Modified Bain's Circuit as an Alternate to Non-invasive Ventilation in COVID 19.

Introduction COVID-19 is a pandemic that severely affects the lungs. Symptomatically affected individuals often become severely hypoxic, requiring non-invasive ventilation. The scarcity of resources in resource-compromised countries like India led to the adoption of novel strategies like using Bain's circuit for assisting spontaneous ventilation. This study compares the outcome when a standard circuit is replaced with a shortened Bain's circuit. Aims and objectives To compare shortened Bain's circuit and bilevel positive airway pressure (BiPAP) in spontaneously ventilated COVID 19 patients with regards to effects on hemodynamic stability and efficacy of ventilation using blood gas analysis. Methodology Twenty-four COVID patients aged between 35-70 years, requiring non-invasive ventilation but not tolerating BiPAP or not improving on BiPAP were enrolled in the study. Baseline heart rate and arterial blood gases (ABG) were recorded. Patients were then ventilated using shortened Bain's circuit. Heart rate and ABG were then recorded two hours after ventilation. Results Hemodynamic and blood gas parameters were comparable between the two groups at baseline and on BiPAP. Group A showed better hemodynamic and blood gas profiles compared to group B, but the difference was not statistically significant because of small sample size. Conclusion Shortened Bain's circuit may be a viable alternative to non-invasive ventilation in spontaneously breathing hypoxic patients with efficacy comparable to a standard Bain's circuit and reduced chances of carbon dioxide retention. Studies with a larger sample size are needed to further validate the conclusion.

Sensitivity analysis and evaluation of MicroFacPM: a microscale motor vehicle emission factor model for particulate matter emissions.

A microscale emission factor model (MicroFacPM) for predicting real-time site-specific motor vehicle particulate matter emissions was presented in the companion paper titled "Development of a Microscale Emission Factor Model for Particulate Matter (MicroFacPM) for Predicting Real-Time Motor Vehicle Emissions". The emission rates discussed are in mass per unit distance with the model providing estimates of fine particulate matter (PM2.5) and coarse particulate matter. This paper complements the companion paper by presenting a sensitivity analysis of the model to input variables and evaluation model outputs using data from limited field studies. The sensitivity analysis has shown that MicroFacPM emission estimates are very sensitive to vehicle fleet composition, speed, and the percentage of high-emitting vehicles. The vehicle fleet composition can affect fleet emission rates from 8 mg/mi to 1215 mg/mi; an increase of 5% in the smoking (high-emitting) current average U.S. light-duty vehicle fleet (compared with 0%) increased PM2.5 emission rates by -272% for 2000; and for the current U.S. fleet, PM2.5 emission rates are reduced by a factor of -0.64 for speeds >50 miles per hour (mph) relative to a speed of 10 mph. MicroFacPM can also be applied to examine the contribution of emission rates per vehicle class, model year, and sources of PM. The model evaluation is presented for the Tuscarora Mountain Tunnel, Pennsylvania Turnpike, PA, and some limited evaluations at two locations: Sepulveda Tunnel, Los Angeles, CA, and Van Nuys Tunnel, Van Nuys, CA. In general, the performance of MicroFacPM has shown very encouraging results.

Application of a microscale emission factor model for particulate matter to calculate vehicle-generated contributions to fine particulate emissions.

This paper discusses the evaluation and application of a new generation of particulate matter (PM) emission factor model (MicroFacPM). MicroFacPM that was evaluated in Tuscarora Mountain Tunnel, Pennsylvania Turnpike, PA shows good agreement between measured and modeled emissions. MicroFacPM application is presented to the vehicle traffic on the main approach road to the Ambassador Bridge, which is one of the most important international border entry points in North America, connecting Detroit, MI, with Windsor, Ontario, Canada. An increase in border security has forced heavy-duty diesel vehicles to line up for several kilometers through the city of Windsor causing concern about elevated concentrations of ambient PM. MicroFacPM has been developed to model vehicle-generated PM (fine [PM2.5] and coarse < or = 10 microm [PM10]) from the on-road vehicle fleet, which in this case includes traffic at very low speeds (10 km/h). The Windsor case study gives vehicle generated PM2.5 sources and their breakdown by vehicle age and class. It shows that the primary sources of vehicle-generated PM2.5 emissions are the late-model heavy-duty diesel vehicles. We also applied CALINE4 and AERMOD in conjunction with MicroFacPM, using Canadian traffic and climate conditions, to describe the vehicle-generated PM2.5 dispersion near this roadway during the month of May in 2003.

