Acute and Critical Care

Original Articles

Pulmonary
Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation: Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh; Acute Crit Care. 2024;39(1):91-99. Published online January 26, 2024; DOI: https://doi.org/10.4266/acc.2023.00871

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Abstract PDF Supplementary Material: Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

Liver
Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study: Seon Woo Yoo, Min-Jong Ki, Dal Kim, Seul Ki Kim, SeungYong Park, Hyo Jin Han, Heung Bum Lee; Acute Crit Care. 2021;36(4):322-331. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00276

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Background
The molecular adsorbent recirculating system (MARS) is a hepatic replacement system that supports excretory liver function in patients with liver failure. However, since MARS has been employed in our hospital, bleeding complications have occurred in many patients during or after MARS. The objective of this study was to determine how MARS affects coagulopathy and identify specific factors associated with bleeding complications.
Methods
We retrospectively analyzed data from 17 patients undergoing a total of 41 MARS sessions. Complete blood count, coagulation profiles, and blood chemistry values were compared before and after MARS. To identify pre-MARS factors associated with increased bleeding after MARS, we divided patients into bleeder and non-bleeder groups and compared their pre-MARS laboratory values.
Results
MARS significantly reduced bilirubin and creatinine levels. MARS also increased prothrombin time and reduced platelet and fibrinogen, thus negatively impacting coagulation. Pre-MARS hemoglobin was significantly lower in the bleeder group than in the non-bleeder group (P=0.015). When comparing the upper and lower 33% of MARS sessions based on the hemoglobin reduction rate, hemoglobin reduction was significantly greater in MARS sessions involving patients with low pre-MARS international normalized ratio of prothrombin time (PT-INR) and factor V (P=0.038 and P=0.023, respectively).
Conclusions
MARS could appears to alter coagulation-related factors such as factor V and increase the risk of bleeding complications particularly in patient with low hemoglobin. However, individual differences among patients were large, and various factors, such as low hemoglobin, PT-INR, and factor V levels, appear to be involved.

Citations

Citations to this article as recorded by

Fractionated plasma separation and adsorption integrated with continuous veno‐venous hemofiltration in patients with acute liver failure: A single center experience from China
Jianhua Dong, Li Huang, Chuan Li, Bian Wu, Xi Yang, Yongchun Ge
Journal of Clinical Apheresis.2024;[Epub] CrossRef
Crosslinked Bifunctional Particles for the Removal of Bilirubin in Hyperbilirubinemia Cases
María del Prado Garrido, Ana Maria Borreguero, Maria Jesús Ramos, Manuel Carmona, Francisco Javier Redondo Calvo, Juan Francisco Rodriguez
Materials.2023; 16(8): 2999. CrossRef
The Effect of Molecular Adsorbent Recirculating System in Patients With Liver Failure: A Case Series of 44 Patients
Shahin Isha, Anna S. Jenkins, Abby J. Hanson, Parthkumar H. Satashia, Sai Abhishek Narra, Gunjan D. Mundhra, Mohammed Mustafa Hasan, Ashrita Donepudi, Abishek Giri, Patrick W. Johnson, Dolores Villar, Christan Santos, Juan Canabal, Philip Lowman, Pablo Mo
Transplantation Proceedings.2023; 55(9): 2126. CrossRef
Extracorporeal organ support and the kidney
Maria-Jimena Muciño-Bermejo
Frontiers in Nephrology.2022;[Epub] CrossRef

Pediatrics
Characteristics, management and clinical outcomes of patients with sepsis: a multicenter cohort study in Korea: Kyeongman Jeon, Soo Jin Na, Dong Kyu Oh, Sunghoon Park, Eun Young Choi, Seok Chan Kim, Gil Myeong Seong, Jeongwon Heo, Youjin Chang, Won Gun Kwack, Byung Ju Kang, Won-Il Choi, Kyung Chan Kim, So Young Park, Sang Hyun Kwak, Yoon Mi Shin, Heung Bum Lee, So Hee Park, Jae Hwa Cho, Beongki Kim, Chae‐Man Lim; Acute Crit Care. 2019;34(3):179-191. Published online July 1, 2019; DOI: https://doi.org/10.4266/acc.2019.00514

