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weaning protocol

Bruno Garcia Montagnini, Karine Vandressa Pernoncine, Lorena Ireno Borges, Nathalia Orlandini Costa, Estefânia Gastadello Moreira, Janete Aparecida Anselmo-Franci, Ana Carolina Inhasz Kiss, Daniela Cristina Ceccatto Gerardin
Triclosan (TCS) is a phenolic compound with antimicrobial action widely used in cosmetics and other personal care products and other industry segments. Its widespread use over the decades has made TCS one of the most commonly detected compounds in wastewater and effluent worldwide already being found in human urine, plasma and milk. In this study, the (anti)estrogenicity of TCS was evaluated in the uterotrophic assay in 18-day old female Wistar rats. In a second protocol, female rats were evaluated for the reproductive effects of TCS in a two-generation reproduction toxicity study...
October 12, 2018: Toxicology
Pedro Espitia-Pérez, Suelen Marin Albino, Lyda Espitia-Pérez, Hugo Brango, Helen da Rosa, Alexandre Kleber Silveira, Diogo Pompéu Moraes, Camila Cerveira, Moara Mingori, Camila Tiefensee Ribeiro, Daniel Pens Gelain, Carlos Eduardo Schnorr, José Cláudio Fonseca Moreira
Fish consumption and ubiquitous methylmercury (MeHg) exposure represent a public health problem globally. Micronutrients presented in fish affects MeHg uptake/distribution. Vitamin A (VitA), another fish micronutrient is used in nutritional supplementation, especially during pregnancy. However, there is no information about the health effects arising from their combined exposure. The present study aimed to examine the effects of both MeHg and retinyl palmitate administered to pregnant and lactating rats. Thirty Wistar female rats were orally supplemented with MeHg (0,5 mg/Kg/day) and retinyl palmitate (7500 µg RAE1 /Kg/day), either individually or in combination from the gestational day 0 to weaning...
October 11, 2018: Neurotoxicology
Michael Salna, Yasuhiro Shudo, Jeffrey J Teuteberg, Dipanjan Banerjee, Richard V Ha, Y Joseph Woo, William Hiesinger
INTRODUCTION: The planned use of a temporary right ventricular assist device (RVAD) at the time of left ventricular assist device (LVAD) implantation may prevent the need for a permanent biventricular assist device (BiVAD). Herein we describe our RVAD weaning protocol that was effectively employed in 4 patients to prevent the need for permanent BiVAD. METHODS: Four patients in refractory cardiogenic shock underwent planned RVAD insertion during LVAD implantation due to severely depressed right ventricular function with dilation preoperatively...
October 1, 2018: Heart Surgery Forum
Masayoshi Inoue
Mechanical ventilation is a useful treatment option for respiratory insufficiency following thoracic and cardiovascular surgery. Ventilation mode is classified as volume-controlled-ventilation(VCV) and pressure-controlled ventilation(PCV). Non-invasive ventilation(NIV) without tracheal intubation has been recently developed and is effective in patients with chronic obstructive pulmonary disease (COPD) exacerbation. Several pulmonary complications by mechanical ventilation such as ventilator-induced lung injury(VILI) or ventilator-associated pneumonia(VAP) could be avoided with NIV...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Ilia Bresesti, Sanja Zivanovic, Kevin Nicolas Ives, Gianluca Lista, Charles Christoph Roehr
AIM: This study compared how non-invasive respiratory support (NRS) was provided in neonatal units in Italy and the UK. METHODS: An NRS questionnaire was sent to tertiary neonatal centres, identified by national societies, from November 2015 to May 2016. RESULTS: Responses were received from 49/57 (86%) UK units and 103/115 (90%) Italian units. NRS was started in the delivery room by 61% of UK units and 85% of Italian units. In neonatal intensive care units, 33% of UK units used nasal high-flow therapy (HFT) as primary support, compared to 3% in Italy...
October 11, 2018: Acta Paediatrica
Jessica H Beeson, Heather L Blackmore, Sarah K Carr, Laura Dearden, Daniella E Duque-Guimarães, Laura C Kusinski, Lucas C Pantaleão, Adele G Pinnock, Catherine E Aiken, Dino A Giussani, Denise S Fernandez-Twinn, Susan E Ozanne
OBJECTIVE: Obesity during pregnancy is associated with an elevated risk of cardiovascular disease in the offspring. With increased numbers of women entering pregnancy overweight or obese, there is a requirement for targeted interventions to reduce disease risk in future generations. Using an established murine model of maternal obesity during pregnancy, we investigated if a treadmill exercise intervention in the mother could improve offspring cardiac health and explored potential underlying mechanisms...
October 2018: Molecular Metabolism
Oliver Miera, Matthias Germann, My Y Cho, Joachim Photiadis, Eva M Delmo Walter, Roland Hetzer, Felix Berger, Katharina R L Schmitt
BACKGROUND: The majority of children supported with ventricular assist devices (VADs) are bridged to heart transplantation. Although bridge to recovery has been reported, low recovery patient numbers has precluded systematic analysis. The aim of this study was to delineate recovery rates and predictors of recovery and to report on long-term follow-up after VAD explantation in children. METHODS: Children bridged to recovery at our institution from January 1990 to May 2016 were compared with a non-recovery cohort...
