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INTRODUCTION: The utilization of healthcare services in a growing population has raised concerns about its impact on clinical outcomes. Studies have shown that increased hospital census is associated with higher admission rates and unnecessary consults, tests, and procedures in various areas of healthcare. Traumatic brain injuries (TBIs), a significant concern due to their potential for long-term disabilities, are commonly encountered in intensive care units (ICUs) and are a leading cause of patient mortality. Despite extensive research on various aspects of TBI, the effect of the patient census on TBI outcomes remains unexplored. This study aims to investigate the relationship between healthcare provider patient census and clinical outcomes in TBI patients at a level I trauma center. METHODS: A retrospective review was conducted from 2017 to 2022. The mean number of patients per day in the trauma service was determined, with patients below this average considered to be present on low-census days and those above it on high-census days. Patient demographics, mechanisms of injury, vital signs, TBI severity, and associated injuries were analyzed. Adjusted regression analyses were conducted. RESULTS: Over the study period, 1,527 TBI patients were identified. Demographics were similar between patients admitted on high- and low-census days. Patients with moderate TBI were 30% less likely to be admitted to the ICU on high-census days, whereas there was no difference in ICU admission for patients with mild or severe TBI. Delirium was significantly higher in patients admitted on high-census days compared to those on low-census days. This was further identified to be predominantly driven by patients with mild TBI admitted on high-census days. CONCLUSION: While most outcomes remained consistent, significant rates of delirium were found in our mild TBI patients admitted on high-census days suggesting the need for additional factors in the evaluation of these patients on admission. This study also reveals potential under-triage in moderate TBI patients on high-census days as they had significantly lower rates of ICU admission. These findings emphasize the need for further investigations to optimize patient care strategies within the context of fluctuating healthcare system demands.

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BACKGROUND: Relatives of deceased critically ill patients are at high risk for symptoms of complicated grief (CG) with potential individual and social burdens. The prevalence and predictors of CG, and in particular the involvement of individual facets of relatives' coping strategies, are not well understood. RESEARCH QUESTION: How high is the prevalence and what are the predictors of CG, and how are coping strategies associated with CG symptoms? STUDY DESIGN AND METHODS: In this observational single-center cohort study, relatives of deceased critically ill patients were surveyed 6 months later, using the Inventory of Complicated Grief (ICG) and the Brief-COPE questionnaire to assess CG symptoms and coping strategies, respectively. Patients' and relatives' characteristics were obtained. The primary outcome was the ICG sum score. RESULTS: Relatives of 89 of the 298 patients who died in the ICU during the study period were included. The mean ICG sum score (SD) was 41.6+10.9. Eighty-four relatives (94.4%) had an ICG score of >25. Multivariable analysis revealed that being a partner affected the ICG sum score significantly (coefficient 4.9, 95% confidence interval [1.8; 8.0], p=0.003), as did the coping strategies self-distraction (coefficient 4.4, 95% CI [2.5; 6.3], p<0.001), acceptance (coefficient -4.4, 95% CI [-6.3; -2.5], p<0.001), and self-blame (coefficient 3.8, 95% CI [1.4; 6.3], p=0.002). INTERPRETATION: Almost all relatives of deceased critically ill patients show symptoms of CG. Relatives' functional and dysfunctional coping strategies may be associated with their CG symptoms. Knowledge of individual relatives' coping strategies may be helpful in supporting them. Adequate supportive interventions should be developed.

