Nasopharyngeal ventilation (NPV) is a common technique used to support breathing, particularly when a patient’s respiration is inadequate, such as under sedation. It involves delivering oxygen through an endotracheal tube positioned above the glottis. Accurate tidal volume measurement is crucial for anesthesiologists, with the gold standard being a pneumotachograph. However, due to leakage from the mouth or mask, this method has limitations when applied to NPV. This study introduces a computational model that calculates respiratory flow in real time by accounting for leak flow. Results show that tidal volume measurements using this method are comparable to the gold standard, assuming the model’s assumptions hold true.

High-flow nasal cannula (HFNC) is becoming the gold standard to treat respiratory distress at any age since it potentially provides several significant clinical advantages. An obstacle to the diffusion of this simple and effective system of oxygen therapy is the impossibility to know the optimal flow rate leading to such advantages that allows the reduction in the respiratory effort without causing hyperinflation. To assist clinicians during HFNC treatment in setting the optimal flow rate and in determining the most relevant parameters related to respiratory mechanics and the effort of the patient, we developed a new programmable data monitoring, acquisition, and elaborating system (Pro_HFNC). The application of Pro_HFNC is fully compatible with HFNC as it is interfaced with patient through a facial mask and two specific catheters. The unavoidable and unpredictable loss of air flow occurring around the contour of the mask is evaluated and compensated by a specific algorithm implemented by Pro_HFNC. Our preliminary clinical trials on pediatric patients treated with HFNC show that Pro_HFNC is actually capable to detect for any specific patient both the lower threshold of the delivered flow beyond which the benefits of HFNC application are reached and all the parameters useful for a complete evaluation of the respiratory profile. Pro_HFNC can really help physicians in setting the optimal flow rate during HFNC treatment, thus allowing for the most effective HFNC performance.

IntroductionAlthough neonatal breathing patterns vary after perinatal asphyxia, whether they change during therapeutic hypothermia (TH) remains unclear. We characterized breathing patterns in infants during TH for hypoxic-ischemic encephalopathy (HIE) and normothermia after rewarming.MethodsIn seventeen spontaneously breathing infants receiving TH for HIE and in three who did not receive TH, we analyzed respiratory flow and esophageal pressure tracings for respiratory timing variables, pulmonary mechanics and respiratory effort. Breaths were classified as braked (inspiratory:expiratory ratio ≥1.5) and unbraked (<1.5).ResultsAccording to the expiratory flow shape braked breaths were chategorized into early peak expiratory flow, late peak expiratory flow, slow flow, and post-inspiratory hold flow (PiHF). The most braked breaths had lower rates, larger tidal volume but lower minute ventilation, inspiratory airway resistance and respiratory effort, except for the PiHF, which had higher resistance and respiratory effort. The braked pattern predominated during TH, but not during normothermia or in the uncooled infants.ConclusionsWe speculate that during TH for HIE low respiratory rates favor neonatal braked breathing to preserve lung volume. Given the generally low respiratory effort, it seems reasonable to leave spontaneous breathing unassisted. However, if the PiHF pattern predominates, ventilatory support may be required.

DAMA/LIBRA is an experiment investigating the presence of Dark Matter particles in the Galactic halo. The target detectors are ultra-radiopure NaI(Tl) crystal scintillators. They are placed inside a low-background set-up at the underground Gran Sasso National Laboratory (LNGS) of the I.N.F.N.. DAMA/LIBRA has been in operation in two phases by pursuing the annual modulation as signature to point-out in a model-independent way the presence and the features of the Dark Matter (DM) signal in the counting rate. In its second phase of measurement, DAMA/LIBRA–phase2, it has been working with a lower software energy threshold with respect to DAMA/LIBRA–phase1. DAMA/LIBRA–phase2 confirms the evidence of a signal that meets all the requirements of the model independent Dark Matter annual modulation signature, at 11.8 [Formula: see text] C.L. in the energy region (1–6) keV. In the energy region (2–6) keV, where data are also available from DAMA/NaI and DAMA/LIBRA–phase1, the achieved C.L. for the full exposure (2.86 ton × yr, 22 annual cycles) is 13.7 [Formula: see text]; the modulation amplitude of the single-hit scintillation events is: [Formula: see text] cpd/kg/keV, and the measured period and phase are well in agreement with those expected for DM particles. Detailed studies have excluded that the observed modulation is due to systematics or side reaction. In this proceedings the results achieved so far by the DAMA/LIBRA experiment and the new ones corresponding to two new annual cycles of data will be presented. Future perspectives of the experiment will be addressed.

