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 Cottereau¹⁰, Bruno Giraudeau^{4

5

6}, Mélanie Adda¹¹, Djillali Annane^{12

13}, Juliette Audibert¹⁴, François Barbier¹⁵, Patrick Bardou¹⁶, Simon Bourcier^{17

18}, Jeremy Bourenne¹⁹, Alexandre Boyer^{20

21}, François Brenas²², Vincent Das¹⁰, Arnaud Desachy²³, Jérôme Devaquet²⁴, Marc Feissel²⁵, Frédérique Ganster²⁶, Maïté Garrouste-Orgeas^{27

28

29}, Guillaume Grillet³⁰, Olivier Guisset^{20

31}, Rebecca Hamidfar-Roy^{32

33}, Anne-Claire Hyacinthe³⁴, Sebastien Jochmans³⁵, Mercé Jourdain^{36

37

38}, Alexandre Lautrette^{39

40}, Nicolas Lerolle^{41

42}, Olivier Lesieur⁴³, Fabien Lion⁴⁴, Philippe Mateu⁴⁵, Bruno Megarbane^{7

46}, Sybille Merceron^{7

8

9}, Emmanuelle Mercier^{5

47

48}, Jonathan Messika⁴⁹, Paul Morin-Longuet⁵⁰, Bénédicte Philippon-Jouve⁵¹, Jean-Pierre Quenot^{52

53

54}, Anne Renault^{55

56}, Xavier Repesse⁵⁷, Jean-Philippe Rigaud⁵⁸, Ségolène Robin^{17

59

60}, Antoine Roquilly^{61

62}, Amélie Seguin⁶³, Didier Thevenin⁶⁴, Patrice Tirot⁶⁵, Isabelle Vinatier⁶⁶, Elie Azoulay^{7

