nach oben

Erschienen in:

22.09.2017 | Original

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

verfasst von: René Robert, Amélie Le Gouge, Nancy Kentish-Barnes, Alice Cottereau, Bruno Giraudeau, Mélanie Adda, Djillali Annane, Juliette Audibert, François Barbier, Patrick Bardou, Simon Bourcier, Jeremy Bourenne, Alexandre Boyer, François Brenas, Vincent Das, Arnaud Desachy, Jérôme Devaquet, Marc Feissel, Frédérique Ganster, Maïté Garrouste-Orgeas, Guillaume Grillet, Olivier Guisset, Rebecca Hamidfar-Roy, Anne-Claire Hyacinthe, Sebastien Jochmans, Mercé Jourdain, Alexandre Lautrette, Nicolas Lerolle, Olivier Lesieur, Fabien Lion, Philippe Mateu, Bruno Megarbane, Sybille Merceron, Emmanuelle Mercier, Jonathan Messika, Paul Morin-Longuet, Bénédicte Philippon-Jouve, Jean-Pierre Quenot, Anne Renault, Xavier Repesse, Jean-Philippe Rigaud, Ségolène Robin, Antoine Roquilly, Amélie Seguin, Didier Thevenin, Patrice Tirot, Isabelle Vinatier, Elie Azoulay, Jean Reignier

Erschienen in: Intensive Care Medicine | Ausgabe 12/2017

Einloggen, um Zugang zu erhalten

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.

Nur mit Berechtigung zugänglich

Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, Rubenfeld GD (2004) Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 32:638–643CrossRefPubMed

Curtis JR, Vincent JL (2010) Ethics and end-of-life care for adults in the intensive care unit. Lancet 376:1347–1353CrossRefPubMed

Lesieur O, Leloup M, Gonzalez F, Mamzer MF, EPILAT study group (2015) Withholding or withdrawal of treatment under French rules: a study performed in 43 intensive care units. Ann Intensive Care 5:56CrossRefPubMed

Azoulay E, Metnitz B, Sprung CL, Timsit JF, Lemaire F, Bauer P, Schlemmer B, Moreno R, Metnitz P, SAPS 3 Investigators (2009) End-of-life practices in 282 intensive care units: data from the SAPS 3 database. Intensive Care Med 35:623–630CrossRefPubMed

Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, Schobersberger W, Wennberg E, Woodcock T (2003) End-of-life practices in European intensive care units: the Ethicus Study. JAMA 290:790–797CrossRefPubMed

Kentish-Barnes N, Lemiale V, Chaize M, Pochard F, Azoulay E (2009) Assessing burden in families of critical care patients. Crit Care Med 37:S448–S456CrossRefPubMed

Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478CrossRefPubMed

Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994CrossRefPubMed

SRLF (2010) Limitation et arrêt des traitements en réanimation adulte. Actualisation des Recommandations de la Société de Réanimation de Langue Française. Réanimation 19:679–698CrossRef

10.

Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, Rushton CH, Kaufman DC (2008) Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine. Crit Care Med 36:953–963CrossRefPubMed

11.

Downar J, Delaney JW, Hawryluck L, Kenny L (2016) Guidelines for the withdrawal of life-sustaining measures. Intensive Care Med 42:1003–1017CrossRefPubMed

12.

Paruk F, Kissoon N, Hartog CS, Feldman C, Hodgson ER, Lipman J, Guidet B, Du B, Argent A, Sprung CL (2014) The Durban World Congress Ethics Round Table Conference Report: III. Withdrawing mechanical ventilation—the approach should be individualized. J Crit Care 29:902–907CrossRefPubMed

13.

Aita K, Kai I (2010) Physicians’ psychosocial barriers to different modes of withdrawal of life support in critical care: a qualitative study in Japan. Soc Sci Med 70:616–622CrossRefPubMed

14.

Faber-Langendoen K (1994) The clinical management of dying patients receiving mechanical ventilation. A survey of physician practice. Chest 106:880–888CrossRefPubMed

15.

Gerstel E, Engelberg RA, Koepsell T, Curtis JR (2008) Duration of withdrawal of life support in the intensive care unit and association with family satisfaction. Am J Respir Crit Care Med 178:798–804CrossRefPubMedPubMedCentral

16.

