Australian Critical Care最新文献

{"title":"Post-traumatic stress disorder specific to parents in the neonatal intensive care unit","authors":"Lisa McKeown BN ,&nbsp;Sonia Pervin PhD ,&nbsp;Kylie Burke PhD ,&nbsp;Vanessa E. Cobham PhD ,&nbsp;Katie Foxcroft BN, MAppSc ,&nbsp;Leonie Callaway MBBS (Hons I), FRACP, PhD","doi":"10.1016/j.aucc.2025.101257","DOIUrl":"10.1016/j.aucc.2025.101257","url":null,"abstract":"<div><h3>Introduction</h3><div>The experience of having an infant admitted to the neonatal intensive care unit (NICU) can be highly traumatic for parents, potentially leading to symptoms of post-traumatic stress disorder (PTSD). Despite the significant emotional impact of the NICU experience, the prevalence rates of probable PTSD among NICU parents, as measured by validated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) self-report instruments, have not been extensively documented. The aim of this study was to address this gap.</div></div><div><h3>Objective</h3><div>The aim of this pilot study was to assess the prevalence rates of probable PTSD in NICU parents at five time points over 12 months. A secondary aim was to identify differences in probable PTSD between mothers and fathers.</div></div><div><h3>Methods</h3><div>The standardised PTSD Checklist for DSM-5 self-report measure was used to screen parents for symptoms of probable PTSD at the NICU hospital admission, discharge, and 3 months, 6 months, and 12 months of infant corrected age. Probable PTSD was identified with a cut-off score ≥31.</div></div><div><h3>Results</h3><div>A total of 102 parents participated in the study. At hospital admission, 13% of NICU parents met the criteria for a probable PTSD diagnosis, with mothers being twice as likely as fathers to report PTSD symptoms. The majority of parents recovered. A critical subset of parents (6%) reported severe and persistent symptoms of probable PTSD at 12 months.</div></div><div><h3>Conclusions</h3><div>The use of the PTSD Checklist for DSM-5 administered by neonatal nurses can help identify potential signs of parental stress or trauma. Further research must assess whether early screening and referral improve parental outcomes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101257"},"PeriodicalIF":2.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of mindfulness-based interventions on psychosocial well-being and occupational-related outcomes among nurses in the intensive care unit: A systematic review and meta-analysis","authors":"Meilin Liu BS, RN ,&nbsp;Ya Guo BS, RN ,&nbsp;Jing Bai BS, RN,&nbsp;Zhuoling Wang BM,&nbsp;Jiming Han PhD, MD,&nbsp;Jiayu Zhu BS, RN,&nbsp;Jin Wang MSN, RN","doi":"10.1016/j.aucc.2025.101255","DOIUrl":"10.1016/j.aucc.2025.101255","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Mindfulness-based interventions may contribute to the mental health status and well-being of nurses. Current results are inconsistent, and there are no systematic review and meta-analyses for intensive care unit (ICU) nurses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;The aim of this study was to assess the effectiveness of mindfulness-based interventions on psychosocial well-being and occupational-related outcomes among nurses in the ICU.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a comprehensive literature search across 12 electronic databases, including PubMed, Web of Science, Embase, CINAHL, PsycINFO, Cochrane Library, CNKI, Wanfang, VIP, SinoMed, ClinicalTrials.gov, and preprint repositories (bioRxiv and medRxiv). Additionally, we screened the reference lists of included studies to identify other potentially relevant research. The search covered records from the inception of each database up to July 2024. Two researchers independently screened studies and extracted data. ReviewManager (version 5.3 was used to conduct the meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 29 studies were included in the meta-analysis to evaluate the effects of mindfulness-based interventions across different timeframes: immediate-term effects (within 10 days post intervention), short-term effects (10 days–3 months), medium-term effects (3–6 months), and long-term effects (beyond 6 months). The results showed that mindfulness-based interventions significantly alleviated anxiety (mean difference [MD]: −10.80, 95% confidence interval [CI]: [-16.76, −4.83], I&lt;sup&gt;2&lt;/sup&gt; = 78%, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) and depression (MD: −12.02, 95% CI: [-12.43, −11.61], I&lt;sup&gt;2&lt;/sup&gt; = 