The primary endpoint classified patients who died before discharge as weaning failures, including those temporarily liberated from invasive ventilation.
Transfer to a specialized weaning center was considered part of the original ICU treatment episode; endpoint assessment occurred at discharge from the ICU or center.
Among ICU survivors in an exploratory analysis, intervention was associated with higher odds of successful weaning (OR 2.10, 95% CI 1.09–4.04), but the analysis excluded patients who died and is vulnerable to selection bias.
Adjusted competing-risk analysis found no statistically significant association with successful weaning (sHR 1.12, 95% CI 0.91–1.38; p = 0.30).
PRiVENT was a prospective, nonrandomized evaluation; its authors note limitations for causal inference and uncertainty about the intervention’s clinical and economic effects.
Guideline-Based Recommendations
Diagnosis
In PRiVENT, investigators assessed the primary endpoint at ICU discharge or, after transfer, at discharge from the specialized weaning facility.
In PRiVENT, death before discharge was classified as weaning failure, even if invasive ventilation had previously been discontinued.
Management
The authors state that prolonged weaning has multiple contributing factors, is frequently complicated by chronic underlying diseases, and necessitates individualized, multidisciplinary treatment.
PRiVENT incorporated specialized consultations, interprofessional collaboration, and educational activities to enable early access to specialized expertise.
Monitoring & Follow-up
The authors state that weaning success, ventilation duration, mortality, and resource utilization should be considered together.
The authors caution that the survivor-only exploratory analysis is vulnerable to selection bias and that timing of successful weaning and death should be considered as a competing risk.
Risks
The authors note that the prospective, nonrandomized design retains limitations for causal inference; knowledge transfer between institutions and the COVID-19 pandemic complicated intervention evaluation.
The authors state that longer ventilation duration may partly reflect ongoing efforts to achieve liberation, but the data do not establish the underlying mechanisms.
The authors report that PRiVENT requires additional organizational and personnel resources; whether these are offset by savings during the index hospitalization remains unclear.
Patient & Prescribing Data
Patients enrolled in PRiVENT were at elevated risk for prolonged weaning and long-term dependence on invasive ventilation.
The article describes a regional healthcare intervention, not a medication regimen. It reports that specialized weaning expertise was delivered through consultations, interprofessional collaboration, and education.
Clinical Best Practices
The authors distinguish liberation from invasive ventilation from duration of ventilation, describing them as associated but separate objectives.
For the PRiVENT primary endpoint, investigators assessed status at the specified discharge point and classified deaths before discharge as weaning failures.
The authors caution that outcome analyses require consideration of design limitations, including survivor selection and competing risks.
The authors identify organizational resources and longer-term economic outcomes as relevant; they state that the PRiVENT health economic evaluation will be important for examining these issues.