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Background: In resource-limited facilities, the greatest number of unfavorable maternal-fetal outcomes at referral hospitals is chronicled from emergency obstetric referrals of critically ill patients from lower health facilities. An efficient obstetric referral system is thus necessitated for improving maternal health. Referral practices have not been optimized effectively till date, owing to paucity of a detailed profile of referred women and indigenous barriers encountered during implementation process. Materials and methods: This five-year retrospective audit was conducted in the Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi from September 2018 to 2023, in which records of all critically ill obstetric women referred were reviewed. The primary outcomes included were proportion and pattern of patients being referred, while secondary outcomes included demographic variables, referring hospital, reason and number of steps in referral, duration of hospital stay and fetomaternal outcome. The data were recorded on a predesigned case proforma and analyzed using the SPSSv23 version of software, after application of appropriate statistical tests. Results: The referral rate to obstetric intensive care unit (ICU) ranged from 39 to 47% in last 5 years; hypertensive disorder of pregnancy (31%) being the foremost cause of the referrals. Around 2/3rd women were transferred without escort (70%) or prior communication (90.6%) and referral slips were incomplete in half the admissions. Conclusion: Ensuring emergency obstetric care (EmOC) at various levels by up-gradation of health infrastructure would go a long way in improving fetomaternal health outcomes. There is need of standardized referral slips tailor-made to each state and contextualized protocols for early recognition of complications and effective communication between referral centers. How to cite this article: Marwah S, Suri J, Shikha T, Sharma P, Bharti R, Mann M, et al. Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India. Indian J Crit Care Med 2024;28(8):734-740.

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BACKGROUND: The role of the geriatric nutritional risk index (GNRI) as a prognostic factor in intensive care unit (ICU) patients with acute kidney injury (AKI) remains uncertain. OBJECTIVES: The aim of this study was to investigate the impact of the GNRI on mortality outcomes in critically ill patients with AKI. METHODS: For this retrospective study, we included 12,058 patients who were diagnosed with AKI based on ICD-9 codes from the eICU Collaborative Research Database. Based on the values of GNRI, nutrition-related risks were categorized into four groups: major risk (GNRI < 82), moderate risk (82 ≤ GNRI < 92), low risk (92 ≤ GNRI < 98), and no risk (GNRI ≥ 98). Multivariate analysis was used to evaluate the relationship between GNRI and outcomes. RESULTS: Patients with higher nutrition-related risk tended to be older, female, had lower blood pressure, lower body mass index, and more comorbidities. Multivariate analysis showed GNRI scores were associated with in-hospital mortality. (Major risk vs. No risk: OR, 95% CI: 1.90, 1.54-2.33, P < 0.001, P for trend < 0.001). Moreover, increased nutrition-related risk was negatively associated with the length of hospital stay (Coefficient: -0.033; P < 0.001) and the length of ICU stay (Coefficient: -0.108; P < 0.001). The association between GNRI scores and the risks of in-hospital mortality was consistent in all subgroups. CONCLUSIONS: GNRI serves as a significant nutrition assessment tool that is pivotal to predicting the prognosis of critically ill patients with AKI.

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In intensive care unit (ICU) patients undergoing mechanical ventilation (MV), the occurrence of difficult weaning contributes to increased ventilator-related complications, prolonged hospitalization duration, and a significant rise in healthcare costs. Therefore, early identification of influencing factors and prediction of patients at risk of difficult weaning can facilitate early intervention and preventive measures. This study aimed to strengthen airway management for ICU patients by constructing a risk prediction model with comprehensive and individualized offline programs based on machine learning techniques. This study involved the collection of data from 487 patients undergoing MV in the ICU, with a total of 36 variables recorded. The dataset was divided into a training set (70% of the data) and a test set (30% of the data). Five machine learning models, namely logistic regression, random forest, support vector machine, light gradient boosting machine, and extreme gradient boosting, were compared to predict the risk of difficult weaning in ICU patients with MV. Significant influencing factors were identified based on the results of these models, and a risk prediction model for ICU patients with MV was established. When evaluating the models using AUC (Area under the Curve of ROC) and Accuracy as performance metrics, the Random Forest algorithm exhibited the best performance among the five machine learning algorithms. The area under the operating characteristic curve for the subjects was 0.805, with an accuracy of 0.748, recall (0.888), specificity (0.767) and F1 score (0.825). This study successfully developed a risk prediction model for ICU patients with MV using a machine learning algorithm. The Random Forest algorithm demonstrated the highest prediction performance. These findings can assist clinicians in accurately assessing the risk of difficult weaning in patients and formulating effective individualized treatment plans. Ultimately, this can help reduce the risk of difficult weaning and improve the quality of life for patients.

