Patient and family-centered interdisciplinary rounds and patient satisfaction: A controlled intervention study.

Nurse-led, multicomponent models of family care in adult intensive care units.

Minor things of major importance-nurses' experience of using the Komfort Bundle when caring for critically ill patients: A qualitative study.

Nurse-led interventions targeting post-intensive care syndrome domains in adult intensive care unit survivors: A systematic review.

Effectiveness of virtual reality interventions for delirium prevention in intensive care units: A systematic review and meta-analysis.

Postoperative delirium (POD) is a common and serious complication in intensive care unit (ICU) patients after cardiac surgery. Its long-term impact remains uncertain. The aim was to determine the association between postoperative delirium and 8-year all-cause mortality in adult cardiac ICU patients. This retrospective cohort study analysed patients admitted to a university hospital ICU following cardiac surgery. Data from pre-, peri-, and postoperative phases were collected. The primary outcome was mortality up to 8years after ICU discharge. Secondary outcomes included POD incidence, ICU readmission, mortality at day 7 and 30 post-discharge, and ICU and hospital length of stay (LoS). Regression analyses were conducted to examine associations. The study included 551 patients, predominantly male (71%, n=397), with a median age of 72 (IQR 64-77) years. POD was diagnosed in 18.7% (n=103). Overall, the 8-year mortality rate was 16.7% (n=92). Compared to non-POD patients, those with POD had significantly higher 6-8years mortality (n=9 (8.7%) vs. n=16 (3.6%), p=0.033). Patients with POD had a longer LoS in ICU (median 4 vs. 2days, p<0.001) and hospital (15 vs. 12days, p<0.001), as well as higher ICU readmission rates within 30days (12.3% vs. 6.6%, p=0.037). POD patients also showed higher mortality at 30days (3.8% vs. 0.9%, p=0.028). However, after adjusting for confounders, POD was no longer significantly associated with long-term 6-8years mortality (p=0.205). POD affects nearly one in five patients after cardiac surgery and is associated with adverse short-term outcomes, including longer stays and higher readmission and early mortality rates. Its independent effect on long-term mortality may be limited. Further studies are needed to explore its influence on quality of life and cognitive function.

Fluid balance monitoring is a common practice in intensive care units (ICUs) to assess the volemic status of critically ill patients. However, its accuracy is limited in estimating insensible water loss (IWL), a component that is difficult to quantify but potentially significant. Literature shows considerable heterogeneity in the methods used to estimate IWL, with limited standardisation. To assess its use, a nationwide cross-sectional survey was conducted, targeting adult ICUs in Italy. The aim was to evaluate the extent to which IWL is included in daily fluid balance calculations and to describe the methods used for its estimation. The survey consisted of a 26-item questionnaire and was distributed via REDCap software from March 10, 2025 to April 10, 2025. Responses were obtained from 100 ICUs, of which 75 were included in the final analysis. Of these, 70.6% reported including IWL in fluid balance assessments. Among these, 79% used a specific formula, with the most frequently adopted being 0.5ml/kg/hour (52%). The main parameters considered in the calculation were body weight (83%), body temperature (86.6%), and type of ventilatory support (60.3%). Furthermore, 73.6% of respondents considered IWL to be moderately or extremely relevant. Findings suggest that IWL is widely taken into account in clinical practice, although with heterogeneous approaches. Our results highlight the need for future physiological studies to standardise its estimation and improve the accuracy of fluid balance assessments in critically ill patients. This paper underlines the lack of evidences and standardisation in IWL's estimation. It provides available alternatives and foundation for further investigations.

To adapt and validate a good practice manual on humanisation, originally designed for adult critical care patients, to the paediatric intensive care unit (PICU) context. A methodological study to adapt and validate a clinical practice manual was conducted using a three-round Delphi consensus technique between February and October 2023 with 53 experts (56.6% nurses, 28.3% physicians, 15.1% other professionals) from 15 Spanish hospitals. In the first round, participants evaluated 160 practices from the Manual of Good Practices in Humanization for Adult Intensive Care Units (HU-CI Project) and adapted them to the paediatric context. In the second round, they validated these modifications and 30 additional proposals. In the third round, the consensus practices were classified into three levels. Consensus was defined as ≥75% agreement. Of 57 initial participants, 53 completed the three Delphi rounds, resulting in a 93% retention rate. Among participants, 79.2% were women, 56.6% were nurses, and 94.4% had experience in PICUs. From the original 160 initial practices, 47.4% (n=76) reached consensus without modification, 16.9% (n=27) were modified, and 35.6% (n=57) were discarded. Additionally, 30 new practices were proposed and accepted, resulting in 132 final practices. These were categorised as basic (65%, n=86), advanced (22%, n=29), and excellent (13%, n=17). This study adapted and validated the first humanisation manual specifically for PICUs, providing a structured, measurable framework that may promote child- and family-centred care and support continuous quality improvement. The consensus-validated practices provide PICU teams with a structured, measurable framework that may help promote child- and family-centred care. Nursing staff play a key role in daily implementation of family involvement, communication, and comfort measures, whilst the three-level classification allows progressive evaluation of PICU humanisation according to unit resources.

