Predictors of extubation failure in neurocritical patients: A systematic review

ObjectiveThe objective of this study was to identify predictors of extubation failure in neurocritical patients.MethodsThis was systematic review performed through a bibliographic search of the databases PubMed/Medline, Lilacs, SciELO, and Web of Science, from February 2020 to October 2021. Cohort studies that investigated the predictors of extubation failure were included, defined as the need for reintubation within 48 h after extubation, in adult neurocritical patients. The risk-of-bias assessment was performed using the Newcastle–Ottawa Scale, for cohort studies.ResultsEight studies, totaling 18 487 participants, were included. A total of 15 predictors for extubation failure in neurocritical patients have been identified. Of these, four were the most frequent: low score on the Glasgow Coma Scale (motor score ≤5, 8T–10T), female gender, time on mechanical ventilation (≥7 days, ≥ 10 days), and moderate or large secretion volume.ConclusionsIn addition to the conventional parameters of weaning and extubation, other factors, such as a low score on the Glasgow Coma Scale, female gender, mechanical ventilation time, and moderate or large secretion volume, must be taken into account to prevent extubation failure in neurocritical patients in clinical practice.     

Effects of diet and handling on initiation of independent ingestion in rats

The present study examined the effects of dietary manipulation on the age of onset of weaning in rat pups. In Experiment 1, female rats were placed on a standard chow (SC) or high-fat (HF) diet 1 week following mating. Pups were weighed daily from birth to Day 12, then animals were placed into specialized cages for separate recording of food intake of pups and dams. Pups were offered the same diet as their dam, and food intake and body weight were determined twice daily until Day 25. The results demonstrated that pups reared by dams fed the HF diet initiated independent ingestion on Day 16, approximately 24 hr before pups reared by dams fed the SC diet. There were no differences in body weight in pups across the two diets. While few differences were noted across diets in pups' or dams' behavior, HF pups appeared to demonstrate a delay in the establishment of circadian patterns of food intake. In Experiment 2, all dams were maintained on an SC diet until the day after parturition. At that time, dams and litters were placed into specialized cages and divided into four groups: HF/HF, HF/SC, SC/SC, and SC/HF (dam's diet/pup's diet, respectively). The results demonstrated that dams given the HF diet had pups that initiated food intake approximately 2 days before the pups of dams given the SC diet. In addition, pups offered the HF diet, independent of the dam's diet, initiated food intake approximately 0.8 days prior to pups offered the SC diet. Further, by Day 12, HF dams had pups that were heavier than SC dams. The results suggest that the onset of weaning in rats is affected by maternal diet and the weaning diet available to the pup.     

Principles of artificial ventilation

The application of intermittent positive pressure ventilation (IPPV) during the 1952 Copenhagen polio epidemic led to the development of the world’s first intensive care unit. The requirement for ventilatory support is the most common indication for intensive therapy unit (ITU) admission and is a defining feature of the specialty. Ventilator technology continues to develop and there are many ways to deliver IPPV. The variety of modes of ventilation is increasingly complex and expanding, without evidence that any one mode is associated with improved outcome. Ventilatory support is part of the treatment for a range of conditions including acute respiratory failure, raised intracranial pressure (ICP) and circulatory shock. Ventilator-associated lung injury is reduced by using low tidal volumes and limiting plateau airway pressure to less than 30 cmH₂O. Prolonged artificial ventilation has an associated morbidity and mortality and thus should be reviewed by an expert clinician on a daily basis. Weaning aims to identify those patients who will be able to breathe spontaneously. Protocols exist to facilitate timely extubation without the need for re-intubation.     

老年患者长期使用呼吸机停机时的护理方法分析

目的 分析长期使用呼吸机的老年患者停机时的护理方法 .方法 随机选取本院2018年12月—2019年12月收治的长期使用呼吸机的老年患者82例,均分为两组,每组41例,对照组采用常规护理干预,观察组在常规护理干预基础上实施综合护理干预,对比两组患者护理后的撤机成功率和撤机时间.结果 在对长期使用呼吸机的老年患者进行护理...     

