Non-invasive mechanical ventilation weaning protocols: a systematic review

ABSTRACT The aim of this study was to perform a systematic review of studies that investigated non-invasive ventilation (NIV) weaning protocols in adult or hospitalized elderly individuals. Through a systematic review based on the Prisma protocol, studies of eight databases published in Portuguese, English or Spanish were considered. The primary outcomes of this review were the success rate of NIV weaning, NIV duration and duration of intensive care unit (ICU) and hospital stay, and secondary endpoint were adverse events associated with protocols for NIV weaning. The methodological quality of clinical trials was assessed using the PEDro scale and for observational studies the Dows and Black scale. Four of the 18,476 initial references met the inclusion criteria and were included in this review. Two of the four articles were randomized clinical trials and two were observational studies. The studies assessed elderly patients with respiratory failure, mainly due to exacerbation of chronic obstructive pulmonary disease (COPD), and acute cardiogenic pulmonary edema. High weaning success rates were observed in three of the four studies, and one study demonstrated the superiority of implementing an immediate protocol for weaning to reduce NIV duration and ICU stay. However, because of the heterogeneity and poor methodological quality of the studies, it is not possible to make recommendations on the implementation of weaning protocols in this population.