Journal of the Intensive Care Society最新文献

{"title":"Sleep physiology and critical illness: A narrative review.","authors":"Jessie Welbourne","doi":"10.1177/17511437261450009","DOIUrl":"10.1177/17511437261450009","url":null,"abstract":"<p><p>In health, humans spend approximately one-third of their lives asleep. Sleep involves all organ systems, and it is an inherent mechanism for regulation and optimisation of bodily functions. Critical illness commonly results in a wide range of adverse health outcomes, many of which may theoretically be ameliorated by functions that are enhanced by sleep. Sleep deprivation and its subsequent organ dysfunction leads to muscle weakness, immunocompromise and the cardiovascular changes of the stress responses; these features are common features of critical illness and its sequalae. Sleep is reframed as an inherent mechanism for recovery and repair and a key mechanism for improving critical care outcomes. An understanding of how sleep affects our patients could lead to novel therapies that would enhance their recovery. This review covers sleep physiology, measurements to assess it in the critically ill, common pathological features that impact sleep during critical illness and the logical interventions and areas for research that might optimise sleep related outcomes.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"400-410"},"PeriodicalIF":1.9,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139237","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 PaCO₂-EtCO₂ gradient in patients with a prehospital inserted arterial catheter for a trauma mechanism by a helicopter emergency medical service in the United Kingdom.","authors":"Owen Hibberd, James Price, Edwin Li Ping Wah-Pun Sin, Hazel Farman, Michael Phillips, Muzammil Arif Din S/O Abdul Jabbar, Ed Benjamin Graham Barnard","doi":"10.1177/17511437261454107","DOIUrl":"10.1177/17511437261454107","url":null,"abstract":"<p><p>This study aims to describe the gradient and the frequency with which the end tidal carbon dioxide (EtCO₂) misclassifies the arterial carbon dioxide (PaCO₂) in the prehospital environment. This retrospective observational study included 53 adult patients (aged ⩾ 18 years) who underwent prehospital arterial catheterisation following a traumatic mechanism who were conveyed to the regional Major Trauma Centre (MTC), 01.02.2015-17.04.2023. The PaCO₂-EtCO₂ gradient was more than >1 kPa difference in most patients (43/53 (81.1%)) and the ETCO2 misclassified the PaCO₂ in over two-thirds of patients (38/53 (71.7%)). Overall, EtCO₂ is not a reliable surrogate for PaCO₂ during trauma.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"373-376"},"PeriodicalIF":1.9,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139278","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":"Effects of expiratory muscle strength training on swallowing in survivors of critical illness: A systematic review and narrative synthesis.","authors":"Philip Skurok, Brian W Johnston, Emma Brown, Caroline Timothy, Christopher Morse, Peter Turton","doi":"10.1177/17511437261444651","DOIUrl":"10.1177/17511437261444651","url":null,"abstract":"<p><strong>Background: </strong>Post-extubation dysphagia (PED) is a common complication of critical illness and is associated with aspiration pneumonia, prolonged hospitalisation, and prolonged recovery. Expiratory muscle strength training (EMST) has been shown to improve swallowing function in selected populations, but its role in survivors of critical illness remains unclear.</p><p><strong>Objective: </strong>To systematically review the evidence evaluating the effects of EMST on swallowing outcomes in survivors of critical illness with PED.</p><p><strong>Methods: </strong>This systematic review was registered with PROSPERO (CRD42023444479) and conducted in accordance with PRISMA guidelines. Searches of MEDLINE, PubMed, EMBASE, CINAHL, and Cochrane databases were performed from 2000 to March 2026. Eligible studies included adult patients requiring >48 h of mechanical ventilation who underwent volitional EMST following extubation. Due to anticipated limited evidence, all quantitative study designs were included. Risk of bias was assessed using the Newcastle-Ottawa scale and the Joanna Briggs Institute checklist. Meta-analysis was not performed due to heterogeneity.</p><p><strong>Results: </strong>Three studies met inclusion criteria, including two from the same research group: one case series (<i>n</i> = 2) and two single-group cohort studies (<i>n</i> = 50 and <i>n</i> = 13). All studies reported improvements in swallowing measures, alongside increases in respiratory muscle strength and cough flow. However, EMST was either combined with inspiratory muscle training or other therapies, and no randomised controlled trials were identified. Methodological quality was low, with high risk of bias and absence of comparator groups.</p><p><strong>Conclusions: </strong>Evidence supporting EMST for PED in survivors of critical illness is extremely limited and of low methodological quality. Whilst mechanistic plausibility and data from other populations suggest potential benefit, robust randomised controlled trials with standardised training protocols and outcome measures are required before clinical implementation can be recommended.