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Telemedicine is the use of technology to provide healthcare services and information remotely, without requiring physical proximity between patients and healthcare providers. The coronavirus disease 2019 (COVID-19) pandemic has accelerated the rapid growth of telemedicine worldwide. Integrating artificial intelligence (AI) into telemedicine has the potential to enhance and expand its capabilities in addressing various healthcare needs, such as patient monitoring, healthcare information technology (IT), intelligent diagnosis, and assistance. Despite the potential benefits, implementing AI in telemedicine presents challenges that can be overcome with physician-guided implementation. AI can assist physicians in decision-making, improve healthcare delivery, and automate administrative tasks. To ensure optimal effectiveness, AI-powered telemedicine should comply with existing clinical practices and adhere to a framework adaptable to various technologies. It should also consider technical and scientific factors, including trustworthiness, reproducibility, usability, availability, and cost. Education and training are crucial for the appropriate use of new healthcare technologies such as AI-enabled telemedicine. This article examines the benefits and limitations of AI-based telemedicine in various medical domains and underscores the importance of physician-guided implementation, compliance with existing clinical practices, and appropriate education and training for healthcare providers.

The COVID-19 pandemic imposed an unprecedented demand for intensive care unit (ICU) resources in Brazil, where shortages of trained intensivists prompted the implementation of telemedicine-based critical care support strategies. This study aimed to evaluate the association between adherence to the Tele-ICU COVID-19 Brazil Program and clinical outcomes of ICU patients with COVID-19. We conducted a retrospective cohort study including all ICUs participating in the Tele-ICU COVID-19 Brazil Program between April and December 2020. Program adherence was assessed at 2 levels: patient coverage, defined as the number of daily multidisciplinary rounds per patient divided by the patient's total ICU length of stay (LOS), and ICU coverage, defined as the number of daily multidisciplinary round days in the ICU divided by the total number of patient-days in that ICU. We compared outcomes between groups categorized by an empirically defined 50% cutoff: low patient coverage (<50%) versus high patient coverage (≥50%) and low ICU coverage (<50%) versus high ICU coverage (≥50%). Multilevel mixed-effects models accounting for ICU-level clustering were used to assess outcomes: logistic regression for ICU mortality (adjusted odds ratios) and linear mixed-effects regression with log-transformed ICU LOS (exponentiated coefficients, exp[β]). A total of 1680 patients were included. Compared with the low patient coverage group (<50%), patients in the high patient coverage (≥50%) had lower Sequential Organ Failure Assessment scores (median 2, IQR 0-5 vs median 3, IQR 0-6; P=.007); shorter ICU LOS (median 6, IQR 3-11 days vs median 11, IQR 6-20 days; P<.001); and shorter hospital LOS (median 9, IQR 5-16 days vs median 14, IQR 8-26 days; P<.001). In unadjusted analyses, ICU mortality did not differ significantly between the low and high patient coverage groups (50.1% vs 46.3%; P=.16). In multilevel analysis, mechanical ventilation and vasopressor use were independently associated with higher ICU mortality. Higher patient coverage was independently associated with lower ICU mortality (adjusted odds ratio 0.52, 95% CI 0.27-0.99; P=.048). In the log-transformed mixed-effects model for ICU LOS, a higher Sequential Organ Failure Assessment score (exp[β] 1.037, 95% CI 1.02-1.05; P<.001) and use of mechanical ventilation (exp[β] 1.23, 95% CI 1.05-1.43; P=.01) were associated with longer ICU LOS, whereas higher patient coverage was independently associated with shorter ICU LOS (exp[β] 0.17, 95% CI 0.13-0.21; P<.001). ICU coverage was not independently associated with ICU mortality or ICU LOS. Greater patient-level coverage by remote intensivist-led multidisciplinary rounds within the Tele-ICU program was independently associated with lower ICU mortality and shorter ICU LOS. These findings support the potential contribution of tele-critical care strategies to expanding specialist support during public health emergencies.

The role of telemedicine in intensive care has been increasing steadily. Tele-intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention. RR2-10.2196/19695.

