Evidence map›Paper›PMID 42714473›Full record

Observational studyIntensive care medicine2026

Distinct weaning phenotypes in patients unsuccessful in weaning from invasive mechanical ventilation: a secondary analysis of the WEAN SAFE cohort.

Reginald Caldecott, Yueyun Zhu, Bairbre A McNicholas, Emanuele Rezoagli, Shaurya Taran, Tài Pham, Leo Heunks, Giacomo Bellani, Laurent Brochard, Andrew J Simpkin and 2 more

Registry-linked trialAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Intensive care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03255109 (WEAN SAFE), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03255109 completednot on this map

WEAN SAFE (WorldwidE AssessmeNt of Separation of pAtients From Ventilatory assistancE)

Typeobservational_patient_registrySponsorEuropean Society of Intensive Care MedicineRan2017 to 2018Enrolled11,000ConditionsAcute Severe Respiratory Failure, Acute Respiratory Distress Syndrome
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Reginald CaldecottAnaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway, Ireland.ORCID http://orcid.org/0000-0001-8296-2999
Yueyun ZhuSchool of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland.
Bairbre A McNicholasAnaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway, Ireland.
Emanuele RezoagliDepartment of Anesthesia and Intensive Care, ASST Bergamo Est, Seriate, Italy.
Shaurya TaranInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Tài PhamService de médecine intensive-réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de recherche CARMAS, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France.ORCID http://orcid.org/0000-0002-4373-0711
Leo HeunksDepartment of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
Giacomo BellaniSchool of Medicine and Surgery, University of Trento, Trento, Italy.
Laurent BrochardInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Andrew J SimpkinSchool of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland.
John G LaffeyAnaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway, Ireland. jlaffey@universityofgalway.ie.ORCID http://orcid.org/0000-0002-1246-9573
WEAN SAFE Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo characterise the trajectories and outcomes of patients who enter the weaning process but fail to wean from invasive mechanical ventilation (MV).

methodsIn 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.

resultsOf 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.

conclusionsThree 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 registrationClinicalTrials.gov, NCT03255109.

Indexed as

Respiration, ArtificialVentilator WeaningAgedCohort StudiesFemaleHospital MortalityHumansIntensive Care UnitsMaleMiddle AgedPhenotypeRespiratory InsufficiencyTreatment FailureWithholding TreatmentAcute hypoxaemic respiratory failureFailed WeanInvasive mechanical ventilationVentilator liberationWeaning patternWeaning trajectoryWLST decisions

Identifiers

PMID42714473

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.