Browsing by Author "Liu, Yi-Ching"

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Combined noninvasive ventilation and mechanical insufflator-exsufflator for acute respiratory failure in patients with neuromuscular disease: effectiveness and outcome predictors
(2019-09-01)
Chen, Tai-Heng
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Liang, Wen-Chen
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Chen, I-Chen
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Liu, Yi-Ching
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Hsu, Jong-Hau
Background: To determine the effectiveness of combined noninvasive ventilation (NIV) and mechanical insufflator-exsufflator (MI-E) for acute respiratory failure (ARF) in patients with neuromuscular disease (NMD), and outcome predictors. Methods: A prospectively observational study of patients with ARF was conducted in a pediatric intensive care unit (PICU). All received combined NIV/MI-E during PICU stays between 2007 and 2017. Pertinent clinical variables of heart rate (HR), respiratory rate (RR), pH, PaCO2, and PaO2/FiO(2) ratio were collected at baseline and at 2 h, 4-8 h, and 12-24 h after initiating use of NIV/MI-E. Treatment success was defined as avoiding intubation. Results: A total of 62 ARF episodes in 56 patients with NMD (median age, 13 years) were enrolled. The most frequent underlying NMD was spinal muscular atrophy (32/62, 52%). ARF was primarily due to pneumonia (65%). The treatment success rate was 86%. PICU stay and hospitalization were shorter in the success group (9.4 +/- 6.1 vs. 21.9 +/- 13.9 days and 16.3 +/- 7.8 vs. 33.6 +/- 17.9 days, respectively; both p < 0.05). HR, RR, pH, and PaCO2 showed a progressive improvement, particularly after 4 h following successful NIV/MI-E treatment. RR decrease at 4 h, and pH increase and PaCO2 decrease at 4-8 h might predict success of NIV/MI-E treatment. The multivariate analysis identified PaCO2 at 4-8 h of 58.0 mmHg as an outcome predictor of NIV/MI-E treatment. Conclusions: Applying combined NIV/MI-E in the acute care setting is an efficient means of averting intubation in NMD patients with ARF. Clinical features within 8 h of the institution may predict treatment outcome. The reviews of this paper are available via the supplemental material section.
Optimal consolidation of fresh agricultural products in a multi-temperature joint distribution system
(2018-01-01)
Chen, Mu-Chen
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Lu, Chung-Cheng
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Liu, Yi-Ching
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運輸與物流管理系註：原交通所+運管所
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Department of Transportation and Logistics Management
Purpose - The purpose of this paper is to deal with an optimal consolidation problem for fresh agricultural products (e.g. fruits and vegetables) in a multi-temperature joint distribution (MTJD) system that is developed to resolve the challenge of timely delivery of small and diverse shipments in food cold chains. Design/methodology/approach - An integer programming optimization model is developed to consolidate a set of agricultural shipments with different storage requirements into a number of distinct containers according to the classification criteria. The formulated model for consolidating fresh agricultural products is evaluated using numerical examples. Findings - Critical factors that affect the quality or shelf life of fresh agricultural products are examined to form the criteria for classifying the storage requirements of these products. The formulated model can minimize the consolidation cost and the loss of product value due to a reduction in shelf life after consolidation. Research limitations/implications - Although the decision model for product consolidation developed in this paper takes into account practical concerns as much as possible, some additional conditions in the cold chain of fresh fruits and vegetables can be included to further enhance the application of the proposed consolidation model. Practical implications - Provided that the container environment is appropriately controlled, the shelf life of fresh fruits and vegetables can be maintained during the logistics process. As a result, product quality can be managed to reduce product loss. Originality/value - This paper adopts temperature, relative humidity and ethylene production, which generally affect the quality and shelf life of fresh agricultural products, as the main factors for determining the product consolidation. It is among the first to deal with the optimal consolidation of fresh agricultural products in the MTJD system with the consideration of product shelf life.