Weaning from mechanical ventilation in people with neuromuscular disease: a systematic review

ObjectiveThis systematic review aimed in assessing the effects of different weaning protocols in people with neuromuscular disease (NMD) receiving invasive mechanical ventilation, identifying which protocol is the best and how different protocols can affect weaning outcome success, duration of weaning, intensive care unit (ICU) and hospital stay and mortality.DesignSystematic review.Data sourcesElectronic databases (MEDLINE, EMBASE, Web of Science and Scopus) were searched from January 2009 to August 2020.Eligibility criteria for selecting studiesRandomised controlled trials (RCTs) and non-RCT that evaluated patients with NMD (adults and children from 5 years old) in the weaning process managed with a protocol (pressure support ventilation; synchronised intermittent mandatory ventilation; continuous positive airway pressure; ‘T’ piece).Primary outcomeWeaning success.Secondary outcomesWeaning duration, ICU stay, hospital stay, ICU mortality, complications (pneumothorax, ventilation-associated pneumonia).Data extraction and synthesisTwo review authors assessed the titles and the abstracts for inclusion and reviewed the full texts independently.ResultsWe found no studies that fulfilled the inclusion criteria.ConclusionsThe absence of studies about different weaning protocols for patients with NMD does not allow concluding the superiority of any specific weaning protocol for patients with NMD or determining the impact of different types of protocols on other outcomes. The result of this review encourages further studies.PROSPERO registration numberCRD42019117393.

Medical Learning Tool for Ventilator Weaning Protocols.

Mechanical ventilation is one of the most used medical procedures in intensive care units across the world. In clinical practice, it represents a high level of complexity, especially in both stages, the extubation and weaning protocols. In order to enhance medical and nursing student's training skills regarding those topics, an interactive application was developed to teach basic information for ventilator weaning. The application has two fully graphic modules, which provide theoretical information and a set of clinical cases of patients under spontaneous breathing tests. It also includes information about medical records and interactive panels for weaning criteria and patient clinical condition during the weaning trials. A usability testing was performed with 12 subjects to validate the application usability, where the level of satisfaction with them showed that the app provides a straightforward tool to interact with the critical concepts of ventilator weaning.

A comprehensive protocol for ventilator weaning and extubation: a prospective observational study

Background Ventilator weaning protocols have been shown to reduce the duration of mechanical ventilation (MV), intensive care unit length of stay, and resource use. However, weaning protocols have not significantly affected mortality or reintubation rates. The extubation process is a critical component of respiratory care in patients who receive MV. Post-extubation respiratory failure (PERF) is a common event associated with significant morbidity and mortality. We hypothesized that a comprehensive protocol for ventilator weaning and extubation would be effective for preventing PERF and reintubation and reducing mortality in critically ill patients. Methods A ventilator weaning and extubation protocol was developed. The protocol consisted of checklists across four evaluations: spontaneous breathing trial, extubation, prophylactic non-invasive positive pressure ventilation (NPPV), and evaluation after extubation. Observational data were collected after implementing the protocol in patients admitted to the Advanced Emergency and Critical Care Center of Shinshu University Hospital. Not only outcomes of patients but also influences of each component of the protocol on the clinical decision-making process were investigated. Further, a comparison between PERF and non-PERF patients was performed. Results A total of 464 consecutive patients received MV for more than 48 h, and 248 (77 women; mean age, 65 ± 17 years) were deemed eligible. The overall PERF and reintubation rates were 9.7% and 5.2%, respectively. Overall, 54.1% of patients with PERF received reintubation. Hospital stay and mortality were not significantly different between PERF and non-PERF patients (p = 0.16 and 0.057, respectively). As a result, the 28-day and hospital mortality were 1.2% and 6.9%, respectively. Conclusions We found that the rates of PERF, reintubation, and hospital mortality were lower than those in previous reports even with nearly the same degree of severity at extubation. The comprehensive protocol for ventilator weaning and extubation may prevent PERF and reintubation and reduce mortality in critically ill patients.