scholarly journals Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicholas A. Ettinger ◽  
Nathan Serazin ◽  
Richard Nguyen ◽  
Jennifer Werdenberg ◽  
Minke Huibers ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Low Cost ◽  
Age Groups ◽  
Positive Pressure ◽  
Older Children ◽  
Flow Rates ◽  
Young Infants ◽  
Resource Limited ◽  
Nasal Cannulae ◽  
Patient Interface

Abstract Background/aim Low-cost commercial bCPAP devices have been deployed in resource-limited settings to treat neonatal respiratory failure. The use of these devices has increased access to pediatric respiratory support for infants. However, constrained resources may result in substitution of recommended consumables and/or use in older age groups. We hypothesized that commercially available bCPAP devices, the standard WHO-style device and various improvised adaptations would all generate effective, safe positive pressure at the patient interface. Methods Performance of 2 commercially available bCPAP devices was tested against the standard WHO-style bCPAP device, as well as several improvised modifications of these devices, by measuring positive pressure delivered at the patient interface. Variables tested included different flow rates, patient interfaces and respiratory circuit tubing. Results Both commercial devices utilized according to manufacturer recommendations generated the expected positive pressure at the patient interface. When testing the recommended WHO-style bCPAP device with recommended materials as well as other improvised modifications, we found variable and potentially unpredictable generation of positive pressure at the patient interface. Conclusions Modified or improvised bCPAP devices should be used with extreme caution as the support provided may be more or less than expected depending on respiratory tubing and flow rates employed. Our data support the effectiveness of bCPAP in newborns and young infants. But, to our knowledge, there are no bCPAP patient interfaces for older children effective with low liter flow devices. Therefore, based on these results, we recommend against using WHO-style bCPAP devices for non-infant patients with respiratory failure and instead recommend using standard oxygen therapy with nasal cannulae or face-masks, as well as early consideration of transfer to a higher level of care.

scholarly journals Foreign Body Aspiration in Infants and Older Children: A Comparative Study

2019 ◽  
Vol 99 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Shorook Na’ara ◽  
Igor Vainer ◽  
Moran Amit ◽  
Arie Gordin
Keyword(s):  
Foreign Body ◽  
Medical Center ◽  
Age Groups ◽  
Signs And Symptoms ◽  
Foreign Body Aspiration ◽  
Preschool Age ◽  
Small Airways ◽  
Older Children ◽  
X Ray ◽  
Young Infants

Background: Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. We compared FBA in infants to FBA in older children. Methods: Retrospective analysis of all the cases of suspected FBA of children under the age of 18 years hospitalized at one medical center during 2002 to 2016. We analyzed the data according to age: up to 1 year (infants) and 1 to 18 years. Results: One hundred seventy-five children with suspected FBA were admitted; of whom, 27 (15%) were infants and 148 (85%) were older children (age 1-18 years). For the 2 age groups, adults witnessed 85% and 73%, respectively, of the incidents ( P = .4). In the neonate group, 48% presented with normal X-ray findings compared to only 20% in the older group; 15% of the older group had a positive chest X-ray for a foreign body, while none had such in the infants’ group ( P = .01). For the 2 age groups, the majority of the FBs found were from organic origin. About half of the patients were diagnosed and managed within 24 hours of the aspiration event. In 10%, repeated bronchoscopy was performed due to a retained FB remnant. In a multivariate analysis, signs and symptoms ( P < .05), location of the FB ( P < .001), and witnessed aspiration ( P < .001) were independent prognostic factors for the length of hospitalization. Conclusion: Foreign body aspiration is not uncommon in young infants; the management is challenging due to small airways, the need to use smaller bronchoscopes, and the lack of working channel forces in pediatric bronchoscopes.

scholarly journals The CXCR5 T follicular helper cell compartment in children with antibody deficiencies – in search of a prognostic marker of childhood hypogammaglobulinemia

