Cough flows as a criterion for decannulation of autonomously breathing patients with tracheostomy tubes.

BACKGROUND: Adequate cough or exsufflation flow can indicate an option for safe tracheostomy decannulation to noninvasive management. Cough peak flow via the upper airways with the tube capped is an outcome predictor for decannulation readiness in patients with neuromuscular impairment. However, this threshold value is typically measured with tracheotomy tube removed, which is not acceptable culturally in China. The aim of this study was to assess the feasibility and safety of using cough flow measured with tracheostomy tube and speaking valve (CFSV) > 100 L/min as a cutoff value for decannulation. STUDY DESIGN: Prospective observational study conducted between January 2019 and September 2022 in a tertiary rehabilitation hospital. METHODS: Patients with prolonged tracheostomy tube placement were referred for screening. Each patient was assessed using a standardized tracheostomy decannulation protocol, in which CFSV greater than 100 L/min indicated that the patients' cough ability was sufficient for decannulation. Patients whose CFSV matched the threshold value and other protocol criteria were decannulated, and the reintubation and mortality rates were followed-up for 6 months. RESULTS: A total of 218 patients were screened and 193 patients were included. A total of 105 patients underwent decannulation, 103 patients were decannulated successfully, and 2 patients decannulated failure, required reinsertion of the tracheostomy tube within 48 h (failure rate 1.9%). Three patients required reinsertion or translaryngeal intubation within 6 months. CONCLUSIONS: CFSV greater than 100 L/min could be a reliable threshold value for successful decannulation in patients with various primary diseases with a tracheostomy tube. TRIAL REGISTRATION: This observational study was not registered online.

Superhydrophobic, stretchable kirigami pencil-on-paper multifunctional device platform.

Wearable electronics with applications in healthcare, human-machine interfaces, and robotics often explore complex manufacturing procedures and are not disposable. Although the use of conductive pencil patterns on cellulose paper provides inexpensive, disposable sensors, they have limited stretchability and are easily affected by variations in the ambient environment. This work presents the combination of pencil-on-paper with the hydrophobic fumed SiO2 (Hf-SiO2) coating and stretchable kirigami structures from laser cutting to prepare a superhydrophobic, stretchable pencil-on-paper multifunctional sensing platform. The resulting sensor exhibits a large response to NO2 gas at elevated temperature from self-heating, which is minimally affected by the variations in the ambient temperature and relative humidity, as well as mechanical deformations such as bending and stretching states. The integrated temperature sensor and electrodes with the sensing platform can accurately detect temperature and electrophysiological signals to alert for adverse thermal effects and cardiopulmonary diseases. The thermal therapy and electrical stimulation provided by the platform can also deliver effective means to battle against inflammation/infection and treat chronic wounds. The superhydrophobic pencil-onpaper multifunctional device platform provides a low-cost, disposable solution to disease diagnostic confirmation and early treatment for personal and population health.

Vanadium Oxide-Doped Laser-Induced Graphene Multi-Parameter Sensor to Decouple Soil Nitrogen Loss and Temperature.

Monitoring nitrogen utilization efficiency and soil temperature in agricultural systems for timely intervention is essential for crop health with reduced environmental pollution. Herein, this work presents a high-performance multi-parameter sensor based on vanadium oxide (VOX )-doped laser-induced graphene (LIG) foam to completely decouple nitrogen oxides (NOX ) and temperature. The highly porous 3D VOX -doped LIG foam composite is readily obtained by laser scribing vanadium sulfide (V5 S8 )-doped block copolymer and phenolic resin self-assembled films. The heterojunction formed at the LIG/VOX interface provides the sensor with enhanced response to NOX and an ultralow limit of detection of 3 ppb (theoretical estimate of 451 ppt) at room temperature. The sensor also exhibits a wide detection range, fast response/recovery, good selectivity, and stability over 16 days. Meanwhile, the sensor can accurately detect temperature over a wide linear range of 10-110 °C. The encapsulation of the sensor with a soft membrane further allows for temperature sensing without being affected by NOX . The unencapsulated sensor operated at elevated temperature removes the influences of relative humidity and temperature variations for accurate NOX measurements. The capability to decouple nitrogen loss and soil temperature paves the way for the development of future multimodal decoupled electronics for precision agriculture and health monitoring.

Pencil-on-Paper Humidity Sensor Treated with NaCl Solution for Health Monitoring and Skin Characterization.

Although flexible humidity sensors are essential for human health monitoring, it is still challenging to achieve high sensitivity and easy disposal with simple, low-cost fabrication processes. This study presents the design and fabrication of highly reliable hand-drawn interdigital electrodes from pencil-on-paper treated with NaCl solution for highly sensitive hydration sensors working over a wide range of relative humidity (RH) levels from 5.6% to 90%. The applications of the resulting flexible humidity sensor go beyond the monitoring of respiratory rate and proximity to characterizations of human skin types and evaluations of skin barrier functions through insensible sweat measurements. The sensor array can also be integrated with a diaper to result in smart diapers to alert for an early diaper change. The design and fabrication strategies presented in this work could also be leveraged for the development of wearable, self-powered, and recyclable sensors and actuators in the future.

Tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital: a prospective cohort study.

BACKGROUND: The aim of the study was to assess the feasibility of a standardized tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital. METHODS: This prospective cohort study recruited conscious patients with prolonged tracheostomy who were referred to the pulmonary rehabilitation department of a tertiary rehabilitation hospital between January 2019 and December 2021. A pulmonary rehabilitation team used a standardized tracheostomy decannulation protocol developed by the authors. The primary outcome was the success rate of decannulation. Secondary outcomes included decannulation time from referral and reintubation rate after a follow-up of 3 months. RESULTS: Of the 115 patients referred for weaning from mechanical ventilation and tracheostomy decannulation over the study period, 80.0% (92/115) were finally evaluated for tracheostomy decannulation. The mean time of tracheostomy in patients transferred to our department was 70.6 days. After assessment by a multidisciplinary team, 57 patients met all the decannulation indications and underwent decannulation. Fifty-six cases were successful, and 1 case was intubated again. The median time to decannulation after referral was 42.7 days. Reintubation after a follow-up of 3 months did not occur in any patients. CONCLUSIONS: A standardized tracheostomy decannulation protocol implemented by a pulmonary rehabilitation team is associated with successful tracheostomy decannulation in patients with prolonged tracheostomy. Not every tracheostomy patient must undergo upper airway endoscopy before decannulation. Tolerance of speaking valve continuously for 4 h can be used as an alternative means for tube occlusion. A swallow assessment was used to evaluate the feeding mode and did not affect the final decision to decannulate. TRIAL REGISTRATION: 2018bkky-121.

Moisture-resistant, stretchable NOx gas sensors based on laser-induced graphene for environmental monitoring and breath analysis.

The accurate, continuous analysis of healthcare-relevant gases such as nitrogen oxides (NOx) in a humid environment remains elusive for low-cost, stretchable gas sensing devices. This study presents the design and demonstration of a moisture-resistant, stretchable NOx gas sensor based on laser-induced graphene (LIG). Sandwiched between a soft elastomeric substrate and a moisture-resistant semipermeable encapsulant, the LIG sensing and electrode layer is first optimized by tuning laser processing parameters such as power, image density, and defocus distance. The gas sensor, using a needlelike LIG prepared with optimal laser processing parameters, exhibits a large response of 4.18‰ ppm-1 to NO and 6.66‰ ppm-1 to NO2, an ultralow detection limit of 8.3 ppb to NO and 4.0 ppb to NO2, fast response/recovery, and excellent selectivity. The design of a stretchable serpentine structure in the LIG electrode and strain isolation from the stiff island allows the gas sensor to be stretched by 30%. Combined with a moisture-resistant property against a relative humidity of 90%, the reported gas sensor has further been demonstrated to monitor the personal local environment during different times of the day and analyze human breath samples to classify patients with respiratory diseases from healthy volunteers. Moisture-resistant, stretchable NOx gas sensors can expand the capability of wearable devices to detect biomarkers from humans and exposed environments for early disease diagnostics.

Abnormal Pulmonary Function in Early Parkinson's Disease: A Preliminary Prospective Observational Study.

Early Parkinson's disease (PD) may cause respiratory dysfunction; however the findings vary among studies. The aim of the preliminary prospective observational study was to explore the deterioration of pulmonary function at various stages in patients with early PD. A total of 237 patients with PD were screened. Fifty-six patients were included (modified Hoehn and Yahr stage ≤ 2.5). In addition, 56 age-matched healthy controls were also included in the study. Significant differences between the PD and control groups were found in all the investigated lung-function parameters. The maximal voluntary ventilation (MVV) percent predicted was the only parameter that distinguished PD stages (101.1 ± 14.9% vs. 82.8 ± 19.2% vs. 71.4 ± 12.9%, Hoehn and Yahr stages 1.5 vs. 2 vs. 2.5, respectively; p < 0.005). MVV could be the most sensitive parameter for distinguishing the severity of early-stage PD.

Intrinsically Breathable and Flexible NO2 Gas Sensors Produced by Laser Direct Writing of Self-Assembled Block Copolymers.

The surge in air pollution and respiratory diseases across the globe has spurred significant interest in the development of flexible gas sensors prepared by low-cost and scalable fabrication methods. However, the limited breathability in the commonly used substrate materials reduces the exchange of air and moisture to result in irritation and a low level of comfort. This study presents the design and demonstration of a breathable, flexible, and highly sensitive NO2 gas sensor based on the silver (Ag)-decorated laser-induced graphene (LIG) foam. The scalable laser direct writing transforms the self-assembled block copolymer and resin mixture with different mass ratios into highly porous LIG with varying pore sizes. Decoration of Ag nanoparticles on the porous LIG further increases the specific surface area and conductivity to result in a highly sensitive and selective composite to detect nitrogen oxides. The as-fabricated Ag/LIG gas sensor on a flexible polyethylene substrate exhibits a large response of -12‰, a fast response/recovery of 40/291 s, and a low detection limit of a few parts per billion at room temperature. Integrating the Ag/LIG composite on diverse fabric substrates further results in breathable gas sensors and intelligent clothing, which allows permeation of air and moisture to provide long-term practical use with an improved level of comfort.

