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1.
Healthcare (Basel) ; 10(11)2022 Nov 07.
Article in English | MEDLINE | ID: covidwho-2110003

ABSTRACT

BACKGROUND: During the COVID-19 breakout, a global call for low-cost portable ventilators was made following the strong demand for ventilatory support techniques. Among a few development projects, COVIDair non-invasive ventilator was developed and produced in a record time during the critical period of spring 2020. OBJECTIVES: To evaluate COVIDair performance (i.e., inspiratory trigger delay time, TDT, pressurization time and inspiratory to expiratory time ratio, I:E) on a test bench simulating physiological characteristics of breathing. METHOD: Performance tests were conducted on a breathing simulator (ASL 5000, IngMar Medical™) in two different lung mechanics (i.e., normal and severe restrictive). RESULTS: Under normal pulmonary mechanics, the inspiratory TDT is on average between 89.0 (±2.1) and 135.0 (±9.7) ms. In a situation of severe restrictive pulmonary mechanics, the inspiratory TDT is on average between 80 (±3.1) and 99.2 (±5.5) ms. Pressurization time to pre-set inspiratory pressure was on average from 234.6 (±5.5) to 318.6 (±1.9) ms. The absolute difference between the actual I:E cycling measure and the pre-set I:E cycling value ranged from 0.1 to 10.7% on average. CONCLUSION: In normal and severe restrictive pulmonary mechanics scenarios, the performance of COVIDair meets the expected standards for non-invasive ventilators.

2.
Antibiotics (Basel) ; 11(11)2022 Nov 11.
Article in English | MEDLINE | ID: covidwho-2109904

ABSTRACT

Patients with severe COVID-19, especially those followed in the ICU, are at risk for developing bacterial and fungal superinfections. In this study, we aimed to describe the burden of hospital-acquired superinfections in a cohort of consecutive, severe COVID-19 patients hospitalized between February and May 2021 in the intensive care unit (ICU) department of San Salvatore Hospital in Pesaro, Italy. Among 89 patients considered, 68 (76.4%) acquired a secondary infection during their ICU stay. A total of 46 cases of ventilator-associated pneumonia (VAP), 31 bloodstream infections (BSIs) and 15 catheter-associated urinary tract infections (CAUTIs) were diagnosed. Overall mortality during ICU stay was 48%. A multivariate analysis showed that factors independently associated with mortality were male gender (OR: 4.875, CI: 1.227-19.366, p = 0.024), higher BMI (OR: 4.938, CI:1.356-17.980, p = 0.015) and the presence of VAP (OR: 6.518, CI: 2.178-19.510, p = 0.001). Gram-negative bacteria accounted for most of the isolates (68.8%), followed by Gram-positive bacteria (25.8%) and fungi (5.3%). Over half of the infections (58%) were caused by MDR opportunistic pathogens. Factors that were independently associated with an increased risk of infections caused by an MDR pathogen were higher BMI (OR: 4.378, CI: 1.467-13.064, p = 0.0008) and a higher Charlson Comorbidity Index (OR: 3.451, 95% CI: 1.113-10.700, p = 0.032). Secondary infections represent a common and life-threatening complication in critically ill patients with COVID-19. Efforts to minimize the likelihood of acquiring such infections, often caused by difficult-to-treat MDR organisms-especially in some subgroups of patients with specific risk factors-must be pursued.

