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.