30 CFR 75.371 - Mine ventilation plan; contents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (see § 75.325(a)(3)). (k) The minimum mean entry air velocity in exhausting face ventilation systems where coal is being cut, mined, drilled for blasting, or loaded, if the velocity will be less than 60... loaded, where at least 60 feet per minute or some other minimum mean entry air velocity will be...

30 CFR 75.371 - Mine ventilation plan; contents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (see § 75.325(a)(3)). (k) The minimum mean entry air velocity in exhausting face ventilation systems where coal is being cut, mined, drilled for blasting, or loaded, if the velocity will be less than 60... loaded, where at least 60 feet per minute or some other minimum mean entry air velocity will be...

Assessment of codes, by-laws and regulations relating to air wells in building design

NASA Astrophysics Data System (ADS)

Fadzil, Sharifah Fairuz Syed; Karamazaman, Nazli

2017-10-01

Codes and by-laws concerning air well design (for buildings and lavatories) in Malaysia has been established in the Malaysian Uniform Building By-Laws UBBL number 40 (1) and (2) since the 1980s. Wells are there to fulfill the ventilation and daylighting requirements. The minimum well area according to building storey height are compared between UBBL and the Singapore's well requirements from the Building Construction Authority BCA. A visual and graphical representation (with schematics building and well diagrams drawn to scale) of the minimum well sizes and dimensions is given. It can be seen that if the minimum requirement of well size is used for buildings above 8 storeys high, a thin well resulted which is not proportionate to the building height. A proposed dimension is graphed and given to be used in the UBBL which translated to graphics (3 dimensional buildings drawn to scale) created a much better well proportion.

Good Practice Recommendations in the Field of Heating, Ventilation, and Air Conditioning for Health Related Research Laboratories.

ERIC Educational Resources Information Center

Laboratory Design Notes, 1966

1966-01-01

A collection of laboratory design notes to set forth minimum criteria required in the design of basic medical research laboratory buildings. Recommendations contained are primarily concerned with features of design which affect quality of performance and future flexibility of facility systems. Subjects of economy and safety are discussed where…

Humidification during invasive and noninvasive mechanical ventilation: 2012.

PubMed

Restrepo, Ruben D; Walsh, Brian K

2012-05-01

We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1990 and December 2011. The update of this clinical practice guideline is based on 184 clinical trials and systematic reviews, and 10 articles investigating humidification during invasive and noninvasive mechanical ventilation. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system: 1. Humidification is recommended on every patient receiving invasive mechanical ventilation. 2. Active humidification is suggested for noninvasive mechanical ventilation, as it may improve adherence and comfort. 3. When providing active humidification to patients who are invasively ventilated, it is suggested that the device provide a humidity level between 33 mg H(2)O/L and 44 mg H(2)O/L and gas temperature between 34°C and 41°C at the circuit Y-piece, with a relative humidity of 100%. 4. When providing passive humidification to patients undergoing invasive mechanical ventilation, it is suggested that the HME provide a minimum of 30 mg H(2)O/L. 5. Passive humidification is not recommended for noninvasive mechanical ventilation. 6. When providing humidification to patients with low tidal volumes, such as when lung-protective ventilation strategies are used, HMEs are not recommended because they contribute additional dead space, which can increase the ventilation requirement and P(aCO(2)). 7. It is suggested that HMEs are not used as a prevention strategy for ventilator-associated pneumonia.

Do submesoscale frontal processes ventilate the oxygen minimum zone off Peru?

NASA Astrophysics Data System (ADS)

Thomsen, S.; Kanzow, T.; Colas, F.; Echevin, V.; Krahmann, G.; Engel, A.

2016-08-01

The Peruvian upwelling system encompasses the most intense and shallowest oxygen minimum zone (OMZ) in the ocean. This system shows pronounced submesoscale activity like filaments and fronts. We carried out glider-based observations off Peru during austral summer 2013 to investigate whether submesoscale frontal processes ventilate the Peruvian OMZ. We present observational evidence for the subduction of highly oxygenated surface water in a submesoscale cold filament. The subduction event ventilates the oxycline but does not reach OMZ core waters. In a regional submesoscale-permitting model we study the pathways of newly upwelled water. About 50% of upwelled virtual floats are subducted below the mixed layer within 5 days emphasizing a hitherto unrecognized importance of subduction for the ventilation of the Peruvian oxycline.

Variation in Definition of Prolonged Mechanical Ventilation.

PubMed

Rose, Louise; McGinlay, Michael; Amin, Reshma; Burns, Karen Ea; Connolly, Bronwen; Hart, Nicholas; Jouvet, Philippe; Katz, Sherri; Leasa, David; Mawdsley, Cathy; McAuley, Danny F; Schultz, Marcus J; Blackwood, Bronagh

2017-10-01

Consistency of definitional criteria for terminology applied to describe subject cohorts receiving mechanical ventilation within ICU and post-acute care settings is important for understanding prevalence, risk stratification, effectiveness of interventions, and projections for resource allocation. Our objective was to quantify the application and definition of terms for prolonged mechanical ventilation. We conducted a scoping review of studies (all designs except single-case study) reporting a study population (adult and pediatric) using the term prolonged mechanical ventilation or a synonym. We screened 5,331 references, reviewed 539 full-text references, and excluded 120. Of the 419 studies (representing 38 countries) meeting inclusion criteria, 297 (71%) reported data on a heterogeneous subject cohort, and 66 (16%) included surgical subjects only (46 of those 66, 70% cardiac surgery). Other studies described COPD (16, 4%), trauma (22, 5%), neuromuscular (17, 4%), and sepsis (1, 0.2%) cohorts. A total of 741 terms were used to refer to the 419 study cohorts. The most common terms were: prolonged mechanical ventilation (253, 60%), admission to specialized unit (107, 26%), and long-term mechanical ventilation (79, 19%). Some authors (282, 67%) defined their cohorts based on duration of mechanical ventilation, with 154 studies (55%) using this as the sole criterion. We identified 37 different durations of ventilation ranging from 5 h to 1 y, with > 21 d being the most common (28 of 282, 7%). For studies describing a surgical cohort, minimum ventilation duration required for inclusion was ≥ 24 h for 20 of 66 studies (30%). More than half of all studies (237, 57%) did not provide a reason/rationale for definitional criteria used, with only 28 studies (7%) referring to a consensus definition. We conclude that substantial variation exists in the terminology and definitional criteria for cohorts of subjects receiving prolonged mechanical ventilation. Standardization of terminology and definitional criteria is required for study data to be maximally informative. Copyright © 2017 by Daedalus Enterprises.

Inadequate humidification of respiratory gases during mechanical ventilation of the newborn.

PubMed Central

Tarnow-Mordi, W O; Sutton, P; Wilkinson, A R

1986-01-01

Proximal airway humidity was measured during mechanical ventilation in 14 infants using an electronic hygrometer. Values below recommended minimum humidity of adult inspired gas were recorded on 251 of 396 occasions. Inadequate humidification, largely due to inadequate proximal airway temperature, is commoner than recognised in infants receiving mechanical ventilation. PMID:3740912

Modeling ventilation time in forage tower silos.

PubMed

Bahloul, A; Chavez, M; Reggio, M; Roberge, B; Goyer, N

2012-10-01

The fermentation process in forage tower silos produces a significant amount of gases, which can easily reach dangerous concentrations and constitute a hazard for silo operators. To maintain a non-toxic environment, silo ventilation is applied. Literature reviews show that the fermentation gases reach high concentrations in the headspace of a silo and flow down the silo from the chute door to the feed room. In this article, a detailed parametric analysis of forced ventilation scenarios built via numerical simulation was performed. The methodology is based on the solution of the Navier-Stokes equations, coupled with transport equations for the gas concentrations. Validation was achieved by comparing the numerical results with experimental data obtained from a scale model silo using the tracer gas testing method for O2 and CO2 concentrations. Good agreement was found between the experimental and numerical results. The set of numerical simulations made it possible to establish a simple analytical model to predict the minimum time required to ventilate a silo to make it safe to enter. This ventilation time takes into account the headspace above the forage, the airflow rate, and the initial concentrations of O2 and CO2. The final analytical model was validated with available results from the literature.

Winter ventilation rates at primary schools: comparison between Portugal and Finland.

PubMed

Canha, N; Almeida, S M; Freitas, M C; Täubel, M; Hänninen, O

2013-01-01

This study focused on examination of ventilation rates in classrooms with two different types of ventilation systems: natural and mechanical. Carbon dioxide (CO2) measurements were conducted in primary schools of Portugal characterized by natural ventilation and compared to Finland where mechanical ventilation is the norm. The winter period was selected since this season exerts a great influence in naturally ventilated classrooms, where opening of windows and doors occurs due to outdoor atmospheric conditions. The ventilation rates were calculated by monitoring CO2 concentrations generated by the occupants (used as a tracer gas) and application of the buildup phase method. A comparison between both countries' results was conducted with respect to ventilation rates and how these levels corresponded to national regulatory standards. Finnish primary schools (n = 2) registered a mean ventilation rate of 13.3 L/s per person, which is higher than the recommended ventilation standards. However, the Finnish classroom that presented the lowest ventilation rate (7.2 L/s per person) displayed short-term CO2 levels above 1200 ppm, which is the threshold limit value (TLV) recommended by national guidelines. The Portuguese classrooms (n = 2) showed low ventilation rates with mean values of 2.4 L/s per person, which is markedly lower than the minimum recommended value of 7 L/s per person as defined by ASHRAE and 20% less than the REHVA minimum of 3 L/s per person. Carbon dioxide levels of 1000 ppm, close to the TLV of 1200 ppm, were also reached in both Portuguese classrooms studied. The situation in Portugal indicates a potentially serious indoor air quality problem and strengthens the need for intervention to improve ventilation rates in naturally ventilated classrooms.

46 CFR 108.437 - Pipe sizes and discharge rates for enclosed ventilation systems for rotating electrical equipment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Pipe sizes and discharge rates for enclosed ventilation... Systems Fixed Carbon Dioxide Fire Extinguishing Systems § 108.437 Pipe sizes and discharge rates for enclosed ventilation systems for rotating electrical equipment. (a) The minimum pipe size for the initial...

Plutonium Finishing Plant (PFP) HVAC System Component Index

DOE Office of Scientific and Technical Information (OSTI.GOV)

DICK, J.D.

2000-02-28

The Plutonium Finishing Plant (PFP) WAC System includes sub-systems 25A through 25K. Specific system boundaries and justifications are contained in HNF-SD-CP-SDD-005, ''Definition and Means of Maintaining the Ventilation System Confinement Portion of the PFP Safety Envelope.'' The procurement requirements associated with the system necessitates procurement of some system equipment as Commercial Grade Items in accordance with HNF-PRO-268, ''Control of Purchased Items and Services.'' This document lists safety class and safety significant components for the Heating Ventilation Air Conditioning and specifies the critical characteristics for Commercial Grade Items, as required by HNF-PRO-268 and HNF-PRO-1819. These are the minimum specifications that themore » equipment must meet in order to properly perform its safety function. There may be several manufacturers or models that meet the critical characteristics for any one item.« less

Comfort and human factors in office and residential settings. (Latest citations from the NTIS data base). Published Search

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-04-01

The bibliography contains citations concerning human factors engineering, anthropometry, and ergonomics as they relate to human comfort in the office and home. Human requirements, including ventilation, temperature control, and lighting, are considered. Research regarding environmental architecture, and engineering, safety, and convenience aspects are discussed. (Contains a minimum of 142 citations and includes a subject term index and title list.)

HOW THE LEED VENTILATION CREDIT IMPACTS ENERGY CONSUMPTION OF GSHP SYSTEMS A CASE STUDY FOR PRIMARY SCHOOLS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Xiaobing

2011-01-01

This paper presents a study on the impacts of increased outdoor air (OA) ventilation on the performance of ground-source heat pump (GSHP) systems that heat and cool typical primary schools. Four locations Phoenix, Miami, Seattle, and Chicago are selected in this study to represent different climate zones in the United States. eQUEST, an integrated building and HVAC system energy analysis program, is used to simulate a typical primary school and the GSHP system at the four locations with minimum and 30% more than minimum OA ventilation. The simulation results show that, without an energy recovery ventilator, the 30% more OAmore » ventilation results in an 8.0 13.3% increase in total GSHP system energy consumption at the four locations. The peak heating and cooling loads increase by 20.2 30% and 14.9 18.4%, respectively, at the four locations. The load imbalance of the ground heat exchanger is increased in hot climates but reduced in mild and cold climates.« less

A tracer study of ventilation in the Japan/East Sea

NASA Astrophysics Data System (ADS)

Postlethwaite, C. F.; Rohling, E. J.; Jenkins, W. J.; Walker, C. F.

2005-06-01

During the Circulation Research in East Asian Marginal Seas (CREAMS) summer cruises in 1999, a suite of samples was collected for tracer analysis. Oxygen isotopes combined with tritium-helium ventilation timescales and noble gas measurements give unique insights into the ventilation of water masses in the Japan/East Sea (JES). In particular, noble gases and oxygen isotopes are indicators of brine rejection, which may assist in explaining the recent changes observed in the ventilation of the JES. Oxygen isotope data presented here indicate that both thermally driven convection and brine rejection have played significant roles in deep-water formation but that brine rejection is unlikely to be a significant contributor at the moment. A 6-box ventilation model of the JES, calibrated with tritium and helium-3 measurements, performed better when a significant decrease of dense-water formation rates in the mid-1960s was incorporated. However, the model calculations suggest that Japan Sea Intermediate Water formation is still occurring. Subduction of sea-ice melt water may be a significant ventilation mechanism for this water mass, based on an argon saturation minimum at the recently ventilated salinity minimum in the northwestern sector of the JES. The salinity and oxygen isotope budgets imply a potential bottom-water formation rate of 3.97±0.89×10 12 m 3 yr -1 due to brine rejection, which could account for a time averaged fraction of between 25% and 35% of the ventilation of subsurface water formation in the JES.

Houses need to breathe--right?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sherman, Max H.

2004-10-01

Houses need to breathe, but we can no longer leave the important functions associated with ventilation to be met accidentally. A designed ventilation system must be considered as much a part of a home as its heating system. Windows are a key part of that system because they allow a quick increase in ventilation for unusual events, but neither they nor a leaky building shell can be counted on to provide minimum levels.

Ventilation of Welding Fumes in Vocational Agriculture Laboratories in Missouri.

ERIC Educational Resources Information Center

Carr, Brenda; And Others

1982-01-01

This study was intended to measure the effectiveness of ventilation systems in removing airborne contaminants produced by arc welding in vocational agriculture laboratories in Missouri. It was found that most schools did not meet the minimum Occupational Safety and Health Administration standards. (SK)

Effects of elevated carbon dioxide concentrations on broiler chicken performance from 28 to 49 days

USDA-ARS?s Scientific Manuscript database

Improvements in modern broiler housing have substantially reduced air leakage, making proper operation of ventilation systems critical to maintaining a suitable environment. Fuel prices have increased in recent years, leading to reduced minimum ventilation in order to conserve fuel which increases ...

Use of Advanced Technologies and New Procedures in Medical Field Operations (Utilisation de technologies avancees et de procedures nouvelles dans les operations sanitaires)

DTIC Science & Technology

2010-04-01

that are now digitally enhanced and also part-task trainers (attrappe). Paper 12 – Using Advanced Prosthetics for Stress Inoculation Training and to...concept of minimum treatment called the “Just seven procedure”: just bridge the fracture , just align the limb, just stiff enough to allow evacuation...require energy, some more than others. Oxygen economizing systems like on-demand valves should be compulsory for spontaneous ventilation. Pulseoximeters

Laboratory Ventilation and Safety.

ERIC Educational Resources Information Center

Steere, Norman V.

1965-01-01

In order to meet the needs of both safety and economy, laboratory ventilation systems must effectively remove air-borne toxic and flammable materials and at the same time exhaust a minimum volume of air. Laboratory hoods are the most commonly used means of removing gases, dusts, mists, vapors, and fumed from laboratory operations. To be effective,…

Design local exhaust ventilation on sieve machine at PT.Perkebunan Nusantara VIII Ciater using design for assembly (DFA) approach with Boothroyd and Dewhurst method

NASA Astrophysics Data System (ADS)

Khalqihi, K. I.; Rahayu, M.; Rendra, M.

2017-12-01

PT Perkebunan Nusantara VIII Ciater is a company produced black tea orthodox more or less 4 tons every day. At the production section, PT Perkebunan Nusantara VIII will use local exhaust ventilation specially at sortation area on sieve machine. To maintain the quality of the black tea orthodox, all machine must be scheduled for maintenance every once a month and takes time 2 hours in workhours, with additional local exhaust ventilation, it will increase time for maintenance process, if maintenance takes time more than 2 hours it will caused production process delayed. To support maintenance process in PT Perkebunan Nusantara VIII Ciater, designing local exhaust ventilation using design for assembly approach with Boothroyd and Dewhurst method, design for assembly approach is choosen to simplify maintenance process which required assembly process. There are 2 LEV designs for this research. Design 1 with 94 components, assembly time 647.88 seconds and assembly efficiency level 23.62%. Design 2 with 82 components, assembly time 567.84 seconds and assembly efficiency level 24.83%. Design 2 is choosen for this research based on DFA goals, minimum total part that use, optimization assembly time, and assembly efficiency level.

The ventilation problem in schools: literature review

DOE PAGES

Fisk, W. J.

2017-07-06

Based on a review of literature published in refereed archival journals, ventilation rates in classrooms often fall far short of the minimum ventilation rates specified in standards. We report that there is compelling evidence, from both cross-sectional and intervention studies, of an association of increased student performance with increased ventilation rates. There is evidence that reduced respiratory health effects and reduced student absence are associated with increased ventilation rates. Increasing ventilation rates in schools imposes energy costs and can increase heating, ventilating, and air-conditioning system capital costs. The net annual costs, ranging from a few dollars to about 10 dollarsmore » per person, are less than 0.1% of typical public spending on elementary and secondary education in the United States. Finally, such expenditures seem like a small price to pay given the evidence of health and performance benefits.« less

The ventilation problem in schools: literature review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fisk, W. J.

Based on a review of literature published in refereed archival journals, ventilation rates in classrooms often fall far short of the minimum ventilation rates specified in standards. We report that there is compelling evidence, from both cross-sectional and intervention studies, of an association of increased student performance with increased ventilation rates. There is evidence that reduced respiratory health effects and reduced student absence are associated with increased ventilation rates. Increasing ventilation rates in schools imposes energy costs and can increase heating, ventilating, and air-conditioning system capital costs. The net annual costs, ranging from a few dollars to about 10 dollarsmore » per person, are less than 0.1% of typical public spending on elementary and secondary education in the United States. Finally, such expenditures seem like a small price to pay given the evidence of health and performance benefits.« less

Non-invasive Positive Pressure Ventilation during Sleep at 3800m: relationship to Acute Mountain Sickness and sleeping oxyhemoglobin saturation

PubMed Central

Johnson, PL; Popa, DA; Prisk, GK; Sullivan, CE; Edwards, N

2014-01-01

Background and objectives Ascent to high altitude results in hypobaric hypoxia and some individuals will develop Acute Mountain Sickness, which has been shown to be associated with low oxyhemoglobin saturation during sleep. Previous research has shown that positive end-expiratory pressure by use of expiratory valves in a face mask while awake, results in a reduction in AMS symptoms and higher oxyhemoglobin saturation. We aimed to test whether pressure ventilation during sleep would prevent AMS by keeping oxyhaemoglobin higher during sleep. Methods We compared sleeping oxyhemoglobin saturation and the incidence and severity of Acute Mountain Sickness in seven subjects sleeping for two consecutive nights at 3800m above sea level using either non-invasive positive pressure ventilation that delivered positive inspiratory and expiratory airway pressure via a face mask, or sleeping without assisted ventilation. The presence and severity of Acute Mountain Sickness was assessed by administration of the Lake Louise questionnaire. Results We found significant increases in the mean and minimum sleeping oxyhemoglobin saturation and decreases in AMS symptoms in subjects who used positive pressure ventilation during sleep. Mean and minimum sleeping SaO2 was lower in subjects who developed AMS after the night spent without positive pressure ventilation. Conclusion The use of positive pressure ventilation during sleep at 3800m significantly increased the sleeping oxygen saturation; we suggest that the marked reduction in symptoms of AMS is due to this higher sleeping SaO2. We agree with the findings from previous studies that the development of AMS is associated with a lower sleeping oxygen saturation. PMID:20051046

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hodgson, Alfred T.; Shendell, Derek G.; Fisk, William J.

Indoor exposures to toxic and odorous volatile organic compounds (VOCs) are of general concern. Recently, VOCs in portable or relocatable classrooms (RCs) have received particular attention. However, very little was known about indoor environmental quality (IEQ) and the sources, composition, and indoor concentrations of VOCs in RCs. This project task focused on developing and demonstrating a process for selecting interior finish materials for RCs that have relatively low impacts with respect to their emissions of toxic and odorous VOCs. This task was part of a larger project to demonstrate the potential for simultaneous improvements in IEQ and energy efficiency inmore » four new RCs equipped both with a continuously ventilating advanced heating, ventilating, and air conditioning system (HVAC) and a standard HVAC system. These HVACs were operated on alternate weeks. One RC per pair was constructed with standard interior finish materials, and the other included alternate interior materials identified in our prior laboratory study to have low VOC emissions. The RCs were sited in side-by-side pairs at two elementary schools in distinct northern California climate zones. Classroom VOC emission rates (mg hr{sup -1}) and concentrations were predicted based on VOC emission factors ({micro}g m{sup -2} hr{sup -1}) measured for individual materials in the laboratory, the quantities of installed materials and design ventilation rates. Predicted emission rates were compared to values derived from classroom measurements of VOC concentrations and ventilation rates made at pre-occupancy, eight weeks, and 27 weeks. Predicted concentrations were compared to measured integrated VOC indoor minus outdoor concentrations during school hours in the fall cooling season with the advanced HVAC operated. These measured concentrations also were compared between standard and material-modified RCs. Our combined laboratory and field process proved effective by correctly predicting that IEQ impacts of material VOC emissions would be minor when RCs were ventilated at or above code-minimum requirements. Assuming code-minimum ventilation rates are maintained, the benefits attributable to the use of alternate interior finish materials in RC's constructed by the manufacturer associated with this study are small, implying that it is not imperative to use such alternative finishing materials. However, it is essential to avoid materials that can degrade IEQ, and the results of this study demonstrate that laboratory-based material testing combined with modeling and field validation can help to achieve that aim.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Apte, Michael G.; Norman, Bourassa; Faulkner, David

An improved HVAC system for portable classrooms was specified to address key problems in existing units. These included low energy efficiency, poor control of and provision for adequate ventilation, and excessive acoustic noise. Working with industry, a prototype improved heat pump air conditioner was developed to meet the specification. A one-year measurement-intensive field-test of ten of these IHPAC systems was conducted in occupied classrooms in two distinct California climates. These measurements are compared to those made in parallel in side by side portable classrooms equipped with standard 10 SEER heat pump air conditioner equipment. The IHPAC units were found tomore » work as designed, providing predicted annual energy efficiency improvements of about 36 percent to 42 percent across California's climate zones, relative to 10 SEER units. Classroom ventilation was vastly improved as evidenced by far lower indoor minus outdoor CO2 concentrations. TheIHPAC units were found to provide ventilation that meets both California State energy and occupational codes and the ASHRAE minimum ventilation requirements; the classrooms equipped with the 10 SEER equipment universally did not meet these targets. The IHPAC system provided a major improvement in indoor acoustic conditions. HVAC system generated background noise was reduced in fan-only and fan and compressor modes, reducing the nose levels to better than the design objective of 45 dB(A), and acceptable for additional design points by the Collaborative on High Performance Schools. The IHPAC provided superior ventilation, with indoor minus outdoor CO2 concentrations that showed that the Title 24 minimum ventilation requirement of 15 CFM per occupant was nearly always being met. The opposite was found in the classrooms utilizing the 10 SEER system, where the indoor minus outdoor CO2 concentrations frequently exceeded levels that reflect inadequate ventilation. Improved ventilation conditions in the IHPAC lead to effective removal of volatile organic compounds and aldehydes, on average lowering the concentrations by 57 percent relative to the levels in the 10 SEER classrooms. The average IHPAC to 10 SEER formaldehyde ratio was about 67 percent, indicating only a 33 percent reduction of this compound in indoor air. The IHPAC thermal control system provided less variability in occupied classroom temperature than the 10 SEER thermostats. The average room temperatures in all seasons tended to be slightly lower in the IHPAC classrooms, often below the lower limit of the ASHRAE 55 thermal comfort band. State-wide and national energy modeling provided conservative estimates of potential energy savings by use of the IHPAC system that would provide payback a the range of time far lower than the lifetime of the equipment. Assuming electricity costs of $0.15/kWh, the perclassroom range of savings is from about $85 to $195 per year in California, and about $89 to $250 per year in the U.S., depending upon the city. These modelsdid not include the non-energy benefits to the classrooms including better air quality and acoustic conditions that could lead to improved health and learning in school. Market connection efforts that were part of the study give all indication that this has been a very successful project. The successes include the specification of the IHPAC equipment in the CHPS portable classroom standards, the release of a commercial product based on the standards that is now being installed in schools around the U.S., and the fact that a public utility company is currently considering the addition of the technology to its customer incentive program. These successes indicate that the IHPAC may reach its potential to improve ventilation and save energy in classrooms.« less

Pulmonary lesion induced by low and high positive end-expiratory pressure levels during protective ventilation in experimental acute lung injury.

PubMed

Pássaro, Caroline P; Silva, Pedro L; Rzezinski, Andréia F; Abrantes, Simone; Santiago, Viviane R; Nardelli, Liliane; Santos, Raquel S; Barbosa, Carolina M L; Morales, Marcelo M; Zin, Walter A; Amato, Marcelo B P; Capelozzi, Vera L; Pelosi, Paolo; Rocco, Patricia R M

2009-03-01

To investigate the effects of low and high levels of positive end-expiratory pressure (PEEP), without recruitment maneuvers, during lung protective ventilation in an experimental model of acute lung injury (ALI). Prospective, randomized, and controlled experimental study. University research laboratory. Wistar rats were randomly assigned to control (C) [saline (0.1 mL), intraperitoneally] and ALI [paraquat (15 mg/kg), intraperitoneally] groups. After 24 hours, each group was further randomized into four groups (six rats each) at different PEEP levels = 1.5, 3, 4.5, or 6 cm H2O and ventilated with a constant tidal volume (6 mL/kg) and open thorax. Lung mechanics [static elastance (Est, L) and viscoelastic pressure (DeltaP2, L)] and arterial blood gases were measured before (Pre) and at the end of 1-hour mechanical ventilation (Post). Pulmonary histology (light and electron microscopy) and type III procollagen (PCIII) messenger RNA (mRNA) expression were measured after 1 hour of mechanical ventilation. In ALI group, low and high PEEP levels induced a greater percentage of increase in Est, L (44% and 50%) and DeltaP2, L (56% and 36%) in Post values related to Pre. Low PEEP yielded alveolar collapse whereas high PEEP caused overdistension and atelectasis, with both levels worsening oxygenation and increasing PCIII mRNA expression. In the present nonrecruited ALI model, protective mechanical ventilation with lower and higher PEEP levels than required for better oxygenation increased Est, L and DeltaP2, L, the amount of atelectasis, and PCIII mRNA expression. PEEP selection titrated for a minimum elastance and maximum oxygenation may prevent lung injury while deviation from these settings may be harmful.

Assessment of the living and workplace health and safety conditions of site-resident construction workers in Tehran, Iran.

PubMed

Mohseni, Peyman Hossein; Farshad, Ali Asghar; Mirkazemi, Roksana; Orak, Rouhangiz Jamshidi

2015-01-01

The purpose of this study was to assess living and workplace safety conditions of construction workers in Tehran, Iran. This cross-sectional study was conducted among 410 construction sites in a municipal area of Tehran whose municipal building permits were issued in 2011. Data on ventilation, workplace safety and hygiene were collected by direct observation and interviews with site foremen. Noise levels were estimated from 10 sound-level-meter stations in the municipality area. Lack of ventilation in the workers' rooms was abundant. Bathrooms were unhygienic and minimum requirements such as lighting and ventilation did not exist in 80% of the cases. In nearly 50% of large construction sites, sewage and garbage disposal were inappropriate. Elevator safety was poor at all sites and no measures for fall prevention were present in over 88% of active construction sites. This study showed that the mean 24-h equivalent continuous sound level Leq was over 70 dB in 80% of the sites during weekdays. The results of this study revealed poor health and safety living and working conditions of construction workers in Tehran.

Anesthetic Management of Patients Undergoing Right Lung Surgery After Left Upper Lobectomy: Selection of Tubes for One-Lung Ventilation (OLV) and Oxygenation During OLV.

PubMed

Kawagoe, Izumi; Hayashida, Masakazu; Suzuki, Kenji; Kitamura, Yoshitaka; Oh, Shiaki; Satoh, Daizoh; Inada, Eiichi

2016-08-01

To investigate anesthesia management in patients undergoing right lung surgery after a previous left upper lobectomy (LUL) that may require special precautions since angulation of the left bronchus can hamper correct placement of a left-sided double-lumen tube (DLT), and one-lung ventilation (OLV) depending solely on the left lower lobe may lead to inadequate oxygenation. A retrospective data analysis. Single university hospital. Patients underwent right lung surgery after previous LUL. None. Anesthesia management was investigated in 18 patients who underwent right lung surgery following LUL. All intubation procedures were performed under bronchoscopic guidance to prevent airway trauma. OLV could be achieved with a left-sided DLT in 12 patients, while tubes other than this were required in 6 patients, including a right-sided DLT (n = 3) and a bronchial blocker (n = 3). The presence or absence of remarkable bronchial angulation, characterized by a combination of a wide (>140°) angle between the trachea and left main bronchus and a narrow (<100°) angle between the left main and lower bronchi critically affected tube selections. The minimum SpO2 during OLV was 90.9±4.1%. In 2 patients, intermittent bilateral ventilation was required to treat desaturation. In all the patients, the scheduled surgery could be completed. Extent of left bronchial angulations had a critical impact on whether or not a left-sided DLT could be used in patients undergoing right lung surgery after LUL. Copyright © 2016 Elsevier Inc. All rights reserved.

The comparison of manual and LabVIEW-based fuzzy control on mechanical ventilation.

PubMed

Guler, Hasan; Ata, Fikret

2014-09-01

The aim of this article is to develop a knowledge-based therapy for management of rats with respiratory distress. A mechanical ventilator was designed to achieve this aim. The designed ventilator is called an intelligent mechanical ventilator since fuzzy logic was used to control the pneumatic equipment according to the rat's status. LabVIEW software was used to control all equipments in the ventilator prototype and to monitor respiratory variables in the experiment. The designed ventilator can be controlled both manually and by fuzzy logic. Eight female Wistar-Albino rats were used to test the designed ventilator and to show the effectiveness of fuzzy control over manual control on pressure control ventilation mode. The anesthetized rats were first ventilated for 20 min manually. After that time, they were ventilated for 20 min by fuzzy logic. Student's t-test for p < 0.05 was applied to the measured minimum, maximum and mean peak inspiration pressures to analyze the obtained results. The results show that there is no statistical difference in the rat's lung parameters before and after the experiments. It can be said that the designed ventilator and developed knowledge-based therapy support artificial respiration of living things successfully. © IMechE 2014.

Healthy Zero Energy Buildings (HZEB) Program - Cross-Sectional Study of Contaminant Levels, Source, Strengths, and Ventilation Rates in Retail Stores

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chan, Wanyu R.; Sidheswaran, Meera; Cohn, Sebastian

2014-02-01

This field study measured ventilation rates and indoor air quality parameters in 21 visits to retail stores in California. The data was collected to guide the development of new, science-based commercial building ventilation rate standards that balance the dual objectives of increasing energy efficiency and maintaining acceptable indoor air quality. Data collection occurred between September 2011 and March 2013. Three types of stores participated in this study: grocery stores, furniture/hardware stores, and apparel stores. Ventilation rates and indoor air contaminant concentrations were measured on a weekday, typically between 9 am and 6 pm. Ventilation rates measured using a tracer gasmore » decay method exceeded the minimum requirement of California’s Title 24 Standard in all but one store. Even though there was adequate ventilation according to Title 24, concentrations of formaldehyde, acetaldehyde, and acrolein exceeded the most stringent chronic health guidelines. Other indoor air contaminants measured included carbon dioxide (CO{sub 2}), carbon monoxide (CO), ozone (O{sub 3}), and particulate matter (PM). Concentrations of CO{sub 2} were kept low by adequate ventilation, and were assumed low also because the sampling occurred on a weekday when retail stores were less busy. CO concentrations were also low. The indoor-outdoor ratios of O{sub 3} showed that the first-order loss rate may vary by store trade types and also by ventilation mode (mechanical versus natural). Analysis of fine and ultrafine PM measurements showed that a substantial portion of the particle mass in grocery stores with cooking-related emissions was in particles less than 0.3 μm. Stores without cooking as an indoor source had PM size distributions that were more similar indoors and outdoors. The whole-building emission rates of volatile organic compounds (VOCs) and PM were estimated from the measured ventilation rates and indoor and outdoor contaminant concentrations. Mass balance models were then used to determine the ventilation rates, filtration strategies, or source reductions needed to maintain indoor contaminant concentrations below reference levels. Several scenarios of potential concern were considered: (i) formaldehyde levels in furniture/hardware stores, (ii) contaminants associated with cooking (e.g., PM, acrolein, and acetaldehyde) in grocery stores, and (iii) outdoor contaminants (e.g., PM and O{sub 3}) impacting stores that use natural ventilation. Estimated formaldehyde emission rates suggest that retail stores would need to ventilate at levels far exceeding the current Title 24 requirement to lower indoor concentrations below California’s stringent formaldehyde reference level. Given the high costs of providing ventilation but only modest chronic health benefit is expected, effective source control is an attractive alternative, as demonstrated by some retail stores in this study. Predictions showed that grocery stores need MERV 13 air filters, instead of MERV 8 filters that are more commonly used, to maintain indoor PM at levels that meet the chronic health standards for PM. Exposure to acrolein is a potential health concern in grocery stores, and should be addressed by increasing the use of kitchen range hoods or improving their contaminant removal efficiency. In stores that rely on natural ventilation, indoor PM can be a health concern if the stores are located in areas with high outdoor PM. This concern may be addressed by switching to mechanical ventilation when the outdoor air quality is poor, while continuing natural ventilation when outdoor air quality is good.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mendell, Mark J.; Apte, Mike G.

This report considers the question of whether the California Energy Commission should incorporate the ASHRAE 62.1 ventilation standard into the Title 24 ventilation rate (VR) standards, thus allowing buildings to follow the Indoor Air Quality Procedure. This, in contrast to the current prescriptive standard, allows the option of using ventilation rate as one of several strategies, which might include source reduction and air cleaning, to meet specified targets of indoor air concentrations and occupant acceptability. The research findings reviewed in this report suggest that a revised approach to a ventilation standard for commercial buildings is necessary, because the current prescriptivemore » ASHRAE 62.1 Ventilation Rate Procedure (VRP) apparently does not provide occupants with either sufficiently acceptable or sufficiently healthprotective air quality. One possible solution would be a dramatic increase in the minimum ventilation rates (VRs) prescribed by a VRP. This solution, however, is not feasible for at least three reasons: the current need to reduce energy use rather than increase it further, the problem of polluted outdoor air in many cities, and the apparent limited ability of increasing VRs to reduce all indoor airborne contaminants of concern (per Hodgson (2003)). Any feasible solution is thus likely to include methods of pollutant reduction other than increased outdoor air ventilation; e.g., source reduction or air cleaning. The alternative 62.1 Indoor Air Quality Procedure (IAQP) offers multiple possible benefits in this direction over the VRP, but seems too limited by insufficient specifications and inadequate available data to provide adequate protection for occupants. Ventilation system designers rarely choose to use it, finding it too arbitrary and requiring use of much non-engineering judgment and information that is not readily available. This report suggests strategies to revise the current ASHRAE IAQP to reduce its current limitations. These strategies, however, would make it more complex and more prescriptive, and would require substantial research. One practical intermediate strategy to save energy would be an alternate VRP, allowing VRs lower than currently prescribed, as long as indoor VOC concentrations were no higher than with VRs prescribed under the current VRP. This kind of hybrid, with source reduction and use of air cleaning optional but permitted, could eventually evolve, as data, materials, and air-cleaning technology allowed gradual lowering of allowable concentrations, into a fully developed IAQP. Ultimately, it seems that VR standards must evolve to resemble the IAQP, especially in California, where buildings must achieve zero net energy use within 20 years.« less

Infiltration as Ventilation: Weather-Induced Dilution

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sherman, Max H.; Turner, William J.N.; Walker, Iain S.

The purpose of outdoor air ventilation is to dilute or remove indoor contaminants to which occupants are exposed. It can be provided by mechanical or natural means. In most homes, especially older homes, weather-driven infiltration provides the dominant fraction of the total ventilation. As we seek to provide good indoor air quality at minimum energy cost, it is important to neither over-ventilate nor under-ventilate. Thus, it becomes critically important to evaluate correctly the contribution infiltration makes to the total outdoor air ventilation rate. Because weather-driven infiltration is dependent on building air leakage and weather-induced pressure differences, a given amount ofmore » air leakage will provide different amounts of infiltration. Varying rates of infiltration will provide different levels of contaminant dilution and hence effective ventilation. This paper derives these interactions and then calculates the impact of weather-driven infiltration for different climates. A new “N-factor” is introduced to provide a convenient method for calculating the ventilation contribution of infiltration for over 1,000 locations across North America. The results of this work could be used in indoor air quality standards (specifically ASHRAE 62.2) to account for the contribution of weather-driven infiltration towards the dilution of indoor pollutants.« less

Perturbed Partial Cavity Drag Reduction at High Reynolds Numbers

NASA Astrophysics Data System (ADS)

Makiharju, Simo; Elbing, Brian; Wiggins, Andrew; Dowling, David; Perlin, Marc; Ceccio, Steven

2010-11-01

Ventilated partial cavities were investigated at Reynolds numbers to 80 million. These cavities could be suitable for friction drag reduction on ocean going vessels and thereby lead to environmental and economical benefits. The test model was a 3.05 m wide by 12.9 m long flat plate, with a 0.18 m backward-facing step and a cavity-terminating beach, which had an adjustable slope, tilt and height. The step and beach trapped a ventilated partial cavity over the longitudinal mid-section of the model. Large-scale flow perturbations, mimicking the effect of ambient ocean waves were investigated. For the conditions tested a cavity could be maintained under perturbed flow conditions when the gas flux supplied was greater than the minimum required to maintain a cavity under steady conditions, with larger perturbations requiring more excess gas flux to maintain the cavity. High-speed video was used to observe the unsteady three dimensional cavity closure, the overall cavity shape, and the cavity oscillations. Cavities with friction drag reduction exceeding 95% were attained at optimal conditions. A simplified energy cost-benefit analysis of partial cavity drag reduction was also performed. The results suggest that PCDR could potentially lead to energy savings.

Inhaled Antibiotics for Ventilator-Associated Infections.

PubMed

Palmer, Lucy B

2017-09-01

Multidrug-resistant organisms are creating a challenge for physicians treating the critically ill. As new antibiotics lag behind the emergence of worsening resistance, intensivists in countries with high rates of extensively drug-resistant bacteria are turning to inhaled antibiotics as adjunctive therapy. These drugs can provide high concentrations of drug in the lung that could not be achieved with intravenous antibiotics without significant systemic toxicity. This article summarizes current evidence describing the use of inhaled antibiotics for the treatment of bacterial ventilator-associated pneumonia and ventilator-associated tracheobronchitis. Preliminary data suggest aerosolized antimicrobials may effectively treat resistant pathogens with high minimum inhibitory concentrations. Copyright © 2017 Elsevier Inc. All rights reserved.

46 CFR 185.352 - Ventilation of gasoline machinery spaces.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Ventilation of gasoline machinery spaces. 185.352... (UNDER 100 GROSS TONS) OPERATIONS Miscellaneous Operating Requirements § 185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by...

46 CFR 185.352 - Ventilation of gasoline machinery spaces.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Ventilation of gasoline machinery spaces. 185.352... (UNDER 100 GROSS TONS) OPERATIONS Miscellaneous Operating Requirements § 185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by...

46 CFR 185.352 - Ventilation of gasoline machinery spaces.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Ventilation of gasoline machinery spaces. 185.352... (UNDER 100 GROSS TONS) OPERATIONS Miscellaneous Operating Requirements § 185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by...

Efficiency index: a new parameter to define breathing patterns during dynamic Xe-127 ventilation studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Slosman, D.; Susskind, H.; Bossuyt, A.

1986-03-01

Ventilation imaging can be improved by gating scintigraphic data with the respiratory cycle using temporal Fourier analysis (TFA) to quantify the temporal behavior of the ventilation. Sixteen consecutive images, representing equal-time increments of an average respiratory cycle, were produced by TFA in the posterior view on a pixel-by-pixel basis. An Efficiency Index (EFF), defined as the ratio of the summation of all the differences between maximum and minimum counts for each pixel to that for the entire lung during the respiratory cycle, was derived to describe the pattern of ventilation. The gated ventilation studies were carried out with Xe-127 inmore » 12 subjects: normal lung function (4), small airway disease (2), COPD (5), and restrictive disease (1). EFF for the first three harmonics correlated linearly with FEV1 (r = 0.701, p< 0.01). This approach is suggested as a very sensitive method to quantify the extent and regional distribution of airway obstruction.« less

Placement of Intubating Laryngeal Mask Airway Is Easier than Placement of Laryngeal Tube during Manual In-Line Stabilisation of The Neck

PubMed Central

Komatsu, R.; Nagata, O.; Kamata, K.; Yamagata, K.; Sessler, D.I.; Ozaki, M.

2005-01-01

Summary We compared the usefulness of the laryngeal tube (LT) with the intubating laryngeal mask airway (ILMA) in 51 patients whose necks were stabilised by manual in-line traction. After induction of anaesthesia and neuromuscular block, the LT and ILMA were inserted consecutively in a randomised, crossover design. During pressure-controlled ventilation (20 cmH2O inspiratory pressure), we measured insertion attempts, time to establish positive-pressure ventilation, tidal volume, gastric insufflation, and minimum airway pressure at which gas leaked around the cuff. Data were compared using Wilcoxon signed-rank tests; P<0.05 was considered significant. Insertion was more difficult with the LT (successful at first attempt in 16 patients) than with the ILMA (successful at first attempt in 42 patients, P<0.0001). Time required for insertion was longer for the LT (28 [23–35] sec, median [interquartile range]) than the ILMA (20 [15–25] sec, P=0.0009). Tidal volume was less for the LT (440 [290–670] ml) than the ILMA. (630 [440–750] ml, P=0.013). Minimum airway pressure at which gas leak occurred and incidence of gastric insufflation were similar with two devices. In patients whose necks were stabilised with manual in-line traction, insertion of the ILMA was easier and quicker than insertion of the LT and tidal volume was greater with the ILMA than the LT. PMID:15644005

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eliseeva, Ekaterina A.; Spears, Michael; Chan, Wanyu R.

Background – This study investigated the associations of ventilation rates (VRs), estimated from indoor CO2 concentrations, in offices with the amount of respiratory infections, illness absences, and building-related health symptoms in occupants. Methods – Office buildings were recruited from three California climate zones. In one or more study spaces within each building, real-time logging sensors measured carbon dioxide, temperature, and relative humidity for one year. Ventilation rates were estimated using daily peak CO2 levels, and also using an alternative metric. Data on occupants and health outcomes were collected through web-based surveys every three months. Multivariate models were used to assessmore » relationships between metrics of ventilation rate or CO2 and occupant outcomes. For all outcomes, negative associations were hypothesized with VR metrics, and positive associations with CO2 metrics. Results – Difficulty recruiting buildings and low survey response limited sample size and study power. In 16 studied spaces within 9 office buildings, VRs were uniformly high over the year, from twice to over nine times the California office VR standard (7 L/s or 15 cfm per person). VR and CO2 metrics had no statistically significant relationships with occupant outcomes, except for a small significantly positive association of the alternative VR metric with respiratory illness-related absence, contrary to hypotheses. Conclusions– The very high time-averaged VRs in the California office buildings studied presumably resulted from “economizer cycles” bringing in large volumes of outdoor air; however, in almost all buildings even the estimated minimum VRs supplied (without the economizer) substantially exceeded the minimum required VR. These high VRs may explain the absence of hypothesized relationships with occupant outcomes. Among uniformly high VRs, little variation in contaminant concentration and occupant effects would be expected. These findings may provide initial evidence for an upper bound of the range of VRs within which increased VRs provide benefits in reducing illness absence.« less

City ventilation of Hong Kong at no-wind conditions

NASA Astrophysics Data System (ADS)

Yang, Lina; Li, Yuguo

We hypothesize that city ventilation due to both thermally-driven mountain slope flows and building surface flows is important in removing ambient airborne pollutants in the high-rise dense city Hong Kong at no-wind conditions. Both spatial and temporal urban surface temperature profiles are an important boundary condition for studying city ventilation by thermal buoyancy. Field measurements were carried out to investigate the diurnal thermal behavior of urban surfaces (mountain slopes, and building exterior walls and roofs) in Hong Kong by using the infrared thermography. The maximum urban surface temperature was measured in the early noon hours (14:00-15:00 h) and the minimum temperature was observed just before sunrise (5:00 h). The vertical surface temperature of the building exterior wall was found to increase with height at daytime and the opposite occurred at nighttime. The solar radiation and the physical properties of the various urban surfaces were found to be important factors affecting the surface thermal behaviors. The temperature difference between the measured maximum and minimum surface temperatures of the four selected exterior walls can be at the highest of 16.7 °C in the early afternoon hours (15:00 h). Based on the measured surface temperatures, the ventilation rate due to thermal buoyancy-induced wall surface flows of buildings and mountain slope winds were estimated through an integral analysis of the natural convection flow over a flat surface. At no-wind conditions, the total air change rate by the building wall flows (2-4 ACH) was found to be 2-4 times greater than that by the slope flows due to mountain surface (1 ACH) due to larger building exterior surface areas and temperature differences with surrounding air. The results provide useful insights into the ventilation of a high-rise dense city at no-wind conditions.

46 CFR 92.15-5 - Vessels using fuel having a flashpoint of 110 degrees or lower.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND MISCELLANEOUS VESSELS CONSTRUCTION AND ARRANGEMENT Ventilation § 92.15-5 Vessels using fuel having... machinery or fuel tanks shall have ventilation as required by this section. (1) At least 2 ventilators... exposed to the natural atmosphere at all times are not required to be fitted with ventilators. ...

Design and Development of a Regenerative Blower for EVA Suit Ventilation

NASA Technical Reports Server (NTRS)

Izenson, Michael G.; Chen, Weibo; Hill, Roger W.; Phillips, Scott D.; Paul, Heather L.

2011-01-01

Ventilation subsystems in future space suits require a dedicated ventilation fan. The unique requirements for the ventilation fan - including stringent safety requirements and the ability to increase output to operate in buddy mode - combine to make a regenerative blower an attractive choice. This paper describes progress in the design, development, and testing of a regenerative blower designed to meet requirements for ventilation subsystems in future space suits. We have developed analysis methods for the blower s complex, internal flows and identified impeller geometries that enable significant improvements in blower efficiency. We verified these predictions by test, measuring aerodynamic efficiencies of 45% at operating conditions that correspond to the ventilation fan s design point. We have developed a compact motor/controller to drive the blower efficiently at low rotating speed (4500 rpm). Finally, we have assembled a low-pressure oxygen test loop to demonstrate the blower s reliability under prototypical conditions.

Long-distance transport of ventilated patients: advantages and limitations of air medical repatriation on commercial airlines.

PubMed

Veldman, Alex; Diefenbach, Michael; Fischer, Doris; Benton, Alida; Bloch, Richard

2004-01-01

To illustrate the advantages and limitations of transporting ventilated intensive care unit patients over intercontinental distances on commercial airlines, this case series reports 8 ventilated patients repatriated by an air medical transport company. Eight ventilated patients, 3 suffering from internal and 5 from neurologic diseases. Distances ranged from 1700 to 10280 nautical miles with transport times from 04:10 hours to 21:55 hours. For 3 patients, a dedicated patient transport compartment (PTC) in the aircraft cabin was used. All patients were ventilator-dependent for a minimum of 11 days before transport (48 days median, 113 days maximum). One patient went into cardiac arrest during the flight and died. None of the other patients experienced any emergency or invasive procedures, other than peripheral venous access necessary during the flight. In all patients, ventilation was adjusted with respect to the blood gas analysis at least once during the transport. No technical failures or drop-outs occurred during the flights. None of the flights had to be diverted for technical or medical reasons. Long distance international transport of ventilated intensive care unit patients is an extremely cost intensive and logistically challenging task. In a certain subgroup of relatively stable ventilated patients, transport on commercial airlines offers advantages in terms of cost effectiveness and reduced transport time and acceleration/deceleration trauma as a result of multiple fuel stops.

Development of an Outdoor Temperature-Based Control Algorithm for Residential Mechanical Ventilation Control

DOE Office of Scientific and Technical Information (OSTI.GOV)

Less, Brennan; Walker, Iain; Tang, Yihuan

2014-06-01

Smart ventilation systems use controls to ventilate more during those periods that provide either an energy or IAQ advantage (or both) and less during periods that provide a dis advantage. Using detailed building simulations, this study addresses one of the simplest and lowest cost types of smart controllers —outdoor temperature- based control. If the outdoor temperature falls below a certain cut- off, the fan is simply turned off. T he main principle of smart ventilation used in this study is to shift ventilation from time periods with large indoor -outdoor temperature differences, to periods where these differences are smaller, andmore » their energy impacts are expected to be less. Energy and IAQ performance are assessed relative to a base case of a continuously operated ventilation fan sized to comply with ASHRAE 62.2-2013 whole house ventilation requirements. In order to satisfy 62.2-2013, annual pollutant exposure must be equivalent between the temperature controlled and continuous fan cases. This requires ventilation to be greater than 62.2 requirements when the ventilation system operates. This is achieved by increasing the mechanical ventilation system air flow rates.« less

46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation system must... 46 Shipping 4 2010-10-01 2010-10-01 false Power ventilation systems except machinery space...

46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation system must... 46 Shipping 4 2011-10-01 2011-10-01 false Power ventilation systems except machinery space...

46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation system must... 46 Shipping 4 2014-10-01 2014-10-01 false Power ventilation systems except machinery space...

46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation system must... 46 Shipping 4 2012-10-01 2012-10-01 false Power ventilation systems except machinery space...

46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation system must... 46 Shipping 4 2013-10-01 2013-10-01 false Power ventilation systems except machinery space...

Nebulized heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomized controlled trial.

PubMed

Dixon, Barry; Schultz, Marcus J; Smith, Roger; Fink, James B; Santamaria, John D; Campbell, Duncan J

2010-01-01

Prolonged mechanical ventilation has the potential to aggravate or initiate pulmonary inflammation and cause lung damage through fibrin deposition. Heparin may reduce pulmonary inflammation and fibrin deposition. We therefore assessed whether nebulized heparin improved lung function in patients expected to require prolonged mechanical ventilation. Fifty patients expected to require mechanical ventilation for more than 48 hours were enrolled in a double-blind randomized placebo-controlled trial of nebulized heparin (25,000 U) or placebo (normal saline) 4 or 6 hourly, depending on patient height. The study drug was continued while the patient remained ventilated to a maximum of 14 days from randomization. Nebulized heparin was not associated with a significant improvement in the primary end-point, the average daily partial pressure of oxygen to inspired fraction of oxygen ratio while mechanically ventilated, but was associated with improvement in the secondary end-point, ventilator-free days amongst survivors at day 28 (22.6 ± 4.0 versus 18.0 ± 7.1, treatment difference 4.6 days, 95% CI 0.9 to 8.3, P = 0.02). Heparin administration was not associated with any increase in adverse events. Nebulized heparin was associated with fewer days of mechanical ventilation in critically ill patients expected to require prolonged mechanical ventilation. Further trials are required to confirm these findings. The Australian Clinical Trials Registry (ACTR-12608000121369).

Field evaluation of ventilation system performance in enclosed parking garages

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ayari, A.M.; Grot, D.A.; Krarti, M.

2000-07-01

This paper summarizes the results of a field study to determine the ventilation requirements and the contaminant levels in existing enclosed parking garages. The testing was conducted in seven parking garages with different sizes, traffic flow patterns, vehicle types, and locations. In particular, the study compares the actual ventilation rates measured using the tracer gas technique with the ventilation requirements of ANSI/ASHRAE Standard 62-1989. In addition, the field test evaluated the effectiveness of the existing ventilation systems in maintaining acceptable contaminant levels within enclosed parking garages.

46 CFR 154.1205 - Mechanical ventilation system: Standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 5 2010-10-01 2010-10-01 false Mechanical ventilation system: Standards. 154.1205... Equipment Cargo Area: Mechanical Ventilation System § 154.1205 Mechanical ventilation system: Standards. (a) Each exhaust type mechanical ventilation system required under § 154.1200 (a) must have ducts for...

AT1 receptor blocker losartan protects against mechanical ventilation-induced diaphragmatic dysfunction

PubMed Central

Kwon, Oh Sung; Smuder, Ashley J.; Wiggs, Michael P.; Hall, Stephanie E.; Sollanek, Kurt J.; Morton, Aaron B.; Talbert, Erin E.; Toklu, Hale Z.; Tumer, Nihal

2015-01-01

Mechanical ventilation is a life-saving intervention for patients in respiratory failure. Unfortunately, prolonged ventilator support results in diaphragmatic atrophy and contractile dysfunction leading to diaphragm weakness, which is predicted to contribute to problems in weaning patients from the ventilator. While it is established that ventilator-induced oxidative stress is required for the development of ventilator-induced diaphragm weakness, the signaling pathway(s) that trigger oxidant production remain unknown. However, recent evidence reveals that increased plasma levels of angiotensin II (ANG II) result in oxidative stress and atrophy in limb skeletal muscles. Using a well-established animal model of mechanical ventilation, we tested the hypothesis that increased circulating levels of ANG II are required for both ventilator-induced diaphragmatic oxidative stress and diaphragm weakness. Cause and effect was determined by administering an angiotensin-converting enzyme inhibitor (enalapril) to prevent ventilator-induced increases in plasma ANG II levels, and the ANG II type 1 receptor antagonist (losartan) was provided to prevent the activation of ANG II type 1 receptors. Enalapril prevented the increase in plasma ANG II levels but did not protect against ventilator-induced diaphragmatic oxidative stress or diaphragm weakness. In contrast, losartan attenuated both ventilator-induced oxidative stress and diaphragm weakness. These findings indicate that circulating ANG II is not essential for the development of ventilator-induced diaphragm weakness but that activation of ANG II type 1 receptors appears to be a requirement for ventilator-induced diaphragm weakness. Importantly, these experiments provide the first evidence that the Food and Drug Administration-approved drug losartan may have clinical benefits to protect against ventilator-induced diaphragm weakness in humans. PMID:26359481

Criteria for Postoperative Mechanical Ventilation After Thymectomy in Patients With Myasthenia Gravis: A Retrospective Analysis.

PubMed

Chigurupati, Keerthi; Gadhinglajkar, Shrinivas; Sreedhar, Rupa; Nair, Muraleedharan; Unnikrishnan, Madathipat; Pillai, Manjusha

2018-02-01

To determine the criteria for postoperative mechanical ventilation after thymectomy in patients with Myasthenia Gravis. Retrospective study. Teritiary care centre. 77 Myasthenia gravis patients operated for thymectomy were studied. After obtaining clearance from Institutional ethics committee, medical records of 77 patients with MG, who were operated for thymectomy between January 2005 and December 2015 were reviewed in a retrospective manner. Perioperative variables collected from the patient records were demographic data, duration of the disease, Osserman and Genkin classification, Anti-acetylcholine antibody (AChR) positivity, preoperative daily dose of drug, history of preoperative myasthenic crisis, preoperative vital capacity, technique of anesthesia, drugs used for anesthesia, perioperative complications, and duration of postoperative mechanical ventilation. The patients were divided into two groups, group I and group II consisting of those who required postoperative ventilation for < 300 minutes and > 300 minutes, respectively. The determinants of prolonged postoperative ventilation were studied. The requirement of mechanical ventilation was higher in patients with higher Osserman's grade of myasthenia gravis. Duration of the disease had no effect on the duration of mechanical ventilation in myasthenic patients post thymectomy (p = 0.89). The patients with a preoperative history of myasthenic crisis had a requirement for prolonged mechanical ventilation (p=0.03). Patients with preoperative vital capacity < 2.9 litres and preoperative CT scan showing thymoma had a requirement for prolonged mechanical ventilation with p values < 0.001 and 0.035, respectively. Patients who showed positivity for anti-acetylcholine antibodies had a prolonged mechanical ventilation (p=0.026). Preoperative dose of pyridostigmine and the choice of continuation or discontinuation of antcholinesterases on the day of surgery had no influence on the duration of mechanical ventilation (p value of 0.19 and 0.36 respectively). Epidural analgesia intra and postoperatively significantly reduced the requirement of mechanical ventilation (p=0.006). The predictors of postoperative ventilation in myasthenic patients undergoing thymectomy as per our study are: 1. Grade of myasthenia; 2. History of preoperative myasthenic crisis; 3. Anti-acetylcholine antibodies positivity; 4. Presence of thymoma; and 5. a vital capacity < 2.9 litres. Use of thoracic epidural as a part of combined anesthetic technique helps to reduce the need of mechanical ventilation in these patients. Copyright © 2018 Elsevier Inc. All rights reserved.

77 FR 58421 - Model Safety Evaluation for Plant-Specific Adoption of Technical Specifications Task Force...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-20

... Ventilation System Surveillance Requirements To Operate for 10 Hours per Month,'' Using the Consolidated Line... currently require operating the ventilation system for at least 10 continuous hours with the heaters... Technical Specifications (TSs) Task Force (TSTF) Traveler TSTF-522, Revision 0, ``Revise Ventilation System...

Hydrotherapy for the long-term ventilated patient: A case study and implications for practice.

PubMed

Wegner, Sally; Thomas, Peter; James, Christine

2017-11-01

Hydrotherapy of mechanically ventilated patients has been shown to be safe and feasible in both the acute stages of critical illness and in those requiring long term mechanical ventilation. This case study describes the hydrotherapy sessions of a 36 year old female, who after suffering complications of pneumococcal meningitis, became an incomplete quadriplegic and required long term mechanical ventilation. When implementing hydrotherapy with patients on mechanical ventilation a number of factors should be considered. These include staff resources and training, airway and ventilation management, patient preparation and safety procedures. Hydrotherapy can be safely utilised with mechanically ventilated patients, and may facilitate a patient's ability to participate in active exercise and rehabilitation. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lstiburek, Joseph

2017-01-01

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lstiburek, Joseph

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less

Ventilation rates in recently constructed U.S. school classrooms.

PubMed

Batterman, S; Su, F-C; Wald, A; Watkins, F; Godwin, C; Thun, G

2017-09-01

Low ventilation rates (VRs) in schools have been associated with absenteeism, poorer academic performance, and teacher dissatisfaction. We measured VRs in 37 recently constructed or renovated and mechanically ventilated U.S. schools, including LEED and EnergyStar-certified buildings, using CO 2 and the steady-state, build-up, decay, and transient mass balance methods. The transient mass balance method better matched conditions (specifically, changes in occupancy) and minimized biases seen in the other methods. During the school day, air change rates (ACRs) averaged 2.0±1.3 hour -1 , and only 22% of classrooms met recommended minimum ventilation rates. HVAC systems were shut off at the school day close, and ACRs dropped to 0.21±0.19 hour -1 . VRs did not differ by building type, although cost-cutting and comfort measures resulted in low VRs and potentially impaired IAQ. VRs were lower in schools that used unit ventilators or radiant heating, in smaller schools and in larger classrooms. The steady-state, build-up, and decay methods had significant limitations and biases, showing the need to confirm that these methods are appropriate. Findings highlight the need to increase VRs and to ensure that energy saving and comfort measures do not compromise ventilation and IAQ. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

46 CFR 111.103-3 - Machinery space ventilation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Machinery space ventilation. 111.103-3 Section 111.103-3...-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-3 Machinery space ventilation. (a) Each machinery space ventilation system must have two controls to stop the ventilation, one of which may be the supply...

46 CFR 111.103-3 - Machinery space ventilation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Machinery space ventilation. 111.103-3 Section 111.103-3...-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-3 Machinery space ventilation. (a) Each machinery space ventilation system must have two controls to stop the ventilation, one of which may be the supply...

46 CFR 111.103-3 - Machinery space ventilation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Machinery space ventilation. 111.103-3 Section 111.103-3...-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-3 Machinery space ventilation. (a) Each machinery space ventilation system must have two controls to stop the ventilation, one of which may be the supply...

46 CFR 111.103-3 - Machinery space ventilation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Machinery space ventilation. 111.103-3 Section 111.103-3...-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-3 Machinery space ventilation. (a) Each machinery space ventilation system must have two controls to stop the ventilation, one of which may be the supply...

46 CFR 111.103-3 - Machinery space ventilation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Machinery space ventilation. 111.103-3 Section 111.103-3...-GENERAL REQUIREMENTS Remote Stopping Systems § 111.103-3 Machinery space ventilation. (a) Each machinery space ventilation system must have two controls to stop the ventilation, one of which may be the supply...

Outcomes for patients with Guillain-Barré syndrome requiring mechanical ventilation: a literature review.

PubMed

de Boisanger, L

2016-02-01

This is a literature review of outcomes for patients with Guillain-Barré Syndrome (GBS) who require admission to the intensive care unit for mechanical ventilation. Respiratory distress is the leading cause of death in the acute phase, and occurs in about 25 % of patients. The aim of this review is to compile, analyse, and summarise the most relevant literature looking at outcomes for Guillain-Barré (GB) patients requiring admission to the intensive care unit and mechanical ventilation. A PubMed and Google-Scholar literature search was performed using the key words 'Guillain-Barré, Outcomes, Mechanical Ventilation, Prognosis, Mortality, ICU. All 7 papers from the years 2000-2014 which assessed outcomes for GBS patients requiring mechanical ventilation were included, and critically analysed. The parameters recorded by these studies looked at mortality, disability, length of hospitalisation, and complications. The mortality of GB patients requiring mechanical ventilation varied from 8.3 to 20 %, Disability was primarily measured by the GBS disability scale. One study deemed that a score of 0-1 was a positive outcome, and found that slightly over half 53.8 % of the patients fulfilled that criteria. Over half of the mechanically ventilated patients were required to be admitted for over 3 weeks. Complications during ICU admission are common, with bed-sores (40 %), pneumonia (30.2 %) and sepsis (17.4) being the most frequently encountered in one study. Accurate data are limited by the fact that these studies are retrospective, often covering long periods in the past. Larger, more recent, prospective, multi-centre studies will be required.

46 CFR 119.470 - Ventilation of spaces containing diesel fuel tanks.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Ventilation of spaces containing diesel fuel tanks. 119... MACHINERY INSTALLATION Specific Machinery Requirements § 119.470 Ventilation of spaces containing diesel... containing a diesel fuel tank and no machinery must meet one of the following requirements: (1) A space of 14...

46 CFR 119.470 - Ventilation of spaces containing diesel fuel tanks.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Ventilation of spaces containing diesel fuel tanks. 119... MACHINERY INSTALLATION Specific Machinery Requirements § 119.470 Ventilation of spaces containing diesel... containing a diesel fuel tank and no machinery must meet one of the following requirements: (1) A space of 14...

The seasonal performance of a liquid-desiccant air conditioner

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lowenstein, A.; Novosel, D.

1995-08-01

Prior reports on liquid-desiccant systems have focused on their steady-state operation at ARI design conditions. By studying their performance during an entire cooling season, the computer modeling presented here shows that liquid-desiccant systems can have a very high seasonal coefficient of performance (COP). For a liquid-desiccant system that uses a double-effect boiler, COPs ranging from 1.44 in a humid location (Houston) to 2.24 in a dry location (Phoenix) are achieved by fully exploiting indirect evaporative cooling and providing only the minimum latent cooling needed to meet the loads on the building. This minimizes the amount of water absorbed by themore » desiccant and, hence, the amount of thermal energy needed to regenerate it. In applications where latent loads are very high, such as processing the high volumes of ventilation air required to maintain good indoor air quality, the liquid-desiccant air conditioner again has an advantage over vapor-compression equipment. In this study, a liquid-desiccant system is modeled that cools and dehumidifies only the ventilation air of an office building in Atlanta. Although processing an airstream that is only 25% of the total air delivered to the building, the liquid-desiccant system is able to meet 52% of the building`s seasonal cooling requirements and reduce the building`s peak electrical demand by about 47%.« less

Positive End-Expiratory Pressure and Variable Ventilation in Lung-Healthy Rats under General Anesthesia

PubMed Central

Camilo, Luciana M.; Ávila, Mariana B.; Cruz, Luis Felipe S.; Ribeiro, Gabriel C. M.; Spieth, Peter M.; Reske, Andreas A.; Amato, Marcelo; Giannella-Neto, Antonio; Zin, Walter A.; Carvalho, Alysson R.

2014-01-01

Objectives Variable ventilation (VV) seems to improve respiratory function in acute lung injury and may be combined with positive end-expiratory pressure (PEEP) in order to protect the lungs even in healthy subjects. We hypothesized that VV in combination with moderate levels of PEEP reduce the deterioration of pulmonary function related to general anesthesia. Hence, we aimed at evaluating the alveolar stability and lung protection of the combination of VV at different PEEP levels. Design Randomized experimental study. Setting Animal research facility. Subjects Forty-nine male Wistar rats (200–270 g). Interventions Animals were ventilated during 2 hours with protective low tidal volume (VT) in volume control ventilation (VCV) or VV and PEEP adjusted at the level of minimum respiratory system elastance (Ers), obtained during a decremental PEEP trial subsequent to a recruitment maneuver, and 2 cmH2O above or below of this level. Measurements and Main Results Ers, gas exchange and hemodynamic variables were measured. Cytokines were determined in lung homogenate and plasma samples and left lung was used for histologic analysis and diffuse alveolar damage scoring. A progressive time-dependent increase in Ers was observed independent on ventilatory mode or PEEP level. Despite of that, the rate of increase of Ers and lung tissue IL-1 beta concentration were significantly lower in VV than in VCV at the level of the PEEP of minimum Ers. A significant increase in lung tissue cytokines (IL-6, IL-1 beta, CINC-1 and TNF-alpha) as well as a ventral to dorsal and cranial to caudal reduction in aeration was observed in all ventilated rats with no significant differences among groups. Conclusions VV combined with PEEP adjusted at the level of the PEEP of minimal Ers seemed to better prevent anesthesia-induced atelectasis and might improve lung protection throughout general anesthesia. PMID:25383882

Technology for noninvasive mechanical ventilation: looking into the black box

PubMed Central

Navajas, Daniel; Montserrat, Josep M.

