BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid er...BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.展开更多
BACKGROUND Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure(PEEP)adjustments and to evaluate the wea...BACKGROUND Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure(PEEP)adjustments and to evaluate the weaning process from mechanical ventilation.The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores(LUSs).AIM To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.METHODS An observational study was conducted over 18 months in a tertiary care hospital.Patients of both genders,aged between 18-75 years,who had been admitted to the intensive care unit,and required mechanical ventilation,were studied.A standard ventilatory strategy was used and incremental levels of PEEP[5,10,and 15 cm water(H_(2)O)]were applied.Baseline characteristics,including oxygen saturation(SpO2),LUS,mean arterial pressure(MAP),heart rate(HR),and their changes with incremental PEEP levels,were recorded and analyzed.RESULTS In this study,45.9%of patients required a PEEP of 5 cm H_(2)O to achieve the endpoint of lung aeration(LUS of 0).In addition,86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H_(2)O,respectively.The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels(P<0.001 for 5 and 10 cm H_(2)O and P=0.032 for 15 cm H_(2)O).SpO2 increased significantly with higher PEEP levels(P<0.001),confirming the effectiveness of PEEP in improving oxygenation.The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.CONCLUSION Increasing PEEP levels in mechanically ventilated patients improves lung aeration,which can be effectively assessed using bedside lung ultrasonography.展开更多
Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials t...Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials to help with weaning decisions.These scores aim to provide a structured framework to support clinical judgment.However,their effectiveness varies across patient populations,and their predictive accuracy remains inconsistent.In this review,we aim to identify the strengths and limitations of commonly used clinical prediction tools in assessing readiness for ventilator liberation.While scores such as the Rapid Shallow Breathing Index and the Integrative Weaning Index are widely adopted,their sensitivity and specificity often fall short in complex clinical settings.Factors such as underlying disease pathophysiology,patient characteristics,and clinician subjectivity impact score performance and reliability.Moreover,disparities in validation across diverse populations limit generalizability.With growing interest in artificial intelligence(AI)and machine learning,there is potential for enhanced prediction models that integrate multidimensional data and adapt to individual patient profiles.However,current AI approaches face challenges related to interpretability,bias,and ethical implementation.This paper underscores the need for more robust,individualized,and transparent prediction systems and advocates for careful integration of emerging technologies into clinical workflows to optimize weaning success and patient outcomes.展开更多
The longitudinal ventilation strategy is commonly used for road tunnels in urban environment in Sweden.This is partly due to how tunnels in urban environment was planned and designed before the EU Directive[1](2004/54...The longitudinal ventilation strategy is commonly used for road tunnels in urban environment in Sweden.This is partly due to how tunnels in urban environment was planned and designed before the EU Directive[1](2004/54/EC)came in place.Even in new tunnels both to practical and economic reasons the use of longitudinal ventilation has been an outspoken demand from the Swedish road authority,SRA.Swedish law[2]requires that a risk analysis is carried out to demonstrate that an acceptable level of risk is achieved in the tunnels with longitudinal ventilation if there is a risk of queues.Otherwise transverse or semi-transverse ventilation strategy shall be used.During recent development,or a late awakening,it is clear that dense populated areas in Sweden will experience queues.This threatens the foundation of the Swedish modern tunnel safety concept which calls for enhancement.This paper presents the risk-reducing effect of three alternative strategies,enhancements package,focusing on evacuation safety for road users.It is a combination of traffic management,fixed firefighting systems,reduced distance between escape routes and regulation of traffic with dangerous goods.In addition,it provides a comprehensive review of safety system details,combined with a longitudinal ventilation concept.展开更多
Indoor air quality(IAQ)is often overlooked,yet a poorly maintained environment can lead to significant health issues and reduced concentration and productivity in work or educational settings.This study presents an in...Indoor air quality(IAQ)is often overlooked,yet a poorly maintained environment can lead to significant health issues and reduced concentration and productivity in work or educational settings.This study presents an innovative control system for mechanical ventilation specifically designed for university classrooms,with the dual goal of enhancing IAQ and increasing energy efficiency.Two classrooms with distinct construction characteristics were analyzed:one with exterior walls and windows,and the other completely underground.For each classroom,a model was developed using DesignBuilder software,which was calibrated with experimental data regarding CO_(2) concentration,temperature,and relative humidity levels.The proposed ventilation system operates based on CO_(2) concentration,relative humidity,and potential for free heating and cooling.In addition,the analysis was conducted for other locations,demonstrating consistent energy savings across different climates and environments,always showing an annual reduction in energy consumption.Results demonstrate that mechanical ventilation,when integrated with heat recovery and free cooling strategies,significantly reduces energy consumption by up to 25%,while also maintaining optimal CO_(2) levels to enhance comfort and air quality.These findings emphasize the essential need for well-designed mechanical ventilation systems to ensure both psychophysical well-being and IAQ in enclosed spaces,particularly in environments intended for extended occupancy,such as classrooms.Furthermore,this approach has broad applicability,as it could be adapted to various building types,thereby contributing to sustainable energy management practices and promoting healthier indoor spaces.This study serves as a model for future designs aiming to balance energy efficiency with indoor air quality,especially relevant in the post-COVID era,where the importance of indoor air quality has become more widely recognized.展开更多
Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted o...Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted on 60 severe patients admitted to the hospital from December 2022 to December 2024,all of whom underwent MV treatment.Based on weaning status,thirty-eight patients were successfully weaned(success group),and 22 patients failed weaning(failure group).All patients underwent lung ultrasound and multi-organ evaluation.The parameter differences between the two groups were compared,risk factors for weaning risk were evaluated,and a receiver operating characteristic curve(ROC)was drawn to assess the predictive value of lung ultrasound combined with multi-organ evaluation for weaning risk.Results:The lung ultrasound score(LUS)of the success group was lower than that of the failure group,the left ventricular ejection fraction(LVEF)was higher than that of the failure group,and the diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF)were higher than those of the failure group(P<0.05).Multifactor analysis showed that LUS was a risk factor for weaning risk,while LVEF,DE,and DTF were protective factors(P<0.05).The ROC showed that the area under the curve(AUC)of a single parameter for weaning risk was smaller than that of the combined parameters(P<0.05).Conclusion:Lung ultrasound combined with multi-organ evaluation can predict the weaning risk of severe patients undergoing MV treatment,and the diagnostic efficiency of multiple parameters combined evaluation is higher.展开更多
Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a seri...Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a serious threat to the life and health of newborns.This paper systematically reviews the core pathogenesis of HMD,focusing on the abnormal metabolism of pulmonary surfactant(PS),genetic factors,immature lung development,and the synergistic effects of inflammatory oxidative stress.It highlights the advances in non-invasive ventilation(NIV)therapy for HMD,including the mechanisms of action,clinical application effects,and optimization strategies of mainstream modalities such as nasal continuous positive airway pressure ventilation(NCPAP),nasal intermittent positive pressure ventilation(NIPPV),and heated humidified high-flow nasal cannula ventilation(HHHFNC).The aim is to provide references for standardized clinical treatment.展开更多
With different structural forms of ventilation pipes have various attenuation effects on incident shock waves while meeting ventilation requirements.The attenuation mechanism and the propagation law of shock waves in ...With different structural forms of ventilation pipes have various attenuation effects on incident shock waves while meeting ventilation requirements.The attenuation mechanism and the propagation law of shock waves in ventilation pipes of different structures are investigated by experiments and numerical simulations.Furthermore,for the same structure,the effects of peak pressure and positive pressure time on the attenuation rate are discussed.It is found that the attenuation rate increases with the incident shock wave pressure,and the shock wave attenuation rate tends to reach its limiting value k for the same structure and reasonably short positive pressure time.Under the same conditions,the attenuation rate is calculated using the pressure of the shock wave as follows:diffusion chamber pipe,branch pipe and selfconsumption pipe;the attenuation rate per unit volume is calculated as follows:self-consumption pipe,branch pipe and diffusion chamber pipe.In addition,an easy method is provided to calculate the attenuation rate of the shock wave in single and multi-stage ventilation pipes.Corresponding parameters are provided for various structures,and the margin of error between the formulae and experimental results is within 10%,which is significant for engineering applications.展开更多
During the train meeting events,train equipment compartments are exposed to the worst pressure changes,potentially affecting the ventilation performance of equipment,particularly for electrical facilities equipped wit...During the train meeting events,train equipment compartments are exposed to the worst pressure changes,potentially affecting the ventilation performance of equipment,particularly for electrical facilities equipped with independent air ducts.In this paper,a two-step method is used for numerical computation:(1)obtaining the temporal and spatial transient node data of the flow field sections during the train-passing simulation and(2)using the data as the input data for the equipment compartment simulation.In addition,this paper also compares the difference in equipment ventilation between the single-train and trainpassing scenarios in real vehicle tests.The results indicate that the primary factors influencing ventilation effectiveness are the aerodynamic compression and deceleration of airflow induced by the other train's nose,as well as the instability of the external flow field in the wake of the other train.During train crossing,the air is forced into the air duct,with a maximum ratio of the airflow in-duct to the airflow out-duct reaching 3.2.The average mass flow falls below the rated mass flow for the converter.Compared to the rated air volume of converter,the maximum suppression rates obtained from testing and simulation are-24.5%and-16.8%,respectively.Compared to the single-train operation,the maximum suppression rates obtained from testing and simulation are-15%and-18%,respectively.These findings provide valuable insights into the design and operation of high-speed trains.展开更多
