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Protocolized Weaning From Mechanical Ventilation in the PICU: A Systematic Review and Meta-Analysis
Letícia Nascimento Machado1, Humberto Magalhães Silva1, Isabel de Siqueira Ferraz1
1Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
Pediatric Pulmonology
|May 26, 2026
Summary
Protocolized weaning may shorten invasive mechanical ventilation (IMV) duration in pediatric intensive care units (PICUs). However, evidence quality is low due to bias and heterogeneity, requiring further research.
Area of Science:
- Pediatric Critical Care Medicine
- Mechanical Ventilation
- Evidence-Based Practice
Background:
- Standardized weaning protocols for invasive mechanical ventilation (IMV) are common in adult ICUs.
- Evidence for IMV weaning protocols in pediatric intensive care units (PICUs) is limited and inconsistent.
Purpose of the Study:
- To assess the impact of protocolized weaning versus usual care on clinical outcomes in PICUs.
- To synthesize evidence from randomized controlled trials (RCTs) and non-randomized studies.
Main Methods:
- Systematic review and meta-analysis of RCTs and non-randomized interventional studies.
- Searched major databases (PubMed, Embase, Cochrane Library, ClinicalTrials.gov) through July 2025.
- Assessed risk of bias using RoB 2 and ROBINS-I tools.
Main Results:
- Seventeen studies (16,805 pediatric patients) were included.
- Protocolized weaning showed a trend toward reduced IMV duration in RCTs (non-significant) and a significant reduction in non-randomized studies.
- Combined analysis revealed a significant reduction in IMV duration (MD: -20.86 h; p=0.001); PICU length of stay also decreased overall.
- No significant differences in hospital LOS, extubation failure, or mortality; RCT evidence remains inconclusive.
Conclusions:
- Protocolized weaning is associated with shorter mechanical ventilation duration in pediatric patients.
- The certainty of evidence is low due to high risk of bias and heterogeneity.
- Further high-quality research is needed to confirm findings.
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