Cerebral Air Embolism During a Flight

Introduction: We report a case of a 67 year old lady with an acute drop in conscious level whilst on a transatlantic flight. She had a background history of TII DM and recent mild COVID. Past surgical history of a gastric bypass, at which time a CXR had incidentally shown a bulla, with no underlying respiratory symptoms, or history of COPD. Method(s): On arrival in the emergency department, her GCS was 7/15, and she required immediate intubation. Non-contrast CT head showed multiple tiny gas locules in keeping with air emboli. CT Chest, Abdo, Pelvis showed an 88mm bulla within the left lung lingula with a bronchus and many large pulmonary vessels running on its edge. Result(s): It was thought the change in air pressure during the flight caused a communication to open between the bulla and the pulmonary circulation resulting in the release of air emboli. Conclusion(s): She required ITU admission for 8 days. After initial stabilisation she was stepped down to HASU. Neurologically she was dysphagic, dysarthric, quadriplegic and GCS 14 due to confusion. MRI whole spine ruled out spinal cord pathology. Repeat CT head showed air initially present had completely resorbed leaving multifocal, small areas of cortical and subcortical ischaemia in both cerebral hemispheres. MRI head confirmed innumerable small early subacute embolic ischaemic infarcts across multiple vascular distributions.

V-tube: The first prototype of pneumatic actuated soft nasal swab for COVID-19 screening

Swab and tube are widely used in respiratory specimen collections for current COVID-19 screening. This paper proposes the design of a novel pneumatic actuated soft nasal swab, named V-tube. The V-tube consists of three main parts: an outer tube, a cap integrated with broth container and an active film (AF) that can be squeezed out of the tube under positive air pressure to collect nasal mucus cells. The working process and material selection of this swab is studied via Finite Element Analysis (FEA). It is expected to integrate the V-tube with a dual arm mobile collaborative robot (MCR) to accomplish nucleic acid sampling instead of medical staff. Therefore, a robot-applicable pneumatic system is designed to supply appropriate force to drive the V-tube. The potential manufacturing and control issues of the V-tube are discussed for further studies. © 2022 IEEE.

High-flow nasal oxygen in acute hypoxemic respiratory failure: A narrative review of the evidence before and after the COVID-19 pandemic.

High-flow nasal oxygen (HFNO) is a type of non-invasive advanced respiratory support that allows the delivery of high-flow and humidified air through a nasal cannula. It can deliver a higher inspired oxygen fraction than conventional oxygen therapy (COT), improves secretion clearance, has a small positive end-expiratory pressure, and exhibits a washout effect on the upper air space that diminishes dead space ventilation. HFNO has been shown to reduce the work of breathing in acute hypoxemic respiratory failure (AHRF) and has become an interesting option for non-invasive respiratory support. Evidence published before the COVID-19 pandemic suggested a possible reduction of the need for invasive mechanical ventilation compared to COT. The COVID-19 pandemic has resulted in a substantial increase in AHRF worldwide, overwhelming both acute and intensive care unit capacity in most countries. This triggered new trials, adding to the body of evidence on HFNO in AHRF and its possible benefits compared to COT or non-invasive ventilation. We have summarized and discussed this recent evidence to inform the best supportive strategy in AHRF both related and unrelated to COVID-19.

Cumulative effects of air pollution and climate drivers on COVID-19 multiwaves in Bucharest, Romania.

