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1. The HEV Ventilator

Author

Buytaert, J., Abud, A. Abed, Allport, P., Álvarez, A. Pazos, Akiba, K., Francisco, O. Augusto de Aguiar, Bay, A., Bernard, F., Baron, S., Bertella, C., Brunner, J., Bowcock, T., Jode, M. Buytaert-De, Byczynski, W., De Carvalho, R., Coco, V., Collins, P., Collins, R., Dikic, N., Dousse, N., Dowd, B., Dumps, R., Durante, P., Fadel, W., Farry, S., Prieto, A. Fernández, Flynn, G., Lima, V. Franco, Frei, R., Torreira, A. Gallas, Guida, R., Hennessy, K., Henriques, A., Hutchcroft, D., Ilic, S., Jevtic, A., Joram, C., Kapusniak, K., Cid, E. Lemos, Lindner, J., Lindner, R., Milovanovic, M., Mico, S., Morant, J., Morel, M., Männe, G., Murray, D., Nasteva, I., Neufeld, N., Neuhold, I., López, F. Pardo-Sobrino, Trigo, E. Pérez, Jallas, G. Pichel, Pilorz, E., Piquilloud, L., Pons, X., Reiner, D., Roosens, C., Rostalski, P., Schmidt, B., Saucet, E., Sanders, F., Sigaud, C., Schoettker, P., Schwemmer, R., Schindler, H., Sharma, A., Svihra, P., van Leemput, J., Vignaux, L., Vasey, F., Woonton, H., and Wyllie, K.

Subjects
Physics - Medical Physics
Abstract

HEV is a low-cost, versatile, high-quality ventilator, which has been designed in response to the COVID-19 pandemic. The ventilator is intended to be used both in and out of hospital intensive care units, and for both invasive and non-invasive ventilation. The hardware can be complemented with an external turbine for use in regions where compressed air supplies are not reliably available. The standard modes provided include PC-A/C(Pressure Assist Control),PC-A/C-PRVC(Pressure Regulated Volume Control), PC-PSV (Pressure Support Ventilation) and CPAP (Continuous Positive airway pressure). HEV is designed to support remote training and post market surveillance via a web interface and data logging to complement the standard touch screen operation, making it suitable for a wide range of geographical deployment. The HEV design places emphasis on the quality of the pressure curves and the reactivity of the trigger, delivering a global performance which will be applicable to ventilator needs beyond theCOVID-19 pandemic. This article describes the conceptual design and presents the prototype units together with their performance evaluation., Comment: 34 pages, 18 figures, Extended version of the article submitted to PNAS

Published
2020

2. The HEV Ventilator

Author

Buytaert, J, Collins, P, Abed Abud, A, Allport, P, Pazos Alvarez, A, Akiba, K, Augusto de Aguiar Francisco, O, Bay, A, Bernard, F, Baron, S, Bertella, C, Brunner, J, Bowcock, T, Buytaert-De Jode, M, Byczynski, W, De Carvalho, R, Coco, V, Collins, R, Dikic, N, Dousse, N, Dowd, B, Dumps, R, Durante, P, Fadel, W, Farry, S, Fernandez Prieto, A, Flynn, G, Franco Lima, V, Frei, R, Gallas Torreira, A, Guida, R, Hennessy, K, Henriques, A, Hutchcroft, D, Ilic, S, Jevtic, A, Joram, C, Kapusniak, K, Lemos Cid, E, Lindner, J, Lindner, R, Milovanovic, M, Mico, S, Morant, J, Morel, M, Männel, G, Murray, D, Nasteva, I, Neufeld, N, Neuhold, I, Pardo-Sobrino Lopez, F, Perez Trigo, E, Pichel Jallas, G, Pilorz, E, Piquilloud, L, Pons, X, Reiner, D, Roosens, C, Rostalski, P, Sanders, F, Saucet, E, Schmidt, B, Schoettker, P, Schwemmer, R, Schindler, H, Sharma, A, Sigaud, C, Svihra, P, van Leemput, J, Vignaux, L, Vasey, F, Woonton, H, and Wyllie, K

