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.

Effect of Scutellaria baicalensis Georgi on metabolism in RSV infection mice based on metabolomics / 药学学报

This study, aiming at finding biomarkers which can assist in the diagnosis of respiratory syncytial virus (RSV) pneumonia and analyzing the metabolic pathways of anti-RSV activity of Scutellaria baicalensis Georgi (SG)., explores the improvement effect of SG on mice models infected by RSV with the metabolomics technology based on UPLC-Q-Exactive HF X-MS. Mice models affected by RSV are established by nasal drip method and the changes of body weight, rectal temperature and pathological damage of lung tissue are evaluated. The lung tissue samples of mice in each group are collected and analyzed by UPLC-Q-Exactive HF X-MS. The differential metabolites of SG drug intervention are explored by metabolomics technology, and the metabolic pathways regulated by SG are analyzed. The results show that SG can significantly improve the pathological state of the lung tissue of the mice and make its body weight and rectal temperature tend to be normal. In the lung tissue samples, 46 biomarkers, such as guanine, L-asparagine, and arachidonic acid, are screened for disease development in RSV model mice. SG improved RSV infection by recalling 22 potential biomarkers, such as uric acid, arachidonic acid, and alanine. The 22 potential markers mainly involved 11 abnormal metabolic pathways, including phenylalanine, tyrosine, and tryptophan biosynthesis, and arachidonic acid metabolism, alanine, aspartic acid and glutamate metabolism are closely related to the five metabolic pathways. SG improves RSV-infected mice mainly by regulating amino acids, lipids, cofactors and vitamins and nucleotide metabolites. All animal experiments were conducted under the guidance and approval of the Animal Ethics Review Committee of Shandong University of Traditional Chinese Medicine. (approval number: SDUTCM20210311001).

Comparação de desfechos clínicos e correlação entre funcionalidade e tempo de ventilação mecânica de pacientes em uti / Comparison of clinical outcomes and correlation between functionality and time of mechanical ventilation in icu patients / Comparación de los resultados clínicos y correlación entre la funcionalidad y el tiempo de ventilación mecánica de los pacientes en uti

O objetivo deste estudo foi comparar os desfechos clínicos dos pacientes em suporte ventilatório invasivo por período curto e prolongado e correlacionar funcionalidade e tempo de ventilação mecânica (VM). Estudo documental retrospectivo, realizado na UTI neurocirúrgica de um hospital escola. Dos prontuários clínicos foram coletados: idade, sexo, hipótese diagnóstica de internação, tempo de internação e de VM em dias, o desfecho sucesso ou falha da extubação e o nível de funcionalidade. Os prontuários foram divididos em grupo um (GI): pacientes em VM por até três dias e grupo dois (GII): pacientes em VM por mais de três dias. Foram analisados 210 prontuários, 73% dos pacientes permaneceram menos de três dias em VM. A idade média de GI foi 51,8±15,5 anos e GII 48,7±16,3 anos (p=0,20), prevalência do sexo masculino em GI (59%) e GII (68%). O acidente vascular cerebral foi o diagnóstico mais prevalente no GI (18%) e o tumor cerebral no GII (21%) e hipertensão arterial, a comorbidade mais prevalente em GI (28%) e GII (25%). O GII permaneceu maior tempo (p<0,0001) em VM e internação na UTI que o GI e percentual de sucesso no desmame/extubação menor (p=0,01) que o GI. Não houve correlação significativa entre funcionalidade e tempo de VM em GI e GII (p>0,05). Os pacientes em suporte ventilatório invasivo por período prolongado evoluíram com maior permanência em VM, maior tempo de internação na UTI e menor taxa de sucesso no desmame/extubação. O tempo de permanência em suporte ventilatório invasivo não interferiu na funcionalidade desses pacientes.

The aim of this study was to compare the clinical outcomes of patients on short- and long-term invasive ventilatory support and to correlate functionality and duration of mechanical ventilation (MV). Retrospective documental study, carried out in the neurosurgical ICU of a teaching hospital. The following were collected from the clinical records: age, gender, diagnostic hypothesis of hospitalization, length of hospital stay and MV in days, the outcome of success or failure of extubation and the level of functionality. The medical records were divided into group one (GI): patients on MV for up to three days and group two (GII): patients on MV for more than three days. A total of 210 medical records were analyzed, 73% of the patients remained on MV for less than three days. The mean age of GI was 51.8±15.5 years and GII 48.7±16.3 years (p=0.20), male prevalence in GI (59%) and GII (68%). Stroke was the most prevalent diagnosis in GI (18%) and brain tumor in GII (21%) and hypertension was the most prevalent comorbidity in GI (28%) and GII (25%). GII remained longer (p<0.0001) in MV and ICU admission than GI and the percentage of success in weaning/extubation was lower (p=0.01) than GI. There was no significant correlation between functionality and time on MV in GI and GII (p>0.05). Patients on invasive ventilatory support for a long period evolved with longer MV stays, longer ICU stays and lower weaning/extubation success rates. The length of stay on invasive ventilatory support did not interfere with the functionality of these patients.

