Acute and Critical Care

Original Articles

Pulmonary
Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis: Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee; Acute Crit Care. 2022;37(4):561-570. Published online October 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00444

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Abstract PDF Supplementary Material: Background
Delayed intubation is associated with poor prognosis in patients with respiratory failure. However, the effect of delayed intubation in patients with idiopathic pulmonary fibrosis (IPF) remains unknown. This study aimed to analyze whether timing of intubation after high-concentration oxygen therapy was associated with worse clinical outcomes in IPF patients. Methods: This retrospective propensity score-matched study enrolled adult patients with IPF who underwent mechanical ventilation between January 2011 and July 2021. Patients were divided into early and delayed intubation groups. Delayed intubation was defined as use of high-concentration oxygen therapy for at least 48 hours before tracheal intubation. The primary outcome was intensive care unit (ICU) mortality, and a conditional logistic regression model was used to evaluate the association between timing of intubation and clinical outcomes. Results: The median duration of high-concentration oxygen therapy before intubation was 0.5 days in the early intubation group (n=60) and 5.1 days in the delayed intubation group (n=36). The ICU mortality rate was 56.7% and 75% in the early and delayed intubation groups, respectively, before propensity matching (P=0.075). After matching for demographic and clinical covariates, 33 matched pairs were selected. In the propensity-matched cohort, delayed intubation significantly increased the risk of ICU mortality (adjusted odds ratio, 3.99; 95% confidence interval, 1.02–15.63; P=0.046). However, in-hospital mortality did not differ significantly between the groups. Conclusions: In patients with IPF, delayed intubation after initiation of high-concentration oxygen therapy was significantly associated with increased risk of ICU mortality compared to early intubation.

Nutrition
Comparison of mNUTRIC-S2 and mNUTRIC scores to assess nutritional risk and predict intensive care unit mortality: So Jeong Kim, Hong Yeul Lee, Sun Mi Choi, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2022;37(4):618-626. Published online October 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00612

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Background
Nutritional status is associated with mortality. The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is one of the most commonly used nutritional risk assessment tools in intensive care units (ICUs). The purpose of this study was to compare the mortality predictive ability of the mNUTRIC score to that of the mNUTRIC-S2 score, which uses the Simplified Acute Physiology Score (SAPS) II instead of the Acute Physiology and Chronic Health Evaluation (APACHE) II. Methods: This retrospective cohort analysis included patients admitted to the ICU between January and September 2020. Each patient’s electronic medical records were reviewed. The model discrimination for predicting ICU mortality was assessed by the area under the receiver operating characteristic (ROC) curve, and a Cox regression model was performed to confirm the relationship between the groups and mortality. Results: In total, 220 patients were enrolled. The ROC curve for predicting ICU mortality was 0.64 for the mNUTRIC score versus 0.67 for the mNUTRIC-S2 score. The difference between the areas was 0.03 (95% confidence interval [CI], –0.01 to 0.06; P=0.09). Patients with mNUTRIC-S2 score ≥5 had a greater risk of ICU mortality (hazard ratio [HR], 3.64; 95% CI, 1.85–7.14; P<0.001); however, no such relationship was observed with mNUTRIC score (HR, 1.69; 95% CI, 0.62–4.62; P=0.31). Conclusions: The mNUTRIC-S2 score was significantly associated with ICU mortality. A cutoff score of 5 was selected as most appropriate.

Citations

Citations to this article as recorded by

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study
Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim
Acute and Critical Care.2024; 39(1): 127. CrossRef

Pulmonary
Reduction of PaCO₂ by high-flow nasal cannula in acute hypercapnic respiratory failure patients receiving conventional oxygen therapy: Hyun Woo Lee, Sun Mi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee; Acute Crit Care. 2019;34(3):202-211. Published online August 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00563

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13 Web of Science
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Abstract PDF

Background
It has been suggested that a high-flow nasal cannula (HFNC) could help to remove carbon dioxide (CO₂) from anatomical dead spaces, but evidence to support that is lacking. The objective of this study was to elucidate whether use of an HFNC could reduce the arterial partial pressure of CO₂ (PaCO₂) in patients with acute hypercapnic respiratory failure who are receiving conventional oxygen (O₂) therapy.
Methods
A propensity score-matched observational study was conducted to evaluate patients treated with an HFNC for acute hypercapnic respiratory failure from 2015 to 2016. The hypercapnia group was defined as patients with a PaCO₂ >50 mm Hg and arterial pH <7.35.
Results
Eighteen patients in the hypercapnia group and 177 patients in the nonhypercapnia group were eligible for the present study. Eighteen patients in each group were matched by propensity score. Decreased PaCO₂ and consequent pH normalization over time occurred in the hypercapnia group (P=0.002 and P=0.005, respectively). The initial PaCO₂ level correlated linearly with PaCO₂ removal after the use of an HFNC (R²=0.378, P=0.010). The fraction of inspired O₂ used in the intensive care unit was consistently higher for 48 hours in the nonhypercapnia group. Physiological parameters such as respiratory rate and arterial partial pressure of O₂ improved over time in both groups.
Conclusions
Physiological parameters can improve after the use of an HFNC in patients with acute hypercapnic respiratory failure given low-flow O₂ therapy via a facial mask. Further studies are needed to identify which hypercapnic patients might benefit from an HFNC.

