Weaning Methods Research Articles

Gradual weaning does not improve performance for calves with low starter intake at the beginning of the weaning process

The weaning process may cause intense stress for dairy calves, even when low volumes of liquid diet are fed. Management tools that increase the intake of solid feeds, such as gradual weaning, can provide better physiological and metabolic conditions through better ruminal development, leading to better adaptation to ruminant metabolism and aiding in stress mitigation. The objective of this study was to evaluate the effects of 2 weaning protocols and 2 levels of concentrate intake on the performance and physiological and behavioral variables related to stress in dairy calves. Thirty-six newborn male Holstein calves were used in a randomized block design with a 2 × 2 factorial arrangement: 2 weaning strategies, abrupt or gradual, and 2 levels of concentrate intake at 5 wk of age, high (>350 g/d) or low (≤350 g/d). Calves were equally managed until they were 5 wk of age and then grouped according to concentrate intake. Statistical analyzes were performed using the MIXED procedure of SAS software (SAS Institute Inc., Cary, NC), and no significant interaction was observed between studied factors (weaning method and starter intake level); therefore, we considered each factor separately and their interactions with age. The highest dry matter intake and concentration of β-hydroxybutyrate were recorded for animals with a high level of starter intake independent of the weaning method. Structural growth (cm/wk) and average daily gain were superior for calves with high starter intake, but weaning method had no effect. The gradual weaning protocol increased the time eating starter, regardless of the level of concentrate intake. Even animals with low concentrate intake that were weaned abruptly showed levels of cortisol and acid-soluble glycoprotein within normal physiological levels. Apparently, other factors besides the milk supply affect the starter intake level of calves in a conventional feeding program. The adoption of gradual weaning is not effective in improving performance when a calf has low intake 3 wk before weaning is complete, but it reduced vocalization on d 2 postweaning.

Simultaneous reduction of flow and fraction of inspired oxygen (FiO2) versus reduction of flow first or FiO2 first in patients ready to be weaned from high-flow nasal cannula oxygen therapy: study protocol for a randomized controlled trial (SLOWH trial)

BackgroundHigh-flow nasal cannula (HFNC) oxygen therapy has been widely used in critically ill patients. Despite the effectiveness of HFNC as a treatment, optimal methods to withdraw HFNC after recovery from preexisting conditions have not been investigated to date. In this study, we will evaluate the safety and efficacy of simultaneous reduction of flow and fraction of inspired oxygen (FiO2) compared with sequential reduction of either flow first or FiO2 reduction first in patients with HFNC.Methods/designThis is a prospective, investigator-initiated, randomized controlled trial with three experimental intervention groups. A total of 100 adult patients receiving HFNC and satisfying weaning criteria will be enrolled and randomly assigned to one of the following groups: flow reduction (FR) first, FiO2 reduction (OR) first, or simultaneous reduction (SR). In the FR group, flow will be reduced first by 10 L/min/h. When it reaches 20 L/min, FiO2 will then be reduced by 0.1 /h until it reaches 0.3. In the OR group, the FiO2 will be gradually reduced first by 0.1 /h until it reaches 0.3, then flow will be reduced by 10 L/min until it reaches 20 L/min. Finally, in the SR group, both the flow and FiO2 will be gradually reduced simultaneously by 10 L/min and 0.1/h, respectively. Weaning will proceed only when patients satisfy the weaning criteria at every weaning point. When the HFNC weaning-off targets are reached (20 L/min and 0.3 for flow and FiO2, respectively), the patient will be transferred to conventional oxygen therapy (mainly low-flow nasal prongs). The primary outcome is the time to successful weaning from HFNC for 24 h. Secondary outcomes will include the success or failure rate in weaning off HFNC and changes in arterial blood gas analyses, intolerance rate, length of hospital stay, and in-hospital mortality.DiscussionThis study will be the first clinical trial to investigate the safety and efficacy of three different methods of weaning in adult patients receiving HFNC. Once this study is completed, we expect to be able to suggest the better strategy for withdrawal of HFNC based on the results.Trial registrationClinicalTrials.gov, NCT03845244. Registered on 19 February 2019.

