Weaning Methods Research Articles

A Case of Neonate with Vein of Galen Malformation Refractory to Weaning Attempts from Mechanical Ventilation Managed Successfully with Noninvasive Ventilation

AbstractWeaning of patients with vein of Galen malformations (VOGM) from mechanical ventilation can be challenging in the postprocedure period due to underlying high-output cardiac failure and the fluid overload caused by the neurointervention procedure. We present the case of a neonate with VOGM who was refractory to multiple weaning attempts from mechanical ventilation and was successfully managed with noninvasive ventilation (NIV). NIV can be safely used as a method of weaning, post mechanical ventilation in this subset of patients. The use of NIV will facilitate successful weaning and reduce the incidence of extubation failure in neonates with VOGM in cardiac failure.

PREDICTION OF WEANING FAILURE OF MECHANICAL VENTILATION USING CLINICAL PARAMETERS IN PICU

ABSTRACT Background: Mechanical ventilation is a life support intervention that is used for a large number of patients in Pediatric intensive care units. The current pediatric literature shows that the science of ventilator weaning and extubation remains undetermined. No optimal weaning method has been described for a more rapid and successful extubation. Objective: Weaning predictors are used as a decision point in protocols to determine whether a patient may advance to a spontaneous breathing trial. We designed a study to determine the effect of including a weaning predictor (clinical weaning parameters) in a weaning protocol. Subjects & Methods:  Cross section study was conducted on 53 children who admitted to PICU. All patients should be eligible for weaning from mechanical ventilation. Clinical data and laboratory investigations were obtained on admission. Patients underwent a spontaneous breathing trial (SBT) after reversal of the underlying cause for respiratory failure and when they met all the weaning criteria. Then Rapid shallow breathing index (RSBI) was performed. As RSBI ≤ 8 breath/min/ml/kg, PaO 2 > 60 mmHg , Pa CO 2 200 mg , Tidal volume (V T ) > 5 ml/kg, V e >200 ml/min/kg, PEEP < 5 CmH 2 O and RR < 45 breath/min.  Weaning failure is defined as the inability to sustain spontaneous breathing without any form of ventilator support, for at least 48 h. The results were tabulated and analyzed with SPSS. Results: RSBI differed significantly between patients who succeeded weaning from mechanical ventilation and those who failed (3.12±1 vs. 9.5±1.04 breath/min/ml/kg; P < 0.001). A cutoff value ≥3.5 breath/min/ml/kg on were associated with a prediction of failure of weaning from mechanical ventilation with a 100%sensitivity, 75% specificity,0.724 positive predictive value (PPV), 1 negative predictive value (NPV) and 84.91% accuracy. Conclusion and key messages: Clinical weaning parameter could be considered a sensitive and specific marker for prediction of weaning failure. Keywords Weaning; extubation; mechanical ventilation; pediatric Intensive Care Unit; weaning criteria; spontaneous breathing.

MÉTODO BABY-LED WEANING (BLW) NO CONTEXTO DA ALIMENTAÇÃO COMPLEMENTAR: UMA REVISÃO

ABSTRACTObjective: To review the scientific findings on the baby-led weaning method (BLW) in the context of complementary feeding.Data sources: Two independent examiners searched the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed database in August 2016. No time-period was defined for the publication dates. The following descriptors were used: “baby-led weaning” OR “baby-led” OR “BLW”. Inclusion criteria were: original studies that were available in English, and which addressed the BLW method. Exclusion criteria were: references in other languages, opinion articles and literature reviews, editorials and publications that did not elaborate on the intended subject. Of the 97 references identified, 13 were included in the descriptive synthesis.Data synthesis: The BLW group of babies, when compared to the traditional eating group, were less prone to being overweight, less demanding of food, and ate the same foods as the family. The number of choking episodes did not differ between groups. Mothers who opted for the implementation of BLW had higher levels of schooling, held managerial positions at work, and were more likely to have breastfed until the sixth month of the child’s life. Concerns were raised about messes made during meals, wasting food, and choking, but most of the mothers recommended adopting the method. Health professionals were hesitant to indicate this method.Conclusions: BLW was recommended by mothers who followed the method with their own children. However, concerns have been reported, which, coupled with professionals’ fears about the inability of infants to self-feed, reflect a lack of knowledge about the method.