El objetivo de este estudio fue comparar los resultados clínicos de los pacientes con soporte ventilatorio invasivo a corto y largo plazo y correlacionar la funcionalidad y el tiempo de ventilación mecánica (VM). Se trata de un estudio documental retrospectivo, realizado en la UCI neuroquirúrgica de un hospital universitario. Se recogieron los siguientes datos de las historias clínicas: edad, sexo, hipótesis diagnóstica, duración de la estancia y tiempo de VM en días, el resultado éxito o fracaso de la extubación y el nivel de funcionalidad. Las historias clínicas se dividieron en el grupo uno (GI): pacientes bajo VM hasta tres días y el grupo dos (GII): pacientes bajo VM durante más de tres días. Se analizaron 210 historias clínicas, el 73% de los pacientes permanecieron menos de tres días con VM. La edad media de GI fue de 51,8±15,5 años y la de GII de 48,7±16,3 años (p=0,20), con prevalencia masculina en GI (59%) y GII (68%). El ictus fue el diagnóstico más prevalente en GI (18%) y el tumor cerebral en GII (21%) y la hipertensión, la comorbilidad más prevalente en GI (28%) y GII (25%). El GII permaneció más tiempo (p<0,0001) en la VM y la estancia en la UCI que el GI y el porcentaje de éxito en el destete/extubación fue menor (p=0,01) que el GI. No hubo correlación significativa entre la funcionalidad y el tiempo de VM en GI y GII (p>0,05). Los pacientes con soporte ventilatorio invasivo a largo plazo evolucionaron con una mayor estancia en la VM, una mayor estancia en la UCI y una menor tasa de éxito de destete/extubación. La duración de la estancia con soporte ventilatorio invasivo no interfirió en la funcionalidad de estos pacientes.

Metodología para evaluar el nivel de protección respiratoria de mascarillas y respiradores ante partículas similares a las que transmiten el SARS-CoV-2 / Methodology for evaluating the level of respiratory protection of masks and respirators against particles similar to those that transmit SARS-CoV-2

RESUMEN Objetivo: Desarrollar una metodología para evaluar el nivel de protección respiratoria de respiradores, mascarillas quirúrgicas y mascarillas comunitarias que usa la población peruana, usando partículas de un tamaño similar a las que contienen al virus activo del SARS-CoV-2. Materiales y métodos: Se ha determinado una relación lineal directa entre el logaritmo de la concentración de partículas suspendidas en aire y el tiempo transcurrido; por lo cual es posible comparar la cantidad de partículas internas y externas a la mascarilla o respirador en un mismo periodo y conocer el porcentaje de protección respiratoria de cada muestra evaluada. Resultados: Se ha logrado implementar una metodología para evaluar el nivel de protección respiratoria ante aerosoles menores a 5,0 µm. Asimismo, el empleo de accesorios como ligas o ajustadores detrás de cabeza y nuca, y el uso de clips nasales robustos, incrementan significativamente el nivel de protección respiratoria ante partículas con alta probabilidad de contener al SARS-CoV-2. Conclusiones: Se observa una concordancia entre los valores de protección respiratoria obtenidos y los esperados, considerando el nivel de filtración del material empleado de cada mascarilla quirúrgica o respirador, y su nivel de ajuste. Se observó un incremento significativo en los niveles de protección respiratoria.

ABSTRACT Objective: To develop a methodology for evaluating the level of respiratory protection provided by respirators, surgical masks and community face masks used by the Peruvian population; protection was evaluated against particles of a size similar to those containing active SARS-CoV-2 virus. Materials and methods: A direct linear relationship has been determined between the logarithm of the concentration of airborne particles and the elapsed time; thus, it is possible to compare the quantity of particles inside and outside of the mask or respirator in the same time period, as well as to obtain the percentage of respiratory protection for each evaluated sample. Results: A methodology was established to evaluate the level of respiratory protection against aerosols smaller than 5.0 μm. Also, the use of accessories such as rubber bands or adjusters behind the head and neck, and the use of robust nasal clips, significantly increased the level of respiratory protection against particles with a high probability of containing SARS-CoV-2. Conclusions: We found concordance between the obtained respiratory protection values and those expected, considering the filtration level of the material used for each surgical mask or respirator, as well as the tightness. A significant increase in the levels of respiratory protection was observed.

Extubação em unidade de terapia intensiva pediátrica: métodos preditores. Uma revisão integrativa da literatura / Extubation in the pediatric intensive care unit: predictive methods. An integrative literature review

RESUMO Para a extubação orotraqueal em pacientes pediátricos, é fortemente recomendada a avaliação de sua prontidão. No entanto, a utilização de um dispositivo ou prática que fosse superior ao julgamento clínico ainda não foi determinada com exatidão. Assim, é importante realizar uma revisão sobre as técnicas preditoras de escolha na prática clínica para prever a falha de extubação orotraqueal em pacientes pediátricos. A partir de uma busca nas bases de dados PubMed®, Biblioteca Virtual em Saúde, Cochrane Library e Scopus, realizamos um levantamento das variáveis preditoras de falha de extubação orotraqueal mais comumente utilizadas na prática clínica em pacientes pediátricos. Dos oito preditores descritos, observamos três mais usados: teste de respiração espontânea, índice de respiração rápida e superficial e pressão inspiratória máxima. Embora a disparidade dos dados apresentados nos estudos tenha inviabilizado um tratamento estatístico, foi possível, a partir desse meio, descrever e analisar o desempenho desses testes.