DAMA/LIBRA is an experiment investigating the presence of Dark Matter particles in the Galactic halo. The target detectors are ultra-radiopure NaI(Tl) crystal scintillators. They are placed inside a low-background set-up at the underground Gran Sasso National Laboratory (LNGS) of the I.N.F.N.. DAMA/LIBRA has been in operation in two phases by pursuing the annual modulation as signature to point-out in a model-independent way the presence and the features of the Dark Matter (DM) signal in the counting rate. In its second phase of measurement, DAMA/LIBRA–phase2, it has been working with a lower software energy threshold with respect to DAMA/LIBRA–phase1. DAMA/LIBRA–phase2 confirms the evidence of a signal that meets all the requirements of the model independent Dark Matter annual modulation signature, at 11.8 [Formula: see text] C.L. in the energy region (1–6) keV. In the energy region (2–6) keV, where data are also available from DAMA/NaI and DAMA/LIBRA–phase1, the achieved C.L. for the full exposure (2.86 ton × yr, 22 annual cycles) is 13.7 [Formula: see text]; the modulation amplitude of the single-hit scintillation events is: [Formula: see text] cpd/kg/keV, and the measured period and phase are well in agreement with those expected for DM particles. Detailed studies have excluded that the observed modulation is due to systematics or side reaction. In this proceedings the results achieved so far by the DAMA/LIBRA experiment and the new ones corresponding to two new annual cycles of data will be presented. Future perspectives of the experiment will be addressed.

Experimental observations and theoretical arguments point out that Dark Matter (DM) particles are one of the most prominent component of the Universe. This motivated the pioneer DAMA experiment to investigate the presence of these particles in the galactic halo, by exploiting the model independent signature of the DM annual modulation of the rate and very highly radio-pure apparatus in underground site. In this paper the results obtained by other two annual cycles of DAMA/LIBRA-phase2 are presented and the long-standing model-independent annual modulation effect measured by DAMA deep underground at the Gran Sasso National Laboratory (LNGS) of the I.N.F.N. with different experimental configurations is summarized. The improved experimental configuration of DAMA/LIBRA-phase2, $\simeq$ 250 kg highly radio-pure NaI(Tl), allowed to lower the software energy threshold. The total exposure of DAMA/LIBRA-phase2 over 8 annual cycles is 1.53 ton $\times$ yr. DAMA/LIBRA-phase2 confirms the evidence of a signal that meets all the requirements of the model independent Dark Matter annual modulation signature, at 11.8 $\sigma$ C.L. in the energy region (1-6) keV. In the energy region between 2 and 6 keV, where data are also available from DAMA/NaI and DAMA/LIBRA-phase1 (2.86 ton $\times$ yr), the achieved C.L. is 13.7 $\sigma$; the modulation amplitude of the single-hit scintillation events is: $(0.01014 \pm 0.00074)$ cpd/kg/keV, the measured phase is $(142.4 \pm 4.2)$ days and the measured period is $(0.99834 \pm 0.00067)$ yr, all these values are well in agreement with those expected for DM particles. No systematics or side reaction able to mimic the exploited DM signature (i.e. to account for the whole measured modulation amplitude and to simultaneously satisfy all the requirements of the signature), has been found or suggested by anyone throughout some decades thus far.

