Critical Care Bulletin: Sept/October 2026

Effect of an Integrated Early Enteral Nutrition Management Protocol on Nutritional Target Attainment in Mechanically Ventilated ICU Patients: A Quasi-Experimental Study Guided by the MRC Framework

Item Type: Journal Article

Authors: Zhang, Jie;Wang, Nan;Hang, Yongqing;Huang, Jinya;Yang, Ping and Duan, Peibei

Publication Date: 2026

Journal: Nursing in Critical Care 31(5), pp. e70683

Abstract: 

Background Achieving early enteral nutrition (EN) targets remains challenging in mechanically ventilated intensive care unit (ICU) patients. Evidence for nursing-led multicomponent protocols incorporating traditional Chinese medicine (TCM) approaches is limited. Aims To develop an integrated early EN management protocol using the Medical Research Council (MRC) framework and conduct a preliminary evaluation in mechanically ventilated ICU patients. 

Study Design A single-centre quasi-experimental before-and-after study was conducted in a tertiary ICU in China. Adults at nutritional risk receiving mechanical ventilation (MV) and EN were enrolled during sequential control and intervention phases. The intervention group received the MRC-guided protocol and the control group received routine EN care. The primary outcome was EN target attainment on Days 3 and 7. 

Results Eighty-two patients were analysed (intervention, n = 40; control, n = 42). EN target attainment was higher in the intervention group on Day 3 (70.0% ± 17.5% vs. 53.5% ± 18.7%; p < 0.001; Cohen's d = 0.91) and Day 7 (83.7% ± 9.4% vs. 64.1% ± 15.4%; p < 0.001; Cohen's d = 1.53). Both differences remained significant after adjustment for calendar time. Earlier EN initiation and post-pyloric feeding were associated with higher attainment in exploratory group-adjusted analyses. Albumin showed a significant group-by-time interaction (p = 0.002). MV duration, ICU length of stay and feeding intolerance did not differ significantly between groups. 

Conclusions In this single-centre quasi-experimental study, protocol implementation was associated with higher early EN target attainment and was feasible in the study setting, without a detected increase in feeding intolerance. Causal inference is limited by the before-and-after design, and component-specific effects require evaluation in multicentre randomised controlled trials. 

Relevance to Clinical Practice The protocol provides critical care nurses with a structured approach to early EN delivery, tolerance monitoring and supportive care. Implementation elsewhere requires context-specific adaptation and further evaluation.

Access or request full text: https://libkey.io/10.1111/nicc.70683

 A network meta-analysis of intensive nursing interventions for delirium in ICU patients

Item Type: Journal Article

Authors: Wang, Rui;Wu, Jiang and Huang, Jingmin

Publication Date: 2026

Journal: Medicine 105(39), pp. e50667

Abstract: 

Background Delirium prevalence in the intensive care unit (ICU) is high. Intensive nursing interventions have been performed to reduce delirium in ICU patients. There is now a wide variety of intensive nursing interventions available for treating delirium. However, the optimal intervention remains unknown. This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of intensive nursing interventions in patients with delirium. 

Methods We included randomized controlled trials of different intensive nursing interventions for delirium in the ICU. A Bayesian NMA was conducted to evaluate the efficacy of various types of intensive nursing interventions. The outcomes assessed were the cure rate, intensive care delirium screening checklist (ICDSC) scores, and acute physiologic assessment and chronic health evaluation II (APACHE II) scores for different treatments. 

Results This meta-analysis included 21 studies. We analyzed a total of 5 different intensive nursing interventions: auricular points acupressure, music therapy, cognitive function exercise, regular nursing, increasing visiting hours, and targeted nursing. When compared with regular nursing, the other 5 intensive nursing interventions showed no significant difference in cure rate, ICDSC, and APACHE II scores (P > .05). Auricular points acupressure had the highest surface under the cumulative ranking area value for cure rate and APACHE II, indicating it ranked first in these outcomes. Music therapy demonstrated the most favorable effect on reducing ICDSC, with music therapy ranking first in this regard. 

