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Volume 34 (2); May 2019
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Review Articles
Basic science and research
Two-photon intravital imaging of leukocyte migration during inflammation in the respiratory system
Young Min Kim, Soi Jeong, Young Ho Choe, Young-Min Hyun
Acute Crit Care. 2019;34(2):101-107.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00542
  • 6,951 View
  • 166 Download
  • 2 Citations
AbstractAbstract PDF
Two-photon intravital imaging is a powerful method by which researchers are able to directly observe biological phenomena in live organisms. Researchers in various biomedical research fields have applied two-photon imaging to a variety of target organs by utilizing this technology’s ability to penetrate to significant depths with minimal phototoxicity. The mouse respiratory system in inflammation models is a good example, as two-photon intravital imaging can provide insights as to how the immune system is activated in response to inflammation within the respiratory system. Inflammation models can be generated via influenza viral, bacterial, or lipopolysaccharide injection. To exteriorize the lungs or trachea, thoracotomy or tracheotomy is performed, respectively; the appropriate combination of inflammation induction and organ exposure is selected depending on the study purpose. On the other hand, visualizing the movement of leukocytes is also an important component; to this end, immune cell populations of interest are either labeled via the genetic attachment of fluorescent proteins or stained with antibodies or dyes. With the proper selection of methods at each step, twophoton intravital imaging can yield visual evidence regarding immune responses to inflammation.

Citations

Citations to this article as recorded by  
  • Intravital Imaging of Pulmonary Immune Response in Inflammation and Infection
    Nazli Alizadeh-Tabrizi, Stefan Hall, Christian Lehmann
    Frontiers in Cell and Developmental Biology.2021;[Epub]     CrossRef
  • Probe-based intravital microscopy: filling the gap between in vivo imaging and tissue sample microscopy in basic research and clinical applications
    Katrien Van Dyck, Eliane Vanhoffelen, Jonas Yserbyt, Patrick Van Dijck, Marco Erreni, Sophie Hernot, Greetje Vande Velde
    Journal of Physics: Photonics.2021; 3(3): 032003.     CrossRef
Rapid response system
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute Crit Care. 2019;34(2):108-116.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00535
  • 9,507 View
  • 371 Download
  • 20 Citations
AbstractAbstract PDF
The inpatient treatment process is becoming more and more complicated with advanced treatments, aging of the patient population, and multiple comorbidities. During the process, patients often experience unexpected deterioration, about half of which might be preventable. Early identification of patient deterioration and the proper response are priorities in most healthcare facilities. A rapid response system (RRS) is a safety net to identify antecedents of these adverse events and to respond in a timely manner. The RRS has become an essential part of the medical system worldwide, supported by all major quality improvement organizations. An RRS consists of a trigger system and response team and needs constant assessment and process improvement. Although the effectiveness and cost-benefit of RRS remain controversial, according to previous studies, it may be beneficial by decreasing in-hospital cardiac arrest and mortality. Since the first implementation of RRS in Korea in 2008, it has been developed in over 15 medical centers and continues to expand. Recent accreditation standards and an RRS pilot program by the Korean government will promote the proliferation of RRSs in Korea.

