Ventilation-Weaning Protocols in Children Admitted to Pediatric Intensive Care Units: Systematic Review of Randomized Trials

Abstract

Objective: To determine whether implementing a ventilator weaning protocol in a Pediatric Intensive Care Unit (PICU) can decrease the duration of invasive mechanical ventilation (IMV), the PICU and hospital length of stay (LOS), mortality rates, and extubation failure compared to usual care. Methods: PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials were searched. The randomized controlled trials reporting a weaning protocol compared with usual care in a PICU were selected. The risk of bias and the certainty of evidence were assessed. The duration of IMV was the main outcome, and PICU and hospital LOS, extubation failure, and mortality were the secondary outcomes. Results: Seven trials were included (n = 11,742). The implemented protocols included a weaning sedation plus ventilation protocol, a weaning protocol, and automated computer-driven weaning. The IMV time was shorter with the weaning protocol (MD −1.2, 95% CI −1.27 to −1.13; 1 trial, N = 260; moderate-certainty evidence) and the automated computer drive weaning protocol (MD −2.33, 95% CI −3.42 to −1.24; 1 trial, N = 2199; moderate-certainty evidence). The weaning sedation plus ventilation protocol reduced hospital LOS in children intubated for respiratory disease (MD −1.2, 95% CI −1.27 to −1.13; 1 trial, N = 260; moderate-certainty evidence). However, no significant differences were observed between protocols and usual care in PICU LOS, extubation failure, or mortality. Conclusion: Limited evidence indicates that weaning protocols may shorten IMV duration and that sedation and weaning protocols may reduce hospital stay in children with respiratory disease admitted to the PICU. However, their safety and effectiveness in reducing extubation failure or mortality remain unproven. This underscores the need for high-quality studies, as current practice is based on low-certainty evidence.