Research ArticleResearchQuality Improvement

Randomized trial of 38 cardiac surgery patients finds nurse-led early mobilization algorithm cuts post-ICU syndrome and improves sleep

The Journal of cardiovascular nursing (PubMed)Aug 12, 2026

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Brief summary

A randomized controlled trial of 38 adult cardiac surgery patients in an intensive care unit found that a nurse-led, algorithm-based early mobilization protocol initiated 12 hours post-admission significantly reduced post-intensive care syndrome scores, alleviated anxiety and depression, and improved sleep quality without adverse events.

What NurseJet pulled from the source

Post-intensive care syndrome (PICS) represents a multifaceted complication encompassing physical, cognitive, and psychological impairments among intensive care unit (ICU) survivors, particularly following cardiac surgery. In a randomized controlled pretest-posttest trial conducted at a tertiary hospital in South Korea, 38 adult cardiac surgery patients were randomly allocated 1:1 to an experimental group (n = 19) or a control group (n = 19). The experimental group received a structured, nurse-led, algorithm-based early mobilization (EM) protocol initiated 12 hours after ICU admission and continued until transfer to the step-down unit. Outcomes were measured using validated instruments including the PICS Questionnaire, Hospital Anxiety and Depression Scale (HADS), Korean Modified Leeds Sleep Evaluation Questionnaire, and Nursing Service Satisfaction Tool, analyzed nonparametrically. Patients in the nurse-led algorithm group demonstrated statistically significant improvements compared with the control group in PICS scores (Z = -3.83, p < .001), anxiety and depression scores (Z = -3.52, p < .001), sleep quality (Z = -3.83, p < .001), and across all subdomains of nursing care satisfaction (Z range: -3.58 to -3.83, p < .001). Crucially, zero mobilization-related adverse events were documented during the study period.

Why this matters for nurses

Bedside critical care nurses coordinate the daily progression of postoperative cardiac patients who are connected to invasive lines, chest tubes, and telemetry. Demonstrating that a standardized nurse-led mobility algorithm initiated at 12 hours safely reduces cognitive, physical, and emotional sequelae empowers nurses to champion timely progressive mobility rather than deferring until transfer.

Bedside takeaway

An RCT of 38 cardiac surgery ICU patients showed a nurse-led mobility algorithm started at 12 hours cut PICS scores, eased anxiety, and improved sleep without adverse events.

Key takeaways

Randomized trial evaluated 38 adult cardiac surgery ICU patients receiving either standard care (n = 19) or a nurse-led early mobilization algorithm (n = 19).
Nurse-driven mobilization commenced within 12 hours of ICU admission and continued until unit transfer.
Protocol significantly lowered post-intensive care syndrome (PICS) scores compared to control (Z = -3.83, p < .001).
Psychological distress including anxiety and depression was significantly mitigated (Z = -3.52, p < .001).
Patients experienced significantly better sleep quality (Z = -3.83, p < .001) and higher nursing care satisfaction across all subdomains.
No adverse events related to mobilization occurred, confirming clinical safety.

Practice implications

Initiate structured mobility assessments early postoperatively once hemodynamic and surgical stability criteria are satisfied. Screen patients for mobilization readiness using algorithm-based criteria, monitor lines, tubes, and vital sign stability throughout each mobility phase, and advocate for progressive sitting and ambulation to optimize recovery and prevent delirium and PICS.

Limitations & cautions

Small sample size (38 patients); conducted at a single tertiary hospital in South Korea; focused specifically on cardiac surgery ICU patients, which may limit generalizability to medical or trauma ICU populations; long-term post-discharge outcomes were not reported.
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The Journal of cardiovascular nursing (PubMed)

The Journal of cardiovascular nursing (PubMed). Nurse-Led Algorithm-Based Early Mobilization Protocol for Reducing Post-Intensive Care Syndrome in Intensive Care Unit Patients: A Randomized Controlled Trial.

