Weaning protocols and automatic modes

Weaning of 150 days post hatch Lota lota from live feed (zooplankton) to formulated dry feed (FDF) was investigated. L. lota could not be forced from live feed to FDF. They refused FDF for periods up to 21 d. Body mass decreased for 20%, condition factor for 15%, and hepatosomatic index for 50%. In 21 days lasting co-feeding experiments with FDF and live feed L. lota selected exclusively the live feed organisms. NaCl in a concentration of 5% was a dietary feeding attractant for L. lota. When FDF was supplemented with 5% NaCl, L. lota could be abruptly weaned from live to dry feed. During a 21 d lasting experiment body mass increased for circa 40%, total length for 10%, condition factor for 5% and hepatosomatic index remained constant. These values were similar to live zooplankton feeding. However, increased mortality of > 20% was recorded for fish fed with the 5% NaCl containing FDF. To reduce mortality FDF was supplemented with zooplankton meal to upgrade its quality and extruded to optimize its density and sedimentation rate. With the adjusted FDF mortality rates were reduced to < 5%. Using the optimized dry feed easy and sustainable weaning protocols were developed where NaCl and zooplankton meal were gradually reduced to adapt fish to pure FDF.

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Opioid tapering and weaning protocols in pediatric critical care units: a systematic review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.10.909 ◽

2018 ◽

Vol 64 (10) ◽

pp. 909-915 ◽

Cited By ~ 1

Author(s):

Pedro Bichaff ◽

Karina T Setani ◽

Emiliana H. G Motta ◽

Artur F Delgado ◽

Werther B Carvalho ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Initial Dose ◽

Assessment Tool ◽

Experimental Studies ◽

Pediatric Intensive Care ◽

Signs And Symptoms ◽

Abstinence Syndrome ◽

Great Heterogeneity ◽

Weaning Protocols

SUMMARY OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly. METHODS: A systematic review was made from data of four different databases. Forty-nine articles of observational and experimental studies were selected based on the inclusion criteria (critical pediatric patients in acute use of opioids) and exclusion criteria (previous chronic use of opioids, other medications). The data regarding specific themes were separated in sections: initial dose of methadone, use of protocols in clinical practice, abstinence scales and adjuvant drugs. RESULTS: The articles showed a great heterogeneity of ways to calculate the initial dose of methadone. The pediatric intensive care units of the study had different weaning protocols, with a lower incidence of abstinence when a pre-defined sequence of tapering was used. The Withdrawal Assessment Tool – 1 was the most used scale for tapering the opioids, with good sensitivity and specificity for signs and symptoms. CONCLUSION: There is still little evidence of other medications that can help prevent the abstinence syndrome of opioids. This study tries to promote a better practice during opioid weaning.

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Weaning Protocols After Ambulatory Surgery

Pain Control in Ambulatory Surgery Centers ◽

10.1007/978-3-030-55262-6_28 ◽

2021 ◽

pp. 369-377

Author(s):

Nitish Aggarwal ◽

Jill Zafar ◽

Gopal Kodumudi ◽

Nalini Vadivelu ◽

Maxwell Laurans ◽

...

Keyword(s):

Ambulatory Surgery ◽

Weaning Protocols

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Perceptions of Physicians, Nurses, and Respiratory Therapists About the Role of Acute Care Nurse Practitioners

American Journal of Critical Care ◽

10.4037/ajcc2004.13.6.480 ◽

2004 ◽

Vol 13 (6) ◽

pp. 480-488 ◽

Cited By ~ 30

Author(s):

Leslie A. Hoffman ◽

Mary Beth Happ ◽

Carmella Scharfenberg ◽

Dana DiVirgilio-Thomas ◽

Frederick J. Tasota

Keyword(s):

Critical Care ◽

Acute Care ◽

Nurse Practitioners ◽

Medical Management ◽

Management Teams ◽

Care Nurse ◽

Respiratory Therapists ◽

Attending Physicians ◽

Weaning Protocols ◽

Family Focus

• Background Information about the contributions of acute care nurse practitioners to medical management teams in critical care settings is limited.• Objective To examine contributions of acute care nurse practitioners to medical management of critically ill patients from the perspectives of 3 disciplines: medicine, respiratory care, and nursing.• Methods Attending physicians, respiratory therapists, and nurses in 2 intensive care units were asked to list 3 advantages and 3 disadvantages of collaborative care provided by acute care nurse practitioners. Qualitative methods (coding/constant comparative analysis) were used to identify common themes and subthemes. Overall response rate was 35% (from 69% for attending physicians to 26% for nurses).• Results Responses were grouped into 4 main themes: accessibility, competence/knowledge, care coordination/communication, and system issues. Acute care nurse practitioners were valued for their accessibility, expertise in routine daily management of patients, and ability to meet patient/family needs, especially for “long-stay” patients. Also, they were respected for their commitment to providing quality care and for their communication skills, exemplified through teaching of nursing staff, patient/family involvement, and fluency in weaning protocols. Physicians valued acute care nurse practitioners’ continuity of care, patient/family focus, and commitment. Nurses valued their accessibility, commitment, and patient/family focus. Respiratory therapists valued their accessibility, commitment, and consistency in implementing weaning protocols.• Conclusion Responses reflected unique advantages of acute care nurse practitioners as members of medical management teams in critical care settings. Despite perceptions of the acute care nurse practitioner’s role as medically oriented, the themes reflect a clear nursing focus.

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A comprehensive protocol for ventilator weaning and extubation: a prospective observational study

Journal of Intensive Care ◽

10.1186/s40560-019-0402-4 ◽

2019 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Kenichi Nitta ◽

Kazufumi Okamoto ◽

Hiroshi Imamura ◽

Katsunori Mochizuki ◽

Hiroshi Takayama ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Decision Making ◽

Unit Length ◽

Spontaneous Breathing Trial ◽

Ventilator Weaning ◽

University Hospital ◽

Positive Pressure ◽

Weaning Protocols

Abstract Background Ventilator weaning protocols have been shown to reduce the duration of mechanical ventilation (MV), intensive care unit length of stay, and resource use. However, weaning protocols have not significantly affected mortality or reintubation rates. The extubation process is a critical component of respiratory care in patients who receive MV. Post-extubation respiratory failure (PERF) is a common event associated with significant morbidity and mortality. We hypothesized that a comprehensive protocol for ventilator weaning and extubation would be effective for preventing PERF and reintubation and reducing mortality in critically ill patients. Methods A ventilator weaning and extubation protocol was developed. The protocol consisted of checklists across four evaluations: spontaneous breathing trial, extubation, prophylactic non-invasive positive pressure ventilation (NPPV), and evaluation after extubation. Observational data were collected after implementing the protocol in patients admitted to the Advanced Emergency and Critical Care Center of Shinshu University Hospital. Not only outcomes of patients but also influences of each component of the protocol on the clinical decision-making process were investigated. Further, a comparison between PERF and non-PERF patients was performed. Results A total of 464 consecutive patients received MV for more than 48 h, and 248 (77 women; mean age, 65 ± 17 years) were deemed eligible. The overall PERF and reintubation rates were 9.7% and 5.2%, respectively. Overall, 54.1% of patients with PERF received reintubation. Hospital stay and mortality were not significantly different between PERF and non-PERF patients (p = 0.16 and 0.057, respectively). As a result, the 28-day and hospital mortality were 1.2% and 6.9%, respectively. Conclusions We found that the rates of PERF, reintubation, and hospital mortality were lower than those in previous reports even with nearly the same degree of severity at extubation. The comprehensive protocol for ventilator weaning and extubation may prevent PERF and reintubation and reduce mortality in critically ill patients.

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