8 research outputs found
Bilateral adrenalectomy for asynchronous metastases of a malignant melanoma
- Publication venue
- 'SciELO Agencia Nacional de Investigacion y Desarrollo (ANID)'
- Publication date
- 01/01/2013
- Field of study
Indexación: Web of Science; Scielo.Clinical case: We report a 70 years old male with a history of an ear lobe melanoma with was excised seven years ago, who had a bronchial relapse and required a right pneumonectomy. During a follow up abdominal CAT scan, a 9 cm tumor in the left adrenal gland was detected. The patient was operated, performing a left adrenalectomy and nephrectomy. The pathologic study confirmed the presence of a fusocellular melanoma. One year later, a right adrenal mass was detected and excised. The pathological study of the piece again confirmed a metastasis of a malignant melanoma. The patient died due to progression of the disease, 10 years after the adrenalectomy.
Key words: Adrenal metastases, laparoscopic adrenalectomy, melanoma.Objetivo: Presentar un caso de metástasis suprarrenal bilateral asincrónica de Melanoma cutáneo tratado con adrenalectomía laparoscópica bilateral. Caso clínico: Paciente de 70 años con antecedente de melanoma del pabellón auricular extirpado 7 años antes de su consulta urológica. Posteriormente, presenta una recidiva bronquial tratada con quimioterapia, radioterapia y neumonectomía derecha. En sus exámenes de seguimiento una Tomografía computada muestra el hallazgo incidental de una lesión tumoral de 9 cm en la glándula suprarrenal izquierda. Se realizó nefrectomía y adrenalectomía izquierda laparoscópica en bloque sin incidencias. El análisis histopatológico confirmó el hallazgo de una metástasis de melanoma fuso-celular. Un año después el paciente presenta un nuevo hallazgo incidental de un tumor de 3 cm en la glándula suprarrenal derecha, la cual fue tratada con adrenalectomía laparoscópica, y cuyo análisis histopatológico demostró metástasis de melanoma maligno. El paciente fallece por progresión de su enfermedad 10 años después de su cirugía suprarrenal. Conclusiones: En los pacientes con metástasis suprarrenal de melanoma, la adrenalectomía incrementa la supervivencia cáncer especifica en relación a los pacientes tratados sin cirugía. El abordaje laparoscópico constituye una alternativa terapéutica con menor morbilidad que la cirugía abierta en cirujanos con experiencia laparoscópica.
Palabras clave: Metástasis suprarrenal, adrenalectomía laparoscópica, melanoma.http://ref.scielo.org/mymgk
A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)
- Author
- Abbott TE
- Abdallah RI
- Abdel-Aal IR
- Abdelmonem SA
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- Jeong IY
- Jeong WY
- Jeong WY
- Jian Z
- Jiao LR
- Jibaja M
- Jimenez-Herrera MF
- Jiménez GJ
- Jo YH
- Joachim J
- Jochmans S
- John G
- Jonas M
- Jonas M
- Jonas M
- Jones C
- Joshi R
- Joshi V
- Jovaisa T
- JSEPTIC (Japanese Society of Education for Physicians and Trainees in Intensive Care) Clinical Trial Group
- Juan WC
- Juanas CA
- Judickas S
- Juez A
- Juliarena A
- Jun IG
- Jun IG
- Jung K
- Jung KW
- Junior JM
- Kaczirek K
- Kaese S
- Kalani N
- Kalenka A
- Kalfon P
- Kamali E
- Kaminsky GE
- Kaneko M
- Kang M
- Kang M
- Kang PL
- Kang PL
- Kang PL
- Kang PL
- Kang Y
- Kao KC
- Kappler F
- Kara A
- Karachi F
- Karanjia N
- Karbing DS
- Karsten E
- Kasdan H
- Kashiya S
- Kashyap R
- Katabami K
- Katabami K
- Katabami K
- Katabami K
- Katira BH
- Kavanagh BP
- Kawamura N
- Kawano S
- Kay FU
- Kayaaslan B
- Kayambu G
- Kazutoshi F
- Ke MW
- Ke MW
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- Keep J
- Keller E
- Kellner F
- Kelly JM
- Kenardy J
- Keough E
- Kerhuel L
- Kerr C
- Kezyte G
- Khadjibaev A
- Khaliq W
- Khine H
- Kim DJ
- Kim HJ
- Kim JM
- Kim JM
- Kim JW
- Kim KS
- Kim KS
- Kim KS
- Kim KS
- Kim MH
- Kim MH
- Kim W
- Kimmoun A
- King HS
- Kinnear J
- Kirakli C
- Kirakli C
- Kirca H
- Kirman M
- Kirwan CJ
- Kittnar O
- Klapsing P
- Klaus DA
- Kleinpell R
- Kluge S
- Knafelj R
- Knight LD
- Ko JI
- Ko SB
- Kobayashi A
- Koco E
- Kodate A
- Kodate A
- Kodate A
- Kokkini S
- Kolnikova I
- Komuro T
- Kondili E
- Kongpolprom N
- Kooner G
- Kostalas M
- Kosuk ME
- Kotsopoulos A
- Kou PS
- Kouatchet A
- Kovacikova L
- Kox M
- Kraegpoeth A
- Krenn CG
- Krishna B
- Kristof J
- Kruger A
- Kruger A
- Krüger A
- Ku NS
- Ku NS
- Kubik M
- Kubota K
- Kuebler WM
- Kulaga EV
- Kulkarni AP
- Kumari BK
- Kumbamu A
- Kunze-Szikszay N
- Kurmukov IA
- Kurth T
- Kurtz P
- Kurtz P
- Kwon HM
- Kwon HM
- Kwon WY
- Kwon WY
- Kwon WY
- Kye YC
- Kyle UG
- Kyle UG
- Labaune MA
- Labra C
- Lacerda P
- Laerkner E
- Lafaurie M
- Lafuente E
- Lagonidis D
- Lagos R
- Lahmer T
- Lai CC
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- Lake K
- Lan SK
- Lapteva K
- Lapteva K
- Larsson JS
- Latini R
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- Latini R
- Latorre J
- Lattuada M
- Lattuada M
- Lau YH
- Laurent A
- Lauretta MP
- Laureys S
- Lavrentieva A
- Lawrence N
- Lazzeri EH
- Le Brocque R
- Lebherz-Eichinger D
- Lebiedz P
- Lebrón-Gallardo M
- Lebut J
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- Lee CT
