Distinct weaning phenotypes in patients unsuccessful in weaning from invasive mechanical ventilation: a secondary analysis of the WEAN SAFE cohort
- Autori: Caldecott, R.; Zhu, Y.; Mcnicholas, B.A.; Rezoagli, E.; Taran, S.; Pham, T.; Heunks, L.; Bellani, G.; Brochard, L.; Simpkin, A.J.; Laffey, J.G.; Null, N.; Abrough, F.; Acharya, S.P.; Amin, P.; Arabi, Y.; Aragao, I.; Bauer, P.; Beduneau, G.; Beitler, J.; Berkius, J.; Bugedo, G.; Camporota, L.; Cerny, V.; Cho, Y.; Clarkson, K.; Estenssoro, E.; Goligher, E.; Grasselli, G.; Gritsan, A.; Hashemian, S.M.; Hermans, G.; Heunks, L.M.; Jovanovic, B.; Kurahashi, K.; Laake, J.H.; Matamis, D.; Moerer, O.; Molnar, Z.; Ozylmaz, E.; Panka, B.; Papali, A.; Peñuelas, Ó.; Perbet, S.; Piquilloud, L.; Qiu, H.; Razek, A.A.; Rittayamai, N.; Roldan, R.; Serpa Neto, A.; Szuldrzynski, K.; Talmor, D.; Tomescu, D.; Van Haren, F.; Villagomez, A.; Zeggwagh, A.A.; Abe, T.; Aboshady, A.; Acampo-de Jong, M.; Acharya, S.; Adderley, J.; Adiguzel, N.; Agrawal, V.K.; Aguilar, G.; Aguirre, G.; Aguirre-Bermeo, H.; Ahlström, B.; Akbas, T.; Akker, M.; Al Sadeh, G.; Alamri, S.; Algaba, A.; Ali, M.; Aliberti, A.; Allegue, J.M.; Alvarez, D.; Amador, J.; Andersen, F.H.; Ansari, S.; Apichatbutr, Y.; Apostolopoulou, O.; Arabi, Y.; Arellano, D.; Arica, M.; Arikan, H.; Arinaga, K.; Arnal, J.; Asano, K.; AsÃn-Corrochano, M.; Avalos Cabrera, J.M.; Avila Fuentes, S.; Aydemir, S.; Aygencel, G.; Azevedo, L.; Bacakoglu, F.; Badie, J.; Baedorf Kassis, E.; Bai, G.; Balaraj, G.; Ballico, B.; Banner-Goodspeed, V.; Banwarie, P.; Barbieri, R.; Baronia, A.; Barrett, J.; Barrot, L.; Barrueco-Francioni, J.E.; Barry, J.; Bauer, P.; Bawangade, H.; Beavis, S.; Beck, E.; Beehre, N.; Belenguer Muncharaz, A.; Belliato, M.; Bellissima, A.; Beltramelli, R.; Ben Souissi, A.; Benitez-Cano, A.; Benlamin, M.; Benslama, A.; Bento, L.; Benvenuti, D.; Berkius, J.; Bernabe, L.; Bersten, A.; Berta, G.; Bertini, P.; Bertram-Ralph, E.; Besbes, M.; Bettini, L.R.; Beuret, P.; Bewley, J.; Bezzi, M.; Bhakhtiani, L.; Bhandary, R.; Bhowmick, K.; Bihari, S.; Bissett, B.; Blythe, D.; Bocher, S.; Boedjawan, N.; Bojanowski, C.M.; Boni, E.; Boraso, S.; Borelli, M.; Borello, S.; Borislavova, M.; Bosma, K.J.; Bottiroli, M.; Boyd, O.; Bozbay, S.; Briva, A.; Bruel, C.; Bruni, A.; Buehner, U.; Bugedo, G.; Bulpa, P.; Burt, K.; Buscot, M.; Buttera, S.; Cabrera, J.; Caccese, R.; Caironi, P.; Canchos Gutierrez, I.; Canedo, N.; Cani, A.; Cappellini, I.; Carazo, J.; Cardonnet, L.P.; Carpio, D.; Carriedo, D.; Carrillo, R.; Carvalho, J.; Caser, E.; Castelli, A.; Castillo Quintero, M.; Castro, H.; Catorze, N.; Cengiz, M.; Cereijo, E.; Ceunen, H.; Chaintoutis, C.; Chang, Y.; Chaparro, G.; Chapman, C.; Chau, S.; Chavez, C.E.; Chelazzi, C.; Chelly, J.; Chemouni, F.; Chen, K.; Chena, A.; Chiarandini, P.; Chilton, P.; Chiumello, D.; Cho, Y.; Chou-Lie, Y.; Chudeau, N.; Cinel, I.; Cinnella, G.; Clark, M.; Clark, T.; Clarkson, K.; Clementi, S.; Coaguila, L.; Codecido, A.J.; Collins, A.; Colombo, R.; Conde, J.; Consales, G.; Cook, T.; Coppadoro, A.; Cornejo, R.; Cortegiani, A.; Coxo, C.; Cracchiolo, A.N.; Crespo