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Ventilator Weaning and Discontinuation Practices for Critically Ill Patients
Karen E A Burns1,2,3, Leena Rizvi2, Deborah J Cook4,5
1Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
JAMA
|March 23, 2021
Summary
Discontinuation of invasive mechanical ventilation (IMV) practices vary globally. Spontaneous breathing trials (SBTs) are common but associated with worse outcomes if failed or delayed, highlighting the need for standardized weaning protocols.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Clinical Research
Background:
- Invasive mechanical ventilation (IMV) is a cornerstone of critical care, yet its discontinuation process lacks standardized characterization.
- Understanding variations in IMV weaning practices is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate international practice variations in IMV discontinuation.
- To analyze associations between initial weaning strategies and clinical outcomes.
- To identify factors influencing the use of specific weaning methods and spontaneous breathing trial (SBT) success.
Main Methods:
- Prospective, multinational, observational study involving 1868 critically ill adults across 142 intensive care units (ICUs) in 19 countries.
- Data collected on IMV duration, initial discontinuation events (extubation, SBT, tracheostomy), and clinical outcomes including mortality and length of stay.
- Comparative analyses were performed between different weaning strategies and timing of SBTs.
Main Results:
- Significant international variation in IMV discontinuation practices was observed, including direct extubation (22.7%), initial SBT (49.8%), and direct tracheostomy (8.0%).
- Patients undergoing initial SBTs experienced higher ICU mortality, longer ventilation duration, and extended ICU stays compared to direct extubation.
- Failed SBTs and delayed SBTs (>2.3 days post-intubation) were associated with substantially worse clinical outcomes, including increased mortality and prolonged hospitalizations.
Conclusions:
- Weaning practices for invasive mechanical ventilation differ significantly across international intensive care units.
- The timing and success of spontaneous breathing trials critically impact patient outcomes, suggesting a need for optimized weaning protocols.
- Further research into standardized, evidence-based weaning strategies is warranted to improve care for mechanically ventilated patients.
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