Simulated disease process during late pregnancy compromises developmental outcomes of lambs independently of the weaning method applied

Stress during pregnancy negatively affects fetal development, and artificial weaning can negatively affect animal health and welfare; however, maternal care can reverse the possible consequences of stress on the offspring. Our study aims to determine the combined effect of a prenatal disease challenge and artificial weaning on welfare and productive performance of lambs. During pregnancy, 43 ewes were distributed into three experimental groups, and at 70th and 120th days of pregnancy (Ig;n=14; Fg=14;), the ewes were administered with Escherichia coli Lipopolysaccharides (LPS). Fifteen ewes were included in the control group (Cg=15). Cortisol and rectal temperature measurements were done subsequently to LPS or saline injection. Fourty-six lambs (21 males; 25 females) born in a six-day interval from Ig, Fg, and Cg ewes were subjected to two types of weaning, namely progressive (from 39 to 45days) and abrupt (at 45days of age). Lamb data, including plasma cortisol levels, rectal temperature, weaning weight, and performance in feedlot were analyzed and compared through F test and Student's t-test (PDIFF; P=0.05). The injection of LPS resulted in a 619% increase in cortisol levels after two hours, and rectal temperature reached 39.48±0.134°C after four hours of LPS administration in a pregnant sheep. Both male and female lambs from the Fg group had lower birth weight (P<0.05) as compared to other groups. Cortisol levels and rectal temperature decreased during progressive weaning (P<0.05), in which a higher weaning weight was observed than in abrupt weaning (P<0.05). On the first day at feedlot, cortisol level was reduced after 60min upon entrance (P <0.05), and higher cortisol values were observed during abrupt weaning (P <0.05). Lower values of dry mater intake and average daily gain were observed for Fg males (P<0.05). LPS challenge during late pregnancy compromised the lambs’ indicators of productive performance. Albeit progressive weaning was less stressful during feedlot entrance and total bond separation, more days of maternal care during weaning had no relation with stress during pregnancy.

A randomized pilot study comparing the role of PEEP, O2 flow, and high-flow air for weaning of ventilatory support in very low birth weight infants

There is a lack of evidence to guide step-wise weaning of positive pressure respiratory support for premature infants. This study sought to compare the efficacy of three weaning protocols we designed to facilitate weaning of very low birth weight (VLBW, less than 1500g) preterm infants from nasal continuous positive airway pressure (NCPAP) support. This was a prospective, randomized, controlled trial of VLBW preterm infants who received positive pressure ventilatory support in our neonatal intensive care unit (NICU) from April 2008 through March 2009. When these infants were weaned to CPAP as their last step of respiratory support, they would be randomly assigned to one of the following three groups as their further weaning methods (M): (M1) CPAP group, (M2) O2 flow group, and (M3) air flow group. The time period they needed to wean off any kind of respiratory support, as well as the likelihood of developing relevant prematurity related morbidities, were compared among patients using different weaning modalities. 181 patients were enrolled in the study. Their gestational age (GA) and birth weight (BW) were 29.1±2.5, 28.7±2.4, 28.7±2.4 (mean±SD) weeks and 1142±232, 1099±234, 1083±219g, in M1, M2 and M3, respectively. The time (period) needed to wean off support was 16.0±10.0 days (M1), 11.6±6.4 days (M2), and 15.0±8.9 days (M3), respectively (p=.033). Incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) were both significantly higher in the O2 flow group (p=.048). Although using low oxygen flow significantly shortens CPAP weaning time, it may increase risks of BPD and ROP, both known to be related to oxygen toxicity. Unless the infant has BPD and is O2-dependent, clinicians should consider using air flow or just splinting with no support at all when weaning NCPAP.

The Effects of Weaning Methods on Gut Microbiota Composition and Horse Physiology.

