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Background Methods Results Conclusions Oesophagectomy for surgical management of oesophageal carcinoma has previously been performed via an open approach (OE), with a change in recent years to a minimally invasive technique (MIO). We performed a retrospective study to compare the rates of post‐operative complications between OE and MIO patients at our institution. Secondary outcomes included nodal yield and ICU LOS.This is a retrospective, observational, case‐matched single centre study of 2‐stage oesophagectomies for carcinoma from January 2011 to December 2021. Fourty‐four MIO patients were matched by age to 44 OE patients. Post‐operative pulmonary, cardiac and surgical complications were defined using the Esophagectomy Complications Consensus Group (ECCG) guidelines.Baseline characteristics were similar for the two groups, with a higher ASA grade for patients undergoing MIO. There was no significant difference in post‐operative pulmonary complication rates between the OE versus MIO groups (41% versus 55%, P = 0.29). There were more cardiac arrhythmias in the MIO group however this was not statistically significant (9.1% versus 22.7%, P = 0.08). Rate of re‐operation was equal between the groups with no difference between rates of other surgical complications, ICU LOS or hospital LOS. Significantly higher nodal yield was achieved in the MIO group. Overall rate of Clavien‐Dindo graded complications were similar (55% versus 66%, P = 0.28).MIO was associated with higher lymph node yield, and comparable complication rates when compared to OE and does not significantly alter time spent in hospital. [ABSTRACT FROM AUTHOR]

Summary Introduction Methods Results Discussion Cognitive impairment is a significant healthcare problem globally and its prevalence is projected to affect over 150 million people worldwide. Survivors of critical illness are impacted frequently by long‐term neurocognitive dysfunction regardless of presenting illness, but the mechanisms are poorly understood. The goal of this review was to synthesise the existing evidence regarding potential mechanisms underlying neurocognitive dysfunction following critical illness in order to guide potential avenues for future research.We performed a systematic search of the literature for studies published between 1 January 1974 and 15 July 2023. We included publications involving adult patients with critical illness due to any aetiology that assessed for cognitive impairment following recovery from illness, and explored or investigated potential underlying causative mechanisms. The quality and risk of bias of the individual studies was assessed using the Newcastle‐Ottawa scale.Of the 7658 reviewed references, 37 studies comprising 4344 patients were selected for inclusion. Most studies were single centre with sample sizes of < 100 patients. The proportion of patients with long‐term cognitive impairment ranged from 13% to 100%. A wide variety of theoretical mechanisms were explored, with biomarkers and neuroimaging utilised most frequently. Many studies reported associations between investigated mechanisms and reduced cognition; several of these mechanisms have been implicated in other forms of long‐term neurodegenerative conditions. Increased levels of inflammatory cytokines during acute illness and white matter hyperintensities on neuroimaging following recovery were the associations reported most commonly.The underlying pathophysiology of neurocognitive decline after critical illness is not yet understood fully. The mechanisms implicated in other neurodegenerative conditions suggest that this may represent an accelerated version of the same processes. Large scale studies are required to further elucidate the cause of this significant problem for survivors of critical illness. [ABSTRACT FROM AUTHOR]

Background Aims Materials and methods Results Conclusions Pregnant and post‐partum (collectively peri‐partum) women may be at increased risk of severe COVID‐19 disease.To describe the characteristics, interventions, and outcomes of peri‐partum patients admitted to intensive care units (ICUs) in Australia with COVID‐19.We conducted a prospective, multicentre observational study using the SPRINT‐SARI Australia database across 63 ICUs in Australia. All women <45 years of age, admitted to a participating Australian ICU, with laboratory‐confirmed COVID‐19 between 1 March 2020 and 1 June 2023 were included. Participants were categorised as either peri‐partum, defined as pregnant or up to six weeks post‐partum, or non‐pregnant. The primary outcome was in‐hospital mortality.A total of 737 eligible female patients were admitted to ICUs over the study period: 168/737 (23%) were peri‐partum, while 569/737 (77%) were non‐pregnant. The median age of peri‐partum women was 31 (interquartile range (IQR) 27–36) years old, and median gestation was 28.0 (IQR 4–40) weeks. When compared to non‐pregnant women, peri‐partum women had lower rates of comorbidities (1.8% vs 14.4% P < 0.001), lower vaccination rates (27.4% vs 45.2%, P < 0.001), similar rates of mechanical ventilation, and greater use of tocilizumab (29.2% vs 4.0%, P < 0.001). Complications were low in both groups. In‐hospital mortality was lower in peri‐partum patients: 1/168 (0.6%) vs 24/569 (4.2%); P = 0.04.Peri‐partum patients made up ~25% of all women aged <45 years old admitted to Australian ICUs with COVID‐19, and nearly 30% required mechanical ventilation. Despite lower vaccination rates in peri‐partum patients, in‐hospital mortality was lower than in non‐pregnant patients. [ABSTRACT FROM AUTHOR]

Aim: Medical institutions restricted visitation to neonatal intensive care units (NICUs) during the coronavirus disease (COVID‐19) pandemic. Therefore, this study aimed to investigate the impact of COVID‐19 NICU visitor restrictions on parents. Methods: We conducted a questionnaire of 378 parents of infants who were hospitalised for more than 1 week at two NICUs in our area and discharged between 1 April 2020 and 31 March 2022. While the visiting rules for NICUs during this period varied depending on the phase of the COVID‐19 epidemic, generally, only parents were allowed to visit the NICUs for a few hours daily. Results: A total of 157 parents (A University Hospital (AMUH), n = 79; AK General Hospital (AKGH), n = 78) responded to the survey (41.3% response rate), with 40% stating that their emotions towards their infants were affected by restrictions due to the COVID‐19 pandemic. Parents' feelings towards their infants were influenced by mode of delivery, parity, duration of hospitalisation and opportunities to visit the NICU. More than 70% of respondents felt stressed due to COVID‐19 restrictions, and anxiety and emotional stress related to visitor restrictions were significantly affected by the number and duration of visits and allowability of family member visits. Parents felt that the restrictions had a negative impact on breastfeeding, overall infant care and infant–family bonding. Conclusion: As parents felt an impact on the bond with their infant during visitation restrictions, it is essential for facilities to implement measures to protect infant–family bonding during potential future pandemics. [ABSTRACT FROM AUTHOR]

Background and purpose: Exacerbation of myasthenia gravis (MG) with respiratory failure requires intensive care. We aimed to study the risk factors for intensive care unit admission for MG exacerbation and myasthenic crisis (MC) and the prognosis of people with MG (pwMG) thereafter. Methods: This retrospective study investigated patients in the Helsinki and Uusimaa hospital district during the years 2008–2021. PwMG (International Classification of Diseases, 10th revision code G70.0) were identified through a data repository search, followed by a chart review of patient records. Risk factors for intensive care due to MG exacerbation were evaluated as compared with the patients only treated in the outpatient clinic and those treated in the neurological ward for MG exacerbation. The outcomes of patients in intensive care for any reason were also compared with those of patients in intensive care for exacerbation of bronchial asthma. Results: Of 577 pwMG, 35 (6.1%) needed intensive care for MG within a median of 5.3 months from diagnosis. The mean (±SD) age at MG diagnosis was higher in the intensive care group (60.5 [±16.1] years) compared to the outpatient (48.3 [±20.9] years; p < 0.001) and neurological ward groups (53.4 [±20.8] years; p = 0.044). Thymoma (odds ratio [OR] 4.8, 95% confidence interval [CI] 1.19–19.43; p = 0.028) and female sex (OR 2.1, 95% CI 1.02–4.48; p = 0.045) were independent risk factors for intensive care. In‐hospital mortality was 4% for MC patients. Six‐month mortality after intensive care for MG exacerbation (14.3%) was twice that for asthma exacerbation (7.7%). Conclusion: Our study shows an increased risk of intensive care treatment for patients with late‐onset MG, female sex or thymoma, occurring usually within 6 months from diagnosis, which emphasises the importance of early treatment choices. [ABSTRACT FROM AUTHOR]

A 25‐week‐old Oriental shorthair cat was anaesthetised to perform computed tomography and bronchoscopy. During endotracheal intubation, a deciduous premolar was contacted with the laryngoscope blade, dislodged, and subsequently aspirated into the trachea. The tooth was removed via bronchoscopy, and the cat was recovered in the intensive care unit due to the development of laryngeal oedema. The risk factors for tooth dislodgement in the cat and proposed improvements in the immediate period after dislodgement are discussed in this report. [ABSTRACT FROM AUTHOR]

