WorldWideScience

Sample records for excluding ventilation services

  1. 20 CFR 404.1313 - World War II service excluded.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false World War II service excluded. 404.1313... DISABILITY INSURANCE (1950- ) Wage Credits for Veterans and Members of the Uniformed Services World War II Veterans § 404.1313 World War II service excluded. Your service was not in the active service of the United...

  2. [Weaning from invasive mechanical ventilation in pediatric patients (excluding premature neonates)].

    Science.gov (United States)

    Leclerc, F; Noizet, O; Botte, A; Binoche, A; Chaari, W; Sadik, A; Riou, Y

    2010-04-01

    The process of weaning from mechanical ventilation (WMV) is the same in children as in adults. In the pediatric literature, weaning failure rate ranges from 1.4 to 34%. So far, no indices of weaning success have been demonstrated to be sufficiently accurate. The criteria for assessing readiness to wean, which must be screened daily, have neither been validated nor adapted to the pediatric population. The spontaneous breathing test (SBT), the reference screening test for weaning, precedes extubation; it can be achieved with pressure support ventilation or spontaneous breathing (T piece or canopy or flow-inflating bag). A standardized weaning protocol (which can be computer driven) was used in only three pediatric studies and the impact on shortening the duration of mechanical ventilation has not yet been demonstrated. It should be paired with a sedative interruption protocol. Weaning criteria, SBT criteria, and/or protocol tolerance are guides, but clinicians must individualize decisions to use these criteria. The use of noninvasive ventilation is increasing and its place in weaning protocols for children needs to be determined; it might modify the definitions of weaning failure and weaning success in the future. Copyright 2010 Elsevier Masson SAS. All rights reserved.

  3. 20 CFR 404.1323 - Post-World War II service excluded.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Post-World War II service excluded. 404.1323... DISABILITY INSURANCE (1950- ) Wage Credits for Veterans and Members of the Uniformed Services Post-World War II Veterans § 404.1323 Post-World War II service excluded. Your service was not in the active service...

  4. Should We Exclude Live Donor Liver Transplantation for Liver Transplant Recipients Requiring Mechanical Ventilation and Intensive Care Unit Care?

    Science.gov (United States)

    Goldaracena, Nicolas; Spetzler, Vinzent N; Sapisochin, Gonzalo; J, Echeverri; Moritz, Kaths; Cattral, Mark S; Greig, Paul D; Lilly, Les; McGilvray, Ian D; Levy, Gary A; Ghanekar, Anand; Renner, Eberhard L; Grant, David R; Selzner, Markus; Selzner, Nazia

    2015-09-01

    Patients with acute and chronic liver disease often require admission to intensive care unit (ICU) and mechanical ventilation support before liver transplantation (LT). Rapid disease progression and high mortality on LT waiting lists makes live donor LT (LDLT) an attractive option for this patient population. During 2000 to 2011, all ICU-bound and mechanically ventilated patients receiving an LDLT (n = 7) were compared to patients receiving a deceased donor LT (DDLT) (n = 38). Both groups were comparable regarding length of pretransplant ICU stay (DDLT: 2 [1-31] days vs LDLT: 2 [1-8] days; P = 0.2), days under mechanical ventilation (DDLT: 2 [1-31] days vs LDLT: 2 [1-5] days; P = 0.2), pretransplant dialysis (DDLT: 45% vs LDLT: 43%; P = 1) and model for end-stage liver disease score (DDLT: 33 ± 8 vs LDLT: 33 ± 10; P = 0.911). Live donors median evaluation time was 24 hours (18-561 hours). As expected, median time on waiting list was significantly lower in the LDLT group (DDLT: 13 [0-1704] days vs LDLT: 10 [1-33] days; P = 0.008). Incidence of postoperative complications was numerically, albeit not significantly higher in the DDLT versus LDLT (68% vs 29%; P = 0.08). No difference was detected between LDLT and DDLT patients regarding 1-year (DDLT: 76% vs LDLT: 85%), 3-year (DDLT: 68% vs LDLT: 85%), and 5-year (DDLT: 68% vs LDLT: 85%) graft and patient survivals (P = 0.41). No severe donor complication occurred after live donation. The LDLT may provide a faster access to transplantation and therefore, offers an alternative treatment option for critically ill patients requiring ICU care and mechanical ventilation support at the time of transplantation.

  5. 9 CFR 130.19 - User fees for other veterinary diagnostic services or materials provided at NVSL (excluding FADDL).

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false User fees for other veterinary... User fees for other veterinary diagnostic services or materials provided at NVSL (excluding FADDL). (a) User fees for other veterinary diagnostic services or materials available from NVSL (excluding FADDL...

  6. NGO Provision of Basic Education: Alternative or Complementary Service Delivery to Support Access to the Excluded?

    Science.gov (United States)

    Rose, Pauline

    2009-01-01

    This paper focuses on approaches by non-government organisations (NGOs) to reach primary school-aged children excluded from access to the conventional state education system. It highlights recent shifts in international literature and agency priorities from the portrayal of NGO provision as a (non-formal) "alternative" to (formal) state…

  7. [Attempt to exclude invasive cardiology services in Poland--rationing, national sovereignty and European Union law].

    Science.gov (United States)

    Gericke, Christian A; Busse, Reinhard; Sakowska, Izabela; Kuszewski, Krzysztof; Maciag, Agnieszka

    2006-01-01

    One of the guiding principles of health policy in many European countries is equitable access to health care services. One of the life saving procedures is percutaneous transluminal coronary angioplasty (PTCA) performed after coronary angiography. Introducing payment for these procedures would limit access for low-income patients. Fortunately, despite political debate, invasive cardiology develops well in Poland. It is important to notice that within the European Union Polish citizens would be able to receive this treatment in other member states and, according to a European Court of Justice ruling, the costs would have to be reimbursed by the National Health Fund. The wider implication is that the 10 new EU member states now have to realise that health care is no longer a matter of national sovereignty - a fact legislators and health care managers in the 15 member states of the pre-accession EU are still struggling with.

  8. Routine screening for postnatal depression in a public health family service unit: a retrospective study of self-excluding women.

    Science.gov (United States)

    Grussu, Pietro; Quatraro, Rosa Maria

    2015-01-01

    At this time, there is limited scientific knowledge about women who exclude themselves from screening programs for postnatal depression. In this retrospective descriptive study, we have sought to investigate the socio-demographic and psycho-social factors of women who withdraw from PND screening of their own accord. Study participants were 525 women attending antenatal classes who later took part in institutional routine screening for PND at the Consultorio Familiare Service of the National Health Service, Italy. The PND screening program consisted of the completion of the postpartum depression predictors inventory-revised and psychological well-being (PWB) questionnaires within eight to nine months of pregnancy, and Edinburgh Postnatal Depression Scale, GHQ-12 and PWB within six to eight weeks after childbirth. The Responders group was made up of 346 subjects - 65.9% of the total sample - who completed the entire program of screening for PND. The Non-Responders group, on the other hand, consisted of 179 subjects - 34.1% of the total sample - who, after childbirth, withdrew from the screening program. Compared to the Responders group, the Non-Responders group showed a greater number of subjects with marital dissatisfaction, and with unemployment as a stressful event. Health professionals who detect marital dissatisfaction and/or unemployment as a stressful event in pregnant women should bear in mind that these individuals, besides being at high risk for depression after delivery, will also tend to exclude themselves from screening for PND.

  9. An evaluation of ventilator reliability: a multivariate, failure time analysis of 5 common ventilator brands.

    Science.gov (United States)

    Blanch, P B

    2001-08-01

    Mechanical ventilator failures expose patients to unacceptable risks and are expensive. By identifying factors that correlate with the amount of time between consecutive ventilator failures, we might reduce patient risk, save money, and shed light on a number of important questions concerning whether reliability changes as a function of time. Investigate the correlation between several explanatory variables and the time between consecutive ventilator failures and address the following questions: (1) Are ventilators as safe and reliable following repairs as they were before failing? (2) Does reliability change significantly as a ventilator is used or ages? (3) Does a hospital's particular operating environment play a role in ventilator reliability? (4) Are ventilator service contracts worth the money? A retrospective review was conducted using repair and maintenance records from 2 hospitals: a 570-bed teaching hospital and a 410-bed local community hospital. Records were examined from a total of 66 individual ventilators, of 5 different brands, used between July 1, 1991, and January 3, 2001. The ventilators included 13 Tyco-Mallinckrodt Infant Star, 10 Bird VIP, 11 Bird 6400ST, 16 Bird 8400STi, and 16 Tyco-Mallinckrodt 7200ae. The dependent variable was the operating time between or before unexpected mechanical failures; this was determined by the difference between hours logged on the ventilator hour meter at the time of failure and that recorded when the study began, or when the ventilator was new. Thereafter (when applicable), the time before failure was the difference in hours at consecutive failures. Seven independent explanatory covariates were selected and analyzed as potential correlates with time between failures. Another independent variable, the site of ventilator use (community or teaching hospital), was also tested for significance. Data were analyzed using the Cox proportional hazard model, the multiple-groups survival statistic, and the Cox

  10. Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service.

    Science.gov (United States)

    Lee, James S; O'Dochartaigh, Domhnall; MacKenzie, Mark; Hudson, Darren; Couperthwaite, Stephanie; Villa-Roel, Cristina; Rowe, Brian H

    2015-06-01

    Non-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation. The authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support. A retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model. From a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS)failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001). Patients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.

  11. Multifamily Ventilation Retrofit Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Ueno, K.; Lstiburek, J.; Bergey, D.

    2012-12-01

    In multifamily buildings, central ventilation systems often have poor performance, overventilating some portions of the building (causing excess energy use), while simultaneously underventilating other portions (causing diminished indoor air quality). BSC and Innova Services Corporation performed a series of field tests at a mid-rise test building undergoing a major energy audit and retrofit, which included ventilation system upgrades.

  12. Paid carers' experiences of caring for mechanically ventilated children at home: implications for services and training.

    Science.gov (United States)

    Maddox, Christina; Pontin, David

    2013-06-01

    UK survival rates for long-term mechanically ventilated children have increased and paid carers are trained to care for them at home, however there is limited literature on carers' training needs and experience of sharing care. Using a qualitative abductive design, we purposively sampled experienced carers to generate data via diaries, semi-structured interviews, and researcher reflexive notes. Research ethics approval was granted from NHS and University committees. Five analytical themes emerged - Parent as expert; Role definition tensions; Training and Continuing Learning Needs; Mixed Emotions; Support Mechanisms highlighting the challenges of working in family homes for carers and their associated learning needs. Further work on preparing carers to share feelings with parents, using burnout prevention techniques, and building confidence is suggested. Carers highlight the lack of clinical supervision during their night-working hours. One solution may be to provide access to registered nurse support when working out-of-office hours.

  13. Trials of electronet fencing to exclude coyotes

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This report is on the trials of using electronet fencing to exclude coyotes for the protection of black-footed ferrets in Montana. Reintroduction of black-tailed...

  14. Displacement ventilation

    DEFF Research Database (Denmark)

    Kosonen, Risto; Melikov, Arsen Krikor; Mundt, Elisabeth

    The aim of this Guidebook is to give the state-of-the art knowledge of the displacement ventilation technology, and to simplify and improve the practical design procedure. The Guidebook discusses methods of total volume ventilation by mixing ventilation and displacement ventilation and it gives...... insights of the performance of the displacement ventilation. It also shows practical case studies in some typical applications and the latest research findings to create good local micro-climatic conditions....

  15. An excluded diagnosis

    Directory of Open Access Journals (Sweden)

    Paolo Ghiringhelli

    2007-12-01

    Full Text Available We describe a 50-years-old patient with septic fever of unidentifiable source, following resection for rectal adenocarcinoma. He has been in treatment for sepsi two months before. Blood coltures, an accurate amanestic analysis and a transesophageal echocardiography were the major tools for the diagnosis of this disease. After the diagnosis of infective endocarditis had been excluded, antibiotic treatment (with teicoplanin and rifampicine was given for the presence of Staphylococcus epidermidis. The previous pacemaker system was removed and a DDD pacemaker was implanted.

  16. Being Included and Excluded

    DEFF Research Database (Denmark)

    Korzenevica, Marina

    2016-01-01

    Following the civil war of 1996–2006, there was a dramatic increase in the labor mobility of young men and the inclusion of young women in formal education, which led to the transformation of the political landscape of rural Nepal. Mobility and schooling represent a level of prestige that rural...... politics. It analyzes how formal education and mobility either challenge or reinforce traditional gendered norms which dictate a lowly position for young married women in the household and their absence from community politics. The article concludes that women are simultaneously excluded and included from...... people regard as a prerequisite for participating in local community politics. Based on a fieldwork in two villages of Panchthar district in eastern Nepal, this article explores how these changes strengthen or weaken women’s political agency and how this is reflected in their participation in community...

  17. 48 CFR 9.404 - Excluded Parties List System.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Excluded Parties List... ACQUISITION PLANNING CONTRACTOR QUALIFICATIONS Debarment, Suspension, and Ineligibility 9.404 Excluded Parties List System. (a) The General Services Administration (GSA)— (1) Operates the web-based Excluded Parties...

  18. 29 CFR 1471.950 - Excluded Parties List System

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Excluded Parties List System 1471.950 Section 1471.950... GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 1471.950 Excluded Parties List System Excluded Parties List System (EPLS) means the list maintained and disseminated by the General Services...

  19. Demand Controlled Ventilation and Classroom Ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mendell, Mark J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Davies, Molly [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Eliseeva, Ekaterina [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Faulkner, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hong, Tienzen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sullivan, Douglas P. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-05-01

    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling.

  20. Demand controlled ventilation and classroom ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Fisk, William J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mendell, Mark J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Davies, Molly [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Eliseeva, Ekaterina [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Faulkner, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hong, Tienzen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sullivan, Douglas P. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-01-06

    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling.

  1. Displacement Ventilation

    DEFF Research Database (Denmark)

    Nielsen, Peter Vilhelm

    Displacement ventilation is an interesting new type of air distribution principle which should be considered in connection with design of comfort ventilation in both smal1 and large spaces. Research activities on displacement ventilation are large all over the world and new knowledge of design...... methods appears continuously. This book gives an easy introduction to the basis of displacement ventilation and the chapters are written in the order which is used in a design procedure. The main text is extended by five appendices which show some of the new research activities taking place at Aalborg...

  2. Ventilative Cooling

    DEFF Research Database (Denmark)

    Heiselberg, Per Kvols; Kolokotroni, Maria

    -of-the-art of ventilative cooling potentials and limitations, its consideration in current energy performance regulations, available building components and control strategies and analysis methods and tools. In addition, the report provides twenty six examples of operational buildings using ventilative cooling ranging from...

  3. Ventilation Effectiveness

    DEFF Research Database (Denmark)

    Mundt, M.; Mathisen, H. M.; Moser, M.

    Improving the ventilation effectiveness allows the indoor air quality to be significantly enhanced without the need for higher air changes in the building, thereby avoiding the higher costs and energy consumption associated with increasing the ventilation rates. This Guidebook provides easy...

  4. Liquid Ventilation

    Directory of Open Access Journals (Sweden)

    Qutaiba A. Tawfic

    2011-01-01

    Full Text Available Mammals have lungs to breathe air and they have no gills to breath liquids. 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 theoretical 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. The potential for multiple clinical applications for liquid-assisted ventilation will be clarified and optimized in future. Keywords: Liquid ventilation; perfluorochemicals; perfluorocarbon; respiratory distress; surfactant.

  5. 42 CFR 409.49 - Excluded services.

    Science.gov (United States)

    2010-10-01

    ... benefit. (1) A drug is any chemical compound that may be used on or administered to humans or animals as... pain or suffering or to control or improve any physiological pathologic condition. (2) A biological is...

  6. Office of Inspector General List of Excluded Individuals and Entities

    Data.gov (United States)

    U.S. Department of Health & Human Services — The objective is to ensure that providers who bill Federal health care programs do not submit claims for services furnished, ordered or prescribed by an excluded...

  7. Ventilator graphics.

    Science.gov (United States)

    Prabhakaran, Priya; Sasser, William C; Kalra, Yuvrai; Rutledge, Chrystal; Tofil, Nancy M

    2016-12-01

    Providing optimal mechanical ventilation to critically-ill children remains a challenge. Patient-ventilator dyssynchrony results frequently with numerous deleterious consequences on patient outcome including increased requirement for sedation, prolonged duration of ventilation, and greater imposed work of breathing. Most currently used ventilators have real-time, continuously-displayed graphics of pressure, volume, and flow versus time (scalars) as well as pressure, and flow versus volume (loops). A clear understanding of these graphics provides a lot of information about the mechanics of the respiratory system and the patient ventilator interaction in a dynamic fashion. Using this information will facilitate tailoring the support provided and the manner in which it is provided to best suit the dynamic needs of the patient. This paper starts with a description of the scalars and loops followed by a discussion of the information that can be obtained from each of these graphics. A review will follow, on the common types of dyssynchronous interactions and how each of these can be detected on the ventilator graphics. The final section discusses how graphics can be used to optimize the ventilator support provided to patients.

  8. Healthcare Technology Management (HTM) of mechanical ventilators by clinical engineers.

    Science.gov (United States)

    Yoshioka, Jun; Nakane, Masaki; Kawamae, Kaneyuki

    2014-01-01

    Mechanical ventilator failures expose patients to unacceptable risks, and maintaining mechanical ventilator safety is an important issue. We examined the usefulness of maintaining mechanical ventilators by clinical engineers (CEs) using a specialized calibrator. These evaluations and the ability to make in-house repairs proved useful for obviating the need to rent ventilators which, in turn, might prove faulty themselves. The CEs' involvement in maintaining mechanical ventilators is desirable, ensures prompt service, and, most importantly, enhances safe management of mechanical ventilators.

  9. Mechanical Ventilation

    Science.gov (United States)

    ... cared for in a hospital’s intensive care unit (ICU). People who need a ventilator for a longer time may be in a regular unit of a hospital, a rehabilitation facility, or cared for at home. Why are ...

  10. ASME N511-19XX, Standard for periodic in-service testing of nuclear air treatment, heating, ventilating and air conditioning systems

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-08-01

    A draft version of the Standard is presented in this document. The Standard covers the requirements for periodic in-service testing of nuclear safety-related air treatment, heating, ventilating, and air conditioning systems in nuclear facilities. The Standard provides a basis for the development of test programs and does not include acceptance criteria, except in cases where the results of one test influence the performance of other tests. The Standard covers general inspection and test requirements, reference values, inspection and test requirements, generic tests, acceptance criteria, in-service test requirements, testing following an abnormal incident, corrective action requirements, and quality assurance. Mandatory appendices provide a visual inspection checklist and four test procedures. Non-mandatory appendices provide additional information and guidance on mounting frame pressure leak test procedure, corrective action, challenge gas substitute selection criteria, and test program development. 8 refs., 10 tabs.

  11. Personalized ventilation

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor

    2004-01-01

    The thermal environment and air quality in buildings affects occupants' health, comfort and performance. The heating, ventilating and air-conditioning (HVAC) of buildings today is designed to provide a uniform room environment. However, large individual differences exist between occupants in regard...... microenvironment. Furthermore, HVAC systems should be designed to protect occupants from airborne transmission of infectious agents that may be present in exhaled air. Personalized ventilation is a new development in the field of HVAC and has the potential to fulfill the above requirements. This paper reviews...... existing knowledge on performance of personalized ventilation (PV) and on human response to it. The airflow interaction in the vicinity of the human body is analyzed and its impact on thermal comfort and inhaled air quality is discussed together with control strategies and the application of PV in practice...

  12. Personalized ventilation.

    Science.gov (United States)

    Melikov, A K

    2004-01-01

    The thermal environment and air quality in buildings affects occupants' health, comfort and performance. The heating, ventilating and air-conditioning (HVAC) of buildings today is designed to provide a uniform room environment. However, large individual differences exist between occupants in regard to physiological and psychological response, clothing insulation, activity, air temperature and air movement preference, etc. Environmental conditions acceptable for most occupants in rooms may be achieved by providing each occupant with the possibility to generate and control his/her own preferred microenvironment. Furthermore, HVAC systems should be designed to protect occupants from airborne transmission of infectious agents that may be present in exhaled air. Personalized ventilation is a new development in the field of HVAC and has the potential to fulfill the above requirements. This paper reviews existing knowledge on performance of personalized ventilation (PV) and on human response to it. The airflow interaction in the vicinity of the human body is analyzed and its impact on thermal comfort and inhaled air quality is discussed together with control strategies and the application of PV in practice. Performance criteria are defined. Recommendations for design of PV that would be in compliance with the criteria are given. Future research needed on the topic is outlined. Personalized ventilation can improve occupants' comfort, decrease SBS symptoms and reduce the risk of transmission of contagion between occupants in comparison with total volume ventilation. However in order to perform efficiently in rooms in practice, the design (air distribution, control, etc.) has to be carefully considered together with type of occupant activity (occupancy rate, occupied density, etc.).

  13. Low-energy mechanical ventilation

    DEFF Research Database (Denmark)

    Andersen, Claus Wessel; Hviid, Christian Anker

    2014-01-01

    and with as little energy consumption as 41.1 kWh/m2/year including heating and all building services with no use of renewable energy such as PVcells or solar heating. One of the key means of reaching the objectives was to implement mechanical ventilation with low pressure loss and therefore low energy consumption....... The project consists of two buildings, building one is 6 stories high, and building two is 4 stories high. The buildings have a gross area of 50,500 m2 including underground parking. The ventilation and indoor climate concept was to use mechanical ventilation together with mechanical cooling and fanassisted......, with an average of 1.1 kJ/m3. The yearly mean SFP based on estimated runtime is approx. 0.8 kJ/m3. The case shows the unlocked potential that lies within mechanical ventilation for nearzero energy consuming buildings....

  14. Displacement Ventilation

    DEFF Research Database (Denmark)

    Bjørn, Erik; Mattsson, Magnus; Sandberg, Mats

    Full-scale experiments were made in a displacement ventilated room with two breathing thermal manikins to study the effect of movements and breathing on the vertical contaminant distribution, and on the personal exposure of occupants. Concentrations were measured with tracer gas equipment...... in the room and in the inhalation of both manikins. Tracer gas was added in the heat plume above a sitting manikin, or in the exhalation through either the nose or the mouth. The other manikin moved back and forth at different speeds on a low trolley. The mentioned experimental conditions have a significant...

  15. Kitchen ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Kelso, R.M. [Univ. of Tennessee, Knoxville, TN (United States). College of Architecture; Rousseau, C. [Newcomb and Boyd Consulting Engineers, Atlanta, GA (United States)

    1995-09-01

    Kitchen ventilation is a subject that has not received the attention that has been given to more glamorous HVAC and R topics. Consequently, its theoretical and technical development has not advanced like these topics. However, a group has been working within the ASHRAE Technical Committee (TC) and Task Group (TG) framework to correct this situation. The group is TG5.KV and it achieved TG status last year after starting as an informal group and then a sub-committee of TC9.8. One of its efforts has been to write a Handbook chapter, which will appear in the 1995 ASHRAE Handbook -- Applications. This article is a survey of that chapter.

  16. 75 FR 49528 - Freescale Semiconductor, Inc., Networking and Multimedia Group (“NMG”) Excluding the Multimedia...

    Science.gov (United States)

    2010-08-13

    ... Employment and Training Administration Freescale Semiconductor, Inc., Networking and Multimedia Group (``NMG'') Excluding the Multimedia Applications Division Including On- Site Leased Workers of Synergy Services..., applicable to workers of Freescale Semiconductor, Inc., Networking and Multimedia Group (``NMG''), excluding...

  17. Excluding interlopers from asteroid families

    Science.gov (United States)

    Novakovic, B.; Radovic, V.

    2014-07-01

    from AstDys database. Next, all family members that do not meet adopted criteria (based on physical and spectral characteristics) are excluded from the initial catalogue. Finally, the HCM analysis is performed again using the improved catalogue. Results: We apply this approach to the Themis family. In the first step the HCM links 3061 asteroids to the family. Among them we identify 113 potential interlopers. After removing interlopers, in the second run of the HCM, the total number of members has decreased to 2847. Thus, 101 extra objects have been excluded from the membership list (see Figure).

  18. 21 CFR 868.5955 - Intermittent mandatory ventilation attachment.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intermittent mandatory ventilation attachment. 868... SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5955 Intermittent mandatory ventilation attachment. (a) Identification. An intermittent mandatory ventilation (IMV) attachment...

  19. Variable mechanical ventilation

    Science.gov (United States)

    Fontela, Paula Caitano; Prestes, Renata Bernardy; Forgiarini Jr., Luiz Alberto; Friedman, Gilberto

    2017-01-01

    Objective To review the literature on the use of variable mechanical ventilation and the main outcomes of this technique. Methods Search, selection, and analysis of all original articles on variable ventilation, without restriction on the period of publication and language, available in the electronic databases LILACS, MEDLINE®, and PubMed, by searching the terms "variable ventilation" OR "noisy ventilation" OR "biologically variable ventilation". Results A total of 36 studies were selected. Of these, 24 were original studies, including 21 experimental studies and three clinical studies. Conclusion Several experimental studies reported the beneficial effects of distinct variable ventilation strategies on lung function using different models of lung injury and healthy lungs. Variable ventilation seems to be a viable strategy for improving gas exchange and respiratory mechanics and preventing lung injury associated with mechanical ventilation. However, further clinical studies are necessary to assess the potential of variable ventilation strategies for the clinical improvement of patients undergoing mechanical ventilation. PMID:28444076

  20. VENTILATION NEEDS DURING CONSTRUCTION

    Energy Technology Data Exchange (ETDEWEB)

    C.R. Gorrell

    1998-07-23

    The purpose of this analysis is to determine ventilation needs during construction and development of the subsurface repository and develop systems to satisfy those needs. For this analysis, construction is defined as pre-emplacement excavation and development is excavation that takes place simultaneously with emplacement. The three options presented in the ''Overall Development and Emplacement Ventilation Systems'' analysis (Reference 5.5) for development ventilation will be applied to construction ventilation in this analysis as well as adding new and updated ventilation factors to each option for both construction and development. The objective of this analysis is to develop a preferred ventilation system to support License Application Design. The scope of this analysis includes: (1) Description of ventilation conditions; (2) Ventilation factors (fire hazards, dust control, construction logistics, and monitoring and control systems); (3) Local ventilation alternatives; (4) Global ventilation options; and (5) Evaluation of options.

  1. Variable mechanical ventilation.

    Science.gov (United States)

    Fontela, Paula Caitano; Prestes, Renata Bernardy; Forgiarini, Luiz Alberto; Friedman, Gilberto

    2017-01-01

    To review the literature on the use of variable mechanical ventilation and the main outcomes of this technique. Search, selection, and analysis of all original articles on variable ventilation, without restriction on the period of publication and language, available in the electronic databases LILACS, MEDLINE®, and PubMed, by searching the terms "variable ventilation" OR "noisy ventilation" OR "biologically variable ventilation". A total of 36 studies were selected. Of these, 24 were original studies, including 21 experimental studies and three clinical studies. Several experimental studies reported the beneficial effects of distinct variable ventilation strategies on lung function using different models of lung injury and healthy lungs. Variable ventilation seems to be a viable strategy for improving gas exchange and respiratory mechanics and preventing lung injury associated with mechanical ventilation. However, further clinical studies are necessary to assess the potential of variable ventilation strategies for the clinical improvement of patients undergoing mechanical ventilation.

  2. Variable mechanical ventilation

    OpenAIRE

    Fontela, Paula Caitano; Prestes, Renata Bernardy; Forgiarini Jr.,Luiz Alberto; Friedman, Gilberto

    2017-01-01

    Objective To review the literature on the use of variable mechanical ventilation and the main outcomes of this technique. Methods Search, selection, and analysis of all original articles on variable ventilation, without restriction on the period of publication and language, available in the electronic databases LILACS, MEDLINE?, and PubMed, by searching the terms "variable ventilation" OR "noisy ventilation" OR "biologically variable ventilation". Results A total of 36 studies were selected. ...

  3. The reality of patients requiring prolonged mechanical ventilation: a multicenter study.

    Science.gov (United States)

    Loss, Sérgio Henrique; de Oliveira, Roselaine Pinheiro; Maccari, Juçara Gasparetto; Savi, Augusto; Boniatti, Marcio Manozzo; Hetzel, Márcio Pereira; Dallegrave, Daniele Munaretto; Balzano, Patrícia de Campos; Oliveira, Eubrando Silvestre; Höher, Jorge Amilton; Torelly, André Peretti; Teixeira, Cassiano

    2015-01-01

    The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.

  4. 26 CFR 1.410(b)-6 - Excludable employees.

    Science.gov (United States)

    2010-04-01

    ... section 861(a)(3)) is treated as an excludable employee. (2) Special treaty rule. In addition, an employee... year (for purposes of this paragraph (f)(1)(v), a plan that uses the elapsed time method of determining... provided for such term by 29 CFR 2530.200b-2 under the general method of crediting service for the employee...

  5. Variation in Definition of Prolonged Mechanical Ventilation.

    Science.gov (United States)

    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

  6. Ventilator associated pneumonia or ventilator induced pneumonia.

    Science.gov (United States)

    Khan, Zahid Hussain; Ceriana, Piero; Donner, Claudio F

    2017-01-01

    Ventilator associated pneumonia currently in vogue seems to have some pitfalls as far as the nomenclature is concerned and thus it imparts an erroneous impression to the reader. As the driving force is in fact the ventilator, the phraseology should preferably be changed to ventilator induced pneumonia to convey the in depth meaning of the term thus evading the terminology currently in practice. A new and emerging paradigm dealing with all side effects of mechanical ventilation can be helpful to solve this etymological conflict.

  7. Patient-Ventilator Dyssynchrony

    Directory of Open Access Journals (Sweden)

    Elvira-Markela Antonogiannaki

    2017-11-01

    Full Text Available In mechanically ventilated patients, assisted mechanical ventilation (MV is employed early, following the acute phase of critical illness, in order to eliminate the detrimental effects of controlled MV, most notably the development of ventilator-induced diaphragmatic dysfunction. Nevertheless, the benefits of assisted MV are often counteracted by the development of patient-ventilator dyssynchrony. Patient-ventilator dyssynchrony occurs when either the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration, respectively, or if the magnitude of mechanical assist does not respond to the patient’s respiratory demand. As patient-ventilator dyssynchrony has been associated with several adverse effects and can adversely influence patient outcome, every effort should be made to recognize and correct this occurrence at bedside. To detect patient-ventilator dyssynchronies, the physician should assess patient comfort and carefully inspect the pressure- and flow-time waveforms, available on the ventilator screen of all modern ventilators. Modern ventilators offer several modifiable settings to improve patient-ventilator interaction. New proportional modes of ventilation are also very helpful in improving patient-ventilator interaction.

  8. Mechanical ventilator - infants

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007240.htm Mechanical ventilator - infants To use the sharing features on this page, please enable JavaScript. A mechanical ventilator is a machine that assists with breathing. ...

  9. Diffuse ceiling ventilation

    DEFF Research Database (Denmark)

    Zhang, Chen

    Diffuse ceiling ventilation is an innovative ventilation concept where the suspended ceiling serves as air diffuser to supply fresh air into the room. Compared with conventional ventilation systems, diffuse ceiling ventilation can significantly reduce or even eliminate draught risk due to the low...... momentum supply. In addition, this ventilation system uses a ceiling plenum to deliver air and requires less energy consumption for air transport than full-ducted systems. There is a growing interest in applying diffuse ceiling ventilation in offices and other commercial buildings due to the benefits from...... both thermal comfort and energy efficient aspects. The present study aims to characterize the air distribution and thermal comfort in the rooms with diffuse ceiling ventilation. Both the stand-alone ventilation system and its integration with a radiant ceiling system are investigated. This study also...

  10. 7 CFR 58.137 - Excluded milk.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Excluded milk. 58.137 Section 58.137 Agriculture... Milk § 58.137 Excluded milk. A plant shall not accept milk from a producer if: (a) The milk has been in...) Three of the last five milk samples have exceeded the maximum bacterial estimate of 500,000 per ml...

  11. AFSC/ABL: 2009 Chinook Excluder Samples

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This project genetically analyzed 1,620 chinook salmon samples from the 2009 spring salmon excluder device test. These samples were collected over a short period of...

  12. Complications of mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Drašković Biljana

    2011-01-01

    Full Text Available Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into: 1 airway-associated complications; 2 complications in the response of patients to mechanical ventilation; and 3 complications related to the patient’s response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient’s response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma, it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma and may cause subtle damages due to the activation of inflammatory processes (biotrauma. Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by health-care workers.

  13. Design Principles for Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per

    For many years mechanical and natural ventilation systems have developed separately. Naturally, the next step in this development is the development of ventilation concepts that utilize and combine the best features from each system to create a new type of ventilation system -Hybrid Ventilation. ....... The hybrid ventilation concepts, design challenges and - principles are discussed and illustrated by four building examples....

  14. Mechanical ventilation in children.

    Science.gov (United States)

    Kendirli, Tanil; Kavaz, Asli; Yalaki, Zahide; Oztürk Hişmi, Burcu; Derelli, Emel; Ince, Erdal

    2006-01-01

    Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. Ninety-one patients (22.3%) were treated with mechanical ventilation. Ages of all patients were between 1-180 (median: 8) months. The mechanical ventilation time was 18.8 +/- 14.1 days. Indication of mechanical ventilation could be divided into four groups as respiratory failure (64.8%), cardiovascular failure (19.7%), central nervous system disease (9.8%) and safety airway (5.4%). Tracheostomy was performed in four patients. The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated.

  15. Natural Ventilation in Atria

    DEFF Research Database (Denmark)

    Svidt, Kjeld; Heiselberg, Per; Hendriksen, Ole Juhl

    This case study comprises a monitoring programme as well as a Computational Fluid Dynamics (CFD) analysis of a natural ventilated atrium. The purpose has been to analyse the performance of a typical natural ventilation system in Denmark under both summer and winter conditions.......This case study comprises a monitoring programme as well as a Computational Fluid Dynamics (CFD) analysis of a natural ventilated atrium. The purpose has been to analyse the performance of a typical natural ventilation system in Denmark under both summer and winter conditions....

  16. What is the Right to Exclude Immigrants?

    DEFF Research Database (Denmark)

    Lægaard, Sune

    2010-01-01

    of states. The right to exclude claimed by states is analysed and it is shown to differ both conceptually and normatively from rights to impose political authority within a territory. The paper finally indicates how this analysis might broaden the focus of debates about immigration and suggest alternative......It is normally taken for granted that states have a right to control immigration into their territory. When immigration is raised as a normative issue two questions become salient, one about what the right to exclude is, and one about whether and how it might be justified. This paper considers...... the first question. The paper starts by noting that standard debates about immigration have not addressed what the right to exclude is. Standard debates about immigration furthermore tend to result either in fairly strong cases for open borders or in denials that considerations of justice apply...

  17. Polyelectrolyte solutions: Excluded-volume considerations

    Science.gov (United States)

    Mattoussi, Hedi; Karasz, Frank E.

    1993-12-01

    We provide experimental evidence for the electrostatically related excluded-volume effects on the colligative properties and the single chain behavior of polyelectrolyte solutions in the dilute regime. The data are compared to the theory developed by Fixman, Skolnick, Odijk, and Houwaart. Good agreement between these theoretical considerations and the experimental data is observed.

  18. 21 CFR 1308.22 - Excluded substances.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Excluded substances. 1308.22 Section 1308.22 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE SCHEDULES OF CONTROLLED SUBSTANCES... may, under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301), be lawfully sold over the counter...

  19. VENTILATION MODEL REPORT

    Energy Technology Data Exchange (ETDEWEB)

    V. Chipman

    2002-10-31

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their postclosure analyses.

  20. 42 CFR 411.15 - Particular services excluded from coverage.

    Science.gov (United States)

    2010-10-01

    ... agencies, or other third parties. (b) Low vision aid exclusion—(1) Scope. The scope of the eyeglass... or more lens to aid vision or provide magnification of images for impaired vision. (2) Exceptions. (i... dental) that replace all or part of an internal body organ (for example, intraocular lenses); artificial...

  1. Ventilation rates and health

    DEFF Research Database (Denmark)

    Sundell, Jan; Levin, H; Nazaroff, W W

    2011-01-01

    The scientific literature through 2005 on the effects of ventilation rates on health in indoor environments has been reviewed by a multidisciplinary group. The group judged 27 papers published in peer-reviewed scientific journals as providing sufficient information on both ventilation rates...... and health effects to inform the relationship. Consistency was found across multiple investigations and different epidemiologic designs for different populations. Multiple health endpoints show similar relationships with ventilation rate. There is biological plausibility for an association of health outcomes...... studies of the relationship between ventilation rates and health, especially in diverse climates, in locations with polluted outdoor air and in buildings other than offices. PRACTICAL IMPLICATIONS: Ventilation with outdoor air plays an important role influencing human exposures to indoor pollutants...

  2. 9 CFR 354.226 - Lighting and ventilation.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Lighting and ventilation. 354.226 Section 354.226 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE... Facilities § 354.226 Lighting and ventilation. There shall be ample light, either natural or artificial or...

  3. Ventilator waveform interpretation in mechanically ventilated small animals.

    Science.gov (United States)

    Corona, Terry M; Aumann, Marcel

    2011-10-01

    To review the topic of ventilator waveforms analysis with emphasis on interpretation of ventilator waveforms and their use in the management and monitoring of mechanically ventilated small animal patients. Human clinical studies, scientific reviews, and textbooks, as well as veterinary textbooks and clinical examples of ventilator waveforms in mechanically ventilated dogs. Ventilator waveforms are graphic representations of data collected from the ventilator and reflect patient-ventilator interactions. The 4 parameters pressure, volume, flow, and time are most descriptive of mechanical ventilation. Typically, 3 different graphs, also referred to as scalars, consisting of pressure versus time, volume versus time, and flow versus time, with time always plotted on the x-axis, are used. Changes in the ventilator settings as well as in the characteristics of the lungs such as airway resistance (R(aw)) and respiratory system compliance (C(rs)) can be recognized from specific variations in the waveforms. Flow-volume and pressure-volume loops provide additional information about changes in lung function. Patient-ventilator dyssynchrony is a common problem during mechanical ventilation and can lead to patient discomfort and an increased work of breathing. Ventilator waveforms are helpful to identify dyssynchrony, which can be divided into trigger, flow, cycle, and expiratory dyssynchrony. Ventilator waveforms allow the clinician to assess changes in respiratory mechanics, and can be useful in monitoring the progression of disease pathology and response to therapy. Adjustments in ventilator settings based on proper analysis and interpretation of these waveforms can help the clinician to optimize ventilation therapy. Ventilator waveforms are graphic representations of patient-ventilator interactions. Proper interpretation of ventilator waveforms affords the critical care clinician a better understanding of the patient's respiratory function, response to therapy, and causes

  4. NNDSS - Table II. Salmonellosis (excluding typhoid fever and paratyphoid fever) to Shigellosis

    Data.gov (United States)

    U.S. Department of Health & Human Services — NNDSS - Table II. Salmonellosis (excluding typhoid fever and paratyphoid fever) to Shigellosis - 2018. In this Table, provisional cases of selected notifiable...

  5. Mechanical Ventilation Antioxidant Trial.

    Science.gov (United States)

    Howe, Kimberly P; Clochesy, John M; Goldstein, Lawrence S; Owen, Hugh

    2015-09-01

    Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation. To test the clinical effectiveness of antioxidant supplementation in reducing the duration of mechanical ventilation. A randomized, prospective, placebo-controlled double-blind design was used to test whether enterally administered antioxidant supplementation would decrease the duration of mechanical ventilation, all-cause mortality, and length of stay in the intensive care unit and hospital. Patients received vitamin C 1000 mg plus vitamin E 1000 IU, vitamin C 1000 mg plus vitamin E 1000 IU plus N-acetylcysteine 400 mg, or placebo solution as a bolus injection via their enteral feeding tube every 8 hours. Clinical and statistically significant differences in duration of mechanical ventilation were seen among the 3 groups (Mantel-Cox log rank statistic = 5.69, df = 1, P = .017). The 3 groups did not differ significantly in all-cause mortality during hospitalization or in the length of stay in the intensive care unit or hospital. Enteral administration of antioxidants is a simple, safe, inexpensive, and effective intervention that decreases the duration of mechanical ventilation in critically ill adults. ©2015 American Association of Critical-Care Nurses.

  6. Clean Water Act (excluding Section 404)

    Energy Technology Data Exchange (ETDEWEB)

    1993-01-15

    This Reference Book contains a current copy of the Clean Water Act (excluding Section 404) and those regulations that implement the statutes and appear to be most relevant to US Department of Energy (DOE) activities. The document is provided to DOE and contractor staff for informational purposes only and should not be interpreted as legal guidance. Updates that include important new requirements will be provided periodically. Questions concerning this Reference Book may be directed to Mark Petts, EH-231 (202/586-2609).

  7. Chaos in Ocean Ventilation

    Science.gov (United States)

    MacGilchrist, G. A.; Marshall, D. P.; Johnson, H. L.; Lique, C.; Thomas, M. D.

    2016-02-01

    Ventilation of the subtropical ocean is important for setting the ocean stratification, the oceanic cycling of biogeochemical elements and the storage of carbon dioxide and heat on inter-annual to decadal timescales. In the textbook view, subtropical ocean ventilation is achieved through advection by the time-mean gyre circulation, with fluid parcels moving along sloping density surfaces into the ocean interior. At the same time, it is well accepted that the ocean circulation is highly nonlinear, with the kinetic energy budget dominated by mesoscale eddies. Consequently, ventilated fluid parcels, rather than remaining coherent as they move into the ocean interior, will be rapidly strained and stirred into surrounding water. To investigate the role of this nonlinear circulation in the ventilation process, we calculate a non-dimensional `filamentation number' - the ratio of the Lagrangian ventilation timescale and the timescale of strain by the nonlinear flow - across two density surfaces in the subtropical North Atlantic in an ocean circulation model. This number predicts the filament width of a ventilated fluid parcel, and is found to be large across both density surfaces (indicating small filament width), particularly on the deeper surface. A Lagrangian mapping from distributions of particles to the year in which they were ventilated is thus shown to be highly chaotic, with particles located side-by-side having been ventilated decades apart, even where the density surface is close to the ocean surface. This novel Lagrangian approach avoids the loss of information through diffusion, and emphasises the importance of mesoscale eddies in the ventilation of the subtropical ocean.

  8. Diffuse Ceiling Ventilation

    DEFF Research Database (Denmark)

    Zhang, Chen; Yu, Tao; Heiselberg, Per Kvols

    -cooling period and night cooling potential. The investment cost of this ventilation system is about 5-10% lower than the conventional ones, because the acoustic ceiling could be directly applied as air diffuser and the use of plenum to distribute air reduces the cost of ductwork. There is a growing interest...... in applying diffuse ceiling ventilation in offices and other commercial buildings because of the benefits from both thermal comfort and energy efficiency aspects. The design guide introduces the principle and key characteristics of room air distribution with diffuse ceiling ventilation and the design...

  9. Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia.

    Science.gov (United States)

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

    2017-03-01

    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. 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. Noninvasive ventilation versus invasive mechanical ventilation. 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). 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

  10. Assessment of pulmonary ventilation scans using xenon-127 in the diagnosis of pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Rowe, I.F.; Sleight, P.J.; Gaunt, J.I.; Croft, D.N.

    1984-03-01

    Pulmonary ventilation scans using /sup 127/Xe were compared with scans using /sup 133/Xe in the diagnosis of pulmonary embolism. A perfusion scan using sup(99m)Tc-microspheres and ventilation scans with each of the xenon isotopes were performed on 44 patients referred for lung scanning to confirm or exclude a suspected clinical diagnosis of pulmonary embolism. No significant difference was found in the frequency of diagnosis of pulmonary embolism when comparing each of the ventilation scans with the corresponding perfusion scan. For reasons discussed, /sup 127/Xe may be more useful than /sup 133/Xe for pulmonary ventilation scanning.

  11. What Is a Ventilator?

    Science.gov (United States)

    ... who are on ventilators for shorter periods. The advantage of this tube is that it can be ... Privacy Policy Freedom of Information Act (FOIA) Accessibility Copyright and Usage No FEAR Act Grants and Funding ...

  12. Why We Ventilate

    Energy Technology Data Exchange (ETDEWEB)

    Logue, Jennifer M.; Sherman, Max H.; Price, Phil N.; Singer, Brett C.

    2011-09-01

    It is widely accepted that ventilation is critical for providing good indoor air quality (IAQ) in homes. However, the definition of"good" IAQ, and the most effective, energy efficient methods for delivering it are still matters of research and debate. This paper presents the results of work done at the Lawrence Berkeley National Lab to identify the air pollutants that drive the need for ventilation as part of a larger effort to develop a health-based ventilation standard. First, we present results of a hazard analysis that identified the pollutants that most commonly reach concentrations in homes that exceed health-based standards or guidelines for chronic or acute exposures. Second, we present results of an impact assessment that identified the air pollutants that cause the most harm to the U.S. population from chronic inhalation in residences. Lastly, we describe the implications of our findings for developing effective ventilation standards.

  13. Diffuse Ceiling Ventilation

    DEFF Research Database (Denmark)

    Zhang, Chen; Heiselberg, Per; Nielsen, Peter V.

    2014-01-01

    As a novel air distribution system, diffuse ceiling ventilation combines the suspended acoustic ceiling with ventilation supply. Due to the low-impulse supply from the large ceiling area, the system does not generate draught when supplying cold air. However, heat sources play an important role on...... temperature as well as optimizing the radiant cooling potential by combining with thermal mass is conducted and gives a direction for further investigation....

  14. Conventional mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Tobias Joseph

    2010-01-01

    Full Text Available The provision of mechanical ventilation for the support of infants and children with respiratory failure or insufficiency is one of the most common techniques that are performed in the Pediatric Intensive Care Unit (PICU. Despite its widespread application in the PICUs of the 21st century, before the 1930s, respiratory failure was uniformly fatal due to the lack of equipment and techniques for airway management and ventilatory support. The operating rooms of the 1950s and 1960s provided the arena for the development of the manual skills and the refinement of the equipment needed for airway management, which subsequently led to the more widespread use of endotracheal intubation thereby ushering in the era of positive pressure ventilation. Although there seems to be an ever increasing complexity in the techniques of mechanical ventilation, its successful use in the PICU should be guided by the basic principles of gas exchange and the physiology of respiratory function. With an understanding of these key concepts and the use of basic concepts of mechanical ventilation, this technique can be successfully applied in both the PICU and the operating room. This article reviews the basic physiology of gas exchange, principles of pulmonary physiology, and the concepts of mechanical ventilation to provide an overview of the knowledge required for the provision of conventional mechanical ventilation in various clinical arenas.

  15. Triggering of the ventilator in patient-ventilator interactions.

    Science.gov (United States)

    Sassoon, Catherine Sh

    2011-01-01

    With current ventilator triggering design, in initiating ventilator breaths patient effort is only a small fraction of the total effort expended to overcome the inspiratory load. Similarly, advances in ventilator pressure or flow delivery and inspiratory flow termination improve patient effort or inspiratory muscle work during mechanical ventilation. Yet refinements in ventilator design do not necessarily allow optimal patient-ventilator interactions, as the clinician is key in managing patient factors and selecting appropriate ventilator factors to maintain patient-ventilator synchrony. In patient-ventilator interactions, unmatched patient flow demand by ventilator flow delivery results in flow asynchrony, whereas mismatches between mechanical inspiratory time (mechanical T(I)) and neural T(I) produce timing asynchrony. Wasted efforts are an example of timing asynchrony. In the triggering phase, trigger thresholds that are set too high or the type of triggering methods induces wasted efforts. Wasted efforts can be aggravated by respiratory muscle weakness or other conditions that reduce respiratory drive. In the post-triggering phase, ventilator factors play an important role in patient-ventilator interaction; this role includes the assistance level, set inspiratory flow rate, T(I), pressurization rate, and cycling-off threshold, and to some extent, applied PEEP. This paper proposes an algorithm that clinicians can use to adjust ventilator settings with the goal to eliminate or reduce patients' wasted efforts.

  16. Queueing process with excluded-volume effect.

    Science.gov (United States)

    Arita, Chikashi

    2009-11-01

    We introduce an extension of the M/M/1 queueing process with a spatial structure and excluded-volume effect. The rule of particle hopping is the same as for the totally asymmetric simple exclusion process (TASEP). A stationary-state solution is constructed in a slightly arranged matrix product form of the open TASEP. We obtain the critical line that separates the parameter space depending on whether the model has the stationary state. We calculate the average length of the model and the number of particles and show the monotonicity of the probability of the length in the stationary state. We also consider a generalization of the model with backward hopping of particles allowed and an alternate joined system of the M/M/1 queueing process and the open TASEP.

  17. 34 CFR 85.950 - Excluded Parties List System

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Excluded Parties List System 85.950 Section 85.950... (NONPROCUREMENT) Definitions § 85.950 Excluded Parties List System Excluded Parties List System (EPLS) means the... entitled, “List of Parties Excluded or Disqualified from Federal Procurement and Nonprocurement Programs...

  18. 26 CFR 1.401(a)(26)-6 - Excludable employees.

    Science.gov (United States)

    2010-04-01

    ... nonresident aliens) may be treated as an excludable employee. (ii) Special treaty rule. In addition, an...), a plan that uses the elapsed time method of determining years of service may use either 91... general method of crediting service for the employee. If one of the equivalencies set forth in 29 CFR 2530...

  19. Mechanical ventilation strategies.

    Science.gov (United States)

    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.

  20. CFD and Ventilation Research

    DEFF Research Database (Denmark)

    Li, Y.; Nielsen, Peter V.

    2011-01-01

    There has been a rapid growth of scientific literature on the application of computational fluid dynamics (CFD) in the research of ventilation and indoor air science. With a 1000–10,000 times increase in computer hardware capability in the past 20 years, CFD has become an integral part...... of scientific research and engineering development of complex air distribution and ventilation systems in buildings. This review discusses the major and specific challenges of CFD in terms of turbulence modelling, numerical approximation, and boundary conditions relevant to building ventilation. We emphasize...... the growing need for CFD verification and validation, suggest on-going needs for analytical and experimental methods to support the numerical solutions, and discuss the growing capacity of CFD in opening up new research areas. We suggest that CFD has not become a replacement for experiment and theoretical...

  1. Effects of Volume Guaranteed Ventilation Combined with Two Different Modes in Preterm Infants.

    Science.gov (United States)

    Unal, Sezin; Ergenekon, Ebru; Aktas, Selma; Altuntas, Nilgun; Beken, Serdar; Kazanci, Ebru; Kulali, Ferit; Gulbahar, Ozlem; Hirfanoglu, Ibrahim M; Onal, Esra; Turkyilmaz, Canan; Koc, Esin; Atalay, Yildiz

    2017-07-11

    Volume-controlled ventilation modes have been shown to reduce duration of mechanical ventilation, incidence of chronic lung disease, failure of primary mode of ventilation, hypocarbia, severe intraventricular hemorrhage, pneumothorax, and periventricular leukomalacia in preterm infants when compared with pressure limited ventilation modes. Volume-guarantee (VG) ventilation is the most commonly used mode for volume-controlled ventilation. Assist control, pressure-support ventilation (PSV), and synchronized intermittent mandatory ventilation (SIMV) can be combined with VG; however, there is a lack of knowledge on the superiority of each regarding clinical outcomes. Therefore, we investigated the effects of SIMV+VG and PSV+VG on ventilatory parameters, pulmonary inflammation, morbidity, and mortality in preterm infants. Preterm infants who were born in our hospital between 24-32 weeks gestation and needed mechanical ventilation for respiratory distress syndrome were considered eligible. Patients requiring high-frequency oscillatory ventilation for primary treatment were excluded. Subjects were randomized to either SIMV+VG or PSV+VG. Continuously recorded ventilatory parameters, clinical data, blood gas values, and tracheal aspirate cytokine levels were analyzed. The study enrolled 42 subjects. Clinical data were similar between groups. PSV+VG delivered closer tidal volumes to set tidal volumes (60% vs 49%, P = .02). Clinical data, including days on ventilation, morbidity, and mortality, were similar between groups. Chronic lung disease occurred less often and heart rate was lower in subjects who were ventilated with PSV+VG. The incidence of hypocarbia and hypercarbia were similar. Interleukin-β in the tracheal aspirates increased during both modes. PSV+VG provided closer tidal volumes to the set value in ventilated preterm infants with respiratory distress syndrome and was not associated with overventilation or a difference in mortality or morbidity when compared to

  2. Ventilation with heat recovery

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.; Svendsen, Svend

    2005-01-01

    This paper presents the experiences from the use of ventilation with heat recovery in several experimental single-family houses developed and built within the last four years to meet the new Danish energy requirements of 2005. Included are descriptions of the ventilation system components...... and the main functional demands as well as measurements of the thermal efficiency, electricity consumptions and building air tightness. The paper addresses the aspects of minimizing the heat loss from the duct system and the heat recovery unit (when placed in an unheated attic space) in order to obtain...

