Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysisBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.c7237 (Published 13 January 2011) Cite this as: BMJ 2011;342:c7237
- Bronagh Blackwood, lecturer in nursing1,
- Fiona Alderdice, director1,
- Karen Burns, clinician scientist2,
- Chris Cardwell, lecturer in medical statistics3,
- Gavin Lavery, consultant in intensive care medicine4,
- Peter O’Halloran, lecturer in nursing1
- 1Nursing and Midwifery Research Unit, Queen’s University Belfast, Belfast, BT9 5BN, Northern Ireland
- 2St Michael’s Hospital, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada
- 3Centre for Public Health, Queen’s University Belfast, Belfast
- 4Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast, Belfast
- Correspondence to: B Blackwood
- Accepted 8 November 2010
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 (I2=76%, P<0.01) and duration of weaning (I2=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.
We thank Harald Herkner, H S Jeffrey Man, Carmen Silvia Valente Barbas, and Nathan L Pace for their help and editorial advice during the preparation of the review. The results of a Cochrane review can be interpreted differently, depending on people’s perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of review authors and are not necessarily shared by the Cochrane Collaboration. This paper is based on a Cochrane review first published in the Cochrane Library 2010 Issue 5 (www.thecochranelibrary.com). Cochrane reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.
Contributors: BB, FA, and PO’H were involved in the design of the review. BB developed the search strategy. BB, PO’H, KB, and FA conducted the screening, and BB, PO’H, and KB undertook assessment of risk of bias and data extraction. BB, PO’H and CC were involved in data entry and data analysis. BB wrote the first draft of the review, and all authors contributed to the various drafts of the report. BB is guarantor.
Funding: The review was funded through a Cochrane Fellowship Award for BB from the Research and Development Office, Northern Ireland, and the Health Research Board, Ireland.
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.
Data sharing: No additional data available.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.