Evaluación técnico-económica utilizando trigo (Triticum vulgare), alfalfa (Medicago sativa), cebada (Hordeum vulgare) como complemento alimenticio en la producción de pollo de engorde

Anexo A. Balanceo de raciones para tratamiento 1, ABC + trigo. ETAPA DE INICIACIÓN MATERIA PRIMA proteína Energía Kcal/Kg Humedad Grasas Fibra Cenizas Fosforo Calcio Cys+Met Triptófano Lisina REQUERIMIENTO 21 3200 2.0 5.0% 8.0 0.45 1.00 0.90 1.10 ABC 21 3200 13.00% 2.0 5.0 8.0 0.45 1.00 0.90 1.10 TRIGO 10.2 2965 11.5 1.4 2.4 1.5 0.29 0.05 0.34 0.10 0.24 BALANCEO ABC 14.7 2240 1.4 3.5 5.6 0.31 0.7 0.63 0.77 TRIGO 3.06 889 0.42 0.72 2.5 0.08 0.015 0.10 0.07 TOTAL SIMNISTRO 17.76 3129 1.8 4.22 8.1 0.39 0.71 0.73 0.84 ETAPA LEVANTE FINALZACIÓN MATERIA PRIMA Proteína Energía Kcal/Kg Humedad Grasas Fibra Cenizas Fosforo Calcio Cys+Met Triptofano Lisina REQUERIMIENTO 18 3200 2.0 6.0 8.0 0.35 0.90 0.72 1.0 ABC 18 3200 13.00% 2.0 6.0 8.0 0.35 0.90 0.72 1.0 TRIGO 10.2 2965 11.5 1.4 2.4 1.5 0.29 0.05 0.34 0.10 0.24 BALANCEO ABC 12.6 2240 1.4 4.2 5.6 0.24 0.63 0.50 0.53 TRIGO 3.06 889 0.42 0.72 2.5 0.08 0.015 0.10 0.07 TOTAL SIMNISTRO 15.66 3129 1.8 4.92 8.1 0.32 0.64 0.60 0.60 Fuente. Los autores 2018 Balanceo de dieta para T2: ABC 70% + Alfalfa (Medicago Sativa) 30% Anexo B. Balanceo de dieta para el T2: ABC 70% + Alfalfa (Medicago Sativa) 30% ETAPA DE INICIACIÓN MATERIA PRIMA Proteina Energía Kcal/Kg Humedad Grasas Fibra Cenizas Fosforo Calcio Cys+Met Triptofano Lisina REQUERIMIENTO 21 3200 2.0 5.0 8.0 0.45 1.00 0.90 1.10 ABC 21 3200 13.00% 2.0 5.0 8.0 0.45 1.00 0.90 1.10 ALFALFA 15.2 620 11.5 2.3 26.2 11.2 0.25 1.60 0.20 0.12 0.35 BALANCEO ABC 14.7 2240 1.4 3.5 6.4 0.31 0.7 0.63 0.77 ALFALFA 4.56 186 0.6 7.8 3.3 0.07 0.48 0.06 0.10 TOTAL SIMNISTRO 19.26 2426 2.0 11.3 9.7 0.38 1.1 0.69 0.87 ETAPA LEVANTE FINALZACIÓN MATERIA PRIMA Proteina Energía Kcal/Kg Humedad Grasas Fibra Cenizas Fosforo Calcio Cys+Met Triptofano Lisina REQUERIMIENTO 18 3200 2.0 6.0 8.0 0.35 0.90 0.72 1.0 ABC 18 3200 13.00% 2.0 6.0 8.0 0.35 0.90 0.72 1.0 ALFALFA 15.2 620 11.5 2.3 26.2 11.2 0.25 1.60 0.20 0.12 0.35 BALANCEO ABC 12.6 2240 1.4 4.2 5.6 0.24 0.63 0.50 0.53 ALFALFA 4.56 186 0.6 7.8 3.3 0.07 0.48 0.06 0.10 TOTAL SIMNISTRO 17.16 2426 2.0 12 8.9 0.31 1.1 0.56 0.63 Fuente. Los autores 2018. Anexo C. Balanceo de dieta para T3: ABC 70% + Cebada (Hordeum Vulgare) 30% ETAPA DE INICIACIÓN MATERIA PRIMA Proteina Energía Kcal/Kg Humedad Grasas Fibra Cenizas Fosforo Calcio Cys+Met Triptofano Lisina REQUERIMIENTO 21 3200 2.0 5.0 8.0 0.45 1.00 0.90 1.10 ABC 21 3200 13.00% 2.0 5.0 8.0 0.45 1.00 0.90 1.10 CEBADA 9.6 2345 11.1% 1.7 4.7 2.2 0.32 0.06 0.29 0.087 0.26 BALANCEO ABC 14.7 2240 1.4 3.5 6.4 0.31 0.7 0.63 0.77 CEBADA 7.29 703 0.5 1.4 0.6 0.09 0.01 0.08 0.07 TOTAL SIMNISTRO 21.99 2943 1.9 4.9 7.0 0.41 0.7 0.71 0.84 ETAPA LEVANTE FINALZACIÓN MATERIA PRIMA Proteína Energía Kcal/Kg Humedad Grasas Fibra Cenizas Fosforo Calcio Cys+Met Triptofano Lisina REQUERIMIENTO 18 3200 2.0 6.0 8.0 0.35 0.90 0.72 1.0 ABC 18 3200 13.00% 2.0 6.0 8.0 0.35 0.90 0.72 1.0 CEBADA 9.6 2345 11.1% 1.7 4.7 2.2 0.32 0.06 0.29 0.087 0.26 BALANCEO ABC 12.6 2240 1.4 4.2 5.6 0.24 