<![CDATA[Mechanical ventilation is an essential life-support intervention for critically ill patients but is associated with an increased risk of ventilator-associated pneumonia (VAP), prolonged mechanical ventilation, and other adverse outcomes. Nursing care bundles combine multiple evidence-based interventions to prevent complications and improve the quality of ventilator care. This systematic review aimed to synthesize current evidence regarding the components, effectiveness, and implementation of nursing care bundles among adult patients receiving invasive mechanical ventilation. A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed/MEDLINE, Scopus, ScienceDirect, and CINAHL were searched for studies published between January 2021 and July 2026, with Google Scholar used as a supplementary source. The review question was developed using the PICO framework. Eligible studies involved adults receiving invasive mechanical ventilation and evaluated nursing or ventilator care bundles in relation to VAP prevention, bundle compliance, duration of mechanical ventilation, ICU length of stay, mortality, or weaning outcomes. Methodological quality was assessed using appropriate Joanna Briggs Institute critical appraisal tools. Findings were synthesized narratively. A total of 600 records were identified, 55 duplicates were removed, and 545 records were screened. Following eligibility assessment, 45 studies were included in the final synthesis. The reviewed evidence showed that nursing care bundles incorporating oral care, head-of-bed elevation, secretion management, airway care, sedation optimization, spontaneous awakening and breathing trials, early mobilization, and ventilator-weaning assessment were generally associated with improved clinical outcomes. Higher bundle compliance was associated with lower VAP incidence, fewer mechanical ventilation days, and shorter ICU or hospital length of stay. Multifaceted implementation strategies involving education, checklists, audit, feedback, and organizational support were consistently identified as important determinants of sustained adherence. Nursing care bundles represent an effective and comprehensive approach to improving the safety and quality of care for mechanically ventilated patients. Their effectiveness depends not only on the selection of evidence-based interventions but also on consistent nurse adherence, continuous education, monitoring, audit-feedback, adequate staffing, and organizational support.]]>
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