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

Introduction: Prolonged weaning from invasive mechanical ventilation remains a major clinical challenge. While outcomes from certified weaning centers are increasingly documented, data on long-term survival and post-discharge trajectories are limited. This study evaluated both in-hospital weaning outcomes and long-term survival in patients treated at two specialized weaning centers in Germany.

We conducted a retrospective cohort study using the WeanNet registry, focusing on patients admitted for prolonged weaning between 2016 and 2020 at two centers (Greifswald and Hemer). After data cleaning, 718 patients (Greifswald: 337; Hemer: 381) were included. The 3-year follow-up was performed using structured outpatient assessments, clinical records, and telephone interviews.

In-hospital mortality was markedly lower in both centers (Greifswald: 6.2%; Hemer: 3.4%) compared to national WeanNet data (13.4%). Among discharged patients, increased age, discharge with invasive ventilation (hazard ratio [HR] 2.60; 95% confidence interval [CI]: 1.99-3.39), and tracheostomy without ventilation (HR 1.90; 95% CI: 1.40-2.60) were significantly associated with higher 36-month mortality. Comorbidities such as left heart failure, thoracorestrictive disease, chronic kidney disease, oncologic disease, and diabetes were also linked to poorer outcomes.

Patients discharged with invasive ventilation or tracheostomy exhibit significantly reduced long-term survival, highlighting the urgent need for structured post-discharge care pathways. Regular re-evaluation of weaning potential and tracheostomy decannulation should be integrated into follow-up programs to improve outcomes in this vulnerable population.