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BMC Pulmonary Medicine Apr 2022Pneumoconiosis is a diffuse interstitial fibronodular lung disease, which is caused by the inhalation of crystalline silica. Whole lung lavage (WLL) is a therapeutic...
BACKGROUND
Pneumoconiosis is a diffuse interstitial fibronodular lung disease, which is caused by the inhalation of crystalline silica. Whole lung lavage (WLL) is a therapeutic procedure used to treat pneumoconiosis. This study is to compare the effects of different negative pressure suction on lung injury in patients with pneumoconiosis undergoing WLL.
MATERIALS AND METHODS
A prospective study was conducted with 24 consecutively pneumoconiosis patients who underwent WLL from March 2020 to July 2020 at Emergency General Hospital, China. The patients were divided into two groups: high negative suction pressure group (group H, n = 13, negative suction pressure of 300-400 mmHg) and low negative suction pressure group (group L, n = 11, negative suction pressure of 40-50 mmHg). The arterial blood gas, lung function, lavage data, oxidative stress, and inflammatory responses to access lung injury were monitored.
RESULTS
Compared with those of group H, the right and left lung residual were significantly increased in the group L (P = 0.04, P = 0.01). Potential of hydrogen (pH), arterial partial pressure of oxygen (PaO), arterial partial pressure of carbon dioxide (PaCO), lactic acid (LAC) and glucose (GLU) varied from point to point in time (P < 0.01, respectively). There was statistical difference in the trend of superoxide dismutase (SOD) and interleukin-10 (IL-10) over time between the two groups (P < 0.01, P = 0.02). In comparison with the group H, the levels of IL-10 (P = 0.01) and SOD (P < 0.01) in WLL fluid were significantly increased in the group L. There was no statistical difference in the trend of maximal volumtary ventilation (MVV), forced vital capacity (FVC), forced expiratory volume in one second (FEV1%), residual volume (RV), residual volume/total lung capacity (RV/TLC), carbon monoxide dispersion factor (DLCO%), forced expiratory volume in one second/ forced vital capacity (FEV1/FVC%) over time between the two groups (P > 0.05, respectively).
CONCLUSION
Low negative suction pressure has the potential benefit to reduce lung injury in patients with pneumoconiosis undergoing WLL, although it can lead to increased residual lavage fluid. Despite differing suction strategies, pulmonary function parameters including FEV1%, RV and DLCO% became worse than before WLL. Trial Registration Chinese Clinical Trial registration number ChiCTR2000031024, 21/03/2020.
Topics: Bronchoalveolar Lavage; Humans; Interleukin-10; Lung; Lung Diseases, Interstitial; Lung Injury; Pneumoconiosis; Prospective Studies; Suction; Superoxide Dismutase
PubMed: 35459122
DOI: 10.1186/s12890-022-01952-w -
International Journal of Surgery... Jul 2019There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG) and closed-suction drainage (CSD) following pancreatoduodenectomy on clinical... (Meta-Analysis)
Meta-Analysis
Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates. A meta-analysis.
INTRODUCTION
There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG) and closed-suction drainage (CSD) following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage.
METHODS
The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF) rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT) was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model) with odds ratios and 95% confidence intervals (OR (95%CI)) as an effect measure was utilized.
RESULTS
Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD) were included. In meta-analysis of all studies, overall [OR (95%CI) = 0.81 (0.42, 1.56); p = 0.53; I = 79%; Tau = 0.54]; grade A [OR (95%CI) = 0.71 (0.33, 1.53); p = 0.39; I = 65%; Tau = 0.47]; grade B [OR (95%CI) = 1.23 (0.74, 2.05); p = 0.42; I = 0%]; and grade C [OR (95%CI) = 1.08 (0.56, 2.09); p = 0.82; I = 5%] POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95%CI) = 1.55 (0.79, 3.04); p = 0.20; I = 0%]. No publication bias was found (t = 0.48; p = 0.64).
CONCLUSION
This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.