3.
Front Med (Lausanne) ; 9: 1000147, 2022.
Article in English | MEDLINE | ID: covidwho-2109788

ABSTRACT

Introduction: The systemic viral disease caused by the SARS-CoV-2 called coronavirus disease 2019 (COVID-19) continues to be a public health problem worldwide. Objective: This study is aimed to evaluate the association and predictive value of indices of systemic inflammation with severity and non-survival of COVID-19 in Mexican patients. Materials and Methods: A retrospective study was carried out on 807 subjects with a confirmed diagnosis of COVID-19. Clinical characteristics, acute respiratory distress syndrome (ARDS), severity according to PaO2/FiO2 ratio, invasive mechanical ventilation (IMV), and non-survival outcome were considered to assess the predictive value and the association of 11 systemic inflammatory indices derived from hematological parameters analyzed at the hospital admission of patients. The receiver operating characteristics curve was applied to determine the thresholds for 11 biomarkers, and their prognostic values were assessed via the Kaplan-Meier method. Results: 26% of the studied subjects showed COVID-19 severe (PaO2/FiO2 ratio ≤ 100), 82.4% required IMV, and 39.2% were non-survival. The indices NHL, NLR, RDW, dNLR, and SIRI displayed predictive values for severe COVID-19 and non-survival. NHL, SIRI, and NLR showed predictive value for IMV. The cut-off values for RDW (OR = 1.85, p < 0.001), NHL (OR = 1.67, p = 0.004) and NLR (OR = 1.56, p = 0.012) were mainly associated with severe COVID-19. NHL (OR = 3.07, p < 0.001), AISI (OR = 2.64, p < 0.001) and SIRI (OR = 2.51, p < 0.001) were associated with IMV support, while for non-survival the main indices associated were NHL (OR = 2.65, p < 0.001), NLR (OR = 2.26, p < 0.001), dNLR (OR = 1.92, p < 0.001), SIRI (OR = 1.67, p = 0.002) and SII (OR = 1.50, p = 0.010). The patients with an RDW, PLR, NLR, dNLR, MLR, SII, and NHL above the cut-off had a survival probability of COVID-19 50% lower, with an estimated mean survival time of 40 days. Conclusion: The emergent systemic inflammation indices NHL, NLR, RDW, SII, and SIRI have a predictive power of severe COVID-19, IMV support, and low survival probability during hospitalization by COVID-19 in Mexican patients.

4.
Eur J Med Res ; 27(1): 218, 2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2108966

ABSTRACT

PURPOSE: This study aimed to investigate air leakage during invasive mechanical ventilation (IMV) in a pediatric intensive care unit (PICU) and explore potential risk factors. METHODS: We conducted a retrospective cohort study of children who underwent IMV in a single-center PICU in a tertiary referral hospital. Air leakage risk factors and factors associated with an improved outcome were assessed. RESULTS: A total of 548 children who underwent IMV were enrolled in this study. Air leakage occurred in 7.5% (41/548) of the cases in the PICU. Air leakage increased the duration of IMV and hospitalization time. Multivariate logistic regression analysis showed a higher risk of air leakage during IMV for PICU patients with acute respiratory dyspnea syndrome (ARDS) (OR = 4.38), a higher pediatric critical illness score (PCIS) (OR = 1.08), or a higher peak inspiratory pressure (PIP) (OR = 1.08), whereas the risk was lower for patients with central respiratory failure (OR = 0.14). The logistic model had excellent predictive power for air leakage, with an area under the curve of 0.883 and tenfold cross-validation. Patients aged between 1 and 6 years who were diagnosed with measles or pneumonia and had a low positive end-expiratory pressure (PEEP) or high PaO2/FiO2 ratio were associated with improved outcomes. Patients diagnosed with central respiratory failure or congenital heart diseases were associated with less desirable outcomes. CONCLUSIONS: Patients with ARDS, a higher PCIS at admission or a higher PIP were at higher risk of air leakage.


