Intensive & critical care nursing最新文献

{"title":"Essential aspects of the prevention of ventilator-associated pneumonia: A State-of-the-Art Review.","authors":"Evdoxia Tsigou, Georgios Papathanakos, Elena Conoscenti, Marios Karvouniaris, Efstratios Vamvakas, Christina Bampou, Nikolaos Dalavouras, Maria Markou, Maria Panagiotouni, Elisabeth Paramythiotou, Vipin Varghese, Stijn Blot, Despoina Koulenti","doi":"10.1016/j.iccn.2026.104598","DOIUrl":"https://doi.org/10.1016/j.iccn.2026.104598","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in the ICU and is associated with high antibiotic consumption and increased healthcare resource utilization.</p><p><strong>Objectives: </strong>This review provides an updated overview of current strategies for VAP prevention.</p><p><strong>Methods: </strong>A narrative review of the literature was conducted, including randomized controlled trials, systematic reviews, meta-analyses, and recent international guidelines and position papers on VAP prevention.</p><p><strong>Results: </strong>Successful VAP prevention depends on both effective implementation strategies and evidence-based clinical interventions. Current preventive measures target the main mechanisms involved in VAP pathogenesis, including prolonged mechanical ventilation, microaspiration, endotracheal tube biofilm formation, and colonization of the aerodigestive tract. Routine preventive measures with the strongest supporting evidence include minimizing the duration of mechanical ventilation and sedation, avoiding unnecessary intubation and re-intubation, semi-recumbent positioning, oral care with toothbrushing rather than chlorhexidine, early enteral nutrition, and the use of structured prevention bundles. Additional interventions, such as subglottic secretion drainage, selective digestive or oropharyngeal decontamination, inhaled antibiotics, early tracheostomy, and post-pyloric feeding, may be beneficial in appropriately selected patients or specific clinical settings. In contrast, some interventions have inconsistent evidence of clinical benefit and are not recommended for routine use.</p><p><strong>Conclusions: </strong>Preventing VAP requires a multimodal approach that integrates organizational support with evidence-based preventive measures. As new evidence continues to emerge, prevention bundles should be regularly updated to optimize effectiveness while avoiding interventions that are ineffective or potentially harmful.</p><p><strong>Implications for clinical practice: </strong>Implementation of VAP prevention strategies should focus on interventions supported by the best available evidence, while tailoring selected strategies to local epidemiology, available resources, and individual patient characteristics. Consistent adherence to multidisciplinary prevention bundles remains fundamental for reducing the burden of VAP.</p>","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":" ","pages":"104598"},"PeriodicalIF":4.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focal upper limb peripheral nerve injury after prone positioning in patients with ARDS: A prospective neurophysiological cohort study.","authors":"Filippo Binda, Federica Marelli, Veronica Rossi, Maurizio Vergari, Giada Aglieco, Martina Nigro, Maura Lusignani, Alessandro Galazzi, Gemma Via-Clavero, Oriol Roca, Giacomo Grasselli","doi":"10.1016/j.iccn.2026.104587","DOIUrl":"https://doi.org/10.1016/j.iccn.2026.104587","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the incidence, timing, and neurophysiological characteristics of focal upper limb peripheral nerve injury (PNI) related to positional brachial plexus involvement after prone positioning in patients with acute respiratory distress syndrome (ARDS).</p><p><strong>Methods: </strong>Prospective single-centre observational cohort study conducted in the ICU of an academic tertiary-level hospital in Milan (Italy), between April 2022 and September 2025. All adult patients with ARDS requiring invasive mechanical ventilation and treated with prone positioning were screened. Patients underwent predefined longitudinal neurophysiological assessments at baseline, after each prone positioning cycle and before ICU discharge, whenever feasible. Focal upper limb PNI was defined using specific electrodiagnostic criteria. Cumulative incidence analyses accounted for ICU death as a competing event.</p><p><strong>Results: </strong>Overall, 128 prone positioning cycles were performed in 54 patients. Focal upper limb PNI occurred in 11 patients (20.4%; 95% CI 10.6-33.5), after a median of 2 prone positioning cycles (IQR 1-3) and 36 h (IQR 21-50) of cumulative prone exposure. By day 28, the estimated cumulative incidence was 29.1% (95% CI 11.6-46.7), rising to 42.7% (95% CI 17.6-67.9) in patients exposed to at least one uninterrupted prone cycle lasting ≥24 h, compared with 8.6% (95% CI 0-20.4) in patients with shorter exposure (p = 0.047). Among prone positioning-related complications, pressure ulcers were the most frequent, occurring in 40.7% (22/54) of patients and predominantly involving the facial region, whereas no vascular access loss or accidental endotracheal tube displacement were recorded.