Rationale: One important concern during high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemic respiratory failure is to not delay intubation.Objectives: To validate the diagnostic...

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201803-0589OC

An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy

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Background: 
High-flow nasal cannulae (HFNC) create positive oropharyngeal airway pressure but it is unclear how their use affects lung volume. Electrical impedance tomography (EIT) allows assessment of changes in lung volume by measuring changes in lung impedance. Primary objectives were to investigate the effects of HFNC on airway pressure (Paw) and end-expiratory lung volume (EELV), and to identify any correlation between the two. Secondary objectives were to investigate the effects of HFNC on respiratory rate (RR), dyspnoea, tidal volume and oxygenation; and the interaction between body mass index (BMI) and EELV.

Methods: 
Twenty patients prescribed HFNC post-cardiac surgery were investigated. Impedance measures, Paw, PaO2/FiO2 ratio, RR and modified Borg scores were recorded first on low flow oxygen (nasal cannula or Hudson face mask) and then on HFNC.

Results: A strong and significant correlation existed between Paw and end-expiratory lung impedance (EELI) (r=0.7, p<0.001). Compared with low flow oxygen, HFNC significantly increased EELI by 25.6% (95% CI 24.3, 26.9) and Paw by 3.0 cmH2O (95% CI 2.4, 3.7). RR reduced by 3.4 breaths per minute (95% CI 1.7, 5.2) with HFNC use, tidal impedance variation increased by 10.5% (95% CI 6.1, 18.3) and PaO2/FiO2 ratio improved by 30.6 mmHg (95% CI 17.9, 43.3). HFNC improved subjective dyspnoea scoring (p=0.023). Increases in EELI were significantly influenced by BMI, with larger increases associated with higher BMIs (p<0.001).

Conclusions: 
This study suggests that HFNC improve dyspnoea and oxygenation by increasing both EELV and tidal volume, and are most beneficial in patients with higher BMIs.

Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients

Lysophosphatidylcholines are a group of bioactive lipids heavily investigated in the context of inflammation and atherosclerosis development While present in plasma during physiological conditions, their concentration can drastically increase in certain inflammatory states Lysophosphatidylcholines are widely regarded as potent pro-inflammatory and deleterious mediators, but an increasing number of more recent studies show multiple beneficial properties under various pathological conditions Many of the discrepancies in the published studies are due to the investigation of different species or mixtures of lysophatidylcholines and the use of supra-physiological concentrations in the absence of serum or other carrier proteins Furthermore, interpretation of the results is complicated by the rapid metabolism of lysophosphatidylcholine (LPC) in cells and tissues to pro-inflammatory lysophosphatidic acid Interestingly, most of the recent studies, in contrast to older studies, found lower LPC plasma levels associated with unfavorable disease outcomes Being the most abundant lysophospholipid in plasma, it is of utmost importance to understand its physiological functions and shed light on the discordant literature connected to its research LPCs should be recognized as important homeostatic mediators involved in all stages of vascular inflammation In this review, we want to point out potential pro- and anti-inflammatory activities of lysophospholipids in the vascular system and highlight recent discoveries about the effect of lysophosphatidylcholines on immune cells at the endothelial vascular interface We will also look at their potential clinical application as biomarkers

https://www.mdpi.com/1422-0067/21/12/4501/pdf

An Updated Review of Pro- and Anti-Inflammatory Properties of Plasma Lysophosphatidylcholines in the Vascular System

High-flow nasal cannula oxygenation has distinct advantages over other oxygen devices because of its unique effects on respiratory physiology. In particular, adjustable oxygen delivery and flow-dependent carbon dioxide clearance reduce work of breathing and better match inspiratory demand during respiratory distress. Historically, few studies had evaluated whether the physiologic effects of these devices translated into clinical benefit. However, recent publications have begun to address this knowledge gap. High-flow nasal cannula oxygenation has been shown to have similar, and in some cases superior clinical efficacy compared with conventional low-flow oxygen supplementation and noninvasive positive pressure ventilation in acute hypoxemic respiratory failure. High-flow nasal cannula oxygenation also prevents reintubations in medical and postoperative surgical populations, provides preoxygenation for laryngoscopy, and supports oxygenation during bronchoscopy. This review examines the evidence for high-flow nasal cannula oxygenation use in adults, including a focus on the unique effects of high flow on respiratory physiology and keys for tailoring flow for specific clinical scenarios.

https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201707-548FR

High-Flow Nasal Cannula Oxygen in Adults: An Evidence-based Assessment.

