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Original Articles

Nursing
Predictors of delayed extubation post–coronary artery bypass graft and its relationship with length of stay and in-hospital mortality in Jordan: Mohannad Eid Aburuz, Fatma Refaat Ahmed, Haya Ibrahim Ali Abu Maloh, Elham Othman, Ahmed Abdel Hafez, Rawia Gamil, Ahmad Rajeh Saifan; Received August 29, 2024 Accepted March 9, 2026 Published online May 19, 2026; DOI: https://doi.org/10.4266/acc.003432 [Epub ahead of print]

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Abstract PDF: Background
Coronary artery bypass graft (CABG) surgery is an invasive procedure done to resolve symptoms and improve quality of life in patients with coronary artery disease. However, it is a major operation that has its own complications and risks. Delayed extubation (DE) after surgery has been associated with higher-than-average rates of morbidity and mortality. The objective of this study was to determine the incidence and most important predictors of DE following CABG surgery.
Methods
This prospective observational study was conducted on 300 adult patients who underwent non-urgent CABG. Data were collected from 4 hospitals in Alexandria, Egypt, by trained research assistants and were analyzed using logistic regression, independent t-testing, and Fisher's exact test.
Results
Seventy-five participants (25%) developed DE. Patients with age ≥60 years, operation time ≥7 hours, cardiopulmonary bypass time ≥120 minutes, or body mass index ≥28 kg/m2 had a 1.71, 1.88, 2.25, or 2.33 times higher risk of developing DE than those in the counterpoint groups. The only protective variable was the ejection fraction (EF). Patients with EF ≥50% were 21% less likely to develop DE than those with EF less than 50%. Participants who developed DE stayed longer in the intensive care unit (mean±standard deviation [SD], 7.9±1.60 vs. 3.1±1.2; P<0.001) and in the hospital (mean±SD, 22.6±3.1 vs. 15.1±2.9; P<0.001) than those who did not develop DE.
Conclusions
Performing CABG as early as possible, controlling body mass index, shortening the operation and cardiopulmonary bypass times, and enhancing EF might decrease the occurrence of postoperative DE and its associated mortality.

Pulmonary
Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit: Anthony D. Mompiere, Jos L.M.L. le Noble, Manon Fleuren-Janssen, Kelly Broen, Frits van Osch, Norbert Foudraine; Acute Crit Care. 2024;39(3):359-368. Published online August 22, 2024; DOI: https://doi.org/10.4266/acc.2023.01137

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Abstract PDF

Background
Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19.
Methods
This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission.
Results
The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54–8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59–8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033).
Conclusions
Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.

Citations

Citations to this article as recorded by

Prognostic value and nonlinear association of the rdw/albumin ratio with mortality among COVID-19 patients: a MIMIC-IV database analysis
Ping Huang, Qiuyue Yang, Xintong Wang, Qiqi Lai, Jiannan Zhang, Kai Kang, Mingyan Zhao
BMC Infectious Diseases.2026;[Epub] CrossRef
Red Cell Distribution Width-to-Albumin Ratio as a Predictor of Preeclampsia in Advanced Maternal Age: A Retrospective Cohort Study
Nuoni Wang, Shihao Liu, Wenjun Zhou, Liangqing Ge, Sulan Huang
International Journal of Women's Health.2026; Volume 18: 1. CrossRef
Red Blood Cell Distribution Width Is Not a Predictor of Hospital Mortality in Elderly and Nonelderly COVID‐19‐Infected Patients: A Prospective Study at a Brazilian Quaternary University Hospital
Helena Duani, Máderson Alvares de Souza Cabral, Carla Jorge Machado, Thalyta Nogueira Fonseca, Milena Soriano Marcolino, Vandack Alencar Nobre, Cecilia Gómez Ravetti, Paula Frizera Vassallo, Unaí Tupinambás, Muhammad Abu Bakr Shabbir
Canadian Journal of Infectious Diseases and Medical Microbiology.2025;[Epub] CrossRef
Association of red blood cell distribution width with short- and long-term all-cause mortality in patients with acute pancreatitis and sepsis
Qingzhou Song, Xuanlin Wu, Firooz Ahmad Taheri, Linghou Meng, Wentao Wang, Xianwei Mo
BMC Gastroenterology.2025;[Epub] CrossRef
Association Between Red Cell Distribution Width and Mortality in Patients with Klebsiella pneumoniae Bloodstream Infection: A Cohort Study
Yingxiu Huang, Ting Ao, Ming Hu, Peng Zhen
Infection and Drug Resistance.2025; Volume 18: 5961. CrossRef

Nursing
The effects of environmental interventions for delirium in critically ill surgical patients: Hak-Jae Lee, Yoon-Joong Jung, Nak-Joon Choi, Suk-Kyung Hong; Acute Crit Care. 2023;38(4):479-487. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00990

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Abstract PDF

Background
Delirium occurs at high rates among patients in intensive care units and increases the risk of morbidity and mortality. The purpose of this study was to investigate the effects of environmental interventions on delirium.
Methods
This prospective cohort study enrolled 192 patients admitted to the surgical intensive care unit (SICU) during the pre-intervention (June 2013 to October 2013) and post-intervention (June 2014 to October 2014) periods. Environmental interventions involved a cognitive assessment, an orientation, and a comfortable environment including proper sleep conditions. The primary outcomes were the prevalence, duration, and onset of delirium.
Results
There were no statistically significant differences in incidence rate, time of delirium onset, general characteristics, and mortality between the pre-intervention and post-intervention groups. The durations of delirium were 14.4±19.1 and 7.7±7.3 days in the pre-intervention and post-intervention groups, respectively, a significant reduction (P=0.027). The lengths of SICU stay were 20.0±22.9 and 12.6±8.7 days for the pre-intervention and post-intervention groups, respectively, also a significant reduction (P=0.030).
Conclusions
The implementation of an environmental intervention program reduced the duration of delirium and length of stay in the SICU for critically ill surgical patients.