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"355-366"},"PeriodicalIF":1.9,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13190362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017795","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":"Applying gastric residual volume as one of the indicators for enteral feeding intolerance: A scoping review.","authors":"Duc T Nguyen, An T Bui, Anh K Dang, Trang Q T Tran, Dung Q Nguyen, Linh T Nguyen, Thuc M T Luu, Huong T Le","doi":"10.1177/17511437261447665","DOIUrl":"10.1177/17511437261447665","url":null,"abstract":"<p><strong>Rationale: </strong>Measuring gastric residual volume (GRV) remains common in intensive care units (ICUs), despite weak evidence linking it to enteral feeding intolerance (EFI), gastric emptying, aspiration, or ventilator-associated pneumonia. Thresholds defining high GRV vary widely (75-1200 ml). This scoping review aimed to: (1) identify GRV thresholds indicating feeding intolerance in adult ICU patients; and (2) describe GRV-related management practices.</p><p><strong>Methods: </strong>This review was conducted following the Population-Concept-Context (PCC) framework. A comprehensive search was performed in PubMed and Web of Science, extracting studies published in English and Vietnamese from 2010 to 2024. Studies were eligible if they were original research, trials, pre-and-post intervention study, and case reports/case series, and reported both GRV threshold and specific management strategies, while reviews or other studies that only had either GRV cutoff or its interventions were excluded.</p><p><strong>Results: </strong>Among 73 records for screening, 25 studies were eligible. Most involved hemodynamically stable, mechanically ventilated ICU patients receiving enteral nutrition (EN). GRV monitoring was typically performed every 4-6 h, with the cutoff ranging from 150 to 500 mL. Most studies used 200-250 mL as the most frequently used reference point. Some other studies combined GRV and clinical symptoms-such as nausea, vomiting, or distension-to determine intolerance. When GRV was below the lower threshold, feeding was typically continued or increased by 10-30 mL/h. Elevated GRV prompted various interventions, including temporary suspension of EN, prokinetic administration, or transition to post-pyloric nutrition.</p><p><strong>Conclusion: </strong>Most studies used 200-250 mL as a cautious GRV threshold for an early recognition of feeding intolerance, and the time to check GRV was normally every 4-6 h. Management of high GRV for lower thresholds tended to be less absolute, by reducing feeding rate and prescribing prokinetics, while stricter management was performed if GRV exceeded the higher GRV threshold.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"387-399"},"PeriodicalIF":1.9,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13190358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017810","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":"Temporal trends in time to asystole in patients considered for organ donation after circulatory death.","authors":"Craig Nicolson, Athanasios Tsanas, Dale Gardiner, Dan Harvey, Martin Shaw, Nazir Lone, Kathryn Puxty","doi":"10.1177/17511437261450006","DOIUrl":"10.1177/17511437261450006","url":null,"abstract":"<p><strong>Introduction: </strong>Prolonged time to asystole is a common barrier to successful organ donation after circulatory death, yet there have been few attempts to evaluate trends in its occurrence over time. This study investigated temporal trends in time to asystole among patients considered for donation after circulatory death in the UK (2014-2024).</p><p><strong>Methods: </strong>This observational study was conducted using NHS Organ Donation & Transplant (ODT) datasets. We analysed temporal trends in time to asystole and donation outcomes using descriptive statistics. Additionally, to explore evident impacts of the COVID-19 pandemic we performed pre-post comparisons and an interrupted time series (ITS) analysis.</p><p><strong>Results: </strong>Of 9466 participants, 58.5% proceeded to solid organ donation. Non-proceeding cases were primarily due to prolonged time to asystole (55.1%). Donation rates increased from 50% to 60% pre-2020 to consistently above 60% post-2022, whilst cases not proceeding due to prolonged time to asystole decreased from 25% to 20%. ITS analysis confirmed a significant post-pandemic reduction in time to asystole and a sustained drop in referrals, suggesting improved donation efficiency. Successful donors typically received higher levels of support and had lower neurological status compared to those with prolonged time to asystole.