Grant: CIHR Clinician Scientist - Phase 2

Background: Nearly 40% of the time spent on ventilators is directed at weaning or transferring the work of breathing from the ventilator back to the patient. While evidence exists to support use of selected techniques, many factors limit their use in practice resulting in weaning practice variation. Automated weaning systems aim to limit practice variation and reduce the time spent on ventilators. The influence of different weaning practices on outcomes is unknown. Meanwhile, implementing research in the intensive care unit (ICU)is challenging as it requires consent from surrogates, investigates conditions with high death rates and is undertaken during emergencies. Difficulties in conducting ICU research prolongs study periods, limits broad application of study findings and delays awareness of important study findings. Goals: This research program has focused on (i)characterizing the extent of weaning practice variability nationally and internationally, (ii)evaluating new technology that automates weaning in a multicentre study and (iii) identifying the challenges of conducting clinical research in the ICU setting. Methods: In renewing my Phase 2 Award, I will build and expand my research program by: 1. conducting an international study (in Canada, the United States, the United Kingdom, Europe, India and Australia/New Zealand) of how clinicians wean patients from ventilators and how different approaches influence outcomes. 2. combining results of several small trials comparing automated weaning to other strategies to see if a large trial is warranted. 3. evaluating whether a physician introduction of the research team to surrogate decision makers can be implemented Relevance: The first two studies will inform the design of future weaning studies to reduce weaning practice variation and improve outcomes. The last study will enable conduct of a larger trial comparing how different approaches for introducing ICU research influence participation.