Conclusion This NMA suggests that auricular points acupressure might be the optimal intervention for increasing the cure rate and decreasing ICDSC and APACHE II scores in ICU patients with delirium. However, the surface under the cumulative ranking area values reflect relative ranking rather than absolute efficacy, and no intervention demonstrated statistically significant superiority over regular nursing. Additionally, increasing visiting hours appears to hold promise as an effective intervention for reducing delirium in the ICU. Further research and larger studies are warranted to confirm these findings and to explore the long-term benefits of these intensive nursing interventions in delirium management.

Access or request full text: https://libkey.io/10.1097/MD.0000000000050667

Older patients and intensive care: factors that influence patients decisions on life sustaining measures

Item Type: Journal Article

Authors: Rosada, Adrian;Ferizaj, Drin;Lahmann, Nils;Schaefer, Frank Samuel and Müller-Werdan, Ursula

Publication Date: 2026

Journal: BMC Geriatrics 26(1)
Abstract: 

Background Physicians treating older patients are frequently unaware of their patients' personal attitudes towards life-sustaining measures like ventilation, resuscitation, feeding tubes, or ICU admission. In routine clinical practice, there is often little time for reflection prior to deciding in favor or against life sustaining measures in critical medical conditions. Although decisions for or against these measures should ideally be made jointly by the patient and the treating physician, factors like age, disease burden, social inclusion, and affective state may play an important role in the patient's motivation. 

Methods Data from 161 inpatients (mean age 82.0 years) on a geriatric ward were collected and analyzed. Patients were interviewed about their attitudes towards life-sustaining measures like ventilation, resuscitation, tube feeding, ICU admission, and dialysis. Four composite indices were formed by combining sign-aligned component variables: medical burden (age and Charlson Comorbidity Index), functional and cognitive impairment (Barthel Index, iADL, and MoCA), affective distress (Geriatric Depression Scale and Hamilton Depression Scale suicidality item), and social support (living situation, having children, and having friends). These indices with other covariates were then analyzed using a Bayesian Rasch item response model with latent regression. 

Results Overall, 14.3% refused all invasive life sustaining measures, whereas 33.8% wished to receive all of the measures listed above. Artificial nutrition was the most refused measure (refused by 53.4%), whereas ICU admission was the most commonly accepted measure (74.4%). Social support had no meaningful association with the decision to accept or refuse life-sustaining measures. Relevant predictors were primarily lower levels of affective distress, and secondarily better functional and cognitive performance and lower medical burden. 

Conclusions Even among older patients, only a minority completely reject life-sustaining measures, even though their life expectancy is often significantly reduced. Patient's attitude towards life-sustaining measures appears to be related more strongly to affective state, functional performance, and medical burden than living situation or social inclusion. As the patient's emotional and functional state can certainly be influenced by medical treatment, practitioners should bear this in mind and, where appropriate, reassess their patients' attitude towards LSM once the aforementioned conditions have improved. Clinical Trial Number Registered with the clinical trial registry Deutsches Register Klinischer Studien.

Access or request full text: https://libkey.io/10.1186/s12877-026-08315-8

 Methodological Approaches for Ultrasound Assessment of Peripheral and Abdominal Muscle Thickness in Intensive Care: A Scoping Review and Proposed Reporting Framework

Item Type: Journal Article

Authors: Porfirio, Pedro Vinicius;Leite, Wagner Souza;Costa, Layane Santana Pereira;de Moura, Pedro Henrique;Dos Santos, Ana Célia Oliveira;da Silva Junior, Emanuel,Fernandes Ferreira;de Souza, Elaine Araújo;do Nascimento, Marismar Fernandes;de Souza, Helga,Cecilia Muniz and Campos, Shirley Lima

Publication Date: 2026

Journal: Physiotherapy Research International : The Journal for Researchers and Clinicians in Physical Therapy 31(4), pp. e70303

Abstract: 

Objective To map and synthesize methodological approaches used for ultrasound (US) assessment of peripheral (upper- and lower-limb) and abdominal muscle thickness in critically ill patients, and to propose a preliminary Standard Operating Procedure (SOP) as a structured reporting framework. 

Methods A review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist, using systematic searches on PubMed, BIREME (including MEDLINE, LILACS and IBECS) and Embase. Two reviewers independently screened, selected, and extracted data from studies published between 2015 and 2025. Extracted data included muscle groups assessed, thickness measurement criteria, patient and probe positioning, operational US parameters, and reliability information. The proposed SOP was developed based on recurring methodological patterns identified in the literature and subsequently refined through external expert review and pilot feasibility testing in ICU settings. 

