AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) ...AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.展开更多
BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM...BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM To investigate the clinical efficacy of high-flow nasal cannula oxygen(HFNCO)in the resuscitation period of older orthopedic patients.METHODS In this prospective randomized controlled trial,60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups:those who used conventional face mask and those who used HFNCO.All patients were treated with 60%oxygen for 1 h after extubation.Patients in the conventional face mask group were treated with a combination of air(2 L)and oxygen(2 L)using a traditional mask,whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34℃ and flow rate of 40 L/min.We assessed the effectiveness of oxygen therapy by monitoring the patients’arterial blood gas,peripheral oxygen saturation,and postoperative complications.RESULTS The characteristics of the patients were comparable between the groups.One hour after extubation,patients in HFNCO group had a significantly higher arterial partial pressure of oxygen(paO_(2))than that of patients in conventional face mask group(P<0.001).At extubation and 1 h after extubation,patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide(paCO_(2))than the baseline levels(P<0.001).There were no differences in the saturation of peripheral oxygen,paO_(2),and paCO_(2) between the groups before anesthesia and before extubation(P>0.05).There were statistically significant differences in paO_(2) between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation(P<0.001).However,there were no significant differences in the oxygen tolerance score before leaving the room,airway humidification,and pulmonary complications 3 d after surgery between the two groups(P>0.05).CONCLUSION HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia.Thus,HFNCO can be used to prevent postoperative hypoxemia.展开更多
Air flow control is one of the most important control methods for maintaining the stability and reliability of a fuel cell system, which can avoid oxygen starvation or oxygen saturation. The oxygen excess ratio （OER...Air flow control is one of the most important control methods for maintaining the stability and reliability of a fuel cell system, which can avoid oxygen starvation or oxygen saturation. The oxygen excess ratio （OER） is often used to indicate the air flow condition. Based on a fuel cell system model for vehicles, OER performance was analyzed for different stack currents and temperatures in this paper, and the results show that the optimal OER was affected weakly by the stack temperature. In order to ensure the system working in optimal OER, a control scheme that includes an optimal OER regulator and a fuzzy control was proposed. According to the stack current, a reference value of air flow rate was obtained with the optimal OER regulator and then the air compressor motor voltage was controlled with the fuzzy controller to adjust the air flow rate provided by the air compressor. Simulation results show that the control method has good dynamic and static characteristics.展开更多
Four different pulverized coals have been used to study the effects of oxygen concentration on combustion characteristics under different enriched-oxygen conditions by entrained flow reactor experiments. The results s...Four different pulverized coals have been used to study the effects of oxygen concentration on combustion characteristics under different enriched-oxygen conditions by entrained flow reactor experiments. The results show that: with the increase of oxygen concentration, the ignition temperature of four coals greatly decreases and the low volatile coals decrease faster; with the increase of oxygen concentration, the ignition mode of pulverized coal has an obviously transformation from homogeneous ignition to heterogeneous ignition, and the corresponding oxygen concentrations are about 40% and 50%-60% respectively for bituminous coal and lignite, and both about 30% for lean coal and anthracite; with the increase of oxygen concentration, the optimal pulverized coal concentrations of bituminous coal and lignite increase firstly and then decrease, but for lean coal and anthracite, the optimal pulverized coal concentrations decrease slowly with the increase of oxygen concentration.展开更多
Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to inve...Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.展开更多
The traditional practice of employing a two-stage coal-fed gasification process is to feed all of the oxygen to provide a vigorous amount of combustion in the first stage but only feed the coal without oxygen in the s...The traditional practice of employing a two-stage coal-fed gasification process is to feed all of the oxygen to provide a vigorous amount of combustion in the first stage but only feed the coal without oxygen in the second stage to allow the endothermic gasification process to occur downstream of the second stage. One of the merits of this 2-stage practice is to keep the gasifier temperature low downstream from the 2nd stage. This helps to extend the life of refractory bricks, decrease gasifier shut-down frequency for scheduled maintenance, and reduce the maintenance costs. In this traditional 2-stage practice, the temperature reduction in the second stage is achieved at the expense of a higher than normal temperature in the first stage. This study investigates a concept totally opposite to the traditional two-stage coal feeding practices in which the injected oxygen is split between the two stages, while all the coal is fed into the first stage. The hypothesis of this two-stage oxygen injection is that a distributed oxygen injection scheme can also distribute the release of heat to a larger gasifier volume and, thus, reduce the peak temperature distribution in the gasifier. The increased life expectancy and reduced maintenance of the refractory bricks can prevail in the entire gasifier and not just downstream from the second stage. In this study, both experiments and computational simulations have been performed to verify the hypothesis. A series of experiments conducted at 2.5 - 3.0 bars shows that the peak temperature and temperature range in the gasifier do decrease from 600?C - 1550?C with one stage oxygen injection to 950?C - 1230?C with a 60 - 40 oxygen split-injection. The CFD results conducted at 2.5 bars show that 1) the carbon conversion ratio for different oxygen injection schemes are all above 95%;2) H2 (about 70% vol.) dominates the syngas composition at the exit;3) the 80% - 20% case yields the lowest peak temperature and the most uniform temperature distribution along the gasifier;and 4) the 40% - 60% case produces the syngas with the highest HHV. Both experimental data and CFD predictions verify the hypothesis that it is feasible to reduce the peak temperature and achieve more uniform temperature in the gasifier by adequately controlling a two-stage oxygen injection with only minor changes of the composition and heating value of the syngas.展开更多
基金Supported by The Department of Anesthesiology and Perioperative Medicine,Tufts Medical Center,Boston,United States
文摘AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.
