Evidence-based medicine summary of the best evidence for the management of airway humidification and oxygen therapy during the withdrawal phase in mechanically ventilated patients after tracheotomy in the adult ICU

To systematically integrate the best evidence on airway-humidification oxygen therapy strategies for adult ICU tracheostomy patients following mechanical ventilation weaning, and to provide a scientific basis for clinical management. Evidence-based questions were formulated using the PIPOST framework. Sixteen Chinese and English databases (e.g., PubMed, Cochrane and CNKI) and professional organization platforms were searched from inception to June 2026. Two researchers independently assessed the methodological quality of the included literature, with evidence extraction and synthesis conducted via evidence-synthesis group consensus meetings. Sixteen high-quality publications were included: 2 guidelines, 6 systematic reviews, 4 evidence summaries, and 4 expert consensuses. We extracted 44 recommendations across 8 domains (e.g., target population, device selection, protocol adjustment) using the JBI evidence grading system.Eighteen recommendations (40.9%) were Grade A (strong), and 26 (59.1%) Grade B (weak). Evidence levels were distributed as Level 1 (18 items, RCTs/meta-analyses) and Level 5 (26 items, expert opinions). The proposed airway-humidified oxygen therapy strategy covers comprehensive management from baseline parameter setting to complex clinical decisions. Implementation should integrate arterial blood gas analysis, dynamic sputum characteristic assessment, and respiratory mechanics monitoring for stepwise protocol optimization. Respiratory therapy teams should establish multimodal evaluation pathways to mitigate complications (e.g., airway mucosal injury, sputum crust formation). This synthesis updates and complements existing relevant evidence summaries, providing refined decision-making references specifically for adult ICU tracheostomy patients following mechanical ventilation weaning. This study adhered to the Fudan University Evidence-Based Nursing Center reporting standards (JBI methodology) and was registered in the Evidence-Based Nursing Practice Database (ID: ES20246022).