</p><p><strong>Discussion: </strong>The findings demonstrate reduced prolonged time to asystole occurrence and increased organ donation rates. Whilst there has been ongoing improvement over the study period there is evidence of a systemic change following the COVID-19 pandemic, which resulted in a smaller, more efficient referral pool. This may be attributed to better identification of suitable donors during the referral process, and while causation cannot be definitively established, the study supports ongoing evaluation and refinement of the donation pathways.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"335-345"},"PeriodicalIF":1.9,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989330","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":"Thrombolysis for pulmonary embolism: A network meta-analysis.","authors":"Amy Ross, Patrick Glaister, Nichola Robinson, Iain Crossingham","doi":"10.1177/17511437261450011","DOIUrl":"10.1177/17511437261450011","url":null,"abstract":"<p><strong>Background: </strong>Thrombolysis is an adjunct therapy in the management of pulmonary embolism. Several different thrombolytic agents are available. A recent shortage of alteplase led us to consider the relative merits of different agents.</p><p><strong>Methods: </strong>We performed a systematic review of thrombolytic agents for pulmonary embolism. Studies comparing any thrombolytic agent with placebo, usual care or another thrombolytic agent were included. Both a standard pairwise analysis and a network meta-analyses (using a Bayesian framework) were performed.</p><p><strong>Results: </strong>28 studies were identified. In the pairwise analysis, thrombolysis did not show any benefit in mortality when compared with placebo (OR 0.69, 95% CI 0.43 to 1.1, 17 trials, 2220 participants) but it did cause an increase in serious bleeding events (OR 2.57, 95% CI 1.33 to 4.94, 14 trials, 2028 participants). The network analysis did not show superiority of any one thrombolytic agent over any other or over placebo for the outcome of mortality. tenecteplase was associated with significantly more bleeding than placebo.</p><p><strong>Conclusion: </strong>No thrombolytic performs significantly better than placebo in pulmonary embolism. Thrombolytic agents, particularly tenecteplase, are associated with serious bleeding.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"346-354"},"PeriodicalIF":1.9,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989343","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":"Service evaluation: Accuracy of using end-tidal CO₂ to estimate PaCO₂ values in suspected traumatic brain injury patients requiring mechanical ventilation.","authors":"Johan Victor Rehnberg, Julian Hannah, James Plumb, Peter Owen","doi":"10.1177/17511437261444655","DOIUrl":"10.1177/17511437261444655","url":null,"abstract":"<p><p>This service evaluation assessed the accuracy of estimating arterial partial pressure of carbon dioxide (PaCO₂) from end-tidal CO₂ (ETCO₂) in prehospital suspected traumatic brain injury (TBI) patients requiring mechanical ventilation. Thirty-one cases with paired ETCO₂ and emergency department (ED) PaCO₂ measurements were analysed. Estimated PaCO₂ (ETCO₂ + 0.5 kPa) significantly underestimated measured PaCO₂, with a mean bias of 1.17 kPa and wide limits of agreement. Nearly half of patients were outside the normocapnic range despite apparently acceptable estimated values. Findings highlight the risk of inadvertent hypercapnia when relying on ETCO₂-based estimation alone. Lower ETCO₂ targets or point-of-care PaCO₂ measurement may improve ventilation accuracy and reduce secondary brain injury.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"370-372"},"PeriodicalIF":1.9,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784270","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 Triad of Dying: A framework for palliation and compassionate decision-making in the ICU.","authors":"Ned Gilbert-Kawai, Edward Presswood","doi":"10.1177/17511437261429269","DOIUrl":"10.1177/17511437261429269","url":null,"abstract":"<p><strong>Background: </strong>End-of-life decision-making in the intensive care unit (ICU) remains ethically complex and emotionally charged. There is a need for frameworks that support compassionate, values-based care when curative treatment is no longer appropriate.</p><p><strong>Methods: </strong>This paper introduces the 'Triad of Dying', an easy to recall, clinical and ethical framework comprising comfort, dignity, and the presence of loved ones, to guide ICU clinicians in withdrawing life-sustaining treatment.</p><p><strong>Results: </strong>The framework integrates established palliative principles into a cohesive and memorable tool for bedside decision-making, interdisciplinary practice, and trainee education. It enhances communication with families and promotes person-centred care.</p><p><strong>Conclusion: </strong>The Triad of dying provides a practical scaffold for reframing ICU death as a meaningful, human event rather than a medical failure. It fosters ethically grounded palliation that honours the values and identities of patients at life's end.