Aprv Avoids Ecmo in Severe Ards Patients Referred for Ecls

INTRODUCTION: Severe ARDS has mortality rates exceeding 45% particularly when meeting criteria for ECMO. APRV has been used for over 4 decades to improve oxygenation when failing conventional MV strategies and may reduce the need for ECMO rescue if implemented early. METHOD(S): Retrospective study of all adult patients referred for V-V ECMO evaluation at UF-Jacksonville for ARDS from 7/17 - 8/2021 including COVID-19 illness that were managed on APRV without ECMO. The EMR was used to search for the datapoints: survival to discharge, P/F ratio at time of referral and then at 1, 6, and 24 hours after initiating APRV when ECMO was not implemented, paralytic and vasopressor usage prior to and 6 hours after initiating APRV, and lactate levels at time 0, 6 hours and 24 hours after initiating APRV. RESULT(S): There were 65 consults for V-V ECMO due to ARDS that were managed on APRV without ECMO. The mean age was 40.1 years;59% men and 41% women;category of ARDS was medical in 72%, trauma in 26%, and surgical in 2%. All patients were on ARDsnet ventilation strategy when referred. The survival to discharge was 79.3% with 50% going home, 39% to rehab, and 11% to an LTAC. The mean P/F ratio at time of evaluation was 77.1;1 hour after initiating APRV it was 122.7;6 hours after initiating it was 163.8;24 hours after initiating it was 211.8 and the mean FiO2 at 24 hours was 59.2%. At time of evaluation 50.8% of patients were on paralytic infusions and 33.3% were on vasopressors while 6 hours after initiating APRV it was 0% for the former and 14.5% for the latter. Mean serum lactate was 3.1 mmol/L at time 0, then 2.6 mmol/L 6 hours after APRV was initiated, and 2.3 mmol/L 24 hours after initiating APRV. CONCLUSION(S): We had excellent success using APRV to improve severe hypoxia in patients failing on standard ventilation using ARDSnet strategy, with a survival rate without ECMO of nearly 80%. The reduction in paralytic use and vasopressor requirements likely contributed to improved pulmonary and cardiovascular function allowing the vast majority of survivors to go home directly or home after shortterm rehab stay. APRV should be considered in severe ARDS and may avoid the need for ECMO in some patients if applied before the patient is in extremis.

Outcomes Using Aprv for Severe Covid-19 Ards Referred for Ecmo

INTRODUCTION: Severe ARDS has mortality rates exceeding 45% particularly when meeting criteria for ECMO;COVID-19 patients requiring MV for ARDS have even higher mortality rates. APRV has been used for over 4 decades to improve oxygenation when failing conventional MV strategies, but it was implemented in many ICUs for the 1st time during the COVID-19 pandemic. METHOD(S): Retrospective study of all adult patients referred for V-V ECMO evaluation at UF-Jacksonville due to COVID-19 induced ARDS from 6/2020 - 9/2021. The EMR was used to search for the datapoints: survival to discharge, P/F ratio at time of referral and then at 1, 6, and 24 hours after initiating APRV when ECMO was not implemented, and paralytic and vasopressor usage prior to and 6 hours after initiating APRV. RESULT(S): A total of 30 patients were referred for V-V ECMO. 20 patients (12 men, 8 women, mean age 41.4 years) were managed without ECMO utilizing APRV. The survival rate was 55% (11/20) with 91% discharged to home and 9% to rehab;five deaths were attributed to other specific causes such as: loss of airway, STEMI, myocarditis (VF) in 2 patients, and MSSA bacteremia. All patients were on ARDsnet ventilation strategy when referred. The mean P/F ratio at time of evaluation was 71.0;1 hour after initiating APRV it was 129.2;6 hours after initiating it was 135.5;24 hours after initiating it was 172.9 and the mean FiO2 at 24 hours was 67.9%. At time of evaluation 52.6% of patients were on paralytic infusions and 15.8% were on vasopressors while 6 hours after initiating APRV it was 0% for both. 10 patients required ECMO with survival rate of 30%. Six of the 10 patients went on ECMO immediately at the time of ECLS consult due to being in extremis from severe hypoxia as well as some patients also with critical respiratory acidosis. CONCLUSION(S): We had good success using APRV to improve severe hypoxia in patients failing on standard ventilation using ARDSnet strategy with a survival rate without ECMO of 55%. The reduction in paralytic use and vasopressor requirements likely contributed to >90% of survivors being able to go directly home. APRV should be considered in COVID-19 induced ARDS and may avoid the need for ECMO in some patients.

