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weaning protocol

Danielle K Maue, Alvaro J Tori, Andrew Beardsley, Nadia Krupp, Acrista J Hole, Elizabeth As Moser, Courtney M Rowan
BACKGROUND: Status asthmaticus is one of the most frequent admission diagnoses in the pediatric ICU (PICU). Collaboration between respiratory therapists (RTs) and physicians may help efficiently deliver care to a patient in status asthmaticus. The Pediatric Asthma Severity Score (PASS) is a measure of severity of a patient's asthma exacerbation at a point in time. The aim of this quality improvement initiative was to establish an RT-driven continuous albuterol weaning protocol using the PASS score...
March 19, 2019: Respiratory Care
Guoqiang Jing, Jie Li, Dong Hao, Tao Wang, Yunliang Sun, Huanhuan Tian, Zhong Fu, Yuewei Zhang, Xiaozhi Wang
High flow nasal cannula (HFNC) has been shown to improve extubation outcomes in patients with hypoxemia, but the role of HFNC in weaning patients with chronic obstructive pulmonary disease (COPD) with hypercapnia from invasive ventilation is unclear. We compared the effects of HFNC to noninvasive ventilation (NIV) on postextubation vital signs and arterial blood gases (ABGs) among patients with COPD. Other outcomes included comfort scores, need for bronchoscopy, use of pulmonary medications, and chest physiotherapy...
March 18, 2019: Research in Nursing & Health
Anita Duyndam, Robert Jan Houmes, Joost van Rosmalen, Dick Tibboel, Monique van Dijk, Erwin Ista
BACKGROUND: Critically ill children treated with invasive mechanical ventilation in a paediatric intensive care unit (PICU) may suffer from complications leading to prolonged duration of ventilation and PICU stay. OBJECTIVE: The objective of this study is to find out if the use of a nurse-driven ventilation weaning protocol in a PICU can shorten the duration of mechanical ventilation. METHODS: In a prospective, pretest-posttest implementation study, we implemented a nurse-driven ventilation weaning protocol and compared its outcomes with those of the usual physician-driven weaning...
March 12, 2019: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
R Zachary Thompson, Brian M Gardner, Elizabeth B Autry, Scottie B Day, Ashwin S Krishna
OBJECTIVES: Dexmedetomidine use for sedation in the pediatric intensive care units (PICUs) has increased since its initial US Food and Drug Administration (FDA) approval in adults. However, there is limited evidence to direct providers regarding current usage, dosing, and monitoring for withdrawal symptoms in pediatric patients. This study sought to determine the utilization of dexmedetomidine and management of dexmedetomidine withdrawal symptoms among PICU physicians. METHODS: A questionnaire survey was distributed to all members of the American Academy of Pediatrics Section on Critical Care...
January 2019: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Arnaud Lebret, Gwenaël Boulbria, Pauline Berton, Pierre-Yves Moalic, Jean Le Guennec, Franck Bouchet, Vincent Auvigne, Valérie Normand
Background: Defining shedding and exposure status for PRRSV is essential in herd stabilisation protocols and weaning-age pigs is a key subpopulation. Oral fluid (OF) sampling is a welfare-friendly and cost saving promising alternative to blood sampling. The first objective of our study was to compare the rate of detection of PRRSV-1 in individual serum sample, individual OF sample, litter-based OF sample, collected the day before weaning. The second objective was to evaluate the interest of pooling samples...
2019: Porcine Health Management
Brandon Masi Parker, Tejaus Rao, Ann Matta, Megan Quitanna, H Neal Reynolds, Deborah M Stein, Daniel Haase
INTRODUCTION: This case of Loperamide misuse had refractory ventricular arrhythmias and was successfully supported by VA ECMO. Loperamide is currently available without prescription and can be obtained in large quantities over the internet despite Food and Drug Administration (FDA) 2016 black box warning noting cardiac toxicity. This case illustrates the life-threatening toxicity of loperamide and suggests a supportive modality to provide clinical time while the drug is cleared endogenously or exogenously...
