Gaëtan Béduneau1,2, Tài Pham3,4,5, Frédérique Schortgen6, Lise Piquilloud7,8, Elie Zogheib9,10, Maud Jonas11, Fabien Grelon12, Isabelle Runge13, Steven Grangé1, Guillaume Barberet14, Pierre-Gildas Guitard15, Jean-Pierre Frat16,17,18, Adrien Constan6, Jean-Marie Chretien19, Jordi Mancebo20, Alain Mercat7, Jean-Christophe M Richard21, Laurent Brochard22,23. 1. 1 Medical Intensive Care Unit and. 2. 2 Normandie Univ, UNIROUEN, EA 3830, Rouen, France. 3. 3 AP-HP, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France. 4. 4 Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Paris, France. 5. 5 Unité Mixte de Recherche 1153, INSERM, Sorbonne Paris Cité, Epidémiologie Clinique et Statistiques pour la Recherche en Santé Team, Université Paris Diderot, Paris, France. 6. 6 Medical Intensive Care Unit, Centres Hospitaliers Universitaires Henri Mondor, APHP Paris, Paris, France. 7. 7 Department of Medical Intensive Care and. 8. 8 Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland. 9. 9 Cardio Thoracic and Vascular Intensive Care Unit, Centres Hospitaliers Universitaires Amiens-Picardie, Amiens, France. 10. 10 INSERM U1088, CURS, Université Jules Verne, Picardie, France. 11. 11 Medical Intensive Care Unit, Hôtel-Dieu, University Hospital of Nantes, Nantes, France. 12. 12 Intensive Care Unit, Hospital of Le Mans, Le Mans, France. 13. 13 Medical Intensive Care Unit Regional Medical Center, Orleans, France. 14. 18 Medical Intensive Care Unit, Mulhouse Regional Hospital, Mulhouse, France. 15. 19 Surgical Intensive Care, Rouen University Hospital, Rouen, France. 16. 20 Service de Réanimation Médicale, Centres Hospitaliers Universitaires de Poitiers, Poitiers, France. 17. 21 INSERM, CIC-1402, Équipe 5 ALIVE, Poitiers, France. 18. 22 Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France. 19. 23 Department of Clinical Research and Innovation, University Hospital of Angers, Angers, France. 20. 24 Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain. 21. 25 Annecy Genevois General Hospital, Annecy, France. 22. 26 Keenan Research Centre, Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto, Ontario, Canada; and. 23. 27 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
RATIONALE: The weaning process concerns all patients receiving mechanical ventilation. A previous classification into simple, prolonged, and difficult weaning ignored weaning failure and presupposed the use of spontaneous breathing trials. OBJECTIVES: To describe the weaning process, defined as starting with any attempt at separation from mechanical ventilation and its prognosis, according to a new operational classification working for all patients under ventilation. METHODS: This was a multinational prospective multicenter observational study over 3 months of all patients receiving mechanical ventilation in 36 intensive care units, with daily collection of ventilation and weaning modalities. Pragmatic definitions of separation attempt and weaning success allowed us to allocate patients in four groups. MEASUREMENTS AND MAIN RESULTS: A total of 2,729 patients were enrolled. Although half of them could not be classified using the previous definition, 99% entered the groups on the basis of our new definition as follows: 24% never started a weaning process, 57% had a weaning process of less than 24 hours (group 1), 10% had a difficult weaning of more than 1 day and less than 1 week (group 2), and 9% had a prolonged weaning duration of 1 week or more (group 3). Duration of ventilation, intensive care unit stay, and mortality (6, 17, and 29% for the three groups, respectively) all significantly increased from one group to the next. The unadjusted risk of dying was 19% after the first separation attempt and increased to 37% after 10 days. CONCLUSIONS: A new classification allows us to categorize all weaning situations. Every additional day without a weaning success after the first separation attempt increases the risk of dying.
RATIONALE: The weaning process concerns all patients receiving mechanical ventilation. A previous classification into simple, prolonged, and difficult weaning ignored weaning failure and presupposed the use of spontaneous breathing trials. OBJECTIVES: To describe the weaning process, defined as starting with any attempt at separation from mechanical ventilation and its prognosis, according to a new operational classification working for all patients under ventilation. METHODS: This was a multinational prospective multicenter observational study over 3 months of all patients receiving mechanical ventilation in 36 intensive care units, with daily collection of ventilation and weaning modalities. Pragmatic definitions of separation attempt and weaning success allowed us to allocate patients in four groups. MEASUREMENTS AND MAIN RESULTS: A total of 2,729 patients were enrolled. Although half of them could not be classified using the previous definition, 99% entered the groups on the basis of our new definition as follows: 24% never started a weaning process, 57% had a weaning process of less than 24 hours (group 1), 10% had a difficult weaning of more than 1 day and less than 1 week (group 2), and 9% had a prolonged weaning duration of 1 week or more (group 3). Duration of ventilation, intensive care unit stay, and mortality (6, 17, and 29% for the three groups, respectively) all significantly increased from one group to the next. The unadjusted risk of dying was 19% after the first separation attempt and increased to 37% after 10 days. CONCLUSIONS: A new classification allows us to categorize all weaning situations. Every additional day without a weaning success after the first separation attempt increases the risk of dying.
Authors: Samir Jaber; Giacomo Bellani; Lluis Blanch; Alexandre Demoule; Andrés Esteban; Luciano Gattinoni; Claude Guérin; Nicholas Hill; John G Laffey; Salvatore Maurizio Maggiore; Jordi Mancebo; Paul H Mayo; Jarrod M Mosier; Paolo Navalesi; Michael Quintel; Jean Louis Vincent; John J Marini Journal: Intensive Care Med Date: 2017-08-07 Impact factor: 17.440
Authors: Belaid Bouhemad; Francesco Mojoli; Nicolas Nowobilski; Arif Hussain; Isabelle Rouquette; Pierre- Grégoire Guinot; Silvia Mongodi Journal: Intensive Care Med Date: 2020-01-08 Impact factor: 17.440
Authors: Walter Videtta; Jeanette Vallejos; Gisela Roda; Hugo Collazos; Nico Naccarelli; Alex Tamayo; Noelia Calderón; Ariadna Bairaclioti; Martín Yoshida; Gabriel Vandaele; Ruth Toloza; Juan Quartino; Pablo Dunne; Maria G Rodríguez; Marcos A Teheran Wilches; Jhimmy J Morales Vasquez; Brenda L Fernandez Fernandez Journal: Acta Neurochir Suppl Date: 2021
Authors: Bruno M Tomazini; Israel S Maia; Alexandre B Cavalcanti; Otavio Berwanger; Regis G Rosa; Viviane C Veiga; Alvaro Avezum; Renato D Lopes; Flavia R Bueno; Maria Vitoria A O Silva; Franca P Baldassare; Eduardo L V Costa; Ricardo A B Moura; Michele O Honorato; Andre N Costa; Lucas P Damiani; Thiago Lisboa; Letícia Kawano-Dourado; Fernando G Zampieri; Guilherme B Olivato; Cassia Righy; Cristina P Amendola; Roberta M L Roepke; Daniela H M Freitas; Daniel N Forte; Flávio G R Freitas; Caio C F Fernandes; Livia M G Melro; Gedealvares F S Junior; Douglas Costa Morais; Stevin Zung; Flávia R Machado; Luciano C P Azevedo Journal: JAMA Date: 2020-10-06 Impact factor: 56.272