Marika Nemeckova (marika2.nemeckova@northumbria.ac.uk), Alison Steven, Ian Joy and Linda Tinkler discuss alarm fatigue, the desensitisation of nurses and other clinical staff to alarm signals. It is a patient safety risk, a professional concern and a workforce issue to manage meaningfully, confidently and safely.

Getting patients out of intensive care units (ICUs) is a major goal for acute care clinicians, as prolonged stays increase the risk of complications and strain critical resources such as staff, equipment, and beds. The ICU Liberation bundle or the ABCDEF (A-F) care bundle is an evidence-based framework for improving outcomes in critically ill patients by addressing pain, sedation, delirium, mobility, and family engagement. However, variability in documentation and lack of standardized data elements hinder effective implementation and evaluation of adherence to bundle components. This study aims to characterize data elements of the A-F liberation bundle using a large, single-center critical care database and to develop standardized bundle cards that map bundle components to controlled vocabularies. We conducted a retrospective analysis of data elements related to A-F bundle using the MIMIC-IV database. Clinical concepts were mapped to standardized vocabularies and aligned with the OMOP common data model. Bundle cards were developed for each component to provide structured, accessible documentation of assessment tools, adherence criteria, and terminology mappings. Pain assessments were documented in over 11,000 patients, with a median of 23 assessments per day. Sedation levels for nearly 59,000 patients were evaluated, with 37.7% meeting Society of Critical Care Medicine (SCCM) adherence criteria. Delirium assessments followed standardized protocols incorporating RASS and CAM-ICU scores. Components E and F lacked formal compliance specifications; bundle cards for these components identified key activities and highlighted gaps in standardized vocabularies. Adherence analyses revealed variability likely due to non-standardized documentation practices. We developed and validated six ICU Liberation Bundle cards that map bundle components to standardized vocabularies and common data models, enabling retrospective adherence evaluation in real-world data. These information resources promote consistent documentation, support interoperability, and provide a foundation for prospective monitoring to enhance bundle implementation in critical care.

The integration of artificial intelligence (AI) into clinical decision support systems (CDSSs) for mechanical ventilation in intensive care units (ICUs) holds great potential. However, the lack of transparency and explainability hinders the adoption of opaque AI models in clinical practice. Explanation user interfaces (XUIs), incorporating explainable AI algorithms, are considered a key solution to enhance trust and usability. Despite growing research on explainable AI in health care, little is known about how clinicians perceive and interact with such explanation interfaces in high-stakes environments such as the ICU. Addressing this gap is essential to ensure that AI-supported CDSS are not only accurate but also trusted, interpretable, and seamlessly integrated into clinical workflows. This study aimed to evaluate the first iteration of the design and evaluation phase of an XUI for an AI-based CDSS intended to optimize mechanical ventilation in the ICU. Specifically, it explores how different user groups-ICU nurses and physicians-perceive and prioritize explanation concepts, providing the empirical foundation for subsequent refinement iterations. A midfidelity prototype was developed using the prototyping software Justinmind, based on existing guidelines, scientific literature, and insights from previous user-centered design (UCD) phases. The design process followed ISO (International Organization for Standardization) 9241-210 principles for UCD and combined qualitative and quantitative feedback to identify usability strengths, design challenges, and role-specific explanation needs. The prototype was evaluated formatively through 2 usability walkthroughs (walkthrough 1: 4 resident physicians and walkthrough 2: 4 ICU nurses), which included guided group discussions and Likert-scale assessments of explanation concepts in terms of understandability, suitability, and visual appeal. The XUI was structured into 2 levels: a first level displaying high-level explanations (outlier warning and output certainty) alongside the CDSS output, and a second level offering more detailed explanations (available input, feature importance, and rule-based explanation) for users seeking deeper insight. While both user groups appreciated the first level, physicians found the second level of the XUI useful, whereas ICU nurses found it overly detailed. Thus, the structure was able to address the differing needs for explanations. The layered design helped balance transparency and information overload by providing initially concise explanations and more detailed ones on demand. The evaluation further strengthened evidence for role-dependent explanation needs, suggesting that nurses prefer actionable, concise insights, whereas physicians benefit from more granular transparency information. This study underscores the importance of UCD in designing XUIs for CDSS. It highlights the differing information needs of physicians and ICU nurses, emphasizing the value of involving users early in the development of suitable XUIs. The findings provide practical guidance for designing layered, role-sensitive explanation interfaces in critical care and form the basis for future iterative evaluations and experimental studies assessing their impact on decision-making and clinician trust.