2016-01-01

Current devices for providing noninvasive respiratory support contain sensors and built-in intelligence for automatically modifying ventilation according to the patient's needs. These devices, including automatic continuous positive airway pressure devices and noninvasive ventilators, are technologically complex and offer a considerable number of different modes of ventilation and setting options, the details of which are sometimes difficult to capture by the user. Therefore, better predicting and interpreting the actual performance of these ventilation devices in clinical application requires understanding their functioning principles and assessing their performance under well controlled bench test conditions with simulated patients. This concise review presents an updated perspective of the theoretical basis of intelligent continuous positive airway pressure and noninvasive ventilation devices, and of the tools available for assessing how these devices respond under specific ventilation phenotypes in patients requiring breathing support. PMID:27730162

Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation.

PubMed

Dariel, Anne; Poocharoen, Wannisa; de Silva, Nicole; Pleasants, Hazel; Gerstle, Justin Ted

2015-02-01

Nonsurgical closure after primary silo placement, secondary plastic closure (SPC), has been used as an alternative to secondary surgical closure (SSC) in gastroschisis. The benefits described were closure without formal surgical procedure, cosmetic aspect, and minimization of intra-abdominal pressures. This study compared requirements for mechanical ventilation and general anesthesia, nutritional care, and outcomes between SPC and SSC. We included patients with primary staged-silo reduction with a 1-year minimum follow-up. SPC was performed at bedside with sedation using a nonadherent dressing. SSC was performed in operating room under general anesthesia using standard surgical techniques. This retrospective study included 64 patients, 23 SPC and 41 SSC. The characteristics of the two groups were comparable. Mechanical ventilation was used for 15 SPC and 41 SSC (p=0.0001) with a comparable median duration (5.5 and 6.0 days, not significant [NS]). General anesthesia was required for 9 SPC and 41 SSC (p<0.0001). Complications included one SPC and six SSC with necrotizing enterocolitis, zero SPC and four SSC with intestinal atresia, two SPC and four SSC with small bowel obstruction, zero SPC and one SSC with abdominal compartment syndrome resulting in a short bowel syndrome (NS). Median duration of parenteral nutrition (30 and 27 days), time to first feeds (14 and 14 days), time at or above minimal enteral feeding (22 and 17 days), time to full feeds (31 and 28 days), length of stay (LOS) in neonatal intensive care unit (24 and 23.5 days) and overall hospital LOS (37 and 36 days) were not statistically different between SPC and SSC patients without complications, respectively. These data were comparable for SPC and SSC patients with complications. Five SPC and six SSC developed an umbilical hernia (NS); two patients in each group required a surgical repair (NS). Plastic closure of gastroschisis after primary silo reduction is simple, safe, reproducible, and associated with a significant lower incidence of mechanical ventilation. Nutritional management and length of hospital stay were similar to conventional surgical closure for patients. Plastic closure allows nonoperative management without general anesthesia at patient's bedside, in comparison with surgical closure that must be performed under general anesthesia in the operating room. Plastic closure does not appear to be associated with more umbilical hernias in this retrospective study. Georg Thieme Verlag KG Stuttgart · New York.

Evaluation of the indoor air quality minimum ventilation rate procedure for use in California retail buildings.

PubMed

Dutton, S M; Mendell, M J; Chan, W R; Barrios, M; Sidheswaran, M A; Sullivan, D P; Eliseeva, E A; Fisk, W J

2015-02-01

This research assesses benefits of adding to California Title-24 ventilation rate (VR) standards a performance-based option, similar to the American Society of Heating, Refrigerating, and Air Conditioning Engineers 'Indoor Air Quality Procedure' (IAQP) for retail spaces. Ventilation rates and concentrations of contaminants of concern (CoC) were measured in 13 stores. Mass balance models were used to estimate 'IAQP-based' VRs that would maintain concentrations of all CoCs below health- or odor-based reference concentration limits. An intervention study in a 'big box' store assessed how the current VR, the Title 24-prescribed VR, and the IAQP-based VR (0.24, 0.69, and 1.51 air changes per hour) influenced measured IAQ and perceived of IAQ. Neither current VRs nor Title 24-prescribed VRs would maintain all CoCs below reference limits in 12 of 13 stores. In the big box store, the IAQP-based VR kept all CoCs below limits. More than 80% of subjects reported acceptable air quality at all three VRs. In 11 of 13 buildings, saving energy through lower VRs while maintaining acceptable IAQ would require source reduction or gas-phase air cleaning for CoCs. In only one of the 13 retail stores surveyed, application of the IAQP would have allowed reduced VRs without additional contaminant-reduction strategies. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Regenerative Blower for EVA Suit Ventilation Fan

NASA Technical Reports Server (NTRS)

Izenson, Michael G.; Chen, Weibo; Paul, Heather L.

2010-01-01

Portable life support systems in future space suits will include a ventilation subsystem driven by a dedicated fan. This ventilation fan must meet challenging requirements for pressure rise, flow rate, efficiency, size, safety, and reliability. This paper describes research and development that showed the feasibility of a regenerative blower that is uniquely suited to meet these requirements. We proved feasibility through component tests, blower tests, and design analysis. Based on the requirements for the Constellation Space Suit Element (CSSE) Portable Life Support System (PLSS) ventilation fan, we designed the critical elements of the blower. We measured the effects of key design parameters on blower performance using separate effects tests, and used the results of these tests to design a regenerative blower that will meet the ventilation fan requirements. We assembled a proof-of-concept blower and measured its performance at sub-atmospheric pressures that simulate a PLSS ventilation loop environment. Head/flow performance and maximum efficiency point data were used to specify the design and operating conditions for the ventilation fan. We identified materials for the blower that will enhance safety for operation in a lunar environment, and produced a solid model that illustrates the final design. The proof-of-concept blower produced the flow rate and pressure rise needed for the CSSE ventilation subsystem while running at 5400 rpm, consuming only 9 W of electric power using a non-optimized, commercial motor and controller and inefficient bearings. Scaling the test results to a complete design shows that a lightweight, compact, reliable, and low power regenerative blower can meet the performance requirements for future space suit life support systems.

40 CFR 61.53 - Stack sampling.

Code of Federal Regulations, 2014 CFR

2014-07-01

... operator employing mercury chlor-alkali cell(s) shall test emissions from hydrogen streams according to... the Administrator, for a minimum of 2 years. (b) Mercury chlor-alkali plant—hydrogen and end-box.... (c) Mercury chlor-alkali plants—cell room ventilation system. (1) Stationary sources using mercury...

40 CFR 61.53 - Stack sampling.

Code of Federal Regulations, 2012 CFR

2012-07-01

... operator employing mercury chlor-alkali cell(s) shall test emissions from hydrogen streams according to... the Administrator, for a minimum of 2 years. (b) Mercury chlor-alkali plant—hydrogen and end-box.... (c) Mercury chlor-alkali plants—cell room ventilation system. (1) Stationary sources using mercury...

40 CFR 61.53 - Stack sampling.

Code of Federal Regulations, 2013 CFR

2013-07-01

... operator employing mercury chlor-alkali cell(s) shall test emissions from hydrogen streams according to... the Administrator, for a minimum of 2 years. (b) Mercury chlor-alkali plant—hydrogen and end-box.... (c) Mercury chlor-alkali plants—cell room ventilation system. (1) Stationary sources using mercury...

40 CFR 89.109 - Maintenance instructions and minimum allowable maintenance intervals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... change, oil filter change, fuel filter change, air filter change, cooling system maintenance, adjustment... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE NONROAD COMPRESSION...) Exhaust gas recirculation system-related filters and coolers. (ii) Positive crankcase ventilation valve...

40 CFR 89.109 - Maintenance instructions and minimum allowable maintenance intervals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... change, oil filter change, fuel filter change, air filter change, cooling system maintenance, adjustment... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE NONROAD COMPRESSION...) Exhaust gas recirculation system-related filters and coolers. (ii) Positive crankcase ventilation valve...

The Evolution of Unidirectional Pulmonary Airflow.

PubMed

Farmer, C G

2015-07-01

Conventional wisdom holds that the avian respiratory system is unique because air flows in the same direction through most of the gas-exchange tubules during both phases of ventilation. However, recent studies showing that unidirectional airflow also exists in crocodilians and lizards raise questions about the true phylogenetic distribution of unidirectional airflow, the selective drivers of the trait, the date of origin, and the functional consequences of this phenomenon. These discoveries suggest unidirectional flow was present in the common diapsid ancestor and are inconsistent with the traditional paradigm that unidirectional flow is an adaptation for supporting high rates of gas exchange. Instead, these discoveries suggest it may serve functions such as decreasing the work of breathing, decreasing evaporative respiratory water loss, reducing rates of heat loss, and facilitating crypsis. The divergence in the design of the respiratory system between unidirectionally ventilated lungs and tidally ventilated lungs, such as those found in mammals, is very old, with a minimum date for the divergence in the Permian Period. From this foundation, the avian and mammalian lineages evolved very different respiratory systems. I suggest the difference in design is due to the same selective pressure, expanded aerobic capacity, acting under different environmental conditions. High levels of atmospheric oxygen of the Permian Period relaxed selection for a thin blood-gas barrier and may have resulted in the homogeneous, broncho-alveolar design, whereas the reduced oxygen of the Mesozoic selected for a heterogeneous lung with an extremely thin blood-gas barrier. These differences in lung design may explain the puzzling pattern of ecomorphological diversification of Mesozoic mammals: all were small animals that did not occupy niches requiring a great aerobic capacity. The broncho-alveolar lung and the hypoxia of the Mesozoic may have restricted these mammals from exploiting niches of large body size, where cursorial locomotion can be advantageous, as well as other niches requiring great aerobic capacities, such as those using flapping flight. Furthermore, hypoxia may have exerted positive selection for a parasagittal posture, the diaphragm, and reduced erythrocyte size, innovations that enabled increased rates of ventilation and more rapid rates of diffusion in the lung. ©2015 Int. Union Physiol. Sci./Am. Physiol. Soc.

46 CFR 32.55-5 - Ventilation of tank vessels constructed between November 10, 1936, and July 1, 1951-TB/ALL.

Code of Federal Regulations, 2010 CFR

2010-10-01

... actuated gas ejectors or blowers or ventilators fitted with heads for natural ventilation, will be approved... 46 Shipping 1 2010-10-01 2010-10-01 false Ventilation of tank vessels constructed between November... HOMELAND SECURITY TANK VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Ventilation and Venting...

Promoting Health and Safety in San Francisco's Chinatown Restaurants: Findings and Lessons Learned from a Pilot Observational Checklist

PubMed Central

Gaydos, Megan; Bhatia, Rajiv; Morales, Alvaro; Lee, Pam Tau; Liu, Shaw San; Chang, Charlotte; Salvatore, Alicia L.; Krause, Niklas; Minkler, Meredith

2011-01-01

Noncompliance with labor and occupational health and safety laws contributes to economic and health inequities. Environmental health agencies are well positioned to monitor workplace conditions in many industries and support enhanced enforcement by responsible regulatory agencies. In collaboration with university and community partners, the San Francisco Department of Public Health used an observational checklist to assess preventable occupational injury hazards and compliance with employee notification requirements in 106 restaurants in San Francisco's Chinatown. Sixty-five percent of restaurants had not posted required minimum wage, paid sick leave, or workers' compensation notifications; 82% of restaurants lacked fully stocked first-aid kits; 52% lacked antislip mats; 37% lacked adequate ventilation; and 28% lacked adequate lighting. Supported by a larger community-based participatory research process, this pilot project helped to spur additional innovative health department collaborations to promote healthier workplaces. PMID:21836739

Analysis of a Pediatric Home Mechanical Ventilator Population.

PubMed

Amirnovin, Rambod; Aghamohammadi, Sara; Riley, Carley; Woo, Marlyn S; Del Castillo, Sylvia

2018-05-01

The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed. Data included each child's primary diagnosis, date of tracheostomy placement, duration of mechanical ventilation during hospitalization that consisted of home mechanical ventilator initiation, total length of pediatric ICU stay, ventilator settings at time of discharge from pediatric ICU, and disposition (home, facility, or died). Univariate, bivariate, and regression analysis was used as appropriate. The most common diagnosis requiring the use of home mechanical ventilation was neuromuscular disease (53%), followed by chronic pulmonary disease (29%). The median length of stay in the pediatric ICU decreased significantly after the implementation of a ventilator ward (70 d [30-142] vs 36 d [18-67], P = .02). The distribution of subjects upon discharge was home (71%), skilled nursing facility (24%), and died (4%), with an increase in the proportion of subjects discharged on PEEP and those going to nursing facilities over time ( P = 0.02). The evolution of home mechanical ventilation has allowed earlier transition out of the pediatric ICU and with increasing disposition to skilled nursing facilities over time. There has also been a change in ventilator management, including increased use of PEEP upon discharge, possibly driven by changes in ventilators and in-patient practice patterns. Copyright © 2018 by Daedalus Enterprises.

46 CFR 111.15-10 - Ventilation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... REQUIREMENTS Storage Batteries and Battery Chargers: Construction and Installation § 111.15-10 Ventilation. (a) General. Each room, locker, and box for storage batteries must be arranged or ventilated to prevent... with the battery charger so that the battery cannot be charged without ventilation. (c) Large battery...

46 CFR 111.15-10 - Ventilation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... REQUIREMENTS Storage Batteries and Battery Chargers: Construction and Installation § 111.15-10 Ventilation. (a) General. Each room, locker, and box for storage batteries must be arranged or ventilated to prevent... with the battery charger so that the battery cannot be charged without ventilation. (c) Large battery...

46 CFR 111.15-10 - Ventilation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... REQUIREMENTS Storage Batteries and Battery Chargers: Construction and Installation § 111.15-10 Ventilation. (a) General. Each room, locker, and box for storage batteries must be arranged or ventilated to prevent... with the battery charger so that the battery cannot be charged without ventilation. (c) Large battery...

46 CFR 111.15-10 - Ventilation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... REQUIREMENTS Storage Batteries and Battery Chargers: Construction and Installation § 111.15-10 Ventilation. (a) General. Each room, locker, and box for storage batteries must be arranged or ventilated to prevent... with the battery charger so that the battery cannot be charged without ventilation. (c) Large battery...

46 CFR 111.15-10 - Ventilation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... REQUIREMENTS Storage Batteries and Battery Chargers: Construction and Installation § 111.15-10 Ventilation. (a) General. Each room, locker, and box for storage batteries must be arranged or ventilated to prevent... with the battery charger so that the battery cannot be charged without ventilation. (c) Large battery...

Anaesthetic induction with alfaxalone in the ball python (Python regius): dose response and effect of injection site.

PubMed

James, Lauren E; Williams, Catherine Ja; Bertelsen, Mads F; Wang, Tobias

2018-05-01

To characterise the minimum dose of intramuscular alfaxalone required to facilitate intubation for mechanical ventilation, and to investigate the impact of cranial versus caudal injection on anaesthetic depth. Randomised crossover study. Six healthy juvenile ball pythons (Python regius). Three dosages (10, 20 and 30 mg kg -1 ) of alfaxalone were administered to each python in a caudal location with a minimum 2 weeks washout. Induction and recovery were monitored by assessing muscle tone, righting reflex, response to a noxious stimulus and the ability to intubate. A subsequent experiment assessed the influence of injection site by comparing administration of 20 mg kg -1 alfaxalone in a cranial location (1 cm cranial to the heart) with the caudal site. Respiration rate was monitored throughout, and when intubation was possible, snakes were mechanically ventilated. Regardless of dose and injection site, maximum effect was reached within 10.0 ± 2.7 minutes. When administered at the caudal injection site, intubation was only successful after a dosage of 30 mg kg- 1 , which is higher than in previous reports for other reptiles. However, intubation was possible in all cases after 7.2 ± 1.6 minutes upon cranial administration of 20 mg kg -1 , and anaesthetic duration was significantly lengthened (p < 0.001). Both 30 mg kg -1 at the caudal site and 20 mg kg -1 at the cranial site led to apnoea approximately 10 minutes post-injection, at which time the snakes were intubated and mechanically ventilated. Alfaxalone provided rapid, smooth induction when administered intramuscularly to pythons, and may serve as a useful induction agent prior to provision of volatile anaesthetics. The same dosage injected in the cranial site led to deeper anaesthesia than when injected caudally, suggesting that shunting to the liver and first-pass metabolism of alfaxalone occur when injected caudally, via the renal portal system. Copyright © 2018 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Analysis of the systems of ventilation of residential houses of Ukraine and Estonia

NASA Astrophysics Data System (ADS)

Savchenko, Olena; Zhelykh, Vasyl; Voll, Hendrik

2017-12-01

The most common ventilation system in residential buildings in Ukraine is natural ventilation. In recent years, due to increased tightness of structures, an increase in the content of synthetic finishing materials in them, the quality of microclimate parameters deteriorated. One of the measures to improve the parameters of indoor air in residential buildings is the use of mechanical inflow and exhaust ventilation system. In this article the regulatory documents concerning the design of ventilation systems in Ukraine and Estonia and the requirements for air exchange in residential buildings are considered. It is established that the existing normative documents in Ukraine are analogous to European norms, which allow design the system of ventilation of residential buildings according to European standards. However, the basis for the design of ventilation systems in Ukraine is the national standards, in which mechanical ventilation, unfortunately, is provided only for the design of high-rise buildings. To maintain acceptable microclimate parameters in residential buildings, it is advisable for designers to apply the requirements for designing ventilation systems in accordance with European standards.

40 CFR 63.843 - Emission limits for existing sources.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) The emission capture system shall be installed and operated to meet the generally accepted engineering standards for minimum exhaust rates as published by the American Conference of Governmental Industrial Hygienists in Chapters 3 and 5 of “Industrial Ventilation: A Handbook of Recommended Practice” (incorporated...

40 CFR 63.843 - Emission limits for existing sources.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) The emission capture system shall be installed and operated to meet the generally accepted engineering standards for minimum exhaust rates as published by the American Conference of Governmental Industrial Hygienists in Chapters 3 and 5 of “Industrial Ventilation: A Handbook of Recommended Practice” (incorporated...

40 CFR 63.843 - Emission limits for existing sources.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) The emission capture system shall be installed and operated to meet the generally accepted engineering standards for minimum exhaust rates as published by the American Conference of Governmental Industrial Hygienists in Chapters 3 and 5 of “Industrial Ventilation: A Handbook of Recommended Practice” (incorporated...

40 CFR 63.843 - Emission limits for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) The emission capture system shall be installed and operated to meet the generally accepted engineering standards for minimum exhaust rates as published by the American Conference of Governmental Industrial Hygienists in Chapters 3 and 5 of “Industrial Ventilation: A Handbook of Recommended Practice” (incorporated...

40 CFR 63.843 - Emission limits for existing sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) The emission capture system shall be installed and operated to meet the generally accepted engineering standards for minimum exhaust rates as published by the American Conference of Governmental Industrial Hygienists in Chapters 3 and 5 of “Industrial Ventilation: A Handbook of Recommended Practice” (incorporated...

Overview of existing regulations for ventilation requirements of enclosed vehicular parking facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krarti, M.; Ayari, A.M.

1999-07-01

This paper provides an overview of the current standards and regulations regarding the ventilation in enclosed parking facilities in the US and other countries. First, the paper discusses the emission rates of motor vehicle pollutants and their health effects. In particular, typical emission rates for different vehicle and fuel types are presented to highlight the effect of various parameters on the ventilation rate requirements for parking garages. In addition, the paper provides a brief description of some of the common ventilation problems reported in the literature for enclosed parking garages.

75 FR 52980 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

.../maintaining): $303,512. Description: The Safety Standards for Underground Coal Mine Ventilation Belt Entry rule provides safety requirements for the use of the conveyor belt entry as a ventilation intake to... Underground Coal Mine Ventilation--Belt Entry Used as an Intake Air Course to Ventilate Working Sections and...

Evaluation of design ventilation requirements for enclosed parking facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ayari, A.; Krarti, M.

2000-07-01

This paper proposes a new design approach to determine the ventilation requirements for enclosed parking garages. The design approach accounts for various factors that affect the indoor air quality within a parking facility, including the average CO emission rate, the average travel time, the number of cars, and the acceptable CO level within the parking garage. This paper first describes the results of a parametric analysis based on the design method that was developed. Then the design method is presented to explain how the ventilation flow rate can be determined for any enclosed parking facility. Finally, some suggestions are proposedmore » to save fan energy for ventilating parking garages using demand ventilation control strategies.« less

29 CFR 1915.34 - Mechanical paint removers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Mechanical paint removers. 1915.34 Section 1915.34 Labor... Preservation § 1915.34 Mechanical paint removers. (a) Power tools. (1) Employees engaged in the removal of... confined space, mechanical exhaust ventilation sufficient to keep the dust concentration to a minimum shall...

50 CFR 14.161 - Primary enclosures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the total surface area of each ventilated wall. When openings are located on all four walls of the enclosure, the openings shall comprise at least 8 percent of the total surface area of each wall. At least... specifies maximum densities minimum space for transporting rodents that fall within the specified weight...

50 CFR 14.161 - Primary enclosures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the total surface area of each ventilated wall. When openings are located on all four walls of the enclosure, the openings shall comprise at least 8 percent of the total surface area of each wall. At least... specifies maximum densities minimum space for transporting rodents that fall within the specified weight...

50 CFR 14.161 - Primary enclosures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the total surface area of each ventilated wall. When openings are located on all four walls of the enclosure, the openings shall comprise at least 8 percent of the total surface area of each wall. At least... specifies maximum densities minimum space for transporting rodents that fall within the specified weight...

Assessment of the impact of dipped guideways on urban rail transit systems: Ventilation and safety requirements

NASA Technical Reports Server (NTRS)

1982-01-01

The ventilation and fire safety requirements for subway tunnels with dipped profiles between stations as compared to subway tunnels with level profiles were evaluated. This evaluation is based upon computer simulations of a train fire emergency condition. Each of the tunnel configurations evaluated was developed from characteristics that are representative of modern transit systems. The results of the study indicate that: (1) The level tunnel system required about 10% more station cooling than dipped tunnel systems in order to meet design requirements; and (2) The emergency ventilation requirements are greater with dipped tunnel systems than with level tunnel systems.

30 CFR 36.45 - Quantity of ventilating air.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Quantity of ventilating air. 36.45 Section 36... TRANSPORTATION EQUIPMENT Test Requirements § 36.45 Quantity of ventilating air. (a) Results of the engine tests shall be used to calculate ventilation (cubic feet of air per minute) that shall be supplied by positive...

30 CFR 36.45 - Quantity of ventilating air.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Quantity of ventilating air. 36.45 Section 36... TRANSPORTATION EQUIPMENT Test Requirements § 36.45 Quantity of ventilating air. (a) Results of the engine tests shall be used to calculate ventilation (cubic feet of air per minute) that shall be supplied by positive...

30 CFR 36.45 - Quantity of ventilating air.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Quantity of ventilating air. 36.45 Section 36... TRANSPORTATION EQUIPMENT Test Requirements § 36.45 Quantity of ventilating air. (a) Results of the engine tests shall be used to calculate ventilation (cubic feet of air per minute) that shall be supplied by positive...

46 CFR 182.470 - Ventilation of spaces containing diesel fuel tanks.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Ventilation of spaces containing diesel fuel tanks. 182... Ventilation of spaces containing diesel fuel tanks. (a) Unless provided with ventilation that complies with § 182.465, a space containing a diesel fuel tank and no machinery must meet the requirements of this...

46 CFR 182.470 - Ventilation of spaces containing diesel fuel tanks.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Ventilation of spaces containing diesel fuel tanks. 182... Ventilation of spaces containing diesel fuel tanks. (a) Unless provided with ventilation that complies with § 182.465, a space containing a diesel fuel tank and no machinery must meet the requirements of this...

46 CFR 58.01-45 - Machinery space, ventilation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 2 2011-10-01 2011-10-01 false Machinery space, ventilation. 58.01-45 Section 58.01-45... MACHINERY AND RELATED SYSTEMS General Requirements § 58.01-45 Machinery space, ventilation. Each machinery space must be ventilated to ensure that, when machinery or boilers are operating at full power in all...

46 CFR 58.01-45 - Machinery space, ventilation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 2 2014-10-01 2014-10-01 false Machinery space, ventilation. 58.01-45 Section 58.01-45... MACHINERY AND RELATED SYSTEMS General Requirements § 58.01-45 Machinery space, ventilation. Each machinery space must be ventilated to ensure that, when machinery or boilers are operating at full power in all...

46 CFR 58.01-45 - Machinery space, ventilation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 2 2012-10-01 2012-10-01 false Machinery space, ventilation. 58.01-45 Section 58.01-45... MACHINERY AND RELATED SYSTEMS General Requirements § 58.01-45 Machinery space, ventilation. Each machinery space must be ventilated to ensure that, when machinery or boilers are operating at full power in all...

46 CFR 58.01-45 - Machinery space, ventilation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 2 2013-10-01 2013-10-01 false Machinery space, ventilation. 58.01-45 Section 58.01-45... MACHINERY AND RELATED SYSTEMS General Requirements § 58.01-45 Machinery space, ventilation. Each machinery space must be ventilated to ensure that, when machinery or boilers are operating at full power in all...

46 CFR 58.01-45 - Machinery space, ventilation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Machinery space, ventilation. 58.01-45 Section 58.01-45... MACHINERY AND RELATED SYSTEMS General Requirements § 58.01-45 Machinery space, ventilation. Each machinery space must be ventilated to ensure that, when machinery or boilers are operating at full power in all...

Using domiciliary non-invasive ventilator data downloads to inform clinical decision-making to optimise ventilation delivery and patient compliance

PubMed Central

Mansell, Stephanie K; Cutts, Steven; Hackney, Isobel; Wood, Martin J; Hawksworth, Kevin; Creer, Dean D; Kilbride, Cherry; Mandal, Swapna

2018-01-01

Introduction Ventilation parameter data from patients receiving home mechanical ventilation can be collected via secure data cards and modem technology. This can then be reviewed by clinicians and ventilator prescriptions adjusted. Typically available measures include tidal volume (VT), leak, respiratory rate, minute ventilation, patient triggered breaths, achieved pressures and patient compliance. This study aimed to assess the potential impact of ventilator data downloads on management of patients requiring home non-invasive ventilation (NIV). Methods A longitudinal within-group design with repeated measurements was used. Baseline ventilator data were downloaded, reviewed and adjustments made to optimise ventilation. Leak, VT and compliance data were collected for comparison at the first review and 3–7 weeks later. Ventilator data were monitored and amended remotely via a modem by a consultant physiotherapist between the first review and second appointment. Results Analysis of data from 52 patients showed increased patient compliance (% days used >4 hours) from 90% to 96% (p=0.007), increased usage from 6.53 to 6.94 hours (p=0.211) and a change in VT(9.4 vs 8.7 mL/kg/ideal body weight, p=0.022). There was no change in leak following review of NIV prescriptions (mean (SD): 43 (23.4) L/min vs 45 (19.9)L/min, p=0.272). Conclusion Ventilator data downloads, via early remote assessment, can help optimise patient ventilation through identification of modifiable factors, in particular interface leak and ventilator prescriptions. However, a prospective study is required to assess whether using ventilator data downloads provides value in terms of patient outcomes and cost-effectiveness. The presented data will help to inform the design of such a study. PMID:29531743

[Guide for the use of jet-ventilation during ENT and oral surgery].

PubMed

Bourgain, J-L; Chollet, M; Fischler, M; Gueret, G; Mayne, A

2010-10-01

The aim of this synthesis was to give recommendations on the use of jet-ventilation during ENT surgical and endoscopy procedures. Literature was collected from PUBMED and analysed by the members of French association of anaesthesiologists in ENT surgery, all skilled in this field. Presentation of these recommendations was given during the general assembly held in Reims, the 15th May 2009. Jet-ventilation is especially indicated during upper airway endoscopy and laryngeal invasive endoscopic surgery. Furthermore, transtracheal jet ventilation is included on most of difficult oxygenation and difficult intubation algorithm. The main risk of jet-ventilation is pulmonary barotrauma when expiration of injected gas is impeded by an upper airway obstruction. Failure and complications of tracheal puncture are rare when performed by experimented operators. Clinical use of jet ventilation requires a dedicated device. Practice of jet ventilation without intubation may be dangerous when applied without control of driving pressure and end expiratory tracheal pressure. Every anaesthetist should be familiar with transtracheal ventilation since they may face a "cannot ventilate cannot intubate" situation. Upper airway endoscopy and laryngeal surgery are the ideal field for training jet ventilation, even more so as this technique offers perfect operative conditions. To apply this project, jet ventilation should be used more frequently in routine practice. To maintain skill, regular use of these techniques is required. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Daytime Mouthpiece for Continuous Noninvasive Ventilation in Individuals With Amyotrophic Lateral Sclerosis.

PubMed

Bédard, Marie-Eve; McKim, Douglas A

2016-10-01

Noninvasive ventilation (NIV) is commonly used to provide ventilatory support for individuals with amyotrophic lateral sclerosis (ALS). Once 24-h ventilation is required, the decision between invasive tracheostomy ventilation and palliation is often faced. This study describes the use and outcomes of daytime mouthpiece ventilation added to nighttime mask ventilation for continuous NIV in subjects with ALS as an effective alternative. This was a retrospective study of 39 subjects with ALS using daytime mouthpiece ventilation over a 17-y period. Thirty-one subjects were successful with mouthpiece ventilation, 2 were excluded, 2 stopped because of lack of motivation, and 4 with bulbar subscores of the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (b-ALSFRS-R) between 0 and 3 physically failed to use it consistently. No subject in the successful group had a b-ALSFRS-R score of <6. Thirty of the successful subjects were able to generate a maximum insufflation capacity - vital capacity difference with lung volume recruitment. The median (range) survival to tracheostomy or death from initiation of nocturnal NIV and mouthpiece ventilation were 648 (176-2,188) and 286 (41-1,769) d, respectively. Peak cough flow with lung-volume recruitment >180 L/min at initiation of mouthpiece ventilation was associated with a longer survival (637 ± 468 vs 240 ± 158 d (P = .01). Mouthpiece ventilation provides effective ventilation and prolonged survival for individuals with ALS requiring full-time ventilatory support and maintaining adequate bulbar function. Copyright © 2016 by Daedalus Enterprises.

Improving Patient Safety with X-Ray and Anesthesia Machine Ventilator Synchronization: A Medical Device Interoperability Case Study

NASA Astrophysics Data System (ADS)

Arney, David; Goldman, Julian M.; Whitehead, Susan F.; Lee, Insup

When a x-ray image is needed during surgery, clinicians may stop the anesthesia machine ventilator while the exposure is made. If the ventilator is not restarted promptly, the patient may experience severe complications. This paper explores the interconnection of a ventilator and simulated x-ray into a prototype plug-and-play medical device system. This work assists ongoing interoperability framework development standards efforts to develop functional and non-functional requirements and illustrates the potential patient safety benefits of interoperable medical device systems by implementing a solution to a clinical use case requiring interoperability.

Rapid shift and millennial-scale variations in Holocene North Pacific Intermediate Water ventilation.

PubMed

Lembke-Jene, Lester; Tiedemann, Ralf; Nürnberg, Dirk; Gong, Xun; Lohmann, Gerrit

2018-05-22

The Pacific hosts the largest oxygen minimum zones (OMZs) in the world ocean, which are thought to intensify and expand under future climate change, with significant consequences for marine ecosystems, biogeochemical cycles, and fisheries. At present, no deep ventilation occurs in the North Pacific due to a persistent halocline, but relatively better-oxygenated subsurface North Pacific Intermediate Water (NPIW) mitigates OMZ development in lower latitudes. Over the past decades, instrumental data show decreasing oxygenation in NPIW; however, long-term variations in middepth ventilation are potentially large, obscuring anthropogenic influences against millennial-scale natural background shifts. Here, we use paleoceanographic proxy evidence from the Okhotsk Sea, the foremost North Pacific ventilation region, to show that its modern oxygenated pattern is a relatively recent feature, with little to no ventilation before six thousand years ago, constituting an apparent Early-Middle Holocene (EMH) threshold or "tipping point." Complementary paleomodeling results likewise indicate a warmer, saltier EMH NPIW, different from its modern conditions. During the EMH, the Okhotsk Sea switched from a modern oxygenation source to a sink, through a combination of sea ice loss, higher water temperatures, and remineralization rates, inhibiting ventilation. We estimate a strongly decreased EMH NPIW oxygenation of ∼30 to 50%, and increased middepth Pacific nutrient concentrations and carbon storage. Our results ( i ) imply that under past or future warmer-than-present conditions, oceanic biogeochemical feedback mechanisms may change or even switch direction, and ( ii ) provide constraints on the high-latitude North Pacific's influence on mesopelagic ventilation dynamics, with consequences for large oceanic regions. Copyright © 2018 the Author(s). Published by PNAS.

Driving Pressure and Hospital Mortality in Patients Without ARDS: A Cohort Study.

PubMed

Schmidt, Marcello F S; Amaral, Andre C K B; Fan, Eddy; Rubenfeld, Gordon D

2018-01-01

Driving pressure (ΔP) is associated with mortality in patients with ARDS and with pulmonary complications in patients undergoing general anesthesia. Whether ΔP is associated with outcomes of patients without ARDS who undergo ventilation in the ICU is unknown. Our objective was to determine the independent association between ΔP and outcomes in mechanically ventilated patients without ARDS on day 1 of mechanical ventilation. This was a retrospective analysis of a cohort of 622 mechanically ventilated adult patients without ARDS on day 1 of mechanical ventilation from five ICUs in a tertiary center in the United States. The primary outcome was hospital mortality. The presence of ARDS was determined using the minimum daily Pao 2 to Fio 2 (PF) ratio and an automated text search of chest radiography reports. The data set was validated by first testing the model in 543 patients with ARDS. In patients without ARDS on day 1 of mechanical ventilation, ΔP was not independently associated with hospital mortality (OR, 1.01; 95% CI, 0.97-1.05). The results of the primary analysis were confirmed in a series of preplanned sensitivity analyses. In this cohort of patients without ARDS on day 1 of mechanical ventilation and within the limits of ventilatory settings normally used by clinicians, ΔP was not associated with hospital mortality. This study also confirms the association between ΔP and mortality in patients with ARDS not enrolled in a trial and in hypoxemic patients without ARDS. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Calibrated energy simulations of potential energy savings in actual retail buildings

NASA Astrophysics Data System (ADS)

Alhafi, Zuhaira

Retail stores are commercial buildings with high energy consumption due to their typically large volumes and long hours of operation. This dissertation assesses heating, ventilating and air conditioning saving strategies based on energy simulations with input parameters from actual retail buildings. The dissertation hypothesis is that "Retail store buildings will save a significant amount of energy by (1) modifying ventilation rates, and/or (2) resetting set point temperatures. These strategies have shown to be beneficial in previous studies. As presented in the literature review, potential energy savings ranged from 0.5% to 30% without compromising indoor thermal comfort and indoor air quality. The retail store buildings can be ventilated at rates significantly lower than rates called for in the ASHRAE Standard 62.1-2010 while maintaining acceptable indoor air quality. Therefore, two dissertation objectives are addressed: (1) Investigate opportunities to reduce ventilation rates that do not compromise indoor air quality in retail stores located in Central Pennsylvania, (2) Investigate opportunities to increase (in summer) and decrease (in winter) set point temperatures that do not compromise thermal comfort. This study conducted experimental measurements of ventilation rates required to maintain acceptable air quality and indoor environmental conditions requirements for two retail stores using ASHRAE Standard 62.1_2012. More specifically, among other parameters, occupancy density, indoor and outdoor pollutant concentrations, and indoor temperatures were measured continuously for one week interval. One of these retail stores were tested four times for a yearlong time period. Pollutants monitored were formaldehyde, carbon dioxide, particle size distributions and concentrations, as well as total volatile organic compounds. As a part of the base protocol, the number of occupants in each store was hourly counted during the test, and the results reveal that the occupant densities were approximately 20% to 30% of that called by ASHRAE 62.1. Formaldehyde was the most important contaminant of concern in retail stores investigated. Both stores exceeded the most conservative health guideline for formaldehyde (OEHHA TWA REL = 7.3 ppb). This study found that source removal and reducing the emission rate, as demonstrated in retail stores sampled in this study, is a viable strategy to meet the health guideline. Total volatile compound were present in retail stores at low concentrations well below health guidelines suggested by Molhave (1700microg /m 2) and Bridges (1000 microg /m2). Based on these results and through mass--balance modeling, different ventilation rate reduction scenarios were proposed, and for these scenarios the differences in energy consumption were estimated. Findings of all phases of this desertion have contributed to understanding (a) the trade-off between energy savings and ventilation rates that do not compromise indoor air quality, and (b) the trade-off between energy savings and resets of indoor air temperature that do not compromise thermal comfort. Two models for retail stores were built and calibrated and validated against actual utility bills. Energy simulation results indicated that by lowering the ventilation rates from measured and minimum references would reduce natural gas energy use by estimated values of 6% to 19%. Also, this study found that the electrical cooling energy consumption was not significantly sensitive to different ventilation rates. However, increasing indoor air temperature by 3°C in summer had a significant effect on the energy savings. In winter, both energy savings strategies, ventilation reduction and decrease in set points, had a significant effect on natural gas consumption. Specially, when the indoor air temperature 21°C was decreased to 19.4°C with the same amount of ventilation rate of Molhaves guideline for both cases. Interestingly, the temperature of 23.8°C (75°F), which is the lowest value of ASHRAE 55 thermal comfort for sedentary people (cashiers) and the highest value for thermal comfort adjustments due to activity level (customers and workers) that are calculated by using empirical equation, was the optimum temperature for sedentary and active people in Retail store buildings.

Cardiopulmonary changes during clarinet playing.

PubMed

Hahnengress, Maria L; Böning, Dieter

2010-12-01

Since playing wind instrument impedes normal respiratory functions, its effect on expiratory and blood gases as well as on cardiac function was investigated. In 15 skilled clarinettists expiratory PO(2) and PCO(2) were measured in gas drawn from a modified clarinet barrel when playing a composition (Robert Schumann's "Phantasiestücke" Op. 73 for clarinet and piano) with increasing difficulty from movement 1 to movement 3. Blood gases were measured in arterialized ear lobe blood at the end of each movement and the electrocardiogram was recorded continuously. From the expiratory gas pressures one may conclude that the most advanced players adapt their ventilation to the requirements of the composition and sustain expiration during difficult parts of the composition until hypoxic alveolar PO(2) values are reached (minimum 77 mmHg). Less trained clarinettists tend to hyperventilation or shallow breathing. Oxygen saturation in arterialized blood showed a slight step-wise decrease from movement to movement [control 96.6 ± 0.5 (SD)%, end of concert 95.6 ± 1.0%]. SO(2) was significantly higher because of possibly more effective ventilation in instrumentalists with practise time exceeding 2 h daily. Mean heart rate increased to values like during moderate to heavy physical exercise depending on artistic fitness and the difficulty of the movement (maximal individual value 173 beats/min). Additionally, a large variation might be caused through intrathoracic pressure changes, changing exertion, respiratory influences and emotion. The electrocardiogram showed no pathological events. In general, clarinet playing at a professional level imposes strain on ventilation and circulation but usually not on a pathophysiological level.

Risk Factors for the Mortality of Pneumocystis jirovecii Pneumonia in Non-HIV Patients Who Required Mechanical Ventilation: A Retrospective Case Series Study.

PubMed

Kotani, Toru; Katayama, Shinshu; Miyazaki, Yuya; Fukuda, Satoshi; Sato, Yoko; Ohsugi, Koichi

2017-01-01

The risk factors for the mortality rate of Pneumocystis jirovecii pneumonia (PCP) who required mechanical ventilation (MV) remained unknown. A retrospective chart review was performed of all PCP patients admitted to our intensive care unit and treated for acute hypoxemic respiratory failure to assess the risk factors for the high mortality. Twenty patients without human immunodeficiency virus infection required mechanical ventilation; 19 received noninvasive ventilation; and 11 were intubated. PEEP was incrementally increased and titrated to maintain FIO 2 as low as possible. No mandatory ventilation was used. Sixteen patients (80%) survived. Pneumothorax developed in one patient with rheumatoid arthritis (RA). Median PEEP level in the first 5 days was 10.0 cmH 2 O and not associated with death. Multivariate analysis showed the association of incidence of interstitial lung disease and increase in serum KL-6 with 90-day mortality. We found MV strategies to prevent pneumothorax including liberal use of noninvasive ventilation, and PEEP titration and disuse of mandatory ventilation may improve mortality in this setting. Underlying disease of interstitial lung disease was a risk factor and KL-6 may be a useful predictor associated with mortality in patients with RA. These findings will need to be validated in larger studies.

46 CFR 36.20-5 - Ventilation of pumproom-TB/ALL.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Ventilation of pumproom-TB/ALL. 36.20-5 Section 36.20-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS ELEVATED TEMPERATURE CARGOES Vents and Ventilation § 36.20-5 Ventilation of pumproom—TB/ALL. (a) Where personnel are required to enter pumprooms...

46 CFR 32.55-1 - Ventilation of tank vessels constructed on or after July 1, 1951-TB/ALL.

Code of Federal Regulations, 2011 CFR

2011-10-01

... VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Ventilation and Venting § 32.55-1 Ventilation... means of ventilation. (b) Compartments containing machinery where sources of vapor ignition are normally... approved for this purpose. Machinery spaces below the freeboard deck, in which fuels with flash point of...

46 CFR 32.55-1 - Ventilation of tank vessels constructed on or after July 1, 1951-TB/ALL.

Code of Federal Regulations, 2012 CFR

2012-10-01

... VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Ventilation and Venting § 32.55-1 Ventilation... means of ventilation. (b) Compartments containing machinery where sources of vapor ignition are normally... approved for this purpose. Machinery spaces below the freeboard deck, in which fuels with flash point of...

46 CFR 32.55-1 - Ventilation of tank vessels constructed on or after July 1, 1951-TB/ALL.

Code of Federal Regulations, 2014 CFR

2014-10-01

... VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Ventilation and Venting § 32.55-1 Ventilation... means of ventilation. (b) Compartments containing machinery where sources of vapor ignition are normally... approved for this purpose. Machinery spaces below the freeboard deck, in which fuels with flash point of...

46 CFR 32.55-1 - Ventilation of tank vessels constructed on or after July 1, 1951-TB/ALL.

Code of Federal Regulations, 2010 CFR

2010-10-01

... VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Ventilation and Venting § 32.55-1 Ventilation... means of ventilation. (b) Compartments containing machinery where sources of vapor ignition are normally... approved for this purpose. Machinery spaces below the freeboard deck, in which fuels with flash point of...

46 CFR 32.55-1 - Ventilation of tank vessels constructed on or after July 1, 1951-TB/ALL.

Code of Federal Regulations, 2013 CFR

2013-10-01

... VESSELS SPECIAL EQUIPMENT, MACHINERY, AND HULL REQUIREMENTS Ventilation and Venting § 32.55-1 Ventilation... means of ventilation. (b) Compartments containing machinery where sources of vapor ignition are normally... approved for this purpose. Machinery spaces below the freeboard deck, in which fuels with flash point of...

Early tracheostomy in trauma patients saves time and money.

PubMed

Hyde, Glendon A; Savage, Stephanie A; Zarzaur, Ben L; Hart-Hyde, Jensen E; Schaefer, Candace B; Croce, Martin A; Fabian, Timothy C

2015-01-01

Patients suffering traumatic brain and chest wall injuries are often difficult to liberate from the ventilator yet best timing of tracheostomy remains ill-defined. While prior studies have addressed early versus late tracheostomy, they generally suffer from the use of historical controls, which cannot account for variations in management over time. Propensity scoring can be utilized to identify controls from the same patient population, minimizing impact of confounding variables. The purpose of this study was to determine outcomes associated with early versus late tracheostomy by application of propensity scoring. Patients requiring intubation within 48h and receiving tracheostomy from January 2010 to June 2012 were identified. Early tracheostomy (ET) was a tracheostomy performed by the fifth hospital day. ET patients were matched to late tracheostomy patients (LT, tracheostomy after day 5) using propensity scoring and compared for multiple outcomes. Cost for services was calculated using average daily billing rates at our institution. One hundred and six patients were included, 53 each in the ET (mean day tracheostomy=4) and the LT (mean day tracheostomy=10) cohorts. The average age was 47 years and 94% suffered blunt injury, with an average NISS of 23.7. Patients in the ET group had significantly shorter TICU LOS (21.4 days vs. 28.6 days, p<0.0001) and significantly fewer ventilator days (16.7 days vs. 21.9, p<0.0001) compared to the LT group. ET patients also had significantly less VAP (34% vs. 64.2%, p=0.0019). In the current era of increased health-care costs, early tracheostomy significantly decreased both pulmonary morbidity and critical care resource utilization. This translates to an appreciable cost savings, at minimum $52,173 per patient and a potential total savings of $2.8million/year for the entire LT cohort. For trauma patients requiring prolonged ventilator support, early tracheostomy should be performed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mechanically ventilated children with 2009 pandemic influenza A/H1N1: results from the National Pediatric Intensive Care Registry in Japan.

PubMed

Tokuhira, Natsuko; Shime, Nobuaki; Inoue, Miho; Kawasaki, Tatsuya; Sakurai, Yoshio; Kurosaka, Norimasa; Ueta, Ikuya; Nakagawa, Satoshi

2012-09-01

To outline the characteristics, clinical course, and outcome of pediatric patients requiring mechanical ventilation with influenza A/H1N1 infection in Japan. Prospective case registry analysis. Eleven pediatric or general intensive care units in Japan. Consecutive patients infected with A/H1N1, aged from 1 month to 16 yrs old admitted to the intensive care unit for mechanical ventilation between July 2009 and March 2010. None. Eighty-one children, aged 6.3 [0.8-13.6] (median [interquartile range]) years, were enrolled. Seventy-four (91%) had mechanical ventilation with tracheal intubation. Median duration of mechanical ventilation was 4 days (range 0.04-87) and 18 patients (23%) required mechanical ventilation >7 days. Two patients (2%) required extracorporeal membrane oxygenation. The in-hospital mortality was 1%. Forty-one patients (50%) had at least one underlying chronic condition, including 31 with asthma. Associated clinical symptoms and diagnosis were as follows: acute respiratory distress syndrome (9%), asthma or bronchitis (37%), pneumonia (68%) with 8 (14%) having bacterial pneumonia, neurological symptoms (32%), myocarditis (2%), and rhabdomyolysis (1%). Therapeutic interventions include inotropic support (21%), methylprednisolone therapy (33%), and antimicrobial therapy (88%). Multivariate analysis revealed that inotropic support was the only statistically significant factor associated with mechanical ventilation for more than a week (odds ratio 5.5, 95% confidence interval 1.5-20.5, p = .005). The clinical presentations of pediatric patients requiring mechanical ventilation for A/H1N1 in Japan were diverse. In-hospital mortality of this population was remarkably low. Rapid access to medical facilities in combination with early administration of antiviral agents may have contributed to the low mortality in this population.

Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study.

PubMed

Zhang, Jian; Chen, Chao Qin; Lei, Xiu Zhen; Feng, Zhi Ying; Zhu, Sheng Mei

2013-07-01

This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting) in thoracic surgery patients requiring one-lung ventilation.

Alternatives generation and analysis for double-shell tank primary ventilation systems emissions control and monitoring

DOE Office of Scientific and Technical Information (OSTI.GOV)

SEDERBURG, J.P.

1999-09-30

This AGA addresses the question: ''What equipment upgrades, operational changes, and/or other actions are required relative to the DST tanks farms' ventilation systems to support retrieval, staging (including feed sampling), and delivery of tank waste to the Phase I private contractor?'' Issues and options for the various components within the ventilation subsystem affect each other. Recommended design requirements are presented and the preferred alternatives are detailed.

Effects of volatile and intravenous anesthesia on the alveolar and systemic inflammatory response in thoracic surgical patients.

PubMed

Schilling, Thomas; Kozian, Alf; Senturk, Mert; Huth, Christof; Reinhold, Annegret; Hedenstierna, Göran; Hachenberg, Thomas

2011-07-01

One-lung ventilation (OLV) results in alveolar proinflammatory effects, whereas their extent may depend on administration of anesthetic drugs. The current study evaluates the effects of different volatile anesthetics compared with an intravenous anesthetic and the relationship between pulmonary and systemic inflammation in patients undergoing open thoracic surgery. Sixty-three patients scheduled for elective open thoracic surgery were randomized to receive anesthesia with 4 mg · kg⁻¹ · h⁻¹ propofol (n = 21), 1 minimum alveolar concentration desflurane (n = 21), or 1 minimum alveolar concentration sevoflurane (n = 21). Analgesia was provided by remifentanil (0.25 μg · kg⁻¹ · min⁻¹). After intubation, all patients received pressure-controlled mechanical ventilation with a tidal volume of approximately 7 ml · kg ideal body weight, a peak airway pressure lower than 30 cm H₂O, a respiratory rate adjusted to a Paco2 of 40 mmHg, and a fraction of inspired oxygen lower than 0.8 during OLV. Fiberoptic bronchoalveolar lavage of the ventilated lung was performed immediately after intubation and after surgery. The expression of inflammatory cytokines was determined in the lavage fluids and serum samples by multiplexed bead-based immunoassays. Proinflammatory cytokines increased in the ventilated lung after OLV. Mediator release was more enhanced during propofol anesthesia compared with desflurane or sevoflurane administration. For tumor necrosis factor-α, the values were as follows: propofol, 5.7 (8.6); desflurane, 1.6 (0.6); and sevoflurane, 1.6 (0.7). For interleukin-8, the values were as follows: propofol, 924 (1680); desflurane, 390 (813); and sevoflurane, 412 (410). (Values are given as median [interquartile range] pg · ml⁻¹). Interleukin-1β was similarly reduced during volatile anesthesia. The postoperative serum interleukin-6 concentration was increased in all patients, whereas the systemic proinflammatory response was negligible. OLV increases the alveolar concentrations of proinflammatory mediators in the ventilated lung. Both desflurane and sevoflurane suppress the local alveolar, but not the systemic, inflammatory responses to OLV and thoracic surgery.

Simulated Altitude Investigation of Stewart-Warner Model 906-B Combustion Heater

NASA Technical Reports Server (NTRS)

Ebersbach, Frederick R.; Cervenka, Adolph J.

1947-01-01

An investigation has been conducted to determine thermal and pressure-drop performance and the operational characteristics of a Stewart-Warner model 906-B combustion heater. The performance tests covered a range of ventilating-air flows from 500 to 3185 pounds per hour, combustion-air pressure drops from 5 to 35 inches of water, and pressure altitudes from sea level to 41,000 feet. The operational characteristics investigated were the combustion-air flows for sustained combustion and for consistent ignition covering fuel-air ratios ranging from 0.033 to 0.10 and pressure altitudes from sea level to 45,000 feet. Rated heat output of 50,000 Btu per hour was obtained at pressure altitudes up to 27,000 feet for ventilating-air flows greater than 800 pounds per hour; rated output was not obtained at ventilating-air flow below 800 pounds per hour at any altitude. The maximum heater efficiency was found to be 60.7 percent at a fuel-air ratio of 0.050, a sea-level pressure altitude, a ventilating-air temperature of 0 F, combustion-air temperature of 14 F, a ventilating-air flow of 690 pounds per hour, and a combustion-air flow of 72.7 pounds per hour. The minimum combustion-air flow for sustained combustion at a pressure altitude of 25,000 feet was about 9 pounds per hour for fuel-air ratios between 0.037 and 0.099 and at a pressure altitude of 45,000 feet increased to 18 pounds per hour at a fuel-air ratio of 0.099 and 55 pounds per hour at a fuel-air ratio of 0.036. Combustion could be sustained at combustion-air flows above values of practical interest. The maximum flow was limited, however, by excessively high exhaust-gas temperature or high pressure drop. Both maximum and minimum combustion-air flows for consistent ignition decrease with increasing pressure altitude and the two curves intersect at a pressure altitude of approximately 25,000 feet and a combustion-air flow of approximately 28 pounds per hour.

Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery.

PubMed

Fernandez-Zamora, Maria Dolores; Gordillo-Brenes, Antonio; Banderas-Bravo, Esther; Arboleda-Sánchez, José Andrés; Hinojosa-Pérez, Rafael; Aguilar-Alonso, Eduardo; Herruzo-Aviles, Ángel; Curiel-Balsera, Emilio; Sánchez-Rodríguez, Ángel; Rivera-Fernández, Ricardo

2018-05-01

Mortality among the small percentage of cardiac surgery patients receiving prolonged mechanical ventilation is high, but this issue appears to be inadequately addressed in guidelines. This study is a retrospective analysis of prospective, multi-center, and observational study in Spain including all adults undergoing cardiac surgery in 3 Andalusian hospitals between June 2008 and December 2012. The study included 3,588 adults with mean ± SD age of 63.5 ± 12.8 y and with median (interquartile range) EuroSCORE of 5 (3-7) points. Prolonged mechanical ventilation (> 24 h) was required by 415 subjects (11.6%), with ICU mortality of 44.3% (184 subjects), and was not required by 3,173 subjects (88.4%), with ICU mortality of 3.1% (99 subjects, P < .001). Prolonged mechanical ventilation was associated with more complications and was required by 4.5% of subjects with a EuroSCORE <5, 11.2% with a score of 5-7, 27.2% with a score of 8-10, and 32.2% with a score > 10. In the multivariable analysis, ICU mortality was associated with illness severity, duration of bypass surgery, surgery type, and prolonged mechanical ventilation (odds ratio 15.19, 95% CI 11.56-22.09). The main cause of death was multiple organ failure and sepsis in subjects who required prolonged mechanical ventilation (50.3%) and cardiogenic shock in those who did not (59.2%). Prolonged postoperative mechanical ventilation was required by 10-20% of cardiac surgery subjects, who constitute a specific group that represents most of the postoperative mortality, which is associated with multiple organ failure and sepsis. Copyright © 2018 by Daedalus Enterprises.

Complementary home mechanical ventilation techniques. SEPAR Year 2014.

PubMed

Chiner, Eusebi; Sancho-Chust, José N; Landete, Pedro; Senent, Cristina; Gómez-Merino, Elia

2014-12-01

This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for a randomized controlled trial.

PubMed

Spieth, Peter M; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J; Pelosi, Paolo; Koch, Thea; Gama de Abreu, Marcelo

2014-05-02

General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventilation. The PROtective VARiable ventilation trial ('PROVAR') is a single center, randomized controlled trial enrolling 50 patients who are planning for open abdominal surgery expected to last longer than 3 hours. PROVAR compares conventional (non-variable) lung protective ventilation (CV) with variable lung protective ventilation (VV) regarding pulmonary function and inflammatory response. The primary endpoint of the study is the forced vital capacity on the first postoperative day. Secondary endpoints include further lung function tests, plasma cytokine levels, spatial distribution of ventilation assessed by means of electrical impedance tomography and postoperative pulmonary complications. We hypothesize that VV improves lung function and reduces systemic inflammatory response compared to CV in patients receiving mechanical ventilation during general anesthesia for open abdominal surgery longer than 3 hours. PROVAR is the first randomized controlled trial aiming at intra- and postoperative effects of VV on lung function. This study may help to define the role of VV during general anesthesia requiring mechanical ventilation. Clinicaltrials.gov NCT01683578 (registered on September 3 3012).

Ultra-Short-Course Antibiotics for Patients With Suspected Ventilator-Associated Pneumonia but Minimal and Stable Ventilator Settings.

PubMed

Klompas, Michael; Li, Lingling; Menchaca, John T; Gruber, Susan

2017-04-01

Many patients started on antibiotics for possible ventilator-associated pneumonia (VAP) do not have pneumonia. Patients with minimal and stable ventilator settings may be suitable candidates for early antibiotic discontinuation. We compared outcomes among patients with suspected VAP but minimal and stable ventilator settings treated with 1-3 days vs >3 days of antibiotics. We identified consecutive adult patients started on antibiotics for possible VAP with daily minimum positive end-expiratory pressure of ≤5 cm H2O and fraction of inspired oxygen ≤40% for at least 3 days within a large tertiary care hospital between 2006 and 2014. We compared time to extubation alive vs ventilator death and time to hospital discharge alive vs hospital death using competing risks models among patients prescribed 1-3 days vs >3 days of antibiotics. All models were adjusted for patient demographics, comorbidities, severity of illness, clinical signs of infection, and pathogens. There were 1290 eligible patients, 259 treated for 1-3 days and 1031 treated for >3 days. The 2 groups had similar demographics, comorbidities, and clinical signs. There were no significant differences between groups in time to extubation alive (hazard ratio [HR], 1.16 for short- vs long-course treatment; 95% confidence interval [CI], .98-1.36), ventilator death (HR, 0.82 [95% CI, .55-1.22]), time to hospital discharge alive (HR, 1.07 [95% CI, .91-1.26]), or hospital death (HR, 0.99 [95% CI, .75-1.31]). Very short antibiotic courses (1-3 days) were associated with outcomes similar to longer courses (>3 days) in patients with suspected VAP but minimal and stable ventilator settings. Assessing serial ventilator settings may help clinicians identify candidates for early antibiotic discontinuation. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

A historical perspective on ventilator management.

PubMed

Shapiro, B A

1994-02-01

Paralysis via neuromuscular blockade in ICU patients requires mechanical ventilation. This review historically addresses the technological advances and scientific information upon which ventilatory management concepts are based, with special emphasis on the influence such concepts have had on the use of neuromuscular blocking agents. Specific reference is made to the scientific information and technological advances leading to the newer concepts of ventilatory management. Information from > 100 major studies in the peer-reviewed medical literature, along with the author's 25 yrs of clinical experience and academic involvement in acute respiratory care is presented. Nomenclature related to ventilatory management is specifically defined and consistently utilized to present and interpret the data. Pre-1970 ventilatory management is traced from the clinically unacceptable pressure-limited devices to the reliable performance of volume-limited ventilators. The scientific data and rationale that led to the concept of relatively large tidal volume delivery are reviewed in the light of today's concerns regarding alveolar overdistention, control-mode dyssynchrony, and auto-positive end-expiratory pressure. Also presented are the post-1970 scientific rationales for continuous positive airway pressure/positive end-expiratory pressure therapy, avoidance of alveolar hyperxia, and partial ventilatory support techniques (intermittent mandatory ventilation/synchronized intermittent mandatory ventilation). The development of pressure-support devices is discussed and the capability of pressure-control techniques is presented. The rationale for more recent concepts of total ventilatory support to avoid ventilator-induced lung injury is presented. The traditional techniques utilizing volume-preset ventilators with relatively large tidal volumes remain valid and desirable for the vast majority of patients requiring mechanical ventilation. Neuromuscular blockade is best avoided in these patients. However, adequate analgesia, amnesia, and sedation are required. For patients with severe lung disease, alveolar overdistention and hyperoxia should be avoided and may be best accomplished by total ventilatory support techniques, such as pressure control. Total ventilatory support requires neuromuscular blockade and may not provide eucapnic ventilation.

Oxygen minimum zones in the eastern tropical Atlantic and Pacific oceans

NASA Astrophysics Data System (ADS)

Karstensen, Johannes; Stramma, Lothar; Visbeck, Martin

2008-06-01

Within the eastern tropical oceans of the Atlantic and Pacific basin vast oxygen minimum zones (OMZ) exist in the depth range between 100 and 900 m. Minimum oxygen values are reached at 300-500 m depth which in the eastern Pacific become suboxic (dissolved oxygen content <4.5 μmol kg -1) with dissolved oxygen concentration of less than 1 μmol kg -1. The OMZ of the eastern Atlantic is not suboxic and has relatively high oxygen minimum values of about 17 μmol kg -1 in the South Atlantic and more than 40 μmol kg -1 in the North Atlantic. About 20 (40%) of the North Pacific volume is occupied by an OMZ when using 45 μmol kg -1 (or 90 μmol kg -1, respectively) as an upper bound for OMZ oxygen concentration for ocean densities lighter than σθ < 27.2 kg m -3. The relative volumes reduce to less than half for the South Pacific (7% and 13%, respectively). The abundance of OMZs are considerably smaller (1% and 7%) for the South Atlantic and only ∼0% and 5% for the North Atlantic. Thermal domes characterized by upward displacements of isotherms located in the northeastern Pacific and Atlantic and in the southeastern Atlantic are co-located with the centres of the OMZs. They seem not to be directly involved in the generation of the OMZs. OMZs are a consequence of a combination of weak ocean ventilation, which supplies oxygen, and respiration, which consumes oxygen. Oxygen consumption can be approximated by the apparent oxygen utilization (AOU). However, AOU scaled with an appropriate consumption rate (aOUR) gives a time, the oxygen age. Here we derive oxygen ages using climatological AOU data and an empirical estimate of aOUR. Averaging oxygen ages for main thermocline isopycnals of the Atlantic and Pacific Ocean exhibit an exponential increase with density without an obvious signature of the OMZs. Oxygen supply originates from a surface outcrop area and can also be approximated by the turn-over time, the ratio of ocean volume to ventilating flux. The turn-over time corresponds well to the average oxygen ages for the well ventilated waters. However, in the density ranges of the suboxic OMZs the turn-over time substantially increases. This indicates that reduced ventilation in the outcrop is directly related to the existence of suboxic OMZs, but they are not obviously related to enhanced consumption indicated by the oxygen ages. The turn-over time suggests that the lower thermocline of the North Atlantic would be suboxic but at present this is compensated by the import of water from the well ventilated South Atlantic. The turn-over time approach itself is independent of details of ocean transport pathways. Instead the geographical location of the OMZ is to first order determined by: (i) the patterns of upwelling, either through Ekman or equatorial divergence, (ii) the regions of general sluggish horizontal transport at the eastern boundaries, and (iii) to a lesser extent to regions with high productivity as indicated through ocean colour data.

Energy efficiency buildings program

NASA Astrophysics Data System (ADS)

1981-05-01

Progress is reported in developing techniques for auditing the energy performance of buildings. The ventilation of buildings and indoor air quality is discussed from the viewpoint of (1) combustion generated pollutants; (2) organic contaminants; (3) radon emanation, measurements, and control; (4) strategies for the field monitoring of indoor air quality; and (5) mechanical ventilation systems using air-to-air heat exchanges. The development of energy efficient windows to provide optimum daylight with minimal thermal losses in cold weather and minimum thermal gain in hot weather is considered as well as the production of high frequency solid state ballasts for fluorescent lights to provide more efficient lighting at a 25% savings over conventional core ballasts. Data compilation, analysis, and demonstration activities are summarized.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chan, Wanyu R.; Sidheswaran, Meera; sullivan, Douglas

The HZEB research program aims to generate information needed to develop new science-based commercial building ventilation rate (VR) standards that balance the dual objectives of increasing energy efficiency and maintaining acceptable indoor air quality. This interim report describes the preliminary results from one HZEB field study on retail stores. The primary purpose of this study is to estimate the whole-building source strengths of contaminant of concerns (COCs). This information is needed to determine the VRs necessary to maintain indoor concentrations of COCs below applicable health guidelines.The goal of this study is to identify contaminants in retail stores that should bemore » controlled via ventilation, and to determine the minimum VRs that would satisfy the occupant health and odor criteria.« less

Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD)

PubMed Central

Gadre, Shruti K.; Duggal, Abhijit; Mireles-Cabodevila, Eduardo; Krishnan, Sudhir; Wang, Xiao-Feng; Zell, Katrina; Guzman, Jorge

2018-01-01

Abstract There are limited data on the epidemiology of acute respiratory failure necessitating mechanical ventilation in patients with severe chronic obstructive pulmonary disease (COPD). The prognosis of acute respiratory failure requiring invasive mechanical ventilation is believed to be grim in this population. The purpose of this study was to illustrate the epidemiologic characteristics and outcomes of patients with underlying severe COPD requiring mechanical ventilation. A retrospective study of patients admitted to a quaternary referral medical intensive care unit (ICU) between January 2008 and December 2012 with a diagnosis of severe COPD and requiring invasive mechanical ventilation for acute respiratory failure. We evaluated 670 patients with an established diagnosis of severe COPD requiring mechanical ventilation for acute respiratory failure of whom 47% were male with a mean age of 63.7 ± 12.4 years and Acute physiology and chronic health evaluation (APACHE) III score of 76.3 ± 27.2. Only seventy-nine (12%) were admitted with a COPD exacerbation, 27(4%) had acute respiratory distress syndrome (ARDS), 78 (12%) had pneumonia, 78 (12%) had sepsis, and 312 (47%) had other causes of respiratory failure, including pulmonary embolism, pneumothorax, etc. Eighteen percent of the patients received a trial of noninvasive positive pressure ventilation. The median duration of mechanical ventilation was 3 days (interquartile range IQR 2–7); the median duration for ICU length of stay (LOS) was 5 (IQR 2–9) days and the median duration of hospital LOS was 12 (IQR 7–22) days. The overall ICU mortality was 25%. Patients with COPD exacerbation had a shorter median duration of mechanical ventilation (2 vs 4 days; P = .04), ICU (3 vs 5 days; P = .01), and hospital stay (10 vs 13 days; P = .01). The ICU mortality (9% vs 27%; P < .001), and the hospital mortality (17% vs 32%; P = .004) for mechanically ventilated patients with an acute exacerbation of severe COPD were lower than those with other etiologies of acute respiratory failure. A 1-unit increase in the APACHE III score was associated with a 1% decrease and having an active cancer was associated with a 45% decrease in ICU survival (P < .001). A discharge home at the time of index admission was associated an increased overall survival compared with any other discharge location (P < .001). We report good early outcomes, but significant long-term morbidity in patients with severe COPD requiring invasive mechanical ventilation for acute respiratory failure. A higher APACHE score and presence of active malignancy are associated with a decrease in ICU survival, whereas a discharge home is associated with an increase in the overall survival. PMID:29703009

Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD).