ABSTRACT For extubation in pediatric patients, the evaluation of readiness is strongly recommended. However, a device or practice that is superior to clinical judgment has not yet been accurately determined. Thus, it is important to conduct a review on the techniques of choice in clinical practice to predict extubation failure in pediatric patients. Based on a search in the PubMed®, Biblioteca Virtual em Saúde, Cochrane Library and Scopus databases, we conducted a survey of the predictive variables of extubation failure most commonly used in clinical practice in pediatric patients. Of the eight predictors described, the three most commonly used were the spontaneous breathing test, the rapid shallow breathing index and maximum inspiratory pressure. Although the disparity of the data presented in the studies prevented statistical treatment, it was still possible to describe and analyze the performance of these tests.

Circuit Designed for Driving Blower in Non-invasive Positive Airway Pressure Respirator / 中国医疗器械杂志

One of critical technologies in a non-invasive positive airway pressure respirator is to output the airflow for meeting the requirement of respiratory patient in breath. In order to develop a safe and reliable blower driving system, a circuit based on the special chips MC33035 and MC33039 was designed. The linear relationship between the input control voltage and the output air flow was achieved. This designed circuit will be embedded in the non-invasive ventilator system as a module. And based on this circuit, the secure and controllable ventilation flow can be performed.

Addressing difficulty in communication while wearing a respirator mask during the COVID-19 pandemic by using a laryngophone

Objective@#To describe the use of a laryngophone to aid in verbal communication when wearing elastomeric respirator masks. @*Methods@#Design: Instrumentation Innovation. Setting: Tertiary Private Training Hospital.@*Participants@#Five volunteers using elastomeric respirator masks rated laryngophone use, afterwhich they individually rated an additional volunteer on speech intelligibility before and after laryngophone use. @*Results@#On a scale of 1-10, the average score of the five volunteers for the laryngophone was 8.8 for ease of use, 8.0 for comfort, and 8.0 for ease of communication. Their average speech intelligibility score for the additional volunteer using the respirator mask alone was 2.0, and for use of the respirator mask with laryngophone was 3.6 on a scale of 1-4. @*Conclusion@#This portable laryngophone speaker may be useful in aiding otolaryngologists and health care providers using elastomeric respirator masks in verbal communication by amplifying speech without needing an external microphone, preventing vocal strain.

The handling of safety concerns among anaesthetists when restarting full surgical lists during the COVID-19 pandemic

@#Around June 2020, many institutions restarted full operating schedules to clear the backlog of postponed surgeries because of the first wave in the COVID-19 pandemic. In an online survey distributed among anaesthestists in Asian countries at that time, most of them described their safety concerns and recommendations related to the supply of personal protective equipment and its usage. The second concern was related to pre-operative screening for all elective surgical cases and its related issues. The new norm in practice was found to be non-standardized and involved untested devices or workflow that have since been phased out with growing evidence. Subsequent months after reinstating full elective surgeries tested the ability of many hospitals in handling the workload of non-COVID surgical cases together with rising COVID-19 positive cases in the second and third waves when stay-at-home orders eased.

N95 Filtering Facepiece Respirators during the COVID-19 Pandemic: Basics, Types, and Shortage Solutions

@#The coronavirus disease 2019 (COVID-19) is highly infectious, with the current pandemic causing significant morbidity and mortality worldwide. As large numbers of frontline healthcare workers (HCWs) have also been infected and several have died, there is much global concern about protective measures for them, particularly those performing surgery or other procedures with close patient contact. Since the beginning of the pandemic, there has been and there remains a shortage in the supply of personal protective equipment (PPE), including the N95 filtering facepiece (FFP) respirator, for HCWs. N95 respirators have filtration efficiency of 95% of aerosol particles. Surgical N95 respirators are used where fluid resistance is also required together with respiratory protection, e.g. during surgery or interventional procedures. The shortage of N95 respirators may be overcome by extended use and reuse - comprising rotation and decontamination by approved techniques. The additional role of powered air-purifying respirators (PAPR) is also discussed.

Suitability survey on N95 filter masks for public health emergency personnel / 上海预防医学

Objective To assess the suitability of N95 masks for public health emergency personnel, and to compare the consistency between mask suitability test result and subjective evaluation of mask air tightness so as to guide scientific selection and use of protection masks for emergency personnel. Methods By ambient aerosol condensation nuclear counter method, qualitative suitability test was done among 235 public health emergency personnel from both municipal and district disease control centers.Questionnaires were conducted among them for investigation and comparison of their subjective evaluation of mask air tightness and mask suitability test results. Results Of the 235 subjects, 160 passed the suitability test with the pass rate being 68.1%. With various wearing actions for the test, the subjective evaluation for mask air tightness was compared with suitability test pass rate in terms of consistence, the kappa value range being from -0.09 to 0.43.The kappa value of the action 5 (loudly speaking) was above 0.4, while the kappa values of other 6 actions were all below 0.4.Both kappa value (0.09) and consistency rate (49.7%) were the lowest for action 8 (normal breathing) among all test actions. Conclusion The accuracy of the subjective evaluation for air tightness of the mask proves to be poor, unable to reflect the true protective effect and unable to substitute the suitability test.It is advised that the public health personnel should rely on the suitability test results to correctly choose and use suitable respiratory protective products.

