Evolução Clínica e Fatores Prognósticos de Pacientes Oncológicos com Covid-19 em Ventilação Mecânica / Clinical Evolution and Prognostic Factors of Cancer Patients with COVID-19 in Mechanical Ventilation

Introdução: Pacientes com câncer apresentaram risco de desenvolver quadros respiratórios graves quando acometidos por covid-19, com necessidade de suporte intensivo e de ventilação mecânica invasiva (VMI). Objetivo: Avaliar os fatores associados ao óbito em pacientes oncológicos que tiveram covid-19 e evoluíram com insuficiência respiratória e necessidade de VMI. Método: Estudo de coorte retrospectivo de pacientes com câncer em uma unidade de terapia intensiva (UTI) oncológica, com covid-19 e em VMI de abril de 2020 a dezembro de 2021. Foram incluídos de forma sequencial todos os pacientes com câncer admitidos na UTI em VMI ou que evoluíram com VMI por agravamento da covid-19, sendo excluídos aqueles em controle da doença oncológica há mais de cinco anos. Para a análise estatística, foram utilizadas medidas de tendência central e dispersão, assim como frequências absolutas e relativas. A regressão logística múltipla foi aplicada para a avaliação dos fatores associados à mortalidade, considerando estatisticamente significantes valores de p < 0,05. Resultados: Foram incluídos no estudo 85 pacientes. O óbito foi maior entre os pacientes com tumores sólidos (OR = 3,64; IC 95%: 1,06-12,52; p = 0,04), entre os que necessitaram de suporte renal durante a internação na UTI (OR = 6,88; IC 95%: 1,82-25,98; p = 0,004), os que não puderam ser extubados (OR = 8,00; IC 95%: 2,16-29,67; p = 0,002) e os que apresentaram o valor de pressão de distensão alveolar maior do que 15cmH2O por pelo menos um dia (OR = 5,9; IC 95%: 1,76-19,80; p = 0,004). Conclusão: Características clínicas e de VMI estavam associadas à morte de pacientes oncológicos com covid-19 e em VMI.

Los pacientes con cáncer corrían riesgo de desarrollar afecciones respiratorias graves al ser afectados por la COVID-19, requiriendo soporte intensivo y ventilación mecánica invasiva (VMI). Objetivo: Evaluar los factores asociados a la muerte en pacientes con cáncer que tuvieron COVID-19 y que desarrollaron insuficiencia respiratoria y necesidad de VMI. Método: Estudio de cohorte retrospectivo en pacientes oncológicos internados en una unidad de cuidados intensivos (UCI) de oncología, con COVID-19 y en VMI de abril de 2020 a diciembre de 2021. Se incluyeron secuencialmente todos los pacientes con cáncer ingresados en UCI con VMI o que necesitaron VMI por empeoramiento de la COVID-19, excluyendo a aquellos que llevaban más de cinco años bajo control de la enfermedad oncológica. Para el análisis estadístico se utilizaron medidas de tendencia central y dispersión, así como frecuencias absolutas y relativas. Se aplicó regresión logística múltiple para evaluar los factores asociados a la mortalidad, considerando valores de p<0,05 estadísticamente significativos. Resultados: Se incluyeron en el estudio 85 pacientes. La muerte fue mayor entre los pacientes con tumores sólidos (OR= 3,64; IC 95%, 1,06-12,52; p=0,04), entre los que requirieron soporte renal durante la estancia en UCI (OR = 6,88; IC 95%, 1,82-25,98; p= 0,004), entre los que no pudieron ser extubados (OR= 8,00; IC 95%, 2,16-29,67; p= 0,002) y entre los que presentaron un valor de presión de distensión alveolar mayor a 15cmH2O durante al menos un día (OR = 5,9; IC 95%, 1,76-19,80; p=0,004). Conclusión: Las características clínicas y de VMI se asociaron con la muerte en pacientes oncológicos con COVID-19 y en VMI.

