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We describe cases of intestinal failure wherein inpatient admission was critical toward enteral autonomy. We performed a retrospective chart review of 6 children with long-term parenteral nutrition dependence who were weaned from parenteral nutrition after admission. Admissions included feeding and medication titration, interdisciplinary care, and a home parenteral nutrition team consultation.
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This pilot study aimed to investigate the relation between cardio-respiratory parameters derived from Central Venous Pressure (CVP) waveform and Extubation Failure (EF) in mechanically ventilated ICU patients during post-extubation period. This study also proposes a new methodology for analysing these parameters during rest/sleep periods to try to improve the identification of EF. We conducted a prospective observational study, computing CVP-derived parameters including breathing effort, spectral analyses, and entropy in twenty critically ill patients post-extubation. The Dynamic Warping Index (DWi) was calculated from the respiratory component extracted from the CVP signal to identify rest/sleep states. The obtained parameters from EF patients and patients without EF were compared both during arbitrary periods and during reduced DWi (rest/sleep). We have analysed data from twenty patients of which nine experienced EF. Our findings may suggest significantly increased respiratory effort in EF patients compared to those successfully extubated. Our study also suggests the occurrence of significant change in the frequency dispersion of the cardiac signal component. We also identified a possible improvement in the differentiation between the two groups of patients when assessed during rest/sleep states. Although with caveats regarding the sample size, the results of this pilot study may suggest that CVP-derived cardio-respiratory parameters are valuable for monitoring respiratory failure during post-extubation, which could aid in managing non-invasive interventions and possibly reduce the incidence of EF. Our findings also indicate the possible importance of considering sleep/rest state when assessing cardio-respiratory parameters, which could enhance respiratory failure detection/monitoring.
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Extubação , Pressão Venosa Central , Unidades de Terapia Intensiva , Respiração Artificial , Sono , Humanos , Masculino , Feminino , Projetos Piloto , Pessoa de Meia-Idade , Extubação/métodos , Estudos Prospectivos , Idoso , Monitorização Fisiológica/métodos , Respiração Artificial/métodos , Estado Terminal , Descanso , Desmame do Respirador/métodos , Adulto , Insuficiência Respiratória/terapia , Insuficiência Respiratória/fisiopatologia , Respiração , Cuidados Críticos/métodosRESUMO
The aim of this study was to develop a feeding protocol for the larviculture of Apistogramma cacatuoides, using the histological approach to larval nutrition conditions. For this, three experiments were carried out. Experiment 1 was carried out in a randomized design to determine the optimal amount of Artemia nauplii (AN) per larva, and three treatments were evaluated: P1-feeding with 25 A. nauplii per larva (AN/L) during the first 5 days, followed by 50 AN/L from the 6th to the 10th day and 100 AN/L from the 11th to the 20th day; P2 and P3-37 and 50 AN/L during the first 5 days, 75 and 100 AN/L from the 6th to the 10th day and 150 and 200 AN/L from the 11th to the 20th day. Experiment 2 was carried out in a randomized design to determine the daily frequency of feeding and evaluated four feeding frequencies: F1-feeding only once a day (09:00); (F2)-feeding twice a day (09:00 and 17:00); F3-feeding three times a day (09:00, 11:30 and 17:00); and F4-feeding four times a day (09:00, 11: 30, 14:00 and 17:00). Experiment 3 lasted 40 days and was conducted in a randomized design to evaluate three periods for the beginning of the feeding transition: WE10:AN for 10 days, followed by 3 days of co-feeding and commercial feed until the end of the experimental period; WE15:AN for 15 days, followed by 3 days of co-feeding and commercial feed; WE20:AN for 20 days, followed by 3 days of co-feeding and commercial feed. The results of this study showed that, for the best development of the larvae, they should receive the feeding protocol 50-100-200 AN/L (P3) until the 20th day of exogenous feeding. From the 21st day, the transition to inert food should begin with 3 days of co-feeding, and feeding during larviculture should be carried out at a frequency of twice a day; this protocol provided a good nutritional status for the larvae, as shown by the histological approach.
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BACKGROUND: Continuous positive airway pressure (CPAP) benefits preterm infants with respiratory distress, including reduced bronchopulmonary dysplasia (BPD) incidence, surfactant use, and extubation failure. Successful CPAP weaning also promotes oral feeding. However, there is no consensus on the optimal weaning of CPAP in neonates. This study aims to determine the effects of CPAP (CPAP) weaning guideline implementation on neonatal outcomes. METHODS: CPAP gradual pressure weaning guidelines were implemented in the Penn State Children's Hospital NICU in 2020. We included baseline data from infants (Epoch1) before bubble CPAP implementation in 2018-19. We included infants (Epoch2) after implementing the guidelines during 2020-21. The inclusion criteria were infants <32 weeks gestation with CPAP support. Compliance with the CPAP weaning guidelines was the primary process measure. Primary outcome measures included successful CPAP wean on the first attempt. Balancing measures used were total days on respiratory support and length of hospital stay. RESULTS: 195 infants were included in this study, 95 infants in Epoch 1 before bubble CPAP implementation and 100 infants in Epoch 2 after implementing guidelines. Infants in the two Epochs were similar in median gestational age at 29 vs 30 weeks (p=0.47) and were similar in median birth weight at 1190 vs 1130 grams (p=0.73). After implementing weaning guidelines, the successful weaning off CPAP improved from 9.5% to 54% (p<0.001). The total days needed to achieve full oral feeds decreased by 7 days (29 vs 22 median days, p<0.001). The BPD incidence was not significantly different between the two Epochs at 17% vs 16%, p= 0.87. There was no difference in total days of respiratory support, total length of stay, the number of infants discharged on home nasogastric feeding, and demographic variables. CONCLUSION: The implementation of the bubble CPAP weaning guideline improves the successful weaning of CPAP and promotes oral feeding in preterm infants.
