Intensive and Critical Care Nursing最新文献

{"title":"From coping to conservation: understanding acoustic burden in ICU nursing – Letter on Song et al.","authors":"Tang Li, Tao Yu","doi":"10.1016/j.iccn.2025.104277","DOIUrl":"10.1016/j.iccn.2025.104277","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104277"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insensible water loss in Italian intensive care units: a nationwide survey on its integration into daily fluid balance and quantification practices","authors":"Francesco Baiguera ,&nbsp;Alessandro Tonelli ,&nbsp;Emma Bresciani ,&nbsp;Fabrizio Boe ,&nbsp;Floriana Pinto ,&nbsp;Alice Lavetti ,&nbsp;Simone Piva ,&nbsp;Nicola Latronico","doi":"10.1016/j.iccn.2025.104331","DOIUrl":"10.1016/j.iccn.2025.104331","url":null,"abstract":"<div><h3>Background</h3><div>Fluid balance monitoring is a common practice in intensive care units (ICUs) to assess the volemic status of critically ill patients. However, its accuracy is limited in estimating insensible water loss (IWL), a component that is difficult to quantify but potentially significant. Literature shows considerable heterogeneity in the methods used to estimate IWL, with limited standardisation.</div></div><div><h3>Aim</h3><div>To assess its use, a nationwide cross-sectional survey was conducted, targeting adult ICUs in Italy. The aim was to evaluate the extent to which IWL is included in daily fluid balance calculations and to describe the methods used for its estimation.</div></div><div><h3>Materials and methods</h3><div>The survey consisted of a 26-item questionnaire and was distributed via REDCap software from March 10, 2025 to April 10, 2025.</div></div><div><h3>Results</h3><div>Responses were obtained from 100 ICUs, of which 75 were included in the final analysis. Of these, 70.6 % reported including IWL in fluid balance assessments. Among these, 79 % used a specific formula, with the most frequently adopted being 0.5 ml/kg/hour (52 %). The main parameters considered in the calculation were body weight (83 %), body temperature (86.6 %), and type of ventilatory support (60.3 %). Furthermore, 73.6 % of respondents considered IWL to be moderately or extremely relevant.</div></div><div><h3>Conclusions</h3><div>Findings suggest that IWL is widely taken into account in clinical practice, although with heterogeneous approaches. Our results highlight the need for future physiological studies to standardise its estimation and improve the accuracy of fluid balance assessments in critically ill patients.</div></div><div><h3>Implications for clinical practice</h3><div>This paper underlines the lack of evidences and standardisation in IWL’s estimation. It provides available alternatives and foundation for further investigations.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104331"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From coping to conservation: Understanding acoustic burden in ICU nursing – Response to Li & Yu","authors":"Pyoung Jik Lee ,&nbsp;Ziwei Song","doi":"10.1016/j.iccn.2025.104309","DOIUrl":"10.1016/j.iccn.2025.104309","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104309"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotracheal tube cuff modifications for VAP prevention: Bridging evidence and clinical practice – Letter on Li S et al.","authors":"Rongyi Xu,&nbsp;Deyi Pan,&nbsp;Lisong Chen","doi":"10.1016/j.iccn.2025.104269","DOIUrl":"10.1016/j.iccn.2025.104269","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104269"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early enteral nutritional support and clinical outcomes in critically ill children: A scoping review","authors":"Marina Maffeo ,&nbsp;Gabriele Caggianelli ,&nbsp;Emanuele Buccione ,&nbsp;Valentina Vanzi ,&nbsp;Daniele Ciofi ,&nbsp;Mirco Gregorini ,&nbsp;Maurizio Zega ,&nbsp;Jacopo Fiorini","doi":"10.1016/j.iccn.2026.104336","DOIUrl":"10.1016/j.iccn.2026.104336","url":null,"abstract":"<div><h3>Background and aims</h3><div>Pediatric malnutrition, is defined as an imbalance between nutrient intake and requirements leading to cumulative energy, protein, or micronutrient deficits, is highly prevalent among critically ill children and negatively affects growth and recovery. Early enteral nutrition (EEN) is increasingly recognized as a key strategy to prevent or address malnutrition in pediatric intensive care units (PICUs). Although emerging evidence suggests that EEN improves clinical outcomes, uncertainty persists regarding its feasibility and impact in this population. This scoping review aimed to map existing evidence on the use of EEN in critically ill children, evaluate its effects on key clinical outcomes including mechanical ventilation duration, length of stay, and infection risk; and identify barriers and facilitators to its implementation in pediatric intensive care settings.