Exploring work motivation in High and Intensive Care wards with the confession booth: An innovative approach.

Characteristics and prognostic factors of adult poisoning patients in the intensive care unit: A retrospective cohort study using the Japanese intensive care patient database.

Survivorship after critical illness is often characterised by fragmented recovery and lingering cognitive, psychological, and physical impairments collectively described as post-intensive care syndrome. Current recovery frameworks and follow-up models remain inconsistently delivered, poorly standardised, and rarely address survivors' and families' need to make sense of the intensive care unit (ICU) experience in a transparent, inclusive, and sensitive way. The Critical Illness Survivorship Programme is proposed to humanise post-intensive care by integrating generative artificial intelligence technologies with co-designed, person-centred recovery strategies. This discussion paper provides the theoretical foundation for the proposed Critical Illness Survivorship Programme, which intends to humanise post-intensive care recovery through ethically governed, artificial intelligence-enabled narrative approaches. The Critical Illness Survivorship Programme redefines recovery as both a biological and narrative process. Drawing from interpretive nursing inquiry, narrative medicine, cognitive rehabilitation, and responsible artificial intelligence design, the Critical Illness Survivorship Programme is designed to generate personalised intensive care unit journey summaries that translate complex health-record data into accessible, emotionally attuned stories, visualisations, and audio outputs. These narratives aim to support sense-making, memory integration, and emotional recovery while promoting transparency, inclusivity, and cultural sensitivity. The proposed Critical Illness Survivorship Programme will offer a conceptual pathway for developing ethically governed, artificial intelligence-enabled tools that bridge digital innovation and human connection in survivorship care. It emphasises interdisciplinary collaboration, trauma-informed communication, and co-design as essential safeguards for compassionate technology integration. Future research should examine the feasibility, ethical oversight, and educational implications of the Critical Illness Survivorship Programme within clinical pathways. By reframing technology as a partner in empathy and understanding, the Critical Illness Survivorship Programme proposes a potential model of recovery - one that restores coherence, dignity, and meaning in life after critical illness.

Evolution of triglyceride and total cholesterol levels after critical illness: Preliminary insights into post-ICU metabolic sequelae.

The association of perturbed skeletal muscle metabolism with intensive care unit (ICU)-acquired weakness (ICUAW) is not clear. The objective of the present study was to characterize temporal changes in skeletal muscle mitochondrial function, ATP concentration, and substrate utilization during and up to 6 mo post-ICU admission in critically ill patients, and to delineate mechanisms underpinning ICUAW by comparing the expression of genes involved in skeletal muscle mitochondrial function and substrate utilization in the critically ill patients to control groups that had either undergone elective surgery or leg immobilization (i.e., muscle disuse). The study design was a randomized controlled trial of functional electrical stimulation-assisted cycle ergometry (FESCE) versus standard care, with skeletal muscle mitochondrial respirometry defined a priori in a nested subgroup of patients as the primary outcome. Mitochondrial respirometry did not change 7 days or 6 mo after ICU admission and was not impacted by FESCE. However, a 20% reduction in muscle ATP content by day 7 of ICU stay persisted after 6 mo and tended to associate with ICUAW (P = 0.078, R2 = 0.582). Moreover, a 40% lower muscle glycogen and 2.5-fold greater muscle lactate were observed earlier at day 1 compared with elective surgery patients. These changes reflected expression of genes related to glycogen metabolism when disuse was accounted for, and a greater expression of the gene encoding glycogen phosphorylase (PYGM) was predictive of mortality. We conclude that muscle glycogen metabolism is rapidly dysregulated in critical illness, which may have implications for muscle ATP resynthesis and ICUAW.NEW & NOTEWORTHY The association of skeletal muscle metabolism with intensive care unit (ICU)-acquired weakness (ICUAW) is not clear. We report for the first time that reduced muscle ATP content by day 7 of ICU stay persisted after 6 mo and tended to be associated with ICUAW. Moreover, lower muscle glycogen and greater muscle lactate were observed earlier at day 1 compared with elective surgery patients. These changes reflected the expression of genes related to glycogen metabolism, which were predictive of mortality.