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La atrofia muscular espinal (AME) 5q es una de las enfermedades neuromusculares de mayor incidencia en la infancia. Sin embargo, la prevalencia de AME tipo 1, su forma más severa de presentación, es menor debido a muertes prematuras evitables antes de los dos años por insuficiencia ventilatoria subtratada. La irrupción de nuevos tratamientos modificadores de la enfermedad pueden cambiar dramáticamente este pronóstico y es una oportunidad para actualizar el manejo respiratorio, a través de cuidados estandarizados básicos, preferentemente no invasivos, abordando la debilidad de los músculos respiratorios, la insuficiencia tusígena y ventilatoria, con un enfoque preventivo. La siguiente revisión literaria entrega estrategias para evitar la intubación y la traqueostomía usando soporte ventilatorio no invasivo (SVN), reclutamiento de volumen pulmonar (RVP) y facilitación de la tos. Se analizan en detalle los protocolos de extubación en niños con AME tipo 1.
Spinal muscular atrophy (SMA) 5q is one of the neuromuscular diseases with the highest incidence in childhood. Nevertheless, the prevalence of its most severe form SMA1 is lower due to premature preventable deaths before two years of age related to ventilatory insufficiency undertreated. The emergence of new disease-modifying treatments can dramatically change this prognosis and is an opportunity to update respiratory management, through basic standardized care, mostly non-invasive, addressing respiratory muscles pump weakness, cough and ventilatory insufficiency with a preventive approach. This literature review provides consensus recommendations for strategies to avoid intubation and tracheostomy using noninvasive ventilatory support (NVS), lung volume recruitment (LVR), and cough facilitation. Extubation protocols in children with SMA type 1 are analyzed in detail.
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Humanos , Criança , Atrofia Muscular Espinal/terapia , Insuficiência Respiratória/prevenção & controle , Unidades de Terapia Intensiva Pediátrica , Desmame do Respirador , Tosse , Extubação , Ventilação não Invasiva , Medidas de Volume PulmonarRESUMO
BACKGROUND: Re-intubation is necessary in 2% to 30% of cases of patients receiving a planned extubation. This procedure is associated with prolonged mechanical ventilation, a greater need for tracheostomy, a higher incidence of ventilator-associated pneumonia, and higher mortality. The aim of this study was to evaluate the effect of re-intubation within 48 h on mortality after planned extubation by using a randomized controlled trial database. METHODS: Secondary analysis of a multi-center randomized trial, which evaluated the effect of reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial, followed by extubation. The study included adult subjects who received invasive mechanical ventilation for > 12 h. The subjects were divided into an extubation failure group and an extubation success group. The outcome was in-hospital mortality. Two multivariate logistic regression models were constructed to identify independent factors associated with mortality. RESULTS: Among the 336 subjects studied, extubation failed in 52 (15.4%) and they were re-intubated within 48 h. Most re-intubations occurred between 12 and 24 h after planned extubation (median [interquartile range] 16 [6-36] h). Mortality of the extubation failure group was higher both in the ICU (32.6% vs 6.6%; odds ratio [OR] 6.77, 95% CI 3.22-14.24; P < .001) and in-hospital (42.3% vs 14.0%; OR 4.47, 95% CI 2.34-8.51; P < .001) versus the extubation success group. Multivariate logistic regression analyses showed that re-intubation within 48 h was independently associated with both ICU mortality (OR 6.10, 95% CI 2.84-13.07; P < .001) and in-hospital mortality (OR 3.36, 95% CI 1.67-6.73; P = .001). In-hospital mortality was also associated with rescue noninvasive ventilation after extubation (OR 2.44, 95% CI 1.25-4.75; P = .009). CONCLUSIONS: Re-intubation within 48 h after planned extubation was associated with mortality in subjects who were critically ill.
