Clinical Outcomes and Long-Term Survival in Patients Undergoing Prolonged Weaning

Area of Science:

• Critical Care Medicine
• Pulmonology
• Respiratory Therapy

Background:

• Prolonged weaning from mechanical ventilation presents significant clinical challenges.
• Limited data exists on long-term survival and post-discharge outcomes for patients from specialized weaning centers.
• This study addresses the need for comprehensive outcome data beyond in-hospital care.

Purpose of the Study:

• To evaluate in-hospital weaning outcomes at two specialized German centers.
• To assess long-term survival and identify factors influencing mortality in patients after prolonged mechanical ventilation.
• To inform the development of improved post-discharge care strategies.

Main Methods:

• Retrospective cohort study utilizing the WeanNet registry (2016-2020).
• Inclusion of 718 patients from two specialized weaning centers (Greifswald and Hemer).
• 3-year follow-up via outpatient assessments, clinical records, and telephone interviews.

Main Results:

• In-hospital mortality was lower than national averages (Greifswald: 6.2%; Hemer: 3.4% vs. 13.4%).
• Discharge with invasive ventilation (HR 2.60) or tracheostomy (HR 1.90) significantly increased 36-month mortality.
• Comorbidities including heart failure, chronic kidney disease, and diabetes were associated with poorer outcomes.

Conclusions:

• Discharge status (invasive ventilation or tracheostomy) is a critical predictor of reduced long-term survival.
• Structured post-discharge care pathways are urgently needed for patients requiring ongoing respiratory support.
• Regular reassessment of weaning potential and tracheostomy decannulation should be prioritized in follow-up programs.