Factors contributing to the unsuccessful weaning of COVID-19 patients, from invasive mechanical ventilation: A systematic review

ABSTRACT Introduction: Patients with COVID-19 experience a higher burden during the weaning process, with lower rates of successful extubation compared to non-COVID-19 patients. Additionally, there is an increased need for prolonged respiratory support and longer stays in the Intensive Care Unit (ICU). Aim: This systematic review aims to investigate and identify the main factors contributing to unsuccessful weaning from mechanical ventilation in patients with COVID-19, in order to support clinical decision-making and improve patient prognosis. Methodology: A systematic search of the international literature was conducted using the electronic scientific databases PubMed and Scopus. The search was carried out in English, and primary studies published between 2020 and 2025 were included. Results: Through the search strategy, a total of 1,523 articles were retrieved, of which 9 primary studies were included and evaluated in the present systematic review. All included studies explore and address the presence of factors contributing to unsuccessful weaning from mechanical ventilation in COVID-19 patients, in comparison with the respective control groups. Conclusions: Unsuccessful weaning from invasive mechanical ventilation in patients with COVID-19 reflects a set of interacting factors related both to patient-specific characteristics and to parameters concerning the disease itself, mechanical ventilation, and the required clinical interventions.