Research ArticleResearchWorkflowQuality Improvement

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

PLOS One (PubMed)Jul 10, 2026

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Brief summary

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.

What NurseJet pulled from the source

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.

Why this matters for nurses

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.

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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.

Practice 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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PLOS One (PubMed)

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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https://pubmed.ncbi.nlm.nih.gov/42430391/

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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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Nursing in Critical Care (PubMed)Jul 1, 2026Research Article

In a quasi-experimental study of 60 ICU nurses, adding short text-message reminders to a training session significantly improved nurses' knowledge and performance in ventilator-associated pneumonia prevention compared with the training session alone.

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Research ArticleResearchInfection ControlAI summary · original source linked below

Sixty intensive care unit nurses in Kermanshah, Iran attended a training session on ventilator-associated pneumonia (VAP) prevention and were randomly split into a 30-nurse intervention group and a 30-nurse control group. The intervention group received educational text messages with key points from the session every other day for two weeks; the control group received none. Most participants were women (n = 40, 66 percent), more than half were over 30 years old (n = 28, 53 percent), and most had less than 10 years of experience (n = 52, 86 percent). At pre-test the groups were similar, with mean knowledge scores of 21.1 plus or minus 2.9 (intervention) and 20.2 plus or minus 2.9 (control) and performance scores of 120.8 plus or minus 10.4 and 120.1 plus or minus 13.4. At post-test the SMS group scored significantly higher than the control group on knowledge (22.1 plus or minus 1.9 vs 20.2 plus or minus 1.5; p less than 0.001) and on performance (126.9 plus or minus 8.2 vs 120.8 plus or minus 9.7; p less than 0.02). The authors conclude that ongoing SMS reminders improved nurses' VAP-prevention knowledge and performance.

Key takeaways

Sixty ICU nurses were randomized to receive VAP-prevention text-message reminders every other day for two weeks (n = 30) or training alone (n = 30).
At post-test, the SMS group scored significantly higher than the control group on knowledge (22.1 vs 20.2; p less than 0.001) and performance (126.9 vs 120.8; p less than 0.02).
The two groups had similar knowledge and performance scores before the intervention.
The authors describe the reminders as a low-cost microlearning approach that can reinforce infection-prevention behaviours, including in resource-limited settings.

Why this matters on shift

Ventilator-associated pneumonia is a serious ICU infection, and sustaining nurses' prevention knowledge and bedside adherence after a single training session is a common challenge. This study may matter for nurses and educators because it tests a simple, low-cost reinforcement, brief text messages, and finds it improved both knowledge and performance over training alone.

Bedside takeaway

Worth knowing that in a small ICU study, adding brief text-message reminders after a training session significantly improved nurses' knowledge and performance on ventilator-associated pneumonia prevention compared with training alone.

Nursing implications

For ICU nurses and educators, the findings suggest that short, repeated text-message reminders after a training session can be a practical way to keep VAP-prevention steps front of mind and improve measured performance. Because the effect was seen over a two-week window in one setting, such reminders are best viewed as a supplement to established VAP-prevention bundles rather than a replacement.

Limitations & cautions

This was a single-center quasi-experimental study of only 60 nurses in one Iranian city, so the results may not generalise to other units or countries. Performance was measured with a questionnaire over a short two-week period, so the study does not show whether gains persisted longer term or whether they translated into lower VAP rates for patients.
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Citations · exact source links

Nursing in Critical Care (PubMed). Effect of Short Messages on ICU Nurses' Knowledge and Performance Regarding Ventilator-Associated Pneumonia Prevention: A Quasi-Experimental Study.

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American Journal of Critical Care (PubMed)Jul 1, 2026Research Article

In a prospective cohort at one 900-bed center, nasogastric tube-related pressure injuries were significantly more frequent on the internal medicine ward than in the ICU, an unexpected reversal the authors link to comorbidity burden, staffing ratios, and tube-fixation technique.

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Research ArticleResearchAI summary · original source linked below

This prospective cohort study followed adults who had a nasogastric tube placed during or within four hours before admission to the ICU (88 patients) or internal medicine ward (48 patients) of a 900-bed medical center, monitoring daily for tube-related pressure injuries from July 2022 to July 2024. Contrary to the expectation that sicker ICU patients would fare worse, incidence was significantly lower in the ICU (4 patients; 0.47 per 100 patient-days) than on the internal medicine ward (13 patients; 3.02 per 100 patient-days; P < .001). Internal medicine ward patients had a higher Charlson Comorbidity Index (mean 7.7 vs 3.0; P = .02), and nasogastric tube fixation methods differed between the departments. The authors name comorbidity burden, nurse-to-patient ratios, and fixation technique as possible contributors that warrant further study.

Key takeaways

Nasogastric tube-related pressure injury incidence was significantly lower in the ICU (0.47 per 100 patient-days) than on the internal medicine ward (3.02 per 100 patient-days; P < .001).
Four of 88 ICU patients versus 13 of 48 internal medicine ward patients developed a tube-related pressure injury.
Internal medicine ward patients carried a higher comorbidity burden (Charlson index 7.7 vs 3.0; P = .02).
Nasogastric tube fixation methods differed between the two departments and are a suspected contributor.

Why this matters on shift

Medical device-related pressure injuries from nasogastric tubes are painful, largely preventable, and easy to overlook under the tape. This study may matter for nurses because it challenges the assumption that these injuries cluster in the ICU, pointing instead to comorbidity, staffing, and fixation technique as drivers that apply on any ward.

Bedside takeaway

Worth knowing that nasogastric tube-related pressure injuries were more common on the internal medicine ward than in the ICU (3.02 vs 0.47 per 100 patient-days), pointing to comorbidity, staffing, and tube fixation as drivers.

Nursing implications

For nurses on any unit with tube-fed patients, the findings reinforce routinely inspecting the skin under and around nasogastric tube fixation (nares and cheeks), rotating or adjusting securement to relieve pressure, and not assuming lower-acuity wards are low risk. Consistent, pressure-relieving fixation technique and regular skin checks may matter as much as patient acuity.

Limitations & cautions

This was a single-center study with a small sample (88 ICU and 48 internal medicine ward patients), so the counterintuitive finding may not generalize, and the authors flag comorbidity burden, nurse-to-patient ratios, and fixation technique as confounders needing further investigation. Patients with pre-existing facial injuries or wounds were excluded, and the observational design cannot establish why incidence differed between departments.
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Citations · exact source links

American Journal of Critical Care (PubMed). Incidence of Nasogastric Tube-Related Pressure Injuries in Intensive Care Unit and Internal Medicine Ward.

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Key takeaways

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More updates for this clinical area

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

Repeated text-message reminders improved ICU nurses' VAP-prevention knowledge and performance in a quasi-experimental study

Nasogastric tube-related pressure injuries were more common on the internal medicine ward than in the ICU