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Abstract PDF

Background
Mortality rates associated with sepsis have increased progressively in Korea, but domestic epidemiologic data remain limited. The objective of this study was to investigate the characteristics, management and clinical outcomes of sepsis patients in Korea.
Methods
This study is a multicenter retrospective cohort study. A total of 64,021 adult patients who visited an emergency department (ED) within one of the 19 participating hospitals during a 1-month period were screened for eligibility. Among these, patients diagnosed with sepsis based on the third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were included in the study.
Results
Using the Sepsis-3 criteria, 977 sepsis patients were identified, among which 36.5% presented with septic shock. The respiratory system (61.8%) was the most common site of infection. The pathogen involved was identified in 444 patients (45.5%) and multi-drug resistance (MDR) pathogens were isolated in 171 patients. Empiric antibiotic therapy was appropriate in 68.6% of patients, but the appropriateness was significantly reduced in infections associated with MDR pathogens as compared with non-MDR pathogens (58.8% vs. 76.0%, P<0.001). Hospital mortality was 43.2% and 18.5% in sepsis patients with and without shock, respectively. Of the 703 patients who survived to discharge, 61.5% were discharged to home and 38.6% were transferred to other hospitals or facilities.
Conclusions
This study found the prevalence of sepsis in adult patients visiting an ED in Korea was 1.5% (15.2/1,000 patients). Patients with sepsis, especially septic shock, had a high mortality and were often referred to step-down centers after acute and critical care.

