Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849181
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Acute hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS) are life-threatening conditions marked by impaired gas exchange due to ventilation-perfusion mismatch and intrapulmonary shunting, often...Acute hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS) are life-threatening conditions marked by impaired gas exchange due to ventilation-perfusion mismatch and intrapulmonary shunting, often from inflammatory alveolar-capillary injury. Recognizing ARDS and initiating lung-protective strategies, such as low tidal volume ventilation, individualized positive end-expiratory pressure, and prone positioning are crucial. Prone positioning improves oxygenation and outcomes in intubated patients and may benefit select awake patients when used early with close monitoring. Noninvasive support including a high-flow nasal cannula, may be appropriate for selected patients who are prone. Understanding the physiologic underpinnings and applying evidence-based interventions can significantly improve patient outcomes.
Meza D, Uppalapu S, O'Hea J
… +2 more, Ross S, Flores A
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849180
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To receive optimal care, health care professionals must be cohesive in their approach within their organizational structure. The implementation of a protocol-based ventilator management guideline in an intensive care set...To receive optimal care, health care professionals must be cohesive in their approach within their organizational structure. The implementation of a protocol-based ventilator management guideline in an intensive care setting will yield favorable results. Utilizing a multidisciplinary approach optimizes practice standardization and fosters growth for the health care professional to practice their craft within set guardrails. Empowering health care professionals to utilize their critical thinking skills is an effective way to build the framework of success for all stakeholders. In turn, the needs of the patient are brought to the forefront with a streamlined objective.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849179
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Airway pressure release ventilation (APRV) was historically used only to treat severe acute respiratory distress syndrome. However, because APRV optimizes alveolar recruitment and oxygenation while minimizing ventilator-...Airway pressure release ventilation (APRV) was historically used only to treat severe acute respiratory distress syndrome. However, because APRV optimizes alveolar recruitment and oxygenation while minimizing ventilator-induced lung injury, practice trends have shifted. Early initiation of APRV is now considered for lung protection rather than late use as salvage therapy. This mode limits ventilatory associated lung injury, decreases sedation requirements, and optimizes hemodynamic profiles. It has transitioned from a rescue therapy to a mode of lung protective ventilation. This article explains the foundation of APRV showcases the benefits of early implementation, and provides a practical blueprint for the bedside clinician.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849178
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The article discusses the types of respiratory failure, evidence, indications for noninvasive support modalities of continuous positive airway pressure, high flow nasal cannula, and bilevel positive airway pressure and c...The article discusses the types of respiratory failure, evidence, indications for noninvasive support modalities of continuous positive airway pressure, high flow nasal cannula, and bilevel positive airway pressure and considerations for using and monitoring each modality to provide optimal patient outcomes.
Adduono K, Siao SF, Work B
… +3 more, Huang CY, Chia-Hui Chen C, Boehm LM
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849177
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Acute respiratory failure (ARF) is a severe condition frequently treated in intensive care units (ICUs) worldwide. ARF presents a spectrum of outcomes, from immediate complications to long-term impacts. This literature r...Acute respiratory failure (ARF) is a severe condition frequently treated in intensive care units (ICUs) worldwide. ARF presents a spectrum of outcomes, from immediate complications to long-term impacts. This literature review examines the implementation of the ABCDEF bundle to address the complex pathophysiology of ARF. This bundle addresses critical aspects of care, including pain management, agitation/sedation, delirium, immobility, and sleep optimization, to improve respiratory function and support timely weaning from mechanical ventilation. We highlight the bundles' components as necessary in mitigating the adverse effects of ARF and enhancing patient recovery. We also identify barriers to implementation within ICUs.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849176
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The human respiratory system is essential for oxygenation and carbon dioxide elimination; however, various pulmonary diseases can severely compromise its function. This article explores common respiratory disorders, emph...The human respiratory system is essential for oxygenation and carbon dioxide elimination; however, various pulmonary diseases can severely compromise its function. This article explores common respiratory disorders, emphasizing their pathophysiology, clinical trends, and treatment strategies. Advances in respiratory support devices have significantly improved patient outcomes. Additionally, the role of arterial blood gas analysis in guiding treatment decisions is discussed. The benefits and risks of prone positioning as a therapeutic intervention for acute respiratory distress syndrome are also examined. By understanding the evolving landscape of pulmonary diseases and therapeutic modalities, health care providers can enhance patient care and improve outcomes.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849175
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Pulse oximeters are widely used to monitor saturation of peripheral oxygen (SpO2) in the clinical setting. Patients with dark skin pigmentation are at risk for hidden hypoxemia due to overestimation of SpO2 compared to t...Pulse oximeters are widely used to monitor saturation of peripheral oxygen (SpO2) in the clinical setting. Patients with dark skin pigmentation are at risk for hidden hypoxemia due to overestimation of SpO2 compared to true arterial oxygen saturation resulting from melanin absorption of the red and infrared light sources. Clinicians must be aware of this potential inaccuracy when interpreting SpO2 value, considering the overall assessment of the patient. Ongoing improvement of current and emerging oxygen monitoring technology is essential to improve accuracy and equitable care for all patients.