Adequate oral food intake remains a challenge in Intensive Care Unit (ICU) survivors on the general hospital ward, with evidence suggesting that daily energy and protein intake from oral food intake are inadequate during recovery from critical illness. Currently, limited evidence is available regarding meal intake distribution patterns and the impact of prolonged enteral tube feeding on oral intake in survivors of critical illness. This study aimed to: (1) investigate daily distribution of energy and protein intake patterns of oral meals; and (2) evaluate the impact of enteral tube feeding on oral food intake, including potential differences across mealtimes, in post-ICU patients during the first 14 days of recovery after critical illness on the ward. This was a pre-post comparison of two prospective observational cohorts (PROSPECT-I and II) conducted at Hospital Gelderse Vallei (the Netherlands) before and after the implementation of a tailored nutrition protocol in post-ICU patients during recovery on the general hospital ward. Adult ICU survivors who stayed ≥72 h in the ICU and were receiving enteral tube feeding at ICU discharge were included. Daily energy and protein content from oral food consumption during the first 14 days post-ICU were analysed. Ordered and consumed intake data were pooled by mealtime (breakfast, lunch, and dinner) and intake distributions across mealtimes (within-group comparisons) were compared using the Kruskal-Wallis test, with Dunn's post-hoc test applied in case of significant differences. Oral food consumption data from 90 participants (n = 24 pre-implementation and n = 66 post-implementation) with a median hospital stay of 10 days post-ICU discharge were analysed. For all ordered meals, median oral energy content ranged from approximately 481 to 555 kcal across main meals, and median oral protein content ranged from 22.1 g to 28.2 g. However, median energy intake from consumed meals ranged from 302 to 354 kcal, with no differences between specific meal moments (all p > 0.05). Absolute protein intake did not differ across meals (p = 0.423), with median values ranging from 14.5 to 15.0 g per mealtime. Following implementation of the tailored nutrition protocol, patients received enteral tube feeding for a longer duration (median 5 vs. 3 days, p = 0.002). Patients had lower energy and protein intake from oral food intake (both p < 0.001). The tailored nutrition intervention resulted in higher total daily energy (2115 vs. 1816 kcal, p < 0.001) and protein intake levels (108.1 vs. 91.5 g, p < 0.001). Post-ICU patients showed an even distribution of energy and protein intake from oral food consumption throughout the day, suggesting a per-meal intake threshold. The introduction of a tailored nutrition protocol resulted in prolonged enteral tube feeding post-ICU, increased energy and protein adequacy, but reduced oral meal consumption.

Spontaneous diuresis as a marker of successful liberation from positive pressure ventilation: A retrospective observational study.

Therapeutic drug monitoring is essential for ensuring the efficacy and safety of vancomycin therapy in critically ill patients. This study aimed to develop a machine learning model for individualized prediction of vancomycin concentration-time curves in ICU patients. Adult ICU patients who received intravenous vancomycin and underwent therapeutic drug monitoring at Peking Union Medical College Hospital between January 2014 and December 2023 were retrospectively included. A total of 401 patients were randomly divided into training (n = 280) and testing (n = 121) cohorts. Individual pharmacokinetic parameters were estimated using Bayesian posterior inference and served as reference targets. Five machine learning algorithms were evaluated, and the two with the best predictive performance, Lasso Regression and LightGBM, were integrated with a one-compartment pharmacokinetic model to construct the final predictive model. In the internal testing cohort, the model achieved a mean absolute percentage error (MAPE) of 39.5% for vancomycin concentration prediction. External validation in an independent cohort of 2283 patients showed consistent performance (MAPE = 35.6%). The machine learning-based model significantly outperformed the classic pharmacokinetic model (p < 0.001) in both internal and external validations. A user-friendly software tool based on the model was also developed to facilitate clinical implementation. These findings suggest that the proposed model offers a robust and practical decision-support tool for optimizing individualized vancomycin dosing in ICU settings. Trial Registration: ClinicalTrials.gov identifier: NCT06431412.

