Debbie A. Long RN, PhD , Lori Anthony MClinEpi , Kate Masterson RN, PhD , Warwick Butt MBBS, FCICM , Julie Smith MD , Leigh Dunn BAppSci , Ashfaque Quadir MBBS, FRACP , Anthony Slater MBBS, FCICM , Kristen S. Gibbons PhD
{"title":"Current provision and perceptions of paediatric intensive care unit follow-up services: A binational organisational and clinician survey","authors":"Debbie A. Long RN, PhD , Lori Anthony MClinEpi , Kate Masterson RN, PhD , Warwick Butt MBBS, FCICM , Julie Smith MD , Leigh Dunn BAppSci , Ashfaque Quadir MBBS, FRACP , Anthony Slater MBBS, FCICM , Kristen S. Gibbons PhD","doi":"10.1016/j.aucc.2025.101229","DOIUrl":"10.1016/j.aucc.2025.101229","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to (i) evaluate follow-up services in Australia and New Zealand for children surviving paediatric intensive care; (ii) assess clinician and service-wide knowledge of post–intensive care syndrome-paediatrics; and (iii) identify barriers to long-term follow-up services post paediatric intensive care unit admission.</div></div><div><h3>Methods</h3><div>Two cross-sectional, web-based REDCap surveys were designed for organisational leadership and individual clinician respondents. All paediatric intensive care units with staffed paediatric beds in Australia and New Zealand were invited to participate.</div></div><div><h3>Results</h3><div>Eleven paediatric intensive care units and 345 clinicians responded to the two surveys. None of the 11 paediatric intensive care units reported having any dedicated outpatient follow-up services. Only 53% of clinicians had heard of the term post–intensive care syndrome-paediatrics prior to the survey. However, most clinicians believed that follow-up care should be provided to children following a paediatric intensive care unit admission (96%) via a combination of modalities (49%) (e.g., telehealth and face-to-face) conducted by a multidisciplinary team (32%). Both the individual clinicians and the organisational leadership respondents identified staffing and budget restraints as the biggest barriers to follow-up care.</div></div><div><h3>Conclusions</h3><div>Despite growing international evidence to support the implementation of paediatric intensive care unit follow-up services, Australian and New Zealand paediatric intensive care units do not currently offer such services. In implementing paediatric intensive care unit follow-up practices, staffing and budgetary restraints need to be addressed. Improving clinician- and organisation-wide awareness and understanding of post–intensive care syndrome-paediatrics and its impacts may also help to reduce barriers to implementing follow-up services in Australian and New Zealand paediatric intensive care units.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101229"},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143860628","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}
Adrian Goldsworthy DPT , Mohd Fairuz Shiratuddin PhD , Oystein Tronstad BPhty , John F. Fraser PhD, FCIM , Matthew Olsen PhD , Lotti Tajouri PhD , Kok Wai Wong PhD
{"title":"Do virtual reality interventions cause seizures in the critically ill? A rapid review","authors":"Adrian Goldsworthy DPT , Mohd Fairuz Shiratuddin PhD , Oystein Tronstad BPhty , John F. Fraser PhD, FCIM , Matthew Olsen PhD , Lotti Tajouri PhD , Kok Wai Wong PhD","doi":"10.1016/j.aucc.2025.101231","DOIUrl":"10.1016/j.aucc.2025.101231","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this research was to investigate if the use of virtual reality, increasingly utilised within intensive care medicine due to its demonstrated benefits in improving pain and anxiety, has been reported to result in seizures.</div></div><div><h3>Review method used</h3><div>A rapid systematic review and synthesis of qualitative and quantitative data was performed.</div></div><div><h3>Data sources</h3><div>Five databases (PubMed, Scopus, EMBASE, PsycInfo, and CINAHL) were systematically searched. An additional gray literature search was also conducted. Articles were restricted to those published on or after January 1st, 2014.</div></div><div><h3>Review methods</h3><div>The number of participants, virtual reality sessions, and length of sessions was undertaken. Subgroup analysis was undertaken for both adult and paediatric patient populations. An additional subgroup analysis was undertaken on articles which did not exclude individuals with a history of epilepsy. A tailored risk-of-bias assessment was conducted.</div></div><div><h3>Results</h3><div>Of the 563 articles identified through database and gray literature searching, 27 articles met inclusion criteria. A total of 886 patients have been reported within the literature with a combined 1843 virtual reality sessions, totalling more than 614.64 h of virtual reality. No seizures have been reported within intensive care patients receiving virtual reality interventions.</div></div><div><h3>Conclusions</h3><div>Historically, individuals with a history of epilepsy and photosensitivity have been commonly excluded from interventions and clinical trials involving virtual reality. The results of this systematic review demonstrate that the risk of virtual reality is minimal when utilised appropriately. A history of photosensitivity or epilepsy should not constitute an absolute contraindication for the use of virtual reality. Instead, clinicians should utilise clinical judgement when evaluating a patient's risk and ensure that appropriate visual experiences are utilised which do not unnecessarily strobe the patient.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101231"},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815276","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}
