scholarly journals A New Medical Device to Provide Independent Ventilation to Two Subjects Using a Single Ventilator: Evaluation in Lung-Healthy Pigs

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Ignacio Lugones ◽  
Roberto Orofino Giambastiani ◽  
Oscar Robledo ◽  
Martín Marcos ◽  
Javier Mouly ◽  
...  
Keyword(s):  
Medical Device ◽  
Developed Countries ◽  
Secondary Outcome ◽  
Positive End Expiratory Pressure ◽  
New Device ◽  
Arterial Blood ◽  
Number Of Patients ◽  
Significant Difference ◽  
End Tidal ◽  
End Tidal Co2

Background. The global crisis situation caused by SARS-CoV-2 has created an explosive demand for ventilators, which cannot be met even in developed countries. Designing a simple and inexpensive device with the ability to increase the number of patients that can be connected to existing ventilators would have a major impact on the number of lives that could be saved. We conducted a study to determine whether two pigs with significant differences in size and weight could be ventilated simultaneously using a single ventilator connected to a new medical device called DuplicARⓇ. Methods. Six pigs (median weight 12 kg, range 9–25 kg) were connected in pairs to a single ventilator using the new device for 6 hours. Both the ventilator and the device were manipulated throughout the experiment according to the needs of each animal. Tidal volume and positive end-expiratory pressure were individually controlled with the device. Primary and secondary outcome variables were defined to assess ventilation and hemodynamics in all animals throughout the experiment. Results. Median difference in weight between the animals of each pair was 67% (range: 11–108). All animals could be successfully oxygenated and ventilated for 6 hours through manipulation of the ventilator and the DuplicARⓇ device, despite significant discrepancies in body size and weight. Mean PaCO2 in arterial blood was 42.1 ± 4.4 mmHg, mean PaO2 was 162.8 ± 46.8 mmHg, and mean oxygen saturation was 98 ± 1.3%. End-tidal CO2 values showed no statistically significant difference among subjects of each pair. Mean difference in arterial PaCO2 measured at the same time in both animals of each pair was 4.8 ± 3 mmHg, reflecting the ability of the device to ventilate each animal according to its particular requirements. Independent management of PEEP was achieved by manipulation of the device controllers. Conclusion. It is possible to ventilate two lung-healthy animals with a single ventilator according to each one’s needs through manipulation of both the ventilator and the DuplicARⓇ device. This gives this device the potential to expand local ventilators surge capacity during disasters or pandemics until emergency supplies can be delivered from central stockpiles.

scholarly journals The Use of Milrinone Versus Conventional Treatment for the Management of Life-Threatening Bronchial Asthma

2019 ◽  
Vol 13 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Amr Sobhy ◽  
Doaa M. K. Eldin ◽  
Hany V. Zaki
Keyword(s):  
Bronchial Asthma ◽  
Conventional Treatment ◽  
Controlled Trial ◽  
Blood Gases ◽  
Categorical Variables ◽  
Chi Square ◽  
Arterial Blood ◽  
Number Of Patients ◽  
Significant Difference ◽  
Life Threatening

Background and Aims: In our study, we investigated the effectiveness of intravenous milrinone in life-threatening bronchial asthma as compared to conventional treatment. Methods: Fifty patients aged 18-50 years, presenting with life-threatening asthma were enrolled in a Randomised Controlled Trial (RCT). They were randomly allocated into Group C (25 patients): who received the standard pharmacotherapy and placebo, and Group M (25 patients): who in addition to the standard therapy, received 25 μg milrinone as an initial slow IV bolus diluted in 10 ml of normal saline. The following data were recorded: PEFR (Peak Expiratory Flow Rate) expressed as a percentage of the patient’s previous value, Respiratory Rate (RR), MABP (Mean Arterial Blood Pressure), arterial blood gases, and the number of patients requiring mechanical ventilation. Differences between groups were tested using Analysis of Variance (ANOVA) for quantitative variables with post hoc using the Least Significant Difference (LSD) test, and Chi square test for categorical variables. Results: Group M showed marked improvement in PEFR that was highly significant (P < 0.001) 10 min after injection and significant after one hour from the start of treatment in comparison to Group C. There was also an improvement in RR and PO2 that was significant in group M. Milrinone was associated with a reduction in MABP only after 10 min from injection, and showed a statistically significant decrease in the number of patients requiring mechanical ventilator support (P ˂ 0.05). Conclusion: Milronine is a promising agent as a rescue drug in the treatment of life-threatening bronchial asthma.