Suitability survey on N95 filter masks for public health emergency personnel / 上海预防医学

Objective To assess the suitability of N95 masks for public health emergency personnel. To compare the consistency between mask fit test result and subjective evaluation of mask-wearing air tightness so as to guide scientific selection and use of protection masks for emergency personnel. Methods By ambient aerosol condensation nuclear counter method, the quantitative fit test was done among 235 public health emergency personnel from both Municipal and District disease control centers. Questionnaires were conducted among them for investigation and comparison of their subjective evaluation of mask-wearing air tightness and mask fit test results. Results Of the 235 subjects , 160 passed the fittest with the pass rate being 68.1%. With various wearing actions for the test, the subjective evaluation for mask-wearing air tightness was compared with the fit test pass rate in terms of consistence, the kappa value range being from −0.09 to 0.43. K value of the action 5 (loudly speaking) was above 0.4, while the k values of other 6 actions were all below 0.4. Both Kappa value (0.09) and consistency rate (49.7%) were the lowest for action 8 (normal breathing) among all test actions. Conclusion The accuracy of the subjective evaluation for mask-wearing air tightness proves to be poor, unable to reflect the true protective effect and substitute for the fit test. It is advised that the public health personnel should rely on the fit test results to correctly choose and use suitable respiratory protective products.

Utilidad de la antropometría facial en la selección de tallas de respiradores: Estudio piloto en trabajadores peruanos de construcción civil / Utility of facial anthropometry in selecting respirator size: a pilot study in civil construction workers

Las dimensiones antropométricas faciales son usadas para predecir la talla del respirador de trabajadores expuestos a agentes químicos inhalatorios; sin embargo, la característica multirracial de la población peruana no ha sido evaluada respecto a las tallas de los respiradores en el mercado. Objetivo: Determinar si el uso de las dimensiones antropométricas faciales es útil para determinar la talla de los respiradores de media cara, en un grupo de trabajadores peruanos de construcción civil. Material y métodos: Estudio piloto, transversal, analítico, realizado en 117 trabajadores en quienes se utilizó la longitud de la cara y la anchura de la boca, para determinar la talla del respirador de media cara de tres marcas y su verificación con pruebas de ajuste. Se consideró los parámetros faciales porque son puntos sensibles de fuga de aire para las pruebas de ajuste. Resultados: La media de la longitud de la cara en 12,2 ± 0,6 cm y la media del ancho de la boca fue de 5,3 ± 0,6 cm. Luego se hacer las pruebas de ajuste, se observó que pasó satisfactoriamente la marca A, mientras que en las marcas B y C se obtuvo dificultad para el ajuste en varias variables. Conclusión: Las dimensiones antropométricas faciales pueden ser usadas para la selección de la talla del respirador, sin embargo, deberá considerarse la marca del respirador.

Facial anthropometric features are used to predict the size of respirators in workers exposed to inhalatory chemical products. However, the multiracial features of the Peruvian population has not been taken into account in this process. Objective: to determine whether the use of facial anthropometric measurements is useful to select the size of half-face respirators in civil construction workers. Methods: A cross-sectional study was conducted in 117 workers in whom the length of the face and widening of the mouth was used to determine the size of three half- face respirators. Results: Mean length of face was 12.2 ± 0.6 cm and mean of mouth widening was 5.3 ± 0.6 cm. After performing adjustment, only brand A passed the evaluation, the B and C brands had difficulties in adjusting to several variables. Conclusion: Facial anthropometric features can be used to select the size of respirators.

Application of simple respirator combined with respiratory function training in airway management of patients with cerebral apoplexy after tracheotomy / 中国实用护理杂志

Objective To observe the application effect of simple respirator combined with respiratory function training in airway management of patients with cerebral apoplexy after tracheotomy. Methods Totally 93 patients with stroke tracheotomy from May 2017 to April 2018 were randomly divided into the intervention group (45 cases) and thecontrol group (48 cases). The control group was treated with routine nursing after tracheotomy, and the intervention group was trained by simple ventilator combined with breathing function on the basis of the control group.The incidence of pulmonary infection during the tracheal cannula in two groups was observed, the total retention time of the trachea cannula, the incidence of blood oxygen saturation<94% from 24 h to 48 h, the number of cases of catheterization, and the incidence of pulmonary infection were observed. Results In the intervention group and the control group, the pulmonary infection rate was 6.67% (3/45) in the intervention group, which was lower than the control group. The lung infection rate was 20.83% (10/48). The significance of learning ( χ2=3.89, P=0.04);the total indwelling time of tracheal intubation in the intervention group (25.73±6.51) d was shorter than that in the control group (28.28 ± 4.79) d, the difference was statistically significant (t=-2.16, P =0.03);within the intervention group and the control group, within 24-48 hours, the oxygen saturation of the intervention group was <0.94 (6.6% (3/45), and the incidence of pulmonary infection was 2.22% (1/45). The incidence rate of re-intubation was 0 (0/45), which was lower than 22.92% (11/48), 14.58% (7/48), and 10.42% (5/48) of the control group. The difference was statistically significant (χ2=4.80, 4.51, 4.75, P=0.03, 0.03, 0.03). Conclusions The simple breathing apparatus combined with respiratory function training can effectively improve the respiratory function of the patients, reduce the occurrence of pulmonary infection and re tube after the tracheal tubing and tubing, shorten the retention time of the trachea cannula, reduce the patient's pain and economic burden, and reduce the risk of nursing. It is scientific and effective. Airway management measures should be widely applied in clinical practice.