Topics: Drainage; Humans; Length of Stay; Odds Ratio; Pancreas; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Suction
PubMed: 31078675
DOI: 10.1016/j.ijsu.2019.05.001 -
Journal of Periodontology Sep 2020The risk of transmitting airborne pathogens is an important consideration in dentistry and has acquired special significance in the context of recent respiratory disease... (Review)
Review
The risk of transmitting airborne pathogens is an important consideration in dentistry and has acquired special significance in the context of recent respiratory disease epidemics. The purpose of this review, therefore, is to examine (1) what is currently known regarding the physics of aerosol creation, (2) the types of environmental contaminants generated by dental procedures, (3) the nature, quantity, and sources of microbiota in these contaminants and (4) the risk of disease transmission from patients to dental healthcare workers. Most dental procedures that use ultrasonics, handpieces, air-water syringes, and lasers generate sprays, a fraction of which are aerosolized. The vast heterogeneity in the types of airborne samples collected (spatter, settled aerosol, or harvested air), the presence and type of at-source aerosol reduction methods (high-volume evacuators, low volume suction, or none), the methods of microbial sampling (petri dishes with solid media, filter paper discs, air harvesters, and liquid transport media) and assessment of microbial bioload (growth conditions, time of growth, specificity of microbial characterization) are barriers to drawing robust conclusions. For example, although several studies have reported the presence of microorganisms in aerosols generated by ultrasonic scalers and high-speed turbines, the specific types of organisms or their source is not as well studied. This paucity of data does not allow for definitive conclusions to be drawn regarding saliva as a major source of airborne microorganisms during aerosol generating dental procedures. Well-controlled, large-scale, multi center studies using atraumatic air harvesters, open-ended methods for microbial characterization and integrated data modeling are urgently needed to characterize the microbial constituents of aerosols created during dental procedures and to estimate time and extent of spread of these infectious agents.
Topics: Aerosols; Air Microbiology; Dental Scaling; Humans; Saliva; Suction
PubMed: 32662070
DOI: 10.1002/JPER.20-0395 -
The Journal of Extra-corporeal... Jun 2019The 1/2″ venous line has long been the drainage tubing diameter of choice for adult patients undergoing cardiac surgery. However, several programs use a smaller...
The 1/2″ venous line has long been the drainage tubing diameter of choice for adult patients undergoing cardiac surgery. However, several programs use a smaller diameter venous line when used in conjunction with kinetic-assisted venous drainage or vacuum-assisted venous drainage. In 2014, our perfusion team made an institution-wide effort to miniaturize the cardiopulmonary bypass (CPB) circuit for children. One of our changes was the transition to a 3/8″ diameter venous line for drainage, even in our larger patients (up to 80 kg). We reviewed the current literature on this topic and delineated the various parameters required to be able to use the 3/8″ venous line with gravity drainage with the aim of using it on patients up to 115 kg with the appropriate venous reservoir. We have successfully used the 3/8″ venous line in more than 40 of our larger patients (35-90 kg) without the need for assisted venous drainage. We were able to reduce CPB prime from 625 ± 118 to 425 ± 52 mL before retrograde autologous priming (RAP)/venous autologous priming (VAP). The prime was further reduced to 325 ± 66 mL after RAP/VAP. Homologous blood utilization was reduced from 217 ± 311 mL to 27 ± 77 mL. Both results were statistically significant. We hypothesize that taking into account two of the parameters of Poiseuille's law, namely length and diameter, it is possible to safely drain large children and mid-size adults via gravity venous drainage and the 3/8″ venous line. This technique allows reducing prime volume, simplifies CPB circuits with increased safety and potentially reduces the need for homologous blood transfusion.
Topics: Cardiopulmonary Bypass; Drainage; Humans; Retrospective Studies; Suction
PubMed: 31239580
DOI: No ID Found -
RoFo : Fortschritte Auf Dem Gebiete Der... May 2016Intracranial hypotension has been reported as a complication of accidental drainage after surgical treatment in several cases. Application of negative pressure systems... (Review)
Review
PURPOSE
Intracranial hypotension has been reported as a complication of accidental drainage after surgical treatment in several cases. Application of negative pressure systems (wound drains, VAC(®)-therapy, chest tube drainage) had typically led to severe intracranial hypotension including intracranial hemorrhage and tonsillar herniation. In the last year the authors observed 2 cases of accidental spinal drainage of CSF in patients with neurological deficits, regressing after reduction of the device suction.
MATERIAL AND METHODS
We conducted a systematic PubMed-based research of the literature to study the variety and frequency of the reported symptoms from 1st of January 1980 until 1st of October 2015.
RESULTS
Reviewing the literature 24 relevant citations including 27 reported cases of posttraumatic or postoperative loss of CSF leading to neurological symptoms were identified. All 15 reported cases in which a negative pressure suction device had been applied showed severe neurological and radiological symptoms such as coma or brain herniation and intracranial hemorrhage. In all cases patients recovered rapidly after removal of the suction device. Milder symptoms were observed in the patients without negative pressure suction, mainly only presenting with headaches or cranial nerve involvement.Additionally, we give an overview about current recommendations regarding cranial and spinal imaging to rule out dural laceration and cranial hypotension.
