Abstract / Summary
Background: Prolonged mechanical ventilation (PMV) creates substantial clinical and intensive care unit (ICU) burdens. Specialized weaning units (SWUs) provide multidisciplinary ventilator liberation and rehabilitation, but practical guidance and outcome data from resource-limited settings are limited. Objective: To synthesize evidence on the organization and clinical management of SWUs, describe implementation of a ventilator-dependent unit (VDU) adapted to a resource-limited tertiary hospital, and report a clinical evaluation. Methods: A structured narrative review was conducted in PubMed for publications from January 2000 to December 2025 using terms related to PMV, difficult weaning, SWUs, VDU, rehabilitation, and models of care. Guidelines, consensus statements, systematic reviews, randomized trials, observational studies, and key implementation reports were narratively synthesized. Results: Evidence supports geographically defined units, explicit admission and escalation criteria, protocolized weaning, multidisciplinary rehabilitation, airway and tracheostomy safety, nutrition, communication support, caregiver training, and early discharge planning. Our center establishes VDU according to these principles through ICU-adjacent open wards, 24-hour nurse coverage, shared allied-health services, and defined re-referral pathways. Among 97 VDU admissions, 60.9% were liberated from mechanical ventilation and in-unit mortality was 1.0%. Conclusion: A structured SWU framework can be pragmatically adapted to a resource-limited tertiary hospital. The VDU was feasible and had acceptable safety outcomes; prospective multicenter studies are needed to establish effectiveness and cost-effectiveness.