Do simple ventilation and gas exchange measurements predict early successful weaning from respiratory support in unselected general intensive care patients?

Background. The value of respiratory variables as weaning predictors in the intensive care unit (ICU) is controversial. We evaluated the ability of tidal volume (Vtexp), respiratory rate ( f ), minute volume (MVexp), rapid shallow breathing index ( f/Vt), inspired–expired oxygen concentration difference [(I–E)O2], and end-tidal carbon dioxide concentration (PE′CO2) at the end of a weaning trial to predict early weaning outcomes. Methods. Seventy-three patients who required .24 h of mechanical ventilation were studied. A controlled pressure support weaning trial was undertaken until 5 cm H2O continuous positive airway pressure or predefined criteria were reached. The ability of data from the last 5 min of the trial to predict whether a predefined endpoint indicating discontinuation of ventilator support within the next 24 h was evaluated. Results. Pre-test probability for achieving the outcome was 44% in the cohort (n¼32). Non-achievers were older, had higher APACHE II and organ failure scores before the trial, and higher baseline arterial H+ concentrations. The Vt, MV, f, and f/Vt had no predictive power using a range of cut-off values or from receiver operating characteristic (ROC) analysis. The [I–E]O2 and PE′CO2 had weak discriminatory power [areaunder the ROC curve: [I–E]O2 0.64 (P¼0.03); PE′CO2 0.63 (P¼0.05)]. Using best cut-off values for [I–E]O2 of 5.6% and PE′CO2 of 5.1 kPa, positive and negative likelihood ratios were 2 and 0.5, respectively, which only changed the pre- to post-test probability by about 20%. Conclusions. In unselected ICU patients, respiratory variables predict early weaning from mechanical ventilation poorly.

Organ Recital Mainzer Dom.

Concert performance in 2012 Internationaler Orgelsommer 4 August 2012. Showcase of British music from 19th and 20th centuries. Weitz Fanfare and Gothic March; Handel Organ Concerto Op 4 No 5; W.T.Best Sonata in G; Francis Jackson Toccata, Chorale and Fugue; Hollins A Song of Sunshine; Healey Willan Introduction Passacaglia and Fugue

Interactive support effects on career agency and occupational engagement among young adults.

The PIC model by Gati and Asher describes three career decision making stages: pre-screening, in-depth exploration, and choice of career options. We consider the role that three different forms of support (general career support by parents, emotional/instrumental support, and informational support) may play for young adults in each of these three decision-making stages. The authors further propose that different forms of support may predict career agency and occupational engagement, which are important career decision precedents. In addition, we consider the role of personality traits and perceptions (decision-making window) on these two outcomes. Using an online survey sample (N = 281), we found that general career support was important for career agency and occupational engagement. However, it was the combination of higher general career support with either emotional/instrumental support or informational support that was found to lead to both greater career agency and higher occupational engagement. Personality also played a role: Greater proactivity also led to greater occupational engagement, even when there was little urgency for participants to make decisions (window of decision-making was wide open and not restricted). In practical terms, the findings suggest that the learning required in each of the three PIC processes (pre-screening, in-depth exploration, choice of career options may benefit when the learner has access to the three support measures.