8

9}, Jean Reignier^{67

68

69}

Affiliations

¹ Inserm CIC, 1402, axe Alive, Poitiers, France.
² Université de Poitiers, Poitiers, France.
³ Service de Réanimation Médicale, CHU Poitiers, Poitiers, France.
⁴ Inserm CIC 1415, Tours, France.
⁵ Université de Tours, Tours, France.
⁶ CHU Tours, Tours, France.
⁷ Université Paris Diderot, Paris, France.
⁸ Service de Réanimation Médicale, CHU Saint-Louis, Paris, France.
⁹ Groupe de Recherche Famiréa, Paris, France.
¹⁰ Service de Réanimation polyvalente, CHI André Grégoire, Montreuil, France.
¹¹ Aix-Marseille Université, APHM, URMITE, UMR CNRS 7278, Hôpital Nord, Réanimation des Détresses Respiratoires et Infections Sévères, Marseille, France.
¹² Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France.
¹³ Service de Réanimation Médicale, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France.
¹⁴ Service de Réanimation Polyvalente, CH de Chartres, Chartres, France.
¹⁵ Service de Réanimation Médicale, CHR d'Orléans, Orléans, France.
¹⁶ Service de Réanimation Médico-Chirurgicale, CH de Montauban, Montauban, France.
¹⁷ Université Paris-Descartes, Paris, France.
¹⁸ Service de Réanimation Médicale, CHU Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France.
¹⁹ Aix-Marseille Université, APHM, Hôpital La Timone, Réanimation et surveillance continue, Marseille, France.
²⁰ Université de Bordeaux, Bordeaux, France.
²¹ Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
²² Service de Réanimation Polyvalente, CH Emile Roux, Le Puy En Velay, France.
²³ Service de Réanimation Polyvalente, CH d'Angoulême, Angoulême, France.
²⁴ Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France.
²⁵ Service de Réanimation Polyvalente, CH de Belfort-Montbéliard, Belfort, France.
²⁶ Service de Réanimation Médicale, Hôpital Emile Muller, Mulhouse, France.
²⁷ Service de médecine intensive et de réanimation, Groupe Hospitalier Paris Saint Joseph, Paris, France.
²⁸ Groupe de recherche Outcomerea, Paris, France.
²⁹ IAME, UMR 1137, INSERM Université Paris Diderot, Département de biostatistiques-HUPNVS-AP-HP, UFR de Médecine-Bichat, Paris, France.
³⁰ Service de Réanimation Polyvalente, CH Bretagne Sud, Lorient, France.
³¹ Service de Réanimation Médicale, CHU Bordeaux, Hôpital Saint-André, Bordeaux, France.
³² Université Grenoble-Alpes, Grenoble, France.
³³ CHU Albert Michallon, Clinique de la Réanimation Médicale, Grenoble, France.
³⁴ Service de Réanimation Polyvalente, Centre Hospitalier Annecy Genevois, Pringy, France.
³⁵ Service de Réanimation Médicale, CH Marc Jacquet, Melun, France.
³⁶ Université de Lille, Lille, France.
³⁷ Inserm U1190, Lille, France.
³⁸ Service de Réanimation Polyvalente, CHRU de Lille-Hôpital Roger Salengro, Lille, France.
³⁹ Université de Clermont-Ferrand, Clermont-Ferrand, France.
⁴⁰ Service de Réanimation Médicale, CHU Gabriel Montpied, Clermont-Ferrand, France.
⁴¹ Université d'Angers, Angers, France.
⁴² Département de Réanimation médicale et Médecine hyperbare, CHU Angers, Angers, France.
⁴³ Service de Réanimation Polyvalente, CH de La Rochelle, La Rochelle, France.
⁴⁴ Service de Réanimation Médico-Chirurgicale, Institut Gustave Roussy, Paris Villejuif, France.
⁴⁵ Service de Réanimation polyvalente, CH de Charleville-Mézières, Charleville-Mézières, France.
⁴⁶ Service de Réanimation Médicale et Toxicologique, Assistance-Publique-Hopitaux de Paris, CHU Lariboisière, Paris, France.
⁴⁷ Service de Réanimation Médicale, CHU de Tours, Hôpital Bretonneau, Tours, France.
⁴⁸ Réseau CRICS, Tours, France.
⁴⁹ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Réanimation médico-chirurgicale, Hôpital Louis Mourier, AP-HP, Colombes, France.
⁵⁰ Service de Réanimation Polyvalente, CH Saint Nazaire, Saint Nazaire, France.
⁵¹ Service de Réanimation Médico-chirurgicale, CH de Roanne, Roanne, France.
⁵² Service de Réanimation Médicale, Université de Bourgogne Franche Comté, CHU Dijon, France.
⁵³ Equipe Lipness, UMR 866, Dijon, France.
⁵⁴ INSERM CIC 1432, Dijon, France.
⁵⁵ Equipe de recherche EPS (Ethique, professionnalisme et santé) EA 686, Université de Bretagne Occidentale, Brest, France.
⁵⁶ Service de Réanimation Médicale, CHU de la Cavale Blanche, Brest, France.
⁵⁷ Service de Réanimation Médico-Chirurgicale, Assistance publique-hôpitaux de Paris, CHU Ambroise Paré, Boulogne-Billancourt, France.
⁵⁸ Service d'Anesthésie-Réanimation, CH de Dieppe, Dieppe, France.
⁵⁹ Hôpital Européen Georges Pompidou, Paris, France.
⁶⁰ Service d'Anesthésie-Réanimation, Paris, France.
⁶¹ Université de Nantes, Nantes, France.
⁶² Département d'Anesthésie et Réanimation, CHU de Nantes, Nantes, France.
⁶³ Service de Réanimation Médicale, CHU Côte de Nacre, Caen, France.
⁶⁴ Service de Réanimation Polyvalente, CH de Lens, Lens, France.
⁶⁵ Service de Réanimation Médico-chirurgicale, CH du Mans, Le Mans, France.
⁶⁶ Service de Réanimation Polyvalente, CHD de la Vendée, La Roche-Sur-Yon, France.
⁶⁷ Université de Nantes, Nantes, France. jean.reignier@chu-nantes.fr.
⁶⁸ Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France. jean.reignier@chu-nantes.fr.
⁶⁹ Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. jean.reignier@chu-nantes.fr.

PMID: 28936597
DOI: 10.1007/s00134-017-4891-0

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.

. 2017 Dec;43(12):1793-1807.

doi: 10.1007/s00134-017-4891-0. Epub 2017 Sep 22.