Subject(s)
Respiratory Distress Syndrome , Respiratory Insufficiency , Child , Humans , Infant , Child, Preschool , Respiration, Artificial/adverse effects , Retrospective Studies , Intensive Care Units, Pediatric , Risk Factors , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/therapy , Intensive Care Units
5.
Eur J Med Res ; 27(1): 226, 2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2108965

ABSTRACT

BACKGROUND: Evidence regarding the timing of the application of mechanical ventilation among patients with severe coronavirus disease (COVID-19) is insufficient. This systematic review and meta-analysis aimed to evaluate the effectiveness of early intubation compared to late intubation in patients with severe and critical COVID-19. METHODS: For this study, we searched the MEDLINE, EMBASE, and Cochrane databases as well as one Korean domestic database on July 15, 2021. We updated the search monthly from September 10, 2021 to February 10, 2022. Studies that compared early intubation with late intubation in patients with severe COVID-19 were eligible for inclusion. Relative risk (RR) and mean difference (MD) were calculated as measures of effect using the random-effects model for the pooled estimates of in-hospital mortality, intensive care unit (ICU) length of stay (LOS), duration of mechanical ventilation (MV), hospital LOS, ICU-free days, and ventilator-free days. Subgroup analysis was performed based on the definition of early intubation and the index time. To assess the risk of bias in the included studies, we used the Risk of Bias Assessment tool for Non-randomized studies 2.0. RESULTS: Of the 1523 records identified, 12 cohort studies, involving 2843 patients with severe COVID-19 were eligible. There were no differences in in-hospital mortality (8 studies, n = 795; RR 0.91, 95% CI 0.75-1.10, P = 0.32, I2 = 33%), LOS in the ICU (9 studies, n = 978; MD -1.77 days, 95% CI -4.61 to 1.07 days, P = 0.22, I2 = 78%), MV duration (9 studies, n = 1,066; MD -0.03 day, 95% CI -1.79 to 1.72 days, P = 0.97, I2 = 49%), ICU-free days (1 study, n = 32; 0 day vs. 0 day; P = 0.39), and ventilator-free days (4 studies, n = 344; MD 0.94 day, 95% CI -4.56 to 6.43 days, P = 0.74, I2 = 54%) between the early and late intubation groups. However, the early intubation group had significant advantage in terms of hospital LOS (6 studies, n = 738; MD -4.32 days, 95% CI -7.20 to -1.44 days, P = 0.003, I2 = 45%). CONCLUSION: This study showed no significant difference in both primary and secondary outcomes between the early intubation and late intubation groups. Trial registration This study was registered in the Prospective Register of Systematic Reviews on 16 February, 2022 (registration number CRD42022311122).


Subject(s)
COVID-19 , Humans , COVID-19/therapy , Respiration, Artificial , Intensive Care Units , Length of Stay , Intubation, Intratracheal
6.
Mol Med ; 28(1): 131, 2022 11 08.
Article in English | MEDLINE | ID: covidwho-2108708

ABSTRACT

BACKGROUND: Respiratory failure in severe coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Acetylcholine (ACh) reduces systemic inflammation in experimental bacterial and viral infections. Pyridostigmine increases the half-life of endogenous ACh, potentially reducing systemic inflammation. We aimed to determine if pyridostigmine decreases a composite outcome of invasive mechanical ventilation (IMV) and death in adult patients with severe COVID-19. METHODS: We performed a double-blinded, placebo-controlled, phase 2/3 randomized controlled trial of oral pyridostigmine (60 mg/day) or placebo as add-on therapy in adult patients admitted due to confirmed severe COVID-19 not requiring IMV at enrollment. The primary outcome was a composite of IMV or death by day 28. Secondary outcomes included reduction of inflammatory markers and circulating cytokines, and 90-day mortality. Adverse events (AEs) related to study treatment were documented and described. RESULTS: We recruited 188 participants (94 per group); 112 (59.6%) were men; the median (IQR) age was 52 (44-64) years. The study was terminated early due to a significant reduction in the primary outcome in the treatment arm and increased difficulty with recruitment. The primary outcome occurred in 22 (23.4%) participants in the placebo group vs. 11 (11.7%) in the pyridostigmine group (hazard ratio, 0.47, 95% confidence interval 0.24-0.9; P = 0.03). This effect was driven by a reduction in mortality (19 vs. 8 deaths, respectively). CONCLUSION: Our data indicate that adding pyridostigmine to standard care reduces mortality among patients hospitalized for severe COVID-19.


