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Halpern, P. "(A176) Mechanical Ventilation in Disasters: “To Intubate or Not to Intubate – That is the Question!”". Prehospital and Disaster Medicine 26, S1 (maj 2011): s49—s50. http://dx.doi.org/10.1017/s1049023x11001749.
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The provision of mechanical ventilatory support for large numbers of casualties in disasters is a complex, controversial issue. Some experts consider this modality unsuitable for large disasters and a waste of resources better devoted to eminently salvageable victims. However, the reality has usually been that rescue teams bring with them some ventilatory capability, even if only for perioperative support. Also, there are many instances when the environment, the existing and potential capacities, allow for significant numbers of victims to be saved by providing artificial ventilation, that would otherwise have likely died. It is therefore important to discuss the issue, with all its complexity, so that the disaster preparedness and relief community fully understands its implications and makes informed, locally relevant decisions before and after disasters strike. The purpose of this presentation is to describe the ethical dilemmas, the technical and clinical considerations for such an endeavor. Ethical considerations: providing the most care to the most victims is the dictum of disaster medical management. Lowered standards of care are accepted and often the norm. However, in many moderate and even major disasters, the ability exists to save lives that will certainly be lost otherwise, by providing intensive care including mechanical ventilatory support, or may be provided if the managers so determine. Is it then ethical, to allow certain victims to die when such support may be available? What is the cost-benefit ratio of such a decision? Who should receive this limited resource? The young and healthy? The very sick? The salvageable? The postoperative? For how long? Until the international team leaves? Types of ventilator-dependency in disasters: (1) Primary ventilatory failure, normal lungs, prolonged ventilator dependency, e.g. botulinum toxin; (2) Combined ventilatory and hypoxemic failure, short to medium-term ventilator dependency, e.g. Sarin gas intoxication; (3) Primary hypoxemic failure, parenchymal lung injury, prolonged ventilator dependency, e.g. Anthrax, mustard gas, ricin; (4) Perioperative and prophylactic ventilatory support, short term but unpredictable. Ventilator supply versus demand: (1) Insufficient ventilators for first few hours only, then supplies come in; (2) Insufficient ventilators for days, then national or international relief expected; (3) Insufficient ventilators and no expected supplies. Care environment: (1) ICU, minority of casualties; (2) General floors: inexperienced nursing, medical staff; (3) Insufficient monitoring devices; (4) Insufficient numbers and quality of respiratory therapists; (5) Commercial companies normally providing technical support understaffed. Basic requirements from the ventilators: allows spontaneous ventilation, incorporates some alarms (ideally disconnect and minute volume), made by a reputable and stable company (will be there when the disaster strikes), low cost, user friendly, long shelf life, quick activation from storage, low weight and volume, few spares, few or generic disposables, little and simple maintenance, independent of compressed oxygen (i.e. electric, multiple voltages, long-life battery). The system: Mechanical ventilation is a complete patient care unit comprising: Bed and space, Oxygen supply, Vacuum, Cardiorespiratory monitor, Mechanical ventilator, Nursing staff, Medical staff, Expert consultatory staff, Logistic and technical support staff. Potential mechanical ventilators: (1) BVM or bag-valve-tube; (2) Transport-type, pneumatic or electrical ventilators; (3) Intermediate capability pneumatic, electrical or electronic ventilators; (4) Full capability intensive care ventilators; (5) Single patient use ventilators.
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PAVLIDOU (Κ. ΠΑΥΛΙΔΟΥ), K., I. SAVVAS (Ι. ΣΑΒΒΑΣ) i T. ANAGNOSTOU (Τ. ΑΝΑΓΝΩΣΤΟΥ). "Mechanical ventilation. Part II: Basic principles and function of ventilators." Journal of the Hellenic Veterinary Medical Society 62, nr 4 (13.11.2017): 334. http://dx.doi.org/10.12681/jhvms.14864.
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Mechanical ventilation is the process of supporting respiration by manual or mechanical means. When normal breathing is inefficient or has stopped, mechanical ventilation is life-saving and should be applied at once. The ventilator increases the patient's ventilation by inflating the lungs with oxygen or a mixture of air and oxygen. Ventilators play an important role in the anaesthetic management of patients, as well as in the treatment of patients in the ICU. However, there are differences between the anaesthetic ventilators and the ventilators in ICU. The main indication for mechanical ventilation is difficulty in ventilation and/or oxygenation of the patient because of any respiratory or other disease. The aims of mechanical ventilation are to supply adequate oxygen to patients with a limited vital capacity, to treat ventilatory failure, to reduce dyspnoea and to facilitate rest of fatigued breathing muscles. Depression of the central nervous system function is a pre-requirement for mechanical ventilation. Some times, opioids or muscle relaxants can be used in order to depress patient's breathing. Mechanical ventilation can be applied using many different modes: assisted ventilation, controlled ventilation, continuous positive pressure ventilation, intermittent positive pressure ventilation and jet ventilation. Furthermore, there are different types of automatic ventilators built to provide positive pressure ventilation in anaesthetized or heavily sedated or comatose patients: manual ventilators (Ambu-bag), volumecontrolled ventilators with pressure cycling, volume-controlled ventilators with time cycling and pressure-controlled ventilators. In veterinary practice, the ventilator should be portable, compact and easy to operate. The controls on most anaesthetic ventilators include settings for tidal volume, inspiratory time, inspiratory pressure, respiratory rate and inspiration: expiration (I:E) ratio. The initial settings should be between 10-20 ml/kg for tidal volume, 12-30 cmH2 0 for the inspiratory pressure and 8-15 breaths/min for the respiratory rate. Mechanical ventilation is a very important part of treatment in the ICU, but many problems may arise during application of mechanical ventilation in critically ill patients. All connections should be checked in advance and periodically for mechanical problems like leaks. Moreover, complications like lung injury, pneumonia, pneumothorax, myopathy and respiratory failure can occur during the course of mechanical ventilation causing difficulty in weaning.
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Yamasaki, Kimiyo. "Mechanical ventilators circuit types". Journal of Mechanical Ventilation 4, nr 4 (15.12.2023): 165–67. http://dx.doi.org/10.53097/jmv.10092.
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Clinicians might have opportunities to recognize different types of mechanical ventilators circuits and compare them in critical care situations. As a clinician it is important to know the features of those configurations and take them into consideration when choosing modes and settings for patients because it affects the outcome of monitoring and ventilators’ performance. There are three types of ventilators circuits: double limb, single limb with exhalation valve, and single limb with exhalation port. Keywords: Ventilator circuits, exhalation valve, exhalation port
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Ahmed, Dr Saim, Ehtisham Ahmed, Ahmad khan i Zeeshan Rafiq. "Low Cost and Portable Mechanical Ventilator". Sir Syed University Research Journal of Engineering & Technology 12, nr 1 (10.04.2022): 58–64. http://dx.doi.org/10.33317/ssurj.428.
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This paper presents a low cost and portable mechanical ventilator in order to contribute towards the increasing demand of mechanical ventilators all over the world due to the global pandemic of COVID-19. The proposed system’s portability makes it different from the other ventilators which are currently in use in different hospitals. It could be easily carried from one place to another without facing any difficulty because of its small size and low weight as compared to the previous versions of ventilators. Moreover, the aim is to design provide an adequate amount of oxygen and clears CO2 simultaneously to the patients and it will also prevent infection. The proposed ventilator is one of the simplest variations of a mechanical ventilator and the idea behind this vision is to make it too simple so that any ward nurse or a common man can easily operate it as efficiently so an expert can also invest his/her time while looking after much more severe cases as compared to not making much of his/her timeless productive while standing in front of the ventilators and taking care of patients which are in the initial phase.
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Toma, Shane, Mia Shokry i ehab daoud. "Mechanical ventilator flow and pressure sensors: Does location matter?" Journal of Mechanical Ventilation 4, nr 1 (15.03.2023): 19–29. http://dx.doi.org/10.53097/jmv.10071.