As survival rates after critical illness improve, increasing numbers of ICU survivors experience post-intensive care syndrome (PICS), with physical, cognitive and psychiatric impairments. However, there is a lack of robust population-level estimates on incidence rates to guide the implementation of measures to address this issue. We conducted a retrospective nationwide cohort study using the South Korean National Health Insurance Service database. Adults admitted to any ICU who were alive ≥ 12 months after hospital discharge were included. To estimate the incidence of PICS, we did not include patients with any PICS-related diagnosis in the year before the index ICU admission. Post-intensive care syndrome was defined as a new diagnosis in at least one domain - physical, cognitive or psychiatric - within 12 months of hospital discharge. Among 234,069 ICU survivors with no prior PICS diagnosis, 130,110 (55.6%) developed PICS within 12 months of hospital discharge. Risk factors included older age (odds ratio (OR) 1.01, 95%CI 1.01-1.01); female sex (OR 1.17, 95%CI 1.15-1.19); lower income, particularly among Medical Aid beneficiaries (OR 1.16, 95%CI 1.12-1.21); pre-existing disability (mild-to-moderate: OR 1.12; 95%CI 1.09-1.15; severe: OR 1.08, 95%CI 1.05-1.12); higher comorbidity burden such as cerebrovascular disease (OR 1.88, 95%CI 1.84-1.92), dementia (OR 3.11, 95%CI 2.91-3.31) or chronic pulmonary disease (OR 1.25, 95%CI 1.22-1.28); and exposure to mechanical ventilation (OR 1.40, 95%CI, 1.36-1.44) or continuous renal replacement therapy (OR 1.12, 95%CI 1.05-1.12). In a nationwide cohort of 234,069 ICU survivors, over half developed PICS within 12 months, with physical impairment most common. These findings quantify the survivorship burden attributable to critical illness and underpin the need for structured, multidisciplinary follow-up and rehabilitation for high-risk groups.

The aim of this study was to describe the methodological development of appropriate use criteria for arterial catheter use in adult intensive care units using the RAND Corporation/University of California, Los Angeles (RAND/UCLA) Appropriateness Method. This methods paper reports the prespecified development phase of an appropriateness study. The RAND/UCLA Appropriateness Method was applied in sequential phases, including defining scope and key terms, synthesising evidence through a literature review and national survey, developing clinical indications, and rating indications across two rounds by an interdisciplinary expert panel. Panel members had expertise in arterial catheter insertion and management across intensive care, anaesthesiology, emergency medicine, infectious diseases, critical care nursing, and clinical and tertiary intensive care education. Clinical indications were iteratively developed based on common clinical scenarios, anticipated uses, practice guidelines, and available evidence on efficacy and safety. Each indication was rated on a 9-point scale (1 = harms outweigh benefits; 9 = benefits outweigh harms) and classified as appropriate (median: 7-9 without disagreement), uncertain/neutral (median: 4-6 or any median with disagreement), or inappropriate (median: 1-3 without disagreement). Disagreement was assessed using the Interpercentile Range Adjusted for Symmetry method. The RAND/UCLA Appropriateness Method provides a structured, transparent, and reproducible approach for developing appropriate use criteria for arterial catheters in adult intensive care. The final appropriateness ratings and clinical recommendations derived from this process are reported separately.

Variations in outcomes following burn injury and admission to an Australian or New Zealand intensive care unit: A retrospective data linkage cohort study.

The reliability of the College of Intensive Care Medicine of Australia and New Zealand viva examination.

