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Difficult weaning

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)...
August 31, 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
Martina Trckova, Alena Lorencova, Vladimir Babak, Jiri Neca, Miroslav Ciganek
A three-week trial was conducted to evaluate the effects of leonardite and lignite, natural sources of humic substances, on selected indicators of health status of weaned piglets. A total of 45 weaned piglets were assigned to three dietary treatments: Control - basal diet without any medication; Leonardite or Lignite - diet supplemented with lignite or leonardite at a dose of 20 g/kg, respectively. Leonardite differed from lignite in the content of humic substances and minerals. Diarrhoea incidence and severity, growth performance, haematological and biochemical status, biomarkers of oxidative stress, serum fatty acid (FA) profile and faecal microbiota composition were monitored...
August 2018: Research in Veterinary Science
Julia A Calderón Díaz, Edgar García Manzanilla, Alessia Diana, Laura A Boyle
This study aimed to (1) identify cross-fostering (CF) practices employed on a commercial farm; (2) characterize CF pigs according to litter of origin traits, and (3) investigate the implications of CF practices on pig mortality, performance and welfare. This was an observational study whereby pigs were managed according to normal farming practice. Pigs ( n = 1,016) born within 1 week were classified as non-CF (NCF); CF during the first (CFW1) and second or third (CFW2+) weeks of lactation. Pigs were individually weighed and inspected for the presence of tail (TL), ear (EL) and body lesions (BL) at weaning (7...
2018: Frontiers in Veterinary Science
Zhanqi Zhao, Chan-Ching Chu, Mei-Yun Chang, Hao-Tai Chang, Yeong-Long Hsu
RATIONALE: Methylmalonic acidemia (MMA) is an autosomal recessive disease of organic acidemia. PATIENT CONCERNS: We report a 26-year-old male who presented with metabolic acidosis, acute renal failure required hemodialysis and acute respiratory failure required mechanical ventilation support. Progressive hypotonia of muscles made weaning from mechanical ventilator difficult. DIAGNOSES: High level of serum methylmalonic acid and the mut genotype sequences confirmed the diagnosis of this adult-onset MMA...
June 2018: Medicine (Baltimore)
So-Hyun Nam, Kyoung-Ah Kwon
BACKGROUND: Lymphatic malformations are histologically benign vascular structures that vary in anatomic lesion and size. Extensive head and neck lymphatic malformations may be life-threatening. In the present study, we described three difficult-to-treat infants with giant cervico-mediastinal lymphatic malformations accompanied by severe respiratory distress. CASE PRESENTATIONS: Case 1. A Korean girl born at a gestational age of 37 weeks and weighing 2920 g had a large cervical mass compressing the trachea...
June 15, 2018: Journal of Medical Case Reports
Yuanda Xu, Qi Qing, Minyong Liang, Weibo Liang, Zhimin Lin, Weiliang Wu, Weiqun He, Xiaoqing Liu, Yuanming Luo, Yimin Li, Jianxing He
RATIONALE: Many factors contribute to a complicated postoperative course following difficult weaning off a ventilator after lung transplantation. PATIENT CONCERNS: A female patient underwent a successful surgery but received a size-mismatched lung graft. The graft had been pruned before transplantation. She experienced delayed ventilator weaning 3 days after lung transplantation. DIAGNOSES: A postoperative X-ray revealed a normal mediastinal structure and diaphragm position...
June 2018: Medicine (Baltimore)
Zoe Christoforidou, Rachel Burt, Imke Mulder, Bhupinder P Gill, John Pluske, Denise Kelly, Christopher R Stokes, Michael Bailey, Marie C Lewis
Epidemiological studies have demonstrated that exposure to farm environments during childhood can be linked to reductions in the incidence of immune disorders, but generating an appropriate model is difficult. 108 half-sibling piglets were born on either extensive (outdoor) or intensive (indoor) farms: at 1 day old, a subset of piglets from each litter were transferred to a high-hygiene isolator facility to create differences in rearing environment either during birth/first day or during the subsequent 56 days of life...
2018: Frontiers in Immunology
Hamza Zafar, Lisa Anderson, Andrew T Cox, Rachel Bastiaenen
A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria. For haemodynamically stable patients, the optimal management strategy is poorly defined. Three main strategies were considered: surgical thrombectomy, thrombolysis and anticoagulation. Surgery with reversal of anticoagulation may lead to further coagulation and increased risk of bleeding complications...
May 30, 2018: BMJ Case Reports
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