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Introduction Accurate measurements of parameters are essential during mechanical ventilation support. These measurements are achieved through sensors that monitor flows, volumes and pressures. External and internal flow sensors are both commonly used in mechanical ventilation systems to measure gas entering and leaving the lungs. The sensors could be located outside the ventilator (external or proximal) or inside the ventilator (internal or distal), each of which have their own respective advantages and disadvantages. There are differences in the way they function and the information they provide, which can affect their accuracy and usefulness in different clinical situations. The purpose of this study was to examine the differences between two critical care ventilators utilizing external sensors to two other ventilators utilizing internal sensors. Methods A bench study using a lung simulator was conducted using three passive, single compartment models: 1) compliance of 40 ml/cmH2O, resistance of 10 cmH2O, 2) compliance of 40 ml/cmH2O, resistance of 20 cmH2O, and 3) compliance of 20 ml/cmH2O, resistance of 10 cmH2O. In each study, two different modes of ventilation, volume controlled (tidal volume 400 ml, respiratory rate 20, PEEP 5 cmH2O, inspiratory time 0.7 seconds) and pressure controlled (inspiratory pressure 15 cmH2O, respiratory rate 20, PEEP 5 cmH2O, inspiratory time 0.7 seconds) were tested. We compared the inspiratory flow, inspiratory tidal volume, peak inspiratory pressures and PEEP in four commercially available critical care ventilators. Two use external flow sensors: G5 (Hamilton Medical), Bellavista 1000e (Vyaire Medical), and two use internal flow sensors: Evita Infinity 500 (Drager), and PB 980 (Medtronic). We also compared these parameters to a mathematical model. Results There were statistically significant differences (P < 0.001) in all four measured parameters: inspiratory flow, tidal volume, PIP and PEEP between all four ventilators, and between the mathematical model and all four ventilators in both modes, in all three clinical scenarios. The post-hoc Dunn test showed significant differences between each ventilator, except for a few parameters in PIP and PEEP, but not in flow or volume. There were variable but significant differences between some of the four parameters measured from the ventilator compared to those measured from the simulator of all four ventilators in both modes. The two ventilators using external sensors had more accurate differences between the delivered and measured tidal volumes (P < 0.001) and inspiratory flow (P < 0.001), however, the other two ventilators with internal sensors had more accurate differences between the delivered and measured PIP (P < 0.001) and PEEP (P < 0.001) levels. Conclusions All four ventilators performed differently from each other and from the mathematical model. The two ventilators using external sensors had more accurate differences between the delivered and measured tidal volumes and inspiratory flow, the two ventilators with internal sensors had more accurate differences between the delivered and measured PIP and PEEP levels. Differences between the ventilators depend on multiple factors including location, type of sensor, and respiratory mechanics. Keywords: Flow sensor, Pressure sensor, PIP, PEEP, Tidal volume, Flow
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Canelli, Robert, Nicole Spence, Nisha Kumar, Gerardo Rodriguez i Mauricio Gonzalez. "The Ventilator Management Team: Repurposing Anesthesia Workstations and Personnel to Combat COVID-19". Journal of Intensive Care Medicine 35, nr 9 (17.07.2020): 927–32. http://dx.doi.org/10.1177/0885066620942097.
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The coronavirus disease 2019 pandemic resulted in unprecedented numbers of patients with respiratory failure requiring ventilatory support. The number of patients who required critical care quickly outpaced the availability of intensive care unit (ICU) beds. Consequently, health care systems had to creatively expand critical care services into alternative hospital locations with repurposed staff and equipment. Deploying anesthesia workstations to the ICU to serve as mechanical ventilators requires equipment preparation, multidisciplinary planning, and targeted education. We aim to contextualize this process, highlighting major differences between anesthesia workstations and ICU ventilators, and to share the insights gained from our experiences creating an anesthesia provider-based ventilator management team.
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Raymond, Samuel J., Sam Baker, Yuzhe Liu, Mauricio J. Bustamante, Brett Ley, Michael J. Horzewski, David B. Camarillo i David N. Cornfield. "A low-cost, highly functional, emergency use ventilator for the COVID-19 crisis". PLOS ONE 17, nr 3 (30.03.2022): e0266173. http://dx.doi.org/10.1371/journal.pone.0266173.
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Respiratory failure complicates most critically ill patients with COVID-19 and is characterized by heterogeneous pulmonary parenchymal involvement, profound hypoxemia and pulmonary vascular injury. The high incidence of COVID-19 related respiratory failure has exposed critical shortages in the supply of mechanical ventilators, and providers with the necessary skills to treat. Traditional mass-produced ventilators rely on an internal compressor and mixer to moderate and control the gas mixture delivered to a patient. However, the current emergency has energized the pursuit of alternative designs, enabling greater flexibility in supply chain, manufacturing, storage, and maintenance considerations. To achieve this, we hypothesized that using the medical gasses and flow interruption strategy would allow for a high performance, low cost, functional ventilator. A low-cost ventilator designed and built-in accordance with the Emergency Use guidance from the US Food and Drug Administration (FDA) is presented wherein pressurized medical grade gases enter the ventilator and time limited flow interruption determines the ventilator rate and tidal volume. This simple strategy obviates the need for many components needed in traditional ventilators, thereby dramatically shortening the time from storage to clinical deployment, increasing reliability, while still providing life-saving ventilatory support. The overall design philosophy and its applicability in this new crisis is described, followed by both bench top and animal testing results used to confirm the precision, safety and reliability of this low cost and novel approach to mechanical ventilation. The ventilator meets and exceeds the critical requirements included in the FDA emergency use guidelines. The ventilator has received emergency use authorization from the FDA.
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Ullah, Nasim, i Al-sharef Mohammad. "Cascaded robust control of mechanical ventilator using fractional order sliding mode control". Mathematical Biosciences and Engineering 19, nr 2 (2021): 1332–54. http://dx.doi.org/10.3934/mbe.2022061.
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<abstract><p>A mechanical ventilator is an important medical equipment that assists patients who have breathing difficulties. In recent times a huge percentage of COVID-19 infected patients suffered from respiratory system failure. In order to ensure the abundant availability of mechanical ventilators during COVID-19 pandemic, most of the manufacturers around the globe utilized open source designs. Patients safety is of utmost importance while using mechanical ventilators for assisting them in breathing. Closed loop feedback control system plays vital role in ensuring the stability and reliability of dynamical systems such as mechanical ventilators. Ideal characteristics of mechanical ventilators include safety of patients, reliability, quick and smooth air pressure buildup and release.Unfortunately most of the open source designs and mechanical ventilator units with classical control loops cannot achieve the above mentioned ideal characteristics under system uncertainties. This article proposes a cascaded approach to formulate robust control system for regulating the states of ventilator unit using blower model reduction techniques. Model reduction allows to cascade the blower dynamics in the main controller design for airway pressure. The proposed controller is derived based on both integer and non integer calculus and the stability of the closed loop is ensured using Lyapunov theorems. The effectiveness of the proposed control method is demonstrated using extensive numerical simulations.</p></abstract>
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Gallagher, John J. "Alternative Modes of Mechanical Ventilation". AACN Advanced Critical Care 29, nr 4 (15.12.2018): 396–404. http://dx.doi.org/10.4037/aacnacc2018372.
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Modern mechanical ventilators are more complex than those first developed in the 1950s. Newer ventilation modes can be difficult to understand and implement clinically, although they provide more treatment options than traditional modes. These newer modes, which can be considered alternative or nontraditional, generally are classified as either volume controlled or pressure controlled. Dual-control modes incorporate qualities of pressure-controlled and volume-controlled modes. Some ventilation modes provide variable ventilatory support depending on patient effort and may be classified as closed-loop ventilation modes. Alternative modes of ventilation are tools for lung protection, alveolar recruitment, and ventilator liberation. Understanding the function and application of these alternative modes prior to implementation is essential and is most beneficial for the patient.
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Vika Lestari, Nindi, Dewi Rachmawati i Tri Cahyo Sepdianto. "Overview of Painfor Patients on Mechanical Ventilators". Jurnal Keperawatan Malang (JKM) 9, nr 1 (15.01.2024): 47–57. http://dx.doi.org/10.36916/jkm.v9i1.256.