BACKGROUND:In this study,we aimed to evaluate the impact of mechanical ventilator(MV)utilizaton during cardiopulmonary resuscitation(CPR)on out-of-hospital cardiac arrest(OHCA)patient clinical outcomes in the emergenc...BACKGROUND:In this study,we aimed to evaluate the impact of mechanical ventilator(MV)utilizaton during cardiopulmonary resuscitation(CPR)on out-of-hospital cardiac arrest(OHCA)patient clinical outcomes in the emergency department.METHODS:This single-centered,retrospective,case-control study analyzed electronic medical records.Patients aged>18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included.These patients were accessed according to the ventilatory method used:MV ventilation(volume control,tidal volume 6-8 mL/kg,frequency 10 beat per minute,inspiratory time 1 s)and manual resuscitator bag valve(BV)ventilation.The primary outcome was the return of spontaneous circulation(ROSC).After 1:1 propensity score matching,the clinical outcomes were analyzed.RESULTS:A total of 649 patients were enrolled in this study.Before matching,the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups.After 1:1 matching between the two groups using propensity scores,522 patients(261 MV and 261 BV)were analyzed.Propensity score matching yielded an adequate balance(standardized mean difference<0.10)for all covariates.The estimated odds ratio(OR)for ROSC was 1.23(95%confidence interval[CI]:0.85-1.77;P=0.267),for survival at hospital admission was 1.02(95%CI:0.68-1.53;P=0.918),for survival at hospital discharge was 2.31(95%CI:1.10-5.20;P=0.033),and for good neurologic outcome was 2.56(95%CI:0.84-9.43;P=0.116).CONCLUSION:In patients with OHCA admitted to the emergency department,MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures.However,survival at hospital discharge was significantly higher in the MV group,suggesting potential benefits of MV use in selected patients.展开更多
Carbon dioxide(CO_(2))is often monitored as a convenient yardstick for indoor air safety,yet its ability to stand in for pathogen-laden aerosols has never been settled.To probe the question,we reproduced an open-plan ...Carbon dioxide(CO_(2))is often monitored as a convenient yardstick for indoor air safety,yet its ability to stand in for pathogen-laden aerosols has never been settled.To probe the question,we reproduced an open-plan office at full scale(7.2m×5.2m×2.8m)and introduced a breathing plume that carried 4% CO_(2),together with a polydisperse aerosol spanning 0.5–10μm(1320 particles s^(−1)).Inlet air was supplied at 0.7,1.4,and 2.1 m s^(−1),and the resulting fields were simulated with a Realisable k–εRANS model coupled to Lagrangian particle tracking.Nine strategically placed probes provided validation;the calibrated solution deviated fromthe experiment by 58 ppm for CO_(2)(8.1%RMSE)and 0.008 m s^(−1)for velocity(15.7%RMSE).Despite this agreement,gas and particles behaved in sharply different ways.Room-averaged CO_(2)varied by<15%,whereas the aerosol mass rose to almost three-fold the background within slowmoving corner vortices.Sub-micron particles stayed aloft along streamlines,while those≥5μmpeeled away and settled on nearby surfaces.The divergence shows that neither the CO_(2)level nor themeanageof air,taken in isolation,delineates all high-exposure zones.We therefore recommend that ventilation design be informed by a composite diagnosis that couples gas data,size-resolved particle measurements,and rapid CFD appraisal.展开更多
Objectives:To propose a new idea of“lung ventilation and Qi regulation”for preventing and treating lung cancer,and to summarize the corresponding Tongfei Huajie prescription,as a systematic theoretical and practical...Objectives:To propose a new idea of“lung ventilation and Qi regulation”for preventing and treating lung cancer,and to summarize the corresponding Tongfei Huajie prescription,as a systematic theoretical and practical innovation.Methods:Based on the etiology and pathogenesis of lung cancer,the anatomy,physiology and pathology of the lung,and inspired by the ancient“Tuoyue”(bellows)theory,this study combined the clinical observation of ventilation issues in lung cancer patients.The Tongfei Huajie prescription was formulated following the classic principle of monarch(Jun),minister(Chen),assistant(Zuo),and guide(Shi),and was interpreted with modern pharmacological research.Results:A novel therapeutic concept of“lung ventilation and Qi regulation”was proposed.The corresponding Tongfei Huajie prescription was developed,which has the effects of ventilating the lung,expelling phlegm dampness,tonifying Qi,tonifying the kidney and spleen for lung health,soothing the liver and descending lung Qi,and clearing the heart and moistening the lung.Clinical application has achieved obvious curative effect.Conclusions:This work presents a systematic summary of the innovation in“theory,method,formula and herb”for lung cancer treatment,demonstrating the advantages of Traditional Chinese Medicine in this field.展开更多
Mechanical ventilation is a specialized oxygen therapy and life support technology with significant importance for critically ill patients. In fact, 40%–66% of patients in the intensive care unit(ICU) require mechani...Mechanical ventilation is a specialized oxygen therapy and life support technology with significant importance for critically ill patients. In fact, 40%–66% of patients in the intensive care unit(ICU) require mechanical ventilation.^([1,2]) However, the mechanical ventilation can lead to ventilatorassociated lung injury(VALI),^([3]) ultimately resulting in difficulties in weaning from mechanical ventilation,prolonged hospital stays, and even increased mortality.展开更多
Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive...Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.展开更多
Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of ...Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of patients undergoing invasive mechanical ventilation via oral endotracheal intubation in the ICU of our hospital from January 2022 to December 2023 were studied.All patients underwent a 30-minute spontaneous breathing trial(SBT)using low-level pressure support ventilation(PSV)after meeting the clinical weaning screening criteria.Among them,150 patients who met the clinical weaning criteria were weaned from the ventilator.They were divided into a successful weaning group(n=100)and a failed weaning group(n=50)based on the weaning outcome.Clinical data,including age,gender,APACHE II score,duration of mechanical ventilation,DTF,and CPEF,were collected from 150 patients.The differences in clinical data between the two groups were compared,and the correlation between DTF,CPEF,and the success rate of weaning was analyzed.Results:There were no significant differences between the two groups in gender ratio(χ^(2)=0.884,P=0.347>0.05),age(t=0.350,P=0.727>0.05),and APACHE II score(t=1.295,P=0.197>0.05),but there was a significant difference in the duration of mechanical ventilation(t=3.766,P<0.001).The DTF and CPEF values in the successful weaning group were significantly higher than those in the failed weaning group(P<0.05).ROC curves were drawn to predict the weaning results using DTF,CPEF,and the combination of DTF and CPEF.The results showed that the specificity of the combination of DTF and CPEF was comparable to that of either metric alone,but the sensitivity and AUC were significantly higher than those of either metric alone.Conclusion:The combination of DTF and CPEF can be used as an effective indicator to evaluate the weaning efficacy of mechanically ventilated patients,which has important clinical significance for guiding clinical weaning treatment,improving the success rate of weaning,reducing the incidence of ventilator-associated pneumonia,and shortening the length of hospital stay.展开更多
A recent study on the rapid imaging of pulmonary ventilation using hyperpolarized ^(129)Xe MRI has demonstrated the ability to achieve isotropic 3D ventilation imaging with a spatial resolution of 3×3×3mm^(3...A recent study on the rapid imaging of pulmonary ventilation using hyperpolarized ^(129)Xe MRI has demonstrated the ability to achieve isotropic 3D ventilation imaging with a spatial resolution of 3×3×3mm^(3) in humans,within an acquisition time of just 3.5 seconds(https://doi.org/10.1002/mrm.30120).展开更多
The relationship between the site selection of a hilly terrain and the natural ventilation of the Dangdamen building complex,which is a traditional folk house,is revealed by a computational fluid dynamics（CFD）simula...The relationship between the site selection of a hilly terrain and the natural ventilation of the Dangdamen building complex,which is a traditional folk house,is revealed by a computational fluid dynamics（CFD）simulation.The wind press and speed distributions around the building in four cases with different weather conditions and topographies are simulated.The simulation results show that a hill can reduce the absolute values of the wind pressure at the windward and leeward sides of the building.The encouraging effect of the patio on the natural ventilation in a terrain with a hill is greater than that without a hill.The same situation occurs when comparing the patio effects between summer and winter.The wind speed around the building can be reduced by the hill as it is an obstacle and the degrees of the influence of the hill in summer and in winter are quite different because of different wind directions.The analysis results show that this kind of site selection,with the hill to the north,is a suitable way to settle the conflict of the natural ventilation requirements in summer and in winter under subtropical climate conditions,especially in houses with patios.展开更多
The necessity and feasibility of the use of the personalized ventilation（PV）technology in a toll booth is described.First,the indoor environment of the toll booth equipped with a PV system is analyzed.Based on the a...The necessity and feasibility of the use of the personalized ventilation（PV）technology in a toll booth is described.First,the indoor environment of the toll booth equipped with a PV system is analyzed.Based on the analysis results,a set of equipment for controlling the indoor air quality（IAQ）of the toll booth is devised.Then,a full-scale model of the toll booth is set up in the laboratory.The airflow organization,the optimum operation parameters,and the restraint effects of the PV system on pollution are also experimentally studied.The experimental results on the air supply characteristics show that the PV system can effectively reduce the air age,improve the ventilation efficiency,and enhance the comfort and acceptability of human beings.In addition,this system plays a significant role in preventing pollution.展开更多
In order to analyze the ventilation and cooling performance of single-tunnel plastic greenhouse in Yangtze-Huai region, the effects of two different ventilation modes （side window, side window＋roof window） on the t...In order to analyze the ventilation and cooling performance of single-tunnel plastic greenhouse in Yangtze-Huai region, the effects of two different ventilation modes （side window, side window＋roof window） on the temperature and humidity of plastic greenhouse were studied. The results showed that the ventilation mode of opening side window and roof window could effectively reduce the temperature and humidity at the plant canopy height, which was conducive to the growth of plant in greenhouse.展开更多
文摘BACKGROUND There has been a growing interest in noninvasive ventilation(NIV)in comparison to invasive mechanical ventilation(IMV)as a standard of care for acute respiratory failure(ARF),especially in the post-covid era,but direct head-to-head cost comparisons between the two modalities are not available in literature.AIM To compare the cost along with the clinical effectiveness of NIV in comparison to IMV in ARF.METHODS A prospective observational single-center case control study including adult patients with ARF(PaO2/FiO2 ratio<300)admitted from January 1,2024 to December 31,2024 in medical intensive care unit(ICU)of a tertiary care hospital requiring either NIV or invasive ventilation.NIV and IMV groups were compared based on average length of ICU and hospital stay,mortality,net cost of ICU treatment,need for intubation and tracheostomy.RESULTS A total of 319 patients were included in the study(197 in NIV,122 in IMV group).Statistically significant difference in length of ICU stay(NIV group:5±3.25 days,IMV group:9±2.6 days;P<0.05)and mortality rate was seen(11%NIV vs 34%IMV;P<0.01).On multivariate analyses,mortality showed a stronger association with IMV[odds ratio(OR)=7.73;95%CI:3.12-19.18]as compared to ICU stay(OR=2.73;95%CI:2.15-3.48).A total of 33 patients(17%)in NIV group required intubation of which 3 were tracheostomized,while 14 patients(11%)in IMV group needed tracheostomy.The net average cost of ICU stay was₹83902 in NIV group while in IMV group,the net ICU cost was₹476216.The average cost of ICU stay was five times higher with IMV.CONCLUSION NIV has potential economic and clinical benefits as compared to invasive ventilation in ARF.
