9 research outputs found
Mind the Gap: Education Inequality at the Regional Level in Portugal, 1986-2005
- Publication venue
- Publication date
- Field of study
Portugal stands as one of the most unequal countries in terms of income among the developed countries. Over the period 1980-2005, income inequality kept high, fostered mainly by a monotonic increase in earnings inequality. Given the close link between education and earnings, it is of major importance to study the distribution of education. This paper examines the distribution of education at the regional level in Portugal between 1986 and 2005. Our results indicate that education inequality decreased for the whole country as the average education level of the workforce rose, over the sample years. This finding does not apply at the regional level however, with several districts initially poor in terms of education exhibiting an increase in education inequality. The evidence also supports the existence of a Kuznets curve of education: as the average level of education rises, education inequality first increases, and, after reaching a peak at 5.13 years of schooling, starts declining.
Chapter 1
- Author
- Alves Gustavo R.
- Alves João B.
- Bertramo Brenda
- Biléssimo Simone
- Castro Manuel
- Concari Sonia B.
- Costa Ricardo J.
- da Silva Juarez B.
- de Almeida Nival N.
- de Arregui Gaston S.
- de Bona Daniel D.
- de Oliveira Vanderli F.
- Dobboletta Elsa
- Díaz-Orueta Gabriel
- Felgueiras Manuel Carlos
- Fernández Rubén A.
- Ferreira Golberi
- Fidalgo André
- García-Loro Felix
- García-Zubía Javier
- Gustavsson Ingvar
- Gómez Mario J.
- Hernández-Jayo Unai
- Kulesza Wlodek J.
- Lerro Federico
- Lima Delberis A.
- Lima Natércia
- Marchisio Susana
- Marques Maria Arcelina
- Merendino Claudio
- Nilsson Kristian
- Pacheco Fernando S.
- Pavani Ana M.
- Paz Héctor R.
- Pester Andreas
- Plano Miguel
- Pozzo María I.
- SanCristóbal-Ruiz Elio
- Schlichting Luis C.
- Soria Mario F.
- Temporão Guilherme
- Viegas Clara
- Zackrisson Johan
- Zutin Danilo G.
- Publication venue
- 'Springer Science and Business Media LLC'
- Publication date
- 01/01/2018
- Field of study
Experimenting is fundamental to the training process of all scientists and engineers. While experiments have been traditionally done inside laboratories, the emergence of Information and Communication Technologies added two alter-natives accessible anytime, anywhere. These two alternatives are known as virtual and remote labs, and are sometimes indistinguishably referred as online labs. Sim-ilarly to other instructional technologies, virtual and remote labs require some ef-fort from teachers in integrating them into curricula, taking into consideration sev-eral factors that affect their adoption (i.e. cost) and their educational effectiveness (i.e. benefit). This chapter analyses these two dimensions and sustains the case where only through international cooperation it is possible to serve the large num-ber of teachers and students involved in engineering education. It presents an ex-ample in the area of Electrical and Electronics Engineering, based on a remote lab named Virtual Instruments System in Reality, and it then describes how a number of European and Latin-American institutions have been cooperating under the scope of an Erasmus+ project2, for spreading its use in Brazil and Argentina.info:eu-repo/semantics/publishedVersio
Adipose Tissue-Derived Extracellular Vesicles and the Tumor Microenvironment: Revisiting the Hallmarks of Cancer
- Author
- Publication venue
- 'MDPI AG'
- Publication date
- 01/07/2021
- Field of study