PubMed

Gadre, Shruti K; Duggal, Abhijit; Mireles-Cabodevila, Eduardo; Krishnan, Sudhir; Wang, Xiao-Feng; Zell, Katrina; Guzman, Jorge

2018-04-01

There are limited data on the epidemiology of acute respiratory failure necessitating mechanical ventilation in patients with severe chronic obstructive pulmonary disease (COPD). The prognosis of acute respiratory failure requiring invasive mechanical ventilation is believed to be grim in this population. The purpose of this study was to illustrate the epidemiologic characteristics and outcomes of patients with underlying severe COPD requiring mechanical ventilation.A retrospective study of patients admitted to a quaternary referral medical intensive care unit (ICU) between January 2008 and December 2012 with a diagnosis of severe COPD and requiring invasive mechanical ventilation for acute respiratory failure.We evaluated 670 patients with an established diagnosis of severe COPD requiring mechanical ventilation for acute respiratory failure of whom 47% were male with a mean age of 63.7 ± 12.4 years and Acute physiology and chronic health evaluation (APACHE) III score of 76.3 ± 27.2. Only seventy-nine (12%) were admitted with a COPD exacerbation, 27(4%) had acute respiratory distress syndrome (ARDS), 78 (12%) had pneumonia, 78 (12%) had sepsis, and 312 (47%) had other causes of respiratory failure, including pulmonary embolism, pneumothorax, etc. Eighteen percent of the patients received a trial of noninvasive positive pressure ventilation. The median duration of mechanical ventilation was 3 days (interquartile range IQR 2-7); the median duration for ICU length of stay (LOS) was 5 (IQR 2-9) days and the median duration of hospital LOS was 12 (IQR 7-22) days. The overall ICU mortality was 25%. Patients with COPD exacerbation had a shorter median duration of mechanical ventilation (2 vs 4 days; P = .04), ICU (3 vs 5 days; P = .01), and hospital stay (10 vs 13 days; P = .01). The ICU mortality (9% vs 27%; P < .001), and the hospital mortality (17% vs 32%; P = .004) for mechanically ventilated patients with an acute exacerbation of severe COPD were lower than those with other etiologies of acute respiratory failure. A 1-unit increase in the APACHE III score was associated with a 1% decrease and having an active cancer was associated with a 45% decrease in ICU survival (P < .001). A discharge home at the time of index admission was associated an increased overall survival compared with any other discharge location (P < .001).We report good early outcomes, but significant long-term morbidity in patients with severe COPD requiring invasive mechanical ventilation for acute respiratory failure. A higher APACHE score and presence of active malignancy are associated with a decrease in ICU survival, whereas a discharge home is associated with an increase in the overall survival.

Computational fluid dynamics (CFD) investigation of impacts of an obstruction on airflow in underground mines.

PubMed

Zhou, L; Goodman, G; Martikainen, A

2013-01-01

Continuous airflow monitoring can improve the safety of the underground work force by ensuring the uninterrupted and controlled distribution of mine ventilation to all working areas. Air velocity measurements vary significantly and can change rapidly depending on the exact measurement location and, in particular, due to the presence of obstructions in the air stream. Air velocity must be measured at locations away from obstructions to avoid the vortices and eddies that can produce inaccurate readings. Further, an uninterrupted measurement path cannot always be guaranteed when using continuous airflow monitors due to the presence of nearby equipment, personnel, roof falls and rib rolls. Effective use of these devices requires selection of a minimum distance from an obstacle, such that an air velocity measurement can be made but not affected by the presence of that obstacle. This paper investigates the impacts of an obstruction on the behavior of downstream airflow using a numerical CFD model calibrated with experimental test results from underground testing. Factors including entry size, obstruction size and the inlet or incident velocity are examined for their effects on the distributions of airflow around an obstruction. A relationship is developed between the minimum measurement distance and the hydraulic diameters of the entry and the obstruction. A final analysis considers the impacts of continuous monitor location on the accuracy of velocity measurements and on the application of minimum measurement distance guidelines.

Computational fluid dynamics (CFD) investigation of impacts of an obstruction on airflow in underground mines

PubMed Central

Zhou, L.; Goodman, G.; Martikainen, A.

2015-01-01

Continuous airflow monitoring can improve the safety of the underground work force by ensuring the uninterrupted and controlled distribution of mine ventilation to all working areas. Air velocity measurements vary significantly and can change rapidly depending on the exact measurement location and, in particular, due to the presence of obstructions in the air stream. Air velocity must be measured at locations away from obstructions to avoid the vortices and eddies that can produce inaccurate readings. Further, an uninterrupted measurement path cannot always be guaranteed when using continuous airflow monitors due to the presence of nearby equipment, personnel, roof falls and rib rolls. Effective use of these devices requires selection of a minimum distance from an obstacle, such that an air velocity measurement can be made but not affected by the presence of that obstacle. This paper investigates the impacts of an obstruction on the behavior of downstream airflow using a numerical CFD model calibrated with experimental test results from underground testing. Factors including entry size, obstruction size and the inlet or incident velocity are examined for their effects on the distributions of airflow around an obstruction. A relationship is developed between the minimum measurement distance and the hydraulic diameters of the entry and the obstruction. A final analysis considers the impacts of continuous monitor location on the accuracy of velocity measurements and on the application of minimum measurement distance guidelines. PMID:26388684

75 FR 52701 - Approval and Promulgation of Implementation Plans; State of Missouri

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

... information claimed to be Confidential Business Information (CBI) or other information whose disclosure is.... Ventilation Limits 5. Ongoing Ventilation Testing and Reporting Requirements 6. Winter Construction Work..., including building enclosure and ventilation projects, implementation of work practice standards, process...

International Space Station Crew Quarters Ventilation and Acoustic Design Implementation

NASA Technical Reports Server (NTRS)

Broyan, James L., Jr.; Cady, Scott M; Welsh, David A.

2010-01-01

The International Space Station (ISS) United States Operational Segment has four permanent rack sized ISS Crew Quarters (CQs) providing a private crew member space. The CQs use Node 2 cabin air for ventilation/thermal cooling, as opposed to conditioned ducted air-from the ISS Common Cabin Air Assembly (CCAA) or the ISS fluid cooling loop. Consequently, CQ can only increase the air flow rate to reduce the temperature delta between the cabin and the CQ interior. However, increasing airflow causes increased acoustic noise so efficient airflow distribution is an important design parameter. The CQ utilized a two fan push-pull configuration to ensure fresh air at the crew member's head position and reduce acoustic exposure. The CQ ventilation ducts are conduits to the louder Node 2 cabin aisle way which required significant acoustic mitigation controls. The CQ interior needs to be below noise criteria curve 40 (NC-40). The design implementation of the CQ ventilation system and acoustic mitigation are very inter-related and require consideration of crew comfort balanced with use of interior habitable volume, accommodation of fan failures, and possible crew uses that impact ventilation and acoustic performance. Each CQ required 13% of its total volume and approximately 6% of its total mass to reduce acoustic noise. This paper illustrates the types of model analysis, assumptions, vehicle interactions, and trade-offs required for CQ ventilation and acoustics. Additionally, on-orbit ventilation system performance and initial crew feedback is presented. This approach is applicable to any private enclosed space that the crew will occupy.

Contributing Factors for Morbidity and Mortality in Patients with Organophosphate Poisoning on Mechanical Ventilation: A Retrospective Study in a Teaching Hospital

PubMed Central

Patil, Gurulingappa; Nikhil, M.

2016-01-01

Introduction One of the most common causes of poisoning in agricultural based developing countries like India is due to Organophosphorus (OP) compound. Its widespread use and easy availability has increased the likelihood of poisoning with these compounds. Aim To study the morbidity and mortality in patients with acute OP poisoning requiring mechanical ventilation. Materials and Methods This was a retrospective study constituting patients of all age groups admitted to the Intensive Care Unit (ICU) with diagnosis of OP poisoning between January 2015 to December 2015. Of 66 OP poisoning cases those patients who went against medical advice, 20 were excluded from the study and thus 46 patients were included. Diagnosis was performed from the history taken either from the patient or from the patient’s relatives and presenting symptoms. Demographic data, month of the year, age of patient, mode of poisoning, cholinesterase levels, duration of mechanical ventilation and mortality were recorded. Data are presented as mean±SD. Results A 97.83% (45/46) of cases were suicidal. Out of 46, 9 were intubated and mechanically ventilated. Duration of mechanical ventilation varied from less than 48 hours to more than 7 days. Mortality rate was 50%, 0% and 100% in those who required mechanical ventilation for more than 7 days, 2 to 7 days and <2days respectively. None of the predictors like age, severity of poisoning, cholinesterase levels and duration of ventilation were independent predictors of death and all of them contributed to the mortality. Overall mortality rate in those who required mechanical ventilation was 22.22%. Conclusion Morbidity and mortality due to OP poisoning is directly proportional to the age, severity of poisoning and duration of mechanical ventilation and inversely proportional to serum cholinesterase level. PMID:28208980

International Space Station USOS Crew Quarters Ventilation and Acoustic Design Implementation

NASA Technical Reports Server (NTRS)

Broyan, James Lee, Jr.

2009-01-01

The International Space Station (ISS) United States Operational Segment (USOS) has four permanent rack sized ISS Crew Quarters (CQ) providing a private crewmember space. The CQ uses Node 2 cabin air for ventilation/thermal cooling, as opposed to conditioned ducted air from the ISS Temperature Humidity Control System or the ISS fluid cooling loop connections. Consequently, CQ can only increase the air flow rate to reduce the temperature delta between the cabin and the CQ interior. However, increasing airflow causes increased acoustic noise so efficient airflow distribution is an important design parameter. The CQ utilized a two fan push-pull configuration to ensure fresh air at the crewmember s head position and reduce acoustic exposure. The CQ interior needs to be below Noise Curve 40 (NC-40). The CQ ventilation ducts are open to the significantly louder Node 2 cabin aisle way which required significantly acoustic mitigation controls. The design implementation of the CQ ventilation system and acoustic mitigation are very inter-related and require consideration of crew comfort balanced with use of interior habitable volume, accommodation of fan failures, and possible crew uses that impact ventilation and acoustic performance. This paper illustrates the types of model analysis, assumptions, vehicle interactions, and trade-offs required for CQ ventilation and acoustics. Additionally, on-orbit ventilation system performance and initial crew feedback is presented. This approach is applicable to any private enclosed space that the crew will occupy.

Design and calibration of a high-frequency oscillatory ventilator.

PubMed

Simon, B A; Mitzner, W

1991-02-01

High-frequency ventilation (HFV) is a modality of mechanical ventilation which presents difficult technical demands to the clinical or laboratory investigator. The essential features of an ideal HFV system are described, including wide frequency range, control of tidal volume and mean airway pressure, minimal dead space, and high effective internal impedance. The design and performance of a high-frequency oscillatory ventilation system is described which approaches these requirements. The ventilator utilizes a linear motor regulated by a closed loop controller and driving a novel frictionless double-diaphragm piston pump. Finally, the ventilator performance is tested using the impedance model of Venegas [1].

Daily nursing care on patients undergoing venous-venous extracorporeal membrane oxygenation: a challenging procedure!

PubMed

Redaelli, Sara; Zanella, Alberto; Milan, Manuela; Isgrò, Stefano; Lucchini, Alberto; Pesenti, Antonio; Patroniti, Nicolò

2016-12-01

Daily nursing in critical care patients may alter vital parameters, especially in the most critically ill patients. The aim of our study was to evaluate feasibility and safety of daily nursing on patients undergoing venous-venous extracorporeal membrane oxygenation (vv-ECMO) for severe respiratory failure. Daily nursing was performed following defined phases (sponge bath, elevation with scooping stretcher, change position of endotracheal tube, dressing replacement). We recorded physiological and ECMO parameters before and during daily nursing in 5 patients for several days (total: 25 daily nursing) and adverse events: desaturation, hypertension, reduction of mixed venous oxygen saturation, arterial oxygen saturation or ECMO blood flow and elevation in minute ventilation. Sedative drug dosage and additional bolus were recorded. Daily nursing was performed in 92 % of cases (23/25), with a minimum of two adverse events per daily nursing. Hypertension and tachycardia were mostly recorded at the beginning, while desaturation, reduction in mixed venous oxygen saturation and blood flow were recorded during elevation with scooping stretcher. Increase in minute ventilation was frequent in spontaneous breathing patients. Additional bolus of sedation was required before and/or during nursing. Daily nursing significantly alters physiologic parameters; thus, it should be performed only when physicians are readily available to treat adverse events.

Conservative fluid management prevents age-associated ventilator induced mortality.

PubMed

Herbert, Joseph A; Valentine, Michael S; Saravanan, Nivi; Schneck, Matthew B; Pidaparti, Ramana; Fowler, Alpha A; Reynolds, Angela M; Heise, Rebecca L

2016-08-01

Approximately 800 thousand patients require mechanical ventilation in the United States annually with an in-hospital mortality rate of over 30%. The majority of patients requiring mechanical ventilation are over the age of 65 and advanced age is known to increase the severity of ventilator-induced lung injury (VILI) and in-hospital mortality rates. However, the mechanisms which predispose aging ventilator patients to increased mortality rates are not fully understood. Ventilation with conservative fluid management decreases mortality rates in acute respiratory distress patients, but to date there has been no investigation of the effect of conservative fluid management on VILI and ventilator associated mortality rates. We hypothesized that age-associated increases in susceptibility and incidence of pulmonary edema strongly promote age-related increases in ventilator associated mortality. 2month old and 20month old male C57BL6 mice were mechanically ventilated with either high tidal volume (HVT) or low tidal volume (LVT) for up to 4h with either liberal or conservative fluid support. During ventilation, lung compliance, total lung capacity, and hysteresis curves were quantified. Following ventilation, bronchoalveolar lavage fluid was analyzed for total protein content and inflammatory cell infiltration. Wet to dry ratios were used to directly measure edema in excised lungs. Lung histology was performed to quantify alveolar barrier damage/destruction. Age matched non-ventilated mice were used as controls. At 4h, both advanced age and HVT ventilation significantly increased markers of inflammation and injury, degraded pulmonary mechanics, and decreased survival rates. Conservative fluid support significantly diminished pulmonary edema and improved pulmonary mechanics by 1h in advanced age HVT subjects. In 4h ventilations, conservative fluid support significantly diminished pulmonary edema, improved lung mechanics, and resulted in significantly lower mortality rates in older subjects. Our study demonstrates that conservative fluid alone can attenuate the age associated increase in ventilator associated mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Conservative Fluid Management Prevents Age-Associated Ventilator Induced Mortality

PubMed Central

Herbert, Joseph A.; Valentine, Michael S.; Saravanan, Nivi; Schneck, Matthew B.; Pidaparti, Ramana; Fowler, Alpha A.; Reynolds, Angela M.; Heise, Rebecca L.

2017-01-01

Background Approximately 800 thousand patients require mechanical ventilation in the United States annually with an in-hospital mortality rate of over 30%. The majority of patients requiring mechanical ventilation are over the age of 65 and advanced age is known to increase the severity of ventilator-induced lung injury (VILI) and in-hosptial mortality rates. However, the mechanisms which predispose aging ventilator patients to increased mortality rates are not fully understood. Ventilation with conservative fluid management decreases mortality rates in acute respiratory distress patients, but to date there has been no investigation of the effect of conservative fluid management on VILI and ventilator associated mortality rates. We hypothesized that age-associated increases in susceptibility and incidence of pulmonary edema strongly promote age-related increases in ventilator associated mortality. Methods 2 month old and 20 month old male C57BL6 mice were mechanically ventilated with either high tidal volume (HVT) or low tidal volume (LVT) for up to 4 hours with either liberal or conservative fluid support. During ventilation, lung compliance, total lung capacity, and hysteresis curves were quantified. Following ventilation, bronchoalveolar lavage fluid was analyzed for total protein content and inflammatory cell infiltration. Wet to dry ratios were used to directly measure edema in excised lungs. Lung histology was performed to quantify alveolar barrier damage/destruction. Age matched non-ventilated mice were used as controls. Results At 4hrs, both advanced age and HVT ventilation significantly increased markers of inflammation and injury, degraded pulmonary mechanics, and decreased survival rates. Conservative fluid support significantly diminished pulmonary edema and improved pulmonary mechanics by 1hr in advanced age HVT subjects. In 4hr ventilations, conservative fluid support significantly diminished pulmonary edema, improved lung mechanics, and resulted in significantly lower mortality rates in older subjects. Conclusion Our study demonstrates that conservative fluid alone can attenuate the age associated increase in ventilator associated mortality. PMID:27188767

Ventilation, temperature, and HVAC characteristics in small and medium commercial buildings in California.

PubMed

Bennett, D H; Fisk, W; Apte, M G; Wu, X; Trout, A; Faulkner, D; Sullivan, D

2012-08-01

This field study of 37 small and medium commercial buildings throughout California obtained information on ventilation rate, temperature, and heating, ventilating, and air-conditioning (HVAC) system characteristics. The study included seven retail establishments; five restaurants; eight offices; two each of gas stations, hair salons, healthcare facilities, grocery stores, dental offices, and fitness centers; and five other buildings. Fourteen (38%) of the buildings either could not or did not provide outdoor air through the HVAC system. The air exchange rate averaged 1.6 (s.d. = 1.7) exchanges per hour and was similar between buildings with and without outdoor air supplied through the HVAC system, indicating that some buildings have significant leakage or ventilation through open windows and doors. Not all buildings had sufficient air exchange to meet ASHRAE 62.1 Standards, including buildings used for fitness centers, hair salons, offices, and retail establishments. The majority of the time, buildings were within the ASHRAE temperature comfort range. Offices were frequently overcooled in the summer. All of the buildings had filters, but over half the buildings had a filter with a minimum efficiency reporting value rating of 4 or lower, which are not very effective for removing fine particles. Most U.S. commercial buildings (96%) are small- to medium-sized, using nearly 18% of the country's energy, and sheltering a large population daily. Little is known about the ventilation systems in these buildings. This study found a wide variety of ventilation conditions, with many buildings failing to meet relevant ventilation standards. Regulators may want to consider implementing more complete building inspections at commissioning and point of sale. © 2012 John Wiley & Sons A/S.

Anaesthesia ventilators.

PubMed

Jain, Rajnish K; Swaminathan, Srinivasan

2013-09-01

Anaesthesia ventilators are an integral part of all modern anaesthesia workstations. Automatic ventilators in the operating rooms, which were very simple with few modes of ventilation when introduced, have become very sophisticated with many advanced ventilation modes. Several systems of classification of anaesthesia ventilators exist based upon various parameters. Modern anaesthesia ventilators have either a double circuit, bellow design or a single circuit piston configuration. In the bellows ventilators, ascending bellows design is safer than descending bellows. Piston ventilators have the advantage of delivering accurate tidal volume. They work with electricity as their driving force and do not require a driving gas. To enable improved patient safety, several modifications were done in circle system with the different types of anaesthesia ventilators. Fresh gas decoupling is a modification done in piston ventilators and in descending bellows ventilator to reduce th incidence of ventilator induced volutrauma. In addition to the conventional volume control mode, modern anaesthesia ventilators also provide newer modes of ventilation such as synchronised intermittent mandatory ventilation, pressure-control ventilation and pressure-support ventilation (PSV). PSV mode is particularly useful for patients maintained on spontaneous respiration with laryngeal mask airway. Along with the innumerable benefits provided by these machines, there are various inherent hazards associated with the use of the ventilators in the operating room. To use these workstations safely, it is important for every Anaesthesiologist to have a basic understanding of the mechanics of these ventilators and breathing circuits.

46 CFR 185.352 - Ventilation of gasoline machinery spaces.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Ventilation of gasoline machinery spaces. 185.352... machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by... sufficient to insure at least one complete change of air in the space served. ...

46 CFR 185.352 - Ventilation of gasoline machinery spaces.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Ventilation of gasoline machinery spaces. 185.352... machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by... sufficient to insure at least one complete change of air in the space served. ...

Outcome of ventilated infants born at term without major congenital abnormalities.

PubMed

Ramadan, Ghada; Paul, Nicola; Morton, Margaret; Peacock, Janet L; Greenough, Anne

2012-02-01

The longer-term outcome of term-born infants without congenital anomalies requiring ventilation in the first 24 h after birth has rarely been reported. Our aims were to determine the mortality and long-term morbidity of such infants and identify risk factors for adverse outcome. The outcomes of 43 of 45 infants born at term consecutively requiring mechanical ventilation were reviewed. The infants had: meconium aspiration syndrome (n = 11), hypoxic ischaemic encephalopathy (HIE) (n = 11), respiratory depression (n = 12), sepsis (n = 5), persistent pulmonary hypertension of the newborn (n = 3) and middle cerebral artery infarction (n = 1). Eleven infants developed seizures (26%), 13 (30%) had abnormal electroencephalograms and 11 (26%) had abnormal MRI scans; 26% had an adverse outcome: six died, and five had severe neurodisability at 2 years. The infants with congenital toxoplasmosis and a middle cerebral artery infarction were excluded from the prediction analysis. In the remaining 41 patients, requirement for anticonvulsants (relative risk, RR = 4.44, 95% CI = 1.48 to 12.70; p = 0.014) and prolonged ventilation (longer than 3 days) (RR 4.83, 95% CI 1.51 to 15.64) predicted adverse outcome. Infants with HIE had an increased risk of adverse outcome (relative risk 5.45, 95% CI 1.01 to 33.85), but an adverse outcome occurred in infants with other diagnoses. Mortality and neurodisability at follow-up were common in infants born at term without major congenital anomalies who required mechanical ventilation in the first 24 h after birth, particularly in those who developed seizures requiring treatment and prolonged ventilation.

Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation

PubMed Central

Mahmood, Ismail; Tawfeek, Zainab; El-Menyar, Ayman; Zarour, Ahmad; Afifi, Ibrahim; Kumar, Suresh; Latifi, Rifat; Al-Thani, Hassan

2015-01-01

Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results. A total of 56 chest trauma patients with occult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years. Hemopneumothorax was managed conservatively in 72% cases and 28% underwent tube thoracostomy as indicated. 29% of patients developed pneumonia, 16% had Acute Respiratory Distress Syndrome (ARDS), and 7% died. Thickness of hemothorax, duration of mechanical ventilation, and development of ARDS were significantly associated with tube thoracostomy in comparison to no-chest tube group. Conclusions. The majority of occult hemopneumothorax can be carefully managed without tube thoracostomy in patients who required positive pressure ventilation. Tube thoracotomy could be restricted to those who had evidence of increase in the size of the hemothorax or pneumothorax on follow-up chest radiographs or developed respiratory compromise. PMID:25785199

46 CFR 119.465 - Ventilation of spaces containing diesel machinery.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Ventilation of spaces containing diesel machinery. 119... MACHINERY INSTALLATION Specific Machinery Requirements § 119.465 Ventilation of spaces containing diesel machinery. (a) A space containing diesel machinery must be fitted with adequate means, such as dripproof...

46 CFR 119.465 - Ventilation of spaces containing diesel machinery.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Ventilation of spaces containing diesel machinery. 119... MACHINERY INSTALLATION Specific Machinery Requirements § 119.465 Ventilation of spaces containing diesel machinery. (a) A space containing diesel machinery must be fitted with adequate means, such as dripproof...

24 CFR 3280.710 - Venting, ventilation and combustion air.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Venting, ventilation and combustion... Fuel Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting as required by... appliance listing and the appliance manufacturer's instructions. (b) Venting and combustion air systems...

24 CFR 3280.710 - Venting, ventilation and combustion air.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 5 2014-04-01 2014-04-01 false Venting, ventilation and combustion... Fuel Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting as required by... appliance listing and the appliance manufacturer's instructions. (b) Venting and combustion air systems...

24 CFR 3280.710 - Venting, ventilation and combustion air.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 5 2012-04-01 2012-04-01 false Venting, ventilation and combustion... Fuel Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting as required by... appliance listing and the appliance manufacturer's instructions. (b) Venting and combustion air systems...

24 CFR 3280.710 - Venting, ventilation and combustion air.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Venting, ventilation and combustion... Fuel Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting as required by... appliance listing and the appliance manufacturer's instructions. (b) Venting and combustion air systems...

24 CFR 3280.710 - Venting, ventilation and combustion air.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 5 2013-04-01 2013-04-01 false Venting, ventilation and combustion... Fuel Burning Systems § 3280.710 Venting, ventilation and combustion air. (a) The venting as required by... appliance listing and the appliance manufacturer's instructions. (b) Venting and combustion air systems...

Adaptive support ventilation: State of the art review

PubMed Central

Fernández, Jaime; Miguelena, Dayra; Mulett, Hernando; Godoy, Javier; Martinón-Torres, Federico

2013-01-01

Mechanical ventilation is one of the most commonly applied interventions in intensive care units. Despite its life-saving role, it can be a risky procedure for the patient if not applied appropriately. To decrease risks, new ventilator modes continue to be developed in an attempt to improve patient outcomes. Advances in ventilator modes include closed-loop systems that facilitate ventilator manipulation of variables based on measured respiratory parameters. Adaptive support ventilation (ASV) is a positive pressure mode of mechanical ventilation that is closed-loop controlled, and automatically adjust based on the patient's requirements. In order to deliver safe and appropriate patient care, clinicians need to achieve a thorough understanding of this mode, including its effects on underlying respiratory mechanics. This article will discuss ASV while emphasizing appropriate ventilator settings, their advantages and disadvantages, their particular effects on oxygenation and ventilation, and the monitoring priorities for clinicians. PMID:23833471

Ventilation.

PubMed

Turner, W A; Bearg, D W; Brennan, T

1995-01-01

This chapter begins with an overview of the history of ventilation guidelines, which has led to the guidelines that are in effect today. Of particular interest is the most recent return in the past 5 years to ventilation rates that more closely reflect a mean or average of the range of guidelines that have existed over the past century. OSHA's and the EPA's recognition of the need to operate ventilation systems in buildings in an accountable manner is also of note. Of even more interest is the resurgence of the concept of minimum mixing and once-through ventilation air that has been pursued in parts of Northern Europe for the past 10 years, and in a school that is being designed with this concept in New Hampshire. In addition, the design concept of equipping office buildings with low pressure drop high efficiency particle filtration to remove fine particles from all of the air that is supplied to the occupants is being used increasingly in the U.S. This chapter also presents an overview of the various types of ventilation systems found in homes and commercial office buildings and the common indoor air quality problems that may be associated with them. It also offers an overview of common HVAC evaluation techniques that can be used to determine if a ventilation system is performing in a manner that makes sense for the use of the space and the needs of the occupants. Are the occupants receiving a reasonable supply of outdoor air? Is the air that they receive of reasonable quality? Are obvious pollutants being exhausted? Ventilation systems have become extremely complex and more difficult to run and maintain over the past 40 years. This trend will continue to drive the need for professionally maintained HVAC equipment that is serviced and run by individuals who are accountable for the quality of the air that the system delivers.

Ventilation requirements in buildings—I. Control of occupancy odor and tobacco smoke odor

NASA Astrophysics Data System (ADS)

Cain, William S.; Leaderer, Brian P.; Isseroff, Ruth; Berglund, Larry G.; Huey, Raymond J.; Lipsitt, Eric D.; Perlman, Dan

Psychophysical measurements of odor, supplemented with certain physical measurements, were taken to examine ventilation requirements during smoking and nonsmoking occupancy in an environmental chamber. The facility provided the means to compare impressions of visitors (persons who inhaled air from the chamber only briefly) with impressions of occupants. For nonsmoking occupancy, 47 combinations of temperature, humidity, ventilation rate and occupancy density were examined. Odor level depended entirely on ventilation rate per person irrespective of the number of persons in the chamber. The ventilation necessary to satisfy 75 % of visitors equalled only about 4 ℓ s -1 per person. Occupants, however, were satisfied with far less. In an array of 38 conditions of smoking occupancy, the ventilation deemed necessary to satisfy 75 % of visitors under customary conditions of occupancy equalled 17.5 ℓ s -1 per person. For both smoking and nonsmoking conditions, a combination of high temperature (25.5°C) and humidity (r.h. > 70 %) exacerbated the odor problem. During smoking, carbon monoxide rarely reached dangerous levels, but suspended particulate matter often reached levels considered unacceptable outdoors. The results highlight the energy penalty incurred in ventilation for smoking occupancy.

Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome.

PubMed

Akkanti, Bindu; Rajagopal, Keshava; Patel, Kirti P; Aravind, Sangeeta; Nunez-Centanu, Emmanuel; Hussain, Rahat; Shabari, Farshad Raissi; Hofstetter, Wayne L; Vaporciyan, Ara A; Banjac, Igor S; Kar, Biswajit; Gregoric, Igor D; Loyalka, Pranav

2017-06-01

Extracorporeal carbon dioxide removal (ECCO 2 R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels. ECCO 2 R using a miniaturized system was instituted and provided effective carbon dioxide elimination. This facilitated establishment of lung-protective ventilator settings and lung function recovery. Extracorporeal lung support increasingly is being applied to treat ARDS. However, conventional extracorporeal membrane oxygenation (ECMO) generally involves using large cannulae capable of carrying high flow rates. A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. In the absence of profound hypoxemia, ECCO 2 R may be used to reduce ventilator support requirements to lung-protective levels, while avoiding risks associated with conventional ECMO.

Effects of alfaxalone administered intravenously to healthy yearling loggerhead sea turtles (Caretta caretta) at three different doses.

PubMed

Phillips, Brianne E; Posner, Lysa P; Lewbart, Gregory A; Christiansen, Emily F; Harms, Craig A

2017-04-15

OBJECTIVE To compare physiologic and anesthetic effects of alfaxalone administered IV to yearling loggerhead sea turtles (Caretta caretta) at 3 different doses. DESIGN Randomized crossover study. ANIMALS 9 healthy yearling loggerhead sea turtles. PROCEDURES Animals received each of 3 doses of alfaxalone (3 mg/kg [1.4 mg/lb], 5 mg/kg [2.3 mg/lb], or 10 mg/kg [4.5 mg/lb]) administered IV in randomly assigned order, with a minimum 7-day washout period between doses. Endotracheal intubation was attempted following anesthetic induction, and heart rate, sedation depth, cloacal temperature, and respirations were monitored. Times to first effect, induction, first voluntary muscle movement, first respiration, and recovery were recorded. Venous blood gas analysis was performed at 0 and 30 minutes. Assisted ventilation was performed if apnea persisted 30 minutes following induction. RESULTS Median anesthetic induction time for all 3 doses was 2 minutes. Endotracheal intubation was accomplished in all turtles following induction. Heart rate significantly increased after the 3- and 5-mg/kg doses were administered. Median intervals from alfaxalone administration to first spontaneous respiration were 16, 22, and 54 minutes for the 3-, 5-, and 10-mg/kg doses, respectively, and median intervals to recovery were 28, 46, and 90 minutes, respectively. Assisted ventilation was required for 1 turtle after receiving the 5-mg/kg dose and for 5 turtles after receiving the 10-mg/kg dose. The 10-mg/kg dose resulted in respiratory acidosis and marked hypoxemia at 30 minutes. CONCLUSIONS AND CLINICAL RELEVANCE IV alfaxalone administration to loggerhead sea turtles resulted in a rapid anesthetic induction and dose-dependent duration of sedation. Assisted ventilation is recommended if the 10 mg/kg dose is administered.

Is the scaling of swim speed in sharks driven by metabolism?

PubMed Central

Jacoby, David M. P.; Siriwat, Penthai; Freeman, Robin; Carbone, Chris

2015-01-01

The movement rates of sharks are intrinsically linked to foraging ecology, predator–prey dynamics and wider ecosystem functioning in marine systems. During ram ventilation, however, shark movement rates are linked not only to ecological parameters, but also to physiology, as minimum speeds are required to provide sufficient water flow across the gills to maintain metabolism. We develop a geometric model predicting a positive scaling relationship between swim speeds in relation to body size and ultimately shark metabolism, taking into account estimates for the scaling of gill dimensions. Empirical data from 64 studies (26 species) were compiled to test our model while controlling for the influence of phylogenetic similarity between related species. Our model predictions were found to closely resemble the observed relationships from tracked sharks, providing a means to infer mobility in particularly intractable species. PMID:26631246

Reduction of duration and cost of mechanical ventilation in an intensive care unit by use of a ventilatory management team.

PubMed

Cohen, I L; Bari, N; Strosberg, M A; Weinberg, P F; Wacksman, R M; Millstein, B H; Fein, I A

1991-10-01

To test the hypothesis that a formal interdisciplinary team approach to managing ICU patients requiring mechanical ventilation enhances ICU efficiency. Retrospective review with cost-effectiveness analysis. A 20-bed medical-surgical ICU in a 450-bed community referral teaching hospital with a critical care fellowship training program. All patients requiring mechanical ventilation in the ICU were included, comparing patients admitted 1 yr before the inception of the ventilatory management team (group 1) with those patients admitted for 1 yr after the inception of the team (group 2). Group 1 included 198 patients with 206 episodes of mechanical ventilation and group 2 included 165 patients with 183 episodes of mechanical ventilation. A team consisting of an ICU attending physician, nurse, and respiratory therapist was formed to conduct rounds regularly and supervise the ventilatory management of ICU patients who were referred to the critical care service. The two study groups were demographically comparable. However, there were significant reductions in resource use in group 2. The number of days on mechanical ventilation decreased (3.9 days per episode of mechanical ventilation [95% confidence interval 0.3 to 7.5 days]), as did days in the ICU (3.3 days per episode of mechanical ventilation [90% confidence interval 0.3 to 6.3 days]), numbers of arterial blood gases (23.2 per episode of mechanical ventilation; p less than .001), and number of indwelling arterial catheters (1 per episode of mechanical ventilation; p less than .001). The estimated cost savings from these reductions was $1,303 per episode of mechanical ventilation. We conclude that a ventilatory management team, or some component thereof, can significantly and safely expedite the process of "weaning" patients from mechanical ventilatory support in the ICU.

Mechanical ventilation during extracorporeal membrane oxygenation.

PubMed

Schmidt, Matthieu; Pellegrino, Vincent; Combes, Alain; Scheinkestel, Carlos; Cooper, D Jamie; Hodgson, Carol

2014-01-21

The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported respiratory failure patients may not be optimal for more severe forms of respiratory failure requiring ECMO support. The influence of positive end-expiratory pressure on the reduction of the left ventricular compliance may be a matter of concern for patients receiving ECMO support for cardiac failure. The objectives of this review were to describe potential mechanisms for lung injury during ECMO for respiratory or cardiac failure, to assess the possible benefits from the use of ultra-protective lung ventilation strategies and to review published guidelines and expert opinions available on mechanical ventilation-specific management of patients requiring ECMO, including mode and ventilator settings. Articles were identified through a detailed search of PubMed, Ovid, Cochrane databases and Google Scholar. Additional references were retrieved from the selected studies. Growing evidence suggests that mechanical ventilation settings are important in ECMO patients to minimize further lung damage and improve outcomes. An ultra-protective ventilation strategy may be optimal for mechanical ventilation during ECMO for respiratory failure. The effects of airway pressure on right and left ventricular afterload should be considered during venoarterial ECMO support of cardiac failure. Future studies are needed to better understand the potential impact of invasive mechanical ventilation modes and settings on outcomes.

Mechanical ventilation during extracorporeal membrane oxygenation

PubMed Central

2014-01-01

The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported respiratory failure patients may not be optimal for more severe forms of respiratory failure requiring ECMO support. The influence of positive end-expiratory pressure on the reduction of the left ventricular compliance may be a matter of concern for patients receiving ECMO support for cardiac failure. The objectives of this review were to describe potential mechanisms for lung injury during ECMO for respiratory or cardiac failure, to assess the possible benefits from the use of ultra-protective lung ventilation strategies and to review published guidelines and expert opinions available on mechanical ventilation-specific management of patients requiring ECMO, including mode and ventilator settings. Articles were identified through a detailed search of PubMed, Ovid, Cochrane databases and Google Scholar. Additional references were retrieved from the selected studies. Growing evidence suggests that mechanical ventilation settings are important in ECMO patients to minimize further lung damage and improve outcomes. An ultra-protective ventilation strategy may be optimal for mechanical ventilation during ECMO for respiratory failure. The effects of airway pressure on right and left ventricular afterload should be considered during venoarterial ECMO support of cardiac failure. Future studies are needed to better understand the potential impact of invasive mechanical ventilation modes and settings on outcomes. PMID:24447458

Closed-loop mechanical ventilation for lung injury: a novel physiological-feedback mode following the principles of the open lung concept.

PubMed

Schwaiberger, David; Pickerodt, Philipp A; Pomprapa, Anake; Tjarks, Onno; Kork, Felix; Boemke, Willehad; Francis, Roland C E; Leonhardt, Steffen; Lachmann, Burkhard

2018-06-01

Adherence to low tidal volume (V T ) ventilation and selected positive end-expiratory pressures are low during mechanical ventilation for treatment of the acute respiratory distress syndrome. Using a pig model of severe lung injury, we tested the feasibility and physiological responses to a novel fully closed-loop mechanical ventilation algorithm based on the "open lung" concept. Lung injury was induced by surfactant washout in pigs (n = 8). Animals were ventilated following the principles of the "open lung approach" (OLA) using a fully closed-loop physiological feedback algorithm for mechanical ventilation. Standard gas exchange, respiratory- and hemodynamic parameters were measured. Electrical impedance tomography was used to quantify regional ventilation distribution during mechanical ventilation. Automatized mechanical ventilation provided strict adherence to low V T -ventilation for 6 h in severely lung injured pigs. Using the "open lung" approach, tidal volume delivery required low lung distending pressures, increased recruitment and ventilation of dorsal lung regions and improved arterial blood oxygenation. Physiological feedback closed-loop mechanical ventilation according to the principles of the open lung concept is feasible and provides low tidal volume ventilation without human intervention. Of importance, the "open lung approach"-ventilation improved gas exchange and reduced lung driving pressures by opening atelectasis and shifting of ventilation to dorsal lung regions.

40 CFR 170.110 - Restrictions associated with pesticide applications.

Code of Federal Regulations, 2014 CFR

2014-07-01

... respiratory protection device is required for application by the product labeling. (3) Applied otherwise... fans or other mechanical ventilating systems; or (iii) Four hours of ventilation using vents, windows...) Aerosol (3) Not in 1 or 2 above, and for which a respiratory protection device is required for application...

40 CFR 170.110 - Restrictions associated with pesticide applications.

Code of Federal Regulations, 2011 CFR

2011-07-01

... respiratory protection device is required for application by the product labeling. (3) Applied otherwise... fans or other mechanical ventilating systems; or (iii) Four hours of ventilation using vents, windows...) Aerosol (3) Not in 1 or 2 above, and for which a respiratory protection device is required for application...

40 CFR 170.110 - Restrictions associated with pesticide applications.

Code of Federal Regulations, 2012 CFR

2012-07-01

... respiratory protection device is required for application by the product labeling. (3) Applied otherwise... fans or other mechanical ventilating systems; or (iii) Four hours of ventilation using vents, windows...) Aerosol (3) Not in 1 or 2 above, and for which a respiratory protection device is required for application...

40 CFR 170.110 - Restrictions associated with pesticide applications.

Code of Federal Regulations, 2013 CFR

2013-07-01

... respiratory protection device is required for application by the product labeling. (3) Applied otherwise... fans or other mechanical ventilating systems; or (iii) Four hours of ventilation using vents, windows...) Aerosol (3) Not in 1 or 2 above, and for which a respiratory protection device is required for application...

ENERGY STAR Certified Ventilating Fans

EPA Pesticide Factsheets

Certified models meet all ENERGY STAR requirements as listed in the Version 4.0 ENERGY STAR Program Requirements for Ventilating Fans that are effective as of October 1, 2015. A detailed listing of key efficiency criteria are available at http://www.energystar.gov/index.cfm?c=vent_fans.pr_crit_vent_fans

77 FR 16869 - Proposed Models for Plant-Specific Adoption of Technical Specifications Task Force Traveler TSTF...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-22

... Ventilation System Surveillance Requirements to Operate for 10 hours per Month.'' DATES: Comment period....1, which currently require operating the heaters in the respective systems for at least 10... Adoption of Technical Specifications Task Force Traveler TSTF-522, Revision 0, ``Revise Ventilation System...

Ventilation requirements for control of occupancy odor and tobacco smoke odor: laboratory studies. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cain, W.S.; Isseroff, R.; Leaderer, B.P.

1981-04-01

Experiments on occupancy odor addressed the question of why required ventilation rate per occupant increased progressively with increases in the number of persons in a space. In order to investigate ventilation requirements under approximately ideal conditions, we constructed an aluminum-lined environmental chamber with excellent control over environmental conditions and a ventilation system that provided rapid and uniform mixing of air. Psychophysical experiments on occupancy odor explored 47 different combinations of occupancy density, temperature and humidity, and ventilation rate. The experiments collected judgements both from visitors, who smelled air from the chamber only once every few minutes, and from occupants, whomore » remained in the chamber for an hour at a time. The judgements of visitors revealed that occupancy odor increased only gradually over time and rarely reached very high or objectionable levels. Judgements of occupants also revealed rather minor dissatisfaction. Only during combinations of high temperature and humidity did objectionability become more than a minor issue to either group. Experiments on cigarette smoking explored rates of 4, 8, and 16 cigarettes per hour under various environmental conditions and with ventilation rates as high as 68 cfm (34 L.s/sup -1/) per occupant. As soon as occupants lit cigarettes in the chamber, the odor level increased dramatically. At ventilation rates far greater than necessary to control occupancy odor, the odor from cigarette smoking remained quite intense. In general, the odor proved impossible to control adequately even with a ventilation rate of 68 cfm (34 L.s/sup -1/) per occupant (4 occupants) and even when only one occupant smoked at a time. As in the case of occupancy odor, a combination of high temperature and humidity exacerbated the odor problem.« less

Differential lung ventilation via tracheostomy using two endotracheal tubes in an infant: a case report.

PubMed

Demirkol, Demet; Ataman, Yasemin; Gündoğdu, Gökhan

2017-09-08

This case report presents differential lung ventilation in an infant. The aim is to define an alternative technique for performing differential lung ventilation in children. To the best of our knowledge, this is the first report of this kind. A 4.2-kg, 2.5-month-old Asian boy was referred to our facility with refractory hypoxemia and hypercarbia due to asymmetric lung disease with atelectasis of the left lung and hyperinflation of the right lung. He was unresponsive to conventional ventilator strategies; different ventilator settings were required. To perform differential lung ventilation, two separate single-lumen endotracheal tubes were inserted into the main bronchus of each lung by tracheotomy; the tracheal tubes were attached to discrete ventilators. The left lung was ventilated with a lung salvage strategy using high-frequency oscillatory ventilation, and the right lung was ventilated with a lung-protective strategy using pressure-regulated volume control mode. Differential lung ventilation was performed successfully with this technique without complications. Differential lung ventilation may be a lifesaving procedure in select patients who have asymmetric lung disease. Inserting two single-lumen endotracheal tubes via tracheotomy for differential lung ventilation can be an effective and safe alternative method.

Changes in Ocean Heat, Carbon Content, and Ventilation: A Review of the First Decade of GO-SHIP Global Repeat Hydrography.

PubMed

Talley, L D; Feely, R A; Sloyan, B M; Wanninkhof, R; Baringer, M O; Bullister, J L; Carlson, C A; Doney, S C; Fine, R A; Firing, E; Gruber, N; Hansell, D A; Ishii, M; Johnson, G C; Katsumata, K; Key, R M; Kramp, M; Langdon, C; Macdonald, A M; Mathis, J T; McDonagh, E L; Mecking, S; Millero, F J; Mordy, C W; Nakano, T; Sabine, C L; Smethie, W M; Swift, J H; Tanhua, T; Thurnherr, A M; Warner, M J; Zhang, J-Z

2016-01-01

Global ship-based programs, with highly accurate, full water column physical and biogeochemical observations repeated decadally since the 1970s, provide a crucial resource for documenting ocean change. The ocean, a central component of Earth's climate system, is taking up most of Earth's excess anthropogenic heat, with about 19% of this excess in the abyssal ocean beneath 2,000 m, dominated by Southern Ocean warming. The ocean also has taken up about 27% of anthropogenic carbon, resulting in acidification of the upper ocean. Increased stratification has resulted in a decline in oxygen and increase in nutrients in the Northern Hemisphere thermocline and an expansion of tropical oxygen minimum zones. Southern Hemisphere thermocline oxygen increased in the 2000s owing to stronger wind forcing and ventilation. The most recent decade of global hydrography has mapped dissolved organic carbon, a large, bioactive reservoir, for the first time and quantified its contribution to export production (∼20%) and deep-ocean oxygen utilization. Ship-based measurements also show that vertical diffusivity increases from a minimum in the thermocline to a maximum within the bottom 1,500 m, shifting our physical paradigm of the ocean's overturning circulation.

46 CFR 78.47-75 - Ventilation alarm failure.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 3 2013-10-01 2013-10-01 false Ventilation alarm failure. 78.47-75 Section 78.47-75... Fire and Emergency Equipment, Etc. § 78.47-75 Ventilation alarm failure. (a) The alarm required by § 72... FAILURE IN VEHICULAR SPACE.” (b) [Reserved] [CGFR 66-33, 31 FR 15284, Dec. 6, 1966] ...

46 CFR 78.47-75 - Ventilation alarm failure.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 3 2014-10-01 2014-10-01 false Ventilation alarm failure. 78.47-75 Section 78.47-75... Fire and Emergency Equipment, Etc. § 78.47-75 Ventilation alarm failure. (a) The alarm required by § 72... FAILURE IN VEHICULAR SPACE.” (b) [Reserved] [CGFR 66-33, 31 FR 15284, Dec. 6, 1966] ...

46 CFR 78.47-75 - Ventilation alarm failure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 3 2010-10-01 2010-10-01 false Ventilation alarm failure. 78.47-75 Section 78.47-75... Fire and Emergency Equipment, Etc. § 78.47-75 Ventilation alarm failure. (a) The alarm required by § 72... FAILURE IN VEHICULAR SPACE.” (b) [Reserved] [CGFR 66-33, 31 FR 15284, Dec. 6, 1966] ...

46 CFR 78.47-75 - Ventilation alarm failure.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 3 2012-10-01 2012-10-01 false Ventilation alarm failure. 78.47-75 Section 78.47-75... Fire and Emergency Equipment, Etc. § 78.47-75 Ventilation alarm failure. (a) The alarm required by § 72... FAILURE IN VEHICULAR SPACE.” (b) [Reserved] [CGFR 66-33, 31 FR 15284, Dec. 6, 1966] ...

46 CFR 78.47-75 - Ventilation alarm failure.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 3 2011-10-01 2011-10-01 false Ventilation alarm failure. 78.47-75 Section 78.47-75... Fire and Emergency Equipment, Etc. § 78.47-75 Ventilation alarm failure. (a) The alarm required by § 72... FAILURE IN VEHICULAR SPACE.” (b) [Reserved] [CGFR 66-33, 31 FR 15284, Dec. 6, 1966] ...

Minimum airflow reset of single-duct VAV terminal boxes

NASA Astrophysics Data System (ADS)

Cho, Young-Hum

Single duct Variable Air Volume (VAV) systems are currently the most widely used type of HVAC system in the United States. When installing such a system, it is critical to determine the minimum airflow set point of the terminal box, as an optimally selected set point will improve the level of thermal comfort and indoor air quality (IAQ) while at the same time lower overall energy costs. In principle, this minimum rate should be calculated according to the minimum ventilation requirement based on ASHRAE standard 62.1 and maximum heating load of the zone. Several factors must be carefully considered when calculating this minimum rate. Terminal boxes with conventional control sequences may result in occupant discomfort and energy waste. If the minimum rate of airflow is set too high, the AHUs will consume excess fan power, and the terminal boxes may cause significant simultaneous room heating and cooling. At the same time, a rate that is too low will result in poor air circulation and indoor air quality in the air-conditioned space. Currently, many scholars are investigating how to change the algorithm of the advanced VAV terminal box controller without retrofitting. Some of these controllers have been found to effectively improve thermal comfort, indoor air quality, and energy efficiency. However, minimum airflow set points have not yet been identified, nor has controller performance been verified in confirmed studies. In this study, control algorithms were developed that automatically identify and reset terminal box minimum airflow set points, thereby improving indoor air quality and thermal comfort levels, and reducing the overall rate of energy consumption. A theoretical analysis of the optimal minimum airflow and discharge air temperature was performed to identify the potential energy benefits of resetting the terminal box minimum airflow set points. Applicable control algorithms for calculating the ideal values for the minimum airflow reset were developed and applied to actual systems for performance validation. The results of the theoretical analysis, numeric simulations, and experiments show that the optimal control algorithms can automatically identify the minimum rate of heating airflow under actual working conditions. Improved control helps to stabilize room air temperatures. The vertical difference in the room air temperature was lower than the comfort value. Measurements of room CO2 levels indicate that when the minimum airflow set point was reduced it did not adversely affect the indoor air quality. According to the measured energy results, optimal control algorithms give a lower rate of reheating energy consumption than conventional controls.

Simulation of deep ventilation in Crater Lake, Oregon, 1951–2099

USGS Publications Warehouse

Wood, Tamara M.; Wherry, Susan A.; Piccolroaz, Sebastiano; Girdner, Scott F

2016-05-04

The frequency of deep ventilation events in Crater Lake, a caldera lake in the Oregon Cascade Mountains, was simulated in six future climate scenarios, using a 1-dimensional deep ventilation model (1DDV) that was developed to simulate the ventilation of deep water initiated by reverse stratification and subsequent thermobaric instability. The model was calibrated and validated with lake temperature data collected from 1994 to 2011. Wind and air temperature data from three general circulation models and two representative concentration pathways were used to simulate the change in lake temperature and the frequency of deep ventilation events in possible future climates. The lumped model air2water was used to project lake surface temperature, a required boundary condition for the lake model, based on air temperature in the future climates.The 1DDV model was used to simulate daily water temperature profiles through 2099. All future climate scenarios projected increased water temperature throughout the water column and a substantive reduction in the frequency of deep ventilation events. The least extreme scenario projected the frequency of deep ventilation events to decrease from about 1 in 2 years in current conditions to about 1 in 3 years by 2100. The most extreme scenario considered projected the frequency of deep ventilation events to be about 1 in 7.7 years by 2100. All scenarios predicted that the temperature of the entire water column will be greater than 4 °C for increasing lengths of time in the future and that the conditions required for thermobaric instability induced mixing will become rare or non-existent.The disruption of deep ventilation by itself does not provide a complete picture of the potential ecological and water quality consequences of warming climate to Crater Lake. Estimating the effect of warming climate on deep water oxygen depletion and water clarity will require careful modeling studies to combine the physical mixing processes affected by the atmosphere with the multitude of factors affecting the growth of algae and corresponding water clarity.

[Possibilities of bi-level positive pressure ventilation in chronic hypoventilation].

PubMed

Saaresranta, Tarja; Anttalainen, Ulla; Polo, Olli

2011-01-01

During the last decade, noninvasive bi-level positive pressure ventilation has enabled respiratory support in inpatient wards and at home. In many cases, a bi-level airway pressure ventilator can be used to avoid artificial airway and respirator therapy, and may shorten hospital stay and save costs. The treatment alleviates the patient's dyspnea and fatigue, whereby the quality of life improves, and in certain situations also the life span increases. The implementation of bi-level positive pressure ventilation by the physician requires knowledge of the basics of respiratory physiology and familiarization with the bi-level airway pressure ventilator.

Change Is In the Air: What You Need to Know About Pharmacy Ventilation Under United States Pharmacopeia <800>.

PubMed

Laniewicz, Cheryl

2017-01-01

On July 1, 2018, United States Pharmacopeia <800> takes effect in those states that adopt it, and the discussion within this article may be applicable to those states that develop their own standards. United States Pharmacopeia <800> changes requirements for storage and compounding of hazardous drugs. The new requirements have important implications for air management and ventilation in some pharmacies. This article discusses how United States Pharmacopeia <800> compares to United States Pharmacopeia <797>, how the changes impact room ventilation and pressurization requirements, and how high-performance airflow control systems that ensure compliance and safety are impacted. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

Weaning from mechanical ventilation: why are we still looking for alternative methods?

PubMed

Frutos-Vivar, F; Esteban, A

2013-12-01

Most patients who require mechanical ventilation for longer than 24 hours, and who improve the condition leading to the indication of ventilatory support, can be weaned after passing a first spontaneous breathing test. The challenge is to improve the weaning of patients who fail that first test. We have methods that can be referred to as traditional, such as the T-tube, pressure support or synchronized intermittent mandatory ventilation (SIMV). In recent years, however, new applications of usual techniques as noninvasive ventilation, new ventilation methods such as automatic tube compensation (ATC), mandatory minute ventilation (MMV), adaptive support ventilation or automatic weaning systems based on pressure support have been described. Their possible role in weaning from mechanical ventilation among patients with difficult or prolonged weaning remains to be established. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Prolonged weaning: from the intensive care unit to home.

PubMed

Navalesi, P; Frigerio, P; Patzlaff, A; Häußermann, S; Henseke, P; Kubitschek, M

2014-01-01

Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. There are several potential causes which can lead to prolonged weaning. It is nonetheless important to understand the problem from the point of view of each individual patient in order to adopt appropriate treatment and define precise prognosis. An otherwise stable patient who remains on mechanical ventilation will be considered for transfer to a specialized weaning unit (SWU). Though there is not a precise definition, SWU can be considered as highly specialized and protected environments for patients requiring mechanical ventilation despite resolution of the acute disorder. Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed. Copyright © 2014 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation

PubMed Central

Collaco, Joseph M.; Baker, Christopher D.; Carroll, John L.; Sharma, Girish D.; Brozek, Jan L.; Finder, Jonathan D.; Ackerman, Veda L.; Arens, Raanan; Boroughs, Deborah S.; Carter, Jodi; Daigle, Karen L.; Dougherty, Joan; Gozal, David; Kevill, Katharine; Kravitz, Richard M.; Kriseman, Tony; MacLusky, Ian; Rivera-Spoljaric, Katherine; Tori, Alvaro J.; Ferkol, Thomas; Halbower, Ann C.

2016-01-01

Background: Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. Purpose: To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. Methods: The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. Results: Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. Conclusions: Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child’s care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available. PMID:27082538

Education on invasive mechanical ventilation involving intensive care nurses: a systematic review.

PubMed

Guilhermino, Michelle C; Inder, Kerry J; Sundin, Deborah

2018-03-26

Intensive care unit nurses are critical for managing mechanical ventilation. Continuing education is essential in building and maintaining nurses' knowledge and skills, potentially improving patient outcomes. The aim of this study was to determine whether continuing education programmes on invasive mechanical ventilation involving intensive care unit nurses are effective in improving patient outcomes. Five electronic databases were searched from 2001 to 2016 using keywords such as mechanical ventilation, nursing and education. Inclusion criteria were invasive mechanical ventilation continuing education programmes that involved nurses and measured patient outcomes. Primary outcomes were intensive care unit mortality and in-hospital mortality. Secondary outcomes included hospital and intensive care unit length of stay, length of intubation, failed weaning trials, re-intubation incidence, ventilation-associated pneumonia rate and lung-protective ventilator strategies. Studies were excluded if they excluded nurses, patients were ventilated for less than 24 h, the education content focused on protocol implementation or oral care exclusively or the outcomes were participant satisfaction. Quality was assessed by two reviewers using an education intervention critical appraisal worksheet and a risk of bias assessment tool. Data were extracted independently by two reviewers and analysed narratively due to heterogeneity. Twelve studies met the inclusion criteria for full review: 11 pre- and post-intervention observational and 1 quasi-experimental design. Studies reported statistically significant reductions in hospital length of stay, length of intubation, ventilator-associated pneumonia rates, failed weaning trials and improvements in lung-protective ventilation compliance. Non-statistically significant results were reported for in-hospital and intensive care unit mortality, re-intubation and intensive care unit length of stay. Limited evidence of the effectiveness of continuing education programmes on mechanical ventilation involving nurses in improving patient outcomes exists. Comprehensive continuing education is required. Well-designed trials are required to confirm that comprehensive continuing education involving intensive care nurses about mechanical ventilation improves patient outcomes. © 2018 British Association of Critical Care Nurses.

Intraoperative mechanical ventilation for the pediatric patient.

PubMed

Kneyber, Martin C J

2015-09-01

Invasive mechanical ventilation is required when children undergo general anesthesia for any procedure. It is remarkable that one of the most practiced interventions such as pediatric mechanical ventilation is hardly supported by any scientific evidence but rather based on personal experience and data from adults, especially as ventilation itself is increasingly recognized as a harmful intervention that causes ventilator-induced lung injury. The use of low tidal volume and higher levels of positive end-expiratory pressure became an integral part of lung-protective ventilation following the outcomes of clinical trials in critically ill adults. This approach has been readily adopted in pediatric ventilation. However, a clear association between tidal volume and mortality has not been ascertained in pediatrics. In fact, experimental studies have suggested that young children might be less susceptible to ventilator-induced lung injury. As such, no recommendations on optimal lung-protective ventilation strategy in children with or without lung injury can be made. Copyright © 2015 Elsevier Ltd. All rights reserved.

Building America Case Study: Sealed Crawl Spaces with Integrated Whole-House Ventilation in a Cold Climate, Ithaca, New York

DOE Office of Scientific and Technical Information (OSTI.GOV)

"9One method of code-compliance for crawlspaces is to seal and insulate the crawlspace, rather than venting to the outdoors. However, codes require mechanical ventilation; either via conditioned supply air from the HVAC system, or a continuous exhaust ventilation strategy. As the CARB's building partner, Ithaca Neighborhood Housing Services, intended to use the unvented crawlspace in a recent development, CARB was interested in investigating a hybrid ventilation method that includes the exhaust air from the crawlspace as a portion of an ASHRAE 62.2 compliant whole-house ventilation strategy. This hybrid ventilation method was evaluated through a series of long-term monitoring tests thatmore » observed temperature, humidity, and pressure conditions through the home and crawlspace. Additionally, CARB worked with NREL to perform multi-point tracer gas testing on six separate ventilation strategies - varying portions of 62.2 required flow supplied by the crawlspace fan and an upstairs bathroom fan. The intent of the tracer gas testing was to identify effective Reciprocal Age of Air (RAoA), which is equivalent to the air change rate in well-mixed zones, for each strategy while characterizing localized infiltration rates in several areas of the home.« less

Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation.

PubMed

Hallstrom, A; Cobb, L; Johnson, E; Copass, M

2000-05-25

Despite extensive training of citizens of Seattle in cardiopulmonary resuscitation (CPR), bystanders do not perform CPR in almost half of witnessed cardiac arrests. Instructions in chest compression plus mouth-to-mouth ventilation given by dispatchers over the telephone can require 2.4 minutes. In experimental studies, chest compression alone is associated with survival rates similar to those with chest compression plus mouth-to-mouth ventilation. We conducted a randomized study to compare CPR by chest compression alone with CPR by chest compression plus mouth-to-mouth ventilation. The setting of the trial was an urban, fire-department-based, emergency-medical-care system with central dispatching. In a randomized manner, telephone dispatchers gave bystanders at the scene of apparent cardiac arrest instructions in either chest compression alone or chest compression plus mouth-to-mouth ventilation. The primary end point was survival to hospital discharge. Data were analyzed for 241 patients randomly assigned to receive chest compression alone and 279 assigned to chest compression plus mouth-to-mouth ventilation. Complete instructions were delivered in 62 percent of episodes for the group receiving chest compression plus mouth-to-mouth ventilation and 81 percent of episodes for the group receiving chest compression alone (P=0.005). Instructions for compression required 1.4 minutes less to complete than instructions for compression plus mouth-to-mouth ventilation. Survival to hospital discharge was better among patients assigned to chest compression alone than among those assigned to chest compression plus mouth-to-mouth ventilation (14.6 percent vs. 10.4 percent), but the difference was not statistically significant (P=0.18). The outcome after CPR with chest compression alone is similar to that after chest compression with mouth-to-mouth ventilation, and chest compression alone may be the preferred approach for bystanders inexperienced in CPR.

Technical Note: A proposal of air ventilation system design criteria for a clinical room in a heavy-ion medical facility.

PubMed

Kum, Oyeon

2018-06-01

An optimized air ventilation system design for a treatment room in Heavy-ion Medical Facility is an important issue in the aspects of nuclear safety because the activated air produced in a treatment room can directly affect the medical staff and the general public in the radiation-free area. Optimized design criteria of air ventilation system for a clinical room in 430 MeV/u carbon ion beam medical accelerator facility was performed by using a combination of MCNPX2.7.0 and CINDER'90 codes. Effective dose rate and its accumulated effective dose by inhalation and residual gamma were calculated for a normal treatment scenario (2 min irradiation for one fraction) as a function of decay time. Natural doses around the site were measured before construction and used as reference data. With no air ventilation system, the maximum effective dose rate was about 3 μSv/h (total dose of 90 mSv/y) and minimum 0.2 μSv/h (total dose of 6 mSv/y), which are over the legal limits for medical staff and for the general public. Although inhalation dose contribution was relatively small, it was considered seriously because of its long-lasting effects in the body. The integrated dose per year was 1.8 mSv/y in the radiation-free area with the 20-min rate of air ventilation system. An optimal air ventilation rate of 20 min is proposed for a clinical room, which also agrees with the best mechanical design value. © 2018 American Association of Physicists in Medicine.

Review and Extension of CO2-Based Methods to Determine Ventilation Rates with Application to School Classrooms

PubMed Central

Batterman, Stuart

2017-01-01

The ventilation rate (VR) is a key parameter affecting indoor environmental quality (IEQ) and the energy consumption of buildings. This paper reviews the use of CO2 as a “natural” tracer gas for estimating VRs, focusing on applications in school classrooms. It provides details and guidance for the steady-state, build-up, decay and transient mass balance methods. An extension to the build-up method and an analysis of the post-exercise recovery period that can increase CO2 generation rates are presented. Measurements in four mechanically-ventilated school buildings demonstrate the methods and highlight issues affecting their applicability. VRs during the school day fell below recommended minimum levels, and VRs during evening and early morning were on the order of 0.1 h−1, reflecting shutdown of the ventilation systems. The transient mass balance method was the most flexible and advantageous method given the low air change rates and dynamic occupancy patterns observed in the classrooms. While the extension to the build-up method improved stability and consistency, the accuracy of this and the steady-state method may be limited. Decay-based methods did not reflect the VR during the school day due to heating, ventilation and air conditioning (HVAC) system shutdown. Since the number of occupants in classrooms changes over the day, the VR expressed on a per person basis (e.g., L·s−1·person−1) depends on the occupancy metric. If occupancy measurements can be obtained, then the transient mass balance method likely will provide the most consistent and accurate results among the CO2-based methods. Improved VR measurements can benefit many applications, including research examining the linkage between ventilation and health. PMID:28165398

Review and Extension of CO₂-Based Methods to Determine Ventilation Rates with Application to School Classrooms.

PubMed

Batterman, Stuart

2017-02-04

The ventilation rate (VR) is a key parameter affecting indoor environmental quality (IEQ) and the energy consumption of buildings. This paper reviews the use of CO₂ as a "natural" tracer gas for estimating VRs, focusing on applications in school classrooms. It provides details and guidance for the steady-state, build-up, decay and transient mass balance methods. An extension to the build-up method and an analysis of the post-exercise recovery period that can increase CO₂ generation rates are presented. Measurements in four mechanically-ventilated school buildings demonstrate the methods and highlight issues affecting their applicability. VRs during the school day fell below recommended minimum levels, and VRs during evening and early morning were on the order of 0.1 h -1 , reflecting shutdown of the ventilation systems. The transient mass balance method was the most flexible and advantageous method given the low air change rates and dynamic occupancy patterns observed in the classrooms. While the extension to the build-up method improved stability and consistency, the accuracy of this and the steady-state method may be limited. Decay-based methods did not reflect the VR during the school day due to heating, ventilation and air conditioning (HVAC) system shutdown. Since the number of occupants in classrooms changes over the day, the VR expressed on a per person basis (e.g., L·s -1 ·person -1 ) depends on the occupancy metric. If occupancy measurements can be obtained, then the transient mass balance method likely will provide the most consistent and accurate results among the CO₂-based methods. Improved VR measurements can benefit many applications, including research examining the linkage between ventilation and health.

Clinical outcome of Guillain-Barré syndrome after prolonged mechanical ventilation.

PubMed

van den Berg, Bianca; Storm, Eline F; Garssen, Marcel J P; Blomkwist-Markens, Patricia H; Jacobs, Bart C

2018-04-07

Patients with Guillain-Barré syndrome (GBS) may suffer from respiratory failure for months or longer. The aim of this study was to determine the frequency, clinical course and outcome of patients with GBS requiring prolonged mechanical ventilation (MV). Prospectively collected data from 526 patients with GBS participating in previous trials were analysed to determine the frequency and duration of prolonged MV (longer than 2 months). In addition, a cross-sectional study was conducted in patients with GBS requiring MV to determine the clinical course and long-term outcome with the ability to walk unaided as primary endpoint. In the cohort study, 145 of 526 patients with GBS (28%) required MV, including 33 (6%) patients with prolonged MV. Patients requiring prolonged MV had a lower Medical Research Council sum score and more frequent bulbar involvement and inexcitable nerves compared with shorter ventilated patients. At 6 months, 18% of patients with prolonged MV were able to walk unaided compared with 76% of patients requiring shorter MV (P<0.001). In the cross-sectional study, 63 patients requiring MV were included with a median follow-up of 11 years (range 2-44 years). Twenty-six (41%) of these patients needed prolonged MV (median 93 days, range 62-261). Fifteen (58%) of these patients were able to walk unaided at maximum follow-up and eight (31%) reached this endpoint more than 1 year after diagnosis. Prolonged ventilation in GBS is associated with poor prognosis, yet patients requiring prolonged ventilation may show slow but persistent recovery for years and even reach the ability to walk and live independently. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

PubMed

Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

2016-04-01

We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery.

Antibiotic therapy in ventilator-associated tracheobronchitis: a literature review.

PubMed

Alves, Abel Eduardo; Pereira, José Manuel

2018-03-01

The concept of ventilator-associated tracheobronchitis is controversial; its definition is not unanimously accepted and often overlaps with ventilator-associated pneumonia. Ventilator-associated tracheobronchitis has an incidence similar to that of ventilator-associated pneumonia, with a high prevalence of isolated multiresistant agents, resulting in an increase in the time of mechanical ventilation and hospitalization but without an impact on mortality. The performance of quantitative cultures may allow better diagnostic definition of tracheobronchitis associated with mechanical ventilation, possibly avoiding the overdiagnosis of this condition. One of the major difficulties in differentiating between ventilator-associated tracheobronchitis and ventilator-associated pneumonia is the exclusion of a pulmonary infiltrate by chest radiography; thoracic computed tomography, thoracic ultrasonography, or invasive specimen collection may also be required. The institution of systemic antibiotic therapy does not improve the clinical impact of ventilator-associated tracheobronchitis, particularly in reducing time of mechanical ventilation, hospitalization or mortality, despite the possible reduced progression to ventilator-associated pneumonia. However, there are doubts regarding the methodology used. Thus, considering the high prevalence of tracheobronchitis associated with mechanical ventilation, routine treatment of this condition would result in high antibiotic usage without clear benefits. However, we suggest the institution of antibiotic therapy in patients with tracheobronchitis associated with mechanical ventilation and septic shock and/or worsening of oxygenation, and other auxiliary diagnostic tests should be simultaneously performed to exclude ventilator-associated pneumonia. This review provides a better understanding of the differentiation between tracheobronchitis associated with mechanical ventilation and pneumonia associated with mechanical ventilation, which can significantly decrease the use of antibiotics in critically ventilated patients.

Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis

PubMed Central

Kawazoe, Yu; Miyamoto, Kyohei; Morimoto, Takeshi; Yamamoto, Tomonori; Fuke, Akihiro; Hashimoto, Atsunori; Koami, Hiroyuki; Beppu, Satoru; Katayama, Yoichi; Itoh, Makoto; Ohta, Yoshinori

2017-01-01

Importance Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis. Objectives To examine whether a sedation strategy with dexmedetomidine can improve clinical outcomes in patients with sepsis undergoing ventilation. Design, Setting, and Participants Open-label, multicenter randomized clinical trial conducted at 8 intensive care units in Japan from February 2013 until January 2016 among 201 consecutive adult patients with sepsis requiring mechanical ventilation for at least 24 hours. Interventions Patients were randomized to receive either sedation with dexmedetomidine (n = 100) or sedation without dexmedetomidine (control group; n = 101). Other agents used in both groups were fentanyl, propofol, and midazolam. Main Outcomes and Measures The co–primary outcomes were mortality and ventilator-free days (over a 28-day duration). Sequential Organ Failure Assessment score (days 1, 2, 4, 6, 8), sedation control, occurrence of delirium and coma, intensive care unit stay duration, renal function, inflammation, and nutrition state were assessed as secondary outcomes. Results Of the 203 screened patients, 201 were randomized. The mean age was 69 years (SD, 14 years); 63% were male. Mortality at 28 days was not significantly different in the dexmedetomidine group vs the control group (19 patients [22.8%] vs 28 patients [30.8%]; hazard ratio, 0.69; 95% CI, 0.38-1.22; P = .20). Ventilator-free days over 28 days were not significantly different between groups (dexmedetomidine group: median, 20 [interquartile range, 5-24] days; control group: median, 18 [interquartile range, 0.5-23] days; P = .20). The dexmedetomidine group had a significantly higher rate of well-controlled sedation during mechanical ventilation (range, 17%-58% vs 20%-39%; P = .01); other outcomes were not significantly different between groups. Adverse events occurred in 8 (8%) and 3 (3%) patients in the dexmedetomidine and control groups, respectively. Conclusions and Relevance Among patients requiring mechanical ventilation, the use of dexmedetomidine compared with no dexmedetomidine did not result in statistically significant improvement in mortality or ventilator-free days. However, the study may have been underpowered for mortality, and additional research may be needed to evaluate this further. Trial Registration clinicaltrials.gov Identifier: NCT01760967 PMID:28322414

[The incidence and risk factors of ventilator-associated pneumonia in patients with severe traumatic brain injury].

PubMed

Marjanović, Vesna; Novak, Vesna; Velicković, Ljubinka; Marjanović, Goran

2011-01-01

Patients with severe traumatic brain injury are at a risk of developing ventilator-associated pneumonia. The aim of this study was to describe the incidence, etiology, risk factors for development of ventilator-associated pneumonia and outcome in patients with severe traumatic brain injury. A retrospective study was done in 72 patients with severe traumatic brain injury, who required mechanical ventilation for more than 48 hours. Ventilator-associated pneumonia was found in 31 of 72 (43.06%) patients with severe traumatic brain injury. The risk factors for ventilator-associated pneumonia were: prolonged mechanical ventilation (12.42 vs 4.34 days, p < 0.001), longer stay at intensive care unit (17 vs 5 days, p < 0.001) and chest injury (51.61 vs 19.51%, p < 0.009) compared to patients without ventilator-associated pneumonia. The mortality rate in the patients with ventilator-associated pneumonia was higher (38.71 vs 21.95%, p = 0.12). The development of ventilator-associated pneumonia in patients with severe traumatic brain injury led to the increased morbidity due to the prolonged mechanical ventilation, longer stay at intensive care unit and chest injury, but had no effect on mortality.

46 CFR 111.33-9 - Ventilation exhaust.

Code of Federal Regulations, 2010 CFR

2010-10-01

... REQUIREMENTS Power Semiconductor Rectifier Systems § 111.33-9 Ventilation exhaust. The exhaust of each forced-air semiconductor rectifier system must: (a) Terminate in a location other than a hazardous location...

Membrane humidification--a new method for humidification of respiratory gases in ventilator treatment of neonates.

PubMed Central

Hanssler, L; Tennhoff, W; Roll, C

1992-01-01

A humidifier system for neonatology that functions according to the 'membrane humidification' principle was subjected to a performance test in our laboratory. Humidification and heating of the respiratory gases took place in a module consisting of a net of hollow fibres placed inside the incubator. In 18 measurement combinations flow, respiratory gas temperature, and incubator temperature were varied. At respiratory gas temperatures within the range of 33-37 degrees C the minimum international standard for the absolute air humidity in the respiratory gas was achieved or exceeded in all measurements. No controlled clinical tests regarding the importance and long term effects of different temperatures and different humidity levels in the inspiratory air are yet available for the ventilation treatment of neonates. PMID:1444554

Mechanical ventilation weaning and extubation after spinal cord injury: a Western Trauma Association multicenter study.

PubMed

Kornblith, Lucy Z; Kutcher, Matthew E; Callcut, Rachael A; Redick, Brittney J; Hu, Charles K; Cogbill, Thomas H; Baker, Christopher C; Shapiro, Mark L; Burlew, Clay C; Kaups, Krista L; DeMoya, Marc A; Haan, James M; Koontz, Christopher H; Zolin, Samuel J; Gordy, Stephanie D; Shatz, David V; Paul, Doug B; Cohen, Mitchell J

2013-12-01

Respiratory failure after acute spinal cord injury (SCI) is well recognized, but data defining which patients need long-term ventilator support and criteria for weaning and extubation are lacking. We hypothesized that many patients with SCI, even those with cervical SCI, can be successfully managed without long-term mechanical ventilation and its associated morbidity. Under the auspices of the Western Trauma Association Multi-Center Trials Group, a retrospective study of patients with SCI at 14 major trauma centers was conducted. Comprehensive injury, demographic, and outcome data on patients with acute SCI were compiled. The primary outcome variable was the need for mechanical ventilation at discharge. Secondary outcomes included the use of tracheostomy and development of acute lung injury and ventilator-associated pneumonia. A total of 360 patients had SCI requiring mechanical ventilation. Sixteen patients were excluded for death within the first 2 days of hospitalization. Of the 344 patients included, 222 (64.5%) had cervical SCI. Notably, 62.6% of the patients with cervical SCI were ventilator free by discharge. One hundred forty-nine patients (43.3%) underwent tracheostomy, and 53.7% of them were successfully weaned from the ventilator, compared with an 85.6% success rate among those with no tracheostomy (p < 0.05). Patients who underwent tracheostomy had significantly higher rates of ventilator-associated pneumonia (61.1% vs. 20.5%, p < 0.05) and acute lung injury (12.8% vs. 3.6%, p < 0.05) and fewer ventilator-free days (1 vs. 24 p < 0.05). When controlled for injury severity, thoracic injury, and respiratory comorbidities, tracheostomy after cervical SCI was an independent predictor of ventilator dependence with an associated 14-fold higher likelihood of prolonged mechanical ventilation (odds ratio, 14.1; 95% confidence interval, 2.78-71.67; p < 0.05). While many patients with SCI require short-term mechanical ventilation, the majority can be successfully weaned before discharge. In patients with SCI, tracheostomy is associated with major morbidity, and its use, especially among patients with cervical SCI, deserves further study. Prognostic study, level III.

Optimizing Speech Production in the Ventilator-Assisted Individual Following Cervical Spinal Cord Injury: A Preliminary Investigation

ERIC Educational Resources Information Center

MacBean, Naomi; Ward, Elizabeth; Murdoch, Bruce; Cahill, Louise; Solley, Maura; Geraghty, Timothy; Hukins, Craig

2009-01-01

Background: Mechanical ventilation is commonly used during the acute management of cervical spinal cord injury, and is required on an ongoing basis in the majority of patients with injuries at or above C3. However, to date there have been limited systematic investigations of the options available to improve speech while ventilator-assisted…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Apte, Michael G.; Buchanan, Ian S.; Faulkner, David

The primary goals of this research effort are to develop, evaluate, and demonstrate a very practical HVAC system for classrooms that consistently provides classrooms with the quantity of ventilation in current minimum standards, while saving energy, and reducing HVAC-related noise levels. This research is motivated by the public benefits of energy efficiency, evidence that many classrooms are under-ventilated, and public concerns about indoor environmental quality in classrooms. This report presents an interim status update and preliminary findings from energy and indoor environmental quality (IEQ) measurements in sixteen relocatable classrooms in California. The field study includes measurements of HVAC energy use,more » ventilation rates, and IEQ conditions. Ten of the classrooms were equipped with a new HVAC technology and six control classrooms were equipped with a standard HVAC system. Energy use and many IEQ parameters have been monitored continuously, while unoccupied acoustic measurements were measured in one of four planned seasonal measurement campaigns. Continuously monitored data are remotely accessed via a LonWorks{reg_sign} network and stored in a relational database at LBNL. Preliminary results are presented here.« less

Do submesoscale frontal processes ventilate the oxygen minimum zone off Peru?

NASA Astrophysics Data System (ADS)

Thomsen, S.; Kanzow, T.; Colas, F.; Echevin, V.; Krahmann, G.; Engel, A.

2016-02-01

The Peruvian upwelling region shows pronounced near-surface submesoscale variability including filaments and sharp density fronts. Submesoscale frontal processes can drive large vertical velocities and enhance vertical tracer fluxes in the upper ocean. The associated high temporal and spatial variability poses a large challenge to observational approaches targeting these processes. In this study the role of submesoscale processes for the ventilation of the near-coastal oxygen minimum zone off Peru is investigated. We use satellite based sea surface temperature measurements and multiple high-resolution glider observations of temperature, salinity, oxygen and chlorophyll fluorescence carried out in January and February 2013 off Peru near 14°S during active upwelling. Additionally, high-resolution regional ocean circulation model outputs (ROMS) outputs are analysed. At the beginning of our observational survey a previously upwelled, productive and highly oxygenated water body is found in the mixed layer. Subsequently, a cold filament forms and the waters are moved offshore. After the decay of the filament and the relaxation of the upwelling front, the oxygen enriched surface water is found in the previously less oxygenated thermocline suggesting the occurrence of frontal subduction. A numerical model simulation is used to analyse the evolution of Lagrangian numerical floats in several upwelling filaments, whose vertical structure and hydrographic properties agree well with the observations. The floats trajectories support our interpretation that the subduction of previously upwelled water occurs in filaments off Peru. We find that 40 - 60 % of the floats seeded in the newly upwelled water is subducted within a time period of 5 days. This hightlights the importance of this process in ventilating the oxycline off Peru.

The growing role of noninvasive ventilation in patients requiring prolonged mechanical ventilation.

PubMed

Hess, Dean R

2012-06-01

For many patients with chronic respiratory failure requiring ventilator support, noninvasive ventilation (NIV) is preferable to invasive support by tracheostomy. Currently available evidence does not support the use of nocturnal NIV in unselected patients with stable COPD. Several European studies have reported benefit for high intensity NIV, in which setting of inspiratory pressure and respiratory rate are selected to achieve normocapnia. There have also been studies reporting benefit for the use of NIV as an adjunct to exercise training. NIV may be useful as an adjunct to airway clearance techniques in patients with cystic fibrosis. Accumulating evidence supports the use of NIV in patients with obesity hypoventilation syndrome. There is considerable observational evidence supporting the use of NIV in patients with chronic respiratory failure related to neuromuscular disease, and one randomized controlled trial reported that the use of NIV was life-prolonging in patients with amyotrophic lateral sclerosis. A variety of interfaces can be used to provide NIV in patients with stable chronic respiratory failure. The mouthpiece is an interface that is unique in this patient population, and has been used with success in patients with neuromuscular disease. Bi-level pressure ventilators are commonly used for NIV, although there are now a new generation of intermediate ventilators that are portable, have a long battery life, and can be used for NIV and invasive applications. Pressure support ventilation, pressure controlled ventilation, and volume controlled ventilation have been used successfully for chronic applications of NIV. New modes have recently become available, but their benefits await evidence to support their widespread use. The success of NIV in a given patient population depends on selection of an appropriate patient, selection of an appropriate interface, selection of an appropriate ventilator and ventilator settings, the skills of the clinician, the motivation of the patient, and the support of the family. 2012 Daedalus Enterprises

High-Frequency Oscillatory Ventilation Use and Severe Pediatric ARDS in the Pediatric Hematopoietic Cell Transplant Recipient.

PubMed

Rowan, Courtney M; Loomis, Ashley; McArthur, Jennifer; Smith, Lincoln S; Gertz, Shira J; Fitzgerald, Julie C; Nitu, Mara E; Moser, Elizabeth As; Hsing, Deyin D; Duncan, Christine N; Mahadeo, Kris M; Moffet, Jerelyn; Hall, Mark W; Pinos, Emily L; Tamburro, Robert F; Cheifetz, Ira M

2018-04-01

The effectiveness of high-frequency oscillatory ventilation (HFOV) in the pediatric hematopoietic cell transplant patient has not been established. We sought to identify current practice patterns of HFOV, investigate parameters during HFOV and their association with mortality, and compare the use of HFOV to conventional mechanical ventilation in severe pediatric ARDS. This is a retrospective analysis of a multi-center database of pediatric and young adult allogeneic hematopoietic cell transplant subjects requiring invasive mechanical ventilation for critical illness from 2009 through 2014. Twelve United States pediatric centers contributed data. Continuous variables were compared using a Wilcoxon rank-sum test or a Kruskal-Wallis analysis. For categorical variables, univariate analysis with logistic regression was performed. The database contains 222 patients, of which 85 subjects were managed with HFOV. Of this HFOV cohort, the overall pediatric ICU survival was 23.5% ( n = 20). HFOV survivors were transitioned to HFOV at a lower oxygenation index than nonsurvivors (25.6, interquartile range 21.1-36.8, vs 37.2, interquartile range 26.5-52.2, P = .046). Survivors were transitioned to HFOV earlier in the course of mechanical ventilation, (day 0 vs day 2, P = .002). No subject survived who was transitioned to HFOV after 1 week of invasive mechanical ventilation. We compared subjects with severe pediatric ARDS treated only with conventional mechanical ventilation versus early HFOV (within 2 d of invasive mechanical ventilation) versus late HFOV. There was a trend toward difference in survival (conventional mechanical ventilation 24%, early HFOV 30%, and late HFOV 9%, P = .08). In this large database of pediatric allogeneic hematopoietic cell transplant subjects who had acute respiratory failure requiring invasive mechanical ventilation for critical illness with severe pediatric ARDS, early use of HFOV was associated with improved survival compared to late implementation of HFOV, and the subjects had outcomes similar to those treated only with conventional mechanical ventilation. Copyright © 2018 by Daedalus Enterprises.

A Prognostic Model for One-year Mortality in Patients Requiring Prolonged Mechanical Ventilation

PubMed Central

Carson, Shannon S.; Garrett, Joanne; Hanson, Laura C.; Lanier, Joyce; Govert, Joe; Brake, Mary C.; Landucci, Dante L.; Cox, Christopher E.; Carey, Timothy S.

2009-01-01

Objective A measure that identifies patients who are at high risk of mortality after prolonged ventilation will help physicians communicate prognosis to patients or surrogate decision-makers. Our objective was to develop and validate a prognostic model for 1-year mortality in patients ventilated for 21 days or more. Design Prospective cohort study. Setting University-based tertiary care hospital Patients 300 consecutive medical, surgical, and trauma patients requiring mechanical ventilation for at least 21 days were prospectively enrolled. Measurements and Main Results Predictive variables were measured on day 21 of ventilation for the first 200 patients and entered into logistic regression models with 1-year and 3-month mortality as outcomes. Final models were validated using data from 100 subsequent patients. One-year mortality was 51% in the development set and 58% in the validation set. Independent predictors of mortality included requirement for vasopressors, hemodialysis, platelet count ≤150 ×109/L, and age ≥50. Areas under the ROC curve for the development model and validation model were 0.82 (se 0.03) and 0.82 (se 0.05) respectively. The model had sensitivity of 0.42 (se 0.12) and specificity of 0.99 (se 0.01) for identifying patients who had ≥90% risk of death at 1 year. Observed mortality was highly consistent with both 3- and 12-month predicted mortality. These four predictive variables can be used in a simple prognostic score that clearly identifies low risk patients (no risk factors, 15% mortality) and high risk patients (3 or 4 risk factors, 97% mortality). Conclusions Simple clinical variables measured on day 21 of mechanical ventilation can identify patients at highest and lowest risk of death from prolonged ventilation. PMID:18552692

Addressing Kitchen Contaminants for Healthy, Low-Energy Homes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stratton, J. Chris; Singer, Brett C.

2014-01-01

Cooking and cooking burners emit pollutants that can adversely affect indoor air quality in residences and significantly impact occupant health. Effective kitchen exhaust ventilation can reduce exposure to cooking-related air pollutants as an enabling step to healthier, low-energy homes. This report by Lawrence Berkeley National Laboratory identifies barriers to the widespread adoption of kitchen exhaust ventilation technologies and practice and proposes a suite of strategies to overcome these barriers. The recommendations have been vetted by a group of industry, regulatory, health, and research experts and stakeholders who convened for two meetings and provided input and feedback to early drafts ofmore » this document. The most fundamental barriers are (1) the common misconception, based on a sensory perception of risk, that kitchen exhaust when cooking is unnecessary and (2) the lack of a code requirement for kitchen ventilation in most U.S. locations. Highest priority objectives include the following: (1) Raise awareness among the public and the building industry of the need to install and routinely use kitchen ventilation; (2) Incorporate kitchen exhaust ventilation as a requirement of building codes and improve the mechanisms for code enforcement; (3) Provide best practice product and use-behavior guidance to ventilation equipment purchasers and installers, and; (4) Develop test methods and performance targets to advance development of high performance products. A specific, urgent need is the development of an over-the-range microwave that meets the airflow and sound requirements of ASHRAE Standard 62.2.« less

Addressing Kitchen Contaminants for Healthy, Low-Energy Homes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stratton, J. Chris; Singer, Brett C.

2014-01-01

Cooking and cooking burners emit pollutants that can adversely affect indoor air quality in residences and significantly impact occupant health. Effective kitchen exhaust ventilation can reduce exposure to cooking-related air pollutants as an enabling step to healthier, low-energy homes. This report identifies barriers to the widespread adoption of kitchen exhaust ventilation technologies and practice and proposes a suite of strategies to overcome these barriers. The recommendations have been vetted by a group of industry, regulatory, health, and research experts and stakeholders who convened for two web-based meetings and provided input and feedback to early drafts of this document. The mostmore » fundamental barriers are (1) the common misconception, based on a sensory perception of risk, that kitchen exhaust when cooking is unnecessary and (2) the lack of a code requirement for kitchen ventilation in most US locations. Highest priority objectives include the following: (1) Raise awareness among the public and the building industry of the need to install and routinely use kitchen ventilation; (2) Incorporate kitchen exhaust ventilation as a requirement of building codes and improve the mechanisms for code enforcement; (3) Provide best practice product and use-behavior guidance to ventilation equipment purchasers and installers, and; (4) Develop test methods and performance targets to advance development of high performance products. A specific, urgent need is the development of an over-the-range microwave that meets the airflow and sound requirements of ASHRAE Standard 62.2.« less

Abandoned coal mine stores gas for Colorado peak-day demands

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, L.W.

1978-09-01

Since 1961, the Leyden Mine, from which 6 million tons of coal had been removed to leave a 150 million cu ft void, has been used for gas storage at 250 psig max pressure, after the hoisting and ventilation shafts had been sealed with concrete, rock, sand, and mud. Following several withdrawal expansions, a design for maximum delivery of 230 million cu ft/day for five days with a pressure drop in the cavern down to 100 psig was developed to satisfy customer requirements for peak shaving. This required redesigning the gathering system by looping large existing lines, eliminating inefficient ones,more » and drilling additional wells; installing three lightweight 3500-hp Centaur turbine/compressor units from Solar Turbines International to provide the minimum 200 psig compressor discharge pressure needed for gas distribution on peak usage days; and installing Donaldson Co. engine air-inlet silencers on the turbine inlets to reduce noise levels below the public code requirement. In the 1977-78 heating season, the Leyden facility produced 196 million cu ft/day of gas; with continued load growth and well drilling to reduce pressure loss, the maximum design flow rate will be attained.« less

Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome.

PubMed

Wu, Xiujuan; Li, Chunrong; Zhang, Bing; Shen, Donghui; Li, Ting; Liu, Kangding; Zhang, Hong-Liang

2015-09-02

Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system. Respiratory failure requiring mechanical ventilation (MV) is a serious complication of GBS. Identification of modifiable risk factors for MV and poor short-term prognosis in mechanically ventilated patients with GBS may contribute to the individualized management and may help improve the outcome of the patients. We retrospectively analyzed the clinical data of 541 patients who were diagnosed with GBS from 2003 to 2014. Independent predictors for MV and short-term prognosis in mechanically ventilated patients were identified via multivariate logistic regression analysis. The mean age was 41.6 years with a male predilection (61.2%). Eighty patients (14.8%) required MV. Multivariate analysis revealed that shorter interval from onset to admission (p < 0.05), facial nerve palsy (p < 0.01), glossopharyngeal and vagal nerve deficits (p < 0.01) and lower Medical Research Council (MRC) sum score at nadir (p < 0.01) were risk factors for MV; disease occurrence in summer (p < 0.01) was a protective factor. As to prognostic factors, absence of antecedent infections (p < 0.01) and lower MRC sum score at nadir (p < 0.01) were predictors of poor short-term prognosis in mechanically ventilated patients regardless of treatment modality. We further investigated the predictors of poor short-term prognosis in patients requiring MV with different nadir MRC sum scores. Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95% confidence interval 1.068-97.407, p < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection. Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct. Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.

Special Considerations in Neonatal Mechanical Ventilation.

PubMed

Dalgleish, Stacey; Kostecky, Linda; Charania, Irina

2016-12-01

Care of infants supported with mechanical ventilation is complex, time intensive, and requires constant vigilance by an expertly prepared health care team. Current evidence must guide nursing practice regarding ventilated neonates. This article highlights the importance of common language to establish a shared mental model and enhance clear communication among the interprofessional team. Knowledge regarding the underpinnings of an open lung strategy and the interplay between the pathophysiology and individual infant's response to a specific ventilator strategy is most likely to result in a positive clinical outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

The use of tracheostomy speaking valves in mechanically ventilated patients results in improved communication and does not prolong ventilation time in cardiothoracic intensive care unit patients.

PubMed

Sutt, Anna-Liisa; Cornwell, Petrea; Mullany, Daniel; Kinneally, Toni; Fraser, John F

2015-06-01

The aim of this study was to assess the effect of the introduction of in-line tracheostomy speaking valves (SVs) on duration of mechanical ventilation and time to verbal communication in patients requiring tracheostomy for prolonged mechanical ventilation in a predominantly cardiothoracic intensive care unit (ICU). We performed a retrospective preobservational-postobservational study using data from the ICU clinical information system and medical record. Extracted data included demographics, diagnoses and disease severity, mechanical ventilation requirements, and details on verbal communication and oral intake. Data were collected on 129 patients. Mean age was 59 ± 16 years, with 75% male. Demographics, case mix, and median time from intubation to tracheostomy (6 days preimplementation-postimplementation) were unchanged between timepoints. A significant decrease in time from tracheostomy to establishing verbal communication was observed (18 days preimplementation and 9 days postimplementation, P <.05). There was no difference in length of mechanical ventilation (20 days preimplementation-post) or time to decannulation (14 days preimplementation-postimplementation). No adverse events were documented in relation to the introduction of in-line SVs. In-line SVs were successfully implemented in mechanically ventilated tracheostomized patient population. This resulted in earlier verbal communication, no detrimental effect on ventilator weaning times, and no change in decannulation times. The purpose of the study was to compare tracheostomy outcomes in mechanically ventilated patients in a cardiothoracic ICU preintroduction and postintroduction of in-line SVs. It was hypothesized that in-line SVs would improve communication and swallowing specific outcomes with no increase in average time to decannulation or the number of adverse events. Copyright © 2015 Elsevier Inc. All rights reserved.

ETS levels in hospitality environments satisfying ASHRAE standard 62-1989: "ventilation for acceptable indoor air quality"

NASA Astrophysics Data System (ADS)

Moschandreas, D. J.; Vuilleumier, K. L.

Prior to this study, indoor air constituent levels and ventilation rates of hospitality environments had not been measured simultaneously. This investigation measured indoor Environmental Tobacco Smoke-related (ETS-related) constituent levels in two restaurants, a billiard hall and a casino. The objective of this study was to characterize ETS-related constituent levels inside hospitality environments when the ventilation rates satisfy the requirements of the ASHRAE 62-1989 Ventilation Standard. The ventilation rate of each selected hospitality environment was measured and adjusted. The study advanced only if the requirements of the ASHRAE 62-1989 Ventilation Standard - the pertinent standard of the American Society of Heating, Refrigeration and Air Conditioning Engineers - were satisfied. The supply rates of outdoor air and occupant density were measured intermittently to assure that the ventilation rate of each facility satisfied the standard under occupied conditions. Six ETS-related constituents were measured: respirable suspended particulate (RSP) matter, fluorescent particulate matter (FPM, an estimate of the ETS particle concentrations), ultraviolet particulate matter (UVPM, a second estimate of the ETS particle concentrations), solanesol, nicotine and 3-ethenylpyridine (3-EP). ETS-related constituent levels in smoking sections, non-smoking sections and outdoors were sampled daily for eight consecutive days at each hospitality environment. This study found that the difference between the concentrations of ETS-related constituents in indoor smoking and non-smoking sections was statistically significant. Differences between indoor non-smoking sections and outdoor ETS-related constituent levels were identified but were not statistically significant. Similarly, differences between weekday and weekend evenings were identified but were not statistically significant. The difference between indoor smoking sections and outdoors was statistically significant. Most importantly, ETS-related constituent concentrations measured indoors did not exceed existing occupational standards. It was concluded that if the measured ventilation rates of the sampled facilities satisfied the ASHRAE 62-1989 Ventilation Standard requirements, the corresponding ETS-related constituents were measured at concentrations below known harmful levels as specified by the American Conference of Governmental Industrial Hygiene (ACGIH).

A complete audit cycle to assess adherence to a lung protective ventilation strategy.

PubMed

Joynes, Emma; Dalay, Satinder; Patel, Jaimin M; Fayek, Samia

2014-11-01

There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS). There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (V t) of 6 ml/kg of ideal body weight (IBW) and plateau airway pressure of ≤30 cm H2O. The initial audit failed to meet this standard with V t's of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with V t's of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care.

[Impacts of different methods in laryngeal mask airway positioning on the airway management of elderly patients with general anesthesia].

PubMed

Yan, F; Li, J; Wang, H J; Yang, X; Yang, J B; Tu, X J

2018-05-15

Objective: By observing the clinical effect of ultrasound, fiberoptic bronchoscopy and traditional standard in positioning the general anesthesia of laryngeal mask ventilation in elderly patients, the superiority of laryngeal mask positioning with visualization technique of ultrasound and fiberoptic bronchoscope on airway management in elderly patients with general anesthesia was analyzed. Methods: One hundred and twenty cases of elderly patients with general anesthesia of laryngeal mask ventilation from the People's Hospital of Yuyao city from October 2016 to October 2017 were selected and randomly divided into 3 groups( n =40)according to American Society of Anesthesiologists (ASA) grading criteria Ⅰ-Ⅲ. Group A: traditional standard positioning laryngeal mask group. Group B: fiberoptic bronchoscope positioning laryngeal mask group. Group C: ultrasound positioning laryngeal mask group. The general information of sex ratio of male and female, mass, and height, and operation type, operation duration, anaesthesia duration, and modified Mallampati grade were observed and compared among the three groups. The number of successful laryngeal mask ventilation after laryngeal mask placement in 3 groups was observed, the laryngeal mask placement time (T(0)) and the normal ventilation time after adjustment (T(1)) in each group were recorded, and the first success rate of laryngeal mask placement, the success rate after adjusting the positioning, and the success rate of re-placement were calculated. Moreover, the mean peak airway pressure at 5 min after operation, the minimum intrathecal injection gas for minimum ventilation (V(min)), the minimum laryngeal mask intravesical pressure (ICP(min)), and the lowest air pressure for oral and pharyngeal leakage (OLP(min)) were recorded. The airway seal pressure (OLP(60)) and the volume of gas injection (V(60)) when the intravesical pressure was 60 cmH(2)O (1 cmH(2)O=0.098 kPa) were used to record the incidence of postoperative laryngeal mask bleeding, cough, nausea and vomiting, and the incidence of pharyngalgia, odynophagia, hoarseness and other related complications after 24 hours of the operation. Results: There was no significant difference in general information, airway evaluation and anesthesia operation among the three groups (all P >0.05). The incidence of intraoperative laryngeal mask bleeding in group B and C was 7.9% and 2.6% respectively, the incidence of odynophagia at 24 hours after operation was 5.3% and 0 respectively, and the incidence of pharyngalgia and hoarseness was 18.4% and 7.9% respectively, less than that in group A (24.2%, 12.1% and 36.3%). The difference was statistically significant (χ(2)=8.900, 6.880, 9.000, P <0.05). The success rate of adjustment and positioning after the placement of laryngeal mask was 84.2% and 94.7% respectively in group B and C, higher than that in group A of 72.7%, and the difference was statistically significant (χ(2)=6.500, P <0.05). The lowest laryngeal mask intralaryngeal pressure for ventilation in group B and C was (35.39±4.67) cmH(2)O and (32.61±3.22) cmH(2)O, lower than that in group A of (39.30 ± 5.93) cmH(2)O, the intralaryngeal pressure was 60 cmH(2)O, and the airway seal pressure was (25.82±4.48) cmH(2)O and (28.34±6.99) cmH(2)O, higher than that in group A of (22.45±4.98) cmH(2)O, which was significantly different ( F =18.200, 9.720, P <0.05). Conclusions: In elderly patients with general anesthesia, it is feasible to manage the airway by ultrasound or fiberoptic bronchoscopy with laryngeal mask. Ultrasound positioning laryngeal mask improves the accuracy of the intraoperative ventilation, and reduces the incidence of postoperative airway related complications.

[Investigation of the H₂S contamination in cabin causing fishermen's eye burns].

PubMed

Qian, Ding-Guo; Wang, Jian-Yue; Wang, Yun-Ming; Ma, Yin-Xiang; Huang, Yu-Geng; Zhou, Chang-Bo; Tang, Zhi-Bo

2010-12-01

To investigate the H(2)S pollution in cabins which caused the fishermen's eye burns. Fifty-six fishing boats' H(2)S concentration was surveyed and 56 fishermen's eyes were inspected. The air samples were collected from 21 fishing boats' cabins, where the eye burns took place and the monitoring conditions met the inspection requirement, in order to confirm the concentration of H(2)S when eye burns and the systemic poisoning happened. Thirty fishing boats were divided into two groups: one was using air ventilating and spraying, the other was using naturally ventilation to find out the effective method of dispersing H(2)S. Five fishing boats were surveyed in which the fishermen had slight symptom of bulbar conjunctiva hyperemia and cough to find out the minimum concentration of H(2)S which caused the eye burns and respiratory mucosa. Among 56 fishermen who were surveyed, 46 fishermen's eyes (92 eyes) burnt and they were from 21 vessels, 10 of them (20 eyes) were moderate, 36 of them (72 eyes) were light. The concentration of H(2)S in the 21 fishing boats' cabins which caused eye burns was (99 ± 38) mg/m(3). The first measuring of the concentration of H(2)S in the 30 fishing boats in which fish were not discharged yet was (219 ± 31) mg/m(3). Air ventilating and spraying group's concentration of H(2)S was (213 ± 24) mg/m(3), while that of naturally ventilation group's was (225 ± 36) mg/m(3). Dispersing after 1 hour, the concentration of H(2)S of air ventilating and spraying group was (21 ± 3) mg/m(3), the decreased concentration was (192 ± 21) mg/m(3), fell 90%; the concentration of naturally ventilation group was (184 ± 36) mg/m(3), the decreased concentration was (41 ± 8) mg/m(3), fell 18%. The difference between the two groups' decreased concentration was significant (t = 25.627, P < 0.05). The threshold value of H(2)S concentration that could cause the eye burns was 38 mg/m(3)(exposure time 120 min). In 7 vessels, the concentration of H(2)S in the cabins was (123 ± 9) mg/m(3) where 10 fishermen's moderate eye burns happened. In other 7 vessels, the concentration of H(2)S in the cabins was (54 ± 7) mg/m(3) where 19 fishermen's light eye burns happened. The difference of H(2)S concentration between the two groups was significant (t = 14.236, P < 0.05). High H(2)S concentration and long exposure time in cabin can cause serious eye burns. The bilge air ventilation and inner cabin spraying are the effective method to clear the H(2)S in cabin within short time.

[Air quality control systems: heating, ventilating, and air conditioning (HVAC)].

PubMed

Bellucci Sessa, R; Riccio, G

2004-01-01

After a brief illustration of the principal layout schemes of Heating, Ventilating, and Air Conditioning (HVAC), the first part of this paper summarizes the standards, both voluntary and compulsory, regulating HVAC facilities design and installation with regard to the question of Indoor Air Quality (IAQ). The paper then examines the problem of ventilation systems maintenance and the essential hygienistic requirements in whose absence HVAC facilities may become a risk factor for people working or living in the building. Lastly, the paper deals with HVAC design strategies and methods, which aim not only to satisfy comfort and air quality requirements, but also to ensure easy and effective maintenance procedures.

A randomized clinical trial comparing an extended-use hygroscopic condenser humidifier with heated-water humidification in mechanically ventilated patients.

PubMed

Kollef, M H; Shapiro, S D; Boyd, V; Silver, P; Von Harz, B; Trovillion, E; Prentice, D

1998-03-01

To determine the safety and cost-effectiveness of mechanical ventilation with an extended-use hygroscopic condenser humidifier (Duration; Nellcor Puritan-Bennett; Eden Prairie, Minn) compared with mechanical ventilation with heated-water humidification. Prospective randomized clinical trial. Medical and surgical ICUs of Barnes-Jewish Hospital, St. Louis, a university-affiliated teaching hospital. Three hundred ten consecutive qualified patients undergoing mechanical ventilation. Patients requiring mechanical ventilation were randomly assigned to receive humidification with either an extended-use hygroscopic condenser humidifier (for up to the first 7 days of mechanical ventilation) or heated-water humidification. Occurrence of ventilator-associated pneumonia, endotracheal tube occlusion, duration of mechanical ventilation, lengths of intensive care and hospitalization, acquired multiorgan dysfunction, and hospital mortality. One hundred sixty-three patients were randomly assigned to receive humidification with an extended-use hygroscopic condenser humidifier, and 147 patients were randomly assigned to receive heated-water humidification. The two groups were similar at the time of randomization with regard to demographic characteristics, ICU admission diagnoses, and severity of illness. Risk factors for the development of ventilator-associated pneumonia were also similar during the study period for both treatment groups. Ventilator-associated pneumonia was seen in 15 (9.2%) patients receiving humidification with an extended-use hygroscopic condenser humidifier and in 15 (10.2%) patients receiving heated-water humidification (relative risk, 0.90; 95% confidence interval=0.46 to 1.78; p=0.766). No statistically significant differences for hospital mortality, duration of mechanical ventilation, lengths of stay in the hospital ICU, or acquired organ system derangements were found between the two treatment groups. No episode of endotracheal tube occlusion occurred during the study period in either treatment group. The total cost of providing humidification was $2,605 for patients receiving a hygroscopic condenser humidifier compared with $5,625 for patients receiving heated-water humidification. Our findings suggest that the initial application of an extended-use hygroscopic condenser humidifier is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidification.

[Anesthesia ventilators].

PubMed

Otteni, J C; Beydon, L; Cazalaà, J B; Feiss, P; Nivoche, Y

1997-01-01

To review anaesthesia ventilators in current use in France by categories of ventilators. References were obtained from computerized bibliographic search. (Medline), recent review articles, the library of the service and personal files. Anaesthesia ventilators can be allocated into three groups, depending on whether they readminister expired gases or not or allow both modalities. Contemporary ventilators provide either constant volume ventilation, or constant pressure ventilation, with or without a pressure plateau. Ventilators readministering expired gases after CO2 absorption, or closed circuit ventilators, are either of a double- or a single-circuit design. Double-circuit ventilators, or pneumatical bag or bellows squeezers, or bag-in-bottle or bellows-in-bottle (or box) ventilators, consist of a primary, or driving circuit (bottle or box) and a secondary or patient circuit (including a bag or a bellows or membrane chambers). Bellows-in-bottle ventilators have either standing bellows ascending at expiration, or hanging bellows, descending at expiration. Ascending bellows require a positive pressure of about 2 cmH2O throughout exhalation to allow the bellows to refill. The expired gas volume is a valuable indicator for leak and disconnection. Descending bellows generate a slight negative pressure during exhalation. In case of leak or disconnection they aspirate ambient air and cannot act therefore as an indicator for integrity of the circuit and the patient connection. Closed circuit ventilators with a single-circuit (patient circuit) include a insufflating device consisting either in a bellows or a cylinder with a piston, operated by a electric or pneumatic motor. As the hanging bellows of the double circuit ventilators, they generate a slight negative pressure during exhalation and aspirate ambient air in case of leak or disconnection. Ventilators not designed for the readministration of expired gases, or open circuit ventilators, are generally stand-alone mechanical ventilators modified to allow the administration of inhalational anaesthetic agents.

The Paleoceanography of the Bering Sea During the Last Glacial Cycle

DTIC Science & Technology

2006-02-01

Stabeno, 1998). Water from the Bering (1995) inferred that the oxygen minimum zone Sea is relatively low salinity and rich in nutrients, (OMZ...fresher, warmer, and enriched in nutrients, particu- planktonic species Neogloboquadrina pachyderma larly silicate, which dissolves from opal- rich seafloor...2- rich 33 North Pacific intermediate water (NPIW), (2) decrease in the [02] of newly-formed NPIW without a change in ventilation rate (Crusius et al

30 CFR 7.27 - Test for flame resistance of brattice cloth.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Test for flame resistance of brattice cloth. 7... Ventilation Tubing § 7.27 Test for flame resistance of brattice cloth. (a) Test procedures. (1) Prepare 6... for a minimum of 24 hours at a temperature of 70 ±10 °F (21 ±5.5 °C) and a relative humidity of 55 ±10...

30 CFR 7.27 - Test for flame resistance of brattice cloth.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Test for flame resistance of brattice cloth. 7... Ventilation Tubing § 7.27 Test for flame resistance of brattice cloth. (a) Test procedures. (1) Prepare 6... for a minimum of 24 hours at a temperature of 70 ±10 °F (21 ±5.5 °C) and a relative humidity of 55 ±10...

30 CFR 7.27 - Test for flame resistance of brattice cloth.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Test for flame resistance of brattice cloth. 7... Ventilation Tubing § 7.27 Test for flame resistance of brattice cloth. (a) Test procedures. (1) Prepare 6... for a minimum of 24 hours at a temperature of 70 ±10 °F (21 ±5.5 °C) and a relative humidity of 55 ±10...

30 CFR 7.27 - Test for flame resistance of brattice cloth.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Test for flame resistance of brattice cloth. 7... Ventilation Tubing § 7.27 Test for flame resistance of brattice cloth. (a) Test procedures. (1) Prepare 6... for a minimum of 24 hours at a temperature of 70 ±10 °F (21 ±5.5 °C) and a relative humidity of 55 ±10...

30 CFR 7.27 - Test for flame resistance of brattice cloth.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Test for flame resistance of brattice cloth. 7... Ventilation Tubing § 7.27 Test for flame resistance of brattice cloth. (a) Test procedures. (1) Prepare 6... for a minimum of 24 hours at a temperature of 70 ±10 °F (21 ±5.5 °C) and a relative humidity of 55 ±10...

[Implementation of modern trends in the methods of the ventilation support in the new apparatus for artificial lung ventilation Avenir-221 P].

PubMed

Gal'perin, Iu Sh; Alkhimova, L R; Dmitriev, N D; Kozlova, I A; Nemirovskiĭ, S B; Makarov, M V; Safronov, A Iu

2005-01-01

In the new ventilator Avenir-221 P modern lines of development of ventilation support in intensive therapy of adults and children are implemented. The capacities of the ventilator are successfully combined with its technical decisions which include microprocessor parametrical controlling, programming-controlled electric drive, an information saturation, intuitively clear control system, protection against interruption of power supply sources and oxygen feeding falls. A set of functional characteristics (modes VCV, PCV, Ass/Contr, PSV, SIMV, PEEP, Sigh, etc.) in combination with an original design make the device the most accessible and promising for application in intensive care and resuscitation units of a wide network of Russian hospitals and clinics. The ventilator Avenir-221 P has passed all required tests and is presently commercially available.

Energy Use Consequences of Ventilating a Net-Zero Energy House

PubMed Central

Ng, Lisa C.; Payne, W. Vance

2016-01-01

A Net-Zero Energy Residential Test Facility (NZERTF) has been constructed at the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland to demonstrate that a home similar in size, aesthetics, and amenities to those in the surrounding communities can achieve net-zero energy use over the course of a year while meeting the average electricity and water use needs of a family of four in the United States. The facility incorporates renewable energy and energy efficient technologies, including an air-to-air heat pump system, a solar photovoltaic system, a solar thermal domestic hot water system, and a heat recovery ventilation system sized to meet American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) Standard 62.2-2010 ventilation requirements. The largest energy end use within the home was space conditioning, which included heat loss through the building envelope, ventilation air supplied by the heat recovery ventilator (HRV), and internal loads. While HRVs are often described as being able to save energy when compared to ventilating without heat recovery, there have been no studies using a full year of measured data that determine the thermal load and energy impacts of HRV-based ventilation on the central heating and cooling system. Over the course of a year, continuous operation of the HRV at the NZERTF resulted in an annual savings of 7 % in heat pump energy use compared with the hypothetical case of ventilating without heat recovery. The heat pump electrical use varied from an increase of 5 % in the cooling months to 36 % savings in the heating months compared with ventilation without heat recovery. The increase in the cooling months occurred when the outdoor temperature was lower than the indoor temperature, during which the availability of an economizer mode would have been beneficial. Nevertheless, the fan energy required to operate the selected HRV at the NZERTF paid for itself in the heat pump energy saved compared with ventilation without heat recovery. PMID:26903776

Energy Use Consequences of Ventilating a Net-Zero Energy House.

PubMed

Ng, Lisa C; Payne, W Vance

2016-03-05

A Net-Zero Energy Residential Test Facility (NZERTF) has been constructed at the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland to demonstrate that a home similar in size, aesthetics, and amenities to those in the surrounding communities can achieve net-zero energy use over the course of a year while meeting the average electricity and water use needs of a family of four in the United States. The facility incorporates renewable energy and energy efficient technologies, including an air-to-air heat pump system, a solar photovoltaic system, a solar thermal domestic hot water system, and a heat recovery ventilation system sized to meet American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) Standard 62.2-2010 ventilation requirements. The largest energy end use within the home was space conditioning, which included heat loss through the building envelope, ventilation air supplied by the heat recovery ventilator (HRV), and internal loads. While HRVs are often described as being able to save energy when compared to ventilating without heat recovery, there have been no studies using a full year of measured data that determine the thermal load and energy impacts of HRV-based ventilation on the central heating and cooling system. Over the course of a year, continuous operation of the HRV at the NZERTF resulted in an annual savings of 7 % in heat pump energy use compared with the hypothetical case of ventilating without heat recovery. The heat pump electrical use varied from an increase of 5 % in the cooling months to 36 % savings in the heating months compared with ventilation without heat recovery. The increase in the cooling months occurred when the outdoor temperature was lower than the indoor temperature, during which the availability of an economizer mode would have been beneficial. Nevertheless, the fan energy required to operate the selected HRV at the NZERTF paid for itself in the heat pump energy saved compared with ventilation without heat recovery.

Non-invasive mechanical ventilation with spinal anesthesia for cesarean delivery.

PubMed

Erdogan, G; Okyay, D Z; Yurtlu, S; Hanci, V; Ayoglu, H; Koksal, B; Turan, I O

2010-10-01

We present the successful use of perioperative non-invasive mechanical ventilation in a morbidly obese pregnant woman with bronchial asthma, severe preeclampsia and pulmonary edema undergoing an emergency cesarean delivery with spinal anesthesia. The combination of non-invasive mechanical ventilation with neuraxial anesthesia may be of value in selected parturients with acute or chronic respiratory insufficiency requiring surgery. Copyright © 2010 Elsevier Ltd. All rights reserved.

Prone versus supine position in mechanically ventilated children: a pilot study.

PubMed

Sawhney, Ashu; Kumar, Nirmal; Sreenivas, Vishnubhatla; Gupta, Sangeeta; Tyagi, Vineet; Puliyel, Jacob M

2005-05-01

It is known that mechanically ventilated patients in the prone position have improved oxygenation compared with those supine. We did a prospective, randomized, controlled trial to evaluate the effect of prone position during mechanical ventilation, on survival in critically ill children. Forty-two children needing mechanical ventilation for various illnesses were randomized to receive initial ventilation for four hours prone or supine by drawing lots. Initial severity of illness and blood gases in all children were noted. In a crossover design, after the initial four hours the children were turned over and ventilated in the alternate posture for an hour. Oxygenation parameters and mean airway pressures were noted at one hour, four hours, and five hours. Mortality, duration of ventilation, and the above parameters were compared in the two groups. Initial PRISM scores were similar in the two groups. Mortality in the prone group was less than in the supine group. The odds ratio of mortality was 0.20 (95% CI 0.05-0.75). Duration of ventilation was similar in the two groups. The oxygenation index was significantly lower in the prone group at one, four, and five hours after onset of ventilation. Prone position in the first few hours of ventilation significantly improves gas exchange and oxygenation, reduces the mean airway pressures required to ventilate children, and may cause significant improvement in survival. Our study protocol allowed ventilator settings to be changed as needed during ventilation.

Intensification of the Northeast Pacific oxygen minimum zone during the Bölling-Alleröd warm period

USGS Publications Warehouse

Zheng, Yen; van Geen, Alexander; Anderson, Robert F.; Gardner, James V.; Dean, Walter E.

2000-01-01

Although climate records from several locations around the world show nearly synchronous and abrupt changes, the nature of the inferred teleconnection is still poorly understood. On the basis of preserved laminations and molybdenum enrichments in open margin sediments we demonstrate that the oxygen content of northeast Pacific waters at 800 m depth during the Bölling-Alleröd warm period (15–13 kyr) was greatly reduced. Existing oxygen isotopic records of benthic and planktonic foraminifera suggest that this was probably due to suppressed ventilation at higher latitudes of the North Pacific. Comparison with ventilation records for the North Atlantic indicates an antiphased pattern of convection relative to the North Pacific over the past 22 kyr, perhaps due to variations in water vapor transport across Central America.

Field and Laboratory Testing of Approaches to Smart Whole-House Mechanical Ventilation Control

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martin, Eric; Fenaughty, Karen; Parker, Danny

Whole-house mechanical ventilation is a critical component to a comprehensive strategy for good indoor air quality (IAQ). However, due to lack of integration with standard heating and cooling systems, and perceptions from a portion of the homebuilding industry about risks related to increased energy use, increased cost, and decreased comfort, voluntary and code-required adoption varies among regions. Smart ventilation controls (SVC) balance energy consumption, comfort, and IAQ by optimizing mechanical ventilation operation to reduce the heating and/or cooling loads, improve management of indoor moisture, and maintain IAQ equivalence according to ASHRAE 62.2.

Field and Laboratory Testing of Approaches to Smart Whole-House Mechanical Ventilation Control

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martin, Eric; Fenaughty, Karen; Parker, Danny

Whole-house mechanical ventilation is a critical component to a comprehensive strategy for good indoor air quality (IAQ). However, due to lack of integration with standard heating and cooling systems, and perceptions from a portion of the homebuilding industry about risks related to increased energy use, increased cost, and decreased comfort, voluntary and code-required adoption varies amongst regions. Smart ventilation controls (SVC) balance energy consumption, comfort, and IAQ by optimizing mechanical ventilation operation to reduce the heating and/or cooling loads, improve management of indoor moisture, and maintain IAQ equivalence according to ASHRAE 62.2.

Increased risk of pneumonia among ventilated patients with traumatic brain injury: every day counts!

PubMed

Hui, Xuan; Haider, Adil H; Hashmi, Zain G; Rushing, Amy P; Dhiman, Nitasha; Scott, Valerie K; Selvarajah, Shalini; Haut, Elliott R; Efron, David T; Schneider, Eric B

2013-09-01

Patients with traumatic brain injury (TBI) frequently require mechanical ventilation (MV). The objective of this study was to examine the association between time spent on MV and the development of pneumonia among patients with TBI. Patients older than 18 y with head abbreviated injury scale (AIS) scores coded 1-6 requiring MV in the National Trauma Data Bank 2007-2010 data set were included. The study was limited to hospitals reporting pneumonia cases. AIS scores were calculated using ICDMAP-90 software. Patients with injuries in any other region with AIS score >3, significant burns, or a hospital length of stay >30 d were excluded. A generalized linear model was used to determine the approximate relative risk of developing all-cause pneumonia (aspiration pneumonia, ventilator-associated pneumonia [VAP], and infectious pneumonia identified by the International Classification of Disease, Ninth Revision, diagnosis code) for each day of MV, controlling for age, gender, Glasgow coma scale motor score, comorbidity (Charlson comorbidity index) score, insurance status, and injury type and severity. Among the 24,525 patients with TBI who required MV included in this study, 1593 (6.5%) developed all-cause pneumonia. After controlling for demographic and injury factors, each additional day on the ventilator was associated with a 7% increase in the risk of pneumonia (risk ratio 1.07, 95% confidence interval 1.07-1.08). Patients who have sustained TBIs and require MV are at higher risk for VAP than individuals extubated earlier; therefore, shortening MV exposure will likely reduce the risk of VAP. As patients with TBI frequently require MV because of neurologic impairment, it is key to develop aggressive strategies to expedite ventilator independence. Copyright © 2013 Elsevier Inc. All rights reserved.

Use of a Supraglottic Airway to Relieve Ventilation-Impeding Gastric Insufflation During Emergency Airway Management in an Infant.

PubMed

Dodd, Kenneth W; Strobel, Ashley M; Driver, Brian E; Reardon, Robert F

2016-10-01

Positive-pressure bag-valve-mask ventilation during emergency airway management often results in significant gastric insufflation, which may impede adequate ventilation and oxygenation. Current-generation supraglottic airways have beneficial features, such as channels for gastric decompression while ventilation is ongoing. A 5-week-old female infant required resuscitation for hypoxemic respiratory failure caused by rhinovirus with pneumonia. Bag-valve-mask ventilation led to gastric insufflation that compromised ventilation, thereby interfering with intubation because of precipitous oxygen desaturation during laryngoscopy. A current-generation supraglottic airway (LMA Supreme; Teleflex Inc, Morrisville, NC) was used to facilitate gastric decompression while ventilation and oxygenation was ongoing. After gastric decompression, ventilation was markedly improved and the pulse oxygen saturation improved to 100%. Intubation was successful on the next attempt, without oxygen desaturation. Current-generation supraglottic airways have 3 distinct advantages compared with first-generation supraglottic airways, which make them better devices for emergency airway management: gastric decompression ports, conduits for intubation, and higher oropharyngeal leak pressures. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The fluid mechanics of natural ventilation

NASA Astrophysics Data System (ADS)

Linden, Paul

1999-11-01

Natural ventilation of buildings is the flow generated by temperature differences and by the wind. Modern buildings have extreme designs with large, tall open plan spaces and large cooling requirements. Natural ventilation offers a means of cooling these buildings and providing good indoor air quality. The essential feature of ventilation is an exchange between an interior space and the external ambient. Recent work shows that in many circumstances temperature variations play a controlling feature on the ventilation since the directional buoyancy force has a large influence on the flow patterns within the space and on the nature of the exchange with the outside. Two forms of buoyancy-driven ventilation are discussed: mixing ventilation in which the interior is at approximately uniform temperature and displacement ventilation where there is strong internal stratification. The dynamics of these flows are considered and the effects of wind on them are examined both experimentally and theoretically. The aim behind this work is to give designers rules and intuition on how air moves within a building and the research shows a fascinating branch of fluid mechanics.

Three-year experience with neonatal ventilation from a tertiary care hospital in Delhi.

PubMed

Singh, M; Deorari, A K; Paul, V K; Mittal, M; Shanker, S; Munshi, U; Jain, Y

1993-06-01

Ninety neonates were ventilated over a period of 33 months of whom 50 (55.5%) survived. Fifty seven babies received IPPV while 33 CPAP. IPPV mode was being used more frequently recently and survival rates have steadily improved over past 3 years. Survival was cent per cent in babies above 1.5 kg on CPAP mode while 16/26 (57.7%) survived on IPPV mode. Of 22 extremely VLBW (< 1 kg) babies, six survived. HMD was the commonest indication of ventilation (50%), of which 53% (24/45) survived. The other important indications of ventilation were apnea in 13 and transient tachypnea in 11 babies. All babies requiring ventilation for transient tachypnea survived. Nosocomial infections were common in association with ventilation 34/90 (37.7%), out of which in 14 was responsible for about a third of deaths. Pulmonary air leaks developed in 12 babies of which 6 died. Two babies developed BPD and one ROP. Neonatal ventilation should be ventured in centres where basic facilities for level II care already exist. It may not be cost effective to ventilate extremely low birth weight neonates.

A Real-time Ventilator Management Dashboard: Toward Hardwiring Compliance with Evidence-based Guidelines

PubMed Central

Starmer, John; Giuse, Dario

2008-01-01

Care of mechanically ventilated patients requires coordination between multiple caregivers, necessitating the availability of accurate and timely information on patient status. Researchers have documented positive effects of several interventions on the rates of developing ventilator associated complications, such as providing regular oral care and elevating the head of the bed. Informatics tools, such as electronic whiteboards, reminders, and alerts have been shown to aid in clinician compliance with guidelines or protocols. The purpose of this project was to design and implement a real-time ventilator management dashboard to show patient status with respect to elements important for ventilator management and infection prevention in the adult Intensive Care Units at Vanderbilt University Medical Center. PMID:18998939

Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery.

PubMed

Maia, Lígia de Albuquerque; Silva, Pedro Leme; Pelosi, Paolo; Rocco, Patricia Rieken Macedo

2017-06-01

The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m 2 .

[Intraoperative monitoring in artificial respiration of premature and newborn infants. I. Monitoring of respiratory parameters and alveolar ventilation].

PubMed

Lenz, G; Heipertz, W; Leidig, E; Madee, S

1986-06-01

Monitoring of ventilation serves to ensure adequate alveolar ventilation and arterial oxygenation, and to avoid pulmonary damage due to mechanical ventilation. Basic clinical monitoring, i.e., inspection, auscultation (including precordial or oesophageal stethoscope) and monitoring of heart rate and blood pressure, is mandatory. Mechanical ventilation is monitored by ventilation pressures (peak pressure, plateau pressure and endexpiratory pressure), ventilation volumes (measured at the in/expiratory valve of the respirator and by hot-wire anemometry at the tube connector), ventilation rate, and inspiratory oxygen concentration (FiO2). Alveolar ventilation should be continuously and indirectly recorded by capnometry (pECO2) and by measurement of transcutaneous pCO2 (tcpCO2), whereas oxygenation is determined via measurement of transcutaneous pO2 (tcpO2). Invasive monitoring of gas exchange is essential in prolonged or intrathoracic interventions as well as in neonates with cardiopulmonary problems. paCO2 may be estimated by capillary or venous blood gas analysis; arterial blood gas analysis is required for exact determination of paCO2 as well as arteriocutaneous pCO2 (atcDCO2) and arterio-end-expiratory (aEDCO2) gradients.

Small scale power generation from biomass-technical potential

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lepori, W.A.; Cardenas, M.M.; Carney, O.B.

1983-12-01

System and nursery pig performance data for the Winter of 1983 were collected for a 96-pig capacity modified-open-front (MOF) naturally ventilated and a 96-pig capacity mechanically ventilated swine nurseries. Both nurseries utilized active solar collectors to provide in-floor heating at the rear of each pen along with hovers. The mechanically ventilated nursery utilized solar preheated ventilation air. The naturally ventilated nursery had double glazed solar windows to passively heat the interior space. The relative humidity in the naturally ventilated (NV) nursery averaged 20 percentage points higher than the mechanically ventilated (MV) nursery with no significant differences in air temperature. Themore » MV nursery used 50% more energy than the NV nursery and the NV nursery required 1.9 kWh/pig marketed less than that needed for the MV nursery. Pig performance figure were not significantly different between the two buildings. The feed to gain ration were 2.0 + or - 0.35 and 1.96 + or 0.38 for the MV and NV nurseries respectively.« less

CPAP Devices for Emergency Prehospital Use: A Bench Study.

PubMed

Brusasco, Claudia; Corradi, Francesco; De Ferrari, Alessandra; Ball, Lorenzo; Kacmarek, Robert M; Pelosi, Paolo

2015-12-01

CPAP is frequently used in prehospital and emergency settings. An air-flow output minimum of 60 L/min and a constant positive pressure are 2 important features for a successful CPAP device. Unlike hospital CPAP devices, which require electricity, CPAP devices for ambulance use need only an oxygen source to function. The aim of the study was to evaluate and compare on a bench model the performance of 3 orofacial mask devices (Ventumask, EasyVent, and Boussignac CPAP system) and 2 helmets (Ventukit and EVE Coulisse) used to apply CPAP in the prehospital setting. A static test evaluated air-flow output, positive pressure applied, and FIO2 delivered by each device. A dynamic test assessed airway pressure stability during simulated ventilation. Efficiency of devices was compared based on oxygen flow needed to generate a minimum air flow of 60 L/min at each CPAP setting. The EasyVent and EVE Coulisse devices delivered significantly higher mean air-flow outputs compared with the Ventumask and Ventukit under all CPAP conditions tested. The Boussignac CPAP system never reached an air-flow output of 60 L/min. The EasyVent had significantly lower pressure excursion than the Ventumask at all CPAP levels, and the EVE Coulisse had lower pressure excursion than the Ventukit at 5, 15, and 20 cm H2O, whereas at 10 cm H2O, no significant difference was observed between the 2 devices. Estimated oxygen consumption was lower for the EasyVent and EVE Coulisse compared with the Ventumask and Ventukit. Air-flow output, pressure applied, FIO2 delivered, device oxygen consumption, and ability to maintain air flow at 60 L/min differed significantly among the CPAP devices tested. Only the EasyVent and EVE Coulisse achieved the required minimum level of air-flow output needed to ensure an effective therapy under all CPAP conditions. Copyright © 2015 by Daedalus Enterprises.

A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure

PubMed Central

Chang, Suchi; Shi, Jindong; Fu, Cuiping; Wu, Xu; Li, Shanqun

2016-01-01

Background COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects. Objective We evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure. Patients and methods Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation – volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2–4 hours and 48 hours. Results Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2–4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both); after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05). Vital signs during 2–4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2–4 hours and 48 hours was significantly lower than that in the control group (P<0.05), while other variables were not significantly different between groups (P>0.05). Conclusion Among elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining a low peak inspiratory pressure. PRVC can reduce pulmonary barotrauma risk, making it a safer protective ventilation mode than synchronized intermittent mandatory ventilation – volume control. PMID:27274223

A comparison of synchronized intermittent mandatory ventilation and pressure-regulated volume control ventilation in elderly patients with acute exacerbations of COPD and respiratory failure.

PubMed

Chang, Suchi; Shi, Jindong; Fu, Cuiping; Wu, Xu; Li, Shanqun

2016-01-01

COPD is the third leading cause of death worldwide. Acute exacerbations of COPD may cause respiratory failure, requiring intensive care unit admission and mechanical ventilation. Intensive care unit patients with acute exacerbations of COPD requiring mechanical ventilation have higher mortality rates than other hospitalized patients. Although mechanical ventilation is the most effective intervention for these conditions, invasive ventilation techniques have yielded variable effects. We evaluated pressure-regulated volume control (PRVC) ventilation treatment efficacy and preventive effects on pulmonary barotrauma in elderly COPD patients with respiratory failure. Thirty-nine intubated patients were divided into experimental and control groups and treated with the PRVC and synchronized intermittent mandatory ventilation - volume control methods, respectively. Vital signs, respiratory mechanics, and arterial blood gas analyses were monitored for 2-4 hours and 48 hours. Both groups showed rapidly improved pH, partial pressure of oxygen (PaO2), and PaO2 per fraction of inspired O2 levels and lower partial pressure of carbon dioxide (PaCO2) levels. The pH and PaCO2 levels at 2-4 hours were lower and higher, respectively, in the test group than those in the control group (P<0.05 for both); after 48 hours, blood gas analyses showed no statistical difference in any marker (P>0.05). Vital signs during 2-4 hours and 48 hours of treatment showed no statistical difference in either group (P>0.05). The level of peak inspiratory pressure in the experimental group after mechanical ventilation for 2-4 hours and 48 hours was significantly lower than that in the control group (P<0.05), while other variables were not significantly different between groups (P>0.05). Among elderly COPD patients with respiratory failure, application of PRVC resulted in rapid improvement in arterial blood gas analyses while maintaining a low peak inspiratory pressure. PRVC can reduce pulmonary barotrauma risk, making it a safer protective ventilation mode than synchronized intermittent mandatory ventilation - volume control.

Analgesia and Sedation Requirements in Mechanically Ventilated Trauma Patients With Acute, Preinjury Use of Cocaine and/or Amphetamines.

PubMed

Kram, Bridgette; Kram, Shawn J; Sharpe, Michelle L; James, Michael L; Kuchibhatla, Maragatha; Shapiro, Mark L

2017-03-01

The purpose of this study was to determine whether mechanically ventilated trauma patients with a positive urine drug screen (UDS) for cocaine and/or amphetamines have different opioid analgesic and sedative requirements compared with similar patients with a negative drug screen for these stimulants. This retrospective, single-center cohort study at a tertiary care, academic medical and level 1 trauma center in the United States included patients ≥16 years of age who were admitted to an adult intensive care unit with a diagnosis of trauma between 2009 and 2013 with a UDS documented within 24 hours of admission, and were mechanically ventilated for >24 hours. The primary end point was the daily dose of opioid received during mechanical ventilation, expressed as morphine equivalents, for patients presenting with a positive UDS for cocaine and/or amphetamines compared with patients with a negative UDS for these stimulants. Secondary end points included the daily benzodiazepine dose and median infusion rates of propofol and dexmedetomidine received during mechanical ventilation, duration of mechanical ventilation, intensive care unit and hospital length of stay, and in-hospital mortality. Analgesic and sedative goals were similar for the duration of the study period, and both intermittent and continuous infusions of opioids and sedatives were administered to achieve these targets, although a standardized approach was not used. A multivariate logistic regression analysis and a propensity-adjusted model evaluated patient characteristics predictive of a higher median opioid requirement. A total of 150 patients were included in the final analysis. In a univariate analysis, opioid and sedative requirements were similar for patients presenting with a positive UDS for cocaine and/or amphetamines compared with patients with a negative UDS for these stimulants. In the multivariate regression analysis, increasing age and Abbreviated Injury Scale (head and neck) were associated with decreased daily opioid requirements (odds ratio [OR], .95, 95% confidence interval [CI], .93-.97 and OR, .71, 95% CI, .65-.77, respectively), whereas preinjury stimulant use was not predictive of opioid requirements (OR, .88, 95% CI, .40-1.90). In a propensity score--adjusted model, preinjury stimulant use was similarly not predictive of opioid requirements during mechanical ventilation (OR, .97, 95% CI, .44-2.11). For trauma patients presenting with acute, preinjury use of cocaine and/or amphetamines, analgesic and sedative requirements are variables and may not be greater than those patients presenting with a stimulant-negative UDS to achieve desirable pain control and depth of sedation, although this observation should be interpreted cautiously in light of the wide CI observed in the propensity score--adjusted model. Although unexpected, these findings indicate that empirically increasing analgesic and sedative doses based on positive UDS results for these stimulants may not be necessary.

Research of CO2 concentration in naturally ventilated lecture room

NASA Astrophysics Data System (ADS)

Laska, Marta; Dudkiewicz, Edyta

2017-11-01

Naturally ventilated buildings especially dedicated for educational purposes need to be design to achieve required level of thermal comfort and indoor air quality. It is crucial in terms of both: health and productivity of the room users. Higher requirements of indoor environment are important due to the level of students concentration, their ability to acquire new knowledge and willingness to interact with the lecturer. The article presents the results of experimental study and surveys undertaken in naturally ventilated lecture room. The data is analysed in terms of CO2 concentration and its possible influence on users. Furthermore the outcome of the research is compared with the CO2 concentration models available in the literature.

Noninvasive Ventilation in Premature Neonates.

PubMed

Flanagan, Keri Ann

2016-04-01

The use of noninvasive ventilation is a constantly evolving treatment option for respiratory disease in the premature infant. The goals of these noninvasive ventilation techniques are to improve gas exchange in the premature infant's lungs and to minimize the need for intubation and invasive mechanical ventilation. The goals of this article are to consider various uses of nasal interfaces, discuss skin care and developmental positioning concerns faced by the bedside nurse, and discuss the medical management aimed to reduce morbidity and mortality. This article explores the nursing role, the advances in medical strategies for noninvasive ventilation, and the team approach to noninvasive ventilation use in this population. Search strategy included a literature review on medical databases, such as EBSCOhost, CINAHL, PubMed, and NeoReviews. Innovative products, nursing research on developmental positioning and skin care, and advanced medical management have led to better and safer outcomes for premature infants requiring noninvasive ventilation. The medical focus of avoiding long-term mechanical ventilation would not be possible without the technology to provide noninvasive ventilation to these premature infants and the watchful eye of the nurse in terms of careful positioning, preventing skin breakdown and facial scarring, and a proper seal to maximize ventilation accuracy. This article encourages nursing-based research to quantify some of the knowledge about skin care and positioning as well as research into most appropriate uses for noninvasive ventilation devices.

