• Nicolas Paul, Elena Ribet Buse, Julius J Grunow, Stefan J Schaller, Claudia D Spies, Andreas Edel, and Björn Weiss.
• Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
• Chest. 2025 Jan 27.

BackgroundThere is limited knowledge about long-term mortality, care pathways and health-related quality of life (HrQoL) among intensive care unit (ICU) patients receiving prolonged mechanical ventilation (PMV).Research QuestionWhat are the long-term mortality, care pathways, and HrQoL of patients receiving invasive PMV, stratified by weaning success?Study Designand methods: We conducted a secondary analysis of patients from the cluster-randomised controlled Enhanced Recovery after Intensive Care trial who were treated in two ICU clusters and received invasive PMV (≥21 days via endotracheal tube/tracheostomy or ≥four days via tracheostomy). Data on weaning success, mortality, care place transitions, readmissions, and HrQoL were collected for six months after ICU discharge.ResultsOf 90 patients receiving PMV in the ICU, 46% (41/90 patients) died (21 patients in the ICU and 20 patients within six months after ICU discharge). Of 69 patients discharged alive, 25% (17/69 patients) could not be weaned, whereas 75% (52/69 patients) were successfully weaned within six months. Patients experienced a median of 3 [Q1, Q3: 2, 5] care place transitions within six months, with more care place transitions among successfully weaned patients (median 4 [Q1, Q3: 2, 5] vs 2 [1, 3], p=0.004). The readmission rate among all patients was 46% after six months. Half of the successfully weaned patients transitioned home, whereas unsuccessfully weaned patients mostly transitioned from weaning centres to nursing homes or died. Unsuccessfully weaned patients had fewer quality-adjusted life days within six months than successfully weaned patients (median 0 [Q1, Q3: 0, 32.6] vs 73.1 [23.2, 135], p=0.002).InterpretationThree quarters of patients receiving PMV who were discharged alive were weaned, but their HrQoL was reduced. The decision to proceed with PMV should weigh in patient preferences for living with HrQoL limitations and patients' likelihood of weaning.Trial RegistrationClinicalTrials.gov (identifier: NCT03671447) on September 12, 2018.Copyright © 2025. Published by Elsevier Inc.

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