Conclusion
The SANDWICH trial showed a significant, albeit small, reduction in duration of IMV for children. The process evaluation showed that the intervention’s ease of use and flexibility facilitated its adoption. Provision of a common language, designated bedside nursing involvement, and clear pathways for clinical decision-making collectively worked to expedite extubation. To further enhance this momentum, findings suggest the benefits of more explicit direction in decision-making pathways, robustly embedding new practice as part of a collective endeavour within unit routines, and capitalising on the skills of ANPs and physiotherapists to include a greater role in patient extubation.