Australian Critical Care最新文献

{"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}

{"title":"Rationalising arterial blood gas sampling analysis in the intensive care unit: A before-and-after study","authors":"Aniket Nadkarni MBBS, FCICM ,&nbsp;Nihada Besic RN, MN ,&nbsp;Joannies Yap RN, BN ,&nbsp;Svatka Micik RN, PhD ,&nbsp;Lee-anne S. Chapple MNutDiet, PhD ,&nbsp;Emmanuel Gnanamanickam BCom, MPH, PhD ,&nbsp;Benjamin Reddi MA, PhD, FCICM ,&nbsp;Michael Farquharson MBBS, FCICM","doi":"10.1016/j.aucc.2025.101237","DOIUrl":"10.1016/j.aucc.2025.101237","url":null,"abstract":"<div><h3>Background</h3><div>Arterial blood gas (ABG) sampling is a frequent intensive care unit investigation with associated costs and labour burden. However, frequency of ABG sampling is not evidence based, and its use could be rationalised. Education strategies and other quality improvement methods can likely reduce ABG sampling, reducing cost, saving clinical time, and limiting the volume of blood drawn.</div></div><div><h3>Aim/objective</h3><div>The aim of this study was to determine whether a multimodal intervention would reduce unnecessary ABG sampling.</div></div><div><h3>Methods</h3><div>A single-centre before-and-after study was conducted from August 2021 to July 2022 in a 48-bed quaternary Australian intensive care unit. A multimodal intervention, including a visual cue, education sessions, and a clinical decision support tool, was introduced over 6 months. Data were compared between a 3-month preintervention and a 3-month postintervention period. Data were collected on baseline patient demographics, illness severity, admission diagnosis, length of stay, mortality, and the number of ABG samples collected. Analysis of changes in the blood volume drawn, clinical time required, and total cost were derived from simple calculations using the numbers of ABG samples analysed.</div></div><div><h3>Results</h3><div>The study included 1130 patients. Baseline variables in the preintervention and postintervention cohorts were comparable. The intervention was associated with nearly a 40% reduction in the rate of sampling (incident rate reduction: 0.61, 95% confidence interval: 0.54–0.70). This would yield an aggregate saving approximating 86 L of blood, 2400 h of clinical workload, and an estimated cost of $AUD 39 per patient/day.</div></div><div><h3>Conclusions</h3><div>A multimodal intervention to rationalise investigations reduced ABG sampling rates. The magnitude of this reduction confers notable reductions in the volume of blood drawn, repurposed clinical time, and financial savings.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101237"},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892149","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":"Recruitment and retention of intensive care unit survivors in follow-up studies: A systematic review","authors":"Beverley Ewens RN, PhD Bev,&nbsp;Vivien Kemp BA (Hons),&nbsp;Yvonne Middlewick RN, PhD,&nbsp;Amanda Towell-Barnard RN, DCur,&nbsp;Lisa Whitehead RN, PhD","doi":"10.1016/j.aucc.2025.101232","DOIUrl":"10.1016/j.aucc.2025.101232","url":null,"abstract":"<div><h3>Background</h3><div>Engaging intensive care unit survivors in research is challenging. Studies have reported recruitment and attrition rates; details are lacking on retention strategies and attrition.</div></div><div><h3>Objective</h3><div>The aim of this study was to explore barriers and enablers to recruitment and retention in research of people post intensive care discharge.</div></div><div><h3>Methods</h3><div>A convergent mixed-method review using the Joanna Briggs Institute (JBI) methodology considered studies that reported on recruitment, retention, and attrition rates of adult post–intensive care survivors in longitudinal studies. CINAHL Ultimate (CINAHL+), PubMed, Excerpta Medica Database (EMBASE), PsycINFO, Scopus, Proquest Health, and Medical Collection were searched in March 2024 using Medical Subject Headings terms and keywords related to post–intensive care survivors, patient selection, and research in peer-reviewed journals or theses published in English. Risk of bias was assessed with JBI's critical appraisal tools. Qualitative data were extracted and themed, and quantitative data were extracted using predefined data fields and qualitised. Synthesis was guided by the JBI mixed-method convergent integrated approach.