• Alice Cottereau, René Robert, Amélie le Gouge, Mélanie Adda, Juliette Audibert, François Barbier, Patrick Bardou, Simon Bourcier, Alexandre Boyer, François Brenas, Emmanuel Canet, Daniel Da Silva, Vincent Das, Arnaud Desachy, Jérôme Devaquet, Nathalie Embriaco, Beatrice Eon, Marc Feissel, Diane Friedman, Frédérique Ganster, Maïté Garrouste-Orgeas, Guillaume Grillet, Olivier Guisset, Christophe Guitton, Rebecca Hamidfar-Roy, Anne-Claire Hyacinthe, Sebastien Jochmans, Fabien Lion, Mercé Jourdain, Alexandre Lautrette, Nicolas Lerolle, Olivier Lesieur, Philippe Mateu, Bruno Megarbane, 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, Laetitia Contentin, Nancy Kentish-Barnes, and Jean Reignier.
• Medical-Surgical Intensive Care Unit, District Hospital Center, Montreuil, France.
• Intensive Care Med. 2016 Aug 1; 42 (8): 1248-57.

PurposeTerminal extubation (TE) and terminal weaning (TW) are the methods available for withdrawing mechanical ventilation. Perceptions of TE and TW by intensive care unit (ICU) staff may influence bedside practices and the feasibility of studies comparing these methods.MethodsFrom January to June 2013, 5 nurses and 5 physicians in each of 46 (out of 70, 65.7 %) French ICUs completed an anonymous self-questionnaire. Clusters of staff members defined by perceptions of TE and TW were identified by exploratory analysis. Denominators for computing percentages were total numbers of responses to each item; cases with missing data were excluded for the relevant item.ResultsOf the 451 (98 %) participants (225 nurses and 226 physicians), 37 (8.4 %) had never or almost never performed TW and 138 (31.3 %) had never or almost never performed TE. A moral difference between TW and TE was perceived by 205 (45.8 %) participants. The exploratory analysis identified three clusters defined by personal beliefs about TW and TE: 21.2 % of participants preferred TW, 18.1 % preferred TE, and 60.7 % had no preference. A preference for TW seemed chiefly related to unfavorable perceptions or insufficient knowledge of TE. Staff members who preferred TE and those with no preference perceived TE as providing a more natural dying process with less ambiguity.ConclusionNearly two-fifths of ICU nurses and physicians in participating ICUs preferred TW or TE. This finding suggests both a need for shared decision-making and training before performing TE or TW and a high risk of poor compliance with randomly allocated TW or TE.

27 keywords...

hide…