Gastrointestinal dysfunction (GD) is common in intensive care patients with a wide range of admission diagnoses. Whether GD increases the severity and worsens outcomes from critical illness remains contentious. The aim of this study was to determine the frequency, severity, and risk factors associated with the development of GD in intensive care patients and to correlate these with clinical outcomes. Adult critically ill patients receiving enteral and/or parenteral nutrition with an expected ICU stay ≥72 h were prospectively studied between February 2019 to July 2020. Predefined GI signs and symptoms, ICU interventions, organ scoring, and clinical outcomes were documented from admission to ICU discharge or at 90 days. Data on GD using the Acute Gastrointestinal Injury (AGI) and Gastrointestinal Dysfunction Score (GIDS) scoring systems were collected, and associations between GD and clinical outcomes (ICU length of stay, mechanical ventilation duration, and mortality) were analysed using logistic regression and Poisson mixed-effects models with fixed and random effects, adjusting for age, illness severity, and other covariates. Of 2247 ICU patients screened, a convenience sample of 100 patients were enrolled (75 general ICU, 25 cardiac ICU; 61 % male; median age 53 years [range 41-82]). All patients had at least one GI dysfunction sign/symptom. Gut dysfunction was present in all patients based on the AGI and 79 % by the GIDS. Severe GD occurred in 46 % (AGI) and 25 % (GIDS). A gut-related ICU admission diagnosis was present in 23 % of patients, which increased the odds of severe GD (AGI OR 9.8, 95 % CI 2.66-31.83, p < 0.001; GIDS OR 4.3, 95 % CI 1.4-13.0, p = 0.01). Elevated serum lactate was associated with GD severity (AGI OR 1.30, p = 0.04; GIDS OR 1.32, p = 0.02). Severe GD was associated with longer ICU stays (median 13 vs 10 days, p = 0.02) and mechanical ventilation duration (12 vs 10.5 days, p = 0.05). A 1-Litre fluid balance was associated with an increase in AGI grading of 5.1 % (p = 0.02) and GIDS of 7.9 % (p < 0.001). Aggressive enteral feeding increased AGI odds by 82 % (OR 1.82, p = 0.015). Multiple inotropes were associated with higher GIDS at 72 h (p = 0.023). ICU mortality was 21 %, with no differences by GD. These findings support the importance of consistent GD assessment to guide clinical decision-making in critical care. There is an urgent need for a robust, standardised, and objective approach to GD assessment in ICU practice, one that accounts for severity, dynamic risk factors, and the potential to alter clinical outcomes through timely recognition and intervention.

Systemic lupus erythematosus (SLE) and idiopathic pulmonary fibrosis (IPF) share immune-inflammatory features, yet their convergent peripheral-blood transcriptomic signatures remain incompletely defined. We sought to identify shared blood gene programs linking SLE and IPF, prioritize robust cross-disease markers, and evaluate parsimonious diagnostic models with experimental and external assessments. Peripheral-blood transcriptomes were analyzed in GEO discovery cohorts (SLE: GSE49454; IPF: GSE33566). Differential expression (limma) and weighted gene co-expression network analysis (WGCNA) were performed separately per disease, and concordant shared signals were integrated to form a shared candidate pool. Consensus feature selection combined LASSO logistic regression, nested cross-validated SVM-RFE, and random forest to derive parsimonious gene panels for SLE and IPF. Logistic-regression models were trained in discovery cohorts and externally validated in independent cohorts (SLE: GSE65391, GSE72509; IPF: baseline samples from longitudinal GSE93606). Experimental validation was conducted in an independent hospital cohort (60 SLE, 30 healthy controls) using PBMC RT-qPCR and serum GRN ELISA, with correlation and covariate-adjusted association analyses. Fixed models were additionally applied without refitting to non-target inflammatory cohorts (RA: GSE93272; ICU sepsis/non-infectious critical illness: GSE134347). Discovery analyses identified 389 SLE and 248 IPF DEGs and yielded 43 concordantly regulated shared DEGs; WGCNA identified 43 shared module genes, producing a non-redundant shared candidate pool of 78 genes enriched for B-cell and myeloid programs. Consensus selection generated a 6-gene SLE panel (EIF2AK2, GRN, ASGR2, KLRB1, LGALS9, KLF13) and a 4-gene IPF panel (GRN, ARG1, KLRB1, FCMR). The SLE model achieved AUC 0.996 in discovery and validated at AUC 0.888 (GSE65391) and 0.761 (GSE72509); the IPF model achieved AUC 0.906 in discovery and 0.722 in baseline validation. In the hospital cohort, RT-qPCR confirmed dysregulation of the six-gene panel, and serum GRN was markedly elevated in SLE (median [IQR] 43.58 [38.44-54.42] vs. 14.26 [12.79-15.26] ng/mL). Within SLE, serum GRN correlated with SLEDAI and inversely with C3/C4 and WBC; after covariate adjustment, associations with WBC, ESR, C3, and C4 remained significant, whereas associations with hs-CRP and SLEDAI were attenuated. In non-target cohorts, the SLE model showed moderate discrimination for RA (AUC 0.73) but limited discrimination for ICU sepsis (AUC 0.64) and none for non-infectious critical illness (AUC 0.50), while the IPF model showed minimal discrimination for RA (AUC 0.51) but high discrimination for ICU groups (AUC 0.99 and 0.96). GRN and KLRB1 anchor a shared peripheral-blood transcriptomic signature linking SLE and IPF, enabling parsimonious diagnostic models with multi-cohort validation and clinical experimental support. External in silico applications to other inflammatory contexts indicate context-dependent model behavior, underscoring the importance of cohort-appropriate interpretation and validation.

