The coronavirus pandemic has revealed flaws in the global supply chain for oxygen that can put virus patients’ lives at risk. David Cheeseman, Chief Engineer of Oxair Gas Systems, a leading global supplier of on-site gas generating equipment, explains how the latest technology can replace outsourcing conventional oxygen tanks.
The Covid-19 pandemic has resulted in dwindling oxygen supplies as demand soared during the crisis, with deadly consequences for patients, particularly in countries suffering high infection rates. Generating a constant flow of oxygen on site helps hospitals save lives by becoming less reliant on outsourcing conventional canisters.
Severe shortages of this life-saving gas were reported from all corners of the world during the pandemic, raising concerns that fault lines have been exposed in the supply chain with hospitals being forced to ration oxygen to avoid the risk of running out.
There is an off-the-shelf automated solution to avoid potential shortages in the form of Oxygen Pressure Swing Adsorption (PSA) systems, robust technology which has been designed to deliver consistent, high purity oxygen on tap to hospitals and medical facilities even in the remotest locations around the world.
Medical facilities are often forced to rely on outsourcing oxygen, with failing supply lines posing a potential catastrophe for hospitals, not to mention the added stress on frontline staff associated with the storage, handling and removal of traditional oxygen cylinders.
PSA medical oxygen offers better patient care with a permanent flow of high-quality oxygen to suit the needs of the hospital – and the equipment is capable of piping oxygen around every department as needed. In cases where the hospital does not have a central piping system, suppliers like Oxair will install an onsite cylinder filling system. It’s a highly cost-effective and hygienic alternative to the inconvenience and uncertainty of outsourcing canisters.
This automated system delivers constant oxygen of 94-95 percent purity through PSA filtration, a unique process that separates oxygen from compressed air. The gas is then conditioned and filtered before being stored in a buffer tank to be used directly by the hospital on demand.
It’s not just in the middle of a global pandemic when outsourcing conventional canisters can hit a bottleneck. Ensuring a reliable supply to hospitals in remote or troubled locations proves a constant challenge when faced with poor infrastructure, limited resources and haphazard road conditions.
An ideal example, Heal Africa hospital in The Democratic Republic of the Congo (DRC), had been relying on tanker deliveries of oxygen from a neighbouring state, but staff found that patients were being left at risk due to faulty equipment which, upon testing, was discovered to be supplying just 60 percent oxygen purity compared with the standard 93 percent needed for medical grade applications.
It was decided that a new oxygen system was vital and the hospital was able to overcome its supply difficulties by having an Oxair OA450 system installed, piping oxygen around the hospital to every department as needed, providing a cost-effective and hygienic alternative to the inconvenience of ordering in traditional carbon steel cylinders which are also prone to corrosion.
Meanwhile, medical facilities on the subcontinent have not only seen the life-saving benefits of turning to automation but cost savings too. The Sunrise Hospital in Hyderabad, India, installed a PSA system to supply its oxygen – saving the hospital almost a thousand pounds a month by reducing its dependence on cylinders.
The multi-specialist facility was going through cylinders at a costly rate of up to 16 a day. Now Sunrise’s owner is happy because the hospital is saving money which can be redirected to improving other services, while the staff are happy because they have more time to care for patients.
By embracing an automated process, Sunrise is following in the footsteps of many other hospitals in the Indian medical sector that have realised the benefits of having their own source of oxygen, helping to eliminate possible future interruptions.
To improve the flow of oxygen, suppliers should be ready to step up and do whatever is necessary to help healthcare services during the current coronavirus crisis – and beyond – by providing life-saving oxygen equipment wherever it is needed.
PSA systems that are ‘plug-and-play’ means that they are literally ready to start working as soon as they are delivered and plugged in – with voltage adapted to the country of delivery. Wherever they may be located, hospitals can rely on technology which is tried and tested over many years, coupled with almost instant access to vital oxygen supplies.
