Airway Pressure Release Ventilation Mode Improves Circulatory and Respiratory Function in Patients After Cardiopulmonary Bypass, a Randomized Trial.

IMPORTANCE: Postoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality, and resource utilization in cardiac surgery patients. OBJECTIVES: To investigate the effects of airway pressure release ventilation (APRV) on respiration and hemodynamics in post cardiac surgery patients. MAIN OUTCOMES AND MEASURES: A single-center randomized control trial was performed. In total, 138 patients undergoing cardiopulmonary bypass were prospectively screened. Ultimately 39 patients met the inclusion criteria and were randomized into two groups: 19 patients were managed with pressure control ventilation (PCV) and 20 patients were managed with APRV. Respiratory mechanics after 4 h, hemodynamics within the first day, and Chest radiograph score (CRS) and blood gasses within the first three days were recorded and compared. RESULTS: A higher cardiac index (3.1 ± 0.7 vs. 2.8 ± 0.8 L⋅min-1⋅m2; p < 0.05), and shock volume index (35.4 ± 9.2 vs. 33.1 ± 9.7 ml m-2; p < 0.05) were also observed in the APRV group after 4 h as well as within the first day (p < 0.05). Compared to the PCV group, the PaO2/FiO2 was significantly higher after 4 h in patients of APRV group (340 ± 97 vs. 301 ± 82, p < 0.05) and within the first three days (p < 0.05) in the APRV group. CRS revealed less overall lung injury in the APRV group (p < 0.001). The duration of mechanical ventilation and ICU length of stay were not significantly (p = 0.248 and 0.424, respectively). CONCLUSIONS AND RELEVANCE: Compared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients.

Risk Factors for Patient-Ventilator Asynchrony and Its Impact on Clinical Outcomes: Analytics Based on Deep Learning Algorithm.

Background and objectives: Patient-ventilator asynchronies (PVAs) are common in mechanically ventilated patients. However, the epidemiology of PVAs and its impact on clinical outcome remains controversial. The current study aims to evaluate the epidemiology and risk factors of PVAs and their impact on clinical outcomes using big data analytics. Methods: The study was conducted in a tertiary care hospital; all patients with mechanical ventilation from June to December 2019 were included for analysis. Negative binomial regression and distributed lag non-linear models (DLNM) were used to explore risk factors for PVAs. PVAs were included as a time-varying covariate into Cox regression models to investigate its influence on the hazard of mortality and ventilator-associated events (VAEs). Results: A total of 146 patients involving 50,124 h and 51,451,138 respiratory cycles were analyzed. The overall mortality rate was 15.6%. Double triggering was less likely to occur during day hours (RR: 0.88; 95% CI: 0.85-0.90; p < 0.001) and occurred most frequently in pressure control ventilation (PCV) mode (median: 3; IQR: 1-9 per hour). Ineffective effort was more likely to occur during day time (RR: 1.09; 95% CI: 1.05-1.13; p < 0.001), and occurred most frequently in PSV mode (median: 8; IQR: 2-29 per hour). The effect of sedatives and analgesics showed temporal patterns in DLNM. PVAs were not associated mortality and VAE in Cox regression models with time-varying covariates. Conclusions: Our study showed that counts of PVAs were significantly influenced by time of the day, ventilation mode, ventilation settings (e.g., tidal volume and plateau pressure), and sedatives and analgesics. However, PVAs were not associated with the hazard of VAE or mortality after adjusting for protective ventilation strategies such as tidal volume, plateau pressure, and positive end expiratory pressure (PEEP).

Detection of patient-ventilator asynchrony from mechanical ventilation waveforms using a two-layer long short-term memory neural network.

BACKGROUND AND OBJECTIVE: Mismatch between invasive mechanical ventilation and the requirements of patients results in patient-ventilator asynchrony (PVA), which is associated with a series of adverse clinical outcomes. Although the efficiency of the available approaches for automatically detecting various types of PVA from the ventilator waveforms is unsatisfactory, the feasibility of powerful deep learning approaches in addressing this problem has not been investigated. METHODS: We propose a 2-layer long short-term memory (LSTM) network to detect two most frequently encountered types of PVA, namely, double triggering (DT) and ineffective inspiratory effort during expiration (IEE), on two datasets. The performance of the networks is evaluated first using cross-validation on the combined dataset, and then using a cross testing scheme, in which the LSTM networks are established on one dataset and tested on the other. RESULTS: Compared with the reported rule-based algorithms and the machine learning models, the proposed 2-layer LSTM network exhibits the best overall performance, with the F1 scores of 0.983 and 0.979 for DT and IEE detection, respectively, on the combined dataset. Furthermore, it outperforms the other approaches in cross testing. CONCLUSIONS: The findings suggest that LSTM is an excellent technique for accurate recognition of PVA in clinics. Such a technique can help detect and correct PVA for a better patient ventilator interaction.

Free-space propagation of guided optical vortices excited in an annular core fiber.

The analytical expression for the propagation of guided optical vortices through free space is derived and used to study the dynamic evolution of guided optical vortices after passing through the free space, and the dependence of guided optical vortices on the control parameters where the effect of propagation distance is stressed. It is shown that the motion, pair creation and annihilation of guided optical vortices may take place. In particular, the creation and annihilation of a pair of guided optical vortices do not take place by varying fiber length.