文摘BACKGROUND Hypoxemia is a common complication in older patients during postoperative recovery and can cause pulmonary complications.Therefore,reducing the incidence of postoperative hypoxemia is a clinical concern.AIM To investigate the clinical efficacy of high-flow nasal cannula oxygen(HFNCO)in the resuscitation period of older orthopedic patients.METHODS In this prospective randomized controlled trial,60 older patients who underwent orthopedic surgery under general anesthesia were randomly divided into two groups:those who used conventional face mask and those who used HFNCO.All patients were treated with 60%oxygen for 1 h after extubation.Patients in the conventional face mask group were treated with a combination of air(2 L)and oxygen(2 L)using a traditional mask,whereas those in the HFNCO group were treated with HFNCO at a constant temperature of 34℃ and flow rate of 40 L/min.We assessed the effectiveness of oxygen therapy by monitoring the patients’arterial blood gas,peripheral oxygen saturation,and postoperative complications.RESULTS The characteristics of the patients were comparable between the groups.One hour after extubation,patients in HFNCO group had a significantly higher arterial partial pressure of oxygen(paO_(2))than that of patients in conventional face mask group(P<0.001).At extubation and 1 h after extubation,patients in both groups showed a significantly higher arterial partial pressure of carbon dioxide(paCO_(2))than the baseline levels(P<0.001).There were no differences in the saturation of peripheral oxygen,paO_(2),and paCO_(2) between the groups before anesthesia and before extubation(P>0.05).There were statistically significant differences in paO_(2) between the two groups before anesthesia and 1 h after extubation and immediately after extubation and 1 h after extubation(P<0.001).However,there were no significant differences in the oxygen tolerance score before leaving the room,airway humidification,and pulmonary complications 3 d after surgery between the two groups(P>0.05).CONCLUSION HFNCO can improve oxygen partial pressure and respiratory function in elderly patients undergoing orthopedic surgery under general endotracheal anesthesia.Thus,HFNCO can be used to prevent postoperative hypoxemia.
基金supported by the National Natural Science Foundation of China (No. 51177138)the Research Fund for the Doctoral Program of High Education of China (No.20100184110015)Sichuan Province International Technology Cooperation and Exchange Program (No. 2012HH0007)
文摘Air flow control is one of the most important control methods for maintaining the stability and reliability of a fuel cell system, which can avoid oxygen starvation or oxygen saturation. The oxygen excess ratio （OER） is often used to indicate the air flow condition. Based on a fuel cell system model for vehicles, OER performance was analyzed for different stack currents and temperatures in this paper, and the results show that the optimal OER was affected weakly by the stack temperature. In order to ensure the system working in optimal OER, a control scheme that includes an optimal OER regulator and a fuzzy control was proposed. According to the stack current, a reference value of air flow rate was obtained with the optimal OER regulator and then the air compressor motor voltage was controlled with the fuzzy controller to adjust the air flow rate provided by the air compressor. Simulation results show that the control method has good dynamic and static characteristics.
文摘Four different pulverized coals have been used to study the effects of oxygen concentration on combustion characteristics under different enriched-oxygen conditions by entrained flow reactor experiments. The results show that: with the increase of oxygen concentration, the ignition temperature of four coals greatly decreases and the low volatile coals decrease faster; with the increase of oxygen concentration, the ignition mode of pulverized coal has an obviously transformation from homogeneous ignition to heterogeneous ignition, and the corresponding oxygen concentrations are about 40% and 50%-60% respectively for bituminous coal and lignite, and both about 30% for lean coal and anthracite; with the increase of oxygen concentration, the optimal pulverized coal concentrations of bituminous coal and lignite increase firstly and then decrease, but for lean coal and anthracite, the optimal pulverized coal concentrations decrease slowly with the increase of oxygen concentration.
文摘Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.
文摘The traditional practice of employing a two-stage coal-fed gasification process is to feed all of the oxygen to provide a vigorous amount of combustion in the first stage but only feed the coal without oxygen in the second stage to allow the endothermic gasification process to occur downstream of the second stage. One of the merits of this 2-stage practice is to keep the gasifier temperature low downstream from the 2nd stage. This helps to extend the life of refractory bricks, decrease gasifier shut-down frequency for scheduled maintenance, and reduce the maintenance costs. In this traditional 2-stage practice, the temperature reduction in the second stage is achieved at the expense of a higher than normal temperature in the first stage. This study investigates a concept totally opposite to the traditional two-stage coal feeding practices in which the injected oxygen is split between the two stages, while all the coal is fed into the first stage. The hypothesis of this two-stage oxygen injection is that a distributed oxygen injection scheme can also distribute the release of heat to a larger gasifier volume and, thus, reduce the peak temperature distribution in the gasifier. The increased life expectancy and reduced maintenance of the refractory bricks can prevail in the entire gasifier and not just downstream from the second stage. In this study, both experiments and computational simulations have been performed to verify the hypothesis. A series of experiments conducted at 2.5 - 3.0 bars shows that the peak temperature and temperature range in the gasifier do decrease from 600?C - 1550?C with one stage oxygen injection to 950?C - 1230?C with a 60 - 40 oxygen split-injection. The CFD results conducted at 2.5 bars show that 1) the carbon conversion ratio for different oxygen injection schemes are all above 95%;2) H2 (about 70% vol.) dominates the syngas composition at the exit;3) the 80% - 20% case yields the lowest peak temperature and the most uniform temperature distribution along the gasifier;and 4) the 40% - 60% case produces the syngas with the highest HHV. Both experimental data and CFD predictions verify the hypothesis that it is feasible to reduce the peak temperature and achieve more uniform temperature in the gasifier by adequately controlling a two-stage oxygen injection with only minor changes of the composition and heating value of the syngas.