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BACKGROUND: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support. METHODS: These guidelines are based on clinical practice consensus recommendations and scientific statements. We convened an international multidisciplinary consensus panel including 30 clinician-scientists with expertise in ECMO from all chapters of the Extracorporeal Life Support Organization (ELSO). We used a modified Delphi process with three rounds of voting and asked panelists to assess the recommendation levels. RESULTS: We identified five key clinical areas needing guidance: (1) neurological monitoring, (2) post-cannulation early physiological targets and ABI, (3) neurological therapy including medical and surgical intervention, (4) neurological prognostication, and (5) neurological follow-up and outcomes. The consensus produced 30 statements and recommendations regarding key clinical areas. We identified several knowledge gaps to shape future research efforts. CONCLUSIONS: The impact of ABI on morbidity and mortality in ECMO patients is significant. Particularly, early detection and timely intervention are crucial for improving outcomes. These consensus recommendations and scientific statements serve to guide the neurological monitoring and prevention of ABI, and management strategy of ECMO-associated ABI.

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BACKGROUND: In response to the high patient admission rates during the COVID-19 pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We sought to find out whether the provisional ICU setting led to a higher alarm burden and more staff with alarm fatigue. OBJECTIVE: We aimed to compare alarm situations between provisional COVID-19 ICUs and non-COVID-19 ICUs during the second COVID-19 wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by health care staff. METHODS: Our approach involved a comparative analysis of alarm data from 2 provisional COVID-19 ICUs and 2 standard non-COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the 2 ICU types. We analyzed alarm log data from the patient monitoring systems of all 4 ICUs to inferentially assess the differences. In addition, we assessed staff alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on health care personnel. RESULTS: COVID-19 ICUs had significantly more alarms per bed per day than non-COVID-19 ICUs (P<.001), and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-19-specific alarm patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs experienced alarm fatigue. However, physicians and nurses who were working in COVID-19 ICUs reported a significantly higher level of alarm fatigue (P=.04). CONCLUSIONS: Staff in COVID-19 ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management, emphasizing the importance of alarm management training as part of the preparations for future pandemics. However, the limitations of our study design and the specific pandemic conditions warrant further studies to confirm these findings and to explore effective alarm management strategies in different ICU settings.

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BACKGROUND: Quantitative EEG is frequently used to monitor children affected by acute encephalopathy (AE), with the expectation of providing comprehensive insights into continuous EEG monitoring. However, the potential of quantitative EEG for estimating outcomes in this context remains unclear. We sought reliable prognostic markers within the color density spectral array (CDSA) of the continuous EEG for AE-affected children undergoing therapeutic hypothermia (TH). METHODS: This retrospective study analyzed CDSA data from eight scalp electrodes of 15 AE-affected children undergoing TH. Two CDSA features were investigated-high-frequency lines (HFLs) and periodic elevation in the low frequency band (PLFB)-along with the corresponding EEG characteristics. The inter-rater reliability for CDSA was assessed by four pediatric neurologists. Outcomes were grouped into either no/mild or severe decline in motor and cognitive functions, then compared with CDSA features. RESULTS: The median EEG recording time was 114 (81-151) h per child. While at least 41 % of HFLs corresponded to typical sleep spindles, 94 % of PLFB aligned with cyclic changes in the amplitude of delta/theta waves on the raw EEG. Inter-rater reliability was higher for HFLs than for PLFB (kappa values: 0.69 vs. 0.46). HFLs were significantly more prevalent in children with no/mild decline than in children with severe decline (p = 0.017), whereas PLFB did not differ significantly (p = 0.33). CONCLUSIONS: This study provides preliminary evidence that reduced HFLs on CDSA predict unfavorable outcomes in AE-affected children undergoing TH. This suggests that maintaining high-frequency waves is critical for optimal brain function.