Subject(s)
COVID-19 , Adult , Male , Humans , Middle Aged , Female , COVID-19/drug therapy , Pyridostigmine Bromide/therapeutic use , SARS-CoV-2 , Respiration, Artificial , Inflammation , Treatment Outcome
7.
Indoor and Built Environment ; 2022.
Article in English | Web of Science | ID: covidwho-2108477

ABSTRACT

Understanding of the droplet transmission of respiratory diseases is necessary to control the outbreak of COVID-19. HVAC systems considering droplet transmission are commonly used to prevent numerous respiratory diseases by reducing indoor virus concentrations. The transmission of the virus was directly related to indoor flow patterns generated by HVAC systems. Thus, a study on operating conditions such as direction or the tilt angle was required. In this study, the effective ventilation rate and probability of droplet transmission according to the tilt angle of supply air and the number of people were studied. A CO2 tracer gas method was used to validate the results of simulations. The breathing plane and personal respiratory zone were introduced for the probability of droplet transmission. The result showed that ventilation performance showed 17% of the maximum difference among tilt angles. Various turbulent kinetic energies were obtained according to the seated positions, resulting in non-uniform CO2 concentration. Numerous conditions were examined with locational analysis of individuals. As a result, the flow rates for ventilation were recommended to be higher than 250 m(3)/h and 350 m(3)/h with a tilt angle of 60 degrees for an occupancy of 8 and 16 people, respectively.

8.
Immunology ; 2022 Nov 08.
Article in English | MEDLINE | ID: covidwho-2108036

ABSTRACT

Severe cases of COVID-19 present hyperinflammatory condition that can be fatal. Little is known about the role of regulatory responses in SARS-CoV-2 infection. In this study, we evaluated the phenotype of regulatory T cells in the blood (peripheral blood mononuclear cell) and the lungs (broncho-alveolar) of adult patients with severe COVID-19 under invasive mechanical ventilation. Our results show important dynamic variation on Treg cells phenotype during COVID-19 with changes in number and functional parameters from the day of intubation (Day 1 of intensive care unit admission) to Day 7. We observed that compared with surviving patients, non-survivors presented lower numbers of Treg cells in the blood. In addition, lung Tregs of non-survivors also displayed higher PD1 and lower FOXP3 expressions suggesting dysfunctional phenotype. Further signs of Treg dysregulation were observed in non-survivors such as limited production of IL-10 in the lungs and higher production of IL-17A in the blood and in the lungs, which were associated with increased PD1 expression. These findings were also associated with lower pulmonary levels of Treg-stimulating factors like TNF and IL-2. Tregs in the blood and lungs are profoundly dysfunctional in non-surviving COVID-19 patients.

9.
Rev Esp Anestesiol Reanim ; 69(9): 544-555, 2022 Nov.
Article in Spanish | MEDLINE | ID: covidwho-2105814

ABSTRACT

Background: The severe acute respiratory syndrome-coronavirus 2 pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. Methods: Validation consisted of (a) testing tidal volume delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome by saline lavage. Results: Differences in tidal volume in the simulated models were marginally different (largest difference 33 ml [95% CI 31 to 36]; P < .001). Plateau pressure was not different (-0.3 cmH2O [95% CI -0.9 to 0.3]; P = .409), and positive end-expiratory pressure was marginally different (0.3 cmH2O [95% CI 0.2 to 0.3]; P < .001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias -0.29 [limits of agreement 0.82 to -1.42], and mean bias 0.56 [limits of agreement 1.94 to -0.81], at a plateau pressure of 15 and 30 cmH2O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after acute respiratory distress syndrome induction. Conclusions: The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The ACUTE-19 can provide the basis for the development of a future affordable commercial ventilator.