  3. Meeting Residential Ventilation Standards Through Dynamic Control of Ventilation Systems

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.; Walker, Iain S.

    2011-04-01

    Existing ventilation standards, including American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE) Standard 62.2, specify continuous operation of a defined mechanical ventilation system to provide minimum ventilation, with time-based intermittent operation as an option. This requirement ignores several factors and concerns including: other equipment such as household exhaust fans that might incidentally provide ventilation, negative impacts of ventilation when outdoor pollutant levels are high, the importance of minimizing energy use particularly during times of peak electricity demand, and how the energy used to condition air as part of ventilation system operation changes with outdoor conditions. Dynamic control of ventilation systems can provide ventilation equivalent to or better than what is required by standards while minimizing energy costs and can also add value by shifting load during peak times and reducing intake of outdoor air contaminants. This article describes the logic that enables dynamic control of whole-house ventilation systems to meet the intent of ventilation standards and demonstrates the dynamic ventilation system control concept through simulations and field tests of the Residential Integrated Ventilation-Energy Controller (RIVEC).

  4. [Treatment of adenomyosis (excluding pregnancy project)].

    Science.gov (United States)

    Pelage, L; Fenomanana, S; Brun, J-L; Levaillant, J-M; Fernandez, H

    2015-05-01

    In this review we aimed to update the possibilities of adenomyosis treatment in women excluding those with a desire for pregnancy. Adenomyosis is defined as the presence of endometrial tissue within the myometrium and frequently underestimated. Over the last decades, its pathophysiology has been better known. The diagnosis is essentially based on clinical symptoms like menorrhagia and dysmenorrhea. Transvaginal ultrasound and magnetic resonance imaging are the main tools of the radiologic diagnosis. However, the definitive diagnosis is histological. The most effective treatment remains hysterectomy; however it is expensive, radical and at risk of morbidity compared with medical or surgical conservative management. The literature has reported several series of patients undergoing various treatments, thus allowing different therapeutic options. The levonorgestrel-releasing intrauterine device showed its efficacy alone or in combination with hysteroscopic treatment. Oral progestins, GnRH agonists are useful at short term or in preoperative condition. Some conservative treatments like focused ultrasound therapies or uterus-sparing operative treatment stay under evaluation and seems to be effective. Embolization has been the subject of several studies and must be outlined. Furthermore, several molecules, such as modulators of progesterone receptors and the aromatase inhibitors have been recently studied and are perhaps future treatments. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  5. Neutron resonance data exclude random matrix theory

    Science.gov (United States)

    Koehler, P. E.; Bečvář, F.; Krtička, M.; Guber, K. H.; Ullmann, J. L.

    2013-02-01

    Almost since the time it was formulated, the overwhelming consensus has been that random matrix theory (RMT) is in excellent agreement with neutron resonance data. However, over the past few years, we have obtained new neutron-width data at Oak Ridge and Los Alamos National Laboratories that are in stark disagreement with this theory. We also have reanalyzed neutron widths in the most famous data set, the nuclear data ensemble (NDE), and found that it is seriously flawed, and, when analyzed carefully, excludes RMT with high confidence. More recently, we carefully examined energy spacings for these same resonances in the NDE using the $\\Delta_{3}$ statistic. We conclude that the data can be found to either confirm or refute the theory depending on which nuclides and whether known or suspected p-wave resonances are included in the analysis, in essence confirming results of our neutron-width analysis of the NDE. We also have examined radiation widths resulting from our Oak Ridge and Los Alamos measurements, and find that in some cases they do not agree with RMT. Although these disagreements presently are not understood, they could have broad impact on basic and applied nuclear physics, from nuclear astrophysics to nuclear criticality safety.

  6. Neutron resonance data exclude random matrix theory

    Energy Technology Data Exchange (ETDEWEB)

    Koehler, P.E. [Physics Division, Oak Ridge National Laboratory, MailStop 6356, Oak Ridge, Tennessee 37831 (United States); Becvar, F.; Krticka, M. [Charles University, Faculty of Mathematics and Physics, 180 00 Prague 8 (Czech Republic); Guber, K.H. [Reactor and Nuclear Systems Division, Oak Ridge National Laboratory, Mail Stop 6356, Oak Ridge, Tennessee 37831 (United States); Ullmann, J.L. [Los Alamos National Laboratory, Los Alamos, New Mexico 87545 (United States)

    2013-02-15

    Almost since the time it was formulated, the overwhelming consensus has been that random matrix theory (RMT) is in excellent agreement with neutron resonance data. However, over the past few years, we have obtained new neutron-width data at Oak Ridge and Los Alamos National Laboratories that are in stark disagreement with this theory. We also have reanalyzed neutron widths in the most famous data set, the nuclear data ensemble (NDE), and found that it is seriously flawed, and, when analyzed carefully, excludes RMT with high confidence. More recently, we carefully examined energy spacings for these same resonances in the NDE using the {Delta}{sub 3} statistic. We conclude that the data can be found to either confirm or refute the theory depending on which nuclides and whether known or suspected p-wave resonances are included in the analysis, in essence confirming results of our neutron-width analysis of the NDE. We also have examined radiation widths resulting from our Oak Ridge and Los Alamos measurements, and find that in some cases they do not agree with RMT. Although these disagreements presently are not understood, they could have broad impact on basic and applied nuclear physics, from nuclear astrophysics to nuclear criticality safety. (Copyright copyright 2013 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  7. Hybrid Ventilation Air Flow Process

    DEFF Research Database (Denmark)

    Heiselberg, Per Kvols

    The scope of this annex is therefore to obtain better knowledge of the use of hybrid ventilation technologies. The annex focus on development of control strategies for hybrid ventilation, on development of methods to predict hybrid ventilation performance in office buildings and on implementation...

  8. Ventilation Criteria for Aeromedical Evacuation.

    Science.gov (United States)

    1986-09-01

    number) FIELD GROUP i SUB-GROUP Aeromedical evacuation; Ventilatory requirements; 06 11 06 12 iAir evacuation; and Mechanical ventilation . 19...ABSTRACT (Continue on reverse if necessary and identify by block number) -., fr evacLation of patients requiring mechanical ventilation exposes these...reasonably stable from a medical standpoint; none required mechanical ventilation . Unfortunately, we find no .- , studies that describe the

  9. The amazing Minivent ventilator

    African Journals Online (AJOL)

    TYYCVNCi2nM. Acknowledgements – The authors wish to thank Dr Christine Ball for the photograph of Dr Cohen and Dr Cohen for providing them with the last Minivent ventilator in his possession. It is still functioning and may be seen in the Nagin ...

  10. Measure Guideline: Ventilation Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Springer, D.; Dakin, B.; German, A.

    2012-04-01

    The purpose of this measure guideline on ventilation cooling is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  11. Understanding mechanical ventilators.

    Science.gov (United States)

    Chatburn, Robert L

    2010-12-01

    The respiratory care academic community has not yet adopted a standardized system for classifying and describing modes of ventilation. As a result, there is enough confusion that patient care, clinician education and even ventilator sales are all put at risk. This article summarizes a ventilator mode taxonomy that has been extensively published over the last 15 years. Specifically, the classification system has three components: a description of the control variables within breath; a description of the sequence of mandatory and spontaneous breaths; and a specification for the targeting scheme. This three-level specification provides scalability of detail to make the mode description appropriate for the particular need. At the bedside, we need only refer to a mode briefly using the first or perhaps first and second components. To distinguish between similar modes and brand names, we would need to include all components. This taxonomy uses the equation of motion for the respiratory system as the underlying theoretical framework. All terms relevant to describing modes of mechanical ventilation are defined in an extensive appendix.

  12. Mechanical ventilation of mice

    NARCIS (Netherlands)

    Schwarte, L. A.; Zuurbier, C. J.; Ince, C.

    2000-01-01

    Due to growing interest in murine functional genomics research, there is an increasing need for physiological stable in vivo murine models. Of special importance is support and control of ventilation by artificial respiration, which is difficult to execute as a consequence of the small size of the

  13. Ventilation for Free

    NARCIS (Netherlands)

    Scholten, R.D.; Ter Haar, J.

    2014-01-01

    This "designers' manual" is made during the TIDO-course AR0533 Innovation & Sustainability. The goal of this manual is to give a clear and simple overview of some of the possibilities for using natural ventilation in buildings. These systems are described through their formulas to give an idea of

  14. Elforbrug til mekanisk ventilation

    DEFF Research Database (Denmark)

    Olufsen, P.

    I Energi 2000 er ventilationsområdet udpeget som et af de områder, hvor der bør tages initiativ til at fremme elbesparelser. I rapporten beskrives og analyseres målinger af elforbruget til ventilation i 12 bygninger, der alle anvendes til administration eller lignende formål. På grundlag af...

  15. Home mechanical ventilation in Canada: a national survey.

    Science.gov (United States)

    Rose, Louise; McKim, Douglas A; Katz, Sherri L; Leasa, David; Nonoyama, Mika; Pedersen, Cheryl; Goldstein, Roger S; Road, Jeremy D

    2015-05-01

    No comprehensive Canadian national data describe the prevalence of and service provision for ventilator-assisted individuals living at home, data critical to health-care system planning for appropriate resourcing. Our objective was to generate national data profiling service providers, users, types of services, criteria for initiation and monitoring, ventilator servicing arrangements, education, and barriers to home transition. Eligible providers delivering services to ventilator-assisted individuals (adult and pediatric) living at home were identified by our national provider inventory and referrals from other providers. The survey was administered via a web link from August 2012 to April 2013. The survey response rate was 152/171 (89%). We identified 4,334 ventilator-assisted individuals: an estimated prevalence of 12.9/100,000 population, with 73% receiving noninvasive ventilation (NIV) and 18% receiving intermittent mandatory ventilation (9% not reported). Services were delivered by 39 institutional providers and 113 community providers. We identified variation in initiation criteria for NIV, with polysomnography demonstrating nocturnal hypoventilation (57%), daytime hypercapnia (38%), and nocturnal hypercapnia (32%) as the most common criteria. Various models of ventilator servicing were reported. Most providers (64%) stated that caregiver competency was a prerequisite for home discharge; however, repeated competency assessment and retraining were offered by only 45%. Important barriers to home transition were: insufficient funding for paid caregivers, equipment, and supplies; a shortage of paid caregivers; and negotiating public funding arrangements. Ventilatory support in the community appears well-established, with most individuals managed with NIV. Although caregiver competency is a prerequisite to discharge, ongoing assessment and retraining were infrequent. Funding and caregiver availability were important barriers to home transition. Copyright © 2015

  16. Patient-ventilator dyssynchrony during assisted invasive mechanical ventilation.

    Science.gov (United States)

    Murias, G; Villagra, A; Blanch, L

    2013-04-01

    Patient-ventilator dyssynchrony is common during mechanical ventilation. Dyssynchrony decreases comfort, prolongs mechanical ventilation and intensive care unit stays, and might lead to worse outcome. Dyssynchrony can occur during the triggering of the ventilator, the inspiration period after triggering, the transition from inspiration to expiration, and the expiratory phase. The most common dyssynchronies are delayed triggering, autotriggering, ineffective inspiratory efforts (which can occur at any point in the respiratory cycle), mismatch between the patient's and ventilator's inspiratory times, and double triggering. At present, the detection of dyssynchronies usually depends on healthcare staff observing ventilator waveforms; however, performance is suboptimal and many events go undetected. To date, technological complexity has made it impossible to evaluate patient-ventilator synchrony throughout the course of mechanical ventilation. Studies have shown that a high index of dyssynchrony may increase the duration of mechanical ventilation. Better training, better ventilatory modes, and/or computerized systems that permit better synchronization of patients' demands and ventilator outputs are necessary to improve patient-ventilator synchrony.

  17. Performance of ductless personalized ventilation in conjunction with displacement ventilation

    DEFF Research Database (Denmark)

    Dalewski, Mariusz; Melikov, Arsen Krikor; Vesely, Michal

    2014-01-01

    The performance of ductless personalized ventilation (DPV) in conjunction with displacement ventilation was studied and compared with displacement ventilation alone and mixing ventilation. Thirty subjects were exposed in a climate chamber to environmental conditions representing three levels...... perception of the environment. The subjects could control the position of the DPV supply diffuser and the personalized air flow (air velocity). The use of DPV improved perceived air quality and thermal comfort compared to displacement ventilation alone. At 26 °C and 29 °C the percentage dissatisfied with air...... movement decreased with DPV compared to corresponding conditions with displacement ventilation alone and reached the same level as mixing or displacement ventilation at 23 °C. Subjects were able to control the volume and speed of the personalized air flow in order to avoid eye irritation. However...

  18. Human response to ductless personalized ventilation coupled with displacement ventilation

    DEFF Research Database (Denmark)

    Dalewski, Mariusz; Veselý, Michal; Melikov, Arsen K.

    2012-01-01

    A human subject experiment was carried out to investigate the extent to which ductless personalized ventilation (DPV) in conjunction with displacement ventilation can improve perceived air quality (PAQ) and thermal comfort at elevated room air temperature in comparison with displacement ventilation...... alone. The experimental conditions comprised displacement ventilation alone (room air temperature of 23 °C, 26 °C, 29 °C) and DPV with displacement ventilation (26 °C, 29 °C), both operating at supply air temperatures 3, 5 or 6K lower than room air temperature, as well as mixing ventilation (23 °C, 3 K......). During one hour exposure participants answered questionnaires regarding PAQ and thermal comfort. PAQ was significantly better with DPV than without DPV at the same background conditions. Thermal comfort improved when DPV was used. Combining DPV with displacement ventilation showed the potential...

  19. Excluding the Excluded : New Labour’s Penchant for Punishment

    OpenAIRE

    Bell, Emma

    2011-01-01

    New Labour’s emphasis on personal responsibility leads it to shun any definition of the socially excluded as the passive victims of socio-economic circumstances. It encourages them to act positively to re-integrate themselves into “mainstream” society by participating in welfare-to-work schemes etc. Importantly, this involves an acceptance of a certain value system as promoted by the government. Refusal to accept these values - often taken to denote membership of an underclass (increasingly u...

  20. Management of critically ill patients receiving noninvasive and invasive mechanical ventilation in the emergency department

    Directory of Open Access Journals (Sweden)

    Rose L

    2012-03-01

    Full Text Available Louise RoseLawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, CanadaAbstract: Patients requiring noninvasive and invasive ventilation frequently present to emergency departments, and may remain for prolonged periods due to constrained critical care services. Emergency clinicians often do not receive the same education on management of mechanical ventilation or have similar exposure to these patients as do their critical care colleagues. The aim of this review was to synthesize the evidence on management of patients requiring noninvasive and invasive ventilation in the emergency department including indications, clinical applications, monitoring priorities, and potential complications. Noninvasive ventilation is recommended for patients with acute exacerbation of chronic obstructive pulmonary disease or cardiogenic pulmonary edema. Less evidence supports its use in asthma and other causes of acute respiratory failure. Use of noninvasive ventilation in the prehospital setting is relatively new, and some evidence suggests benefit. Monitoring priorities for noninvasive ventilation include response to treatment, respiratory and hemodynamic stability, noninvasive ventilation tolerance, detection of noninvasive ventilation failure, and identification of air leaks around the interface. Application of injurious ventilation increases patient morbidity and mortality. Lung-protective ventilation with low tidal volumes based on determination of predicted body weight and control of plateau pressure has been shown to reduce mortality in patients with acute respiratory distress syndrome, and some evidence exists to suggest this strategy should be used in patients without lung injury. Monitoring of the invasively ventilated patient should focus on assessing response to mechanical ventilation and other interventions, and avoiding complications, such as ventilator-associated pneumonia. Several key aspects of management of noninvasive

  1. Design Procedure for Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per; Tjelflaat, Per Olaf

    Mechanical and natural ventilation systems have developed separately during many years. The natural next step in this development is development of ventilation concepts that utilises and combines the best features from each system into a new type of ventilation system - Hybrid Ventilation....... Buildings with hybrid ventilation often include other sustainable technologies and an energy optimisation requires an integrated approach in the design of the building and its mechanical systems. Therefore, the hybrid ventilation design procedure differs from the design procedure for conventional HVAC....... The first ideas on a design procedure for hybrid ventilation is presented and the different types of design methods, that is needed in different phases of the design process, is discussed....

  2. ASHRAE and residential ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.

    2003-10-01

    In the last quarter of a century, the western world has become increasingly aware of environmental threats to health and safety. During this period, people psychologically retreated away from outdoors hazards such as pesticides, smog, lead, oil spills, and dioxin to the seeming security of their homes. However, the indoor environment may not be healthier than the outdoor environment, as has become more apparent over the past few years with issues such as mold, formaldehyde, and sick-building syndrome. While the built human environment has changed substantially over the past 10,000 years, human biology has not; poor indoor air quality creates health risks and can be uncomfortable. The human race has found, over time, that it is essential to manage the indoor environments of their homes. ASHRAE has long been in the business of ventilation, but most of the focus of that effort has been in the area of commercial and institutional buildings. Residential ventilation was traditionally not a major concern because it was felt that, between operable windows and envelope leakage, people were getting enough outside air in their homes. In the quarter of a century since the first oil shock, houses have gotten much more energy efficient. At the same time, the kinds of materials and functions in houses changed in character in response to people's needs. People became more environmentally conscious and aware not only about the resources they were consuming but about the environment in which they lived. All of these factors contributed to an increasing level of public concern about residential indoor air quality and ventilation. Where once there was an easy feeling about the residential indoor environment, there is now a desire to define levels of acceptability and performance. Many institutions--both public and private--have interests in Indoor Air Quality (IAQ), but ASHRAE, as the professional society that has had ventilation as part of its mission for over 100 years, is the

  3. 26 CFR 1.1563-2 - Excluded stock.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 13 2010-04-01 2010-04-01 false Excluded stock. 1.1563-2 Section 1.1563-2...) INCOME TAXES Certain Controlled Corporations § 1.1563-2 Excluded stock. (a) Certain stock excluded. For purposes of sections 1561 through 1563 and the regulations thereunder, the term “stock” does not include...

  4. [Ventilation-perfusion ratios].

    Science.gov (United States)

    Schaffartzik, W

    1994-10-01

    Knowledge of normal and impaired pulmonary gas exchange is essential to the anaesthesiologist. Analysis of an arterial blood sample allows evaluation of whether or not pulmonary gas exchange is normal. For this purpose comparison with the oxygenation index or the alveolar-arterial PO2 difference is helpful. Pathological changes of these variables are mainly caused by ventilation-perfusion (VA/Q) mismatch. In daily practice, venous admixture or intrapulmonary shunt can be calculated using arterial and mixed-venous blood. By analysing arterial and expired PCO2, dead-space ventilation can be determined, but extended analyses of VA/Q distribution are not possible in daily practice. However, knowledge of the principles of typical disturbances of pulmonary gas exchange in acute and chronic lung disease allows the use of therapeutic strategies based on the pathophysiological changes.

  5. Diffuse Ceiling Ventilation

    DEFF Research Database (Denmark)

    Zhang, Chen; Yu, Tao; Heiselberg, Per Kvols

    -cooling period and night cooling potential. The investment cost of this ventilation system is about 5-10% lower than the conventional ones, because the acoustic ceiling could be directly applied as air diffuser and the use of plenum to distribute air reduces the cost of ductwork. There is a growing interest...... and manufacturers and the users of diffuse ceiling technology. The design guide introduces the principle and key characteristics of room air distribution with diffuse ceiling ventilation. It provides an overview of potential benefit and limitations of this technology. The benefits include high thermal comfort, high...... cooling capacity, energy saving, low investment cost and low noise level; while the limitations include condensation risk and the limit on the room geometry. Furthermore, the crucial design parameters are summarized and their effects on the system performance are discussed. In addition to the stand...

  6. Ventilation i industrien

    DEFF Research Database (Denmark)

    Valbjørn, O.

    I en række afsnit belyses problemer med træk, kulde, varme, og luftforurening på industriens arbejdspladser, og hvordan man ved ventilation og bygningsudformning kan bekæmpe disse gener. Hvert afsnit kan i princippet læses for sig, og anvisningen kan derfor bruges som håndbog, både af de der er...

  7. Noninvasive mechanical ventilation

    OpenAIRE

    Karakurt, Sait

    2016-01-01

    Noninvasive mechanical ventilation (NIMV) has been widelyapplied to the patient with respiratory failure since 1990’s aroundthe world. The respiratory function of the patient with respiratoryfailure should be supported by using positive pressure ventilationuntil primary problem of the patient is treated. Positive pressureshould be given noninvasively or invasively. If the patient isconscious (except unconsiousness due to CO2 retention) and hasintact bulber function(sufficient cough reflex and...

  8. SEPARATION OF MECHANICAL VENTILATION

    OpenAIRE

    Ida Bagus Wisnu Parbawa Kusuma; I Nengah Kuning Atmajaya

    2014-01-01

    The weaning from mechanical ventilation can be defined as the process of letting theventilator either directly or in stages. Indication of weaning from mechanicalventilation, seen from several parameters such as disease processes, PaO2, PEEP,FiO2, pH, Hb, awareness, body temperature, cardiac function, lung function, drugssedative agent or paralysis agent, and psicologic status of patient. Based on thelength of the weaning, can be devided into two, long-term weaning dan short-termweaning. Shor...

  9. Ventilation i industrien

    DEFF Research Database (Denmark)

    Valbjørn, O.

    I en række afsnit belyses problemer med træk, kulde, varme, og luftforurening på industriens arbejdspladser, og hvordan man ved ventilation og bygningsudformning kan bekæmpe disse gener. Hvert afsnit kan i princippet læses for sig, og anvisningen kan derfor bruges som håndbog, både af de der er u...

  10. Harnessing natural ventilation benefits.

    Science.gov (United States)

    O'Leary, John

    2013-04-01

    Making sure that a healthcare establishment has a good supply of clean fresh air is an important factor in keeping patients, staff, and visitors, free from the negative effects of CO2 and other contaminants. John O'Leary of Trend Controls, a major international supplier of building energy management solutions (BEMS), examines the growing use of natural ventilation, and the health, energy-saving, and financial benefits, that it offers.

  11. Purge ventilation operability

    Energy Technology Data Exchange (ETDEWEB)

    Marella, J.R.

    1995-04-10

    A determination of minimum requirements for purge exhaust ventilation system operability has been performed. HLWE and HLW Regulatory Program personnel have evaluated the various scenarios of equipment conditions and HLWE has developed the requirements for purge exhaust systems. This report is provided to document operability requirements to assist Tank Farm personnel to determine whether a system is operable/inoperable and to define required compensatory actions.

  12. Pretest Predictions for Ventilation Tests

    Energy Technology Data Exchange (ETDEWEB)

    Y. Sun; H. Yang; H.N. Kalia

    2007-01-17

    The objective of this calculation is to predict the temperatures of the ventilating air, waste package surface, concrete pipe walls, and insulation that will be developed during the ventilation tests involving various test conditions. The results will be used as input to the following three areas: (1) Decisions regarding testing set-up and performance. (2) Assessing how best to scale the test phenomena measured. (3) Validating numerical approach for modeling continuous ventilation. The scope of the calculation is to identify the physical mechanisms and parameters related to thermal response in the ventilation tests, and develop and describe numerical methods that can be used to calculate the effects of continuous ventilation. Sensitivity studies to assess the impact of variation of linear power densities (linear heat loads) and ventilation air flow rates are included. The calculation is limited to thermal effect only.

  13. [Pulmonary complications associated with mechanical ventilation in neonates].

    Science.gov (United States)

    Torres-Castro, Cristabel; Valle-Leal, Jaime; Martínez-Limón, Alba J; Lastra-Jiménez, Zaira; Delgado-Bojórquez, Lesvia Carmina

    To determine the incidence of0 associated with mechanical ventilation in patients admitted to a service in a second level hospital NICU. Retrospective analytical study records of newborns admitted to NICU room and receiving mechanical ventilation in a secondary hospital health care. Demographic data, of mechanical ventilation, intubation and complications reported in the clinical record were collected and analyzed in SPSS 20. 53 patients selected a total of 40 complications found. The annual incidence of pulmonary complications associated with mechanical ventilation in the area of service neonatology NICU, at a second level hospital at Sonora was 49.05% (95% CI 0.35 to 0.62). The most frequent pulmonary complications were atelectasis 35%, pneumonia 27.5%, pneumothorax 15%, bronchopulmonary dysplasia 15%, pneumomediastinum 15% and pulmonary hemorrhage 2.5%. The presentation of pulmonary complications secondary to mechanical ventilation in neonatal patients is similar to that reported in developing countries. Atelectasis is the most common pulmonary complication in neonatal patients undergoing mechanical ventilation. Copyright © 2016 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  14. Mechanical ventilation in neurosurgical patients

    OpenAIRE

    Keshav Goyal; Ranadhir Mitra; Shweta Kedia

    2013-01-01

    Mechanical ventilation significantly affects cerebral oxygenation and cerebral blood flow through changes in arterial carbon dioxide levels. Neurosurgical patients might require mechanical ventilation for correction and maintenance of changes in the pulmonary system that occur either due to neurosurgical pathology or following surgery during the acute phase. This review discusses the basics of mechanical ventilation relevant to the neurosurgeon in the day-to-day management of neurosurgical pa...

  15. Mechanical ventilation in neurosurgical patients

    Directory of Open Access Journals (Sweden)

    Keshav Goyal

    2013-01-01

    Full Text Available Mechanical ventilation significantly affects cerebral oxygenation and cerebral blood flow through changes in arterial carbon dioxide levels. Neurosurgical patients might require mechanical ventilation for correction and maintenance of changes in the pulmonary system that occur either due to neurosurgical pathology or following surgery during the acute phase. This review discusses the basics of mechanical ventilation relevant to the neurosurgeon in the day-to-day management of neurosurgical patient requiring artificial support of the respiration.

  16. Ventilation Surge Techniques. Volume I

    Science.gov (United States)

    1981-12-01

    Whon Data Rntere), 20. The experimental program examined airflow patterns for both mechanically driven and thermally driven ventilation . Mechanical ...were used in the study. *The experimental program examined airflow patterns for both mechanically driven and thermally driven ventilation . Mechanical ... Ventilation can be supplied by mechanical means such as fans, blowers, and pumps or by natural forces such’as those created by wind or thermal buoyancy. The

  17. Design Principles for Natural and Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per

    For many years mechanical and natural ventilation systems have developed separately. Naturally, the next step in this development is the development of ventilation concepts that utilize and combine the best features from each system to create a new type of ventilation system- Hybrid Ventilation. ....... The hybrid ventilation concepts, design challenges and principles are discussed and illustrated by four building examples....

  18. Design Principles for Natural and Hybrid Ventilation

    OpenAIRE

    Heiselberg, Per

    2000-01-01

    For many years mechanical and natural ventilation systems have developed separately. Naturally, the next step in this development is the development of ventilation concepts that utilize and combine the best features from each system to create a new type of ventilation system- Hybrid Ventilation. The hybrid ventilation concepts, design challenges and principles are discussed and illustrated by four building examples.

  19. 7 CFR 205.310 - Agricultural products produced on an exempt or excluded operation.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Agricultural products produced on an exempt or excluded operation. 205.310 Section 205.310 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) ORGANIC FOODS PRODUCTION AC...

  20. Long-Term Mechanical Ventilation.

    Science.gov (United States)

    Sahetya, Sarina; Allgood, Sarah; Gay, Peter C; Lechtzin, Noah

    2016-12-01

    Although precise numbers are difficult to obtain, the population of patients receiving long-term ventilation has increased over the last 20 years, and includes patients with chronic lung diseases, neuromuscular diseases, spinal cord injury, and children with complex disorders. This article reviews the equipment and logistics involved with ventilation outside of the hospital. Discussed are common locations for long-term ventilation, airway and secretion management, and many of the potential challenges faced by individuals on long-term ventilation. Published by Elsevier Inc.

  1. Monitoring during Mechnical Ventilation

    Directory of Open Access Journals (Sweden)

    Dean Hess

    1996-01-01

    Full Text Available Monitoring is a continuous, or nearly continuous, evaluation of the physiological function of a patient in real time to guide management decisions, including when to make therapeutic interventions and assessment of those interventions. Pulse oximeters pass two wavelengths of light through a pulsating vascular bed and determine oxygen saturation. The accuracy of pulse oximetry is about ±4%. Capnography measures carbon dioxide at the airway and displays a waveform called the capnogram. End-tidal PCO2 represents alveolar PCO2 and is determined by the ventilation-perfusion quotient. Use of end-tidal PCO2 as an indication of arterial PCO2 is often deceiving and incorrect in critically ill patients. Because there is normally very little carbon dioxide in the stomach, a useful application of capnography is the detection of esophageal intubation. Intra-arterial blood gas systems are available, but the clinical impact and cost effectiveness of these is unclear. Mixed venous oxygenation (PvO2 or SvO2 is a global indicator of tissue oxygenation and is affected by arterial oxygen content, oxygen consumption and cardiac output. Indirect calorimetry is the calculation of energy expenditure and respiratory quotient by the measurement of oxygen consumption and carbon dioxide production. A variety of mechanics can be determined in mechanically ventilated patients including resistance, compliance, auto-peak end-expiratory pressure (PEEP and work of breathing. The static pressure-volume curve can be used to identify lower and upper infection points, which can be used to determine the appropriate PEEP setting and to avoid alveolar overdistension. Although some forms of monitoring have become a standard of care during mechanical ventilation (eg, pulse oximetry, there is little evidence that use of any monitor affects patient outcome.

  2. Plane Stratified Flow in a Room Ventilated by Displacement Ventilation

    DEFF Research Database (Denmark)

    Nielsen, Peter Vilhelm; Nickel, J.; Baron, D. J. G.

    2004-01-01

    The air movement in the occupied zone of a room ventilated by displacement ventilation exists as a stratified flow along the floor. This flow can be radial or plane according to the number of wall-mounted diffusers and the room geometry. The paper addresses the situations where plane flow...

  3. Monitoring ventilation during anesthesia.

    Science.gov (United States)

    Kay, B

    1978-01-01

    In patients under anesthesia, ventilation is often monitored less adequately than circulation. A simple method, neglected in adults, is the use of a precordial or oesophageal stethoscope. Respiratory volumes may be measured directly, or inferred from flowrates or pressure changes. A rough measurement of inspired volumes may be made using a nonrebreathing valve, and controlling fresh gas input to maintain a constant underfilled reservoir bag. Spirometry of expired volumes is difficult and requires sophisticated apparatus. Respiratory volumes are easily inferred from flowrates using the Wright or Dräger respirometers. Flowrates may also be inferred from pressure changes, which are easy to record, as in the pneumotachorgraph. Accurate measurements require attention to many details, such as linearity of the transducer response over the flowrates measured. Calibration should be with the anesthetic gases used, at controlled temperature and humidity. Positive pressure ventilation peaks give a high flow artefact, and electronic drift requires regular recalibration. Electrical impedance changes may also be used to infer and record respiratory volumes, with reasonable accuracy if individual calibration is carried out. Anesthesia offers excellent opportunities to measure compliance and resistance, but itself changes these values, so that relation to normal values or changes due to pathology is difficult. Occlusion pressure is also readily measured during anesthesia, as an indication of respiratory drive, but rigid control of all other factors affecting respiratory muscle tensions is necessary.

  4. Thermal plumes in ventilated rooms

    DEFF Research Database (Denmark)

    Kofoed, Peter; Nielsen, Peter V.

    1990-01-01

    The design of a displacement ventilation system involves determination of the flow rate in the thermal plumes. The flow rate in the plumes and the vertical temperature gradient influence each other, and they are influenced by many factors. This paper shows some descriptions of these effects. Free...... to be the only possible approach to obtain the volume flow in: thermal plumes in ventilated rooms....

  5. Lecture Notes on Mixing Ventilation

    DEFF Research Database (Denmark)

    Nielsen, Peter Vilhelm

    The main task of the ventilation system or the air-conditioning system is to supply· and remove air and airborne materials and to supply or remove heat from a room. The necessary level of fresh air will be supplied to· a room by a ventilation system, and heat from equipment or solar radiation can...

  6. Ventilation and Heat Recovering System

    Directory of Open Access Journals (Sweden)

    Olga Bancea

    2007-01-01

    Full Text Available Some aspects concerning the heat reducing for ventilation, achieved by using heat recovering components and a combined heating--ventilating system, assuring both comfort and human health are presented. The floor imbedded systems together with air outlets elements could fulfill all the aesthetically desires, as well as comfort and they are ideal for family houses.

  7. Innovation in home mechanical ventilation

    NARCIS (Netherlands)

    Hazenberg, Andrea

    2017-01-01

    Patients on home mechanical ventilation (HMV) are ventilator dependent, usually for the rest of their lives. In the past decades, the number of patients on HMV increased to nearly 3,000 in 2016 in the Netherlands. Current indications for HMV are patients diagnosed with either neuromuscular disease,

  8. Free Convection Personalized Ventilation (FCPV)

    DEFF Research Database (Denmark)

    Nielsen, Peter V.

    Normally we supply fresh air to a room with a diffuser, and this air is distributed in the room according to different principles as: mixing ventilation, displacement ventilation etc. That means we have to supply a very large amount of air to the whole room, although a person in the room totally ...

  9. Natural ventilation for free stall dairy barns

    OpenAIRE

    Gay, Susan Wood

    2009-01-01

    Natural ventilation is a result of a combination good construction, correct temperature, humidity control, air exchange. This publication discusses how to achieve natural ventilation in your structure.

  10. Inhalation therapy in mechanical ventilation

    Science.gov (United States)

    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

  11. Inhalation therapy in mechanical ventilation.

    Science.gov (United States)

    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.

  12. Sealed Crawl Spaces with Integrated Whole-House Ventilation in a Cold Climate

    Energy Technology Data Exchange (ETDEWEB)

    Zoeller, William [National Renewable Energy Lab. (NREL), Golden, CO (United States); Williamson, James [National Renewable Energy Lab. (NREL), Golden, CO (United States); Puttafunta, Srikanth [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-07-30

    One 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

  13. 48 CFR 609.404 - Excluded parties list system.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Excluded parties list system. 609.404 Section 609.404 Federal Acquisition Regulations System DEPARTMENT OF STATE COMPETITION... Excluded parties list system. A/OPE shall accomplish the agency responsibilities prescribed in FAR 9.404(c...

  14. 8 CFR 1241.20 - Aliens ordered excluded.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Aliens ordered excluded. 1241.20 Section 1241.20 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS APPREHENSION AND DETENTION OF ALIENS ORDERED REMOVED Deportation of Excluded Aliens...

  15. The Value of the Right to Exclude: An Empirical Assessment

    NARCIS (Netherlands)

    J.M. Klick (Jonathan); G. Parchomovsky (Gideon)

    2016-01-01

    markdownabstractProperty theorists have long deemed the right to exclude fundamental and essential for the efficient use and allocation of property. Recently, however, proponents of the progressive property movement have called into question the centrality of the right to exclude, suggesting that it

  16. High-frequency oscillatory ventilation and pediatric cardiac surgery : Yes, we can!

    NARCIS (Netherlands)

    Kneyber, Martin C. J.

    2011-01-01

    In the previous issue of Critical Care, Bojan and colleagues reported their experiences with high-frequency oscillatory ventilation (HFOV) after pediatric cardiac surgery. A total of 120 patients were treated with HFOV on the day of surgery, thus excluding rescue HFOV use. The main finding of the

  17. Ultrasonographic finding of lung sliding in patients on mechanical ventilation with alveolar-interstitial syndrome.

    Science.gov (United States)

    Rode, Bojan; Vučić, Marinko; Siranović, Mladen; Kovač, Nataša; Kelečić, Mijo; Gopčević, Aleksandar

    2011-04-01

    To determine the visibility of pleural lung sliding in alveolar-interstitial syndrome (AIS) in patients on mechanical ventilation at two different time points, as a confirmatory ultrasonographic method for excluding pneumothorax. Fifty-two mechanically ventilated patients in the semirecumbent position in a surgical/neurosurgical intensive care unit with ultrasonographic lung 'comet tails' in three upper anterolateral intercostal spaces, indicating the presence of AIS, were scanned for lung sliding in the same three intercostal spaces with a linear 5-10 MHz transducer after starting mechanical ventilation and on weaning trials. Pneumothorax and atelectasis were excluded by chest radiograph. Absent lung sliding was found in 22.7% of intercostal spaces scanned after starting mechanical ventilation and in 21.2% of scans taken on weaning trials. The lowest invisible rate was in patients with acute heart failure and the highest in patients with acute respiratory distress syndrome. Lung sliding specificity in AIS during mechanical ventilation was 78%. Our opinion is that different levels of airway pressure between starting mechanical ventilation and weaning trials have no influence on lung sliding visibility.

  18. Computational Fluid Dynamics in Ventilation

    DEFF Research Database (Denmark)

    Nielsen, Peter V.; Allard, Francis; Awbi, Hazim B.

    2008-01-01

    Computational Fluid Dynamics in Ventilation Design is a new title in the is a new title in the REHVA guidebook series. The guidebook is written for people who need to use and discuss results based on CFD predictions, and it gives insight into the subject for those who are not used to work with CFD....... The guidebook is also written for people working with CFD which have to be more aware of how this numerical method is applied in the area of ventilation. The guidebook has, for example, chapters that are very important for CFD quality control in general and for the quality control of ventilation related...

  19. Pulmonary mechanics during mechanical ventilation.

    Science.gov (United States)

    Henderson, William R; Sheel, A William

    2012-03-15

    The use of mechanical ventilation has become widespread in the management of hypoxic respiratory failure. Investigations of pulmonary mechanics in this clinical scenario have demonstrated that there are significant differences in compliance, resistance and gas flow when compared with normal subjects. This paper will review the mechanisms by which pulmonary mechanics are assessed in mechanically ventilated patients and will review how the data can be used for investigative research purposes as well as to inform rational ventilator management. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. Contaminant Distribution Around Persons in Rooms Ventilated by Displacement Ventilation

    DEFF Research Database (Denmark)

    Brohus, Henrik; Nielsen, Peter V.

    An optimal design of the ventilation system needs a proper prediction of the velocity, temperature and contaminant distribution in the room. Traditionally this is done either by the use of simplified models or by a somewhat more comprehensive CFD-simulation. Common to both methods is usually the ...... the lack of consideration for the persons present in the room. This paper deals with some of the effects of persons present in a displacement ventilated room, especially the effect on the contaminant distribution....

  1. Preoperational test report, vent building ventilation system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  2. Performance of Portable Ventilators at Altitude

    Science.gov (United States)

    2015-03-30

    of equipment at altitude. Changes in barometric pressure can affect the performance of mechanical ventilators calibrated for operation at sea level...performance of mechanical ventilators calibrated for operation at sea level. Deploying ventilators that can maintain a consistent tidal volume (VT) delivery...temperature, density, and humidity. These changes can affect the performance of mechanical ventilators calibrated for operation at sea level. The

  3. Climate control of natural ventilated pig houses

    NARCIS (Netherlands)

    Bontsema, J.; Straten, van G.; Salomons, L.; Klooster, van 't C.E.

    1996-01-01

    Ventilation in pig houses is important for maintaining a good climate for the welfare of animals and humans and for an optimal production. Mechanical ventilation has a good performance, since the ventilation rate can easily be controlled, but it is energy demanding, whereas natural ventilation is

  4. Use of Adaptive Support Ventilation (ASV in Ventilator Associated Pneumonia (VAP - A Case Report

    Directory of Open Access Journals (Sweden)

    Bipphy Kath

    2009-01-01

    Full Text Available Prolonged ventilation leads to a higher incidence of ventilator associated pneumonia(VAP resulting in ventilator dependency, increased costs and subsequent weaning failures. Prevention and aggressive treatment of VAP alongwith patient friendly newer modes of ventilation like adaptive support ventilation go a long way in successful management of these cases.

  5. Equivalence in Ventilation and Indoor Air Quality

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max; Walker, Iain; Logue, Jennifer

    2011-08-01

    We ventilate buildings to provide acceptable indoor air quality (IAQ). Ventilation standards (such as American Society of Heating, Refrigerating, and Air-Conditioning Enginners [ASHRAE] Standard 62) specify minimum ventilation rates without taking into account the impact of those rates on IAQ. Innovative ventilation management is often a desirable element of reducing energy consumption or improving IAQ or comfort. Variable ventilation is one innovative strategy. To use variable ventilation in a way that meets standards, it is necessary to have a method for determining equivalence in terms of either ventilation or indoor air quality. This study develops methods to calculate either equivalent ventilation or equivalent IAQ. We demonstrate that equivalent ventilation can be used as the basis for dynamic ventilation control, reducing peak load and infiltration of outdoor contaminants. We also show that equivalent IAQ could allow some contaminants to exceed current standards if other contaminants are more stringently controlled.

  6. Mechanical ventilation in obese patients

    National Research Council Canada - National Science Library

    Leme Silva, P; Pelosi, P; Rocco, P R M

    2012-01-01

    Recent data show an alarming increasing trend in obesity around the world. Mechanical ventilation in this population requires specific ventilatory settings due to the mechanical and inflammatory alterations observed in obesity...

  7. 42 CFR 412.23 - Excluded hospitals: Classifications.

    Science.gov (United States)

    2010-10-01

    ...-language pathology, social services, psychological services (including neuropsychological services), and... party for the actual construction, renovation, lease or demolition for a long-term care hospital; and (2...

  8. Innovation in home mechanical ventilation

    OpenAIRE

    Hazenberg, Andrea

    2017-01-01

    Patients on home mechanical ventilation (HMV) are ventilator dependent, usually for the rest of their lives. In the past decades, the number of patients on HMV increased to nearly 3,000 in 2016 in the Netherlands. Current indications for HMV are patients diagnosed with either neuromuscular disease, spine deformities, lung disease or sleep apnea. Improving the quality of life by reducing the complaints of chronic respiratory failure is the ultimate goal for HMV. In the Netherlands patients hav...

  9. Wind Extraction for Natural Ventilation

    Science.gov (United States)

    Fagundes, Tadeu; Yaghoobian, Neda; Kumar, Rajan; Ordonez, Juan

    2017-11-01

    Due to the depletion of energy resources and the environmental impact of pollution and unsustainable energy resources, energy consumption has become one of the main concerns in our rapidly growing world. Natural ventilation, a traditional method to remove anthropogenic and solar heat gains, proved to be a cost-effective, alternative method to mechanical ventilation. However, while natural ventilation is simple in theory, its detailed design can be a challenge, particularly for wind-driven ventilation, which its performance highly involves the buildings' form, surrounding topography, turbulent flow characteristics, and climate. One of the main challenges with wind-driven natural ventilation schemes is due to the turbulent and unpredictable nature of the wind around the building that impose complex pressure loads on the structure. In practice, these challenges have resulted in founding the natural ventilation mainly on buoyancy (rather than the wind), as the primary force. This study is the initial step for investigating the physical principals of wind extraction over building walls and investigating strategies to reduce the dependence of the wind extraction on the incoming flow characteristics and the target building form.

  10. Mechanical ventilation after lung transplantation.

    Science.gov (United States)

    Thakuria, Louit; Davey, Rosada; Romano, Rosalba; Carby, Martin R; Kaul, Sundeep; Griffiths, Mark J; Simon, André R; Reed, Anna K; Marczin, Nandor

    2016-02-01

    To explore the hypothesis that early ventilation strategies influence clinical outcomes in lung transplantation, we have examined our routine ventilation practices in terms of tidal volumes (Vt) and inflation pressures. A total of 124 bilateral lung transplants between 2010 and 2013 were retrospectively assigned to low (8 mL/kg) Vt groups based on ventilation characteristics during the first 6 hours after surgery. Those same 124 patients were also stratified to low-pressure (<25 cm H2O) and high-pressure (≥25 cm H2O) groups. Eighty percent of patients were ventilated using pressure control mode. Low, medium, and high Vt were applied to 10%, 43%, and 47% of patients, respectively. After correcting for patients requiring extracorporeal support, there was no difference in short-term to midterm outcomes among the different Vt groups. Low inflation pressures were applied to 61% of patients, who had a shorter length of intensive care unit stay (5 vs 12 days; P = .012), higher forced expiratory volume in 1 second at 3 months (77.8% vs 60.3%; P < .001), and increased 6-month survival rate (95% vs 77%; P = .008). Low Vt ventilation has not been fully adopted in our practice. Ventilation with higher inflation pressures, but not Vt, was significantly associated with poorer outcomes after lung transplantation. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Determinants of ventilation behavior in naturally ventilated dwellings: Identification and quantification of relationships

    NARCIS (Netherlands)

    Levie, D.; Kluizenaar, Y. de; Hoes-van Oeffelen, E.C.M.; Hofstetter, H.; Janssen, S.A.; Spiekman, M.E.; Koene, F.G.H.

    2014-01-01

    Background: Ventilation in dwellings is essential for well-being and health. However, insight in determinants of ventilation behavior is still limited. Aim: Identifying determinants of ventilation behavior and quantifying relationships. Secondly, identifying households characteristics associated

  12. Impact of Fire Ventilation on General Ventilation in the Building

    Science.gov (United States)

    Zender-Świercz, Ewa; Telejko, Marek

    2017-10-01

    The fire of building is a threat to its users. The biggest threat is generation, during lifetime of fire, hot gases and smoke. The purpose of quick and efficient evacuation from the area covered by the fire, at first step the escape routes have to be secured from smokiness. The smoke ventilation systems are used for this purpose. The proper design and execution of smoke ventilation is important not only because of the safety, but also of the maintenance of comfort in the building at a time when there is no fire. The manuscript presents the effect of incorrectly realized smoke ventilation in the stairwell of the medium building. The analysis shows that the flaps of smoke ventilation located in the stairwell may have a significant impact on the proper functioning of mechanical ventilation in the period when there is no fire. The improperly installed or incorrect insulated components cause perturbation of air flow and they change pressure distribution in the building. The conclusion of the analysis is the need to include the entire technical equipment of the building during the design and realization of its individual elements. The impact of various installations at each other is very important, and the omission of any of them can cause disturbances in the proper work of another.

  13. Respiratory severity score on day of life 30 is predictive of mortality and the length of mechanical ventilation in premature infants with protracted ventilation.

    Science.gov (United States)

    Malkar, Manish B; Gardner, William P; Mandy, George T; Stenger, Michael R; Nelin, Leif D; Shepherd, Edward G; Welty, Stephen E

    2015-04-01

    We tested the hypothesis that Respiratory Severity Score (RSS) on day of life 30 is predictive of mortality and length of mechanical ventilation in premature infants on prolonged mechanical ventilation. A retrospective chart review was performed using the Nationwide Children's Hospital medical record and Vermont-Oxford Network databases. The primary outcome variable was survival to hospital discharge and the secondary outcome was length of mechanical ventilation after day of life 30. We identified 199 neonates admitted to Nationwide Children's Hospital between 2004 and 2007 with birth weight less than 1,500 g that received prolonged mechanical ventilation in the first 30 days of their life. A total of 184 infants were included in the analysis, excluding 14 patients with congenital anomalies and one infant with incomplete data. RSS on day of life 30 was significantly greater in the group of infants that died compared to those that survived (P = 0.003, 95% CI = [0.08, 0.40]). Further analysis demonstrated that the maximum difference in mortality was obtained with a threshold RSS of 6. Of the 109 patients who had RSS less than 6 on day of life 30, mortality rate was 4.6% (5/109) while those greater than or equal to 6 had a mortality rate of 21.3% (16/75). Both Kaplan-Meier survival curves comparing mortality and length of mechanical ventilation in infants with RSS ventilation after day of life 30 (P mechanical ventilation in premature infants requiring mechanical ventilation through 30 days of life. © 2014 Wiley Periodicals, Inc.

  14. The Mechanical Impact of Aerodynamic Stall on Tunnel Ventilation Fans

    Directory of Open Access Journals (Sweden)

    A. G. Sheard

    2012-01-01

    Full Text Available This paper describes work aimed at establishing the ability of a tunnel ventilation fan to operate without risk of mechanical failure in the event of aerodynamic stall. The research establishes the aerodynamic characteristics of a typical tunnel ventilation fan when operated in both stable and stalled aerodynamic conditions, with and without an anti-stall stabilisation ring, with and without a “nonstalling” blade angle and at full, half, and one quarter design speed. It also measures the fan’s peak stress, thus facilitating an analysis of the implications of the experimental results for mechanical design methodology. The paper concludes by presenting three different strategies for tunnel ventilation fan selection in applications where the selected fan will most likely stall. The first strategy selects a fan with a low-blade angle that is nonstalling. The second strategy selects a fan with a high-pressure developing capability. The third strategy selects a fan with a fitted stabilisation ring. Tunnel ventilation system designers each have their favoured fan selection strategy. However, all three strategies can produce system designs within which a tunnel ventilation fan performs reliably in-service. The paper considers the advantages and disadvantages of each selection strategy and considered the strengths and weaknesses of each.

  15. [Potentially excluded population from health coverage and health impact since Royal Decree 16/2012: The Central Catalonia experience].

    Science.gov (United States)

    Álamo-Junquera, Dolores; Sala, Núria; Millet, Joan-Pau; Ortega-Gutiérrez, Lluïsa; Planas-Giner, Albert; Rovira, Carol; Comet, Dolors

    2015-01-01

    To assess the proportion of population potentially excluded from healthcare coverage since the Royal Decree-Law 16/2012. To describe the use of health services, the distribution of chronic and infectious diseases, and the pharmaceutical costs in 2012 of the persons potentially excluded compared to the those who maintain their coverage. An observational analytical cross-sectional study was designed and conducted on a Primary Care based population in the Central Catalonia Management Area of the Institut Català de la Salut PARTICIPANTS AND MAIN MEASUREMENTS: Individuals potentially excluded since the application of the Royal Decree-Law 16/2012 were selected and compared with individuals who maintained their healthcare coverage, randomly matched by sex, age and Primary Care service. The information obtained included the use of health services, the distribution of chronic and infectious diseases, and the pharmaceutical costs during the year 2012. A total of 1,699 individuals were identified as potentially excluded from healthcare coverage, 0.53% of the total of population (51.4% men), with a median of age of 34years (interquartile range, 28-43). The use of healthcare services, the chronic morbidity recorded, and the pharmaceutical costs during the year 2012 of the excluded individuals was lower than those of the non-excluded ones (P<.001). On the other hand, the infectious morbidity was higher in the excluded individuals (P<.001). The results of the study suggests that this legislative measure does not seem to be justified for medical or economic reasons. It could also cause public health problems and contribute to the risk of social fracture. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  16. Tidal ventilation distribution during pressure-controlled ventilation and pressure support ventilation in post-cardiac surgery patients.

    Science.gov (United States)

    Blankman, P; VAN DER Kreeft, S M; Gommers, D

    2014-09-01

    Inhomogeneous ventilation is an important contributor to ventilator-induced lung injury. Therefore, this study examines homogeneity of lung ventilation by means of electrical impedance tomography (EIT) measurements during pressure-controlled ventilation (PCV) and pressure support ventilation (PSV) using the same ventilation pressures. Twenty mechanically ventilated patients were studied after cardiac surgery. On arrival at the intensive care unit, ventilation distribution was measured with EIT just above the diaphragm for 15 min. After awakening, PCV was switched to PSV and EIT measurements were again recorded. Tidal impedance variation, a measure of tidal volume, increased during PSV compared with PCV, despite using the same ventilation pressures (P = 0.045). The distribution of tidal ventilation to the dependent lung region was more pronounced during PSV compared with PCV, especially during the first half of the inspiration. An even distribution of tidal ventilation between the dependent and non-dependent lung regions was seen during PCV at lower tidal volumes (ventilation was predominantly distributed to the dependent lung during PSV at low tidal volumes. In post-cardiac surgery patients, PSV showed improved ventilation of the dependent lung region due to the contribution of the diaphragm activity, which is even more pronounced during lower assist levels. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  17. Ventilation systems for high halls

    Energy Technology Data Exchange (ETDEWEB)

    Sodec, F.; Veldboer, W.