Subjects
Detectors and Experimental Techniques
Abstract

HEV is a low-cost, versatile, high-quality ventilator, which has been designed in response to the COVID-19 pandemic. The ventilator is intended to be used both in and out of hospital intensive care units, and for both invasive and non-invasive ventilation. The hard-ware can be complemented with an external turbine for use in regions where compressed air supplies are not reliably available. The standard modes provided include PC–A/C (Pressure Assist Control), PC–A/C–PRVC (Pressure Regulated Volume Control), PC-PSV (Pressure Support Ventilation) and CPAP (Continuous Positive Airway Pressure). HEV is designed to support remote training and post market surveillance via a web interface and data logging to complement the standard touch screen operation, making it suitable for a wide range of geographical deployment. The HEV design places emphasis on the quality of the pressure curves and the reactivity of the trigger,delivering a global performance which will be applicable to ventilator needs beyond the COVID-19 pandemic. This article describes the conceptual design and presents the prototype units together with their performance evaluation.

Published
2020

7. Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Author

Conway Morris, Andrew, Kohler, Katharina, De Corte, Thomas, Ercole, Ari, De Grooth, Harm-Jan, Elbers, Paul W G, Povoa, Pedro, Morais, Rui, Koulenti, Despoina, Jog, Sameer, Nielsen, Nathan, Jubb, Alasdair, Cecconi, Maurizio, De Waele, Jan, Marco, Bezzi, Alicia, Gira, Philipp, Eller, Tarikul, Hamid, Injamam Ull Haque, Wim De Buyser, Antonella, Cudia, Daniel De Backer, Pierre, Foulon, Vincent, Collin, Jan De Waele, Jolien Van Hecke, Elisabeth De Waele, Claire Van Malderen, Jean-Baptiste, Mesland, Patrick, Biston, Michael, Piagnerelli, Lionel, Haentjens, Nicolas De Schryver, Jan Van Leemput, Philippe, Vanhove, Pierre, Bulpa, Viktoria, Ilieva, David, Katz, Alexandra, Binnie, Anna, Geagea, Fernando, Tirapegui, Gustavo, Lago, Jerónimo, Graf, Rodrigo, Perez-Araos, Patricio, Vargas, Felipe, Martinez, Eduardo, Labarca, Daniel Molano Franco, Daniela, Parra-Tanoux, Luis Felipe Reyes, David, Yepes, Filip, Periš, Sanda Stojanović Stipić, Cynthia Vanessa Campozano Burgos, Paulo Roberto Navas Boada, Jose Luis Barberan Brun, Juan Pablo Paredes Ballesteros, Gamal, Abdelnasser, Ahmed, Hammouda, Omar, Elmandouh, Ahmed, Azzam, Aliae Mohamed Hussein, Islam, Galal, Ahmed, K Awad, Mohammed, A Azab, Maged, Abdalla, Hebatallah, Assal, Mostafa, Alfishawy, Sherief, Ghozy, Samar, Tharwat, Abdullah, Eldaly, Anneli, Ellervee, Veronika, Reinhard, Anne, Chrisment, Chrystelle, Poyat, Julio, Badie, Fernando Berdaguer Ferrari, Björn, Weiss, Clara, Schellenberg, Julius, J