Combating Critical Issues in the ICU


Over 5.7 million critically ill patients are admitted to intensive care units (ICUs) in the U.S. each year. For over two decades, I have led research to reduce risk and prevent serious complications for these vulnerable patients.

Ventilator-associated pneumonia is one of the most common complications associated with critical illness. In the 1990s, about one in four patients on a hospital ventilator breathing machine contracted pneumonia and half would die. The protocols I developed through studies funded by the National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH) led to clinical practice changes and a significant decrease in ICU ventilator-associated pneumonia.

More recently I’ve turned my attention to an emerging problem I believe to be the most critical issue in the ICU today: delirium. Up to 80% of critically ill, mechanically ventilated adults experience delirium. Substantial negative outcomes associated with delirium include increased complications during hospitalization and long-term cognitive and health-status effects.

The ICU, with its blaring lights and blinking and beeping equipment, isn’t always the most nurturing environment. Patients can easily become disoriented and unable to interpret what’s happening around them. A pilot study I conducted showed that ICU patients who heard messages recorded in a familiar voice were better oriented and had more favorable outcomes than control group patients who did not hear any messages.

My pilot study provided the foundation for a four-year, $1.94 million clinical trial for which I am the principal investigator. Funded by the NINR of the NIH, the Family Automated Voice Reorientation (FAVoR) intervention uses scripted audio messages recorded by the patient’s family. A small speaker by the patient’s head emits a series of messages in a family member’s soothing, familiar voice, played hourly during the daytime to provide information about the ICU environment: “Dad, you are a patient at the University of Miami Hospital… your nurses and doctors are here looking after you… All of our family know you’re here, and we are in and out, looking after you too…. It is loud and noisy because of the machines helping you get better.”

FAVoR is testing whether this recorded intervention enables patients to interpret the ICU environment more accurately. FAVoR holds promise for reducing the risk of delirium ICU patients’ face, for improving their nighttime sleep, and for helping them to achieve better cognitive and physical healing outcomes after leaving the ICU.

This novel and non-pharmacological intervention has the potential for wide-ranging payoffs, as well as for replication in other populations. Because FAVoR is nursing-oriented, low-tech, and low-cost, it also holds hope for resource-challenged environments worldwide.

This is just one example of the $13.7 million in funded research taking place at the University of Miami School of Nursing and Health Studies. From the ICU to migrant communities in Florida, our diverse research is informing policy, saving health care costs, and ultimately saving lives among our most vulnerable and underserved populations.

Cindy L. Munro, PhD, RN, ANP-BC, FAAN, FAANP, FAAAS, is dean and professor of the University of Miami School of Nursing and Health Studies.

Research reported in this publication is supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR016702. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

This blog post is part of a series focusing on different aspects of nursing research in recognition of National Nurses Week. Visit for more information.

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Funding research gives all of us a better chance of living a healthier life.
Pam Hirata, heart disease survivor