Authors

Affiliations

¹ Inserm CIC, 1402, axe Alive, Poitiers, France.
² Université de Poitiers, Poitiers, France.
³ Service de Réanimation Médicale, CHU Poitiers, Poitiers, France.
⁴ Inserm CIC 1415, Tours, France.
⁵ Université de Tours, Tours, France.
⁶ CHU Tours, Tours, France.
⁷ Université Paris Diderot, Paris, France.
⁸ Service de Réanimation Médicale, CHU Saint-Louis, Paris, France.
⁹ Groupe de Recherche Famiréa, Paris, France.
¹⁰ Service de Réanimation polyvalente, CHI André Grégoire, Montreuil, France.
¹¹ Aix-Marseille Université, APHM, URMITE, UMR CNRS 7278, Hôpital Nord, Réanimation des Détresses Respiratoires et Infections Sévères, Marseille, France.
¹² Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France.
¹³ Service de Réanimation Médicale, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France.
¹⁴ Service de Réanimation Polyvalente, CH de Chartres, Chartres, France.
¹⁵ Service de Réanimation Médicale, CHR d'Orléans, Orléans, France.
¹⁶ Service de Réanimation Médico-Chirurgicale, CH de Montauban, Montauban, France.
¹⁷ Université Paris-Descartes, Paris, France.
¹⁸ Service de Réanimation Médicale, CHU Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France.
¹⁹ Aix-Marseille Université, APHM, Hôpital La Timone, Réanimation et surveillance continue, Marseille, France.
²⁰ Université de Bordeaux, Bordeaux, France.
²¹ Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
²² Service de Réanimation Polyvalente, CH Emile Roux, Le Puy En Velay, France.
²³ Service de Réanimation Polyvalente, CH d'Angoulême, Angoulême, France.
²⁴ Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France.
²⁵ Service de Réanimation Polyvalente, CH de Belfort-Montbéliard, Belfort, France.
²⁶ Service de Réanimation Médicale, Hôpital Emile Muller, Mulhouse, France.
²⁷ Service de médecine intensive et de réanimation, Groupe Hospitalier Paris Saint Joseph, Paris, France.
²⁸ Groupe de recherche Outcomerea, Paris, France.
²⁹ IAME, UMR 1137, INSERM Université Paris Diderot, Département de biostatistiques-HUPNVS-AP-HP, UFR de Médecine-Bichat, Paris, France.
³⁰ Service de Réanimation Polyvalente, CH Bretagne Sud, Lorient, France.
³¹ Service de Réanimation Médicale, CHU Bordeaux, Hôpital Saint-André, Bordeaux, France.
³² Université Grenoble-Alpes, Grenoble, France.
³³ CHU Albert Michallon, Clinique de la Réanimation Médicale, Grenoble, France.
³⁴ Service de Réanimation Polyvalente, Centre Hospitalier Annecy Genevois, Pringy, France.
³⁵ Service de Réanimation Médicale, CH Marc Jacquet, Melun, France.
³⁶ Université de Lille, Lille, France.
³⁷ Inserm U1190, Lille, France.
³⁸ Service de Réanimation Polyvalente, CHRU de Lille-Hôpital Roger Salengro, Lille, France.
³⁹ Université de Clermont-Ferrand, Clermont-Ferrand, France.
⁴⁰ Service de Réanimation Médicale, CHU Gabriel Montpied, Clermont-Ferrand, France.
⁴¹ Université d'Angers, Angers, France.
⁴² Département de Réanimation médicale et Médecine hyperbare, CHU Angers, Angers, France.
⁴³ Service de Réanimation Polyvalente, CH de La Rochelle, La Rochelle, France.
⁴⁴ Service de Réanimation Médico-Chirurgicale, Institut Gustave Roussy, Paris Villejuif, France.
⁴⁵ Service de Réanimation polyvalente, CH de Charleville-Mézières, Charleville-Mézières, France.
⁴⁶ Service de Réanimation Médicale et Toxicologique, Assistance-Publique-Hopitaux de Paris, CHU Lariboisière, Paris, France.
⁴⁷ Service de Réanimation Médicale, CHU de Tours, Hôpital Bretonneau, Tours, France.
⁴⁸ Réseau CRICS, Tours, France.
⁴⁹ IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Réanimation médico-chirurgicale, Hôpital Louis Mourier, AP-HP, Colombes, France.
⁵⁰ Service de Réanimation Polyvalente, CH Saint Nazaire, Saint Nazaire, France.
⁵¹ Service de Réanimation Médico-chirurgicale, CH de Roanne, Roanne, France.
⁵² Service de Réanimation Médicale, Université de Bourgogne Franche Comté, CHU Dijon, France.
⁵³ Equipe Lipness, UMR 866, Dijon, France.
⁵⁴ INSERM CIC 1432, Dijon, France.
⁵⁵ Equipe de recherche EPS (Ethique, professionnalisme et santé) EA 686, Université de Bretagne Occidentale, Brest, France.
⁵⁶ Service de Réanimation Médicale, CHU de la Cavale Blanche, Brest, France.
⁵⁷ Service de Réanimation Médico-Chirurgicale, Assistance publique-hôpitaux de Paris, CHU Ambroise Paré, Boulogne-Billancourt, France.
⁵⁸ Service d'Anesthésie-Réanimation, CH de Dieppe, Dieppe, France.
⁵⁹ Hôpital Européen Georges Pompidou, Paris, France.
⁶⁰ Service d'Anesthésie-Réanimation, Paris, France.
⁶¹ Université de Nantes, Nantes, France.
⁶² Département d'Anesthésie et Réanimation, CHU de Nantes, Nantes, France.
⁶³ Service de Réanimation Médicale, CHU Côte de Nacre, Caen, France.
⁶⁴ Service de Réanimation Polyvalente, CH de Lens, Lens, France.
⁶⁵ Service de Réanimation Médico-chirurgicale, CH du Mans, Le Mans, France.
⁶⁶ Service de Réanimation Polyvalente, CHD de la Vendée, La Roche-Sur-Yon, France.
⁶⁷ Université de Nantes, Nantes, France. jean.reignier@chu-nantes.fr.
⁶⁸ Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France. jean.reignier@chu-nantes.fr.
⁶⁹ Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. jean.reignier@chu-nantes.fr.

