Background: Although there are many advances in the treatment of Acute Respiratory Distress Syndrome (ARDS), the mortality rate is still high (40%-60%). The new strategy \u2018protective ventilation\u2019 helped to lower the fatality rate and shortening the duration of mechanical ventilation in comparison with traditional modes. However, there is controversy about the effects of protective ventilation. Objectives: (1) To estimate the change of arterial blood gas and hemodynamic in the first 48hrs in the patients suffering from ALI or ARDS under protective ventilation. (2) To discover the disadvantages of this ventilation mode. Subjects: 30 ALI and ARDS patients (22 males and 8 females) treated at ICU, Viet Duc Hospital between April 2005 and October 2005. Method: Prospective and self-control study. Protective ventilation was applied for these patients. Artery blood gas, hemodynamic and disadvantages of protective ventilation were monitored during first 48hrs. Results: Protective ventilation significantly lowers airway pressure (p < 0.001). There was no change of PaCO2 (p > 0.05), and PaO2 was improved clearly after 12hrs of ventilation (p < 0.05). There were no significant changes of mean arterial pressure, heart rate and central venous pressure. 83.3% patients needed a high dose of sedation during protective ventilation. Conclusion: Protective ventilation lowered airway pressure, improved PaO2 and had no hemodynamic effect. However, patients required a high dose of sedation during this mode of ventilation.
Protective ventilation ; acute lung injury ; acute respiratory distress syndrome

Transmission of tuberculosis (TB) is a recognized risk to patients and healthcare workers in healthcare settings. The literature review suggests that implementation of combination control measures reduces the risk of TB transmission. Guidelines suggest a three-level hierarchy of controls including administrative, environmental, and respiratory protection. Among environmental controls, installation of ventilation systems is a priority because ventilation reduces the number of infectious particles in the air. Natural ventilation is cost-effective but depends on climatic conditions. Supplemented intervention such as air-cleaning methods including high efficiency particulate air filtration and ultraviolet germicidal irradiation should be considered in areas where adequate ventilation is difficult to achieve. Personal protective equipment including particulate respirators provides additional benefit when administrative and environmental controls cannot assure protection.
Delivery of Health Care ; Environment, Controlled ; Filtration ; Humans ; Infection Control* ; Personal Protective Equipment ; Tuberculosis* ; Ventilation ; Ventilators, Mechanical

PURPOSE: Personal protection equipment (PPE) is compulsory for the safety of physicians and patients in the presence of biological hazards. In particular, such equipment is required for airway management of patients with highly contagious respiratory diseases. However, there are only a few studies about the effect of PPE on airway management with various advanced airway devices including the newly developed video-laryngoscope. We conducted a study on the effect of PPE level C on airway management with five different types of advanced airway devices including the laryngeal mask airway (LMA), direct laryngoscope (DL), airwayscope (AWS), video-laryngoscope made by Stortz (DCI), and the Levitanscope (LE). METHODS: Twenty-two emergency physician and residents in two emergency centers were trained to do trials with PPE and without PPE while performing airway management with five different airway devices. The procedures were done on two types of manikins. We compared the time from the start of the procedure to the first successful ventilation for each device and for each type of manikin. A short questionnaire was used to examine participants' subjective experiences. RESULTS: For both types of manikin, there were no significant differences in performance time between the group not wearing PPE and the PPE wearing group for any device. However, when compared with the other devices, the performance time for the LMA was faster than the other devices, and the Levitanscope(R) took a significantly longer time in both groups. According to the questionnaires, the most comfortable & uncomfortable airway devices were the LMA and the Levitanscope(R). CONCLUSION: When PPE level C was compared with the no protection state, there were no significant statistical time differences for performing advanced airway management with any particular airway device.
Airway Management ; Biohazard Release ; Emergencies ; Humans ; Laryngeal Masks ; Laryngoscopes ; Manikins ; Protective Clothing ; Surveys and Questionnaires ; Ventilation

ventilation, using personal protective equipment, and developing awareness of FA's adverse effects. This study observed that both government and private colleges had better ventilation when more windows and doors were present, but active ventilation strategies like powerful exhaust, along with monitoring of FA level (personal or dissection hall), were needed. Students exposed to FA suffered eye and nose mucosal irritation. But faculty and workers with prolonged exposure to FA had more severe respiratory symptoms and suffered migraines. Hence personal FA monitoring and personal protective equipment must be made mandatory for those with prolonged exposure to FA. In addition, proper ventilation should be in place to reduce formalin vapours levels in workspaces.]]>
Cadaver ; Cost-Benefit Analysis ; Formaldehyde ; Humans ; Migraine Disorders ; Nose ; Personal Protective Equipment ; Ventilation

OBJECTIVETo study the filtration efficiency of a positive pressure powered air purifying medical protective equipment and the effect of the flow rate on the microenvironment of the equipment.

