ICU / Critical Care

Key takeaways

• Intraoperative rescue fentanyl use did not differ significantly between groups.
• Hypotension was more common with dexmedetomidine, while postoperative shivering was less common.
• Other in-hospital outcomes were similar between the two regimens.

Nursing implications

• During PACU and postoperative handoff, monitor pain, hemodynamics, sedation, and shivering according to the administered regimen and local protocol.

Limitations & cautions

• Abstract-only summary. The trial involved elective tumor craniotomy at five Indian centers, both groups also received locoregional analgesia, and the abstract does not provide longer-term outcome results in detail.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Sixty percent of patients in the included studies received home mechanical ventilation.
• Survival improved progressively over time in both ventilated and non-ventilated groups.
• As respiratory survival improved, cardiac and other causes accounted for a larger share of deaths.

Nursing implications

• During admissions and handoffs, verify the established ventilation, airway-clearance, and cardiac-monitoring plan and coordinate concerns with the multidisciplinary team.

Limitations & cautions

• Abstract-only summary. This was a study-level meta-analysis of heterogeneous observational survival reports; the ventilated and non-ventilated groups were not randomized, so associations should not be interpreted as treatment effects.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Primary events occurred in 3.4% versus 3.0% with balanced fluid and saline, respectively (risk ratio 1.10; 95% CI 0.88-1.40).
• Hyperchloremia was reported in 31.4% versus 49.0%, respectively.

Nursing implications

• Keep fluid-type documentation and ordered monitoring clear; this result does not justify independently changing the resuscitation plan.

Limitations & cautions

• Abstract-only summary. A nonsignificant result does not prove equivalence. Findings concern children with suspected septic shock and abnormal perfusion.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The score uses routinely available peri-intubation data to estimate ventilation beyond 48 hours.
• External-validation AUROCs ranged from 0.65 to 0.71, lower than several development and internal-validation estimates.
• The authors reported net benefit in decision-curve analyses, but no prospective impact on patient outcomes was tested.
• Ventilator settings in the model are predictors, not causal targets that should be changed to alter the score.

Nursing implications

• If the score is locally approved, enter peri-intubation data accurately and interpret the output alongside trajectory, diagnosis, frailty, ventilator response, and team assessment. Do not change ventilator settings to manipulate a prediction or use the score alone for treatment decisions.

Limitations & cautions

• The study was retrospective, discrimination was modest in external validation, and the model omitted potentially important factors such as diagnosis and frailty. Its clinical value and effect on patient outcomes have not been established prospectively.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The ISTH document covers factor-concentrate use for bleeding in cardiac surgery, trauma, obstetric care, and organ transplantation.
• It reviews fibrinogen concentrate, prothrombin complex concentrate, recombinant activated factor VII, and factor XIII concentrate.
• The guidance incorporates evidence published since the prior 2018 ISTH guidance and evolving bleeding-management practice.
• Its pragmatic guidance is based on the available evidence and expert consensus; the abstract does not support a single universal regimen.

Nursing implications

• Activate the approved major-bleeding pathway, communicate the surgical context and evolving blood loss, obtain ordered coagulation testing promptly, and verify the exact product, dose, route, and monitoring plan before administration. Track response and complications through the local protocol.

Limitations & cautions

• The accessible PubMed abstract describes the guidance scope but does not list agent-specific indications, contraindications, doses, evidence certainty, or recommendation strength. Those details require review of the full guidance, and expert consensus contributes where evidence is limited.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• All 24 included studies were retrospective and most evaluated hospitalized adults using routinely collected structured data.
• Pooled sensitivity was 76.6% and specificity was 84.5%, with a summary ROC area of 0.87.
• At a pooled bloodstream-infection prevalence of 9.5%, positive predictive value was 34.2% and negative predictive value was 97.2%.
• The authors concluded that present accuracy is insufficient to solidly support clinical decision-making.

Nursing implications

• Treat an ML prediction as one data point. Continue the approved sepsis or bloodstream-infection assessment, obtain ordered cultures correctly, and escalate clinical deterioration or discordance between the patient and the model rather than allowing the score to replace judgment.