Introduction: This is a phenomenologically designed qualitative study conducted to explore and conceptualize the problems experienced by intensive care nurses caring for patients undergoing continuous renal replacement therapy. Methods: Face‐to‐face, semi‐structured interviews were conducted with the participants. The interviews were transcribed verbatim, then thematic analysis was conducted. Results: The study was conducted 12 intensive care nurses. As a result, 3 main and 6 sub‐themes were identified. The themes identified were changing routines, uncertainty in terms of patient benefit, and need for adaptation. Conclusion: It was found that nurses experienced challenges in providing care to patients undergoing continuous renal replacement therapy, spent more effort to prevent complications, and lacked information on the subject. It is recommended to consider institutional and individual actions to meet the educational needs of nurses for implementing continuous renal replacement therapy. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions The survival rate of people with HIV admitted to intensive care units (ICUs) is approaching that of people without HIV. We conducted a matched‐cohort study of people with and without HIV admitted to ICU at a large hospital to compare short‐term mortality, during 2000–2019.People with HIV were matched to people without HIV (1:2) on age, sex, admission year and Acute Physiology and Chronic Health Evaluation (APACHE)‐II score. Applying logistic regression models fitted using independence estimating equations, we describe population‐averaged associations of HIV with short‐term (in‐ICU, in‐hospital) mortality during a patient's first admission to ICU, and explore whether these varied by year.A total of 177 people with HIV were matched to 354 people without HIV (71.2% vs. 71.2% male; median age: 47 vs. 48 years, median APACHE‐II: 18 vs. 17, median admission year: 2013 vs. 2013). Among people with HIV, 73.4% were on antiretroviral therapy, 51.2% had HIV‐RNA ≤50 copies/mL and median CD4 T‐cell count was 132 cells/μ$$ \upmu $$L. People with HIV had higher in‐ICU (24.3% vs. 15.3%) and in‐hospital (31.6% vs. 20.1%) mortality. People with HIV had 1.69‐fold higher odds (95% confidence interval: 1.03–2.76) of in‐ICU mortality and 1.86 (1.19–2.91) higher odds of in‐hospital mortality than people without HIV, adjusted for age, sex, year and APACHE‐II. There was no evidence that these associations varied by year (p‐interaction‐in‐ICU = 0.90; p‐interaction‐in‐hospital = 0.46).Our findings suggest that although outcomes have improved over time, people with HIV continue to have higher short‐term in‐ICU and in‐hospital mortality following ICU admission compared with people without HIV with similar characteristics. [ABSTRACT FROM AUTHOR]

Background and purpose Methods Results Conclusions Few data are available on the course of myasthenia gravis (MG) regarding disease severity and stability over time in real‐world settings. This study used the French National Health Insurance Database (SNDS) to assess markers of disease severity in patients with MG longitudinally.All patients with MG‐related claims in the SNDS between 2013 and 2020 were identified. Patients were followed for up to 8 years after the first claim. Intensive care unit (ICU) stays, treatment with intravenous immunoglobulin (IVIg) or plasma exchange (PE), and death were documented throughout the follow‐up period. Standardized mortality rates were estimated, and mortality‐related variables were identified using a Cox model.In all, 14,459 individuals constituted the full study population, including 6354 incident patients. In the incident population, 2199 (34.6%) were admitted to ICUs at least once, principally during the first year after the index date (N = 1477; 23.3%). This proportion decreased progressively to reach 3.0% in the seventh year. A total of 2817 patients received IVIg and 432 PE, again principally in the first year. In the full study population, the standardized mortality rate was 1.08 (95% confidence interval [CI] 1.03–1.13), being lower in men (0.95, 95% CI 0.89–1.02) than in women (1.15, 95% CI 1.07–1.23) and in patients aged >65 years (1.06, 95% CI 1.01–1.11) than in younger patients (1.50, 95% CI 1.24–1.76). Male gender, older age and higher comorbidity were independently associated with mortality.A subgroup of patients with MG require ICU admission and rescue therapy with IVIg or PE, indicative of poor disease control. New therapies are needed to improve disease control and reduce disease burden. [ABSTRACT FROM AUTHOR]

Background: Few formal instruments exist to assess the communicative competence of patients hospitalized in intensive care units (ICUs). This can limit interventions by health professionals. Aims: To map the categories and instruments for assessing the communicative competence of adult patients with minimal response in ICUs. Methods & Procedures: A scoping review was carried out following the Joanna Briggs Institute protocol between February and March 2022 and using the MEDLINE (PubMed), Scopus, Scielo, Business Source Complete (via EBSCOhost), Academic Search Complete (via EBSCOhost) and Web of Science databases, in Portuguese, English and Spanish. Main Contribution: Eight studies met the inclusion criteria. The different communication and pain assessment protocols covered awareness, cognition, sensory capacity, motor capacity, language, speech and literacy. Conclusions & Implications: The present review offers a starting point for the construction of a formal assessment instrument to enable clinicians to implement an augmentative or alternative communication system (AACS) for the voluntary, independent and active participation of patients. WHAT THIS PAPER ADDS: What is already known on the subject: Patients in ICUs are subject to various forms of treatment and continuous and intensive monitoring, compromising their capacity to communicate and actively participate (e.g., sharing symptoms and making decisions). Although there is some awareness of their disadvantage in such a regard, few protocols of assessment of communicative competence have been adapted to patients with a minimum response. What this paper adds to the existing knowledge: The present review highlights different protocols for the assessment of communication and pain. They include the following categories: awareness, sensory capacity, auditory and visual acuity, positioning and motor capacity, language, speech, and literacy. The review offers a starting point for the construction of a formal assessment instrument encompassing the aforementioned categories, along with duly validated guidelines for its application. What are the potential or actual clinical implications of this work?: Our formal assessment instrument takes into account the need to adapt to different patient profiles. It is hoped that it will provide speech therapists and other health professionals with the information required to implement an AACS in which patients participate actively. [ABSTRACT FROM AUTHOR]

Background: Medical devices commonly used for the treatment and care of critically ill patients can cause pressure injuries in intensive care units (ICUs). The endotracheal tube (ETT) is one of the most common medical devices to cause pressure injuries. Aim: This study investigated the incidence of, characteristics of and risk factors for ETT‐related pressure injuries for ICU patients. Study Design: This study adopted a prospective descriptive research design. The sample consisted of 146 endotracheally intubated patients. Data were collected using a patient information form, an Endotracheal Tube‐Related Pressure Injuries Assessment Form, the Braden Risk Assessment Tool and the Nutritional Assessment Test. Results: The study revealed that 80.14% of the patients developed ETT‐related pressure injuries. Over half of the ETT‐related pressure injuries appeared on Day 3 or 4 (56.41%). High body mass index was found to be associated with the development of ETT‐related pressure injuries (OR: 1.15, 95% CI: 1.05–1.26, p =.003). None of the other variables were statistically significant in the development of pressure injuries. Conclusions: The incidence of ETT‐related pressure injuries was quite high in the internal, surgical and anaesthesia ICUs. High body mass index was associated with the development of ETT‐related pressure injuries. Intensive care nurses should implement interventions to prevent ETT‐related pressure injuries in critically ill patients receiving mechanical ventilation support. Relevance to Clinical Practice: ETT‐related pressure injuries are common in ICU patients. High body mass index was associated with the development of ETT‐related pressure injuries in critically ill patients. The skin and mucosa should be assessed for the development of ETT‐related pressure injuries during the daily assessment of the patients receiving mechanical ventilation support. The ETT should be repositioned regularly, and the most suitable ETT fixation method should be used. [ABSTRACT FROM AUTHOR]

Background: The visit restrictions imposed as a result of COVID‐19 precluded the entrance of the patient's family into the confines of the intensive care unit. Aim: This study evaluated the experiences of intensive care nurses (ICNs) regarding COVID‐19 visit restrictions and their opinions on these restrictions. Study Design: From May 2023 to July 2023, semi‐structured interviews with 15 ICNs from intensive care units in a tertiary public hospital in Türkiye were conducted. Data were analysed using qualitative content analysis with an inductive approach. Reporting of the study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: The analysis revealed two main themes, 'widespread negative impacts of visit restrictions' and 'adaptive strategies to the visitation ban', and seven sub‐themes supporting the main themes. Nurses perceived that the visit restrictions imposed during the COVID‐19 pandemic had a severe negative effect on patients, their relatives, themselves and the care environment. They also did not support visit restriction in future pandemics. Conclusions: The COVID‐19 visitation policy weakened the involvement of family members in patient care and created serious challenges in the intensive care setting. The study revealed an urgent need for patient‐centred, family‐sensitive and consistently applied protocols in future pandemics. Relevance to Clinical Practice: In future pandemics, strategies such as the benefit–benefit ratio of the visit, the provision and use of adequate personal protective equipment, and vaccination requirements should be considered in visiting decisions of patients hospitalized because of infection. Participation of nurses responsible for patient care in decisions regarding visitor practices should be supported. [ABSTRACT FROM AUTHOR]

Background: Intensive care units (ICUs) are environments where nurses are open to emotional interactions because of complex structures and dynamic relationships. Nurses' susceptibility to emotional contagion and their spiritual care competence may affect the quality of care by influencing their ability to manage and respond to the emotional dynamics present in these environments. Aim: This study aimed to determine the level of emotional contagion and spiritual care competence in intensive care nurses. Study Design: This study is a descriptive cross‐sectional study conducted with 199 nurses working in the ICUs of a training and research hospital in Turkey. The data were collected between December 2021 and June 2022 using the Emotional Contagion Scale (ECS) and the Spiritual Care Competence Scale (SCCS). Results: The mean score of the nurses was 50.29 ± 15.36 on the ECS and 90.29 ± 29.53 on the SCCS. A statistically significant difference was found between the ECS and SCCS and gender, marital status, weekly working hours and some approaches about spiritual care (p <.05). It was determined that there was a statistically significant positive correlation between the total scales and sub‐dimensions of the ECS and SCCS (p <.05). In this study, it was found that intensive care nurses' susceptibility to emotional contagion was high, and that their spiritual care competence was at a moderate level. The results show that gender, marital status, weekly working hours, type of ICU and some approaches about spiritual care are crucial factors in nurses' emotional contagion and spiritual care competence. In addition, as the intensive care nurses' susceptibility to emotional contagion increased, their spiritual care competence also increased. Conclusions: The results of this study will guide the planning of interventions to protect intensive care nurses from the negative effects of emotional contagion and increase their spiritual care competence. Relevance to Clinical Practice: It is necessary to protect intensive care nurses from the negative effects of emotional contagion and to increase their competences in spiritual care. [ABSTRACT FROM AUTHOR]