0.63 0.50 0.53 CEBADA 7.29 703 0.5 1.4 0.6 0.09 0.01 0.08 0.07 TOTAL SIMNISTRO 19.8 2426 2.0 5.6 8.9 0.33 0.64 0.58 0.6 Fuente. Los autores 2018. Anexo D. Consumo de alimento para los cuatro tratamientos TRATAMIENTO T0= ALIMENTO BALANCEADO COMERCIAL (ABC) DIA SEM 1 2 3 4 5 6 7 Total semana Kgs/ave/sem Total consumo acumulado/ave/sem Kgs Total Consumo Acum/Lote Kgs 1 18 19.7 20 20.6 23 26 30 0.157 0.157 39.25 2 36 42 48 54 60 66 72 0.378 0.535 94.50 3 78 84 90 93 95 97 99 0.636 1.171 159.00 4 102 105 108 111 114 117 120 0.777 1.948 194.25 5 123 126 129 132 136 140 145 0.931 2.879 232.75 6 150 156 162 169 176 183 190 1.186 4.065 296.50 7 197 204 211 218 223 227 231 1.511 5.576 377.75 TOTAL 5.576 139.40 TRATAMIENTO T1 (ABC 70% + Trigo (Triticum vulgare) 30%) SEM DIA 1 2 3 4 5 6 7 Total semana/Kgs/ave/sem Total consumo acumulado/ave/sem Kgs Total Consumo Lote Kgs 1 18 18.6 19.5 20 23 26 26.32 0.151 0.151 37.75 2 36 42 48 54 60 66 72 0.378 0.529 90.72 3 77.5 84 90 93 95 97 99 0.636 1.165 152.64 4 102 105 108 111 114 117 120 0.777 1.942 186.48 5 123 126 129 132 136 140 145 0.931 2.873 223.44 6 150 156 162 169 176 183 190 1.186 4.059 284.64 7 197 204 211 218 223 227 231 1.511 5.570 332.42 TOTAL 5.570 130.81 TRATAMIENTO T2 (ABC 70% + Alfalfa (Medicago sativa) 30%) DIA SEM 1 2 3 4 5 6 7 Total semana/Kgs/ave/sem Total consumo acumulado/ave/sem Kgs Consumo Lote Kgs 1 15 16.2 16.8 17 16.88 20.52 29.04 0.131 0.131 32.86 2 32 41.1 47.4 53.52 59.28 65.52 71.68 0.370 0.501 92.62 3 77.6 84 90 93 95 97 99 0.468 0.971 112.46 4 102 105 108 111 114 117 120 0.777 1.747 186.48 5 123 126 129 132 136 140 145 0.931 2.679 223.44 6 150 156 162 169 176 183 190 1.186 3.864 284.64 7 197 204 211 218 223 227 231 1.511 5.376 347.53 TOTAL 5.376 128.00 TRATAMIENTO T3= Alimento Balanceado Comercial 70%, Cebada (Hordeum vulgare) 30% DIA SEM 1 2 3 4 5 6 7 Total semana/Kgs Total consumo acumulado /ave/semana Kgs Consumo Lote Kgs 1 18 19.2 20.5 21.4 23 26 30 0.158 0.158 39.52 2 36 42 48 54 60 66 72 0.378 0.536 90.72 3 78 84 90 93 95 97 99 0.636 1.172 152.64 4 102 105 108 111 114 117 120 0.777 1.949 186.48 5 123 126 129 132 136 140 145 0.931 2.880 223.44 6 150 156 162 169 176 183 190 1.015 3.895 243.60 7 197 204 211 218 223 227 231 1.511 5.406 347.53 TOTAL 5.406 128.39 Fuente. Los autores 2018 Anexo E. Resultados de control de peso en los cuatro tratamientos PESO TTO. TO: ABC T1: ABC + TRIGO (Triticum vulgare) T2: ABC +ALFALFA (Medicago sativa) T3: ABC + CEBADA (Hordeum vulgare) Peso Pollo kgs Peso Lote Kgs Peso Pollo Kgs Peso Lote Ks Peso Pollo Kgs Peso Lote Kgs Peso Pollo Kgs Peso Lote Kgs 1 0.149 3.72 0.144 3.60 0.145 3.63 0.156 3.90 2 0.291 7.26 0.315 7.56 0.221 5.53 0.288 6.91 3 0.609 15.22 0.495 11.89 0.467 11.20 0.475 11.40 4 0.995 24.86 0.702 16.85 0.761 18.26 0.859 20.62 5 1.432 35.80 1.346 32.30 1.330 31.92 1.499 35.98 6 2.035 50.85 1.642 37.76 1.774 42.57 2.098 50.35 7 3.398 84.95 2.730 60.O6 2.854 65.64 3.115 71.65 Fuente: Los autores, 2018 Anexo F. Ganancia de peso total/ave (g) y peso total TRATAMIENTO REPETICIONES PESO TOTAL/AVE (g) PESO TOTAL (g) T0: Alimento balanceado comercial (ABC) 100% 25 3.398 84.950 T1: