Background Mechanical ventilation (MV) carries potential risks to mortality and morbidity; therefore, weaning should not be delayed. To safely reduce ventilator support, practice has transitioned from individual preference to a structured approach with guidelines.

Objectives To highlight international challenges in developing PICU nurses’ role in weaning children from MV by reviewing the prevalence of, and evidence for, weaning protocols, and the current state of nurses’ roles and responsibilities in ventilator weaning.

Main body Protocolised weaning has shown some success in reducing MV duration in adults and children. Consequently protocols have gained popularity with surveys reporting their use in 56–69% of European adults ICUs and 18% of UK PICUs. Findings from two systematic reviews show support for weaning protocols in adults, but that cannot yet be said regarding children. There are only a small number of randomised trials of protocolised weaning in children; they used diverse protocols and reported discordant findings making it impossible to pool results. Internationally, there is insufficient information about PICU nurses’ role in weaning, but a recent UK survey reported that nurses rarely titrated ventilator settings. It is possible that reticence to actively engage in the weaning process is linked to associated risks with pediatric extubation, but does not explain why nurses cannot progress weaning to the point of extubation.

Key challenges If paediatric nurses are to confidently engage in the process of weaning they require suitable training and support. Developing appropriate protocols may be an important vehicle for safely changing practice in this respect.