Early supplemental parenteral nutrition shortens ventilation and intensive care unit stay in ICU patients aged ≥60 Years requiring mechanical ventilation: A randomized controlled trial.

Derivation and validation of a clinical prediction score for ICU utilization at trauma intake.

Transitions of care from the intensive care unit (ICU) are high-risk periods for interruptions in nutrition therapy and inadequate nutrient delivery, which may impair recovery following critical illness. As patients leave the ICU, changes in metabolic demand, functional status, feeding tolerance, and discharge setting necessitate deliberate reassessment and coordinated nutrition planning. This narrative review outlines practical strategies to optimize nutrition support during ICU transitions, including reassessment of nutrition status, reevaluation of energy and protein needs, selection of appropriate feeding routes and schedules, and early integration of nutrition into transition of care and discharge planning. We present four patient cases to illustrate application of these strategies across diverse clinical scenarios and discharge destinations including a lung transplant recipient, a patient in a medical ICU, a patient in a neuro ICU, and a patient in a trauma ICU. Collectively, these cases demonstrate that proactive reassessment, timely adjustment of feeding regimens, and early discharge planning can reduce avoidable interruptions in nutrition therapy and support continuity of care across ICU transitions.

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.

Survivors of intensive care unit (ICU) admissions frequently experience psychological distress, with anxiety and depression being particularly prevalent. While the Hospital Anxiety and Depression Scale (HADS) is a commonly used instrument for assessing these conditions, there is limited evidence comparing its effectiveness with simpler tools like the Visual Analogue Scale (VAS) in ICU settings. The objective of this study was to compare the accuracy of the VAS with the HADS for screening anxiety and depression in ICU patients. A prospective, single-centre observational cohort study was conducted in a tertiary ICU. Adult patients with an ICU length of stay exceeding 48 h were enrolled. Anxiety and depression symptoms were self-reported using both the VAS (0-10 scale) for pre-ICU and ICU stay and HADS (0-21 scale). Borderline and probable anxiety/depression were defined by HADS scores ≥8 and ≥ 11, respectively. Paired t-tests compared VAS scores before and during ICU stay. Receiver operating characteristic curve analysis assessed the accuracy of the VAS against that of the HADS, with optimal cut-off values determined using the nearest method and bootstrapped confidence intervals. Of 135 participants (response rate: 93.8%, mean age: 63 ± 16 years; 42% female, median Acute physiology and Chronic Health Evaluation II score: 15), 48.2% and 47.4% met criteria for anxiety and depression, respectively. No significant differences were observed in pre-ICU versus in-ICU VAS scores. The area under the receiver operating characteristic curve for in-ICU VAS was 0.77 and 0.79 for borderline and probable anxiety and 0.73 and 0.76 for borderline and probable depression, respectively. Optimal VAS cut-offs were 4 and 3 for borderline and probable anxiety and 4 and 2 for borderline and probable depression, respectively. The VAS demonstrated acceptable discriminatory capability compared to the HADS and may serve as a rapid, effective screening tool for anxiety and depression in ICU patients. Given the high prevalence of these conditions, further research is warranted to validate these findings and explore clinical integration.

Patients in intensive care units (ICUs) are at an increased risk of healthcare-associated infections with Gram-negative bacteria (GNB), for which sinks in patient rooms are known reservoirs. We investigated the association between water-free care practices and the incidence of GNB detections in Dutch ICUs in non-outbreak settings. We performed a retrospective ecological study (2018-2022) using data from the Infectious diseases Surveillance Information System-Antibiotic Resistance (ISIS-AR), the National Intensive Care Evaluation registry and a questionnaire on water-free care. Detections (colonisation and infections) of seven bacteria groups (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., all Enterobacterales, extended-spectrum beta-lactamase-producing Enterobacterales [ESBL-E] and carbapenemase-producing Enterobacterales) were analysed at ICU-year level. Incidence rate ratios (IRRs) were calculated for water-free vs. non-water-free ICUs, adjusted for ICU and patient characteristics. Data from 37 ICUs were analysed, 22 ICU-years in the water-free group and 131 in the non-water-free group. Water-free ICUs were larger, with more surgery admissions and mechanically ventilated patients. For all bacteria, adjusted IRRs were close to 1 with broad 95% confidence intervals (CIs), ranging from 0.82 (95% CI: 0.44-1.52) for ESBL-E to 1.39 (95% CI: 0.69-2.84) for Acinetobacter spp. Sensitivity analyses showed similar results. Although positive effects of water-free care on GNB detection rates have been described in single ICUs, these findings were not reflected in this Dutch multi-centre study. Possible explanations are low infection prevalence, high prevention standards, widespread usage of selective decontamination and insufficient power to detect small differences. Evidence for benefits of water-free care in non-outbreak settings remains limited, highlighting the importance of future research in different ICU settings.

