Research ArticleResearchPolicyQuality Improvement

Flexible daytime family visitation lowered postoperative delirium from 44% to 30% in one orthopedic ICU

The Journal of International Medical Research (PubMed)Jul 10, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a single-center randomized trial of 405 postoperative adults aged 60 or older in an orthopedic ICU, flexible daytime family visitation reduced delirium from 44.4% to 29.5% and sedative use from 44.9% to 32.0%, without a detected increase in hospital-acquired infection or length of stay.

What NurseJet pulled from the source

This parallel-group randomized trial enrolled 405 adults aged 60 or older who entered one orthopedic ICU within 24 hours after surgery. Participants received either flexible daytime family visitation or routine restricted visitation, and delirium was assessed daily with the CAM-ICU and Intensive Care Delirium Screening Checklist. Delirium occurred in 29.5% with flexible visitation and 44.4% with restricted visitation; sedative use was 32.0% versus 44.9%. Hospital-acquired infection was similar (3.5% versus 3.9%), and median length of stay was 16 days in both groups. Hospitalization costs were lower with flexible visitation. A cervical-spine subgroup appeared to benefit most, but that surgical-type analysis was exploratory.

Why this matters for nurses

ICU nurses perform delirium surveillance, coordinate family presence, and work within visitation and infection-control policies. This trial matters because it evaluated a modifiable care-environment policy and included delirium, sedative exposure, infection, length of stay, and cost rather than a single outcome.

Bedside takeaway

Be aware that flexible daytime family visitation reduced delirium and sedative use in one orthopedic ICU without a detected rise in infection or length of stay.

How This Applies in Practice

Use this when: Your orthopedic ICU is evaluating a facility-approved flexible daytime visitation plan for postoperative adults aged 60 or older.

On your shift

Use the unit's standardized delirium tool each day while the visitation plan is in place.
Track sedative exposure, hospital-acquired infection, and length of stay as balancing measures alongside delirium.

Keep in mind: The evidence comes from one orthopedic ICU and does not establish the best visitation model for other populations. Follow facility policy rather than changing visitation restrictions independently.

Explain this for my unit

Key takeaways

The trial randomized 405 postoperative adults aged 60 or older in a single orthopedic ICU.
Flexible daytime visitation reduced measured delirium from 44.4% to 29.5%.
Sedative use was lower, while hospital-acquired infection and median length of stay did not differ significantly.
The apparent larger benefit after cervical-spine surgery came from an exploratory subgroup analysis.

Practice implications

The findings support local review of structured daytime family access as one component of postoperative delirium prevention for older orthopedic ICU patients. Individual nurses should not change visitation restrictions independently; implementation requires an approved policy, consistent delirium assessment, and monitoring of balancing outcomes.

Limitations & cautions

This was a single-center orthopedic ICU study limited to postoperative adults aged 60 or older. Visitation could not be blinded, the results may not transfer to other ICU populations or visitation models, cost findings are setting-specific, and the surgical-subgroup result was exploratory.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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The Journal of International Medical Research (PubMed)

The Journal of International Medical Research (PubMed). Flexible family visitation and postoperative delirium in an orthopedic intensive care unit: A randomized trial examining surgical-type heterogeneity and cost outcomes.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42432993/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Hospital Pediatrics (PubMed)Jul 14, 2026Systematic ReviewPractice applicable

A systematic review of 23 pediatric inpatient studies found that most alarm-reduction projects lowered monitor-alarm frequency and every study measuring nonactionable alarms reported a decrease, but study heterogeneity prevented comparison of individual strategies and safety balancing measures were inconsistent.

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Systematic ReviewResearchQuality ImprovementWorkflowPractice applicableAI summary · original source linked below

This systematic review examined interventions intended to reduce pulse-oximeter and cardiorespiratory-monitor alarms in pediatric inpatient care. The 23 included studies comprised 12 NICU studies, two PICU studies, eight medical-surgical studies, and one spanning PICU and medical-surgical care; 16 were quality-improvement studies, five were nonrandomized, and two were randomized trials. Common approaches included staff education, universal or patient-specific parameter changes, longer alarm delays, and standardized communication about monitoring plans. Most studies reported fewer alarms, and every study that measured nonactionable alarms reported a decrease. However, heterogeneity prevented comparison of individual interventions, balancing measures were inconsistently reported, and the review found no standardized method for synthesizing quality-improvement studies.

