Le contrôle de la ventilation procède d’une interaction complexe entre des efférences centrales à destination des groupes musculaires ventilatoires et des afférences ventilatoires provenant de mécano et de chémorécepteurs. Cette commande de la ventilation s’adapte en permanence aux besoins ventilatoires. L’activation électrique du diaphragme (EAdi) informe sur la commande ventilatoire, la charge des muscles respiratoires, la synchronie patient-ventilateur et l’efficacité de la ventilation des patients de réanimation. L’utilisation inadaptée d’un mode deventilation spontanée avec une sur ou sous-assistance peut entrainer des dysfonctions diaphragmatiques, des lésions alvéolaires et des asynchronies. La première étude a permis de cibler l’assistance du mode NAVA en fonction de l’EAdi enregistrée lors d’un échec de test de sevrage. Nous avons observé une augmentation quotidienne de cette EAdi au cours du sevrage jusqu’à l’extubation. La deuxième étude a montré que cette augmentation n’est pas associée à une modification de l’efficacité neuro-ventilatoire lors du test de sevrage, possiblement en rapport avec l’inhibition d’une sédation résiduelle. La troisième étude a montré l’importance de l’inhibition de cette sédation résiduelle par midazolam sur l’EAdi et le volume courant au début du sevrage ainsi que la corrélation qui existe entre les deux. Une dernière étude a montré l’absence d’augmentation du volume courant sous NAVA chez des patients transplantés pulmonaires aux poumons dénervés sans réflexe de Herring Breuer par rapport à un groupe contrôle. Par ailleurs le volume courant sous NAVA était corrélé à la capacité pulmonaire totale. Ces études ont montré l’intérêt du monitorage l’EAdi dans le sevrage. / The control of breathing results from a complex interaction involving differentrespiratory centers, which feed signals to a central control mechanism that, in turn, provides outputto the effector muscles. Afferent inputs arising from chemo- and mechanoreceptors, related to thephysical status of the respiratory system and to the activation of the respiratory muscles, modulatepermanently the respiratory command to adapt ventilation to the needs. Diaphragm electricalactivation provides information about respiratory drive, respiratory muscle loading, patientventilatorsynchrony and efficiency of breathing in critically ill patients. The use of inappropriatelevel of assist during spontaneous breathing with over or under assist might be harmful withdiaphragmatic dysfunction, alveolar injury and asynchrony. The first study settled NAVA modeaccording to the EAdi recorded during a failed spontaneous breathing trial (SBT). An unexpecteddaily increase of EAdi has been found during SBT until extubation. The second study did not findany increase of the neuroventilatory efficiency during weaning, possibly because of residualsedation. A third study described the inhibition of residual sedation on EAdi and tidal volume at thebeginning of the weaning, and the correlation between them. The last study did not find anyincrease of tidal volume under NAVA after lung transplantation, with denervated lung withoutHerring Breuer reflex, compared to a control group. Moreover tidal volume under NAVA wascorrelated to total lung capacity. These studies highlight the interest of EAdi monitoring duringweaning.

