Guideline for the Management of Neonates Born to Mothers With COVID-19.

For the extended duration of the coronavirus disease 2019 (COVID-19) pandemic, reports emerged that mother-to-child transmission rates were low. However, the pandemic protocols including strict isolation, testing for severe acute respiratory syndrome coronavirus 2, and negative pressure isolation remained in Korea. Recently, the guideline for the management of neonates born to mothers with COVID-19 have been revised based on guidelines in other countries. Here, we introduce this newly developed guideline and review the foreign guidelines that were used for reference.Copyright © 2022 The Korean Society of Pediatric Infectious Diseases.

The airflow distribution and aerosol diffusion rules in the negative pressure isolation ward

Negative pressure wards are significant in preventing the spread of infectious pathogens which play a crucial role in fighting against COVID-19. Owing to the negative pressure, contaminated air with pathogens is not able to flow from the wards to non-contaminated zones while fresh filtered air will be transported to the ward via the ventilation system. As airflow controlled by ventilation systems affects the motion of pathogens, for example, infectious aerosol particles, the ability of a negative pressure ward to reduce the risk of infection highly relies on an effective ventilation system. In this investigation, impacts of airflow patterns under various human postures and ventilation processes aerosols diffusion are analyzed via the computational fluid dynamics (CFD) simulation. According to the results, among three airflow patterns, the highest contaminant removal efficiency is 57% at 200 s with the top supply and bottom return mode;besides, in three postures, in the case that the patient is in a standing position, the contaminant removal efficiency is the highest. Furthermore, it is found that the best airflow scheme is a slit tuyere in the ward, with a top supply and side return mode and a sitting position for the patient. This study may provide a reference for the design of airflow in negative pressure isolation wards, control of contaminants, and prevention of viral infections, so as to ensure a good working and recovery environment for medical staff and patients. [ FROM AUTHOR] Copyright of Simulation is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Principles of management for patients with oral cancer during the COVID-19 pandemic

The outbreak of coronavirus disease 2019 (COVID-19) affects the world. It is highly contagious and spreads quickly. COVID-19 severely increases the medical burden and interferes with our normal work. This article introduces our experience on treat oral cancer patients during the epidemic. The negative impact can be minimized through reasonable and orderly arrangement.Copyright © 2021 The Authors

Optimized PI Control with Tracking Differentiator for Negative Pressure Cabin Control

To block the epidemics like "Corona Virus Disease 2019(COVID-19)"spreading, an effective isolation of the infected patients during the transportation is an important issue, which makes the negative pressure cabin (NPC) become a key equipment. There exist some practical NPCs in service, whose pressures are mostly controlled using the conventional PID controller with parameters regulated by engineering methods. Until now, there is no report about the model of NPC system from the authors' best knowledge. In this paper, the model of the NPC system is reported, which is an inherent nonlinear system. Because of the nonlinear nature of the cabin pressure, the conventional PID controller cannot achieve desire performance to balance the transient and the steady state performance, even though the optimized PID parameters are chosen using the on-line optimization based on genetic algorithm. To solve such a problem, Tracking Differentiator (TD) and PI controller are combined to achieve the desire performance using the optimized parameters. The experiment results show the improvement of the proposed method. © 2022 IEEE.

One-year monitoring SARS-CoV-2 RNA surface contamination in hospitals reveals no correlation with organic material and negative pressure as a limiting factor for contamination.

Understanding transmission routes of SARS-CoV-2 is crucial to establish effective interventions in healthcare institutions. Although the role of surface contamination in SARS-CoV-2 transmission has been controversial, fomites have been proposed as a contributing factor. Longitudinal studies about SARS-CoV-2 surface contamination in hospitals with different infrastructure (presence or absence of negative pressure systems) are needed to improve our understanding of their effectiveness on patient healthcare and to advance our knowledge about the viral spread. We performed a one-year longitudinal study to evaluate surface contamination with SARS-CoV-2 RNA in reference hospitals. These hospitals have to admit all COVID-19 patients from public health services that require hospitalization. Surfaces samples were molecular tested for SARS-CoV-2 RNA presence considering three factors: the dirtiness by measuring organic material, the circulation of a high transmissibility variant, and the presence or absence of negative pressure systems in hospitalized patients' rooms. Our results show that: (i) There is no correlation between the amount of organic material dirtiness and SARS-CoV-2 RNA detected on surfaces; (ii) SARS-CoV-2 high transmissible Gamma variant introduction significantly increased surface contamination; (iii) the hospital with negative pressure systems was associated with lower levels of SARS-CoV-2 surface contamination and, iv) most environmental samples recovered from contaminated surfaces were assigned as non-infectious. This study provides data gathered for one year about the surface contamination with SARS-CoV-2 RNA sampling hospital settings. Our results suggest that spatial dynamics of SARS-CoV-2 RNA contamination varies according with the type of SARS-CoV-2 genetic variant and the presence of negative pressure systems. In addition, we showed that there is no correlation between the amount of organic material dirtiness and the quantity of viral RNA detected in hospital settings. Our findings suggest that SARS CoV-2 RNA surface contamination monitoring might be useful for the understanding of SARS-CoV-2 dissemination with impact on hospital management and public health policies. This is of special relevance for the Latin-American region where ICU rooms with negative pressure are insufficient.