Citations

Citations to this article as recorded by  
  • Development of a comprehensive model for the role of the rapid response team nurse
    Youn-Hui Won, Jiyeon Kang
    Intensive and Critical Care Nursing.2022; 68: 103136.     CrossRef
  • Characteristics and outcomes of patients screened by rapid response team who transferred to the intensive care unit
    Song-I. Lee, Jeong Suk Koh, Yoon Joo Kim, Da Hyun Kang, Jeong Eun Lee
    BMC Emergency Medicine.2022;[Epub]     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
  • Korean nurses’ perception and performance on communication with physicians in clinical deterioration
    Bo-Gyeong Jin, Kyoungrim Kang, Hyun-Jin Cho
    Medicine.2022; 101(38): e30570.     CrossRef
  • Clinical Nurses’ Intention to Use Defibrillators in South Korea: A Path Analysis
    Dongchoon Uhm, Gye-Hyun Jung
    Healthcare.2022; 11(1): 61.     CrossRef
  • Rapid Response System Should Be Enhanced at Non-general Ward Locations: a Retrospective Multicenter Cohort Study in Korea
    Byung Ju Kang, Sang-Bum Hong, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Jae Young Moon, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jong-Joon Ahn
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study
    Jinmi Lee, Yujung Shin, Eunjoo Choi, Sunhui Choi, Jeongsuk Son, Youn Kyung Jung, Sang-Bum Hong, Tai-Heng Chen
    PLOS ONE.2021; 16(2): e0247066.     CrossRef
  • A multicentre validation study of the deep learning-based early warning score for predicting in-hospital cardiac arrest in patients admitted to general wards
    Yeon Joo Lee, Kyung-Jae Cho, Oyeon Kwon, Hyunho Park, Yeha Lee, Joon-Myoung Kwon, Jinsik Park, Jung Soo Kim, Man-Jong Lee, Ah Jin Kim, Ryoung-Eun Ko, Kyeongman Jeon, You Hwan Jo
    Resuscitation.2021; 163: 78.     CrossRef
  • Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
    Sang Hyuk Kim, Ji Young Hong, Youlim Kim
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study
    Sang Hyuk Kim, Hye Suk Choi, Eun Suk Jin, Hayoung Choi, Hyun Lee, Sang-Hwa Lee, Chang Youl Lee, Myung Goo Lee, Youlim Kim
    Scientific Reports.2021;[Epub]     CrossRef
  • A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea
    Su Yeon Lee, Jee Hwan Ahn, Byung Ju Kang, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jae Young Moon, Sang-Bum Hong, Amit Bahl
    PLOS ONE.2021; 16(10): e0258221.     CrossRef
  • Incorporating a real-time automatic alerting system based on electronic medical records could improve rapid response systems: a retrospective cohort study
    Seung-Hun You, Sun-Young Jung, Hyun Joo Lee, Sulhee Kim, Eunjin Yang
    Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2021;[Epub]     CrossRef
  • Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
    Mi-Jung Yoon, Jin-Hee Park
    Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491.     CrossRef
  • Early Warning Score and Cancer Patients at End-of-Life
    Jae-woo Lee, Ye-Seul Kim, Yonghwan Kim, Hyo-Sun Yoo, Hee-Taik Kang
    Korean Journal of Clinical Geriatrics.2021; 22(2): 67.     CrossRef
  • Effectiveness of a daytime rapid response system in hospitalized surgical ward patients
    Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh
    Acute and Critical Care.2020; 35(2): 77.     CrossRef
  • Current State and Strategy for Establishing a Digitally Innovative Hospital: Memorial Review Article for Opening of Yongin Severance Hospital
    Soo-Jeong Kim, Ji Woong Roh, Sungwon Kim, Jin Young Park, Donghoon Choi
    Yonsei Medical Journal.2020; 61(8): 647.     CrossRef
  • Bleeding management after implementation of the Hemorrhage Code (Code H) at the Hospital Israelita Albert Einstein, São Paulo, Brazil
    Michele Jaures, Neila Maria Marques Negrini Pigatti, Roseny dos Reis Rodrigues, Fernanda Paulino Fernandes, João Carlos de Campos Guerra
    Einstein (São Paulo).2020;[Epub]     CrossRef
  • Management of post-cardiac arrest syndrome