Kentish-Barnes N, Chaize M, Seegers V, Legriel S, Cariou A, Jaber S, Lefrant JY, Floccard B, Renault A, Vinatier I, Mathonnet A, Reuter D, Guisset O, Cohen-Solal Z, Cracco C, Seguin A, Durand-Gasselin J, Eon B, Thirion M, Rigaud JP, Philippon-Jouve B, Argaud L, Chouquer R, Adda M, Dedrie C, Georges H, Lebas E, Rolin N, Bollaert PE, Lecuyer L, Viquesnel G, Leone M, Chalumeau-Lemoine L, Garrouste M, Schlemmer B, Chevret S, Falissard B, Azoulay E (2015) Complicated grief after death of a relative in the intensive care unit. Eur Respir J 45:1341–1352CrossRefPubMed

17.

Campbell M (2007) How to withdraw mechanical ventilation: a systematic review of the literature. AACN Adv Crit Care 18:397–403PubMed

18.

Cottereau A, Robert R, le Gouge A, Adda M, Audibert J, Barbier F, Bardou P, Bourcier S, Boyer A, Brenas F, Canet E, Da Silva D, Das V, Desachy A, Devaquet J, Embriaco N, Eon B, Feissel M, Friedman D, Ganster F, Garrouste-Orgeas M, Grillet G, Guisset O, Guitton C, Hamidfar-Roy R, Hyacinthe AC, Jochmans S, Lion F, Jourdain M, Lautrette A, Lerolle N, Lesieur O, Mateu P, Megarbane B, 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, Contentin L, Kentish-Barnes N, Reignier J (2016) ICU physicians’ and nurses’ perceptions of terminal extubation and terminal weaning: a self-questionnaire study. Intensive Care Med 42:1248–1257CrossRefPubMed

19.

Willms DC, Brewer JA (2005) Survey of respiratory therapists’ attitudes and concerns regarding terminal extubation. Respir Care 50:1046–1049PubMed

20.

Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, Lavagne P, Jacquot C (2001) Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 29:2258–2263CrossRefPubMed

21.

Hall JC, Jobson L, Langdon PE (2014) Measuring symptoms of post-traumatic stress disorder in people with intellectual disabilities: the development and psychometric properties of the Impact of Event Scale-Intellectual Disabilities (IES-IDs). Br J Clin Psychol 53:315–332CrossRefPubMed

22.

Jabre P, Belpomme V, Azoulay E, Jacob L, Bertrand L, Lapostolle F, Tazarourte K, Bouilleau G, Pinaud V, Broche C, Normand D, Baubet T, Ricard-Hibon A, Istria J, Beltramini A, Alheritiere A, Assez N, Nace L, Vivien B, Turi L, Launay S, Desmaizieres M, Borron SW, Vicaut E, Adnet F (2013) Family presence during cardiopulmonary resuscitation. N Engl J Med 368:1008–1018CrossRefPubMed

23.

Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, Waldmann C, Gager M (2004) Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med 30:456–460CrossRefPubMed

24.

Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P, Grassin M, Zittoun R, le Gall JR, Dhainaut JF, Schlemmer B (2001) Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med 29:1893–1897CrossRefPubMed

25.

Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF 3rd, Shear MK, Day N, Beery LC, Newsom JT, Jacobs S (1997) Traumatic grief as a risk factor for mental and physical morbidity. Am J Psychiatry 154:616–623CrossRefPubMed

26.

Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinova K, Lafabrie A, Abizanda R, Svantesson M, Rubulotta F, Ricou B, Benoit D, Heyland D, Joynt G, Francais A, Azeivedo-Maia P, Owczuk R, Benbenishty J, de Vita M, Valentin A, Ksomos A, Cohen S, Kompan L, Ho K, Abroug F, Kaarlola A, Gerlach H, Kyprianou T, Michalsen A, Chevret S, Schlemmer B, Conflicus Study Investigators for the Ethics Section of the European Society of Intensive Care Medicine (2009) Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med 180:853–860CrossRefPubMed

27.

Karasek R, Baker D, Marxer F, Ahlbom A, Theorell T (1981) Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men. Am J Public Health 71:694–705CrossRefPubMedPubMedCentral

28.

Harrell F (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer, New YorkCrossRef

29.