Research on the relationship between architectural features in northeast China and vertical aerosol transmission of COVID-19.

During the COVID-19 pandemic, many buildings in northeast China have had clusters of infected cases in the vertical layout. There is speculation that vertical aerosol transmission occurs. The houses in northeast China are airtight, and range hoods may be used for a long period of time when cooking. The pathway and factors influencing vertical aerosol transmission are worth studying. To elucidate a viral aerosol transmission pathway, we selected a multistory apartment and a high-rise building in Changchun city, Jilin province, China, to conduct an in-depth investigation and on-site simulation experiments. According to epidemiological investigation information on infected cases, building structures, drainage, ventilation, etc., we used fluorescent microspheres to simulate the behaviors of infected people, such as breathing and flushing the toilet after defecation, to discharge simulated viruses and track and monitor them. The field simulation experiment confirmed the transmission of fluorescent microsphere aerosols to other rooms in two types of buildings using a vertical aerosol transmission pathway of toilet flush-sewage pipe-floor drain without a water seal. Our study showed that, in the absence of a U-shaped trap or floor drain water seal whether in a multistory apartment or high-rise residential building, there is a transmission pathway of "excretion of virus through feces-toilet flushing-sewage pipe-floor drain without water seal," which will cause the vertical transmission of viral aerosol across floors during the COVID-19 pandemic. Moreover, the negative pressure generated by turning on the range hood when closing doors and windows increase aerosol transmission. Based on this negative pressure, prevention and control measures for residential buildings in northeast China during the COVID-19 pandemic were proposed.

Design and Performance Evaluation of a Portable Chamber for Prevention of Aerosol Airborne – Infection

Since the emergence of the COVID-19 pandemic, complications for healthcare workers in hospitals have increased. Healthcare workers have had to develop innovative solutions to deal with the shortage of resources and isolation rooms for those infected with the coronavirus. One of the solutions used is to convert the general patient room into a negative pressure room to prevent airborne infections from leaking into the surrounding environment. However, this was not always easy due to many limitations, such as the overall design of the chamber and the unavailability of mechanical parts to create negative pressure. Another solution is to use medical masks. However, they are not appropriate, especially for patients who suffer from breath shortness. With all these problems, a simple solution was reached in the present work, which is to create a portable isolation room that is simple in terms of cost and implementation. The objective was to investigate the dispersion of the infection inside the portable chamber in addition to its effectiveness in minimizing the risk of infection for healthcare workers. Thus, the airborne infection is eliminated by connecting the exit of the portable chamber directly to a vacuum pump. In the present study, a comparison was made between a normal room without a portable chamber and another with a portable chamber. Six different strategies were applied to remove pollutants. The results showed that strategy 6 was more effective than other strategies (2, 3, 4, and 5) by percentages of 61.6%, 70.4%, 52.4%, and 33.0%, respectively. © 2022, Journal of Advanced Research in Fluid Mechanics and Thermal Sciences. All Rights Reserved.

Atypical negative pressure pulmonary edema after extracorporeal membrane oxygenation therapy for COVID-19.

NPPE imaging findings were reported to show a preferential central and nondependent distribution. However, in our case, NPPE showed a peripheral accent pattern, resembling the ARDS pattern of COVID-19 pneumonia 4 months ago. Capillary damage from COVID-19 might still exist.

Negative Pressure Ventilation for COVID-19 Respiratory Failure: A Phoenix from the Ashes?