Background: The quality of the sleep in the intensive care unit (ICU) is generally poor. It is known that several factors contribute to this situation. Aim: To describe the experiences of adult patients during night‐time sleep in the ICU. Design: A qualitative study using a phenomenological approach was conducted from May to October 2021. Patients were intensive care patients (n = 10) who were treated for at least 24 h in tertiary ICUs. Methods: The data were obtained through semi‐structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed. Results: The analysis resulted in three main themes: (a) inadequate sleep at night; (b) factors negatively affecting night‐time sleep; and (c) patient expectations for improved night‐time sleep. Night‐time sleep of patients treated in intensive care were determined to generally have inadequate and be interrupted. Patients associated the cause of this situation with the physical environment conditions in the ICU, loud noises made by health employees and emotional reactions. It was stated that some physical environment changes that can be made in ICUs and psychological support will positively affect sleep. Conclusions: Intensive care patients may not have quality night‐time sleep because of multifactorial reasons. Noise in the ICU is a significant factor preventing patients from sleeping. In addition to reorganization of the physical environment to ensure adequate sleep, there is a need for an integrated approach dealing with patients' feelings and concerns. Relevance to Clinical Practice: Each patient has their own unique sleep pattern. To ensure effective management of sleep problems, health professionals should organize care and physical conditions in line with guidelines and create patient‐specific night‐time sleep management programmes. [ABSTRACT FROM AUTHOR]

Background: Multiple risk assessment scales are available for predicting the development of pressure injuries (PIs) in patients in the intensive care unit (ICU). Most PI risk assessment tools have been validated at the time of admission; however, another time point during treatment could better reflect clinical changes and therefore, the risk of PIs. Aim: The study aimed to examine the predictive validity of PI risk assessment scale designed for ICU patients, the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index, at several time points or intervals during ICU stay. Study Design: This was an observational prospective study undertaken over a period of 1 year (July 2021–June 2022). Patients admitted to ICU for >3 days were included. The number, location and degree of the PIs were recorded. The level of risk for developing PIs during the stay was determined by calculating the COMHON scores at admission, and 72 h, as well as the highest and mean score. Predictive validity was studied using accuracy parameters and areas under the receiver operating characteristic curve (AUC). The best cutoff point was also determined and used to compare risk between categories. Results: Of the 286 patients included in the study, 160 (59%) were male. The level of severity evaluated using the APACHE II scale was 18.4 ± 5.8 points. Invasive mechanical ventilation was used in 32.1% (n = 92) of the patients and 20.6% (n = 59) received high flow oxygen therapy. The incidence of PI was 15.4% (n = 44), with sacral location in 47.7% (n = 21) and grade II in 75% (n = 33) of the patients. The AUC was 0.907 (0.872–0.942); 0.881 (0.842–0.920); 0.877 (0.835–0.920) and 0.749 (0.667–0.831) at the mean, the highest, 72 h and ICU admission scores, respectively. The best cutoff point was 13 in all patients. The risk of developing a PI was 6.4 times higher in the high‐risk group (>13 points). Conclusions: The best predictive capacity for the COMHON index risk assessment was the mean and highest scores. The predictive accuracy was higher on the third day of the patient's stay than on admission, and this was attributed to the clinical changes observed in some patients over the course of their critical illness. Relevance for Clinical Practice: Patients in ICU are at high risk of developing PIs, therefore, preventive measures should be maximized. Risk assessment should be carried out sequentially owing to the changes that patients present throughout their ICU stay and preventive measures should be used according to the risk level. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic stretched Swedish intensive care unit (ICU) resources to an extent never experienced before, but even before the pandemic staffing was difficult and the number of staffed ICU beds was low. Studies have revealed high levels of COVID‐19 ICU staff burn‐out and fatigue, and as similar situations with high demands are likely to occur in the future a better understanding of resources that improve staff resilience is important. Using the job‐demand resource theory as a framework, we explored ICU professionals' views on demands and resources when working in COVID‐19 ICUs with the aim to highlight factors that increased the job resources. Methods: Data were collected via a web survey distributed to COVID‐19 ICU professionals, including both regular and temporary roles, working in 13 COVID‐19 ICU wards in Stockholm and Sörmland counties during the spring 2021. A total of 251 written responses to the question "What would have made work in the COVID‐19 ICU less demanding?" were analyzed using thematic analysis. One year later a member‐checking focus group interview was conducted to validate and further explore staff experiences. Results: The main themes were work strategy, fairness and support, continuity, accessible leadership, introduction/information, and crisis preparedness. The analysis of the focus group conducted confirmed the main results and the extreme demands on ICU staff during the initial stages of the pandemic. Conclusion: To increase staff health and performance in a long‐term crisis our results suggest; maintaining workplace leadership, scheduling work in advance and, when possible, schedule for recovery. [ABSTRACT FROM AUTHOR]

Background: Feeding intolerance is common in critically ill patients and can lead to malnutrition. Prokinetic agents may be used to enhance the uptake of nutrition. However, the evidence on the effectiveness and safety of prokinetic agents is sparse, and there is a lack of data on their use in intensive care units (ICU). Methods: We will conduct an international 14‐day inception cohort study of 1000 acutely admitted adult ICU patients. Data will be collected from ICU admission and daily during ICU stay for up to 90 days. The primary outcome will be the proportion of ICU patients who receive prokinetic agents. Secondary outcomes include mortality, days alive without life support, days alive out of ICU, days alive out of hospital (all within 90 days) and the number of patients with one or more serious adverse events. Results: We will present data on the use of prokinetic agents descriptively and use Cox regressions with death and ICU discharge as competing events to evaluate the association between patient characteristics and the use of prokinetic agents. We will use extended Cox models with time‐varying covariates and linear regression models to assess the associations between the use of prokinetic agents and the secondary outcomes. Conclusion: The outlined international cohort study will provide valuable epidemiological data on the use of prokinetic agents in adult, acutely admitted ICU patients. [ABSTRACT FROM AUTHOR]

Background: This Intensive Care Medicine Rapid Practice Guideline (ICM‐RPG) provides an evidence‐based recommendation to address the question: in adult patients in intensive care units (ICUs), should we use small‐volume or conventional blood collection tubes? Methods: We included 23 panelists in 8 countries and assessed and managed financial and intellectual conflicts of interest. Methodological support was provided by the Guidelines in Intensive Care, Development, and Evaluation (GUIDE) group. We conducted a systematic review, including evidence from observational and randomized studies. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, we evaluated the certainty of evidence and developed recommendations using the Evidence‐to‐Decision framework. Results: We identified 8 studies (1 cluster and 2 patient‐level randomized trials; 5 observational studies) comparing small‐volume to conventional tubes. We had high certainty evidence that small‐volume tubes reduce daily and cumulative blood sampling volume; and moderate certainty evidence that they reduce the risk of transfusion and mean number of red blood cell units transfused, but these estimates were limited by imprecision. We had high certainty that small‐volume tubes have a similar rate of specimens with insufficient quantity. The panel considered that the desirable effects of small‐volume tubes outweigh the undesirable effects, are less wasteful of resources, and are feasible, as demonstrated by successful implementation across multiple countries, although there are upfront implementation costs to validate small‐volume tubes on laboratory instrumentation. Conclusion: This ICM‐RPG panel made a strong recommendation for the use of small‐volume sample collection tubes in adult ICUs based on overall moderate certainty evidence. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to illustrate the outcomes of abnormally invasive placenta (AIP) cases managed in three leading centers in Lebanon. Methods: We conducted a retrospective multicenter cohort study. Patients managed conservatively (cesarean delivery with successful placental separation) or radically (cesarean hysterectomy) were included in the study. Data included patient characteristics, surgical outcomes (blood loss, operative time, transfusion, partial bladder resection), maternal outcomes (death, length of stay, ICU admission, postoperative hemoglobin level) and neonatal outcomes (Apgar score, neonatal weight, admission to neonatal intensive care unit, neonatal death). Results: The study included 189 patients. In the radical treatment subgroup (141/189), patients were para 3 and delivered at 34 4/7 weeks in average, bled 1.5 L and were transfused with three packed red blood cells, with operative time averaging 160 min. A total of 36% were admitted to the ICU and patients stayed on average for 1 week despite partial bladder resection in 19% of cases. Unscheduled radical delivery occurred at a lower gestational age, was associated with more blood loss, higher rate and volume of transfusion, and risk of maternal and neonatal death. In addition, patients delivered in an unscheduled fashion experienced higher rates of partial bladder resection and longer interventions. In the conservative treatment subgroup, on average patients were para 2 and delivered at 36 weeks, bled 800 mL on average with low rates of transfusion (35%) and ICU admission (22.9%). With regard to neonatal outcomes, the average neonatal birth weight was 2.4 kg in the radical subgroup and 2.5 kg in the conservative subgroup. Neonatal death occurred in 5.4% of cases requiring radical management while it occurred in 2% of patients treated conservatively. Conclusion: Through their multidisciplinary approach, the three centers demonstrated that management of AIP in Lebanon has led to excellent outcomes with no maternal mortality occurring in scheduled radical treatment. By comparison of the three leading centers, pitfalls in each center were identified and addressed. Synopsis: Delivering patients with abnormally invasive placenta should occur in tertiary centers, scheduled when possible. Referral pathways should be designed to guarantee access to appropriate care. [ABSTRACT FROM AUTHOR]