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https://pubmed.ncbi.nlm.nih.gov/42585547/

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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Journal of critical care (PubMed)Aug 13, 2026Systematic Review

A systematic review and meta-analysis of seven randomized controlled trials encompassing approximately 9,127 critically ill patients found that pantoprazole stress-ulcer prophylaxis reduced clinically important gastrointestinal bleeding by 47% compared to placebo without altering all-cause mortality or increasing risks of ventilator-associated pneumonia or Clostridioides difficile infection.

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Stress-related mucosal damage represents a common risk among critically ill patients undergoing mechanical ventilation or experiencing coagulopathy, yet the balance between bleeding prevention and potential adverse infectious risks associated with gastric acid suppression has remained debated. Following PRISMA-2020 guidelines, this systematic review and meta-analysis synthesized evidence from seven randomized controlled trials (RCTs) identified across PubMed, Scopus, and Cochrane CENTRAL, evaluating approximately 9,127 adult and pediatric intensive care unit (ICU) patients (4,575 assigned to pantoprazole and 4,552 assigned to placebo). Pantoprazole administration significantly reduced the primary outcome of clinically important gastrointestinal bleeding (relative risk [RR]: 0.53; 95% CI: 0.29–0.94; p = 0.03). However, pantoprazole did not alter all-cause mortality (RR ≈ 0.99; 95% CI: 0.92–1.05; p = 0.68). In secondary safety assessments, infection rates were comparable between groups, with no statistically significant increase in ventilator-associated pneumonia (RR = 0.99; p = 0.78) or Clostridioides difficile infection (RR = 1.11; p = 0.73). Robustness was confirmed across sensitivity analyses.

Key takeaways

Meta-analysis synthesized 7 randomized controlled trials encompassing ~9,127 ICU patients (4,575 receiving pantoprazole, 4,552 receiving placebo).
Pantoprazole prophylaxis reduced clinically important GI bleeding by 47% (RR 0.53, 95% CI: 0.29–0.94, p = 0.03).
All-cause mortality was unaffected by prophylaxis (RR 0.99, 95% CI: 0.92–1.05, p = 0.68).
Risk of ventilator-associated pneumonia was not increased in pantoprazole-treated patients (RR 0.99, p = 0.78).
Incidence of Clostridioides difficile infection showed no significant difference compared to placebo (RR 1.11, p = 0.73).

Why this matters on shift

Critical care and acute care nurses administer proton pump inhibitors daily to prevent gastrointestinal bleeding in ventilated and severely ill patients, but frequent clinical concerns exist regarding secondary nosocomial pneumonia and C. diff colitis from altered gastric microbiome. Clarifying that pantoprazole provides robust gastroprotection without elevated pneumonia or C. diff risk reinforces safe, targeted medication administration guidelines.

Bedside takeaway

A meta-analysis of ~9,127 ICU patients showed pantoprazole halved clinically important GI bleeding (RR 0.53) without increasing mortality, VAP, or C. diff infection.

Nursing implications

Confirm that ICU patients receiving acid-suppressive prophylaxis meet established risk criteria (e.g., invasive mechanical ventilation >= 48 hours or coagulopathy). Monitor patients for signs of occult and overt gastrointestinal bleeding, inspect stools and gastric aspirates, and re-evaluate the ongoing necessity of proton pump inhibitor therapy as patients transition toward enteral nutrition and clinical recovery in collaboration with the clinical pharmacist and care team.

Limitations & cautions

Included heterogeneous ICU patient populations spanning both adult and pediatric cohorts; variations in specific pantoprazole dosages and administration routes across included trials; long-term post-ICU outpatient outcomes not assessed.
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Citations · exact source links

Journal of critical care (PubMed). Efficacy and safety of pantoprazole for stress-ulcer prophylaxis in critically ill patients: A systematic review and Meta-analysis of randomized controlled trials.

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Journal of intensive care medicine (PubMed)Sep 2, 2026Systematic Review

A systematic review and meta-analysis of seven randomized controlled trials involving 910 patients found that midline venous catheters had significantly higher risks of overall complications, premature catheter removal, occlusion, and infiltration, alongside shorter dwell times compared with PICCs.

