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Technology and Innovation ; 22(2):199-217, 2022.
Article in English | ProQuest Central | ID: covidwho-2002774


In the first quarter of 2020, SARs-CoV-2 (COVID-19) infections began to grow at an alarming rate despite drastic measures to reduce infection rates. Severe COVID-19 cases required mechanical ventilation, resulting in ventilator shortages worldwide. To address the ventilator shortages, the authors developed the CoreVent 2020, an emergency-use ventilator for adult patients that was designed, built, and tested in ten days. The CoreVent 2020 is a pressure-cycled, time-limited ventilator with a breath-assist mode that operates on standard pressurized oxygen and medical air. It provides adjustable peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP). A medical-grade commercially available breathing circuit is used to minimize non-medical component requirements. The CoreVent 2020 was fabricated in-house at Stony Brook University Hospital and tested on three mechanical lung simulators in which the operating modes and alarm features were demonstrated. Animal studies were also performed in both normal breathing mode and breath-assisted modes. Arterial blood gas measurements confirmed that the ventilator provided satisfactory ventilation for the test subjects. The COVID-19 pandemic presented unique constraints on the design and innovation process not normally encountered in typical practice. Design decisions such as component choice, delivery time, and ease of high-volume, rapid manufacturing influenced all aspects of the design process. This aspect of the design/innovation process is also discussed, as well as an introductory discussion on how training and simulations can be developed so that innovation can occur efficiently in future crises situations.

Int Immunopharmacol ; 90: 107261, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-957149


BACKGROUND: There is still no specific treatment strategies for COVID-19 other than supportive management. DESIGN: A prospective case-control study determined by admittance to the hospital based on bed availability. PARTICIPANTS: Eighteen patients with COVID-19 infection (laboratory confirmed) severe pneumonia admitted to hospital between 20th March and 19th April 2020. Patients admitted to the hospital during the study period were assigned to different beds based on bed availability. Depending on the bed the patient was admitted, the treatment was ozone autohemotherapy or standard treatment. Patients in the case group received ozonated blood twice daily starting on the day of admission for a median of four days. Each treatment involved administration of 200 mL autologous whole blood enriched with 200 mL of oxygen-ozone mixture with a 40 µg/mL ozone concentration. MAIN OUTCOMES: The primary outcome was time from hospital admission to clinical improvement. RESULTS: Nine patients (50%) received ozonated autohemotherapy beginning on the day of admission. Ozonated autohemotherapy was associated with shorter time to clinical improvement (median [IQR]), 7 days [6-10] vs 28 days [8-31], p = 0.04) and better outcomes at 14-days (88.8% vs 33.3%, p = 0.01). In risk-adjusted analyses, ozonated autohemotherapy was associated with a shorter mean time to clinical improvement (-11.3 days, p = 0.04, 95% CI -22.25 to -0.42). CONCLUSION: Ozonated autohemotherapy was associated with a significantly shorter time to clinical improvement in this prospective case-control study. Given the small sample size and study design, these results require evaluation in larger randomized controlled trials. CLINICAL TRIAL REGISTRATION NUMBER: NCT04444531.

Blood Transfusion, Autologous , COVID-19/therapy , Ozone/therapeutic use , SARS-CoV-2 , Aged , Aged, 80 and over , COVID-19/mortality , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Treatment Outcome
Ann Surg ; 272(2): e63-e65, 2020 08.
Article in English | MEDLINE | ID: covidwho-706917


BACKGROUND: A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation. High density consolidations in the bronchial tree and in the pulmonary parenchyma have been described in the advanced phase of the disease. We noted a subset of patients who had a sudden, significant increase in peak airway, plateau and peak inspiratory pressures. Partial or complete ETT occlusion was noted to be the culprit in the majority of these patients. METHODS: With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients. All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist. During multidisciplinary rounds, all arterial blood gas (ABG) results, ventilator settings and ventilator measurements are discussed and addressed. ARDSNet Protocols are employed. In patients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway and peak inspiratory pressures are noted in conjunction with desaturation. Data was collected retrospectively and demographics, ventilatory settings and ABG results were recorded. RESULTS: Our team has observed impeded ventilation in intubated patients who are several days into the critical course. Pathologic evaluation of the removed endotracheal tube contents from one of our patients demonstrated a specimen consistent with sloughed tracheobronchial tissues and inflammatory cells in a background of dense mucin. Of 110 patients admitted to our adult COVID-19 ICUs, 28 patients required urgent exchange of their ETT. CONCLUSION: Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent.

Bronchi/injuries , Coronavirus Infections/therapy , Intubation, Intratracheal/adverse effects , Pneumonia, Viral/therapy , Respiration, Artificial/adverse effects , Trachea/injuries , Adult , Betacoronavirus , COVID-19 , Female , Humans , Intensive Care Units , Male , Pandemics , SARS-CoV-2