The Multi Split Ventilator System: Performance Testing of Respiratory Support Shared by Multiple Patients

2022 ◽  
Author(s):  
Donald Gaucher ◽  
A Zachary Trimble ◽  
Brennan Yamamoto ◽  
Ebrahim Seidi ◽  
Scott Miller ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endotracheal Tube ◽  
System Performance ◽  
Minute Ventilation ◽  
Ventilatory Support ◽  
Performance Testing ◽  
Simulated Patients ◽  
Performance Tests ◽  
Feasible Option ◽  
Multiple Patients

Abstract Ventilator sharing has been proposed as a method of increasing ventilator capacity during instances of critical shortage. We sought to assess the ability of a regulated, shared ventilator system (Multi Split Ventilator System, MSVS) to individualize support to multiple simulated patients using one ventilator. We employed simulated patients of varying size, compliance, minute ventilation requirement, and PEEP requirement. Performance tests were performed to assess the ability of the QSVS, versus control, to achieve individualized respiratory goals to clinically disparate patients sharing a single ventilator following ARDSNet guidelines. Resilience tests measured the effects of simulated adverse events occurring to one patient on another patient sharing a single ventilator. The QSVS met individual oxygenation and ventilation requirements for multiple simulated patients with a tolerance similar to a single ventilator. Abrupt endotracheal tube occlusion or extubation occurring to one patient resulted in modest, clinically tolerable changes in ventilation parameters for the remaining patients. The QSVS is a regulated, shared ventilator system capable of individualizing ventilatory support to clinically dissimilar simulated patients. It is also resilient to common adverse events. The QSVS represents a feasible option to ventilate multiple patients during a severe ventilator shortage.

The Multi Split Ventilator System: Design and Function of a Regulated, Shared Ventilator System

2020 ◽  
Author(s):  
Donald Gaucher ◽  
A Zachary Trimble ◽  
Brennan Yamamoto ◽  
Scott Miller ◽  
John Vossler ◽  
...  
Keyword(s):  
Patient Safety ◽  
Tidal Volume ◽  
Minute Ventilation ◽  
Simulated Patient ◽  
Simulated Patients ◽  
Laboratory Assessment ◽  
Safety Consideration ◽  
Clinical Changes ◽  
And Function ◽  
Multiple Patients

Abstract The objective of this paper is to describe the design and function of the Multi Split Ventilator system (MSVS); an airflow apparatus that enables physicians to provide individualized, isolated ventilation to up to four patients using a single ventilator. Method: The study design is laboratory assessment of the ability of the MSVS to decouple the pressures and resulting tidal volumes between patient limbs in response to adverse extubation (disconnection) or endotracheal tube occlusion of one of the patients in the system. We compare the airflow decoupling of the MSVS against an existing unregulated split ventilator system (USVS) design over eight prototypical patient pairs. Simulated patient prototypes of varying size, minute ventilation requirement, and PEEP requirement were employed. Result: Respiratory support was developed for varying simulated patient pairs using the MSVS and a USVS. The results demonstrate that patients supported with the MSVS showed significantly smaller changes to tidal volume and PEEP after extubation events, and tidal volume after occlusion events. Conclusion: It was found that the MSVS as a regulated, shared ventilator system effectively buffered simulated patients from clinical changes occurring to another patient connected to the split ventilator. This decoupling ability resulted in significantly smaller changes in delivered support when compared to existing USVS designs, which is an important patient safety consideration if deciding to support multiple patients with a single ventilator.

scholarly journals A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Erol Karaaslan ◽  
Sedat Akbas ◽  
Ahmet Selim Ozkan ◽  
Cemil Colak ◽  
Zekine Begec
Keyword(s):  
Laryngeal Mask Airway ◽  
Adverse Events ◽  
Endotracheal Tube ◽  
Sore Throat ◽  
Fiberoptic Bronchoscopy ◽  
Laryngeal Mask ◽  
Controlled Clinical Trial ◽  
Airway Protection ◽  
Link Type ◽  
Single Blind