    1982-02-01

    A ventilation system for high halls is described which meets the demands of steady air flow in spite of inverse thermal currents, intensive ventilation of working areas during heating and cooling and ventilation free of draught. The main element of the ventilation system is the air outlet in the ceiling, with variable beam direction. The horizontal, rotated beams are superimposed by a vertical beam whose strength may be varied. This way, the beam direction can be adapted to the thermal load of the hall and the height of blowout. The blowout angle is large for heating and small for cooling. Studies have shown that halls are ventilated thoroughly and free of draught by this system. The variable, rotary outlet presented in the article is best suited for heights of 4.00 to 12.00 m. The outlet, with a rated diameter of 400 mm, has been in use for two years now in fields as varied as diecasting works, halls at fairs, sports halls, etc. The air volume flow rate is 1000 to 3000 m/sup 3//h per outlet. A bigger version is now being developed; it will have a rated diameter of 710 mm and an air volume flow rate of 3000 to 9000 m/sup 3//h.

  18. Residential ventilation standards scoping study

    Energy Technology Data Exchange (ETDEWEB)

    McKone, Thomas E.; Sherman, Max H.

    2003-10-01

    The goals of this scoping study are to identify research needed to develop improved ventilation standards for California's Title 24 Building Energy Efficiency Standards. The 2008 Title 24 Standards are the primary target for the outcome of this research, but this scoping study is not limited to that timeframe. We prepared this scoping study to provide the California Energy Commission with broad and flexible options for developing a research plan to advance the standards. This document presents the findings of a scoping study commissioned by the Public Interest Energy Research (PIER) program of the California Energy Commission to determine what research is necessary to develop new residential ventilation requirements for California. This study is one of three companion efforts needed to complete the job of determining the ventilation needs of California residences, determining the bases for setting residential ventilation requirements, and determining appropriate ventilation technologies to meet these needs and requirements in an energy efficient manner. Rather than providing research results, this scoping study identifies important research questions along with the level of effort necessary to address these questions and the costs, risks, and benefits of pursuing alternative research questions. In approaching these questions and corresponding levels of effort, feasibility and timing were important considerations. The Commission has specified Summer 2005 as the latest date for completing this research in time to update the 2008 version of California's Energy Code (Title 24).

  19. Excluded-volume effects in the diffusion of hard spheres

    KAUST Repository

    Bruna, Maria

    2012-01-03

    Excluded-volume effects can play an important role in determining transport properties in diffusion of particles. Here, the diffusion of finite-sized hard-core interacting particles in two or three dimensions is considered systematically using the method of matched asymptotic expansions. The result is a nonlinear diffusion equation for the one-particle distribution function, with excluded-volume effects enhancing the overall collective diffusion rate. An expression for the effective (collective) diffusion coefficient is obtained. Stochastic simulations of the full particle system are shown to compare well with the solution of this equation for two examples. © 2012 American Physical Society.

  20. Air Distribution in a Furnished Room Ventilated by Mixing Ventilation

    DEFF Research Database (Denmark)

    Nielsen, June Richter; Nielsen, Peter V.; Svidt, Kjeld

    Using isothermal full-scale experiments and two-dimensional isothermal CFD simulations it is investigated how normal office furniture influences the air movements in a room with mixing ventilation. Three different set-ups are made in the experiments and different sizes and locations of the furnit......Using isothermal full-scale experiments and two-dimensional isothermal CFD simulations it is investigated how normal office furniture influences the air movements in a room with mixing ventilation. Three different set-ups are made in the experiments and different sizes and locations...... of the furniture volume are simulated. The simulations are made in three different lengths of the room....

  1. Sealed Crawl Spaces with Integrated Whole-House Ventilation in a Cold Climate

    Energy Technology Data Exchange (ETDEWEB)

    Zoeller, William [Consortium for Advanced Residential Buildings, Norwalk, CT (United States); Williamson, James [Consortium for Advanced Residential Buildings, Norwalk, CT (United States); Puttagunta, Srikanth [Consortium for Advanced Residential Buildings, Norwalk, CT (United States)

    2015-07-01

    One 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 that observed temperature, humidity, and pressure conditions through the home and crawlspace.

  2. Pneumoperitoneum associated with artificial ventilation.

    Science.gov (United States)

    Summers, B

    1979-06-09

    Four adults injured in serious road-traffic accidents developed pneumoperitoneum after artificial ventilation. No case could be attributed to injury or to perforation of a hollow viscus in the belly, but doubt about this in one patient resulted in exploratory laparotomy. In three patients the origin of intraperitoneal air was considered to be leakage through minute ruptures in alveoli subjected to the stress of artificial ventilation, with air tracking to the mediastinum, pleural space, subcutaneous tissues of the neck and chest, and peritoneal cavity. The fourth patient later developed herniation of the stomach through a rupture in the diaphragm, the presence of a pneumothorax on the same side suggesting direct passage of air through the diaphragm. Pneumoperitoneum induced by artificial ventilation is probably more common than reports suggest and should be distinguished clinically and radiologically from that caused by rupture or perforation of a hollow viscus. This will reduce the number of needles laparotomies performed on patients who are already seriously ill.

  3. 5 CFR 2634.203 - Persons excluded by rule.

    Science.gov (United States)

    2010-01-01

    ... FINANCIAL DISCLOSURE, QUALIFIED TRUSTS, AND CERTIFICATES OF DIVESTITURE Persons Required To File Public Financial Disclosure Reports § 2634.203 Persons excluded by rule. (a) In general. Any individual or group of... not affect adversely the integrity of the Government or the public's confidence in the integrity of...

  4. 40 CFR 240.201 - Solid wastes excluded.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Solid wastes excluded. 240.201 Section 240.201 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.201 Solid...

  5. 42 CFR 412.25 - Excluded hospital units: Common requirements.

    Science.gov (United States)

    2010-10-01

    ... decreased at any time during a cost reporting period if the hospital notifies its fiscal intermediary and... chief medical officer of the hospital in which it is located. (B) It maintains admission and discharge... 42 Public Health 2 2010-10-01 2010-10-01 false Excluded hospital units: Common requirements. 412...

  6. 8 CFR 1240.38 - Fingerprinting of excluded aliens.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Fingerprinting of excluded aliens. 1240.38 Section 1240.38 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PROCEEDINGS TO DETERMINE REMOVABILITY OF ALIENS IN THE UNITED STATES Exclusion of...

  7. The public space and the right to exclude

    Directory of Open Access Journals (Sweden)

    Verónica Urzúa Bastida

    2012-03-01

    Full Text Available This paper raises that the notion of «public space», as is currently used, legitimize, at the same time is the base of what might be called the right to exclude. This is not happening by law, but culture. To argue this, there will develop three ideas: comfort, planning and civic order, presents in the above mentioned notion.

  8. 29 CFR 548.305 - Excluding certain additions to wages.

    Science.gov (United States)

    2010-07-01

    ... excluded are: modest housing, bonuses or prizes of various sorts, tuition paid by the employer for the... business. It may also include such things as payment by the employer of the employee's social security tax...-of-living bonus of $260 each calendar quarter, or $20 per week. The employee works overtime in only 2...

  9. University Benefits Survey. Part I (All Benefits Excluding Pensions).

    Science.gov (United States)

    University of Western Ontario, London.

    Results of a 1986 survey of benefits, excluding pensions, for 17 Ontario, Canada, universities are presented. Information is provided on the following areas: whether the university self- administers insurance plans, communication of benefits, proposed changes in benefits, provision of accidental death and dismemberment insurance, maternity leave…

  10. University Benefits Survey. Part 1 (All Benefits Excluding Pensions).

    Science.gov (United States)

    University of Western Ontario, London.

    Results of a 1983 survey of benefits, excluding pensions, for 17 Ontario, Canada, universities are presented. Information is provided on the following areas: whether the university self-administers insurance plans, communication of benefits, proposed changes in benefits, provision of life and dismemberment insurance, maternity leave policy,…

  11. [Mechanical ventilation in pediatrics (III). Weaning, complications and other types of ventilation. Noninvasive ventilation].

    Science.gov (United States)

    Pons Odena, M; Cambra Lasaosa, F J

    2003-08-01

    Noninvasive ventilation (NIV), i.e. without tracheal intubation, has been reintroduced for the treatment of respiratory failure to reduce the complications of mechanical ventilation. Nowadays, NIV with positive pressure is the preferred method, applied through a mask held in place by a harness. Several masks can be used (nasal, bucconasal facial) and a variety of means can be used to keep them in place. Many respirators can be selected, ranging from those traditionally used in the intensive care unit(ICU) to specific NV respirators and conventional ICU respirators with specific software for NIV. Many respiratory modalities can be used according to the respirator (biphasic positive airway pressure [BIPAP], proportional assist ventilation, pressure support, synchronized intermittent mandatory ventilation [SIMV], etc.). NIV is mainly indicated in exacerbations of chronic respiratory failure: neuromuscular diseases, pretransplantation cystic fibrosis, and obstructive sleep apnea syndrome. It is also indicated in acute respiratory failure: pneumonia, status asthmaticus, and acute lung edema. The main contraindications are a weakened airway protection reflex(absent cough reflex) and hemodynamic instabiity. The advantages of NIV derive mainly from avoiding the complications associated with invasive ventilation. NIV also presents some disadvantages, especially the greater workload involved to ensure good patient adaptation to the respirator. The most common sequelae of NIV are skin lesions due to pressure on the nasal bridge.

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

    Science.gov (United States)

    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.

  13. Liquid lung ventilation as an alternative ventilatory support

    NARCIS (Netherlands)

    S.J.C. Verbrugge (Serge); D.A.M.P.J. Gommers (Diederik); B.F. Lachmann (Burkhard)

    1995-01-01

    textabstractThe concept of liquid ventilation has evolved in recent years into the concept of partial liquid ventilation. In this technique, conventional mechanical ventilation is combined with intratracheal perfluorocarbon administration. Partial liquid ventilation is a promising technique for

  14. Projected incidence of mechanical ventilation in Ontario to 2026: Preparing for the aging baby boomers.

    Science.gov (United States)

    Needham, Dale M; Bronskill, Susan E; Calinawan, Jonah R; Sibbald, William J; Pronovost, Peter J; Laupacis, Andreas

    2005-03-01

    The aging baby boomers are expected to have a significant impact on the healthcare system. Mechanical ventilation is an age-dependent, costly, and relatively nondiscretionary medical service that may be particularly affected by the aging population. We forecast the future incidence of mechanical ventilation to the year 2026 to understand the impact of aging baby boomers on critical care resources. Population-based, sex-specific, and age-specific mechanical ventilation incidences for adults for the year 2000 were directly standardized to population projections to estimate the incidence of mechanical ventilation, in 5-yr intervals, from 2006 to 2026. Sensitivity analyses were performed by varying population projections and mechanical ventilation incidence for the elderly. Province of Ontario, Canada. Noncardiac surgery, mechanically ventilated adults. None. The projected number of ventilated patients in 2026 was 34,478, representing an 80% increase from 2000. The crude incidence increased 31%, from 222 to 291 per 100,000 adults. The annually compounded projected growth rate during this 26-yr period was 2.3%, similar to the actual growth rate experienced in the 1990s. The projected incidence was relatively insensitive to changes in assumptions, with estimates for 2026 ranging from 31,473 to 36,313 ventilated adults. The incidence of mechanical ventilation projected to the year 2026 will steadily increase and outpace population growth as occurred in the 1990s. In the current environment in which intensive care unit resources are limited and ventilated patients already use a significant proportion of acute care resources, planning for this continued growth is necessary. Existing evidence-based strategies that improve both the efficiency and efficacy of critical care services should be carefully evaluated for widespread implementation.

  15. Human versus Computer Controlled Selection of Ventilator Settings: An Evaluation of Adaptive Support Ventilation and Mid-Frequency Ventilation

    Science.gov (United States)

    Mireles-Cabodevila, Eduardo; Diaz-Guzman, Enrique; Arroliga, Alejandro C.; Chatburn, Robert L.

    2012-01-01

    Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes). Two examples are adaptive support ventilation (ASV) and mid-frequency ventilation (MFV). We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios. Methods. A survey of critical care clinicians provided reference ventilator settings for a 70 kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario's respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings. Results. Tidal volumes ranged from 6.1 to 8.3 mL/kg for the clinician, 6.7 to 11.9 mL/kg for ASV, and 3.5 to 9.9 mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes. Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme. PMID:23119152

  16. Human versus Computer Controlled Selection of Ventilator Settings: An Evaluation of Adaptive Support Ventilation and Mid-Frequency Ventilation

    Directory of Open Access Journals (Sweden)

    Eduardo Mireles-Cabodevila

    2012-01-01

    Full Text Available Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes. Two examples are adaptive support ventilation (ASV and mid-frequency ventilation (MFV. We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios. Methods. A survey of critical care clinicians provided reference ventilator settings for a 70 kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario’s respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings. Results. Tidal volumes ranged from 6.1 to 8.3 mL/kg for the clinician, 6.7 to 11.9 mL/kg for ASV, and 3.5 to 9.9 mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes. Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme.

  17. Ventilation effectiveness : health benefits of heat recovery ventilators

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2010-08-15

    Studies have shown that the installation of a heat recovery ventilator (HRV) in homes in northern Canada could improve indoor air quality and the respiratory health of inhabitants. Low ventilation rates are common in many homes in the North because the climate is severe, homes are smaller and lack basements, and occupancies are higher, leading to unhealthy indoor air quality. Northern communities also have a high rate of respiratory infections. HRVs recover much of the energy used to ventilate, which is desirable in cold regions with high heating costs. For the study, the test sample was divided into two types of houses, notably houses with active HRVs and those with control HRVs that were installed and operated but that did not function. The study results showed that HRVs provided increased ventilation. Complaints by residents about HRV noise, discomfort, or low humidity were common but equally spread between those with active and placebo HRVs. The study showed that the system design needs to be improved to better suit the needs of Inuit families. The nature of northern housing presents installation and maintenance challenges. It is hard to retrofit HRV ducting inside small, existing houses, and building supplies arrive infrequently, so detailed planning and careful take-offs of all supplies and materials must be done well in advance of construction. In addition, contractors are hard to locate and have variable expertise, and there is little technical follow-up. Robust technical support by local contractors and housing authorities is therefore important. 2 refs.

  18. The School Advanced Ventilation Engineering Software (SAVES)

    Science.gov (United States)

    The School Advanced Ventilation Engineering Software (SAVES) package is a tool to help school designers assess the potential financial payback and indoor humidity control benefits of Energy Recovery Ventilation (ERV) systems for school applications.

  19. Perioperative lung protective ventilation in obese patients

    NARCIS (Netherlands)

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F.; Repine, John E.

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent

  20. Decisional responsibility for mechanical ventilation and weaning

    DEFF Research Database (Denmark)

    Rose, Louise; Blackwood, Bronagh; Egerod, Ingrid

    2011-01-01

    Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our ob...

  1. Mechanisms of natural ventilation in livestock buildings

    DEFF Research Database (Denmark)

    Rong, Li; Bjerg, Bjarne Schmidt; Batzanas, Thomas

    2016-01-01

    Studies on the mechanisms of natural ventilation in livestock buildings are reviewed and influences on discharge and pressure coefficients are discussed. Compared to studies conducted on buildings for human occupation and industrial buildings which focus on thermal comfort, ventilation systems...

  2. Pressure support ventilation attenuates ventilator-induced protein modifications in the diaphragm

    OpenAIRE

    Powers, Scott K; DeCramer, Marc; Gayan-Ramirez, Ghislaine; Levine, Sanford

    2008-01-01

    Common medical conditions that require mechanical ventilation include chronic obstructive lung disease, acute lung injury, sepsis, heart failure, drug overdose, neuromuscular disorders, and surgery. Although mechanical ventilation can be a life saving measure, prolonged mechanical ventilation can also present clinical problems. Indeed, numerous well-controlled animal studies have demonstrated that prolonged mechanical ventilation results in diaphragmatic weakness due to both atrophy and contr...

  3. Effects of ventilation behaviour on indoor heat load based on test reference years

    Science.gov (United States)

    Rosenfelder, Madeleine; Koppe, Christina; Pfafferott, Jens; Matzarakis, Andreas

    2016-02-01

    Since 2003, most European countries established heat health warning systems to alert the population to heat load. Heat health warning systems are based on predicted meteorological conditions outdoors. But the majority of the European population spends a substantial amount of time indoors, and indoor thermal conditions can differ substantially from outdoor conditions. The German Meteorological Service (Deutscher Wetterdienst, DWD) extended the existing heat health warning system (HHWS) with a thermal building simulation model to consider heat load indoors. In this study, the thermal building simulation model is used to simulate a standardized building representing a modern nursing home, because elderly and sick people are most sensitive to heat stress. Different types of natural ventilation were simulated. Based on current and future test reference years, changes in the future heat load indoors were analyzed. Results show differences between the various ventilation options and the possibility to minimize the thermal heat stress during summer by using an appropriate ventilation method. Nighttime ventilation for indoor thermal comfort is most important. A fully opened window at nighttime and the 2-h ventilation in the morning and evening are more sufficient to avoid heat stress than a tilted window at nighttime and the 1-h ventilation in the morning and the evening. Especially the ventilation in the morning seems to be effective to keep the heat load indoors low. Comparing the results for the current and the future test reference years, an increase of heat stress on all ventilation types can be recognized.

  4. Newer nonconventional modes of mechanical ventilation

    OpenAIRE

    Preet Mohinder Singh; Anuradha Borle; Anjan Trikha

    2014-01-01

    The conventional modes of ventilation suffer many limitations. Although they are popularly used and are well-understood, often they fail to match the patient-based requirements. Over the years, many small modifications in ventilators have been incorporated to improve patient outcome. The ventilators of newer generation respond to patient′s demands by additional feedback systems. In this review, we discuss the popular newer modes of ventilation that have been accepted in to clinical practice. ...

  5. Adequacy of Wind Ventilation in Upgraded Shelters.

    Science.gov (United States)

    1980-05-01

    etc. caused by atmospheric winds or thermal effects 2) Forced Ventilation - ventilation by artifical means using mechanical devices. If natural...through all the inlet or exit openings. The variation of ventilation throughput with the free stream wind velocity (V) is shown in araphical form in...ADEAUAC Y OF WIND VENTILATION IN UPGRADED SHELTERSG(U) NAY 80 R H HENNINGER, R J TSAL DCPAOI-78-C-0319 UNCLASSIFIED GARD-Al-11 (1713) NL

  6. Ventilation Host and Risk Area Techniques

    Science.gov (United States)

    1982-04-01

    is one option for ensuring that ventilation equipme is availabie during & crisis situation to shelters requiring mechanical ventilatioa. However...natural, wind-driven ventilation will suffice. However, for situations requiring mechanical ventilation to supply ad distribute air in shelters...Agency. DETACHABLE SUMMARY FINAL REPORT RTI/-072/O0-08F April 198• Ventilation : Most and Risk Area Technique. by S. B. York, 11I, K. J. Reeves, and R. J

  7. Evaluation of Shelter Ventilation by Model Tests

    Science.gov (United States)

    1983-03-01

    ventilation is created by mechanical devices such as pedal venti- lators and Kearny pumps. If natural ventilation in a shelter. can be predicted with...past have centered around the design, performance analysis and deployment of mechanical ventilating units (Ref. 11-14). Other studies include one on...calculated as the sum of the air volume flow rates through all the windward openings. The variation of model ventilation througnput versus wind speed

  8. Options for mechanical ventilation in neuromuscular diseases.

    Science.gov (United States)

    Unterborn, J N; Hill, N S

    1994-12-01

    A variety of mechanical devices may be used to provide assistance when ventilation and cough are severely impaired by progressive respiratory weakness caused by neuromuscular disease. Traditionally, positive pressure ventilation via a tracheostomy has been used, but if upper airway function is adequate, a variety of noninvasive devices also may be considered. Although positive pressure ventilation is the preferred noninvasive mode for assisting ventilation, other modes may be selected depending on patient needs, preferences, and physical characteristics.

  9. Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

    OpenAIRE

    Parshotam Lal Gautam; Gaganjot Kaur; Sunil Katyal; Ruchi Gupta; Preetveen Sandhu; Nikhil Gautam

    2016-01-01

    Background: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV) is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV) is a new dynamic ins...

  10. Neonatal mechanical ventilation: Indications and outcome

    OpenAIRE

    Qazi Iqbal; Mir M Younus; Asif Ahmed; Ikhlas Ahmad; Javed Iqbal; Bashir A Charoo; S Wajid Ali

    2015-01-01

    Background and Aims: Decreasing mortality in sick and ventilated neonates is an endeavor of all neonatologists. To reduce the high mortality in this group of neonates, identification of risk factors is important. This study was undertaken to find out the indications of ventilation and complications in ventilated neonates and also study possible predictors of outcome. Subjects: Age

  11. 14 CFR 252.9 - Ventilation systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Ventilation systems. 252.9 Section 252.9... REGULATIONS SMOKING ABOARD AIRCRAFT § 252.9 Ventilation systems. Air carriers shall prohibit smoking whenever the ventilation system is not fully functioning. Fully functioning for this purpose means operating so...

  12. 46 CFR 194.10-25 - Ventilation.

    Science.gov (United States)

    2010-10-01

    ... magazines. (1) All integral magazines shall be provided with natural or mechanical ventilation. Design... vans shall be provided with natural ventilation sufficient to maintain the inside air temperature below... 46 Shipping 7 2010-10-01 2010-10-01 false Ventilation. 194.10-25 Section 194.10-25 Shipping COAST...

  13. 46 CFR 98.25-75 - Ventilation.

    Science.gov (United States)

    2010-10-01

    ... shall be fitted with efficient natural or mechanical ventilation. (b) Enclosed compartments in which... 46 Shipping 4 2010-10-01 2010-10-01 false Ventilation. 98.25-75 Section 98.25-75 Shipping COAST... Ventilation. (a) All enclosed spaces containing cargo tanks fitted with bottom outlet connections shall be...

  14. Implementation of natural ventilation in pig houses

    NARCIS (Netherlands)

    Klooster, van 't C.E.

    1994-01-01

    A description of experimental work and discussion on implementation of natural ventilation in pig houses is given. A literature review describes the state of the art, animal growth data are given. It includes characterization of ventilation openings, a technique to estimate the ventilation

  15. Building technical services - Compact equipment for heating, hot water preparation, ventilation and cooling - Final report; Haustechnik - Kompaktgeraete (Heizen, Warmwasser, Lueften, Kuehlen - alles aus einem). Erkenntnisse aus der Praxis - Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Haessig, W.; Streit, S. [Haessig Sustech GmbH, Uster (Switzerland); Helfenfinger, D.; Keller, P. [Hochschule fuer Technik und Architektur Luzern (HSLU), Luzern (Switzerland)

    2009-06-15

    This comprehensive final report for the Swiss Federal Office of Energy (SFOE) presents and discusses the knowledge gained in practice concerning compact equipment that can be used for heating, hot water preparation, ventilation and cooling. Such units combine heat-pumps and the further equipment necessary. Data on various factors were collected over a period of one year in three apartment blocks that meet Swiss Minergie-P very low energy consumption standards. Apart from the above mentioned factors, the study also considered humidity and carbon dioxide levels in the apartments and inhabitant behaviour. The authors note that the energy consumption of several apartments fell below the Minergie-P limiting, annual value of 30 kWh/m2. An increase in electricity consumption dependent on room temperatures is noted and commented on. The economic feasibility of Minergie-P and so-called passive housing is commented on.

  16. Displacement Ventilation in Hospital Environments

    DEFF Research Database (Denmark)

    Li, Yuguo; Nielsen, Peter V.; Sandberg, Mats

    2011-01-01

    Hospital differ from conventional buildings in terms of ventilation needs. Exhaled infectious droplets or droplet nuclei of an infected patient need to be removed in general wards, waiting areas and isolation rooms to minimize transmission to health-care workers, other patients and visitors...

  17. Non-invasive mechanical ventilation

    African Journals Online (AJOL)

    Nicky

    2005-07-10

    Jul 10, 2005 ... Drinker P, McKahnn C. The use of a new apparatus for the prolonged administration of artificial respiration. JAMA 1929; 92: 1658-1660. 5. Emerson J. Some reflections on Iron Lungs and other inventions. Respiratory Care 1998;. 43: 574-583. 6. Brigg C. The benefits of non-invasive ventilation and CPAP ...

  18. Thermal Plumes in Ventilated Rooms

    DEFF Research Database (Denmark)

    Kofoed, Peter; Nielsen, Peter V.

    The design of a displacement ventilation system involves determination of the flow rate in the thermal plumes. The flow rate in the plumes and the vertical temperature gradient influence each other, and they are influenced by many factors. This paper shows some descriptions of these effects....

  19. Cardiogenic oscillation induced ventilator autotriggering

    Directory of Open Access Journals (Sweden)

    Narender Kaloria

    2015-01-01

    Full Text Available Cardiogenic oscillation during mechanical ventilation can auto-trigger the ventilator resembling patient initiated breadth. This gives a false sense of intact respiratory drive and determination brain death, even if other tests are positive, is not appropriate in such a situation. It will prolong the ICU stay and confound the brain-death determination. In this case report, we describe a 35 year old man who was brought to the hospital after many hours of critical delay following multiple gun shot injuries. The patient suffered a cardiac arrest while on the way from another hospital. After an emergency laparotomy, patient was shifted to Intensive Care Unit (ICU with Glasgow Coma Scale (GCS score of E1VTM1 and was mechanically ventilated. Despite absence of brainstem reflexes, the ventilator continued to be triggered on continuous positive airway pressure (CPAP mode and the patient maintained normal oxygen saturation and acceptable levels of carbon dioxide. An apnoea test confirmed absent respiratory drive. Ventilatory waveform graph analysis, revealed cardiogenic oscillation as the cause for autotrigerring.

  20. Thermal Plumes in Ventilated Rooms

    DEFF Research Database (Denmark)

    Kofoed, Peter; Nielsen, Peter V.

    Ventilation systems with vertical displacement flow have been used in industrial areas with extensive heat loads for many years. Hot and contaminant air is carried directly from the occupied zone towards the ceiling by hot processes and other activities which create a natural convection flow....

  1. International Ventilation Cooling Application Database

    DEFF Research Database (Denmark)

    Holzer, Peter; Psomas, Theofanis Ch.; OSullivan, Paul

    2016-01-01

    The currently running International Energy Agency, Energy and Conservation in Buildings, Annex 62 Ventilative Cooling (VC) project, is coordinating research towards extended use of VC. Within this Annex 62 the joint research activity of International VC Application Database has been carried out, ...

  2. The air quality in ventilation installations. Practical guidelines; Qualite de l'air dans les installations aerauliques. Guide pratique

    Energy Technology Data Exchange (ETDEWEB)

    Angeli, L. [France Air, 91 - Chilly Mazarin (France); Bianchina, M. [Unelvent, 93 - Le Bourget (France); Blazy, M. [Anjos, 01 - Torcieu (France); Boulanger, X. [Aldes, 21 - Chenove (France); Chiesa, M. [Atlantic (France); Duclos, M. [Groupe Titanair, 69 - Lyon (France); Hubert, D.; Kridorian, O. [Groupe Astato, Blanc Mesnil (France); Josserand, O. [Carrier (Belgium); Lancieux, C. [Camfil, 60 - Saint Martin Longueau (France); Lemaire, J.C. [Agence de l' Environnement et de la Maitrise de l' Energie, ADEME, 75 - Paris (France); Petit, Ph. [Compagnie Industrielle d' Applications Thermiques ( CIAT ), 75 - Paris (France); Ribot, B. [Electricite de France (EDF), 75 - Paris (France); Tokarek, S. [Gaz de France (GDF), 75 - Paris (France); Bernard, A.M.; Tissot, A. [Centre Technique des Industries Aerauliques et Thermiques (CETIAT), 69 - Villeurbanne (France)

    2004-07-01

    The present guide aims to provide design departments, maintenance companies and builders with practical guidelines and recommendations for the installation of ventilation and air-conditioning systems. The objective is to ensure good Indoor Air Quality (IAQ) and to safeguard the health and well-being of the occupants. The guide deals with aspects of design, dimensioning, installation and servicing, all of which play a major role in guaranteeing IAQ and duct-work hygiene. These steps are reviewed for the principal ventilation systems met in both residential and commercial premises. The first part presents the system and draws the attention of the user to specific points which require particular care in term of IAQ. The second part details recommended practice component by component, in respect of design, installation and servicing. Application of these simple guidelines during the various project stages is essential, in order to ensure a good IAQ in ventilation systems. Content: introduction; good ventilation; systems: exhaust ventilation, balanced ventilation, air handling unit, terminal ventilation units, impact of systems on indoor air quality, components: air inlet, air filter, heat recovery unit, heating or cooling coil, humidifier, mechanical fan unit, cowl and hybrid ventilation fan, mixing box, ventilation duct-work, air outlet and air terminal device; references.

  3. Ventilator-delivered mask ventilation compared with three standard methods of mask ventilation in a manikin model.

    Science.gov (United States)

    Tracy, M B; Klimek, J; Coughtrey, H; Shingde, V; Ponnampalam, G; Hinder, M; Maheshwari, R; Tracy, S K

    2011-05-01

    Little is known regarding the variations in effective ventilation during bag and mask resuscitation with standard methods compared with that delivered by ventilator-delivered mask ventilation (VDMV). To measure the variations in delivered airway pressure, tidal volume (TV), minute ventilation (MV) and inspiratory time during a 3-min period of mask ventilation comparing VDMV with three commonly used hand-delivered methods of bag and mask ventilation: Laerdal self-inflating bag (SIB); anaesthetic bag and T-piece Neopuff. A modified resuscitation manikin was used to measure variation in mechanical ventilation during 3-min periods of mask ventilation. Thirty-six experienced practitioners gave positive pressure mask ventilation targeting acceptable chest wall movement with a rate of 60 inflations/min and when pressures could be targeted or set, a peak inspiratory pressure (PIP) of 18 cm water, positive end-expiratory pressure (PEEP) of 5 cm water, for 3 min with each of the four mask ventilation methods. Each mode was randomly sequenced. A total of 21 136 inflations were recorded and analysed. VDMV achieved PIP and PEEP closest to that targeted and significantly lower variation in all measured parameters (pventilation on a manikin, VDMV produced the least variation in delivered ventilation. SIB produced wide variation and unacceptably high TV and MV in experienced hands.

  4. 45 CFR 2506.5 - If a debt is not excluded from these regulations, may it be compromised, suspended, terminated...

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false If a debt is not excluded from these regulations, may it be compromised, suspended, terminated, or waived? 2506.5 Section 2506.5 Public Welfare Regulations Relating to Public Welfare (Continued) CORPORATION FOR NATIONAL AND COMMUNITY SERVICE COLLECTION...

  5. Volume-Targeted Ventilation in the Neonate: Benchmarking Ventilators on an Active Lung Model.

    Science.gov (United States)

    Krieger, Tobias J; Wald, Martin

    2017-03-01

    Mechanically ventilated neonates have been observed to receive substantially different ventilation after switching ventilator models, despite identical ventilator settings. This study aims at establishing the range of output variability among 10 neonatal ventilators under various breathing conditions. Relative benchmarking test of 10 neonatal ventilators on an active neonatal lung model. Neonatal ICU. Ten current neonatal ventilators. Ventilators were set identically to flow-triggered, synchronized, volume-targeted, pressure-controlled, continuous mandatory ventilation and connected to a neonatal lung model. The latter was configured to simulate three patients (500, 1,500, and 3,500 g) in three breathing modes each (passive breathing, constant active breathing, and variable active breathing). Averaged across all weight conditions, the included ventilators delivered between 86% and 110% of the target tidal volume in the passive mode, between 88% and 126% during constant active breathing, and between 86% and 120% under variable active breathing. The largest relative deviation occurred during the 500 g constant active condition, where the highest output machine produced 147% of the tidal volume of the lowest output machine. All machines deviate significantly in volume output and ventilation regulation. These differences depend on ventilation type, respiratory force, and patient behavior, preventing the creation of a simple conversion table between ventilator models. Universal neonatal tidal volume targets for mechanical ventilation cannot be transferred from one ventilator to another without considering necessary adjustments.

  6. Empowering the digitally excluded: learning initiatives for (invisible groups

    Directory of Open Access Journals (Sweden)

    Jane Seale

    2012-12-01

    Full Text Available There is growing evidence that some digitally excluded groups of learners are receiving more attention than others. Discussions regarding why some digitally excluded learners are more visible than others and therefore worthy of more committed digital inclusion interventions raises important questions about how we define and conceptualise digital inclusion and digital inclusion practice; particularly in relation to empowerment. In this article, we draw on a range of research, practice and policy literature to examine two important questions: what is empowerment and in whose hands does empowerment lie? We argue that empowerment involves making informed choices about technology use, but that learners often require support- human intervention- to make these choices. However, current digital inclusion research has failed to produce a detailed critique of what constitutes empowering support from educational institutions and their staff. A lack of open and reflexive accounts of practice means that we are no closer to identifying and understanding the kinds of empowering practices that are required to challenge the kinds of prejudices, stereotypes, risk-aversiveness and low aspirations associated with the most invisible of digitally excluded learners.

  7. Influence of Persons' Movements on Ventilation Effectiveness

    DEFF Research Database (Denmark)

    Brohus, Henrik; Hyldig, Mikkel; Kamper, Simon

    2008-01-01

    Most often the ventilation effectiveness of a ventilated room is determined without considering the influence of persons´ movements. Even though the main reason for supplying the ventilation may be to create a healthy and productive environment for the occupants, their own influence...... on the ventilation is usually disregarded. This paper presents results from a systematic investigation of the movements´ influence on the ventilation effectiveness using human subjects combined with tracer gas measurements. Several typical "movements" are defined and carefully repeated to determine the influence......, even though the movements reduce the effectiveness. Furthermore, it is found that the influence of the different movements vary substantially....

  8. 32 CFR 220.6 - Certain payers excluded.

    Science.gov (United States)

    2010-07-01

    ... Uniformed Services or other authorized representative for the United States makes a determination, based on...) MISCELLANEOUS COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.6 Certain...

  9. Lung analysis in children mechanically ventilated with atelectasis after cardiac surgery

    OpenAIRE

    Nakato, Adriane Muller; Krueger,Eddy; Domingues,Adriana Maria Trevisan; Sum, Cássio Fon Ben; Schneider Junior,Bertoldo

    2015-01-01

    ABSTRACT The main objective of this study is to associate the healthy area of the lung (evaluated by radiography) with the data of respiratory mechanics in children with atelectasis after cardiac surgery, under mechanical ventilation in the assisted controlled mode. Altogether, 46 children were selected, but 16 were excluded due to irregular respiratory waves or lack of the data on arterial blood gases. A group of 30 children under assisted controlled mode were analyzed, and 10 from this grou...

  10. Clinical review: liberation from mechanical ventilation.

    Science.gov (United States)

    El-Khatib, Mohamad F; Bou-Khalil, Pierre

    2008-01-01

    Mechanical ventilation is the defining event of intensive care unit (ICU) management. Although it is a life saving intervention in patients with acute respiratory failure and other disease entities, a major goal of critical care clinicians should be to liberate patients from mechanical ventilation as early as possible to avoid the multitude of complications and risks associated with prolonged unnecessary mechanical ventilation, including ventilator induced lung injury, ventilator associated pneumonia, increased length of ICU and hospital stay, and increased cost of care delivery. This review highlights the recent developments in assessing and testing for readiness of liberation from mechanical ventilation, the etiology of weaning failure, the value of weaning protocols, and a simple practical approach for liberation from mechanical ventilation.

  11. Short-term airing by natural ventilation

    DEFF Research Database (Denmark)

    Perino, Marco; Heiselberg, Per

    2009-01-01

    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...... 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.......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...

  12. Testing of mechanical ventilators and infant incubators in healthcare institutions.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2017-12-05

    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 1y, 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 © 2017 by Daedalus Enterprises.

  14. Summary of human responses to ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Seppanen, Olli A.; Fisk, William J.

    2004-06-01

    The effects of ventilation on indoor air quality and health is a complex issue. 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 and associated risks is seldom possible. The selection of ventilation rates has to be based also on epidemiological research (e.g. Seppanen et al., 1999), laboratory and field experiments (e.g. CEN 1996, Wargocki et al., 2002a) and experience (e.g. ECA 2003). Ventilation may also have harmful effects on indoor air quality and climate if not properly designed, installed, maintained and operated as summarized by Seppdnen (2003). Ventilation may bring indoors harmful substances that deteriorate the indoor environment. Ventilation also affects air and moisture flow through the building envelope and may lead to moisture problems that deteriorate the structures of the building. Ventilation changes the pressure differences over the structures of building and may cause or prevent the infiltration of pollutants from structures or adjacent spaces. Ventilation is also in many cases used to control the thermal environment or humidity in buildings. Ventilation can be implemented with various methods which may also affect health (e.g. Seppdnen and Fisk, 2002, Wargocki et al., 2002a). In non residential buildings and hot climates, ventilation is often integrated with air-conditioning which makes the operation of ventilation system more complex. As ventilation is used for many purposes its health effects are also various and complex. This paper summarizes the current knowledge on positive and negative effects of ventilation on health and other human responses. The focus of the paper is on office-type working environment and residential buildings. In the industrial premises the problems of air quality are usually

  15. Effect of an interactive cardiopulmonary resuscitation assist device with an automated external defibrillator synchronised with a ventilator on the CPR performance of emergency medical service staff: a randomised simulation study.

    Science.gov (United States)

    Nitzschke, Rainer; Doehn, Christoph; Kersten, Jan F; Blanz, Julian; Kalwa, Tobias J; Scotti, Norman A; Kubitz, Jens C

    2017-04-04

    The present study evaluates whether the quality of advanced cardiac life support (ALS) is improved with an interactive prototype assist device. This device consists of an automated external defibrillator linked to a ventilator and provides synchronised visual and acoustic instructions for guidance through the ALS algorithm and assistance for face-mask ventilations. We compared the cardiopulmonary resuscitation (CPR) quality of emergency medical system (EMS) staff members using the study device or standard equipment in a mannequin simulation study with a prospective, controlled, randomised cross-over study design. Main outcome was the effect of the study device compared to the standard equipment and the effect of the number of prior ALS trainings of the EMS staff on the CPR quality. Data were analysed using analyses of covariance (ANCOVA) and binary logistic regression, accounting for the study design. In 106 simulations of 56 two-person rescuer teams, the mean hands-off time was 24.5% with study equipment and 23.5% with standard equipment (Difference 1.0% (95% CI: -0.4 to 2.5%); p = 0.156). With both types of equipment, the hands-off time decreased with an increasing cumulative number of previous CPR trainings (p = 0.042). The study equipment reduced the mean time until administration of adrenaline (epinephrine) by 23 s (p = 0.003) and that of amiodarone by 17 s (p = 0.016). It also increased the mean number of changes in the person doing chest compressions (0.6 per simulation; p CPR.com compared to the standard equipment (p = 0.004). With an increasing number of prior CPR trainings, the time intervals in the ALS algorithm until the defibrillations decreased with standard equipment but increased with the study device. EMS staff with limited training in CPR profit from guidance through the ALS algorithm by the study device. However, the study device somehow reduced the ALS quality of well-trained rescuers and thus can only be recommended for

  16. Long-Term Survival Rate in Patients With Acute Respiratory Failure Treated With Noninvasive Ventilation in Ordinary Wards.

    Science.gov (United States)

    Cabrini, Luca; Landoni, Giovanni; Bocchino, Speranza; Lembo, Rosalba; Monti, Giacomo; Greco, Massimiliano; Zambon, Massimo; Colombo, Sergio; Pasin, Laura; Beretta, Luigi; Zangrillo, Alberto

    2016-12-01

    Noninvasive ventilation is a life-saving technique increasingly used to treat acute respiratory failure. Noninvasive ventilation has been applied mostly in ICUs, but several reasons brought to an increasing application of noninvasive ventilation in ordinary wards. Few articles evaluated the outcomes of patients receiving noninvasive ventilation including long-term follow-up. The aim of the present study was to assess 1-year survival rate of patients treated with noninvasive ventilation outside the ICU for acute respiratory failure of heterogeneous causes and to identify the predictors of long-term mortality. Prospective, observational, pragmatic study. Ordinary wards of a teaching hospital. Consecutive patients treated with noninvasive ventilation for acute respiratory failure. None. Two-hundred and twenty-patients were enrolled. Mortality rates at 30-day, 90-days, and 1-year follow-up were 20%, 26%, and 34%. When excluding patients with "do-not-resuscitate" status, mortality rates were 13%, 19%, and 28%. The multivariate analyses identified solid cancer, pneumonia in hematologic patients, and do-not-resuscitate status as independent predictors of mortality with postoperative acute respiratory failure associated with improved survival. The same predictors were confirmed when excluding do-not-resuscitate patients from the analyses. Noninvasive ventilation applied in ordinary wards was effective, with long-term outcomes not different from those reported for ICU settings. Solid cancer, pneumonia in hematologic malignancies, and do-not-resuscitate status predicted mortality, whereas patients with postoperative acute respiratory failure had the best survival rate. Additional studies are required to evaluate noninvasive ventilation efficacy in the wards compared with ICU.

  17. Non-invasive Mechanical Ventilation Enhances Patient Autonomy in Decision-Making Regarding Chronic Ventilation.

    Science.gov (United States)

    Sviri, S; Linton, D M; van Heerden, P V

    2005-06-01

    Patients with respiratory failure due to progressive muscle weakness often require chronic ventilatory support, but many do not make decisions regarding ventilation prior to a crisis. We studied the use of non-invasive ventilation as a tool to enable communication and facilitate decision-making regarding chronic ventilation. Patients with profound muscle weakness and acute respiratory failure, were supported or weaned by non-invasive positive or negative pressure ventilation. The patients were then interviewed and their informed autonomous decisions were used to plan their future management. Non-invasive ventilation could be used safely to support patients with acute respiratory failure until decisions regarding chronic ventilation are made and as an alternative means of ventilation for those who refuse tracheostomy. Non-invasive ventilation may be used in patients with profound muscle weakness, as a means of enhancing patient autonomy by improving communication and maintaining ventilation until decisions about ongoing care are made.

  18. Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction.

    Science.gov (United States)

    Sassoon, Catherine S H; Zhu, Ercheng; Caiozzo, Vincent J

    2004-09-15

    Controlled mechanical ventilation induced a profound diaphragm muscle dysfunction and atrophy. The effects of diaphragmatic contractions with assisted mechanical ventilation on diaphragmatic isometric, isotonic contractile properties, or the expression of muscle atrophy factor-box (MAF-box), the gene responsible for muscle atrophy, are unknown. We hypothesize that assisted mechanical ventilation will preserve diaphragmatic force and prevent overexpression of MAF-box. Studying sedated rabbits randomized equally into control animals, those with 3 days of assisted ventilation, and those with controlled ventilation, we assessed in vitro diaphragmatic isometric and isotonic contractile function. The concentrations of contractile proteins, myosin heavy chain isoform, and MAF-box mRNA were measured. Tetanic force decreased by 14% with assisted ventilation and 48% with controlled ventilation. Maximum shortening velocity tended to increase with controlled compared with assisted ventilation and control. Peak power output decreased 20% with assisted ventilation and 41% with controlled ventilation. Contractile proteins were unchanged with either modes of ventilation; myosin heavy chain 2X mRNA tended to increase and that of 2A to decrease with controlled ventilation. MAF-box gene was overexpressed with controlled ventilation. We conclude that preserving diaphragmatic contractions during mechanical ventilation attenuates the force loss induced by complete inactivity and maintains MAF-box gene expression in control.

  19. Excluded volume effect enhances the homology pairing of model chromosomes

    Science.gov (United States)

    Takamiya, Kazunori; Yamamoto, Keisuke; Isami, Shuhei; Nishimori, Hiraku; Awazu, Akinori

    To investigate the structural dynamics of the homology pairing of polymers, we mod- eled the scenario of homologous chromosome pairings during meiosis in Schizosaccharomyces pombe, one of the simplest model organisms of eukaryotes. We consider a simple model consist- ing of pairs of homologous polymers with the same structures that are confined in a cylindrical container, which represents the local parts of chromosomes contained in an elongated nucleus of S. pombe. Brownian dynamics simulations of this model showed that the excluded volume effects among non-homological chromosomes and the transitional dynamics of nuclear shape serve to enhance the pairing of homologous chromosomes.

  20. Development of a Residential Integrated Ventilation Controller

    Energy Technology Data Exchange (ETDEWEB)

    Staff Scientist; Walker, Iain; Sherman, Max; Dickerhoff, Darryl

    2011-12-01

    The goal of this study was to develop a Residential Integrated Ventilation Controller (RIVEC) to reduce the energy impact of required mechanical ventilation by 20percent, maintain or improve indoor air quality and provide demand response benefits. This represents potential energy savings of about 140 GWh of electricity and 83 million therms of natural gas as well as proportional peak savings in California. The RIVEC controller is intended to meet the 2008 Title 24 requirements for residential ventilation as well as taking into account the issues of outdoor conditions, other ventilation devices (including economizers), peak demand concerns and occupant preferences. The controller is designed to manage all the residential ventilation systems that are currently available. A key innovation in this controller is the ability to implement the concept of efficacy and intermittent ventilation which allows time shifting of ventilation. Using this approach ventilation can be shifted away from times of high cost or high outdoor pollution towards times when it is cheaper and more effective. Simulations, based on the ones used to develop the new residential ventilation requirements for the California Buildings Energy code, were used to further define the specific criteria and strategies needed for the controller. These simulations provide estimates of the energy, peak power and contaminant improvement possible for different California climates for the various ventilation systems. Results from a field test of the prototype controller corroborate the predicted performance.

  1. Emergency medicine residents' knowledge of mechanical ventilation.

    Science.gov (United States)

    Wilcox, Susan R; Seigel, Todd A; Strout, Tania D; Schneider, Jeffrey I; Mitchell, Patricia M; Marcolini, Evie G; Cocchi, Michael N; Smithline, Howard A; Lutfy-Clayton, Lucienne; Mullen, Marie; Ilgen, Jonathan S; Richards, Jeremy B

    2015-04-01

    Although Emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) residency curricula. The objective of this study was to quantify EM residents' education, experience, and knowledge regarding mechanical ventilation. We developed a survey of residents' educational experiences with ventilators and an assessment tool with nine clinical questions. Correlation and regression analyses were performed to evaluate the relationship between residents' scores on the assessment instrument and their training, education, and comfort with ventilation. Of 312 EM residents, 218 responded (69.9%). The overall correct response rate for the assessment tool was 73.3%, standard deviation (SD) ± 22.3. Seventy-seven percent (n = 167) of respondents reported ≤ 3 h of mechanical ventilation education in their residency curricula over the past year. Residents reported frequently caring for ventilated patients in the ED, as 64% (n = 139) recalled caring for ≥ 4 ventilated patients per month. Fifty-three percent (n = 116) of residents endorsed feeling comfortable caring for mechanically ventilated ED patients. In multiregression analysis, the only significant predictor of total test score was residents' comfort with caring for mechanically ventilated patients (F = 10.963, p = 0.001). EM residents report caring for mechanically ventilated patients frequently, but receive little education on mechanical ventilation. Furthermore, as residents' performance on the assessment tool is only correlated with their self-reported comfort with caring for ventilated patients, these results demonstrate an opportunity for increased educational focus on mechanical ventilation management in EM residency training. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Paediatric ventilation treatment of acute lung injury in Nordic intensive care units.

    Science.gov (United States)

    Jensen, L L; Baratt-Due, A; Englund, P N; Harju, J A; Sigurðsson, T S; Liberg, J-P

    2015-05-01

    Treatment of acute respiratory distress syndrome (ARDS) in children is largely based on extrapolated knowledge obtained from adults and which varies between different hospitals. This study explores ventilation treatment strategies for children with ARDS in the Nordic countries, and compares these with international practice. In October 2012, a questionnaire covering ventilation treatment strategies for children aged 1 month to 6 years of age with ARDS was sent to 21 large Nordic intensive care units that treat children with ARDS. Pre-terms and children with congenital conditions were excluded. Eighteen of the 21 (86%) targeted intensive care units responded to the questionnaire. Fifty per cent of these facilities were paediatric intensive care units. Written guidelines existed in 44% of the units. Fifty per cent of the units frequently used cuffed endotracheal tubes. Ventilation was achieved by pressure control for 89% vs. volume control for 11% of units. Bronchodilators were used by all units, whereas steroids usage was 83% and surfactant 39%. Inhaled nitric oxide and high frequency oscillation were available in 94% of the units. Neurally adjusted ventilator assist was used by 44% of the units. Extracorporeal membrane oxygenation could be started in 44% of the units. Ventilation treatment strategies for paediatric ARDS in the Nordic countries are relatively uniform and largely in accordance with international practice. The use of steroids and surfactant is more frequent than shown in other studies. © 2015 The Authors. The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  3. 48 CFR 52.247-7 - Freight Excluded.

    Science.gov (United States)

    2010-10-01

    ... package carrier; shipments of unusual value, explosives and other dangerous articles, household goods... contracts for transportation or for transportation-related services when any commodities or types of...

  4. Diffusion of multiple species with excluded-volume effects

    KAUST Repository

    Bruna, Maria

    2012-01-01

    Stochastic models of diffusion with excluded-volume effects are used to model many biological and physical systems at a discrete level. The average properties of the population may be described by a continuum model based on partial differential equations. In this paper we consider multiple interacting subpopulations/species and study how the inter-species competition emerges at the population level. Each individual is described as a finite-size hard core interacting particle undergoing Brownian motion. The link between the discrete stochastic equations of motion and the continuum model is considered systematically using the method of matched asymptotic expansions. The system for two species leads to a nonlinear cross-diffusion system for each subpopulation, which captures the enhancement of the effective diffusion rate due to excluded-volume interactions between particles of the same species, and the diminishment due to particles of the other species. This model can explain two alternative notions of the diffusion coefficient that are often confounded, namely collective diffusion and self-diffusion. Simulations of the discrete system show good agreement with the analytic results. © 2012 American Institute of Physics.

  5. HLA region excluded by linkage analyses of early onset periodontitis

    Energy Technology Data Exchange (ETDEWEB)

    Sun, C.; Wang, S.; Lopez, N.

    1994-09-01

    Previous studies suggested that HLA genes may influence susceptibility to early-onset periodontitis (EOP). Segregation analyses indicate that EOP may be due to a single major gene. We conducted linkage analyses to assess possible HLA effects on EOP. Fifty families with two or more close relatives affected by EOP were ascertained in Virginia and Chile. A microsatellite polymorphism within the HLA region (at the tumor necrosis factor beta locus) was typed using PCR. Linkage analyses used a donimant model most strongly supported by previous studies. Assuming locus homogeneity, our results exclude a susceptibility gene within 10 cM on either side of our marker locus. This encompasses all of the HLA region. Analyses assuming alternative models gave qualitatively similar results. Allowing for locus heterogeneity, our data still provide no support for HLA-region involvement. However, our data do not statistically exclude (LOD <-2.0) hypotheses of disease-locus heterogeneity, including models where up to half of our families could contain an EOP disease gene located in the HLA region. This is due to the limited power of even our relatively large collection of families and the inherent difficulties of mapping genes for disorders that have complex and heterogeneous etiologies. Additional statistical analyses, recruitment of families, and typing of flanking DNA markers are planned to more conclusively address these issues with respect to the HLA region and other candidate locations in the human genome. Additional results for markers covering most of the human genome will also be presented.