Extracellular vesicles (EVs) are crucial elements that sustain the communication between tumor cells and their microenvironment, and have emerged as a widespread mechanism of tumor formation and metastasis. In obesity, the adipose tissue becomes hypertrophic and hyperplastic, triggering increased production of pro-inflammatory adipokines, such as tumor necrosis factor α, interleukin 6, interleukin 1, and leptin. Furthermore, obese adipose tissue undergoes dysregulation in the cargo content of the released EVs, resulting in an increased content of pro-inflammatory proteins, fatty acids, and oncogenic microRNAs. These alterations drive obesity-associated inflammatory responses both locally and systemically. After being ignored for a long time, adipose tissues have recently received considerable attention as a major player in tumor microenvironment-linked obesity and cancer. The role of adipose tissue in the establishment and progression of cancer is reinforced by its high plasticity and inflammatory content. Such a relationship may be established by direct contact between adipocytes and cancer cells within the microenvironment or systemically, via EV-mediated cell-to-cell communication. Here, we highlight cues evidencing the influence of adipose tissue-derived EVs on the hallmarks of cancer, which are critical for tumor malignancy
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
- Asín-Corrochano Marta
- Avalos Cabrera Jesus Milagrito
- Avila Fuentes Silvia
- Aydemir Semih
- Aygencel Gulbin
- Azevedo Luciano
- Bacakoglu Feza
- Badie Julio
- Baedorf Kassis Elias
- Bai Gabriela
- Balaraj Govindan
- Ballico Bruno
- Banner-Goodspeed Valerie
- Banwarie Preveen
- Barbieri Rosella
- Baronia Arvind
- Barrett Jonathan
- Barrot Loïc
- Barrueco-Francioni Jesus Emilio
- Barry Jeffrey
- Bauer Philippe
- Bauer Philippe
- Bawangade Harshal
- Beavis Sarah
- Beck Eduardo
- Beduneau Gaëtan
- Beduneau Gaëtan
- Beehre Nina
- Beitler Jeremy
- Belenguer Muncharaz Alberto
- Bellani Giacomo
- Bellani Giacomo
- Belliato Mirko
- Bellissima Agrippino
- Beltramelli Rodrigo
- Ben Souissi Asma
- Benitez-Cano Adela
- Benlamin Mohamed
- Benslama Abdellatif
- Bento Luis
- Benvenuti Daniela
- Berkius Johan
- Berkius Johan
- Bernabe Laura
- Bersten Andrew
- Berta Giacomo
- Bertini Pietro
- Bertram-Ralph Elliot
- Besbes Mohamed
- Bettini Lisandro Roberto
- Beuret Pascal
- Bewley Jeremy
- Bezzi Marco
- Bhakhtiani Lakshay
- Bhandary Rakesh
- Bhowmick Kaushik
- Bihari Shailesh
- Bissett Bernie
- Blythe David
- Bocher Simon
- Boedjawan Narain
- Bojanowski Christine M
- Boni Elisa
- Boraso Sabrina
- Borelli Massimo
- Borello Silvina
- Borislavova Margarita
- Bosma Karen J
- Bottiroli Maurizio
- Boyd Owen
- Bozbay Suha
- Briva Arturo
- Brochard Laurent
- Brochard Laurent
- Bruel Cédric
- Bruni Andrea
- Buehner Ulrike
- Bugedo Guillermo
- Bugedo Guillermo
- Bulpa Pierre
- Burt Karen
- Buscot Mathieu
- Buttera Stefania
- Cabrera Jorge
- Caccese Roberta
- Caironi Pietro
- Camporota Luigi
- Canchos Gutierrez Ivan
- Canedo Nancy
- Cani Alma
- Cappellini Iacopo
- Carazo Jesus
- Cardonnet Luis Pablo
- Carpio David
- Carriedo Demetrio
- Carrillo Ramón
- Carvalho João
- Caser Eliana
- Castelli Antonio
- Castillo Quintero Manuel
- Castro Heloisa
- Catorze Nuno
- Cengiz Melike
- Cereijo Enrique
- Cerny Vladimir
- Ceunen Helga
- Chaintoutis Christos
- Chang Youjin
- Chaparro Gustavogcha
- Chapman Carmel
- Chau Simon
- Chavez Cecilia Eugenia
- Chelazzi Cosimo
- Chelly Jonathan
- Chemouni Frank
- Chen Kai
- Chena Ariel
- Chiarandini Paolo
- Chilton Phil
- Chiumello Davide
- Cho Young-Jae
- Cho Young-Jae
- Chou-Lie Yvette
- Chudeau Nicolas
- Cinel Ismail
- Cinnella Gilda
- Clark Michele
- Clark Thomas
- Clarkson Kevin
- Clarkson Kevin
- Clementi Stefano
- Coaguila Luis
- Codecido Alexis Jaspe
- Collins Amy
- Colombo Riccardo
- Conde Juan
- Consales Guglielmo
- Cook Tim
- Coppadoro Andrea
- Cornejo Rodrigo
- Cortegiani Andrea
- Coxo Cristina
- Cracchiolo Andrea Neville
- Crespo Ramirez Mónica
- Crova Philippe
- Cruz José
- Cubattoli Lucia
- Curto Francesco
- Czempik Piotr
- D'Andrea Rocco
- da Silva Ramos Fernando
- Dangers Laurence
- Danguy des Déserts Marc
- Danin Pierre-Eric
- Dantas Fabianne
- Daubin Cédric
- Dawei Wu
- de Haro Candelaria
- de Jesus Montelongo Felipe
- De Mendoza Diego
- de Pablo Raúl
- De Pascale Gennaro
- De Rosa Silvia
- Decavèle Maxens
- Declercq Pierre-Louis
- Deicas Alberto
- del Carmen Campos Moreno María
- Dellamonica Jean
- Delmas Benjamin
- Demirkiran Hilmi
- Demirkiran Oktay
- Dendane Tarek
- di Mussi Rossella
- Diakaki Chrysi
- Diaz Anatilde
- Diaz Willy
- Dikmen Yalim
- Dimoula Aikaterini
- Doble Patricia
- Doha Nagwa
- Domingos Guilherme
- Dres Martin
- Dries David
- Duggal Abhijit
- Duke Graeme
- Dunts Pavel
