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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]

Introduction: Ninety percent of hypercalcemic cases are caused by primary hyperparathyroidism or malignancy. Less frequent causes are granulomatous diseases, drug-induced diseases, and intoxications., Case Report: We present two women with life-threatening hypercalcemia due to the intake of vitamin D-concentrated supplements, which turned out to be 100-1,000 times higher than stated on the label of over-the-counter dietary supplements. Laboratory analysis revealed ionized calcium levels of 4.00 (16.00) and 4.56 mmol/L (18.24 mg/dL) with vitamin D(25) concentrations of 1,372 and 644 nmol/L, respectively. Apart from a patient with general symptoms of hypercalcemia, a case of refractory status epilepticus after correction of serum calcium levels, and in need of prolonged ICU treatment, is described., Conclusion: Initial drug-taking history in the presented cases did not reveal the use of over-the-counter supplements, which underlines the importance of a thorough evaluation of (non-)prescribed medication. Moreover, these supplements may contain higher levels of vitamin D than the label states. As a result, hypercalcemia may be an underlying cause for life-threatening complications, including a well-documented refractory status epilepticus.

Introduction: Electrocardiogram (ECG) abnormalities in patients with blunt chest trauma are diverse and non-specific, but may be indicative of potentially life-threatening conditions., Case Presentation: We report a rare case of pneumopericardium with extreme ECG abnormalities after blunt chest trauma in a 22-year-old male. The diagnosis was confirmed using computed tomography (CT) scanning. The case is discussed, together with its differential diagnosis and the aetiology of pneumopericardium and tension pneumopericardium., Conclusion: Pneumopericardium should be distinguished from other pathologies such as myocardial contusion and myocardial infarction because of the possible development of tension pneumopericardium. Early CT scanning is important in the evaluation of blunt chest trauma.