Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis

Bronagh Blackwood, Fiona Alderdice, Karen Burns, Chris Cardwell, Gavin Lavery, Peter O'Halloran, Bronagh Blackwood, Fiona Alderdice, Karen Burns, Chris Cardwell, Gavin Lavery, Peter O'Halloran

Abstract

Objective: To investigate the effects of weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, quality of life, weaning duration, and length of stay in the intensive care unit and hospital.

Design: Systematic review.

Data sources: Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, LILACS, ISI Web of Science, ISI Conference Proceedings, Cambridge Scientific Abstracts, and reference lists of articles. We did not apply language restrictions. Review methods We included randomised and quasi-randomised controlled trials of weaning from mechanical ventilation with and without protocols in critically ill adults. Data selection Three authors independently assessed trial quality and extracted data. A priori subgroup and sensitivity analyses were performed. We contacted study authors for additional information.

Results: Eleven trials that included 1971 patients met the inclusion criteria. Compared with usual care, the geometric mean duration of mechanical ventilation in the weaning protocol group was reduced by 25% (95% confidence interval 9% to 39%, P=0.006; 10 trials); the duration of weaning was reduced by 78% (31% to 93%, P=0.009; six trials); and stay in the intensive care unit length by 10% (2% to 19%, P=0.02; eight trials). There was significant heterogeneity among studies for total duration of mechanical ventilation (I(2)=76%, P<0.01) and duration of weaning (I(2)=97%, P<0.01), which could not be explained by subgroup analyses based on type of unit or type of approach.

Conclusion: There is evidence of a reduction in the duration of mechanical ventilation, weaning, and stay in the intensive care unit when standardised weaning protocols are used, but there is significant heterogeneity among studies and an insufficient number of studies to investigate the source of this heterogeneity. Some studies suggest that organisational context could influence outcomes, but this could not be evaluated as it was outside the scope of this review.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Ethical approval: Not required.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787695/bin/blab791053.f1_default.jpg
Fig 1 Identification of studies on weaning from mechanical ventilation
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Fig 2 Summary of risk of bias assessment
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Fig 3 Duration of mechanical ventilation with and without weaning protocol; subgroup analysis by type of unit. Mean difference calculated with fixed effects model
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Fig 4 Duration of mechanical ventilation with and without weaning protocol; subgroup analysis by type of approach. Mean difference calculated with fixed effects model
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Fig 5 Mortality in hospital and intensive care unit according to weaning with and without protocol. Odds ratio calculated with fixed effects model
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Fig 6 Duration of weaning with and without weaning protocol. Mean difference calculated with fixed effects model
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Fig 7 Length of stay in intensive care unit with and without weaning protocol. Mean difference calculated with fixed effects model
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Fig 8 Length of stay in hospital with and without weaning protocol. Mean difference calculated with fixed effects model

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