Effect of Protocolized Weaning and Spontaneous Breathing Trial vs Conventional Weaning on Duration of Mechanical Ventilation: A Randomized Controlled Trial.

BACKGROUND: Identifying ventilated patients ready for extubation is a challenge for clinicians. Premature extubation increases risks of reintubation while delayed weaning increases complications of prolonged ventilation. We compared the duration of mechanical ventilation (MV) and extubation failure in children extubated using a weaning protocol based on pressure support spontaneous breathing trial (PS SBT) vs those extubated after nonprotocolized physician-directed weaning. PATIENTS AND METHODS: A prospective randomized controlled trial was conducted in the pediatric intensive care unit of a tertiary care hospital in children ventilated for ≥24 hours. All eligible patients underwent daily screening and were randomized once found fit. The intervention group underwent PS SBT of 2 hours duration followed by a T-piece trial and extubation. Controls underwent conventional weaning with synchronized intermittent mandatory ventilation mode and a T-piece trial before extubation. RESULTS: Eighty patients were randomized into two groups of 40 each. About 77.5% of patients passed the PS SBT on the first attempt. No statistical difference was found either in the duration of MV between the two groups [median (interquartile range) in days: 4.77 (2.89, 9.46) in controls and 4.94 (2.23, 6.35) in cases, p = 0.62] or in the rate of extubation failure (13% and 10.5%, p = 1). Mortality was found to be significantly higher in the reintubated patients compared to those not reintubated in both groups (p = 0.002 in cases and 0.005 in controls). CONCLUSION: Weaning using PS SBT-based protocol though did not shorten the duration of MV, it was found to be safe for assessing extubation readiness and did not increase extubation failure (CTRI no-CTRI/2018/04/013270). HOW TO CITE THIS ARTICLE: Kishore R, Jhamb U. Effect of Protocolized Weaning and Spontaneous Breathing Trial vs Conventional Weaning on Duration of Mechanical Ventilation: A Randomized Controlled Trial. Indian J Crit Care Med 2021;25(9):1059-1065.

Novel mutation in the CD27 gene in a patient presenting with hypogammaglobulinemia, bronchiectasis and EBV-driven lymphoproliferative disease.

CD27 deficiency is a rare primary immune deficiency which affects T cells, B cells and NK cells and is associated with hypogammaglobulinemia. Clinical presentation varies from asymptomatic disease to life-threatening Epstein Barr Virus (EBV)-driven complications including malignancy. Delay in diagnosis and late presentation adversely affects the clinical outcome and survival. We report a 10-year-old girl who had been symptomatic since 3 years of age with recurrent infections, developed bronchiectasis and was found to have hypogammaglobulinemia. Initially diagnosed as common variable immune deficiency, she had persistent lymphadenopathy, hepatosplenomegaly and pancytopenia, raising a clinical suspicion of a lymphoproliferative condition. On investigation, she was found to have a novel mutation involving the CD27 gene with very high EBV load. She was given rituximab injections to which she showed partial response and later developed non-Hodgkin's lymphoma .

Energy-dispersive X-ray Spectroscopy Analysis of Erbium, Chromium:Yttrium-scandium-gallium-garnet-treated Enamel Surfaces: An In Vitro Study.

AIM AND OBJECTIVE: The present study evaluated the effects of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser on the weight percentage of mineral content of enamel when etched at three different power settings. MATERIALS AND METHODS: Total 20 extracted molar teeth were taken as samples. Enamel slabs were prepared by sectioning the crown from the buccal and lingual aspect with a double-sided diamond disk at slow speed. The 40 specimens were divided into four groups, i.e., control, 1 W, 2 W, and 3 W of 10 specimens each and then irradiation by Er,Cr:YSGG was done. The elements evaluated were calcium (Ca), potassium (K), magnesium (Mg), sodium (Na), and phosphorus (P). The mean weights of these minerals and the Ca:P ratio in each slab were measured by energy-dispersive X-ray spectroscopy analysis (EDAX). One-way analysis of variance (ANOVA) followed by the Turkey's test was performed with the help of critical difference (CD) or least significant difference (LSD) at 5 and 1% level of significance. RESULTS: There was no significant differences among the four groups for the five minerals and for the calcium:phosphorous ratio (p > 0.05). Photomicrographs by scanning electron microscopy observations revealed that the surfaces exposed to a 3 watt irradiation showed more roughness than those of the 1 watt and 2 watt groups. CONCLUSION: The Er,Cr:YSGG irradiation of enamel at 1 W, 2 W, and 3 W had no significant effect on the mean percentage weights of Ca, K, Mg, Na, and P or the Ca/P ratio in any group. CLINICAL SIGNIFICANCE: Constriction with conviction is the new motto of restorative dentistry. Er,Cr:YSGG not only fulfills the aim but also is proving to alter the surface properties by recrystallization and change in composition making the prepared surface caries resistant.