Background: Respiratory support is critical in intensive care settings. Nurses are at the forefront of managing ventilated patients, yet disparities in knowledge and protocol adherence persist across healthcare systems. This systematic review aimed to synthesize recent global evidence on nursing practices in the management of patients receiving respiratory support. Methods: The review followed PRISMA 2020 guidelines. Literature was searched in PubMed, Scopus, and ScienceDirect for original articles published between 2022 and 2025. We include studies examined nursing care for mechanically ventilated patients, with reported outcomes or interventions. We exclude studies involving pediatric populations or non-nursing staff. Seven studies met the inclusion criteria. Data extraction was performed using a predesigned table and quality assessment using JBI critical appraisal tools. Results: Included studies from Saudi Arabia, Egypt, India, Ethiopia, and Sweden show substantial variations in nurses’ knowledge, practice, and confidence levels. Educational interventions improve nursing competencies. Major challenges identified included lack of structured training, inadequate protocol adherence, and inconsistent institutional support. Nurse-led protocols and standardized assessment tools impacted ventilation outcomes including duration, extubation success, and complication rates. Conclusion: Nursing adherence to evidence-based practices is essential for optimal respiratory support. Continuous education, protocol standardization, and greater nurse autonomy are important to improve patient outcomes in mechanical ventilation settings.