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Halpern, P. "(A176) Mechanical Ventilation in Disasters: “To Intubate or Not to Intubate – That is the Question!”." Prehospital and Disaster Medicine 26, S1 (May 2011): s49—s50. http://dx.doi.org/10.1017/s1049023x11001749.
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The provision of mechanical ventilatory support for large numbers of casualties in disasters is a complex, controversial issue. Some experts consider this modality unsuitable for large disasters and a waste of resources better devoted to eminently salvageable victims. However, the reality has usually been that rescue teams bring with them some ventilatory capability, even if only for perioperative support. Also, there are many instances when the environment, the existing and potential capacities, allow for significant numbers of victims to be saved by providing artificial ventilation, that would otherwise have likely died. It is therefore important to discuss the issue, with all its complexity, so that the disaster preparedness and relief community fully understands its implications and makes informed, locally relevant decisions before and after disasters strike. The purpose of this presentation is to describe the ethical dilemmas, the technical and clinical considerations for such an endeavor. Ethical considerations: providing the most care to the most victims is the dictum of disaster medical management. Lowered standards of care are accepted and often the norm. However, in many moderate and even major disasters, the ability exists to save lives that will certainly be lost otherwise, by providing intensive care including mechanical ventilatory support, or may be provided if the managers so determine. Is it then ethical, to allow certain victims to die when such support may be available? What is the cost-benefit ratio of such a decision? Who should receive this limited resource? The young and healthy? The very sick? The salvageable? The postoperative? For how long? Until the international team leaves? Types of ventilator-dependency in disasters: (1) Primary ventilatory failure, normal lungs, prolonged ventilator dependency, e.g. botulinum toxin; (2) Combined ventilatory and hypoxemic failure, short to medium-term ventilator dependency, e.g. Sarin gas intoxication; (3) Primary hypoxemic failure, parenchymal lung injury, prolonged ventilator dependency, e.g. Anthrax, mustard gas, ricin; (4) Perioperative and prophylactic ventilatory support, short term but unpredictable. Ventilator supply versus demand: (1) Insufficient ventilators for first few hours only, then supplies come in; (2) Insufficient ventilators for days, then national or international relief expected; (3) Insufficient ventilators and no expected supplies. Care environment: (1) ICU, minority of casualties; (2) General floors: inexperienced nursing, medical staff; (3) Insufficient monitoring devices; (4) Insufficient numbers and quality of respiratory therapists; (5) Commercial companies normally providing technical support understaffed. Basic requirements from the ventilators: allows spontaneous ventilation, incorporates some alarms (ideally disconnect and minute volume), made by a reputable and stable company (will be there when the disaster strikes), low cost, user friendly, long shelf life, quick activation from storage, low weight and volume, few spares, few or generic disposables, little and simple maintenance, independent of compressed oxygen (i.e. electric, multiple voltages, long-life battery). The system: Mechanical ventilation is a complete patient care unit comprising: Bed and space, Oxygen supply, Vacuum, Cardiorespiratory monitor, Mechanical ventilator, Nursing staff, Medical staff, Expert consultatory staff, Logistic and technical support staff. Potential mechanical ventilators: (1) BVM or bag-valve-tube; (2) Transport-type, pneumatic or electrical ventilators; (3) Intermediate capability pneumatic, electrical or electronic ventilators; (4) Full capability intensive care ventilators; (5) Single patient use ventilators.
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Srinivasan, Shriya S., Khalil B. Ramadi, Francesco Vicario, Declan Gwynne, Alison Hayward, David Lagier, Robert Langer, Joseph J. Frassica, Rebecca M. Baron, and Giovanni Traverso. "A rapidly deployable individualized system for augmenting ventilator capacity." Science Translational Medicine 12, no. 549 (May 18, 2020): eabb9401. http://dx.doi.org/10.1126/scitranslmed.abb9401.
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Strategies to split ventilators to support multiple patients requiring ventilatory support have been proposed and used in emergency cases in which shortages of ventilators cannot otherwise be remedied by production or procurement strategies. However, the current approaches to ventilator sharing lack the ability to individualize ventilation to each patient, measure pulmonary mechanics, and accommodate rebalancing of the airflow when one patient improves or deteriorates, posing safety concerns to patients. Potential cross-contamination, lack of alarms, insufficient monitoring, and inability to adapt to sudden changes in patient status have prevented widespread acceptance of ventilator sharing. We have developed an individualized system for augmenting ventilator efficacy (iSAVE) as a rapidly deployable platform that uses a single ventilator to simultaneously and more safely support two individuals. The iSAVE enables individual-specific volume and pressure control and the rebalancing of ventilation in response to improvement or deterioration in an individual’s respiratory status. The iSAVE incorporates mechanisms to measure pulmonary mechanics, mitigate cross-contamination and backflow, and accommodate sudden flow changes due to individual interdependencies within the respiratory circuit. We demonstrate these capacities through validation using closed- and open-circuit ventilators on linear test lungs. We show that the iSAVE can temporarily ventilate two pigs on one ventilator as efficaciously as each pig on its own ventilator. By leveraging off-the-shelf medical components, the iSAVE could rapidly expand the ventilation capacity of health care facilities during emergency situations such as pandemics.
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Yeshurun, Tamir, Yoav Bar David, Alon Herman, Stav Bar-Sheshet, Ronen Zilberman, Gil Bachar, Alexander Liberzon, and Gideon Segev. "A simulation of a medical ventilator with a realistic lungs model." F1000Research 9 (November 5, 2020): 1302. http://dx.doi.org/10.12688/f1000research.25873.1.
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Background: The outbreak of COVID-19 pandemic highlighted the necessity for accessible and affordable medical ventilators for healthcare providers. To meet this challenge, researchers and engineers world-wide have embarked on an effort to design simple medical ventilators that can be easily distributed. This study provides a simulation model of a simple one-sensor controlled, medical ventilator system including a realistic lungs model and the synchronization between a patient breathing and the ventilator. This model can assist in the design and optimization of these newly developed systems. Methods: The model simulates the ventilator system suggested and built by the “Manshema” team which employs a positive-pressure controlled system, with air and oxygen inputs from a hospital external gas supply. The model was constructed using Simscape™ (MathWorks®) and guidelines for building an equivalent model in OpenModelica software are suggested. The model implements an autonomously breathing, realistic lung model, and was calibrated against the ventilator prototype, accurately simulating the ventilator operation. Results: The model allows studying the expected gas flow and pressure in the patient’s lungs, testing various control schemes and their synchronization with the patient’s breathing. The model components, inputs, and outputs are described, an example for a simple, positive end expiratory pressure control mode is given, and the synchronization with healthy and ARDS patients is analyzed. Conclusions: We provide a simulator of a medical ventilation including realistic, autonomously breathing lungs model. The simulator allows testing different control schemes for the ventilator and its synchronization with a breathing patient. Implementation of this model may assist in efforts to develop simple and accessible medical ventilators to meet the global demand.
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Pollard, J. "We'll breathe again [medical ventilators]." Engineering & Technology 15, no. 5 (June 1, 2020): 60–63. http://dx.doi.org/10.1049/et.2020.0508.
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Pearce, Joshua M. "A review of open source ventilators for COVID-19 and future pandemics." F1000Research 9 (March 30, 2020): 218. http://dx.doi.org/10.12688/f1000research.22942.1.
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Coronavirus Disease 2019 (COVID-19) threatens to overwhelm our medical infrastructure at the regional level causing spikes in mortality rates because of shortages of critical equipment, like ventilators. Fortunately, with the recent development and widespread deployment of small-scale manufacturing technologies like RepRap-class 3-D printers and open source microcontrollers, mass distributed manufacturing of ventilators has the potential to overcome medical supply shortages. In this study, after providing a background on ventilators, the academic literature is reviewed to find the existing and already openly-published, vetted designs for ventilators systems. These articles are analyzed to determine if the designs are open source both in spirit (license) as well as practical details (e.g. possessing accessible design source files, bill of materials, assembly instructions, wiring diagrams, firmware and software as well as operation and calibration instructions). Next, the existing Internet and gray literature are reviewed for open source ventilator projects and designs. The results of this review found that the tested and peer-reviewed systems lacked complete documentation and the open systems that were documented were either at the very early stages of design (sometimes without even a prototype) and were essentially only basically tested (if at all). With the considerably larger motivation of an ongoing pandemic, it is assumed these projects will garner greater attention and resources to make significant progress to reach a functional and easily-replicated system. There is a large amount of future work needed to move open source ventilators up to the level considered scientific-grade equipment, and even further work needed to reach medical-grade hardware. Future work is needed to achieve the potential of this approach by developing policies, updating regulations, and securing funding mechanisms for the development and testing of open source ventilators for both the current COVID19 pandemic as well as for future pandemics and for everyday use in low-resource settings.
