title: ICU physicians' and nurses' perceptions of terminal extubation and terminal weaning: a self-questionnaire study.
abstract: OBJECTIVE
  Terminal extubation (TE) and terminal weaning (TW) are the methods available for withdrawing mechanical ventilation. Perceptions of TE and TW by intensive care unit (ICU) staff may influence bedside practices and the feasibility of studies comparing these methods.
  
  
  METHODS
  From January to June 2013, 5 nurses and 5 physicians in each of 46 (out of 70, 65.7 %) French ICUs completed an anonymous self-questionnaire. Clusters of staff members defined by perceptions of TE and TW were identified by exploratory analysis. Denominators for computing percentages were total numbers of responses to each item; cases with missing data were excluded for the relevant item.
  
  
  RESULTS
  Of the 451 (98 %) participants (225 nurses and 226 physicians), 37 (8.4 %) had never or almost never performed TW and 138 (31.3 %) had never or almost never performed TE. A moral difference between TW and TE was perceived by 205 (45.8 %) participants. The exploratory analysis identified three clusters defined by personal beliefs about TW and TE: 21.2 % of participants preferred TW, 18.1 % preferred TE, and 60.7 % had no preference. A preference for TW seemed chiefly related to unfavorable perceptions or insufficient knowledge of TE. Staff members who preferred TE and those with no preference perceived TE as providing a more natural dying process with less ambiguity.
  
  
  CONCLUSIONS
  Nearly two-fifths of ICU nurses and physicians in participating ICUs preferred TW or TE. This finding suggests both a need for shared decision-making and training before performing TE or TW and a high risk of poor compliance with randomly allocated TW or TE.
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Montreuil, France.
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authors.initials: A
authors.lastname: Cottereau
authors.affiliation: Medical Intensive Care Unit, University Hospital, Poitiers, France.|INSERM CIC 1402, Equipe 5 ALIVE, University Hospital, Poitiers, France.
authors.forename: René
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authors.lastname: Robert
authors.affiliation: Biometrical Department, INSERM CIC 1415, University Hospital, Tours, France.
authors.forename: Amélie
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authors.lastname: le Gouge
authors.affiliation: Medical Intensive Care Unit, University Hospital, Hopital Nord, Marseille, France.
authors.forename: Mélanie
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Chartres, France.
authors.forename: Juliette
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authors.lastname: Audibert
authors.affiliation: Orléans Medical Intensive Care Unit, District Hospital Center, Orléans, France.
authors.forename: François
authors.initials: F
authors.lastname: Barbier
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Montauban, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bardou
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Simon
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authors.lastname: Bourcier
authors.affiliation: Medical Intensive Care Unit, Pellegrin University Hospital, Bordeaux, France.
authors.forename: Alexandre
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authors.lastname: Boyer
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Le Puy-En-Velay, France.
authors.forename: François
authors.initials: F
authors.lastname: Brenas
authors.affiliation: Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Emmanuel
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authors.lastname: Canet
authors.affiliation: Medical-Surgical Intensive Care Unit, Delafontaine Hospital Center, Saint-Denis, France.
authors.forename: Daniel
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authors.lastname: Da Silva
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Montreuil, France.
authors.forename: Vincent
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Angoulême, France.
authors.forename: Arnaud
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authors.affiliation: Medical-Surgical Intensive Care Unit, Foch Hospital Center, Suresnes, France.
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Toulon, France.
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authors.affiliation: Medical Intensive Care Unit, University Hospital, Hopital La Timone, Marseille, France.
authors.forename: Beatrice
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Belfort, France.
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authors.forename: Diane
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Mulhouse, France.
authors.forename: Frédérique
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authors.forename: Maïté
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Lorient, France.
authors.forename: Guillaume
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authors.lastname: Grillet
authors.affiliation: Medical Intensive Care Unit, Saint-André University Hospital, Bordeaux, France.
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authors.lastname: Guisset
authors.affiliation: Medical Intensive Care Unit, Nantes University Hospital, Nantes, France.
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authors.affiliation: Medical Intensive Care Unit, Michalon University Hospital, Grenoble, France.
authors.forename: Rebecca
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authors.lastname: Hamidfar-Roy
authors.affiliation: Medical-Surgical Intensive Care Unit, Annecy Hospital Center, Pringy, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Hyacinthe
authors.affiliation: Medical-Surgical Intensive Care Unit, Marc Jaquet Hospital Center, Melun, France.
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authors.affiliation: Medical-Surgical Intensive Care Unit, Institut Gustave Roussy, Villejuif, France.
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Charleville-Mézières, France.
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authors.affiliation: Medical Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
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authors.lastname: Megarbane
authors.affiliation: Medical Intensive Care Unit, University Hospital, Tours, France.
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Saint-Nazaire, France.
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authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Roanne, France.
authors.forename: Bénédicte
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authors.lastname: Philippon-Jouve
authors.affiliation: Medical Intensive Care Unit, University Hospital, Dijon, France.
authors.forename: Jean-Pierre
authors.initials: JP
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authors.affiliation: Medical Intensive Care Unit, La Cavale Blanche University Hospital, Brest, France.
authors.forename: Anne
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authors.lastname: Renault
authors.affiliation: Medical-Surgical Intensive Care Unit, Ambroise Paré University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Boulogne, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Repesse
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Dieppe, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Rigaud
authors.affiliation: Surgical Intensive Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Ségolène
authors.initials: S
authors.lastname: Robin
authors.affiliation: Surgical Intensive Care Unit, Hotel Dieu University Hospital, Nantes, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roquilly
authors.affiliation: Medical Intensive Care Unit, Côte de Nacre University Hospital, Caen, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Seguin
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Lens, France.
authors.forename: Didier
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authors.lastname: Thevenin
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Center, Le Mans, France.
authors.forename: Patrice
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authors.lastname: Tirot
authors.affiliation: Biometrical Department, INSERM CIC 1415, University Hospital, Tours, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Contentin
authors.affiliation: Saint-Louis University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris Diderot Sorbonne University, Paris, France.
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authors.lastname: Kentish-Barnes
authors.affiliation: Medical Intensive Care Unit, Saint-André University Hospital, Bordeaux, France. jean.reignier@chu-nantes.fr.|Service de Réanimation Médicale, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. jean.reignier@chu-nantes.fr.
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mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000941:ethics* / Q000523:psychology*; D001291:Attitude of Health Personnel; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D012121:Respiration, Artificial / Q000941:ethics* / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Critical care; Ethics; Mechanical ventilation; Terminal extubation; Terminal weaning; Treatment limitation