Background: INTELLiVENT-adaptive support ventilation (ASV) is an automated closed-loop mode of invasive ventilation for use in critically ill patients. INTELLiVENT-ASV automatically adjusts, without the intervention of the caregiver, ventilator settings to achieve the lowest work and force of breathing. Aims: The aim of this case series is to describe the specific adjustments of INTELLiVENT-ASV in patients with acute hypoxemic respiratory failure, who were intubated for invasive ventilation. Study design: We describe three patients with severe acute respiratory distress syndrome (ARDS) because of COVID-19 who received invasive ventilation in our intensive care unit (ICU) in the first year of the COVID-19 pandemic. Results: INTELLiVENT-ASV could be used successfully, but only after certain adjustments in the settings of the ventilator. Specifically, the high oxygen targets that are automatically chosen by INTELLiVENT-ASV when the lung condition ‘ARDS’ is ticked had to be lowered, and the titration ranges for positive end expiratory pressure (PEEP) and inspired oxygen fraction (FiO2) had to be narrowed. Conclusions: The challenges taught us how to adjust the ventilator settings so that INTELLiVENT-ASV could be used in successive COVID-19 ARDS patients, and we experienced the benefits of this closed-loop ventilation in clinical practice. Relevance to clinical practice: INTELLiVENT-ASV is attractive to use in clinical practice. It is safe and effective in providing lung-protective ventilation. A closely observing user always remains needed. INTELLiVENT-ASV has a strong potential to reduce the workload associated with ventilation because of the automated adjustments.
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IntroductionThe driving pressure (ΔP) has an independent association with outcome in patients with acute respiratory distress syndrome (ARDS). INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop mode of ventilation that targets the lowest work and force of breathing.AimTo compare transpulmonary and respiratory system ΔP between closed-loop ventilation and conventional pressure controlled ventilation in patients with moderate-to-severe ARDS.MethodsSingle-center randomized cross-over clinical trial in patients in the early phase of ARDS. Patients were randomly assigned to start with a 4-h period of closed-loop ventilation or conventional ventilation, after which the alternate ventilation mode was selected. The primary outcome was the transpulmonary ΔP; secondary outcomes included respiratory system ΔP, and other key parameters of ventilation.ResultsThirteen patients were included, and all had fully analyzable data sets. Compared to conventional ventilation, with closed-loop ventilation the median transpulmonary ΔP with was lower (7.0 [5.0–10.0] vs. 10.0 [8.0–11.0] cmH2O, mean difference − 2.5 [95% CI − 2.6 to − 2.1] cmH2O; P = 0.0001). Inspiratory transpulmonary pressure and the respiratory rate were also lower. Tidal volume, however, was higher with closed-loop ventilation, but stayed below generally accepted safety cutoffs in the majority of patients.ConclusionsIn this small physiological study, when compared to conventional pressure controlled ventilation INTELLiVENT-ASV reduced the transpulmonary ΔP in patients in the early phase of moderate-to-severe ARDS. This closed-loop ventilation mode also led to a lower inspiratory transpulmonary pressure and a lower respiratory rate, thereby reducing the intensity of ventilation.Trial registration Clinicaltrials.gov, NCT03211494, July 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1.
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BACKGROUNDLung protective ventilation is considered standard of care in the intensive care unit. However, modifying the ventilator settings can be challenging and is time consuming. Closed loop modes of ventilation are increasingly attractive for use in critically ill patients. With closed loop ventilation, settings that are typically managed by the ICU professionals are under control of the ventilator's algorithms.OBJECTIVESTo describe the effectiveness, safety, efficacy and workload with currently available closed loop ventilation modes.DESIGNSystematic review of randomised clinical trials.DATA SOURCESA comprehensive systematic search in PubMed, Embase and the Cochrane Central register of Controlled Trials search was performed in January 2023.ELIGIBILITY CRITERIARandomised clinical trials that compared closed loop ventilation with conventional ventilation modes and reported on effectiveness, safety, efficacy or workload.RESULTSThe search identified 51 studies that met the inclusion criteria. Closed loop ventilation, when compared with conventional ventilation, demonstrates enhanced management of crucial ventilator variables and parameters essential for lung protection across diverse patient cohorts. Adverse events were seldom reported. Several studies indicate potential improvements in patient outcomes with closed loop ventilation; however, it is worth noting that these studies might have been underpowered to conclusively demonstrate such benefits. Closed loop ventilation resulted in a reduction of various aspects associated with the workload of ICU professionals but there have been no studies that studied workload in sufficient detail.CONCLUSIONSClosed loop ventilation modes are at least as effective in choosing correct ventilator settings as ventilation performed by ICU professionals and have the potential to reduce the workload related to ventilation. Nevertheless, there is a lack of sufficient research to comprehensively assess the overall impact of these modes on patient outcomes, and on the workload of ICU staff.