Over more than two years of global health crisis due to ongoing COVID-19 pandemic, Romania experienced a five-wave pattern. This study aims to assess the potential impact of environmental drivers on COVID-19 transmission in Bucharest, capital of Romania during the analyzed epidemic period. Through descriptive statistics and cross-correlation tests applied to time series of daily observational and geospatial data of major outdoor inhalable particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) or ≤ 10 µm (PM10), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide (SO2), carbon monoxide (CO), Aerosol Optical Depth at 550 nm (AOD) and radon (222Rn), we investigated the COVID-19 waves patterns under different meteorological conditions. This study examined the contribution of individual climate variables on the ground level air pollutants concentrations and COVID-19 disease severity. As compared to the long-term average AOD over Bucharest from 2015 to 2019, for the same year periods, this study revealed major AOD level reduction by ~28 % during the spring lockdown of the first COVID-19 wave (15 March 2020-15 May 2020), and ~16 % during the third COVID-19 wave (1 February 2021-1 June 2021). This study found positive correlations between exposure to air pollutants PM2.5, PM10, NO2, SO2, CO and 222Rn, and significant negative correlations, especially for spring-summer periods between ground O3 levels, air temperature, Planetary Boundary Layer height, and surface solar irradiance with COVID-19 incidence and deaths. For the analyzed time period 1 January 2020-1 April 2022, before and during each COVID-19 wave were recorded stagnant synoptic anticyclonic conditions favorable for SARS-CoV-2 virus spreading, with positive Omega surface charts composite average (Pa/s) at 850 mb during fall- winter seasons, clearly evidenced for the second, the fourth and the fifth waves. These findings are relevant for viral infections controls and health safety strategies design in highly polluted urban environments.

Low-cost CPAP device for patients with COVID-19

The increase in COVID-19 infections due to the appearance of new variants causes serious health problems in the population. Although the majority of those infected have no symptoms, approximately 19% will require oxygen therapy for respiratory support, either by invasive or non-invasive ventilation. The high costs of this equipment mean that hospitals in developing countries have a limited supply of such equipment. Therefore, this paper presents the redesign, simulation, fabrication, and evaluation of a CPAP device that was developed in Europe but has now been replicated in Latin America. It starts with the analysis of the device’s original design and through exploratory techniques and computer simulation the materials, parts, and assembly are determined. Functional tests validate that a prototype similar to the original was obtained that will provide noninvasive positive air pressure that keeps patients' airways open. © 2022 IEEE Computer Society. All rights reserved.

Helmet Non-Invasive Ventilation for Acute Respiratory Failure: A Case Series

Rationale: The helmet is a novel interface for delivering non-invasive ventilation (NIV) to hospitalized patients with respiratory failure. Its purported benefits compared to traditional oronasal interface includes better tolerance, lower intubation rates, improved survival, increased ventilator free days and decreased ICU length of stay. However, to date, only small randomized control trials (RCTs) have been conducted on this topic. Given this, we conducted an observational study describing single-centre institutional and patient experience with this device in both COVID and non-COVID patients. Methods: With REB approval, we enrolled all patients with respiratory failure admitted to the Juravinski Hospital ICU in Hamilton, Canada who used the helmet interface (Intersurgical StarMed) for delivery of NIV between November 1, 2020 and June 30, 2021. We collected patient demographics, past medical history, reason for respiratory failure, NIV settings and patient outcomes. We also recorded any complications ascribed to the device and conducted informal interviews with clinicians regarding issues with helmet use. We present results descriptively without statistical comparisons.Results: We included 13 patients in this observational cohort study. The mean age was 66.3 ± (standard deviation) 10.3 years and 39.4% of the patients were female. The most common etiology for respiratory failure was pneumonia (76.9%). The mean duration of NIV during the ICU admission was 127.9 ± 198.8 minutes, with a mean maximum inspiratory positive air pressure (IPAP) of 16.2 ± 3.2 cm H2O and a mean maximum expiratory positive airway pressure (EPAP) of 8.5 cm H20 ± 1.7. Three patients (23%) did not tolerate the helmet. Seven (53.8%) patients ultimately required intubation, and 5 (38.5%) patients died while in the ICU. The most common reason for intubation was worsening hypoxia (30.8%). The mean length of stay in ICU was 30.8 ± 29.9 days. 1 (8%) patient had an aspiration event with helmet use, but no other complications were recorded. Clinician interviews revealed that the most common issues with the helmet were patient agitation , oronasal mucosal dryness due to lack of humidity and skin breakdown at the armpits. Conclusion: This observational cohort study reports our institutional experience with the helmet interface for delivery of NIV. In our 8-month experience, we found that the helmet was well tolerated in the majority of patients and just over half ultimately required intubation. Issues regarding lack of humidity, skin breakdown around the armpits and agitation will need to be addressed as we continue to gain expertise with this interface. (Table Presented).

