Practice In Intensive Care Unit Research Articles

Environmental Factors Affecting Early Mobilization and Physical Disability Post-Intensive Care: An Integrative Review Through the Lens of the World Health Organization International Classification of Functioning, Disability, and Health.

Early mobilization (EM) is one of few potential protective factors associated with reduced physical disability post-intensive care (PD PIC). However, only 45% of intensive care units (ICUs) in the United States routinely practice EM despite its recognized benefits. To analyze the evidence on the relationship between critical care EM, PD PIC, and environmental factors, using the theoretical lens of the World Health Organization's (WHO's) International Classification of Functioning, Disability, and Health (ICF). The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the WHO ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized. Early mobilization was related to improved functioning on the disability continuum of the WHO ICF. Early mobilization was influenced by several WHO ICF environmental factors. Dedicated physical and occupational therapy teams in the ICU, interdisciplinary rounds, and positive family and staff perception of EM facilitated intervention delivery. However, poor staffing levels, negative unit culture, perceived workload burden, and lack of equipment, education, and financial support impeded delivery of EM. Early mobilization is a promising intervention that may reduce PD PIC. However, environmental factors negatively influence delivery of EM in the ICU. Several gaps in EM research limit its acceptability in ICU practice. Existing EM research is challenged by poor methodological quality. Further study is necessary to better understand the role of EM on PD PIC and improve patient outcomes following critical illness.

Early Mobilization Intervention to Improve Outcomes and Control Acquired Muscle Weakness among Pediatric Critically Ill Patients

AbstractPersistent immobility is linked with short and long-term disabilities in children admitted to critical area. Aim: the aim of the study was to assess the effect of early mobilization intervention on controling acquired muscle weakness among pediatric critically Ill patients. Randomized control trail was carried out on 80 pediatric patients divided equally into the study and the control groups in pediatric intensive care unit at Aswan University Hospital. Tools: Three tools were used to collect data: Tool I, included personal data , medical data and assessment scale for monitoring children's muscle strength .Tool II: Assessment delirium scale (Richmond Agitation-Sedation Scale. Tool III: Assess signs of intolerance. Results: after early mobilization intervention, mean of muscle strength in the study group (4.63 ± 0.59) was higher than the control group (3.52 ± 1.89) with highly statistically significant difference (p < 0.001). Majority of children in the study group their ambulation distance at ICU discharge were increased. The mean time of moving out of bed was 2.90 ± 1.66 days for children in the study group vs. 3.20 ± 1.42 of them in the control group. Mean length of hospital stay was 4.28 ± 1.59 days for children in the study group vs. 6.38 ± 2.10 day of them in the control group with statistically significant difference between the two groups (P=0.005). Conclusion: Ambulation distance at ICU discharge was increased among studied group. There was significance difference between the two groups regarding length of hospital stay. Implementation of early mobilization intervention improves the children' muscle strength. Recommendation: Early mobilization protocol should be incorporated into daily clinical practice of pediatric intensive care unit.

Brain growth in extremely preterm infants before and after implementing NAVA ventilation.

During neurally adjusted ventilatory assist (NAVA) both the timing and degree of ventilatory assist are controlled by the patient's respiratory center (1) resulting in improved synchrony and lower peak inspiratory pressures and lower oxygen requirements compared with conventional ventilation in low birth weight infants (2,3). However, there are no randomized controlled trials yet available evaluating the effects of NAVA ventilation on the neurodevelopmental outcomes, nor are there studies reporting the use of NAVA ventilation as a standard neonatal intensive care unit practice in extremely preterm infants.

How to prevent ROP in preterm infants in Indonesia?

