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Background: This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices—maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns—with weaning failure. Methods: This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. Results: Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01–1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86–0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98–1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. Conclusions: Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study.

BackgroundLung weight may be measured with quantitative chest computed tomography (CT) in patients with COVID-19 to characterize the severity of pulmonary edema and assess prognosis. However, this quantitative analysis is often not accessible, which led to the hypothesis that specific laboratory data may help identify overweight lungs.MethodsThis cross-sectional study was a secondary analysis of data from SARITA2, a randomized clinical trial comparing nitazoxanide and placebo in patients with COVID-19 pneumonia. Adult patients (≥18 years) requiring supplemental oxygen due to COVID-19 pneumonia were enrolled between April 20 and October 15, 2020, in 19 hospitals in Brazil. The weight of the lungs as well as laboratory data [hemoglobin, leukocytes, neutrophils, lymphocytes, C-reactive protein, D-dimer, lactate dehydrogenase (LDH), and ferritin] and 47 additional specific blood biomarkers were assessed.ResultsNinety-three patients were included in the study: 46 patients presented with underweight lungs (defined by ≤0% of excess lung weight) and 47 patients presented with overweight lungs (>0% of excess lung weight). Leukocytes, neutrophils, D-dimer, and LDH were higher in patients with overweight lungs. Among the 47 blood biomarkers investigated, interferon alpha 2 protein was higher and leukocyte inhibitory factor was lower in patients with overweight lungs. According to CombiROC analysis, the combinations of D-dimer/LDH/leukocytes, D-dimer/LDH/neutrophils, and D-dimer/LDH/leukocytes/neutrophils achieved the highest area under the curve with the best accuracy to detect overweight lungs.ConclusionThe combinations of these specific laboratory data: D-dimer/LDH/leukocytes or D-dimer/LDH/neutrophils or D-dimer/LDH/leukocytes/neutrophils were the best predictors of overweight lungs in patients with COVID-19 pneumonia at hospital admission.Clinical trial registrationBrazilian Registry of Clinical Trials (REBEC) number RBR-88bs9x and ClinicalTrials.gov number NCT04561219.

The effect of feeding spray-dried plasma (SDP) during the starter period was evaluated with a commercial broiler integrator on performance and overall health of broilers. The I See Inside (ISI) methodology assessing gut health in broilers was used as a tool to evaluate the impact of dietary interventions under commercial conditions. One hundred farms with approximately 1.1 million broilers were used at a Brazilian broiler integrator. Two groups of farms were fed either a control or an SDP diet containing 1% SDP, from 0 to 10 d of age. Diets were formulated to have similar nutritional density, containing zinc bacitracin and CuSO4 from 0 to 28 d. After 10 d, both groups were fed common commercial diets. Performance data were analyzed together or by type of ventilation system: positive pressure or negative pressure. Birds were sent to market as they reached 3.05 kg; therefore, age at slaughter (AS) was evaluated as a dependent variable along with other performance measures. From the 100 farms in the trial, 35 (16 control and 19 SDP farms) were selected for the assessment of broilers health, biosecurity, and local management. For that, 6 broilers per farm at 14 ± 2 d of age were necropsied and ileum sampled for the ISI methodology evaluation. Biosecurity and management were also evaluated to obtain the influence of those parameters on animal health. SDP-fed birds demonstrated improved feed conversion ratio, reduced mortality, and 1 d less for AS (P < 0.05) vs. control group (P < 0.05) regardless of the type of ventilation. During necropsy, birds fed SDP showed lower coccidiosis and locomotor system lesions as the overall ISI score compared to controls. Histologic intestinal alterations were also lower in SDP-fed broilers (P < 0.05). In conclusion, feeding 1% SDP in the starter period to broilers resulted in improved performance and health under both good and bad management and biosecurity standards independent of the type of ventilation. Overall, there was good agreement between the ISI method and performance improvements observed.