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Few people I know act likea magnet in the way Laura does. If you hear her speak, see her move, enjoy her smile - you can't help but want to be a part of what makes her heart beat faster. She radiates passion for her dream topic biomimicry and before you know it you're caught in that dream. From the day I met her, I was captivated by her enthusiasm and knowledge about this topic. In fact, meeting Laura made me decide to join the university as I thought: if people like Laura work at THUAS, I want to be a part of this organization'. Over the years I have seen her finish the Msc in biomimicry at Arizona State University followed by a PhD at TUDelft. And all that next to her full time job as a teacher. It's only a miracle that she still found the time to go outdoors and be in Nature. But luckily, she did as this is what nourishes her - and that nourishment is brought into the classroom affecting generations of students. I am very proud of how she builds her tribe just like Nature does; grassroots from the bottom up, not supported but also not inhibited by formal structures. In that way she truly acts as a bridge helping others to tap into Nature's wisdom. This morning I harvested the remaining vegetables from my garden and turned them into lunch. It's the second year I grow vegetables and it feels like I am only at the beginning of learning to collaborate with Nature. In Spring and Summer, Ihave witnessed in awe how seeds become seedlings which then grow into mature plants carrying fruit. The sheer wonder of Nature never ceases to amaze me, and my garden is only an attempt to be more aware of seasonal rhythms. It's Autumn right now, a time of year that invites us to go inside, reflect and let go of old baggage that no longer serves us. We'll be approaching the stage of wintering soon in which our inner journey will benefit from the darkness of wintertime introspection, along with the space to process the old, integrate learnings, and then germinate the new. Over the course of her career, Laura has gone through these seasonal cycles - reinventing herself in the past decade as a teacher, researcher and regenerative leader. One of Laura's many qualities is that she embodies three leadership characteristics derived from Nature. First, she acknowledges the importance of interconnection. Many times, we think of Nature as being separate from us, but in reality we humans are Nature. Connection with Nature enables us to think within systems and understand that we can't direct the system, but instead we're all part of multiple systems. Second, sensing the system and our part in it builds resilience. Even if things don't go as we expected or imagined, rather than reacting, we can step back and engage with more insight. Laura's adaptability to a system's needs while spotting opportunities to crack it open, is admirable. As the system is always in evolution, so is she - remarkably receptive to change even in the final stages of her career. Third, Laura creates space for people to develop and thrive, acting as multipliers of her vision and love for the natural world. In her leadership she embodies the ideal elder while being able to perceive the world through the eyes of a child - with continuous wonder for how life unfolds. This book is a bricolage of Laura's post-doc research conducted the past two years. In it you will find an array of fascinating reads and tools that help you deepen your practice as a biomimicry professional. The book is a community effort integrating tools Laura has co-created with her ecosystem as well as more in-depth readings written by some of the talents she has nourished over time. I wish for you to enjoy this careful curation of both practical as well as more conceptual contributions. May it inspire your own thriving in bringing Nature based wisdom to the core of our daily lives.
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Network Applied Design Research (NADR) made an inventory of the current state of Circular Design Research in the Netherlands. In this publication, readers will find a summary of six promising ‘gateways to circularity’ that may serve as entry points for future research initiatives. These six gateways are: Looped Systems; Extension of Useful Lifetime; Servitisation; New Materials and Production Techniques; Information Technology and Digitization; and Creating Public and Industry Awareness. The final chapter offers an outlook into topics that require more profound examination. The NADR hopes that this publication will serve as a starting point for discussions among designers, entrepreneurs, and researchers, with the goal of initiating future collaborative projects. It is the NADR's belief that only through intensive international cooperation, we can contribute to the realization of a sustainable, circular, and habitable world.
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This article will discuss philosophical debates on economic growth and environmental sustainability, the role of management responsibility, and the risk of subversion to business as usual. This discussion will be framed using the concepts of Cradle to Cradle (C2C) and Circular Economy about sustainable production. The case study illustrating the danger of subversion of these progressive models discussed here is based on the assignments submitted by Masters students as part of a course related to sustainable production and consumption at Leiden University. The evaluation of the supposedly best practice cases placed on the website of the Ellen MacArthur Foundation or those awarded Cradle to Cradle certificate has led some students to conclude that these cases illustrated green-washing. Larger implications of identified cases of green-washing for the field of sustainable business and ecological management are discussed. “This is a post-peer-review, pre-copyedit version of an article published in 'Philosophy of Management'. The final authenticated version is available online at: https://doi.org/10.1007/s40926-019-00108-x LinkedIn: https://www.linkedin.com/in/helenkopnina/
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Wat is er op dit moment (medio augustus 2020) in de wetenschappelijke literatuur bekend over (de effecten van maatregelen tegen) de verspreiding van het coronavirus en wat is de betekenis daarvan voor organisatoren van evenementen?
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This publication the avocado advisory report which is based on popular papers (practice briefs) of master and bachelor theses and business assignments of students at three Dutch Universities of Applied Sciences: Van Hall Larenstein (VHL), InHolland and HAS Green Academy, and Meru University of Science and Technology in Kenya. All 23 theses and business assignments were commissioned through the research project entitled “Food Waste Reduction and Food Quality LivingLab (FORQLAB)” in Kenya.
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