January Frailty more significant than age in predicting weaning success from mechanical ventilation

Research led by a team of investigators at University of Galway has revealed that frailty has a greater impact than age on the outcomes of patients being weaned off invasive mechanical ventilation, required by patients with various forms of respiratory failure.  

Despite the widespread use and clear benefits of mechanical ventilation, it is not a risk-free intervention.

The research is a sub-study of the international study – “Worldwide Assessment of Separation of Patients from Ventilatory Assistance” (WEAN SAFE), led by the European Society of Intensive Care Medicine and the European Respiratory Society.

The sub-study was jointly first authored by University of Galway medical students, Rionach Sheerin and Caoimhe Laffey as part of the Health Research Board Summer scholarship programme. Professor Andrew Simpkin, Professor in Statistics at the School of Mathematical and Statistical Sciences from University of Galway led the analysis team for the study.

Weaning is the process by which mechanical ventilation support is gradually reduced and then discontinued, to allow a patient to breathe by themselves. This sub-study sought to understand why delayed and failed weaning of patients from invasive mechanical ventilation worsens patient outcomes, increases the risk of dying and increases the length of intensive care unit and hospital stay.

The international WEAN SAFE study analysed data from 4,523 patients across 481 intensive care units in 50 countries.

The University of Galway sub-study categorised patients into four groups based on age and also based on frailty - a medical condition where a person’s body systems lose their built-in reserves, making them vulnerable to stressors like illness or injury.

The findings, published in Annals of Intensive Care and available at: https://rdcu.be/d7mQR, demonstrate that frailty plays a more decisive role than age in determining both the likelihood of delayed and failed weaning and overall survival rates.

Key Findings:

• Frail patients, regardless of their age, faced significantly higher risks of delayed weaning (28%) and weaning failure (23%) compared to non-frail and younger patients (12% and 13%, respectively).
• Frail and elderly patients (4% of the study population) had the poorest outcomes, with hospital mortality reaching 46%.
• Older age, though significant, had a lesser impact on outcomes compared to frailty.

Professor John Laffey, Professor of Anaesthesia and Intensive Care Medicine at University of Galway’s College of Medicine, Nursing and Health Sciences, and Consultant in Anaesthesia and Intensive Care Medicine at Galway University Hospitals, said: “Delayed and failed weaning from mechanical intubation is a critical challenge in ICUs worldwide, with far-reaching implications for patient recovery and resource utilisation. Patients requiring intensive care are increasingly older and more frail. The study's findings point to the importance of incorporating frailty assessments into ICU protocols to guide decision-making, optimise care, and further improve outcomes for these at-risk populations.”

Dr Bairbre McNicholas, Senior Lecturer at University of Galway and Consultant in Intensive Care Medicine at Galway University Hospitals, said: “This study highlights the value of frailty assessments in critical care settings as is provides clear evidence that frailty, rather than age alone, should be a key consideration in managing weaning processes.”

The WEAN SAFE study is a global initiative to advance understanding of the challenges associated with Intensive Care Unit mechanical ventilation and weaning processes. It is the first global study to describe the weaning process in detail, characterising different approaches used by physicians globally in regard to weaning for mechanical ventilation, and the impact of delayed and failed weaning from ventilation. The study’s findings provide a robust evidence base to inform clinical practice and improve patient care worldwide.

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