| Contributors: |
Tài, Pham; Leo, Heunk; Giacomo, Bellani; Fabiana, Madotto; Irene, Aragao; Gaëtan, Beduneau; Ewan C, Goligher; Giacomo, Grasselli; Jon Henrik, Laake; Jordi, Mancebo; Oscar, Peñuela; Lise, Piquilloud; Antonio, Pesenti; Hannah, Wunsch; Frank, van Haren; Laurent, Brochard; John G, Laffey; Abrough, Fekri; P Acharya, Subhash; Amin, Pravin; Arabi, Yaseen; Aragao, Irene; Bauer, Philippe; Beduneau, Gaëtan; Beitler, Jeremy; Berkius, Johan; Bugedo, Guillermo; Camporota, Luigi; Cerny, Vladimir; Cho, Young-Jae; Clarkson, Kevin; Estenssoro, Elisa; Goligher, Ewan; Grasselli, Giacomo; Gritsan, Alexey; Mohammadreza Hashemian, Seyed; Hermans, Greet; M Heunks, Leo; Jovanovic, Bojan; Kurahashi, Kiyoyasu; Henrik Laake, Jon; Matamis, Dimitrio; Moerer, Onnen; Molnar, Zsolt; Ozyilmaz, Ezgi; Panka, Bernardo; Papali, Alfred; Peñuelas, Óscar; Perbet, Sébastien; Piquilloud, Lise; Qiu, Haibo; Abdel Razek, Assem; Rittayamai, Nuttapol; Roldan, Rollin; Serpa Neto, Ary; Szuldrzynski, Konstanty; Talmor, Daniel; Tomescu, Dana; Van Haren, Frank; Villagomez, Asisclo; Ali Zeggwagh, Amine; Abe, Toshikazu; Aboshady, Abdelrhman; Acampo-de Jong, Melanie; Acharya, Subhash; Adderley, Jane; Adiguzel, Nalan; Kumar Agrawal, Vijay; Aguilar, Gerardo; Aguirre, Gaston; Aguirre-Bermeo, Hernan; Ahlström, Björn; Akbas, Türkay; Akker, Mustafa; Al Sadeh, Ghamdan; Alamri, Sultan; Algaba, Angela; Ali, Muneeb; Aliberti, Anna; Manuel Allegue, Jose; Alvarez, Diana; Amador, Joaquin; H Andersen, Finn; Ansari, Sharique; Apichatbutr, Yutthana; Apostolopoulou, Olympia; Arellano, Daniel; Arica, Mestanza; Arikan, Huseyin; Arinaga, Koichi; Arnal, Jean-Michel; Asano, Kengo; Asín-Corrochano, Marta; Milagrito Avalos Cabrera, Jesu; Avila Fuentes, Silvia; Aydemir, Semih; Aygencel, Gulbin; Azevedo, Luciano; Bacakoglu, Feza |
| Description: |
Background 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.Methods 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.Findings 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 ( |