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Pearce, Joshua M. "A review of open source ventilators for COVID-19 and future pandemics." F1000Research 9 (April 30, 2020): 218. http://dx.doi.org/10.12688/f1000research.22942.2.
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Coronavirus Disease 2019 (COVID-19) threatens to overwhelm our medical infrastructure at the regional level causing spikes in mortality rates because of shortages of critical equipment, like ventilators. Fortunately, with the recent development and widespread deployment of small-scale manufacturing technologies like RepRap-class 3-D printers and open source microcontrollers, mass distributed manufacturing of ventilators has the potential to overcome medical supply shortages. In this study, after providing a background on ventilators, the academic literature is reviewed to find the existing and already openly-published, vetted designs for ventilators systems. These articles are analyzed to determine if the designs are open source both in spirit (license) as well as practical details (e.g. possessing accessible design source files, bill of materials, assembly instructions, wiring diagrams, firmware and software as well as operation and calibration instructions). Next, the existing Internet and gray literature are reviewed for open source ventilator projects and designs. The results of this review found that the tested and peer-reviewed systems lacked complete documentation and the open systems that were documented were either at the very early stages of design (sometimes without even a prototype) and were essentially only basically tested (if at all). With the considerably larger motivation of an ongoing pandemic, it is assumed these projects will garner greater attention and resources to make significant progress to reach a functional and easily-replicated system. There is a large amount of future work needed to move open source ventilators up to the level considered scientific-grade equipment, and even further work needed to reach medical-grade hardware. Future work is needed to achieve the potential of this approach by developing policies, updating regulations, and securing funding mechanisms for the development and testing of open source ventilators for both the current COVID19 pandemic as well as for future pandemics and for everyday use in low-resource settings.
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Lugones, Ignacio, Roberto Orofino Giambastiani, Oscar Robledo, Martín Marcos, Javier Mouly, Agustín Gallo, Verónica Laulhé, and María Fernanda Biancolini. "A New Medical Device to Provide Independent Ventilation to Two Subjects Using a Single Ventilator: Evaluation in Lung-Healthy Pigs." Anesthesiology Research and Practice 2020 (December 30, 2020): 1–6. http://dx.doi.org/10.1155/2020/8866806.
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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.
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Ishack, Stephanie, and Shari R. Lipner. "Use of 3D printing to support COVID-19 medical supply shortages: a review." Journal of 3D Printing in Medicine 5, no. 2 (June 2021): 83–95. http://dx.doi.org/10.2217/3dp-2020-0031.
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The novel coronavirus, COVID-19, created a pandemic with significant mortality and morbidity which poses challenges for patients and healthcare workers. The global spread of COVID-19 has resulted in shortages of personal protective equipment (PPE) leaving frontline health workers unprotected and overwhelming the healthcare system. 3D printing is well suited to address shortages of masks, face shields, testing kits and ventilators. In this article, we review 3D printing and suggest potential applications for creating PPE for healthcare workers treating COVID-19 patients. A comprehensive literature review was conducted using PubMed with keywords “Coronavirus disease 2019”, “COVID-19”, “severe acute respiratory syndrome coronavirus 2”, “SARS-CoV-2”, “supply shortages”, “N95 respirator masks”, “personal protective equipment”, “PPE”, “ventilators”, “three-dimensional model”, “three-dimensional printing” “3D printing” and “ventilator”. A summary of important studies relevant to the development of 3D-printed clinical applications for COVID-19 is presented. 3D technology has great potential to revolutionize healthcare through accessibility, affordably and personalization.
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Powell, Tia, Kelly C. Christ, and Guthrie S. Birkhead. "Allocation of Ventilators in a Public Health Disaster." Disaster Medicine and Public Health Preparedness 2, no. 1 (March 2008): 20–26. http://dx.doi.org/10.1097/dmp.0b013e3181620794.
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ABSTRACTBackground: In a public health emergency, many more patients could require mechanical ventilators than can be accommodated.Methods: To plan for such a crisis, the New York State Department of Health and the New York State Task Force on Life and the Law convened a workgroup to develop ethical and clinical guidelines for ventilator triage.Results: The workgroup crafted an ethical framework including the following components: duty to care, duty to steward resources, duty to plan, distributive justice, and transparency. Incorporating the ethical framework, the clinical guidelines propose both withholding and withdrawing ventilators from patients with the highest probability of mortality to benefit patients with the highest likelihood of survival. Triage scores derive from the sepsis-related organ failure assessment system, which assigns points based on function in 6 basic medical domains. Triage may not be implemented by a facility without clear permission from public health authorities.Conclusions: New York State released the draft guidelines for public comment, allowing for revision to reflect both community values and medical innovation. This ventilator triage system represents a radical shift from ordinary standards of care, and may serve as a model for allocating other scarce resources in disasters. (Disaster Med Public Health Preparedness. 2008;2:20–26)
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Choudhary, Abdul Hakim, Manisha K. Palaskar, Mohammad Kausar, Mahesh R., and D. K. Sharma. "Resource optimization through process re-engineering of inhalational therapy unit at a tertiary care public hospital." International Journal of Research in Medical Sciences 7, no. 12 (November 27, 2019): 4469. http://dx.doi.org/10.18203/2320-6012.ijrms20195502.
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Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment.
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Edriss, Hawa, Jeremy Whiting, and Kenneth Nugent. "The Frequency of White Blood Cell and Temperature Events During Mechanical Ventilation and Their Association With Ventilator-Associated Events." Journal of Intensive Care Medicine 32, no. 4 (September 15, 2015): 273–77. http://dx.doi.org/10.1177/0885066615605036.
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Background: Changes in white blood cell (WBC) counts and/or temperature could have important implications in patients on ventilators, but the frequency of these events is uncertain. Methods: We reviewed the medical records from 281 ventilation episodes in our medical intensive care unit to determine patient characteristics and the indications for ventilation. We determined the number of days during each ventilation episode in which the temperature (<96.8°F, >100.4°F) or WBC count (<4000/µL, >12 000/µL) was out of the normal range. Results: This study included 257 patients with a mean Acute Physiology and Chronic Health Evaluation 2 score of 13.5 ± 5.9 and a mean initial Pao2/Fio2 of 210 ± 110. The median number of ventilator days was 4 (interquartile range, 3-9). One hundred ninety-six of 275 eligible ventilator episodes (71.3%) had 1 or more temperature events, and 194 of 253 eligible ventilator episodes (76.7%) had 1 or more WBC events. Nineteen patients met the Center for Disease Control criteria for a ventilator-associated event (VAE). Twelve patients had an increased WBC count during the VAE period, and 11 had an increased temperature during this period. Conclusions: White blood cell counts and temperature events occur frequently in patients on ventilators and need evaluation but do not reliably identify patients with ventilator-associated complications.
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Austriaco, Nicanor Pier Giorgio. "To the Sickest or to the Healthiest?" National Catholic Bioethics Quarterly 20, no. 3 (2020): 455–62. http://dx.doi.org/10.5840/ncbq202020343.
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The COVID-19 pandemic has raised questions about the just allocation of limited medical resources. In this essay, I consider four pressing moral questions raised by the scarcity of mechanical ventilators, using the guiding principle that the primary criterion should be the conviction that each and every human being has equal moral status because each has an intrinsic dignity that makes him or her inestimable and inviolable. I propose that any legitimate criteria for ventilator allocation cannot discriminate among patient populations on the basis of any judgments that are not medically relevant. Instead, ventilators should be distributed solely on the basis of the likelihood that they will benefit patients and enable them to heal.