In Search of a Performing Seal: Rethinking the Design of Tight-Fitting Respiratory Protective Equipment Facepieces for Users With Facial Hair

BACKGROUND: Air-purifying, tight-fitting facepieces are examples of respiratory protective equipment and are worn to protect workers from potentially harmful particulate and vapors. Research shows that the presence of facial hair on users' face significantly reduces the efficacy of these devices. This article sets out to establish if an acceptable seal could be achieved between facial hair and the facepiece. The team also created and investigated a low-cost “pressure testing” method for assessing the efficacy of a seal to be used during the early design process for a facepiece designed to overcome the facial hair issue. METHODS: Nine new designs for face mask seals were prototyped as flat samples. A researcher developed a test rig, and a test protocol was used to evaluate the efficacy of the new seal designs against facial hair. Six of the seal designs were also tested using a version of the conventional fit test. The results were compared with those of the researcher-developed test to look for a correlation between the two test methods. RESULTS: None of the seals performed any better against facial hair than a typical, commercially available facepiece. The pressure testing method devised by the researchers performed well but was not as robust as the fit factor testing. CONCLUSION: The results show that sealing against facial hair is extremely problematic unless an excessive force is applied to the facepiece's seal area pushing it against the face. The means of pressure testing devised by the researchers could be seen as a low-cost technique to be used at the early stages of a the design process, before fit testing is viable.

Do Various Respirator Models Fit the Workers in the Norwegian Smelting Industry?

BACKGROUND: Respirator fit testing is a method to assess if the respirator provides an adequate face seal for the worker. METHODS: Workers from four Norwegian smelters were invited to participate in the study, and 701 respirator fit tests were performed on 127 workers. Fourteen respirator models were included: one FFABE1P3 and 11 FFP3 respirator models produced in one size and two silicone half masks with P3 filters available in three sizes. The workers performed a quantitative fit test according to Health and Safety Executive 282/28 with 5–6 different respirator models, and they rated the respirators based on comfort. Predictors of overall fit factors were explored. RESULTS: The pass rate for all fit tests was 62%, 56% for women, and 63% for men. The silicone respirators had the highest percentage of passed tests (92–100%). The pass rate for the FFP3 models varied from 19–89%, whereas the FFABE1P3 respirator had a pass rate of 36%. Five workers did not pass with any respirators, and 14 passed with all the respirators tested. Only 63% passed the test with the respirator they normally used. The mean comfort score on the scale from 1 to 5 was 3.2. The respirator model was the strongest predictor of the overall fit factor. The other predictors (age, sex, and comfort score) did not improve the fit of the model. CONCLUSION: There were large differences in how well the different respirator models fitted the Norwegian smelter workers. The results can be useful when choosing which respirators to include in respirator fit testing programs in similar populations.

Medidas de acurácia da resposta disfuncional ao desmame ventilatório: subsídios para metodologia e aprimoramento do raciocínio diagnóstico através da simulação clínica / Accuracy measures os dysfunctional response to weaning: subsidies for methodology and improvement of diagnostic reasoning through clinical simulation