10.
J Infect Chemother ; 2022 Nov 12.
Article in English | MEDLINE | ID: covidwho-2105376

ABSTRACT

BACKGROUND: Aspergillus is one of the important pathogens that contribute to high mortality in patients with coronavirus disease 2019 (COVID-19) in intensive care units (ICUs). Although incidence rates of Aspergillus coinfection are high globally, a Japanese national survey reported a low incidence. This study aimed to describe the clinical characteristics of patients with COVID-19-associated pulmonary aspergillosis at our institute. METHODS: We identified patients with microbiologically confirmed COVID-19 on mechanical ventilation in the ICU. Of these patients, we identified patients in whom Aspergillus was cultured from the respiratory specimen. RESULTS: Of a total of 169 patients, seven had aspergillosis (4.1%), which included three patients, three patients, and one patient with possible, probable, and proven aspergillosis, respectively, according to the criteria of the European Confederation of Medical Mycology International Society. All patients received systemic steroid therapy. Two patients (one each with proven and probable aspergillosis) had tracheobronchitis diagnosed by bronchoscopy. All patients in whom Aspergillus was repeatedly isolated from samples died. The mortality rates for all cases and probable and proven cases were 57% (4/7) and 75% (3/4), respectively. CONCLUSIONS: The incidence rate of aspergillosis in patients with COVID-19 in the ICU was higher in our institute than that reported by a Japanese national survey (4.1% vs. 0.5%). Repeated detection of Aspergillus might suggest a true Aspergillus infection, such as chronic aspergillosis, rather than colonization. In patients with severe COVID-19 patients, it is important to always keep CAPA in mind.

13.
Expert Rev Respir Med ; 16(10): 1101-1108, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2107130

ABSTRACT

BACKGROUND: We attempted to investigate the change in mortality of intubated patients with coronavirus disease (COVID-19) from first to subsequent waves across several countries. METHODS: We pre-registered our meta-analysis with PROSPERO [Anonymized]. We searched PubMed, Scopus, and gray literature for observational studies reporting data on all-cause mortality of intubated patients with COVID-19 recruited both during first and subsequent waves of the pandemic. We considered studies published after 31 August 2020 up to 12 July 2021. The primary outcome of the meta-analysis was all-cause mortality. We used a random effects model to calculate pooled risk ratio (RR) and 95% confidence intervals (CI). RESULTS: By incorporating data of 363,660 patients from 43 countries included in 28 studies, we found that all-cause mortality of intubated patients with COVID-19 increased from first to subsequent waves (from 62.2% to 72.6%; RR 0.90, 95% CI 0.85-0.94, p < 0.00001). This finding was independent of the geo-economic variation of the included studies and persisted in several pre-specified subgroup and sensitivity analyses. CONCLUSIONS: The robust finding of this meta-analysis suggests that mortality of intubated patients with COVID-19 did not improve over time. Future research should target this group of patients to further optimize their management.


Subject(s)
COVID-19 , Humans , Pandemics , SARS-CoV-2
14.
Cureus ; 14(9): e29610, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2100369

