Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study
Abstract Objective To understand the impact of both frailty and chronologic age on outcomes of weaning from invasive mechanical ventilation (MV). Methods The study population consisted of patients enrolled in the ‘WorldwidE. AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE...
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2025-01-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-025-01435-1 |
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| author | Caoimhe M. Laffey Rionach Sheerin Omid Khazaei Bairbre A. McNicholas Tài Pham Leo Heunks Giacomo Bellani Laurent Brochard Dana Tomescu Andrew J. Simpkin John G. Laffey on behalf of the WEAN SAFE Investigators |
| author_facet | Caoimhe M. Laffey Rionach Sheerin Omid Khazaei Bairbre A. McNicholas Tài Pham Leo Heunks Giacomo Bellani Laurent Brochard Dana Tomescu Andrew J. Simpkin John G. Laffey on behalf of the WEAN SAFE Investigators |
| author_sort | Caoimhe M. Laffey |
| collection | DOAJ |
| description | Abstract Objective To understand the impact of both frailty and chronologic age on outcomes of weaning from invasive mechanical ventilation (MV). Methods The study population consisted of patients enrolled in the ‘WorldwidE. AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE) study. We defined 4 non-overlapping groups, namely: ‘frail’ (clinical frailty scale [CFS] score > 4; age < 80 years); ‘elderly’ (CFS ≤ 4; age ≥ 80y), ‘frail \elderly’ (CFS > 4; age ≥ 80 years), and a ‘not frail or elderly’ population. The primary outcome was the impact of frailty and older age on delayed weaning and failed weaning from invasive MV. Secondary outcomes included the impact of frailty and age on ICU and hospital survival. Results In the study population, 760 (17%) were frail, while 360 (8%) were elderly, 197 (4%) were frail and elderly, while 3,176 (70%) were not frail or elderly. The frail and elderly cohorts were more likely to be female, had hypoxemic/hypercapnic respiratory failure or sepsis, and had more comorbidities. The proportion of delayed weaning and of failed weaning from invasive MV was significantly higher in the frail (28 and 23%), the elderly (25 and 19%), and the frail and elderly groups (22% and 25%), compared to the not frail or elderly population (12% and 13%, P < 0.01). ICU and hospital mortality was higher in the frail (21 and 33%), the elderly (19 and 31%), and the frail and elderly groups (26 and 46%), compared to the not frail or elderly population (12% and 18%, P < 0.001). In multivariate analyses, there was an independent association between frailty and delayed weaning initiation and weaning failure. Old age was independently associated with risk of weaning failure. Conclusions Frailty status had a more consistent impact than older age on weaning outcomes. However, overall outcomes in these cohorts are encouraging once separation attempts have been initiated. |
| format | Article |
| id | doaj-art-de77dc2f7cde4afeaff7435e40c9053b |
| institution | DOAJ |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj-art-de77dc2f7cde4afeaff7435e40c9053b2025-08-20T02:55:28ZengSpringerOpenAnnals of Intensive Care2110-58202025-01-0115111110.1186/s13613-025-01435-1Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE studyCaoimhe M. Laffey0Rionach Sheerin1Omid Khazaei2Bairbre A. McNicholas3Tài Pham4Leo Heunks5Giacomo Bellani6Laurent Brochard7Dana Tomescu8Andrew J. Simpkin9John G. Laffey10on behalf of the WEAN SAFE InvestigatorsAnaesthesia and Intensive Care Medicine, School of Medicine, University of GalwayAnaesthesia and Intensive Care Medicine, School of Medicine, University of GalwaySchool of Mathematical and Statistical Sciences, University of GalwayAnaesthesia and Intensive Care Medicine, School of Medicine, University of GalwayService de médecine intensive-réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de recherche CARMAS, Hôpitaux Universitaires Paris-SaclayDepartment of Intensive Care, Radboud University Medical CenterSchool of Medicine and Surgery, University of TrentoInterdepartmental Division of Critical Care Medicine, University of TorontoDepartment of Anesthesia and Intensive Care, “Carol Davila” University of Medicine and PharmacySchool of Mathematical and Statistical Sciences, University of GalwayAnaesthesia and Intensive Care Medicine, School of Medicine, University of GalwayAbstract Objective To understand the impact of both frailty and chronologic age on outcomes of weaning from invasive mechanical ventilation (MV). Methods The study population consisted of patients enrolled in the ‘WorldwidE. AssessmeNt of Separation of pAtients From ventilatory assistancE (WEAN SAFE) study. We defined 4 non-overlapping groups, namely: ‘frail’ (clinical frailty scale [CFS] score > 4; age < 80 years); ‘elderly’ (CFS ≤ 4; age ≥ 80y), ‘frail \elderly’ (CFS > 4; age ≥ 80 years), and a ‘not frail or elderly’ population. The primary outcome was the impact of frailty and older age on delayed weaning and failed weaning from invasive MV. Secondary outcomes included the impact of frailty and age on ICU and hospital survival. Results In the study population, 760 (17%) were frail, while 360 (8%) were elderly, 197 (4%) were frail and elderly, while 3,176 (70%) were not frail or elderly. The frail and elderly cohorts were more likely to be female, had hypoxemic/hypercapnic respiratory failure or sepsis, and had more comorbidities. The proportion of delayed weaning and of failed weaning from invasive MV was significantly higher in the frail (28 and 23%), the elderly (25 and 19%), and the frail and elderly groups (22% and 25%), compared to the not frail or elderly population (12% and 13%, P < 0.01). ICU and hospital mortality was higher in the frail (21 and 33%), the elderly (19 and 31%), and the frail and elderly groups (26 and 46%), compared to the not frail or elderly population (12% and 18%, P < 0.001). In multivariate analyses, there was an independent association between frailty and delayed weaning initiation and weaning failure. Old age was independently associated with risk of weaning failure. Conclusions Frailty status had a more consistent impact than older age on weaning outcomes. However, overall outcomes in these cohorts are encouraging once separation attempts have been initiated.https://doi.org/10.1186/s13613-025-01435-1Clinical frailty scaleOlder ageElderlyFrailtyVentilator weaningVentilator liberation |
| spellingShingle | Caoimhe M. Laffey Rionach Sheerin Omid Khazaei Bairbre A. McNicholas Tài Pham Leo Heunks Giacomo Bellani Laurent Brochard Dana Tomescu Andrew J. Simpkin John G. Laffey on behalf of the WEAN SAFE Investigators Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study Annals of Intensive Care Clinical frailty scale Older age Elderly Frailty Ventilator weaning Ventilator liberation |
| title | Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study |
| title_full | Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study |
| title_fullStr | Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study |
| title_full_unstemmed | Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study |
| title_short | Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study |
| title_sort | impact of frailty and older age on weaning from invasive ventilation a secondary analysis of the wean safe study |
| topic | Clinical frailty scale Older age Elderly Frailty Ventilator weaning Ventilator liberation |
| url | https://doi.org/10.1186/s13613-025-01435-1 |
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