Inhalation therapy in mechanical ventilation

PubMed Central

Maccari, Juçara Gasparetto; Teixeira, Cassiano; Gazzana, Marcelo Basso; Savi, Augusto; Dexheimer-Neto, Felippe Leopoldo; Knorst, Marli Maria

2015-01-01

Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients. PMID:26578139

Tracheostomy and mechanical ventilation weaning in children affected by respiratory virus according to a weaning protocol in a pediatric intensive care unit in Argentina: an observational restrospective trial

PubMed Central

2011-01-01

We describe difficult weaning after prolonged mechanical ventilation in three tracheostomized children affected by respiratory virus infection. Although the spontaneous breathing trials were successful, the patients failed all extubations. Therefore a tracheostomy was performed and the weaning plan was begun. The strategy for weaning was the decrease of ventilation support combining pressure control ventilation (PCV) with increasing periods of continuous positive airway pressure + pressure support ventilation (CPAP + PSV) and then CPAP + PSV with increasing intervals of T-piece. They presented acute respiratory distress syndrome on admission with high requirements of mechanical ventilation (MV). Intervening factors in the capabilities and loads of the respiratory system were considered and optimized. The average MV time was 69 days and weaning time 31 days. We report satisfactory results within the context of a directed weaning protocol. PMID:21244710

Optimization of Ventilation Energy Demands and Indoor Air Quality in High-Performance Homes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hun, Diana E; Jackson, Mark C; Shrestha, Som S

2014-01-01

High-performance homes require that ventilation energy demands and indoor air quality (IAQ) be simultaneously optimized. We attempted to bridge these two areas by conducting tests in a research house located in Oak Ridge, TN, that was 20 months old, energy-efficient (i.e., expected to consume 50% less energy than a house built per the 2006 IRC), tightly-built (i.e., natural ventilation rate ~0.02 h-1), unoccupied, and unfurnished. We identified air pollutants of concern in the test home that could generally serve as indicators of IAQ, and conduced field experiments and computer simulations to determine the effectiveness and energy required by various techniquesmore » that lessened the concentration of these contaminants. Formaldehyde was selected as the main pollutant of concern among the contaminants that were sampled in the initial survey because it was the only compound that showed concentrations that were greater than the recommended exposure levels. Field data indicate that concentrations were higher during the summer primarily because emissions from sources rise with increases in temperature. Furthermore, supply ventilation and gas-phase filtration were effective means to reduce formaldehyde concentrations; however, exhaust ventilation had minimal influence on this pollutant. Results from simulations suggest that formaldehyde concentrations obtained while ventilating per ASHRAE 62.2-2010 could be decreased by about 20% from May through September through three strategies: 1) increasing ASHRAE supply ventilation by a factor of two, 2) reducing the thermostat setpoint from 76 to 74 F, or 3) running a gas-phase filtration system while decreasing supply ventilation per ASHRAE by half. In the mixed-humid climate of Oak Ridge, these strategies caused increases in electricity cost of ~$5 to ~$15/month depending on outdoor conditions.« less

Intensive care unit readmission during childhood after preterm birth with respiratory failure.

PubMed

Mourani, Peter M; Kinsella, John P; Clermont, Gilles; Kong, Lan; Perkins, Amy M; Weissfeld, Lisa; Cutter, Gary; Linde-Zwirble, Walter T; Abman, Steven H; Angus, Derek C; Watson, R Scott

2014-04-01

To determine the incidence and risk factors for readmission to the intensive care unit (ICU) among preterm infants who required mechanical ventilation at birth. We studied preterm newborns (birth weight 500-1250 g) who required mechanical ventilation at birth and were enrolled in a multicenter trial of inhaled nitric oxide therapy. Patients were assessed up to 4.5 years of age via annual in-person evaluations and structured telephone interviews. Univariate and multivariable analyses of baseline and birth hospitalization predictors of ICU readmission were performed. Of 512 subjects providing follow-up data, 58% were readmitted to the hospital (51% of these had multiple readmissions, averaging 3.9 readmissions per subject), 19% were readmitted to an ICU, and 12% required additional mechanical ventilation support. In univariate analyses, ICU readmission was more common among male subjects (OR 2.01; 95% CI 1.27-3.18), infants with grade 3-4 intracranial hemorrhage (OR 2.13; 95% CI 1.23-3.69), increasing duration of birth hospitalization (OR 1.01 per day; 95% CI 1.00-1.02), and prolonged oxygen therapy (OR 1.01 per day; 95% CI 1.00-1.01). In the first year after birth hospitalization, children readmitted to an ICU incurred greater health care costs (median $69,700 vs $30,200 for subjects admitted to the ward and $9600 for subjects never admitted). Small preterm infants who were mechanically ventilated at birth have substantial risk for readmission to an ICU and late mechanical ventilation, require extensive health care resources, and incur high treatment costs. Copyright © 2014 Mosby, Inc. All rights reserved.

Estimation of energy requirements for mechanically ventilated, critically ill patients using nutritional status

PubMed Central

Kan, Mee-Nin; Chang, Han-Hsin; Sheu, Woei-Fen; Cheng, Chien-Hsiang; Lee, Bor-Jen; Huang, Yi-Chia

2003-01-01

Background There is very little information on what is considered an adequate energy intake for mechanically ventilated, critically ill patients. The purpose of the present study was to determine this energy requirement by making use of patients' nutritional status. Methods The study was conducted in a multidisciplinary intensive care unit of Taichung Veterans General Hospital, Taiwan. Patients were hemodynamically stable and not comatose, and were requiring at least 7 days of mechanical ventilation. Fifty-four patients successfully completed this study. The resting energy expenditure was measured using indirect calorimetry. The total energy requirement was considered 120% of the measured energy expenditure. The daily nutrient intake was recorded. Nutritional status was assessed using single and multiple parameters, nitrogen balance, and medical records, and was performed within 24 hours of admission and after 7 days in the intensive care unit. Results Fifteen patients were being underfed (<90% of total energy requirement), 20 patients were in the appropriate feeding (AF) group (within ± 10% of total energy requirement), and 19 patients received overfeeding (>110% of total energy requirement). Patients in the underfeeding group received only 68.3% of their energy requirement, while the overfeeding group patients received up to 136.5% of their required calories. Only patients in the AF group had a positive nitrogen balance (0.04 ± 5.1) on day 7. AF group patients had a significantly higher Nutritional Risk Index value at day 7 than at day 1. Conclusion AF patients had more improvement in nutritional status than patients in the other feeding groups. To provide at least 120% of the resting energy expenditure seemed adequate to meet the caloric energy needs of hemodynamically stable, mechanically ventilated, critically ill patients. PMID:12974978

Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia

PubMed Central

Valley, Thomas S.; Walkey, Allan J.; Lindenauer, Peter K.; Wiener, Renda Soylemez; Cooke, Colin R.

2016-01-01

Objective Despite increasing use, evidence is mixed as to the appropriate use of noninvasive ventilation in patients with pneumonia. We aimed to determine the relationship between receipt of noninvasive ventilation and outcomes for patients with pneumonia in a real-world setting. Design, Setting, Patients We performed a retrospective cohort study of Medicare beneficiaries (aged > 64 yr) admitted to 2,757 acute-care hospitals in the United States with pneumonia, who received mechanical ventilation from 2010 to 2011. Exposures Noninvasive ventilation versus invasive mechanical ventilation. Measurement and Main Results The primary outcome was 30-day mortality with Medicare reimbursement as a secondary outcome. To account for unmeasured confounding associated with noninvasive ventilation use, an instrumental variable was used—the differential distance to a high noninvasive ventilation use hospital. All models were adjusted for patient and hospital characteristics to account for measured differences between groups. Among 65,747 Medicare beneficiaries with pneumonia who required mechanical ventilation, 12,480 (19%) received noninvasive ventilation. Patients receiving noninvasive ventilation were more likely to be older, male, white, rural-dwelling, have fewer comorbidities, and were less likely to be acutely ill as measured by organ failures. Results of the instrumental variable analysis suggested that, among marginal patients, receipt of noninvasive ventilation was not significantly associated with differences in 30-day mortality when compared with invasive mechanical ventilation (54% vs 55%; p = 0.92; 95% CI of absolute difference, –13.8 to 12.4) but was associated with significantly lower Medicare spending ($18,433 vs $27,051; p = 0.02). Conclusions Among Medicare beneficiaries hospitalized with pneumonia who received mechanical ventilation, noninvasive ventilation use was not associated with a real-world mortality benefit. Given the wide CIs, however, substantial harm associated with noninvasive ventilation could not be excluded. The use of noninvasive ventilation for patients with pneumonia should be cautioned, but targeted enrollment of marginal patients with pneumonia could enrich future randomized trials. PMID:27749319

Low tidal volume mechanical ventilation against no ventilation during cardiopulmonary bypass heart surgery (MECANO): study protocol for a randomized controlled trial.

PubMed

Nguyen, Lee S; Merzoug, Messaouda; Estagnasie, Philippe; Brusset, Alain; Law Koune, Jean-Dominique; Aubert, Stephane; Waldmann, Thierry; Grinda, Jean-Michel; Gibert, Hadrien; Squara, Pierre

2017-12-02

Postoperative pulmonary complications are a leading cause of morbidity and mortality after cardiac surgery. There are no recommendations on mechanical ventilation associated with cardiopulmonary bypass (CPB) during surgery and anesthesiologists perform either no ventilation (noV) at all during CPB or maintain low tidal volume (LTV) ventilation. Indirect evidence points towards better pulmonary outcomes when LTV is performed but no large-scale prospective trial has yet been published in cardiac surgery. The MECANO trial is a single-center, double-blind, randomized, controlled trial comparing two mechanical ventilation strategies, noV and LTV, during cardiac surgery with CPB. In total, 1500 patients are expected to be included, without any restrictions. They will be randomized between noV and LTV on a 1:1 ratio. The noV group will receive no ventilation during CPB. The LTV group will receive 5 breaths/minute with a tidal volume of 3 mL/kg and positive end-expiratory pressure of 5 cmH2O. The primary endpoint will be a composite of all-cause mortality, early respiratory failure defined as a ratio of partial pressure of oxygen/fraction of inspired oxygen <200 mmHg at 1 hour after arrival in the ICU, heavy oxygenation support (defined as a patient requiring either non-invasive ventilation, mechanical ventilation or high-flow oxygen) at 2 days after arrival in the ICU or ventilator-acquired pneumonia defined by the Center of Disease Control. Lung recruitment maneuvers will be performed in the noV and LTV groups at the end of surgery and at arrival in ICU with an insufflation at +30 cmH20 for 5 seconds. Secondary endpoints are those composing the primary endpoint with the addition of pneumothorax, CPB duration, quantity of postoperative bleeding, red blood cell transfusions, revision surgery requirements, length of stay in the ICU and in the hospital and total hospitalization costs. Patients will be followed until hospital discharge. The MECANO trial is the first of its kind to compare in a double-blind design, a no-ventilation to a low-tidal volume strategy for mechanical ventilation during cardiac surgery with CPB, with a primary composite outcome including death, respiratory failure and postoperative pneumonia. ClinicalTrials.gov, NCT03098524 . Registered on 27 February 2017.

Protective ventilation of preterm lambs exposed to acute chorioamnionitis does not reduce ventilation-induced lung or brain injury.

PubMed

Barton, Samantha K; Moss, Timothy J M; Hooper, Stuart B; Crossley, Kelly J; Gill, Andrew W; Kluckow, Martin; Zahra, Valerie; Wong, Flora Y; Pichler, Gerhard; Galinsky, Robert; Miller, Suzanne L; Tolcos, Mary; Polglase, Graeme R

2014-01-01

The onset of mechanical ventilation is a critical time for the initiation of cerebral white matter (WM) injury in preterm neonates, particularly if they are inadvertently exposed to high tidal volumes (VT) in the delivery room. Protective ventilation strategies at birth reduce ventilation-induced lung and brain inflammation and injury, however its efficacy in a compromised newborn is not known. Chorioamnionitis is a common antecedent of preterm birth, and increases the risk and severity of WM injury. We investigated the effects of high VT ventilation, after chorioamnionitis, on preterm lung and WM inflammation and injury, and whether a protective ventilation strategy could mitigate the response. Pregnant ewes (n = 18) received intra-amniotic lipopolysaccharide (LPS) 2 days before delivery, instrumentation and ventilation at 127±1 days gestation. Lambs were either immediately euthanased and used as unventilated controls (LPSUVC; n = 6), or were ventilated using an injurious high VT strategy (LPSINJ; n = 5) or a protective ventilation strategy (LPSPROT; n = 7) for a total of 90 min. Mean arterial pressure, heart rate and cerebral haemodynamics and oxygenation were measured continuously. Lungs and brains underwent molecular and histological assessment of inflammation and injury. LPSINJ lambs had poorer oxygenation than LPSPROT lambs. Ventilation requirements and cardiopulmonary and systemic haemodynamics were not different between ventilation strategies. Compared to unventilated lambs, LPSINJ and LPSPROT lambs had increases in pro-inflammatory cytokine expression within the lungs and brain, and increased astrogliosis (p<0.02) and cell death (p<0.05) in the WM, which were equivalent in magnitude between groups. Ventilation after acute chorioamnionitis, irrespective of strategy used, increases haemodynamic instability and lung and cerebral inflammation and injury. Mechanical ventilation is a potential contributor to WM injury in infants exposed to chorioamnionitis.

A Selected Bibliography on Microbiological Laboratory Design.

ERIC Educational Resources Information Center

Laboratory Design Notes, 1967

1967-01-01

Reference sources on microbiological laboratory design are cited. Subjects covered include--(1) policies and general requirements, (2) ventilated cabinets, (3) animal isolation equipment, (4) air handling, ventilation, and filtration, (5) germicidal ultraviolet irradiation, (6) aerosol test facilities, (7) process production of microorganisms, and…

An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit

PubMed Central

Karatas, Mevlut; Saylan, Sedat; Kostakoglu, Ugur; Yilmaz, Gurdal

2016-01-01

Objectives: Ventilator-associated pneumonia (VAP) is a significant cause of hospital-related infections, one that must be prevented due to its high morbidity and mortality. The purpose of this study was to evaluate the incidence and risk factors in patients developing VAP in our intensive care units (ICUs). Methods: This retrospective cohort study involved in mechanically ventilated patients hospitalized for more than 48 hours. VAP diagnosed patients were divided into two groups, those developing pneumonia (VAP(+)) and those not (VAP(-)).\\ Results: We researched 1560 patients in adult ICUs, 1152 (73.8%) of whom were mechanically ventilated. The MV use rate was 52%. VAP developed in 15.4% of patients. The VAP rate was calculated as 15.7/1000 ventilator days. Mean length of stay in the ICU for VAP(+) and VAP(-) patients were (26.7±16.3 and 18.1±12.7 days (p<0.001)) and mean length of MV use was (23.5±10.3 and 12.6±7.4 days (p<0.001)). High APACHE II and Charlson co-morbidity index scores, extended length of hospitalization and MV time, previous history of hospitalization and antibiotherapy, reintubation, enteral nutrition, chronic obstructive pulmonary disease, cerebrovascular disease, diabetes mellitus and organ failure were determined as significant risk factors for VAP. The mortality rate in the VAP(+) was 65.2%, with 23.6% being attributed to VAP. Conclusion: VAPs are prominent nosocomial infections that can cause considerable morbidity and mortality in ICUs. Patient care procedures for the early diagnosis of patients with a high risk of VAP and for the reduction of risk factors must be implemented by providing training concerning risk factors related to VAP for ICU personnel, and preventable risk factors must be reduced to a minimum. PMID:27648020

Late Glacial-Holocene record of benthic foraminiferal morphogroups from the eastern Arabian Sea OMZ: Paleoenvironmental implications

NASA Astrophysics Data System (ADS)

Verma, K.; Bharti, S. K.; Singh, A. D.

2018-03-01

The Arabian Sea is characterized today by a well-developed and perennial oxygen minimum zone (OMZ) at mid-water depths. The Indian margin where the OMZ impinges provides sediment records ideal to study past changes in the OMZ intensity and its vertical extent in response to the changes of monsoon-driven primary productivity and intermediate water ventilation. Benthic foraminifera, depending upon their adaptation capabilities to variation in sea floor environment and microhabitat preferences, develop various functional morphologies that can be potentially used in paleoenvironmental reconstruction. In this study, we analysed benthic foraminiferal morphogroups in assemblage records of the last 30 ka in a sediment core collected from the lower OMZ of the Indian margin (off Goa). In total, nine morphogroups within two broadly classified epifaunal and infaunal microhabitat categories are identified. The abundance of morphogroups varies significantly during the late Glacial, Deglacial and Holocene. It appears that monsoon wind driven organic matter flux, and water column ventilation governing the OMZ intensity and sea-bottom oxygen condition, have profound influence on structuring the benthic foraminiferal morphogroups. We found a few morphogroups showing major changes in their abundances during the periods corresponding to the northern hemisphere climatic events. Benthic foraminifera with planoconvex tests are abundant during the cold Heinrich events, when the sea bottom was oxygenated due to a better ventilated, weak OMZ; whereas, those having tapered/cylindrical tests dominate during the last glacial maximum and the Holocene between 5 and 8 ka BP, when the OMZ was intensified and poorly ventilated, leading to oxygen-depleted benthic environment. Characteristically, increased abundance of taxa with milioline tests during the Heinrich 1 further suggests enhanced ventilation attributed probably to the influence of oxygen-rich Antarctic Intermediate Water (AAIW).

Controlling factors of the OMZ in the Arabian Sea

NASA Astrophysics Data System (ADS)

Resplandy, L.; Lévy, M.; Bopp, L.; Echevin, V.; Pous, S.; Sarma, V. V. S. S.; Kumar, D.

2012-05-01

In-situ observations indicate that the Arabian Sea oxygen minimum zone (OMZ) is only weakly influenced by the strong seasonal cycle of ocean dynamic and biogeochemistry forced by the asian monsoon system and it is spatially decorrelated from the coastal upwelling systems where the biological production is the strongest. In this study we examine the factors controlling the seasonality and the spatial distribution of the OMZ in the Arabian Sea using a coupled bio-physical model. We find that the oxygen concentration in the OMZ displays a seasonal cycle with an amplitude of 5-15 % of the annual mean oxygen concentration. The OMZ is ventilated by lateral ventilation along the western boundary current and in the coastal undercurrent along India during the summer monsoon and by coastal downwelling and negative Ekman pumping during the fall intermonsoon and winter monsoon. This ventilation is counterbalanced by strong coastal upwelling and positive Ekman pumping of low oxygen waters at the base of the OMZ during the spring intermonsoon. Although the factors controlling the OMZ seasonality are associated with the men circulation, we find that mesoscale dynamics modulates them by limiting the vertical ventilation during winter and enhancing it through lateral advection during the rest of the year. Processes explaining the establishment and spatial distribution of the OMZ were quantified using a perturbation experiment initialised with no OMZ. As expected, the oxygen depletion is triggered by strong biological activity in central Arabian Sea during winter and in western and eastern boundary coastal upwelling systems during summer. We find that the 3-D ocean dynamic largely controls the spatial distribution of the OMZ. The eastward shift ensues from the northward lateral transport of ventilated waters along the western and eastern coasts and the advection offshore of low oxygen waters formed in the upwelling system.

A Study on The Development of Local Exhaust Ventilation System (LEV’s) for Installation of Laser Cutting Machine

NASA Astrophysics Data System (ADS)

Harun, S. I.; Idris, S. R. A.; Tamar Jaya, N.

2017-09-01

Local exhaust ventilation (LEV) is an engineering system frequently used in the workplace to protect operators from hazardous substances. The objective of this project is design and fabricate the ventilation system as installation for chamber room of laser cutting machine and to stimulate the air flow inside chamber room of laser cutting machine with the ventilation system that designed. LEV’s fabricated with rated voltage D.C 10.8V and 1.5 ampere. Its capacity 600 ml, continuously use limit approximately 12-15 minute, overall length LEV’s fabricated is 966 mm with net weight 0.88 kg and maximum airflow is 1.3 meter cubic per minute. Stimulate the air flow inside chamber room of laser cutting machine with the ventilation system that designed and fabricated overall result get 2 main gas vapor which air and carbon dioxide. For air gas which experimented by using anemometer, general duct velocity that produce is same with other gas produce, carbon dioxide which 5 m/s until 10 m/s. Overall result for 5 m/s and 10 m/s as minimum and maximum duct velocity produce for both air and carbon dioxide. The air gas flow velocity that captured by LEV’s fabricated, 3.998 m/s average velocity captured from 5 m/s duct velocity which it efficiency of 79.960% and 7.667 m/s average velocity captured from 10 m/s duct velocity with efficiency of 76.665%. For carbon dioxide gas flow velocity that captured by LEV’s fabricated, 3.674 m/s average velocity captured from 5 m/s duct velocity which it efficiency of 73.480% and 8.255 m/s average velocity captured from 10 m/s duct velocity with efficiency of 82.545%.

Biogeochemical Implications of Recent Changes in the Ventilation of the Japan/East Sea

NASA Astrophysics Data System (ADS)

Jenkins, W. J.

2006-12-01

The Japan/East Sea (JES) is a highly productive marine ecosystem that constitutes an important fisheries resource for a number of nations. As a weakly stratified marginal sea separated from the Pacific Ocean by shallow straits, the ventilation of the abyssal JES is remarkably susceptible to climate change. Not surprisingly, such changes have indeed been noted for the late-glacial and Holocene. Over the past half-century or more, there has been a trend toward increasing deep water temperatures, increasing dissolved inorganic nutrients, and decreasing dissolved oxygen levels that are consistent with a reduction in deep ventilation in recent decades. I present a minimum complexity model of the Japan Sea that utilize observations of the transient tracers CFCs, tritium, and 3He to place useful constraints on the character, magnitude, and timing of these changes. I describe these changes within the context of differing mechanisms for deep water formation and ventilation. The converse of ventilation is the return of deep nutrients to the surface ocean, which in turn forms the basis of the food pyramid, and hence the support for new primary production in this strategically important marginal sea. The tracer constrained model calculations suggest that the primary (convective) supply of inorganic nitrogen to the shallow JES reduced by nearly a factor of two (from 1.7 to 0.9 Tmoles) in the latter half of the 20^th century. I relate the changes in abyssal nutrient reflux to climatic modulation of water mass formation changes, and present the implications for water column remineralization processes. The implications of the large scale changes for the sustenance of fishery stocks is significant.

National Trends (2009-2013) for Palliative Care Utilization for Patients Receiving Prolonged Mechanical Ventilation.

PubMed

Chatterjee, Kshitij; Goyal, Abhinav; Kakkera, Krishna; Harrington, Sarah; Corwin, Howard L

2018-05-04

Patients requiring mechanical ventilation have high morbidity and mortality. Providing palliative care services has been suggested as a way to improve comprehensive management of critically ill patients. We examined the trend in the utilization of palliative care among adults who require prolonged mechanical ventilation. Primary objectives were to determine the trend in palliative care utilization over time, predictors for palliative care utilization, and palliative care impact on hospital length of stay. Retrospective, cross-sectional study. The National Inpatient Sample data between 2009 and 2013 was used for this study. Adults (age ≥ 18 yr) who underwent prolonged mechanical ventilation (≥ 96 consecutive hr) were studied. Palliative care and mechanical ventilation were identified using the corresponding International Classification of Diseases, 9th revision, Clinical Modification, codes. A total of 1,751,870 hospitalizations with prolonged mechanical ventilation were identified between 2009 and 2013. The utilization of palliative care increased yearly from 6.5% in 2009 to 13.1% in 2013 (p < 0.001). Among the mechanically ventilated patients who died, palliative care increased from 15.9% in 2009 to 33.3% in 2013 (p < 0.001). Median hospital length of stay for patients with and without palliative care was 13 and 17 days, respectively (p < 0.001). Patients discharged to either short- or long-term care facilities had a shorter length of stay if palliative care was provided (15 vs 19 d; p < 0.001). The factors associated with a higher palliative care utilization included older age, malignancy, larger hospitals in urban areas, and teaching hospitals. Non-Caucasian race was associated with lower palliative care utilization. Among patients who undergo prolonged mechanical ventilation, palliative care utilization is increasing, particularly in patients who die during hospitalization. Using palliative care for mechanically ventilated patients who are discharged to either short- or long-term care facilities is associated with a shorter hospital length of stay.

Radio-frequency tracking of respiratory equipment: rationale and early experience at the Cleveland Clinic.

PubMed

Stoller, James K; Roberts, Vincent; Matt, David; Chom, Leslie; Sasidhar, Madhu; Chatburn, Robert L

2013-12-01

When respiratory therapists (RTs) seek respiratory care equipment, finding it quickly is desirable, both to expedite patient care and to avert RTs wasting time. To optimize RTs' ability to quickly locate ventilators, we developed and implemented a radio-frequency identification (RFID) tagging system called eTrak. The Clinical Engineering and Information Technology groups at Cleveland Clinic collaboratively developed a Wi-Fi-based RFID program that used active RFID tags. Altogether, 218 ventilators, 82 noninvasive ventilators, and various non-respiratory equipment were tagged, beginning in March 2010. We calculated the difference in time required to locate equipment before versus after implementation. The eTrak system had a mean 145 log-ons per week over the first year of use, and was associated with a decreased time required for RTs to locate ventilators: median 18 min (range 1-45 min) versus 3 min (range 1-6 min) (P < .001). Surveys of RTs regarding whether equipment was hard to find before versus after implementing eTrak showed a non-significant trend toward improvement. An RFID tracking system for respiratory equipment shortened the time to locate ventilators and non-significantly improved RT satisfaction with finding equipment. RFID tagging of equipment warrants further investigation.

Liquid ventilation.

PubMed

Sarkar, Suman; Paswan, Anil; Prakas, S

2014-01-01

Human have lungs to breathe air and they have no gills to breath liquids like fish. When the surface tension at the air-liquid interface of the lung increases as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV) is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen as the inert carrier of oxygen and carbon dioxide offers a number of advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. It is well-known that respiratory diseases are one of the most common causes of morbidity and mortality in intensive care unit. During the past few years several new modalities of treatment have been introduced. One of them and probably the most fascinating, is of LV. Partial LV, on which much of the existing research has concentrated, requires partial filling of lungs with perfluorocarbons (PFC's) and ventilation with gas tidal volumes using conventional mechanical ventilators. Various physico-chemical properties of PFC's make them the ideal media. It results in a dramatic improvement in lung compliance and oxygenation and decline in mean airway pressure and oxygen requirements. No long-term side-effect reported.

Post-hypercapnic alkalosis is associated with ventilator dependence and increased ICU stay.

PubMed

Banga, Amit; Khilnani, G C

2009-12-01

Posthypercapnic alkalosis (PHA) is frequently overlooked as a complication of mechanical ventilation in patients with exacerbation of chronic obstructive pulmonary disease (COPD). The current study was conducted to determine the incidence, risk factors for development and effect on outcome of PHA. Eighty-four patients (62 +/- 11 years, range 42-78 years, M:F 58: 26) with exacerbation of COPD with underlying chronic hypercapnic respiratory failure requiring mechanical ventilation were included in a retrospective fashion. PHA was defined as static or rising serum bicarbonate levels, 72 hours or more after return of PaCO2 to baseline, with concurrent pH > 7.44. Development of PHA was noted in 17 patients (20.2%). Corticosteroid use >or=10 days during the hospital stay was an independent risk factor for development of PHA (Adjusted OR, 95% CI: 9.4, 1.6-55.3; P = 0.013). Development of PHA was associated with an increased incidence of ventilator dependence (64.7% vs. 37.3%, OR, 95% CI: 3.1, 1.1-9.4, P = 0.04) and duration of ICU stay (14.7 +/- 6.7 vs. 9.5 +/- 5.9, P = 0.01) but no increase in hospital mortality (43.3% vs. 41.2%, P = NS). It is concluded that PHA is a common complication in patients with exacerbation of COPD requiring mechanical ventilation and is associated with increased incidence of ventilator dependence and ICU stay.

Analysis and Design of Crew Sleep Station for ISS

NASA Technical Reports Server (NTRS)

Keener, John F.; Paul, Thomas; Eckhardt, Bradley; Smith, Fredrick

2002-01-01

This paper details the analysis and design of the Temporary Sleep Station (TeSS) environmental control system for International Space Station (ISS). The TeSS will provide crewmembers with a private and personal space, to accommodate sleeping, donning and doffing of clothing, personal communication and performance of recreational activities. The need for privacy to accommodate these activities requires adequate ventilation inside the TeSS. This study considers whether temperature, carbon dioxide, and humidity within the TeSS remain within crew comfort and safety levels for various expected operating scenarios. Evaluation of these scenarios required the use and integration of various simulation codes. An approach was adapted for this study, whereby results from a particular code were integrated with other codes when necessary. Computational Fluid Dynamics (CFD) methods were used to evaluate the flow field inside the TeSS, from which local gradients for temperature, velocity, and species concentration such as CO (sub 2) could be determined. A model of the TeSS, containing a human, as well as equipment such as a laptop computer, was developed in FLUENT, a finite-volume code. Other factors, such as detailed analysis of the heat transfer through the structure, radiation, and air circulation from the TeSS to the US Laboratory Aisle, where the TeSS is housed, were considered in the model. A complementary model was developed in G189A, a code which has been used by NASA/JSC for environmental control systems analyses since the Apollo program. Boundary conditions were exchanged between the FLUENT and G189A TeSS models. G189A provides human respiration rates to the FLUENT model, while the FLUENT model provides local convective heat transfer coefficients to G189A model. An additional benefit from using an approach with both a systems simulation and CFD model, is the capability to verify the results of each model by comparison to the results of the other model. The G189A and FLUENT models were used to evaluate various ventilation designs for the TeSS over a range of operating conditions with varying crew metabolic load, equipment operating modes, ventilation flow rates, and with the TeSS doors open and closed. Results from the study were instrumental in the optimization of a design for the TeSS ventilation hardware. A special case was considered where failure of the TeSS ventilation system occurred. In this case, a study was conducted in order to determine the time required for the CO (sub 2) concentration inside the TeSS to increase to ISS limit values under transient conditions. A lumped-capacitance code, SINDA-FLUINT was used in this case to provide accurate predictions of the human reaction to the TeSS cabin conditions including core and skin temperatures and body heat storage. A simple two-dimensional CFD model of a crewmember inside the TeSS was developed in FLUENT in order to determine the volume envelope of the respired air from the human, which maintained a minimum velocity profile. This volume was then used in the SINDA-FLUINT model to facilitate the calculations of CO (sub 2) concentrations, dry bulb temperatures and humidity levels inside the TeSS.

Minimum oxygen flow needed for vital support during simulated post-cardiorespiratory arrest resuscitation.

PubMed

Sanz-Sanjosé, E; Ariño Irujo, J J; Sánchez Martín, C E; González Perrino, C; López-Timoneda, F

2016-05-01

According to the ERC and the AHA guidelines, FiO2 should be titrated to achieve an O2Sat ≥ 94%. The aim of this study was to determine the minimum oxygen flow and time needed to reach an FiO2 of 0.32 and 0.80 during post-cardiac arrest care. An experimental analysis was performed that consisted of a simulated post-cardiac arrest situation. Different resuscitators were tested and connected to an artificial lung: Mark IV, SPUR II, Revivator Res-Q, O-TWO. The oxygen flow levels tested were 2, 5, 10 and 15 lpm. Bonferroni and Mann-Whitney U tests were used. An FiO2 of 0.32 or more was obtained using any of the oxygen flow and resuscitators. Only the Mark IV achieved an FiO2 of 0.80 after a minimum of 75s ventilating with 2 or 5 lpm. Clinical and statistical differences (P<.05) were found: at 15 lpm it took 35s to reach an FiO2 of 0.80 or more for Mark IV (85.6 [0.3]) and Revivator (84.3 [1.5]) compared to 50s for SPUR II (87.1 [6.4]); at 2 lpm, all of the devices reached an FiO2 of ≥ 0.32 at 30s(Mark IV (34.8 [1.3]), Revivator (35.7 [1.5]) and SPUR II (34.4 [2.1]), except for O-TWO, which took 35s (36.3 [4.3]). Patients could be ventilated with any of the resuscitators using 2 lpm to obtain an FiO2 of 0.32, although possibly O-TWO would be the last option during the first 60s. In order to reach an FiO2 of 0.80, ventilating with 10 lpm should be sufficient, and preferably using Mark IV or Revivator Res-Q. In conclusion, on observing the results of our study, in any possible scenario, it would be advisable to use Revivator Res-Q or Mark IV rather than O-TWO or SPUR II. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Performance and Life Tests of a Regenerative Blower for EVA Suit Ventilation

NASA Technical Reports Server (NTRS)

Izenson, Michael G.; Chen, Weibo; McCormick, John; Paul, Heather L.; Jennings, Mallory A.

2012-01-01

Ventilation fans for future space suits must meet demanding performance specifications, satisfy stringent safety requirements for operation in an oxygen atmosphere, and be able to increase output to operate in buddy mode. A regenerative blower is an attractive choice due to its ability to meet these requirements at low operating speed. This paper describes progress in the development and testing of a regenerative blower designed to meet requirements for ventilation subsystems in future space suits. The blower includes a custom-designed motor that has significantly improved its efficiency. We have measured the blower s head/flow performance and power consumption under conditions that simulate both the normal and buddy mode operating points. We have operated the blower for TBD hours and demonstrated safe operation in an oxygen test loop at prototypical pressures. We also demonstrated operation with simulated lunar dust.

Performance and Life Tests of a Regenerative Blower for EVA Suit Ventilation

NASA Technical Reports Server (NTRS)

Izenson, Mike; Chen, Weibo; Paul, Heather L.; Jennings, Mallory A.

2011-01-01

Ventilation fans for future space suits must meet demanding performance specifications, satisfy stringent safety requirements for operation in an oxygen atmosphere, and be able to increase output to operate in buddy mode. A regenerative blower is an attractive choice due to its ability to meet these requirements at low operating speed. This paper describes progress in the development and testing of a regenerative blower designed to meet requirements for ventilation subsystems in a future space suit Portable Life Support Systems (PLSS). The blower assembly includes a custom-designed motor that has significantly improved in efficiency during this development effort. The blower was tested at both nominal and buddy mode operating points and head/flow performance and power consumption were measured. The blower was operated for over 1000 hours to demonstrate safe operation in an oxygen test loop at prototypical pressures. In addition, the blower demonstrated operation with the introduction of simulated lunar dust.

Extra corporeal membrane oxygenation to facilitate lung protective ventilation and prevent ventilator-induced lung injury in severe Pneumocystis pneumonia with pneumomediastinum: a case report and short literature review.

PubMed

Ali, Husain Shabbir; Hassan, Ibrahim Fawzy; George, Saibu

2016-04-14

Pulmonary infections caused by Pneumocystis jirovecii in immunocompromised host can be associated with cysts, pneumatoceles and air leaks that can progress to pneumomediastinum and pneumothoraxes. In such cases, it can be challenging to maintain adequate gas exchange by conventional mechanical ventilation and at the same time prevent further ventilator-induced lung injury. We report a young HIV positive male with poorly compliant lungs and pneumomediastinum secondary to severe Pneumocystis infection, rescued with veno-venous extra corporeal membrane oxygenation (V-V ECMO). A 26 year old male with no significant past medical history was admitted with fever, cough and shortness of breath. He initially required non-invasive ventilation for respiratory failure. However, his respiratory function progressively deteriorated due to increasing pulmonary infiltrates and development of pneumomediastinum, eventually requiring endotracheal intubation and invasive ventilation. Despite attempts at optimizing gas exchange by ventilatory maneuvers, patients' pulmonary parameters worsened necessitating rescue ECMO therapy. The introduction of V-V ECMO facilitated the use of ultra-protective lung ventilation and prevented progression of pneumomediastinum, maintaining optimal gas exchange. It allowed time for the antibiotics to show effect and pulmonary parenchyma to heal. Further diagnostic workup revealed Pneumocystis jirovecii as the causative organism for pneumonia and serology confirmed Human Immunodeficiency Virus infection. Patient was successfully treated with appropriate antimicrobials and de-cannulated after six days of ECMO support. ECMO was an effective salvage therapy in HIV positive patient with an otherwise fatal respiratory failure due to Pneumocystis pneumonia and air leak syndrome.

"Living with dying": the evolution of family members' experience of mechanical ventilation.

PubMed

Sinuff, Tasnim; Giacomini, Mita; Shaw, Rhona; Swinton, Marilyn; Cook, Deborah J

2009-01-01

Communication with families about mechanical ventilation may be more effective once we gain a better understanding of what families experience and understand about this life support technology when their loved ones are admitted to the intensive care unit (ICU). We conducted in-depth interviews with family members of 27 critically ill patients who required mechanical ventilation for > or = 7 days and had an estimated ICU mortality of > or = 50%. Team members reviewed transcripts independently and used grounded theory analysis. The central theme of family members' experience with mechanical ventilation was "living with dying." Initial reactions to the ventilator were of shock and surprise. Family members perceived no option except mechanical ventilation. Although the ventilator kept the patient alive, it also symbolized proximity to death. In time, families became accustomed to images of the ICU as ventilation became more familiar and routine. Their shock and horror were replaced by hope that the ventilator would allow the body to rest, heal, and recover. However, ongoing exposure to their loved one's critical illness and the new role as family spokesperson were traumatizing. Family members' experiences and their understanding of mechanical ventilation change over time, influenced by their habituation to the ICU environment and its routines. They face uncertainty about death, but maintain hope. Understanding these experiences may engender more respectful, meaningful communication about life support with families.

The effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation.

PubMed

Bousarri, Mitra Payami; Shirvani, Yadolah; Agha-Hassan-Kashani, Saeed; Nasab, Nouredin Mousavi

2014-05-01

In patients undergoing mechanical ventilation, mucus production and secretion is high as a result of the endotracheal tube. Because endotracheal suction in these patients is essential, chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretion and improving alveolar ventilation. As one of the complications of mechanical ventilation and endotracheal suctioning is decrease of cardiac output, this study was carried out to determine the effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation. This study was a randomized clinical trial with a crossover design. The study subjects included 50 mechanically ventilated patients, hospitalized in intensive care wards of Valiasr and Mousavi hospitals in Zanjan, Iran. Subjects were selected by consecutive sampling and randomly allocated to groups 1 and 2. The patients received endotracheal suctioning with or without rib cage compression, with a minimum of 3 h interval between the two interventions. Expiratory rib cage compression was performed for 5 min before endotracheal suctioning. Vital signs were measured 5 min before and 15 and 25 min after endotracheal suctioning. Data were recorded on a data recording sheet. Data were analyzed using paired t-tests. There were statistically significant differences in the means of vital signs measured 5 min before with 15 and 25 min after endotracheal suctioning with rib cage compression (P < 0. 01). There was no significant difference in the means of diastolic pressure measured 25 min after with baseline in this stage). But on the reverse mode, there was a significant difference between the means of pulse and respiratory rate 15 min after endotracheal suctioning and the baseline values (P < 0.002). This effect continued up to 25 min after endotracheal suctioning just for respiratory rate (P = 0.016). Moreover, there were statistically significant differences in the means of vital signs measured 5 min before and 15 min after endotracheal suctioning between the two methods (P ≤ 0001). Findings showed that expiratory rib cage compression before endotracheal suctioning improves the vital signs to normal range in patients under mechanical ventilation. More studies are suggested on performing expiratory rib cage compression before endotracheal suctioning in patients undergoing mechanical ventilation.

pRotective vEntilation with veno-venouS lung assisT in respiratory failure: A protocol for a multicentre randomised controlled trial of extracorporeal carbon dioxide removal in patients with acute hypoxaemic respiratory failure.

PubMed

McNamee, J J; Gillies, M A; Barrett, N A; Agus, A M; Beale, R; Bentley, A; Bodenham, A; Brett, S J; Brodie, D; Finney, S J; Gordon, A J; Griffiths, M; Harrison, D; Jackson, C; McDowell, C; McNally, C; Perkins, G D; Tunnicliffe, W; Vuylsteke, A; Walsh, T S; Wise, M P; Young, D; McAuley, D F

2017-05-01

One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO 2 R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO 2 R in patients with acute hypoxaemic respiratory failure. Patients requiring intubation and mechanical ventilation for acute hypoxaemic respiratory failure will be randomly allocated to receive either vv-ECCO 2 R and lower tidal volume mechanical ventilation or standard care with stratification by recruitment centre. There is a need for a large randomised controlled trial to establish whether vv-ECCO 2 R in acute hypoxaemic respiratory failure can allow the use of a more protective lung ventilation strategy and is associated with improved patient outcomes.

Mine fire experiments and simulation with MFIRE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Laage, L.W.; Yang, Hang

1995-12-31

A major concern of mine fires is the heat generated ventilation disturbances which can move products of combustion (POC) through unexpected passageways. Fire emergency planning requires simulation of the interaction of the fire and ventilation system to predict the state of the ventilation system and the subsequent distribution of temperatures and POC. Several computer models were developed by the U.S. Bureau of Mines (USBM) to perform this simulation. The most recent, MFIRE, simulates a mine`s ventilation system and its response to altered ventilation parameters such as the development of new mine workings or changes in ventilation control structures, external influencemore » such as varying outside temperatures, and internal influences such as fires. Extensive output allows quantitative analysis of the effects of the proposed alteration to die ventilation system. This paper describes recent USBM research to validate MFIRE`s calculation of temperature distribution in an airway due to a mine fire, as temperatures are the most significant source of ventilation disturbances. Fire tests were conducted at the Waldo Mine near Magdalena, NM. From these experiments, temperature profiles were developed as functions of time and distance from the fire and compared with simulations from MFIRE.« less

Persistent pulmonary hypertension of the newborn.

PubMed

Nair, P M C; Bataclan, Maria Flordeliz A

2004-06-01

This article attempts to define a complicated, yet not rare disease of the neonate, which presents with extreme hypoxemia due to increased pulmonary vascular resistance, resulting in diversion of the pulmonary venous blood through persistent fetal channels, namely ductus arteriosus and foramen ovale. Pathophysiology, diagnostic approach and the various modalities of management are analyzed. Persistent pulmonary hypertension of the newborn is multi-factorial, which is reflected in the management as well. These babies are extremely labile to hypoxia and should be stabilized with minimum handling. One hundred percent oxygen and ventilation are the mainstay of treatment. The role of hyperventilation, alkalinization, various non-specific vasodilators such as tolazoline, magnesium sulphate, selective vasodilators such as inhaled nitric oxide, adenosine and the role of high frequency oscillatory ventilation and extra corporeal membrane oxygenation are discussed. With the newer modalities of management, the outlook has improved with mortality of less than 20% and fewer long-term deficits.

Multi-objective aerodynamic shape optimization of small livestock trailers

NASA Astrophysics Data System (ADS)

Gilkeson, C. A.; Toropov, V. V.; Thompson, H. M.; Wilson, M. C. T.; Foxley, N. A.; Gaskell, P. H.

2013-11-01

This article presents a formal optimization study of the design of small livestock trailers, within which the majority of animals are transported to market in the UK. The benefits of employing a headboard fairing to reduce aerodynamic drag without compromising the ventilation of the animals' microclimate are investigated using a multi-stage process involving computational fluid dynamics (CFD), optimal Latin hypercube (OLH) design of experiments (DoE) and moving least squares (MLS) metamodels. Fairings are parameterized in terms of three design variables and CFD solutions are obtained at 50 permutations of design variables. Both global and local search methods are employed to locate the global minimum from metamodels of the objective functions and a Pareto front is generated. The importance of carefully selecting an objective function is demonstrated and optimal fairing designs, offering drag reductions in excess of 5% without compromising animal ventilation, are presented.

Dynamics of tropical oxygen minium zones (OMZ): The role of vertical mixing and eddy stirring in ventilating the OMZ in the tropical Atlantic

NASA Astrophysics Data System (ADS)

Visbeck, M.; Banyte, D.; Brandt, P.; Dengler, M.; Fischer, T.; Karstensen, J.; Krahmann, G.; Tanhua, T. S.; Stramma, L.

2013-12-01

Equatorial Dynamics provide an essential influence on the ventilation pathways of well oxygenated surface water on their route to tropical oxygen minimum zones (OMZ). The large scale wind driven circulation shield OMZs from the direct ventilation pathways. They are located in the so called ';shadow zones' equator ward of the subtropical gyres. From what is known most of the oxygen is supplied via pathways from the western boundary modulated by the complex zonal equatorial current system and marginally by vertical mixing. What was less clear is which of the possible pathways are most effective in transporting dissolved oxygen towards the OMZ. A collaborative research program focused on the dynamics of oxygen minimum zones, called SFB754 "Climate - Biogeochemistry Interactions in the Tropical Ocean", allowed us to conduct two ocean tracer release experiments to investigate the vertical and horizontal mixing rates and associated oxygen transports. Specifically we report on the first deliberate tracer release experiment (GUTRE, Guinea Upwelling Tracer Release Experiment) in the tropical northeast Atlantic carried out in order to determine the diapycnal diffusivity coefficient in the upper layer of the OMZ. A tracer (CF3SF5) was injected in spring of 2008 and subsequently measured during three designated tracer survey cruises until the end of 2010. We found that, generally, the diffusivity is larger than expected for low latitudes and similar in magnitude to what has previously been experimentally determined in the Canary Basin. When combining the tracer study with estimates of diapycnal mixing based on microstructure profiling and a newly developed method using ship board ADCPs we were able to compute the vertical oxygen flux and its divergence for the OMZ. To our surprise, the vertical flux of oxygen by diapycnal mixing provides about 30% of the total ventilation. The estimate was derived from the simple advection-diffusion model taking into account moored and ship based velocity observations of the equatorial current systems along 23°W in the tropical Atlantic. However, the advective pathways are less certain and possibly more variable. Firstly, the strength of lateral eddy stirring and the role in oxygen transport is less well known, and is the focus of the ongoing second tracer release experiment (OSTRE, Oxygen Supply Tracer Release Experiment). Secondly, the analysis of historical data from the equatorial regime suggests that the observed decline in dissolved oxygen in the tropical North Atlantic might in part be a consequence of reduced horizontal ventilation by equatorial intermediate current systems. The uncertainty of the long-term variability of the circulation in the equatorial systems and additional uncertainty in the biogeochemical consumption rates provide a challenge for estimates of the future of the OMZ regimes. Model prediction of future oxygen changes depend on the models ability to reproduce the observed oxygen ventilation pathways and processes, which might limit the prediction's accuracy.

Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics.

PubMed

Kheterpal, Sachin; Martin, Lizabeth; Shanks, Amy M; Tremper, Kevin K

2009-04-01

There are no existing data regarding risk factors for impossible mask ventilation and limited data regarding its incidence. The authors sought to determine the incidence, predictors, and outcomes associated with impossible mask ventilation. The authors performed an observational study over a 4-yr period. For each adult patient undergoing a general anesthetic, preoperative patient characteristics, detailed airway physical exam, and airway outcome data were collected. The primary outcome was impossible mask ventilation defined as the inability to exchange air during bag-mask ventilation attempts, despite multiple providers, airway adjuvants, or neuromuscular blockade. Secondary outcomes included the final, definitive airway management technique and direct laryngoscopy view. The incidence of impossible mask ventilation was calculated. Independent (P < 0.05) predictors of impossible mask ventilation were identified by performing a logistic regression full model fit. Over a 4-yr period from 2004 to 2008, 53,041 attempts at mask ventilation were recorded. A total of 77 cases of impossible mask ventilation (0.15%) were observed. Neck radiation changes, male sex, sleep apnea, Mallampati III or IV, and presence of beard were identified as independent predictors. The receiver-operating-characteristic area under the curve for this model was 0.80 +/- 0.03. Nineteen impossible mask ventilation patients (25%) also demonstrated difficult intubation, with 15 being intubated successfully. Twelve patients required an alternative intubation technique, including two surgical airways and two patients who were awakened and underwent successful fiberoptic intubation. Impossible mask ventilation is an infrequent airway event that is associated with difficult intubation. Neck radiation changes represent the most significant clinical predictor of impossible mask ventilation in the patient dataset.

Ocean (de)oxygenation from the Last Glacial Maximum to the twenty-first century: insights from Earth System models.

PubMed

Bopp, L; Resplandy, L; Untersee, A; Le Mezo, P; Kageyama, M

2017-09-13

All Earth System models project a consistent decrease in the oxygen content of oceans for the coming decades because of ocean warming, reduced ventilation and increased stratification. But large uncertainties for these future projections of ocean deoxygenation remain for the subsurface tropical oceans where the major oxygen minimum zones are located. Here, we combine global warming projections, model-based estimates of natural short-term variability, as well as data and model estimates of the Last Glacial Maximum (LGM) ocean oxygenation to gain some insights into the major mechanisms of oxygenation changes across these different time scales. We show that the primary uncertainty on future ocean deoxygenation in the subsurface tropical oceans is in fact controlled by a robust compensation between decreasing oxygen saturation (O 2sat ) due to warming and decreasing apparent oxygen utilization (AOU) due to increased ventilation of the corresponding water masses. Modelled short-term natural variability in subsurface oxygen levels also reveals a compensation between O 2sat and AOU, controlled by the latter. Finally, using a model simulation of the LGM, reproducing data-based reconstructions of past ocean (de)oxygenation, we show that the deoxygenation trend of the subsurface ocean during deglaciation was controlled by a combination of warming-induced decreasing O 2sat and increasing AOU driven by a reduced ventilation of tropical subsurface waters.This article is part of the themed issue 'Ocean ventilation and deoxygenation in a warming world'. © 2017 The Author(s).

Ocean (de)oxygenation from the Last Glacial Maximum to the twenty-first century: insights from Earth System models

NASA Astrophysics Data System (ADS)

Bopp, L.; Resplandy, L.; Untersee, A.; Le Mezo, P.; Kageyama, M.

2017-08-01

All Earth System models project a consistent decrease in the oxygen content of oceans for the coming decades because of ocean warming, reduced ventilation and increased stratification. But large uncertainties for these future projections of ocean deoxygenation remain for the subsurface tropical oceans where the major oxygen minimum zones are located. Here, we combine global warming projections, model-based estimates of natural short-term variability, as well as data and model estimates of the Last Glacial Maximum (LGM) ocean oxygenation to gain some insights into the major mechanisms of oxygenation changes across these different time scales. We show that the primary uncertainty on future ocean deoxygenation in the subsurface tropical oceans is in fact controlled by a robust compensation between decreasing oxygen saturation (O2sat) due to warming and decreasing apparent oxygen utilization (AOU) due to increased ventilation of the corresponding water masses. Modelled short-term natural variability in subsurface oxygen levels also reveals a compensation between O2sat and AOU, controlled by the latter. Finally, using a model simulation of the LGM, reproducing data-based reconstructions of past ocean (de)oxygenation, we show that the deoxygenation trend of the subsurface ocean during deglaciation was controlled by a combination of warming-induced decreasing O2sat and increasing AOU driven by a reduced ventilation of tropical subsurface waters. This article is part of the themed issue 'Ocean ventilation and deoxygenation in a warming world'.

Mechanical ventilation for severe asthma.

PubMed

Leatherman, James

2015-06-01

Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting.

A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

PubMed Central

2012-01-01

Background Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality. Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation. Results We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. Conclusion These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored. PMID:23020101

A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting.

PubMed

Caserta, Raquel A; Marra, Alexandre R; Durão, Marcelino S; Silva, Cláudia Vallone; Pavao dos Santos, Oscar Fernando; Neves, Henrique Sutton de Sousa; Edmond, Michael B; Timenetsky, Karina Tavares

2012-09-29

Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality. A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement's (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation. We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.

Testing of mechanical ventilators and infant incubators in healthcare institutions.

PubMed

Badnjevic, Almir; Gurbeta, Lejla; Jimenez, Elvira Ruiz; Iadanza, Ernesto

2017-01-01

The medical device industry has grown rapidly and incessantly over the past century. The sophistication and complexity of the designed instrumentation is nowadays rising and, with it, has also increased the need to develop some better, more effective and efficient maintenance processes, as part of the safety and performance requirements. This paper presents the results of performance tests conducted on 50 mechanical ventilators and 50 infant incubators used in various public healthcare institutions. Testing was conducted in accordance to safety and performance requirements stated in relevant international standards, directives and legal metrology policies. Testing of output parameters for mechanical ventilators was performed in 4 measuring points while testing of output parameters for infant incubators was performed in 7 measuring points for each infant incubator. As performance criteria, relative error of output parameters for mechanical ventilators and absolute error of output parameters for infant incubators was calculated. The ranges of permissible error, for both groups of devices, are regulated by the Rules on Metrological and Technical Requirements published in the Official Gazette of Bosnia and Herzegovina No. 75/14, which are defined based on international recommendations, standards and guidelines. All ventilators and incubators were tested by etalons calibrated in an ISO 17025 accredited laboratory, which provides compliance to international standards for all measured parameters.The results show that 30% of the tested medical devices are not operating properly and should be serviced, recalibrated and/or removed from daily application.

Caloric Requirements of Patients With Brain Impairment and Cerebral Palsy Who Are Dependent on Chronic Ventilation.

PubMed

Gale, Rena; Namestnic, Julia; Singer, Pierre; Kagan, Ilya

2017-11-01

Israeli law mandates chronic ventilator support for children and adolescents who are severely brain impaired and show minimal responses. Feeding protocols in these cases have been based on the caloric requirements of healthy children, deducting calories for lack of activity as well as an individual adjustment according to the cerebral palsy growth curves. However, patients are still inclined to gain excessive weight. Our objective was to determine the caloric requirements of these patients. Sixteen patients hospitalized in a dedicated unit who were ventilated through tracheostomies and fed via gastrostomies were included. Patients were aged 3-24 years; duration of ventilation was 1-7.5 years; and diagnoses included congenital genetic or brain malformations (n = 9), hypoxic accidents (n = 4), and postbacterial or postviral encephalitis (n = 3). Resting energy expenditure (REE) was determined by indirect calorimetry. REE values were compared with the caloric requirements of age-comparable healthy children and the calories actually delivered. Data were analyzed with paired t tests, Pearson correlations, and linear regression. The REE of our patients was 46% lower than the estimated caloric requirements of healthy children. In practice, patients received 32% more calories than that measured by REE. These findings were not affected by age, weight, diagnosis, or length of hospitalization. The caloric expenditure of these patients is very low. A diet guided by indirect calorimetry is proposed to aid in providing optimal nutrition support for this unique population to avoid overfeeding and obesity.

Outcome of Patients with Systemic Sclerosis in the Intensive Care Unit.

PubMed

Pène, Frédéric; Hissem, Tarik; Bérezné, Alice; Allanore, Yannick; Geri, Guillaume; Charpentier, Julien; Avouac, Jérôme; Guillevin, Loïc; Cariou, Alain; Chiche, Jean-Daniel; Mira, Jean-Paul; Mouthon, Luc

2015-08-01

Patients with systemic sclerosis (SSc) are prone to disease-specific or treatment-related life-threatening complications that may warrant intensive care unit (ICU) admission. We assessed the characteristics and current outcome of patients with SSc admitted to the ICU. We performed a single-center retrospective study over 6 years (November 2006-December 2012). All patients with SSc admitted to the ICU were enrolled. Short-term (in-ICU and in-hospital) and longterm (6-mo and 1-yr) mortality rates were studied, and the prognostic factors were analyzed. Forty-one patients with a median age of 50 years [interquartile range (IQR) 40-65] were included. Twenty-nine patients (72.5%) displayed diffuse cutaneous SSc. The time from diagnosis to ICU admission was 78 months (IQR 34-128). Twenty-eight patients (71.7%) previously had pulmonary fibrosis, and 12 (31.5%) had pulmonary hypertension. The main reason for ICU admission was acute respiratory failure in 27 patients (65.8%). Noninvasive ventilation was first attempted in 13 patients (31.7%) and was successful in 8 of them, whereas others required endotracheal intubation within 24 h. Altogether, 13 patients (31.7%) required endotracheal intubation and mechanical ventilation. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 31.8%, 39.0%, 46.4%, and 61.0%, respectively. Invasive mechanical ventilation was the worst prognostic factor, associated with an in-hospital mortality rate of 84.6%. This study provides reliable prognostic data in patients with SSc who required ICU admission. The devastating outcome of invasive mechanical ventilation in patients with SSc requires a reappraisal of indications for ICU admission and early identification of patients likely to benefit from noninvasive ventilation.

The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation.

PubMed

Lecuyer, Lucien; Chevret, Sylvie; Thiery, Guillaume; Darmon, Michael; Schlemmer, Benoît; Azoulay, Elie

2007-03-01

Cancer patients requiring mechanical ventilation are widely viewed as poor candidates for intensive care unit (ICU) admission. We designed a prospective study evaluating a new admission policy titled The ICU Trial. Prospective study. Intensive care unit. One hundred eighty-eight patients requiring mechanical ventilation and having at least one other organ failure. Over a 3-yr period, all patients with hematologic malignancies or solid tumors proposed for ICU admission underwent a triage procedure. Bedridden patients and patients in whom palliative care was the only cancer treatment option were not admitted to the ICU. Patients at earliest phase of the malignancy (diagnosis < 30 days) were admitted without any restriction. All other patients were prospectively included in The ICU Trial, consisting of a full-code ICU admission followed by reappraisal of the level of care on day 5. Among the 188 patients, 103 survived the first 4 ICU days and 85 died from the acute illness. Hospital survival was 21.8% overall. Among the 103 survivors on day 5, none of the characteristics of the malignancy were significantly different between the 62 patients who died and the 41 who survived. Time course of organ dysfunction over the first 6 ICU days differed significantly between survivors and nonsurvivors. Organ failure scores were more accurate on day 6 than at admission or on day 3 for predicting survival. All patients who required initiation of mechanical ventilation, vasopressors, or dialysis after 3 days in the ICU died. Survival was 40% in mechanically ventilated cancer patients who survived to day 5 and 21.8% overall. If these results are confirmed in future interventional studies, we recommend ICU admission with full-code management followed by reappraisal on day 6 in all nonbedridden cancer patients for whom lifespan-extending cancer treatment is available.

Invasive Mechanical Ventilation and Mortality in Pediatric Hematopoietic Stem Cell Transplantation: A Multicenter Study.

PubMed

Rowan, Courtney M; Gertz, Shira J; McArthur, Jennifer; Fitzgerald, Julie C; Nitu, Mara E; Loomis, Ashley; Hsing, Deyin D; Duncan, Christine N; Mahadeo, Kris M; Smith, Lincoln S; Moffet, Jerelyn; Hall, Mark W; Pinos, Emily L; Cheifetz, Ira M; Tamburro, Robert F

2016-04-01

To establish the current respiratory practice patterns in pediatric hematopoietic stem cell transplant patients and investigate their associations with mortality across multiple centers. Retrospective cohort between 2009 and 2014. Twelve children's hospitals in the United States. Two hundred twenty-two pediatric allogeneic hematopoietic stem cell transplant recipients with acute respiratory failure using invasive mechanical ventilation. None. PICU mortality of our cohort was 60.4%. Mortality at 180 days post PICU discharge was 74%. Length of PICU stay prior to initiation of invasive mechanical ventilation was significantly lower in survivors, and the odds of mortality increased for longer length of PICU stay prior to intubation. A total of 91 patients (41%) received noninvasive ventilation at some point during their PICU stay prior to intubation. Noninvasive ventilation use preintubation was associated with increased mortality (odds ratio, 2.1; 95% CI, 1.2-3.6; p = 0.010). Patients ventilated longer than 15 days had higher odds of death (odds ratio, 2.4; 95% CI, 1.3-4.2; p = 0.004). Almost 40% of patients (n = 85) were placed on high-frequency oscillatory ventilation with a mortality of 76.5% (odds ratio, 3.3; 95% CI, 1.7-6.5; p = 0.0004). Of the 20 patients who survived high-frequency oscillatory ventilation, 18 were placed on high-frequency oscillatory ventilation no later than the third day of invasive mechanical ventilation. In this subset of 85 patients, transition to high-frequency oscillatory ventilation within 2 days of the start of invasive mechanical ventilation resulted in a 76% decrease in the odds of death compared with those who transitioned to high-frequency oscillatory ventilation later in the invasive mechanical ventilation course. This study suggests that perhaps earlier more aggressive critical care interventions in the pediatric hematopoietic stem cell transplant patient with respiratory failure requiring invasive mechanical ventilation may offer an opportunity to improve outcomes.

Catering Gluten-Free When Simultaneously Using Wheat Flour.

PubMed

Miller, Kathryn; McGough, Norma; Urwin, Heidi

2016-02-01

A European law on gluten-free (GF) labeling came into force in 2012, covering foods sold prepacked and in food service establishments, and a similar U.S. Food and Drug Administration (FDA) regulation covers GF labeling from August 2014. Gluten is found in the grains wheat, rye, and barley. A common source of gluten in the kitchen is wheat flour. This research aimed to determine variables that have a significant effect on gluten contamination in commercial kitchens when wheat flour is in use and to establish controls necessary to assure GF production. A pilot study was used to test the following hypotheses: (i) increasing duration of exposure to wheat flour would increase gluten contamination, (ii) increasing distance between the site of preparation and the site of wheat flour would reduce gluten contamination, (iii) the use of a ventilation hood would decrease gluten contamination, and (iv) the use of a barrier segregating the site of preparation of a GF meal and the use of wheat flour would decrease gluten contamination. Petri dishes containing GF rice pudding were placed in three directions at increasing distances (0.5 to 2 m) from a site of wheat flour use. A barrier was in place between a third of samples and the site of wheat flour. After wheat flour was handled for 0.5 and 4.0 h, petri dishes were sealed and the contents were analyzed for gluten. The experiment was duplicated with the ventilation hood on and off. The pilot study revealed that a distance of 2 m from the use of wheat flour was required to control gluten contamination at ≤20 ppm if wheat flour had been in use for 4.0 h. The identified control of distance was tested in five different study sites. In each of the study sites, a test meal was prepared a minimum of 2 m away from the site of wheat flour use. Although kitchens vary and must be considered individually, the established control of a minimum 2 m distance, along with good hygiene practices, was found to be effective in preparing GF meals at all five study sites.

Cost containment and mechanical ventilation in the United States.

PubMed

Cohen, I L; Booth, F V

1994-08-01

In many ICUs, admission and discharge hinge on the need for intubation and ventilatory support. As few as 5% to 10% of ICU patients require prolonged mechanical ventilation, and this patient group consumes > or = 50% of ICU patient days and ICU resources. Prolonged ventilatory support and chronic ventilator dependency, both in the ICU and non-ICU settings, have a significant and growing impact on healthcare economics. In the United States, the need for prolonged mechanical ventilation is increasingly recognized as separate and distinct from the initial diagnosis and/or procedure that leads to hospitalization. This distinction has led to improved reimbursement under the prospective diagnosis-related group (DRG) system, and demands more precise accounting from healthcare providers responsible for these patients. Using both published and theoretical examples, mechanical ventilation in the United States is discussed, with a focus on cost containment. Included in the discussion are ventilator teams, standards of care, management protocols, stepdown units, rehabilitation units, and home care. The expanding role of total quality management (TQM) is also presented.

Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure.

PubMed

Zhang, Zhongheng; Gu, Wan-Jie; Chen, Kun; Ni, Hongying

2017-01-01

Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

PubMed Central

Gu, Wan-Jie; Chen, Kun; Ni, Hongying

2017-01-01

Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation. PMID:28127231

Significant Improvements in Pyranometer Nighttime Offsets Using High-Flow DC Ventilation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kutchenreiter, Mark; Michalski, J.J.; Long, C.N.

2017-05-22

Accurate solar radiation measurements using pyranometers are required to understand radiative impacts on the Earth's energy budget, solar energy production, and to validate radiative transfer models. Ventilators of pyranometers, which are used to keep the domes clean and dry, also affect instrument thermal offset accuracy. This poster presents a high-level overview of the ventilators for single-black-detector pyranometers and black-and-white pyranometers. For single-black-detector pyranometers with ventilators, high-flow-rate (50-CFM and higher), 12-V DC fans lower the offsets, lower the scatter, and improve the predictability of nighttime offsets compared to lower-flow-rate (35-CFM), 120-V AC fans operated in the same type of environmental setup.more » Black-and-white pyranometers, which are used to measure diffuse horizontal irradiance, sometimes show minor improvement with DC fan ventilation, but their offsets are always small, usually no more than 1 W/m2, whether AC- or DC-ventilated.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dutton, Spencer M.; Chan, Wanyu R.; Mendell, Mark J.

California's building efficiency standards (Title 24) mandate minimum prescribed ventilation rates (VRs) for commercial buildings. Title 24 standards currently include a prescriptive procedure similar to ASHRAE’s prescriptive “ventilation rate procedure”, but does not include an alternative procedure, akin to ASHRAE’s non-prescriptive “indoor air quality procedure” (IAQP). The IAQP determines minimum VRs based on objectively and subjectively evaluated indoor air quality (IAQ). The first primary goal of this study was to determine, in a set of California retail stores, the adequacy of Title 24 VRs and observed current measured VRs in providing the level of IAQ specified through an IAQP process,more » The second primary goal was to evaluate whether several VRs implemented experimentally in a big box store would achieve adequate IAQ, assessed objectively and subjectively. For the first goal, a list of contaminants of concern (CoCs) and reference exposure levels (RELs) were selected for evaluating IAQ. Ventilation rates and indoor and outdoor CoC concentrations were measured in 13 stores, including one “big box” store. Mass balance models were employed to calculate indoor contaminant source strengths for CoCs in each store. Using these source strengths and typical outdoor air contaminant concentrations, mass balance models were again used to calculate for each store the “IAQP” VR that would maintain indoor CoC concentrations below selected RELs. These IAQP VRs were compared to the observed VRs and to the Title 24- prescribed VRs. For the second goal, a VR intervention study was performed in the big box store to determine how objectively assessed indoor contaminant levels and subjectively assessed IAQ varied with VR. The three intervention study VRs included an approximation of the store’s current VR [0.24 air changes per hour (ACH)], the Title 24-prescribed VR [0.69 ACH], and the calculated IAQPbased VR [1.51 ACH]). Calculations of IAQP-based VRs showed that for the big box store and 11 of the 12 other stores, neither current measured VRs nor the Title 24-prescribed VRs would be sufficient to maintain indoor concentrations of all CoCs below RELs. In the intervention study, with the IAQP-based VR applied in the big box store, all CoCs were controlled below RELs (within margins of error). Also, at all three VRs in this store, the percentage of subjects reporting acceptable air quality exceeded an 80% criterion of acceptability. The IAQP allows consideration of outdoor air ventilation as just one of several possible tools for achieving adequate IAQ. In two of the 13 surveyed buildings, applying the IAQP to allow lower VRs could have saved energy whilst still maintaining acceptable indoor air quality. In the remaining 11 buildings, saving energy through lower VRs would require combination with other strategies, either reducing indoor sources of CoCs such as formaldehyde, or use of gas phase air cleaning technologies. Based on the findings from applying the IAQP calculations to retail stores and the IAQP-based intervention study, recommendations are made regarding the potential introduction of a comparable procedure in Title 24.« less

Laser welding of fused quartz

DOEpatents

Piltch, Martin S.; Carpenter, Robert W.; Archer, III, McIlwaine

2003-06-10

Refractory materials, such as fused quartz plates and rods are welded using a heat source, such as a high power continuous wave carbon dioxide laser. The radiation is optimized through a process of varying the power, the focus, and the feed rates of the laser such that full penetration welds may be accomplished. The process of optimization varies the characteristic wavelengths of the laser until the radiation is almost completely absorbed by the refractory material, thereby leading to a very rapid heating of the material to the melting point. This optimization naturally occurs when a carbon dioxide laser is used to weld quartz. As such this method of quartz welding creates a minimum sized heat-affected zone. Furthermore, the welding apparatus and process requires a ventilation system to carry away the silicon oxides that are produced during the welding process to avoid the deposition of the silicon oxides on the surface of the quartz plates or the contamination of the welds with the silicon oxides.

Mechanical ventilation and sepsis induce skeletal muscle catabolism in neonatal pigs

USDA-ARS?s Scientific Manuscript database

Reduced rates of skeletal muscle accretion are a prominent feature of the metabolic response to sepsis in infants and children. Septic neonates often require medical support with mechanical ventilation (MV). The combined effects of MV and sepsis in muscle have not been examined in neonates, in whom ...

