Journal of the Intensive Care Society最新文献

{"title":"Continuous versus intermittent, non-invasive monitoring of vital signs in hospitalised, ward based adult patients: A systematic review and narrative synthesis.","authors":"Brian W Johnston, Silvia Manes, Solomon Miles Donnelly, Angela Hall, Ingeborg Dorothea Welters","doi":"10.1177/17511437261483948","DOIUrl":"10.1177/17511437261483948","url":null,"abstract":"<p><strong>Background: </strong>Intermittent monitoring (IM) of vital signs remains the standard of care for hospitalised ward patients, yet this approach creates gaps during which patient deterioration may go unrecognised. Wearable wireless devices capable of continuously measuring physiological parameters offer the potential for earlier detection of clinical decline and prevention of intensive care unit admissions. This systematic review aimed to compare continuous, non-invasive vital signs monitoring with standard IM for the identification of deterioration and prevention of complications in adult, ward-based hospitalised patients.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, MEDLINE, EMBASE and the Cochrane database was conducted for English-language studies published from January 1980 to December 2025. Eligible studies compared continuous, non-invasive vital signs monitoring with IM in adult ward patients and reported clinical outcomes related to deterioration. Randomised controlled trials were assessed using the Cochrane risk of bias tool and non-randomised studies using the Newcastle-Ottawa scale. Outcomes of interest included mortality, hospital and ICU length of stay, ICU transfers, rapid response or escalation calls, time-critical treatment delivery and clinical complications.</p><p><strong>Results: </strong>Following removal of duplicates, 2028 records were screened, yielding 96 articles for full-text review. Thirty-one studies met the eligibility criteria. Two of these compared algorithm-generated monitoring outputs with periodically calculated early warning scores and were excluded from the primary analysis, leaving 29 studies (7 randomised controlled trials, 12 before-and-after studies, 10 observational cohort studies) in the final synthesis. Several studies reported reductions in mortality, ICU transfers or length of stay with continuous monitoring, but few of these reached statistical significance. Some reported earlier escalation and fewer postoperative complications in continuously monitored patients. Differences between studies in design, monitoring system and outcome definition prevented meta-analysis and limited direct comparison.</p><p><strong>Conclusions: </strong>Current evidence does not demonstrate superiority of continuous over intermittent vital signs monitoring for improving clinical outcomes in ward-based patients, although trends suggest possible reductions in deterioration, mortality and hospital length of stay. To clarify these effects, larger standardised randomised trials are required. Future research should evaluate continuous monitoring in combination with decision-support tools and automated alert systems.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261483948"},"PeriodicalIF":1.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of laxative use in critically unwell patients: Are we doing more harm than good?","authors":"Adam Reynolds, Pippa Whitaker, Hugh Montgomery, Edward Palmer","doi":"10.1177/17511437261487004","DOIUrl":"10.1177/17511437261487004","url":null,"abstract":"<p><strong>Introduction: </strong>Diarrhoea is common in critically unwell patients and is associated with prolonged intensive care unit (ICU) stay and increased mortality. Its causes are multifactorial; however, emerging evidence suggests that laxative exposure may be an important, and potentially modifiable, contributor. Laxatives are frequently prescribed in ICU patients to prevent constipation, increasingly as part of bowel management protocols (BMP) and care bundles, despite limited supporting evidence. This systematic review evaluated the effects and prevailing associations of laxatives on clinical outcomes in critically unwell adults.</p><p><strong>Methods: </strong>A systematic literature search of MEDLINE (including PubMed), EMBASE, CENTRAL, CINAHL and ClinicalTrials.gov databases was conducted on 21st July 2026 to review studies that included data on the impact of laxatives on clinical outcomes in critically unwell adult patients. Non-English studies, conference abstracts and studies with paediatric patients or adult patients not admitted to ICU were excluded. Two reviewers independently screened studies and extracted data. Methodological quality and risk of bias were assessed using the ROBINS-I V2 tool for observational studies and RoB 2 for randomised trials. Owing to substantial clinical and methodological heterogeneity, findings were synthesised narratively.</p><p><strong>Results: </strong>The systematic literature search identified 28 studies suitable for review inclusion. Of these, 27 were full-text articles, comprising 21 observational studies and six randomised trials; the remaining study was a meta-analysis.