Vitamin D plasma levels during critical illnesses

While the negative experience of intensive care delirium has been established in adults, paediatric delirium (PD) is increasingly being recognized internationally. Knowledge, however, is still lacking regarding the experience of delirium in critically ill children. Therefore, we wish to provide insight into the subjective experience of delirium to better understand the children's perspective and enable the development of strategies to support children and their parents during and after the delirium episode. We aimed to describe the lived experience of delirium in a paediatric intensive care unit survivor. Our research question was: How does a child make sense of delirium after critical illness? We interviewed 16-year-old Eric 10 months after discharge from the intensive care unit, using Frank's narrative theory to analyse Eric's narrative and performing thematic analysis to further interpret his experiences. We identified Eric's story as a Quest narrative. According to Frank's theory, Eric uses his narrative to understand his experiences and perhaps to help others. We identified the following themes: Being lost, being pursued, being paralysed, and being back. During delirium, Eric lost control of reality during delusions and hallucinations. He experienced being pursued, being paralysed, and finally regaining his sense of reality. After discharge, Eric told and retold his story to his mother. Together, they developed a version of the story that was used to develop strategies to deal with delirium in the event of future admissions. Similarly to adults, children experience the distress of delusions and hallucinations during ICU delirium. The adolescent in our case was able to reflect on and suggest explanations for his delusional experiences. Mother and child prepared strategies to manage delirium during future admissions.

Inconsistent pain management in intensive care settings contributes to poor patient outcomes and prolonged hospital stays. Implementing evidence-based pain management strategies is critical to mitigating complications, such as oversedation and excessive analgesia. The process is inherently complex, requiring an exploration of contextual factors that enable implementation, the mechanisms triggered within these contexts, and strategies to enhance stakeholder engagement. In this discussion paper, we examined sociocultural, organisational, professional, and individual factors influencing the implementation of pain management interventions in intensive care settings. We considered their implications for diverse stakeholders and have offered evidence-informed recommendations to strengthen implementation. In this discussion we synthesise findings from a theory-driven, three-phase realist evaluation that examined and refined program theories related to successful implementation of pain management interventions. Phase one involved a scoping review of the literature and a survey with open-ended questions to elicit initial program theories. Phases two and three comprised a rapid realist review followed by stakeholder interviews to iteratively refine these theories. Interventions succeed or fail not solely based on design but within complex contexts where knowledge, power, and professional identity intersect. Across micro, meso, and macro levels of care, mechanisms such as empowerment, moral distress, and institutional trust influenced intensive care nurses' willingness and capacity to adopt interventions. Biomedical hierarchies may marginalise nursing knowledge, while interprofessional hierarchies and organisational cultures can either constrain or enable meaningful change. We have advanced critical nursing scholarship by conceptualising pain management not merely as a clinical intervention but as a socially embedded practice. We have offered implications for educators, policymakers, nurse leaders, and practitioners to promote equitable, context-sensitive strategies for implementing pain management interventions, thereby possibly enhancing clinical practice and improving patient outcomes.

Sustainable continuous renal replacement therapy: The influence of blood flow rates, effluent dose, autoeffluent, and citrate anticoagulation on carbon dioxide emissions.

Association between frailty and long-term outcomes in patients undergoing TAVI admitted to private intensive care units in Australia.

Quantifying the climate and water footprint of artificial intelligence in anaesthesia and intensive care.

