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