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At least 19 recordsLinked to original sources

PubMed2000

The weaning continuum use of Acute Physiology and Chronic Health Evaluation III, Burns Wean Assessment Program, Therapeutic Intervention Scoring System, and Wean Index scores to establish stages of weaning.

OBJECTIVE: To determine whether four stages of weaning (acute, prewean, wean, and outcome) could be identified by using clinical instruments designed to quantify severity of illness, patient stability, or weaning readiness. The instruments used were the Acute Physiology and Chronic Health Evaluation (APACHE III), the Therapeutic Intervention Scoring System (TISS), the Burns Wean Assessment Program (BWAP), and the Wean Index (WI). The stages were adapted from those proposed by the American Association of Critical Care Nurses Third National Study Group's Weaning Continuum Model. DESIGN: Prospective, convenience cohort. This study was part of a larger study designed to test an outcomes managed approach to weaning by using an outcomes manager and a clinical pathway. SETTING: University medical intensive care unit. PATIENTS: Adult patients requiring mechanical ventilation >3 days admitted to the medical intensive care unit between November 1994 and May 1995. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Scores for the APACHE III, TISS, BWAP, and WI were collected on 97 patients every other day until they weaned, were transferred, or died. Outcomes described for each stage of weaning were dated on the clinical pathway when achieved. Comments about patient stability and ventilator progress also were recorded along with a subjective determination of the stage of weaning. We used decision rules to identify time intervals for each stage of weaning and outcomes attained by stage. Finally, APACHE III, TISS, BWAP, and WI scores were placed in each stage by date for analysis. The APACHE III, TISS, and BWAP scores were able to differentiate the acute, prewean, and wean stages but not the outcome stage. CONCLUSIONS: By identifying distinct scores for each stage, we may be able to better explore appropriate interventions for the stages as well as predict weaning outcomes. Indices that include physiologic and respiratory factors can differentiate weaning stages, but respiratory factors alone cannot.

APACHE↗

PubMed1989

Plasma lactose after weaning and its relationship with lactose content of milk, post-weaning plasma oestradiol-17 beta and weaning to mating interval in sows.

Twenty first-liter sows were used to investigate the relationship between plasma lactose concentrations following weaning and milk production, total milk content of lactose, post-weaning plasma oestradiol-17beta (E2) concentration and weaning to mating interval. Milk production was estimated from 6 out of 8 hourly successive "weighing-suckling-weighing" of piglets on day 21 of a 28-day lactation. Sows were cannulated in the jugular vein and sampled at 8-h intervals from 2 h to 66 h after weaning. Plasma lactose concentrations (means +/- SE) after weaning increased from 52 +/- 4 microM at the beginning of sampling to a peak value of 183 +/- 23 microM 40 h later and then decreased to 91 +/- 11 microM 66 h after weaning (P less than 0.001). Milk production on day 21 (7.5 +/- 0.3 kg) and the corresponding milk content of lactose (400.5 +/- 0.2 g) were not related (P greater than 0.10) to area under the curve, timing, amplitude and spreading of the lactose peak in plasma. Similarly, none of the characteristics of the lactose peak were related (P greater than 0.10) to weaning to mating interval. There was a linear increase (P less than 0.0001) in mean plasma E2 concentrations (means +/- SE) from 5.6 +/- 0.3 pg/ml, 2 h after weaning, to 12.9 +/- 1.2 pg/ml at the end of the sampling period. On a within-sow basis, there was a correlation (r = 0.28; P less than 0.01) between post-weaning plasma lactose and E2 concentrations. Results showed the existence of the post-weaning peak of plasma lactose in sows.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1988

[The performance of weaned piglets after a five week weaning period in relation to the weaning weight, the feed composition and the use of an effective ergotropic].

