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Dexmedetomidine May Improve Early Organ Dysfunction in Adults With Septic Shock

A systematic review and meta-analysis published in European Journal of Anesthesiology and Intensive Care assessed the efficacy of dexmedetomidine (Dex) in comparison to other sedatives. The study included eight RCTs comprising 702 adult patients with septic shock. The results of the meta-analysis demonstrated a significant decrease in the day-2 SOFA score (P = 0.009) and the incidence of AKI (P = 0.004) treated with Dex compared to other sedatives. However, Dex significantly increased the duration of hospital stay (P = 0.01) and the incidence of hypotension (P = 0.04). Evidence for long-term clinical benefits of Dex in adults with septic shock is limited, and future studies are warranted.

Virtual Reality Appears to Provide Additional Analgesic Benefit for ICU Patients

A systematic review and meta-analysis published in Frontiers in Medicine evaluated the impact of virtual reality technology or intervention on pain levels and analgesic dosage in ICU adult patients. Thirteen studies comprising 979 patients were included. A meta-analysis of seven RCTs demonstrated that head-mounted virtual reality devices delivering 360° relaxing nature scenes significantly reduced pain scores compared to conventional care (SMD = ‒0.66; 95% CI, 0.93 to ‒0.40; P = 0.032). The effect was most pronounced during acute procedural pain. Future studies should be conducted to validate the efficacy of virtual reality for pain reduction in the ICU.

Adult ECMO Survivors Experience Substantial Psychological Distress

A systematic review and meta-analysis published in General Hospital Psychiatry evaluated the long-term psychological outcomes after ECMO treatment. Forty-two studies met inclusion criteria. The pooled prevalence of anxiety across 26 studies (n = 936 patients) was 28% (95% CI, 21-36), with a mean Hospital Anxiety and Depression Scale (HADS) anxiety score of 4.67 (95% CI, 3.84-5.50). Depression prevalence across 32 studies (n = 1224 patients) was 21% (95% CI, 16-27), with a mean HADS depression score of 4.35 (95% CI, 3.56-5.14). Post-traumatic stress disorder prevalence across 30 studies (n = 1128 patients) was 19% (95% CI, 15-23). These findings support routine psychological screening and integration of mental healthcare into ECMO survivorship pathways.

Prophylactic PPIs Decrease Risk of Upper Gastrointestinal Bleeding in Critically Ill Adults Undergoing Invasive Mechanical Ventilation

A systematic review and meta-analysis published in Critical Care Research and Practice assessed the safety and efficacy of prophylactic proton pump inhibitors (PPIs) among critically ill adults undergoing invasive ventilation. Nine RCTs encompassing 8388 patients were included. All-cause mortality rates were comparable between the PPI and control groups (OR = 0.98; 95% CI, 0.89-1.07; P = 0.61). Prophylactic PPI significantly reduced the incidence of UGIB (OR = 0.42; 95% CI, 0.23-0.75; P = 0.003) and clinically important UGIB (OR = 0.36; 95% CI, 0.19-0.69; P = 0.002). The analysis revealed no significant increase in the risk of ventilator-associated pneumonia (OR = 0.99; 95% CI, 0.87-1.12; P = 0.86) or Clostridioides difficile infection (OR = 1.63; 95% CI, 0.97-2.73; P = 0.07) with PPI use. Duration of ICU stay and invasive ventilation did not differ significantly between groups.

Incidence of Sepsis-Associated Delirium Is High in ICU Patients

A systematic review and meta-analysis published in Intensive and Critical Care Nursing investigated the incidence and risk factors of sepsis-associated delirium (SAD) in ICU patients. Fifty-two studies comprising 89,789 ICU patients were included. The pooled incidence of SAD was 43% (95% CI, 39-47). Seventeen significant factors were identified across 32 studies that reported risk factors. High-evidence strength factors (≥5 studies) included higher APACHE II and SOFA scores, advanced age, elevated neuron-specific enolase and S100β protein levels, mechanical ventilation, hyperlactatemia, and cerebrovascular disease. Mechanical ventilation had the strongest association with SAD (OR = 2.623). These findings suggest that nurses should perform routine delirium screening in high-risk patients with sepsis and implement targeted interventions. Future research on standardized diagnosis and nurse-led prevention strategies is needed.

Nurse Staffing Optimization Emerges as Most Actionable Strategy to Reduce Outcome Disparities in Patients With Neurological Disorders

A systematic review in Risk Management and Healthcare Policy aimed to synthesize evidence on the associations between social determinants of health and nursing care quality and patient outcomes across major neurological disorders. Sixty-five observational studies comprising 5,412,847 patients with stroke, dementia, Parkinson disease, multiple sclerosis, epilepsy, and traumatic brain injury were included. Low socioeconomic status was associated with 39% increased stroke mortality and 36%-66% higher rates of poor functional outcomes. Racial and ethnic minorities experienced 15%-25% reduced access to acute stroke treatments and 27% higher readmission rates. Uninsured patients faced three-fold increased mortality and substantially reduced rehabilitation access, while rural patients received thrombolysis 50%-55% less frequently. Optimal nurse staffing ratios (<3 patients per nurse) were associated with substantially reduced racial disparities in stroke readmissions, representing a critical modifiable nursing intervention.

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