  6. Particle deposition in ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sippola, Mark Raymond [Univ. of California, Berkeley, CA (United States)

    2002-09-01

    Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 μm were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on the

  7. Airflow Sensitivity Assessment Based on Underground Mine Ventilation Systems Modeling

    Directory of Open Access Journals (Sweden)

    Wacław Dziurzyński

    2017-09-01

    Full Text Available This paper presents a method for determining the sensitivity of the main air flow directions in ventilation subnetworks to changes in aerodynamic resistance and air density in mine workings. The authors have developed formulae for determining the sensitivity of the main subnetwork air flows by establishing the degree of dependency of the air volume stream in a given working on the variations in resistance or air density of other workings of the network. They have been implemented in the Ventgraph mine ventilation network simulator. This software, widely used in Polish collieries, provides an extended possibility to predict the process of ventilation, air distribution and, in the case of underground fire, the spread of combustion gasses. The new method facilitates an assessment by mine ventilation services of the stability of ventilation systems in exploitation areas and determines the sensitivity of the main subnetwork air flow directions to changes in aerodynamic resistance and air density. Recently in some Polish collieries new longwalls are developed in seams located deeper than the bottom of the intake shaft. Such a solution is called “exploitation below the level of access” or “sublevel”. The new approach may be applied to such developments to assess the potential of changes in direction and air flow rates. In addition, an interpretation of the developed sensitivity indicator is presented. While analyzing air distributions for sublevel exploitation, the application of current numerical models for calculations of the distribution results in tangible benefits, such as the evaluation of the safety or risk levels for such exploitation. Application of the Ventgraph computer program, and particularly the module POŻAR (fire with the newly developed options, allows for an additional approach to the sensitivity indicator in evaluating air flow safety levels for the risks present during exploitation below the level of the intake shaft. The

  8. Effect of body position on ventilation distribution in ventilated preterm infants.

    Science.gov (United States)

    Hough, Judith L; Johnston, Leanne; Brauer, Sandy; Woodgate, Paul; Schibler, Andreas

    2013-02-01

    Positioning is considered vital to the maintenance of good lung ventilation by optimizing oxygen transport and gas exchange in ventilated premature infants. Previous studies suggest that the prone position is advantageous; however, no data exist on regional ventilation distribution for this age group. To investigate the effect of body position on regional ventilation distribution in ventilated and nonventilated preterm infants using electrical impedance tomography. Randomized crossover study design. Neonatal ICU. A total of 24 ventilated preterm infants were compared with six spontaneously breathing preterm infants. Random assignment of the order of the positions supine, prone, and quarter prone. Ventilation distribution was measured with regional impedance amplitudes and global inhomogeneity indices using electrical impedance tomography. In the spontaneously breathing infants, regional impedance amplitudes were increased in the posterior compared with the anterior lung (p < 0.01) and in the right compared with the left lung (p = 0.03). No differences were found in the ventilated infants. Ventilation was more inhomogeneous in the ventilated compared with the healthy infants (p < 0.01). Assessment of temporal regional lung filling showed that the posterior lung filled earlier than the anterior lung in the spontaneously breathing infants (p < 0.02) whereas in the in the ventilated infants the right lung filled before the left lung (p < 0.01). In contrast to previous studies showing that ventilation is distributed to the nondependent lung in infants and children, this study shows that gravity has little effect on regional ventilation distribution.

  9. Comparison of Active and Passive Humidifiers on Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    H. Dilek Mersin Özcanoğlu

    2010-12-01

    Full Text Available Objective: To research the effectiveness on humidifying, respiratory mechanics, bacterial colonization and infection rates of continuous usage for 96 hours of active and passive humidifiers which are used for heating and moisturizing the inspired gases in patients under mechanical ventilation. Materials and Methods: Adult patients who are expected to support at least 4 days under mechanical ventilation, excluding patients with primary lung disease and sepsis, are included in the research. Patients are separated in two groups as a passive humidifier group (heat moisture exchange filter (n=16 and an active humidifier group (n=14. In passive humidifier group, humidifier is used continuously for 96 hours without change. In active humidifier group moisturizing is obtained by using sterile distilled water in heated humidifier. Patients whose demographic characteristics were recorded and first 24 hour APACHE II scores were calculated, were taking chest X-Ray’s daily. Respiratory mechanics measurements were recorded twice a day which were watched in Servo300A ventilators respiratory mechanics monitor, in patients under volume controlled ventilation. The amount of moisture and liquidity of the secretion in endotracheal tube were recorded and scored visually. The endotracheal aspiration samples at the beginning and at the end of 96th hour and respiratory circuits ventilator side sample taken at 96th hour were studied microbiologically. Cultures and colonial counts were studied at Cerrahpasa Medical Faculty Microbiology Laboratory. Results: There were no significant difference in two groups by demographic data, APACHE II scores and illness diagnoses. In passive humidifier group, respiratory mechanics showed no significant difference between the beginning and the 4th day (p>0.05. In active humidifier group when MAP, PEEPtot, EEF, Rins, Rexp values showed no significant difference between the beginning and the 4th day but PIP values showed significant

  10. 5 CFR 894.302 - What is an excluded position?

    Science.gov (United States)

    2010-01-01

    ... Farm Credit Administration, if private interests elect or appoint a member of the board of directors... September 30, 1979, by service in an Executive agency, the United States Postal Service, or the Smithsonian... employee (a non-full-time employee without a prearranged regular tour of duty). (h) A beneficiary or...

  11. 42 CFR 412.27 - Excluded psychiatric units: Additional requirements.

    Science.gov (United States)

    2010-10-01

    ... personnel, psychological services, social work services, psychiatric nursing, and therapeutic activities. (c... of assessment/diagnostic data. Medical records must stress the psychiatric components of the record... health nursing, or its equivalent, from a school of nursing accredited by the National League for Nursing...

  12. Demand controlled ventilation in a bathroom

    DEFF Research Database (Denmark)

    Mortensen, Dorthe Kragsig; Nielsen, Toke Rammer; Topp, Claus

    2008-01-01

    consumption during periods where the demand for ventilation is low and poor indoor climate during periods where the demand for ventilation is high. Controlling the ventilation rate by demand can improve the energy performance of the ventilation system and the indoor climate. This paper compares the indoor...... climate and energy consumption of a Constant Air Volume (CAV) system and a Demand Controlled Ventilation (DCV) system for two different bathroom designs. The air change rate of the CAV system corresponded to 0.5h-1. The ventilation rate of the DCV system was controlled by occupancy and by the relative....... The indoor climate and the energy consumption were estimated based on a simplified calculation of the variation of the water content within the bathroom during a day. The results showed that the DCV system controlled by occupancy and relative humidity had an improved energy performance and an improved indoor...

  13. Noninvasive ventilation for acute respiratory failure.

    Science.gov (United States)

    Jasmer, R M; Matthay, M A

    2000-01-01

    Noninvasive ventilation refers to any form of ventilatory support applied without the use of an endotracheal tube. It offers the potential to provide primary treatment for acute respiratory failure while avoiding complications associated with mechanical ventilation with endotracheal intubation. Noninvasive ventilation has been most commonly studied in hypercapnic respiratory failure. A review of randomized, controlled studies shows mixed results and methodologic limitations affect the interpretation of current evidence. Patient selection is clearly the most important issue in considering noninvasive ventilation for acute respiratory failure. Unfortunately, patients who benefit from noninvasive ventilation represent only a minority of the total group with any one disease, and thus it is difficult to make broad conclusions concerning applicability of this treatment modality. Future studies are needed to focus on determining the specific patient populations who will benefit the most, evaluating the optimal ventilatory mode and mask for providing noninvasive ventilation, and clarifying its impact on clinical outcomes.

  14. Patient-ventilator asynchrony during noninvasive ventilation: a bench and clinical study

    National Research Council Canada - National Science Library

    Carteaux, Guillaume; Lyazidi, Aissam; Cordoba-Izquierdo, Ana; Vignaux, Laurence; Jolliet, Philippe; Thille, Arnaud W; Richard, Jean-Christophe M; Brochard, Laurent

    2012-01-01

    ...—and dedicated NIV ventilators. First, a bench model simulating spontaneous breathing efforts was used to assess the respective impact of inspiratory and expiratory leaks on cycling and triggering functions in 19 ventilators...

  15. Luftkvalitet i nyere skoler uden mekanisk ventilation

    DEFF Research Database (Denmark)

    Aggerholm, Søren

    I skoler uden mekanisk ventilation må der udluftes konsekvent for at forbedre luftkvaliteten. Rapporten viser resultatet af målinger af kuldioxidkoncentrationen i fire skoler uden mekanisk ventilation og én skole med mekanisk udsugning. Kuldioxidkoncentrationen er brugt som indikator...... for luftkvaliteten. Rapporten beskriver desuden de energimæssige konsekvenser ved at etablere mekanisk ventilation. Resultaterne har især interesse for skoleforvaltninger og rådgivende teknikere....

  16. Predicting Ventilation Failure in Children with Inhalation Injury.

    Science.gov (United States)

    1994-08-01

    tracheobron- supported adequately by mechanical ventilation would chitis and oxygenation abnormalities after 2 to 4 weeks of allow rapid enrollment of...these patients in trials of mechanical ventilation . Ventilatory indexes obtained early in new support techniques such as extracorporeal CO2 the...not be adequately supported by mechanical ventilation after smoke monary ventilation , combined liquid-gas ventilation , inhalation injury. Early

  17. Decision-making processes of weaning from mechanical ventilation: a comparative ethnographic insight into the dynamics of the decision-making environment

    OpenAIRE

    Kydonaki, Kalliopi

    2011-01-01

    Many critical clinical conditions result in respiratory failure and precipitate the use of mechanical ventilation for their management. A prolonged period of mechanical ventilation is costly for both the patient, in terms of adverse effects, and the health care service. Therefore, immediate liberation of the patient from mechanical ventilation and constitution of spontaneous breathing, a process called weaning, is vital. This daily lifesaving practice, on which nurses are takin...

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

    Science.gov (United States)

    2010-01-01

    care units, high-frequency percussive ventilation is preferentially used to provide mechanical ventilation in support of patients with acute lung... mechanical ventilation were admitted to the burn intensive care unit. The study was conducted over a 3-yr period between April 2006 and May 2009. This trial...was registered with ClinicalTrials.gov as NCT00351741. Interventions: Subjects were randomly assigned to receive mechanical ventilation through a high

  19. Comparison of Work of Breathing During Mechanical Ventilation Using Assist Control and Intermittent Mandatory Ventilation

    Science.gov (United States)

    1994-07-19

    AD-A285 516 AD MIPR NO: 92MM2539 TITLE: COMPARISON OF WORK OF BREATHING DURING MECHANICAL VENTILATION USING ASSIST CONTROL AND INTERMITTENT MANDATORY...1993, for the subject MIPR, titled: Comparison of Work of Breathing During Mechanical Ventilation Using Assist Control and Intermittent Mandatory...MIPR 92MM2539, titled: Comparison of Work of Breathing During Mechanical Ventilation Using Assist Control and Intermittent Mandatory Ventilation . 2

  20. Neurally adjusted ventilatory assist: a ventilation tool or a ventilation toy?

    Science.gov (United States)

    Verbrugghe, Walter; Jorens, Philippe G

    2011-03-01

    Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to various modes of assisted ventilation. Neurally adjusted ventilatory assist (NAVA) is the newest development. The implementation of NAVA requires the introduction of a catheter to measure the electrical activity of the diaphragm (EA(di)). NAVA relies, opposite to conventional assisted ventilation modes, on the EA(di) to trigger the ventilator breath and to adjust the ventilatory assist to the neural drive. The amplitude of the ventilator assist is determined by the instantaneous EA(di) and the NAVA level set by the clinician. The NAVA level amplifies the EA(di) signal and determines instantaneous ventilator assist on a breath-to-breath basis. Experimental and clinical data suggest superior patient-ventilator synchrony with NAVA. Patient-ventilator asynchrony is present in 25% of mechanically ventilated patients in the intensive care unit and may contribute to patient discomfort, sleep fragmentation, higher use of sedation, development of delirium, ventilator-induced lung injury, prolonged mechanical ventilation, and ultimately mortality. With NAVA, the reliance on the EA(di) signal, together with an intact ventilatory drive and intact breathing reflexes, allows integration of the ventilator in the neuro-ventilatory coupling on a higher level than conventional ventilation modes. The simple monitoring of the EA(di) signal alone may provide the clinician with important information to guide ventilator management, especially during the weaning process. Although, until now, little evidence proves the superiority of NAVA on clinically relevant end points, it seems evident that patient populations (eg, COPD and small children) with major patient-ventilator asynchrony may benefit from this new ventilatory tool.

  1. A Contemporary Assessment of Acute Mechanical Ventilation in Beijing: Description, Costs, and Outcomes.

    Science.gov (United States)

    Ye, Yanping; Zhu, Bo; Jiang, Li; Jiang, Qi; Wang, Meiping; Hua, Lin; Xi, Xiuming

    2017-07-01

    To evaluate the contemporary practice, outcomes, and costs related to mechanical ventilation among ICUs in China. A prospective observational cohort study. Fourteen ICUs among 13 hospitals in Beijing, China. Seven hundred ninety-three patients who received at least 24 hours of mechanical ventilation within the first 48 hours of ICU stay. None. The mean age was 64 years. Sixty-three percent were male. New acute respiratory failure accounted for 85.5% of mechanical ventilation cases. Only 4.7% of the patients received mechanical ventilation for acute exacerbation of chronic obstructive pulmonary disease. The most widely used ventilation mode was the combination of synchronized intermittent mandatory ventilation and pressure support (43.6%). Use of lung-protective ventilation is widespread with tidal volumes of 7.1 mL/kg (2.1 mL/kg). The ICU/hospital mortality was 27.6%/29.3%, respectively (8.5%/9.7% for surgical patients and 41.3%/43.2% for medical patients, respectively). The mean level of ICU/hospital cost per patient was $15,271 (18,940)/$22,946 (25,575), respectively. The mean daily ICU cost per patient was $1,212. For the first time, we obtained a preliminary epidemiology data of mechanical ventilation in Beijing, China, through the study. Compared with the other nations, our patients are older, predominantly male, and treated according to prevailing international guidelines yet at a relatively high cost and high mortality. The expanding elderly population predicts increase demand for mechanical ventilation that must be met by continuous improvement in quality and efficiency of critical care services.

  2. Concentration Distribution in a Mixing Ventilated Room

    DEFF Research Database (Denmark)

    Jensen, Rasmus Lund; Pedersen, D. N.; Nielsen, Peter Vilhelm

    2001-01-01

    Today there is an increasing focus on the importance of a proper ventilation system to obtain good working conditions in the term of air and thermal quality to ensure high productivity. Different ventilation principles are used, e.g., mixing ventilation and displacement ventilation. In order....... Full scale experiments along with a breathing thermal manikin (BTM) have been used. The results show that the location of the sources is of great importance, just as well as temperature differences. Furthermore, the concentration in the breathing zone showed large differences throughout the room....

  3. Sleep and Mechanical Ventilation in Critical Care.

    Science.gov (United States)

    Blissitt, Patricia A

    2016-06-01

    Sleep disturbances in critically ill mechanically ventilated patients are common. Although many factors may potentially contribute to sleep loss in critical care, issues around mechanical ventilation are among the more complex. Sleep deprivation has systemic effects that may prolong the need for mechanical ventilation and length of stay in critical care and result in worse outcomes. This article provides a brief review of the physiology of sleep, physiologic changes in breathing associated with sleep, and the impact of mechanical ventilation on sleep. A summary of the issues regarding research studies to date is also included. Recommendations for the critical care nurse are provided. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Mechanical ventilation of the anesthetized patient.

    Science.gov (United States)

    Damico, Nicole K

    2015-03-01

    Patients who require general anesthesia to undergo a surgical procedure often require mechanical ventilation during the perioperative period. Ventilators incorporated into modern anesthesia machines offer various options for patient management. The unique effects of general anesthesia and surgery on pulmonary physiology must be considered when selecting an individualized plan for mechanical ventilation during the perioperative period. In this article, the pulmonary effects of general anesthesia are reviewed and available options for mechanical ventilation of the anesthetized patient during the perioperative period are presented. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Concentration Distribution in a Mixing Ventilated Room

    DEFF Research Database (Denmark)

    Jensen, Rasmus Lund; Pedersen, D.N.; Nielsen, Peter V.

    2001-01-01

    Today there is an increasing focus on the importance of a proper ventilation system to obtain good working conditions in the term of air and thermal quality to ensure high productivity. Different ventilation principles are used, e.g., mixing ventilation and displacement ventilation. In order...... that the air is fully mixed. The objective of this work is to determine the influence of the location of a pollutant, temperature differences and whether the room is furnished or not. It is also investigated if it is sufficient to determine the mean concentration in the room to determine the personal exposure...

  6. Fractal nature of regional ventilation distribution.

    Science.gov (United States)

    Altemeier, W A; McKinney, S; Glenny, R W

    2000-05-01

    High-resolution measurements of pulmonary perfusion reveal substantial spatial heterogeneity that is fractally distributed. This observation led to the hypothesis that the vascular tree is the principal determinant of regional blood flow. Recent studies using aerosol deposition show similar ventilation heterogeneity that is closely correlated with perfusion. We hypothesize that ventilation has fractal characteristics similar to blood flow. We measured regional ventilation and perfusion with aerosolized and injected fluorescent microspheres in six anesthetized, mechanically ventilated pigs in both prone and supine postures. Adjacent regions were clustered into progressively larger groups. Coefficients of variation were calculated for each cluster size to determine fractal dimensions. At the smallest size lung piece, local ventilation and perfusion are highly correlated, with no significant difference between ventilation and perfusion heterogeneity. On average, the fractal dimension of ventilation is 1.16 in the prone posture and 1. 09 in the supine posture. Ventilation has fractal properties similar to perfusion. Efficient gas exchange is preserved, despite ventilation and perfusion heterogeneity, through close correlation. One potential explanation is the similar geometry of bronchial and vascular structures.

  7. [VENTILOP survey. Survey in peroperative mechanical ventilation].

    Science.gov (United States)

    Fischer, F; Collange, O; Mahoudeau, G; Simon, M; Moussa, H; Thibaud, A; Steib, A; Pottecher, T; Mertes, M

    2014-06-01

    Mechanical ventilation can initiate ventilator-associated lung injury and postoperative pulmonary complications. The aim of this study was to evaluate (1) how mechanical ventilation was comprehended by anaesthetists (physician and nurses) and (2) the need for educational programs. A computing questionnary was sent by electronic-mail to the entire anaesthetist from Alsace region in France (297 physicians), and to a pool of 99 nurse anaesthetists. Mechanical ventilation during anaesthesia was considered as optimized when low tidal volume (6-8mL) of ideal body weight was associated with positive end expiratory pressure, FiO2 less than 50%, I/E adjustment and recruitment maneuvers. The participation rate was 50.5% (172 professionals). Only 2.3% of professionals used the five parameters for optimized ventilation. Majority of professionals considered that mechanical ventilation adjustment influenced the patients' postoperative outcome. Majority of the professionals asked for a specific educational program in the field of mechanical ventilation. Only 2.3% of professionals optimized mechanical ventilation during anaesthesia. Guidelines and specific educational programs in the field of mechanical ventilation are widely expected. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  8. Boundary conditions for the use of personal ventilation over mixing ventilation in open plan offices

    DEFF Research Database (Denmark)

    Petersen, Steffen; Hviid, Christian Anker

    2013-01-01

    This paper investigates the boundary conditions for choosing a combined Personal Ventilation (PV) and Mixing Ventilation (MV) over conventional mixing ventilation in an office with multiple workers. A simplified procedure for annual performance assessment of PV/MV systems in terms of air quality,...

  9. Ventilation strategies and outcome in randomised trials of high frequency ventilation

    OpenAIRE

    Thome, U; Carlo, W; Pohlandt, F

    2005-01-01

    Objective: Randomised controlled trials comparing elective use of high frequency ventilation (HFV) with conventional mechanical ventilation (CMV) in preterm infants have yielded conflicting results. We hypothesised that the variability of results may be explained by differences in study design, ventilation strategies, delay in initiation of HFV, and use of permissive hypercapnia.

  10. ROV inspection inside ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sharp, R.E.; Street, P.F.; Cole, G.V. [AEA Technology, Harwell (United Kingdom)

    1996-12-31

    An instrumentation package for carrying out visual inspections and radiation monitoring within radioactive duct-work has been developed. This paper describes the first application of the package in the main ventilation duct of the Dounreay fuel cycle area. The package was deployed via a commerical ROV within a duct consisting of two parallel runs, over 300 metres long, between 0.9 and 1.7 metres high and 1.1 metres wide. An integrated, computer-controlled station was used for data collection, recording in digital form and on video tape. (Author).

  11. [Cases and duration of mechanical ventilation in German hospitals : An analysis of DRG incentives and developments in respiratory medicine].

    Science.gov (United States)

    Biermann, A; Geissler, A

    2016-09-01

    Diagnosis-related groups (DRGs) have been used to reimburse hospitals services in Germany since 2003/04. Like any other reimbursement system, DRGs offer specific incentives for hospitals that may lead to unintended consequences for patients. In the German context, specific procedures and their documentation are suspected to be primarily performed to increase hospital revenues. Mechanical ventilation of patients and particularly the duration of ventilation, which is an important variable for the DRG-classification, are often discussed to be among these procedures. The aim of this study was to examine incentives created by the German DRG-based payment system with regard to mechanical ventilation and to identify factors that explain the considerable increase of mechanically ventilated patients in recent years. Moreover, the assumption that hospitals perform mechanical ventilation in order to gain economic benefits was examined. In order to gain insights on the development of the number of mechanically ventilated patients, patient-level data provided by the German Federal Statistical Office and the German Institute for the Hospital Remuneration System were analyzed. The type of performed ventilation, the total number of ventilation hours, the age distribution, mortality and the DRG distribution for mechanical ventilation were calculated, using methods of descriptive and inferential statistics. Furthermore, changes in DRG-definitions and changes in respiratory medicine were compared for the years 2005-2012. Since the introduction of the DRG-based payment system in Germany, the hours of ventilation and the number of mechanically ventilated patients have substantially increased, while mortality has decreased. During the same period there has been a switch to less invasive ventilation methods. The age distribution has shifted to higher age-groups. A ventilation duration determined by DRG definitions could not be found. Due to advances in respiratory medicine, new

  12. Aerosol delivery with two ventilation modes during mechanical ventilation: a randomized study.

    Science.gov (United States)

    Dugernier, Jonathan; Reychler, Gregory; Wittebole, Xavier; Roeseler, Jean; Depoortere, Virginie; Sottiaux, Thierry; Michotte, Jean-Bernard; Vanbever, Rita; Dugernier, Thierry; Goffette, Pierre; Docquier, Marie-Agnes; Raftopoulos, Christian; Hantson, Philippe; Jamar, François; Laterre, Pierre-François

    2016-12-01

    Volume-controlled ventilation has been suggested to optimize lung deposition during nebulization although promoting spontaneous ventilation is targeted to avoid ventilator-induced diaphragmatic dysfunction. Comparing topographic aerosol lung deposition during volume-controlled ventilation and spontaneous ventilation in pressure support has never been performed. The aim of this study was to compare lung deposition of a radiolabeled aerosol generated with a vibrating-mesh nebulizer during invasive mechanical ventilation, with two modes: pressure support ventilation and volume-controlled ventilation. Seventeen postoperative neurosurgery patients without pulmonary disease were randomly ventilated in pressure support or volume-controlled ventilation. Diethylenetriaminepentaacetic acid labeled with technetium-99m (2 mCi/3 mL) was administrated using a vibrating-mesh nebulizer (Aerogen Solo(®), provided by Aerogen Ltd, Galway, Ireland) connected to the endotracheal tube. Pulmonary and extrapulmonary particles deposition was analyzed using planar scintigraphy. Lung deposition was 10.5 ± 3.0 and 15.1 ± 5.0 % of the nominal dose during pressure support and volume-controlled ventilation, respectively (p ventilation (27.4 ± 6.6 vs. 20.7 ± 6.0 %, p ventilation modes. A high intersubject variability of lung deposition was observed with both modes regarding lung doses, aerosol penetration and distribution between the right and the left lung. In the specific conditions of the study, volume-controlled ventilation was associated with higher lung deposition of nebulized particles as compared to pressure support ventilation. The clinical benefit of this effect warrants further studies. Clinical trial registration NCT01879488.

  13. Frequently Asked Questions about Ventilator-Associated Pneumonia

    Science.gov (United States)

    ... Vaccine Safety Frequently Asked Questions about Ventilator-associated Pneumonia Recommend on Facebook Tweet Share Compartir What is a Ventilator-associated Pneumonia (VAP)? Ventilator-associated pneumonia (VAP) is a lung ...

  14. Performances of domiciliary ventilators compared by using a parametric procedure

    Directory of Open Access Journals (Sweden)

    Fresnel Emeline

    2016-12-01

    Performances of domiciliary ventilators strongly depend not only on the breathing dynamics but also on the ventilator strategy. One given ventilator may be more adequate than another one for a given patient.

  15. Neuromuscular paralysis for newborn infants receiving mechanical ventilation

    NARCIS (Netherlands)

    Cools, F.; Offringa, M.

    2005-01-01

    BACKGROUND: Ventilated newborn infants breathing in asynchrony with the ventilator are at risk for complications during mechanical ventilation, such as pneumothorax or intraventricular hemorrhage, and are exposed to more severe barotrauma, which consequently could impair their clinical outcome.

  16. Hypercapnia attenuates ventilator-induced diaphragm atrophy and modulates dysfunction

    NARCIS (Netherlands)

    Schellekens, W.J.M.; Hees, H.W.H. van; Kox, M.; Linkels, M.; Acuna, G.L.; Dekhuijzen, P.N.R.; Scheffer, G.J.; Hoeven, J.G. van der; Heunks, L.M.A.

    2014-01-01

    INTRODUCTION: Diaphragm weakness induced by prolonged mechanical ventilation may contribute to difficult weaning from the ventilator. Hypercapnia is an accepted side effect of low tidal volume mechanical ventilation, but the effects of hypercapnia on respiratory muscle function are largely unknown.

  17. Trends in mechanical ventilation: are we ventilating our patients in the best possible way?

    Directory of Open Access Journals (Sweden)

    Raffaele L. Dellaca’

    2017-06-01

    To learn how mechanical ventilation developed in recent decades and to provide a better understanding of the actual technology and practice. To learn how and why interdisciplinary research and competences are necessary for providing the best ventilation treatment to patients. To understand which are the most relevant technical limitations in modern mechanical ventilators that can affect their performance in delivery of the treatment. To better understand and classify ventilation modes. To learn the classification, benefits, drawbacks and future perspectives of automatic ventilation tailoring algorithms.

  18. Thermal comfort of seated occupants in rooms with personalized ventilation combined with mixing or displacement ventilation

    DEFF Research Database (Denmark)

    Forejt, L.; Melikov, Arsen Krikor; Cermak, Radim

    2004-01-01

    The performance of two personalized ventilation systems combined with mixing or displacement ventilation was studied under different conditions in regard to thermal comfort of seated occupants. The cooling performance of personalized ventilation was found to be independent of room air distribution....... Differences between the personalized air terminal devices were identified in terms of the cooling distribution over the manikin¿s body. The personalized ventilation supplying air from the front towards the face provided a more uniform cooling of the body than the personalized ventilation supplying air from...

  19. History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury.

    Science.gov (United States)

    Slutsky, Arthur S

    2015-05-15

    Mechanical ventilation is a life-saving therapy that catalyzed the development of modern intensive care units. The origins of modern mechanical ventilation can be traced back about five centuries to the seminal work of Andreas Vesalius. This article is a short history of mechanical ventilation, tracing its origins over the centuries to the present day. One of the great advances in ventilatory support over the past few decades has been the development of lung-protective ventilatory strategies, based on our understanding of the iatrogenic consequences of mechanical ventilation such as ventilator-induced lung injury. These strategies have markedly improved clinical outcomes in patients with respiratory failure.

  20. Rights to ecosystem services

    NARCIS (Netherlands)

    Davidson, M.

    2014-01-01

    Ecosystem services are the benefits people obtain from ecosystems. Many of these services are provided outside the borders of the land where they are produced; this article investigates who is entitled to these non-excludable ecosystem services from two libertarian perspectives. Taking a

  1. Using an epidemiological model to investigate unwarranted variation: the case of ventilation tubes for otitis media with effusion in England.

    Science.gov (United States)

    Schang, Laura; De Poli, Chiara; Airoldi, Mara; Morton, Alec; Bohm, Natalie; Lakhanpaul, Monica; Schilder, Anne; Bevan, Gwyn

    2014-10-01

    To investigate unwarranted variation in ventilation tube insertions for otitis media with effusion in children in England. This procedure is known to be 'overused' from clinical audits, as only one in three ventilation tube insertions conforms to the appropriateness criteria of the National Institute for Health and Care Excellence (NICE); but audits cannot identify the scale of 'underuse' - i.e. patients who would benefit but are not treated. To explore both 'underuse' and 'overuse' of ventilation tubes for otitis media with effusion, we developed an epidemiological model based on: definitions of children with otitis media with effusion expected to benefit from ventilation tubes according to NICE guidance; epidemiological and clinical information from a systematic review; and expert judgement. A range of estimates was derived using Monte Carlo simulation and compared with the number of ventilation tubes provided in the English National Health Service in 2010. About 32,200 children in England would be expected to benefit from ventilation tubes for otitis media with effusion per year (between 20,411 and 45,231 with 90% certainty). The observed number of ventilation tubes for otitis media with effusion-associated diagnoses was 16,824. The expected population capacity to benefit from ventilation tubes for otitis media with effusion based on NICE guidance appeared to exceed, by far, the number of ventilation tubes provided in the English National Health Service. So, while there is known 'overuse', there also may be substantial 'underuse' of ventilation tubes for otitis media with effusion if NICE criteria were applied. Future investigations of unwarranted variation should, therefore, not only focus on the patients who are treated but also consider the potential for benefit at the population level. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  2. Preoperational test report, primary ventilation system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  3. Methodology for ventilation/perfusion SPECT

    DEFF Research Database (Denmark)

    Bajc, Marika; Neilly, Brian; Miniati, Massimo

    2010-01-01

    Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the scintigraphic technique of choice for the diagnosis of pulmonary embolism and many other disorders that affect lung function. Data from recent ventilation studies show that the theoretic advantages of Technegas ov...

  4. YMP Engineered Barrier Systems Scaled Ventilation Testing

    Energy Technology Data Exchange (ETDEWEB)

    S.D. Dunn; B. Lowry; B. Walsh; J.D. Mar; C. Howard; R. Johnston; T. Williams

    2002-11-22

    Yucca Mountain, approximately 100 miles northwest of Las Vegas, Nevada, has been selected as the site for the nation's first geologic repository for high level nuclear waste. The Yucca Mountain Project (YMP) is currently developing the design for the underground facilities. Ventilation is a key component of the design as a way to maintain the desired thermal conditions in the emplacement drifts prior to closure. As a means of determining the effects of continuous ventilation on heat removal from the emplacement drifts two series of scaled ventilation tests have been performed. Both test series were performed in the DOE/North Las Vegas Atlas facility. The tests provided scaled (nominally 25% of the full scale emplacement drift design) thermal and flow process data that will be used to validate YMP heat and mass transport codes. The Phase I Ventilation Test series evaluated the ability of ambient ventilation air to remove energy under varying flow and input power conditions. The Phase II Ventilation Test series evaluated the ability of pre-conditioned ventilation air to remove energy under varying flow, input temperature and moisture content, and simulated waste package input power conditions. Twenty-two distinct ventilation tests were run.

  5. Hybrid ventilation systems and high performance buildings

    Energy Technology Data Exchange (ETDEWEB)

    Utzinger, D.M. [Wisconsin Univ., Milwaukee, WI (United States). School of Architecture and Urban Planning

    2009-07-01

    This paper described hybrid ventilation design strategies and their impact on 3 high performance buildings located in southern Wisconsin. The Hybrid ventilation systems combined occupant controlled natural ventilation with mechanical ventilation systems. Natural ventilation was shown to provide adequate ventilation when appropriately designed. Proper control integration of natural ventilation into hybrid systems was shown to reduce energy consumption in high performance buildings. This paper also described the lessons learned from the 3 buildings. The author served as energy consultant on all three projects and had the responsibility of designing and integrating the natural ventilation systems into the HVAC control strategy. A post occupancy evaluation of building energy performance has provided learning material for architecture students. The 3 buildings included the Schlitz Audubon Nature Center completed in 2003; the Urban Ecology Center completed in 2004; and the Aldo Leopold Legacy Center completed in 2007. This paper included the size, measured energy utilization intensity and percentage of energy supplied by renewable solar power and bio-fuels on site for each building. 6 refs., 2 tabs., 6 figs.

  6. Endotoxemia accelerates diaphragm dysfunction in ventilated rabbits.

    Science.gov (United States)

    Yang, Yi; Yu, Tao; Pan, Chun; Longhini, Federico; Liu, Ling; Huang, Yingzi; Guo, Fengmei; Qiu, Haibo

    2016-12-01

    Ventilators may induce diaphragm dysfunction, and most of the septic population who are admitted to the intensive care unit require mechanical ventilation. However, there is no evidence that sepsis accelerates the onset of ventilator-induced diaphragm dysfunction or affects the microcirculation. Our study investigated whether lipopolysaccharide (LPS)-induced endotoxemia accelerated diaphragm dysfunction in ventilated rabbits by evaluating microcirculation, lipid accumulation, and diaphragm contractility. After anesthesia and tracheostomy, 25 invasively monitored and mechanically ventilated New Zealand white rabbits were randomized to control (n = 5), controlled mechanical ventilation (CMV) (n = 5), pressure support ventilation (PSV; n = 5), CMV or PSV with LPS-induced endotoxemia (CMV-LPS and PSV-LPS, respectively; n = 5 for each). Rabbits were anesthetized and ventilated for 24 h, except the control rabbits (30 min). Diaphragmatic contractility was evaluated using neuromechanical and neuroventilatory efficiency. We evaluated the following at the end of the protocol: (1) diaphragm microcirculation; (2) lipid accumulation; and (3) diaphragm muscular fibers structure. Diaphragm contractility, microcirculation, lipid accumulation, and fiber structures were severely compromised in endotoxemic animals after 24 h compared to nonendotoxemic rabbits. Moreover, a slight but significant increase in lipid accumulation was observed in CMV and PSV groups compared with controls (P rabbits, affects the microcirculation, and results in diaphragmatic lipid accumulation and contractility impairment. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Simulating People Moving in Displacement Ventilated Rooms

    DEFF Research Database (Denmark)

    Mattsson, M.; Bjørn, Erik; Sandberg, M.

    A displacement ventilation system works better the more uni-directional the air flow through the ventilated room is: from floor to ceiling. Thus, from an air quality point of view, there should be as little vertical mixing of the room air as possible. It is therefore comprehensible that physical...

  8. Naturlig ventilation og træk

    DEFF Research Database (Denmark)

    Nielsen, Peter Vilhelm

    2002-01-01

    Nye ventilationsprincipper som naturlig ventilation er med til at sætte fokus på de strømningselementer, der skal anvendes til dimensionering af luftfordelingen i et rum. Artiklen anviser, hvordan træk fra vinduer og tagåbninger i rum med naturlig ventilation kan beregnes ved hjælp af...

  9. Echocardiographic evaluation during weaning from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Luciele Medianeira Schifelbain

    2011-01-01

    Full Text Available INTRODUCTION: Echocardiographic, electrocardiographic and other cardiorespiratory variables can change during weaning from mechanical ventilation. OBJECTIVES: To analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from mechanical ventilation, using two different weaning methods: pressure support ventilation and T-tube; and comparing patient subgroups: success vs. failure in weaning. METHODS: Randomized crossover clinical trial including patients under mechanical ventilation for more than 48 h and considered ready for weaning. Cardiorespiratory variables, oxygenation, electrocardiogram and Doppler echocardiogram findings were analyzed at baseline and after 30 min in pressure support ventilation and T-tube. Pressure support ventilation vs. T-tube and weaning success vs. failure were compared using ANOVA and Student's t-test. The level of significance was p<0.05. RESULTS: Twenty-four adult patients were evaluated. Seven patients failed at the first weaning attempt. No echocardiographic or electrocardiographic differences were observed between pressure support ventilation and T-tube. Weaning failure patients presented increases in left atrium, intraventricular septum thickness, posterior wall thickness and diameter of left ventricle and shorter isovolumetric relaxation time. Successfully weaned patients had higher levels of oxygenation. CONCLUSION: No differences were observed between Doppler echocardiographic variables and electrocardiographic and other cardiorespiratory variables during pressure support ventilation and T-tube. However cardiac structures were smaller, isovolumetric relaxation time was larger, and oxygenation level was greater in successfully weaned patients

  10. Carbon dioxide production during mechanical ventilation

    DEFF Research Database (Denmark)

    Henneberg, S; Söderberg, D; Groth, T

    1987-01-01

    studied CO2 production (VCO2) and oxygen consumption (VO2) in mechanically ventilated ICU patients, where CO2 stores were altered by: a) changing minute ventilation by 15%, b) reducing body temperature, and c) changing the level of sedation. Expired gases went through a mixing chamber and were analyzed...

  11. New modes of assisted mechanical ventilation.

    Science.gov (United States)

    Suarez-Sipmann, F

    2014-05-01

    Recent major advances in mechanical ventilation have resulted in new exciting modes of assisted ventilation. Compared to traditional ventilation modes such as assisted-controlled ventilation or pressure support ventilation, these new modes offer a number of physiological advantages derived from the improved patient control over the ventilator. By implementing advanced closed-loop control systems and using information on lung mechanics, respiratory muscle function and respiratory drive, these modes are specifically designed to improve patient-ventilator synchrony and reduce the work of breathing. Depending on their specific operational characteristics, these modes can assist spontaneous breathing efforts synchronically in time and magnitude, adapt to changing patient demands, implement automated weaning protocols, and introduce a more physiological variability in the breathing pattern. Clinicians have now the possibility to individualize and optimize ventilatory assistance during the complex transition from fully controlled to spontaneous assisted ventilation. The growing evidence of the physiological and clinical benefits of these new modes is favoring their progressive introduction into clinical practice. Future clinical trials should improve our understanding of these modes and help determine whether the claimed benefits result in better outcomes. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  12. Evaporation Controlled Emission in Ventilated Rooms

    DEFF Research Database (Denmark)

    Topp, Claus; Nielsen, Peter V.; Heiselberg, Per

    -scale ventilated room when the emission is fully or partly evaporation controlled. The objective of the present research work has been to investigate the change of emission rates from small-scale experiments to full-scale ventilated rooms and to investigate the influence of the local air velocity field near...

  13. Tuberculosis peer educators: personal experiences of working with socially excluded communities in London.

    Science.gov (United States)

    Croft, L A; Hayward, A C; Story, A

    2013-10-01

    Peer education is a relatively unexplored intervention for tuberculosis (TB) control, particularly among socially excluded communities. In London, peer educators are used to raise awareness of TB and promote uptake of radiological screening among people using homeless and/or drug and alcohol treatment services. To understand the motivation and personal impact of being a peer educator on people with experience of anti-tuberculosis treatment, homelessness and addiction. In-depth semi-structured interviews with peer educators were recorded and transcribed, and then analysed using a grounded theory approach to identify themes. Reflexivity and thick description were used to support transparency of findings. Becoming a peer educator supports individuals in making sense of past experiences and renewing their sense of self. The role places value on personal experience and the communication approach this supports. The project environment is an important motivator, providing the peer with structure, social support and respect. Being a peer educator with experience of homelessness and addiction can be beneficial and empowering and help long-term recovery. Peers are an underused resource for strengthening TB control among socially excluded populations. There is a need for further research into the contribution of peers to TB control, including analyses of economic effectiveness.

  14. Assisted Ventilation in Patients with Acute Respiratory Distress Syndrome: Lung-distending Pressure and Patient-Ventilator Interaction

    NARCIS (Netherlands)

    Doorduin, J.; Sinderby, C.A.; Beck, J.; Hoeven, J.G. van der; Heunks, L.M.

    2015-01-01

    BACKGROUND: In patients with acute respiratory distress syndrome (ARDS), the use of assisted mechanical ventilation is a subject of debate. Assisted ventilation has benefits over controlled ventilation, such as preserved diaphragm function and improved oxygenation. Therefore, higher level of

  15. Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia

    National Research Council Canada - National Science Library

    Choi, Jessica Siu-Ping; Jones, Alice Yee-Men

    2005-01-01

    ... in ventilator-associated pneumonia. Tracheal suction is often employed by nursing staff in the management of mechanically ventilated patients with ventilator-associated pneumonia but this technique has the potential to increase respiratory resistance...

  16. Determinants of prosocial behavior in included versus excluded contexts

    Directory of Open Access Journals (Sweden)

    Esther eCuadrado

    2016-01-01

    Full Text Available Prosocial behavior is increasingly becoming necessary as more and more individuals experience exclusion. In this context it is important to understand the motivational determinants of prosocial behavior. Here we report two experiments which analyzed the influence of dispositional (prosocialness; rejection sensitivity and motivational variables (prosocial self-efficacy; prosocial collective efficacy; trust; anger; social affiliation motivation on prosocial behavior under neutral contexts (Study 1, and once under inclusion or exclusion conditions (Study 2. Both studies provided evidence for the predicted mediation of prosocial behavior. Results in both neutral and inclusion and exclusion conditions supported our predictive model of prosocial behavior. In the model dispositional variables predicted motivational variables, which in turn predicted prosocial behavior. We showed that the investigated variables predicted prosocial behavior; this suggests that to promote prosocial behavior one could (1 foster prosocialness, prosocial self and collective efficacy, trust in others and affiliation motivation and (2 try to reduce negative feelings and the tendency to dread rejection in an attempt to reduce the negative impact that these variables have on prosocial behavior. Moreover, the few differences that emerged in the model between the inclusion and exclusion contexts suggested that in interventions with excluded individuals special care emphasis should be placed on addressing rejection sensitivity and lack of trust.

  17. Should the Standard Count Be Excluded from Neutron Probe Calibration?

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Zhuanfang

    2017-10-12

    About 6 decades after its introduction, the neutron probe remains one of the most accurate methods for indirect measurement of soil moisture content. Traditionally, the calibration of a neutron probe involves the ratio of the neutron count in the soil to a standard count, which is the neutron count in the fixed environment such as the probe shield or a specially-designed calibration tank. The drawback of this count-ratio-based calibration is that the error in the standard count is carried through to all the measurements. An alternative calibration is to use the neutron counts only, not the ratio, with proper correction for radioactive decay and counting time. To evaluate both approaches, the shield counts of a neutron probe used for three decades were analyzed. The results show that the surrounding conditions have a substantial effect on the standard count. The error in the standard count also impacts the calculation of water storage and could indicate false consistency among replicates. The analysis of the shield counts indicates negligible aging effect of the instrument over a period of 26 years. It is concluded that, by excluding the standard count, the use of the count-based calibration is appropriate and sometimes even better than ratio-based calibration. The count-based calibration is especially useful for historical data when the standard count was questionable or absent

  18. Modelling and Simulation of Volume Controlled Mechanical Ventilation System

    Directory of Open Access Journals (Sweden)

    Yan Shi

    2014-01-01

    Full Text Available Volume controlled mechanical ventilation system is a typical time-delay system, which is applied to ventilate patients who cannot breathe adequately on their own. To illustrate the influences of key parameters of the ventilator on the dynamics of the ventilated respiratory system, this paper firstly derived a new mathematical model of the ventilation system; secondly, simulation and experimental results are compared to verify the mathematical model; lastly, the influences of key parameters of ventilator on the dynamics of the ventilated respiratory system are carried out. This study can be helpful in the VCV ventilation treatment and respiratory diagnostics.

  19. Methodology for ventilation/perfusion SPECT

    DEFF Research Database (Denmark)

    Bajc, Marika; Neilly, Brian; Miniati, Massimo

    2010-01-01

    Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) is the scintigraphic technique of choice for the diagnosis of pulmonary embolism and many other disorders that affect lung function. Data from recent ventilation studies show that the theoretic advantages of Technegas over...... radiolabeled liquid aerosols are not restricted to the presence of obstructive lung disease. Radiolabeled macroaggregated human albumin is the imaging agent of choice for perfusion scintigraphy. An optimal combination of nuclide activities and acquisition times for ventilation and perfusion, collimators......, and imaging matrix yields an adequate V/Q SPECT study in approximately 20 minutes of imaging time. The recommended protocol based on the patient remaining in an unchanged position during the initial ventilation study and the perfusion study allows presentation of matching ventilation and perfusion slices...

  20. Short Term Airing by Natural Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per; Perino, M.

    2010-01-01

    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......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...... 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...

  1. Functionality of Ventilated Facades: Protection of Insulation

    Directory of Open Access Journals (Sweden)

    Petrichenko Mikhail

    2016-01-01

    Full Text Available This article discusses about methods of construction of the ventilated facades. The ventilated facade is not only the element of facing, it is the supporting structure. Their main objective - creation of air ventilating space between a facade and an external wall of the building. Moving of air in this gap protects a heater from destruction, interfering with a moisture congestion. In addition, the ventilated facade protect the building from aggressive influence of external environment, have a sound and thermal insulation properties. There are several problems of systems of the ventilated facades connected with an application of a heater. For more effective using it is necessary to minimize contact of a heater with environment.

  2. Potential of Natural Ventilation in Shopping Centres

    DEFF Research Database (Denmark)

    Diederichsen, Alice; Friis, Kristina; Brohus, Henrik

    2008-01-01

    The indoor environmental quality (IEQ) is a fundamental requirement for a well performing shopping centre. This paper contains a pilot study of the potential of using hybrid ventilation (a combination of automatically controlled natural and mechanical ventilation - respectively NV and MV) in shop......The indoor environmental quality (IEQ) is a fundamental requirement for a well performing shopping centre. This paper contains a pilot study of the potential of using hybrid ventilation (a combination of automatically controlled natural and mechanical ventilation - respectively NV and MV......) in shopping centres with focus on both the achieved IEQ and energy consumptions for air movement. By thermal building simulations it is found that there exists an interesting potential for hybrid ventilation of shopping centres, which can lead to great savings in the electrical energy consumptions...

  3. Mechanical Ventilation: State of the Art.

    Science.gov (United States)

    Pham, Tài; Brochard, Laurent J; Slutsky, Arthur S

    2017-09-01

    Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs. We also highlight recent data on patient-ventilator dyssynchrony, humidified high-flow oxygen through nasal cannula, extracorporeal life support, and the weaning phase. Finally, we discuss the future of mechanical ventilation, addressing avenues for improvement. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  4. Housing and natural ventilation. Indoor climate, energy, reliability; Bolig og naturlig ventilation: indeklima energi driftssikkerhed

    Energy Technology Data Exchange (ETDEWEB)

    Marsh, R.; Lauring, M. (eds.)

    2003-07-01

    The aim of this book is to show how natural ventilation can be used successfully in housing. Housing ventilation aims at balancing complex and often diametrically opposed demands. This book examines the complexity with different quantitative and qualitative approaches. In the first chapter, History, the Danish housing ventilation from 1850-2002 is examined. The requirements for natural ventilation have developed historically, based upon a spatial organisation with fresh air supply to the less polluted rooms and stack effect removal from the more polluted rooms. A series of important factors relating to a healthy indoor climate, energy savings and demands for functional stability have affected this development. In the second chapter, Models, a series of architectural models for natural ventilated large building types are analysed. There has for many years been much R and D activity aimed at using natural ventilation in large buildings. Much of the knowledge about the requirements for natural ventilation (spatial organisation, fresh air supply and stack effect removal) can therefore be used in the development of naturally ventilated housing. The third chapter, Principles, develops a set of principles for naturally ventilated housing by examining the requirements relating to spatial organisation, fresh air supply, and stack effect removal. By optimizing the architectural and technical design of a typical terraced house, the three aims for the successful use of natural ventilation in housing can be achieved; a very low energy consumption and environmental impact, a healthy indoor climate and a functionally stable ventilation system. The fourth chapter, Houses, presents architectural designs for a series of naturally ventilated terraced houses. The designs focus on the use of spatial organisation, fresh air supply and stack removal to optimize the natural ventilation. Architecture and technology are integrated in the design to achieve low energy consumption, a healthy

  5. Both high level pressure support ventilation and controlled mechanical ventilation induce diaphragm dysfunction and atrophy.

    Science.gov (United States)

    Hudson, Matthew B; Smuder, Ashley J; Nelson, W Bradley; Bruells, Christian S; Levine, Sanford; Powers, Scott K

    2012-04-01

    Previous workers have demonstrated that controlled mechanical ventilation results in diaphragm inactivity and elicits a rapid development of diaphragm weakness as a result of both contractile dysfunction and fiber atrophy. Limited data exist regarding the impact of pressure support ventilation, a commonly used mode of mechanical ventilation-that permits partial mechanical activity of the diaphragm-on diaphragm structure and function. We carried out the present study to test the hypothesis that high-level pressure support ventilation decreases the diaphragm pathology associated with CMV. Sprague-Dawley rats were randomly assigned to one of the following five groups:1) control (no mechanical ventilation); 2) 12 hrs of controlled mechanical ventilation (12CMV); 3) 18 hrs of controlled mechanical ventilation (18CMV); 4) 12 hrs of pressure support ventilation (12PSV); or 5) 18 hrs of pressure support ventilation (18PSV). We carried out the following measurements on diaphragm specimens: 4-hydroxynonenal-a marker of oxidative stress, active caspase-3 (casp-3), active calpain-1 (calp-1), fiber type cross-sectional area, and specific force (sp F). Compared with the control, both 12PSV and 18PSV promoted a significant decrement in diaphragmatic specific force production, but to a lesser degree than 12CMV and 18CMV. Furthermore, 12CMV, 18PSV, and 18CMV resulted in significant atrophy in all diaphragm fiber types as well as significant increases in a biomarker of oxidative stress (4-hydroxynonenal) and increased proteolytic activity (20S proteasome, calpain-1, and caspase-3). Furthermore, although no inspiratory effort occurs during controlled mechanical ventilation, it was observed that pressure support ventilation resulted in large decrement, approximately 96%, in inspiratory effort compared with spontaneously breathing animals. High levels of prolonged pressure support ventilation promote diaphragmatic atrophy and contractile dysfunction. Furthermore, similar to controlled

  6. Mechanical ventilation during extracorporeal membrane oxygenation

    Science.gov (United States)

    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

  7. 26 CFR 1.552-4 - Certain excluded banks.

    Science.gov (United States)

    2010-04-01

    ... supervision exercised over it by the foreign government under its banking and credit laws; a copy (in English... of their stock ownership in the corporation, and the amount of distributions or other payments to... Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED...

  8. Probiotics for preventing ventilator-associated pneumonia

    Science.gov (United States)

    Bo, Lulong; Li, Jinbao; Tao, Tianzhu; Bai, Yu; Ye, Xiaofei; Hotchkiss, Richard S; Kollef, Marin H; Crooks, Neil H; Deng, Xiaoming

    2014-01-01

    Background Ventilator-associated pneumonia (VAP) is common in intensive care units (ICUs). Some evidence indicates that probiotics may reduce the incidence of VAP. Several additional published studies have demonstrated that probiotics are safe and efficacious in preventing VAP in ICUs. We aimed to systematically summarise the results of all available data to generate the best evidence for the prevention of VAP. Objectives To evaluate the effectiveness and safety of probiotics for preventing VAP. Search methods We searched CENTRAL (2014, Issue 8), MEDLINE (1948 to September week 1, 2014) and EMBASE (2010 to September 2014). Selection criteria Randomised controlled trials (RCTs) comparing probiotics with placebo or another control (excluding RCTs that use probiotics in both study groups) to prevent VAP. Data collection and analysis Two review authors independently assessed eligibility and the quality of trials, and extracted data. Main results We included eight RCTs, with 1083 participants. All studies compared a form of probiotic (Lactobacillus casei rhamnosus; Lactobacillus plantarum; Synbiotic 2000FORTE; Ergyphilus; combination Bifidobacterium longum + Lactobacillus bulgaricus + Streptococcus thermophilus) versus a control group (placebo; glutamine; fermentable fibre; peptide; chlorhexidine). The analysis of all RCTs showed that the use of probiotics decreased the incidence of VAP (odds ratio (OR) 0.70, 95% confidence interval (CI) 0.52 to 0.95, low quality evidence). However, the aggregated results were uncertain for ICU mortality (OR 0.84, 95% CI 0.58 to 1.22 very low quality evidence), in-hospital mortality (OR 0.78, 95% CI 0.54 to 1.14, very low quality evidence), incidence of diarrhoea (OR 0.72, 95% CI 0.47 to 1.09, very low quality evidence), length of ICU stay (mean difference (MD) −1.60, 95% CI −6.53 to 3.33, very low quality evidence), duration of mechanical ventilation (MD −6.15, 95% CI −18.77 to 6.47, very low quality evidence) and antibiotic

  9. Spontaneous Breathing Trials and Conservative Sedation Practices Reduce Mechanical Ventilation Duration in Subjects With ARDS.