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Yuan, Yue Yang, Chong Chang Yang, and Pei Feng. "A System Controller Designed for Bi-PAP Noninvasive Ventilator with an ARM MCU." Advanced Materials Research 753-755 (August 2013): 2483–88. http://dx.doi.org/10.4028/www.scientific.net/amr.753-755.2483.
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Being aim at designing a system controller used in the Noninvasive Bidirectional Positive Airway Pressure Ventilation (N-Bi-PAPV) and advancing this medical device to serve the respiratory patients who suffer from the OSAHS, COPD and etc, by using an embed ARM Microcomputer LM3S9B92, the system controller including its circuit diagram and embed software was designed in accordance with the request of Bi-PAP medical ventilator. And the ventilators critical parameters were clearly defined and ranged for this system. After testing in a spontaneously breathing simulator, this system controller may be used to control the ventilator performing function well.
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Dahlgren, B. E., and H. G. Nilsson. "Compact Ventilators in Emergency Medicine." Journal of the World Association for Emergency and Disaster Medicine 3, no. 1 (1987): 31–32. http://dx.doi.org/10.1017/s1049023x00028673.
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An increasing amount of medical equipment is brought to the scene of a medical emergency. Most of these apparatus seem to be only slightly modified versions of equipment originally designed to be used inside the hospital. This equipment has to function in various extreme environmental conditions.
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Kremeier, P. "The COVID-19 Pandemic as a Stress Test – ensuring Individual Medical Respiratory Care: Aspects to Objectify the Discussion." Clinical Social Work and Health Intervention 12, no. 2 (June 30, 2021): 63–67. http://dx.doi.org/10.22359/cswhi_12_2_12.
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The COVID-19 pandemic confronts intensive care medicine with a new clinical picture, which is manifested in various forms and which clearly differs from the classic acute respiratory distress syndrome (ARDS). Ventilation therapy for COVID-19 pneumonia is complex and, contrary to previous guidelines for the treatment of acute respiratory failure, an increasing number of these patients do not primarily receive invasive ventilation. High-flow O2 therapy and non-invasive ventilation by mask or ventilation helmet have become key treatment options. In endeavours to provide respiratory care to all segments of the population whenever necessary, other therapeutic devices may be employed. The fact that milder cases of these diseases can also be treated with less expensive out-of-hospital ventilators and HFOT devices and that a full-fledged intensive care ventilator may not be imperative must be considered in the final decision. Nevertheless, answers to the triage and allocation of ventilators must be found in a discussion involving society as a whole and the health sciences in particular. The health sciences are called upon to contribute to the public debate on the distribution of all necessary resources during the pandemic.
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Blakeman, Thomas C., Dario Rodriquez, Warren C. Dorlac, Dennis J. Hanseman, Ellie Hattery, and Richard D. Branson. "Performance of Portable Ventilators for Mass-Casualty Care." Prehospital and Disaster Medicine 26, no. 5 (October 2011): 330–34. http://dx.doi.org/10.1017/s1049023x1100656x.
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AbstractIntroduction: Disasters and mass-casualty scenarios may overwhelm medical resources regardless of the level of preparation. Disaster response requires medical equipment, such as ventilators, that can be operated under adverse circumstances and should be able to provide respiratory support for a variety of patient populations.Objective: The objective of this study was to evaluate the performance of three portable ventilators designed to provide ventilatory support outside the hospital setting and in mass-casualty incidents, and their adherence to the Task Force for Mass Critical Care recommendations for mass-casualty care ventilators.Methods: Each device was evaluated at minimum and maximum respiratory rate and tidal volume settings to determine the accuracy of set versus delivered VT at lung compliance settings of 0.02, 0.08 and 0.1 L/cm H20 with corresponding resistance settings of 10, 25, and 5 cm H2O/L/sec, to simulate patients with ARDS, severe asthma, and normal lungs. Additionally, different FIO2 settings with each device (if applicable) were evaluated to determine accuracy of FIO2 delivery and evaluate the effect on delivered VT. Ventilators also were tested for duration of battery life.Results: VT decreased with all three devices as compliance decreased. The decrease was more pronounced when the internal compressor was activated. At the 0.65 FIO2 setting on the MCV 200, the measured FIO2 varied widely depending on the set VT. Battery life range was 311-582 minutes with the 73X having the longest battery life. Delivered VT decreased toward the end of battery life with the SAVe having the largest decrease. The respiratory rate on the SAVe also decreased approaching the end of battery life.Conclusion: The 73X and MCV 200 were the closest to satisfying the Task Force for Mass Critical Care requirements for mass casualty ventilators, although neither had the capability to provide PEEP. The 73X provided the most consistent tidal volume delivery across all compliances, had the longest battery duration and the least decline in VT at the end of battery life.
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VanKoevering, Kyle K., Pratyusha Yalamanchi, Catherine T. Haring, Anne G. Phillips, Stephen Lewis Harvey, Alvaro Rojas-Pena, David A. Zopf, and Glenn E. Green. "Delivery system can vary ventilatory parameters across multiple patients from a single source of mechanical ventilation." PLOS ONE 15, no. 12 (December 10, 2020): e0243601. http://dx.doi.org/10.1371/journal.pone.0243601.
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Background Current limitations in the supply of ventilators during the Covid19 pandemic have limited respiratory support for patients with respiratory failure. Split ventilation allows a single ventilator to be used for more than one patient but is not practicable due to requirements for matched patient settings, risks of cross-contamination, harmful interference between patients and the inability to individualize ventilator support parameters. We hypothesized that a system could be developed to circumvent these limitations. Methods and findings A novel delivery system was developed to allow individualized peak inspiratory pressure settings and PEEP using a pressure regulatory valve, developed de novo, and an inline PEEP ‘booster’. One-way valves, filters, monitoring ports and wye splitters were assembled in-line to complete the system and achieve the design targets. This system was then tested to see if previously described limitations could be addressed. The system was investigated in mechanical and animal trials (ultimately with a pig and sheep concurrently ventilated from the same ventilator). The system demonstrated the ability to provide ventilation across clinically relevant scenarios including circuit occlusion, unmatched physiology, and a surgical procedure, while allowing significantly different pressures to be safely delivered to each animal for individualized support. Conclusions In settings of limited ventilator availability, systems can be developed to allow increased delivery of ventilator support to patients. This enables more rapid deployment of ventilator capacity under constraints of time, space and financial cost. These systems can be smaller, lighter, more readily stored and more rapidly deployable than ventilators. However, optimizing ventilator support for patients with individualized ventilation parameters will still be dependent upon ease of use and the availability of medical personnel.
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Sha, Haiwang, and Fen He. "Analysis of the Effect of Emergency Ventilators on the Treatment of Critical Illness Based on Smart Medical Big Data." Journal of Healthcare Engineering 2021 (September 21, 2021): 1–10. http://dx.doi.org/10.1155/2021/7698769.
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Respiratory failure refers to pulmonary ventilation and ventilatory dysfunction caused by various reasons, which makes the patient unable to maintain the gas exchange required for stillness and causes a series of pathophysiological changes and corresponding clinical manifestations. In order to solve the problem of respiratory failure in critically ill patients, it is of great significance to analyze the role of microprocessor-based emergency ventilator in the treatment of critically ill patients. This article aims to study the role of microprocessor-based emergency ventilator in the treatment of critically ill patients. This paper presents the key technology based on the ARM11 processor. A breathing motion model is detected and established through a ventilator. The research objects are mainly divided into group A and group B. By comparing the two groups of emergency ventilator ventilation, it can effectively prevent the increase in respiratory muscle fatigue, reduce oxygen consumption, improve the patient's ventilation function and oxygen balance, quickly correct hypoxia and carbon dioxide storage, cooperate with drug treatment, and quickly take out the ventilator after relief. Good treatment results were achieved. The results show that the emergency ventilator controlled by a microcomputer is effective. The total effective rate of the control group was 71.11%, which was significantly lower than that of the observation group (86.67%).
