New definitions for weaning for mechanically ventilated patients: the WIND study

Weaning from mechanical ventilation is an ill-defined process. The 2007 International Consensus Conference (ICC) weaning definition is difficult to apply as it uses spontaneous breathing trials (SBT) which are not universally used and excludes tracheostomised patients and those who fail to wean or die. In this prospective, multinational observational study, Béduneau et al propose a weaning classification for utilisation in daily practice for all mechanically ventilated patients (Am J Respir Crit Care Med 2017;195:772–83). 2709 intubated patients from 36 European intensive care units (ICUs) were observed until ICU discharge or day 60. The authors propose a classification based on weaning duration from first separation attempt (extubation or SBT in intubated patients or ≥24 hours spontaneous ventilation in tracheostomised patients). Group ‘no weaning’ (24%) had no separation attempt; group 1 (57%) weaned in <1 day (mortality 5%); group 2 (10%) weaned in >1 and <7 days (mortality 15%), group 3 (9%) had a weaning duration of ≥7 days (mortality 30%). Group 3 was divided into 3a (completed wean after ≥7 days, 62%) and …