Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study.
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Serval ID
serval:BIB_5CEE1AEB3CD3
Type
Article: article from journal or magazin.
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Publications
Institution
Title
Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study.
Journal
The Lancet. Respiratory medicine
Working group(s)
WEAN SAFE Investigators
Contributor(s)
Abrough F., Acharya S.P., Amin P., Arabi Y., Aragao I., Bauer P., Beduneau G., Beitler J., Berkius J., Bugedo G., Camporota L., Cerny V., Cho Y.J., Clarkson K., Estenssoro E., Goligher E., Grasselli G., Gritsan A., Hashemian S.M., Hermans G., Heunks L.M., Jovanovic B., Kurahashi K., Laake J.H., Matamis D., Moerer O., Molnar Z., Ozyilmaz E., Panka B., Papali A., Peñuelas Ó., Perbet S., Piquilloud L., Qiu H., Razek A.A., Rittayamai N., Roldan R., Serpa Neto A., Szuldrzynski K., Talmor D., Tomescu D., Van Haren F., Villagomez A., Zeggwagh A.A., Abe T., Aboshady A., Acampo-de Jong M., Acharya S., Adderley J., Adiguzel N., Agrawal V.K., Aguilar G., Aguirre G., Aguirre-Bermeo H., Ahlström B., Akbas T., Akker M., Al Sadeh G., Alamri S., Algaba A., Ali M., Aliberti A., Allegue J.M., Alvarez D., Amador J., Andersen F.H., Ansari S., Apichatbutr Y., Apostolopoulou O., Arabi Y., Arellano D., Arica M., Arikan H., Arinaga K., Arnal J.M., Asano K., Asín-Corrochano M., Avalos Cabrera J.M., Avila Fuentes S., Aydemir S., Aygencel G., Azevedo L., Bacakoglu F., Badie J., Baedorf Kassis E., Bai G., Balaraj G., Ballico B., Banner-Goodspeed V., Banwarie P., Barbieri R., Baronia A., Barrett J., Barrot L., Barrueco-Francioni J.E., Barry J., Bauer P., Bawangade H., Beavis S., Beck E., Beehre N., Belenguer Muncharaz A., Bellani G., Belliato M., Bellissima A., Beltramelli R., Ben Souissi A., Benitez-Cano A., Benlamin M., Benslama A., Bento L., Benvenuti D., Berkius J., Bernabe L., Bersten A., Berta G., Bertini P., Bertram-Ralph E., Besbes M., Bettini L.R., Beuret P., Bewley J., Bezzi M., Bhakhtiani L., Bhandary R., Bhowmick K., Bihari S., Bissett B., Blythe D., Bocher S., Boedjawan N., Bojanowski C.M., Boni E., Boraso S., Borelli M., Borello S., Borislavova M., Bosma K.J., Bottiroli M., Boyd O., Bozbay S., Briva A., Brochard L., Bruel C., Bruni A., Buehner U., Bugedo G., Bulpa P., Burt K., Buscot M., Buttera S., Cabrera J., Caccese R., Caironi P., Canchos Gutierrez I., Canedo N., Cani A., Cappellini I., Carazo J., Cardonnet L.P., Carpio D., Carriedo D., Carrillo R., Carvalho J., Caser E., Castelli A., Castillo Quintero M., Castro H., Catorze N., Cengiz M., Cereijo E., Ceunen H., Chaintoutis C., Chang Y., Chaparro G., Chapman C., Chau S., Chavez C.E., Chelazzi C., Chelly J., Chemouni F., Chen K., Chena A., Chiarandini P., Chilton P., Chiumello D., Cho Y.J., Chou-Lie Y., Chudeau N., Cinel I., Cinnella G., Clark M., Clark T., Clarkson K., Clementi S., Coaguila L., Codecido A.J., Collins A., Colombo R., Conde J., Consales G., Cook T., Coppadoro A., Cornejo R., Cortegiani A., Coxo C., Cracchiolo A.N., Crespo Ramirez M., Crova P., Cruz J., Cubattoli L., Çukurova Z., Curto F., Czempik P., D'Andrea R., da Silva Ramos F., Dangers L., Danguy des Déserts M., Danin P.E., Dantas F., Daubin C., Dawei W., de Haro C., de Jesus Montelongo F., De Mendoza D., de Pablo R., De Pascale G., De Rosa S., Decavèle