Smart and Agile Turnaround Management

Oil&Gas facilities operators are looking for safe and efficient Turnaround cycles with minimum downtime. However planning such project, ensuring availability of materials, of equipment and of skilled personnel, as well as orchestrating the hundreds of processes and stakeholders involved in the execution to keep it on schedule and on budget is a huge and complex challenge. How to handle and take into account what is planned and what is unplanned? A Turnaround project can be managed with similar approach than an EPC (Engineering Procurement Construction) project. It should leverage collaborative best practices developed to handle capital projects. Those practices allow to plan more productively, to execute with agility while taking into account unplanned changes "on the fly" without affecting on-going activities. A digital collaborative platform enables integrated knowledge as well as real-time visibility into every aspect of the Turnaround. It provides seamless collaboration for productive planning and intelligent execution. This is a strategy, which eliminates unproductive tasks and brings stakeholders together in a dynamic, collaborative management system. With better orchestration, plant owners and operators can reduce their planning and preparation workload by around 30% with also positive impact on all subcontractors. With a better seamless execution, plant owners and operators can get things done right the first time and recover to unplanned events. They can reduce the risk to be out of schedule and keep on track with more margin. They can even reduce the execution time by up to 5% in some situation. Finally, it enforces the reuse of insights that are gathered along Turnarounds to improve safety and extend by 20% the cycle in future Turnaround. A 3D collaborative platform provides an easy to use single source of truth to manage and monitor a Turnaround. Using such 3D environment, one can quickly identify the location of an issue where potential bottlenecks occur, and get access to any relevant vendor's specification, inspection or maintenance history report. Such 3D platform can also help to easily track with color-coding the leak test results of the many joints and their potential disturbances after Turnaround inspection.

Anastomotic Troubleshooting

Anastomotic leak remains a critical and feared complication in colorectal surgery. The development of a leak can be catastrophic for a patient, resulting in overall increased morbidity and mortality. To help mitigate this risk, there are several ways to assess and potentially validate the integrity of a new anastomosis to give the patient the best chance of avoiding this postoperative complication. A majority of anastomoses will appear intact with no obvious sign of anastomotic dehiscence on gross examination. However, each anastomosis should be interrogated before the conclusion of an operation. The most common method to assess for an anastomotic leak is the air leak test (ALT). The ALT is a safe intraoperative method utilized to test the integrity of left-sided colon and rectal anastomoses and most importantly allows the ability to repair a failed test before concluding the operation. Additional troubleshooting is sometimes needed due to technical difficulties with the circular stapler. Problems, such as incomplete doughnuts and stapler misfiring, do occur and each surgeon should be prepared to address them.

A Digital Pressure Meter Equipped with Pressure Leak Detection

A manual sphygmomanometer is an instrument used to measure blood pressure, and consists of an inflatable cuff, a mercury manometer (or aneroid gauge) and an inflation ball and gauge. To assess the condition, accuracy and safety of mercury and anaeroid sphygmomanometers in use in general practice and to pilot a scheme for sphyg- momanometer maintenance within the district. Therefore, it must be calibrated periodically. Using the MPX 5050GP sensor as a positive pressure sensor. Requires a maximum pressure of 300 mmHg. This tool is also equipped with a SD Card as external storage. The display used in this module is TFT Nextion 2.8”. After conductings measurements of the three comparisons consisting of Multifunction, DPM and mercury tensimeter to 6 times, the smallest result 0 mmHg and the largest results 251.52 mmHg. While the error in mercury tensimeter’s of leak test to module and rigel is 0.56% and 0.404%.

Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

The cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.

Laryngeal air column width ratio in predicting postextubation stridor

Background Cuff leak test (CLT) has been used widely to assess upper airway patency before extubation but with low positive predictive value. Aim To assess the diagnostic accuracy of the airway column width ratio (ACWR) in predicting postextubation stridor (PES). Patients and methods 50 Patients who intubated &gt;24 hours were observed for postextubation stridor and reintubation. Laryngeal ultrasound was done to measure the ACW with ETT cuff deflated immediately after intubation and 3–4 h before extubation. Cuff leak test was done. Results Fifty patients were included with mean age 58 ± 14.71 years, 68% were males and 32% were females. PES developed in 8% of patients. There was highly statistically significant difference between both groups regarding ACW before extubation and ACW ratio (p-value =0.006 and 0.000 respectively). The mean ACW ratio in stridor group (0.79 ± 0.03) was significantly lower than in non-stridor group (0.94 ± 0.04). Reintubation was higher in stridor group (100%) than non-stridor group (23.9%), P = 0.001. There was statistically significant higher duration of mechanical ventilation in stridor group (7.50 ± 0.58 vs. 4.23 ± 2.50 days, P = 0.013). A cut off point of ACW ratio ≤0.81 has a sensitivity 100% and Specificity 100%. Conclusion ACW showed excellent utility in prediction of patients with PES. Air column width ratio of ≤ 0.81 was a good predictor of PES.

Evaluation of testing procedures for real-scale sewage pipes

Tests to determine the tightness of wastewater pipes can in some cases produce results that are worthy of discussion. Therefore, testing procedures for real-scale sewage pipes used for house connections were evaluated and data was statistically analyzed. The results of the investigation showed that leaky pipes are detected with a very high degree of reliability by all leak test methods. The test methods are also robust against errors by expert testers and deviations from the test specifications. In contrast, tight pipelines can also be incorrectly classified as ‘leaking’ (test failed) to a significant extent during leak tests. Even for the more reliable test methods, i.e. air overpressure, air underpressure and water with low test pressure, a tight pipe is incorrectly classified as leaking (false positive) in one out of ten cases (10%). The highest false positive rate was 20% for water with high test pressure. In addition to the leak test methods, the quality of the visual inspection was also analysed. Here it was found that visual inspection is not sufficiently reliable for determining the tightness of pipelines above the groundwater level. Error rates of approximately. 50% were found for the detection of tight and leaky pipelines.