Citations

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Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study
Sang Won Park, Na Young Yeo, Seonguk Kang, Taejun Ha, Tae-Hoon Kim, DooHee Lee, Dowon Kim, Seheon Choi, Minkyu Kim, DongHoon Lee, DoHyeon Kim, Woo Jin Kim, Seung-Joon Lee, Yeon-Jeong Heo, Da Hye Moon, Seon-Sook Han, Yoon Kim, Hyun-Soo Choi, Dong Kyu Oh, S
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Pre-Sepsis Length of Hospital Stay and Mortality: A Nationwide Multicenter Cohort Study
Joong-Yub Kim, Hong Yeul Lee, Jinwoo Lee, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee
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Rehab Salah Taha, Mohamed Elsayed Afandy, Abdelaziz Hamid Elbadawi, Mohamed Samir Abd El Ghafar
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Antibiogram of Multidrug-Resistant Bacteria Based on Sepsis Onset Location in Korea: A Multicenter Cohort Study
Hyung-Jun Kim, Dong Kyu Oh, Sung Yoon Lim, Young-Jae Cho, Sunghoon Park, Gee Young Suh, Chae-Man Lim, Yeon Joo Lee
Journal of Korean Medical Science.2023;[Epub] CrossRef
HYPOTENSION AT THE TIME OF SEPSIS RECOGNITION IS NOT ASSOCIATED WITH INCREASED MORTALITY IN SEPSIS PATIENTS WITH NORMAL LACTATE LEVELS
Ji Hwan Kim, Yong Kyun Kim, Dong Kyu Oh, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Sung Yun Lim, Yeon Joo Lee, Young-Jae Cho, Mi-Hyeon Park, Sang-Bum Hong, Chae-Man Lim, Sunghoon Park
Shock.2023; 59(3): 360. CrossRef
Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
Clinical and Experimental Emergency Medicine.2023; 10(2): 157. CrossRef
Effects of prior antiplatelet and/or nonsteroidal anti-inflammatory drug use on mortality in patients undergoing abdominal surgery for abdominal sepsis
Se Hun Kim, Ki Hoon Kim
Surgery.2023; 174(3): 611. CrossRef
Clinical effects of bacteremia in sepsis patients with community-acquired pneumonia
Tae Wan Kim, Se-Uk Lee, Boram Park, Kyeongman Jeon, Sunghoon Park, Gee Young Suh, Dong Kyu Oh, Soo Yeon Lee, Mi Hyeon Park, Haein Lee, Chae-man Lim, Ryoung-Eun Ko, Sang-Bum Hong, Suk-Kyung Hong, Yeon Joo Lee, Young-Jae Cho, Sung Yoon Lim, Jeongwon Heo, Ja
BMC Infectious Diseases.2023;[Epub] CrossRef
Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
Clinical Characteristics and Outcomes of Neutropenic Sepsis: A Multicenter Cohort Study
Soo Jin Na, Dong Kyu Oh, Sunghoon Park, Yeon Joo Lee, Sang-Bum Hong, Mi-Hyun Park, Ryoung-Eun Ko, Chae-Man Lim, Kyeongman Jeon
Shock.2022; 57(5): 659. CrossRef
Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study
Dong-gon Hyun, Su Yeon Lee, Jee Hwan Ahn, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Sunghoon Park, Jeongwon Heo, Jae-myeong Lee, Kyung Cha
Critical Care.2022;[Epub] CrossRef
Clinical outcomes and prognostic factors of patients with sepsis caused by intra-abdominal infection in the intensive care unit: a post-hoc analysis of a prospective cohort study in Korea
Chan Hee Park, Jeong Woo Lee, Hak Jae Lee, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Suk-Kyung Hong, Chae-Man Lim, Sang-Bum Hong, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Sunghoon Park, Chae-Ma
BMC Infectious Diseases.2022;[Epub] CrossRef
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L. I. Gomanova, A. Y. Brazhnikov
Epidemiology and Vaccinal Prevention.2021; 20(3): 107. CrossRef
Characteristics, Management, and Clinical Outcomes of Patients with Hospital-Acquired and Ventilator-Associated Pneumonia: A Multicenter Cohort Study in Korea
Ryoung-Eun Ko, Kyung Hoon Min, Sang-Bum Hong, Ae-Rin Baek, Hyun-Kyung Lee, Woo Hyun Cho, Changhwan Kim, Youjin Chang, Sung-Soon Lee, Jee Youn Oh, Heung Bum Lee, Soohyun Bae, Jae Young Moon, Kwang Ha Yoo, Kyeongman Jeon
Tuberculosis and Respiratory Diseases.2021; 84(4): 317. CrossRef
Clinical Usefulness of Red Cell Distribution Width/Albumin Ratio to Discriminate 28-Day Mortality in Critically Ill Patients with Pneumonia Receiving Invasive Mechanical Ventilation, Compared with Lacate/Albumin Ratio: A Retrospective Cohort Study
Jong Hwan Jeong, Manbong Heo, Seung Jun Lee, Yi Yeong Jeong, Jong Deog Lee, Jung-Wan Yoo
Diagnostics.2021; 11(12): 2344. CrossRef
Review of 20 Years of Continuous Quality Improvement of a Rapid Response System, at Four Institutions, to Identify Key Process Responsible for Its Success
Mary Anne Vandegrift, Robert Granata, Vicken Y. Totten, John Kellett, Frank Sebat
Critical Care Explorations.2021; 3(8): e0448. CrossRef
An Update on Sepsis Biomarkers
Mi-Hee Kim, Jung-Hyun Choi
Infection & Chemotherapy.2020; 52(1): 1. CrossRef
Normothermia in Patients With Sepsis Who Present to Emergency Departments Is Associated With Low Compliance With Sepsis Bundles and Increased In-Hospital Mortality Rate*
Sunghoon Park, Kyeongman Jeon, Dong Kyu Oh, Eun Young Choi, Gil Myeong Seong, Jeongwon Heo, Youjin Chang, Won Gun Kwack, Byung Ju Kang, Won-Il Choi, Kyung Chan Kim, So Young Park, Yoon Mi Shin, Heung Bum Lee, So Hee Park, Seok Chan Kim, Sang Hyun Kwak, Ja
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Optimal antimicrobial therapy and antimicrobial stewardship in sepsis and septic shock
Hyeri Seok, Dae Won Park
Journal of the Korean Medical Association.2019; 62(12): 638. CrossRef
Sepsis
Yunghee Lee, Young-Jae Cho
The Korean Journal of Medicine.2019; 94(6): 495. CrossRef

Review Article

Neurology
Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines: Seung Yong Park, Heung Bum Lee; Acute Crit Care. 2019;34(2):117-125. Published online April 17, 2019; DOI: https://doi.org/10.4266/acc.2019.00451

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Abstract PDF

Delirium is an acute, confusional state characterized by altered consciousness and a reduced ability to focus, sustain, or shift attention. It is associated with a number of complex underlying medical conditions and can be difficult to recognize. Many critically ill patients (e.g., up to 80% of patients in the intensive care unit [ICU]) experience delirium due to underlying medical or surgical health problems, recent surgical or other invasive procedures, medications, or various noxious stimuli (e.g., underlying psychological stressors, mechanical ventilation, noise, light, patient care interactions, and drug-induced sleep disruption or deprivation). Delirium is associated with a longer duration of mechanical ventilation and ICU admittance as well as an increased risk of death, disability, and long-term cognitive dysfunction. Therefore, the early recognition of delirium is important and ICU medical staff should devote careful attention to both watching for the occurrence of delirium and its prevention and management. This review presents a brief overview of delirium and an update of the literature with reference to the 2018 Society of Critical Care Medicine Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.