Weaning has been described as one of the most stressful events in the life of horses. Given the importance of the interaction between the gut-brain axis and gut microbiota under stress, we evaluated (i) the effect of two different weaning methods on the composition of gut microbiota across time and (ii) how the shifts of gut microbiota composition after weaning affect the host. A total of 34 foals were randomly subjected to a progressive (P) or an abrupt (A) weaning method. In the P method, mares were separated from foals at progressively increasing intervals every day, starting from five min during the fourth week prior to weaning and ending with 6 h during the last week before weaning. In the A method, mares and foals were never separated prior to weaning (0 d). Different host phenotypes and gut microbiota composition were studied across 6 age strata (days −30, 0, 3, 5, 7, and 30 after weaning) by 16S rRNA gene sequencing. Results revealed that the beneficial species belonging to Prevotella, Paraprevotella, and Ruminococcus were more abundant in the A group prior to weaning compared to the P group, suggesting that the gut microbiota in the A cohort was better adapted to weaning. Streptococcus, on the other hand, showed the opposite pattern after weaning. Fungal loads, which are thought to increase the capacity for fermenting the complex polysaccharides from diet, were higher in P relative to A. Beyond the effects of weaning methods, maternal separation at weaning markedly shifted the composition of the gut microbiota in all foals, which fell into three distinct community types at 3 days post-weaning. Most genera in community type 2 (i.e., Eubacterium, Coprococcus, Clostridium XI, and Blautia spp.) were negatively correlated with salivary cortisol levels, but positively correlated with telomere length and N-butyrate production. Average daily gain was also greater in the foals harboring a community type 2 microbiota. Therefore, community type 2 is likely to confer better stress response adaptation following weaning. This study identified potential microbial biomarkers that could predict the likelihood for physiological adaptations to weaning in horses, although causality remains to be addressed.

Use of automatic tube compensation (ATC) for weaning from mechanical ventilation in acute respiratory failure

Aim of studyTo evaluate the automatic tube compensation (ATC) as a method of weaning from mechanical ventilation in acute respiratory failure in comparison to pressure support volume (PSV). Patients and methods60 patients with, acute respiratory failure were enrolled in this study. Patients who met the criteria of weaning had one hour of a spontaneous breathing trial (SBT) either with ATC (n=35) or with PSV (n=25). Patients who passed the weaning trial were extubated and put on oxygen, while others who didn’t pass were put back on mechanical ventilation. ResultsThe SBT in the 60 enrolled patients weaning was successful in 35 patients (58.3%). 20 of the 35 patients (57.1%) who underwent ATC had successful weaning, and 15 out of the 25 patients (60%) who underwent PSV had also successful weaning. The difference had no statistical significance (p=0.7). Sensitivity of 80.36% with a positive predictive value (PPV) of 90.14% and a specificity of 79.63% with a negative predictive value (NPV) of 81.25% were shown in ATC, while PSV showed a sensitivity of 76.35% with a PPV of 88.63% and a specificity of 80.36% with a NPV of 71.4%. ATC was superior to PSV regarding PaO2/FIO2 ratio, oxygen saturation, oxygen tension, dynamic compliance and airway resistance. ConclusionATC is a useful mode of weaning in patients mechanically ventilated due to acute respiratory failure.

Weaning Premature Infants from Nasal Continuous Positive Airway Pressure - Current Practice and Scientific Evidence.

Objective In the past decade, a number of trials have been conducted to determine the optimal strategy of weaning premature infants from nasal continuous airway pressure (nCPAP). However, a paucity of information exists on how weaning is actually performed in clinical routine. Aim of this study was to investigate the current practice of weaning premature infants from nCPAP in Germany. Methods An online survey was performed in German tertiary care neonatal units. Results All 160 German tertiary care units were contacted. Replies were retrieved from 85/160 (53%) units, of which 83/160 (52%) completed the questionnaire. 66/83 (80%) respondents indicated to wean without the use of formal written policies. In 44/83 (53%) units weaning decisions are made jointly between physicians and nurses, whereas physicians are the sole decision makers in 33/83 (40%) as are nurses in 6/83 (7%) units. Many units use more than one weaning strategy. 81/83 units (98%) gradually reduce nCPAP pressure as the initial step in the weaning process. 9/83 (11%) units stop nCPAP at standard criteria [CICADA (CeasIng nCpap At standarD criteriA) method] and 58/83 (70%) units use a cycling nCPAP on/off strategy. 52/83 (63%) of the responding units use nasal high flow at least at some point during the weaning process, either as a gradual weaning method or during nCPAP breaks. Conclusion Weaning strategies from nCPAP vary widely in German tertiary care neonatal units. It appears that evidence is still insufficient to promote a distinct weaning strategy which in turn highlights the urgent need for further adequately powered clinical trials.