In partnership with Ziehm Imaging, Carestream Health has added a mobile C-arm into its product portfolio. Known as the Ziehm Vision RFD C-arm, this surgical imaging system will further enhance Carestream’s mobile and fluoroscopic product offerings. The system will be available in the U.S. and Canada this year.
The Vision RFD C-arm offers a 25kw generator, in either a 20.5 x 20.5 cm or 31 x 31 cm field of view flat-panel CMOS digital detector, allowing for broad procedural work including vascular, cardiac, spine ortho-trauma and pain management, in addition to many general surgical applications. The system’s Advanced Active Cooling enables extended case times beyond traditional air-cooled systems. It also provides an intuitive graphical interface that benefits technologists with reduced training time as well as improved productivity.
“The partnership with Carestream confirms Ziehm Imaging’s industry-leading technology,” said Nelson Mendes, President and CEO of Orthoscan and Ziehm Imaging Inc. “As a result of this partnership, we’re able to provide Carestream and its customers with one of the most innovative C-arms on the market. The Ziehm Vision RFD delivers advanced surgical care with the Ziehm Usability Concept, provides exceptional image quality and helps to reduce exposure significantly with the next-generation SmartDose, thereby providing a very unique package.”
Ziehm Vision RFD systems will be available for sale and service through Carestream.
Tübingen, Germany-based Atriva Therapeutics, a biopharmaceutical company that is pioneering the development of host-targeting antiviral therapies, has enrolled its first patient in its Phase II RESPIRE [1] trial in COVID-19. Prof. Martin Witzenrath, M.D., Vice Director Department of Infectious Diseases and Respiratory Medicine, supervised the first administration of study medication (MEK inhibitor ATR-002 or placebo) at the Charité – Universitätsmedizin Berlin, Germany.
Dr Rainer Lichtenberger, CEO of Atriva Therapeutics, commented: “We are excited to assess the efficacy of ATR-002 in treating COVID-19 and are looking forward to the results of the clinical trial. We can now test our lead candidate against SARS-CoV-2 because our pharmacological target is a common cellular mechanism that RNA viruses use. ATR-002 leaves the virus itself untouched but blocks a cellular factor that the virus needs for its replication and has the potential to reduce the viral load in the infected host.
“Host-directed approaches maintain efficacy also against mutated viruses – a problem that we are commonly seeing in the influenza virus and, unfortunately, in SARS-CoV-2 as well. If we were to see the positive outcomes of the trial we hope for, ATR-002 could provide efficient help against COVID-19 regardless of the given genetic subtype of the underlying viral strain.”
Prof. Gernot Rohde, M.D., Head of Pneumology and Professor for Respiratory Medicine and Allergology at the Goethe University Hospital, Frankfurt am Main, Germany and Global Coordinating Investigator of the RESPIRE trial, said: “While we have been lucky that SARS-CoV-2 vaccines were developed at unprecedented speed, we still are in desperate need for effective therapies against COVID-19. The pandemic situation remains very critical and is far from being under control.
“Being able to contribute to the development of a COVID-19 therapy, I am very much looking forward to the effects that we may see with ATR-002. I am convinced that a medication that can prevent hospitalized patients with a moderate to severe stage of COVID-19 from deteriorating and requiring ICU admission and ventilator support would mean huge progress and could also play a role in impeding the severe long-term effects that are being described as “Long COVID” Syndrome (PASC).”
RESPIRE is a randomized, double-blind, placebo-controlled, international, multi-center Phase II clinical trial in 220 adult patients with moderate to severe COVID-19, requiring hospitalization, but not requiring ICU admission or ventilator support at the time of screening or randomization. On top of standard of care, half of the patients will receive ATR-002 900 mg, administered as tablets once daily on day 1, followed by ATR-002 600 mg once daily on days 2 to 6. Patients in the control group will receive placebo in a matching scheme, on top of standard of care.
