Resource-scarce regions with serious COVID-19 outbreaks do not have enough ventilators to support critically ill patients,and these shortages are especially devastating in developing countries.To help alleviate this s...Resource-scarce regions with serious COVID-19 outbreaks do not have enough ventilators to support critically ill patients,and these shortages are especially devastating in developing countries.To help alleviate this strain,we have designed and tested the accessible low-barrier in vivo-validated economical ventilator(ALIVE Vent),a COVID-19-inspired,cost-effective,open-source,in vivo-validated solution made from commercially available components.The ALIVE Vent operates using compressed oxygen and air to drive inspiration,while two solenoid valves ensure one-way flow and precise cycle timing.The device was functionally tested and profiled using a variable resistance and compliance artificial lung and validated in anesthetized large animals.Our functional test results revealed its effective operation under a wide variety of ventilation conditions defined by the American Association of Respiratory Care guidelines for ventilator stockpiling.The large animal test showed that our ventilator performed similarly if not better than a standard ventilator in maintaining optimal ventilation status.The FiO2,respiratory rate,inspiratory to expiratory time ratio,positive-end expiratory pressure,and peak inspiratory pressure were successfully maintained within normal,clinically validated ranges,and the animals were recovered without any complications.In regions with limited access to ventilators,the ALIVE Vent can help alleviate shortages,and we have ensured that all used materials are publicly available.While this pandemic has elucidated enormous global inequalities in healthcare,innovative,cost-effective solutions aimed at reducing socio-economic barriers,such as the ALIVE Vent,can help enable access to prompt healthcare and life saving technology on a global scale and beyond COVID-19.展开更多
Objective: Robotic technology is a prerequisite for performance of totally endoscopic coronary artery bypass grafting. During the implementation phase of totally endoscopic coronary artery bypass, surgeon-related tech...Objective: Robotic technology is a prerequisite for performance of totally endoscopic coronary artery bypass grafting. During the implementation phase of totally endoscopic coronary artery bypass, surgeon-related technical difficulties might be encountered. It was the aim of this study to assess the incidence of these challenges, to find risk factors, and to describe clinical results associated with technical errors. Methods: From October 2001 through October 2004, 40 patients received robotically assisted totally endoscopic left internal thoracic artery grafts to the left anterior descending coronary artery system with the da Vinci telemanipulation device. All patients underwent remote access cardiopulmonary bypass perfusion through groin access, and all anastomoses were performed on the arrested heart. Results: Undesirable technical events of various grades occurred in 20(50% ) of 40 patients: bleeding from a port hole in 3(8% ), left internal thoracic artery damage in 3(8% ), epicardial lesion in 3(8% ), remote access perfusion problems in 9(23% ), bleeding from the anastomosis in 4(10% ), and anastomotic stenosis in 2(5% ). There was no hospital mortality. The following differences were noted between patients without technical difficulties(group 1) and those in whom problems occurred(group 2): total operative time of 314 minutes(260- 540 minutes) versus 418 minutes(270- 690 minutes; P=.007), ventilation time of 6 hours(0- 26 hours) versus 14 hours(0- 278 hours; P=.004), intensive care unit stay of 20 hours(11- 70 hours) versus 44 hours(16- 336 hours; P=.183), hospital stay of 7 days(4- 13 days) versus 8 days(5- 21 days; P=.038), and cumulative freedom from angina at 36 months of 93% versus 100% (P= .317). Conclusion: We conclude that technical difficulties during totally endoscopic coronary artery bypass grafting translate into markedly increased operative time, moderately prolonged postoperative ventilation time, and slightly increased hospital stay. Short-term survival and freedom from angina, however, do not seem to be compromised.展开更多
基金the National Institutes of Health(NIH R01 HL089315-01 and NIH R01 HL152155,YJW)the Thoracic Surgery Foundation Resident Research Fellowship(YZ)the National Science Foundation Graduate Research Fellowship Program(AMI).
文摘Resource-scarce regions with serious COVID-19 outbreaks do not have enough ventilators to support critically ill patients,and these shortages are especially devastating in developing countries.To help alleviate this strain,we have designed and tested the accessible low-barrier in vivo-validated economical ventilator(ALIVE Vent),a COVID-19-inspired,cost-effective,open-source,in vivo-validated solution made from commercially available components.The ALIVE Vent operates using compressed oxygen and air to drive inspiration,while two solenoid valves ensure one-way flow and precise cycle timing.The device was functionally tested and profiled using a variable resistance and compliance artificial lung and validated in anesthetized large animals.Our functional test results revealed its effective operation under a wide variety of ventilation conditions defined by the American Association of Respiratory Care guidelines for ventilator stockpiling.The large animal test showed that our ventilator performed similarly if not better than a standard ventilator in maintaining optimal ventilation status.The FiO2,respiratory rate,inspiratory to expiratory time ratio,positive-end expiratory pressure,and peak inspiratory pressure were successfully maintained within normal,clinically validated ranges,and the animals were recovered without any complications.In regions with limited access to ventilators,the ALIVE Vent can help alleviate shortages,and we have ensured that all used materials are publicly available.While this pandemic has elucidated enormous global inequalities in healthcare,innovative,cost-effective solutions aimed at reducing socio-economic barriers,such as the ALIVE Vent,can help enable access to prompt healthcare and life saving technology on a global scale and beyond COVID-19.
文摘Objective: Robotic technology is a prerequisite for performance of totally endoscopic coronary artery bypass grafting. During the implementation phase of totally endoscopic coronary artery bypass, surgeon-related technical difficulties might be encountered. It was the aim of this study to assess the incidence of these challenges, to find risk factors, and to describe clinical results associated with technical errors. Methods: From October 2001 through October 2004, 40 patients received robotically assisted totally endoscopic left internal thoracic artery grafts to the left anterior descending coronary artery system with the da Vinci telemanipulation device. All patients underwent remote access cardiopulmonary bypass perfusion through groin access, and all anastomoses were performed on the arrested heart. Results: Undesirable technical events of various grades occurred in 20(50% ) of 40 patients: bleeding from a port hole in 3(8% ), left internal thoracic artery damage in 3(8% ), epicardial lesion in 3(8% ), remote access perfusion problems in 9(23% ), bleeding from the anastomosis in 4(10% ), and anastomotic stenosis in 2(5% ). There was no hospital mortality. The following differences were noted between patients without technical difficulties(group 1) and those in whom problems occurred(group 2): total operative time of 314 minutes(260- 540 minutes) versus 418 minutes(270- 690 minutes; P=.007), ventilation time of 6 hours(0- 26 hours) versus 14 hours(0- 278 hours; P=.004), intensive care unit stay of 20 hours(11- 70 hours) versus 44 hours(16- 336 hours; P=.183), hospital stay of 7 days(4- 13 days) versus 8 days(5- 21 days; P=.038), and cumulative freedom from angina at 36 months of 93% versus 100% (P= .317). Conclusion: We conclude that technical difficulties during totally endoscopic coronary artery bypass grafting translate into markedly increased operative time, moderately prolonged postoperative ventilation time, and slightly increased hospital stay. Short-term survival and freedom from angina, however, do not seem to be compromised.