Grunow, Marco, Lorenz, Stefan, J Schaller, Peter, Spieth, Marc, Bota, Falk, Fichtner, Kristina, Fuest, Tobias, Lahmer, Johannes, Herrmann, Patrick, Meybohm, Nikolaos, Markou, Georgia, Vasileiadou, Evangelia, Chrysanthopoulou, Panagiotis, Papamichalis, Ioanna, Soultati, Sameer, Jog, Kushal, Kalvit, Sheila Nainan Myatra, Ivan, Krupa, Aisa, Tharwat, Alistair, Nichol, Aine, Mccarthy, Ata, Mahmoodpoor, Tommaso, Tonetti, Paolo, Isoni, Savino, Spadaro, Carlo Alberto Volta, Lucia, Mirabella, Alberto, Noto, Gaetano, Florio, Amedeo, Guzzardella, Chiara, Paleari, Federica, Baccanelli, Marzia, Savi, Massimo, Antonelli, Gennaro De Pascale, San, Luca, Barbara, Vaccarini, Giorgia, Montrucchio, Gabriele, Sales, Donadello, Katia, Leonardo, Gottin, Marta, Nizzero, Enrico, Polati, De Rosa, Silvia, Demet, Sulemanji, Abdurraouf, Abusalama, Muhammed, Elhadi, Montelongo De FelipeJesus, Daniel Rodriguez Gonzalez, Victor Hugo Madrigal Robles, Nancy, Canedo, Alejandro Esquivel Chavez, Tarek, Dendane, Bart, Grady, Ben de Jong, Eveline van der Heiden, Patrick, Thoral, Bas van den Bogaard, Peter, E Spronk, Sefanja, Achterberg, Melanie, Groeneveld, Ralph K, L So, Calvin de Wijs, Harm, Scholten, Albertus, Beishuizen, Alexander, D Cornet, Auke, C Reidinga, Hetty, Kranen, Roos, Mensink, Spaarne, Gasthuis, Sylvia den Boer, Marcel de Groot, Oliver, Beck, Carina, Bethlehem, Bas van Bussel, Tim, Frenzel, Celestine de Jong, Rob, Wilting, Jozef, Kesecioglu, Jannet, Mehagnoul-Schipper, Datonye, Alasia, Ashok, Kumar, Ahad, Qayyum, Muhammad, Rana, Mustafa Abu Jayyab, Rosario Quispe Sierra, Aaron Mark Hernandez, José de Almeida, Lúcia, Taborda, Mónica, Anselmo, Tiago, Ramires, Catarina, Silva, Carolina, Roriz, Rui, Morais, Pedro, Póvoa, Patricia, Patricio, André, Pinto, Maria Lurdes Santos, Vasco, Costa, Pedro, Cunha, Celina, Gonçalves, Sandra, Nunes, João, Camões, Diana, Adrião, Ana, Oliveira, Ali, Omrani, Muna Al Maslamani, Abdurrahmaan Suei Elbuzidi, Bara Mahmoud Al Qudah, Abdel Rauof Akkari, Mohamed, Alkhatteb, Anas, Baiou, Ahmed, Husain, Mohamed, Alwraidat, Ibrahim Abdulsalam Saif, Dana, Bakdach, Amna, Ahmed, Mohamed, Aleef, Awadh, Bintaher, Cristina, Petrisor, Evgeniy, Popov, Ksenia, Popova, Mariia, Dementienko, Boris, Teplykh, Alexey, Pyregov, Liubov, Davydova, Belskii, Vladislav, Elena, Neporada, Ivan, Zverev, Svetlana, Meshchaninova, Dmitry, Sokolov, Elena, Gavrilova, Irina, Shlyk, Igor, Poliakov, Marina, Vlasova, Ohoud, Aljuhani, Amina, Alkhalaf, Felwa Bin Humaid, Yaseen, Arabi, Ahmed, Kuhail, Omar, Elrabi, Madihah, E Ghannam, Ng Teng Fong, Amit, Kansal, Vui Kian Ho, Jensen, Ng, Raquel Rodrígez García, Xiana Taboada Fraga, Mª Del Pilar García-Bonillo, Antonio, Padilla-Serrano, Marta Martin