# Developing a Program Theory on Ventilator Weaning in Adult Intensive Care: Protocol for a Multimethods Study

## TL;DR

This study aims to develop a program theory for ventilator weaning in adult intensive care to improve understanding and outcomes.

## Contribution

The novelty is creating a structured, interdisciplinary program theory for ventilator weaning using a multimethods approach.

## Key findings

- A program theory will be developed through triangulating literature reviews and stakeholder input.
- The iterative process will refine the theory until it aligns with stakeholder feedback and data.
- The final theory is expected to enhance clinical decision-making and research in ventilator weaning.

## Abstract

Worldwide, mechanical ventilation and ventilator weaning have been widely researched. Nevertheless, rates of weaning failure remain high. According to the Medical Research Council framework, ventilator weaning is a complex intervention. While there are various guidelines on this, there is no abstract theoretical understanding that organizes the interventions, outcomes, and their contexts.

This study aims to explore the interconnectedness of interventions, outcomes, and context in ventilator weaning of adult intensive care patients.

Using the approach of Funnell and Rogers, we develop a program theory for ventilator weaning in a multimethod study comprising 2 main steps. First, 3 literature reviews on interventions and outcomes, predictors of weaning failure, and patients’ experiences were triangulated with stakeholder conversations. Using abduction, we then developed an initial program theory. Second, the initial theory will be revised in an iterative process. To this end, semistructured group discussions and workshops will be conducted, followed by a deductive thematic analysis and adaptation of our theory. This process will be repeated until stakeholder statements and data analyses are congruent with the program theory.

The initial program theory developed in step 1 is presented in this protocol and serves as the basis for review and refinement in step 2. The results of this iterative process and the final program theory are expected in 2026.

Following the Medical Research Council framework, a program theory on ventilator weaning will be developed in this study. This may enable a differentiated understanding of ventilator weaning and more sustainable and comprehensive research. The program theory emphasizes the interdisciplinary nature of ventilator weaning and supports health care professionals in combining interventions appropriately and evaluating relevant outcomes.

Open Science Framework YGJ3T; https://doi.org/10.17605/OSF.IO/YGJ3T

DERR1-10.2196/83342