Abstract Background Proper initial care for sexual assault victims within the healthcare system is critical, as mishandling may cause lasting trauma. Professionals must be trained through evidence-based simulations designed with instructional design principles. These include authenticity, supportive information, and just-in-time procedural guidance. Visual aids with appropriate language, actions, and questions can enhance this training. Objective This study aimed to assess the needs for developing an authentic visual aid to support healthcare professionals during simulation training on the initial approach to sexual assault victims. Methods A descriptive observational study was conducted using an online survey. Healthcare professionals evaluated the relevance of proposed items for the visual aid using a five-point Likert scale (1 = least, 5 = most relevant). Items were based on a literature review and reviewed by experts. Data was analyzed by rating frequency and further refined through a Delphi consensus round. Ethics approval was granted by the Faculdade Pernambucana de Saúde (CAAE: 75552723.8.0000.5569). Results A total of 186 professionals participated. The most highly rated items were: “show respect” (98.4%), “demonstrate empathy” (96.2%), “listen without interrupting” (83.9%), and “not blame the victim” (78.5%). These insights informed the development of the visual aid. Conclusion Evidence-based simulation training for healthcare professionals should incorporate instructional design elements, including authentic visual aids for just-in-time consultation, to enhance the initial response to sexual assault victims. Take-home message Authentic visual aids should be part of simulation training to better prepare healthcare professionals in the sensitive and critical initial care of sexual assault victims. Financing No conflict.

Mechanical ventilation is a complex yet essential aspect of critical care. This article provides a brief review of historical developments related to descriptions of ventilators, the derivation of the foundational equation of motion for the respiratory system and its derivatives, and a short overview of the taxonomy for modes of ventilation. These topics are then applied in a step-by-step procedure for interpreting patient-ventilator interactions through waveform analysis.

Background: Point-of-care ultrasound (POCUS) has emerged as a valuable tool for rapid diagnosis, procedural guidance, and real-time clinical decision-making in neonatal and pediatric critical care. Despite its growing use in acute medicine, the evidence describing its implementation, utility, and impact in interfacility and prehospital transport settings remains limited. This scoping review aims to systematically map the current body of evidence on POCUS use during neonatal and pediatric transport and to identify knowledge gaps to inform future research, training, and clinical integration. Methods: A scoping review was conducted following PRISMA-ScR 2020 guidelines, searching PubMed, Embase, Scopus, CINAHL, and Web of Science for studies describing POCUS use during neonatal and pediatric transport. Results: Of 3676 unique articles identified, 20 met inclusion criteria, including 10 cohort studies, 3 case series, 4 case reports, 2 narrative reviews, and 1 textbook chapter. Fifteen studies reported extractable patient-level data and were included in quantitative synthesis, encompassing 4278 patients. Among these, 1153 (27.0%) patients were under 18 years old, and 576 (13.5%) had POCUS performed during transport. POCUS was primarily used for diagnostic assessment—mainly lung and cardiac imaging—with variability in protocols, operator training, and transport characteristics. Eleven studies (73.3%) reported that POCUS altered clinical management, influencing management in 106 (18.4%) patients through diagnostic clarification, resuscitation decisions, medical or ventilator adjustments, and changes in transport destination. Conclusions: Evidence suggests that POCUS supports clinical decision-making and timely intervention during neonatal and pediatric transport, though use remains inconsistent. Future studies should focus on developing structured training frameworks, validating transport-specific protocols, and assessing the impact of POCUS on clinical outcomes and transport safety.