文摘BACKGROUND Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure(PEEP)adjustments and to evaluate the weaning process from mechanical ventilation.The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores(LUSs).AIM To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.METHODS An observational study was conducted over 18 months in a tertiary care hospital.Patients of both genders,aged between 18-75 years,who had been admitted to the intensive care unit,and required mechanical ventilation,were studied.A standard ventilatory strategy was used and incremental levels of PEEP[5,10,and 15 cm water(H_(2)O)]were applied.Baseline characteristics,including oxygen saturation(SpO2),LUS,mean arterial pressure(MAP),heart rate(HR),and their changes with incremental PEEP levels,were recorded and analyzed.RESULTS In this study,45.9%of patients required a PEEP of 5 cm H_(2)O to achieve the endpoint of lung aeration(LUS of 0).In addition,86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H_(2)O,respectively.The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels(P<0.001 for 5 and 10 cm H_(2)O and P=0.032 for 15 cm H_(2)O).SpO2 increased significantly with higher PEEP levels(P<0.001),confirming the effectiveness of PEEP in improving oxygenation.The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.CONCLUSION Increasing PEEP levels in mechanically ventilated patients improves lung aeration,which can be effectively assessed using bedside lung ultrasonography.
文摘Prediction of weaning success from invasive mechanical ventilation remains a challenge in everyday clinical practice.Several prediction scores have been developed to guide success during spontaneous breathing trials to help with weaning decisions.These scores aim to provide a structured framework to support clinical judgment.However,their effectiveness varies across patient populations,and their predictive accuracy remains inconsistent.In this review,we aim to identify the strengths and limitations of commonly used clinical prediction tools in assessing readiness for ventilator liberation.While scores such as the Rapid Shallow Breathing Index and the Integrative Weaning Index are widely adopted,their sensitivity and specificity often fall short in complex clinical settings.Factors such as underlying disease pathophysiology,patient characteristics,and clinician subjectivity impact score performance and reliability.Moreover,disparities in validation across diverse populations limit generalizability.With growing interest in artificial intelligence(AI)and machine learning,there is potential for enhanced prediction models that integrate multidimensional data and adapt to individual patient profiles.However,current AI approaches face challenges related to interpretability,bias,and ethical implementation.This paper underscores the need for more robust,individualized,and transparent prediction systems and advocates for careful integration of emerging technologies into clinical workflows to optimize weaning success and patient outcomes.
文摘The longitudinal ventilation strategy is commonly used for road tunnels in urban environment in Sweden.This is partly due to how tunnels in urban environment was planned and designed before the EU Directive[1](2004/54/EC)came in place.Even in new tunnels both to practical and economic reasons the use of longitudinal ventilation has been an outspoken demand from the Swedish road authority,SRA.Swedish law[2]requires that a risk analysis is carried out to demonstrate that an acceptable level of risk is achieved in the tunnels with longitudinal ventilation if there is a risk of queues.Otherwise transverse or semi-transverse ventilation strategy shall be used.During recent development,or a late awakening,it is clear that dense populated areas in Sweden will experience queues.This threatens the foundation of the Swedish modern tunnel safety concept which calls for enhancement.This paper presents the risk-reducing effect of three alternative strategies,enhancements package,focusing on evacuation safety for road users.It is a combination of traffic management,fixed firefighting systems,reduced distance between escape routes and regulation of traffic with dangerous goods.In addition,it provides a comprehensive review of safety system details,combined with a longitudinal ventilation concept.
基金Funding Statement:This research was conducted as part of the Tech4You Project“Technologies for climate change adaptation and quality of life improvement”,n.ECS0000009,CUP H23C22000370006,Italian PNRR,Mission 4,Component 2,Investment 1.5 funded by the European Union-NextGenerationEU.