Background and AimsRetinopathy of prematurity (ROP) is a severe disease in preterm infants. It is seen more frequently in Low‐Middle Income Countries (LMIC) like Indonesia compared to High‐Income Countries (HIC). Risk factors for ROP development are ‐extreme‐ preterm birth, use of oxygen, neonatal infections, respiratory problems, inadequate nutrition, and blood and exchange transfusions. In this paper, we give an overview of steps that can be taken in LMIC to prevent ROP and provide guidelines for screening and treating ROP.MethodsBased on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in preterm infants in LMIC.ResultsPrevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29‐32 weeks) by using 30% oxygen. Respiratory problems must be prevented by starting continuous positive airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory problems in more mature infants. If needed, the surfactant should be given in a minimally invasive manner, as ROP's lower incidence was found using this technique. The use of oxygen must be strictly regulated with a saturation monitor of 91‐95%. Infections must be prevented as much as possible. Both oral and parenteral nutrition should be started in all preterm infants on day one of life with preferably mothers' milk. Blood transfusions can be prevented by reducing the amount of blood needed for laboratory analysis.DiscussionPreterm babies should be born in facilities able to care for them optimally. The use of oxygen must be strictly regulated. ROP screening is mandatory in infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In case of progression of ROP, immediate mandatory treatment is required.ConclusionConcerted action is needed to reduce the incidence of ROP in LMIC. "STOP ‐ R1O2P3" is an acronym that can help implement standard practices in all neonatal intensive care units in LMIC to prevent development and progression.

Cost-effectiveness of Oral Versus Intravenous Ibuprofen Therapy in Preterm Infants With Patent Ductus Arteriosus in the Neonatal Intensive Care Setting: A Cohort-based Study

PurposeUse of ibuprofen for the patent ductus arteriosus (PDA) has become increasingly common. This study aimed to evaluate the clinical and economic impact of oral ibuprofen versus intravenous ibuprofen for PDA among preterm infants. MethodsThis retrospective, cohort-based pilot study examined the clinical and economic associations of oral versus intravenous ibuprofen for PDA. A decision-analytic model was constructed, from the hospital perspective, to follow the oral versus intravenous administrations of ibuprofen for PDA and their clinical and economic consequences. The course regimen of either formulation was an initial 10 mg/kg followed by 5 mg/kg at 24- and 48-h intervals. Clinical and resource utilization data were extracted from Cerner medical database, from 2014 through 2018, at the tertiary neonatal intensive care unit setting in Qatar. The primary outcome measures were the rate of successful closure based on the ductal diameter measure after the first course of treatment and the overall direct medical cost of PDA management. A population of 118 neonates was required for results with 80% power and 0.05 significance. Sensitivity analyses involving unit costs and a subgroup analysis based on gestational age and birth weight, added to a second-order probabilistic analysis of all model inputs, were performed. FindingsForty infants were available for inclusion in the oral ibuprofen study group, not achieving the desired sample size, with successful PDA closure reported in 64% of cases compared with a reduced success of 36% with intravenous ibuprofen (n = 59) (risk ratio = 0.56; 95% CI, 0.32–0.97; P = 0.04), which was associated with economic advantage to oral ibuprofen. The probabilistic analysis illustrated that oral ibuprofen costs less than intravenous ibuprofen in 72% of patient cases, with QAR 48,751 (US $13,356) (95% CI, QAR 47,500–50,000, US $13,014–$13,699) in mean savings. Sensitivity analyses confirmed the robustness of study conclusions and found that the rate of closure success versus failure was the most influential on results, followed by the occurrence of adverse drug events with both intravenous and oral ibuprofen. Although both ibuprofen formulations had similar safety profiles (P = 0.16), the intravenous formulation was associated with a larger number of adverse drug effects. ImplicationsThis is the first cost-effectiveness evaluation of oral versus intravenous formulations of ibuprofen among infants with PDA. The oral ibuprofen might be associated with an enhanced ductal closure at a considerably lower cost. The study results support recent trends in neonatal intensive care unit practices in favor of the oral administration of ibuprofen.

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS

ObjectiveTo describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.MethodsThis was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice.ResultsOn the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only.ConclusionOur results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

Knowledge, attitude, and expertise of nurses in intensive care unit regarding oral and dental care in hospitalized patients.

