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Difficult weaning

Dieter Köhler
Since 2005, invasive long-term ventilation in Germany has increased significantly from around 1000 to 20 000 patients in Germany. Due to complex home care, the health care system incurs additional costs of around 4 billion euros per year. In addition, in the last 2 - 3 years more tracheostomized patients have been discharged home without ventilation (usually after stroke), and they receive the same complex home care. These patients have almost never been given the chance of a professional weaning trial by a weaning center...
February 2019: Deutsche Medizinische Wochenschrift
Luigi Vetrugno, Giovanni Maria Guadagnin, Federico Barbariol, Nicola Langiano, Alberto Zangrillo, Tiziana Bove
Of the various muscles that make up the respiratory system, the diaphragm is the prima donna. In the past, only specialist research centers were able to estimate and challenge the effort of this muscle; this was achieved by measuring transdiaphragmatic pressure-an invasive technique involving a double-balloon probe inserted through the esophagus-or by measuring twitch pressure (ie, the pressure generated at the outside tip of the endotracheal tube). However, the prevalence of diaphragm dysfunction in critically ill patients requiring intubation can exceed 60% (at the time of hospital admission) and may rise to as high as 80% in patients requiring prolonged mechanical ventilation and experiencing difficult weaning...
January 4, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Caroline E Gebhard, Antoine Rochon, Jennifer Cogan, Hosham Ased, Georges Desjardins, Alain Deschamps, Paul Gavra, Jean-Sebastien Lebon, Pierre Couture, Christian Ayoub, Sylvie Levesque, Mahsa Elmi-Sarabi, Etienne J Couture, André Y Denault
OBJECTIVE: To report the authors' 12 years of experience with intratracheal milrinone administration and to assess the efficacy and limitations of intratracheal milrinone bolus administration for the treatment of unexpected acute right ventricular (RV) failure in patients undergoing cardiac surgery. DESIGN: Retrospective analysis. SETTING: Single-center university hospital. PARTICIPANTS: One hundred seventy-six patients (4...
September 13, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Xi Chen, Zehong Yang, Huiling Hu, Wentao Duan, Aiping Wang, Yanbin Dong, Weihang Gao, Song Deng, Bo Cheng, Jiali Li, Nannan Sun, Zhibin Cheng, Wenfeng Guo, Yanwu Li, Yong Gao
Weaning is a stressful event associated with gastrointestinal disorders and increased disease susceptibility. Many studies have reported the changes happened in the gut of various mammals such as pigs and rats after weaning. These findings suggest that the development of intestinal tract mainly is affected at the time of weaning through interfering in the differentiation and proliferation of intestinal stem cells. Weaning stress stimulates the rapid differentiation and proliferation of intestinal stem cells in order to adjust to changes caused by weaning, which are mainly manifested as deeper crypt depth and intestine decreased villus height...
January 24, 2019: Current Protein & Peptide Science
Sébastien Dupuis, Dave Brindamour, Stephanie Karzon, Anne Julie Frenette, Emmanuel Charbonney, Marc M Perreault, Patrick Bellemare, Lisa Burry, David R Williamson
BACKGROUND: Delirium, agitation, and anxiety may hinder weaning from mechanical ventilation and lead to increased morbidity and healthcare costs. The most appropriate clinical approach to weaning in these contexts remains unclear and challenging to clinicians. The objective of this systematic review was to identify effective and safe interventions to wean patients that are difficult-to-wean from mechanical ventilation due to delirium, agitation, or anxiety. METHODS: A systematic review was performed using MEDLINE, EMBASE, and PubMed...
January 23, 2019: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Heather Dunn, Laurie Quinn, Susan Corbridge, Mary Kapella, Kamal Eldeirawi, Alana Steffen, Eileen Collins
RATIONALE: Patients on prolonged mechanical ventilation (PMV) at Long-Term Acute Care Hospital's (LTACHs) are clinically heterogeneous making it difficult to manage care and predict clinical outcomes. OBJECTIVES: Identify and describe subgroups of patients on PMV at LTACHs and examine for group differences. METHODS: Latent class analysis was completed on data obtained during medical record review at Midwestern LTACH. MAIN RESULTS: A three-class solution was identified...
January 14, 2019: Heart & Lung: the Journal of Critical Care
Douglas Evans, Deborah Shure, Linda Clark, Gerard J Criner, Martin Dres, Marcelo Gama de Abreu, Franco Laghi, David McDonagh, Basil Petrof, Teresa Nelson, Thomas Similowski
BACKGROUND: Mechanical ventilation (MV) is a life-saving technology that restores or assists breathing. Like any treatment, MV has side effects. In some patients it can cause diaphragmatic atrophy, injury, and dysfunction (ventilator-induced diaphragmatic dysfunction, VIDD). Accumulating evidence suggests that VIDD makes weaning from MV difficult, which involves increased morbidity and mortality. METHODS AND ANALYSIS: This paper describes the protocol of a randomized, controlled, open-label, multicenter trial that is designed to investigate the safety and effectiveness of a novel therapy, temporary transvenous diaphragm pacing (TTVDP), to improve weaning from MV in up to 88 mechanically ventilated adult patients who have failed at least two spontaneous breathing trials over at least 7 days...
January 17, 2019: Trials
J J Li, J Chu, M Hu
Objective: To discuss the surgical safeness of the cleft palate children with airway stenosis by means of analyzing characteristics of the shape of the upper airway and comparing clinical data of cleft palate children with airway stenosis and non-airway stenosis. Methods: Tracing back from Apirl 2015 to Apirl 2017, 126 cleft palate children treated in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, were included (46 male and 80 female, age of 7 to 74 months, median age 18 months)...
January 9, 2019: Zhonghua Kou Qiang Yi Xue za Zhi, Zhonghua Kouqiang Yixue Zazhi, Chinese Journal of Stomatology
Christina Routsi, Ioannis Stanopoulos, Stelios Kokkoris, Antonios Sideris, Spyros Zakynthinos
Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. In this review, we summarize the contemporary evidence of the most important clinical and diagnostic aspects of weaning failure of cardiovascular origin with special focus on treatment. Pathophysiological mechanisms are complex and mainly include increase in right and left ventricular preload and afterload and potentially induce myocardial ischemia...
January 9, 2019: Annals of Intensive Care
Massimiliano Polastri, Stefano Oldani, Lara Pisani, Stefano Nava
Intensive care unit-acquired weakness is characterised by severe impairment of muscle function that often arises after prolonged mechanical ventilation, difficult weaning, and severe sepsis. Elastic band exercises constitute an inexpensive and simple technique that is quite appealing for implementation in a "protected environment" such as the intensive care unit; however, elastic band application in the intensive care unit and in critical patients has not yet been described. A 72-year-old male was referred to the respiratory intensive care unit for hypoxemic respiratory failure due to acute respiratory distress syndrome...
February 2018: Tanaffos
Chao-Nan Jin, Ling-Ling Tang
BACKGROUND: The emerging avian influenza A (H7N9) virus, a subtype of influenza viruses, was first discovered in March 2013 in China. Infected patients frequently present with pneumonia and acute respiratory disorder syndrome with high rates of intensive care unit admission and death. Neurological complications, such as Guillain-Barré syndrome(GBS), and intensive care unit-acquired weakness, including critical illness polyneuropathy and myopathy, have only rarely been reported previously...
December 20, 2018: BMC Infectious Diseases
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
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