Weaning Process Research Articles

Prevention of pneumonia associated with invasive mechanical ventilation in an intensive care unit

Introduction: ventilator-associated pneumonia represents between 30 % and 70 % of morbidity and mortality rates; its incidence is reflected in increased hospital stay and health care costs for health care institutions. Objective: to determine the nursing care to be applied in adult patients for the prevention of ventilator-associated pneumonia in Intensive Care Units. Methods: the study was carried out by means of a research strategy applied in the search engines and databases Google Scholar, Pubmed, Lilacs, SciELO, Cochrane, CINAHL. After the search, 143040 records were identified; 86 articles that met the search criteria: Healthcare - Associated Pneumoniae, Respiration Artificial associated with nursing care; and inclusion criteria were annexed to the study. Results: the following main activities focused on the prevention of ventilator-associated pneumonia were determined: Strict hand hygiene with alcohol-based products (ABP) before handling the airway. Control and maintenance of pneumotap pressure (> 20 cm H2O). Avoid supine decubitus at 0°, whenever possible. Aspiration of subglottic secretions. Promote the process of early weaning, in a safe manner. Oral hygiene with chlorhexidine (0,12 – 0,2 %). Conclusions: nursing activities decrease the incidence of pneumonia in mechanical ventilation. Continuous training should be promoted in order to provide care validated under scientific evidence

Heart rate variability as a predictor of mechanical ventilation weaning outcomes

BackgroundDelays in the mechanical ventilation (MV) weaning process increase mortality. The spontaneous breathing test is the gold standard to assess weaning and extubation success, although it has approximately 85% accuracy. Studies have demonstrated a correlation between decreased heart rate variability (HRV) and weaning failure. ObjectivesTo assess the usefulness of HRV as a predictor of MV weaning outcomes. MethodsCross-sectional analytical study in adults of both sexes on MV in intensive care unit (ICU) stay. Patients were divided into weaning success and failure groups. Clinical data were collected, and HRV records were obtained with a heart rate monitor. ResultsThe study included 68 individuals – 91.1% in the weaning success group and 8.9% in the failure group. All HRV indices analyzed in both groups were lower than the reference values. No statistical difference was found in the mean RR interval (RRi), the standard deviation of the NN interval (SDNN), and the square root of the mean squared differences of successive NN intervals (RMSSD) between the groups. The weaning failure group had a significant increase in LF (41 vs. 69.4) and LF/HF ratio (0.685 vs. 2.6) and a significant decrease in HF (58.85 vs. 30.2). ConclusionsHRV measure with spectral analysis can be a good predictor of MV weaning failure. Integrating this assessment tool in ICU to predict weaning outcomes could provide more precise prognoses and more adequate assistance quality.

NRF2 is a potential biomarker for the evaluation of weaning-related oxidative stress in goat kids

Weaning stress is crucial threatening factor in animal breeding. The aim of this study was to investigate the effects of weaning to oxidative stress and stress status of goat kids at the molecular levels. In the study, blood samples were collected at the weaning process (7 days before weaning- Pre-W, Day of weaning- Day-W and 7 days after weaning- Post-W) from 24 healthy Damascus goats. Cortisol, MDA (Malondialdehyde), COX-2 (Cyclooxygenase-2), and NRF2 (Nuclear factor erythroid 2-related factor 2) proteins levels were investigated in plasma, while COX-2 and NRF2 genes expression levels were determined from leukocytes. Compared to Pre-W, COX-2 gene was upregulated almost 2-fold in Day-W. On the other hand, NRF2 gene expression levels were tended to upregulation in Day-W, and it was upregulated approximately 2-fold in Post-W. While MDA levels were gradually increased in the weaning process, the levels of COX-2 and NRF2 proteins showed similar changes with gene expression trends. Positive correlations were also found between cortisol and COX-2 and NRF-2 protein levels in plasma. It was thought that significant outputs gained in terms of MDA levels in plasma of kids at the weaning process. For the first time, determination of COX-2 and NRF2 levels both mRNA and protein levels in the weaning process of goat kids were satisfactorily evaluated in this study. Particularly, NRF2 was found to have the potential to be a fundamental biomarker to assess the oxidative status of weaning kids.

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. European Society of Intensive Care Medicine, European Respiratory Society.