Mampre D, Stabenau K, Thurmond K
… +1 more, Petersen E
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849174
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The pulmonary system is sensitive to aerospace exposures, including changes in atmospheric composition and pressure, alterations in gravitational forces, and exposure to radiation and toxins. Providing nursing care in th...The pulmonary system is sensitive to aerospace exposures, including changes in atmospheric composition and pressure, alterations in gravitational forces, and exposure to radiation and toxins. Providing nursing care in the aerospace environment requires understanding of pulmonary conditions such as high-altitude pulmonary edema, decompression-related illness and injury, arterial gas embolism, acceleration atelectasis, hypoxia, hypercapnia, and exposure syndromes. In addition to these conditions, we discuss changes in pulmonary physiology in microgravity, in-flight nursing medical capabilities, and treatment of pulmonary conditions in microgravity environments.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849173
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Effective management of pulmonary hypertension in critical care settings is essential to improve patient outcomes, particularly given the complexity and rapid progression of this condition. These guidelines are designed...Effective management of pulmonary hypertension in critical care settings is essential to improve patient outcomes, particularly given the complexity and rapid progression of this condition. These guidelines are designed to enhance the clinical skills of critical care nurses by providing practical recommendations and evidence-based interventions. Key management strategies include treating the underlying causes of clinical deterioration, optimizing right ventricular function, and addressing associated complications.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849172
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Idiopathic pulmonary fibrosis and progressive pulmonary fibrosis are advanced interstitial lung diseases with high morbidity and mortality, particularly during and following acute exacerbations. Intensive care unit admis...Idiopathic pulmonary fibrosis and progressive pulmonary fibrosis are advanced interstitial lung diseases with high morbidity and mortality, particularly during and following acute exacerbations. Intensive care unit admissions are often due to respiratory failure, with limited treatment options. Advanced life support measures, such as mechanical ventilation and extracorporeal membrane oxygenation, should be considered only as bridges to lung transplantation. The integration of palliative care and ongoing discussions about goals of care with patients and their families remain essential in managing these complex cases.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849171
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Nursing care for patients who undergo complex thoracic surgery centers on a plan which is based on evidence, focusing on preoperative preparation and postoperative avoidance of complications. Regardless of the nature of...Nursing care for patients who undergo complex thoracic surgery centers on a plan which is based on evidence, focusing on preoperative preparation and postoperative avoidance of complications. Regardless of the nature of the surgery, whether it is invasive or minimally so, thorough patient assessment and rigorous pain, cardiopulmonary, wound, and drain management are paramount to yielding desired outcomes.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849170
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There is a high incidence of traumatically injured patients who have rib fractures and/or pulmonary contusions, and these injuries accompany a significant morbidity and mortality rate. By ensuring adequate pain control t...There is a high incidence of traumatically injured patients who have rib fractures and/or pulmonary contusions, and these injuries accompany a significant morbidity and mortality rate. By ensuring adequate pain control through multimodal analgesia and other minimally invasive modalities, we can help facilitate early mobilization, incentive spirometer use, coughing, deep breathing, and secretion mobilization, which will in turn prevent hypoxia and hypoventilation. By preventing hypoxia and hypoventilation, we prevent and/or reduce the need to mechanically ventilate our trauma patients with chest wall trauma, which decreases intensive care unit and hospital length of stay and overall health care costs.
Crit Care Nurs Clin North Am
· 2025 Sep · PMID 40849169
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Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by severe inflammation and impaired gas exchange, leading to hypoxemic respiratory failure. It significantly impacts patients by in...Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by severe inflammation and impaired gas exchange, leading to hypoxemic respiratory failure. It significantly impacts patients by increasing morbidity, mortality, and need for prolonged intensive care unit care. ARDS progresses through 3 phases-exudative, proliferative, and fibrotic-each requiring distinct management strategies. Extracorporeal membrane oxygenation offers life-saving support for severe cases by oxygenating blood outside the body when conventional methods fail. Emerging technologies, like artificial intelligence, assist in predicting ARDS progression and personalizing treatment, while protocolized approaches to ventilation, weaning, and early mobilization continue to improve patient outcomes.
