| Sumario: | 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. Impact Statements: What is known about the topic: ○Weaning and extubation in neurocritical care carry a high risk of failure because neurological impairment, such as reduced consciousness, weak cough and dysphagia, compromises airway protection.○Extubation failure and reintubation are associated with longer mechanical ventilation and worse ICU outcomes in brain ‐ injured populations.○Existing guidance is fragmented and often extrapolated from general ICU populations, with limited neurocritical‐specific, practice ‐ ready recommendations.What this paper adds: ○Provides an integrated evidence summary on weaning and extubation management for mechanically ventilated neurocritical care patients.○Consolidates 32 pieces of evidence across 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○Highlights implementation priorities and evidence gaps, including uneven evidence quality, limited neurocritical ‐ specific trials and uncertain feasibility in resource‐constrained settings.
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