In a three-factorial experiment with 216 piglets of the same age (33 +/- 4 days) but a different weight (weaning weight from 5.5 to 9 kg) a conventional piglet rearing feed containing 20% crude protein (standard), a high-energy diet and a low-protein diet (16% crude protein) were tested. In three weaning weight classes the three diets were fed without or with Bisergon [2-N-(2-hydroxyethyl)-carbamoyl-3-methylquinoxaline-1.4-dioxide] over a period of 21 days. From the 22nd to the 71st day after weaning all the piglets received the standard diet without ergotropic. Among the factors studied the Bisergon supplement had the biggest effect. The additional weight gain varied from 9% in case of heavy piglets fed the high energy diet to 150% in case of light piglets fed the low protein diet. The ergotropic improved feed conversion by 22% and lowered the frequency of gastrointestinal diseases requiring treatment by 28%. At the end of the rearing period the weight of the piglets initially fed with Bisergon (means = 34.6 kg) was significantly higher than that of the control animals (means = 31.6 kg). The weaning weight and the diets influenced the final weight especially in the groups without ergotropic. In this case the piglets fed with the high-energy diet gained 30% more and those fed with the low-protein diet 40% less compared with the standard group. The average live weight gain of the light piglets (weaning weight 6.1 kg) was 30% lower than that of the heavier piglets (weaning weight 8.5 kg). The frequency of treatment against diarrhoea of the heavy piglets was by one third lower than that of the light animals. The piglets fed with the low-protein diet appeared to show a limitation of gastrointestinal diseases, but these animals also had the lowest feed intake. Independent of the Bisergon supplementation the weaning weight clearly influenced the live weight after the 10-week experiment. The initially better development of the animals started with the high-energy diet was compensated. In contrast to this, the piglets weighing 6.1 and 7.2 kg fed with the low-protein diet could not compensate the retarded development in comparison with the piglets fed with the standard or the high-energy diet. This experiment confirms the enormous improvement of the performance and of the health status of weaned piglets caused by the ergotropic Bisergon.(ABSTRACT TRUNCATED AT 400 WORDS)

Animal Feed↗

PubMed1999

Is there a preferred technique for weaning the difficult-to-wean patient? A systematic review of the literature.

OBJECTIVE: To answer the following question: In difficult-to-wean patients, which of the three commonly used techniques of weaning (T-piece, synchronized intermittent mandatory ventilation, or pressure support ventilation) leads to the highest proportion of successfully weaned patients and the shortest weaning time? DATA SOURCES: Computerized literature searches in MEDLINE (1975-1996), Cinahl (1982-1996), and Healthplan (1985-1996), exploding all Mesh headings pertaining to Mechanical Ventilation and Weaning. Searches were restricted to the English language, adults, and humans. Personal files were hand searched, and references of selected articles were reviewed. STUDY SELECTION: a) POPULATION: Patients requiring a gradual weaning process from the ventilator (either requiring prolonged initial ventilation of >72 hrs or a failed trial of spontaneous breathing after >24 hrs of ventilation); b) INTERVENTIONS: At least two of the following three modes of weaning from mechanical ventilation must have been compared: T-piece, synchronized intermittent mandatory ventilation, or pressure support ventilation; c) OUTCOMES: At least one of the following: weaning time (time from initiation of weaning to extubation) or successful weaning rate (successfully off the ventilator for >48 hrs); and d) STUDY DESIGN: Controlled trial. DATA EXTRACTION: Two reviewers independently reviewed the articles and graded them according to their methodologic rigor. Data on the success of weaning and the time to wean were summarized for each study. DATA SYNTHESIS: The search strategy identified 667 potentially relevant studies; of these, 228 had weaning as their primary focus, and of these, 48 addressed modes of ventilation during weaning. Only 16 of these 48 studies had one of the specified outcomes, and only ten of these were controlled trials. Of the ten trials, only four fulfilled all our selection criteria. The results of the trials were conflicting, and there was heterogeneity among studies that precluded meaningful pooling of the results. CONCLUSIONS: There are few trials designed to determine the most effective mode of ventilation for weaning, and more work is required in this area. From the trials reviewed, we could not identify a superior weaning technique among the three most popular modes, T-piece, pressure support ventilation, or synchronized intermittent mandatory ventilation. However, it appears that synchronized intermittent mandatory ventilation may lead to a longer duration of the weaning process than either T-piece or pressure support ventilation. Finally, the manner in which the mode of weaning is applied may have a greater effect on the likelihood of weaning than the mode itself.