Limitations & cautions

• The evidence was retrospective, model architectures and populations varied, and heterogeneity was substantial at I2 of 74%. Predictive values depend on infection prevalence, and the abstract does not establish that using these models improves outcomes or antibiotic stewardship.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The double-blind trial included 779 eligible adults across 21 Danish hospitals.
• Sustained return of spontaneous circulation was 39% with bicarbonate and 37% with placebo, a nonsignificant difference.
• The trial did not show significant differences in 30-day survival or favorable neurologic outcome.
• Post-arrest alkalosis and hypernatremia were more common in the bicarbonate group.

Nursing implications

• During a code, use sodium bicarbonate only within the approved resuscitation algorithm or a specific clinical indication and order. After administration, communicate the dose and timing and monitor ordered acid-base and sodium results during post-arrest care.

Limitations & cautions

• The primary analysis excluded randomized patients later found ineligible, and the trial enrolled adults who had received at least one epinephrine dose in Danish hospitals. Confidence intervals for survival outcomes were wide, so the study does not exclude smaller benefits or harms in specific indications.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The trial randomized 86 adults with trauma-related or postoperative moderate-to-severe ARDS.
• The EIT-guided multicomponent strategy produced greater improvement in PaO2/FiO2 during days 1 through 3.
• Overall respiratory-system compliance trajectories and secondary clinical outcomes were broadly similar between groups.
• The study cannot isolate the effect of EIT from the other ventilation components or establish patient-centered benefit.

Nursing implications

• When EIT-guided titration is ordered, verify the protocol and target parameters, monitor oxygenation, plateau and driving pressures, hemodynamics, and signs of intolerance, and document the response to each change. Escalate deterioration through the ARDS pathway.

Limitations & cautions

• This was a single-center study with 82 analyzable patients and a multicomponent intervention. It was powered for physiologic endpoints, not mortality or other patient-centered outcomes; exploratory subgroup and length-of-stay findings require confirmation.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The review included 10 qualitative studies published between 1999 and 2025; no quantitative studies met eligibility criteria.
• Patients described problem-focused, emotion-focused, and meaning-based coping strategies during ICU delirium.
• Families supported patients through emotional presence, reorientation, cognitive stimulation, and collaboration with the care team.
• Family caregivers also managed their own burden through information-seeking, avoidance, and positive reappraisal.

Nursing implications

• During delirium care, assess what helps the patient feel oriented and connected, invite family observations when appropriate, and check what information or support the caregiver needs. Use these findings to inform communication within the established delirium and family-engagement pathway, not as proof of an intervention effect.

Limitations & cautions

• All 10 included studies were qualitative, and no eligible quantitative evidence was identified. The review describes experiences and coping strategies but cannot determine whether those strategies reduce delirium, psychological distress, or other clinical outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The review included seven randomized placebo-controlled trials and more than 12,000 hospitalized adults with traumatic brain injury, intracerebral hemorrhage, or subarachnoid hemorrhage.
• Short-term mortality was not significantly reduced, with a pooled risk ratio of 0.93 and a 95% confidence interval reaching 1.00.
• Tranexamic acid did not improve functional independence or reduce the combined outcome of functional dependence or death.
• Rebleeding and thromboembolic events did not differ significantly, but rebleeding results had substantial between-study heterogeneity.

Nursing implications

• Use tranexamic acid only for the protocol-defined indication and ordered regimen, verify dose and timing, and continue serial neurologic, bleeding, and thromboembolic surveillance. Do not interpret the pooled finding as a reason to delay or independently change an indication-specific treatment plan.

Limitations & cautions

• The review pooled three clinically distinct conditions: traumatic brain injury, spontaneous intracerebral hemorrhage, and subarachnoid hemorrhage. Aggregate results may not resolve timing-dependent or diagnosis-specific effects, and rebleeding estimates were heterogeneous and inconclusive.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The retrospective cohort included 428 infants born before 28 weeks of gestation.
• Combined early oral-motor intervention and kangaroo care was associated with lower adjusted odds of feeding intolerance than oral-motor intervention alone.
• Among infants reaching oral-intake milestones, combined care was associated with shorter time to 50% and 80% oral intake.
• Oral-motor function mediated an estimated 26.5% of the association, but mediation and treatment effects cannot be established from this observational design.