The efficacy of calorimetry-based nutritional support versus recommended dietary intake-based nutritional support in the successful weaning of chronically ventilated patients: A study protocol for a double blind randomized controlled trial

Mechanically ventilated patients are weaned during acute care hospitalization when it is determined that they are ready for withdrawal. If weaning fails, patients are admitted to a rehabilitation medical center for continued supportive care and additional weaning attempts. This study's objective is to increase the success rate of weaning from prolonged mechanical ventilation (PMV), and to shorten the overall weaning period by tailoring the patient's caloric intake according to their individually measured energy needs. We designed a randomized, controlled, double-blinded trial to be conducted among PMV patients undergoing routine ventilation-weaning attempts. Patients in the intervention arm will be fed according to energy needs determined by calorimetry. Patients in the control arm will be fed according to the standard of care, namely the Recommended Dietary Allowance (RDA) guidelines. Each patient will undergo up to five weaning attempts. Study outcomes will include successful weaning rate, time to successful weaning, and 3-12 months survival rate. This trial aims to examine the safety and efficacy of a nutritional diet based on an individual's measured caloric needs in terms of weaning rates and weaning time. We hypothesize that calorimetry-based nutrition plan will prove to be superior in both success rate and time to successful weaning compared to the standard nutrition plan based on the resting energy expenditure (REE) formula during the weaning process. ClinicalTrials.gov identifier: NCT04825717.

Behavioral and hormonal assessment of stress in foals (Equus caballus) throughout the weaning process.

This study had the aim to demonstrate the midterm effects (three weeks) of weaning on foals' welfare. For this purpose, foals' behavioral changes and fecal levels metabolites of cortisol were evaluated. The observations took place at the state stud farm of Baden-Wuerttemberg in Germany. Ten foals (six colts and four fillies) were observed from one day before weaning up until three weeks after weaning. Weaning was divided into three blocks, the first in September, the second in October, and the last in November. The behavioral observation was done during an eight-hour period between 7:00 a.m. and 5:00 p.m. The observer documented the exact behavior shown by the foal every five minutes during the eight hours. To scale the stress experienced by the foal, the glucocorticoid metabolite 11,17-dioxoandrostane was measured with the 11-oxoetiocholanolone enzyme immunoassay, which allows assessing the foal's plasma cortisol level changes throughout the trail through fecal samples. All foals displayed a distinct hormonal stress response to the weaning process through increased fecal cortisol metabolite levels. Their body posture distribution took a shift from mainly moving before weaning to mainly standing during the three weeks after weaning. Compared with the day before weaning, the foals showed less active behavior and significantly increased their resting behavior. Regarding the overall resting behavior, the weaned foals initially increased their time spent resting in a lying position during daytime and then started to decrease the time lying. After weaning, the foals showed a significant increase in resting while standing. In conclusion, the foals showed an expected behavioral development and an expected curve of cortisol metabolite values throughout the study. However, it seemed that the changes had not returned "back to normal" at three weeks after weaning. Therefore, we suggest that weaned foals need a minimum of three weeks to acclimate to the new situation.

Children of the grave: Investigating non-adult feeding practices in medieval and early modern Estonia through stable isotope analysis.

Studying infant diet and feeding practices through stable isotope analysis provides direct insight into the life and health of vulnerable population groups in the past. Although the general diet in medieval and early modern Livonia has been reconstructed from written sources, little is known about childhood diet during this tumultuous period of Eastern European history. This study presents a comparative investigation of the staple non-adult diet in urban/rural communities during the 13th-17th centuries AD, with a special focus on feeding practices. We aim to reveal the impact of socio-economic circumstances on early childhood nutrition, which affects the physical development and overall survival of this susceptible population group. Bone collagen samples from 176 individuals between the fetal and the 7-15 age categories from four urban/rural South-Estonian cemeteries were cross-sectionally analyzed via EA-IRMS (Elemental Analysis with Isotope Ratio Mass Spectroscopy) for δ13C and δ15N. Results suggest that South-Estonian children had a staple terrestrial C3 diet integrated with animal proteins. Significant divergences were observed between urban and rural sites and slight variation occurred among rural subgroups, possibly resulting from a wider food choice available in towns, different consumption of C4 foods, and/or secular changes. This study provides the first data regarding infant feeding practices in medieval and early modern Livonia. These practices were similar among the different contexts, indicating comparable cultural traditions in child rearing. Breastfeeding was likely practiced for 1-2 years, with supplementary foods introduced around 1 year of age. The weaning process was probably concluded around the age of 3. The δ13C and δ15N values of older children are comparable to those of the adults from the same sites, indicating their diets became similar after weaning, when they started working and obtained a more mature social status.