Objective: Placenta accreta spectrum (PAS) is a complex disorder of uterine wall disruption with significant morbidity and mortality, particularly at time of delivery. Both physician and physical hospital resource allocation/utilization remains a challenge in PAS cases including intensive care unit (ICU) beds. The primary objective of the present study was to identify preoperative risk factors for ICU admission and create an ICU admission prediction model for patient counseling and resource utilization decision making in an evidence‐based manner. Methods: This was a case–control study of 145 patients at our PAS referral center undergoing cesarean hysterectomy for PAS. Final confirmation by histopathology was required for inclusion. Patient disposition after surgery (ICU vs post‐anesthesia care unit) was our primary outcome and pre‐/intra‐/postoperative variables were obtained via electronic medical records with an emphasis on the predictive capabilities of the preoperative variables. Uni‐ and multivariate analysis was performed to identify independent predictive factors for ICU admission. Results: In this large cohort of 145 patients who underwent cesarean hysterectomy for PAS, with histopathologic confirmation, 63 (43%) were admitted to the ICU following delivery. These patients were more likely to be delivered at an earlier gestational age (34 vs 35 weeks, P < 0.001), have had >2 episodes of vaginal bleeding and emergent delivery compared to patients admitted to patients with routine recovery care (44% vs 18.3%, P = 0.009). Uni‐ and multivariate logistic regression showed an area under the curve of 0.73 (95% CI: [0.63, 0.81], P < 0.001) for prediction of ICU admission with these three variables. Patients with all three predictors had 100% ICU admission rate. Conclusion: Resource prediction, utilization and allocation remains a challenge in PAS management. By identifying patients with preoperative risk factors for ICU admission, not only can patients be counseled but this resource can be requested preoperatively for staffing and utilization purposes. Synopsis: Maternal ICU admission after cesarean hysterectomy for placenta accreta spectrum may be predicted by vaginal bleeding, gestational age and emergent delivery. [ABSTRACT FROM AUTHOR]

Background Aims Study Design Results Relevance to Clinical Practice Hyperglycaemia is common in intensive care units (ICUs), with a prevalence of up to 86.2%, increasing mortality. Technology has evolved towards continuous glucose monitoring (CGM), and its use in ICUs began especially during the coronavirus pandemic (COVID‐19). Various studies have evaluated the reliability of CGM, indicating that it is safe for use in critically ill patients.The aim of this study was to compare the use of CGM with point‐of‐care glucose (POC‐G) testing in ICU. Specific objectives include evaluating the glycaemic control, the frequency of POC‐G measurements, the incidence of hyperglycaemia, hypoglycaemia and morbidity and mortality at 90 days.An experimental, controlled and randomized clinical trial with a single‐blind design will be conducted at Hospital Clinic of Barcelona (HCB). A sample size of 376 participants will be recruited and randomly assigned to two groups: an experimental group, where glycaemic management will be based on CGM; and a control group, where glucose will be managed through POC‐G testing, with a blinded CGM.The primary variable considered will be time in range (TIR), with secondary outcomes including, time above range (TAR), time below range (TBR), number of POC‐G measurements, incidence of hyperglycaemia and hypoglycaemia, and mortality. Hypothesis testing will use the Kolmogorov–Smirnov test to assess data normality, with appropriate statistical tests applied, considering a p‐value <.05.The results obtained will help us understand the impact of CGM on critically ill patients. CGM could potentially reduce the workload of nurses and improve the efficiency of decision‐making by the ICU team, enabling early identification and treatment of glucose complications, thereby enhancing safety. Patient safety, a reduction in patient fingerstick and a decreased care burden are the criteria that add value to this research. [ABSTRACT FROM AUTHOR]

Background Aim Study design Results Conclusions Relevance for Clinical Practice Mechanical ventilation is a widely used treatment modality in cardiac surgery intensive care units (ICUs), especially for patients requiring respiratory support during postoperative management.The aim of this study was to define the process of developing a scale to assess adherence to mechanical ventilation in cardiac surgery patients and to assess the validity and reliability of the scale.This is a scale development and scale validation study. The study was conducted with 222 patients between April and September 2023. In the first stage, face‐to‐face interviews were conducted with seven nurses. Based on the literature review and content analysis of the interviews, the researchers created an item pool. In the second stage, the validity and reliability of the Mechanical Ventilator Compliance Scale in cardiac surgery patients were assessed. The scale was developed to be used by nurses working in cardiac surgery ICUs.The first 36‐item scale was subjected to content validity assessment by 14 experts. It was revised according to the experts' feedback and a content validity criterion of 0.83 was obtained. Confirmatory factor analysis showed good fit values for the scale (χ2/SD = 3.09, GFI = 0.90, AGFI = 0.90, CFI = 0.91, RMSEA = 0.06, and RMR = 0.07). Test‐retest analysis to assess the reliability of the scale showed good agreement between responses over time (ICC: 0.932; p < .001). Cronbach's alpha values for the scale and its subscales, behavioural and physical responses were 0.956, 0.949 and 0.912, respectively.The study findings indicate that the scale is a reliable and valid tool for assessing mechanical ventilator compliance in cardiac surgery patients.This study provides nurses in cardiac surgery intensive care units with a measurement tool to objectively assess patients' compliance with mechanical ventilation therapy. The scale provides more reliable results by preventing subjective judgement and estimation in patient assessment. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion CoolCuddle, enabling parents to cuddle their babies with neonatal encephalopathy (NE) during therapeutic hypothermia and intensive care (TH), was developed in research settings. To determine the impact of implementing CoolCuddle in usual care in six diverse neonatal intensive care units on the cooling process and intensive care.This vital sign cohort study embedded within the CoolCuddle implementation study enrolled 36 infants receiving TH for NE. Nurses received training on CoolCuddle and a standard operating procedure using an instruction video. After consenting, parents experienced up to 2 h of CoolCuddle with 30 min of pre‐ and post‐cuddle observation. We used multilevel, clustered linear modelling to assess the physiological stability in temperature, cardio‐respiratory and neurophysiology across the CoolCuddle.In 60 CoolCuddles over 93.12 h, respiratory parameters, heart rate or neurological function did not vary between the epochs (p > 0.05). During cuddle, sleep–wake cycling on amplitude‐integrated EEG increased (p = 0.008) and there was weak evidence of lower pain scores (p = 0.08). No adverse effects were observed.Implementing CoolCuddle with support in usual practice maintained physiological stability and did not significantly affect the cooling process or intensive care, and may improve infant comfort. Ongoing monitoring of adverse effects when implementing CoolCuddle is recommended. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The glycemic response to critical COVID‐19 remains uncertain. We aimed to assess the association between COVID‐19, insulin requirements, glycemic control, and mortality in intensive care unit (ICU) patients.We conducted a retrospective observational study of 350 COVID‐19 patients and 1067 non‐COVID‐19 patients admitted to the ICU. Insulin requirement was defined as the total units of exogenous insulin required to cover one gram of administered carbohydrates (insulin‐to‐carbohydrate ratio, ICR). We used multivariable generalized linear mixed‐model (GLMM) analysis to assess the association of the interaction between COVID‐19 and ICU‐day with daily ICR, adjusted for fixed and time‐dependent covariates. Glycemic control was assessed after stratification on diabetes and COVID‐19. We used multivariable logistic regression analysis to assess the association between ICR and 90‐day mortality.The mean (95% CI) of the mean daily ICR among patients without diabetes was 0.09 (0.08–0.11) U/g and 0.15 (0.11–0.18) U/g in the non‐COVID‐19 group and COVID‐19 group (p = .01), respectively. In diabetes patients, the corresponding ICRs were 0.52 (0.43–0.62) U/g and 0.59 (0.50–0.68) U/g (p = .32). In multivariable GLMM analysis, the interaction between COVID‐19 and ICU‐day was independently associated with ICR (risk estimate 1.22, 95% CI 1.15–1.31, p < .001). COVID‐19 was associated with higher hypoglycemia prevalence irrespective of diabetes status, higher average glucose levels, more pronounced glucose variability, and a lower proportion of glucose values within target range among patients without diabetes. On multivariable logistic regression analysis, the adjusted odds ratio for 90‐day mortality was 1.77 (95% CI 0.94–3.34, p = .076) per one unit increase in mean ICR.In our cohort of ICU patients, COVID‐19 was associated with higher daily insulin requirements per gram of administered carbohydrates, and worse glycemic control. We found no robust association between ICR and increased odds of death at 90 days. [ABSTRACT FROM AUTHOR]