- Lee DS
- Lee DS
- Lee EY
- Lee JH
- Lee S
- Lee SH
- Lee SJ
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- Lee YJ
- Lee YJ
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- Legrand M
- Legrand M
- Legriel S
- Leitao AL
- Leite RT
- Leonard H
- Leone M
- Leone M
- Lerma FA
- Lesmes SP
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- Letizia T
- Levrat Q
- Levy B
- León JL
- León JP
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- Lheureux O
- Lheureux O
- Lheureux O
- Lheureux O
- Li R
- Li SH
- Liao X
- Lichtenstein D
- Lim TH
- Limuti R
- Lin KC
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- Lin PH
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- Lin WC
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- Lipcsey M
- Lischinsky A
- Lissonde F
- Lissonde F
- Litchfield K
- Liu CP
- Liu CP
- Liu CP
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- Liu D
- Llaurado-Serra M
- Llorente B
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- Lobato MS
- Lobo-Civico A
- Loizou C
- Lombardo MD
- Londoño JG
- Longani N
- Longhi L
- Lopes JA
- Lopez GD
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- Lopez-Caler C
- Lopez-Gude MJ
- Lorini L
- Lortat-Jacob B
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- Lotay R
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- Louf-Durier A
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- Louis B
- Lourido CM
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- Luciani A
- Lucinio NM
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- Luján J
- Lukaszewicz AC
- Luna RR
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- Lusk J
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- Ly H
- Lázaro AS
- López AR
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- López MA
- Macfarlane B
- MacKay A
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- Mackey G
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- MacPhee I
- Macrì M
- Madueño VP
- Maekawa K
- Maekawa K
- Maekawa K
- Maekawa K
- Maertens B
- Maggiorini M
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- Magnanimi E
- Magnoni S
- Magret M
- Mainardi JL
- Maistry N
- Maitra S
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- Manca T
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- Mandal K
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- Marmanidou K
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- Masjedi M
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- Matsuda Y
- Matsukubo S
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- Mazza E
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- Mecklenburg A
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- Mellis C
- Melnyk L
- Melo N
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- Mendsaikhan N
- Menendez R
- Mengelle C
- Mercat A
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- Mezidi M
- Mezidi M
- Michel L
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- Mignot T
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- Mihara Y
- Millar M
- Mimoun M
- Mimoz O
- Min A
- Min HJ
- Mingone D
- Mion MM
- Mira JP
- Mirabella L
- Miranda F
- Miranda R
- Mirković T
- Mistry M
- Mistry N
- Mitchell M
- Mitchell S
- Mizobuchi S
- Mizugaki A
- Mizugaki A
- Mlcek M
- Moerer O
- Moffatt S
- Moggia F
- Mohamed AN
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- Mohankumar L
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- Moon YJ
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- Moore M
- Mora-Ordoñez J
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- Moraes RB
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- Morimatsu H
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- Morman D
- Moro F
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- Motos A
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- Mourvillier B
- Moxham J
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- Muncharaz AB
- Munteanu G
- Murakami H
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- Nagib H
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- Nandha R
- Naran P
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- Oddo M
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- Olaechea P
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- Pozzebon S
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- Quinart A
- Quintana S
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- Rattray J
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- Rello J
- Renault A
- Renes-Carreño E
- Renuka S
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- Restrepo MI
- Reusch S
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- Revel N
- Revuelto-Rey J
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- Riozzi P
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- Rivera-Romero L
- Rizoli S
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- Rodriguez-Fernandez S
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- Roesthuis L
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- Rolin N
- Rolla F