Adolescent relatives' experiences and perceptions of everyday life when a family member is critically ill and admitted to an ICU and in the aftermath: A qualitative study.

Nebulization with mucolytic and bronchodilator agents is frequently applied in Intensive Care Units (ICUs) for invasively ventilated patients, despite limited evidence for clinical benefit and potential risks associated with routine use. Understanding current practice and rationale behind nebulization is essential to targeted de-implementation strategies. We conducted a nationwide, cross-sectional telephone survey among ICU healthcare professionals in the Netherlands. The survey addressed nebulization practices for mucolytics and bronchodilators, including agents used, administration strategy, clinical indications, evaluation strategies, and local protocols. Open-ended questions explored underlying clinical reasoning and factors influencing nebulization practices. Representatives from 54 of 71 Dutch ICUs (76%) participated. Most respondents were ventilation practitioners (72%, 39/54), supplemented by ICU nurses and intensivists. Nebulization with mucolytics was reported in 47 ICUs (87%) ICUs and with bronchodilators in all ICUs. On-demand nebulization predominated (91.5%, 43/47 for mucolytics; 83.3%, 45/54 for bronchodilators). Thick secretions were the main indication for mucolytics, whereas obstructive pulmonary disease and bronchospasm were leading indications for bronchodilators. Acetylcysteine and salbutamol/ipratropium were most frequently used. Local protocols were present in 41 (76%) ICUs. Active humidification was commonly applied on indication, particularly in prolonged ventilation. Responses to open-ended questions revealed that, beyond clinical triggers, nebulization decisions were frequently shaped by personal preference, habitual practice, and organizational context, rather than by evidence-based reasoning. Nebulization in Dutch ICUs is predominantly on-demand but practice remains variable and partly driven by ingrained habits instead of evidence. Non-indicated nebulization persists and represents potential low-value care. This nationwide survey demonstrates that nebulization practices in Dutch ICUs remain highly variable, often driven by non-standardized protocols and subjective interpretation of indications rather than evidence. To promote more consistent and evidence-based care, implementing a practical decision-support tool could guide clinicians toward indication-based nebulization and support de-implementation of routine, non-indicated use.

Impact of sleep disturbances on post-intensive care syndrome-cognitive impairment in intensive care unit survivors: A prospective cohort study.

Mortality among patients managed by a nurse practitioner or physicians in a medical-surgical intensive care unit: A retrospective cohort study.

Family engagement in critical care settings can enhance healthcare outcomes and patient care satisfaction in the intensive care unit. However, there is limited evidence regarding the barriers to and facilitators of engaging families in direct care, notably early mobilisation. To synthesise evidence on barriers and facilitators to including family members in early mobilisation of adult patients in intensive care units. Integrative review using Whittemore and Knafl's five-stage framework. A systematic search (January 2015-March 2025) across CINAHL, MEDLINE, ProQuest, ProQuest Dissertations and Theses, and Scopus databases of English-language primary studies examining family participation in early mobilisation of adult patients in intensive care units. Studies were critically appraised using Joanna Briggs Institute tools, and data were extracted and thematically synthesised. Ten studies ranging from moderate to high quality were included in the final review. Thematic synthesis produced four themes affecting family engagement: patient vulnerability and readiness for shared movement (clinical condition); family confidence and relationships (readiness, knowledge, emotional state); clinician gatekeeping and guidance (workload, confidence, communication); and organisational culture and systems (protocols, visitation policies, resources). Family engagement in early mobilisation is influenced by barriers and facilitators at multiple levels, including patient, family, clinician, and organisational levels. Multi-level approaches combining structured education, clinician training, and supportive policies are essential to enable safe and sustainable participation. A practical first step in promoting family engagement in early mobilisation is to clarify families' roles within the intensive care team. Providing families with clear information, education, and guidance would reduce uncertainty and support safe participation in mobilisation activities. Organisational policies and structured programs that enable clinician-led invitation, supervision, and communication are also important in facilitating consistent and appropriate family engagement. Attention to patient readiness, family confidence, and contextual constraints is essential when including families in early mobilisation practices.