OBJETIVO: Analisar as medidas de acurácia diagnóstica da Resposta Disfuncional ao Desmame Ventilatório e os seus desfechos na extubação de pacientes de terapia intensiva e aplicar as medidas de acurácia da Resposta Disfuncional ao Desmame Ventilatório, utilizando- se a metodologia da simulação clínica. MÉTODO: Um estudo longitudinal do tipo coorte prospectiva com abordagem quantitativa. LOCAL: unidade de terapia intensiva de um hospital de ensino no Sudeste do Brasil e laboratório de simulação clínica em Portugal. PACIENTES: A amostra selecionada no estudo foi constituída por 46 pacientes ventilados mecanicamente. Em cada paciente foram verificadas as características definidoras em cinco tempos distintos, desmembrados em intervalos de 5, 10, 15, 30 e 60 minutos. Nesse caso, cada paciente era avaliado por cinco vezes, totalizando um quantitativo de 230 avaliações. MEDIDAS E PRINCIPAIS RESULTADOS: As principais causas de reintubação foram hipoxemia e aumento do trabalho respiratório. Prevalência de Insucesso foram de 14 eventos (33,3%) e a prevalência da RDDV foram de 13 eventos (30,95%). No total, foram obtidos 35 eventos, considerando-se a RDDV e os desfechos clínicos. A associação entre resposta disfuncional na extubação e o insucesso na extubação apresentou, por meio do teste do qui-quadrado um valor de 16,098 (p=0,00006). Os indicadores clínicos que mais se destacaram pelas métricas de acurácia diagnóstica foram: desconforto respiratório, respiração abdominal paradoxal, aumento da concentração respiratória, uso importante da musculatura acessória, ruídos adventícios respiratórios, percepção aumentada de oxigênio e fadiga. O desmame foi conduzido pela equipe multiprofissional (médicos, enfermeiros e fisioterapeutas). O desmame foi conduzido pela equipe multiprofissional (médicos, enfermeiros e fisioterapeutas). As características preditivas foram calculadas a partir dos testes de regressão logística e demonstraram que ruídos adventícios respiratórios, desconforto respiratório e uso importante da musculatura acessória respiratória foram estatisticamente significativas e constituíram o modelo de regressão. Apresentado modelo de regressão logística entre a variável dependente - presença de RDDV - e cada uma das variáveis independentes, os indicadores clínicos e desfechos da extubação orotraqueal. Essa análise permitiu identificar se a relação entre as variáveis testadas era distribuída ao acaso. Dessa forma, obteve-se a relação entre cada variável independente e a variável desfecho insucesso na extubação, sendo medida a força de associação através do teste do qui-quadrado, Odds Ratio (O.R.) e por seu intervalo de confiança (IC) de 95%. Os impactos gerados pelo insucesso de desmame e extubação são multifacetados e constituem indicadores de qualidade em UTIs, pois há aumento das infecções e da mortalidade hospitalar, o que onera expressivamente os custos da internação. A extubação deve ser guiada por julgamento clínico e dados objetivos para minimizar o risco de reintubações. Por meio da simulação clínica, construiu-se um caso clínico com bases conceituais e metodológicas na teoria do duplo processamento, por meio do qual foram desenvolvidas as cenas, a partir das habilidades esperadas dos enfermeiros, durante a simulação. A elaboração e a validação do cenário clínico para a simulação foram importantes para reduzir incertezas na sua construção. CONCLUSÕES: O estudo permitiu a distinção entre o constructo clínico da RDDV, numa avaliação das respostas apresentadas à experiência da extubação orotraqueal, na perspectiva de uma visão holística, e o insucesso de extubação, num modelo mais voltado à terapia e processos fisiopatológicos.

OBJECTIVE: To analyze the diagnostic accuracy measures of the Dysfunctional Ventilatory Weaning Response and their outcomes in extubation of intensive care patients and apply the measures of accuracy of the Dysfunctional Ventilatory Weaning Response using the clinical simulation methodology. METHOD: A prospective cohort longitudinal study with a quantitative approach. SETTING: Intensive care unit of a teaching hospital in southeastern Brazil and clinical simulation laboratory in Portugal. PATIENTS: The sample selected in the study consisted of 46 mechanically ventilated patients. In each patient, the defining characteristics were verified at five different times, broken down at intervals of 5, 10, 15, 30 and 60 minutes. Therefore, each patient was evaluated five times, for a total of 230 evaluations. MEASURES AND MAIN RESULTS: The main causes of reintubation were hypoxemia and increased respiratory work. Failure prevalence was 14 events (33.3%) and the prevalence of DVWR was 13 events (30.95%), in total, 35 events were obtained, considering DVWR and clinical outcomes. The association between dysfunctional response in extubation and failure in extubation showed, through the chi-square test, a value of 16.098 (p = 0.00006). The clinical indicators that most stood out for the metrics of diagnostic accuracy were respiratory distress, paradoxical abdominal breathing, increased respiratory concentration, important use of accessory muscles, adventitious respiratory sounds, increased oxygen perception and fatigue. Weaning was carried out by the multiprofessional team (doctors, nurses and physiotherapists). Predictive characteristics were calculated from logistic regression tests and demonstrated that adventitious respiratory sounds, respiratory distress and important use of respiratory accessory muscles were statistically significant and constituted the regression model. A logistic regression model was presents between the dependent variable- presence of DVWRr- and each of the independent variables, the clinical indicators and outcomes of orotracheal extubation. This analysis made it possible to identify whether the relationship between the variables tested was randomly distributed. Thus, the relationship between each independent variable and the outcome variable extubation failure was obtained, and the strength of association was measured using the chi-square test, OddsRatio (OR) and its 95% confidence interval (CI). The impacts generated by the failure of weaning and extubation are multi-faceted and constitute quality indicators in ICUs, since there is an increase in infections, in-hospital mortality and significantly increase the costs of hospitalization. Extubation should be guided by clinical judgment and objective data to minimize the risk of reintubations. Through clinical simulation, a clinical case was constructed with conceptual and methodological bases in the double processing theory, through which scenes were developed, based on the skills expected of nurses during the simulation. The elaboration and validation of the clinical scenario for the simulation was important to reduce uncertainties in its construction. CONCLUSIONS: The study allowed the distinction between the clinical construct of DVWR, in an evaluation of the responses presented, the experience of orotracheal extubation, from the perspective of a holistic view and the extubation failure, in a model more focused on therapy and pathophysiological processes.