Breath monitoring of sedated and under-treatment patients is a key clinical procedure in hospitals. Non-invasive de-vices are preferable to perform a comfortable screening, and they assume greater importance in case the patients are newborns. Ultra High Frequency (UHF) Radio Frequency IDentification (RFID) breath sensors are passive devices that can enable low-invasive and wireless monitoring of respiration. By embedding temperature sensors within their Integrated Circuits (ICs), these devices are compact and can record temperature signals that can be correlated with typical flow-based signals. This paper aims at assessing the feasibility of involving RFID breath sensors for the monitoring of newborns breathing temperature in a real hospital ward. A pediatric disposable facemask was sensorized with a T-match dipole antenna. Following a preliminary evaluation of its electromagnetic performance and safety, in-hospital breath monitoring was performed on a newborn undergoing mild hypothermia treatment. Compared to traditional flow meter measurements, RFID results are promising and the ease-of-use and the wireless transmission of the data permit the monitoring of patients without interfering with the undergoing treatments.

Experimental observations and theoretical arguments at Galaxy and larger scales suggested that a large fraction of the universe is composed by Dark Matter particles. This motivated the DAMA experimental efforts to investigate the presence of such particles in the galactic halo by exploiting a model-independent signature and very highly radiopure set-ups deep underground. Here, a review of the model-independent positive results, obtained by the DAMA set-ups at the Gran Sasso National Laboratory of the INFN, and some of the implications will be given.

Abnormal breathing can be a symptom of an unhealthy status. Conventional diagnostic exams involve cumbersome and intrusive instrumentation, such as nasal cannulas, that is, uncomfortable for the user and that, most of the times, do not consider the breathing asymmetries between the two nostrils. This article describes a two-channel flexible epidermal sensor for the wireless and less-invasive bilateral monitoring of nasal breathing based on temperature measurement. The device is suitable to adhere to the prolabium and comprises two coupled T-match antennas whose Ultra-High Frequency (UHF) Radio-Frequency Identification (RFID) Integrated Circuits (ICs) are placed at the entrance of the nostrils. They are provided with embedded temperature sensors so that they implement both sensing and transmission of the data. A measurement campaign is carried out to provide a quantitative characterization of the dual-channel device as a breath sensor by comparison with a conventional flow meter. The two nostrils can be independently monitored due to a negligible cross-sensitivity of the two ICs' temperature data. Moreover, temperature-based measurements proved capable to reproduce typical clinical breathing features, with less than 12% uncertainty with respect to flow waveforms.

The long-standing model-independent annual modulation effect measured by DAMA deep underground at the Gran Sasso National Laboratory (LNGS) of the I.N.F.N. using different experimental configurations is summarized also including the results of two new annual cycles collected by DAMA/LIBRA-phase2; the total exposure of DAMA/LIBRA–phase2 over 8 annual cycles is 1.53 t yr. The evidence of a signal that meets all the requirements of the model independent dark matter (DM) annual modulation signature is further confirmed at 11.8 $$\sigma$$ C.L. in the energy region (1–6) keV. In the energy region between 2 and 6 keV, where data are also available from DAMA/NaI and DAMA/LIBRA–phase1, the achieved C.L. for the full exposure (2.86 t yr) is 13.7 $$\sigma$$ .

Abnormal breathing can be a symptom of an unhealthy status. Conventional diagnostic exams involve cum-bersome and intrusive instrumentation that are overall un-comfortable for the user. Ultra High Frequency (UHF) Radio Frequency IDentification (RFID) devices, instead, enable non-invasive wireless monitoring of respiration by means of epidermal antennas with embedded temperature sensors. Two sampling points in the same device could be useful to independently measure the respiratory flow of the two nostrils, which are known to work differently. At this purpose, this paper proposes a two-channel flexible epidermal sensor for the bilateral monitoring of nasal breathing based on temperature measurement. It compactly adheres on the prolabium, and comprises two coupled T-match asymmetric dipole antennas whose ICs are placed at the exit of the nostrils. The sensor can be read up to 60 cm. Experimental tests on some prototypes demonstrated that, thanks to negligible cross-sensitivity of the two ICs' temperature data, the breathing rate can be accurately estimated independently for the two nostrils.

To determine whether in infants with bronchiolitis admitted to a pediatric intensive care unit (PICU) the starting rate for high‐flow nasal cannula (HFNC) therapy set by the attending physicians upon clinical judgment meets patients' peak inspiratory flow (PIF) demands and how it influences respiratory mechanics and breathing effort.