ABSTRACT

INTRODUCTION: Severe COVID-19 is associated with serious complications and poor outcomes. Older age and underlying comorbidities are known risk factors for severe COVID-19, but a better understanding of baseline characteristics and outcomes of patients with severe COVID-19 is urgently needed. METHODS: This study was a retrospective case series of 227 consecutive patients with laboratory-confirmed COVID-19 admitted to the intensive care unit (ICU) at our institution between March 2020 and December 2021. Demographic and clinical data were collected. RESULTS: The median age of patients was 65 years, and 180 (79.3%) were male. Cardiovascular comorbidities were frequent and included hypertension (n=148; 65.2%), dyslipidemia (n=116; 51.1%), obesity (n=114; 50.2%), and diabetes mellitus (n=80; 35.2%). About 20% of the patients had the chronic respiratory disease, with sleep apnea being the most common. Immunosuppression was identified in 13% of the patients, with autoimmunity, post-transplantation, and neoplasms being the most represented causes. Most patients were admitted to the ICU at six to 15 days after symptom onset, corresponding to stages IIb (pulmonary involvement/hypoxia) and III (hyperinflammatory). All patients received systemic steroids, with an average treatment duration of 22 days. Several ventilatory support strategies were used; 80 patients were supported entirely noninvasively with high flow nasal oxygenation and noninvasive ventilation, while 164 patients were invasively ventilated. Most intubations (65%) occurred in the first 24 hours after admission, and the mean duration of mechanical ventilation was 14 days. The reintubation rate was 10%, occurring on average two to three days after planned extubation. Thirty-two tracheostomies were performed. Bacterial co-infection was treated in 75% of patients, and Aspergillus co-infection complicating COVID-19 pneumonia was diagnosed in eight patients. Median ICU and hospital stays were 15 and 25 days, respectively, and the 28-day mortality rate was 38%. Patients over 75 years experienced a higher mortality rate (56%). Increased age and multimorbidity, particularly comprising cardiovascular disease and associated risk factors, were significantly more common in patients who died within 28 days after ICU admission. CONCLUSIONS: A large proportion of critically ill COVID-19 patients required prolonged mechanical ventilation. ICU/hospital stay and mortality were particularly elevated in older patients and patients with cardiovascular risk factors. Considerable discrepancy existed between the proportion of patients with microbiological documentation of bacterial infections and those receiving antimicrobials. Improved methods for adequate microbiological diagnosis are needed and stewardship programs should be reinforced.

15.
Respir Care ; 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2100062

ABSTRACT

BACKGROUND: Ventilatory parameters measured soon after initiation of mechanical ventilation have limited ability to predict outcome of COVID-19-related ARDS. We hypothesized that ventilatory parameters measured after one week of mechanical ventilation might differ between survivors and non-survivors. METHODS: One hundred twenty-seven subjects with COVID-related ARDS had gas exchange and lung mechanics assessed on the day of intubation and one week later. The main parameters of interest were PaO2 /FIO2 , ventilatory ratio (VR), respiratory system compliance (CRS), and a composite score that was calculated as (PaO2 /FIO2 /100) × CRS/VR. The primary outcome was death in the ICU. RESULTS: Of the 127 subjects, 42 (33%) died in the ICU and 85 (67%) were successfully extubated. On the day of intubation, PaO2 /FIO2 , CRS, and composite score of survivors and non-survivors were similar, but survivors had a lower VR. At one week, as compared to survivors, non-survivors had a significantly higher VR (2.04 ± 0.76 vs 1.60 ± 0.43, P < .001), lower CRS (27.4 ± 6.4 mL/cm H2O vs 32.4 ± 9.3 mL/cm H2O, P = .002), and lower composite score (20.6 ± 11.9 vs 34.5 ± 18.6, P < .001), with no statistically significant difference in PaO2 /FIO2 (137 ± 49 vs 155 ± 48, P = .08). CONCLUSIONS: In subjects with COVID ARDS, parameters that reflect dead space (VR), lung mechanics (CRS), and a combined score that included PaO2 /FIO2 , VR, and CRS differed between survivors and non-survivors after one week of mechanical ventilation but with considerable overlap of values between survivors and non-survivors.