Development of a microscale emission factor model for particulate matter for predicting real-time motor vehicle emissions.

The U.S. Environmental Protection Agency's National Exposure Research Laboratory is pursuing a project to improve the methodology for modeling human exposure to motor vehicle emissions. The overall project goal is to develop improved methods for modeling the source through the air pathway to human exposure in significant exposure microenvironments. Current particulate matter (PM) emission models, particle emission factor model (used in the United States, except California) and motor vehicle emission factor model (used in California only), are suitable only for county-scale modeling and emission inventories. There is a need to develop a site-specific real-time emission factor model for PM emissions to support human exposure studies near roadways. A microscale emission factor model for predicting site-specific real-time motor vehicle PM (MicroFacPM) emissions for total suspended PM, PM less than 10 microm aerodynamic diameter, and PM less than 2.5 microm aerodynamic diameter has been developed. The algorithm used to calculate emission factors in MicroFacPM is disaggregated, and emission factors are calculated from a real-time fleet, rather than from a fleet-wide average estimated by a vehicle-miles-traveled weighting of the emission factors for different vehicle classes. MicroFacPM requires input information necessary to characterize the site-specific real-time fleet being modeled. Other variables required include average vehicle speed, time and day of the year, ambient temperature, and relative humidity.

Development and Preliminary Evaluation of a Particulate Matter Emission Factor Model for European Motor Vehicles.

Although modeling of gaseous emissions from motor vehicles is now quite advanced, prediction of particulate emissions is still at an unsophisticated stage. Emission factors for gasoline vehicles are not reliably available, since gasoline vehicles are not included in the European Union (EU) emission test procedure. Regarding diesel vehicles, emission factors are available for different driving cycles but give little information about change of emissions with speed or engine load. We have developed size-specific speed-dependent emission factors for gasoline and diesel vehicles. Other vehicle-generated emission factors are also considered and the empirical equation for re-entrained road dust is modified to include humidity effects. A methodology is proposed to calculate modal (accelerating, cruising, or idling) emission factors. The emission factors cover particle size ranges up to 10 um, either from published data or from user-defined size distributions. A particulate matter emission factor model (PMFAC), which incorporates virtually all the available information on particulate emissions for European motor vehicles, has been developed. PMFAC calculates the emission factors for five particle size ranges [i.e., total suspended particulates (TSP), PM10, PM5, PM25, and PM1] from both vehicle exhaust and nonexhaust emissions, such as tire wear, brake wear, and re-entrained road dust. The model can be used for an unlimited number of roads and lanes, and to calculate emission factors near an intersection in user-defined elements of the lane. PMFAC can be used for a variety of fleet structures. Hot emission factors at the user-defined speed can be calculated for individual vehicles, along with relative cold-to-hot emission factors. The model accounts for the proportions of distance driven with cold engines as a function of ambient temperature and road type (i.e., urban, rural, or motorway). A preliminary evaluation of PMFAC with an available dispersion model to predict the airborne concentration in the urban environment is presented. The trial was on the A6 trunk road where it passes through Loughborough, a medium-size town in the English East Midlands. This evaluation for TSP and PM10 was carried out for a range of traffic fleet compositions, speeds, and meteorological conditions. Given the limited basis of the evaluation, encouraging agreement was shown between predicted and measured concentrations.