Results Of 2.293 identified records, 29 studies (1.736 patients) were included. B-mode imaging and linear transducers were the most frequently reported US parameters, and the supine position with the head of the bed elevated to 30° was the predominant patient position. Although 79.3% of studies described muscle thickness measurement criteria, important methodological details such as depth, gain, and anatomical landmarks were inconsistently reported. Lower-limb muscles were the most frequently assessed, whereas upper-limb and abdominal muscles remained comparatively underrepresented. Considerable variability was identified across acquisition procedures, anatomical landmarks, measurement criteria, and reporting practices. 

Conclusions Ultrasound assessment of muscle thickness in critically ill patients shows substantial methodological and reporting variability. A preliminary SOP was developed and pilot-tested to improve consistency and comparability. Standardization may support bedside monitoring and inform physiotherapy assessment and rehabilitation decisions, although multicenter validation is required. Trial Registration Open Science Framework: https://doi.org/10.17605/OSF.IO/S95MJ.

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 Digitalizing Ventilator Safety: Enhancing Workflow Efficiency and Competency in Critical Care

Item Type: Journal Article

Authors: Ong, Wei Jun Dan;Peña, Eleanor Dela;Khan, Faheem A.;Chong, Woon Hean Keenan and Azul, Lawrence Ace

Publication Date: 2026

Journal: Critical Care Nurse 46(5), pp. 53–60

Abstract: 

Background Noninvasive ventilation is increasingly delivered outside intensive care units; however, ventilator alarm management, documentation, and competency validation remain inconsistent when paper-based processes are used. Delayed or inconsistent responses to actionable alarms may contribute to clinical deterioration and escalation of care. Local Problem Nurses and respiratory therapists reported fragmented documentation, limited access to standardized troubleshooting guides, and time-consuming competency tracking for noninvasive ventilation devices in acute medical units that provide intermediate-level care. 

Methods This quality improvement project, which used a pre-post design, involved implementation of a digital ventilator safety workflow using QR code-linked alarm guidance and a secure online checklist. Data were collected during a 6-month baseline period and a 6-month postimplementation period. Clinical content, workflow mapping, and alarm-guidance pathways were developed in-house by the respiratory therapy department and deployed through AskVijay, a digital clinical guidance platform. Competency validation was conducted during onboarding and annual assessment. 

Results Digital implementation was associated with an increase in checklist completion compliance from 80% to 100% and a reduction in checklist completion time from a median of 8.5 minutes to 3.9 minutes. Use of required digital fields supported more complete documentation. Centralized electronic records enabled consolidated competency documentation and facilitated tracking of checklist and competency completion. 

Conclusion A digital ventilator safety workflow supported standardized documentation, point-of-care access to alarm guidance, and competency tracking for unit-based noninvasive ventilation care. In-house clinical development enabled iterative refinement to align with local practice needs and workflows.

Access or request full text: https://libkey.io/10.4037/ccn2026554

 Psychosocial coping with intensive care delirium: a mixed-methods systematic review of patient and family perspectives

Item Type: Journal Article

Authors: Oh, Eunkyeong;Marx-Rosenberg, Gabriella;Schimböck, Florian;Groth, Nikolas;Nydahl, Peter and Gallinat, Jürgen

Publication Date: 2026

Journal: Critical Care (London, England) 30(1)
Abstract: 

Objective This review aims to identify, synthesize, and critically appraise evidence on psychosocial coping strategies employed by intensive care unit (ICU) patients and their family caregivers during an episode of ICU delirium, organized within the transactional model of stress and coping. 

Design Mixed-methods systematic review (MMSR) following the Joanna Briggs Institute (JBI). Information Sources A systematic search was conducted in MEDLINE (PubMed), CINAHL, PsycINFO, and PSYNDEX. The literature search concluded on the 6th of November 2025. Methods Following JBI methodology for mixed-methods systematic reviews, qualitative findings were analyzed using the JBI meta-aggregation approach. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). The transactional model of stress and coping served as the theoretical framework. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. 

