Mechanical Ventilation Discontinuation Practices in Asia: A Multinational Survey
- Additional Document Info
- View All
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 amongst Asian Intensive Care specialists. METHODS: Survey using a validated questionnaire, distributed using a snowball method to Asian Intensive Care specialists. RESULTS: Of 2,967 invited specialists from 20 territories, 2,074 (69.9%) took part. 60.5% were from China. 42% of all respondents worked in Intensive Care units where respiratory therapists were present. 78.9% used a spontaneous breathing trial as the initial weaning step. 44.3% frequently-always used pressure support alone, 53.4% intermittent spontaneous breathing trials with pressure support in between and 19.8% synchronized intermittent mandatory ventilation with pressure support as a weaning mode. 56.3% routinely stopped feeds before extubation. 71.5% generally followed a sedation protocol or guideline. 61.8% worked in an Intensive Care unit with a weaning protocol. Of these 78.2% frequently-always followed the protocol. Multivariate analysis involving a modified Poisson regression analysis showed that working in an Intensive Care unit with a weaning protocol and frequently-always following it was positively associated with upper-middle income territory, university affiliated hospital, or in an Intensive Care unit that employed respiratory therapists; and negatively with low-income or low-middle income territory or a public hospital. There was no significant association with "in house" intensivist at night, multidisciplinary Intensive Care unit, closed Intensive Care unit or nurse-patient ratio. There was heterogenity in agreement/disagreement with the statement "evidence clearly supports protocolized weaning over non-protocolized weaning". CONCLUSIONS: A substantial minority of Asian Intensive Care specialists do not wean patients in accordance with best available evidence or current guidelines. There is clinical equipoise regarding the benefit of protocolized weaning.
has subject area