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Midline venous catheters (MVCs) have been increasingly utilized as alternatives to peripherally inserted central catheters (PICCs) for intermediate-duration intravenous therapy to preserve central veins and reduce central line-associated bloodstream infections. This systematic review and meta-analysis synthesized data from seven randomized controlled trials (RCTs) encompassing 910 pediatric and adult patients (454 MVC, 456 PICC) identified across PubMed, Embase, Scopus, and Cochrane Central through March 2025. Compared with PICCs, MVCs were associated with a more than twofold higher risk of total complications (RR: 2.57; 95% CI: 1.54–4.31; p = 0.0003), nearly fourfold higher risk of premature catheter removal (RR: 3.91; 95% CI: 1.85–8.27; p = 0.0004), and significantly shorter median dwell time (weighted mean difference: -2.06 days; 95% CI: -3.18 to -0.94; p = 0.0003). Specific mechanical complications were markedly increased with MVCs, including catheter occlusion (RR: 3.61; 95% CI: 2.13–6.11; p < 0.00001), infiltration (RR: 3.77; 95% CI: 1.08–13.14; p = 0.04), and leakage (RR: 2.91; 95% CI: 1.00–8.50; p = 0.05). In contrast, no statistically significant differences were observed between MVCs and PICCs for catheter-related bloodstream infections, venous thrombosis, phlebitis, dislodgement, internal malposition, or local insertion site infections, although event rates were low and confidence intervals wide.

Key takeaways

Meta-analysis included seven RCTs encompassing 910 patients (454 receiving midlines and 456 receiving PICCs).
Midline catheters demonstrated higher risk of overall complications (RR 2.57, 95% CI: 1.54–4.31, p = 0.0003) and premature removal (RR 3.91, 95% CI: 1.85–8.27, p = 0.0004).
Median catheter dwell time was 2.06 days shorter in the midline group compared to PICCs (p = 0.0003).
Mechanical failures were more frequent with midlines, including occlusion (RR 3.61, p < 0.00001), infiltration (RR 3.77, p = 0.04), and leakage (RR 2.91, p = 0.05).
Infection and thrombosis rates did not differ significantly between lines, though low event counts preclude claiming clinical equivalence.

Why this matters on shift

Vascular access device selection directly impacts inpatient therapy completion, nurse workload, and patient comfort. While midline catheters are frequently selected to avoid central line placement, understanding that midlines carry substantially higher rates of premature failure, occlusion, and extravasation reinforces that device choice must match anticipated therapy duration and infusate properties rather than treating midlines as universal drop-in substitutes.

Bedside takeaway

A meta-analysis of 7 RCTs and 910 patients found midline catheters had a 2.6-fold higher complication rate, more occlusions, and 2 days shorter dwell time than PICCs.

Nursing implications

When maintaining midline catheters, monitor closely for early signs of occlusion, sluggish flush resistance, and insertion site leakage. For patients requiring extended intravenous therapy beyond 1 to 2 weeks, consult with vascular access teams and follow institutional device selection algorithms rather than presuming midlines will achieve dwell longevity comparable to PICCs.

Limitations & cautions

Analysis included seven RCTs with a total of 910 patients; event rates for bloodstream infections and venous thrombosis were low, resulting in wide confidence intervals and limited statistical power to establish equivalence for infectious outcomes.
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Citations · exact source links

Journal of intensive care medicine (PubMed). Comparison of Midline Venous Catheters Versus Peripherally Inserted Central Catheters for Intravenous Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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American journal of preventive cardiology (PubMed)May 30, 2026Systematic Review

A systematic review and meta-analysis of externally validated AI-ECG models across 538,735 individuals found that AI algorithms identify asymptomatic left ventricular systolic dysfunction with pooled AUROCs of 0.87 to 0.93 across ejection fraction thresholds, though real-world delays between ECG and echocardiography introduce risk of bias.

