Analysis on the Effect of Yiqi Huoxue Decoction Combined with Neuromuscular Electrical Stimulation in Improving ICU-Acquired Debility in Mechanically Ventilated Patients

Objective:To investigate the effect of Yiqi Huoxue decoction combined with neuromuscular electrical stimulation on improving intensive care unit(ICU)acquired debility in mechanically ventilated patients.Methods:50 patients who were admitted to the ICU and received mechanical ventilation treatment in our hospital from June 2022 to June 2023 and were complicated with ICU-acquired neurasthenia were selected,and randomly grouped using the randomized envelope method into two groups:control group with 25 patients who received neuromuscular electrical stimulation alone;observation group with 25 patients who received the traditional Chinese medicine Yiqi Huoxue decoction.Comparison indexes:treatment efficiency,degree of emotional recovery(APACHEⅡscore),muscle strength status(MRC score),motor status(FAC rating),and self-care ability(BI index score).Results:The treatment efficiency of patients in the observation group patients was higher as compared to those in the control group(P<0.05).There was no significant difference in the comparison of the results of the scores(ratings)of each index between the two groups before treatment(P>0.05).After the treatment,the APACHEⅡscores of patients in the observation group were significantly lower as compared to those in the control group,while the MRC scores,FAC ratings,and BI index scores were higher in the observation group than those of the control group patients(P<0.05).Conclusion:The combined application of Yiqi Huoxue decoction and neuromuscular electrical stimulation in the treatment of patients with ICU-acquired neurasthenia complicated by mechanical ventilation significantly enhanced the clinical efficacy,the patient’s muscle strength,motor status,and ability of self-care.Hence,it has high application value and is worthy to be popularized.

Application Effect of Stratified Nursing Intervention for ICU Mechanically Ventilated Patients in the Context of Aspiration Risk Assessment

Objective:To explore the application effect of stratified nursing intervention based on the background of misinspiration risk assessment in mechanically ventilated patients in intensive care unit(ICU).Methods:100 cases of mechanically ventilated patients who were admitted to the ICU of our hospital from March 2022 to March 2023 were selected and divided into an observation group and a control group according to the random number table method,with 50 cases in each of the two groups.The control group was given routine care in ICU,and the observation group was given stratified nursing interventions based on the background of the risk of aspiration assessment on the basis of the control group,and both groups were cared for until they were transferred out of the ICU,and the mechanical ventilation time,ICU stay time,muscle strength score,complication rate,adherence,and satisfaction were observed and compared between the two groups.Results:The mechanical ventilation time and ICU stay time of the observation group were shorter than that of the control group after the intervention;the muscle strength score,compliance and satisfaction of the observation group were higher than that of the control group after the intervention;and the complication rate of the observation group was lower than that of the control group after the intervention,all of which were P<0.05.Conclusion:The application of stratified nursing intervention based on the background of misaspiration risk assessment in ICU mechanically ventilated patients can improve the patient's muscle strength,shorten the time of mechanical ventilation,promote the patient's recovery,reduce the occurrence of complications,and improve the patient's compliance and satisfaction.

Smoke distribution in naturally ventilated urban transportation tunnels with multiple shafts

The smoke spreading law of urban transportation tunnels with multiple shafts under natural ventilation is studied.A full-scale burning experiment is conducted in an actual tunnel.The study shows that smoke temperatures below the tunnel ceiling reduce rapidly along the longitudinal towards the tunnel exits. A noticeable temperature stratification is observed near the fire source.Most fire smoke is exhausted out of the shafts while the number of the smoke shafts in the downstream is more than that in the upstream.Large eddy simulation LES based on computational fluid dynamics CFD is carried out using the fire dynamics simulator FDS software with parallel processing in which the grid size of the fire-domain is set to be 0.083 m.The simulation results of temperatures under the ceiling the smoke fronts and the shafts＇smoke exhaust or air supply agree reasonably with the experimental data. Further simulations indicate that the decreasing ambient temperature or shaft spacing might reduce smoke temperatures under the tunnel ceiling and increase mass flow rates out of the shafts.This study provides technical scientific evidence and supports for the design and construction of such kinds of tunnels.