Nursing implications

• Within an approved neonatal pathway, assess physiologic and feeding readiness, prepare the parent and infant for safe kangaroo care, document session timing and tolerance, and coordinate oral-motor support with the feeding team. Pause and escalate instability, stress cues, or feeding-intolerance findings.

Limitations & cautions

• This was a retrospective observational study, and exposure was defined as at least one 60-minute kangaroo-care session by the first oral-feeding training day. Residual confounding and selection bias may remain, milestone-time analyses included achievers, and mediation estimates depend on untestable assumptions.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The review synthesized 13 studies of prehospital whole-blood use in adult hemorrhagic shock.
• Physiologic measures, including shock index and shock reversal, generally favored whole blood over standard strategies.
• A consistent mortality reduction was not demonstrated across the included studies.
• Subgroup survival signals are hypothesis-generating and do not establish which patients should receive whole blood.

Nursing implications

• During trauma handoff, capture the product, volume, timing, warming method, response, and suspected transfusion reactions. Continue the hemorrhage pathway, trend perfusion and bleeding, obtain ordered samples without delaying resuscitation, and coordinate blood-bank and massive-transfusion communication.

Limitations & cautions

• The 13 studies were heterogeneous and mortality findings varied. The abstract does not report a pooled overall mortality estimate or establish causal benefit, and favorable subgroup findings may be affected by selection, protocol, and survivorship differences.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The prospective crossover study assigned eligible bed-episodes to usual-care and Quiet ICU nights in counterbalanced four-night sequences.
• The bundle combined quieter communication and alarm-hygiene measures with muted bedside alarm audio while central alarm visibility was maintained.
• Equivalent continuous and maximum sound levels were lower during Quiet ICU nights, as was time above 80 dBA.
• The study did not determine whether the bundle changes alarm response, staff workload, sleep, delirium, or other patient outcomes.

Nursing implications

• Treat alarm-audio changes as a unit-level safety intervention rather than an individual workaround. If a formally approved quiet-hours pathway exists, confirm central alarm visibility, response ownership, escalation coverage, and patient-specific exceptions before using it, and report missed, delayed, or unclear alarm routing immediately.

Limitations & cautions

• This was a single-ICU study of 69 bed-episodes and 220 nights, with sound rather than patient or staff outcomes as the primary focus. No identified safety incidents does not establish safety, and the approach depends on reliable central monitoring, alarm governance, staffing, and local infrastructure.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The per-protocol analysis included 127 neonates born at 26 weeks 0 days through 31 weeks 6 days who required delivery-room resuscitation.
• The composite of in-hospital mortality, severe intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35.9% with intact-cord resuscitation and 60.3% with conventional clamping.
• Mortality was 26.6% versus 41.3%, and severe intraventricular hemorrhage was 9.4% versus 20.6%, respectively.
• Maternal safety outcomes were comparable between groups in this trial.

Nursing implications

• For an anticipated very preterm birth, confirm the ordered cord-management and resuscitation plan, equipment position, role assignments, monitoring, and escalation route before delivery. Document timing, respiratory support, oxygenation, temperature, and transition findings according to the neonatal pathway.

Limitations & cautions

• This was a single-center, open-label trial with 127 neonates and a per-protocol analysis. The composite combined outcomes of different clinical importance, and the findings may not generalize to centers without the same equipment, staffing, obstetric coordination, or neonatal population.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The randomized placebo-controlled trial enrolled 214 adults who survived an ICU admission with sepsis.
• The primary outcome was time to first infection-related rehospitalization or death during 365 days after randomization.
• The hazard ratio was 1.23 with a 95% confidence interval from 0.80 to 1.91, showing no benefit for the tested strategy.
• PCV13 antibody and transcriptional responses were variable, and no vaccine-related serious adverse events were reported.

Nursing implications

• At ICU transition, reconcile vaccination status against the patient's age, risk factors, prior doses, and current immunization guidance rather than using sepsis survivorship alone as a new indication. Provide clear follow-up and infection return precautions through the discharge pathway.

