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IntroductionIn adult patients in intensive care units (ICU), early mobilization is one of the central non-pharmacological interventions studied for recovery from critical illness. Several systematic reviews (SRs) have been conducted to determine the effect of this intervention on ICU-acquired weakness (ICU-AW) with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may be generating research waste that makes it difficult for clinicians to keep up to date with the best available evidence. Therefore, this meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilization in critically ill adult patients on different clinical outcomes.MethodsA meta-research of early mobilization SRs in critically ill adult patients will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction, and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the “Evidence-Based Research” framework. The methodological quality of the SRs will be assessed with the AMSTAR 2 tool and the quality of the reports through compliance with the PRISMA statement. To assess the potential reasons for discordance in the results of the SRs, only SRs that an MA has carried out will be analyzed, considering divergence in results and their interpretation.Expected resultsThe analysis of this meta-research will assess the redundancy in the conducting of SR on the mobilization of critically ill adult patients, their methodological quality, and the quality of the reporting of their findings, as well as the causes of possible discrepancies between their results. These findings could guide the development of better and more timely SRs on the effectiveness of early mobilization of adult critically ill patients. The decrease in waste research could facilitate evidence-based decision-making by stakeholders.Registration numberosf.io/kxwq9

In this white paper, key recommendations for visitation by children in intensive care units (ICU; both pediatric and adult), intermediate care units and emergency departments (ED) are presented. In ICUs and EDs in German-speaking countries, the visiting policies for children and adolescents are regulated very heterogeneously: sometimes they are allowed to visit patients without restrictions in age and time duration, sometimes this is only possible from the age of teenager on, and only for a short duration. A request from children to visit often triggers different, sometimes restrictive reactions among the staff. Management is encouraged to reflect on this attitude together with their employees and to develop a culture of family-centered care. Despite limited evidence, there are more advantages for than against a visit, also in hygienic, psychosocial, ethical, religious, and cultural aspects. No general recommendation can be made for or against visits. The decisions for a visit are complex and require careful consideration.

Physiotherapists are experts in early mobilisation and respiratory techniques, assisting patients in their recovery from critical illness in the Intensive Care Unit (ICU). However, current provision of physiotherapyand practice delivered across Europe is varied and inconsistent. This project will utalise a large-scale survey design to identify physiotherapy practices in ICU across Europe and will allow development of targeted education packages and inform physiotherapy curricula, which will benefit patients in the long-term to receive the best and evidence-informed care across the whole continent.

BACKGROUND Relatives of patients in the intensive care unit (ICU) face a challenging situation: they often experience an existential crisis with great emotional stress and at the same time they are often actively involved in therapeutic decisions. The visiting restrictions of the coronavirus disease 2019 (COVID-19) pandemic have created new challenges in providing support to relatives. OBJECTIVES The aim of this work is to present current and new developments in supporting relatives of critically ill patients in the form of a narrative review. RESULTS In recent years, numerous new approaches and projects to support relatives have been developed. They can be assigned to the following six areas: 1) presence of relatives in the ICU, 2) proactive involvement in care, 3) structured communication/information and online offers, 4) multidisciplinary cooperation, 5) organizational management and 6) follow-up offers. The evidence and the current implementation status of these measures are very heterogeneous internationally and nationally. CONCLUSIONS Measures for providing support for ICU relatives are diverse. Some can even be implemented despite visit bans. Recent digital developments enable virtual visits and a better exchange of information between the ICU team and relatives.

Relatives of patients in the intensive care unit (ICU) face a challenging situation: they often experience an existential crisis with great emotional stress and at the same time they are often actively involved in therapeutic decisions. The visiting restrictions of the coronavirus disease 2019 (COVID-19) pandemic have created new challenges in providing support to relatives.; The aim of this work is to present current and new developments in supporting relatives of critically ill patients in the form of a narrative review.; In recent years, numerous new approaches and projects to support relatives have been developed. They can be assigned to the following six areas: 1) presence of relatives in the ICU, 2) proactive involvement in care, 3) structured communication/information and online offers, 4) multidisciplinary cooperation, 5) organizational management and 6) follow-up offers. The evidence and the current implementation status of these measures are very heterogeneous internationally and nationally.; Measures for providing support for ICU relatives are diverse. Some can even be implemented despite visit bans. Recent digital developments enable virtual visits and a better exchange of information between the ICU team and relatives.

Supplemental material, sj-docx-1-jic-10.1177_08850666221097644 for Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic by Keibun Liu, Kensuke Nakamura, Sapna R. Kudchadkar, Hajime Katsukawa, Peter Nydahl, Eugene Wesley Ely, Kunihiko Takahashi, Shigeaki Inoue and Osamu Nishida in Journal of Intensive Care Medicine

Supplemental material, sj-docx-1-jic-10.1177_08850666221097644 for Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic by Keibun Liu, Kensuke Nakamura, Sapna R. Kudchadkar, Hajime Katsukawa, Peter Nydahl, Eugene Wesley Ely, Kunihiko Takahashi, Shigeaki Inoue and Osamu Nishida in Journal of Intensive Care Medicine

PURPOSE We assessed the prevalence and variables associated with haloperidol use for delirium in ICU patients and explored any associations of haloperidol use with 90-day mortality. METHODS All acutely admitted, adult ICU patients were screened during a 2-week inception period. We followed the patient throughout their ICU stay and assessed 90-day mortality. We assessed patients and their variables in the first 24 and 72 h in ICU and studied their association together with that of ICU characteristics with haloperidol use. RESULTS We included 1260 patients from 99 ICUs in 13 countries. Delirium occurred in 314/1260 patients [25% (95% confidence interval 23-27)] of whom 145 received haloperidol [46% (41-52)]. Other interventions for delirium were benzodiazepines in 36% (31-42), dexmedetomidine in 21% (17-26), quetiapine in 19% (14-23) and olanzapine in 9% (6-12) of the patients with delirium. In the first 24 h in the ICU, all subtypes of delirium [hyperactive, adjusted odds ratio (aOR) 29.7 (12.9-74.5); mixed 10.0 (5.0-20.2); hypoactive 3.0 (1.2-6.7)] and circulatory support 2.7 (1.7-4.3) were associated with haloperidol use. At 72 h after ICU admission, circulatory support remained associated with subsequent use of haloperidol, aOR 2.6 (1.1-6.9). Haloperidol use within 0-24 h and within 0-72 h of ICU admission was not associated with 90-day mortality [aOR 1.2 (0.5-2.5); p = 0.66] and [aOR 1.9 (1.0-3.9); p = 0.07], respectively. CONCLUSIONS In our study, haloperidol was the main pharmacological agent used for delirium in adult patients regardless of delirium subtype. Benzodiazepines, other anti-psychotics and dexmedetomidine were other frequently used agents. Haloperidol use was not statistically significantly associated with increased 90-day mortality.