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

René Robert 1 Amélie Le Gouge 2 Nancy Kentish-Barnes 3 Alice Cottereau Bruno Giraudeau 4 Mélanie Adda Djillali Annane 5 Juliette Audibert François Barbier 6 Patrick Bardou 7 Simon Bourcier 8 Jeremy Bourenne Alexandre Boyer 9 François Brenas Vincent Das Arnaud Desachy Jérôme Devaquet 10 Marc Feissel 11 Frederique Ganster 12 Maïté Garrouste-Orgeas 13 Guillaume Grillet Olivier Guisset 14 Rebecca Hamidfar-Roy 15 Anne Hyacinthe Sebastien Jochmans Mercé Jourdain 16 Alexandre Lautrette 17 Nicolas Lerolle 18 Olivier Lesieur 19 Fabien Lion Philippe Mateu Bruno Megarbane 20 Sybille Merceron 21 Emmanuelle Mercier 22 Jonathan Messika 23 Paul Morin-Longuet Bénédicte Philippon-Jouve Jean-Pierre Quenot 24, 25, 26 Anne Renault Xavier Repessé 27 Jean Rigaud Ségolène Robin Antoine Roquilly 28 Amélie Seguin 29 Didier Thevenin Patrice Tirot Isabelle Vinatier Elie Azoulay 30 Jean Reignier 31, 32, *
* Auteur correspondant
25 LIPNESS - Equipe LIPNESS (LNC - U1231)
LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
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. ClinicalTrials.gov identifier: NCT01818895.
Type de document :
Article dans une revue
Intensive Care Medicine, Springer Verlag, 2017, 〈10.1007/s00134-017-4891-0〉
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https://hal-univ-bourgogne.archives-ouvertes.fr/hal-01629508
Contributeur : Lnc - Université de Bourgogne <>
Soumis le : lundi 6 novembre 2017 - 15:11:20
Dernière modification le : samedi 1 septembre 2018 - 01:15:04

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René Robert, Amélie Le Gouge, Nancy Kentish-Barnes, Alice Cottereau, Bruno Giraudeau, et al.. Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study). Intensive Care Medicine, Springer Verlag, 2017, 〈10.1007/s00134-017-4891-0〉. 〈hal-01629508〉

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