Intensive and Critical Care Nursing最新文献

{"title":"The role of AI-driven communication in delirium prevention, detection, and care for critically ill ICU patients: A systematic review with inductive thematic synthesis","authors":"Vinciya Pandian ,&nbsp;Farshid Rahimibashar ,&nbsp;Masoud Arabfard ,&nbsp;Fadwa Alhalaiqa ,&nbsp;Amir Vahedian-Azimi","doi":"10.1016/j.iccn.2025.104323","DOIUrl":"10.1016/j.iccn.2025.104323","url":null,"abstract":"<div><h3>Background</h3><div>Delirium remains one of the most consequential complications among critically ill patients in ICUs, exerting profound effects on morbidity, mortality, and annual healthcare costs exceeding $81 billion. Communication barriers between sedated or mechanically ventilated patients, their families, and multidisciplinary teams frequently delay recognition and impair management of delirium. This systematic review examines how AI-driven communication technologies can address these barriers, enhance early detection, and promote more integrated, patient- and family-centered delirium care.</div></div><div><h3>Methods</h3><div>A systematic review of literature published between 2015 and 2025 was conducted across five electronic databases: Scopus, PubMed, Web of Science, Embase, and IEEE Xplore. The search strategy employed keywords as “delirium,” “intensive care,” “artificial intelligence,” “AI-driven communication technologies”, “natural language processing”, “computer vision”, “multidisciplinary clinical collaboration”, and “family engagement”. Studies were eligible for inclusion if they focused on AI-enhanced communication in ICU delirium care. The included studies were analyzed using an inductive thematic synthesis approach.</div></div><div><h3>Results</h3><div>From 87 screened records, 16 studies demonstrated AI’s significant benefits across three clinical domains: 1) Prevention using AI-driven tools; 2) Early Detection via multimodal AI systems; and 3) Patient Care through Natural Language Processing (NLP)-powered support. An inductive thematic synthesis of these findings further delineated six core thematic domains: (1) inherent communication barriers; (2) AI as a multidirectional interface; (3) passive AI listening for early detection; (4) AI-enhanced family engagement; (5) AI-structured handovers for teamwork; and (6) ethical-regulatory-practical challenges.</div></div><div><h3>Conclusion</h3><div>AI-driven communication tools effectively bridge critical gaps in ICU delirium care, facilitating early detection, prevention, and patient-centered management. By enabling proactive interventions and fostering a collaborative care environment, these technologies demonstrate direct potential to reduce delirium duration, decrease antipsychotic use, improve long-term cognitive outcomes, and alleviate the substantial economic burden on healthcare systems. These findings validate AI’s role in transforming delirium care through enhanced multidirectional communication.</div></div><div><h3>Implications for Clinical Practice</h3><div>ICU nurses are pivotal in utilizing AI tools through interpreting NLP-generated alerts, calibrating computer vision outputs, and facilitating family engagement to translate AI insights into empathetic, tailored bedside interventions, thereby reinforcing human-AI collaboration.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104323"},"PeriodicalIF":4.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883463","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":"Single-use vs. reusable products for six respiratory procedures in an intensive care unit: A retrospective evaluation of plastic waste implications","authors":"Alberto Lucchini ,&nbsp;Giancarla Nava ,&nbsp;Marta Villa ,&nbsp;Matteo Cesana ,&nbsp;Stefano Citterio ,&nbsp;Davide Ausili ,&nbsp;Marco Giani ,&nbsp;Emanuele Rezoagli ,&nbsp;Stefano Bambi","doi":"10.1016/j.iccn.2025.104327","DOIUrl":"10.1016/j.iccn.2025.104327","url":null,"abstract":"<div><h3>Objective</h3><div>Intensive care units (ICUs) are recognised as carbon “hotspots” within hospitals due to their reliance on resource-intensive technologies. This study aimed to compare reusable and disposable products used for six common respiratory procedures in an Italian ICU to determine the potential for reducing plastic waste generation and the carbon footprint associated with plastic waste incineration.</div></div><div><h3>Methods</h3><div>We performed a retrospective evaluation in a 10-bed ICU over 12 months. The comparison between reusable and single-use devices was based on theoretical calculations: each device was weighed with a precision scale, and annual totals were estimated by multiplying individual device weights by the number of procedures recorded in the clinical information system. CO₂e emissions were calculated using the European Environment Agency emission factor of 2.9 kg CO₂e per kg of plastic waste incinerated.