Objectives A clear development process and scientifically validated clinical practice competencies in standard critical care nursing (SCCN) have not yet been developed in Japan. Thus, this study aimed to develop a consensus-based set of SCCN competencies to provide a framework for critical care nursing education, training and evaluation. Design Multistep, modified Delphi study (a systematic review, focus group interviews, a three-round web-based Delphi survey and an external validation process). Participants A systematic review of 23 studies, focus group interviews by 12 experts, a Delphi survey by 239 critical care experts (physicians, nurses and physical therapists) and an external validation by 5 experts (physicians and nurses). Results A systematic review identified 685 unique competencies. The focus group interviews resulted in the addition of 3 performance indicator items, a synthesis of 2 subdomains and 10 elements. Of the 239 participants, 218 (91.2%), 209 (98.9%) and 201 (96.2%) responded in rounds 1, 2 and 3 of the Delphi survey, respectively. After round 3, 57 items were below the consensus level and were removed in the final round. External validation process feedback was received from experts after two revisions to ensure that the final competencies were valid, applicable, useful and clear. The final set of competencies was classified into 6 domains, 26 subdomains, 99 elements and 525 performance indicators. Conclusions This study found a set of SCCN competencies after a multistep, modified Delphi study. The results of this study are robust, and the competency framework can be used in multiple areas to improve clinical practice, including the assessment, training and certification of standard critical care nurses.

Aim: We investigated adverse events (AEs) in a Japanese intensive care unit (ICU) and evaluated the impact of cause‐specific AEs on mortality and length of stay.Design: A retrospective observational study in the ICU of an academic hospital.Methods: We reviewed medical records with the Global Trigger Tool.Results: Of the 246 patients, 126 (51%) experienced one or more AEs with an incidence of 201 per 1000 patient‐days and 115 per 100 admissions. A total of 294 AEs were detected with 119 (42%) adverse drug events, 67 (24%) procedural complications, 63 (22%) surgical complications, 26 (9%) nosocomial infections, 5 (2%) therapeutic errors and 4 (1%) diagnostic errors. Adverse event (AE) presence was associated with length of ICU stay (β = 2.85, 95% confidence interval [CI]: 1.09–4.61). Adverse drug events, procedural complications and nosocomial infections were strongly associated with length of ICU stay (β = 2.38, 95% CI: 0.77–3.98; β = 3.75, 95% CI: 2.03–5.48; β = 6.52, 95% CI: 4.07–8.97 respectively).

Aim: Several studies have shown an association between fluid overload (FO) and mortality or duration of mechanical ventilation in critically ill patients. However, the association between FO and delirium duration remains unclear.Methods: This retrospective observational cohort study was undertaken at University of Tsukuba Hospital (Tsukuba, Japan) from April 2015 to March 2017. Mechanically ventilated patients who stayed in the intensive care unit for more than 7 days were eligible for inclusion. Univariate analysis was carried out with the Mann–Whitney U‐test for continuous variables and Fisher’s exact test for categorical variables. A multivariate proportional odds logistic regression model was used to evaluate the association between FO and delirium/coma days (DCDs) during the 7‐day study period.Results: A total of 118 patients were included and divided into FO and non‐FO groups. Fluid overload occurred in 40% of patients. The FO group had a higher APACHE II score than the non‐FO group (19 [16–26] versus 23 [20–29], P = 0.017). Cumulative fluid balance at day 3 was higher in the FO group (3,238 [281–6,530] versus 7,886 [4,106–10,631], P < 0.001). Delirium days within 7 days was longer in the FO group (1 [0–3] versus 2 [1–3], P = 0.048) and DCDs was longer in the FO group (4 [1–5] versus 6 [3–7], P = 0.002). After adjusting for covariates, there were significant associations between FO and DCDs (odds ratio, 2.16; 95% confidence interval, 1.05–4.47).Conclusions: Our findings suggest that FO is associated with increased DCDs in mechanically ventilated patients.

Background: Limited information is currently available on the barriers to implementing mobilization at the bedside for critically ill patients. Therefore, we investigated the current practice of and barriers to the implementation of mobilization in intensive care units (ICU). Methods: A multicenter prospective observational study was conducted at nine hospitals between June 2019 and December 2019. Consecutive patients admitted to the ICU for more than 48 h were enrolled. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Results: The 203 patients enrolled in the present study were divided into 69 elective surgical patients and 134 unplanned admission patients. The mean periods of time until the initiation of rehabilitation programs after ICU admission were 2.9 ± 7.7 and 1.7 ± 2.0 days, respectively. Median ICU mobility scales were five (Interquartile range: three and eight) and six (Interquartile range: three and nine), respectively. The most common barriers to mobilization in the ICU were circulatory instability (29.9%) and a physician’s order for postoperative bed rest (23.4%) in the unplanned admission and elective surgery groups, respectively. Conclusions: Rehabilitation programs were initiated later for unplanned admission patients and were less intense than those for elective surgical patients, irrespective of the time after ICU admission.

Critically ill patients admitted to the intensive care unit (ICU) experience various symptoms and discomfort. Although thirst is a typical distressing symptom and should be assessed daily, it is crucial to understand its prevalence and risk factors in the ICU setting. Nevertheless, currently, systematic reviews of prevalence and risk factors are lacking. This study evaluated the prevalence and risk factors of thirst in critically ill patients. We conducted a comprehensive search of the MEDLINE, Cochrane Library, and CINAHL databases. The study design included cohort, cross-sectional, and intervention studies, including randomized and non-randomized controlled trials with control groups. The point estimates from each study were combined using a random-effects meta-analysis model. We aggregated the prevalence of thirst in ICU patients and calculated the point estimates and 95% confidence intervals. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Fifteen studies were eligible for inclusion, of which seven reported the prevalence of thirst. A total of 2,204 patients were combined, with a prevalence estimate of 0.70. The risk factors for thirst were categorized as patient and treatment factors: four patient factors (e.g., serum sodium concentration and severity of illness) and six treatment factors (e.g., nil per os and use of diuretics) were identified. However, the results showed high heterogeneity in the prevalence of thirst among critically ill patients. It was established that 70% of critically ill patients experienced thirst. Additional investigations are required to obtain a more comprehensive overview of thirst among these patients. Systematic review registration number The protocol was registered in PROSPERO (ID: CRD42023428619) on June 6, 2023. (URL: https://www.crd.york.ac.uk)