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The following is a summary of “Impact of comorbidities on management and outcomes of patients weaning from invasive mechanical ventilation: insights from the WEAN SAFE study,” published in the March 2025 issue of Critical Care by Khazaei et al. 

Researchers conducted a retrospective study to analyze how the number and type of comorbidities affected the weaning process from invasive mechanical ventilation (MV) in individuals registered in the WorldwidE AssessmeNt of Separation of pAtients from ventilatory assistancE (WEAN SAFE) study.  

They analyzed individuals from the WEAN SAFE study who initiated the weaning process. Individuals were grouped based on the number of comorbidities (none, 1, 2, or 3 plus) and specific comorbidity type. The primary outcome assessed the effect of comorbidities on delayed and failed weaning from invasive MV. Secondary outcomes were the impact of comorbidities on the intensive care unit (ICU) and hospital survival, as well as decisions to limit life-sustaining interventions.  

The results showed that among 4,523 individuals, 1,614 (35.7%) had 1 comorbidity, 889 (19.7%) had 2, 432 (9.6%) had 3 or more, and 1,562 (34.5%) had none. Respiratory (22%) and cardiovascular (11%) conditions were the most common. The likelihood of weaning failure from invasive MV increased with a higher number of comorbidities. Individuals with comorbidities had higher rates of failed separation attempts, received more extubation attempts, and required multiple extubation attempts. Neuromuscular conditions were linked to prolonged weaning, while respiratory, hepatic, renal, neuromuscular, and immune dysfunction comorbidities increased weaning failure. Hospital mortality rose from 16% in those without comorbidities to 34% in those with three or more. Each comorbidity independently contributed to higher hospital mortality and was associated with decisions to limit life-sustaining interventions.  

Investigators concluded that comorbidities negatively impact weaning outcomes in patients invasively ventilated, independent of weaning aggressiveness. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05341-7