文摘Indoor air quality(IAQ)is often overlooked,yet a poorly maintained environment can lead to significant health issues and reduced concentration and productivity in work or educational settings.This study presents an innovative control system for mechanical ventilation specifically designed for university classrooms,with the dual goal of enhancing IAQ and increasing energy efficiency.Two classrooms with distinct construction characteristics were analyzed:one with exterior walls and windows,and the other completely underground.For each classroom,a model was developed using DesignBuilder software,which was calibrated with experimental data regarding CO_(2) concentration,temperature,and relative humidity levels.The proposed ventilation system operates based on CO_(2) concentration,relative humidity,and potential for free heating and cooling.In addition,the analysis was conducted for other locations,demonstrating consistent energy savings across different climates and environments,always showing an annual reduction in energy consumption.Results demonstrate that mechanical ventilation,when integrated with heat recovery and free cooling strategies,significantly reduces energy consumption by up to 25%,while also maintaining optimal CO_(2) levels to enhance comfort and air quality.These findings emphasize the essential need for well-designed mechanical ventilation systems to ensure both psychophysical well-being and IAQ in enclosed spaces,particularly in environments intended for extended occupancy,such as classrooms.Furthermore,this approach has broad applicability,as it could be adapted to various building types,thereby contributing to sustainable energy management practices and promoting healthier indoor spaces.This study serves as a model for future designs aiming to balance energy efficiency with indoor air quality,especially relevant in the post-COVID era,where the importance of indoor air quality has become more widely recognized.
基金Sichuan Provincial Medical Scientific Research Project(Project No.:s19085)。
文摘Objective:To explore the role of lung ultrasound combined with multi-organ evaluation in assessing the risk of weaning from mechanical ventilation(MV)in severe patients.Methods:A retrospective analysis was conducted on 60 severe patients admitted to the hospital from December 2022 to December 2024,all of whom underwent MV treatment.Based on weaning status,thirty-eight patients were successfully weaned(success group),and 22 patients failed weaning(failure group).All patients underwent lung ultrasound and multi-organ evaluation.The parameter differences between the two groups were compared,risk factors for weaning risk were evaluated,and a receiver operating characteristic curve(ROC)was drawn to assess the predictive value of lung ultrasound combined with multi-organ evaluation for weaning risk.Results:The lung ultrasound score(LUS)of the success group was lower than that of the failure group,the left ventricular ejection fraction(LVEF)was higher than that of the failure group,and the diaphragmatic excursion(DE)and diaphragmatic thickening fraction(DTF)were higher than those of the failure group(P<0.05).Multifactor analysis showed that LUS was a risk factor for weaning risk,while LVEF,DE,and DTF were protective factors(P<0.05).The ROC showed that the area under the curve(AUC)of a single parameter for weaning risk was smaller than that of the combined parameters(P<0.05).Conclusion:Lung ultrasound combined with multi-organ evaluation can predict the weaning risk of severe patients undergoing MV treatment,and the diagnostic efficiency of multiple parameters combined evaluation is higher.
文摘Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a serious threat to the life and health of newborns.This paper systematically reviews the core pathogenesis of HMD,focusing on the abnormal metabolism of pulmonary surfactant(PS),genetic factors,immature lung development,and the synergistic effects of inflammatory oxidative stress.It highlights the advances in non-invasive ventilation(NIV)therapy for HMD,including the mechanisms of action,clinical application effects,and optimization strategies of mainstream modalities such as nasal continuous positive airway pressure ventilation(NCPAP),nasal intermittent positive pressure ventilation(NIPPV),and heated humidified high-flow nasal cannula ventilation(HHHFNC).The aim is to provide references for standardized clinical treatment.
文摘With different structural forms of ventilation pipes have various attenuation effects on incident shock waves while meeting ventilation requirements.The attenuation mechanism and the propagation law of shock waves in ventilation pipes of different structures are investigated by experiments and numerical simulations.Furthermore,for the same structure,the effects of peak pressure and positive pressure time on the attenuation rate are discussed.It is found that the attenuation rate increases with the incident shock wave pressure,and the shock wave attenuation rate tends to reach its limiting value k for the same structure and reasonably short positive pressure time.Under the same conditions,the attenuation rate is calculated using the pressure of the shock wave as follows:diffusion chamber pipe,branch pipe and selfconsumption pipe;the attenuation rate per unit volume is calculated as follows:self-consumption pipe,branch pipe and diffusion chamber pipe.In addition,an easy method is provided to calculate the attenuation rate of the shock wave in single and multi-stage ventilation pipes.Corresponding parameters are provided for various structures,and the margin of error between the formulae and experimental results is within 10%,which is significant for engineering applications.
基金support by Technology R&D Program of China State Railway Group Co.,Ltd(Grant number N2022J013)the Hunan Provincial Innovation Foundation for Postgraduate(Grant number CX20220279)+1 种基金the Fundamental Research Funds for the Central Universities of Central South University(Grant number 2022ZZTS0193)China Scholarship Council(202106370112)。
文摘During the train meeting events,train equipment compartments are exposed to the worst pressure changes,potentially affecting the ventilation performance of equipment,particularly for electrical facilities equipped with independent air ducts.In this paper,a two-step method is used for numerical computation:(1)obtaining the temporal and spatial transient node data of the flow field sections during the train-passing simulation and(2)using the data as the input data for the equipment compartment simulation.In addition,this paper also compares the difference in equipment ventilation between the single-train and trainpassing scenarios in real vehicle tests.The results indicate that the primary factors influencing ventilation effectiveness are the aerodynamic compression and deceleration of airflow induced by the other train's nose,as well as the instability of the external flow field in the wake of the other train.During train crossing,the air is forced into the air duct,with a maximum ratio of the airflow in-duct to the airflow out-duct reaching 3.2.The average mass flow falls below the rated mass flow for the converter.Compared to the rated air volume of converter,the maximum suppression rates obtained from testing and simulation are-24.5%and-16.8%,respectively.Compared to the single-train operation,the maximum suppression rates obtained from testing and simulation are-15%and-18%,respectively.These findings provide valuable insights into the design and operation of high-speed trains.
