Best Available Evidence on Weaning and Extubation in Mechanically Ventilated Neurocritical Care Patients: An Evidence Summary.

BACKGROUND

Weaning and extubation in neurocritical care are high - risk decisions complicated by impaired consciousness and airway - protection challenges and practice guidance remains fragmented.

AIMS: To map, evaluate and synthesize the available evidence on weaning and extubation management for neurocritical care patients receiving mechanical ventilation.

STUDY

DESIGN

This study was designed as an evidence summary and conducted according to the methodological standards for evidence summaries established by the Fudan University Evidence - Based Nursing Center. Twenty - seven information sources were searched from inception to 7 June 2025, including clinical decision support systems, guideline repositories, professional association websites, evidence-based practice platforms and speciality databases. Eligible evidence included guidelines/manuals, evidence summaries, expert consensus, systematic reviews and randomized controlled trials. The evidence summary was registered with the Fudan University Evidence - Based Nursing Center and guided by the 6S evidence pyramid. Quality appraisal, evidence extraction, synthesis and grading were conducted using evidence type-specific tools and a pre-established evidence grading system.

RESULTS

Seventeen studies met the inclusion criteria and quality requirements. Thirty - two pieces of evidence were synthesized into six domains: functional rehabilitation and training interventions; airway protection and secretion management; swallowing and phonation training; weaning/extubation decision - making and peri - extubation management; sedation management and consciousness support; and risk factors and predictors of extubation failure.

CONCLUSIONS

This study consolidated 32 pieces of evidence on weaning and extubation in neurocritical care, providing a structured synthesis while highlighting uneven evidence quality and uncertain feasibility in resource - limited settings.

RELEVANCE TO CLINICAL PRACTICE: Clinicians should prioritize positioning, early rehabilitation, artificial airway management and secretion clearance, while combining evidence with expert consensus and tailoring implementation to patient status and local resources.