Meta-analysis of 15,289 neonatal PICCs reveals trade-offs: upper-extremity lines reduce thrombosis and phlebitis but increase CLABSI and tip malposition

Family members of critically ill adult patients frequently develop post-intensive care syndrome-family (PICS-F), characterized by acute and long-lasting psychological trauma, anxiety, and depression. This systematic review and meta-analysis synthesized evidence from six major biomedical databases through May 2026 to evaluate nurse-led, continuity-oriented family support models. Seventeen reports representing 16 independent randomized and quasi-experimental trials and 3,887 family members were analyzed using random-effects models with Hedges g standardized mean differences (SMDs) and GRADE assessment. For primary short-term outcomes measured between two weeks and three months post-ICU discharge, nurse-led support was not associated with significant reductions in family anxiety (SMD -0.05, 95% CI: -0.24 to 0.14; very low certainty), overall depression (SMD -0.01, 95% CI: -0.23 to 0.21; very low certainty), or PTSD-related symptoms (SMD 0.02, 95% CI: -0.11 to 0.15; moderate certainty). However, subgroup analysis revealed that interventions delivered specifically during the active in-ICU phase produced a statistically significant reduction in family depression scores (SMD -0.40, 95% CI: -0.67 to -0.12). Nurse-type comparisons demonstrated no consistent performance differences between dedicated clinical nurse specialists and bedside nurses.

Ventilator weaning in the intensive care unit is often complicated by severe patient distress, agitation, and escalating sedative requirements that paradoxically lengthen mechanical ventilation. In a parallel-group randomized controlled trial conducted in a general adult ICU, 100 critically ill patients ventilated for at least 48 hours were randomized to standard weaning care alone or standard care with daily individualized music therapy. The intervention consisted of daily sessions averaging 25 minutes delivered by a music therapist, incorporating music-assisted relaxation, guided listening, and clinical improvisation tailored to patient preferences. The primary outcome—ventilator weaning duration—did not differ significantly between groups (p = 0.97). However, patients receiving music therapy exhibited significant reductions in agitation and sedation instability on the Richmond Agitation-Sedation Scale (RASS) on days 1 and 3 (p = 0.048, 0.005, and 0.024). Significantly fewer music therapy patients required propofol infusions during weaning (p = 0.028), and tracheostomy placement was significantly reduced (14% rate reduction, p = 0.025). Perceived pain and vital signs showed no significant differences.

Nurse staffing ratios remain central to inpatient quality and nurse retention, yet prior meta-analyses relied largely on coarse categorical groupings rather than quantifying marginal mortality shifts per extra patient. In this systematic review and per-unit linear random-effects meta-analysis (PROSPERO CRD420261368891), researchers searched PubMed, Embase, CINAHL, and Web of Science through July 10, 2026, for observational studies of acute care adults reporting fully adjusted per-unit effect estimates. Thirteen low-risk-of-bias studies spanning 3,831,327 patients across 1,593 hospitals were synthesized using restricted maximum likelihood and Bayesian hierarchical modeling. Each additional patient per nurse was associated with higher odds of 30-day all-cause mortality (pooled odds ratio [OR] 1.057, 95% CI: 1.041–1.074; I² = 43.3%; 95% prediction interval: 1.018–1.098). Bayesian modeling yielded a 1.000 posterior probability of a positive association. Although small-study effects were detected (Egger test t = 4.33, p < 0.001), trim-and-fill adjustment maintained significance. Because all included data were observational, evidence certainty was rated very low under GRADE, indicating estimates serve as policy reference parameters rather than definitive causal proof.