Physician-based prehospital teams provide advanced critical care services in the UK (eg, prehospital anaesthesia). The last review of such teams in 2009, which included England, Wales and Northern Ireland, reported only one physician-based prehospital team available 24/7. Helicopter Emergency Medical Services (HEMS) across the UK offer paid physician-based teams, while other organisations may provide physician-based teams on a voluntary ad hoc basis. The primary aim of this study was to determine if access to a physician-based HEMS team has changed in the past 12 years. An online survey was distributed to all UK HEMS organisations in January 2024. The primary outcome measure was the number of physician-based teams operated by HEMS in 2024 and the operational hours of such teams. Secondary outcomes included interventions offered by HEMS teams and any additional medical teams offered (eg, paramedic only). All 21 HEMS responded. The number of potentially available physician-based HEMS teams has increased from 11 in England, Wales and Northern Ireland in 2009 to 28 in 2024, with two services in Scotland (total=30). HEMS providing consistent 24/7 physician-based prehospital teams increased from one (5.9%) in 2009 to 11 (52.4%) in 2024. The East of England has the highest 24/7 availability, with Northern Ireland, South West England and Northern England the least. Within physician-based teams, variation remains in advanced interventions available-for example, 19 services (90.4%) offer blood transfusion while only one (4.7%) offers resuscitative balloon occlusion of the aorta. Only one service is completely government funded; the others are funded by charity alone or a combination of charity and government sources. Both geographical and temporal variations in access to a physician-based HEMS remain across the UK, although there has been improvement since 2009. However, within this provision, variation exists in terms of interventions provided such as the provision of blood products.

Explainable AI for critical care: a systematic review of interpretable models for sepsis and ICU mortality prediction.

Comprehensive and continuous assessment of organ physiology and biochemistry, beyond the capabilities of conventional monitoring tools, can enable timely interventions for perioperative complications such as organ ischaemia and transplant rejection. Here we present an integrated bioresorbable system that enables multiplexed, real-time and spatially mapped electrochemical monitoring of deep organs throughout the surgical course. Using a 3D printing-based, photolithography-free fabrication process, the system features a flexible, 3D programmed, individually addressable microneedle sensor array with backward-facing barbs for conformal and stable organ interfacing and 3D parenchymal probing. Electrochemical functionalization of microneedle tips enable concurrent monitoring and spatial mapping of key biochemical markers, such as electrolytes, metabolites and oxygenation, in deep organs for at least 7 days. An electrically programmable self-destruction mechanism offers controllability over the degradation process, eliminating the need for device retrieval. Demonstrations in clinically relevant complications such as kidney ischaemia and gut disorders in animal models highlight the broad applications of this device in intra- and postoperative monitoring, advancing perioperative care and critical care medicine.

ABSTRACTBackgroundAdmission to an intensive care unit (ICU) places substantial physical, psychological and existential burden on patients, but little is known about the support needs of survivors of COVID‐19 critical care.AimTo explore the experiences of survivors of COVID‐19 critical illness during their recovery phase, including perceptions of care received and support offered to them. Research questions were (i) what are patients' experiences during ICU admission and in the recovery period at a psychological, physical and functional level and (ii) what are participants' preferences for support during the post‐discharge period?Study DesignA qualitative study nested within a national multicentre longitudinal study examining the psychological impact of COVID‐19 critical care. Semi‐structured interviews were conducted with adult patients aged ≥ 18 years, treated for presumed/diagnosed COVID‐19 infection and survived to ICU discharge following an admission of ≥ 24 h. Interviews explored patients' ICU and post‐discharge experiences and preferences for post‐discharge support. Analysis drew on principles of the constant comparative method and interpretive reflexive thematic analysis.FindingsFifteen participants completed interviews. Participants reported uncertainties and difficulties in adjusting to their illness, to ICU care and to post‐ICU discharge. Participants experienced extreme functional loss and knew their illnesses to be highly dangerous, yet did not appraise their symptoms as being severe. This dissonance was exacerbated by the dearth of knowledge regarding the effects and prognosis of COVID‐19 critical illness. Participants desired follow‐up support but more commonly spoke of wanting to negotiate a clear path towards recovery and being disappointed in some professionals' failures to provide this. Psychological symptoms emerged later in survivorship, but patients did not routinely access psychological support.ConclusionsMore tailored and consistent post‐discharge support, using novel approaches, may standardise equity of care and address patients' needs.Relevance to Clinical PracticeGreater support for patients and staff is needed to facilitate understanding and acceptance of uncertainty related to unprecedented public health emergencies such as COVID‐19.

