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Difficult weaning

Byeong-Ho Jeong, Kyeong Yoon Lee, Jimyoung Nam, Myeong Gyun Ko, Soo Jin Na, Gee Young Suh, Kyeongman Jeon
BACKGROUND: Although the WIND (Weaning according to a New Definition) classification based on duration of ventilation after the first separation attempt has been proposed, this new classification has not been tested in clinical practice. The objective of this cohort study was to evaluate the clinical relevance of WIND classification and its association with hospital mortality compared to the International Consensus Conference (ICC) classification. METHODS: All consecutive medical ICU patients who were mechanically ventilated for more than 24 h between July 2010 and September 2013 were prospectively registered...
November 29, 2018: Annals of Intensive Care
José Alejandro Bohórquez, Miaomiao Wang, Marta Pérez-Simó, Enric Vidal, Rosa Rosell, Llilianne Ganges
Classical swine fever virus (CSFV) is one of the most important pathogens affecting swine. After infection with a moderate virulence strain at eight hours after birth, CSFV is able to induce viral persistence. These animals may appear clinically healthy or showed unspecific clinical signs despite the permanent viremia and high viral shedding, in absence of immune response to the virus. Given the role played by this infection in disease control, we aimed to evaluate the capacity of CSFV to induce postnatal persistent infection at three weeks after birth...
November 20, 2018: Transboundary and Emerging Diseases
Agustín Carámbula, Antonella Visca, Silvana D'Amico, Martín Angulo
Atrophy and weakness of the respiratory and peripheral muscles is a common problem in the intensive care unit (ICU). It is difficult to diagnose, particularly in the early stages of critical disease. Consequently, many cases are detected only in advanced stages, for example, when difficulties in mechanical ventilation weaning are encountered. The aim of this review is to describe the main tools that are currently available for evaluation of peripheral and respiratory muscles in the ICU. Techniques of varying complexity and specificity are discussed, and particular emphasis is placed on those with greater relevance in daily clinical practice, such as ultrasound...
November 16, 2018: Archivos de Bronconeumología
W J J Gerrits
Recent interest in increasing rates of body weight gain in heifer calves before weaning is based on the promise of an increase in milk production during first lactation. This increase is usually realized by increasing milk or milk replacer intake, delaying the onset of rumen development. Simultaneously feeding liquids and solid feeds brings about new challenges. Macronutrient metabolism in growing calves is reviewed, combining literature from heifer and veal calves with the objective to provide insights useful for developing novel feeding strategies...
November 8, 2018: Journal of Dairy Science
Gustavo S Silva, Luis G Corbellini, Daniel L C Linhares, Kimberlee L Baker, Derald J Holtkamp
Biosecurity is defined as the set of practices carried out to prevent the introduction and spread of infectious agents in a herd. These practices are essential in swine production, especially for highly infectious agents such as porcine reproductive and respiratory syndrome virus (PRRSv). Even with years of research and experience over the last three decades, PRRSv is still causing productivity losses and is the major health problem affecting the global swine industry. Despite knowledge of the various ways in which the virus can be transmitted from one herd to another (e...
November 15, 2018: Preventive Veterinary Medicine
Keyvan Razazi, Florence Boissier, Mathilde Neuville, Sébastien Jochmans, Martial Tchir, Faten May, Nicolas de Prost, Christian Brun-Buisson, Guillaume Carteaux, Armand Mekontso Dessap
BACKGROUND: Pleural effusion is common during invasive mechanical ventilation, but its role during weaning is unclear. We aimed at assessing the prevalence and risk factors for pleural effusion at initiation of weaning. We also assessed its impact on weaning outcomes and its evolution in patients with difficult weaning. METHODS: We performed a prospective multicenter study in five intensive care units in France. Two hundred and forty-nine patients were explored using ultrasonography...
November 1, 2018: Annals of Intensive Care
Gavin D Perkins, Dipesh Mistry, Simon Gates, Fang Gao, Catherine Snelson, Nicholas Hart, Luigi Camporota, James Varley, Coralie Carle, Elankumaran Paramasivam, Beverley Hoddell, Daniel F McAuley, Timothy S Walsh, Bronagh Blackwood, Louise Rose, Sarah E Lamb, Stavros Petrou, Duncan Young, Ranjit Lall
Importance: In adults in whom weaning from invasive mechanical ventilation is difficult, noninvasive ventilation may facilitate early liberation, but there is uncertainty about its effectiveness in a general intensive care patient population. Objective: To investigate among patients with difficulty weaning the effects of protocolized weaning with early extubation to noninvasive ventilation on time to liberation from ventilation compared with protocolized invasive weaning...
