Cross-Silo Federated Learning for Predicting Successful Mechanical Ventilation Weaning Across 5 Intensive Care Unit Databases: Retrospective Database Analysis.

BACKGROUND: The prediction of weaning from mechanical ventilation (MV) can support clinical decision-making and help reduce the risk of weaning failure in intensive care units (ICUs). Cross-silo federated learning (FL) offers a promising approach to developing robust predictive models across multiple institutions without requiring the sharing of patient-level data. OBJECTIVE: This study aimed to evaluate the feasibility and efficacy of FL for predicting successful weaning from MV across 5 diverse ICU databases and to compare its performance with local learning (LL) and centralized learning (CL) approaches that differ in their data-sharing requirements. METHODS: -score. All data use complied with local ethical regulations and institutional review board approvals, and all databases contained deidentified patient data accessed under institutional data use agreements and governed by applicable privacy regulations. RESULTS: -score=0.49-0.67), reflecting differences in data distribution and class balance. CONCLUSIONS: Our findings highlight performance differences between learning approaches for MV weaning prediction. LL models achieved the highest performance within their respective institutions (AUROC=0.68-0.84), CL achieved the highest performance on pooled test data (AUROC=0.81), and FL showed lower but reasonable performance while avoiding direct sharing of patient-level data (AUROC=0.74). The choice between approaches depends on institutional data-sharing constraints, local dataset characteristics, and acceptable performance thresholds. As privacy was not formally measured, these findings should be read as a performance comparison rather than a privacy-performance trade-off.