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Background: Pre-admission frailty has been associated with higher hospital mortality in patients with critical illness. We aimed to measure the prevalence of frailty and its associated outcomes in patients with COVID-19 critical illness. Methods: A historical cohort study of all adults admitted to ICU with a pneumonia diagnosis in Alberta, Canada between May 1, 2020, and October 31, 2020. At ICU admission patients were routinely assessed for frailty using the Clinical Frailty Scale (CFS). Frailty was defined as a CFS score ≥5. Primary outcomes were pre-admission frailty prevalence and hospital mortality. Results: The cohort (n=521) prevalence of frailty was 34.2% (n=178), mean (SD) age was 58.8 (14.9) years, APACHE II 22.8 (8.0), and 39.5% (n=206) were female. COVID-19 pneumonia was diagnosed in (19.0%; n=99) admissions; pre-admission frailty was present in 20.2% (n=20) vs. 79.8% (n=79) non-frail (p<.001). Among ICU patients admitted with COVID-19, hospital mortality in frail patients was 35.4% (n=63) vs. 14.0% (n=48) in non-frail (p<.001). Conclusion: Pre-admission frailty was present in 20.2% of COVID-19 ICU admissions and was associated with higher risk of hospital mortality. Frailty assessment may yield valuable prognostic information when considering COVID-19 ICU admission; however, further study is needed to identify effect on patient-centred outcomes in this heterogeneous population.

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BACKGROUND: Patient safety is a global health issue that affects patients worldwide. Providing safe care in the intensive care units (ICUs) is one of the most crucial tasks for nurses. Numerous factors can impact the capacity of nurses to deliver safe care within ICUs. Consequently, this study was undertaken with the aim of identifying the components of safe nursing care in ICUs. METHODS: The current research constitutes a qualitative conventional content analysis study conducted from January 2022 to June 2022. The study participants comprised nurses, intensivists, nurse responsible for patient safety, paramedic, patients, and patients' family member, totaling 21 individuals selected through purposive sampling. Data collection involved individual, in-depth, and semi-structured interviews. Subsequently, data analysis was performed utilizing the approach outlined by Graneheim and Lundman (Nurse Educ Today 24(2):105-12, 2004), leading to the identification of participants' perspectives. RESULTS: Three themes were identified as components of safe nursing care in ICUs. These themes include professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). CONCLUSIONS: The findings of this study underscore the significance of advocating for safe nursing practices in ICUs by emphasizing professional conduct, holistic care, and safety-focused organizational structures. These results align with existing research, suggesting that by introducing tailored interventions and tactics informed by these elements, a safer environment for nursing care can be established for ICUs patients.

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Objectives: The objective of this systematic review was to synthesise literature pertaining to patient and family violence (PFV) directed at Intensive Care Unit (ICU) staff. Design: Study design was a systematic review. The data was not amenable to meta-analysis. Data Sources and Review Methods: Electronic searches of databases were conducted to identify studies between 1 January 2000 and 6 March 2023, limited to literature in English only. Published empirical peer-reviewed literature of any design (qualitative or quantitative) were included. Studies which only described workplace violence outside of ICU, systematic reviews, commentaries, editorials, letters, non-English literature and grey literature were excluded. All studies were appraised for quality and risk of bias using validated tools. Results: Eighteen studies were identified: 13 quantitative; 2 qualitative and 3 mixed methodology. Themes included: (i) what is abuse and what do I do about it? (ii) who is at risk? (iii) it is common, but how common? (iv) workplace factors; (v) impact on patient care; (vi) effect on staff; (vii)the importance of the institutional response; and (viii) current or suggested solutions. Conclusions: This systematic review demonstrated that PFV in the ICU is neither well-understood nor well-managed due to multiple factors including non-standardised definition of abuse, normalisation, inadequate organisational support and general lack of education of staff and public. This will guide in future research and policy decision making.