Cancer patients were at risk of developing severe respiratory conditions when affected by COVID-19, requiring intensive support and invasive mechanical ventilation (IMV). Objective: Evaluate the factors associated with death of cancer patients by COVID-19 who developed respiratory failure and need of IMV. Method: Retrospective cohort study of cancer patients in an oncology intensive care unit (ICU), with COVID-19 and on IMV was carried out from April 2020 to December 2021. All patients with cancer admitted to the ICU on IMV or who developed IMV due to worsening of COVID-19 were sequentially included, excluding those who had been in follow-up of the oncological disease for more than five years. For statistical analysis, measures of central tendency and dispersion were used, as well as absolute and relative frequencies. Multiple logistic regression was applied to evaluate factors associated with mortality, considering statistically significant values of p < 0.05. Results: 85 patients were included in the study. Death was higher for patients with solid tumors (OR= 3.64; 95% CI, 1.06-12.52; p = 0.04), in addition to those who required renal support while in ICU (OR = 6.88; 95% CI, 1.82-25.98; p = 0.004), those who could not be extubated (OR= 8.00; 95% CI, 2.16-29.67; p = 0.002) and who presented an alveolar distension pressure value greater than 15cmH2O for at least one day (OR= 5.9; 95% CI, 1.76-19.80; p = 0.004). Conclusion:Clinical and IMV characteristics were associated with death in cancer patients with COVID-19 and IMV

Construção e validação da escala de verificação da adesão às recomendações das Diretrizes Brasileiras de Ventilação Mecânica / Construction and validation of the scale for verifying adherence to the recom-mendations of The Brazilian Guidelines For Mechanical Ventilation / Construcción y validación de la escala para verificar la adherencia a las recomenda-ciones de Las Directrices Brasileñas Sobre Ventilación Mecánica

Objetivo: construir e validar uma escala de verificação da adesão às recomendações das Diretrizes Brasileiras de Ventilação Mecânica por profissionais da saúde. Método: estudo metodológico, conduzido no período entre setembro e dezembro de 2019 em um hospital público com 87 pacientes. Para a validação de conteúdo, adotou-se o Índice de Validação de Conteúdo; para a validade de critério, o Coeficiente de Correlação de Pearson; para a consistência interna, o alfa de Cronbach; e, para a confiabilidade interobservador, o Coeficiente Kappa e o Coeficiente de Correlação Intraclasse. Resultados: a escala identificou uma validade de conteúdo e consistência interna aceitável. A correlação de Pearson indicou uma correlação do escore de adesão com a saturação (r = 0,31; p≤0,005), o escore médio para o observador A e B resultou, respectivamente, em 88,89(±5,23) e 88,86(±5,34), e o intervalo de confiança foi de 0,96. Conclusão: a escala apresentou validade e confiabilidade para verificar a adesão às Diretrizes Brasileiras de Ventilação Mecânica dos profissionais.(AU)

Objective: to construct and validate a scale for verifying adherence to the recommendations of the Brazilian Guidelines for Mechanical Ventilation by healthcare professionals. Method: methodological study, conducted between September and December 2019 in a public hospital with 87 patients. For content validation, the Content Validation Index was adopted; for criterion validity, Pearson's Correlation Coefficient; for internal consistency, Cronbach's alpha; and, for interobserver reliability, the Kappa Coefficient, and the Intraclass Correlation Coefficient. Results: the scale identified acceptable content validity and internal consistency. Pearson's correlation indicated a correlation between adherence score and saturation (r = 0.31; p≤0.005), the average score for observer A and B resulted, respectively, in 88.89(±5.23) and 88.86(±5.34), and the confidence interval was 0.96. Conclusion: the scale showed validity and reliability to verify adherence to the Brazilian Guidelines for Mechanical Ventilation by professionals.(AU)

Objetivo: construir y validar una escala para verificar la adherencia a las recomendaciones de las directrices brasileñas sobre ventilación mecánica por parte de los profesionales de la salud. Método: estudio metodológico, realizado entre septiembre y diciembre de 2019 en un hospital público con 87 pacientes. Se adoptó el Índice de Validación de Contenido para la validación de contenido, para la validez de criterio, el Coeficiente de Correlación de Pearson, para la consistencia interna, el alfa de Cronbach y, para la fiabilidad interobservador, el Coeficiente Kappa y el Coeficiente de Correlación Intraclase. Resultados: la escala presentó una validez de contenido y una consistencia interna aceptables. La correlación de Pearson indicó una correlación de la puntuación de adherencia con la saturación (r = 0,31; p≤0,005), la puntuación media para el observador A y B resultó de 88,89(±5,23) y 88,86(±5,34), respectivamente, y el intervalo de confianza fue de 0,96. Conclusión: la escala presentó validez y confiabilidad para verificar la adherencia a las Directrices Brasileñas de Ventilación Mecánica de los profesionales.(AU)

Adequacy of a novel qualitative fit test kit and protocol during the COVID-19 pandemic

