A rare case of persistent air leak: beware of all the tubes

Background Patients with acute respiratory failure, impaired consciousness, and impaired airway reflexes will require invasive mechanical ventilation. Monitoring of such patients is important. The use of ventilator scalars and loops help in monitoring, diagnosing the abnormality, and treating the patients effectively. We report a rare cause one should suspect in a case of persistent and fixed air leak in a patient requiring mechanical ventilation. Case presentation We describe a 28-year-old young patient requiring ventilator support due to neuromuscular weakness. His neuromuscular weakness was rapidly progressing involving the respiratory muscles. The patient was intubated and put on mechanical ventilator support. He was transferred from another health care center to our hospital. On evaluation, the patient was intubated with ETT no 8. The patient had persistent air leak as observed on the ventilator graphics. We checked for ETT cuff malfunction, ventilator circuit, catheter mount, and HME for any disconnection causing the leak. The air leak which we observed in our patient was due to the malpositioned Ryle’s tube. Conclusions Vigilant monitoring of patients requiring mechanical ventilation is necessary. For the evaluation of the cause of air leak, algorithmic approach will help in correctly identifying the abnormality.

Design of a Ventilation Control System in Underground Mines and Tunnels

Abstract— Today no one is free of accidents, especially in high-risk work environments such as in-mine and/or tunnel work. It is quite common that in this type of high-risk activities and where evacuation accesses are distant from the area of operations, the response time plays an important role in the event of a dangerous event, which can materialize in an accident if necessary. you do not act quickly. Having a realtime ventilation monitoring and control system helps us as a tool to prevent a possible risk event. This control system, by constantly monitoring the ventilation inside the tunnel or inside the mine, can send us an alert to a web server that can be monitored through a computer and/or a smartphone that is on the surface when there is a lack of air, when the temperature rises considerably and the humidity begins to rise or the air flow is minimal then the system will activate an alert to the different monitoring or control devices. Additionally, this prototype contributes to saving energy because it will automate the switching on of the fans only in the presence of people in the work area. This prototype thus achieves real-time supervision and allows us to make the best decision when faced with an event that endangers human life in the workplace. Keywords—Temperature; esp-32; Arduino; air sensor, mine, ventilation, work safe

Validation of a new wearable device for type 3 sleep test without flowmeter

Background Ventilation monitoring during sleep is performed by sleep test instrumentation that is uncomfortable for the patients due to the presence of the flowmeter. The objective of this study was to evaluate if an innovative type 3 wearable system, the X10X and X10Y, is able to correctly detect events of apnea and hypopnea and to classify the severity of sleep apnea without the use of a flowmeter. Methods 40 patients with sleep disordered breathing were analyzed by continuous and simultaneous recording of X10X and X10Y and another certified type 3 system, SOMNOtouch, used for comparison. Evaluation was performed in terms of quality of respiratory signals (scores from 1, lowest, to 5, highest), duration and classification of apneas, as well as identification and duration of hypopneas. Results 580 periods were evaluated. Mean quality assigned score was 3.37±1.42 and 3.25±1.35 for X10X and X10Y and SOMNOtouch, respectively. The agreement between the two systems was evaluated with grades 4 and 5 in 383 out of 580 cases. A high correlation (r2 = 0.921; p<0.001) was found between the AHI indexes obtained from the two systems. X10X and X10Y devices were able to correctly classify 72.3% of the obstructive apneas, 81% of the central apneas, 61.3% of the hypopneas, and 64.6% of the mixed apneas when compared to SOMNOtouch device. Conclusion The X10X and X10Y devices are able to provide a correct grading of sleep respiratory disorders without the need of a nasal cannula for respiratory flow measurement and can be considered as a type 3 sleep test device for screening tests.

Comparison of the Full Outline of Unresponsiveness (FOUR) Score with the Glasgow Coma Scale (GCS) as a Coma Assessment Scale in Pediatric Intensive Care

Rapid assessment of cerebral dysfunction is crucial for the management of patients in intensive care units. The Glasgow Coma Scale (GCS) evaluates eye, verbal, and motor responses, but is insufficient to effectively evaluate patients on mechanical ventilation, or who are unable to speak. The Full Outline of Unresponsiveness (FOUR) score includes additional information such as brainstem reflexes and respiratory status to provide a more complete clinical assessment. In this study, we aimed to compare the FOUR score with GCS in the assessment of patients with coma. This prospective study included patients between 1 month and under 18 years of age, who were hospitalized in the pediatric intensive care unit due to risk of coma or ongoing impairment of consciousness between May 2018 and June 2019. Information regarding FOUR scores, GCS values, patient demographics, duration of hospitalization, requirement for mechanical ventilation, and patient comorbidities were recorded and analyzed. Among the 80 patients included in the study, a statistically significant correlation was found between (low) GCS and FOUR scores during admission, and mortality and requirement for mechanical ventilation. Monitoring the level of consciousness is important in pediatric intensive care units and may be predictive of the course and disease outcome. Similar to the GCS, the FOUR score is a good indicator for predicting mortality and requirement for mechanical ventilation.