Abstract Background There are doubts among anesthesiologists on the use of the Laryngeal Mask Airway (LMA) in nasal surgeries because of concerns about the occurrence of blood leakages to the airway. We hypothesized that the use of LMA-Supreme (LMA-S) in nasal surgery is comparable with endotracheal tube (ETT) according to airway protection against blood leakage through the fiberoptic bronchoscopy, oropharyngeal leakage pressure (OLP), heart rate (HR), mean arterial pressure (MAP), and postoperative adverse events. Methods The present study was conducted in a prospective, randomized, single-blind, controlled manner on 80 patients, who underwent septoplasty procedures under general anesthesia, after dividing them randomly into two groups according to the device used (LMA-S or ETT). The presence of blood in the airway (glottis/trachea, distal trachea) was analyzed with the fiberoptic bronchoscope and a four-point scale. Both groups were evaluated for OLP; HR; MAP; postoperative sore throat, nausea, and vomiting; dysphagia; and dysphonia. Results In the fiberoptic evaluation of the airway postoperatively, less blood leakage was detected in both anatomic areas in the LMA-S group than in the ETT group (glottis/trachea, p = 0.004; distal trachea, p = 0.034). Sore throat was detected less frequently in the LMA-S group at a significant level in the 2nd, 6th, and 12th hours of postoperative period; however, other adverse events were similar in both groups. Hemodynamic parameters were not different between the two groups. Conclusion The present findings demonstrate that the LMA-S provided more effective airway protection than the ETT in preventing blood leakage in the septoplasty procedures. We believe that the LMA-S can be used safely and as an alternative to the ETT in septoplasty cases. Trial registration This trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT03903679 on April 5, 2019.

scholarly journals I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Chaoliang Tang ◽  
Xiaoqing Chai ◽  
Fang Kang ◽  
Xiang Huang ◽  
Tao Hou ◽  
...  
Keyword(s):  
Stress Response ◽  
Tracheal Intubation ◽  
Adverse Events ◽  
Endotracheal Tube ◽  
Posterior Fossa ◽  
Carbon Dioxide Tension ◽  
Uneventful Recovery ◽  
Posterior Fossa Surgery ◽  
Necrosis Factor Alpha ◽  
Respiratory Variables

Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients.Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared.Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P<0.05versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasmaβ-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI.Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.

Management of the Extubation Problem in the Premature Child

1980 ◽  
Vol 89 (6) ◽  
pp. 508-511 ◽  
Author(s):  
Robin T. Cotton ◽  
Allan B. Seid
Keyword(s):  
Endotracheal Tube ◽  
Ventilatory Support ◽  
Disease Process ◽  
Upper Respiratory Tract ◽  
Endoscopic Evaluation ◽  
Newborn Period ◽  
Edema Formation ◽  
Premature Child ◽  
Upper Respiratory

Long-term endotracheal intubation is a widely established means of giving ventilatory support in the newborn period. Though such long-term intubation is well tolerated by the premature infant, laryngeal complications do occur and extubation may be impossible even though the initial disease process for which the intubation was performed has resolved. In such a situation, careful endoscopic evaluation of the upper respiratory tract is advocated to identify the site of the problem. If subglottic edema or mucosal ulceration in the subglottic area is the site of the damage and if, during endoscopic evaluation immediately following removal of the endotracheal tube, the subglottic area starts to narrow because of edema formation or edema fluid filling up compressed granulation tissue, then a split of the cricoid in the midline anteriorly, leaving the endotracheal tube in as a stent, appears to be a preferable alternative to performing a tracheotomy. Of 12 consecutive patients, 9 have been successfully extubated.

Abstract 122: Compression-Induced Ventilation Volumes Decrease with Chest Compression Depth and Prolonged CPR

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Simone Ordelman ◽  
Paul Aelen ◽  
Paul van Berkom ◽  
Gerrit J Noordergraaf
Keyword(s):  
Gas Exchange ◽  
Endotracheal Tube ◽  
Chest Compression ◽  
Minute Ventilation ◽  
Time Effect ◽  
Chest Compressions ◽  
Initial Value ◽  
Compression Depth ◽  
Minute Period ◽  
Over Time