2021 ◽  
Vol 49 (2) ◽  
pp. 113-121
Author(s):  
Aleksandra Szczawinska-Poplonyk ◽  
Katarzyna Tapolska-Jozwiak ◽  
Husam Samara ◽  
Maciej Boruczkowski ◽  
Barbara Wieckowska
Keyword(s):  
Prognostic Marker ◽  
Age Groups ◽  
Flow Cytometric Analysis ◽  
Affinity Maturation ◽  
Older Children ◽  
Cell Compartment ◽  
Humoral Immune ◽  
Tfh Cells ◽  
Follicular Helper ◽  
Young Infants

Background: Novel immunodiagnostic markers are required in order to discriminate between mild hypogammaglobulinemia and severe humoral primary immune deficiencies in children. The efficacy of an antibody response to infections and vaccines is underpinned by T follicular helper (Tfh) cells, activating an immunoglobulin class switch recombination, somatic hyper-mutations, and affinity maturation. Objective: To determine the formation of the Tfh cells in antibody deficient children and to define their importance as prognostic markers helpful in defining the severity of hypogammaglobulinemia. Methods: We retrospectively reviewed medical records of 200 children aged from 2 months to 10 years, in whom hypogammaglobulinemia was assessed, from January to December 2019. In all the children studied, a flow cytometric analysis of the Tfh cell compartment was performed. Results: In young infants aged from 2 to 9 months, the mean relative frequency of the Tfh population was lower than in the control population. Concomitantly, the relative values of Tfh cells, corresponding with the 95th percentile, were below the reference values in all age groups. Conclusions: A deficiency of Tfh cells in young infants mirrors the immaturity of the humoral immune response, whereas in older children Tfh cells are proposed as a prognostic marker facilitating to distinguish between mild hypogammaglobulinemia and the developing common variable immunodeficiency.

scholarly journals Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Maria Cristina Basile ◽  
Tommaso Mauri ◽  
Elena Spinelli ◽  
Francesca Dalla Corte ◽  
Giacomo Montanari ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Respiratory Rate ◽  
Regional Distribution ◽  
High Flow ◽  
Physiological Study ◽  
Positive Pressure ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Flow Rates ◽  
Arterial Blood

Abstract Background Nasal high flow delivered at flow rates higher than 60 L/min in patients with acute hypoxemic respiratory failure might be associated with improved physiological effects. However, poor comfort might limit feasibility of its clinical use. Methods We performed a prospective randomized cross-over physiological study on 12 ICU patients with acute hypoxemic respiratory failure. Patients underwent three steps at the following gas flow: 0.5 L/kg PBW/min, 1 L/kg PBW/min, and 1.5 L/kg PBW/min in random order for 20 min. Temperature and FiO2 remained unchanged. Toward the end of each phase, we collected arterial blood gases, lung volumes, and regional distribution of ventilation assessed by electrical impedance tomography (EIT), and comfort. Results In five patients, the etiology was pulmonary; infective disease characterized seven patients; median PaO2/FiO2 at enrollment was 213 [IQR 136–232]. The range of flow rate during NHF 1.5 was 75–120 L/min. PaO2/FiO2 increased with flow, albeit non significantly (p = 0.064), PaCO2 and arterial pH remained stable (p = 0.108 and p = 0.105). Respiratory rate decreased at higher flow rates (p = 0.014). Inhomogeneity of ventilation decreased significantly at higher flows (p = 0.004) and lung volume at end-expiration significantly increased (p = 0.007), but mostly in the non-dependent regions. Comfort was significantly poorer during the step performed at the highest flow (p < 0.001). Conclusions NHF delivered at rates higher than 60 L/min in critically ill patients with acute hypoxemic respiratory failure is associated with reduced respiratory rate, increased lung homogeneity, and additional positive pressure effect, but also with worse comfort.

scholarly journals A low-cost, rapidly scalable, emergency use ventilator for the COVID-19 crisis

2020 ◽  
Author(s):  
Samuel J Raymond ◽  
Trevor Wesolowski ◽  
Sam Baker ◽  
Yuzhe Liu ◽  
Jordan L Edmunds ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
World View ◽  
Low Cost ◽  
Cost Effective ◽  
Positive Pressure ◽  
Animal Testing ◽  
Mechanical Ventilators ◽  
Novel Approach ◽  
Animal Data ◽  
Safety And Reliability