Controlled Clinical Trials as Topic↗

PubMed1991

Effect of fractionated weaning on hormonal patterns and weaning to oestrus interval in primiparous sows.

The effect of weaning the 4-5 heaviest piglets in the litter on day 33 of lactation and the remainder 2 days later (fractionated weaning) on plasma levels of prolactin, cortisol, oestradiol-17 beta (E2), progesterone (P4) and LH, as well as on the weaning to oestrus interval in primiparous sows was studied. Twelve crossbred sows were grouped into 6 pairs according to farrowing date and litter size. The litter of 1 sow in each pair (F) was weaned in 2 stages, and the other conventionally weaned at 35 days (C). Blood samples were collected via a permanent jugular vein catheter every 3 h from 9 a m to 9 p m daily throughout the experimental period, and intensively at 15 min intervals for 12 h on the day of first and final weaning and for 6 h on the day after each weaning. All sows were slaughtered following their first post-weaning oestrus and the reproductive organs were macroscopically examined. Lactational oestrus was not observed in any of the sows. Sows from 5 out of 6 pairs showed oestrus within 8 days of weaning and post-mortem examination showed normal ovulation. There was a tendency for the F sows to have a shorter weaning to oestrus interval, as compared with the C sows (5 of 6 pairs, 4.8 days v 5.6 days). The plasma levels of prolactin around weaning were not significantly different between the 2 groups. Within 6 h after final weaning, the prolactin concentrations decreased gradually from 7.6 and 8.7 to 1.6 and 1.7 microgram/l in the control and treatment groups, respectively. The plasma levels of cortisol, showing a diurnal rhythm (with the lowest level at 6 and/or 9 p m), did on no occasion differ between the 2 groups. On the day of final weaning, no diurnal rhythm was observed, with cortisol remaining high at 6 and 9 p m. The plasma levels of E2 and P4 were low until final weaning in both groups. After final weaning the E2 levels rose faster in the F sows than in the C sows, to 44.3 and 34.8 pmol/l, respectively, on day 2 (p less than 0.01). No significant differences in levels of plasma LH and the number of LH pulses were observed between the groups. After final weaning the average and base levels of LH and the number of LH pulse(s) increased significantly.

Animals↗

PubMed1998

Endocrine responses to weaning and changes in post-weaning diet in the young pig.

The effects of weaning and changing post-weaning diet composition on growth patterns and growth-related hormonal profiles were evaluated in neonatal pigs. Forty-eight crossbred piglets were assigned to two groups (n = 24/group) based on weaning at 2 or 3 wk of age (2W and 3W groups. respectively). At weaning, piglets were removed from the sow and placed on a commercial starter ration for the first 11 d post-weaning (Phase I diet). At Day 12 post-weaning, pigs were placed on a growing ration for the remainder of the study (Phase II diet). Body weights and blood samples were collected twice weekly from birth until 42 d of age. Serum insulin-like growth factor (IGF)-1, IGF-2, and average daily gain (ADG) were reduced (P < 0.05) in both groups as a result of weaning, whereas serum growth hormone (GH) was elevated (P < 0.05). Earlier weaning resulted in a greater reduction in growth rate and serum IGF-2 values (P < 0.05). Mild reductions in ADG occurred after the Phase I to II dietary change in both weaning groups (P < 0.05), but serum IGF-1 decreased only in the 2W group (P < 0.05). Growth hormone concentrations tended to increase after the change in post-weaning diets (P = 0.07 and 0.16 in 2W and 3W, respectively). Serum thyroxine (T4) and triiodothyronine (T3) levels were unaltered by weaning but declined in both groups after the change in starter diets (P < 0.05). Changes in cortisol concentrations were not associated with weaning or the change in post-weaning diets. With the exception of serum IGF-1 concentrations, which were elevated in the 2W group, growth and endocrine endpoints were equivalent between experimental groups at the end of the study (42 d of age). These results indicate that earlier weaning and changing solid diets can more severely affect patterns of early growth and related hormone secretion, but effective compensatory mechanisms restore normal physiological and physical development.