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Ruef, C. "Bacterial contamination of ventilators." Journal of Hospital Infection 30, no. 4 (August 1995): 317–18. http://dx.doi.org/10.1016/0195-6701(95)90268-6.
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Alfaray, Ricky Indra, Muhammad Iqbal Mahfud, and Rafiqy Sa'adiy Faizun. "Duration Of Ventilation Support Usage And Development Of Ventilator-Associated Pneumonia: When Is The Most Time At Risk?" Indonesian Journal of Anesthesiology and Reanimation 1, no. 1 (July 30, 2019): 26. http://dx.doi.org/10.20473/ijar.v1i12019.26-31.
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Introduction: Ventilator-Associated pneumonia (VAP) is pneumonia that occurs in patients who have been mechanically ventilated for a duration of more than 48 hours. The duration of ventilator use was identified as a risk factor which is a trigger of VAP. Objective: This study aimed to determine the association between the duration of ventilator use and the incidence of VAP in patients in the Intensive Care Unit of Dr. Mohammad Hoesin General Hospital, Palembang. Method and Material: This study was an observational analytic study using a cross-sectional design. The samples were all patients who use a ventilator for more than 48 hours at the ICU room period of July 1, 2014, to June 30, 2015. Data were obtained from the patient’s medical records of a total of 146 patients, but the number of patients who comply with the criteria was 106 patients. Result and Discussion: Out of the 106 samples, 41 patients (38.7%) developed VAP and 65 patients (61.3%) did not develop VAP. The analysis using Chi-Square test showed that patients who used ventilator for >5 days had an OR = 3.273 compared to patients using ventilator 2-5 days (p-value = 0.016; 95% CI = 1.223 to 8.754). Conclusion: There is a significant association between the duration of ventilator use and the incidence of VAP in patients at the ICU of Dr. Mohammad Hoesin General Hospital, Palembang. Patients using ventilators for more than 5 days 3,386 times more at risk of developing VAP compared to patients using ventilators 2-5 days. The riskiest time for the patient using ventilator was more than 5 days of usage. And, the mortality rate of VAP patients was 63.4% from 41 patients while the mortality rate of whole ICU patients was 50.9%.
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Guérin, Claude, Martin Cour, Neven Stevic, Florian Degivry, Erwan L’Her, Bruno Louis, and Laurent Argaud. "Simultaneous ventilation in the Covid-19 pandemic. A bench study." PLOS ONE 16, no. 1 (January 19, 2021): e0245578. http://dx.doi.org/10.1371/journal.pone.0245578.
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COVID-19 pandemic sets the healthcare system to a shortage of ventilators. We aimed at assessing tidal volume (VT) delivery and air recirculation during expiration when one ventilator is divided into 2 test-lungs. The study was performed in a research laboratory in a medical ICU of a University hospital. An ICU (V500) and a lower-level ventilator (Elisée 350) were attached to two test-lungs (QuickLung) through a dedicated flow-splitter. A 50 mL/cmH2O Compliance (C) and 5 cmH2O/L/s Resistance (R) were set in both A and B test-lungs (A C50R5 / B C50R5, step1), A C50-R20 / B C20-R20 (step 2), A C20-R20 / B C10-R20 (step 3), and A C50-R20 / B C20-R5 (step 4). Each ventilator was set in volume and pressure control mode to deliver 800mL VT. We assessed VT from a pneumotachograph placed immediately before each lung, pendelluft air, and expiratory resistance (circuit and valve). Values are median (1st-3rd quartiles) and compared between ventilators by non-parametric tests. Between Elisée 350 and V500 in volume control VT in A/B test- lungs were 381/387 vs. 412/433 mL in step 1, 501/270 vs. 492/370 mL in step 2, 509/237 vs. 496/332 mL in step 3, and 496/281 vs. 480/329 mL in step 4. In pressure control the corresponding values were 373/336 vs. 430/414 mL, 416/185 vs. 322/234 mL, 193/108 vs. 176/ 92 mL and 422/201 vs. 481/329mL, respectively (P<0.001 between ventilators at each step for each volume). Pendelluft air volume ranged between 0.7 to 37.8 ml and negatively correlated with expiratory resistance in steps 2 and 3. The lower-level ventilator performed closely to the ICU ventilator. In the clinical setting, these findings suggest that, due to dependence of VT to C, pressure control should be preferred to maintain adequate VT at least in one patient when C and/or R changes abruptly and monitoring of VT should be done carefully. Increasing expiratory resistance should reduce pendelluft volume.
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Motta, Daniel, Luiz Fernando Taboada Gomes Amaral, Bruno Caetano dos Santos Silva, Lucas de Freitas Gomes, Willams Teles Barbosa, Rodrigo Santiago Coelho, and Bruna Aparecida Souza Machado. "Collaborative and Structured Network for Maintenance of Mechanical Ventilators during the SARS-CoV-2 Pandemic." Healthcare 9, no. 6 (June 18, 2021): 754. http://dx.doi.org/10.3390/healthcare9060754.
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The SARS-CoV-2 pandemic in Brazil has grown rapidly since the first case was reported on 26 February 2020. As the pandemic has spread, the low availability of medical equipment has increased, especially mechanical ventilators. The Brazilian Unified Health System (SUS) claimed to have only 40,508 mechanical ventilators, which would be insufficient to support the Brazilian population at the pandemic peak. This lack of ventilators, especially in public hospitals, required quick, assertive, and effective actions to minimize the health crisis. This work provides an overview of the rapid deployment of a network for maintaining disused mechanical ventilators in public and private healthcare units in some regions of Brazil during the SARS-CoV-2 pandemic. Data referring to the processes of maintaining equipment, acquiring parts, and conducting national and international training were collected and analyzed. In total, 4047 ventilators were received by the maintenance sites, and 2516 ventilators were successfully repaired and returned to the healthcare units, which represents a success rate of 62.17%. The results show that the maintenance initiative directly impacted the availability and reliability of the equipment, allowing access to ventilators in the public and private health system and increasing the capacity of beds during the pandemic.
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Malik, Ali Ahmad, Tariq Masood, and Rehana Kousar. "Repurposing factories with robotics in the face of COVID-19: Movie 1." Science Robotics 5, no. 43 (June 17, 2020): eabc2782. http://dx.doi.org/10.1126/scirobotics.abc2782.
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Lugones, Ignacio, Matías Ramos, María Fernanda Biancolini, and Roberto Orofino Giambastiani. "Combined Ventilation of Two Subjects with a Single Mechanical Ventilator Using a New Medical Device: An In Vitro Study." Anesthesiology Research and Practice 2021 (February 18, 2021): 1–7. http://dx.doi.org/10.1155/2021/6691591.
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Introduction. The SARS-CoV-2 pandemic has created a sudden lack of ventilators. DuplicARⓇ is a novel device that allows simultaneous and independent ventilation of two subjects with a single ventilator. The aims of this study are (a) to determine the efficacy of DuplicARⓇ to independently regulate the peak and positive-end expiratory pressures in each subject, both under pressure-controlled ventilation and volume-controlled ventilation and (b) to determine the ventilation mode in which DuplicARⓇ presents the best performance and safety. Materials and Methods. Two test lungs are connected to a single ventilator using DuplicARⓇ. Three experimental stages are established: (1) two identical subjects, (2) two subjects with the same weight but different lung compliance, and (3) two subjects with different weights and lung compliances. In each stage, the test lungs are ventilated in two ventilation modes. The positive-end expiratory pressure requirements are increased successively in one of the subjects. The goal is to achieve a tidal volume of 7 ml/kg for each subject in all different stages through manipulation of the ventilator and the DuplicARⓇ controllers. Results. DuplicARⓇ allows adequate ventilation of two subjects with different weights and/or lung compliances and/or PEEP requirements. This is achieved by adjusting the total tidal volume for both subjects (in volume-controlled ventilation) or the highest peak pressure needed (in pressure-controlled ventilation) along with the basal positive-end expiratory pressure on the ventilator and simultaneously manipulating the DuplicARⓇ controllers to decrease the tidal volume or the peak pressure in the subject that needs less and/or to increase the positive-end expiratory pressure in the subject that needs more. While ventilatory goals can be achieved in any of the ventilation modes, DuplicARⓇ performs better in pressure-controlled ventilation, as changes experienced in the variables of one subject do not modify the other one. Conclusions. DuplicARⓇ is an effective tool to manage the peak inspiratory pressure and the positive-end expiratory pressure independently in two subjects connected to a single ventilator. The driving pressure can be adjusted to meet the requirements of subjects with different weights and lung compliances. Pressure-controlled ventilation has advantages over volume-controlled ventilation and is therefore the recommended ventilation mode.