Lors d’essais de feux d’hydrocarbures liquides dans le dispositif DIVA de l’IRSN, un phénomène oscillatoire basse-fréquence (BF), a été observé. Ce phénomène se manifeste par des fluctuations importantes de la pression dans le local, qui peuvent conduire à une perte de confinement et ainsi favoriser la propagation du feu et le rejet de polluants au-delà du local. Il s’accompagne de déplacements intermittents de la flamme hors du bac. L’étude fine de ce phénomène oscillatoire a tout d’abord consisté à concevoir une maquette à l’échelle 1:4 du dispositif DIVA dans lequel nous avons fait varier différents paramètres. L’analyse des résultats obtenus nous a permis d’identifier différents régimes de combustion, de décrire les mécanismes responsables de l’apparition des oscillations BF et de caractériser les propriétés de ces oscillations (fréquence et amplitude). L’occurrence et la persistance des oscillations BF dépendent essentiellement de l’équilibre, plus ou moins précaire, entre la quantité d’air disponible pour la combustion et le débit d’évaporation du combustible résultant des flux thermiques reçus à sa surface. Une étude numérique exploratoire utilisant le code CFD SAFIR a été ensuite conduite en utilisant le débit d’évaporation mesuré expérimentalement, puis en le calculant à l’aide d’un modèle d’évaporation. Si le code ne permet pas de décrire correctement le déplacement de la flamme hors du bac, il reproduit de façon satisfaisante le comportement oscillatoire BF du feu, en particulier sa fréquence dominante. / During liquid hydrocarbon fire tests in the DIVA device of IRSN, a low-frequency (LF) oscillatory phenomenon, was observed. This phenomenon manifests itself by large variations of the average pressure in the room, which can lead to a loss of confinement and thus promote the spread of fire and the release of pollutants beyond the local. It is accompanied by intermittent displacements of the flame outside the fuel pan. The fine study of this phenomenon consisted in designing a 1:4 scale model of the DIVA device, allowing us to carry out a very large number of tests, varying some parameters. The analysis of the results obtained allowed us to identify different combustion regimes, to describe the mechanisms responsible for the appearance of the LF oscillations, and to characterize the properties of these oscillations (frequency and amplitude). The occurrence and persistence of LF oscillations essentially depend on the precarious equilibrium between the supply of fresh air and the supply of fuel vapors which results from the heat flux received at its surface. An exploratory numerical study using the CFD code SAFIR was then conducted using both the experimentally measured evaporation rate and that calculated using an evaporation model. The model does not correctly describe the displacements of the flame outside the fuel pan. However, it satisfactorily reproduces the LF oscillatory fire behavior, especially its dominant frequency.

Background Controlled mechanical ventilation with randomly variable tidal volume patterns has been shown to improve gas exchange and respiratory system mechanics compared to conventional ventilation in numerous experimental models of acute respiratory distress syndrome (ARDS). Multiple mechanisms have been proposed to explain this phenomenon called stochastic resonance. The recruitment of collapsed lung regions has been proposed as the dominant mechanism, but the role of respiratory system recruitment and de-recruitment dynamics during variable ventilation and the influence of periodic instead of random variation has not been elucidated. Objectives The primary objective of this thesis was to investigate the effects of periodic tidal volume patterns during variable ventilation on functional parameters with a special focus on gas exchange, respiratory system mechanics and cardiovascular interactions. Further aims were to elucidate the relationship between recruitment and de-recruitment dynamics and recruitment effects of random variable ventilation as well as the impact of an excessive increase in pattern period during variable ventilation on respiratory system