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- Romero I
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- Ruberto F
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- Saigal S
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- Sakieva FI
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- Sakuraya M
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- Salgado DR
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- Sampley S
- Sampson D
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- Samy W
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- Sandiumenge A
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- Savi C
- Savin I
- Savvidou S
- Sawamura A
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- Scala S
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- Scanziani E
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- Schröder T
- Schuepbach R
- Schultz MJ
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- Schwarze S
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- Sciurti R
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- Seet E
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- Serbource-Goguel J
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- Shah H
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- Shum HP
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- Sibley S
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- Sidhu P
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- Signouret T
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- Simoes CM
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- Singer M
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- Sirvent JM
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- Smekal D
- Snelson C
- Snyder AZ
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- Soeffker G
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- Soilemezi E
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- Souza VA
- Spadaro S
- Spadaro S
- Spahn DR
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- Spazzadeschi A
- Spijkstra JJ
- Spronk PE
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- Sprung CL
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- Stamm J
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- Stanić R
- Starczewska M
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- Stiphout C
- Stocchetti N
- Stocchetti N
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- Street H
- Stretti F
- Struijs A
- Stubbs C
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- Stümpfle R
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- Suh GJ
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- Suh JW
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- Sun WZ
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- Suzuki T
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- Sylla P
- Sáez VC
- Sánchez B
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- Sánchez EC
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- Tabatabaei HR
- Tabei SH
- Taccone F
- Taccone FS
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- 'Springer Science and Business Media LLC'
- Publication date
- 01/01/2016
- Field of study
Meeting abstrac
ROOTSTOCK-SCION INTERACTION: 2. EFFECT ON THE COMPOSITION OF CABERNET SAUVIGNON GRAPE MUST
- Author
- ALBERTO MIELE
- ALVARENGA A.A.
- BAVARESCO L.
- BERDEJA M.
- BRANCADORO L.
- CHOU M-I.
- DELAS J.
- DIAS F.A.N.
- FEKETE I.
- GONG H.J.
- JOGAIAH S.
- JOGAIAH S.
- JONES T.H.
- KAMILOGLU Ö.
- KELLER M.
- KELLER M.
- KODUR S.
- KODUR S.
- LAMBERT J-J.
- LEÃO P.C de S.
- LUIZ ANTENOR RIZZON
- MIELE A.
- MIELE A.
- MIELE A.
- MORALES M.
- MOTA R.V. da.
- NASSUR R. de C.M.R.
- NUZZO V.
- OLLAT N.
- ORDOÑEZ R.
- ORLANDO T. das G. S.
- REYNOLDS A.G.
- RIBÉREAU-GAYON J.
- RIBÉREAU-GAYON P.
- SATISHA J.
- SATO A.J.
- SOUZA C.R. de.
- TECCHIO M.A.
- TERRA M.M.
- WALKER R.R.
- WIKLER A.J.
- Publication venue
- 'FapUNIFESP (SciELO)'
- Publication date
- Field of study
Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action
- Author
- Abbas Mohamed
- Abbo Lilian M.
- Abdukhalilova Gulnora K.
- Abraham Yishak
- Abu-Zidan Fikri M.
- Abubakar Salisu
- Adamou Harissou
- Adebisi Yusuff Adebayo
- Afandiyeva Gulara
- Agastra Ervis
- Al Omari Abdelkarim
- Al-Hasan Majdi N.
- Alfouzan Wadha A.
- Ali Sajjad
- Ali Syed Muhammad
- Allaw Fatima
- Allwell-Brown Gbemisola
- Amir Afreenish
- Amponsah Obed Kwabena Offe
- Ansaloni Luca
- Ansari Shamshul
- Arauz Ana Belen
- Augustin Goran
- Awazi Bih
- Azfar Mohammad
- Bah Mamadou Saliou Bailo
- Bala Miklosh
- Banagala Anura S. K.
- Baral Suman
- Barie Philip S.
- Bassetti Matteo
- Bavestrello Luis
- Beilman Gregory
- Bekele Kebebe
- Benboubker Moussa
- Beović Bojana
- Bergamasco Maria Daniela
- Bertagnolio Silvia
- Biffl Walter L.
- Blot Stijn
- Boermeester Marja A.
- Bonomo Robert A.
- Brink Adrian
- Brusaferro Silvio
- Butemba Jonathan
- Camacho-Ortiz Adrian
- Canton Rafael
- Cascio Antonio
- Cassini Alessandro
- Catarci Marco
- Catena Fausto
- Catena Rodolfo
- Caínzos Miguel A.
- Chamani-Tabriz Leili
- Chandy Sujith J.
- Charani Esmita
- Cheadle William G.
