Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE) - a multicentre, prospective, observational cohort study

Oct 18, 2026

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Successful separation from invasive mechanical ventilation is vital after severe respiratory failure, yet current management and outcomes during weaning remain insufficiently characterized. This international multicentre prospective observational cohort study enrolled patients ventilated invasively for at least 2 days across 481 intensive care units in 50 countries. Weaning initiation, eligibility criteria, failure risks, duration, and timing were evaluated, with primary assessment of successful weaning at 90 days. Results quantify epidemiology, delays, sedation associations, and clinical outcomes after weaning.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Background

Methods

Findings

Interpretation

Funding

Introduction

Articles Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study Tài Pham, Leo Heunks, Giacomo Bellani, Fabiana Madotto, Irene Aragao, Gaëtan Beduneau, Ewan C Goligher, Giacomo Grasselli, Jon Henrik Laake, Jordi Mancebo, Oscar Peñuelas, Lise Piquilloud, Antonio Pesenti, Hannah Wunsch, Frank van Haren, Laurent Brochard*, John G Laffey*, for the WEAN SAFE Investigators† Summary Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with [ClinicalTrials.gov](ClinicalTrials.gov), NCT03255109 . Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding European Society of Intensive Care Medicine, European Respiratory Society. Copyright © 2023 Published by Elsevier Ltd. All rights reserved. Introduction Successful separation of patients from invasive mechanical ventilation, referred to as weaning from mechanical ventilation, represents a crucial step in the recovery process following severe respiratory failure.1–3 Many of the serious complications of invasive mechanical ventilation are directly related to the duration of ventilation.4–6 Prolonged weaning of patients from invasive mechanical ventilation worsens patient outcomes, increases the risk of dying, and increases length of intensive care unit and hospital stay.7,8 Together with age, duration of ventilat

FAQs

What was the main aim of the WEAN SAFE study?

To describe the epidemiology, management, timings, risk for failure, and outcomes of weaning from invasive mechanical ventilation in patients requiring at least 2 days of ventilation.

How did the study define successful weaning?

Successful weaning meant no reintubation or death within 7 days after extubation.

Which factors were linked to delayed initiation and weaning failure?

Higher sedation scores were independently associated with delayed initiation, and both delayed initiation of weaning and higher sedation scores were independently associated with weaning failure.

Oct 18, 2026

Uploaded by Kurz