mechanics. Finally, the relationship between recruitment effects during variable ventilation and the recruitment and de-recruitment dynamics as well as the ability of random variable ventilation to prevent de-recruitment are to be clarified. Methods Recruitment and de-recruitment dynamics were investigated based on the analysis of the time course of dynamic respiratory system elastance in a double-hit model of ARDS in pigs, a model of lung inflammation in rats, and in silico. The effects of periodic variable ventilation were studied for a wide range of pattern periods using a non-linear computational model of respiratory system mechanics, and in two experimental studies: Partial pressure of oxygen in arterial blood (PaO2) was the primary outcome of the longitudinal study during six hours of therapy in a double-hit model of ARDS in pigs. A cross-over study in a hydrochloric acid-induced model of ARDS in rats was performed to investigate the effects of periodic variable ventilation on baroreflex and respiratory sinus arrhythmia in context of the improvement of the primary end-point PaO2. In both studies, tidal volume patterns were chosen to have main periods overlapping with the dynamics of cardiovascular and respiratory sub-systems. Results and Discussion Periodic variable ventilation, but not random variable ventilation, improved PaO2 compared to conventional ventilation in the double hit model of ARDS. In both experimental studies, variable ventilation independent of pattern period improved respiratory system elastance. The study in silico indicated that periodic patterns have no additional positive effect on respiratory system mechanics compared to random patterns, but will attenuate recruitment for an excessive increase in pattern period. Baroreflex and respiratory sinus arrhythmia were affected by periodic tidal volume patterns in the acid-induced ARDS model; however, pattern period was associated with a decrease in PaO2. Recruitment and de-recruitment dynamics in the experimental model were similar to values derived by analysis of dynamic computed tomography according to literature. In the computational study, re-cruitment during random variable ventilation was maximised for specific values of recruitment and de-recruitment dynamics. Recruitment dynamics were lower during random variable ventilation compared to conventional recruitment manoeuvres, however in the range of de-recruitment dynamics of the respective model. Consequently, random variable ventilation with a coefficient of variation of 30 % was sufficient to prevent an increase of respiratory system elastance during ventilation in the study on acute lung inflammation in rats. Conclusion The asymmetry between recruitment and de-recruitment dynamics, which could be quantified by the analysis of the time course of dynamic elastance, was associated with recruitment during random variable ventilation in numerical simulations. Periodic variable ventilation improved arterial oxygenation to a clinically relevant extent without concomitant improvement of lung recruitment compared to random variable ventilation in a double-hit model of ARDS. Cardiovascular-respiratory interactions and asymmetry of recruitment and de-recruitment dynamics were not associated with this improvement. / Hintergrund In zahlreichen experimentellen Modellen des Akuten Atemnotsyndroms (ARDS) konnte gezeigt werden, dass die kontrollierte maschinelle Beatmung mit zufällig variablen Tidalvolumen pro Atemzug den Gasaustausch und die Atemmechanik im Vergleich zur konventionellen maschinellen Beatmung deutlich verbessert. Es wurden mehrere Mechanismen zur Erklärung dieses Phänomens, der Stochastischen Resonanz, vorgeschlagen. Die Wiedereröffnung kollabierter Lungenareale (Rekrutierung) ist dabei als dominanter Mechanismus der variablen Beatmung identifiziert wurden. Die Rolle der Dynamik von Rekrutierung und Derekrutierung sowie der Einfluss von Periodizität an Stelle von Zufälligkeit in der Sequenz der Tidalvolumina während Zufälliger Variabler Maschineller Beatmung (ZVB) wurde bisher lediglich in numerischen Simulationen evaluiert. Fragestellung Hauptziel dieser Arbeit