Limitations & cautions

• The trial tested one PCV13 dose at ICU discharge in a defined adult sepsis-survivor population and was not designed to replace routine risk- and age-based immunization guidance. The confidence interval allowed possible benefit or harm, and immunogenicity varied across serotypes and participants.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The multicenter open-label, blinded-endpoint trial randomized 433 adults with anterior-circulation large-vessel occlusion at eight stroke centers.
• Individualized management targeted mean arterial pressure within 10% of the first pre-thrombectomy measurement; standard management targeted systolic pressure from 140 to 180 mm Hg.
• Favorable 90-day function occurred in 44.2% and 48.8% of participants, respectively, without a statistically significant difference.
• Mortality and symptomatic intracranial hemorrhage did not differ significantly between groups.

Nursing implications

• During thrombectomy care, verify the prescribed blood-pressure target and vasoactive plan, use correctly sized and positioned monitoring equipment, and document readings alongside medications and procedural events. Escalate sustained deviation, hypotension, hypertension, or neurological deterioration promptly.

Limitations & cautions

• The open-label trial was conducted at eight French academic stroke centers, and the groups had similar achieved blood-pressure levels and variability, limiting separation between strategies. It studied anterior large-vessel occlusion during thrombectomy and does not define targets before or after the procedure or for other stroke populations.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The analysis included 308 patients from ten ICU clusters who received invasive ventilation for at least two days and at least one spontaneous breathing trial.
• Spontaneous breathing trials occurred on 51% of intervention patient-days and 27% of control patient-days.
• Weaning success was 36% with the intervention and 28% under the control condition, a nonsignificant difference.
• The adjusted model associated telemedicine support with a shorter interval from the first breathing trial to successful weaning.

Nursing implications

• During an approved weaning pathway, document daily readiness screening, the planned breathing trial, tolerance findings, sedation and mobility barriers, and the next reassessment. Use tele-ICU input to clarify the plan without delaying bedside escalation for instability.

Limitations & cautions

• This was a secondary analysis of one metropolitan stepped-wedge trial, with 55 patients in the control condition and 253 in the intervention condition. It included only patients ventilated for at least two days who had at least one breathing trial, and the intervention bundled telemedicine rounding around several ICU quality indicators, limiting causal attribution and generalizability.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The multicenter trial enrolled 1,840 mechanically ventilated adults who remained unresponsive after cardiac-arrest resuscitation.
• Survival with a favorable 180-day functional outcome was 38.2% with conservative oxygen and 39.7% with liberal oxygen.
• The relative risk was 0.97 with a 95% confidence interval from 0.87 to 1.09.
• The trial compared specific oxygen protocols and does not support changing an individual patient's ordered targets without the treating team's direction.

Nursing implications

• Confirm the ordered post-arrest saturation range and oxygen-titration plan at handoff, trend oxygenation with ventilation and neurological findings, and document changes in support. Escalate hypoxemia, ventilator problems, or acute neurological or hemodynamic change through the unit pathway.

Limitations & cautions

• The trial studied unresponsive, mechanically ventilated adults in ICUs in Australia, New Zealand, and Ireland using two specific oxygen protocols. It does not establish the best target for patients outside those criteria, and the primary-outcome denominators were lower than the numbers assigned to each group.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The review included 5,041 patients treated endoscopically and 3,180 treated with catheter-based approaches.
• Pooled mortality and rebleeding associations favored endoscopic evacuation in the overall analysis.
• Overall complications and infection were similar, while catheter-based approaches had lower intraoperative blood loss.
• Functional outcomes conflicted across scales, and predominantly nonrandomized evidence prevents a causal treatment conclusion.

Nursing implications

• Document the operative approach and ordered targets, then trend neurological examination, level of consciousness, pupils, blood pressure, airway and respiratory status, and drain or access-site findings. Escalate acute change through the neurocritical pathway.

Limitations & cautions

• The review pooled mostly nonrandomized studies, several outcomes had substantial heterogeneity, catheter techniques varied, and functional measures did not agree. Selection bias and strategy differences may explain part of the observed mortality and rebleeding associations.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The single-center pilot randomized 40 mechanically ventilated adults with ARDS.
• Pulmonary arterial compliance was higher with transpulmonary pressure-guided PEEP during 72-hour monitoring.
• Compliance did not change significantly over time, and its trend did not differ significantly between groups.
• The trial evaluated physiology and cannot establish a mortality or recovery benefit.

