Nursing in Critical Care最新文献

{"title":"Family Presence During Invasive Procedures or Resuscitation, Nurse Perception and Preparedness Questionnaire (FPDIP/R-NPPQ): A Validity and Reliability Study.","authors":"Davide Bartoli, Francesca Trotta, Mariachiara Figura, Marco Di Muzio, Daniele Napolitano, Marco Fatata, Gianluca Pucciarelli, Francesco Petrosino","doi":"10.1111/nicc.70470","DOIUrl":"10.1111/nicc.70470","url":null,"abstract":"<p><strong>Background: </strong>Family presence during invasive procedures and resuscitation (FPDIP/R; FPDR) is increasingly advocated, yet no validated instrument assesses nurses' perceptions and preparedness including organisational readiness for implementation.</p><p><strong>Aim: </strong>To develop and psychometrically validate the FPDIP/R-NPPQ.</p><p><strong>Study design: </strong>A multicentre cross-sectional survey was conducted in three Italian hospitals (April-July 2024). Registered nurses (N = 212) completed a study-specific instrument initially comprising 52 items; psychometric analyses were performed on 37 Likert-type items. We applied a two-step strategy: exploratory factor analysis (EFA; parallel analysis, principal axis factoring, oblimin rotation, marker-index screening) followed by confirmatory factor analysis (CFA) using robust maximum likelihood for ordinal/non-normal data. Reliability was estimated via McDonald's ω. A grant from the Center of Excellence for Nursing Scholarship, Rome, March 2025, is funding this research.</p><p><strong>Results: </strong>EFA supported a 19-item, three-factor solution explaining 57.47% of variance: (1) emotional value and relational benefits of family presence (5 items); (2) communication skills and structured management (6 items); and (3) operational support through a dedicated staff member (8 items). CFA confirmed good fit (RMSEA = 0.05, 90% CI 0.04-0.06; CFit = 0.36; CFI = 0.93; TLI = 0.92; SRMR = 0.07), with standardised loadings ranging 0.24-0.92 and ω = 0.82-0.87 across factors. Model refinement improved fit without permitting cross-loadings, preserving construct distinctiveness while accounting for localised method effects.</p><p><strong>Conclusions: </strong>The FPDIP/R-NPPQ is a valid and reliable 19-item, three-factor instrument measuring nurses' readiness for family presence during invasive procedures and resuscitation. By distinguishing attitudes towards family presence, communication/management preparedness and organisational readiness (including the facilitator role), the tool enables services to identify implementation barriers and to plan targeted training and governance strategies prior to adopting FPDR/FPDIP policies.</p><p><strong>Relevance to clinical practice: </strong>The FPDIP/R-NPPQ supports clinical governance by providing actionable subscale profiles to guide implementation of FPDIP/R. It can be used to baseline readiness across units, identify specific training and protocol needs and inform organisational decisions such as the allocation of a trained family facilitator, thereby supporting safer and more standardised family presence practices during critical procedures.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70470"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624704","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}

{"title":"Correction to 'Impact of Music Therapy on Patients in the Critical Care Unit: A Qualitative Study'.","authors":"","doi":"10.1111/nicc.70442","DOIUrl":"10.1111/nicc.70442","url":null,"abstract":"","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70442"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476298","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":"Between Compassion and Capacity: Intensive Care Units Nurses' Perceptions on Family-Centred Visiting in China.","authors":"Jiaying Xie, Lan Cao, Nina Wang, Guo Chen, Na Wu, Hanyang Su","doi":"10.1111/nicc.70502","DOIUrl":"https://doi.org/10.1111/nicc.70502","url":null,"abstract":"<p><strong>Background: </strong>Family-centred visiting (FCV) has become an integral element of humane and holistic intensive care in many Western settings. However, its adoption in Chinese ICUs remains limited, and the perspectives of nurses, who are central to implementing visiting policies, are underexplored.</p><p><strong>Aim: </strong>To explore ICU nurses' attitudes and perceptions towards FCV and identify impact factors influencing its potential implementation in China.</p><p><strong>Study design: </strong>This study employed a descriptive qualitative design. Twenty ICU nurses were recruited through purposive sampling from a tertiary hospital in Hunan Province, China. Semi-structured, face-to-face interviews were conducted between March and June 2024. Data were analysed using Colaizzi's seven-step method. The reporting followed COREQ guidelines.