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Background: The installation of a ventilator is a stressor that can cause discomfort and anxiety, potentially leading to complications and having serious impacts on the patient's condition. Objective: To determine the pain scale in patients with mechanical ventilators using the CPOT. Method: The design is descriptive, involving a sample of 30 individuals who meet the criteria of being ventilator-dependent on day 1 and classified as priority 1 critical patients. The sample was taken using an accidental sampling technique. The instrument used is the CPOT pain scale, which consists of four indicators: facial expressions, body movements, muscle tension, and compliance with the ventilator and vocalization (for non-intubated patients). Result: The research results showed that 60% of respondents experienced mild pain, 26.6% experienced moderate pain, and 13.3% experienced severe pain. These differences in pain levels are due to the varying interventions provided to the patients, which impacted physiological responses in the form of vital signs. Implication: It is recommended for nurses to identify the pain scale in patients attached to ventilators and provide psychotherapy to reduce pain so that patients can avoid complications. Keywords:CPOT Scale; Mechanical Ventilator;Pain
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LaChance, Julienne, Manuel Schottdorf, Tom J. Zajdel, Jonny L. Saunders, Sophie Dvali, Chase Marshall, Lorenzo Seirup i in. "PVP1—The People’s Ventilator Project: A fully open, low-cost, pressure-controlled ventilator research platform compatible with adult and pediatric uses". PLOS ONE 17, nr 5 (11.05.2022): e0266810. http://dx.doi.org/10.1371/journal.pone.0266810.
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Mechanical ventilators are safety-critical devices that help patients breathe, commonly found in hospital intensive care units (ICUs)—yet, the high costs and proprietary nature of commercial ventilators inhibit their use as an educational and research platform. We present a fully open ventilator device—The People’s Ventilator: PVP1—with complete hardware and software documentation including detailed build instructions and a DIY cost of $1,700 USD. We validate PVP1 against both key performance criteria specified in the U.S. Food and Drug Administration’s Emergency Use Authorization for Ventilators, and in a pediatric context against a state-of-the-art commercial ventilator. Notably, PVP1 performs well over a wide range of test conditions and performance stability is demonstrated for a minimum of 75,000 breath cycles over three days with an adult mechanical test lung. As an open project, PVP1 can enable future educational, academic, and clinical developments in the ventilator space.
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Arowolo, Mathew Oluwole, Cyril Omeiza Ohiani-Greg i Ademilua Busayo Ademola. "Design and Implementation of a Portable Ventilator with Variable Breath per Minute (BPM)". Dutse Journal of Pure and Applied Sciences 10, nr 2b (17.07.2024): 45–56. http://dx.doi.org/10.4314/dujopas.v10i2b.5.
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The Covid-19 pandemic underscored the critical role of ventilators in society, prompting attention to the shortage and cost of medical ventilators. This study focuses on the development of a portable ventilator designed for use in resource-limited settings, addressing the need for a small, lightweight mechanical ventilator. The device, controlled by an Arduino microcontroller, features adjustable ventilation modes and monitoring capabilities for vital signs. Utilizing a cam arm mechanism and a touch screen LED display, the ventilator aims to provide reliable and cost-effective ventilation. Evaluation includes performance, usability, and safety assessments. The device, weighing 11 lbs. and measuring 6.6 x 11.4 x 9.4 inches, contributes to accessible and portable ventilators for emergency situations, benefiting rural communities with vulnerable populations and limited hospital ventilators. The ventilator system, powered by an internal battery lasting up to three hours, offers hot-swappable detachable and external batteries for extended ventilation.
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Fernandes e Fizardo, Trima P., Anisha Cotta, Jane Fernanades, Myola Dias i Skylia Estibeiro. "Low Cost Portable Ventilator". International Journal of Research in Science and Technology 13, nr 01 (2023): 14–23. http://dx.doi.org/10.37648/ijrst.v13i01.002.
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The COVID-19 pandemic has produced critical shortages of ventilators worldwide. This aim of this paper is to build mechanical ventilators with low cost. This project is based on the development and validation of a simple, portable and low-cost ventilator which overcome few limitations offered by the mechanical ventilators. This device is very simple to operate so any less experienced person will be able to operate with ease. Designing portable, solar powered and rechargeable battery operated Ambu bag compressing machine, which sends real time cloud messages to the doctors and other medical authorities about the patient. The shortage of ventilators is met effectively by developing this project. This project is a low cost yet effective ventilating system for the people affected with COVID-19 and other respiratory diseases.
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Chatburn, Robert L. "Understanding mechanical ventilators". Expert Review of Respiratory Medicine 4, nr 6 (grudzień 2010): 809–19. http://dx.doi.org/10.1586/ers.10.66.
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Restrepo, Ruben D., i Felix Khusid. "Essentials of ventilator graphics". Indian Journal of Respiratory Care 03, nr 01 (1.12.2022): 396–404. http://dx.doi.org/10.5005/ijrc-3-1-396.
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Respiratory function monitoring involves the integration of information such as airway pressures, flow and volume to evaluate changes in pulmonary mechanics. Ventilator graphics are an essential and valuable tool in the care of mechanically ventilated patients. Clinicians responsible for both setting up the ventilators and managing the patients should have a thorough understanding of the different waveforms to be able to recognise mechanical and/or clinical abnormalities. The scalar graphics allow the assessment of each variable (pressure, flow and volume) over time. Despite the ability to customise graphics on modern ventilators, scalars are typically displayed together in the same screen. There are an innumerable number of changes that can be detected in the scalars that may facilitate the management of the mechanical ventilator, and thus optimise the care of the ventilated patient. The loops provide a two-dimensional view of two variables plotted against each other. Understanding how the patient and the ventilator interact must be considered a critical component of the overall assessment of patients undergoing any type of mechanical ventilation since detection and management of asynchrony impacts important clinical outcomes in the ICU.
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Wilkens, MD, MPH, Eric P., i Gary M. Klein, MD, MPH, MBA. "Mechanical ventilation in disaster situations: A new paradigm using the AGILITIES Score System". American Journal of Disaster Medicine 5, nr 6 (1.11.2010): 369–84. http://dx.doi.org/10.5055/ajdm.2010.0043.
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Background: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans.Methods: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well.Results: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster.Conclusions: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals.This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients’ use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.
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Wilkens, MD, MPH, Eric P., i Gary M. Klein, MD, MPH, MBA. "Mechanical ventilation in disaster situations: A new paradigm using the AGILITIES Score System". American Journal of Disaster Medicine 14, nr 4 (1.10.2019): 311–26. http://dx.doi.org/10.5055/ajdm.2019.0347.
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Background: The failure of life-critical systems such as mechanical ventilators in the wake of a pandemic or a disaster may result in death, and therefore, state and federal government agencies must have precautions in place to ensure availability, reliability, and predictability through comprehensive preparedness and response plans.Methods: All 50 state emergency preparedness response plans were extensively examined for the attention given to the critically injured and ill patient population during a pandemic or mass casualty event. Public health authorities of each state were contacted as well.Results: Nine of 51 state plans (17.6 percent) included a plan or committee for mechanical ventilation triage and management in a pandemic influenza event. All 51 state plans relied on the Centers for Disease Control and Prevention Flu Surge 2.0 spreadsheet to provide estimates for their influenza planning. In the absence of more specific guidance, the authors have developed and provided guidelines recommended for ventilator triage and the implementation of the AGILITIES Score in the event of a pandemic, mass casualty event, or other catastrophic disaster.Conclusions: The authors present and describe the AGILITIES Score Ventilator Triage System and provide related guidelines to be adopted uniformly by government agencies and hospitals. This scoring system and the set of guidelines are to be used in disaster settings, such as Hurricane Katrina, and are based on three key factors: relative health, duration of time on mechanical ventilation, and patients’ use of resources during a disaster. For any event requiring large numbers of ventilators for patients, the United States is woefully unprepared. The deficiencies in this aspect of preparedness include (1) lack of accountability for physical ventilators, (2) lack of understanding with which healthcare professionals can safely operate these ventilators, (3) lack of understanding from where additional ventilator resources exist, and (4) a triage strategy to provide ventilator support to those patients with the greatest chances of survival.
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Ari, Arzu, James B. Fink i Sue Pilbeam. "Secondhand aerosol exposure during mechanical ventilation with and without expiratory filters: An in-vitro study". Indian Journal of Respiratory Care 05, nr 01 (2.12.2022): 677–82. http://dx.doi.org/10.5005/jp-journals-11010-05103.
