Australian Critical Care最新文献

{"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 , L. Perry RN, PhD , 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, 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}

{"title":"Effectiveness of virtual reality on anxiety, pain, sleep quality, and post-traumatic stress disorder for critically ill patients in intensive care units: A systematic review and meta-analysis of randomised controlled trials","authors":"Shuying Lu RN, BS ,&nbsp;Yuanyuan Ji RN, MM ,&nbsp;Na Wang RN, BS ,&nbsp;Mengxian Ou RN, MSN ,&nbsp;Naqin Zhang RN, MSN ,&nbsp;Xiaoyu Wang RN, BS ,&nbsp;Mengqi Yan RN, BS ,&nbsp;Namuna Dallakoti RN, BS ,&nbsp;Ying Wu RN, PhD ,&nbsp;Jun Wang RN, MM","doi":"10.1016/j.aucc.2025.101233","DOIUrl":"10.1016/j.aucc.2025.101233","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to determine the effectiveness of virtual reality on anxiety, pain, sleep quality, and posttraumatic stress disorder in critically ill patients within intensive care units.</div></div><div><h3>Data sources</h3><div>The data sources included PubMed, EMBASE, Web of Science, CENTRAL, PsycINFO, and CINAHL DATA databases.</div></div><div><h3>Methods</h3><div>Two authors independently conducted the literature search and quality assessment process. The pooled results were calculated using the standardised mean difference (SMD) and its 95% confidence interval (CI) using the Review Manager software (Version 5.4).</div></div><div><h3>Results</h3><div>Ten randomised controlled trials published from 2020 to 2024 were included. Most of the studies were classified as having a low risk of bias or some concerns. The evidence certainty varied from low to moderate for the different outcomes. The pooled results indicated statistically significant effectiveness in anxiety (SMD: −0.46, 95% CI: −0.80 to −0.11, <em>P</em> = 0.01) and sleep quality (SMD: 0.66, 95% CI: 0.29–1.03, <em>P</em> &lt; 0.001) postintervention. No statistically significant effects were found for pain (SMD: −0.11, 95% CI: −0.79–0.57, <em>P</em> = 0.75) or posttraumatic stress disorder (SMD: −0.29, 95 % CI: −0.59–0.02, <em>P</em> = 0.06).</div></div><div><h3>Conclusions</h3><div>Virtual reality is practical for mitigating anxiety and enhancing sleep quality in critically ill patients within intensive care units; however, its effects on pain and posttraumatic stress disorder are nonsignificant. Virtual reality can broaden its utility and content within intensive care units by incorporating meditation, hypnosis, and cognitive behavioural strategies. Careful consideration should be given to the timing and frequency of virtual reality sessions for patients who are critically ill and unable to remain conscious.</div></div><div><h3>Implications for clinical practice</h3><div>Virtual reality is a promising complementary therapy in intensive care units. It can reduce anxiety and improve sleep quality. Still, its effects on pain and posttraumatic stress disorder are not significant, and future research should focus on optimising devices, expanding content, and selecting appropriate intervention timing and frequency.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101233"},"PeriodicalIF":2.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874120","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":"Daily prediction of next-day disease severity in critically ill patients: A prospective cohort study","authors":"Wenbo Zhang PhD ,&nbsp;Eline G.M. Cox MD, PhD ,&nbsp;Èmese R.H. Heijkoop MD, MSc ,&nbsp;Manon Klaver MD, MSc ,&nbsp;Peter H.J. van der Voort MD, PhD ,&nbsp;Harold Snieder PhD ,&nbsp;Gerton Lunter PhD ,&nbsp;Frederik Keus MD, PhD","doi":"10.1016/j.aucc.2025.101230","DOIUrl":"10.1016/j.aucc.2025.101230","url":null,"abstract":"<div><h3>Background</h3><div>Predictive models for intensive care unit (ICU) patients mainly focus on mortality, but short-term disease severity is more relevant for day-to-day decision-making.</div></div><div><h3>Aim</h3><div>The aim of this study was to develop and validate a daily prediction model for next-day disease severity in ICU patients.</div></div><div><h3>Methods</h3><div>Data from the Simple Intensive Care Studies-II prospective cohort study of acutely admitted critically ill adults, including data collected during the first 7 days of admission such as Sequential Organ Failure Assessment (SOFA) score–related measurements, were used to fit a mixed-effects logistic regression model for next-day deterioration. Deterioration was defined as a decline in the total (≥2) and organ-specific (≥1) SOFA scores. Performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis.</div></div><div><h3>Results</h3><div>A total of 1009 patients were included. The final predictive model for overall next-day deterioration included six predictors (the total SOFA score on the current day, the minimum value of arterial pH, Glasgow Coma Scale score, mean arterial blood pressure, mechanical ventilation, and its effect differing between the first and subsequent ICU days). The model achieved an AUC of 0.74 (95% confidence interval: 0.70−0.78). In the decision curve analysis, within probability thresholds of 0.2–0.5, the model showed a higher net benefit than did strategies of treating all patients or treating no patients. Organ-specific prediction models for next-day deterioration in respiration, cardiovascular, and renal function showed slightly better performance than the overall model (AUCs: 0.79, 0.79, and 0.81, respectively).</div></div><div><h3>Conclusions</h3><div>Daily prediction models can predict next-day disease severity in overall, respiration, cardiovascular, and renal function amongst ICU patients. They offer clinical benefits within a range of probability thresholds and could support decision-making for ICU physicians.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101230"},"PeriodicalIF":2.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868468","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}