    Youngjoon Kang
    Acute and Critical Care.2019; 34(3): 173.     CrossRef
  • Effect of a rapid response system on code rates and in-hospital mortality in medical wards
    Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Sulhee Kim, Eunjin Yang, Hyun Joo Lee, Hannah Lee, Ho Geol Ryu, Seung-Young Oh, Eun Jin Ha, Sang-Bae Ko, Jaeyoung Cho
    Acute and Critical Care.2019; 34(4): 246.     CrossRef
  • Evidence revealed the effects of rapid response system
    Jae Hwa Cho
    Acute and Critical Care.2019; 34(4): 282.     CrossRef
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
  • 16,712 View
  • 1,115 Download
  • 26 Citations
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study
    Öznur Erbay Dalli, Nermin Kelebek Girgin, Ferda Kahveci
    Journal of Clinical Nursing.2023; 32(1-2): 96.     CrossRef
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    Jean-Pierre Bénézech
    La Revue de l'Infirmière.2022; 71(277): 42.     CrossRef
  • Associations of Smoking With Delirium and Opioid Use in Older Adults With Traumatic Hip Fracture
    Kristin Salottolo, Richard Meinig, Landon Fine, Michael Kelly, Robert Madayag, Francie Ekengren, Allen Tanner, David Bar-Or
    JAAOS: Global Research and Reviews.2022;[Epub]     CrossRef
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    Cláudia Oliveira, Cátia Filipa Garnacho Martins Nobre, Rita Margarida Dourado Marques, Maria Manuela Madureira Lebre Mendes, Patrícia Cruz Pontífice Sousa
    Revista Cuidarte.2022;[Epub]     CrossRef
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    Scientific Reports.2022;[Epub]     CrossRef
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    Jing Liu, Jianli Li, Jinhua He, Huanhuan Zhang, Meinv Liu, Junfang Rong
    Frontiers in Aging Neuroscience.2022;[Epub]     CrossRef
  • The Effects of Pain, Agitation, Delirium, Immobility, and Sleep Disruption Education on Novice Nurses in Adult Intensive Care Units
    Szu-Ying Lee, Chieh-Yu Liu, Te-Yu Wu
    Healthcare.2022; 10(8): 1538.     CrossRef
  • Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation
    Katarzyna Wojnar-Gruszka, Aurelia Sega, Lucyna Płaszewska-Żywko, Stanisław Wojtan, Marcelina Potocka, Maria Kózka
    International Journal of Environmental Research and Public Health.2022; 19(17): 10894.     CrossRef
  • Item analysis of the Korean version of the Intensive Care Experience Questionnaire: Using the Rasch Model based on Item Response Theory
    Jiyeon Kang, Minhui Kim
    Journal of Korean Critical Care Nursing.2022; 15(3): 37.     CrossRef
  • Complex Hallucinations in Hospitalized Rehabilitation Patients With COVID-19
    Mari Tobita, Shan-Pin Fanchiang, Aida Saldivar, Sarah Taylor, Barry Jordan
    Archives of Rehabilitation Research and Clinical Translation.2022; 4(4): 100234.     CrossRef
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    Tomoki Nakamizo, Toshie Kanda, Yosuke Kudo, Eriko Sugawara, Erina Hashimoto, Ayana Okazaki, Makoto Usuda, Toru Nagai, Hiroshi Hara, Ken Johkura
    Journal of the Neurological Sciences.2021; 420: 117251.     CrossRef
  • Critical Care Considerations for Damage Control in a Trauma Patient
    Shannon Gaasch
    AACN Advanced Critical Care.2021; 32(1): 64.     CrossRef
  • Development and Validation of a Clinical Prediction Model for Sleep Disorders in the ICU: A Retrospective Cohort Study
    Yun Li, Lina Zhao, Chenyi Yang, Zhiqiang Yu, Jiannan Song, Qi Zhou, Xizhe Zhang, Jie Gao, Qiang Wang, Haiyun Wang
    Frontiers in Neuroscience.2021;[Epub]     CrossRef
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    Claudia Dziegielewski, Charlenn Skead, Toros Canturk, Colleen Webber, Shannon M. Fernando, Laura H. Thompson, Madison Foster, Vanja Ristovic, Peter G. Lawlor, Dipayan Chaudhuri, Chintan Dave, Brent Herritt, Shirley H. Bush, Salmaan Kanji, Peter Tanuseputr
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    Mu‐Hsing Ho, Lee‐Fen Yu, Pu‐Hung Lin, Hui‐Chen (Rita) Chang, Victoria Traynor, Wen‐Cheng Huang, Jed Montayre, Kee‐Hsin Chen