0%, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) in the medium term for ICU nurses. Significant immediate-term effects were observed on well-being (standardised mean difference [SMD]: 0.58, 95% CI: [0.40, 0.76], I&lt;sup&gt;2&lt;/sup&gt; = 0%, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), resilience (MD: 14.41, 95% CI: [9.71, 19.11], I&lt;sup&gt;2&lt;/sup&gt; = 91%, &lt;em&gt;P&lt;/em&gt; &lt; 0.001), and death anxiety (MD: −2.35, 95% CI: [-4.39, −0.31], I&lt;sup&gt;2&lt;/sup&gt; = 30%, &lt;em&gt;P&lt;/em&gt; = 0.02). Mindfulness-based interventions also showed significant short-term effects on well-being (SMD: 0.54, 95% CI: [0.10, 0.99], I&lt;sup&gt;2&lt;/sup&gt; = 43%, &lt;em&gt;P&lt;/em&gt; = 0.02), sleep quality (MD: −1.19, 95% CI: [-2.32, −0.05], I&lt;sup&gt;2&lt;/sup&gt; = 50%, &lt;em&gt;P&lt;/em&gt; = 0.04), and stress (SMD: −0.75, 95% CI: [-1.34, −0.17], I&lt;sup&gt;2&lt;/sup&gt; = 79%, &lt;em&gt;P&lt;/em&gt; = 0.01). Significant effects were observed across immediate-term, short-term, and medium-term timeframes for stress reduction (medium-term effects: MD: −9.69, 95% CI: [-10.18, −9.21], I&lt;sup&gt;2&lt;/sup&gt; = 0%, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) and mindfulness improvement (medium-term effects: MD: 9.28, 95% CI: [7.20, 11.37], I&lt;sup&gt;2&lt;/sup&gt; = 0%, &lt;em&gt;P&lt;/em&gt; &lt; 0.001). Additionally, mindfulness-based interventions significantly reduced burnout in the immediate term (SMD: −1.28, 95% CI: [-2.31, −0.25], I&lt;sup&gt;2&lt;/sup&gt; = 92%, &lt;em&gt;P&lt;/em&gt; = 0.0","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101255"},"PeriodicalIF":2.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory rate-oxygenation (ROX) index and National Early Warning Score 2 (NEWS2): Promising prognostic tools in cardiogenic pulmonary oedema","authors":"Isabelle de Almeida Souza BN ,&nbsp;Asiya Shalova BN ,&nbsp;Nayane Maria Vieira MN,&nbsp;João Carlos Clark Barros BN,&nbsp;Gustavo Martins Ferreira BN,&nbsp;Paula Schmidt Azevedo PhD,&nbsp;Bertha Furlan Polegato PhD,&nbsp;Leonardo Antônio Mamede Zornoff PhD,&nbsp;Sérgio Alberto Rupp de Paiva PhD,&nbsp;Taline Lazzarin BN,&nbsp;Marcos Ferreira Minicucci PhD","doi":"10.1016/j.aucc.2025.101261","DOIUrl":"10.1016/j.aucc.2025.101261","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101261"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mediating effect of resilience on the relationship between alarm fatigue and burnout among critical care nurses","authors":"Sameer A. Alkubati RN, PhD ,&nbsp;Essa Alshammari RN, MSN ,&nbsp;Hamdan Albaqawi RN, PhD ,&nbsp;Abdulhafith Alharbi RN, PhD ,&nbsp;Adel O. Laradhi RN, PhD ,&nbsp;Galal F. Albani RN, PhD ,&nbsp;Eddieson Pasay-an RN, PhD ,&nbsp;Mohamed A. Tlili RN, PhD ,&nbsp;Aziza Z. Ali RN, PhD","doi":"10.1016/j.aucc.2025.101258","DOIUrl":"10.1016/j.aucc.2025.101258","url":null,"abstract":"<div><h3>Background</h3><div>Burnout is a common problem in intensive care units and may be related to exposure to high levels of alarms.</div></div><div><h3>Objectives</h3><div>The aims of this study were to identify factors influencing burnout among critical care nurses and to examine the role of resilience in mediating the relationship between alarm fatigue and burnout.</div></div><div><h3>Methods</h3><div>A cross-sectional correlational design was used with 306 critical care nurses in critical and intensive care units in Ha'il City, Saudi Arabia's public hospitals from June to August 2024. A path analysis was conducted using the AMOS 23.0 software.</div></div><div><h3>Results</h3><div>Multiple linear regression analysis revealed that being Saudi (p = 0.033), having more years of experience (p = 0.020), and having a higher alarm fatigue score or lower resilience were significant predictors of higher emotional exhaustion. Having more years of experience (p &lt; 0.001), higher alarm fatigue scores (p = 0.001), and lower resilience (p &lt; 0.001) were significant predictors of higher depersonalisation. Alarm fatigue had an indirect impact on emotional exhaustion and depersonalisation (β = 0.12, p &lt; 0.001 and β = 0.09, p &lt; 0.001, respectively). Furthermore, alarm fatigue had a significant positive direct effect on emotional exhaustion and depersonalisation (β = 0.31, p &lt; 0.001 and β = 0.19, p = 0.011, respectively) and a negative direct effect on resilience and personal achievement (β = −0.32, p &lt; 0.001 and β = −0.25, p &lt; 0.001, respectively). In addition, alarm fatigue had a total positive effect on emotional exhaustion and depersonalisation (β = 0.43, p &lt; 0.001 and β = 0.28, p = 0.001, respectively) and a negative effect on personal achievement (β = −0.28, p &lt; 0.001). Resilience had a direct negative effect on emotional exhaustion and depersonalisation (β = −0.37, p &lt; 0.001 and β = −0.28, p &lt; 0.001, respectively).