Nurse-led evidence-based protocolized weaning for invasive mechanical ventilation patients in the ICU: a hybrid type 1 effectiveness-implementation study

TL;DR

This study shows that a nurse-led weaning program can safely shorten the time patients spend on ventilators in the ICU.

Contribution

It introduces a nurse-led protocolized weaning approach with evidence of effectiveness and implementation success in a surgical ICU.

Findings

Nurse-led protocolized weaning reduced weaning duration by 1.2 hours without increasing reintubation rates.

Nurses' knowledge improved significantly, and protocol adherence exceeded 95% for key indicators.

Implementation success relied on behavioral changes, workflow optimization, and resource support.

Abstract

Prolonged invasive mechanical ventilation (IMV) increases risks of complications and healthcare burdens. Protocol-directed weaning reduces IMV duration but faces implementation barriers. Nurse-led protocolized weaning (NLPW) offers promise, yet evidence on its effectiveness within specific healthcare contexts and systematic implementation processes remains limited.

This hybrid type 1 effectiveness-implementation study evaluated the clinical impact and feasibility of implementation of a structured NLPW program in a surgical ICU.

A mixed-methods design was employed. Quantitative component: A quasi-experimental study with historical controls compared patient outcomes (weaning duration, IMV duration, ICU stay, 24-hours reintubation) before (May-Sep 2023, n = 147) and during (May-Aug 2024, n = 147) implementing an evidence-based NLPW program guided by the Knowledge-to-Action framework. Qualitative component: Semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR) identified implementation barriers and facilitators. Nurses’ knowledge changes and protocol adherence were assessed.

Among 294 included patients (mean age 62.3 ± 17.8 years, 50.3% male), NLPW significantly reduced mean weaning duration (1.66 ± 0.92 vs. 2.8 ± 1.35 h; Δ = 1.2 h, P < 0.001) without increasing reintubation rates or shortening total IMV duration. Post-implementation, nurses’ knowledge scores increased significantly (70.3 ± 7.6 to 83.5 ± 5.1; P < 0.05), and protocol adherence exceeded 95% for core process indicators. Qualitative analysis revealed three critical success factors: (1) individual behavioral changes, (2) optimization of nursing workflows, and (3) utilization of resources to support clinical practice.

A theory-informed, NLPW program safely accelerated liberation from IMV in surgical ICU patients and enhanced nursing expertise. Successful implementation requires addressing contextual barriers through tailored training, workflow optimization, and resource support. NLPW represents a scalable strategy to standardize ventilator weaning, particularly in settings with limited respiratory therapy support. Future studies should evaluate long-term sustainability and generalizability across diverse ICU populations.

: No Patient or Public Contribution.

The online version contains supplementary material available at 10.1186/s12890-025-03967-5.

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