    Journal of Advanced Nursing.2021; 77(8): 3483.     CrossRef
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    Jan N. M. Schieveld, Jacqueline J. M. H. Strik
    American Journal of Respiratory and Critical Care Medicine.2021; 203(7): 921.     CrossRef
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    Hannah Lee, Seongmi Choi, Eun Jin Jang, Juhee Lee, Dalho Kim, Seokha Yoo, Seung-Young Oh, Ho Geol Ryu
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
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    Sandra Lange, Wioletta Mędrzycka-Dąbrowska, Adriano Friganovic, Ber Oomen, Sabina Krupa
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    Dong Jung Kim, Bongyeon Sohn, Hakju Kim, Hyoung Woo Chang, Jae Hang Lee, Jun Sung Kim, Cheong Lim, Kay-Hyun Park
    The Korean Journal of Thoracic and Cardiovascular Surgery.2020; 53(1): 8.     CrossRef
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    Juan Carlos Muñoz Camargo
    Enfermería Intensiva.2020; 31(2): 94.     CrossRef
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    J.C. Muñoz Camargo
    Enfermería Intensiva (English ed.).2020; 31(2): 94.     CrossRef
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    Yue Zhai, Shining Cai, Yuxia Zhang
    Journal of Pain and Symptom Management.2020; 60(4): 847.     CrossRef
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    Eric M. Davis, Chintan Ramani, Mark Quigg
    Current Treatment Options in Neurology.2020;[Epub]     CrossRef
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    Melissa L.P. Mattison
    Annals of Internal Medicine.2020; 173(7): ITC49.     CrossRef
  • Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients
    Denise Battaglini, Gregorio Santori, Karthikka Chandraptham, Francesca Iannuzzi, Matilde Bastianello, Fabio Tarantino, Lorenzo Ball, Daniele Roberto Giacobbe, Antonio Vena, Matteo Bassetti, Matilde Inglese, Antonio Uccelli, Patricia Rieken Macedo Rocco, N
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Original Articles
CPR/Resuscitation
Utility of the early lactate area score as a prognostic marker for septic shock patients in the emergency department
Gina Yu, Seung Joon Yoo, Sang-Hun Lee, June Sung Kim, Sungmin Jung, Youn-Jung Kim, Won Young Kim, Seung Mok Ryoo
Acute Crit Care. 2019;34(2):126-132.   Published online April 12, 2019
DOI: https://doi.org/10.4266/acc.2018.00283
  • 14,878 View
  • 255 Download
  • 9 Citations
AbstractAbstract PDF
Background
The current Surviving Sepsis Campaign guidelines recommend the remeasurement of lactate levels if the initial lactate level is elevated; however, the prognostic value of lactate kinetics is limited and inconsistent. We attempted to determine the efficacy of the lactate area score (calculated from repeated lactate measurements during initial resuscitation) as a prognostic marker of septic shock in the emergency department (ED).
Methods
We performed a retrospective study of adult patients with septic shock in the ED of a single tertiary medical center. Serial lactate levels were measured five times within 12 hours. We also compared the initial lactate level, maximum lactate level, and lactate area score. The lactate area score was defined as the sum of the area under the curve measured at 2, 4, 6, and 12 hours following the initial measurement.
Results
A total of 362 patients were enrolled in this study, and the overall 28-day mortality was 31.8%. The lactate area score of serial lactate levels as well as the initial (median [interquartile range], 4.9 [3.4 to 10.5]; P=0.003) and maximum (7.3 [4.2 to 13.2]; P<0.001) lactate levels were significantly higher in the non-survivor group. However, in multivariate analysis, only the lactate area score (odds ratio, 1.013; 95% confidence interval, 1.007 to 1.019) was significantly associated with 28-day mortality.