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.

Bacterial superinfection in pregnant women with severe COVID-19: Prevalence, resistance patterns and outcomes.

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.

Mortality is high both during intensive care unit (ICU) stay and in the year following discharge, yet factors influencing long-term survival remain poorly defined. We hypothesized that pre-existing chronic conditions may be more strongly associated with post-ICU survival than acute illness severity or admission diagnosis. This is a post-hoc analysis of the prospective, observational, multicenter FROG-ICU cohort, which included all consecutive patients admitted to 21 French ICUs and followed for one year after discharge. ICU survivors with complete data on admission severity scores (Sequential Organ Failure Assessment [SOFA], Simplified Acute Physiology Score II [SAPS-II]), comorbidities (Charlson Comorbidity Index [CCI]), and cardiovascular/renal biomarkers at discharge (n=1400) were included. Associations with one-year mortality were assessed using Cox models. Discriminatory performance was evaluated with time-dependent area under the receiver operating characteristic curve (AUC). Among 1548 ICU survivors, 1400 were analyzed (median age 61years, 63% male). Admission diagnoses included acute respiratory failure (19%), septic shock (24%), and neurologic conditions (16%). The CCI was the strongest predictor of mortality at day 7 (AUC 0.70 [95% Confidence Interval [CI], 0.64-0.77]), at 3weeks (AUC 0.75 [0.69-0.78]), and remained high over one year, outperforming SAPS-II (0.63 [0.54-0.72]) and SOFA (0.61 [0.53-0.68]). Although cardiovascular (NT-proBNP, bio-ADM) and kidney (pNGAL) biomarkers had comparable short-term discriminatory value, CCI performed better for long-term outcomes across different admission diagnoses. In this analysis, pre-existing chronic conditions were primary drivers of short- and long-term survival after ICU discharge, exceeding prognostic value of acute illness severity at admission. French and European Outcome Registry in Intensive Care Units (FROG-ICU) study: ClinicalTrials.govNCT01367093. Registered 3 June 2011.

Impacts of non-pharmacological interventions on post-intensive care syndrome: An umbrella review of systematic reviews and meta-analyses of randomized controlled trials.

The presence of family members during invasive procedures in neonatal and pediatric intensive care units is limited, despite its emotional benefits. Exploring parents' experiences in these contexts can help us move toward more family-centered models of care. (I) To explore the experiences of parents of pediatric and neonatal patients admitted to intensive care units regarding being present during invasive procedures; (II) Understand the needs, limitations, and suggestions for improvement expressed by parents regarding their presence during invasive procedures. Qualitative phenomenological study based on in-depth interviews with parents of pediatric patients admitted to an intensive care unit. The thematic analysis followed the approach of Braun and Clarke, and the COREQ guidelines were respected. 22 parents participated in the study. Two major themes emerged from the analysis: (1) The influence of family presence during invasive procedures, and (2) Parents' needs. Participants viewed being present as essential to fulfilling their role as caregivers, providing comfort to their children, and strengthening emotional bonds. They endorsed being present, despite the emotional burden entailed. They identified the following key needs: receiving clear information, having emotional support, having the freedom to decide whether to be present, and having a private and safe environment. Parents view being present during procedures as a right and a way of exercising their parental role. It promotes the emotional well-being of the child and strengthens their relationship with professionals. The presence of family members should be encouraged through specific training for staff and support personnel. Safe environments must be created, and teams must foster a sensitive approach toward the active role of parents in caregiving.

Drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair: A quantile regression study.

Single-use vs. reusable products for six respiratory procedures in an intensive care unit: A retrospective evaluation of plastic waste implications.