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Background: Concerns have been expressed about risk of exposure to exhaled aerosols to ICU personnel. AIM: To quantify amount of aerosol collected at the exhaust outlet of mechanical ventilators operated with and without filters in the expiratory limb. Methods: Two categories of ventilators were tested: (1) Ventilators without Proprietary Filters: Servo-i (Maquet) and Galileo (Hamilton) and (2) Ventilator with proprietary filters: PB 840 (Covidien). Each ventilator was attached to a simple test lung and operated with VT 500 ml, RR 20 bpm, PIF 50 L/min, PEEP 5 cmH2O. Four separate doses of albuterol (2.5 mg/3mL) were administered via jet nebuliser (eValueMed, Tri-anim) placed at the “Y”. In Experiment A, a filter (Respirgard 303) was placed at the exhaust port. In Experiment B, two filters were attached to the ventilators without proprietary filters: (1) at the end of expiratory limb and (2) at the exhaust outlet. Drug was eluted from filters and measured using spectrophotometry. Results: Drug deposited at the exhaust port without expiratory filtering was >160 fold higher than with expiratory filtering. The collecting filter used in this study was less efficient than the proprietary filter designed for use with the ventilator. Regardless of type of filter used, placement of filter in the expiratory limb reduced secondhand aerosol exposure significantly. Conclusion: Risk of secondhand exposure to exhaled aerosol can account for >45% of nominal dose as well as droplet nuclei produced by patients. Using expiratory filters decreases risk of exposure to aerosol released to the atmosphere during mechanical ventilation.
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Kacmarek, Robert. "Newest Generation of Mechanical Ventilators: Improving Patient-Ventilator Interface". Seminars in Respiratory and Critical Care Medicine 14, nr 04 (lipiec 1993): 251–61. http://dx.doi.org/10.1055/s-2007-1006325.
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Purnawan, Iwan, Eman Sutrisna i Arif Imam Hidayat. "Gambaran Respon Pasien ICU Terhadap Pemasangan Ventilator Mekanik di ICU RSUD RSUD Prof. Dr. Margono Soekarjo". Journal of Bionursing 2, nr 2 (31.05.2020): 120–25. http://dx.doi.org/10.20884/1.bion.2020.2.2.42.
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Background: One of the reasons a patient is treated in the Intensive Care Unit is respiratory failure. Mechanical ventilator is the last method if other breath assistance models are no longer able to overcome the patient's breathing problems. The installation of a ventilator is one of the stressors of either pain or the process of adaptation of the presence of foreign bodies in the path of his breath. The purpose of this study was to look at the clinical response of patients with mechanical ventilators. Method: This research is a type of quantitative research with a descriptive analytic approach. Respondents involved in this study were 76 patients. The statistical test used is the frequency distribution to see a picture of the patient's response to the installation of a mechanical ventilator. These responses include the ability to adapt to mechanical ventilators and muscle tension. Results: Patient demographic data showed that the average age of patients was 40.7 and the sex was almost the same, 44.7% (male) and 45.3% (female). Almost all respondents showed discomfort response. Only 6.6% (n = 76) showed an adaptation response when viewed from the sound of a mechanical ventilator alarm. Meanwhile, when viewed from muscle tension, all patients who are fitted with a mechanical ventilator show that the muscles are tense and stiff. Conclusion: The installation of a mechanical ventilator has unpleasant effects on the patient.
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Motghar, Siddhant R., Dr P. G. Mehar, Er V. D. Dhopte i Dr S. R. Ikhar. "Periodic Modulation and Functional Demonstrations of Mechanically Operated Reciprocating Ventilator". International Journal for Research in Applied Science and Engineering Technology 10, nr 9 (30.09.2022): 469–74. http://dx.doi.org/10.22214/ijraset.2022.46648.
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Abstract: During this period of COVID-19 pandemic, the lack of medical equipment (like ventilators) leads to complications arising in the medical field. A low-cost ventilator seems to be an alternative substitute to fill the lacking. This paper presents a numerical analysis for predicting the delivered parameters of a low-cost mechanical ventilator. Based on several manufactured mechanical ventilators, two proposed designs are investigated in this study. Fluid-structure interaction (FSI) analysis is used for solving any problems with the first design, and computational fluid dynamic (CFD) analysis with moving boundary is used for solving any issues with the second design. For this purpose, ANSYS Workbench platform is used to solve the set of equations. The results showed that the Ambu-bag-based mechanical ventilator exhibited difficulties in controlling ventilation variables, which certainly will cause serious health problems such as barotrauma. The mechanical ventilator based on piston-cylinder is more satisfactory with regards to delivered parameters to the patient. The ways to obtain pressure control mode (PCM) and volume control mode (VCM) are identified. Finally, the ventilator output is highly affected by inlet flow, length of the cylinder, and piston diameter.
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Busono, P., R. Riyanto, D. K. Wibowo i R. Febryarto. "Performance Analysis of Emergency Ventilator #BPPT3S-LEN for In-Hospital Use". Journal of Physics: Conference Series 2377, nr 1 (1.11.2022): 012027. http://dx.doi.org/10.1088/1742-6596/2377/1/012027.
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Covid-19 is a global pandemic that originated in Wuhan, China in 2019. It spread very fast around the globe. Many countries suffer from this disease. About 532.2 million people were confirmed and 6.3 million patients were reported dead globally. People infected by this disease will suffer from breathing problems, ranging from light problems to respiration failure. Mechanical ventilators are commonly used to treat patients with respiration failure. However, the increasing number of Covid-19 patients staying in the hospitals, caused the hospitals to lack mechanical ventilators. The emergency ventilator was a choice need to be developed to respond to the lack of mechanical ventilators in the hospitals. It is easy to develop, electronics and medical components available in the local market. Emergency Ventilator #BPPT3S-LEN is an automatic BVM-based resuscitator. This medical device was developed based on the Emergency Use Ventilator Design Guidance of AAMI/CR501:2020 of the USA and MHRA of the UK. It consists of a mechanical part for squeezing, airbag, breathing circuit, pressure gauge, one-way valve, relief valve, flow sensor, PEEP valve, mask or endotracheal tube. Ventilation parameters need to be set in this device including tidal volume, respiration rate, inspirations/expiration time ratio, and PEEP (positive end-expiratory pressure). Measured parameters were tidal volume, respiration rate, peak inspiratory pressure, inspiration/expiration time ratio. Alarm systems were set for maximum inspiration pressure, minimum battery voltage, AC power failure. Self-calibration software was installed in this device. Medical doctors tested about 5 emergency ventilators in regional public hospital RSUD Dr. Saiful Anwar Malang, Indonesia. It was reported that the devices gave better results than manual bagging for measurement results of tidal volume, respiration rate, and peak inspiratory pressure.
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Rubinson, Lewis, Frances Vaughn, Steve Nelson, Sam Giordano, Tom Kallstrom, Tim Buckley, Tabinda Burney i in. "Mechanical Ventilators in US Acute Care Hospitals". Disaster Medicine and Public Health Preparedness 4, nr 3 (październik 2010): 199–206. http://dx.doi.org/10.1001/dmp.2010.18.
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ABSTRACTObjective: The supply and distribution of mechanical ventilation capacity is of profound importance for planning for severe public health emergencies. However, the capability of US health systems to provide mechanical ventilation for children and adults remains poorly quantified. The objective of this study was to determine the quantity of adult and pediatric mechanical ventilators at US acute care hospitals.Methods: A total of 5752 US acute care hospitals included in the 2007 American Hospital Association database were surveyed. We measured the quantities of mechanical ventilators and their features.Results: Responding to the survey were 4305 (74.8%) hospitals, which accounted for 83.8% of US intensive care unit beds. Of the 52 118 full-feature mechanical ventilators owned by respondent hospitals, 24 204 (46.4%) are pediatric/neonatal capable. Accounting for nonrespondents, we estimate that there are 62 188 full-feature mechanical ventilators owned by US acute care hospitals. The median number of full-feature mechanical ventilators per 100 000 population for individual states is 19.7 (interquartile ratio 17.2–23.1), ranging from 11.9 to 77.6. The median number of pediatric-capable device full-feature mechanical ventilators per 100 000 population younger than 14 years old is 52.3 (interquartile ratio 43.1–63.9) and the range across states is 22.1 to 206.2. In addition, respondent hospitals reported owning 82 755 ventilators other than full-feature mechanical ventilators; we estimate that there are 98 738 devices other than full-feature ventilators at all of the US acute care hospitals.Conclusions: The number of mechanical ventilators per US population exceeds those reported by other developed countries, but there is wide variation across states in the population-adjusted supply. There are considerably more pediatric-capable ventilators than there are for adults only on a population-adjusted basis.(Disaster Med Public Health Preparedness. 2010;4:199-206)
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Oh, Teik. "Mechanical Ventilation and Ventilators". Anaesthesia and Intensive Care 14, nr 3 (sierpień 1986): 225. http://dx.doi.org/10.1177/0310057x8601400302.
