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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. Graphic abstract: (Figure presented.)
Distinct weaning phenotypes in patients unsuccessful in weaning from invasive mechanical ventilation: a secondary analysis of the WEAN SAFE cohort
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.;Zumaran R.;Zhu B.;Zheng J.;Zhao H.;Zhang W.;Zhang G.;Zhang W.;Zhang H.;Zhang J.;Zetterquist H.;Zerman A.;Zerbi S. M.;Zarka J.;Zani G.;Zang B.;Zambon M.;Zalba-Etayo B.;Zaki A.;Zakalik G.;Yun X.;Yumoto T.;Yuangtrakul N.;Yuan B.;Yu T.;Yu G.;Yu R.;Lee B. Y.;Yoshido H. H. L.;Yoshida N.;Yildirim F.;Ye Z.;Yazicioglu Mocin O.;Yates E.;Yang X.;Yanez J.;Yan J.;Yamamoto K.;Xu H.;Xing Z. -J.;Xi G.;Wu J. -F.;Wright C.;Wrathall D.;Won Huh J.;Wojtas J.;Wilson A.;Williams K.;Williams E.;Wilby E.;Whiteley S.;Wert M.;Welters I.;Welsh D.;Weller D.;Wei B. -L.;Ween-Velken N. C.;Wardi G.;Wang S.;Walsh D.;Wajdi M.;von Seth M.;Volta C. A.;Voiriot G.;Vochin A.;Vj R.;Vitale G.;Vinorum O. G.;Villegas Succar C.;Villagra A.;Villagomez A.;Vilela Costa Pinto B.;Vieira J.;Vidal A.;Vermeijden J. W.;Ventura S.;Vazquez-Sanchez A.;Vaz A.;Vatsik M.;Vascotto E.;Vaschetto R.;Vargas-Ordonez M.;Vanhoof M.;Van Haren F.;Van Der Meer N.;van der Hoeven H.;van den Hul I.;Van Axel A.;Vallverdu I.;Valenti M. F.;Vagginelli F.;Ubeda A.;Tyagi S.;Turkoglu M.;Turan S.;Tulaimat A.;Tsuei B.;Truwit J.;Trongtrakul K.;Trinder J.;Tonnelier A.;Tonetti T.;Tomaszewski C.;Tomas R.;Todeschini M.;Tirapu J.;Timenetsky K.;Tilouch N.;Thyrault M.;Thungtitigul P.;Thomas M.;Thille A. W.;Theerawit P.;Thakur A.;Terzi N.;Terragni P.;Temprano S.;Teerapuncharoen K.;Tarantino F.;Taniguchi D.;Taniguchi L.;Tangsujaritvijit V.;Tang Z.;Tamasato T.;Tallott M.;Takaba A.;Tainter C.;Szuldrzynski K.;Szabo Z.;Sutherasan Y.;Surlemont E.;SunPark T.;Sundaram V.;Sun R.;Sun C.;Straus S.;Strano M. T.;Strand K.;Stevenson E.;Stephenson L.;Stefanovic B.;Stapleton A.;Spivey M.;Spittle N.;Spangfors M.;Spagnoli M.;Spadaro S.;Sozutek D.;Sovatzis S.;Sousa E.;Souloy X.;Soto G.;Sosa Medellin M. A.;Sook Hong K.;Soetens F.;Snyman L.;Snape S.;Smith M.;Smith T.;Smith P.;Smischney N.;Smiechowicz J.;Slessor D.;Sjobo B. A.;Simons K.;Silva Sales B.;Silva D.;Silesky Jimenez J. I.;Siddiqui S.;Shuhua C.;Short J.;Shin P.;Shime N.;Shiga T.;Shebl E.;Shapovalov K.;Shanmugasundaram P.;Shang Y.;Shah B.;Shah A.;Setten M.;Serpa Neto A.;Serednicki W.;Serano L.;Seok Chan K.;Seker Tekdos Y.;Seiler F.;Seely A.;Seckin Yucesoy F.;Schwarz G. L.;Schultz M. J.;Schortgen F.;Schneider F.;Scano R.;Sazak H.;Savioli M.;Sauneuf B.;Sarkany A.;Sari S.;Saravanabavan L.;Sanui M.;Santos C.;Santos M.;Sani E.;Sandoval Y.;Sanchez-Ballesteros J.;Sanchez P.;San Juan Roman N.;Samuelsson L.;Sami Mebazaa M.;Samavedam S.;Salgado P.;Sales G.;Salem M.;Saito S.;Saiphoklang N.;Saha R.;Saha R.;Sagardia