Post-intensive care syndrome affects up to 70% of adult intensive care unit (ICU) survivors, with ICU-acquired weakness contributing substantially to long-term disability. Despite evidence supporting early and structured rehabilitation to enhance physical recovery, targeted upper-limb rehabilitation approaches in the ICU remain comparatively underexplored. This scoping review will map and summarise existing evidence on upper-limb weakness and rehabilitation strategies delivered by healthcare professionals for critically ill adults. This scoping review protocol has been developed in accordance with the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, ensuring transparent and comprehensive reporting. Searches will be conducted in MEDLINE (Ovid), CINAHL (EBSCO), Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL). The search will include studies published between March 2009 and August 2025, aligning with National Institute of Clinical Excellence (NICE) Guideline CG83 (2009), which marked a major policy shift in ICU rehabilitation practice. Quantitative data will be summarised descriptively (eg, frequencies and proportions), while qualitative data will undergo thematic synthesis to identify patterns in experiences, perceptions and implementation of upper-limb rehabilitation. Grey literature (eg, OpenGrey and relevant conference proceedings) will also be screened to reduce publication bias. Rayyan AI software will be used to manage citation screening and reviewer collaboration; no artificial intelligence-assisted decision tools will be used to determine study inclusion. As this review will synthesise previously published data, ethical approval is not required. Results will be disseminated through peer-reviewed publication, conference presentations and open-access platforms. Findings from this review will inform the development of evidence-based ICU rehabilitation guidelines and highlight priorities for future research to improve upper-limb recovery in critically ill adults. Open Science Framework (osf.io/j86nf).

Expert consensus on research priorities for the prevention of delirium in adult ICU patients.

Elizabethkingia meningoseptica is an emerging nosocomial pathogen with complex antimicrobial resistance. We conducted a retrospective study in intensive care units (August 2022-December 2024) involving thirteen patients (ten adults, three paediatric). Universal resistance to piperacillin/tazobactam, aminoglycosides but susceptibility to minocycline was observed. Environmental sampling revealed contamination in water outlets and sink holes. Whole genome sequencing demonstrated clonal relationships between clinical and environmental isolates, confirming nosocomial transmission. Neurological complications were significantly associated with mortality. Following targeted interventions including enhanced disinfection and thermal water flushing, no new cases occurred during three-month follow-up. This study highlights environmental surveillance and integrated infection control importance.

Systematic review: The impact of virtual reality interventions on stress and anxiety in intensive care units.

Effect of antimicrobial therapy on bacterial burden in endotracheal aspirates from mechanically ventilated critical care patients with severe lower respiratory tract infection as assessed by the BIOFIRE® Filmarray® Pneumonia plus panel.

Effects of virtual reality-based interventions on symptom management among adult patients in the intensive care unit: A systematic review and meta-analysis of randomized controlled trials.

An increase in skin blood flow after red blood cell transfusion is associated with an improvement in organ function in critically ill patients.

Does Intermittent Nutrition Enterally Normalise hormonal and metabolic responses to feeding in critically ill adults? The DINE-normal proof-of-concept study.

Increased global attention on enhancing the support available for critical care survivors to improve their health outcomes has led to an exploration of the integration of care between intensive care and primary care. The satisfaction of the experience between critical care survivors and their general practitioner (GP) remains unknown. To determine how satisfied Australian critical care survivors are with their GP and general practice experience. A prospective multi-centre observational cohort study of adult intensive care unit patients was completed across three tertiary hospitals in Victoria, Australia. Adult intensive care unit survivors who were mechanically ventilated for >24h were eligible for inclusion. The primary outcome measure was the frequency scores of the General Practice Assessment Questionnaire domains. The General Practice Assessment Questionnaire is a 35-item survey measuring the domains of general practice reception, access, continuity of care, communication, enablement and overall satisfaction. A total of 51 participants were recruited. Of these, 98% reported having a preferred GP, 96% reported confidence and trust in their GP and 88% would recommend their clinic to new patients. High satisfaction was reported across all General Practice Assessment Questionnaire domains. Survivors of critical illness report high satisfaction in their experience with their GP and general practice from participants from socioeconomically diverse areas.

