Prolonged Mechanical Ventilation in ICU Patients

• In ICU
• Tue, 15 Jul 2025

About 25% of ICU patients require mechanical ventilation, with most discontinuing it after 3–4 days. However, around 5% need prolonged mechanical ventilation (PMV), typically defined as ventilation for 21 or more days or 4+ days with tracheostomy. 

The number of PMV patients has been rising. PMV is associated with high in-hospital mortality (~29%), a 50% weaning success rate, and significant long-term mortality, healthcare resource use, and costs (over $300,000 per patient annually). Patients on PMV often experience reduced long-term quality of life and functional independence. Due to these poor outcomes and high costs, decisions to continue PMV should consider realistic expectations of survival, care transitions, readmissions, and quality of life. However, longitudinal data on PMV care pathways are limited. 

A recent study analyses mortality, care pathways, readmissions, and quality of life for PMV patients in three German ICUs, comparing outcomes by weaning success. This secondary analysis used data from the Enhanced Recovery After Intensive Care trial, focusing on patients in 2 ICU clusters who received invasive PMV. The study tracked weaning success, mortality, care transitions, hospital readmissions, and health-related quality of life for six months after ICU discharge.

Among 90 ICU patients receiving PMV, 46% died—21 in the ICU and 20 within 6 months after discharge. Of the 69 survivors, 75% were successfully weaned within 6 months, while 25% were not. Patients had a median of three care place transitions over 6 months, with more transitions in those successfully weaned. The overall hospital readmission rate was 46%. Half of the successfully weaned patients returned home, whereas most unsuccessfully weaned patients moved to nursing homes or died. Unsuccessfully weaned patients had significantly fewer quality-adjusted life days compared to those successfully weaned.

The study’s mortality and readmission rates aligned with previous research: an in-hospital mortality of ~23% and 6-month mortality of 46%, with a 46% readmission rate matching a large Canadian cohort. Compared to a U.S. cohort with slightly lower illness severity, the weaning success rate and number of care transitions were similar, with successfully weaned patients showing more transitions, possibly reflecting progress through recovery stages.

Only 9% of ICU survivors in this study had good health-related quality of life (HrQoL) at 6 months, lower than some previous studies, possibly due to the older age of this cohort. Predictors of weaning success were not identified here, though prior research has linked factors like illness severity scores, respiratory function, and comorbidities with outcomes.

The findings underscore that while 75% of ICU survivors were weaned and 38% alive and home at 6 months, mortality and poor quality of life remain high, especially for unsuccessfully weaned patients. This highlights the importance of personalised decision-making in PMV, balancing survival chances and quality of life against patient values and preferences. Yet, previous studies show that physicians and surrogates often have unrealistic expectations and poor communication regarding prognosis, which can affect treatment choices.

Overall, the study highlights the complexity of PMV outcomes, the economic burden, and the critical need for informed, patient-centred decisions. Further research on predictors of weaning success could improve shared decision-making.

Source: Chest
Image Credit: iStock 
 

References:

Paul N, Buse ER, Grunow JJ et al. (2025) Prolonged Mechanical Ventilation in Critically Ill Patients. Chest. 168(1):106-118.