Results Ten qualitative studies were included, originating from seven countries, published between 1999 and 2025. No quantitative studies meeting the eligibility criteria were identified, representing a significant gap in literature. Patients employed problem-focused coping strategies (active sense-making, reality orientation, proactive avoidance of delirium triggers), emotion-focused strategies (social connection, distancing, self-control), and meaning-based strategies (positive reappraisal, identity restoration). Families directed coping efforts both at supporting the patient through emotional presence, active reorientation, cognitive stimulation, and collaboration with the healthcare team, and at managing their own distress through information-seeking, avoidance, and positive reappraisal. 

Conclusions Both ICU patients and their families actively employ a broad range of coping strategies in response to delirium, consistent with the transactional model of stress and coping. Family caregivers emerge as a primary coping resource for patients while simultaneously managing their own psychological burden. These findings suggest that coping strategies may directly influence the trajectory of delirium-related psychological distress, and provide an evidence base for developing patient- and family-centered, coping-informed psychosocial interventions in ICU delirium care.

Access or request full text: https://libkey.io/10.1186/s13054-026-06232-1

Virtual reality to aid recovery from critical illness: a feasibility trial of a rehabilitation intervention co-developed with key stakeholders

Item Type: Journal Article

Authors: Lynch, Ceri;Gill, Sarah;Drew, Cheney J. G.;Smalley, Michelle;Battle, Ceri;Cullen, Katherine;Greenstock, Craig and Smallman, Kim

Publication Date: 2026

Journal: BMJ Open 16(8), pp. e119613

Abstract: 

Background Improved survival from critical illness has led to an increase in patients with long-term physical and psychological morbidity. Postintensive care rehabilitation services are variable and it is recognised that there is a need for inclusive and accessible interventions to support recovery after critical illness. We engaged with people with lived experience of critical care admission to co-produce a virtual reality mediated intervention (ViRtual REality to AiD recoverY post intensive care unit (ICU) (VR READY). 

Objectives Our primary objective was to determine the feasibility and acceptability of VR READY to improve the patient experience during recovery from critical illness. Secondary objectives included assessment of the feasibility and acceptability of selected outcome measures for use in future efficacy and cost-effectiveness studies for ICU recovery. Design The co-developed intervention (VR READY) was evaluated in a single arm, non-randomised feasibility trial with embedded process evaluation in patients leaving critical care. 

Setting District General Hospital in Wales. Participants Adults who had been admitted to an ICU requiring organ support for more than 48 hours during their current hospital admission. Patients were approached at the point of stepping down from the ICU to a general ward (±48 hours). 87 patients were screened for eligibility, 37 were approached and 22 participants were recruited. Intervention Participants were asked to use VR READY for at least 5 min per day for 14 days. 

Primary and Secondary Outcome Measures The primary outcome was feasibility defined by prespecified criteria. Secondary outcomes prioritised by patients and pertaining to recovery and well-being were assessed at baseline and 14 days. A qualitative interview was conducted 4-6 weeks later. Results 22 participants were recruited with 91% completion of baseline measures, 49.5% completion at 14-day follow-up and 27.3% completing the qualitative interview. Intervention adherence was poor (37.9%), however qualitative findings suggested that participants that engaged with the intervention considered VR READY beneficial to their recovery. While feasibility criteria were met for recruitment and data completion, criteria for retention and intervention adherence were not. 

Conclusions Critical illness is a traumatic experience. Our co-developed rehabilitation intervention VR READY was not feasible in its current format, potentially as a result of being offered too early in recovery when patients were struggling with fatigue, motivation and resilience. VR READY may be beneficial to recovery but further research is needed into optimal mode and timing. Trial Registration Number ISRCTN88854487.