Effects of different feeding methods and space allowance on the growth performance, individual and social behaviors of Holstein calves

The importance of nutrient provisions and weaning methods for calves has been well established over the past few years, while as increasing interest has focused on contribution of animal behavior and their overall performance in production regimes. The present study investigated the effects of feeding methods and space allowance on growth performance, individual and social behaviors in Holstein calves. Twenty-four Chinese Holstein male and female calves were allocated to either an individual or group of 6 and fed either with a bucket or a teat. Milk replacer, calf starter, and Chinese wildrye were offered during the experiment. A fecal index used in the present study was defined as the total fecal scores/total number of calves in each treatment. The results showed that there was no significant difference among the 4 treatments in terms of feed intake, body weight, average daily gain, and fecal index. For the feeding behaviors, the ingesting milk time and ingesting milk rate were significantly affected by space allowance, while the feeding methods showed a significant influence on the bunting behavior of the calves. There was no significant difference among the 4 treatments in terms of licking fixtures, self-grooming, and lying down behaviors, irrespective of the feeding method or space allowance. However, sucking an empty bucket or the teat was significantly affected by the feeding method. Several selected group behaviors were examined in the present study, and similar values for sniffing the other calves, social grooming, and cross-sucking behaviors were observed. Overall, the present study demonstrated that different feeding methods and space allowances had a significant effect on the feeding behavior of calves, while the feed intake, growth performance, health condition, individual and group social behaviors were not significantly influenced. Furthermore, under intensified production systems, Holstein calves raised in a group may obtain a similar production performance, thus reducing management input and profitability compared with those kept individually. However, there may be competition during the feeding period.

Mechanical ventilation practice in Egyptian pediatric intensive care units.

IntroductionMechanical ventilation is one of the indispensable tools in pediatric intensive care units. Few studies addressed the epidemiology of pediatric patients on mechanical ventilation and the frequently used modes of ventilation. This is the first study to describe the practice of mechanical ventilation (MV) in Egyptian pediatric intensive care units (PICUs).MethodsThis prospective observational study was conducted from January 2014 to December 2014 in two pediatric intensive care units at Cairo University Pediatric Hospital. The study included all children who were intubated and mechanically ventilated for more than 12 hours of admission. Pre-coded data was entered into the SPSS version 21 for data analysis. Comparison between groups was performed using Mann Whitney test for quantitative variables and Chi square with Fisher’s exact test for qualitative ones. Multivariate logistic regression model was conducted to explore the significant predictors for PICU mortality.ResultsIn total, 893 children were admitted and 293 were mechanically ventilated. The incidence of utilizing MV in children was 32.8%. Neurologic causes were the most common reasons for initiation of MV, with 114 (38.9%) cases. The most commonly preferred mode for initiation of MV is SIMV with PS. Complication occurred in 117 (39.9%) of the cases. The most commonly preferred method of weaning was PS with CPAP in 115/154 (74.7%) cases. Mortality occurred in 134/293 (45.7%) of patients. Duration of mechanical ventilation was significantly longer with neuromuscular diseases, and with the occurrence of complications (p<0.001). There was a significant relationship between mortality and higher PRISM III score, cardiovascular cases, sepsis, multiple organ dysfunction syndrome (MODS), ventilator-associated pneumonia (VAP), and with barotrauma.ConclusionsIn our practice, MV is used oftentimes with almost a third of admissions requiring intubation for different reasons. Most children are ventilated due to neurologic causes. This study paves the way for improving our knowledge of MV with avoiding the fatal complications.

Gangs of piglets: Welfare and growth of imprinted and guided weaners

Weaning stress accompanied by outburst of aggression is a critical point in pig production as it compromises piglets’ welfare and leads to poor growth rate and health problems. Therefore, a weaning methods to smoothen the lactation–weaning transition are of great importance. In the present study a simple practical approach based on the imprinting phenomenon to improve weaned piglets’ welfare and growth performance was implemented. From birth, piglets were continually exposed to the simple 2D shapes, either a white circle on a black background (WC) or a black cross on a white background (BC). At weaning, piglets were allotted to weaning groups consisting of one WC and one BC litter, whereby test weaning pens, but not the control pens, were virtually divided using WC and BC signage on respective halves of the pen. The approach was tested in low- and high-density weaning groups, i.e. 10 or 20 individuals per pen (120 animals in total). The results revealed better growth performance of the test group (12–17% higher daily gain). On the whole, the number of post-weaning fights was lower in the test group and the majority of fights (62–75%) occurred among WC and BC. As regards the territoriality, piglets post-weaning tendency to remain in the area marked with a familiar sign was in general significant − i.e. more distinct grouping in the test pens (p<0.05), comparing to the control pen. It appears that virtual splitting of weaning pens using simple 2D symbols to which pigs were exposed during lactation may decrease weaning aggression, promote distinct grouping and territorial behaviour, and promote growth performance of weaned piglets under farm conditions, especially in groups with lower stock density.