Fuzzy Evaluation of Thermal Comfort in Naturally Ventilated Residential Buildings in China

In order to assess the differences between the human body thermal sensation in naturally ventilated space and that in air-conditioned space,the fuzzy evaluation model was adopted in the research of thermal sensation in naturally ventilated space.Based on the questionnaires and field measurements,the membership functions were presented by the statistic of the covering frequency to the fuzzy subset.Dry-bulb temperature was taken as the only independent variable for membership functions.The maximum values of membership grades are all at 0.5 or so,which is a distinction character on thermal comfort of naturally ventilated space.By the calculating results of membership grades value to different fuzzy evaluation subsets,the Predicted Mean Vote(PMV)was obtained.Furthermore,energy coefficient(Ea)was introduced to calculate the energy consumption,and the prediction methods of residential building energy consumption were also discussed.Finally,the importance of evaluation model of thermal sense is shown through the energy consumption prediction in a specific residential building.

THREE DIMENSIONAL MULTIPHASE COMPUTATIONAL FLUID DYNAMICS ANALYSIS OF VENTILATED SUPERCAVITATION

For some vehicles travelling through water, it is advantageous to cover the vehicle in a supercavity for the sake of reducing the drag acting on it. The method of artificial ventilation is most effective for generating and dominating the supercavity. This paper focuses on the numerical simulation of flow field around three dimensional body. The method is based on the multiphase computational fluid dynamics （CFD） model combined with the turbulence model and the full cavity model. The flow field of cavity is simulated by solving the compressible Navier-Stokes equations. The fundamental similarity parameters of ventilated supercavitaty flows that include cavitation number, Froude number, ventilation rate and drag coefficient are all investigated numerically in the case of steady flow and gravity field. We discuss the following simulations results in section 3： The variations of the cavitation number and the supercavity＇s relative diameter with ventilation rate （subtopic 3.1）; The drag coefficient versus the cavitation number （subtopic 3.2）; Deformation of supercavity axis caused by gravitational effect for three different fixed Froude numbers-2.8, 3.4, 4.2 （subtopic 3.3）. In subtopic 3.2, we give the comparison results of the drag reduction ratio among numerical simulation and experiment conducted in hydrodynamic tunnel and towing tank respectively. In subtopic 3.3, we summarize our discussion of gravitational effect on the axis deformation of supercavity as follows： In the case of smaller Froude number, the inclination of the cavity axis increases monotonously with increasing horizontal length, and reaches its maximal value at the end of supercavity; This deformation can be almost completely negligible when the Froude number Fr〉7. The comparisons with the experimental data in the hydrodynamic tunnel and the towing tank indicate that the present method is effective for predicting the flows around ventilated supercavity; that the numerical results is in good agreement with the experimental ones and that the maximal value of the drag reduction ratio can reach 88% compared with that the condition of fully-wetted.

Expiratory flow-limitation in mechanically ventilated patients: A risk for ventilator-induced lung injury?

Expiratory flow limitation(EFL), that is the inability of expiratory flow to increase in spite of an increase of the driving pressure, is a common and unrecognized occurrence during mechanical ventilation in a variety of intensive care unit conditions. Recent evidence suggests that the presence of EFL is associated with an increase in mortality, at least in acute respiratory distress syndrome(ARDS) patients, and in pulmonary complications in patients undergoing surgery. EFL is a major cause of intrinsic positive end-expiratory pressure(PEEPi), which in ARDS patients is heterogeneously distributed, with a consequent increase of ventilation/perfusion mismatch and reduction of arterial oxygenation. Airway collapse is frequently concomitant to the presence of EFL.When airways close and reopen during tidal ventilation, abnormally high stresses are generated that can damage the bronchiolar epithelium and uncouple small airways from the alveolar septa, possibly generating the small airways abnormalities detected at autopsy in ARDS. Finally, the high stresses and airway distortion generated downstream the choke points may contribute to parenchymal injury, but this possibility is still unproven. PEEP application can abolish EFL, decrease PEEPi heterogeneity, and limit recruitment/derecruitment.Whether increasing PEEP up to EFL disappearance is a useful criterion for PEEP titration can only be determined by future studies.