</p><p><strong>Results: </strong>Three overarching themes were identified: (1) balancing compassion and capacity, (2) the Family presence as a double-edged sword for patient care and (3) institutional and cultural constraints on family involvement. While nurses acknowledged FCV's emotional benefits, they expressed concern about increased workload, infection risk and blurred professional boundaries. Their attitudes were strongly shaped by hierarchical institutional norms and Confucian values, which both encourage filial duty and reinforce deference to medical authority.</p><p><strong>Conclusions: </strong>ICU nurses' ambivalence towards FCV reflects a complex interplay of professional, institutional and cultural factors. Culturally sensitive training, policy reform and pilot programmes could support the gradual implementation of flexible visiting practices.</p><p><strong>Relevance to clinical practice: </strong>Findings highlight the need for context-adapted FCV models that balance humanised care with safety and capacity, empowering nurses as key facilitators of family engagement.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70502"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845938","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":"Environmental Sustainability Perspectives Among Critical Care Professionals: A Qualitative Systematic Review and Meta-Synthesis.","authors":"Xingyun Shen, Xu Wen, Chenjing Wang, Fengtian Liu, Xianghong Sun","doi":"10.1111/nicc.70487","DOIUrl":"10.1111/nicc.70487","url":null,"abstract":"<p><strong>Background: </strong>Intensive care units (ICUs) generate substantial emissions and waste, yet qualitative evidence on ICU professionals' perspectives on environmental sustainability remains limited.</p><p><strong>Aims: </strong>To examine and synthesise qualitative evidence on intensive care professionals' perspectives and views regarding environmental sustainability.</p><p><strong>Study design: </strong>A qualitative meta-synthesis. A systematic search of English and Chinese databases (PubMed, Web of Science, CINAHL, Embase, Cochrane Library, Scopus, CNKI, Wanfang Data, VIP Information and CBM) was conducted from inception to 15 October 2025. Methodological quality was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative findings were extracted and synthesised using meta-aggregation.</p><p><strong>Findings: </strong>Seven studies met the inclusion criteria. Three themes were identified: (a) the inherent characteristics of the ICU setting, (b) barriers to implementing sustainable practices in intensive care units and (c) strategies for implementing sustainable practices in intensive care units.</p><p><strong>Conclusion: </strong>The ICU environment presents distinctive challenges to advancing sustainable critical care, and professionals face multiple, interrelated barriers in everyday practice. Targeted, systematic and context-sensitive strategies are needed to reduce the environmental impact of ICUs while supporting safe, sustainable ('green') intensive care.</p><p><strong>Relevance to clinical practice: </strong>This review supports integrating sustainability into ICU education and routine workflows, strengthening multidisciplinary collaboration and implementing practical unit-level protocols (e.g., greener procurement and standardised waste segregation) to advance a 'green ICU' without compromising patient safety.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70487"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730472","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":"Assessment Tools for Cognitive Impairment in Critically Ill Patients Post-ICU Transfer: A Comparative Study.","authors":"Li Yao, Qinqin Li, Wenting Yang, Weigang Yue, Liping Yang, Tingrui Wang, Yan Liu, Zhigang Zhang, Yinhua Wang","doi":"10.1111/nicc.70455","DOIUrl":"10.1111/nicc.70455","url":null,"abstract":"<p><strong>Background: </strong>Although the survival rates of patients in the Intensive Care Unit (ICU) have improved, cognitive impairments following ICU discharge continue to be a significant concern, directly impacting long-term rehabilitation and quality of life. Consequently, the research and implementation of effective assessment tools for these cognitive impairments are particularly critical.</p><p><strong>Aim: </strong>The aim of this study was to evaluate the comparative effectiveness of the Montreal Cognitive Assessment (MoCA) and the Telephone Interview for Cognitive Status-modified (TICS-m) for assessing cognitive impairment in critically ill individuals after leaving the ICU.