The Efficacy Of Respiratory Therapist-Led Protocols In Reducing Mechanical Ventilation Duration: A Systematic Review
Abstract
Background: Mechanical ventilation (MV) is a cornerstone intervention in critical care medicine, providing life-sustaining support for patients with acute respiratory failure. However, prolonged MV is associated with significant morbidity, including ventilator-associated pneumonia (VAP), ventilator-induced diaphragm dysfunction (VIDD), and increased mortality. The weaning process—the transition from mechanical support to spontaneous breathing—consumes approximately 40% to 50% of the total duration of ventilation. Traditional physician-directed weaning is often characterized by variability, delays in recognition of weaning readiness, and prolonged "dead time" where patients remain ventilated despite physiological recovery. Respiratory Therapist (RT)-led protocols have been proposed as a mechanism to standardize care, reduce variability, and accelerate liberation from MV.
Objectives: This systematic review evaluates the efficacy of RT-led weaning protocols compared to physician-directed usual care in reducing the total duration of mechanical ventilation, weaning duration, and intensive care unit (ICU) length of stay (LOS). Secondary objectives include assessing safety outcomes (reintubation rates, mortality) and adverse events (VAP).
Methods: A systematic review was conducted adhering to PRISMA guidelines. The PICO framework defined the eligibility criteria: Population (critically ill adults), Intervention (RT-led/driven protocols), Comparison (physician-directed/usual care),…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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