Challenging Problems on Ventilated Cavitation and Paths to Their Computational Solutions

Ventilated cavitation has been successfully employed as ship drag reduction technology and potentially can mitigate flowinduced vibration. The obtained successes were based on solutions of design problems considered in the framework of ideal fluid theory with their following validation by towing tank tests. However, various aspects of the interaction of ventilated cavities with the viscous flows around the ship hulls remain unclear, whereas there is usually no possibility to simultaneously keep the full-scale Froude number and cavitation number in the test facilities. So, the further progress of the application of ventilated cavitation substantially depends on the ability of computational tools to predict this interaction. This paper briefly describes the state-of-the-art computation of ventilated cavitation and points out the most challenging unsolved problems that appeared in the model tests (prediction of air demand by cavities, ventilation effect on ship drag, on hydrofoil lift, and on the propagation of shock waves in cavities).

Accounting for anisotropic effects in the prediction of the hydro-mechanical response of a ventilated tunnel in an argillaceous rock

In order to investigate the hydro-mechanical （HM） and chemical perturbations induced in an argillaceous formation by forced ventilation during the operational period of a nuclear waste repository, a specific experiment has been performed in a tunnel, at Mont Terri Underground Research Laboratory （URL） in Switzerland. This experiment has been selected in the international project DECOVALEX for model vali- dation and the numerical simulation of this ventilation experiment （VE） is the object of the present paper. Since the argillaceous rock exhibits anisotropic properties, particular attention is given to the evaluation of the effects of various anisotropic features on the predicted results. In situ measurements such as relative humidity （RH）, global water mass extracted, pore water pressure, water content, and relative displace- ments are compared to predictions using both isotropic and anisotropic parameters. Water permeability anisotropy is shown to be the most influencing parameter by far, whereas in situ stress anisotropy has an effect only during the excavation phase. The anisotropy for mechanical parameterization has also some influence, in particular through HM couplings. These HM couplings have the potential to be very significant in terms of providing confidence in describing the experimental observation, and should be considered for further investigation.

Heat and hazardous contaminant transports in ventilated high-rise industrial halls

Performances and efficiencies of displacement ventilation(DV) and partial ventilation(PV) for industrial halls of different configurations as well as the heat and mass transports within the industrial halls were numerically investigated. Three levels of Rayleigh number(5.8×1010, 1.0×1012 and 2.1×1012) and two values of source contaminant flux(5 mg/s and 50 mg/s) were considered. The inlet Reynolds numbers were 2×104, 5×104, 1.5×105 and 4.5×105 for DV and 5×105, 1×106, 2×106 and 4×106 for PV, respectively. From the results, it is concluded that the above parameters have very complex impacts on the conjugated heat and mass transports. From points of view of acceptable indoor air quality and ventilation efficiency, PV at Re=1×106 with side-located sources and 65% of the supply air extracted through floor level outlets is the best choice when Ra=5.8×1010. However, DVs at Re=5×104 and Re=1.5×105with center-located sources and floor-mounted air suppliers are the best choices for Ra=1.0×1012 and Ra=2.1×1012, respectively. When source contaminant flux reaches 50 mg/s, local extraction as a supplement of general ventilation is recommended. The results can be a first approximation to 3D numerical investigation and preliminary ventilation system design guidelines for high-rise industrial halls.