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Extubação , Estado Terminal , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Intubação Intratraqueal , Respiração Artificial , Desmame do Respirador , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Extubação/estatística & dados numéricos , Estado Terminal/mortalidade , Estado Terminal/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , Modelos Logísticos , Pneumonia Associada à Ventilação Mecânica/mortalidade , Respiração Artificial/estatística & dados numéricos , Fatores de TempoRESUMO
BACKGROUND: In 2013, a new predictor of successful mechanical ventilation liberation named timed inspiratory effort (TIE) index was devised with the normalization of the maximum inspiratory pressure (obtained within 60 s of unidirectional airway occlusion) with the time at which the value was reached. The aim of this study was to verify whether the presence of a sequence of a certain number of inspiratory effort values between 30-60 s > 1.0 cm H2O/s could predict weaning success in a performance comparable to the TIE index. METHODS: This was a retrospective observational study using 4 databases of previous studies on the TIE index. All patients receiving mechanical ventilation for ≤ 24 h were eligible. Liberation from mechanical ventilation-extubation decisions was made based on performance with spontaneous breathing trials. P < .05 was considered significant. The performance of the TIE index was evaluated by calculating the area under the receiver operating characteristics (AUROC) curve. RESULTS: From 349 eligible patients, 165 subjects were selected for analysis. The AUROC for the TIE index in the studied sample was 0.92 (95% CI 0.87-0.97, P < .001). A sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s was found in 51.5% of the subjects, with successful ventilatory liberation occurring in 95.3%. The highest specificity values belonged to the sequence of ≤ 4 and ≤ 5 inspiratory efforts > 1.0 cm H2O/s; the highest positive predictive value and positive likelihood ratio belonged to the sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s. The mean time that could have been spared if the procedure were interrupted after the first sequence of 4 inspiratory efforts > 1.0 cm H2O/s was 23 ± 3 s. CONCLUSIONS: The presence of a sequence of ≤ 4 inspiratory efforts > 1.0 cm H2O/s during the TIE index measurement was a reliable predictor of weaning success, which could allow timely interruption of the procedure and entail a substantial reduction in airway occlusion time.
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Inalação , Respiração Artificial , Desmame do Respirador , Humanos , Desmame do Respirador/métodos , Estudos Retrospectivos , Masculino , Feminino , Inalação/fisiologia , Pessoa de Meia-Idade , Idoso , Fatores de Tempo , Respiração Artificial/métodos , Curva ROC , Extubação/métodos , Valor Preditivo dos Testes , Pressões Respiratórias Máximas , Obstrução das Vias Respiratórias/terapia , Obstrução das Vias Respiratórias/fisiopatologia , Área Sob a CurvaRESUMO
The growth of Nelore cattle was analysed considering the following performance parameters; the effect of the calving order of cows on the phenotypic expression of birth weight (BW), average daily gain from birth to weaning (BWG), and weaning weight (WW), the estimated genetic parameters for the traits, including the covariance components between direct and maternal genetic effects. Genetic trends and correlated responses were also obtained for the studied traits. The calving order of cows, as well as other fixed effects used to obtain the adjusted phenotypic means, were statistically significant (p < 0.001) for studied traits. Direct heritability was estimated at 0.24 ± 0.01 (BW), 0.15 ± 0.01 (BWG), and 0.18 ± 0.01 (WW), while maternal heritability was 0.06 ± 0.01 (BW), 0.12 ± 0.01 (BWG), and 0.11 ± 0.01 (WW). The correlations between direct and maternal effects within the same trait were negligible. Moderate to higher direct genetic correlations (ranging from 0.54 ± 0.04 to 0.98 ± 0.01) and maternal genetic correlations (ranging from 0.34 ± 0.09 to 0.99 ± 0.002) were estimated between the studied traits. Unlike direct genetic effects, there was no significant change in maternal genetic effects over time (p > 0.05). These results indicated the need for revising selection indexes for enhancing maternal ability. Correlated responses were generally lower compared to direct responses, except for BWG. The selection for BWG, considering the maternal genetic effect, would be more efficient to improve maternal ability of the cows for pre-weaning growth in relation to selection for WW. Our results found that direct genetic merit improves pre-weaning weight and this trait can be incorporated into the breeding goal as reflected in the WW.
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Peso ao Nascer , Desmame , Animais , Bovinos/genética , Bovinos/crescimento & desenvolvimento , Bovinos/fisiologia , Feminino , Aumento de Peso/genética , Fenótipo , Herança Materna , Cruzamento , MasculinoRESUMO
Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.
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BACKGROUND: Weaning patients with COPD from mechanical ventilation (MV) presents a challenge, as literature on this topic is limited. This study compares PSV and T-piece during spontaneous breathing trials (SBT) in this specific population. METHODS: A search of PubMed, EMBASE, and Cochrane in September 2023 yielded four randomized controlled trials (RCTs) encompassing 560 patients. Among these, 287 (51%) used T-piece during SBTs. RESULTS: The PSV group demonstrated a significant improvement in the successful extubation rate compared to the T-piece (risk ratio [RR] 1.14; 95% confidence interval [CI] 1.03-1.26; p = 0.02). Otherwise, there was no statistically significant difference in the reintubation (RR 1.07; 95% CI 0.79-1.45; p = 0.67) or the ICU mortality rates (RR 0.99; 95% CI 0.63-1.55; p = 0.95). CONCLUSION: Although PSV in SBTs exhibits superior extubation success, consistent weaning protocols warrant further exploration through additional studies.