</div></div><div><h3>Methods</h3><div>A scoping review was conducted following Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were performed in PubMed, Embase, Scopus, CINAHL, and the Cochrane Library. Studies were eligible if they involved children aged 1 month to 18 years and initiated enteral nutrition within 48 h of PICU admission. Keywords included child, critical illness, enteral nutrition, intensive care units, and pediatrics. Studies in English or Italian were included without date restrictions.</div></div><div><h3>Results</h3><div>Sixteen thousand seven hundred ninety-nine records were identified; 15,556 were screened after duplicates were removed, and 14 studies met inclusion criteria (USA n = 6; Asia n = 4; Africa n = 3; Europe n = 1). Most were cohort studies, with one randomized trial. EEN was consistently associated with shorter mechanical ventilation duration (5.86 ± 3.63 vs 11.96 ± 9.17 days, p = 0.002), reduced PICU and hospital length of stay (4 vs 11.5 days, p &lt; 0.001), and lower infection rates (16.7 % vs 41.1 %, p = 0.001). Barriers to EEN included hemodynamic instability, gastrointestinal intolerance, and procedural interruptions, while facilitators included multidisciplinary teamwork, nurse-led feeding protocols, and standardized nutritional guidelines.</div></div><div><h3>Conclusion</h3><div>EEN initiated within 24–48 h was generally associated with favorable clinical outcomes; however, evidence on feasibility and safety remains limited and heterogeneous. Strengthening nursing autonomy and implementing standardized feeding pathways may enhance timely nutrition delivery and support recovery in pediatric intensive care.</div></div><div><h3>Implications for clinical practice</h3><div>Pediatric intensive care nurses play a pivotal role in initiating and monitoring EEN. Empowering nurses through evidence-based feeding protocols and multidisciplinary education can promote timely nutrition delivery and improve recovery in critically ill children.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104336"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causes, characteristics and improvement strategies for delayed interventions during paediatric deterioration: A mixed methods systematic review","authors":"Shannon Cresham Fox ,&nbsp;Takawira C. Marufu ,&nbsp;Emma Popejoy ,&nbsp;Nicola Taylor ,&nbsp;Damien Roland ,&nbsp;Joseph C. Manning","doi":"10.1016/j.iccn.2025.104330","DOIUrl":"10.1016/j.iccn.2025.104330","url":null,"abstract":"<div><h3>Background</h3><div>Children are susceptible to deterioration due to compensatory mechanisms. Timely recognition and intervention are strongly associated with improved clinical outcomes, whereas delays elevate mortality risk. Failure to rescue (FtR), the inability to prevent death following deterioration, represents a critical safety concern, yet contributory factors and contextual characteristics remain inadequately synthesised.</div></div><div><h3>Aim</h3><div>Identify and evaluate causes, characteristics and improvement strategies associated with delayed intervention during paediatric clinical deterioration in hospitalised children.</div></div><div><h3>Methods</h3><div>A mixed-methods systematic review of five databases was conducted including studies on hospitalised children (0–18 years) reporting outcomes related to FtR (e.g. mortality), published after 2000. Rigour was ensured through PROSPERO registration (CRD420250651864) and appraisal checklists. Data were analysed using a convergent segregated approach.</div></div><div><h3>Results</h3><div>Fifty-two studies included 820,000 hospitalised children and 4.4 million clinical events were synthesised. Qualitative and quantitative findings resulted in three themes: recognition, escalation and response, with qualitative findings presenting insight into barriers associated with each stage (including unclear escalation pathways and training gaps). Whilst quantitative findings reported prevalence of delayed recognition, escalation and response with pervasive organisational factors contributing to delays (e.g. staffing). Younger children and children with medical complexity (CMC) were at increased risk, and global majority populations were disproportionately affected. Integrated synthesis showed delays stem from individual, organisational, and systemic factors, while experienced nurses play a critical role in timely intervention.