A systematic review of nurse‐led weaning protocol for mechanically ventilated adult patients

Abstract

Objectives The aim of this systematic review is to synthesize the current best evidence for the effectiveness of weaning protocols led by nurses compared with usual physician‐led care. Background Protocol‐directed weaning has been shown to reduce the duration of mechanical ventilation. Studies have reported that a weaning protocol administered by nurses leads to a reduction in the duration of mechanical ventilation and has a major effect on weaning outcomes. This can have especially positive consequences for critically ill patients. Study design Systematic review with meta‐analysis. Search strategy The databases CINAHL, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from as far back as the database allowed until January 2016. Inclusion and exclusion criteria Searches were performed to identify the best available evidence including quantitative studies of nurse‐led weaning protocols for mechanically ventilated adult patients. We excluded all studies of weaning protocols implemented by non‐nurses and non‐invasive mechanical ventilation and studies that addressed patient populations younger than 18 years of age. Results The database searches resulted in retrieving 369 articles. Three eligible studies with a total of 532 patients were included in the final review. Pooled data showed a statistically significant difference in favour of the nurse‐led weaning protocol for reducing the duration of mechanical ventilation (mean differences = −1.69 days, 95% confidence interval = −3.23 to 0.16), intensive care unit length of stay (mean differences = −2.04 days, 95% confidence interval = −2.57 to −1.52, I2 = 18%, and p = 0.00001); and hospital length of stay (mean differences = −2.9 days, 95% confidence interval = −4.24 to −1.56, I2 = 0%, and p = 0.00001). Conclusion There is evidence that the use of nurse‐led weaning protocols for mechanically ventilated adult patients has a positive impact on weaning outcomes and patient safety. Relevance to clinical practice This review provides evidence supporting intensive care unit nurses' crucial role and abilities to lead weaning from mechanical ventilation.

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“…Protocol-directed weaning remains widely established practice and is effective in safely reducing the length of time patients continue on mechanical ventilation. However, whether there are differences in beneficial outcomes when weaning protocols are led by nurses compared with physicians was the research question investigated by Hirzallah et al (2019). In their systematic review of the literature, Hirzallah et al (2019) initially identified 369 papers, of which only three studies, involving 532 patients, met the criteria for inclusion for final analysis.…”

“…However, whether there are differences in beneficial outcomes when weaning protocols are led by nurses compared with physicians was the research question investigated by Hirzallah et al (2019). In their systematic review of the literature, Hirzallah et al (2019) initially identified 369 papers, of which only three studies, involving 532 patients, met the criteria for inclusion for final analysis. Pooled data analysis identified statistically significant differences supporting nurse-led weaning protocols with respect to the length of time patients were on mechanical ventilation, duration of ICU stay and length of hospitalization when compared with physician-led weaning protocols.…”

“…However, whether there are differences in beneficial outcomes when weaning protocols are led by nurses compared with physicians was the research question investigated by Hirzallah et al . (). In their systematic review of the literature, Hirzallah et al .…”

“…Pooled data analysis identified statistically significant differences supporting nurse‐led weaning protocols with respect to the length of time patients were on mechanical ventilation, duration of ICU stay and length of hospitalization when compared with physician‐led weaning protocols. While these results are encouraging and highlight the impact that critical care nurses can have patient outcomes, Hirzallah et al's () caution against wholesale adoption is warranted as their analysis demonstrated wide variations across the protocol content and design, with some only being applicable to specific ICU populations.…”

Workforce and Task Sharing For Nurses in the Japanese Intensive Care Unit -Cross Sectional Postal Survey

“…Generally, the role of nurses tends to expand in the ICU. For example, previous study suggested that weaning from MV provided by nurses based on the protocol decreased the duration of MV [5]. Additionally, the titillate of sedative and analgesic agents by nurses decreases the duration of MV [6].…”