Cuadrado, Carlos, Ferrando, Ignacio, Catalan-Monzon, Laura, Galarza, Fernando, Frutos-Vivar, Jorge, Jimenez, Carmen, Rodríguez-Solis, Enric, Franquesa-Gonzalez, Guillermo Pérez Acosta, Luciano Santana Cabrera, Juan Pablo Aviles Parra, Francisco Muñoyerro Gonzalez, Maria Del Carmen Lorente Conesa, Ignacio Yago Martinez Varela, Orville Victoriano Baez Pravia, Maria Cruz Martin Delgado, Carlos Munoz de Cabo, Ana-Maria, Ioan, Cesar, Perez-Calvo, Arnoldo, Santos, Ane, Abad-Motos, Javier, Ripolles-Melchor, Belén Civantos Martin, Santiago Yus Teruel, Juan Higuera Lucas, Aaron Blandino Ortiz, Raúl de Pablo Sánchez, Jesús Emilio Barrueco-Francioni, Lorena Forcelledo Espina, José, M Bonell-Goytisolo, Iñigo, Salaverria, Antonia Socias Mir, Emilio, Rodriguez-Ruiz, Virginia Hidalgo Valverde, Patricia Jimeno Cubero, Francisca Arbol Linde, Nieves Cruza Leganes, Juan Maria Romeu, Pablo, Concha, José Angel Berezo-Garcia, Virginia, Fraile, Cristina, Cuenca-Rubio, David, Pérez-Torres, Ainhoa, Serrano, Clara Martínez Valero, Andrea Ortiz Suner, Leire, Larrañaga, Noemi, Legaristi, Gerardo, Ferrigno, Safa, Khlafalla, Rosita, Bihariesingh-Sanchit, Hallands, Sjukhus, Frank, Zoerner, Jonathan, Grip, Kristina, Kilsand, Johan, Mårtensson, Jonas, Österlind, Akademiska, Sjukhuset, Magnus von Seth, Västerviks, Sjukhus, Johan, Berkius, Samuele, Ceruti, Andrea, Glotta, Seval, Izdes, Işıl Özkoçak Turan, Ahmet, Cosar, Burcin, Halacli, Necla, Dereli, Mehmet, Yilmaz, Türkay, Akbas, Gülseren, Elay, Selin, Eyüpoğlu, Yelíz, Bílír, Kemal Tolga Saraçoğlu, Ebru, Kaya, Ayca Sultan Sahin, Pervin Korkmaz Ekren, Tuğçe, Mengi, Kezban Ozmen Suner, Yakup, Tomak, Ahmet, Eroglu, Asad, Alsabbah, Katie, Hanlon, Kevin, Gervin, Sean, Mcmahon, Samantha, Hagan, Caroline, V Higenbottam, Randeep, Mullhi, Lottie, Poulton, Tomasz, Torlinski, Allen, Gareth, Nick, Truman, Gopal, Vijayakumar, Chris, Hall, Alasdair, Jubb, Lenka, Cagova, Nicola, Jones, Sam, Graham, Nicole, Robin, Amanda, Cowton, Adrian, Donnelly, Natalia, Singatullina, Melanie, Kent, Carole, Boulanger, Zoë, Campbell, Elizabeth, Potter, Natalie, Duric, Tamas, Szakmany, Royal, Brompton, Orinta, Kviatkovske, Nandor, Marczin, Caroline, Ellis, Rajnish, Saha, Chunda, Sri-Chandana, John, Allan, Lana, Mumelj, Harish, Venkatesh, Vera Nina Gotz, Anthony, Cochrane, Barbara, Ficial, Shruthi, Kamble, Nuttha, Lumlertgul, Christopher, Oddy, Susan, Jain, Giulia Beatrice Crapelli, Aikaterini, Vlachou, David, Golden, Sweyn, Garrioch, Jeremy, Henning, Gupta, Loveleena, Miriam, Davey, Lina, Grauslyte, Erika, Salciute-Simene, Martin, Cook, Danny, Barling, Phil, Broadhurst, Sarah, Purvis, Michael, Spivey, Benjamin, Shuker, Irina, Grecu, Daniel, Harding, James, T Dean, Nathan, D