    Science.gov (United States)

    Kallet, Richard H; Zhuo, Hanjing; Yip, Vivian; Gomez, Antonio; Lipnick, Michael S

    2018-01-01

    Spontaneous breathing trials (SBTs) and daily sedation interruptions (DSIs) reduce both the duration of mechanical ventilation and ICU length of stay (LOS). The impact of these practices in patients with ARDS has not previously been reported. We examined whether implementation of SBT/DSI protocols reduce duration of mechanical ventilation and ICU LOS in a retrospective group of subjects with ARDS at a large, urban, level-1 trauma center. All ARDS survivors from 2002 to 2016 (N = 1,053) were partitioned into 2 groups: 397 in the pre-SBT/DSI group (June 2002-December 2007) and 656 in the post-SBT/DSI group (January 2009-April 2016). Patients from 2008, during the protocol implementation period, were excluded. An additional SBT protocol database (2008-2010) was used to assess the efficacy of SBT in transitioning subjects with ARDS to unassisted breathing. Comparisons were assessed by either unpaired t tests or Mann-Whitney tests. Multiple comparisons were made using either one-way analysis of variance or Kruskal-Wallis and Dunn's tests. Linear regression modeling was used to determine variables independently associated with mechanical ventilation duration and ICU LOS; differences were considered statistically significant when P mechanical ventilation duration (14 [6-29] vs 9 [4-17] d, respectively, P mechanical ventilation duration and ICU LOS. Among subjects with ARDS in the SBT performance database, most achieved unassisted breathing with a median of 2 SBTs. Evidenced-based protocols governing weaning and sedation practices were associated with both reduced mechanical ventilation duration and ICU LOS in subjects with ARDS. However, higher respiratory system compliance in the SBT/DSI cohort also contributed to these improved outcomes. Copyright © 2018 by Daedalus Enterprises.

  10. A new system for continuous and remote monitoring of patients receiving home mechanical ventilation

    Science.gov (United States)

    Battista, L.

    2016-09-01

    Home mechanical ventilation is the treatment of patients with respiratory failure or insufficiency by means of a mechanical ventilator at a patient's home. In order to allow remote patient monitoring, several tele-monitoring systems have been introduced in the last few years. However, most of them usually do not allow real-time services, as they have their own proprietary communication protocol implemented and some ventilation parameters are not always measured. Moreover, they monitor only some breaths during the whole day, despite the fact that a patient's respiratory state may change continuously during the day. In order to reduce the above drawbacks, this work reports the development of a novel remote monitoring system for long-term, home-based ventilation therapy; the proposed system allows for continuous monitoring of the main physical quantities involved during home-care ventilation (e.g., differential pressure, volume, and air flow rate) and is developed in order to allow observations of different remote therapy units located in different places of a city, region, or country. The developed remote patient monitoring system is able to detect various clinical events (e.g., events of tube disconnection and sleep apnea events) and has been successfully tested by means of experimental tests carried out with pulmonary ventilators typically used to support sick patients.

  11. Thallium myocardial tomoscintigraphy: detection of ischemia during weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Tomoscintigraphie myocardique au thallium: detection de l'ischemie provoquee par le sevrage de la ventilation assistee chez le bronchiteux chronique

    Energy Technology Data Exchange (ETDEWEB)

    Andre, L.; Valette, H.; Obama, S.; Archambaud, F.; Richard, C.; Teboul, J.L.; Hebert, J.L.; Auzepy, P.; Desgrez, A. (Hopital de Bicetre, 94 - Le Kremlin-Bicetre (FR))

    1990-01-01

    In order to evidence myocardial ischemia-leading to ventricular dysfunction-during weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease, thallium myocardial tomography and gated blood pool studies were performed in 9 patients during mechanical ventilation and during weaning from mechanical ventilation. During the latter, results of gated blood pool studies showed a diffuse homogeneous left ventricular dysfunction. A fixed lower thallium uptake in the septum than in the lateral wall was found with the quantitative analysis of myocardial tomograms. Partial volume effect is likely the cause of this septal defect. The hypothesis of a diffuse ischemia cannot be excluded; but, without the absolute quantification of tomographic data, it cannot be proven.

  12. Polder maps: improving OMIT maps by excluding bulk solvent.

    Science.gov (United States)

    Liebschner, Dorothee; Afonine, Pavel V; Moriarty, Nigel W; Poon, Billy K; Sobolev, Oleg V; Terwilliger, Thomas C; Adams, Paul D

    2017-02-01

    The crystallographic maps that are routinely used during the structure-solution workflow are almost always model-biased because model information is used for their calculation. As these maps are also used to validate the atomic models that result from model building and refinement, this constitutes an immediate problem: anything added to the model will manifest itself in the map and thus hinder the validation. OMIT maps are a common tool to verify the presence of atoms in the model. The simplest way to compute an OMIT map is to exclude the atoms in question from the structure, update the corresponding structure factors and compute a residual map. It is then expected that if these atoms are present in the crystal structure, the electron density for the omitted atoms will be seen as positive features in this map. This, however, is complicated by the flat bulk-solvent model which is almost universally used in modern crystallographic refinement programs. This model postulates constant electron density at any voxel of the unit-cell volume that is not occupied by the atomic model. Consequently, if the density arising from the omitted atoms is weak then the bulk-solvent model may obscure it further. A possible solution to this problem is to prevent bulk solvent from entering the selected OMIT regions, which may improve the interpretative power of residual maps. This approach is called a polder (OMIT) map. Polder OMIT maps can be particularly useful for displaying weak densities of ligands, solvent molecules, side chains, alternative conformations and residues both in terminal regions and in loops. The tools described in this manuscript have been implemented and are available in PHENIX.

  13. The politics of corruption, inequality, and the socially excluded.

    Science.gov (United States)

    Santos Salas, Anna

    2013-07-01

    In this article, the production of knowledge in the context of socially excluded people exposed to inequality, oppression, and exploitation is problematized. The analysis follows Enrique Dussel's philosophical exegesis of the politics of power and corruption and his vision of a critical transformation of the social political order. The argument is also informed by the work of critical educator Paulo Freire, who elucidates the conditions of oppression and marginalization and highlights the importance of conscientization to develop a critical awareness of these conditions. Hannah Arendt's work on the politics of understanding totalitarianism also assists in the elucidation of the machinery that operates behind oppression to sustain power and inequality. The article emphasizes the need to recognize the inequality of conditions that exists between the producer of knowledge and those who live through inequality and oppression in their lived corporality. A critical transformation of the process of production of knowledge is needed to both acknowledge the conditions that sustain this endeavour in the first place and avoid the corruption of knowledge. A work of conscientization is also necessary among knowledge producers to undertake a critical analysis of inequality that exposes the corruption of power. This analysis needs to examine and unmask the hidden mechanisms that perpetuate inequality and oppression and serve only the interests of a few. The abysmal gaps between the wealthy and the poor within and among countries bespeak a degree of human indifference that reflects a most serious and complex phenomenon that perverts something profoundly human in our societies. © 2013 John Wiley & Sons Ltd.

  14. In Vitro Assessment of Small Charged Pharmaceutical Aerosols in a Model of a Ventilated Neonate.

    Science.gov (United States)

    Holbrook, Landon; Hindle, Michael; Longest, P Worth

    2017-08-01

    Aerosolized medications may benefit infants receiving mechanical ventilation; however, the lung delivery efficiency of these aerosols is unacceptably low. In vitro experiments were conducted to evaluate aerosol delivery through conventional and modified ventilation systems to the end of a 3mm endotracheal tube (ETT) under steady state and realistic cyclic flow conditions. System modifications were employed to investigate the use of small charged particles and included streamlined components, a reduction in nebulizer liquid flow rate, synchronization with inspiration, and implementation of a previously designed low-flow induction charger (LF-IC), which was further modified in this study. Cyclic flow experiments implemented a modern ventilator with bias airflow and an inline flow meter, both of which are frequently excluded from in vitro tests but included in clinical practice. The modified LF-IC system demonstrated superior delivery efficiency to the end of the ETT (34%) compared with the commercial system (~1.3%) operating under cyclic ventilation conditions. These findings indicate that commercial systems still provide very low lung delivery efficiencies despite decades of innovation. In contrast, the modified system increased dose delivery to the end of the ETT by 26-fold. Despite initial concerns, the charged aerosol could be efficiently delivered through the small diameter ETT and reach the lungs. Future studies will be required to determine if the applied particle charge can eliminate expected high exhalation aerosol loss and will require the development of a realistic lung model.

  15. Generating Charged Pharmaceutical Aerosols Intended to Improve Targeted Drug Delivery in Ventilated Infants.

    Science.gov (United States)

    Holbrook, Landon; Hindle, Michael; Longest, P Worth

    2015-10-01

    The delivery of pharmaceutical aerosols to infants receiving mechanical ventilation is extremely challenging due to small diameter flow passages, low tidal volumes, and frequent exhalation of the aerosol. The use of small charged particles is proposed as a novel method to prevent deposition in ventilator components and foster deposition in the lower infant airways. The objective of this study was to compare the performance of multiple new devices for generating small charged particles that are expected to maximize respiratory drug delivery in ventilated infants. Criteria used to select a leading device included production of a charged aerosol with a mass median aerodynamic diameter (MMAD) ≤ approximately 1.8 μm; low device depositional loss of the aerosol (MMAD of 0.14 μm and a drug delivery rate of 25 μg/min. However, the device was excluded because it failed to produce a charged aerosol. In contrast, the LF-IC produced a 1.6 μm aerosol with high net charge, low device depositional loss (MMAD, the LF-IC produced >100 elementary charges per particle, which was an order of magnitude increase compared to the case of zero charging voltage. In conclusion, the LF-IC was selected as a leading system that is expected to improve aerosol delivery efficiency in ventilated infants through the use of small charged particles.

  16. Electrical Impedance Tomography During Mechanical Ventilation.

    Science.gov (United States)

    Walsh, Brian K; Smallwood, Craig D

    2016-10-01

    Electrical impedance tomography (EIT) is a noninvasive, non-radiologic imaging modality that may be useful for the quantification of lung disorders and titration of mechanical ventilation. The principle of operation is based on changes in electrical conductivity that occur as a function of changes in lung volume during ventilation. EIT offers potentially important benefits over standard imaging modalities because the system is portable and non-radiologic and can be applied to patients for long periods of time. Rather than providing a technical dissection of the methods utilized to gather, compile, reconstruct, and display EIT images, the present article seeks to provide an overview of the clinical application of this technology as it relates to monitoring mechanical ventilation and providing decision support at the bedside. EIT has been shown to be useful in the detection of pneumothoraces, quantification of pulmonary edema and comparison of distribution of ventilation between different modes of ventilation and may offer superior individual titration of PEEP and other ventilator parameters compared with existing approaches. Although application of EIT is still primarily done within a research context, it may prove to be a useful bedside tool in the future. However, head-to-head comparisons with existing methods of mechanical ventilation titration in humans need to be conducted before its application in general ICUs can be recommended. Copyright © 2016 by Daedalus Enterprises.

  17. Infiltration as Ventilation: Weather-Induced Dilution

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Turner, William J.N. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Walker, Iain S. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2011-06-01

    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 of 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.

  18. Casino Self- and Forced Excluders' Gambling Behavior Before and After Exclusion.

    Science.gov (United States)

    Kotter, Roxana; Kräplin, Anja; Bühringer, Gerhard

    2017-11-11

    Casino exclusion programs are intended to prevent or limit gambling-related harm. Although previous research showed that self-exclusion is associated with reduced gambling, it remains unknown whether self- and forced excluded subjects show different patterns of gambling behavior and if exclusion from casino gambling affects all gambling activities. The present study retrospectively investigated (1) the role of voluntariness of exclusion for the first time, and (2) general gambling behavior of excluded individuals before and after exclusion. A total of N = 215 casino excluders (self-excluders: n = 187, forced excluders: n = 28) completed an online survey or a face-to-face interview up to 8 years after enrollment. Self- and forced excluders showed similar rates of abstinence (self-excluders: 19.3%, forced excluders: 28.6%) and reduction (self-excluders: 67.4%, forced excluders: 60.7%), even though forced excluders reported a significantly greater initial gambling intensity compared to self-excluders (e.g., pre-exclusion gambling time; self-excluders: 3.2 days/week, forced excluders: 4.3 days/week). Overall, results indicated that 20.5% of excluders stopped all gambling activities and another 66.5% reduced their gambling. Those who continued gambling significantly reduced this behavior in every segment, except for gambling halls. Findings indicate that self- and forced exclusion are associated with similarly reduced gambling behavior, even in non-excluded segments. However, unchanged gambling in gambling halls emphasizes the importance to implement consistent exclusion programs over all gambling segments.

  19. Preoperational test report, primary ventilation condensate system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-01-29

    Preoperational test report for Primary Ventilation Condensate System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides a collection point for condensate generated by the W-030 primary vent offgas cooling system serving tanks AYIOI, AY102, AZIOI, AZI02. The system is located inside a shielded ventilation equipment cell and consists of a condensate seal pot, sampling features, a drain line to existing Catch Tank 241-AZ-151, and a cell sump jet pump. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  20. Multilevel Ventilation: Theory and Simplified Mathematical Model

    Directory of Open Access Journals (Sweden)

    P. Torok

    2008-01-01

    Full Text Available Considering the issues of artificial ventilation (AV in non-homogenous pathological lung processes (acute lung injury, acute respiratory distress syndrome, pneumonia, etc., the authors created a mathematical model of multicompartment non-homogenous injured lungs that were ventilated by a new mode of AV, the so-called three-level ventilation. Multilevel ventilation was defined a type (modification of ALV whose basic ventilation level was produced by the modes CMV, PCV or PS (ASB and add-on level, and the so-called background ventilation was generated by the levels of PEEP and high PEEP (PEEPh with varying frequency and duration. Multi-level ventilation on 3 pressure levels was realized by the mathematical model as a combination of pressure-controlled ventilation (PCV and two levels of PEEP and PEEPh. The objective was to prove that in cases of considerably non-homogenous gas distribution in acute pathological disorders of lungs, gas entry into the so-called slow bronchoalveolar compartments could be improved by multilevel AV, without substabtially changing the volume of so-called fast compartments. Material and Method. Multi-level ventilation at 3 pressure levels was realized by the mathematical model as a combination of PCV and two levels of PEEP and PEEPh. Results. By comparing the single-level AV in the PCV mode with the so-called three-level ventilation defined as a combination of PCV+PEEPh/PEEP, the authors have discovered that the loading of slow compartments in the model was considerably improved by 50—60% as compared with the baseline values. In absolute terms, this difference was as many as 2—10 times of the volume. Conclusion. The mathematical model may demonstrate that the application of the so-called three-level AV causes considerable changes in gas distribution in the lung parenchyma disordered by a non-homogenous pathological process. The authors state that the proposed mathematical model requires clinical verification in order

  1. Secretion management in the mechanically ventilated patient.

    Science.gov (United States)

    Branson, Richard D

    2007-10-01

    Secretion management in the mechanically ventilated patient includes routine methods for maintaining mucociliary function, as well as techniques for secretion removal. Humidification, mobilization of the patient, and airway suctioning are all routine procedures for managing secretions in the ventilated patient. Early ambulation of the post-surgical patient and routine turning of the ventilated patient are common secretion-management techniques that have little supporting evidence of efficacy. Humidification is a standard of care and a requisite for secretion management. Both active and passive humidification can be used. The humidifier selected and the level of humidification required depend on the patient's condition and the expected duration of intubation. In patients with thick, copious secretions, heated humidification is superior to a heat and moisture exchanger. Airway suctioning is the most important secretion removal technique. Open-circuit and closed-circuit suctioning have similar efficacy. Instilling saline prior to suctioning, to thin the secretions or stimulate a cough, is not supported by the literature. Adequate humidification and as-needed suctioning are the foundation of secretion management in the mechanically ventilated patient. Intermittent therapy for secretion removal includes techniques either to simulate a cough, to mechanically loosen secretions, or both. Patient positioning for secretion drainage is also widely used. Percussion and postural drainage have been widely employed for mechanically ventilated patients but have not been shown to reduce ventilator-associated pneumonia or atelectasis. Manual hyperinflation and insufflation-exsufflation, which attempt to improve secretion removal by simulating a cough, have been described in mechanically ventilated patients, but neither has been studied sufficiently to support routine use. Continuous lateral rotation with a specialized bed reduces atelectasis in some patients, but has not been shown

  2. Weaning newborn infants from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Paolo Biban

    2013-06-01

    Full Text Available Invasive mechanical ventilation is a life-saving procedure which is largely used in neonatal intensive care units, particularly in very premature newborn infants. However, this essential treatment may increase mortality and cause substantial morbidity, including lung or airway injuries, unplanned extubations, adverse hemodynamic effects, analgosedative dependency and severe infectious complications, such as ventilator-associated pneumonia. Therefore, limiting the duration of airway intubation and mechanical ventilator support is crucial for the neonatologist, who should aim to a shorter process of discontinuing mechanical ventilation as well as an earlier appreciation of readiness for spontaneous breathing trials. Unfortunately, there is scarce information about the best ways to perform an effective weaning process in infants undergoing mechanical ventilation, thus in most cases the weaning course is still based upon the individual judgment of the attending clinician. Nonetheless, some evidence indicate that volume targeted ventilation modes are more effective in reducing the duration of mechanical ventilation than traditional pressure limited ventilation modes, particularly in very preterm babies. Weaning and extubation directly from high frequency ventilation could be another option, even though its effectiveness, when compared to switching and subsequent weaning and extubating from conventional ventilation, is yet to be adequately investigated. Some data suggest the use of weaning protocols could reduce the weaning time and duration of mechanical ventilation, but better designed prospective studies are still needed to confirm these preliminary observations. Finally, the implementation of short spontaneous breathing tests in preterm infants has been shown to be beneficial in some centres, favoring an earlier extubation at higher ventilatory settings compared with historical controls, without worsening the extubation failure rate. Further

  3. Special Considerations in Neonatal Mechanical Ventilation.

    Science.gov (United States)

    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.

  4. Do new anesthesia ventilators deliver small tidal volumes accurately during volume-controlled ventilation?

    Science.gov (United States)

    Bachiller, Patricia R; McDonough, Joseph M; Feldman, Jeffrey M

    2008-05-01

    During mechanical ventilation of infants and neonates, small changes in tidal volume may lead to hypo- or hyperventilation, barotrauma, or volutrauma. Partly because breathing circuit compliance and fresh gas flow affect tidal volume delivery by traditional anesthesia ventilators in volume-controlled ventilation (VCV) mode, pressure-controlled ventilation (PCV) using a circle breathing system has become a common approach to minimizing the risk of mechanical ventilation for small patients, although delivered tidal volume is not assured during PCV. A new generation of anesthesia machine ventilators addresses the problems of VCV by adjusting for fresh gas flow and for the compliance of the breathing circuit. In this study, we evaluated the accuracy of new anesthesia ventilators to deliver small tidal volumes. Four anesthesia ventilator systems were evaluated to determine the accuracy of volume delivery to the airway during VCV at tidal volume settings of 100, 200, and 500 mL under different conditions of breathing circuit compliance (fully extended and fully contracted circuits) and lung compliance. A mechanical test lung (adult and infant) was used to simulate lung compliances ranging from 0.0025 to 0.03 L/cm H(2)O. Volumes and pressures were measured using a calibrated screen pneumotachograph and custom software. We tested the Smartvent 7900, Avance, and Aisys anesthesia ventilator systems (GE Healthcare, Madison, WI) and the Apollo anesthesia ventilator (Draeger Medical, Telford, PA). The Smartvent 7900 and Avance ventilators use inspiratory flow sensors to control the volume delivered, whereas the Aisys and Apollo ventilators compensate for the compliance of the circuit. We found that the anesthesia ventilators that use compliance compensation (Aisys and Apollo) accurately delivered both large and small tidal volumes to the airway of the test lung under conditions of normal and low lung compliance during VCV (ranging from 95.5% to 106.2% of the set tidal volume

  5. Methane emission from naturally ventilated livestock buildings can be determined from gas concentration measurements

    DEFF Research Database (Denmark)

    Bjerg, Bjarne; Zhang, Guoqiang; Madsen, Jørgen

    2012-01-01

    Determination of emission of contaminant gases as ammonia, methane, or laughing gas from natural ventilated livestock buildings with large opening is a challenge due to the large variations in gas concentration and air velocity in the openings. The close relation between calculated animal heat...... gas emission and the precision of the estimation are influenced by different calculation procedures, measuring period length, measure point locations, measure point numbers, and criteria for excluding measuring data. The analyses were based on existing data from a 6-day measuring period in a naturally...... ventilated, 150 milking cow building. The results showed that the methane emission can be determined with much higher precision than ammonia or laughing gas emissions, and, for methane, relatively precise estimations can be based on measure periods as short as 3 h. This result makes it feasible...

  6. National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation.

    Science.gov (United States)

    Rinieri, Philippe; Peillon, Christophe; Bessou, Jean-Paul; Veber, Benoît; Falcoz, Pierre-Emmanuel; Melki, Jean; Baste, Jean-Marc

    2015-01-01

    Extracorporeal membrane oxygenation (ECMO) for respiratory support is increasingly used in intensive care units (ICU), but rarely during thoracic surgical procedures outside the transplantation setting. ECMO can be an alternative to cardiopulmonary bypass for major trachea-bronchial surgery and single-lung procedures without in-field ventilation. Our aim was to evaluate the intraoperative use of ECMO as respiratory support in thoracic surgery: benefits, indications and complications. This was a multicentre retrospective study (questionnaire) of use of ECMO as respiratory support during the thoracic surgical procedure. Lung transplantation and lung resection for tumour invading the great vessels and/or the left atrium were excluded, because they concern respiratory and circulatory support. From March 2009 to September 2012, 17 of the 34 centres in France applied ECMO within veno-venous (VV) (n=20) or veno-arterial (VA) (n=16) indications in 36 patients. Ten VA ECMO were performed with peripheral cannulation and 6 with central cannulation; all VV ECMO were achieved through peripheral cannulation. Group 1 (total respiratory support) was composed of 28 patients without mechanical ventilation, involving 23 tracheo-bronchial and 5 single-lung procedures. Group 2 (partial respiratory support) was made up of 5 patients with respiratory insufficiency. Group 3 was made up of 3 patients who underwent thoracic surgery in a setting of acute respiratory distress syndrome (ARDS) with preoperative ECMO. Mortality at 30 days in Groups 1, 2 and 3 was 7, 40 and 67%, respectively (PECMO was weaned intraoperatively or within 24 h in 75% of patients. In Group 2, ECMO was weaned in ICU over several days. In Group 1, 2 patients with VA support were converted to VV support for chronic respiratory indications. Bleeding was the major complication with 17% of patients requiring return to theatre for haemostasis. There were two cannulation-related complications (6%). VV or VA ECMO is a

  7. 21 CFR 1308.26 - Excluded veterinary anabolic steroid implant products.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Excluded veterinary anabolic steroid implant... SCHEDULES OF CONTROLLED SUBSTANCES Excluded Veterinary Anabolic Steroid Implant Products § 1308.26 Excluded veterinary anabolic steroid implant products. (a) Products containing an anabolic steroid, that are expressly...

  8. 20 CFR 404.1015 - Family services.

    Science.gov (United States)

    2010-04-01

    .... (b) Family work for other than sole proprietor. Work for a corporation is not excluded under this...- ) Employment, Wages, Self-Employment, and Self-Employment Income Work Excluded from Employment § 404.1015 Family services. (a) General. If you work as an employee of a relative, the work is excluded from...

  9. Liberation from prolonged mechanical ventilation.

    Science.gov (United States)

    Scheinhorn, David J; Chao, David C; Stearn-Hassenpflug, Meg

    2002-07-01

    After weaning from PMV, patients are usually far from ready to resume normal activities. A prolonged recovery period after catastrophic illness is the rule, with multidisciplinary rehabilitation and discharge planning efforts. Following such efforts, reports of success of restorative care are institutional and population specific. That all PMV patients are not "chronically critically ill" introduces selection factors that make comparisons between institutions even more difficult. Half of the authors' patients were able to go home in past years [14], although more recently, with patients admitted more debilitated and more ill, the percent returning home has gradually declined to the low 20% range. Bagley et al [11] report discharge to home in 31% of patients weaned. Gracey et al [6,133], treating younger, postsurgical patients, have reported the highest discharge to home rate, 57%; over 70% were eventually discharged to home after first being transferred to a rehabilitation unit. On the other hand, the few reports of survival 1 or more years after discharge are in the 50% range at best (Table 2). Carson and colleagues [9] report a 23% 1-year survival in 133 PMV patients. Their premorbid functional status and age analysis showed younger and more independent patients having a better mortality (56%), and older and more dependent patients having a 95% mortality at 1 year. Nasraway et al [25] report a 1-year mortality of 50.5% in 97 patients transferred from five ICUs to multiple ECFs. Most of these patients would probably meet criteria for PMV, with median time mechanically ventilated 33 days, and 71 ventilator dependent at the time of ICU discharge. A report from 25 Vencor Hospitals [134] not included in Table 2 because weaning outcome was not reported, examines mortality and cost in patients > 65 years of age primarily referred for failure to wean from mechanical ventilation (91% of the cohort of 1619 patients.) There was a 58% in-hospital mortality by day 102 (28

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

    Science.gov (United States)

    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.

  11. 33 CFR 183.620 - Natural ventilation system.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Natural ventilation system. 183... (CONTINUED) BOATING SAFETY BOATS AND ASSOCIATED EQUIPMENT Ventilation § 183.620 Natural ventilation system. (a) Except for compartments open to the atmosphere, a natural ventilation system that meets the...

  12. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Mechanical ventilation system: General. 154.1200 Section... Equipment Cargo Area: Mechanical Ventilation System § 154.1200 Mechanical ventilation system: General. (a... cargo handling equipment must have a fixed, exhaust-type mechanical ventilation system. (b) The...

  13. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Science.gov (United States)

    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...

  14. [Prognostic criteria of the premature infants weaning from mechanical ventilation during trigger ventilation].

    Science.gov (United States)

    Grebennikov, V A; Kriakvina, O A; Bolunova, E S; Degtiareva, M V

    2013-01-01

    Modern mechanical ventilation modes do not prevent ventilator-associated lung injury therefore respiratory cessation must be stopped as soon as possible. However extubation recommendations absence makes difficulties in process of weaning the infants from the mechanical ventilation. To assess the prognostic criteria of the extubating and weaning from mechanical ventilation in premature infants during trigger ventilation (PSV/PSV + VG). 66 Pediatric patients were divided into two groups during the period of weaning from mechanical ventilation: PSV + PG ventilation mode was used in the group 1 (n = 33), and PSV in the group 2 (n = 33). Basic characteristics were same in both groups: gestational age 31.1 +/- 2.5 weeks, mass of body 1586.2 +/- 356.8 grams. Extubation was successful if reintubation was not needed during 48 hrs. 90% of successful extubations were done when the compliance was over 1.1 ml mbar(-1). Compliance decrease under 0.75 ml mbar(-1) was an adverse prognostic criterion of the weaning from mechanical ventilation and extubation. Index breathing rate/breathing volume (RVR) can be used as general criterion of the weaning from mechanical ventilation. Progressive RVR increase to 8 is an adverse prognostic criterion of PSV/ PSV + VG mode use during the period of weaning from mechanical ventilation. Parameters of mechanical ventilation which maintain acceptable gas composition of blood and SpO2 mast be considered before extubation. Positive dynamics and stabilization of compliance and resistance are essential criteria of the successful weaning from mechanical ventilation and extubation. RVR can be used as objective criterion of an extubation.

  15. Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation.

    Science.gov (United States)

    Bordessoule, Alice; Emeriaud, Guillaume; Morneau, Sylvain; Jouvet, Philippe; Beck, Jennifer

    2012-08-01

    Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation controlled by the electrical activity of the diaphragm (Edi). The aim was to evaluate patient-ventilator interaction in infants during NAVA as compared with conventional ventilation. Infants were successively ventilated with NAVA, pressure control ventilation (PCV), and pressure support ventilation (PSV). Edi and ventilator pressure (Pvent) waveforms were compared and their variability was assessed by coefficients of variation. Ten patients (mean age 4.3 ± 2.4 mo and weight 5.9 ± 2.2 kg) were studied. In PCV and PSV, 4 ± 4.6% and 6.5 ± 7.7% of the neural efforts failed to trigger the ventilator. This did not occur during NAVA. Trigger delays were shorter with NAVA as compared with PCV and PSV (93 ± 20 ms vs. 193 ± 87 ms and 135 ± 29 ms). During PCV and PSV, the ventilator cycled off before the end of neural inspiration in 12 ± 13% and 21 ± 19% of the breaths (0 ± 0% during NAVA). During PCV and PSV, 24 ± 11% and 25 ± 9% of the neural breath cycle was asynchronous with the ventilator as compared with 11 ± 3% with NAVA. A large variability was observed for Edi in all modes, which was transmitted into Pvent during NAVA (coefficient of variation: 24 ± 8%) and not in PCV (coefficient of variation 2 ± 1%) or PSV (2 ± 2%). NAVA improves patient-ventilator interaction and delivers adequate ventilation with variable pressure in infants.

  16. Energy diagnosis of industrial ventilation systems; Diagnostic energetique des installations de ventilation industrielle

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-11-01

    Industrial ventilation systems are numerous and represent an important source of potential energy saving. This book shades light on the principles of ventilation systems used in companies and on the investigation methods to be implemented for an energy diagnosis of these systems. It proposes some solutions for the improvement of existing ventilation systems and some suggestions for the formulation and presentation of recommendations. (J.S.)

  17. Using a Ventilation Controller to Optimize Residential Passive Ventilation For Energy and Indoor Air Quality

    Energy Technology Data Exchange (ETDEWEB)

    Turner, William [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Walker, Iain [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-08-01

    One way to reduce the energy impact of providing residential ventilation is to use passive and hybrid systems. However, these passive and hybrid (sometimes called mixed-mode) systems must still meet chronic and acute health standards for ventilation. This study uses a computer simulation approach to examine the energy and indoor air quality (IAQ) implications of passive and hybrid ventilation systems, in 16 California climate zones. Both uncontrolled and flow controlled passive stacks are assessed. A new hybrid ventilation system is outlined that uses an intelligent ventilation controller to minimise energy use, while ensuring chronic and acute IAQ standards are met. ASHRAE Standard 62.2-2010 – the United States standard for residential ventilation - is used as the chronic standard, and exposure limits for PM2.5, formaldehyde and NO2 are used as the acute standards.The results show that controlled passive ventilation and hybrid ventilation can be used in homes to provide equivalent IAQ to continuous mechanical ventilation, for less use of energy.

  18. Comfort parameters - Ventilation of a subway wagon

    Science.gov (United States)

    Petr, Pavlíček; Ladislav, Tříska

    2017-09-01

    Research and development of a ventilation system is being carried out as a part of project TA04030774 of the Technology Agency of the Czech Republic. Name of the project is "Research and Development of Mass-optimized Components for Rail Vehicles". Problems being solved are development and testing of a new concept for ventilation systems for public transport vehicles. The main improvements should be a reduction of the mass of the whole system, easy installation and reduction of the noise of the ventilation system. This article is focused on the comfort parameters in a subway wagon (measurement and evaluation carried out on a function sample in accordance with the regulations). The input to the project is a ventilator hybrid casing for a subway wagon, which was manufactured and tested during the Ministry of Industry and Trade project TIP FR-TI3/449.

  19. Adaptive Intelligent Ventilation Noise Control Project

    Data.gov (United States)

    National Aeronautics and Space Administration — To address NASA needs for quiet crew volumes in a space habitat, Physical Optics Corporation (POC) proposes to develop a new Adaptive Intelligent Ventilation Noise...

  20. Adaptive Intelligent Ventilation Noise Control Project

    Data.gov (United States)

    National Aeronautics and Space Administration — To address the NASA need for quiet on-orbit crew quarters (CQ), Physical Optics Corporation (POC) proposes to develop a new Adaptive Intelligent Ventilation Noise...

  1. Design of Natural and Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per

    The effectiveness of natural ventilation, i.e. its ability to ensure indoor air quality and passive cooling in a building, depends greatly on the design process. Mechanical ventilation systems can be designed separately from the design of the building in which they are installed. They can also...... be installed in existing buildings after a few modifications. In contrast, ventilation systems using only natural forces such as wind and thermal buoyancy need to be designed together with the building, since the building itself and its components are the elements that can reduce or increase air movement...... as well as influence the air content (dust, pollution etc.). Architects and engineers need to acquire qualitative and quantitative information about the interactions between building characteristics and natural ventilation in order to design buildings and systems consistent with a passive low...

  2. Process control migration towards LHC ventilation functionality

    CERN Document Server

    Blanc, D

    2003-01-01

    The adaptation of the ventilation systems as well as the integration of equipment to fit with the new LHC ventilation requirements lead us to consider a global re-engineering of the existing control system. This, decade old process control structure is composed of elements which are mixed between industrial and home made devices. The proposed modifications are made in order to upgrade the present control system and to provide efficient and well adapted control architecture to integrate the LHC ventilation equipment of the injection tunnels. Moreover, we need a plan for the next fifteen years of the LHC life cycle. The document is to present the situation of the present control system of the LEP ventilation process and to propose a plan for the migration of the control architecture. This is done considering the fact that elements of the present control infrastructure could no longer be supported from 2003 and major components must be removed from the CERN communication infrastructure.

  3. Modelling of Natural and Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per

    as well as influence the air content (dust, pollution etc.). Architects and engineers need to acquire qualitative and quantitative information about the interactions between building characteristics and natural ventilation in order to design buildings and systems consistent with a passive low......The effectiveness of natural ventilation, i.e. its ability to ensure indoor air quality and passive cooling in a building, depends greatly on the design process. Mechanical ventilation systems can be designed separately from the design of the building in which they are installed. They can also...... be installed in existing buildings after a few modifications. In contrast, ventilation systems using only natural forces such as wind and thermal buoyancy need to be designed together with the building, since the building itself and its components are the elements that can reduce or increase air movement...

  4. Mechanical ventilation strategies for the surgical patient

    NARCIS (Netherlands)

    Schultz, Marcus J.; Abreu, Marcelo Gama de; Pelosi, Paolo

    2015-01-01

    Purpose of review To summarize clinical evidence for intraoperative ventilation settings, which could protect against postoperative pulmonary complications (PPCs) in surgical patients with uninjured lungs. Recent findings There is convincing evidence for protection against PPCs by low tidal volumes:

  5. 46 CFR 111.15-10 - Ventilation.

    Science.gov (United States)

    2010-10-01

    .... (3) Each blower must have a non-sparking fan. (4) The power ventilation system must be interlocked... vertical; and (iv) That has no appliances, such as flame arresters, that impede free passage of air or gas...

  6. Comparison of Airway Pressure Release Ventilation to Conventional Mechanical Ventilation in the Early Management of Smoke Inhalation Injury in Swine

    Science.gov (United States)

    2011-01-01

    Comparison of airway pressure release ventilation to conventional mechanical ventilation in the early management of smoke inhalation injury in swine...Acute respiratory distress syndrome (ARDS) is a complication of smoke inha- lation injury, with an incidence as high as 54% in mechanically ventilated ... mechanical ventilation on oxygenation in a porcine model of acute respiratory distress syndrome induced by wood smoke inhalation. Design: Prospective

  7. Evaluating Ventilation Systems for Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, Robb [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States); Arena, Lois [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States)

    2013-02-01

    In an effort to improve housing options near Las Vegas, Nevada, the Clark County Community Resources Division (CCCRD) performs substantial renovations to foreclosed homes. After dramatic energy, aesthetic, and health and safety improvements are made, homes are rented or sold to qualified residents. This report describes the evaluation and selection of ventilation systems for these homes, including key considerations when selecting an ideal system. The report then describes CCCRD’s decision process with respect to ventilation.

  8. Computational Fluid Dynamics in Ventilation Design

    DEFF Research Database (Denmark)

    Nielsen, Peter V.

    2008-01-01

    . The guidebook has, for example, chapters that are very important for CFD quality control in general, and for the quality control of ventilation related problems in particular. A large number of CFD predictions are made nowadays, and it is often difficult to judge the quality level of these predictions....... The guidebook introduces rules for good quality prediction work, and it is the purpose of the guidebook to improve the technical level of CFD work in ventilation....

  9. Sensor-based demand controlled ventilation

    Energy Technology Data Exchange (ETDEWEB)

    De Almeida, A.T. [Universidade de Coimbra (Portugal). Dep. Eng. Electrotecnica; Fisk, W.J. [Lawrence Berkeley National Lab., CA (United States)

    1997-07-01

    In most buildings, occupancy and indoor pollutant emission rates vary with time. With sensor-based demand-controlled ventilation (SBDCV), the rate of ventilation (i.e., rate of outside air supply) also varies with time to compensate for the changes in pollutant generation. In other words, SBDCV involves the application of sensing, feedback and control to modulate ventilation. Compared to ventilation without feedback, SBDCV offers two potential advantages: (1) better control of indoor pollutant concentrations; and (2) lower energy use and peak energy demand. SBDCV has the potential to improve indoor air quality by increasing the rate of ventilation when indoor pollutant generation rates are high and occupants are present. SBDCV can also save energy by decreasing the rate of ventilation when indoor pollutant generation rates are low or occupants are absent. After providing background information on indoor air quality and ventilation, this report provides a relatively comprehensive discussion of SBDCV. Topics covered in the report include basic principles of SBDCV, sensor technologies, technologies for controlling air flow rates, case studies of SBDCV, application of SBDCV to laboratory buildings, and research needs. SBDCV appears to be an increasingly attractive technology option. Based on the review of literature and theoretical considerations, the application of SBDCV has the potential to be cost-effective in applications with the following characteristics: (a) a single or small number of dominant pollutants, so that ventilation sufficient to control the concentration of the dominant pollutants provides effective control of all other pollutants; (b) large buildings or rooms with unpredictable temporally variable occupancy or pollutant emission; and (c) climates with high heating or cooling loads or locations with expensive energy.

  10. Solar ventilation for vehicles. Solarstandentlueftung fuer Kraftfahrzeuge

    Energy Technology Data Exchange (ETDEWEB)

    Watzlawick, R. (Webasto Karosseriesysteme GmbH, Stockdorf (Germany)); Ganz, T. (Webasto Karosseriesysteme GmbH, Stockdorf (Germany)); Adelmann, P. (STECA GmbH, Memmingen (Germany))

    1993-01-01

    Considerable improvement in comfort and further price reductions by a simple process for including the solar cells in a sliding roof and the solar module itself make solar ventilation an attractive component in vehicle air conditioning. With regard to increasing shortages of raw materials and the trend towards engines with optimized consumption, solar ventilation can make a considerable contribution to environmentally-friendly air conditioning in the vehicles. (orig.)

  11. Efficacy of Conventional and High-Frequency Ventilation at Altitude

    Science.gov (United States)

    1988-12-01

    evacuation; Mechanical ventilation ;--andL If.’jJI t’ 06 I 12 i ~High-Frequency ventilation ’& ~.~.- 19 ABSTRACT (Continue on reverse If neesry and identify by...The inspired gas and the subsequent rate of appearance of these gases in arterial blood were monitored. With conventional mechanical ventilation (CMV...AND HIGH-FREQUENCY VENTILATION AT ALTITUDE INTRODUCTION The logistics of aeromedical evacuation of patients requiring mechanical ventilation is

  12. Non-invasive ventilation for cystic fibrosis.

    Science.gov (United States)

    Moran, Fidelma; Bradley, Judy M; Piper, Amanda J

    2017-02-20

    Non-invasive ventilation may be a means to temporarily reverse or slow the progression of respiratory failure in cystic fibrosis by providing ventilatory support and avoiding tracheal intubation. Using non-invasive ventilation, in the appropriate situation or individuals, can improve lung mechanics through increasing airflow and gas exchange and decreasing the work of breathing. Non-invasive ventilation thus acts as an external respiratory muscle. This is an update of a previously published review. To compare the effect of non-invasive ventilation versus no non-invasive ventilation in people with cystic fibrosis for airway clearance, during sleep and during exercise. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. We searched the reference lists of each trial for additional publications possibly containing other trials.Most recent search: 08 August 2016. Randomised controlled trials comparing a form of pressure preset or volume preset non-invasive ventilation to no non-invasive ventilation used for airway clearance or during sleep or exercise in people with acute or chronic respiratory failure in cystic fibrosis. Three reviewers independently assessed trials for inclusion criteria and methodological quality, and extracted data. Ten trials met the inclusion criteria with a total of 191 participants. Seven trials evaluated single treatment sessions, one evaluated a two-week intervention, one evaluated a six-week intervention and one a three-month intervention. It is only possible to blind trials of airway clearance and overnight ventilatory support to the outcome assessors. In most of the trials we judged there was an unclear risk of bias with regards to blinding due to inadequate descriptions. The six-week trial was the only one judged to have a low risk of bias for all

  13. 3 Level Ventilation: the First Clinical Experience

    Directory of Open Access Journals (Sweden)

    P. Torok

    2008-01-01

    Full Text Available Considering the issues of artificial ventilation (AV in non-homogenous pathological lung processes (acute lung injury (ALI, acute respiratory distress syndrome (ARDS, pneumonia, etc., the authors applied the three-level lung ventilation to a group of 12 patients with non-homogenous lung injury. Three-level ventilation was defined as a type (modification of AV whose basic ventilation level was produced by the modes CMV, PCV or PS (ASB and add-on level, the so-called background ventilation was generated by two levels of PEEP. PEEP (constant and PEEPh (PEEP high with varying frequency and duration of transition between the individual levels of PEEP. Objective: to elucidate whether in cases of considerably non-homogenous gas distribution in acute pathological disorders, three-level ventilation (3LV can correct gas distribution into the so-called slow bronchoalveolar compartments, by decreasing the volume load of the so-called fast compartments and to improve lung gas exchange, by following the principles of safe ventilation. Results. 3LV was applied to 12 patients with severe non-homogenous lung injury/disorder (atypic pneumonia and ARDS/ALI and low-success PCV ventilation after recruitment manoeuvre (PaO2 (kPA /FiO2 = 5—6. There were pronounced positive changes in pulmonary gas exchange within 1—4 hours after initiation of 3LV at a fPCV of 26±4 breaths/min-1 and PEEPh at a fPEEPH of 7±2 breaths/min-1 with a minute ventilation of 12±4 l/min. 3LV reduced a intrapulmonary shunt fraction 50±5 to 30±5%, increased CO2 elimination, with PaCO2 falling to the values below 6±0.3 kPa, and PaO2 to 7.5±1.2 kPa, with FiO2 being decreased to 0.8—0.4. Lung recruitment also improved gas exchange: with PEEP=1.2±0.4 kPa, static tho-racopulmonary compliance (Cst elevated from 0.18±0.02 l/kPa to 0.3±0.02 l/kPa and then to 0.38±0.05 l/kPa. Airways resistance (Raw decreased by more than 30%. Improved lung aeration was also estimated as a manifestation of

  14. Daily Goals Formulation and Enhanced Visualization of Mechanical Ventilation Variance Improves Mechanical Ventilation Score.

    Science.gov (United States)

    Walsh, Brian K; Smallwood, Craig; Rettig, Jordan; Kacmarek, Robert M; Thompson, John; Arnold, John H

    2017-03-01

    The systematic implementation of evidence-based practice through the use of guidelines, checklists, and protocols mitigates the risks associated with mechanical ventilation, yet variation in practice remains prevalent. Recent advances in software and hardware have allowed for the development and deployment of an enhanced visualization tool that identifies mechanical ventilation goal variance. Our aim was to assess the utility of daily goal establishment and a computer-aided visualization of variance. This study was composed of 3 phases: a retrospective observational phase (baseline) followed by 2 prospective sequential interventions. Phase I intervention comprised daily goal establishment of mechanical ventilation. Phase II intervention was the setting and monitoring of daily goals of mechanical ventilation with a web-based data visualization system (T3). A single score of mechanical ventilation was developed to evaluate the outcome. The baseline phase evaluated 130 subjects, phase I enrolled 31 subjects, and phase II enrolled 36 subjects. There were no differences in demographic characteristics between cohorts. A total of 171 verbalizations of goals of mechanical ventilation were completed in phase I. The use of T3 increased by 87% from phase I. Mechanical ventilation score improved by 8.4% in phase I and 11.3% in phase II from baseline ( P = .032). The largest effect was in the low risk V T category, with a 40.3% improvement from baseline in phase I, which was maintained at 39% improvement from baseline in phase II ( P = .01). mechanical ventilation score was 9% higher on average in those who survived. Daily goal formation and computer-enhanced visualization of mechanical ventilation variance were associated with an improvement in goal attainment by evidence of an improved mechanical ventilation score. Further research is needed to determine whether improvements in mechanical ventilation score through a targeted, process-oriented intervention will lead to

  15. Tempo de ventilação mecânica e desenvolvimento de displasia broncopulmonar Duration of mechanical ventilation and development of bronchopulmonary dysplasia

    Directory of Open Access Journals (Sweden)

    Ana Damaris Gonzaga

    2007-02-01

    Full Text Available OBJETIVO: Verificar a associação entre o tempo de uso da ventilação mecânica e o desenvolvimento de displasia broncopulmonar em recém-nascidos com peso de nascimento 15 dias. Foi calculada a razão de chance para o desenvolvimento de displasia broncopulmonar em cada período de utilização da ventilação mecânica. RESULTADOS: Dos 216 prontuários avaliados, 121 preencheram os critérios de inclusão. As médias do peso de nascimento e idade gestacional foram de 1199,8 g e 31,8 semanas. No período de 1 a 7 dias de uso da ventilação mecânica, 15,5% dos recém-nascidos evoluíram com displasia broncopulmonar; no período de 8 a 14 dias, 60%; e no período > 15 dias, 88,2%; com razão de chance de 0,16, 11,25 e 16,36, respectivamente. CONCLUSÃO: A possibilidade de um recém-nascido com peso de nascimento OBJECTIVE: Verify the association between duration of mechanical ventilation and development of bronchopulmonary dysplasia in neonates weighting at birth less than 1500g. METHODS: Retrospective study conducted with neonates weighting less than 1500g at birth submitted to mechanical ventilation. Neonates presenting major birth defects, transferred to other services or died before the 28th day of life were excluded from the study. Three groups were analyzed according to duration of mechanical ventilation: 1 to 7 days, 8 to 14 days and more than 15 days. The chance ratio of developing bronchopulmonary dysplasia was calculated for each group. RESULTS: From the 216 clinical histories assessed, 121 met the criteria for inclusion in the study. Mean birth weight and gestational age were 1199.8 g and 31.8 weeks. Of all neonates submitted to mechanical ventilation from 1 to 7 days, 15.5% developed bronchopulmonary dysplasia; from 8 to 14 days 60% and from more than 15 days, 88.2%; chance ratios were equal to 0.16; 11.25 and 16.36, respectively. CONCLUSION: The chance of a neonate weighting less than 1500 g developing bronchopulmonary dysplasia

  16. Transporting newborn infants with suspected duct dependent congenital heart disease on low‐dose prostaglandin E1 without routine mechanical ventilation

    Science.gov (United States)

    Carmo, Kathryn A Browning; Barr, Peter; West, Maureen; Hopper, Neil W; White, Jennifer P; Badawi, Nadia

    2007-01-01

    Aim To evaluate the safety of transporting newborn infants with suspected duct dependent congenital heart disease (CHD) treated with prostaglandin E1 (PGE1) without routine mechanical ventilation. Methods A retrospective population‐based audit of newborn infants with suspected CHD transported on PGE1 by the New South Wales newborn and paediatric Transport Service from 1995 through 2005. Results Mechanical ventilation was not used prior to treatment with PGE1 in 94 (31%) of the 300 infants. The indications for mechanical ventilation in the remaining 206 infants (69%) included elective mechanical ventilation because of the intention to use PGE1 (n  =  125) and severe hypoxaemia, acidosis or cardiorespiratory failure prior to commencing PGE1 (n  =  81). 16 (17%) of the 94 infants who were not ventilated initially required mechanical ventilation before transport because of apnoea, which developed within one hour of commencing PGE1. 2 (2.6%) of the 78 infants transported without mechanical ventilation developed apnoea in transit and both were receiving ⩾15 ng/kg/min of PGE1. Apnoea was more likely to occur in non‐ventilated infants when the PGE1 infusion rate was ⩾15 ng/kg/min compared with Newborn infants with suspected duct dependent CHD treated with low dose PGE1 (mechanical ventilation for safe transport. PMID:16905574

  17. Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation.

    Science.gov (United States)

    Browning Carmo, Kathryn A; Barr, Peter; West, Maureen; Hopper, Neil W; White, Jennifer P; Badawi, Nadia

    2007-03-01

    To evaluate the safety of transporting newborn infants with suspected duct dependent congenital heart disease (CHD) treated with prostaglandin E1 (PGE1) without routine mechanical ventilation. A retrospective population-based audit of newborn infants with suspected CHD transported on PGE1 by the New South Wales newborn and paediatric Transport Service from 1995 through 2005. Mechanical ventilation was not used prior to treatment with PGE1 in 94 (31%) of the 300 infants. The indications for mechanical ventilation in the remaining 206 infants (69%) included elective mechanical ventilation because of the intention to use PGE1 (n = 125) and severe hypoxaemia, acidosis or cardiorespiratory failure prior to commencing PGE1 (n = 81). 16 (17%) of the 94 infants who were not ventilated initially required mechanical ventilation before transport because of apnoea, which developed within one hour of commencing PGE1. 2 (2.6%) of the 78 infants transported without mechanical ventilation developed apnoea in transit and both were receiving >or=15 ng/kg/min of PGE1. Apnoea was more likely to occur in non-ventilated infants when the PGE1 infusion rate was >or=15 ng/kg/min compared with Newborn infants with suspected duct dependent CHD treated with low dose PGE1 (mechanical ventilation for safe transport.

  18. [Tolerance of endotracheal tubes in patients on mechanical ventilation].

    Science.gov (United States)

    Nydahl, P; Hermes, C; Dubb, R; Kaltwasser, A; Schuchhardt, D

    2015-02-01

    Modern concepts for sedation and analgesia and guidelines recommend light analgesia and sedation, so that patients on mechanically ventilation are more awake, compared to previous concepts. Hence, these patients are more alert and able to experience their situation on the ventilator and their endotracheal tube (ETT). There is currently no convincing evidence of how patients tolerate the tube under present conditions, which interventions could help them, or whether they want to be sedated deeper because of the tube. Based upon our own observations, a broad range of reactions are possible. The tolerance of the ETT in intensive care patients was explored. A systematic literature research without time constraints in the databases PubMed and CINAHL was performed. Included were quantitative and qualitative studies written in German or English that investigated tolerance of the ETT in adult intensive care patients. Excluded were anesthetic studies including in- and extubation immediately before and after operations. Of the 2348 hits, 14 studies were included, including 4 qualitative studies about the experience of intensive care, 8 quantitative studies including 2 randomized controlled studies, and 2 studies with a mixed approach. Within the studies different aspects could be identified, which may in- or decrease the tolerance of an ETT. Aspects like breathlessness, pain during endotracheal suctioning and inability to speak decrease the tolerance. Information, the presence of relatives and early mobilization appear to increase the tolerance. Tolerance of the ETT is a complex phenomenon. A reflected and critical evaluation of the behavior of the patient with an ETT is recommended. Interventions that increase the tolerance of the ETT should be adapted to the situation of the patient and should be evaluated daily.

  19. 32 CFR 644.450 - Items excluded from usual restoration obligation.

    Science.gov (United States)

    2010-07-01

    ... gypsum block walls. (3) Floor joints, roof trusses (including roof boards and roofing), and framing..., ventilators, and metal ceilings. (8) Structural steel or iron. (9) Fire escapes. (10) Heating systems. (11...

  20. Development of mechanical ventilation system with low energy consumption for renovation of buildings

    DEFF Research Database (Denmark)

    Terkildsen, Søren

    in reducing CO2-emmissions. Over the last decade, initiatives have been taken to reduce its energy consumption e.g. by the European Union, national governments or NGOs. The initiatives have mostly focused on improving the thermal properties of the building envelope to reduce heat losses. Building services......A general reduction in total energy consumption is needed, due to the increasing concerns about climate change caused by CO2-emmissions from fossil fuels. In 2004, the building sector accounted for 40% of the total energy consumption in the EU and the US and therefore must play a crucial role......, including ventilation, therefore now represent a larger part of the total energy consumption. Mechanical ventilation has been the most widely used principle of ventilation over the last 50 years, but the conventional system design needs revising to meet future energy requirements. The increase in the use...

  1. Experimental Evaluation of Ventilation Systems in a Single-Family Dwelling

    CERN Document Server

    Koffi, Juslin; Akoua, Jean-Jacques

    2010-01-01

    The French regulation on residential building ventilation relies on an overall and continuous air renewal. The fresh air should enter the building through the "habitable rooms" while the polluted air is extracted in the service rooms. In this way, internal air is drained from the lowest polluted rooms to the highest polluted ones. However, internal pressure equilibrium and air movements in buildings result from the combined effects ventilation system and parameters such as wind, temperature difference or doors opening. This paper aims to analyse the influence of these parameters on pollutant transfer within buildings. In so doing, experiments are carried out using tracer gas release for representing pollution sources in an experimental house. Mechanical exhaust, balanced and natural ventilation systems are thus tested. Results show the followings: - For all cases, internal doors' opening causes the most important pollutant spread. - When doors are closed, the best performances are obtained with balanced venti...

