Measurement of condensed water mass during mechanical ventilation with heated wire humidifiers: experiments with and without pre-warming.

Heated wire humidifiers (HWHs) are employed in mechanical ventilation with the objective of heating and humidifying the gases delivered to the mechanical ventilator. They use a control based on the adjustment of gas temperature at the chamber outlet. The condensation occurring within the breathing circuit is one of the most important concerns related to this control strategy. In the present study we focused on the measurement of the condensation amount within the breathing circuit during the employment of a commercial HWH (MR850, Fisher & Paykel). The measurement of the condensed vapor mass, performed during 7 h of ventilation, provides more objective information than the visual-based scale used in literature. Moreover, two solutions were proposed to minimize the condensation in the breathing circuit tract downward the heated chamber: i) a flexible insulating pipe was used to cover the mentioned breathing circuit tract, and ii) the air delivered by ventilator was heated before it passes through the chamber at different inlet temperature Ti obtained by employing pre-warming. To assess the improvement obtained by these two solutions, experiments have been carried out with and without their employment at two minute volumes. Results show that: i) insulation and pre-warming allows minimizing the condensation (e.g., at 8 L·min(-1) the mass of condensation after 7 h of ventilation decreases from 9.3 g to 2.5 g by using insulation and T(i)=27 °C); ii) the condensation mass decreases with T(i) (e.g., at 8 L·min(-1) the mass condensation was 2.5 g at T(i)= 27 °C and 1.1 g at T(i)= 30 °C); and iii) the amount of condensation linearly increases with time of ventilation.

A transistors-based, bidirectional flowmeter for neonatal ventilation: design and experimental characterization.

A bidirectional, low cost flowmeter for neonatal artificial ventilation, suitable for application in mono-patient breathing circuits, is described here. The sensing element consists of two nominally identical bipolar junction transistors employed as hot bodies. The sensor working principle is based on the convective heat transfer between the transistors, heated by Joule phenomenon, and the colder hitting fluid which represents the measurand. The proposed design allows the sensor to discriminate flow direction. Static calibration has been carried out in a range of flowrate values (from -8 L·min(-1) up to +8 L L·min(-1)) covering the ones employed in neonatal ventilation, at different pipe diameters (ie., 10 mm and 30 mm) and collector currents (i.e., 500 mA, 300 mA, and 100 mA) in order to assess the influence of these two parameters on sensor's response. Results show that the configuration with a pipe diameter of 10 mm at the highest collector current guarantees the highest sensitivity (i.e., 763 mV/Lmin1 at low flowrate ± 1 L-min(-1)) and ensures the minimum dead space (2 mL vs 18 mL for 30 mm of diameter). On the other hand, the 30 mm pipe diameter allows extending the range of measurement (up to ±6 L-min 1 vs ±3.5 L· min(-1) at 10 mm), and improving both the discrimination threshold (<;0.1 L·min-(1)) and the symmetry of response. These characteristics together with the low dead space and low cost foster its application to neonatal ventilation.

Efficacy and safety of subcutaneous immunotherapy with a biologically standardized extract of Ambrosia artemisiifolia pollen: a double-blind, placebo-controlled study.

BACKGROUND: The allergological relevance of Ambrosia in Europe is growing but the efficacy of the injective immunotherapy for this allergen has been documented only in Northern America. OBJECTIVE: We sought to study the safety and efficacy of injective immunotherapy in European patients sensitized to Ambrosia artemisiifolia. METHODS: Thirty-two patients (18 M/14 F, mean age 36.78, range 23-60 years) suffering from rhinoconjunctivitis and/or asthma and sensitized to Ambrosia were enrolled and randomized in a double-blind, placebo-controlled (DBPC) study lasting 1 year. A maintenance dose corresponding to 7.2 microg of Amb a 1 was administered at 4-week intervals after the build-up. During the second and the third year, all patients were under active therapy in an open fashion. Symptom and medication scores, skin reactivity to Ambrosia (parallel line biological assay), and pollen counts were assessed throughout the trial. RESULTS: Twenty-three patients completed the trial. No severe adverse event was observed. During the DBPC phase, actively treated patients showed an improvement in asthmatic symptoms (P=0.02) and drug (P=0.0068) scores days with asthmatic symptoms (P=0.003), days with rhinitis symptoms (P=0.05), and days with intake of drugs (P=0.0058), as compared to before therapy. No improvement for any of these parameters was detected in the placebo group. Moreover, the number of days with rhinitis and asthma was significantly higher in the placebo as compared to the active group (P=0.048 and P<0.0001, respectively). Patients who switched from placebo to active therapy improved in rhinoconjunctivitis, asthma, and drug intake. The skin reactivity decreased significantly (12.2-fold, P=0.0001) in the active group whereas a slight increase (1.07-fold, P=0.87) was observed in the placebo group after the DBPC phase. After switching to active therapy, patients previously under placebo showed a significant decrease of this parameter (4.78-fold, P=0.002). CONCLUSION: Injective immunotherapy is safe and clinically effective in European patients sensitized to Ambrosia.