- Dybwik Knut
- Dykyy Maksym
- Eckert Philippe
- Efe Serdar
- Elatrous Souheil
- Elay Gülseren
- Elmaryul Abubaker S
- Elsaadany Mohamed
- Elsayed Hany
- Elsayed Samar
- Emery Malo
- Ena Sébastien
- Eng Kevin
- Englert Joshua A
- Erdogan Elif
- Ergin Ozcan Perihan
- Eroglu Ege
- Escobar Miguel
- Esen Tekeli Arzu
- Esen Figen
- Esquivel Gallegos Helbert
- Esquivel Alejandro
- Estenssoro Elisa
- Ezzouine Hanane
- Facchini Alberto
- Faheem Mohammad
- Fanelli Vito
- Farina Maria Fernanda
- Fartoukh Muriel
- Fehrle Lutz
- Feng Feng
- Feng Yufeng
- Fernandez Borja
- Fernandez Irene
- Fernandez-Rodriguez Maria Lorena
- Ferrando Carlos
- Ferreira da Silva Maria João
- Ferreruela Mireia
- Ferrier Janet
- Flamm Zamorano Matias Jesús
- Flood Laura
- Floris Leda
- Fluckiger Martin
- Forteza Catalina
- Fortunato Antonella
- Frans Eric
- Frattari Antonella
- Fredes Sebastian
- Frenzel Tim
- Fumagalli Roberto
- Furche Mariano Andres
- Fusari Maurizio
- Fysh Edward
- Galeas-Lopez Juan Luis
- Galerneau Louis-Marie
- Garcia Olivares Pablo
- Garcia Analía
- Garcia Elisabet
- Garcia María Fernanda
- Garlicki Jaroslaw
- Garnero Aude
- Garofalo Eugenio
- Gautam Prabha
- Gazenkampf Andrey
- Gelinotte Stéphanie
- Gelormini Domenico
- Ghrenassia Etienne
- Giacomucci Angelo
- Giannoni Robert
- Gigante Andrea
- Glober Nancy
- Gnesin Paolo
- Goligher Ewan
- Goligher Ewan C
- Gollo Yari
- Gomaa Dina
- Gomero Paredes Rosita
- Gomes Rui
- Gomez Aroa
- Gomez Oscar
- Gomez Raúl Alejandro
- Gondim Louise
- Gonzalez Isabel
- Gonzalez Manuel
- Gonzalez-Castro Alejandro
- Gordillo Romero Orlando
- Gordo Federico
- Gouin Philippe
- Graf Santos Jerónimo
- Grainne Rooney
- Grando Matilde
- Granov Grabovica Sanja
- Grasselli Giacomo
- Grasselli Giacomo
- Grasselli Giacomo
- Grasso Rinaldo
- Grasso Salvatore
- Grimmer Lisa
- Grissom Colin
- Gritsan Alexey
- Gritsan Alexey
- Gu Qing
- Guan Xiang-Dong
- Guarracino Fabio
- Guasch Neus
- Guatteri Luca
- Gueret Renaud
- Guerot Emmanuel
- Guitard Pierre-Gildas
- Gumus Ayca
- Gurjar Mohan
- Gutierrez Patricia
- Guérin Claude
- Gül Fethi
- Hachimi Abdelhamid
- Hadzibegovic Adi
- Hagan Samantha
- Hammel Clare
- Han Song Joo
- Hanlon Gabrielle
- Hashemian Seyed Mohammadreza
- Hashemian Seyed Mohammadreza
- Heines Serge
- Henriksson Johanna
- Herbrecht Jean-Etienne
- Heredia Orbegoso Gabriel Omar
- Hermans Greet
- Hermans Greet
- Hermon Andrew
- Hernandez Carmen
- Hernandez Rosana
- Herrera Luis
- Herrera-Gutierrez Manuel
- Heunks Leo
- Heunks Leo
- Heunks Leo M
- Hidalgo Juan
- Hill Dianne
- Holmquist Dagmar
- Homez Marcela
- Hongtao Xia
- Hormis Anil
- Horner Daniel
- Hornos M Carmen
- Hou Meihong
- House Stacy
- Housni Brahim
- Hugill Keith
- Humbert Louis
- Humphreys Sally
- Hunter Stephanie
- Hwa Young Lee
- Iezzi Nicolas
- Ilutovich Santiago
- Inal Volkan
- Innes Richard
- Ioannides Panagiotis
- Iotti Giorgio Antonio
- Ippolito Mariachiara
- Irie Hiromasa
- Iriyama Hiroki
- Itagaki Taiga
- Izura Javier
- Izza Santiago
- Jabeen Rakhshanda
- Jamaati Hamidreza
- Jamadarkhana Sunil
- Jamoussi Amira
- Jankowski Milosz
- Jaramillo Luis Alberto
- Jeon Kyeongman
- Jeong Lee Seok
- Jeswani Deepak
- Jha Simant
- Jiang Liangyan
- Jing Chen
- Jochmans Sébastien
- Johnstad Bror Anders
- Jongmin Lee
- Joret Aurélie
- Jovanovic Bojan
- Jovanovic Bojan
- Junhasavasdikul Detajin
- Jurado Maria Teresa
- Kam Elisa
- Kamohara Hidenobu
- Kane Caroline
- Kara Iskender
- Karakurt Sait
- Karnjanarachata Cherdkiat
- Kataoka Jun
- Katayama Shinshu
- Kaushik Shuchi
- Kelebek Girgin Nermin
- Kerr Kathryn
- Kerslake Ian
- Khairnar Prakash
- Khalid Abidi
- Khan Akram
- Khanna Ashish K
- Khorasanee Reza
- Kienhorst Dieneke
- Kirakli Cenk
- Knafelj Rihard
- Kol Mark Kol
- Kongpolprom Napplika
- Kopitko Csaba
- Korkmaz Ekren Pervin
- Kubisz-Pudelko Agnieszka
- Kulcsar Zoltan
- Kumasawa Junji
- Kurahashi Kiyoyasu
- Kurahashi Kiyoyasu
- Kuriyama Akira
- Kutchak Fernanda
- Laake Jon Henrik
- Laake Jon Henrik
- Laake Jon Henrik
- Labarca Eduardo
- Labat Françoise
- Laborda César
- Laca Barrera Manuel Alberto
- Laffey John G
- Lagache Laurie
- Landaverde Lopez Antonio
- Lanspa Michael
- Lascari Valeria
- Le Meur Matthieu
- Lee Jarone
- Lee Jinwoo