Mechanical Ventilation, Weaning Practices, and Decision Making in European PICUs.

This survey had three key objectives: 1) To describe responsibility for key ventilation and weaning decisions in European PICUs and explore variations across Europe; 2) To describe the use of protocols, spontaneous breathing trials, noninvasive ventilation, high-flow nasal cannula use, and automated weaning systems; and 3) To describe nurse-to-patient staffing ratios and perceived nursing autonomy and influence over ventilation decision making. Cross-sectional electronic survey. European PICUs. Senior ICU nurse and physician from participating PICUs. None. Response rate was 64% (65/102) representing 19 European countries. Determination of weaning failure was most commonly based on collaborative decision making (81% PICUs; 95% CI, 70-89%). Compared to this decision, selection of initial ventilator settings and weaning method was least likely to be collaborative (relative risk, 0.30; 95% CI, 0.20-0.47 and relative risk, 0.45; 95% CI, 0.32-0.45). Most PICUs (> 75%) enabled physicians in registrar (fellow) positions to have responsibility for key ventilation decisions. Availability of written guidelines/protocols for ventilation (31%), weaning (22%), and noninvasive ventilation (33%) was uncommon, whereas sedation protocols (66%) and sedation assessment tools (76%) were common. Availability of protocols was similar across European regions (all p > 0.05). High-flow nasal cannula (53%), noninvasive ventilation (52%) to avoid intubation, and spontaneous breathing trials (44%) were used in approximately half the PICUs greater than 50% of the time. A nurse-to-patient ratio of 1:2 was most frequent for invasively (50%) and noninvasively (70%) ventilated patients. Perceived nursing autonomy (median [interquartile range], 4 [2-6]) and influence (median [interquartile range], 7 [5-8]) for ventilation and weaning decisions varied across Europe (p = 0.007 and p = 0.01, respectively) and were highest in Northern European countries. We found variability across European PICUs in interprofessional team involvement for ventilation decision making, nurse staffing, and perceived nursing autonomy and influence over decisions. Patterns of adoption of tools/adjuncts for weaning and sedation were similar.

Management practices associated with stress in cattle on western Canadian cow-calf operations: A mixed methods study.

Handling, weaning, and euthanasia are some of the most stressful practices performed on cow-calf operations. Although strategies to minimize stress exist, their use on western Canadian cow-calf operations is unknown. The objectives were to describe current stress-associated practices on western Canadian cow-calf operations, describe producer and operation demographics associated with the use of nonabrupt weaning methods, and explore producer perceptions toward these practices. A questionnaire focusing on stressful management practices was delivered to 109 cow-calf producers in western Canada. Fifteen respondents were purposively selected for individual interviews. The majority of producers reported calves less than 1 wk of age were handled by manual restraint (87%) and those older than 1 wk of age were handled using a cattle squeeze or table. Most producers performed abrupt weaning (70%). Interviewees often mentioned that cost and logistics were major factors in deciding on a weaning strategy. Pasture availability and facilities were viewed as constraints toward the adoption of a nonabrupt weaning method. Animal stress was considered, as producers expressed concern that nonabrupt weaning methods may cause increased stress because of the additional handling required. Producers conveyed that animal age was a major factor that impacted weaning stress and that improved animal performance might motivate them to adopt a nonabrupt weaning strategy. Producers also expressed reluctance to change previously successful traditional approaches. Of respondents, 13% did not euthanize cattle on farm and 8% did not confirm death. Producers interviewed reported that the decision to euthanize cattle on farm was difficult and that veterinary advice was often considered. Factors that influenced their decision to euthanize included the animal's likelihood of recovery and degree of pain and distress. Finally, producers explained that they considered whether the animal was salvageable and able to be transported. Identification of common methods of handling provides focus for future research to determine optimal handling strategies. Identified barriers to nonabrupt weaning may be addressed through research, extension, or policy to encourage the adoption of weaning methods that could improve animal welfare. Confirmation of death after euthanasia was identified as an area that needs to be addressed by producer education to minimize animal stress during on-farm euthanasia.