Nursing implications

• When the multidisciplinary team uses a prescribed PEEP strategy, trend oxygenation, blood pressure, rhythm, perfusion, ventilator synchrony, and ordered right-heart measures. Escalate abrupt hemodynamic or respiratory changes and do not independently alter ventilator settings.

Limitations & cautions

• This was a 40-patient, single-center pilot focused on pathophysiological outcomes over 72 hours. The abstract does not establish differences in mortality, ventilator-free days, length of stay, adverse events, or longer-term recovery, and the strategy requires specialized measurements and expertise.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The protocol-concordant analysis included six randomized Pentaglobin trials and 411 adults.
• Short-term and exact 28-day mortality estimates were not statistically significant.
• Significant estimates emerged only after exploratory inclusion of historical or indirect evidence.
• Most Pentaglobin reports provided incomplete safety information.

Nursing implications

• Continue the approved sepsis pathway and do not present IgM-enriched immunoglobulin as established routine therapy. If it is prescribed for a selected patient, verify the indication and infusion plan, complete ordered monitoring, and escalate suspected reactions or clinical deterioration.

Limitations & cautions

• The core synthesis was small, mortality endpoints varied, and safety reporting was incomplete. Favorable estimates came only from post hoc sensitivity analyses that expanded the language or formulation criteria, so they do not establish efficacy.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The review pooled 22 randomized trials involving 1,522 ICU patients.
• Sensory stimulation was associated with improved measured consciousness and lower delirium incidence.
• Pooled analyses also favored sensory stimulation for delirium duration and awakening time.
• Subgroup findings suggested that modality, delivery person, duration, and frequency may influence results.

Nursing implications

• For an eligible patient, use the unit-approved delirium and stimulation plan, coordinate timing with rest and other care, and document the patient's response. Include family only through the established orientation and safety process, and stop or escalate when stimulation causes distress or physiologic intolerance.

Limitations & cautions

• The abstract does not report the certainty of evidence, between-study heterogeneity, named measurement scales, or full results for mechanical ventilation. Interventions varied across modality, provider, frequency, and duration, and subgroup comparisons should not be treated as definitive prescriptions.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Twenty-three NHS hospitals contributed 250 outside-operating-theatre emergency intubations, including 233 rapid-sequence inductions.
• Severe hypotension affected 24 of 219 patients with a recorded post-induction blood pressure.
• Severe hypoxia affected 14 of 221 patients with recorded oxygen saturation, and 6 of 233 patients had a post-induction cardiac arrest.
• Among patients without a pre-emptive vasopressor, 40 of 105 later required vasopressor administration.

Nursing implications

• Before an emergency intubation, use the local checklist to confirm monitoring, suction, oxygenation, vascular access, and resuscitation readiness and clarify team roles. Capture blood pressure and oxygenation promptly after induction and escalate deterioration through the airway protocol.

Limitations & cautions

• This was an observational convenience sample and service evaluation rather than a randomized comparison, so it cannot establish that a specific drug or dose caused an adverse event. Some post-induction vital signs were missing, and findings from 23 UK hospitals may not transfer to other systems.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Four clinical practice guidelines, consensus statements, or position papers met the review criteria.
• Guidelines were strongest in scope, purpose, and clarity but weakest in applicability.
• The quality of recommendations was moderate overall, despite generally satisfactory guideline-development scores.
• Weak supporting studies limit certainty about which nutritional screening recommendations improve patient outcomes.

Nursing implications

• Complete the locally approved nutrition screen at the specified time points, document factors that may distort the score, and escalate identified risk or feeding barriers to the dietitian and critical-care team. Track implementation gaps separately from uncertainty in the evidence base.

Limitations & cautions

• Only four guidance documents were included, and the study appraised guideline methods and supporting evidence rather than comparing screening tools or patient outcomes. Its scores do not show that a specific tool, threshold, or intervention improves nutrition or clinical outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Critically ill patients face overlapping exposure risks related to devices, antimicrobials, immune dysfunction, and the ICU environment.
• The review frames MDRO prevention as coordinated work across bedside nursing, infection prevention, laboratory, and antimicrobial-stewardship teams.
• Nursing responsibilities include surveillance, hygiene, and correct implementation and de-escalation of ordered precautions.
• This is a clinical review, so it does not quantify the independent effect of any single prevention measure.