scholarly journals Clinical agreement and interchangeability of TEG5000 and TEG6s during cardiac surgery

2020 ◽  
Vol 48 (1) ◽  
pp. 43-52
Author(s):  
Qi Wong ◽  
Kelly P Byrne ◽  
Scott C Robinson
Keyword(s):  
Cardiac Surgery ◽  
Reaction Time ◽  
Alpha Angle ◽  
Maximum Amplitude ◽  
Surgical Patients ◽  
Treatment Recommendation ◽  
New Device ◽  
Management Algorithm ◽  
Arterial Blood ◽  
Significant Difference

TEG6s® is a new device introduced by the Haemonetics Corporation and designed to provide the same information as TEG® 5000 (Haemonetics Corporation, Braintree, MA, USA) but with much greater ease of use. We tested whether using citrated TEG6s gave reaction time, maximum amplitude and percentage of clot that had lysed at 30 minutes values similar to a non-citrated TEG5000, to allow clinical interchangeability using our current thrombelastography management algorithm for cardiac surgery. We also examined the agreement between the alpha-angle and functional fibrinogen maximum amplitude in our cardiac surgical patients.  In total, 243 paired arterial blood samples in 99 patients were tested, using TEG5000 (non-citrated) and TEG6s (citrated) after induction of anaesthesia (prior to heparin administration), following protamine administration at the end of the cardiac bypass and whenever a TEG5000 was requested after this by the attending anaesthetist. Bland–Altman plots and Lin’s concordance coefficient were used to compare agreement whereas modified Bland–Altman plots and McNemar’s test were used to illustrate the differences in management recommendations between the two thrombelastography devices.  All 243 samples were compared for reaction time and alpha-angle; 239 samples were compared for maximum amplitude; 136 samples were compared for the percentage of clot that had lysed at 30 minutes; 16 samples were compared for functional fibrinogen maximum amplitude. Lin’s concordance coefficient for these parameters was: reaction time 0.63, alpha-angle 0.39, maximum amplitude 0.5, percentage of clot that had lysed at 30 minutes 0.09 and functional fibrinogen maximum amplitude 0.31. Differences between the two devices became more marked at more abnormal values. Significant differences in median values, suggesting a fixed bias, were found for maximum amplitude and functional fibrinogen maximum amplitude. Differences in treatment recommendation could only be calculated for reaction time and maximum amplitude. Maximum amplitude was found to have a significant difference in treatment recommendation between the two devices using our current thrombelastography management algorithm for cardiac surgery with TEG6s recommending treatment in 11.5% more patients than TEG5000.  Using the TEG6s with our current TEG5000–based thrombelastography management algorithm for cardiac surgery would result in a change in treatment recommendation in at least 10% of our cardiac surgical patients. Agreement between the two thrombelastography devices appears to decrease with increasing patient coagulopathy. New algorithms will need to be developed and tested to validate TEG6s for cardiac surgical patients in our institution.

Capnography in Critical Care Medicine

1997 ◽  
Vol 12 (1) ◽  
pp. 18-32
Author(s):  
Eugene Y. Cheng ◽  
Harvey Woehlck ◽  
Anthony J. Mazzeo
Keyword(s):  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Infrared Spectrometry ◽  
Wave Form ◽  
Positive End Expiratory Pressure ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Noninvasive Monitor ◽  
End Tidal

Capnography is a noninvasive method of monitoring exhaled CO2 and is used in many situations as a reflection of arterial CO2 concentration. Expired CO2 can be accurately measured using infrared spectrometry, mass spectrometry, and Raman scattering. Colorimetric CO2 detectors are useful as a qualitive indicator of the presence of CO2. Trending end-tidal CO2 and analysis of the capnographic wave form can provide information on changes in a patient's cardiopulmonary status or malfunction of equipment used to support a patient's cardiovascular or pulmonary systems. The accuracy of end-tidal CO2 measurements as a reflection of arterial CO2 tension in critically ill patients with respiratory or cardiovascular problems is limited. Changes in deadspace, respiratory rate and depth, positive end-expiratory pressure, areolar circulation, and cardiac output can significantly impact end-tidal CO2 values more than arterial CO2 concentrations. With marked changes in end-tidal CO2 that are of concern, arterial blood gas analysis should be obtained to determine if the end-tidal CO2 measurement is representatire of a change in arterial CO2 concentrations. Despite the limitations of end-tidal CO2 as a reflection of arterial CO2, it is still useful as a noninvasive monitor to alert clinicians of potential changes in a patient's cardiopulmonary condition.