Key takeaways

The review included 23 studies across neonatal, pediatric intensive-care, and pediatric medical-surgical settings.
Sixteen studies were quality-improvement projects, five were nonrandomized, and only two were randomized trials.
Most studies reported lower alarm frequency, and all studies measuring nonactionable alarms reported decreases.
The review could not compare individual interventions because of heterogeneity, and safety balancing measures were reported inconsistently.

Why this matters on shift

Pediatric nurses are exposed to repeated monitor alarms and are central to monitoring-plan communication and response. This review matters because it identifies recurring alarm-reduction approaches while warning that lower alarm counts alone do not establish that a change is safer.

Bedside takeaway

Worth knowing that pediatric alarm-reduction projects usually lowered alarm counts, but heterogeneous methods and inconsistent safety balancing measures prevent naming one best approach.

Nursing implications

Pediatric units can use the review to structure approved alarm-reduction work around clear monitoring plans, staff education, nonactionable-alarm measurement, and balancing outcomes. Alarm limits or delays should not be changed outside approved orders and unit protocols, and the review did not identify one superior approach.

Limitations & cautions

The evidence was dominated by heterogeneous quality-improvement and nonrandomized studies, with only two randomized trials. Intervention effects could not be compared, balancing measures were inconsistent, no pooled effect estimate was available, and methods for systematically reviewing quality-improvement studies are not standardized.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Hospital Pediatrics (PubMed). Interventions to Reduce Monitor Alarms Across Pediatric Inpatient Settings: A Systematic Review.

Explain this for my unit

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American Journal of Respiratory and Critical Care Medicine (PubMed)Jul 13, 2026Research Article

In a 115-patient multicenter randomized trial of acute respiratory failure, early in-bed cycling plus intravenous amino acids appeared safe but did not improve discharge walking distance, other functional outcomes, or 6-month outcomes versus usual care.

ICUAI summaryReview source

Research ArticleResearchWorkflowAI summary · original source linked below

Investigators at multiple centers randomized 115 adults with acute respiratory failure, more than 90% of whom were mechanically ventilated, to usual care alone or usual care plus 45 minutes per day of in-bed cycling and intravenous amino acids targeting total protein intake of 2.0 to 2.5 g/kg/day. The intervention delivered 40 plus or minus 7 minutes of cycling per day and 1.9 plus or minus 0.6 g/kg/day of protein, versus 0.9 plus or minus 0.6 g/kg/day with usual care. At hospital discharge, median 6-minute walk distance was 108 m in the intervention group and 95 m with usual care; the median difference was 10 m (95% CI -75 to 84; P=.51). Other ICU-discharge, hospital-discharge, and 6-month outcomes were also similar. Enrollment stopped early because recruitment was slow, not because of safety concerns. The combined strategy appeared safe but did not improve the trial's functional outcomes.

Key takeaways

The multicenter phase 2 trial randomized 115 adults with acute respiratory failure, and more than 90% were mechanically ventilated.
The intervention combined daily in-bed cycling with intravenous amino acids and approximately doubled achieved total protein intake.
Discharge 6-minute walk distance did not differ significantly between intervention and usual-care groups.
Secondary outcomes through 6 months were also similar, and enrollment stopped early because recruitment was slow.

Why this matters on shift

Early mobility and nutrition require coordinated bedside work and are intended to address long-lasting weakness after critical illness. This trial matters for ICU nurses because it tested an intensive combined protocol with blinded functional assessment and found no added functional benefit over usual care.

Bedside takeaway

Be aware that adding early in-bed cycling and IV amino acids to usual ICU care did not improve discharge walking distance or 6-month outcomes in this 115-patient trial, although the combined protocol appeared safe.