J.;Saez I.;Sadahiro T.;Ruiz-Aguilar A. L.;Ruiz Robledo A.;Ruilan W.;Rubatto Birri P. N.;Rouze A.;Roux D.;Rose A.;Rortveit L.;Romano M. E.;Rogers A.;Rodriguez Tucto X. Y.;Rodriguez Gonzalez D.;Rodriguez G.;Rodriguez C.;Roche-Campo F.;Roca O.;Rivette M.;Riva I.;Rittayamai N.;Risso Vazquez A.;Rios F.;Rinket M.;Rieder M.;Richardson A.;Rice T.;Ricart P.;Rialp G.;Reynaud F.;Resano Sarmiento N.;Reina R.;Regli A.;Redwanul Huq S. M.;Ray B.;Rathod D.;Ranieri M.;Ramey E.;Ramdhani N.;Rajab M.;Raj Ashok S.;Rai A.;Rahe Pereira M. A.;Rabie A.;Rabee M.;Rabbani R.;Quispe Soto R.;Quispe Sierra R.;Quintana T.;Qu H.;Qiu H.;Qin T.;Qian C.;Qi Y.;Pugh R.;Prol-Silva E.;Prieto I.;Preda G.;Pratto R.;Prat G.;Povoa P.;Portugal J.;Portilla M.;Porta V.;Porras W.;Plotnikow G.;Platas E.;Pisani L.;Pirompanich P.;Piras C.;Piras S.;Piraino T.;Piquilloud L.;Pintado M. -C.;Pinciroli R.;Piervincenzi E.;Pierucci E.;Picetti E.;Philippart F.;Pham T.;Petrova M.;Petnak T.;Persona P.;Perkins G.;Perez-Torres D.;Perez-Teran P.;Perez-Araos R.;Perez Maita R.;Perez Cheng M.;Perez Calvo C.;Perez M.;Pereira V.;Pereira T.;Perchiazzi G.;Pena Padilla A. G.;Pellegrini C.;Pecci E.;Paz E.;Paz G.;Pavlotsky V. A.;Pavesi M.;Paul D.;Pattnaik S.;Patil J.;Pati B. K.;Patel G.;Patel M.;Patao L.;Pasin L.;Pasha T.;Parrilla D.;Parrilla F. J.;Parke R.;Parekh A.;Papavasilopoulou T.;Papanikolaou M.;Panka B.;Pan W.;Pan G.;Palmese S.;Palazon Sanchez E. L.;Palaniswamy V.;Pagella G.;Pachas Alvarado F.;Ozyilmaz E.;Ozkan Kuscu O.;Oziemski P.;Oveges N.;Ovalle Olmos R.;Ota K.;Ortiz-Ruiz De Gordoa L.;Orsenigo F.;Orlandi M. C.;Omura K.;Olmos A.;Oliveri C.;Oliveira Filho W.;Oliveira M. T.;Ojados A.;Oikonomou M.;Ohshimo S.;Oguchi M.;Oeckler R.;Obata Y.;Nur Soyturk A.;Nseir S.;Nonas S.;Noc M.;Nitta K.;Nikolic E.;Nikolakopoulou S.;Niiyama S.;Nichol A.;Nga Phan T.;Naz Aslam T.;Navalesi P.;Nasir K.;Nasi A.;Nandakumar S.;Nanchal R.;Namendys-Silva S. A.;Nakayama I.;Nakanishi M.;Nahar D.;Nagata I.;Muttini S.;Muthukrishnan M.;Muthuchellappan R.;Mustafa M.;Munoz de Cabo C.;Munoz T.;Mouloudi E.;Mouhssine D.;Motherway C.;Morocho Tutillo D. R.;Moreno Torres D.;Morales M.;Morakul S.;Mora Aznar M.;Monza G.;Montini L.;Montiel R.;Molnar Z.;Molin A.;Mojoli F.;Moghal A.;Moerer O.;Mochizuki K.;Mistraletti G.;Mishra S.;Mirabella L.;Minwei Z.;Millan M. T.;Milet I.;Milagros O.;Mikhaeil M.;Michaux I.;Mervat M. K. E.;Mendes V.;Mellado Artigas R.;Mei C.;Medve L.;McKown A.;McGuinness S.;McCullough J.;McCredie V.;Maugeri J.;Mattsson A.;Massa E.;Maseda E.;Masaaki S.;Mas A.;Martin-Loeches I.;Martinez-Fidalgo C.;Martinez F.;Martin Dal Gesso C.;Martin A.;Martin F.;Markman E.;del Carmen Marin M.;Marin N.;Marey I.;Manzano A.;Mansson H.;Malyarchikov A.;Malpartida G.;Mallapura Maheswarappa H.;Malaga P.;Magret Iglesias M.;Maggiore S. M.;Madrigal Robles V. H.;Macheda S.;Lynch C.;Luo H.;Lugo Goytia