Determine the incidence and predictors of missed organ donation opportunities. Population-based, prospective cohort study. All adult ICU and PICU (medical, surgical, neurologic, and cardiovascular) and emergency departments (EDs) in a Canadian province with a population of 5 million. Consecutive patients that died with devastating brain injury, regardless of etiology, and were mechanically ventilated in the last 12 hours of life over a period of 42 months. None. Patients were defined as eligible potential donors if they were diagnosed with death by neurologic criteria (DNC), probable DNC (neurologic examination consistent, but without full assessment), or had death by circulatory criteria (DCC) within 2 hours of withdrawal of life-sustaining measures (WLSMs). Missed donation opportunities were defined as occurring when there was no evidence in the medical record that the family of an eligible potential donor was approached regarding donation. Multivariable logistic regression was performed to identify predictors of missed opportunities. There were 3481 patients and 1072 eligible potential organ donors, including 481 with confirmed DNC, 154 with probable DNC, and 437 with DCC within 2 hours of WLSM. There were 172 (16%) missed organ donation opportunities. In multivariable analysis, risk factors included older age (odds ratio [OR] per decade, 1.1 [1.0-1.3]), death in an ED rather than ICU (OR, 5.4 [3.0-10.0]), death in a regional rather than urban hospital (OR, 2.8 [1.7-4.6]), and DCC rather than DNC (6.7 [4.4-10.1]). Missed opportunities were less common when the most responsible physician was a donation specialist (OR, 0.3 [0.2-0.5]). Missed cases categorized as probable DNC were proportionally more common in EDs (45%) than in ICUs (21%; p = 0.0005). Missed organ donation opportunities occur with regularity, especially in EDs and regional hospitals, and among older patients and potential DCC donors. Donation physicians are likely to have a positive impact in reducing missed opportunities.

Peripheral intravenous catheter (PIVC) failures remain common, hindering patient care. Ultrasound-guided PIVC (USG-PIVC) placement offers improved first-time and overall insertion success rates, reduced complications, and enhanced patient satisfaction. Yet, in our adult intensive care unit (ICU), most USG-PIVCs were placed by physicians, a skill that nursing staff could also benefit from acquiring. Our aim was to select the most appropriate handheld ultrasound device and develop a comprehensive USG-PIVC nursing education program to improve PIVC success rates and enhance patient care. This quality improvement initiative's literature review guided development of an education model and evaluation of three handheld ultrasound devices. Nurses received two hours of didactic training, two hours of classroom simulation, and supervised clinical practice. Outcomes were analyzed by the lead ICU clinical educator. Five ICU nurses performed 76 USG-PIVC placements with 70%-90% overall insertion success rates, ie within two attempts. The preferred of three ultrasound devices was selected for its highest success rate, portability, transducer probe, and screen integration lending to ease of use, quick start-up, and clinical support. Nurses were overwhelmingly positive about the education program, as evidenced by informal qualitative feedback collected at each end of session. Our comprehensive USG-PIVC insertion program empowers nurses to improve vascular access through a structured approach, combining online learning, simulation, and supervised clinical practice, with effective ultrasound technology selection. This approach provides other organizations with insight to equip nurses and leverage ultrasound technology toward meeting the 2024 Canadian Vascular Access Association guidelines' (in press) recommendations for ultrasound guidance and product selection.

Critically ill patients may be overexposed to valproate because altered protein binding leads to a disproportionate free valproate fraction. The Fraser equation was derived and internally validated to estimate critically ill patients' free valproate concentrations, but it requires external validation. Adult intensive care unit (ICU) patients at two academic centers with concurrently measured free and total valproate concentrations were included. Free valproate concentrations were estimated using the Fraser equation which includes total valproate, albumin and BUN concentration, and whether the patient received propofol or aspirin. The primary outcome was Fraser equation performance, assessed using Bland-Altman methods. Comparative performance against estimates from the Doré equation (an alternative predictive equation), therapeutic concordance using a target free valproate range of 5-15 mg/L, and equation improvements were explored. Overall, 315 patients and 556 free-total valproate concentration pairs were included. The mean (±SD) age was 58 (±17) years and 90 (29%) patients were on valproate prior to hospital admission. The Fraser equation estimated free valproate concentrations were correlated with measured concentrations (r = 0.728) with a negative bias (mean bias -2.77 mg/L, 95% LOA -18.9, 13.4). The Fraser equation increasingly underestimated measured concentrations as measured concentrations increased. 71% of Fraser equation estimates were therapeutically concordant (e.g., estimate and measured both within reference range) compared to 61.9% of Doré estimates (p = 0.001). Fraser equation modifications led to minor performance improvements but did not overcome worsening underestimation with higher measured free valproate concentrations. The Fraser equation was moderately accurate and corresponded with an appropriate interpretation for 71% of free valproate concentrations. Worse underestimation with higher measured free valproate concentrations suggests direct measurement of free valproate concentrations is warranted. While the Fraser equation could complement therapeutic decision making at centers where direct free valproate measurements are unavailable or slow to return, its accuracy is currently insufficient to replace direct measurement.