文摘BACKGROUND:In this study,we aimed to evaluate the impact of mechanical ventilator(MV)utilizaton during cardiopulmonary resuscitation(CPR)on out-of-hospital cardiac arrest(OHCA)patient clinical outcomes in the emergency department.METHODS:This single-centered,retrospective,case-control study analyzed electronic medical records.Patients aged>18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included.These patients were accessed according to the ventilatory method used:MV ventilation(volume control,tidal volume 6-8 mL/kg,frequency 10 beat per minute,inspiratory time 1 s)and manual resuscitator bag valve(BV)ventilation.The primary outcome was the return of spontaneous circulation(ROSC).After 1:1 propensity score matching,the clinical outcomes were analyzed.RESULTS:A total of 649 patients were enrolled in this study.Before matching,the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups.After 1:1 matching between the two groups using propensity scores,522 patients(261 MV and 261 BV)were analyzed.Propensity score matching yielded an adequate balance(standardized mean difference<0.10)for all covariates.The estimated odds ratio(OR)for ROSC was 1.23(95%confidence interval[CI]:0.85-1.77;P=0.267),for survival at hospital admission was 1.02(95%CI:0.68-1.53;P=0.918),for survival at hospital discharge was 2.31(95%CI:1.10-5.20;P=0.033),and for good neurologic outcome was 2.56(95%CI:0.84-9.43;P=0.116).CONCLUSION:In patients with OHCA admitted to the emergency department,MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures.However,survival at hospital discharge was significantly higher in the MV group,suggesting potential benefits of MV use in selected patients.
文摘Carbon dioxide(CO_(2))is often monitored as a convenient yardstick for indoor air safety,yet its ability to stand in for pathogen-laden aerosols has never been settled.To probe the question,we reproduced an open-plan office at full scale(7.2m×5.2m×2.8m)and introduced a breathing plume that carried 4% CO_(2),together with a polydisperse aerosol spanning 0.5–10μm(1320 particles s^(−1)).Inlet air was supplied at 0.7,1.4,and 2.1 m s^(−1),and the resulting fields were simulated with a Realisable k–εRANS model coupled to Lagrangian particle tracking.Nine strategically placed probes provided validation;the calibrated solution deviated fromthe experiment by 58 ppm for CO_(2)(8.1%RMSE)and 0.008 m s^(−1)for velocity(15.7%RMSE).Despite this agreement,gas and particles behaved in sharply different ways.Room-averaged CO_(2)varied by<15%,whereas the aerosol mass rose to almost three-fold the background within slowmoving corner vortices.Sub-micron particles stayed aloft along streamlines,while those≥5μmpeeled away and settled on nearby surfaces.The divergence shows that neither the CO_(2)level nor themeanageof air,taken in isolation,delineates all high-exposure zones.We therefore recommend that ventilation design be informed by a composite diagnosis that couples gas data,size-resolved particle measurements,and rapid CFD appraisal.
基金supported by the Project of LI Ruiyu National Famous Traditional Chinese Medicine Expert Inheritance Studio(No.[2022]4 issued by the National Administration of Traditional Chinese Medicine and No.[2024]3 issued by Hebei Administration of Traditional Chinese Medicine)the Seventh Batch of National Academic Experience Inheritance Project for Senior Traditional Chinese Medicine Experts(No.[2022]76 issued by the National Administration of Traditional Chinese Medicinethe Scientific Research Project of Hebei Administration of Traditional Chinese Medicine(No.2025593).
文摘Objectives:To propose a new idea of“lung ventilation and Qi regulation”for preventing and treating lung cancer,and to summarize the corresponding Tongfei Huajie prescription,as a systematic theoretical and practical innovation.Methods:Based on the etiology and pathogenesis of lung cancer,the anatomy,physiology and pathology of the lung,and inspired by the ancient“Tuoyue”(bellows)theory,this study combined the clinical observation of ventilation issues in lung cancer patients.The Tongfei Huajie prescription was formulated following the classic principle of monarch(Jun),minister(Chen),assistant(Zuo),and guide(Shi),and was interpreted with modern pharmacological research.Results:A novel therapeutic concept of“lung ventilation and Qi regulation”was proposed.The corresponding Tongfei Huajie prescription was developed,which has the effects of ventilating the lung,expelling phlegm dampness,tonifying Qi,tonifying the kidney and spleen for lung health,soothing the liver and descending lung Qi,and clearing the heart and moistening the lung.Clinical application has achieved obvious curative effect.Conclusions:This work presents a systematic summary of the innovation in“theory,method,formula and herb”for lung cancer treatment,demonstrating the advantages of Traditional Chinese Medicine in this field.
