SmartCare™ versus non-automated weaning strategies for weaning time in invasively ventilated critically ill adults

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this review is to compare weaning time (time from randomization to extubation as defined by study authors) between invasively ventilated critically ill adults weaned with SmartCare™ versus non‐automated weaning strategies. Our secondary objectives are to ascertain whether differences exist between the alternative weaning strategies and the following clinical outcomes: time to successful extubation (time from randomization to successful extubation as defined by study authors); time to first spontaneous breathing trial (SBT) and first successful SBT (time from randomization to first SBT and first successful SBT as defined by study authors); mortality (the most protracted duration and at time points reported by study authors); ventilator associated pneumonia (VAP) as defined by the study authors; total duration of ventilation (time from invasive ventilation initiation to extubation as defined by the study authors); intensive care unit (ICU) length of stay; use of non‐invasive ventilation (NIV) following extubation; adverse events (including but not limited to reintubation, self‐extubation, the requirement for tracheostomy, and prolonged ventilation as defined by the study authors); clinician acceptance of the alternative weaning strategies; hospital length of stay. The third objective of our review is to explore, using subgroup analyses, variation in weaning time, ICU length of stay, mortality, VAP, use of NIV, and reintubation by the type of (i) clinician primarily involved in implementing the SmartCare™ weaning strategy, (ii) ICU (as a reflection of the population involved) and (iii) non‐automated weaning strategy utilized. We plan to conduct a sensitivity analysis evaluating variation in weaning time based on the (iv) methodologic quality (low or moderate versus high risk of bias) of the included studies.