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Pacholczyk, Tadeusz. "An Alternative Perspective on Rationing Ventilators." Ethics & Medics 45, no. 7 (2020): 5–6. http://dx.doi.org/10.5840/em20204576.
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The COVID-19 pandemic has resulted in discussion on how to allocate scarce medical resources such as ventilators. Some bioethicists have suggested that difficult determinations about withholding or withdrawing treatment should be made by triage officers or committees to alleviate the psychological strain on frontline clinicians. However, this raises concerns about shifting important personal medical decisions away from physicians and their patients. According to the principle of subsidiarity, frontline clinicians, together with their patients, should be making these decisions, with ethics committees or triage committees serving only in an advisory capacity. Several ethical principles can help health care professionals allocate scarce resources. These include basing exclusion criteria on clinical status rather than nonmedical characteristics; randomizing treatment for clinically similar patients; obtaining free and informed consent when considering the withdrawal of treatment, even in situations where treatment is possibly futile; and emphasizing quality palliative care for all patients.
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Bernards, A. T., H. I. J. Harinck, L. Dijkshoorn, T. J. K. van der Reijden, and P. J. van den Broek. "Persistent Acinetobacter baumannii? Look Inside Your Medical Equipment." Infection Control & Hospital Epidemiology 25, no. 11 (November 2004): 1002–4. http://dx.doi.org/10.1086/502335.
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AbstractTwo outbreaks of multidrug-resistant Acinetobacter baumannii occurred in our hospital. The outbreak strains were eventually isolated from respiratory ventilators, an apparatus used to cool or warm patients, and four continuous veno-venous hemofiltration machines. Removing dust from the machines and replacing all dust filters brought the outbreaks to an end.
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Sumpena, Sumpena, Yuma Akbar, Nirat Nirat, and Mario Hengky. "ICU Patient Prediction for Moving with Decision Tree C4.5 and Naïve Bayes Algorithm." SinkrOn 4, no. 1 (September 29, 2019): 88. http://dx.doi.org/10.33395/sinkron.v4i1.10150.
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Critical patients need intensive care and supervision by the medical team in the Intensive Care Unit (ICU), including ventilators, monitors, Central Venous Pressure (CVP), Electrocardiogram (ECG), Echocardiogram (ECHO), medical supply, and medical information that is fast, precise, and accurate. In the ICU treatment room requires data that needs to be processed and analyzed for decision making. This study analyzed the ventilator, CVP and also Sepsis Diagnosis related to the data of moving patients and patients dying. This study also uses the decision tree algorithm C.45 and Naive Bayes to determine the level of accuracy of patient care and supervision information in the ICU. The results showed that the decision tree algorithm C.45 has an accuracy of 81.55% and Naive Bayes of 81.54%. The decision tree C.45 algorithm has almost the same advantages as the Naive Bayes algorithm.
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Vivas Fernández, Francisco José, José Sánchez Segovia, Ismael Martel Bravo, Carlos García Ramos, Daniel Ruiz Castilla, José Gamero López, and José Manuel Andújar Márquez. "ResUHUrge: A Low Cost and Fully Functional Ventilator Indicated for Application in COVID-19 Patients." Sensors 20, no. 23 (November 27, 2020): 6774. http://dx.doi.org/10.3390/s20236774.
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Although the cure for the SARS-CoV-2 virus (COVID-19) will come in the form of pharmaceutical solutions and/or a vaccine, one of the only ways to face it at present is to guarantee the best quality of health for patients, so that they can overcome the disease on their own. Therefore, and considering that COVID-19 generally causes damage to the respiratory system (in the form of lung infection), it is essential to ensure the best pulmonary ventilation for the patient. However, depending on the severity of the disease and the health condition of the patient, the situation can become critical when the patient has respiratory distress or becomes unable to breathe on his/her own. In that case, the ventilator becomes the lifeline of the patient. This device must keep patients stable until, on their own or with the help of medications, they manage to overcome the lung infection. However, with thousands or hundreds of thousands of infected patients, no country has enough ventilators. If this situation has become critical in the Global North, it has turned disastrous in developing countries, where ventilators are even more scarce. This article shows the race against time of a multidisciplinary research team at the University of Huelva, UHU, southwest of Spain, to develop an inexpensive, multifunctional, and easy-to-manufacture ventilator, which has been named ResUHUrge. The device meets all medical requirements and is developed with open-source hardware and software.
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Nardi, Nicolas, Guillaume Mortamet, Laurence Ducharme-Crevier, Guillaume Emeriaud, and Philippe Jouvet. "Recent Advances in Pediatric Ventilatory Assistance." F1000Research 6 (March 17, 2017): 290. http://dx.doi.org/10.12688/f1000research.10408.1.
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In this review on respiratory assistance, we aim to discuss the following recent advances: the optimization and customization of mechanical ventilation, the use of high-frequency oscillatory ventilation, and the role of noninvasive ventilation. The prevention of ventilator-induced lung injury and diaphragmatic dysfunction is now a key aspect in the management of mechanical ventilation, since these complications may lead to higher mortality and prolonged length of stay in intensive care units. Different physiological measurements, such as esophageal pressure, electrical activity of the diaphragm, and volumetric capnography, may be useful objective tools to help guide ventilator assistance. Companies that design medical devices including ventilators and respiratory monitoring platforms play a key role in knowledge application. The creation of a ventilation consortium that includes companies, clinicians, researchers, and stakeholders could be a solution to promote much-needed device development and knowledge implementation.
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Rao, Shivaram, Nitin Bhat, Adarsha Gopadi Krishna Bhat, and H. Manjunatha Hande. "Incidence, determinants and outcomes of ventilator associated pneumonia in medical intensive care unit: a prospective cohort study from South Western India." International Journal of Research in Medical Sciences 9, no. 5 (April 28, 2021): 1306. http://dx.doi.org/10.18203/2320-6012.ijrms20211429.
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Background: Ventilators are being increasingly used in developing countries as a result of which complications like ventilator associated pneumonia is also increasing. Present study is being undertaken to evaluate the impact of risk factors and their changing trends for Ventilator associated pneumonia.Methods: A prospective observational study was conducted in mechanically ventilated patients of medical intensive care unit from October 2013 to April 2015.Results: In present study 166 patients receiving mechanical ventilation in a medical ICU were observed. Incidence of VAP in present study is 43.5 for 1000 days of mechanical ventilation. The risk factors that were significant in the study are organ failure (p=0.001), emergency intubation (p=0.001), reintubation (p=0.023) and COPD (p=0.026). The common organisms responsible for VAP were Acinetobacter (30%), Klebsiella pneumoniae (27.1%) and Pseudomonas aeruginosa (20%). The mortality was higher in VAP group (31.3%) compared to the non VAP group (15.7%).Conclusions: There is high incidence of VAP in the developing countries. The risk factors that were found to be associated with VAP in the present study were the presence of COPD, reintubation, organ failure and emergency intubation. VAP is associated with significantly increased duration of hospital stay, morbidity and mortality.
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Bhoyar, Ankit D. "Design Construction and Performance Test of a Low-Cost Pandemic Ventilator for Breathing Support." International Journal for Research in Applied Science and Engineering Technology 9, no. 8 (August 31, 2021): 2374–80. http://dx.doi.org/10.22214/ijraset.2021.37771.
