Mouth-to-mouth ventilation through cardiopulmonary resuscitation, is there any other way?

Objective: to provide and explore possibility of new idea that perform mouth-to-mouth ventilation through cardiopulmonary resuscitation. Methods: stage one was establishing the ventilation technique using cola bottles, stage two was measuring the tidal volume when different sized cola bottles were used. Result: the smallest sized cola bottle (500 ml) could also make obvious thorax rise in manikin CPR model. The tidal volume was 174.5 ± 9.1 ml, 220 ± 7.6 ml and 447 ± 15.9 ml respectively for 500 ml, 600 ml and 1.25 L cola bottles when using single hand performance. There were statistical differences (0.001) in tidal volume of different sized cola bottle by using one hand performance and two hands. Conclusion: Larger sized cola bottles (600 ml, 1.25 L) could be used as substitute ventilation technique for mouth-to-mouth ventilation in special circumnutates.

Anatomic accuracy, physiologic characteristics, and fidelity of very low birth weight infant airway simulators

Background Medical simulation training requires realistic simulators with high fidelity. This prospective multi-center study investigated anatomic precision, physiologic characteristics, and fidelity of four commercially available very low birth weight infant simulators. Methods We measured airway angles and distances in the simulators Premature AirwayPaul (SIMCharacters), Premature Anne (Laerdal Medical), Premie HAL S2209 (Gaumard), and Preterm Baby (Lifecast Body Simulation) using computer tomography and compared these to human cadavers of premature stillbirths. The simulators’ physiologic characteristics were tested, and highly experienced experts rated their physical and functional fidelity. Results The airway angles corresponded to those of the reference cadavers in three simulators. The nasal inlet to glottis distance and the mouth aperture to glottis distance were only accurate in one simulator. All simulators had airway resistances up to 20 times higher and compliances up to 19 times lower than published reference values. Fifty-six highly experienced experts gave three simulators (Premature AirwayPaul: 5.1 ± 1.0, Premature Anne 4.9 ± 1.1, Preterm Baby 5.0 ± 1.0) good overall ratings and one simulator (Premie HAL S2209: 2.8 ± 1.0) an unfavorable rating. Conclusion The simulator physiology deviated significantly from preterm infants’ reference values concerning resistance and compliance, potentially promoting a wrong ventilation technique. Impact Very low birth weight infant simulators showed physiological properties far deviating from corresponding patient reference values. Only ventilation with very high peak pressure achieved tidal volumes in the simulators, as aimed at in very low birth weight infants, potentially promoting a wrong ventilation technique. Compared to very low birth weight infant cadavers, most tested simulators accurately reproduced the anatomic angular relationships, but their airway dimensions were relatively too large for the represented body. The more professional experience the experts had, the lower they rated the very low birth weight infant simulators.

Intermittent Abdominal Pressure Ventilation: An Alternative for Respiratory Support

Intermittent abdominal pressure ventilation is a positive pressure ventilation technique that works with abdominal compressions. It has been known since 1938; however, for many years, it was out of production. In recent years, a new device has been produced that has captured the attention to this old respiratory support technique. We considered eight patients with respiratory failure secondary to a neuromuscular disease (congenital myopathy, Duchenne dystrophy, and amyotrophic lateral sclerosis) intolerant to daytime noninvasive ventilation (NIV). IAPV was proposed as an alternative to NIV. We performed baseline and post-IAPV respiratory function assessment. All patients, two years later, are still using intermittent abdominal ventilation. Intermittent positive abdominal mechanical ventilation can be a valid alternative to noninvasive mechanical ventilation with a nasal or face mask. It improves gas exchange, symptoms, and quality of life, decreases the incidence of pneumonia, and can avert the need for intubation and tracheotomy.

mouth-to-mouth ventilation through cardiopulmonary resuscitation, is there any other way?

Abstractobjectiveto provide and explore possibility of new idea that perform mouth-to-mouth ventilation through cardiopulmonary resuscitation.Methodsstage one is establishing the ventilation technique using cola bottle, stage two is measuring the tidal volume when different sized cola bottles were used.Resultthe smallest sized cola bottle(500ml) can also make obvious thorax rise in manikin CPR model. The tidal volume is 174.5+9.1ml, 220+7.6ml and 447+15.9ml respectively for 500ml, 600ml and 1.25L cola bottles when using single hand performance. There are statistical differences (0.001) in tidal volume of different sized cola bottle by using one hand performance and two hands.Conclusionlarger sized cola bottles(600ml,1.25L) could be used as substitute ventilation technique for mouth-to-mouth ventilation in special circumnutates.