Extubation failure and the use of noninvasive ventilation during the weaning process in critically ill COVID-19 patients.

To assess the outcome of extubation in COVID-19 patients and the use of noninvasive ventilation in the weaning process. This retrospective, observational, single-center study was conducted in COVID-19 patients aged 18 years or older who were admitted to an intensive care unit between April 2020 and December 2021, placed under mechanical ventilation for more than 48 hours and progressed to weaning. Early extubation was defined as extubation without a spontaneous breathing trial and immediate use of noninvasive ventilation after extubation. In patients who underwent a spontaneous breathing trial, noninvasive ventilation could be used as prophylactic ventilatory assistance when started immediately after extubation (prophylactic noninvasive ventilation) or as rescue therapy in cases of postextubation respiratory failure (therapeutic noninvasive ventilation). The primary outcome was extubation failure during the intensive care unit stay. Three hundred eighty-four extubated patients were included. Extubation failure was observed in 107 (27.9%) patients. Forty-seven (12.2%) patients received prophylactic noninvasive ventilation. In 26 (6.8%) patients, early extubation was performed with immediate use of noninvasive ventilation. Noninvasive ventilation for the management of postextubation respiratory failure was administered to 64 (16.7%) patients. We found that COVID-19 patients had a high rate of extubation failure. Despite the high risk of extubation failure, we observed low use of prophylactic noninvasive ventilation in these patients.

Initiation of mechanical weaning of ICU patients and investigation of nurses' knowledge and role.

ABSTRACT Introduction: The process of weaning from MV involves a methodical practice, during which certain conditions should be met. Critical care nurses play a key role in the ongoing assessment and monitoring of the patient weaned from MV, using a thorough 'Airway, Breathing and Circulation' approach. Adjusting weaning parameters requires a high level of skill and training, as well as a good knowledge of cardiorespiratory physiology and pathophysiology. The purpose of this study is to investigate the role of ICU nurses and the level of knowledge they possess regarding the process of weaning patients from MV. Materials and Methods: The research was conducted in a sample of 90 employees in the ICU of a General Hospital. A quantitative survey was conducted with a questionnaire, during the time-period July-September 2021. The questionnaire used for data collection consists of 43 questions categorised as follows: a) Demographic data; b) Overview of mechanical ventilation recovery; c) Mechanical ventilation weaning methods and methods; d) Evaluation criteria weaning readiness; e) Spontaneous respiration test, g) Causes of intubation failure; h) Weaning protocols and suppression. Results: Most nurses did not answer all the questions correctly, meaning nurses do not have the required knowledge and skills to successfully manage patient intubation. Two more key findings of this research were: a) protocols can help in the successful intubation of the patient; b) nurses need training in successfully ossifying patients. Conclusions: There is a need for nurses to participate in continuing education programs, as well as a need to create an interdisciplinary team. However, further research on a larger sample of respondents is necessary in order to extract results that can be generalized.

Extubation failure and the use of noninvasive ventilation during the weaning process in critically ill COVID-19 patients

Extubation failure and the use of noninvasive ventilation during the weaning process in critically ill COVID-19 patients

An interspecies comparison of the weaning process in primates: insights into “earlier weaning” in humans

An interspecies comparison of the weaning process in primates: insights into “earlier weaning” in humans

Weaning from prolonged mechanical ventilation on a specialised weaning unit: a retrospective comparison of patients with and without SARS-CoV-2 infection

