Energy and Entropy Analyses of a Pilot-Scale Dual Heating HDH Desalination System

This study focuses on energy and entropy analysis to theoretically investigate the performance of a pilot scale dual heated humidification-dehumidification (HDH) desalination system. Two cases of HDH systems are considered in the analysis. The first case is a dual heated (DH) cycle consisting of 1.59 kW air heater and 1.42 kW water heater with a heat rate ratio of 0.89 (CAOW-DH-I). Whereas the second case is a dual heated HDH cycle comprising of 1.59 kW air heater and 2.82 kW water heater with a heat rate ratio of 1.77 (CAOW-DH-II). As a first step, mathematical code was developed based on heat and mass transfer and entropy generation within the major components of the system. The code was validated against the experimental data obtained from a pilot scale HDH system and was found to be in a good agreement with the experimental results. Theoretical results revealed that there is an optimal mass flowrate ratio at which GOR is maximized, and entropy generation is minimized. Furthermore, the degree of irreversibility within the humidifier component is low and approaches zero, while the specific entropy generation within other components are relatively high and are of the same order of magnitude. Entropy analysis also showed that the dual heated system with heat rate ratio greater than unity is better than the one with heat rate ratio less than unity.

Airway Care Interventions for Invasively Ventilated Critically Ill Adults—A Dutch National Survey

Airway care interventions may prevent accumulation of airway secretions and promote their evacuation, but evidence is scarce. Interventions include heated humidification, nebulization of mucolytics and/or bronchodilators, manual hyperinflation and use of mechanical insufflation-exsufflation (MI-E). Our aim is to identify current airway care practices for invasively ventilated patients in intensive care units (ICU) in the Netherlands. A self–administered web-based survey was sent to a single pre–appointed representative of all ICUs in the Netherlands. Response rate was 85% (72 ICUs). We found substantial heterogeneity in the intensity and combinations of airway care interventions used. Most (81%) ICUs reported using heated humidification as a routine prophylactic intervention. All (100%) responding ICUs used nebulized mucolytics and/or bronchodilators; however, only 43% ICUs reported nebulization as a routine prophylactic intervention. Most (81%) ICUs used manual hyperinflation, although only initiated with a clinical indication like difficult oxygenation. Few (22%) ICUs used MI-E for invasively ventilated patients. Use was always based on the indication of insufficient cough strength or as a continuation of home use. In the Netherlands, use of routine prophylactic airway care interventions is common despite evidence of no benefit. There is an urgent need for evidence of the benefit of these interventions to inform evidence-based guidelines.

REINVENT: International Survey on REstrictive thoracic diseases IN long term home noninvasive VENTilation

Background and aimLittle is known about the current use of long-term home non-invasive ventilation (LTHNIV) in restrictive thoracic diseases (RTD), including chest wall and neuromuscular disorders (CWD, NMD). This study aimed to capture the pattern of LTHNIV in RTD patients via a web-based international survey.MethodsThe survey involved ERS Assembly 2.02 (NIV dedicated group) October-December 2019.Results166/748 (22.2%) members from 41 countries responded; 80% were physicians, of whom 43% worked in a respiratory intermediate intensive care unit (RIICU). The NMD:CWD ratio was 5:1, Amyotrophic lateral sclerosis (ALS) being the most frequent indication within NMD (78%). The main reason to initiate LTHNIV was diurnal hypercapnia (71%). Quality of life/sleep was the most important goal to achieve. In 25% of cases, clinicians based their choice of the ventilator on patients’ feedback. Among NIV-modes, pressure support ventilation spontaneous-timed (PSV-ST) was the most frequently prescribed for day and night-time. Mouthpieces were the preferred daytime NIV interface, whereas oro-nasal masks the first choice overnight. Heated humidification was frequently added to LTHNIV (72%). Single-limb circuits with intentional leaks (79%) were the most frequently prescribed. Follow-up was most often provided in an outpatient setting.ConclusionsThis ERS survey illustrates physicians’ practices of LTHNIV in RTD patients. NMD and, specifically, ALS were the main indications for LTHNIV. NIV was started mostly because of diurnal hypoventilation with a primary goal of patient-centred benefits. Bi-level PSV-ST and oro-nasal masks were more likely to be chosen for providing NIV. LTHNIV efficacy was assessed mainly in an outpatient setting.

Impact of Gas Flow and Humidity on Trans-Nasal Aerosol Deposition via Nasal Cannula in Adults: A Randomized Cross-Over Study

Background: Trans-nasal pulmonary aerosol delivery using high flow nasal cannula (HFNC) devices is described with the administration of high gas flows exceeding patient inspiratory flow (HF) and with lower flows (LF). The aim of this pilot clinical trial was to compare deposition and distribution of radiolabeled aerosol via nasal cannula in healthy adults across three rates of gas flow delivered with active heated humidification, and to further identify the impact of aerosol administration without heated humidity. Methods: Twenty-three (23) healthy adults (16F) were randomized to receive aerosol with active heated humidification or unheated oxygen at gas flows of 10 L/min (n = 8), 30 L/min (n = 7), or 50 L/min (n = 8). Diethylenetriaminepentaacetic acid labeled with 1 millicurie (37 MBq) of Technetium-99m (DTPA-Tc99m) was mixed with NaCl to a fill volume of 1 mL, and administered via mesh nebulizer placed at the inlet of the humidifier. Radioactivity counts were performed using a gamma camera and the regions of interest (ROIs) were delimited with counts from the lungs, upper airways, stomach, nebulizer, circuit, and expiratory filter. A mass balance was calculated and each compartment was expressed as a percentage of the total. Results: Lung deposition (mean ± SD) with heated humidified gas was greater at 10 L/min than 30 L/min or 50 L/min (17.2 ± 6.8%, 5.71 ± 2.04%, and 3.46 ± 1.24%, respectively; p = 0.0001). Using unheated carrier gas, a lung dose of aerosol was similar to the active heated humidification condition at 10 L/min, but greater at 30 and 50 L/min (p = 0.011). Administered gas flow and lung deposition were negatively correlated (r = −0.880, p < 0.001). Conclusions: Both flow and active heated humidity inversely impact aerosol delivery through HFNC. Nevertheless, aerosol administration across the range of commonly used flows can provide measurable levels of lung deposition in healthy adult subjects (NCT 02519465).