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Abstract: Mass casualty incidents such as those that are being experienced during the novel coronavirus disease (COVID-19) pandemic can overwhelm local healthcare systems, where the number of casualties exceeds local resources and capabilities in a short period of time. The introduction of patients with worsening lung function as a result of COVID-19 has strained traditional ventilator supplies. Mechanical ventilator is a medical device which is usually utilized to ventilate patients who cannot breathe adequately on their own. Among many types of ventilators Bag Valve Mask (BVM) is a manual ventilator in which a bag is pressed to deliver air into the lungs of the patient. In present work, a mechanical system along with speed controller has been developed to automate the operation of BVM. The constructed prototype contains crank, powered by servo motor, supported by wooden frame. To bridge the gap during ventilator shortages and to help clinicians triage patients, manual resuscitator devices can be used to deliver respirations to a patient requiring breathing support. With principal dimensions of 0.54*0.64 m2 , bvm weighs 0.9 kg and DC power convertor for supplying power for a continuous operation, the prototype can be moved easily. The dimensions of the frame are selected as such to be compatible with the physical dimension of Ambu bag. The performance of the device was tested using Airflow meter which illustrates that the Tidal Volume vs. Time graph of the automated system is similar to the graph produced by manual operation of the BVM, but with a mean deviation of 0.182 Litres with manual operation and 0.1 Litres with prototype. For patients who require ventilatory support, manual ventilation is a vital procedure. It has to be performed by experienced healthcare providers that are regularly trained for the use of bag-valve-mask (BVM) in emergency situations. Keywords: Mechanical Ventilator, Automated BVM, BPM, COVID-19, Ventilator design, Airflow meter
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Yamada, Yoshitsugu, and Hong-Lin Du. "Analysis of the mechanisms of expiratory asynchrony in pressure support ventilation: a mathematical approach." Journal of Applied Physiology 88, no. 6 (June 1, 2000): 2143–50. http://dx.doi.org/10.1152/jappl.2000.88.6.2143.
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A mathematical model was developed to analyze the mechanisms of expiratory asynchrony during pressure support ventilation (PSV). Solving the model revealed several results. 1) Ratio of the flow at the end of patient neural inspiration to peak inspiratory flow (V˙ti/V˙peak) during PSV is determined by the ratio of time constant of the respiratory system (τ) to patient neural inspiratory time (Ti) and the ratio of the set pressure support (Pps) level to maximal inspiratory muscle pressure (Pmus max). 2)V˙ti/V˙peakis affected more by τ/Ti than by Pps/Pmus max.V˙ti/V˙peakincreases in a sigmoidal relationship to τ/Ti. An increase in Pps/Pmus max slightly shifts theV˙ti/V˙peak-τ/Ticurve to the right, i.e.,V˙ti/V˙peakbecomes lower as Pps/Pmus max increases at the same τ/Ti. 3) Under the selected adult respiratory mechanics,V˙ti/V˙peakranges from 1 to 85% and has an excellent linear correlation with τ/Ti. 4) In mechanical ventilators, single fixed levels of the flow termination criterion will always have chances of both synchronized termination and asynchronized termination, depending on patient mechanics. An increase in τ/Ti causes more delayed and less premature termination opportunities. An increase in Pps/Pmus max narrows the synchronized zone, making inspiratory termination predisposed to be in asynchrony. Increasing the expiratory trigger sensitivity of a ventilator shifts the synchronized zone to the right, causing less delayed and more premature termination. Automation of expiratory trigger sensitivity in future mechanical ventilators may also be possible. In conclusion, our model provides a useful tool to analyze the mechanisms of expiratory asynchrony in PSV.
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Cawley, Michael J. "Mechanical Ventilation." Journal of Pharmacy Practice 24, no. 1 (November 30, 2010): 7–16. http://dx.doi.org/10.1177/0897190010388145.
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Mechanical ventilation is a common therapeutic modality required for the management of patients unable to maintain adequate intrinsic ventilation and oxygenation. Mechanical ventilators can be found within various hospital and nonhospital environments (ie, nursing homes, skilled nursing facilities, and patient’s home residence), but these devices generally require the skill of a multidisciplinary health care team to optimize therapeutic outcomes. Unfortunately, pharmacists have been excluded in the discussion of mechanical ventilation since this therapeutic modality may be perceived as irrelevant to drug utilization and the usual scope of practice of a hospital pharmacist. However, the pharmacist provides a crucial role as a member of the multidisciplinary team in the management of the mechanically ventilated patient by verifying accuracy of prescribed medications, providing recommendations of alternative drug selections, monitoring for drug and disease interactions, assisting in the development of institutional weaning protocols, and providing quality assessment of drug utilization. Pharmacists may be intimidated by the introduction of advanced ventilator microprocessor technology, but understanding and integrating ventilator management with the pharmacotherapeutic needs of the patient will ultimately help the pharmacist be a better qualified and respected practitioner. The goal of this article is to assist the pharmacy practitioner with a better understanding of mechanical ventilation and to apply this information to improve delivery of pharmaceutical care.
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Yuan, Yue Yang, Chong Chang Yang, and Zhi Xin Cao. "The Technology of Ventilator Airflow Control." Applied Mechanics and Materials 385-386 (August 2013): 484–87. http://dx.doi.org/10.4028/www.scientific.net/amm.385-386.484.
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Aiming at improving and optimizing the ventilators performance and by reviewing the whole procession for design and research of a modern medical mechanical ventilator, many things about its ventilation control are taken into being considered toward the perspective of machine system in this paper. They are included those building the respiratory system model, getting its parameters and the technique of ventilation control, etc. Their essential mechanism, related key technologies and the working principle of each sub-system are described in detail. And a control-experimentation for realizing the ventilation in a test plat is also given out. And a continuous positive airway pressure (CPAP) control mode realized in this experiment shown the technologies of airflow control are considered well in our design.
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Poursoltan, Lily, Seyed-Mohammad Seyed-Hosseini, and Armin Jabbarzadeh. "Green Closed-Loop Supply Chain Network under the COVID-19 Pandemic." Sustainability 13, no. 16 (August 21, 2021): 9407. http://dx.doi.org/10.3390/su13169407.
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The closed-loop supply chain considers conceptually the possibility of reverse logistics with the use of recycling, remanufacturing and disposal centers. This study contributes for the first time a green closed-loop supply chain framework for the ventilators, which are highly important in the case of the COVID-19 pandemic. The proposed model simulates a case study of Iranian medical ventilator production. The proposed model includes environmental sustainability to limit the carbon emissions as a constraint. A novel stochastic optimization model with strategic and tactical decision making is presented for this closed-loop supply chain network design problem. To make the proposed ventilator logistics network design more realistic, most of the parameters are considered to be uncertain, along with the normal probability distribution. Finally, to show the managerial dimensions under the COVID-19 pandemic for our proposed model, some sensitivity analyses are performed. Results confirm the high impact of carbon emissions and demand variations on the optimal solution in the case of COVID-19.
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Alyazji, Qasem Anwar, and Gulsum Asiksoy. "Evaluating Mechanical Ventilators Using Multi Criteria Decision Making Techniques." International Journal of Online and Biomedical Engineering (iJOE) 17, no. 07 (July 2, 2021): 4. http://dx.doi.org/10.3991/ijoe.v17i07.21769.
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Mechanical ventilator (MV) is used to help the patient breathe by delivering gas to the lungs at a certain rate using positive pressure. The complex evaluation of mechanical ventilator devices at present time is a very important and topical issue, due to the presence of many mechanical ventilator companies, as it seems that the process of evaluation and selection of ventilator equipment needs strong experience in this field. Our paper show that multi criteria decision making (MCDM) methods can be applied to comparing and evaluating some alternatives of mechanical ventilator devices. This study will determine new methodology to help the decision makers to choosing the best mechanical ventilator among the five alternatives based on eight criteria; Cost of the MV device; Maximum Inspiratory flow; Maximum Pressure; Tidal volume; PEEP; Weight of ventilator; Screen size and Internal battery time. This study used two techniques; TOPSIS technique and PROMETHEE II technique. Our paper used the same weights criteria in these two techniques. The weight for each criteria should be determined by the medical engineer expert and the decision makers. Choosing mechanical ventilator will affect the quality of the therapeutic and diagnostic processes, the way the treating doctor works, and also affect the patient's comfort. Because of these reasons, we designed a new methodology based on MCDM. This study will be an important basis for choosing the best mechanical ventilator, and will assist decision-makers such as medical engineers, ICU doctors, and users to evaluating and choosing the best ventilator based on several criteria.