Comparison of effects of four weaning methods on health and performance of beef calves

Weaning of beef calves is a stressful event that negatively impacts health and performance. A variety of interventions have been proposed to reduce stress and improve gains following weaning. This study used 288 7- to 8-month-old calves from two separate locations, to examine four different weaning strategies, as well as the impact of shipment. Calves were blocked by weight and sex, and then randomly assigned to one of four treatments: abrupt weaning (AW), where calves were separated from the dam on day 0 (D0) and allowed no further contact with the dam; fence line (FL), where calves were weaned on D0 but had fence line contact with dams for 7 days; nose flap (NF), where on day -6 calves received a nose flap that interferes with suckling, then had the flap removed and were weaned from the dam on D0; and intermittent separation (SEP), where calves were removed from dams for 24-h intervals on day -13 and day -6, then weaned on D0, but allowed fence line contact with the dam for 7 days. Each treatment group was further divided into two subgroups, one of which was shipped early (D0 for AW, day 7 for others) or shipped later (day 28). Body weight and sickness were recorded for all groups. Results showed a negative impact on gain for early shipping compared to later shipping, and poorer gain in AW calves than most other treatments. Results of the analyses of morbidity were inconclusive. This study found that delayed shipment following FL weaning improves performance under common management conditions for the US cow–calf industry.

Review of the Transitional Pain Service as a method of postoperative opioid weaning and a service aimed at minimizing the risk of chronic post-surgical pain.

Opioid use and prescribing have become a subject of increasing focus and scrutiny. The ongoing "opioid epidemic" in North America has further increased interest in this area. In patients presenting for surgery, the prescribing of opioids during and following admission to hospital is commonplace and has been identified as a potential contributor to the growing opioid problem in North America. This review aims to present the timeline of the "opioid epidemic" as well as to introduce the concept of a "Transitional Pain Service". The Transitional Pain Service is a multidisciplinary service originating at Toronto General Hospital that employs a multi-faceted approach to monitoring opioid use after discharge from surgery, and aims to safely wean patients from opioids while maintaining effective pain management. This approach and its results will be discussed in this review.

Mechanical ventilation weaning practices in neonatal and pediatric ICUs in Brazil: the Weaning Survey-Brazil.

ABSTRACTObjective:The aim of this study was to describe practices for weaning from mechanical ventilation (MV), in terms of the use of protocols, methods, and criteria, in pediatric ICUs (PICUs), neonatal ICUs (NICUs), and mixed neonatal/pediatric ICUs (NPICUs) in Brazil. Methods:This was a cross-sectional survey carried out by sending an electronic questionnaire to a total of 298 NICUs, PICUs, and NPICUs throughout Brazil. Results:Completed questionnaires were assessed for 146 hospitals, NICUs accounting for 49.3% of the questionnaires received, whereas PICUs and NPICUs accounted for 35.6% and 15.1%, respectively. Weaning protocols were applied in 57.5% of the units. In the NICUs and NPICUs that used weaning protocols, the method of MV weaning most commonly employed (in 60.5% and 50.0%, respectively) was standardized gradual withdrawal from ventilatory support, whereas that employed in most (53.0%) of the PICUs was spontaneous breathing trial (SBT). During the SBTs, the most common ventilation mode, in all ICUs, was pressure-support ventilation (10.03 ± 3.15 cmH2O) with positive end-expiratory pressure. The mean SBT duration was 35.76 ± 29.03 min in the NICUs, compared with 76.42 ± 41.09 min in the PICUs. The SBT parameters, weaning ventilation modes, and time frame considered for extubation failure were not found to be dependent on the age profile of the ICU population. The findings of the clinical evaluation and arterial blood gas analysis are frequently used as criteria to assess readiness for extubation, regardless of the age group served by the ICU. Conclusions:In Brazil, the clinical practices for weaning from MV and extubation appear to vary depending on the age group served by the ICU. It seems that weaning protocols and SBTs are used mainly in PICUs, whereas gradual withdrawal from ventilatory support is more widely used in NICUs and NPICUs.

