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Khonsari RH, Oranger M, François PM, Mendoza-Ruiz A, Leroux K, Boussaid G, Prieur D, Hodge JP, Belle A, Midler V, Morelot-Panzini C, Patout M, Gonzalez-Bermejo J. Quality versus emergency: How good were ventilation fittings produced by additive manufacturing to address shortages during the COVID19 pandemic? PLoS One 2022; 17:e0263808. [PMID: 35446853 PMCID: PMC9022824 DOI: 10.1371/journal.pone.0263808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The coronavirus disease pandemic (COVID-19) increased the risk of shortage in intensive care devices, including fittings with intentional leaks. 3D-printing has been used worldwide to produce missing devices. Here we provide key elements towards better quality control of 3D-printed ventilation fittings in a context of sanitary crisis. MATERIAL AND METHODS Five 3D-printed designs were assessed for non-intentional (junctional and parietal) and intentional leaks: 4 fittings 3D-printed in-house using FDeposition Modelling (FDM), 1 FDM 3D-printed fitting provided by an independent maker, and 2 fittings 3D-printed in-house using Polyjet technology. Five industrial models were included as controls. Two values of wall thickness and the use of coating were tested for in-house FDM-printed devices. RESULTS Industrial and Polyjet-printed fittings had no parietal and junctional leaks, and satisfactory intentional leaks. In-house FDM-printed fittings had constant parietal leaks without coating, but this post-treatment method was efficient in controlling parietal sealing, even in devices with thinner walls (0.7 mm vs 2.3 mm). Nevertheless, the use of coating systematically induced absent or insufficient intentional leaks. Junctional leaks were constant with FDM-printed fittings but could be controlled using rubber junctions rather than usual rigid junctions. The properties of Polyjet-printed and FDM-printed fittings were stable over a period of 18 months. CONCLUSIONS 3D-printing is a valid technology to produce ventilation devices but requires care in the choice of printing methods, raw materials, and post-treatment procedures. Even in a context of sanitary crisis, devices produced outside hospitals should be used only after professional quality control, with precise data available on printing protocols. The mechanical properties of ventilation devices are crucial for efficient ventilation, avoiding rebreathing of CO2, and preventing the dispersion of viral particles that can contaminate health professionals. Specific norms are still required to formalise quality control procedures for ventilation fittings, with the rise of 3D-printing initiatives and the perspective of new pandemics.
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Affiliation(s)
- Roman Hossein Khonsari
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- Délégation Inter-Départementale pour le Développement de la Fabrication Additive (DIDDFA), Direction générale, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Mathilde Oranger
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
| | | | | | | | - Ghilas Boussaid
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Delphine Prieur
- Délégation Inter-Départementale pour le Développement de la Fabrication Additive (DIDDFA), Direction générale, Assistance Publique – Hôpitaux de Paris, Paris, France
| | | | - Antoine Belle
- Service de Pneumologie, Centre Hospitalier Intercommunal de Compiègne-Noyon, Compiègne, France
| | - Vincent Midler
- Département de la Maîtrise d’Ouvrage et de la Politique Technique – DEFIP, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Capucine Morelot-Panzini
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
| | - Maxime Patout
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
- Service des Pathologies du Sommeil (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jésus Gonzalez-Bermejo
- Service de Réhabilitation Respiratoire (Département R3S), Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Sorbonne Université, Paris, France
- Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM UMRS1158, Paris, France
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Cavicchiolo ME, Trevisanuto D, Priante E, Moschino L, Mosca F, Baraldi E. Italian neonatologists and SARS-CoV-2: lessons learned to face coming new waves. Pediatr Res 2022; 91:513-521. [PMID: 33828228 PMCID: PMC8025440 DOI: 10.1038/s41390-021-01477-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/18/2022]
Abstract
The aim of this review was threefold: (a) to retrieve all SARS-CoV-2 evidences published by Italian neonatologists working in maternity centers and NICUs during the pandemic; (b) to summarize current evidence for the management of term and preterm infants with a SARS-CoV-2-related illness; and (c) to provide an update for dealing with the second wave of COVID-19 and discuss open questions. A review was conducted using MEDLINE/PubMed and the national COVID-19 registry of the Italian Society of Neonatology including citations from December 1, 2019 to October 28, 2020. Sixty-three articles were included. Collected data were divided into the following topics: (a) antenatal management, (b) management in delivery room, (c) postnatal management, (d) mother-baby dyad and breastfeeding management, (e) neonatal emergency transport system reorganization, (f) parents' management and perspective during SARS-CoV-2 pandemic, and (g) future perspective. Evidences have evolved over the pandemic period and the current review can be useful in the management of the mother-neonate dyad during SARS-CoV-2 future waves. Italian neonatologists have played an active role in producing official guidelines and reporting data that have contributed to improve the care of neonates. A joint European action plan is mandatory to face COVID-19 in neonates with more awareness. IMPACT: A joint European action plan is mandatory to face COVID-19 in neonates with more awareness. This review summarizes the available evidences from neonatal COVID-19 management in Italy analyzing all the published paper in this specific field of interest. The current review can be useful in the management of the mother-neonate dyad during the SARS-CoV-2 future waves.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Daniele Trevisanuto
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Elena Priante
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Laura Moschino
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padua, Italy.
- Institute of Pediatric Research (IRP), Fondazione Città della Speranza, Padova, Italy.
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