The usefulness of protocols for reducing the time newborn infants spend on mechanical ventilation in the neonatal intensive care unit

Wielenga et al, 21 March 2016, Cochrane review

Review question: Are protocols useful for reducing the time newborn infants spend on mechanicalventilation in the neonatal intensive care unit?

Background: Mechanical ventilation is used to help newborns to breath when they are too sick or born too premature to breath on their own. However, mechanical ventilation is not without risk, and can cause (permanent) damage to the lungs. For example, the pressure needed to fill the lungs with air may destroy the very fragile air sacs, and result in scaring of the lungs. For this reason, it is important to recognize when a newborn is mature and strong enough to start breathing for himself/herself, and to reduce (wean) the ventilator support. There is, unfortunately, no current agreement on the best way to wean newborns off the ventilator. Researchers have studied the usefulness of standardized protocols to guide the process of weaning off theventilator in adults and children. In adults, 17 studies of weaning protocols have shown benefit in helping the doctors and nurses wean adults off the ventilator in a safe and timely manner. In children, three studies of weaning protocols have shown they are beneficial in reducing time on the ventilator, but the studies were too few to show harms. As yet, we do not know if weaning protocols in neonates provide benefits or harms. However, these standardized protocols have supplied us with firm evidence for their usefulness in weaning from mechanical ventilation in the care of children. Key results :We found no studies that involved newborn infants before the 28th day of life. We found two studies with a subpopulation of newborns, but we were not able to extract the data from this subgroup out of the total group studied.

Authors’ conclusions: Based on the results of this review, there is no evidence to support or refute the superiority or inferiority of weaning by protocol over non-protocol weaning on duration of invasive mechanical ventilation in newborn infant