- Lee Su Hwan
- Lee Won-Yeon
- Lee Young Ju
- Legernaes Terje
- Leiner Tamaas
- Lemiale Virginie
- Leonor Tiago
- Lepper Philipp M
- Li Dahuan
- Li Hongbin
- Li Oleg
- Lima Ana Raquel
- Lind Dan
- Litton Edward
- Liu Jialin
- Liu Ling
- Liu Ning
- Llitjos Jean-François
- Llorente Beatriz
- Lopez Nava Claudia
- Lopez Claudia Elizabeth
- Lopez Rodolfo
- Lovazzano Pablo
- Lu Min
- Lucchese Francesca
- Lugano Manuela
- Lugo Goytia Gustavo
- Luo Hua
- Lynch Ceri
- Macheda Sebastiano
- Madotto Fabiana
- Madrigal Robles Victor Hugo
- Maggiore Salvatore Maurizio
- Magret Iglesias Mònica
- Malaga Peter
- Mallapura Maheswarappa Harish
- Malpartida Guillermo
- Malyarchikov Andrey
- Mancebo Jordi
- Mansson Helena
- Manzano Anaid
- Marey Ismael
- Marin Maria del Carmen
- Marin Nathalie
- Markman Eliana
- Martin Dal Gesso Cristina
- Martin Alex
- Martin Felix
- Martin-Loeches Ignacio
- Martinez Felipe
- Martínez-Fidalgo Conchita
- Mas Arantxa
- Masaaki Sakuraya
- Maseda Emilio
- Massa Eleni
- Matamis Dimitrios
- Mattsson Anna
- Maugeri Jessica
- McCredie Victoria
- McCullough James
- McGuinness Shay
- McKown Andrew
- Medve László
- Mei Chengqing
- Mellado Artigas Ricard
- Mendes Vitor
- Mervat Mohamed Khalaf Ebraheim
- Michaux Isabelle
- Mikhaeil Michael
- Milagros Olga
- Milet Igor
- Millan Maria Teresa
- Minwei Zhang
- Mirabella Lucia
- Mishra Sanghamitra
- Mistraletti Giovanni
- Mochizuki Katsunori
- Moerer Onnen
- Moerer Onnen
- Moghal Arif
- Mojoli Francesco
- Molin Alexandre
- Molnar Zsolt
- Molnar Zsolt
- Montiel Raquel
- Montini Luca
- Monza Gianmario
- Mora Aznar Maria
- Morakul Sunthiti
- Morales Maria
- Moreno Torres Daniel
- Morocho Tutillo Diego Rolando
- Motherway Catherine
- Mouhssine Doumiri
- Mouloudi Eleni
- Munoz de Cabo Carlos
- Mustafa Mohamed
- Muthuchellappan Radhakrishnan
- Muthukrishnan Muraleekrishnan
- Muttini Stefano
- Muñoz Tapia
- Nagata Isao
- Nahar Dick
- Nakanishi Misuzu
- Nakayama Izumi
- Namendys-Silva Silvio Antonio
- Nanchal Rahul
- Nandakumar Sivakumar
- Nasi Alessandra
- Nasir Kamal
- Navalesi Paolo
- Naz Aslam Tayyba
- Nga Phan Thuy
- Nichol Alistair
- Niiyama Shuhei
- Nikolakopoulou Sofia
- Nikolic Elena
- Nitta Kenichi
- Noc Marko
- Nonas Stephanie
- Nseir Saad
- Nur Soyturk Ayse
- Obata Yukako
- Oeckler Richard
- Oguchi Moe
- Ohshimo Shinichiro
- Oikonomou Marina
- Ojados Agueda
- Oliveira Filho Wilson
- Oliveira Maria Teresa
- Oliveri Carlo
- Olmos Aitor
- Omura Kazuya
- Orlandi Maria Cristina
- Orsenigo Francesca
- Ortiz-Ruiz De Gordoa Laura
- Ota Kei
- Ovalle Olmos Rainier
- Oziemski Peter
- Ozkan Kuscu Ozlem
- Ozyilmaz Ezgi
- Pachas Alvarado Fernando
- Pagella Gonzalo
- Palaniswamy Vijayanand
- Palazon Sanchez Eugenio Luis
- Palmese Salvatore
- Pan Guojun
- Pan Wensen
- Panka Bernardo
- Panka Bernardo
- Papali Alfred
- Papanikolaou Metaxia
- Papavasilopoulou Theonymfi
- Parekh Ameet
- Parke Rachael
- Parrilla Dácil
- Parrilla Francisco J
- Pasha Taha
- Pasin Laura
- Patel Grisma
- Patel Mayur
- Pati Basanta Kumar
- Patil Jayaprakash
- Pattnaik Saroj
- Patão Luis
- Paul Daniel
- Pavesi Maurizio
- Pavlotsky Vanesa Alejandra
- Paz Enrique
- Paz Graciela
- Pecci Elisabetta
- Pellegrini Carlos
- Perbet Sébastien
- Perchiazzi Gaetano
- Pereira Tiago
- Pereira Vera
- Perez Calvo Cesar
- Perez Cheng Meisy
- Perez Maita Ronald
- Perez Manuel
- Perez-Teran Purificación
- Perez-Torres David
- Perkins Gavin
- Persona Paolo
- Pesenti Antonio
- Petnak Tananchai
- Petrova Marina
- Peña Padilla Andrea Gabriela
- Peñuelas Oscar
- Peñuelas Óscar
- Pham Tai
- Pham Tài
- Philippart François
- Picetti Edoardo
- Pierucci Elisabetta
- Piervincenzi Edoardo
- Pinciroli Riccardo
- Pintado Maria-Consuelo
- Piquilloud Lise
- Piquilloud Lise
- Piquilloud Lise
- Piraino Thomas
- Piras Claudio
- Piras Stephanie
- Pirompanich Pattarin
- Pisani Luigi
- Platas Enrique
- Plotnikow Gustavo
- Porras Willy
- Porta Virginia
- Portilla Mariana
- Portugal José
- Povoa Pedro
- Prat Gwenael
- Pratto Romina
- Preda Gabriel
- Prieto Isidro
- Prol-Silva Estefania
- Pugh Richard
- Pérez-Araos Rodrigo
- Qi Yupeng
- Qian Chuanyun
- Qin Tiehe
- Qiu Haibo
- Qiu Haibo
- Qu Hongping
- Quintana Teobaldo
- Quispe Sierra Rosari