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In Intensive Care Units (ICUs), patients are at risk of developing ocular complications, especially exposure keratopathy. Plan, Do, Study, Act for PDSA cycle. Despite national guidelines, implementation remains challenging. Using the PDSA cycle, we devised an eye care protocol integrated into the electronic patient record system, complemented by a poster summary of guidelines. An initial audit showed 2% adherence to eye exposure guidelines; post-intervention, adherence rose to 76%. A 9-month analysis revealed 16% of patients experienced eye exposure in ICU. This initiative emphasises the new protocol's efficacy and the role of education in its adoption, advocating a more standardised approach to eye care in ICUs.

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BACKGROUND: Some patients with psychotropic drug poisoning need intensive care unit (ICU) admission, but risk prediction models for prolonged ICU stays are lacking. OBJECTIVES: Develop and evaluate a prediction model for prolonged ICU stays in patients with psychotropic drug poisoning. METHODS: The clinical data of patients with psychotropic drug poisoning were collected from the Medical Information Mart for Intensive Care (MIMIC)-Ⅳ 2.2 database. Patients were grouped by their ICU length of stay: non-prolonged (<2 days) and prolonged (≥2 days). Variable selection methods included LASSO and logistic regression. The selected variables were used to construct the model, which was subsequently evaluated for discrimination, calibration, and clinical utility. RESULTS: The cohort included 413 patients with psychotropic drug poisoning, 49.4 % male, with a median age of 41 years. The variables stepwise selected for model construction through LASSO and logistic regression include sepsis, SAPS Ⅱ, heart rate, respiratory rate, and mechanical ventilation. The model showed good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.785 (95 % CI: 0.736-0.833) and was validated well with bootstrap internal validation (AUC: 0.792, 95 % CI: 0.745-0.839). Calibration curves indicated good fit (χ2 = 4.148, P = 0.844), aligning observed and predicted rates of prolonged ICU stays. Decision curve analysis (DCA) showed positive net benefits across a threshold probability range of 0.07-0.85. CONCLUSIONS: The model developed in this study may help predict the risk of prolonged ICU stays for patients with psychotropic drug poisoning.

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BACKGROUND: Pneumonia, a leading cause of morbidity and mortality worldwide, often necessitates Intensive Care Unit (ICU) admission. Accurate prediction of pneumonia mortality is crucial for tailored prevention and treatment plans. However, existing mortality prediction models face limited adoption in clinical practice due to their lack of interpretability. OBJECTIVE: This study aimed to develop an interpretable model for predicting pneumonia mortality in ICUs. Leveraging the Shapley Additive Explanation (SHAP) method, we sought to elucidate the Extreme Gradient Boosting (XGBoost) model and identify prognostic factors for pneumonia. METHODS: Conducted as a retrospective cohort study, we utilized electronic health records from the eICU-CRD (2014-2015) for all adult pneumonia patients. The first 24 h of each ICU admission records were considered, with 70% of the dataset allocated for model training and 30% for validation. The XGBoost model was employed, and performance was assessed using the area under the receiver operating characteristic curve (AUC). The SHAP method provided insights into the XGBoost model. RESULTS: Among 10,962 pneumonia patients, in-hospital mortality was 16.33%. The XGBoost model demonstrated superior predictive performance (AUC: 0.778 ± 0.016)) compared to traditional scoring systems and other machine learning method, which achieved an improvement of 10% points. SHAP analysis identified Aspartate Aminotransferase (AST) as the most crucial predictor. CONCLUSIONS: Interpretable predictive models enhance mortality risk assessment for pneumonia patients in the ICU, fostering transparency. AST emerged as the foremost predictor, followed by patient age, albumin, BMI et al. These insights, rooted in strong correlations with mortality, facilitate improved clinical decision-making and resource allocation.

