René Robert1,2,3, Amélie Le Gouge4,5,6, Nancy Kentish-Barnes7,8,9, Alice Cottereau10, Bruno Giraudeau4,5,6, Mélanie Adda11, Djillali Annane12,13, Juliette Audibert14, François Barbier15, Patrick Bardou16, Simon Bourcier17,18, Jeremy Bourenne19, Alexandre Boyer20,21, François Brenas22, Vincent Das10, Arnaud Desachy23, Jérôme Devaquet24, Marc Feissel25, Frédérique Ganster26, Maïté Garrouste-Orgeas27,28,29, Guillaume Grillet30, Olivier Guisset20,31, Rebecca Hamidfar-Roy32,33, Anne-Claire Hyacinthe34, Sebastien Jochmans35, Mercé Jourdain36,37,38, Alexandre Lautrette39,40, Nicolas Lerolle41,42, Olivier Lesieur43, Fabien Lion44, Philippe Mateu45, Bruno Megarbane7,46, Sybille Merceron7,8,9, Emmanuelle Mercier5,47,48, Jonathan Messika49, Paul Morin-Longuet50, Bénédicte Philippon-Jouve51, Jean-Pierre Quenot52,53,54, Anne Renault55,56, Xavier Repesse57, Jean-Philippe Rigaud58, Ségolène Robin17,59,60, Antoine Roquilly61,62, Amélie Seguin63, Didier Thevenin64, Patrice Tirot65, Isabelle Vinatier66, Elie Azoulay7,8,9, Jean Reignier67,68,69. 1. Inserm CIC, 1402, axe Alive, Poitiers, France. 2. Université de Poitiers, Poitiers, France. 3. Service de Réanimation Médicale, CHU Poitiers, Poitiers, France. 4. Inserm CIC 1415, Tours, France. 5. Université de Tours, Tours, France. 6. CHU Tours, Tours, France. 7. Université Paris Diderot, Paris, France. 8. Service de Réanimation Médicale, CHU Saint-Louis, Paris, France. 9. Groupe de Recherche Famiréa, Paris, France. 10. Service de Réanimation polyvalente, CHI André Grégoire, Montreuil, France. 11. Aix-Marseille Université, APHM, URMITE, UMR CNRS 7278, Hôpital Nord, Réanimation des Détresses Respiratoires et Infections Sévères, Marseille, France. 12. Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France. 13. Service de Réanimation Médicale, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France. 14. Service de Réanimation Polyvalente, CH de Chartres, Chartres, France. 15. Service de Réanimation Médicale, CHR d'Orléans, Orléans, France. 16. Service de Réanimation Médico-Chirurgicale, CH de Montauban, Montauban, France. 17. Université Paris-Descartes, Paris, France. 18. Service de Réanimation Médicale, CHU Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France. 19. Aix-Marseille Université, APHM, Hôpital La Timone, Réanimation et surveillance continue, Marseille, France. 20. Université de Bordeaux, Bordeaux, France. 21. Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France. 22. Service de Réanimation Polyvalente, CH Emile Roux, Le Puy En Velay, France. 23. Service de Réanimation Polyvalente, CH d'Angoulême, Angoulême, France. 24. Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France. 25. Service de Réanimation Polyvalente, CH de Belfort-Montbéliard, Belfort, France. 26. Service de Réanimation Médicale, Hôpital Emile Muller, Mulhouse, France. 27. Service de médecine intensive et de réanimation, Groupe Hospitalier Paris Saint Joseph, Paris, France. 28. Groupe de recherche Outcomerea, Paris, France. 29. IAME, UMR 1137, INSERM Université Paris Diderot, Département de biostatistiques-HUPNVS-AP-HP, UFR de Médecine-Bichat, Paris, France. 30. Service de Réanimation Polyvalente, CH Bretagne Sud, Lorient, France. 31. Service de Réanimation Médicale, CHU Bordeaux, Hôpital Saint-André, Bordeaux, France. 32. Université Grenoble-Alpes, Grenoble, France. 33. CHU Albert Michallon, Clinique de la Réanimation Médicale, Grenoble, France. 34. Service de Réanimation Polyvalente, Centre Hospitalier Annecy Genevois, Pringy, France. 35. Service de Réanimation Médicale, CH Marc Jacquet, Melun, France. 36. Université de Lille, Lille, France. 37. Inserm U1190, Lille, France. 38. Service de Réanimation Polyvalente, CHRU de Lille-Hôpital Roger Salengro, Lille, France. 39. Université de Clermont-Ferrand, Clermont-Ferrand, France. 40. Service de Réanimation Médicale, CHU Gabriel Montpied, Clermont-Ferrand, France. 41. Université d'Angers, Angers, France. 42. Département de Réanimation médicale et Médecine hyperbare, CHU Angers, Angers, France. 43. Service de Réanimation Polyvalente, CH de La Rochelle, La Rochelle, France. 44. Service de Réanimation Médico-Chirurgicale, Institut Gustave Roussy, Paris Villejuif, France. 45. Service de Réanimation polyvalente, CH de Charleville-Mézières, Charleville-Mézières, France. 46. Service de Réanimation Médicale et Toxicologique, Assistance-Publique-Hopitaux de Paris, CHU Lariboisière, Paris, France. 47. Service de Réanimation Médicale, CHU de Tours, Hôpital Bretonneau, Tours, France. 48. Réseau CRICS, Tours, France. 49. IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Réanimation médico-chirurgicale, Hôpital Louis Mourier, AP-HP, Colombes, France. 50. Service de Réanimation Polyvalente, CH Saint Nazaire, Saint Nazaire, France. 51. Service de Réanimation Médico-chirurgicale, CH de Roanne, Roanne, France. 52. Service de Réanimation Médicale, Université de Bourgogne Franche Comté, CHU Dijon, France. 53. Equipe Lipness, UMR 866, Dijon, France. 54. INSERM CIC 1432, Dijon, France. 55. Equipe de recherche EPS (Ethique, professionnalisme et santé) EA 686, Université de Bretagne Occidentale, Brest, France. 56. Service de Réanimation Médicale, CHU de la Cavale Blanche, Brest, France. 