Nursing implications

For ICU teams, the result supports reviewing goals, workload, tolerance, and local evidence before adding this exact combined protocol. It should not be read as a reason to stop ordered mobility or nutrition practices, because cycling and amino acids were tested together rather than separately.

Limitations & cautions

The phase 2 trial randomized 115 patients and stopped before its planned 128 evaluable participants because of slow recruitment. The combined design cannot isolate cycling from amino acids, the confidence interval around walking distance was wide, and findings may not apply beyond adults with acute respiratory failure.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

American Journal of Respiratory and Critical Care Medicine (PubMed). Nutrition and Exercise in Critical Illness (NEXIS) trial: randomized trial of combined in-bed cycling and intravenous amino acid plus usual care.

Explain this for my unit

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AI-summarized from the linked source. Review the original article before applying to practice.

European Respiratory Review (PubMed)Jul 1, 2026Systematic Review

Across 18 randomized studies with 4,094 children aged 24 months or younger with bronchiolitis, high-flow nasal cannula reduced treatment failure versus low-flow oxygen but did not significantly reduce mechanical ventilation or outperform CPAP.

Peds ICUAI summaryReview source

Systematic ReviewResearchWorkflowNew Grad FriendlyAI summary · original source linked below

This systematic review and meta-analysis included 18 randomized studies and 4,094 children aged 24 months or younger with bronchiolitis. Trials compared high-flow nasal cannula with low-flow nasal cannula or continuous positive airway pressure. High-flow therapy did not significantly reduce mechanical ventilation versus low-flow oxygen (RR 0.69, 95% CI 0.33 to 1.44) or CPAP (RR 0.90, 95% CI 0.65 to 1.24). Compared with low-flow oxygen, it reduced treatment failure (RR 0.44, 95% CI 0.23 to 0.87) and shortened pediatric ICU stay by 0.40 days (95% CI 0.02 to 0.78 days shorter). Compared with CPAP, treatment failure and PICU stay did not differ significantly. The review supports high-flow therapy as an escalation option from low-flow oxygen, but it does not show that high-flow prevents intubation or performs better than CPAP across the studied outcomes.

Key takeaways

Eighteen randomized studies included 4,094 children aged 24 months or younger with bronchiolitis.
High-flow nasal cannula reduced treatment failure versus low-flow oxygen, with a pooled risk ratio of 0.44.
High-flow therapy did not significantly reduce mechanical ventilation compared with either low-flow oxygen or CPAP.
Treatment failure and PICU length of stay did not differ significantly between high-flow therapy and CPAP.

Why this matters on shift

Pediatric nurses frequently monitor infants receiving escalating oxygen support and identify signs of treatment failure. This review matters because it separates a lower failure rate versus low-flow oxygen from the absence of evidence that high-flow reduces mechanical ventilation or outperforms CPAP.

Bedside takeaway

Worth knowing that high-flow nasal cannula reduced treatment failure versus low-flow oxygen in bronchiolitis, but did not significantly reduce mechanical ventilation or outperform CPAP.

Nursing implications

For pediatric teams, the findings support following locally approved criteria for starting, monitoring, and escalating high-flow therapy rather than assuming it prevents intubation. Device selection, settings, reassessment, and movement to CPAP or invasive support remain clinician-directed and protocol-specific.

Limitations & cautions

The review pooled studies with different respiratory-support comparisons, and the abstract does not provide certainty ratings, detailed risk-of-bias findings, or standardized definitions of treatment failure. It also does not identify which patient subgroups or high-flow protocols are most likely to benefit.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European Respiratory Review (PubMed). Respiratory support in paediatric patients with bronchiolitis: a systematic review and meta-analysis.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Pediatric monitor-alarm projects usually reduced alarm burden, but safety balancing measures were inconsistent

Early in-bed cycling plus IV amino acids did not improve functional outcomes in the NEXIS ICU trial

High-flow nasal cannula lowered treatment failure versus low-flow oxygen, with no significant ventilation difference