Implementation and feasibility of inverse-ratio Airway Pressure Release Ventilation (APRV): Switching from Conventional Ventilation to APRV in Two French ICUs.

Background:To evaluate the switching of patients mechanically ventilated on Pressure Support or Volume Control to inverse-ratio Airway Pressure Release Ventilation (APRV) during the COVID-19 pandemic.Methods:We performed a single-center retrospective observational analysis in two ICUs in a tertiary referral university teaching hospital in France. Were included patients with Covid-19 pneumonia requiring invasive ventilation with a PaO2:FiO2 ratio lower than 200 mmHg who performed a 6-hour trial of inverse-ratio APRV.Results:Seventeen consecutive patients who completed a 6-hour APRV trial in April 2020 were included. Three patients who were unable to be maintained on APRV due to an immediate fall in SpO2 were not included. In 12/17 patients (71%), the increase in PaO2:FiO2 ratio was greater than 20%. Mean (± standard deviation) PaO2:FiO2 ratio increased from 126 (± 28) mmHg to 178 (± 53) mmHg after 6 hours of APRV (p<0.001). Two patients presented a decrease in PaO2:FiO2 ratio after 6 hours of APRV. There was no appearance of significant hemodynamic impairment during APRV and an eventual increase in PaCO2 during the first hour of APRV was managed by increasing the respiratory rate (i.e. shortening T-high) and/or increasing tidal volume (i.e. increasing T-low).Conclusions:Switching from Conventional Ventilation (Pressure Support or Volume Assist Control) to inverse-ratio APRV for a 6-hour period in two ICUs that were not previously familiar with this ventilation technique was well tolerated, and associated with a marked improvement in oxygenation. Further studies evaluating inverse-ratio APRV in acute respiratory failure are warranted.Trial registration:NCT04386369

Investigation of the natural ventilation of wind catchers with different geometries in arid region houses

The wind catcher or wind tower is a natural ventilation technique that has been employed in the Middle East region and still until nowadays. The present paper aims to study the effect of the one-sided position of a wind catcher device against the ventilated space or building geometry and its natural ventilation performance. Four models based on the traditional design of a one-sided wind catcher are studied and compared. The study is achieved under the climatic conditions of the South-west of Algeria (arid region). The obtained results showed that the front and Takhtabush’s models were able to create the maximum pressure difference (ΔP) between the windward and leeward of the tower-house system. Internal airflow velocities increased with the increase of wind speed in all studied models. For example, at Vwind = 2 m/s, the internal flow velocities were 1.7, 1.8, 1.3, and 2.5 m/s for model 1, 2, 3, and 4, respectively. However, at Vwind = 6 m/s, the internal flow velocities were 5.6, 5.5, 2.5, and 7 m/s for model 1, 2, 3, and 4, respectively. The higher internal airflow velocities are given by Takhtabush, traditional, front and middle tower models, respectively, with a reduction rate between the tower outlet and occupied space by 72, 42, 36, and 33% for the middle tower, Takhtabush, traditional tower, and the front model tower, respectively. This reduction is due to the due to internal flow resistance. The third part of the study investigates the effect of window (exist opening) position on the opposite wall. The upper, middle and lower window positions are studied and compared. The air stagnation or recirculation zone inside the ventilated space reduced from 55% with the lower window to 46% for the middle window and reached 35% for the upper window position. The Front and Takhtabush models for the one-sided wind catcher with an upper window position are highly recommended for the wind-driven natural ventilation in residential houses that are located in arid regions.

A Novel Multi-ventilation Technique to Split Ventilators

ABSTRACTBackgroundDespite efforts to initially contain Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2), it has spread worldwide and has strained international healthcare systems to the point where advanced respiratory resources and ventilators are depleted. This study aims to explore splitting ventilators, or “multi-ventilation,” as a viable alternative in these demanding times. We investigated whether individualized tidal volume and positive end expiratory pressure (PEEP) delivery is possible to lungs of different compliances that are being simultaneously ventilated from one anesthesia ventilator.MethodsWe performed a controlled experiment in an operating room environment without animal or human participants. Two “test lungs” were connected to distinct modified Y-pieces that were ventilated in parallel from a single anesthesia ventilator.ResultsVentilation can be manipulated to qualitatively deliver individually tailored tidal volumes in the setting of varying PEEP and compliance requirements in pressure control mode.ConclusionsSplitting ventilators, or “multi-ventilation,” is a viable alternative to acute ventilator shortage during a pandemic. Ventilators can be split for individualized tidal volume and positive end-expiratory pressure delivery in multiple subjects of differing compliances and demographics.