[SYSVENT: Proof of Concept Study of a Prototype to Ventilate Critical Care Patients]

INTRODUCTION

The new coronavirus pandemic has led to scarcity of invasive ventilation resources in hospitals in several countries. In this context, the Portuguese Medical Association invited intensive care physicians who, in collaboration with SYSADVANCE S.A., developed SYSVENT OM1, a ventilator capable of operating in controlled and assisted modes (volume and pressure) and able to treat patients admitted to intensive care units. In this study we do the proof of concept comparing programmed tidal volume, inspiratory pressure and positive end-expiratory pressure with those measured by the ventilator and an external measuring equipment.

MATERIAL AND METHODS

We set up the ventilator in tandem with an artificial lung and a flow analyzer. We measured expiratory tidal volume, and inspiratory pressure against three levels of compliance, each with six steps of tidal volume. Positive end-expiratory pressure was measured at 2 cmH2O incremental along eight steps. For each measurement, we performed three readings.

RESULTS

Considering each of the three single variables, the mean value of the highest difference between programmed values and measured values is, for all of them, within what we considered to be acceptable for a prototype model (tidal volume = -28.1 mL, inspiratory pressure = 0.8 cmH2O and positive end-expiratory pressure = -1.1 cmH2O). This difference is greater when evaluated with the external measuring equipment in comparison with the ventilator.

DISCUSSION

The results showed a good monitoring and accuracy performance. Technical limitations related with the artificial lung and the flow analyzer have been documented, which do not compromise the results, but limit their amplitude.

CONCLUSION

For tested parameters, the ventilator has a good operating performance, is in accordance with the initial premises and has potential for clinical use.

The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies

The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.

[Pericardioperitoneal shunt in the treatment of pericardial effusions in neoplasic patients]

Neoplasia-related pericardial effusions are a frequent finding and pose diagnostic and therapeutic challenges. Although they appear in the context of an underlying neoplastic disease, 50% of these effusions have a benign etiology; they are indirectly caused by the tumor. The remaining cases (neoplastic pericardial effusions - NPE) derive from extension of tu- moral disease to the epi and/or pericardium and have, therefore, a worst prognosis. Despite several treatment options, the lack of appropriate guidelines difficults the evaluation of their efficacy and safety. Pericardioperitoneal shunt (PPS) is a surgical pericardial drainage method, which has demonstrated its usefulness in the management of NPE. At the CHC, this procedure is performed under videoassisted toracoscopic guidance (VATS). During the last 8 years, 18 patients have been submitted to this therapeutic option, which proved to be safe, efficacious and with low morbimortality rates.