A Study on Industrial IoT for the Mining Industry: Synthesized Architecture and Open Research Directions

The Industrial Internet of Things (IIoT) has the potential to improve the production and business processes by enabling the extraction of valuable information from industrial processes. The mining industry, however, is rather traditional and somewhat slow to change due to infrastructural limitations in communication, data management, storage, and exchange of information. Most research efforts so far on applying IIoT in the mining industry focus on specific concerns such as ventilation monitoring, accident analysis, fleet and personnel management, tailing dam monitoring, and pre-alarm system while an overall IIoT architecture suitable for the general conditions in the mining industry is still missing. This article analyzes the current state of Information Technology in the mining sector and identifies a major challenge of vertical fragmentation due to the technological variety of various systems and devices offered by different vendors, preventing interoperability, data distribution, and the exchange of information securely between devices and systems. Based on guidelines and practices from the major IIoT standards, a high-level IIoT architecture suitable for the mining industry is then synthesized and presented, addressing the identified challenges and enabling smart mines by automation, interoperable systems, data distribution, and real-time visibility of the mining status. Remote controlling, data processing, and interoperability techniques of the architecture evolve all stages of mining from prospecting to reclamation. The adoption of such IIoT architecture in the mining industry offers safer mine site for workers, predictable mining operations, interoperable environment for both traditional and modern systems and devices, automation to reduce human intervention, and enables underground surveillance by converging operational technology (OT) and information technology (IT). Significant open research challenges and directions are also studied and identified in this paper, such as mobility management, scalability, virtualization at the IIoT edge, and digital twins.

Listeria monocytogenes meningoencephalitis in a patient with Systemic Lupus Erythematosus

Introduction: Infectious complications are common in systemic lupus erythematosus. Although uncommon, central nervous system infections do occur and have significant lethality, with several etiological agents. Methods: We report on the case of a 29-year-old woman recently diagnosed with systemic lupus erythematosus with hematological, cutaneous, serous and renal manifestations (class IV lupus nephritis), who underwent corticosteroid pulse therapy and mycophenolate induction therapy. After 3 months of evolution, she developed headache and altered mental status. Computed tomography showed an area of hypoattenuation in the left frontal white matter and her cerebrospinal fluid examination showed pleocytosis and hyperproteinorrhachia. Peripheral blood and CSF culture identified Listeria monocytogenes. The patient presented deterioration of her neurological status, requiring invasive mechanical ventilation, monitoring of intracranial pressure and, despite all the intensive support, persisted in a comatose state and developed multiple organ failure, evolving to death due to nosocomial bloodstream infection. Discussion: Infection from L. monocytogenes usually occurs after eating contaminated food, manifesting itself with diarrhea and, occasionally, invasively, such as neurolisteriosis. Further investigation with CSF analysis and MRI is necessary, and the diagnosis consists of isolating the bacteria in sterile body fluid. Conclusion: The case presents a patient whose diagnosis of meningoencephalitis became an important differential with neuropsychiatric disorder. The poor outcome reinforces the need to remember this infectious condition as a serious complication in the natural history of SLE.

EIT based intrathoracic pulsatile impedance measurements during apnea: a case study

Intrathoracic ventilation related and pulsatile (perfusion) impedance changes can be measured by the noninvasive and radiation-free imaging method Electrical Impedance Tomography (EIT). Ventilation monitoring is still the key research area in EIT, whereby perfusion monitoring gain more and more in interest. However, there are still many unknown influencing factors concerning pulsatile impedance measurements which have to be investigated. Hence, in this observational case study the impact of prolonged apnea periods on pulsatile impedance changes was examined in a patient with suspected brain death undergoing several apnea tests. In addition, the correlation between changes in pulsatile impedance and certain blood gas parameters (carbon dioxide partial pressure, pCO2; oxygen partial pressure, pO2; pH; bicarbonate, HCO3 -) were explored. Results show that the pulsatile impedance signal changes over time during apnea. An increase in the area under the curve (Mean AuC) and the maximum amplitude (Mean Max) of heart beat associated impedance signals was observed (Mean AuC: up to 65 %; Mean Max: up to 57 %). Furthermore, a positive correlation between the increase in impedance and pCO2and HCO3 - was assessed (both: up to 0.99), whereas pO2and pH show a negative correlation (both: up to -0.99). These preliminary results indicate that pulsatile EIT monitoring may be applied to get additional information regarding cardio-pulmonary interactions sustaining diagnosis or treatment of lung diseases.