G.;Lugano M.;Lucchese F.;Lu M.;Lovazzano P.;Lopez Nava C.;Lopez C. E.;Lopez R.;Llorente B.;Llitjos J. -F.;Liu J.;Liu L.;Liu N.;Litton E.;Lind D.;Lima A. R.;Li O.;Li H.;Li D.;Lepper P. M.;Leonor T.;Lemiale V.;Leiner T.;Legernaes T.;Lee J.;Lee W. -Y.;Lee J.;Lee Y. J.;Lee S. H.;Le Meur M.;Lascari V.;Lanspa M.;Landaverde Lopez A.;Lagache L.;Laca Barrera M. A.;Laborda C.;Labat F.;Labarca E.;Laake J. H.;Kutchak F.;Kuriyama A.;Kurahashi K.;Kumasawa J.;Kulcsar Z.;Kubisz-Pudelko A.;Korkmaz Ekren P.;Kopitko C.;Kongpolprom N.;Kol M. K.;Knafelj R.;Kirakli C.;Kienhorst D.;Khorasanee R.;Khanna A. K.;Khan A.;Khalid A.;Khairnar P.;Kerslake I.;Kerr K.;Kelebek Girgin N.;Kaushik S.;Katayama S.;Kataoka J.;Karnjanarachata C.;Karakurt S.;Kara I.;Kane C.;Kamohara H.;Kam E.;Jurado M. T.;Junhasavasdikul D.;Jovanovic B.;Joret A.;Jongmin L.;Johnstad B. A.;Jochmans S.;Jing C.;Jiang L.;Jha S.;Jeswani D.;Lee S. J.;Jeon K.;Jaramillo L. A.;Jankowski M.;Jamoussi A.;Jamadarkhana S.;Jamaati H.;Jabeen R.;Izza S.;Izura J.;Itagaki T.;Iriyama H.;Irie H.;Ippolito M.;Iotti G. A.;Ioannides P.;Innes R.;Inal V.;Ilutovich S.;Iezzi N.;Lee H. Y.;Hunter S.;Humbert L.;Humphreys S.;Hugill K.;Housni B.;House S.;Hou M.;Hornos M. C.;Horner D.;Hormis A.;Hongtao X.;Homez M.;Holmquist D.;Hill D.;Hidalgo J.;Herrera-Gutierrez M.;Herrera L.;Hernandez C.;Hernandez R.;Hermon A.;Hermans G.;Heredia Orbegoso G. O.;Herbrecht J. -E.;Henriksson J.;Heines S.;Hashemian S. M.;Hanlon G.;Han Song J.;Hammel C.;Hagan S.;Hadzibegovic A.;Hachimi A.;Gutierrez P.;Gurjar M.;Gumus A.;Gul F.;Guitard P. -G.;Guerot E.;Guerin C.;Gueret R.;Guatteri L.;Guasch N.;Guarracino F.;Guan X. -D.;Gu Q.;Gritsan A.;Grissom C.;Grimmer L.;Grasso R.;Grasso S.;Grasselli G.;Granov Grabovica S.;Grando M.;Grainne R.;Graf Santos J.;Gouin P.;Gordo F.;Gordillo Romero O.;Gonzalez-Castro A.;Gonzalez I.;Gonzalez M.;Gondim L.;Gomez A.;Gomez O.;Gomez R. A.;Gomes R.;Gomero Paredes R.;Gomaa D.;Gollo Y.;Gnesin P.;Glober N.;Gigante A.;Giannoni R.;Giacomucci A.;Ghrenassia E.;Gelormini D.;Gelinotte S.;Gazenkampf A.;Gautam P.;Garofalo E.;Garnero A.;Garlicki J.;Garcia Olivares P.;Garcia E.;Garcia M. F.;Garcia A.;Galerneau L. -M.;Galeas-Lopez J. L.;Fysh E.;Fusari M.;Furche M. A.;Fumagalli R.;Frenzel T.;Fredes S.;Frattari A.;Frans E.;Fortunato A.;Forteza C.;Fluckiger M.;Floris L.;Flood L.;Flamm Zamorano M. J.;Ferrier J.;Ferreruela M.;Ferreira da Silva M. J.;Ferrando C.;Fernandez-Rodriguez M. L.;Fernandez B.;Fernandez I.;Feng Y.;Feng F.;Fehrle L.;Fartoukh M.;FARINA M. F.;Fanelli V.;Faheem M.;Facchini A.;Ezzouine H.;Esquivel Gallegos H.;Esquivel A.;Esen Tekeli A.;Esen F.;Escobar M.;Eroglu E.;Ergin Ozcan P.;Erdogan E.;Englert J. A.;Eng K.;Ena S.;Emery M.;Elsayed S.;Elsayed H.;Elsaadany M.;Elmaryul A. S.;Elay G.;Elatrous S.;Efe S.;Eckert P.;Dykyy M.;Dybwik K.;Dunts P.;Duke G.;Duggal A.;Dries D.;Dres M.;Domingos