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.