This paper focuses on the feasibility of fuzzy logic control for networked control systems (NCSs). In order to evaluate its feasibility, a networked control system for servo motor control is implemented on a Profibus-DP network. The NCS consists of several independent, but interacting, processes running on two separate stations. By using this NCS, the network-induced delay is analyzed to find the cause of the delay. Furthermore, the fuzzy logic controller's performance is compared with that of conventional proportional-integral-derivative controllers. Based on the experimental results, it is found that the fuzzy logic controller can be a viable choice for an NCS due to its robustness against parameter uncertainty.

Remote fuzzy logic control of networked control system via Profibus-DP

Objective High-flow nasal cannula (HFNC) therapy is an oxygen delivery system. However, evidence regarding the clinical applications of HFNC is still emerging. We herein evaluated the clinical predictors of HFNC therapy success for adult patients with acute hypoxemic respiratory failure. Methods We retrospectively reviewed the medical records of the subjects with acute hypoxemic respiratory failure supported by HFNC therapy in the medical intensive care unit between July 2011 and March 2013. Therapy success was defined as the avoidance of intubation. The patients' baseline characteristics and the serial changes in the respiratory parameters after HFNC therapy at 1 and 24 hours were measured. Results Of the 75 eligible patients, 62.7% successfully avoided intubation. Overall, HFNC therapy significantly improved the physiologic parameters, such as partial pressure of arterial oxygen (PaO2), saturation of arterial oxygen (SaO2), respiratory rate (RR), and heart rate (HR), throughout the first 24 hours. After the adjustment for the other clinical variables, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), cardiogenic pulmonary edema, and PaO2 improvement at 1 and 24 hours were associated with therapy success. The overall intensive care unit (ICU) mortality was 25.3%. However, out of 37.3% of the patients who required intubation, the ICU mortality in this proportion of patients was 67.9%. The ICU mortality in the therapy failure group was associated with the use of a vasopressor and a limited PaO2 improvement at 1 hour. Conclusion HFNC therapy showed a good compliance and the improvement of the physiologic parameters in an adult population. The failure to improve oxygenation within 24 hours was a useful predictor of intubation. Among the failure group, the vasopressor use and failed oxygenation improvement were associated with ICU mortality.

https://www.jstage.jst.go.jp/article/internalmedicine/54/18/54_54.4266/_pdf

High-Flow Nasal Cannula Therapy for Acute Hypoxemic Respiratory Failure in Adults: A Retrospective Analysis

Performance management of computer networks is intended to improve a given network performance in order for more efficient information exchange between subsystems of an integrated large-scale system. Importance of perfomance management is growing as many functions of the large- scale system depend on the quality of communication services provided by the network. The role of performance management is to manipulate the adjustable protocol parameters on line so that the network can adapt itself to a dynamic environment. This can be divided into two subtasks : performance evaluation to find how changes in protocol parameters affect the network performance and decision making to determine the magnitude and direction of parameter adjustment. This paper is the first part of the two papers focusing on conceptual design, development, and evaluation of performance management for token bus networks. This paper specifically deals with the task of performance evaluation which utilizes the principle of perturbation analysis of discrete event dynamic systems. The developed algorithm can estimate the network performance under a perturbed protocol parameter setting from observations of the network operations under a nominal parameter setting

Performance management of communication networks for computer integrated manufacturing

Association between Anxiety, Depression and Asthma

Clozapine blood concentration is a predictor of QTc prolongation in patients with psychosis using clozapine

8477 Uterine Artery Embolization Via Transradial Versus Transfemoral Arterial Access: Technical and Clinical Results

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