Background: Septic cardiomyopathy (SCM) has no current unified definition, although it can be associated with significant mortality. It encompasses a wide spectrum of cardiac dysfunction ranging from mild to severe systolic and/or diastolic dysfunction of the left and/or right ventricle. The objective of this review is to evaluate the imaging modalities and parameters used to define SCM and the clinical outcomes. Methods: We conducted a systematic review of the literature, including studies up to August 2025, examining the impact of cardiac dysfunction, specifically related to the systolic and/or diastolic dysfunction of the left or right ventricle. We focussed on mortality and comparable phrases as the primary outcome. We considered all cardiac imaging methods. All relevant studies were identified in a search strategy including MEDLINE, Embase and Scopus. Results: About 2669 articles were identified, of which 142 full-text publications were evaluated. Final analysis included 87 publications. Forty five articles provided a definition of SCM. Seventy studies used TTE. Eighteen studies associated LV dysfunction to mortality. Thirteen studies found an association between diastolic dysfunction or RV dysfunction and mortality. About 64% of the studies assessed cardiac function within 24-h of admission. Twenty eight studies re-assessed reversibility of cardiac dysfunction. Interpretation: Cardiac dysfunction is commonly reported in the critically ill septic population. There was considerable heterogeneity with regards to the diagnostic criteria of SCM, parameters used to determine cardiac dysfunction, outcomes evaluated, timing of study or assessing reversibility. Given the high prevalence of cardiac dysfunction in sepsis, a unified assessment and definition of SCM is needed.
The Guideline for Provision of Intensive Care Services version 3 (GPICS3) emphasises the need for physiotherapy staffing models that reflect local service demands and minimum standards rather than specified ratios. Therefore, demand for each activity required to meet GPICS3 minimum standards must be quantified. Provision of physical rehabilitation is one such, but it is unknown what proportion of patients require it each day. Post-hoc analysis of mobility data from 960 patients across 84 UK ICUs was undertaken to calculate rehabilitation demand. It was 45.3% of patients but varied substantially by ICU speciality. National staff-to-bed ratios therefore risk inaccurately quantifying staffing requirements to meet minimum standards.
Introduction: Diarrhoea is common in critically unwell patients and is associated with prolonged intensive care unit (ICU) stay and increased mortality. Its causes are multifactorial; however, emerging evidence suggests that laxative exposure may be an important, and potentially modifiable, contributor. Laxatives are frequently prescribed in ICU patients to prevent constipation, increasingly as part of bowel management protocols (BMP) and care bundles, despite limited supporting evidence. This systematic review evaluated the effects and prevailing associations of laxatives on clinical outcomes in critically unwell adults. Methods: A systematic literature search of MEDLINE (including PubMed), EMBASE, CENTRAL, CINAHL and ClinicalTrials.gov databases was conducted on 21st July 2026 to review studies that included data on the impact of laxatives on clinical outcomes in critically unwell adult patients. Non-English studies, conference abstracts and studies with paediatric patients or adult patients not admitted to ICU were excluded. Two reviewers independently screened studies and extracted data. Methodological quality and risk of bias were assessed using the ROBINS-I V2 tool for observational studies and RoB 2 for randomised trials. Owing to substantial clinical and methodological heterogeneity, findings were synthesised narratively. Results: The systematic literature search identified 28 studies suitable for review inclusion. Of these, 27 were full-text articles, comprising 21 observational studies and six randomised trials; the remaining study was a meta-analysis. Conclusions: Despite their frequency, diarrhoea and constipation in critically unwell patients lack clear, consensus definitions. Evidence supporting prophylactic laxative use is limited; studies have not demonstrated consistent improvements in clinically meaningful outcomes and suggest that prophylactic use may contribute to ICU-associated diarrhoea. Although therapeutic laxative use induces defecation, the optimal agent, dose, timing and patient selection remain uncertain. Standardised definitions of bowel dysfunction and high-quality randomised trials are needed to determine the effects of specific laxative strategies on clinical outcomes and diarrhoea incidence in critically unwell patients.
Background: Intermittent monitoring (IM) of vital signs remains the standard of care for hospitalised ward patients, yet this approach creates gaps during which patient deterioration may go unrecognised. Wearable wireless devices capable of continuously measuring physiological parameters offer the potential for earlier detection of clinical decline and prevention of intensive care unit admissions. This systematic review aimed to compare continuous, non-invasive vital signs monitoring with standard IM for the identification of deterioration and prevention of complications in adult, ward-based hospitalised patients. Methods: A comprehensive search of PubMed, MEDLINE, EMBASE and the Cochrane database was conducted for English-language studies published from January 1980 to December 2025. Eligible studies compared continuous, non-invasive vital signs monitoring with IM in adult ward patients and reported clinical outcomes related to deterioration. Randomised controlled trials were assessed using the Cochrane risk of bias tool and non-randomised studies using the Newcastle-Ottawa scale. Outcomes of interest included mortality, hospital and ICU length of stay, ICU transfers, rapid response or escalation calls, time-critical treatment delivery and clinical complications. Results: Following removal of duplicates, 2028 records were screened, yielding 96 articles for full-text review. Thirty-one studies met the eligibility criteria. Two of these compared algorithm-generated monitoring outputs with periodically calculated early warning scores and were excluded from the primary analysis, leaving 29 studies (7 randomised controlled trials, 12 before-and-after studies, 10 observational cohort studies) in the final synthesis. Several studies reported reductions in mortality, ICU transfers or length of stay with continuous monitoring, but few of these reached statistical significance. Some reported earlier escalation and fewer postoperative complications in continuously monitored patients. Differences between studies in design, monitoring system and outcome definition prevented meta-analysis and limited direct comparison. Conclusions: Current evidence does not demonstrate superiority of continuous over intermittent vital signs monitoring for improving clinical outcomes in ward-based patients, although trends suggest possible reductions in deterioration, mortality and hospital length of stay. To clarify these effects, larger standardised randomised trials are required. Future research should evaluate continuous monitoring in combination with decision-support tools and automated alert systems.