Negative Air Pressure Isolation Room for COVID-19 Patients in the Philippines: A Simulation of the Proposed Design using SolidWorks

Since the start of the 2019 pandemic, medical staff and non-medical staff are fighting on the front line in all hospitals worldwide. However, the possibility of healthcare workers' scarcity due to the increasing medical infection rate is ignored in many recent studies. To prevent such things to happen, the installation of a negative air pressure isolation room is proposed to Norzagaray Municipal Hospital (NMH). Primary parameters such as filtration, pressure management, and dilution ventilation were investigated in SOLIDWORKS simulation software by removing one parameter per simulation. Two existing schemes were simulated, and the primary parameters present were evaluated. Three ventilation design set-ups were designed and the effects of the varying placements of the primary parameters to the airflow pattern in a negative air pressure isolation room were determined. Cost-benefit analysis (CBA) was conducted to determine if the cost of installing the negative air pressure room outweighs its benefit. The set-up where the High efficiency particulate air (HEPA) machine is inside the room is proposed to NMH as this abides by the Department of Health (DOH) memorandum and standards on Airborne Infection Isolation Rooms (AIIRs) and is the most effective of the three set-ups. Results show that filtration filters the infectious particles, pressure management manages the proper airflow direction, and dilution ventilation makes sure there are enough air changes per hour to filter a percentage of infectious particles. In the existing schemes, all the primary parameters were used to contain the infectious particles in the room, however, the effectivity of the filtration also depends on the location of the patient, supply, and exhaust. The most significant effect of the varying placements of the primary parameters can be seen in filtration as only the set-up where the HEPA machine is inside the room was able to filter 100% of the infectious particles. It is also the most profitable ventilation design set-up with a 2.08 CBA ratio and has the least payback period of 5.8 months. © 2021 IEEE.

Short-Term Continuous Positive Air Pressure Treatment: Effects on Quality of Life and Sleep in Patients with Obstructive Sleep Apnea.

Background and Objectives: The aim of this study was to evaluate short-term continuous positive air pressure (CPAP) treatment for health-related quality of life (HRQL) in patients with obstructive sleep apnea. Materials and Methods: Our subjects were 18-65 years old, diagnosed with moderate-to-severe obstructive sleep apnea and treated with CPAP between January 2020 and June 2021 in Hospital of Lithuanian University of Health Sciences Kaunas clinics. All the patients completed the Epworth Sleepiness Scale (ESS), the 36-Item Short Form Health Survey (SF-36), the and Pittsburgh Sleep Quality Index (PSQI) before and after 3 months of treatment. Polysomnography was also repeated. Statistical analyses were performed using SPSS 27.0 software. The value of p < 0.05 was considered as statistically significant. Results: The active-treatment group comprised 17 subjects with a mean age of 51.9 ± 8.9 years. The total SF-36 questionnaire score improved from 499.8 ± 122.3 to 589.6 ± 124.7 (p = 0.012). The SF-36 role limitations due to emotional problems (p = 0.021), energy (fatigue) (p = 0.035), and general health (p = 0.042) domains score significantly improved after CPAP treatment for 3 months. The PSQI mean score at baseline was 12.6 ± 2.9 and in the post-treatment group, it was -5.5 ± 2.3 (p = 0.001). The ESS also changed significantly from a pretreatment mean score of 10.9 ± 5.7 to -5.3 ± 3.2 (p = 0.002) after 3 months. Conclusions: Improvement in HRQL is seen even after a short treatment period with CPAP. Questionnaires are a good tool to evaluate CPAP treatment efficacy.

Time-Variant Positive Air Pressure in Drainage Stacks as a Pathogen Transmission Pathway of COVID-19.