- Quispe Soto Rocio
- Rabbani Raihan
- Rabee Mohamed
- Rabie Ahmed
- Rahe Pereira Maria Augusta
- Rai Ashish
- Raj Ashok Sundar
- Rajab Mostafa
- Ramdhani Navin
- Ramey Elizabeth
- Ranieri Marco
- Rathod Darshana
- Ray Banambar
- Razek Assem Abdel
- Redwanul Huq Shihan Mahmud
- Regli Adrian
- Reina Rosa
- Resano Sarmiento Natalia
- Reynaud Faustine
- Rialp Gemma
- Ricart Pilar
- Rice Todd
- Richardson Angus
- Rieder Marcelo
- Rinket Martin
- Rios Fernando
- Rios Fernando
- Risso Vazquez Alejandro
- Rittayamai Nuttapol
- Rittayamai Nuttapol
- Riva Ivano
- Rivette Monaly
- Roca Oriol
- Roche-Campo Ferran
- Rodriguez Gonzalez Daniel
- Rodriguez Tucto Xandra Yanina
- Rodriguez Covadonga
- Rodriguez Gabriel
- Rogers Angela
- Roldan Rollin
- Romano María Elena
- Rose Alastair
- Roux Damien
- Rouze Anahita
- Rubatto Birri Paolo Nahuel
- Ruilan Wang
- Ruiz Robledo Aldana
- Ruiz-Aguilar Antonio Luis
- Rørtveit Linda
- Sadahiro Tomohito
- Saez Ignacio
- Sagardia Judith
- Saha Rajnish
- Saha Rohit
- Saiphoklang Narongkorn
- Saito Shigeki
- Salem Maie
- Sales Gabriele
- Salgado Patricia
- Samavedam Srinivas
- Sami Mebazaa Mhamed
- Samuelsson Line
- San Juan Roman Nandyelly
- Sanchez Patricia
- Sanchez-Ballesteros Jesus
- Sandoval Yazcitk
- Sani Emanuele
- Santos Carla
- Santos Martin
- Sanui Masamitsu
- Saravanabavan Lakshmikanthcharan
- Sari Sema
- Sarkany Agnes
- Sauneuf Bertrand
- Savioli Monica
- Sazak Hilal
- Scano Riccardo
- Schneider Francis
- Schortgen Frédérique
- Schultz Marcus J
- Schwarz Gabriele Leonie
- Seely Andrew
- Seiler Frederik
- Seker Tekdos Yasemin
- Seok Chan Kim
- Serano Luca
- Serednicki Wojciech
- Serpa Neto Ary
- Serpa Neto Ary
- Setten Mariano
- Seçkin Yücesoy Faruk
- Shah Asim
- Shah Bhagyesh
- Shang You
- Shanmugasundaram Pradeep
- Shapovalov Konstantin
- Shebl Eman
- Shiga Takuya
- Shime Nobuaki
- Shin Phil
- Short Jack
- Shuhua Chen
- Siddiqui Sughrat
- Silesky Jimenez Juan Ignacio
- Silva Sales Betania
- Silva Daniel
- Simons Koen
- Sjøbø Brit Ågot
- Slessor David
- Smiechowicz Jakub
- Smischney Nathan
- Smith Mark
- Smith Paul
- Smith Tim
- Snape Sarah
- Snyman Lindi
- Soetens Filiep
- Sook Hong Kyung
- Sosa Medellin Miguel Ángel
- Soto Giovanna
- Souloy Xavier
- Sousa Elsa
- Sovatzis Stefania
- Sozutek Didem
- Spadaro Savino
- Spagnoli Marco
- Spittle Nick
- Spivey Mike
- Spångfors Martin
- Stapleton Andrew
- Stefanovic Branislava
- Stephenson Lorraine
- Stevenson Elizabeth
- Strand Kristian
- Strano Maria Teresa
- Straus Slavenka
- Sun Chenliang
- Sun Rongqing
- Sundaram Venkat
- SunPark Tai
- Surlemont Elisabeth
- Sutherasan Yuda
- Szabo Zsuzsanna
- Szuldrzynski Konstanty
- Szuldrzynski Konstanty
- Tainter Christopher
- Takaba Akihiro
- Tallott Mandy
- Talmor Daniel
- Tamasato Tamasato
- Tang Zhanhong
- Tangsujaritvijit Viratch
- Taniguchi Daisuke
- Taniguchi Leandro
- Tarantino Fabio
- Teerapuncharoen Krittika
- Temprano Susana
- Terragni Pierpaolo
- Terzi Nicolas
- Thakur Anand
- Theerawit Pongdhep
- Thille Arnaud W
- Thomas Matt
- Thungtitigul Poungrat
- Thyrault Martial
- Tilouch Nejla
- Timenetsky Karina
- Tirapu Juna
- Todeschini Manuel
- Tomas Roser
- Tomaszewski Christian
- Tomescu Dana
- Tonetti Tommaso
- Tonnelier Alexandre
- Trinder John
- Trongtrakul Konlawij
- Truwit Jonathon
- Tsuei Betty
- Tulaimat Aiman
- Turan Sema
- Turkoglu Melda
- Tyagi Sanjeev
- Ubeda Alejandro
- Vagginelli Federica
- Valenti María Florencia
- Vallverdu Imma
- Van Axel Alisha
- van den Hul Ingrid
- van der Hoeven Hans
- Van Der Meer Nardo
- van Haren Frank
- Van Haren Frank
- Van Haren Frank
- Vanhoof Marc
- Vargas-Ordoñez Mónica
- Vaschetto Rosanna
- Vascotto Ettore
- Vatsik Maria
- Vaz Ana
- Vazquez-Sanchez Antonia
- Ventura Sara
- Vermeijden Jan Wytze
- Vidal Anxela
- Vieira Jocyelle
- Vilela Costa Pinto Bruno
- Villagomez Asisclo
- Villagomez Asisclo
- Villagra Ana
- Villegas Succar Cristina
- Vinorum Ole Georg
- Vitale Giovanni
- Vj Ramesh
- Vochin Ana
- Voiriot Guillaume
- Volta Carlo Alberto
- von Seth Magnus
- Wajdi Maazouzi
- Walsh Don
- Wang Shouhong
- Wardi Gabriel
- Ween-Velken Nils Christian
- Wei Bi-Lin
- Weller Dolf
- Welsh Deborah
- Welters Ingeborg
- Wert Michael
- Whiteley Simon