- Chebet Diana
- Cheng Vincent Chi-Chung
- Chiara Francesca
- Chikowe Ibrahim
- Chioti Anna
- Coccolini Federico
- Cocuz Maria Elena
- Coimbra Raul
- Cortese Francesco
- Cui Yunfeng
- Czepiel Jacek
- Cástro-Sanchez Enrique
- Darzi Ara
- Dasic Mira
- de Francisco Serpa Nataliya
- de Jonge Stijn W.
- De Palma Alessandra
- De Silva Danushka
- De Simone Belinda
- De Waele Jan
- Delibegovic Samir
- Dellinger E. Patchen
- Demetrashvili Zaza
- Dhingra Sameer
- Diaz Jose J.
- Dima Claudia
- Dirani Natalia
- Dodoo Cornelius C.
- Dorj Gereltuya
- Duane Therese M.
- Eckmann Christian
- Egyir Beverly
- Elmangory Mutasim M.
- Enani Mushira A.
- Ergonul Onder
- Escalera-Antezana Juan Pablo
- Escandon Kevin
- Ettu Abdul-Wahab Omo-ope
- Fadare Joseph O.
- Fantoni Massimo
- Farahbakhsh Mohammad
- Faro Mario Paulo
- Ferreres Alberto
- Flocco Gianina
- Foianini Esteban
- Fry Donald E.
- Garcia Alberto Federico
- Gerardi Chiara
- Ghannam Wagih
- Giamarellou Helen
- Gkiokas George
- Glushkova Natalya
- Goff Debra A.
- Gomi Harumi
- Gottfredsson Magnus
- Griffiths Ewen A.
- Guerra Gronerth Rosio Isabel
- Guirao Xavier
- Gupta Yogesh K.
- Halle-Ekane Gregory
- Hansen Sonja
- Haque Mainul
- Hara Gabriel Levy
- Hardcastle Timothy C.
- Hayman David T. S.
- Hecker Andreas
- Hell Markus
- Ho Vanessa P.
- Hodonou Adrien M.
- Isik Arda
- Islam Salequl
- Itani Kamal M. F.
- Jaidane Nadia
- Jammer Ib
- Jenkins David R.
- Jensen Peter Østrup
- Jumbam Desmond
- Kafil Hossein Samadi
- Kamara Ibrahim Franklyn
- Kanj Souha S.
- Kapoor Gaetanjali
- Kapoor Garima
- Kariuki Samuel
- Keikha Masoud
- Khamis Faryal
- Khanna Ashish K.
- Khanna Sahil
- Khokha Vladimir
- Kiggundu Reuben
- Kiguba Ronald
- Kim Hong Bin
- Kim Peter K.
- Kirkpatrick Andrew W.
- Kluger Yoram
- Ko Wen-Chien
- Kok Kenneth Y. Y.
- Kotecha Vihar
- Kouma Ibrahima
- Kovacevic Bojan
- Krasniqi Jehona
- Krutova Marcela
- Kryvoruchko Igor
- Kullar Ravina
- Labi Kwaku A.
- Labricciosa Francesco M.
- Lakatos Botond
- Lakoh Sulaiman
- Lansang Mary Ann D.
- Laxminarayan Ramanan
- Lee Young Ran
- Leone Marc
- Leppaniemi Ari
- Litvin Andrey
- Lohsiriwat Varut
- Machain Gustavo M.
- Mahomoodally Fawzi
- Maier Ronald V.
- Majumder Md Anwarul Azim
- Malama Sydney
- Manasa Justen
- Manchanda Vikas
- Manzano-Nunez Ramiro
- Martin-Loeches Ignacio
- Martínez-Martínez Luis
- Marwah Sanjay
- Maseda Emilio
- Mathewos Maleda
- Maves Ryan C.
- McNamara Deborah
- Memish Ziad
- Mertz Dominik
- Mishra Shyam Kumar
- Montravers Philippe
- Moro Maria Luisa
- Mossialos Elias
- Motta Fabrizio
- Mudenda Steward
- Mugabi Patrick
- Mugisha Mc Juan Muco
- Mylonakis Eleftherios
- Napolitano Lena M.
- Nathwani Dilip
- Nkamba Leontine
- Nsutebu Emmanuel Fru
- Ogunsola Sade
- Ordoñez Carlos A.
- Ordoñez Juliana Maria
- Ottolino Pablo
- Ouedraogo Abdoul-Salam
- O’Connor Donal B.
- Pagani Leonardo
- Paiva José Artur
- Palmieri Miriam
- Pan Angelo
- Pant Narayan
- Panyko Arpád
- Paolillo Ciro
- Patel Jay
- Pea Federico
- Petrone Patrizio
- Petrosillo Nicola
- Pintar Tadeja
- Plaudis Haralds
- Podda Mauro
- Ponce-de-Leon Alfredo
- Powell Susan L.
- Puello-Guerrero Adrián
- Pulcini Celine
- Rasa Kemal
- Regimbeau Jean-Marc
- Rello Jordi
- Retamozo-Palacios Manuel Renato
- Reynolds-Campbell Glendee
- Ribeiro Julival
- Rickard Jennifer
- Rocha-Pereira Nuno
- Rodriguez-Taveras Carlos
- Rosenthal Victor D.