Weaning İçin Pulmoner Rehabilitasyon Programı içeren Yeni Bir Model

INTRODUCTION: Our chronic respiratory failure service where we manage the patients with acute /chronic respiratory failure, is a hospital unit with multidisciplinary team with structured integrated pulmonary rehabilitation (PR) and home care unit. The aim of the study was to present our weaning experiences of inpatient hospital service in patients with prolonged mechanical ventilation (MV) and whether multidisciplinary structured inpatient service model could be an alternative method for weaning. METHODS: Twenty-three patients with home invasive mechanical ventilation (IMV) who underwent multidisciplinary inpatient PR program and weaning trials were analyzed. Dyspnea scores, body composition, respiratory muscle strength, physicological status, echocardiagraphic measurements before PR and weaning process, duration of IMV (since the opening of the tracheostomy), ABG levels before and 24 hours after weaning were recorded. RESULTS: One patient was with pneumonia, 13 with COPD, 5 with bronchiectasis, 2 with kyphoscoliosis, and 2 with congestive heart failure. The median value of duration of IMV was 126 days. The weaning trial was performed on 15 of 21 patients. Six patients were not found to be appropriate for weaning. 12 of 15 patients were decannulated with 80% weaning success. Four patients were discharged with long term oxygen therapy (LTOT), nocturnal non-IMV, 7 with LTOT, and 1 without device. The patients with weaning failure had higher anxiety depression scores, systolic pulmonary arterial pressures, lower maximum inspiratory, expiratory pressures, and shorter duration of IMV. DISCUSSION AND CONCLUSION: This study showed that chronic respiratory failure inpatients services consisting of multidisciplinary team and integrating PR into patients’ managements could serve as weaning centers in case of absence of specialized centers in prolonged MV.

BABY-LED WEANING, AN OVERVIEW OF THE NEW APPROACH TO FOOD INTRODUCTION: INTEGRATIVE LITERATURE REVIEW.

ABSTRACTObjective:To analyze the scientific literature on Baby-Led Weaning with an integrative literature review to identify risks and benefits.Data source:The databases used were: National Library of Medicine (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS – Literatura Latino-Americana e do Caribe em Ciências da Saúde), US National Library of Medicine (PubMed), and Virtual Health Library (BVS – Biblioteca Virtual em Saúde) in December 2017. The inclusion criteria established were publications in English with the descriptor “baby-led weaning” in the heading, abstract, or keywords, classified as original articles, of primary nature, and available online and in full. We excluded review articles, editorials, letters to the editor, critical commentaries, and books on the subject, as well as articles not available in full and duplicates.Data summary:We identified 106 articles, of which 17 met the selection criteria. The Baby-Led Weaning method was significantly associated with the baby’s satiety, the start of complementary feeding, and adequacy of weight gain. On the other hand, choking and the intake of micronutrients were negatively associated, however with no statistical differences.Conclusions:Despite the benefits found, the risks still deserve attention and should be investigated with longitudinal randomized controlled studies to ensure the safety of the method when practiced exclusively.

307 A social facilitator can reduce calf walking behavior at weaning

Abstract Common industry practice is to wean beef calves prior to natural weaning with the objectives of improving cow body weight and preparing calves for the subsequent receiving, growing, and finishing phases of production. Discontinuing the cow-calf social and nutritional bond before natural weaning, however, causes atypical walking and vocalizing behaviors by calves that are detrimental to calf growth and health. A proposed alternative weaning method is the addition of a social facilitator cow at weaning to reduce calf stress. Utilizing global positioning system (GPS) technology, we were able to determine total distance walked, total time devoted to walking, and area of the pasture utilized by the calf. Thus, the objective of the present study was to evaluate the effects of a social facilitator on calf growth during weaning and more specifically, walking behaviors, utilizing a Garmin® product. Angus x Simmental heifer calves (n = 80) were used in this study, and in all four replications calves were randomly allotted to each treatment group (n = 10), social facilitator (SF) or control (CON) on the day of weaning (day 0). Calves in the SF group were placed on pasture at weaning with a social facilitator, and CON calves were placed in a similar sized pasture without a social facilitator. All calves were allocated their own GPS tracking device on days 0 (weaning), 7, and 14 for a full 24 hours before removal. Data were analyzed as a randomized complete block design with repeated measurements (SAS 9.4). Placing calves with a social facilitator decreased the distance walked (P = 0.001), and the amount of time calves devoted to walking (P = 0.001). Placing a social facilitator with calves at weaning, therefore, has an effect on walking distance and amount of time calves devote to walking.