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"268-272"},"PeriodicalIF":1.9,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784321","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":"Infectious meningitis and encephalitis: A primer for acute care practitioners.","authors":"Martin Beed, Chit Wong, Rob A Dineen, Louise Berry, Peter G Brindley","doi":"10.1177/17511437261437982","DOIUrl":"10.1177/17511437261437982","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Meningitis and encephalitis affect all ages, are prone to misdiagnosis and outcome can be devastating. We provide this common primer for all in the sepsis \"chain-of-survival.\" Meningitis equals inflammation/infection of the protective membranes that cover the brain; whereas encephalitis affects the brain parenchyma. Meningitis is more common, but they can co-exist as meningoencephalitis. Encephalitis can also affect the spinal cord (encephalomyelitis). Worldwide, meningitis affects 2.5 million people annually, and kills over 200,000. Central nervous system (CNS) infections account for 3.9% of all UK intensive care unit (ICU) infections, and 0.7% of adult ICU admissions. While this means these are not common causes for admission, they do have high morbidity and mortality. The median ICU stay is 4 days, of which 3 days was the median spent requiring advanced respiratory support or support for more than one organ. The median in-hospital stay is 20 days. Most admissions come through the emergency department (ED). Signs and symptoms can be vague and varied; hence potential misdiagnosis as flu, psychiatric disorders, intoxication, even hangover. The median time between hospital admission and transfer to ICU is 1 day, and by this time approximately one-third are comatose and one-sixth need respiratory support. The risk of misdiagnosis matters given high mortality and morbidity: 18%-25% die in hospital and 1-in-10 survivors lose independence. During the past 20 years mortality has fallen, but those left with some form of permanent disability remains constant at nearly 40%. Fortunately, early recognition and treatment can greatly improve outcome. Regarding diagnosis, history and physical examination still have great value. Next, lumbar puncture (LP) should be expedited unless contraindicated by coagulopathy, skin infection, or raised ICP. LP testing should incorporate opening pressure, microscopy, culture and cell count, glucose and protein and often polymerase chain reaction (PCR) for meningococcus, pneumococcus, herpes simplex virus (HSV1&2), varicella (VZV) and enterovirus. Radiologically, head computed tomography (CT) is first line. It may reduce the risk of LP by excluding pathologies likely to trigger herniation. CT is indicated if their Glasgow Coma Score (GCS) is falling or ⩽9, or if seizures, focal neurological signs or papilloedema. Normal CT cannot rule out raised ICP, but LP is avoided if the CT shows herniation, basal cistern or foramen magnum effacement, cerebral swelling, intracranial lesions/collections with mass effect or obstructive hydrocephalus. Magnetic resonance imaging (MRI) is logistically tougher but better at detecting meningitis/encephalitis. MRI can suggest the causative organisms, along with complications such as infarct, pus and parenchymal changes. Treatment centres on prompt antimicrobials: usually a third-generation intravenous (IV) cephalosporin, typically within 1 h, and at an increased (i.e. \"meningitis\") dose. In","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"377-386"},"PeriodicalIF":1.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640259","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":"Nursing interventions to ensure the safety of critically ill patients in intrahospital transportation: A scoping review.","authors":"Ana Filipa Lemos, Diana Vareta","doi":"10.1177/17511437261422929","DOIUrl":"10.1177/17511437261422929","url":null,"abstract":"<p><strong>Background: </strong>Intrahospital transportation of critically ill patients is a high-risk process, frequently linked to complications and increased vulnerability to adverse events. Ensuring safety requires nursing interventions that uphold the standards of care provided in critical care units.</p><p><strong>Objective: </strong>To identify nursing interventions that promote patient safety during intrahospital transportation. Methods: A scoping review was conducted following Arksey and O'Malley's framework. The search was performed in 2024 across PubMed and EBSCOhost (CINAHL Complete, MEDLINE Complete, Nursing & Allied Health Collection: Comprehensive, and Cochrane Central Register of Controlled Trials).</p><p><strong>Results: </strong>Seven publications met the criteria. All studies emphasized the need for strategies to prevent complications during transport. Four categories of interventions emerged: identification and management of adverse events, use of checklists, continuous nurse training, and effective communication.</p><p><strong>Conclusions: </strong>Nurses play a pivotal role in maintaining safety and quality of care. By applying evidence-based strategies, they minimize risks and ensure safer intrahospital transportation.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"273-279"},"PeriodicalIF":1.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640274","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}