Available data on patients requiring prolonged mechanical ventilation due to severe COVID-19 are sparse. Here we compare patients with ARDS related or not related to SARS-CoV-2 infection treated in a specialised weaning unit. A retrospective analysis of all patients with prolonged mechanical ventilation associated with an ARDS admitted from the 21st November 2013 to the 23rd July 2021 to the weaning unit of the University Hospital RWTH Aachen was performed. ARDS patients with COVID-19 (cARDS) were compared to patients with ARDS not related to COVID-19 (ncARDS). In total, n=129 patients in prolonged need for mechanical ventilation after ARDS were treated in the weaning unit, of whom n=38 had been suffering from ARDS related to COVID-19. Both patients groups were similar in terms of demographic parameters, underlying chronic illnesses, severity of ARDS and the duration of mechanical ventilation before being admitted to the weaning unit. During ICU stay, prone positioning and therapy with systemic corticosteroids was used more frequently in cARDS patients. Furthermore, therapy with vasoconstrictors was needed more often (cARDS: 42.1% vs. ncARDS 12.1%; p=0.0003) and urinary output was lower (cARDS: 1980 ml vs. ncARDS: 2600 ml; p=0.0037) in this patient group. The clinical course of the weaning process was similar in patients with cARDS and ncARDS, there were no significant differences in the occurrence of complications and the duration of mechanical ventilation. There were n=5 deaths (13.2%) in the cARDS and n=15 deaths (16.5%) in the ncARDS group. After hospital discharge, n=4 patients required non-invasive ventilation whereas out-of-hospital invasive ventilation was only necessary in one patient (all in the ncARDS group). After having survived the acute phase, the disease prognosis of patients with severe COVID-19 is favourable and most patients can be successfully weaned from mechanical ventilation. In addition, there were only minor differences compared to patients with ARDS unrelated to COVID-19.

Weaning from mechanical ventilation: a narrative review

The “weaning” from mechanical ventilation is a process that involves several assessments and steps to aid a patient to reach a “liberation” from the ventilator and allow for breathing autonomy.The process of “weaning” from mechanical ventilation involves several assessments and steps to support a patient in reaching a “liberation” from the ventilator and allow for spontaneous breathing. The weaning process consists of evaluating if the patient is able to breathe with minimal or no ventilation support. This assessment is performed by a diagnostic test named spontaneous breathing trial (SBT), repeated every 24 hours to ensure extubation success. Even though many patients do not meet the eligibility criteria for starting the weaning process, they can still be weaned. For this reason, these criteria should be evaluated in order to assess a possible weaning, rather than adopting absolute standards which have to be met simultaneously. The SBT helps the healthcare professionals to understand the patient’s capacity to sustain physiological breathing once they are extubated (or on spontaneous breathing if a tracheostomy tube is maintained in place). Several patients fail to meet the weaning criteria after less than 20 minutes of the SBT. Therefore, a 30-minute trial is enough to estimate the patient’s capacity to withhold spontaneous breathing. Even if the SBT is currently the gold standard method to conduct the weaning trial, it does not prevent the occurrence of complications after extubation such as upper airways obstruction, increased resistance, loss of airway protective reflexes, cough efficiency, and drainage of tracheobronchial secretions. The preventive use of NIV or High Flow Nasal Cannula is strongly recommended for patients experiencing extubation failure and mechanically ventilated for more than 24 hours after an SBT. A well-performed SBT usually leads to definitive extubation; on the other hand, SBT failure requires a comprehensive investigation on potentially reversible conditions. Prolonged weaning is highly wasteful in terms of time and resources due to the need for a systematic and multidisciplinary approach to successfully face the weaning process.