Citations

Citations to this article as recorded by

A Perioperative Care Strategy for Prevention of Postoperative Delirium in Elderly Patients with Gastrointestinal Tumors: A Clinical Observational Study
Chang Xie, Xia Yang
Journal of Multidisciplinary Healthcare.2026; Volume 19: 1. CrossRef
A Nurse‐Led Approach to Preventing Delirium in the ICU: A Randomised Controlled Trial of NICE Guideline‐Based Sensory Modulation
Serpil Topçu, Melis Şen Yılmaz, Merve Kıymaç Sarı, Dilek Özdemir Ürkmez, Zekeriya Ervatan
Nursing in Critical Care.2026;[Epub] CrossRef
The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic review
Marli Lopo Vitorino, Adriana Henriques, Graça Melo, Helga Rafael Henriques
Intensive and Critical Care Nursing.2025; 89: 103976. CrossRef
Delirium in Critically Ill Geriatric Surgical Patients: A Systematic Review of Screening, Risk Factors, Diagnosis, and Management
Zackary Yates, Philip Lee, Nikita Nunes Espat, Ruth Zagales, Nickolas Hernandez, Quratulain Amin, Andrew Ford, Caitlin Tweedie, Adel Elkbuli
Journal of Trauma Nursing.2025; 32(4): 169. CrossRef
The incidence and risk factors of perioperative delirium in elderly patients with hip fracture under the Unaccompanied- Care model
XiaoLing Chen, Yixin Huang, Fengxiang Chen, Xiaole Jiang, Dongze Lin, Fengfei Lin
Journal of Orthopaedic Surgery and Research.2025;[Epub] CrossRef
The effects of restricted visitation on delirium incidence in the intensive care units of a tertiary hospital in South Korea
Leerang Lim, Christine Kang, Minseob Kim, Jinwoo Lee, Hong Yeul Lee, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
Acute and Critical Care.2025; 40(3): 452. CrossRef
Clinical Nursing Management of Adult Patients with Delirium in a Hospital Setting—A Systematic Review
Anna Szewczak, Dorota Siwicka, Jadwiga Klukow, Joanna Czerwik-Marcinkowska, Szymon Zmorzynski
Journal of Clinical Medicine.2025; 14(22): 8113. CrossRef
Reasons influencing the nurses’ prioritization process while preventing and managing delirium: findings from a qualitative study
Luisa Sist, Nikita Valentina Ugenti, Stefania Chiappinotto, Rossella Messina, Paola Rucci, Alvisa Palese
Aging Clinical and Experimental Research.2024;[Epub] CrossRef

Infection
Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19: Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim; Acute Crit Care. 2023;38(1):41-48. Published online February 22, 2023; DOI: https://doi.org/10.4266/acc.2022.01235

8,348 View
136 Download
4 Web of Science
3 Crossref

Abstract PDF

Background
Predicting the length of stay (LOS) for coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) is essential for efficient use of ICU resources. We analyzed the clinical characteristics of patients with severe COVID-19 based on their clinical care and determined the predictive factors associated with prolonged LOS.
Methods
We included 96 COVID-19 patients who received oxygen therapy at a high-flow nasal cannula level or above after ICU admission during March 2021 to February 2022. The demographic characteristics at the time of ICU admission and results of severity analysis (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation [APACHE] II), blood tests, and ICU treatments were analyzed using a logistic regression model. Additionally, blood tests (C-reactive protein, D-dimer, and the PaO2 to FiO2 ratio [P/F ratio]) were performed on days 3 and 5 of ICU admission to identify factors associated with prolonged LOS.
Results
Univariable analyses showed statistically significant results for SOFA score at the time of ICU admission, C-reactive protein level, high-dose steroids, mechanical ventilation (MV) care, continuous renal replacement therapy, extracorporeal membrane oxygenation, and prone position. Multivariable analysis showed that MV care and P/F ratio on hospital day 5 were independent factors for prolonged ICU LOS. For D-dimer, no significant variation was observed at admission; however, after days 3 and 5 days of admission, significant between-group variation was detected.
Conclusions
MV care and P/F ratio on hospital day 5 are independent factors that can predict prolonged LOS for COVID-19 patients.

Citations

Citations to this article as recorded by

Direct and indirect effects of the COVID-19 pandemic on mortality and critical care utilization in South Korea
Mindong Sung, Hye Jin Jang, Soyul Han, Sungho Won, Bora Lee, Young Sam Kim
Acute and Critical Care.2026; 41(2): 315. CrossRef
Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19
Marcella M Musumeci, Bruno Valle Pinheiro2, Luciana Dias Chiavegato1, Danielle Silva Almeida Phillip1, Flavia R Machado3, Fabrício Freires3, Osvaldo Shigueomi Beppu1, Jaquelina Sonoe Ota Arakaki1, Roberta Pulcheri Ramos1
Jornal Brasileiro de Pneumologia.2023; : e20230131. CrossRef
The distorted memories of patients treated in the intensive care unit during the COVID-19 pandemic: A qualitative study
Gisela Vogel, Ulla Forinder, Anna Sandgren, Christer Svensen, Eva Joelsson-Alm
Intensive and Critical Care Nursing.2023; 79: 103522. CrossRef

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