Animal Feed↗

PubMedDate not supplied

Prevalence of myocardial ischemia during mechanical ventilation and weaning and its effects on weaning success.

BACKGROUND: Myocardial ischemia may be considered both a consequence of weaning from ventilation and a potential cause of weaning failure. A limited number of investigations have evaluated myocardial ischemia during mechanical ventilation and weaning and its effect on weaning success. The purpose of this pilot investigation was to determine the prevalence of myocardial ischemia in a diverse group of medical intensive care unit (MICU) patients during baseline mechanical ventilation, during weaning using continuous positive airway pressure, and up to 24 hours after extubation and to evaluate the relationship between ischemia and weaning failure. METHODS: This study was a prospective, repeated-measure, descriptive investigation that studied 43 ventilated MICU patients. Slightly more than half of participants were male (53%), and participants had a mean age of 51.1 +/- 14.6 years and were ventilated an average of 11.7 +/- 11.3 days. Myocardial ischemia was evaluated by examination of plasma cardiac troponin I, creatine phosphokinase-myocardial band (CK-MB), and ST-segment changes on electrocardiogram. Continuous electrocardiographic data were obtained by a calibrated, frequency-modulated, continuous 3-channel electrocardiographic recorder using leads I, II, and V2. RESULTS: Seventy percent of these participants (n = 30) exhibited ST-segment deviation at some point during data collection (baseline mechanical ventilation, during weaning, after extubation). Twenty-four participants exhibited ST-segment deviation at baseline, 7 during weaning, and 8 after extubation. Nine participants exhibited ST-segment deviation at >1 data collection time point. None had ST-segment deviation at all 3 time points. Cardiac enzyme concentrations were highly variable; five participants demonstrated clinically important increases in either CK-MB and/or troponin I. Thirty-five percent of participants required >1 weaning trial. Participants who exhibited ST-segment deviation during baseline ventilation were 60% more likely to fail their initial weaning trial. There were no significant differences in CK-MB or troponin I levels between those participants who were successfully weaned with 1 trial and those who failed to wean during that first trial. CONCLUSIONS: Silent myocardial ischemia was a common occurrence in this diverse group of MICU patients, although only 21% had previously diagnosed coronary disease. Clinicians must be aware of the potential for silent ischemia, monitor and evaluate their patients for such, and intervene to promote optimal cardiovascular function, particularly during the stress of ventilator weaning.

Adult↗

PubMed2003

Weaning practices among breastfeeding women who weaned prior to six months postpartum.

We describe weaning practices among 222 breastfeeding mothers who weaned their babies < or = 6 months postpartum. After initiating weaning, one fourth of participants weaned within 2 days and three fourths by 14 days (range, 0-90 days). Shorter weaning duration was associated with earlier ages at weaning. After adjustment for time of weaning, women who returned to work were more likely to take > 3 days to wean (odds ratio = 2.98; 95% confidence interval = 1.53, 5.79). Women weaning in < or = 3 days versus 4 or more days were more likely to report binding their breasts (31% or 15%, P = .007) or using ice packs (9% vs 1%, P = .0006) and were more likely to report feeling happier since weaning (23% vs 9%, P = .005). Most women weaning < or = 6 months postpartum took 4 or more days to wean their baby. Experience and anecdote have been the norm in informing weaning practices. This study is a first step toward more rigorous evaluation.

Adolescent↗

PubMed1997

Factors associated with prolonged weaning-to-mating interval among sows on farms that wean pigs early.