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Extubação , Doença Pulmonar Obstrutiva Crônica , Ensaios Clínicos Controlados Aleatórios como Assunto , Desmame do Respirador , Humanos , Desmame do Respirador/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/instrumentação , Respiração Artificial/métodosRESUMO
The objective of this study was to evaluate the inclusion of the autolyzed yeast (AY) Saccharomyces cerevisiae with or without an immunomodulator (1,3/1,6 ß-glucans) as a total/partial substitute for blood plasma (BP) in the diet of post-weaning piglets; zootechnical performance, intestinal health and microbiota, immune responses and energy metabolism were assessed. A total of 240 castrated male and female piglets, with a mean age of 22 days and mean initial weight of 5.24 ± 0.82 kg, were randomly divided into blocks of four treatments with 12 replicates. The dietary inclusions were blood plasma (BP), autolyzed yeast (AY), autolyzed yeast + immunomodulator (AYI) and 50% BP and 50% AY (BPAY). In pre-initial phase II (29-35 days), piglets fed AY showed better feed conversion (FCR = 1.358) than the piglets in the BP (1.484), AYI (1.379) and BPAY (1.442) groups, i.e., 8.49% (0.126), 1.52% (0.021) and 4.50% (0.084), respectively (p = 0.0293). In the total period (21-42 days), better FCR was observed in the AYI (1.458) group, i.e., 4.64% (0.071), 1.15% (0.017) and 4.58% (0.070), than in the BP (1.529), AY (1.475) and BPAY (1.528) groups, respectively (p = 0.0150). In piglets fed AY (n = 3) and BPAY (n = 2), there was a reduction in the number of medications, i.e., 82.35% (-14n) and 88.23% (-15n), respectively (p = 0.0001), compared with that in the BP group (n = 17). In the AY group (73.83 mg/dL), AYI group (69.92 mg/dL), and BPAY group (69.58 mg/dL), piglets exhibited increases in triglyceride levels of 79.32%, 69.83%, and 69.00%, respectively, in comparison to those in the BP group, which had triglyceride levels of 41.17 mg/dL (p = 0.0400). The beta-hydroxybutyrate concentration in the AY group (79.96 ng/µL) was lower by 31.95%, 22.64%, and 5.89% compared to the BP group (117.50 ng/µL), AYI group (103.36 ng/µL), and BPAY group (84.67 ng/µL), respectively (p = 0.0072). In the AYI group, there was modulation of the microbiota, with an increase in the relative abundance of bacteria of the genera Lactobacillus, Collinsella and Bulleidia. AY, associated or not associated with an immunomodulator, is a potential substitute for BP in diets for piglets in the nursery phase, with positive effects on immune, metabolic, and intestinal microbial performance.
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BACKGROUND: Epidemiological data on patients with COVID-19 referred to specialized weaning centers (SWCs) are sparse, particularly in low- and middle-income countries. Our aim was to describe clinical features, epidemiology, and outcomes of subjects admitted to SWCs in Argentina. METHODS: We conducted a prospective, multi-center, observational study between July 2020-December 2021 in 12 SWCs. We collected demographic characteristics, laboratory results, pulmonary function, and dependence on mechanical ventilation at admission, decannulation, weaning from mechanical ventilation, and status at discharge. A multiple logistic model was built to predict home discharge. RESULTS: We enrolled 568 tracheostomized adult subjects after the acute COVID-19 phase who were transferred to SWCs. Age was 62 [52-71], males 70%, Charlson comorbidity index was 2 [0-3], and length of stay in ICU was 42 [32-56] d. Of the 315 ventilator-dependent subjects, 72.4% were weaned, 427 (75.2%) were decannulated, and 366 subjects (64.5%) were discharged home. The mortality rate was 6.0%. In multivariate analysis, age (odds ratio 0.30 [95% CI 0.16-0.56], P < .001), Charlson comorbidity index (odds ratio 0.43 [95% CI 0.22-0.84], P < .01), mechanical ventilation duration in ICU (odds ratio 0.80 [95% CI 0.72-0.89], P < .001), renal failure (odds ratio 0.40 [95% CI 0.22-0.73], P = .003), and expiratory muscle weakness (odds ratio 0.35 [95% CI 0.19-0.62], P < .001) were independently associated with home discharge. CONCLUSIONS: Most subjects with COVID-19 transferred to SWCs were weaned, achieved decannulation, and were discharged to home. Age, high-comorbidity burden, prolonged mechanical ventilation in ICU, renal failure at admission, and expiratory muscle weakness were inversely associated with home discharge.