Carriers and diseases caused by Staphylococci, one of the important hospital pathogens, are an important problem in the emergence of antibiotic resistance and finding effective treatments. Our study aimed to investigate the relationship between changes in hematological and biochemical parameters and the development of antibiotic-resistant Staphylococcus infections in patients hospitalized in the intensive care unit (ICU). The study included the 1st and 5th day data of 100 patients who had been hospitalized in the adult ICU for at least 5 days. Demographic data, blood and biochemical parameters and culture samples of the patients were evaluated. The higher NLR, CRP, LAC, and WBC values and lower HGB values observed on the 5th day compared to the 1st day suggest that patients in the ICU were likely exposed to hospital-acquired Staphylococcus infections, which adversely affected their prognosis. Indeed, the 31 Staphylococcus strains identified were isolated from blood (18), sputum (6), wound (4), urine (0), stool (0) and, catheter (3) cultures. It was determined that the most isolated strains, S. aureus, were resistant to levofloxacin, erythomycin, tetracycline, nitroforantoin, trimethoprim/sulfamethoxazole, oxacillin MIC, clindamycin, fusidic acid and oxsf. Based on our results, the observed increase in hematological and biochemical values on day 5 relative to day 1 reinforces the probability of hospital-acquired infection. Since this situation will put the life of the patient and the individuals related to the patient at risk, monitoring these values, early diagnosis and initiation of treatment are vital.

Procalcitonin (PCT) is increasingly used to support sepsis diagnosis, but its role in predicting outcomes remains uncertain, particularly in low-resource settings. We evaluated whether single and serial PCT measurements were associated with 28-day mortality in critically ill adults with suspected sepsis. We conducted a retrospective study of adult intensive care unit (ICU) patients with suspected sepsis and at least one PCT measurement at a tertiary hospital in South Africa (August 2022-July 2023). Baseline PCT was analysed using multivariable logistic regression. Among patients with≥2 PCT values, we examined the association between PCT slope (from patient-level linear regression) and mortality. Latent class mixed models (LCMM) were used to identify PCT trajectory subgroups. Of 371 patients, 119 (32 %) died within 28days. Higher baseline log-PCT was independently associated with increased mortality (adjusted odds ratio [aOR] 1.58; 95 % CI 1.01-2.50). A rising PCT slope trended toward higher mortality (aOR 3.56 per unit/day; p=0.06). LCMM identified three trajectory classes with distinct mortality risks (class 2: aOR 4.53; class 3: aOR 4.35, vs. reference). These models were based entirely on laboratory data and did not assess clinical scoring systems. Both baseline and serial PCT measurements predicted mortality in ICU patients with suspected sepsis. Modelling approaches based on routine laboratory data may offer scalable tools for early risk stratification in resource-limited settings.

Background: Antibiotic resistance is a significant health problem in healthcare settings, especially intensive care units (ICUs), where patients are critically ill. This study aims to identify the bacterial profile and antibiotic resistance patterns of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter, and Escherichia coli (ESKAPEE) in blood specimens collected from adult patients admitted to the ICUs of public hospitals in Abu Dhabi, United Arab Emirates. The World Health Organization lists these pathogens as priority pathogens that greatly threaten humans. Methods: This cross-sectional study used routinely collected data through the AMR surveillance system between 2018 and 2022. Results: A total of 838 culture-positive blood specimens were reported during the study period, and 965 ESKAPEE pathogens were isolated. The most frequently isolated bacteria were Klebsiella pneumoniae (31%), Escherichia coli (22%), and Staphylococcus aureus (20%). Acinetobacter baumannii exhibited high resistance to Amikacin (81%), Meropenem (72%), and Imipenem (87%). Escherichia coli demonstrated resistance to Imipenem (42%) and Cefotaxime (54%). Klebsiella pneumoniae showed resistance to Imipenem (37%) and Cefotaxime (39%). Staphylococcus aureus showed resistance to Penicillin G (80%), Oxacillin (4%), and Ciprofloxacin (54%). Conclusions: The study showed a high prevalence of resistance in the most frequently isolated ESKAPEE pathogens in adult ICU patients. This brings into focus the need for appropriate infection control measures and strong antibiotic stewardship programs. The findings of the study support the ongoing efforts to deploy a better diagnostic tool for rapid pathogen identification, which is key in the targeted management of patients with bloodstream infection, especially in ICUs.