Nursing workforce characteristics, such as staffing and specialized training, are integral to the delivery of high-quality patient care in the intensive care unit (ICU). Nurse staffing is defined as the number of nurses per patient but also skill-mix (combination of registered nurses and other nursing support staff) and expertise of available nurses for the specific patient population each shift. When nurse staffing is suboptimal the risk of adverse patient outcomes and patient mortality increases. In addition, existing research has established the importance of staffing ICUs with interprofessional teams-registered nurses (RNs), physicians, and respiratory therapists (RTs). Yet, shifting characteristics of the nursing workforce- such high turnover and a more novice workforce- are still under studied and may impact the interprofessional team and its ability to collaborate effectively. This study is an analysis of previously collected qualitative data from 9 ICUs within a single academic medical system in the US. Participants (RNs, physicians, RTs, and other ICU providers) working in study ICUs across 4 hospitals were purposively sampled and interviewed individually. Thematic analysis was used to analyze interview transcripts; 2 researchers coded each transcript independently. Consensus on any coding disagreement was reached through discussions at research team meetings. Once all data was coded, the team iteratively reviewed the data and codes and generated themes that focused on the primary research question of this analysis: how nursing workforce characteristics influence the interprofessional team. Our final sample included RNs (n = 11), RTs (n = 4), physicians (n = 4), and a dietician (n = 1). Three interconnected themes were identified in the analysis: (1) The effects of a transition to a more novice nursing workforce in ICUs extends beyond nurse staffing to the interprofessional team and their ability to provide care; (2) Staffing decisions do not incorporate interprofessional team needs, leading to decreased collaboration and disruptions in patient care; and (3) Adequate nurse staffing and additional support can balance increased burden on the interprofessional team. These themes highlight how nurse workforce characteristics can influence the interprofessional team in adult ICUs in a post-COVID era. Characteristics of the nursing workforce, such as nurse experience and expertise, have downstream effects on interprofessional team members and their ability to deliver care in the ICU. A multi-pronged approach, which includes adequate support staff for nursing, increased retention of experienced ICU nurses, and improving communication across professions, is vital to improve interprofessional team collaboration and allow ICU teams to provide the best care possible to their patients.

Central venous access device (CVAD) insertion is a routine procedure in intensive care units (ICUs); however, it is associated with procedural risks. While structured training enhances safety, significant variability exists in training, supervision, and competency assessment across ICUs. Standardised education and assessment frameworks are recommended to improve procedural safety and patient outcomes. This study aimed to evaluate ICU trainees' experiences with CVAD insertion training, identify any significant variation in current educational frameworks, and gather recommendations for enhancing training and assessment. A web-based survey was distributed to ICU trainees across Australia, New Zealand, Singapore, and Hong Kong. Data were analysed using descriptive statistics and regression models. Key outcomes included trainee's perceptions of training disparities, accreditation processes, and practice variations across ICUs, informing the development of a standardised CVAD training framework. Among 237 respondents, 199 responses were analysed. Fewer than two-thirds of trainees in tertiary and metropolitan ICUs and only 17% in regional and private ICUs, reported access to structured multimodal CVAD training, while 15.3% indicated no formal training was available. Fewer than a quarter (23.1%) of less experienced trainees reported having undergone competency assessments in the past 12 months. Commonly perceived challenges included coordinating ultrasound guidance and manipulating the guidewire and catheter. Most trainees (52.3%) recommended six to ten supervised insertions and competency across multiple insertion sites (∼60%) for accreditation. These findings highlight trainees' perceptions of critical gaps in CVAD training, emphasising the need for structured multimodal education, standardised competency assessments, and improved access to training resources across diverse ICU settings.

Strategies for Family-Centered End-of-Life Care in the Adult Intensive Care Unit.

To estimate key statistical parameters and provide practical guidance for planning stepped wedge cluster randomised trials in Australian and New Zealand intensive care units (ICUs). Cross-sectional retrospective observational study using routinely collected ICU data. Adult public hospital ICUs contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database between 2010 and 2023. All adult ICU admissions to 132 ICUs. Subgroups included unplanned admissions and admissions involving invasive mechanical ventilation or vasopressor use. In-hospital mortality during the index hospitalisation within 90 days of ICU admission. Intra-cluster correlation coefficients (ICCs) and cluster auto-correlations (CACs) were estimated using exchangeable, block-exchangeable, and discrete time decay models using a cross-sectional design. Among 1,291,849 eligible ICU admissions, observed mortality ranged from 10.3% (all ICU admissions) to 23.0% (non-elective invasively ventilated patients in Mega-ROX ICUs). ICCs ranged from 0.008 to 0.022 and CACs from 0.83 to 1.00, with block-exchangeable or discrete time decay models most often providing the best fit. In a worked example, a 50-ICU stepped wedge trial with 10 steps (11 two-month periods) enrolling 45 unplanned ventilated patients per ICU per period (total ≈24,750 patients) would have 81.6% power to detect an absolute mortality reduction of 2.7%. Stepped wedge cluster randomised trials are feasible for evaluating ICU-wide interventions when routine data are available. The ICC and CAC estimates presented here provide Australian and New Zealand-specific parameters for future trial planning and demonstrate the potential of this design for pragmatic large-scale ICU research.