Background Aim Study Design and Methods Results Conclusions Relevance to Clinical Practice Position change and interventions to increase lung capacity should be considered in mechanically ventilated patients. The most effective of these is the prone position.This systematic review and meta‐analysis aimed to determine the effects of the prone position on respiratory parameters and outcomes and to guide nurses working in the intensive care unit.This systematic review‐meta‐analysis was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta‐Analyses guideline. ScienceDirect, CINAHL, Academic Search Complete (EBSCOhost), MEDLINE, EMBASE, Web of Science, Cochrane and PubMed databases were searched between January 2022 and January 2023 to access studies related to prone position in COVID‐19 patients.Twenty‐three studies were included. This meta‐analysis shows that a prone position is feasible and can achieve improvements in gas exchange. Prone position increases PaO2/FiO2 in the majority of patients followed with a diagnosis of COVID‐19 and severe hypoxemic.The study has shown that the prone position is effective in improving patients' respiratory function and oxygenation.The results presented in this article support the notion that the prone position can be an effective strategy in the clinical management of COVID‐19 patients. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Sickle cell disease (SCD) is a global hemoglobinopathy; approximately 300 000 individuals are diagnosed annually. Acute chest syndrome (ACS), a common complication, leads to significant hospitalization and mortality, particularly in cases of severe respiratory distress. ECMO outcomes in this specific population are poorly described.This retrospective observational study, utilizing data from the Extracorporeal Life Support Organization (ELSO) registry, focuses on children and young adults (<40 years) with SCD undergoing ECMO from 1998 to 2022.We observed a growing trend in ECMO cases over the last 15 years, with 210 SCD patients identified in the registry (five neonates, 95 children, 110 adults). ECMO was predominantly initiated for pulmonary support (62%), and most of the primary diagnoses were related to SCD (reported as “SCD” or “acute chest syndrome”). The global survival rate was 55.8% (59% for children and 52.7% for adults). None of the children supported for extracorporeal cardiopulmonary resuscitation survived, and only 2/18 (11%) of adults cannulated for ECPR survived. Complication rates, including acute renal failure (33.8%) neurological events (13%), thrombotic (23.3%), or bleeding events (22.9%) were not noticeably different from reported outcomes in the ELSO registry.Our findings suggest that ECMO outcomes in SCD patients align with general ECMO trends and may not be limited by suspected unfavorable results in children and young adults. Despite limitations, our study contributes valuable insights into using ECMO in SCD, emphasizing the need for further research and understanding in this underexplored domain. [ABSTRACT FROM AUTHOR]

Background and Purpose: The optic nerve sheath diameter (ONSD) is a commonly used estimate of intracranial pressure (ICP). The rationale behind this is that pressure changes in the cerebrospinal fluid affect the optic nerve subarachnoid space (ONSAS) thickness. Still, possible effects on other compartments of the optic nerve sheath (ONS) have not been studied. This is the first study ever to analyze all measurable compartments of the ONS for associations with elevated ICP. Methods: We measured changes in ICP and changes in ONS compartments in 75 patients treated with invasive ICP monitoring at the Karolinska University Hospital. Associations between changes in ICP and changes in ONS compartments were estimated with generalized estimating equations. The potential to identify elevated ICP was assessed with the area under the receiver operating characteristic curve (AUROC) for ONS compartments associated with ICP changes. Results: Both ONSAS and perioptic dura mater thickness were significantly associated with changes in ICP in multivariable modeling. ONSAS was the only compartment that independently predicted changes in ICP, with an AUROC of 0.69 for predicting ICP increase. Still, both the perioptic dura mater thickness and the optic nerve diameter added value in predicting ICP changes in multivariable modeling. Conclusions: The results from this study challenge the current understanding of the mechanism behind the association between ICP and ONSD. Contrary to the common opinion that ONSAS is the only affected compartment, this study shows a more complex picture. It suggests that all ONS compartments may add value in predicting changes in ICP. [ABSTRACT FROM AUTHOR]

Oxidative stress (OS) develops in critically ill patients as a metabolic consequence of the immunoinflammatory and degenerative processes of the tissues. These induce increased and/or dysregulated fluxes of reactive species enhancing their pro‐oxidant activity and toxicity. At the same time, OS sustains its own inflammatory and immunometabolic pathogenesis, leading to a pervasive and vitious cycle of events that contribute to defective immunity, organ dysfunction and poor prognosis. Protein damage is a key player of these OS effects; it generates increased levels of protein oxidation products and misfolded proteins in both the cellular and extracellular environment, and contributes to forms DAMPs and other proteinaceous material to be removed by endocytosis and proteostasis processes of different cell types, as endothelial cells, tissue resident monocytes‐macrophages and peripheral immune cells. An excess of OS and protein damage in critical illness can overwhelm such cellular processes ultimately interfering with systemic proteostasis, and consequently with innate immunity and cell death pathways of the tissues thus sustaining organ dysfunction mechanisms. Extracorporeal therapies based on biocompatible/bioactive membranes and new adsorption techniques may hold some potential in reducing the impact of OS on the defective proteostasis of patients with critical illness. These can help neutralizing reactive and toxic species, also removing solutes in a wide spectrum of molecular weights thus improving proteostasis and its immunometabolic corelates. Pharmacological therapy is also moving steps forward which could help to enhance the efficacy of extracorporeal treatments. This narrative review article explores the aspects behind the origin and pathogenic role of OS in intensive care and critically ill patients, with a focus on protein damage as a cause of impaired systemic proteostasis and immune dysfunction in critical illness. [ABSTRACT FROM AUTHOR]

Background: The debriefing phase is the simulation phase where performance improves and learning occurs. Aim: This study examined the effects of the learning conversation (LC)‐based, 3D (defusing, discovering and deepening) model‐based and unstructured debriefing methods on satisfaction and debriefing experience after in‐situ simulation among intensive care unit (ICU) nurses. Study Design: In this randomized controlled experimental study, three debriefing methods were compared, according to which 119 ICU nurses were divided into the following groups: LC group (n = 38), 3D group (n = 40) and control group (n = 41). In‐ situ simulation was performed with an intensive care patient scenario. p <.05 was considered statistically significant. Results: The total Debriefing Experience Scale—Experience with Debriefing part scores were 89.76 ± 8.10 in the LC group, 88.90 ± 8.70 in the 3D group and 88.29 ± 7.28 in the control group. No significant difference was found in debriefing experience and satisfaction between the groups (p >.05), but a significant difference was observed in the LC group. The groups showed a homogeneous distribution regarding participant characteristics. Conclusion: Debriefing experience and satisfaction do not differ between the methods. Relevance to Clinical Practice: Implementation of the simulation in the ICU in ‐ situ with ICU nurses is beneficial in obtaining a fidelity experience. Performing the debriefing application after simulation in line with the model supports the International Nursing Association for Clinical Simulation and Learning (INACSL) debriefing standards. [ABSTRACT FROM AUTHOR]

Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a life‐threatening disease with high mortality and morbidity. Patients with aSAH in Sweden are cared for at one of six neuro intensive care units (NICU) or at a general intensive care unit (ICU).This study aimed to describe the incidence, length of stay, time in ventilator and mortality for these patients. Methods: This is a retrospective, descriptive study of patients with aSAH, registered in the Swedish Intensive care Registry between 2017 and 2019. The cohort was divided in sub‐cohorts (NICU and general ICU) and regions. Mortality was analysed with logistic regression. Results: A total of 1520 patients with aSAH from five regions were included in the study. Mean age of the patients were 60.6 years and 58% were female. Mortality within 180 days of admission was 30% (n = 456) of which 17% (n = 258) died during intensive care. A majority of the patients were treated at one hospital and in one ICU (70%, n = 1062). More than half of the patients (59%, n = 897) had their first intensive care admission at a hospital with a NICU. Patients in the North region had the lowest median GCS (10) and the highest SAPS3 score (60) when admitted to NICU. Treatment with invasive mechanical ventilation differed significantly between regions; 91% (n = 80) in the region with highest proportion versus 56% (n = 94) in the region with the lowest proportion, as did mortality; 16% (n = 44) versus 8% (n = 23). No differences between regions were found regarding age, sex and length of stay. Conclusions: Patients with aSAH treated in a NICU or in an ICU in Sweden differs in characteristics. The study further showed some differences between regions which might be reduced if there were national consensus and treatment guidelines implemented. [ABSTRACT FROM AUTHOR]

The overall prognosis of older patients with acute myeloid leukemia (AML) is dismal. Only a small subgroup experiences long‐term survival. The discrimination between patients who are candidates for potentially curative approaches and those who are not is crucial since ‐ in addition to differences in terms of AML‐directed treatment ‐ different policies concerning intensive care unit (ICU) admission and involvement of specialized palliative care (SPC) seem obvious. To shed more light on characteristics, outcomes and health care utilization of older individuals with AML, we conducted an analysis comprising 107 consecutive patients with newly diagnosed AML aged ≥70 years treated at an academic tertiary care center in Germany between 1 January 2015, and 31 December 2020. Median age was 75 years (range: 70–87 years); 45% of patients were female. The proportion of patients receiving intensive induction chemotherapy was 35%, 55% had low‐intensity treatment and 10% did not receive AML‐directed treatment or follow‐up ended before treatment initiation. At least one ICU admission was documented for 47% of patients; SPC was involved in 43% of cases. Median follow‐up was 199 days. The median overall survival (OS) was 2.5 months; the 1‐year OS rate was 16%. Among patients who died during observation, the median proportion of time spent in the hospital between AML diagnosis and death was 56%. The most common places of death were normal wards (31%) and the ICU (28%). Patients less frequently died in a palliative care unit (14%) or at home (12%). In summary, results of the present analysis confirm the unfavorable prognosis of older patients with AML despite intensive health care utilization. Future efforts in this patient group should aim at optimizing the balance between appropriate AML‐directed treatment on the one hand and health care utilization including ICU stays on the other hand. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: The optimal utilisation of echocardiography in intensive care units (ICU) is not yet known; however, its use is becoming more frequent. Management change from transthoracic echocardiography (TTE) in ICU is quoted to be from 3% to 50%. Methods: A retrospective review of clinical practice was performed over a 2‐month period in a tertiary adult ICU, to explore the utilisation of formal TTEs and the findings of these. The rate of management change and critical findings were investigated, along with the indication for TTE and the patient cohort. Results: Sixty‐three TTEs were performed in 54 patients. A change in management occurred in 25.4% (16/63) of TTEs, with critical findings being found in 47.6% (30/63) of all TTEs. The most common indications for formal TTEs were incompletely differentiated or further evaluation of shock, and post arrest cardiac function. Discussion: Almost half of the TTEs performed had critical findings, with common critical findings being severe LV dysfunction, severe RV dysfunction and regional wall motion abnormalities. Despite critical findings being seen frequently, there was only management change in 25%, suggesting that several of the critical findings were already suspected, clinically confirmed or had anticipatory management prior to TTE. Conclusion: Critical findings are common in critically ill patients. However, not all critical findings will lead to a change in management. Formal TTEs in the ICU should be focussed to the clinical question being asked and a screening intensivist performed bedside TTE may be appropriate in certain situations to decrease workload of cardiology department. [ABSTRACT FROM AUTHOR]

