Objective To systematically integrate the best evidence on pulmonary rehabilitation nursing for patients with tracheostomy after stroke (TAS), so as to provide evidence-based basis for clinical practice. Methods Following evidence-based medicine principles, we conducted a systematic search of literatures related to pulmonary rehabilitation nursing for patients with TAS in databases including UpToDate, BMJ Best Practice, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, and China Biology Medicine (CBM). Literature types included guidelines, expert consensus, systematic reviews, meta-analyses, evidence summaries, and original studies, with the search period spanning from the inception of the database to Jan. 2025. Two researchers independently assessed the quality of the included literatures using standardized tools such as Appraisal of Guidelines for Research and Evaluation-Ⅱ and Joanna Briggs Institute tools, followed by grading and synthesizing evidences meeting the criteria. Results A total of 20 articles were included, including 6 guidelines, 5 expert consensuses, 4 meta-analyses, 3 clinical decision-making papers, 1 systematic review, and 1 randomized controlled trial. A total of 32 recommendations were formed, covering 6 dimensions: airway management (8 items), comprehensive pulmonary rehabilitation training (8 items), basic treatment (5 items), safety management (4 items), extubation nursing (3 items) and prevention of complications during the peri-extubation period (4 items). The evidence grades ranged from grade A (strong recommendation) to grade B (recommendation). Conclusion This study systematically synthesizes core elements of pulmonary rehabilitation nursing for patients with TAS through evidence-based methodology. The established multidimensional evidence framework provides scientific guidance for improving respiratory function, reducing complications, and optimizing extubation decisions. Clinicians are advised to adapt these recommendations to local contexts for practical implementation.