Objectives@#To develop our own qualitative fit test kit and protocol for respirators and validate this against the manufacturer-issued kit.@*Methods@#This is a crossover study of 50 healthcare workers in a tertiary government hospital. Some healthcare workers were tested multiple times according to the number of respirators they want tested. Qualitative fit testing was done according to manufacturer protocol for the commercial kits or according to our own protocol for the novel kits.@*Results@#A total of 63 fit tests were analyzed. This novel kit was determined to be noninferior to manufacturer-issued kits in detecting leaks among worn respirators (p=0.005). @*Conclusion@# A fit test kit can be successfully created from readily available household and hospital materials. Fit tests with these novel kits using our validated protocol are shown to be noninferior to commercial test kits. This can greatly aid in qualitative fit testing of respirators in a logistically constrained pandemic setting.

Expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment / 生物医学工程学杂志

The setting and adjustment of ventilator parameters need to rely on a large amount of clinical data and rich experience. This paper explored the problem of difficult decision-making of ventilator parameters due to the time-varying and sudden changes of clinical patient's state, and proposed an expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment based on fuzzy control rule and neural network. Based on the method and the real-time physiological state of clinical patients, we generated a mechanical ventilation decision-making solution set with continuity and smoothness, and automatically provided explicit parameter adjustment suggestions to medical personnel. This method can solve the problems of low control precision and poor dynamic quality of the ventilator's stepwise adjustment, handle multi-input control decision problems more rationally, and improve ventilation comfort for patients.

Effect of fraction of inspired oxygen baseline level on the mask ventilation time before intubation in emergency patients by monitoring of expiratory oxygen concentration / 中华危重病急救医学

OBJECTIVE@#To investigate the effect of different fraction of inspired oxygen (FiO2) baseline levels before endotracheal intubation on the time of expiratory oxygen concentration (EtO2) reaching the standard in emergency patients with the EtO2 as the monitoring index.@*METHODS@#A retrospective observational study was conducted. The clinical data of patients receiving endotracheal intubation in the emergency department of Peking Union Medical College Hospital from January 1 to November 1 in 2021 were enrolled. In order to avoid interference with the final result due to inadequate ventilation caused by non-standard operation or air leakage, the process of the continuous mechanical ventilation after FiO2 was adjusted to pure oxygen in patients who had been intubated was selected to simulate the process of mask ventilation under pure oxygen before intubation. Combined with the electronic medical record and the ventilator record, the changes of the time required to reach 0.90 of EtO2 (that was, the time required to reach the standard of EtO2) and the respiratory cycle required to reach the standard after adjusting FiO2 to pure oxygen under different baseline levels of FiO2 were analyzed.@*RESULTS@#113 EtO2 assay records were collected from 42 patients. Among them, 2 patients had only one EtO2 record due to the FiO2 baseline level of 0.80, while the rest had two or more records of EtO2 reaching time and respiratory cycle corresponding to different FiO2 baseline level. Among the 42 patients, most of them were male (59.5%), elderly [median age was 62 (40, 70) years old] patients with respiratory diseases (40.5%). There were significant differences in lung function among different patients, but the majority of patients with normal function [oxygenation index (PaO2/FiO2) > 300 mmHg (1 mmHg ≈ 0.133 kPa), 38.0%]. In the setting of ventilator parameters, combined with the slightly lower arterial partial pressure of carbon dioxide of patients [33 (28, 37) mmHg], mild hyperventilation phenomenon was considered to be widespread. With the increased in FiO2 baseline level, the time of EtO2 reaching standard and the number of respiratory cycles showed a gradually decreasing trend. When the FiO2 baseline level was 0.35, the time of EtO2 reaching the standard was the longest [79 (52, 87) s], and the corresponding median respiratory cycle was 22 (16, 26) cycles. When the FiO2 baseline level was increased from 0.35 to 0.80, the median time of EtO2 reaching the standard was shortened from 79 (52, 78) s to 30 (21, 44) s, and the median respiratory cycle was also reduced from 22 (16, 26) cycles to 10 (8, 13) cycles, with statistically significant differences (both P < 0.05).@*CONCLUSIONS@#The higher the FiO2 baseline level of the mask ventilation in front of the endotracheal intubation in emergency patients, the shorter the time for EtO2 reaching the standard, and the shorter the mask ventilation time.

Research and Development Trend of Medical Oxygen Production Equipment / 中国医疗器械杂志

Oxygen therapy is an effective clinical method for the treatment of respiratory disorders, oxygen concentrator as a necessary medical auxiliary equipment in hospitals, its research and development has been a hot spot. The study reviewed the development history of the ventilator, introduced the two preparation technique of the oxygen generator pressure swing absorption (PSA) and vacuum pressure swing adsorption (VPSA), and analyzed the core technology development of the oxygen generator. In addition, the study compared some major brands of oxygen concentrators on the market and prospected the development trend of oxygen concentrators.