war es, die Auswirkungen der Periodischen Variablen Maschinellen Beatmung (PVB) auf Gasaustausch, Mechanik des Respiratorischen Systems sowie Kardiovaskulärer Wechselwirkungen zu untersuchen. Ferner sollten mögliche Mechanismen der PVB identifiziert werden. Der Zusammenhang zwischen der Rekrutierungsdynamik und den Rekrutierungseffekten der ZVB sowie den Auswirkungen einer übermäßigen Erhöhung der Periodendauer während der PVB auf die Mechanik des Respiratorischen System war ebenfalls zu untersuchen. Ferner war der Zusammenhang zwischen den Rekrutierungseffekten bei der ZVB und der Dynamik der Rekrutierung / Derekrutierung des Respiratorischen Systems zu untersuchen. Material und Methoden In einem nichtlinearen numerischen Modell der Atemmechanik wurden die Auswirkungen der PVB für einen breiten Bereich von Periodendauern untersucht. Die Dynamik der Rekrutierung und Derekrutierung der Lunge wurde basierend auf der Analyse des Zeitverlaufs der dynamischen Elastance des Respiratorischen Systems in einem Doppelhit-Modell des ARDS im Schwein, einem Modell der Lungenentzündung in der Ratte sowie in silico untersucht. Die Effekte der PVB auf Gasaustausch und Atemmechanik wurden in zwei experimentelle Studien in verschiedenen Modellen des experimentellen ARDS untersucht: Der Partialdruck von Sauerstoff im arteriellen Blut (PaO2 ) war die primäre Zielgröße in der Längsschnittuntersuchung während der sechsstündigen Therapie des experimentellen ARDS am Hausschwein, welches induziert wurde durch wiederholte Auswaschung von Surfaktant mit anschließender beatmungsinduzierter Lungenschädigung. In einer Cross-over-Studie an einem salzsäureinduzierten Modell des ARDS in Ratten wurden die Auswirkungen der PVB auf Baroreflex- und respiratorische Sinusarrhythmie im Zusammenhang mit dem primären Endpunkt PaO2 untersucht. Ergebnisse und Diskussion PVB jedoch nicht die ZVB, verbesserte den PaO2 im Vergleich zur konventionellen maschinellen Beatmung im Doppelhit-Modell des ARDS während sechstündiger Therapie. In beiden Studien verbesserte die PVB unabhängig von der Periodendauer die Elastance des Respiratorischen Systems. Die Simulationen am Computermodell bestätigten, dass periodische Muster keinen zusätzlichen positiven Effekt auf die Mechanik des Atmungssystems im Vergleich zu zufälligen Mustern haben, aber die Rekrutierung während Variabler Maschineller Beatmung für eine übermäßige Erhöhung der Periodendauer abschwächen können. Baroreflex und Respiratorische Sinusarrhythmie wurden durch periodische Sequenz aufeinander folgender Tidalvolumina im säure-induzierten ARDS-Modell beeinflusst, jedoch war die Musterperiode mit einem Rückgang des PaO2 assoziiert. Die im experimentellen Modell bestimmte Dynamik der Rekrutierung und Derekrutierung bestätigte aus der Literatur bekannte Werte, die durch die Analyse der dynamischen Computertomographie gewonnen wurden. In der numerischen Modell-Studie zeigte sich, dass die Rekrutierung während der ZVB für bestimmte Verhältnisse zwischen Rekrutierungs- und Derekrutierungsdynamik (Asymmetrie) maximiert werden. Die Dynamik der Rekrutierung war bei der ZVB im Vergleich zu herkömmlichen Rekrutierungsmanövern geringer, jedoch innerhalb des Wertebereichs der Dynamik der Rekrutierung des jeweiligen Modells. Folglich konnte durch ZVB mit einem Variationskoeffizienten von 30 % die Derekru- tierung der Lunge in einem Modell der akuten Lungenentzündung verhindert werden. Schlussfolgerung Die Asymmetrie zwischen der Dynamik der Rekrutierung und Derekrutierung der Lunge, die durch die Analyse des Zeitverlaufs der dynamischen Elastance quantifiziert werden konnte, war mit der Rekrutierung während der Zufälligen Variablen Beatmung in numerischen Simulationen assoziiert. Die Periodisch Variable Beatmung verbesserte die arterielle Oxygenierung in einem klinisch relevanten Umfang ohne gleichzeitige Verbesserung der Lungenrekrutierung im Vergleich zur Zufälligen Variablen Beatmung in einem Doppelhit-Modell des ARDS am Schwein. Weder Kardiovaskulär-respiratorische Wechselwirkungen noch die Asymmetrien der Rekrutierungs- und Derekruitierungsdynamik standen mit dieser Verbesserung im Zusammenhang.