</p><p><strong>Study design: </strong>Using convenience sampling, we recruited ICU patients admitted from January 2021 to November 2022 at a hospital in China. We assessed their cognitive status using the MoCA and TICS-m scales on the day of hospital discharge, comparing the efficacy of the two scales in identifying cognitive impairment after ICU and analysing their correlation.</p><p><strong>Results: </strong>A total of 396 patients were recruited for the study. The total scores of MoCA and TICS-m scales were 24.73 ± 4.64 and 33.20 ± 8.38, respectively, showing a correlation of r = 0.570 (p < 0.001). The incidence of cognitive impairment as assessed by the MoCA was 41.4%, compared to 44.2% for the TICS-m, with no significant difference between the two (χ² = 1.571, p = 0.152). 51.01% of ICU patients were assessed with normal cognitive function on both MoCA and TICS-m scales, whereas 36.62% were assessed with cognitive impairment on both MoCA and TICS-m scales. The Kappa consistency test results showed a value of 0.747, p < 0.001. The sensitivity of the TICS-m scale compared to the MoCA scale is 0.884, specificity is 0.871, positive predictive value is 0.829, and negative predictive value is 0.914.</p><p><strong>Conclusions: </strong>Both the MoCA and TICS-m scales demonstrated strong consistency and reliability in assessing cognitive impairment among ICU patients. The TICS-m scale, with its telephone questionnaire format, enables effective follow-up on patients' cognitive status post-ICU.</p><p><strong>Relevance to clinical practice: </strong>Given the efficacy of the TICS-m scale in detecting cognitive dysfunction among critically ill patients post-discharge, it is recommended that healthcare professionals incorporate its use for the ongoing assessment of cognitive function in patients following their discharge from the ICU. Future research could assess the scale's predictive value across different clinical settings.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70455"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576534","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":"ICU Nurses' Perspectives on Artificial Intelligence in Adult Intensive Care Units: Knowledge, Attitudes and Job-Security Concerns.","authors":"Zahra Ahmed Sayed, Rafi Alnjadat, Alia Khwaldeh, Laith Mahmoud Mohammad Alqudah","doi":"10.1111/nicc.70477","DOIUrl":"10.1111/nicc.70477","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is increasingly integrated into healthcare, particularly in adult intensive care units (ICUs), yet nurses' knowledge, attitudes and concerns regarding AI remain insufficiently examined. This study aimed to assess ICU nurses' AI-related knowledge, attitudes and job-related concerns, and to explore associations among these variables.</p><p><strong>Aim: </strong>To assess ICU nurses' knowledge of artificial intelligence, attitudes towards its use in healthcare and job-related concerns, and to examine the relationships among these variables.</p><p><strong>Study design: </strong>A descriptive cross-sectional study was conducted among adult ICU nurses recruited through convenience sampling from five hospitals in Irbid, Jordan, between February and April 2025.</p><p><strong>Results: </strong>Of the 105 eligible nurses invited, 91 completed the questionnaire and were included in the analysis. AI knowledge ranged from limited to moderate (mean 4.18 ± 1.50). Attitudes towards AI were moderately positive (57.95 ± 11.45), while job security concerns were moderate (18.1 ± 4.5; 95% CI: 17.2-19.0). Greater factual knowledge of AI concepts was significantly associated with more positive attitudes (r = 0.366, p < 0.001) and lower job security concerns (r = -0.302, p = 0.004). Attitudes were inversely associated with job security concerns (r = -0.275, p = 0.008).</p><p><strong>Conclusions: </strong>ICU nurses showed positive attitudes towards AI despite limited technical knowledge. Associations with job-related concerns highlight the need for targeted education and further multisite research on AI readiness in critical care.</p><p><strong>Relevance to clinical practice: </strong>Structured AI literacy programmes, ethical governance frameworks and nurse involvement in AI implementation planning are essential to promote safe and balanced AI integration in adult critical care settings.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70477"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647358","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":"Influence of Music on Cortisol Levels in Mechanically Ventilated Critically Ill Patients: A Systematic Review.","authors":"Carmen Fernández-Álvarez, David Zuazua-Rico, M Pilar Mosteiro-Díaz, Alba Maestro-González","doi":"10.1111/nicc.70475","DOIUrl":"10.1111/nicc.70475","url":null,"abstract":"<p><strong>Background: </strong>Music has been proposed as a simple, non-invasive intervention to modulate stress responses in patients undergoing invasive mechanical ventilation (IMV). Its potential impact on cortisol levels represents a promising approach to mitigating physiological stress in intensive care.