Nursing implications

• Verify the organism-specific precaution plan at handoff, perform the approved hygiene and device-care bundle, and communicate changes in cultures, antimicrobial therapy, or isolation status. Escalate uncertainty promptly to infection prevention and the treating team.

Limitations & cautions

• The PubMed abstract describes a narrative clinical review without a reported systematic search, evidence grading, sample, or pooled effect estimates. It does not establish the comparative effectiveness of specific surveillance, isolation, stewardship, or hygiene interventions, and local resistance patterns may change implementation.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The meta-analysis included 22 randomized trials and 1,396 adult ICU patients.
• Continuous monitoring was associated with fewer hypoglycemic events and 10.12 percentage points more time in the target range.
• Average glucose and daily insulin use were lower with continuous monitoring.
• Heterogeneity was substantial for some glycemic outcomes, and the abstract provides limited detail about device performance, trial quality, or mortality events.

Nursing implications

• Use continuous glucose data within the approved ICU insulin protocol, review trends and alarms alongside the patient's perfusion and medication status, and confirm unexpected or treatment-changing values as required. Escalate recurrent hypoglycemia, rapidly changing readings, or discordance with the clinical picture.

Limitations & cautions

• The included trials likely differed in devices, target ranges, insulin protocols, patient acuity, and confirmatory testing, and heterogeneity was substantial for average glucose and time in range. The abstract does not report risk-of-bias findings, device accuracy, adverse events, or mortality-event counts, so pooled survival results should be considered exploratory rather than causal.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The study analyzed 183 paired assessments by 21 NICU nurses and 12 nursing students.
• Overall COMFORTneo interrater reliability was excellent at 0.85.
• Reliability ranged from 0.41 at 24 to 26 weeks' gestation to 0.92 at 36 weeks or later.
• Lower agreement in extremely preterm infants and variation by scale item support structured calibration and cautious interpretation.

Nursing implications

• Score the approved neonatal pain tool at the specified times, document contextual factors and item-level observations, and compare trends rather than relying on one number. When scores and the clinical picture conflict, repeat assessment with an experienced colleague and escalate through the neonatal pain pathway.

Limitations & cautions

• This was a reliability study rather than a test of diagnostic accuracy, treatment response, or patient outcomes. The sample involved 183 paired assessments from one clinical context, subgroup sizes were unequal, and there is no objective pain reference standard, particularly for extremely preterm infants.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The analysis included 5,168 patients across 18 randomized trials of thrombolysis given 4.5 to 24 hours after acute ischemic stroke.
• Excellent 90-day recovery increased from 33.2% with control to 40.3% with thrombolysis in the pooled analysis.
• Symptomatic intracranial hemorrhage increased from 1.4% to 3.2%, while 90-day mortality was not significantly different.
• Eleven trials required advanced imaging selection, and thrombectomy availability contributed substantially to heterogeneity.

Nursing implications

• Activate the stroke pathway promptly even when onset is beyond 4.5 hours, document last known well and eligibility information accurately, and expedite protocol-directed imaging and specialist review. After treatment, follow the ordered neurologic, blood-pressure, access-site, and bleeding monitoring schedule and escalate any deterioration immediately.

Limitations & cautions

• Trials differed in thrombolytic agents, imaging selection, stroke territory, severity, and access to thrombectomy. Most participants were selected for favorable imaging rather than treated solely by clock time, and trial-level meta-regression cannot remove all confounding. The findings should not be generalized to unselected patients or used to choose reperfusion therapy without a stroke specialist and local protocol.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The quality-improvement study assessed 155 ICU nurses before and after a lecture, booklet, and poster intervention.
• Median handover performance increased from 103 to 138 on a validated 38-item checklist.
• Vital-sign checks, destination coordination, patient or family explanations, nurse accompaniment, and clinical handoff all became more frequent.
• The uncontrolled pre-post design cannot establish causation, and infection-control performance remained an identified gap.

Nursing implications

• Use the local intrahospital-transfer checklist to confirm current vital signs, destination readiness, route, monitoring, oxygen, medications, access, and emergency equipment. Explain the plan to the patient or family when appropriate, keep qualified staff with the patient as required, and deliver a structured clinical handoff at the destination.