OBJECTIVE: To determine factors associated with weaning-to-mating interval among sows on commercial farms that wean pigs early. DESIGN: Cohort study. ANIMALS: 11,861 farrowing sows. PROCEDURE: Production, farrowing, and feed intake records were reviewed for sows on 16 farms for which mean duration of lactation was between 14.9 and 18.9 days. RESULTS: Among sows with high feed intake during lactation (> or = 5.6 kg/d [12.3 lb/d]), lactation duration was not associated with weaning-to-mating interval, but among sows with low feed intake during lactation (< 5.6 kg/d), weaning-to-mating interval increased as lactation duration decreased. Furthermore, among sows with the lowest feed intake during lactation (< 4.2 kg/d [9.2 lb/d]), those that had heavier litter weights at weaning (> 54 kg [119 lb]) had a longer weaning-to-mating interval than did those that had lighter litter weights at weaning. Sows with low feed intake and high litter weight at weaning accounted for 5 to 20% of sows on each farm. In general, weaning-to-mating interval increased as parity decreased, but the change in weaning-to-mating interval associated with a particular change in lactation duration varied with parity. CLINICAL IMPLICATIONS: When feed intake during lactation is maximized (> or = 5.6 kg/d), lactation duration is not significantly associated with weaning-to-mating interval. Producers should consider fostering or partially weaning litters when sows with high litter weights are not consuming sufficient feed.

Analysis of Variance↗

PubMed2004

Effect of early weaning, split-weaning and nursery feeding programmes on the growth of Landrace x Desi pigs.

An experiment using 164 crossbred pigs born to 20 first-parity sows was conducted to evaluate the growth performance of piglets in four weaning management regimens: T1, conventional weaning at 56 days; T2, early weaning at 28 days; T3, split-weaning of the heavier half of the litter at day 28, the remaining half being weaned at 56 days; and T4, split-weaning of the lighter half of the litter at 28 days, with the animals kept on a special nutrient diet up to 56 days, and the heavier half being weaned at 56 days. Split-weaning of the lighter half in combination with feeding a special nutrient diet resulted in an increase of average daily gain of 21% from day 28 to day 140 compared to conventional weaning and of 36% compared to early weaning at day 28. Compared to the control (T1), the average weights of piglets at the 140th day in groups T4 and T3 were 19.6% and 6.16%, respectively, higher, whereas that of the T2 was 8% lower. It is concluded that feeding a special nutrient diet to lighter pigs is beneficial in overcoming the post-weaning lag and enables maximal weight gain.

Animal Feed↗

PubMed1991

Digestive development of the early-weaned pig. 1. Effect of continuous nutrient supply on the development of the digestive tract and on changes in digestive enzyme activity during the first week post-weaning.

Gastric intubation was adopted to examine the effect of continuous nutrient supply on digestive development of the pig during the immediate post-weaning period. The 14 d-weaned animals were slaughtered at 3, 5 and 7 d post-weaning (3W, 5W and 7W respectively) and the suckled animals were slaughtered at 14 and 22 d of age (14SR and 22SR respectively). The weight of the pancreas (g/kg bodyweight) was significantly greater (P less than 0.05) in the 5W and 7W groups, as was the weight of large intestine (g/kg) in all weaned groups (P less than 0.01) compared with sow-reared pigs. The stomach weight (g/kg) tended to be greater in the weaned groups. Weaning, in conjunction with a continuous nutrient supply, did not significantly alter the time-related changes in the weight of the small intestine (SI) or the SI mucosa, although both variables tended to be lowest in the 3W group. However, there was a 20% reduction in the protein content of the mucosa within the first 3 d post-weaning (P less than 0.01) which persisted during the 7 d experimental period. Lactase, (beta-galactosidase; EC 3.2.1.23) activity (mumol/g protein and mol/d) of the 7W group was reduced to approximately 40% of the 22SR value. Hence, continuous nutrient supply may have delayed, but did not prevent, the loss of lactase activity at weaning. The activity of sucrase (sucrose-alpha-glucosidase; EC 3.2.1.48) was significantly higher in 22SR compared with 14SR animals. Sucrase activity in weaned pigs was intermediate to the values for sow-reared pigs whereas maltase (alpha-glucosidase; EC 3.2.1.20) and glucoamylase (glucan 1,4-alpha-glucosidase; EC 3.2.1.3) were significantly increased in relation to their sow-reared counterparts. Continuous nutrient supply did not prevent the reduction in villous height and the crypt hypertrophy associated with weaning. The results of the present study suggest that there may be some degree of interaction between nutrient intake and gut development during the immediate post-weaning period but that there is also a component of the adaptive response which is independent of nutrient intake. They confirm the rapid substrate induction of the brush-border glucoamylases and indicate the importance of considering total as well as specific enzyme activity for satisfactory interpretation of changes in digestive function.