November 13, 2018: JAMA: the Journal of the American Medical Association
Roy S Hwang, Vishad Sukul, Claire Collison, Julia Prusik, Julie G Pilitsis
BACKGROUND: Intrathecal (IT) Baclofen is beneficial for spasticity, but if pumps become infected necessitating removal, baclofen withdrawal is difficult to manage and life-threatening. Furthermore there is no consistency between dosing and severity of withdrawal. Case reports detail full baclofen withdrawal at dosages of 260 μg/day. OBJECTIVE: To demonstrate that in patients on stable IT baclofen for prolonged periods, externalizing a patient's original IT pump is a safe, effective way to wean IT doses...
October 16, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Chieko Mitaka, Masahiko Odoh, Daizoh Satoh, Tadasuke Hashiguchi, Eiichi Inada
BACKGROUND: Weaning from prolonged mechanical ventilation is extremely difficult in tracheostomized patients with restrictive pulmonary dysfunction. High-flow oxygen via tracheostomy supplies heated and humidified oxygen gas at > 10 L/minute. However, little has been reported on the use of high-flow oxygen via tracheostomy during weaning from ventilators in patients with restrictive pulmonary dysfunction. We report successful weaning from ventilators in patients with restrictive pulmonary dysfunction using high-flow oxygen via tracheostomy...
October 12, 2018: Journal of Medical Case Reports
Narongkorn Saiphoklang, Jeerayuth Auttajaroon
BACKGROUND: Weaning from mechanical ventilation is classified as simple, difficult, or prolonged according to weaning process. Theoretically, simple weaning group usually has better clinical outcomes than non-simple group; however, the results of previous studies were still inconsistent. OBJECTIVES: The purpose of the study was to determine the incidence, predictors, and outcomes of ventilator weaning and causes of weaning failure. METHODS: A prospective observational study was performed between June and December 2013 in all patients (n = 164) who required mechanical ventilation with endotracheal intubation in medical wards at Thammasat University Hospital, Thailand...
2018: PloS One
Domenico Luca Grieco, Maria Maddalena Bitondo, Hernan Aguirre-Bermeo, Stefano Italiano, Francesco Antonio Idone, Antonia Moccaldo, Maria Teresa Santantonio, Davide Eleuteri, Massimo Antonelli, Jordi Mancebo, Salvatore Maurizio Maggiore
PURPOSE: Optimizing pressure support ventilation (PSV) can improve patient-ventilator interaction. We conducted a two-center, randomized cross-over study to determine whether automated PSV lowers asynchrony rate during difficult weaning from mechanical ventilation. METHODS: Thirty patients failing the first weaning attempt were randomly ventilated for 2 three-hour consecutive periods with: 1)PSV managed by physicians (convPSV); 2)PSV managed by Smartcare® (autoPSV)...
December 2018: Journal of Critical Care
Stephanie M Matheson, Grant A Walling, Sandra A Edwards
BACKGROUND: In polytocous livestock species, litter size and offspring weight act antagonistically; in modern pig breeds, selection for increased litter size has resulted in lower mean birth weights, an increased number of small piglets and an increased number of those affected by varying degrees of intrauterine growth retardation (IUGR). IUGR poses life-long challenges, both mental, with morphological brain changes and altered cognition, and physical, such as immaturity of organs, reduced colostrum intake and weight gain...
September 18, 2018: Genetics, Selection, Evolution: GSE
Qi Qing, Minyong Liang, Qingwen Sun, Bifang Xie, Chun Yang, Weibo Liang, Weiqun He, Xiaoqing Liu, Yimin Li, Rongchang Chen, Yuanda Xu
Background: Weaning from mechanical ventilation (MV) is an important and universal issue in critically ill patients, with no consensus that predicts weaning success. Twitch tracheal airway pressure (TwPtr) may be a more objective indicator of diaphragm function. The present study evaluated TwPtr relative to negative inspiratory force (NIF) or Medical Research Council (MRC) score, for predicting success of weaning from MV. Methods: From December 2015 to March 2017, 62 patients were included who received invasive MV >48 hours and then underwent a test for spontaneous breathing...