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Le Mense, Gregory P., and Steven A. Sahn. "Safety and Value of Thoracentesis in Medical ICU Patients." Journal of Intensive Care Medicine 13, no. 3 (May 1998): 144–48. http://dx.doi.org/10.1177/088506669801300306.
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The objective of this study was to determine the safety and value of thoracentesis in an ICU, Thoracentesis is a safe procedure for critically ill patients, even those on mechanical ventilators, and usually confirms the suspected diagnosis. However, thoracentesis revealed an unexpected diagnosis that changed management in 12% of patients. Repeat or contralateral thoracentesis is indicated when either the clinical course is inconsistent or may represent a complication of the original diagnosis.
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Jain, Gaurav. "Rationing of Medical Supplies, Including Ventilators, for Patients With Kidney Disease." Mayo Clinic Proceedings 95, no. 7 (July 2020): 1550–51. http://dx.doi.org/10.1016/j.mayocp.2020.04.029.
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Hamahata, Natsumi, Ryota Sato, Kimiyo Yamasaki, Sophie Pereira, and Ehab Daoud. "Estimating actual inspiratory muscle pressure from airway occlusion pressure at 100 msec." Journal of Mechanical Ventilation 1, no. 1 (September 1, 2020): 8–13. http://dx.doi.org/10.53097/jmv.10003.
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Background: Quantification of the patient’s respiratory effort during mechanical ventilation is very important, and calculating the actual muscle pressure (Pmus) during mechanical ventilation is a cumbersome task and usually requires an esophageal balloon manometry. Airway occlusion pressure at 100 milliseconds (P0.1) can easily be obtained non-invasively. There has been no study investigating the association between Pmus and P0.1. Therefore, we aimed to investigate whether P0.1 correlates to Pmus and can be used to estimate actual Pmus Materials and Methods: A bench study using lung simulator (ASL 5000) to simulate an active breathing patient with Pmus from 1 to 30 cmH2O by increments of 1 was conducted. Twenty active breaths were measured in each Pmus. The clinical scenario was constructed as a normal lung with a fixed setting of compliances of 60 mL/cmH2O and resistances of 10 cmH2O/l/sec. All experiments were conducted using the pressure support ventilation mode (PSV) on a Hamilton-G5 ventilator (Hamilton Medical AG, Switzerland), Puritan Bennett 840TM (Covidien-Nellcor, CA) and Avea (CareFusion, CA). Main results: There was significant correlation between P 0.1 and Pmus (correlation coefficient = - 0.992, 95% CI: - 0.995 to -0.988, P-value<0.001). The equation was calculated as follows: Pmus = -2.99 x (P0.1) + 0.53 Conclusion: Estimation of Pmus using P 0.1 as a substitute is feasible, available, and reliable. Estimation of Pmus has multiple implications, especially in weaning of mechanical ventilation, adjusting ventilator support, and calculating respiratory mechanics during invasive mechanical ventilation. Keywords: P 0.1, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure Keywords: P 0.1, P mus, Inspiratory occlusion pressure, WOB, Esophageal balloon, mechanical ventilators, respiratory failure
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Alfieri, Nancy, Karam Ramotar, Pamela Armstrong, Mary E. Spornitz, Glenda Ross, James Winnick, and D. Roy Cook. "Two Consecutive Outbreaks ofStenotrophomonas Maltophilia (Xanthomonas Maltophilia)in an Intensive-care Unit Defined by Restriction Fragment-Length Polymorphism Typing." Infection Control & Hospital Epidemiology 20, no. 8 (August 1999): 553–56. http://dx.doi.org/10.1086/501668.
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AbstractObjective:To investigate and control consecutive outbreaks ofStenotrophomonas maltophiliainfections in intensive-care–unit (ICU) patients.Design:Epidemiological investigation; restriction fragment-length polymorphism typing by pulsed-field gel electrophoresis (PFGE) of genomic DNA of outbreak strains; institution of infection control measures to limit spread.Setting:The medical-surgical ICU in an 800-bed tertiary-care center in Calgary, Alberta, Canada.Results:S maltophiliawas recovered from 14 ICU patients (12 infected, 2 colonized) between February 1993 and February 1994. Ten of the 14 patient isolates and 1 environmental isolate were available for PFGE typing. Patient isolates from 6 of the first 10 patients were identical. Isolates from the next 3 of 4 patients and an isolate recovered from a ventilator being used by a patient not infected withS maltophiliaalso were identical, but different from the first 6. The ventilator isolate was temporally associated with the latter 4 patients.Conclusion:Molecular typing allowed us to determine that there were two separate consecutiveS maltophiliaoutbreaks rather than a single protracted outbreak. Recovery ofS maltophiliafrom patient ventilators and an in-line suction catheter suggests that the organism may have been spread by cross-contamination from contaminated equipment or from an environmental source.
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Daoud, Ehab, Jewelyn Cabigan, Gary Kaneshiro, and Kimiyo Yamasaki. "Split-ventilation for more than one patient, can it be done? Yes." Journal of Mechanical Ventilation 1, no. 1 (September 1, 2020): 1–7. http://dx.doi.org/10.53097/jmv.10002.
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Background: The COVID-19 pandemic crisis has led to an international shortage of mechanical ventilation. Due to this shortfall, the surge of increasing number of patients to limited resources of mechanical ventilators has reinvigorated the interest in the concept of split ventilation or co-ventilation (ventilating more than one patient with the same ventilator). However, major medical societies have condemned the concept in a joint statement for multiple reasons. Materials and Methods: In this paper, we will describe the history of the concept, what is trending in the literature about it and along our modification to ventilate two patients with one ventilator. We will describe how to overcome such concerns regarding cross contamination, re-breathing, safely adjusting the settings for tidal volume and positive end expiratory pressure to each patient and how to safely monitor each patient. Main results: Our experimental setup shows that we can safely ventilate two patients using one ventilator. Conclusion: The concept of ventilating more than one patient with a single ventilator is feasible especially in crisis situations. However, we caution that it has to be done under careful monitoring with expertise in mechanical ventilation. More research and investment are crucially needed in this current pandemic crisis.
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Wheatley, Denise, and Krystal Young. "Adaptive Support Ventilation (ASV). Beneficial or not?" Journal of Mechanical Ventilation 2, no. 1 (March 1, 2021): 34–44. http://dx.doi.org/10.53097/jmv.10026.
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Ventilators functions and features have evolved with the advancement of technology along with the addition of microprocessors. It is important to understand and examine the benefits and risks associated with these advanced automated modes. Adaptive Support Ventilation (ASV) is a mode that is unique to the Hamilton Medical ventilators, thereby limiting the number of clinicians who have experience with using this mode. ASV can make changes to respiratory rate and tidal volume and adjusting the driving pressure in the absence of a professional. ASV changes ventilator strategies when it detects changes to a patient’s lung dynamics. The scope of ASV mode is not universally understood. Respiratory therapists may feel their position would be threatened with the use of smart automated modes. This paper will aim to review the literature on the ASV mode of ventilation. The literature review will address the following research questions to broaden the understanding of the risks and benefits of the ASV mode. 1) Is the ASV mode effective for weaning patients? 2) Is ASV a safe mode of ventilation for patients with COPD and ARDS? 3) Is ASV a safe mode of ventilation with changes in lung dynamics? 4) Does ASV impact the bedside respiratory therapist? Conclusions: ASV appears to be at least effective or even more superior to other modes especially during weaning off mechanical ventilation, and in other forms of respiratory failure. More studies in different clinical conditions and head-to-head with other modes. Keywords: ASV, COPD, ARDS, Weaning
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He, Zhong Hai, Yi Hao Du, and Zhao Xia Wu. "Generation of Respiratory Flow Having Fractal Signal Feature." Advanced Materials Research 366 (October 2011): 211–14. http://dx.doi.org/10.4028/www.scientific.net/amr.366.211.
