Frequency of the requirement of inappropriate uncuffed tracheal tube size for pediatric patients: a retrospective observational analysis.

BACKGROUND: The insertion of inappropriately sized uncuffed endotracheal tubes (ETTs) with a tight seal or presence of air leakage may be necessary in children. This study aimed to analyze the frequency of the requirement of inappropriately sized uncuffed ETT insertion, air leakage after the ETT was replaced with one of a larger size, and factors associated with air leakage after ETT replacement. METHODS: Patients under 2 years of age who underwent oral surgery under general anesthesia with uncuffed ETTs between December 2013 and May 2015 were enrolled. The ETT size was selected at the discretion of the attending anesthesiologists. A leak test was performed after intubation. The ETT was replaced when considered necessary. Data regarding the leak pressure (PLeak) and inspiratory and expiratory tidal volumes were extracted from anesthesia records. We considered a PLeak of 10 < PLeak ≤ 30 cmH2O to be appropriate. The frequencies of the requirement of inappropriately sized ETTs, absence of leakage after ETT replacement, ETT size difference, and leak rate were calculated. A logistic regression was performed, with PLeak, leak rate, and size difference included as explanatory variables and presence of leakage after replacement as the outcome variable. RESULTS: Out of the 156 patients enrolled, 109 underwent ETT replacement, with the requirement of inappropriately sized ETTs being observed in 25 patients (23%). ETT replacement was performed in patients with PLeak ≤ 10 cmH2O; leakage was absent after replacement (PLeak < 30 cmH2O) in 52% of patients (25/48). In the multivariate logistic model, the leak rate before ETT replacement was significantly associated with the presence of leakage after replacement (p = 0.021). CONCLUSIONS: Inappropriately sized ETTs were inserted in approximately 23% of the patients. The leak rate may be useful to guide ETT replacement.

Fuzzy logic programming and adaptable design of medical products for the COVID-19 anti-epidemic normalization.

BACKGROUND: The COVID-19 prevention and control constantly affects lives worldwide. In this paper, household medical products were analyzed using fuzzy logic. Considering the household anti-epidemic status, economic and environmental benefits, the adaptable design method of anti-epidemic products in the vestibule was proposed. The measure of adaptable design method still have shortcomings. Therefore, an improved method that is based on fuzzy logic programming is required. METHOD: Firstly, common medical product types used in vestibules and household anti-epidemic products were identified and summarized into product sets. Then matching degree matrix was obtained by functional configuration decomposition and matching calculations. Secondly, experts were invited to evaluate the paired comparative probability matrices and linguistic variables, and the evaluation data were converted by trapezoidal membership functions, fuzzy numbers and the defuzzification method to obtain the usage probability values (PR) for product functions. Finally, the matching degree value (P) and the product function (PF) were calculated by adaptability measure formula, and product function, the adaptability factor and the adaptability (A) were obtained. RESULTS AND DISCUSSION: Our results show that the degree of adaptability of each product function in the product set from PF1 to PF10can be evaluated. Based on the principles of sorting of values from high to low, the top five PF (n = 10) for P value is PF10, PF5, PF6, PF8 and PF1; The top five PF for P value is PF2, PF1, PF3, PF7 and PF8; The top five PF for A value is PF2(0.242), PF1(0.232), PF5(0.225), PF8(0.222) and PF3(0.221). These values allow us to summarize and draw visual charts according to the above data sorting mode. The higher the value of the product function, the more it can be prioritized for design development with functional cost savings, simplification or clustering. CONCLUSION: This study proposes an adaptable design method based on fuzzy logic programming. The data results in this study can guide the development and programming of the vestibule anti-epidemic products. The higher adaptability value of a product function indicates that it is more capable of being simplified, clustered, and adapting to changes in the product set.

Evidence Review and Practice Recommendation on the Material, Design, and Maintenance of Cloth Masks.

Despite numerous masking recommendations from public health agencies, including the World Health Organization, editorials, and commentaries providing support for this notion, none had examined different homemade masks or demonstrated that perhaps not all cloth masks are the same. This article aims to provide evidence-based recommendations on cloth-mask materials, its design, and, importantly, its maintenance. Articles were obtained from PubMed and preprint servers up to June 10, 2020. Current evidence suggests that filtration effectiveness can range from 3% to 95%. Multiple layer (hybrid) homemade masks made from a combination of high density 100% cotton and materials with electrostatic charge would be more effective than one made from a single material. Mask fit greatly affects filtration efficiency, and adding an overhead knot or nylon overlay potentially provides the best fit for cloth masks. There is a paucity of evidence for masks maintenance as most studies are in the laboratory setting; however, switching every 4 hours as in medical masks and stored in dedicated containers while awaiting disinfection is recommended. Outside of these recommendations to improve the effectiveness of cloth masks to reduce infection transmission, there is a need for countries to set up independent testing labs for homemade masks made based on locally available materials. This can use existing occupational health laboratories usually used for accrediting masks and respirators.

N95 mask reuse in a major urban hospital: COVID-19 response process and procedure.

BACKGROUND: The shortage of single-use N95 respirator masks (NRMs) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has prompted consideration of NRM recycling to extend limited stocks by healthcare providers and facilities. AIM: To assess potential reuse via autoclaving of NRMs worn daily in a major urban Canadian hospital. METHODS: NRM reusability was assessed following collection from volunteer staff after 2-8 h use, sterilization by autoclaving and PortaCount fit testing. A workflow was developed for reprocessing hundreds of NRMs daily. FINDINGS: Used NRMs passed fit testing after autoclaving once, with 86% passing a second reuse/autoclave cycle. A separate cohort of used masks pre-warmed before autoclaving passed fit testing. To recycle 200-1000 NRMs daily, procedures for collection, sterilization and re-distribution were developed to minimize particle aerosolization risk during NRM handling, to reject NRM showing obvious wear, and to promote adoption by staff. NRM recovery ranged from 49% to 80% across 12 collection cycles. CONCLUSION: Reuse of NRMs is feasible in major hospitals and other healthcare facilities. In sharp contrast to studies of unused NRMs passing fit testing after 10 autoclave cycles, we show that daily wear substantially reduces NRM fit, limiting reuse to a single cycle, but still increasing NRM stocks by ∼66%. Such reuse requires development of a comprehensive plan that includes communication across staffing levels, from front-line workers to hospital administration, to increase the collection, acceptance of and adherence to sterilization processes for NRM recovery.