International Practice Variation in Weaning Critically Ill Adults from Invasive Mechanical Ventilation

• DOI: 10.1513/annalsats.201705-410oc
• Publication Date: 2018-03-06T21:46:40Z
• Authors: Karen E. A. Burns; Stavroula Raptis; Rosane Nisenbaum; Leena Rizvi; Andrew Jones; Jyoti Bakshi; Wylie Tan; Aleksander Meret; Deborah J. Cook; Francois Lellouche; Scott K. Epstein; David Gattas; Farhad N. Kapadia; Jesús Villar; Laurent Brochard; Martin R. Lessard; Maureen O. Meade
• Keywords: Ventilator weaning

Rationale: Randomized trials and meta-analyses have informed several aspects of weaning. Results are rarely replicated in practice, as evidence is applied intensive care units that differ from the settings which it was generated.Objectives: We aimed to: 1) describe weaning practice variation (identifying candidates, conducting spontaneous breathing trials, using ventilator modes, other during weaning); 2) characterize regional differences practices; 3) identify factors associated with variation.Methods: conducted a cross-sectional, self-administered, international postal survey adult intensivist members critical societies six geographic regions, including Canada, India, United Kingdom, Europe, Australia/New Zealand, States. worked to randomly select potential respondents membership lists administer questionnaires goal obtaining 200 responses per region.Results: analyzed 1,144 (Canada, 156; 136; 219; 260; 196; States, 177). Across most screened patients once daily candidates (regional range, 70.0%–95.6%) less often twice (range, 12.2%–33.1%) or more than 1.6%–18.2%). To wean patients, used pressure support alone 31.0%–71.7%) 35.7%–68.1%). conduct predominantly positive end-expiratory 56.5%–72.3%) T-piece (8.9%–59.5%). we found important screening frequency, techniques; written directives guide care, noninvasive ventilation; roles played by available personnel various weaning.Conclusions: Our findings document presence extent on an scale, highlight multidisciplinary collaborative nature