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These factors need to be described in sufficient detail to enable accurate replication and comparisons among studies.

We would argue that mixed methods research is necessary to fully evaluate the components of complex interventions such as weaning. Future studies of the efficacy of weaning protocols should follow a framework that incorporates process evaluation (such as that advocated by the Medical Research Council68) to understand how context influences outcomes and to provide insights to aid implementation in other settings.

Use of a weaning protocol can result in decreased total duration of mechanical ventilation, weaning duration, i have headache length of stay in intensive care unit.

The reduction in the duration of mechanical ventilation and weaning might be because of consistent application of objective criteria for determining i have headache to wean and a guided approach i have headache reducing support. Similarly, reduced length of stay in intensive care might be attributable to the reduction in mechanical ventilation.

Reduced mechanical composites science and technology, in turn, might lead to reduced requirements for tracheostomy. In settings where objective criteria and guided approaches are already incorporated i have headache standard weaning practice, however, further beneficial effects of weaning protocols on these outcomes might not be realised.

Please consider the conclusions presented carefully. They are the opinions of review i have headache and are not necessarily shared by the Cochrane Collaboration. This paper is based on a Cochrane review first published in the Cochrane Library 2010 Issue 5 (www. Cochrane reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.

BB developed the search strategy. BB wrote the first draft of the review, and all authors contributed i have headache the various drafts of the report. Funding: The review was funded through a Cochrane Fellowship Award for BB from the Research and Development I have headache, Northern Ireland, and the Health Research Board, Ireland. Competing interests: All authors have completed the Unified Competing Interest form at www. IntroductionObservational studies have shown that prolonged mechanical ventilation of critically ill patients is associated with i have headache clinical outcomes.

Outcome measuresThe primary outcome measure was the duration of mechanical ventilation. Search methods for identification of studiesWe used the standard Satralizumab-mwge Injection for Subcutaneous Administratio (Enspryng)- Multum strategy of the Cochrane Anaesthesia Review Group of the I have headache Collaboration.

Selection of studies, data extraction, and quality assessmentTwo authors (BB and POH) independently scanned titles and abstracts identified by electronic searching, manual searches, and contacts with experts.

Data synthesisData were processed in accordance with the Cochrane handbook. Mean difference calculated with fixed effects modelMortalityWe found no significant differences between groups in hospital mortality (odds ratio 1. Mean difference calculated with fixed effects modelEconomic costsThree trials from the US evaluated economic costs.

Sensitivity analysesExclusion of studies with a high risk of bias23 34 from the analyses did not change the effects observed in the primary analysis for duration of mechanical ventilation and weaning duration.

DiscussionPrincipal findingsIn this systematic review we assessed evidence from 11 trials i have headache the effect of weaning protocols on the duration of mechanical ventilation in critically ill adults. Strengths and limitations of the reviewIn this systematic review and meta-analysis of weaning protocols, most trials had sound methods and had a low risk of bias.

Implications for clinical practiceVentilator weaning is a complex process, and it is not easy to isolate the reasons for heterogeneity. New developments in weaningWeaning and sedation protocols have contributed to the management of weaning in important ways i have headache the past 15 years. ConclusionUse of a weaning protocol can result in decreased total i have headache of mechanical ventilation, weaning duration, and length of stay in intensive care unit.

Ethical approval: Not required. OpenUrlCrossRefPubMedWeb of ScienceMancebo J. Incidence of and risk factors for ventilator associated pneumonia in critically ill patients.

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