The building sector is responsible for 36% of the energy usage and 39 % of all CO2- emissions in European union (EU). Therefore, it is of great interest to investigate how the building sector can become more energy efficient and lower the environmental impact. It is reported that 80-90 % of a building’s total energy usage occurs during the operational phase. The energy usage is mainly due to lightning, technical equipment and the heating, cooling and ventilation system (HVAC-system). During the last century the energy efficiency in lightning developed significantly meaning the energy used in the HVAC-system becomes increasingly significant. As EU aim to increase the energy efficiency and the ratio of renewable energy in the grid, one can assume that the importance of other phases in the HVAC system lifecycle will be increasingly interesting as for example the manufacturing process and material usage which can be evaluated through life cycle assessment (LCA).This thesis presents a comparison between the environmental impacts of a hybrid ventilation (HV) system and a mechanical ventilation system with heat recovery (MVHR) system through a LCA perspective designed for an office building in Lystrup, Denmark. The office building in Lystrup, Denmark was chosen as the HV system is implemented there. The HV system consists of an automated natural ventilation (NV) system and a mechanical exhaust air ventilation (MEV) system. The environmental impact from the NV was provided through environmental products declarations provided by the company dimensioning the NV system. The data was lacking for the MEV system and that system was therefore dimensioned and evaluated through LCA. The mechanical ventilation system chosen for comparison is a mechanical ventilation system with heat recovery (MVHR) decided by the commissioner of the project, Sweco AB. The MVHR system was dimensioned as well. The project was significantly affected by lack of data resulting in many assumptions. The system boundary of the life cycle was set to cradle to grave excluding the energy usage of producing the ventilation components. The assumed lifetime is 25 years. Gabi Education software was used for calculating the LCA results. The impact categories chosen are global warming potential (GWP), ozone depletion potential (ODP), acidification potential (AP), eutrophication potential (EP), photochemical ozone depletion potential (PODP), abiotic depletion potential (ADP) elements and ADP fossil which are used in the EN15804 standard when conducting LCA for construction components. The CML2001-IA 2001 IA method was used for the life cycle impact assessment in the LCA software which also is recommended according to EN15804.The LCA results were compared between the systems and interpreted through contribution analysis were the result was divided in the following categories; Energy usage (use phase), transportation, material usage (including raw material extraction and material processing) and end of life treatment. The two systems score similarly on all environmental impacts categories except for the global warming potential (GWP) and the abiotic depletion potential (ADP) fossil were the MVHR system scores approximately 3 times higher than the HV system. The MVHR system consumes approximately 3 times more energy during the use phase. The contribution analysis showed that the energy usage (use phase) dominated the contribution in almost all environmental impact categories. Further, the environmental impact caused by the material usage was compared between the MVHR - and HV system and the MVHR system scored higher in all categories except ADP elements.The conclusion drawn from this report is that the HV system is better if one looks to GWP and ADP fossil. The HV contributes less to climate change which is an important environmental concern. Further, the energy usage during use phase contributed most to environmental impacts for both the MVHR - and HV system. The environmental impact of the material usage is less for the HV - compared with the MVHR system. / Byggnadssektorn står för 36 % av energianvändningen och 39 % av alla koldioxidutsläpp i Europeiska unionen (EU). Därför är det av stort intresse att undersöka hur byggsektorn kan bli mer energieffektiv och undersöka hur dess miljöpåverkan kan minskas. Det rapporteras att 80–90 % av en byggnads totala energianvändningen inträffar under driftsfasen. Energianvändningen beror främst på belysning och värme-, kyla- och ventilationssystemet (VVS-systemet). Under det sista århundradet har energieffektiviteten gällande belysning förbättrats avsevärt, vilket innebär att betydelsen för energianvändningen till VVS-systemet ökat. Eftersom EU strävar efter att öka energieffektiviteten och mängden förnybar energi i elnätet kan man anta att betydelsen av andra faser i VVS-systemets livscykel kommer att bli allt mer intressant, till exempel tillverkningsprocessen och materialanvändningen vilket kan utvärderas genom livscykelanalys (LCA).   