  2. Partial liquid ventilation improves lung function in ventilation-induced lung injury

    NARCIS (Netherlands)

    G.F. Vazquez de Anda; R.A. Lachmann; S.J.C. Verbrugge (Serge); D.A.M.P.J. Gommers (Diederik); J.J. Haitsma (Jack); B.F. Lachmann (Burkhard)

    2001-01-01

    textabstractDisturbances in lung function and lung mechanics are present after ventilation with high peak inspiratory pressures (PIP) and low levels of positive end-expiratory pressure (PEEP). Therefore, the authors investigated whether partial liquid ventilation can re-establish

  3. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).

    Science.gov (United States)

    Kneyber, Martin C J; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jürg; Macrae, Duncan; Markhorst, Dick G; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C

    2017-12-01

    Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

  4. Comparative performance assessment of a non-ventilated and ventilated BIPV rooftop configurations in the Netherlands

    NARCIS (Netherlands)

    Ritzen, M.J.; Vroon, Z.A.E.P.; Rovers, R.; Geurts, C.P.W.

    2017-01-01

    Backside ventilation is one of the most common passive cooling methods of PV modules in the built environment, but might be under constraint when integrating PV in the building envelope. To investigate the short and long term effect of backside ventilation on Building Integrated PV (BIPV)

  5. Mechanical ventilation in emergency departments: Non invasive or invasive mechanical ventilation. Where is the answer?

    OpenAIRE

    Esquinas Rodriguez Antonio M; Cosentini Roberto; Papadakos Peter J

    2012-01-01

    The Emergency Department length of stay for patients requiring mechanical ventilation paper in this issue is very illustrative of many variables that still confound the way we treat patients that may not require endotracheal intubation (ETI) but may benefit from non-invasive mechanical ventilation (NIV) [1].

  6. Recovery Ventilation and Oxygen Debt-A Mathematical Model for the Prediction of Recovery Ventilation

    OpenAIRE

    G. P. Dimri; Arora, B. S.

    1982-01-01

    A Mathematical model has been evolved for the estimation of recovery ventilation following an exercise. The model has been used to estimate recovery ventilation in moderate to heavy exercise for a period of 32 minutes. The model gives satisfactory predictions for persons of different age groups and under different environment conditions thus establishing its universal applicability.

  7. Characteristics of rain penetration through a gravity ventilator used for natural ventilation.

    Science.gov (United States)

    Kim, Taehyeung; Lee, Dong Ho; Ahn, Kwangseog; Ha, Hyunchul; Park, Heechang; Piao, Cheng Xu; Li, Xiaoyu; Seo, Jeoungyoon

    2008-01-01

    Gravity ventilators rely simply on air buoyancy to extract air and are widely used to exhaust air contaminants and heat from workplaces using minimal energy. They are designed to maximize the exhaust flow rate, but the rain penetration sometimes causes malfunctioning. In this study, the characteristics of rain penetration through a ventilator were examined as a preliminary study to develop a ventilator with the maximum exhaust capacity while minimizing rain penetration. A model ventilator was built and exposed to artificial rain and wind. The paths, intensities and amounts of penetration through the ventilator were observed and measured in qualitative and quantitative fashions. In the first phase, the pathways and intensities of rain penetration were visually observed. In the second phase, the amounts of rain penetration were quantitatively measured under the different configurations of ventilator components that were installed based on the information obtained in the first-phase experiment. The effects of wind speed, grill direction, rain drainage width, outer wall height, neck height and leaning angle of the outer wall from the vertical position were analyzed. Wind speed significantly affected rain penetration. Under the low crosswind conditions, the rain penetration intensities were under the limit of detection. Under the high crosswind conditions, grill direction and neck height were the most significant factors in reducing rain penetration. The installation of rain drainage was also important in reducing rain penetration. The experimental results suggest that, with proper configurations of its components, a gravity ventilator can be used for natural ventilation without significant rain penetration problems.

  8. Analysis of trials comparing High Frequency Ventilation with Conventional Mechanical Ventilation : Clinical Epidemiology in Intensive Care

    NARCIS (Netherlands)

    Bollen, C.W.

    2006-01-01

    An abundance of experimental and clinical evidence indicates that mechanical ventilation can cause ventilator induced lung damage (VILI). Primary mechanisms leading to VILI are volutrauma, i.e. use of large tidal volumes resulting in over-distension, and atelectotrauma, i.e. repetitive closing and

  9. Changes in lung volume and ventilation during surfactant treatment in ventilated preterm infants

    NARCIS (Netherlands)

    Miedema, Martijn; de Jongh, Frans H.; Frerichs, Inez; van Veenendaal, Mariëtte B.; van Kaam, Anton H.

    2011-01-01

    The immediate and regional effects of exogenous surfactant in open lung high-frequency oscillatory ventilated (HFOV) preterm infants are unknown. To assess regional changes in lung volume, mechanics, and ventilation during and after surfactant administration in HFOV preterm infants with respiratory

  10. 41 CFR 105-68.415 - What must I do if a Federal agency excludes the participant or a principal after I enter into a...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What must I do if a Federal agency excludes the participant or a principal after I enter into a covered transaction? 105-68.415 Section 105-68.415 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES...

  11. 41 CFR 105-68.310 - What must I do if a Federal agency excludes a person with whom I am already doing business in a...

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What must I do if a Federal agency excludes a person with whom I am already doing business in a covered transaction? 105-68.310 Section 105-68.310 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES...

  12. Prolonged mechanical ventilation in Canadian intensive care units: a national survey.

    Science.gov (United States)

    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.

  13. Ventilation practices in subarachnoid hemorrhage: a cohort study exploring the use of lung protective ventilation.

    Science.gov (United States)

    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 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 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

  14. Vaccination coverage among adults, excluding influenza vaccination - United States, 2013.

    Science.gov (United States)

    Williams, Walter W; Lu, Peng-Jun; O'Halloran, Alissa; Bridges, Carolyn B; Kim, David K; Pilishvili, Tamara; Hales, Craig M; Markowitz, Lauri E

    2015-02-06

    among the general population, and adult patients largely rely on health care provider recommendations for vaccination. The Community Preventive Services Task Force and the National Vaccine Advisory Committee have recommended that health care providers incorporate vaccination needs assessment, recommendation, and offer of vaccination into every clinical encounter with adult patients to improve vaccination rates and to narrow the widening racial/ethnic disparities in vaccination coverage.

  15. Ventilator versus manual hyperinflation in clearing sputum in ventilated intensive care unit patients.

    Science.gov (United States)

    Dennis, Diane; Jacob, Wendy; Budgeon, Charley

    2012-01-01

    The aim of hyperinflation in the ventilated intensive care unit patient is to increase oxygenation, reverse lung collapse and clear sputum. The efficacy and consistency of manual hyperventilation is well supported in the literature, but there is limited published evidence supporting hyperventilation utilising a ventilator. Despite this, a recent survey established that almost 40% of Australian tertiary intensive care units utilise ventilator hyperinflation. The aim of this non-inferiority cross-over study was to determine whether ventilator hyperinflation was as effective as manual hyperinflation in clearing sputum from patients receiving mechanical ventilation using a prescriptive ventilator hyperinflation protocol. Forty-six patients received two randomly ordered physiotherapy treatments on the same day by the same physiotherapist. The efficacy of the hyperinflation modes was measured by sputum wet weight. Secondary measures included compliance, tidal volume, airway pressure and PaO2/FiO2 ratio. There was no difference in wet weight of sputum cleared using ventilator hyperinflation or manual hyperinflation (mean 3.2 g, P=0.989). Further, no difference in compliance (P=0.823), tidal volume (P=0.219), heart rate (P=0.579), respiratory rate (P=0.929) or mean arterial pressure (P=0.593) was detected. A statistically significant difference was seen in mean airway pressure (P=0.002) between techniques. The effect of techniques on the PaO2/FiO2 response ratio was dependent on time (interaction P=0.024). Physiotherapy using ventilator hyperinflation cleared a comparable amount of sputum and was as safe as manual hyperinflation. This research describes a ventilator hyperinflation protocol that will serve as a platform for continued discussion, research and development of its application in ventilated patients.

  16. The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation.

    Science.gov (United States)

    Kobayashi, Hidetsugu; Uchino, Shigehiko; Takinami, Masanori; Uezono, Shoichi

    2017-11-01

    The Centers for Disease Control and Prevention recently released a surveillance definition for respiratory complications in ventilated patients, ventilator-associated events (VAEs), to replace ventilator-associated pneumonia (VAP). VAEs consist of ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC), and possible VAP. A duration of mechanical ventilation of at least 4 d is required to diagnose VAE. However, the observed duration of mechanical ventilation was mechanical ventilation for ≥ 4 d. This single-center retrospective cohort study was conducted in the general ICU of an academic hospital. We included 407 adult subjects who were admitted to the ICU and required mechanical ventilation for at least 4 d. VAC and IVAC were identified from the electronic medical records. VAP was defined according to the Centers for Disease Control and Prevention 2008 criteria and was identified from the surveillance data of the infection control team of our hospital. Clinical outcomes were studied in the VAC, IVAC, and VAP groups. Possible VAP was not investigated. Higher mortality was seen in VAC and IVAC subjects, but not in VAP subjects, compared with those without VAEs and VAP. By multivariable hazard analysis for hospital mortality, IVAC was independently associated with hospital mortality (hazard ratio 2.42, 95% CI 1.39-4.20, P = .002). VAC also tended to show a similar association with hospital mortality (hazard ratio 1.45, 95% CI 0.97-2.18, P = .07). On the other hand, VAP did not increase a hazard of hospital death (hazard ratio 1.08, 95% CI 0.44-2.66, P = .87). We found that a VAE was related to hospital mortality in critically ill subjects with prolonged mechanical ventilation, and that VAP was not. Copyright © 2017 by Daedalus Enterprises.

  17. Image-based monitoring of one-lung ventilation.

    Science.gov (United States)

    Jean, S; Cinel, I; Gratz, I; Tay, C; Lotano, V; Deal, E; Parrillo, J E; Dellinger, R P

    2008-12-01

    With the increasing demand for one-lung ventilation in both thoracic surgery and other procedures, identifying the correct placement becomes increasingly important. Currently, endobronchial intubation is suspected based on a combination of auscultation and physiological findings. We investigated the ability of the visual display of airflow-induced vibrations to detect single-lung ventilation with a double-lumen endotracheal tube. Double-lumen tubes were placed prior to surgery. Tracheal and endobronchial lumens were alternately clamped to produce unilateral lung ventilation of right and left lung. Vibration response imaging, which detects vibrations transmitted to the surface of the thorax, was performed during both right- and left-lung ventilation. Geographical area of vibration response image as well as amount and distribution of lung sounds were assessed. During single-lung ventilation, the image and video obtained from the vibration response imaging identifies the ventilated lung with a larger and darker image on the ventilated side. During single-lung ventilation, 87.2 +/- 5.7% of the measured vibrations was detected over the ventilated lung and 12.8 +/- 5.7% over the non-ventilated lung (P single-lung ventilation, the vibration distribution in the non-ventilated lung had a majority of vibration detected by the medial sensors closest to the midline (P lung is ventilated. During single-lung ventilation, vibration response imaging clearly showed increased vibration in the lung that is being ventilated. Distribution of residual vibration differed in the non-ventilated lung in a manner that suggests transmission of vibrations across the mediastinum from the ventilated lung. The lung image and video obtained from vibration response imaging may provide useful and immediate information to help one-lung ventilation assessment.

  18. T-piece versus self-inflating bag ventilation in preterm neonates at birth.

    Science.gov (United States)

    Guinsburg, Ruth; de Almeida, Maria Fernanda Branco; de Castro, Junia Sampel; Gonçalves-Ferri, Walusa Assad; Marques, Patricia Franco; Caldas, Jamil Pedro Siqueira; Krebs, Vera Lucia Jornada; Souza Rugolo, Ligia Maria Suppo de; de Almeida, João Henrique Carvalho Leme; Luz, Jorge Hecker; Procianoy, Renato S; Duarte, José Luiz Muniz Bandeira; Penido, Marcia Gomes; Ferreira, Daniela Marques de Lima Mota; Alves Filho, Navantino; Diniz, Edna Maria de Albuquerque; Santos, Juliana Paula; Acquesta, Ana Lucia; Santos, Cristina Nunes Dos; Gonzalez, Maria Rafaela Conde; da Silva, Regina Pg Vieira Cavalcanti; Meneses, Jucile; Lopes, José Maria de Andrade; Martinez, Franciscó Eulógio

    2017-06-29

    To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. Pragmatic prospective cohort study. 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded. Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome. 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

  19. Low resource ventilation unit; Ressourcebesparende ventilationsenhed

    Energy Technology Data Exchange (ETDEWEB)

    Drivsholm, C.

    2012-03-15

    In the project a resource-saving ventilation device was developed which is based on the use of a regenerator and a reversible air flow. The regenerator is placed in the building envelope, and the concept works in the way that the heat in the air during ventilation is stored in the regenerator and brought back into the building by a reversible air change. The heated air is blown from inside the building out through the regenerator. In this way the regenerator accumulates the heat in the air. Over a period of 30-120 seconds, the regenerator capacity is utilized. When the regenerator cannot be further heated, the air flow is reversed and there is now blown cold air through the regenerator. Thereby the heat from the regenerator is released to the cold fresh air. Thus, the fresh air brings heat back into the building, whereby the air is replaced with a limited heat loss. Ventilation with a regenerator is described as micro-ventilation. The developed micro-ventilation unit was tested by the Danish Technological Institute. The test results shows that the unit performs according to expectations: 1) The heat recovery is 85%; 2) The flow through the unit is 80m3 per hour in a 5 section unit; 3) The noise level is 30 db(A) in a representative room; 4) The energy consumption is <300 J/m3. The unit is introduced into the market, and the first plants have been sold. (LN)

  20. Intelligent decision support systems for mechanical ventilation.

    Science.gov (United States)

    Tehrani, Fleur T; Roum, James H

    2008-11-01

    An overview of different methodologies used in various intelligent decision support systems (IDSSs) for mechanical ventilation is provided. The applications of the techniques are compared in view of today's intensive care unit (ICU) requirements. Information available in the literature is utilized to provide a methodological review of different systems. Comparisons are made of different systems developed for specific ventilation modes as well as those intended for use in wider applications. The inputs and the optimized parameters of different systems are discussed and rule-based systems are compared to model-based techniques. The knowledge-based systems used for closed-loop control of weaning from mechanical ventilation are also described. Finally, in view of increasing trend towards automation of mechanical ventilation, the potential utility of intelligent advisory systems for this purpose is discussed. IDSSs for mechanical ventilation can be quite helpful to clinicians in today's ICU settings. To be useful, such systems should be designed to be effective, safe, and easy to use at patient's bedside. In particular, these systems must be capable of noise removal, artifact detection and effective validation of data. Systems that can also be adapted for closed-loop control/weaning of patients at the discretion of the clinician, may have a higher potential for use in the future.

  1. Improving comfort and health with personalized ventilation

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor

    2004-01-01

    The thermal environment and air quality in buildings affects occupants¿ health, comfort and performance. The heating, ventilating and air-conditioning (HVAC) of buildings today is designed to provide a uniform room environment. However, large individual differences exist between occupants in regard...... microenvironment. Furthermore, HVAC systems should be designed to protect occupants from airborne transmission of infectious agents that may be present in exhaled air. Personalized ventilation is a new development in the field of HVAC and has the potential to fulfil the above requirements. This paper reviews...... existing knowledge on performance of personalized ventilation (PV) and on human response to it. The airflow interaction in the vicinity of the human body is analysed and its impact on thermal comfort and inhaled air quality is discussed together with control strategies and the application of PV in practice...

  2. Personal Exposure in Displacement Ventilated Rooms

    DEFF Research Database (Denmark)

    Brohus, Henrik; Nielsen, Peter Vilhelm

    1996-01-01

    in the lower part of the room close to the occupant. A personal exposure model for displacement ventilated rooms is proposed. The model takes the influence of gradients and the human thermal boundary layer into account. Two new quantities describing the interaction between a person and the ventilation......Personal exposure in a displacement ventilated room is examined. The stratified flow and the considerable concentration gradients necessitate an improvement of the widely used fully mixing compartmental approach. The exposure of a seated and a standing person in proportion to the stratification...... height is examined by means of full-scale measurements. A breathing thermal manikin is used to simulate a person. It is found that the flow in the boundary layer around a person is able to a great extent to entrain and transport air from below the breathing zone. In the case of non-passive, heated...

  3. Home Mechanical Ventilation in South Korea

    Science.gov (United States)

    Kim, Dong Hyun; Choi, Won Ah

    2014-01-01

    Purpose To survey the use of invasive and noninvasive home mechanical ventilation (HMV) methods in South Korea from the perspective of physical medicine and rehabilitation (PM&R). Materials and Methods For 413 users of HMV, retrospective reviews of PM&R interventions and survey of HMV methods employed from Mar 2000 to Dec 2009. Results Of the 413 users, the majority of whom with progressive neuromuscular disorders (NMDs) (n=358), 284 patients initially used noninvasive mechanical ventilation (NIV), while 63 others who were using tracheostomy mechanical ventilation switched to NIV as part of their rehabilitation. The NMD patients began HMV at an earlier age (34.9±20.3 yrs), and used for longer (14.7±7.5) hours than patients with non-neuromuscular causes of respiratory impairment. Conclusion Noninvasive management was preferred over invasive ones, and transition to the former was a result of PM&R interventions. PMID:25323913

  4. Energy Analysis of the Ductless Personalized Ventilation

    DEFF Research Database (Denmark)

    Lelong, Cyril; Dalewski, Mariusz; Melikov, Arsen Krikor

    2013-01-01

    This study explores the impact of different occupancy profiles on the potential energy savings due to using ductless personalized ventilation (DPV) combined with displacement ventilation. Energy simulations were performed with the dynamic simulation software IDA-ICE in order to investigate optimal...... energy efficient strategies for implantation of DPV in practice. The impact of using DPV on annual energy use has been studied for different occupancy profiles in cold climates. The results suggest that using DPV combined with displacement ventilation may significantly reduce building energy use while...... providing good air quality and thermal comfort for the occupants. Matching DPV use with occupants’ presence at their workplaces may allow reducing the energy use of DPV significantly....

  5. Phrenic pacing compared with mechanical ventilation

    DEFF Research Database (Denmark)

    Andersen, Morten Packert; Laub, Michael; Biering-Sørensen, Fin

    2017-01-01

    mechanical ventilator dependent tetraplegics met the inclusion criteria. Data were retrieved from medical records and a structured follow-up interview with seven individuals from each group. RESULTS: No significant differences were found when comparing age at injury, time since injury, length...... of hospitalization, incidence of pneumonia, number of pneumonia hospitalizations, number of tracheal suctions, speech quality and activities of daily living or quality of life. On the Short Form Health Survey (SF36) mental health summary the median for both users of phrenic nerve pacing and users of mechanical...... ventilation was one s.d. above the mean of a standard population. CONCLUSIONS: Nine people have had a phrenic nerve pacer implanted. They do not significantly differ from a group of home mechanical ventilator dependent tetraplegics on a number of performance measures, but both groups seem to have better...

  6. Performance of displacement ventilation in practice

    DEFF Research Database (Denmark)

    Naidenov, K.; Pitchurov, G.; Langkilde, Gunnar

    2002-01-01

    This paper presents results of a field study in offices with displacement ventilation. It comprises detailed physical measurements of the thermal environment and collection of occupants´ response at 227 workplaces. The results, both physical measurements and human response, identified draught...... as the major local discomfort in the rooms with displacement ventilation. Twenty-three percent of the occupants were daily bothered by draught. In some buildings the maintenance personnel tried to improve occupants´ thermal comfort by raising the supply air temperature or office workers themselves blocked...... the diffusers by rearranging the furniture. Half of the surveyed occupants were not satisfied with the indoor air quality. The main conclusion is that displacement ventilation needs careful design and room furnishing in order to ensure a comfortable environment. Occupants must understand the underlying...

  7. Multiple factors influencing OR ventilation system effectiveness

    Directory of Open Access Journals (Sweden)

    Buhl Sebastian

    2016-09-01

    Full Text Available The issue of surgical site infections has become more critical during the last years. The number of airborne microbes depends on the number released by the staff in the room or supplied from neighbouring rooms. In order to minimize the risk of nosocomial infections during surgical procedures technical developments like ventilation systems were introduced in the operating room (OR. In this study several factors like clothing and types of ventilation systems have been investigated and their impact on the effectiveness for reducing microbial burden in the OR has been assessed. In case of OR-gowns we found a benefit for a disposable Swedish clothing concept regarding microbiological contamination in comparison with the German standard multiuse clothing. Moreover our study shows that there is comparable effectiveness of a fairly novel temperature controlled airflow ventilation system (TAF compared to standard low turbulent uni-directional airflow (TAV.

  8. SUPRAGLOTTIC JET VENTILATION VERSUS CONVENTIONAL ENDOTRACHEAL VENTILATION IN MINOR LARYNGEAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Illendual Upendranath

    2016-08-01

    Full Text Available Any attempt at intubation will cause many cardiovascular responses and the major concern during this time is to attenuate the same. Similar response is seen during procedures on Larynx in microlaryngeal surgery which produces an intense cardiovascular stimulation during suspension laryngoscopy and intubation. AIM OF STUDY Supraglottic jet ventilation versus conventional endotracheal ventilation in minor laryngeal surgeries. To evaluate the haemodynamic response in supraglottic jet ventilation and conventional intubation in minor laryngeal surgeries. METHODS Patients were randomised to 2 Groups: 30 patients in each group; Group A - in whom supraglottic jet ventilation was planned and Group B - in whom endotracheal intubation was planned. RESULT The haemodynamic response in terms of increase in MAP and HR is significantly more with endotracheal intubation than with supraglottic jet ventilation. CONCLUSION Our study showed that supraglottic jet ventilation showed a better haemodynamic stability when compared to conventional endotracheal intubation in patients undergoing minor laryngeal surgeries. Statistical scores were also in favour of the patients treated with supraglottic jet ventilation based on the p values.

  9. Demand-controlled mechanical ventilation. Behovsstyret mekanisk ventilation; Fugt som reguleringsparameter - et pilotprojekt

    Energy Technology Data Exchange (ETDEWEB)

    1992-06-01

    This report presents the results from the registration throughout a month of relative humidity, temperature and outdoor air exchanger as well as the concentration of carbon dioxide in each room of an inhabited single family house, in which all rooms are ventilated by a mechanical balanced ventilation system with variable air volume. The ventilation outdoor air rate is controlled by the relative humidity, which is kept on a value adequate to reduce the living conditions for house dust mites and prevent condensation on the indoor surfaces of the building. Due to the demand control ventilation of each individual room a higher efficiency for reducing water vapors in the dwelling as a whole is likely to be achieved. The results show that it is possible with this kind of ventilation system and in the context of Danish outdoor climate to maintain humidity conditions that is anticipated to reduce the number of house dust mites in all rooms of a dwelling during more than five months of the year. In all the months the mean daily mechanical ventilation rate is estimated to be 39% below the level recommended in the Danish Building Code. At the same time indoor condensation was avoided on poorly insulated surfaces of the building. The concentration of carbon dioxide was below the level recommended in international ventilation standards. (au) (13 refs.)

  10. Ventilator gas flow rates affect inspiratory time and ventilator efficiency index in term lambs.

    Science.gov (United States)

    Bach, Katinka P; Kuschel, Carl A; Oliver, Mark H; Bloomfield, Frank H

    2009-01-01

    Despite increasing survival in the smallest preterm infants, the incidence of chronic lung disease has not decreased. Research into ventilatory strategies has concentrated on minimising barotrauma, volutrauma and atelectotrauma, but little attention has been paid to the role of bias gas flow rates and the potential for rheotrauma or shear stress injury. Ventilated preterm infants frequently receive relatively high gas flow rates. We hypothesised that altering bias gas flow rates would change the efficiency of ventilation and thereby affect ventilatory parameters. We tested this hypothesis using an artificial lung followed by ventilation of 8 term lambs. Between flows of 2 and 15 l/min, inflation time (Ti) in the artificial lung was inversely related to the bias gas flow rate. In the ventilated lambs, Ti was inversely related to flow rates up to 10 l/min, with no statistically significant effect at flow rates >10 l/min. There were no adverse effects on gas exchange or cardiovascular parameters until a flow rate of 3 l/min was used, when inadequate gas exchange occurred. Ti is inversely associated with the bias gas flow rate. Flow rates much lower than those used in many neonatal units seem to provide adequate ventilation. We suggest that the role of ventilator gas flow rates, which may potentially influence shear stress in ventilator-induced lung injury, merits further investigation. Copyright 2009 S. Karger AG, Basel.

  11. Trends in mechanical ventilation: are we ventilating our patients in the best possible way?

    Science.gov (United States)

    Veneroni, Chiara; Farre’, Ramon

    2017-01-01

    This review addresses how the combination of physiology, medicine and engineering principles contributed to the development and advancement of mechanical ventilation, emphasising the most urgent needs for improvement and the most promising directions of future development. Several aspects of mechanical ventilation are introduced, highlighting on one side the importance of interdisciplinary research for further development and, on the other, the importance of training physicians sufficiently on the technological aspects of modern devices to exploit properly the great complexity and potentials of this treatment. Educational aims To learn how mechanical ventilation developed in recent decades and to provide a better understanding of the actual technology and practice. To learn how and why interdisciplinary research and competences are necessary for providing the best ventilation treatment to patients. To understand which are the most relevant technical limitations in modern mechanical ventilators that can affect their performance in delivery of the treatment. To better understand and classify ventilation modes. To learn the classification, benefits, drawbacks and future perspectives of automatic ventilation tailoring algorithms. PMID:28620428

  12. Thermoregulation and ventilation of termite mounds

    Science.gov (United States)

    Korb, Judith

    2003-05-01

    Some of the most sophisticated of all animal-built structures are the mounds of African termites of the subfamily Macrotermitinae, the fungus-growing termites. They have long been studied as fascinating textbook examples of thermoregulation or ventilation of animal buildings. However, little research has been designed to provide critical tests of these paradigms, derived from a very small number of original papers. Here I review results from recent studies on Macrotermes bellicosus that considered the interdependence of ambient temperature, thermoregulation, ventilation and mound architecture, and that question some of the fundamental paradigms of termite mounds. M. bellicosus achieves thermal homeostasis within the mound, but ambient temperature has an influence too. In colonies in comparably cool habitats, mound architecture is adapted to reduce the loss of metabolically produced heat to the environment. While this has no negative consequences in small colonies, it produces a trade-off with gas exchange in large colonies, resulting in suboptimally low nest temperatures and increased CO2 concentrations. Along with the alteration in mound architecture, the gas exchange/ventilation mechanism also changes. While mounds in the thermally appropriate savannah have a very efficient circular ventilation during the day, the ventilation in the cooler forest is a less efficient upward movement of air, with gas exchange restricted by reduced surface exchange area. These results, together with other recent findings, question entrenched ideas such as the thermosiphon-ventilation mechanism or the assumption that mounds function to dissipate internally produced heat. Models trying to explain the proximate mechanisms of mound building, or building elements, are discussed.

  13. Advanced design of local ventilation systems

    Energy Technology Data Exchange (ETDEWEB)

    Kulmala, I. [VTT Manufacturing Technology, Espoo (Finland). Safety Technology

    1997-12-31

    Local ventilation is widely used in industry for controlling airborne contaminants. However, the present design practices of local ventilation systems are mainly based on empirical equations and do not take quantitatively into account the various factors affecting the performance of these systems. The aim of this study was to determine the applicability and limitations of more advanced fluid mechanical methods to the design and development of local ventilation systems. The most important factors affecting the performance of local ventilation systems were determined and their effect was studied in a systematic manner. The numerical calculations were made with the FLUENT computer code and they were verified by laboratory experiments, previous measurements or analytical solutions. The results proved that the numerical calculations can provide a realistic simulation of exhaust openings, effects of ambient air flows and wake regions. The experiences with the low-velocity local supply air showed that these systems can also be modelled fairly well. The results were used to improve the efficiency and thermal comfort of a local ventilation unit and to increase the effective control range of exhaust hoods. In the simulation of the interaction of a hot buoyant source and local exhaust, the predicted capture efficiencies were clearly higher than those observed experimentally. The deviations between measurements and non-isothermal flow calculations may have partly been caused by the inability to achieve grid independent solutions. CFD simulations is an advanced and flexible tool for designing and developing local ventilation. The simulations can provide insight into the time-averaged flow field which may assist us in understanding the observed phenomena and to explain experimental results. However, for successful calculations the applicability and limitations of the models must be known. (orig.) 78 refs.

  14. Determinants of Receiving Palliative Care and Ventilator Withdrawal Among Patients With Prolonged Mechanical Ventilation.

    Science.gov (United States)

    Chen, Yang-Ching; Fan, Hsien-Yu; Curtis, J Randall; Lee, Oscar Kuang-Sheng; Liu, Chih-Kuang; Huang, Sheng-Jean

    2017-10-01

    Increasing numbers of patients with prolonged mechanical ventilation generates a tremendous strain on healthcare systems. Patients with prolonged mechanical ventilation suffer from long-term poor quality of life. However, no study has ever explored the willingness to receive palliative care or terminal withdrawal and the factors influencing willingness. Cross-sectional study. Five different hospitals of Taipei City Hospital system. Adult patients with ventilatory support for more than 60 days. None. We identified the family members of 145 consecutive patients with prolonged mechanical ventilation in five hospitals of Taipei City Hospital system and enrolled family members for 106 patients (73.1%). We collected information from patient families' regarding concepts (knowledge, attitude, and experiences) of palliative care, caregiver burden, family function, patient quality of life, and physician-family communications. From the medical record, we obtained duration of hospitalization, consciousness level, disease severity, medical cost, and the presence of do-not-resuscitate orders. The vast majority of family members agreed with the concept of palliative care (90.4%) with 17.3% of the family members agreeing to ventilator withdrawal currently and 67.5% terminally in anticipation of death. Approximately half of the family members regretted having chosen prolonged mechanical ventilation (56.7%). Reduced patient quality of life and increased family understanding of palliative care significantly associated with increased caregiver willingness to endorse palliative care and withdraw life-sustaining agents in anticipation of death. Longer duration of ventilator usage and hospitalization was associated with increased feelings of regret about choosing prolonged mechanical ventilation. During prolonged mechanical ventilation, physicians should thoroughly discuss its benefits and burdens. Families should be given the opportunity to discuss the circumstances under which they

  15. Preoperational test report, recirculation ventilation systems

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-11-11

    This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  16. Design of Energy Efficient Hybrid Ventilation

    DEFF Research Database (Denmark)

    Heiselberg, Per

    The focus in the development has for both systems been to minimise energy consumption while maintaining a comfortable and healthy indoor environment. The natural next step in this development is to develop ventilation concepts that utilises and combines the best features from each system[Mechanic......The focus in the development has for both systems been to minimise energy consumption while maintaining a comfortable and healthy indoor environment. The natural next step in this development is to develop ventilation concepts that utilises and combines the best features from each system...

  17. Ductless personalized ventilation with local air cleaning

    OpenAIRE

    Dalewski, Mariusz; Vesely, Michal; Melikov, Arsen Krikor

    2012-01-01

    An experiment with 28 human subjects was performed to examine effects of using a local air cleaning device combined with ductless personalized ventilation (DPV) on perceived air quality. Experiments were performed in a test room with displacement ventilation. The DPV at one of two desks was equipped with an activated carbon filter installed at the air intake, while the DPV at the second desk was without such a filter. The air temperature in the occupied zone (1.1 m above the floor) was 29 °C....

  18. No-sedation during mechanical ventilation

    DEFF Research Database (Denmark)

    Laerkner, Eva; Stroem, Thomas; Toft, Palle

    2016-01-01

    BACKGROUND: Evidence is growing that less or no-sedation is possible and beneficial for patients during mechanical ventilation. AIM: To investigate if there was a difference in patient consciousness and nursing workload comparing a group of patients receiving no-sedation with a group of sedated...... patients with daily wake up, and also to estimate economic consequences of a no-sedation strategy. DESIGN AND METHODS: Data were collected during a prospective trial of 140 mechanically ventilated patients randomized to either no-sedation or to sedation with daily wake up. From day 1 to 7 in the intensive...

  19. Achieving Natural and Hybrid Ventilation in Practice

    DEFF Research Database (Denmark)

    Liddament, Martin; Axley, James; Heiselberg, Per

    2006-01-01

    Case studies provide essential evidence about the performance of buildings. They also illustrate the methods by which a technology can be implemented as well as highlighting problems. Various case study buildings (both new and retrofit) that incorporate mixed mode, natural ventilation and low...... energy cooling are reviewed in this paper. An outline of the tasks that ventilation is required to perform is also presented. The results show that many buildings perform well and can provide good thermal comfort and air quality for much of the occupied period. Various solutions have been introduced...

  20. Sedation and analgesia to facilitate mechanical ventilation.

    Science.gov (United States)

    Nemergut, Michael E; Yaster, Myron; Colby, Christopher E

    2013-09-01

    Regardless of age, health care professionals have a professional and ethical obligation to provide safe and effective analgesia to patients undergoing painful procedures. Historically, newborns, particularly premature and sick infants, have been undertreated for pain. Intubation of the trachea and mechanical ventilation are ubiquitous painful procedures in the neonatal intensive care unit that are poorly assessed and treated. The authors review the use of sedation and analgesia to facilitate endotracheal tube placement and mechanical ventilation. Controversies regarding possible adverse neurodevelopmental outcomes after sedative and anesthetic exposure and in the failure to treat pain is also discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Weaning Automation with Adaptive Support Ventilation: A Randomized Controlled Trial in Cardiothoracic Surgery Patients

    NARCIS (Netherlands)

    Dongelmans, Dave A.; Veelo, Denise P.; Paulus, Frederique; de Mol, Bas A. J. M.; Korevaar, Johanna C.; Kudoga, Anna; Middelhoek, Pauline; Binnekade, Jan M.; Schultz, Marcus J.

    2009-01-01

    Background: Adaptive support ventilation (ASV) is a microprocessor-controlled mode of mechanical ventilation that switches automatically from controlled ventilation to assisted ventilation and selects ventilatory settings according to measured lung mechanics. Methods: In a randomized controlled

  2. Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries).

    Science.gov (United States)

    de Lesquen, Henri; Avaro, Jean-Philippe; Gust, Lucile; Ford, Robert Michael; Beranger, Fabien; Natale, Claudia; Bonnet, Pierre-Mathieu; D'Journo, Xavier-Benoît

    2015-03-01

    This review aims to answer the most common questions in routine surgical practice during the first 48 h of blunt chest trauma (BCT) management. Two authors identified relevant manuscripts published since January 1994 to January 2014. Using preferred reporting items for systematic reviews and meta-analyses statement, they focused on the surgical management of BCT, excluded both child and vascular injuries and selected 80 studies. Tension pneumothorax should be promptly diagnosed and treated by needle decompression closely followed with chest tube insertion (Grade D). All traumatic pneumothoraces are considered for chest tube insertion. However, observation is possible for selected patients with small unilateral pneumothoraces without respiratory disease or need for positive pressure ventilation (Grade C). Symptomatic traumatic haemothoraces or haemothoraces >500 ml should be treated by chest tube insertion (Grade D). Occult pneumothoraces and occult haemothoraces are managed by observation with daily chest X-rays (Grades B and C). Periprocedural antibiotics are used to prevent chest-tube-related infectious complications (Grade B). No sign of life at the initial assessment and cardiopulmonary resuscitation duration >10 min are considered as contraindications of Emergency Department Thoracotomy (Grade C). Damage Control Thoracotomy is performed for either massive air leakage or refractive shock or ongoing bleeding enhanced by chest tube output >1500 ml initially or >200 ml/h for 3 h (Grade D). In the case of haemodynamically stable patients, early video-assisted thoracic surgery is performed for retained haemothoraces (Grade B). Fixation of flail chest can be considered if mechanical ventilation for 48 h is probably required (Grade B). Fixation of sternal fractures is performed for displaced fractures with overlap or comminution, intractable pain or respiratory insufficiency (Grade D). Lung herniation, traumatic diaphragmatic rupture and pericardial rupture are life

  3. Thermal comfort and ventilation effectiveness in an office room with radiant floor cooling and displacement ventilation

    DEFF Research Database (Denmark)

    Krajcik, Michal; Tomasi, Roberta; Simone, Angela

    2016-01-01

    retain the favorable air and temperature distribution patterns and high ventilation effectiveness that are typically attained by displacement ventilation, while exploiting the energy conservation advantages of a high temperature cooling system. The tests were performed under a range of boundary......The influence of displacement ventilation and a cooled floor on indoor climate in the cooling season were experimentally studied in a room representing an office with a shaded window, occupied by two simulated employees. The aim was to investigate whether the combination of these two systems can...

  4. Efficient ventilation in school buildings. Design guidebook; Ventilation performante dans les ecoles. Guide de conception

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    This guidebook aims at giving practical advices for the design of ventilation systems for school buildings in order to maintain air quality levels and energy consumptions conformable with the real needs: 1 - the specific problem of schools (various types of rooms, particular indoor pollutions); 2 - main criteria to consider (air quality and hygiene, hygro-thermal comfort, ventilation efficiency, acoustic comfort, energy mastery); 3 - main existing solutions (simple-flux blow-off or blow-in mechanical ventilation systems, dual-flux systems, air conditioning systems); 4 - choice of an adapted solution (selection criteria, global solution for the school); setting-up and follow-up (rules, training, maintenance). (J.S.)

  5. [Comparative studies of the circulatory system during high frequency inspiratory ventilation and inspiratory positive pressure ventilation].

    Science.gov (United States)

    Nestorowicz, A; Powała-Niedźwiecki, K

    1989-02-06

    The studies were carried out in 14 dogs in which two different ventilation techniques were used under the general anaesthesia: HFIV and IPPV. Functioning of the cardio-vascular system was evaluated, basing on the measurements of pulse rate, pressure in the peripheral vessels, pulmonary artery and central venous pressure and calculation of the stroke volume, cardiac index, and pulmonary vessels resistance index. It was found that both techniques of ventilation did not exert any effect on the functioning of cardio-vascular system. Stroke volume was lower during IPPV than that during HFIV ventilation.

  6. Chest trauma: A case for single lung ventilation

    National Research Council Canada - National Science Library

    Pandharikar, Nagaraj; Sachdev, Anil; Gupta, Neeraj; Gupta, Suresh; Gupta, Dhiren

    2016-01-01

    .... The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation...

  7. Elective ventilation for organ donation: law, policy and public ethics.

    Science.gov (United States)

    Coggon, John

    2013-03-01

    This paper examines questions concerning elective ventilation, contextualised within English law and policy. It presents the general debate with reference both to the Exeter Protocol on elective ventilation, and the considerable developments in legal principle since the time that that protocol was declared to be unlawful. I distinguish different aspects of what might be labelled elective ventilation policies under the following four headings: 'basic elective ventilation'; 'epistemically complex elective ventilation'; 'practically complex elective ventilation'; and 'epistemically and practically complex elective ventilation'. I give a legal analysis of each. In concluding remarks on their potential practical viability, I emphasise the importance not just of ascertaining the legal and ethical acceptability of these and other forms of elective ventilation, but also of assessing their professional and political acceptability. This importance relates both to the successful implementation of the individual practices, and to guarding against possible harmful effects in the wider efforts to increase the rates of posthumous organ donation.

  8. Indoor Air Quality: Is Increased Ventilation the Answer?

    Science.gov (United States)

    Hansen, Shirley

    1989-01-01

    Explains how indoor air quality is affected by pollutants in the air and also by temperature, humidity, and ventilation. Increased ventilation alone seldom solves the "sick building syndrome." Lists ways to improve indoor air quality and optimize energy efficiency. (MLF)

  9. 30 CFR 75.330 - Face ventilation control devices.

    Science.gov (United States)

    2010-07-01

    ... control devices. (a) Brattice cloth, ventilation tubing and other face ventilation control devices shall... maintaining concentrations of respirable dust, methane, and other harmful gases, in accordance with the levels...

  10. The lived experience of patients on mechanical ventilation: research ...

    African Journals Online (AJOL)

    1994: 152). An independent coder verified the identified major themes, namely: experiences of patients related to the process of ventilation, as well as their experiences of the environment while connected to the ventilator. A literature control ...

  11. Dimensionless study on dynamics of pressure controlled mechanical ventilation system

    Energy Technology Data Exchange (ETDEWEB)

    Shi, Yan; Niu, Jinglong; Cai, Maolin; Xu, Weiqing [Beihang University, Beijing (Korea, Republic of)

    2015-02-15

    Dynamics of mechanical ventilation system can be referred in pulmonary diagnostics and treatments. In this paper, to conveniently grasp the essential characteristics of mechanical ventilation system, a dimensionless model of mechanical ventilation system is presented. For the validation of the mathematical model, a prototype mechanical ventilation system of a lung simulator is proposed. Through the simulation and experimental studies on the dimensionless dynamics of the mechanical ventilation system, firstly, the mathematical model is proved to be authentic and reliable. Secondly, the dimensionless dynamics of the mechanical ventilation system are obtained. Last, the influences of key parameters on the dimensionless dynamics of the mechanical ventilation system are illustrated. The study provides a novel method to study the dynamic of mechanical ventilation system, which can be referred in the respiratory diagnostics and treatment.

  12. Mechanical ventilation in neurocritical care patients: a systematic literature review

    NARCIS (Netherlands)

    Borsellino, Beatrice; Schultz, Marcus J.; Gama de Abreu, Marcelo; Robba, Chiara; Bilotta, Federico

    2016-01-01

    Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute

  13. Hypoxia in a neonate caused by intermittent positive pressure ventilation.

    OpenAIRE

    Beddis, I R; Silverman, M

    1980-01-01

    A newborn baby receiving mechanical ventilation was noted to have an extremely variable degree of hypoxia, despite the administration of 100% oxygen. The hypoxia was relieved rapidly when mechanical ventilation was withdrawn.

  14. Lung Transplantation for Ventilator-Dependent Respiratory Failure

    NARCIS (Netherlands)

    Vermeijden, J. Wytze; Zijlstra, Jan G.; Erasmus, Michiel E.; van der Bij, Wim; Verschuuren, Erik A.

    Introduction: Lung transplantation of patients on mechanical ventilation is controversial, but successful transplantation of these patients has been reported. This report describes our institutional experience with lung transplantation of mechanically Ventilated patients since 2003. Methods: A

  15. Adaptive support ventilation: State of the art review.

    Science.gov (United States)

    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.

  16. The Effects of Ventilation in Homes on Health

    DEFF Research Database (Denmark)

    Wargocki, Pawel

    2013-01-01

    and to reduce emissions. Often, especially in existing buildings, this strategy is difficult to implement, in which case exposures are controlled by providing sufficient, presumably clean, outdoor ventilation air to dilute and remove the contaminants. The present paper attempts to find out how much ventilation...... in existing homes. No data were found indicating that buildings having dedicated natural ventilation systems perform less well than the dwellings in which mechanical ventilation systems are installed. Newly installed mechanical ventilation systems were observed to improve health conditions. In homes...... Guidelines for Indoor Air Quality and improving ventilation measurements). Exposures should also be controlled using different ventilation methods for comparison. Future studies should also advance the understanding of how ventilation systems should be operated to achieve optimal performance. These data...

  17. 8 CFR 241.21 - Stay of deportation of excluded alien.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Stay of deportation of excluded alien. 241.21 Section 241.21 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS APPREHENSION AND DETENTION OF ALIENS ORDERED REMOVED Deportation of Excluded Aliens (for Hearings Commenced...

  18. 22 CFR 40.102 - Guardian required to accompany excluded alien.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Guardian required to accompany excluded alien. 40.102 Section 40.102 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH... Guardian required to accompany excluded alien. INA 212(a)(9)(B) is not applicable at the time of visa...

  19. Bias towards dementia: are hip fracture trials excluding too many patients? A systematic review

    NARCIS (Netherlands)

    Hebert-Davies, Jonah; Laflamme, G.-Yves; Rouleau, Dominique; Bhandari, Mohit; Devereaux, Philip J.; Guyatt, Gordon; Heetveld, Martin J.; Jeray, Kyle; Liew, Susan; Richardson, Martin J.; Schemitsch, Emil H.; Swiontkowski, Marc; Tornetta, Paul; Walter, Stephen; Mohit, Bhandari; Sprague, Sheila; Viveiros, Helena; Simunovic, Nicole; Swinton, Marilyn; Heels-Ansdell, Diane; Buckingham, Lisa; Duraikannan, Aravin; Swiontkowski, Marc F.; Agel, Julie; van Lieshout, Esther M. M.; Zielinski, Stephanie M.; Goslings, J. Carel; Haverlag, Robert; Ponsen, M. J.; de Rijcke, P. A. R.; Koppert, C. L.; Buijk, Steven E.; Groenendijk, Richard P. R.; Dawson, I.; de Rycke, P. A. R.; Tetteroo, G. W. M.; Bruijninckx, M. M. M.; Doornebosch, P.; deGraaf, E. J. R.; Patka, Peter; Eversdijk, Martin; Peters, Rolf; van Waes, Oscar; den Hartog, Dennis; van Waes, O.; Oprel, P.; Gasthuis, Kennemer; Visser, Gijs A.; Stockmann, Heyn; Silvis, Rob; Snellen, J. P.; Rybroek, A.; Scheepers, J. J. G.; Vermeulen, Erik G. J.; Siroen, M. P. C.; Vuylsteke, Ronald; Brom, H. L. F.; Ryna, H.; van Laarhoven, H. A. J.; Haag, Den; Rhemrev, S.; Bosman, C. H. R.; van Otterloo, Alexander Mol; Hoogendoorn, Jochem; Idenburg, Floris; de Vries, A. C.; Meylaerts, S. A. G.; Roukema, Gert R.; Josaputra, H.; Keller, Paul; de Rooij, P. P.; Kuiken, H.; Boxma, H.; Cleffken, B. I.; Liem, Ronald; Poolman, Rudolf W.; Simons, Maarten P.; van der Heijden, F. H. W. M.; Willems, W. J.; de Meulemeester, Frank R. A. J.; van der Hart, Cor; Tarkan, K.; Festen, S.; de Nies, F.; Out, N. J. M.; Bosma, J.; de Graaf Gasthuis, Reinier; van der Elst, Maarten; van der Pol, Carmen C.; van't Reit, Martyne; Karsten, T. M.; de Vries, M. R.; Stassen, P. S.; Schep, N.; Schmidt, Ben; Hoffman, W. H.; Segers, J. M.; Zijl, Jacco; Verhoeven, Bart; Smits, Anke; Theunissen, Evert B. M.; Wille, J.; Govaert, Lonnek; Wittich, Phillippe; Brauw, Maurits; Wille, Jan; Ritchie, Ewan D.; Wittish, H.; Wessel, R. N.; Hammacher, E. R.; Ziekenhuis, Elisabeth; Verhofstad, Michiel H. J.; Meijer, Joast M. R.; van Egmond, Teun; van den Heijden, F. H. W. M.; Campo, Martin; Verhagen, Ronald; van Kampen, A.; Biert, J.; van Vugt, Arie B.; Edwards, Michael; Blokhuis, Taco; Frolke, Jan Paul M.; Geeraidts, L.; de Waal Malefyt, M. C.; Schreurs, B.; Simmermacher, Roger K. J.; van Mulken, Jeroen; van Gaalen, Steven M.; Bronovo, Ziekenhuis; Bronkhorst, Maarten W. G. A.; Guicherit, O. R.; Frihagen, Frede; Nordsletten, Lars; Kibsgaard, Thomas; Haug, Knut Jorgen; Lona, Tariei; Ugland, Stein; Nilsen, Kenneth; Brekke, Anne Christin; Vesterhus, Elise Berg; Tetsworth, Kevin; Weinrauch, Patrick; Pincus, Paul; Donald, Geoff; yang, Steven; Halliday, Brett; Gervais, Trevor; Holt, Michael; Flynn, Annette; Pirpiris, Marinis; Love, David; Bucknill, Andrew; Farrugia, Richard J.; Dowrick, Adam; Donohue, Craig; Bedi, Harvinder; Li, Doug; Edwards, Elton; Csonguray, Steven; Miller, Russell; Wang, Otis; Chia, Andrew; Jain, Arvind; Mammen, Mathan; Moaveni, Ash; Murdock, Zoe; Sage, Claire; Bahadur, Tegh; Jain, Anil Kumar; Pankaj, Amite; Pesantez, Rodrigo; Martinez, Adriana; Novoa, Catherine; Buckley, Richard E.; Duffy, Paul; Korley, Robert; Johnston, Kelly; Puloski, Shannon; Carcary, Kimberly; Avram, Victoria; Bicknell, Ryan; Yach, Jeff; Bardana, Davide; Wood, Gavin; Lambert, Sue; Sanders, David W.; Howard, Jamie; Macleod, Mark; Lawendy, Abdel; Bartley, Debra; Laney, Tim; Tieszer, Christina; Peterson, Devin; Zalzal, Paul; Naumetz, Victor; Brien, Heather; Weening, Brad; Wai, Eugene K.; Papp, Steven; Roffey, Darren; McCormack, Robert; Stone, Trevor; Perey, Bertrand; Viskontas, Darius; Boyer, Dory; Moola, Farhad; Zomar, Mauri; Moon, Karyn; McKee, Michael; Hall, Jeremy; Ahn, Henry; Vicente, Milena R.; Wild, Lisa M.; Kreder, Hans J.; Stephen, David J. G.; Nousianinen, Markku; Kunz, Monica; Syed, Khalid; Azad, Tania; Coles, Chad; Leighton, Ross; Johnstone, David; Glazebrook, Mark; Alexander, David; Coady, Cathy; Trask, Kelly; Dobbin, Gwendolyn; Oliver, Todd M.; Jones, Vicky; Ronan, James; Brown, Desmond T.; Carlilse, Hope; Shaughnessy, Lisa; Schwappach, John; Davis, Craig A.; Weingarten, Peter; Weinerman, Stewart; Newman, Heike; Baker, Janell; Browner, Kieran; Hurley, Meghan; Payton, Krystal; Zura, Robert; Manson, Maria J.; Goetz, David; Broderick, Scott J.; Porter, Scott; Pace, Thomas; Tanner, Stephanie L.; Snider, Becky; Schmidt, Andrew H.; Haas, Jonathan; Templeman, David; Westberg, Jerald R.; Mullis, Brian; Ertl, J. P.; Shively, Karl; Frizzel, Valda; Moore, Molly M.; Marcantonio, Andrew J.; Iorio, Richard; Lobo, Margaret; Kain, Michael; Specht, Lawrence; Tilzey, John; Garfi, John; Prayson, Michael J.; Laughlin, Richard; Rubino, Joe; Lawless, Mathew; DiPaola, Matt; Gayton, Chris; Dulaney-Cripe, Liz; Vallier, Heather A.; Wilber, John; Wilber, Roger G.; Sontich, John H.; Patterson, Brendan; Dolenc, Andrea; Robinson, Chalitha; DePaolo, Charles J.; Alosky, Rachel; Shell, E.; Keeve, Jonathan P.; Anderson, Chris; McDonald, Michael; Hoffman, Jodi; Baele, Joseph; Weber, Tim; Edison, Matt; Musapatika, Dana; Jones, Clifford; Ringler, James; Endres, Terrance; Gelbke, Martin; Jabara, Michael; Sietsema, Debra L.; Engerman, Susan M.; Switzer, Julie A.; Li, Mangnai; Marston, Scott; Cole, Peter; Vang, Sandy X.; Ly, Thuan; Anderson, Sarah; Foley, Amy; McBeth, Jessica; Comstock, Curt; Ziran, Navid; Shaer, James; Hileman, Barbara; Karges, David; Cannada, Lisa; Kuldjanov, Djoldas; Watson, John Tracy; Mills, James Jackman Emily; Hill, Leslie; Simon, Tiffanya; Abdelgawad, Amr; Shunia, Juan; Jenkins, Mark; Zumwalt, Mimi; Romero, Amanda West; Lowe, Jason; Goldstein, Jessica; Zamorano, David P.; Lawson, Deanna; Archdeacon, Michael; Wyrick, John; Hampton, Shelley; Lewis, Courtland G.; Ademi, Arben; Sullivan, Raymond; Caminiti, Stephanie; Graves, Matthew; Smith, Lori; Della Rocca, Gregory J.; Crist, Brett D.; Murtha, Yvonne; Anderson, Linda K.; Kliewer, Toni K.; McPherson, Melinda K.; Sullivan, Kelly M.; Jarrett, Sharon L.; Sagebien, Carlos; Seuffert, Patricia; Mehta, Samir; Esterhai, John; Ahn, Jaimo; Tjoumakaris, Fotios; Horan, Annamarie D.; Kaminski, Christine; Tarkin, Ivan; Siska, Peter; Luther, Arlene; Irrgang, James; Farrell, Dana J.; Gorczyca, John T.; Gross, Jonathan M.; Kates, Stephen Lloyd; Colosi, Jen; Hibsch, Nancy; Noble, Krista; Neu, Sarah; Agarwal, Animesh; Wright, Rebecca; Hsu, Joseph R.; Randall, Gayle M.; Ficke, James R.; Charlton, Michael; Fan, Mary; Garcia, Socorro H.; Obremskey, William T.; Richards, Justin Edward; Robinson, Kenya; Carroll, Eben; Kulp, Brenda; Guyatt, Gordon H.; Devereaux, Philip James; Einhorn, Thomas A.; Koval, Ken J.; Tetsworth, Kevin D.; Culgin, Sarah; Desjardin, Heather; Beimers, Lijkele; de Vries, Jasper; Zurcher, Arthur W.; Albers, G. H. Rob; Rademakers, Maarten; Breugem, Stefan; van der Haven, Ibo; Damen, Peter Jan; Bulstra, Gythe H.; Somford, P.; Haverkamp, Daniël; Gasthuis, Onze Lieve Vrouwe; Molekamp, Willem Jan Kleyn; Kleipool, E. B.; Keizer, Stefan B.; Swen, Jan-Willem A.; Nelissen, Eelco M.; Hollander, Peter H. C. den; Metsaars, Weineke; Thomassen, J. W.; Fontijne, W. Peter J.; Wiersma, Saskia C.; Boetes, Bastiaan; JT, Edgar; Ziekenhuis, Spaarne; Nolte, Peter A.; de Jong, Tjitte; van Noort, Arthur; Vergroesen, Diederik A.; van den Bekerom, Michel P. J.; Schutte, Bernard G.; Schuman, Lein; Hillen, Robert Jan; Cheung, John; van der Heide, Huub J. L.; Nagels, Jochem; Krips, Rover; Mullers, J. Bernard; Schüller, Hans; Ziekenhuis, Amphia; van den Hout, Joost A. A. M.; Joosten, Adrianus J. P.; van der Broek, Chris M.; Bolder, Stefan B. T.; Eygendaal, Denise; Moonen, Adrianus F. C. M.; van Geenen, Rutger C. I.; Hoebink, Eric A.; Wagenmakers, Robert; van Helden, Wouter; Kooijman, Rob; Postema, Roelf R.; Lampe, Harald I. H.; Ziekenhuizen, Gelre; Bolhuis, Hugo W.; Bullens, Pieter H. J.; Hogervorst, Mike; de Kroon, Karin E.; Jansen, Rob H.; Raven, Eric E. J.; van Jonbergen, Hans-Peter W.; Reuver, Joost M.; Barnaart, Alexander F. W.; Roerdink, W. Herbert; van Erve, Ruud H. G. P.; Koorevaar, Rinco; Frima, Anthony Hans; Flikweert, Elvira R.; Falke, Mark L. M.; Kurek, Frans J.; Slingerland, Adrianus C. H.; Vallei, Gelderse; van Dijk, Jan P.; van Helden, Wouter H.; Mauer-Hansen, Espen; Boee, Berte; Clarke-Jensen, Jon; Brekke, Anne Christine; Vestergaard, Elise Berg; Carr, Ashley; Russ, Matthias; Li, Douglas; Doig, Stephen; Laflamme, Yves; Fernandes, Julio C.; Poirier, Marie-France; Bogoch, Earl; Kreder, Hans; Axelrod, Terry; Jenkinson, Richard; Wadey, Veronica; Nousiainen, Markku; Stephen, David; Macnevin, Melanie; Richardson, Glen C.; Biddulph, Michael; Gross, Michael; Dunbar, Michael; Dobbin, Gwen; Zarin, Jeffrey; Parvataneni, Hari; Baker, Janell K.; Roberson, James R.; Erens, Greg; Montelione, Anita; Woodard, Shawndra; Ertl, Janos; Cummings, Judd; Worman, Ripley; Webster, Mark; Parr, Andrew; Frizzell, Valda; Moore, Molly; Wilk, Richard; Torchia, Michael; Cross, William; Sems, Andrew; Taunton, Michael; Sanchez-Satelo, Joaquin; Sierrz, Rafsel; Timm, Kimberly; Foreman, Barbara; DePaolo, Charles; Hill, Rocky; Lewis, Coutland; Srivastava, Ajay; Bakeman, James; Sietsema, Deb; Strathy, Gregg; Johnson, Paul; Peter, Kathleen; Morton, Maeghan E.; Parvizi, Javad; Austin, Matthew; Morrison, Tiffany; Mont, Michael; Copeland, Carol; Delanois, Ronald; Khanuja, Harpal; Weddington, Shaquita; Bacon, Madeline; Mullen, Marylou; Kanlic, Enes; Abdelgawad, Amr Atef; Shunia, Juan Gerardo; Horan, Annamarie

    2012-01-01

    Patients with hip fractures are older and often present many co-morbidities, including dementia. These patients cannot answer quality of life questionnaires and are generally excluded from trials. We hypothesized that a significant number of patients are being excluded from these studies and this

  20. 38 CFR 17.260 - Patient care costs to be excluded from direct costs.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Patient care costs to be excluded from direct costs. 17.260 Section 17.260 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Grants for Exchange of Information § 17.260 Patient care costs to be excluded from...