Peter Andrew Lioufas MBBS(Hons), MTrauma, GradDipSurgAnat , Hannah Rotherham MBBS, MHSM, FCICM , Kellie Gumm MA, GradDipHIthProm, CertICU, DipNursing , Roselyn Santos BSc, MComp , David J. Read MBBS, MEpid Distinct, FRACS , Daryl Jones MBBS BSc(Hons), MD, PhD, FRACP, FCICM , Jeffrey Presneill MBBS, PhD, MBiostat, FRACP, FCICM
{"title":"A retrospective cohort study of Medical Emergency Team events amongst adult trauma patients","authors":"Peter Andrew Lioufas MBBS(Hons), MTrauma, GradDipSurgAnat , Hannah Rotherham MBBS, MHSM, FCICM , Kellie Gumm MA, GradDipHIthProm, CertICU, DipNursing , Roselyn Santos BSc, MComp , David J. Read MBBS, MEpid Distinct, FRACS , Daryl Jones MBBS BSc(Hons), MD, PhD, FRACP, FCICM , Jeffrey Presneill MBBS, PhD, MBiostat, FRACP, FCICM","doi":"10.1016/j.aucc.2025.101226","DOIUrl":"10.1016/j.aucc.2025.101226","url":null,"abstract":"<div><h3>Background</h3><div>The clinical associations of patient deterioration necessitating a Medical Emergency Team (MET) response have been studied in several types of hospital patient cohorts. However, there is limited information on MET events in the Australasian trauma population.</div></div><div><h3>Methods</h3><div>A retrospective patient cohort study was conducted through merger of the Royal Melbourne Hospital trauma and MET registries between July 1st, 2018, and December 31st, 2022. Data included patient demographics, MET events, selected trauma characteristics, and hospital survival. These data were summarised using standard descriptive statistics and univariable tables, along with a multivariable logistic regression model using hospital mortality as the dependent variable. Ethics approval was obtained (QA2022121) as per the institutional policy.</div></div><div><h3>Results</h3><div>There were 20 815 trauma admissions involving 20 111 individual patients. Overall, MET events occurred in 6% of admissions and were more common within major trauma patients. Overall, hospital mortality occurred in 2% of admissions, distributed as 7.1% major and 0.3% nonmajor trauma. Mortality for patients attended by at least one MET response was 5.9% overall but 9.0% in cases of major trauma. Within a multivariable logistic model accounting for clustered observations within individuals, MET events considered together were strongly associated with hospital mortality (odds ratio [OR]: 3.7 [95% confidence interval {CI}: 2.6–5.3]), as were advanced patient age (OR ≥ 24) and the presence of major trauma (OR: 11 [95% CI: 7.8–17]). MET events triggered by a systolic blood pressure <90 mmHg showed the strongest independent association with subsequent in-hospital mortality (OR: 7.5 [95% CI: 4.2–13]), whereas those triggered by heart rates >130 bpm showed the least association (OR: 1.4 [95% CI: 0.61–3.1]).</div></div><div><h3>Conclusion</h3><div>MET events occurred in 6% of adult trauma centre patients, more commonly in the presence of major trauma. While patient age and trauma severity were each strong independent predictors of hospital mortality, there was substantial heterogeneity in the clinical implications of MET events according to the type of underlying physiological disturbance.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101226"},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815275","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":"Long-term outcomes following a rapid response team attendance","authors":"Krishnaswamy Sundararajan MD, MPH, FCICM, MPhil, MHA, FRACMA , Toby Gilbert MB BCh, BAO, MHSM, MRCPI, FRACP , Alice O'Connell MBBS, FRACP, PhD , Arthas Flabouris MD, FCICM, FANZCA","doi":"10.1016/j.aucc.2025.101221","DOIUrl":"10.1016/j.aucc.2025.101221","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to describe the long-term results of patients needing a rapid response team (RRT) call at a university-affiliated Australian hospital that accepts quaternary referrals.</div></div><div><h3>Methods</h3><div>An observational study to evaluate the database of RRT for inpatients aged ≥16 years was linked to a population registry of deaths (July 2013–July 2021). Outcomes were 96-month cumulative survival, RRT call, hospital and posthospital (the period beyond hospital stay associated with RRT call) mortality, and trend over time.