Weaning protocol to reduce mechanical ventilation time in children admitted to pediatric intensive care units: Protocol for a Systematic Review and Meta-Analysis

Abstract Background Invasive Mechanical ventilation (IMV) is necessary for most Pediatric Intensive Care Units (PICU) patients. Although it is a complex process, weaning should be performed as soon as possible due to the adverse effects of IMV. This review aims to identify whether the use of a weaning protocol in a PICU, compared to usual care, can reduce the duration of IMV, length of stay in the PICU, mortality, and adverse events in children. Methods The strategy review and selective reports were developed using the population, intervention, comparison, outcome, and study design (PICOS) format. PUBMED, EMBASE, CINHAL, Web of Science, Cochrane Central Register of Controlled Trials, International Clinical Trials Registration Platform, and gray literature will be systematically searched for randomized controlled trials (RCTs). The studies’ methods should have been compared to protocol and nonprotocol weaning in children older than 28 days and younger than 18 years old, assisted at the PICU, and mechanically ventilated through an endotracheal tube. The risk of bias will be evaluated using the Cochrane Risk of Bias Tool for Randomized Trials. A meta-analysis will be conducted to compare the differences in the outcomes if at least two studies are sufficiently homogeneous concerning participants, interventions, and outcome measures. Subgroup analyses will also be performed looking for protocol type, indication for IMV, clinical condition, and age group differences. Discussion The results will synthesize the weaning protocol in a PICU and compare it to usual care to provide information to guide the pediatric intensivist therapist in weaning children from mechanical ventilation. Systematic review registration: PROSPERO CRD42023399650.