Denna rapport jämför miljöpåverkan från ett hybridventilationssystem (HV) med ett mekaniskt ventilationssystem med värmeåtervinningssystem (FTX-system) ur ett LCA-perspektiv. Studien utförs på kontorsbyggnad i Lystrup, Danmark. Kontorsbyggnaden i Lystrup valdes eftersom ett HV-systemet är implementerat där. HV-systemet består av ett automatiserat naturligt ventilationssystem (NV) och ett mekaniskt frånluftsventilationssystem (F-system). Miljöpåverkan från det NV-systemet tillhandahölls ur miljöproduktdeklarationer (EPD:er) som dimensioneringsföretaget tillhandahöll. Uppgifterna saknades för F-systemet och därför dimensionerades det förhand för att sedan utvärderades genom LCA. Hv-systemet jämfördes mot ett FTX system vilket bestämdes av uppdragsgivaren på företaget Sweco AB. FTX-systemet dimensionerades också förhand för att sedan utvärderas genom LCA. Livscykelns systemgräns sattes till från ”vagga-till-grav” exklusive energianvändningen för att producera ventilationskomponenterna då denna data saknades. Den antagna livslängden för ventilationssystemen är 25 år. LCA programvaran Gabi Education användes för att beräkna LCA resultaten. De miljöpåverkanskategorier som undersökts i den här studien är: global uppvärmningspotentialen, ozonuttunnande potential, försurningspotential, eutrofieringspotential, fotokemisk ozonuttunningspotential, abiotisk utarmningspotential (material) och abiotisk utarmningspotential (fossila bränslekällor) vilka skall användas enligt EN15804-standarden då LCA:er utförs på byggkomponenter. CML2001-IA metoden användes som livscykelkonsekvensbedömningen LCA-programvaran, vilket också rekommenderas enligt EN15804.   LCA-resultaten jämfördes mellan systemen och tolkades genom en bidragsanalys där resultatet delades in i följande kategorier: Energianvändningen (användningsfas), transport, materialanvändning (inklusive råvaruutvinning och materialbearbetning) och slutanvändningsfasen för komponenterna. De två systemen var likvärdiga i de flest miljöpåverkanskategorier utom den globala uppvärmningen potential och abiotiska utarmning potential fossil där FTX-systemet bidrog med ungefär 3 gånger så hög potentiell påverkan än det HV-systemet. FTX-systemet förbrukar ungefär 3 gånger mer energi under användningsfasen. Bidragsanalysen visade att energianvändningen (under användningsfasen) var den dominerade faktorn i nästan alla kategorier av miljöpåverkan. Utöver denna analysen jämfördes miljöpåverkan orsakad av materialanvändningen mellan FTX - och HV-systemet, där FTX-systemet fick högre poäng i alla kategorier utom i abiotiska utarmnings potential (material).   Slutsatsen från den här studien är att det HV-systemet är bättre om man ser till global uppvärmningspotential och abiotisk utarmningspotential fossil. Det HV-system har alltså mindre potential till att bidra till klimatförändringar och mindre potential att utarma fossila bränslekällor. Enligt den här studien är energianvändningen under användningsfasen den faktor som bidrar mest till miljöpåverkanskategorierna för både FTX - och det HV-systemet. Miljöpåverkan orsakad av materialåtgången är mindre för det HV-systemet än FTX systemet.

Bakgrund: Specialistsjuksköterskor med inriktning mot intensivvård har ansvar för omvårdnaden av de svårast sjuka patienterna samt kommunicerar med deras närstående. Coronaviruset (SARS-CoV-2) även kallad för Covid-19, leder till en atypisk form av akut andningsbesvär som i vissa fall kräver ventilatorbehandling. Dessa patienter kommer alla att behöva urträning ur respiratorn inför extubation. Urträning initieras oftast på intensivvårdsavdelningen och tillhör intensivvårdssjuksköterskans arbete. En förkortad ventilatorbehandling kan minska patientens lidande, mortaliteten och sänka samhällskostnader. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors framgångsfaktorer för ventilatorurträning av patienter med Covid-19. Metod: Vi har använt oss av kvalitativ metod och intervjuat åtta intensivvårdssjuksköterskor i Västra Sverige. Intervjuerna analyserades kvalitativ innehållsanalys med manifest ansats som resulterade i tre kategorier. Resultat: Denna kvalitativa intervjustudie visade att en längre och svårare urträningsprocess kräver tålamod och försiktighet. Samtliga intensivvårdssjuksköterskor beskrev urträningsprocessen för patienter med Covid-19 som både längre och svårare i jämförelse med patienter som ventilatorbehandlats av andra orsaker. Tidiga insatser kan lindra sjukdomsförlopp och underlätta urträningen. Intensivvårdssjuksköterskorna beskrev att de under pandemin lärt sig använda både medicinska och omvårdnadsmässiga insatser tidigt för att bromsa, lindra eller förhindra ett progrederande sjukdomsförlopp. Mobilisering, teamsamverkan och kontinuitet var viktigt vid urträning och framgångsfaktorer som påverkades av personalens kompetens, stressnivå och andraorganisatoriska faktorer. Slutsats: Denna kvalitativa intervjustudie visade att intensivvårdssjuksköterskor upplever att erfarenhet under pandemins gång har förbättrat förutsättningarna för patienter med Covid-19 i behovav urträning från ventilatorbehandling. Och dessa lärdomar ligger till grund för de faktorer som i dagsläget ofta ligger till grund för en framgångsrik ventilatorurträning. Deras erfarenhet och kunskaper skiljer sig åt och resultatet tyder på att mer utbildning och kontinuitet krävs för att kunna ge en säkrare vård.

