ICU / Critical Care

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.