Journal of the Intensive Care Society最新文献

{"title":"JICS education: mechanical ventilation - physiology, mechanism and modes.","authors":"Benjamin Wattley, Luigi Camporota","doi":"10.1177/17511437261470614","DOIUrl":"10.1177/17511437261470614","url":null,"abstract":"<p><p>Mechanical ventilation remains a cornerstone of organ support in critically ill patients, yet modern intensive care ventilators incorporate increasingly complex modes and proprietary terminology that can obscure the physiological principles underpinning their use. A clear understanding of these principles is essential to enable safe, individualised, and lung protective ventilation. This article provides the physiological foundation for a four-part educational series on mechanical ventilation in adult critical care. Key concepts including positive end-expiratory pressure, airway pressures, resistance, compliance, elastance, and respiratory time constants are reviewed. Evidence supporting contemporary ventilation strategies is summarised, emphasising the importance of low tidal volume ventilation and individualisation of ventilator settings according to patient physiology. The ventilator breath cycle is described in terms of triggering, delivery, cycling, and expiration, providing a framework that is independent of manufacturer-specific nomenclature. A structured approach to ventilator modes based on control variables, breath sequence, and targeting schemes is presented using the Taxonomic Attribute Grouping system. Conventional pressure- and volume-controlled modes are discussed alongside assisted and mandatory ventilation strategies. Advanced modes, including airway pressure release ventilation and closed-loop systems, are reviewed with reference to their physiological rationale and current evidence base. Mechanical ventilation should be understood as a set of physiological principles rather than a collection of proprietary mode names. By focusing on pressure, flow, volume, timing, and patient-ventilator interaction, clinicians can better adapt ventilatory support to the changing pathophysiology of individual patients. This article aims to provide a practical framework for trainees and clinicians seeking to understand contemporary mechanical ventilation and to support subsequent articles addressing lung-protective ventilation, difficult weaning, and extracorporeal respiratory support.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261470614"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654661","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 impact of physiotherapy led lung ultrasound on patient management: A single centre service evaluation.","authors":"Ema Swingwood, Tom Lunn, Olivia James, Sean Harrison, Tim Hutchinson, Ryan Hanney, Mark Juniper","doi":"10.1177/17511437261471434","DOIUrl":"10.1177/17511437261471434","url":null,"abstract":"<p><strong>Background: </strong>Lung ultrasound (LUS) is a non-invasive, point-of-care imaging modality increasingly used by physiotherapists to support diagnosis and guide intervention in critically ill patients. Evidence describing its impact on physiotherapy assessment, management, and resource utilisation remains limited.</p><p><strong>Objectives: </strong>To describe physiotherapy-led LUS practice, including scan indications, scan findings, influence on physiotherapy intervention selection, and potential implications for resource utilisation.</p><p><strong>Methods: </strong>A single-centre, prospective service evaluation was conducted between September 2024 and May 2025. Data were collected for all patients receiving physiotherapy-led LUS capturing patient demographics, scan indications and findings, intervention changes, and predicted resource implications. Descriptive statistics were used to summarise outcomes.</p><p><strong>Results: </strong>117 scans were completed. Patients were predominantly post-cardiac surgery in intensive care (43/117, 37%). Acute deterioration was the most common indication (41%). LUS most frequently identified lobar collapse and pleural effusion. Physiotherapists reported reduced diagnostic uncertainty (97%), modified interventions (76% of cases) and the prevention of physiotherapy intervention that would otherwise have been ineffective (85/117, 73%). Predicted reductions in imaging and treatment duration were noted in 39% of assessments.</p><p><strong>Conclusions: </strong>Physiotherapy-led LUS appears feasible and may enhance assessment accuracy, guide targeted interventions, and optimise resource utilisation across respiratory care.