CClinicalTrials.gg
CompletedNCT03255109WEAN SAFEUpdated Feb 12, 2019

WorldwidE AssessmeNt of Separation of pAtients From Ventilatory assistancE

An observational study in Acute Severe Respiratory Failure and Acute Respiratory Distress Syndrome, sponsored by European Society of Intensive Care Medicine. Completed at 1 site in Belgium. Open to participants aged 16 Years and older. Per ClinicalTrials.gov, last updated 2019-02-12.

Sponsored by European Society of Intensive Care Medicine · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
11,000
Ages
16 Years and older
Sex
All
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Study summary

WEAN SAFE (WorldwidE AssessmeNt of Separation of pAtients From ventilatory assistancE) is a multi-centre, prospective, observational, 4-week inception cohort study being carried out by the Acute Respiratory Failure section of ESICM. Weaning represents a challenge for intensivists and patients spend a considerable amount of time in being liberated from mechanical ventilation. While guidelines do exist on the classification of weaning, a recent study has shown that these may not be applicable to all patients. Moreover, different practices exist in regard to weaning procedures. WEAN SAFE will prospectively assess the burden of, management and spectrum of approaches to weaning from ventilation, in patients that require invasive mechanical ventilation for any reason, for a time period of at least 24 hours.

Read the detailed description

The purpose of this study is to describe, in a large population of ICU patients the burden of, management and spectrum of approaches to weaning from ventilation, in patients that require invasive mechanical ventilation for any reason, for a time period of at least 24 hours. It will answer the following questions:

  • What are the current approaches taken to wean patients from invasive mechanical ventilation?
  • What is the frequency of delayed weaning from invasive mechanical ventilation?
  • What are the factors that are used to determine when patients are in the weaning phase?
  • What are the barriers to effective weaning from invasive MV?
  • What factors (patient, institutional, medical practice) contribute to failed attempts to wean from invasive mechanical ventilation?
  • What is the impact of premorbid conditions on weaning from invasive MV?
  • What is the utility of existing classifications for weaning from invasive MV?
  • What is the impact of early versus delayed and/or failed weaning from invasive MV?

Patients will be screened for the study when undergoing mechanical ventilation and admitted in the ICU.

Day 1 will be defined as the first day when IMV commences Day 2 commences at 6-10am (fixed time point each day per ICU practice) after IMV commences. Patients undergoing invasive mechanical ventilation on the morning of day 1 will be screened for the study Patients still undergoing IMV on Day 2, will be enrolled in the study Patients not undergoing invasive mechanical ventilation or liberated from invasive mechanical ventilation on day 1 will be re-evaluated daily for the presence of inclusion criteria.

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Conditions studied

  • Acute Severe Respiratory Failure
  • Acute Respiratory Distress Syndrome

Keywords

  • Lung
  • acute
  • respiratory
  • distress
  • weaning
  • mechanical ventilation
  • respiratory infection
03

Who can participate

Ages eligible
16 Years and older
Sexes eligible
All
Sampling method
Probability sample

Study population

Due to the observational nature of the present study, patients enrolled in other observational/interventional study CAN be enrolled in the present study.

We aim to collect a large "convenience sample", with > 5,000 patients. Based on the LUNG SAFE data (NCT02010073; JAMA, 2016 Jul 19;316(3):347), we can estimate to enroll about 11 patients invasively ventilated on Day 2 following intubation per participating ICU in a 4 week period. We are therefore targeting the enrollment of 500 registered ICUs (considering a 10% dropout)

Inclusion criteria

Screening: all patients admitted in the ICU and aged >16 will be screened daily

  • A patient will be included if he/she is undergoing Invasive mechanical ventilation on the second morning (between 6am and 10 am) after initiation of mechanical ventilation or after ICU admission (if ventilation was already in place).