Effects of Low-Stress Weaning on Calf Growth Performance and Carcass Characteristics

ObjectivesThe objective of this study was to compare the influence of two low stress weaning methods with conventional weaning on post-weaning performance and carcass characteristics of beef steers.Materials and MethodsAngus × Simmental crossbred steer calves (n = 90) from a single source were stratified by body weight and dam age into three groups; one treatment was randomly assigned to each group: ABRUPT (calves isolated from dams on the day of weaning), FENCE (calves separated from dams via a barbed wire fence for 7 d prior to completely weaning), and NOSE (nose-flap inserted and calves remained with dams for 7 d prior to completely weaning). At d +7 post-weaning calves were transported to a commercial feedlot where they received standard step-up and finishing rations typical for a Northern Plains feedlot. To understand the influence of each weaning method on haptoglobin (an acute-phase protein), blood samples were collected via coccygeal venipuncture at d –7 (PreTreat), 0 (Weaning), and +7 (PostWean) from a subsample of calves (n = 10 per treatment) and analyzed using a bovine haptoglobin ELISA kit. Body weights (BW) were recorded on study d –34 (PreWean), –7 (PreTreat), 0 (Weaning), 7 (PostWean), 32 (Receiving), 175 (Ultrasound), and 253 (Final) and average daily gains (ADG) were calculated between each time period. On d 175 post-weaning BW were recorded, and ultrasound fat thickness and intramuscular fat were determined and utilized to project marketing dates. Carcass measurements were recorded at the time of harvest and included hot carcass weight, 12th rib backfat, ribeye area, USDA Yield Grade and Quality Grade, and marbling score. Haptoglobin, BW, and ADG data were analyzed as repeated measures using the ante-dependence covariance structure in the MIXED procedure of SAS (SAS Inst. Inc., Cary, NC) for effects of weaning treatment, day, and their interaction; birth weight was included as a covariate for ADG and BW. Carcass traits were analyzed for the effect of weaning treatment using the MIXED procedure. Separation of least-squares means was performed using LSD with a Tukey’s adjustment and assuming an α level of 0.05.ResultsWeaning method interacted (P < 0.0001) with time period for ADG and BW. Calf BW increased in all treatments until the PostWean period, wherein BW decreased (P < 0.0001) in ABRUPT and NOSE and was maintained (P > 0.05) in FENCE. From the Receiving to Final time periods BW increased similarly (P > 0.05) for all treatments. Calf ADG was greater (P < 0.01) in calves in the NOSE treatment at Weaning than ABRUPT or FENCE. In the PostWean period, the FENCE calves had ADG that was not different (P > 0.05) than zero but was greater (P < 0.0001) than the negative ADG of ABRUPT and NOSE calves. During the Receiving period ADG was greater (P < 0.05) for ABRUPT compared to NOSE and FENCE. Time influenced (P < 0.001) haptoglobin concentration. No difference in haptoglobin was observed between the PreTreat and Weaning or PostWean periods; however, haptoglobin concentration was greater (P < 0.001) at PostWean compared to Weaning. Weaning method did not influence (P > 0.05) carcass measurements.ConclusionCollectively these data suggest low stress weaning methods do not significantly improve post-weaning growth performance or carcass merit compared to calves weaned using conventional methods.

Complementary feeding: new styles versus old myths.

Early life feeding habits may potentially alter future metabolic programming and body composition. Complementary feeding is the period of time when infants introduce food different from milk in their diet, together with a gradual reduction of the intake of milk (either breast milk or formula), to finally acquire the diet model of their family. This period is important in the transition of the infant from milk feeding to family foods, and is necessary for both nutritional and developmental reasons. The timing for introducing complementary foods and the method of feeding have changed over time. Available literature data show increasing interest and concerns about the impact of complementary feeding timing and modality on the onset of later non-communicable disorders, such as overweight and obesity, allergic diseases, celiac disease, or diabetes. While international scientific guidelines on complementary feeding have been published, many baby food companies' websites, blogs, and books, in most European countries exist. The aim of this manuscript is to look over current recommendations, and to revise "old myths." The adoption of an adequate weaning method is a cornerstone in the development of life-long health status. A correct strategy could reduce the risk of feeding disorders and other health problems later in life.

