BackgroundFluid therapy is a common intervention in critically ill patients. It is increasingly recognised that deresuscitation is an essential part of fluid therapy and delayed deresuscitation is associated with longer invasive ventilation and length of intensive care unit (ICU) stay. However, optimal timing and rate of deresuscitation remain unclear. Lung ultrasound (LUS) may be used to identify fluid overload. We hypothesise that daily LUS-guided deresuscitation is superior to deresuscitation without LUS in critically ill patients expected to undergo invasive ventilation for more than 24 h in terms of ventilator free-days and being alive at day 28.MethodsThe “effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients” (CONFIDENCE) is a national, multicentre, open-label, randomised controlled trial (RCT) in adult critically ill patients that are expected to be invasively ventilated for at least 24 h. Patients with conditions that preclude a negative fluid balance or LUS examination are excluded. CONFIDENCE will operate in 10 ICUs in the Netherlands and enrol 1000 patients. After hemodynamic stabilisation, patients assigned to the intervention will receive daily LUS with fluid balance recommendations. Subjects in the control arm are deresuscitated at the physician’s discretion without the use of LUS. The primary endpoint is the number of ventilator-free days and being alive at day 28. Secondary endpoints include the duration of invasive ventilation; 28-day mortality; 90-day mortality; ICU, in hospital and total length of stay; cumulative fluid balance on days 1–7 after randomisation and on days 1–7 after start of LUS examination; mean serum lactate on days 1–7; the incidence of reintubations, chest drain placement, atrial fibrillation, kidney injury (KDIGO stadium ≥ 2) and hypernatremia; the use of invasive hemodynamic monitoring, and chest-X-ray; and quality of life at day 28.DiscussionThe CONFIDENCE trial is the first RCT comparing the effect of LUS-guided deresuscitation to routine care in invasively ventilated ICU patients. If proven effective, LUS-guided deresuscitation could improve outcomes in some of the most vulnerable and resource-intensive patients in a manner that is non-invasive, easy to perform, and well-implementable.Trial registrationClinicalTrials.gov NCT05188092. Registered since January 12, 2022
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This review evaluates the reliability and validity of ultrasound to quantify muscles in older adults. The databases PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for studies. In 17 studies, the reliability (n = 13) and validity (n = 8) of ultrasound to quantify muscles in community-dwelling older adults (≥60 years) or a clinical population were evaluated. Four out of 13 reliability studies investigated both intra-rater and inter-rater reliability. Intraclass correlation coefficient (ICC) scores for reliability ranged from -0.26 to 1.00. The highest ICC scores were found for the vastus lateralis, rectus femoris, upper arm anterior, and the trunk (ICC = 0.72 to 1.000). All included validity studies found ICC scores ranging from 0.92 to 0.999. Two studies describing the validity of ultrasound to predict lean body mass showed good validity as compared with dual-energy X-ray absorptiometry (r(2) = 0.92 to 0.96). This systematic review shows that ultrasound is a reliable and valid tool for the assessment of muscle size in older adults. More high-quality research is required to confirm these findings in both clinical and healthy populations. Furthermore, ultrasound assessment of small muscles needs further evaluation. Ultrasound to predict lean body mass is feasible; however, future research is required to validate prediction equations in older adults with varying function and health.
Abstract Aims: To lower the threshold for applying ultrasound (US) guidance during peripheral intravenous cannulation, nurses need to be trained and gain experience in using this technique. The primary outcome was to quantify the number of procedures novices require to perform before competency in US-guided peripheral intravenous cannulation was achieved. Materials and methods: A multicenter prospective observational study, divided into two phases after a theoretical training session: a handson training session and a supervised life-case training session. The number of US-guided peripheral intravenous cannulations a participant needed to perform in the life-case setting to become competent was the outcome of interest. Cusum analysis was used to determine the learning curve of each individual participant. Results: Forty-nine practitioners participated and performed 1855 procedures. First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). The overall first attempt success rate during this study was 93%. The cusum learning curve for each practitioner showed that a mean number of 34 procedures was required to achieve competency. Time needed to perform a procedure successfully decreased when more experience was achieved by the practitioner, from 14±3 minutes on first procedure to 3±1 minutes during the fortieth procedure (p<0.001). Conclusions: Competency in US-guided peripheral intravenous cannulation can be gained after following a fixed educational curriculum, resulting in an increased first attempt cannulation success as the number of performed procedures increased.