Development of an Active Mechanical Lung for Simulating Human Pulmonary Ventilation / 中国医疗器械杂志

At present, the passive simulated lung including the splint lung is an important device for hospitals and manufacturers in testing the functions of a respirator. However, the human respiration simulated by this passive simulated lung is quite different from the actual respiration. And it is not able to simulate the spontaneous breathing. Therefore, including" the device simulating respiratory muscle work "," the simulated thorax" and" the simulated airway", an active mechanical lung to simulate human pulmonary ventilation was designed:3D printed human respiratory tract was developed and connected the left and right air bags at the end of the respiratory tract to simulate the left and right lungs of the human body. By controlling a motor running to drive the crank and rod to move a piston back and forth, and to deliver an alternating pressure in the simulated pleural, and so as to generate an active respiratory airflow in airway. The experimental respiratory airflow and pressure from the active mechanical lung developed in this study are consistent with the target airflow and pressure which collected from the normal adult. The developed active mechanical lung function will be conducive to improve the quality of the respirator.

Facteurs pronostiques des pneumopathies acquises sous ventilation mécanique en réanimation polyvalente du CHU d'Angre (RCI) / Prognostic factors for pneumopathy acquired under mechanical ventilation in multi-purpose resuscitation at the Angre CHU (RCI)

Objectifs : Identifier les facteurs de mauvais pronostic des pneumopathies acquises sous ventilation mécanique(PAVM) afin d'améliorer leur prise en charge.Patients et methode : Etude prospective, descriptive et analytique portant sur les patients admis en réanimation du CHU d'Angré du 1er novembre 2019 au 31 juillet 2021 et ayant présenté une PAVM.Resultats : Nous avons colligé 43 patients sur 625 admissions soit 6,88%. L'âge moyen était de 49,06 ans. Le sex ratio était de 0,38. Le principal motif d'admission était le coma avec 88,37%. L'HTA et le diabète étaient les principaux antécédents .Les PAVM précoces représentaient 53,49%. Le Klebsiella pneumoniae était le principal germe. Les patients intubés à l'admission représentaient 79,07%. La durée moyenne de ventilation était de 26,95 jours et la durée moyenne d'hospitalisation était de 30,8140 jours. Une antibiothérapie probabiliste a été réalisée chez 75,76% des patients. La mortalité était de 76,74%. Les facteurs de mortalité étaient une durée de ventilation mécanique supérieure à 15 jours et l'âge supérieur à 50 ans.Conclusion :La mortalité secondaire au PAVM demeure élevée. L'identification des deux facteurs pronostiques devrait améliorer la prise en charge ultérieure de tous nouveaux cas

Objectives: To identify the factors of poor prognosis of ventilator-associated lung disease (VAP) in order to improve their management. Patients and method: Prospective, descriptive and analytical study of patients admitted to intensive care at the Angré University Hospital from November 1, 2019 to July 31, 2021 and having presented VAP.Results: We collected 43 patients out of 625 admissions, i.e. 6.88%. The average age was 49.06 years. The sex ratio was 0.38. The main reason for admission was coma with 88.37%. Hypertension and diabetes were the main antecedents. Early VAP accounted for 53.49%. Klebsiella pneumoniae was the main germ. Patients intubated on admission accounted for 79.07%. The average duration of ventilation was 26.95 days and the average duration of hospitalization was 30.8140 days. Probabilistic antibiotic therapy was performed in 75.76% of patients. Mortality was 76.74%. The mortality factors were duration of mechanical ventilation greater than 15 days and age greater than 50 years.Conclusion:Secondary mortality from VAP remains high. The identification of the two prognostic factors should improve the subsequent management of all new cases.

Research and Design of Calibration Device for Medical Test Lung / 中国医疗器械杂志

In order to solve the problems of quality control and traceability of medical test lung for meeting the calibration conditions of JJF 1234-2018 Calibration Specification for Ventilators, the calibration device and method are researched for compliance and airway resistance of medical test lung in this paper. A calibration device for medical test lung is designed using constant volume active piston technology to simulate human breathing. Through comparison experiment, the deviation between this device and the similar foreign device can be found. The deviation is lower than 0.4% for lung compliance and lower than 0.7% for airway resistance. The calibration of lung compliance and airway resistance can be completed by this device. This device has a clear and complete traceability path to ensure quality control from the source. The calibration of ventilator is improved. This paper provides a reference for related metrology departments and medical institutions to study on quality inspection of respiratory medical instruments.

