Journal of the Intensive Care Society最新文献

{"title":"The effectiveness of selective neutrophil elastase inhibitors (sivelestat) in acute lung injury or acute respiratory distress syndrome: A systematic review and meta-analysis of randomized controlled trials.","authors":"Awirut Charoensappakit, Kritsanawan Sae-Khow, Nuntanuj Vutthikraivit, Patinya Maneesow, Kent Doi, Monvasi Pachinburavan, Asada Leelahavanichkul","doi":"10.1177/17511437261425058","DOIUrl":"10.1177/17511437261425058","url":null,"abstract":"<p><strong>Introduction: </strong>The neutrophil elastase (NE) inhibitor is a potential treatment strategy for acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the clinical effectiveness of sivelestat sodium, a selective NE inhibitor, remains controversial. We performed a systematic review and meta-analysis to evaluate the effects of sivelestat in patients with ALI/ARDS.</p><p><strong>Method: </strong>The literature search, selection, and data extraction were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement (PRISMA) guidelines. The randomized controlled trials (RCTs) with reference lists were retrieved from Scopus, PubMed, and Cochrane Library, using the Cochrane risk-of-bias tool for the quality assessment. Logarithm relative risk (logRR), risk difference (RD), and standardized mean difference (SMD) were calculated using the fixed effects model or random effects model, depending on heterogeneity.</p><p><strong>Result: </strong>Ten RCTs involving 1170 patients (583 receiving sivelestat and 587 receiving standard care or placebo) were included. Sivelestat was associated with a significant reduction in 28-30-day mortality, shorter duration of mechanical ventilation, and improvement in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO₂/FiO₂ ratio) in a time-dependent manner. These beneficial effects were more pronounced in patients with sepsis-related ALI/ARDS. The incidence of adverse events did not differ between groups.</p><p><strong>Conclusion: </strong>Sivelestat might be a promising adjunctive treatment for ALI/ARDS, especially in the sepsis etiology, as evidenced by reduced mortality, shortened mechanical ventilation duration, and improved oxygenation. The large-scale, well-designed RCTs are warranted.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"324-334"},"PeriodicalIF":1.9,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640244","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":"Predictive models for ICU patient readmission based on machine learning: A systematic review.","authors":"Zhixiang Zheng, Wenjun Yan, Kai Cao, Zhi Zhao","doi":"10.1177/17511437261431540","DOIUrl":"10.1177/17511437261431540","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) prediction models can accurately identify high-risk populations by integrating multi-dimensional clinical data, providing decision support for doctors in formulating individualized discharge plans and optimizing follow-up intervention strategies, thereby reducing the risk of readmission from the source. Currently, the number of AI prediction models for readmission of critically ill patients is increasing, but the quality and applicability of these models in clinical practice and future research remain uncertain.</p><p><strong>Objective: </strong>To systematically evaluate published studies on AI prediction models for critically ill patients.</p><p><strong>Methods: </strong>This study conducted a computerized search of the CNKI, Wanfang Data, VIP, SinoMed, PubMed, Web of Science, Cochrane, and Embase databases, with the time range from 2020 to June 25, 2025. Information such as study design, data sources, outcome definitions, sample size, predictors, model development, and performance was extracted from the selected studies. The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist was used to evaluate the risk of bias and applicability.</p><p><strong>Results: </strong>A total of 387 studies were retrieved, and after screening, 31 studies with their 31 prediction models were included in this review. All studies developed risk prediction models for readmission of critically ill patients using artificial intelligence algorithms. The readmission risk of critically ill patients ranged from 1.3% to 13.7%. The most commonly used predictors were structured data. The reported area under the curve (AUC) ranged from 0.66 to 0.98. All studies had a high risk of bias, mainly due to poor reporting quality in the analysis domain and insufficient applicability. The pooled AUC of the 24 validation models was 0.82, with a 95% confidence interval of 0.77-0.87.</p><p><strong>Conclusion: </strong>These study results constitute a comprehensive set of high-quality evidence, demonstrating that AI prediction models exhibit moderate-to-high predictive performance and that their predictive performance is significantly higher than that of traditional prediction models.</p><p><strong>Patient or public contribution: </strong>No Patient or Public Contribution. This Meta-analysis is based on the systematic review and statistical combination of the published clinical research data. The processes of research design, data extraction, and result interpretation did not involve the participation of patients or the public.</p><p><strong>Registration: </strong>The protocol for this study has been registered in PROSPERO (registration number: CRD42025637829).</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"308-323"},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628675","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 Code of Practice 2025 and the medicolegal definition of death.","authors":"Liam Scott, Ian Thomas","doi":"10.1177/17511437261418498","DOIUrl":"10.1177/17511437261418498","url":null,"abstract":"<p><p>In January 2025 the Academy of Medical Royal Colleges published an updated Code of Practice for the Diagnosis and Confirmation of Death, the first major update for 17 years. It represents the authoritative medical consensus on the diagnosis and confirmation of death in all contexts (and in all age groups) in the UK. This paper reviews the new Code, highlighting the major updates from the 2008 guidance and their relevance for intensive care clinicians. It goes on to explore the wider legal history and context, in particular the role that previous versions of the Academy's guidelines have played during the emergence of a common law definition of death. It examines the important legal cases in which the Code of Practice was endorsed and ultimately adopted by the courts as the definitive medical and legal definition of death in the UK.