Grant: Operating Grant

Background: The requirement for ventilator support is a defining feature of critical illness. Weaning is the process during which the work of breathing is transferred from the ventilator back to the patient. About 40% of the time spent on ventilators is dedicated to weaning. Limiting the time spent on ventilators has been identified as a key research priority in critical care. Studies support the use of screening protocols to identify weaning candidates and the conduct of tests of patient's ability to breathe spontaneously (SBTs) in patients who meet specific criteria. Once daily screening is the standard of care in most intensive care units (ICUs) with 24 hours elapsing between screening periods. The presence of respiratory therapists (RTs) 24/7 in our ICUs presents a unique opportunity to study how weaning strategies are delivered to critically ill adults and whether alternative strategies may improve patient outcomes. Methods: We propose to conduct a pilot trial in 100 critically ill adults comparing both once vs at least twice daily screening and Pressure Support vs. continuous positive airway pressure in 8 Canadian ICUs. Primary Objective: To assess our ability to enroll critically ill adults who can breathe spontaneously or initiate breaths on one of several commonly used modes of ventilation into a single trial evaluating both interventions. Secondary Objectives: To assess clinician's ability to conduct the trial as designed, record clinical practices in managing patients prior to weaning, identify barriers to enrolling patients, and obtain preliminary estimates of the effect of the different screening and SBT strategies on outcomes. Relevance: Each day of mechanical ventilation is associated with increased morbidity, costs, and patient discomfort. With dedicated RTs available in our ICUs, a significant opportunity exists to screen patients more frequently, conduct more frequent SBTs, and reduce the time spent on ventilators and in the ICU.