Performance and Behavioural Responses of Group Housed Dairy Calves to Two Different Weaning Methods.

The weaning of dairy calves is a significant stressor which can impact on calf performance and welfare. However, many traditional methods of assessing the effects of stressors can be invasive and impractical for farmers. This study aimed to use a combination of non-invasive monitoring technologies alongside traditional measures of calf performance to examine the impact of two contrasting weaning methods commonly used on dairy farms in the United Kingdom. Ninety group-housed Holstein Friesian calves were allocated to one of two weaning methods: (i) gradual weaning (GW) with volume of milk replacer (MR) stepping down from 36 days of age and complete withdrawal of MR at 57 days of age and (ii) abrupt weaning (AW) with consistent daily volume of milk replacer and complete withdrawal of MR at 50 days of age. Feeding regimes were such that calves from both treatments were offered the same total amount of milk powder. Gradually weaned calves displayed increased solid feed intake at an earlier age when compared with AW calves. Feed conversion efficiency (FCE) was reduced in gradually weaned calves between days 36 and 49. However, there was no difference in live weight (LWT) or average daily gain (ADG) throughout this period. Abrupt weaning at 50 days of age resulted in decreased ADG and FCE between days 50 and 56. However, there were no treatment differences in ADG between days 57 and 62. Live weight tended to be increased by 2.2 kg in GW calves when compared with AW calves at the end of experiment on day 63. Frequency of unrewarded visits to the milk feeder throughout the pre-wean period was consistently increased in GW calves. Daily lying time was reduced in AW compared with GW calves in the days following abrupt weaning (days 50-55). However, these differences did not persist between days 57 and 62. Heart rate variability (HRV) tended to be decreased in GW compared with AW calves in the period following complete withdrawal of milk replacer. Findings from the current study suggest that calves offered the same total amount of milk powder can be weaned either gradually from 36 days of age or abruptly at 50 days of age without significant impact to live weight at 63 days of age. However, both behavioural and physiological data collected using the methods described could suggest that gradual weaning of calves from 36 days of age results in an increase in underlying frustration. This study highlights the potential of using a combination of non-invasive monitoring technologies in assessing calf response to common management practices.

Behavioral and hormonal effects of 2 weaning methods in trotter mares

Given the paucity of published data on the effects of artificial weaning on mares, the aim of the present study was to investigate the behavioral and hormonal effects of two different weaning methods in trotter mares. In stud 1 (10 mares, S1), weaning was performed around 5 months post-partum, two foals/week, and mares put to paddock after separation. In stud 2 (12 mares, S2), weaning was performed around 7 months post-partum, all foals on the same day, and mares put into indoor individual stalls for two days after separation. Behavioral observations and saliva and hair sampling for radioimmunoassay cortisol levels assessment were done on day -7, day 0 (weaning day), day 7, and day 30. Milk was sampled on day -7 and day 0. On field, behavioral observations were done using instantaneous scan sampling every two minutes for one hour on each day of observation. Behavioral data were analyzed using Friedman ANOVAs, Mann-Whitney U-tests, and Generalized Linear Mixed Models. Cortisol data were analyzed using repeated-measure ANOVAs. Spearman correlations were used to assess correlations. Mares in both studs ate the least on day 0 (P < 0.001). On day 0, vocalizations and locomotion were higher than in any other day (P = 0.003 and P = 0.045, respectively) and higher than in the other stud (both P < 0.001) in S1 and S2, respectively. Saliva cortisol concentrations showed weak, but significant, correlations with eating, stall pacing, pawing, and vocalizing. Results suggest that artificial weaning could be a stressor for mares in both groups. Mares whose foals were weaned earlier did not show more stress-associated changes in behavioral or endocrine parameters than those whose foals were weaned later, but housed more restrictively for two days after weaning.

