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.

scholarly journals Individualized System for Augmenting Ventilator Efficacy (iSAVE): A Rapidly deployable system to expand ventilator capacity

2020 ◽  
Author(s):  
Shriya Srinivasan ◽  
Khalil B Ramadi ◽  
Francesco Vicario ◽  
Declan Gwynne ◽  
Alison Hayward ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Pressure Control ◽  
Patient Specific ◽  
Cross Contamination ◽  
Ventilator Support ◽  
Flow Changes ◽  
Safety Features ◽  
Multiple Patients ◽  
Air Streams

AbstractThe COVID-19 pandemic is overwhelming healthcare systems worldwide. A significant portion of COVID-19 patients develop pneumonia and acute respiratory distress syndrome (ARDS), necessitating ventilator support. Some health systems do not have the capacity to accommodate this surge in ventilator demand, leading to shortages and inevitable mortality. Some clinicians have, of necessity, jerry-rigged ventilators to support multiple patients, but these devices lack protected air streams or individualized controls for each patient. Moreover, some have not been tested under conditions of ARDS. We have developed the Individualized System for Augmenting Ventilator Efficacy (iSAVE), a rapidly deployable platform to more safely use a single ventilator to simultaneously support multiple critically-ill patients. The iSAVE enables patient-specific volume and pressure control and incorporates safety features to mitigate cross-contamination between patients and flow changes due to patient interdependencies within the respiratory circuit. Here we demonstrate through simulated and in vivo pig evaluation the capacity of the iSAVE to support a range of respiratory clinical states. By leveraging off-the-shelf components that are readily available to intensive care unit (ICU) caregivers, the iSAVE could potentially be translated for human application to expand the ventilation capacity of hospitals using existing ventilators, minimizing the need to procure additional ventilators.

scholarly journals Blood Pressure Control Practice and Determinants among Ambulatory Hypertensive Patients Attending Primary Health care facilities in Addis Ababa

2019 ◽  
Author(s):  
Firehiwot Amare ◽  
Teshome Nedi ◽  
Derbew Fikadu Berhe
Keyword(s):  
Blood Pressure ◽  
Addis Ababa ◽  
Sampling Technique ◽  
Complete Information ◽  
Pressure Control ◽  
Health Care Facilities ◽  
Cross Sectional ◽  
Hypertensive Patients ◽  
Patient Interview ◽  
Study Participants

Abstract Background Hypertension is the major risk factor for cardiovascular diseases (CVDs) related morbidity and mortality. Blood pressure (BP) is often not adequately controlled in clinical practice. Information regarding BP control in primary care settings is limited in Ethiopia.The aim of this study was to assess BP control and associated factors among hypertensive patients attending primary healthcare facilities in Addis Ababa. Methods A cross sectional study was conducted in 12 health centers in Addis Ababa city selected by multistage sampling. A total of 616 hypertensive patients were included by a systematic random sampling technique. Data was collected by patient interview and patients’ medical record review. Results Out of 634 study participants, 616 had complete information onmedical record and during patient interview. The mean age of study participants was 58.90 (SD 13.04), most of them 321(52.1%) were ≥60 years old, and on monotherapy 485(78.9%). Methyldopa was the most monotherapy prescribed,128 (20.8%). Only 31%(n=191) of patients had controlled BP. Determinants for poor BP control were age of less than 60 years (Adjusted Odds Ratio (AOR)= 3.06, 95% CI: 1.96, 4.78), work status; government employee (AOR= 2.41, 95% CI: 1.18, 4.90), retired (AOR=1.79, 95% CI: 1.01, 3.18), private business (AOR= 2.09, 95% CI: 1.17, 3.74) and being hypertensive for 10 or more years (AOR= 1.96, 95% CI: 1.11, 3.43). Significant predictors of achieving controlled BP were; weekly BP measurement (AOR 0.57, 95% CI: 0.36, 0.90) and tertiary level education (AOR= 0.26, 95% CI: 0.13, 0.54). Conclusion Only one third of patients had controlled BP. Effort should be made to address identified determinants including age, regular BP monitoring and level of education.