CONCLUSION
Patients with dural laceration complicated by accidental drainage of CSF can present with life-threatening conditions. Increasing use of negative pressure suction devices makes the reported condition an important differential diagnosis. A precise radiological examination can help to rule out dural laceration and intracranial hypotension.
KEY POINTS
• Undetected dural laceration complicated by negative pressure suction drains can induce life-threatening symptoms.• Increasing use of negative pressure suction devices makes the reported condition an important differential diagnosis for radiologists Citation Format: • Sporns PB, Schwindt W, Cnyrim CD et al. Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits. Fortschr Röntgenstr 2016; 188: 451 - 458.
Topics: Brain Damage, Chronic; Cerebrospinal Fluid Leak; Cerebrospinal Fluid Shunts; Cross-Sectional Studies; Dura Mater; Humans; Intracranial Hypotension; Medical Errors; Postoperative Care; Suction
PubMed: 26844423
DOI: 10.1055/s-0035-1567034 -
Biomechanics and Modeling in... Jun 2021The present study investigates the layer-specific mechanical behavior of human skin. Motivated by skin's histology, a biphasic model is proposed which differentiates...
The present study investigates the layer-specific mechanical behavior of human skin. Motivated by skin's histology, a biphasic model is proposed which differentiates between epidermis, papillary and reticular dermis, and hypodermis. Inverse analysis of ex vivo tensile and in vivo suction experiments yields mechanical parameters for each layer and predicts a stiff reticular dermis and successively softer papillary dermis, epidermis and hypodermis. Layer-specific analysis of simulations underlines the dominating role of the reticular dermis in tensile loading. Furthermore, it shows that the observed out-of-plane deflection in ex vivo tensile tests is a direct consequence of the layered structure of skin. In in vivo suction experiments, the softer upper layers strongly influence the mechanical response, whose dissipative part is determined by interstitial fluid redistribution within the tissue. Magnetic resonance imaging-based visualization of skin deformation in suction experiments confirms the deformation pattern predicted by the multilayer model, showing a consistent decrease in dermal thickness for large probe opening diameters.
Topics: Biomechanical Phenomena; Computer Simulation; Humans; Magnetic Resonance Imaging; Skin; Suction; Tensile Strength
PubMed: 33566274
DOI: 10.1007/s10237-021-01424-w -
Performance of a new single-use bronchoscope versus a marketed single-use comparator: a bench study.BMC Pulmonary Medicine May 2022Single-use flexible bronchoscopes eliminate cross contamination from reusable bronchoscopes and are cost-effective in a number of clinical settings. The present bench...
BACKGROUND
Single-use flexible bronchoscopes eliminate cross contamination from reusable bronchoscopes and are cost-effective in a number of clinical settings. The present bench study aimed to compare the performance of a new single-use bronchoscope (Boston Scientific EXALT Model B) to a marketed single-use comparator (Ambu aScope 4), each in slim, regular and large diameters.
METHODS
Three bronchoscopy tasks were performed: water suction and visualization, "mucus" mass (synthetic mucoid mixture) suctioned in 30 s, and "mucus" plug (thicker mucoid mixture) suction. Suction ability, task completion times, and subjective ratings of visualization and overall performance on a scale of one to 10 (best) were compared. All bronchoscopy tasks were completed by 15 physicians representing diversity in specialization including pulmonary, interventional pulmonary, critical care, anesthesia, and thoracic surgery. Each physician utilized the six bronchoscope versions with block randomization by bronchoscope and task.
RESULTS
Aspirated mean mass of "mucus" using EXALT Model B Regular was comparable to that for an aScope 4 Large (41.8 ± 8.3 g vs. 41.5 ± 5.7 g respectively, p = 0.914). In comparisons of scopes with the same outer diameter, the aspirated mean mass by weight of water and "mucus" was significantly greater for EXALT Model B than for aScope 4 (p < 0.001 for all three diameters). Mean ratings for visualization attributes were significantly better for EXALT Model B compared to aScope 4 (p-value range 0.001-0.029).
CONCLUSION
A new single-use bronchoscope provided strong suction capability and visualization compared to same-diameter marketed single-use comparators in a bench model simulation.
Topics: Bronchoscopes; Bronchoscopy; Cost-Benefit Analysis; Humans; Suction; Water
PubMed: 35550062
DOI: 10.1186/s12890-022-01982-4 -
BMC Oral Health Apr 2022Due to exposure to potentially infectious aerosols during treatments, the dental personnel is considered being at high risk for aerosol transmitted diseases like...