</div></div><div><h3>Conclusion</h3><div>The findings revealed a high prevalence of emotional exhaustion and depersonalisation coupled with low levels of personal accomplishment. Resilience partially mediates the relationship between alarm fatigue, emotional exhaustion, and depersonalisation. Healthcare institutions must initiate proper alarm systems and training programs to help mitigate unnecessary alarms and empower resilience among nurses.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101258"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical care nurses’ responses to clinical scenarios involving cardiopulmonary resuscitation for deceased inpatients without a Do Not Resuscitate order: A cross-sectional study","authors":"Heidi Hoi Ying Hui RN, MPH ,&nbsp;Joanne Cordina RN, GradCertNurs ,&nbsp;Judeil Krlan Teus RN, MAdvN ,&nbsp;Susan Maitland RN, MN ,&nbsp;Michael Watts RN, GCertCritCare ,&nbsp;Sahn Zanotti RN, GradCertNurs ,&nbsp;Suzanne Sheppard-Law RN, PhD ,&nbsp;Eamon Merrick RN, PhD ,&nbsp;George Skowronski MBBS(HONS), FRACP, FRCP, FCICM ,&nbsp;Suzanne Bowdler RN, MN ,&nbsp;Edwina Light PhD ,&nbsp;Amy Montgomery RN, NP, PhD ,&nbsp;Anne Preisz MBioeth ,&nbsp;Linda Sheahan MBE, FRACP, FAChPM ,&nbsp;Cameron Stewart PhD, FACLM(Hons), FAAL ,&nbsp;Ian Kerridge MPhil, FRACP, FRCPA ,&nbsp;Gemma McErlean RN, PhD","doi":"10.1016/j.aucc.2025.101254","DOIUrl":"10.1016/j.aucc.2025.101254","url":null,"abstract":"<div><h3>Background</h3><div>Current Australian resuscitation training focusses on the practical application of cardiopulmonary resuscitation but lacks clarity on when it is inappropriate. Nurses are often first responders to inpatient emergencies and may take different approaches to cardiopulmonary resuscitation due to their views about its benefit. There is a lack of literature on how the absence of Do Not Resuscitate orders affect nurses’ decisions regarding resuscitation in hospital settings.</div></div><div><h3>Objective</h3><div>The aim of this study was to explore nurse's views of initiating cardiopulmonary resuscitation on inpatients with unequivocal signs of death without a Do Not Resuscitate order, using hypothetical scenarios.</div></div><div><h3>Methods</h3><div>The cross-sectional survey recruited nurses across five Australian hospitals between October 2023 and April 2024. Participants were provided two hypothetical clinical scenarios (scenario 1: Mr D, an 84-year-old man; scenario 2: Mr G, a 35-year-old man). In both scenarios, the patients had unequivocal signs of death and absent Do Not Resuscitate orders. Respondents were asked to indicate their actions. Responses from participants working in the intensive care unit, emergency department, or critical care are reported here. Results were analysed using descriptive statistics.</div></div><div><h3>Results</h3><div>Eighty participants working in the intensive care unit, emergency department, or critical care completed the survey. Most nurses indicated they would call a Code Blue and initiate full resuscitation in both scenarios (scenario 1: 51.3% [n = 41] vs scenario 2: 92.5% [n = 74]). Fear and a misunderstanding of the law was a recurring reason for initiating resuscitation in both scenarios. Ethical judgement and family's expectations were predominant reasons for initiating resuscitation for the younger patient (scenario 2).</div></div><div><h3>Conclusions</h3><div>Most nurses working in the intensive care unit, emergency department, or critical care areas chose to call a Code Blue and initiate full resuscitation in both scenarios where patients showed unequivocal signs of death and an absent Do Not Resuscitate order. Nurses' decisions were influenced by multiple factors, including patient's age and misconception of the law.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101254"},"PeriodicalIF":2.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Bereaved family members’ perspectives of their organ donation decision at three months post death of the donor-eligible patient in critical care: A qualitative enquiry” [Aust. Crit. Care 38 (2025) 101132]","authors":"J.E. Potter RN, PhD ,&nbsp;L. Perry RN, PhD ,&nbsp;R.M. Elliott RN, PhD","doi":"10.1016/j.aucc.2025.101259","DOIUrl":"10.1016/j.aucc.2025.101259","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101259"},"PeriodicalIF":2.6,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of clinical prediction tools in cardiogenic pulmonary oedema management: Confounders and future directions","authors":"Hao Xu M.D,&nbsp;Sai Xiang Ph.D","doi":"10.1016/j.aucc.2025.101253","DOIUrl":"10.1016/j.aucc.2025.101253","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101253"},"PeriodicalIF":2.