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Mechanical ventilation (MV) is a critical intervention for critically ill patients in intensive care units (ICUs). However, extended durations of MV are associated with adverse outcomes such as prolonged ICU stays, elevated mortality rates, and increased health-care costs. To address these challenges, nurse-led weaning protocols have been identified to be a promising strategy for enhancing the weaning process. This approach leverages the advantages of nurses' closer patient monitoring and more stringent adherence to protocols relative to physicians.
This systematic review and meta-analysis evaluated the safety and efficacy of nurse-led weaning protocols compared with physician-directed weaning, specifically in terms of reducing MV duration and improving patient outcomes in ICU settings.
A comprehensive search of databases was conducted to identify randomized controlled trials (RCTs) that compared nurse-led weaning protocols with physician-directed weaning. A total of 6 RCTs met the inclusion criteria, encompassing 1278 patients across various countries. Data on MV duration, failed weaning rates, in-hospital mortality, and ICU length of stay were extracted and analyzed using meta-analytic techniques.
The meta-analysis revealed that nurse-led weaning protocols significantly reduced MV duration by 8% to 45% across the included studies. However, no significant differences were observed in the rates of failed weaning (risk ratio [RR]: 0.96; 95% confidence interval [CI] [0.63, 1.47]; p = 0.86) or in-hospital mortality (RR: 1.06; 95% CI [0.85, 1.33]; p = 0.58). Additionally, patients in the nurse-led group experienced a shorter ICU length of stay, with a standardized mean difference of 0.62 (p < 0.01).
Nurse-led weaning protocols are a safe and effective strategy for reducing MV duration without compromising patient safety. The implementation of these protocols has the potential to enhance ICU operational efficiency and reduce health-care costs, thereby reinforcing the critical role of nurses in leading interventions in critical care environments.
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