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Characterization of weaning practices in intensive care units in Global South countries: a clinical practice survey

Escobar RB 1 , Pereira AB 2 , Westphal GA 3 , Hashmi M 4 , Napoli SL 5 , Rajagopal S 6 Show all authors , Vijayaraghavan BKT 6 , Siaw-Frimpong M 7 , Sendagire C 8 , Hasan MS 9 , Pan C 10 , Luo JC 11 , Nin N 12 , Ibarra-Estrada M 13 , Lescano-Alva CA 14 , Reyes LF 15 , Luna IG 16 , Aryal D 17 , Bruhn A 18 , Ospina-Tascón GA 19 , Kattan E 1 , GS-Wean Investigators , Cavalcanti AB 20

Affiliations 

  • 1 Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile - Santiago, Chile
  • 2 Hospital São José - Joinville (SC), Brazil
  • 3 Intensive Care Unit, Centro Hospitalar Unimed - Joinville (SC), Brazil
  • 4 Department of Critical Care Medicine, Ziauddin University - Karachi, Pakistan
  • 5 Hospital General de Agudos "Dr. Juan A. Fernández" - Buenos Aires, Argentina
  • 6 Department of Critical Care Medicine, Apollo Hospitals - Chennai, India
  • 7 Directorate of Anaesthesia and Intensive Care, Komfo Anokye Teaching Hospital - Kumasi, Ghana
  • 8 Department of Anesthesia and Critical Care, Makerere University College of Health Sciences - Kampala, Uganda
  • 9 Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya - Kuala Lumpur, Malaysia
  • 10 Department of Critical Care Medicine, Health Management Center, University of Electronic Science and Technology of China, Sichuan Provincial People's Hospital - Chengdu, China
  • 11 Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital - Chengdu, China
  • 12 Unidad de Cuidados Intensivos, Hospital Español "Juan Jose Crottoggini" - Montevideo, Uruguay
  • 13 Critical Care Unit, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara - Jalisco, México
  • 14 Department of Critical Care Medicine, Edgardo Rebagliati Martins National Hospital - Lima, Peru
  • 15 Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana - Chía, Colombia
  • 16 Intensive Care Unit, Hospital General San Francisco, Instituto Ecuatoriano de Seguridad Social - Quito, Ecuador
  • 17 Nepal Intensive Care Research Foundation - Kathmandu, Nepal
  • 18 SENTINET: Surveillance, Epidemiology, and New Technologies for Infectious Emerging Threats - Santiago, Chile
  • 19 Department of Intensive Care Medicine, Fundación Valle del Lili - Cali, Colombia
  • 20 Research Institute, HCor-Hospital do Coração - São Paulo (SP), Brazil
Crit Care Sci, 2026;38:e20260112.
PMID: 42788542 DOI: 10.62675/2965-2774.20260112

Abstract

OBJECTIVE: To characterize current practices and protocols for mechanical ventilation weaning in intensive care units in Global South countries, describing practice variability and identifying opportunities for standardization that may reduce extubation failure.

METHODS: We conducted an international, multicenter electronic survey of healthcare professionals working in intensive care units across Global South countries. A structured questionnaire collected data on current weaning practices, including weaning protocols, spontaneous breathing trials, extubation criteria, post-extubation respiratory support, and management of high-risk patients. Descriptive analyses were used to summarize institutional characteristics and clinical practices.

RESULTS: Of 1,098 responses, 738 participants from Global South intensive care units were included (Latin America: 427, Asia: 278, and Africa: 33). Most respondents were physicians working in mixed medical-surgical units, with a median of 16 intensive care unit beds and substantial variability in staffing ratios across regions. Overall, 74% of intensive care units reported a weaning protocol. The spontaneous breathing trial was the most common method to assess extubation readiness, predominantly using pressure support with positive end-expiratory pressure in high-risk patients, although marked regional variation was observed. Return to mechanical ventilation for 1 hour after a successful spontaneous breathing trial was reported in 20% of cases. Post-extubation respiratory support also varied widely, with non-invasive ventilation more frequently used in Asia and Brazil and high-flow nasal cannula in Africa and China.

CONCLUSION: Weaning practices in Global South intensive care units are highly heterogeneous. Despite widespread use of key evidence-based strategies, variability in spontaneous breathing trial techniques and post-extubation support highlights the need for context-adapted guidelines and targeted research to improve extubation outcomes.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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