Background <p>Airway management in tracheostomized patient is a critical aspect of clinical care, with humidification therapy playing a vital role in maintaining mucociliary clearance function. However, the mechanisms of action, influencing factors and optimization strategies of humidification therapy have not been systematically elucidated, leading to a lack of evidence-based guidance in clinical practice for selecting and adjusting humidification protocols.</p> Objective <p>This review aims to explore the mechanisms by which humidification therapy enhances mucociliary clearance in tracheostomized patients, evaluate its clinical efficacy and identify key factors influencing therapeutic outcomes. Ultimately, it proposes optimization strategies to improve the precision and effectiveness of airway management.</p> Methods <p>This narrative review was conducted by systematically searching PubMed, Scopus, Google Scholar and the Cochrane Library using keywords including “humidification therapy” “tracheostomy” “mucociliary clearance” “airway humidification” “respiratory physiological function” “clinical efficacy” “key influencing factors” and “evidence-based optimization strategies”. The search spanned English-language literature published between January 2000 and March 2025. Inclusion criteria comprised original studies, systematic reviews and clinical guidelines focusing on the mechanisms of humidification therapy in enhancing mucociliary clearance in tracheostomized patients, its clinical outcomes and comparative analyses with traditional airway management approaches. Exclusion criteria involved studies on non-tracheostomized populations, animal models or interventions lacking explicit differentiation of humidification therapy from other respiratory treatments, as well as unpublished conference abstracts and opinion-based articles. Literature selection prioritized studies elucidating mechanistic pathways of humidification therapy, empirical investigations into five core influencing factors (humidification modalities, patient-specific characteristics, solution parameters, therapeutic parameter optimization and environmental interactions) and those evaluating clinical efficacy or proposing optimization strategies. Final inclusion required rigorous thematic alignment with functional recovery of the mucociliary system and evidence-based advancements in airway management.</p> Results <p>Humidification therapy significantly improves mucociliary clearance by maintaining airway mucosal hydration, reducing sputum viscosity and enhancing ciliary activity. Compared to conventional airway management, it demonstrates superior efficacy in reducing mucus plug formation, lowering airway obstruction risks and improving patient comfort. Five key influencing factors were identified: humidification methods, patient-specific variables, humidification solution properties, parameter optimization and environmental interactions.</p> Conclusion <p>Humidification therapy is a crucial intervention for enhancing mucociliary clearance in tracheostomized patients. A deeper understanding of its mechanisms and influencing factors, combined with evidence-based optimization strategies—including precise humidification protocols and multidisciplinary care coordination—can significantly improve therapeutic outcomes. This review underscores the necessity of individualized humidification approaches in tracheostomy care to optimize respiratory management and patient prognosis.</p>