METHODSThe filtration efficiency of high efficiency particulate air (HEPA) filter was measured with the biologic aerosol of simulating virus (Escherichia coli bacteriophage f(2)). The simulation work was done at the walk rate of 4 km/h in summer. The effect of the flow rate on the oxygen content, the carbon dioxide content, the temperature and the humidity of the microenvironment of the equipment was investigated. The clinical experiments were conducted in three appointed hospital for fighting against SARS.

RESULTSThe HEPA filter could filtrate 99.99% simulating viruses in the air. When the flow rate ranged from 75 to 125 L/min, the microenvironment parameters of the equipment were: the oxygen content was between 19.6% and 20.1% (the physiological safety limit is more than 14.6%); the carbon dioxide content ranged from 0.43% to 0.57% (the physiological safety limit is less than 1.0%); the temperature was between 32.0 degrees C to 32.2 degrees C; the humidity ranged from 49.7% to 59.4% (the physiological safety limit is the temperature 31 degrees C and the humidity 85% or temperature 38 degrees C and humidity 50%). Each microenvironment parameter met the demand of a healthy person under the normal workload. In the clinical experiments, the doctors wearing the equipment who performed the tracheotomy for a SARS patient in a deep coma were not infected.

CONCLUSIONThe medical protective equipment can protect the doctor and nurse in SARS contaminated areas effectively and improve their work conditions.

Air ; analysis ; Air Microbiology ; Carbon Dioxide ; analysis ; Colony Count, Microbial ; Humans ; Humidity ; Occupational Medicine ; instrumentation ; Oxygen ; analysis ; Protective Devices ; Respiratory Protective Devices ; Temperature ; Ventilation

BACKGROUND: This study was conducted with aim of providing an overview of the current status of occupational health services and identifying the most common harmful agents at workplaces of Iranian self-employed enterprises (Nano-Scale Enterprises). METHODS: A cross-sectional study was performed among a random sample including 1,758 employees engaging in self-employed enterprises with 5 and less employees. RESULTS: Coverage of occupational health surveillance was very poor, annual health examinations were been conducted only for 64 (3.64%) of males and 31 (1.76%) of females, and occupational health trainings were not included of the services at all. Personal Protective Equipment were available in 462 (26.3%) of the enterprises. only in 0.4% of the enterprises working processes were been equipped by a local exhaust ventilation system. Difficult postures were the most common (81.5%) adverse working conditions. CONCLUSION: This study revealed a poor level of the implementation of occupational health services in Iranian self-employed enterprises. Based on the findings, providing basic training on the occupational health, more enforcing in conduction of health examinations and providing PPE, and taking appropriate strategies aimed at eliminating or minimizing work environment harmful agents are the major factor that should be considered to improve the level of occupational health services among the studied enterprises.
Cross-Sectional Studies ; Female ; Humans ; Iran* ; Male ; Occupational Health Services* ; Occupational Health* ; Personal Protective Equipment ; Posture ; Ventilation

OBJECTIVES: This study was carried out to determine the knowledge(K), attitude(A) and practice(P) on major industrial safety and health problems among on-the-job training students. METHODS: We used self-administered questionnaire regarding rules or regulations, the management of hazardous materials, the work place hygiene, the use of protective device, arrangement and improvement job site, ventilation, safety and health education, and inspection and management of equipment. RESULTS: In general, the mean score of KAP in educated group compared with non-educated group was significantly higher. As increasing the frequency of education, the mean scores of KAP were increased. There were not significant differences among 'work duration' groups on total mean scores of knowledge and practice. But on that of the attitude, there was significant differences among 'work duration'groups. There were significant differences among 'size of enterprise'groups on total mean scores of knowledge and attitude. But on that of the practice, there was no significant differences among'size of enterprise' groups. In stepwise multiple regression analysis, education frequency and method were significantly attributed to KAP, but the coefficient of determination were low. CONCLUSIONS: it is suggested that the increase of education time was the most important thing for improving the knowledge, attitude and practice on industrial safety and health in technical high school students.
Education ; Hazardous Substances ; Health Education ; Humans ; Hygiene ; Inservice Training ; Protective Devices ; Questionnaires ; Social Control, Formal ; Ventilation ; Workplace