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OBJECTIVE: This study aims to clarify the uncertain association between vasopressor administration and the development of intensive care unit-acquired weakness (ICUAW) in critically ill adult patients. METHODS: We conducted a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to October 10, 2023. Titles and abstracts were independently screened by two authors, who then reviewed full texts and extracted relevant data from the studies that met the inclusion criteria. This review included prospective and retrospective cohort studies that explored the relationship between vasopressor use and ICUAW utilizing univariate or multivariate analysis in adult ICU patients. RESULTS: A total of 15 studies were included in our review, collectively indicating a statistically significant association between the use of vasopressors and the occurrence of ICUAW (odds ratio [OR], 3.43; 95% confidence intervals [CI], 1.95-6.04), including studies utilizing multivariate analysis (OR, 3.43; 95% CI, 1.76-6.70). Specifically, the use of noradrenaline was significantly associated with ICUAW (OR, 4.42; 95% CI, 1.69-11.56). Subgroup and sensitivity analyses further underscored the significant relationship between vasopressor use and ICUAW, particularly in studies focusing on patients with clinical weakness, varying study designs, different sample sizes, and relatively low risk of bias. However, this association was not observed in studies limited to patients with abnormal electrophysiology. CONCLUSIONS: Our review underscores a significant link between the use of vasopressors and the development of ICUAW in critically ill adult patients. This finding helps better identify patients at higher risk of ICUAW and suggests considering targeted therapies to mitigate this risk.

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Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low-birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cuídame (meaning "Take Care of Me" in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5-20 vs 7, IQR 4-10.5 d; P<.001), feeding (median 53.5, IQR 34-68 vs 44.5, IQR 37-62 d; P=.049), and observation of neurobehavior (median 18, IQR 9-33 vs 11, IQR 7-16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7-23 vs 21, IQR 10-31 d; P=.02), diaper change (median 9.5, IQR 4-20 vs 14.5, IQR 9-32 d; P=.04), and infection prevention (median 1, IQR 1-2 vs 6, IQR 3-12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention.

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Background: Many factors, such as religion, geography, and customs, influence end-of-life practices. This variability exists even between different physicians. Objective: To observe and describe the end-of-life actions of patients in the intensive care unit (ICU) and document the variables that might influence decision-making at the end of life. Materials and Methods: This is a cross-sectional study performed in the ICU patients of a private hospital from March 2017 to March 2022. We used the Philips Tasy Electronic Medical Record database of clinical records; 298 patients were included in the study during these five years (2017-2022). The data analysis was done with the statistical package SPSS version 23 for Windows. Results: A total of 297 patients were included in this study, of which more than half were men. About 60% of our sample had private health insurance, whereas the remaining paid out of pocket. Most patients had withholding treatment, followed by failed cardiopulmonary resuscitation, withdrawal treatment, and brain death, and none of the patients had acceleration of the dying process. The main cause of admission to the ICU in our center was respiratory complications. Most of our samples were Catholics. Conclusions: Decision-making at the end of life is a complex process. Active participation of the patient, when possible, the patient's family, doctors, and nurses, can give different perspectives and a more compassionate and individualized approach to end-of-life care.

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Background & Objective: Acute respiratory failure (ARF) is a life-threatening condition that necessitates intensive care and often results in high morbidity and mortality. Predictive nursing, combined with a risk early warning system, offers a proactive approach to patient care that could potentially improve outcomes in patients with ARF. However, the efficiency of this approach in intensive care settings is still unclear. This study aimed to analyze the effect of predictive nursing based on risk early warning system in patients with acute respiratory failure in intensive care unit (ICU) setting. Methods: A retrospective cohort study included records of 368 patients admitted to ICU of a tertiary care hospital due to ARF from January 2021 to January 2023. Patients were divided into two groups based on the received care: standard care (control group, n=197) and predictive nursing care based on a risk early warning system (observation group, n=171). Data on demographics, clinical characteristics, complications, Acute Physiology, Age and Chronic Health Evaluation-II (APACHE-II) and Sequential Organ Failure Assessment (SOFA) scores, and duration of hospitalization were collected and analyzed. Results: The observation group exhibited significantly lower incidence of complications related to ventilator use and shorter durations of mechanical ventilation, ICU stay, and total hospitalization compared to the control group (p<0.001). Furthermore, patients in the observation group had significantly lower APACHE-II and SOFA scores and blood lactate levels at both one week and two weeks post-intervention. Conclusion: Predictive nursing care based on a risk early warning system significantly improved clinical outcomes and reduced mortality rates in ICU patients with ARF. The results underscore the potential of integrating predictive nursing care into routine practice, thereby transforming the care paradigm for ICU patients with ARF. Future research should explore the applicability of predictive nursing for other clinical conditions and in various healthcare settings.

