Challenges and Development Prospects of Artificial Ventilation Systems Application in Afar Region, Ethiopia

Due to hot weather situation of Afar region the air conditioner with cooling is more applicable in ensuring the thermal comfort needed. Familiarity with the Artificial Ventilation Systems (AVS) is essential to diagnose its social, economical and environmental problems and recommend strategies for redemption.This research discusses the challenges, complains and opportunities for Artificial Ventilation Systems application towards buildings of living rooms and offices in Afar regional state.  In this study purposive sample surveys of 120 buildings were undertaken in Assaiyta, Logia and Samara. Air conditioning (AC) unit with R-22 operating refrigerant which is not environmentally friendly were dominantly used in all selected sites. Among the AC types, the split type is the dominant types of air conditioning units followed by window type. In Assaiyta and Logia Towns fan forced ventilation type and natural ventilation is extensively used than air conditioning this could be due to the high initial cost of AC and its power supply (electricity). Among the Occupants complains for their Artificial Ventilation Systems, the noise level coming out of the system was the highest. It could be due to the equipment age, lose fittings and improper maintenance of units. According to major respondents the maintenance of Artificial Ventilation Systems is carried out once in two years or not at all. This illustrates a poor maintenance policy.The presence of odor due to cigarette smoking and close proximity to toilets were an indicator of Indoor Air Quality problem. Financial limitation, unavailability, unaffordable, lack of awareness and energy source for the operating of environmentally friendly Air conditioner were challenges of the majority respondents in the three selected sites of Afar region. Solar energy potential, the presence of more NGOs, and higher institution were some of the opportunities to exploit the maximum benefits of Artificial Ventilation Systems for improving the living and working condition of occupants in the region. Keywords:  Artificial Ventilation Systems, Complains, Refrigerated air conditioner, Indoor Air Qualit

Ventilator Dependency in ALS: Management, Disease Progression, and Issues of Coping

The natural progression of amyotrophic lateral sclerosis (ALS) leads to respiratory fail ure and death. Artificial ventilation can prolong the course, leading to extreme degrees of weakness and dependence. Little specific information is available to counsel ALS patients about making the decision for artificial ventilation. In order to gain more infor mation, we visited four ventilator-dependent ALS patients and their primary caregivers. We determined the neurologic state and level of function of the patients and inter viewed their primary caregivers to assess medical care and management needs (both social and financial) and how they were being met. We also administrated question naires to assess the psychological well-being of both patient and primary caregiver and how the relationship between the patient and primary caregiver changed under these circumstances. Key Words: ALS—Artificial ventilation—Disease progression.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68609/2/10.1177_154596839601000306.pd

Recently published papers: An ancient debate, novel monitors and post ICU outcome in the elderly

Tracheostomies have been around for close to 3000 years, so one would hope that the controversies might have been thrashed out by now, but apparently not. Judging by some recent publications it would appear that we still do not know when or how to insert them. Monitoring is fundamental to critical care; two papers describe novel/modified techniques for assessing traumatic brain injury and cardiac output. The intensive care unit imposes a heavy treatment burden, particularly on the elderly. What impact does this have on the lives of the survivors

Associations of Disease-Modifying Therapies With COVID-19 Severity in Multiple Sclerosis