16.
Int J Environ Res Public Health ; 19(21)2022 Nov 06.
Article in English | MEDLINE | ID: covidwho-2099555

ABSTRACT

The COVID-19 pandemic has generated a renewed interest in indoor air quality to limit viral spread. In the case of educational spaces, due to the high concentration of people and the fact that most of the existing buildings do not have any mechanical ventilation system, the different administrations have established natural ventilation protocols to guarantee an air quality that reduces risk of contagion by the SARS-CoV-2 virus after the return to the classrooms. Many of the initial protocols established a ventilation pattern that opted for continuous or intermittent ventilation to varying degrees of intensity. This study, carried out on a university campus in Spain, analyses the performance of natural ventilation activated through the information provided by monitoring and visualisation of real-time data. In order to carry out this analysis, a experiment was set up where a preliminary study of ventilation without providing information to the users was carried out, which was then compared with the result of providing live feedback to the occupants of two classrooms and an administration office in different periods of 2020, 2021 and 2022. In the administration office, a CO2-concentration-based method was applied retrospectively to assess the risk of airborne infection. This experience has served as a basis to establish a route for user-informed improvement of air quality in educational spaces in general through low-cost systems that allow a rational use of natural ventilation while helping maintain an adequate compromise between IAQ, comfort and energy consumption, without having to resort to mechanical ventilation systems.


Subject(s)
Air Pollution, Indoor , COVID-19 , Humans , COVID-19/epidemiology , Spain/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2 , Ventilation/methods , Air Pollution, Indoor/analysis
17.
Int J Environ Res Public Health ; 19(21)2022 Nov 05.
Article in English | MEDLINE | ID: covidwho-2099549

ABSTRACT

The supply of fresh air for underground rail transit systems is not as simple as opening windows, which is a conventional ventilation (CV) measure adopted in aboveground vehicles. This study aims to improve contaminant dilution and air purification in subway car ventilation systems and the safety of rail transit post-coronavirus disease pandemic era. We designed an air conditioning (AC) terminal system combined with stratum ventilation (SV) to enable energy consumption reduction for subway cars. We experimentally tested the effectiveness of a turbulence model to investigate ventilation in subway cars. Further, we compared the velocity fields of CV and SV in subway cars to understand the differences in their airflow organizations and contaminant removal efficiencies, along with the energy savings of four ventilation scenarios, based on the calculations carried out using computational fluid dynamics. At a ventilation flow rate of 7200 m3/h, the CO2 concentration and temperature in the breathing areas of seated passengers were better in the SV than in the CV at a rate of 8500 m3/h. Additionally, the energy-saving rate of SV with AC cooling was 14.05%. The study provides new ideas for reducing the energy consumption of rail transit and broadens indoor application scenarios of SV technology.


Subject(s)
Air Pollutants , Air Pollution, Indoor , Railroads , Automobiles , Air Pollution, Indoor/prevention & control , Air Pollution, Indoor/analysis , Air Pollutants/analysis , Environmental Monitoring , Ventilation
18.
Diagnostics (Basel) ; 12(10)2022 Sep 21.
Article in English | MEDLINE | ID: covidwho-2099390

ABSTRACT

BACKGROUND: We studied prone positioning effects on lung aeration in spontaneously breathing invasively ventilated patients with coronavirus disease 2019 (COVID-19). METHODS: changes in lung aeration were studied prospectively by electrical impedance tomography (EIT) from before to after placing the patient prone, and back to supine. Mixed effect models with a random intercept and only fixed effects were used to evaluate changes in lung aeration. RESULTS: fifteen spontaneously breathing invasively ventilated patients were enrolled, and remained prone for a median of 19 [17 to 21] hours. At 16 h the global inhomogeneity index was lower. At 2 h, there were neither changes in dorsal nor in ventral compliance; after 16 h, only dorsal compliance (ßFe +18.9 [95% Confidence interval (CI): 9.1 to 28.8]) and dorsal end-expiratory lung impedance (EELI) were increased (ßFe, +252 [95% CI: 13 to 496]); at 2 and 16 h, dorsal silent spaces was unchanged (ßFe, -4.6 [95% CI: -12.3 to +3.2]). The observed changes induced by prone positioning disappeared after turning patients back to supine. CONCLUSIONS: in this cohort of spontaneously breathing invasively ventilated COVID-19 patients, prone positioning decreased inhomogeneity, increased lung volumes, and improved dorsal compliance.