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261471434"},"PeriodicalIF":1.9,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620923","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":"Hospital ward transitions and outcomes in critical care survivors: A multi-hospital cohort study.","authors":"Toby Falodun, John Masterson, Nazir I Lone","doi":"10.1177/17511437261470611","DOIUrl":"10.1177/17511437261470611","url":null,"abstract":"<p><strong>Background: </strong>Hospital ward transitions remain poorly understood despite their importance to patient flow and efficiency. Transition patterns are shaped by local policy and pathways, but in critically ill patients, transitions may also accumulate in response to clinical complexity. This study aimed to characterise patterns of ward transitions, identify determinants of ward transition frequency, and evaluate associations with adverse patient outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study comprised patients admitted through the emergency department (ED) across three acute hospitals in a region of Scotland between 2017 and 2022 who experienced a critical care admission prior to hospital discharge. Ward transition patterns were characterised using descriptive statistics and frequency distributions. Regression analyses were conducted to identify factors associated with transition frequency and to examine associations with 7-day ED reattendance, 30-day emergency hospital readmission, 30-day post-discharge mortality, and hospital length of stay.</p><p><strong>Results: </strong>12,836 critical care survivors were included. In univariable analyses, factors including age, comorbidity burden, smoking status, deprivation, and level of organ support were associated with transition frequency. Greater transition burden was associated with increased odds of 7-day ED reattendance (adjusted OR = 1.12, 99.89% CI: 1.07-1.17) and prolonged length of stay (adjusted beta coefficient 1.35, 99.89% CI: 1.34-1.36), but not 30-day readmission (adjusted OR = 1.01, 99.89% CI: 0.96-1.05) or 30-day mortality (adjusted OR = 0.99, 99.89% CI: 0.86-1.14).</p><p><strong>Conclusion: </strong>Increased ward transitions in critically ill patients mark clinical complexity. It is associated with longer hospital stays and may help identify those at greater risk of early ED reattendance.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261470611"},"PeriodicalIF":1.9,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621776","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.","authors":"Neha Passi, Jessie Welbourne","doi":"10.1177/17511437261470609","DOIUrl":"https://doi.org/10.1177/17511437261470609","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261470609"},"PeriodicalIF":1.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13388490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563290","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":"Implementation of procalcitonin-guided antibiotic stopping advice in sepsis: A mixed-methods process evaluation in a clinical trial context.","authors":"Ruth Louise Poole, Christina Lloydwin, Harley Anderson, Paul Dark, Ranjit Lall, Anower Hossain, Judith White","doi":"10.1177/17511437261458968","DOIUrl":"10.1177/17511437261458968","url":null,"abstract":"<p><strong>Background: </strong>Appropriate antibiotic use can save life in sepsis while reducing the risk of bacterial resistance. Biomarkers, such as procalcitonin (PCT), can inform the timing of the clinical decision to stop a course of antibiotics. The recently reported multicentre ADAPT-Sepsis trial showed that a daily PCT-guided protocol can safely reduce the duration of antibiotic use in people with suspected sepsis. This linked study aimed to identify potential barriers and facilitators to implementation of PCT testing.</p><p><strong>Methods: </strong>This process evaluation collected qualitative and quantitative data from clinical teams involved in the delivery of adapt-sepsis. Trial site staff were invited to complete a questionnaire and to participate in a semistructured interview. Responses were thematically analysed and compared with constructs from the Consolidated Framework for Implementation Research (CFIR v2.0).</p><p><strong>Results: </strong>A total of 69 staff from 26 critical care units responded to the online questionnaire (<i>n</i> = 55); the interview invitation (<i>n</i> = 3); or both (<i>n</i> = 11). Interviewees included critical care consultants, junior doctors, and research nurses. At least 60% of ADAPT-Sepsis trial staff respondents supported the continuation of PCT testing, even before trial results were publicised. Several of the implementation facilitators related to factors evident at the level of the site/organisation, such as microbiology involvement and increasing access to knowledge and information about evidence supporting the tests. Cost was raised as a potential barrier.</p><p><strong>Conclusion: </strong>Adoption of biomarker tests such as PCT may be facilitated by communicating high-quality evidence, supported by staff focussed on antimicrobial stewardship. Cost implications have been considered in a related economic analysis.</p><p><strong>Study registration: </strong>This study was prospectively registered online. The unique identifying number at researchregistry.com is researchregistry4244.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261458968"},"PeriodicalIF":1.