Background: Ventilator weaning is of great importance for intensive care patients in order to avoid complications caused by prolonged ventilation. However, not all patients succeed in weaning immediately. Their spontaneous breathing may be insufficient, resulting in extubation failure and the subsequent need for reintubation. To identify patients at high risk for weaning failure, a variety of potential predictors has already been examined in individual studies and meta-analyses over the last decades. However, an overview of all the predictors investigated is missing. Aim: To provide an overview of empirically investigated predictors for weaning failure. Methods: A systematic evidence map was developed. To this end, we conducted a systematic search in the Medline, Cochrane, and CINAHL databases in December 2023 and added a citation search and a manual search in June 2024. Studies on predictors for weaning failure in adults ventilated in the intensive care unit were included. Studies on children, outpatients, non-invasive ventilation, or explanatory factors of weaning failure were excluded. Two reviewers performed the screening and data extraction independently. Data synthesis followed an inductive approach in which the predictors were thematically analyzed, sorted, and clustered. Results: Of the 1388 records obtained, 140 studies were included in the analysis. The 112 prospective and 28 retrospective studies investigated a total of 145 predictors. These were assigned to the four central clusters ‘Imaging procedures’ (n = 22), ‘Physiological parameters’ (n = 61), ‘Scores and indices’ (n = 53), and ‘Machine learning models’ (n = 9). The most frequently investigated predictors are the rapid shallow breathing index, the diaphragm thickening fraction, the respiratory rate, the P/F ratio, and the diaphragm excursion. Conclusion: Predictors for weaning failure are widely researched. To date, 145 predictors have been investigated with varying intensity in 140 studies that are in line with the current weaning definition. It is no longer just individual predictors that are investigated, but more comprehensive assessments, indices and machine learning models in the last decade. Future research should be conducted in line with international weaning definitions and further investigate poorly researched predictors. Registration, Protocol: https://doi.org/10.17605/OSF.IO/2KDYU

Background: Mechanical ventilation is a core intervention in critical care, but may also lead to negative consequences. Therefore, ventilator weaning is crucial for patient recovery. Numerous weaning interventions have been investigated, but an overview of interventions to evaluate different foci on weaning research is still missing.Aim: To provide an overview of interventions associated with ventilator weaning.Study Design: We conducted a scoping review. A systematic search of the Medline, CINAHL and Cochrane Library databases was carried out in May 2023. Interventions from studies or reviews that aimed to extubate or decannulate mechanically ventilated patients in intensive care units were included. Studies concerning children, outpatients or non‐invasive ventilation were excluded. Screening and data extraction were conducted independently by three reviewers. Identified interventions were thematically analysed and clustered.Results: Of the 7175 records identified, 193 studies were included. A total of six clusters were formed: entitled enteral nutrition (three studies), tracheostomy (17 studies), physical treatment (13 studies), ventilation modes and settings (47 studies), intervention bundles (42 studies), and pharmacological interventions including analgesic agents (8 studies), sedative agents (53 studies) and other agents (15 studies).Conclusions: Ventilator weaning is widely researched with a special focus on ventilation modes and pharmacological agents. Some aspects remain poorly researched or unaddressed (e.g. nutrition, delirium treatment, sleep promotion).Relevance to Clinical Practice: This review compiles studies on ventilator weaning interventions in thematic clusters, highlighting the need for multidisciplinary care and consideration of various interventions. Future research should combine different interventions and investigate their interconnection.