1097 PREDICTORS OF WEANING FROM TEMPORARY MECHANICAL CIRCULATORY SUPPORT IN PATIENTS WITH CARDIOGENIC SHOCK

Abstract Introduction In cardiogenic shock (CS) patients with temporary mechanical circulatory support (TMCS) the weaning process is crucial to verify patients’ myocardial recovery or device dependency. To date, there are no specific guidelines on weaning strategies. Hypothesis We investigated clinical predictors of successful weaning from TMCS and developed with them a novel prognostic scoring system. Methods Eighty CS patients (62.5 ± 11.8 years, 86.2% male, 63.7% with ACS) with Impella support were evaluated. Hemodynamic, echocardiographic and laboratory data were collected at admission (T0), 24 (T1), 48 (T2), 96 (T3) hours after TMCS implantation. CS patients were classified according to successful or unsuccessful weaning, defined as hemodynamic/myocardial recovery, and death/need for LVAD/heart transplant, respectively. Independent predictors of weaning and their discriminating cut-off values were identified. Finally, a prognostic weaning score (W-Score) was derived. Results Thirty-eight (47.5%) CS patients showed successful (SW-group) while 42 (52.5%) unsuccessful (UW-group) weaning from TMCS. Clinical characteristics were similar between the two groups. SW-group showed higher T1, T2, T3 LVEF (p=0.013, p=0.001, p=0.001), T1 CPO (p=0.04), T2 MAP (p=0.019) and lower T1, T2 inotropic score values (p=0.001, p=0.001), T2 HR and PCWP (p=0.01, p=0.008), T1 and T3 creatinine (p=0.018, p=0.009), lactate (p=0.009, p=0.002) and NT-proBNP (p=0.017, p=0.001). T1 LVEF, NT-proBNP and inotropic score together with T3 creatinine and lactate resulted independent predictors of SW (p<0.05). T1 LVEF ≥ 10%, T1 inotropic score ≤ 8, T1 NT-proBNP ≤ 8068 ng/L, T3 lactate ≤ 1,59 mmol/L, T3 creatinine ≤ 1,76 mg/dl identified patients with SW (overall, AUC ≥0.7, p<0.05). W-Score was developed enabling SW with a cut-off score ≥ 7 (80% sensitivity, 85% specificity, AUC 0.92, p <0.001). Conclusions W-Score, based on T1 LVEF/inotropic score/NT-proBNP, T3 creatinine/lactate values may be useful to identify CS patients undergoing successful weaning from TMCS.

52: PROSPECTIVE REAL-TIME VALIDATION OF A LUNG ULTRASOUND DEEP LEARNING MODEL IN THE INTENSIVE CARE UNIT

Introduction: Lung ultrasound (LUS) shows diagnostic superiority to chest radiography in the ICU setting however its widespread deployment is challenged by limited user base and its dependence on clinical expertise. Artificial intelligence models have been developed to overcome these barriers through LUS automation; however, bedside pragmatic performance has never been demonstrated. In this study, we aimed to evaluate the accuracy of a bedside, real-time deployment of a deep learning model capable of distinguishing between normal (A line pattern) and abnormal (B line pattern) lung parenchyma on lung ultrasound in critically ill patients. Methods: Prospective, observational study evaluating the performance of a previously-trained LUS deep learning (DL) model on 100 admitted patients to an academic intensive care unit (ICU). Enrolled patients received an anterior zone LUS exam (4 views) with frame-by-frame DL model predictions using a portable device. Clip-level model predictions were analyzed and compared to blinded expert review for A vs B line pattern. Four clip-level prediction cutoffs were applied to maximize model sensitivity and specificity at bedside. Results: A total of 100 unique ICU patients (400 clips) were enrolled from two tertiary care sites. The majority of patients were receiving mechanical ventilation (56/100), 12 patients were in the weaning process with ongoing trach-mask trials, 4 patients were on High-Flow Nasal Cannula, 4 were on non-invasive ventilation (BiPAP), and 25 patients were on nasal prongs. The Mindray M9 and Sonosite X-Porte ultrasound machines were used to scan 50 patients each. When compared to gold-standard expert annotation, the real-time inference yielded an accuracy of 95%, sensitivity of 93%, and specificity of 96% for identification of the B line pattern. Varying the prediction cutoffs reveal that diagnostic performance may be readily customized to suit the clinical environment. Conclusions: Promoting the feasibility and direct application of bedside AI in the ICU, we have shown that a binary DL ultrasound model demonstrates excellent bedside accuracy in distinguishing between normal and abnormal lungs when deployed in real-time in the ICU.