August 11, 2018: Journal of Heart and Lung Transplantation
Carlos Gabriel de Lade, Ana Eliza Andreazzi, Mariana Bolotari, Vinícius Moreira Gonçalves Costa, Vera Maria Peters, Martha de Oliveira Guerra
Background: Obesity is associated with several comorbidities, such as cardiovascular disease and type 2 diabetes mellitus, and may have its origin in early life stages, such as in the lactation period, through metabolic programming. Physical activity aids in decreasing the chances of developing cardiovascular and metabolic diseases, even with small weight losses and, in children, can play an essential role in preventing weight gain and other health problems. The present study aimed to evaluate the effects of moderate intensity endurance training and high intensity interval training (HIIT) protocols on obesity-related parameters and cardiorespiratory capacity in overfed Wistar rats throughout the breastfeeding period...
2018: Diabetology & Metabolic Syndrome
Naveed Hussain, Janet Schwenn, Jennifer Trzaski, Mariann Pappagallo
Background: In infants with CLD there are no objective tests to monitor an infant's progress towards weaning out of oxygen inhalation therapy (O2 IT). A test involving staged maneuvers of increasing respiratory stress while decreasing oxygen support, termed Stress Oximetry (StressOx), has been used at our center for weaning O2 IT. Objective: To report the clinical utility of "StressOx" in evaluating readiness for discontinuing O2 IT in infants with CLD...
2018: International Journal of Pediatrics
Mohammed E Al-Sofiani, Michael Quartuccio, Erica Hall, Rita Rastogi Kalyani
PURPOSE OF REVIEW: While there has been a growing utilization of total pancreatectomy with islet autotransplantation (TPIAT) for patients with medically refractory chronic pancreatitis over the past few decades, there remains a lack of consensus clinical guidelines to inform the counseling and management of patients undergoing TPIAT. In this article, we review the current clinical practice and published experience of several TPIAT centers, outline key aspects in managing patients undergoing TPIAT, and discuss the glycemic outcomes of this procedure...
September 28, 2018: Current Diabetes Reports
Amy L Lembeck, Deborah Tuttle, Robert Locke, Laura Lawler, Pamela Jimenez, Amy Mackley, David A Paul
OBJECTIVE: The aim of the study is to determine length of stay and length of treatment in infants with neonatal abstinence syndrome (NAS) in the neonatal intensive care unit (NICU) compared to those in the pediatric floor. METHODS: Retrospective cohort of infants ≥34 weeks gestation admitted with diagnosis of NAS at a single regional perinatal referral center from July 2014 to October 2015. A standardized NAS protocol for both the NICU and pediatric floor, which included guidelines for the initiation of oral morphine, escalation, and weaning, was followed...
September 24, 2018: Journal of Addiction Medicine
Suzi Laine Longo Dos Santos Bacci, Janser Moura Pereira, Amanda Cristina da Silva Chagas, Lais Ribeiro Carvalho, Vivian Mara Gonçalves de Oliveira Azevedo
BACKGROUND: Weaning a patient from mechanical ventilation is a complex procedure that involves clinical and contextual aspects. Mechanical ventilation also depends on the characteristics of health professionals who work in intensive care. OBJECTIVE: This study described the organizational aspects associated with the physical therapist's performance in the weaning procedure from mechanical ventilation and extubation in neonatal, pediatric and mixed (neonatal and pediatric) intensive care units in Brazil...
September 12, 2018: Brazilian Journal of Physical Therapy
Rambod Amirnovin, L Nelson Sanchez-Pinto, Carol Okuhara, Phuong Lieu, Joyce Y Koh, John W Rodgers, Lara P Nelson
OBJECTIVES: Opioids and benzodiazepines are commonly used to provide analgesia and sedation for critically ill children with cardiac disease. These medications have been associated with adverse effects including delirium, dependence, withdrawal, bowel dysfunction, and potential neurodevelopmental abnormalities. Our objective was to implement a risk-stratified opioid and benzodiazepine weaning protocol to reduce the exposure to opioids and benzodiazepines in pediatric patients with cardiac disease...
September 17, 2018: Pediatric Critical Care Medicine
Raymond P Onders, MaryJo Elmo, Cindy Kaplan, Robert Schilz, Bashar Katirji, Glen Tinkoff
BACKGROUND: Cervical spinal cord injury can result in catastrophic respiratory failure requiring mechanical ventilation with high morbidity, mortality, and cost. Diaphragm pacing was developed to replace/decrease mechanical ventilation. We report the largest long-term results in traumatic cervical spinal cord injury. METHODS: In this retrospective review of prospective institutional review board protocols, all patients underwent laparoscopic diaphragm mapping and implantation of electrodes for diaphragm strengthening and ventilator weaning...
