319, p = 0.004) and 3 (R2 = 0.635, p < 0.001). CONCLUSIONS: Double cycling on the third day of mechanical ventilation was associated with strong inspiratory efforts and, possibly, changes in diaphragm thickness.


Subject(s)
Diaphragm , Respiration, Artificial , Adult , Aged , Diaphragm/diagnostic imaging , Humans , Positive-Pressure Respiration , Retrospective Studies , Ventilators, Mechanical
19.
Emerg Med Clin North Am ; 40(3): 473-488, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35953212

ABSTRACT

Acute respiratory failure requiring invasive mechanical ventilation is a common presentation in the emergency department. Providers can further improve care for these patients by understanding common modes of mechanical ventilation, recognizing changes in respiratory mechanics, and tailoring ventilator settings and therapies accordingly.


Subject(s)
Respiration, Artificial , Respiratory Distress Syndrome , Emergency Service, Hospital , Humans , Respiratory Distress Syndrome/therapy , Respiratory Mechanics , Ventilators, Mechanical
20.
Respir Med ; 201: 106946, 2022 09.
Article in English | MEDLINE | ID: mdl-35963032

ABSTRACT

OBJECTIVES: High-flow nasal cannula (HFNC) therapy is a widely used non-invasive respiratory support that may decrease invasive mechanical ventilation. This study evaluated the real-world effect of HFNC on the duration of mechanical ventilation among acute bronchiolitis patients on a nationwide level. METHODS: We retrospectively analyzed bronchiolitis patients (28 days-3 years old) who were admitted to tertiary hospitals for respiratory support from 2012 to 2019 using the Korean National Health Insurance database. We defined the pre-/post-HFNC period as 12 months periods before and after the initiation of HFNC in each hospital, allowing 6 months for a transition period. We compared ventilator-free days (VFDs) of two periods using a multivariable regression model. RESULTS: In 45 hospitals, 3359 and 3565 patients of pre-HFNC and post-HFNC periods were evaluated. During the post-HFNC period, 11% of patients used HFNC, and 18.7% used mechanical ventilation. VFDs did not vary in the two periods (26.8 vs. 26.7 days, p = 0.46). In the adjusted model, VFDs did not increase in the post-HFNC period (0.08 days, 95% confidence interval: 0.09, 0.25). HFNC application rate in each hospital was not associated with an increase in mean VFDs of pre- and post-HFNC (p = 0.24). CONCLUSIONS: The application of HFNC did not increase VFDs in bronchiolitis patients in a nationwide tertiary hospital setting. This finding suggests that bronchiolitis patients may not benefit from the routine use of HFNC as rescue therapy in terms of reducing invasive procedures or utilizing resources.


Subject(s)
Bronchiolitis , Cannula , Bronchiolitis/therapy , Humans , Oxygen Inhalation Therapy/methods , Retrospective Studies , Ventilators, Mechanical
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