Cleveland Clinic journal of medicine
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The US Public Health Service recently updated its guidelines for managing health care workers exposed to blood or other body fluids that might contain blood-borne viruses. The update addresses, among other things, timely administration of hepatitis B immune globulin and hepatitis B vaccine, appropriate testing for hepatitis C exposure, and new information on prophylaxis after exposure to human immunodeficiency virus (HIV).
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It is often unclear when and how to wean patients from mechanical ventilation. We have devised an evidence-based protocol in which patients undergo a 30-minute trial of spontaneous breathing with a T tube or pressure support of 7 cm H2O. Those who can tolerate the trial are extubated, while those who cannot are reconnected to mechanical ventilation but undergo another trial every day until they can be extubated. More study is needed to improve the criteria to predict successful spontaneous breathing and extubation, and to clarify the role of non-invasive ventilation to avoid reintubation.