Karen E A Burns1, Stavroula Raptis2, Rosane Nisenbaum2, Leena Rizvi1, Andrew Jones3, Jyoti Bakshi2, Wylie Tan2, Aleksander Meret4, Deborah J Cook5, Francois Lellouche6, Scott K Epstein7, David Gattas8, Farhad N Kapadia9, Jesús Villar2,10,11, Laurent Brochard1,2, Martin R Lessard12, Maureen O Meade5. 1. 1 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. 2. 2 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 3. 3 Department Critical Care Medicine, Guy's and St. Thomas' NHS Trust, London, United Kingdom. 4. 4 Faculty of Medicine and. 5. 5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. 6. 6 Institut Universitaire de Cardiologie et Pneumologie, Faculté de Médecine, Université Laval, Quebec, Quebec, Canada. 7. 7 Tufts University School of Medicine, Boston, Massachusetts. 8. 8 The George Institute for Global Health, Sydney, New South Wales, Australia. 9. 9 Department of Intensive Care, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, India. 10. 10 Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain; and. 11. CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 12. Département d'anesthésie-réanimation, Centre hospitalier affilié universitaire de Québec, Université Laval, Quebec, Quebec, Canada.
Abstract
RATIONALE: Randomized trials and meta-analyses have informed several aspects of weaning. Results are rarely replicated in practice, as evidence is applied in intensive care units that differ from the settings in which it was generated. OBJECTIVES: We aimed to: 1) describe weaning practice variation (identifying weaning candidates, conducting spontaneous breathing trials, using ventilator modes, and other aspects of care during weaning); 2) characterize regional differences in weaning practices; and 3) identify factors associated with practice variation. METHODS: We conducted a cross-sectional, self-administered, international postal survey of adult intensivist members of regional critical care societies from six geographic regions, including Canada, India, the United Kingdom, Europe, Australia/New Zealand, and the United States. We worked with societies to randomly select potential respondents from membership lists and administer questionnaires with the goal of obtaining 200 responses per region. RESULTS: We analyzed 1,144 questionnaires (Canada, 156; India, 136; United Kingdom, 219; Europe, 260; Australia/New Zealand, 196; United States, 177). Across regions, most respondents screened patients once daily to identify spontaneous breathing trials candidates (regional range, 70.0%-95.6%) and less often screened twice daily (range, 12.2%-33.1%) or more than twice daily (range, 1.6%-18.2%). To wean patients, most respondents used pressure support alone (range, 31.0%-71.7%) or with spontaneous breathing trials (range, 35.7%-68.1%). To conduct spontaneous breathing trials, respondents predominantly used pressure support with positive end-expiratory pressure (range, 56.5%-72.3%) and T-piece (8.9%-59.5%). Across regions, we found important variation in screening frequency, spontaneous breathing trials techniques; ventilator modes, written directives to guide care, noninvasive ventilation; and the roles played by available personnel in various aspects of weaning. CONCLUSIONS: Our findings document the presence and extent of practice variation in ventilator weaning on an international scale, and highlight the multidisciplinary and collaborative nature of weaning.
RATIONALE: Randomized trials and meta-analyses have informed several aspects of weaning. Results are rarely replicated in practice, as evidence is applied in intensive care units that differ from the settings in which it was generated. OBJECTIVES: We aimed to: 1) describe weaning practice variation (identifying weaning candidates, conducting spontaneous breathing trials, using ventilator modes, and other aspects of care during weaning); 2) characterize regional differences in weaning practices; and 3) identify factors associated with practice variation. METHODS: We conducted a cross-sectional, self-administered, international postal survey of adult intensivist members of regional critical care societies from six geographic regions, including Canada, India, the United Kingdom, Europe, Australia/New Zealand, and the United States. We worked with societies to randomly select potential respondents from membership lists and administer questionnaires with the goal of obtaining 200 responses per region. RESULTS: We analyzed 1,144 questionnaires (Canada, 156; India, 136; United Kingdom, 219; Europe, 260; Australia/New Zealand, 196; United States, 177). Across regions, most respondents screened patients once daily to identify spontaneous breathing trials candidates (regional range, 70.0%-95.6%) and less often screened twice daily (range, 12.2%-33.1%) or more than twice daily (range, 1.6%-18.2%). To wean patients, most respondents used pressure support alone (range, 31.0%-71.7%) or with spontaneous breathing trials (range, 35.7%-68.1%). To conduct spontaneous breathing trials, respondents predominantly used pressure support with positive end-expiratory pressure (range, 56.5%-72.3%) and T-piece (8.9%-59.5%). Across regions, we found important variation in screening frequency, spontaneous breathing trials techniques; ventilator modes, written directives to guide care, noninvasive ventilation; and the roles played by available personnel in various aspects of weaning. CONCLUSIONS: Our findings document the presence and extent of practice variation in ventilator weaning on an international scale, and highlight the multidisciplinary and collaborative nature of weaning.
Entities:
Keywords:
guidelines; international practice; invasive ventilation; noninvasive ventilation; weaning
Authors: Karen E A Burns; Leena Rizvi; Deborah J Cook; Gerald Lebovic; Peter Dodek; Jesús Villar; Arthur S Slutsky; Andrew Jones; Farhad N Kapadia; David J Gattas; Scott K Epstein; Paolo Pelosi; Kallirroi Kefala; Maureen O Meade Journal: JAMA Date: 2021-03-23 Impact factor: 56.272
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Authors: Bronagh Blackwood; Lyvonne N Tume; Kevin P Morris; Mike Clarke; Clíona McDowell; Karla Hemming; Mark J Peters; Lisa McIlmurray; Joanne Jordan; Ashley Agus; Margaret Murray; Roger Parslow; Timothy S Walsh; Duncan Macrae; Christina Easter; Richard G Feltbower; Daniel F McAuley Journal: JAMA Date: 2021-08-03 Impact factor: 56.272
Authors: Iftekhar Khan; Mandy Maredza; Melina Dritsaki; Dipesh Mistry; Ranjit Lall; Sarah E Lamb; Keith Couper; Simon Gates; Gavin D Perkins; Stavros Petrou Journal: Pharmacoecon Open Date: 2020-12
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