Research and Design of Automatic Test System for Ventilator Performance / 中国医疗器械杂志

Ventilator is an important medical instrument which can replace the function of autonomous ventilation artificially. Its safety and reliability are related to the health and even life safety of patients. With the publishing of the new national standard and international standard for ventilators, higher requirements are put forward for the detection and evaluation. This study mainly introduces an automatic test system for ventilator performance. The test system is based on PF-300 air-flow analyzer of Imtmedical and standard simulation lung. The automatic switch module of simulation lung is developed, and the automatic test system of ventilator is designed using the software development platform based on Python. It can not only automatically test all ventilation control parameters and monitoring parameters of the ventilator, but also realize automatic data recording, form reports and data analysis, and improve the efficiency and quality of inspection, detection and quality control.

Design of Portable Noninvasive Positive Pressure Ventilator System Based on Threshold Trigger of Flow Rate Change / 中国医疗器械杂志

In order to effectively treat respiratory diseases, a non-invasive positive pressure ventilator system is designed, the overall structure design of the system is proposed, and the hardware construction is completed. The breathing state of the patient is identified by the threshold triggering method of the flow rate of change, and the calculation of the flow rate of change is realized by the least squares method. At the same time, the breathing parameters are calculated in real time according to the flow-time and pressure-time characteristic curves. In addition, CMV, CPAP, BiPAP and PSV ventilation modes are also implemented. Finally, the parameter measurement accuracy and ventilation mode setting tests are carried out. The results show that the calculation of key breathing parameters provided by the system meets the relevant standards, and supports the stable output of 4 ventilation modes at the same time, provides breathing treatment for patients, and meets the basic functional requirements of the ventilator.

Respiratory mechanics analysis of inspiratory trigger in mechanical ventilation / 中华危重病急救医学

OBJECTIVE@#To find out the circuit pressure and flow at the trigger point by observing the characteristics of the inspiratory trigger waveform of the ventilator, confirm the intra-alveolar pressure as the index to reflect the effort of the trigger according to the working principle of the ventilator combined with the laws of respiratory mechanics, establish the related mathematical formula, and analyze its influencing factors and logical relationship.@*METHODS@#A test-lung was connected to the circuit in a PB840 ventilator and a SV600 ventilator set in pressure-support mode. The positive end-expiratory pressure (PEEP) was set at 5 cmH2O (1 cmH2O ≈ 0.098 kPa), and the wall of test-lung was pulled outwards till an inspiratory was effectively triggered separately in slow, medium, fast power, and separately in flow-trigger mode (sensitivity VTrig 3 L/min, 5 L/min) and pressure-trigger mode (sensitivity PTrig 2 cmH2O, 4 cmH2O). By adjusting the scale of the curve in the ventilator display, the loop pressure and flow corresponding to the trigger point under different triggering conditions were observed. Taking intraalveolar pressure (Pa) as the research object, the Pa (called Pa-T) needed to reach the effective trigger time (TT) was analyzed in the method of respiratory mechanics, and the amplitude of pressure change (ΔP) and the time span (ΔT) of Pa during triggering were also analyzed.@*RESULTS@#(1) Corresponding relationship between pressure and flow rate at TT time: in flow-trigger mode, in slow, medium and fast trigger, the inhalation flow rate was VTrig, and the circuit pressure was separately PEEP, PEEP-Pn, and PEEP-Pn' (Pn, Pn', being the decline range, and Pn' > Pn). In pressure-trigger mode, the inhalation flow rate was 1 L/min (PB840 ventilator) or 2 L/min (SV600 ventilator), and the circuit pressure was PEEP-PTrig. (2) Calculation of Pa-T: in flow-trigger mode, in slow trigger: Pa-T = PEEP-VTrigR (R represented airway resistance). In medium trigger: Pa-T = PEEP-Pn-VTrigR. In fast trigger: Pa-T = PEEP-Pn'-VTrigR. In pressure-trigger mode: Pa-T = PEEP-PTrig-1R. (3) Calculation of ΔP: in flow trigger mode, in flow trigger: without intrinsic PEEP (PEEPi), ΔP = VTrigR; with PEEPi, ΔP = PEEPi-PEEP+VTrigR. In medium trigger: without PEEPi, ΔP = Pn+VTrigR; with PEEPi, ΔP = PEEPi-PEEP+Pn+VTrigR. In fast trigger: without PEEPi, ΔP = Pn'+VTrigR; with PEEPi, ΔP = PEEPi-PEEP+Pn'+VTrigR. In pressure-trigger mode, without PEEPi, ΔP = PTrig+1R; with PEEPi, ΔP = PEEPi-PEEP+PTrig+1R. (4) Pressure time change rate of Pa (FP): FP = ΔP/ΔT. In the same ΔP, the shorter the ΔT, the greater the triggering ability. Similarly, in the same ΔT, the bigger the ΔP, the greater the triggering ability. The FP could better reflect the patient's triggering ability.@*CONCLUSIONS@#The patient's inspiratory effort is reflected by three indicators: the minimum intrapulmonary pressure required for triggering, the pressure span of intrapulmonary pressure, and the pressure time change rate of intrapulmonary pressure, and formula is established, which can intuitively present the logical relationship between inspiratory trigger related factors and facilitate clinical analysis.

