Objectives To evaluate the effects of paternal and maternal voice interventions on procedural pain, comfort, heart rate, oxygen saturation, and behavioral state during arterial blood sampling in preterm infants, and to compare their effects with routine care and with each other. Methods A three-arm randomized controlled trial was conducted in China between May 2024 and June 2025. Of 135 randomized preterm infants, 119 completed the study (paternal voice, n = 39; maternal voice, n = 39; routine care, n = 41). Parental voice recordings were played from 10 min before until 10 min after arterial blood sampling. Outcomes were assessed at five time points. Generalized estimating equations were used for repeated-measures analyses. Results GEE analysis showed significant group and time effects for pain (P = 0.027 and P < 0.001), with lower pain scores in the paternal voice group than in routine care (mean difference = −0.51; 95% CI −0.96 to −0.06; P = 0.021). Paternal voice was also associated with lower heart rates during sampling, and better comfort scores at 1 and 5 min after sampling, although the overall group effect for comfort was not significant. Maternal voice intervention did not differ significantly from routine care. No between-group differences were observed for oxygen saturation or behavioral state. Conclusions Paternal voice was associated with favorable pain and heart rate responses in preterm infants during and after arterial blood sampling, with time-specific differences in comfort during early recovery. Its overall effect on comfort and relative effectiveness compared with maternal voice require further investigation. Implications for Clinical Practice Paternal voice may offer a simple, safe, and feasible adjunct to procedural pain management and family-centered care in preterm infants.
Background Family members of adult ICU patients are at risk of post-intensive care syndrome-family (PICS-F), but the psychological effects and optimal timing of nurse-led support remain uncertain. Objective To evaluate nurse-led, continuity-oriented family support for PICS-F-related psychological outcomes and explore differences by intervention phase and nurse type. Methods PubMed, CINAHL, Web of Science, PsycINFO, Embase, and the Cochrane Library were searched from inception to May 2026. Randomized and quasi-experimental studies were eligible if they evaluated nurse-led family support in adult ICUs and assessed at least one family-level PICS-F psychological outcome. Short-term outcomes assessed from 2 weeks to 3 months after ICU discharge formed the primary analyses. Random-effects meta-analyses used Hedges' g standardized mean differences (SMDs). Subgroup analyses were conducted by primary intervention phase and nurse type. Risk of bias and certainty of evidence were assessed using validated tools and GRADE. Results Seventeen reports representing 16 independent studies and 3,887 family participants were included. Nurse-led support was not associated with short-term anxiety (SMD = −0.05, 95% CI −0.24 to 0.14; very low certainty), depression (SMD = −0.01, 95% CI −0.23 to 0.21; very low certainty), or post-traumatic stress disorder-related symptoms (SMD = 0.02, 95% CI −0.11 to 0.15; moderate certainty). In-ICU support was associated with lower depression scores (SMD = −0.40, 95% CI −0.67 to −0.12), although phase comparisons included few studies. No ICU transition study contributed an eligible short-term primary outcome. Nurse-type analyses showed no consistent differences. Conclusions Nurse-led, continuity-oriented family support was not associated with improvements in short-term PICS-F-related psychological outcomes. Current evidence does not identify an optimal intervention phase or nurse type. Implications for clinical practice Intervention timing should be considered, although the optimal phase remains uncertain. Nurse-led support may strengthen family-centred care, but persistent distress may require tailored psychological support and referral.
Objectives: To investigate the association between transfusion of blood products during intensive care unit (ICU) stay and the incidence of ICU-acquired colonisation and infection with multidrug-resistant (MDR) bacteria (ICU-MDR-col, ICU-MDR-inf, respectively).Methods: Secondary analysis of two prospective multicentre cohort studies conducted in eight ICUs in France. Adult patients admitted to participating ICUs were enrolled consecutively from May 2019 to June 2021. All patients underwent systematic screening for colonisation with MDR bacteria at admission and weekly thereafter. Exposure to transfusion of blood products during ICU stay, including packed red blood cells (PRBCs), fresh frozen plasma (FFP) and platelet concentrates (PCs), was recorded. The primary outcome was the incidence of ICU-MDR-col and/or ICU-MDR-inf (ICU-MDR-col/inf) until ICU discharge, censored at day 28. Secondary outcomes included the incidence of ICU-MDR-col and ICU-MDR-inf, considered separately. Associations were assessed using mixed-effects Poisson regression models adjusted for prespecified confounders. Subgroup analyses were performed according to immunosuppression status at ICU admission.Results: Among 1103 patients, 358 (32.5%) received transfusion of any blood product. Overall, 292 (26.5%) patients experienced at least one ICU-MDR-col/inf event. Transfusion was associated with an increased incidence of ICU-MDR-col/inf (adjusted incidence rate ratio [aIRR] 1.31, 95% confidence interval [CI] 1.06–1.62; p = 0.013), mainly driven by ICU-MDR-inf (aIRR 1.62, 95% CI 1.16–2.24; p = 0.004), but not ICU-MDR-col considered individually. This association was restricted to PRBC transfusion. No significant heterogeneity was observed according to immunosuppression status.Conclusions: Transfusion of PBRCs was associated with an increased incidence of ICU-acquired MDR infections, with no significant heterogeneity observed according to immunosuppression status.Implications for Clinical Practice: These findings support a restrictive approach to transfusion and warrant further investigation into its immunological and ecological consequences in critically ill patients.