Introduction: Compression-induced ventilation may aid gas exchange during CPR. We hypothesized that the amount of gas moving in and out of the lungs depends on chest compression depth. Methods: VF was induced in five female, anesthetized and intubated pigs of about 30 kg. After 30 seconds of non-intervention time, chest compressions were started and maintained at a rate of 100 compressions per minute. Every two minutes chest compression depth was altered, resulting in 14 minutes of CPR with a depth sequence of 4 cm, 3 cm, 4 cm, 5 cm, 5.5 cm, 5 cm and 4 cm. Ventilations were performed manually with a bag-valve device 10 times per minute during continuous chest compressions by a dedicated expert. Airway flow was measured at the end of the endotracheal tube. Compression-induced ventilation was determined from the periods between the manual ventilations. The average compression-induced minute ventilation volume was determined over the last minute of each two minute period of CPR at each specific chest compression depth. Results: The compression-induced ventilation volume in the first period of CPR at 4 cm of depth was 1.6 ± 0.9 L/min (about 4% of total ventilation volume). The figure shows how the compression-induced ventilation volume decreases with increasing chest compression depth, relative to this initial value. CPR with a chest compression depth of 4 cm was performed three times in each pig, and the corresponding compression-induced ventilation volumes decreased with time. This suggested that there might be just a time effect (e.g. atelectasis). However, the final compression depth of 4 cm resulted in larger compression-induced ventilation volumes than the preceding 5 cm and 5.5 cm compression depths, indicating that the decreased volume over time could not purely be a time effect, but must also be an effect of the depth. Conclusion: In conclusion, compression-induced ventilation volume appears to decrease with deeper chest compressions as well as with prolonged CPR.

A Study of Contemporary System Performance Testing Framework

2018 ◽  
pp. 7563-7576
Author(s):  
Alex Ng ◽  
Shiping Chen
Keyword(s):  
System Performance ◽  
Large Scale ◽  
Performance Test ◽  
Performance Testing ◽  
General Purpose ◽  
Testing Framework ◽  
The Core ◽  
Application Logic ◽  
The Common ◽  
Whole Life Cycle

Performance testing is one of the vital activities spanning the whole life cycle of software engineering. As a result, there are a considerable number of performance testing products and open source tools available. It has been observed that most of the existing performance testing products and tools are either too expensive and complicated for small projects, or too specific and simple for diverse performance tests. In this chapter, we will present an overview of existing performance test products/tools, provide a summary of some of the contemporary system performance testing frameworks, and capture the key requirements for a general-purpose performance testing framework. Based on our previous works, we propose a system performance testing framework which is suitable for both simple and small, as well as complicated and large-scale performance testing projects. The core of our framework contains an abstraction to facilitate performance testing by separating the application logic from the common performance testing functionality, and a set of general-purpose data model.

scholarly journals Combining Performance Testing and Metadata Models to Support Fault Detection and Diagnostics in Smart Buildings

2019 ◽  
Vol 2 (3) ◽  
pp. 28
Author(s):  
Elena Markoska ◽  
Aslak Johansen ◽  
Mikkel Baun Kjærgaard ◽  
Sanja Lazarova-Molnar ◽  
Muhyiddine Jradi ◽  
...  
Keyword(s):  
Energy Efficiency ◽  
Fault Detection ◽  
Performance Test ◽  
Performance Testing ◽  
Performance Tests ◽  
Actual Performance ◽  
Hypothetical Scenario ◽  
Wide Range ◽  
Promising Practice

Performance testing of components and subsystems of buildings is a promising practice for increasing energy efficiency and closing gaps between intended and actual performance of buildings. A typical shortcoming of performance testing is the difficulty of linking a failing test to a faulty or underperforming component. Furthermore, a failing test can also be linked to a wrongly configured performance test. In this paper, we present Building Metadata Performance Testing (BuMPeT), a method that addresses this shortcoming by using building metadata models to extend performance testing with fault detection and diagnostics (FDD) capabilities. We present four different procedures that apply BuMPeT to different data sources and components. We have applied the proposed method to a case study building, located in Denmark, to test its capacity and benefits. Additionally, we use two real case scenarios to showcase examples of failing performance tests in the building, as well as discovery of causes of underperformance. Finally, to examine the limits to the benefits of the applied procedure, a detailed elaboration of a hypothetical scenario is presented. Our findings demonstrate that the method has potential and it can serve to increase the energy efficiency of a wide range of buildings.

Generic Performance Tests for the Fertilizer Sample Preparation Laboratory

1995 ◽  
Vol 78 (2) ◽  
pp. 294-300
Author(s):  
Robert L Beine ◽  
David H Tompkins ◽  
Kirk R Ranta ◽  
Julio Puentes
Keyword(s):  
Sample Preparation ◽  
Performance Testing ◽  
Empirical Method ◽  
Performance Tests ◽  
Measuring Time ◽  
Fertilizer Sample ◽  
Initial Reduction ◽  
Good Sample ◽  
Almost All ◽  
Ground Material