All-fiber mode-locked nanosecond laser employing intracavity chirped fiber gratings.

We demonstrate that nanosecond pulses are generated directly from an all-fiber mode-locked ytterbium-doped fiber laser. A pair of Chirped Fiber Gratings (CFGs) with different sign of dispersion is employed for intracavity dispersion management. Self-starting stabilized mode-locking operation is achieved by nonlinear polarization evolution (NPE). The 1.27 ns pulses are obtained after one CFG with large positive dispersion. The pulse energy is up to 15 nJ at a repetition rate of 3.48 MHz.

Propagation of Hermite-Gaussian and Laguerre-Gaussian beams beyond the paraxial approximation.

On the basis of the vectorial Rayleigh-Sommerfeld formulas and by means of the relation between Hermite and Laguerre polynomials, the analytical expressions for the propagation of the Hermite-Gaussian (HG) and Laguerre-Gaussian (LG) beams beyond the paraxial approximation are derived, with the corresponding far-field propagation expressions and that for the Gaussian beams being given as special cases of the results. Some detailed comparisons of our results with the expansion series and paraxial expressions are made, which show the advantages of our results over the expansion series. With the results obtained, some typical intensity patterns of nonparaxial HG and LG beams are shown.

Polarization properties of vectorial nonparaxial Gaussian beams in the far field.

The polarization properties of vectorial coherent nonparaxial Gaussian beams are studied. It is shown that, when the source of a nonparaxial Gaussian beam is completely polarized, the degree of polarization of the propagation field maintains a constant value of 1. However, when the source is completely unpolarized, the degree of polarization does not maintain a constant value of 0. In the far field, vectorial nonparaxial Gaussian beams can become partially polarized, except on the propagation axis, and are spatially nonuniform across a typical cross section of the beam even though the source field is completely unpolarized.

Improved diffraction integral for studying the diffracted field of a spherical microlens.

By introducing a new kind of Green function, we formulate an improved diffraction integral, which can be used to numerically evaluate the diffracted field of a microlens of plane-convex shape. Analytical expressions for the diffracted field of microlens are derived for the case where the curvature radius of the convex surface is larger than the dimension of the microlens aperture. The validity of the results and the diffracted field of the microlens are illustrated with numerical examples. The focal shifts of the diffracted field are found to depend mainly on the Fresnel number N of the microlens.

Partially coherent vectorial nonparaxial beams.

Generalized vectorial Rayleigh-Sommerfeld diffraction integrals are developed for the cross-spectral-density matrices of spatially partially coherent beams. Using the Gaussian Schell-model (GSM) beam as an example, we derive the expressions for the propagation of cross-spectral-density matrices and intensity of partially coherent vectorial nonparaxial beams, and the corresponding far-field asymptotic forms, beyond the paraxial approximation. The propagation of the vectorial nonparaxial GSM beams are evaluated and analyzed. It is shown that a 3 x 3 cross-spectral-density matrix or a vector theory is required for the exact description of nonparaxial GSM beams.

Vectorial nonparaxial propagation equation of elliptical Gaussian beams in the presence of a rectangular aperture.

Based on the vectorial Rayleigh-Sommerfeld diffraction integrals, an analytical propagation equation of vectorial, nonparaxial, elliptical Gaussian beams through a rectangular aperture is derived. Unlike in previous work, the aperture effect and nonrotational symmetry of the beam and aperture are considered in our theoretical model. The results of the far-field and paraxial approximation for the apertured case are treated as special cases of our general expression. It is found that two f parameters fx, fy and two truncation parameters deltax, deltay in the x and y directions, respectively, have to be introduced that affect the beam nonparaxial evolution behavior in both the near field and the far field.

Partially coherent nonparaxial beams.

The concept of a partially coherent nonparaxial beam is proposed. A closed-form expression for the propagation of nonparaxial Gaussian Schell model (GSM) beams in free space is derived and applied to study the propagation properties of nonparaxial GSM beams. It is shown that for partially coherent nonparaxial beams a new parameter f(sigma) has to be introduced, which together with the parameter f, determines the beam nonparaxiality.

Nonparaxial propagation of vectorial Gaussian beams diffracted at a circular aperture.

Based on the vectorial Rayleigh diffraction integral, the nonparaxial propagation of vectorial Gaussian beams diffracted at a circular aperture is studied. The far-field and paraxial cases are treated as special cases of our general result. It is shown that for the apertured case the f parameter still plays an important role in determining the nonparaxiality of vectorial diffracted Gaussian beams, but both the f parameter and truncation affect the beam evolution behavior.

Nonparaxial analysis of far-field properties of Gaussian beams diffracted at a circular aperture.

On the basis of angular spectrum representation and the stationary-phase method, a far-field expression for nonparaxial Gaussian beams diffracted at a circular aperture is derived, which permits us to study the far-field nonparaxial properties of apertured Gaussian beams both analytically and numerically. It is shown that for the apertured case, the f -parameter and the truncation parameter affect the beam's far-field properties. The f -parameter plays the more important role in determining the beam nonparaxiality than does the truncation parameter, whereas the truncation parameter additionally influences the beam diffraction. A comparison with the paraxial case is made. For the unapertured case our results reduce to the previous ones.