Ventilatory weaning: systematic review
DOI:
https://doi.org/10.56294/saludcyt202291%20Keywords:
Ventilator Weaning, Mechanical Ventilation, Mechanical Ventilator, Intensive Care UnitsAbstract
Introduction: mechanical ventilation is a life support treatment, in which using a machine that provides ventilatory and oxygen support, we facilitate gas exchange and work of breathing in patients with respiratory failure.
Aim: we propose to systematically review the literature with the highest level of evidence on weaning from mechanical ventilatory support.
Methods: the PRISMA method was used during the writing of this review.
Results: 957 references were found, of which 909 were eliminated because they were not empirical articles, did not address the aim of the review, or did not have the full text. Finally, 48 articles were included. The evidence indicates that the use of standardized weaning protocols or guidelines helps to decrease the total duration (days) of mechanical ventilation by an average of 25 %.
Conclusions: optimal management of mechanical ventilation and weaning requires a dynamic and collaborative decision to minimize complications and avoid delays in the extubation transition, so we must take into account several factors, such as the initial intubation facility, the patient's medical condition, the environment within which extubation will take place, the team acting in that process
References
1. Schreiber AF, Ceriana P, Ambrosino N, Malovini A, Nava S. Physiotherapy and Weaning From Prolonged Mechanical Ventilation. Respir Care 2019;64:17-25. https://doi.org/10.4187/respcare.06280.
2. Muñoz FG. Ventilación mecánica. ACTA MEDICA PERUANA 2011;28:87-104.
3. Hernández-López GD, Cerón-Juárez R, Escobar-Ortiz D, Graciano-Gaytán L, Gorordo-Delsol LA, Merinos-Sánchez G, et al. Retiro de la ventilación mecánica. Medicina crítica (Colegio Mexicano de Medicina Crítica) 2017;31:238-45.
4. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Revista Española de Cardiología 2021;74:790-9. https://doi.org/10.1016/j.recesp.2021.06.016.
5. Wilcox SR, Strout TD, Schneider JI, Mitchell PM, Smith J, Lutfy-Clayton L, et al. Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation. West J Emerg Med 2016;17:271-9. https://doi.org/10.5811/westjem.2016.2.29517.
6. Kapitan KS. Ventilatory failure. Can you sustain what you need? Ann Am Thorac Soc 2013;10:396-9. https://doi.org/10.1513/AnnalsATS.201305-132OT.
7. Walter JM, Corbridge TC, Singer BD. Invasive Mechanical Ventilation. South Med J 2018;111:746-53. https://doi.org/10.14423/SMJ.0000000000000905.
8. Muñoz V, Calvo L, Ramírez MF, Arias M, Villota M, Wilches-Luna EC, et al. Ventilatory weaning practices in intensive care units in the city of Cali. Rev Bras Ter Intensiva 2014;26:137-42. https://doi.org/10.5935/0103-507X.20140020.
9. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994;150:896-903. https://doi.org/10.1164/ajrccm.150.4.7921460.
10. Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995;332:345-50. https://doi.org/10.1056/NEJM199502093320601.
11. Esteban A, Alía I, Ibañez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest 1994;106:1188-93. https://doi.org/10.1378/chest.106.4.1188.
12. Blackwood B, Alderdice F, Burns KE, Cardwell CR, Lavery G, O’Halloran P. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. Cochrane Database Syst Rev 2010:CD006904. https://doi.org/10.1002/14651858.CD006904.pub2.
13. Saeed F, Lasrado S. Extubation. StatPearls, Treasure Island (FL): StatPearls Publishing; 2022.
14. Baptistella AR, Sarmento FJ, da Silva KR, Baptistella SF, Taglietti M, Zuquello RÁ, et al. Predictive factors of weaning from mechanical ventilation and extubation outcome: A systematic review. J Crit Care 2018;48:56-62. https://doi.org/10.1016/j.jcrc.2018.08.023.
