• Gaëtan Béduneau, Tài Pham, Frédérique Schortgen, Lise Piquilloud, Elie Zogheib, Maud Jonas, Fabien Grelon, Isabelle Runge, Nicolas Terzi14 INSERM, U1075, Caen, France.15 Université de Caen, Caen, France.16 Service de Réanimation Médicale, Centre Hospitalier Régional Universitaire Caen, Caen, France.17 Service de Réanimation Médicale, Centres Hospitaliers Universitaires Grenob, Steven Grangé, Guillaume Barberet, Pierre-Gildas Guitard, Jean-Pierre Frat, Adrien Constan, Jean-Marie Chretien, Jordi Mancebo, Alain Mercat, RichardJean-Christophe MJM25 Annecy Genevois General Hospital, Annecy, France., Laurent Brochard, and WIND (Weaning according to a New Definition) Study Group and the REVA (Réseau Européen de Recherche en Ventilation Artificielle) Network ‡.
• 1 Medical Intensive Care Unit and.
• Am. J. Respir. Crit. Care Med. 2017 Mar 15; 195 (6): 772-783.

RationaleThe weaning process concerns all patients receiving mechanical ventilation. A previous classification into simple, prolonged, and difficult weaning ignored weaning failure and presupposed the use of spontaneous breathing trials.ObjectivesTo describe the weaning process, defined as starting with any attempt at separation from mechanical ventilation and its prognosis, according to a new operational classification working for all patients under ventilation.MethodsThis was a multinational prospective multicenter observational study over 3 months of all patients receiving mechanical ventilation in 36 intensive care units, with daily collection of ventilation and weaning modalities. Pragmatic definitions of separation attempt and weaning success allowed us to allocate patients in four groups.Measurements And Main ResultsA total of 2,729 patients were enrolled. Although half of them could not be classified using the previous definition, 99% entered the groups on the basis of our new definition as follows: 24% never started a weaning process, 57% had a weaning process of less than 24 hours (group 1), 10% had a difficult weaning of more than 1 day and less than 1 week (group 2), and 9% had a prolonged weaning duration of 1 week or more (group 3). Duration of ventilation, intensive care unit stay, and mortality (6, 17, and 29% for the three groups, respectively) all significantly increased from one group to the next. The unadjusted risk of dying was 19% after the first separation attempt and increased to 37% after 10 days.ConclusionsA new classification allows us to categorize all weaning situations. Every additional day without a weaning success after the first separation attempt increases the risk of dying.

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