G.;Doha N.;Doble P.;Dimoula A.;Dikmen Y.;Diaz W.;Diaz A.;Diakaki C.;di Mussi R.;Dendane T.;Demirkiran H.;Demirkiran O.;Delmas B.;Dellamonica J.;del Carmen Campos Moreno M.;Deicas A.;Declercq P. -L.;Decavele M.;De Rosa S.;De Pascale G.;de Pablo R.;De Mendoza D.;de Jesus Montelongo F.;de Haro C.;Dawei W.;Daubin C.;Dantas F.;Danin P. -E.;Danguy des Deserts M.;Dangers L.;da Silva Ramos F.;D'Andrea R.;Czempik P.;Curto F.;Cukurova Z.;Cubattoli L.;Cruz J.;Crova P.;Crespo Ramirez M.;Cracchiolo A. N.;Coxo C.;Cortegiani A.;Cornejo R.;Coppadoro A.;Cook T.;Consales G.;Conde J.;Colombo R.;Collins A.;Codecido A. J.;Coaguila L.;Clementi S.;Clarkson K.;Clark T.;Clark M.;Cinnella G.;Cinel I.;Chudeau N.;Chou-Lie Y.;Cho Y. -J.;Chiumello D.;Chilton P.;Chiarandini P.;Chena A.;Chen K.;Chemouni F.;Chelly J.;Chelazzi C.;Chavez C. E.;Chau S.;Chapman C.;Chaparro G.;Chang Y.;Chaintoutis C.;Ceunen H.;Cereijo E.;Cengiz M.;Catorze N.;Castro H.;Castillo Quintero M.;Castelli A.;Caser E.;Carvalho J.;Carrillo R.;Carriedo D.;Carpio D.;Cardonnet L. P.;Carazo J.;Cappellini I.;Cani A.;Canedo N.;Canchos Gutierrez I.;Caironi P.;Caccese R.;Cabrera J.;Buttera S.;Buscot M.;Burt K.;Bulpa P.;Bugedo G.;Buehner U.;Bruni A.;Bruel C.;Briva A.;Bozbay S.;Boyd O.;Bottiroli M.;Bosma K. J.;Borislavova M.;Borello S.;Borelli M.;Boraso S.;Boni E.;Bojanowski C. M.;Boedjawan N.;Bocher S.;Blythe D.;Bissett B.;Bihari S.;Bhowmick K.;Bhandary R.;Bhakhtiani L.;Bezzi M.;Bewley J.;Beuret P.;Bettini L. R.;Besbes M.;Bertram-Ralph E.;Bertini P.;Berta G.;Bersten A.;Bernabe L.;Berkius J.;Benvenuti D.;Bento L.;Benslama A.;Benlamin M.;Benitez-Cano A.;Ben Souissi A.;Beltramelli R.;Bellissima A.;Belliato M.;Belenguer Muncharaz A.;Beehre N.;Beck E.;Beavis S.;Bawangade H.;Bauer P.;Barry J.;Barrueco-Francioni J. E.;Barrot L.;Barrett J.;Baronia A.;Barbieri R.;Banwarie P.;Banner-Goodspeed V.;Ballico B.;Balaraj G.;Bai G.;Baedorf Kassis E.;Badie J.;Bacakoglu F.;Azevedo L.;Aygencel G.;Aydemir S.;Avila Fuentes S.;Avalos Cabrera J. M.;Asin-Corrochano M.;Asano K.;Arnal J. -M.;Arinaga K.;Arikan H.;Arica M.;Arellano D.;Arabi Y.;Apostolopoulou O.;Apichatbutr Y.;Ansari S.;Andersen F. H.;Amador J.;Alvarez D.;Allegue J. M.;Aliberti A.;Ali M.;Algaba A.;Alamri S.;Al Sadeh G.;Akker M.;Akbas T.;Ahlstrom B.;Aguirre-Bermeo H.;Aguirre G.;Aguilar G.;Agrawal V. K.;Adiguzel N.;Adderley J.;Acharya S.;Acampo-de Jong M.;Aboshady A.;Abe T.;Zeggwagh A. A.;Tomescu D.;Talmor D.;Roldan R.;Razek A. A.;Perbet S.;Penuelas O.;Papali A.;Ozylmaz E.;Matamis D.;Heunks L. M.;Goligher E.;Estenssoro E.;Cerny V.;Camporota L.;Beitler J.;Beduneau G.;Aragao I.;Amin P.;Acharya S. P.;Abrough F.
2026-01-01
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. Graphic abstract: (Figure presented.)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11770/413939
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