This article examines the environmental impact of palliative and end-of-life care interventions in the ICU and emphasizes the importance of improving the sustainability of healthcare services. It discusses the potential reduction in resource utilization and carbon footprint that can be achieved through palliative care interventions. The article also highlights the need for healthcare professionals to consider sustainability without compromising patient care and suggests reviewing medications and interventions in line with patients' goals of care. It calls for further research to understand the impact of different treatment options and the challenges of providing palliative care in the ICU. [Extracted from the article]

Summary: Physical disability is a common component of post‐intensive care syndrome, but the importance of musculoskeletal health in this population is currently unknown. We aimed to determine the musculoskeletal health state of intensive care unit survivors and assess its relationship with health‐related quality of life; employment; and psychological and physical function. We conducted a multicentre prospective cohort study of adults admitted to intensive care for > 48 h without musculoskeletal trauma or neurological insult. Patients were followed up 6 months after admission where musculoskeletal health state was measured using the validated Musculoskeletal Health Questionnaire score. Of the 254 participants, 150 (59%) had a musculoskeletal problem and only 60 (24%) had received physiotherapy after discharge. Functional Comorbidity Index, Clinical Frailty Scale, duration of intensive care unit stay and prone positioning were all independently associated with worse musculoskeletal health. Musculoskeletal health state moderately correlated with quality of life, rs = 0.499 (95%CI 0.392–0.589); anxiety, rs = ‐0.433 (95%CI ‐0.538 to ‐0.315); and depression, rs = ‐0.537 (95%CI ‐0.631 to ‐0.434) (all p < 0.001). Patients with a musculoskeletal problem were less physically active than those without a problem (median (IQR [range]) number of 30 min physical activity sessions per week 1 (0–3.25 [0–7]) vs. 4 (1–7 [0–7]), p < 0.001, respectively). This study found that musculoskeletal health problems were common after intensive care unit stay. However, we observed that < 25% of patients received physical rehabilitation after discharge home. Our work has identified potential high‐risk groups to target in future interventional studies. [ABSTRACT FROM AUTHOR]

Background and Aim: Assisted mechanical ventilation may alter the pressure profile in the thorax compared to normal breathing, which can affect the blood flow to and from the heart. Studies suggest that in patients with severe lung disease, airway pressure release ventilation (APRV) may be haemodynamically beneficial compared to other ventilator settings. The primary aim of this study was to investigate if APRV affects cardiac index in intubated intensive care patients without severe lung disease when compared to pressure support ventilation (PSV). The secondary aim comprised potential changes in other haemodynamic and ventilatory parameters. Methods: Twenty patients were enrolled in the intensive care unit (ICU) at Sahlgrenska University Hospital. Eligible patients met the inclusion criteria; 18 years of age or above, intubated and mechanically ventilated, triggering and stable on PSV mode, with indwelling haemodynamic monitoring via a pulse‐induced continuous cardiac output (PiCCO) catheter. The study protocol started with a 30‐min interval on PSV mode, followed by a 30‐min interval on APRV mode, and finally a 30‐min interval back on PSV mode. At the end of each interval, PiCCO outputs, ventilator outputs, arterial and venous blood gas analyses, heart rate and central venous pressure were recorded and compared between modes. Results: There was no significant difference in cardiac index (3.42 vs. 3.39 L/min/m2) between PSV and APRV, but a significant increase in central venous pressure (+1.0 mmHg, p =.027). Furthermore, we found a significant reduction in peak airway pressure (−3.16 cmH2O, p <.01) and an increase in mean airway pressure (+2.1 cmH2O, p <.01). No statistically significant change was found in oxygenation index (partial pressure of O2 [pO2]/fraction of inspired oxygen) nor in other secondary outcomes when comparing PSV and APRV. There was no significant association between global end‐diastolic volume index and cardiac index (R2 = 0.0089) or central venous pressure (R2 = 0.278). All parameters returned to baseline after switching the ventilator mode back to PSV. Conclusion: We could not detect any changes in cardiac index in ICU patients without severe lung disease during APRV compared to PSV mode, despite lower peak airway pressure and increased mean airway pressure. [ABSTRACT FROM AUTHOR]

Background: Digital modalities which enable asynchronous learning, such as audio podcasts and videos demonstrating procedures, may benefit acquisition and retention of knowledge and clinical skills. The main objective of this nationwide cross‐sectional survey study was to evaluate key aspects and factors related to usage of audio podcasts and procedural videos in anaesthesiology and intensive care. Methods: A 20‐item multiple‐choice‐question online survey was created through a consensus process including pilot testing among residents and consultants. Data were collected over a 3‐month period, September–November 2023. Results: The survey was completed by 466 anaesthetists. More than a third reported using procedural videos ≥1 time per week, whereas fewer than one in four participants used audio podcasts at least once per week. Multivariable logistic regression analysis showed that working at a university hospital, male sex, and younger age were independently associated with podcast use ≥1 time per week, with the highest odds ratio (OR) for younger age (<40 years vs. ≥40 years old; OR 5.86 (95% confidence interval 3.55–9.67), p <.001). Younger age was also significantly associated with higher frequency of video use (OR 1.71 (1.13–2.58), p =.011), while working predominantly in intensive care was associated with a lower frequency of video use. Podcasts were often used during commuting (42.3%), household work (30.7%), and exercise (24.9%), indicating a role in multi‐tasking. Approximately half of respondents expressed that audio podcast‐based learning has a moderate to very large positive impact on acquisition of theoretical knowledge, as well as practical skills. A vast majority, 85.2%, reported that procedural videos have a moderate to very large impact on development of clinical skills. Conclusion: Audio podcasts and procedural videos are appreciated tools with potential to supplement more traditional didactic techniques in anaesthesiology and intensive care. Procedural video use is common, with perceived large effects on development of clinical skills. Further data are needed to fully understand learning outcomes, quality of peer‐review processes, and potential sex‐differences. [ABSTRACT FROM AUTHOR]

Background: Postextubation dysphagia (PED) is a common complication to endotracheal intubation in critically ill patients and may lead to pneumonia, prolonged ventilation, longer hospital stays, and increased mortality. Recognizing dysphagia is paramount to preventing adverse events. The aim of this study was to describe PED management by investigating practice in Danish intensive care units (ICUs) focusing on current practice in 2023 (screening, prevention, and treatment), perceived best practice (barriers and facilitators), and when possible, to compare practice in 2017 and 2023. Methods: Self‐reported, cross‐sectional survey of dysphagia practice in Danish ICUs administered from April to May 2023. In addition, data were compared with the 2017 Dysphagia in Intensive Care Evaluation study, when possible. Results: Only half of Danish ICUs reported to have a PED protocol, and less than half routinely screen patients for dysphagia after extubation. Most common screening methods were the oral mechanism examination, water test, and Facio‐oral tract therapy. Nurses and physicians often relied on an overall physical assessment of the patient. Best treatment methods were uniformly agreed to be patient positioning, modification of food and fluids, use of ergonomic utensils, and compensatory maneuvers. Key barriers to dysphagia management were lack of specialized staff, under‐recognition of dysphagia as a health issue, and lack of standardized protocols. Conclusion: Awareness of PED is increasing and identification, prevention, and treatment is slowly improving, but systematic implementation of protocols for dysphagia screening and treatment could enhance dysphagia management in Danish ICUs. [ABSTRACT FROM AUTHOR]

Critically ill patients experience high rates of malnutrition and significant muscle loss during their intensive care unit (ICU) admission, impacting recovery. Nutrition is likely to play an important role in mitigating the development and progression of malnutrition and muscle loss observed in ICU, yet definitive clinical trials of nutrition interventions in ICU have failed to show benefit. As improvements in the quality of medical care mean that sicker patients are able to survive the initial insult, combined with an aging and increasingly comorbid population, it is anticipated that ICU length of stay will continue to increase. This review aims to discuss nutrition considerations unique to critically ill patients who have persistent critical illness, defined as an ICU stay of >10 days. A discussion of nutrition concepts relevant to patients with persistent critical illness will include energy and protein metabolism, prescription, and delivery; monitoring of nutrition at the bedside; and the role of the healthcare team in optimizing nutrition support. [ABSTRACT FROM AUTHOR]

