Background: Mechanical ventilation is widely used in neonates presenting with respiratory distress; however, it is not without complications. Early weaning of neonates is vital however the process of extubation is difficult to determine precisely. The use of lung ultrasound in neonates is recently accepted as a reliable tool in the assessment of several lung conditions. The aim of this study was to assess the use of lung ultrasound score as a quantitative method to assist in the decision of weaning mechanically ventilated neonates. Results: The study was conducted on 40 neonates admitted to the NICU with different causes of respiratory distress needing respiratory support by mechanical ventilation. Lung ultrasound was performed using a linear superficial probe at least three times, at admission, before switching mechanical ventilation mode and before weaning. The initial lung ultrasound score for all patients was between 9 and 36 (mean 25 ± 6.97, median 26) with the 11 patients initiated on Sync. Intermittent ventilation (SIMV) showing significantly lower scores than those initiated on assist/control ventilation (ACV). Patients successfully switched from ACV to SIMV showed significantly lower scores than those who failed. Patients successfully weaned from SIMV showed significantly lower scores than those who failed. ROC analysis showed a cut-off score of ≤ 14 had 85% sensitivity and 100% specificity for a successful switch between ACV to SIMV. It also showed that a score ≤ 6 had 87.5% sensitivity and 100% specificity for successful extubation. Conclusion: The use of quantitative lung ultrasound scores in assessment of mechanically ventilated neonates shows a great potential in aiding the process of weaning.
In the current study, a three-dimensional CFD model is utilized to investigate the variation of the flow structure and bed shear stress at a single cylindrical pier during scour development. The scour development is presented by seven solidified geometries of the scour hole, collected during previous experimental work at different scour stages. Different turbulence models are evaluated and the (k-ω) model is chosen due to its relative accuracy in capturing the flow oscillation and vortex shedding at the pier downstream side with personal computer computational and storage resources. The numerical results are verified against dimensionless parameters from different previous experimental works. This research describes in detail the flow structure and bed shear stress variations through seven stages of the scour hole development. The dimensionless area-averaged circulation coefficient (Ψi) is developed to evaluate the changes in the vortex strength through the scouring process by eliminating the calculation area effect. It was concluded that the circulation in the (Y) direction is the main driving factor in the development of the scour hole more than the circulation in the (X) direction. The ratio between the horseshoe vortex (HV) mean size and the scouring depth (DV/dS) in addition to the location of the maximum bed shear stress are investigated during different stages of the scour development.
Background: Several neonatal chest conditions require Invasive mechanical ventilation, which is lifesaving for the critically ill neonates. Limiting the duration of airway intubation and mechanical ventilator support is crucial. Weaning from mechanical ventilation induces significant changes in lung aeration which can be easily detected by lung sonography. Aim of the Work:Is to identify the role of pulmonary sonography in evaluation of the artificially ventilated neonates. Patients and Methods:The study included 40 neonates suffering from peripheral diseases requiring mechanical ventilation. All patients had chest ultrasound studies after clinical assessment. Chest ultrasound was performed during the different modes of mechanical ventilation including Assisted Controlled Ventilation (AC), Synchronized Intermittent Mechanical Ventilation (SIMV) and before extubation, follow-up the patients for 48 hours postextubation to assess if its failure occurred. Lung ultrasound was done using a standardized evaluation of lung aeration, i.e. Lung Ultrasound Score (LUS). Other traditional investigations including blood gases and chest X-ray were performed as well.Results: LUS was significantly higher in the 10 patients with post extubation failure. A cut off value of LUS of >13 was highly sensitive and specific for failure of switching from AC to SIMV mode and >6 prior to extubation was indicative of post extubation failure. Conclusion:Chest ultrasound provides a rapid, non invasive, objective and reliable tool for guiding the mechanical ventilation weaning process in neonates through the LUS with high confidence even when compared to other traditional indices as blood gases and respiratory mechanics. A cut off value of LUS of >13 was highly sensitive and specific for failure of switching from AC to SIMV mode and >6 prior to extubation was indicative of post extubation failure.
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