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 evaluates both in-hospital weaning outcomes and long-term survival in patients treated at two specialized weaning centers in Germany. Methods: 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. Three-year follow-up was performed using structured outpatient assessments, clinical records, and telephone interviews. Results: 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 (HR 2.60; 95% 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. Conclusion: 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.