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Sykes, Keith. "Mechanical ventilators: Part 1". Current Anaesthesia & Critical Care 4, nr 2 (kwiecień 1993): 114–20. http://dx.doi.org/10.1016/s0953-7112(05)80187-5.
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Sykes, Keith. "Mechanical ventilators: Part 2". Current Anaesthesia & Critical Care 4, nr 3 (lipiec 1993): 164–70. http://dx.doi.org/10.1016/0953-7112(93)90031-8.
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Fredberg, J. J., G. M. Glass, B. R. Boynton i I. D. Frantz. "Factors influencing mechanical performance of neonatal high-frequency ventilators". Journal of Applied Physiology 62, nr 6 (1.06.1987): 2485–90. http://dx.doi.org/10.1152/jappl.1987.62.6.2485.
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Factors influencing the mechanical performance of neonatal high-frequency ventilators of diverse design were assessed under controlled conditions. Each of eight ventilators was coupled to in vitro models of the neonatal respiratory system simulating disease of varying severity. The principal performance characteristics examined were frequency dependence and load dependence of tidal volume delivered, peak inspiratory flow rate, and waveforms of pressure at either end of the endotracheal tube. Despite wide diversity of ventilator designs, including jets, flow interrupters, and oscillators, common features emerged. In almost all devices tidal volume increased with endotracheal tube size, was invariant with respiratory system compliance, and decreased with frequency of oscillation. Peak inspiratory flow rates for a given tidal volume and frequency were smallest in the group of oscillators compared with jets and flow interrupters. Proximal pressure was a poor indicator of distal pressure. These findings suggest that delivered tidal volume may be sensitive to endotracheal tube size and airway patency but relatively insensitive to changes in lung tissue or chest wall mechanical properties. In these regards high-frequency ventilation differs from pressure-limited conventional mechanical ventilation. Comparison of data obtained at different clinical centers using high-frequency ventilators of varying design may be possible by taking these factors into account.
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Koomen, Erik, Joppe Nijman, Ben Nieuwenstein i Teus Kappen. "Tidal Volume in Pediatric Ventilation: Do You Get What You See?" Journal of Clinical Medicine 11, nr 1 (24.12.2021): 98. http://dx.doi.org/10.3390/jcm11010098.
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Mechanical ventilators are increasingly evolving into computer-driven devices. These technical advancements have impact on clinical decisions in pediatric intensive care units (PICUs). A good understanding of the design of mechanical ventilators can improve clinical care. Tidal volume (TV) is one of the corner stones of ventilation: multiple technical factors influence the TV and, thus, influence clinical decision making. Ventilator manufacturers make various design choices regarding the phase, site and conditions of TV measurement as well as algorithmic processing choices. Such choice may impact the measurement and subsequent display of TV. A software change of the TV measuring algorithm of the SERVO-i® (Getinge, Solna, Sweden) at the PICU of the University Medical Centre Utrecht was studied in a prospective cohort. It showed, as example, a clinically significant impact of 8% difference in reported TV. Design choices in both the hardware and software of mechanical ventilators can have a clinically relevant impact on the measurement of tidal volume. In our search for the optimal TV for lung-protective ventilation, such choices should be taken into account.
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Hassen, Kedir Abdureman, Micheal Alemayehu Nemera, Andualem Wubetie Aniley, Ararso Baru Olani i Sofoniyas Getaneh Bedane. "Knowledge Regarding Mechanical Ventilation and Practice of Ventilatory Care among Nurses Working in Intensive Care Units in Selected Governmental Hospitals in Addis Ababa, Ethiopia: A Descriptive Cross-Sectional Study". Critical Care Research and Practice 2023 (13.02.2023): 1–8. http://dx.doi.org/10.1155/2023/4977612.
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Introduction. Mechanical ventilation (MV) is a backbone and major supportive modality in intensive care units (ICUs) even though it has side effects and complications. Knowledge of nurses about mechanical ventilators and good practice of nursing care for the ventilated patient plays a crucial role in improving the effectiveness of mechanical ventilation, preventing harm, and optimizing the patient outcome. This study intended to assess the knowledge regarding MV and the practice of ventilator care among nurses working in the ICU. Method. A descriptive cross-sectional study design was conducted. All nurses working in the intensive care unit of selected governmental hospitals were included in the study. The data were collected from March 1 to 30, 2021 with structured and pretested self-administered questionnaires. The collected data were evaluated with SPSS version 26 software. The variables, which have an independent association with poor outcomes, were identified based on OR, with 95% CI and a p value less than 0.05. Results. Of 146 nurses who participated in the study, 51.4% were males. About 71.4% had a BSc in nursing and 57.5% of them had training related to MV. More than half (51.4%) of nurses had poor knowledge regarding MV and the majority (58.9%) of them had poor practice in ventilatory care. The educational level (AOR, 5.1; 95% CI, 1.190–22.002) was positively associated with knowledge. Likewise, the educational level (AOR 5.0 (1.011–24.971)) and work experience (AOR 4.543 (1.430–14.435)) were positively associated with the practice of nurses. Conclusions. Knowledge regarding mechanical ventilators and the practice of ventilatory care among nurses in the selected public hospitals was poor. The educational levels were found statistically associated with both the knowledge and practice of nurses. To improve nursing care offered for MV patients, upgrading the educational level of intensive care nurses plays a vital role.
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Wati, Dyah Kanya, Antonius Pudjiadi i Abdul Latief. "Factors associated with failure to wean children from mechanical ventilators". Paediatrica Indonesiana 53, nr 2 (30.04.2013): 59. http://dx.doi.org/10.14238/pi53.2.2013.59-64.
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Background Patients with failure to wean from mechanicalventilators in 48 hours have increased risk of morbidity, howeveronly a few protocols can be used for children.Objective To assess possible factors associated with failure towean from mechanical ventilators in the pediatric intensive careunit (PICU).Methods This cross sectional study performed from June 2011 toJune 2012 had 124 subjects with 79 patients who were successfullyweaned and 45 patients who fail to be wean ed from mechanicalventilators. Data was analyzed by 2x2 contingency tables. Resultswith P value <0.05 were further analysis by logistic regressionmultivariate analysis.Results Factors associated with failure to wean from mechanicalventilators were abn ormal electrolyte (P= 0.001) and acidbase status (P <0.001), lower ratio between tidal volume(TV)/inspiration time (IT) (P<0.001), lower mechanical load(P <0.001), and longer duration of mechanical ventilator use(P<0.001). Multivariate analyses revealed that the significantrisk factors for failure to wean were TV/IT (OR6.0; 95%CI3.5 to7.5; P= 0.001) , mechanical load (OR 11.5, 95%CI 10.3 to 15.5;P= 0.002), and duration of mechanical ventilator use (OR 12.5;95%CI 8.5to 14.9; P=0.026).Conclusions Lower ratio of TV /IT and mechanical load, as wellas longer duration of ventilator use are factors associated withfailure to wean from a mechanical ventilator.
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Nugent, Kenneth, i Gilbert Berdine. "Mechanical power during mechanical ventilation". Southwest Respiratory and Critical Care Chronicles 12, nr 50 (29.01.2024): 16–23. http://dx.doi.org/10.12746/swrccc.v12i50.1275.
