Journal Article

Epidemiology of Weaning Outcome according to a New Definition. The WIND Study

Centre Hospitalier Le Mans (CH Le Mans), Guitard, Pierre-Gildas, Service de Soins Intensifs [CHU Rouen] ; CHU Rouen ; Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN) ; Normandie Université (NU), Terzi, Nicolas, Richard, Jean-Christophe, Jonas, Maud, Barberet, Guillaume, Grange, Steven, Béduneau, Gaétan, Frat, Jean-Pierre, Mancebo, Jordi, Runge, Isabelle, Hospices Civils de Lyon (HCL), Chretien, Jean-Marie, CHU Tenon [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux ; Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Piquilloud, Lise, Schortgen, Frederi

2017

Overview

The weaning process concerns all patients receiving mechanical ventilation. A previous classification into simple, prolonged, and difficult weaning ignored weaning failure and presupposed the use of spontaneous breathing trials. To describe the weaning process, defined as starting with any attempt at separation from mechanical ventilation and its prognosis, according to a new operational classification working for all patients under ventilation. This was a multinational prospective multicenter observational study over 3 months of all patients receiving mechanical ventilation in 36 intensive care units, with daily collection of ventilation and weaning modalities. Pragmatic definitions of separation attempt and weaning success allowed us to allocate patients in four groups. A total of 2,729 patients were enrolled. Although half of them could not be classified using the previous definition, 99% entered the groups on the basis of our new definition as follows: 24% never started a weaning process, 57% had a weaning process of less than 24 hours (group 1), 10% had a difficult weaning of more than 1 day and less than 1 week (group 2), and 9% had a prolonged weaning duration of 1 week or more (group 3). Duration of ventilation, intensive care unit stay, and mortality (6, 17, and 29% for the three groups, respectively) all significantly increased from one group to the next. The unadjusted risk of dying was 19% after the first separation attempt and increased to 37% after 10 days. A new classification allows us to categorize all weaning situations. Every additional day without a weaning success after the first separation attempt increases the risk of dying.

• Publisher: American Thoracic Society,CCSD,Oxford University Press
• Subject: Female / France / Human health and pathology / Humans / Intensive Care Units / Length of Stay - statistics & numerical data / Life Sciences / Male / Middle Aged / Outcome Assessment (Health Care) - methods / Outcome Assessment (Health Care) - statistics & numerical data / Prospective Studies / Pulmonology and respiratory tract / Spain / Switzerland / Time Factors / Ventilator Weaning - classification / Ventilator Weaning - methods / Ventilator Weaning - statistics & numerical data