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143922803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid administration and weaning practices in mechanically ventilated adult intensive care unit patients: A retrospective analysis","authors":"Rosalind Helliwell RN, MNursing ,&nbsp;Elizabeth Manias RN, PhD, FAAN, FACCCN, FANZCAP","doi":"10.1016/j.aucc.2025.101240","DOIUrl":"10.1016/j.aucc.2025.101240","url":null,"abstract":"<div><h3>Background</h3><div>Opioids are commonly administered via continuous infusion in the intensive care unit (ICU) to manage pain and anxiety during mechanical ventilation, yet strategies for safe and effective weaning remain inconsistent. This study aimed to identify clinical and opioid-related factors associated with failed weaning and prolonged opioid cessation.</div></div><div><h3>Objective</h3><div>The purpose of this study was to examine opioid administration and weaning practices in mechanically ventilated adults, specifically analysing associations between opioid exposure, infusion duration, percentage reduction in dose, and failed weaning attempts to identify key factors influencing weaning outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted in a metropolitan general ICU in Australia. Adult patients receiving continuous opioids and mechanical ventilation for ≥24 h were included. Demographic and clinical data were extracted from medical records and the Australian and New Zealand Intensive Care Society Adult Patient Database. The primary outcome was the association between patient and opioid infusion factors with failed weaning events, defined as a ≥10% reduction from the average hourly opioid rate in the 4 h before weaning. Multivariate logistic regression, Cox proportional hazards models, and linear regression were employed.</div></div><div><h3>Results</h3><div>Among the 240 patients, 75.8% experienced at least one failed opioid weaning attempt. Higher cumulative opioid exposure and prolonged infusion duration were significantly associated with weaning failure (<em>χ</em>² = 27.41, degrees of freedom [<em>df</em>] = 1, <em>p</em> &lt; 0.001). A greater percentage reduction in opioid dose was also a significant predictor of failure (odds ratio: 1.0224, 95% confidence interval: 1.010–1.036, Wald <em>χ</em>^<em>2</em> = 11.81, <em>p</em> = 0.0006). Median dose reductions during weaning ranged from 22.6%–39.3% across opioid types. No significant correlation was observed between opioid infusion rates and pain scores (<em>β</em> = −0.00248, <em>t</em> = −1.85, <em>p</em> = 0.065).</div></div><div><h3>Conclusions</h3><div>Failed opioid weaning was common, and high percentage reductions in continuous opioid infusion were linked to weaning failure. Findings suggest the need for structured, gradual opioid tapering strategies and standardised weaning protocols in adult ICUs.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101240"},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory physiotherapy in intensive care: A survey investigating respiratory physiotherapy interventions for mechanically ventilated patients in the intensive care unit","authors":"Jackson Wood BPT(Hons) ,&nbsp;Chantelle Chapman BPT(Hons) ,&nbsp;Michelle Paton MPhty, PhD, MACP","doi":"10.1016/j.aucc.2025.101239","DOIUrl":"10.1016/j.aucc.2025.101239","url":null,"abstract":"<div><h3>Background</h3><div>Physiotherapists play a key role in respiratory care for mechanically ventilated (MV) patients. Despite this, there is limited understanding of which interventions are commonly utilised to treat respiratory compromise in this cohort or what key barriers exist to their implementation.</div></div><div><h3>Aims</h3><div>The aim of this study was to identify preferred respiratory physiotherapy treatments for MV patients across Australian intensive care units (ICUs) and comprehend key barriers to their application.