{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T20:29:28Z","timestamp":1781555368910,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T00:00:00Z","timestamp":1629072000000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"French Ministry of Health","award":["PHRC r\u00e9gional 2018"],"award-info":[{"award-number":["PHRC r\u00e9gional 2018"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,7,29]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Fluid overload is associated with a poor prognosis in the critically ill patients, especially at the time of weaning from mechanical ventilation as it may promote weaning failure from cardiac origin. Some data suggest that early administration of diuretics would shorten the duration of mechanical ventilation. However, this strategy may expose patients to a higher risk of haemodynamic and metabolic complications. Currently, there is no recommendation for the use of diuretics during weaning and there is an equipoise on the timing of their initiation in this context.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>This study is a multicentre randomised controlled trial comparing two strategies of fluid removal during weaning in 13 French intensive care units (ICU). The preventive strategy is initiated systematically when the fluid balance or weight change is positive and the patients have criteria for clinical stability; the curative strategy is initiated only in case of weaning failure documented as of cardiac origin. Four hundred and ten patients will be randomised with a 1:1 ratio. The primary outcome is the duration of weaning from mechanical ventilation, defined as the number of days between randomisation and successful extubation (alive without reintubation nor tracheostomy within the 7\u2009days after extubation) at day 28. Secondary outcomes include daily and cumulated fluid balance, metabolic and haemodynamic complications, ventilator-associated pneumonia, weaning complications, number of ventilator-free days, total duration of mechanical ventilation, the length of stay in ICU and mortality in ICU, in hospital and, at day 28. A subgroup analysis for the primary outcome is planned in patients with kidney injury (Kidney Disease: Improving Global Outcomes class 2 or more) at the time of randomisation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>The study has been approved by the ethics committee (Comit\u00e9 de Protection des Personnes Paris 1) and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>\n                     <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04050007\">NCT04050007<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Protocol version<\/jats:title>\n                  <jats:p>V.1; 12 March 2019.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-048286","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T13:28:48Z","timestamp":1629120528000},"page":"e048286","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Comparison of a preventive or curative strategy of fluid removal on the weaning of mechanical ventilation: a study protocol for a multicentre randomised open-label parallel-group trial"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct04050007","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9191-6089","authenticated-orcid":false,"given":"Martin","family":"Dres","sequence":"first","affiliation":[{"name":"Service de M\u00e9decine intensive R\u00e9animation, APHP.Sorbonne Universit\u00e9, H\u00f4pital Pitie Salp\u00eatriere, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice","family":"Estellat","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Sant\u00e9 Publique, APHP.Sorbonne Universit\u00e9, H\u00f4pital Pitie Salpetriere, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Luc","family":"Baudel","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine intensive R\u00e9animation, APHP.Sorbonne Universit\u00e9, H\u00f4pital Saint Antoine, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Beloncle","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine intensive R\u00e9animation et m\u00e9dedine hyperbare, CHU Angers, Angers, Pays de la Loire, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Cousty","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation Polyvalente, CHU de La R\u00e9union Sites Sud Saint-Pierre, Saint-Pierre, R\u00e9union"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Galbois","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation polyvalente, H\u00f4pital Claude Galien, Quincy-sous-Senart, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Gu\u00e9rin","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier Universitaire de Bic\u00eatre, Le Kremlin-Bicetre, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Labbe","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation et USC M\u00e9dico-Chirurgicale, APHP.Sorbonne University, Tenon Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2578-3422","authenticated-orcid":false,"given":"Guylaine","family":"Labro","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation m\u00e9dicale, Centre Hospitalier de Mulhouse, Mulhouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordane","family":"Lebut","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation et Surveillance Continue, Groupement Hospitalier Nord Essonne, Longjumeau, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Mira","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine intensive R\u00e9animation, Groupe Hospitalier Paris Centre\u2014H\u00f4pital Cochin, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwenael","family":"Prat","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine intensive et R\u00e9animation, CHU de Brest, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2351-682X","authenticated-orcid":false,"given":"Jean-Pierre","family":"Quenot","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine intensive R\u00e9animation, CHU Dijon, Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armand Mekontso","family":"Dessap","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, APHP. H\u00f4pitaux Universitaires Henri Mondor, Creteil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"key":"2025101814033728000_11.8.e048286.1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201208-1523CI"},{"key":"2025101814033728000_11.8.e048286.2","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1186\/s13054-016-1533-9","article-title":"Cardiac dysfunction induced by weaning from mechanical ventilation: incidence, risk factors, and effects of fluid removal","volume":"20","author":"Liu","year":"2016","journal-title":"Crit Care"},{"key":"2025101814033728000_11.8.e048286.3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1186\/s13054-019-2601-8","article-title":"Myocardial ischemia during ventilator weaning: a prospective multicenter cohort study","volume":"23","author":"Bedet","year":"2019","journal-title":"Critical Care"},{"key":"2025101814033728000_11.8.e048286.4","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.6.1664"},{"key":"2025101814033728000_11.8.e048286.