</div></div><div><h3>Results</h3><div>A total of 1608 records were identified; 12 high-quality articles were included, with a total of 2551 participants. Studies focussed on outcome measures following hospital discharge to the community. Three superordinate and eight subordinate themes emerged: factors influencing participation/nonengagement, retention strategies, and researcher insights. Attrition was predominantly due to mortality or ill health. Non-health-related themes included transport difficulties, expense, and inconvenience. Challenges included symptoms triggered by participation, being unaware of appointments, and not understanding study requirements. Enabling strategies included reminder calls, letters, cards, and home visits. Researcher insights included the impact of critical illness on survivors’ wellbeing, finances, and communication challenges.</div></div><div><h3>Discussion</h3><div>Recruitment and retention strategies were under-reported. Person-centred approaches considering survivors’ challenges may increase recruitment and retention. Retention strategies should be evaluated to determine the impact on engagement or withdrawal from studies. The strong likelihood of attrition should be factored into sample size calculations to reduce risk of bias in longitudinal studies.</div></div><div><h3>Registration</h3><div>This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO [CRD42022315688]).</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101232"},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888075","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":"Australian clinical practice guideline for physical rehabilitation and mobilisation in adult intensive care units","authors":"Carol L. Hodgson PT, PhD ,&nbsp;Tessa Broadley BBiomedSc (Hons) ,&nbsp;Michelle Paton M.Phty, PhD ,&nbsp;Alisa M. Higgins MPH, PhD ,&nbsp;Shannah Anderson ,&nbsp;Sue Brennan PhD ,&nbsp;Catherine L. Granger BPhysio(Hons), PhD ,&nbsp;Naomi E. Hammond RN, PhD ,&nbsp;Sherene Magana Cruz ,&nbsp;Jenna K. Lang PhD ,&nbsp;I. Anne Leditschke MBBS ,&nbsp;Neil R. Orford FCICM, PhD ,&nbsp;Selina M. Parry B.Physio (Hons), PhD ,&nbsp;Bronwyn Price BPhty ,&nbsp;Pam Taylor ,&nbsp;Andrew A. Udy FCICM, PhD ,&nbsp;Sally E. Green PhD","doi":"10.1016/j.aucc.2025.101235","DOIUrl":"10.1016/j.aucc.2025.101235","url":null,"abstract":"<div><h3>Background</h3><div>The evidence base for research on physical rehabilitation and mobilisation in the intensive care unit has led to uncertainty about best practice.</div></div><div><h3>Objective</h3><div>The objective of this guideline was to develop evidence-based recommendations to support clinical decision-making for physical rehabilitation management of adults undergoing invasive mechanical ventilation in Australian intensive care units.</div></div><div><h3>Methods</h3><div>The guideline development group, comprising national representation of clinical experts, methodologists, and consumers, followed a rigorous process, adhering to Australian National Health and Medical Research Council Guidelines for Guidelines, to create the recommendations. The guideline development group determined the scope of the guideline and defined the key clinical question. A systematic review was conducted to evaluate all available evidence based on the predefined outcomes. Meta-analyses were performed using a restricted maximum likelihood approach, and results were summarised in an evidence profile. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was applied to evaluate the certainty of evidence, and the GRADE Evidence to Decision framework was used to formulate recommendations.</div></div><div><h3>Summary of recommendations</h3><div>Based on the evidence profile and GRADE Evidence to Decision framework, the group developed three conditional recommendations and 14 Good Clinical Practice statements to guide practice. The guideline provides conditional recommendations in favour of undertaking physical rehabilitation and mobilisation in adults receiving invasive mechanical ventilation in the intensive care unit whilst acknowledging the uncertainty of evidence. It was endorsed by four key professional organisations.</div></div><div><h3>Conclusion</h3><div>The recommendations within this guideline were developed following best methodological practice. Despite the overall low certainty of evidence, the resulting guideline provides support to clinical decision-making, facilitates the translation of research into practice, and enhances the reach and impact of clinical research. Additionally, the guideline development group identified evidence gaps that could be addressed by future research.</div></div><div><h3>Trial registration</h3><div>Not applicable.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101235"},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143881276","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}