BACKGROUND
Due to exposure to potentially infectious aerosols during treatments, the dental personnel is considered being at high risk for aerosol transmitted diseases like COVID-19. The aim of this study was to evaluate aerosol exposure during different dental treatments as well as the efficacy of dental suction to reduce aerosol spreading.
METHODS
Dental powder-jet (PJ; Air-Flow), a water-cooled dental handpiece with a diamond bur (HP) and water-cooled ultrasonic scaling (US) were used in a simulation head, mounted on a dental unit in various treatment settings. The influence of the use of a small saliva ejector (SE) and high-volume suction (HVS) was evaluated. As a proxy of aerosols, air-born particles (PM10) were detected using a Laser Spectrometer in 30 cm distance from the mouth. As control, background particle counts (BC) were measured before and after experiments.
RESULTS
With only SE, integrated aerosol levels [median (Q25/Q75) µg/m s] for PJ [91,246 (58,213/118,386) µg/m s, p < 0.001, ANOVA] were significantly increased compared to BC [7243 (6501/8407) µg/m s], whilst HP [11,119 (7190/17,234) µg/m s, p > 0.05] and US [6558 (6002/7066) µg/m s; p > 0.05] did not increase aerosol levels significantly. The use of HVS significantly decreased aerosol exposure for PJ [37,170 (29,634/51,719) µg/m s; p < 0.01] and HP [5476 (5066/5638) µg/m s; p < 0.001] compared to SE only, even reaching lower particle counts than BC levels for HP usage (p < 0.001).
CONCLUSIONS
To reduce the exposure to potentially infectious aerosols, HVS should be used during aerosol-forming dental treatments.
Topics: Aerosols; COVID-19; Humans; SARS-CoV-2; Suction; Water
PubMed: 35428223
DOI: 10.1186/s12903-022-02155-9 -
Annals of the Royal College of Surgeons... Sep 2018Vernagel (sodium polyacrylate) is a powder commonly used in hospitals worldwide for the management and disposal of body fluids. It reacts with fluids to form a semisolid...
Vernagel (sodium polyacrylate) is a powder commonly used in hospitals worldwide for the management and disposal of body fluids. It reacts with fluids to form a semisolid gel. Its main use is to reduce spillages. If ingested, this substance presents significant risk of asphyxiation. There have been 15 reported cases of Vernagel ingestion in 6 years and 1 death from asphyxiation. We present the case of an elderly patient who was admitted following a fall. He accidentally ingested a sachet of Vernagel during the early hours of the morning. An urgent rigid panendoscopy was performed and the material was evacuated using suction aspiration. Patients should be supervised when using Vernagel on the ward, to avoid ingestion. Ear, nose and throat doctors should be aware of Vernagel and its properties. Owing to the risk of airway obstruction, excellent coordination between the anaesthetist and surgeon is crucial, and prompt management is required.
Topics: Acrylic Resins; Aged; Asphyxia; Endoscopy; Foreign Bodies; Humans; Male; Risk Factors; Suction
PubMed: 29909673
DOI: 10.1308/rcsann.2018.0104 -
Revista Brasileira de Terapia Intensiva 2015Evidence-based practices search for the best available scientific evidence to support problem solving and decision making. Because of the complexity and amount of... (Review)
Review
Evidence-based practices search for the best available scientific evidence to support problem solving and decision making. Because of the complexity and amount of information related to health care, the results of methodologically sound scientific papers must be integrated by performing literature reviews. Although endotracheal suctioning is the most frequently performed invasive procedure in intubated newborns in neonatal intensive care units, few Brazilian studies of good methodological quality have examined this practice, and a national consensus or standardization of this technique is lacking. Therefore, the purpose of this study was to review secondary studies on the subject to establish recommendations for endotracheal suctioning in intubated newborns and promote the adoption of best-practice concepts when conducting this procedure. An integrative literature review was performed, and the recommendations of this study are to only perform endotracheal suctioning in newborns when there are signs of tracheal secretions and to avoid routinely performing the procedure. In addition, endotracheal suctioning should be conducted by at least two people, the suctioning time should be less than 15 seconds, the negative suction pressure should be below 100 mmHg, and hyperoxygenation should not be used on a routine basis. If indicated, oxygenation is recommended with an inspired oxygen fraction value that is 10 to 20% greater than the value of the previous fraction, and it should be performed 30 to 60 seconds before, during and 1 minute after the procedure. Saline instillation should not be performed routinely, and the standards for invasive procedures must be respected.
Topics: Evidence-Based Medicine; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intubation, Intratracheal; Oxygen; Suction; Time Factors
PubMed: 26465249
DOI: 10.5935/0103-507X.20150048