57. Service de Réanimation Médico-Chirurgicale, Assistance publique-hôpitaux de Paris, CHU Ambroise Paré, Boulogne-Billancourt, France. 58. Service d'Anesthésie-Réanimation, CH de Dieppe, Dieppe, France. 59. Hôpital Européen Georges Pompidou, Paris, France. 60. Service d'Anesthésie-Réanimation, Paris, France. 61. Université de Nantes, Nantes, France. 62. Département d'Anesthésie et Réanimation, CHU de Nantes, Nantes, France. 63. Service de Réanimation Médicale, CHU Côte de Nacre, Caen, France. 64. Service de Réanimation Polyvalente, CH de Lens, Lens, France. 65. Service de Réanimation Médico-chirurgicale, CH du Mans, Le Mans, France. 66. Service de Réanimation Polyvalente, CHD de la Vendée, La Roche-Sur-Yon, France. 67. Université de Nantes, Nantes, France. jean.reignier@chu-nantes.fr. 68. Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France. jean.reignier@chu-nantes.fr. 69. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. jean.reignier@chu-nantes.fr.
Abstract
PURPOSE: The relative merits of immediate extubation versus terminal weaning for mechanical ventilation withdrawal are controversial, particularly regarding the experience of patients and relatives. METHODS: This prospective observational multicentre study (ARREVE) was done in 43 French ICUs to compare terminal weaning and immediate extubation, as chosen by the ICU team. Terminal weaning was a gradual decrease in the amount of ventilatory assistance and immediate extubation was extubation without any previous decrease in ventilatory assistance. The primary outcome was posttraumatic stress symptoms (Impact of Event Scale Revised, IES-R) in relatives 3 months after the death. Secondary outcomes were complicated grief, anxiety, and depression symptoms in relatives; comfort of patients during the dying process; and job strain in staff. RESULTS: We enrolled 212 (85.5%) relatives of 248 patients with terminal weaning and 190 relatives (90.5%) of 210 patients with immediate extubation. Immediate extubation was associated with airway obstruction and a higher mean Behavioural Pain Scale score compared to terminal weaning. In relatives, IES-R scores after 3 months were not significantly different between groups (31.9 ± 18.1 versus 30.5 ± 16.2, respectively; adjusted difference, -1.9; 95% confidence interval, -5.9 to 2.1; p = 0.36); neither were there any differences in complicated grief, anxiety, or depression scores. Assistant nurses had lower job strain scores in the immediate extubation group. CONCLUSIONS: Compared to terminal weaning, immediate extubation was not associated with differences in psychological welfare of relatives when each method constituted standard practice in the ICU where it was applied. Patients had more airway obstruction and gasps with immediate extubation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01818895.
PURPOSE: The relative merits of immediate extubation versus terminal weaning for mechanical ventilation withdrawal are controversial, particularly regarding the experience of patients and relatives. METHODS: This prospective observational multicentre study (ARREVE) was done in 43 French ICUs to compare terminal weaning and immediate extubation, as chosen by the ICU team. Terminal weaning was a gradual decrease in the amount of ventilatory assistance and immediate extubation was extubation without any previous decrease in ventilatory assistance. The primary outcome was posttraumatic stress symptoms (Impact of Event Scale Revised, IES-R) in relatives 3 months after the death. Secondary outcomes were complicated grief, anxiety, and depression symptoms in relatives; comfort of patients during the dying process; and job strain in staff. RESULTS: We enrolled 212 (85.5%) relatives of 248 patients with terminal weaning and 190 relatives (90.5%) of 210 patients with immediate extubation. Immediate extubation was associated with airway obstruction and a higher mean Behavioural Pain Scale score compared to terminal weaning. In relatives, IES-R scores after 3 months were not significantly different between groups (31.9 ± 18.1 versus 30.5 ± 16.2, respectively; adjusted difference, -1.9; 95% confidence interval, -5.9 to 2.1; p = 0.36); neither were there any differences in complicated grief, anxiety, or depression scores. Assistant nurses had lower job strain scores in the immediate extubation group. CONCLUSIONS: Compared to terminal weaning, immediate extubation was not associated with differences in psychological welfare of relatives when each method constituted standard practice in the ICU where it was applied. Patients had more airway obstruction and gasps with immediate extubation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01818895.
Authors: H G Prigerson; A J Bierhals; S V Kasl; C F Reynolds; M K Shear; N Day; L C Beery; J T Newsom; S Jacobs Journal: Am J Psychiatry Date: 1997-05 Impact factor: 18.112
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Authors: Fábio Holanda Lacerda; Pedro Garcia Checoli; Carla Marchini Dias da Silva; Carlos Eduardo Brandão; Daniel Neves Forte; Bruno Adler Maccagnan Pinheiro Besen Journal: Rev Bras Ter Intensiva Date: 2020 Oct-Dec