03101nas a2200325   4500000000100000008004100001260001700042100001600059700001700075700001700092700002100109700002100130700001600151700001700167700001700184700001400201700002100215700002300236700001800259700001900277700001800296700002100314700001900335700001800354245010800372300001200480490000700492520226200499022001402761       2018                            d  c-242712097221 aBurns Karen1 aCook Deborah1 aGattas David1 aRaptis Stavroula1 aNisenbaum Rosane1 aRizvi Leena1 aJones Andrew1 aBakshi Jyoti1 aTan Wylie1 aMeret Aleksander1 aLellouche Francois1 aEpstein Scott1 aKapadia Farhad1 aVillar Jesús1 aBrochard Laurent1 aLessard Martin1 aMeade Maureen00aInternational Practice Variation in Weaning Critically Ill Adults from Invasive Mechanical Ventilation.  a494-5020 v153 a<p><b>RATIONALE: </b>Randomized trials and meta-analyses have informed several aspects of weaning. Results are rarely replicated in practice, as evidence is applied in intensive care units that differ from the settings in which it was generated.</p><p><b>OBJECTIVES: </b>We aimed to: 1) describe weaning practice variation (identifying weaning candidates, conducting spontaneous breathing trials, using ventilator modes, and other aspects of care during weaning); 2) characterize regional differences in weaning practices; and 3) identify factors associated with practice variation.</p><p><b>METHODS: </b>We conducted a cross-sectional, self-administered, international postal survey of adult intensivist members of regional critical care societies from six geographic regions, including Canada, India, the United Kingdom, Europe, Australia/New Zealand, and the United States. We worked with societies to randomly select potential respondents from membership lists and administer questionnaires with the goal of obtaining 200 responses per region.</p><p><b>RESULTS: </b>We analyzed 1,144 questionnaires (Canada, 156; India, 136; United Kingdom, 219; Europe, 260; Australia/New Zealand, 196; United States, 177). Across regions, most respondents screened patients once daily to identify spontaneous breathing trials candidates (regional range, 70.0%-95.6%) and less often screened twice daily (range, 12.2%-33.1%) or more than twice daily (range, 1.6%-18.2%). To wean patients, most respondents used pressure support alone (range, 31.0%-71.7%) or with spontaneous breathing trials (range, 35.7%-68.1%). To conduct spontaneous breathing trials, respondents predominantly used pressure support with positive end-expiratory pressure (range, 56.5%-72.3%) and T-piece (8.9%-59.5%). Across regions, we found important variation in screening frequency, spontaneous breathing trials techniques; ventilator modes, written directives to guide care, noninvasive ventilation; and the roles played by available personnel in various aspects of weaning.</p><p><b>CONCLUSIONS: </b>Our findings document the presence and extent of practice variation in ventilator weaning on an international scale, and highlight the multidisciplinary and collaborative nature of weaning.</p>  a2325-6621