46 CFR 72.05-50 - Ventilation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... automatic fire dampers are required, they shall be designed to operate at approximately 165 degrees F. for... designed as to close against the anticipated draft in the duct. The damper shall be made accessible for....05-10(e). (d) All ventilation systems shall be designed, where practicable, so that all ducts leading...

30 CFR 18.22 - Boring-type machines equipped for auxiliary face ventilation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Boring-type machines equipped for auxiliary... AND ACCESSORIES Construction and Design Requirements § 18.22 Boring-type machines equipped for auxiliary face ventilation. Each boring-type continuous-mining machine that is submitted for approval shall...

30 CFR 18.22 - Boring-type machines equipped for auxiliary face ventilation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Boring-type machines equipped for auxiliary... AND ACCESSORIES Construction and Design Requirements § 18.22 Boring-type machines equipped for auxiliary face ventilation. Each boring-type continuous-mining machine that is submitted for approval shall...

30 CFR 18.22 - Boring-type machines equipped for auxiliary face ventilation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Boring-type machines equipped for auxiliary... AND ACCESSORIES Construction and Design Requirements § 18.22 Boring-type machines equipped for auxiliary face ventilation. Each boring-type continuous-mining machine that is submitted for approval shall...

30 CFR 18.22 - Boring-type machines equipped for auxiliary face ventilation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Boring-type machines equipped for auxiliary... AND ACCESSORIES Construction and Design Requirements § 18.22 Boring-type machines equipped for auxiliary face ventilation. Each boring-type continuous-mining machine that is submitted for approval shall...

30 CFR 18.22 - Boring-type machines equipped for auxiliary face ventilation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Boring-type machines equipped for auxiliary... AND ACCESSORIES Construction and Design Requirements § 18.22 Boring-type machines equipped for auxiliary face ventilation. Each boring-type continuous-mining machine that is submitted for approval shall...

Heating, Ventilation, and Air Conditioning Series. Duty Task List.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This task list is intended for use in planning and/or evaluating a competency-based course in heating, ventilation, and air conditioning. The guide outlines the tasks entailed in eight different duties typically required of employees in the following occupations: residential installer, domestic refrigeration technician, air conditioning and…

Home Mechanical Ventilation: A 12-Year Population-Based Retrospective Cohort Study.

PubMed

Povitz, Marcus; Rose, Louise; Shariff, Salimah Z; Leonard, Sean; Welk, Blayne; Jenkyn, Krista Bray; Leasa, David J; Gershon, Andrea S

2018-04-01

Increasing numbers of individuals are being initiated on home mechanical ventilation, including noninvasive (bi-level) and invasive mechanical ventilation delivered via tracheostomy due to chronic respiratory failure to enable symptom management and promote quality of life. Given the high care needs of these individuals, a better understanding of the indications for home mechanical ventilation, and health-care utilization is needed. We performed a retrospective cohort study using provincial health administrative data from Ontario, Canada (population ∼13,000,000). Home mechanical ventilation users were characterized using health administrative data to determine the indications for home mechanical ventilation, the need for acute care at the time of ventilation approval, and their health service use and mortality rates following approval. The annual incidence of home mechanical ventilation approval rose from 1.8/100,000 in 2000 to 5.0/100,000 in 2012, or an annual increase of approximately 0.3/100,000 persons/y. The leading indications were neuromuscular disease, thoracic restriction, and COPD. The indication for the remainder could not be determined due to limitations of the administrative databases. Of the 4,670 individuals, 23.0% commenced home mechanical ventilation following an acute care hospitalization. Among individuals who survived at least 1 y, fewer required hospitalization in the year that followed home mechanical ventilation approval (29.9% vs 39.8%) as compared with the year prior. Utilization of home mechanical ventilation is increasing in Ontario, Canada, and further study is needed to clarify the factors contributing to this and to further optimize utilization of health-care resources. Copyright © 2018 by Daedalus Enterprises.

Metabolic Requirement of Septic Shock Patients Before and After Liberation From Mechanical Ventilation.

PubMed

Lee, Peggy Siu-Pik; Lee, Kar Lung; Betts, James A; Law, Kin Ip

2017-08-01

This study identified the difference in energy expenditure and substrate utilization of patients during and upon liberation from mechanical ventilation. Patients under intensive care who were diagnosed with septic shock and dependent on mechanical ventilation were recruited. Indirect calorimetry measurements were performed during and upon liberation from mechanical ventilation. Thirty-five patients were recruited (20 men and 15 women; mean age, 69 ± 10 years). Measured energy expenditures during ventilation and upon liberation were 2090 ± 489 kcal·d -1 and 1910 ± 579 kcal·d -1 , respectively ( P < .05). Energy intake was provided at 1148 ± 495 kcal·d -1 and differed significantly from all measured energy expenditures ( P < .05). Mean carbohydrate utilization was 0.19 ± 0.1 g·min -1 when patients were on mechanical ventilation compared with 0.15 ± 0.09 g·min -1 upon liberation ( P < .05). Mean lipid oxidation was 0.08 ± 0.05 g·min -1 during and 0.09 ± 0.07 g·min -1 upon liberation from mechanical ventilation ( P > .05). Measured energy expenditure was higher during than upon liberation from mechanical ventilation. This could be the increase in work of breathing from the continuous positive pressure support, repeated weaning cycles from mechanical ventilation, and/or the asynchronization between patients' respiration and ventilator support. Future studies should examine whether more appropriately matching energy expenditure with energy intake would promote positive health outcomes.

[Ten-year evolution of mechanical ventilation in acute respiratory failure in the hematogical patient admitted to the intensive care unit].

PubMed

Belenguer-Muncharaz, A; Albert-Rodrigo, L; Ferrandiz-Sellés, A; Cebrián-Graullera, G

2013-10-01

A comparison was made between invasive mechanical ventilation (IMV) and noninvasive positive pressure ventilation (NPPV) in haematological patients with acute respiratory failure. A retrospective observational study was made from 2001 to December 2011. A clinical-surgical intensive care unit (ICU) in a tertiary hospital. Patients with hematological malignancies suffering acute respiratory failure (ARF) and requiring mechanical ventilation in the form of either IMV or NPPV. Analysis of infection and organ failure rates, duration of mechanical ventilation and ICU and hospital stays, as well as ICU, hospital and mortality after 90 days. The same variables were analyzed in the comparison between NPPV success and failure. Forty-one patients were included, of which 35 required IMV and 6 NPPV. ICU mortality was higher in the IMV group (100% vs 37% in NPPV, P=.006). The intubation rate in NPPV was 40%. Compared with successful NPPV, failure in the NPPV group involved more complications, a longer duration of mechanical ventilation and ICU stay, and greater ICU and hospital mortality. Multivariate analysis of mortality in the NPPV group identified NPPV failure (OR 13 [95%CI 1.33-77.96], P=.008) and progression to acute respiratory distress syndrome (OR 10 [95%CI 1.95-89.22], P=.03) as prognostic factors. The use of NPPV reduced mortality compared with IMV. NPPV failure was associated with more complications. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Noninvasive ventilation for acute exacerbations of asthma: A systematic review of the literature.

PubMed

Green, Elyce; Jain, Paras; Bernoth, Maree

2017-11-01

Asthma is a chronic disease characterised by reversible airway obstruction caused by bronchospasm, mucous and oedema. People with asthma commonly experience acute exacerbations of their disease requiring hospitalisation and subsequent utilisation of economic and healthcare resources. Noninvasive ventilation has been suggested as a treatment for acute exacerbations of asthma due to its ability to provide airway stenting, optimal oxygen delivery and decreased work of breathing. This paper is a systematic review of the available published research focused on the use of noninvasive ventilation for the treatment of acute exacerbations of asthma to determine if this treatment provides better outcomes for patients compared to standard medical therapy. Database searches were conducted using EBSCOhost, MEDLINE and PubMed. Search terms used were combinations of 'noninvasive ventilation', 'BiPAP', 'CPAP', 'wheez*' and 'asthma'. Articles were included if they were research papers focused on adult patients with asthma and a treatment of noninvasive ventilation, and were published in full text in English. Included articles were reviewed using the National Health and Medical Research Council (Australia) evidence hierarchy and quality appraisal tools. There were 492 articles identified from the database searches. After application of inclusion/exclusion criteria 13 articles were included in the systematic review. Studies varied significantly in design, endpoints and outcomes. There was a trend in better outcomes for patients with acute asthma who were treated with noninvasive ventilation compared to standard medical therapy, however, the variability of the studies meant that no conclusive recommendations could be made. More research is required before noninvasive ventilation can be conclusively recommended for the treatment of acute exacerbations of asthma. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Hemodynamic effects of external continuous negative pressure ventilation compared with those of continuous positive pressure ventilation in dogs with acute lung injury.

PubMed

Skaburskis, M; Helal, R; Zidulka, A

1987-10-01

Patients with noncardiogenic pulmonary edema requiring ventilatory assistance are usually supported with CPPV using positive end-expiratory pressure (PEEP), but CPPV requires endotracheal intubation and may decrease cardiac output (QT). The purpose of this study was to examine thoracoabdominal continuous negative pressure ventilation (CNPV) using external negative end-expiratory pressure (NEEP). The effects on gas exchange and hemodynamics were compared with those of CPPV with PEEP, with the premise that CNPV might sustain venous return and improve QT. In 6 supine, anesthetized and paralyzed dogs with oleic-acid-induced pulmonary edema, 30 min of CNPV was alternated twice with 30 min of CPPV. Positive and negative pressure ventilation were carefully matched for fractional inspired oxygen concentration (FIO2 = 0.56), breathing frequency, and tidal volume. In addition, we matched the increase in delta FRC obtained with the constant distending pressures produced by both modes of ventilation. An average of -9 cm H2O of NEEP produced the same delta FRC as 10.8 cm H2O of PEEP. Gas exchange did not differ significantly between the 2 modes. However, QT was 15.8% higher during CNPV than during CPPV (p less than 0.02). Mixed venous oxygen saturation also improved during CNPV compared with that during CPPV (58.3 versus 54.5%, p less than 0.01). Negative pressure ventilation using NEEP may be a viable alternative to positive pressure ventilation with PEEP in the management of critically ill patients with noncardiogenic pulmonary edema. It offers comparable improvement in gas exchange with the advantages of less cardiac depression and the possible avoidance of endotracheal intubation.

Does oral alprazolam affect ventilation? A randomised, double-blind, placebo-controlled trial.

PubMed

Carraro, G E; Russi, E W; Buechi, S; Bloch, Konrad E

2009-05-01

The respiratory effects of benzodiazepines have been controversial. This investigation aimed to study the effects of oral alprazolam on ventilation. In a randomised, double-blind cross-over protocol, 20 healthy men ingested 1 mg of alprazolam or placebo in random order, 1 week apart. Ventilation was unobtrusively monitored by inductance plethysmography along with end-tidal PCO(2) and pulse oximetry 60-160 min after drug intake. Subjects were encouraged to keep their eyes open. Mean +/- SD minute ventilation 120 min after alprazolam and placebo was similar (6.21 +/- 0.71 vs 6.41 +/- 1.12 L/min, P = NS). End-tidal PCO(2) and oxygen saturation did also not differ between treatments. However, coefficients of variation of minute ventilation after alprazolam exceeded those after placebo (43 +/- 23% vs 31 +/- 13%, P < 0.05). More encouragements to keep the eyes open were required after alprazolam than after placebo (5.2 +/- 5.7 vs 1.3 +/- 2.3 calls, P < 0.05). In a multiple regression analysis, higher coefficients of variation of minute ventilation after alprazolam were related to a greater number of calls. Oral alprazolam in a mildly sedative dose has no clinically relevant effect on ventilation in healthy, awake men. The increased variability of ventilation on alprazolam seems related to vigilance fluctuations rather than to a direct drug effect on ventilation.

Short-term airing by natural ventilation - implication on IAQ and thermal comfort.

PubMed

Heiselberg, P; Perino, M

2010-04-01

The need to improve the energy efficiency of buildings requires new and more efficient ventilation systems. It has been demonstrated that innovative operating concepts that make use of natural ventilation seem to be more appreciated by occupants. Among the available ventilation strategies that are currently available, buoyancy driven, single-sided natural ventilation has proved to be very effective and can provide high air change rates for temperature and Indoor Air Quality (IAQ) control. However, to promote a wider distribution of these systems an improvement in the knowledge of their working principles is necessary. The present study analyses and presents the results of an experimental evaluation of airing performance in terms of ventilation characteristics, IAQ and thermal comfort. It includes investigations of the consequences of opening time, opening frequency, opening area and expected airflow rate, ventilation efficiency, thermal comfort and dynamic temperature conditions. A suitable laboratory test rig was developed to perform extensive experimental analyses of the phenomenon under controlled and repeatable conditions. The results showed that short-term window airing is very effective and can provide both acceptable IAQ and thermal comfort conditions in buildings. Practical Implications This study gives the necessary background and in-depth knowledge of the performance of window airing by single-sided natural ventilation necessary for the development of control strategies for window airing (length of opening period and opening frequency) for optimum IAQ and thermal comfort in naturally ventilated buildings.

Reducing the ingress of urban noise through natural ventilation openings.

PubMed

Oldham, D J; de Salis, M H; Sharples, S

2004-01-01

For buildings in busy urban areas affected by high levels of road traffic noise the potential to use natural ventilation can be limited by excessive noise entering through ventilation openings. This paper is concerned with techniques to reduce noise ingress into naturally ventilated buildings while minimizing airflow path resistance. A combined experimental and theoretical approach to the interaction of airflow and sound transmission through ventilators for natural ventilation applications is described. A key element of the investigation has been the development of testing facilities capable of measuring the airflow and sound transmission losses for a range of ventilation noise control strategies. It is demonstrated that a combination of sound reduction mechanisms -- one covering low frequency sound and another covering high frequency sound -- is required to attenuate effectively noise from typical urban sources. A method is proposed for quantifying the acoustic performance of different strategies to enable comparisons and informed decisions to be made leading to the possibility of a design methodology for optimizing the ventilation and acoustic performance of different strategies. The need for employing techniques for combating low frequency sound in tandem with techniques for reducing high frequency sound in reducing the ingress of noise from urban sources such as road traffic to acceptable levels is demonstrated. A technique is proposed for enabling the acoustic and airflow performance of apertures for natural ventilation systems to be designed simultaneously.

Course of Weaning from Prolonged Mechanical Ventilation after Cardiac Surgery

PubMed Central

Herlihy, James P.; Koch, Stephen M.; Jackson, Robert; Nora, Hope

2006-01-01

In order to determine the temporal pattern of weaning from mechanical ventilation for patients undergoing prolonged mechanical ventilation after cardiac surgery, we performed a retrospective review of 21 patients' weaning courses at our long-term acute care hospital. Using multiple regression analysis of an estimate of individual patients' percentage of mechanical ventilator support per day (%MVSD), we determined that 14 of 21 patients (67%) showed a statistically significant quadratic or cubic relationship between time and %MVSD. These patients showed little or no improvement in their ventilator dependence until a point in time when, abruptly, they began to make rapid progress (a “wean turning point”), after which they progressed to discontinuation of mechanical ventilation in a relatively short period of time. The other 7 patients appeared to have a similar weaning pattern, although the data were not statistically significant. Most patients in the study group weaned from the ventilator through a specific temporal pattern that is newly described herein. Data analysis suggested that the mechanism for the development of a wean turning point was improvement of pulmonary mechanics rather than improvement in gas exchange or respiratory load. Although these observations need to be confirmed by a prospective trial, they may have implications for weaning cardiac surgery patients from prolonged mechanical ventilation, and possibly for weaning a broader group of patients who require prolonged mechanical ventilation. PMID:16878611

Humidifier Development and Applicability to the Next Generation Portable Life Support System

NASA Technical Reports Server (NTRS)

Conger, Bruce C.; Barnes, Bruce G.; Sompayrac, Robert G.; Paul, Heather L.

2011-01-01

A development effort at the NASA Johnson Space Center investigated technologies to determine whether a humidifier would be required in the Portable Life Support System (PLSS) envisioned for future exploration missions. The humidifier has been included in the baseline PLSS schematic since performance testing of the Rapid Cycle Amine (RCA) indicates that the RCA over-dries the ventilation gas stream. Performance tests of a developmental humidifier unit and commercial off-the-shelf (COTS) units were conducted in December 2009. Following these tests, NASA revisited the need for a humidifier via system analysis. Results of this investigation indicate that it is feasible to meet humidity requirements without the humidifier if other changes are made to the PLSS ventilation loop and the Liquid Cooling and Ventilation Garment (LCVG).

High resolution pCO2 monitoring reveals ventilation of Bunker Cave (NW Germany) and its impact on speleothem growth

NASA Astrophysics Data System (ADS)

Riechelmann, Sylvia; Breitenbach, Sebastian F. M.; Schröder-Ritzrau, Andrea; Immenhauser, Adrian

2017-04-01

Understanding the environmental processes that influence geochemical proxies archived in speleothems depends critically on detailed cave monitoring. Cave air pCO2 is one of the most important factors controlling speleothem growth. The pCO2 concentration of cave air depends on (i) the productivity of its source(s), (ii) CO2-transport dynamics through the epikarst and (iii) cave ventilation processes. We monitored the pCO2 concentration ca. 100 m from the lower entrance of the Bunker-Emst-Cave system (NW Germany) with a CORA CO2-logger at a two-hourly resolution between April 2012 and February 2014. Near-atmospheric minimum pCO2 concentrations of 408 ppm are observed in winter, while higher values up to 811 ppm are recorded in summer. Higher summer concentrations are due to increased plant and soil microbial activity, resulting in elevated CO2 in the soil, which is transferred to the cave with infiltrating water. Generally, the front passages of Bunker Cave are well ventilated. Besides the seasonal pattern, pCO2 concentrations vary at diurnal scale. Correlations of pCO2 with the temperature difference between surface and cave air are positive during summer and negative in winter, with no clear pattern for spring and autumn months. Thus, Bunker Cave ventilation is driven by temperature and density differences between cave and surface air, with two entrances at different elevations allowing dynamic ventilation. During summer, relatively cooler cave air flows from the upper to the lower entrance, while in winter this pattern is reversed due to ascending warm cave air. The situation is further complicated by preferential south/southwestern winds that point directly on the cave entrances. Thus, cave ventilation is frequently disturbed, especially during periods of higher wind speed. Modern ventilation systematics only developed when the two cave entrances were artificially opened (1863 and 1926). Before that, ventilation was restricted and cave pCO2 concentrations were presumably higher under natural conditions. Thus, the present-day ventilation system of Bunker Cave is not a direct analogue for natural ventilation conditions. pCO2 concentrations are relatively low compared to other caves, and because the difference between summer and winter pCO2 is relatively low (max. 400 ppm), a significant effect on seasonal speleothem growth rate is unlikely. In case of Bunker Cave, it is rather a combination of the availability of water, and thus of calcium and carbonate ions and pCO2 concentrations that allow higher carbonate precipitation during winter than summer. Holocene speleothems from Bunker Cave display relatively slow growth rates. We suggest that - with absence of major entrances to the cave system during the Holocene - ventilation was minimal and pCO2 concentrations significantly higher, making winterly water supply the governing factor regulating speleothem growth. Thus, stalagmites from Bunker Cave are likely to record a climatic signal biased towards the winter season.

Routine aspiration of subglottic secretions after major heart surgery: impact on the incidence of ventilator-associated pneumonia.

PubMed

Pérez Granda, M J; Barrio, J M; Hortal, J; Muñoz, P; Rincón, C; Bouza, E

2013-12-01

Aspiration of subglottic secretions (ASS) is recommended in patients requiring mechanical ventilation for ≥48h. We assessed the impact of the introduction of ASS routinely in all patients after major heart surgery in an ecological study comparing ventilator-acquired pneumonia (VAP) incidence, days of mechanical ventilation, and cost of antimicrobial agents before and after the implementation of ASS. Before and after the intervention the results (per 1000 days) were: VAP incidence, 23.92 vs 16.46 (P = 0.04); cost of antimicrobials, €71,384 vs €63,446 (P = 0.002); and days of mechanical ventilation, 507.5 vs 377.5 (P = 0.009). From the moment of induction of anaesthesia all patients undergoing major heart surgery should routinely receive ASS. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Improved oxygenation 24 hours after transition to airway pressure release ventilation or high-frequency oscillatory ventilation accurately discriminates survival in immunocompromised pediatric patients with acute respiratory distress syndrome*.

PubMed

Yehya, Nadir; Topjian, Alexis A; Thomas, Neal J; Friess, Stuart H

2014-05-01

Children with an immunocompromised condition and requiring invasive mechanical ventilation have high risk of death. Such patients are commonly transitioned to rescue modes of nonconventional ventilation, including airway pressure release ventilation and high-frequency oscillatory ventilation, for acute respiratory distress syndrome refractory to conventional ventilation. Our aim was to describe our experience with airway pressure release ventilation and high-frequency oscillatory ventilation in children with an immunocompromised condition and acute respiratory distress syndrome refractory to conventional ventilation and to identify factors associated with survival. Retrospective cohort study. Tertiary care, university-affiliated PICU. Sixty pediatric patients with an immunocompromised condition and acute respiratory distress syndrome refractory to conventional ventilation transitioned to either airway pressure release ventilation or high-frequency oscillatory ventilation. None. Demographic data, ventilator settings, arterial blood gases, oxygenation index, and PaO(2)/FIO(2) were recorded before transition to either mode of nonconventional ventilation and at predetermined intervals after transition for up to 5 days. Mortality in the entire cohort was 63% and did not differ between patients transitioned to airway pressure release ventilation and high-frequency oscillatory ventilation. For both airway pressure release ventilation and high-frequency oscillatory ventilation, improvements in oxygenation index and PaO(2)/FIO(2) at 24 hours expressed as a fraction of pretransition values (oxygenation index(24)/oxygenation index(pre) and PaO(2)/FIO(224)/PaO(2)/FIO(2pre)) reliably discriminated nonsurvivors from survivors, with receiver operating characteristic areas under the curves between 0.89 and 0.95 (p for all curves < 0.001). Sensitivity-specificity analysis suggested that less than 15% reduction in oxygenation index (90% sensitive, 75% specific) or less than 90% increase in PaO(2)/FIO(2) (80% sensitive, 94% specific) 24 hours after transition to airway pressure release ventilation were the optimal cutoffs to identify nonsurvivors. The comparable values 24 hours after transition to high-frequency oscillatory ventilation were less than 5% reduction in oxygenation index (100% sensitive, 83% specific) or less than 80% increase in PaO(2)/FIO(2) (91% sensitive, 89% specific) to identify nonsurvivors. In this single-center retrospective study of pediatric patients with an immunocompromised condition and acute respiratory distress syndrome failing conventional ventilation transitioned to either airway pressure release ventilation or high-frequency oscillatory ventilation, improved oxygenation at 24 hours expressed as PaO(2)/FIO(224)/PaO(2)/FIO(2pre) or oxygenation index(24)/oxygenation indexpre reliably discriminates nonsurvivors from survivors. These findings should be prospectively verified.

43 CFR 5451.1 - Minimum performance bond requirements; types.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Minimum performance bond requirements... § 5451.1 Minimum performance bond requirements; types. (a) A minimum performance bond of not less than 20... minimum bond as provided in § 5451.2 of this title. A minimum performance bond of not less than $500 will...

Case-Mix, Care Processes, and Outcomes in Medically-Ill Patients Receiving Mechanical Ventilation in a Low-Resource Setting from Southern India: A Prospective Clinical Case Series.

PubMed

Karthikeyan, Balasubramanian; Kadhiravan, Tamilarasu; Deepanjali, Surendran; Swaminathan, Rathinam Palamalai

2015-01-01

Mechanical ventilation is a resource intensive organ support treatment, and historical studies from low-resource settings had reported a high mortality. We aimed to study the outcomes in patients receiving mechanical ventilation in a contemporary low-resource setting. We prospectively studied the characteristics and outcomes (disease-related, mechanical ventilation-related, and process of care-related) in 237 adults mechanically ventilated for a medical illness at a teaching hospital in southern India during February 2011 to August 2012. Vital status of patients discharged from hospital was ascertained on Day 90 or later. Mean age of the patients was 40 ± 17 years; 140 (51%) were men. Poisoning and envenomation accounted for 98 (41%) of 237 admissions. In total, 87 (37%) patients died in-hospital; 16 (7%) died after discharge; 115 (49%) were alive at 90-day assessment; and 19 (8%) were lost to follow-up. Weaning was attempted in 171 (72%) patients; most patients (78 of 99 [79%]) failing the first attempt could be weaned off. Prolonged mechanical ventilation was required in 20 (8%) patients. Adherence to head-end elevation and deep vein thrombosis prophylaxis were 164 (69%) and 147 (62%) respectively. Risk of nosocomial infections particularly ventilator-associated pneumonia was high (57.2 per 1,000 ventilator-days). Higher APACHE II score quartiles (adjusted HR [95% CI] quartile 2, 2.65 [1.19-5.89]; quartile 3, 2.98 [1.24-7.15]; quartile 4, 5.78 [2.45-13.60]), and new-onset organ failure (2.98 [1.94-4.56]) were independently associated with the risk of death. Patients with poisoning had higher risk of reintubation (43% vs. 20%; P = 0.001) and ventilator-associated pneumonia (75% vs. 53%; P = 0.001). But, their mortality was significantly lower compared to the rest (24% vs. 44%; P = 0.002). The case-mix considerably differs from other settings. Mortality in this low-resource setting is similar to high-resource settings. But, further improvements in care processes and prevention of nosocomial infections are required.

Generation rate of carbon monoxide from CO2 arc welding.

PubMed

Ojima, Jun

2013-01-01

CO poisoning has been a serious industrial hazard in Japanese workplaces. Although incomplete combustion is the major cause of CO generation, there is a risk of CO poisoning during some welding operations. The aim of the present study was to evaluate the generation rate of CO from CO2 arc welding under controlled laboratory conditions and estimate the ventilation requirements for the prevention of CO poisoning. Bead on plate welding was carried out with an automatic welding robot on a rolled steel base metal under several conditions. The concentration of emitted CO from the welding was measured by a real-time CO monitor in a well-ventilated laboratory that was free from ambient CO contamination. The generation rate of CO was obtained from the three measurements-the flow rate of the welding exhaust gas, CO concentration in the exhaust gas and the arcing time. Then the ventilation requirement to prevent CO poisoning was calculated. The generation rate of CO was found to be 386-883 ml/min with a solid wire and 331-1,293 ml/min with a flux cored wire respectively. It was found that the CO concentration in a room would be maintained theoretically below the OSHA PEL (50 ppm) providing the ventilation rate in the room was 6.6-25.9 m3/min. The actual ventilation requirement was then estimated to be 6.6-259 m3/min considering incomplete mixing. In order to prevent CO poisoning, some countermeasures against gaseous emission as well as welding fumes should be taken eagerly.

A multicenter mortality prediction model for patients receiving prolonged mechanical ventilation

PubMed Central

Carson, Shannon S.; Kahn, Jeremy M.; Hough, Catherine L.; Seeley, Eric J.; White, Douglas B.; Douglas, Ivor S.; Cox, Christopher E.; Caldwell, Ellen; Bangdiwala, Shrikant I.; Garrett, Joanne M.; Rubenfeld, Gordon D.

2012-01-01

Objective Significant deficiencies exist in the communication of prognosis for patients requiring prolonged mechanical ventilation after acute illness, in part because of clinician uncertainty about long-term outcomes. We sought to refine a mortality prediction model for patients requiring prolonged ventilation using a multicentered study design. Design Cohort study. Setting Five geographically diverse tertiary care medical centers in the United States (California, Colorado, North Carolina, Pennsylvania, Washington). Patients Two hundred sixty adult patients who received at least 21 days of mechanical ventilation after acute illness. Interventions None. Measurements and Main Results For the probability model, we included age, platelet count, and requirement for vasopressors and/or hemodialysis, each measured on day 21 of mechanical ventilation, in a logistic regression model with 1-yr mortality as the outcome variable. We subsequently modified a simplified prognostic scoring rule (ProVent score) by categorizing the risk variables (age 18–49, 50–64, and >65 yrs; platelet count 0–150 and >150; vasopressors; hemodialysis) in another logistic regression model and assigning points to variables according to β coefficient values. Overall mortality at 1 yr was 48%. The area under the curve of the receiver operator characteristic curve for the primary ProVent probability model was 0.79 (95% confidence interval, 0.75–0.81), and the p value for the Hosmer-Lemeshow goodness-of-fit statistic was .89. The area under the curve for the categorical model was 0.77, and the p value for the goodness-of-fit statistic was .34. The area under the curve for the ProVent score was 0.76, and the p value for the Hosmer-Lemeshow goodness-of-fit statistic was .60. For the 50 patients with a ProVent score >2, only one patient was able to be discharged directly home, and 1-yr mortality was 86%. Conclusion The ProVent probability model is a simple and reproducible model that can accurately identify patients requiring prolonged mechanical ventilation who are at high risk of 1-yr mortality. PMID:22080643

Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation.

PubMed

Martin, Ubaldo J; Hincapie, Luis; Nimchuk, Mark; Gaughan, John; Criner, Gerard J

2005-10-01

To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. Retrospective analysis of 49 consecutive patients. Multidisciplinary ventilatory rehabilitation unit in an academic medical center. Forty-nine consecutive chronic ventilator-dependent patients referred to a tertiary care hospital ventilator rehabilitation unit. None. Patients were 58 +/- 7 yrs old with multiple etiologies for respiratory failure. On admission, all patients were bedridden and had severe weakness of upper and lower extremities measured by a 5-point muscle strength score and a 7-point Functional Independence Measurement. Postrehabilitation, patients had increases in upper and lower extremity strength (p < .05) and were able to stand and ambulate. All weaned from mechanical ventilation, but three required subsequent intermittent support. Six patients died before hospital discharge. Upper extremity strength on admission inversely correlated with time to wean from mechanical ventilation (R = .72, p < .001). : Patients receiving chronic ventilation are weak and deconditioned but respond to aggressive whole-body and respiratory muscle training with an improvement in strength, weaning outcome, and functional status. Whole-body rehabilitation should be considered a significant component of their therapy.

High-Frequency Percussive Ventilation and Low Tidal Volume Ventilation in Burns: A Randomized Controlled Trial

DTIC Science & Technology

2010-01-01

incidence of ventilator-associated pneumonia ( VAP ) in patients with inha- lation injury when supported with HFPV compared with conventional modes of...mean ratio of PaO2 to FIO2 was 58 6 with a mean positive end- expiratory pressure of 22 2 cm H2O before rescue. Two of these patients were...a sample size of 110 patients in each arm would have been required to detect a difference in VAP with 80% power. A multicentered study would be

Mechanical ventilation alone, and in the presence sepsis, induces peripheral skeletal muscle catabolism in neonatal pigs

USDA-ARS?s Scientific Manuscript database

Reduced rates of skeletal muscle accretion are a prominent feature of the metabolic response to sepsis in infants and children. Septic neonates often require medical support with mechanical ventilation (MV). The combined effects of MV and sepsis in muscle have not been examined in neonates, in whom ...

Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study.

PubMed

Luckraz, Heyman; Manga, Na'ngono; Senanayake, Eshan L; Abdelaziz, Mahmoud; Gopal, Shameer; Charman, Susan C; Giri, Ramesh; Oppong, Raymond; Andronis, Lazaros

2018-05-01

Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom. Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416). Patients who were diagnosed as developing ventilator-associated pneumonia, as per the surveillance definition for ventilator-associated pneumonia (n = 338), were propensity score matched with those who did not (n = 338). Costs of treating post-op cardiac surgery patients in intensive care and cost difference if ventilator-associated pneumonia occurred based on Healthcare Resource Group categories were assessed. Secondary outcomes included differences in morbidity, mortality and cardiac intensive care unit and in-hospital length of stay. There were no significant differences in the pre-operative characteristics or procedures between the groups. Ventilator-associated pneumonia developed in 10% of post-cardiac surgery patients. Post-operatively, the ventilator-associated pneumonia group required longer ventilation (p < 0.01), more respiratory support, longer cardiac intensive care unit (8 vs 3, p < 0.001) and in-hospital stay (16 vs 9) days. The overall cost for post-operative recovery after cardiac surgery for ventilator-associated pneumonia patients was £15,124 compared to £6295 for non-ventilator-associated pneumonia (p < 0.01). The additional cost of treating patients with ventilator-associated pneumonia was £8829. Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.

Unexpected death of a ventilator-dependent amyotrophic lateral sclerosis patient.

PubMed

di Paolo, M; Evangelisti, L; Ambrosino, N

2013-01-01

Amyotrophic lateral sclerosis (ALS) is a fatal, progressive, neurodegenerative disease and most patients affected die of respiratory compromise and/or pneumonia within 2-3 years of diagnosis. As ALS progresses, ventilator assistance is required. In the end stages of the disease, patients suffer from respiratory failure and may become ventilator-dependent. Deaths due to malfunction of mechanical ventilators are reported but there are very few forensic autopsy records. We report the case of a 69-year-old ALS female ventilator-dependent, trachostomised patient who was found dead by her husband, with the ventilator in "stand-by" mode. A forensic autopsy was performed. Samples of internal organs were taken for histological and toxicological examination. The ventilator internal memory was also analysed and tested in order to find possible malfunction. Gross examination did not reveal any sign of trauma but showed brain and lung congestion. Pulmonary histological examination revealed thickening of peribronchial interstitial space, alveolar over-distension, break of inter-alveolar walls and diffuse alveolar haemorrhages. Focal microhemorrhages were also detected in other organs. Analysis of the ventilator internal memory showed that during the night of death, there had been several voltage drops. Specific tests revealed malfunction of the internal battery which was unable to provide the necessary voltage, as a consequence the ventilator switched off, stopping ventilation. Battery malfunction reduced the volume of the ventilator alarm, which was not heard by the caregiver. Histological pattern, with acute pulmonary emphysema and focal polivisceral haemorrhages, is strongly suggestive of a death due to "acute" asphyxia. The authors also discuss the need for strict supervision and follow up of these ventilatory dependent patients and their devices. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

Variation in ventilation time after coronary artery bypass grafting: an analysis from the society of thoracic surgeons adult cardiac surgery database.

PubMed

Jacobs, Jeffrey P; He, Xia; O'Brien, Sean M; Welke, Karl F; Filardo, Giovanni; Han, Jane M; Ferraris, Victor A; Prager, Richard L; Shahian, David M

2013-09-01

Short postoperative ventilation times are accepted as a marker of quality. This analysis assesses center level variation in postoperative ventilation time in a subset of patients undergoing isolated coronary artery bypass grafting (CABG). In 2009 and 2010, 325,129 patients in the STS Adult Cardiac Surgery Database underwent isolated CABG. Patients were excluded if they were intubated before entering the operating room, required ventilation for greater than 24 hours, or had missing data on key covariates. The final study cohort was 274,231 isolated CABG patients from 1,008 centers. Bayesian hierarchical models were used to assess between-center variation in ventilation time and to explore the effect of center-level covariates. Analyses were performed with and without adjusting for case mix. After adjusting for case mix, the ratio of median ventilator time at the 90th percentile of the center-level distribution compared with the tenth percentile was 9.0:5.0=1.8 (95% credible interval: 1.79 to 1.85). This ratio illustrates the scale of between-center differences: centers above the 90th percentile have a ventilation time of at least 1.8 times that of centers below the tenth percentile. Smaller hospital volume, presence of a residency program, and some census regions were associated with longer ventilation times. After adjustment for severity of illness, substantial inter-center variation exists in postoperative ventilation time in this subset of patients undergoing isolated CABG. This finding represents an opportunity for multi-institutional quality improvement initiatives designed to limit variations in ventilator management and achieve the shortest possible ventilation times for all patients, thus benefiting both clinical outcomes and resource utilization. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Lung volume changes during cleaning of closed endotracheal suction catheters: a randomized crossover study using electrical impedance tomography.

PubMed

Corley, Amanda; Sharpe, Nicola; Caruana, Lawrence R; Spooner, Amy J; Fraser, John F

2014-04-01

Airway suctioning in mechanically ventilated patients is required to maintain airway patency. Closed suction catheters (CSCs) minimize lung volume loss during suctioning but require cleaning post-suction. Despite their widespread use, there is no published evidence examining lung volumes during CSC cleaning. The study objectives were to quantify lung volume changes during CSC cleaning and to determine whether these changes were preventable using a CSC with a valve in situ between the airway and catheter cleaning chamber. This prospective randomized crossover study was conducted in a metropolitan tertiary ICU. Ten patients mechanically ventilated via volume-controlled synchronized intermittent mandatory ventilation (SIMV-VC) and requiring manual hyperinflation (MHI) were included in this study. CSC cleaning was performed using 2 different brands of CSC (one with a valve [Ballard Trach Care 72, Kimberly-Clark, Roswell, Georgia] and one without [Portex Steri-Cath DL, Smiths Medical, Dublin, Ohio]). The maneuvers were performed during both SIMV-VC and MHI. Lung volume change was measured via impedance change using electrical impedance tomography. A mixed model was used to compare the estimated means. During cleaning of the valveless CSC, significant decreases in lung impedance occurred during MHI (-2563 impedance units, 95% CI 2213-2913, P < .001), and significant increases in lung impedance occurred during SIMV (762 impedance units, 95% CI 452-1072, P < .001). In contrast, cleaning of the CSC with a valve in situ resulted in non-significant lung volume changes and maintenance of normal ventilation during MHI and SIMV-VC, respectively (188 impedance units, 95% CI -136 to 511, P = .22; and 22 impedance units, 95% CI -342 to 299, P = .89). When there is no valve between the airway and suction catheter, cleaning of the CSC results in significant derangements in lung volume. Therefore, the presence of such a valve should be considered essential in preserving lung volumes and uninterrupted ventilation in mechanically ventilated patients.

Impact of Prolonged Mechanical Ventilation in Very Low Birth Weight Infants: Results From a National Cohort Study.

PubMed

Choi, Young-Bin; Lee, Juyoung; Park, Jisun; Jun, Yong Hoon

2018-03-01

To evaluate the in-hospital consequences of prolonged respiratory support with invasive mechanical ventilation in very low birth weight infants. A cohort study was performed using prospectively collected data from 69 neonatal intensive care units participating in the Korean national registry. In total, 3508 very low birth weight infants born between January 1, 2013 and December 31, 2014 were reviewed. The adjusted hazard ratio for death increased significantly for infants who received mechanical ventilation for more than 2 weeks compared with those were mechanically ventilated for 7 days or less. The individual mortality rate increased after 8 weeks, reaching 50% and 60% at 14 and 16 weeks of cumulative mechanical ventilation, respectively. After adjusting for potential confounders, the cumulative duration of mechanical ventilation was associated with a clinically significant increase in the odds of bronchopulmonary dysplasia and pulmonary hypertension. Mechanical ventilation exposure for longer than 2 weeks, compared with 7 days or less, was associated with retinopathy of prematurity requiring laser coagulation and periventricular leukomalacia. The odds of abnormal auditory screening test results were significantly increased in infants who needed mechanical ventilation for more than 4 weeks. A longer cumulative duration of mechanical ventilation was associated with increased lengths of hospitalization and parenteral nutrition and a higher probability of discharge with poor achievement of physical growth. Although mechanical ventilation is a life-saving intervention for premature infants, these results indicate that it is associated with negative consequences when applied for prolonged periods. Copyright © 2017 Elsevier Inc. All rights reserved.

The assessment of airway maneuvers and interventions in university Canadian football, ice hockey, and soccer players.

PubMed

Delaney, J Scott; Al-Kashmiri, Ammar; Baylis, Penny-Jane; Troutman, Tracy; Aljufaili, Mahmood; Correa, José A

2011-01-01

Managing an airway in an unconscious athlete is a lifesaving skill that may be made more difficult by the recent changes in protective equipment. Different airway maneuvers and techniques may be required to help ventilate an unconscious athlete who is wearing full protective equipment. To assess the effectiveness of different airway maneuvers with football, ice hockey, and soccer players wearing full protective equipment. Crossover study. University sports medicine clinic. A total of 146 university varsity athletes, consisting of 62 football, 45 ice hockey, and 39 soccer players. Athletes were assessed for different airway and physical characteristics. Three investigators then evaluated the effectiveness of different bag-valve-mask (BVM) ventilation techniques in supine athletes who were wearing protective equipment while inline cervical spine immobilization was maintained. The effectiveness of 1-person BVM ventilation (1-BVM), 2-person BVM ventilation (2-BVM), and inline immobilization and ventilation (IIV) was judged by each investigator for each athlete using a 4-point rating scale. All forms of ventilation were least difficult in soccer players and most difficult in football players. When compared with 1-BVM, both 2-BVM and IIV were deemed more effective by all investigators for all athletes. Interference from the helmet and stabilizer were common reasons for difficult ventilation in football and ice hockey players. Sports medicine professionals should practice and be comfortable with different ventilation techniques for athletes wearing full equipment. The use of a new ventilation technique, termed inline immobilization and ventilation, may be beneficial, especially when the number of responders is limited.

[Cardiac arrest during anesthesia and recovery period].

PubMed

Otteni, J C; Steib, A; Pottecher, T

1990-01-01

Cardiac arrests (CA) occurring during anaesthesia and recovery can be classified into three groups: CA not related to anaesthesia (NACA), CA related to anaesthesia (ACA), whether partially (PACA) or totally (TACA). In the French survey, NACAs were three times more frequent than ACAs. Nearly 25% of ACAs occurred at induction and consisted mainly in TACAs. Another quarter of ACAs occurred during maintenance and consisted mainly in PACAs. About 50% of ACAs occurred after the end of anaesthesia and had the highest mortality rate. Cardiac arrest corresponds to the status of a heart unable to generate the minimum aortic blood flow required for functioning of vital organs. For the brain, a zero-blood flow of more than 4 seconds results in coma. Consequently CA exists when the time interval between two subsequent efficient systoles is greater than 4 seconds. Anaesthetic agents can result in CA by 1) overdose (absolute, relative), 2) anaphylactoid/anaphylactic reactions, 3) specific effects (acetylcholine-like effect, hyperkalaemia and malignant hyperthermia for succinylcholine; vagal effect of vecuronium and atracurium; cardiotoxicity of bupivacaine) and 4) drug interaction. In hypoxic CA, severe neurologic impairment often still exists at the time of onset of CA. The anaesthesia machine and controlled ventilation can induce CA by hypoxic ventilation, overdose of anaesthetic vapour, excessive CO2 reinhalation, hypoventilation, disconnection, excessive pressure in airways. Cardiac hypothermia can be a cause of CA as well as a cause of unsuccessful CPR. Massive infusion of unwarmed fluids and IPPV with unheated gases generate a temperature gradient within the heart which may result in severe arrhythmias and CA.(ABSTRACT TRUNCATED AT 250 WORDS)

12 CFR 3.10 - Minimum capital requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Minimum capital requirements. 3.10 Section 3.10 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY CAPITAL ADEQUACY STANDARDS Capital Ratio Requirements and Buffers § 3.10 Minimum capital requirements. (a) Minimum capital...

Effect of Ventilation Strategies on Residential Ozone Levels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walker, Iain S.; Sherman, Max H.

Elevated outdoor ozone levels are associated with adverse health effects. Because people spend the vast majority of their time indoors, reduction in indoor levels of ozone of outdoor origin would lower population exposures and might also lead to a reduction in ozone-associated adverse health effects. In most buildings, indoor ozone levels are diminished with respect to outdoor levels to an extent that depends on surface reactions and on the degree to which ozone penetrates the building envelope. Ozone enters buildings from outdoors together with the airflows that are driven by natural and mechanical means, including deliberate ventilation used to reducemore » concentrations of indoor-generated pollutants. When assessing the effect of deliberate ventilation on occupant health one should consider not only the positive effects on removing pollutants of indoor origin but also the possibility that enhanced ventilation might increase indoor levels of pollutants originating outdoors. This study considers how changes in residential ventilation that are designed to comply with ASHRAE Standard 62.2 might influence indoor levels of ozone. Simulation results show that the building envelope can contribute significantly to filtration of ozone. Consequently, the use of exhaust ventilation systems is predicted to produce lower indoor ozone concentrations than would occur with balanced ventilation systems operating at the same air-­exchange rate. We also investigated a strategy for reducing exposure to ozone that would deliberately reduce ventilation rates during times of high outdoor ozone concentration while still meeting daily average ventilation requirements.« less

Circadian and circannual rhythms in the metabolism and ventilation of red-eared sliders (Trachemys scripta elegans).

PubMed

Reyes, Catalina; Milsom, William K

2010-01-01

Endogenous circadian and circannual rhythms may exist in the metabolism, ventilation, and breathing pattern of turtles that could further prolong dive times during daily and seasonal periods of reduced activity. To test this hypothesis, turtles were held under seasonal or constant environmental conditions over a 1-yr period, and in each season, V(O)(2) and respiratory variables were measured in all animals under both the prevailing seasonal conditions and the constant conditions for 24 h. Endogenous circadian and circannual rhythms in metabolism and ventilation occurred independent of ambient temperature, photoperiod, and activity, although long-term entrainment to daily and seasonal changes in temperature and photoperiod were required for them to be expressed. Metabolism and ventilation were always higher during the photophase, and the day-night difference was greater at any given temperature when the photoperiod was provided. When corrected for temperature, turtles had elevated metabolic and ventilation rates in the fall and spring (corresponding to the reproductive seasons) and suppressed metabolism and ventilation during winter. The strength of the circadian rhythm varied seasonally, with proportionately larger day-night differences in colder seasons. Daily and seasonal cycles in ventilation largely followed metabolism, although daily and seasonal changes did occur in the breathing pattern independent of levels of total ventilation. These endogenous circadian and circannual changes in metabolism, ventilation, and breathing pattern prolonged dive times at night and in winter and may serve to reduce the costs of breathing and transport and risk of predation.

Energy and cost associated with ventilating office buildings in a tropical climate.

PubMed

Rim, Donghyun; Schiavon, Stefano; Nazaroff, William W

2015-01-01

Providing sufficient amounts of outdoor air to occupants is a critical building function for supporting occupant health, well-being and productivity. In tropical climates, high ventilation rates require substantial amounts of energy to cool and dehumidify supply air. This study evaluates the energy consumption and associated cost for thermally conditioning outdoor air provided for building ventilation in tropical climates, considering Singapore as an example locale. We investigated the influence on energy consumption and cost of the following factors: outdoor air temperature and humidity, ventilation rate (L/s per person), indoor air temperature and humidity, air conditioning system coefficient of performance (COP), and cost of electricity. Results show that dehumidification of outdoor air accounts for more than 80% of the energy needed for building ventilation in Singapore's tropical climate. Improved system performance and/or a small increase in the indoor temperature set point would permit relatively large ventilation rates (such as 25 L/s per person) at modest or no cost increment. Overall, even in a thermally demanding tropical climate, the energy cost associated with increasing ventilation rate up to 25 L/s per person is less than 1% of the wages of an office worker in an advanced economy like Singapore's. This result implies that the benefits of increasing outdoor air ventilation rate up to 25 L/s per person--which is suggested to provide for productivity increases, lower sick building syndrome symptom prevalence, and reduced sick leave--can be much larger than the incremental cost of ventilation.

Short-term airing by natural ventilation - modeling and control strategies.

PubMed

Perino, M; Heiselberg, P

2009-10-01

The need to improve the energy efficiency of buildings requires new and more efficient ventilation systems. It has been demonstrated that innovative operating concepts that make use of natural ventilation seem to be more appreciated by occupants. This kind of system frequently integrates traditional mechanical ventilation components with natural ventilation devices, such as motorized windows and louvers. Among the various ventilation strategies that are currently available, buoyancy driven single-sided natural ventilation has proved to be very effective and can provide high air change rates for temperature and IAQ control. However, in order to promote a wider applications of these systems, an improvement in the knowledge of their working principles and the availability of new design and simulation tools is necessary. In this context, the paper analyses and presents the results of a research that was aimed at developing and validating numerical models for the analysis of buoyancy driven single-sided natural ventilation systems. Once validated, these models can be used to optimize control strategies in order to achieve satisfactory indoor comfort conditions and IAQ. Practical Implications Numerical and experimental analyses have proved that short-term airing by intermittent ventilation is an effective measure to satisfactorily control IAQ. Different control strategies have been investigated to optimize the capabilities of the systems. The proposed zonal model has provided good performances and could be adopted as a design tool, while CFD simulations can be profitably used for detailed studies of the pollutant concentration distribution in a room and to address local discomfort problems.

Design and Construction of a Microcontroller-Based Ventilator Synchronized with Pulse Oximeter.

PubMed

Gölcük, Adem; Işık, Hakan; Güler, İnan

2016-07-01

This study aims to introduce a novel device with which mechanical ventilator and pulse oximeter work in synchronization. Serial communication technique was used to enable communication between the pulse oximeter and the ventilator. The SpO2 value and the pulse rate read on the pulse oximeter were transmitted to the mechanical ventilator through transmitter (Tx) and receiver (Rx) lines. The fuzzy-logic-based software developed for the mechanical ventilator interprets these values and calculates the percentage of oxygen (FiO2) and Positive End-Expiratory Pressure (PEEP) to be delivered to the patient. The fuzzy-logic-based software was developed to check the changing medical states of patients and to produce new results (FiO2 ve PEEP) according to each new state. FiO2 and PEEP values delivered from the ventilator to the patient can be calculated in this way without requiring any arterial blood gas analysis. Our experiments and the feedbacks from physicians show that this device makes it possible to obtain more successful results when compared to the current practices.

Summary of human responses to ventilation.

PubMed

Seppänen, O A; Fisk, W J

2004-01-01

It is known that ventilation is necessary to remove indoor-generated pollutants from indoor air or dilute their concentration to acceptable levels. But as the limit values of all pollutants are not known the exact determination of required ventilation rates based on pollutant concentrations is seldom possible. The selection of ventilation rates has to be based also on epidemiological research, laboratory and field experiments and experience. The existing literature indicates that ventilation has a significant impact on several important human outcomes including: (1) communicable respiratory illnesses; (2) sick building syndrome symptoms; (3) task performance and productivity, and (4) perceived air quality (PAQ) among occupants or sensory panels (5) respiratory allergies and asthma. In many studies, prevalence of sick building syndrome symptoms has also been associated with characteristics of HVAC-systems. Often the prevalence of SBS symptoms is higher in air-conditioned buildings than in naturally ventilated buildings. The evidence suggests that better hygiene, commissioning, operation and maintenance of air handling systems may be particularly important for reducing the negative effects of HVAC systems. Ventilation may also have harmful effects on indoor air quality and climate if not properly designed, installed, maintained and operated. Ventilation may bring indoors harmful substances or deteriorate indoor environment. Ventilation interacts also with the building envelope and may deteriorate the structures of the building. Ventilation changes the pressure differences across the structures of building and may cause or prevent infiltration of pollutants from structures or adjacent spaces. Ventilation is also in many cases used to control the thermal environment or humidity in buildings. The paper summarises the current knowledge on positive and negative effects of ventilation on health and other human responses. The focus is on office-type working environment and residential buildings. The review shows that ventilation has various positive impacts on health and productivity of building occupants. Ventilation reduces the prevalence of airborne infectious diseases and thus the number of sick leave days. In office environment a ventilation rate up to 20-25 L/s per person seem to decrease the prevalence of SBS-symptoms. Air conditioning systems may increase the prevalence of SBS-symptoms relative to natural ventilation if not clean. In residential buildings the air change rate in cold climates should not be below app. 0.5 ach. Ventilation systems may cause pressure differences over the building envelope and bring harmful pollutants indoors.

Contextualizing ethics: ventilators, H1N1 and marginalized populations.

PubMed

Silva, Diego S; Nie, Jason X; Rossiter, Kate; Sahni, Sachin; Upshur, Ross E G

2010-01-01

If the H1N1 pandemic worsens, there may not be enough ventilated beds to care for all persons with respiratory failure. To date, researchers who explicitly discuss the ethics of intensive care unit admission and the allocation of ventilators during an influenza pandemic have based criteria predominantly on the principles of utility and efficiency, that is, promoting actions that maximize the greatest good for the greatest number of people. However, haphazardly applying utility and efficiency potentially disadvantages marginalized populations who might be at increased risk of severe reactions to H1N1. In Canada, Aboriginals represent 3% of Canadians, yet 11% of H1N1 cases requiring hospitalization involve Aboriginal persons. Aboriginal persons suffer from high rates of obesity due to socio-economic inequalities. Obesity is also a risk factor for severe H1N1 reactions. Yet, since obesity is found to increase the duration of stay in ventilated beds and a long stay is not considered an optimal use of ventilators, applying the principles of utility and efficiency may magnify existing social inequalities. Although promoting utility and efficiency is important, other ethical principles, such as equity and need, require thoughtful consideration and implementation. Furthermore, since public resources are being used to address a public health hazard, the viewpoints of the public, and specifically stakeholders who will be disproportionately affected, should inform decision-makers. Finally, giving attention to the needs and rights of marginalized populations means that ventilators should not be allocated based on criteria that exacerbate the social injustices faced by these groups of people.

The relationship between in-house attending coverage and nighttime extubation following congenital heart surgery*.

PubMed

Iannucci, Glen J; Oster, Matthew E; Chanani, Nikhil K; Gillespie, Scott E; McCracken, Courtney E; Kanter, Kirk R; Mahle, William T

2014-03-01

Many cardiac ICUs have instituted 24/7 attending physician in-house coverage, which theoretically may allow for more expeditious weaning from ventilation and extubation. We aimed to determine whether this staffing strategy impacts rates of nighttime extubation and duration of mechanical ventilation. National data were obtained from the Virtual PICU System database for all patients admitted to the cardiac ICU following congenital heart surgery in 2011 who required postoperative mechanical ventilation. Contemporaneous data from our local institution were collected in addition to the Virtual PICU System data. The combined dataset (n = 2,429) was divided based on the type of nighttime staffing model in order to compare rates of nighttime extubation and duration of mechanical ventilation between units that used an in-house attending staffing strategy and those that employed nighttime residents, fellows, or midlevel providers only. Institutions that currently use 24/7 in-house attending coverage did not demonstrate statistically significant differences in rates of nighttime extubation or the duration of mechanical ventilation in comparison to units without in-house attendings. Younger patients cared for in non-in-house attending units were more likely to require reintubation. Pediatric patients who have undergone congenital heart surgery can be safely and effectively extubated without the routine presence of an attending physician. The utilization of nighttime in-house attending coverage does not appear to have significant benefits on the rate of nighttime extubation and may not reduce the duration of mechanical ventilation in units that already use in-house residents, fellows, or other midlevel providers.

Roles of sunlight and natural ventilation for controlling infection: historical and current perspectives.

PubMed

Hobday, R A; Dancer, S J

2013-08-01

Infections caught in buildings are a major global cause of sickness and mortality. Understanding how infections spread is pivotal to public health yet current knowledge of indoor transmission remains poor. To review the roles of natural ventilation and sunlight for controlling infection within healthcare environments. Comprehensive literature search was performed, using electronic and library databases to retrieve English language papers combining infection; risk; pathogen; and mention of ventilation; fresh air; and sunlight. Foreign language articles with English translation were included, with no limit imposed on publication date. In the past, hospitals were designed with south-facing glazing, cross-ventilation and high ceilings because fresh air and sunlight were thought to reduce infection risk. Historical and recent studies suggest that natural ventilation offers protection from transmission of airborne pathogens. Particle size, dispersal characteristics and transmission risk require more work to justify infection control practices concerning airborne pathogens. Sunlight boosts resistance to infection, with older studies suggesting potential roles for surface decontamination. Current knowledge of indoor transmission of pathogens is inadequate, partly due to lack of agreed definitions for particle types and mechanisms of spread. There is recent evidence to support historical data on the effects of natural ventilation but virtually none for sunlight. Modern practice of designing healthcare buildings for comfort favours pathogen persistence. As the number of effective antimicrobial agents declines, further work is required to clarify absolute risks from airborne pathogens along with any potential benefits from additional fresh air and sunlight. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Pandemic influenza-implications for critical care resources in Australia and New Zealand.

PubMed

Anderson, Therese A; Hart, Graeme K; Kainer, Marion A

2003-09-01

To quantify resource requirements (additional beds and ventilator capacity), for critical care services in the event of pandemic influenza. Cross-sectional survey about existing and potential critical care resources. Participants comprised 156 of the 176 Australasian (Australia and New Zealand) critical care units on the database of the Australian and New Zealand Intensive Care Society (ANZICS) Research Centre for Critical Care Resources. The Meltzer, Cox and Fukuda model was adapted to map a range of influenza attack rate estimates for hospitalisation and episodes likely to require intensive care and to predict critical care admission rates and bed day requirements. Estimations of ventilation rates were based on those for community-acquired pneumonia. The estimated extra number of persons requiring hospitalisation ranged from 8,455 (10% attack rate) to 150,087 (45% attack rate). The estimated number of additional admissions to critical care units ranged from 423 (5% admission rate, 10% attack rate) to 37,522 (25% admission rate, 45% attack rate). The potential number of required intensive care bed days ranged from 846 bed days (2 day length of stay, 10% attack rate) to 375,220 bed days (10 day length of stay, 45% attack rate). The number of persons likely to require mechanical ventilation ranged from 106 (25% of projected critical care admissions, 10% attack rate) to 28,142 (75% of projected critical care admissions, 45% attack rate). An additional 1,195 emergency ventilator beds were identified in public sector and 248 in private sector hospitals. Cancellation of elective surgery could release a potential 76,402 intensive care bed days (per annum), but in the event of pandemic influenza, 31,150 bed days could be required over an 8- to 12-week period. Australasian critical care services would be overwhelmed in the event of pandemic influenza. More work is required in relation to modelling, contingency plans, and resource allocation.

[Pressure support ventilation and proportional assist ventilation during weaning from mechanical ventilation].

PubMed

Aguirre-Bermeo, H; Bottiroli, M; Italiano, S; Roche-Campo, F; Santos, J A; Alonso, M; Mancebo, J

2014-01-01

To compare tolerance, duration of mechanical ventilation (MV) and clinical outcomes during weaning from MV in patients subjected to either pressure support ventilation (PSV) or proportional assist ventilation (PAV). A prospective, observational study was carried out. Intensive Care Unit. A total of 40 consecutive subjects were allocated to either the PSV or the PAV group until each group contained 20 patients. Patients were included in the study when they met the criteria to begin weaning and the attending physician decided to initiate the weaning process. The physician selected the modality and set the ventilatory parameters. None. Demographic data, respiratory mechanics, ventilatory parameters, duration of MV, and clinical outcomes (reintubation, tracheostomy, mortality). Baseline characteristics were similar in both groups. No significant differences were observed between the PSV and PAV groups in terms of the total duration of MV (10 [5-18] vs. 9 [7-19] days; P=.85), reintubation (5 [31%] vs. 3 [19%]; P=.69), or mortality (4 [20%] vs. 5 [25%] deaths; P=1). Eight patients (40%) in the PSV group and 6 patients (30%) in the PAV group (P=.74) required a return to volume assist-control ventilation due to clinical deterioration. Tolerance, duration of MV and clinical outcomes during weaning from mechanical ventilation were similar in PSV and PAV. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons

PubMed Central

Urrego, Juliana; Ko, Albert I.; da Silva Santos Carbone, Andrea; Paião, Dayse Sanchez Guimarães; Sgarbi, Renata Viebrantz Enne; Yeckel, Catherine W.; Andrews, Jason R.; Croda, Julio

2015-01-01

Prisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO2) levels. We used a modified Wells–Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m2 per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons. PMID:26195459

The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons.

PubMed

Urrego, Juliana; Ko, Albert I; da Silva Santos Carbone, Andrea; Paião, Dayse Sanchez Guimarães; Sgarbi, Renata Viebrantz Enne; Yeckel, Catherine W; Andrews, Jason R; Croda, Julio

2015-10-01

Prisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO2) levels. We used a modified Wells-Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m(2) per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons. © The American Society of Tropical Medicine and Hygiene.

46 CFR 148.255 - Ferrosilicon, aluminum ferrosilicon, and aluminum silicon containing more than 30% but less than...

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DANGEROUS CARGOES CARRIAGE OF BULK SOLID MATERIALS THAT REQUIRE... two separate fans. The total ventilation must be at least five air changes per hour, based on the empty hold. Ventilation must not allow escaping gas to reach accommodation or work spaces, on or under...

46 CFR 148.255 - Ferrosilicon, aluminum ferrosilicon, and aluminum silicon containing more than 30% but less than...

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DANGEROUS CARGOES CARRIAGE OF BULK SOLID MATERIALS THAT REQUIRE... two separate fans. The total ventilation must be at least five air changes per hour, based on the empty hold. Ventilation must not allow escaping gas to reach accommodation or work spaces, on or under...

46 CFR 148.255 - Ferrosilicon, aluminum ferrosilicon, and aluminum silicon containing more than 30% but less than...

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DANGEROUS CARGOES CARRIAGE OF BULK SOLID MATERIALS THAT REQUIRE... two separate fans. The total ventilation must be at least five air changes per hour, based on the empty hold. Ventilation must not allow escaping gas to reach accommodation or work spaces, on or under...

46 CFR 148.255 - Ferrosilicon, aluminum ferrosilicon, and aluminum silicon containing more than 30% but less than...

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DANGEROUS CARGOES CARRIAGE OF BULK SOLID MATERIALS THAT REQUIRE... two separate fans. The total ventilation must be at least five air changes per hour, based on the empty hold. Ventilation must not allow escaping gas to reach accommodation or work spaces, on or under...

46 CFR 105.25-7 - Ventilation systems for cargo tank or pumping system compartment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Ventilation systems for cargo tank or pumping system compartment. 105.25-7 Section 105.25-7 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS COMMERCIAL FISHING VESSELS DISPENSING PETROLEUM PRODUCTS Additional Requirements-When Cargo Tanks Are Installed...

40 CFR 63.8243 - What equations and procedures must I use to demonstrate continuous compliance?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Continuous Compliance Requirements § 63... hydrogen streams and end box ventilation system vents. For each consecutive 52-week period, you must determine the g Hg/Mg Cl2 produced from all by-product hydrogen streams and all end box ventilation system...

40 CFR 63.8243 - What equations and procedures must I use to demonstrate continuous compliance?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Continuous Compliance Requirements § 63... hydrogen streams and end box ventilation system vents. For each consecutive 52-week period, you must determine the g Hg/Mg Cl2 produced from all by-product hydrogen streams and all end box ventilation system...

40 CFR 63.8243 - What equations and procedures must I use to demonstrate continuous compliance?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Continuous Compliance Requirements § 63... hydrogen streams and end box ventilation system vents. For each consecutive 52-week period, you must determine the g Hg/Mg Cl2 produced from all by-product hydrogen streams and all end box ventilation system...

30 CFR 75.370 - Mine ventilation plan; submission and approval.

Code of Federal Regulations, 2010 CFR

2010-07-01

... copy to the representative of miners at the time of notification. In the event of a situation requiring... district manager. Any intentional change to the ventilation system that alters the main air current or any split of the main air current in a manner that could materially affect the safety and health of the...

Introduction to Heating, Ventilation and Air Conditioning (HVAC). Instructor Edition. Introduction to Construction Series.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This instructor's guide contains the materials required to teach a competency-based introductory course in heating, ventilating, and air conditioning (HVAC) to students who have chosen to explore careers in construction. It contains three units: HVAC materials, HVAC tools, and applied skills. Each instructional unit includes some or all of the…

49 CFR Table 1 of Subpart B to... - Minimum Coefficient of Retroreflection (RA) (in Candela/Lux/Meter2) Requirement for...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Minimum Coefficient of Retroreflection (RA) (in Candela/Lux/Meter2) Requirement for Retroreflective Sheeting (Minimum Photometric Performance Requirements... Retroreflection (RA) (in Candela/Lux/Meter2) Requirement for Retroreflective Sheeting (Minimum Photometric...

Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia.

PubMed

Waltrick, Renata; Possamai, Dimitri Sauter; de Aguiar, Fernanda Perito; Dadam, Micheli; de Souza Filho, Valmir João; Ramos, Lucas Rocker; Laurett, Renata da Silva; Fujiwara, Kênia; Caldeira Filho, Milton; Koenig, Álvaro; Westphal, Glauco Adrieno

2015-01-01

>To evaluate the agreement between a new epidemiological surveillance method of the Center for Disease Control and Prevention and the clinical pulmonary infection score for mechanical ventilator-associated pneumonia detection. This was a prospective cohort study that evaluated patients in the intensive care units of two hospitals who were intubated for more than 48 hours between August 2013 and June 2014. Patients were evaluated daily by physical therapist using the clinical pulmonary infection score. A nurse independently applied the new surveillance method proposed by the Center for Disease Control and Prevention. The diagnostic agreement between the methods was evaluated. A clinical pulmonary infection score of ≥ 7 indicated a clinical diagnosis of mechanical ventilator-associated pneumonia, and the association of a clinical pulmonary infection score ≥ 7 with an isolated semiquantitative culture consisting of ≥ 104 colony-forming units indicated a definitive diagnosis. Of the 801 patients admitted to the intensive care units, 198 required mechanical ventilation. Of these, 168 were intubated for more than 48 hours. A total of 18 (10.7%) cases of mechanical ventilation-associated infectious conditions were identified, 14 (8.3%) of which exhibited possible or probable mechanical ventilator-associated pneumonia, which represented 35% (14/38) of mechanical ventilator-associated pneumonia cases. The Center for Disease Control and Prevention method identified cases of mechanical ventilator-associated pneumonia with a sensitivity of 0.37, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.84. The differences resulted in discrepancies in the mechanical ventilator-associated pneumonia incidence density (CDC, 5.2/1000 days of mechanical ventilation; clinical pulmonary infection score ≥ 7, 13.1/1000 days of mechanical ventilation). The Center for Disease Control and Prevention method failed to detect mechanical ventilator-associated pneumonia cases and may not be satisfactory as a surveillance method.

Multisensor System for Isotemporal Measurements to Assess Indoor Climatic Conditions in Poultry Farms

PubMed Central

Bustamante, Eliseo; Guijarro, Enrique; García-Diego, Fernando-Juan; Balasch, Sebastián; Hospitaler, Antonio; Torres, Antonio G.