OBJETIVO: Analizar las medidas de precisión diagnóstica de la Respuesta Ventilatoria Disfuncional al Destete y sus resultados en la extubación de pacientes de terapia intensiva, y aplicar las medidas de precisión de la Respuesta Ventilatoria Disfuncional al Destete utilizando simulación clínica. MÉTODO: Estudio longitudinal tipo cohorte prospectivo con abordaje cuantitativo. LUGAR: Unidad de terapia intensiva de hospital de enseñanza del Sudeste de Brasil y laboratorio de simulación clínica en Portugal. PACIENTES: Muestra integrada por 46 pacientes en ventilación mecánica. Fueron verificadas en cada paciente las características definitorias en cinco momentos distintos, separados en intervalos de 5, 10, 15, 30 y 60 minutos. Consecuentemente, cada paciente fue evaluado cinco veces, habiéndose realizado en total 230 evaluaciones. MEDIDAS Y RESULTADOS PRINCIPALES: Las principales causas de reintubación fueron: hipoxemia y aumento del trabajo respiratorio; El fracaso se manifestó en 14 eventos (33,3%), la prevalencia de RVDD se expresó en 13 eventos (30,95%). En total se registraron 35 eventos, considerando la RVDD y los resultados clínicos. La asociación entre respuesta disfuncional en extubación y fracaso en extubación presentó, según resultados del test Chi-cuadrado, valor de 16,098 (p=0,00006). Los indicadores clínicos más destacados en las mediciones de precisión diagnóstica fueron: incomodidad respiratoria, respiración abdominal paradojal, aumento de concentración respiratoria, uso significativo de musculatura accesoria, ruidos adventicios respiratorios, percepción aumentada de oxígeno y fatiga. El destete fue dirigido por el equipo multiprofesional (médicos, enfermeros y fisioterapeutas). Fue presentada la regresión logística entre la variable dependiente - presencia de RVDD- y cada variable independiente, los indicadores clínicos y resultados de la extubación ortotraqueal. Dicho análisis permitió identificar si la relación entre las variables testeadas tenía distribución aleatoria. Así, se obtuvo la relación entre cada variable independiente y la variable resultante en fracaso en la extubación, midiéndose la fuerza asociativa por test de Chi-cuadrado, Razón de Chances (OR) e intervalo de confianza (IC) del 95%. Los impactos determinados por el fracaso del destete y extubación presentan múltiples facetas y constituyen indicadores de calidad en UTIs, al existir incremento de infecciones, mortalidad hospitalaria y manifiesto aumento de costos de internación. La extubación debe orientarse por juicio clínico y datos objetivos, para minimizar el riesgo de reintubaciones. Se construyó un caso clínico mediante simulación con bases conceptuales y metodológicas de la teoría del doble procesamiento. En base al mismo se elaboraron escenarios, partiéndose de las habilidades esperadas de los enfermeros durante la simulación. La elaboración y validación del escenario clínico de la simulación resultó importante para reducir la incertidumbre en su construcción. CONCLUSIONES: El estudio permitió distinguir entre el constructo clínico de la RVDD, en una evaluación de las respuestas manifestadas ante la experiencia de la extubación ortotraqueal en la perspectiva de una visión holística, y el fracaso de la extubación en un modelo más orientado a la terapia y a procesos fisiopatológicos.

Improvement and application of the opening method of mechanical ventilator humidification tank liquid / 中国实用护理杂志

Objective@#To improve the opening method of humidifier, enhance the efficiency and success rate of opening the humidifiers.@*Methods@#Use all the recycled humidifier from respirators in the wards from 1st of May to 31st of October 2015 as control group. Use the recycled humidifiers from 1st Feb to 31st July 2016 as the test group. Use metal tools to open humidifier bottles in the control group while use the newly developed and improved opening device to open the bottles in the test group to test and compare the damage rate.@*Results@#The testing group that used the practical opening device for humidifier has a decrease in damage rate from 5.97% (16/268) to 1.22% (3/245), and this difference before and after was statistically significant (χ2=8.082, P<0.01).@*Conclusions@#The use of the opening device for humidifier can enhance the intact rate, greatly improve working efficiency and save the cost.

Comfort and exertion while using filtering facepiece respirators with exhalation valve and an active venting system among male military personnel

<p><b>INTRODUCTION</b>This study aimed to determine if disposable filtering facepiece respirators (FFRs) that come with an exhalation valve (EV) and a novel active venting system (AVS) provided greater perceived comfort and exertion when compared to standard N95 FFRs without these features among male military personnel performing prolonged essential outdoor duties.</p><p><b>METHODS</b>We used a randomised open-label controlled crossover study design to compare three FFR options: (a) standard FFR; (b) FFR with EV; and (c) FFR with EV+AVS. Male military personnel aged between 18 and 20 years completed a questionnaire at the start of outdoor duty (baseline), after two hours of standardised non-strenuous outdoor duty and after 12 hours of duty divided into two-hour work-rest cycles. Participants rated the degree of discomfort, exertion and symptoms using a five-point Likert scale. The association between outcomes and types of FFR was assessed using a multivariate ordered probit mixed-effects model.</p><p><b>RESULTS</b>For a majority of the symptoms, study participants gave FFR with EV and FFR EV+AVS significantly better scores than standard FFR. Both FFR with EV and FFR with EV+AVS had significantly less discomfort (FFR with EV+AVS: 91.1%; FFR with EV: 57.6%) and exertion (FFR with EV+AVS: 83.5%; FFR with EV: 34.4%) than standard FFR. FFR with EV+AVS also had significantly better scores for exertion (53.4%) and comfort (39.4%) when compared to FFR with EV.</p><p><b>CONCLUSION</b>Usage of FFR with EV+AVS resulted in significantly reduced symptoms, discomfort and exertion when compared to FFR with EV and standard FFR.</p>