- 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
- Alessandra Nasi
- Alex Martin
- Alexandre Molin
- Alexandre Tonnelier
- Alexey Gritsan
- Alexey Gritsan
- Alexis Jaspe Codecido
- Alfred Papali
- Alisha Van Axel
- Alistair Nichol
- Alma Cani
- Ameet Parekh
- Amine Ali Zeggwagh
- Amira Jamoussi
- Amy Collins
- Ana Raquel Lima
- Ana Vaz
- Ana Villagra
- Ana Vochin
- Anahita Rouze
- Anaid Manzano
- Analía Garcia
- Anand Thakur
- Anatilde Diaz
- Andrea Bruni
- Andrea Coppadoro
- Andrea Cortegiani
- Andrea Gabriela Peña Padilla
- Andrea Gigante
- Andrea Neville Cracchiolo
- Andrew Bersten
- Andrew Hermon
- Andrew McKown
- Andrew Seely
- Andrew Stapleton
- Andrey Gazenkampf
- Andrey Malyarchikov
- Angela Algaba
- Angela Rogers
- Angelo Giacomucci
- Angus Richardson
- Anil Hormis
- Anna Aliberti
- Anna Mattsson
- Antoinette Wilson
- Antonella Fortunato
- Antonella Frattari
- Antonia Vazquez-Sanchez
- Antonio Castelli
- Antonio Landaverde Lopez
- Antonio Luis Ruiz-Aguilar
- Anxela Vidal
- Aragao Irene
- Arantxa Mas
- Ariel Chena
- Arif Moghal
- Arnaud W Thille
- Aroa Gomez
- Arturo Briva
- Arvind Baronia
- Ary Serpa Neto
- Ary Serpa Neto
- Arzu Esen Tekeli
- Ashish K Khanna
- Ashish Rai
- Asim Shah
- Asisclo Villagomez
- Asisclo Villagomez
- Asma Ben Souissi
- Assem Abdel Razek
- Aude Garnero
- Aurélie Joret
- Avsar Zerman
- Ayca Gumus
- Ayse Nur Soyturk
- Banambar Ray
- Basanta Kumar Pati
- Beatriz Llorente
- Beduneau Gaëtan
- Begoña Zalba-Etayo
- Bellani Giacomo
- Benjamin Delmas
- Bernardo Panka
- Bernardo Panka
- Bernie Bissett
- Bertrand Sauneuf
- Betania Silva Sales
- Betty Tsuei
- Bhagyesh Shah
- Bi-Lin Wei
- Bin Zang
- Bin Zhu
- Björn Ahlström
- Bo Young Lee
- Bojan Jovanovic
- Bojan Jovanovic
- Borja Fernandez
- Boyun Yuan
- Brahim Housni
- Branislava Stefanovic
- Brit Ågot Sjøbø
- Brochard Laurent
- Bror Anders Johnstad
- Bruno Ballico
- Bruno Vilela Costa Pinto
- Candelaria de Haro
- Carla Santos
- Carlo Alberto Volta
- Carlo Oliveri
- Carlos Ferrando
- Carlos Munoz de Cabo
- Carlos Pellegrini
- Carmel Chapman
- Carmen Hernandez
- Caroline Kane
- Catalina Forteza
- Catherine Motherway
- Cecilia Eugenia Chavez
- Cenk Kirakli
- Ceri Lynch
- Cesar Perez Calvo
- Chen Jing
- Chen Shuhua
- Chengqing Mei
- Chenliang Sun
- Cherdkiat Karnjanarachata
- Christian Tomaszewski
- Christine M Bojanowski
- Christopher Tainter
- Christopher Wright
- Christos Chaintoutis
- Chrysi Diakaki
- Chuanyun Qian
- Clare Hammel
- Claude Guérin
- Claudia Elizabeth Lopez
- Claudia Lopez Nava
- Claudio Piras
- Colin Grissom
- Conchita Martínez-Fidalgo
- Cosimo Chelazzi
- Covadonga Rodriguez
- Cristina Coxo
- Cristina Martin Dal Gesso
- Cristina Villegas Succar
- Csaba Kopitko
- Cédric Bruel
- Cédric Daubin
- César Laborda
- Dagmar Holmquist
- Dahuan Li
- Daisuke Taniguchi
- Damien Roux
- Dan Lind
- Dana Tomescu
- Daniel Arellano
- Daniel Horner
- Daniel Moreno Torres
- Daniel Paul
- Daniel Rodriguez Gonzalez
- Daniel Silva
- Daniel Talmor
- Daniela Benvenuti
- Darshana Rathod
- David Blythe
- David Carpio
- David Dries
- David Perez-Torres
- David Slessor
- David Wrathall
- Davide Chiumello
- Deborah Welsh
- Deepak Jeswani
- Demetrio Carriedo
- Detajin Junhasavasdikul
- Diana Alvarez
- Dianne Hill
- Dick Nahar
- Didem Sozutek
- Diego De Mendoza
- Diego Rolando Morocho Tutillo
- Dieneke Kienhorst
- Dimitrios Matamis
- Dina Gomaa
- Dolf Weller
- Domenico Gelormini
- Don Walsh
- Doumiri Mouhssine
- Dácil Parrilla
- Edoardo Picetti
- Edoardo Piervincenzi
- Eduardo Beck
- Eduardo Labarca
- Edward Fysh
- Edward Litton
- Ege Eroglu
- Elena Nikolic
- Eleni Massa
- Eleni Mouloudi
- Eliana Caser
- Eliana Markman
- Elias Baedorf Kassis
- Elif Erdogan
- Elisa Boni
- Elisa Estenssoro
- Elisa Kam
- Elisabet Garcia
- Elisabeth Surlemont
- Elisabetta Pecci
- Elisabetta Pierucci
- Elizabeth Ramey
- Elizabeth Stevenson
- Elizabeth Wilby
- Elliot Bertram-Ralph
- Elliot Yates
- Elsa Sousa
- Eman Shebl
- Emanuele Sani
- Emilio Maseda
- Emmanuel Guerot
- Enrique Cereijo
- Enrique Paz
- Enrique Platas
- Eric Frans
- Erin Williams
- Estefania Prol-Silva
- Etienne Ghrenassia
- Ettore Vascotto
- Eugenio Garofalo
- Eugenio Luis Palazon Sanchez
- Ewan Goligher
- Ezgi Ozyilmaz