February 26, 2019: Clinical Toxicology
Erwan L'her, Samir Jaber, Daniel Verzilli, Christophe Jacob, Brigitte Huiban, Emmanuel Futier, Thomas Kerforne, Victoire Pateau, Pierre-Alexandre Bouchard, Maellen Gouillou, Emmanuel Nowak, François Lellouche
INTRODUCTION: Hypoxemia and hyperoxia may occur after surgery with potential related complications. The FreeO2 PostOp trial is a prospective, multicentre, randomised controlled trial that evaluates the clinical impact of automated O2 administration versus conventional O2 therapy after major abdominal or thoracic surgeries. The study is powered to demonstrate benefits of automated oxygen titration and weaning in term of oxygenation, which is an important surrogate for complications after such interventions...
January 17, 2019: BMJ Open
Sarah N Bowe, C Alessandra Colaianni, Alisa Yamasaki, Brian M Cummings, Christopher J Hartnick
Importance: Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation. Objective: Using principles of continuous QI, the objectives of this study were to (1) describe step-by-step methods to sustain QI efforts and (2) revisit a series of process, outcome, and balance measures for sedation weaning management following implementation of a new electronic health record (EHR)...
February 14, 2019: JAMA Otolaryngology—Head & Neck Surgery
Jean Deschamps, Jordan Webber, Robin Featherstone, Meghan Sebastianski, Ben Vandermeer, Janek Senaratne, Sean M Bagshaw
INTRODUCTION: Predicting successful liberation from mechanical ventilation (MV) among critically ill patients receiving MV can be challenging. The current parameters used to predict successful extubation have shown variable predictive value. Brain natriuretic peptide (BNP) has been proposed as a novel biomarker to help guide decision-making in readiness for liberation of MV following a spontaneous breathing trial (SBT). Current evidence on the predictive ability of BNP has been uncertain, and BNP has not been integrated into clinical practice guidelines...
February 12, 2019: BMJ Open
Jaishankar Raman, Mazahir Alimohamed, Nikola Dobrilovic, Omar Lateef, Salim Aziz
BACKGROUND: Bleeding and need for blood products are major complications associated with extracorporeal membrane oxygenation (ECMO) use. This study evaluated bleeding complications with low and standard heparinization protocols in the maintenance of venoarterial (VA)-ECMO. METHODS: A retrospective comparison was performed of 2 methods of heparinization in a contemporaneous series of adult patients supported with VA-ECMO at Rush University Medical Center, between November 2011 and November 2016...
January 31, 2019: Journal of Heart and Lung Transplantation
Xiaoyan Jiang, Toshihide Kurihara, Shin-Ichi Ikeda, Hiromitsu Kunimi, Kiwako Mori, Hidemasa Torii, Kazuo Tsubota
Murine model of myopia can be a powerful tool for myopia research because of the comparatively easy genetic manipulation. One way to induce myopia in animals is to put clear minus lenses in front of eyes for weeks (lens-induced myopia, LIM). However, extant protocols for inducement and evaluation vary from laboratory to laboratory. Here, we described a highly practical and reproducible method to induce LIM in mice using newly designed eyeglasses. The method fixes the lens stably in front of the mouse eye while allows the lens to be taken off for cleaning or topical drug administration...
January 22, 2019: Journal of Visualized Experiments: JoVE
Yeukai Tm Mangwiro, James Sm Cuffe, Dayana Mahizir, Kristina Anevska, Sogand Gravina, Tania Romano, Karen M Moritz, Jessica F Briffa, Mary E Wlodek
KEY POINTS: Fetal growth is dependent on effective placental nutrient transportation, which is regulated by mTORC1 modulation of nutrient transporter expression. These transporters are dysregulated in pregnancies affected by uteroplacental insufficiency and maternal obesity. Nutrient transporters and mTOR were altered in placentae of mothers born growth restricted compared to normal birth weight dams, with maternal diet- and fetal sex-specific responses. Exercise initiated during pregnancy (PregEx) downregulated MTOR protein expression, despite an increase in mTOR activation in male associated placentae, and reduced nutrient transporter gene abundance, which was also dependent on maternal diet and fetal sex...
February 7, 2019: Journal of Physiology
Falk Fichtner, Onnen Moerer, Sven Laudi, Steffen Weber-Carstens, Monika Nothacker, Udo Kaisers
BACKGROUND: Mechanical ventilation is life-saving for patients with acute respiratory insufficiency. In a German prevalence study, 13.6% of patients in intensive care units received mechanical ventilation for more than 12 hours; 20% of these patients received mechanical ventilation as treatment for acute respiratory distress syndrome (ARDS). The new S3 guideline is the first to contain recommendations for the entire process of treatment in these groups of patients (indications, ventilation modes/parameters, ac- companying measures, treatments for refractory impairment of gas exchange, weaning, and follow-up care)...