Accurate muscle mass assessment is essential in critical care, but no consensus exists on the optimal method because of invasiveness and limited feasibility in immobile patients. We evaluated the effectiveness of non-invasive and easily applicable ultrasound, traditional bioelectrical impedance analysis (BIA), and wearable technology in this context. We recruited patients who stayed in the intensive care unit (ICU) for at least 7days. Muscle mass was assessed at three time points: within 48h of admission and on days 7 and 14 after admission. We analyzed the data of 53 patients (age: 71.8 ± 11.3years; length of ICU stay: 10days). Their muscle mass significantly declined during their ICU stay. The rectus femoris (RF) muscle thickness declined by day 7 and declined further by day 14 (89.7% of initial value). The total anterior thigh muscle thickness and cross-sectional area (CSA) of the RF showed a similar trend. The traditional BIA device reflected a decrease in skeletal muscle mass to 96.2% and 91.8% on day 7 and 14, respectively, while wearable device assessment showed a modest decline to 95% and 89.2% on day 7 and 14, respectively. The groups experiencing weaning failure, death, or discharge to a facility other than home exhibited a higher percentage decline in muscle mass compared with the groups experiencing weaning success, survival, or discharge to home, respectively. Ultrasound is a reliable method for monitoring muscle atrophy in critically ill patients, demonstrating a consistent decrease in muscle mass. The outcomes of traditional BIA and wearable devices suggest that careful consideration of their interpretations is necessary. Utilizing these tools may be valuable for assessing patient prognosis and facilitating more proactive interventions for patients experiencing muscle loss.

ABSTRACTBackgroundPatients admitted to intensive care units (ICU) generally require expensive, advanced technological interventions as well as a high level of specialised and timely care to survive their medical crisis. Work in this setting can generate significant pressures for ICU nurses.AimTo understand and prioritise ICU nurses' preferences for improving their work system based on the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.Study DesignUsing a sequential exploratory mixed‐methods design, qualitative interview data were first collected from ICU nurses employed in a tertiary hospital in Iran to identify interventions for improving their work system. Data saturation guided sample size. Directed content analysis was used for extracting themes representing areas for intervention. The qualitative data were then integrated into an Analytic Hierarchy Process for weighting and prioritising the identified interventions using quantitative pairwise comparisons and mathematical calculations.ResultsFourteen ICU nurses were interviewed. Directed content analysis of the transcribed data yielded 17 themes impacting nurses' well‐being and performance. The Analytic Hierarchy Process indicated that the themes with the highest priority for improving the ICU work system for nurses were Workload and Staffing, and micro‐level Support and Resources—associated with SEIPS Organisation and Person components, respectively. Notable intervention importance was also found for themes Collaboration and Support, Equipment and Technology Enhancement, Culture and Management, and Spatial Design and Arrangement.ConclusionsICU nurses identified a high number of challenges in their work environment. Modern decision‐making analyses were able to quantify and prioritise their preferences. These provide direction for designing future interventions.Relevance to Clinical PracticeAs technological advances continue to support patient survival, there is a need for judicious decision‐making in providing immediate and long‐term solutions for associated changes in the work system faced by critical care nurses to ensure nurse well‐being and patient care.

When shortcuts fall short: The hidden danger of abbreviations in critical care.

Barriers to and facilitators for implementing a Care Partner program for adult patients with persistent critical illness.

From vision to implementation: Rwanda's first adult critical care medicine fellowship.

Contemporary structures, processes, and outcomes of critical care nursing education: An integrative review.

Portable handheld ultrasound for VExUS assessment in critical care: Reliability and time efficiency in resident-led examinations.

AI in critical care: A roadmap to the future.

Reported contributors to communication vulnerability for adult patients in critical care.

Anesthetic reporting in stroke thrombectomy randomized clinical trials: a systematic review.