Limitations & cautions

• The study used a single-group pre-post design without a concurrent control, so observation effects, secular changes, and repeated measurement could explain some improvement. It measured checklist adherence rather than transfer complications or patient outcomes. Generalizability outside the participating ICUs is uncertain, and infection-control practices remained below the desired level.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The study evaluated 157 paired measurements against central laboratory glucose in critically ill adults receiving insulin.
• Libre 2 and capillary glucose had comparable mean absolute relative difference in this sample.
• Neither monitoring method met ISO 15197:2013 numerical accuracy criteria.
• All Libre 2 readings fell in clinically acceptable error-grid zones, but too few hypoglycemic events were captured to establish low-range reliability.

Nursing implications

• Use continuous glucose data only within the ICU's approved insulin and confirmation protocol. Compare unexpected readings with the patient's condition and trend, inspect the sensor site, and obtain the required confirmatory sample before a treatment change when values are low, rapidly changing, or discordant.

Limitations & cautions

• The abstract reports 157 paired measurements but not the number of participants or all clinical subgroups. Few hypoglycemic measurements were available, both index methods missed the ISO numerical standard, and error-grid placement does not establish interchangeability with laboratory testing. The findings may not generalize to other sensors, perfusion states, or insulin protocols.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The systematic review included 12 ICU studies but could not pool results because methods and outcomes differed.
• Sensitivity ranged from 64% to 100%, while specificity ranged from 0% to 95%.
• Multiple qEEG trends and patient-specific confirmed-seizure templates tended to improve screening performance.
• Low specificity and positive predictive value mean suspected events still require expert raw-EEG review.

Nursing implications

• Use qEEG only within a facility-approved neuromonitoring workflow and apply the display patterns and escalation thresholds taught for that system. When a concerning trend appears, document the timing and clinical context and prompt qualified review of the corresponding raw EEG rather than treating the screen as a diagnosis.

Limitations & cautions

• Only 12 heterogeneous studies were eligible, preventing meta-analysis. qEEG trends, reviewer training, seizure definitions, and outcomes varied, and some studies had patient-selection bias concerns. The very broad sensitivity and specificity ranges limit generalization to a particular ICU or display system.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The Bayesian synthesis included 10 randomized trials and 1,601 adults undergoing stroke thrombectomy.
• Successful reperfusion was higher with general anesthesia than with non-general-anesthesia strategies.
• The functional-independence estimate favored general anesthesia, but its 95% credible interval included no difference.
• Intraoperative hypotension was substantially more frequent with general anesthesia, while mortality did not differ clearly.

Nursing implications

• Do not treat the anesthesia strategy as a bedside nursing choice. During the approved thrombectomy pathway, maintain time-sensitive preparation, closely trend blood pressure and neurologic status, and promptly communicate hypotension or deterioration to the stroke and anesthesia teams.

Limitations & cautions

• The trials were open label and used heterogeneous non-general-anesthesia comparators. The Bayesian functional-independence estimate favored general anesthesia, but its credible interval included no difference, and pneumonia also trended higher without a conclusive credible interval. Confirmatory evidence is still needed.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The open-label trial enrolled 101 post-cardiac-surgery patients and analyzed 98.
• Virtual reality did not significantly reduce pain during chest-drain removal compared with usual care.
• State-anxiety differences were also not statistically significant.
• Mean satisfaction with the virtual-reality experience was high at 8.3 out of 10.

Nursing implications

• Do not assume that high patient satisfaction with virtual reality means it reduces procedural pain or anxiety. Continue facility-approved pain assessment and comfort measures for chest-drain removal, and evaluate any new distraction tool against clinical outcomes as well as acceptability.

Limitations & cautions

• This was an open-label, single-center study limited to spontaneously breathing patients who could communicate. The analysis included 98 patients, and the study does not establish whether different virtual-reality content, patient selection, or use alongside other interventions would change outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• The review included nine randomized trials and 4,381 adults after thrombolysis or endovascular thrombectomy.
• Intensive systolic targets below 160 mmHg did not produce a clinically meaningful functional benefit.
• Any intracranial hemorrhage was similar with intensive and conventional management.
• Intensive management probably increased all-cause mortality, with a pooled risk ratio of 1.19.

