ICU Daily Gazette | 25 October 2026 — Issue 013

INTENSIVE CARE QUALITY PLATFORM · RESEARCH AND VISUAL EDUCATION DESK

ICU
DAILY GAZETTE

25 October 2026 · SundayIssue 013 · Istanbulwww.yogunbakimkalite.com

Reading the effect of a care bundle together with the limits of its design.
Refeeding syndrome, restarting neuromuscular blockers, and a chart workshop on post-ICU muscle research.

Screening window: 24 October 2026 00:27 – 25 October 2026 00:27 (Europe/Istanbul). All three studies are dated 24 October; because publication times were not stated, we do not claim that all of them fall within an exact last-24-hour window. The visual education section is based on the graphical abstract of the third study published the same day. Research findings, chart-reading education and editorial comment are presented separately.

LEAD · BEFORE–AFTER STUDY WITH HISTORICAL CONTROLS · 24 OCTOBER 2026

A care bundle for refeeding syndrome: a promising preliminary evaluation

Wang and colleagues evaluated a risk-management bundle developed at a single centre in China in 64 adults. Patients receiving enteral or parenteral nutrition and expected to stay in the ICU for at least five days were included. The control group received routine care in March–May 2025; the intervention group received bundle care in June–October 2025.

Early assessmentRisk screening and individualised nutrition.

Dynamic monitoringElectrolyte follow-up and thiamine supplementation.

TeamworkMultidisciplinary collaboration.

Outcomes in two groups of 32 patients each

Outcome	Bundle care	Historical control
Refeeding syndrome	18.8%	59.4%

Relative risk for the syndrome: 0.32 (95% CI 0.15–0.69).

Evidence limit: No randomisation; the small sample, differences in care between periods and confounders may affect the results. The association does not prove a causal benefit of the bundle or the effect of any single component; no survival benefit can be inferred.

Access: The publisher abstract of the accepted early version was checked; the full PDF/supplements were not read. No diagnostic criterion, dose or implementation protocol is recommended.
Wang X-e et al. BMC Nursing, 24 October 2026.
Original research · DOI: 10.1186/s12912-026-05356-7 ↗

MULTI-DATABASE RETROSPECTIVE COHORT · 24 OCTOBER 2026

Restarting neuromuscular blockers after discontinuation is common

Using MIMIC-III/IV, eICU, HiRID, AmsterdamUMCdb and institutional data, Okamura and colleagues studied 829 mechanically ventilated patients with PaO₂/FiO₂ <200 who received neuromuscular blockers for more than 24 hours.

332 / 829 · 40.0%Use for more than 48 hours.

291 / 737 · 39.4%Restarted among patients in whom the drug was stopped.

Of the 737 patients in whom the drug was stopped, 260 (35.3%) died in the ICU. Duration of use was associated with restarting; no statistically significant association with ICU mortality was found. Practice varied markedly across datasets.

Evidence limit: This is not a treatment-duration trial. Factors such as illness severity and treatment selection may explain the association. A non-significant mortality association does not show that prolonged use is safe or equivalent, and no stopping/restarting threshold is provided.

Access: The structured abstract of the accepted early version was verified; the full PDF and supplements were not read. Because the unit of the duration effect estimate could not be confirmed from the abstract, no numerical OR is given.
Okamura G et al. BMC Pulmonary Medicine, 24 October 2026.
Publisher abstract of the cohort · DOI: 10.1186/s12890-026-04856-1 ↗

MECHANISTIC STUDY + VISUAL EDUCATION FROM THE SAME SOURCE · 24 OCTOBER 2026

In the muscle-response chart, read the baseline too

Study: Fischer-Hammerschmied and colleagues compared 20 people 3–6 months after ICU discharge with 20 age- and sex-matched controls. Muscle protein synthesis was measured with biopsies before and after resistance exercise and protein intake.

Muscle protein synthesis · %/hour

Group	Before	After
Post-ICU	0.041	0.071
Control	0.030	0.070

Chart-reading lesson: The four panels of the original graphic show the participants, the experimental set-up, the synthesis response and the authors’ interpretation. In the post-ICU group the baseline was higher and the increase smaller. Similar final values are not evidence of equivalence.

Inference limit: A single-session mechanistic response; it does not demonstrate long-term benefit for muscle strength, function or survival. The findings do not constitute an exercise or protein-dose prescription for acutely ill ICU patients.

The publisher abstract and the actual graphical abstract were viewed; the full PDF/supplements were not read. The table was prepared for this gazette; the source image was not reproduced. This education section is not a separate study.
Fischer-Hammerschmied A et al. Critical Care, 24 October 2026.
Study and graphical abstract · DOI: 10.1186/s13054-026-06418-7 ↗

EDITORIAL COMMENT · NOT A RESEARCH FINDING

Design, timing and denominator in the same table

At the unit quality meeting we can write three questions next to every finding: who was compared, when was it measured, and who makes up the denominator of the rate? For a care bundle this means a historical control; for drug use, a selected subgroup; for the muscle study, a single-session response after discharge. Making these distinctions visible helps the team share the uncertainty behind a decision while discussing the research.

Editorial desk: www.yogunbakimkalite.com · 25 October 2026 · Issue 013. This is the English edition.
Source transparency: The publisher structured abstracts, publication dates and accepted-early-version information of three new studies were verified; full PDFs and supplements were not read. The third study’s graphical abstract was actually viewed. The sources’ publication day is 24 October; this is not the data-collection date or an exact last-24-hour verification. Clinical content is educational information limited to the scope of the sources.