  1. 40 CFR 1048.20 - What requirements from this part apply to excluded stationary engines?

    Science.gov (United States)

    2010-07-01

    ... of another company you choose to designate. (3) State the engine displacement (in liters) and maximum... to excluded stationary engines? 1048.20 Section 1048.20 Protection of Environment ENVIRONMENTAL...-IGNITION ENGINES Overview and Applicability § 1048.20 What requirements from this part apply to excluded...

  2. 41 CFR 101-30.302 - Types of items excluded from cataloging.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Types of items excluded...-FEDERAL CATALOG SYSTEM 30.3-Cataloging Items of Supply § 101-30.302 Types of items excluded from...) Items procured in foreign markets for use in overseas activities of Federal agencies. (e) Printed forms. ...

  3. 26 CFR 31.3402(e)-1 - Included and excluded wages.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Included and excluded wages. 31.3402(e)-1... SOURCE Collection of Income Tax at Source § 31.3402(e)-1 Included and excluded wages. (a) If a portion of... not more than 31 consecutive days constitutes wages, and the remainder does not constitute wages, all...

  4. Preventing Inclusion? Inclusive Early Childhood Education and the Option to Exclude

    Science.gov (United States)

    Cologon, Kathy

    2014-01-01

    While there is increasing international commitment to inclusive education, as outlined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD), many children remain excluded at school. One marginalised and frequently excluded group of people are people who experience disability. In the recently released first report on…

  5. Evaluating the influence of ventilation and ventilation-compression synchronization on chest compression force and depth during simulated neonatal resuscitation.

    Science.gov (United States)

    Dellimore, K H; Scheffer, C; Smith, J; Van Den Heever, D J; Lloyd, D L

    2017-06-01

    To investigate the influence of ventilation and ventilation-compression synchronization on compression force and sternal displacement during simulated neonatal cardiopulmonary resuscitation (NCPR) on an infant manikin. Five Neonatal Resuscitation Program trained clinicians were recruited to perform simulated NCPR on an infant manikin using two-finger (TF) and two-thumb (TT) compression, with synchronous and asynchronous ventilation, as well as without ventilation. The sternal displacement and force were recorded and analyzed. Synchronous ventilation and compression yielded sternal displacements and forces in the range of 22.8-32.4 mm and 15.0-29.8 N, respectively, while asynchronous ventilation and compression produced depths and forces in the range of 21.2-32.4 mm and 14.0-28.8 N, respectively. Ventilation exerts a significant influence on sternal displacement and force during simulated NCPR, regardless of the compression method used. Ventilation-compression synchronization, however, is only significant during TF compression with lower compression forces measured during synchronous ventilation than in asynchronous ventilation. This occurs for two reasons: (i) the strong influence of ventilation forces on the lower magnitude compression forces produced during TF compression relative to TT compression and (ii) in asynchronous ventilation, compression and ventilation may occur simultaneously, with inflation and deflation providing an opposing force to the applied compression force.

  6. [Controlled mechanical lung ventilation with guaranteed volume in newborns].

    Science.gov (United States)

    Kriakvina, O A; Grebennikov, V A; Tsypin, L E; Volodin, N N

    2011-01-01

    Mechanical ventilation with guaranteed volumes combines advantages of time-cyclic ventilation with limitation of pressure and constant flow, with volume control ventilation. This symbiosis allows to choose the optimal, stable breathing volume of the newborn, while maintaining pressure control. The review presents the principles of work, the main advantages and limitations of ventilation systems with the guaranteed volumes, as well as results and analysis of studies.

  7. Attic Ventilation Guidelines to Minimize Icings at Eaves

    Science.gov (United States)

    1998-01-01

    by sizing natural, and if necessary, mechanical attic ventilation systems to maintain an attictemperature of 30F when the outside temperature is 22F...JAN 1998 2. REPORT TYPE 3. DATES COVERED - 4. TITLE AND SUBTITLE Attic Ventilation Guidelines to Minimize Icings at Eaves 5a. CONTRACT NUMBER...develop on roofs that slope to cold eaves. Ventilating the space below the snow-covered roof with outdoor aur to create a "cold" ventilated roof is

  8. Displacement Ventilation in a Room with Low-Level Diffusers

    DEFF Research Database (Denmark)

    Nielsen, Peter V.

    Ventilation systems with vertical displacement flow have been used in industrial areas with high thermal loads for many years. Quite resently the vertical displacement flow systems have grown popular as comfort ventilation in rooms with thermal loads e.g. offices.......Ventilation systems with vertical displacement flow have been used in industrial areas with high thermal loads for many years. Quite resently the vertical displacement flow systems have grown popular as comfort ventilation in rooms with thermal loads e.g. offices....

  9. Design guidelines for natural ventilation systems in tertiary sector buildings

    OpenAIRE

    Van Moeseke, Geoffrey; Bruyère, Isabelle; De Herde, André; CISBAT 2005: Renewables in a changing climate

    2005-01-01

    Parameters determining efficiency of natural ventilation systems are numerous. The most important are architecture and system design. This article get onto both but focuses on system design. Through dynamic simulations it shows that natural ventilation management has a large impact on energy saving but most of all on thermal comfort. Natural ventilation techniques are also weighted against hybrid solutions and high efficiency mechanical cooling solutions. Natural ventilation techniques show t...

  10. The Design and Simulation of Natural Personalised Ventilation (NPV System for Multi-Bed Hospital Wards

    Directory of Open Access Journals (Sweden)

    Zulfikar A. Adamu

    2015-05-01

    Full Text Available Adequate ventilation is necessary for thermal comfort and reducing risks from infectious bio-aerosols in hospital wards, but achieving this with mechanical ventilation has carbon and energy implications. Natural ventilation is often limited to window-based designs whose dilution/mixing effectiveness are subject to constraints of wind speed, cross ventilation, and in the case of hospital wards, proximity of patients to external walls. A buoyancy-driven natural ventilation system capable of achieving dilution/mixing was shown to be feasible in a preceding study of novel system called natural personalised ventilation (NPV. This system combined both architecture and airflow engineering principles of space design and buoyancy and was tested and validated (salt-bath experiment for a single bed ward. This research extends the previous work and is proof-of-concept on the feasibility of NPV system for multi-bed wards. Two different four-bed ward types were investigated of using computational fluid dynamics (CFD simulations under wind-neutral conditions. Results predict that NPV system could deliver fresh air to multiple patients, including those located 10 m away from external wall, with absolute flow rates of between 32 L·s−1 and 54 L·s−1 for each patient/bed. Compared to same wards simulated using window design, ingress of airborne contaminants into patients’ breathing zone and summer overheating potential were minimised, while overall ward dilution was maximised. Findings suggest the NPV has potentials for enabling architects and building service engineers to decouple airflow delivery from the visualisation and illumination responsibilities placed upon windows.

  11. ADMINISTRATIVE AND ENGINEERING CONTROLS FOR THE OPERATION OF VENTILATION SYSTEMS FOR UNDERGROUND RADIOACTIVE WASTE STORAGE TANKS

    Energy Technology Data Exchange (ETDEWEB)

    Wiersma, B.; Hansen, A.

    2013-11-13

    Liquid radioactive wastes from the Savannah River Site are stored in large underground carbon steel tanks. The majority of the waste is confined in double shell tanks, which have a primary shell, where the waste is stored, and a secondary shell, which creates an annular region between the two shells, that provides secondary containment and leak detection capabilities should leakage from the primary shell occur. Each of the DST is equipped with a purge ventilation system for the interior of the primary shell and annulus ventilation system for the secondary containment. Administrative flammability controls require continuous ventilation to remove hydrogen gas and other vapors from the waste tanks while preventing the release of radionuclides to the atmosphere. Should a leak from the primary to the annulus occur, the annulus ventilation would also serve this purpose. The functionality of the annulus ventilation is necessary to preserve the structural integrity of the primary shell and the secondary. An administrative corrosion control program is in place to ensure integrity of the tank. Given the critical functions of the purge and annulus ventilation systems, engineering controls are also necessary to ensure that the systems remain robust. The system consists of components that are constructed of metal (e.g., steel, stainless steel, aluminum, copper, etc.) and/or polymeric (polypropylene, polyethylene, silicone, polyurethane, etc.) materials. The performance of these materials in anticipated service environments (e.g., normal waste storage, waste removal, etc.) was evaluated. The most aggressive vapor space environment occurs during chemical cleaning of the residual heels by utilizing oxalic acid. The presence of NO{sub x} and mercury in the vapors generated from the process could potentially accelerate the degradation of aluminum, carbon steel, and copper. Once identified, the most susceptible materials were either replaced and/or plans for discontinuing operations

  12. The Comparison Effects of Two Methods of (Adaptive Support Ventilation Minute Ventilation: 110% and Adaptive Support Ventilation Minute Ventilation: 120% on Mechanical Ventilation and Hemodynamic Changes and Length of being in Recovery in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Babak Ali Kiaei

    2017-01-01

    Full Text Available Background: The conventional method for ventilation is supported by accommodative or adaptive support ventilation (ASV that the latter method is done with two methods: ASV minute ventilation (mv: 110% and ASV mv: 120%. Regarding these methods this study compared the differences in duration of mechanical ventilation and hemodynamic changes during recovery and length of stay in Intensive Care Units (ICU. Materials and Methods: In a clinical trial study, forty patients candidate for ventilation were selected and randomly divided into two groups of A and B. All patients were ventilated by Rafael ventilator. Ventilator parameters were set on ASV mv: 110% or ASV mv: 120% and patients were monitored on pulse oximetry, electrocardiography monitoring, central vein pressure and arterial pressure. Finally, the data entered to computer and analyzed by SPSS software. Results: The time average of connection to ventilator in two groups in modes of ASV mv: 110% and 120% was 12.3 ± 3.66 and 10.8 ± 2.07 days respectively, and according to t-test, there was no significant difference between two groups (P = 0.11. The average of length of stay in ICU in two groups of 110% and 120% was 16.35 ± 3.51 and 15.5 ± 2.62 days respectively, and according to t-test, there found to be no significant difference between two groups (P = 0.41. Conclusion: Using ASV mv: 120% can decrease extubation time compared with ASV mv: 110%. Furthermore, there is not a considerable side effect on hemodynamic of patients.

  13. Race, treatment preferences, and hospice enrollment. Eligibility criteria may exclude patients with the greatest needs for care

    Science.gov (United States)

    Fishman, Jessica; O'Dwyer, Peter; Lu, Hien L.; Henderson, Hope; Asch, David A.; Casarett, David J.

    2009-01-01

    Background The requirement that patients give up curative treatment makes hospice enrollment unappealing for some patients, and may particularly limit use among African American patients. Objectives To determine whether African-American patients with cancer are more likely than white patients are to have preferences for cancer treatment that exclude them from hospice, and whether they are less likely to want specific hospice services. Methods 283 patients receiving treatment for cancer at six oncology clinics within the University of Pennsylvania Cancer Network completed conjoint interviews measuring their perceived need for five hospice services and their preferences for continuing cancer treatment. Patients were followed for six months or until death. Results African American patients had stronger preferences for continuing their cancer treatments on a 7-point scale even after adjusting for age, sex, finances, education, ECOG performance status, quality of life, and physical and psychological symptom burden (adjusted means 4.75 vs. 3.96; β coefficient 0.82; 95% confidence interval 0.22-1.41; p=0.007). African-American patients also had greater perceived needs for hospice services after adjusting for these characteristics (adjusted means 2.31 vs. 1.83) (β coefficient 0.51; 95% confidence interval 0.11-0.92; p=0.01). However, this effect disappeared after adjusting for household finances. Conclusions Hospice eligibility criteria may exclude African-American patients disproportionately despite greater perceived needs for hospice services in this population. The mechanisms driving this health disparity likely include both cultural differences and economic characteristics, and consideration should be given to redesigning hospice eligibility criteria. PMID:19107761

  14. Race, treatment preferences, and hospice enrollment: eligibility criteria may exclude patients with the greatest needs for care.

    Science.gov (United States)

    Fishman, Jessica; O'Dwyer, Peter; Lu, Hien L; Henderson, Hope R; Henderson, Hope; Asch, David A; Casarett, David J

    2009-02-01

    The requirement that patients give up curative treatment makes hospice enrollment unappealing for some patients and may particularly limit use among African-American patients. The current study was conducted to determine whether African-American patients with cancer are more likely than white patients to have preferences for cancer treatment that exclude them from hospice and whether they are less likely to want specific hospice services. Two hundred eighty-three patients who were receiving treatment for cancer at 6 oncology clinics within the University of Pennsylvania Cancer Network completed conjoint interviews measuring their perceived need for 5 hospice services and their preferences for continuing cancer treatment. Patients were followed for 6 months or until death. African-American patients had stronger preferences for continuing their cancer treatments on a 7-point scale even after adjusting for age, sex, finances, education, Eastern Cooperative Oncology Group performance status, quality of life, and physical and psychologic symptom burden (adjusted mean score, 4.75 vs 3.96; beta coefficient, 0.82; 95% confidence interval, 0.22-1.41 [P = .007]). African-American patients also had greater perceived needs for hospice services after adjusting for these characteristics (adjusted mean score, 2.31 vs 1.83; beta coefficient, 0.51; 95% confidence interval, 0.11-0.92 [P = .01]). However, this effect disappeared after adjusting for household finances. Hospice eligibility criteria may exclude African-American patients disproportionately despite greater perceived needs for hospice services in this population. The mechanisms driving this health disparity likely include both cultural differences and economic characteristics, and consideration should be given to redesigning hospice eligibility criteria. (c) 2008 American Cancer Society.

  15. 21 CFR 888.4230 - Cement ventilation tube.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cement ventilation tube. 888.4230 Section 888.4230...) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4230 Cement ventilation tube. (a) Identification. A cement ventilation tube is a tube-like device usually made of plastic intended to be inserted into...

  16. Intelligent ventilation in the intensive care unit | Sviri | Southern ...

    African Journals Online (AJOL)

    During the study period, 1 220 patients were ventilated in the MICU. Most patients (84%) were ventilated with ASV on admission. The median duration of ventilation with ASV was 6 days. The weaning success rate was 81%, and tracheostomy was required in 13%. Sixty-eight patients (6%) with severe hypoxia and high ...

  17. Experimental Analysis and Model Validation of an Opaque Ventilated Facade

    DEFF Research Database (Denmark)

    López, F. Peci; Jensen, Rasmus Lund; Heiselberg, Per

    2012-01-01

    Natural ventilation is a convenient way of reducing energy consumption in buildings. In this study an experimental module of an opaque ventilated façade (OVF) was built and tested for assessing its potential of supplying free ventilation and air preheating for the building. A numerical model was ...

  18. 46 CFR 78.47-53 - Automatic ventilation dampers.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 3 2010-10-01 2010-10-01 false Automatic ventilation dampers. 78.47-53 Section 78.47-53... Fire and Emergency Equipment, Etc. § 78.47-53 Automatic ventilation dampers. (a) The manual operating positions for automatic fire dampers in ventilation ducts passing through main vertical zone bulkheads shall...

  19. Hybrid Ventilation in New and Retrofitted Office Buildings

    DEFF Research Database (Denmark)

    Heiselberg, Per

    The scope of this annex is to obtain better knowledge of the use of hybrid ventilation technologies. The annex will focus on development of control strategies for hybrid ventilation, on development of methods to predict hybrid ventilation performance in office buildings and on development...

  20. 33 CFR 183.630 - Standards for natural ventilation.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Standards for natural ventilation... (CONTINUED) BOATING SAFETY BOATS AND ASSOCIATED EQUIPMENT Ventilation § 183.630 Standards for natural ventilation. (a) For the purpose of § 183.620, “natural ventilation” means an airflow in a compartment in a...

  1. 46 CFR 169.315 - Ventilation (other than machinery spaces).

    Science.gov (United States)

    2010-10-01

    ... section is satisfied, a vessel having only a natural ventilation system must satisfy the following: V/A≥1... 46 Shipping 7 2010-10-01 2010-10-01 false Ventilation (other than machinery spaces). 169.315... SCHOOL VESSELS Construction and Arrangement Hull Structure § 169.315 Ventilation (other than machinery...

  2. Biphasic cuirass ventilation is better than bag-valve mask ventilation for resuscitation following organophosphate poisoning

    Directory of Open Access Journals (Sweden)

    Ilan Gur

    2015-01-01

    Conclusions: The noninvasive, easy-to-operate Biphasic Cuirass Ventilation device was effective in reducing OP-induced mortality and might be advantageous in an organophosphate mass casualty event. This finding should be validated in further investigations.

  3. Ventilation in medium-sized and large boiler houses; Ventilation i medelstora och stoerre pannhus

    Energy Technology Data Exchange (ETDEWEB)

    Grotherus, Dan [AaF Installation AB, Oerebro (Sweden); Larsson, Tord [Oerebro Univ. (Sweden). Dept. of Technology

    2005-04-01

    The purpose of this report is to exemplify and clarify the need for ventilation in medium-sized and large boiler houses. We will furthermore present some recommendations, guidelines and advice for the design and construction of a boiler house ventilation system to the plant owners and suppliers of equipment. Boiler house ventilation can be performed in different ways using mechanical or natural ventilation. The solution to be chosen depends on the following factors: Working environment requirements and a necessity to control temperature and pressure in the boiler house; The design of the boiler plant and house; The need for combustion air; The investment expenditure as well as operation and maintenance costs. Mechanical ventilation should be chosen if the aim is a controllable 'climate'. The mechanical ventilation can be either centrally situated or distributed with many aggregates in the boiler house. Centrally situated ventilation equipment will give a higher accessibility and lower maintenance costs than a distributed ventilation system. If the boiler house is designed with natural ventilation the air and flue gas fans will be the only ones installed. In this case temperature and pressure inside the boiler house will be difficult to control. The design factor for the ventilation plant in a boiler house is in most cases the demand to cool the air inside the boiler house to approximately 45 deg C. This is the highest temperature allowed by the Occupational Safety and Health Act in a work environment where the boiler operator is working alone. The air flow which is required for the combustion is normally less than the air flow needed to cool the air in the boiler house. The supply air which is cooling the air inside the boiler house should be supplied on several different levels to attain an efficient cooling. If the combustion air is taken from the heated indoor air the boiler house will work as a heat reclaimer. The difference between outdoor and indoor

  4. Improve train tunnel. A dynamical ventilation method

    NARCIS (Netherlands)

    Phaff, J.C.; Gids, W.F. de

    1996-01-01

    Train tunnels and subways are an interesting field of ventilation. Trains move air through tunnels at rates of 600 m3/s (over 2 x 106 m3 per hour) which is much more than flow rates in buildings. Air pressures can vary up to some 3000 Pa leading to air velocities in the range of 10 to 50 m/s. This

  5. Indirect Calorimetry in Mechanically Ventilated Patients

    DEFF Research Database (Denmark)

    Allingstrup, Matilde Jo; Kondrup, Jens; Perner, Anders

    2017-01-01

    Background and Aims: The 2 currently available indirect calorimeters, CCM Express Indirect Calorimeter (MedGraphics, St Paul, MN) and Quark RMR ICU Indirect Calorimeter (COSMED, Rome, Italy), have not been validated against a gold standard in mechanically ventilated patients. Our aim was to do so...

  6. Enhanced natural ventilation method for atrium space

    NARCIS (Netherlands)

    An, H.

    2011-01-01

    This paper is written for the TIDO-course AR0532 Smart & Bioclimatic Design Theory. Energy saving is a relevant issue nowadays. Heating, ventilation and air conditioning (HVAC) occupies the largest portion both in residential and non-residential field. This consumption goes with the demand for

  7. Improving underground ventilation conditions in coal mines

    CSIR Research Space (South Africa)

    Meyer, CF

    1993-11-01

    Full Text Available The aim of this project was to establish the needs of the industry with regard to bord and pillar ventilation requirements. In addition, the aim was to establish whether sufficient research has already been done by the mining industry and if further...

  8. Climate sensitivity of the Antarctic ventilation

    Science.gov (United States)

    Ito, T.; Lynch-Stieglitz, J.

    2014-12-01

    Simple box models of ocean-atmosphere carbon cycle predict that Antarctic ventilation can regulate the steady-state atmospheric CO2 through its control over the biological carbon storage in the deep ocean. A weakened upwelling would lead to a more complete nutrient utilization at the surface and an increased retention of biogenic carbon in the deep ocean. We perform a suite of numerical sensitivity experiments using a coupled seaice and global ocean circulation model to better understand what regulates the Antarctic ventilation and its link to glacial climate. The model is first spun up with a modern climatological surface forcing, which exhibits a multi-decadal oscillation, where the Southern Ocean is heated from below through the influx of warm and salty North Atlantic Deep Water, and the accumulation of heat induces intermittent convective overturning. Through the sensitivity experiments, we explore and illustrate the rich and complex behavior of the Antarctic ventilation and its response to the northern sinking, the surface wind stress, and the global mean temperature. When the northern sinking is weakened by a freshwater perturbation, the intermittent convection events are suppressed as the heat source is reduced. When the atmospheric temperature is lowered uniformly, the Antarctic seaice extent increases and the southern overturning weakens on centennial timescales. However, the convective overturning rebounds on the millennial timescale if the northern sinking is active. We will discuss implications of our results to the deep ventilation of the Southern Ocean and its impact on the ocean carbon storage.

  9. Psychosocial problems arising from home ventilation

    NARCIS (Netherlands)

    van Kesteren, RG; Velthuis, B; van Leyden, LW

    Objective: To study psychosocial questions and problems of patients, who are chronically dependent on artificial ventilation, and their families. Design: A total of 38 patients and family members (n = 43) were randomly selected. Several patients (n = 12) received respiratory support by nasal mask;

  10. Modelling ventilated bulk storage of agromaterials

    NARCIS (Netherlands)

    Grubben, N.L.M.; Keesman, K.J.

    2015-01-01

    Storage of season-dependent agro-materials is a key process in providing food, feed and biomass throughout the whole year. We review the state of the art in physical modelling, simulation and control of ventilated bulk storage facilities, and in particular the storage of potatoes, from a

  11. A computerized aid in ventilating neonates

    DEFF Research Database (Denmark)

    Arrøe, M

    1991-01-01

    and contains a continuous evaluation of the last six values of pCO2 and pO2 resulting in statements and warnings in potentially harmful situations. The program is consistent with the written instructions of the department. The ventilator treatment of 30 premature babies is evaluated retrospectively using...

  12. Sensory source strength of used ventilation filters

    DEFF Research Database (Denmark)

    Clausen, Geo; Alm, Ole Martin; Fanger, Povl Ole

    2002-01-01

    A two-year-old filter was placed in a ventilation system recirculating the air in an experimental space. Via glass tubes supplied with a small fan it was possible to extract air upstream and downstream of the filter to an adjacent room. A panel could thus perform sensory assessments of the air fr...

  13. Displacement Ventilation by Different Types of Diffusers

    DEFF Research Database (Denmark)

    Nielsen, Peter V.; Hoff, Lars; Pedersen, Lars Germann

    The paper describes measuring results of the air movement from three different types of diffusers for displacement ventilation. Two of the diffusers are lowlevel wall mounted diffusers, one with a low and one with a high initial entrainment. The third diffuser is of the floor mounted type....

  14. Physiological Effects of Positive Pressure Ventilation.

    Science.gov (United States)

    1992-05-01

    treated by mechanical ventilatory support.. This paper presents the more common forms of mechanical ventilatory support with the adjuncts of PEEP and CPAP ...44 Researcher .......... .............. 46 Consultant . .............. 49 Educator .......... ............... 51 Manager...similar to continuous positive pressure ventilation ( CPAP ) except that PEEP pressure is maintained at end-expiration only and CPAP is maintained

  15. Ventilator associated pneumonia and infection control

    NARCIS (Netherlands)

    Alp, E.; Voss, A.

    2006-01-01

    Ventilator associated pneumonia (VAP) is the leading cause of morbidity and mortality in intensive care units. The incidence of VAP varies from 7% to 70% in different studies and the mortality rates are 20-75% according to the study population. Aspiration of colonized pathogenic microorganisms on

  16. [Percutaneous tracheostomy in the ventilated patient].

    Science.gov (United States)

    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.

  17. A Medical Student Workshop in Mechanical Ventilation.

    Science.gov (United States)

    And Others; Kushins, Lawrence G.

    1980-01-01

    In order to teach applied respiratory physiology to medical students, the anesthesiology faculty at the University of Florida College of Medicine has designed and implemented a course that includes a laboratory workshop in mechanical ventilation of an animal model that allows students to apply and expand their knowledge. (JMD)

  18. Diaphragm Dysfunction in Mechanically Ventilated Patients.

    Science.gov (United States)

    Dot, Irene; Pérez-Teran, Purificación; Samper, Manuel-Andrés; Masclans, Joan-Ramon

    2017-03-01

    Muscle involvement is found in most critical patients admitted to the intensive care unit (ICU). Diaphragmatic muscle alteration, initially included in this category, has been differentiated in recent years, and a specific type of muscular dysfunction has been shown to occur in patients undergoing mechanical ventilation. We found this muscle dysfunction to appear in this subgroup of patients shortly after the start of mechanical ventilation, observing it to be mainly associated with certain control modes, and also with sepsis and/or multi-organ failure. Although the specific etiology of process is unknown, the muscle presents oxidative stress and mitochondrial changes. These cause changes in protein turnover, resulting in atrophy and impaired contractility, and leading to impaired functionality. The term 'ventilator-induced diaphragm dysfunction' was first coined by Vassilakopoulos et al. in 2004, and this phenomenon, along with injury cause by over-distention of the lung and barotrauma, represents a challenge in the daily life of ventilated patients. Diaphragmatic dysfunction affects prognosis by delaying extubation, prolonging hospital stay, and impairing the quality of life of these patients in the years following hospital discharge. Ultrasound, a non-invasive technique that is readily available in most ICUs, could be used to diagnose this condition promptly, thus preventing delays in starting rehabilitation and positively influencing prognosis in these patients. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Survival after Pneumocystis jirovecii pneumonia requiring ventilation ...

    African Journals Online (AJOL)

    Pneumocystis pneumonia (PCP) in patients with the human immunodeficiency virus (HIV) is associated with a high mortality rate, which increases substantially with the need for mechanical ventilation. Local experience of patients with PCP admitted to the intensive care unit has revealed mortality rates close to 100%.

  20. Implementation of ventilation in existing schools

    DEFF Research Database (Denmark)

    Hviid, Christian Anker; Petersen, Steffen

    ; they evaluate both scientific and practical implementation The analyses lead to a list of criteria associated with the implementation of ventilation in existing schools. Generic retrofitting scenarios which prioritize energy savings, indoor climate and building/facade integration are assembled and illustrated...

  1. 46 CFR 194.15-5 - Ventilation.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Ventilation. 194.15-5 Section 194.15-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS HANDLING, USE, AND CONTROL OF EXPLOSIVES AND OTHER HAZARDOUS MATERIALS Chemistry Laboratory and Scientific Laboratory § 194...

  2. Interfaces and ventilator settings for long-term noninvasive ventilation in COPD patients

    Directory of Open Access Journals (Sweden)

    Callegari J

    2017-06-01

    Full Text Available Jens Callegari,1 Friederike Sophie Magnet,1 Steven Taubner,1 Melanie Berger,2 Sarah Bettina Schwarz,1 Wolfram Windisch,1 Jan Hendrik Storre3,4 1Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln, Witten/Herdecke University Hospital, 2Department of Pneumology, Malteser Hospital St Hildegardis, Cologne, 3Department of Pneumology, University Medical Hospital, Freiburg, 4Department of Intensive Care, Sleep Medicine and Mechanical Ventilation, Asklepios Fachkliniken Munich-Gauting, Gauting, Germany Introduction: The establishment of high-intensity (HI noninvasive ventilation (NIV that targets elevated PaCO2 has led to an increase in the use of long-term NIV to treat patients with chronic hypercapnic COPD. However, the role of the ventilation interface, especially in more aggressive ventilation strategies, has not been systematically assessed.Methods: Ventilator settings and NIV compliance were assessed in this prospective cross-sectional monocentric cohort study of COPD patients with pre-existing NIV. Daytime ­arterialized blood gas analyses and lung function testing were also performed. The primary end point was the distribution among study patients of interfaces (full-face masks [FFMs] vs nasal masks [NMs] in a real-life setting.Results: The majority of the 123 patients studied used an FFM (77%, while 23% used an NM. Ventilation settings were as follows: mean ± standard deviation (SD inspiratory positive airway pressure (IPAP was 23.2±4.6 mbar and mean ± SD breathing rate was 16.7±2.4/minute. Pressure support ventilation (PSV mode was used in 52.8% of patients, while assisted pressure-controlled ventilation (aPCV was used in 47.2% of patients. Higher IPAP levels were associated with an increased use of FFMs (IPAP <21 mbar: 73% vs IPAP >25 mbar: 84%. Mean compliance was 6.5 hours/day, with no differences between FFM (6.4 hours/day and NM (6.7 hours/day users. PaCO2 assessment of ventilation quality revealed

  3. Biologically variable ventilation improves oxygenation and respiratory mechanics during one-lung ventilation.

    Science.gov (United States)

    McMullen, Michael C; Girling, Linda G; Graham, M Ruth; Mutch, W Alan C

    2006-07-01

    Hypoxemia is common during one-lung ventilation (OLV). Atelectasis contributes to the problem. Biologically variable ventilation (BVV), using microprocessors to reinstitute physiologic variability to respiratory rate and tidal volume, has been shown to be advantageous over conventional monotonous control mode ventilation (CMV) in improving oxygenation during the period of lung reinflation after OLV in an experimental model. Here, using a porcine model, the authors compared BVV with CMV during OLV to assess gas exchange and respiratory mechanics. Eight pigs (25-30 kg) were studied in each of two groups. After induction of anesthesia-tidal volume 12 ml/kg with CMV and surgical intervention-tidal volume was reduced to 9 ml/kg. OLV was initiated with an endobronchial blocker, and the animals were randomly allocated to either continue CMV or switch to BVV for 90 min. After OLV, a recruitment maneuver was undertaken, and both lungs were ventilated for a further 60 min. At predetermined intervals, hemodynamics, respiratory gases (arterial, venous, and end-tidal samples) and mechanics (airway pressures, static and dynamic compliances) were measured. Derived indices (pulmonary vascular resistance, shunt fraction, and dead space ventilation) were calculated. By 15 min of OLV, arterial oxygen tension was greater in the BVV group (group x time interaction, P = 0.003), and shunt fraction was lower with BVV from 30 to 90 min (group effect, P = 0.0004). From 60 to 90 min, arterial carbon dioxide tension was lower with BVV (group x time interaction, P = 0.0001) and dead space ventilation was less from 60 to 90 min (group x time interaction, P = 0.0001). Static compliance was greater by 60 min of BVV and remained greater during return to ventilation of both lungs (group effect, P = 0.0001). In this model of OLV, BVV resulted in superior gas exchange and respiratory mechanics when compared with CMV. Improved static compliance persisted with restoration of two-lung ventilation.

  4. A RESEARCH ON VENTILATION EFFICIENCY OF PIPED VENTILATION SYSTEMS IN GEOTHERMALLY HEATED GREENHOUSES

    Directory of Open Access Journals (Sweden)

    İbrahim Örüng

    2016-07-01

    Full Text Available Greenhouse play significant roles in human nutrition. Vegetable and fruit consumption at certain amounts is the basic pre-condition for a well nutrition. It is possible to produce sufficient quantities of fruits and vegetables in places with available climate conditions. However, fruits and vegetables should be grown in special buildings to have a year-long production in places without available climate conditions. These places include under-cover production facilities, greenhouses, low and high tunnel facilities. Environmental conditions are adjusted are adjusted in greenhouses as to provide proper conditions for plant growth and development. Ventilation is used to remove excess heat, moisture and carbon dioxide from the greenhouses. Either natural or mechanical ventilation is used in greenhouses. Mechanical ventilation systems have various advantages over natural systems. However, mostly natural ventilation systems are preferred because of their low installation and operational costs. Both systems operates based on negative pressure. Air exchange rates are usually low in winters and it is quite hard to evenly distribute cold fresh air within the greenhouse. Air inlets are usually placed over side walls and outlets are commonly placed along the ridge. In this study an alternative natural ventilation system was proposed for more efficient ventilation of the greenhouses. In this system, fresh air gets into the greenhouse through ventilation pipes installed beneath the greenhouse floor. The incoming fresh air also heated with geothermal hot water lines, thus direct contact of cold fresh air is prevented. The design and efficiency of piped ventilation systems were provided in this paper.

  5. Mechanical ventilation in the newborn; a simplified approach. Part 2: High-frequency ventilation.

    Science.gov (United States)

    Muhlethaler, Vincent; Malcolm, Girvan

    2014-10-01

    High frequency oscillatory ventilation (HFOV) is becoming an increasingly popular intervention in the neonatal intensive care unit. This article will attempt to explain the principles of HFOV. It is inherently more difficult to become skilled in this technique than in other forms of mechanical ventilation, so caution is warranted. © 2010 The Author. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  6. Effective, industrial ventilation systems. New generation of ventilation systems under development; Effectieve, industriele ventilatiesystemen

    Energy Technology Data Exchange (ETDEWEB)

    Moons, A.; Knoll, B. [TNO Bouw en Ondergrond, Delft (Netherlands)

    2008-02-15

    Industrial processes and tools can expose employees to various harmful substances. This is a burden that often takes place decentralized. Room ventilation alone usually does not offer enough protection. New ventilation concepts can offer employees effective protection. (mk) [Dutch] Industriele processen en gereedschappen kunnen werknemers blootstellen aan allerlei schadelijke stoffen. Een belasting die vaak zeer decentraal plaatsheeft. Alleen ruimteventilatie biedt doorgaans onvoldoende bescherming. Nieuwe ventilatieconcepten kunnen medewerkers wel een effectieve bescherming bieden.

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

    Science.gov (United States)

    Patil, Gurulingappa; Murthy, Navya; Nikhil, M

    2016-12-01

    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. To study the morbidity and mortality in patients with acute OP poisoning requiring mechanical ventilation. 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. 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 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%. 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.

  8. Non-invasive mechanical ventilation after the successful weaning: a comparison with the venturi mask

    Directory of Open Access Journals (Sweden)

    Esra Adıyeke

    Full Text Available Abstract Background and objectives: This study compared the rates of acute respiratory failure, reintubation, length of intensive care stay and mortality in patients in whom the non-invasive mechanical ventilation (NIMV was applied instead of the routine venturi face mask (VM application after a successful weaning. Methods: Following the approval of the hospital ethics committee, 62 patients who were under mechanical ventilation for at least 48 hours were scheduled for this study. 12 patients were excluded because of the weaning failure during T-tube trial. The patients who had optimum weaning criteria after the T-tube trial of 30 minutes were extubated. The patients were kept on VM for 1 hour to observe the hemodynamic and respiratory stability. The group of 50 patients who were successful to wean randomly allocated to have either VM (n = 25, or NIV (n = 25. Systolic arterial pressure (SAP, heart rate (HR, respiratory rate (RR, PaO2, PCO2, and pH values were recorded. Results: The number of patients who developed respiratory failure in the NIV group was significantly less than VM group of patients (3 reintubation vs. 14 NIV + 5 reintubation in the VM group. The length of stay in the ICU was also significantly shorter in NIV group (5.2 ± 4.9 vs. 16.7 ± 7.7 days. Conclusions: The ratio of the respiratory failure and the length of stay in the ICU were lower when non-invasive mechanical ventilation was used after extubation even if the patient is regarded as ‘successfully weaned’. We recommend the use of NIMV in such patients to avoid unexpected ventilator failure.

  9. Ventrain: an ejector ventilator for emergency use.

    Science.gov (United States)

    Hamaekers, A E W; Borg, P A J; Enk, D

    2012-06-01

    A small, flow-regulated, manually operated ventilator designed for ventilation through a narrow-bore transtracheal catheter (TTC) has become available (Ventrain, Dolphys Medical BV, Eindhoven, The Netherlands). It is driven by a predetermined flow of oxygen from a high-pressure source and facilitates expiration by suction. The aim of this bench study was to test the efficacy of this new ventilator. The driving pressure, generated insufflation, and suction pressures and also the suction capacity of the Ventrain were measured at different oxygen flows. The minute volume achieved in an artificial lung through a TTC with an inner diameter (ID) of 2 mm was determined at different settings. Oxygen flows of 6-15 litre min(-1) resulted in driving pressures of 0.5-2.3 bar. Insufflation pressures, measured proximal to the TTC, ranged from 23 to 138 cm H(2)O. The maximal subatmospheric pressure build-up was -217 cm H(2)O. The suction capacity increased to a maximum of 12.4 litre min(-1) at an oxygen flow of 15 litre min(-1). At this flow, the achievable minute volume through the TTC ranged from 5.9 to 7.1 litres depending on the compliance of the artificial lung. The results of this bench study suggest that the Ventrain is capable of achieving a normal minute volume for an average adult through a 2 mm ID TTC. Further in vivo studies are needed to determine the value of the Ventrain as a portable emergency ventilator in a 'cannot intubate, cannot ventilate' situation.

  10. Mechanical ventilation and house-dust mites. Mekanisk ventilation og husstoevmider

    Energy Technology Data Exchange (ETDEWEB)

    Korsgaard, J. (Lungeklinikken, Aarhus Kommunehospital, Aarhus (DK))

    1991-01-01

    Nationally and internationally, it is recognised that the rational way to reduce inhabitant exposure to house-dust meters in a temperate climate is to reduce indoor absolute humidity to a level below 7.0 g/kg in the dry winter period. Consequently, it is medically recommended to install mechanical ventilation as environmental treatment of patients with chronic asthma caused by indoor exposure to house-dust mites. In this controlled investigation on the effect of mechanical ventilation on indoor climate conditions, it is documented that the establishment of a basic ventilation rate of 0.5 ach implies a significant reduction in the occurrence of house-dust mites in dwellings. Parallel with this effect, the rate of inside condensation on double-glazed windows was reduced, and the reported complaint rate of humid air, stuffy and dustry air and the indoor smelling sensation were reduced by a factor 2 to 7. No side effects relating to ventilation equipment were reported. It is conclued that the installation of mechanical ventilation in the treatment of mite allergy should be individualized with recommended air exchange rates adjusted to the actual size of dwelling and number of inhabitants. Furthermore care should be taken to avoid risk of condensation in the ventilation equipment. (author).

  11. The cost of ventilation in birds measured via unidirectional artificial ventilation.

    Science.gov (United States)

    Markley, Jessamyn S; Carrier, David R

    2010-02-01

    The highly derived mechanism birds use to ventilate their lungs relies on dorsoventral excursions of their heavily muscled sternum and abdominal viscera. Our expectation of the level of mechanical work involved in this mechanism led us to hypothesize that the metabolic cost of breathing is higher in birds than in other tetrapods. To test this theory, we used unidirectional artificial ventilation (UDV) to stop normal ventilatory movements in guinea fowl (Numida meleagris L.) at rest and during treadmill locomotion at three speeds. Oxygen consumption was measured during normal breathing and UDV, and the difference was used to approximate the cost of ventilation. Contrary to our prediction, metabolism increased when ventilatory movements ceased during UDV at rest. Although we do not understand why this occurred we suspect that UDV induced a homeostatic mechanism to counteract the loss of carbon dioxide. Nevertheless, across all running speeds, metabolism decreased significantly with UDV, indicating a minimum cost of ventilation during running of 1.43+/-0.62% of total running metabolism or 0.48+/-0.21 mL O(2) (L ventilated)(-1). These results suggest that the metabolic cost of ventilation is low in birds and that it is within the range of costs reported previously for other amniotes. Elsevier Inc.

  12. Changes in lung volume and ventilation during lung recruitment in high-frequency ventilated preterm infants with respiratory distress syndrome

    NARCIS (Netherlands)

    Miedema, Martijn; de Jongh, Frans H.; Frerichs, Inez; van Veenendaal, Mariëtte B.; van Kaam, Anton H.

    2011-01-01

    To assess global and regional changes in lung volume and ventilation during lung recruitment in preterm infants with respiratory distress syndrome. Using electrical impedance tomography, changes in lung volume and ventilation were measured in 15 high-frequency oscillatory ventilated preterm infants

  13. Single-Lung Transplant Results in Position Dependent Changes in Regional Ventilation: An Observational Case Series Using Electrical Impedance Tomography

    Directory of Open Access Journals (Sweden)

    Kollengode Ramanathan

    2016-01-01

    Full Text Available Background. Lung transplantation is the optimal treatment for end stage lung disease. Donor shortage necessitates single-lung transplants (SLT, yet minimal data exists regarding regional ventilation in diseased versus transplanted lung measured by Electrical Impedance Tomography (EIT. Method. We aimed to determine regional ventilation in six SLT outpatients using EIT. We assessed end expiratory volume and tidal volumes. End expiratory lung impedance (EELI and Global Tidal Variation of Impedance were assessed in supine, right lateral, left lateral, sitting, and standing positions in transplanted and diseased lungs. A mixed model with random intercept per subject was used for statistical analysis. Results. EELI was significantly altered between diseased and transplanted lungs whilst lying on right and left side. One patient demonstrated pendelluft between lungs and was therefore excluded for further comparison of tidal variation. Tidal variation was significantly higher in the transplanted lung for the remaining five patients in all positions, except when lying on the right side. Conclusion. Ventilation to transplanted lung is better than diseased lung, especially in lateral positions. Positioning in patients with active unilateral lung pathologies will be implicated. This is the first study demonstrating changes in regional ventilation, associated with changes of position between transplanted and diseased lung.

  14. Single-Lung Transplant Results in Position Dependent Changes in Regional Ventilation: An Observational Case Series Using Electrical Impedance Tomography.

    Science.gov (United States)

    Ramanathan, Kollengode; Mohammed, Hend; Hopkins, Peter; Corley, Amanda; Caruana, Lawrence; Dunster, Kimble; Barnett, Adrian G; Fraser, John F

    2016-01-01

    Background. Lung transplantation is the optimal treatment for end stage lung disease. Donor shortage necessitates single-lung transplants (SLT), yet minimal data exists regarding regional ventilation in diseased versus transplanted lung measured by Electrical Impedance Tomography (EIT). Method. We aimed to determine regional ventilation in six SLT outpatients using EIT. We assessed end expiratory volume and tidal volumes. End expiratory lung impedance (EELI) and Global Tidal Variation of Impedance were assessed in supine, right lateral, left lateral, sitting, and standing positions in transplanted and diseased lungs. A mixed model with random intercept per subject was used for statistical analysis. Results. EELI was significantly altered between diseased and transplanted lungs whilst lying on right and left side. One patient demonstrated pendelluft between lungs and was therefore excluded for further comparison of tidal variation. Tidal variation was significantly higher in the transplanted lung for the remaining five patients in all positions, except when lying on the right side. Conclusion. Ventilation to transplanted lung is better than diseased lung, especially in lateral positions. Positioning in patients with active unilateral lung pathologies will be implicated. This is the first study demonstrating changes in regional ventilation, associated with changes of position between transplanted and diseased lung.

  15. Non-invasive ventilation in obesity hypoventilation syndrome without severe obstructive sleep apnoea.

    Science.gov (United States)

    Masa, Juan F; Corral, Jaime; Caballero, Candela; Barrot, Emilia; Terán-Santos, Joaquin; Alonso-Álvarez, Maria L; Gomez-Garcia, Teresa; González, Mónica; López-Martín, Soledad; De Lucas, Pilar; Marin, José M; Marti, Sergi; Díaz-Cambriles, Trinidad; Chiner, Eusebi; Egea, Carlos; Miranda, Erika; Mokhlesi, Babak; García-Ledesma, Estefanía; Sánchez-Quiroga, M-Ángeles; Ordax, Estrella; González-Mangado, Nicolás; Troncoso, Maria F; Martinez-Martinez, Maria-Ángeles; Cantalejo, Olga; Ojeda, Elena; Carrizo, Santiago J; Gallego, Begoña; Pallero, Mercedes; Ramón, M Antonia; Díaz-de-Atauri, Josefa; Muñoz-Méndez, Jesús; Senent, Cristina; Sancho-Chust, Jose N; Ribas-Solís, Francisco J; Romero, Auxiliadora; Benítez, José M; Sanchez-Gómez, Jesús; Golpe, Rafael; Santiago-Recuerda, Ana; Gomez, Silvia; Bengoa, Mónica

    2016-10-01

    Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO2) as the main outcome measure. Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO2 of -6 (95% CI -7.7 to -4.2) mm Hg versus -2.8 (95% CI -4.3 to -1.3) mm Hg, (p<0.001) and serum bicarbonate of -3.4 (95% CI -4.5 to -2.3) versus -1 (95% CI -1.7 to -0.2 95% CI)  mmol/L (p<0.001). PaCO2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. NIV is more effective than lifestyle modification in improving daytime PaCO2, sleepiness and polysomnographic parameters. Long-term prospective studies are necessary to determine whether NIV reduces

  16. SY Tank Farm ventilation isolation option risk assessment report

    Energy Technology Data Exchange (ETDEWEB)

    Powers, T.B.; Morales, S.D.

    1994-03-01

    The safety of the 241-SY Tank Farm ventilation system has been under extensive scrutiny due to safety concerns associated with tank 101-SY. Hydrogen and other gases are generated and trapped in the waste below the liquid surface. Periodically, these gases are released into the dome space and vented through the exhaust system. This attention to the ventilation system has resulted in the development of several alternative ventilation system designs. The ventilation system provides the primary means of mitigation of accidents associated with flammable gases. This report provides an assessment of various alternatives ventilation system designs.

  17. Modeling and Control of Livestock Ventilation Systems and Indoor Environments

    DEFF Research Database (Denmark)

    Wu, Zhuang; Heiselberg, Per; Stoustrup, Jakob

    2005-01-01

    The hybrid ventilation systems have been widely used for livestock barns to provide optimum indoor climate by controlling the ventilation rate and air flow distribution within the ventilated building structure. The purpose of this paper is to develop models for livestock ventilation systems and i...... constraints and random disturbances is designed through system linearization. The well designed control systems are able to determine the demand ventilation rate and airflow pattern, improve and optimize the indoor Thermal Comfort (TC), Indoor Air Quality (IAQ) and energy use....

