Managing patients on extracorporeal membrane oxygenation support during the COVID-19 pandemic – a proposal for a nursing standard operating procedure

Background Extracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19). However, it requires specialized clinicians and resources in advanced technology. Moreover, the COVID-19 remains an ongoing global emergency, and there is no evidence-based practice in preparedness. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that regulates safety and efficiency in using personal protective equipment (PPE) during ECMO-relevant procedures while providing ECMO therapy for patients with COVID-19. Methods After performing a narrative literature search, we developed a high-fidelity translational simulation scenario. It included practicing appropriate donning and doffing PPE during work organization, ECMO-related procedures, and routine daily nursing care and management of ECMO over nine hours. In addition, we held supplementary constructive debrief meetings to consult international expert in the field. Results A proposal for nursing standardized operating procedures was created, divided into categories. They included work organization, workload references, competences, infrastructural conditions, cannulation equipment, daily routine nursing care, and procedures during ECMO. Conclusions High-fidelity medical simulation can play an important role in staff training, improvement in previously gained proficiency, and development of optimal SOP for nursing care and management during ECMO in patients with COVID-19. Optimal SOPs may further guide multidisciplinary teams, including intensive care units and interventional departments

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

In-process workpiece based temperature measurement in cylindrical grinding

In conventional grinding processes a huge partition of the machining energy is received by the workpiece. Damage due to high thermal load might happen on the surface as well as in sublayers of the workpiece where favourable process parameters and optimized coolant supply are stringent to avoid them. To detect thermal damage known as grinding burn various established techniques like barkhausen noise measurement for ferromagnetic materials or the NITAL-etching test are available for measurement after the workpiece is machined. In this work the development and influencing factors of grinding burn are studied by a continuously in-process and workpiece based measurement of the temperatures in cylindrical grinding. A two-color pyrometer is used with a rotary joint between the rotating and stationary fibre from the workpiece to the sensor element. The radial and circumferential temperature profiles below the workpiece surface are measured to determine the thermal limits and temperature gradients. Due to the high temporal resolution the temperature gradient for single workpiece revolutions can be shown and evaluated. The heating and cooling rates are calculated and compared for different depths in the workpiece, where the heating rates are up to 50 times higher than the cooling rates depending on the distance to the surface. The knowledge can help to model grind hardening processes which rely on finite element simulations of the temperature distribution in the workpiece.ISSN:2212-827

Flushing velocity observations and analysis during EDM drilling

Insufficient flushing is the greatest limitation factor for material removal rate (MRR) in electrical discharge machining (EDM). In order to increase the flushing efficiency during erosion and thus to increase MRR, better understanding of the dielectric distributions and flow directions is required. Additionally the discharge development and its influence to the fluid flow and flushing efficiency must be taken into account. The dielectric flow trajectory can be tracked by high speed imaging with an auxiliary magnification lens. Consequently, flow velocity vectors, bubble development and movement can be analyzed. The flushing behavior is observed with particle tracking velocimetry (PTV), the corresponding data from the measurements are used to compare and validate the computational fluid dynamics (CFD) simulations. This paper describes a setup for high speed imaging in micro meter scale of a common EDM drilling process using electrode with multi-hole flushing. The analysis of the erosion process is performed within two conditions: first, the initial contact of the electrode with the material surface and second, erosion inside a predrilled hole. It is concluded that those two described conditions have a high influence to the flushing and therefore to the MRR, whereas the flushing efficiency drops by an increase of the drilling depth.ISSN:2212-827

A study of the interaction between coolant jet nozzle flow and the airflow around a grinding wheel in cylindrical grinding

A grinding wheel rotating at high circumferential speed induces a boundary-layer airflow which possibly can detain the coolant from submerging into the grinding zone, in order to prevent thermal damage. To study the profile of the airflow, general laws of fluid dynamics are applied and the analytical results compared with results from CFD simulations. These are used to investigate the interaction of the coolant with the grinding wheel under the influence of the airflow with different coolant nozzle types and parameters. For validation high speed imaging is employed. The conclusions may help for a general understanding of the interaction between wheel-airflow-coolant.ISSN:2212-827