ICU Nurses’ Knowledge, Attitudes, and Practices in Identifying Patient–Ventilator Asynchrony: A Cross-Sectional Study

Abstract Background： Patient–ventilator asynchrony (PVA) is a common complication of mechanical ventilation, with an incidence of approximately 23%, and has been linked to ventilator-induced lung injury, weaning failure, prolonged hospitalization, and increased mortality. Consequently, accurate recognition and timely management of PVA can directly influence therapeutic effectiveness and clinical outcomes. Objective: This study evaluated ICU nurses’ competencies in identifying PVA through ventilator waveform monitoring, with a focus on their knowledge, attitudes, and clinical practices. It also examined how gender, clinical experience, and mechanical ventilation training influenced these competencies. Methods: A multicenter cross-sectional study was conducted from December 2023 to April 2025 in the intensive care units of ten tertiary hospitals across six provincial-level regions in China. Data collection included demographic characteristics, a validated assessment of PVA recognition ability, and standardized scales evaluating nurses’ attitudes and practices. Results: Among the 250 nurses recruited, 212 returned valid responses, yielding an effective response rate of 84.8%. Overall, nurses demonstrated limited ability in recognizing PVA (pass rate: 44.81%), moderately positive attitudes (60.85%), and suboptimal practices (44.34%). Male nurses outperformed females in PVA recognition ( P < 0.05). Nurses with ≥5 years of experience and those who had received mechanical ventilation training showed significantly better performance in all domains, with those trained for over 100 hours exhibiting the most substantial gains. Additionally, significant positive correlations were identified among recognition ability, attitudes, and clinical practice ( P < 0.001). Conclusions: ICU nurses showed insufficient competency in identifying PVA, as well as in related attitudes and clinical implementation. Mechanical ventilation training emerged as a key driver for improving these domains. Integrating targeted training into the standardized ICU nurse education system may enhance ventilator management quality and improve patient outcomes. Clinical trial number Not applicable.