Pairing spontaneous awakening and breathing trials to improve weaning of intensive care unit patients: A Systematic Review Protocol

Abstract

Abstract:
 Background: The ICU nursing role is to minimize the agitation and suffering experienced by mechanically ventilated sedated patients while facilitating effective and safe clinical care, seeking to optimize outcomes for service users and health systems. This can be achieved with bundled EBP interventions. One care bundle for those patients is the “Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility” (ABCDEF) bundle. It deploys tailored, patient-centered pharmacological and non-pharmacological therapies for implementation in ward management and clinical practice. It seeks to shatter the paradigm of extended mechanical ventilation and associated sedation for ICU patients by guiding clinical decision-making and interventions algorithmically. 
 Method: Randomized controlled studies will be included for the present systematic review with adult and pediatric patients who have been managed using the Awakening and Breathing Coordination protocol compared to the routine care in the ICUs. The Cochrane Library (Wiley), MEDLINE (PubMed), Scopus, and Web of Science electronic databases will be searched for articles published in English. The clinical outcomes of interest include successful weaning, incidence/prevalence of VAP, sedation level, and reduced stay in the ICU/hospital stay time. The reviewers will independently extract data with a standard form, recording observations concerning the reviewed studies’ research design, population, clinical interventions and outcomes, and techniques of data collection and analysis. Their independent findings will then be compared to check for consistency, and in the event of contrasting findings or interpretations, a third-party research expert will arbitrate.
 Results: The evidence from this review would particularly assist nursing decision-making on using spontaneous awakening trials and spontaneous breathing trials in combination for ventilated patients.
 Conclusion: The results could drive evidence-based practice to improve the quality of care for mechanically ventilated sedated patients in ICUs by building on the safety and clinical effectiveness of Randomized controlled trials.
 Protocol registration: PROSPERO CRD42022344884