- Rossolini Gian Maria
- Rwegerera Godfrey M.
- Rwigamba Megan
- Sabbatucci Michela
- Sakakushev Boris E.
- Saladžinskas Žilvinas
- Salama Rasha E.
- Sali Tondore
- Salile Samson Sahile
- Sall Ibrahima
- Sartelli Massimo
- Sawyer Robert G.
- Scatizzi Marco
- Seni Jeremiah
- Septimus Edward J.
- Sganga Gabriele
- Shabanzadeh Daniel Mønsted
- Shelat Vishal G.
- Shibabaw Agumas
- Siquini Walter
- Somville Francis
- Souf Selma
- Stefani Stefania
- Tacconelli Evelina
- Tan Buon Kim
- Tattevin Pierre
- Telles João Paulo
- Tessier Jeffrey
- Thang Nguyen Toan
- Timmermann Cristian
- Timsit Jean-François
- Tochie Joel Noutakdie
- Tolonen Matti
- Trueba Gabriel
- Tsioutis Constantinos
- Tumietto Fabio
- Tuon Felipe Francisco
- Téllez-Almenares Orlando
- Ulrych Jan
- Uranues Selman
- van Dongen Maarten
- van Goor Harry
- Velmahos George C.
- Vereczkei Andras
- Viaggi Bruno
- Viale Pierluigi
- Vila Jordi
- Voss Andreas
- Vraneš Jasmina
- Wanjiru-Korir Nyambura
- Watkins Richard R.
- Waworuntu Olivia
- Wechsler-Fördös Agnes
- Worldwide Antimicrobial Resistance National/International Network Group (WARNING) Collaborators
- Xiao Yonghong
- Yadgarova Klara
- Yahaya Mohammed
- Yahya Ali I.
- Zakaria Andee Dzulkarnaen
- Zakrison Tanya L.
- Zamora Mesia Victor
- Publication venue
- BioMed Central
- Publication date
- 01/01/2023
- Field of study
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice
Recommended from our members
ESICM LIVES 2016: part three: Milan, Italy. 1–5 October 2016
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- Abbott T. E. F.
- Abdallah R. I.
- Abdel-Aal I. R.
- Abdelmonem S. A.
- Abdo W. F.
- Abellan A. Naharro
- Abellán A. Naharro
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- Abrams S. T.
- Ackerley C.
- Acuña M.
- Adda M.
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- Adriano G.
- Adrie C.
- Affatato R.
- Afonso-Rivero D.
- Agarossi A.
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- Ageeva T.
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- Aguayo-DeHoyos E.
- Aguilar A. L. Ruiz
- Aguilar-Alonso E.
- Aguirregabyria M.
- Ahmadnia E.
- Ahn C.
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- Aitken L. M.
- Akalaev R.
- Akbarzadeh A.
- Akcan-Arikan A.
- Akhlagh S. H.
- Akhtar N.
- Akiduki N.
- Akin S.
- Akizuki N.
- Akkoc T.
- Ala-Kokko T.
- Alanio A.
- Albaiceta G. Muñiz
- Albaladejo P.
- Alberto F.
- Albuisson E.
- Alcala M. A.
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- Aldecoa C.
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- Publication venue
- 'Springer Science and Business Media LLC'
- Publication date
- 18/11/2016
- Field of study
Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study
- Author
- Abe T.
- Aboshady Abdelrhman
- Abrough Fekri
- Acampo-de Jong Melanie J.
- Acharya S.
- Acharya Subhash P.
- Adderley Jane
- Adiguzel N.
- Agrawal V.K.
- Aguilar G.
- Aguirre Gaston
- Aguirre-Bermeo Hernán
- Ahlström B.
- Akbas Türkay
- Akker M.
- Al Sadeh G.
- Alamri S.
- Algaba Ángela
- Ali M.
- Aliberti A.
- Allegue J.M.
- Alvarez Diana
- Amador J.
- Amin P.
- Andersen F.H.
- Ansari S.
- Apichatbutr Yutthana
- Apostolopoulou Olympia
- Arabi Y.
- Aragao Irene César
- Arellano D.
- Arica Mestanza
- Arikan Huseyin
- Arinaga K.
- Arnal J.-M.
- Asano Kengo
- Asín-Corrochano M.
- Avalos Cabrera J.M.
- Avila Fuentes S.
- Aydemir Semih
- Aygencel Gulbin
- Azevedo L.
- Bacakoglu Feza
- Badie Julio C.
- Baedorf Kassis E.
- Bai Gabriela
- Balaraj Govindan
- Ballico B.
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- Zhang Weixin
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- Çukurova Z.