</p><p><strong>Aim: </strong>To examine the effectiveness of music interventions in reducing cortisol levels and, consequently, modulating the stress response in mechanically ventilated patients in intensive care units (ICUs).</p><p><strong>Study design: </strong>A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD42023409196). Five electronic databases were searched without date restrictions. Eligible studies were randomised controlled trials (RCTs) assessing music interventions in adult patients receiving IMV, with serum cortisol as the primary outcome. Risk of bias was assessed using the Cochrane RoB 2 tool. Owing to substantial heterogeneity, findings were synthesised narratively.</p><p><strong>Results: </strong>Five RCTs (n = 208) met the inclusion criteria. Three reported significant reductions in cortisol following music interventions, while two found no differences. Variability in music type, intervention duration, sedation status and measurement timing contributed to inconsistent results. Risk of bias was low in two studies, whereas three were rated as raising some concerns.</p><p><strong>Conclusions: </strong>Current evidence on the effect of music on cortisol in mechanically ventilated patients is limited and inconsistent. Findings remain contradictory, preventing firm conclusions about efficacy. Future multicentre trials with standardised protocols and rigorous control of confounders are required.</p><p><strong>Relevance to clinical practice: </strong>This review highlights a major gap in evidence regarding the biological impact of music in IMV patients. Results from five small, heterogeneous RCTs are inconclusive, and some of them are limited by methodological concerns. Thus, current evidence is insufficient to support changes in clinical practice. While music remains a low-risk intervention of interest, its actual effect on physiological stress has yet to be demonstrated. Large-scale, high-quality studies are needed before clinical recommendations can be made.</p><p><strong>Systematic review registration: </strong>PROSPERO ID: CRD42023409196.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70475"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634961","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}

{"title":"Not Just Visitors: A Sibling's Story.","authors":"Jessica Smith","doi":"10.1111/nicc.70498","DOIUrl":"https://doi.org/10.1111/nicc.70498","url":null,"abstract":"","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70498"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788534","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":"Best Evidence Summary: Communication Strategies for Implementing Palliative Care in Adult ICUs.","authors":"Shangrong Luo, Tianju Dong, Wenyi Yu, Peng Li, Meng Rao","doi":"10.1111/nicc.70501","DOIUrl":"https://doi.org/10.1111/nicc.70501","url":null,"abstract":"<p><strong>Background: </strong>The integration of palliative care in the Intensive Care Unit (ICU) is crucial for mitigating end of life suffering and upholding patient autonomy. However, effective implementation is often hampered by communication challenges. This review aims to synthesise the best evidence on communication strategies to facilitate palliative care in the ICU.</p><p><strong>Aim: </strong>To integrate the best evidence on communication strategies for palliative care in ICU patients and to establish an evidence-based foundation for standardising-related practices in critical care settings.</p><p><strong>Study design: </strong>A systematic search was conducted across multiple databases and platforms including UpToDate, BMJ Best Practice, Joanna Briggs Institute (JBI), Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), PubMed, Web of Science, Embase, Cochrane Library and CINAHL. Eligible study designs included clinical practice guidelines, evidence summaries, clinical decision support systems, expert consensus publications and systematic reviews related to palliative care communication in the ICU. The search period was from database inception to December 2024. Two independent researchers trained in evidence-based methodology conducted literature screening, quality assessment and evidence synthesis. Standardised appraisal tools were used for critical appraisal.