Early mobilization for mechanically ventilated patients in the intensive care unit:a systematic review and meta-analysis

Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation(MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.Methods: A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality.Secondary outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and hospital.Results: Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.Conclusions: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.

Incidence and risk factors of gastrointestinal bleeding in mechanically ventilated patients

The widespread use of gastrointestinal bleeding prophylaxis in critically ill patients was one of the most controversial issues. Since few studies reported the incidence of gastrointestinal bleeding in mechanically ventilated patients, this study aimed to identify the incidence and risk factors related to gastrointestinal bleeding in patients undergoing mechanical ventilation for more than 48 hours. A total of 283 IOU patients who had received mechanical ventilation for longer than 48 hours at a provincial hospital affiliated to Shandong University from January 1,2007 to December 31, 2009 were analyzed retrospectively. Those were excluded from the study if they had a history of gastrointestinal bleeding or ulceration, recent gastrointestinal surgery, brain death and active bleeding from the nose or throat. Demographic data of the patients included patient age, diagnosis on admission, duration of ICU stay, duration of ventilation, patterns and parameters of ventilation, ICU mortality, APACHE II score, multiple organ dysfunction, and indexes of biochemistry, kidney function, liver function and coagulation function. Risk factors of gastrointestinal bleeding were analyzed by univariate analysis and multiple logistic regression analysis. In the 242 patients who were given mechanical ventilation longer than 48 hours, the incidence of gastrointestinal bleeding was 46.7%. The bleeding in 3.3% of the patients was clinically significant. Significant risk factors were peak inspiratory pressure 〉30cmH2O, renal failure, liver failure, PLT count〈50xl09/L and prolonged APTT. Enteral nutrition had a beneficial effect on gastrointestinal bleeding. However, the multiple logistic regression analysis revealed that the independent risk factors of gastrointestinal bleeding were as follows： high pressure ventilator setting 〉 30cmH2O（RR=3.478, 95%CI=2.208-10.733）, renal failure（RR=1 .687, 95%CI=1.098-3.482）, PLT count〈50×10^9/L （RR=3.762, 95%CI=2.346-14.685）, and prolonged APTT（RR=5.368, 95%CI=2.487-11.266）. Enteral nutrition（RR=0.436, 95%CI= 0.346-0.764） was the independent protective factor. The incidence of gastrointestinal bleeding was high in the patients who received mechanical ventilation, and bleeding usually occurred within the first 48 hours. High pressure ventilator setting, renal failure, decreased PLT count and prolonged APTT were the significant risk factors of gastrointestinal bleeding. However, enteral nutrition was the independent protective factor.

Effect of Ventilation Strategies on Particle Distribution in a Two-Zone Ventilated Room

A computational fluid dynamic （ CFD ） analysis of air movement and aerosol particle transport in a two-zone ventilated room with an inter-zonal opening is presented to study the impact of ventilation strategies and size of the opening on indoor particle dispersion and concentration distribution. The comparisons of average particle concentrations in both zones between the computations and the experiments from the literature are generally satisfactory and acceptable. The combined effects of sizes of the opening and the inlet and outlet locations （three different strategies） are simulated and discussed. The results show that ventilation strategy and size of the opening influence the particle removal rate in zone 1. The removal rate is decreased when the air supply system is changed from the tap-inlet to the bottom-inlet configuration. The top-inlet system obtains a better particle deposition in zone I than the bottom-inlet configuration. However, the particle concentration at breathing level is lower for bottomsupply system than for top-supply. Decreasing the size of interzonal opening increases the particle deposition rate in zone 1 only for the top.supply system, especially for coarse particles.