Introduction : La dysfonction diaphragmatique est très fréquente chez des patients adultes aux soins intensifs et elle est associée à des évolutions cliniques défavorables. Il n’y a pour l’instant aucune méthode reconnue pour évaluer la fonction du diaphragme chez l’enfant sous ventilation mécanique (VM), et aucune étude décrivant son évolution dans le temps chez cette population. Méthodes : Dans ce travail, nous avons évalué la fonction contractile du diaphragme chez des enfants sous ventilation invasive aux soins intensifs pédiatriques (SIP) et en salle d’opération (SOP). Pour ce faire, la pression au tube endotrachéal (Paw) et l’activité électrique du diaphragme (EAdi) étaient enregistrées simultanément lors de respirations spontanées pendant une brève manœuvre d’occlusion des voies respiratoires. Afin de prendre en compte la commande respiratoire, un ratio d’efficience neuro-mécanique (NME, Paw/EAdi) a d’abord été calculé puis validé par une analyse de variabilité. La fonction du diaphragme a ensuite été comparée entre les deux populations, et son évolution dans le temps au sein du groupe SIP décrite. Résultats : Le NME médian était la mesure de fonction diaphragmatique la plus fiable, avec un coefficient de variation de 23.7% et 21.1% dans les groups SIP et SOP, respectivement. Le NME dans le groupe SIP après 21 heures de VM (1.80 cmH2O/μV, IQR 1.25–2.39) était significativement inférieur à celui du groupe SOP (3.65 cmH2O/μV, IQR 3.45–4.24, p = 0.015). Dans le groupe SIP, le NME n’a pas diminué de façon significative pendant la VM (coefficient de corrélation -0.011, p = 0.133). Conclusion : La fonction diaphragmatique peut être mesurée au chevet des enfants sous VM par de brèves manœuvres d’occlusion. L’efficience du diaphragme était significativement plus élevée dans un groupe sain que dans une cohorte d’enfants critiquement malades, mais elle était stable dans ce groupe avec une commande respiratoire préservée. Dans le futur, les contributions relatives de la maladie critique et de la ventilation mécanique sur la fonction diaphragmatique devront être mieux caractérisées avant de procéder à l’évaluation de potentielles interventions visant à protéger le diaphragme. / Introduction : Diaphragmatic dysfunction is highly prevalent in adult critical care and is associated with worse outcomes. There is at present no recognized method to assess diaphragmatic function in children under mechanical ventilation (MV) and no study describing its evolution over time in this population. Methods : In this work, we have assessed the contractile function of the diaphragm in children under invasive MV in the pediatric intensive care unit (PICU) and in the operating room (OR). This was done by simultaneously recording airway pressure at the endotracheal tube (Paw) and electrical activity of the diaphragm (EAdi) over consecutive spontaneous breaths during brief airway occlusion maneuvers. In order to account for central respiratory drive, a neuro-mechanical efficiency ratio (NME, Paw/EAdi) was first computed and then validated using variability analysis. Diaphragmatic function was then compared between the two populations and its evolution over time in the PICU group described. Results : Median NME was the most reliable measure of diaphragmatic function with a coefficient of variation of 23.7% and 21.1% in the PICU and OR groups, respectively. NME in the PICU group after 21 hours of MV (1.80 cmH2O/μV, IQR 1.25–2.39) was significantly lower than in the OR group (3.65 cmH2O/μV, IQR 3.45–4.24, p = 0.015). In the PICU group, NME did not decrease significantly over time under MV (correlation coefficient -0.011, p = 0.133). Conclusion : Diaphragmatic function can be measured at the bedside of children under MV using brief airway occlusions. Diaphragm efficiency was significantly higher in healthy controls than in a cohort of critically ill children, but it was stable over time under MV in this group with preserved respiratory drive. In the future, the relative contributions of critical illness and mechanical ventilation on diaphragmatic function should be better characterized before evaluating potential interventions aimed at protecting the diaphragm.