Nielsen, Sama, Al-Bayati, Mohammed, Al-Sadawi, Mariane, Charron, Peter, Stubenrauch, Jairo, Santanilla, Catherine, Wentowski, Dorothea, Rosenberger, Polikseni, Eksarko, Randeep, Jawa, Intensive care medicine, ACS - Microcirculation, ACS - Diabetes & metabolism, AII - Infectious diseases, Conway Morris, Andrew [0000-0002-3211-3216], Kohler, Katharina [0000-0003-1919-0193], De Corte, Thomas [0000-0001-5011-6640], Ercole, Ari [0000-0001-8350-8093], De Grooth, Harm-Jan [0000-0002-7499-076X], Elbers, Paul WG [0000-0003-0447-6893], Povoa, Pedro [0000-0002-7069-7304], Morais, Rui [0000-0003-4114-6949], Koulenti, Despoina [0000-0003-4364-2612], Jog, Sameer [0000-0002-1134-1260], Nielsen, Nathan [0000-0002-3131-7540], Jubb, Alasdair [0000-0001-5593-866X], Cecconi, Maurizio [0000-0002-4376-6538], De Waele, Jan [0000-0003-1017-9748], Apollo - University of Cambridge Repository, UCL - SSS/DDUV/GECE - Génétique cellulaire, UCL - (SLuc) Service de soins intensifs, Conway Morris A., Kohler K., De Corte T., Ercole A., De Grooth H.-J., Elbers P.W.G., Povoa P., Morais R., Koulenti D., Jog S., Nielsen N., Jubb A., Cecconi M., De Waele J., Bezzi M., Gira A., Eller P., Hamid T., Haque I.U., De Buyser W., Cudia A., De Backer D., Foulon P., Collin V., Van Hecke J., De Waele E., Van Malderen C., Mesland J.-B., Piagnerelli M., Haentjens L., De Schryver N., Van Leemput J., Vanhove P., Bulpa P., Ilieva V., Katz D., Geagea A., Binnie A., Tirapegui F., Lago G., Graf J., Perez-Araos R., Vargas P., Martinez F., Labarca E., Franco D.M., Parra-Tanoux D., Reyes L.F., Yepes D., Peris F., Stipic S.S., Burgos C.V.C., Boada P.R.N., Brun J.L.B., Ballesteros J.P.P., Hammouda A., Elmandouh O., Azzam A., Hussein A.M., Galal I., Awad A.K., Azab M.A., Abdalla M., Assal H., Alfishawy M., Ghozy S., Tharwat S., Eldaly A., Reinhard V., Chrisment A., Poyat C., Badie J., Ferrari F.B., Weiss B., Kuhn K.F., Grunow J.J., Lorenz M., Schaller S., Spieth P., Bota M., Fichtner F., Fuest K., Lahmer T., Herrmann J., Meybohm P., Markou N., Vasileiadou G., Chrysanthopoulou E., Papamichalis P., Soultati I., Kalvit K., Myatra S.N., Krupa I., Tharwat A., Nichol A., McCarthy A., Mahmoodpoor A., Tonetti T., Isoni P., Spadaro S., Volta C.A., Mirabella L., Noto A., Florio G., Guzzardella A., Paleari C., Baccanelli F., Savi M., Antonelli M., Vaccarini B., Montrucchio G., Sales G., Donadello K., Gottin L., Polati E., De Rosa S., Sulemanji D., Abusalama A., Elhadi M., De Jesus M.F., Gonzalez D.R., Canedo N., Chavez A.E., Dendane T., Grady B., de Jong B., van der Heiden E., Thoral P., van den Bogaard B., Spronk P.E., Achterberg S., Groeneveld M., So R.K.L., de Wijs C., Scholten H., Beishuizen A., Cornet A.D., Reidinga A.C., Kranen H., Mensink R., Boer S., de Groot M., Beck O., Bethlehem C., van Bussel B., Frenzel T., de Jong C., Wilting