ABC 70% + Trigo (Tritucum Vulgare) 30% 22 2.730 60.060 T2: ABC 70% + Alfalfa (Medicago Sativa) 30% 23 2.854 65.642 T3: ABC 70% + Cebada (Hordeum Vulgare) 30% 23 3.115 71.645 Fuente: Los autores, 2018 Anexo G. Costos de la alimentación en cada uno de los tratamientos por ave. TRATAMIENTO TO= ABC (ALIMENTO BALANCEADO COMERCIAL) ALIMENTO Consumo kg/ave Valor Kg alimento Valor Total Iniciación 0.228 1.455 228 Levante 5.514 1.411 5.514 Engorde 1.511 1.572 $2.375 Total, Costo/ave$ 8.117 TRATAMIENTO T1 = ABC 70% + TRIGO (Triticum vulgare) 30% ALIMENTO Consumo kg/ave Valor Kg alimento $Valor Total$ Iniciación 105.5 1.455 106 Levante 2735 1.411 3.859 Engorde 1057 1.572 1.662 Trigo 452 1.280 578 Total, Costo/ave $6205 TRATAMIENTO T2 = ABC 70$ Valor Total $Iniciación 0.91 1.455 133 Levante 2.609 1.411 3.680 Engorde 1.057 1.572 1.662 Alfalfa 0.452 1.037 469 Total, Costo/ave$ 5944 TRATAMIENTO T2 = ABC 70% + CEBADA (Hordeum vulgare) + 30% ALIMENTO Consumo kg/ave Valor Kg alimento $Valor Total$ Iniciación 0.110 1.455 160 Levante 2.615 1.411 3.691 Engorde 1.222 1.572 1.662 Cebada 0.452 1.600 723 Total, Costo/ave $6236 Fuente: Los autores, 2018 Anexo H. Costos totales para los 4 tratamientos. COSTO GRUPO TOTAL T0 T1 T2 T3 Costo aves$3.500/ave /25 aves $87.500$87.500 $87.500$87.500 $350.000 Costo arriendo$20.000 $20.000$20.000 $20.000$80.000 Costo alimento $202.925$148.920 $142.656$149.664 $644.165 Costo sanidad$250/ave/25 aves $6.25O$6.25O $6.25O$6.25O $25.000 Costo mano de obra$111.652 $111.652$111.652 $111.652$446.610 SUBTOTAL $428.327$374.322 $368.058$375.066 1.545.775 Imprevistos 3% $12.849$11.229 $11.041$11.251 $46.370 TOTAL$441.176 $385.551$379.099 $386.317$1.592.148 Fuente. Los autores. Anexo I. Ingresos por venta de pollos para los cuatro tratamientos INGRESOS- GRUPO T0 T1 T2 T3 Total aves para venta 25 22 23 23 Total kgs de carne de pollos para venta 84.95 60.06 65.64 71.65 Valor venta kg. de carne de pollo $9.000 9.000 9.000 9.000 Ingreso por venta de pollos$764.550 $540.540$590.760 $ 648.850 Fuente: Los autores, 2018La producción de pollo de engorde es una de las actividades agropecuarias alternativa para pequeños productores de la zona de Boyacá; para lo cual como profesionales debemos proponer alternativas nutricionales sostenibles en el tiempo, que bajen los costos de producción y mejoren la calidad de la carne de pollo para el consumidor. El presente proyecto aplicado se desarrolló para evaluar técnica y económica la producción de pollo haciendo uso de trigo (Triticum vulgare), alfalfa (Medicago sativa) y cebada (Hordeum vulgare), como reemplazo de concentrado comercial en un 30% de las dietas propuestas. Se utilizaron 100 pollos de la línea Roos, los cuales se distribuyeron en 4 tratamientos, T0 (ABC Alimento balanceado comercial 100%,), T1 (ABC 70% + Trigo 30%), T2 (ABC 70% + Alfalfa 30%), T3 (ABC 70% + Cebada 30%); se hizo evaluación de ganancia de peso (GDP), conversión alimenticia (CA) y costos de producción (CP), utilizando el modelo de bloques completamente al zar y test de Duncan. De acuerdo al Anova no se encontraron diferencias significativas (P>0.05) en la GDP en gr, el mejor