Determinants of Weaning Practices Among Mothers of Infants Aged Below 12 Months in Masvingo, Zimbabwe

BackgroundPoor weaning practices have been reported to contribute to high infant mortality and morbidity rates especially in developing countries. ObjectivesThis study sought to determine factors related to weaning that predispose, reinforce and enable mothers of infants younger than age 12 months to comply or not to comply with the World Health Organization (WHO) 2009 guidelines on appropriate infant feeding. MethodsThe present study was a descriptive cross-sectional study. An interviewer-administered questionnaire was used to collect data on weaning and infant feeding practices from a sample of 300 mothers of infants aged younger than 12 months, resident in the Rujeko community, and registered and seen at the Rujeko Council Clinic during the study time. FindingsThe study results indicated that noncompliance with WHO infant feeding guidelines was high among the study participants. The rate of exclusive breastfeeding in the first 6 months was very low (14.8%), with the mean age of introduction of complementary foods to infants of 5 weeks (range 1-24 weeks). Early supplementation of breast milk was not associated with mother’s age, level of education, and religion. Scheduled breastfeeding was more prevalent among the mothers who worked outside the home (P = .018). Provision of formal advice and influence from health care workers was found to improve young child feeding and weaning practices among mothers (P = .011). ConclusionsVarious weaning methods were used, and mothers identified numerous factors as impeding their efforts to follow proper breastfeeding practices. The findings highlight the need to develop personal skills among mothers to prepare nutritionally balanced diets.

A WEANING MARKER FROM VENO-ARTERIAL EXTRA CORPOREAL MEMBRANE OXYGENATION USING A NOVEL MICROCIRCULATORY IMAGING

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in the treatment of cardiogenic shock. However, marker of successful weaning remains largely unknown. We sought to examine microcirculation as a new method for weaning. Methods: Weaning was performed by

Sudden versus gradual pressure wean from Nasal CPAP in preterm infants: a randomized controlled trial.

In preterm infants, nasal continuous positive airway pressure (NCPAP) is widely used for treatment of respiratory distress syndrome. However, the strategies for successfully weaning infants off NCPAP are still not well defined and there remains considerable variation between the methods. The objective of this study is to determine whether gradual weaning of NCPAP pressure is more successful than sudden weaning off NCPAP to room air. A randomized controlled trial was conducted in a level 3 neonatal intensive care unit on 70 preterm neonates who were born between 26 and 32 weeks gestation and required NCPAP for at least 48 h. When infants were stable on NCPAP at 0.21 FiO2 and 5 cm H2O positive end expiratory pressure, neonates were randomized to the gradual wean group (reduction in pressure by 1 cm every 8 h until 3 cm H20 was reached) or to sudden wean group (one time NCPAP removal to room air). The primary outcome was a success at the first trial to wean to room air. Secondary outcomes were a number of trials, and weight and postmenstrual age (PMA) at the time of successful wean. Total number of days on NCPAP and length of stay (LOS) in the hospital were also compared between the groups. Of the 70 infants included in the study, 35 were randomized to sudden group and 33 infants to gradual group (2 excluded for protocol deviation). In sudden and gradual groups, 14 and 22 infants, respectively, were weaned successfully in the first attempt (P=0.03). The infants were successfully weaned at 32.7±1.7 weeks versus 33.1±2.4 weeks (P=0.39) PMA and at a weight of 1651±290 g versus 1589±398 g (P=0.46) in the sudden and gradual groups, respectively. The total number of days on NCPAP was 27±19 days versus 32±24 days (P=0.38) and LOS was 63±25 days versus 63±22 days (P=0.99) in the sudden and gradual groups, respectively. Gradual weaning method was more successful as compared to sudden weaning method in the initial trial off NCPAP. There was no difference in the PMA, weight at the time of successful wean, total days on NCPAP and LOS between the two groups.

A study on the awareness of the weaning practices and the determinants affecting them in a rural hospital based pediatric outpatient clinic of Maval Taluka, Maharashtra

Background: Malnutrition and micronutrient deficiencies is a very common cause of late weaning and improper weaning practices. There are many factors affecting the weaning practices in developing countries like India which may act as hindrance to the proper weaning methods. The objective of this study was to know the awareness about weaning or complementary feeding practices in the mothers of children attending the pediatric OPD. And to study the various determinants affecting the weaning or Complementary feeding practices in this rural population.Methods: This study is a cross-sectional study conducted in pediatric immunization outpatient clinic of M.I.M.E.R medical college, Talegaon (D) during the period from May to September 2016.About 300 parents were interviewed with a semi open questionnaire.Results: Out of total 304 respondents, total unawareness regarding weaning was the reason for not starting complimentary feeding at 6-months in 64 respondents (21.1%). Majority of the respondents (210, 69.1%) revealed that they prefer home based complimentary feeding. A total of 125 respondents (41.1%) admitted that they stopped the feeding in the event of illness.Conclusions: Incorrect weaning practices, withholding breastfeeding and improper feeding during illnesses are the major deterrents which can hamper proper weaning techniques and are major contributory factors in increasing Malnutrition.

Clinical trial on the effects of a free-access acidified milk replacer feeding program on the health and growth of dairy replacement heifers and veal calves

The objectives of this study were to evaluate the effects of free-access acidified milk replacer feeding on the pre- and postweaning health of dairy and veal calves. Individually housed calves were systematically assigned at birth to 1 of 2 feeding programs: free-access feeding (ad libitum) of acidified milk replacer (ACD, n=249) or traditional restricted feeding (3L fed twice daily) of milk replacer (RES, n=249). Calves were fed milk replacer containing 24% crude protein and 18% fat. Acidified milk replacer was prepared to a target pH between 4.0 and 4.5 using formic acid. Calves were weaned off milk replacer at approximately 6wk of age. Weaning occurred over 5d, and during this weaning period, ACD calves had access to milk replacer for 12h/d and RES calves were offered only one feeding of milk replacer (3 L) daily. Calves were monitored daily for signs of disease. Fecal consistency scores were assigned each week from birth until weaning. A subset of calves was systematically selected for fecal sampling at 3 time points between 7 and 27d of age. Fecal samples were analyzed for enterotoxigenic Escherichia coli F5, Cryptosporidium parvum, rotavirus, and coronavirus. Hip width, hip height, body length, heart girth, and body weight were measured at birth and weaning. Postweaning body weight measurements were collected from the heifers at approximately 8mo of age. Postweaning body weight and carcass grading information was collected from the veal calves at slaughter once a live weight between 300 and 350kg had been achieved. The odds of ACD calves being treated for a preweaning disease event tended to be lower than that of the RES calves (1.2 vs. 5.2%, respectively). Preweaning mortality, postweaning disease treatment, and postweaning mortality did not differ between feeding treatments. The ACD feeding treatment supported greater preweaning average daily gain (0.59 vs. 0.43kg/d) and structural growth than RES feeding. Postweaning average daily gain and carcass characteristics were similar for ACD and RES calves. These results indicate that free-access acidified milk replacer feeding tended to support improved health, and greater body weight gain and structural growth during the preweaning period; these effects did not persist in the postweaning period. The growth advantage observed before weaning in the ACD calves likely disappeared due to the weaning methods used.

Noninvasive ventilation during the weaning process in chronically critically ill patients.

Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process.We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h.231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97).NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.

Influence of weaning methods on the diaphragm after mechanical ventilation in a rat model.

BackgroundMechanical ventilation (MV) is associated with diaphragm weakness, a phenomenon termed ventilator-induced diaphragmatic dysfunction. Weaning should balance diaphragmatic loading as well as prevention of overload after MV. The weaning methods pressure support ventilation (PSV) and spontaneous breathing trials (SBT) lead to gradual or intermittent reloading of a weak diaphragm, respectively. This study investigated which weaning method allows more efficient restoration of diaphragm homeostasis.MethodsRats (n = 8 per group) received 12 h of MV followed by either 12 h of pressure support ventilation (PSV) or intermittent spontaneous breathing trials (SBT) and were compared to rats euthanized after 12 h MV (CMV) and to acutely euthanized rats (CON). Force generation, activity of calpain-1 and caspase-3, oxidative stress, and markers of protein synthesis (phosphorylated AKT to total AKT) were measured in the diaphragm.ResultsReduction of diaphragmatic force caused by CMV compared to CON was worsened with PSV and SBT (both p < 0.05 vs. CON and CMV). Both PSV and SBT reversed oxidative stress and calpain-1 activation caused by CMV. Reduced pAKT/AKT was observed after CMV and both weaning procedures.ConclusionsMV resulted in a loss of diaphragmatic contractility, which was aggravated in SBT and PSV despite reversal of oxidative stress and proteolysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0285-2) contains supplementary material, which is available to authorized users.