Telemedicine Critical Care (TCC) improves adherence to evidence based protocols associated with improved mortality among patients receiving invasive mechanical ventilation (IMV). We sought to evaluate the relationship between hospital availability of TCC and outcomes among patients receiving IMV. We performed a cross-sectional study of 66,522 adults who received IMV for non-postoperative acute respiratory failure at 318 non-federal hospitals in New York, Massachusetts, Maryland, and Florida in 2018. Hospital-level TCC availability was ascertained from the 2018 American Hospital Association Annual Survey. The primary outcome was in-hospital mortality. Secondary outcomes included the composite of tracheostomy or reintubation and duration of IMV. We used two-level hierarchical multivariable regression models to investigate the association between TCC availability and outcomes. 20,270 (30.5%) patients were admitted into 89 TCC-available hospitals. There was no difference between TCC and non-TCC-available hospitals in mortality (odds ratio [OR] 0.94, 99% confidence interval [CI] 0.84–1.05), composite of tracheostomy or reintubation (OR 0.95 [0.82–1.11], or duration of IMV (OR 0.95 [0.83–1.09]). There was no difference in outcomes among the subgroup of patients with acute respiratory distress syndrome. Hospital TCC availability was not associated with improved outcomes among patients receiving IMV. •Telemedicine critical care has been widely adopted; its benefit remains uncertain.•TeleICU can improve processes of care and hasten expert oversight.•Mechanical ventilation is a commonly used, high-risk procedure in critical care.•TeleICU availability wasn't associated with better mechanical ventilation outcomes.

To synthesize current evidence on ICU Command Centers as socio-technical systems that support real-time clinical coordination, data-driven resource allocation, and interdisciplinary workflows, with particular emphasis on implications for critical care nursing practice. A narrative review of peer-reviewed articles and gray literature published from 2005 to 2024 was conducted through PubMed, Embase, and Web of Science, as well as institutional reports. Findings were grouped thematically across five domains: clinical impact, operational efficiency, enabling technologies, barriers to implementation, and case examples. Nursing-related outcomes were specifically highlighted. Authoritative ICU Command Center models are associated with improved adherence to best practices, reduced ICU mortality and length of stay, and enhanced operational efficiency. Platforms integrating predictive dashboards and remote expert support improve staff responsiveness and reduce documentation burden. For nurses, Command Centers may reduce alarm fatigue, streamline workflows, and enhance team communication—especially when systems are tailored to frontline needs. ICU Command Centers represent a scalable, data-driven infrastructure for high-acuity care. Their impact depends on alignment with clinical workflows, especially those of nurses, and on trust-building strategies that promote adoption and sustained use. When integrated effectively, ICU Command Centers can reduce cognitive overload and optimize nursing care by supporting prioritization, protocol adherence, and interdisciplinary coordination. Involving nurses in the design and implementation phases is key to ensuring usability and clinical relevance.

Refractory shock in children carries persistently high mortality, particularly in low-resource settings. It occurs when circulatory failure persists despite adequate fluid resuscitation and vasoactive medications. This review summarizes pathophysiology, recognition, and escalation strategies for pediatric refractory shock, emphasizing early identification in the emergency department. It examines evidence for fluid management, vasoactive therapy, and point-of-care ultrasound in optimizing decision-making, along with second-line options such as corticosteroids, vasopressin, and milrinone. Special attention is given to resource-constrained settings, describing evidence-based adaptations including conservative fluid strategies from the FEAST trial, simplified algorithms, simulation-based training, and telemedicine. Improving outcomes requires rapid recognition, precise hemodynamic phenotyping, and timely evidence-based interventions.

Sepsis is a major health care problem with high morbidity and mortality rates and affects millions of patients. Telemedicine, defined as the exchange of medical information via electronic communication, improves the outcome of patients with sepsis and decreases the mortality rate and length of stay in the intensive care unit (ICU). Additional telemedicine rounds could be an effective component of performance-improvement programs for sepsis, especially in underserved rural areas and hospitals without ready access to critical care physicians. Our aim was to evaluate the impact of additional daily telemedicine rounds on adherence to sepsis bundles. We hypothesized that additional telemedicine support may increase adherence to sepsis guidelines and improve the detection rates of sepsis and septic shock. We conducted a retrospective, observational, multicenter study between January 2014 and July 2015 with one tele-ICU center and three ICUs in Germany. We implemented telemedicine as part of standard care and collected data continuously during the study. During the daily telemedicine rounds, routine screening for sepsis was conducted and adherence to the Surviving Sepsis Campaign's 3-hour and 6-hour sepsis bundles were evaluated. In total, 1168 patients were included in this study, of which 196 were positive for severe sepsis and septic shock. We found that additional telemedicine rounds improved adherence to the 3-hour (Quarter 1, 35% vs Quarter 6, 76.2%; P=.01) and 6-hour (Quarter 1, 50% vs Quarter 6, 95.2%; P=.001) sepsis bundles. In addition, we noted an increase in adherence to the item \"Administration of fluids when hypotension\" (Quarter 1, 80% vs Quarter 6, 100%; P=.049) of the 3-hour bundle and the item \"Remeasurement of lactate\" (Quarter 1, 65% vs Quarter 6, 100%, P=.003) of the 6-hour bundle. The ICU length of stay after diagnosis of severe sepsis and septic shock remained unchanged over the observation period. Due to a higher number of patients with sepsis in Quarter 5 (N=60) than in other quarters, we observed stronger effects of the additional rounds on mortality in this quarter (Quarter 1, 50% vs Quarter 5, 23.33%, P=.046). Additional telemedicine rounds are an effective component of and should be included in performance-improvement programs for sepsis management.

