Browsing by Subject "Ventilator"

Now showing 1 - 5 of 5
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    The ethical dilemma of ventilator sharing during the COVID-19 pandemic
    (International Society of Global Health, 2020-10-08) Bhatt, Harshil U.; Singh, Sandeep; Medicine, School of Medicine
    Ventilator sharing, an ethically challenging and difficult decision for the healthcare providers to make, has emerged due to scarce medical supplies during the COVID-19 pandemic. Healthcare professionals find themselves tangled in the ethical complexity of ventilator sharing at every step – selecting patients, maintaining patient privacy, using appropriate ventilator settings, and avoiding complications. It becomes hard to morally answer questions related to ventilator sharing due to a lack of scientific research in this regard.
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    Innovative Use of High-Fidelity Lung Simulators to Test a Ventilator Splitter Device
    (Wolters Kluwer, 2020-06-02) Boyer, Tanna J.; Mitchell, Sally A.; Cartwright, Johnny F.; Ahmed, Rami A.; Anesthesia, School of Medicine
    The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed health care system inadequacies. Hospital ventilator shortages in Italy compelled US physicians to consider cre-ative solutions, such as using Y-pieces or T-pieces, to preclude the need to make decisions of life or death based on medical equipment availability. We add to current knowledge and testing capacity for ventilator splitters by reporting the ability to examine the functionality of ventilator splitters by using 2 high-fidelity lung simulators. Data obtained by the high-fidelity lung simula-tors included: tidal volume, respiratory rate, minute ventilation, peak inspiratory pressure, peak plateau pressure, and positive end-expiratory pressure.
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    Mortality Rates in a Diverse Cohort of Mechanically Ventilated Patients With Novel Coronavirus in the Urban Midwest
    (Wolters Kluwer, 2020-08) Twigg, Homer L. III; Khan, Sikandar H.; Perkins, Anthony J.; Roberts, Scott; Sears, Catherine R.; Rahman, Omar; Smith, Joseph P.; Kapoor, Rajat; Farber, Mark O.; Ellender, Timothy; Carlos, Graham; Gilroy, Grant; Buckley, John; Bosslet, Gabriel; Machado, Roberto; Gao, Sujuan; Khan, Babar A.; Medicine, School of Medicine
    Objectives: Differences in mortality rates previously reported in critically ill patients with coronavirus disease 2019 have increased the need for additional data on mortality and risk factors for death. We conducted this study to describe length of stay, mortality, and risk factors associated with in-hospital mortality in mechanically ventilated patients with coronavirus disease 2019. Design: Observational study. Setting: Two urban, academic referral hospitals in Indianapolis, Indiana. Patients or Subjects: Participants were critically ill patients 18 years old and older, admitted with coronavirus disease 2019 between March 1, 2020, and April 27, 2020. Interventions: None. Measurements and Main Results: Outcomes included in-hospital mortality, duration of mechanical ventilation, and length of stay. A total of 242 patients were included with mean age of 59.6 years (sd, 15.5 yr), 41.7% female and 45% African American. Mortality in the overall cohort was 19.8% and 20.5% in the mechanically ventilated subset. Patients who died were older compared with those that survived (deceased: mean age, 72.8 yr [sd, 10.6 yr] vs patients discharged alive: 54.3 yr [sd, 14.8 yr]; p < 0.001 vs still hospitalized: 59.5 yr [sd, 14.4 yr]; p < 0.001) and had more comorbidities compared with those that survived (deceased: 2 [0.5–3] vs survived: 1 [interquartile range, 0–1]; p = 0.001 vs still hospitalized: 1 [interquartile range, 0–2]; p = 0.015). Older age and end-stage renal disease were associated with increased hazard of in-hospital mortality: age 65–74 years (hazard ratio, 3.1 yr; 95% CI, 1.2–7.9 yr), age 75+ (hazard ratio, 4.1 yr; 95% CI, 1.6–10.5 yr), and end-stage renal disease (hazard ratio, 5.9 yr; 95% CI, 1.3–26.9 yr). The overall median duration of mechanical ventilation was 9.3 days (interquartile range, 5.7–13.7 d), and median ICU length of stay in those that died was 8.7 days (interquartile range, 4.0–14.9 d), compared with 9.2 days (interquartile range, 4.0–14.0 d) in those discharged alive, and 12.7 days (interquartile range, 7.2–20.3 d) in those still remaining hospitalized. Conclusions: We found mortality rates in mechanically ventilated patients with coronavirus disease 2019 to be lower than some previously reported with longer lengths of stay.
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    A novel inline PEEP valve design for differential multi-ventilation
    (Elsevier, 2020-07-10) Bunting, Leonard; Roy, Steven; Pinson, Hannah; Greensweig, Tobin; Medicine, School of Medicine
    Background: Ventilator sharing is one option to emergently increase ventilator capacity during a crisis but has been criticized for its inability to adjust for individual patient needs. Newer ventilator sharing designs use valves and restrictors to control pressures for each patient. A key component of these designs is an inline Positive End Expiratory Pressure (PEEP) Valve but these are not readily available. Creating an inline PEEP valve by converting a standard bag-valve-mask PEEP valve is possible with the addition of a 3D printer collar. Methods: This was a feasibility study assessing the performance and safety of a method for converting a standard PEEP valve into an inline PEEP valve. A collar was designed and printed that covers the exhaust ports of the valve and returns exhaled gases to the ventilator. Results The collar piece was simple to print and easily assembled with the standard PEEP valve. In bench testing it successfully created differential pressures in 2 simulated expiratory limbs without leaking to the atmosphere at pressures greater than 60 cm of H2O. Conclusion: Our novel inline PEEP valve design shows promise as an option for building a safer ventilator sharing system.
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    The physics of human breathing: flow, timing, volume, and pressure parameters for normal, on-demand, and ventilator respiration
    (IOP, 2021-09-27) Pleil, Joachim D.; Wallace, M. Ariel Geer; Davis, Michael D.; Matty, Christopher M.; Pediatrics, School of Medicine
    Normal breathing for healthy humans is taken for granted; it occurs without conscious effort using ambient (1-atmosphere) pressure with 21% oxygen (O2) concentration. The body automatically adjusts for stress, exercise, altitude, and mild disease by increasing the volume and frequency of breathing. Longer term adaptations for exercise and altitude include increases in red blood cell counts and higher concentrations of capillaries in muscle tissue. When more challenging external environmental conditions or pulmonary illnesses exceed the capability for these adaptations, the human system requires technology to maintain sufficient ventilation to preserve life. On the environmental side there are two conditions to be addressed: toxicity of the surrounding atmosphere and changes in external pressure and O2concentration. On the medical side, mechanisms for assisting breathing include O2supplementation at ambient pressure, positive pressure/flow without additional O2, or a combination of both. This overview describes the various technologies applied to maintaining a safe breathing environment. Topics for environmental intervention include filter-based and flowing air-supply masks for toxic environments (occupational and laboratory protection), and on-demand gas supply systems for firefighters, self-contained underwater breathing apparatus divers, and altitude (high performance aircraft, spacecraft) applications. The topics for medical intervention include nasal cannula, continuous positive airway pressure, and medical ventilators. The primary purpose of this article is to provide a basic understanding of normal human breathing and the adaptation of breathing in different environments using available technologies.