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MSEs have encountered limitations while pushing the limits of catheter tip sensors performance. The limitations summarized: - sensors are not immune to electrical signal noise, cross talk, and EM fields; - sensors are not immune to high magnetic fields, i.e. not suitable for MR imaging; - extending the amount of sensors on the catheter tip is limited due to cluttering of wires. A fundamentally different approach using integrated optics is chosen for developing a new generation catheter sensors. The complexity of the design and production problems represents a knowledge gap, that can be bridged in the proposed consortium. This project consists of four work packages, total duration two years, subdivided into four phases. A crucial deliverable of the project is presented at the end of phase IV (WP4), namely a demonstrator integrating pressure and temperature sensors (obtained from WP1) with a newly designed readout system. This system is modularly extendable for future catheter tip sensors. In WP1, pressure- and temperature sensors are developed using two design approaches. In WP2 the influence of downscaling an ultrasound MZI device is explored and the microfabrication process parameters are studied. An additional goal of WP2 is to find the most suitable method for measuring lactate concentration. Among the deliverables five manuscripts: manuscript 1 includes simulations and measurements of the developed pressure and temperature sensors, manuscript 2 answers the question: can a grated fiber be used for measuring pressure and temperature on a tip? Manuscript 3 answers the question: which method is most suitable for measuring lactate concentration on a tip? Manuscript 4 answers the question: does a US intensity detector fit on a catheter tip while obeying the LoR? Manuscript 5 describes the performance of the demonstrator (Phase IV), i.e. integration of T/P sensing with a modular read out system.
The application of sensors in water technology is a crucial step to provide broader, more efficient and circular systems. Among the different technologies used in this field, ultrasound-based systems are widely used, basically to generate energy peaks for cell lysis and particle separation. In this work, we propose the adaptation of an ultrasound system to monitor the concentration of solid particles in wastewater treatment plants settlers as well as to indicate sludge level (real time). A similar sensor was developed and tested in another project which operated successfully at solids concentration up to 1% in UASB reactors. Such measurements are nowadays obtained via time-consuming physical (solids) analysis, which can compromise the efficiency of the settlers and the quality of the effluent. The present project proposes an improved version of the sensor, which will combine solids concentration monitoring and sludge level detection. The defined targets have the intention to make a sensor with a much broader range of applications, been suitable not only for UASB reactors but also to settler and aerobic tanks. The project is a cooperation between the Water Technology lectoraat of NHL Stenden University of Applied Sciences, two SME’s - YNOVIO B.V. and Lamp-ion B.V. - and the INCT group (Brazil). If proven feasible, the concept can generate a big business market to the involved Dutch partners as well as favor the automation of WWTP in the Netherlands, Brazil and around the world.
The ongoing debate over the use of fossil fuels, particularly diesel, in engines due to concerns about global climate change has prompted the exploration of alternative propulsion methods and fuels. Despite various proposed alternatives, diesel engines continue to play a vital role in the global market [1]. This discussion has spurred innovations aimed at enhancing the performance and sustainability of diesel engines, including the utilization of biodiesel mixtures, synthetic fuels, and water-in-diesel emulsions (W/D emulsions) [2-5]. Scientific evidence indicates that the presence of water in water-diesel emulsions can improve engine performance and reduce emissions, such as particulate matter and NOx [6,7]. This performance enhancement is attributed to the phenomenon of micro-explosion, or secondary atomization, caused by the differing boiling points of water and diesel [8]. The rapid temperature increase during fuel injection leads to the explosive vaporization of dispersed water droplets, breaking up the diesel emulsion into smaller droplets and resulting in a shorter combustion time. Various processes, including membrane emulsification, ultrasound emulsification, and high shear stirring, are employed to create these emulsions, often necessitating the use of surfactants for stability [9]. This research proposes a two-fold approach: firstly, the use of Electrohydrodynamic Atomization (EHDA, or electrospray) to create stable water-diesel emulsions. Secondly, the employment of magnetic fields in treating both diesel and water-diesel emulsions. EHDA is already used in several applications, such as drug encapsulation, bioencapsulation, thin film coatings and is also known for its ability to form stable emulsions. [10-13]. For the second approach, it has been shown that nanobubbles can be formed [17] and stabilized due to the electric charging action of magnetic fields [18]. We hypothesize that the charged bubbles can further stabilize the diesel-water emulsion and also enhance the explosive evaporation due to the additional Coulomb forces in play.
