Grant: CIHR Clinician Scientist - Phase 2

Weaning is the process during which mechanical ventilation is withdrawn and the work of breathing is transferred from the ventilator back to the patient. About 40% of the total time spent on mechanical ventilation is dedicated to weaning. Protracted ventilation is associated with ventilator-related complications and longer stays in the intensive care unit(ICU). Practice variation in weaning may impact on patient safety and outcomes. Research in acutely ill patients is distinct from other research; requiring consent from Substitute Decision Makers (SDMs), investigating conditions with high mortality, and implementing protocols under emergency conditions. Difficulties in obtaining consent reduce opportunities for critically ill patients to participate in research, prolong study implementation, limit the generalizability of study results, and delay identification of potentially effective and ineffective treatments. The proposed research program will build and expand upon my current research by examining the impact of current practices (in weaning and obtaining consent) on outcomes (clinical and recruitment). The International Study of Mechanical Ventilation Discontinuation Practices will establish the impact of weaning practice variation on clinical outcomes, within and among geographic regions, and important predictors of this jpractice variation. The Consent Study, a multicentre, observational study, will examine the process by which Critical Care research is conducted in Canadian ICUs. The Consent Study will describe current practices in the 'consent to research' process and identify (i) factors that favorably impact upon obtaining consent, (ii) barriers to obtaining consent, and (iii) highlight modifiable factors in the consent procurement process that will enhance the feasibility of future Critical Care research.