Lindroth H, Sahajwani J, Hudson M
… +8 more, Heier L, Gonzalez AA, Bhattacharyya A, Zheng Z, Boustani M, Herasevich V, McGowan M, Barry B
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382095
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This article summarizes existing ethical frameworks for healthcare artificial intelligence (AI) and ambient sensing technology, such as computer vision, and examines their application to improve patient outcomes in the i...This article summarizes existing ethical frameworks for healthcare artificial intelligence (AI) and ambient sensing technology, such as computer vision, and examines their application to improve patient outcomes in the intensive care unit (ICU). Integrating ethical considerations such as privacy, fairness, and autonomy into the lifecycle of an AI tool is necessary to fully harvest AI's potential to deliver safe, high-quality, personalized, and low-cost healthcare services that provide positive experiences for patients, families, and clinicians while improving health outcomes. Drawing from agile science, the article proposes a practical roadmap for clinician and researcher use to identify, integrate, and monitor ethical considerations throughout the lifecycle of an AI tool with the intention to improve patient care. A use case illustrates the application of the agile science-informed roadmap that details the development of a passive digital marker for delirium severity.
Mitchell Tan K, Zandi A, Tavakolian K
… +1 more, Wung SF
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382094
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This article examines the current technologies used with indwelling urinary catheters to monitor potential catheter-associated urinary tract infections (CAUTIs) in the intensive care unit. Advancements in medical interne...This article examines the current technologies used with indwelling urinary catheters to monitor potential catheter-associated urinary tract infections (CAUTIs) in the intensive care unit. Advancements in medical internet-of-things, artificial intelligence, and machine learning technologies can enable remote monitoring, improving working conditions for critical care nurses, alleviating increasing workloads, reducing direct health care costs, and paving the way for predictive analytics to lower CAUTI rates. The most effective approach to preventing CAUTIs is implementing technologies that facilitate for the early removal of indwelling urinary catheters from patients.
Keim-Malpass J, Kausch SL, Barros A
… +2 more, Muir KJ, Spaeder MC
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382093
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We present an overview of historical approaches used to capture therapeutic intensity and the burden of care, as well as patient illness severity, which serve as proxies for nurse workload. This overview includes a case...We present an overview of historical approaches used to capture therapeutic intensity and the burden of care, as well as patient illness severity, which serve as proxies for nurse workload. This overview includes a case study that extends on these concepts and seeks to develop a computable biomarker, referred to as pharmacomarkers, that represents a composite of medication-related orders, including new medication changes, infusion rate changes, as-needed pro re nata (PRN) medications, scheduled medications, and all medications in general. Additionally, we discuss the development and visualization of pharmacomarkers as alternative measures for nurse workload in the intensive care unit setting.
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382092
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This scoping review systematically examines the emerging field of multimodal family engagement technologies in intensive care units (ICUs). Despite significant advancements in medical technology, family engagement remain...This scoping review systematically examines the emerging field of multimodal family engagement technologies in intensive care units (ICUs). Despite significant advancements in medical technology, family engagement remains an underutilized resource in many ICU settings. This review consolidates current evidence by evaluating the effectiveness of these systems in improving patient outcomes and family satisfaction. By synthesizing data on system development, implementation, and outcomes, this article aims to guide future research and clinical integration. It focuses on overcoming existing barriers and maximizing the potential of these technologies in intensive care environments.
Crit Care Nurs Clin North Am
· 2025 Jun · PMID 40382091
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Best Practice Advisories (BPAs) are clinical decision support tools integrated into the patient's electronic health record to assist registered nurses. They provide reminders and highlight patterns based on clinical asse...Best Practice Advisories (BPAs) are clinical decision support tools integrated into the patient's electronic health record to assist registered nurses. They provide reminders and highlight patterns based on clinical assessment findings. To analyze their use at a hospital in Southern Arizona, the AUTOS (Artifact, User, Task, Organization, and Situation) framework was used, which follows a human-centered design approach. Although BPAs offer significant support, they can disrupt critical care nurses' workflows. In 2023, this Southern Arizona hospital reported more than 36 unique BPAs, resulting in an average of 783 alerts for critical care nurses in the intensive care unit each month.