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Observational Study
. 2017 Dec;43(12):1793-1807.
doi: 10.1007/s00134-017-4891-0. Epub 2017 Sep 22.

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

René Robert  1   2   3 , Amélie Le Gouge  4   5   6 , Nancy Kentish-Barnes  7   8   9 , Alice Cottereau  10 , Bruno Giraudeau  4   5   6 , Mélanie Adda  11 , Djillali Annane  12   13 , Juliette Audibert  14 , François Barbier  15 , Patrick Bardou  16 , Simon Bourcier  17   18 , Jeremy Bourenne  19 , Alexandre Boyer  20   21 , François Brenas  22 , Vincent Das  10 , Arnaud Desachy  23 , Jérôme Devaquet  24 , Marc Feissel  25 , Frédérique Ganster  26 , Maïté Garrouste-Orgeas  27   28   29 , Guillaume Grillet  30 , Olivier Guisset  20   31 , Rebecca Hamidfar-Roy  32   33 , Anne-Claire Hyacinthe  34 , Sebastien Jochmans  35 , Mercé Jourdain  36   37   38 , Alexandre Lautrette  39   40 , Nicolas Lerolle  41   42 , Olivier Lesieur  43 , Fabien Lion  44 , Philippe Mateu  45 , Bruno Megarbane  7   46 , Sybille Merceron  7   8   9 , Emmanuelle Mercier  5   47   48 , Jonathan Messika  49 , Paul Morin-Longuet  50 , Bénédicte Philippon-Jouve  51 , Jean-Pierre Quenot  52   53   54 , Anne Renault  55   56 , Xavier Repesse  57 , Jean-Philippe Rigaud  58 , Ségolène Robin  17   59   60 , Antoine Roquilly  61   62 , Amélie Seguin  63 , Didier Thevenin  64 , Patrice Tirot  65 , Isabelle Vinatier  66 , Elie Azoulay  7   8   9 , Jean Reignier  67   68   69
Affiliations
Observational Study

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

René Robert et al. Intensive Care Med. 2017 Dec.

Erratum in

  • Correction to: Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).
    Robert R, Le Gouge A, Kentish-Barnes N, Cottereau A, Giraudeau B, Adda M, Annane D, Audibert J, Barbier F, Bardou P, Bourcier S, Bourenne J, Boyer A, Brenas F, Das V, Desachy A, Devaquet J, Feissel M, Ganster F, Garrouste-Orgeas M, Grillet G, Guisset O, Hamidfar-Roy R, Hyacinthe AC, Jochmans S, Jourdain M, Lautrette A, Lerolle N, Lesieur O, Lion F, Mateu P, Megarbane B, Merceron S, Mercier E, Messika J, Morin-Longuet P, Philippon-Jouve B, Quenot JP, Renault A, Repesse X, Rigaud JP, Robin S, Roquilly A, Seguin A, Thevenin D, Tirot P, Vinatier I, Azoulay E, Reignier J. Robert R, et al. Intensive Care Med. 2017 Dec;43(12):1942-1943. doi: 10.1007/s00134-017-4999-2. Intensive Care Med. 2017. PMID: 29178042

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.

Keywords: Critical care; Ethics; Immediate extubation; Mechanical ventilation; Terminal weaning; Treatment limitation.

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