Acute and Critical Care

Review Articles

Nursing
Nursing delirium management to promoting critically ill patients’ safety: an umbrella review: Daniela Carvalho Plácido, Maria do Rosário Pinto, Maria Cândida Durão, Helga Rafael Henriques, Joana Ferreira Teixeira; Acute Crit Care. 2025;40(3):373-392. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.005221

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Abstract PDF: Delirium is an acute disorder characterized by changes in the patient’s cognitive function, which another neurocognitive or pre-existing disease cannot explain. It produces adverse outcomes for critically ill patients and their families related to adverse events associated with the accidental removal of medical devices that increase the risk of the patient and the length of stay at the hospital, manifested by agitation and confusion behaviors. Five reviewers conducted An Umbrella Review from May to August 2023 through research in the databases Medline, CINAHL, Scopus, Web of Science, Cochrane Database of Systematic Reviews and articles obtained through research in other sources. After verifying their eligibility, we obtained 22 systematic reviews and meta-analyses for data extraction and analysis. From the results obtained, the importance of the implementation of surveillance interventions and systematic evaluation of the presence of delirium is highlighted, with particular emphasis on the use of the scale, Confusion Assessment Method, followed by the implementation of multicomponent interventions, pharmacological or not, highlighting the use of dexmedetomidine and family as support, as well early mobilization for the management of delirium. Managing delirium in critically ill patients based on Meyer and Lavin's theory, is an area sensitive to nursing care with an impact on the prevention of complications and consequent promotion of the safety of these patients, which also translates into positive results for the family and health organizations, reducing morbidity, mortality, length of stay and health costs.

Nursing
Promoting patient safety in critically ill patients: nursing interventions in surveillance and prevention of ocular injuries: Anabela Carvalho Raposo, Maria Candida Durao, Maria do Rosário Pinto, Helga Rafael Henriques, Joana Ferreira Teixeira; Acute Crit Care. 2025;40(1):10-17. Published online February 12, 2025; DOI: https://doi.org/10.4266/acc.005014

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1 Web of Science
2 Crossref

Corneal surface injuries occur frequently (59.4%) in critically ill patients, and the average time for their appearance is 8 days. Such injuries are primarily related to dry eye, which increases the risk of exposure injury in patients admitted to intensive care units. This can result in a severe ulcer or perforation that results in partial to total loss of vision, decreasing the quality of the patient's life. This is a sensitive nursing care area requiring further investigation. Thus, this review aims to analyse nursing interventions that aim to prevent ocular surface injuries. An integrative literature review was carried out from May to August 2023 in the Medline, CINAHL, Scopus, Web of Science, and PubMed databases using the Whittemore and Knafl methodology. Inclusion and exclusion criteria were subsequently applied to assess the results. After verifying result eligibility, seven documents were identified for data extraction and analysis. The results suggest the importance of recognizing risk factors for ocular injuries in critically ill patients, surveillance as a nursing competency, adequate ocular hygiene and effective lubrication, and managing environmental conditions to prevent corneal injuries. Implementing surveillance and intervention protocols for critically ill patients at risk of corneal injuries requires specialized training for critical care nurses. Specifically, environmental management, including temperature and humidity control, is highlighted as an area that merits further research.

Citations

Citations to this article as recorded by

Lens on eye care in intensive care units: deficiencies, training, and improvement recommendations – a descriptive observational study
Ayşegül Tuğba Yıldız, Özlem Ceyhan
BMC Nursing.2025;[Epub] CrossRef
Ocular Surface Disorders in ICU Patients: Evidence-Based Nursing Prevention Strategies
Weiwei Ni, Xinwei Jiao
Translational Vision Science & Technology.2025; 14(12): 21. CrossRef

Nursing
Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review: Daniela Fradinho Almeida, Maria do Rosário Pinto, Maria Candida Durao, Helga Rafael Henriques, Joana Ferreira Teixeira; Acute Crit Care. 2024;39(3):341-349. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00528

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Abstract PDF: Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%–0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20–30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.

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