For the past 50 years, positive pressure ventilation has been a cornerstone of treatment for respiratory failure. Consensus surrounding the epidemiology of respiratory failure has permitted a relatively good fit between the supply of ventilators and the demand. However, the current COVID-19 pandemic has increased demand for mechanical ventilators well beyond supply. Respiratory failure complicates most critically ill patients with COVID-19 and is characterized by highly heterogeneous pulmonary parenchymal involvement, profound hypoxemia and pulmonary vascular injury. The profound increase in the incidence of respiratory failure has exposed critical shortages in the supply of mechanical ventilators, and those with the necessary skills to treat. While most traditional ventilators rely on an internal compressor and mixer to moderate and control the gas mixture delivered to a patient, the current emergency climate has catalyzed alternative designs that might enable greater flexibility in terms of supply chain, manufacturing, storage and maintenance. Design considerations of these 'emergency response' ventilators have generally fallen into two categories: those that rely on mechanical compression of a known volume of gas and those powered by an internal compressor to deliver time cycled pressure- or volume-limited gas to the patient. The present work introduces a low-cost, ventilator designed and built in accordance with the Emergence Use guidance provided by the US Food and Drug Administration (FDA) wherein an external gas supply feeds into the ventilator and time limited flow interruption guarantees tidal volume. The goal of this device is to allow a patient to be treated by a single ventilator platform, capable of supporting the various treatment paradigms during a potential COVID-19 related hospitalization. This is a unique aspect of this design as it attempts to become a one-device-one-visit solution to the problem. The device is designed as a single use ventilator that is sufficiently robust to treat a patient being mechanically ventilated. The overall design philosophy and its applicability in this new crisis-laden world view is first described, followed by both bench top and animal testing results used to confirm the precision, capability, safety and reliability of this low cost and novel approach to mechanical ventilation during the COVID-19 pandemic. The ventilator is shown to perform in a range of critical requirements listed in the FDA emergency regulations and can safely and effectively ventilate a porcine subject. As of August 2020, only 13 emergency ventilators have been authorized by the FDA, and this work represents the first to publish animal data using the ventilator. This proof-of-concept provides support for this cost-effective, readily mass-produced ventilator that can be used to support patients when the demand for ventilators outstrips supply in hospital settings worldwide. More details for this project can be found at https://ventilator.stanford.edu/

RTS,S/AS01, a vaccine targeting pre-erythrocytic stages of Plasmodium falciparum

2017 ◽  
Vol 1 (6) ◽  
pp. 533-537
Author(s):  
Lorenz von Seidlein ◽  
Borimas Hanboonkunupakarn ◽  
Podjanee Jittmala ◽  
Sasithon Pukrittayakamee
Keyword(s):  
Protective Efficacy ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
Phase Iii ◽  
European Medicines Agency ◽  
Older Children ◽  
Pivotal Phase ◽  
Malaria Epidemiology ◽  
Maximum Benefit ◽  
Sub Saharan

RTS,S/AS01 is the most advanced vaccine to prevent malaria. It is safe and moderately effective. A large pivotal phase III trial in over 15 000 young children in sub-Saharan Africa completed in 2014 showed that the vaccine could protect around one-third of children (aged 5–17 months) and one-fourth of infants (aged 6–12 weeks) from uncomplicated falciparum malaria. The European Medicines Agency approved licensing and programmatic roll-out of the RTSS vaccine in malaria endemic countries in sub-Saharan Africa. WHO is planning further studies in a large Malaria Vaccine Implementation Programme, in more than 400 000 young African children. With the changing malaria epidemiology in Africa resulting in older children at risk, alternative modes of employment are under evaluation, for example the use of RTS,S/AS01 in older children as part of seasonal malaria prophylaxis. Another strategy is combining mass drug administrations with mass vaccine campaigns for all age groups in regional malaria elimination campaigns. A phase II trial is ongoing to evaluate the safety and immunogenicity of the RTSS in combination with antimalarial drugs in Thailand. Such novel approaches aim to extract the maximum benefit from the well-documented, short-lasting protective efficacy of RTS,S/AS01.

