ABSTRACT
Background@#With the surge of COVID-19 infections, there were concerns about shortage of mechanical ventilator in several countries including the Philippines.@*Objective@#To transform a locally made, low-cost, neonatal ventilator into a volume- and pressure-controlled, adult ventilator and to determine its safe use among ventilated, adult patients at the Philippine General Hospital.@*Methods@#The modification of the neonatal ventilator (OstreaVent1) to the adult OstreaVent2 was based on the critical need for adult ventilators, in volume or pressure mode, in the Philippines due to the COVID-19 pandemic. The adult ventilator settings were calibrated and tested for two days to check for consistency and tolerance and then submitted to a third party for certification. Once certified, a safety trial of 10 stable adult patients on mechanical ventilator was conducted. The patients were placed on the OstreaVent2 for four hours while ventilator parameters, patient’s vital signs, and arterial blood gases were monitored at baseline, during, and after placement on the OstreaVent2. A poststudy chest radiograph was also done to rule out pulmonary complications, particularly atelectasis and pneumothorax. @*Results@#The prototype OstreaVent2 received an FDA Certification for Medical Listing after passing its thirdparty certification. Ten patients (60% male) recruited in the study had a mean age of 39.1 ± 11.6 years. Half of the patients had a diagnosis of non-COVID-19 pneumonia. During the 4-hour study period, the patients while on the OstreaVent2, had stable ventilator settings and most of the variabilities were within the acceptable tolerances. Vital signs were stable and arterial blood gases were within normal limits. One patient developed alar flaring which was relieved by endotracheal tube suctioning. No patient was withdrawn from the study. One patient who was already transferred out of the ICU subsequently deteriorated and died three days after transfer to the stepdown unit from a non-ventilator related cause.@*Conclusion@#The new OstreaVent2 is safe to use among adults who need ventilator support. Variabilities in the ventilator’s performance were within acceptable tolerances. Clinical and blood gas measurements of the patients were stable while on the ventilator.
Subject(s)
Respiration, ArtificialABSTRACT
Objectives@#To explore the current experiences and perspectives of patients with chronic obstructive pulmonary disease (COPD) with advance care planning (ACP).@*Methods@#A cross-sectional survey was conducted among patients diagnosed with COPD in the Philippine General Hospital. Results were illustrated using descriptive statistics.@*Results@#A total of 90 patients were interviewed and included in the analysis. Nearly all patients were unfamiliar with the terms ACP (95.55%), end-of-life care (99.89%), and do-not-resuscitate order (100%). The majority expressed a desire to have ACP discussions (94.44%) which were not viewed as distressing and were deemed beneficial (96.67%). Patients who were employed were more likely to express readiness to sign legal papers. Patients living with their nuclear family or living alone, and those with higher COPD assessment test (CAT) scores were more likely to relegate health care decisions to their doctors.@*Conclusion@#Most patients with COPD in our cohort are unfamiliar with ACP and have not received ACP discussions. Most think that it will improve healthcare and quality of life. Some demographic and clinical factors may make patients more likely to engage in ACP-related activities.
Subject(s)
Advance Care Planning , Pulmonary Disease, Chronic Obstructive , Palliative MedicineABSTRACT
@#The Bajaus’ ability to free dive for prolonged periods is attributed to their exceptional physiologic response and large spleens. The spleen has been traditionally viewed as a hematologic and immunologic organ. Unconventionally, this review explores the spleen’s role as a respiratory organ and how apnea training can enhance the spleen’s form and function. Eligible articles obtained from Pubmed were discussed. The selected studies have shown that an 8-week home-based apnea training regimen can enhance the spleen volume by as much as 24% and that prolonged apnea training can increase both splenic contraction and baseline serum hemoglobin levels. However, the sample size and heterogeneity of these studies largely limit the generalizability of these findings. Thus, several future studies are needed to further explore the spleen’s respiratory function in humans.
