Weaning from mechanical ventilation in people with neuromuscular disease: a systematic review

• Published in: BMJ open 2021-09, Vol.11 (9), p.e047449-e047449
• Main Authors: Bernardes Neto, Saint Clair Gomes, Torres-Castro, Rodrigo, Lima, Íllia, Resqueti, Vanessa R, Fregonezi, Guilherme A F
• Format: Article
• Language: English
• Subjects: Acidosis; Adult; Amyotrophic lateral sclerosis; Child; Child, Preschool; Clinical trials; Congenital diseases; Continuous Positive Airway Pressure; Disease; Extubation; Hospitals; Humans; intensive & critical care; Intensive Care Units; Metabolism; Mortality; Muscular dystrophy; Myasthenia gravis; Neurology; neuromuscular disease; Neuromuscular diseases; Neuromuscular Diseases - complications; Neuromuscular Diseases - therapy; Ostomy; Patients; Respiration; Respiration, Artificial; respiratory medicine (see thoracic medicine); Success; Systematic review; Tracheotomy; Ventilator Weaning; Ventilators; Weaning
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-047449

ObjectiveThis systematic review aimed in assessing the effects of different weaning protocols in people with neuromuscular disease (NMD) receiving invasive mechanical ventilation, identifying which protocol is the best and how different protocols can affect weaning outcome success, duration of weaning, intensive care unit (ICU) and hospital stay and mortality.DesignSystematic review.Data sourcesElectronic databases (MEDLINE, EMBASE, Web of Science and Scopus) were searched from January 2009 to August 2020.Eligibility criteria for selecting studiesRandomised controlled trials (RCTs) and non-RCT that evaluated patients with NMD (adults and children from 5 years old) in the weaning process managed with a protocol (pressure support ventilation; synchronised intermittent mandatory ventilation; continuous positive airway pressure; ‘T’ piece).Primary outcomeWeaning success.Secondary outcomesWeaning duration, ICU stay, hospital stay, ICU mortality, complications (pneumothorax, ventilation-associated pneumonia).Data extraction and synthesisTwo review authors assessed the titles and the abstracts for inclusion and reviewed the full texts independently.ResultsWe found no studies that fulfilled the inclusion criteria.ConclusionsThe absence of studies about different weaning protocols for patients with NMD does not allow concluding the superiority of any specific weaning protocol for patients with NMD or determining the impact of different types of protocols on other outcomes. The result of this review encourages further studies.PROSPERO registration numberCRD42019117393.