Background: Continuous renal replacement therapy (CKRT) is delivered to some of the most critically ill patients in hospitals. This therapy is expensive and requires coordination of multidisciplinary teams to ensure the prescribed dose is delivered. With increased demands on the critical care nursing staff and increased complexities of patients admitted to critical care units, we evaluated the role of specialized renal technologists in ensuring the prescribed dose is delivered. Therefore, the aim of this study is to investigate the impact of supporting intensive care unit nurses with specialized renal technologists on optimizing efficiency of CKRT sessions in the United Arab Emirates. Methods: This is a retrospective study that compared critically ill patients on CKRT overseen by specialized renal technologists versus who are non‐covered in the year 2021. Results: A total of 331 sessions on 158 patients were included in the study. The mean filter life was longer in specialized renal technologists—covered patients compared to the non‐covered group (66 vs. 59 h, p = 0.019). After adjustment by multiple regression analysis for risk factors (i.e., age, gender, mechanical ventilation, sepsis, mean arterial pressure, vasopressors, and SOFA) that may affect CKRT machines' filter life, presence of a specialized renal technologists resulted in significantly longer filter life (co‐efficient 0.129; CI 95% 1.080, 11.970; p‐value: 0.019). Conclusion: Our study suggests that specialized renal technologists play a vital role in prolonging CKRT machine's filter life span and optimizing CKRT machine's efficiency. Further research should focus on other potential benefits of having specialized renal technologists performing CKRT sessions, and to confirm the finding of this study. Additionally, a cost–benefit analysis could be conducted to determine the economic impact of having specialized teams performing CKRT. [ABSTRACT FROM AUTHOR]

Aim: Abdominal massage facilitates gastric and colonic motility, reduces intra‐abdominal distension and increases circulation. In‐bed range of motion (ROM) exercise has effects on muscle strength, cardiac parameters and excretion. The aim of this study was to assess the effects of abdominal massage and in‐bed ROM exercise on gastrointestinal complications and patient comfort in intensive care patients receiving enteral nutrition. Methods: This randomized controlled trial was conducted in the internal intensive care units of two tertiary public hospitals. The sample consisted of 130 patients randomly assigned to three groups (abdominal massage = 44, in‐bed ROM exercise = 43, control = 43). The individuals received abdominal massage and in‐bed ROM exercises every morning before enteral feeding for 3 days. We assessed gastrointestinal complications and comfort levels of the patients 24 h after each intervention. Results: While the differences in abdominal distention, defecation status, constipation, and gastric residual volume complications were significant (p <.05), there was no significant difference in diarrhea and vomiting (p >.05). Comfort level showed a statistically significant change in the experimental groups in the in‐group comparison (p <.05). Conclusion: Abdominal massage and in‐bed ROM exercise reduce abdominal distention, constipation and gastric residual volume. Abdominal massage affects the frequency of defecation; and, both interventions increase the comfort while reducing the pain level over time. [ABSTRACT FROM AUTHOR]

Background: Survival from pediatric critical illness in high‐income countries is high, and the focus now must be on optimizing the recovery of survivors. Muscle mass wasting during critical illness is problematic, so identifying factors that may reduce this is important. Therefore, the aim of this study was to examine the relationship between quadricep muscle mass wasting (assessed by ultrasound), with protein and energy intake during and after pediatric critical illness. Methods: A prospective cohort study in a mixed cardiac and general pediatric intensive care unit in England, United Kingdom. Serial ultrasound measurements were undertaken at day 1, 3, 5, 7, and 10. Results: Thirty‐four children (median age 6.65 [0.47–57.5] months) were included, and all showed a reduction in quadricep muscle thickness during critical care admission, with a mean muscle wasting of 7.75%. The 11 children followed‐up had all recovered their baseline muscle thickness by 3 months after intensive care discharge. This muscle mass wasting was not related to protein (P = 0.53, ρ = 0.019) (95% CI: −0.011 to 0.049) or energy intake (P = 0.138, ρ = 0.375 95% CI: −0.144 to 0.732) by 72 h after admission, nor with severity of illness, highest C‐reactive protein, or exposure to intravenous steroids. Children exposed to neuromuscular blocking drugs exhibited 7.2% (95% CI: −0.13% to 14.54%) worse muscle mass wasting, but this was not statistically significant (P = 0.063). Conclusion: Our study did not find any association between protein or energy intake at 72 h and quadricep muscle mass wasting. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusion Relevance to Clinical Practice Healthcare's carbon footprint contributes to 4.4% of global net emissions and intensive care units (ICUs) are very resource intensive. Existing studies on environmental sustainability in ICUs focused on carbon footprint generated from energy and electricity consumption, use of medical consumables and equipment, but few studies quantified carbon footprint generated from pharmaceuticals used in ICUs.To evaluate carbon footprint arising from sedation practices in the ICUs.A pilot, prospective observational study was conducted in two ICUs from 1 August to 22 September 2022 in Singapore General Hospital. Adult patients who were consecutively sedated, intubated and expected to be mechanically ventilated for at least 24 h were included. Total amount of analgesia and sedatives used and wasted in eligible patients were collected. Carbon emission from ICU sedation practices were then quantified using available life cycle assessment data.A total of 31 patients were recruited. Top analgesia and sedative used in both ICUs were fentanyl and propofol, respectively. Carbon footprint from sedative usage and wastage across 7 weeks in both ICUs were 2.206 kg CO2‐e and 0.286 g CO2‐e, respectively. In total, this equates to driving 15.8 km by car. Proportion of drug wasted ranged from 5.1% to 25.0%, with the top reason for wastage being the drug was no longer clinically indicated. Recommendations to reduce carbon footprint include choosing sedatives with lower carbon emissions where possible and having effective communication among doctors and nurses regarding management plans to minimize unnecessary wastage.Our study quantified carbon footprint arising from sedation practices, mainly drug usage and wastage in two ICUs in Singpore General Hospital.Adopting a holistic approach to environmental sustainability in the ICU, sedation practices also contribute to generating greenhouse gases, albeit small, and can be targeted to reduce unnecessary carbon footprint. [ABSTRACT FROM AUTHOR]

Summary: Despite the existence of evidence‐based guidelines for the assessment and management of pain in the critical care setting, the prevalence of acute pain remains high. Inadequate pain management is associated with longer duration of mechanical ventilation, reduced capacity for rehabilitation and long‐term psychological sequelae. This study aimed to describe the experiences of pain management from healthcare professionals working in intensive care units. Healthcare professionals were recruited from intensive care units in London, UK using a purposive sampling technique. Semi‐structured interviews were transcribed verbatim. Transcripts were analysed using an inductive thematic analysis technique. Thirty participants were recruited from eight diverse intensive care units. Five themes were identified. First, there was a lack of consensus in pain assessment in the ICU where nursing staff described more knowledge and confidence of validated pain measures than physicians, and concerns over validity and usability were raised. Second, there was a universal perception of resource availability impacting the quality of pain management including high clinical workload, staff turnover and availability of certain pain management techniques. Third, acknowledgement of the importance of pain management was highest in those with experience of interacting with critical care survivors. Fourth, participants described their own emotional reaction to managing those in pain which influenced their learning. Finally, there was a perception that, due to the complexity of the intensive care unit population, pain was de‐prioritised and there were conflicting views as to whether standardised analgosedation algorithms were useful. This study provides evidence to suggest interdisciplinary training, collaboratively designed decision‐making tools, prioritisation initiatives and research priorities are areas that could be targeted to improve pain management in critical care. [ABSTRACT FROM AUTHOR]

Aim: This population-based study investigated the occurrence of capillary leak syndrome (CLS) in children with multisystem inflammatory syndrome in children (MIS-C), associated with COVID-19. We also examined associations between CLS and MIS-C disease severity. Methods: All eligible individuals aged 0-18 years, who were diagnosed with MIS-C in Skåne, southern Sweden, from 1 April 2020 to 31 July 2021, were studied. They were all included in the Pediatric Rheumatology Quality Register and clinical and laboratory data were compared between patients with and without CLS. Results: We included 31 patients (61% male) with MIS-C in the study. The median age at diagnosis was 10.6 years (range 1.99-17.15) and 45% developed CLS. All six patients who required intensive care had CLS. Patients with CLS also had a higher incidence of reduced cardiac function, measured as low ejection fraction. The CLS group exhibited significantly higher C-reactive protein values (p < 0.001) and N-terminal pro-Btype natriuretic peptide levels (p < 0.001), as well as lower platelet counts (p = 0.03), during the first week of treatment. Individuals with CLS also received more intense immunosuppression. Conclusion: CLS was a common complication of MIS-C in our study and these patients had a more severe disease course that required more intensive treatment. [ABSTRACT FROM AUTHOR]