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"261-267"},"PeriodicalIF":1.9,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595382","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":"Exploring the impact of occupational therapy provision in the intensive care unit: A UK single-centre service evaluation.","authors":"James Bruce, Jemma Smith, Vishnuprakash Shankaranarayanan, Ema Swingwood","doi":"10.1177/17511437261431545","DOIUrl":"10.1177/17511437261431545","url":null,"abstract":"<p><strong>Background: </strong>Occupational Therapy (OT) in the Intensive Care Unit (ICU) supports recovery in physical, cognitive, emotional domains, and activities of daily living (ADL), yet. Provision across the UK remains inconsistent, with variable staffing and role integration and no data illustrating the potential impact from such roles.</p><p><strong>Method: </strong>A retrospective service evaluation was undertaken in a UK NHS adult ICU to examine the association of increased OT staffing with changes in rehabilitation activity and functional status. Patients with ICU stays over 7 days were included in line with NICE CG83 high rehabilitation risk criteria. Three 1-month timepoints were compared. Data included delivery of OT interventions, functional outcomes (Modified Barthel Index), and discharge destination.</p><p><strong>Results: </strong>Ninety-nine patients were included. Increased OT staffing was associated with a greater proportion of patients receiving OT assessments, upper limb rehabilitation, personal activities of daily living retraining, cognitive screening, delirium management, and therapy handover. Modified Barthel index scores at hospital discharge increased across timepoints 1, 2 and 3 (55, 71.5 and 82, respectively (<i>p</i> = 0.02)). Discharge destination patterns varied and could not be attributed solely to staffing changes.</p><p><strong>Discussion: </strong>Increased OT staffing was associated with greater delivery of rehabilitation interventions and potential improvements in functional outcomes. However, differences in patient clinical complexity across timepoints may also have influenced these results. Further evaluation is required to establish causal relationships.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"302-307"},"PeriodicalIF":1.9,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595300","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":"Physiotherapy in deceased organ donation: A mixed methods study of current practice and perceptions amongst UK-based intensive care physiotherapists.","authors":"Shannon Saunders, Ema Swingwood, Zoe van Willigen, Sarah Rand, Harriet Shannon","doi":"10.1177/17511437261423807","DOIUrl":"10.1177/17511437261423807","url":null,"abstract":"<p><strong>Background: </strong>Potential organ donors are often identified in intensive care following brainstem or circulatory death. Clinical optimisation is fundamental for maintaining organ viability and physiotherapists are well positioned to support this through targeted interventions. Despite this, the physiotherapy role in deceased organ donation remains underexplored. This study aimed to describe current practice and explore the perceptions of physiotherapists in the United Kingdom involved in managing deceased organ donors.</p><p><strong>Methodology: </strong>An explanatory sequential mixed methods design was utilised. An online survey was used to describe the national picture of current physiotherapy practice. Online semi-structured interviews were undertaken to explore perceptions and attitudes of physiotherapists towards the physiotherapy management of deceased organ donors.</p><p><strong>Results: </strong>Fifty-six physiotherapists completed the survey, with 52% (<i>n</i> = 29) reporting involvement in donor management \"always,\" or \"most of the time.\" Treatment aims included secretion clearance (49%, <i>n</i> = 26) and lung optimisation (45%, <i>n</i> = 24). Suctioning was the most frequently performed intervention (95%, <i>n</i> = 53), followed by positioning (71%, <i>n</i> = 40) and manual techniques (71%, <i>n</i> = 40). Only 5% (<i>n</i> = 3) reported having local guidelines. Seven physiotherapists participated in interviews, identifying six key themes: experiences, barriers, role perceptions, physiotherapist learning needs, multidisciplinary team learning needs, and future needs.</p><p><strong>Discussion: </strong>The role of physiotherapy in organ donor management is under-recognised and lacks national consensus. Findings highlight disparities in practice, limited guidance and the need for further training to strengthen clinical reasoning. Guidance development that addresses the practical, ethical and emotional complexities of this work is urgently needed to support physiotherapists in this evolving area.