- Ezgi Özyilmaz
- Fabianne Dantas
- Fabio Guarracino
- Fabio Tarantino
- Faruk Seçkin Yücesoy
- Fatma Yildirim
- Faustine Reynaud
- Federica Vagginelli
- Federico Gordo
- Fekri Abrough
- Felipe de Jesus Montelongo
- Felipe Martinez
- Felix Martin
- Feng Feng
- Fernanda Kutchak
- Fernando da Silva Ramos
- Fernando Pachas Alvarado
- Fernando Rios
- Fernando Rios
- Ferran Roche-Campo
- Fethi Gül
- Feza Bacakoglu
- Figen Esen
- Filiep Soetens
- Finn H Andersen
- Francesca Lucchese
- Francesca Orsenigo
- Francesco Curto
- Francesco Mojoli
- Francis Schneider
- Francisco J Parrilla
- Frank Chemouni
- Frank Van Haren
- Frank Van Haren
- François Philippart
- Françoise Labat
- Frederik Seiler
- Frédérique Schortgen
- Gabriel Omar Heredia Orbegoso
- Gabriel Preda
- Gabriel Rodriguez
- Gabriel Wardi
- Gabriela Bai
- Gabriele Leonie Schwarz
- Gabriele Sales
- Gabrielle Hanlon
- Gaetano Perchiazzi
- Gaston Aguirre
- Gavin Perkins
- Gaëtan Beduneau
- Gemma Rialp
- Gennaro De Pascale
- Gerardo Aguilar
- Ghamdan Al Sadeh
- Giacomo Bellani
- Giacomo Berta
- Giacomo Grasselli
- Giacomo Grasselli
- Gianluca Zani
- Gianmario Monza
- Gilda Cinnella
- Giorgio Antonio Iotti
- Giovanna Soto
- Giovanni Mistraletti
- Giovanni Vitale
- Goligher Ewan C
- Gong Yu
- Gonzalo Pagella
- Govindan Balaraj
- Graciela Paz
- Graciela Zakalik
- Graeme Duke
- Grasselli Giacomo
- Greet Hermans
- Greet Hermans
- Grisma Patel
- Guglielmo Consales
- Guilherme Domingos
- Guillaume Voiriot
- Guillermo Bugedo
- Guillermo Bugedo
- Guillermo Malpartida
- Gulbin Aygencel
- Guo Xi
- Guojun Pan
- Guoxiu Zhang
- Gustavo Lugo Goytia
- Gustavo Plotnikow
- Gustavogcha Chaparro
- Gwenael Prat
- Gülseren Elay
- Haibo Qiu
- Haibo Qiu
- Hamidreza Jamaati
- Hanane Ezzouine
- Hans van der Hoeven
- Hany Elsayed
- Harald Zetterquist
- Harish Mallapura Maheswarappa
- Harshal Bawangade
- Hector Higo Leon Yoshido
- Helbert Esquivel Gallegos
- Helena Mansson
- Helga Ceunen
- Heloisa Castro
- Hernan Aguirre-Bermeo
- Heunks Leo
- Hidenobu Kamohara
- Hilal Sazak
- Hilmi Demirkiran
- Hiroki Iriyama
- Hiromasa Irie
- Hongbin Li
- Hongping Qu
- Hongsheng Zhao
- Hongwen Zhang
- Hongyang Xu
- Hua Luo
- Huseyin Arikan
- Iacopo Cappellini
- Ian Kerslake
- Ignacio Martin-Loeches
- Ignacio Saez
- Igor Milet
- Imma Vallverdu
- Ingeborg Welters
- Ingrid van den Hul
- Irene Aragao
- Irene Fernandez
- Isabel Gonzalez
- Isabelle Michaux
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- Jia Zheng
- Jialin Liu
- Jian-Feng Wu
- Jie Yan
- Jin Won Huh
- Jinwoo Lee
- Jiuzhi Zhang
- Joaquin Amador
- Jocyelle Vieira
- Johan Berkius
- Johan Berkius
- Johanna Henriksson
- John Trinder
- Jon Henrik Laake
- Jon Henrik Laake
- Jonathan Barrett
- Jonathan Chelly
- Jonathan Zarka
- Jonathon Truwit
- Joo Han Song
- Jorge Cabrera
- Jose Manuel Allegue
- Joshua A Englert
- José Cruz
- José Portugal
- João Carvalho
- Juan Conde
- Juan Hidalgo
- Juan Ignacio Silesky Jimenez
- Juan Luis Galeas-Lopez
- Judith Sagardia
- Julio Badie
- Julio Yáñez
- Jun Kataoka
- Juna Tirapu
- Junji Kumasawa
- Kai Chen
- Kamal Nasir
- Karen Burt
- Karen J Bosma
- Karen Williams
- Karina Timenetsky
- Kathryn Kerr
- Katsunori Mochizuki
- Kaushik Bhowmick
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- Kei Ota
- Keith Hugill
- Kengo Asano
- Kenichi Nitta
- Kevin Clarkson
- Kevin Clarkson
- Kevin Eng
- Kim Seok Chan
- Kiyoyasu Kurahashi
- Kiyoyasu Kurahashi
- Knut Dybwik
- Koen Simons
- 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
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- Laurence Dangers
- Laurent Brochard
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- Leda Floris
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- Leo M Heunks
- Liangyan Jiang
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- Lise Piquilloud
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- Louis Humbert
- Louis-Marie Galerneau
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- Luca Guatteri
- Luca Montini (ORCID:0000-0003-4602-5134)
- Luca Serano
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- 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
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.
