Prolonged Invasive Mechanical Ventilation in a Tertiary Respiratory ICU: Outcomes, Challenges, and Future Directions

Background Prolonged invasive mechanical ventilation (PMV) represents a major challenge in critical care and is associated with high mortality, resource utilization, and long-term morbidity. Data from dedicated respiratory intensive care units (RICUs), particularly in resource-limited settings, remain limited. This study evaluates the clinical characteristics, management strategies, and outcomes of patients requiring PMV in a tertiary RICU. Methods This single-center observational case series included 40 consecutive patients requiring PMV, defined as >7 days of invasive mechanical ventilation, who were admitted to a tertiary RICU between January 2023 and March 2026. Data collected included demographics, primary diagnosis, comorbidities, APACHE II scores, microbiological profiles, ventilatory parameters, and outcomes. Standardized weaning protocols incorporating spontaneous breathing trials (SBTs), early tracheostomy, non-invasive ventilation (NIV) bridging, physiotherapy, and multidisciplinary care were applied. Successful weaning was defined as liberation from invasive ventilation without reintubation within 48 hours. Results The mean age was 66.5 years, with high illness severity reflected by a mean APACHE II score of 36.5. Common underlying conditions included severe pneumonia with acute respiratory distress syndrome, COPD/bronchiectasis overlap, and postoperative respiratory failure. Multidrug-resistant (MDR) Gram-negative infections, particularly Pseudomonas aeruginosa and Klebsiella pneumoniae, were frequently identified. Seventeen patients (42.5%) were successfully weaned, and 12 patients (30%) achieved decannulation. The mean duration of mechanical ventilation was 14 days, and the mean hospital stay was 48 days. Despite predicted mortality exceeding 70% in most patients, observed survival exceeded expectations. Successful outcomes were associated with early tracheostomy, culture-directed antimicrobial therapy, structured weaning protocols, early mobilization, and nutritional optimization. Conclusions PMV in a tertiary RICU is associated with significant morbidity but can achieve meaningful weaning success through a protocolized multidisciplinary approach. Outcomes in this high-acuity cohort compare favorably with general ICU data despite the absence of dedicated weaning units. The establishment of specialized weaning units and structured post-discharge follow-up programs may further improve outcomes in resource-constrained settings.