Best Evidence Summary for Peri-Extubation Management Among Difficult-to-Wean Patients in the Intensive Care Unit

To systematically synthesize the best available domestic and international evidence regarding peri-extubation management among difficult-to-wean ICU patients, so as to offer evidence-based recommendations for routine clinical practice.

A systematic search was conducted across various domestic and international databases and websites, including Up To Date, National Institute of Health and Clinical Excellence (NICE), National Guideline Clearinghouse (NGC), Guideline International Network (GIN), Chinese Medical Journal Full-text Database, China National Knowledge Infrastructure (CNKI), Yimaitong, Wanfang Database, and VIP Database, to obtain the best evidence on peri-extubation management for ICU patients with difficult extubation, including guidelines, expert consensus documents, clinical decision-making materials, systematic reviews or meta-analyses, and randomized controlled trials (RCTs). The search period covered from the establishment of each database until March 2026. Literature quality assessment was independently performed by two researchers who have published evidence-based research articles and received professional evidence-based training, with expert input solicited; eligible literature was selected for evidence extraction and summarization.

This study ultimately included 23 publications, comprising 8 guidelines, 5 expert consensus documents, 8 systematic reviews, and 2 randomized controlled trials (RCTs). Through analysis, organization, and evidence synthesis of the included literature, evidence was summarized across seven key areas: multidisciplinary team (MDT) collaboration, pre-weaning preparation and assessment, comprehensive management strategies for difficult weaning, management of special patient populations, intubation removal strategies during weaning, post-intubation management strategies, and health education, encompassing 48 pieces of best available evidence.

This study summarizes the optimal evidence for peri-extubation management in patients with difficult weaning from seven perspectives, providing guidance for ICU clinicians to develop and implement tailored weaning protocols aimed at improving clinical outcomes and quality of life for these patients.