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"165-178"},"PeriodicalIF":1.9,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505209","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":"Paediatric and adult neurological point-of-care ultrasound: Review of the evidence, and the UK accreditation pathway.","authors":"Manprit Waraich, Bogdana Zoica, Emma Alexander, Jennie Stephens, Hannah Conway, Michael Griksaitis, Justin Kirk-Bayley, Ashley Miller, Prashant Parulekar, Marcus Peck, Antonio Rubino, Jonathan Nicholas Wilkinson","doi":"10.1177/17511437261428885","DOIUrl":"10.1177/17511437261428885","url":null,"abstract":"<p><p>Neurological emergencies such as stroke and traumatic brain injury are major contributors to morbidity and mortality in critically ill patients. These conditions frequently result in alterations in cerebral haemodynamics, including raised intracranial pressure, which require timely recognition and management to optimise outcomes. Neuro point-of-care ultrasound (NeuroPOCUS), incorporating transcranial Doppler (TCD), transcranial colour-coded duplex (TCCD) ultrasound, and optic nerve sheath diameter (ONSD) measurement, offers a non-invasive, bedside means of assessing cerebral physiology and is increasingly recognised as a valuable adjunct in neurocritical care. Despite the successful adoption of point-of-care ultrasound in critical care through established accreditation pathways such as FUSIC^® and CACTUS^®, the UK has lacked a dedicated framework for NeuroPOCUS. To address this gap, we have developed and launched a UK-specific NeuroPOCUS accreditation programme, combining structured theoretical teaching with supervised practical training. The pathway addresses the distinct needs of both paediatric and adult populations, combining theoretical learning with practical application. Core learning materials include neuroanatomy, Doppler principles, standardised insonation techniques, and interpretation of cerebral blood flow velocities and indices such as pulsatility (PI) and resistivity (RI). Supporting resources feature videos of transcranial colour-coded Duplex (TCCD) imaging in normal subjects and clinical case examples. Participants will complete a logbook of 50 supervised cases, facilitated by remote mentorship. A novel accreditation pathway provides an opportunity for further research into the use of NeuroPOCUS in neurocritical care. This article outlines the core techniques of NeuroPOCUS, the physiological insights it offers, key clinical applications, and the proposed accreditation pathway aimed at standardising practice and clinician training in the care of critically ill patients with neurological injury or dysfunction.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"248-260"},"PeriodicalIF":1.9,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469507","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":"Echocardiographic parameters correlate poorly with pulmonary artery catheter-derived right atrial pressure in ischaemic cardiogenic shock.","authors":"Hazem Lashin, Olusegun Olusanya, Andrew Smith, Sanjeev Bhattacharrya","doi":"10.1177/17511437261428884","DOIUrl":"10.1177/17511437261428884","url":null,"abstract":"<p><p>Accurate estimation of right atrial pressure (RAP) is crucial in cardiogenic shock, yet echocardiographic surrogates are often unreliable. In this exploratory analysis of 43 patients with ischaemic cardiogenic shock, pulmonary artery catheter-derived RAP was compared with right heart echocardiographic indices. Only right ventricular e' velocity demonstrated a weak correlation with RAP (<i>rho</i> = 0.31, <i>p</i> = 0.04), but did not significantly discriminate elevated pressure. Other Doppler and morphometric measures showed no meaningful associations. Echocardiographic parameters correlated poorly with invasive RAP, indicating that conventional indices cannot reliably substitute for pulmonary artery catheterisation in assessing venous congestion in this population.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"367-369"},"PeriodicalIF":1.9,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12965891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379113","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":"Integrating end-of-life care into intensive care practice: Outcomes following Gold Standards Framework accreditation.","authors":"Michael Reay, Michelle Jennings, Louis Harpham-Lockyer, Joanne Bowen","doi":"10.1177/17511437261425826","DOIUrl":"10.1177/17511437261425826","url":null,"abstract":"<p><p>In 2023, the Intensive Care Unit at the Dudley Group NHS Foundation Trust became the first in the UK to achieve Gold Standards Framework (GSF) accreditation. This study evaluates the impact of GSF implementation on end-of-life care delivery and associated metrics. Coding of end-of-life care increased from 10.7% to 16.1% and the proportion of deaths recognised as GSF Amber/Red rose from 14.5% to 58.1% with an increased number of referrals to Specialist Palliative Care. GSF accreditation was associated with sustained improvements in key end-of-life care metrics in intensive care, enhancing collaboration with Specialist Palliative Care and supporting more individualised, patient-centred care.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"227-229"},"PeriodicalIF":1.9,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12953159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356876","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":"About time: Echocardiography update in UK intensive care curriculum.","authors":"Waqas Akhtar","doi":"10.1177/17511437261427947","DOIUrl":"10.1177/17511437261427947","url":null,"abstract":"","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"17511437261427947"},"PeriodicalIF":1.9,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345404","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":"Achieving accurate simple medical gas administration: A message from the bench.","authors":"Thomas D A Standley","doi":"10.1177/17511437261425057","DOIUrl":"10.1177/17511437261425057","url":null,"abstract":"<p><p>Assessment and support of hypoxic patients is common in intensive care medicine. Simple oxygen therapy systems are typically used at the beginning of the patient journey, but their performance is influenced by the device used and the patient's respiratory pattern. A solution to overcome this issue is presented, which eliminates device factors and the patient's respiratory pattern from early simple medical gas administration; whereby an oro-nasal mask uses a novel interface combined to visual feedback. The resultant accuracy of medical gas administration achieved, should aid early assessment, support, and rescue of patients in respiratory distress.</p>","PeriodicalId":39161,"journal":{"name":"Journal of the Intensive Care Society","volume":" ","pages":"230-233"},"PeriodicalIF":1.9,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327640","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}