Intensive and Critical Care Nursing最新文献

{"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":"2026-01-17","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":"A mixed-methods systematic review of factors affecting missed nursing care in intensive care","authors":"Huimiao Jing ,&nbsp;Xue Bai ,&nbsp;Weiguang Wen ,&nbsp;Ni Yang ,&nbsp;Jie Zhai ,&nbsp;Yingli Gao","doi":"10.1016/j.iccn.2026.104344","DOIUrl":"10.1016/j.iccn.2026.104344","url":null,"abstract":"<div><h3>Objectives</h3><div>To systematically review and synthesize evidence on the factors influencing missed nursing care in intensive care unit, using the conservation of resources as the analytical framework.</div></div><div><h3>Methods</h3><div>A convergent integrated mixed-methods systematic review was conducted according to the Joanna Briggs Institute guidelines. Nine databases (PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, CNKI, VIP, CBM, Wanfang) were searched from inception to October 2024. The Mixed Methods Appraisal Tool was used to assess methodological quality, and quantitative findings were transformed and thematically integrated with qualitative evidence.</div></div><div><h3>Results</h3><div>Thirteen studies were included. Findings were synthesised within the conservation of resources theory framework, with influencing factors mapped to the four corresponding core resource domains: personal (e.g., clinical title, experience), energy (e.g., staffing, workload), social (e.g., teamwork, communication), and material (e.g., equipment, medications). High patient acuity was consistently identified as a primary external demand straining these resources.</div></div><div><h3>Conclusions</h3><div>Missed nursing care in the ICU is conceptualised as an outcome of an imbalance between clinical demands and nurses’ resource reserves. The conservation of resources theory provides a coherent explanatory framework, indicating that interventions must address multifactorial resource deficits to mitigate missed care.</div></div><div><h3>Implications for clinical practice</h3><div>Clinical management strategies should focus on optimizing staffing models to protect energy resources, enhancing teamwork and communication to strengthen social resources, and ensuring the reliable availability of material resources. Building supportive work environments and training in priority-setting are also recommended to reduce the incidence of missed nursing care.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104344"},"PeriodicalIF":4.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000160","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":"Practice of nebulization in intensive care unit patients receiving invasive ventilation – A nationwide survey","authors":"Sarah F.C. Mugge ,&nbsp;Andrea A. Esmeijer ,&nbsp;Annelies Visser ,&nbsp;Willemke Stilma ,&nbsp;Dave A. Dongelmans ,&nbsp;Frederique Paulus","doi":"10.1016/j.iccn.2026.104342","DOIUrl":"10.1016/j.iccn.2026.104342","url":null,"abstract":"<div><h3>Background</h3><div>Nebulization with mucolytic and bronchodilator agents is frequently applied in Intensive Care Units (ICUs) for invasively ventilated patients, despite limited evidence for clinical benefit and potential risks associated with routine use. Understanding current practice and rationale behind nebulization is essential to targeted de-implementation strategies.</div></div><div><h3>Methods</h3><div>We conducted a nationwide, cross-sectional telephone survey among ICU healthcare professionals in the Netherlands. The survey addressed nebulization practices for mucolytics and bronchodilators, including agents used, administration strategy, clinical indications, evaluation strategies, and local protocols. Open-ended questions explored underlying clinical reasoning and factors influencing nebulization practices.</div></div><div><h3>Results</h3><div>Representatives from 54 of 71 Dutch ICUs (76%) participated. Most respondents were ventilation practitioners (72%, 39/54), supplemented by ICU nurses and intensivists. Nebulization with mucolytics was reported in 47 ICUs (87%) ICUs and with bronchodilators in all ICUs. On-demand nebulization predominated (91.5%, 43/47 for mucolytics; 83.3%, 45/54 for bronchodilators). Thick secretions were the main indication for mucolytics, whereas obstructive pulmonary disease and bronchospasm were leading indications for bronchodilators. Acetylcysteine and salbutamol/ipratropium were most frequently used. Local protocols were present in 41 (76%) ICUs. Active humidification was commonly applied on indication, particularly in prolonged ventilation. Responses to open-ended questions revealed that, beyond clinical triggers, nebulization decisions were frequently shaped by personal preference, habitual practice, and organizational context, rather than by evidence-based reasoning.</div></div><div><h3>Conclusion</h3><div>Nebulization in Dutch ICUs is predominantly on-demand but practice remains variable and partly driven by ingrained habits instead of evidence. Non-indicated nebulization persists and represents potential low-value care.