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Mechanical ventilation provides lifesaving support for patients with acute respiratory failure. However, the pressures and volumes required to maintain gas exchange can cause ventilator-induced lung injury. The current approach to mechanical ventilation involves attention to both tidal volume and airway pressures, in particular plateau pressures and driving pressures. The ventilator provides energy to overcome airway resistance and to inflate alveolar structures. This energy delivered to the respiratory system per unit time equals mechanical power. Calculation of mechanical power provides a composite number that integrates pressures, volumes, and respiratory rates. Increased levels of mechanical power have been associated with tissue injury in animal models. In patients, mechanical power can predict outcomes, such as ICU mortality, when used in multivariable analyses. Increases in mechanical power during the initial phase of ventilation have been associated with worse outcomes. Mechanical power calculations can be used in patients on noninvasive ventilation, and measurements of mechanical power have been used to compare ventilator modes. Calculation of mechanical power requires measurement of the area in a hysteresis loop. Alternatively, simplified formulas have been developed to provide this calculation. However, this information is not available on most ventilators. Therefore, clinicians will need to make this calculation. In summary, calculation of mechanical power provides an estimate of the energy requirements for mechanical ventilation based on a composite of factors, including airway resistance, lung elastance, respiratory rate, and tidal volume.
Key words: mechanical ventilation, mechanical power, ventilator-induced lung injury, energy, work
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Flor, Omar, Mauricio Fuentes, Henry Carvajal, Josué Quiroga, Verónica Luzuriaga, Jeysson Tapia i Patricia Acosta-Vargas. "Emergency Mechanical Ventilator Design: Low-Cost and Accessible Components". Electronics 11, nr 23 (26.11.2022): 3910. http://dx.doi.org/10.3390/electronics11233910.
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This paper presents the fundamentals; criteria; and mechanical, electrical, and electronic aspects required to properly operate and control emerging mechanical ventilators. We present the basis for their design and manufacture as a contribution to implementing this type of equipment at low cost for intensive care units. In particular, we describe the materials and the mechanical, electrical, and electronic aspects used to implement the SURKAN mechanical ventilator, which was developed in Ecuador during the COVID-19 pandemic for some health centers in the country. The proposed mechanical ventilator provides a functional and reliable design that can be considered a reference for future developments and new implementations.
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Gonzales Carazas, Maryanne Melanie, Cesar Miguel Gavidia, Roberto Davila Fernandez, Juan Alberto Vargas Zuñiga, Alberto Crespo Paiva, William Bocanegra, Joan Calderon i in. "Biological evaluation of a mechanical ventilator that operates by controlling an automated manual resuscitator. A descriptive study in swine". PLOS ONE 17, nr 3 (3.03.2022): e0264774. http://dx.doi.org/10.1371/journal.pone.0264774.
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The Covid-19 outbreak challenged health systems around the world to design and implement cost-effective devices produced locally to meet the increased demand of mechanical ventilators worldwide. This study evaluates the physiological responses of healthy swine maintained under volume- or pressure-controlled mechanical ventilation by a mechanical ventilator implemented to bring life-support by automating a resuscitation bag and closely controlling ventilatory parameters. Physiological parameters were monitored in eight sedated animals (t0) prior to inducing deep anaesthesia, and during the next six hours of mechanical ventilation (t1-7). Hemodynamic conditions were monitored periodically using a portable gas analyser machine (i.e. BEecf, carbonate, SaO2, lactate, pH, PaO2, PaCO2) and a capnometer (i.e. ETCO2). Electrocardiogram, echocardiography and lung ultrasonography were performed to detect in vivo alterations in these vital organs and pathological findings from necropsy were reported. The mechanical ventilator properly controlled physiological levels of blood biochemistry such as oxygenation parameters (PaO2, PaCO2, SaO2, ETCO2), acid-base equilibrium (pH, carbonate, BEecf), and perfusion of tissues (lactate levels). In addition, histopathological analysis showed no evidence of acute tissue damage in lung, heart, liver, kidney, or brain. All animals were able to breathe spontaneously after undergoing mechanical ventilation. These preclinical data, supports the biological safety of the medical device to move forward to further evaluation in clinical studies.
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Brewster, John F., M. Ruth Graham i W. Alan C. Mutch. "Convexity, Jensen's inequality and benefits of noisy mechanical ventilation". Journal of The Royal Society Interface 2, nr 4 (7.06.2005): 393–96. http://dx.doi.org/10.1098/rsif.2005.0043.
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Mechanical ventilators breathe for you when you cannot or when your lungs are too sick to do their job. Most ventilators monotonously deliver the same-sized breaths, like clockwork; however, healthy people do not breathe this way. This has led to the development of a biologically variable ventilator—one that incorporates noise. There are indications that such a noisy ventilator may be beneficial for patients with very sick lungs. In this paper we use a probabilistic argument, based on Jensen's inequality, to identify the circumstances in which the addition of noise may be beneficial and, equally important, the circumstances in which it may not be beneficial. Using the local convexity of the relationship between airway pressure and tidal volume in the lung, we show that the addition of noise at low volume or low pressure results in higher mean volume (at the same mean pressure) or lower mean pressure (at the same mean volume). The consequence is enhanced gas exchange or less stress on the lungs, both clinically desirable. The argument has implications for other life support devices, such as cardiopulmonary bypass pumps. This paper illustrates the benefits of research that takes place at the interface between mathematics and medicine.
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Hayati, Teti, Busjra M. Nur, Fitrian Rayasari, Yani Sofiani i Diana Irawati. "Perbandingan Pemberian Hiperoksigenasi Satu Menit DAB Dua Menit pada Proses Suction terhadap Saturasi Oksigen Pasien Terpasang Ventilator". Journal of Telenursing (JOTING) 1, nr 1 (18.04.2019): 67–79. http://dx.doi.org/10.31539/joting.v1i1.493.
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This study aims to identify the effect of 1 minute hyperoxygenation on the suctioning process on oxygen saturation of patients with mechanical ventilators. Quasi experimental research design pre-post test with control group design. The sample in this study were 34 respondents who installed mechanical ventilators. Analysis using the Wilcoxon test. The results showed oxygen I saturation before median hyperoxygenation 97 min 95-99, after median hyperoxygenation 99 min 98-100 with p value 0.05. While in the intervention group II before median hyperoxygenation 97 min 95-100, after median hyperoxygenation 99 min 95-100, with p value 0.05. Conclusions there were significant differences in oxygen saturation before and after 1 minute hyperoxygenation administration.
Keywords: Hyperoxygenation, Suction Process, Oxygen Saturation, Ventilator.
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Tamburrano, Paolo, Francesco Sciatti, Elia Distaso, Luigi Di Lorenzo i Riccardo Amirante. "Validation of a Simulink Model for Simulating the Two Typical Controlled Ventilation Modes of Intensive Care Units Mechanical Ventilators". Applied Sciences 12, nr 4 (16.02.2022): 2057. http://dx.doi.org/10.3390/app12042057.
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Mechanical ventilators are vital components of critical care services for patients with severe acute respiratory failure. In particular, pressure- and volume-controlled mechanical ventilation systems are the typical modes used in intensive care units (ICUs) to ventilate patients who cannot breathe adequately on their own. In this paper, a Simulink model is proposed to simulate these two typical modes employed in intensive care lung ventilators. Firstly, these two modes of ventilation are described in detail in the present paper. Secondly, the suggested Simulink model is analysed: it consists of using well-established subroutines already present in Simulink through the Simscape Fluids (gas) library, to simulate all the pneumatic components employed in some commercial ICU ventilators, such as pressure reducing valves, pressure relief valves, check valves, tanks, ON\OFF and proportional directional valves, etc. Finally, the simulation results of both modes in terms of pressure, tidal volume, and inspired/expired flow are compared with the real-life quantitative trends taken from previously recorded real-life experiments in order to validate the Simulink model. The accuracy of the model is high, as the numerical predictions are in good agreement with the real-life data, the percentage error being less than 10% in most comparisons. In this way, the model can easily be used by manufacturers and start-ups in order to produce new mechanical ventilators in the shortest time possible. Moreover, it can also be used by doctors and trainees to evaluate how the mechanical ventilator responds to different patients.
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Carlon, Graziano C., i Arthur H. Combs. "Mechanical ventilators and respiratory centers". Critical Care Medicine 28, nr 6 (czerwiec 2000): 2154–55. http://dx.doi.org/10.1097/00003246-200006000-00094.
