Zachary Smith , Amanda L. McKinney , Reagan Bollig , Catherine L. McKnight , Brian J. Daley , A. Shaun Rowe
{"title":"Evaluation of alcohol withdrawal assessment in mechanically ventilated patients in a trauma/surgical intensive care unit","authors":"Zachary Smith , Amanda L. McKinney , Reagan Bollig , Catherine L. McKnight , Brian J. Daley , A. Shaun Rowe","doi":"10.1016/j.iccn.2025.104144","DOIUrl":"10.1016/j.iccn.2025.104144","url":null,"abstract":"<div><h3>Objective</h3><div>Alcohol withdrawal syndrome (AWS) is a common and potentially life-threatening complication in critically ill patients. AWS has been shown to increase mortality as well as several other morbidities in critically ill patients. The optimal method for monitoring AWS in mechanically ventilated patients is unclear. As the use of the Clinical Institute Withdrawal Assessment of Alcohol, Revised (CIWA-Ar) has not been validated in mechanically ventilated patients, the purpose of the study was to determine if the use of Richmond Agitation-Sedation Scale (RASS) or CIWA-Ar resulted in improved outcomes in mechanically ventilated critically ill patients with AWS.</div></div><div><h3>Methods</h3><div>A retrospective, quasi-experimental study was conducted in a Trauma Surgical Intensive Care Unit. Mechanically ventilated patients admitted to the trauma service and receiving symptom-triggered benzodiazepine therapy for AWS were included. Before April 2020, regardless of mechanical ventilation status, AWS therapy was guided by CIWA-Ar. After April 2020, AWS therapy for mechanically ventilated patients was guided by RASS.</div></div><div><h3>Results</h3><div>Forty-eight patients were included (RASS: n = 24, CIWA-Ar: n = 24). Patients in the RASS group had a shorter median ICU length of stay (6 days [2.5–12] vs. 9 days [<span><span>[5]</span></span>, <span><span>[6]</span></span>, <span><span>[7]</span></span>, <span><span>[8]</span></span>, <span><span>[9]</span></span>, <span><span>[10]</span></span>, <span><span>[11]</span></span>, <span><span>[12]</span></span>, <span><span>[13]</span></span>, <span><span>[14]</span></span>, <span><span>[15]</span></span>, <span><span>[16]</span></span>, <span><span>[17]</span></span>, <span><span>[18]</span></span>, <span><span>[19]</span></span>, <span><span>[20]</span></span>, <span><span>[21]</span></span>, <span><span>[22]</span></span>]; p = 0.0224) and shorter median time on mechanical ventilation (2.6 days [1.2–6.5] vs. 5.7 days [2.3–9.8]; p = 0.0253) as compared to the CIWA-Ar group. However, the RASS group had a longer median hospital length of stay (16 days [9.5–23] vs. 15 days [12–47]; p = 0.0328).</div></div><div><h3>Conclusion</h3><div>Using RASS to guide symptom-triggered benzodiazepine therapy for AWS in mechanically ventilated patients was associated with significantly shorter ICU length of stay and duration of mechanical ventilation compared to CIWA-Ar.</div></div><div><h3>Implication for clinical practice</h3><div>Implementing a RASS guided monitoring algorithm in patients with AWS may lead to better assessment of ventilated patients at high risk of AWS. This may lead to shorter lengths of stay and duration of mechanical ventilation.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"91 ","pages":"Article 104144"},"PeriodicalIF":4.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571333","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":"Alleviating muscle weakness in ICU through nutritional interventions; too good to be true?","authors":"Eline Vanderwegen, Jan Gunst , Michael P. Casaer","doi":"10.1016/j.iccn.2025.104141","DOIUrl":"10.1016/j.iccn.2025.104141","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"91 ","pages":"Article 104141"},"PeriodicalIF":4.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593244","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":"Sleep disturbance in ICU: A pathway to delirium","authors":"L.J. Delaney , Rosalind Elliott","doi":"10.1016/j.iccn.2025.104138","DOIUrl":"10.1016/j.iccn.2025.104138","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104138"},"PeriodicalIF":4.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557199","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":"What would Vilfredo Pareto do if he was an intensivist treating sepsis in a sparsely-resourced setting? … Seeking solid sustainable solutions for sepsis care in LMICs","authors":"Mervyn Mer , Marcus J. Schultz , Martin W. Dünser","doi":"10.1016/j.iccn.2025.104142","DOIUrl":"10.1016/j.iccn.2025.104142","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104142"},"PeriodicalIF":4.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563074","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":"Empowering ICU and emergency department nurses in resource-limited sepsis response through action-oriented protocol adaptation – letter on Williams et al.","authors":"Yalcin Golcuk","doi":"10.1016/j.iccn.2025.104143","DOIUrl":"10.1016/j.iccn.2025.104143","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"91 ","pages":"Article 104143"},"PeriodicalIF":4.9,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511123","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}
Anne Mette N. Adams , Diane Chamberlain , Charlotte Brun Thorup , Mette Grønkjær , Shalyn Rouke , Tiffany Conroy
{"title":"CALM ICU guidelines: Preliminary guidelines on non-pharmacological strategies for agitation in the ICU − A Delphi study","authors":"Anne Mette N. Adams , Diane Chamberlain , Charlotte Brun Thorup , Mette Grønkjær , Shalyn Rouke , Tiffany Conroy","doi":"10.1016/j.iccn.2025.104135","DOIUrl":"10.1016/j.iccn.2025.104135","url":null,"abstract":"<div><h3>Aim</h3><div>To develop preliminary clinical practice guidelines for the non-pharmacological prevention and management of patient agitation in the intensive care unit.</div></div><div><h3>Methods</h3><div>A modified three-round Delphi study was conducted between January and May 2022 and involved 114 participants from Denmark and Australia, including clinicians, researchers, patients, and family members. The first Delphi round was built on a systematic review of non-pharmacological interventions for managing agitation, a modified umbrella review encompassing qualitative reviews on patient experiences in the intensive care unit and guidelines for managing agitation across all health care settings along with stakeholder consultation. Recommendations were included if they reached a consensus level (IQR ≥ 1) of 75 % or higher in both Denmark and Australia.