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‌Review the Latest Research in Critical Care

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Emergency Nurses Are Vulnerable to the Psychological Impact of Unexpected or Traumatic Deaths

An integrative review, published in Journal of Emergency Nursing, examined the mental health concerns of emergency nurses who care for patients who die unexpectedly. A narrative synthesis was completed, and data were analyzed using the Mixed Methods Appraisal Tool to mitigate biases. Fifteen studies were included, focusing on clinical events such as traumas, gunshot wounds, and motor vehicle accidents. The studies addressed coping mechanisms, end-of-life care education, and peer and managerial support. Symptoms reported by nurses included avoidance, substance abuse, and sleep disturbances. There is a need for intervention studies to address these issues and improve outcomes for nurses facing unexpected deaths.

Robotic Therapy Is a Safe and Effective Adjunct to Conventional Physiotherapy for the Early Mobilization of Critically Ill Neurosurgical Patients

An RCT published in Journal of Neuroengineering and Rehabilitation evaluated the safety and efficacy of a robotic system (VEMOTION) as an add-on intervention for early mobilization in patients with critical neurosurgical conditions. Participants in the control group (n = 9) received standard physiotherapy, while those in the study group (n = 9) received robot therapy in addition to conventional physiotherapy. The primary outcome was the occurrence of (serious) adverse events (SAEs/AEs). Secondary outcomes included improvements in physical and respiratory function as measured by the Chelsea Critical Care Physical Assessment Tool (CPAx). No AEs or SAEs were observed in either group. The study group showed greater improvements in the CPAx, with a median increase of 15 (IQR 11-19) points, compared to a median increase of 4 (IQR 0-5) points in the control group (P = 0.0002). Large-scale studies are needed to confirm these findings and establish the robot's role in daily clinical practice.

AI May Predict Clinical Outcomes and Length of Stay in NICUs

A systematic review in Journal of Medical Internet Research explored the benefits and challenges of using AI in the NICU to predict clinical outcomes and length of stay. A total of 24 studies were included in the review, comprising 15 retrospective and 9 prospective designs. AI showed promise in enhancing diagnostic accuracy and care planning, but significant challenges persist, such as data quality, model generalization, and ethical concerns. The review highlighted AI’s potential to improve NICU care, particularly through predictive models, medical imaging, and personalized interventions. However, the evidence was limited by significant methodological variability, small sample sizes, risk of bias, and a lack of external validation in included studies. Future research should focus on robust validation, comprehensive implementation strategies, and ethical frameworks to ensure AI's effective and responsible integration into NICU settings.

Implementation of a Patient-Ventilator Asynchrony Management Protocol Was Associated With Improved Clinical Outcomes in ICU Patients

An RCT in BioMed Central Research Notes investigated the impact of implementing a patient-ventilator asynchrony (PVA) management protocol on clinical outcomes in 66 mechanically ventilated ICU patients. Patients in the intervention group were evaluated for PVA every 2 hours throughout their ICU stay, as long as they remained on mechanical ventilation. If PVA was detected, appropriate interventions were implemented in accordance with the protocol. The control group received routine care without a specific PVA management protocol. There was a significant difference between the intervention and control groups in terms of duration of mechanical ventilation (P < 0.001), length of ICU stay (P < 0.001), and successful weaning from the ventilator (P < 0.001). However, there was no significant difference between the two groups in terms of ICU mortality (P = 0.202) and self-extubation (P = 0.787). Further studies are warranted to confirm these findings and examine their generalizability across different clinical contexts.

Continuous Infusion of β-Lactams May Reduce Hospital Mortality and Increase the Cure Rate in Critically Ill Patients With Sepsis or Septic Shock Compared to Intermittent Infusion

A systematic review and meta-analysis in BioMed Central Infectious Diseases assessed whether continuous infusion of β-lactam antibiotics improves clinical outcomes compared with intermittent infusion in adult patients with sepsis or septic shock. Eleven studies involving 9166 patients were analyzed. Continuous infusion was associated with lower hospital mortality (RR 0.92; 95% CI, 0.85-0.99), higher survival at the end of the study (RR 1.04; 95% CI, 1.02-1.07), and higher clinical cure rate (RR 1.42; 95% CI, 1.12-1.80). However, there was no significant difference in overall mortality, ICU mortality, ICU or hospital length of stay, or adverse events.

A Restrictive Fluid Strategy With Early De-Escalation May Reduce Fluid Accumulation and Hospital Stay in Critically Ill Patients With Circulatory Shock

An RCT in Critical Care examined the feasibility of adding a restrictive fluid strategy with early de-escalation to standard care for critically ill patients with circulatory shock. After initial fluid resuscitation, patients were randomly assigned (1:1) to either a restrictive fluid strategy or usual care. A total of 100 patients were randomized, with 50 assigned to the restrictive strategy and 50 to usual care. By day 3, the restrictive group showed a lower cumulative fluid balance than usual care (2353 mL vs. 793 mL, P < 0.001). This trend continued to day 7 (3032 mL vs. 1125 mL, P < 0.001). The restrictive group also had shorter ICU and hospital stays (7 vs. 10 days, P = 0.006; 16 vs. 22 days, P = 0.02). There were no significant differences in hospital or 30-day mortality rates, incidences of AKI, or use of RRT.

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