Conclusions
The early lactate area score may be a possible prognostic marker for predicting the 28-day mortality of adult septic shock patients. Further prospective interventional studies should be conducted to validate our results.

Citations

Citations to this article as recorded by  
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    Han Chen, Shu-Rong Gong, Rong-Guo Yu
    BMC Anesthesiology.2022;[Epub]     CrossRef
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    Farshad Tehrani, Hazhir Teymourian, Brian Wuerstle, Jonathan Kavner, Ravi Patel, Allison Furmidge, Reza Aghavali, Hamed Hosseini-Toudeshki, Christopher Brown, Fangyu Zhang, Kuldeep Mahato, Zhengxing Li, Abbas Barfidokht, Lu Yin, Paul Warren, Nickey Huang,
    Nature Biomedical Engineering.2022; 6(11): 1214.     CrossRef
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    Han Chen, Shu-Rong Gong, Rong-Guo Yu
    BMC Anesthesiology.2021;[Epub]     CrossRef
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    Scientific Reports.2021;[Epub]     CrossRef
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Basic science and research
The effects of BMS-470539 on lipopolysaccharide-induced acute lung injury
Eun-A Jang, Jin-Young Kim, Tran Duc Tin, Ji-A Song, Seong-Heon Lee, Sang-Hyun Kwak
Acute Crit Care. 2019;34(2):133-140.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00507
  • 5,870 View
  • 145 Download
  • 5 Citations
AbstractAbstract PDF
Background
Overactivation of inflammatory cells, including macrophages and neutrophils, is associated with acute lung injury. BMS-470539 is a selective agonist of melanocortin 1 receptor, which triggers the inhibition of proinflammatory responses, suppressing neutrophil infiltration and protecting tissue. This study evaluated the effects of BMS-470539 on lipopolysaccharide-induced acute lung injury in a mouse model.
Methods
Mice received a subcutaneous injection of saline or BMS-470539 (18.47 mg/kg) 1 hour before an intratracheal injection of saline or lipopolysaccharide (20 μg). Mice were sacrificed to analyze the severity of pulmonary edema (lung wet-to-dry weight [W/D] ratio) and inflammatory responses (level of leukocytes, polymorphonuclear neutrophils [PMNs] and tumor necrosis factor alpha [TNF-α] in bronchoalveolar lavage fluid [BALF]), and neutrophil infiltration (myeloperoxidase activity). TNF-α activation was also measured in neutrophils from bone marrow. Survival was investigated in a second-hit sepsis mouse model.
Results
BMS-470539 improved sepsis-induced pulmonary edema, as demonstrated by a decreased W/D ratio (5.76%±0.83% to 3.81%±0.86%, P<0.05). The inflammatory response also improved, as shown by decreased levels of leukocytes (551±116 to 357±86×10²/mm³, P<0.05), PMNs (51.52%±16.23% to 18.41%±7.25%, P<0.01), and TNF-α (550±338 to 128±52 pg/ml, P<0.01) in the BALF. BMS-470539 also improved the inflammatory response, as shown by TNF-α levels (850±158 to 423±59 pg/ml, P<0.01) in neutrophils. BMS-470539 downregulated neutrophil infiltration in the lung (myeloperoxidase: 654±98 to 218±89 U/g, P<0.001). Lastly, BMS improved the survival rate (0% to 70%, P<0.01) in a mice multiple organ failure model.
Conclusions
BMS-470539 improved lipopolysaccharide-induced acute lung injury and mortality in mice by affecting the inflammatory response.

