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...
| Publicado en: | Nursing in Critical Care Vol. 31; no. 5; pp. 1 - 18 |
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| Autores principales: | , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Wiley-Blackwell
Sep2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=197253704&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 197253704 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13621017 Q15 jtl: Nursing in Critical Care issn: 13621017 maglogo: Y pubinfo: dt: Sep2026 vid: 31 iid: 5 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 197253704 10.1111/nicc.70670 197253704 ppf: 1 ppct: 17 formats: tig: atl: Best Available Evidence on Weaning and Extubation in Mechanically Ventilated Neurocritical Care Patients: An Evidence Summary. aug: au: Hong, Yuezhen Wang, Meixin Zhang, Chenxing Arbing, Rachel H. A. Chen, Wei‐Ti Han, Xuanye Huang, Feifei affil: School of Nursing, Fujian Medical University, Fuzhou, China sug: ab: 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. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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