19.
Biomedicines ; 10(11)2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2099346

ABSTRACT

Worldwide, healthcare systems had to respond to an exponential increase in COVID-19 patients with a noteworthy increment in intensive care units (ICU) admissions and invasive mechanical ventilation (IMV). The aim was to determine low intensity respiratory muscle training (RMT) effects in COVID-19 patients upon medical discharge and after an ICU stay with IMV. A retrospective case-series study was performed. Forty COVID-19 patients were enrolled and divided into twenty participants who received IMV during ICU stay (IMV group) and 20 participants who did not receive IMV nor an ICU stay (non-IMV group). Maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), COPD assessment test (CAT) and Medical Research Council (MRC) dyspnea scale were collected at baseline and after 12 weeks of low intensity RMT. A greater MRC dyspnea score and lower PImax were shown at baseline in the IMV group versus the non-IMV group (p < 0.01). RMT effects on the total sample improved all outcome measurements (p < 0.05; d = 0.38-0.98). Intragroup comparisons after RMT improved PImax, CAT and MRC scores in the IMV group (p = 0.001; d = 0.94-1.09), but not for PImax in the non-IMV group (p > 0.05). Between-groups comparison after RMT only showed MRC dyspnea improvements (p = 0.020; d = 0.74) in the IMV group versus non-IMV group. Furthermore, PImax decrease was only predicted by the IMV presence (R2 = 0.378). Low intensity RMT may improve respiratory muscle strength, health related quality of life and dyspnea in COVID-19 patients. Especially, low intensity RMT could improve dyspnea level and maybe PImax in COVID-19 patients who received IMV in ICU.

20.
Trials ; 23(1): 218, 2022 Mar 18.
Article in English | MEDLINE | ID: covidwho-2098433

ABSTRACT

BACKGROUND: Non-invasive ventilation (NIV) is indicated to avoid orotracheal intubation (OTI) to reduce hospital stay and mortality. Patients infected by SARS-CoV2 can progress to respiratory failure (RF); however, in the initial phase, they can be submitted to oxygen therapy and NIV. Such resources can produce aerosol and can cause a high risk of contagion to health professionals. Safe NIV strategies are sought, and therefore, the authors adapted diving masks to be used as NIV masks (called an Owner mask). OBJECTIVE: To assess the Owner mask safety and effectiveness regarding conventional orofacial mask for patients in respiratory failure with and without confirmation or suspicion of COVID-19. METHODS: A Brazilian multicentric study to assess patients admitted to the intensive care unit regarding their clinical, sociodemographic and anthropometric data. The primary outcome will be the rate of tracheal intubation, and secondary outcomes will include in-hospital mortality, the difference in PaO2/FiO2 ratio and PaCO2 levels, time in the intensive care unit and hospitalization time, adverse effects, degree of comfort and level of satisfaction of the mask use, success rate of NIV (not progressing to OTI), and behavior of the ventilatory variables obtained in NIV with an Owner mask and with a conventional face mask. Patients with COVID-19 and clinical signs indicative of RF will be submitted to NIV with an Owner mask [NIV Owner COVID Group (n = 63)] or with a conventional orofacial mask [NIV orofacial COVID Group (n = 63)], and those patients in RF due to causes not related to COVID-19 will be allocated into the NIV Owner Non-COVID Group (n = 97) or to the NIV Orofacial Non-COVID Group (n = 97) in a randomized way, which will total 383 patients, admitting 20% for loss to follow-up. DISCUSSION: This is the first randomized and controlled trial during the COVID-19 pandemic about the safety and effectiveness of the Owner mask compared to the conventional orofacial mask. Experimental studies have shown that the Owner mask enables adequate sealing on the patient's face and the present study is relevant as it aims to minimize the aerosolization of the virus in the environment and improve the safety of health professionals. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC): RBR - 7xmbgsz . Registered on 15 April 2021.


Subject(s)
COVID-19 , Diving , Noninvasive Ventilation , Humans , Noninvasive Ventilation/adverse effects , Noninvasive Ventilation/methods , Pandemics/prevention & control , RNA, Viral , Randomized Controlled Trials as Topic , SARS-CoV-2
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