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Mechanical Ventilation Discontinuation Practices in Asia A Multinational Survey

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Abstract
Rationale: There are limited data on mechanical discontinuation practices in Asia.

Objectives: To document self-reported mechanical discontinuation practices and determine whether there is clinical equipoise regarding protocolized weaning among Asian Intensive Care specialists.

Methods: A survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists.

Results: Of the 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. The majority of respondents (60.5%) were from China. Of the respondents, 42% worked in intensive care units (ICUs) where respiratory therapists were present; 78.9% used a spontaneous breathing trial as the initial weaning step; 44.3% frequently/always used pressure support (PS) alone, 53.4% intermittent spontaneous breathing trials with PS in between, and 19.8% synchronized intermittent mandatory ventilation with PS as a weaning mode. Of the respondents, 56.3% routinely stopped feeds before extubation, 71.5% generally followed a sedation protocol or guideline, and 61.8% worked in an ICU with a weaning protocol. Of these, 78.2% frequently always followed the protocol. A multivariate analysis involving a modified Poisson regression analysis showed that working in an ICU with a weaning protocol and frequently/always following it was positively associated with an upper-middle-income territory, a university-affiliated hospital, or in an ICU that employed respiratory therapists; and negatively with a low-income or lower-middle-income territory or a public hospital. There was no significant association with "in-house" intensivist at night, multidisciplinary ICU, closed ICU, or nurse-patient ratio. There was heterogeneity in agreement/disagreement with the statement, "evidence clearly supports protocolized weaning over nonprotocolized weaning."

Conclusions: A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with the best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.
Author(s)
고윤석Anna LeeBabu Raja ShresthaBambang WahjuprajitnoBin DuBoonsong PatjanasoontornCharles D GomersallCheng Cheng TanChi Hung Czarina LeungHussain N Al RahmaJason PhuaJigeeshu V DivatiaJose Emmanuel M PalKanishka IndraratnaKaren E A BurnsMadiha HashmiMohammad Omar FaruqMoritoki Egi
Issued Date
2021
Type
Article
Keyword
Intensive carePolls & surveysRespiratory diseasesVentilationWeaning
DOI
10.1513/AnnalsATS.202008-968OC
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7105
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2468339217&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Mechanical%20Ventilation%20Discontinuation%20Practices%20in%20Asia%20A%20Multinational%20Survey&offset=0&pcAvailability=true
Publisher
ANNALS OF THE AMERICAN THORACIC SOCIETY
Location
미국
Language
영어
ISSN
1546-3222
Citation Volume
18
Citation Number
8
Citation Start Page
1352
Citation End Page
1359
Appears in Collections:
Medicine > Medicine
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