People with multiple sclerosis (MS) are a vulnerable group for severe COVID- 19, particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the characteristics of COVID-19 severity in an international sample of people with MS. Data from 12 data-sources in 28 countries were aggregated (sources could include patients from 1-12 countries). Demographic (age, sex), clinical (MS-phenotype, disability), and DMT (untreated, alemtuzumab, cladribine, dimethyl-fumarate, glatiramer acetate, interferon, natalizumab, ocrelizumab, rituximab, siponimod, other DMTs) covariates were queried, alongside COVID-19 severity outcomes, hospitalisation, ICU admission, requiring artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression, adjusted for age, sex, MS-phenotype, and EDSS. 657(28.1%) with suspected and 1,683(61.9%) with confirmed COVID-19 were analysed. Among suspected+confirmed and confirmed-only COVID-19, 20.9% and 26.9% were hospitalised, 5.4% and 7.2% were admitted to ICU, 4.1% and 5.4% required artificial ventilation, and 3.2% and 3.9% died. Older age, progressive MS-phenotype, and higher disability were associated with worse COVID-19 outcomes. Compared to dimethyl-fumarate, ocrelizumab and rituximab were associated with hospitalisation (aOR=1.56,95%CI=1.01- 2.41; aOR=2.43,95%CI=1.48-4.02) and ICU admission (aOR=2.30,95%CI=0.98-5.39;aOR=3.93,95%CI=1.56-9.89), though only rituximab was associated with higher risk of artificial ventilation (aOR=4.00,95%CI=1.54-10.39). Compared to pooled other DMTs, ocrelizumab and rituximab were associated with hospitalisation (aOR=1.75,95%CI=1.29- 2.38; aOR=2.76,95%CI=1.87-4.07) and ICU admission (aOR=2.55,95%CI=1.49-4.36;aOR=4.32,95%CI=2.27-8.23) but only rituximab with artificial ventilation (aOR=6.15,95%CI=3.09-12.27). Compared to natalizumab, ocrelizumab and rituximab wereassociated with hospitalisation (aOR=1.86,95%CI=1.13-3.07; aOR=2.88,95%CI=1.68-4.92) and ICU admission (aOR=2.13,95%CI=0.85-5.35; aOR=3.23,95%CI=1.17-8.91), but only rituximab with ventilation (aOR=5.52,95%CI=1.71-17.84). Importantly, associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death. Stratification by age, MS-phenotype, and EDSS found no indications that DMT associations with COVID-19 severity reflected differential DMT allocation by underlying COVID-19 severity. Using the largest cohort of people with MS and COVID-19 available, we demonstrated consistent associations of rituximab with increased risk of hospitalisation, ICU admission, and requiring artificial ventilation, and ocrelizumab with hospitalisation and ICU admission. Despite the study's cross-sectional design, the internal and external consistency of these results with prior studies suggests rituximab/ocrelizumab use may be a risk factor for more severe COVID-19

Withdrawal of parenteral phenobarbitone - Implications for resource-poor countries

Parenteral phenobarbitone is an integral part of the management of status epilepticus, especially in the context of resource-poor countries. It is highly effective at controlling seizures. It is safe, cheap, can be given by rapid intravenous push or intramuscular route, boluses can be repeated, and it is recommended as part of the Advanced Paediatric Life Support guidelines. The proposed alternatives lack efficacy, practicality and/or place the child in status epilepticus at risk of respiratory compromise. The impact of the loss of parenteral phenobarbitone would be increased cardiac complications, lack of early seizure control, prolonged seizures resulting in brain damage and systemic complications. Increased numbers of patients will require artificial ventilation in centres without facilities, and centres with facilities will be unable to cope with the load of ventilated patients because of lack of safe transport systems and bed space

Obesity Not A Risk Factor For Adverse Seasonal Influenza Outcomes Among Hospitalized Adults: Evidence From A Us Multisite Study