scholarly journals Validation of a point-of-care rapid diagnostic test for hepatitis C for use in resource-limited settings

2019 ◽  
Vol 11 (4) ◽  
pp. 314-315
Author(s):  
James S Leathers ◽  
Maria Belen Pisano ◽  
Viviana Re ◽  
Gertine van Oord ◽  
Amir Sultan ◽  
...  
Keyword(s):  
Point Of Care ◽  
Low Cost ◽  
Rapid Diagnosis ◽  
Direct Acting Antivirals ◽  
Resource Limited Settings ◽  
Rapid Diagnosis Test ◽  
Resource Limited ◽  
Specificity And Sensitivity ◽  
Hcv Screening ◽  
Direct Acting

Abstract Background Treatment of HCV with direct-acting antivirals has enabled the discussion of HCV eradication worldwide. Envisioning this aim requires implementation of mass screening in resource-limited areas, usually constrained by testing costs. Methods We validated a low-cost, rapid diagnosis test (RDT) for HCV in three different continents in 141 individuals. Results The HCV RDT showed 100% specificity and sensitivity across different samples regardless of genotype or viral load (in samples with such information, 90%). Conclusions The HCV test validated in this study can allow for HCV screening in areas of need when properly used.

Real time fall detection using infrared cameras and reflective tapes under day/night luminance

2021 ◽  
pp. 1-16
Author(s):  
E. Ramanujam ◽  
S. Padmavathi
Keyword(s):  
Low Cost ◽  
Age Groups ◽  
Orientation Angle ◽  
Fall Detection ◽  
Living Environment ◽  
Vision Systems ◽  
Ir Camera ◽  
Cluttered Environments ◽  
Infrared Cameras ◽  
Time Fall

Falls are the leading cause of injuries and death in elderly individuals who live alone at home. The core service of assistive living technology is to monitor elders’ activities through wearable devices, ambient sensors, and vision systems. Vision systems are among the best solutions, as their implementation and maintenance costs are the lowest. However, current vision systems are limited in their ability to handle cluttered environments, occlusion, illumination changes throughout the day, and monitoring without illumination. To overcome these issues, this paper proposes a 24/7 monitoring system for elders that uses retroreflective tape fabricated as part of conventional clothing, monitored through low-cost infrared (IR) cameras fixed in the living environment. IR camera records video even when there are changes in illumination or zero luminance. For classification among clutter and occlusion, the tape is considered as a blob instead of a human silhouette; the orientation angle, fitted through ellipse modeling, of the blob in each frame allows classification that detects falls without pretrained data. System performance was tested using subjects in various age groups and “fall” or “non-fall” were detected with 99.01% accuracy.

scholarly journals Diagnostic Capabilities of a Smartphone- Based Low-Cost Microscope

2020 ◽  
Vol 6 (3) ◽  
pp. 522-525
Author(s):  
Dorina Hasselbeck ◽  
Max B. Schäfer ◽  
Kent W. Stewart ◽  
Peter P. Pott
Keyword(s):  
Low Cost ◽  
Field Of View ◽  
Parasitic Diseases ◽  
Optical Parameters ◽  
Trade Off ◽  
Resource Limited ◽  
Wide Range ◽  
Diagnostic Applications ◽  
Diagnostic Capabilities

AbstractMicroscopy enables fast and effective diagnostics. However, in resource-limited regions microscopy is not accessible to everyone. Smartphone-based low-cost microscopes could be a powerful tool for diagnostic and educational purposes. In this paper, the imaging quality of a smartphone-based microscope with four different optical parameters is presented and a systematic overview of the resulting diagnostic applications is given. With the chosen configuration, aiming for a reasonable trade-off, an average resolution of 1.23 μm and a field of view of 1.12 mm2 was achieved. This enables a wide range of diagnostic applications such as the diagnosis of Malaria and other parasitic diseases.

scholarly journals Evaluation of a Humidified Nasal High-Flow Oxygen System, Using Oxygraphy, Capnography and Measurement of Upper Airway Pressures