</div></div><div><h3>Conclusion</h3><div>Individual, organisational and systemic factors contribute to delayed intervention. CMC and global majority populations were disproportionately affected. Findings highlight critical points of delay. Reporting participant characteristics (e.g. ethnicity, medical complexity) is essential to understand their impact upon deterioration pathways.</div></div><div><h3>Implications for clinical practice</h3><div>Nurses are pivotal in recognising and responding to deterioration, and should recognise high-risk groups. Awareness should translate into advocacy for early intervention.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104330"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Title language, culture and communication vulnerability – Response to Bloomer et al.","authors":"Laura Istanboulian ,&nbsp;Amy Freeman-Sanderson ,&nbsp;Praisy Rampogu ,&nbsp;Kelly Smith ,&nbsp;Karen Soldatić","doi":"10.1016/j.iccn.2025.104286","DOIUrl":"10.1016/j.iccn.2025.104286","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104286"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of family participants in randomized ICU clinical trials: A systematic review","authors":"Vanessa Debay ,&nbsp;Max Moghrabi ,&nbsp;Sebastian Barriga ,&nbsp;Michael Goldfarb","doi":"10.1016/j.iccn.2026.104337","DOIUrl":"10.1016/j.iccn.2026.104337","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the demographic characteristics of family participants enrolled in randomized controlled trials (RCTs) of family-centered interventions in the adult intensive care unit (ICU), and to assess how sex, gender, race, and ethnicity were reported, defined, and analyzed.</div></div><div><h3>Methods</h3><div>This study is a secondary analysis of a previously registered systematic review. A comprehensive search was conducted in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library up to July 2023, and was updated through October 2025, to identify RCTs of family-centered interventions in adult ICUs. Data were extracted on participant demographics, definitions of sex, gender, race, and ethnicity, and whether these variables were analyzed in relation to study outcomes.</div></div><div><h3>Results</h3><div>Fifty-eight RCTs comprising 12,383 family participants were included. The mean participant age was 51.4 ± 5.6 years; 67 % were women. Spouses or partners (41 %) and adult children (35 %) were the most common relationships to the patient. Race and/or ethnicity was reported in 34 % of studies; among these, 74 % of participants were White. Sex was reported in 66 % of studies and gender in 33 %, though over half conflated the two constructs. Only 26 % and 19 % of studies analyzed outcomes by sex and gender, respectively.</div></div><div><h3>Conclusions</h3><div>Family participants in ICU clinical trials are predominantly middle-aged women closely related to the patient, with limited racial and ethnic diversity. Reporting of key demographic variables remains inconsistent, constraining interpretation and generalizability.</div></div><div><h3>Implications for clinical practice</h3><div>Standardized and transparent reporting of demographic variables in ICU family research is essential to ensure that family-centered interventions are inclusive, equitable, and generalizable across diverse populations. Improved demographic characterization will enhance both research validity and the delivery of culturally responsive critical care.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104337"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex cases and coordination: Reports from organ donation specialists in Canada","authors":"Amina Silva ,&nbsp;Ken Lotherington ,&nbsp;Sonny Dhanani ,&nbsp;Julia Luvizutto ,&nbsp;Vanessa Silva e Silva","doi":"10.1016/j.iccn.2026.104335","DOIUrl":"10.1016/j.iccn.2026.104335","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore Organ and Tissue Donation Coordinator nurses’ experiences and perceptions of their most challenging and complex cases, with a focus on emotional, ethical, and procedural factors.</div></div><div><h3>Methods</h3><div>Qualitative descriptive study where data were collected using a semi-structured interview guide and analyzed using a thematic analysis approach.