Citations

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    Weijun Shen, Xuan Zhao, Shitong Li
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    Rudolf Lucas, Yalda Hadizamani, Perenlei Enkhbaatar, Gabor Csanyi, Robert W. Caldwell, Harald Hundsberger, Supriya Sridhar, Alice Ann Lever, Martina Hudel, Dipankar Ash, Masuko Ushio-Fukai, Tohru Fukai, Trinad Chakraborty, Alexander Verin, Douglas C. Eato
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    Roshan Dinparastisaleh, Mehdi Mirsaeidi
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Infection
Relationship between low hemoglobin levels and mortality in patients with septic shock
Sung Min Jung, Youn-Jung Kim, Seung Mok Ryoo, Won Young Kim
Acute Crit Care. 2019;34(2):141-147.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00465
  • 14,503 View
  • 231 Download
  • 7 Citations
AbstractAbstract PDFSupplementary Material
Background
Hemoglobin levels are a critical parameter for oxygen delivery in patients with shock. On comparing target hemoglobin levels upon transfusion initiation, the correlation between the severity of decrease in hemoglobin levels and patient outcomes remains unclear. We evaluated the association between initial hemoglobin levels and mortality in patients with septic shock treated with protocol-driven resuscitation bundle therapy at an emergency department.
Methods
Data of adult patients diagnosed with septic shock between June 2012 and December 2016 were extracted from a prospectively compiled septic shock registry at a single academic medical center. Patients were classified into four groups according to initial hemoglobin levels: ≥9.0 g/dl, 8.0−8.9 g/dl, 7.0−7.9 g/dl, and <7.0 g/dl. The primary endpoint was 90-day mortality.
Results
In total, 2,265 patients (male, 58.3%; median age, 70.0 years [interquartile range, 60 to 78 years]) with septic shock were included. For the four groups, 90-day mortality rates were as follows: 29.1%, 43.0%, 46.5%, and 46.9% for ≥9.0 g/dl (n=1,808), 8.0−8.9 g/dl (n=217), 7.0−7.9 g/dl (n=135), and <7.0 g/dl (n=105), respectively (P<0.001). Multivariate logistic regression showed that initial hemoglobin levels were an independent factor associated with 90-day mortality and mortality proportionally increased with decreasing hemoglobin levels (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.36 to 2.61 for 8.0−8.9 g/dl; OR, 1.97; 95% CI, 1.31 to 2.95 for 7.0–7.9 g/dl; and OR, 2.35; 95% CI, 1.52 to 3.63 for <7.0 g/dl).
Conclusions
Low hemoglobin levels (<9.0 g/dl) were observed in approximately 20% of patients with septic shock, and the severity of decrease in these levels correlated with mortality.

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    Na Cai, Wei Liao, Zhiqiang Chen, Min Tao, Sheng Chen
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    Byuk Sung Ko, Sung-Hyuk Choi, Tae Gun Shin, Kyuseok Kim, You Hwan Jo, Seung Mok Ryoo, Yoo Seok Park, Woon Yong Kwon, Han Sung Choi, Sung Phil Chung, Gil Joon Suh, Hyunggoo Kang, Tae Ho Lim, Donghee Son, Won Young Kim
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Pulmonary
Use of extracorporeal membrane oxygenation in patients with acute high-risk pulmonary embolism: a case series with literature review
You Na Oh, Dong Kyu Oh, Younsuck Koh, Chae-Man Lim, Jin-Won Huh, Jae Seung Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong
Acute Crit Care. 2019;34(2):148-154.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00500
  • 5,599 View
  • 198 Download
  • 14 Citations
AbstractAbstract PDF
Background
Although extracorporeal membrane oxygenation (ECMO) has been used for the treatment of acute high-risk pulmonary embolism (PE), there are limited reports which focus on this approach. Herein, we described our experience with ECMO in patients with acute high-risk PE.
Methods
We retrospectively reviewed medical records of patients diagnosed with acute highrisk PE and treated with ECMO between January 2014 and December 2018.