Wearable Pressure Sensors Based on MXene/Tissue Papers for Wireless Human Health Monitoring.

Though the widely available, low-cost, and disposable papers have been explored in flexible paper-based pressure sensors, it is still difficult for them to simultaneously achieve ultrahigh sensitivity, low limit and broad range of detection, and high-pressure resolution. Herein, we demonstrate a novel flexible paper-based pressure sensing platform that features the MXene-coated tissue paper (MTP) sandwiched between a polyimide encapsulation layer and a printing paper with interdigital electrodes. After replacing the polyimide with weighing paper in the MTP pressure sensor, the silver interdigital electrodes can be recycled through incineration. The resulting pressure sensor with polyimide or paper encapsulation exhibits a high sensitivity of 509.5 or 344.0 kPa-1, a low limit (∼1 Pa) and a broad range (100 kPa) of detection, and outstanding stability over 10 000 loading/unloading cycles. With ultrahigh sensitivity over a wide pressure range, the flexible pressure sensor can monitor various physiological signals and human movements. Configuring the pressure sensors into an array layout results in a smart artificial electronic skin to recognize the spatial pressure distribution. The flexible pressure sensor can also be integrated with signal processing and wireless communication modules on a face mask as a remote respiration monitoring system to wirelessly detect various respiration conditions and respiratory abnormalities for early self-identification of opioid overdose, pulmonary fibrosis, and other cardiopulmonary diseases.

Ventilation improvement after pneumonia treatment evaluated with electrical impedance tomography: an observational study.

Objective.Due to radiation exposure, not all patients with pneumonia receive chest x-rays or CT measurements to confirm treatment effectiveness. The aim of this study was to examine the ability to use electrical impedance tomography (EIT) to evaluate the treatment effectiveness in such patient group.Approach.A total of 35 consecutive patients with non-severe pneumonia were included in this prospective study. The patients received standard treatment according to our internal protocol. EIT measurements were performed in supine position before the treatment started and on day 6 of the treatment period. The EIT-based global inhomogeneity (GI) index and center of ventilation (CoV) index were calculated. The clinical pulmonary infection score (CPIS) was obtained at both time points.Main results.Clinically significant improvements inGIandCoVwere found in the patient group (ΔGI: -34% ± 17% and ΔCoV: -10% ± 11%;p<0.001). Although the CPIS was also significantly improved (ΔCPIS-0.70 ± 0.17,p<0.001), no correlations were demonstrated when compared to ΔGIor ΔCoV. Significance.EIT demonstrated individual improvement of ventilation heterogeneity after standard treatment in non-severe pneumonia, and provided different information compared to CPIS. EIT has the potential to become a routine non-invasive, non-radiative tool to assess pneumonia treatment effectiveness.

The influence of an electrical impedance tomography belt on lung function determined by spirometry in sitting position.

OBJECTIVE: The aim of the study was to examine whether an electrical impedance tomography (EIT) electrode belt changed the lung function in healthy volunteers and patients with respiratory muscle weakness (RMW) and chronic obstructive pulmonary disease (COPD). APPROACH: In total, thirty subjects were included (10 healthy volunteers, 10 subjects with RMW, maximum inspiratory pressure < 40 cmH2O, and 10 COPD, grade I-IV). Spirometry measurements were conducted in a sitting position once a day at similar times on two consecutive days. Slow expiratory vital capacity (VC), forced vital capacity (FVC) and maximum voluntary ventilation (MVV) manoeuvres were performed. On day 1, spirometry was performed without the EIT electrode belt, and on day 2, the belt was attached to the thorax. MAIN RESULTS: Lung function was not influenced by the electrode belt in healthy subjects. The test-retest reliability in the healthy group was 0.89, 0.89 and 0.85 for VC, FVC and MVV, respectively. On the other hand, all investigated parameters were significantly decreased in the RMW group (VC, 51.3 ± 18.0 versus 46.5 ± 18.0% predicted, without versus with EIT belt, p< 0.01; FVC, 51.7 ± 19.0 versus 45.8 ± 18.1% predicted, p< 0.01; MVV, 41.0 ± 20.0 versus 38.8 ± 19.6% predicted, p< 0.01). VC and MVV also decreased significantly in the COPD group (VC, 77.4 ± 20.5 versus 74.6 ± 18.8% predicted, p< 0.05; MVV, 57.4 ± 15.7 versus 54.4 ± 12.5% predicted, p< 0.05). SIGNIFICANCE: An EIT electrode belt could reduce lung volumes in subjects with pre-existing lung diseases. Comparing lung function acquired with an electrode belt to corresponding values obtained without the belt should be avoided.