Integrated EIT system for functional lung ventilation imaging

BackgroundElectrical impedance tomography (EIT) has been used for functional lung imaging of regional air distributions during mechanical ventilation in intensive care units (ICU). From numerous clinical and animal studies focusing on specific lung functions, a consensus about how to use the EIT technique has been formed lately. We present an integrated EIT system implementing the functions proposed in the consensus. The integrated EIT system could improve the usefulness when monitoring of mechanical ventilation for lung protection so that it could facilitate the clinical acceptance of this new technique.MethodsUsing a custom-designed 16-channel EIT system with 50 frames/s temporal resolution, the integrated EIT system software was developed to implement five functional images and six EIT measures that can be observed in real-time screen view and analysis screen view mode, respectively. We evaluated the performance of the integrated EIT system with ten mechanically ventilated porcine subjects in normal and disease models.ResultsQuantitative and simultaneous imaging of tidal volume (TV), end-expiratory lung volume change (triangleEELV), compliance, ventilation delay, and overdistension/collapse images were performed. Clinically useful parameters were successfully extracted including anterior/posterior ventilation ratio (A/P ratio), center of ventilation ({mathrm{CoV}}_{{x}}, {mathrm{CoV}}_{{y}}), global inhomogeneity (GI), coefficient of variation (CV), ventilation delay and percentile of overdistension/collapse. The integrated EIT system was demonstrated to suggest an optimal positive end-expiratory pressure (PEEP) for lung protective ventilation in normal and in the disease model of an acute injury. Optimal PEEP for normal and disease model was 2.3 and 7.9 , {mathrm{cmH}}_{2}mathrm{O}, respectively.ConclusionsThe proposed integrated approach for functional lung ventilation imaging could facilitate clinical acceptance of the bedside EIT imaging method in ICU. Future clinical studies of applying the proposed methods to human subjects are needed to show the clinical significance of the method for lung protective mechanical ventilation and mechanical ventilator weaning in ICU.

Assessment of Some Predictors of Weaning from Mechanical Ventilation in Acutely Intoxicated Patients Admitted to the Poison Control Center-Ain Shams University

Background: Respiratory failure is a common complication of poisoning with significant morbidity and mortality. Mechanical ventilation is life saving. Weaning is the process of liberating patient from mechanical ventilatory support. Interleukin-6 (IL-6) and C-reactive protein (CRP) are inflammatory mediators, released in response to many stressful conditions as weaning from mechanical ventilation. Aim of the work: The aim of the study was to assess the role of serum (IL6) level and (CRP) as predictors of outcome of weaning from mechanical ventilation in acutely intoxicated patients admitted to the Poison Control Center– Ain Shams University Hospitals (PCC-ASUHs). And to assess their role in selection of the most appropriate mode for weaning by comparing weaning by pressure support ventilation (PSV) mode, synchronized intermittent mandatory ventilation (SIMV) mode and weaning by the once-daily trial of spontaneous breathing trial by using (T-piece). Patients and Methods: The study included 58 acutely intoxicated patients, intubated and mechanically ventilated, admitted to the Intensive Care Unit (ICU) of PCC-ASUHs during the period from May 2016 till September 2018. Patients were categorized consecutively according to the outcome of the 2-hour of spontaneous breathing trial (SBT) into 2 groups: Group I (The SBT Success group): included 19 patients who succeed spontaneous breathing trial. Group II (The SBT failed group): included 39 patients who failed SBT which was further subdivided into 3 groups according to the method of weaning: group (1) PSV group, group (2) SIMV group and group (3) Once T-piece group, each group including 13 patients. Results: IL-6 was significantly increased after 2 days in patients who failed the SBT compared to the success group, while CRP was significantly higher in the failed group during weaning trial and 2 days after. There is no significant difference between the three weaning modes regarding IL6 and CRP. Conclusion: Patients who failed the SBT presented higher inflammatory parameters than those who passed. CRP could predict the outcome of weaning from mechanical ventilation.