2012-01-01

The rearing of poultry for meat production (broilers) is an agricultural food industry with high relevance to the economy and development of some countries. Periodic episodes of extreme climatic conditions during the summer season can cause high mortality among birds, resulting in economic losses. In this context, ventilation systems within poultry houses play a critical role to ensure appropriate indoor climatic conditions. The objective of this study was to develop a multisensor system to evaluate the design of the ventilation system in broiler houses. A measurement system equipped with three types of sensors: air velocity, temperature and differential pressure was designed and built. The system consisted in a laptop, a data acquisition card, a multiplexor module and a set of 24 air temperature, 24 air velocity and two differential pressure sensors. The system was able to acquire up to a maximum of 128 signals simultaneously at 5 second intervals. The multisensor system was calibrated under laboratory conditions and it was then tested in field tests. Field tests were conducted in a commercial broiler farm under four different pressure and ventilation scenarios in two sections within the building. The calibration curves obtained under laboratory conditions showed similar regression coefficients among temperature, air velocity and pressure sensors and a high goodness fit (R2 = 0.99) with the reference. Under field test conditions, the multisensor system showed a high number of input signals from different locations with minimum internal delay in acquiring signals. The variation among air velocity sensors was not significant. The developed multisensor system was able to integrate calibrated sensors of temperature, air velocity and differential pressure and operated succesfully under different conditions in a mechanically-ventilated broiler farm. This system can be used to obtain quasi-instantaneous fields of the air velocity and temperature, as well as differential pressure maps to assess the design and functioning of ventilation system and as a verification and validation (V&V) system of Computational Fluid Dynamics (CFD) simulations in poultry farms. PMID:22778611

Ventilation Transport Trade Study for Future Space Suit Life Support Systems

NASA Technical Reports Server (NTRS)

Kempf, Robert; Vogel, Matthew; Paul, Heather L.

2008-01-01

A new and advanced portable life support system (PLSS) for space suit surface exploration will require a durable, compact, and energy efficient system to transport the ventilation stream through the space suit. Current space suits used by NASA circulate the ventilation stream via a ball-bearing supported centrifugal fan. As NASA enters the design phase for the next generation PLSS, it is necessary to evaluate available technologies to determine what improvements can be made in mass, volume, power, and reliability for a ventilation transport system. Several air movement devices already designed for commercial, military, and space applications are optimized in these areas and could be adapted for EVA use. This paper summarizes the efforts to identify and compare the latest fan and bearing technologies to determine candidates for the next generation PLSS.

Mechanical ventilation strategies.

PubMed

Keszler, Martin

2017-08-01

Although only a small proportion of full term and late preterm infants require invasive respiratory support, they are not immune from ventilator-associated lung injury. The process of lung damage from mechanical ventilation is multifactorial and cannot be linked to any single variable. Atelectrauma and volutrauma have been identified as the most important and potentially preventable elements of lung injury. Respiratory support strategies for full term and late preterm infants have not been as thoroughly studied as those for preterm infants; consequently, a strong evidence base on which to make recommendations is lacking. The choice of modalities of support and ventilation strategies should be guided by the specific underlying pathophysiologic considerations and the ventilatory approach must be individualized for each patient based on the predominant pathophysiology at the time. Copyright © 2017 Elsevier Ltd. All rights reserved.

Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH).

PubMed

Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo

2016-01-01

Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

Strategic national stockpile: overview and ventilator assets.

PubMed

Malatino, Eileen M

2008-01-01

Acquiring a resupply of critical medical assets following a national emergency will be crucial to saving lives. The Strategic National Stockpile is a national repository of various medications, vaccines, antidotes, and medical/surgical equipment that would be used to augment federal, state, and local public health agencies in the event of a terrorist attack or other public health emergency. Portable ventilators are included in the stockpile Managed Inventory. These ventilators and the ancillary equipment needed for one adult or one pediatric patient are kitted in a durable case that is staged and ready for deployment. A state that requires these assets initiates a request for federal assistance through established guidelines. This paper provides an overview of the Strategic National Stockpile, the types of ventilators and ancillary equipment currently available, and the process for requesting these assets.

Prevention of bronchopulmonary dysplasia in extremely low gestational age neonates: current evidence.

PubMed

Poets, Christian F; Lorenz, Laila

2018-05-01

Bronchopulmonary dysplasia (BPD) is one of the most frequent complications in extremely low gestational age neonates, but has remained largely unchanged in rate. We reviewed data on BPD prevention focusing on recent meta-analyses. Interventions with proven effectiveness in reducing BPD include the primary use of non-invasive respiratory support, the application of surfactant without endotracheal ventilation and the use of volume-targeted ventilation in infants requiring endotracheal intubation. Following extubation, synchronised nasal ventilation is more effective than continuous positive airway pressure in reducing BPD. Pharmacologically, commencing caffeine citrate on postnatal day 1 or 2 seems more effective than a later start. Applying intramuscular vitamin A for the first 4 weeks reduces BPD, but is expensive and painful and thus not widely used. Low-dose hydrocortisone for the first 10 days prevents BPD, but was associated with almost twice as many cases of late-onset sepsis in infants born at 24-25 weeks' gestation. Inhaled corticosteroids, despite reducing BPD, were associated with a higher mortality rate. Administering dexamethasone to infants still requiring mechanical ventilation around postnatal weeks 2-3 may represent the best trade-off between restricting steroids to infants at risk of BPD while still affording high efficacy. Finally, identifying infants colonised with ureaplasma and treating those requiring intubation and mechanical ventilation with azithromycin is another promising approach to BPD prevention. Further interventions yet only backed by cohort studies include exclusive breastmilk feeding and a better prevention of nosocomial infections. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Perspectives on advance care planning among patients recently requiring non-invasive ventilation for acute respiratory failure: A qualitative study using thematic analysis.

PubMed

Smith, Tracy A; Disler, Rebecca T; Jenkins, Christine R; Ingham, Jane M; Davidson, Patricia M

2017-06-01

Patients requiring non-invasive ventilation for acute-on-chronic respiratory failure due to chronic obstructive pulmonary disease or heart failure exacerbations may have a poor prognosis underscoring the importance of advance care planning. We aimed to describe attitudes to, and experiences of, discussing the future among patients recently treated with non-invasive ventilation. Qualitative research using thematic analysis. Tertiary teaching hospital. Patients with acute hypercapnic respiratory failure requiring non-invasive ventilation. Individuals recently treated with non-invasive ventilation describe feeling the future is beyond their control and instead controlled by their illness. Participants often recognised their poor prognosis but avoided discussing some difficult topics. The majority preferred not to undergo cardiopulmonary resuscitation but most had not discussed this with healthcare professionals. When participants voiced concerns about their future health to family members, they were met with polarised responses. Some encountered willingness for further discussion, while others met deflection, deterring further conversation. An overarching narrative of 'Looking through my illness to an uncertain but concerning future' unites these themes. This study suggests opportunities and barriers for advance care planning in individuals with chronic disease. Patients' understanding of their prognosis and their attitudes to cardiopulmonary resuscitation suggests an opportunity for advance care planning. Structuring discussions around patients' preferences for care during future exacerbations may foster a sense of control over the future despite illness. The diversity of familial responses to patients' concerns about their future health has implications for advance care planning. These findings have the potential to improve care for patients with respiratory failure and suggest an important ongoing research agenda.

Re J (A Minor) (Wardship: Medical Treatment)

PubMed

1992-06-10

The Civil Division of England's Court of Appeal overturned the lower court's order of mechanical ventilation for a profoundly handicapped sixteen-month-old child against the clinical judgment of the child's doctors. Since hitting his head in a fall at age four weeks, J had not mentally developed past that time and he was blind and he suffered from severe cerebral palsy and epilepsy. He required nasogastric tubal feeding and, although he occasionally responded to sound, whether or not he recognized his caregivers was uncertain. His divorced mother and the local authority shared parental authority over J, who resided with foster parents. The consultant pediatrician reported that if J were to suffer a life-threatening event, ordinary resuscitation, antibiotics and physiotherapy would be appropriate, but intervention with intensive measures including mechanical ventilation would be medically inappropriate. Two other specialists agreed with those findings, but another consultant found mechanical ventilation not to be cruel and thought J could be weaned from it if it became so. The mother and local health authority asked the court to require the health authority to continue all treatment, including mechanical ventilation, of J. The Official Solicitor and the health authority opposed such an order. The lower court granted an interim order requiring mechanical ventilation if necessary over the five weeks prior to the main hearing. The appellate court viewed such an order as an abuse of judicial power and held that the physician's duty to the patient is to treat with the necessary consent in accord with the best clinical judgment and that, as long as those with parental authority consent to J's treatment by the health authority, he must be treated in accord with the best clinical judgment of that authority's personnel.

Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports.

PubMed

Pène, Frédéric; Aubron, Cécile; Azoulay, Elie; Blot, François; Thiéry, Guillaume; Raynard, Bruno; Schlemmer, Benoît; Nitenberg, Gérard; Buzyn, Agnès; Arnaud, Philippe; Socié, Gérard; Mira, Jean-Paul

2006-02-01

Because the overall outcome of critically ill hematologic patients has improved, we evaluated the short-term and long-term outcomes of the poor risk subgroup of allogeneic hematopoietic stem-cell transplantation (HSCT) recipients requiring admission to the intensive care unit (ICU). This was a retrospective multicenter study of allogeneic HSCT recipients admitted to the ICU between 1997 and 2003. Two hundred nine critically ill allogeneic HSCT recipients were included in the study. Admission in the ICU occurred during the engraftment period (< or = 30 days after transplantation) for 70 of the patients and after the engraftment period for 139 patients. The overall in-ICU, in-hospital, 6-month, and 1-year survival rates were 48.3%, 32.5%, 27.2%, and 21%, respectively. Mechanical ventilation was required in 122 patients and led to a dramatic decrease in survival rates, resulting in in-ICU, in-hospital, 6-month, and 1-year survival rates of 18%, 15.6%, 14%, and 10.6%, respectively. Mechanical ventilation, elevated bilirubin level, and corticosteroid treatment for the indication of active graft-versus-host disease (GVHD) were independent predictors of death in the whole cohort. In the subgroup of patients requiring mechanical ventilation, associated organ failures, such as shock and liver dysfunction, were independent predictors of death. ICU admission during engraftment period was associated with acceptable outcome in mechanically ventilated patients, whereas patients with late complications of HSCT in the setting of active GVHD had a poor outcome. Extensive unlimited intensive care support is justified for allogeneic HSCT recipients with complications occurring during the engraftment period. Conversely, initiation or maintenance of mechanical ventilation is questionable in the setting of active GVHD.

5. VIEW OF VENTILATION HOUSES AND ROOF MONITOR FROM SOUTHEAST ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

5. VIEW OF VENTILATION HOUSES AND ROOF MONITOR FROM SOUTHEAST CORNER OF ROOF. ROOF MONITOR WINDOWS HAVE BEEN INFILLED WITH BRICK. THE VENTILATION HOUSES ARE PART OF THE ORIGINAL CENTRAL AIR CONDITIONING SYSTEM AND CONTAINED AIR WASHERS, FANS AND OTHER HUMIDFYING EQUIPMENT FROM PARKS-CRAMER COMPANY OF FITCHBURG, MASSACHUSETTS. LOCATING THIS EQUIPMENT ON THE ROOF MADE IT UNNECESSARY TO CONSTRUCT A FULL BASEMENT, AND THEREFORE LOWERED CONSTRUCTION COSTS. THIS ARRANGEMENT ALSO PUT THE AIR CONDITIONING EQUIPMENT CLOSEST TO THE TOP FLOOR SPINNING ROOM, WHICH HAD THE GREATEST COOLING REQUIREMENTS. - Stark Mill, 117 Corinth Road, Hogansville, Troup County, GA

Nonstationary heat and mass transfer in the multilayer building construction with ventilation channels

NASA Astrophysics Data System (ADS)

Kharkov, N. S.

2017-11-01

Results of numerical modeling of the coupled nonstationary heat and mass transfer problem under conditions of a convective flow in facade system of a three-layer concrete panel for two different constructions (with ventilation channels and without) are presented. The positive effect of ventilation channels on the energy and humidity regime over a period of 12 months is shown. Used new method of replacement a solid zone (requiring specification of porosity and material structure, what complicates process of convergence of the solution) on quasi-solid in form of a multicomponent mixture (with restrictions on convection and mass fractions).

Ventilatory Management and Extubation Criteria of the Neurological/Neurosurgical Patient

PubMed Central

Souter, M. J.; Manno, Edward M.

2013-01-01

Approximately 200 000 patients per year will require mechanical ventilation secondary to neurological injury or disease. The associated mortality, morbidity, and costs are significant. The neurological patient presents a unique set of challenges to airway management, mechanical ventilation, and defining extubation readiness. Neurological injury and disease can directly or indirectly involve the process involved with respiration or airway control. This article will review the basics of airway management and mechanical ventilation in the neurological patient. The current state of the literature evaluating extubation criteria in the neurological patient will also be reviewed. PMID:23983886

Long term intubation and successful weaning in two children with Guillain-Barre syndrome.

PubMed

Javed, H; Nair, M P; Koul, R L; Chacko, A; Fazalullah, M

2000-07-01

No definite criteria exists in Guillian-Barre syndrome in children regarding prolonged ventilation through an endo-tracheal tube without tracheostomy and successful weaning using a T-piece. Here we report two such cases of Guillian-Barre syndrome requiring prolonged intubation for 56 days and ventilation for 30 days and ultimately successfully weaning them using the T-piece. Both the children eventually made a complete recovery, highlighting the point that in children prolonged intubation and ventilation using the portex tube is equally good, if not, better than tracheostomy with its attendant risks.

Application unit for the administration of contrast gases for pulmonary magnetic resonance imaging: optimization of ventilation distribution for (3) He-MRI.

PubMed

Güldner, M; Becker, St; Wolf, U; Düber, C; Friesenecker, A; Gast, K K; Heil, W; Hoffmann, C; Karpuk, S; Otten, E W; Rivoire, J; Salhi, Z; Scholz, A; Schreiber, L M; Terekhov, M

2015-09-01

MRI of lung airspaces using gases with MR-active nuclei ((3) He, (129) Xe, and (19) F) is an important area of research in pulmonary imaging. The volume-controlled administration of gas mixtures is important for obtaining quantitative information from MR images. State-of-the-art gas administration using plastic bags (PBs) does not allow for a precise determination of both the volume and timing of a (3) He bolus. A novel application unit (AU) was built according to the requirements of the German medical devices law. Integrated spirometers enable the monitoring of the inhaled gas flow. The device is particularly suited for hyperpolarized (HP) gases (e.g., storage and administration with minimal HP losses). The setup was tested in a clinical trial (n = 10 healthy volunteers) according to the German medicinal products law using static and dynamic ventilation HP-(3) He MRI. The required specifications for the AU were successfully realized. Compared to PB-administration, better reproducibility of gas intrapulmonary distribution was observed when using the AU for both static and dynamic ventilation imaging. The new AU meets the special requirements for HP gases, which are storage and administration with minimal losses. Our data suggest that gas AU-administration is superior to manual modes for determining the key parameters of dynamic ventilation measurements. © 2014 Wiley Periodicals, Inc.

Coexistence of Ureaplasma and chorioamnionitis is associated with prolonged mechanical ventilation.

PubMed

Jung, Euiseok; Choi, Chang Won; Kim, Su Yeong; Sung, Tae-Jung; Kim, Haeryoung; Park, Kyoung Un; Kim, Han-Suk; Kim, Beyong Il; Choi, Jung-Hwan

2017-01-01

Both histologic chorioamnionitis (HCAM) and Ureaplasma infection are considered important contributors to perinatal lung injury. We tested the hypothesis that coexistence of maternal HCAM and perinatal Ureaplasma exposure increases the risk of prolonged mechanical ventilation in extremely low-birthweight (ELBW) infants. A retrospective cohort study was carried out of all ELBW infants born between January 2008 and December 2013 at a single academic center. Placental pathology and gastric fluid Ureaplasma data were available for all infants. Culture and polymerase chain reaction were used to detect Ureaplasma in gastric fluid. Prolonged mechanical ventilation was defined as mechanical ventilation that began within 28 days after birth and continued. Of 111 ELBW infants enrolled, 84 survived beyond 36 weeks of postmenstrual age (PMA) and were included in the analysis. Eighteen infants (21.4%) had both HCAM and Ureaplasma exposure. Seven infants (8.3%) required mechanical ventilation beyond 36 weeks of PMA. Coexistence of HCAM and Ureaplasma in gastric fluid was significantly associated with prolonged mechanical ventilation after adjustment for gestational age, sex, mode of delivery, and use of macrolide antibiotics (OR, 8.7; 95%CI: 1.1-67.2). Coexistence of maternal HCAM and perinatal Ureaplasma exposure significantly increases the risk of prolonged mechanical ventilation in ELBW infants. © 2016 Japan Pediatric Society.

Randomized prospective crossover study of biphasic intermittent positive airway pressure ventilation (BIPAP) versus pressure support ventilation (PSV) in surgical intensive care patients.

PubMed

Elrazek, E Abd

2004-10-01

The aim of this prospective, randomized and crossover study was to assess the role of a relatively new mode of mechanical ventilation, biphasic intermittent positive airway pressure (BIPAP) in comparison to another well established one, pressure-support ventilation (PSV) in surgical intensive care patients. 24 generally stable patients, breathing on their own after short-term (< 24 hours) postoperative controlled mechanical ventilation (CMV) were randomized to start on either PSV or BIPAP, and indirect calorimetry measurements were performed after 1 hour adaptation period at two time intervals; immediately after the investigated ventilatory mode was started and 1 hour later. Statistics included a two-tailed paired t-test to compare the two sets of different data, p < 0.5 was considered significant. Oxygen consumption (VO2), energy expenditure (EE), Carbon dioxide production (VCO2), and respiratory quotient (RQ) did not differ significantly between the two groups. There were also no significant differences regarding respiratory rate (RR), minute volume (MV) and arterial blood gas analysis (ABGs). Both modes of ventilation were well tolerated by all patients. PSV and BIPAP can be used for weaning patients comfortably in surgical intensive care after short-term postoperative ventilation. BIPAP may have the credit of being smoother than PSV where no patient effort is required.

Ventilator-associated pneumonia caused by ESKAPE organisms: cause, clinical features, and management.

PubMed

Sandiumenge, Alberto; Rello, Jordi

2012-05-01

Despite important geographical variations, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species (ESKAPE) pathogens constitute more than 80% of ventilator-associated pneumonia (VAP) episodes. Their clinical importance relies on their virulence and ability in developing mechanisms to decrease susceptibility to antimicrobials, increasing inappropriate therapy and affecting negatively on ICU patients' outcome. This review updates information on VAP due to ESKAPE pathogens. Although methicillin-resistant Staphylococcus aureus VAP may be clinically similar to that caused by susceptible strains, it is associated with poorer outcomes despite adequate treatment. Local colonization determines treatment options. The contribution of tracheobronchitis is an important issue. Minimum inhibitory concentration should be considered for nonfermentative Gram-negative bacteria VAP to prescribe extended infusion β-lactam treatment due to an increase of resistant strains. Strategies promoting antimicrobial diversity may protect against emergence and spread of resistance by ESKAPE pathogens. VAP due to ESKAPE pathogens represents a global challenge that can be prevented using stewardship programmes promoting diversity.

Development of a Fan for Future Space Suit Applications

NASA Technical Reports Server (NTRS)

Paul. Heather L.; Converse, David; Dionne, Steven; Moser, Jeff

2010-01-01

NASA's next generation space suit system will place new demands on the fan used to circulate breathing gas through the ventilation loop of the portable life support system. Long duration missions with frequent extravehicular activities (EVAs), the requirement for significant increases in reliability and durability, and a mission profile that imposes strict limits on weight, volume and power create the basis for a set of requirements that demand more performance than is available from existing fan designs. This paper describes the development of a new fan to meet these needs. A centrifugal fan was designed with a normal operating speed of approximately 39,400 rpm to meet the ventilation flow requirements while also meeting the aggressive minimal packaging, weight and power requirements. The prototype fan also operates at 56,000 rpm to satisfy a second operating condition associated with a single fan providing ventilation flow to two spacesuits connected in series. This fan incorporates a novel nonmetallic "can" to keep the oxygen flow separate from the motor electronics, thus eliminating ignition potential. The nonmetallic can enables a small package size and low power consumption. To keep cost and schedule within project bounds a commercial motor controller was used. The fan design has been detailed and implemented using materials and approaches selected to address anticipated mission needs. Test data is presented to show how this fan performs relative to anticipated ventilation requirements for the EVA portable life support system. Additionally, data is presented to show tolerance to anticipated environmental factors such as acoustics, shock, and vibration. Recommendations for forward work to progress the technology readiness level and prepare the fan for the next EVA space suit system are also discussed.

The Assessment of Airway Maneuvers and Interventions in University Canadian Football, Ice Hockey, and Soccer Players

PubMed Central

Delaney, J. Scott; Al-Kashmiri, Ammar; Baylis, Penny-Jane; Troutman, Tracy; Aljufaili, Mahmood; Correa, José A.

2011-01-01

Abstract Context: Managing an airway in an unconscious athlete is a lifesaving skill that may be made more difficult by the recent changes in protective equipment. Different airway maneuvers and techniques may be required to help ventilate an unconscious athlete who is wearing full protective equipment. Objective: To assess the effectiveness of different airway maneuvers with football, ice hockey, and soccer players wearing full protective equipment. Design: Crossover study. Setting: University sports medicine clinic. Patients or Other Participants: A total of 146 university varsity athletes, consisting of 62 football, 45 ice hockey, and 39 soccer players. Intervention(s): Athletes were assessed for different airway and physical characteristics. Three investigators then evaluated the effectiveness of different bag-valve-mask (BVM) ventilation techniques in supine athletes who were wearing protective equipment while inline cervical spine immobilization was maintained. Main Outcome Measure(s): The effectiveness of 1-person BVM ventilation (1-BVM), 2-person BVM ventilation (2-BVM), and inline immobilization and ventilation (IIV) was judged by each investigator for each athlete using a 4-point rating scale. Results: All forms of ventilation were least difficult in soccer players and most difficult in football players. When compared with 1-BVM, both 2-BVM and IIV were deemed more effective by all investigators for all athletes. Interference from the helmet and stabilizer were common reasons for difficult ventilation in football and ice hockey players. Conclusions: Sports medicine professionals should practice and be comfortable with different ventilation techniques for athletes wearing full equipment. The use of a new ventilation technique, termed inline immobilization and ventilation, may be beneficial, especially when the number of responders is limited. PMID:21391796

Acute refractory hypoxemia after chest trauma reversed by high-frequency oscillatory ventilation: a case report

PubMed Central

2013-01-01

Introduction Polytrauma often results in significant hypoxemia secondary to direct lung contusion or indirectly through atelectasis, systemic inflammatory response, large volume fluid resuscitation and blood product transfusion. In addition to causing hypoxemia, atelectasis and acute lung injury can lead to right ventricular failure through an acute increase in pulmonary vascular resistance. Mechanical ventilation is often applied, accompanied with recruitment maneuvers and positive end-expiratory pressure in order to recruit alveoli and reverse atelectasis, while preventing excessive alveolar damage. This strategy should lead to the reversal of the hypoxemic condition and the detrimental heart–lung interaction that may occur. However, as described in this case report, hemodynamic instability and intractable alveolar atelectasis sometimes do not respond to conventional ventilation strategies. Case presentation We describe the case of a 21-year-old Caucasian man with severe chest trauma requiring surgical interventions, who developed refractory hypoxemia and overt right ventricular failure. After multiple failed attempts of recruitment using conventional ventilation, the patient was ventilated with high-frequency oscillatory ventilation. This mode of ventilation allowed the reversal of the hemodynamic effects of severe hypoxemia and of the acute cor pulmonale. We use this case report to describe the physiological advantages of high-frequency oscillatory ventilation in patients with chest trauma, and formulate the arguments to explain the positive effect observed in our patient. Conclusions High-frequency oscillatory ventilation can be used in the context of a blunt chest trauma accompanied by severe hypoxemia due to atelectasis. The positive effect is due to its capacity to recruit the collapsed alveoli and, as a result, the relief of increased pulmonary vascular resistance and subsequently the reversal of acute cor pulmonale. This approach may represent an alternative in case of failure of the conventional ventilation strategy. PMID:23855954

Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study.

PubMed

Bloos, F; Müller, S; Harz, A; Gugel, M; Geil, D; Egerland, K; Reinhart, K; Marx, G

2009-08-01

Adherence to guidelines to avoid complications associated with mechanical ventilation is often incomplete. The goal of this study was to assess whether staff training in pre-defined interventions (bundle) improves the quality of care in mechanically ventilated patients. This study was performed on a 50-bed intensive care unit of a tertiary care university hospital. Application of a ventilator bundle consisting of semirecumbent positioning, lung protective ventilation in patients with acute lung injury (ALI), ulcer prophylaxis, and deep vein thrombosis prophylaxis (DVTP) was assessed before and after staff training in post-surgical patients requiring mechanical ventilation for at least 24 h. A total of 133 patients before and 141 patients after staff training were included. Overall bundle adherence increased from 15 to 33.8% (P<0.001). Semirecumbent position was achieved in 24.9% of patient days before and 46.9% of patient days after staff training (P<0.001). Administration of DVTP increased from 89.5 to 91.5% (P=0.048). Ulcer prophylaxis of >90% was achieved in both groups. Median tidal volume in patients with ALI remained unaltered. Days on mechanical ventilation were reduced from 6 (interquartile range 2.0-15.0) to 4 (2.0-9.0) (P=0.017). Rate of ventilator-associated pneumonia (VAP), ICU length of stay, and ICU mortality remained unaffected. In patients with VAP, the median ICU length of stay was reduced by 9 days (P=0.04). Staff training by an ICU change team improved compliance to a pre-defined ventilator bundle. This led to a reduction in the days spent on mechanical ventilation, despite incomplete bundle implementation.

29 CFR 783.26 - The section 6(b)(2) minimum wage requirement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false The section 6(b)(2) minimum wage requirement. 783.26... The section 6(b)(2) minimum wage requirement. Section 6(b), with paragraph (2) thereof, requires the... prescribed by” paragraph (1) of the subsection is the minimum wage rate applicable according to the schedule...

Development Specification for the FN-323/324, Oxygen Ventilation Loop Fan Assembly

NASA Technical Reports Server (NTRS)

Ralston, Russell; Campbell, Colin

2017-01-01

This specification establishes the requirements for design, performance, safety, and manufacture of the FN-323/324, Oxygen Ventilation Loop Fan Assembly as part of the Advanced EMU (AEMU) Portable Life Support System (PLSS). Fan development for the advanced Portable Life Support System (PLSS) began in 2009 with the development of Fan 1.0. This fan was used in PLSS 2.0 for circulation of the ventilation loop gas. Fan 2.0 was delivered in 2015 and will be used in the PLSS 2.5 Live Loads test series. This fan used the same motor as Fan 1.0, but had a larger volute and impeller in hopes of achieving lower speeds. The next iteration of the advanced PLSS fan is the subject of the requirements contained within this document, and will be used with the PLSS 2.5 -302 configuration.

Respiratory muscle dysfunction: a multicausal entity in the critically ill patient undergoing mechanical ventilation.

PubMed

Díaz, Magda C; Ospina-Tascón, Gustavo A; Salazar C, Blanca C

2014-02-01

Respiratory muscle dysfunction, particularly of the diaphragm, may play a key role in the pathophysiological mechanisms that lead to difficulty in weaning patients from mechanical ventilation. The limited mobility of critically ill patients, and of the diaphragm in particular when prolonged mechanical ventilation support is required, promotes the early onset of respiratory muscle dysfunction, but this can also be caused or exacerbated by other factors that are common in these patients, such as sepsis, malnutrition, advanced age, duration and type of ventilation, and use of certain medications, such as steroids and neuromuscular blocking agents. In this review we will study in depth this multicausal origin, in which a common mechanism is altered protein metabolism, according to the findings reported in various models. The understanding of this multicausality produced by the same pathophysiological mechanism could facilitate the management and monitoring of patients undergoing mechanical ventilation. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

Occult pneumothorax in the mechanically ventilated trauma patient

PubMed Central

Ball, Chad G.; Hameed, S. Morad; Evans, Dave; Kortbeek, John B.; Kirkpatrick, Andrew W.

2003-01-01

The term occult pneumothorax (OP) describes a pneumothorax that is not suspected on the basis of clinical examination or plain radiography but is ultimately detected with thoracoabdominal computed tomography (CT). This situation is increasingly common in trauma care with the increased use of CT. The rate is approximately 5% in injured people presenting to hospital, with CT revealing at least twice as many pneumothoraces as suspected on plain radiography. Whereas pneumothorax is a common and treatable cause of mortality and morbidity, there is substantial disagreement regarding the appropriate treatment of OP. The greatest controversy is in patients in the critical care unit who require positive-pressure ventilation. There is little current evidence to direct the proper management of ventilated trauma patients with OP, and no studies have focussed specifically on these patients. Future randomized trials will need to consider the potential effects of OP on pulmonary mechanics and potential influences on the known risks of ventilator-induced lung injury associated with mechanical ventilation. PMID:14577712

Dynamic airway pressure-time curve profile (Stress Index): a systematic review.

PubMed

Terragni, Pierpaolo; Bussone, Guido; Mascia, Luciana

2016-01-01

The assessment of respiratory mechanics at the bedside is necessary in order to identify the most protective ventilatory strategy. Indeed in the last 20 years, adverse effects of positive ventilation to the lung structures have led to a reappraisal of the objectives of mechanical ventilation. The ventilator setting requires repeated readjustment over the period of mechanical ventilation dependency and careful respiratory monitoring to minimize the risks, preventing further injury and permitting the lung and airways healing. Among the different methods that have been proposed and validated, the analysis of dynamic P-t curve (named Stress Index, SI) represents an adequate tool available at the bedside, repeatable and, therefore, able to identify the amount of overdistension occurring in the daily clinical practice, when modifying positive end-expiratory pressure. In this review we will analyze the evidence that supports respiratory mechanics assessment at the bedside and the application of the dynamic P/t curve profile (SI) to optimize protective ventilation in patients with acute respiratory failure.

The use of intermittent positive pressure ventilation to differentiate pneumonia from atelectasis during anesthesia in a red panda (Ailurus fulgens).

PubMed

Phair, Kristen; West, Gary; Biller, David

2010-12-01

Radiography is a valuable tool for assessment of pulmonary disease. Specifically, radiographs utilizing positive pressure ventilation can distinguish between anesthesia-induced atelectasis and pulmonary disease when survey radiographs are ambiguous. Positive pressure ventilation can be used to radiographically prove or disprove pulmonary disease. This is of particular clinical importance when working with exotic, zoo, or wildlife species because the majority of these patients require general anesthesia to perform physical examinations and diagnostics such as radiography safely and efficiently. This report is a case example of pulmonary disease in a red panda (Ailurus fulgens) and demonstrates how positive pressure ventilation verified both the presence of pulmonary disease and the eventual resolution of the disease. Anesthetized patients on gas anesthesia will rapidly become atelectic. Through the use of positive pressure ventilation, anesthesia-induced atelectasis and true pulmonary disease can readily be distinguished. This is a technique that should not be overlooked when performing thoracic radiography in zoo species.

Space station ventilation study

NASA Technical Reports Server (NTRS)

Colombo, G. V.; Allen, G. E.

1972-01-01

A ventilation system design and selection method which is applicable to any manned vehicle were developed. The method was used to generate design options for the NASA 33-foot diameter space station, all of which meet the ventilation system design requirements. System characteristics such as weight, volume, and power were normalized to dollar costs for each option. Total system costs for the various options ranged from a worst case $8 million to a group of four which were all approximately $2 million. A system design was then chosen from the $2 million group and is presented in detail. A ventilation system layout was designed for the MSFC space station mockup which provided comfortable, efficient ventilation of the mockup. A conditioned air distribution system design for the 14-foot diameter modular space station, using the same techniques, is also presented. The tradeoff study resulted in the selection of a system which costs $1.9 million, as compared to the alternate configuration which would have cost $2.6 million.

Energy and Cost Associated with Ventilating Office Buildings in a Tropical Climate

PubMed Central

Rim, Donghyun; Schiavon, Stefano; Nazaroff, William W.

2015-01-01

Providing sufficient amounts of outdoor air to occupants is a critical building function for supporting occupant health, well-being and productivity. In tropical climates, high ventilation rates require substantial amounts of energy to cool and dehumidify supply air. This study evaluates the energy consumption and associated cost for thermally conditioning outdoor air provided for building ventilation in tropical climates, considering Singapore as an example locale. We investigated the influence on energy consumption and cost of the following factors: outdoor air temperature and humidity, ventilation rate (L/s per person), indoor air temperature and humidity, air conditioning system coefficient of performance (COP), and cost of electricity. Results show that dehumidification of outdoor air accounts for more than 80% of the energy needed for building ventilation in Singapore’s tropical climate. Improved system performance and/or a small increase in the indoor temperature set point would permit relatively large ventilation rates (such as 25 L/s per person) at modest or no cost increment. Overall, even in a thermally demanding tropical climate, the energy cost associated with increasing ventilation rate up to 25 L/s per person is less than 1% of the wages of an office worker in an advanced economy like Singapore’s. This result implies that the benefits of increasing outdoor air ventilation rate up to 25 L/s per person — which is suggested to provide for productivity increases, lower sick building syndrome symptom prevalence, and reduced sick leave — can be much larger than the incremental cost of ventilation. PMID:25822504

Iatrogenic pneumothorax related to mechanical ventilation

PubMed Central

Hsu, Chien-Wei; Sun, Shu-Fen

2014-01-01

Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilator-related pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation. The diagnosis of pneumothorax in critical illness is established from the patients’ history, physical examination and radiological investigation, although the appearances of a pneumothorax on a supine radiograph may be different from the classic appearance on an erect radiograph. For this reason, ultrasonography is beneficial for excluding the diagnosis of pneumothorax. Respiration-dependent movement of the visceral pleura and lung surface with respect to the parietal pleura and chest wall can be easily visualized with transthoracic sonography given that the presence of air in the pleural space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation II score or PaO2/FiO2 < 200 mmHg were found to have higher mortality. PMID:24834397

The influence of mechanical ventilation on physiological parameters in ball pythons (Python regius).

PubMed

Jakobsen, Sashia L; Williams, Catherine J A; Wang, Tobias; Bertelsen, Mads F

2017-05-01

Mechanical ventilation is widely recommended for reptiles during anesthesia, and while it is well-known that their low ectothermic metabolism requires much lower ventilation than in mammals, very little is known about the influence of ventilation protocol on the recovery from anesthesia. Here, 15 ball pythons (Python regius) were induced and maintained with isoflurane for 60min at one of three ventilation protocols (30, 125, or 250mlmin -1 kg -1 body mass) while an arterial catheter was inserted, and ventilation was then continued on 100% oxygen at the specified rate until voluntary extubation. Mean arterial blood pressure and heart rate (HR) were measured, and arterial blood samples collected at 60, 80, 180min and 12 and 24h after intubation. In all three groups, there was evidence of a metabolic acidosis, and snakes maintained at 30mlmin -1 kg -1 experienced an additional respiratory acidosis, while the two other ventilation protocols resulted in normal or low arterial PCO 2 . In general, normal acid-base status was restored within 12h in all three protocols. HR increased by 143±64% during anesthesia with high mechanical ventilation (250mlmin -1 kg -1 ) in comparison with recovered values. Recovery times after mechanical ventilation at 30, 125, or 250mlmin -1 kg -1 were 289±70, 126±16, and 68±7min, respectively. Mild overventilation may result in a faster recovery, and the associated lowering of arterial PCO 2 normalised arterial pH in the face of metabolic acidosis. Copyright © 2017 Elsevier Inc. All rights reserved.

A Novel In-Line Delivery System to Administer Dry Powder Mannitol to Mechanically Ventilated Patients.

PubMed

Feng, Benny; Tang, Patricia; Leung, Sharon Shui Yee; Dhanani, Jayesh; Chan, Hak-Kim

2017-04-01

Mechanically ventilated patients commonly suffer from ventilator-associated pneumonia, hypoxemia, and other lower respiratory tract infection as a result of pathogen colonization and poor sputum clearance. Consequently, there is a high rate of morbidity and mortality in these patients. Dry powder mannitol increases sputum clearance, and therefore, we developed a system to administer it to mechanically ventilated patients without disconnection from the ventilator. The inspiratory line from a ventilator was split by using a three-way valve into two parallel lines where one contains a humidifier for normal breathing cycle and the other line contains a dry powder inhaler (Osmohaler™). The inspiratory air went through the dry powder line and aerosolized the mannitol powder only when its administration to a patient is required. We determined the delivered dose and particle size distributions of emitted aerosols in vitro from 9.5 mm endotracheal and 7.5 mm tracheostomy tubes, with inspiratory airflow of 60, 70, and 80 L/min. This novel setup was able to deliver 24.6% ± 3.33% of the 160 mg loaded dose mannitol powder (4 × 40 mg capsules) and 26.7% ± 2.19% of the 320 mg dose (4 × 80 mg capsules) when the endotracheal tube was used. With the shorter tracheostomy tube, the delivery dose increased to 35.6% ± 3.01% and 39.5% ± 2.04% of the 160 and 320 mg doses, respectively. The volume median diameters of the aerosols were in the respirable range with the largest value being 5.17 ± 0.87 μm. This delivery system has been shown to consistently deliver a high respirable dose of mannitol powder. Since this setup does not require disconnection of patients from the ventilator, it is safer for hypoxemic patients and easier to be adapted in a real clinical use.

Fire safety experiments on MIR Orbital Station

NASA Technical Reports Server (NTRS)

Egorov, S. D.; Belayev, A. YU.; Klimin, L. P.; Voiteshonok, V. S.; Ivanov, A. V.; Semenov, A. V.; Zaitsev, E. N.; Balashov, E. V.; Andreeva, T. V.

1995-01-01

The process of heterogeneous combustion of most materials under zero-g without forced motion of air is practically impossible. However, ventilation is required to support astronauts' life and cool equipment. The presence of ventilation flows in station compartments at accidental ignition can cause a fire. An additional, but exceedingly important parameter of the fire risk of solid materials under zero-g is the minimum air gas velocity at which the extinction of materials occurs. Therefore, the conception of fire safety can be based on temporarily lowering the intensity of ventilation and even turning it off. The information on the limiting conditions of combustion under natural conditions is needed from both scientific and practical points of view. It will enable us to judge the reliability of results of ground-based investigations and develop a conception of fire safety of inhabited sealed compartments of space stations to by provided be means of nontraditional and highly-effective methods without both employing large quantities of fire-extinguishing compounds and hard restrictions on use of polymers. In this connection, an experimental installation was created to study the process of heterogeneous combustion of solid non-metals and to determine the conditions of its extinction under microgravity. This installation was delivered to the orbital station 'Mir' and the cosmonauts Viktorenko and Kondakova performed initial experiments on it in late 1994. The experimental installation consists of a combustion chamber with an electrical systems for ignition of samples, a device for cleaning air from combustion products, an air suction unit, air pipes and a control panel. The whole experiment is controlled by telemetry and recorded with two video cameras located at two different places. Besides the picture, parameters are recorded to determine the velocity of the air flow incoming to the samples, the time points of switching on/off the devices, etc. The combustion chamber temperature is also controlled. The main objectives of experiments of this series were as follows: (1) verification of the reliability of the installation in orbital flight; (2) verification of the experimental procedure; and (3) investigation of combustion of two types of materials under microgravity at various velocities of the incoming air flow.

WE-AB-BRA-06: 4DCT-Ventilation: A Novel Imaging Modality for Thoracic Surgical Evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vinogradskiy, Y; Jackson, M; Schubert, L

Purpose: The current standard-of-care imaging used to evaluate lung cancer patients for surgical resection is nuclear-medicine ventilation. Surgeons use nuclear-medicine images along with pulmonary function tests (PFT) to calculate percent predicted postoperative (%PPO) PFT values by estimating the amount of functioning lung that would be lost with surgery. 4DCT-ventilation is an emerging imaging modality developed in radiation oncology that uses 4DCT data to calculate lung ventilation maps. We perform the first retrospective study to assess the use of 4DCT-ventilation for pre-operative surgical evaluation. The purpose of this work was to compare %PPO-PFT values calculated with 4DCT-ventilation and nuclear-medicine imaging. Methods:more » 16 lung cancer patients retrospectively reviewed had undergone 4DCTs, nuclear-medicine imaging, and had Forced Expiratory Volume in 1 second (FEV1) acquired as part of a standard PFT. For each patient, 4DCT data sets, spatial registration, and a density-change based model were used to compute 4DCT-ventilation maps. Both 4DCT and nuclear-medicine images were used to calculate %PPO-FEV1 using %PPO-FEV1=pre-operative FEV1*(1-fraction of total ventilation of resected lung). Fraction of ventilation resected was calculated assuming lobectomy and pneumonectomy. The %PPO-FEV1 values were compared between the 4DCT-ventilation-based calculations and the nuclear-medicine-based calculations using correlation coefficients and average differences. Results: The correlation between %PPO-FEV1 values calculated with 4DCT-ventilation and nuclear-medicine were 0.81 (p<0.01) and 0.99 (p<0.01) for pneumonectomy and lobectomy respectively. The average difference between the 4DCT-ventilation based and the nuclear-medicine-based %PPO-FEV1 values were small, 4.1±8.5% and 2.9±3.0% for pneumonectomy and lobectomy respectively. Conclusion: The high correlation results provide a strong rationale for a clinical trial translating 4DCT-ventilation to the surgical domain. Compared to nuclear-medicine, 4DCT-ventilation is cheaper, does not require a radioactive contrast agent, provides a faster imaging procedure, and has improved spatial resolution. 4DCT-ventilation can reduce the cost and imaging time for patients while providing improved spatial accuracy and quantitative results for surgeons. YV discloses grant from State of Colorado.« less

Natural ventilation for the prevention of airborne contagion.

PubMed

Escombe, A Roderick; Oeser, Clarissa C; Gilman, Robert H; Navincopa, Marcos; Ticona, Eduardo; Pan, William; Martínez, Carlos; Chacaltana, Jesus; Rodríguez, Richard; Moore, David A J; Friedland, Jon S; Evans, Carlton A

2007-02-01

Institutional transmission of airborne infections such as tuberculosis (TB) is an important public health problem, especially in resource-limited settings where protective measures such as negative-pressure isolation rooms are difficult to implement. Natural ventilation may offer a low-cost alternative. Our objective was to investigate the rates, determinants, and effects of natural ventilation in health care settings. The study was carried out in eight hospitals in Lima, Peru; five were hospitals of "old-fashioned" design built pre-1950, and three of "modern" design, built 1970-1990. In these hospitals 70 naturally ventilated clinical rooms where infectious patients are likely to be encountered were studied. These included respiratory isolation rooms, TB wards, respiratory wards, general medical wards, outpatient consulting rooms, waiting rooms, and emergency departments. These rooms were compared with 12 mechanically ventilated negative-pressure respiratory isolation rooms built post-2000. Ventilation was measured using a carbon dioxide tracer gas technique in 368 experiments. Architectural and environmental variables were measured. For each experiment, infection risk was estimated for TB exposure using the Wells-Riley model of airborne infection. We found that opening windows and doors provided median ventilation of 28 air changes/hour (ACH), more than double that of mechanically ventilated negative-pressure rooms ventilated at the 12 ACH recommended for high-risk areas, and 18 times that with windows and doors closed (p < 0.001). Facilities built more than 50 years ago, characterised by large windows and high ceilings, had greater ventilation than modern naturally ventilated rooms (40 versus 17 ACH; p < 0.001). Even within the lowest quartile of wind speeds, natural ventilation exceeded mechanical (p < 0.001). The Wells-Riley airborne infection model predicted that in mechanically ventilated rooms 39% of susceptible individuals would become infected following 24 h of exposure to untreated TB patients of infectiousness characterised in a well-documented outbreak. This infection rate compared with 33% in modern and 11% in pre-1950 naturally ventilated facilities with windows and doors open. Opening windows and doors maximises natural ventilation so that the risk of airborne contagion is much lower than with costly, maintenance-requiring mechanical ventilation systems. Old-fashioned clinical areas with high ceilings and large windows provide greatest protection. Natural ventilation costs little and is maintenance free, and is particularly suited to limited-resource settings and tropical climates, where the burden of TB and institutional TB transmission is highest. In settings where respiratory isolation is difficult and climate permits, windows and doors should be opened to reduce the risk of airborne contagion.

Adverse events during rotary-wing transport of mechanically ventilated patients: a retrospective cohort study

PubMed Central

Seymour, Christopher W; Kahn, Jeremy M; Schwab, C William; Fuchs, Barry D

2008-01-01

Introduction Patients triaged to tertiary care centers frequently undergo rotary-wing transport and may be exposed to additional risk for adverse events. The incidence of physiologic adverse events and their predisposing factors in mechanically ventilated patients undergoing aeromedical transport are unknown. Methods We performed a retrospective review of flight records of all interfacility, rotary-wing transports to a tertiary care, university hospital during 2001 to 2003. All patients receiving mechanical ventilation via endotracheal tube or tracheostomy were included; trauma, scene flights, and fixed transports were excluded. Data were abstracted from patient flight and hospital records. Adverse events were classified as either major (death, arrest, pneumothorax, or seizure) or minor (physiologic decompensation, new arrhythmia, or requirement for new sedation/paralysis). Bivariate associations between hospital and flight characteristics and the presence of adverse events were examined. Results Six hundred eighty-two interfacility flights occurred during the period of review, with 191 patients receiving mechanical ventilation. Fifty-eight different hospitals transferred patients, with diagnoses that were primarily cardiopulmonary (45%) and neurologic (37%). Median flight distance and time were 42 (31 to 83) km and 13 (8 to 22) minutes, respectively. No major adverse events occurred during flight. Forty patients (22%) experienced a minor physiologic adverse event. Vasopressor requirement prior to flight and flight distance were associated with the presence of adverse events in-flight (P < 0.05). Patient demographics, time of day, season, transferring hospital characteristics, and ventilator settings before and during flight were not associated with adverse events. Conclusion Major adverse events are rare during interfacility, rotary-wing transfer of critically ill, mechanically ventilated patients. Patients transferred over a longer distance or transferred on vasopressors may be at greater risk for minor adverse events during flight. PMID:18498659

Should lung transplantation be performed for patients on mechanical respiratory support? The US experience.

PubMed

Mason, David P; Thuita, Lucy; Nowicki, Edward R; Murthy, Sudish C; Pettersson, Gösta B; Blackstone, Eugene H

2010-03-01

The study objectives were to (1) compare survival after lung transplantation in patients requiring pretransplant mechanical ventilation or extracorporeal membrane oxygenation with that of patients not requiring mechanical support and (2) identify risk factors for mortality. Data were obtained from the United Network for Organ Sharing for lung transplantation from October 1987 to January 2008. A total of 15,934 primary transplants were performed: 586 in patients on mechanical ventilation and 51 in patients on extracorporeal membrane oxygenation. Differences between nonsupport patients and those on mechanical ventilation or extracorporeal membrane oxygenation support were expressed as 2 propensity scores for use in comparing risk-adjusted survival. Unadjusted survival at 1, 6, 12, and 24 months was 83%, 67%, 62%, and 57% for mechanical ventilation, respectively; 72%, 53%, 50%, and 45% for extracorporeal membrane oxygenation, respectively; and 93%, 85%, 79%, and 70% for unsupported patients, respectively (P < .0001). Recipients on mechanical ventilation were younger, had lower forced vital capacity, and had diagnoses other than emphysema. Recipients on extracorporeal membrane oxygenation were also younger, had higher body mass index, and had diagnoses other than cystic fibrosis/bronchiectasis. Once these variables, transplant year, and propensity for mechanical support were accounted for, survival remained worse after lung transplantation for patients on mechanical ventilation and extracorporeal membrane oxygenation. Although survival after lung transplantation is markedly worse when preoperative mechanical support is necessary, it is not dismal. Thus, additional risk factors for mortality should be considered when selecting patients for lung transplantation to maximize survival. Reduced survival for this high-risk population raises the important issue of balancing maximal individual patient survival against benefit to the maximum number of patients. Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Retrospective Application of New Pediatric Ventilator-Associated Pneumonia Criteria Identifies a High-Risk Population.

PubMed

Gionfriddo, Ashley; Nonoyama, Mika L; Laussen, Peter C; Cox, Peter N; Clarke, Megan; Floh, Alejandro A

2018-06-01

To promote standardization, the Centers for Disease Control and Prevention introduced a new ventilator-associated pneumonia classification, which was modified for pediatrics (pediatric ventilator-associated pneumonia according to proposed criteria [PVAP]). We evaluated the frequency of PVAP in a cohort of children diagnosed with ventilator-associated pneumonia according to traditional criteria and compared their strength of association with clinically relevant outcomes. Retrospective cohort study. Tertiary care pediatric hospital. Critically ill children (0-18 yr) diagnosed with ventilator-associated pneumonia between January 2006 and December 2015 were identified from an infection control database. Patients were excluded if on high frequency ventilation, extracorporeal membrane oxygenation, or reintubated 24 hours following extubation. None. Patients were assessed for PVAP diagnosis. Primary outcome was the proportion of subjects diagnosed with PVAP. Secondary outcomes included association with intervals of care. Two hundred seventy-seven children who had been diagnosed with ventilator-associated pneumonia were eligible for review; 46 were excluded for being ventilated under 48 hours (n = 16), on high frequency ventilation (n = 12), on extracorporeal membrane oxygenation (n = 8), ineligible bacteria isolated from culture (n = 8), and other causes (n = 4). ICU admission diagnoses included congenital heart disease (47%), neurological (16%), trauma (7%), respiratory (7%), posttransplant (4%), neuromuscular (3%), and cardiomyopathy (3%). Only 16% of subjects (n = 45) met the new PVAP definition, with 18% (n = 49) having any ventilator-associated condition. Failure to fulfill new definitions was based on inadequate increase in mean airway pressure in 90% or FIO2 in 92%. PVAP was associated with prolonged ventilation (median [interquartile range], 29 d [13-51 d] vs 16 d [8-34.5 d]; p = 0.002), ICU (median [interquartile range], 40 d [20-100 d] vs 25 d [14-61 d]; p = 0.004) and hospital length of stay (median [interquartile range], 81 d [40-182 d] vs 54 d [31-108 d]; p = 0.04), and death (33% vs 16%; p = 0.008). Few children with ventilator-associated pneumonia diagnosis met the proposed PVAP criteria. PVAP was associated with increased morbidity and mortality. This work suggests that additional study is required before new definitions for ventilator-associated pneumonia are introduced for children.

Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group.

PubMed

Gadek, J E; DeMichele, S J; Karlstad, M D; Pacht, E R; Donahoe, M; Albertson, T E; Van Hoozen, C; Wennberg, A K; Nelson, J L; Noursalehi, M

1999-08-01

Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), gamma-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS. Prospective, multicentered, double-blind, randomized controlled trial. Intensive care units of five academic and teaching hospitals in the United States. We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study. Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4-7 days. Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2, a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (approximately 2.5-fold) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (PaO2/FIO2) from baseline to study days 4 and 7 with lower ventilation variables (FIO2, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8%) patients fed EPA+GLA vs. 13 of 47 (28%) control patients developed a new organ failure during the study (p = .015). The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.

Chemical Emissions of Residential Materials and Products: Review of Available Information

DOE Office of Scientific and Technical Information (OSTI.GOV)

Willem, Henry; Singer, Brett

2010-09-15

This report is prepared in the context of a larger program whose mission is to advance understanding of ventilation and indoor air quality in U.S. homes. A specific objective of this program is to develop the scientific basis ? through controlled experiments, monitoring and analysis ? for health risk-based ventilation standards. Appropriate and adequate ventilation is a basic element of a healthy home. Ventilation provides outdoor air and in the process removes indoor odors and contaminants including potentially unhealthful chemicals emitted by indoor materials, products and activities. Ventilation traditionally was assured to occur via infiltration of outdoor air through cracksmore » and other leakage pathways in the residential building envelope. As building air tightness is improved for energy efficiency, infiltration can be reduced to inadequate levels. This has lead to the development of standards requiring mechanical ventilation. Though nominally intended to ensure acceptable indoor air quality, the standards are not explicitly tied to health risk or pollutant exposure targets. LBNL is currently designing analyses to assess the impact of varying ventilation standards on pollutant concentrations, health risks and energy use. These analyses require information on sources of chemical pollutant emissions, ideally including emission rates and the impact of ventilation on emissions. Some information can be obtained from recent studies that report measurements of various air contaminants and their concentrations in U.S. residences. Another way to obtain this information is the bottom-up approach of collecting and evaluating emissions data from construction and interior materials and common household products. This review contributes to the latter approach by summarizing available information on chemical emissions from new residential products and materials. We review information from the scientific literature and public sources to identify and discuss the databases that provide information on new or low-emission materials and products. The review focuses on the primary chemical or volatile organic compound (VOC) emissions from interior surface materials, furnishings, and some regularly used household products; all of these emissions are amenable to ventilation. Though it is an important and related topic, this review does not consider secondary pollutants that result from reactions of ozone and unsaturated organics bound to or emitted from material surfaces. Semi-volatile organic compounds (SVOCs) have been largely excluded from this review because ventilation generally is not an effective way to control SVOC exposures. Nevertheless, health concerns about exposures to SVOCs emitted from selected materials warrant some discussion.« less

76 FR 50164 - Protocol Gas Verification Program and Minimum Competency Requirements for Air Emission Testing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

...-AQ06 Protocol Gas Verification Program and Minimum Competency Requirements for Air Emission Testing... correct certain portions of the Protocol Gas Verification Program and Minimum Competency Requirements for... final rule that amends the Agency's Protocol Gas Verification Program (PGVP) and the minimum competency...

Contaminants in ventilated filling boxes

NASA Astrophysics Data System (ADS)

Bolster, D. T.; Linden, P. F.

While energy efficiency is important, the adoption of energy-efficient ventilation systems still requires the provision of acceptable indoor air quality. Many low-energy systems, such as displacement or natural ventilation, rely on temperature stratification within the interior environment, always extracting the warmest air from the top of the room. Understanding buoyancy-driven convection in a confined ventilated space is key to understanding the flow that develops with many of these modern low-energy ventilation schemes. In this work we study the transport of an initially uniformly distributed passive contaminant in a displacement-ventilated space. Representing a heat source as an ideal sourced of buoyancy, analytical and numerical models are developed that allow us to compare the average efficiency of contaminant removal between traditional mixing and modern low-energy systems. A set of small-scale analogue laboratory experiments was also conducted to further validate our analytical and numerical solutions.We find that on average traditional and low-energy ventilation methods are similar with regard to pollutant flushing efficiency. This is because the concentration being extracted from the system at any given time is approximately the same for both systems. However, very different vertical concentration gradients exist. For the low-energy system, a peak in contaminant concentration occurs at the temperature interface that is established within the space. This interface is typically designed to sit at some intermediate height in the space. Since this peak does not coincide with the extraction point, displacement ventilation does not offer the same benefits for pollutant flushing as it does for buoyancy removal.

Epithelial and endothelial damage induced by mechanical ventilation modes.

PubMed

Suki, Béla; Hubmayr, Rolf

2014-02-01

The adult respiratory distress syndrome (ARDS) is a common cause of respiratory failure with substantial impact on public health. Patients with ARDS generally require mechanical ventilation, which risks further lung damage. Recent improvements in ARDS outcomes have been attributed to reductions in deforming stress associated with lung protective mechanical ventilation modes and settings. The following review details the mechanics of the lung parenchyma at different spatial scales and the response of its resident cells to deforming stress in order to provide the biologic underpinnings of lung protective care. Although lung injury is typically viewed through the lens of altered barrier properties and mechanical ventilation-associated immune responses, in this review, we call attention to the importance of heterogeneity and the physical failure of the load bearing cell and tissue elements in the pathogenesis of ARDS. Specifically, we introduce a simple elastic network model to better understand the deformations of lung regions, intra-acinar alveoli and cells within a single alveolus, and consider the role of regional distension and interfacial stress-related injury for various ventilation modes. Heterogeneity of stiffness and intercellular and intracellular stress failure are fundamental components of ARDS and their development also depends on the ventilation mode.

Mechanical ventilation in disaster situations: a new paradigm using the AGILITIES Score System.

PubMed

Wilkens, Eric P; Klein, Gary M

2010-01-01

The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans. All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well. Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster. The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals. This scoring system and the set ofguidelines are to be used iA disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients' use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.

Intravenous ketamine in a dissociating dose as a temporizing measure to avoid mechanical ventilation in adult patient with severe asthma exacerbation.

PubMed

Shlamovitz, Gil Z; Hawthorne, Tracy

2011-11-01

Patients experiencing severe asthma exacerbations occasionally deteriorate to respiratory failure requiring endotracheal intubation and mechanical ventilation. Mechanical ventilation in this setting exposes the patients to substantial iatrogenic risk and should be avoided if at all possible. To describe the use of intravenous ketamine in acute asthma exacerbation. We present a case of severe asthma exacerbation in an adult female patient who failed to improve with standard therapies, but promptly improved with the administration of intravenous ketamine (0.75 mg/kg i.v. bolus followed by continuous drip of 0.15 mg/kg/h). This case suggests that intravenous ketamine given in a dissociative dose may be an effective temporizing measure to avoid mechanical ventilation in adult patients with severe asthma exacerbations. Copyright © 2011 Elsevier Inc. All rights reserved.

How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys.

PubMed

Kessler, Ronald C; Rose, Sherri; Koenen, Karestan C; Karam, Elie G; Stang, Paul E; Stein, Dan J; Heeringa, Steven G; Hill, Eric D; Liberzon, Israel; McLaughlin, Katie A; McLean, Samuel A; Pennell, Beth E; Petukhova, Maria; Rosellini, Anthony J; Ruscio, Ayelet M; Shahly, Victoria; Shalev, Arieh Y; Silove, Derrick; Zaslavsky, Alan M; Angermeyer, Matthias C; Bromet, Evelyn J; de Almeida, José Miguel Caldas; de Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Florescu, Silvia E; Gureje, Oye; Haro, Josep Maria; Hinkov, Hristo; Kawakami, Norito; Kovess-Masfety, Viviane; Lee, Sing; Medina-Mora, Maria Elena; Murphy, Samuel D; Navarro-Mateu, Fernando; Piazza, Marina; Posada-Villa, Jose; Scott, Kate; Torres, Yolanda; Carmen Viana, Maria

2014-10-01

Post-traumatic stress disorder (PTSD) should be one of the most preventable mental disorders, since many people exposed to traumatic experiences (TEs) could be targeted in first response settings in the immediate aftermath of exposure for preventive intervention. However, these interventions are costly and the proportion of TE-exposed people who develop PTSD is small. To be cost-effective, risk prediction rules are needed to target high-risk people in the immediate aftermath of a TE. Although a number of studies have been carried out to examine prospective predictors of PTSD among people recently exposed to TEs, most were either small or focused on a narrow sample, making it unclear how well PTSD can be predicted in the total population of people exposed to TEs. The current report investigates this issue in a large sample based on the World Health Organization (WHO)'s World Mental Health Surveys. Retrospective reports were obtained on the predictors of PTSD associated with 47,466 TE exposures in representative community surveys carried out in 24 countries. Machine learning methods (random forests, penalized regression, super learner) were used to develop a model predicting PTSD from information about TE type, socio-demographics, and prior histories of cumulative TE exposure and DSM-IV disorders. DSM-IV PTSD prevalence was 4.0% across the 47,466 TE exposures. 95.6% of these PTSD cases were associated with the 10.0% of exposures (i.e., 4,747) classified by machine learning algorithm as having highest predicted PTSD risk. The 47,466 exposures were divided into 20 ventiles (20 groups of equal size) ranked by predicted PTSD risk. PTSD occurred after 56.3% of the TEs in the highest-risk ventile, 20.0% of the TEs in the second highest ventile, and 0.0-1.3% of the TEs in the 18 remaining ventiles. These patterns of differential risk were quite stable across demographic-geographic sub-samples. These results demonstrate that a sensitive risk algorithm can be created using data collected in the immediate aftermath of TE exposure to target people at highest risk of PTSD. However, validation of the algorithm is needed in prospective samples, and additional work is warranted to refine the algorithm both in terms of determining a minimum required predictor set and developing a practical administration and scoring protocol that can be used in routine clinical practice. Copyright © 2014 World Psychiatric Association.

Assessing Thermal Comfort Due to a Ventilated Double Window

NASA Astrophysics Data System (ADS)

Carlos, Jorge S.; Corvacho, Helena

2017-10-01

Building design and its components are the result of a complex process, which should provide pleasant conditions to its inhabitants. Therefore, indoor acceptable comfort is influenced by the architectural design. ISO and ASHRAE standards define thermal comfort as the condition of mind that expresses satisfaction with the thermal environment. The energy demand for heating, beside the building’s physical properties, also depend on human behaviour, like opening or closing windows. Generally, windows are the weakest façade element concerning to thermal performance. A lower thermal resistance allows higher thermal conduction through it. When a window is very hot or cold, and the occupant is very close to it, it may result in thermal discomfort. The functionality of a ventilated double window introduces new physical considerations to a traditional window. In consequence, it is necessary to study the local effect on human comfort in function of the boundary conditions. Wind, solar availability, air temperature and therefore heating and indoor air quality conditions will affect the relationship between this passive system and the indoor environment. In the present paper, the influence of thermal performance and ventilation on human comfort resulting from the construction and geometry solutions is shown, helping to choose the best solution. The presented approach shows that in order to save energy it is possible to reduce the air changes of a room to the minimum, without compromising air quality, enhancing simultaneously local thermal performance and comfort. The results of the study on the effect of two parallel windows with a ventilated channel in the same fenestration on comfort conditions for several different room dimensions, are also presented. As the room dimensions’ rate changes so does the window to floor rate; therefore, under the same climatic conditions and same construction solution, different results are obtained.

Evolution of the use of noninvasive mechanical ventilation in chronic obstructive pulmonary disease in a Spanish region, 1997-2010.

PubMed

Carpe-Carpe, Bienvenida; Hernando-Arizaleta, Lauro; Ibáñez-Pérez, M Carmen; Palomar-Rodríguez, Joaquín A; Esquinas-Rodríguez, Antonio M

2013-08-01

Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain). A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression. We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC]=-3.4, 95% CI: - 4.8; -2.0, P <.05) and in the group without ventilatory intervention (APC=-4.2%, -5.6; -2.8, P <.05); upward trend in the use of NIV (APC=16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC=-4.5%, -10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, -1.3; 2.4) and in the group without intervention (APC=0.1, -1.6; 1.9); downward trend with statistical significance in the NIV group (APC=-7.1, -11.7; -2.2, P <.05) and not statistically significant in the IMV group (APC=-0,8, -6, 1; 4.8). The mean stay did not change substantially. The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

Modeling particle dispersion and deposition in indoor environments

NASA Astrophysics Data System (ADS)

Gao, N. P.; Niu, J. L.

Particle dispersion and deposition in man-made enclosed environments are closely related to the well-being of occupants. The present study developed a three-dimensional drift-flux model for particle movements in turbulent indoor airflows, and combined it into Eulerian approaches. To account for the process of particle deposition at solid boundaries, a semi-empirical deposition model was adopted in which the size-dependent deposition characteristics were well resolved. After validation against the experimental data in a scaled isothermal chamber and in a full-scale non-isothermal environmental chamber, the drift-flux model was used to investigate the deposition rates and human exposures to particles from two different sources with three typical ventilation systems: mixing ventilation (MV), displacement ventilation (DV), and under-floor air distribution (UFAD). For particles originating from the supply air, a V-shaped curve of the deposition velocity variation as a function of particle size was observed. The minimum deposition appeared at 0.1- 0.5μm. For supermicron particles, the ventilation type and air exchange rate had an ignorable effect on the deposition rate. The movements of submicron particles were like tracer gases while the gravitational settling effect should be taken into account for particles larger than 2.5μm. The temporal increment of human exposure to a step-up particle release in the supply air was determined, among many factors, by the distance between the occupant and air outlet. The larger the particle size, the lower the human exposure. For particles released from an internal heat source, the concentration stratification of small particles (diameter <10μm) in the vertical direction appeared with DV and UFAD, and it was found the advantageous principle for gaseous pollutants that a relatively less-polluted occupied zone existed in DV and UFAD was also applicable to small particles.

Influence of propofol and volatile anaesthetics on the inflammatory response in the ventilated lung.

PubMed

Kalimeris, K; Christodoulaki, K; Karakitsos, P; Batistatou, A; Lekka, M; Bai, M; Kitsiouli, E; Nakos, G; Kostopanagiotou, G

2011-07-01

The immunomodulatory effects of volatile anaesthetics in vitro and the protective effect of propofol in lung injury spurred us to study the effects of volatile anaesthetics and propofol on lung tissue in vivo. Twenty-seven pigs were randomized to 4-h general anaesthesia with propofol (8 mg/kg/h, group P, n=9), sevoflurane [minimum alveolar concentration (MAC)=1.0, group S, n=9) or desflurane (MAC=1.0, group D, n=9). Four healthy animals served as the no-ventilation group. Bronchoalveolar lavage fluid (BALF) was obtained to measure the cell counts, platelet-activating factor acetylhydrolase (PAF-AcH), phospholipase A(2) (PLA(2)) and superoxide dismutase (SOD) activity. Lung tissues were evaluated histologically and for caspase-3 expression. Volatile anaesthetics reduced PAF-AcH levels without affecting PLA(2) activity and resulted in decreased alveolar macrophage and increased lymphocyte counts in BALF (sevoflurane: 29 ± 23%; desflurane: 26 ± 6%, both P<0.05 compared with 4 ± 2% in the no-ventilation group). These findings were accompanied by atelectasis and inflammatory cells' infiltration in the inhalational anaesthetics groups. Also, sevoflurane reduced SOD activity and both sevoflurane and desflurane induced significant caspase-3 expression. In contrast, propofol resulted in a minor degree of inflammation and preserved BALF cells' composition without triggering apoptosis. Halogenated anaesthetics seem to trigger an immune lymphocytic response in the lung, inducing significant apoptosis and impairment of PAF-AcH. In contrast, propofol preserves anti-inflammatory and anti-oxidant defences during mechanical ventilation, thus preventing the emergence of apoptosis. © 2011 The Authors. Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.

Cooking-related PM2.5 and acrolein measured in grocery stores and comparison with other retail types.

PubMed

Chan, W R; Sidheswaran, M; Sullivan, D P; Cohn, S; Fisk, W J

2016-06-01

We measured particulate matter (PM), acrolein, and other indoor air contaminants in eight visits to grocery stores in California. Retail stores of other types (hardware, furniture, and apparel) were also sampled on additional visits. Based on tracer gas decay data, most stores had adequate ventilation according to minimum ventilation rate standards. Grocery stores had significantly higher concentrations of acrolein, fine and ultrafine PM, compared to other retail stores, likely attributable to cooking. Indoor concentrations of PM2.5 and acrolein exceeded health guidelines in all tested grocery stores. Acrolein emission rates to indoors in grocery stores had a mean estimate about 30 times higher than in other retail store types. About 80% of the indoor PM2.5 measured in grocery stores was emitted indoors, compared to only 20% for the other retail store types. Calculations suggest a substantial increase in outdoor air ventilation rate by a factor of three from current level is needed to reduce indoor acrolein concentrations. Alternatively, acrolein emission to indoors needs to be reduced 70% by better capturing of cooking exhaust. To maintain indoor PM2.5 below the California annual ambient standard of 12 μg/m(3) , grocery stores need to use air filters with an efficiency rating higher than the MERV 8 air filters commonly used today. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Carbon monoxide poisonings from small, gasoline-powered, internal combustion engines: just what is a "well-ventilated area"?