</div></div><div><h3>Findings</h3><div>29 coordinators were interviewed from April 2022 to February 2023 across all Canadian provinces. Most coordinators have been in their role for 6.9 years, and have experience in critical care. Two overarching themes captured the complexity of coordinators’ experiences: (1) Donation Type, encompassing donation after death determination by circulatory criteria and specific donor circumstances, and (2) Pediatric versus Adult Contexts, highlighting contrasts in family, patient, recipient, and team dynamics. Donation after death determination by circulation criteria cases were characterized by procedural pressure due to sensitivity. In contrast, specific donor types, such as patients undergoing medical assistance in dying, intensified emotional and ethical strain through personal connections with donors. Pediatric cases further amplified emotional complexity, extending family interactions and deepening the search for meaning in care.</div></div><div><h3>Conclusion</h3><div>Our findings highlighted that coordinators face significant challenges in complex organ and tissue donation cases and there is a current need for targeted interventions to psychologically enhance support systems and improve the coordination of deceased organ donation.</div></div><div><h3>Implications for clinical practice</h3><div>Understanding the multifaceted challenges coordinators encounter in complex donation contexts in critical care can inform future training development, psychosocial support, and interdisciplinary communication strategies, thereby improving the overall quality of care provided during donation processes.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104335"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to including family members in early mobilisation of critically ill adults: An integrative review","authors":"Turkiah Alahmari ,&nbsp;Peta Drury ,&nbsp;John Rihari-Thomas ,&nbsp;Yaseen Arabi ,&nbsp;Bronwyn Everett","doi":"10.1016/j.iccn.2026.104346","DOIUrl":"10.1016/j.iccn.2026.104346","url":null,"abstract":"<div><h3>Background</h3><div>Family engagement in critical care settings can enhance healthcare outcomes and patient care satisfaction in the intensive care unit. However, there is limited evidence regarding the barriers to and facilitators of engaging families in direct care, notably early mobilisation.</div></div><div><h3>Objectives</h3><div>To synthesise evidence on barriers and facilitators to including family members in early mobilisation of adult patients in intensive care units.</div></div><div><h3>Methods</h3><div>Integrative review using Whittemore and Knafl’s five-stage framework. A systematic search (January 2015–March 2025) across CINAHL, MEDLINE, ProQuest, ProQuest Dissertations and Theses, and Scopus databases of English-language primary studies examining family participation in early mobilisation of adult patients in intensive care units. Studies were critically appraised using Joanna Briggs Institute tools, and data were extracted and thematically synthesised.</div></div><div><h3>Results</h3><div>Ten studies ranging from moderate to high quality were included in the final review. Thematic synthesis produced four themes affecting family engagement: patient vulnerability and readiness for shared movement (clinical condition); family confidence and relationships (readiness, knowledge, emotional state); clinician gatekeeping and guidance (workload, confidence, communication); and organisational culture and systems (protocols, visitation policies, resources).</div></div><div><h3>Conclusions</h3><div>Family engagement in early mobilisation is influenced by barriers and facilitators at multiple levels, including patient, family, clinician, and organisational levels. Multi-level approaches combining structured education, clinician training, and supportive policies are essential to enable safe and sustainable participation.</div></div><div><h3>Implications for Clinical Practice</h3><div>A practical first step in promoting family engagement in early mobilisation is to clarify families’ roles within the intensive care team. Providing families with clear information, education, and guidance would reduce uncertainty and support safe participation in mobilisation activities. Organisational policies and structured programs that enable clinician-led invitation, supervision, and communication are also important in facilitating consistent and appropriate family engagement. Attention to patient readiness, family confidence, and contextual constraints is essential when including families in early mobilisation practices.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104346"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}