</div></div><div><h3>Results</h3><div>Reusable or low-waste products generated an estimated 143.50 kg of plastic waste, compared with 501.64 kg from single-use devices. Using reusable strategies could have potentially reduced plastic waste by 358.14 kg and avoided approximately 1038.60 kg CO₂e over one year of respiratory procedures, equivalent to approximately 4258 km driven by an average gasoline-powered passenger vehicle.</div></div><div><h3>Conclusion</h3><div>Reusable and low-waste alternatives can substantially reduce plastic waste and the carbon footprint associated with incinerating plastic from disposable ICU respiratory care products. Critical care nurses are well positioned to integrate these sustainable strategies into everyday clinical practice.</div></div><div><h3>Implications for clinical practice</h3><div>Implementing reusable equipment and low-waste alternatives can become part of standard care pathways, aligning clinical excellence with environmental sustainability. These findings support the integration of sustainability into everyday nursing decisions and institutional policies in critical care settings in the future.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104327"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883464","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":"Exploring barriers to patient safety and incident reporting in resource-limited intensive care units: A qualitative study","authors":"Gelana Fekadu ,&nbsp;Rachel Muir ,&nbsp;Georgia Tobiano ,&nbsp;Abera Kenay Tura ,&nbsp;Michael J. Ireland ,&nbsp;Andrea P. Marshall","doi":"10.1016/j.iccn.2025.104325","DOIUrl":"10.1016/j.iccn.2025.104325","url":null,"abstract":"<div><h3>Introduction</h3><div>The burden of patient harm from unsafe care is disproportionately high in low-income countries, particularly in intensive care units (ICUs). Despite this, there is limited empirical evidence explaining the underlying challenges that make patient safety difficult to achieve in resource-limited ICUs.</div></div><div><h3>Objectives</h3><div>To explore the barriers to patient safety and incident-reporting in ICUs at Ethiopian university hospital.</div></div><div><h3>Methods</h3><div>An exploratory qualitative descriptive study was conducted using in-depth interviews guided by a semi-structured protocol and informed by the Theoretical Domains Framework (TDF). Participants were purposively selected, and sample size was determined based on principles of data sufficiency. Reflexive thematic analysis with inductive orientation was employed following Braun and Clarke’s approach.</div></div><div><h3>Results</h3><div>Thirty-nine healthcare professionals participated: 23 (59 %) nurses, 13 (33 %) physicians, and 3 (8 %) clinical pharmacists. The mean age of participants was 32 ± 5 years. Three overarching themes captured the barriers to patient safety and incident reporting in ICUs: (i) Fragile systems: Governance failure and resource constraints; (ii) Normalisation of deviance: teaching-hospital dynamics and clinical oversight, normalised communication lapses, and weak teamwork and relational context; and (iii) Silence trap: Fear in punitive and blame-oriented culture and lack of incident-reporting systems.</div></div><div><h3>Conclusion</h3><div>Patient safety in Ethiopian ICUs is undermined by systemic, operational, and clinician-related obstacles. Structural and cultural barriers further hinder incident-reporting creating a vicious cycle where unsafe care remains hidden and opportunities for learning and improvements are lost. Breaking this cycle requires strong governance, coordinated resource investment, enhancing just culture, strengthening teamwork, establishing robust incident-reporting systems, and ongoing professional development focused on patient safety.</div></div><div><h3>Implications for clinical practice</h3><div>Identifying barriers to patient safety and incident reporting in ICUs may enables targeted interventions that reduce preventable harm, improve care quality, and promote incident reporting and learning to sustain safe clinical practice. <strong>Keywords</strong>: Patient safety, Incident-reporting; Barriers, Intensive care units, Resource-limited settings, Qualitative study, Ethiopian public hospitals.