Nursing Liberation Bundle: Its Effect on Ventilation Duration And Weaning Readiness in Mechanically Ventilated Children

Abstract

Background
Introduction: Prolonged mechanical ventilation (MV) in children delays weaning and may worsen outcomes. This study evaluated the influence of a nursing liberation bundle on weaning readiness and ventilation duration in mechanically ventilated children.
Method: A randomized controlled trial was carried out in a pediatric intensive care unit of a tertiary university hospital (July–December 2025). Of 68 children assessed, 8 were excluded; 60 children aged 1–6 years who had been ventilated for more than 48 hours were assigned at random to a liberation bundle group (n = 30) or a group receiving standard treatment (n = 30), with no loss to follow-up. The four-component bundle (pain assessment and comfort, spontaneous breathing trial [SBT] and weaning, sedation reduction, and family engagement) was applied daily from day 4 of ventilation until extubation. SBT readiness was assessed with a five-item tool, and ventilation duration was recorded in days.
Results: The groups were comparable at baseline. SBT readiness did not differ significantly up to day 6 but was higher in the bundle group on day 7 (90.0% vs. 46.7%, p < 0.001) and before extubation (90.0% vs. 56.7%, p = 0.004). Ventilation duration differed significantly (p = 0.002): 60.0% of the bundle group were ventilated for 4–7 days versus 23.3% of controls, and 16.7% versus 60.0% for 8 days or more.
Conclusion: In this small single-center trial, the bundle was associated with higher SBT readiness late in the intervention period and shorter ventilation duration. Larger, blinded, multicenter trials are needed.