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Background: Weaning from mechanical ventilation and tracheostomy after prolonged intensive care consume enormous resources with optimal management not currently well described. Restoration of respiratory flow via the upper airway is essential and early cuff‐deflation using a one‐way valve (OWV) is recommended. However, extended OWV use may cause dry airways and thickened secretions which challenge the weaning process. High‐flow therapy via the tracheostomy tube (HFT‐T) humidifies inspired air and may be connected via an in‐line OWV (HFT‐T‐OWV) alleviating these problems. We aim to provide clinical and experimental data on the safety of HFT‐T‐OWV along with a practical guide to facilitate clinical use during weaning from mechanical ventilation and tracheostomy. Methods: Data on adverse events of HFT‐T‐OWV were retrieved from a quality register for patients treated at an intensive care rehabilitation center between 2019 and 2022. Benchtop experiments were performed to measure maximum pressures and pressure support generated by HFT‐T‐OWV at 25–60 L/min flow using two different HFT‐T adapters (interfaces). In simulated airway obstruction using a standard OWV (not in‐line) maximum pressures were measured with oxygen delivered via the side port at 1–3 L/min. Results: Of 128 tracheostomized patients who underwent weaning attempts, 124 were treated with HFT‐T‐OWV. The therapy was well tolerated, and no adverse events related to the practice were detected. The main reason for not using HFT‐T‐OWV was partial upper airway obstruction using a OWV. Benchtop experiments demonstrated HFT‐T‐OWV maximum pressures <4 cmH2O and pressure support 0–0.6 cmH2O. In contrast, 1–3 L/min supplemental oxygen via a standard OWV caused pressures between 84 and 148 cmH2O during simulated airway obstruction. Conclusions: Current study clinical data and benchtop experiments indicate that HFT‐T‐OWV was well tolerated and appeared safe. Pressure support was low, but humidification may enable extended use of a OWV without dry airway mucosa and thickened secretions. Results suggest the treatment could offer advantages to standard OWV use, with or without supplementary oxygen, as well as to HFT‐T without a OWV, for weaning from mechanical ventilation and tracheostomy. However, for definitive treatment recommendations, randomized clinical trials are needed. [ABSTRACT FROM AUTHOR]

Objective. Several tests are available in the diagnostics of sporadic Creutzfeldt-Jakob disease (sCJD); however, none of these is conclusive. We review the values of these tests, from an intensive care unit (ICU) perspective. Methods. Case report and review of the literature. Results. A 53-year-old woman initially presenting with psychiatric symptoms developedmyoclonus and was admitted 1 month later to the ICU with a suspected nonconvulsive status epilepticus and respiratory insufficiency, probably due to extensive antiepileptic drug therapy. Typical MRI and EEG findings and a positive 14-3-3 protein led to the diagnosis of sCJD. All treatments were terminated, and autopsy confirmed sCJD. Conclusions. Clinical signs combined with MRI, EEG, and 14-3-3 and/or tau protein determination might be sufficient to diagnose or exclude sCJD andmay therefore prevent the application of unnecessary diagnostic tests. [ABSTRACT FROM AUTHOR]