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COVID-19 , Insuficiência Renal , Humanos , Masculino , COVID-19/epidemiologia , Debilidade Muscular , Estudos Prospectivos , Respiração Artificial , Desmame do Respirador , Feminino , Pessoa de Meia-Idade , IdosoRESUMO
ABSTRACT Objective: To evaluate the association of biomarkers with successful ventilatory weaning in COVID-19 patients. Methods: An observational, retrospective, and single-center study was conducted between March 2020 and April 2021. C-reactive protein, total lymphocytes, and the neutrophil/lymphocyte ratio were evaluated during attrition and extubation, and the variation in these biomarker values was measured. The primary outcome was successful extubation. ROC curves were drawn to find the best cutoff points for the biomarkers based on sensitivity and specificity. Statistical analysis was performed using logistic regression. Results: Of the 2,377 patients admitted to the intensive care unit, 458 were included in the analysis, 356 in the Successful Weaning Group and 102 in the Failure Group. The cutoff points found from the ROC curves were −62.4% for C-reactive protein, +45.7% for total lymphocytes, and −32.9% for neutrophil/lymphocyte ratio. These points were significantly associated with greater extubation success. In the multivariate analysis, only C-reactive protein variation remained statistically significant (OR 2.6; 95%CI 1.51 - 4.5; p < 0.001). Conclusion: In this study, a decrease in C-reactive protein levels was associated with successful extubation in COVID-19 patients. Total lymphocytes and the neutrophil/lymphocyte ratio did not maintain the association after multivariate analysis. However, a decrease in C-reactive protein levels should not be used as a sole variable to identify COVID-19 patients suitable for weaning; as in our study, the area under the ROC curve demonstrated poor accuracy in discriminating extubation outcomes, with low sensitivity and specificity.
RESUMO Objetivo: Avaliar a associação de biomarcadores com o sucesso do desmame ventilatório em pacientes com COVID-19. Métodos: Trata-se de estudo observacional, retrospectivo e de centro único realizado entre março de 2020 e abril de 2021. Foram avaliados a proteína C-reativa, os linfócitos totais e a relação neutrófilos/linfócitos durante o atrito e a extubação; mediu-se a variação desses valores de biomarcadores. O desfecho primário foi o sucesso da extubação. As curvas ROC foram desenhadas para encontrar os melhores pontos de corte dos biomarcadores segundo a sensibilidade e a especificidade. A análise estatística foi realizada por meio de regressão logística. Resultados: Dos 2.377 pacientes admitidos na unidade de terapia intensiva, 458 foram incluídos na análise, 356 no Grupo Sucesso do desmame e 102 no Grupo Fracasso do desmame. Os pontos de corte encontrados nas curvas ROC foram −62,4% para proteína C-reativa, +45,7% para linfócitos totais e −32,9% para relação neutrófilo/linfócito. Esses pontos foram significativamente associados ao maior sucesso da extubação. Na análise multivariada, apenas a variação da proteína C-reativa permaneceu estatisticamente significativa (RC 2,6; IC95% 1,51 - 4,5; p < 0,001). Conclusão: Neste estudo, uma diminuição nos níveis de proteína C-reativa foi associada ao sucesso da extubação em pacientes com COVID-19. Os linfócitos totais e a relação neutrófilos/linfócitos não mantiveram a associação após a análise multivariada. No entanto, uma diminuição nos níveis de proteína C-reativa não deve ser usada como única variável para identificar pacientes com COVID-19 adequados para o desmame; como em nosso estudo, a área sob a curva ROC demonstrou baixa precisão na discriminação dos resultados de extubação, com baixas sensibilidade e especificidade.
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Abstract Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.
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RESUMO Objetivo Analisar a influência da anquiloglossia na prevalência e no tempo de exclusividade do aleitamento materno de lactentes a termo até o sexto mês de vida. Métodos Estudo de coorte prospectivo, realizado com 225 díades mãe-bebê que foram acompanhadas nos seis primeiros meses de vida em centro especializado em amamentação em um hospital terciário. Lactentes a termo com anquiloglossia do tipo assintomática (sem necessidade de cirurgia) foram comparados com lactentes sem alteração em um acompanhamento mensal. O diagnóstico de anquiloglossia foi realizado através do Bristol Tongue Assessment Tool, sendo considerados com diagnóstico positivo aqueles com escore menores ou iguais a 5 considerando os aspectos funcionais e anatômicos. As análises estatísticas foram realizadas através de estatística descritiva, regressão logística (determinantes do desmame), risco relativo e curvas de sobrevivência (para analisar o tempo de aleitamento entre os grupos com e sem anquiloglossia). Resultados A anquiloglossia esteve associada com o desmame (considerado ainda que parcial) antes do sexto mês de vida. Após análise ajustada, foi detectado maior risco de desmame nos lactentes com a alteração presente, com risco presente a partir do segundo mês de vida. Na análise de sobrevida, o tempo de aleitamento nos lactentes com anquiloglossia foi menor quando comparadas às crianças sem alteração. Conclusão Em comparação com lactentes com freio lingual normal, os bebês com anquiloglossia apresentaram tempo menor de aleitamento exclusivo, porém bem acima da média observada na população geral. O risco de desmame para este grupo também foi maior.