Sudden Complete Versus Gradual Weaning from Nasal Continuous Positive Airway Pressure in Preterm Neonates: A Randomized Controlled Trial

Background: Continuous positive airway pressure (CPAP) is used as respiratory support in preterm neonates; however, the best weaning method has not yet been determined. In this study, we compared sudden complete and gradual weaning from nasal CPAP (NCPAP) in preterm newborns. Methods: This randomized controlled trial was conducted on 62 preterm neonates who were born with a gestational week of < 32 weeks and required NCPAP for at least 24 h. The neonates were stable on NCPAP at 0.21 FiO2 and 5 cm H2O positive end-expiratory pressure. They were randomized into two groups of gradual and sudden weaning using random numbers sheet. The primary outcome was successful weaning at the first attempt. The secondary outcomes included the number of NCPAP weaning attempts, the need for mechanical ventilation (nasal and endotracheal), duration of NCPAP, oxygenation, and length of hospital stay. Results: According to the results, 80.6% of the patients in the sudden weaning group and 74.2% of the patients in the gradual weaning group were weaned successfully in the first attempt. However, there was no statistically significant difference between the two groups in this regard (P=0.54). Duration of NCPAP was significantly lower in the sudden weaning group, compared to that in the gradual weaning group (P<0.001). Numbers of NCPAP weaning attempts, the need for mechanical ventilation, duration of oxygenation, and hospital stay in the two groups were not significantly different. Conclusion: There was no difference between sudden complete and gradual weaning from NCPAP in terms of treatment success and complications. The selection of the appropriate technique may depend on available equipment and treatment costs.

Standard v. baby-led complementary feeding: a comparison of food and nutrient intakes in 6-12-month-old infants in the UK.

To compare food and nutrient intakes of infants aged 6-12 months following a baby-led complementary feeding (BLCF) approach and a standard weaning (SW) approach. Participants completed an online questionnaire consisting of sociodemographic questions, a 28 d FFQ and a 24 h dietary recall. UK. Infants (n 134) aged 6-12 months (n 88, BLCF; n 46, SW). There was no difference between weaning methods for the food groups 'fruits', 'vegetables', 'all fish', 'meat and fish', 'sugary' or 'starchy' foods. The SW group was offered 'fortified infant cereals' (P < 0·001), 'salty snacks' at 6-8 months (P = 0·03), 'dairy and dairy-based desserts' at 9-12 months (P = 0·04) and 'pre-prepared baby foods' at all ages (P < 0·001) more often than the BLCF group. The SW group was offered 'oily fish' at all ages (P < 0·001) and 6-8 months (P = 0·01) and 'processed meats' at all ages (P < 0·001), 6-8 months (P = 0·003) and 9-12 months (P < 0·001) less often than the BLCF group. The BLCF group had significantly greater intakes of Na (P = 0·028) and fat from food (P = 0·035), and significantly lower intakes of Fe from milk (P = 0·012) and free sugar in the 6-8 months subgroup (P = 0·03) v. the SW group. Fe intake was below the Reference Nutrient Intake (RNI) for both groups and Na was above the RNI in the BLCF group. Compared with the SW group, the BLCF group was offered foods higher in Na and lower in Fe; however, the foods offered contained less free sugar.

Weaning methods affect ruminal methanogenic archaea composition and diversity in Holstein calves

The objective of the present study was to examine the effect of different weaning methods on the ruminal methanogenic archaea composition and diversity in Holstein calves. Thirty-six newborn Holstein bull calves were assigned to 1 of 3 treatments: (1) conventional weaning (d 56) and fed a high proportion of solid feed (CWS); (2) conventional weaning (d 56) and fed a high proportion of liquid feed (CWL); (3) early weaning (d 42) and fed with a high proportion of solid feed (EWS). High-throughput sequencing of the methyl coenzyme M reductase (mcrA) gene, which encodes the α-subunit of methyl coenzyme M reductase — the enzyme that catalyzes the final step in methanogenesis was used to determine the composition and diversity of rumen methanogens. No significant difference (P>0.05) was observed for operational taxonomic units (OTUs) or richness indices, but diversity indices increased (P<0.05) for calves fed high dietary solids. Predominant families across the three treatments were Methanobacteriaceae, Thermoplasmataceae and Methanomassiliicoccaceae. Calves in the EWS treatment had a higher (P<0.05) relative abundance of Methanobrevibacter sp. strain AbM4 and Methanosphaera stadtmanae, while calves in the CWL treatment had a higher (P<0.05) abundance of Methanosphaera sp. strain SM9. A positive (P<0.05) relationship was identified between butyrate and Methanobrevibacter sp. strain AbM4. In conclusion, the composition and diversity of methanogens in the rumen of Holstein calves varied under the different weaning methods. This study identified a positive relationship between butyrate and Methanobrevibacter sp. strain AbM4, potentially reflecting correlations between ruminal fermentation variables and methanogenesis function. These in-depth analyses provide further understanding of weaning methods for intensified production systems.