M., Declercq P.L., Deicas A., Del Carmen Campos Moreno M., Dellamonica J., Delmas B., Demirkiran O., Demirkiran H., Dendane T., di Mussi R., Diakaki C., Diaz A., Diaz W., Dikmen Y., Dimoula A., Doble P., Doha N., Domingos G., Dres M., Dries D., Duggal A., Duke G., Dunts P., Dybwik K., Dykyy M., Eckert P., Efe S., Elatrous S., Elay G., Elmaryul A.S., Elsaadany M., Elsayed H., Elsayed S., Emery M., Ena S., Eng K., Englert J.A., Erdogan E., Ergin Ozcan P., Eroglu E., Escobar M., Esen F., Esen Tekeli A., Esquivel A., Esquivel Gallegos H., Ezzouine H., Facchini A., Faheem M., Fanelli V., Farina M.F., Fartoukh M., Fehrle L., Feng F., Feng Y., Fernandez I., Fernandez B., Fernandez-Rodriguez M.L., Ferrando C., Ferreira da Silva M.J., Ferreruela M., Ferrier J., Flamm Zamorano M.J., Flood L., Floris L., Fluckiger M., Forteza C., Fortunato A., Frans E., Frattari A., Fredes S., Frenzel T., Fumagalli R., Furche M.A., Fusari M., Fysh E., Galeas-Lopez J.L., Galerneau L.M., Garcia A., Garcia M.F., Garcia E., Garcia Olivares P., Garlicki J., Garnero A., Garofalo E., Gautam P., Gazenkampf A., Gelinotte S., Gelormini D., Ghrenassia E., Giacomucci A., Giannoni R., Gigante A., Glober N., Gnesin P., Gollo Y., Gomaa D., Gomero Paredes R., Gomes R., Gomez R.A., Gomez O., Gomez A., Gondim L., Gonzalez M., Gonzalez I., Gonzalez-Castro A., Gordillo Romero O., Gordo F., Gouin P., Graf Santos J., Grainne R., Grando M., Granov Grabovica S., Grasselli G., Grasso S., Grasso R., Grimmer L., Grissom C., Gritsan A., Gu Q., Guan X.D., Guarracino F., Guasch N., Guatteri L., Gueret R., Guérin C., Guerot E., Guitard P.G., Gül F., Gumus A., Gurjar M., Gutierrez P., Hachimi A., Hadzibegovic A., Hagan S., Hammel C., Han Song J., Hanlon G., Hashemian S.M., Heines S., Henriksson J., Herbrecht J.E., Heredia Orbegoso G.O., Hermans G., Hermon A., Hernandez R., Hernandez C., Herrera L., Herrera-Gutierrez M., Heunks L., Hidalgo J., Hill D., Holmquist D., Homez M., Hongtao X., Hormis A., Horner D., Hornos M.C., Hou M., House S., Housni B., Hugill K., Humphreys S., Humbert L., Hunter S., Hwa Young L., Iezzi N., Ilutovich S., Inal V., Innes R., Ioannides P., Iotti G.A., Ippolito M., Irie H., Iriyama H., Itagaki T., Izura J., Izza S., Jabeen R., Jamaati H., Jamadarkhana S., Jamoussi A., Jankowski M., Jaramillo L.A., Jeon K., Jeong Lee S., Jeswani D., Jha S., Jiang L., Jing C., Jochmans S., Johnstad B.A., Jongmin L., Joret A., Jovanovic B., Junhasavasdikul D., Jurado M.T., Kam E., Kamohara H., Kane C., Kara I., Karakurt S., Karnjanarachata C., Kataoka J., Katayama S., Kaushik S., Kelebek Girgin N., Kerr K., Kerslake I., Khairnar P., Khalid A., Khan A., Khanna A.K., Khorasanee R., Kienhorst D., Kirakli C., Knafelj R., Kol M.K., Kongpolprom N., Kopitko C., Korkmaz Ekren P., Kubisz-Pudelko A., Kulcsar Z., Kumasawa J., Kurahashi K., Kuriyama A., Kutchak F., Laake J.H., Labarca E., Labat F., Laborda C., Laca Barrera M.A., Lagache L., Landaverde Lopez A., Lanspa M., Lascari V., Le Meur M., Lee S.H., Lee Y.J., Lee J., Lee W.Y., Lee J., Legernaes T., Leiner T., Lemiale V., Leonor T., Lepper P.M., Li D., Li H., Li O., Lima A.R., Lind D., Litton E., Liu N., Liu L., Liu J., Llitjos J.F., Llorente B., Lopez R., Lopez C.E., Lopez Nava C., Lovazzano P., Lu M., Lucchese F., Lugano M., Lugo Goytia G., Luo H., Lynch C., Macheda S., Madrigal Robles V.H., Maggiore