Animal Nutritional Physiological Phenomena↗

PubMed1998

Relationships between age at puberty and interval from weaning to estrus and between estrus signs at puberty and after the first weaning in pigs.

The study comprises observations in 464 Swedish Yorkshire pigs at puberty and after the first weaning. The aim was to study relationships between age at puberty and weaning to estrus interval and between estrus signs at puberty and after the first weaning. The estrus signs were checked, and blood samples for progesterone determination were drawn regularly around puberty and after the first weaning. Gilts expressing early puberty (youngest one-third) showed a greater ability to return to estrus and to ovulate within 10 d after weaning than gilts expressing late puberty (oldest one-third) (P = .01). A positive genetic correlation was found between age at puberty and the interval from weaning to the first detected estrus (WEI) (rg = .45). The genetic correlation between age at puberty and the ability to show the standing reflex and to ovulate within 10 d after weaning was negative (rg = -.50). The heritability of the ability to show the standing reflex and to ovulate within 10 d after weaning was .31. Gilts not showing a standing reflex at puberty also had a higher incidence of ovulation without a standing reflex within 10 days after their first weaning (21.4 vs 6.2%, P = .001). There was a significant positive correlation between the total duration and the intensity of the reddening and swelling of the vulva at puberty and after the first weaning. This study demonstrates relationships both between age at puberty and WEI and between some estrus signs at puberty and after the first weaning.

Aging↗

PubMed2006

Effect of weaning age and commingling after the nursery phase of pigs in a wean-to-finish facility on growth, and humoral and behavioral indicators of well-being.

Pigs from one farrowing group in which gilts were bred to farrow pigs that would be either 14 or 21 d of age at weaning, were divided into older and younger age groups (108 pigs per group) and penned 12 pigs per pen in a wean-to-finish facility. At the end of the nursery phase, half the pigs in each age group were removed, rerandomized, and commingled for the finishing phase. The other half remained in their original pens. Pigs were fed common Phase 1 (d 0 to 14) and Phase 2 (d 14 to 35) nursery diets, and a common 4-phase program diet during growing/finishing, with transitions at 45, 68, and 90 kg of BW. The study ended when the lightest weight block averaged 107 kg. Blood was obtained on d 0, 2, 10, 27, 37, 44, and 65 after weaning to determine leukocyte concentrations. In addition, behavior was monitored during the nursery period at weaning (d 0), on d 7, 14, and 27 after weaning, and during the growing/finishing phase on d 35 (after commingling following the nursery phase), 38, 44, and 65 after weaning. Older pigs were heavier (P < 0.001) throughout the nursery period, and the BW difference between younger and older pigs increased from 2 to 6.5 kg at the start and end of the nursery period, respectively. Older pigs had a greater concentration of white blood cells (P < 0.05) and lymphocytes (P < 0.10) on d 0, 2, and 10 after weaning than younger pigs. Younger pigs spent less (P < 0.05) time resting on the day of weaning, and more (P < 0.05) time active during the overall nursery phase. During Phase 3 and in the overall finishing phase, younger pigs had greater (P < 0.01) ADG and G:F than older pigs. Moreover, during Phase 3, ADFI (as fed) decreased (P < 0.05) when older pigs were commingled compared with older pigs that were not commingled. There was no difference in ADFI of younger pigs, regardless of commingling (interaction; P < 0.10). Results of this study indicate that weaning age affects growth performance in a wean-to-finish facility, as well as behavioral and immunological responses to weaning and commingling after the nursery phase. Management strategies should be further explored to optimize these benefits without the detrimental effects on health observed during the nursery period in this study.