Aim: To critically review the clinical question: does negative pressure ventilation (NPV) have a role in the management of COVID-19-associated respiratory failure? Background: NPV was commonly used in the management of respiratory failure until the 1950s when positive pressure devices began to be utilized. Physiological responses to NPV differ from responses to positive pressure ventilation, PPV, in a number of ways that may have clinical advantages in the management of respiratory failure in general, and specifically in the care of COVID-19-associated respiratory failure. Design: Narrative review based on systematic literature research. Data sources: A search on OVID MEDLINE and EMBASE for NPV provided key publications, which were combined with recent relevant literature related to the present COVID-19 pandemic. Results: A total of 83 papers are included in the review and analysis. NPV has been used for >100 years across a range of clinical conditions including polio, adult respiratory distress syndrome, acute respiratory failure in chronic obstructive pulmonary disease patients, a range of neuromuscular disorders, chest wall disease, and post-cardiothoracic and spinal surgery. The potential benefits of NPV, in comparison the treatment of COVID-19 patients, may include improved ventilation, decreased lung damage, improved hemodynamics, ease of proning, and prevention of escalation to intubation. Conclusions: Historic and recent published evidence from animals and man support the use of NPV in acute respiratory failure in general, and strongly suggests that it may be particularly useful in COVID-19-associated respiratory failure. Clinical evaluation of a new lightweight, cost-effective NPV device is justified as it may result in a safe, effective, and economical solution to COVID-19-associated respiratory failure. It could be useful worldwide, but particularly in low and middle-income countries.

Recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 patients: A comparison of international guidelines.

This mini-review provides the practice guideline recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 Patients. Remodeled "quasi-negative-pressure" isolation wards had been proved a feasible, inexpensive, safe, and effective measure to contain nosocomial outbreaks. We should first determine the minimum required ventilation volume of an isolation ward based on the severity of COVID-19 patients. Mechanical ventilation remains the mainstay for achieving the requirement, while the assistance of recirculation is also helpful. Beyond adequate ventilation volume, the "clean to less-clean" directional airflow remains the golden rule for the solution of indoor ventilation. The virus-laden exhaust should be treated with HEPA/UV device or be kept away from living organisms, buildings, and air inlets.

Negative pressure pulmonary edema in a patient with COVID-19.

Negative pressure pulmonary edema (NPPE) should be considered in the differential diagnosis from an episode of asphyxia, and even if NPPE is diagnosed, the possibility of COVID-19 should be kept in mind under coronavirus pandemic conditions.

Negative Pressure Ventilation for Acute and Acute-on-Chronic Respiratory Failure: A systematic review and meta-analysis

Introduction: Respiratory failure is the most common organ failure seen in the intensive care unit1 and is managed with non-invasive or invasive positive pressure ventilation (PPV). Negative pressure ventilation (NPV) could offer a safe and effective alternative, however existing devices, such as the iron lung, are heavy and access to the patient for ongoing care is a limitation. The COVID-19 pandemic necessitated intense focus on the rapid design and manufacture of new ventilators,2 most of which were positive pressure ventilators. However, new, light-weight negative pressure ventilators were also designed and appeared to be safe and effective in an early trial in healthy human volunteers.3 These devices have the potential to offer patients an alternative to PPV, without the limitations associated with the early negative pressure devices. They are cheaper to manufacture, and importantly, do not require a pressurised gas supply, which may be of particular benefit to countries with less well-resourced healthcare facilities in which acute and acute-onchronic respiratory failure continue to cause significant morbidity and mortality.4 Objectives: To address whether acute or acute-onchronic respiratory failure in hospitalised adults can be safely and effectively managed with NPV. Methods: This systematic review was registered with the international prospective register of systematic reviews (ID CRD420200220881). MEDLINE, EMBASE, CENTRAL, medRxiv, bioRxiv and Trip databases were searched (from inception to 22nd April 2021). Eligible studies included non-intubated hospitalised adults who received NPV in the management of acute or acute on chronic respiratory failure. We included randomised controlled trials, non-randomised studies of intervention and case series. Risk of bias was assessed using three separate tools due to differing study designs. Results: 575 unique citations were screened with 14 meeting inclusion criteria. 1032 acute episodes (888 patients) of respiratory failure were managed with NPV, with 234 receiving PPV as a comparator. The majority (n=845, 66.7%) were treated for an acute exacerbation of COPD. 417 patients from four studies were included in the meta-analysis. The effect of NPV on PaCO2, pH and PaO2/FiO2 was similar to PPV with a mean difference -0.39kPa (95% confidence interval (CI): -0.95, 0.18), 0.01 (95% CI: 0.00, 0.02), and -0.16 (95% CI: -1.98, 1.66) respectively. Of those studies not included in the meta-analysis six showed a statistically significantly increase in PaO2 with the use of NPV and 5 showed a statistically significant improvement in PaCO2. Rates of complications were similar with NPV in those studies that compared it to PPV, and NPV appeared to be well tolerated by patients. This systematic review study was limited by a wide range of study designs. Conclusions: NPV appears to be a safe and effective alternative to PPV in the management of acute exacerbation of COPD. Evidence for its use in other forms of respiratory failure is limited but warrants further investigation.