Access or request full text: https://libkey.io/10.1136/bmjopen-2026-119613

 Supratherapeutic drug concentration triggers: A novel data-driven approach to assess their value for medication safety surveillance in intensive care

Item Type: Journal Article

Authors: Langermans, Anne Paulien;Yasrebi-de Kom, Izak,A.R.;de Lange, Dylan Wayne;de Keizer, Nicolette Fransisca;Klopotowska, Joanna E. and RESCUE, Study group

Publication Date: 2026

Journal: British Journal of Clinical Pharmacology 92(9), pp. 3191–3201

Abstract: 

Aims Electronic triggers (e-triggers) are used as screening signals to detect potential adverse drug events (ADEs) and offer an effective system level approach for medication safety surveillance. Their clinical utility is typically evaluated through time-consuming manual chart review by experts, limiting implementation. Estimating associations between e-triggers and relevant ICU patient outcomes may provide a rapid, data-driven alternative. In this study, electronic supratherapeutic drug concentration triggers (eSDCT) were used as a use case. 

Methods Pseudonymized Electronic Health Record (EHR) data from adults admitted to 14 Dutch ICUs (2010-2020) were analysed. Patients with ≥1 therapeutic drug monitoring measurements were included. eSDCTs were selected based on literature, data availability and expert input. Associations with ICU Length of Stay (LOS), ICU mortality and hospital mortality were assessed using adjusted linear and logistic mixed-effects models. 

Results Among 6006 ICU admissions, 49.5% (n = 2973) had ≥1 of the five selected group-level eSDCTs. Exposed admissions showed higher hospital mortality (38.2% vs. 27.9%), ICU mortality (30.6% vs. 20.3%) and longer ICU LOS (median 13.8 IQR 5.6-28.1] vs. 7.5 3.2-15.7] days) compared with unexposed admissions. After adjustment, antibiotic and immunosuppressive eSDCTs remained associated with increased ICU mortality (OR 1.47 1.26-1.70] and 2.86 1.56-5.24]), hospital mortality (OR 1.46 1.27-1.68] and 1.81 1.07-3.10]) and prolonged ICU LOS (expB 1.82 1.71-1.94] and 2.99 2.46-3.62]). Conclusion Our data-driven approach shows that antibiotic and immunosuppressive eSDCTs are associated with worse ICU patient outcomes, supporting their implementation for ICU-level medication safety surveillance.

Access or request full text: https://libkey.io/10.1002/bcp.70610

 Critical care delirium: prevention, identification and management: a narrative review

Item Type: Journal Article

Authors: Kieswick, Stephanie and Gibbison, Ben

Publication Date: 2026

Journal: Anaesthesia 81(9), pp. 1245–1256

Abstract: 

Introduction Delirium is a frequent complication of critical illness and remains an important cause of short- and long-term morbidity for patients admitted to ICUs. Delirium is associated with prolonged mechanical ventilation; extended ICU and hospital stay; and longer-term health issues. Development is associated with patient (e.g. severe physiological derangement); clinical (e.g. sedation); and environmental factors (e.g. loss of day/night variation and sleep deprivation). This review provides an overview of the current understanding of ICU delirium and its implications for critical care practice. Methods We undertook a narrative review of the contemporary literature and synthesised evidence related to epidemiology, pathophysiology, risk factors, diagnostic tools and preventive and therapeutic strategies, with an aim of developing a practical resource for clinicians. 

Results Delirium impacts approximately one-third of patients admitted to general ICUs, with higher rates among older adults and those requiring mechanical ventilation. Diagnosis relies on clinical assessment supported by validated instruments, each with limitations for the critically ill population. Pharmacological interventions have not shown consistent benefit to prevent or treat delirium. In contrast, multicomponent non-pharmacological approaches (e.g. optimal sedation, early mobilisation, re-orientation, sleep hygiene and family engagement) are associated with a reduced incidence of delirium and improved functional outcomes. Delirium contributes to the long-term psychological and cognitive burden of critical illness and structured follow-up and ICU diaries may support recovery. 

Discussion Delirium in the ICU is common and important for patients and multidisciplinary critical care providers. The most effective strategies for prevention and management are non-pharmacological and require co-ordinated, multidisciplinary delivery. Sustained improvements in outcomes require consistent implementation of evidence-based care bundles and better integration of follow-up services for survivors.

