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Ventilation-Weaning Protocols in Children Admitted to Pediatric Intensive Care Units: Systematic Review of Randomized

Suzana C Almeida1, Rayany C de Souza2, Ingrid G Azevedo3

  • 1Graduate Program in Physiotherapy, Physical Education and Physiotherapy School, Universidade Federal de Uberlândia, Uberlândia, Brazil.

Pediatric Pulmonology
|December 22, 2025
PubMed

Insights

Implementing ventilator weaning protocols in pediatric intensive care units may shorten invasive mechanical ventilation duration and hospital stay. However, evidence for reducing extubation failure or mortality remains limited and requires further high-quality studies.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Therapy
  • Evidence-Based Medicine

Background:

  • Mechanical ventilation is a critical support in Pediatric Intensive Care Units (PICUs).
  • Optimizing ventilator weaning is essential for patient recovery and resource management.
  • Current practices vary, necessitating evaluation of standardized protocols.

Purpose of the Study:

  • To assess the efficacy of ventilator weaning protocols in reducing invasive mechanical ventilation (IMV) duration.
  • To evaluate the impact of these protocols on Pediatric Intensive Care Unit (PICU) and hospital length of stay (LOS).
  • To determine the effect on extubation failure rates and mortality in pediatric patients.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials was conducted.
  • Searches were performed across major databases including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Central.
  • Studies comparing weaning protocols to usual care in a PICU setting were selected, with risk of bias and certainty of evidence assessed.

Main Results:

  • Seven trials involving 11,742 patients were analyzed.
  • Weaning protocols and automated computer-driven weaning significantly shortened IMV duration (moderate-certainty evidence).
  • A sedation plus ventilation protocol reduced hospital LOS in children with respiratory disease, but no significant differences were found for PICU LOS, extubation failure, or mortality.

Conclusions:

  • Limited evidence suggests that specific ventilator weaning protocols can decrease IMV duration and hospital stay in pediatric patients.
  • The effectiveness of these protocols in preventing extubation failure or reducing mortality is not yet established.
  • High-quality research is needed to confirm the safety and efficacy of weaning protocols, as current evidence is based on low-certainty findings.
Abstract

Keywords:
airway extubationclinical protocolsintensive care unitspediatricrandomized controlled trialventilator weaning

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