Nurse-Led Weaning Protocols: A Systematic Review and Meta-Analysis

Yingying Wang¹Yan Wang²Su Gu³Liqun Zhu²Ruixiao Jia⁴Min Tan^5*Shaoyong Ma^6*

• ¹First Affiliated Hospital of Wannan Medical College, Wuhu, China
• ²Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu Province, China
• ³Yancheng clinical medical College of jiangsu University, Zhenjiang, Jiangsu Province, China
• ⁴Zhejiang Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, Zhejiang, China
• ⁵Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
• ⁶Wannan Medical College, Wuhu, Anhui Province, China

Background: Studies have demonstrated that protocol-directed weaning reduces the duration of mechanical ventilation (MV). It has been suggested that nurse-led weaning protocols reduce the duration of MV in patients. Nevertheless, the implementation of nurse-led weaning protocols in mechanically ventilated patients is not widespread and their clinical effectiveness remains uncertain.To explore the effectiveness of nurse-led weaning protocols in mechanically ventilated patients relative to physician-led weaning.: Eleven electronic databases (PubMed, Embase, Cochrane Library, CINAHL, EBSCO, Scopus, Web of Science, Sino Med, CNKI, VIP, and Wanfang) were systematically searched from their inception to January 20, 2024. Two researchers conducted literature search and data extraction independently. We performed all statistical analyses using RevMan 5.1. The certainty of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) profiler Guideline Development Tool.Results: Our analysis included a total of six relevant studies. The analysis of pooled data revealed that nurse-led weaning protocols were associated with a significant reduction in the duration of MV (MD = -1.78 days, 95% CI = -3.08 to -0.48, I 2 = 82%, and P = 0.007; 5 studies; moderate quality), length of stay (LOS) in the intensive care unit (ICU) (MD = -2.04 days, 95% CI = -2.65 to -1.44, I 2 = 0%, and P < 0.00001; 5 studies; moderate quality), and LOS (MD = -2.54 days, 95% CI = -3.95 to -1.14, I 2 = 0%, and P = 0.0004; 3 studies; low quality). Furthermore, nurse-led weaning protocols were associated with a reduced incidence of ventilator-associated pneumonia (VAP) (OR = 0.54, 95% CI = 0.31 to 0.96, I 2 = 0%, and P = 0.03; 2 studies; moderate quality).Current evidence indicates that nurse-led weaning protocols have the potential to decrease the duration of MV, ICU LOS, LOS, and incidence of VAP in mechanically ventilated patients. However, these findings should be interpreted with caution due to the moderate-to-low quality of evidence and the limited number of available studies. Further high-quality, large-scale research is needed to confirm the effectiveness and safety of nurse-led weaning protocols in diverse clinical settings.