Mechanical ventilation weaning protocols in critically ill adults and children: barriers and facilitators
Citation: Jordan J, Rose L, Dainty KN, et al. Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative evidence-synthesis. Cochrane Database of Systematic Reviews 2016; (10): CD011812
What is this? Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU). Various methods are used to help wean patients off MV.
In this Cochrane qualitative synthesis, the authors searched for qualitative research into barriers and facilitators that impact on the use of MV weaning protocols in critically ill adults and children. They did not restrict by date, type or language of publication status and did their searches up to July 2016. They identified 11 eligible studies.
What works: Weaning protocols need to take account of the social and cultural environment in which they will be implemented.
Weaning protocols need to accommodate the complexities of clinical practice found in the ICU environment.
Comprehensive inter-professional input will help to ensure broad-based understanding and a sense of ownership of weaning protocols.
Training of all relevant ICU staff will help with implementation of weaning protocols.
Protocols should be designed with the patient profile and requirements of the target ICU in mind.
What doesn’t work: In some circumstances, doctors prefer to wean using their own knowledge and skills rather than a protocol.
Marginalization of junior staff from weaning (by themselves and by physicians) militated against them gaining the experience they and their senior colleagues prioritized.
An under-resourced ICU will impact adversely on protocol implementation.
What’s uncertain: Nothing noted.
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