  18. Emergency Department Blood Gas Utilization and Changes in Ventilator Settings.

    Science.gov (United States)

    Al Ashry, Haitham S; Richards, Jeremy B; Fisher, Daniel F; Sankoff, Jeffrey; Seigel, Todd A; Angotti, Lauren B; Wilcox, Susan R

    2017-09-26

    Mechanically ventilated patients increasingly spend hours in emergency department beds before ICU admission. This study evaluated the performance of blood gases in mechanically ventilated subjects in the emergency department and subsequent changes to mechanical ventilation settings. This was a multi-center, prospective, observational study of subjects ventilated in the emergency department, conducted at 3 academic emergency departments from July 2011 to March 2013. We measured the rate of arterial blood gas (ABG) and venous blood gas (VBG) analysis, and we assessed the associations between the conditions of hypoxemia, hyperoxia, hypercapnia, or acidemia and changes to mechanical ventilator settings. Of 292 ventilated subjects, 17.1% did not have a blood gas sent in the emergency department. Ventilator changes were made significantly more frequently for subjects who had an ABG as the initial blood gas sent in the emergency department (odds ratio 2.70, 95% CI 1.46-4.99, P = .002). However, findings of hypoxemia, hyperoxia, hypercapnia, or acidemia were not correlated with ventilator adjustments. In this prospective observational study of subjects mechanically ventilated in the emergency department, the majority had a blood gas checked while in the emergency department. While ABGs were associated with having changes made to ventilator settings in the emergency department, clinical findings of hypoxemia, hyperoxia, hypercapnia, and acidemia were not. Inattention to blood gas results may lead to missed opportunities in guiding ventilator changes in the emergency department. Copyright © 2017 by Daedalus Enterprises.

  19. Characterization of pediatric patients receiving prolonged mechanical ventilation.

    Science.gov (United States)

    Monteverde, Ezequiel; Fernández, Analía; Poterala, Rossana; Vidal, Nilda; Siaba Serrate, Alejandro; Castelani, Pablo; Albano, Lidia; Podestá, Fernanda; Farias, Julio A

    2011-11-01

    To describe the characteristics and risk factors of pediatric patients who receive prolonged mechanical ventilation, defined as ventilatory support for >21 days. Prospective cohort. Four medical-surgical pediatric intensive care units in four university-affiliated hospitals in Argentina. All consecutive patients from 1 month to 15 yrs old admitted to participating pediatric intensive care units from June 1, 2007, to August 31, 2007, who received mechanical ventilation (invasive or noninvasive) for >12 hrs. None. Demographic and physiologic data on admission to the pediatric intensive care units, drugs and events during the study period, and outcomes were prospectively recorded. A total of 256 patients were included. Of these, 23 (9%) required mechanical ventilation for >21 days and were assigned to the prolonged mechanical ventilation group. Patients requiring prolonged mechanical ventilation had higher mortality (43% vs. 21%, p mechanical ventilation patients (26% vs. 9%, p ventilator-associated pneumonia (35% vs. 8%, p mechanical ventilation group with similar rates of unplanned extubations in both groups. Variables remaining significantly associated with prolonged mechanical ventilation after multivariate analysis were treatment with multiple antibiotics, septic shock, ventilator-associated pneumonia, and use of norepinephrine. Patients with prolonged mechanical ventilation have more complications and require more pediatric intensive care unit resources. Mortality in these patients duplicates that from those requiring shorter support.

  20. Perceived Air Quality in a Displacement Ventilated Room

    DEFF Research Database (Denmark)

    Brohus, Henrik; Knudsen, Henrik Nellemose; Nielsen, Peter V.

    In a displacement ventilated room the non-uniform contaminant distribution causes an improved indoor air quality in the occupied zone compared with conventional mixing ventilation. This has been demonstrated in numerous studies by chemical measurements. In this study the air quality in a displace......In a displacement ventilated room the non-uniform contaminant distribution causes an improved indoor air quality in the occupied zone compared with conventional mixing ventilation. This has been demonstrated in numerous studies by chemical measurements. In this study the air quality...... in a displacement ventilated room was determined directly by asking humans about how they perceived the air quality. A trained sensory panel comprising 12 subjects assessed the perceived air quality immediately after entering a climate chamber. The experiments showed that the perceived air quality...... in the displacement ventilated chamber was substantially better than in the case of mixing ventilation....

  1. [Weaning from prolonged mechanical ventilation at 72 hours of spontaneous breathing].

    Science.gov (United States)

    Villalba, Darío; Plotnikow, Gustavo; Feld, Viviana; Rivero Vairo, Noelia; Scapellato, José; Díaz Nielsen, Ernesto

    2015-01-01

    The aim of this study was to describe the population admitted to a weaning center (WC) to receive invasive mechanical ventilation (MV), analyze their evolution and identify weaning failure predictors. The medical records of 763 patients admitted to the respiratory care service in the period between May 2005 and January 2012 were reviewed; 372 were selected among 415 tracheotomized and mechanically ventilated. Different variables were analyzed as weaning failure predictors. The mean age of patients admitted was 69 years (SD 14.7), 57% were men. The median length of hospitalization in ICU was 33 days (IQR 26-46). Admission to ICU was due to medical causes in 86% of cases. During hospitalization in WC 186 (50%) patients achieved the successful weaning at a median of 13 days (interquartile range-IQR 5-38). A predictor of weaning failure was age. When we studied the subpopulation with partial disconnection of mechanical ventilation, we found a history of COPD and ageas predictors. Although 25% of the patients died, or required referral to a center of major complexity before 2 weeks of hospitalization, more than half of the patients were able to be removed permanently from the invasive mechanical ventilation (MV), this could support the care of chronic critical patients in MV and rehabilitation centers in Argentina because patients in these centers have a chance of weaning from MV, despite the high chances of developing complications.

  2. Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Susan R. Wilcox

    2016-05-01

    Full Text Available Introduction: Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM education or clinical practice. The objective of this study was to quantify EM attendings’ education, experience, and knowledge regarding mechanical ventilation in the emergency department. Methods: We developed a survey of academic EM attendings’ educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings’ scores on the assessment instrument and their training, education, and comfort with ventilation. Results: Of 394 EM attendings surveyed, 211 responded (53.6%. Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46% reported receiving between 0-1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one’s own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians’ comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education. Conclusion: EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0-1 hour. Physicians’ performance on an assessment tool for mechanical ventilation is

  3. Academic Emergency Medicine Physicians' Knowledge of Mechanical Ventilation.

    Science.gov (United States)

    Wilcox, Susan R; Strout, Tania D; Schneider, Jeffrey I; Mitchell, Patricia M; Smith, Jessica; Lutfy-Clayton, Lucienne; Marcolini, Evie G; Aydin, Ani; Seigel, Todd A; Richards, Jeremy B

    2016-05-01

    Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings' education, experience, and knowledge regarding mechanical ventilation in the emergency department. We developed a survey of academic EM attendings' educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings' scores on the assessment instrument and their training, education, and comfort with ventilation. Of 394 EM attendings surveyed, 211 responded (53.6%). Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46%) reported receiving between 0-1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one's own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians' comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education. EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0-1 hour. Physicians' performance on an assessment tool for mechanical ventilation is most strongly correlated with their self-reported comfort with mechanical

  4. [Organization of mechanical ventilation in French Intensive care units].

    Science.gov (United States)

    Montravers, P; Ichai, C; Dupont, H; Payen, J F; Orliaguet, G; Blanchet, P; Malledant, Y; Albanèse, J; Asehnoune, K; Bastien, O; Collange, O; Duranteau, J; Garrigues, B; Lepape, A; Paugam-Burtz, C

    2013-11-01

    To clarify the procedures related to mechanical ventilation in the intensive care unit setting: allocation of ventilators, team education, maintenance and reference documents. Declarative survey. Between September and December 2010, we assessed the assignment and types of ventilators (ICU ventilators, temporary repair ventilators, non-invasive ventilators [NIV], and transportation ventilators), medical and nurse education, maintenance of the ventilators, presence of reference documents. Results are expressed in median/range and proportions. Among the 62 participating ICUs, a median of 15 ventilators/ICU (range 1-50) was reported with more than one trademark in 47 (76%) units. Specific ventilators were used for NIV in 22 (35%) units, temporary repair in 49 (79%) and transportation in all the units. Nurse education courses were given by ICU physicians in 54 (87%) units or by a company in 29 (47%) units. Medical education courses were made by ICU senior physicians in 55 (89%) units or by a company in 21 (34%) units. These courses were organized occasionally in 24 (39%) ICU and bi-annually in 16 (26%) units. Maintenance procedures were made by the ICU staff in 39 (63%) units, dedicated staff (17 [27%]) or bioengineering technicians (14 [23%] ICU). Reference documents were written for maintenance procedures in 48 (77%) units, ventilator setup in 22 (35%) units and ventilator dysfunction in 20 (32%) ICU. This first survey shows disparate distribution of ventilators and practices among French ICU. Education and understanding of the proper use of ventilators are key issues for security improvement. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  5. One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study.

    Science.gov (United States)

    Kozian, A; Schilling, T; Fredén, F; Maripuu, E; Röcken, C; Strang, C; Hachenberg, T; Hedenstierna, G

    2008-04-01

    One-lung ventilation (OLV) increases mechanical stress in the lung and affects ventilation and perfusion (V, Q). There are no data on the effects of OLV on postoperative V/Q matching. Thus, this controlled study evaluates the influence of OLV on V/Q distribution in a pig model using a gamma camera technique [single-photon emission computed tomography (SPECT)] and relates these findings to lung histopathology after OLV. Eleven anaesthetized and ventilated pigs (V(T)=10 ml kg(-1), Fio2=0.40, PEEP=5 cm H2O) were studied. After lung separation, OLV and thoracotomy were performed in seven pigs (OLV group). During OLV and in a two-lung ventilation (TLV), control group (n=4) ventilation settings remained unchanged. SPECT with (81m)Kr (ventilation) and (99m)Tc-labelled macro-aggregated albumin (perfusion) was performed before, during, and 90 min after OLV/TLV. Finally, lung tissue samples were harvested and examined for alveolar damage. OLV affected ventilation and haemodynamic variables, but there were no differences between the OLV group and the control group before and after OLV/TLV. SPECT revealed an increase of perfusion in the dependent lung compared with baseline (49-56%), and a corresponding reduction of perfusion (51-44%) in non-dependent lungs after OLV. No perfusion changes were observed in the control group. This resulted in increased low V/Q regions and a shift of V/Q areas to 0.3-0.5 (10(-0.5)-10(-0.3)) in dependent lungs of OLV pigs and was associated with an increased diffuse alveolar damage score. OLV in pigs results in a substantial V/Q mismatch, hyperperfusion, and alveolar damage in the dependent lung and may thus contribute to gas exchange impairment after thoracic surgery.

  6. Listening to excluded young people's perspectives on how digital technologies support and challenge their lives

    OpenAIRE

    Sue Cranmer

    2010-01-01

    Listening to excluded young people’s perspectives on how digital technologies support and challenge their lives This article reports on the perspectives of young people who have been excluded from school on how ICTs support and challenge them in their everyday lives. Qualitative in-depth semistructured interviews were carried out with 13 young people at a Pupil Referral Unit (PRU). The analysis provides a nuanced account of young people’s online activities for those who are already experie...

  7. Equation of State for the Two-component Van der Waals Gas with Relativistic Excluded Volumes

    OpenAIRE

    Zeeb, Gebhard; Bugaev, Kyrill A.; Reuter, Philipp T.; Stöcker, Horst

    2002-01-01

    A canonical partition function for the two-component excluded volume model is derived, leading to two different van der Waals approximations. The one is known as the Lorentz-Berthelot mixture and the other has been proposed recently. Both models are analysed in the canonical and grand canonical ensemble. In comparison with the one-component van der Waals excluded volume model the suppression of particle densities is reduced in these two-component formulations, but in two essentially different...

  8. Lung-protective mechanical ventilation does not protect against acute kidney injury in patients without lung injury at onset of mechanical ventilation

    NARCIS (Netherlands)

    Cortjens, Bart; Royakkers, Annick A. N. M.; Determann, Rogier M.; van Suijlen, Jeroen D. E.; Kamphuis, Stephan S.; Foppen, Jannetje; de Boer, Anita; Wieland, Cathrien W.; Spronk, Peter E.; Schultz, Marcus J.; Bouman, Catherine S. C.

    2012-01-01

    Introduction: Preclinical and clinical studies suggest that mechanical ventilation contributes to the development of acute kidney injury (AKI), particularly in the setting of lung-injurious ventilator strategies. Objective: To determine whether ventilator settings in critically ill patients without

  9. Buoyancy Driven Natural Ventilation through Horizontal Openings

    DEFF Research Database (Denmark)

    Heiselberg, Per; Li, Zhigang

    2009-01-01

    An experimental study of the phenomenon of buoyancy driven natural ventilation through single-sided horizontal openings was performed in a full-scale laboratory test rig. The measurements were made for opening ratios L/D ranging from 0.027 to 4.455, where L and D are the length of the opening...... and the diameter of the opening, respectively. The basic nature of airflow through single-sided openings, including airflow rate, air velocity, temperature difference between the rooms and the dimensions of the horizontal openings, were measured. A bi-directional airflow rate was measured using the constant...... quite well with the Epstein's formula but in other cases the measured data show clear deviations from the Epstein's formula. Thus, revised formulas for natural ventilation are proposed....

  10. Buoyancy Driven Natural Ventilation through Horizontal Openings

    DEFF Research Database (Denmark)

    Heiselberg, Per

    2009-01-01

    An experimental study of the phenomenon of buoyancy driven natural ventilation through single-sided horizontal openings was performed in a full-scale laboratory test rig. The measurements were made for opening ratios L/D ranging from 0.027 to 4.455, where L and D are the length of the opening...... and the diameter of the opening, respectively. The basic nature of airflow through single-sided openings, including airflow rate, air velocity, temperature difference between the rooms and the dimensions of the horizontal openings, were measured. A bi-directional airflow rate was measured using the constant...... quite well with the Epstein's formula ratio are presented. In some cases the measured airflow rates fit quite well with the Epstein's formula but in other cases the measured data show clear deviations from the Epstein's formula. Thus, revised formulas for natural ventilation are proposed....

  11. Adult ICU ventilators to provide neonatal ventilation: a lung simulator study.

    Science.gov (United States)

    Marchese, Andrew D; Chipman, Daniel; de la Oliva, Pedro; Kacmarek, Robert M

    2009-04-01

    Traditionally, specific ventilators have been manufactured to only provide neonatal mechanical ventilation. However, many of the current generation of ICU ventilators also include a neonatal mode. Using the IngMar ASL5000 lung simulator the Puritan Bennett 840, the Maquet Servo i, the Viasys AVEA, the GE Engström, the Drager Evita XL and Babylog 8000 Plus were evaluated during assisted ventilation in the pressure assist/control mode. Three lung mechanics were set: resistance 50 cmH(2)O/L/s, compliance 2 mL/cmH(2)O; resistance 100 cmH(2)O/L/s, compliance 1 mL/cmH(2)O; and resistance 150 cmH(2)O/L/s, compliance 0.5 mL/cmH(2)O. A maximum negative pressure drop of 4 and 7 cmH(2)O was achieved during simulated inspirations. Each ventilator was evaluated with PEEP 5 cmH(2)O, peak pressure 20 cmH(2)O and inspiratory time 0.3 s and with PEEP 10 cmH(2)O, peak pressure 30 cmH(2)O and inspiratory time 0.4 s. Each ventilator setting was then repeated with a leak of 0.3 L/min at a constant pressure of 5 cmH(2)O. Overall each of the 5 ICU ventilators responded faster or greater than the Babylog with respect to: pressure to trigger (except the Servo i), time to trigger (except the Evita XL), time between trigger and return of pressure to baseline, time from start of breath to 90% of peak pressure (except the Avea) and pressure time product of breath activation. Expiratory tidal volume was also greater with all ICU ventilators except the Avea. Variation in mechanics, leak, PEEP and muscular effort had little effect on these differences. All ICU ventilators tested were able to at least equal the performance of the Babylog 8000 Plus on all variables evaluated.

  12. Intrapulmonary percussive ventilation superimposed on conventional mechanical ventilation: comparison of volume controlled and pressure controlled modes.

    Science.gov (United States)

    Riffard, Guillaume; Buzenet, Julien; Guérin, Claude

    2014-07-01

    Previous bench studies suggest that dynamic hyperinflation may occur if intrapulmonary percussive ventilation (IPV) is superimposed on mechanical ventilation in volume controlled continuous mandatory ventilation (VC-CMV) mode. We tested the hypothesis that pressure controlled continuous mandatory ventilation (PC-CMV) can protect against this risk. An ICU ventilator was connected to an IPV device cone adapter that was attached to a lung model (compliance 30 mL/cm H2O, resistance 20 cm H2O/L/s). We measured inspired tidal volume (VTI) and lung pressure (Plung). Measurements were first taken with IPV off and the ICU ventilator set to VC-CMV or PC-CMV mode with a targeted VTI of 500 mL. For each mode, an inspiratory time (TI) of 0.8 or 1.5 s and PEEP 7 or 15 cm H2O were selected. The experiments were repeated with the IPV set to either 20 or 30 psi. The dependent variables were differences in VTI (ΔVTI) and Plung with IPV off or on. The effect of VC-CMV or PC-CMV mode was tested with the ICU ventilators for TI, PEEP, and IPV working pressure using repeated measures of analysis of variance. At TI 0.8 s and 20 psi, ΔVTI was significantly higher in VC-CMV than in PC-CMV. PEEP had no effect on ΔVTI. At TI 1.5 s and 20 psi and at both TI values at each psi, mode and PEEP had a significant effect on ΔVTI. With the ICU ventilators at TI 1.5 s, PEEP 7 cm H2O, and 30 psi, ΔVTI (mean ± SD) ranged from -27 ± 25 to -176 ± 6 mL in PC-CMV and from 258 ± 369 to 369 ± 16 mL in VC-CMV. The corresponding ranges were -15 ± 17 to -62 ± 68 mL in PC-CMV and 26 ± 21 to 102 ± 95 mL in VC-CMV at TI 0.8 s, PEEP 7 cm H2O, and 20 psi. Similar findings pertained to Plung. When IPV is added to mechanical ventilation, the risk of hyperinflation is greater with VC-CMV than with PC-CMV. We recommend using PC-CMV to deliver IPV and adjusting the trigger variable to avoid autotriggering. Copyright © 2014 by Daedalus Enterprises.

  13. Computational fluid dynamics in ventilation design

    CERN Document Server

    Allard, Francis; Awbi, Hazim B; Davidson, Lars; Schälin, Alois

    2007-01-01

    CFD-calculations have been rapidly developed to a powerful tool for the analysis of air pollution distribution in various spaces. However, the user of CFD-calculation should be aware of the basic principles of calculations and specifically the boundary conditions. Computational Fluid Dynamics (CFD) – in Ventilation Design models is written by a working group of highly qualified international experts representing research, consulting and design.

  14. Lung-protective perioperative mechanical ventilation

    OpenAIRE

    Hemmes, S.N.T.

    2015-01-01

    Intraoperative ventilation has the potential to cause lung injury and possibly increase risk of pulmonary complications after surgery. Use of large tidal volumes could cause overdistension of lung tissue, which can be aggravated by too high levels of positive end-expiratory pressure (PEEP). Too low levels of PEEP, though, could result in repetitive opening and closing of lung tissue. The main aim of this thesis was to investigate the effect of intraoperative use of higher levels of PEEP and r...

  15. Fractal ventilation enhances respiratory sinus arrhythmia

    Directory of Open Access Journals (Sweden)

    Girling Linda G

    2005-05-01

    Full Text Available Abstract Background Programming a mechanical ventilator with a biologically variable or fractal breathing pattern (an example of 1/f noise improves gas exchange and respiratory mechanics. Here we show that fractal ventilation increases respiratory sinus arrhythmia (RSA – a mechanism known to improve ventilation/perfusion matching. Methods Pigs were anaesthetised with propofol/ketamine, paralysed with doxacurium, and ventilated in either control mode (CV or in fractal mode (FV at baseline and then following infusion of oleic acid to result in lung injury. Results Mean RSA and mean positive RSA were nearly double with FV, both at baseline and following oleic acid. At baseline, mean RSA = 18.6 msec with CV and 36.8 msec with FV (n = 10; p = 0.043; post oleic acid, mean RSA = 11.1 msec with CV and 21.8 msec with FV (n = 9, p = 0.028; at baseline, mean positive RSA = 20.8 msec with CV and 38.1 msec with FV (p = 0.047; post oleic acid, mean positive RSA = 13.2 msec with CV and 24.4 msec with FV (p = 0.026. Heart rate variability was also greater with FV. At baseline the coefficient of variation for heart rate was 2.2% during CV and 4.0% during FV. Following oleic acid the variation was 2.1 vs. 5.6% respectively. Conclusion These findings suggest FV enhances physiological entrainment between respiratory, brain stem and cardiac nonlinear oscillators, further supporting the concept that RSA itself reflects cardiorespiratory interaction. In addition, these results provide another mechanism whereby FV may be superior to conventional CV.

  16. Prognosis of deeply comatose patients on ventilators.

    OpenAIRE

    Hung, T P; Chen, S T

    1995-01-01

    Although the concept of brain death has been widely accepted, the criteria required for making the diagnosis remain controversial. This prospective study was undertaken to examine the reliability of a set of clinical criteria adopted in Taiwan. One hundred and forty deeply comatose patients (101 men, 39 women; mean age 49.5 (SD 17.6) years) requiring ventilation were studied. Seventy three patients met the clinical criteria for brainstem death; all developed cardiac asystole (97% within seven...

  17. Fractal ventilation enhances respiratory sinus arrhythmia.

    Science.gov (United States)

    Mutch, W Alan C; Graham, M Ruth; Girling, Linda G; Brewster, John F

    2005-05-09

    Programming a mechanical ventilator with a biologically variable or fractal breathing pattern (an example of 1/f noise) improves gas exchange and respiratory mechanics. Here we show that fractal ventilation increases respiratory sinus arrhythmia (RSA) -- a mechanism known to improve ventilation/perfusion matching. Pigs were anaesthetised with propofol/ketamine, paralysed with doxacurium, and ventilated in either control mode (CV) or in fractal mode (FV) at baseline and then following infusion of oleic acid to result in lung injury. Mean RSA and mean positive RSA were nearly double with FV, both at baseline and following oleic acid. At baseline, mean RSA = 18.6 msec with CV and 36.8 msec with FV (n = 10; p = 0.043); post oleic acid, mean RSA = 11.1 msec with CV and 21.8 msec with FV (n = 9, p = 0.028); at baseline, mean positive RSA = 20.8 msec with CV and 38.1 msec with FV (p = 0.047); post oleic acid, mean positive RSA = 13.2 msec with CV and 24.4 msec with FV (p = 0.026). Heart rate variability was also greater with FV. At baseline the coefficient of variation for heart rate was 2.2% during CV and 4.0% during FV. Following oleic acid the variation was 2.1 vs. 5.6% respectively. These findings suggest FV enhances physiological entrainment between respiratory, brain stem and cardiac nonlinear oscillators, further supporting the concept that RSA itself reflects cardiorespiratory interaction. In addition, these results provide another mechanism whereby FV may be superior to conventional CV.

  18. High-Frequency Percussive Ventilation Revisited

    Science.gov (United States)

    2010-01-01

    Landstuhl Regional Medical Center, Germany; and †United States Army Institute of Surgical Research, Fort Sam Houston, Texas. The author does not have...AND ADDRESS(ES) United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 8. PERFORMING ORGANIZATION REPORT NUMBER 9...Engl J Med 1981;305:1375–9. 25. Pillow JJ. High-frequency oscillatory ventilation: mecha- nisms of gas exchange and lung mechanics. Crit Care Med

  19. Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study.

    Science.gov (United States)

    Gautam, Parshotam Lal; Kaur, Gaganjot; Katyal, Sunil; Gupta, Ruchi; Sandhu, Preetveen; Gautam, Nikhil

    2016-12-01

    The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV) is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV) is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial. Moreover, most of these studies are conducted in chronic obstructive pulmonary disease patients with respiratory failure; the results of these studies may not be applicable to surgical patients. Thus, we proposed to do compare these two modes in surgical Intensive Care Unit (ICU) patients as a randomized crossover study. Comparison of patient-ventilator asynchrony between PSV and PAV plus (PAV+) in surgical patients while weaning. After approval by the Hospital Ethics Committee, we enrolled twenty patients from surgical ICU of tertiary care institute. The patients were ventilated with pressure support mode (PSV) and PAV+ for 12 h as a crossover from one mode to another after 6 h while weaning. Average age and weight of patients were 41.80 ± 15.20 years (mean ± standard deviation [SD]) and 66.50 ± 12.47 (mean ± SD) kg, respectively. Comparing the asynchronies between the two modes, the mean number of total asynchronous recorded breaths in PSV was 7.05 ± 0.83 and 4.35 ± 5.62, respectively, during sleep and awake state, while the same were 6.75 ± 112.24 and 10.85 ± 11.33 in PAV+. Both PSV and PAV+ modes of ventilation performed similarly for patient-ventilator synchrony in surgical patients. In surgical patients with acute respiratory failure, dynamic inspiratory pressure assistance modalities are not superior to PSV with respect to cardiorespiratory

  20. Improving Stack Effect in Hot Humid Building Interiors with Hybrid Turbine Ventilator(s

    Directory of Open Access Journals (Sweden)

    Rifa Radia Tashkina

    2014-01-01

    Full Text Available Natural ventilation strategies have been applied through the ages to offer thermal comfort. At present, these techniques could be employed as one of the methods to overcome the electric consumption that comes from the burning of disproportionate fossil fuel to operate air conditioners. This air conditioning process is the main contributor of CO2 emissions. This paper focuses on the efficiency of stack ventilation which is one of the natural ventilation strategies, and at the same time attempts to overcome the problem of erratic wind flow and the low indoor/outdoor temperature difference in the hot, humid Malaysian climate. Wind flow and sufficient pressure difference are essential for stack ventilation, and as such the irregularity can be overcome with the use of the Hybrid Turbine Ventilator (HTV which extracts hot air from the interior of the building via the roof level. The extraction of hot air is constant and consistent throughout the day time as long as there is sunlight falling on the solar panel for solar electricity. The aim of this paper is to explore the different HTV strategies and find out which building dimensions is most expected to reduce maximum indoor air temperature of a given room in a real weather condition.

  1. ''Ventilated brake discs manufactured in aluminium matrix composites and hypereutectic aluminium alloys''

    Energy Technology Data Exchange (ETDEWEB)

    Goni, J.; Coleto, J.; Eguizabal, P.; Rubio, A. [Fundacion INASMET, San Sebastian (Spain); Garcia, A.; Sanchez, J. [Inst. Univ. de investigacion del Automovil, Madrid (Spain)

    2003-07-01

    Two different aluminium alloy materials have been used to produce ventilated brake discs, on one hand, AS17G0.6 hypereutectic alloy and on the other hand, AS7G0.6 reinforced with 20% in wt. of SiC particles. The casting production technique used has been low pressure casting (LPC) and some of the brake discs have been heat treated using a T6 treatment. Once the ventilated brake discs were produced and machined, they were tested in a dynamometer in order to compare the performance under service conditions of the aluminium alloy and grey cast iron (GCI) discs currently used in the market. (orig.)

  2. [Consequences of mechanical ventilation on diaphragmatic function].

    Science.gov (United States)

    Jung, B; Gleeton, D; Daurat, A; Conseil, M; Mahul, M; Rao, G; Matecki, S; Lacampagne, A; Jaber, S

    2015-04-01

    Mechanical ventilation is associated with ventilator-induced diaphragmatic dysfunction (VIDD) in animal models and also in humans. The main pathophysiological pathways implicated in VIDD seems to be related to muscle inactivity but may also be the consequence of high tidal volumes. Systemic insults from side effects of medication, infection, malnutrition and hypoperfusion also play a part. The diaphragm is caught in the cross-fire of ventilation-induced and systemic-induced dysfunctions. Intracellular consequences of VIDD include oxidative stress, proteolysis, impaired protein synthesis, autophagy activation and excitation-contraction decoupling. VIDD can be diagnosed at the bedside using non-invasive magnetic stimulation of the phrenic nerves which is the gold standard. Other techniques involve patient's participation such as respiratory function tests or ultrasound examination. At this date, only spontaneous ventilatory cycles and perhaps phrenic nerve stimulation appear to diminish the severity of VIDD in humans but several pathways are currently being examined using animal models. Specific pharmacological options are currently under investigation in animal models. Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  3. Respiratory mechanics in mechanically ventilated patients.

    Science.gov (United States)

    Hess, Dean R

    2014-11-01

    Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indices can be determined, such as volume, compliance, resistance, and work of breathing. Plateau pressure is a measure of end-inspiratory distending pressure. It has become increasingly appreciated that end-inspiratory transpulmonary pressure (stress) might be a better indicator of the potential for lung injury than plateau pressure alone. This has resulted in a resurgence of interest in the use of esophageal manometry in mechanically ventilated patients. End-expiratory transpulmonary pressure might also be useful to guide the setting of PEEP to counterbalance the collapsing effects of the chest wall. The shape of the pressure-time curve might also be useful to guide the setting of PEEP (stress index). This has focused interest in the roles of stress and strain to assess the potential for lung injury during mechanical ventilation. This paper covers both basic and advanced respiratory mechanics during mechanical ventilation. Copyright © 2014 by Daedalus Enterprises.

  4. High tidal volume ventilation in infant mice.

    Science.gov (United States)

    Cannizzaro, Vincenzo; Zosky, Graeme R; Hantos, Zoltán; Turner, Debra J; Sly, Peter D

    2008-06-30

    Infant mice were ventilated with either high tidal volume (V(T)) with zero end-expiratory pressure (HVZ), high V(T) with positive end-expiratory pressure (PEEP) (HVP), or low V(T) with PEEP. Thoracic gas volume (TGV) was determined plethysmographically and low-frequency forced oscillations were used to measure the input impedance of the respiratory system. Inflammatory cells, total protein, and cytokines in bronchoalveolar lavage fluid (BALF) and interleukin-6 (IL-6) in serum were measured as markers of pulmonary and systemic inflammatory response, respectively. Coefficients of tissue damping and tissue elastance increased in all ventilated mice, with the largest rise seen in the HVZ group where TGV rapidly decreased. BALF protein levels increased in the HVP group, whereas serum IL-6 rose in the HVZ group. PEEP keeps the lungs open, but provides high volumes to the entire lungs and induces lung injury. Compared to studies in adult and non-neonatal rodents, infant mice demonstrate a different response to similar ventilation strategies underscoring the need for age-specific animal models.

  5. Collective fluid mechanics of honeybee nest ventilation

    Science.gov (United States)

    Gravish, Nick; Combes, Stacey; Wood, Robert J.; Peters, Jacob

    2014-11-01

    Honeybees thermoregulate their brood in the warm summer months by collectively fanning their wings and creating air flow through the nest. During nest ventilation workers flap their wings in close proximity in which wings continuously operate in unsteady oncoming flows (i.e. the wake of neighboring worker bees) and near the ground. The fluid mechanics of this collective aerodynamic phenomena are unstudied and may play an important role in the physiology of colony life. We have performed field and laboratory observations of the nest ventilation wing kinematics and air flow generated by individuals and groups of honeybee workers. Inspired from these field observations we describe here a robotic model system to study collective flapping wing aerodynamics. We microfabricate arrays of 1.4 cm long flapping wings and observe the air flow generated by arrays of two or more fanning robotic wings. We vary phase, frequency, and separation distance among wings and find that net output flow is enhanced when wings operate at the appropriate phase-distance relationship to catch shed vortices from neighboring wings. These results suggest that by varying position within the fanning array honeybee workers may benefit from collective aerodynamic interactions during nest ventilation.

  6. Advanced Controls for Residential Whole-House Ventilation Systems

    Energy Technology Data Exchange (ETDEWEB)

    Turner, William [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Walker, Iain [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sherman, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-08-01

    Whole-house ventilation systems are becoming commonplace in new construction, remodeling/renovation, and weatherization projects, driven by combinations of specific requirements for indoor air quality (IAQ), health and compliance with standards, such as ASHRAE 62.2. Ventilation systems incur an energy penalty on the home via fan power used to drive the airflow, and the additional space-conditioning load associated with heating or cooling the ventilation air. Finding a balance between IAQ and energy use is important if homes are to be adequately ventilated while not increasing the energy burden. This study used computer simulations to examine RIVEC the Residential Integrated Ventilation Controller - a prototype ventilation controller that aims to deliver whole-house ventilation rates that comply with ventilation standards, for the minimum use of energy. Four different whole-house ventilation systems were simulated, both with and without RIVEC, so that the energy and IAQ results could be compared. Simulations were conducted for 13 US climate zones, three house designs, and three envelope leakage values. The results showed that the RIVEC controller could typically return ventilation energy savings greater than 40percent without compromising long-term chronic or short-term acute exposures to relevant indoor contaminants. Critical and average peak power loads were also reduced as a consequence of using RIVEC.

  7. Why we ventilate our houses - An historical look

    Energy Technology Data Exchange (ETDEWEB)

    Matson, Nance E.; Sherman, Max H.

    2004-05-14

    The knowledge of how to ventilate buildings, and how much ventilation is necessary for human health and comfort, has evolved over centuries of trial and error. Humans and animals have developed successful solutions to the problems of regulating temperature and removing air pollutants through the use of ventilation. These solutions include ingenious construction methods, such as engineered passive ventilation (termite mounds and passive stacks), mechanical means (wing-powered, fans), and an evolving effort to identify problems and develop solutions. Ventilation can do more than help prevent building occupants from getting sick; it can provide an improved indoor environment. Codes and standards provide minimum legal requirements for ventilation, but the need for ventilation goes beyond code minima. In this paper we will look at indoor air pollutant sources over time, the evolution of ventilation strategies, current residential ventilation codes and standards (e.g., recently approved ASHRAE Standard 62.2), and briefly discuss ways in which we can go beyond the standards to optimize residential ventilation, reduce indoor air quality problems, and provide corresponding social and economic benefit.

  8. [Independent lung ventilation during general anaesthesia--preliminary report].

    Science.gov (United States)

    Sawulski, Sławomir; Nestorowicz, Andrzej; Sawicki, Marek; Kowalczyk, Michał; Stoń, Mirosław

    2010-01-01

    Unitaleral lung pathology presents a serious challenge for the anaesthesiologist. Conventional ventilation usually leads to over distension of the non-affected lung and hypoventilation of the affected lung. The optimal ventilatory strategy in such situations, is intubation with a double lumen tube and independent lung ventilation with two respirators. This is expensive and difficult, especially in an operating room. A novel approach to this problem is based on the use of a single ventilator with a volume splitter, which enables the independent ventilation of each lung, with the same frequency but different volumes, I:E ratios and PEEPs. We used the splitter in thirty-four patients, of both sexes, aged 19-78 years, and scheduled for elective thoracic surgery. All patients were intubated with a double lumen tube and ventilated in the supine and lateral positions with and without the splitter. When the lateral position was used, the volume delivered by the ventilator was split equally to each lung. In the lateral position, without the splitter, the distribution of gas delivered by the ventilator was unequal: the dependent lung receiving 47.4 +/- 6.8% of the total volume, and the non-dependent lung receiving 52.6 +/- 6.8%. When the splitter was used, both lungs were ventilated with equal volumes. All patients were cardiovasculary stable. A novel method of ventilation during anaesthesia is described, opening up new possibilities for thoracic anaesthesia that allows easy and atraumatic independent lung ventilation.

  9. Pulmonary ventilation defects in older never-smokers.

    Science.gov (United States)

    Sheikh, Khadija; Paulin, Gregory A; Svenningsen, Sarah; Kirby, Miranda; Paterson, Nigel A M; McCormack, David G; Parraga, Grace

    2014-08-01

    Hyperpolarized (3)He MRI previously revealed spatially persistent ventilation defects in healthy, older compared with healthy, younger never-smokers. To understand better the physiological consequences and potential relevance of (3)He MRI ventilation defects, we evaluated (3)He-MRI ventilation-defect percent (VDP) and the effect of deep inspiration (DI) and salbutamol on VDP in older never-smokers. To identify the potential determinants of ventilation defects in these subjects, we evaluated dyspnea, pulmonary function, and cardiopulmonary exercise test (CPET) measurements, as well as occupational and second-hand smoke exposure. Fifty-two never-smokers (71 ± 6 yr) with no history of chronic respiratory disease were evaluated. During a single visit, pulmonary function tests, CPET, and (3)He MRI were performed and the Burden of Obstructive Lung Disease questionnaire administered. For eight of 52 subjects, there was spirometry evidence of airflow limitation (Global Initiative for Chronic Obstructive Lung Disease-Unclassified, I, and II), and occupational exposure was reported in 13 of 52 subjects. In 13 of 52 (25%) subjects, there were no ventilation defects and in 39 of 52 (75%) subjects, ventilation defects were observed. For those subjects with ventilation defects, six of 39 showed a VDP response to DI/salbutamol. Ventilation heterogeneity and VDP were significantly greater, and forced expiratory volume in 1 s (FEV1)/forced vital capacity was significantly lower (P ventilation defects with a response to DI/salbutamol than subjects with ventilation defects without a response to DI/salbutamol and subjects without ventilation defects. In a step-wise, forward multivariate model, FEV1, inspiratory capacity, and airway resistance significantly predicted VDP (R(2) = 0.45, P ventilation defects not reversed by DI/salbutamol; such ventilation defects were likely related to irreversible airway narrowing/collapse but not to dyspnea and decreased exercise capacity. Copyright

  10. Relationship between clothing ventilation and thermal insulation.

    Science.gov (United States)

    Bouskill, L M; Havenith, G; Kuklane, K; Parsons, K C; Withey, W R

    2002-01-01

    Air layers trapped within a clothing microenvironment contribute to the thermal insulation afforded by the ensemble. Any exchange of air between the external environment and these trapped air layers results in a change in the ensemble's thermal insulation and water vapor resistance characteristics. These effects are seldom taken into account when considering the effects of clothing on human heat balance, the thermal characteristics usually being restricted to intrinsic insulation and intrinsic evaporative resistance measurements on static manikins. Environmental assessments based on these measurements alone may therefore lead to under-(or over-) estimation of thermal stress of the worker. The aim of this study was to quantify the relationship between clothing ventilation and thermal insulation properties. A one-layer, air-impermeable ensemble and a three-layer, air-permeable ensemble were tested using an articulated, thermal manikin in a controlled climate chamber (ta = tr = 10 degrees C, PaH2O = 0.73 kPa). The manikin, which was designed for thermal insulation measurements, was also equipped with a system to determine clothing ventilation. Baseline measurements of clothing ventilation (VT) and thermal insulation (total clothing insulation: I(T)--measured, intrinsic insulation: Icl--calculated) were made of the clothing with the manikin standing stationary in still air conditions. Increased clothing ventilation was induced when the manikin "walked" (walking speeds of 0.37 m/sec and 0.77 m/sec) and by increasing the environmental air speed (Va = 1.0 m/sec). These increases in VT reduced Icl, this being ascribed to the increased heat transfer from the manikin skin surface to the cooler external environment due to the exchange of air between the clothing microenvironment and the external environment. Measured air exchanges were shown to have a potential heat exchange capacity of up to 17 and 161 W/m2 for the one- and three-layer ensembles, respectively, emphasizing

  11. Real-time evaluation of ventilation filter-bank systems.

    Science.gov (United States)

    Moyer, Ernest S; Commodore, Michael A; Hayes, Jeffrey L; Fotta, Steven A; Berardinelli, Stephen P

    2007-01-01

    This study evaluated two government facility ventilation systems. One was a metropolitan government office complex with a recirculation system where outside air was the makeup air; the other was a NIOSH facility that used 100% outside air with no recirculation. The methodology employed was a modified American Society of Agricultural Engineers standard (S525) for testing total enclosure filtration efficiency, in agricultural tractor cabs, with optical particle counters (OPC). The low-efficiency bag filters were tested when new and after being in the ventilation system for 3 months. The replacement medium-efficiency filters were evaluated for 6 months (the manufacturer's suggested change-out schedule). These eight-chamber, medium-efficiency filters had an increased filter surface area that resulted in increased airflow through the system. Unfortunately, these filters contained electrostatic filter media and lost filtration efficiency rapidly, which was subsequently confirmed in a 30-day study conducted to determine an appropriate change-out schedule for the eight-chamber bag filters. The study determined that less than 6 months' use was justified due to the reduced efficiency of the electrostatic filter media. The NIOSH facility's air handler #8 (100% outside air unit) was upgraded from electrostatic bag filters, which had a suggested 9-month change-out schedule, to V Bank mechanical, wet-laid, glass fiber filters. The results of a 3-year evaluation showed that the V Bank filters had better filter efficiency after 3 years of service than the electrostatic filters had at 9 months. Both studies employed matched OPC instruments to reduce instrument-to-instrument bias. The methodology is adaptable to monitoring the total efficiency of most air filtration systems, and results can help make decisions about upgrading filter performance.

  12. The influence of music during mechanical ventilation and weaning from mechanical ventilation: A review.

    Science.gov (United States)

    Hetland, Breanna; Lindquist, Ruth; Chlan, Linda L

    2015-01-01

    Mechanical ventilation (MV) causes many distressing symptoms. Weaning, the gradual decrease in ventilator assistance leading to termination of MV, increases respiratory effort, which may exacerbate symptoms and prolong MV. Music, a non-pharmacological intervention without side effects may benefit patients during weaning from mechanical ventilatory support. A narrative review of OVID Medline, PsychINFO, and CINAHL databases was conducted to examine the evidence for the use of music intervention in MV and MV weaning. Music intervention had a positive impact on ventilated patients; 16 quantitative and 2 qualitative studies were identified. Quantitative studies included randomized clinical trials (10), case controls (3), pilot studies (2) and a feasibility study. Evidence supports music as an effective intervention that can lesson symptoms related to MV and promote effective weaning. It has potential to reduce costs and increase patient satisfaction. However, more studies are needed to establish its use during MV weaning. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Personal exposure between people in a room ventilated by textile terminals - with and without personalized ventilation

    DEFF Research Database (Denmark)

    Nielsen, P. V.; Hyldgaard, C.E.; Melikov, Arsen Krikor

    2005-01-01

    The investigation is made in a room ventilated by an air distribution system based on a textile terminal. The air distribution in the room is mainly controlled by buoyancy forces from the heat sources, although the flow from the textile terminal can be characterized as a passive displacement flow...... with a downward direction in areas without thermal load. The system is extended by a personalized ventilation system to study the improved protection of people in a room. The investigation involves full-scale experiments with two breathing thermal manikins. One manikin is the source and the other the target....... In general it is found that when the air is supplied from the textile terminal alone, the flow in the room is fully mixed with a limited protection of the occupants. It is shown that the personalized ventilation improves the protection of occupants by increasing the personal exposure index....

  14. Increasing rate of middle ear ventilation tube insertion in children in Denmark.

    Science.gov (United States)

    Djurhuus, Bjarki Ditlev; Skytthe, Axel; Christensen, Kaare; Faber, Christian Emil

    2014-09-01

    To study the incidence rates of middle ear ventilation tube insertion in children aged 0 to 15 years in Denmark from 1997 to 2010. Using two national registers, the Danish National Health Service Register and the Danish National Patient Register, practically all cases of middle ear ventilation tube insertion performed in Denmark in the period were identified. A possible change in incidence rate over time was examined using Poisson regression analysis, while the cumulative incidence proportion was estimated using life-tables. A total of 502,569 uni- or bilateral ventilation tube insertions distributed among 269,459 different children were identified. From 1997 to 2010 the age standardized incidence rate in 0-15-year-olds increased from 26 to 40 per 1000 person years with an estimated annual increase of 2.0% (95% confidence interval 1.9-2.1%). The largest increase in incidence rate was found in 1-year-olds with an annual increase of 4.5% (95% confidence interval 4.4-4.6%). Age-specific incidence rates remained at maximum around the age of 14 months throughout the period. The cumulative incidence proportion for the 2010 birth cohort by the time they reach the age of 5 years was estimated to 29% (95% confidence interval 28-29%). The rate for middle ear ventilation tube insertion in Denmark was high compared to other developed countries, and an estimated 3 in 10 children born in 2010 will undergo at least one ventilation tube insertion before their fifth birthday. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Effects of Multiple Ventilation Courses and Duration of Mechanical Ventilation on Respiratory Outcomes in Extremely Low-Birth-Weight Infants.

    Science.gov (United States)

    Jensen, Erik A; DeMauro, Sara B; Kornhauser, Michael; Aghai, Zubair H; Greenspan, Jay S; Dysart, Kevin C

    2015-11-01

    Extubation failure is common in extremely preterm infants. The current paucity of data on the adverse long-term respiratory outcomes associated with reinitiation of mechanical ventilation prevents assessment of the risks and benefits of a trial of extubation in this population. To evaluate whether exposure to multiple courses of mechanical ventilation increases the risk of adverse respiratory outcomes before and after adjustment for the cumulative duration of mechanical ventilation. We performed a retrospective cohort study of extremely low-birth-weight (ELBW; birth weight mechanical ventilation. Analysis was conducted between November 2014 and February 2015. Data were obtained from the Alere Neonatal Database. The primary study exposures were the cumulative duration of mechanical ventilation and the number of ventilation courses. The primary outcome was bronchopulmonary dysplasia (BPD) among survivors. Secondary outcomes were death, use of supplemental oxygen at discharge, and tracheostomy. We identified 3343 ELBW infants, of whom 2867 (85.8%) survived to discharge. Among the survivors, 1695 (59.1%) were diagnosed as having BPD, 856 (29.9%) received supplemental oxygen at discharge, and 31 (1.1%) underwent tracheostomy. Exposure to a greater number of mechanical ventilation courses was associated with a progressive increase in the risk of BPD and use of supplemental oxygen at discharge. Compared with a single ventilation course, the adjusted odds ratios for BPD ranged from 1.88 (95% CI, 1.54-2.31) among infants with 2 ventilation courses to 3.81 (95% CI, 2.88-5.04) among those with 4 or more courses. After adjustment for the cumulative duration of mechanical ventilation, the odds of BPD were only increased among infants exposed to 4 or more ventilation courses (adjusted odds ratio, 1.44; 95% CI, 1.04-2.01). The number of ventilation courses was not associated with increased risk of supplemental oxygen use at discharge after adjustment for the length of ventilation

  16. Neurally adjusted ventilatory assist and proportional assist ventilation both improve patient-ventilator interaction.

    Science.gov (United States)

    Schmidt, Matthieu; Kindler, Felix; Cecchini, Jérôme; Poitou, Tymothée; Morawiec, Elise; Persichini, Romain; Similowski, Thomas; Demoule, Alexandre

    2015-02-25

    The objective was to compare the impact of three assistance levels of different modes of mechanical ventilation; neurally adjusted ventilatory assist (NAVA), proportional assist ventilation (PAV), and pressure support ventilation (PSV) on major features of patient-ventilator interaction. PSV, NAVA, and PAV were set to obtain a tidal volume (VT) of 6 to 8 ml/kg (PSV₁₀₀, NAVA₁₀₀, and PAV₁₀₀) in 16 intubated patients. Assistance was further decreased by 50% (PSV₅₀, NAVA₅₀, and PAV₅₀) and then increased by 50% (PSV₁₅₀, NAVA₁₅₀, and PAV₁₅₀) with all modes. The three modes were randomly applied. Airway flow and pressure, electrical activity of the diaphragm (EAdi), and blood gases were measured. VT, peak EAdi, coefficient of variation of VT and EAdi, and the prevalence of the main patient-ventilator asynchronies were calculated. PAV and NAVA prevented the increase of VT with high levels of assistance (median 7.4 (interquartile range (IQR) 5.7 to 10.1) ml/kg and 7.4 (IQR, 5.9 to 10.5) ml/kg with PAV₁₅₀ and NAVA₁₅₀ versus 10.9 (IQR, 8.9 to 12.0) ml/kg with PSV₁₅₀, P variation of VT was higher with NAVA and PAV (19 (IQR, 14 to 31)% and 21 (IQR 16 to 29)% with NAVA₁₀₀ and PAV₁₀₀ versus 13 (IQR 11 to 18)% with PSV₁₀₀, P ventilator asynchrony in fairly similar ways compared with PSV. Further studies are needed to evaluate the possible clinical benefits of NAVA and PAV on clinical outcomes. Clinicaltrials.gov NCT02056093 . Registered 18 December 2013.

  17. Which Nebulizer Position Should Be Avoided? An Extended Study of Aerosol Delivery and Ventilator Performance during Noninvasive Positive Pressure Ventilation.

    Science.gov (United States)

    Peng, Yun; Dai, Bing; Hu, Chun-Xiang; Su, Jia; Tan, Wei; Zhao, Hong-Wen; Kang, Jian

    2017-12-06

    Research on the effect of nebulizer location on aerosol delivery during noninvasive ventilation has reached inconsistent conclusions. To investigate the effects of nebulizer position on aerosol delivery efficiency and ventilator performance during noninvasive ventilation. The Active Servo Lung 5000 respiratory simulation system (ASL5000) was used to simulate a COPD patient. The noninvasive ventilator was set to the spontaneous breathing mode. Six nebulizer positions, 2 exhalation valve types (single-arch exhalation port and whisper swivel), 4 combinations of inspiratory and expiratory pressure, and 2 respiratory rates were used. Significant differences between nebulizer positions existed in aerosol delivery (p ventilator outlet. When the nebulizer was located between the exhalation valve and the simulated lung, increased inspiratory pressure increased and increased expiratory pressure decreased delivery efficiency (both p ventilator, no obvious trend was observed. Compared to baseline, nebulization lowered the air leakage volume displayed on the ventilator. There were no differences in ventilator performance between different nebulizer positions. The closer the nebulizer was to the exhalation valves or ventilator, the lower the aerosol delivery efficiency. Nebulizer position had little clinically significant effect on ventilator performance. © 2017 S. Karger AG, Basel.

  18. Medicare Star excludes diabetes patients with poor CVD risk factor control.

    Science.gov (United States)

    Schmittdiel, Julie; Raebel, Marsha; Dyer, Wendy; Steiner, John; Goodrich, Glenn; Karter, Andy; Nichols, Gregory

    2014-12-01

    CMS recently added medication adherence to antihypertensives, antihyperlipidemics, and oral antihyperglycemics to its Medicare Star quality measures. These CMS metrics exclude patients with Star adherence metrics and assessed the relationship of both Star-defined adherence and exclusion from Star metrics with CVD risk factor control. Cross-sectional, population-based analysis of 129,040 patients with diabetes aged ≥65 years in 2010 from 3 Kaiser Permanente regions. We estimated adjusted risk ratios to assess the relationship between achieving Star adherence and being excluded from Star adherence metrics, with CVD risk factor control (glycated hemoglobin [A1C]Star metrics excluded 27% of patients with diabetes prescribed oral medications. Star-defined nonadherence was negatively associated with CVD risk factor control (risk ratio [RR], 0.95, 0.84, 0.96 for A1C, LDL-C, and SBP control, respectively; PStar metrics due to early nonadherence was also strongly associated with poor control (RR, 0.83, 0.56, 0.87 for A1C, LDL-C, and SBP control, respectively; PStar adherence measures underestimate the prevalence of medication nonadherence in diabetes and exclude patients at high risk for poor CVD outcomes. Up to 3 million elderly patients with diabetes may be excluded from these measures nationally. Quality measures designed to encourage effective medication use should focus on all patients treated for CVD risk.

  19. Computational fluid dynamics in ventilation. 4: Commercial application of CFD in ventilation

    Science.gov (United States)

    Nielsen, Peter V.

    In considering the commercial applications of Computational Fluid Dynamics (CFD) in ventilation, the following are addressed: typical markets (airport centers, large theaters, atria, shopping malls, etc.); typical problems to be solved (energy flow, draft, ventilation effectiveness, pressure distribution, etc.); and high priority areas, activities and quantities (fast preprocessing, effective visualization software, etc.). It is stated that the commercial application of CFD may be looked upon as an advanced 'zonal' model. The 'zonal' model concept is outlined and CFD with large control volumes is considered. An illustrated example of air flow simulation in a theater is given.

  20. Air quality Performance of Ductless Personalized Ventilation in Conjunction with Displacement Ventilation: Impact of Walking Person

    DEFF Research Database (Denmark)

    Bolashikov, Zhecho Dimitrov; Lu, Pengfei; Melikov, Arsen Krikor

    2015-01-01

    The present experiment evaluates the impact of air disturbances from a walking person on inhaled air by ductless personalized ventilation (DPV) with displacement ventilation (DV), when a seated occupant is the source of pollution: bio-effluents and exhaled air. The measurements took place in a full......-scale office room with two side by side workstations. Each desk included a DPV, a personal computer and desk lamps. Two dressed, breathing thermal manikins were used as seated occupants. DV floorstanding air supply was installed at the wall facing the workstations. A real person was walking between the desks...