Background: Critical illness significantly impacts the well‐being of patients and families. Previous studies show that family members are willing to participate in patient care. Involving families in early mobility interventions may contribute to improved recovery and positive outcomes for patients and families. Aim: In this scoping review, we investigated early mobility interventions for critically ill patients evaluated in randomized controlled trials and the extent to which family engagement in those interventions are reported in the literature. Study Design: In this scoping review of reviews, EMBASE, CINAHL, PubMed and Cochrane Central databases were searched in October 2019 and updated in February 2022. Systematic reviews were included and assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2. Data were synthesized using a narrative approach. PRISMA‐ScR guidelines were adhered to for reporting. Results: Thirty‐three reviews were included which described a range of early mobility interventions for critically ill patients; none explicitly mentioned family engagement. Almost half of the reviews were of low or critically low quality. Insufficient detail of early mobility interventions prompted information to be extracted from the primary studies. Conclusions: There are a range of early mobility interventions for critically ill patients but few involve families. Given the positive outcomes of family participation, and family willingness to participate in care, there is a need to explore the feasibility and acceptability of family participation in early mobility interventions. Relevance to Clinical Practice: Family engagement in early mobility interventions for critically ill patients should be encouraged and supported. How to best support family members and clinicians in enacting family involvement in early mobility requires further investigation. [ABSTRACT FROM AUTHOR]

Background: A sense of hope plays an important role in relieving stress and psychological distress of cardiology patients, as well as improving their physical well‐being. Aim: The aim of this study is to investigate the correlation between death anxiety, loneliness and hope levels in patients receiving treatment in a cardiac intensive care unit (ICU). Design: This is a prospective, descriptive and correlational study. Methods: The study was completed with 150 cardiac ICU patients in Istanbul, Turkey. The data were collected using a Patient Information Form, the Templer Death Anxiety Scale (TDAS), the Herth Hope Index (HHI) and the UCLA Loneliness Scale (UCLA‐LS). Results: The patients had a mean age of 63.56 ± 12.74 years. Most of the patients (82%) were treated in the ICU for heart failure. There was a statistically significant positive correlation between total scores of TDAS and UCLA‐LS (r =.337; p <.001) and a statistically significant negative correlation between total scores of UCLA‐LS and HHI (r = −.292; p <.001). Also, there was a statistically significant negative correlation between the scores of UCLA‐LS and Positive Readiness and Expectancy Subscale (r = −.164; p =.044). The multiple linear regression indicated that the model was statistically significant (F = 7.177, p <.001). The variables of age and UCLA‐LS among those included in the model were statistically significant predictors of the death anxiety scores of the patients (23.1%) (p <.05). Conclusions: The cardiology patients who received treatment in the ICU had a high level of death anxiety and moderate levels of loneliness and hope. The age and loneliness level were statistically significant predictors of death anxiety. Relevance to Clinical Practice: It is recommended that individualized nursing care be planned and provided to conscious cardiology patients who are treated in the ICU, considering their age and loneliness levels and that nursing care be planned for individuals who are at risk of fear, anxiety, loneliness and hopelessness by periodically assessing their death anxiety, loneliness and hope levels. [ABSTRACT FROM AUTHOR]

Background: Demographics and comorbidities associated with coronavirus disease 2019 (COVID‐19) severity differs between subpopulations and should be determined to aid future pandemic planning and preparedness. Aim: To describe the demographics and comorbidities of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in Queensland (QLD), Australia, between January 2020 and May 2021. Also, to determine the relationship between these characteristics and disease severity based on the highest level of care. Methods: A retrospective case series analysis was conducted using data obtained from the Notifiable Conditions System. Data on patients confirmed with SARS‐CoV‐2 infection in QLD were included in this analysis. Descriptive statistics and logistic regression modelling were used to analyse factors that contributed to disease severity. Results: One thousand six hundred twenty‐five patients with SARS‐CoV‐2 infection were diagnosed in the study period and analysed. The median age was 41 years and 54.3% (n = 882) were males. A total of 550 patients were hospitalised and 20 patients were admitted to the intensive care unit (ICU). In those admitted to the ICU, 95% (n = 19) were older than 45 years and 95% (n = 19) were male. Comorbidities significantly associated with hospitalisation were chronic cardiac disease (excluding hypertension) and diabetes, and for ICU admission were morbid obesity, chronic respiratory disease and chronic cardiac disease. No demographic factors were shown to be significantly associated with disease severity. Conclusions: Comorbidities associated with the highest level of COVID‐19 disease severity were morbid obesity, chronic respiratory disease and cardiac disease. These data can assist with identifying high‐risk patients susceptible to severe COVID‐19 and can be used to facilitate preparations for future pandemics. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether physicians treating critically ill patients have realistic perceptions of their patients' prognoses. Methods: We sent a survey by email to Finnish anesthesiologists to investigate their ability to estimate the probability of 1‐year survival of intensive care unit (ICU) patients based on data available at the beginning of intensive care. We presented 12 fictional but real‐life‐based patient cases and asked the respondent to estimate the probability of 1‐year survival in each case by choosing one of the alternatives 5%, 10%–90% in 10% intervals and 95%. We compared the physicians' estimates to registry data‐based realistic prognoses of comparable patients treated in the ICU. Based on the difference between the estimate and the realistic prognosis, we categorized the estimates into three groups: (1) difference less than 10 percentage points, (2) difference between 10 and 20 percentage points, and (3) difference over 20 percentage points. Results: We received 210 responses (totally 2520 estimates). Of the respondents, 43 (20.5%) were specialists working mainly in the ICU, 81 (38.6%) were specialists working occasionally in the ICU, 47 (22.4%) were specialists not working in the ICU, and 39 (18.6%) were doctors in training. The difference between the estimate and the realistic prognosis was less than 10 percentage points for 1083 (43.0%) estimates, between 10 and 20 percentage points for 645 (25.6%) estimates, and over 20 percentage points for 792 (31.4%) estimates, out of which 612 (24.3% of all estimates) underestimated and 180 (7.1%) overestimated the likelihood of survival. The median error (the median of the differences between the estimate and the realistic prognosis) for all estimates was −8.8 [interquartile range (IQR), −20.0 to −0.2], which means that the most typical response underestimated the likelihood of survival by 9 percentage points. Based on the 12 estimates, we calculated the median error for each respondent. The median (IQR) of these median errors was −8.6 (−12.6 to −5.0) for specialists working mainly in the ICU, −8.1 (−13.0 to −5.2) for specialists working occasionally in the ICU, −9.7 (−17.7 to −6.3) for specialists not working in the ICU, and −9.1 (−14.5 to −5.1) for doctors in training (p =.29). Conclusion: Finnish anesthesiologists commonly misestimate the long‐term prognoses of ICU patients, more often underestimating than overestimating the likelihood of 1‐year survival. More education about critically ill patients' prognoses and better prediction tools are needed. [ABSTRACT FROM AUTHOR]

Proning, or turning a patient face down, is a technique used to manage patients with acute respiratory distress in intensive care units (ICUs). Research suggests that the type of pillow used in proning may have a significant impact on patient outcomes and increase the risk of disfiguring pressure injuries to the face. However, there is little evidence surrounding the usability of these pillows in the ICU. The aim of this study was to identify redesign opportunities by understanding how the tools, tasks, people, environment, and organization all interact during proning in the ICU. Thirty‐six ICU clinicians from two Australian public metropolitan hospitals completed an online questionnaire regarding their opinions and experiences with proned patients and the prevention of pressure injuries. Seven ICU clinicians then completed journey mapping activities to document the key workflows, critical incidents, considerations, and personnel involved in managing proned patients in the ICU. Several barriers and facilitators to pressure injury prevention were identified, including interactions between the various tools (e.g., proning pillows with one opening limits the management of several medical devices), the tasks (e.g., high frequency of repositioning), the people (e.g., clinical inexperience, patient features), the environment (e.g., limited availability of tools), and the organization (e.g., limited number of staff to support tasks). This holistic approach revealed several opportunities for the redesign of proning pillows and associated systems. Key takeaways include the limitations of a one‐size‐fits‐all approach to proning in the ICU context, and the need for flexibility and customization to improve proning pillows, associated medical devices, prophylactic dressings, aids, and processes. [ABSTRACT FROM AUTHOR]

Purpose: This research was planned to follow the healing process of the oral mucosa in patients in intensive care with an "Impaired Oral Mucous Membrane Integrity" nursing diagnosis based on the "NOC (1100) Oral Health Assessment" outcome criteria. Method: This study, which was planned in a methodological and descriptive type of research, was carried out with 50 patients who were hospitalized in the intensive care clinic of a state hospital between June and December 2022, with a nursing diagnosis of "Impaired Oral Mucous Membrane Integrity." Data were collected using a Patient Information Form and the "NOC (1100) Oral Health Evaluation Scale" for the nursing outcomes classification. In the analysis of the data descriptive statistical methods, Pearson correlation test, Friedman test as well as Cohen's kappa test were used to evaluate the agreement between two independent observers. Findings: In the study, content validity index value of the NOC scale was calculated to be 0.90. The examination of the participants' mean scores on the NOC (1100) Oral Health Assessment Scale showed that there were statistically significant differences in terms of the repeated evaluations, except for the NOC indicators of "Oral mucosal integrity," "Gum integrity," and "Tooth integrity" (p < 0.01). No statistically significant correlation was found between the mean NOC scale scores of the patients according to the variables of age, body mass index, mechanical ventilation time, and length of stay in the intensive care unit (p > 0.05). Conclusions: The findings showed that the Turkish version of NOC (1100) Oral Health Assessment Scale was a valid tool for monitoring the healing process of the oral mucosa in patients in intensive care. Implications of nursing practice: With the use of NOC (1100) Oral Health Assessment Scale, a common language will be formed in the evaluation for monitoring the healing process of the oral mucosa in nursing care. [ABSTRACT FROM AUTHOR]