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01-12-2017 | Original

Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study)

Authors: René Robert, Amélie Le Gouge, Nancy Kentish-Barnes, Alice Cottereau, Bruno Giraudeau, Mélanie Adda, Djillali Annane, Juliette Audibert, François Barbier, Patrick Bardou, Simon Bourcier, Jeremy Bourenne, Alexandre Boyer, François Brenas, Vincent Das, Arnaud Desachy, Jérôme Devaquet, Marc Feissel, Frédérique Ganster, Maïté Garrouste-Orgeas, Guillaume Grillet, Olivier Guisset, Rebecca Hamidfar-Roy, Anne-Claire Hyacinthe, Sebastien Jochmans, Mercé Jourdain, Alexandre Lautrette, Nicolas Lerolle, Olivier Lesieur, Fabien Lion, Philippe Mateu, Bruno Megarbane, Sybille Merceron, Emmanuelle Mercier, Jonathan Messika, Paul Morin-Longuet, Bénédicte Philippon-Jouve, Jean-Pierre Quenot, Anne Renault, Xavier Repesse, Jean-Philippe Rigaud, Ségolène Robin, Antoine Roquilly, Amélie Seguin, Didier Thevenin, Patrice Tirot, Isabelle Vinatier, Elie Azoulay, Jean Reignier

Published in: Intensive Care Medicine | Issue 12/2017

Abstract

Purpose

The relative merits of immediate extubation versus terminal weaning for mechanical ventilation withdrawal are controversial, particularly regarding the experience of patients and relatives.

Methods

This prospective observational multicentre study (ARREVE) was done in 43 French ICUs to compare terminal weaning and immediate extubation, as chosen by the ICU team. Terminal weaning was a gradual decrease in the amount of ventilatory assistance and immediate extubation was extubation without any previous decrease in ventilatory assistance. The primary outcome was posttraumatic stress symptoms (Impact of Event Scale Revised, IES-R) in relatives 3 months after the death. Secondary outcomes were complicated grief, anxiety, and depression symptoms in relatives; comfort of patients during the dying process; and job strain in staff.

Results

We enrolled 212 (85.5%) relatives of 248 patients with terminal weaning and 190 relatives (90.5%) of 210 patients with immediate extubation. Immediate extubation was associated with airway obstruction and a higher mean Behavioural Pain Scale score compared to terminal weaning. In relatives, IES-R scores after 3 months were not significantly different between groups (31.9 ± 18.1 versus 30.5 ± 16.2, respectively; adjusted difference, −1.9; 95% confidence interval, −5.9 to 2.1; p = 0.36); neither were there any differences in complicated grief, anxiety, or depression scores. Assistant nurses had lower job strain scores in the immediate extubation group.

Conclusions

Compared to terminal weaning, immediate extubation was not associated with differences in psychological welfare of relatives when each method constituted standard practice in the ICU where it was applied. Patients had more airway obstruction and gasps with immediate extubation.

Trial registration: ClinicalTrials.gov identifier: NCT01818895.

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Title: Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study)
Authors: René Robert
Amélie Le Gouge
Nancy Kentish-Barnes
Alice Cottereau
Bruno Giraudeau
Mélanie Adda
Djillali Annane
Juliette Audibert
François Barbier
Patrick Bardou
Simon Bourcier
Jeremy Bourenne
Alexandre Boyer
François Brenas
Vincent Das
Arnaud Desachy
Jérôme Devaquet
Marc Feissel
Frédérique Ganster
Maïté Garrouste-Orgeas
Guillaume Grillet
Olivier Guisset
Rebecca Hamidfar-Roy
Anne-Claire Hyacinthe
Sebastien Jochmans
Mercé Jourdain
Alexandre Lautrette
Nicolas Lerolle
Olivier Lesieur
Fabien Lion
Philippe Mateu
Bruno Megarbane
Sybille Merceron
Emmanuelle Mercier
Jonathan Messika
Paul Morin-Longuet
Bénédicte Philippon-Jouve
Jean-Pierre Quenot
Anne Renault
Xavier Repesse
Jean-Philippe Rigaud
Ségolène Robin
Antoine Roquilly
Amélie Seguin
Didier Thevenin
Patrice Tirot
Isabelle Vinatier
Elie Azoulay
Jean Reignier
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4891-0

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Springer Medicine

Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study)

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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