Issues in weaning from mechanical ventilation: literature review

AIM: The aim of this paper is to raise questions on the effect of skill mix and organizational structure on weaning from mechanical ventilation. BACKGROUND: Mechanical ventilation is an essential life-saving technology. There are, however, numerous associated complications that influence the morbidity and mortality of patients receiving intensive care. Therefore, it was essential to use the safest and most effective form of ventilation for the shortest possible duration. Because of the potential complications and costs of mechanical ventilation, research to date have focused on accurate weaning readiness assessment, methods and organizational aspects that influence the weaning process. METHOD: In early 2005, the literature was reviewed from 1986 to 2004 by accessing the following databases: Medline, Proquest, Science Direct, CINAHL, and Blackwell Science. The keywords mechanical ventilation, weaning, protocols, critical care, nursing role, decision-making and weaning readiness were used separately and combinations. DISCUSSION: Controversy exists in weaning practices about appropriate and efficacious weaning readiness assessment indicators, the best method of weaning and the use of weaning protocols. Arguably, the implementation of weaning protocols may have little effect in an environment that favours collaboration between nursing and medical staff, autonomous nursing decision-making in relation to weaning practices, and high numbers of nurses qualified at postgraduate level. CONCLUSION: Further research is required that better quantifies critical care nurses' role in weaning practices and the contextual issues that influence both the nursing role and the process of weaning from mechanical ventilation.     

长期机械通气患者撤机主要影响因素的临床研究

目的分析ICU病房长期机械通气（≥7d）患者撤机的主要影响因素，探讨长期机械通气撤机的策略。方法回顾性调查45例ICU长期机械通气患者入院时一般情况、早期气管切开、原发病，通气前生命体征、辅助检查以及APACHEⅡ评分。根据撤机成败判定标准，将全部病例分为撤机成功组和撤机失败组，依照设定的临床资料调查指标对两组资料进行对比分析。结果撤机成功23例，撤机失败22例，分别占病例总数的51．1％和48．9％；APACHEⅡ评分撤机失败组明显高于撤机成功组，两组间比较差异有显著性（P〈0．01）；早期气管切开比例撤机成功组高于撤机失败组（P〈0．05）；血浆白蛋白（Alh）水平、心功能状态撤机成功组优于撤机失败组。结论长期机械通气患者原发病加重和（或）出现较严重并发症是导致其撤机成功率较低、死亡率较高的重要原因。其中上机前患者的基础状态、血浆Alb水平、心功能状态、APACHEⅡ评分等对撤机成败有一定的预测意义。     

Total and active ghrelin in developing rats during hypoxia

Hypoxia is well known to decrease appetite and weight gain in growing rats, and to induce weight loss in humans. It has been hypothesized that this is mediated by a change in ghrelin, an orexigenic peptide synthesized and released primarily from the stomach. Rats were exposed to hypoxia for 7 d as neonates (birth-7 d of age), weanlings (28–35 d of age), and juveniles (49–56 d of age). Hypoxia had no effect on total or active plasma ghrelin. There was a significant decrease in active ghrelin in weaned rats (0.8±0.1 ng/mL) compared to nursing pups at 7 d of age (2.3±0.2 ng/mL). The proportion of total ghrelin that was active decreased significantly between 7 and 35 d of age. We conclude that the anorexia and weight loss associated with hypoxia is probably not mediated by ghrelin. There appear to be changes in active ghrelin levels in plasma during early development in the rat.     

综合脱机指数预测机械通气脱机价值的Meta分析

目的采用Meta分析系统评价综合脱机指数（IWI）对机械通气脱机的诊断价值。 方法系统检索PubMed、Web of Science、EMbase、中国知网、万方等数据库,检索时间为各数据库建库至2018年10月。由2人按照设定的纳入与排除标准进行筛选文献,查找相关文献,并采用QUADAS-2对纳入文献进行质量评价,利用Meta-DiSc软件进行数据分析、汇总结果。 结果共纳入5篇文献和783例患者,IWI对有创机械通气脱机的合并诊断价值如下：敏感度为0.95（95%CI：0.90~0.99）,特异度为0.81（95%CI：0.68~0.94）,阳性似然比为4.46（95%CI：1.98~10.07）,阴性似然比为0.08（95%CI：0.03~0.19）,诊断比值比为60.34（95%CI：16.54~220.05）,综合受试者曲线下面积为0.9466。 结论IWI在有创机械通气脱机的诊断中具有一定的诊断价值,可作为辅助预测脱机的诊断指标。