Application of virtual product design to the development of HVAC solution for Incheon International Airport Modular COVID-19 testing center

Owing to the spread of COVID-19, the need for an inspection center that can quickly determine whether travelers using the airport are infected has emerged. For rapid determination, not only polymerase chain reaction tests but also antigen–antibody tests and on-site analysis systems are required. However, because it is time- and cost-intensive to construct a building that meets the standards for negative pressure facilities, modular negative pressure facilities are being installed as alternatives. Existing negative pressure facilities have problems such as increased energy consumption due to outdoor air load and condensation due to differences in indoor and outdoor temperatures and humidities caused by excessive external air inflow to achieve the target negative pressure and air change rate (ACH). In addition, owing to the installation of additional devices, additional construction is required to use them for other purposes in the future. To solve these problems, in this study, energy recovery ventilation (ERV) was employed to develop a heating, ventilation and air conditioning (HVAC) solution for the Incheon International Airport COVID-19 Testing Center. To shorten the development period, virtual product design (VPD) using computational fluid dynamics analysis-based design of experiments was performed. Owing to the application of VPD, the Incheon International Airport Modular COVID-19 Testing Center was completed in 2 weeks. The target pressure was measured in all spaces by applying the optimal conditions derived through VPD. In addition, owing to the application of ERV, the ACH of an airborne infectious isolation room exceeded the value suggested by international organizations.

Negative-pressure wound therapy to treat thoracic empyema with COVID-19-related persistent air leaks: A case report.

The novel coronavirus disease (COVID-19) has resulted in a global pandemic. Recently, COVID-19-related pneumothorax has gained attention because of the associated prolonged hospital stay and high mortality. While most cases of pneumothorax respond well to conservative and supportive care, some cases of refractory pneumothorax with persistent air leaks (PALs) do not respond to conventional therapies. There is a lack of evidence-based management strategies to this regard. We describe the case of a 73-year-old man with COVID-19-related acute respiratory distress syndrome (ARDS) who developed delayed tension pneumothorax with PALs caused by alveolopleural fistulas. Despite chest tube drainage, autologous blood pleurodesis, and endoscopic procedures, the PALs could not be closed, and were complicated by thoracic empyema. Subsequent minimally invasive open-window thoracostomy (OWT) with vacuum-assisted closure (VAC) therapy helped successfully control the refractory PALs. Serial chest computed tomography monitoring was useful for the early detection of the pneumothorax and understanding of its temporal relationship with air-filled lung cysts. Our case provides a new perspective to the underlying cause of refractory pneumothorax with PALs, secondary to COVID-19-related ARDS, and underscores the potential of OWT with VAC therapy as a therapeutic alternative in such cases.

Designing a new fast solution to control isolation rooms in hospitals depending on artificial intelligence decision.

Decreasing the COVID spread of infection among patients at physical isolation hospitals during the coronavirus pandemic was the main aim of all governments in the world. It was required to increase isolation places in the hospital's rules to prevent the spread of infection. To deal with influxes of infected COVID-19 patients' quick solutions must be explored. The presented paper studies converting natural rooms in hospitals into isolation sections and constructing new isolation cabinets using prefabricated components as alternative and quick solutions. Artificial Intelligence (AI) helps in the selection and making of a decision on which type of solution will be used. A Multi-Layer Perceptron Neural Network (MLPNN) model is a type of artificial intelligence technique used to design and implement on time, cost, available facilities, area, and spaces as input parameters. The MLPNN result decided to select a prefabricated approach since it saves 43% of the time while the cost was the same for the two approaches. Forty-five hospitals have implemented a prefabricated solution which gave excellent results in a short period of time at reduced costs based on found facilities and spaces. Prefabricated solutions provide a shorter time and lower cost by 43% and 78% in average values respectively as compared to retrofitting existing natural ventilation rooms.