ABSTRACT Purpose To analyze the influence of ankyloglossia on the prevalence and duration of exclusive breastfeeding of full-term infants up to the sixth month of life. Methods Prospective cohort study, carried out with 225 mother-infant dyads who were followed up in the first six months of life in a center specialized in breastfeeding in a tertiary hospital. Full-term infants with asymptomatic ankyloglossia (no need for surgery) were compared with infants without change at monthly follow-up. Ankyloglossia was diagnosed using the Bristol Tongue Assessment Tool, with a positive diagnosis being considered for those with a score less than or equal to 5 considering functional and anatomical aspects. Statistical analyzes were performed using descriptive statistics, logistic regression (weaning determinants), relative risk, and survival curves (to analyze breastfeeding duration between groups with and without ankyloglossia). Results Ankyloglossia was associated with weaning (considered even partial) before the sixth month of life. After adjusted analysis, a higher risk of weaning was detected in infants with this alteration, with a risk present from the second month of life. In the survival analysis, the duration of breastfeeding in infants with ankyloglossia was shorter when compared to children without alterations. Conclusion Compared to infants with normal lingual frenulum, babies with ankyloglossia had shorter exclusive breastfeeding time, but well above the average observed in the general population. The risk of weaning for this group was also higher.
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Objetivo: Analisar a relação entre o desmame precoce e o desenvolvimento de alergias alimentares por meio de uma revisão integrativa. Método:Revisão integrativa da literatura realizada através das bases de dados Pubmed, Mesh e Scielo.Resultados:Através da busca pelos descritores determinados, foram selecionados 25 estudos científicos que atenderam aos critérios de inclusão. Devido sua grande composição, o leite humano é responsável pela promoção do crescimento das bactérias com efeito bifidogênico, estando em quantidades superiores nos lactentes em AME. Conclusão: Apesar de alguns dos estudos não mostrarem resultados significativos em relação ao leite materno ser um fator protetor contra as alergias alimentares, nenhum deles deixoude incentivar o AM ou mostrar os seus benefícios já cientificamente comprovados.
Objective: To analyze the relationship between early weaning and the development of food allergies through an integrative review. Method: Integrative literature review performed through the Pubmed, Mesh and Scielo databases. Results: Through the search for the descriptors determined, 25 scientific studies that met the inclusion criteria were selected. Due to its large composition, human milk is responsible for promoting the growth of bacteria with bifidogenic effect, being in higher amounts in infants in EBF. Conclusion: Although some of the studies did not show significant results regarding breast milk being a protective factor against food allergies, none of them failed to encourage BF or show its scientifically proven benefits.
Objetivo: Analizar la relación entre el destete precoz y el desarrollo de alergias alimentarias a través de una revisión integradora. Metodo:Revisión integradora de la literatura realizada a través de las bases de datos Pubmed, Mesh y Scielo. Resultados: A través de la búsqueda de los descriptores determinados, se seleccionaron 25 estudios científicos que cumplieron con los criterios de inclusión. Debido a su gran composición, la leche humana es responsable de promover el crecimiento de bacterias con efecto bifidogénico, estando en mayores cantidades en bebés en LME. Conclusión:Aunque algunos de los estudios no mostraron resultados significativos con respecto a que la leche materna sea un factor protector contra las alergias alimentarias, ninguno de ellos falló en fomentar la BF o mostrar sus beneficios científicamente probados.
Assuntos
Leite Humano , Desmame , Aleitamento Materno , Hipersensibilidade AlimentarRESUMO
ABSTRACT Purpose: to investigate the prevalence of exclusive breastfeeding up to 6 months old in full-term newborns at a public hospital and the main factors associated with early weaning, during the pandemic caused by severe acute respiratory syndrome. Methods: an observational, cross-sectional study with 98 mothers of full-term babies, conducted from January to August 2021, during the COVID-19 pandemic. The participants answered two structured questionnaires. One was applied immediately after childbirth, with questions on identification and socioeconomic data, obstetric-gynecological background, and current pregnancy and childbirth. The second questionnaire, applied 6 months after childbirth, had questions about the child's feeding status. Statistical tests were used to associate the prevalence of exclusive breastfeeding up to 6 months old and other variables, at the 5% significance level. Results: 16.3% of the babies were exclusively breastfeeding until the sixth month, during the COVID-19 pandemic, in the public hospital where the study was carried out. Exclusive breastfeeding up to 6 months old was not associated with the study variables. Conclusion: the prevalence of exclusive breastfeeding until the sixth month in full-term babies, in a public hospital, during the COVID-19 pandemic, was 16.3%. None of the variables analyzed was associated with early weaning.