Telemetry EmergencyAI summaryReview source

Systematic ReviewResearchQuality ImprovementAI summary · original source linked below

Asymptomatic left ventricular dysfunction (LVD) represents a critical stage in the heart failure trajectory where early detection and guideline-directed medical therapy can prevent symptomatic decompensation and mortality. Transthoracic echocardiography is resource-intensive, prompting interest in 12-lead artificial intelligence-enabled electrocardiography (AI-ECG) as a scalable point-of-care screening tool. This systematic review and meta-analysis synthesized exclusively externally validated AI-ECG studies identified through September 2025, evaluating 12 asymptomatic and 30 symptomatic cohorts comprising 538,735 participants. In asymptomatic cohorts, AI-ECG demonstrated high discriminatory accuracy for left ventricular systolic dysfunction (LVSD), achieving pooled areas under the receiver operating characteristic curve (AUROCs) of 0.87 (95% CI: 0.75–0.99) for ejection fraction (LVEF) <= 35%, 0.93 (95% CI: 0.88–0.97) for LVEF <= 40%, and 0.89 (95% CI: 0.85–0.97) for LVEF <= 50%. These discrimination metrics were comparable to symptomatic cohorts (AUROCs 0.85 to 0.90). For asymptomatic left ventricular diastolic dysfunction (LVDD), performance was moderate (AUROC 0.76, 95% CI: 0.66–0.86). The authors emphasized that substantial heterogeneity (I2 > 85%) and prolonged intervals between ECG acquisition and confirmatory echocardiography in retrospective datasets highlight the need for prospective clinical trial validation.

Key takeaways

Meta-analysis included 12 asymptomatic and 30 symptomatic externally validated AI-ECG cohorts totaling 538,735 individuals.
AI-ECG demonstrated high discriminatory accuracy for asymptomatic systolic dysfunction (pooled AUROC 0.93 for LVEF <= 40%).
For severe systolic impairment (LVEF <= 35%), pooled AUROC was 0.87 (95% CI: 0.75–0.99).
Performance for asymptomatic diastolic dysfunction was moderate with a pooled AUROC of 0.76 (95% CI: 0.66–0.86).
High statistical heterogeneity (I2 > 85%) and real-world time gaps between ECG and echocardiograms necessitate confirmatory prospective validation.

Why this matters on shift

Cardiac telemetry, outpatient clinic, and emergency nurses perform thousands of 12-lead ECGs on patients with hypertension, diabetes, or mild dyspnea who have never had an echocardiogram. Understanding that verified AI-ECG models can reliably flag occult systolic dysfunction from a standard surface ECG illuminates how upcoming clinical decision support tools will help nurses and providers initiate timely cardiac evaluations before acute heart failure hospitalization occurs.

Bedside takeaway

In a meta-analysis of 538,735 patients, externally validated AI-ECG identified asymptomatic systolic dysfunction with pooled AUROCs of 0.87 to 0.93.

Nursing implications

When clinical decision support alerts indicate potential left ventricular systolic dysfunction on an ECG, treat the finding as a screening trigger rather than a definitive diagnosis. Review patient symptoms, medications, and cardiac history, and coordinate with providers for formal transthoracic echocardiography and guideline-directed therapy evaluation.

Limitations & cautions

Substantial statistical heterogeneity across studies (I2 > 85%); potential bias resulting from real-world time delays between ECG recording and confirmatory echocardiography; small-study effects observed in asymptomatic cohorts.
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Citations · exact source links

American journal of preventive cardiology (PubMed). External validation of artificial intelligence-guided electrocardiogram (AI-ECG) in detecting asymptomatic left ventricular dysfunction: A systematic review and meta-analysis.

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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

Meta-analysis of 9,127 critically ill patients finds pantoprazole halves clinically important GI bleeding without increasing pneumonia or C. diff

Meta-analysis of 910 patients finds midline catheters carry higher mechanical complications and shorter dwell times than PICCs

Meta-analysis of 538,735 patients finds AI-enabled ECG detects asymptomatic systolic heart failure with high discriminatory accuracy