Access or request full text: https://libkey.io/10.1111/anae.70192

Best Available Evidence on Weaning and Extubation in Mechanically Ventilated Neurocritical Care Patients: An Evidence Summary

Item Type: Journal Article

Authors: Hong, Yuezhen;Wang, Meixin;Zhang, Chenxing;Arbing, Rachel H. A.;Chen, Wei-Ti;Han, Xuanye and Huang, Feifei

Publication Date: 2026

Journal: Nursing in Critical Care 31(5), pp. e70670

Abstract: 

Background Weaning and extubation in neurocritical care are high - risk decisions complicated by impaired consciousness and airway - protection challenges and practice guidance remains fragmented. Aims To map, evaluate and synthesize the available evidence on weaning and extubation management for neurocritical care patients receiving mechanical ventilation. 

Study Design This study was designed as an evidence summary and conducted according to the methodological standards for evidence summaries established by the Fudan University Evidence - Based Nursing Center. Twenty - seven information sources were searched from inception to 7 June 2025, including clinical decision support systems, guideline repositories, professional association websites, evidence-based practice platforms and speciality databases. Eligible evidence included guidelines/manuals, evidence summaries, expert consensus, systematic reviews and randomized controlled trials. The evidence summary was registered with the Fudan University Evidence - Based Nursing Center and guided by the 6S evidence pyramid. Quality appraisal, evidence extraction, synthesis and grading were conducted using evidence type-specific tools and a pre-established evidence grading system. 

Results Seventeen studies met the inclusion criteria and quality requirements. Thirty - two pieces of evidence were synthesized into six domains: functional rehabilitation and training interventions; airway protection and secretion management; swallowing and phonation training; weaning/extubation decision - making and peri - extubation management; sedation management and consciousness support; and risk factors and predictors of extubation failure. 

Conclusions This study consolidated 32 pieces of evidence on weaning and extubation in neurocritical care, providing a structured synthesis while highlighting uneven evidence quality and uncertain feasibility in resource - limited settings. 

Relevance to Clinical Practice Clinicians should prioritize positioning, early rehabilitation, artificial airway management and secretion clearance, while combining evidence with expert consensus and tailoring implementation to patient status and local resources.

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Inspiring Hope in Critical Care: The Role of Patients' Trust in Nurses

Item Type: Journal Article

Authors: Gabay, Gillie and Ben-Asher, Smadar

Publication Date: 2026

Journal: Nursing in Critical Care 31(5), pp. e70634

Abstract: Background Hope among patients in intensive care units (ICU) supports a 'will to live' and recovery, yet it remains under-investigated. Aim To explore ICU patients' experiences of trust in nurses and how they are linked to hope during and following ICU stays. Study Design A longitudinal narrative study guided by a constructivist paradigm, focusing on patients' meaning-making and interpretations of their lived experiences. Participants were three women and six men, aged 62-81, with life-threatening events and prolonged ICU stays. Each participant was interviewed upon discharge and again approximately 1 month later. Participants were recruited through snowball sampling. Inclusion criteria included prolonged ICU stays and willingness to participate. Data were analysed using reflexive thematic analysis. Findings Participants described both compassionate nursing care characterized by emotional presence and sustained efforts to relieve suffering and experiences of direct or indirect nurse aggression. Four states of trust were identified along a continuum ranging from trust to relying on personal agency and self-efficacy. Incidents of humiliation undermined dignity and weakened patients' capacity to trust. Hope emerged as a relational process closely associated with trust in nurses. Levi's profiles of hope were subsequently used as an interpretive framework for understanding variations in patients' experiences of hope. Conclusions Trust is a relational process that unfolds within ICU nurse-patient interactions. Participants who described trusting relationships with nurses were more likely to report experiences consistent with hope during and following ICU hospitalization. Nurses play a central role in fostering trust and supporting hope during critical illness. Relevance to Clinical Practice The findings highlight the importance of nurse training targeting trust-building nursing practices to support hope among ICU patients. Attention to communication and emotional presence may strengthen therapeutic relationships, establish trust and inspire hope.

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Intensive care decision-making, survival and dying well: a mixed methods study with people who have been intensive care patients

Item Type: Journal Article

Authors: Donaldson, Thomas;Keywood, Kirsty;Frith, Lucy and Holm, Søren

Publication Date: 2026

Journal: Anaesthesia 81(10), pp. 1367–1377

Abstract: 

Introduction Admission to the ICU involves experiential burdens and a risk of a negative dying experience if patients do not survive their critical illness. Many patients who are critically unwell, or their surrogate decision-makers, must decide about accepting ICU treatment without knowing what it is like. People who have been through ICU treatment can provide useful insights into what it might be like to die in ICU and what chance of survival makes ICU treatment acceptable to them. 