The primary objective of the study is to demonstrate the efficacy of ATR-002 versus placebo in addition to standard of care; secondary endpoints include the measurement of changes in clinical signs and symptoms as well as other relevant clinical parameters. Outcomes will be assessed based on the clinical severity status on day 15, using a 7-point ordinal scale as suggested by the WHO COVID-19 Therapeutic Trial Synopsis [2]. All patients will be followed-up for 90 days. The study will also evaluate the pharmacokinetics of ATR-002.
Atriva’s lead product ATR-002 is developed specifically to treat diseases such as influenza and COVID-19, caused by RNA viruses. ATR-002 is a clinical stage MEK inhibitor drug candidate targeting the intracellular Raf/MEK/ERK signaling pathway. This pathway is central for replication of many RNA viruses, such as the influenza virus, hantavirus or respiratory syncytial virus (RSV) and also SARS-CoV-2, the virus that causes COVID-19.
In influenza virus infected cells, the interaction of ATR-002 with MEK (MAPK/ERK kinase) prevents export of the viral genome protein complexes (ribonucleoprotein, RNP) from the nucleus to the cytoplasm, thus blocking the formation of functional new viral particles. This ultimately reduces the viral load in the body. In addition, ATR-002 has the potential to modulate the pro-inflammatory cytokine response of the body, avoiding overshooting cytokine response that can be caused by such viral infections. MEK inhibition can reduce the gene expression of some of the cytokines involved, like TNF-α, IL-1ß, IP-10, IL-8, MCP-1 and MIP-1a, and thus mitigate the overactive inflammatory response in the lungs of patients who are severely ill with influenza or COVID-19.
[2] https://www.who.int/publications/i/item/covid-19-therapeutic-trial-synopsis.
Icare Finland, a specilist in providing fast, easy-to-use, and reliable tools for ophthalmic diagnostics, is launching their next generation self-tonometer, the iCare HOME2.
iCare HOME2 provides unsurpassed ease of use and accuracy in monitoring real-world intraocular pressure behaviour outside of the doctor’s office and clinical hours, supporting glaucoma management. Glaucoma is a chronic, progressive disease of the optic nerve. As intraocular pressure (IOP) is the only modifiable risk factor for glaucoma progression, disease management is centred around the reduction of IOP. Therefore, comprehensive and accurate information on peak IOPs and IOP fluctuation patterns is crucial.
Most patients can utilize iCare HOME2 simply by following the advice and guidance in the instruction materials, freeing up health care professionals’ precious time. iCare HOME2’s smart light guide helps the patient in positioning the device correctly and in making the measurements effortlessly and accurately, every time. It is now easier than ever for doctors to provide glaucoma management based on real-world IOP information, from finding the optimal medication and instillation schedule, to assessing the need for and effectiveness of surgery.
With the novel iCare PATIENT2 mobile app, the patients can follow their own IOP trends from an iOS or Android mobile device and send the IOP measurement results easily for healthcare professional’s review in the cloud based iCare CLINIC software. Using iCare HOME2 and PATIENT2, the patient can actively participate in the care process by providing valuable information to the healthcare professional. Patient motivation for medication compliance can improve, and knowledge of the real-time IOP levels provides daily reassurance.
HORIBA Medical, specialists in automated in vitro diagnostic systems for haematology, haemostasis and clinical chemistry analysis, has obtained the CE Mark certification for its new generation of the Microsemi CRP haematology analyser, the Microsemi CRP LC-767G.
This new generation analyser Microsemi CRP LC-767G is more compact and proposes enhanced software and network connectivity providing higher memory, usability plus a new parameter: Granulocytes-to-Lymphocytes Ratio (GLR). The incredible robustness and ease of use of the Micros range are further improved for this new generation analyser.
Developed by HORIBA Medical in Japan, ‘emi’ means ‘smile’ in Japanese and stands for easy to use, maintenance free and Intelligent. After a highly successful release in Japan, this unique instrument is now available in Europe. This compact, easy to use addition to the Micros range, simultaneously provides a Complete Blood Count (CBC) and C-Reactive Protein (CRP) from just 18 µL of blood – all in just 4 minutes.