September 5, 2018: Surgery
Arnaud W Thille, Grégoire Muller, Arnaud Gacouin, Rémi Coudroy, Alexandre Demoule, Romain Sonneville, François Beloncle, Christophe Girault, Laurence Dangers, Alexandre Lautrette, Séverin Cabasson, Anahita Rouzé, Emmanuel Vivier, Anthony Le Meur, Jean-Damien Ricard, Keyvan Razazi, Guillaume Barberet, Christine Lebert, Stephan Ehrmann, Walter Picard, Jeremy Bourenne, Gael Pradel, Pierre Bailly, Nicolas Terzi, Matthieu Buscot, Guillaume Lacave, Pierre-Eric Danin, Hodanou Nanadoumgar, Aude Gibelin, Lassane Zanre, Nicolas Deye, Stéphanie Ragot, Jean-Pierre Frat
INTRODUCTION: Recent practice guidelines suggest applying non-invasive ventilation (NIV) to prevent postextubation respiratory failure in patients at high risk of extubation failure in intensive care unit (ICU). However, such prophylactic NIV has been only a conditional recommendation given the low certainty of evidence. Likewise, high-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce reintubation rates as compared with standard oxygen and to be as efficient as NIV in patients at high risk...
September 5, 2018: BMJ Open
Ouma Cissé, Isabelle Fajardy, Fabien Delahaye, Anne Dickes, Valérie Montel, Emmanuelle Moitrot, Christophe Breton, Didier Vieau, Christine Laborie
PURPOSE: Poor maternal nutrition sensitises to the development of metabolic diseases and obesity in adulthood over several generations. The prevalence increases when offspring is fed with a high-fat (HF) diet after weaning. This study aims to determine whether such metabolic profiles can be transmitted to the second generation and even aggravated when the mothers were exposed to overnutrition, with attention to potential sex differences. METHODS: Pregnant Wistar rats were subjected to ad libitum (control) or 70% food-restricted diet (FR) during gestation (F0)...
August 30, 2018: European Journal of Nutrition
Sara Volpi, Jason M Ali, Ravi De Silva
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Does the use of a 'hot-shot' (terminal warm blood cardioplegia) lead to improved outcomes following adult cardiac surgery? Altogether, 567 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated...
August 24, 2018: Interactive Cardiovascular and Thoracic Surgery
Tommaso Mauri, Giuseppe Foti, Carla Fornari, Jean-Michel Constantin, Claude Guerin, Paolo Pelosi, Marco Ranieri, Sara Conti, Daniela Tubiolo, Egle Rondelli, Federica Lovisari, Tommaso Fossali, Savino Spadaro, Domenico Luca Grieco, Paolo Navalesi, Italo Calamai, Tobias Becher, Oriol Roca, Yu-Mei Wang, Rihard Knafelj, Andrea Cortegiani, Jordi Mancebo, Laurent Brochard, Antonio Pesenti
BACKGROUND: Adding cyclic short sustained inflations (sigh) to assisted ventilation yields optimizes lung recruitment, decreases heterogeneity and reduces inspiratory effort in patients with acute hypoxemic respiratory failure (AHRF). These findings suggest that adding sigh to pressure support ventilation (PSV) might decrease the risk of lung injury, shorten weaning and improve clinical outcomes. Thus, we conceived a pilot trial to test the feasibility of adding sigh to PSV (the PROTECTION study)...
August 29, 2018: Trials
Christine Wibmer, Pawel Trotsenko, Magdalena M Gilg, Andreas Leithner, Matthias Sperl, Vinay Saraph
PURPOSE: We analysed socio-economic- and health-related quality of life (primary outcome) and radiological outcome (secondary outcome) 5 years after full time rigid bracing (FTRB) plus physiotherapeutic scoliosis-specific exercises (PSSE) in adolescent idiopathic scoliosis. METHODS: We included 41 patients (38 female and 3 male) treated with FTRB (Chênau brace) and PSSE (Schroth) between 2001 and 2010. The study protocol included a clinical and radiological examination, the completion of the SRS-24 questionnaire and acquisition of data on socio-economic factors (educational and employment status) and physical activity...
August 25, 2018: European Spine Journal
Masami Takagaki, Hiroki Yamaguchi, Naoko Ikeda, Kaori Takeda, Fumihito Kasai, Kiyotaka Yahagi, Shunji Kanzaki, Shinichi Mitsuyama, Tasuku Kadowaki, Toru Kotani
We present the cases of eight patients (mean age 75 years; EuroSCORE II 17.0 ± 22.0) who underwent post-cardiotomy venovenous extracorporeal membrane oxygenation (ECMO) without heparinization due to serious bleeding. Three liver cirrhosis, two chronic hemodialysis, three redo sternotomy, and two urgent surgery cases were included. Respiratory ECMO Survival Prediction score was - 5.1 ± 4.2 (estimated survival rate: approximately 30%). Mean ECMO duration was 14 days with 9 circuit exchanges. Five patients were weaned from ECMO and three were discharged alive at 90 days (survival 37...
August 17, 2018: General Thoracic and Cardiovascular Surgery
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