</p><p><strong>Conclusions: </strong>Focal upper limb PNI was a frequent, clinically relevant, and potentially under-recognised complication of prolonged prone positioning in patients with ARDS.</p><p><strong>Implications for clinical practice: </strong>A prone positioning bundle should include systematic upper limb surveillance, repeated reassessment of limb, head and shoulder alignment, and early detection of focal asymmetric upper limb weakness, particularly during uninterrupted prone cycles lasting 24 h or longer.</p>","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":"99 ","pages":"104587"},"PeriodicalIF":4.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care and support needs of families in the first 9 months after PICU discharge: A multi-center, longitudinal, qualitative study.","authors":"Joseph C Manning, Emma Popejoy, Jos M Latour, Elizabeth Draper, Philip Quinlan, Martha A Q Curley, Jane Coad","doi":"10.1016/j.iccn.2026.104357","DOIUrl":"https://doi.org/10.1016/j.iccn.2026.104357","url":null,"abstract":"<p><strong>Aim: </strong>To explore the experiences, associated care and support needs of families in the 9-months following a child's Pediatric Intensive Care Unit (PICU) discharge, using the Post-Intensive Care Syndrome in Pediatrics (PICS-p) framework.</p><p><strong>Methods: </strong>An embedded qualitative study within the OCEANIC longitudinal mixed-methods study was conducted across seven PICUs in England. Forty families were purposively sampled and interviewed at two time points (1-3 and 6-9 months post-discharge). Semi-structured interviews with children, parents, and siblings were analysed using Framework Analysis, informed by both deductive and inductive approaches.</p><p><strong>Findings: </strong>A total of 57 participants (45 parents; 11 children; 1 sibling) were interviewed from May 2020 - November 2022. Themes in care and support revealed multifaceted and interdependent needs across physical, cognitive, emotional, and social health domains. Unmet needs in one domain often exacerbated challenges in others, and across family members. Key concerns included lack of coordinated follow-up care, psychological distress, cognitive burden related to life administration, and financial strain. The COVID-19 pandemic intensified these challenges, particularly through restricted hospital access and disrupted healthcare services.</p><p><strong>Conclusions: </strong>In the nine months following discharge from the PICU, families experience complex, evolving needs post-PICU discharge, many of which remain unmet and interlinked across PICS-p domains. The pandemic context amplified these needs, highlighting systemic gaps in post-discharge support and continuity of care.</p><p><strong>Implications for clinical practice: </strong>Findings illuminate the necessity for integrated, family-centred follow-up services that address physical recovery, psychological support, and social determinants of health. Routine screening for PICS-p morbidity, improved interprofessional communication, and accessible mental health services are essential. Tailored interventions should be developed and tested to support families at risk, ensuring equitable recovery and long-term wellbeing.</p>","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":" ","pages":"104357"},"PeriodicalIF":4.7,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Model establishment based on clinical data from patient monitors: Optimising night-time alarms in intensive care units.","authors":"Jiajia Fang, Chengmin Xiong, Shuping Xia, Peiqin Ding","doi":"10.1016/j.iccn.2025.104192","DOIUrl":"10.1016/j.iccn.2025.104192","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study is to establish a model correlating the number of alarms and effective alarms on a monitor, and to use this model to optimise night-time alarm issues in intensive care units in order to reduce alarm fatigue among night shift nurses.</p><p><strong>Methods: </strong>A retrospective study method was used to track 1,843 samples. Based on partial experimental design analysis, a model for 'alarm frequency' and 'effective alarms' was established for the monitor, which was then optimised using the composite centre factorial (CCF) method. The performance of the model was evaluated using random sampling and night-time model application.</p><p><strong>Results: </strong>We can model based on three factors: 'APACHE II score,' 'Alarm time period,' and 'Nurse ICU work years.' After using this model, the average number of alarms decreased by 11.86%, and the average proportion of effective alarms increased by 4%.