scholarly journals Use of a new transanal irrigation device for bowel disorder management by patients familiar with the irrigation technique: a prospective, interventional, multicenter pilot study

2020 ◽  
Vol 24 (7) ◽  
pp. 731-740
Author(s):  
K. Charvier ◽  
V. Bonniaud ◽  
D. Waz ◽  
C. Desprez ◽  
A.-M. Leroi
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Medical Device ◽  
Bowel Dysfunction ◽  
Secondary Outcome ◽  
Electric Pump ◽  
Open Label ◽  
Serious Adverse Events ◽  
New Device ◽  
Transanal Irrigation

Abstract Background The aim of this study was to evaluate the feasibility of transanal irrigation (TAI) with a new medical device incorporating an electric pump, the IryPump®R Set. Methods An interventional, prospective, open-label, non-comparative, multicenter pilot study on TAI was conducted at three French university hospitals. Patients with experience of TAI were enrolled for a 1-month period during which 5 consecutive TAIs were performed using the IryPump®R Set (B.Braun Melsungen AG Melsungen, Germany). The study’s primary efficacy criterion was successful TAI, defined as (i) use of the patient’s usual irrigation volume of water, (ii) stool evacuation, and (iii) the absence of leakage between TAIs. The first two TAIs were not taken into account in the main analysis. The secondary outcome measures were device acceptability, bowel dysfunction scores, tolerability, and safety. Results Fifteen patients were included between November 2016 and May 2017, and 14 were assessed in the main analysis. The TAI success rate was 72.4% (21 out of 29 procedures). The bowel dysfunction scores at the end of the study did not differ significantly from those recorded on inclusion. A high proportion of patients (> 70%) reported that TAI was feasible with the new medical device. There were no serious adverse events or device-related adverse events. At the end of the study, 50% of the participants were willing to consider further use of the new device. Conclusions In patients familiar with TAI, using a new medical device incorporating an electric pump was feasible. Levels of patient satisfaction were high, especially with regard to comfort of use and a feeling of security during TAI.

scholarly journals Surgical Treatment of Lateral Epicondylitis

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0012 ◽  
Author(s):  
Martin Kroslak ◽  
George A.C. Murrell
Keyword(s):  
Tennis Elbow ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Secondary Outcome ◽  
Sham Operation ◽  
Elbow Pain ◽  
Duration Of Symptoms ◽  
Post Surgery ◽  
Number Of Patients ◽  
Significant Difference

Objectives: A number of surgical techniques for managing tennis elbow have been described, one of the commonest (Nirschl & Pettrone. J Bone Joint Surg Am, 61(6A): 832-839) involves excising the affected portion of extensor carpi radialis brevis (ECRB) origin. The results of this technique, as well as most other described surgical techniques for this condition, have been reported as excellent, yet none have been compared with placebo surgery. Methods: This study was a prospective, randomised, double blinded, placebo controlled clinical trial investigating the surgical excision of the macroscopically degenerated portion of ECRB (Nirschl technique; n=13) compared with a sham operation (skin incision and exposure of ECRB alone; n=13) to manage tennis elbow, in patients with tennis elbow for more than 6 months who failed at least two non-surgical modalities. The primary outcome measure was defined as patient rated frequency of elbow pain with activity at 6 months post-surgery. Secondary outcome measures included patient rated frequency and severity of pain, functional outcomes, range of motion, epicondyle tenderness and strength at 6 months and >12 months post-surgery. Results: The two groups were matched for age, gender, hand dominance and duration of symptoms. Both the surgery and placebo procedures improved patient rated pain frequency and severity, elbow stiffness, difficulty with picking up objects, twisting motions and overall elbow rating over 6 months and at >12 months (p<0.01). Both procedures also improved epicondyle tenderness, pronation-supination range, grip strength and modified ORI-TETS at 6 months (p<0.05). No significant difference was observed between the groups in any parameter at any stage. No side effects or complications were reported. The study was stopped before the calculated number of patients were enrolled, as a post-hoc analysis showed over 6500 patients would need to be recruited in each group to see a significant difference between the groups at 26 weeks, when measuring patient rated frequency of elbow pain with activity. Conclusion: This study indicates that the surgical excision of the degenerative portion of ECRB offers no additional benefit over and above placebo surgery for the management of chronic tennis elbow. [Figure: see text]

scholarly journals Clinical Profile, Need for Dialysis and Mortality of Community Acquired versus Hospital Acquired Acute Kidney Injury