S.M., Magret Iglesias M., Malaga P., Mallapura Maheswarappa H., Malpartida G., Malyarchikov A., Mansson H., Manzano A., Marey I., Marin N., Marin MDC, Markman E., Martin F., Martin A., Martin Dal Gesso C., Martinez F., Martínez-Fidalgo C., Martin-Loeches I., Mas A., Masaaki S., Maseda E., Massa E., Mattsson A., Maugeri J., McCredie V., McCullough J., McGuinness S., McKown A., Medve L., Mei C., Mellado Artigas R., Mendes V., Mervat MKE, Michaux I., Mikhaeil M., Milagros O., Milet I., Millan M.T., Minwei Z., Mirabella L., Mishra S., Mistraletti G., Mochizuki K., Moerer O., Moghal A., Mojoli F., Molin A., Molnar Z., Montiel R., Montini L., Monza G., Mora Aznar M., Morakul S., Morales M., Moreno Torres D., Morocho Tutillo D.R., Motherway C., Mouhssine D., Mouloudi E., Muñoz T., Munoz de Cabo C., Mustafa M., Muthuchellappan R., Muthukrishnan M., Muttini S., Nagata I., Nahar D., Nakanishi M., Nakayama I., Namendys-Silva S.A., Nanchal R., Nandakumar S., Nasi A., Nasir K., Navalesi P., Naz Aslam T., Nga Phan T., Nichol A., Niiyama S., Nikolakopoulou S., Nikolic E., Nitta K., Noc M., Nonas S., Nseir S., Nur Soyturk A., Obata Y., Oeckler R., Oguchi M., Ohshimo S., Oikonomou M., Ojados A., Oliveira M.T., Oliveira Filho W., Oliveri C., Olmos A., Omura K., Orlandi M.C., Orsenigo F., Ortiz-Ruiz De Gordoa L., Ota K., Ovalle Olmos R., Öveges N., Oziemski P., Ozkan Kuscu O., Pachas Alvarado F., Pagella G., Palaniswamy V., Palazon Sanchez E.L., Palmese S., Pan G., Pan W., Panka B., Papanikolaou M., Papavasilopoulou T., Parekh A., Parke R., Parrilla F.J., Parrilla D., Pasha T., Pasin L., Patão L., Patel M., Patel G., Pati B.K., Patil J., Pattnaik S., Paul D., Pavesi M., Pavlotsky V.A., Paz G., Paz E., Pecci E., Pellegrini C., Peña Padilla A.G., Perchiazzi G., Pereira T., Pereira V., Perez M., Perez Calvo C., Perez Cheng M., Perez Maita R., Pérez-Araos R., Perez-Teran P., Perez-Torres D., Perkins G., Persona P., Petnak T., Petrova M., Pham T., Philippart F., Picetti E., Pierucci E., Piervincenzi E., Pinciroli R., Pintado M.C., Piquilloud L., Piraino T., Piras S., Piras C., Pirompanich P., Pisani L., Platas E., Plotnikow G., Porras W., Porta V., Portilla M., Portugal J., Povoa P., Prat G., Pratto R., Preda G., Prieto I., Prol-Silva E., Pugh R., Qi Y., Qian C., Qin T., Qiu H., Qu H., Quintana T., Quispe Sierra R., Quispe Soto R., Rabbani R., Rabee M., Rabie A., Rahe Pereira M.A., Rai A., Raj Ashok S., Rajab M., Ramdhani N., Ramey E., Ranieri M., Rathod D., Ray B., Redwanul Huq S.M., Regli A., Reina R., Resano Sarmiento N., Reynaud F., Rialp G., Ricart P., Rice T., Richardson A., Rieder M., Rinket M., Rios F., Rios F., Risso Vazquez A., Rittayamai N., Riva I., Rivette M., Roca O., Roche-Campo F., Rodriguez C., Rodriguez G., Rodriguez Gonzalez D., Rodriguez Tucto X.Y., Rogers A., Romano M.E., Rørtveit L., Rose A., Roux D., Rouze A., Rubatto Birri P.N., Ruilan W., Ruiz Robledo A., Ruiz-Aguilar A.L., Sadahiro T., Saez I., Sagardia J., Saha R., Saha R., Saiphoklang N., Saito S., Salem M., Sales G., Salgado P., Samavedam S., Sami Mebazaa M., Samuelsson L., San Juan Roman N., Sanchez P., Sanchez-Ballesteros J., Sandoval Y., Sani E., Santos M., Santos C., Sanui M., Saravanabavan L., Sari S., Sarkany A., Sauneuf B., Savioli M., Sazak H., Scano R., Schneider F., Schortgen F., Schultz M.J., Schwarz G.L., Seçkin Yücesoy F., Seely A., Seiler F., Seker Tekdos Y., Seok Chan K., Serano L., Serednicki W., Serpa Neto A., Setten M., Shah A., Shah B., Shang Y., Shanmugasundaram P., Shapovalov K., Shebl E., Shiga T., Shime N., Shin P., Short J., Shuhua C., Siddiqui S., Silesky Jimenez J.I., Silva D., Silva Sales B., Simons K., Sjøbø B.