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Delirium
Melissa L.P. Mattison
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Original Article

Infection/Pharmacology
Clinical Effectiveness and Nephrotoxicity of Aerosolized Colistin Treatment in Multidrug-Resistant Gram-Negative Pneumonia: Seung Yong Park, Mi Seon Park, Chi Ryang Chung, Ju Sin Kim, Seoung Ju Park, Heung Bum Lee; Korean J Crit Care Med. 2016;31(3):208-220. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00129

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Abstract PDF

Background
Colistin (polymyxin E) is active against multidrug-resistant Gram-negative bacteria (MDR-GNB). However, the effectiveness of inhaled colistin is unclear. This study was designed to assess the effectiveness and safety of aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP) caused by MDR-GNB.
Methods
In this retrospective longitudinal study, we evaluated the medical records of 63 patients who received aerosolized colistin treatment for VAP caused by MDR-GNB in the medical intensive care unit (MICU) from February 2012 to March 2014.
Results
A total of 25 patients with VAP caused by MDR-GNB were included in this study. The negative conversion rate was 84.6% after treatment, and acute kidney injury (AKI) occurred in 11 patients (44%, AKI group). The average length of MICU stay and colistin treatment- related factors, such as daily and total cumulative doses and administration period, were not significantly different between groups. In-hospital mortality tended to be higher in the AKI group (p = 0.07). Multivariate analysis showed that a body mass index less than 18 was an independent risk factor of mortality (odds ratio [OR] = 21.95, 95% confidence interval [CI] 1.59-302.23; p = 0.02). Notably, AKI occurrence was closely related to the administration of more than two nephrotoxic drugs combined with aerosolized colistin (OR = 15.03, 95% CI 1.40-161.76; p = 0.025) and septic shock (OR = 8.10, 95% CI 1.40-161.76; p = 0.04).
Conclusions
The use of adjunctive aerosolized colistin treatment appears to be a relatively safe and effective option for the treatment of VAP caused by MDR-GNB. However, more research on the concomitant use of nephrotoxic drugs with aerosolized colistin will be necessary, as this can be an important risk factor of development of AKI.

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Review

Hormonal Changes in Critical Condition: Heung Bum Lee, Chi Ryang Chung; Korean J Crit Care Med. 2010;25(3):123-129.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.123

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Abstract PDF

When disease or trauma progresses to a critical state, the reaction of the endocrine system in creating homeostasis is essential for survival. The association between the severity of hormonal changes and outcome in terms of morbidity and mortality has led to the challenge of development of several endocrine treatments. During sepsis, nitric oxide-mediated apoptosis is observed in the neurons and glial cells of the cerebrovascular centers of the autonomic nervous system. It is probably one of the components of the circulatory dysfunction of sepsis. The regulation of different organs was neither linear nor independent however organs were found to behave as biological oscillators coupled to each other through neurological or hormonal communication pathways. Sepsis, because of systemic inflammatory responsive syndrome, disrupts these communication pathways and leads to organ failures. Endocrine hormonal issues related to the intensive care setting are common challenges to ICU specialists. Disruptions of the endocrine system in sepsis are characterized by 1) an increase in cortisol plasma levels with a loss of the circadian rhythm of its secretion; 2) hyperglycemia due to insulin resistance and rise in hyperglycemic hormones secretion; 3) relative vasopressin deficiency; and 4) euthyroid sick syndrome or non-thyroidal illness syndrome. This article discusses the dynamic changes of four main endocrine axes: hypothalamic-pituitary-adrenal axis, insulin, vasopressin and thyroid during grave states of disease, when a patient is in critical condition.

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The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia
Ki Tae Kim, Byung Kook Lee, Hyoung Youn Lee, Geo Sung Lee, Yong Hun Jung, Kyung Woon Jeung, Hyun Ho Ryu, Byoeng Jo Chun, Jeong Mi Moon
Korean Journal of Critical Care Medicine.2012; 27(4): 255. CrossRef

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