title: Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children: a cochrane systematic review and meta-analysis.
abstract: BACKGROUND
  Automated weaning systems may improve adaptation of mechanical support for a patient's ventilatory needs and facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of ventilation. Our objective was to compare mechanical ventilator weaning duration for critically ill adults and children when managed with automated systems versus non-automated strategies. Secondary objectives were to determine differences in duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), mortality, and adverse events.
  
  
  METHODS
  Electronic databases were searched to 30 September 2013 without language restrictions. We also searched conference proceedings; trial registration websites; and article reference lists. Two authors independently extracted data and assessed risk of bias. We combined data using random-effects modelling.
  
  
  RESULTS
  We identified 21 eligible trials totalling 1,676 participants. Pooled data from 16 trials indicated that automated systems reduced the geometric mean weaning duration by 30% (95% confidence interval (CI) 13% to 45%), with substantial heterogeneity (I(2) = 87%, P <0.00001). Reduced weaning duration was found with mixed or medical ICU populations (42%, 95% CI 10% to 63%) and Smartcare/PS (28%, 95% CI 7% to 49%) but not with surgical populations or using other systems. Automated systems reduced ventilation duration with no heterogeneity (10%, 95% CI 3% to 16%) and ICU LOS (8%, 95% CI 0% to 15%). There was no strong evidence of effect on mortality, hospital LOS, reintubation, self-extubation and non-invasive ventilation following extubation. Automated systems reduced prolonged mechanical ventilation and tracheostomy. Overall quality of evidence was high.
  
  
  CONCLUSIONS
  Automated systems may reduce weaning and ventilation duration and ICU stay. Due to substantial trial heterogeneity an adequately powered, high quality, multi-centre randomized controlled trial is needed.
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. louise.rose@utoronto.ca.|Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, Ontario, M5T IP8, Canada. louise.rose@utoronto.ca.|Provincial Centre of Weaning Excellence, Toronto East General Hospital, Toronto, Canada. louise.rose@utoronto.ca.|Li Ka Shing Institute, St Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada. louise.rose@utoronto.ca.|West Park Healthcare Centre, University of Toronto, 155 College St, Toronto, Ontario, M5T IP8, Canada. louise.rose@utoronto.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. marcus.j.schultz@gmail.com.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.affiliation: Centre for Public Health, Queen's University Belfast, University Rd, Belfast, BT7 1NN, UK. c.cardwell@qub.ac.uk.
authors.forename: Chris R
authors.initials: CR
authors.lastname: Cardwell
authors.affiliation: Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. philippe.jouvet@umontreal.ca.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jouvet
authors.affiliation: Regional Intensive Care Unit, Royal Victoria Hospital, Centre for Infection and Immunity, Queen's University of Belfast, University Rd, Belfast, BT7 1NN, UK. d.f.mcauley@qub.ac.uk.
authors.forename: Danny F
authors.initials: DF
authors.lastname: McAuley
authors.affiliation: Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, University Rd, Belfast, BT7 1NN, UK. b.blackwood@qub.ac.uk.
authors.forename: Bronagh
authors.initials: B
authors.lastname: Blackwood
mesh_terms: D000328:Adult; D060666:Airway Extubation; D001331:Automation; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*