Time-variant positive air pressure in a drainage stack poses a risk of pathogenic virus transmission into a habitable space, however, the excessive risk and its significance have not yet been sufficiently addressed for drainage system designs. This study proposes a novel measure for the probable pathogenic virus transmission risk of a high-rise drainage stack with the occurrence of positive air pressure. The proposed approach is based on time-variant positive air pressures measured in a 38 m high drainage stack of a full-scale experimental tower under steady flow conditions of flow rate 1-4 Ls-1 discharging at a height between 15 m to 33 m above the stack base. The maximum pressure and probabilistic positive air pressures in the discharging stack ventilation section with no water (Zone A of the discharging drainage stack) were determined. It was demonstrated that the positive air pressures were lower in frequency as compared with those in other stack zones and could propagate along the upper 1/3 portion of the ventilation pipe (H' ≥ 0.63) towards the ventilation opening at the rooftop. As the probabilistic positive pressures at a stack height were found to be related to the water discharging height and flow rate, a risk model of positive air pressure is proposed. Taking the 119th, 124th, 140th and 11,547th COVID-19 cases of an epidemiological investigation in Hong Kong as a baseline of concern, excessive risk of system overuse was evaluated. The results showed that for a 20-80% increase in the frequency of discharge flow rate, the number of floors identified at risk increased from 1 to 9 and 1 to 6 in the 34- and 25-storey residential buildings, respectively. The outcome can apply to facilities planning for self-quarantine arrangements in high-rise buildings where pathogenic virus transmission associated with drainage system overuse is a concern.

Meteorological factors, COVID-19 cases, and deaths in top 10 most affected countries: an econometric investigation.

This paper examines the nexus between the Covid-19 confirmed cases, deaths, meteorological factors, including an air pollutant among the world's top 10 infected countries, from 1 February 2020 through 30 June 2020, using advanced econometric techniques to address heterogeneity across the nations. The findings of the study suggest that there exists a strong cross-sectional dependence between Covid-19 cases, deaths, and all the meteorological factors for the countries under study. The findings also reveal that a long-term relationship exists between all the meteorological factors. There exists a bi-directional causality running between the Covid-19 cases and all the meteorological factors. With Covid-19 death cases as the dependent variable, there exists bi-directional causality running between the Covid-19 death cases and Covid-19 confirmed cases, air pressure, humidity, and temperature. Temperature and air pressure exhibit a statistically significant and negative impact on the Covid-19 confirmed cases. Air pollutant PM2.5 also exhibits a significant but positive impact on the Covid-19 confirmed cases. Temperature indicates a statistically significant and negative impact on the Covid-19 death cases. At the same time, Covid-19 confirmed cases and air pollutant PM2.5 exhibit a statistically significant and positive impact on the Covid-19 death cases across the ten countries under study. Hence, it is possible to postulate that cool and dry weather conditions with lower temperatures may promote indoor activities and human gatherings (assembling), leading to virus transmission. This study contributes both practically and theoretically to the concerned field of pandemic management. Our results assist in taking appropriate measures in implementing intersectoral policies and actions as necessary in a timely and efficient manner. Causal relations of Meteorological factors and Covid-19 (2 models used in the study).

Econometric analysis of COVID-19 cases, deaths, and meteorological factors in South Asia.

The pandemic has affected almost 74 million people worldwide as of 17 December 2020. This is the first study that attempts to examine the nexus between the confirmed COVID-19 cases, deaths, meteorological factors, and the air pollutant namely PM2.5 in six South Asian countries, from 1 March 2020 to 30 June 2020, using the advanced econometric techniques that are robust to heterogeneity across nations. Our findings confirm (1) a strong cross-sectional dependence and significant correlation between COVID-19 cases, deaths, meteorological factors, and air pollutant; (2) long-term relationship between all the meteorological variables, air pollutant, and COVID-19 death cases; (3) temperature, air pressure, and humidity exhibit a significant impact on the COVID-19 confirmed cases, while COVID-19 confirmed cases and air pollutant PM2.5 have a statistically significant impact on the COVID-19 death cases. In this way, the conclusion that high temperature and high humidity increase the transmission of the COVID-19 infections can also be applied to the regions with greater transmission rates, where the minimum temperature is mostly over 21 °C and humidity ranges around 80% for months. From the findings, it is evident that majority of the meteorological factors and air pollutant PM2.5 exhibit significant negative and positive effects on the number of COVID-19 confirmed cases and death cases in the six countries under study. Air pollutant PM 2.5 provides more particle surface for the virus to stick and get transported longer distances. Hence, higher particulate pollution levels in the air increase COVID-19 transmission in these six South Asian countries. This information is vital for the government and public health authorities in formulating relevant policies. The study contributes both practically and theoretically to the concerned field of pandemic management.