Research ArticleResearchWorkflow

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

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

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Brief summary

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.

What NurseJet pulled from the source

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.

Why this matters for nurses

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.

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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.

Practice 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.
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Citations

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American Journal of Respiratory and Critical Care Medicine (PubMed)

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.

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https://pubmed.ncbi.nlm.nih.gov/42438140/

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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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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.
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Citations · exact source links

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

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PLOS One (PubMed)Jul 10, 2026Research Article

In a retrospective cohort of 102 mechanically ventilated ICU patients, a documented nurse-led targeted sedation-analgesia workflow was associated with shorter ventilation (median 4.3 vs 5.9 days), more RASS assessments within target (74.0% vs 61.5%), and less deep-sedation exposure.

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Research ArticleResearchWorkflowQuality ImprovementAI summary · original source linked below

This single-center retrospective observational cohort examined adults who received invasive mechanical ventilation for at least 24 hours during 2024 and 2025. Patients were classified as receiving usual physician-directed care (48 patients) or a nurse-led targeted sedation-analgesia workflow (54 patients) using documentation of daily RASS targets, assessment frequency, nurse-driven titration, and closed-loop reassessment. Median ventilation duration was 4.3 days in the nurse-led group versus 5.9 days with usual care (P less than 0.01), and the mean proportion of RASS assessments within target was 74.0% versus 61.5% (P less than 0.01). Deep-sedation exposure was 16.1% versus 27.6% (P less than 0.01), agitation exposure was 9.1% versus 12.4% (P=0.03), and ICU stay averaged 8.0 versus 9.7 days (P=0.02). After adjustment, the nurse-led workflow remained associated with shorter ventilation (adjusted ratio 0.79, 95% CI 0.67 to 0.93), while delirium was not significantly different and no differences were detected in unplanned extubation, 48-hour reintubation, tracheostomy, or 28-day mortality. The authors stress that the study shows association, not causal effectiveness.

Key takeaways

The study compared 54 patients managed with a documented nurse-led targeted workflow and 48 who received usual physician-directed sedation care.
Median invasive ventilation was shorter with the nurse-led workflow (4.3 vs 5.9 days), and 74.0% of RASS assessments were within target versus 61.5% with usual care.
Deep-sedation exposure was lower (16.1% vs 27.6%), as were agitation exposure (9.1% vs 12.4%) and mean ICU length of stay (8.0 vs 9.7 days).
Delirium and measured safety outcomes were not significantly different, and retrospective classification prevents a causal conclusion.

Why this matters on shift

Sedation targets can drift when assessment, titration, and reassessment are not linked into a reliable loop, prolonging exposure to deep sedation. This study matters for ICU nurses because it examines a workflow built around nursing assessment and protocol-guided response, with clinically relevant differences in target attainment and ventilator duration.

Bedside takeaway

Be aware that in a 102-patient retrospective ICU cohort, a nurse-led targeted sedation workflow was linked to 4.3 versus 5.9 ventilator days and more RASS assessments on target, but causality remains unproven.

Nursing implications

For ICU nurses, the findings reinforce consistent documentation of the daily RASS goal, scheduled assessment, protocol-aligned titration, and reassessment after changes when those steps are authorized by local policy and orders. They do not establish that a nurse-led workflow alone shortens ventilation, so broader sedation, analgesia, awakening, and liberation practices still need to be considered.

Limitations & cautions

This was a single-center retrospective study of 102 patients, with groups defined from documentation rather than random assignment, creating risk of selection bias, residual confounding, and misclassification. Adjustment was limited, the study was too small for uncommon safety events, and it found no significant difference in delirium, reintubation, unplanned extubation, tracheostomy, or 28-day mortality.
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Citations · exact source links

PLOS One (PubMed). Association of nurse-led targeted sedation-analgesia management with ventilation duration and sedation quality in mechanically ventilated patients.

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Frontiers in Medicine (PubMed)Jun 23, 2026Research Article

In a prospective self-controlled study of 42 awake mechanically ventilated ICU patients, closed-system suctioning was followed by a sharp rise in self-reported dyspnea that largely resolved within 5 minutes, and this worsening occurred even though oxygen saturation went up.