A new type of artificial airway sealer used between artificial airway and ventilator pipeline / 中华危重病急救医学

The need for mechanical ventilation due to severe hypoxemia and acute respiratory distress syndrome has increased dramatically in the global pandemic of severe respiratory infectious diseases. In clinical scenarios, it is sometimes necessary to briefly disconnect the ventilator pipeline from the artificial airway. Still, this operation can lead to a sharp drop in airway pressure, which is contrary to the protective lung ventilation strategy and increases the risk of environmental exposure to bioaerosol, posing a serious threat to patients and medical workers. At present, there is yet to be a practical solution. A new artificial airway device was designed by the medical staff from the department of critical care medicine of Beijing Tiantan Hospital, Capital Medical University, based on many years of research experience in respiratory support therapy, and recently obtained the National Utility Model Patent of China (ZL 2019 2 0379605.4). The device comprises two connecting pipes, the sealing device body, and the globe valve represented by the iridescent optical ring. It has a simple structure, convenient operation, and low production cost. The device is installed between the artificial airway and the ventilator pipeline and realizes the instantaneous sealing of the artificial airway by adjusting the shut-off valve. Using this device to treat mechanically ventilated patients can minimize the ventilator-induced lung injury caused by the repeated disconnection of pipelines, avoid iatrogenic transmission of bioaerosols, and realize dual protection for patients and medical workers. It has extensive clinical application prospects and high health and economic value.

Modeling the noninvasive bi-level positive airway pressure ventilation therapy system and simulated application / 生物医学工程学杂志

Without artificial airway though oral, nasal or airway incision, the bi-level positive airway pressure (Bi-PAP) has been widely employed for respiratory patients. In an effort to investigate the therapeutic effects and measures for the respiratory patients under the noninvasive Bi-PAP ventilation, a therapy system model was designed for virtual ventilation experiments. In this system model, it includes a sub-model of noninvasive Bi-PAP respirator, a sub-model of respiratory patient, and a sub-model of the breath circuit and mask. And based on the Matlab Simulink, a simulation platform for the noninvasive Bi-PAP therapy system was developed to conduct the virtual experiments in simulated respiratory patient with no spontaneous breathing (NSB), chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The simulated outputs such as the respiratory flows, pressures, volumes, etc, were collected and compared to the outputs which were obtained in the physical experiments with the active servo lung. By statistically analyzed with SPSS, the results demonstrated that there was no significant difference ( P > 0.1) and was in high similarity ( R > 0.7) between the data collected in simulations and physical experiments. The therapy system model of noninvasive Bi-PAP is probably applied for simulating the practical clinical experiment, and maybe conveniently applied to study the technology of noninvasive Bi-PAP for clinicians.

Application of transport ventilator in the inter-hospital transport of critically ill children / 中国当代儿科杂志