Background Data on the association between obesity and seasonal influenza complications is unclear. Objectives We explored the association between body mass index (BMI) and the adverse outcomes of artificial ventilation, intensive care unit (ICU) admission, and X-Ray confirmed pneumonia among patients hospitalized with laboratory-confirmed influenza during the 2012-2013 influenza season. Methods We used a large, multi-site database with laboratory-confirmed influenza hospitalization surveillance data to examine the association between obesity and influenza complications. We controlled for various demographic characteristics, comorbidities, lifestyle factors, and patient care factors. Results We explored the association between obesity and three influenza-related complications: artificial ventilation, ICU admission, and X-ray confirmed pneumonia. No association was observed between obesity or morbid obesity and artificial ventilation. The adjusted ORs for obesity and morbid obesity were 1.045 (95% CI: 0.788, 1.386) and 1.033 (95% CI: 0.774, 1.379). No association was observed between obesity or morbid obesity and ICU admission. The adjusted ORs for obesity and morbid obesity were 0.892 (95% CI: 0.741, 1.074) and 0.855 (95% CI: 0.706, 1.036). A significant association was observed between obesity and X-ray confirmed pneumonia. The adjusted OR was 0.795 (95% CI: 0.687, 0.921). No association was observed between morbid obesity and X-ray confirmed pneumonia. The adjusted OR was 0.890 (95% CI: 0.764, 1.037). Conclusions Our results suggest no association between obesity or morbid obesity and adverse outcomes among patients hospitalized for seasonal influenza

Hyaline membrane disease: a study of lung function and treatment

At present, both the aetiology of hyaline membrane disease and a means of preventing it remain unknown. Recent studies indicate that a significant number of infants die of respiratory failure but there is no general agreement concerning the changes of pulmonary function which lead to this stage. Two approaches have been used in the treatment of respiratory decompensation. First it has been proposed that blood gas and acid base abnormalities which result from respiratory failure can be prevented by oxygen and intravenous alkali and secondly an attempt has been made to correct abnormal lung function itself by means of artificial ventilation. These methods are directed at different aspects of the problem and their efficacy is as yet not established. The application of artificial ventilation in particular must depend on the nature of any ventilation, diffusion or perfusion defect

Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation

Background: Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation techniques is poorly understood.Methods: A prospective randomised clinical trial was undertaken in January 2004 in 70 candidates randomly assigned to training in mouth-to-mouth, mouth-to-mask or mouth-to-face shield ventilation. Each candidate was trained for 10 min, after which tidal volume, respiratory rate, minute volume, peak airway pressure and the presence or absence of stomach inflation were measured. 58 subjects were reassessed 1 year later and study parameters were recorded again. Data were analysed with ANOVA, \textgreekq2 and McNemar tests.Results: Tidal volume, minute volume, peak airway pressure, ventilation rate and stomach inflation rate increased significantly at reassessment with all ventilation techniques compared with the initial assessment. However, at reassessment, mean (SD) tidal volume (960 (446) vs 1008 (366) vs 1402 (302) ml; p<0.05), minute volume (12 (5) vs 13 (7) vs 18 (3) l/min; p<0.05), peak airway pressure (14 (8) vs 17 (13) vs 25 (8) cm H2O; p<0.05) and stomach inflation rate (63% vs 58% vs 100%; p<0.05) were significantly lower with mouth-to-mask and mouth-to-face shield ventilation than with mouth-to-mouth ventilation. The ventilation rate at reassessment did not differ significantly between the ventilation techniques.Conclusions: One year after a single episode of ventilation training, lay persons tended to hyperventilate; however, the degree of hyperventilation and resulting stomach inflation were lower when a mouth-to-mask or a face shield device was employed. Regular training is therefore required to retain ventilation skills; retention of skills may be better with ventilation devices

Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock

Stress doses of hydrocortisone a re known to have immunomodulatory effects in patients with hyperdynamic septic shock. The prognosis correlates with the presence and severity of septic encephalopathy. However, neurological evaluation is influenced by the use of analgesia sedation during artificial ventilation. The objective of this study was to demonstrate the effect of stress doses of hydrocortisone during the initial phase of human septic shock on the serum values of the neurospecific protein S-100B in comparison to the inflammation markers interleukin (IL)-8 in serum and polymorphonuclear (PMN) elastase in plasma. A total of 24 consecutive patients, who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock, were enrolled in this prospective, randomized, double-blind, single-center trial. The severity of illness at recruitment was graded using the Acute Physiology and Chronic Health Evaluation 11 and the Simplified Acute Physiology Score 11 scoring systems. Multi-organ dysfunction syndrome was described by the Sepsis-related Organ Failure Assessment (SOFA) score. All patients were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Hydrocortisone was started in 12 patients with a loading dose of 100 mg and followed by a continuous infusion of 0.18 mg/kg/h for 6 days. Median S-100B serum levels of the hydrocortisone group decreased from 0.32 ng/mL at study entry to 0.07 ng/mL 6 days later without significant differences compared to the placebo group. Initial IL-8 serum levels were significantly higher in the hydrocortisone group up to 12 h after study entry, and significantly decreased from 715 to 17 pg/mL at the end of the observation period. Median PMN elastase plasma levels were not affected by hydrocortisone infusion. Patients with initial S-100B serum levels &gt;0.50 ng/mL revealed significantly higher SOFA scores up to 30 h, IL-8 serum levels up to 12 h, and PMN elastase plasma levels up to 36 h after study entry than those patients with &lt;= 0.50 ng/mL. These effects were independent of the amount of fluid correction for hemodilution. Starting S-100B, IL-8 and PMN elastase values of the hydrocortisone group were within the ranges already known in patients with out-of-hospital cardiac arrest or severe traumatic brain injury. Stress doses of hydrocortisone resulted in a significant reduction in IL-8 serum, but not in S-100B serum and PMN elastase plasma concentrations in patients with hyperdynamic septic shock. For the first time, a similar extent of S-100B increase in serum of septic patients at the time of diagnosis was shown as reported for cardiac arrest or severe traumatic brain injury

Effect of stress doses of hydrocortisone on S-100B vs. interleukin-8 and polymorphonuclear elastase levels in human septic shock

Stress doses of hydrocortisone a re known to have immunomodulatory effects in patients with hyperdynamic septic shock. The prognosis correlates with the presence and severity of septic encephalopathy. However, neurological evaluation is influenced by the use of analgesia sedation during artificial ventilation. The objective of this study was to demonstrate the effect of stress doses of hydrocortisone during the initial phase of human septic shock on the serum values of the neurospecific protein S-100B in comparison to the inflammation markers interleukin (IL)-8 in serum and polymorphonuclear (PMN) elastase in plasma. A total of 24 consecutive patients, who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock, were enrolled in this prospective, randomized, double-blind, single-center trial. The severity of illness at recruitment was graded using the Acute Physiology and Chronic Health Evaluation 11 and the Simplified Acute Physiology Score 11 scoring systems. Multi-organ dysfunction syndrome was described by the Sepsis-related Organ Failure Assessment (SOFA) score. All patients were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Hydrocortisone was started in 12 patients with a loading dose of 100 mg and followed by a continuous infusion of 0.18 mg/kg/h for 6 days. Median S-100B serum levels of the hydrocortisone group decreased from 0.32 ng/mL at study entry to 0.07 ng/mL 6 days later without significant differences compared to the placebo group. Initial IL-8 serum levels were significantly higher in the hydrocortisone group up to 12 h after study entry, and significantly decreased from 715 to 17 pg/mL at the end of the observation period. Median PMN elastase plasma levels were not affected by hydrocortisone infusion. Patients with initial S-100B serum levels &gt;0.50 ng/mL revealed significantly higher SOFA scores up to 30 h, IL-8 serum levels up to 12 h, and PMN elastase plasma levels up to 36 h after study entry than those patients with &lt;= 0.50 ng/mL. These effects were independent of the amount of fluid correction for hemodilution. Starting S-100B, IL-8 and PMN elastase values of the hydrocortisone group were within the ranges already known in patients with out-of-hospital cardiac arrest or severe traumatic brain injury. Stress doses of hydrocortisone resulted in a significant reduction in IL-8 serum, but not in S-100B serum and PMN elastase plasma concentrations in patients with hyperdynamic septic shock. For the first time, a similar extent of S-100B increase in serum of septic patients at the time of diagnosis was shown as reported for cardiac arrest or severe traumatic brain injury