PubMed

Earnest, G S; Mickelsen, R L; McCammon, J B; O'Brien, D M

1997-11-01

This study modeled the time required for a gasoline-powered, 5 horsepower (hp), 4-cycle engine to generate carbon monoxide (CO) concentrations exceeding the National Institute for Occupational Safety and Health 200-ppm ceiling and 1200-ppm immediately dangerous to life and health concentration for various room sizes and ventilation rates. The model permitted the ambiguous term "well-ventilated area" to be defined. The model was compared with field data collected at a site where two workers were poisoned while operating a 5-hp concrete saw in a bathroom having open doors and an operating ventilation system. There is agreement between both the modeled and field-generated data, indicating that hazardous CO concentrations can develop within minutes. Comparison of field and modeling data showed the measured CO generation rate at approximately one-half of the value used in the model, which may be partially because the engine used in the field was not under load during data collection. The generation rate and room size from the actual poisoning was then used in the model. The model determined that ventilation rates of nearly 5000 ft3/min (120 air changes per hour) would be required to prevent the CO concentration from exceeding the 200-ppm ceiling for short periods. Results suggest that small gasoline-powered engines should not be operated inside of buildings or in semienclosed spaces and that manufacturers of such tools should improve their warnings and develop engineering control options for better user protection.

Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects.

PubMed

Umbrello, Michele; Formenti, Paolo

2016-04-01

The majority of patients admitted to the ICU require mechanical ventilation as a part of their process of care. However, mechanical ventilation itself or the underlying disease can lead to dysfunction of the diaphragm, a condition that may contribute to the failure of weaning from mechanical ventilation. However, extended time on the ventilator increases health-care costs and greatly increases patient morbidity and mortality. Nevertheless, symptoms and signs of muscle disease in a bedridden (or bed rest-only) ICU patient are often difficult to assess because of concomitant confounding factors. Conventional assessment of diaphragm function lacks specific, noninvasive, time-saving, and easily performed bedside tools or requires patient cooperation. Recently, the use of ultrasound has raised great interest as a simple, noninvasive method of quantification of diaphragm contractile activity. In this review, we discuss the physiology and the relevant pathophysiology of diaphragm function, and we summarize the recent findings concerning the evaluation of its (dys)function in critically ill patients, with a special focus on the role of ultrasounds. We describe how to assess diaphragm excursion and diaphragm thickening during breathing and the meaning of these measurements under spontaneous or mechanical ventilation as well as the reference values in health and disease. The spread of ultrasonographic assessment of diaphragm function may possibly result in timely identification of patients with diaphragm dysfunction and to a potential improvement in the assessment of recovery from diaphragm weakness. Copyright © 2016 by Daedalus Enterprises.

A retrospective comparison of blood transfusion requirements during cardiopulmonary bypass with two different small adult oxygenators.

PubMed

Lahanas, A; Argerakis, P W; Johnson, K A; Burdan, M L; Ozdirik, J E

2013-11-01

A low haematocrit during cardiopulmonary bypass (CPB) is associated with adverse outcomes and often results in homologous blood transfusions. Oxygenators with improved venous reservoir designs aid in reducing the priming volume. Recently, we changed our small adult oxygenator model from the D905 EOS oxygenator (Dideco, Mirandola, Italy) to the Capiox FX1540 (Terumo Corporation, Tokyo, Japan). We conducted a retrospective study of 42 patents to evaluate the impact of the Capiox FX 1540 on blood transfusion requirements in small patients (body surface area (BSA) up to 1.8 m(2)). The D905 EOS group had a lower minimum intraoperative haematocrit than the FX1540 group (20 ± 3 v 22 ± 4, p = 0.029) with 73% of the patients receiving intraoperative blood transfusions compared with 30% in the FX 1540 group (p = 0.012). Patients in the D905 EOS group received one blood transfusion more during CPB than the FX 1540 patients (p = 0.002). The haematocrits at the end of CPB and in the early postoperative period were identical in both groups. The postoperative ventilation time, length of stay in the intensive care unit and postoperative chest drain bleeding were similar in both groups. In conclusion, the Capiox FX1540 was effective in reducing intraoperative packed red cell transfusions.

Laboratory and Industrial Ventilation

NASA Technical Reports Server (NTRS)

1972-01-01

This handbook supplements the Facilities Engineering Handbook (NHB 7320.1) and provides additional policies and criteria for uniform application to ventilation systems. It expands basic requirements, provides additional design and construction guidance, and places emphasis on those design considerations which will provide for greater effectiveness in the use of these systems. The provisions of this handbook are applicable to all NASA field installations and the Jet Propulsion Laboratory. Since supply of this handbook is limited, abstracts of the portion or portions applicable to a given requirement will be made for the individual specific needs encountered rather than supplying copies of the handbook as has been past practice.

Space Suit Portable Life Support System Rapid Cycle Amine Repackaging and Sub-Scale Test Results

NASA Technical Reports Server (NTRS)

Paul, Heather L.; Rivera, Fatonia L.

2010-01-01

NASA is developing technologies to meet requirements for an extravehicular activity (EVA) Portable Life Support System (PLSS) for exploration. The PLSS Ventilation Subsystem transports clean, conditioned oxygen to the pressure garment for space suit pressurization and human consumption, and recycles the ventilation gas, removing carbon dioxide, humidity, and trace contaminants. This paper provides an overview of the development efforts conducted at the NASA Johnson Space Center to redesign the Rapid Cycle Amine (RCA) canister and valve assembly into a radial flow, cylindrical package for carbon dioxide and humidity control of the PLSS ventilation loop. Future work is also discussed.

Optimizing Oxygenation in the Mechanically Ventilated Patient: Nursing Practice Implications.

PubMed

Barton, Glenn; Vanderspank-Wright, Brandi; Shea, Jacqueline

2016-12-01

Critical care nurses constitute front-line care provision for patients in the intensive care unit (ICU). Hypoxemic respiratory compromise/failure is a primary reason that patients require ICU admission and mechanical ventilation. Critical care nurses must possess advanced knowledge, skill, and judgment when caring for these patients to ensure that interventions aimed at optimizing oxygenation are both effective and safe. This article discusses fundamental aspects of respiratory physiology and clinical indices used to describe oxygenation status. Key nursing interventions including patient assessment, positioning, pharmacology, and managing hemodynamic parameters are discussed, emphasizing their effects toward mitigating ventilation-perfusion mismatch and optimizing oxygenation. Copyright © 2016 Elsevier Inc. All rights reserved.

Kangaroo care for adoptive parents and their critically ill preterm infant.

PubMed

Parker, Leslie; Anderson, Gene Cranston

2002-01-01

In this case study kangaroo care (KC) was facilitated for an adoptive mother and father who were planning to attend the birth of the infant they had arranged to adopt. Unexpectedly, the birth mother delivered at 27 weeks gestation. The infant was critically ill and required mechanical ventilation. However, in this neonatal intensive care unit where all adoptive parents and parents of mechanically ventilated infants are offered KC, these adoptive parents began KC on Day 3 while their infant daughter was still mechanically ventilated. She thrived thereafter and the entire experience was profoundly beneficial for this beginning family both at the hospital and after discharge home.

Annual verifications--a tick-box exercise?

PubMed

Walker, Gwen; Williams, David

2014-09-01

With the onus on healthcare providers and their staff to protect patients against all elements of 'avoidable harm' perhaps never greater, Gwen Walker, a highly experienced infection prevention control nurse specialist, and David Williams, MD of Approved Air, who has 30 years' experience in validation and verification of ventilation and ultraclean ventilation systems, examine changing requirements for, and trends in, operating theatre ventilation. Validation and verification reporting on such vital HVAC equipment should not, they argue, merely be viewed as a 'tick-box exercise'; it should instead 'comprehensively inform key stakeholders, and ultimately form part of clinical governance, thus protecting those ultimately named responsible for organisation-wide safety at Trust board level'.

Ventilation practices in subarachnoid hemorrhage: a cohort study exploring the use of lung protective ventilation.

PubMed

Marhong, Jonathan D; Ferguson, Niall D; Singh, Jeffrey M

2014-10-01

Acute respiratory distress syndrome (ARDS) is common following aneurysmal subarachnoid hemorrhage (SAH), but the influence of mechanical ventilator settings on its development is unclear. We sought to determine adherence to lung protective thresholds in ventilated patients with SAH and describe the association between ventilator settings and subsequent development of ARDS. We conducted a retrospective cohort study of consecutive patients receiving mechanical ventilation within 72 h of SAH at a single academic center. Ventilator settings and blood gas data were collected twice daily for the first 7 days of ventilation along with ICU and hospital outcomes. Lung protective ventilation was defined as follows: tidal volume ≤8 mL/kg of predicted body weight, positive end-expiratory pressure (PEEP) ≥5 cm H(2)O, and peak or plateau pressure ≤30 cm H(2)O. The development of ARDS was ascertained retrospectively by PaO(2)/FiO(2) ≤300 with new bilateral lung opacities on chest X-ray within one day of hypoxemia. We identified 62 patients who underwent early mechanical ventilation following SAH. PS and Continuous Positive Airway Pressure were common ventilator modes with a median tidal volume of 7.8 mL/kg [interquartile range 6.8-8.8], median peak pressure of 14 cm H(2)O [IQR 12-17], and median PEEP of 5 cm H(2)O [IQR 5-6]. Adherence to tidal volumes ≤8 mL/kg was seen in 64 % of all observations and peak pressures <30 cm H(2)O were 94 % of all observations. All three lung protective criteria were seen in 58 % of all observations. Thirty-one patients (50 %) were determined to have ARDS. ARDS patients were more frequently ventilated with a peak pressure >30 cm H(2)O (11.3 % of ARDS ventilation days vs. 0 % of non-ARDS ventilation days; p < 0.01). Initial tidal volume was not associated with subsequent development of ARDS in univariate (p = 0.6) or multivariate analysis (p = 0.49). Only the number of ARDS risk factors was independently associated with the development of ARDS (Adjusted Odds Ratio 2.8 per additional risk factor [95 % CI 1.2-6.5]). Patients with SAH requiring mechanical ventilation frequently breathe spontaneously, generating tidal volumes above usual protective thresholds regardless of meeting ARDS criteria. In patients with SAH, the presence of an additional ARDS risk factor should prompt close screening for the development of ARDS and consideration of adjustment of ventilator settings to meet lung protective thresholds.

ROHHAD Syndrome: The Girl who Forgets to Breathe.

PubMed

Sanklecha, Mukesh; Sundaresan, Suba; Udani, Vrajesh

2016-04-01

ROHHAD syndrome is an exceedingly rare cause of central hypoventilation. A 7-year-old girl with ROHHAD syndrome who had central hypoventilation, rapid weight gain, multiple cardiac arrests and hyperprolactinemia. She required prolonged and repeated ventilation, and finally died due to complications of ventilation. ROHHAD Syndrome should be suspected in any child who presents with obesity, behavioral changes or autonomic instability following a neural crest tumor.

Humidification in the intensive care unit. Prospective study of a new protocol utilizing heated humidification and a hygroscopic condenser humidifier.

PubMed

Branson, R D; Davis, K; Campbell, R S; Johnson, D J; Porembka, D T

1993-12-01

Determine the utility of a proposed algorithm in allowing safe, efficient humidification in mechanically ventilated patients using both a hygroscopic condenser humidifier (HCH) and heated humidifier (HH). A prospective study using an algorithm to chose humidification devices based on physical examination and sputum characteristics. All patients admitted to the surgical ICU. One hundred twenty consecutive patients requiring mechanical ventilation (MV) were studied. Patients were examined by the attending respiratory care practitioner and given either an HCH or HH. If patients demonstrated any of the following--thick or tenacious secretions, core temperature < 32 degrees C, or bloody secretions--they were given an HH. All others used an HCH. If any of the above conditions occurred during HCH use, the patient was given an HH. Duration of ventilation, incidence of nosocomial pneumonia, ventilator circuit colonization, and mortality were determined for patients in each group. Cost of humidification devices, number of suctioning procedures per day, and volume of saline solution instilled were also recorded. Initially, 27 percent (32/120) of patients used an HH and 73 percent (88/120) used an HCH. During the study, ten patients required changing to an HH during HCH use. Patients in the HH group were more likely to have preexisting lung disease and had a longer duration of ventilation (83 +/- 21 h) and higher mortality (21 percent). Patients in the HCH group were more likely to be postoperative, had shorter durations of ventilation (38 +/- 14 h), and lower mortality (9 percent). There was no difference in the incidence of nosocomial pneumonia between the two groups (9 percent vs 6 percent) and endotracheal tube occlusion did not occur in either group. Circuit colonization was common in the HH group (64 percent) but rate in the HCH group (5 percent). Cost per day was significantly less for the HCH group ($4 vs $19.80). Patients who required a change from HCH to HH did so at a mean of 5 days. The proposed algorithm resulted in cost-efficient and safe application of humidification devices in patients in the surgical ICU.

Late Quaternary changes in intermediate water oxygenation and oxygen minimum zone, northern Japan: A benthic foraminiferal perspective

NASA Astrophysics Data System (ADS)

Shibahara, Akihiko; Ohkushi, Ken'ichi; Kennett, James P.; Ikehara, Ken

2007-09-01

A strong oxygen minimum zone (OMZ) currently exists at upper intermediate water depths on the northern Japanese margin, NW Pacific. The OMZ results largely from a combination of high surface water productivity and poor ventilation of upper intermediate waters. We investigated late Quaternary history (last 34 kyr) of ocean floor oxygenation and the OMZ using quantitative changes in benthic foraminiferal assemblages in three sediment cores taken from the continental slope off Shimokita Peninsula and Tokachi, northern Japan, at water depths between 975 and 1363 m. These cores are well located within the present-day OMZ, a region of high surface water productivity, and in close proximity to the source region of North Pacific Intermediate Water. Late Quaternary benthic foraminiferal assemblages experienced major changes in response to changes in dissolved oxygen concentration in ocean floor sediments. Foraminiferal assemblages are interpreted to represent three main groups representing oxic, suboxic, and dysoxic conditions. Assemblage changes in all three cores and hence in bottom water oxygenation coincided with late Quaternary climatic episodes, similar to that known for the southern California margin. These episodes, in turn, are correlated with orbital and millennial climate episodes in the Greenland ice core including the last glacial episode, Bølling-Ållerød (B/A), Younger Dryas, Preboreal (earliest Holocene), early Holocene, and late Holocene. The lowest oxygen conditions, marked by dysoxic taxa and laminated sediments in one core, occurred during the B/A and the Preboreal intervals. Suboxic taxa dominated mainly during the last glacial, the Younger Dryas, and most of the Holocene. Dysoxic conditions during the B/A and Preboreal intervals in this region were possibly caused by high surface water productivity at times of reduced intermediate ventilation in the northwestern Pacific. Remarkable similarities are evident in the late Quaternary sequence of benthic foraminiferal assemblage change between the two very distant continental margins of northern Japan and southern California. The oscillations in OMZ strength, reflected by these faunal changes, were widespread and apparently synchronous over wide areas of the North Pacific, reflecting broad changes in intermediate water ventilation and surface ocean productivity closely linked with late Quaternary climate change on millennial and orbital timescales.

Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation: A single-center randomized controlled trial.

PubMed

Fujimoto, Hiroko; Yamaguchi, Osamu; Hayami, Hajime; Shimosaka, Mika; Tsuboi, Sayaka; Sato, Mitsunori; Takebayashi, Shigeo; Morita, Satoshi; Saito, Mari; Goto, Takahisa; Kurahashi, Kiyoyasu

2018-03-23

Aspiration of subglottic secretion is a widely used intervention to prevent ventilator-associated pneumonia (VAP). This study aimed to compare the efficacy of continuous and intermittent subglottic secretion drainage (SSD) in preventing VAP. A single-center randomized controlled trial was conducted on adult postoperative patients who were expected to undergo mechanical ventilation for more than 48 hours. Primary outcome measure was incidence of VAP and secondary outcome measures were length of mechanical ventilation and intensive-care unit (ICU) stay. Fifty-nine patients received continuous SSD, while 60 patients received intermittent SSD. Of these 119 patients, 88 (74%) were excluded and 15 and 16 patients were allocated to receive continuous and intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7 (43.8%) patients in the continuous and intermittent groups, respectively, (p=0.320). The length of mechanical ventilation was significantly shorter (p=0.034) in the continuous group (99.5±47.1 h) than in the intermittent group (159.9±94.5 h). The length of ICU stay was also shorter (p=0.0097) in the continuous group (6.3±2.1 days) than the intermittent group (9.8±4.8 days). Although continuous SSD did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and ICU stay when compared to intermittent SSD.

Ventilation distribution in rats: Part 2 – A comparison of electrical impedance tomography and hyperpolarised helium magnetic resonance imaging

PubMed Central

2012-01-01

Background Hyperpolarised helium MRI (He3 MRI) is a new technique that enables imaging of the air distribution within the lungs. This allows accurate determination of the ventilation distribution in vivo. The technique has the disadvantages of requiring an expensive helium isotope, complex apparatus and moving the patient to a compatible MRI scanner. Electrical impedance tomography (EIT) a non-invasive bedside technique that allows constant monitoring of lung impedance, which is dependent on changes in air space capacity in the lung. We have used He3MRI measurements of ventilation distribution as the gold standard for assessment of EIT. Methods Seven rats were ventilated in supine, prone, left and right lateral position with 70% helium/30% oxygen for EIT measurements and pure helium for He3 MRI. The same ventilator and settings were used for both measurements. Image dimensions, geometric centre and global in homogeneity index were calculated. Results EIT images were smaller and of lower resolution and contained less anatomical detail than those from He3 MRI. However, both methods could measure positional induced changes in lung ventilation, as assessed by the geometric centre. The global in homogeneity index were comparable between the techniques. Conclusion EIT is a suitable technique for monitoring ventilation distribution and inhomgeneity as assessed by comparison with He3 MRI. PMID:22966835

30 CFR 7.23 - Application requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... APPROVAL OF MINING PRODUCTS TESTING BY APPLICANT OR THIRD PARTY Brattice Cloth and Ventilation Tubing § 7.23 Application requirements. (a) Brattice cloth. A single application may address two or more...

30 CFR 7.23 - Application requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... APPROVAL OF MINING PRODUCTS TESTING BY APPLICANT OR THIRD PARTY Brattice Cloth and Ventilation Tubing § 7.23 Application requirements. (a) Brattice cloth. A single application may address two or more...

30 CFR 7.23 - Application requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... APPROVAL OF MINING PRODUCTS TESTING BY APPLICANT OR THIRD PARTY Brattice Cloth and Ventilation Tubing § 7.23 Application requirements. (a) Brattice cloth. A single application may address two or more...

Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention.

PubMed

Jeng, Mei-Jy; Lee, Yu-Sheng; Tsao, Pei-Chen; Soong, Wen-Jue

2012-11-01

Air leak syndrome includes pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, subcutaneous emphysema, and systemic air embolism. The most common cause of air leak syndrome in neonates is inadequate mechanical ventilation of the fragile and immature lungs. The incidence of air leaks in newborns is inversely related to the birth weight of the infants, especially in very-low-birth-weight and meconium-aspirated infants. When the air leak is asymptomatic and the infant is not mechanically ventilated, there is usually no specific treatment. Emergent needle aspiration and/or tube drainage are necessary in managing tension pneumothorax or pneumopericardium with cardiac tamponade. To prevent air leak syndrome, gentle ventilation with low pressure, low tidal volume, low inspiratory time, high rate, and judicious use of positive end expiratory pressure are the keys to caring for mechanically ventilated infants. Both high-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) can provide adequate gas exchange using extremely low tidal volume and supraphysiologic rate in neonates with acute pulmonary dysfunction, and they are considered to have the potential to reduce the risks of air leak syndrome in neonates. However, there is still no conclusive evidence that HFOV or HFJV can help to reduce new air leaks in published neonatal clinical trials. In conclusion, neonatal air leaks may present as a thoracic emergency requiring emergent intervention. To prevent air leak syndrome, gentle ventilations are key to caring for ventilated infants. There is insufficient evidence showing the role of HFOV and HFJV in the prevention or reduction of new air leaks in newborn infants, so further investigation will be necessary for future applications. Copyright © 2012. Published by Elsevier B.V.

49 CFR 228.313 - Electrical system requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Electrical system requirements. 228.313 Section...; SLEEPING QUARTERS Safety and Health Requirements for Camp Cars Provided by Railroads as Sleeping Quarters § 228.313 Electrical system requirements. (a) All heating, cooking, ventilation, air conditioning, and...

49 CFR 228.313 - Electrical system requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Electrical system requirements. 228.313 Section...; SLEEPING QUARTERS Safety and Health Requirements for Camp Cars Provided by Railroads as Sleeping Quarters § 228.313 Electrical system requirements. (a) All heating, cooking, ventilation, air conditioning, and...

49 CFR 228.313 - Electrical system requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Electrical system requirements. 228.313 Section...; SLEEPING QUARTERS Safety and Health Requirements for Camp Cars Provided by Railroads as Sleeping Quarters § 228.313 Electrical system requirements. (a) All heating, cooking, ventilation, air conditioning, and...

Snake bite: coral snakes.

PubMed

Peterson, Michael E

2006-11-01

North American coral snakes are distinctively colored beginning with a black snout and an alternating pattern of black, yellow, and red. They have fixed front fangs and a poorly developed system for venom delivery, requiring a chewing action to inject the venom. The severity of a coral snake bite is related to the volume of venom injected and the size of the victim. The length of the snake correlates positively with the snakes venom yield. Coral snake venom is primarily neurotoxic with little local tissue reaction or pain at the bite site. The net effect of the neurotoxins is a curare like syndrome. In canine victims there have been reports of marked hemolysis with severe anemia and hemoglobinuria. The onset of clinical signs may be delayed for as much as 10 to 18 hours. The victim begins to have alterations in mental status and develops generalized weakness and muscle fasciculations. Progression to paralysis of the limbs and respiratory muscles then follows. The best flied response to coral snake envenomation is rapid transport to a veterinary medical facility capable of 24 hour critical care and assisted ventilation. First aid treatment advocated in Australia for Elapid bites is the immediate use of a compression bandage. The victim should be hospitalized for a minimum of 48 hours for continuous monitoring. The only definitive treatment for coral snake envenomation is the administration of antivenin (M. fulvius). Once clinical signs of coral snake envenomation become manifest they progress with alarming rapidity and are difficult to reverse. If antivenin is not available or if its administration is delayed, supportive care includes respiratory support. Assisted mechanical ventilation can be used but may have to be employed for up to 48 to 72 hours.

A Phosphate Minimum in the Oxygen Minimum Zone (OMZ) off Peru

NASA Astrophysics Data System (ADS)

Paulmier, A.; Giraud, M.; Sudre, J.; Jonca, J.; Leon, V.; Moron, O.; Dewitte, B.; Lavik, G.; Grasse, P.; Frank, M.; Stramma, L.; Garcon, V.

2016-02-01

The Oxygen Minimum Zone (OMZ) off Peru is known to be associated with the advection of Equatorial SubSurface Waters (ESSW), rich in nutrients and poor in oxygen, through the Peru-Chile UnderCurrent (PCUC), but this circulation remains to be refined within the OMZ. During the Pelágico cruise in November-December 2010, measurements of phosphate revealed the presence of a phosphate minimum (Pmin) in various hydrographic stations, which could not be explained so far and could be associated with a specific water mass. This Pmin, localized at a relatively constant layer ( 20<220 m) and with a patchy distribution mainly between 10 and 16°S, is confirmed and characterized in details from the complementary hydrological data acquired during the German Meteor cruise M77 (Legs 3 and 4, January-February 2009). The significant Pmin present an intense minimum with a mean vertical phosphate decrease of 0.6 µM but highly variable between 0.1 and 2.2 µM. In average, these Pmin are associated with a predominant mixing of SubTropical Under- and Surface Waters (STUW and STSW: 20 and 40%, respectively) within ESSW ( 25%), complemented evenly by overlying (ESW, TSW: 8%) and underlying waters (AAIW, SPDW: 7%). The hypotheses and mechanisms leading to the Pmin formation in the OMZ are further explored and discussed, considering the physical regional contribution associated with various circulation pathways ventilating the OMZ and the local biogeochemical contribution including the potential diazotrophic activity.

Age-related carbon dioxide reactivity in children after moderate and severe traumatic brain injury.

PubMed

Maa, Tensing; Yeates, Keith Owen; Moore-Clingenpeel, Melissa; O'Brien, Nicole F

2016-07-01

OBJECTIVE The objective of this study is to assess carbon dioxide reactivity (CO2R) in children following traumatic brain injury (TBI). METHODS This prospective observational study enrolled children younger than 18 years old following moderate and severe TBI. Thirty-eight mechanically ventilated children had daily CO2R testing performed by measuring changes in their bilateral middle cerebral artery flow velocities using transcranial Doppler ultrasonography (TCD) after a transient increase in minute ventilation. The cohort was divided into 3 age groups: younger than 2 years (n = 12); 2 to 5 years old (n = 9); and older than 5 years (n = 17). RESULTS Children younger than 2 years old had a lower mean CO2R over time. The 2-5-year-old age group had higher mean CO2R than younger patients (p = 0.01), and the highest CO2R values compared with either of the other age groups (vs > 5 years old, p = 0.046; vs < 2 years old, p = 0.002). Having a lower minimum CO2R had a statistically significant negative effect on outcome at discharge (p = 0.0413). Impaired CO2R beyond Postinjury Day 4 trended toward having an effect on outcome at discharge (p = 0.0855). CONCLUSIONS Abnormal CO2R is prevalent in children following TBI, and the degree of impairment varies by age. No clinical or laboratory parameters were identified as risk factors for impaired CO2R. Lower minimum CO2R values are associated with worse outcome at discharge.

Chromium Isotope Anomaly Scaling with Past Warming Episodes

NASA Astrophysics Data System (ADS)

Remmelzwaal, S.; O'Connor, L.; Preston, W.; Parkinson, I. J.; Schmidt, D. N.

2017-12-01

The recent expansion of oxygen minimum zones caused by anthropogenic global warming raises questions about the scale of this expansion with different emission scenarios. Ocean deoxygenation will impact marine ecosystems and fisheries demanding an assessment of the possible extent and intensity of deoxygenation. Here, we used past climate warming events to quantify a potential link between warming and the spread of oxygen minimum zones: including Ocean Anoxic Event (OAE) 1a, OAE 2 in the Cretaceous, the Palaeocene-Eocene Thermal Maximum (PETM), the Eocene Thermal Maximum 2 (ETM2), and Pleistocene glacial-interglacial cycles. We applied the emerging proxy of chromium isotopes in planktic foraminifera to assess redox changes during the PETM, ETM2, and Pleistocene and bulk carbonate for the OAEs. Both δ53Cr and chromium concentrations respond markedly during the PETM indicative of a reduction in dissolved oxygen concentrations caused by changes in ocean ventilation and associated warming [1]. A strong correlation between Δδ53Cr and benthic Δδ18O, a measure of the excursion size in both oxygen and chromium isotopes, suggest temperatures to be one of the main drivers of ocean deoxygenation in the past [1]. Chromium concentrations decrease during ETM2 and OAE1a, and, increase by 4.5 ppm over the Plenus Cold Event during OAE2, which suggests enhanced seafloor ventilation. [1] Remmelzwaal, S.R.C., Dixon, S., Parkinson, I.J., Schmidt, D.N., Monteiro, F.M., Sexton, P., Fehr, M., Peacock, C., Donnadieu, Y., James, R.H., in review. Ocean deoxygenation during the Palaeocene-Eocene Thermal Maximum. EPSL.

Oxygen Pathways and Budget for the Eastern South Pacific Oxygen Minimum Zone

NASA Astrophysics Data System (ADS)

Llanillo, P. J.; Pelegrí, J. L.; Talley, L. D.; Peña-Izquierdo, J.; Cordero, R. R.

2018-03-01

Ventilation of the eastern South Pacific Oxygen Minimum Zone (ESP-OMZ) is quantified using climatological Argo and dissolved oxygen data, combined with reanalysis wind stress data. We (1) estimate all oxygen fluxes (advection and turbulent diffusion) ventilating this OMZ, (2) quantify for the first time the oxygen contribution from the subtropical versus the traditionally studied tropical-equatorial pathway, and (3) derive a refined annual-mean oxygen budget for the ESP-OMZ. In the upper OMZ layer, net oxygen supply is dominated by tropical-equatorial advection, with more than one-third of this supply upwelling into the Ekman layer through previously unevaluated vertical advection, within the overturning component of the regional Subtropical Cell (STC). Below the STC, at the OMZ's core, advection is weak and turbulent diffusion (isoneutral and dianeutral) accounts for 89% of the net oxygen supply, most of it coming from the oxygen-rich subtropical gyre. In the deep OMZ layer, net oxygen supply occurs only through turbulent diffusion and is dominated by the tropical-equatorial pathway. Considering the entire OMZ, net oxygen supply (3.84 ± 0.42 µmol kg-1 yr-1) is dominated by isoneutral turbulent diffusion (56.5%, split into 32.3% of tropical-equatorial origin and 24.2% of subtropical origin), followed by isoneutral advection (32.0%, split into 27.6% of tropical-equatorial origin and 4.4% of subtropical origin) and dianeutral diffusion (11.5%). One-quarter (25.8%) of the net oxygen input escapes through dianeutral advection (most of it upwelling) and, assuming steady state, biological consumption is responsible for most of the oxygen loss (74.2%).

Guidelines-concordant empiric antimicrobial therapy and mortality in patients with severe community-acquired pneumonia requiring mechanical ventilation.

PubMed

Sakamoto, Yukiyo; Yamauchi, Yasuhiro; Yasunaga, Hideo; Takeshima, Hideyuki; Hasegawa, Wakae; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

2017-01-01

Community-acquired pneumonia (CAP) has high morbidity and mortality among adults. Several clinical guidelines recommend prompt administration of combined antimicrobial therapy. However, the association between guidelines concordance and mortality in patients with severe pneumonia remains unclear. The present study aimed to examine the impact of guidelines-concordant empiric antimicrobial therapy on 7-day mortality in patients with extremely severe pneumonia who required mechanical ventilation at admission, using a nationwide inpatient database in Japan. Data of CAP patients aged over 20 years who required mechanical ventilation at admission between April 2012 and March 2014 were retrospectively analyzed. Multivariable logistic regression analysis was performed to examine the association between guidelines-concordant empiric antimicrobial therapy and all-cause 7-day mortality, with adjustment for patient backgrounds and pneumonia severity. There were a total of 3719 eligible patients, 836 (22.5%) of whom received guidelines-concordant combination therapy. Overall, 7-day mortality was 29.5%. Higher 7-day mortality was associated with advanced age, confusion, lower systolic blood pressure, malignant tumor or immunocompromised state, and C-reactive protein ≥20mg/dl or infiltration occupying two-thirds of one lung on chest radiography. After adjustment for these variables, guidelines-concordant combined antimicrobial therapy was associated with significantly lower 7-day mortality (odds ratio: 0.78; 95% confidence interval: 0.65-0.95; P=0.013). Adherence to initial empiric treatment as recommended by the guidelines was associated with better short-term prognosis in patients with extremely severe pneumonia who required mechanical ventilation on hospital admission. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Surgical Closure of Patent Ductus Arteriosus in Premature Neonates Weighing Less Than 1,000 grams: Contemporary Outcomes.

PubMed

Lehenbauer, David G; Fraser, Charles D; Crawford, Todd C; Hibino, Naru; Aucott, Susan; Grimm, Joshua C; Patel, Nishant; Magruder, J Trent; Cameron, Duke E; Vricella, Luca

2018-07-01

The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as "rescue" therapy. The objective of this study was to review our institutions' outcomes of surgical PDA ligation. All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed. Records were queried to identify surgical complications, perioperative morbidity, and mortality. Outcomes included pre- and postoperative ventilator requirements, pre- and postoperative inotropic support, acute kidney injury, surgical complications, and 30-day mortality. One hundred sixty-six preterm neonates underwent surgical ligation. One hundred twenty-one (70.3%) had failed indomethacin closure. One hundred sixty-four (98.8%) patients required mechanical ventilation prior to surgery. At 17 postoperative days, freedom from the ventilator reached 50%. Of 109 (66.4%) patients requiring prolonged preoperative inotropic support, 59 (54.1%) were liberated from inotropes by postoperative day 1. Surgical morbidity was encountered in four neonates (2.4%): two (1.2%) patients had a postoperative pneumothorax requiring tube thoracostomy, one (0.6%) patient had a recurrent laryngeal nerve injury, and one (0.6%) patient had significant intraoperative bleeding. The 30-day all-cause mortality was 1.8% (n = 3); no deaths occurred intraoperatively. In this retrospective investigation, surgical PDA closure was associated with low 30-day mortality and minimal morbidity and resulted in rapid discontinuation of inotropic support and weaning from mechanical ventilation. Given the safety of this intervention, surgical PDA ligation merits consideration in the management strategy of the preterm neonate with a PDA.

Effects of Intraoperative Magnesium Sulfate Administration on Postoperative Tramadol Requirement in Liver Transplantation: A Prospective, Double-Blind Study.

PubMed

Gucyetmez, B; Atalan, H K; Aslan, S; Yazar, S; Polat, K Y

2016-10-01

Magnesium is an N-methyl-d-aspartate receptor blocker and is known to have analgesic effect. Hypomagnesemia can often be seen in liver transplantation and may be associated with higher morbidity and mortality. The objective of this study was to investigate the effects of intraoperative magnesium sulfate administration on postoperative tramadol requirement in liver transplant patients. Liver transplant patients >18 years of age were screened prospectively from October 2014 to April 2015. Of these, 35 randomly selected patients with normal blood magnesium level (≥1.8 mmol/L) were included in a control group and another 35 randomly selected patients with low magnesium level (<1.8 mmol/L) were given 50 mg/kg intravenous magnesium sulfate replacement in the last 30 minutes of the operation. All patients received standard anesthesia induction and maintenance. Patient's age, sex, body mass index, Model for End-Stage Liver Disease and Acute Physiology and Chronic Health Evaluation II scores, 24-hour tramadol requirement, mechanical ventilation duration, and time of 1st tramadol need were recorded. In the magnesium group, mean 24-hour total tramadol requirement (3.7 mg/kg/d) and duration of mechanical ventilation (6.3 h) were significantly lower and time of 1st tramadol need (17.5 h) was significantly higher than in the control group (P < .001 for each). In the multivariate analysis, duration of mechanical ventilation was decreased by the usage of magnesium sulfate (P < .001). Intraoperative use of magnesium sulfate in liver transplantation reduces the need for postoperative tramadol and duration of mechanical ventilation and therefore it is a candidate to be adjuvant agent. Copyright © 2016 Elsevier Inc. All rights reserved.

Advanced life support study

NASA Technical Reports Server (NTRS)

1991-01-01

Summary reports on each of the eight tasks undertaken by this contract are given. Discussed here is an evaluation of a Closed Ecological Life Support System (CELSS), including modeling and analysis of Physical/Chemical Closed Loop Life Support (P/C CLLS); the Environmental Control and Life Support Systems (ECLSS) evolution - Intermodule Ventilation study; advanced technologies interface requirements relative to ECLSS; an ECLSS resupply analysis; the ECLSS module addition relocation systems engineering analysis; an ECLSS cost/benefit analysis to identify rack-level interface requirements of the alternate technologies evaluated in the ventilation study, with a comparison of these with the rack level interface requirements for the baseline technologies; advanced instrumentation - technology database enhancement; and a clean room survey and assessment of various ECLSS evaluation options for different growth scenarios.

Continuous noninvasive ventilation delivered by a novel total face mask: a case series report.

PubMed

Belchior, Inês; Gonçalves, Miguel R; Winck, João Carlos

2012-03-01

Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients. However, nasal ulcerations may occur when conventional masks are used for continuous ventilation. A total face mask, which has no contact with the more sensitive areas of the face, is a possible option. We describe 3 patients with acute respiratory failure due to amyotrophic lateral sclerosis, who developed nasal bridge skin necrosis during continuous NIV, and one patient with post-extubation respiratory failure due to a high spinal cord injury, who had facial trauma with contraindication for conventional mask use. The total face mask was very well tolerated by all the patients, and permitted safe and efficient continuous NIV for several days until the acute respiratory failure episode resolved. None of the patients required endotracheal intubation during the acute episode.

Flow measurement in mechanical ventilation: a review.

PubMed

Schena, Emiliano; Massaroni, Carlo; Saccomandi, Paola; Cecchini, Stefano

2015-03-01

Accurate monitoring of flow rate and volume exchanges is essential to minimize ventilator-induced lung injury. Mechanical ventilators employ flowmeters to estimate the amount of gases delivered to patients and use the flow signal as a feedback to adjust the desired amount of gas to be delivered. Since flowmeters play a crucial role in this field, they are required to fulfill strict criteria in terms of dynamic and static characteristics. Therefore, mechanical ventilators are equipped with only the following kinds of flowmeters: linear pneumotachographs, fixed and variable orifice meters, hot wire anemometers, and ultrasonic flowmeters. This paper provides an overview of these sensors. Their working principles are described together with their relevant advantages and disadvantages. Furthermore, the most promising emerging approaches for flowmeters design (i.e., fiber optic technology and three dimensional micro-fabrication) are briefly reviewed showing their potential for this application. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Apte, Michael G.; Mendell, Mark J.; Sohn, Michael D.

Through mass-balance modeling of various ventilation scenarios that might satisfy the ASHRAE 62.1 Indoor Air Quality (IAQ) Procedure, we estimate indoor concentrations of contaminants of concern (COCs) in California “big box” stores, compare estimates to available thresholds, and for selected scenarios estimate differences in energy consumption. Findings are intended to inform decisions on adding performance-based approaches to ventilation rate (VR) standards for commercial buildings. Using multi-zone mass-balance models and available contaminant source rates, we estimated concentrations of 34 COCs for multiple ventilation scenarios: VRmin (0.04 cfm/ft2 ), VRmax (0.24 cfm/ft2 ), and VRmid (0.14 cfm/ft2 ). We compared COC concentrationsmore » with available health, olfactory, and irritant thresholds. We estimated building energy consumption at different VRs using a previously developed EnergyPlus model. VRmax did control all contaminants adequately, but VRmin did not, and VRmid did so only marginally. Air cleaning and local ventilation near strong sources both showed promise. Higher VRs increased indoor concentrations of outdoor air pollutants. Lowering VRs in big box stores in California from VRmax to VRmid would reduce total energy use by an estimated 6.6% and energy costs by 2.5%. Reducing the required VRs in California’s big box stores could reduce energy use and costs, but poses challenges for health and comfort of occupants. Source removal, air cleaning, and local ventilation may be needed at reduced VRs, and even at current recommended VRs. Also, alternative ventilation strategies taking climate and season into account in ventilation schedules may provide greater energy cost savings than constant ventilation rates, while improving IAQ.« less

Evaluation of ventilators used during transport of critically ill patients: a bench study.

PubMed

Boussen, Salah; Gainnier, Marc; Michelet, Pierre

2013-11-01

To evaluate the most recent transport ventilators' operational performance regarding volume delivery in controlled mode, trigger function, and the quality of pressurization in pressure support mode. Eight recent transport ventilators were included in a bench study in order to evaluate their accuracy to deliver a set tidal volume under normal resistance and compliance conditions, ARDS conditions, and obstructive conditions. The performance of the triggering system was assessed by the measure of the decrease in pressure and the time delay required to open the inspiratory valve. The quality of pressurization was obtained by computing the integral of the pressure-time curve for the first 300 ms and 500 ms after the onset of inspiration. For the targeted tidal volumes of 300, 500, and 800 mL the errors ranged from -3% to 48%, -7% to 18%, and -5% to 25% in the normal conditions, -4% to 27%, -2% to 35%, and -3% to 35% in the ARDS conditions, and -4% to 53%, -6% to 30%, and -30% to 28% in the obstructive conditions. In pressure support mode the pressure drop range was 0.4-1.7 cm H2O, the trigger delay range was 68-198 ms, and the pressurization performance (percent of ideal pressurization, as measured by pressure-time product at 300 ms and 500 ms) ranges were -9% to 44% at 300 ms and 6%-66% at 500 ms (P < .01). There were important differences in the performance of the tested ventilators. The most recent turbine ventilators outperformed the pneumatic ventilators. The best performers among the turbine ventilators proved comparable to modern ICU ventilators.

Implications of Natural Occlusion of Ventilated Racks on Ammonia and Sanitation Practices

PubMed Central

Creamer, Michelle A; Petty, Joann; Martin, Tara; Bergdall, Valerie; Hickman-Davis, Judy M

2014-01-01

Examination of ventilated rat racks prior to semiannual sanitation revealed silicone nozzles and ventilation ports that were partially or completely occluded with granular debris. We subsequently sought to document performance standards for rack sanitation and investigate the effect of ventilation port occlusion on rack function and animal husbandry practices. We hypothesized that individually ventilated cages with occluded airflow would require more frequent cage changes, comparable to those for static cages (that is, every 3 to 4 d). Sprague–Dawley rats were housed under one of 4 conditions: no airflow occlusion, occluded air-supply inlet, occluded air-exhaust outlet, and occlusion of both inlet and outlet. Cages were changed when daily ammonia concentration exceeded 20 ppm or after 14 d had elapsed. Most cages with unoccluded or partial airflow occlusion remained below the 20 ppm limit until day 12 or 13. Cages with occlusion of both inlet and outlet exceeded 20 ppm ammonia by as early as day 5. Airflow was significantly lower in cages with occlusion of both inlet and outlet airflow. Weekly inspection revealed that occlusion of ventilation ports was detectable by 3 mo after semiannual sanitation. This study demonstrates that silicone nozzles should be removed prior to rack sanitation to improve the effectiveness of cleaning ventilation ports and nozzles. While the rack is in use, silicone nozzles and ventilation ports should be inspected regularly to identify occlusion that is likely to diminish environmental quality in the cage. Intracage ammonia levels are significantly higher when both inlet and outlet airflow are occluded. PMID:24602544

Implications of natural occlusion of ventilated racks on ammonia and sanitation practices.

PubMed

Creamer, Michelle A; Petty, Joann; Martin, Tara; Bergdall, Valerie; Hickman-Davis, Judy M

2014-03-01

Examination of ventilated rat racks prior to semiannual sanitation revealed silicone nozzles and ventilation ports that were partially or completely occluded with granular debris. We subsequently sought to document performance standards for rack sanitation and investigate the effect of ventilation port occlusion on rack function and animal husbandry practices. We hypothesized that individually ventilated cages with occluded airflow would require more frequent cage changes, comparable to those for static cages (that is, every 3 to 4 d). Sprague-Dawley rats were housed under one of 4 conditions: no airflow occlusion, occluded air-supply inlet, occluded air-exhaust outlet, and occlusion of both inlet and outlet. Cages were changed when daily ammonia concentration exceeded 20 ppm or after 14 d had elapsed. Most cages with unoccluded or partial airflow occlusion remained below the 20 ppm limit until day 12 or 13. Cages with occlusion of both inlet and outlet exceeded 20 ppm ammonia by as early as day 5. Airflow was significantly lower in cages with occlusion of both inlet and outlet airflow. Weekly inspection revealed that occlusion of ventilation ports was detectable by 3 mo after semiannual sanitation. This study demonstrates that silicone nozzles should be removed prior to rack sanitation to improve the effectiveness of cleaning ventilation ports and nozzles. While the rack is in use, silicone nozzles and ventilation ports should be inspected regularly to identify occlusion that is likely to diminish environmental quality in the cage. Intracage ammonia levels are significantly higher when both inlet and outlet airflow are occluded.

[Percutaneous tracheostomy in the ventilated patient].

PubMed

Añón, J M; Araujo, J B; Escuela, M P; González-Higueras, E

2014-04-01

The medical indications of tracheostomy comprise the alleviation of upper airway obstruction; the prevention of laryngeal and upper airway damage due to prolonged translaryngeal intubation in patients subjected to prolonged mechanical ventilation; and the facilitation of airway access for the removal of secretions. Since 1985, percutaneous tracheostomy (PT) has gained widespread acceptance as a method for creating a surgical airway in patients requiring long-term mechanical ventilation. Since then, several comparative trials of PT and surgical tracheostomy have been conducted, and new techniques for PT have been developed. The use of percutaneous dilatation techniques under bronchoscopic control are now increasingly popular throughout the world. Tracheostomy should be performed as soon as the need for prolonged intubation is identified. However a validated model for the prediction of prolonged mechanical ventilation is not available, and the timing of tracheostomy should be individualized. The present review analyzes the state of the art of PT in mechanically ventilated patients--this being regarded by many as the technique of choice in performing tracheostomy in critically ill patients. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Football Equipment Removal Improves Chest Compression and Ventilation Efficacy.

PubMed

Mihalik, Jason P; Lynall, Robert C; Fraser, Melissa A; Decoster, Laura C; De Maio, Valerie J; Patel, Amar P; Swartz, Erik E

2016-01-01

Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators. We hypothesized that conditions with more football equipment would decrease chest compression and ventilation efficacy. Thirty-two certified athletic trainers were block randomized to participate in six different compression conditions and six different ventilation conditions using human patient simulators. Data for chest compression (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of adequate compressions) and ventilation (total ventilations, mean ventilation volume, and percentage of ventilations delivering adequate volume) conditions were analyzed across all conditions. The fully equipped athlete resulted in the lowest mean compression depth (F5,154 = 22.82; P < 0.001; Effect Size = 0.98) and delivery of adequate compressions (F5,154 = 15.06; P < 0.001; Effect Size = 1.09) compared to all other conditions. Bag-valve mask conditions resulted in delivery of significantly higher mean ventilation volumes compared to all 1- or 2-person pocketmask conditions (F5,150 = 40.05; P < 0.001; Effect Size = 1.47). Two-responder ventilation scenarios resulted in delivery of a greater number of total ventilations (F5,153 = 3.99; P = 0.002; Effect Size = 0.26) and percentage of adequate ventilations (F5,150 = 5.44; P < 0.001; Effect Size = 0.89) compared to one-responder scenarios. Non-chinstrap conditions permitted greater ventilation volumes (F3,28 = 35.17; P < 0.001; Effect Size = 1.78) and a greater percentage of adequate volume (F3,28 = 4.85; P = 0.008; Effect Size = 1.12) compared to conditions with the chinstrap buckled or with the chinstrap in place but not buckled. Chest compression and ventilation delivery are compromised in equipment-intense conditions when compared to conditions whereby equipment was mostly or entirely removed. Emergency medical personnel should remove the helmet and shoulder pads from all football athletes who require cardiopulmonary resuscitation, while maintaining appropriate cervical spine stabilization when injury is suspected. Further research is needed to confirm our findings supporting full equipment removal for chest compression and ventilation delivery.

12 CFR 932.8 - Minimum liquidity requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Minimum liquidity requirements. 932.8 Section 932.8 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.8 Minimum liquidity requirements. In...

7 CFR 932.150 - Modified minimum quality requirements for canned green ripe olives.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Modified minimum quality requirements for canned green... (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts... requirements for canned green ripe olives. The minimum quality requirements prescribed in § 932.52 (a)(1) of...

7 CFR 932.150 - Modified minimum quality requirements for canned green ripe olives.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Modified minimum quality requirements for canned green... (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts... requirements for canned green ripe olives. The minimum quality requirements prescribed in § 932.52 (a)(1) of...

12 CFR 932.8 - Minimum liquidity requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Minimum liquidity requirements. 932.8 Section 932.8 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.8 Minimum liquidity requirements. In...

Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study.

PubMed

Ladha, Karim; Vidal Melo, Marcos F; McLean, Duncan J; Wanderer, Jonathan P; Grabitz, Stephanie D; Kurth, Tobias; Eikermann, Matthias

2015-07-14

To evaluate the effects of intraoperative protective ventilation on major postoperative respiratory complications and to define safe intraoperative mechanical ventilator settings that do not translate into an increased risk of postoperative respiratory complications. Hospital based registry study. Academic tertiary care hospital and two affiliated community hospitals in Massachusetts, United States. 69,265 consecutively enrolled patients over the age of 18 who underwent a non-cardiac surgical procedure between January 2007 and August 2014 and required general anesthesia with endotracheal intubation. Protective ventilation, defined as a median positive end expiratory pressure (PEEP) of 5 cmH2O or more, a median tidal volume of less than 10 mL/kg of predicted body weight, and a median plateau pressure of less than 30 cmH2O. Composite outcome of major respiratory complications, including pulmonary edema, respiratory failure, pneumonia, and re-intubation. Of the 69,265 enrolled patients 34,800 (50.2%) received protective ventilation and 34,465 (49.8%) received non-protective ventilation intraoperatively. Protective ventilation was associated with a decreased risk of postoperative respiratory complications in multivariable regression (adjusted odds ratio 0.90, 95% confidence interval 0.82 to 0.98, P=0.013). The results were similar in the propensity score matched cohort (odds ratio 0.89, 95% confidence interval 0.83 to 0.97, P=0.004). A PEEP of 5 cmH2O and median plateau pressures of 16 cmH2O or less were associated with the lowest risk of postoperative respiratory complications. Intraoperative protective ventilation was associated with a decreased risk of postoperative respiratory complications. A PEEP of 5 cmH2O and a plateau pressure of 16 cmH2O or less were identified as protective mechanical ventilator settings. These findings suggest that protective thresholds differ for intraoperative ventilation in patients with normal lungs compared with those used for patients with acute lung injury. © Ladha et al 2015.

47 CFR 22.951 - Minimum coverage requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Minimum coverage requirement. 22.951 Section 22.951 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Cellular Radiotelephone Service § 22.951 Minimum coverage requirement. Applications for...

Nosocomial pneumonia in the ICU: a prospective cohort study.

PubMed

Hyllienmark, Petra; Gårdlund, Bengt; Persson, Jan-Olov; Ekdahl, Karl

2007-01-01

Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection among patients requiring mechanical ventilation. A prospective surveillance programme of all patients has been implemented at the ICU, Karolinska University Hospital, Sweden since 2001. Within this programme, incidence and risk factors for ICU-acquired pneumonia and associated death over a 2-y period have been studied. Of 329 patients enrolled in the study, 221 required mechanical ventilation. 33 of 221 patients (15%) developed VAP, corresponding to a rate of 29 VAP/1000 ventilator d. Risk factors for VAP were aspiration (hazard ratio 3.79; 95% CI 1.48-9.68), recent surgery (HR 3.58; 95% CI 1.15-11.10) and trauma (HR 3.00; 95% CI 1.03-8.71). 11 patients of 33 (33%) with VAP died within 28 d compared to 46 of 288 (16%) without ICU-acquired pneumonia (odds ratio 2.73; 95% CI 0.97-7.63). We conclude that: 1) incidence of VAP was 15% and the most important risk factor was aspiration; 2) APACHE II score > or = 20 is a stronger predictor for poor outcome than VAP; 3) a minority of patients with APACHE II score > or = 20 develop VAP; and 4) continuous surveillance programmes are feasible and provide valuable data for improvement of quality of care.

Rescue ventilation: resolving a "cannot mask ventilate, cannot intubate" situation during exchange of a Combitube for a definitive airway.

PubMed

Rich, James M; Mason, Andrew M; Tillmann, H A; Foreman, Michael

2009-10-01

Our anesthesia care team was called to care for a patient who was admitted to the emergency department with the esophageal-tracheal double-lumen airway device (Combitube, Tyco Healthcare, Nellcor, Pleasanton, California) in place, which needed to be exchanged for a definitive airway because the patient required an extended period of mechanical ventilation. Several techniques were attempted to exchange the esophageal-tracheal Combitube (ETC) without success. First, we attempted direct laryngoscopy with the ETC in place after deflation of the No. 1 proximal cuff and sweeping the ETC to the left. We were prepared to use bougie-assisted intubation but could not identify any airway anatomy. After removal of the ETC, we unsuccessfully attempted ventilation/intubation with a laryngeal mask airway (LMA Fastrach, LMA North America, San Diego, California). Our third attempt was insertion of another laryngeal mask airway (LMA Unique, LMA North America) with marginal ventilation, but we again experienced unsuccessful intubation using a fiberscope. The ETC was reinserted after each intubation attempt because mask ventilation was impossible. Before proceeding with cricothyrotomy, we repeated direct laryngoscopy but without the ETC in place. We identified the tip of the epiglottis, which allowed for bougie-assisted intubation. This obviated the need for emergency cricothyrotomy.

Ventilator-associated pneumonia: the influence of bacterial resistance, prescription errors, and de-escalation of antimicrobial therapy on mortality rates.

PubMed

Souza-Oliveira, Ana Carolina; Cunha, Thúlio Marquez; Passos, Liliane Barbosa da Silva; Lopes, Gustavo Camargo; Gomes, Fabiola Alves; Röder, Denise Von Dolinger de Brito

2016-01-01

Ventilator-associated pneumonia is the most prevalent nosocomial infection in intensive care units and is associated with high mortality rates (14-70%). This study evaluated factors influencing mortality of patients with Ventilator-associated pneumonia (VAP), including bacterial resistance, prescription errors, and de-escalation of antibiotic therapy. This retrospective study included 120 cases of Ventilator-associated pneumonia admitted to the adult adult intensive care unit of the Federal University of Uberlândia. The chi-square test was used to compare qualitative variables. Student's t-test was used for quantitative variables and multiple logistic regression analysis to identify independent predictors of mortality. De-escalation of antibiotic therapy and resistant bacteria did not influence mortality. Mortality was 4 times and 3 times higher, respectively, in patients who received an inappropriate antibiotic loading dose and in patients whose antibiotic dose was not adjusted for renal function. Multiple logistic regression analysis revealed the incorrect adjustment for renal function was the only independent factor associated with increased mortality. Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations. Copyright © 2016. Published by Elsevier Editora Ltda.

Multicenter comparative study of conventional mechanical gas ventilation to tidal liquid ventilation in oleic acid injured sheep.

PubMed

Wolfson, Marla R; Hirschl, Ronald B; Jackson, J Craig; Gauvin, France; Foley, David S; Lamm, Wayne J E; Gaughan, John; Shaffer, Thomas H

2008-01-01

We performed a multicenter study to test the hypothesis that tidal liquid ventilation (TLV) would improve cardiopulmonary, lung histomorphological, and inflammatory profiles compared with conventional mechanical gas ventilation (CMV). Sheep were studied using the same volume-controlled, pressure-limited ventilator systems, protocols, and treatment strategies in three independent laboratories. Following baseline measurements, oleic acid lung injury was induced and animals were randomized to 4 hours of CMV or TLV targeted to "best PaO2" and PaCO2 35 to 60 mm Hg. The following were significantly higher (p < 0.01) during TLV than CMV: PaO2, venous oxygen saturation, respiratory compliance, cardiac output, stroke volume, oxygen delivery, ventilatory efficiency index; alveolar area, lung % gas exchange space, and expansion index. The following were lower (p < 0.01) during TLV compared with CMV: inspiratory and expiratory pause pressures, mean airway pressure, minute ventilation, physiologic shunt, plasma lactate, lung interleukin-6, interleukin-8, myeloperoxidase, and composite total injury score. No significant laboratories by treatment group interactions were found. In summary, TLV resulted in improved cardiopulmonary physiology at lower ventilatory requirements with more favorable histological and inflammatory profiles than CMV. As such, TLV offers a feasible ventilatory alternative as a lung protective strategy in this model of acute lung injury.

Procedures and Standards for Residential Ventilation System Commissioning: An Annotated Bibliography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stratton, J. Chris; Wray, Craig P.

2013-04-01

Beginning with the 2008 version of Title 24, new homes in California must comply with ANSI/ASHRAE Standard 62.2-2007 requirements for residential ventilation. Where installed, the limited data available indicate that mechanical ventilation systems do not always perform optimally or even as many codes and forecasts predict. Commissioning such systems when they are installed or during subsequent building retrofits is a step towards eliminating deficiencies and optimizing the tradeoff between energy use and acceptable IAQ. Work funded by the California Energy Commission about a decade ago at Berkeley Lab documented procedures for residential commissioning, but did not focus on ventilation systems.more » Since then, standards and approaches for commissioning ventilation systems have been an active area of work in Europe. This report describes our efforts to collect new literature on commissioning procedures and to identify information that can be used to support the future development of residential-ventilation-specific procedures and standards. We recommend that a standardized commissioning process and a commissioning guide for practitioners be developed, along with a combined energy and IAQ benefit assessment standard and tool, and a diagnostic guide for estimating continuous pollutant emission rates of concern in residences (including a database that lists emission test data for commercially-available labeled products).« less

Prolonged mechanical ventilation in Canadian intensive care units: a national survey.

PubMed

Rose, Louise; Fowler, Robert A; Fan, Eddy; Fraser, Ian; Leasa, David; Mawdsley, Cathy; Pedersen, Cheryl; Rubenfeld, Gordon

2015-02-01

We sought to describe prevalence and care practices for patients experiencing prolonged mechanical ventilation (PMV), defined as ventilation for 21 or more consecutive days and medical stability. We provided the survey to eligible units via secure Web link to a nominated unit champion from April to November 2012. Weekly telephone and e-mail reminders were sent for 6 weeks. Response rate was 215 (90%) of 238 units identifying 308 patients requiring PMV on the survey day occupying 11% of all Canadian ventilator-capable beds. Most units (81%) used individualized plans for both weaning and mobilization. Weaning and mobilization protocols were available in 48% and 38% of units, respectively. Of those units with protocols, only 25% reported weaning guidance specific to PMV, and 11% reported mobilization content for PMV. Only 30% of units used specialized mobility equipment. Most units referred to speech language pathologists (88%); use of communication technology was infrequent (11%). Only 29% routinely referred to psychiatry/psychology, and 17% had formal discharge follow-up services. Prolonged mechanical ventilation patients occupied 11% of Canadian acute care ventilator bed capacity. Most units preferred an individualized approach to weaning and mobilization with considerable variation in weaning methods, protocol availability, access to specialized rehabilitation equipment, communication technology, psychiatry, and discharge follow-up. Copyright © 2014 Elsevier Inc. All rights reserved.

Use of ventilator associated pneumonia bundle and statistical process control chart to decrease VAP rate in Syria.

PubMed

Alsadat, Reem; Al-Bardan, Hussam; Mazloum, Mona N; Shamah, Asem A; Eltayeb, Mohamed F E; Marie, Ali; Dakkak, Abdulrahman; Naes, Ola; Esber, Faten; Betelmal, Ibrahim; Kherallah, Mazen

2012-10-01

Implementation of ventilator associated pneumonia (VAP) bundle as a performance improvement project in the critical care units for all mechanically ventilated patients aiming to decrease the VAP rates. VAP bundle was implemented in 4 teaching hospitals after educational sessions and compliance rates along with VAP rates were monitored using statistical process control charts. VAP bundle compliance rates were steadily increasing from 33 to 80% in hospital 1, from 33 to 86% in hospital 2 and from 83 to 100% in hospital 3 during the study period. The VAP bundle was not applied in hospital 4 therefore no data was available. A target level of 95% was reached only in hospital 3. This correlated with a decrease in VAP rates from 30 to 6.4 per 1000 ventilator days in hospital 1, from 12 to 4.9 per 1000 ventilator days in hospital 3, whereas VAP rate failed to decrease in hospital 2 (despite better compliance) and it remained high around 33 per 1000 ventilator days in hospital 4 where VAP bundle was not implemented. VAP bundle has performed differently in different hospitals in our study. Prevention of VAP requires a multidimensional strategy that includes strict infection control interventions, VAP bundle implementation, process and outcome surveillance and education.

Differences in mortality based on worsening ratio of partial pressure of oxygen to fraction of inspired oxygen corrected for immune system status and respiratory support.

PubMed

Miles, Lachlan F; Bailey, Michael; Young, Paul; Pilcher, David V

2012-03-01

To define the relationship between worsening oxygenation status (worst PaO(2)/FiO(2) ratio in the first 24 hours after intensive care unit admission) and mortality in immunosuppressed and immunocompetent ICU patients in the presence and absence of mechanical ventilation. Retrospective cohort study. Data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database. Adult patients admitted to 129 ICUs in Australasia, 2000-2010. In hospital and ICU mortality; relationship between mortality and declining PaO(2)/FiO(2) ratio by ventilation status and immune status. 457 750 patient records were analysed. Worsening oxygenation status was associated with increasing mortality in all groups. Higher mortality was seen in immunosuppressed patients than immunocompetent patients. After multivariate analysis, in mechanically ventilated patients, declining PaO(2)/FiO(2) ratio in the first 24 hours of ICU admission was associated with a more rapidly rising mortality rate in immunosuppressed patients than non-immunosuppressed patients. Immunosuppression did not affect the relationship between oxygenation status and mortality in non-ventilated patients. Immunosuppression increases the risk of mortality with progressively worsening oxygenation status, but only in the presence of mechanical ventilation. Further research into the impact of mechanical ventilation in immunosuppressed patients is required.

Detecting Hardware-assisted Hypervisor Rootkits within Nested Virtualized Environments

DTIC Science & Technology

2012-06-14

least the minimum required for the guest OS and click “Next”. For 64-bit Windows 7 the minimum required is 2048 MB (Figure 66). Figure 66. Memory...prompted for Memory, allocate at least the minimum required for the guest OS, for 64-bit Windows 7 the minimum required is 2048 MB (Figure 79...130 21. Within the virtual disk creation wizard, select VDI for the file type (Figure 81). Figure 81. Select File Type 22. Select Dynamically

Early non-invasive ventilation treatment for severe influenza pneumonia.

PubMed

Masclans, J R; Pérez, M; Almirall, J; Lorente, L; Marqués, A; Socias, L; Vidaur, L; Rello, J

2013-03-01

The role of non-invasive ventilation (NIV) in acute respiratory failure caused by viral pneumonia remains controversial. Our objective was to evaluate the use of NIV in a cohort of (H1N1)v pneumonia. Usefulness and success of NIV were assessed in a prospective, observational registry of patients with influenza A (H1N1) virus pneumonia in 148 Spanish intensive care units (ICUs) in 2009-10. Significant variables for NIV success were included in a multivariate analysis. In all, 685 patients with confirmed influenza A (H1N1)v viral pneumonia were admitted to participating ICUs; 489 were ventilated, 177 with NIV. The NIV was successful in 72 patients (40.7%), the rest required intubation. Low Acute Physiology and Chronic Health Evaluation (APACHE) II, low Sequential Organ Failure Assessment (SOFA) and absence of renal failure were associated with NIV success. Success of NIV was independently associated with fewer than two chest X-ray quadrant opacities (OR 3.5) and no vasopressor requirement (OR 8.1). However, among patients with two or more quadrant opacities, a SOFA score ≤7 presented a higher success rate than those with SOFA score >7 (OR 10.7). Patients in whom NIV was successful required shorter ventilation time, shorter ICU stay and hospital stay than NIV failure. In patients in whom NIV failed, the delay in intubation did not increase mortality (26.5% versus 24.2%). Clinicians used NIV in 25.8% of influenza A (H1N1)v viral pneumonia admitted to ICU, and treatment was effective in 40.6% of them. NIV success was associated with shorter hospital stay and mortality similar to non-ventilated patients. NIV failure was associated with a mortality similar to those who were intubated from the start. © 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.

38 CFR 39.22 - Architectural design standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Mechanical requirements. The heating system, boilers, steam system, ventilation system and air-conditioning system shall be furnished and installed to meet all requirements of the local and State codes and... apply. (c) Plumbing requirements. Plumbing systems shall comply with all applicable local and State...

Examining pediatric emergency home ventilation practices in home health nurses: Opportunities for improved care.

PubMed

Kun, Sheila S; Beas, Virginia N; Keens, Thomas G; Ward, Sally S L; Gold, Jeffrey I

2015-07-01

To assess the pediatric home health nurses' knowledge in tracheostomy and ventilator emergency care on home mechanical ventilation (HMV). Emergencies are frightening experiences for solo home health nurses and require advanced skills in emergency response and care, especially in pediatric patients who pose unique challenges. Nurses with greater years of nursing experience would perform better on emergency HMV case-based scenarios than nurses with less years of experience. An exploratory online survey was used to evaluate emergency case-based pediatric scenarios. Demographic and professional experiences were profiled. Seventy-nine nurses had an average of 6.73 (SD = 1.41) years in pediatric nursing. Over 70% received their HMV training in their agency, 41% had less than 4 years of experience, and 30.4% had encountered at least one emergency situation at home. The online survey was distributed by managers of 22 home health agencies to nurses providing pediatric HMV care. Nurses scored an average of 4.87 out of 10 possible points. There were no significant differences between nurses with <4 years of experience versus those with more experience on ventilator alarms knowledge or total knowledge. Ninety-seven percent of the nurses favored more training in HMV from a variety of settings (e.g., agency, on-line training). Nurses did not perform well in case-based ventilator alarm scenarios. Length of nursing experience did not differentiate greater knowledge. It is clear that nurses require and want more training in emergency-based HMV. Recommendations for an enhanced curriculum are suggested. © 2014 Wiley Periodicals, Inc.

Minimum Stocking Requirements for Retailers in the Special Supplemental Nutrition Program for Women, Infants, and Children: Disparities Across US States.

PubMed

Pelletier, Jennifer E; Schreiber, Liana R N; Laska, Melissa N

2017-07-01

To examine state variation in minimum stocking requirements for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-authorized small food retailers. We obtained minimum stocking requirements for 50 states and the District of Columbia in 2017 from WIC Web pages or e-mail from the state WIC agency. We developed a coding protocol to compare minimum quantities and varieties required for 12 food and beverage categories. We calculated the median, range, and interquartile range for each measure. Nearly all states set minimum varieties and quantities of fruits and vegetables, 100% juice, whole grain-rich foods, breakfast cereal, milk, cheese, eggs, legumes, and peanut butter. Fewer states set requirements for canned fish, yogurt, and tofu. Most measures had a large range in minimum requirements (e.g., $8-$100 of fruits and vegetables, 60-144 oz of breakfast cereal). WIC-participating retailers must adhere to very different minimum stocking requirements across states, which may result in disparities in food and beverage products available to WIC recipients. Public Health Implications. The results provide benchmarks that can inform new local, state, and federal program and policy efforts to increase healthy food availability in retail settings.

49 CFR 176.600 - General stowage requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... General stowage requirements. (a) Each package required to have a POISON GAS, POISON INHALATION HAZARD, or POISON label, being transported on a vessel, must be stowed clear of living quarters and any ventilation... foodstuffs are in different closed cargo transport units. (b) Each package required to have both a POISON GAS...

49 CFR 176.600 - General stowage requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... General stowage requirements. (a) Each package required to have a POISON GAS, POISON INHALATION HAZARD, or POISON label, being transported on a vessel, must be stowed clear of living quarters and any ventilation... foodstuffs are in different closed cargo transport units. (b) Each package required to have both a POISON GAS...