OBJECTIVES@#To study the application value of transport ventilator in the inter-hospital transport of critically ill children.@*METHODS@#The critically ill children in Hunan Children's Hospital who were transported with or without a transport ventilator were included as the observation group (from January 2019 to January 2020; n=122) and the control group (from January 2018 to January 2019; n=120), respectively. The two groups were compared in terms of general data, the changes in heart rate, respiratory rate, and blood oxygen saturation during transport, the incidence rates of adverse events, and outcomes.@*RESULTS@#There were no significant differences between the two groups in sex, age, oxygenation index, pediatric critical illness score, course of disease, primary disease, heart rate, respiratory rate, and transcutaneous oxygen saturation before transport (P>0.05). During transport, there were no significant differences between the two groups in the changes in heart rate, respiratory rate, and transcutaneous oxygen saturation (P>0.05). The incidence rates of tracheal catheter detachment, indwelling needle detachment, and sudden cardiac arrest in the observation group were lower than those in the control group during transport, but the difference was not statistically significant (P>0.05). Compared with the control group, the observation group had significantly shorter duration of mechanical ventilation and length of stay in the pediatric intensive care unit and significantly higher transport success rate and cure/improvement rate (P<0.05).@*CONCLUSIONS@#The application of transport ventilator in the inter-hospital transport can improve the success rate of inter-hospital transport and the prognosis in critically ill children, and therefore, it holds promise for clinical application in the inter-hospital transport of critically ill children.

Aplicação da ferramenta de gestão na padronização e processamento de material ventilatório no Centro de Material e Esterilização / Implementation of a management tool to standardize and process ventilation devices in the Sterile Processing Department

Objetivo: Relatar a experiência da aplicação da ferramenta de gestão 5W2H para a padronização e processamento de material ventilatório no Centro de Material e Esterilização (CME) de um hospital de referência. Método: Trata-se de um relato de experiência com uma equipe de enfermagem atuante no CME em um hospital referência em cirurgia de alta complexidade e aplicação da ferramenta de gestão 5W2H para a padronização e processa-mento de material ventilatório. Resultados: Foram aplicadas quatro etapas: implementação da ferramenta de gestão e do quiz, capacitação da equipe de enfermagem, realização da padronização do material ventilatório e formulação do catálogo do material ventilatório. A ferramenta 5W2H favoreceu o pla-nejamento do processo de trabalho desenvolvido no CME e a identificação das fragilidades da equipe de enfermagem durante o processamento dos itens do material ventilatório. Conclusão: O uso da ferramenta de gestão para o detalhamento do problema associado à capacitação da equipe de enfermagem e à padronização do material ventilatório possibilitou reduzir os problemas relacionados à montagem incorreta e ao extravio dos materiais ventilatórios

Objective: To report the experience of implementing the 5W2H management tool to standardize and process ventilation devices in the Sterile Processing Department (SPD) of a referral hospital. Method: This is an experience report of a nursing team working in the SPD of a referral hospital for high-complexity surgery on the implementation of the 5W2H management tool to standardize and process ventilation devices. Results: The pro-cess consisted of four steps: implementing the management tool and administering the questionnaire, training the nursing team, standardizing the ven-tilation devices, and producing a catalog for the ventilation devices. The 5W2H tool helped plan the work process developed in the SPD and identify the nursing team's weaknesses during the processing of items from the ventilation devices. Conclusion: Using the management tool to detail problems associated with the nursing team training and with the standardization of ventilation devices allowed reducing issues related to incorrect assembly and loss of ventilation devices

Objetivo: Relatar la experiencia de la aplicación de la herramienta de gestión 5W2H para la estandarización y procesamiento de material ven-tilatorio en el Centro de Material y Esterilización (CME) de un hospital de referencia. Método: Se trata de un relato de experiencia con un equipo de enfermería actuante en el CME en un hospital referencia en cirugía de alta complejidad y aplicación de la herramienta de gestión 5W2H para la estanda-rización y procesamiento de material ventilatorio. Resultados: Fueron aplicadas cuatro etapas: implementación de la herramienta de Gestión y del quiz, capacitación del equipo de enfermería, realización de la estandarización del material ventilatorio y formulación del catálogo del material ventilatorio. La herramienta 5W2H favoreció la planificación del proceso de trabajo desarrollado en el CME y la identificación de las fragilidades del equipo de enfer-mería durante el procesamiento de los ítems del material ventilatorio. Conclusión: El uso de la herramienta de gestión para el detalle del problema aso-ciado a la capacitación del equipo de enfermería y a la estandarización del material ventilatorio posibilitó reducir los problemas relacionados al montaje incorrecto y al extravío de los materiales ventilatorios

Recomendaciones internacionales respecto al uso de mascarillas para la prevención de la COVID-19 / international recommendations Regarding the use of masks for the prevention of COVID-19