Å., Slessor D., Smiechowicz J., Smischney N., Smith P., Smith T., Smith M., Snape S., Snyman L., Soetens F., Sook Hong K., Sosa Medellin M.Á., Soto G., Souloy X., Sousa E., Sovatzis S., Sozutek D., Spadaro S., Spagnoli M., Spångfors M., Spittle N., Spivey M., Stapleton A., Stefanovic B., Stephenson L., Stevenson E., Strand K., Strano M.T., Straus S., Sun C., Sun R., Sundaram V., SunPark T., Surlemont E., Sutherasan Y., Szabo Z., Szuldrzynski K., Tainter C., Takaba A., Tallott M., Tamasato T., Tang Z., Tangsujaritvijit V., Taniguchi L., Taniguchi D., Tarantino F., Teerapuncharoen K., Temprano S., Terragni P., Terzi N., Thakur A., Theerawit P., Thille A.W., Thomas M., Thungtitigul P., Thyrault M., Tilouch N., Timenetsky K., Tirapu J., Todeschini M., Tomas R., Tomaszewski C., Tonetti T., Tonnelier A., Trinder J., Trongtrakul K., Truwit J., Tsuei B., Tulaimat A., Turan S., Turkoglu M., Tyagi S., Ubeda A., Vagginelli F., Valenti M.F., Vallverdu I., Van Axel A., van den Hul I., van der Hoeven H., Van Der Meer N., Van Haren F., Vanhoof M., Vargas-Ordoñez M., Vaschetto R., Vascotto E., Vatsik M., Vaz A., Vazquez-Sanchez A., Ventura S., Vermeijden J.W., Vidal A., Vieira J., Vilela Costa Pinto B., Villagomez A., Villagra A., Villegas Succar C., Vinorum O.G., Vitale G., Vj R., Vochin A., Voiriot G., Volta C.A., von Seth M., Wajdi M., Walsh D., Wang S., Wardi G., Ween-Velken N.C., Wei B.L., Weller D., Welsh D., Welters I., Wert M., Whiteley S., Wilby E., Williams E., Williams K., Wilson A., Wojtas J., Won Huh J., Wrathall D., Wright C., Wu J.F., Xi G., Xing Z.J., Xu H., Yamamoto K., Yan J., Yáñez J., Yang X., Yates E., Yazicioglu Mocin O., Ye Z., Yildirim F., Yoshida N., Yoshido HHL, Young Lee B., Yu R., Yu G., Yu T., Yuan B., Yuangtrakul N., Yumoto T., Yun X., Zakalik G., Zaki A., Zalba-Etayo B., Zambon M., Zang B., Zani G., Zarka J., Zerbi S.M., Zerman A., Zetterquist H., Zhang J., Zhang H., Zhang W., Zhang G., Zhang W., Zhao H., Zheng J., Zhu B., Zumaran R.
ISSN
2213-2619 (Electronic)
ISSN-L
2213-2600
Publication state
Published
Issued date
05/2023
Peer-reviewed
Oui
Volume
11
Number
5
Pages
465-476
Language
english
Notes
Publication types: Observational Study ; Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.
WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109.
Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital.
In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates.
European Society of Intensive Care Medicine, European Respiratory Society.
WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109.
Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital.
In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates.
European Society of Intensive Care Medicine, European Respiratory Society.
Keywords
Humans, Respiration, Artificial/adverse effects, Ventilator Weaning, Prospective Studies, Intensive Care Units, Cohort Studies
Pubmed
Web of science
Create date
31/01/2023 15:45
Last modification date
14/10/2023 7:06
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