The task of the master project is to design a building for sports activities in Sehradice, Zlín region. First the documentation was elaborated, the second part HVAC was designed and the last part focussed on daylighting. The building has one floor and flat green roof. The building includes a fitness, a yoga room, a relax room, two saunas, changing rooms and staff room. The superstructure is designed using Heluz ceramic block walls and Spiroll panel floor structure. Façade is insulated with ETICS. HVAC is provided by two gas boilers, two mechanical ventilation units (indoors) and a cooling unit (outdoor). Domestic hot water is provided by the gas boiler and solar panels. The building uses LED lights. Electricity consumption is partially covered by photovoltaics on the roof. The building plot also includes a large carpark in front of the building. The designs were elaborated in Revit, AutoCAD and energy assessment in Deksoft software.

My Masters project is titled Energy-efficient guest house in the city of Lednice. The assignment is to design a building, which meets contemporary standards of energy efficiency. There are three parts of the project. The first part consists of designing the structure of the building. The building is L-shaped with pitched roof, single-storey with attic. There is a pool with sauna, restaurant with kitchen and main hall with entrance and reception on the ground floor. At the attic there are twenty two dwelling units for guests, common room and staff facilities. The main entrance is oriented towards east. The building is masonry system from sand-lime blocks with prefabricated reinforced concrete floor slabs and roof is made of timber roof truss. The building facade is insulated by ETICS. In the second part, there are designed HVAC, lightning and shading, rainwater usage and photovoltaic power station. In the third, there is a calculation of energy need for heating and cooling using monthly balance mehtod. The project is designed with support of AutoCAD, Revit and DEKsoftT softwares.

The aim of the master project is to design a mixed- use building in Brno – Žebětín. The project has three parts: architectural design of the building, HVAC design and HVAC performance simulation of kindergarten. The building is in shape of letter L. It has three floors and flat green roof. The building site includes a car park and playground.The building includes a kindergarten and flats. The ground floor is separated into two parts. First part includes the kindergarten, while the second includes entrance hall and the technical facilities for the flats in second and third floor. Both parts have separate entries. The vertical load-bearing structures are designed from Porotherm ceramic blocks and the horizontal load-bearing structures from reinforced concrete slab. The HVAC includes gas condensing boilers as heat source and photovoltaics for electricity supply on the roof. The HVAC performance simulation of kindergarten is created in DesignBuilder software and includes analyses of internal environment.The project is elaborated in AutoCAD, Revit, Deksoft, BuildingDesign and DesignBuilder.

The subject of this diploma thesis is the elaboration of documentation for the construction of a hotel with a restaurant in Rožnov pod Radhoštěm. The building is designed for short-term accommodation of 50 people. The building is functionally divided into a hotel part and a restaurant part. It is a detached object L-shaped building. The building is designed as a classic building with masonry system. The hotel part is designed as a two-storey with masonry system and sloping roof. The restaurant part is designed as a two-storey with basement. This part is also from masonry system and with sloping roof. The building has 22 double rooms, 1 apartment for 4 people and 1 room for people with reduced mobility, restaurant and technical facilities.