The Microsemi CRP LC-767G provides information of great clinical value enabling quicker and more accurate medical decisions at the Point of Care to ultimately reduce hospitalization times and patient costs. Its powerful and accurate CRP analysis allows the screening of patient samples to quantify the presence of inflammation caused by bacterial, viral (e.g. Covid-19), parasitic infections (e.g. malaria) and other treatable inflammatory diseases.
The simultaneous access to Lymphocytes, GLR and CRP provided on this analyser is helpful for Covid-19 patient screening, monitoring and triage. Measurement is possible immediately after blood sample collection from capillary sample, making this analyser the ideal choice for emergency testing situations.
This new Microsemi CRP LC-767G can also be used to assess infection and inflammatory conditions that require progressive observation. Furthermore, its micro-sampling capabilities are ideal for paediatric blood analysis, at the Point of Care requiring just 10µL for CBC and 18 µL for CBC+CRP, and can be used with capillary, as well as venous blood samples.
The Microsemi CRP is easy to use and does not require specialist staff. Comprehensive and efficient on-board software with colour touchscreen and easy to access patient and control results are features of the Microsemi CRP. It is compact, lightweight and quiet.
In May 2020, a team led by thoracic surgeon Konrad Hoetzenecker of the Department of Surgery of MedUni Vienna and Vienna General Hospital performed a lung transplant on a 44-year-old patient who had been seriously ill with Covid-19, making her the first patient in Europe to receive a lung transplant for this indication. The Vienna lung transplantation programme now plays a leading role in an international consortium comprising experts from the USA, Europe and Asia. Based on the expertise from Vienna, approximately 40 transplants have now been carried out on Covid-19 patients throughout the world.
In a study published in The Lancet Respiratory Medicine, the consortium has now proposed the first general selection criteria for lung transplantation in Covid-19 patients.
“We have collated the first experiences in the world of performing lung transplants on Covid-19 patients. It is clear that such a complex intervention should only be considered for patients who, by virtue of their age and good general health, have a good chance of recovery with new lungs,” explaindc Konrad Hoetzenecker, Head of the lung transplantation programme at MedUni Vienna and Vienna General Hospital. The Vienna team performs around 100 lung transplants a year, making it one of the largest programmes in the world, alongside Toronto, Cleveland and Hanover.
Candidates for a lung transplant
The following factors were established as criteria for potential transplantation: exhaustion of all conservative treatment options, no recovery of the Covid-19-damaged lungs despite at least four weeks of ventilation/ECMO, evidence of advanced and irreversible lung damage in several consecutive CT scans, age below 65 and no relevant comorbidities. In addition to this, candidates for a lung transplant must be in good physical condition and have a good chance of complete physical rehabilitation following the transplant.
“These guidelines can be applied worldwide for making a sound selection of patients who are suitable for a lung transplant following a Covid-19 infection,” according to a statement released by MedUni Vienna.
The surgical team at MedUni Vienna and Vienna General Hospital has meanwhile carried out 12 lung transplantations on Covid-19 patients, demonstrating that even the most seriously ill patients, who would otherwise die, can survive with a lung transplant.
Patient No. 1
In March 2020, patient number one suffered total pulmonary failure as a result of Covid-19, so that artificial ventilation was no longer possible. She could only be kept alive by the circulation pump. At the time of the transplant, the PCR test showed that virus particles were still present but were no longer infectious. The MedUni Vienna/Vienna General Hospital thoracic surgeons and surgical team managed to replace the patient’s completely destroyed lungs with new donor lungs.
Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries.
The Lancet Respiratory Medicine, 2021
https://doi.org/10.1016/S2213-2600(21)00077-1
https://www.sciencedirect.com/science/article/pii/S2213260021000771
April 2024
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