Methods This study utilised a mixed methods approach involving questionnaires and semi-structured interviews which were analysed using a reflexive thematic analysis approach. This was done to provide a deep and rich analysis of how participants' experiences of ICU treatment and end-of-life wishes affected their reflections about what it might be like to die on an ICU, and their willingness to accept ICU treatment again in the future. 

Results Twenty-six people who had experienced ICU as patients were interviewed. Whilst some positive experiences were reported, participants thought the negative experiences associated with ICU made it likely that dying on ICU would be a negative dying experience. Being a patient in an ICU involved a confrontation with mortality, loss of control and total dependence, and was described as a transformative experience. Participants considered the chance of survival to be an important consideration in shared decision-making with ICU clinicians about ICU treatments. The median chance of survival that made ICU treatment acceptable was 30%. 

Discussion An understanding of the experiences associated with being a patient in the ICU can inform how patients and clinicians consider the risk-benefit analysis of ICU treatment. The experiential harms of ICU admission and the risk of ICU treatment resulting in a negative dying experience may outweigh the survival benefit that ICU treatment will offer a patient when there is a low chance of survival.

Access or request full text: https://libkey.io/10.1111/anae.70285

Family-Centred Care Interventions in Adult Intensive Care Units: A Scoping Review of Experiences, Barriers and Facilitators

Item Type: Journal Article

Authors: Chang, Pei-Yu;Nakajima, Shohei;Kuo, Shu-Yu and Tsai, Shao-Yu

Publication Date: 2026

Journal: Nursing in Critical Care 31(5), pp. e70614

Abstract: 

Background Family-centred care (FCC) is recognized as a holistic approach to improve patient outcomes, reduce psychological symptoms in family caregivers, and enhance communication between families and healthcare professionals. However, existing research has primarily focused on clinical outcomes or isolated FCC components, with limited attention given to the experiences of those involved in its implementation. 

Aims This study aimed to synthesize the experiences of family caregivers and healthcare professionals with FCC interventions and to identify the barriers and facilitators to the implementation of FCC interventions in adult intensive care units (ICUs). 

Study Design This review followed the Arksey and O'Malley framework and PRISMA-ScR guidelines, covering studies up to August 2025. The databases searched included CINAHL, Embase, PsycINFO, PubMed, Scopus and the Cochrane Library. Data were synthesized narratively to summarize the main findings across studies. 

Results A total of 32 studies were included. Both family caregivers and healthcare professionals generally expressed willingness to engage in FCC interventions. However, several barriers to implementation were identified, including interpersonal factors, relational challenges and workforce limitations. Strong relationships among families and healthcare teams, a positive unit culture and supportive institutional policies were noted as facilitators. 

Conclusions This scoping review highlights the complex interplay of interpersonal, organizational and environmental factors that influence the successful implementation of FCC interventions in adult ICUs. Addressing identified barriers and leveraging facilitators are essential for developing effective, context-sensitive strategies to enhance the delivery of FCC. Future research should focus on knowledge and tools from implementation science to guide the integration and sustainment of FCC interventions in adult ICUs. 

Relevance to Clinical Practice FCC implementation in ICUs requires addressing barriers and facilitators at multiple levels. Supportive policies, clear communication, leadership support and family needs are essential for facilitating the integration of FCC into ICU practice and strengthening collaboration between families and healthcare professionals. 

Access or request full text: https://libkey.io/10.1111/nicc.70614

Ethical and Emotional Dilemmas in the Medical Decision-Making Process Among Family Members of Intensive Care Patients: A Qualitative Study

Item Type: Journal Article

Authors: Bahcecioglu Turan, Gülcan;Demir, Mizgin and Gür, Fatma

Publication Date: 2026

Journal: Nursing in Critical Care 31(5), pp. e70630

Abstract: 

Background Intensive care units (ICUs) constitute a highly challenging environment for patients' relatives due to critical illnesses and uncertain prognoses, creating significant ethical and emotional strain. Family members often face profound ethical dilemmas and a substantial emotional burden when making medical decisions on behalf of the patient. 