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Costarino, Andrew T. "Performance evaluations of mechanical ventilators". Critical Care Medicine 26, nr 6 (czerwiec 1998): 993–94. http://dx.doi.org/10.1097/00003246-199806000-00011.
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Smith, T. C. "Venous return and mechanical ventilators". JAMA: The Journal of the American Medical Association 256, nr 1 (4.07.1986): 38b—38. http://dx.doi.org/10.1001/jama.256.1.38b.
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Smith, Theodore C. "Venous Return and Mechanical Ventilators". JAMA: The Journal of the American Medical Association 256, nr 1 (4.07.1986): 38. http://dx.doi.org/10.1001/jama.1986.03380010042016.
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Goularte, Theresa A., Marie Manning i Donald E. Craven. "Bacterial Colonization in Humidifying Cascade Reservoirs After 24 and 48 Hours of Continuous Mechanical Ventilation". Infection Control 8, nr 5 (maj 1987): 200–203. http://dx.doi.org/10.1017/s0195941700065942.
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AbstractWe evaluated levels of bacterial colonization in the humidifying cascade reservoirs of 466 mechanical ventilators; 326 reservoirs were cultured after 24 hours and 140 were cultured after 48 hours of continuous mechanical ventilation. Bacterial colonization was absent in 284 (87.1%) of the humidifier reservoirs sampled at 24 hours and 125 (89.3%) of the reservoirs cultured at 48 hours. Levels of bacterial colonization in the remaining humidifiers were low (<100 organisms/mL). The median temperature recorded in the reservoir fluid of 30 different ventilators was 50°C (range 40° to 60°C). In vitro seeding of reservoir fluid at 50°C with 106 organisms/mL of four different species of nosocomial gram-negative bacilli and Staphylococcus aureus demonstrated rapid killing of all five strains over a 6-hour incubation period, and no significant bacterial aerosols were detected. Rates and levels of bacteria in heated humidifier reservoirs are low and nosocomial pathogens survive poorly at the median reservoir temperature of 50°C. We conclude that the heated humidifier reservoir on a mechanical ventilator is an unlikely source of colonization or bacterial aerosols, and therefore it can be changed every 48 hours with the ventilator tubing.
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Reddy, Dr Chanda V. "IOT Based Ambulatory Bag Mechanical Ventilator". International Journal for Research in Applied Science and Engineering Technology 9, nr 8 (31.08.2021): 1435–39. http://dx.doi.org/10.22214/ijraset.2021.37526.
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Abstract: The IoT-based Ambu bag mechanical ventilator is a ventilator that automates the process of hand press mechanism using the rack and pinion mechanism. The circulatory motion of the rack is converted into linear motion which helps to press the Ambu bag. The proposed project works on three modes of operation that is child-adult and elder which is set wrt to the breaths per minute. There are two states of operation one normal state where the normal working is evidenced whereas the other operation mode is emergency where the buzzer is themed on in case of emergency. All the parameters are displayed on LCD and connected to the IoT cloud to communicate remotely in the end device Keywords: Ambulatory Bag, IoT network, Rack and Pinion mechanism, Manual resuscitator, mechanical ventilators
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Tsukuda, Makoto, Atsuko Fukuda, Junko Shogaki i Ikuko Miyawaki. "Validity and Reliability of a Short Form of the Questionnaire for the Reflective Practice of Nursing Involving Invasive Mechanical Ventilation: A Cross-Sectional Study". Nursing Reports 13, nr 3 (1.09.2023): 1170–84. http://dx.doi.org/10.3390/nursrep13030101.
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The number of patients on ventilators is rapidly increasing owing to the coronavirus pandemic. The previously developed Questionnaire for the Reflective Practice of Nursing Involving Invasive Mechanical Ventilation (Q-RPN-IMV) for the care of patients on ventilators includes nurses’ thought processes as items. This study aims to develop a short form of the Q-RPN-IMV for immediate use in practice and to test its reliability and validity. A convenience sample of 629 participants was used to explore the factor structure using factor analysis. The test–retest reliability was assessed using the intraclass correlation coefficient (ICC). The study was a cross-sectional design instrument development study and was reported according to GRRAS guidelines. Q-RPN-IMV short form was divided into ventilator management and patient management. The ventilator management comprised 31 items organized into six factors. Cronbach’s alpha ranged from 0.82 to 0.91, and the ICC ranged from 0.82 to 0.89. The patient management comprised 27 items organized into five factors. Cronbach’s alpha ranged from 0.75 to 0.97, and ICC ranged from 0.75 to 0.97. The Q-RPN-IMV short form is a reliable and validated instrument for assessing care for patients on ventilators. This study was not registered.
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Takeuchi, Muneyuki, Purris Williams, Dean Hess i Robert M. Kacmarek. "Continuous Positive Airway Pressure in New-generation Mechanical Ventilators". Anesthesiology 96, nr 1 (1.01.2002): 162–72. http://dx.doi.org/10.1097/00000542-200201000-00030.
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Background A number of new microprocessor-controlled mechanical ventilators have become available over the last few years. However, the ability of these ventilators to provide continuous positive airway pressure without imposing or performing work has never been evaluated. Methods In a spontaneously breathing lung model, the authors evaluated the Bear 1000, Drager Evita 4, Hamilton Galileo, Nellcor-Puritan-Bennett 740 and 840, Siemens Servo 300A, and Bird Products Tbird AVS at 10 cm H(2)O continuous positive airway pressure. Lung model compliance was 50 ml/cm H(2)O with a resistance of 8.2 cm H(2)O x l(-1) x s(-1), and inspiratory time was set at 1.0 s with peak inspiratory flows of 40, 60, and 80 l/min. In ventilators with both pressure and flow triggering, the response of each was evaluated. Results With all ventilators, peak inspiratory flow, lung model tidal volume, and range of pressure change (below baseline to above baseline) increased as peak flow increased. Inspiratory trigger delay time, inspiratory cycle delay time, expiratory pressure time product, and total area of pressure change were not affected by peak flow, whereas pressure change to trigger inspiration, inspiratory pressure time product, and trigger pressure time product were affected by peak flow on some ventilators. There were significant differences among ventilators on all variables evaluated, but there was little difference between pressure and flow triggering in most variables on individual ventilators except for pressure to trigger. Pressure to trigger was 3.74 +/- 1.89 cm H(2)O (mean +/- SD) in flow triggering and 4.48 +/- 1.67 cm H(2)O in pressure triggering (P < 0.01) across all ventilators. Conclusions Most ventilators evaluated only imposed a small effort to trigger, but most also provided low-level pressure support and imposed an expiratory workload. Pressure triggering during continuous positive airway pressure does require a slightly greater pressure than flow triggering.
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Rofi’i, Mohamad, Mohamad Sofie i Patrisius Kusi Olla. "Pengembangan Bag Valve Mask (BVM) Otomatis". Elektrika 14, nr 1 (30.04.2022): 30. http://dx.doi.org/10.26623/elektrika.v14i1.4988.
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<em><span>Ventilators are one of the medical devices that are needed as a breathing apparatus for COVID-19 patients who have respiratory problems. One of the low-cost ventilators currently being developed by several domestic institutions is the ambu bag-based ventilator. The point is an air bag (bag) that is pressed by two carefully controlled automatic clamps, so that it can reach all, while taking into account portability, aesthetics and ease of manufacture. Therefore, the Bag Valve Mask (BVM) or ambu bag is an emergency option to replace the function of the ventilator. This study aims to make an ambu bag that can be applied as a portable mechanical ventilator. Thus, the ambu bag which was originally used manually can be used automatically like a ventilator machine in general. In determining the type of mechanical arm pressure, several parameters such as minute volume, respiratory rate, and tidal volume are used. As recommended by the American Heart Association (AHA) that the tolerance limit for the RR value is +/-10 BPM, it can be said that the automatic BVM as a result of this study can be used with or without a reservoir as needed or with the addition of oxygen</span></em>
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Edriss, Hawa, Jeremy Whiting i Kenneth Nugent. "The Frequency of White Blood Cell and Temperature Events During Mechanical Ventilation and Their Association With Ventilator-Associated Events". Journal of Intensive Care Medicine 32, nr 4 (15.09.2015): 273–77. http://dx.doi.org/10.1177/0885066615605036.
