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Intuition in Decision Making – An Investigation in the Delivery Room
Published in Frédéric Adam, Dorota Kuchta, Stanisław Stanek, Frédéric Adam, Joanna Iwko, Gaye Kiely, Dorota Kuchta, Ewa Marchwicka, Stephen McCarthy, Gloria Phillips-Wren, Stanisław Stanek, Tadeusz Trzaskalik, Irem Ucal Sari, Rational Decisions in Organisations, 2022
Frédéric Adam, Eugene Dempsey, Brian Walsh, Mmoloki Kenosi
Just after birth, the baby showed signs of poor respiratory effort, and her vitals were a source of concern. The team immediately applied CPAP, but this did not improve her condition, such that IPPV was implemented to seek to increase her fraction of inspired oxygen (FiO2). As this still was not sufficient, the team decided to intubate her. Still the expected progress did not materialise, and the neonatologist decided to re-intubate to ensure the proper insertion of the endotracheal tube. The exceedingly small airways of a preterm baby can prove confusing for anyone other than the most senior neonatologists, and this second intervention finally delivered the expected results. This is a case where learning can only occur “on the job,” and the junior staff member must confront the full complexity of each intervention to learn how to cope with it.
Clinical Decision Support in the Care of Symptomatic Patients with COVID-19: An Approach Based on Machine Learning and Swarm Intelligence
Published in Wellington Pinheiro dos Santos, Juliana Carneiro Gomes, Valter Augusto de Freitas Barbosa, Swarm Intelligence Trends and Applications, 2023
Ingrid Bruno Nunes, Pedro Vitor Soares Gomes de Lima, Andressa Laysa Queiroz Ribeiro, Leandro Ferreira Frade Soares, Maria Eduarda da Silva Santana, Maria Luysa Teles Barcelar, Juliana Carneiro Gomes, Clarisse Lins de Lima, Maira Araûjo de Santana, Rodrigo Gomes de Souza, Valter Augusto de Freitas Barbosa, Ricardo Emmanuel de Souza, Wellington Pinheiro dos Santos
Arterial Blood Gas: measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood of an artery. Hemoglobin Saturation: represents the amount of oxygen circulating in the blood. The value is obtained by comparing the amount of hemoglobin that is or is not bound to oxygen;pH: specifies the acidity or basicity of the water;Total CO2: Carbon dioxide (CO2) is a waste produced by the body. Blood carries CO2 to the lungs. A CO2 blood test measures the amount of carbon dioxide in the blood;— pCO2: means carbon dioxide partial pressure and reflects the amount of carbon dioxide gas dissolved in the blood;HCO3: also called bicarbonate, it is a by-product of the body’s metabolism. Blood carries bicarbonate to the lungs and then it is exhaled as carbon dioxide. The kidneys also help regulate bicarbonate by excreting and reabsorbing it;Base Excess: value that represents how much the sum of the bases present in the organism differs from the reference value (Base Buffer). Reflects the metabolic component of the blood’s acid-base balance;pO2: means partial pressure of oxygen and reflects the amount of dissolved oxygen gas in the blood. It primarily measures the effectiveness of the lungs in pulling oxygen from the atmosphere into the blood-stream;O2 saturation: is attributed to the amount of 02 that is in the blood-stream;FiO2: the inspired oxygen fraction is the percentage of oxygen concentration participating in gas exchange in the alveoli.
Advanced mechanical ventilation modes: design and computer simulations
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
In future works, on the other hand, it is desired to improve the simulation model by using more advanced model, including the gas exchange model, human respiratory control mechanisms and cardiovascular system. Thus, it may also be possible to simulate some of the common lung diseases and create many different virtual patients. Furthermore, the advantages/disadvantages of the corresponding advanced ventilation modes on such pulmonary diseases, or the possible effects on the general cardiopulmonary system can be examined. It also allows performing the research studies on the selection of ventilator parameters in various clinical scenarios. Moreover, this simulation environment can even lead us to design new modes (that operate more autonomously) or improve the algorithms of the existing modes. Additionally, an automatic (intelligent) mechanical ventilator design can also be considered in future works. The concept is the fact that the initial ventilator parameters are set by the physician; however, closed-loop control systems handle the remaining work, such as adjusting the ventilation parameters (respiratory frequency, tidal volume, inspiration/expiration times, support pressures, etc.), and the fraction of inspired oxygen (%FiO2) by using the feedback data which can be partial pressures of oxygen and carbon dioxide in blood, oxygen saturation, end-tidal carbon dioxide, patient’s respiratory effort, heart rate, systolic/diastolic pressures, etc. Such a system can also handle the ventilation mod and automatically changes it depending on the patient’s current status. Finally, it gives information to the physician that the patient is ready for the weaning by performing suitable tests.
Devices for ex vivo heart and lung perfusion
Published in Expert Review of Medical Devices, 2018
Dean P. Schraufnagel, Robert J. Steffen, Patrick R. Vargo, Tamer Attia, Haytham Elgharably, Saad M. Hasan, Alejandro Bribriesco, Per Wierup
The ventilator settings for the Lund Protocol are volume control mode with a low tidal volume (5–7 ml/kg), positive end expiratory pressure (PEEP) of 5 cm H20, respiratory rate 7–20 breaths per minute, and fractional percentage of inspired oxygen (FiO2) of 50%. During the assessment phase, the Lund Protocol calls for increasing PEEP as their recruitment method of choice. The lungs are deemed acceptable for transplantation when the PO2/FiO2 > 300 mm Hg with normal pulmonary vascular resistance, airway pressure, lung compliance, and an acceptable X-ray [18].
Devices for donor lung preservation
Published in Expert Review of Medical Devices, 2022
Cora R Bisbee, Curry Sherard, Jennie H. Kwon, Zubair A. Hashmi, Barry C. Gibney, Taufiek Konrad Rajab
Organ transplantation remains the only effective therapy in end-stage pulmonary disease to extend quality of life and survival. Over four decades, survival after lung transplant has improved, a feat attributed to advances in surgical technique, immunosuppressive therapies, organ preservation, and post-operative care. Transplant volume, however, is restricted by the availability of high-quality donor lungs. The ideal lung donor is described as an individual between 20 and 45 years old, with an arterial partial pressure of oxygen to inspired fraction of oxygen (PaO2/FiO2) ratio greater than 350, no smoking history, a clear chest X-ray, a clean bronchoscopy, and minimal cold ischemic time before transplantation (<6 hours) [1,2]. Unfortunately, these guidelines have resulted in less than 30% utilization of available donor lungs, leaving over two-thousand adult patients in North America listed for lung transplant that either die or are removed from the waitlist after becoming too sick for transplantation [3]. To increase the supply of donor lungs, there are several ongoing efforts to extend criteria for lung donors and optimize preservation of donor lungs. Extended criteria donors (ECD) are defined by 2 or more variances from standard criteria, including age ≥ 55 years, arterial PaO2/FiO2 ≤ 300 mmHg, smoking history ≥ 20 pack years, diabetes, purulent bronchoscopy, blood infection, or abnormal chest radiographs [2]. These variants in ECD may require more extensive physical examination, radiographic imaging, pressure measurements, bronchoscopy, and monitoring. As a result, more time is needed to prepare the recipient for surgery, organize necessary personnel, and perform laboratory testing. Various strategies have been implemented in transplant centers in recent years to accommodate this necessary prolongation in preservation time.