tratamiento fue el de T0, seguido por T3, T2 y T1 (66.30, 52.77, 55.28 y 60.38 gr. respectivamente). Para la CA el mejor tratamiento es el T0 (1.64) seguido por T3 (1.73), T2 (1.88) y finalmente el T1 (2.04). Aplicando el test de Duncan se encontró que la mejor propuesta tanto para GDP como la CA fue el T3. Realizado el análisis de costos el tratamiento T0, fue el de mayor inversión, pero a pesar de esto presento la mayor utilidad; los demás tratamientos a pesar de su reemplazo parcial del 30%, bajaron los costos; pero se presentó mayor mortalidad lo cual influyo negativamente en las rentabilidad económica de los tratamientos propuestos. Palabras clave. Avicultura, nutrición aviar, rentabilidad, sostenibilidad, balanceo de raciones.The production of broiler is one of the alternative agricultural activities for small producers in the Boyacá area; for which as professionals we must propose sustainable nutritional alternatives over time, which lower production costs and improve the quality of chicken meat for the consumer. The present project was developed to evaluate technically and economically the production of chicken using wheat (Triticum vulgare), alfalfa (Medicago sativa) and barley (Hordeum vulgare), as a commercial concentrate replacement in 30% of the proposed diets. 100 chickens of the Roos line were used, which were distributed in 4 treatments, T0 (ABC balanced commercial feed 100%,), T1 (ABC 70% + Wheat 30%), T2 (ABC 70% + Alfalfa 30%), T (ABC 70% + Barley 30%); weight gain (GDP), feed conversion (CA) and production costs (CP) were made, using the block model completely to the tsar and the Duncan test. According to the Anova, no significant differences were found (P> 0.05) in GDP in gr, the best treatment was T0, followed by T3, T2 and T1 (66.30, 52.77, 55.28 and 60.38 gr, respectively). For CA the best treatment is T0 (1.64) followed by T3 (1.73), T2 (1.88) and finally T1 (2.04). Applying the Duncan test it was found that the best proposal for both GDP and CA was T3. Once the cost analysis was done, the T0 treatment was the one with the highest investment, but in spite of this I present the greatest utility; the other treatments, despite their partial replacement of 30%, lowered the costs; but there was a higher mortality which negatively affected the economic profitability of the proposed treatments. Keywords. Poultry, avian nutrition, profitability, sustainability, ration balancing

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas

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

Background 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. Methods 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. Findings 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. Interpretation 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

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

Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

Death in hospital following ICU discharge: insights from the LUNG SAFE study

ackground: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors

Delaying surgery for patients with a previous SARS-CoV-2 infection

Not availabl