Abstract Good sample preparation is an essential first step to almost all laboratory analytical procedures. The procedures presented are intended to stimulate interest in generic methods for performance testing of various steps in fertilizer sample preparation, including initial reduction of unground sample, grinding, and mixing. Sample reduction quality is measured by 2 types of procedures, the first using 2 sizes of glass beads for a more theoretical approach, and the second using 2 common fertilizer materials for a more empirical method. Grinding performance is measured by recovery and carryover methods, followed by particle size and uniformity estimates of the ground material. Mixing after grinding is tested by measuring time-to-blend of a segregated mixture.

scholarly journals Incidence of mortality due to rebound toxicity after ‘treat and release’ practices in prehospital opioid overdose care: a systematic review

2018 ◽  
Vol 36 (4) ◽  
pp. 219-224 ◽  
Author(s):  
Jennifer Anne Greene ◽  
Brent J Deveau ◽  
Justine S Dol ◽  
Michael B Butler
Keyword(s):  
Adverse Events ◽  
Ventilatory Support ◽  
Risk Of Bias ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Serious Adverse Events ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Overdose Mortality ◽  
Do So

IntroductionDeath due to opioid overdose was declared a public health crisis in Canada in 2015. Traditionally, patients who have overdosed on opioids that are managed by emergency medical services (EMS) are treated with the opioid antagonist naloxone, provided ventilatory support and subsequently transported to hospital. However, certain EMS agencies have permitted patients who have been reversed from opioid overdose to refuse transport, if the patient exhibits capacity to do so. Evidence on the safety of this practice is limited. Therefore, our intent was to examine the available literature to determine mortality and serious adverse events within 48 hours of EMS treat and release due to suspected rebound opioid toxicity after naloxone administration.MethodsA systematic search was performed on 11 May 2017 in PubMed, Cochrane Central, Embase and CINHAL. Studies that reported on the outcome of patients treated with prehospital naloxone and released at the scene were included. Analyses for incidence of mortality and adverse events at the scene were conducted. Risk of bias and assessment of publication bias was also done.Results1401 records were screened after duplicate removal. Eighteen full-text studies were reviewed with seven selected for inclusion. None were found to be high risk of bias. In most studies, heroin was the source of the overdose. Mortality within 48 hours was infrequent with only four deaths among 4912 patients ﴾0.081%﴿ in the seven studies. Only one study reported on adverse events and found no incidence of adverse events from their sample of 71 released patients.ConclusionMortality or serious adverse events due to suspected rebound toxicity in patients released on scene post-EMS treatment with naloxone were rare. However, studies involving longer-acting opioids were rare and no study involved fentanyl.

scholarly journals A rapidly deployable individualized system for augmenting ventilator capacity

2020 ◽  
Vol 12 (549) ◽  
pp. eabb9401 ◽  
Author(s):  
Shriya S. Srinivasan ◽  
Khalil B. Ramadi ◽  
Francesco Vicario ◽  
Declan Gwynne ◽  
Alison Hayward ◽  
...  
Keyword(s):  
Ventilatory Support ◽  
Pressure Control ◽  
Open Circuit ◽  
Health Care Facilities ◽  
Pulmonary Mechanics ◽  
Cross Contamination ◽  
Emergency Situations ◽  
Patient Status ◽  
Procurement Strategies ◽  
Multiple Patients

Strategies to split ventilators to support multiple patients requiring ventilatory support have been proposed and used in emergency cases in which shortages of ventilators cannot otherwise be remedied by production or procurement strategies. However, the current approaches to ventilator sharing lack the ability to individualize ventilation to each patient, measure pulmonary mechanics, and accommodate rebalancing of the airflow when one patient improves or deteriorates, posing safety concerns to patients. Potential cross-contamination, lack of alarms, insufficient monitoring, and inability to adapt to sudden changes in patient status have prevented widespread acceptance of ventilator sharing. We have developed an individualized system for augmenting ventilator efficacy (iSAVE) as a rapidly deployable platform that uses a single ventilator to simultaneously and more safely support two individuals. The iSAVE enables individual-specific volume and pressure control and the rebalancing of ventilation in response to improvement or deterioration in an individual’s respiratory status. The iSAVE incorporates mechanisms to measure pulmonary mechanics, mitigate cross-contamination and backflow, and accommodate sudden flow changes due to individual interdependencies within the respiratory circuit. We demonstrate these capacities through validation using closed- and open-circuit ventilators on linear test lungs. We show that the iSAVE can temporarily ventilate two pigs on one ventilator as efficaciously as each pig on its own ventilator. By leveraging off-the-shelf medical components, the iSAVE could rapidly expand the ventilation capacity of health care facilities during emergency situations such as pandemics.

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