Comparison of the timed inspiratory effort index with the T-piece trial as a decision-making tool for extubation: a randomized controlled non-inferiority trial.

The "timed inspiratory effort" (TIE) index, a new predictor of weaning outcome, normalizes the maximal inspiratory pressure with the time required to reach this value up to 60 s, incorporating the time domain into the assessment of inspiratory muscle function. The objective of this study was to determine whether the TIE predicts successful extubation at a similar rate as the T-piece trial with less time required. A non-inferiority randomized controlled trial was performed with ICU subjects eligible for weaning. The participants were allocated to the TIE or the T-piece groups. The primary outcome was successful weaning, and the main secondary outcome was ICU mortality. Eighty participants of each group were included in the final analysis. Time from the start of a successful test to effective extubation was significantly lower in the TIE group than in the T-piece group, 15 (10 to 24) vs 55 (40 to 75) min, P<0.001. In the Kaplan-Meier analysis, no significant differences were found in successful weaning (79.5 vs 82.5%, P=0.268) or survival rate (62.9 vs 53.8%, P=0.210) between the TIE and T-piece groups at the 30th day. In this preliminary study, the TIE index was not inferior to the T-piece trial as a decision-making tool for extubation and allowed a reduction in the decision time.

Comparison of the timed inspiratory effort index with the T-piece trial as a decision-making tool for extubation: a randomized controlled non-inferiority trial

The "timed inspiratory effort" (TIE) index, a new predictor of weaning outcome, normalizes the maximal inspiratory pressure with the time required to reach this value up to 60 s, incorporating the time domain into the assessment of inspiratory muscle function. The objective of this study was to determine whether the TIE predicts successful extubation at a similar rate as the T-piece trial with less time required. A non-inferiority randomized controlled trial was performed with ICU subjects eligible for weaning. The participants were allocated to the TIE or the T-piece groups. The primary outcome was successful weaning, and the main secondary outcome was ICU mortality. Eighty participants of each group were included in the final analysis. Time from the start of a successful test to effective extubation was significantly lower in the TIE group than in the T-piece group, 15 (10 to 24) vs 55 (40 to 75) min, P<0.001. In the Kaplan-Meier analysis, no significant differences were found in successful weaning (79.5 vs 82.5%, P=0.268) or survival rate (62.9 vs 53.8%, P=0.210) between the TIE and T-piece groups at the 30th day. In this preliminary study, the TIE index was not inferior to the T-piece trial as a decision-making tool for extubation and allowed a reduction in the decision time.

Mercury emission factors from intensive shrimp aquaculture and their relative importance to the Jaguaribe River Estuary, NE Brazil.

This study estimated Hg emission factors (EFs) and total Hg loading to the Jaguaribe Estuary, NE Brazil, from intensive shrimp farming, and compares this with other local anthropogenic activities. The EF reached 83.5 mg ha(-1) cycle(-1) (about 175 mg ha(-1) year(-1)), resulting in an annual Hg load to the estuary of 0.35 kg. The calculated EF is comparable to Hg EFs from urban wastewaters (200 mg ha(-1)) and solid waste disposal (400 mg ha(-1) year(-1)) from cities located in the estuary's basin. However, due to the smaller area of aquaculture (2,010 ha), total annual loads are much lower than from these other sources (75 and 150 kg year(-1), respectively). Since shrimp farming effluents are released directly into the estuary, the estimated high EF raises environmental concerns with this expanding industry, suggesting the inclusion of this element in ongoing environmental monitoring programs.