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Research ArticleResearchWorkflowAI summary · original source linked below

Endotracheal suctioning is a routine airway care procedure in mechanically ventilated patients, but its immediate effect on how breathless patients feel has not been well quantified. In this prospective self-controlled observational study conducted from May to October 2025 in a tertiary ICU in Sichuan Province, China, awake mechanically ventilated adults with a Richmond Agitation-Sedation Scale score of 0 to +1 who required closed-system suctioning were enrolled. Dyspnea was assessed with the Dyspnea Visual Analog Scale (D-VAS, 0 to 10) before suctioning (T0), immediately after (T1), and 5 minutes after (T2), while peripheral oxygen saturation (SpO2) and heart rate were recorded at the same times. Fifty-three suctioning procedures from 42 patients were included. D-VAS scores rose from 2.8 plus or minus 1.9 at T0 to 6.4 plus or minus 2.1 at T1 (mean increase 3.6, 95 percent CI 3.1 to 4.1, P less than 0.001), then fell to 3.2 plus or minus 1.7 at T2 (P less than 0.001 versus T1). Dyspnea worsened in 92.5 percent of procedures at T1, and 15.1 percent had not returned to baseline at T2. Even though SpO2 rose from 97.2 plus or minus 2.1 percent to 99.1 plus or minus 1.3 percent at T1, dyspnea worsened substantially, pointing to a possible dissociation between oxygenation and subjective respiratory distress. The authors conclude that closed-system suctioning may cause clinically significant but transient worsening of dyspnea that appears independent of oxygenation, and that individual dyspnea assessment during routine suctioning warrants attention, while noting the study was a single-center convenience sample.

Key takeaways

Across 53 closed-system suctioning procedures in 42 awake ventilated ICU patients, self-reported dyspnea rose sharply immediately after suctioning (D-VAS 2.8 to 6.4, mean increase 3.6, P less than 0.001) and largely settled by 5 minutes (3.2).
Dyspnea worsened in 92.5 percent of procedures right after suctioning, and 15.1 percent had not returned to baseline 5 minutes later.
Oxygen saturation actually increased with suctioning (97.2 percent to 99.1 percent), yet patients still felt more breathless, suggesting SpO2 and subjective distress can move in opposite directions.
The authors call the worsening clinically significant but transient and recommend assessing individual patients' dyspnea during routine suctioning.

Why this matters on shift

Suctioning is one of the most frequent things ICU nurses do for ventilated patients, and it is easy to assume that a stable or rising oxygen saturation means the patient is comfortable. This study may matter for critical care nurses because it shows that awake ventilated patients can feel markedly more breathless right after suctioning even when their SpO2 improves.

Bedside takeaway

Worth knowing that in a small ICU study, closed-system suctioning caused a sharp but short-lived rise in patient-reported breathlessness even as oxygen saturation rose, so a good SpO2 may not mean an awake ventilated patient feels comfortable.

Nursing implications

For ICU nurses, the findings suggest watching for and, where possible, asking about breathlessness around suctioning rather than relying on the oxygen saturation number alone, since most patients in this study felt worse immediately afterward. Knowing the distress is usually brief but occasionally lingers can support brief reassurance and reassessment before assuming an awake ventilated patient is at ease.

Limitations & cautions

This was a single-center convenience sample of only 42 patients and 53 procedures, with no prospective sample size calculation and a one-dimensional dyspnea scale, so the estimates are preliminary. It enrolled only awake, lightly sedated patients able to self-report, so the findings may not apply to more deeply sedated patients, and confirmatory multicenter studies are needed.
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Citations · exact source links

Frontiers in Medicine (PubMed). Impact of closed-system suctioning on self-reported dyspnea in mechanically ventilated patients: a prospective observational study.

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Open original sourceFull brief

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

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

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

A nurse-led sedation workflow was linked to shorter ventilation and more RASS assessments on target in a 102-patient ICU cohort

Closed-system suctioning triggered a sharp but short-lived rise in patient-reported dyspnea even as oxygen saturation went up