Weaning critically ill adults from invasive mechanical ventilation: a national survey.
OBJECTIVE
To determine the stated practices of clinicians in weaning critically ill adults from invasive ventilation.


METHODS
We conducted a cross-sectional, self-administered postal survey of Critical Care physicians and respiratory therapists (RTs) in leadership roles at Canadian teaching hospitals. We identified respondents using electronic mail and telephone correspondence. We used rigorous survey methodology to develop, test, and administer the questionnaire.


RESULTS
One hundred ten of 162 (67.9%) clinicians returned the survey with 99 respondents (55 physicians and 44 RTs) completing it either in-part or in-full. Approximately 95% of respondents acknowledged ever performing spontaneous breathing trials (SBTs) in clinical practice. Of these, 95.6% and 32% of respondents reported conducting daily and twice-daily screening to identify SBT candidates, at least sometimes. The three most common techniques to conduct SBTs included; pressure support (PS) with positive end-expiratory pressure (70.8%), continuous positive airway pressure (35.7%), and use of a T-piece (25.0%). PS ventilation was the weaning strategy used most frequently before SBTs. Most respondents (57.1%) considered continuous infusion of sedative-hypnotics to be a relative contraindication to tracheal extubation. However, concurrent administration of low dose vasopressors, inotropes, and analgesic boluses, or continuous analgesic infusions were considered acceptable amongst 60.8%, 73.2%, 78.4% and 58.8% of respondents, respectively. We did not observe regional variation in whether clinicians ever perform SBTs, the ventilatory modes used prior to an SBT nor in the use of PS and SBTs during the weaning process.


CONCLUSIONS
Pressure support and SBTs are common features of weaning in Canadian teaching hospitals. Compared to the published literature, our survey suggests that weaning practices have evolved over time and that practice variation may be greater on an international level compared to a national level.
Burns
Karen E A
KE
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. Burnsk@smh.toronto.on.ca
Lellouche
Francois
F
Loisel
France
F
Slutsky
Arthur S
AS
Meret
Aleksander
A
Smith
Orla
O
Saskin
Refik
R
Meade
Maureen
M
D000328:Adult; D002170:Canada; D016638:Critical Illness; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006784:Hospitals, Teaching; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000628:therapy; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods* / Q000639:trends