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weaning protocol

Yugo Okabe, Takehiko Asaga, Sayuri Bekku, Hiromi Suzuki, Kanae Kanda, Takeshi Yoda, Tomohiro Hirao, Gotaro Shirakami
Background: Extubation failure is associated with mortality and morbidity in the intensive care unit. Ventilator weaning protocols have been introduced, and extubation is conducted based on the results of a spontaneous breathing trial. Room for improvement still exists in extubation management, and additional objective indices may improve the safety of the weaning and extubation process. Static lung-thorax compliance reflects lung expansion difficulty that is caused by several conditions, such as atelectasis, fibrosis, and pleural effusion...
2018: Journal of Intensive Care
Buba Manjang, Karla Hemming, Chris Bradley, Jeroen Ensink, James T Martin, Jama Sowe, Abdou Jarju, Sandy Cairncross, Semira Manaseki-Holland
OBJECTIVE: Contamination of weaning food leads to diarrhoea in children under 5 years. Public health interventions to improve practices in low-income and middle-income countries are rare and often not evaluated using a randomised method. We describe an intervention implementation and provide baseline data for such a trial. DESIGN: Clustered randomised controlled trial. SETTING: Rural Gambia. PARTICIPANTS: 15 villages/clusters each with 20 randomly selected mothers with children aged 6-24 months per arm...
August 5, 2018: BMJ Open
Olivia Sonneborn, Gill Robers
Weaning of mechanical ventilation occurs in intensive care units by nurses, which stimulates the prospect of nurse-led extubation extending into the PACU environment for improved patient outcomes and reduced demand of hospital resources. Nurse-led patient extubation in the PACU, would involve specially trained nurses weaning mechanical ventilation via an established protocol for a specific patient group, prior to the patient being extubated by an anaesthetist or intensivist.
July 31, 2018: Journal of Perioperative Practice
Adam H Metherel, R J Scott Lacombe, Juan J Aristizabal Henao, Delphine Morin-Rivron, Alex P Kitson, Kathryn E Hopperton, Daniel Chalil, Mojgan Masoodi, Ken D Stark, Richard P Bazinet
Docosahexaenoic acid (DHA, 22:6n-3) must be consumed in the diet or synthesized from n-3 polyunsaturated fatty acid (PUFA) precursors. However, the effect of dietary DHA on the metabolic pathway is not fully understood. Presently, 21-day-old Long Evans rats were weaned onto one of four dietary protocols: 1) 8 weeks of 2% ALA (ALA), 2) 6 weeks ALA followed by 2 weeks of 2% ALA + 2% DHA (DHA), 3) 4 weeks ALA followed by 4 weeks DHA and 4) 8 weeks of DHA. After the feeding period, 2 H5 -ALA and 13 C20 -eicosapentaenoic acid (EPA, 20:5n-3) were co-infused and blood was collected over 3 h for determination of whole-body synthesis-secretion kinetics...
July 5, 2018: Journal of Nutritional Biochemistry
Pierre L Roubertoux, Adeline Ghata, Michèle Carlier
The immaturity at birth and the slowness of ontogenic processes in mice provide the opportunity to measure rates of development. We describe here 18 measures covering the sensorial and motor onset from birth to weaning. The measures are non-invasive, making a follow-up strategy possible. The first basic protocol indicates how to produce mice with known conceptional or chronological age, as the control of the age is a prerequisite to compare rates of development in groups of mice. The second basic protocol describes a set of methods for identifying the pups during a follow-up study...
March 2018: Current Protocols in Mouse Biology
Jun Miyoshi, Vanessa Leone, Kentaro Nobutani, Mark W Musch, Kristina Martinez-Guryn, Yunwei Wang, Sawako Miyoshi, Alexandria M Bobe, A Murat Eren, Eugene B Chang
Murine models are widely used to explore host-microbe interactions because of the challenges and limitations inherent to human studies. However, microbiome studies in murine models are not without their nuances. Inter-individual variations in gut microbiota are frequent even in animals housed within the same room. We therefore sought to find an efficient and effective standard operating procedure (SOP) to minimize these effects to improve consistency and reproducibility in murine microbiota studies. Mice were housed in a single room under specific-pathogen free conditions...