Citations

Citations to this article as recorded by

Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in patients with head and neck cancer
Jun-Young Jo, Jungpil Yoon, Heeyoon Jang, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi
Acute and Critical Care.2024; 39(1): 61. CrossRef
Efficacy and safety of high-flow nasal cannula therapy in elderly patients with acute respiratory failure
J.M. Carratalá, S. Diaz-Lobato, B. Brouzet, P. Más-Serrano, J.L.S. Rocamora, A.G. Castro, A.G. Varela, S.M. Alises
Pulmonology.2023;[Epub] CrossRef
Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report
Joseph Abraham Poonuraparampil, Habib Md Reazaul Karim, Manu P Kesavankutty, Porika Prashanth Nayak
Acute and Critical Care.2022; 37(1): 120. CrossRef
Comparison of Conventional Oxygen Therapy With High-Flow Nasal Oxygenation in the Management of Hypercapnic Respiratory Failure
Jitendra Pratap Singh, Deepak Malviya, Samiksha Parashar, Soumya Sankar Nath, Archana Gautam, Neha Shrivastava
Cureus.2022;[Epub] CrossRef
Current Considerations in Emergency Airway Management
Andrew Pirotte, Vivek Panchananam, Matthew Finley, Austin Petz, Tom Herrmann
Current Emergency and Hospital Medicine Reports.2022; 10(4): 73. CrossRef
S/F and ROX indices in predicting failure of high‐flow nasal cannula in children
Ji Hye Kim, Dong In Suh, June Dong Park
Pediatrics International.2022;[Epub] CrossRef
Nasal High‐flow Oxygen Versus Conventional Oxygen Therapy for Acute Severe Asthma Patients: A Pilot Randomized Controlled Trial
Onlak Ruangsomboon, Chok Limsuwat, Nattakarn Praphruetkit, Apichaya Monsomboon, Tipa Chakorn, Brian C. Hiestand
Academic Emergency Medicine.2021; 28(5): 530. CrossRef
Flow Field Analysis of Adult High-Flow Nasal Cannula Oxygen Therapy
Jingen Xia, Jiaqi Chang, Jixiang Liang, Yixuan Wang, Na Wang, Bo Xiao
Complexity.2021; 2021: 1. CrossRef
Treatment of Severe Acute on Chronic Liver Failure
Aarshi Vipani, Christina C. Lindenmeyer, Vinay Sundaram
Journal of Clinical Gastroenterology.2021; 55(8): 667. CrossRef
Efficacy of High-Flow Nasal Cannula Oxygen Therapy in Patients with Mild Hypercapnia
Lingling Su, Qinyu Zhao, Taotao Liu, Yujun Xu, Weichun Li, Aiping Zhang
Lung.2021; 199(5): 447. CrossRef
High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study
SooHyun Bae, Minkyu Han, Changyoung Kim, Hyeji Lee, Jong-Joon Ahn, Jin Hyoung Kim, Byung Ju Kang
Journal of Korean Medical Science.2020;[Epub] CrossRef
High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future
Lucia Spicuzza, Matteo Schisano
Therapeutic Advances in Chronic Disease.2020; 11: 204062232092010. CrossRef
Impact of High-Flow Nasal Cannula on Arterial Blood Gas Parameters in the Emergency Department
Emre Şancı, Feride Ercan Coşkun, Basak Bayram
Cureus.2020;[Epub] CrossRef

Pulmonary
Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study: Joohae Kim, Sun Mi Choi, Jinwoo Lee, Young Sik Park, Chang Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee; Korean J Crit Care Med. 2017;32(2):154-163. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00976

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29 Web of Science
32 Crossref

Abstract PDF

Background
Acute respiratory distress syndrome (ARDS) remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE) inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS) blockage on the prognosis of patients with ARDS.
Methods
We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU) at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching.
Results
A total of 182 patients were included in the study. Thirty-seven patients (20.3%) took ACE inhibitor or angiotensin receptor blocker (ARB) during ICU admission, and 145 (79.7%) did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166). The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013) and longer ICU stay (32.1 vs. 20.2 days, P < 0.001). In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001).
Conclusions
ACE inhibitor or ARB may have beneficial effect on ARDS patients.

