The Experts below are selected from a list of 21 Experts worldwide ranked by ideXlab platform
J. J. Andrews - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Tests for Detecting Leaks in the Low-Pressure System of Anesthesia Gas Machines
Anesthesia & Analgesia, 1997Co-Authors: Jeffrey A. Myers, Michael L. Good, J. J. AndrewsAbstract:Small leaks in the low-pressure system (LPS) of the Anesthesia Gas Machine can cause hypoxia or patient awareness. We sought to determine the relative sensitivities of the various tests recommended for detecting LPS leaks before Anesthesia. Special adapters were fashioned to create leaks of six different sizes in the LPS that were equivalent to the following: a single 25-, 22-, 20-, or 15-gauge needle, two 15-gauge needles, or a 2.5-mm endotracheal tube connector. With each leak condition, five different leak tests were performed on three each of the following Machines: Ohmeda Modulus I, Ohmeda Modulus II-Plus, and North American Drager Narkomed (2A, 3 and 4), for a total of 54 leaks to be detected for each leak test (3 x 3 x 6). The number of leaks detected with each test was compared by Fisher's exact test, P < 0.05 being considered significant. Only the negative pressure leak test detected all 54 leaks, a significant difference from the positive pressure test, which detected the least number of leaks, 28 (P < 0.05). Some leak tests are more suitable for specific Anesthesia Machines. Adoption of the negative pressure test as a universal LPS leak test may prevent the risks associated with using the wrong test for the particular Anesthesia Machine: hypoxic Gas or patient awareness.
Jeffrey A. Myers - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Tests for Detecting Leaks in the Low-Pressure System of Anesthesia Gas Machines
Anesthesia & Analgesia, 1997Co-Authors: Jeffrey A. Myers, Michael L. Good, J. J. AndrewsAbstract:Small leaks in the low-pressure system (LPS) of the Anesthesia Gas Machine can cause hypoxia or patient awareness. We sought to determine the relative sensitivities of the various tests recommended for detecting LPS leaks before Anesthesia. Special adapters were fashioned to create leaks of six different sizes in the LPS that were equivalent to the following: a single 25-, 22-, 20-, or 15-gauge needle, two 15-gauge needles, or a 2.5-mm endotracheal tube connector. With each leak condition, five different leak tests were performed on three each of the following Machines: Ohmeda Modulus I, Ohmeda Modulus II-Plus, and North American Drager Narkomed (2A, 3 and 4), for a total of 54 leaks to be detected for each leak test (3 x 3 x 6). The number of leaks detected with each test was compared by Fisher's exact test, P < 0.05 being considered significant. Only the negative pressure leak test detected all 54 leaks, a significant difference from the positive pressure test, which detected the least number of leaks, 28 (P < 0.05). Some leak tests are more suitable for specific Anesthesia Machines. Adoption of the negative pressure test as a universal LPS leak test may prevent the risks associated with using the wrong test for the particular Anesthesia Machine: hypoxic Gas or patient awareness.
Pooja S. Yesantharao - One of the best experts on this subject based on the ideXlab platform.
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The Vent-Lock Protocol: 3D Printing and Testing of A Ventilator Multiplexer to Enhance the Capacity of Treating Patients with COVID-19
2020Co-Authors: Helen Xun, Christopher Shallal, Justin Unger, Runhan Tao, Alberto Torres, Michael Vladimirov, Jenna Frye, Mohit Singhala, Brockett Horne, Pooja S. YesantharaoAbstract:Abstract Mechanical ventilators are essential to patients who become critically ill from acute respiratory distress syndrome (ARDS), and shortages have been reported due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We utilized cost-effective, on-demand 3D printing (3DP) technology to produce critical components for a novel ventilator multiplexer system, Vent-Lock, to split one ventilator or Anesthesia Gas Machine between two patients. FloRest, a novel 3DP flow restrictor, provides clinicians control of tidal volumes and positive end expiratory pressure (PEEP), using the 3DP manometer adaptor to monitor pressures. We tested the ventilator splitter circuit in simulation centers between artificial lungs and used an Anesthesia Gas Machine to successfully ventilate two swines. As one of the first studies to demonstrate splitting one Anesthesia Gas Machine between two swines, we present proof-of-concept of a de novo, closed, multiplexing system, with flow restriction for individualized patient therapy. Our studies underscore that while possible, ventilator multiplexing is a complicated synergy between Machine settings, circuit modification, and patient monitoring. Consequently, ventilator multiplexing is reserved only as a last emergency resource, by trained clinicians and respiratory therapists with ventilator operative experience.