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-005-2801-3"},{"key":"2025101814033728000_11.8.e048286.6","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1097\/CCM.0000000000003276","article-title":"Deresuscitation of patients with iatrogenic fluid overload is associated with reduced mortality in critical Illness*","volume":"46","author":"Silversides","year":"2018","journal-title":"Crit Care Med"},{"key":"2025101814033728000_11.8.e048286.7","first-page":"909","article-title":"Comparison of two fluid-management strategies in acute lung injury","volume":"354","author":"Wiedemann","year":"2006","journal-title":"N Engl J Med"},{"key":"2025101814033728000_11.8.e048286.8","doi-asserted-by":"crossref","first-page":"966","DOI":"10.2215\/CJN.08781010","article-title":"Fluid balance, diuretic use, and mortality in acute kidney injury","volume":"6","author":"Grams","year":"2011","journal-title":"CJASN"},{"key":"2025101814033728000_11.8.e048286.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4675-y"},{"key":"2025101814033728000_11.8.e048286.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4500-7"},{"key":"2025101814033728000_11.8.e048286.11","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201205-0939OC"},{"key":"2025101814033728000_11.8.e048286.12","first-page":"493","article-title":"Weaning the cardiac patient from mechanical ventilation","volume":"20","author":"Dres","year":"2014","journal-title":"Curr Opin Crit Care"},{"key":"2025101814033728000_11.8.e048286.13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.14901"},{"key":"2025101814033728000_11.8.e048286.14","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1007\/s00134-014-3334-4","article-title":"Weaning-induced cardiac dysfunction: where are we today?","volume":"40","author":"Teboul","year":"2014","journal-title":"Intensive Care Med"},{"key":"2025101814033728000_11.8.e048286.15","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1097\/CCM.0000000000000295","article-title":"Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema","volume":"42","author":"Dres","year":"2014","journal-title":"Crit Care Med"},{"key":"2025101814033728000_11.8.e048286.16","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-006-0339-7"},{"key":"2025101814033728000_11.8.e048286.17","doi-asserted-by":"publisher","DOI":"10.1186\/cc9076"},{"key":"2025101814033728000_11.8.e048286.18","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31819f13d0"},{"key":"2025101814033728000_11.8.e048286.19","doi-asserted-by":"crossref","DOI":"10.1186\/s13613-019-0483-1","article-title":"Experts\u2019 guidelines of intubation and extubation of the ICU patient of french society of anaesthesia and intensive care medicine (SFAR) and French-speaking intensive care society (SRLF)","volume":"9","author":"Quintard","year":"2019","journal-title":"Ann Intensive Care"},{"key":"2025101814033728000_11.8.e048286.20","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00010206"},{"key":"2025101814033728000_11.8.e048286.21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.14194"},{"key":"2025101814033728000_11.8.e048286.22","first-page":"83","article-title":"Hospital-acquired pneumonia in ICU","volume":"37","author":"Leone","year":"2018","journal-title":"Anaes Crit Care & Pain Med"},{"key":"2025101814033728000_11.8.e048286.23","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201602-0320OC"},{"key":"2025101814033728000_11.8.e048286.24","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00134-015-3653-0","article-title":"Passive leg raising performed before a spontaneous breathing trial predicts weaning-induced cardiac dysfunction","volume":"41","author":"Dres","year":"2015","journal-title":"Intensive Care Med"},{"key":"2025101814033728000_11.8.e048286.25","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13054-019-2309-9","article-title":"Early diuretic use and mortality in critically ill patients with vasopressor support: a propensity score-matching analysis","volume":"23","author":"Shen","year":"2019","journal-title":"Critical Care"},{"key":"2025101814033728000_11.8.e048286.26","first-page":"e0021","article-title":"Estimated effects of early diuretic use in critical illness","volume":"1","author":"McCoy","year":"2019","journal-title":"Crit Care Explor"},{"key":"2025101814033728000_11.8.e048286.27","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200210000-00001"},{"key":"2025101814033728000_11.8.e048286.28","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000194725.48928.3A"},{"key":"2025101814033728000_11.8.e048286.29","doi-asserted-by":"crossref","DOI":"10.1186\/s13613-016-0149-1","article-title":"The passive leg raising test to guide fluid removal in critically ill patients","volume":"6","author":"Monnet","year":"2016","journal-title":"Ann Intensive Care"},{"key":"2025101814033728000_11.8.e048286.30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.2711"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-048286","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T21:03:43Z","timestamp":1760821423000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-048286"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,16]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bmjopen-2020-048286"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-048286","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}