Patient and Family Centered Actionable Processes of Care and Performance Measures for Persistent and Chronic Critical Illness: A Systematic Review.

Two authors independently searched electronic, systemic review, and trial registration databases (inception to November 2016). We included studies with an ICU length of stay of greater than or equal to 7 days as an inclusion criterion and reported actionable processes of care; quality improvement indicators, measures, or tools; or patient/family experience. We excluded case series/reports of less than 10 patients. Paired authors independently extracted data and performed risk of bias assessment. We screened 13,130 references identifying 114 primary studies and 102 relevant reviews. Primary studies reported data on 24,252 participants; median (interquartile range) sample size of 70 (32-182). We identified 42 distinct actionable processes of care, the most commonly investigated related to categories of 1) weaning methods (21 studies; 27 reviews); 2) rehabilitation, mobilization, and physiotherapy (20 studies; 40 reviews); and 3) provision of information, prognosis, and family communication (14 studies; 11 reviews). Processes with limited evidence were generally more patient-centered categories such as communication, promotion of sleep, symptom management, or family support. Of the 21 randomized controlled trials, only two were considered at low risk of bias across all six domains, whereas just two cohort studies and one qualitative study were considered of high quality. We identified 42 distinct actionable processes of care relevant to patients with persistent or chronic critical illness and their families, with most frequently studied processes relating to weaning, rehabilitation/mobilization, and family communication. Qualitative studies highlighted the need to address psychologic needs and distressing symptoms as well as enabling patient communication. Our findings are informative for clinicians and decision-makers when planning high-quality patient and family-focused care.

Noninvasive Ventilation Weaning in Acute Hypercapnic Respiratory Failure due to COPD Exacerbation: A Real-Life Observational Study.

The most recent British Thoracic Society/Intensive Care Society (BTS/ICS) guidelines on the use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF) suggest to maximize NIV use in the first 24 hours and to perform a slow tapering. However, a limited number of studies evaluated the phase of NIV weaning. The aim of this study is to describe the NIV weaning protocol used in AHRF due to acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), patients' characteristics, clinical course, and outcomes in a real-life intermediate respiratory care unit (IRCU) setting. We performed a retrospective study on adult patients hospitalized at the IRCU of San Gerardo Hospital, Monza, Italy, from January 2015 to April 2017 with a diagnosis of AHRF due to COPD exacerbation. The NIV weaning protocol used in our institution consists of the interruption of one of the three daily NIV sessions at the time, starting from the morning session and finishing with the night session. The 51 patients who started weaning were divided into three groups: 20 (39%) patients (median age 80 yrs, 65% males) who completed the protocol and were discharged home without NIV (Completed Group), 20 (39%) did not complete it because they were adapted to domiciliary ventilation (Chronic NIV Group), and 11 (22%) interrupted weaning ex abrupto mainly due to NIV intolerance (Failed Group). Completed Group patients were older, had a higher burden of comorbidities, but a lower severity of COPD compared to Chronic NIV Group. Failed Group patients experienced higher frequency of delirium after NIV discontinuation. None of the patients who completed weaning had AHRF relapse during hospitalization. While other NIV weaning methods have been previously described, our study is the first to describe a protocol that implies the interruption of a ventilation session at the time. The application of a weaning protocol may prevent AHRF relapse in the early stages of NIV interruption and in elderly frail patients.

Research progress of weaning from mechanical ventilation guided by electrical impedance tomography

Weaning failure from mechanical ventilation is an important clinical problem, the traditional methods of assessing whether patients can be weaned from mechanical ventilation or not cannot meet the clinical needs. Finding more effective weaning indicators to determine the optimal timing of weaning has important clinical value for improving the outcome of weaning and reducing the mortality of patients. As a new method of assessing respiratory function of patients, electrical impedance tomography (EIT) is gradually applied to the clinic, and its guided assessment of respiratory function may open a new way for directing successful weaning. This article reviews the progress of EIT in ventilation weaning, in order to provide a new judgment method and theoretical basis for the successful weaning.