Predictors of Successful Decannulation Using a Tracheostomy Retainer in Patients with Prolonged Weaning and Persisting Respiratory Failure

Background: For percutaneously tracheostomized patients with prolonged weaning and persisting respiratory failure, the adequate time point for safe decannulation and switch to noninvasive ventilation is an important clinical issue. Objectives: We aimed to evaluate the usefulness of a tracheostomy retainer (TR) and the predictors of successful decannulation. Methods: We studied 166 of 384 patients with prolonged weaning in whom a TR was inserted into a tracheostoma. Patients were analyzed with regard to successful decannulation and characterized by blood gas values, the duration of previous spontaneous breathing, Simplified Acute Physiology Score (SAPS) and laboratory parameters. Results: In 47 patients (28.3%) recannulation was necessary, mostly due to respiratory decompensation and aspiration. Overall, 80.6% of the patients could be liberated from a tracheostomy with the help of a TR. The need for recannulation was associated with a shorter duration of spontaneous breathing within the last 24/48 h (p < 0.01 each), lower arterial oxygen tension (p = 0.025), greater age (p = 0.025), and a higher creatinine level (p = 0.003) and SAPS (p < 0.001). The risk for recannulation was 9.5% when patients breathed spontaneously for 19-24 h within the 24 h prior to decannulation, but 75.0% when patients breathed for only 0-6 h without ventilatory support (p < 0.001). According to ROC analysis, the SAPS best predicted successful decannulation {[}AUC 0.725 (95% CI: 0.634-0.815), p < 0.001]. Recannulated patients had longer durations of intubation (p = 0.046), tracheostomy (p = 0.003) and hospital stay (p < 0.001). Conclusion: In percutaneously tracheostomized patients with prolonged weaning, the use of a TR seems to facilitate and improve the weaning process considerably. The duration of spontaneous breathing prior to decannulation, age and oxygenation describe the risk for recannulation in these patients. Copyright (c) 2012 S. Karger AG, Base

Frailty in the critically ill: a novel concept

The concept of frailty has been defined as a multidimensional syndrome characterized by the loss of physical and cognitive reserve that predisposes to the accumulation of deficits and increased vulnerability to adverse events. Frailty is strongly correlated with age, and overlaps with and extends aspects of a patient's disability status (that is, functional limitation) and/or burden of comorbid disease. The frail phenotype has more specifically been characterized by adverse changes to a patient's mobility, muscle mass, nutritional status, strength and endurance. We contend that, in selected circumstances, the critically ill patient may be analogous to the frail geriatric patient. The prevalence of frailty amongst critically ill patients is currently unknown; however, it is probably increasing, based on data showing that the utilization of intensive care unit (ICU) resources by older people is rising. Owing to the theoretical similarities in frailty between geriatric and critically ill patients, this concept may have clinical relevance and may be predictive of outcomes, along with showing important interaction with several factors including illness severity, comorbid disease, and the social and structural environment. We believe studies of frailty in critically ill patients are needed to evaluate how it correlates with outcomes such as survival and quality of life, and how it relates to resource utilization, such as length of mechanical ventilation, ICU stay and duration of hospitalization. We hypothesize that the objective measurement of frailty may provide additional support and reinforcement to clinicians confronted with end-of-life decisions on the appropriateness of ICU support and/or withholding of life-sustaining therapies

An ‘isolated diffusion’ gravimetric calibration procedure for radar and microwave moisture measurement in porous building stone

Information about the presence and movement of water is crucial to understanding stone deterioration and rock weathering but hard to obtain. Non-destructive, non-invasive measurements of electromagnetic phenomena can provide proxy data on water contents within porous stone and rock. Commercial geophysical devices, such as radar and microwave moisture sensors, produce raw data or readings in arbitrary units, but can be related to absolute water contents through gravimetric calibration. Calibration procedures typically either equilibrate samples to a set of relative humidities (RH%) using salt solutions or environmental chambers (requiring specialised equipment), or monitor ambient drying which yields less homogenous moisture distributions and takes time. This study proposes and tests a cost- and time-effective ‘isolated diffusion’ gravimetric calibration procedure in which a set of samples are sealed at specific water contents and equilibrated. The procedure is compared to ambient drying over 120 h for three United Kingdom building stones and evaluated with modelled reflection coefficients and relative permittivities. The calibrations determined from isolated diffusion more closely follow modelled behaviour than those from ambient drying, as the calibrations developed from the latter were affected by uneven distributions of moisture. Calibrations for radar measurements developed from two types of back interfaces (air and metal) were very similar to one another, suggesting that measurements are consistent regardless of the type of back interface used. The isolated diffusion calibration procedure provides a cost-effective and simple method to facilitate comparison between different non-destructive testing methods and enables accurate measurement of water contents in porous geomaterials

The Olive Ridley Project (ORP): A successful example of how to engage researchers, conservation practitioners and civil society

The Olive Ridley Project (ORP) was set up to protect sea turtles and their habitats. The project was formed in 2013, and it became a registered charity in the UK in 2016. From its inception, ORP took a multidisciplinary approach to achieve its goals. Part of its objectives, and the reason why the charity came to fruition, are related to the issue of olive ridley sea turtle (Lepidochelys olivacea) entanglement in abandoned, lost or discarded fishing gear (also known as ‘ghost gear’ or ‘ghost nets’), and the search for ghost gear and turtle entanglement ‘hot spots’ throughout the Indian Ocean. The initial ORP research questions were soon challenged by societal interests to develop inclusive educational programmes in local communities and tourist resorts that could raise awareness about the need for conservation of all sea turtle species. In February 2017, ORP opened the first veterinarian-run, fully equipped Marine Turtle Rescue Centre in the Maldives, bringing together the work of researchers, citizen scientists, volunteers, environmentalists, marine biologists and veterinarians. The present work of ORP sits on a strong and scientifically robust collaborative plan. Current ORP research projects range from sea turtle population analyses, spatial ecology, rehabilitation of injured and sick individuals, epibiont parasite analyses, precise turtle identification through photo-ID research, linking ghost gear to responsible fisheries, and analyses of ghost gear drift patterns. The programme enhances community education and outreach by engaging schoolchildren, organizing workshops, promoting sustainable use of ghost gear waste, and training citizen scientists and local fishing communities. The ORP programme encompasses many principles of research engagement, effectively combining scientific knowledge, education and action. This article explores all stages of the process (from research planning and design, to knowledge exchange and inter- and trans-disciplinary impact assessments), describing the active engagement originated by the ORP initiative. A reflective insight into the learning, enrichment and challenges of engaging researchers and community actors is also included, considering the current social and scientific framework

Determinants of tracheostomy decannulation: an international survey

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Cross-reactive and cross-neutralizing activity of human mumps antibodies against a novel mumps virus from bats.

To evaluate the antigenic relationship between bat mumps virus (BMV) and the JL5 vaccine strain of mumps virus (MuV(JL5)), we rescued a chimeric virus bearing the F and HN glycoproteins of BMV in the genomic background of MuV(JL5) Cross-reactivity and cross-neutralization between this chimeric rMuV(JL5)-F/HN(BMV) virus and rMuV(JL5) were demonstrated using hyperimmune mouse sera and a curated panel of human sera. All mouse and human sera that were able to neutralize rMuV(JL5) infection had cross-neutralizing activity against rMuV(JL5)-F/HN(BMV) Our data suggests that people who have neutralizing antibodies against MuV might be protected from infection by BMV