July 2018: Journal of Thoracic Disease
José Augusto Santos Pellegrini, Márcio Manozzo Boniatti, Viviane Corrêa Boniatti, Crislene Zigiotto, Marina Verçoza Viana, Wagner Luiz Nedel, Leonardo da Silva Marques, Moreno Calcagnotto Dos Santos, Clarissa Balbão de Almeida, Cláudia Pellizzer Dal' Pizzol, Patrícia Klarmann Ziegelmann, Sílvia Regina Rios Vieira
BACKGROUND: Little is known about the best strategy for weaning patients with chronic obstructive pulmonary disease (COPD) from mechanical ventilation. Spontaneous breathing trials (SBT) using a T-piece or pressure-support ventilation (PSV) have a central role in this process. Our aim was to compare T-piece and PSV SBTs according to the duration of mechanical ventilation (MV) in patients with COPD. METHODS: Patients with COPD who had at least 48 hours of invasive MV support were randomized to 30 minutes of T-piece or PSV at 10 cm H2O after being considered able to undergo a SBT...
2018: PloS One
Angela Henzen, Lorenz Gygax
Positive and negative stimuli have asymmetric fitness consequences. Whereas, a missed opportunity may be compensated, an unattended threat can be fatal. This is why it has been hypothesised that habituation to positive stimuli is fast while it may be difficult to habituate to negative stimuli, at least for primary (innate) stimuli. However, learning of secondary stimuli may delay the process of habituation. Here, we tested 64 weaned piglets in pairs. In three phases, lasting one week each, piglets were exposed five times to a stimulus of presumed negative, intermediate, or positive valence...
August 22, 2018: Animals: An Open Access Journal From MDPI
Audrey Aquilina, Tiziana Pirotta, Andrew Aquilina
A 31-year-old man was brought to Accident & Emergency after collapsing during a race. On presentation, the patient had a temperature of 41.7°C (rectal). External cooling was started immediately. The patient was intubated in view of a Glasgow Coma Scale of 7 and was transferred to theintensive therapy unit. Laboratory results revealed an acute kidney injury, rhabdomyolysis, disseminated intravascular coagulopathy and acute liver failure. The patient was encephalopathic, jaundiced and difficult to sedate...
July 30, 2018: BMJ Case Reports
Caitlin Karniski, Ewa Krzyszczyk, Janet Mann
Reproductive senescence is evident across many mammalian species. An emerging perspective considers components of reproductive senescence as evolutionarily distinct phenomena: fertility senescence and maternal-effect senescence. While fertility senescence is regarded as the ageing of reproductive physiology, maternal-effect senescence pertains to the declining capacity to provision and rear surviving offspring due to age. Both contribute to reproductive failure in utero making it difficult to differentiate between the two prenatally in the wild...
July 18, 2018: Proceedings. Biological Sciences
Chirag Popat, Doungporn Ruthirago, Mohamed Shehabeldin, Shengping Yang, Kenneth Nugent
BACKGROUND: The majority of patients with acute stroke requiring mechanical ventilation have a poor prognosis and often present difficult decisions regarding extubation. The best criteria for planned extubation in these patients are uncertain. METHODS: We reviewed the electronic medical records of patients hospitalized between 1/1/2010 and 12/15/2015 with acute stroke requiring mechanical ventilation to determine the mortality rate, the respiratory parameters recorded before planned extubation, and the reintubation rate...
July 2018: American Journal of the Medical Sciences
Mariana Hoffman, Marine Van Hollebeke, Beatrix Clerckx, Johannes Muller, Zafeiris Louvaris, Rik Gosselink, Greet Hermans, Daniel Langer
INTRODUCTION: Respiratory muscle dysfunction has been associated with failure to wean from mechanical ventilation. It has therefore been hypothesised that these patients might benefit from inspiratory muscle training (IMT). Evidence, however, is thus far limited to data from small, single-centre studies with heterogeneity in inclusion criteria, training modalities and outcomes. The aim of this study is to evaluate the effects of a novel IMT method on weaning outcomes in selected patients with weaning difficulties...
June 30, 2018: BMJ Open
Satoru Shimizu, Masashi Nakajima, Masayuki Yamazaki, Takashi Nagayama, Ryuta Suzuki
Introduction: Cervical spinal cord injury with the C3 neurological level may cause respiratory failure and require long-term mechanical ventilation. Conventional weaning of spontaneous breathing trials is difficult to perform outside of intensive care or spinal cord units. Case presentation: An 80-year-old man presented with total tetraplegia and restrictive respiratory failure that required assisted ventilation after a falling accident. Cervical spine magnetic resonance imaging showed cervical cord compression that was worst at the C3-C4 intervertebral level...
2018: Spinal Cord Series and Cases
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