</div></div><div><h3>Methods</h3><div>A survey was sent to 145 of the 183 identified Australian ICUs listed in the Australian and New Zealand Intensive Care Society’s Centre for Outcome and Resource Evaluation report. The survey encompassed demographic details, queried the frequency of use for six interventions (using a Likert scale from “often” to “never”), and explored treatment indications, methods, and barriers through multiple-choice responses. Results were presented as proportions (counts and percentages) and relative frequencies (RFs). Group differences were assessed using chi-squared tests, with a p value &lt;0.05 indicating significance.</div></div><div><h3>Results</h3><div>Of the 69 responses (48% response rate), most were from level 3 (67%, n = 46/69) public (83%, n = 57/69) ICUs, with &lt;2.0 full-time equivalent physiotherapy staffing (49%, n = 34/69) for 5–15 beds (44%, n = 30/69). Manual techniques (e.g., percussions and vibrations) were the most common respiratory physiotherapy treatments, with 54% of respondents using them “often”, while intrapulmonary percussive ventilation was the least common, used “never” by 83%. Variation was noted in the application of hyperinflation. Calculation of maximal inspiratory pressure before completing inspiratory muscle training was common (74%). Overall, clinician competence (RF = 28%), confidence (RF = 21%), and access to clinical guidelines (RF = 20%) were the main barriers to implementing techniques, with barriers generally more prevalent among respondents from smaller, private, level 1 and 2 ICUs.</div></div><div><h3>Discussion</h3><div>While physiotherapists prioritise respiratory treatments for MV patients, significant variability exists in practice. This survey highlights the need for standardised guidelines, enhanced educational resources, and the requirement to support colleagues in smaller and private ICUs to ensure consistent, effective management of MV patients throughout Australian ICUs.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101239"},"PeriodicalIF":2.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting intensive care unit–acquired weakness in the first week of an intensive care unit stay: A multicentre external validation study","authors":"Marta Raurell-Torredà RN, PhD ,&nbsp;Alfonso Muriel-García PhD ,&nbsp;Susana Arias-Rivera RN, MSN","doi":"10.1016/j.aucc.2025.101241","DOIUrl":"10.1016/j.aucc.2025.101241","url":null,"abstract":"<div><h3>Background</h3><div>To diagnose intensive care unit–acquired weakness (ICU-AW) in a timely manner, we previously constructed a prediction model based on multicentre data from 642 patients (development cohort), focussing on the presence of ICU-AW on days 3–5 of ICU admission.</div></div><div><h3>Objective</h3><div>The aim of this study was to investigate the external validity of the original prediction model in a new multicentre cohort (10 of the 80 original ICUs) and investigate frailty as a new predictor.</div></div><div><h3>Methods</h3><div>Newly admitted patients with an ICU stay for &gt;48 h were included. Predictors were prospectively recorded, and an outcome of ICU-AW was defined by a Medical Research Council (MRC) mean score &lt;48. We assessed calibration and discrimination in the original prediction model in the validation cohort (411 patients). We then updated the model in the validation cohort by adding frailty, measured using FRAIL-España and the Clinical Frailty Scale-España.</div></div><div><h3>Results</h3><div>Of the 351 patients with an MRC score in the validation cohort, 195 (55.5%) developed ICU-AW. Model calibration and discrimination in the original model were good with these patients (calibration-in-the-large was 0.17 [95% confidence interval {CI}: {-0.07; 0.40}], slope was 0.93 [95% CI: {0.66; 1.21}], and area under the receiver operating characteristic curve was 0.723 [95% CI: {0.67; 0.78}]. However, when the model validation included unconscious patients (unfeasible for MRC score assessment) classified as having ICU-AW, there was a tendency to underestimate ICU-AW. Model updating did not improve performance (net reclassification improvement was −0.2% with Clinical Frailty Scale-España and −0.3% with FRAIL-España.</div></div><div><h3>Conclusions</h3><div>The initial prediction model for ICU-AW shows good performance in this new independent multicentre validation cohort, which confirms that the predictor variables of ICU-AW for the first 5 days of ICU stay are older age, being female, not being conscious for MRC assessment, and receiving renal replacement therapy. Protectors are active mobility and hyperactive delirium. The frailty variable does not enhance the predictive model.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101241"},"PeriodicalIF":2.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}