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13314676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362886","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 thyroid-heart axis-hormone dynamics and outcomes in cardiogenic shock following myocardial infarction.","authors":"Priyanka Boettger, Jamschid Sedighi, Laura Pallmann, Patrick Kellner, Henning Lemm, Roland Prondzinsky, Thomas Karrasch, Karl Werdan, Michael Buerke","doi":"10.1177/17511437261454174","DOIUrl":"10.1177/17511437261454174","url":null,"abstract":"<p><strong>Background: </strong>Thyroid hormone alterations are common in critical illness and may reflect disease severity. Their prognostic significance in infarct-related cardiogenic shock remains incompletely defined.</p><p><strong>Methods: </strong>In this prospective cohort study from a cardiogenic shock registry, 41 patients with acute myocardial infarction complicated by cardiogenic shock underwent serial measurements of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) at baseline and 24, 48, 72, and 96 h after percutaneous coronary intervention. Associations between hormone trajectories and in-hospital mortality were assessed using longitudinal and small-sample-robust methods.</p><p><strong>Results: </strong>Thyroid trajectories diverged by outcome. Survivors maintained higher TSH concentrations over time, whereas non-survivors showed progressive suppression. fT3 declined in both groups early after presentation, with a steeper overall decline in non-survivors and outcome separation becoming most apparent later in the observation period. Lower fT3 was associated with greater illness severity and higher mortality risk. fT4 decreased over time in both groups without consistent between-group differences.</p><p><strong>Conclusions: </strong>In conclusion, dynamic alterations in thyroid hormone levels, particularly reductions in fT3, were associated with greater illness severity and adverse outcomes in cardiogenic shock. Serial thyroid function assessment may improve risk stratification in acute cardiovascular critical illness and warrants further evaluation in larger prospective studies.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261454174"},"PeriodicalIF":1.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333597","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":"Trajectories of sepsis survivors in Australia: A scoping review.","authors":"Berihun Bantie, Anteneh Mengist, Jacqueline H Stephens, Diane Chamberlain","doi":"10.1177/17511437261456097","DOIUrl":"10.1177/17511437261456097","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis poses a substantial global health threat, accounting for approximately 20% of all deaths worldwide. In Australia, available reports indicate a rising incidence, with over 84,000 hospital admissions each year. Although in-hospital survival has improved, many survivors continue to experience long-term physical, psychological, cognitive, and health-related quality-of-life (HRQoL) challenges, collectively known as post-sepsis syndrome (PSS). However, research examining these long-term outcome trajectories remains fragmented and has not been comprehensively synthesised. This scoping review aims to map current evidence, clarify key concepts, and identify gaps in knowledge regarding PSS and related post-sepsis outcomes within the Australian context.</p><p><strong>Methods: </strong>A scoping review was carried out in accordance with the updated methodological framework provided by the Joanna Briggs Institute (JBI). A comprehensive search across multiple databases was conducted, including both peer-reviewed and grey literature. Two reviewers independently screened and extracted data. Narrative thematic analysis was employed to identify key themes and knowledge gaps. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, and the review protocol was published on the Open Science Framework (OSF): https://doi.org/10.17605/osf.io/xhzfq.</p><p><strong>Result: </strong>Eighteen studies, primarily observational cohort designs, investigated outcomes among a total of 542,599 sepsis survivors. Less than half (39%) of the studies provide nationwide data. Six key themes emerged: long-term mortality risk, hospital readmissions, reduced HRQoL, long-term physical impairments, cognitive dysfunction, and mental health challenges. The most frequently reported outcomes were elevated post-hospital mortality and reduced HRQoL. Notably, 1-year mortality rates ranged from 12.5% to 36.9%. HRQoL was consistently impaired across all domains when compared to the general population. Despite ongoing needs in survivors, post-discharge rehabilitation and support services were reported to be inadequate.</p><p><strong>Conclusion and recommendations: </strong>This scoping review shows that sepsis survivors in Australia experience multidimensional long-term complications and increased mortality risk. Stakeholders need to provide greater emphasis on the development of tailored post-sepsis care models and follow-up strategies to improve life after experiencing sepsis. Moreover, methodological limitations in the existing literature-including inconsistent case definitions, limited outcome measurement, short follow-up, and insufficient exploration of factors-highlight the need for robust, longitudinal research to strengthen evidence bases.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261456097"},"PeriodicalIF":1.