Noninvasive and Invasive Ventilatory Support II

2018 ◽  
Author(s):  
Pauline K. Park ◽  
Nicole L Werner ◽  
Carl Haas
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Lung Injury ◽  
Acute Respiratory Failure ◽  
Ventilatory Support ◽  
Underlying Disease ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Pulmonary Mechanics ◽  
Ventilator Induced Lung Injury

Invasive and noninvasive ventilation are important tools in the clinician’s armamentarium for managing acute respiratory failure. Although these modalities do not treat the underlying disease, they can provide the necessary oxygenation and ventilatory support until the causal pathology resolves. Care must be taken as even appropriate application can cause harm. Knowledge of pulmonary mechanics, appreciation of the basic machine settings, and an understanding of how common and advanced modes function allows the clinician to optimally tailor support to the patient while limiting iatrogenic injury. This second chapter reviews indications for mechanical ventilation, routine management, troubleshooting, and liberation from mechanical ventilation This review contains 6 figures, 7 tables and 60 references Keywords: Mechanical ventilation, lung protective ventilation, sedation, ventilator-induced lung injury, liberation from mechanical ventilation 

scholarly journals Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)

2020 ◽  
Vol 26 (5) ◽  
pp. 309-313 ◽  
Author(s):  
Anthony C Smith ◽  
Emma Thomas ◽  
Centaine L Snoswell ◽  
Helen Haydon ◽  
Ateev Mehrotra ◽  
...  
Keyword(s):  
Emergency Response ◽  
Close Contact ◽  
Models Of Care ◽  
Cross Contamination ◽  
Delivery Methods ◽  
Emergency Situations ◽  
The Everyday ◽  
Management Effort ◽  
Flexible Funding

The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.

scholarly journals Current Status of New Modes of Mechanical Ventilation

1996 ◽  
Vol 3 (6) ◽  
pp. 357-360 ◽  
Author(s):  
Robert M Kacmarek
Keyword(s):  
Pressure Support ◽  
Ventilatory Support ◽  
Pressure Control ◽  
Current Status ◽  
Great Promise ◽  
Alveolar Pressure ◽  
Beneficial Effects ◽  
Tracheal Gas Insufflation ◽  
Volume Ventilation ◽  
Protective Strategy

Current approaches to managing patients requiring ventilatory support have focused on a lung protective strategy. This approach limits peak alveolar pressure and tidal volume, and allows hypercapnia. Although hypercapnia is tolerated by many patients, in some the acute acidosis markedly complicates clinical management. Tracheal gas insufflation (TGI) has been designed as an adjunct to conventional ventilation to decreasePaCO2. Although no commercial TGI systems are available, TGI holds great promise and can be expected to be available comercially in the future. Pressure ventilation has become the ventilatory approach of the 1990s, whether pressure support or pressure control. However, problems associated with varying tidal volumes have resulted in manufacturers developing ventilatory modes that combine the beneficial effects of both pressure and volume ventilation.

Revatio = Sildenafil = Viagra Vital Initiative by the Institute for Safe Medication Practices Can Keep Patients Safe Lyrica-Lopressor Mix-up Cell Phones and E-mail Could Prevent Harm Reuse of Insulin Pen for Multiple Patients Risks Transmission of Blood-Borne Disease

2009 ◽  
Vol 44 (5) ◽  
pp. 374-377 ◽  
Author(s):  
Michael R. Cohen
Keyword(s):  
Medication Errors ◽  
Training Programs ◽  
Cell Phones ◽  
Health Care Facilities ◽  
Inservice Training ◽  
Safe Medication ◽  
Care Facilities ◽  
Fail Safe ◽  
Multiple Patients ◽  
E Mail

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at [email protected] . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

scholarly journals Blood pressure control practice and determinants among ambulatory hypertensive patients attending primary health care facilities in Addis Ababa

2020 ◽  
Vol 8 ◽  
pp. 205031212094652
Author(s):  
Firehiwot Amare ◽  
Teshome Nedi ◽  
Derbew Fikadu Berhe
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Medical Records ◽  
Addis Ababa ◽  
Pressure Control ◽  
Health Care Facilities ◽  
Control Practice ◽  
Primary Health ◽  
Care Facilities ◽  
Primary Health Care Facilities