Breath monitoring is critical for multiple applications, ranging from monitoring patients in Intensive Care Units (ICUs) to the design of optimized physical training. Recently proposed Radiofrequency Identification (RFID) tags and systems for breath monitoring only return integrated information on breathing, whereas the air flow through each nostril can provide more useful information. In this paper, a dual-tag temperature-sensing RFID device is introduced for the simultaneous bilateral monitoring of the nostrils’ breath. The device comprises two coupled tapered loops each closed to a transmission line probe excited by a smaller loop hosting the Integrated Circuit (IC). The resulting two-ports tag is such that each temperature-sensing IC is placed just below a nostril. Numerical and preliminary experimentations with epidermal prototypes suggest that the two sensors can be simultaneously read along the nose septum’s direction up to a distance of 50 cm.

Nasopharyngeal tubes are useful in pediatric anesthesia for insufflating oxygen and anesthetics. During nasopharyngeal tube‐anesthesia, gas insufflation provides some positive oropharyngeal pressure that differs from the proximal airway pressure owing to the flow‐dependent pressure drop across the nasopharyngeal tube (ΔPNPT).

The data collected by the DAMA/LIBRA-phase2 set-up during two additional annual cycles have been analyzed, further investigating the long-standing model-independent annual modulation effect pointed out by DAMA deep underground at the Gran Sasso National Laboratory of the I.N.F.N. by using various different experimental configurations. Including the new results, the total exposure of DAMA/LIBRA-phase2 over 8 annual cycles is 1.53 t·yr and the evidence for a signal that meets all the requirements of the model-independent Dark Matter annual modulation signature is 11.8 σ C.L. in the energy region (1 - 6) keV. In the (2 - 6) keV energy interval, where data are also available from DAMA/NaI and DAMA/LIBRA-phase1, the achieved C.L. for the full exposure of 2.86 t·yr is 13.7 σ. No systematics or side reaction able to mimic this signature (i.e., to account for the whole measured modulation amplitude and to simultaneously satisfy all the requirements of the signature) has been found or suggested by anyone throughout some decades thus far. A preliminary result on the further lowering of the software energy threshold and perspectives are also mentioned.