R., Kesecioglu J., Mehagnoul-Schipper J., Alasia D., Kumar A., Qayyum A., Rana M., Jayyab M.A., Sierra R.Q., Hernandez A.M., Taborda L., Ramires T., Silva C., Roriz C., Patricio P., Santos M.L., Costa V., Cunha P., Goncalves C., Nunes S., Camoes J., Adriao D., Oliveira A., Omrani A., Al Maslamani M., elbuzidi A.S., Al qudah B.M., Akkari A.R., Alkhatteb M., Baiou A., Husain A., Alwraidat M., Saif I.A., Bakdach D., Ahmed A., Aleef M., Bintaher A., Petrisor C., Popov E., Popova K., Dementienko M., Teplykh B., Pyregov A., Davydova L., Vladislav B., Neporada E., Zverev I., Meshchaninova S., Sokolov D., Gavrilova E., Shlyk I., Poliakov I., B?aco?a M., Aljuhani O., Alkhalaf A., Humaid F.B., Arabi Y., Kuhail A., Elrabi O., Alghnam M., Kansal A., Ho V.K., Ng J., Garcia R.R., Fraga X.T., del Pilar Garcia-Bonillo M., Padilla-Serrano A., Cuadrado M.M., Ferrando C., Catalan-Monzon I., Galarza L., Frutos-Vivar F., Jimenez J., Rodriguez-Solis C., Franquesa-Gonzalez E., Acosta G.P., Cabrera L.S., Parra J.P.A., Gonzalez F.M., del Carmen Lorente Conesa M., Varela I.Y.M., Pravia O.V.B., Delgado M.C.M., de Cabo C.M., Ioan A.-M., Perez-Calvo C., Santos A., Abad-Motos A., Ripolles-Melchor J., Martin B.C., Teruel S.Y., Lucas J.H., Ortiz A.B., de Pablo Sanchez R., Barrueco-Francioni J.E., Espina L.F., Bonell-Goytisolo J.M., Salaverria I., Mir A.S., Rodriguez-Ruiz E., Valverde V.H., Cubero P.J., Linde F.A., Leganes N.C., Romeu J.M., Concha P., Berezo-Garcia J.A., Fraile V., Cuenca-Rubio C., Perez-Torres D., Serrano A., Valero C.M., Suner A.O., Larranaga L., Legaristi N., Ferrigno G., Khlafalla S., Bihariesingh-Sanchit R., Zoerner F., Grip J., Kilsand K., Osterlind J., von Seth M., Berkius J., Ceruti S., Glotta A., Izdes S., Turan I.O., Cosar A., Halacli B., Dereli N., Yilmaz M., Akbas T., Elay G., Eyupoglu S., Bilir Y., Saracoglu K.T., Kaya E., Sahin A.S., Ekren P.K., Mengi T., Suner K.O., Tomak Y., Eroglu A., Alsabbah A., Hanlon K., Gervin K., McMahon S., Hagan S., Higenbottam C.V., Mullhi R., Poulton L., Torlinski T., Gareth A., Truman N., Vijayakumar G., Hall C., Cagova L., Jones N., Graham S., Robin N., Cowton A., Donnelly A., Singatullina N., Kent M., Boulanger C., Campbell Z., Potter E., Duric N., Szakmany T., Kviatkovske O., Marczin N., Ellis C., Saha R., Sri-Chandana C., Allan J., Mumelj L., Venkatesh H., Gotz V.N., Cochrane A., Lumlertgul N., Ficial B., Jain S., Crapelli G.B., Vlachou A., Golden D., Garrioch S., Henning J., Loveleena G., Davey M., Grauslyte L., Salciute-Simene E., Cook M., Barling D., Broadhurst P., Purvis S., Michael S., Shuker B., Grecu I., Harding D., Dean J.T., Nielsen N.D., Al-Bayati S., Al-Sadawi M., Charron M., Stubenrauch P., Santanilla J., Wentowski C., Rosenberger D., Eksarko P., and Jawa R.