</div></div><div><h3>Implications for Clinical Practice</h3><div>This nationwide survey demonstrates that nebulization practices in Dutch ICUs remain highly variable, often driven by non-standardized protocols and subjective interpretation of indications rather than evidence. To promote more consistent and evidence-based care, implementing a practical decision-support tool could guide clinicians toward indication-based nebulization and support de-implementation of routine, non-indicated use.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104342"},"PeriodicalIF":4.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000173","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":"The dilemma of sepsis bundle care","authors":"Christian Lanckohr ,&nbsp;Sebastian Mang ,&nbsp;Hendrik Bracht","doi":"10.1016/j.iccn.2026.104343","DOIUrl":"10.1016/j.iccn.2026.104343","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104343"},"PeriodicalIF":4.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000254","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":"2026-01-12","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":"Dual role caregivers in critical care nursing: Matrescence and workforce sustainability","authors":"Adrianna Lorraine Watson,&nbsp;Brooklynn Nelson,&nbsp;Grace Houston","doi":"10.1016/j.iccn.2026.104334","DOIUrl":"10.1016/j.iccn.2026.104334","url":null,"abstract":"<div><h3>Aims</h3><div>To interpret the lived experience of matrescence (becoming a mother) among critical care nurse-mothers during maternity leave and the transition back to clinical practice.</div></div><div><h3>Methods</h3><div>An interpretive phenomenological design was used, guided by Heidegger’s hermeneutics and Patricia Benner’s framework. A purposive sample of 54 U.S. critical care nurse-mothers was recruited through a national nursing organization. Semi-structured Zoom interviews were analyzed.</div></div><div><h3>Findings</h3><div>Four emergent main themes captured the intersection of becoming a mother with high-acuity nursing practice: (1) Cognitive Recalibration, subjectively experienced as a “slowed” thinking followed by perceptions of increased ability to mutlitask in caregiving roles; (2) Emotional Labor and Guilt, an ongoing negotiation between professional composure and maternal presence; (3) Becoming What They Believe, the internalization of cultural myths of maternal decline amid limited perceptions of organizational support; and (4) Empathy Reframed Through Motherhood, in which nurse-mothers described expanded compassion, patience, and advocacy that enriched critical care practice.</div></div><div><h3>Conclusions</h3><div>Becoming a dual-role caregiver as a critical care nurse-mother reshapes identity through the interplay of professional, emotional, and cognitive transformation. When this developmental transition is acknowledged and supported, it strengthens nurses’ confidence and sense of purpose; when ignored, it can contribute to strain and attrition.</div></div><div><h3>Implications for Clinical Practice and Policy</h3><div>Recognizing matrescence as a normal phase of professional development can guide leadership practices that value, rather than penalize, dual-role caregivers. Implementing flexible scheduling, equitable parental-leave policies, and supportive reintegration programs can help sustain nurse well-being, strengthen team culture, and promote a more sustainable critical care nursing workforce.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104334"},"PeriodicalIF":4.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924513","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":"Uncovering the Cognitive Mechanisms of Risk Decision-Making among ICU Nurses in Complex Clinical Contexts","authors":"Hui Ge,&nbsp;Tingting Feng,&nbsp;Hao Wu,&nbsp;Huiling Hu,&nbsp;Jiashuai Li,&nbsp;Xue Wu","doi":"10.1016/j.iccn.2025.104329","DOIUrl":"10.1016/j.iccn.2025.104329","url":null,"abstract":"<div><h3>Objectives</h3><div>The intensive care unit is a high-stakes, information-intensive environment requiring nurses to make rapid and accurate decisions. This study aimed to elucidate the cognitive and neural mechanisms underlying nurses’ risk decision-making under time pressure and complex clinical demands.</div></div><div><h3>Methods</h3><div>Thirty ICU nurses participated in a computer-based multitasking experiment simulating concurrent medical multitasking scenarios, with twenty-one valid datasets analyzed. Participants performed priority judgments under high- and low-risk conditions while EEG signals were continuously recorded. Event-related potential components and oscillatory activities across δ, θ, α, and β frequency bands were analyzed. Gaussian Hidden Markov Models were used to characterize cognitive state transition dynamics aligned to task events.</div></div><div><h3>Results</h3><div>Risk decision-making emerged as a multi-stage, dynamically coordinated process involving four distinct cognitive patterns: monolithic stability progression, compulsory path lock-in, multi-path flexible convergence, and flow separation and premature convergence. Correct decisions were associated with enhanced low-frequency oscillations (δ, θ) and stable HMM transitions, reflecting efficient integration and adaptive cognitive control. In contrast, incorrect decisions exhibited early perceptual inefficiency, unstable state transitions, and premature cognitive closure under high-risk conditions.