National data on clinical pharmacy implementation can inform health policy, resource allocation, workforce planning, and academic development. In Chile, such data are limited, particularly for therapeutic drug monitoring (TDM). The objective of this study was to characterize the clinical pharmacy workforce in Chilean hospitals and describe the implementation of core clinical activities, with an emphasis on TDM. A national cross-sectional survey was conducted among pharmacists performing clinical functions in Chilean hospitals, using the 2024 registry of the Clinical Pharmacy Division of the Chilean Society of Intensive Care Medicine as the sampling frame. Descriptive analyses were performed; workforce capacity was expressed as full-time equivalents (FTEs) and regional density per 10 000 inhabitants. Of 220 invited pharmacists, 181 responded (82.3%), representing 83 institutions across 15 of 16 administrative regions. Median age was 35 years (interquartile range [IQR] 31-39); 28.2% were registered Clinical Pharmacy Specialists, and 77.1% worked in public hospitals. The highest density was in the Metropolitan Region (0.12 FTE/10000 inhabitants), followed by Tarapacá and Antofagasta (0.09 each). Deployment was most frequent in Infectious Diseases (36.5%) and intensive care units (34.8%). Pharmacotherapy follow-up and medication therapy review were each reported by 94.5%, adverse drug reaction reporting by 87.3%, and involvement in TDM by 85.1%. Teaching and research were reported by 44.8% and 30.4%, respectively, but 95.5% reported no formally protected time. TDM was available in 81.9% of centers, most commonly for vancomycin (80.7%), valproic acid (63.9%), amikacin (60.2%), and phenytoin (57.8%); pharmacokinetic software to support dose individualization was used in 61.4% of centers. Clinical pharmacy services in Chile are broadly integrated into hospital care-particularly in infectious diseases, critical care, and TDM-while gaps persist in formal credentialing, regional workforce distribution, and institutional structures supporting academic activities.

The development of neonatal intensive care has substantially reduced infant mortality, still, infants remain at high risk for adverse outcomes. Safe care relies on adequate nurse staffing and an appropriate skill mix, which is especially important in neonatal intensive care as infants are extremely vulnerable to harm when quality lapses occur. Although international guidelines recommend optimal nurse-to-patient ratios for neonatal care, these standards have not been fully implemented, leaving it unclear whether current staffing levels align with recommendations for safe staffing. To benchmark the acuity-adjusted registered nurse staffing provision ratio in neonatal intensive care and determine the skill mix distribution and variation of nursing staff across shifts. This retrospective cohort study included infant data from a 16-week period in 2022 in three neonatal intensive care units with a common administration at a university hospital. Data were obtained from the hospital's data repository and the Swedish Neonatal Quality Register, including 609 neonatal admissions and 345 nursing staff members working 1008 shifts. Infants' daily acuity levels were assessed using an adapted version of the British Association of Perinatal Medicine's guideline, classifying infants into three levels: intensive care, high dependency care, and special care. Staffing provision was measured as the number of worked hours per shift, staff category, and unit. The registered nurse provision ratio was defined as the number of registered nurse hours provided divided by the recommended hours. A ratio below 1.0 indicates understaffing. The population's total in-hospital days were 4674, and the mean birth weight was 2843 g (SD 1029), with 57.0 % being boys. The proportion of registered nurses relative to nursing assistants ranged from 22.2 % to 85.7 %, with a median of 46.5 %. Registered nurses with specialist education accounted for a median of 73.0 % of total registered nurse hours. Within each unit, the mean acuity-adjusted number of registered nurses recommended by the British Association of Perinatal Medicine's standard was relatively consistent across shift types and between weekdays and weekends. However, the required number of registered nurses between individual shifts showed considerable variation, ranging from 2.5 to 10.3. During the inclusion period, 81.2 % of the shifts had a registered nurse provision ratio below 1.0, suggesting that most shifts did not meet the recommendations for staffing levels. This study highlights a shortfall in registered nurse staffing relative to recommended levels. Ensuring adequate registered nurse staffing levels is crucial for maintaining high-quality neonatal care and improving infant outcomes.

The effect of intravenous calcium administration on haemodynamics in perioperative cardiothoracic surgery and intensive care: A narrative review.