Subjects
Adult, Coronavirus Disease 2019 (COVID-19), Critical Illness, Intensive Care Unit, Pneumonia, Viral, NCT04836065, Adrenal Cortex Hormone, Critical Care and Intensive Care Medicine, co-infection, COVID-19 Testing, Adrenal Cortex Hormones, Anti-Bacterial Agent, Medicine and Health Sciences, Pneumonia, Bacterial, Humans, Pandemics, Pandemic, Coinfection, Research, Other Research Radboud Institute for Health Sciences [Radboudumc 0], respiratory failure, COVID-19, Anti-Bacterial Agents, Intensive Care Units, NCT, ICU, Critical Illne, Coronavirus Disease 2019 (COVID-19), co-infection, ICU, respiratory failure, Human
Abstract

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, BACKGROUND: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. METHODS: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. RESULTS: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. CONCLUSIONS: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)., European Society of Intensive Care Medicine ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1)

Published
2022

8. The HEV Ventilator: at the interface between particle physics and biomedical engineering.

Author

Buytaert J, Collins P, Abed Abud A, Allport P, Pazos Álvarez A, Akiba K, de Aguiar Francisco OA, Bay A, Bernard F, Baron S, Bertella C, Brunner JX, Bowcock T, Buytaert-De Jode M, Byczynski W, De Carvalho R, Coco V, Collins R, Dikic N, Dousse N, Dowd B, Dreimanis K, Dumps R, Durante P, Fadel W, Farry S, Fernàndez Prieto A, Fernàndez Tèllez A, Flynn G, Franco Lima V, Frei R, Gallas Torreira A, García Chàvez T, Gazis E, Guida R, Hennessy K, Henriques A, Hutchcroft D, Ilic S, Ivanovs A, Jevtic A, Jimenez Dominguez E, Joram C, Kapusniak K, Lemos Cid E, Lindner J, Lindner R, Ivàn Martínez Hernàndez M, Meboldt M, Milovanovic M, Mico S, Morant J, Morel M, Männel G, Murray D, Nasteva I, Neufeld N, Neuhold I, Pardo-Sobrino López F, Pèrez Trigo E, Pichel Jallas G, Pilorz E, Piquilloud L, Pons X, Reiner D, Règules Medel HD, Rodríguez Ramírez S, Rodíguez Cahuantzi M, Roosens C, Rostalski P, Sanders F, Saucet E, Schmid Daners M, Schmidt B, Schoettker P, Schwemmer R, Schindler H, Sharma A, Sivakumaran D, Sigaud C, Spitas V, Steffen N, Svihra P, Tejeda Muñoz G, Tachatos N, Tsolakis E, van Leemput J, Vignaux L, Vasey F, Woonton H, and Wyllie K

Abstract

A high-quality, low-cost ventilator, dubbed HEV, has been developed by the particle physics community working together with biomedical engineers and physicians around the world. The HEV design is suitable for use both in and out of hospital intensive care units, provides a variety of modes and is capable of supporting spontaneous breathing and supplying oxygen-enriched air. An external air supply can be combined with the unit for use in situations where compressed air is not readily available. HEV supports remote training and post market surveillance via a Web interface and data logging to complement standard touch screen operation, making it suitable for a wide range of geographical deployment. The HEV design places emphasis on the ventilation performance, especially the quality and accuracy of the pressure curves, reactivity of the trigger, measurement of delivered volume and control of oxygen mixing, delivering a global performance which will be applicable to ventilator needs beyond the COVID-19 pandemic. This article describes the conceptual design and presents the prototype units together with a performance evaluation., Competing Interests: We declare we have no competing interests., (© 2022 The Authors.)

Published
2022
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9. Pediatric necrotizing soft tissue infection after elective surgery: A case report and literature review.