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Background: In the Intensive Care Unit (ICU), it is vital to meticulously monitor symptoms and thoroughly understand the treatment objectives for critically ill patients. This highlights the necessity of integrating palliative care in this environment. Despite the potential advantages, several barriers impede the effective integration of palliative care in the ICU. Notably, many healthcare professionals (HCPs) in Indonesian ICUs have not fully leveraged the incorporation of palliative care. Purpose: This study aimed to investigate and clarify the experiences of healthcare providers (HCPs) involved in administering palliative care to ICU patients in Indonesia. Methods: This research employed a qualitative descriptive phenomenological approach. Semi-structured, in-depth individual interviews were conducted with four nurses and three doctors working in an Indonesian hospital. Colaizzi's method was used for data analysis. Results: The analysis identified six themes from the interviews, reflecting the experiences of healthcare professionals in delivering palliative care in the ICU. These themes are: 1) Provide Professional Caring, 2) Caring and curing collaboration, 3) Quality Intensive Communication, 4) End-of-Life Care, 5) Controlling Feelings, and 6) Provide Holistic Caring. Conclusion: Providing care for ICU patients demands not only the expertise of HCPs but also compassion, communication skills, and a holistic approach to patient care. By offering comprehensive palliative care in the ICU, healthcare professionals can address the diverse needs of patients and their families, promoting comfort, respect, and an improved quality of life throughout the illness. This inclusive approach enhances the experience for both patients and their families while supporting healthcare providers in delivering empathetic and patient-centered care. It is recommended that hospitals develop policies to enhance palliative care services in Indonesia.

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BACKGROUND: Direct cardiac surgery often necessitates intensive post-operative care, and the intensive care unit (ICU) activity scale represents a crucial metric in assessing and guiding early rehabilitation efforts to enhance patient recovery. AIM: To clarify the clinical application value of the ICU activity scale in the early recovery of patients after cardiac surgery. METHODS: One hundred and twenty patients who underwent cardiac surgery between September 2020 and October 2021 were selected and divided into two groups using the random number table method. The observation group was rated using the ICU activity scale and the corresponding graded rehabilitation interventions were conducted based on the ICU activity scale. The control group was assessed in accordance with the routine rehabilitation activities, and the postoperative rehabilitation indexes of the patients in both groups were compared (time of tracheal intubation, time of ICU admission, occurrence of complications, and activity scores before ICU transfer). The two groups were compared according to postoperative rehabilitation indicators (time of tracheal intubation, length of ICU stay, and occurrence of complications) and activity scores before ICU transfer. RESULTS: In the observation group, tracheal intubation time lasted for 18.30 ± 3.28 h and ICU admission time was 4.04 ± 0.83 d, which were significantly shorter than the control group (t-values: 2.97 and 2.038, respectively, P < 0.05). The observation group also had a significantly lower number of complications and adverse events compared to the control group (P < 0.05). Before ICU transfer, the observation group (6.7%) had few complications and adverse events than the control group (30.0 %), and this difference was statistically significant (P < 0.05). Additionally, the activity score was significantly higher in the observation (26.89 ± 0.97) compared to the control groups (22.63 ± 1.12 points) (t-value; -17.83, P < 0.05). CONCLUSION: Implementation of early goal-directed activities in patients who underwent cardiac surgery using the ICU activity scale can promote the recovery of cardiac function.