PMID: 28936597
DOI: 10.1007/s00134-017-4891-0

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.

PubMed Disclaimer

Comment in

Life after death in the ICU: detecting family-centered outcomes remains difficult.
Courtright KR, Benoit DD, Halpern SD. Courtright KR, et al. Intensive Care Med. 2017 Oct;43(10):1529-1531. doi: 10.1007/s00134-017-4898-6. Epub 2017 Sep 22. Intensive Care Med. 2017. PMID: 28936617 No abstract available.
[Immediate extubation or terminal weaning in ventilated intensive care patients after therapeutic goal change].
Janssens U. Janssens U. Med Klin Intensivmed Notfmed. 2018 Apr;113(3):221-226. doi: 10.1007/s00063-017-0382-x. Epub 2017 Nov 16. Med Klin Intensivmed Notfmed. 2018. PMID: 29147728 German. No abstract available.
Discussion on Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).
Campbell ML, Robert R, Reignier J. Campbell ML, et al. Intensive Care Med. 2018 Feb;44(2):275-276. doi: 10.1007/s00134-017-5037-0. Epub 2017 Dec 29. Intensive Care Med. 2018. PMID: 29285585 Free PMC article. No abstract available.
Reply: Discussion on Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study).
Robert R, Reignier J. Robert R, et al. Intensive Care Med. 2018 Feb;44(2):275-276. doi: 10.1007/s00134-017-5037-0. Epub 2017 Dec 29. Intensive Care Med. 2018. PMID: 29481014 No abstract available.

Cited by

"You helped me keep my head above water"-experience of bereavement research after loss of a loved one in the ICU: insights from the ARREVE study.
Laurent A, Reignier J, Le Gouge A, Cottereau A, 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, Robert R, Kentish-Barnes N. Laurent A, et al. Intensive Care Med. 2019 Sep;45(9):1252-1261. doi: 10.1007/s00134-019-05722-x. Epub 2019 Aug 12. Intensive Care Med. 2019. PMID: 31407041
ICU health care workers opinion on physician-assisted-suicide and euthanasia: a French survey.
Acquier M, Boyer A, Guidet B, Lautrette A, Reignier J, Thiery G, Robert R. Acquier M, et al. Ann Intensive Care. 2023 Mar 18;13(1):19. doi: 10.1186/s13613-023-01114-z. Ann Intensive Care. 2023. PMID: 36933060 Free PMC article.
Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation.
Fehnel CR, Armengol de la Hoz M, Celi LA, Campbell ML, Hanafy K, Nozari A, White DB, Mitchell SL. Fehnel CR, et al. Chest. 2020 Oct;158(4):1456-1463. doi: 10.1016/j.chest.2020.04.027. Epub 2020 Apr 28. Chest. 2020. PMID: 32360728 Free PMC article.
The patient needing prolonged mechanical ventilation: a narrative review.
Ambrosino N, Vitacca M. Ambrosino N, et al. Multidiscip Respir Med. 2018 Feb 26;13:6. doi: 10.1186/s40248-018-0118-7. eCollection 2018. Multidiscip Respir Med. 2018. PMID: 29507719 Free PMC article. Review.
Temporal reciprocal relationships among anxiety, depression, and posttraumatic stress disorder for family surrogates from intensive care units over their first two bereavement years.
Wen FH, Juang YY, Prigerson HG, Chou WC, Huang CC, Hu TH, Chiang MC, Chuang LP, Tang ST. Wen FH, et al. BMC Psychiatry. 2023 Jun 8;23(1):412. doi: 10.1186/s12888-023-04916-4. BMC Psychiatry. 2023. PMID: 37291535 Free PMC article.

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

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

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