15. Bernardes Neto SCG, Torres-Castro R, Lima Í, Resqueti VR, Fregonezi GAF. Weaning from mechanical ventilation in people with neuromuscular disease: a systematic review. BMJ Open 2021;11:e047449. https://doi.org/10.1136/bmjopen-2020-047449.
16. da Silva AR, Novais MCM, Neto MG, Correia HF. Predictors of extubation failure in neurocritical patients: A systematic review. Aust Crit Care 2022:S1036-7314(21)00173-9. https://doi.org/10.1016/j.aucc.2021.11.005.
17. Duan J, Zhang X, Song J. Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis. Crit Care 2021;25:357. https://doi.org/10.1186/s13054-021-03781-5.
18. Dupuis S, Brindamour D, Karzon S, Frenette AJ, Charbonney E, Perreault MM, et al. A systematic review of interventions to facilitate extubation in patients difficult-to-wean due to delirium, agitation, or anxiety and a meta-analysis of the effect of dexmedetomidine. Can J Anaesth 2019;66:318-27. https://doi.org/10.1007/s12630-018-01289-1.
19. Ghauri SK, Javaeed A, Mustafa KJ, Khan AS. Predictors of prolonged mechanical ventilation in patients admitted to intensive care units: A systematic review. Int J Health Sci (Qassim) 2019;13:31-8.
20. Hirzallah FM, Alkaissi A, do Céu Barbieri-Figueiredo M. A systematic review of nurse-led weaning protocol for mechanically ventilated adult patients. Nurs Crit Care 2019;24:89-96. https://doi.org/10.1111/nicc.12404.
21. Kampolis CF, Mermiri M, Mavrovounis G, Koutsoukou A, Loukeri AA, Pantazopoulos I. Comparison of advanced closed-loop ventilation modes with pressure support ventilation for weaning from mechanical ventilation in adults: A systematic review and meta-analysis. J Crit Care 2022;68:1-9. https://doi.org/10.1016/j.jcrc.2021.11.010.
22. Li C, Li X, Han H, Cui H, Wang G, Wang Z. Diaphragmatic ultrasonography for predicting ventilator weaning: A meta-analysis. Medicine (Baltimore) 2018;97:e10968. https://doi.org/10.1097/MD.0000000000010968.
23. Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and Lung Ultrasound to Predict Weaning Outcome: Systematic Review and Meta-Analysis. Chest 2017;152:1140-50. https://doi.org/10.1016/j.chest.2017.08.028.
24. Neuschwander A, Chhor V, Yavchitz A, Resche-Rigon M, Pirracchio R. Automated weaning from mechanical ventilation: Results of a Bayesian network meta-analysis. J Crit Care 2021;61:191-8. https://doi.org/10.1016/j.jcrc.2020.10.025.
25. Torrini F, Gendreau S, Morel J, Carteaux G, Thille AW, Antonelli M, et al. Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis. Crit Care 2021;25:391. https://doi.org/10.1186/s13054-021-03802-3.
26. Trudzinski FC, Neetz B, Bornitz F, Müller M, Weis A, Kronsteiner D, et al. Risk Factors for Prolonged Mechanical Ventilation and Weaning Failure: A Systematic Review. Respiration 2022;101:959-69. https://doi.org/10.1159/000525604.
27. Worraphan S, Thammata A, Chittawatanarat K, Saokaew S, Kengkla K, Prasannarong M. Effects of Inspiratory Muscle Training and Early Mobilization on Weaning of Mechanical Ventilation: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil 2020;101:2002-14. https://doi.org/10.1016/j.apmr.2020.07.004.
28. Yeung J, Couper K, Ryan EG, Gates S, Hart N, Perkins GD. Non-invasive ventilation as a strategy for weaning from invasive mechanical ventilation: a systematic review and Bayesian meta-analysis. Intensive Care Med 2018;44:2192-204. https://doi.org/10.1007/s00134-018-5434-z.
29. Yuan X, Lu X, Chao Y, Beck J, Sinderby C, Xie J, et al. Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis. Crit Care 2021;25:222. https://doi.org/10.1186/s13054-021-03644-z.
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