- Öveges Nándo
- Publication venue
- Elsevier
- Publication date
- 01/01/2023
- Field of study
International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society
Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study
- Author
- Abe Toshikazu
- Aboshady Abdelrhman
- Abrough Fekri
- Acampo-de Jong Melanie
- Acharya Subhash
- Acharya Subhash P
- Adderley Jane
- Adiguzel Nalan
- Agrawal Vijay Kumar
- Aguilar Gerardo
- Aguirre Gaston
- Aguirre-Bermeo Hernan
- Ahlström Björn
- Akbas Türkay
- Akker Mustafa
- Al Sadeh Ghamdan
- Alamri Sultan
- Algaba Angela
- Ali Muneeb
- Aliberti Anna
- Allegue Jose Manuel
- Alvarez Diana
- Amador Joaquin
- Amin Pravin
- Andersen Finn H
- Ansari Sharique
- Apichatbutr Yutthana
- Apostolopoulou Olympia
- Arabi Yaseen
- Arabi Yaseen
- Aragao Irene
- Aragao Irene
- Arellano Daniel
- Arica Mestanza
- Arikan Huseyin
- Arinaga Koichi
- Arnal Jean-Michel
- Asano Kengo
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- Wei Bi-Lin
- Weller Dolf
- Welsh Deborah
- Welters Ingeborg
- Wert Michael
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- Wilby Elizabeth
- Williams Erin
- Williams Karen
- Wilson Antoinette
- Wojtas Jadwiga
- Won Huh Jin
- Wrathall David
- Wright Christopher
- Wu Jian-Feng
- Wunsch Hannah
- Xi Guo
- Xing Zheng-Jiang
- Xu Hongyang
- Yamamoto Kotaro
- Yan Jie
- Yang Xiaobo
- Yates Elliot
- Yazicioglu Mocin Ozlem
- Ye Zhenglong
- Yildirim Fatma
- Yoshida Norifumi
- Yoshido Hector Higo Leon
- Young Lee Bo
- Yu Gong
- Yu Rongguo
- Yu Tao
- Yuan Boyun
- Yuangtrakul Nadwipa
- Yumoto Tetsuya
- Yun Xie
- Yáñez Julio
- Zakalik Graciela
- Zaki Ahmad
- Zalba-Etayo Begoña
- Zambon Massimo
- Zang Bin
- Zani Gianluca
- Zarka Jonathan
- Zeggwagh Amine Ali
- Zerbi Simone Maria
- Zerman Avsar
- Zetterquist Harald
- Zhang Guoxiu
- Zhang Hongwen
- Zhang Jiuzhi
- Zhang Wei
- Zhang Weixin
- Zhao Hongsheng
- Zheng Jia
- Zhu Bin
- Zumaran Ronald
- Çukurova Zafer
- Öveges Nándo
- Özyilmaz Ezgi
- Publication venue
- 'Elsevier BV'
- Publication date
- 21/01/2023
- Field of study
Background
Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.
Methods
WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109.
Findings
Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital.
Interpretation
In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates
Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study
- Author
- Abdelhamid Hachimi
- Abdellatif Benslama
- Abdelrhman Aboshady
- Abhijit Duggal
- Abidi Khalid
- Abubaker S Elmaryul
- Adela Benitez-Cano
- Adi Hadzibegovic
- Adrian Regli
- Agnes Sarkany
- Agnieszka Kubisz-Pudelko
- Agrippino Bellissima
- Agueda Ojados
- Ahmad Zaki
- Ahmed Rabie
- Aikaterini Dimoula
- Aiman Tulaimat
- Aitor Olmos
- Akihiro Takaba
- Akira Kuriyama
- Akram Khan
- Alastair Rose
- Alberto Belenguer Muncharaz
- Alberto Deicas
- Alberto Facchini
- Aldana Ruiz Robledo
- Alejandro Esquivel
- Alejandro Gonzalez-Castro
- Alejandro Risso Vazquez
- Alejandro Ubeda
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- Finn H Andersen
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- Giacomo Grasselli
- Gianluca Zani
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- Gilda Cinnella
- Giorgio Antonio Iotti
- Giovanna Soto
- Giovanni Mistraletti
- Giovanni Vitale
- Goligher Ewan C
- Gong Yu
- Gonzalo Pagella
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- Juna Tirapu
- Junji Kumasawa
- Kai Chen
- Kamal Nasir
- Karen Burt
- Karen J Bosma
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- Katsunori Mochizuki
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- Kevin Clarkson
- Kevin Eng
- Kim Seok Chan
- Kiyoyasu Kurahashi
- Kiyoyasu Kurahashi
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- Koichi Arinaga
- Konlawij Trongtrakul
- Konstantin Shapovalov
- Konstanty Szuldrzynski
- Konstanty Szuldrzynski
- Kotaro Yamamoto
- Kristian Strand
- Krittika Teerapuncharoen
- Kyeongman Jeon