2018: PeerJ
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
Yeukai T M Mangwiro, James S M Cuffe, Jessica F Briffa, Dayana Mahizir, Kristina Anevska, Andrew J Jefferies, Sogand Hosseini, Tania Romano, Karen M Moritz, Mary E Wlodek
KEY POINTS: The placental insulin-like growth factor (IGF) system is critical for normal fetoplacental growth, which is dysregulated following several pregnancy perturbations including uteroplacental insufficiency and maternal obesity. We report that the IGF system was altered in placentae of mothers born growth restricted compared to normal birth weight mothers, with maternal diet- and fetal sex-specific responses. Additionally, we report increased body weight and plasma IGF1 concentrations in fetuses from chow-fed normal birth weight mothers that exercised prior to and continued during pregnancy compared to sedentary mothers...
June 28, 2018: Journal of Physiology
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
Sunay Shah, Ryan Gindi, Mir B Basir, Akshay Khandelwal, Mohammad Alqarqaz, Mohammad Zaidan, Michele Voeltz, Gerald Koenig, Henry E Kim, William W O'Neill, Khaldoon Alaswad
INTRODUCTION: The purpose of the study is to develop an optimal TR-Band weaning strategy while minimizing vascular access site complications of hematoma or radial artery occlusion (RAO). METHODS: The trial was a randomized, prospective, single center study of 129 patients who underwent cardiac catheterization via the radial artery. Group A was an accelerated protocol in which weaning was initiated 20 min after sheath removal. Group B was an adjusted protocol, in which weaning was dependent on the amount of anti-platelet or anti-coagulation used...
April 14, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Xing-Wang Zhu, Yuan Shi, Li-Ping Shi, Ling Liu, Jiang Xue, Rangasamy Ramanathan
BACKGROUND: Invasive mechanical ventilation (IMV) is associated with the development of adverse pulmonary and non-pulmonary outcomes in very premature infants. Various modes of non-invasive respiratory support are increasingly being used to decrease the incidence of bronchopulmonary dysplasia. The aim of this trial is to compare the effect of non-invasive high-frequency oscillatory ventilation (NHFOV) and nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS) as a primary non-invasive ventilation support mode...
June 14, 2018: Trials
Ryan J Sprenger, Sherry A Tanumihardjo, Courtney C Kurtz
Retinoic acid, a bioactive metabolite of vitamin A, plays key roles in immune function and vision and adipose tissue development. Our goal was to study the effect of vitamin A deficiency in physiologic changes seen in hibernating 13-lined ground squirrels (Ictidomys tridecemlineatus). In this study, we first developed a model of vitamin A deficiency that was based on published mouse models; we then examined the role of RA in the circannual cycle of and adipose accumulation in this hibernating species. Gravid female ground squirrels began consuming a deficient diet during the last 2 wk of their 4-wk gestation; pups received the diet until they were 8 wk old, when severe symptoms of hypovitaminosis were observed, requiring the animals' removal from the protocol...
June 1, 2018: Comparative Medicine
Balachandar Jayaraman, Charles M Nyachoti
The immediate post-weaning period is one of the most stressful phases in a pig's life, and during this period, piglets are usually exposed to environmental, social and psychological stressors which have direct or indirect effects on gut health and overall growth performance. In this review, the impact of husbandry practices on gut health outcomes and performance of piglets is discussed. Husbandry practices in the swine barn generally include nutrition and management practices, maintenance of hygienic standards and disease prevention protocols, and animal welfare considerations...