The purpose of this study was conducted to evaluate the knowledge, attitude, and practice of intensive care unit (ICU) nurses about oral and dental care in hospitalized patients. In this descriptive-analytic study, the statistical population included 214 nurses working in the ICU of the affiliated hospitals of Isfahan University in 1394. The level of knowledge, attitude, and practice of ICU nurses was assessed using questionnaires whose justifiability and stability were verified at the beginning of the study with a pilot study. Data were entered into SPSS software and tested by t-test, Spearman, one-way variance, and least significant difference test. The significance level was < 0.05. The data of this study showed that the score of knowledge and performance in male nurses was significantly different from female nurses. There was a significant relationship between nurse's education and their knowledge score (P < 0.001). Furthermore, the performance score of nurses working in different parts was different too (P < 0.001). The findings showed that the knowledge and performance of female nurses about oral care were higher than men, but the attitude of the two sexes is almost the same. Nurses with lower educational degree had less knowledge, but their attitude and performance did not differ. The performance score of nurses working in ICU was different, but they had similar knowledge and attitudes.

Ventilation practices in burn patients-an international prospective observational cohort study.

BackgroundIt is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28).MethodsThis is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (VT) was defined as VT ≤ 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between VT and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma.ResultsA total of 160 patients from 28 ICUs in 16 countries were included. Low VT was used in 74% of patients, median VT size was 7.3 [interquartile range (IQR) 6.2–8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p = 0.58). Median VFD-28 was 17 (IQR 0–26), without a difference between ventilation with low or high VT (p = 0.98). All patients were ventilated with PEEP levels ≥5 cmH2O; 80% of patients had maximum airway pressures <30 cmH2O.ConclusionIn this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low VT was not associated with a reduction in VFD-28.Trial registration Clinicaltrials.gov NCT02312869. Date of registration: 9 December 2014.

Novice Occupational Therapist's Experience of Working in Neonatal Intensive Care Units in KwaZulu-Natal

Introduction: The neonatal intensive care unit, a specifically designed environment to meet the needs of severely ill neonates, is an area where occupational therapists have several roles to play. However, there is limited literature available around the training and practice of South African therapists in these units. Method: The study followed a qualitative, explorative design with homogenous purposeful sampling. Twelve occupational therapists with less than four years post-community service experience were recruited and underwent in-depth interviewing regarding their experiences in neonatal intensive care units in the public health sector. Thematic analysis, with deductive reasoning, was used. Results: The community service occupational therapists initially lacked the knowledge and skills for neonatal intensive care unit work. Knowledgeable supervisors and supportive multidisciplinary teams assisted their clinical practice; whereas a lack of resources, cultural barriers and poor orientation hindered practice. The community service occupational therapists went through a process of adaptation, gaining increased confidence and self-identity throughout their exposure, utilising many coping mechanisms. Conclusions: The training of occupational therapists for neonatal intensive care unit practice urgently requires more attention within the South African context. Recommendations include curriculum review, inclusion of practical exposure, providing additional post-graduate courses and ensuring appropriate community service occupational therapist supervision.

Perception, experience and knowledge of early physiotherapy in intensive care units of Rome: a survey.

Early physiotherapy (EP) programs on critically ill patients in the intensive care unit (ICU) have proven to be safe, feasible and effective. However, despite being considered by all the professionals involved as a fundamental aspect of integrated care, in most cases they are inadequately applied or not performed at all. The main objective of this study is to evaluate the knowledge, perceptions and activities related to EP among physician, nurses and physiotherapists who practice in ICUs of Rome. Obstacles to its application and possible strategies to overcome them are also examined. The study was conducted according to the CHERRIES recommendations. Two questionnaires with 29 questions were created on the Google Form platform and were sent by mail to all the ICUs of public hospitals or accredited private hospitals with the National Health Service in Rome. Thirty (60%) of the contacted ICUs responded. The physiotherapist is present in 76.7% of ICUs and carries out its activities mainly during daytime hours (60.9%), for less than 3 hours in 39.1% of cases and only after a request for specialist advice (65.2%). Only in 4.3% of cases the service is guaranteed even at weekends but only after a request. All 29 professionals interviewed consider both the presence of a physiotherapist within the interdisciplinary team of the ICU and the implementation of an EP program to be necessary, supporting the positive effects of this program. The most frequently obstacles to the implementation of an EP program are clinical instability (69%), low priority to EP practice (62.1%), cardiovascular instability (58.6%) and lack of experience (58.6%). The most frequently indicated strategies to overcome these obstacles are to organize interdisciplinary briefings (86.2%), to avoid excluding patients from treatment without specific motivation (75.9%), to invest in staff training (75.9%), to use protocols and guidelines (58.6%). EP is not currently exploited to its full potential due to lack of funds, culture, experience, training and a hospital organization that limits the provision of effective patient care and efficient service to the National Health Service.