</div></div><div><h3>Conclusions</h3><div>This study is the first to identify four distinct dynamic cognitive patterns of risk decision-making in a simulated ICU multitasking context. The findings indicate that decision accuracy is closely linked to coordinated state-transition dynamics rather than isolated neural activations, highlighting the importance of adaptive cognitive control in clinical judgment.</div></div><div><h3>Implications for clinical practice</h3><div>Although the present findings are exploratory, they may provide a preliminary reference for future research on brain-machine collaboration in clinical nursing contexts. In particular, future work could examine how EEG-decoded cognitive states might be incorporated as input information for robot-assisted systems to characterize nurses’ cognitive intentions during risk tasks. Further studies with larger samples and in more realistic clinical settings are needed to validate the model’s robustness and generalizability.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104329"},"PeriodicalIF":4.7,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919508","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":"A concise, practice-oriented guide to bibliometric analysis for intensive and critical care nursing researchers","authors":"Sameh Eltaybani","doi":"10.1016/j.iccn.2025.104324","DOIUrl":"10.1016/j.iccn.2025.104324","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104324"},"PeriodicalIF":4.7,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914314","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":"Impacts of non-pharmacological interventions on post-intensive care syndrome: An umbrella review of systematic reviews and meta-analyses of randomized controlled trials","authors":"Yingying Cai,&nbsp;Xiaohe Ren,&nbsp;Chuanying Ding","doi":"10.1016/j.iccn.2025.104326","DOIUrl":"10.1016/j.iccn.2025.104326","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the effects of various non-pharmacological interventions on long-term outcomes associated with Post-Intensive Care Syndrome (PICS) in intensive care unit (ICU) survivors, based on existing systematic reviews and <em>meta</em>-analyses.</div></div><div><h3>Methods</h3><div>An umbrella review was conducted. Comprehensive searches of PubMed, Web of Science, Embase, and the Cochrane Library databases were performed up to June 2025 to identify eligible reviews. Two authors independently conducted article selection and data extraction. The methodological quality of the included studies was assessed using the AMSTAR 2 measurement tool. Results were synthesized narratively, and grouped by prevention or care focus.</div></div><div><h3>Results</h3><div>Nine systematic reviews published between 2015 and 2023 encompassing 112 randomized controlled trials and 19,996 ICU survivors were included. The interventions evaluated comprised early mobilization (three reviews), follow-up consultation (two reviews), and other non-pharmacological strategies (four reviews), including ICU diaries, exercise rehabilitation, oxygen therapy, and nurse-led interventions. Reported outcomes covered physical function (activities of daily living, exercise capacity, pulmonary function, muscle strength, and pain), psychological function (anxiety, depression, post-traumatic stress disorder [PTSD]), cognitive function, social reintegration (return to work), and quality of life. According to the evidence map, ICU diaries demonstrated a consistently beneficial effect on PTSD, while follow-up consultations yielded inconsistent results for PTSD. Early mobilization interventions produced variable improvements in physical function and quality of life across studies. Exercise rehabilitation was associated with enhanced physical performance, whereas oxygen therapy strategies showed no significant effects. Nurse-led interventions demonstrated beneficial effects on anxiety and depression. Overall, 78% of the assessed outcomes were rated as low or very low certainty due to methodological heterogeneity and limited sample sizes.</div></div><div><h3>Conclusions</h3><div>Current evidence on non-pharmacological interventions for PICS remains heterogeneous and of generally low certainty. These findings highlight the urgent need for high-quality, adequately powered randomized studies to establish the effectiveness of these interventions and guide evidence-based PICS management.</div></div><div><h3>Implications for clinical practice</h3><div>Clinical practice should emphasize integrated, transitional care pathways that combine ICU diary–based psychological support with individualized mobilization and rehabilitation programs. Establishing standardized core outcome sets and improving methodological rigor in intervention trials will be key to advancing evidence-informed PICS management.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104326"},"PeriodicalIF":4.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883462","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":"Beyond the beeps: Building a culture of intelligent alarm management in critical care","authors":"Shital Dharamkhele ,&nbsp;Nipun Gupta","doi":"10.1016/j.iccn.2025.104328","DOIUrl":"10.1016/j.iccn.2025.104328","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104328"},"PeriodicalIF":4.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883465","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}