Exclusion criteria

Exclusion Criteria:

  • Lack of informed consent (where required)
  • Patients already present in the ICU at the beginning of the study, independently of the form of ventilatory support
04

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
11,000 participants (actual)
Target follow-up
90 Days
Patient registry
Yes
05

What researchers measure

Primary outcomes

  1. The number of patients invasively ventilated in the last 24 hours

    To describe the frequency of simple, difficult and prolonged weaning

    Time frame: 90 days or hospital discharge (whichever occurs first)

Secondary outcomes

  1. The current approaches taken to wean patients from invasive mechanical ventilation and impact on weaning duration

    What are the factors ((patient, institutional, medical practice) that are used to determine when patients are in the weaning phase

    Time frame: 90 days or hospital discharge (whichever occurs first)

06

Study locations

1 site
  • All Centres From All Over the World Willing to Contribute Are Welcome
    Brussels, Belgium
07

References and documents

Publications

  • Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, Welte T. Weaning from mechanical ventilation. Eur Respir J. 2007 May;29(5):1033-56. doi: 10.1183/09031936.00010206. PubMed 17470624 ↗
  • Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, Gonzalez M, Elizalde J, Nightingale P, Abroug F, Pelosi P, Arabi Y, Moreno R, Jibaja M, D'Empaire G, Sandi F, Matamis D, Montanez AM, Anzueto A; VENTILA Group. Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med. 2008 Jan 15;177(2):170-7. doi: 10.1164/rccm.200706-893OC. Epub 2007 Oct 25. PubMed 17962636 ↗
  • McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med. 2012 Dec 6;367(23):2233-9. doi: 10.1056/NEJMra1203367. No abstract available. PubMed 23215559 ↗
  • Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA. 1996 Mar 20;275(11):866-9. PubMed 8596225 ↗
  • Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med. 1998 Aug;158(2):489-93. doi: 10.1164/ajrccm.158.2.9711045. PubMed 9700126 ↗
  • Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013 Jun 15;187(12):1294-302. doi: 10.1164/rccm.201208-1523CI. PubMed 23641924 ↗
  • Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O'Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011 Jan 13;342:c7237. doi: 10.1136/bmj.c7237. PubMed 21233157 ↗
  • Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996 Dec 19;335(25):1864-9. doi: 10.1056/NEJM199612193352502. PubMed 8948561 ↗
  • Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008 Jan 12;371(9607):126-34. doi: 10.1016/S0140-6736(08)60105-1. PubMed 18191684 ↗
  • Beduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Nicolas Terzi, Grange S, Barberet G, Guitard PG, Frat JP, Constan A, Chretien JM, Mancebo J, Mercat A, Richard JM, Brochard L; WIND (Weaning according to a New Definition) Study Group and the REVA (Reseau Europeen de Recherche en Ventilation Artificielle) Network double dagger. Epidemiology of Weaning Outcome according to a New Definition. The WIND Study. Am J Respir Crit Care Med. 2017 Mar 15;195(6):772-783. doi: 10.1164/rccm.201602-0320OC. PubMed 27626706 ↗
  • Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson BT, Wrigge H, Slutsky AS, Pesenti A; LUNG SAFE Investigators; ESICM Trials Group. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016 Feb 23;315(8):788-800. doi: 10.1001/jama.2016.0291. Erratum In: JAMA. 2016 Jul 19;316(3):350. doi: 10.1001/jama.2016.6956. JAMA. 2016 Jul 19;316(3):350. doi: 10.1001/jama.2016.9558. PubMed 26903337 ↗

Individual participant data

Plan to share: No

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Registry details

Key details

Study ID
NCT03255109
Lead sponsor
European Society of Intensive Care Medicine
Responsible party
Sponsor
First posted
Aug 21, 2017
Start date
Oct 1, 2017
Primary completion
May 31, 2018
Completion
Dec 1, 2018
Last update
Feb 12, 2019

Study contacts

John LAFFEY, MD
principal investigator · National University of Galway, Ireland and St Michael's Hospital-University of Toronto, Canada
Giacomo BELLANI, MD
principal investigator · S Gerardo Hospital, University of Milan-Bicocca, Monza, Italy

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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