https://doi.org/10.4081/hls.2024.13010
The effectiveness of ventilator weaning using a weaning protocol compared to non-protocol: a systematic review
Published: 4 September 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Ventilator use can reduce respiratory function, heighten infection risk, extend ventilator dependence, and, in severe cases, necessitate prolonged mechanical ventilation. Systematic weaning protocols can alleviate these issues, enhance breathing, and aid extubation. This review assesses studies on weaning protocols in ICU patients. Using the PRISMA framework, an extensive search was performed in databases such as ClinicalKey Nursing, ScienceDirect, ProQuest, SAGE, EMBASE, MEDLINE, Scopus, SpringerLink, and PubMed. This search aimed to find studies comparing protocolized and non-protocolized weaning in adult ICU patients. Included were peer-reviewed randomized controlled trials (RCTs) and quantitative studies focusing specifically on adult ICU weaning protocols. Studies involving non-adult populations were excluded. The JBI and CASP tools were used to assess the quality of the studies. Out of 475 identified articles, six met the inclusion criteria. Three types of weaning protocols were identified: nurse-led, respiratory therapy-led, and automatic protocols. These protocols demonstrated effectiveness by reducing ventilator time, increasing extubation success, and shortening ICU stays. Evidence supports that weaning protocols positively impact patient outcomes, particularly by shortening intubation periods, and can enhance inter-professional collaboration in the ICU.
Marshall JC, Bosco L, Adhikari NK, et al. What is an intensive care unit? a report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2017;37:270-6.
DOI: https://doi.org/10.1016/j.jcrc.2016.07.015
Jonkman AH, Rauseo M, Carteaux G, et al. Proportional modes of ventilation: technology to assist physiology. Intensive Care Med 2020;46:2301-13.
DOI: https://doi.org/10.1007/s00134-020-06206-z
Gunther I, Pradhan D, Lubinsky A, et al. Use of a multidisciplinary mechanical ventilation weaning protocol to improve patient outcomes and empower staff in a medical intensive care unit. Dimens Crit Care Nurs 2021;40:67-74.
DOI: https://doi.org/10.1097/DCC.0000000000000462
Holm A, Karlsson V, Nikolajsen L, Dreyer P. Strengthening and supporting nurses’ communication with mechanically ventilated patients in the intensive care unit: development of a communication intervention. Int J Nurs Stud Adv 2021;3:100025.
DOI: https://doi.org/10.1016/j.ijnsa.2021.100025
Cuzco C, Torres-Castro R, Torralba Y, et al. Nursing interventions for patient empowerment during intensive care unit discharge: a systematic review. Int J Environ Res Public Health 2021;18:11049.
DOI: https://doi.org/10.3390/ijerph182111049
McNett M, O'Mathúna D, Tucker S, et al. A scoping review of implementation science in adult critical care settings. Crit Care Explor 2020;2:e0301.
DOI: https://doi.org/10.1097/CCE.0000000000000301
Curley MAQ, Wypij D, Watson RS, et al. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. JAMA 2015;313:379-89.
DOI: https://doi.org/10.1001/jama.2014.18399
Danckers M, Grosu H, Jean R, et al. Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians. J Crit Care 2013;28:433-41.
DOI: https://doi.org/10.1016/j.jcrc.2012.10.012
Starnes E, Palokas M, Hinton E. Nurse initiated protocols for spontaneous breathing trials in adult intensive care unit patients: a scoping review protocol. JBI Database System Rev Implement Rep 2019;15:2248-64.
DOI: https://doi.org/10.11124/JBISRIR-2017-004025
Dehghan-Nayeri N, Vasli P, Seylani K, et al. The effectiveness of workshop and multimedia training methods on the nurses' decision-making skills regarding weaning from mechanical ventilation. Dimens Crit Care Nurs 2020;39:91-100.
DOI: https://doi.org/10.1097/DCC.0000000000000404
Barnes‐Daly MA, Pun BT, Harmon LA, et al. Improving health care for critically ill patients using an evidence-based collaborative approach to ABCDEF bundle dissemination and implementation. Worldviews Evid Based Nurs 2018;15:206-16.
DOI: https://doi.org/10.1111/wvn.12290
Rose L, Blackwood B, Egerod I, et al. Decisional responsibility for mechanical ventilation and weaning: an international survey. Crit Care 2011;15:R295.
DOI: https://doi.org/10.1186/cc10588
Roh JH, Synn A, Lim C-M, et al. A weaning protocol administered by critical care nurses for the weaning of patients from mechanical ventilation. J Crit Care 2012;27:549-55.
