A specialist-led interprofessional weaning program to prevent weaning failure in high-risk patients: the PRiVENT study.

PURPOSE: Effective strategies to prevent weaning failure and prolonged invasive mechanical ventilation (IMV) in patients at high risk of weaning failure are limited. We evaluated a structured, specialist-led interprofessional weaning program.

METHODS

In this prospective, multicenter, non-randomized interventional study, mechanically ventilated patients were screened 96 h to 11 days after intubation. Patients meeting predefined high-risk criteria received a specialist-led interprofessional weaning program, while a parallel control group was derived from health insurance claims data. The primary outcome was successful weaning at ICU discharge.

RESULTS

The primary analysis included 349 intervention patients and 1,768 controls. Successful weaning occurred in 58.3% of intervention patients and 51.7% of controls. In the adjusted primary analysis, the odds ratio for successful weaning was 1.46 (95% CI, 0.99-2.17; P = 0.057), and the difference did not reach statistical significance. In prespecified propensity score-matched analysis, successful weaning occurred in 58.3% of intervention patients and 46.4% of matched controls (OR, 2.90; 95% CI, 1.61-5.24; P < 0.001). An exploratory analysis restricted to ICU survivors also showed higher odds of successful weaning in the intervention group (OR, 2.10; 95% CI, 1.09-4.04; P = 0.026). Overall, 16.3% of intervention patients were transferred to a specialized weaning center. These patients had longer ventilation durations, contributing to a longer overall duration of IMV in the intervention group.

CONCLUSIONS

The PRiVENT intervention was feasible and successful weaning was numerically more frequent in the intervention group, although the prespecified adjusted primary analysis did not reach statistical significance. These findings suggest a potential benefit of structured, multidisciplinary weaning support.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT05260853, registered on March 2, 2022.