[Weaning Classification Systems: WIND, ICC and Prolonged Weaning in light of the updated German S3-Guideline on...

Weaning from invasive mechanical ventilation represents a critical transition in intensive care, accounting for a substantial proportion of total ventilation time in successfully extubated patients. Inadequate assessment may lead either to prolonged ventilation with associated complications or to premature extubation attempts with an increased risk of reintubation. To systematically describe weaning processes, several classification models have been proposed. The established International Concensus Classification (ICC) weaning classification ("Budapest classification") categorized weaning courses into three groups (simple, difficult and prolonged) but showed major limitations, including restricted applicability, limited prognostic value, and an overly short observation period. The WIND (Weaning accordIng to a New Definition) classification, introduced in 2017, provides the first time-based and internationally applicable system that allows nearly complete categorization of ventilated patients and demonstrates consistent associations with patient-relevant outcomes. Validation studies across large international cohorts confirmed significantly improved classification rates and prognostic discrimination of WIND compared with the ICC system. In German-speaking countries, however, a more granular differentiation of prolonged weaning remains clinically important. The S2k guideline "Prolonged Weaning" addresses this heterogeneity through six specific subgroups, which are essential for prognosis, resource planning, and long-term care. The 2025 revised "Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation" therefore recommends a hybrid approach, combining the international standardization of the WIND classification with the detailed subgrouping of prolonged weaning from the German S2k guideline. This model enables both international comparability and the level of detail required in clinical practice within German-speaking countries, thus representing a pragmatic consensus.