National survey on practices of French intensivists in weaning from mechanical ventilation

Observational studies have shown patient-level variations in weaning practices. This study aimed to assess the individual opinions of French intensivists about the weaning process.

A national e-survey was conducted in ICUs in France in December 2023.

Among 343 ICUs contacted, 487 physicians answered the questionnaire. The weaning process begins at the first attempt of stopping sedation for 50% of responders, at the time the patient begins to trigger the ventilator for 26%, and at the first spontaneous breathing trial (SBT) for 24%. Fifty-five percent of physicians evaluate the patient's ability to breathe without the ventilator after a gradual lowering of the level of ventilatory assistance, and 45% daily, whatever the level of assistance. SBTs are performed always or frequently for 96% of responders, with pressure support ventilation (PS) for 73%, and without positive end-expiratory pressure for 76%. The main objective of extubation is to reduce the duration of mechanical ventilation for 52% of responders, vs. to make the extubation a success for 48%. An impaired consciousness is a contraindication to extubation for 69% of responders, a negative cuff leak test for 66%, large fluid overload for 43%, sputum retention for 27%, weak cough for 23%, and swallowing disorders for 21%.

Our survey among French intensivists shows that the attempt to separate the patient from the ventilator is largely performed by SBTs. However, daily screening for readiness to SBT seems to be a minority. The level of consciousness is a key factor in the decision of extubation.