Background: The experience of patients under mechanical ventilation in the intensive care unit is described as complex and multifaceted, but an overarching and in-depth understanding of the experience is still missing. Aim: To provide an in-depth analysis and synthesis of patients’ experience when being mechanically ventilated in intensive care units. Methods: We conducted a meta-synthesis according to the methodological recommendations of Sandelowski and Barroso. Our systematic literature search in Medline, CINAHL, and Cochrane was complemented by hand and citation searches. We included only qualitative studies with a rich description of conscious patients’ experience under mechanical ventilation. Studies on children, step-down units, noninvasive ventilation and non-scientific journal articles were excluded. After the title, abstract and full-text screening by three reviewers, we performed initial, axial and selective coding and in-depth analysis in MAXQDA. The synthesis was supported by multiple discussion rounds. Results: Of the 2,563 records identified, 20 studies were included in our synthesis. This revealed the central phenomenon of patients being observers of their own lives. They are yearning for a stable picture of reality and developing various situation-specific needs. Finally, patients are finding ways to deal with the situation. These concepts are interwoven in time and are experienced repeatedly in different dimensions. Conclusion: Patients under mechanical ventilation are highly perceptive. Healthcare professionals are particularly responsible for patients. They should reflect on their role in intensive care and must be sensitized to patients’ differentiated experience. Registration, Protocol: https://doi.org/10.17605/OSF.IO/G8Q6X

Background: Critical care and critical illness are key concepts that have been defined in various publications. A common understanding of the concepts is of great importance, but an up‐to‐date overview and discussion are lacking in the literature. Aim: The aim of this study was to identify and discuss current definitions of critical care, critical illness and chronic critical illness. Study Design: We conducted a narrative review and performed literature searches in Medline, Cochrane Library, CINAHL, Embase, LIVIVO, Google Scholar, OpenGrey, Epistemonikos and Science Open as well as citation searching from July 2024 to September 2025. Reports on definitions were included if they dealt thematically with critical care, critical illness or chronic critical illness, were published within the last 10 years and were available in German or English. Data synthesis followed an inductive approach. We thematically analysed the core concepts of identified definitions, formed thematic clusters and finally approved them in multiple group discussions. Results: In total, 13 definitions of critical care, eight definitions of critical illness and 12 definitions of chronic critical illness were identified. Key components of critical care are the population, interventions, timing, professionals, aim, location and complexity. Critical illness is mainly characterised by future aspects and prevention, underlying causes and treatment. Chronic critical illness is determined by its duration, several complications and frailty. All three terms share the temporality and severity of a disease. Included definitions have a pronounced pathophysiological focus; they point to highly complex and technologised treatment pathways. Conclusion: Current definitions show a generally homogeneous understanding of the care for critically ill patients. To ensure a comprehensive representation, definitions need to be adapted and consider the experiences of those involved. Relevance to Clinical Practice: The analysed clusters of the definitions of critical care, critical illness and chronic critical illness help professionals to develop their terminology and reflect on their clinical approaches.

Background: Internationally, the rate of child loss during pregnancy or birth remains high. This has not only physical but also psychological implications for the parents. While much is known today about the medium- and long-term impact of such a loss, very little research is available on the experience and needs before and during intrauterine or perinatal loss. In addition, healthcare professionals feel insecure and unprepared when dealing with this specific group, which also has a lasting impact on those affected. Aim: To develop recommendations for healthcare professionals on how to deal with families before and during the intrauterine or perinatal loss of their child. Methods: An explorative, sequential and participatory mixed-methods study will be conducted. Along its design, an affected mother is involved throughout the entire study. In detail, workshops, focus groups and narrative interviews with parents are planned. We will include parents who have lost their child during pregnancy or birth within the last 12 months and live in Germany, Austria or Switzerland. The results of the research are then translated into recommendations, which are reviewed and confirmed together with affected parents in a Delphi survey. Finally, a guideline for healthcare professionals will be developed. Discussion: The co-creative design of this study enables the experience-based development of recommendations for healthcare professionals. Clinical trial registration: The study was registered in the National Library of Medicine on January 13 ^th , 2025 with the unique ClinicalTrials.gov identifier NCT06771661 ( https://clinicaltrials.gov/study/NCT06771661 ).

Background: 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. Objective: This study aims to explore the interconnectedness of interventions, outcomes, and context in ventilator weaning of adult intensive care patients. Methods: 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. Results: 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. Conclusions: 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. Trial Registration: Open Science Framework YGJ3T; https://doi.org/10.17605/OSF.IO/YGJ3T International Registered Report Identifier (IRRID): DERR1-10.2196/83342