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333630","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":"Psychology in an extracorporeal membrane oxygenation (ECMO) service in the North-West.","authors":"Maleeha Butt, Sarah Stirling, Hannah Fitzmaurice, Zoey Malpus","doi":"10.1177/17511437261456108","DOIUrl":"10.1177/17511437261456108","url":null,"abstract":"<p><strong>Background: </strong>Long-term psychological complications of ECMO have been reported and current national guidelines state that there should be access to psychologists for patients in intensive care; however, this is not available in all ICUs. This project was based in a cardiothoracic critical care unit (CTCCU) of a hospital in the north-west of England that does not currently have a psychologist. Therefore, the aim of this project was to identify the psychological needs of ECMO patients. A subsidiary aim was to develop and trial an ECMO-specific group intervention.</p><p><strong>Methods: </strong>The prevalence of mental health difficulties in ECMO patients was investigated using data from outcome measures completed 6 weeks post-discharge. Patients were interviewed about their experiences of ECMO, and themes were identified using a thematic analysis. Based on these themes, a pilot 6-week group was developed, and quantitative and qualitative outcomes were collected.</p><p><strong>Results: </strong>Analysis of post-discharge HADS found 50% of patients scored within the clinically significant range for anxiety and 37% for depression. Patient themes included feeling powerless, alone and fears around 'what is normal?'. The ECMO group was well-received by patients, with feedback that they felt 'seen and heard'. Despite the small sample size, the group demonstrated positive outcome data, with a 66% decrease in anxiety symptoms and a 78% decrease in depression symptoms.</p><p><strong>Conclusions: </strong>This project highlighted significant mental health distress for ECMO patients. Positive psychological outcomes were gained from the ECMO group and recommendations were made that embedding psychologists within CTCCU could promote post-traumatic growth for patients.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261456108"},"PeriodicalIF":1.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13259885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253938","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":"Reclaiming \"Chest Physio\": Why professional language matters.","authors":"Samantha Cook, Amanda Thomas, Harriet Shannon","doi":"10.1177/17511437261454175","DOIUrl":"10.1177/17511437261454175","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"291-293"},"PeriodicalIF":1.9,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139280","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":"Aquatic therapy in invasively mechanically ventilated patients: A systematic review of safety, feasibility, and clinical considerations.","authors":"Michal Nissim, Yael Megido","doi":"10.1177/17511437261452040","DOIUrl":"10.1177/17511437261452040","url":null,"abstract":"<p><strong>Background: </strong>Individuals receiving invasive mechanical ventilation experience mobility limitations and are at risk for intensive care unit-acquired weakness and functional decline. Hydrotherapy has been proposed as a potential adjunct within complex care and rehabilitation pathways, as the physical properties of water may facilitate supported movement and upright activity. However, its use in ventilator-dependent populations is often avoided due to safety and feasibility concerns. This systematic review aimed to synthesize the available evidence on the safety, feasibility, and clinical implementation of hydrotherapy in this population.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO. Six electronic databases were searched. Eligible studies included individuals receiving invasive mechanical ventilation who participated in clinically supervised hydrotherapy. Given heterogeneity in study designs and outcomes, a structured narrative synthesis was undertaken with emphasis on safety, feasibility, and ventilator management.</p><p><strong>Results: </strong>Six studies were included. Across all studies, hydrotherapy was consistently reported as safe, with no airway- or ventilation-related adverse events, including accidental extubation, tracheostomy displacement, ventilator disconnection, or water ingress. Feasibility was demonstrated in intensive care, rehabilitation, long-term ventilation, and pediatric prolonged mechanical ventilation settings when structured protocols, multidisciplinary staffing, and continuous physiological monitoring were employed. Reported outcomes included stable respiratory parameters, facilitated movement, and positive experiential responses.</p><p><strong>Conclusions: </strong>Although the evidence base is limited and predominantly descriptive, available findings suggest that hydrotherapy can be safely and feasibly delivered to selected individuals receiving invasive mechanical ventilation in well-resourced clinical environments.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261452040"},"PeriodicalIF":1.9,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139223","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}