We read with interest the report by Milési et al1Milési C. Requirand A. Douillard A. Baleine J. Nogué E. Matecki S. et al.Assessment of peak inspiratory flow in young infants with acute viral bronchiolitis: physiological basis for initial flow setting in patients supported with high-flow nasal cannula.J Pediatr. 2020; 231: 239-245.e1Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar showing a new physiologic approach for setting high flow nasal cannula (HFNC) therapy in infants with bronchiolitis, based on actual inspiratory flow demands, by measuring peak tidal inspiratory flow (PTIF) before HFNC therapy begins. In this study, 29% of PTIF values were >2 L/kg/minute. The authors, thus, cautiously propose a higher initial HFNC flow rate of 2.5 L/kg/minute (or >3 L/kg/minute in particular cases) than the commonly used 2 L/kg/minute. We acknowledge the authors' effort to identify a physiologic variable that may help to couple HFNC flow delivery and patients' flow demands, the basic principle for HFNC efficacy. However, the study did not evaluate whether HFNC therapy itself influences patients’ PTIF and, thus, if the set HFNC flow becomes inadequate or exceedingly high after HFNC begins. We wish to raise some concerns that we see as crucial for their subsequent clinical implications. Although their findings question whether 2 L/kg/minute is adequate in young infants with bronchiolitis, previously published clinical and physiologic studies suggest that this setting may be the correct choice in most infants. Previous clinical findings show that flow rates higher than 2 L/kg/minute (ie, 3 L/kg/minute) bring about no further improvement.2Milési C. Essouri S. Pouyau R. Liet J.M. Afanetti M. Portefaix A. et al.High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study).Intensive Care Med. 2017; 43: 209-216Crossref PubMed Scopus (115) Google Scholar Weiler et al found a dose-dependent relationship between increasing HFNC flow rates and the reduced effort of breathing, optimal flow rates ranging between 1.5 and 2.0 L/kg/minute.3Weiler T. Kamerkar A. Hotz J. Ross P.A. Newth C.J.L. Khemani R.G. The relationship between high flow nasal cannula flow rate and effort of breathing in children.J Pediatr. 2017; 189: 66-71.e3Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Thus, we wonder whether evaluating PTIF only once before HFNC therapy, and then using this PTIF value to set HFNC without further verification, is the right way to match patients and HFNC flow. An empirically consistent scenario is that PTIF will change once HFNC therapy begins. Indeed, breathing frequency slows during HFNC, and longer times flatten the flow tracings, thus, reducing PTIF. Equally important, because HFNC therapy reduces esophageal pressure swings, PTIF values will likely diminish. Thus, after HFNC starts, reduced PTIF values might meet a 2 L/kg/minute set flow rate or an even lower threshold. Although HFNC was developed as a procedure with no monitoring requirement, today's expanded use requires extended physiologic studies to guide clinicians in setting HFNC flow. This study has uncovered the important issue of measuring PTIF to set the optimal initial HFNC flow rate and for that the authors should be complimented; however, we believe that further work is needed to verify what happens to PTIF during HFNC therapy. ReplyThe Journal of PediatricsVol. 234PreviewWe appreciate the kind remarks about our published article in The Journal on the assessment of peak tidal inspiratory flow (PTIF) in young infants with acute viral bronchiolitis (AVB). This study was conducted because we were concerned about the absence of data on PTIF even though it at least partly determines the effectiveness of the first-line treatment most often chosen for AVB management (ie, high-flow nasal cannula oxygen therapy [HFNC]). Indeed, measurements have been recorded in very preterm or healthy full-term neonates but none in patients with AVB. Full-Text PDF Assessment of Peak Inspiratory Flow in Young Infants with Acute Viral Bronchiolitis: Physiological Basis for Initial Flow Setting in Patients Supported with High-Flow Nasal CannulaThe Journal of PediatricsVol. 231PreviewTo assess the inspiratory demand in young infants with acute viral bronchiolitis to provide a physiological basis for initial flow setting for patients supported with high flow nasal cannula. Full-Text PDF

The first DAMA/LIBRA-phase2 model-independent results (exposure: 1.13 ton x yr, and software energy threshold at 1 keV) have recently been released. They further confirm -with high confidence level- the evidence already observed by DAMA/NaI and DAMA/LIBRA-phasel on the basis of the exploited model-independent Dark Matter (DM) annual modulation signature. The total exposure above 2 keV of the three experiments is 2.46 ton x yr. Several DM candidate particles and related scenarios have been analyzed including the latest results. These analyses permit to constrain the parameters' space of the considered candidates in t lie given scenarios, restricting their values with respect to previous analyses thanks to the increased exposure and to the lower energy threshold.

Experimental observations and theoretical arguments at galactic and larger scales pointed out that a large fraction of the Universe is composed of Dark Matter (DM) particles. This has motivated the pioneer DAMA experimental efforts to investigate the presence of such particles in the galactic halo, by exploiting a model independent signature and very highly radio-pure apparatus in deep underground. In this paper, after a short introductory part, the long-standing model-independent annual modulation effect measured by DAMA Collaboration, with various experimental configurations, is examined. In the energy region between 2 and 6 keV, the data from DAMA/NaI, DAMA/LIBRA-phase1 and DAMA/LIBRA-phase2 (full exposure: 2.46 ton × yr) confirm the evidence of a signal that meets all the several specific requirements of the exploited model independent DM annual modulation signature, at 12.9 σ C.L. The DAMA/LIBRA-phase2 configuration, profiting from new high quantum efficiency photomultipliers, new electronics and other improvements with respect to DAMA/LIBRA-phase1, has also allowed the confirmation of such an evidence down to a software energy threshold of 1 keV. The complexity and the uncertainties of corollary model dependent quests for the DM candidate particle(s) and related scenarios are also addressed at some extent and several of the many possibilities are examined. The efforts towards the new phase3 of the experiment are summarized, showing the strategies and the results obtained with the present developments.