Field study on thermal comfort of naturally ventilated residences in southwest China

Kunming,a city in southwest China,has a climate that is different from most of the other places in the world because of its unique geographical characteristics.Due to its temperate climate,most of the residential buildings in this region are naturally ventilated.Accordingly,a winter thermal comfort study was conducted in Kunming to reveal the thermal response of residents.Indoor and outdoor environmental parameters were measured,and participants were investigated about their clothing,thermal sensations,thermal preferences,and thermal acceptance using online questionnaires.Data from 162 valid questionnaires were collected in the survey.Although the climate is referred to as“mild”,the survey showed that the indoor temperature during winter was lower than the typical comfort range.Nevertheless,the participants responded that most of them felt neutral and comfortable.The neutral temperature of participants living in Kunming was determined to be 16.96℃.The acceptable thermal sensation vote(TSV)range of the residents is-0.72 to 1.52.The acceptable indoor air temperature range is 15.03℃ to 19.55℃,and the optimum indoor air temperature is 17.2℃.According to this study,the existing thermal comfort evaluation models can hardly predict residents’thermal responses in Kunming well.

Analysis of hydro-mechanical processes in a ventilated tunnel in an argillaceous rock on the basis of different modelling approaches

In this paper, a modelling benchmark exercise from the DECOVALEX-2011 project is presented. The bench- mark is based on the performance and results of a laboratory drying test and of the ventilation experiment （VE） carried out in the Mont Terri Underground Rock Laboratory （URL）. Both tests involve Opalinus clay. The work aims at the identification, understanding and quantification of mechanisms taking place during the ventilation of a gallery in argillaceous host rocks on one hand and at investigating the capacity of different codes and individuals to reproduce these processes on the other hand. The 4-year in situ VE took place in a 1.3 m diameter unlined tunnel and included two resaturation-desaturation cycles. The test area was equipped with over one hundred sensors （including the global water mass balance of the system, relative humidity （RH）, water content, liquid pressure, relative displacement and concentration of some chemical species） to monitor the rock behaviour during ventilation. The laboratory drying experiment, carried out before the VE, was designed to mimic the in situ conditions. The work was organized in a progressive manner in terms of complexity of the computations to be performed, geared towards the full hydro-mechano-chemical （HMC） understanding of the VE, the final objective. The main results from the modelling work reported herein are that the response of the host rock to ventilation in argillaceous rocks is mainly governed by hydraulic processes （advective Darcy flow and non-advective vapour diffu- sion） and that the hydro-mechanical （TM） back coupling is weak. A ventilation experiment may thus be regarded as a large scale-long time pump test and it is used to determine the hydraulic conductivity of the rock mass.

Numerical Analysis of the Effects of Periodic Gust Flow on the Wake Structure of Ventilated Supercavities

A computational model is established to investigate the effects of a periodic gust flow on the wake structure of ventilated supercavities.The effectiveness of the computational model is validated by comparing with available experimental data.Benefited from this numerical model,the vertical velocity characteristics in the entire flow field can be easily monitored and analyzed under the action of a gust generator;further,the unsteady evolution of the flow parameters of the closed region of the supercavity can be captured in any location.To avoid the adverse effects of mounting struts in the experiments and to obtain more realistic results,the wake structure of a ventilated supercavity without mounting struts is investigated.Unsteady changes in the wake morphology and vorticity distribution pattern of the ventilated supercavity are determined.The results demonstrate that the periodic swing of the gust generator can generate a gust flow and,therefore,generate a periodic variation of the ventilated cavitation numberσ.At the peakσ,a re-entrant jet closure appears in the wake of the ventilated supercavity.At the valleyσ,a twin-vortex closure appears in the wake of the ventilated supercavity.For the forward facing model,the twin vortex appears as a pair of centrally rolled-up vortices,due to the closure of vortex is affected by the structure.For the backward facing model,however,the twin vortex appears alternately as a pair of centrally rolled-up vortices and a pair of centrally rolled-down vortices,against the periodic gust flow.