Citations

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Systematic review and meta-analysis of the clinical outcomes of ACEI/ARB in East-Asian patients with COVID-19
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Renin-angiotensin system modulators in COVID-19 patients with hypertension: friend or foe?
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Clinical and Experimental Hypertension.2022; 44(1): 1. CrossRef
A propensity score‐matching analysis of angiotensin‐converting enzyme inhibitor and angiotensin receptor blocker exposure on in‐hospital mortality in patients with acute respiratory failure
Yi‐Peng Fang, Xin Zhang
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.2022; 42(5): 387. CrossRef
The Renin-Angiotensin System as a Component of Biotrauma in Acute Respiratory Distress Syndrome
Katharina Krenn, Verena Tretter, Felix Kraft, Roman Ullrich
Frontiers in Physiology.2022;[Epub] CrossRef
ACE2-like enzyme B38-CAP suppresses abdominal sepsis and severe acute lung injury
Takafumi Minato, Tomokazu Yamaguchi, Midori Hoshizaki, Satoru Nirasawa, Jianbo An, Saori Takahashi, Josef M. Penninger, Yumiko Imai, Keiji Kuba, Yu Ru Kou
PLOS ONE.2022; 17(7): e0270920. CrossRef
Tidal Volume–Dependent Activation of the Renin-Angiotensin System in Experimental Ventilator-Induced Lung Injury*
Xinjun Mao, Katharina Krenn, Thomas Tripp, Verena Tretter, Roman Reindl-Schwaighofer, Felix Kraft, Bruno K. Podesser, Yi Zhu, Marko Poglitsch, Oliver Domenig, Dietmar Abraham, Roman Ullrich
Critical Care Medicine.2022; 50(9): e696. CrossRef
The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study
Zhishen Ruan, Dan Li, Yuanlong Hu, Zhanjun Qiu, Xianhai Chen
International Journal of Chronic Obstructive Pulmonary Disease.2022; Volume 17: 2001. CrossRef
Renin-angiotensin system at the interface of COVID-19 infection
Rukhsana Gul, Uh-Hyun Kim, Assim A. Alfadda
European Journal of Pharmacology.2021; 890: 173656. CrossRef
A pharmacological framework for integrating treating the host, drug repurposing and the damage response framework in COVID‐19
Jennifer H. Martin, Richard Head
British Journal of Clinical Pharmacology.2021; 87(3): 875. CrossRef
A comprehensive guide to the pharmacologic regulation of angiotensin converting enzyme 2 (ACE2), the SARS-CoV-2 entry receptor
Murat Oz, Dietrich Ernst Lorke, Nadine Kabbani
Pharmacology & Therapeutics.2021; 221: 107750. CrossRef
Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis
Hyun Woo Lee, Chang-Hwan Yoon, Eun Jin Jang, Chang-Hoon Lee
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Evaluation of expression of VDR-associated lncRNAs in COVID-19 patients
Mohammad Taheri, Lina Moallemi Rad, Bashdar Mahmud Hussen, Fwad Nicknafs, Arezou Sayad, Soudeh Ghafouri-Fard
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Coronavirus Disease 2019 (COVID-19) Infection and Renin Angiotensin System Blockers
Chirag Bavishi, Thomas M. Maddox, Franz H. Messerli
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COVID-19, ACE2, and the cardiovascular consequences
Andrew M. South, Debra I. Diz, Mark C. Chappell
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Case Reports

Pulmonary
Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust: Sun Mi Choi, Jiwon Koh, Sang-Min Lee, Jinwoo Lee; Korean J Crit Care Med. 2016;31(2):173-177. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.173

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Abstract PDF: Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.

Successful Management of Tracheobronchomalacia Associated with Empyema Using a Covered Metallic Tracheobronchial Stent: A Case Report: Young Sik Park, Hyo Jae Kang, Yung Jeong Jeong, Sun Mi Choi, Eun Young Heo, Hyeon Jong Moon, Chang Hoon Lee, Hee Soon Chung, Deog Kyeom Kim; Korean J Crit Care Med. 2011;26(2):105-109.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.105

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Abstract PDF: Tracheobronchomalacia is developed by excessively weakened walls of the trachea and bronchi, and shows dynamic collapse of the airway on expiration and causes dyspnea. Airway stenting or surgical correction of the airway may be helpful. We report a case with tracheobronchomalacia which was combined with chronic empyema and treated successfully with stent insertion.

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