December 14, 2018: Deutsches Ärzteblatt International
Antonio Paulo Nassar, Fernando G Zampieri, Jorge I Salluh, Fernando A Bozza, Flávia Ribeiro Machado, Helio Penna Guimarães, Lucas P Damiani, Alexandre Biasi Cavalcanti
BACKGROUND: Although light sedation levels are associated with several beneficial outcomes for critically ill patients on mechanical ventilation, the majority of patients are still deeply sedated. Organizational factors may play a role on adherence to light sedation levels. We aimed to identify organizational factors associated with a moderate to light sedation target on the first 48 h of mechanical ventilation, as well as the association between early achievement of within-target sedation and mortality...
January 29, 2019: Critical Care: the Official Journal of the Critical Care Forum
Raunak Dani, Ajoy Sodani, Kapil Telang, Richa Nigam
Background: The determinants of the outcome in adult convulsive status epilepticus(CSE), also the implication of the value of mean arterial blood pressure (MAP), and random blood sugar at admission on the outcome are not clear. Objectives: The objective of this study is to look for the determinants of unfavorable outcome in CSE. Materials and Methods: Ambispectively gathered data from 55 patients, treated consecutively with identical protocol during January 2010-December 2016, were analyzed...
January 2019: Annals of Indian Academy of Neurology
M C Cantor, A L Stanton, D K Combs, J H C Costa
Automated milk feeders offer flexibility to feed calves high milk allowances, to change the daily quantity of milk offered, and also to dispense additives like probiotics on an individual basis. Our objectives were to test the effects of two milk feeding protocols and a lactic acid bacterium probiotic on performance and behavior in calves. Heifer dairy calves (n=96) were enrolled at birth in a 2 X 2 factorial study design comparing feeding (1) 2 milk feeding protocols, and (2) a lactic acid bacterium based probiotic program, or a placebo, using automated feeders...
January 25, 2019: Journal of Animal Science
Yaron D Barac, Jacob N Schroder, Muath Bishawi, Chetan B Patel, Carmelo A Milano, Mani A Daneshmand
Intra-aortic balloon pump (IABP) is often used to support patients in decompensated heart failure. Placement of the IABP via the axillary artery facilitates long term support with the device and may allow for the conversion of an acute heart failure (HF) patient into a chronic HF patient by using a modified weaning protocol; allowing for medical symptom management and removal of mechanical support. We will discuss strategies for supporting these complicated patients. This article is protected by copyright. All rights reserved...
January 23, 2019: Artificial Organs
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
Laura Garza-Moreno, Maria Pieters, Sergio López-Soria, Marta Carmona, Roman Krejci, Joaquim Segalés, Marina Sibila
This study evaluated different gilt vaccination protocols against Mycoplasma (M.) hyopneumoniae at acclimation and their effect on the genetic diversity. A total of 180 M. hyopneumoniae naïve gilts were selected 1 week post-entry (wpe) at the acclimation barn in a clinically affected M. hyopneumoniae farm. Gilts were distributed according to the M. hyopneumoniae antibodies levels into three different vaccination schedules: A) four doses of a M. hyopneumoniae commercial vaccine at 2, 4, 6 and 8 wpe; B) two vaccine doses at 2 and 6 wpe and PBS at 4 and 8 wpe; and C) four PBS doses at the same wpe...
February 2019: Veterinary Microbiology
Yeukai Tm Mangwiro, Jessica F Briffa, Sogand Gravina, Dayana Mahizir, Kristina Anevska, Tania Romano, Karen M Moritz, James Sm Cuffe, Mary E Wlodek
Fetal growth and development are dependent on adequate placental nutrient transfer. The surface area of the placental villous network is a key determinant of nutrient exchange, which is regulated by vasculogenic and angiogenic factors. These factors are altered by intrauterine growth restriction (IUGR) and maternal obesity in both the first (F1) and second (F2) generations. We investigated the impact of endurance exercise in IUGR dams fed a High-fat diet on placental vasculogenesis and angiogenesis. Uteroplacental insufficiency (Restricted) or sham (Control) surgery was induced on embryonic day (E) 18 in Wistar-Kyoto rats...
December 15, 2018: Placenta
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