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In this paper how to generate respiratory flow that has fractal signal feature is introduced. Physiological signal have fractal feature have been verified by many researchers, such as heart beat rate, interbreath interval. Mechanical ventilators are used to provide life support for patients with respiratory failure. But these machines can damage the lung, causing them to collapse. On the other hand, fractal feature can be used as an indication of health situation; as a result in patient simulation the physiological signal should also have fractal features. The fractal feature is generated by fractional Brownian motion simulation. The fractal dimension is decided by Hurst exponent in routine. The algorithm is realized by R language and result is input into LabVIEW which have friendly interface and easy for simulation control usage. The method can be used in design of mechanical ventilator and medical patient simulator.
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Hilbers, Ellen S. M., Claudette G. J. C. A. de Vries, and Robert E. Geertsma. "MEDICAL TECHNOLOGY AT HOME: SAFETY-RELATED ITEMS IN TECHNICAL DOCUMENTATION." International Journal of Technology Assessment in Health Care 29, no. 1 (January 2013): 20–26. http://dx.doi.org/10.1017/s0266462312000694.
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Objectives: This study aimed to investigate the technical documentation of manufacturers on issues of safe use of their device in a home setting.Methods: Three categories of equipment were selected: infusion pumps, ventilators, and dialysis systems. Risk analyses, instructions for use, labels, and post market surveillance procedures were requested from manufacturers. Additionally, they were asked to fill out a questionnaire on collection of field experience, on incidents, and training activities.Results: Specific risks of device operation by lay users in a home setting were incompletely addressed in the risk analyses. A substantial number of user manuals were designed for professionals, rather than for patients or lay carers. Risk analyses and user information often showed incomplete coherence. Post market surveillance was mainly based on passive collection of field experiences.Conclusions: Manufacturers of infusion pumps, ventilators, and dialysis systems pay insufficient attention to the specific risks of use by lay persons in home settings. It is expected that this conclusion is also applicable for other medical equipment for treatment at home. Manufacturers of medical equipment for home use should pay more attention to use errors, lay use and home-specific risks in design, risk analysis, and user information. Field experiences should be collected more actively. Coherence between risk analysis and user information should be improved. Notified bodies should address these aspects in their assessment. User manuals issued by institutions supervising a specific home therapy should be drawn up in consultation with the manufacturer.
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Kinnear, Benjamin, Matthew Kelleher, Andrew PJ Olson, Dana Sall, and Daniel J. Schumacher. "Developing Trust With Early Medical School Graduates During the COVID-19 Pandemic." Journal of Hospital Medicine 15, no. 6 (June 1, 2020): 367–69. http://dx.doi.org/10.12788/3463.
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The coronavirus disease of 2019 (COVID-19) pandemic has strained the healthcare system by rapidly depleting multiple resources including hospital space, medications, ventilators, personal protective equipment (PPE), clinical revenue, and morale. One of the most essential at-risk resources is healthcare providers. Healthcare providers have been overwhelmed as hospital systems have experienced local surges in COVID-19 patients. Compounding this is the fact that providers are more likely to contract COVID-19, which could sideline portions of an already taxed workforce.
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Otero, Pablo E., Lisa Tarragona, Andrea S. Zaccagnini, Natali Verdier, Martin R. Ceballos, Emiliano Gogniat, Juan M. Cabaleiro, et al. "Ventilator output splitting interface ‘ACRA’: Description and evaluation in lung simulators and in an experimental ARDS animal model." PLOS ONE 16, no. 8 (August 25, 2021): e0256469. http://dx.doi.org/10.1371/journal.pone.0256469.
Full textAbstract:
The current COVID-19 pandemic has led the world to an unprecedented global shortage of ventilators, and its sharing has been proposed as an alternative to meet the surge. This study outlines the performance of a preformed novel interface called ’ACRA’, designed to split ventilator outflow into two breathing systems. The ’ACRA’ interface was built using medical use approved components. It consists of four unidirectional valves, two adjustable flow-restrictor valves placed on the inspiratory limbs of each unit, and one adjustable PEEP valve placed on the expiratory limb of the unit that would require a greater PEEP. The interface was interposed between a ventilator and two lung units (phase I), two breathing simulators (phase II) and two live pigs with heterogeneous lung conditions (phase III). The interface and ventilator adjustments tested the ability to regulate individual pressures and the resulting tidal volumes. Data were analyzed using Friedman and Wilcoxon tests test (p < 0.05). Ventilator outflow splitting, independent pressure adjustments and individual tidal volume monitoring were feasible in all phases. In all experimental measurements, dual ventilation allowed for individual and tight adjustments of the pressure, and thus volume delivered to each paired lung unit without affecting the other unit’s ventilation—all the modifications performed on the ventilator equally affected both paired lung units. Although only suggested during a dire crisis, this experiment supports dual ventilation as an alternative worth to be considered.
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Pelc, Krzysztof. "Can COVID-Era Export Restrictions Be Deterred?" Canadian Journal of Political Science 53, no. 2 (June 2020): 349–56. http://dx.doi.org/10.1017/s0008423920000578.
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The COVID-19 pandemic has led some 75 countries to restrict their exports of hundreds of essential products, ranging from antibiotics and face masks to medical ventilators. Since banning exports decreases global supply and leads to price surges on world markets, the cost of these measures may ultimately be counted in human lives.
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Fennigkoh, Larry, and D. Courtney Nanney. "Data Mining CMMSs: How to Convert Data into Knowledge." Biomedical Instrumentation & Technology 52, s2 (June 1, 2018): 28–33. http://dx.doi.org/10.2345/0899-8205-52.s2.28.
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Although the healthcare technology management (HTM) community has decades of accumulated medical device–related maintenance data, little knowledge has been gleaned from these data. Finding and extracting such knowledge requires the use of the well-established, but admittedly somewhat foreign to HTM, application of inferential statistics. This article sought to provide a basic background on inferential statistics and describe a case study of their application, limitations, and proper interpretation. The research question associated with this case study involved examining the effects of ventilator preventive maintenance (PM) labor hours, age, and manufacturer on needed unscheduled corrective maintenance (CM) labor hours. The study sample included more than 21,000 combined PM inspections and CM work orders on 2,045 ventilators from 26 manufacturers during a five-year period (2012–16). A multiple regression analysis revealed that device age, manufacturer, and accumulated PM inspection labor hours all influenced the amount of CM labor significantly (P < 0.001). In essence, CM labor hours increased with increasing PM labor. However, and despite the statistical significance of these predictors, the regression analysis also indicated that ventilator age, manufacturer, and PM labor hours only explained approximately 16% of all variability in CM labor, with the remainder (84%) caused by other factors that were not included in the study. As such, the regression model obtained here is not suitable for predicting ventilator CM labor hours.
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許澤天, 許澤天. "誰能使用呼吸器？如何在醫療資源不足下進行分配的法律觀點." 月旦醫事法報告 58, no. 58 (August 2021): 113–25. http://dx.doi.org/10.53106/241553062021080058007.
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Barsky, Emily, and Sadath Sayeed. "Parental manual ventilation in resource-limited settings: an ethical controversy." Journal of Medical Ethics 46, no. 7 (May 6, 2020): 459–64. http://dx.doi.org/10.1136/medethics-2019-105992.
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Lower respiratory tract infections are a leading cause of paediatric morbidity and mortality worldwide. Children in low-income countries are disproportionately affected. This is in large part due to limitations in healthcare resources and medical technologies. Mechanical ventilation can be a life-saving therapy for many children with acute respiratory failure. The scarcity of functioning ventilators in low-income countries results in countless preventable deaths. Some hospitals have attempted to adapt to this scarcity by using hand-bag ventilation, as either a bridge to a mechanical ventilator, or until clinical improvement occurs rendering mechanical ventilation no longer necessary. In instances of hand-bag ventilation, an endotracheal tube is first placed. Family members are then asked to play the role of a ventilator, manually compressing a bag repeatedly to inflate the child’s lungs. This approach is fraught with numerous ethical challenges. A careful examination of the data and a nuanced approach to the ethical considerations are imperative. Ethical arguments in support of and in opposition to allowing parental hand-bag ventilation are explored, including the best interests of the child, the child’s right to an open future, beneficence and parental protection, legitimising substandard care, and finally, contextual concerns. An algorithmic, potentially ethically permissible approach to parental participation in manual ventilation is proposed.