Characterization of weaning practices in intensive care units in Global South countries: a clinical practice survey.

OBJECTIVE

To characterize current practices and protocols for mechanical ventilation weaning in intensive care units in Global South countries, describing practice variability and identifying opportunities for standardization that may reduce extubation failure.

METHODS

We conducted an international, multicenter electronic survey of healthcare professionals working in intensive care units across Global South countries. A structured questionnaire collected data on current weaning practices, including weaning protocols, spontaneous breathing trials, extubation criteria, post-extubation respiratory support, and management of high-risk patients. Descriptive analyses were used to summarize institutional characteristics and clinical practices.

RESULTS

Of 1,098 responses, 738 participants from Global South intensive care units were included (Latin America: 427, Asia: 278, and Africa: 33). Most respondents were physicians working in mixed medical-surgical units, with a median of 16 intensive care unit beds and substantial variability in staffing ratios across regions. Overall, 74% of intensive care units reported a weaning protocol. The spontaneous breathing trial was the most common method to assess extubation readiness, predominantly using pressure support with positive end-expiratory pressure in high-risk patients, although marked regional variation was observed. Return to mechanical ventilation for 1 hour after a successful spontaneous breathing trial was reported in 20% of cases. Post-extubation respiratory support also varied widely, with non-invasive ventilation more frequently used in Asia and Brazil and high-flow nasal cannula in Africa and China.

CONCLUSION

Weaning practices in Global South intensive care units are highly heterogeneous. Despite widespread use of key evidence-based strategies, variability in spontaneous breathing trial techniques and post-extubation support highlights the need for context-adapted guidelines and targeted research to improve extubation outcomes.