2011 ◽  
Vol 39 (6) ◽  
pp. 1103-1110 ◽  
Author(s):  
J. E. Ritchie ◽  
A. B. Williams ◽  
C. Gerard ◽  
H. Hockey
Keyword(s):  
Healthy Volunteers ◽  
Airway Pressure ◽  
Gas Flow ◽  
Air Entrainment ◽  
High Flow ◽  
Positive Pressure ◽  
Mean Airway Pressure ◽  
Flow Rates ◽  
Oxygen Fraction ◽  
Airway Pressures

In this study, we evaluated the performance of a humidified nasal high-flow system (Optiflow™, Fisher and Paykel Healthcare) by measuring delivered FiO2 and airway pressures. Oxygraphy, capnography and measurement of airway pressures were performed through a hypopharyngeal catheter in healthy volunteers receiving Optiflow™ humidified nasal high flow therapy at rest and with exercise. The study was conducted in a non-clinical experimental setting. Ten healthy volunteers completed the study after giving informed written consent. Participants received a delivered oxygen fraction of 0.60 with gas flow rates of 10, 20, 30, 40 and 50 l/minute in random order. FiO2, FEO2, FECO2 and airway pressures were measured. Calculation of FiO2 from FEO2 and FECO2 was later performed. Calculated FiO2 approached 0.60 as gas flow rates increased above 30 l/minute during nose breathing at rest. High peak inspiratory flow rates with exercise were associated with increased air entrainment. Hypopharyngeal pressure increased with increasing delivered gas flow rate. At 50 l/minute the system delivered a mean airway pressure of up to 7.1 cmH2O. We believe that the high gas flow rates delivered by this system enable an accurate inspired oxygen fraction to be delivered. The positive mean airway pressure created by the high flow increases the efficacy of this system and may serve as a bridge to formal positive pressure systems.

scholarly journals Incidence of childhood injuries and modifiable household risk factors in rural Ghana: a multistage, cluster-randomised, population-based, household survey

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e039243
Author(s):  
Adam Gyedu ◽  
Barclay T Stewart ◽  
Easmon Otupiri ◽  
Kajal Mehta ◽  
Peter Donkor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factor ◽  
Age Groups ◽  
Secondary Outcome ◽  
Older Children ◽  
Multilevel Regression ◽  
Sampling Weights ◽  
Effective Prevention ◽  
Childhood Injuries ◽  
Rural Ghana

ObjectiveWe aimed to describe the incidence of childhood household injuries and prevalence of modifiable household risk factors in rural Ghana to inform prevention initiatives.Setting357 randomly selected households in rural Ghana.ParticipantsCaregivers of children aged <5 years.Primary and secondary outcome measuresChildhood injuries that occurred within 6 months and 200 metres of the home that resulted in missed school/work, hospitalisation and/or death. Sampling weights were applied, injuries were described and multilevel regression was used to identify risk factors.ResultsCaregivers from 357 households had a mean age of 35 years (SD 12.8) and often supervised ≥2 children (51%). Households typically used biomass fuels (84%) on a cookstove outside the home (79%). Cookstoves were commonly <1 metre of the ground (95%). Weighted incidence of childhood injury was 542 per 1000 child-years. Falls (37%), lacerations (24%), burns (12%) and violence (12%) were common mechanisms. There were differences in mechanism across age groups (p<0.01), but no gender differences (p=0.25). Presence of older children in the home (OR 0.15, 95% CI 0.09 to 0.24; adjusted OR (aOR) 0.26, 95% CI 0.13 to 0.54) and cooking outside the home (OR 0.28, 95% CI 0.19 to 0.42; aOR 0.25, 95% CI 0.13 to 0.49) were protective against injury, but other common modifiable risk factors (eg, stove height, fuel type, secured cabinets) were not.ConclusionsChildhood injuries occurred frequently in rural Ghana. Several common modifiable household risk factors were not associated with an increase in household injuries. Presence of older children was a protective factor, suggesting that efforts to improve supervision of younger children might be effective prevention strategies.

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