关键词: 气管插管拔管；护理；审查指标；障碍因素；循证实践；重症；安全

Abstract: Objective: To examine the current status of nursing care for adult patients with critically ill respiratory conditions pre-extubation, and analyze the barriers to clinical practice, providing a basis for advancing evidence translation. Methods: Based on evidence integration, we established audit indicators and conducted a baseline investigation from April to September 2024, and through focus group interviews, analyzed the barriers and facilitating factors. Results: This study included a total of 28 pieces of evidence summaries and formulated 18 audit indicators. Among them, the implementation rate of 11 indicators in the nurse audits was less than 60%, and the implementation rate of 2 indicators in system audits was 0. The 48-hour extubation success rate was 85.7% in the patient outcome indicators. The incidence of pre-extubation delirium and pain was high, at 33.3% and 76.2% respectively. The main obstacles were the complexity of evidence content; inadequate knowledge, attitude, and behavior of nurses; insufficient collaboration among medical, nursing, and technical teams; and a lack of training, assessment, procedures, standards, evaluation tools, and observation scales related to extubation management. The main facilitating factors included the attention of managers, recognition and support from medical, nursing, and technical teams, and nurses' awareness of improving their professional abilities. Conclusion: There is a significant gap between the clinical practice and evidence for the pre-extubation care management of critically ill adult respiratory patients. We should further optimize the barriers and facilitating factors, and develop feasible implementation plans to ensure the clinical translation of evidence.

Key words: tracheal extubation; care; audit indicators; barriers; evidence-based practice; critically ill; safety