2021 ◽  
Author(s):  
B Dushyanth ◽  
Archana Dambal ◽  
. Siddaganga ◽  
CP Vrushabhveer ◽  
CS Hithashree
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Renal Injury ◽  
Kidney Injury ◽  
Developed Countries ◽  
P Value ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hospital Acquired

Introduction: Occurrence of Acute Kidney Injury (AKI) is high in hospitalised and critically ill patients. Most of the cases reported by the developed countries are Hospital Acquired Acute Kidney Injury (HA-AKI). AKI is a major medical complication in the developing world also and is due to predominantly community acquired causes, where the epidemiology differs from that in developed countries. Many studies have reported that Community Acquired Acute Kidney Injury (CA-AKI) and HA-AKI differ in mortality, need for renal replacement and residual renal injury. Aim: To know the difference in need for renal replacement therapy and in-hospital mortality between patients diagnosed with CA-AKI and HA-AKI using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Materials and Methods: A prospective cohort study was conducted from January 2018-December 2018 after obtaining Institutional Ethical Clearance by comparing 50 cases of CA-AKI and 50 cases of HA-AKI admitted by the General Medicine Department as per the inclusion and exclusion criteria. Serum Creatinine (S.Cr) at admission, after 48 hours and at the time of discharge were measured. Serial urine output measurements were done. Need for dialysis was noted in both the groups. Both groups were compared based on need for dialysis, difference in mortality and residual renal injury at the time of discharge. Chi-square and student t-tests were applied respectively and p-value ≤0.05 was considered as significant. Statistical Package for Social Sciences (SPSS) version 17.0 was used for data entry and analysis. Results: the CA-AKI and HA-AKI groups were comparable in age and gender but differed in some co-morbidities. CA-AKI group had underlying hepatobiliary disorders and Non steroidal Anti-Inflammatory Drug (NSAID) abuse more often than HA- AKI group. There was a significant reduction in S.Cr over the duration of hospital stay in CA-AKI (mean S.Cr at admission was 4.85 mg/dL, at 48 hours 2.05 mg/dL and at discharge 1.20 mg/dL). S.Cr increased after 48 hours of admission from baseline and declined later in HA-AKI but did not reach baseline in many patients in comparison to CA-AKI group (mean S.Cr at admission was 1.10 mg/dL, at 48 hours 2.38 mg/dL, at discharge 1.57 mg/dL). The highest stage of AKI was stage 3 in CA-AKI group (22 vs 11 of HA-AKI). HA-AKI group had more number of patients in stage 2 AKI (26 vs 18 of CA-AKI). There was no significant difference in mortality and requirement of haemodialysis between CA-AKI and HA-AKI groups. Conclusion: There was no difference between the two groups in terms of mortality and need for renal replacement therapy but there was significant residual renal injury in HA-AKI group.

scholarly journals Neonatal Morbidity and Mortality in Advanced Aged Mothers—Maternal Age Is Not an Independent Risk Factor for Infants Born Very Preterm

2021 ◽  
Vol 9 ◽  
Author(s):  
Nasenien Nourkami-Tutdibi ◽  
Erol Tutdibi ◽  
Theresa Faas ◽  
Gudrun Wagenpfeil ◽  
Elizabeth S. Draper ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Maternal Age ◽  
Periventricular Leukomalacia ◽  
Developed Countries ◽  
Morbidity And Mortality ◽  
Pediatric Care ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Very Preterm ◽  
Significant Difference