</div></div><div><h3>Results</h3><div>There were 31 447 calls to 17 349 inpatients, of whom 9274 (53.5%) were males, with a median age of 72 (interquartile range: 57–83) years. At the 96-month census point, 9317 (53.7%) patients were alive. Of the 8032 who died, 204 (2.5%) died at RRT call, 2262 (28.1%) at hospital discharge, and 5570 (69.3%) died following hospital discharge. A total of 5470 (68.1%) patients had died within 12 months of RRT call. Compared with general population deaths, RRT patients died younger (median age: 79 vs 88 years), were more likely to die in a hospital (54.6% vs 41.7%), and were less likely to die in a private location (11.9% vs 18.8%).</div></div><div><h3>Discussion</h3><div>Survival duration varied by RRT trigger, with the least duration observed for cardiac arrest, followed by oxygen desaturation and tachypnoea. Lesser survival duration was also observed for male patients, medical admissions, patients with multiple calls, and those with a not-for-resuscitation order. Mortality decreased over the study period, whilst the RRT dose increased.</div></div><div><h3>Conclusions</h3><div>Most deaths occur within 12 months of an index RRT call and following hospital discharge. RRT patients die at a younger age than the general population. Cumulative survival varied by RRT trigger and improved over time.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101221"},"PeriodicalIF":2.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yujin Park MSN, RN , Sun Ju Chang PhD, RN , Eunhye Kim PhD, RN
{"title":"Artificial intelligence in critical care nursing: A scoping review","authors":"Yujin Park MSN, RN , Sun Ju Chang PhD, RN , Eunhye Kim PhD, RN","doi":"10.1016/j.aucc.2025.101225","DOIUrl":"10.1016/j.aucc.2025.101225","url":null,"abstract":"<div><h3>Background</h3><div>The integration of artificial intelligence (AI) into health care has been rapidly advancing, driven by its potential to enhance nursing care quality through improved decision-making and efficiency. Within critical care nursing, where the complexity and urgency of patient data are paramount, AI technologies offer significant advantages, such as enhanced patient monitoring and support in clinical decision-making.</div></div><div><h3>Aim/objective</h3><div>The aim of this scoping review was to synthesise existing literature on AI applications in critical care nursing and their impact on patient outcomes and nursing practice.</div></div><div><h3>Methods</h3><div>Following Arksey and O'Malley's framework, we conducted a systematic search across seven electronic databases including PubMed, CINAHL, and Embase. Studies were included if they involved AI applications in critical care nursing or reported on AI's impact on patient outcomes and clinical decision-making in critical care settings. A synthesis of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist.</div></div><div><h3>Results</h3><div>Thirty-five studies that addressed this topic were included. The review identified six distinct domains of AI applications: monitoring, nursing intervention, clinical decision support systems, documentation, resource allocation, and predictive analytics. Predictive analytics emerged as the most prevalent application, particularly in forecasting complications such as pressure injuries and sepsis onset. Notably, narrowly focussed AI applications demonstrated superior performance compared to broader applications in clinical decision support systems, particularly in specific tasks like neonatal pain classification. AI-driven documentation systems showed promise in reducing administrative burden and improving accuracy, while resource allocation tools enhanced staffing optimisation and workflow management in intensive care units.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate AI's significant potential to enhance critical care nursing practice while highlighting implementation challenges. Future research should focus on developing standardised implementation strategies and clear guidelines for AI integration in nursing workflow while maintaining the balance between technological advancement and human expertise.</div></div><div><h3>Registration</h3><div>Open Science Framework Registries <span><span>http://osf.io/t2y43/</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101225"},"PeriodicalIF":2.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768348","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}
Hanmei Peng RN, MSN , Jing Shi MD, PhD , Jun Tang MD, PhD , Ying-Xin Li RN, MSN , Xia Li RN, MSN , Xuemei Guo RN, BSN , Meizhu Lu MD, PhD , Xingli Wan RN, PhD , Biru Luo RN, PhD , Mei Rosemary Fu RN, PhD , Yuan Li RN, PhD , Yanling Hu RN, MBA