RESUMO Objetivo: investigar a prevalência de aleitamento materno exclusivo aos seis meses de vida em bebês nascidos a termo em um hospital público e os principais fatores associados ao desmame precoce em período de pandemia causada pela síndrome respiratória aguda grave. Métodos: estudo observacional, transversal, realizado com 98 mães de bebês a termo, no período de janeiro a agosto de 2021, intervalo marcado pela pandemia da COVID-19. As participantes responderam a dois questionários, um no pós-parto imediato, com questões de identificação e socioeconômicas, antecedentes gineco-obstétricos, gestação e parto atual; e, o segundo, seis meses após o parto, continha questões sobre a situação alimentar da criança. Para verificar a associação entre a prevalência do aleitamento materno exclusivo aos seis meses de vida e as demais variáveis foram aplicados os testes Qui-quadrado, Exato de Fisher, Qui-quadrado de comparações múltiplas e Teste T, com nível de significância de 5%. Resultados: 16,3% dos lactentes encontravam-se em aleitamento materno exclusivo no sexto mês, no período da pandemia da COVID-19, no hospital público onde o estudo foi realizado. Não houve associação entre o aleitamento materno exclusivo aos seis meses de vida e as variáveis pesquisadas. Conclusão: a prevalência de amamentação exclusiva no sexto mês em bebês nascidos a termo em um hospital público, durante a pandemia da COVID-19, foi de 16,3% e nenhuma das variáveis analisadas apresentou associação com o desmame precoce.
RESUMO
ABSTRACT Objective: To investigate the repercussions of COVID-19 on the length of breastfeeding and analyze the associated factors in Belo Horizonte, Minas Gerais, Brazil. Method: This is an epidemiological, prospective cohort study. Data were collected from medical records and through telephone interviews. Women who weaned were estimated using Kaplan-Meier survival analysis. The log-rank test was used to verify differences between groups, analyzing weaning time, according to sociodemographic and clinical characteristics. The values of hazard ratio and 95% confidence intervals were estimated using Cox regression analysis. Results: A total of 1,729 women participated in the study. During the COVID-19 pandemic, brown women and women undergoing cesarean section were more likely to stop breastfeeding. Conclusion: The birth route and mothers' ethnic characteristics were associated with early weaning during the COVID-19 pandemic. Such findings are important to guide the assistance of the multidisciplinary team, especially nursing, during the post-pandemic period and in future epidemiological scenarios.
RESUMEN Objetivo: Investigar las repercusiones de la COVID-19 en la duración de la lactancia materna y analizar los factores asociados en Belo Horizonte, Minas Gerais, Brasil. Método: Se trata de un estudio de cohorte prospectivo epidemiológico. Los datos se recogieron de historias clínicas y mediante entrevistas telefónicas. Las mujeres que destetaron se estimaron mediante el análisis de supervivencia de Kaplan-Meier. La prueba de Mantel-Cox se utilizó para verificar diferencias entre grupos, analizando el tiempo de destete, según características sociodemográficas y clínicas. Los valores de cociente de riesgo y los intervalos de confianza del 95% se estimaron mediante análisis de regresión de Cox. Resultados: Un total de 1.729 mujeres participaron en la investigación. Durante la pandemia de COVID-19, las mujeres pardas y aquellas sometidas a cesárea tenían más probabilidades de dejar de amamantar. Conclusión: La ruta de nacimiento y las características étnicas de las madres se asociaron con el destete temprano durante la pandemia de COVID-19. Tales hallazgos son importantes para orientar la asistencia del equipo multidisciplinario, especialmente de enfermería, durante el período pospandemia y en futuros escenarios epidemiológicos.
RESUMO Objetivo: Investigar as repercussões da COVID-19 na duração do aleitamento materno e analisar os fatores associados em Belo Horizonte, Minas Gerais, Brasil. Método: Trata-se de estudo epidemiológico, de coorte prospectiva. Os dados foram coletados em prontuários médicos e por meio de entrevistas telefônicas. As mulheres que apresentaram o desmame foram estimadas por meio da análise de sobrevivência de Kaplan-Meier. O teste log-rank foi utilizado para verificar diferenças entre os grupos, analisando-se o tempo de desmame, segundo as características sociodemográficas e clínicas. Os valores de hazard ratio e intervalos de confiança de 95% foram estimados utilizando-se análise de regressão de Cox. Resultados: Participaram da pesquisa 1.729 mulheres. Durante a pandemia de COVID-19, mulheres pardas e mulheres submetidas à cesariana foram mais suscetíveis a interromper a amamentação. Conclusão: A via de nascimento e as características étnicas das mães associaram-se ao desmame precoce durante a pandemia de COVID-19. Tais achados são importantes para nortear a assistência da equipe multiprofissional, sobretudo da enfermagem, durante o pós-pandemia e em cenários epidemiológicos futuros.