Author

Gheuens L, Roggeman Q, Cortebeeck K, Leyman P, Bernaerts A, De Foer B, Van Leemput J, and van Dinther J

Subjects
Amoxicillin-Potassium Clavulanate Combination, Child, Debridement, Humans, Male, Wound Healing, Cicatrix surgery, Elective Surgical Procedures adverse effects, Fasciitis, Necrotizing diagnosis, Fasciitis, Necrotizing etiology, Fasciitis, Necrotizing therapy, Negative-Pressure Wound Therapy, Soft Tissue Infections diagnosis, Soft Tissue Infections etiology, Soft Tissue Infections therapy
Abstract

Introduction: Necrotizing soft tissue infections (NSTIs) are rare but often lethal. Early diagnosis and aggressive surgical debridement are essential to achieve the best possible outcome., Case Presentation: A 12-year old boy was diagnosed with a necrotizing soft tissue infection following elective revision surgery for functional impairment resulting from scar tissue of the neck. Fever and inflammation of the surgical wound manifested 24-36 hours postoperatively. Antibiotic therapy with amoxicillin-clavulanic acid was initiated, but the patient was unresponsive. Ultrasonography, a wound culture and surgical exploration confirmed the diagnosis. The culture was positive for a Streptococcus pyogenes infection and antibiotic treatment was switched to penicillin and clindamycin. Following the diagnosis, surgical debridement was performed subcutaneously, and only necrotic tissue was removed to preserve as much skin tissue as possible. After eradication of the infection, vacuum-assisted closure of the wound was used to close the subcutaneous space. The patient was discharged after 40 days., Conclusion: In this patient, we treated a necrotizing soft tissue infection with antibiotics, skin sparing surgeries and negative pressure wound therapy (NPWT). We used ultrasonography as imaging technique to help with the diagnosis. The extensiveness of surgical debridement was rather limited. We focused on opening all affected fascial layers. The surgical debridement was subcutaneous, and only necrotic tissue was removed. Because of the location in the neck, we tried to avoid an aggressive skin debridement to preserve as much skin tissue as possible. Negative pressure wound therapy is not frequently used in this context but it contributed to an enhanced wound healing. Ultrasonography for diagnosing NSTIs is useful, but the clinical findings and an explorative surgery will remain most important., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Published
2020
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10. Invasive pulmonary aspergillosis due to a multi-azole resistant Aspergillus fumigatus.

Author

Jeurissen A, Cooreman S, Van Kerckhoven W, Van Leemput J, Vanhove P, Lagrou K, and Heytens L

Subjects
Humans, Invasive Pulmonary Aspergillosis drug therapy, Male, Middle Aged, Antifungal Agents therapeutic use, Aspergillus fumigatus, Azoles therapeutic use, Drug Resistance, Multiple, Fungal, Invasive Pulmonary Aspergillosis diagnosis, Invasive Pulmonary Aspergillosis microbiology
Abstract

A patient with invasive pulmonary aspergillosis due to an azole-resistant Aspergillus fumigatus is described. Despite treatment change from voriconazole to amphotericin B as soon as the resistance data were available, the patient died. Azole resistance is an emerging problem, which significantly complicates the management of A. fumigatus infections. It should be considered in every patient with an invasive A. fumigatus infection who is not responding to voriconazole therapy.

Published
2012
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11. Pelvic inflammatory disease due to Streptococcus pneumoniae: a usual pathogen at an unusual place.

Author

Lemoyne S, Van Leemput J, Smet D, Desmedt E, Devos H, Van Schaeren J, and Jeurissen A

Subjects
Abdominal Pain etiology, Adult, Female, Humans, Pelvic Inflammatory Disease microbiology, Pneumococcal Infections diagnosis
Abstract

We report three cases of pelvic inflammatory disease (PID) due to Streptococcus pneumoniae in previously healthy young women. S. pneumoniae frequently causes bacteremia, meningitis and respiratory infections, but it very rarely infects the genital tract. All our patients presented with an acute onset of severe abdominal pain and had an intrauterine device (IUD) present. No abnormal sexual behavior was noticed. Although the relation between PID due to S. pneumoniae and the use of an IUD has been a topic for discussions, culture of IUD in all our patients and blood culture in 2 of 3 of our patients revealed S. pneumoniae. All patients recovered well with intravenous antibiotic treatment and removal of the IUD.

Published
2008
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