Rocker GM, Heyland DK, Cook DJ, Dodek PM, Kutsogiannis DJ, O’Callaghan CJ (2004) Most critically ill patients are perceived to die in comfort during withdrawal of life support: a Canadian multicentre study: [Les grands malades meurent sans souffrance pendant le retrait du maintien des fonctions vitales: une etude canadienne]. Can J Anaesth 51:623–630CrossRefPubMed

30.

Billings JA (2012) Humane terminal extubation reconsidered: the role for preemptive analgesia and sedation. Crit Care Med 40:625–630CrossRefPubMed

31.

Truog RD, Brock DW, White DB (2012) Should patients receive general anesthesia prior to extubation at the end of life? Crit Care Med 40:631–633CrossRefPubMed

32.

Daubin C, Haddad L, Folscheid D, Boyer A, Chalumeau-Lemoine L, Guisset O, Hubert P, Pillot J, Robert R, Dreyfuss D (2014) Ethical reflections on end-of-life signs and symptoms in the intensive care setting: a place for neuromuscular blockers? Ann Intensive Care 4:17CrossRefPubMedPubMedCentral

33.

Kross EK, Engelberg RA, Gries CJ, Nielsen EL, Zatzick D, Curtis JR (2011) ICU care associated with symptoms of depression and posttraumatic stress disorder among family members of patients who die in the ICU. Chest 139:795–801CrossRefPubMed

34.

Poncet MC, Toullic P, Papazian L, Kentish-Barnes N, Timsit JF, Pochard F, Chevret S, Schlemmer B, Azoulay E (2007) Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 175:698–704CrossRefPubMed

35.

Benbenishty J, Ganz FD, Lippert A, Bulow HH, Wennberg E, Henderson B, Svantesson M, Baras M, Phelan D, Maia P, Sprung CL (2005) Nurse involvement in end-of-life decision making: the ETHICUS Study. Intensive Care Med 32:129–132CrossRefPubMed

36.

Curtis JR, Shannon SE (2005) Transcending the silos: toward an interdisciplinary approach to end-of-life care in the ICU. Intensive Care Med 32:15–17CrossRefPubMed

37.

Hamric AB, Blackhall LJ (2007) Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med 35:422–429CrossRefPubMed

38.

Rocker GM, Cook DJ, O’Callaghan CJ, Pichora D, Dodek PM, Conrad W, Kutsogiannis DJ, Heyland DK (2005) Canadian nurses’ and respiratory therapists’ perspectives on withdrawal of life support in the intensive care unit. J Crit Care 20:59–65CrossRefPubMed

39.

Gries CJ, Curtis JR, Wall RJ, Engelberg RA (2008) Family member satisfaction with end-of-life decision making in the ICU. Chest 133:704–712CrossRefPubMedPubMedCentral

40.

Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9:591–597CrossRefPubMed

41.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRefPubMed

42.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMed

43.

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344CrossRefPubMed

44.

Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR (2003) Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 289:2983–2991CrossRefPubMed

Titel: Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study)
verfasst von: René Robert
Amélie Le Gouge
Nancy Kentish-Barnes
Alice Cottereau
Bruno Giraudeau
Mélanie Adda
Djillali Annane
Juliette Audibert
François Barbier
Patrick Bardou
Simon Bourcier
Jeremy Bourenne
Alexandre Boyer
François Brenas
Vincent Das
Arnaud Desachy
Jérôme Devaquet
Marc Feissel
Frédérique Ganster
Maïté Garrouste-Orgeas
Guillaume Grillet
Olivier Guisset
Rebecca Hamidfar-Roy
Anne-Claire Hyacinthe
Sebastien Jochmans
Mercé Jourdain
Alexandre Lautrette
Nicolas Lerolle
Olivier Lesieur
Fabien Lion
Philippe Mateu
Bruno Megarbane
Sybille Merceron
Emmanuelle Mercier
Jonathan Messika
Paul Morin-Longuet
Bénédicte Philippon-Jouve
Jean-Pierre Quenot
Anne Renault
Xavier Repesse
Jean-Philippe Rigaud
Ségolène Robin
Antoine Roquilly
Amélie Seguin
Didier Thevenin
Patrice Tirot
Isabelle Vinatier
Elie Azoulay
Jean Reignier
Publikationsdatum: 22.09.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 12/2017
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4891-0

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

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