Assessing Nursing Enteral Nutrition Practices and Perspectives in An Intensive Care Unit of A Level Six Hospital in Kenya

Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs). Aim: The study was aimed to survey prevalent enteral nutrition practices in the general intensive care unit, nurses' perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 6 hospital in Kenya. The study design used was crosses sectional descript study. Materials and Methods: thirty four questionnaires were distributed and the results analyzed. A database was prepared and analyzed.Results: all (100%) questionnaires were filled and returned. A majority (32) of staff nurses expressed awareness of nutrition guidelines. A large number (27) of staff nurses knew about existence of nutrition protocols in the ICU. Almost all nurses (82.4%) chose enteral nutrition as their preferred route of nutrition unless contraindicated. All staff nurses were of the opinion that enteral nutrition is to be started at the earliest (within 24-48 h of the ICU stay). Half (50%) were of the thought that the absence of bowel sounds is an absolute contraindication to initiate enteral feeding. Passage of a nasogastric tube (Ryle’s tube) was considered mandatory before starting enteral nutrition by 86% of the respondents. Everyone knew that the method of Ryle's tube feeding in their ICU is intermittent boluses. Only 4 staff nurses were unaware of any method to confirm Ryle's tube position. The backrest elevation rate was 70%. Gastric residual volumes were always checked, but the amount of the gastric residual volume for the next feed to be withheld varied. The majority said that the unused Ryle's tube feed is to be discarded after 24 h. The most preferred (48%) to upgrade their knowledge of enteral nutrition as a personal initiative and CME.Conclusion: Information generated from this study can be helpful in identifying nutrition practices gaps and may be used to review and revise enteral feeding practices where necessary. Keywords: Enteral nutrition, intensive care, nursing, tube feeding

The patient with cirrhosis in the intensive care unit and the management of acute-on-chronic liver failure.

Acute on chronic liver failure (ACLF) is a clinical syndrome characterised by acute hepatic decompensation, multi-organ failure and high mortality, in patients with cirrhosis. Organ dysfunction in ACLF is often reversible and when necessary these patients should be considered appropriate candidates for admission to an intensive care unit (ICU). The yearly increase in numbers of patients with ACLF admitted to ICU has been matched with an improvement in survival. ACLF has only been recently defined. In the absence of evidence-based guidelines we outline a systems-based approach to care which encompasses accepted ICU practice and evidence from trials in this cohort. We advocate for timely referral to specialist liver centres and consider the complexities of proceeding with liver transplantation. Equally, in a proportion of patients who continue to deteriorate, appropriate ceilings of care should be established. Future clinical trials may change treatment paradigms but care of patients with ACLF is undoubtedly becoming an integral part of an intensivist's practice. We hope that this review is a welcome starting point when managing this complex clinical syndrome.

In this issue of CCR

This issue of Critical Care and Resuscitation focuses on several key aspects of modern intensive care unit (ICU) practice in Australia and New Zealand. Organ donation is particularly prominent, with two original articles and a dedicatededitorial. 1, 2, 3 The first article provides strong evidence that, in more difficult organ donation family conversations (ie, when there is no evidence of organ donation registry presence and organ donation is not raised by the family), the likelihood of successful donation is significantly increased by such conversation being led by an organ donation specialist. As supported by the editorial, it is increasingly clear that in this field, like all other aspects of critical care practice, training and specialisation make a difference. The second article demonstrates that organ donation can be successfully achieved under time pressure, even for highly vasopressor-dependent donors, and with good long term outcome when applying an expedited organ donation process. The implications are clear.