Survivors of critical illness frequently do not achieve recommended nutrition targets because of multiple barriers. Consequently, malnutrition is prevalent during hospitalization, yet posthospital discharge nutrition interventions are often missing, leaving a gap during a crucial recovery phase. This scoping review aims to explore barriers to nutrition adequacy, consequences of inadequate nutrition, and interventions for adult survivors of critical illness following hospital discharge. Using Joanna Briggs Institute methodology in conjunction with the PRISMA-ScR checklist, searches were conducted in MEDLINE, Embase, CINAHL, Web of Science, and Cochrane databases (2010-2024) for studies on adult intensive care unit (ICU) survivors posthospital discharge, reporting nutrition barriers, consequences, and/or nutrition interventions. Factors identified from the data are analyzed and presented using a conceptual framework derived from the Biopsychosocial model and the Social Ecological Model. Forty-three studies (mostly observational) were included encompassing 32,165 participants. Commonly reported barriers included (% of studies) appetite loss (40%), dysphagia (26%), and psychological distress (40%), contributing to inadequate dietary intake (19%), malnutrition (42%), and weight loss (56%) persisting up to 12 months. Body composition changes, observed in 21% of studies, demonstrated increased fat mass, whereas lean mass was maintained or lost. Despite high nutrition risk, only 37% reported nutrition input. Nutrition interventions improved nutrition, physical, and psychological outcomes. This review emphasizes the complexity of nutrition recovery faced by ICU survivors, highlighting significant gaps in nutrition care following hospital discharge. Understanding nutrition challenges from survivors' perspective is essential before evaluating specific nutrition interventions addressing the diverse nutrition needs of individuals recovering from critical illness.

Background/Objectives: Our objective was to describe the safety and efficacy of enteral droxidopa, a norepinephrine prodrug, for intravenous (IV) vasopressor weaning in intensive care unit (ICU) patients. Methods: This was a single-center, retrospective descriptive study of adult ICU patients. Patients who received ≥ 4 consecutive doses of droxidopa for IV vasopressor weaning were included. The cessation of the IV vasopressor without re-initiation within 72 h of droxidopa initiation was the primary outcome. The adverse events assessed included hypotension, hypertension, and arrhythmias. Results: Forty-six patients were included, with a median age of 61. Forty-two patients (91%) were on midodrine at the time of droxidopa initiation. The median daily midodrine dose was 80 mg. The median time from ICU admission to droxidopa initiation was 17 days. Patients were on a median of one IV vasopressor at the time of droxidopa initiation, with norepinephrine as the most common agent (50%). The median initial daily droxidopa dose was 300 mg, with a median maximum daily dose of 900 mg. Vasopressor support was discontinued within 72 h of droxidopa initiation in 46% of patients, with a median time to IV vasopressor cessation of 3.3 days. There were no incidences of hypotension, hypertension, arrhythmias, or ICU readmissions related to droxidopa. Droxidopa was continued upon discharge in 29% of patients. Conclusions: Droxidopa may be a safe and effective option to facilitate the weaning of IV vasopressor support in patients who are refractory or intolerant to midodrine. Larger prospective studies are needed to confirm these findings.

Introduction: High-quality palliative care in trauma intensive care units is crucial but often hindered by prognostic uncertainty, time constraints, limited provider training, and cultural differences between acute care surgery and palliative care services. In response, the American College of Surgeons Committee on Trauma recommends early goals-of-care discussions for high-risk trauma patients. However, little is known about how these strategies are implemented in practice. We aimed to identify communication strategies in trauma critical care and evaluate their impact on patient and family-centered care. Methods: We conducted a literature search of PubMed, Embase, CINAHL, and Web of Science for studies published through October 2024. Inclusion criteria focused on adult trauma or surgical ICU patients and studies addressing palliative care, communication strategies, or goals-of-care discussions. Data from eligible studies were extracted and synthesized qualitatively, with themes identified using grounded theory analysis. Results: We identified 39 eligible studies. Thematic analysis identified five key themes: communication frameworks, interdisciplinary approaches, communication barriers, provider education, and impact on patient and family satisfaction. Communication frameworks including structured family meetings, use of communication checklists, and decision aids such as the Best Case/Worst Case Scenario tool improved shared decision-making. Several studies emphasized the importance of shared responsibility for patients between palliative care specialists and trauma providers. Conclusions: Evidence suggests that structured communication frameworks and early interdisciplinary involvement improve family satisfaction and patient-centered outcomes. Despite progress, standardized approaches to palliative communication in trauma ICU settings remain a challenge. Future efforts should focus on targeted education and standardized protocols.