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104325"},"PeriodicalIF":4.7,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842541","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":"Microaspiration dynamics and “bio-inoculum intensity”: Deciphering the clinical paradox of tapered cuffs – Response to Chen et al.","authors":"Suwen Li,&nbsp;Xing Xin,&nbsp;Chenxin Ye,&nbsp;Gendi Lu","doi":"10.1016/j.iccn.2025.104320","DOIUrl":"10.1016/j.iccn.2025.104320","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104320"},"PeriodicalIF":4.7,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839448","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":"Postoperative delirium in the cardiac ICU: A call for nursing-led prevention and compassionate care","authors":"Caroline Arbour ,&nbsp;Tanya Mailhot","doi":"10.1016/j.iccn.2025.104319","DOIUrl":"10.1016/j.iccn.2025.104319","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104319"},"PeriodicalIF":4.7,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839447","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":"Impact of Pre–ICU benzodiazepine and Z–Drug exposure on mortality in critically ill Adults: A nationwide retrospective cohort study","authors":"Tak Kyu Oh ,&nbsp;In-Ae Song","doi":"10.1016/j.iccn.2025.104322","DOIUrl":"10.1016/j.iccn.2025.104322","url":null,"abstract":"<div><h3>Objectives</h3><div>Outpatient use of benzodiazepines and Z-drugs (BZRA) is common, yet its impact on mortality after intensive care unit (ICU) admission remains unclear. We therefore aimed to determine whether outpatient BZRA use within 30 days before ICU admission is independently associated with 30- and 90-day mortality.</div></div><div><h3>Methods</h3><div>Using South Korea’s National Health Insurance Service database, we retrospectively identified adults (≥18 years) with first ICU admissions from 2020 to 2023 and defined pre-ICU BZRA exposure as ≥ 1 prescription within 30 days before admission. We performed 1:1 propensity-score matching on demographic, clinical (including Charlson Comorbidity Index and acute organ dysfunction), socioeconomic, functional, institutional, and temporal variables, then estimated 30- and 90-day mortality associations via conditional logistic regression and Kaplan–Meier survival analysis.</div></div><div><h3>Results</h3><div>Among 1,189,042 unique adult ICU admissions, 115,821 (9.7 %) had pre-ICU BZRA exposure. After matching, 115,820 exposed and 115,820 unexposed patients had excellent covariate balance (all ASDs &lt; 0.10). BZRA exposure was associated with higher 30-day mortality (23.8 % vs 16.6 %; odds ratio [OR] 1.57; 95 % confidence interval [CI] 1.54–1.60; <em>P</em> &lt; 0.001) and higher 90-day mortality (36.8 % vs 27.3 %; OR 1.56; 95 % CI 1.53–1.58; <em>P</em> &lt; 0.001). Kaplan–Meier analysis confirmed reduced cumulative survival (log-rank <em>P</em> &lt; 0.001). Notably, combined benzodiazepine + Z-drug users exhibited the greatest risk: OR 2.46 (95 % CI 2.35–2.58) for 30-day death and OR 2.61 (95 % CI 2.50–2.72) for 90-day death versus non-exposed patients.</div></div><div><h3>Conclusions</h3><div>Outpatient BZRA use within 30 days before ICU admission is independently associated with higher 30- and 90-day mortality, with combination exposure conferring an even greater risk.</div></div><div><h3>Implications for Clinical Practice</h3><div>Recent outpatient BZRA prescriptions are an easily obtainable risk marker that clinicians should incorporate into pre-ICU assessment and triage; where clinically appropriate, medication review and targeted deprescribing may reduce early ICU morbidity and mortality.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104322"},"PeriodicalIF":4.7,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842540","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":"Effect of guided imagery on dyspnea in trauma ICU patients: a randomized controlled trial","authors":"Atena Shojaie ,&nbsp;Naeimeh Naeimi Bafghi ,&nbsp;Atefeh Ahmadi ,&nbsp;Behnaz Bagherian","doi":"10.1016/j.iccn.2025.104280","DOIUrl":"10.1016/j.iccn.2025.104280","url":null,"abstract":"<div><h3>Background</h3><div>Dyspnea is a prevalent and distressing symptom among critically ill patients, particularly in trauma intensive care units, and is often poorly managed in semi-conscious individuals. While guided imagery has shown benefits in various chronic and palliative contexts, its efficacy in ICU trauma patients remains understudied.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 102 trauma ICU patients with Glasgow Coma Scale scores of 9–13 were randomly allocated to an intervention group (n = 51) or a control group (n = 51). The intervention group received nature-based guided imagery sessions twice daily for six consecutive days, in addition to standard ICU care. Respiratory distress was evaluated using the Intensive Care Respiratory Distress Observational Scale (IC-RDOS). Secondary outcomes included PaO₂, PaCO₂, HCO₃⁻, hemoglobin, and Behavioral Pain Scale (BPS) ratings.</div></div><div><h3>Results</h3><div>The intervention group experienced a greater reduction in respiratory distress (IC-RDOS) at Day 6 compared with controls (mean post-test IC-RDOS: 5.36 vs 6.22; between-group p &lt; 0.001). Oxygenation improved in the intervention group (mean PaO₂ at Day 6: 73.8 vs 63.9 mmHg; between-group p &lt; 0.001), while PaCO₂ showed a within-group decrease in the intervention arm but no significant between-group difference (mean post-test PaCO₂: 42.1 vs 43.1 mmHg; between-group p = 0.35). Pain (BPS) decreased modestly in the intervention group compared with the control (mean post-test BPS: 3.68 vs 4.31; between-group p &lt; 0.001). No intervention-related adverse events were reported.