Background: As childbearing is postponed in developed countries, maternal age (MA) has increased over decades with an increasing number of pregnancies between age 35–39 and beyond. The aim of the study was to determine the influence of advanced (AMA) and very advanced maternal age (vAMA) on morbidity and mortality of very preterm (VPT) infants.Methods: This was a population-based cohort study including infants from the “Effective Perinatal Intensive Care in Europe” (EPICE) cohort. The EPICE database contains data of 10329 VPT infants of 8,928 mothers, including stillbirths and terminations of pregnancy. Births occurred in 19 regions in 11 European countries. The study included 7,607 live born infants without severe congenital anomalies. The principal exposure variable was MA at delivery. Infants were divided into three groups [reference 18–34 years, AMA 35–39 years and very(v) AMA ≥40 years]. Infant mortality was defined as in-hospital death before discharge home or into long-term pediatric care. The secondary outcome included a composite of mortality and/or any one of the following major neonatal morbidities: (1) moderate-to-severe bronchopulmonary dysplasia; (2) severe brain injury defined as intraventricular hemorrhage and/or cystic periventricular leukomalacia; (3) severe retinopathy of prematurity; and (4) severe necrotizing enterocolitis.Results: There was no significant difference between MA groups regarding the use of surfactant therapy, postnatal corticosteroids, rate of neonatal sepsis or PDA that needed pharmacological or surgical intervention. Infants of AMA/vAMA mothers required significantly less mechanical ventilation during NICU stay than infants born to non-AMA mothers, but there was no significant difference in length of mechanical ventilation and after stratification by gestational age group. Adverse neonatal outcomes in VPT infants born to AMA/vAMA mothers did not differ from infants born to mothers below the age of 35. Maternal age showed no influence on mortality in live-born VPT infants.Conclusion: Although AMA/vAMA mothers encountered greater pregnancy risk, the mortality and morbidity of VPT infants was independent of maternal age.

scholarly journals Evaluation of Cardiopulmonary, Blood Gases and Clinical Effects of Dexmedetomidine-Ketamine and Midazolam-Ketamine Anesthesia in New Zealand White Rabbits

2021 ◽  
Vol 77 (09) ◽  
pp. 6568-2021
Author(s):  
Ünal YAVUZ ◽  
Kerem YENER ◽  
Adem ŞAHAN ◽  
Pelin Fatoş POLAT DİNÇER ◽  
Ali HAYAT
Keyword(s):  
New Zealand ◽  
Blood Gases ◽  
High Dose ◽  
Clinical Effects ◽  
Arterial Blood ◽  
New Zealand White Rabbits ◽  
Ketamine Anesthesia ◽  
The Difference ◽  
End Tidal ◽  
End Tidal Co2

This study aimed to investigate the effects of dexmedetomidine-ketamine and midazolam-ketamine combinations on cardiopulmonary and clinical parameters in New Zealand white rabbits. The DXK group (n=8) received dexmedetomidine (50 µg/kg) and ketamine (20 mg/kg), and the MDK group (n=8) received midazolam (0.6 mg/kg) and ketamine (20 mg/kg) in the same syringe through the intramuscular (IM) route. Before anaesthesia and for 120 minutes, reflexes, haemodynamic values and blood gas changes were monitored. It was determined that anaesthesia was induced within a shorter time and lasted longer in DXK. The difference between the groups in terms of the time of loss of the pedal reflex (2.0 min in DXK, 7.5 min in MDK) was statistically significant (p<0.05). It was observed that, in both groups, the heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR) and oxy-haemoglobin saturation (SpO2) values decreased, and the end-tidal CO2 (EtCO2) values increased, but these changes were greater in DXK. With regard to arterial blood gasses, a reduction in pH and pO2 and an increase in pCO2 were also more noticeable in DXK. Consequently, at the doses applied, dexmedetomidine-ketamine caused more noticeable changes in the haemodynamic values and blood gasses in comparison to midazolam-ketamine. High-dose dexmedetomidine (50 µg/kg) and low-dose ketamine (20 mg/kg) achieved induction in a shorter time but led to a significant reduction in RR. It was concluded that the combination of midazolam (0.6 mg/kg) and ketamine (20 mg/kg) could be regarded as appropriate for the anaesthesia of New Zealand white rabbits.

Clinical Study of the Changes in Arterial Blood Gas and End Tidal CO2 after Release of Tourniquet

1991 ◽  
Vol 24 (1) ◽  
pp. 104
Author(s):  
See Young Ok ◽  
Jang Won Lee ◽  
Soon Im Kim ◽  
Sung Yell Kim
Keyword(s):  
Clinical Study ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
End Tidal ◽  
End Tidal Co2
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