Objective The use of arterial oxygen targets in mechanically ventilated adults remains controversial. Higher oxygenation and FiO₂ may speed liberation but risk hyperoxemia-related complications; lower targets may increase hypoxemia risk and end-organ damage. This meta-analysis evaluates whether liberal versus conservative oxygen targets impact 28-day ventilator-free days (VFD-28), mortality, or ICU length of stay (LOS). Methods MEDLINE, Embase, and trial registries were searched for randomized trials comparing liberal (≥96% SpO₂ or >100 mmHg PaO₂) or usual oxygenation targets vs. conservative (88-96% SpO₂ or PaO₂ 55-80 mmHg) oxygen targets in mechanically ventilated adults. The primary outcome was VFD-28, reported as mean difference (MD) defined as Conservative minus Liberal with negative values favoring the Liberal group. The results were pooled using DerSimonian–Laird random-effects modeling. When only medians and IQRs were reported, means and SDs were estimated using the Wan method (n ≥ 25); range-only/small-n cases used Hozo. Secondary outcomes included all-cause mortality (risk ratio [RR]) and ICU LOS (MD). Heterogeneity was assessed using τ² and I²; sensitivity analyses included Hartung-Knapp and leave-one-out tests. Trials were aligned on the prespecified 90-day mortality endpoint Results Five trials (n = 18,905) were included. VFD-28 favored liberal targets: pooled MD −0.58 days (95% CI −1.06 to −0.10; negative favors liberal), with low heterogeneity. For 90-day mortality, there was no statistically significant difference between the two groups: pooled RR 1.02 (95% CI 0.98 to 1.06; I² = 0%). ICU LOS also showed no clear difference: pooled MD 0.50 days (95% CI −0.48 to 1.47) with substantial heterogeneity. Findings were robust to cluster design-effect adjustments and sensitivity analyses. Given the few studies in this analysis, the power to detect small-study effects was limited. Discussion Liberal oxygen targets confer a modest VFD benefit without significant differences in ICU LOS or mortality. Further research is warranted to assess potential differences in adverse outcomes such as ventilator-associated lung injury, pneumonia, or ICU-acquired weakness.

Problem Statement: The prognostic value of troponin elevation in septic ICU patients without known history of cardiac disease remains unclear, particularly after accounting for overall illness severity. Background: Minor troponin rises are frequent during sepsis, yet clinicians still lack a clear cut-point that signals danger once cardiac disease is ruled out. We asked whether a modest increase in troponin-T predicts in-hospital death beyond global illness severity. Methods: We studied 1 221 adult first ICU stays labelled “sepsis” in the eICU Collaborative Research Database and removed any case with a cardiac admission diagnosis. Implausible or missing laboratory values were imputed by multiple imputation. Hospital mortality was modelled with logistic regression that included troponin (a continuous and a binary model with threshold > 0.04 ng/mL) together with age, sex, lactate, albumin, BUN, creatinine, intubation status, vasopressor use, dialysis requirement and APACHE-IV predicted mortality. A natural-spline model explored non-linear behavior. Findings were checked in a 1:1 propensity-matched cohort. Results: Overall mortality was 11.7%. Troponin exceeded 0.04 ng/mL in 38% of patients. After adjustment for APACHE-IV probability and other covariates, a troponin level > 0.04 ng/mL was associated with almost twice the odds of death (OR ≈ 1.9), whereas the continuous model suggested only a modest trend (OR ≈ 1.1 per ng/mL). The spline curve rose steeply between 0 and 0.10 ng/mL and flattened thereafter, pinpointing an inflection near 0.05 ng/mL. Matching on all measured confounders confirmed that high-troponin patients had about three-fold greater mortality (OR ≈ 2.8, 1.55-5.05; p<0.001), highlighting that even modest troponin elevation is an independent risk marker for death in septic ICU patients. A bedside heat-map combining troponin, albumin and need for intubation illustrated a simple gradient: risk climbs from 2 % in low-troponin, well-albuminised, non-intubated patients to nearly 7 % when troponin exceeds 0.10 ng/mL in intubated, hypo-albuminemic patients. Conclusions: Even modest troponin elevations (> 0.04 ng/mL) independently predict mortality in sepsis after rigorous adjustment and matching on APACHE-IV physiology, lactate, and organ-support variables. This biologic threshold supports incorporating troponin into bedside triage and future septic cardiomyopathy trials.