</p><p><strong>Conclusions: </strong>Despite their frequency, diarrhoea and constipation in critically unwell patients lack clear, consensus definitions. Evidence supporting prophylactic laxative use is limited; studies have not demonstrated consistent improvements in clinically meaningful outcomes and suggest that prophylactic use may contribute to ICU-associated diarrhoea. Although therapeutic laxative use induces defecation, the optimal agent, dose, timing and patient selection remain uncertain. Standardised definitions of bowel dysfunction and high-quality randomised trials are needed to determine the effects of specific laxative strategies on clinical outcomes and diarrhoea incidence in critically unwell patients.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261487004"},"PeriodicalIF":1.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical cancellation and changes in postoperative level of care among high and moderate risk surgical patients in the UK.","authors":"Joanna K L Wong, Rosanna Sasson, Christopher Oddy","doi":"10.1177/17511437261495043","DOIUrl":"https://doi.org/10.1177/17511437261495043","url":null,"abstract":"<p><strong>Background: </strong>The clinical and administrative pressures leading to cancellation of surgery are well established. However, it is not known whether the same factors lead to a change in patients' planned postoperative destination and level of care.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the REPACC dataset; a nationwide, retrospective, observational study examining the provision of enhanced and critical care services in the UK. The reasons for cancellation and changes to the level of care received postoperatively were ascertained from free-text data.</p><p><strong>Results: </strong>Our analysis included 5990 patients from 65 sites across the UK, of which 539 (9.6%) had their surgery cancelled. The most common reason for surgical cancellation was a lack of resources (51.0%), primarily bed shortages (37.1%). Among the 5451 patients who proceeded with surgery, 81.3% received the anticipated level of care postoperatively, 3.9% required escalation and 14.8% were de-escalated to a lower level of care. Changes to the anticipated level of care occurred most often among patients initially triaged to enhanced care. Clinical reasons were the major cause of escalation (53.3%) and de-escalation (61.2%) postoperatively with bed shortages accounting for a minority. Patients were commonly de-escalated following a postoperative assessment (21.8%).</p><p><strong>Conclusion: </strong>Cancellation of surgery in the UK is primarily a consequence of resource scarcity, whereas clinical reasons account for the majority of those re-allocated to different levels of care postoperatively. Future work should explore the clinical and health economic impacts of this dynamic bed management with particular focus on the role of enhanced care as an interface between critical care and the ward.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261495043"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute spinal cord injury.","authors":"Matthew Boissaud-Cooke, Carla O'Hagan, Andrew Manning, Sam Waddy","doi":"10.1177/17511437261464341","DOIUrl":"https://doi.org/10.1177/17511437261464341","url":null,"abstract":"<p><p>Spinal cord injury results in transient or permanent disruption to the central nervous system with far reaching multi-system consequences, alongside having profound and devastating effects on the individual, their family and wider society. This review provides an overview on the epidemiology, pathophysiology and clinical presentation of spinal cord injury. The clinical syndromes of spinal cord injury are also discussed in detail. The medical and surgical management strategies of spinal cord injury in the acute phase is considered, alongside highlighting the importance of early referral to dedicated spinal rehabilitation services. The natural history and prognosis of traumatic spinal cord injury are also discussed.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261464341"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical care and the law: Pertinent cases from 2025.","authors":"Aaron D'Sa, Thearina DeBeer, Victoria Metaxa, Prashanth Nandhabalan","doi":"10.1177/17511437261494786","DOIUrl":"https://doi.org/10.1177/17511437261494786","url":null,"abstract":"<p><p>This review by the Legal and Ethical Advisory Group (LEAG) follows the 2024 summary, reviewing the important legal cases and Prevention of Future Deaths reports (PFDs) ruled or issued in 2025 that are pertinent to Intensive Care Medicine. The legal cases include Human Rights cases, Clinical Negligence cases, and rulings of the Court of Protection. Not all of the cases relate to events which have occurred in Intensive Care, however the rulings will have a bearing on Intensive Care practice.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261494786"},"PeriodicalIF":1.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I got a bit of closure\": A thematic analysis of experiences of attending a post intensive care multidisciplinary follow up clinic.","authors":"Rachel Clarke, Molly Day, Mia Drew, Lauren Budd, Marie Bromberg, Jasmine Martinez","doi":"10.1177/17511437261493291","DOIUrl":"https://doi.org/10.1177/17511437261493291","url":null,"abstract":"<p><strong>Background: </strong>The impact of critical illness is recognised; however, interventions to support optimal recovery post-ICU are less clear. There is no single accepted model of follow-up services and an uncertain evidence base.