Background: Hypertension is the major risk factor for cardiovascular diseases related morbidity and mortality. Blood pressure is often not adequately controlled in clinical practice. Information regarding blood pressure control in primary care settings is limited in Ethiopia. Objectives: This study aimed to assess blood pressure control practice and determinates among hypertensive patients attending primary health care facilities in Addis Ababa. Methods: A cross-sectional study was conducted on 616 hypertension patients in 12 health centers in Addis Ababa city. Data were collected by interviewing patients and reviewing their medical records. Data were collected from 3 August to 30 October 2015. Results: A complete information was obtained from 616 patients’ medical records, and patients were then interviewed. The mean age was 58.90 (SD ± 13.04) years, and most of them (n = 321, 52.1%) were 60 years old or above, and more than three-fourth (n = 485) were on monotherapy. Methyldopa was the most monotherapy medication prescribed, 128 (20.8%). Only 31% (n = 191) of the patients had controlled blood pressure. Determinants for poor blood pressure control were age less than 60 years (adjusted odds ratio (AOR) = 3.06, 95% confidence interval (CI): 1.96, 4.78); work status: government employee (AOR = 2.41, 95% CI: 1.18, 4.90), retired (AOR = 1.79, 95% CI: 1.01, 3.18), and private business (AOR = 2.09, 95% CI: 1.17, 3.74); and being hypertensive for 10 or more years (AOR = 1.96, 95% CI: 1.11, 3.43). Significant predictors of achieving controlled blood pressure were weekly blood pressure measurement practice (AOR = 0.57, 95% CI: 0.36, 0.90) and tertiary-level education (AOR = 0.26, 95% CI: 0.13, 0.54). Conclusions: Only one-third of the patients had controlled blood pressure. Efforts should be made to address identified determinants including age, regular blood pressure monitoring practice, and level of education.

Respiratory Support of Neonate Affected by Bronchiolitis in Neonatal Intensive Care Unit

2020 ◽  
Vol 37 (S 02) ◽  
pp. S10-S13
Author(s):  
Ilia Bresesti ◽  
Gianluca Lista
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ventilatory Support ◽  
Respiratory Support ◽  
Medical Emergency ◽  
High Frequency Ventilation ◽  
Pulmonary Mechanics

Acute respiratory infections are very common medical emergency in early infancy, often requiring hospitalization. The most frequent respiratory infection at this stage of life is bronchiolitis, with a benign course in the majority of cases. However, especially during neonatal period, infants are at higher risk for developing complications, and ventilatory support of various degrees is needed. The two most widespread methods to provide noninvasive respiratory support are heated humidified high-flow nasal cannula and nasal continuous positive airway pressure. They are both used in neonatal intensive care unit to treat respiratory distress syndrome of the premature infants, and the main concept of recruiting and distending alveoli is valid also for respiratory failure occurring during bronchiolitis. However, there is still ongoing debate about the superiority of one method, and their real efficacy still need to be confirmed. Once respiratory failure does not respond to noninvasive ventilation, more intensive care must be provided in the form of conventional mechanical ventilation or high-frequency ventilation. There is currently no evidence of the optimal ventilation strategy to use, and a deeper comprehension of the pulmonary mechanics during bronchiolitis would be desirable to tailor ventilation according to the degree of severity. Further research is then urgently needed to better clarify these aspects. Key Points

scholarly journals From Mouth-to-Mouth to Bag-Valve-Mask Ventilation: Evolution and Characteristics of Actual Devices—A Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Abdo Khoury ◽  
Sylvère Hugonnot ◽  
Johan Cossus ◽  
Alban De Luca ◽  
Thibaut Desmettre ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Ventilatory Support ◽  
Adverse Outcomes ◽  
Manual Ventilation ◽  
Emergency Situations ◽  
Historical View ◽  
Respiratory Parameters ◽  
Single Use ◽  
Unidirectional Valve ◽  
New Generation

Manual ventilation is a vital procedure, which remains difficult to achieve for patients who require ventilatory support. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. We will give in this paper, a historical view on manual ventilation’s evolution throughout the last decades and describe the technical characteristics, advantages, and hazards of the main devices currently found in the market. Artificial ventilation has developed progressively and research is still going on to improve the actual devices used. Throughout the past years, a brand-new generation of ventilators was developed, but little was done for manual ventilation. Many adverse outcomes due to faulty valve or misassembly were reported in the literature, as well as some difficulties to ensure efficient insufflation according to usual respiratory parameters. These serious incidents underline the importance of BVM system routine check and especially the unidirectional valve reassembly after sterilization, by only experienced and trained personnel. Single use built-in devices may prevent disassembly problems and are safer than the reusable ones. Through new devices and technical improvements, the safety of BVM might be increased.

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