{"title":"Outcome reporting in neonatal septic shock studies: A systematic review","authors":"Hanmei Peng RN, MSN , Jing Shi MD, PhD , Jun Tang MD, PhD , Ying-Xin Li RN, MSN , Xia Li RN, MSN , Xuemei Guo RN, BSN , Meizhu Lu MD, PhD , Xingli Wan RN, PhD , Biru Luo RN, PhD , Mei Rosemary Fu RN, PhD , Yuan Li RN, PhD , Yanling Hu RN, MBA","doi":"10.1016/j.aucc.2025.101227","DOIUrl":"10.1016/j.aucc.2025.101227","url":null,"abstract":"<div><h3>Objectives</h3><div>Neonatal septic shock is a critical condition requiring immediate and individualised intervention. Despite extensive research, there is a significant heterogeneity in outcome reporting across studies which may lead to incomparability of study results and limit evidence synthesis. The aim of this systematic review was to identify and analyse outcomes reported in studies focussing on interventions for neonatal septic shock to inform the development of a core outcome set to standardise outcome reporting for future research and practice.</div></div><div><h3>Methods</h3><div>We conducted this systematic review following the Core Outcome Measures in Effectiveness Trials initiative framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched PubMed, Embase (Ovid), and the Cochrane Library, covering all records until September 2024. Four independent reviewers performed literature screening and data extraction, with disagreements resolved by consensus among two additional reviewers. Extracted outcomes and their definitions were standardised and categorised into core areas and domains using a 38-item standardised taxonomy.</div></div><div><h3>Results</h3><div>From 7139 records, 25 studies involving 4957 neonates were included, yielding 136 outcomes. After consolidation, 66 unique outcomes were identified and classified into four core areas based on the established taxonomy. The most frequently reported area was physiological/clinical outcomes (72%, 18 of 25 studies), encompassing 32 outcomes. This was followed by death (68%, 17/25), resource use (48%, 12/25), and adverse events (36%, 9/25). In addition, outcomes related to life impact were not measured in the included studies.</div></div><div><h3>Conclusions</h3><div>This review demonstrates considerable heterogeneity in outcome reporting across neonatal septic shock studies and highlights the absence of life impact measures. These findings support the need for developing a standardised core outcome set to enhance outcome reporting consistency and clinical relevance.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101227"},"PeriodicalIF":2.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777671","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}
Isabelle de Almeida Souza BN , Asiya Shalova BN , Nayane Maria Vieira MN, João Carlos Clark Barros BN, Gustavo Martins Ferreira BN, Paula Schmidt Azevedo PhD, Bertha Furlan Polegato PhD, Leonardo Antônio Mamede Zornoff PhD, Sérgio Alberto Rupp de Paiva PhD, Taline Lazzarin BN, Marcos Ferreira Minicucci PhD
{"title":"Respiratory rate–oxygenation index and National Early Warning Score 2 score are associated with orotracheal intubation in patients with cardiogenic pulmonary oedema","authors":"Isabelle de Almeida Souza BN , Asiya Shalova BN , Nayane Maria Vieira MN, João Carlos Clark Barros BN, Gustavo Martins Ferreira BN, Paula Schmidt Azevedo PhD, Bertha Furlan Polegato PhD, Leonardo Antônio Mamede Zornoff PhD, Sérgio Alberto Rupp de Paiva PhD, Taline Lazzarin BN, Marcos Ferreira Minicucci PhD","doi":"10.1016/j.aucc.2025.101222","DOIUrl":"10.1016/j.aucc.2025.101222","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluates the association between the respiratory rate–oxygenation (ROX) index and the National Early Warning Score 2 (NEWS2) score with orotracheal intubation (OTI) and in-hospital mortality in patients with cardiogenic pulmonary oedema (CPE).</div></div><div><h3>Methods</h3><div>This retrospective observational study enrolled patients aged 18 years or older who had developed CPE at admission or during hospital stay. Demographic, clinical, and laboratory data were collected within the first 24 h of CPE onset from the electronic records. The outcomes needed for OTI during 24 h after CPE diagnosis and in-hospital mortality were also collected. The ROX index and NEWS2 were calculated using variables collected at CPE occurrence.</div></div><div><h3>Results</h3><div>Two hundred eighty-six patients with CPE were evaluated; however, 68 patients were excluded due to the absence of variables to calculate the ROX index. Thus, we included 218 patients in the analysis. The mean age was 67.8 ± 14.0 years, 51.8% were female, the median of the ROX index was 9.29 (6.06–13.05), and the median of the NEWS2 was 10.0 (7.0–12.0). Amongst these patients, 28.0% needed OTI 24 h after CPE and 30.3% died. In univariate analysis, lower values of the ROX index and higher values of the NEWS2 were associated with OTI. There was no association with mortality. In logistic regression models, the ROX index and NEWS2 were associated with OTI when adjusted by smoking, time of CPE, and endovenous nitrate and morphine (ROX index: odds ratio [OR] = 0.908, 95% confidence interval [CI] = 0.843–0.979, p = 0.012; NEWS2: OR = 1.261, 95% CI = 1.049–1.514, p = 0.013) and when adjusted by age, sex, and time of CPE (at admission or during hospital stay; ROX index: OR = 0.909, 95% CI = 0.847–0.976, p = 0.008; NEWS2: OR = 1.190, 95% CI = 1.015–1.396, p = 0.032).</div></div><div><h3>Conclusions</h3><div>The ROX index and NEWS2 were associated with OTI in CPE despite no association with mortality.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101222"},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724252","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}
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