BACKGROUND: This study aimed to assess the status of infection control during influenza A pandemic (H1N1) 2009. METHODS: A questionnaire survey was conducted in November 2009 at the 100 hospitals designated by the Korea Centers for Disease Control and Prevention (KCDC) as influenza A pandemic (H1N1) 2009-treatment institutions. RESULTS: In 32.3% of the hospitals, the ventilation system of the influenza A pandemic (H1N1) 2009 isolation ward was separated from the hospital's ventilation system. With regard to wearing personal protective equipment while caring for patients with H1N1 infection, during usual patient contact, masks were always worn by all medical staff at all the hospitals; however, medical staff at 38.7% and 51.6% of the hospitals did not wear gloves and gowns, respectively. During aerosol-generating procedures, some medical staff wore surgical masks, whereas medical staff at 10% and 23.3% of the hospitals did not wear gowns and protective goggles, respectively. In all, 64.5% of the hospitals responded that the contents of the guidelines established by the KCDC were insufficient for reference purposes in actual practice. CONCLUSION: Some of influenza A pandemic (H1N1) 2009-treatment institutions are believed to be inadequate in facilities, infection control during patient treatment, and administrative measures among their efforts to prevent transmission in hospital. In preparation against the outbreak of similar diseases in the future, the government needs to establish guidelines highly applicable by medical staff, to secure exclusive spaces and personnel for treating infectious disease patients, and to develop personal protective gear support and management systems.
Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Delivery of Health Care ; Eye Protective Devices ; Humans ; Infection Control ; Influenza, Human ; Korea ; Masks ; Medical Staff ; Pandemics ; Ventilation ; Surveys and Questionnaires

Health services on industrial noisy environment have been provided only for noise-induced hearing loss management until now. But gradually, modern diseases and death have come to be related to stress and mental health deeply, therefore noise-induced mental disorder, like a stress became very important. In this point, the purpose of this study was to analyze the relationship between noise exposure level in worksite and workers' stress symptoms. This study included a survey of 786 manual workers selected from 89 worksites in 21 factories in Puchon. The results were as follows: 1. For demographic characteristics, most of the workers were males(80.8%), the 20~29 years old were 34.5% and those who graduated from high school were 65.3%. The workers whose monthly income ranged from 500,000 to 800,000 won were 37.5% and who have a religion were 47.9%. 2. For occupational characteristics, workers who had worked 1~5 years in the factories were 33.0%. Those who felt much for them workload were 43.9% and who worked more than 8 hours a day were 73.9 %. Those who were dissatisfied with their job and pay were 31.9% and 50.6%. The workers who responded ventilation condition of their worksites were bad were 51.9% and the dissatisfied with working environment of their wofksites were 45.9%. 3. Workers who were suffering from tinnitus were 53.3% and those who perceived hearing loss were 50.l%. Persons who reported they always wore earplugs at work were 35.4%. Those who felt earplugs bigger than their ears were 30.6% and those who experienced eardiseases caused by earplugs were 25.6%. 4. For the noise exposure level in worksite, workers who were exposed to 80-90dB were 30.3%, 90-100dB were 26.4% and 50~70dB were 19.2%. 5. workers' stress symptoms were significantly related to marital status and their monthly income p< 0.05). Workers who were single and had lower monthly income showed higher PSl (Psychiatric symptom Index) scores than those who were married and had higher monthly income. Higher PSl scores were also significantly related to l~2 days night-work per week, much for them workload, dissatisfaction with their job, and bad relationship with their bosses and coworkers. 6. Higher PSl scores were significantly related to severe tinnitus and perceived hearing loss p<0.001). Workers who felt the earplugs they use did not fit their ears showed significantly higher PSl scores(p<0.01). Workers who reported that they did not feel they need earplugs showed significantly higher PSl scores(p<0.05). Increased experience of eardisease caused by earplugs that did not fit were also significantly related to higher PSl scores(p<0.001). 7. The higher noise exposure level in worksite from 80dB was, the more severe stress symptoms including PSl subparts were reported; Anxiety, Anger, Depression, and cognitive disorder(p<0.001). 8. According to the results of stepwise multiple regression analysis, factors affecting workers' PSl scores were perceived hearing loss(R2=0.160), noise exposure level jn worksite(R2=0.110), relationship with coworkers, amount of workload, monthly income and relationship with bosses orderly and the total R2 of this 6 factors was 0.371. 9. The most significant factors that have impact on manual workers' stress symptoms were perceived hearing loss and noise exposure level in worksite, especially noise exposure level in the worksite was the most affective factor on the depression symptom.
Anger ; Anxiety ; Depression ; Ear ; Ear Protective Devices ; Gyeonggi-do ; Health Services ; Hearing ; Hearing Loss ; Hearing Loss, Noise-Induced ; Humans ; Marital Status ; Mental Disorders ; Mental Health ; Noise* ; Tinnitus ; Ventilation ; Workplace*

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.
Anti-Bacterial Agents ; Bronchodilator Agents ; Carbon Dioxide ; Catheters ; Head Protective Devices ; Humans ; Intubation ; Mortality ; Noninvasive Ventilation ; Oxygen ; Oxygen Inhalation Therapy ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency* ; Steroids