Telemedicine has been deployed to address issues in intensive care delivery, as well as to improve outcome and quality of care. Implementation of this technology has been characterized by high variability. Tele-intensive care unit (ICU) interventions involve the combination of multiple technological and organizational components, as well as interconnections of key stakeholders inside the hospital organization. The extensive literature on the benefits of tele-ICUs has been characterized as heterogeneous. On one hand, positive clinical and economical outcomes have been shown in multiple studies. On the other hand, no tangible benefits could be detected in several cases. This could be due to the diverse forms of organizations and the fact that tele-ICU interventions are complex to evaluate. The implementation context of tele-ICUs has been shown to play an important role in the success of the technology. The benefits derived from tele-ICUs depend on the organization where it is deployed and how the telemedicine systems are applied. There is therefore value in analyzing the benefits of tele-ICUs in relation to the characteristics of the organization where it is deployed. To date, research on the topic has not provided a comprehensive overview of literature taking both the technology setup and implementation context into account. We present a protocol for a scoping review of the literature on telemedicine in the ICU and its benefits in intensive care. The purpose of this review is to map out evidence about telemedicine in critical care in light of the implementation context. This review could represent a valuable contribution to support the development of tele-ICU technologies and offer perspectives on possible configurations, based on the implementation context and use case. We have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and the recommendations of the Joanna Briggs Institute methodology for scoping reviews. The scoping review and subsequent systematic review will be completed by spring 2021. The preliminary search has been conducted. After removing all duplicates, we found 2530 results. The review can now be advanced to the next steps of the methodology, including literature database queries with appropriate keywords, retrieval of the results in a reference management tool, and screening of titles and abstracts. The results of the search indicate that there is sufficient literature to complete the scoping review. Upon completion, the scoping review will provide a map of existing evidence on tele-ICU systems given the implementation context. Findings of this research could be used by researchers, clinicians, and implementation teams as they determine the appropriate setup of new or existing tele-ICU systems. The need for future research contributions and systematic reviews will be identified. DERR1-10.2196/19695.

This editorial reviews and reflects how the approach to Tele-critical care has changed from its first inception, through the COVID pandemic and into todays telemedicine world.

Intensive Care Medicine is based on continuous timely monitoring of physiological variables to guide modulation of therapy. This monitoring is often invasive, but there is a trend for the adoption of non-invasive devices, already largely used in wards and homecare, to reduce risk of device-associated side effects. The aim of this study was to assess the accuracy of a non-invasive equipment (Corsano Cardiowatch 287-2B) in the assessment of blood pressure, heart rate, temperature and oxygen saturation in critically ill patients admitted to the ICU. This prospective cohort study developed in an adult ICU admitting patients for level 3 and 2 of care compared the Corsano Cardiowatch 287-2B with the ICU standard monitoring, namely continuous electrocardiogram, invasive arterial blood pressure through arterial catheter, pulse oximeter and central thermometer. Concordance was assessed using the Bland-Altman test. Nineteen patients were included in the study. The number of time-points included for comparison between the two monitoring strategies were more than 50,000 in pulse and heart rate, around 40,000 in oxygen saturation and body temperature and 1,200 in systolic and diastolic blood pressure. Bias for heart rate and pulse were -1.73 and -0.77, respectively. The limits of agreement were between -14.90 and 11.33, for heart rate, and -14.25 and 12.71, for pulse. Small biases were also estimated for oxygen saturation (0.21), with limits of agreement between -6.97 and 7.39, and body temperature (0.58), with limits between -1.12 and 2.47. Concordance was low for diastolic and systolic blood pressure, with bias of 5.18 and -11.27, respectively. Corsano Cardiowatch 287-2B reaches good levels of concordance compared to traditional ICU monitoring for heart and pulse rates and may be a valuable solution for their less invasive monitoring, with promising results for future operationalization for oxygen saturation and body temperature. Concordance is low for blood pressure, meaning the device is currently unsuitable for use with that purpose.