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Vent-Lock: A 3D Printed Ventilator Multiplexer to Enhance the Capacity of Treating Patients with COVID-19
2020Co-Authors: Helen Xun, Christopher Shallal, Justin Unger, Runhan Tao, Alberto Torres, Michael Vladimirov, Jenna Frye, Mohit Singhala, Brockett Horne, Pooja S. YesantharaoAbstract:Mechanical ventilators are essential to patients who become critically ill from acute respiratory distress syndrome (ARDS), and shortages have been reported due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We utilized cost-effective, on-demand 3D printing (3DP) technology to produce critical components for a novel ventilator multiplexer system, Vent-Lock, to split one ventilator or Anesthesia Gas Machine between two patients. FloRest, a novel 3DP flow restrictor, provides clinicians control of tidal volumes and positive end expiratory pressure (PEEP), using the 3DP manometer adaptor to monitor pressures. We tested the ventilator splitter circuit in simulation centers between artificial lungs and used an Anesthesia Gas Machine to successfully ventilate two swines. As one of the first studies to demonstrate splitting one Anesthesia Gas Machine between two swines, we present proof-of-concept of a de novo, closed, multiplexing system, with flow restriction for individualized patient therapy. Our studies underscore that while possible, ventilator multiplexing is a complicated synergy between Machine settings, circuit modification, and patient monitoring. Consequently, ventilator multiplexing is reserved only as a last emergency resource, by trained clinicians and respiratory therapists with ventilator operative experience.
Michael L. Good - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Tests for Detecting Leaks in the Low-Pressure System of Anesthesia Gas Machines
Anesthesia & Analgesia, 1997Co-Authors: Jeffrey A. Myers, Michael L. Good, J. J. AndrewsAbstract:Small leaks in the low-pressure system (LPS) of the Anesthesia Gas Machine can cause hypoxia or patient awareness. We sought to determine the relative sensitivities of the various tests recommended for detecting LPS leaks before Anesthesia. Special adapters were fashioned to create leaks of six different sizes in the LPS that were equivalent to the following: a single 25-, 22-, 20-, or 15-gauge needle, two 15-gauge needles, or a 2.5-mm endotracheal tube connector. With each leak condition, five different leak tests were performed on three each of the following Machines: Ohmeda Modulus I, Ohmeda Modulus II-Plus, and North American Drager Narkomed (2A, 3 and 4), for a total of 54 leaks to be detected for each leak test (3 x 3 x 6). The number of leaks detected with each test was compared by Fisher's exact test, P < 0.05 being considered significant. Only the negative pressure leak test detected all 54 leaks, a significant difference from the positive pressure test, which detected the least number of leaks, 28 (P < 0.05). Some leak tests are more suitable for specific Anesthesia Machines. Adoption of the negative pressure test as a universal LPS leak test may prevent the risks associated with using the wrong test for the particular Anesthesia Machine: hypoxic Gas or patient awareness.
J. Earl Wynands - One of the best experts on this subject based on the ideXlab platform.
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Simulation-based education in Canada: will Anesthesia lead in the future?
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2009Co-Authors: Robert J. Byrick, Viren N. Naik, J. Earl WynandsAbstract:It is remarkable that 40 years have elapsed since Denson and Abrahamson first introduced high fidelity simulation (Sim One) to facilitate the teaching of endotracheal intubation and the induction of Anesthesia. The concept of utilizing a simulator for clinical training was far ahead of its time and not immediately embraced by anesthesiologists or other educators. Simulation technology for medical education underwent a revival in the mid-1980s when computer-generated screen based simulation programs made their appearance, focusing primarily on pharmacology and physiology applications relevant to Anesthesia. The anesthesiologist could choose one of many scenarios that might be encountered by a clinical anesthesiologist. These programs allowed the learner to interpret information and make pharmacological and therapeutic decisions. Such simulators were novel and afforded a meaningful learning experience, especially for novice learners; however, they did not duplicate the application of practical skills and knowledge in a clinical environment in real time. In 1986, Gaba et al. at Stanford University developed a full-scale, high fidelity simulator (‘‘The Comprehensive Anesthesia Simulation Environment [CASE]’’) which allowed the anesthesiologist to manage critical situations. With Jeff Cooper in Boston, they developed an organized program called ‘‘Anesthesia Crisis Resource Management’’ (ACRM), applying principles from the airline industry where pilots and airline crew use ‘‘Crew Resource Management’’ programs to elicit human responses in a realistic environment. The objective of ACRM is to teach participants the importance of non-technical skills such as team working, task management, decision-making and situation awareness, focusing on communication and leadership skills. In the late 90s, several simulation centres appeared in Canada, led by anesthesiologists, to allow learners to practice difficult and rare scenarios without placing patients at risk. Today, simulation centres have been developed in over 50 centres across Canada, including many community colleges, in addition to hospitals and universities. In spite of the exponential growth of simulation, many professions and disciplines have been slow to recognize that simulationbased education is more than a teaching tool—it is a novel form of ‘‘experiential education’’, with which non-technical skills required in professional practice can be learned. Educators know that these are difficult (if not impossible) to teach in the clinical environment. Most Canadian academic departments of Anesthesia have been progressive in integrating simulation into the undergraduate and/or postgraduate curricula. Undergraduate medical students who are given time in an Anesthesia simulator, enthusiastically compete with each other to manage the airway, and pharmacologically treat simple hemodynamic problems. It is often their first opportunity to independently treat a ‘‘patient problem’’ and the majority find it very enjoyable and a great learning experience. At the postgraduate level, simulators are used to teach firstyear residents how to ‘‘troubleshoot’’ the Anesthesia Gas Machine through clinically relevant scenarios, and manage common intraoperative anesthetic problems. Postgraduate years 2–5 often spend at least two, three-hour sessions each year in the simulation center. They usually share this experience in a small group and are usually not in the same R. J. Byrick, MD (&) V. N. Naik, MD Department of Anesthesia, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada e-mail: robert.byrick@utoronto.ca