COVID-19-associated secondary hemophagocytic lymphohistiocytosis requiring hematopoietic cell transplant.

Coronavirus disease 2019 (COVID-19) infection causes a variety of extrapulmonary complications in pediatric patients. Multisystem inflammatory syndrome and hemophagocytic lymphohistiocytosis (HLH) are related to hypercytokinemia in COVID-19 patients. HLH is a disorder of exaggerated inflammation resulting in a cytokine storm and unrestricted hemophagocytosis. HLH can be primary (familial) or secondary (acquired). Secondary HLH (sHLH) can occur in patients with rheumatologic, oncologic, or infectious diseases. The link between COVID-19 and HLH has been reported in pediatric patients. Here we report a case of a pediatric patient who developed refractory sHLH secondary to COVID-19 infection and required a hematopoietic cell transplant for the cure.

Inactivation Rates for Airborne Human Coronavirus by Low Doses of 222 nm Far-UVC Radiation.

Recent research using UV radiation with wavelengths in the 200-235 nm range, often referred to as far-UVC, suggests that the minimal health hazard associated with these wavelengths will allow direct use of far-UVC radiation within occupied indoor spaces to provide continuous disinfection. Earlier experimental studies estimated the susceptibility of airborne human coronavirus OC43 exposed to 222-nm radiation based on fitting an exponential dose-response curve to the data. The current study extends the results to a wider range of doses of 222 nm far-UVC radiation and uses a computational model coupling radiation transport and computational fluid dynamics to improve dosimetry estimates. The new results suggest that the inactivation of human coronavirus OC43 within our exposure system is better described using a bi-exponential dose-response relation, and the estimated susceptibility constant at low doses-the relevant parameter for realistic low dose rate exposures-was 12.4 ± 0.4 cm2/mJ, which described the behavior of 99.7% ± 0.05% of the virus population. This new estimate is more than double the earlier susceptibility constant estimates that were based on a single-exponential dose response. These new results offer further evidence as to the efficacy of far-UVC to inactivate airborne pathogens.

Inactivation Rates for Airborne Human Coronavirus by Low Doses of 222 nm Far-UVC Radiation

Recent research using UV radiation with wavelengths in the 200–235 nm range, often referred to as far-UVC, suggests that the minimal health hazard associated with these wavelengths will allow direct use of far-UVC radiation within occupied indoor spaces to provide continuous disinfection. Earlier experimental studies estimated the susceptibility of airborne human coronavirus OC43 exposed to 222-nm radiation based on fitting an exponential dose–response curve to the data. The current study extends the results to a wider range of doses of 222 nm far-UVC radiation and uses a computational model coupling radiation transport and computational fluid dynamics to improve dosimetry estimates. The new results suggest that the inactivation of human coronavirus OC43 within our exposure system is better described using a bi-exponential dose–response relation, and the estimated susceptibility constant at low doses-the relevant parameter for realistic low dose rate exposures-was 12.4 ±0.4 cm2/mJ, which described the behavior of 99.7% ±0.05% of the virus population. This new estimate is more than double the earlier susceptibility constant estimates that were based on a single-exponential dose response. These new results offer further evidence as to the efficacy of far-UVC to inactivate airborne pathogens.