文摘Mechanical ventilation is a specialized oxygen therapy and life support technology with significant importance for critically ill patients. In fact, 40%–66% of patients in the intensive care unit(ICU) require mechanical ventilation.^([1,2]) However, the mechanical ventilation can lead to ventilatorassociated lung injury(VALI),^([3]) ultimately resulting in difficulties in weaning from mechanical ventilation,prolonged hospital stays, and even increased mortality.
基金2022 Inner Mongolia Autonomous Region Health and Wellness Science and Technology Program Project(Project No.:202201533)。
文摘Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.
文摘Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of patients undergoing invasive mechanical ventilation via oral endotracheal intubation in the ICU of our hospital from January 2022 to December 2023 were studied.All patients underwent a 30-minute spontaneous breathing trial(SBT)using low-level pressure support ventilation(PSV)after meeting the clinical weaning screening criteria.Among them,150 patients who met the clinical weaning criteria were weaned from the ventilator.They were divided into a successful weaning group(n=100)and a failed weaning group(n=50)based on the weaning outcome.Clinical data,including age,gender,APACHE II score,duration of mechanical ventilation,DTF,and CPEF,were collected from 150 patients.The differences in clinical data between the two groups were compared,and the correlation between DTF,CPEF,and the success rate of weaning was analyzed.Results:There were no significant differences between the two groups in gender ratio(χ^(2)=0.884,P=0.347>0.05),age(t=0.350,P=0.727>0.05),and APACHE II score(t=1.295,P=0.197>0.05),but there was a significant difference in the duration of mechanical ventilation(t=3.766,P<0.001).The DTF and CPEF values in the successful weaning group were significantly higher than those in the failed weaning group(P<0.05).ROC curves were drawn to predict the weaning results using DTF,CPEF,and the combination of DTF and CPEF.The results showed that the specificity of the combination of DTF and CPEF was comparable to that of either metric alone,but the sensitivity and AUC were significantly higher than those of either metric alone.Conclusion:The combination of DTF and CPEF can be used as an effective indicator to evaluate the weaning efficacy of mechanically ventilated patients,which has important clinical significance for guiding clinical weaning treatment,improving the success rate of weaning,reducing the incidence of ventilator-associated pneumonia,and shortening the length of hospital stay.
基金supported by the National Natural Science Foundation of China(81930049 and 82171926).
文摘A recent study on the rapid imaging of pulmonary ventilation using hyperpolarized ^(129)Xe MRI has demonstrated the ability to achieve isotropic 3D ventilation imaging with a spatial resolution of 3×3×3mm^(3) in humans,within an acquisition time of just 3.5 seconds(https://doi.org/10.1002/mrm.30120).
基金The National Key Technology R&D Program of China during the11th Five-Year Plan Period(No.2006BAJ04A13,2006BAJ04B04,2006BAJ02A08,2006BAJ02A05,2006BAJ04A05)the Excellent Youth Teachers Program of Ministry of Education of China(No.2007-209).
文摘The relationship between the site selection of a hilly terrain and the natural ventilation of the Dangdamen building complex,which is a traditional folk house,is revealed by a computational fluid dynamics（CFD）simulation.The wind press and speed distributions around the building in four cases with different weather conditions and topographies are simulated.The simulation results show that a hill can reduce the absolute values of the wind pressure at the windward and leeward sides of the building.The encouraging effect of the patio on the natural ventilation in a terrain with a hill is greater than that without a hill.The same situation occurs when comparing the patio effects between summer and winter.The wind speed around the building can be reduced by the hill as it is an obstacle and the degrees of the influence of the hill in summer and in winter are quite different because of different wind directions.The analysis results show that this kind of site selection,with the hill to the north,is a suitable way to settle the conflict of the natural ventilation requirements in summer and in winter under subtropical climate conditions,especially in houses with patios.
文摘The necessity and feasibility of the use of the personalized ventilation（PV）technology in a toll booth is described.First,the indoor environment of the toll booth equipped with a PV system is analyzed.Based on the analysis results,a set of equipment for controlling the indoor air quality（IAQ）of the toll booth is devised.Then,a full-scale model of the toll booth is set up in the laboratory.The airflow organization,the optimum operation parameters,and the restraint effects of the PV system on pollution are also experimentally studied.The experimental results on the air supply characteristics show that the PV system can effectively reduce the air age,improve the ventilation efficiency,and enhance the comfort and acceptability of human beings.In addition,this system plays a significant role in preventing pollution.
基金Supported by Jiangsu Agricultural Science and Technology Innovation Fund[CX(14)2112]~~
文摘In order to analyze the ventilation and cooling performance of single-tunnel plastic greenhouse in Yangtze-Huai region, the effects of two different ventilation modes （side window, side window＋roof window） on the temperature and humidity of plastic greenhouse were studied. The results showed that the ventilation mode of opening side window and roof window could effectively reduce the temperature and humidity at the plant canopy height, which was conducive to the growth of plant in greenhouse.