DOI: https://doi.org/10.1016/j.jcrc.2011.11.008
Woody N. Ventilator weaning protocols: influencing outcomes and promoting success [thesis]. [Tennessee]: Southern Adventist University; 2013.
Hirzallah FM, Alkaissi A, Barbieri-Figueiredo MDC. A systematic review of nurse-led weaning protocol for mechanically ventilated adult patients. Nurs Crit Care 2019;24:89-96.
DOI: https://doi.org/10.1111/nicc.12404
Baptistella AR, Sarmento FJ, da Silva KR, et al. Predictive factors of weaning from mechanical ventilation and extubation outcome: a systematic review. J Crit Care 2018;48:56-62.
DOI: https://doi.org/10.1016/j.jcrc.2018.08.023
Ghanbari A, Ebrahimzadeh AM, Paryad E, et al. Comparison between a nurse-led weaning protocol and a weaning protocol based on physician's clinical judgment in ICU patients. Heart Lung 2020;49:296-300.
DOI: https://doi.org/10.1016/j.hrtlng.2020.01.003
Lago AF, Gastaldi AC, Mazzoni AAS, et al. Comparison of International consensus conference guidelines and WIND classification for weaning from mechanical ventilation in Brazilian critically ill patients: a retrospective cohort study. Medicine (Baltimore) 2019;98:e17534.
DOI: https://doi.org/10.1097/MD.0000000000017534
Vahedian-Azimi A, Bashar FR, Jafarabadi MA, et al. Protocolized ventilator weaning verses usual care: a randomized controlled trial. Int J Crit Illn Inj Sci 2020;10:206-12.
DOI: https://doi.org/10.4103/IJCIIS.IJCIIS_29_20
Vizcaychipi MP, Martins L, White JR, et al. Intensive care weaning (iCareWean) protocol on weaning from mechanical ventilation: a single-blinded multicentre randomised control trial comparing an open-loop decision support system and routine care, in the general intensive care unit. BMJ Open 2020;10:e042145.
DOI: https://doi.org/10.1136/bmjopen-2020-042145
Cederwall C-J, Rose L, Naredi S, et al. Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: a national survey. Intensive Crit Care Nurs 2023;74:103309.
DOI: https://doi.org/10.1016/j.iccn.2022.103309
Nitta K, Okamoto K, Imamura H, et al. A comprehensive protocol for ventilator weaning and extubation: a prospective observational study. J Intensive Care 2019;7:50.
DOI: https://doi.org/10.1186/s40560-019-0402-4
Awang S, Alias N, DeWitt D, et al. Design of a clinical practice guideline in nurse-led ventilator-weaning for nursing training. Front Public Health 2021;9:726647.
DOI: https://doi.org/10.3389/fpubh.2021.726647
Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in critical care. Crit Care Clin 2017;33:225-43.
DOI: https://doi.org/10.1016/j.ccc.2016.12.005
Burns SM. Weaning from mechanical ventilation: where were we then, and where are we now? Crit Care Nurs Clin North Am 2012;24:457-68.
DOI: https://doi.org/10.1016/j.ccell.2012.05.001
Balas MC, Tate J, Tan A, et al. Evaluation of the perceived barriers and facilitators to timely extubation of critically ill adults: an interprofessional survey. Worldviews Evid Based Nurs 2021;18:201-9.
DOI: https://doi.org/10.1111/wvn.12493
Cederwall C-J, Olausson S, Rose L, et al. Person-centred care during prolonged weaning from mechanical ventilation, nurses' views: an interview study. Intensive Critical Care Nurs 2018;46:32-7.
DOI: https://doi.org/10.1016/j.iccn.2017.11.004
Karlsen M-MW, Heggdal K, Finset A, Heyn LG. Attention-seeking actions by patients on mechanical ventilation in intensive care units: a phenomenological-hermeneutical study. J Clin Nurs 2019;28:66-79.
DOI: https://doi.org/10.1111/jocn.14633
Guilhermino MC, Inder KJ, Sundin D. Education on invasive mechanical ventilation involving intensive care nurses: a systematic review. Nurs Crit Care 2018;23:245-55.
DOI: https://doi.org/10.1111/nicc.12346
How to Cite
Aryani, D. F., Hariyati, R. T. S., & Nurachmah, E. (2024). The effectiveness of ventilator weaning using a weaning protocol compared to non-protocol: a systematic review. Healthcare in Low-Resource Settings. https://doi.org/10.4081/hls.2024.13010
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