The British Medical Journal has published the findings of a Cochrane systematic review looking at the effects of weaning protocols on the total duration of mechanical ventilation for critically ill adults, and the differences between protocolised and non-protocolised weaning in terms of mortality, adverse events, quality of life, weaning duration, length of stay (overall and in the ICU).  The full review is also available via the Cochrane website (see link below).

Briefly, the authors conducted a systematic review and identified 11 trials (n=1,971) suitable for inclusion.  They found that compared to usual care, those who had protocolised weaning had:

• A 25% reduction in the duration of mechanical ventilation (N=10 trials, 95% CI 9% to 39%, P=0.006)

• A 78% reduction in weaning duration (N=6, 95% CI 31% to 93%, P=0.009)

• A 10% reduction in length of ICU stay (N=8, 95% CI 2% to 19%, P=0.02)

There was however significant heterogeneity among studies for total duration of mechanical ventilation (P<0.01) and duration of weaning (P<0.01), which could not be explained by subgroup analyses based on type of unit or type of approach. Some studies suggest that organisational context could influence outcomes, but this could not be evaluated as it was outside the scope of this review.  The authors comment that further beneficial effects of protocolised weaning may not be gained on these outcomes in units where objective criteria and guided approaches are already incorporated into standard weaning practice.