Automated systems may result in clinically meaningful reduced durations of weaning, ventilation and ICU stay.

Overall, these systems appear to be safe and can be considered a reasonable approach in the management of ventilator weaning.

These potential reductions are more likely to occur in mixed/medical as opposed to surgical ICU populations and with Smartcare/PS.

Due to limited evidence on automated systems other than Smartcare/PS and ASV no conclusions can be drawn regarding their influence on outcomes.

The method of weaning to which automated systems was compared (protocolized or non-protocolized usual care) did not influence the effect on weaning duration.

Due to substantial heterogeneity in trials reporting weaning duration we believe there is a need for an adequately powered, high quality, multi-centre trial in an adult patient population that excludes patients classified as “simple to wean” with detailed description of ICU organizational characteristics and weaning/sedation strategies in the comparator arm as these may be contributing to clinical heterogeneity.

As little data exists on other automated systems and ASV in prolonged weaning, we are cautious to recommend which should be selected for investigation.

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