Age Factors↗

PubMed2001

Weaning children from mechanical ventilation: a prospective randomized trial of protocol-directed versus physician-directed weaning.

OBJECTIVE: Compare outcomes between physician-directed and protocol-directed weaning from mechanical ventilation in pediatric patients. DESIGN: Prospective-randomized. SETTING: Pediatric and cardiac intensive care units in a 307-bed tertiary referral hospital for children. INTERVENTIONS: The control group (physician-directed) was weaned according to individual physician order for reduction in minute ventilation, positive end-expiratory pressure, and ordered oxygen saturation parameters for reduction in fraction of inspired oxygen (F(IO)(2)). The study group (protocol-directed) was weaned according to a predetermined algorithm developed for the purpose of this investigation. METHODS: The study enrolled 223 patients (116 physician-directed, 107 protocol-directed). All patients were monitored for hemodynamics, ventilator parameters, arterial blood gas values when available, oxygen saturation, weaning time, pre-weaning time, extubation time, and time on F(IO)(2) > or = 0.40. We also monitored the incidence of reintubation, subglottic stenosis, tracheitis, and pneumonia. The protocol-directed group had additional measurements of actual versus predicted minute volume, comparisons of respiratory rate (actual versus predicted for age), and presence of spontaneous breathing effort for 10 consecutive minutes. Data analysis was done according to intent to treat. RESULTS: There was no significant difference in 12-hour and 24-hour pediatric risk of mortality (PRISM III) scores between groups. The protocol-directed group overall had shorter total ventilation time, weaning time, pre-weaning time, time to extubation, and time on F(IO)(2) >0.40, although after stratification for respiratory diagnosis, only the difference in weaning time remained significant. There was no difference in the incidence of reintubation, new-onset tracheitis, subglottic stenosis, or pneumonia. CONCLUSIONS: Protocol-directed weaning resulted in a shorter weaning time than physician-directed weaning in these pediatric patients.

Algorithms↗

PubMed2006

Is there a "right" way to wean my patient from the ventilator? A critical appraisal of Randolph et al: Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial (JAMA 2002; 288:2561-2568).

OBJECTIVE: To review the findings and discuss the implications of mechanical ventilator weaning protocols in children. DESIGN: A critical appraisal of Randolph et al. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial. JAMA 2002;288:2561-2568, and literature review. FINDINGS: There was no difference in ventilator weaning times between children randomized to a ventilator weaning protocol (pressure support, volume support, or no protocol). However, the study did show that increased sedative use during the first 24 hrs of weaning (the only time during which these data were collected) was an important predictor of weaning duration (p < .001) and weaning failure (p = .04). CONCLUSIONS: The majority of children are weaned from mechanical ventilation over a short period of time. Weaning protocols may not shorten this brief duration of weaning but may have other advantages such as improved collaboration between healthcare team members. Future research into the effects of sedation on weaning from mechanical ventilation is needed in children.

Journal Article↗

PubMed1996

Influence of weaning age and nursery diet complexity on growth performance and carcass characteristics and composition of high-health status pigs from weaning to 109 kilograms.