- Kyung Sook Hong
- Laake Jon Henrik
- Laffey John G
- Lakshay Bhakhtiani
- Lakshmikanthcharan Saravanabavan
- Laura Bernabe
- Laura Flood
- Laura Ortiz-Ruiz De Gordoa
- Laura Pasin
- Laurence Dangers
- Laurent Brochard
- Laurie Lagache
- Leandro Taniguchi
- Leda Floris
- Lee Hwa Young
- Lee Jongmin
- Leo Heunks
- Leo M Heunks
- Liangyan Jiang
- Linda Rørtveit
- Lindi Snyman
- Line Samuelsson
- Ling Liu
- Lisa Grimmer
- Lisandro Roberto Bettini
- Lise Piquilloud
- Lise Piquilloud
- Lorraine Stephenson
- Louis Humbert
- Louis-Marie Galerneau
- Louise Gondim
- Loïc Barrot
- Luca Guatteri
- Luca Montini (ORCID:0000-0003-4602-5134)
- Luca Serano
- Lucia Cubattoli
- Lucia Mirabella
- Luciano Azevedo
- Luigi Camporota
- Luigi Pisani
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- Luis Bento
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- Luis Herrera
- Luis Pablo Cardonnet
- Luis Patão
- Lutz Fehrle
- László Medve
- M Carmen Hornos
- Maazouzi Wajdi
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- Magnus von Seth
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- Mancebo Jordi
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- Manuel Gonzalez
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- Manuel Perez
- Manuel Todeschini
- Manuela Lugano
- Marc Danguy des Déserts
- Marc Vanhoof
- Marcela Homez
- Marcelo Rieder
- Marco Bezzi
- Marco Ranieri
- Marco Spagnoli
- Marcus J Schultz
- Margarita Borislavova
- Maria Augusta Rahe Pereira
- Maria Cristina Orlandi
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- Maria Fernanda Farina
- Maria João Ferreira da Silva
- Maria Lorena Fernandez-Rodriguez
- Maria Mora Aznar
- Maria Morales
- Maria Teresa Jurado
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- Maria-Consuelo Pintado
- Mariachiara Ippolito
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- Mark Smith
- Marko Noc
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- Martin Rinket
- Martin Santos
- Martin Spångfors
- María Del Carmen Campos Moreno
- María Elena Romano
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- María Florencia Valenti
- Masamitsu Sanui
- Massimo Borelli
- Massimo Zambon
- Mathieu Buscot
- Matias Jesús Flamm Zamorano
- Matilde Grando
- Matt Thomas
- Matthieu Le Meur
- Maurizio Bottiroli
- Maurizio Fusari
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- Mayur Patel
- Meihong Hou
- Meisy Perez Cheng
- Melanie Acampo-de Jong
- Melda Turkoglu
- Melike Cengiz
- Mestanza Arica
- Metaxia Papanikolaou
- Mhamed Sami Mebazaa
- Michael Lanspa
- Michael Mikhaeil
- Michael Wert
- Michele Clark
- Miguel Escobar
- Miguel Ángel Sosa Medellin
- Mike Spivey
- Milosz Jankowski
- Min Lu
- Mireia Ferreruela
- Mirko Belliato
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- Moe Oguchi
- Mohamed Benlamin
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- Mustafa Akker
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- Mónica Crespo Ramirez
- Mónica Vargas-Ordoñez
- Nadwipa Yuangtrakul
- Nagwa Doha
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- Pavel Dunts
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- Pesenti Antonio
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- Peñuelas Oscar
- Pham Tài
- Phil Chilton
- Phil Shin
- Philipp M Lepper
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- Philippe Bauer
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- Pierpaolo Terragni
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- Pierre-Eric Danin
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- Pierre-Louis Declercq
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- Piotr Czempik
- Piquilloud Lise
- Pongdhep Theerawit
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- Prabha Gautam
- Pradeep Shanmugasundaram
- Prakash Khairnar
- Pravin Amin
- Preveen Banwarie
- Purificación Perez-Teran
- Qing Gu
- Rachael Parke
- Radhakrishnan Muthuchellappan
- Rahul Nanchal
- Raihan Rabbani