</div></div><div><h3>Conclusion</h3><div>Guided imagery may be a feasible adjunctive therapy for alleviating respiratory distress and promoting clinical stability in trauma ICU patients with impaired consciousness. Larger trials are needed to confirm safety and effectiveness before routine clinical implementation.</div></div><div><h3>Implications for clinical practice</h3><div>Incorporating guided imagery into routine ICU nursing care could provide a practical, non-invasive method to reduce respiratory distress in semi-conscious trauma patients, potentially enhancing patient comfort and supporting respiratory function.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104280"},"PeriodicalIF":4.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829408","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":"Mapping the discourse of environmental sustainability in intensive care nursing: a lexicometric exploration of professional meaning-making","authors":"Mariachiara Figura ,&nbsp;Francesca Trotta ,&nbsp;Luciano Midolo ,&nbsp;Francesco Petrosino ,&nbsp;Gianluca Pucciarelli ,&nbsp;Davide Bartoli","doi":"10.1016/j.iccn.2025.104317","DOIUrl":"10.1016/j.iccn.2025.104317","url":null,"abstract":"<div><h3>Introduction</h3><div>Intensive Care Units (ICUs) are among the most resource-intensive hospital environments, contributing substantially to healthcare’s environmental footprint. While sustainable practices are increasingly recognized as essential, little is known about how critical care nurses linguistically frame and make sense of sustainability within their professional culture and daily work.</div></div><div><h3>Aim</h3><div>To explore how critical care nurses construct and articulate meanings of environmental sustainability in their professional discourse.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with 29 critical care nurses across diverse hospital settings. Narratives were analyzed using Automatic Analysis of Textual Data (IRaMuTeQ) with similarity analysis to map term relationships and uncover semantic clusters. Statistical associations (χ² ≥ 3.84; p &lt; 0.05) guided identification of lexical hubs and thematic subnetworks. Computational findings were integrated with qualitative interpretation to ensure contextual depth and rigor.</div></div><div><h3>Results</h3><div>The central lexical hub, <em>sustainability</em>, connected clusters reflecting reflective engagement, collaborative responsibility, organizational structures, and systemic gaps. Secondary hubs included <em>environment</em> (ecological impact and cost considerations), <em>practice</em> (behavioral integration), <em>patient</em> (embedded in bedside care), and <em>waste</em> (material handling, energy use, lifecycle awareness). Nurses framed sustainability as both a professional duty and systemic challenge, mediated by organizational support, personal commitment, and environmental constraints.</div></div><div><h3>Conclusions</h3><div>ICU nurses’ discourse reveals sustainability as a multidimensional construct bridging ethics, operational practice, and systemic limitations. Lexicometric mapping provides a structured view of how sustainability is embedded in professional narratives, offering insights to inform targeted educational and organizational strategies.</div></div><div><h3>Implications for clinical practice</h3><div>Integrating sustainability into professional identity enhances patient care and environmental responsibility. These findings deepen understanding of which dimensions of environmental sustainability can be meaningfully enacted through professional culture and organizational alignment, rather than through the direct imposition of fixed behavioural routines.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104317"},"PeriodicalIF":4.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829379","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":"Time-limited ICU trials: A method for value-based rapid response team decision-making","authors":"Ashwin Subramaniam ,&nbsp;Melissa J. Bloomer ,&nbsp;Daryl Jones","doi":"10.1016/j.iccn.2025.104308","DOIUrl":"10.1016/j.iccn.2025.104308","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104308"},"PeriodicalIF":4.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822489","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 family-centred care to humanisation of ICUs: A paediatric lens on future directions","authors":"Pei-Fen Poh ,&nbsp;Ying Gu ,&nbsp;Jos M. Latour","doi":"10.1016/j.iccn.2025.104321","DOIUrl":"10.1016/j.iccn.2025.104321","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104321"},"PeriodicalIF":4.7,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797022","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}