</p><p><strong>Results: </strong>Fourteen publications were included: three clinical practice guidelines, two evidence-based guidelines and nine systematic reviews. Thirty-four evidence-based recommendations were synthesised across seven key domains: (1) Structured family conferences, (2) Patient value assessment and shared decision-making, (3) Prognostic information disclosure, (4) Written materials and bereavement support, (5) Ethics consultation services, (6) Multidisciplinary team collaboration and (7) Clinician communication training. The evidence hierarchy followed the JBI evidence classification system.</p><p><strong>Conclusion: </strong>Effective communication strategies encompassing multiple domains are essential for facilitating palliative care in the ICU, addressing the complex needs of critically ill patients and their families.</p><p><strong>Relevance to clinical practice: </strong>For clinical practice, this review advocates translating evidence into action by standardising family conferences and integrating multidisciplinary teamwork, thereby enhancing the quality of palliative care communication, respecting patient autonomy and offering sustained support to families in critical care settings.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70501"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788702","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":"Machine Learning Interpretability to Assess the Association Between Time in Tight Range and Mortality in Cardiogenic Shock.","authors":"Yang Jiang, Qing-Lin Li, Yan-Ling Huang, Yi-Le Ning, Li-Hua Chen, Yu Zhang, Xiang-Hui Xu","doi":"10.1111/nicc.70469","DOIUrl":"10.1111/nicc.70469","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiogenic shock (CS) is a critical condition of end-organ hypoperfusion with high mortality. Fluctuations in blood glucose (BG) levels may exacerbate cardiovascular instability in critically ill patients. Time In Tight Range (TITR), defined as the percentage of time in the target BG range of 3.9-7.8 mmol/L (70-140 mg/dL), has become an increasingly important index of glycaemic status, but its impact on mortality in CS remains unclear. Interpretable machine learning (ML) models provide transparent, quantitative and visual insights into the prognostic importance of TITR, clarifying its pivotal role in outcome prediction and providing objective evidence to support individualised glucose management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This study aimed to investigate the relationship between TITR and mortality in patients with CS, and to provide strong evidence for early intervention and personalised blood glucose management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a retrospective multi-cohort study to examine the association between TITR and mortality in patients with CS. The relationship between TITR and in-hospital mortality was analysed using a restricted cubic spline (RCS) model, log-rank test, multivariable Cox and logistic regression analyses. ML models, including XGBoost, LightGBM, CatBoost, Gradient Boosting, Support Vector Machine (SVM), Neural Network and Naive Bayes, were developed to predict mortality and compared with traditional clinical scoring systems. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Sensitivity and subgroup analyses were used to reveal the robustness of the results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;RCS analysis revealed an inverse (L-shaped) association (p &lt; 0.001) between TITR and in-hospital mortality in both the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database (eICU) cohorts. Kaplan-Meier survival analyses revealed the patients with TITR &gt; 57% (High TITR group) had significantly lower in-hospital mortality than those with TITR ≤ 57% (Low TITR group) in both cohorts. The hazard ratios (HRs) (95% confidence interval [CI]) estimated by log-rank test were 1.72 (1.49, 1.99) and 1.49 (1.19, 1.87) in the MIMIC-IV and eICU cohorts, respectively (both p &lt; 0.001). Sensitivity analyses yielded consistent results, confirming the robustness of the findings. In addition, analyses of ICU mortality, 28-day mortality (only available in the MIMIC-IV cohort), also demonstrated a consistent pattern with the primary outcome. Based on area under curve values (AUC), ML models, including CatBoost (AUC = 0.76; 95% CI: 0.73-0.80 in MIMIC-IV; 0.77; 95% CI: 0.72-0.83 in eICU), Gradient Boosting (AUC = 0.75; 95% CI: 0.72-0.79 and 0.74; 95% CI: 0.68-0.80) and XGBoost (AUC = 0.74; 95% CI: 0.70-0.77 and 0.76; 95% CI: 0.71-0.82), outperformed traditional scoring systems. Interpretability analysis via SHAP consistently highlighte","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"31 3","pages":"e70469"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693662","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}