- Banner-Goodspeed Valerie M.
- Banwarie Preveen
- Barbieri R.
- Baronia Arvind Kumar
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- Barrueco-Francioni Jesus Emilio
- Barry Jeffrey
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- Wrathall David Wayne
- Wright Christopher
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- Xi Guo
- Xing Zhengjiang
- Xu H.
- Yamamoto K.
- Yan Jie
- Yang X.
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- Yazicioglu Mocin Özlem
- Ye Zhenglong
- Yildirim F.
- Yoshida Norifumi
- Yoshido Hector Higo Leon
- Young Lee B.
- Yu Gong
- Yu R.
- Yu T.
- Yuan B.
- Yuangtrakul N.
- Yumoto Tetsuya
- Yun Xie
- Yáñez J.
- Zakalik G.
- Zaki Ahmed
- Zalba-Etayo Begoña
- Zambon Massimo
- Zang Bin
- Zani G.
- Zarka Jonathan
- Zeggwagh A.A.
- Zerbi S.M.
- Zerman A.
- Zetterquist H.
- Zhang Guoxiu
- Zhang Hongwen
- Zhang Jiuzhi
- Zhang W.
- Zhang Weixin
- Zhao H.
- Zheng Jia
- Zhu Bin
- Zumaran R.
- 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
Safety of hospital discharge before return of bowel function after elective colorectal surgery
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- Publication venue
- 'Wiley'
- Publication date
- 01/04/2020
- Field of study
© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients
Safety of hospital discharge before return of bowel function after elective colorectal surgery
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- Y Ali
- Y Bei
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- Y Bhahirathan
- Y Bhahirathan
- Y Bharwada
- Y Chechelnitskaya
- Y D Lee
- Y Demiroglu
- Y E Alim
- Y E Aytin
- Y E Karapinar
- Y El Kasmy El Kasmi
- Y El Kasmy El Kasmi
- Y El Kasmy El Kasmi
- Y Embury-Young
- Y Gercek
- Y J Alame
- Y J Lee
- Y J Soh
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- Y Kaya
- Y Kaya
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- Y L Wang
- Y Li
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- Y Mahmoudi
- Y Majeed
- Y Mitkov
- Y N Goh
- Y Nikookam
- Y Q Yeo
- Y Qamar
- Y Shafiq
- Y Toyi
- Y Vroom
- Y Xiao
- Y Youssef
- Y Z Beh
- Yiz Acherman
- Z Abdulrahman
- Z Akbar
- Z Al-Saraff
- Z Al-Sarraf
- Z Ali
- Z B Koçak
- Z Ballarini
- Z Carrington
- Z Garoufalia
- Z Goolam-Mahomed
- Z H Sam
- Z Habib
- Z Iqbal
- Z Millar
- Z Ngwenya
- Z Noriega
- Z S Demirci
- Z Sheikh
- Z Xuan Tan
- Z Y Boh
- Z Yi Tew
- Z Yi Tew
- Z Yusuf
- Á Navarro Barrios
- Çagri Girit
- É Dockry
- Ö Kürklü
- Ö Uslu
- Ö Uslu
- Ö Yumurtaci
- Publication venue
- 'Wiley'
- Publication date
- 01/01/2020
- Field of study
Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients
Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study
- Author
- 't Hart E.
- Aabling R. R.
- Aarts C. A. M.
- Aba M.
- Abad-Motos A.
- Abbasguliyev H.
- Abdelgalil R.
- Abdelhameed F.
- Abdulrahman N.
- Abdulrahman S. M. F.
- Abdulrahman Z.
- Abelevich A.
- Abelló D.
- Ablett A. D.
- Ablett A. D.
- Abrisqueta J.
- Acherman Y. I. Z.
- Adam A. H.
- Adamo V.
- Adams S. I. B.
- Adel A.
- Adeleye O.
- Adeusi L.
- Adiyaman C.
- Adra M.
- Afsar H. B.
- Aftab R.
- Agarwal A.
- Agarwal T.
- Agca M. H.
- Aggiusti A.
- Agresta F.
- Aguilar-Martínez M. M.
- Aguilera M. L.
- Aguilera M. L.
- Aguilera M. L.
- Ahmad H.
- Ahmed A.
- Ahmed H.
- Ahmed K.
- Ahmed M.
- Ahmed M.
- Ahmed S.
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- Ahmed W. U. R.
- Ahmeidat A.
- Ahsan S. D.
- Ainsworth P.
- Aitken E.
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- Akbani U.
- Akbar Z.
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- Žebrák R.
- Publication venue
- 'Wiley'
- Publication date
- 01/01/2020
- Field of study
Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion