Chi Hung Czarina Leung1, Anna Lee1, Yaseen M Arabi2, Jason Phua3,4,5, Jigeeshu V Divatia6, Younsuck Koh7, Bin Du8, Cheng Cheng Tan9, Jose Emmanuel M Palo10, Karen E A Burns11,12,13, Tae-Hyung Kim14, Moritoki Egi15, Mohammad Omar Faruq16, Babu Raja Shrestha17, Shih-Feng Liu18,19, Tuan Dang Nguyen20, Bambang Wahjuprajitno21, Madiha Hashmi22, Boonsong Patjanasoontorn23, Zulaidi Latif24, Kanishka Indraratna25, Hussain N Al Rahma26, Seyed Mohammad Reza Hashemian27, Charles D Gomersall1. 1. Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region. 2. College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 3. Fast Programme and. 4. Chronic Programme, Alexandra Hospital, National University Health System, Singapore, Singapore. 5. Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore. 6. Department of Anesthesia, Critical Care, and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India. 7. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, School of Medicine, University of Ulsan, Seoul, Korea. 8. Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, People's Republic of China. 9. Department of Anesthesiology and Intensive Care, Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia. 10. Acute and Critical Care Institute, The Medical City, Manila, Philippines. 11. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 12. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 13. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 14. Division of Pulmonary and Critical Care Medicine, College of Medicine, Hanyang University Guri Hospital, Hanyang University, Gyeonggi-do, Korea. 15. Department of Anesthesiology, Kobe University Hospital, Kobe University, Kobe City, Japan. 16. General Intensive Care Unit and Emergency Department, United Hospital Ltd., Dhaka, Bangladesh. 17. Department of Anesthesiology and Intensive Care, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal. 18. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and. 19. Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 20. Intensive Critical Care Unit, Bach Mai Hospital, Hanoi, Vietnam. 21. Department of Anesthesiology and Reanimation, University of Airlangga and Dr. Soetomo General Hospital, Surabaya, Indonesia. 22. Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan. 23. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 24. Department of Anesthesiology, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam. 25. Sri Jayewardenepura General Hospital, Sri Jayewardenepura Kotte, Sri Lanka. 26. Directorate of Emergency and Critical Care, Alzahra Hospital, Dubai, United Arab Emirates; and. 27. Chronic Respiratory Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
Rationale: There are limited data on mechanical discontinuation practices in Asia. Objectives: To document self-reported mechanical discontinuation practices and determine whether there is clinical equipoise regarding protocolized weaning among Asian Intensive Care specialists. Methods: A survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists. Results: Of the 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. The majority of respondents (60.5%) were from China. Of the respondents, 42% worked in intensive care units (ICUs) where respiratory therapists were present; 78.9% used a spontaneous breathing trial as the initial weaning step; 44.3% frequently/always used pressure support (PS) alone, 53.4% intermittent spontaneous breathing trials with PS in between, and 19.8% synchronized intermittent mandatory ventilation with PS as a weaning mode. Of the respondents, 56.3% routinely stopped feeds before extubation, 71.5% generally followed a sedation protocol or guideline, and 61.8% worked in an ICU with a weaning protocol. Of these, 78.2% frequently always followed the protocol. A multivariate analysis involving a modified Poisson regression analysis showed that working in an ICU with a weaning protocol and frequently/always following it was positively associated with an upper-middle-income territory, a university-affiliated hospital, or in an ICU that employed respiratory therapists; and negatively with a low-income or lower-middle-income territory or a public hospital. There was no significant association with "in-house" intensivist at night, multidisciplinary ICU, closed ICU, or nurse-patient ratio. There was heterogeneity in agreement/disagreement with the statement, "evidence clearly supports protocolized weaning over nonprotocolized weaning." Conclusions: A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with the best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.
Rationale: There are limited data on mechanical discontinuation practices in Asia. Objectives: To document self-reported mechanical discontinuation practices and determine whether there is clinical equipoise regarding protocolized weaning among Asian Intensive Care specialists. Methods: A survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists. Results: Of the 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. The majority of respondents (60.5%) were from China. Of the respondents, 42% worked in intensive care units (ICUs) where respiratory therapists were present; 78.9% used a spontaneous breathing trial as the initial weaning step; 44.3% frequently/always used pressure support (PS) alone, 53.4% intermittent spontaneous breathing trials with PS in between, and 19.8% synchronized intermittent mandatory ventilation with PS as a weaning mode. Of the respondents, 56.3% routinely stopped feeds before extubation, 71.5% generally followed a sedation protocol or guideline, and 61.8% worked in an ICU with a weaning protocol. Of these, 78.2% frequently always followed the protocol. A multivariate analysis involving a modified Poisson regression analysis showed that working in an ICU with a weaning protocol and frequently/always following it was positively associated with an upper-middle-income territory, a university-affiliated hospital, or in an ICU that employed respiratory therapists; and negatively with a low-income or lower-middle-income territory or a public hospital. There was no significant association with "in-house" intensivist at night, multidisciplinary ICU, closed ICU, or nurse-patient ratio. There was heterogeneity in agreement/disagreement with the statement, "evidence clearly supports protocolized weaning over nonprotocolized weaning." Conclusions: A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with the best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.
Authors: Jason Phua; Chae-Man Lim; Mohammad Omar Faruq; Khalid Mahmood Khan Nafees; Bin Du; Charles D Gomersall; Lowell Ling; Jigeeshu Vasishtha Divatia; Seyed Mohammad Reza Hashemian; Moritoki Egi; Aidos Konkayev; Mohd Basri Mat-Nor; Gentle Sunder Shrestha; Madiha Hashmi; Jose Emmanuel M Palo; Yaseen M Arabi; Hon Liang Tan; Rohan Dissanayake; Ming-Cheng Chan; Chairat Permpikul; Boonsong Patjanasoontorn; Do Ngoc Son; Masaji Nishimura; Younsuck Koh Journal: J Intensive Care Date: 2021-10-07