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Background: Changes in white blood cell (WBC) counts and/or temperature could have important implications in patients on ventilators, but the frequency of these events is uncertain. Methods: We reviewed the medical records from 281 ventilation episodes in our medical intensive care unit to determine patient characteristics and the indications for ventilation. We determined the number of days during each ventilation episode in which the temperature (<96.8°F, >100.4°F) or WBC count (<4000/µL, >12 000/µL) was out of the normal range. Results: This study included 257 patients with a mean Acute Physiology and Chronic Health Evaluation 2 score of 13.5 ± 5.9 and a mean initial Pao2/Fio2 of 210 ± 110. The median number of ventilator days was 4 (interquartile range, 3-9). One hundred ninety-six of 275 eligible ventilator episodes (71.3%) had 1 or more temperature events, and 194 of 253 eligible ventilator episodes (76.7%) had 1 or more WBC events. Nineteen patients met the Center for Disease Control criteria for a ventilator-associated event (VAE). Twelve patients had an increased WBC count during the VAE period, and 11 had an increased temperature during this period. Conclusions: White blood cell counts and temperature events occur frequently in patients on ventilators and need evaluation but do not reliably identify patients with ventilator-associated complications.
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Acho, Leonardo, Alessandro N. Vargas i Gisela Pujol-Vázquez. "Low-Cost, Open-Source Mechanical Ventilator with Pulmonary Monitoring for COVID-19 Patients". Actuators 9, nr 3 (12.09.2020): 84. http://dx.doi.org/10.3390/act9030084.
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This paper shows the construction of a low-cost, open-source mechanical ventilator. The motivation for constructing this kind of ventilator comes from the worldwide shortage of mechanical ventilators for treating COVID-19 patients—the COVID-19 pandemic has been striking hard in some regions, especially the deprived ones. Constructing a low-cost, open-source mechanical ventilator aims to mitigate the effects of this shortage on those regions. The equipment documented here employs commercial spare parts only. This paper also shows a numerical method for monitoring the patients’ pulmonary condition. The method considers pressure measurements from the inspiratory limb and alerts clinicians in real-time whether the patient is under a healthy or unhealthy situation. Experiments carried out in the laboratory that had emulated healthy and unhealthy patients illustrate the potential benefits of the derived mechanical ventilator.
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Palibrk, Ivan, Marija Đukanović, Marija Milenković, Jelena Veličković, Maja Maksimović i Nada Milenković. "ASSISTED MECHANICAL VENTILATION, BASICS OF SYNCHRONIZATION". Respiratio 10,11,12, nr 1,2,3 (3.06.2022): 204–14. http://dx.doi.org/10.26601/rsp.aprs.22.8.
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Brojne komplikacije mehaničke ventilacije nastaju kao posledica loše sinhronizacije disanja bolesnika i aparata za mehaničku ventilaciju (ventilatora). Pored komplikacija evidentan je i diskomfort bolesnika. Savremeni modovi ventilacije u sebi imaju i mogućnost sinhronizacije rada ventilatora sa disajnim pokretima bolesnika. Sinhronizacija, zajedno sa asistiranom mehaničkom ventilacijom, je postala moguća zahvaljujući savremenoj tehnologiji. Sinhronizaciju vršimo trigerovanjem inspirijuma i ekspirijuma. Trigerovanje inspirijuma znači da bolesnik svojim inspiratornim naporom, započinje inspiratorni ciklus aparata za mehaničku ventilaciju. Na ventilatorima postoje dva načina trigerovanja. Trigerovanje volumenom i trigerovanje pritiskom. Posle započinjanja inspirijuma i aktivacije disajnog ciklusa na ventilatoru, aparat nastavlja inspirijum do ciljnog pritiska ili ciljnog volumena (asistirana ventilacija). Pored ovih načina započinjanja inspirijuma, koristi se i NAVA (Neurally adjusted ventilatory assist) tehnologija. Odnosno neuralno vođena ventilatorna asistencija. Elektroda koja se nalazi u nazogastrilčnoj sondi beleži aktivnost dijafragme. Kada se zabeleži ta aktivnost ona je osnova za započinjanje inspirijuma. Pored inspiratornog trigera, na ventilatorima se podešava i ekspiratorni triger. Ovo se odnosi na kontrolisani završetak inspirijuma. Njegovim podešavanjem određujemo kraj spontanog inspirijuma.On nam govori kada se zavrsava spontani inspirijum. Senzitivnost ekspiratornog trigera (ETS) predstavlja procenat od najvećeg inspiratornog protoka (peak inspiratory flow), kada inspirijum prelazi u ekspirijum. Svedoci smo da je asinhronija bolesnikovog disanja sa ventilatorom uobičajena pojava. Uspeh lečenja aparatom za mehaničku ventilaciju zavisi i od sinhronizacije. Trigerovanje je vid sinhronizacije, dostupan je na svim modelima ventilatora.
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VanKoevering, Kyle K., Pratyusha Yalamanchi, Catherine T. Haring, Anne G. Phillips, Stephen Lewis Harvey, Alvaro Rojas-Pena, David A. Zopf i Glenn E. Green. "Delivery system can vary ventilatory parameters across multiple patients from a single source of mechanical ventilation". PLOS ONE 15, nr 12 (10.12.2020): e0243601. http://dx.doi.org/10.1371/journal.pone.0243601.
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Background Current limitations in the supply of ventilators during the Covid19 pandemic have limited respiratory support for patients with respiratory failure. Split ventilation allows a single ventilator to be used for more than one patient but is not practicable due to requirements for matched patient settings, risks of cross-contamination, harmful interference between patients and the inability to individualize ventilator support parameters. We hypothesized that a system could be developed to circumvent these limitations. Methods and findings A novel delivery system was developed to allow individualized peak inspiratory pressure settings and PEEP using a pressure regulatory valve, developed de novo, and an inline PEEP ‘booster’. One-way valves, filters, monitoring ports and wye splitters were assembled in-line to complete the system and achieve the design targets. This system was then tested to see if previously described limitations could be addressed. The system was investigated in mechanical and animal trials (ultimately with a pig and sheep concurrently ventilated from the same ventilator). The system demonstrated the ability to provide ventilation across clinically relevant scenarios including circuit occlusion, unmatched physiology, and a surgical procedure, while allowing significantly different pressures to be safely delivered to each animal for individualized support. Conclusions In settings of limited ventilator availability, systems can be developed to allow increased delivery of ventilator support to patients. This enables more rapid deployment of ventilator capacity under constraints of time, space and financial cost. These systems can be smaller, lighter, more readily stored and more rapidly deployable than ventilators. However, optimizing ventilator support for patients with individualized ventilation parameters will still be dependent upon ease of use and the availability of medical personnel.
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Cawley, Michael J. "Mechanical Ventilation". Journal of Pharmacy Practice 24, nr 1 (30.11.2010): 7–16. http://dx.doi.org/10.1177/0897190010388145.
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Mechanical ventilation is a common therapeutic modality required for the management of patients unable to maintain adequate intrinsic ventilation and oxygenation. Mechanical ventilators can be found within various hospital and nonhospital environments (ie, nursing homes, skilled nursing facilities, and patient’s home residence), but these devices generally require the skill of a multidisciplinary health care team to optimize therapeutic outcomes. Unfortunately, pharmacists have been excluded in the discussion of mechanical ventilation since this therapeutic modality may be perceived as irrelevant to drug utilization and the usual scope of practice of a hospital pharmacist. However, the pharmacist provides a crucial role as a member of the multidisciplinary team in the management of the mechanically ventilated patient by verifying accuracy of prescribed medications, providing recommendations of alternative drug selections, monitoring for drug and disease interactions, assisting in the development of institutional weaning protocols, and providing quality assessment of drug utilization. Pharmacists may be intimidated by the introduction of advanced ventilator microprocessor technology, but understanding and integrating ventilator management with the pharmacotherapeutic needs of the patient will ultimately help the pharmacist be a better qualified and respected practitioner. The goal of this article is to assist the pharmacy practitioner with a better understanding of mechanical ventilation and to apply this information to improve delivery of pharmaceutical care.