Clinical characteristics and outcomes of 85 intensive care patients with Covid-19 in South London: A single centre observational study.

In March 2020, Covid-19 secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was declared a global pandemic. This retrospective observational study included patients with Covid-19, managed in a single intensive care unit (ICU). We collected data on patient characteristics, laboratory and radiological findings and ICU management. Data are reported as median (interquartile range). Binary logistic regression modelling was used to identify variables at ICU admission associated with mortality. 85 patients (age 57.3 years [49.4-64.2], 75.3% male) were followed up for 34 days (26-40). The commonest comorbidities were hypertension (51.8%), obesity (48.7%), and type 2 diabetes (31.8%). Covid-19 presented with shortness of breath (89.4%), fever (82.4%), and cough (81.2%), first noted 8 days (6-10) prior to ICU admission. PaO2/FiO2-ratios at ICU admission were 8.28 kPa (7.04-11.7). Bilateral infiltrates on chest X-ray, lymphopenia, and raised C-reactive protein and ferritin were typical. 81.2% received invasive mechanical ventilation (IMV). Acute kidney injury occurred in 62.4% with renal replacement therapy required in 20.0%. By the end of the follow-up period, 44.7% had died, 30.6% had been discharged from hospital, 14.1% had been discharged from ICU but remained in hospital and 10.6% remained in ICU. ICU length of stay was 14 days (9-23). Age was the only variable at admission which was associated with mortality. PaO2/FiO2-ratio, driving pressure and peak ferritin and neutrophil count over the first 72-hours of IMV all correlated with mortality. We report the clinical characteristics, ICU practices and outcomes of a South London cohort with Covid-19, and have identified factors which correlate with mortality. By sharing our insight, we hope to further understanding of this novel disease.

Audit on enteral drug administration (EDA) and enteral nutrition (EN) practices in neurotrauma intensive care units (NICU):

Audit on enteral drug administration (EDA) and enteral nutrition (EN) practices in neurotrauma intensive care units (NICU):

Impact of COVID-19 on nursing time in intensive care units in Belgium

IntroductionThe COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. ObjectiveTo assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DesignThis study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SettingThree Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. Measurements and main resultsThe study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6–6.4). ConclusionsPatients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.

Prevalence of Noncardiac Multimorbidity in Patients Admitted to Two Cardiac Intensive Care Units and Their Association with Mortality

BackgroundCurrent cardiac intensive care unit (CICU) practice has seen an increase in patient complexity, including an increase in noncardiac organ failure, critical care therapies, and comorbidities. We sought to describe the changing epidemiology of noncardiac multimorbidity in the CICU population. MethodsWe analyzed consecutive unique patient admissions to 2 geographically distant tertiary care CICUs (n = 16,390). We assessed for the prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities (diabetes, chronic lung, liver, and kidney disease, cancer, and stroke/transient ischemic attack) and their associations with hospital and postdischarge 1-year mortality using multivariable logistic regression. ResultsThe prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities was 37.7%, 31.4%, 19.9%, and 11.0%, respectively. Increasing noncardiac comorbidities were associated with a stepwise increase in mortality, length of stay, noncardiac indications for ICU admission, and increased utilization of critical care therapies. After multivariable adjustment, compared with those without noncardiac comorbidities, there was an increased hospital mortality for patients with 1 (odds ratio [OR] 1.30; 95% confidence interval [CI], 1.10-1.54, P = .002), 2 (OR 1.47; 95% CI, 1.22-1.77, P < .001), and ≥3 (OR 1.79; 95% CI, 1.44-2.22, P < .001) noncardiac comorbidities. Similar trends for each additional noncardiac comorbidity were seen for postdischarge 1-year mortality (P < .001, all). ConclusionsIn 2 large contemporary CICU populations, we found that noncardiac multimorbidity was highly prevalent and a strong predictor of short- and long-term adverse clinical outcomes. Further study is needed to define the best care pathways for CICU patients with acute cardiac illness complicated by noncardiac multimorbidity.