Results
Among 16 patients included, median age was 51 years (interquartile range [IQR], 38 to 71 years) and six (37.5%) were male. Cardiac arrest was occurred in 12 (75.0%) including two cases of out-of-hospital arrest. All patients underwent veno-arterial ECMO and median ECMO duration was 1.5 days (IQR, 0.0 to 4.5 days). Systemic thrombolysis and surgical embolectomy were performed in seven (43.8%) and nine (56.3%) patients, respectively including three patients (18.8%) received both treatments. Overall 30-day mortality rate was 43.8% (95% confidence interval, 23.1% to 66.8%) and 30-day mortality rates according to the treatment groups were ECMO alone (33.3%, n=3), ECMO with thrombolysis (50.0%, n=4) and ECMO with embolectomy (44.4%, n=9).
Conclusions
Despite the vigorous treatment efforts, patients with acute high-risk PE were related to substantial morbidity and mortality. We report our experience of ECMO as rescue therapy for refractory shock or cardiac arrest in patients with PE.

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Editorial
Pulmonary
Recent lactate findings: is repeated serum lactate testing necessary in septic shock patients?
Moo Suk Park
Acute Crit Care. 2019;34(2):155-157.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00528
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  • 150 Download
PDF
Case Reports
Pulmonary
Central extracorporeal membrane oxygenation and early rehabilitation for persistent severe pulmonary hypertension following pulmonary endarterectomy
Gil Myeong Seong, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Jae Won Lee, Sung-Ho Jung, Duck-Woo Park, Jae Seung Lee
Acute Crit Care. 2019;34(2):158-164.   Published online November 7, 2018
DOI: https://doi.org/10.4266/acc.2016.01032
  • 4,854 View
  • 118 Download
  • 2 Citations
AbstractAbstract PDF
Chronic thromboembolic pulmonary hypertension is potentially curable with a pulmonary endarterectomy. However, approximately 20% of patients have persistent pulmonary hypertension after pulmonary endarterectomy, which is a major risk factor for postoperative death. Here, we report a 34-year-old woman who suffered persistent severe pulmonary hypertension following a successful pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) and atrial septostomy were successfully performed as rescue treatments, and active rehabilitation during ECMO was prescribed to facilitate recovery.

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    Koray Ak, Gökhan Arslanhan, Yakup Tire, Sinan Tosun, Alper Kararmaz, İsmail Hanta, Bedrettin Yıldızeli
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Cardiology
Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation
Youn-Jung Kim, Jun-Il Bae, Seung Mok Ryoo, Won Young Kim
Acute Crit Care. 2019;34(2):165-169.   Published online November 7, 2018
DOI: https://doi.org/10.4266/acc.2017.00045
  • 8,899 View
  • 184 Download
  • 21 Citations
AbstractAbstract PDF
The inactivated influenza vaccination is generally safe with mostly mild side effects. We report a rare but fatal adverse event following influenza vaccination. A previously healthy 27-yearold woman who received the influenza vaccination 3 days before presenting to the emergency department had rapidly aggravating dyspnea and mental deterioration. She was diagnosed as having acute fulminant myocarditis with refractory cardiogenic shock, which was successfully managed with veno-arterial extracorporeal membrane oxygenation. The cardiac function of the patient recovered in 3 weeks.

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Image in Critical Care
Pulmonary
Pneumothorax caused by delayed tracheal rupture in a pediatric patient with acute respiratory distress syndrome
Minyoung Jung, Jong Ho Cho, Ah Young Choi, Minji Kim, Joongbum Cho
Acute Crit Care. 2019;34(2):170-171.   Published online February 7, 2019
DOI: https://doi.org/10.4266/acc.2018.00234
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Erratum
Cardiology
Application of sepsis-3 criteria to Korean patients with critical illnesses
Jae Yeol Kim, Hwan Il Kim, Gee Young Suh, Sang Won Yoon, Tae-Yop Kim, Sang Haak Lee, Jae Young Moon, Jae-Young Kwon, Sungwon Na, Ho Geol Ryu, Jisook Park, Younsuck Koh
Acute Crit Care. 2019;34(2):172-172.   Published online April 2, 2019
DOI: https://doi.org/10.4266/acc.2018.00318.e1
Corrects: Acute Crit Care 2019;34(1):30
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ACC : Acute and Critical Care