Quality versus emergency: How good were ventilation fittings produced by additive manufacturing to address shortages during the COVID19 pandemic?

Mask interfaces and devices for home noninvasive ventilation in children

Home noninvasive ventilation (NIV), including continuous (CPAP) and bilevel (BPAP) positive airway pressure, is increasingly used in children worldwide. In this narrative review, we present a comprehensive summary of the equipment available for home NIV in pediatrics, excluding neonates. NIV may be challenging in young children, as the majority of the equipment has been developed for adults. Regarding the interfaces, only a few masks have been specifically developed for young children in recent years, while older children may benefit from a large variety of interfaces. Even though much progress has been made, skin injuries are still present, and need to be managed rapidly. Several studies addressed the management of the side effects, but recent studies are lacking regarding orofacial anomalies. No recent study reported the available interfaces for young children and the strategies for an optimal mask fit. Regarding the devices, an adapted NIV device to pediatrics that allows an adequate patient's breathing detection should guarantee optimal ventilatory efficiency and monitoring of NIV. A close follow-up and regular monitoring should be mandatory to rule out the potential issues, optimize NIV therapy and ascertain the efficacy of NIV. However, studies are lacking to guide the choice of devices in young children and the optimal management of home NIV in pediatrics. We summarized the characteristics of the different interfaces available for young children and the limitations of NIV devices. We finally addressed potential areas for future research on long-term home NIV in children.

How makers responded to the Personal Protective Equipment shortage during the COVID-19 pandemic: An analysis focused on the Hauts-de-France region

The COVID-19 pandemic saw makers mobilize around the world to address a shortage of medical equipment. Our research focuses on a group of makers organized in the Hauts-de-France region. Combining interviews with tool-based and hybrid method (quantitative/qualitative), we analyzed the collaborative messaging room used to coordinate the production of face shields. That field work enabled us to update the profile of the participants, the intensity of their contribution, the nature of the innovation implemented, the coordination mechanisms, and the associated difficulties. We identified different makers' profiles given their backgrounds, expertise, and network. We evaluated the type of collaboration they developed with the local public and private actors through an online platform, and how technology facilitated the interactions and circulation of information despite the confinement. We evaluated the level of performance from the point of view of an organization, knowledge transfer, and invention. It reveals how these practices can successfully evolve from resilience to innovation. We discuss the potential of exploiting the makers' open source practices in collaborative and innovative territory dynamics with an interest in sharing the knowledge commons.

Lessons from COVID-19 in the management of acute respiratory failure

Accumulated evidence supports the efficacy of noninvasive respiratory support therapies in coronavirus disease 2019 (COVID-19)-related acute hypoxaemic respiratory failure, alleviating admissions to intensive care units. Noninvasive respiratory support strategies, including high-flow oxygen therapy, continuous positive airway pressure via mask or helmet and noninvasive ventilation, can be alternatives that may avoid the need for invasive ventilation. Alternating different noninvasive respiratory support therapies and introducing complementary interventions, like self-proning, may improve outcomes. Proper monitoring is warranted to ensure the efficacy of the techniques and to avoid complications while supporting transfer to the intensive care unit. This article reviews the latest evidence on noninvasive respiratory support therapies in COVID-19-related acute hypoxaemic respiratory failure.