Systematic review of family engagement interventions in neonatal, paediatric, and adult ICUs.

The purpose of this systematic review was to evaluate interventions that have been used to engage families in direct care activities (active family engagement) in adult, paediatric, and neonatal intensive care unit (ICU) settings. Family engagement is universally advocated across ICU populations and practice settings; however, appraisal of the active family engagement intervention literature remains limited. Ovid Medline, PsycArticles & PsycInfo, Scopus, and CINAHL were searched for family interventions that involved direct care of the patient to enhance the psychological, physical, or emotional well-being of the patient or family in neonatal, paediatric, or adult ICUs. Studies were included if an active family engagement intervention was evaluated. Studies were excluded if they were not published in English or reported non-interventional research. A total of 6210 abstracts were screened and 19 studies were included. Most studies were of low to moderate quality and were conducted in neonatal ICUs within the United States. Intervention dosage and frequency varied widely across studies. The interventions focused on developmental care (neonatal ICU) and involved families in basic patient care. Family member outcomes measured included satisfaction, stress, family-centred care, confidence, anxiety, and depression. Most studies found improvements in one or more outcomes. There is a paucity of literature about active family engagement interventions, especially in adult and paediatric populations. The optimal dosage and frequency of family engagement interventions remains unknown. Our systematic review found that data are limited on the relationship between family engagement and patient outcomes, and provides a timely appraisal to guide future research. Further research on the efficacy of family engagement interventions is warranted. The translation of active family engagement interventions into clinical practice should also be supported.

A cross-sectional study of early mobility practice in intensive care units in Sarawak Hospitals, Malaysia.

AimsTo determine the prevalence, characteristics of EM activities, the relationship between level of activity and mode of ventilation and adherence rate of EM protocol.BackgroundMobilizing ICU patients remains a challenge, despite its safety, feasibility and positive short‐term outcomes.DesignA cross‐sectional point prevalence study.MethodsAll patients who were eligible and admitted to the adult ICUs during March 2018 were recruited. Data were analysed by using the Statistical Package for Social Sciences version 24 for Windows.ResultsThe prevalence of EM practice was 65.6%. The most frequently reported avoidable and unavoidable factors inhibit mobility were deep sedation and vasopressor infusion, respectively. Level II of activity was the most common level of activity performed in ICU patients. The invasive ventilated patient had 12.53 the odds to stay in bed as compared to non‐invasive ventilated patient. An average adherence rate of EM protocol was 52.5%.

The Effect of Various, Everyday Practices on Glucose Levels in Critically Ill Children.

To evaluate the effect of various, everyday intensive care unit (ICU) practices on glucose levels in critically ill pediatric patients with the use of a continuous glucose monitoring system. Seventeen sensors were placed in 16 pediatric patients (8 male). All therapeutic and diagnostic interventions were recorded and 15 minutes later, a flash glucose measurement was obtained by swiping the sensor with a reader. Glucose difference was calculated as the glucose value 15 minutes after the intervention minus the mean daily glucose value for each individual patient. Additionally, the consciousness status of the patient (awake or sedated) was recorded. Two hundred and five painful skin interventions were recorded. The mean difference of glucose values was higher by 1.84 ± 14.76 mg/dL (95% CI: -0.19 to 3.87 mg/dL, P = .076). However, when patients were categorized regarding their consciousness level, mean glucose difference was significantly higher in awake state than in sedated patients (4.76 ± 28.07 vs -2.21 ± 15.77 mg/dL, P < .001). Six hundred forty-nine interventions involving the respiratory system were recorded. Glucose difference during washings proved to be significantly higher than the ones during simple suctions (4.74 ± 14.18 mg/dL vs 0.32 ± 18.22 mg/dL, P = .016). Finally, glucose difference in awake patients was higher by 3.66 ± 13.91 mg/dL compared to glucose difference of -2.25 ± 21.07 mg/dL obtained during respiratory intervention in sedated patients. Diagnostic and therapeutic procedures in the ICU, especially when performed in an awake state, exacerbate the stress and lead to a significant rise in glucose levels.