Endotracheal tube size to leakage ventilation and tracheal dilatation.

PURPOSE: This study analyzed the clinical factors with the aim to determine the relationship between endotracheal tube (ETT) size and leakage ventilation (LV) and tracheal dilatation. METHODS: All patients with ETT intubation and ventilator support for more than 6 months were retrospectively evaluated. The inner tracheal diameter (TD) was measured over image at the starting and 6 months after ventilator initiated. We compared the clinical factors, outcomes and complications between patients with and without LV, as well as with and without a TD enlarging more than 25% after 6 months (TDn). Logistic regression analyses of factors related to the LV and TDn were performed. The cut-off points of the ratio of outer diameter of ETT (OD) to TD were set and evaluated for their accuracy of predicting LV and TDn. RESULTS: 689 patients were enrolled initially and eventually 199 patients were included, of which 52 and 66 patients were identified to have LV and TDn, respectively. Patients with LV had a higher peak inspiratory pressure (PIP), smaller initial ETT OD/TD and higher incidence of pneumonia. Patients with TDn had a higher PIP, larger initial OD/TD and higher incidence of pneumonia. A higher PIP and smaller initial OD/TD were significantly related to LV and a higher PIP and larger initial OD/TD were significantly related to TDn. The incidence of LV and TDn was higher in patients with an initial OD/TD less than 0.51 and more than 0.54, respectively. CONCLUSION: The initial ETT OD/TD ratio is a predictor for LV and TDn.

Predicting weaning and extubation outcomes in long-term mechanically ventilated patients using the modified Burns Wean Assessment Program scores.

BACKGROUND AND OBJECTIVE: A number of clinical factors play pivotal roles in weaning and successful extubation of patients requiring long-term mechanical ventilator (LTMV) support. Many patients fail extubation even after passing weaning protocols and spontaneous breathing trials. This study aimed to assess the effectiveness of using a modified Burns Wean Assessment Program (m-BWAP) scoring instrument to predict extubation outcome in patients requiring LTMV. METHODS: All patients with a diagnostic coding for respiratory failure requiring LTMV for longer than 21 days over a 5-year period in a single centre (total 527 patients) were included. Advanced practice nurses trained in the use of the m-BWAP scored the items according to standard definitions. All patients were weaned by pressure support weaning and spontaneous breathing trails. Patients were divided into successful and unsuccessful groups according to the weaning and extubation outcomes. Baseline data, traditional weaning parameters and m-BWAP of the groups were analysed. The sensitivity and specificity of m-BWAP for predicting successful extubation were calculated. RESULTS: Of the 527 patients included, 145 (27.5%) had successful weaning trials. Of the 130 patients extubated, 102 (78.5%) had successful extubation. The m-BWAP score was higher in the patients with successful weaning trials and successful extubation outcome. Using a cut-off value of 60, the sensitivity and specificity of the m-BWAP to predict successful extubation were 81.4% and 82.1%, respectively. This was better than traditional weaning parameters. CONCLUSIONS: The m-BWAP is a good predictor for weaning and extubation outcome in patients requiring LTMV for longer than 21 days.

Identification of antigens for the development of a subunit vaccine against Photobacterium damselae ssp. piscicida.

Photobacterium damselae ssp. piscicida (Ph.d.p.), the causative agent of photobacteriosis, is among the most important pathogens affecting finfish aquaculture globally. With the emergence of recombinant technology, subunit vaccines have been actively pursued, but mostly for viral diseases. Bacterial subunit vaccines are more difficult to develop since the bacterial genome is more complex, with numerous candidate antigens, leading to a lengthy and laborious screening process. Immunoproteomics, using western blotting on protein analyzed with 2DE and LC-MS/MS to isolate immune-reactive proteins and acquire amino acid sequences, followed by recombinant technology to clone the candidate gene, identified eight candidate antigens from Ph.d.p., which have been cloned and expressed in Escherichia coli BL21(DE3). These proteins were purified and used as antigens in an efficacy trial. Three, rHSP60, rENOLASE, and rGAPDH proteins, elicited higher specific antibody titers and stronger protective immunity than the other five and an inactivated Ph.d.p. whole bacterial vaccine. These three antigens may be candidates for the development of a subunit vaccine against Ph.d.p.