</p><p><strong>Conclusions: </strong>We can use CCF modeling to manage monitors and help reduce patient and nurse fatigue.</p><p><strong>Implications for clinical practice: </strong>The number of monitor alarms and effective alarms related to the patient's condition, working time period, and the nurse's experience. We can tailor the management strategy of the monitor based on clinical conditions, reducing the number of night-time alarms while ensuring patient safety, increasing the effectiveness of alarms, and reducing nurse alarm fatigue. The longer the length of service in critical care, the less significant the improvement in monitor alarm performance.</p>","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":"92 ","pages":"104192"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of acoustic environment in intensive care unit on nurses' well-being during COVID-19: A qualitative interview study.","authors":"Ziwei Song, Pyoung Jik Lee","doi":"10.1016/j.iccn.2025.104189","DOIUrl":"10.1016/j.iccn.2025.104189","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the effects of acoustic environments in intensive care units (ICUs) on nurses' well-being.</p><p><strong>Setting and sample: </strong>The research was conducted with 14 ICU registered nurses recruited from four different hospitals in China.</p><p><strong>Research methodology: </strong>Semi-structured interviews were conducted via video calls to explore ICU nurses' perceptions, reactions, and coping strategies related to noise exposure. A grounded theory approach was used to analyse the data.</p><p><strong>Findings: </strong>The study identified five categories and 11 themes based on nurses' experiences with noise exposure in ICUs. These themes were interconnected to develop a conceptual model. According to the model, exposure to human and non-human noises led to negative emotions and disturbances in ICU activities, such as medical procedures and conversations. Nurses employed various coping strategies to manage negative perceptions of noise. Several nurses expressed concerns about their physical and mental health, which are related to noise exposures. Additionally, their noise perception and coping strategies were influenced by intervening conditions, such as noise sensitivity, attitudes towards colleagues and patients, and childcare.</p><p><strong>Implications for clinical practice: </strong>This study highlights the potential risk of physical and mental well-being among ICU nurses. The findings suggest the necessity of interventions to enhance the acoustic environments of ICUs, such as implementing noise reduction strategies, optimising alarm systems, and providing adequate training and support for staff to cope with noise-related stress.</p>","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":"92 ","pages":"104189"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing statistical rigor, data visualization, and multidisciplinary engagement in longitudinal delirium management research - Letter on Coolens et al.","authors":"Farshid Rahimi-Bashar, Amir Vahedian-Azimi","doi":"10.1016/j.iccn.2025.104198","DOIUrl":"10.1016/j.iccn.2025.104198","url":null,"abstract":"","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":"92 ","pages":"104198"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of alcohol withdrawal assessment in mechanically ventilated patients in a trauma/surgical intensive care unit - Letter on Smith et al.","authors":"Jianjie Ju, Jingjing Chen, Shuo Lin","doi":"10.1016/j.iccn.2025.104199","DOIUrl":"10.1016/j.iccn.2025.104199","url":null,"abstract":"","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":"92 ","pages":"104199"},"PeriodicalIF":4.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communication with the critically ill patient: A nexus between patient needs, communication partner skills and the ICU environment - Response to Kuruppu et al.","authors":"Amy Freeman-Sanderson, Laura Istanboulian, Louise Rose","doi":"10.1016/j.iccn.2025.104193","DOIUrl":"10.1016/j.iccn.2025.104193","url":null,"abstract":"","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":"91 ","pages":"104193"},"PeriodicalIF":4.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting critical care Research Agendas: A new article type in ICCN.","authors":"Stijn Blot, Melissa J Bloomer, Frances Fengzhi Lin","doi":"10.1016/j.iccn.2025.104191","DOIUrl":"10.1016/j.iccn.2025.104191","url":null,"abstract":"","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":"91 ","pages":"104191"},"PeriodicalIF":4.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain rates and risks in ICU patients: A meta-analysis - Response to Mehta et al.","authors":"Risa Herlianita, Hsiao-Yean Chiu","doi":"10.1016/j.iccn.2025.104109","DOIUrl":"10.1016/j.iccn.2025.104109","url":null,"abstract":"","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":" ","pages":"104109"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}