Ramirez, M.; Crova, P.; Cruz, J.; Cubattoli, L.; Çukurova, Z.; Curto, F.; Czempik, P.; D'Andrea, R.; Da Silva Ramos, F.; Dangers, L.; Danguy Des Déserts, M.; Danin, P.; Dantas, F.; Daubin, C.; Dawei, W.; De Haro, C.; De Jesus Montelongo, F.; De Mendoza, D.; De Pablo, R.; De Pascale, G.; De Rosa, S.; Decavèle, M.; Declercq, P.; Deicas, A.; Del Carmen Campos Moreno, M.; Dellamonica, J.; Delmas, B.; Demirkiran, O.; Demirkiran, H.; Dendane, T.; Di Mussi, R.; Diakaki, C.; Diaz, A.; Diaz, W.; Dikmen, Y.; Dimoula, A.; Doble, P.; Doha, N.; Domingos, G.; Dres, M.; Dries, D.; Duggal, A.; Duke, G.; Dunts, P.; Dybwik, K.; Dykyy, M.; Eckert, P.; Efe, S.; Elatrous, S.; Elay, G.; Elmaryul, A.S.; Elsaadany, M.; Elsayed, H.; Elsayed, S.; Emery, M.; Ena, S.; Eng, K.; Englert, J.A.; Erdogan, E.; Ergin Ozcan, P.; Eroglu, E.; Escobar, M.; Esen, F.; Esen Tekeli, A.; Esquivel, A.; Esquivel Gallegos, H.; Ezzouine, H.; Facchini, A.; Faheem, M.; Fanelli, V.; Farina, M.F.; Fartoukh, M.; Fehrle, L.; Feng, F.; Fe
- Anno di pubblicazione: 2026
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/715786
Abstract
Objective: To characterise the trajectories and outcomes of patients who enter the weaning process but fail to wean from invasive mechanical ventilation (MV). Methods: In this secondary analysis of the WorldwidE AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE) cohort, we examined weaning duration and intensity, decisions to withdraw or withhold life-sustaining therapy (WLST), and clinical outcomes in patients not weaning from invasive ventilation. The primary outcome was ICU mortality. Results: Of the 5664 patients in the study population, 1270 (22.4%) never underwent a separation attempt (SA), while 4394 (77.6%) had at least one SA; of these, 664 (15.1%) eventually failed weaning from invasive MV at day 90, while 3730 (65.9%) successfully weaned. Failed-Wean patients had the longest duration of invasive ventilation and longest ICU stay of all groups. Compared with Successful-Wean, Failed-Wean patients underwent more separation attempts, but fewer attempted extubations and more reintubations and tracheostomies. ICU mortality was 78% in Failed-Wean compared with 2% in Successful-Wean. Three clinically distinct Failed-Wean phenotypes were identified, distinguished by separation attempt count and WLST timing: Phenotype A (single SA + WLST), Phenotype B (single SA, no WLST), and Phenotype C (> 1 SA). A failed-first SA was strongly associated with WLST decisions. In this cohort, a WLST decision was associated with a higher hazard of ICU mortality and shorter median time to ICU death. Conclusions: Three weaning failure phenotypes were identified with distinct clinical profiles, weaning trajectories, and outcomes. A strong relationship exists between failed first separation attempts, WLST decision, and the risk of death, which deserves further investigation. Trial registration: ClinicalTrials.gov, NCT03255109.