Prevalencia y factores de riesgo de la neumonía asociada con la asistencia respiratoria mecánica en una unidad de cuidados intensivos de adultos, Cúcuta, Colombia / Prevalence and risk factors of pneumonia associated with mecha-nical ventilation in the adult intensive care unit Cúcuta, Colombia / Prevalência e fatores de risco de pneumonia associada à ventilação mecânica em uma unidade de terapia intensiva para adultos, Cucuta, Colômbia

Objetivo. Determinar la prevalencia y los factores de riesgo del uso de la asistencia respiratoria mecánica que conllevan el desarrollo de neumonía en la unidad de cuidados intensivos de adultos de un hospital de tercer nivel de Cúcuta. Métodos. Estudio observacional, analítico, de corte transversal y con enfoque retrospectivo. Los datos se obtuvieron de las historias clínicas de pacientes que ingresaron a la unidad de cuidados intensivos de adultos del Hospital Universitario Erasmo Meoz de Cúcuta. Se obtuvieron 284 historias clínicas y se analizaron los datos de 69 pacientes que cumplieron con los criterios de inclusión establecidos. Resultados. De los 69 pacientes incluidos, 29 (42%) eran hombres. Se presentó neumonía asociada con asistencia respiratoria mecánica tardía en 28 pacientes (42%) y, con asistencia respiratoria mecánica temprana, en 12 pacientes (15,9%); los gérmenes aislados fueron Klebsiella pneumoniae y Pseudo-monas aeruginosa en un 13% de los cultivos reportados. El promedio de los días de estancia fue 29,7 y de asistencia respiratoria mecánica de 18. La probabilidad de presentar este tipo de neumonía fue 3,3 veces mayor al sufrir una enfermedad inmunosupresora y 3,2 veces mayor en los hombres, lo cual se reflejó en la prueba de ji al cuadrado (p=0,02) Conclusiones. La incidencia de la neumonía asociada con la asistencia respiratoria está en aumento, afectando de manera negativa a los pacientes que requieren soporte respiratorio en las unidades de cuidados intensivos, y eleva la mortalidad, los días de asistencia respiratoria, la estancia hospitalaria e, incluso, los gastos del sistema de salud

Objective: Determine the prevalence and risk factors of use mechanical ventilation that may lead to development pneumonia in the adults' intensive care unit of a third level hospital in Cúcuta. Methods: Observational, analytical, cross-sectional study with a retrospective approach was conducted. Data were obtained from medical records of patients admitted to the adult intensive care unit of the Erasmo Meoz University Hospital in Cúcuta city. We obtained 284 clinical histories and data from 69 patients who met the established inclusion criteria were analyzed. Results: 69 patients were included, 42% (29) patients were men. Pneumonia associated with delayed mechanical ventilation was present in 28 patients (42%) and, with early mechanical ventilation was found in 12 patients (15.9%); Klebsiella pneumoniae and Pseudomonas aeruginosa were isolated in 13% of the reported cultures. The day's average of stay was 29.7 with mechanical ventilation therapy of 18 days. Statistical analysis show that probability of presenting this type of pneumonia was 3.3 times higher when patient have an immunosuppressive disease and 3.2 times higher in men, which it was reflected in the chi-square test (p = 0.02). Conclusions: The incidence of pneumonia associated with respiratory assistance is increasing, negatively affecting patients who require respiratory support in intensive care units, and increases mortality, days of respiratory support, hospital permanence and increment the health system costs

Objetivo. Determinar a prevalência e os fatores de risco do uso de ventilação mecânica que implica o desenvolvimento de pneumonia na unidade de terapia intensiva de um hospital terciário de Cucuta. Métodos. Estudo observacional, analítico, transversal, com abordagem retrospectiva. Os dados foram obtidos dos prontuários de pacientes internados na unidade de terapia intensiva de adultos do Hospital Universitário Erasmo Meoz de Cúcuta. Foram obtidos 284 históricos clínicos e analisados os dados de 69 pacientes que cumpriram com os critérios de inclusão estabelecidos. Resultados. Dos 69 pacientes incluídos, 29 (42%) foram homens. Foi apresentada pneumonia asso-ciada a ventilação mecânica retardada em 28 pacientes (42%) e com ventilação mecânica precoce em 12 pacientes (15,9%); os germes isolados foram Klebsiella pneumoniae e Pseudomonas aeruginosa em 13% das culturas relatadas. O tempo médio de permanência foi de 29,7 dias e a ventilação mecâ-nica 18. A probabilidade de apresentar esse tipo de pneumonia foi 3,3 vezes maior quando se sofre uma doença imunossupressora e 3,2 vezes maior nos homens, que foi refletido no teste qui-quadrado (p = 0,02) Conclusões. A incidência de pneumonia associada à assistência respiratória está em aumento afe-tando negativamente os pacientes que precisam de suporte respiratório em unidades de cuidados intensivos, e aumenta a mortalidade, os dias da assistência respiratória, o tempo de permanência no hospital e até mesmo despesas do sistema de saúde.