Nursing implications

• Use the prescribed post-reperfusion target and the facility's stroke protocol rather than treating a lower systolic pressure as automatically better. Pair blood-pressure surveillance with neurologic reassessment and promptly communicate out-of-range values or clinical deterioration to the stroke team.

Limitations & cautions

• The intensive targets varied across trials, including thresholds below 120, 140, and 160 mmHg; seven studies involved thrombectomy and two involved thrombolysis. Studies were mainly from upper-middle- and high-income countries, and certainty ranged from high to very low across outcomes.
• AI-summarized from the linked source. Review the original article before applying to practice.

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.

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.

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.

Nursing 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.

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.

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.

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.

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.

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.

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

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.

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

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.

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

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.

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

Key takeaways

• Across 11 trials and 4,462 adults, more frequent repositioning did not clearly reduce pressure injuries: 2-hourly versus 4-hourly turning showed no significant difference (RR 1.05, 95% CI 0.79 to 1.39).
• The strongest signal came from one ICU trial where wearable sensors with visual repositioning reminders reduced pressure injuries (RR 0.28, 95% CI 0.10 to 0.75; moderate certainty).
• Operating-room micromovement suggested fewer pressure injuries (RR 0.28, 95% CI 0.11 to 0.67), but events were few and certainty was low.
• Most of the evidence was low or very low certainty, and no trials reported quality of life, procedural pain, or patient satisfaction.

Nursing implications

• Keep repositioning as standard care, but recognize the evidence does not strongly favor one turning interval over another, so individualize frequency to skin assessment and risk rather than treating a rigid two-hour rule as proven. Where wearable repositioning-reminder systems are in use, support them, since the one ICU trial testing them showed a reduction. In the OR, micromovement and pressure-redistribution measures are reasonable adjuncts, and be alert that prone patients in the ICU may be at higher risk and need closer skin surveillance.

Limitations & cautions

• Most included trials were small and rated low or very low certainty, so the findings are uncertain and the apparent benefits of sensor reminders and micromovement each rest on limited data. The wearable-sensor result came from a single ICU trial, and no trials reported quality of life, procedural pain, or patient satisfaction. Economic data were sparse, drawn from two older nursing-home evaluations, limiting conclusions about the relative costs of different regimens.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Agreement between routine nurse ICDSC documentation and researcher CAM-ICU was moderate (Cohen's kappa 0.42) across 1535 assessments in 279 patients.
• A model combining ICDSC components with ventilation status and admission SOFA score discriminated delirium well (AUC 0.87; F1 0.72).
• The simple validated cutoff alone performed worst; richer component-level detail improved accuracy.
• Patients were critically ill adults with acute respiratory failure or sepsis in academic-hospital ICUs.

Nursing implications

• Score every ICDSC component deliberately instead of rushing to a single pass/fail number, and when a screen sits near the threshold, corroborate it with your own bedside picture of attention, fluctuation, and level of consciousness. Use complete, accurate delirium documentation to support ABCDEF/ICU Liberation discussions about lightening sedation and early mobility.

Limitations & cautions

• This was a single health-system, academic-ICU sample focused on respiratory failure and sepsis, so it may not generalize to all units. The optimized model was only internally validated by cross-validation and has not been tested prospectively, so real-world bedside performance is unproven.
• AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

• Across nine studies, nurse-involved early mobilization was associated with significantly shorter ICU stays.
• No significant effect on muscle strength was found.
• Programs varied between nurse-only and multidisciplinary delivery, and none specified the nurse's exact role.
• Several included trials had bias concerns, so read findings as supportive rather than definitive.

Nursing implications

• Support structured, progressive early mobilization as part of the ABCDEF bundle and daily goals, and advocate for a clearly defined nursing role and safety criteria in your unit's mobilization protocol. Frame mobilization around reducing ICU stay and complications rather than expecting measurable strength gains.

Limitations & cautions

• Only nine studies were pooled, several had bias concerns, and the nurse's specific role was not defined. A reduction in ICU length of stay is an association from heterogeneous studies, not proof that mobilization alone shortens stay.
• AI-summarized from the linked source. Review the original article before applying to practice.