La publicación describe las recomendaciones internacionales emitidas a la fecha, respecto al uso de mascarillas en la población general y si éstas señalaban usar doble mascarilla, una sola mascarilla o sólo un respirador (KN95 o N95). De la revisión de 11 documentos emitidos por organismos y autoridades sanitarias internacionales, se identificó que tanto el uso de una mascarilla o un respirador (incluyendo N95 o KN95) ha sido incluido en las recomendaciones para su uso en población general. Independientemente del dispositivo, se ha coincidido en que lo fundamental es el uso adecuado del mismo, que se ajuste bien a la cara, que se pueda usar constantemente y esté disponible. Las opciones, en orden descendente de acuerdo al nivel de protección son: respiradores aprobados por NIOSH, respiradores tipo KN95 con buen ajuste, mascarillas quirúrgicas desechables y en último lugar las mascarillas de tela de múltiples capas con buen ajuste y varilla nasal. La OMS, el CDC de Estados Unidos, el CDC de la Unión Europea y el gobierno de Canadá han precisado los estándares que deben ser cumplidos

Desinfección y reutilización de respiradores N95 durante pandemia por COVID-19 / Disinfection and reuse of N95 respirators during the COVID-19 pandemic

Introducción: Se está viviendo en un contexto de pandemia por COVID-19, en donde se evidencia la escasez de equipos de protección personal en salud y se prevé que continuará en el corto y mediano plazo. Por lo que considerar la reutilización o el uso prolongado de algunos equipos de protección personal, en especial de los respiradores, podría ser una alternativa a considerar. Objetivo: Revisar y dar a conocer, en base a evidencia científica, distintas formas de desinfección para poder reutilizar de manera segura y asequible los respiradores N95. Comentarios principales: Los respiradores N95 o sus equivalentes son de uso exclusivo del personal de salud para la atención de pacientes con sospecha o confirmación de COVID-19 y en procedimientos con generación de aerosoles. Su eficacia depende en gran medida del estado del respirador, de la capacidad de filtración, del sellado y de su uso adecuado. Son diversos los métodos para desinfectar, como la luz ultravioleta tipo C, el peróxido de hidrógeno, calor seco y húmedo, ozono, irradiación por microondas, etc. Si estos procedimientos no son realizados adecuadamente, podrían no ser efectivos. Comentarios globales: En escenarios de escasez de equipos de protección personal la reutilización es un procedimiento viable, económico, seguro, potencialmente escalable y fácil de realizar. Los respiradores N95 requieren un procedimiento especial de desinfección para preservar su capacidad de filtración y sellado. Existe un limitado número de ciclos de desinfección y reutilización. La estufa en calor seco podría ser el método más asequible en entornos privados(AU)

Introduction: We are living in a context of COVID-19 pandemic, where the shortage of personal protective equipment in health is evident and it is expected that it will continue in the short and medium term. So, considering the reuse or prolonged use of some personal protective equipment, especially respirators, could be an alternative to consider. Objective: To review and disseminate, based on scientific evidence, different forms of disinfection in order to safely and affordably reuse N95 respirators. Main comments: N95 respirators or their equivalents are for the exclusive use of health personnel for the care of patients with suspected or confirmed COVID-19 and in aerosol generation procedures. Its effectiveness depends to a large extent on the condition of the respirator, the filtration capacity, the sealing and its proper use. There are several methods to disinfect, such as ultraviolet light type C, hydrogen peroxide, dry and humid heat, ozone, microwave irradiation, etc. If these procedures are not performed properly, they may not be effective. Global feedback: In personal protective equipment shortage scenarios, reuse is a viable, economical, safe, potentially scalable and easy-to-perform procedure. N95 respirators require a special disinfection procedure to preserve their filtration and sealing capacity. There are a limited number of disinfection and reuse cycles. Dry heat stove might be the most affordable method in private settings(AU)

Desarrollo de ventiladores mecánicos en Chile. Crónica de la iniciativa "Un Respiro para Chile", durante la primera ola de la pandemia COVID-19 / Development of mechanical ventilators in Chile. Chronicle of the initiative "Un Respiro para Chile"

At the beginning of the COVID-19 pandemic in Chile, in March 2020, a projection indicated that a significant group of patients with pneumonia would require admission to an Intensive Care Unit and connection to a mechanical ventilator. Therefore, a paucity of these devices and other supplies was predicted. The initiative "Un respiro para Chile" brought together many people and institutions, public and private. In the course of three months, it allowed the design and building of several ventilatory assistance devices, which could be used in critically ill patients.

Parametrização dos alarmes de frequência respiratória em ventiladores mecânicos de pacientes durante o banho / Parameterization of respiratory rate alarms in mechanical ventilators of patients during the bath / Parametrización de las alarmas de frecuencia respiratoria en ventiladores mecánicos de pacientes durante el baño

RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.

ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.

RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.