We examined the influence of weaning age (9 or 19 +/- 1 d) and nursery diet complexity on growth performance and carcass composition of 192 high-health status barrows from weaning to 109 kg. Pigs were fed diets of different complexity (high, medium, or low) in various regimens from weaning to 18.7 kg. They then were fed common corn-soybean meal-based diets from 18.7 to 109 kg. Increasing diet complexity improved ADG from weaning to 7.0 kg (P < .10) but had no effect (P > .10) from 7.0 to 18.7 kg. Thus, increasing diet complexity seems to improve ADG only in the early period after weaning. Age at 109 kg was similar (P > .10) for the pigs weaned at 9 and 19 d. However, pigs fed the medium-complexity regimens were the youngest (P < .01) at 109 kg. Interactions (P < .06) were observed for carcass lipid and lipid:protein accretion from 18.7 to 109 kg. These were the result of pigs weaned at 9 d of age having higher carcass lipid and lipid:CP accretion rates when fed the low-complexity regimens than when fed the medium- or high-complexity regimens. However, pigs weaned at 19 d of age had similar carcass lipid and lipid:protein accretion ratios regardless of diet complexity. When health status was similar, growth performance was similar between weaning ages but was influenced by diet complexity. Carcass lipid and lipid:protein deposition ratios increased when simple regimens were fed to pigs weaned at 9 d of age in the subsequent growing-finishing period.

Aging↗

PubMed2004

Weaning from long-term mechanical ventilation: a nonpulmonary weaning index.

OBJECTIVE: Despite the extensive investigations in the area of weaning, clinicians are still struggling with the question of when to begin the process of weaning. Clinical weaning indices designed to predict the weaning potential are most frequently based on pulmonary factors. However, many physiological, respiratory, and mechanical factors also have impact on weaning, but are often overlooked. We suggest a new "nonpulmonary weaning index" (NPWI), which assesses the influence of factors such as blood albumin and total blood protein on the weaning success. METHODS: We assess the information value of 17 clinical and paraclinical indices in a retrospective study covering 151 patients on a long-term (at least 7 days) mechanical ventilation. The most informative of those 17 indices are used in the formulation of NPWI. Its threshold differentiates the successful from the unsuccessful weaning trials. RESULTS: From all 17 indices the most significant are: total blood protein, blood albumin, PaO2, hematocrit, lactate, the ratio PaO2/FiO2, hemoglobine, and RUE. The proposed index uses only two of them: blood albumin and total blood protein. It is easily calculated and can easily be tracked in time. It has high sensitivity and specificity. CONCLUSIONS: The results of this study suggest that in the decision whether to attempt weaning from long-term mechanical ventilation, more attention should be paid to the nonpulmonary factors.

Adolescent↗

PubMed1999

[Withdrawal from the respirator (weaning) in long-term ventilation. The results in patients in a weaning center].

BACKGROUND AND OBJECTIVE: Patients subjected to an increased load and with a decreased capacity of their respiratory muscles may be difficult to wean from mechanical ventilation. Using a weaning strategy with a focus on unloading respiratory muscles may be successful even after long-term mechanical ventilation. In a prospective uncontrolled study, we examined the outcome of our weaning protocol. PATIENTS AND METHODS: Under prolonged mechanical ventilation in outlying intensive care units (44.3 +/- 38.1 days) 232 patients (64.8 +/- 12.7 years, 149 males, 83 females) with the following underlying diagnoses were investigated: chronic obstructive pulmonary disease (54.3%), neuromuscular diseases (16%), thoracic restriction (10.8%), chronic left heart failure (7.3%), postsurgical ventilatory failure (6.9%) and miscellaneous conditions (4.7%). Our weaning strategy was focused on type of mechanical ventilation, endotracheal tubes, non-invasive interface, oxygen supply and transport capacity, body position and home mechanical ventilation, if an increased load or a decreased capacity of the respiratory muscles remained after weaning. RESULTS: Altogether 65% of the patients (n = 152) were weaned in a mean duration of 7.5 days. Intermittent home mechanical ventilation followed in 45 patients (19.4%). In our hospital died 64 patients (27.6%). After a stay of 19.7 +/- 12.2 days in our hospital 72.4% of the patients (n = 168) were discharged. The postdischarge 3-month mortality of the cohort was 36.5%. CONCLUSION: Applying our weaning strategy about 65% of the patients requiring long-term mechanical ventilation were successfully weaned. Weaning was achieved in approximately one fifth of the time previously spent on mechanical ventilation. However, the 3-month mortality of the investigated cohort was 36.3%.

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