- Rainier Ovalle Olmos
- Rajnish Saha
- Rakesh Bhandary
- Rakhshanda Jabeen
- Ramesh Vj
- Ramón Carrillo
- Raquel Montiel
- Raúl Alejandro Gomez
- Raúl de Pablo
- Renaud Gueret
- Reza Khorasanee
- Ricard Mellado Artigas
- Riccardo Colombo
- Riccardo Pinciroli
- Riccardo Scano
- Richard Innes
- Richard Oeckler
- Richard Pugh
- Rihard Knafelj
- Rinaldo Grasso
- Robert Giannoni
- Roberta Caccese
- Roberto Fumagalli
- Rocco D'Andrea
- Rocio Quispe Soto
- Rodolfo Lopez
- Rodrigo Beltramelli
- Rodrigo Cornejo
- Rodrigo Pérez-Araos
- Rohit Saha
- Rollin Roldan
- Romina Pratto
- Ronald Perez Maita
- Ronald Zumaran
- Rongguo Yu
- Rongqing Sun
- Rooney Grainne
- Rosa Reina
- Rosana Hernandez
- Rosanna Vaschetto
- Rosari Quispe Sierra
- Rosella Barbieri
- Roser Tomas
- Rosita Gomero Paredes
- Rossella di Mussi
- Rui Gomes
- Saad Nseir
- Sabrina Boraso
- Sait Karakurt
- Sakuraya Masaaki
- Sally Humphreys
- Salvatore Grasso
- Salvatore Maurizio Maggiore
- Salvatore Palmese
- Samantha Hagan
- Samar Elsayed
- Sanghamitra Mishra
- Sanja Granov Grabovica
- Sanjeev Tyagi
- Santiago Ilutovich
- Santiago Izza
- Sara Ventura
- Sarah Beavis
- Sarah Snape
- Saroj Pattnaik
- Savino Spadaro
- Sebastian Fredes
- Sebastiano Macheda
- Sema Sari
- Sema Turan
- Semih Aydemir
- Seok Jeong Lee
- Serdar Efe
- Serge Heines
- Seyed Mohammadreza Hashemian
- Seyed Mohammadreza Hashemian
- Shailesh Bihari
- Sharique Ansari
- Shay McGuinness
- Shigeki Saito
- Shihan Mahmud Redwanul Huq
- Shinichiro Ohshimo
- Shinshu Katayama
- Shouhong Wang
- Shuchi Kaushik
- Shuhei Niiyama
- Silvia Avila Fuentes
- Silvia De Rosa
- Silvina Borello
- Silvio Antonio Namendys-Silva
- Simant Jha
- Simon Bocher
- Simon Chau
- Simon Whiteley
- Simone Maria Zerbi
- Sivakumar Nandakumar
- Slavenka Straus
- Sofia Nikolakopoulou
- Souheil Elatrous
- Srinivas Samavedam
- Stacy House
- Stefania Buttera
- Stefania Sovatzis
- Stefano Clementi
- Stefano Muttini
- Stephanie Hunter
- Stephanie Nonas
- Stephanie Piras
- Stéphanie Gelinotte
- Su Hwan Lee
- Subhash Acharya
- Subhash P Acharya
- Sughrat Siddiqui
- Suha Bozbay
- Sultan Alamri
- Sundar Raj Ashok
- Sunil Jamadarkhana
- Sunthiti Morakul
- Susana Temprano
- Sébastien Ena
- Sébastien Jochmans
- Sébastien Perbet
- Taha Pasha
- Tai Pham
- Tai SunPark
- Taiga Itagaki
- Takuya Shiga
- Tamaas Leiner
- Tamasato Tamasato
- Tananchai Petnak
- Tao Yu
- Tapia Muñoz
- Tarek Dendane
- Tayyba Naz Aslam
- Teobaldo Quintana
- Terje Legernaes
- Tetsuya Yumoto
- Theonymfi Papavasilopoulou
- Thomas Clark
- Thomas Piraino
- Thuy Nga Phan
- Tiago Leonor
- Tiago Pereira
- Tiehe Qin
- Tim Cook
- Tim Frenzel
- Tim Smith
- Todd Rice
- Tommaso Tonetti
- Tomohito Sadahiro
- Toshikazu Abe
- Türkay Akbas
- Ulrike Buehner
- Valeria Lascari
- Valerie Banner-Goodspeed
- van Haren Frank
- Vanesa Alejandra Pavlotsky
- Venkat Sundaram
- Vera Pereira
- Victor Hugo Madrigal Robles
- Victoria McCredie
- Vijay Kumar Agrawal
- Vijayanand Palaniswamy
- Viratch Tangsujaritvijit
- Virginia Porta
- Virginie Lemiale
- Vito Fanelli
- Vitor Mendes
- Vladimir Cerny
- Volkan Inal
- Wang Ruilan
- Wei Zhang
- Weixin Zhang
- Wensen Pan
- Willy Diaz
- Willy Porras
- Wilson Oliveira Filho
- Wojciech Serednicki
- Won-Yeon Lee
- Wu Dawei
- Wunsch Hannah
- Xandra Yanina Rodriguez Tucto
- Xavier Souloy
- Xia Hongtao
- Xiang-Dong Guan
- Xiaobo Yang
- Xie Yun
- Yalim Dikmen
- Yari Gollo
- Yaseen Arabi
- Yaseen Arabi
- Yasemin Seker Tekdos
- Yazcitk Sandoval
- You Shang
- Youjin Chang
- Young Ju Lee
- Young-Jae Cho
- Young-Jae Cho
- Yuda Sutherasan
- Yufeng Feng
- Yukako Obata
- Yupeng Qi
- Yutthana Apichatbutr
- Yvette Chou-Lie
- Zafer Çukurova
- Zhang Minwei
- Zhanhong Tang
- Zheng-Jiang Xing
- Zhenglong Ye
- Zoltan Kulcsar
- Zsolt Molnar
- Zsolt Molnar
- Zsuzsanna Szabo
- Óscar Peñuelas
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/01/2023
- Field of study
Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society