</div></div><div><h3>Results</h3><div>A total of 63 recommendations for preventing and managing patient agitation in the ICU were included in the preliminary guidelines. The recommendations were grouped into nine themes, forming a new model of care. The themes include care principles, assessment of agitation, identification and treatment of causes of agitation, caregiver behaviours and developing trusting relationships, family involvement, psychosocial needs, physical needs, individualised care and interventions related to the context. Differences in consensus were noted between the two countries and between stakeholders.</div></div><div><h3>Conclusions</h3><div>The study provides robust evidence for preliminary guidelines for the non-pharmacological prevention and management of patient agitation in the ICU. The guidelines emphasise the importance of developing trusting relationships, addressing individual patient needs and ensuring organisational support for successful implementation. The guidelines are preliminary and will be tailored to each country, graded and undergo public consultation and expert methodological reviews.</div></div><div><h3>Implications for Clinical Practice</h3><div>In the absence of established clinical guidelines, these preliminary guidelines offer a framework for ICU clinicians to manage patient agitation effectively, prioritising non-pharmacological approaches and minimising the use of physical and chemical restraints. The findings highlight the need for further research on non-pharmacological strategies to manage agitation.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104135"},"PeriodicalIF":4.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501767","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}
Huan Xu , Chao Wu , Changchang Chen , Bo Yan , Ning Zha , Kai Zhang , Fang Liu , Hongjuan Lang
{"title":"The effect of illegitimate tasks on work withdrawal behavior of intensive care unit nurses: The chain mediating effect of perceived organizational support and thriving at work","authors":"Huan Xu , Chao Wu , Changchang Chen , Bo Yan , Ning Zha , Kai Zhang , Fang Liu , Hongjuan Lang","doi":"10.1016/j.iccn.2025.104136","DOIUrl":"10.1016/j.iccn.2025.104136","url":null,"abstract":"<div><h3>Background</h3><div>Illegitimate tasks are common in nurses’ daily work, and work withdrawal behavior is closely linked to burnout. However, no research has explored the mechanism through which illegitimate tasks influence ICU nurses’ work withdrawal behavior.</div></div><div><h3>Objectives</h3><div>This study aimed to examine the effects of illegitimate tasks on ICU nurses’ work withdrawal behavior, as well as the mediating roles of perceived organizational support and thriving at work.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted from January to March 2025 in Shaanxi Province, China, using convenience sampling to survey 378 ICU nurses on the Bern Illegitimate Tasks Scale, Nurses’ Perceived Organizational Support Scale, Thriving at Work Scale, and Work Withdrawal Behavior Scale. Data were analyzed using SPSS 27.0, and structural equation modeling was performed using AMOS 26.0.</div></div><div><h3>Results</h3><div>The mean scores for ICU nurses were as follows: illegitimate tasks (18.12 ± 6.63), perceived organizational support (46.21 ± 9.71), thriving at work (38.00 ± 6.19), and work withdrawal behavior (17.16 ± 6.71). Illegitimate tasks had a significant positive effect on work withdrawal behavior (r = 0.381, p < 0.01). Perceived organizational support and thriving at work independently mediated the relationship between illegitimate tasks and work withdrawal behavior, accounting for 31.69 % and 11.43 % of the total effect, respectively. Additionally, perceived organizational support and thriving at work served as chain mediators between illegitimate tasks and work withdrawal behavior, accounting for 17.92 % of the total effect.</div></div><div><h3>Conclusion</h3><div>Nurse managers should address the impact of illegitimate tasks on work withdrawal behavior and implement strategies to enhance ICU nurses’ perceived organizational support and thriving at work, reducing work withdrawal behaviors.</div></div><div><h3>Implications for clinical practice</h3><div>This study suggests that illegitimate tasks increase ICU nurses’ work withdrawal behaviors, while perceived organizational support and thriving at work can mitigate these behaviors. Nurses’ managers should first define ICU nurses’ responsibilities and minimize non-medical tasks. Next, support systems, including flexible scheduling, psychological counseling, and career planning training, should be implemented to reduce ICU nurses’ work withdrawal behavior.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104136"},"PeriodicalIF":4.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481780","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}
Paul J.T. Rood, Lodewijk Francken, Mark van den Boogaard
{"title":"The impact of physical restraints on mental health and quality of life in ICU patients – Response to Sheng et al.","authors":"Paul J.T. Rood, Lodewijk Francken, Mark van den Boogaard","doi":"10.1016/j.iccn.2025.104071","DOIUrl":"10.1016/j.iccn.2025.104071","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104071"},"PeriodicalIF":4.9,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366824","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":"Potassium replacement protocols: Considering the context is important – Response to Ye & Huang","authors":"Melissa J Bloomer , Kylie O’Neill","doi":"10.1016/j.iccn.2025.104057","DOIUrl":"10.1016/j.iccn.2025.104057","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"90 ","pages":"Article 104057"},"PeriodicalIF":4.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364487","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":"Enhancing potassium protocol adherence by addressing cognitive load and hierarchical barriers – Letter on O’Neill et al.","authors":"Juan Ye , Kun Huang","doi":"10.1016/j.iccn.2025.104036","DOIUrl":"10.1016/j.iccn.2025.104036","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"91 ","pages":"Article 104036"},"PeriodicalIF":4.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364543","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}