Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study

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; WEAN SAFE Investigators

doi:10.1186/s13613-025-01435-1

Impact of frailty and older age on weaning from invasive ventilation: a secondary analysis of the WEAN SAFE study

Ann Intensive Care. 2025 Jan 20;15(1):13. doi: 10.1186/s13613-025-01435-1.

Authors

Caoimhe M Laffey^#¹, Rionach Sheerin^#¹, Omid Khazaei^{2

3}, Bairbre A McNicholas^{1

4}, Tài Pham^{5

6}, Leo Heunks⁷, Giacomo Bellani⁸, Laurent Brochard^{9

10}, Dana Tomescu^{11

12}, Andrew J Simpkin^{2

3}, John G Laffey^{13

14

15}; WEAN SAFE Investigators

Affiliations

¹ Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway, Ireland.
² School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland.
³ Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland.
⁴ Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland.
⁵ Service de médecine intensive-réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de recherche CARMAS, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France.
⁶ Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Equipe d'Epidémiologie respiratoire intégrative, CESP, Villejuif, 94807, France.
⁷ Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.
⁸ School of Medicine and Surgery, University of Trento, Trento, Italy.
⁹ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
¹⁰ Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Canada.
¹¹ Department of Anesthesia and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
¹² Department of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Sos Fundeni 258 sect 2 zip, Bucharest, 22328, Romania.
¹³ Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway, Ireland. jlaffey@universityofgalway.ie.
¹⁴ Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland. jlaffey@universityofgalway.ie.
¹⁵ Department of Anaesthesia and Intensive Care Medicine, School of medicine, Clinical Sciences Institute, University of Galway, Galway, H91 YR71, Ireland. jlaffey@universityofgalway.ie.

^# Contributed equally.

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.

Keywords: Clinical frailty scale; Elderly; Frailty; Invasive mechanical ventilation; Older age; Ventilator liberation; Ventilator weaning.

Abstract

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