Assuntos
Humanos , Feminino , Aleitamento Materno , Enfermagem , Pandemias , DesmameRESUMO
This study evaluated the effect of diets containing low levels of soluble and insoluble fiber sources on performance, diarrhea score, chemical and physical characteristics of feces, and behavior in weaning piglets. Thirty-six weaned piglets of 30 days of age with an initial body weight of 8.8 kg were distributed in 36 pens using a completely randomized design in an experimental period of 21 days. The experimental treatments were the Control diet (CONT), the Control diet + 1% beet pulp inclusion (SBP), and the Control diet + 1% lignocellulose inclusion (LCE, Arbocel®). Feed and water were available ad libitum. Body weight and feed intake were measured weekly to calculate the average daily intake, weight gain, and feed conversion ratio. The fecal consistency was determined visually twice daily, classifying feces according to three scores. To determine fecal pH and concentration of fecal short-chain fatty acids (SCFA), samples of fresh feces were collected two weeks after weaning and measured by a digital pH meter and gas chromatography, respectively. The behavior of piglets was observed once a week, using four animals per treatment, from 14:00 to 16:00, every 12 min. Fibre sources had no effect (P>0.05) on performance, except in the period 15 to 21 days after weaning, which was a tendency (P=0.061) of feed intake decrease in SBP and LCE diets. Fiber sources did not affect the fecal consistency score (P>0.05). However, piglets fed SBP and LCE showed a tendency (P<0.10) to have less diarrhea incidence 15 to 21 days post-weaning and in the entire experimental period. Fecal pH and SCFA concentration were not influenced by fiber source (P>0.05), with acetic, propionic, and butyric acids representing around 71%, 19%, and 10% of the total, respectively. Fiber sources did not influence the social and feeding behavior of weaning piglets (P>0.05). Diets containing 1% fiber sources did not alter performance, diarrhea score, fecal pH, fecal SCFA concentration, or feeding and social behavior of weaned piglets.(AU)
O estudo avaliou o efeito de dietas contendo baixos níveis de fontes de fibra solúvel e insolúvel sobre o desempenho, escore de diarreia, características químicas e físicas das fezes e comportamento de leitões desmamados. Trinta e seis leitões desmamados, com 30 dias de idade e peso vivo inicial de 8,8 kg, foram distribuídos em 36 baias, totalizando 12 repetições por tratamento, em um delineamento inteiramente casualizado. Os tratamentos experimentais foram: dieta controle (CONT), dieta controle + 1% de inclusão de polpa de beterraba (SBP) e dieta controle + 1% de inclusão de lignocelulose (LCE, Arbocel®). A ração e a água foram disponibilizadas ad libitum durante os 21 dias experimentais. O consumo médio diário de ração (CRM), ganho de peso diário (GPD) e a conversão alimentar (CA) foram medidos semanalmente. A consistência fecal foi determinada visualmente duas vezes por dia, classificando as fezes de acordo com três classificações. Amostras frescas de fezes, colhidas no 14° dia experimental, foram usadas para determinação do pH e ácidos graxos de cadeia curta (AGCC). O pH foi medido utilizando pHmetro digital, enquanto os AGCC foram determinados com auxílio de cromatografia gasosa. Para avaliar o comportamento foram observados quatro leitões por tratamento, uma vez por semana, das 14:00 às 16:00, a cada 12 minutos. As fontes de fibra não apresentaram efeito (P>0,05) sobre as variáveis de desempenho, exceto no período de 15 a 21 dias pós desmame, onde se observou uma tendência (P=0,061) de redução no consumo médio nos leitões que receberam as dietas contendo SBP e LCE. Não foi observado efeito das fontes de fibra sobre o escore de consistência fecal (P>0,05), embora leitões alimentados com SBP e LCE apresentaram uma tendência (P<0,10) de redução na incidência de diarreia no período de 15 a 21 dias pós desmame e no período total. O pH e a concentração de AGCC não foram influenciados pelas fontes de fibra (P>0,05), onde entres os tratamentos os perfis dos ácidos acético, propiônico e butírico foram semelhantes 71%, 19% e 10%, respectivamente. Não houve efeito das fontes de fibra sobre os comportamentos social e alimentar dos leitões (P>0,05). Dietas contendo 1% de fontes de fibra não alteram o desempenho, escore de diarreia, pH fecal, concentração de ácidos graxos voláteis nas fezes, bem como o comportamento alimentar e social de leitões desmamados.(AU)
Assuntos
Animais , Suínos/fisiologia , Fibras na Dieta/análise , Ração Animal/análise , Ácidos Graxos Voláteis/análise , Aditivos Alimentares/análiseRESUMO
Diet-induced obesity could have detrimental effects on adults and their progeny. The aim of this study was to determine the effect of a high-energy diet on both F1 mice body weight and tissue/organ weight and F2 offspring growth. A simple murine model for obesity was developed using a high-energy diet and mice reared in litters of five or ten, from 30 dams receiving a cafeteria diet of either commercial chow (low energy), or a mixture of commercial chow, chocolate (50% cacao), and salty peanuts (high energy). This diet continued from mating until weaning, when the pups were allocated according to sex into eight groups based on maternal diet, litter size, and post-weaning diet. On day 74, the males were slaughtered, and the females were bred then slaughtered after lactation. As a result, the high-energy maternal diet increased the F1 offspring growth during lactation, while the high-energy post-weaning diet increased the F1 adult body weight and tissue/organ weight. The high-energy maternal diet could negatively affect the onset of the F1 but not the maintenance of breastfeeding of F1 and F2 offspring. For F2 offspring growth, the high energy overlapped the low-energy post-weaning diet, due to problems of gaining weight during lactation.