Understanding the Experiences of Remote Workers: Opportunities for Ambient Workspaces at Home

As the COVID-19 pandemic has forced many to work remotely from home, collaborating solely through digital technologies, a growing population of remote home workers are faced with profound wellbeing challenges. Passive sensing devices and ambient feedback have great potential to support the wellbeing of the remote workers, but there is a lack of background and understanding of the domestic workplace in terms of physical and affective dimensions and challenges to wellbeing. There are profound research gaps on wellbeing in the domestic workplace, with the current push for remote home and hybrid working making this topic timely. To address these gaps and shape a starting point for an “ambient workspaces” agenda, we conducted an exploratory study to map physical and affective aspects of working from home. The study involved both qualitative and quantitative measures of occupant experience, including sensor wristbands, and a custom web application for self-reporting mood and aspects of the environment. It included 13 participants for a period of 4 weeks, during a period of exclusive home working. Based on quantitative and qualitative analysis, our study addresses wellbeing challenges of the domestic workplace, establishes correlations between mood and physical aspects, and discusses the impact of feedback mechanisms in the domestic workplace on the behavior of remote workers. Insights from these observations are then used to inform a future design agenda for ambient technologies that supports the wellbeing of remote workers;addressing the design opportunities for ambient interventions in domestic workspaces. This work offers three contributions: 1) qualitatively and quantitatively informed understandings of the experiences of home-workers;2) a future design agenda for “ambient home workspaces”;and 3) we propose three design concepts for ambient feedback and human–AI interactions in the built environment, to illustrate the utility of the design agenda. © Copyright © 2021 Margariti, Ali, Benthem de Grave, Verweij, Smeddinck and Kirk.

Improved estimates of 222 nm far-UVC susceptibility for aerosolized human coronavirus via a validated high-fidelity coupled radiation-CFD code.

Transmission of SARS-CoV-2 by aerosols has played a significant role in the rapid spread of COVID-19 across the globe. Indoor environments with inadequate ventilation pose a serious infection risk. Whilst vaccines suppress transmission, they are not 100% effective and the risk from variants and new viruses always remains. Consequently, many efforts have focused on ways to disinfect air. One such method involves use of minimally hazardous 222 nm far-UVC light. Whilst a small number of controlled experimental studies have been conducted, determining the efficacy of this approach is difficult because chamber or room geometry, and the air flow within them, influences both far-UVC illumination and aerosol dwell times. Fortunately, computational multiphysics modelling allows the inadequacy of dose-averaged assessment of viral inactivation to be overcome in these complex situations. This article presents the first validation of the WYVERN radiation-CFD code for far-UVC air-disinfection against survival fraction measurements, and the first measurement-informed modelling approach to estimating far-UVC susceptibility of viruses in air. As well as demonstrating the reliability of the code, at circa 70% higher, our findings indicate that aerosolized human coronaviruses are significantly more susceptible to far-UVC than previously thought.

Predicting airborne coronavirus inactivation by far-UVC in populated rooms using a high-fidelity coupled radiation-CFD model.

There are increased risks of contracting COVID-19 in hospitals and long-term care facilities, particularly for vulnerable groups. In these environments aerosolised coronavirus released through breathing increases the chance of spreading the disease. To reduce aerosol transmissions, the use of low dose far-UVC lighting to disinfect in-room air has been proposed. Unlike typical UVC, which has been used to kill microorganisms for decades but is carcinogenic and cataractogenic, recent evidence has shown that far-UVC is safe to use around humans. A high-fidelity, fully-coupled radiation transport and fluid dynamics model has been developed to quantify disinfection rates within a typical ventilated room. The model shows that disinfection rates are increased by a further 50-85% when using far-UVC within currently recommended exposure levels compared to the room's  ventilation alone. With these magnitudes of reduction, far-UVC lighting could be employed to mitigate SARS-CoV-2 transmission before the onset of future waves, or the start of winter when risks of infection are higher. This is particularly significant in poorly-ventilated spaces where other means of reduction are not practical, in addition social distancing can be reduced without increasing the risk.