Decannulation/Weaning Potential and Success in Home Intensive Care

Background: The number of patients receiving home long-term ventilation has risen considerably in recent decades owing to medical advancements. Experts believe that the potential for ventilator weaning or tracheostoma removal is currently insufficiently exploited. Objective: The objective of this study was to investigate the characteristics, prognosis, and decannulation/weaning potential of patients under home intensive care. Methods: In this retrospective analysis of 607 patients on home intensive care, decannulation/weaning status and survival were documented for a 2-year period after initial assessment. At the time of hospital discharge, when clinicians had deemed the weaning process concluded, an independent expert noninvasively assessed the long-term decannulation/weaning. Comparative analyses based on specific criteria, such as ventilation and decannulation/weaning status, age, and underlying diseases, were performed. Potential predictors of survival were identified via multivariable logistic regression. Results: Eighteen percent of patients were decannulated/weaned within 2 years after hospital discharge and had better mean survival than patients not decannulated/weaned (552 vs. 420 days, p < 0.001). More than half of these patients were identified to have decannulation/weaning potential based on the assessment of the independent expert. Patients with neuromuscular and neurological diseases had the best survival (546 and 501 days), patients with postsurgical conditions and cardiological diseases the worst (346 and 323 days). Underlying disease and decannulation/weaning status were significant predictors of 2-year survival. Conclusion: Successful decannulation/weaning of patients on long-term home intensive care is associated with better survival. Even in the absence of decannulation/weaning potential at the time of hospital discharge, patients may develop decannulation/weaning potential over time, which should therefore be assessed repeatedly.

Utility of rapid shallow breathing index in progressive weaning of adult patients from mechanical ventilation using pressure support ventilation

Introduction: Many weaning indices have been proposed to evaluate readiness of a patient to tolerate discontinuation of mechanical ventilation. Aim: This study evaluated the utility of these indices in progressive weaning from mechanical ventilation. Methods: All patients receiving mechanical ventilation and assessed to be ready to wean clinically were included in the study. They were initially placed on pressure support, positive end expiratory pressure (PEEP) of 5-8 cm H2O and FiO2 0.4. Tidal volume, respiratory frequency, minute ventilation and rapid shallow breathing index (RSBI) were measured at baseline, 5 min, 30 min and at 2 h. The patient was also monitored for clinical signs of respiratory distress. If the patient remained stable, the pressure support was reduced by 2 cm H2O and the weaning process repeated till PSV reached 5-8 cm H2O. Results: Respiratory rate (&lt; 35/min) and tidal volume corrected to weight (&gt; 5 mL/kg) had high sensitivity (100% and 98.5% respectively) but lacked specificity. Minute volume of &lt; 10 L/min lacked both sensitivity (73.1%) and specificity (50%). The RSBI (&lt; 105 b/min/L) had very high sensitivity (99.1%), reasonable specificity (83.3%) with a positive predictive value 98.4% and a negative predictive value 90.9%. RSBI corrected to weight (7 breaths/min/mL/kg) was not useful. RSBI rate of &lt; 20% was found to be a good weaning index even for progressive decrease in ventilatory support. Conclusion: RSBI &lt; 105 b/min/L and RSBI rate &lt; 20% are reliable criteria to predict success of progressive weaning from mechanical ventilation using pressure support.

Implementation of a spontaneous awakening/spontaneous breathing trial protocol in a surgical intensive care unit: a before and after study.

Prolonged invasive mechanical ventilation (IMV) influences patient outcome in multiple ways. In this regard the early weaning from IMV is a major goal to be achieved in the treatment of ICU patients. Adopting a weaning protocol that incorporates a Spontaneous Awakening Trial (SAT) and a Spontaneous Breathing Trial (SBT) seems to be essential to reach this goal. Most studies investigating the effectiveness of SAT/SBT protocols in ICU patients' outcomes have focused mainly on medical or mixed (medical and surgical), but not on exclusively surgical patient populations. Surgical patients usually experience more complications and often undergo revision surgeries, therefore needing longer sedation periods and adequate analgo-sedation therapy. Moreover, the longer IMV times make the weaning process more arduous. Our retrospective data analysis therefore investigates the effectiveness of a SAT/SBT protocol implementation in the surgical ICU of Heidelberg University Hospital, focusing exclusively on surgical patients and their outcome related to the weaning process. The SAT/SBT protocol was adopted in Heidelberg ICU starting from 05/2019. We therefore analyzed the time period before and after the implementation between 03/2018 and 08/2020. Adult patients who required invasive ventilation for at least 48 hours were screened for study entry. Demographic data, clinical data and SOFA Score on admission, were collected to define the baseline characteristics of the two groups. Only patients with full adherence to the protocol were included. The primary outcome was defined as the successful extubation, intended as an extubation not followed by successive re-intubations until discharge from the ICU. We performed an univariate analysis to evaluate the rate of successful extubations between the two groups. In total, 199 patients were included in the analysis, 98 of which before the SAT/SBT protocol implementation (control group) and 101 after the SAT/SBT protocol implementation (intervention group). The successful extubation rate in the intervention group resulted in 82% (83/101 patients) compared to 64% (63/98 patients) in the control group (P<0.004). We conclude that even for an exclusively surgical patient population, the implementation of a SAT/SBT protocol could result in a higher rate of successful extubation.