</p><p><strong>Methods: </strong>Thematic analysis was used to analyse semi-structured interviews with 27 ICU-survivors from an ICU in the southwest of Britain on their experience of attending a multi-disciplinary (MDT) follow up clinic. The participants' follow up clinic letters were reviewed to identify related actions by team members.</p><p><strong>Results: </strong>Eight themes emerged from the data: gaining understanding, family involvement, addressing the future, safe space to explore experiences, clinic structure, virtual versus face-to-face appointments, and perception of staff. Clinic letters evidence a range of onwards referrals and provision of advice.</p><p><strong>Conclusion: </strong>Participants valued the MDT follow up clinic. The option to attend in person or virtually increased accessibility. The opportunity to enhance understanding of critical care related experiences and integrate this with self identity and ongoing recovery processes was meaningful for patients. Several participants were referred for further medical and psychological intervention. Patient experience and need should be at the heart of informing potential outcome measurement.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261493291"},"PeriodicalIF":1.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to 'Comment on \"The LoVe score: Development and validation of a bedside clinical index to identify patients at risk for prolonged invasive mechanical ventilation\"'.","authors":"Paul Hilders, Lada Lijović, Paul Elbers","doi":"10.1177/17511437261493298","DOIUrl":"https://doi.org/10.1177/17511437261493298","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261493298"},"PeriodicalIF":1.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JICS Education: Continuous renal replacement therapy.","authors":"Neha N Passi, Christopher J Kirwan","doi":"10.1177/17511437261483952","DOIUrl":"https://doi.org/10.1177/17511437261483952","url":null,"abstract":"<p><p>Delivering continuous renal replacement therapy (CRRT) is an integral mode of organ support provided on intensive care units (ICU). This article provides readers with a comprehensive understanding of CRRT, covering indications for therapy and when and how to start it. Supporting this information are practical tips to help improve therapy efficacy and a summary of the current evidence which should underpin clinical decision making.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261483952"},"PeriodicalIF":1.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"The LoVe score: Development and validation of a bedside clinical index to identify patients at risk of prolonged mechanical ventilation\".","authors":"Fatima Ayyaz, Haris Khan, Ifza Zia","doi":"10.1177/17511437261493301","DOIUrl":"10.1177/17511437261493301","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261493301"},"PeriodicalIF":1.9,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of mechanical insufflation-exsufflation in invasively ventilated critically ill children.","authors":"Lisa Edel, Ema Swingwood, Charlotte Donovan, Harriet Shannon, Emma Shkurka","doi":"10.1177/17511437261488698","DOIUrl":"10.1177/17511437261488698","url":null,"abstract":"<p><strong>Background: </strong>Invasively ventilated, critically ill children are at risk of retained respiratory secretions, which can obstruct airways, impair gas exchange, and cause lung collapse or ventilator-acquired pneumonia. Endotracheal suctioning partially removes secretions, but additional airway clearance interventions may be required. Mechanical insufflation-exsufflation (MI-E), is a cough augmentation device used to improve secretion clearance in adult intensive care, however it is not well characterised in paediatrics.</p><p><strong>Aim: </strong>To explore MI-E use in invasively ventilated, critically ill children.</p><p><strong>Method: </strong>This multi-methods study used an anonymous, electronic survey of UK-based paediatric physiotherapists. A scoping review searched seven electronic databases (1995-2025), using key terms (\"airway clearance technique*\") OR (\"mechanical insufflation exsufflation\") AND (\"mechanical ventilation\") OR (\"invasive ventilation\"). Data were analysed descriptively for both methods, with content analysis for free text survey responses. Mixed-evidence, narrative integration compared and contrasted survey and scoping review findings.</p><p><strong>Results: </strong>Twenty-nine physiotherapists from across the UK completed the survey, 76% (<i>n</i> = 22/29) were advanced specialists, and all reported access to an MI-E device. Six studies (2010-2024), one prospective, the remaining retrospective or case studies, were identified. Both data sources indicated MI-E was most frequently used with acutely unwell neuromuscular patients, though survey responses described a broader clinical application, including children with complex neurological conditions, general respiratory illnesses, trauma, and post-operative surgical or orthopaedic needs. MI-E settings and outcomes were inconsistently reported. Contraindications aligned across sources.</p><p><strong>Conclusions: </strong>MI-E appears increasingly accessible within paediatric critical care. Future research should assess MI-E safety in intubated patients and investigate broader critically ill populations.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261488698"},"PeriodicalIF":1.9,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}