Mechanical ventilation management and ICU workflows: a systematic review of clinical practices led by ICU respiratory therapists and respiratory care education supervisors

Background: Mechanical ventilation requires adjustment, timely liberation assessment, and coordination in intensive care unit teams. Respiratory therapists occupy important operational position, while respiratory care education supervisors influence protocol competence, audit readiness, and practice consistency. This review evaluated therapist-led clinical practices for improving ventilation management and intensive care outcomes. Methods: A systematic review framework followed PRISMA principles. PubMed, Scopus, Web of Science Core Collection, and Cochrane sources were searched for adult or pediatric intensive care studies evaluating respiratory therapist-led ventilation protocols, liberation pathways, standardized order sets, ventilator bundles, or structured competency support. Eligible studies reported clinical, process, safety, or implementation outcomes. Results: Thirteen studies published between 1995 and 2024 were included. Therapist-led protocols shortened ventilation or weaning time, accelerated spontaneous breathing assessment, improved adherence to lung-protective targets, and strengthened protocol execution. Several studies reported unchanged mortality, reintubation, intensive care length of stay, or total ventilation duration, especially where baseline staffing was strong or protocol adherence was limited. Education, repeated feedback, electronic decision support, and clearly delegated authority were prominent implementation components. Conclusion: Respiratory therapist-led ventilation management improves workflow reliability and selected clinical outcomes without consistent evidence of harm. Effects depend on local staffing, protocol fidelity, multidisciplinary agreement, and ongoing competency supervision. Respiratory care education supervisors provide infrastructure for training, performance feedback, and sustained implementation.