September 2017: Animal nutrition
John Nguyen, Noel Nacpil
OBJECTIVE: To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. INTRODUCTION: Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
Tara Burnette, Lindsey Chernicky, Craig V Towers
OBJECTIVE: Standardizing treatment of neonatal abstinence syndrome (NAS) is currently recommended; however, single institution prospective studies are lacking regarding the success of this approach. The study objective was to evaluate overall newborn response and length of stay (LOS) of neonates treated for NAS following the institution of a strict standardized treatment protocol. METHODS: From 1 January 2014 to 30 June 2016, a prospective cohort study was performed collecting neonatal outcomes before and after the standardization of a strict NAS morphine weaning treatment protocol...
May 14, 2018: Journal of Maternal-fetal & Neonatal Medicine
Khaled Emara, Mohamed Ahmed Al Kersh, Fahad Abdulazeez Hayyawi
BACKGROUND: There is no consensus about the duration of post-operative immobilization in the treatment of DDH (developmental dysplasia of hip). Our aim in this study is to compare between two post-operative immobilization protocols for patients undergoing open reduction. MATERIALS AND METHODS: Thirty-eight hips in 32 patients assigned to group A were immobilized in hip spica for four weeks followed by abduction brace application which was gradually weaned through the periods of several months and 29 hips in 24 patients assigned to group B immobilized in hip spica for 12 weeks without further bracing...
May 11, 2018: International Orthopaedics
Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, Phil Alderson, Andrew F Smith
BACKGROUND: Patients in the intensive care unit (ICU) experience sleep deprivation caused by environmental disruption, such as high noise levels and 24-hour lighting, as well as increased patient care activities and invasive monitoring as part of their care. Sleep deprivation affects physical and psychological health, and patients perceive the quality of their sleep to be poor whilst in the ICU. Artificial lighting during night-time hours in the ICU may contribute to reduced production of melatonin in critically ill patients...
May 10, 2018: Cochrane Database of Systematic Reviews
Charles P Opperman, Melissa M Butler, Andrew K Stroud, Michael R Sun
A retrospective, cross-sectional study was completed on 220 patients to determine the effects of implementation of an aggressive policy to curb opioid misuse/abuse in an internal medicine residency clinic. Our findings suggest that the development of a clear and consistent protocol for approaching patients on chronic controlled substances, as well as the initiation of regular didactic sessions addressing chronic pain and pain management, led to a dramatic reduction in the number or opioid prescriptions written by our resident providers without much reduction in patient volume...
March 2018: Journal of Opioid Management
Anne Marie Shine, Daragh Gerard Finn, Noeleen Allen, Colin J McMahon
BACKGROUND: Home enteral tube feeding (HETF) is imperative for many infants and children with congenital heart disease (CHD). Tube weaning (TW) facilitates the progression from tube feeding to oral diet. There is limited literature on TW practices, protocols and success for children with CHD that have been tube fed. AIMS: The objective of this study is to assess the process of weaning HETF in a tertiary referral centre for paediatric CHD. Specifically, we aimed to assess the duration of HETF, duration of TW and the interventions involved...
May 2, 2018: Irish Journal of Medical Science
Michael D Kleinhenz, Nicholas K Van Engen, Patrick J Gorden, Joe S Smith, Butch KuKanich, Suzanne M Rajewski, Philip Walsh, Steven Perkins, Johann F Coetzee
OBJECTIVE To determine the effect of age on the pharmacokinetics and pharmacodynamics of flunixin meglumine following IV and transdermal administration to calves. ANIMALS 8 healthy weaned Holstein bull calves. PROCEDURES At 2 months of age, all calves received an injectable solution of flunixin (2.2 mg/kg, IV); then, after a 10-day washout period, calves received a topical formulation of flunixin (3.33 mg/kg, transdermally). Blood samples were collected at predetermined times before and for 48 and 72 hours, respectively, after IV and transdermal administration...
May 2018: American Journal of Veterinary Research
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