Aim This study aimed to explore the ethical and emotional dilemmas experienced by family members of intensive care patients during the medical decision-making process and the strategies they used to cope with these experiences. 

Study Design This qualitative descriptive study was conducted between January and March 2026 in the adult ICUs of a public hospital located in eastern Türkiye. Data were collected through semi-structured, in-depth interviews with 20 family members selected via purposive sampling. Interviews were discontinued upon reaching data saturation. The study was reported in accordance with the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines to ensure transparency and methodological rigour. 

Findings Four main themes reflecting participants' experiences were identified: 'Ethical Dilemma and Responsibility', 'Intense Emotional Reactions and Internal Reflection', 'Information and Communication Process' and 'Coping and Support Mechanisms'. Participants reported being caught between critical decisions such as prolonging life and alleviating suffering. The weight, uncertainty and irreversibility of these decisions led to significant stress, anxiety and feelings of guilt. Social support, along with spiritual and individual coping strategies, played a crucial role in managing this process. Conclusions Family members of patients in intensive care experience a multilayered burden encompassing ethical, emotional and cognitive dimensions during medical decision-making. Effective communication, guidance and social-spiritual support mechanisms are critical in alleviating this burden. 

Relevance to Clinical Practice This study highlights the ethical and emotional burden experienced by family members during decision-making in intensive care settings and underscores the importance of clear and empathetic communication by healthcare professionals. Additionally, the provision of psychosocial and spiritual support may facilitate decision-making and reduce the burden on family members.


Access or request full text: https://libkey.io/10.1111/nicc.70630

Harnessing Artificial Intelligence to Strengthen Acute and Critical Care Nursing Practice: A Systematic Review

Item Type: Journal Article

Authors: Almagharbeh, Wesam Taher;Alkubati, Sameer A.;Alasmari, Amal Ali;Alharbi, Amal Ali;Alfanash, Hazem AbdulKareem;Abuadas, Fuad H.;El Arab, Rabie Adel;Alkhawaldeh, Abdullah;Alamri, Ayman Ateq;Albalawi, Haia Mahdi and Alatawi, Abeer

Publication Date: 2026

Journal: Nursing in Critical Care 31(5), pp. e70606

Abstract: 

Background Artificial intelligence (AI) is reshaping clinical decision support systems (CDSSs). In acute and critical care, nurses provide continuous surveillance, recognise deterioration, coordinate escalation and translate protocols into bedside action. AI-CDSS may be particularly relevant when they support rather than replace clinical judgement. Aim To examine whether nurse-used AI-CDSS improve patient-important outcomes in acute and critical care contexts and summarise effects on care processes and nurse-reported outcomes. 

Study Design Following PRISMA 2020 and a preregistered protocol, we searched eight databases and major trial registries for English-language studies from 1 January 2010 to 1 January 2026. Searches were conducted on 1 January 2026. We included randomised, quasi-experimental and adjusted cohort studies in which registered nurses or nursing teams were primary users of AI-CDSS generating patient-specific predictions or recommendations. Mortality was pooled using a random effects model; other outcomes were synthesised narratively. 

Results Seven studies involving about 75 000 patients were included. Most evidence came from acute wards, intensive care units, sepsis, deterioration and delirium-prevention contexts, with additional home and palliative care evidence. Three mortality studies were pooled. Nurse-facing AI-CDSS were associated with lower hospital mortality (RR 0.68, 95% CI 0.53-0.87; I² = 24%), although the prediction interval included possible no effect. Length of stay and protocol adherence generally improved when tools were embedded in nursing workflows. Nurse-reported outcomes were sparse. 

Conclusion Nurse-facing AI-CDSS may strengthen acute and critical care nursing by improving surveillance, escalation and protocol delivery for patients at risk of deterioration. Evidence is promising but limited by small study numbers, heterogeneous interventions and sparse nurse-reported outcomes. Critical care implementation should prioritise nurse-centred design, alert burden, equity, safety monitoring and rigorous evaluation before scale-up. Relevance to Clinical Practice Nurse-used AI-CDSS show potential to improve patient outcomes and care processes, but evidence remains limited and context dependent.


Access or request full text: https://libkey.io/10.1111/nicc.70606