Physical restraints are used in the intensive care unit (ICU) to prevent patient self-harm, but they are also associated with adverse outcomes. The COVID-19 pandemic placed unprecedented challenges on health care systems, especially in ICUs. To investigate pandemic-associated trends in the use of physical restraints. In this retrospective pre-post analysis, use of physical restraints in adult ICU patients in a tertiary care center from January 1, 2018, through December 31, 2022, was queried. Patients admitted before March 1, 2020, were deemed the pre-COVID-19 group, and those admitted after were deemed the COVID-19 group. Trends between groups and patient-level risk factors associated with higher physical restraint use were compared. A total of 17 285 patients were admitted to the ICU during the pre-COVID-19 period, and 20 421 were admitted during the COVID-19 period. Physical restraint use increased significantly from the pre-COVID-19 period to the COVID-19 period (29.4% vs 32.5%; P < .001). Physical restraint use was disproportionately higher among self-identified Black and Hispanic persons than in all others both before and during the COVID-19 period. Additionally, physical restraint use among non-English speakers increased from 30.6% in the pre-COVID-19 period to 38.4% in the COVID-19 period. Our findings indicate a critical need to understand and address the drivers of increased use of physical restraints during times of stressors on hospital systems. Furthermore, the racial and ethnic disparities in physical restraint use warrant further study and possibly dedicated quality improvement measures.

A pilot, parallel-group, blinded, placebo-controlled, randomiseD, pRagmatic clinical trial investigating the Effect of temazepAM on objective and subjective measures of sleep in critically ill patients (the DREAM trial).

Despite its clinical significance, research on atrial fibrillation (AF) burden as a dynamic, real-time predictor of adverse outcomes in patients with critical illness is lacking. This study examined the association between high AF burden and in-hospital mortality in critically ill patients, using intensive care unit (ICU) data from the Medical Information Mart for Intensive Care III (MIMIC-III; 2001-2012) and Yongin Severance Hospital (2021-2023). Electrocardiogram waveform data were analyzed using deep learning models to calculate AF burden. Adult ICU patients were included, with exclusion of those aged ≥90 years and those with an AF burden >0.9. AF burden was defined as the ratio of AF waveforms to total waveforms during ICU admission, with a high burden defined as ≥7.0%. Logistic regression and machine learning models were employed to assess the association between AF burden and in-hospital mortality, as well as to evaluate the contribution of AF burden to mortality prediction. From the MIMIC-III database, 7,734 patients were included: 5,734 (74.1%) had a low AF burden (median, 0.3%) and 2,000 (25.9%) had a high AF burden (median, 22.5%). High AF burden was associated with significantly higher in-hospital mortality (18.1% vs. 8.6%, P < 0.001) and was identified as an independent risk factor (adjusted odds ratio, 1.63; 95% confidence interval, 1.36-1.95; P < 0.001). Machine learning models demonstrated that AF burden is a significant contributor to mortality prediction, with an area under the curve of 0.86. AF burden may serve as a dynamic marker for real-time alerts of clinical deterioration and for risk stratification in critically ill patients.

Intensive care unit (ICU) visiting restrictions in hospitals, implemented due to infection control and other factors, limited contact between patients and family members, affecting patients' well-being and clinical outcomes. With the evolution of voice-cloning based on artificial intelligence (AI) technology, it has become possible for health providers to communicate with critically ill patients using highly similar synthetic voices of their loved ones during ICU care. This current randomised, controlled trial will explore the effect of voice-cloning care on improving mental health outcomes for critically ill patients, with ICU-acquired anxiety as the primary indicator. This study will enrol 234 adult ICU patients, who are expected to require mechanical ventilation for over 24 hours and an ICU stay exceeding 72 hours. Participants will be randomly assigned to two groups. The control group will receive standardised communication as part of usual ICU care, while the intervention group will receive Speech-to-Speech Voice-Cloning Care (SVCC) in addition to standard ICU care. The SVCC interventions involve nurses using a participant's family member's cloned voice to deliver pre-set communication scripts during awakening, soothing and preparation for endotracheal tube removal. The primary outcome is expected to lead to improvements in ICU-acquired anxiety for the intervention group, measured by the Hospital Anxiety and Depression Scale. Secondary outcomes include ICU-acquired depression, the incidence of delirium, the mean duration of mechanical ventilation and the average length of ICU stay. This protocol was approved by the Ethics Committee of Peking Union Medical College Hospital (Approval Number: K-6842). The protocol version number is 1.2 and the version date is 8 October 2024. Study findings will be disseminated through peer-reviewed publications and presentations at national and international conferences. ClinicalTrials.gov, ID: NCT06743321.

Are All Low GCS Patients Potential Organ Donors? Insights From a Policy-Driven Brain Death Evaluation Framework.