Correlation of Inferior Vena Cava Respiratory Variability Index with Central Venous Pressure and Hemodynamic Parameters in Ventilated Pigs with Septic Shock

Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, resuscitation should achieve a central venous pressure （CVP） of 8-12 mmHg within the first 6 h. However, it is still uncertain about the sensitivity and specificity of CVP in reflecting the cardiac preload. Ultrasonography is a simple, rapid, non-invasive, and repeatable method for the measurement of sensitivity and specificity of CVP and has thus gradually attracted the increasing attention of physicians. It was reported that ultrasonography can show the inferior vena cava diameter, respiratory variability index, and blood volume in patients with sepsis or heart failure.

Research of Application of Passive Natural Ventilated Strategies of High-Density Urban Area

High-density development is becoming an inevitable tendency in Chinese urbanization. In this study,the application of natural ventilation in high-density urban development is discussed. Based on the domestic and foreign study on natural ventilation,indoor and outdoor natural ventilated strategies,and the application on natural ventilation in underground space development are analyzed. From the study,the relationship between passive and active ventilated technologies is interpreted into what is described to be synergistic,complementary and additive.

Numerical Study of the Transition Between Reentrant Jet and Twin Vortex Flow Regimes in Ventilated Cavitation

Contrary to natural cavitation,ventilated cavitation is controllable and is not harmful.It is particularly used to reduce the drag of the hydraulic vehicles.The ventilated cavitation is characterized by various gas regimes.The mechanisms of ventilated cavitation are investigated in the present work with CFD based on a 2D solver.The attention is especially focused on the transition between the reentrant jet and twin vortex regimes.The results confirmthat the product of ventilated cavitation number and Froude number is lower than 1(σcFr<1)in the twin vortex regime,while it is higher than 1(σcFr>1)in the reentrant jet regime,as reported in the literature.Further analysis shows that ventilated cavitation is significantly influenced by the natural cavitation number.

A thermo-hydro-mechano-chemical formulation for modeling water transport around a ventilated tunnel in an argillaceous rock

Argillaceous rocks are being considered as potential host rocks for deep geological disposal. For the research work in DECOVALEX-2011, 5 participant research teams performed simulations of a labora- tory drying test and a ventilation experiment for Mont Terri underground laboratory built in argillaceous rock formation. Our study starts with establishing a coupled thermo-hydro-mechano-chemical （THMC） processes model to simulate water transport in rock around the ventilated tunnel. Especially in this THMC formulation, a three-phase and two-constituent hydraulic model is introduced to simulate the processes which occur during tunnel ventilation, including desaturation/resaturation in the rock, phase change and air/rock interface, and to explore the Opalinus clay parameter set, It can be found that water content evolution is very sensitive to intrinsic permeability, relative permeability and capillary pressure in clay rock. Water loss from surrounding rock is sensitive to the change of permeability in clay which is induced by excavation damaged zone. Chemical solute transport in the rock near ventilation experiment tunnel is simulated based on the coupled THMC formulation. It can be estimated that chemical osmotic flow has little significance on water flow modeling. Comparisons between simulation results from 5 teams and experimental observations show good agreement. It increases the confidence in modeling and indi- cates that it is a good start for fully THMC understanding of the moisture transportation and mechanical behavior in argillaceous rock.

Thermal comfort in naturally ventilated indoor environment in hot and humid climate zone in P. R. China

To identify human thermal comfort in naturally ventilated buildings,the research based on both subjective and objective data was carried out in Chongqing,P. R. China. The characteristics of subjects' clothing regulation function,changes of actual mean thermal comfort vote (AMV) varying with time and acceptable operative temperature in natural conditions were analyzed. In addition,the indicator actual mean vote-actual percentage dissatisfied (AMV-APD) was used to study the actual dissatisfaction with thermal environment. The results indicate that regulative ability by changing clothing under natural ventilated conditions is very significant but limited simultaneously,about 1.7 ℃ per 0.1 clo. Under naturally ventilated conditions,people may have an acceptable operative temperature of 16-28 ℃. Based on the AMV-APD,the actual minimum percentage dissatisfied can reach 4% at AMV of -0.36.