The effect of planned presence of the family at the time of weaning on the length of weaning from mechanical ventilation in patients with brain injury admitted to intensive care units

BackgroundWeaning the patient from mechanical ventilation (MV) is one of the common treatments in intensive care units (ICU). Among the factors that can complicate the weaning process are psychological problems caused by a lack of family visits.ObjectiveThis study aimed to evaluate the effect of scheduled visiting on weaning from mechanical ventilation in patients with brain injury admitted to ICUs.MethodsThis quasi-experimental study was performed on 60 patients with brain injury referred to one of the hospitals in Central Province, Iran in 2020. The selection of samples based on inclusion criteria and random allocation to the two groups of intervention and control by permuted block randomization was done. The first-degree relatives of the patients at the time of weaning in the intervention group were present at the patient’s bedside twice a day at 10:00 AM and 3:00 PM for 30–45 min and performed what they had been trained to do. Participants in the control group visited patients from the area outside the patient room. Length of weaning, length of mechanical ventilation, and length of stay in the ICU were recorded and measured using a researcher-conducted checklist. The results were analyzed using descriptive and inferential statistics and chi-square and independent t-tests in SPSS16.ResultsThe study results showed that the number of patients weaned from mechanical ventilation in the intervention group was significantly higher than that of the control group (P ≤ 0.05). The mean length of weaning in the intervention and control groups was not statistically significant, but it was clinically significant in the intervention group (P > 0.05). In addition, the length of mechanical ventilation and the length of stay of the intervention group in the ICU were significantly shorter than that of the control group (P ≤ 0.05).ConclusionAccording to the study results, scheduled visiting resulted in faster weaning from mechanical ventilation. As a result, nurse managers are suggested to make arrangements for family members to be present at the patient’s bedside in order for patients to be weaned off the mechanical ventilator more easily.

Sedation With Dexmedetomidine in Critically Ill Burn Patients Reduced Delirium During Weaning From Mechanical Ventilation.

Weaning of mechanical ventilation while maintaining appropriate pain control and preventing delirium is one of the most challenging aspects of burn care.Dexmedetomidine, an α2-adrenergic receptor agonist used for sedation may improve intensive care unit (ICU) patients' arousal status and enhance patient comfort. To determine the efficacy of dexmedetomidine vs. standardized usual care (midazolam or propofol) in maintaining sedation and reducing delirium in burn patients while weaning off mechanical ventilation. A total of 56 mechanically ventilated patients who fulfilled the criteria for weaning were enrolled in the study. Group 1 (26 patients) received dexmedetomidine 1 mcg/kg over 15 minutes as a loading dose, followed by 0.4-0.1 mcg/kg/h. Group 2 (30 patients) received usual sedation with midazolam 0.08 mg/kg/h or propofol 15- 30 mcg /kg/min). Dexmedetomidine was not associated with a significantly shorter duration of mechanical ventilation (Mean {IQR}: 9.3 {4,12} versus 7.5 {4,10}, p=0.3).Patients who received dexmedetomidine had a lower delirium rate (38,4% on Day 1 to 7,7% on Day 5) in comparison with patients from the usual care group (53,3% on Day 1 to 20% on Day 5) during the five days after the onset of weaning process (p=0.02)and had less need for supplemental use of analgesia (23.1% versus 53.3%, p=0.045) and antipsychotic agents (15.4% versus 53.3%, p=0.01). The most notable adverse effect of dexmedetomidine was bradycardia. Dexmedetomidine may provide effective light sedation and is associated with fewer sedation-related adverse effects in burn patients. Sedation with dexmedetomidine during the weaning process in adult burn patients was associated with lower delirium rates, a trend towards the earlier withdrawal of mechanical ventilation but did not seem to improve the total duration of mechanical ventilation.