Application of negative pressure sealing drainage technology combined with silver ion sterilization nursing solution in the nursing of necrotizing fasciitis

Objectives: To study the application effect of negative pressure sealing drainage technology combined with silver ion sterilization nursing solution in the nursing of necrotizing fasciitis. Methods: Medical records of patients with necrotizing fasciitis, treated in our hospital from June 2019 to June 2021, were selected. Patients were retrospectively assigned into two groups based on the debridement method used: debridement with silver ion sterilization nursing solution Group-I, or debridement with negative pressure sealing drainage technology combined with silver ion sterilization nursing solution. Group-II. Wound healing, dressing change times, healing time, treatment cost and patient satisfaction in both groups were statistically compared. Results: The wound healing rate of patients in Group-II group was higher than that of Group-I on the 5th, 10th and 15th day after operation (P < 0.05). Dressing change times, healing time and treatment cost of patients in the Group-II were lower than those of Group-I (P < 0.05). Patient satisfaction in the Group-II was 91.4% (54 / 59), which was higher than that of Group-I (75.4% (40 / 53) (P < 0.05). Conclusions: Negative pressure sealing drainage technology combined with silver ion sterilization nursing solution in the nursing of necrotizing fasciitis is effective. It can promote wound healing, shorten the healing time, reduce the times of wound dressing change and treatment cost. It also improves the overall patient satisfaction, making it an efficient method in clinical application.

Negative-pressure pulmonary edema after mammoplasty: a case report.

Negative-pressure pulmonary edema (NPPE) is a rare but life-threatening postoperative complication that occurs due to the acute obstruction of the upper airway. In our case report, we present a 25-year-old female patient who underwent elective mammoplasty under general anesthesia and developed NPPE 4 hours after extubation. The patient had a preoperative mallampati score of 3. After routine anesthesia induction, the patient was intubated with an endotracheal tube with a guide wire. Aspiration wasn't observed during extubation. The patient was followed in the post-anesthesia care unit (PACU) for 30 minutes with a saturation of 95% and was subsequently transferred to the service. Four hours after the operation, the patient was re-examined due to dyspnea and shortness of breath. Due to oxygen saturation of 88% and pO2of 56mmHg despite mask ventilation, the patient was admitted to the intensive care unit (ICU). A computed tomography (CT) scan revealed extensive diffuse ground-glass opacities and consolidations in both lungs. She did not respond to mask ventilation and was given non-invasive ventilation with continuous positive airway pressure (CPAP). Forced diuresis was induced with furosemide. Tachypnea resolved within 2 hours after CPAP was initiated, the patient did not require oxygen support and COVID-19 polymerase chain reaction (PCR) testing was negative. Subsequently, the patient was discharged to the clinical ward on postoperative day 1. When considering NPPE, early diagnosis and respiratory support are associated with reduced mortality and rapid recovery. Patients who develop laryngospasm during extubation must be closely monitored, and in the case of pulmonary edema, NPPE should be considered in the differential diagnosis.

Droplet aerosols transportation and deposition for three respiratory behaviors in a typical negative pressure isolation ward.

Negative pressure isolation wards could provide safety for health care workers (HCWs) and patients infected with SARS-CoV-2. However, respiratory behavior releases aerosols containing pathogens, resulting in a potential risk of infection for HCWs. In this study, the spatiotemporal distribution of droplet aerosols in a typical negative pressure isolation ward was investigated using a full-scale experiment. In this experiment, artificial saliva was used to simulate the breathing behavior, which can reflect the effect of evaporation on droplet aerosols. Moreover, numerical simulations were used to compare the transport of droplet aerosols released by the three respiratory behaviors (breathing, speaking, and coughing). The results showed that droplet aerosols generated by coughing and speaking can be removed and deposited more quickly. Because reduction in the suspension proportion per unit time was much higher than that in the case of breathing. Under the air supply inlets, there was significant aerosol deposition on the floor, while the breathing area possessed higher aerosol concentrations. The risk of aerosol resuspension and potential infection increased significantly when HCWs moved frequently to these areas. Finally, more than 20% of the droplet aerosols escaped from the ward when the number of suspended aerosols in the aerosol space was 1%.

Research on Airflow Optimization and Infection Risk Assessment of Medical Cabin of Negative-Pressure Ambulance

Medical cabins within negative-pressure ambulances currently only use the front air supply, which causes poor emission of infectious disease droplets. For this problem, based on the classification and design methods of airflow organization, the side and top supply airflow organization model has been designed to study the influence of these airflow organization models on the spread of droplet particles. The distribution of droplet particles within airflow organization models, under conditions in which the patient is coughing and sneezing, is analyzed. According to the comparison and analysis of this distribution, the state of droplet particles, the emission efficiency, and the security coefficient are studied. The response surface method is used to optimize the emission efficiency and security coefficient of the airflow organization. According to the characteristics of the medical cabin within negative-pressure ambulances, a dose-response model is used to evaluate the infection risk of medical personnel and then the infection probability is obtained. These research results can be used to improve the ability of negative-pressure ambulances to prevent cross-infection.