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Volume 35 (3); August 2020
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Review Article
Pulmonary
Home mechanical ventilation: back to basics
Sunghoon Park, Eui-Sik Suh
Acute Crit Care. 2020;35(3):131-141.   Published online August 31, 2020
DOI: https://doi.org/10.4266/acc.2020.00514
  • 11,833 View
  • 527 Download
  • 8 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Over recent decades, the use of home mechanical ventilation (HMV) has steadily increased worldwide, with varying prevalence in different countries. The key indication for HMV is chronic respiratory failure with alveolar hypoventilation (e.g., neuromuscular and chest wall disease, obstructive airway diseases, and obesity-related respiratory failure). Most modern home ventilators are pressure-targeted and have sophisticated modes, alarms, and graphics, thereby facilitating optimization of the ventilator settings. However, different ventilators have different algorithms for tidal volume estimation and leak compensation, and there are also several different circuit configurations. Hence, a basic understanding of the fundamentals of HMV is of paramount importance to healthcare workers taking care of patients with HMV. When choosing a home ventilator, they should take into account many factors, including the current condition and prognosis of the primary disease, the patient’s daily performance status, time (hr/day) needed for ventilator support, family support, and financial costs. In this review, to help readers understand the basic concepts of HMV use, we describe the indications for HMV and the factors that influence successful delivery, including interface, circuits, ventilator accessories, and the ventilator itself.

Citations

Citations to this article as recorded by  
  • An investigation of the effect of the universal model of family-centered care on patient and family outcomes in patients under home invasive mechanical ventilation
    Babak Kavand, Parvaneh Asgari
    Family Practice.2024;[Epub]     CrossRef
  • Burden, social support, and coping strategies in family caregivers of individuals receiving home mechanical ventilation: a cross-sectional study
    Lucyna Płaszewska-Żywko, Izabela Fajfer-Gryz, Jakub Cichoń, Maria Kózka
    BMC Nursing.2024;[Epub]     CrossRef
  • Nusinersen for Spinal Muscular Atrophy Type I with Chronic Respiratory Failure: A Retrospective Study in South Korea
    Hui Jin Shin, Ji-Hoon Na, Hyunjoo Lee, Young-Mock Lee
    Yonsei Medical Journal.2023; 64(12): 705.     CrossRef
  • Adaptation of Caregivers of Individuals on Mechanical Ventilation to Caregiving Role
    Tuba Yilmaz Bulut, İlknur Aydin Avci, Mesiya Aydin
    Indian Journal of Critical Care Medicine.2023; 28(1): 41.     CrossRef
  • Indications and evidence for domiciliary noninvasive ventilation
    Anita Saigal, Amar J Shah, Swapna Mandal
    Expert Review of Respiratory Medicine.2023; : 1.     CrossRef
  • Treatment of acute respiratory failure: noninvasive mechanical ventilation
    Sunghoon Park
    Journal of the Korean Medical Association.2022; 65(3): 144.     CrossRef
  • Mental health reported in adult invasive home mechanical ventilation through a tracheostomy: A scoping review
    Martin Locht Pedersen, Charlotte Handberg, Pia Dreyer
    International Journal of Nursing Studies Advances.2022; 4: 100110.     CrossRef
Original Articles
Nutrition
Effectiveness of a multidisciplinary team for nutrition support in a trauma intensive care unit
Eunsuk Oh, Hongjin Shim, Hyon Ju Yon, Jin Sil Moon, Dae Ryong Kang, Ji Young Jang
Acute Crit Care. 2020;35(3):142-148.   Published online August 19, 2020
DOI: https://doi.org/10.4266/acc.2020.00318
  • 6,338 View
  • 189 Download
  • 8 Web of Science
  • 14 Crossref
AbstractAbstract PDF
Background
We evaluated clinical and nutritional outcomes according to multidisciplinary team involvement in nutrition support in a regional trauma intensive care unit (TICU).
Methods
We retrospectively compared the outcomes for 339 patients admitted to the TICU for >5 days depending on nutrition support team (NST) involvement (n=176) and non-NST involvement (n=163).
Results
The mean age and injury severity score (ISS) were 57.3±16.7 years and 18.6±9.7, respectively. Fifty-three patients (15.6%) had shock on admission and 182 (53.7%) underwent surgery during TICU admission. Some patients were admitted to neurosurgery (46%), general surgery (35.4%), and other (18.6%) departments. There were significant differences in the ISS, Acute Physiology and Chronic Health Evaluation (APACHE) II score, shock on TICU admission, and initial laboratory results. After propensity score matching, the total delivered/required caloric ratio and total delivered/required protein ratio were significantly higher in the NST group than in the non-NST group (calorie: 80.4% vs. 66.7%, P=0.007; protein: 93.1% vs. 68.3%, P<0.001). The NST group had an adequate protein supply more frequently than the non-NST group (protein: 48.0% vs. 25.8%, P=0.002). There was no significant difference in survival, even after adjustment for risk factors using Cox proportional hazard analysis.
Conclusions
The results of our study suggest that multidisciplinary team involvement in nutrition support in TICU patients may improve nutritional, but not clinical, outcomes.

Citations

Citations to this article as recorded by  
  • Impact of a multidisciplinary collaborative nutritional treatment model in patients who are critically ill with neurological disorders: A randomized controlled trial
    Bao-Di Gu, Yun Wang, Rong Ding
    Technology and Health Care.2024; 32(3): 1767.     CrossRef
  • Implementation of a multidisciplinary nutritional support team and clinical outcomes in critically ill patients with COVID-19
    In-Ae Song, Kyunghwa Lee, Sunghee Lee, Keonhee Kim, Tak Kyu Oh
    Clinical Nutrition.2024; 43(2): 315.     CrossRef
  • Nutrition support teams: Institution, evolution, and innovation
    Albert Barrocas, Denise Baird Schwartz, Bruce R. Bistrian, Peggi Guenter, Charles Mueller, Ronni Chernoff, Jeanette M. Hasse
    Nutrition in Clinical Practice.2023; 38(1): 10.     CrossRef
  • Multidisciplinary Difficult Airway Team Characteristics, Airway Securement Success, and Clinical Outcomes: A Systematic Review
    Vinciya Pandian, Talha U. Ghazi, Marielle Qiaoshu He, Ergest Isak, Abdulmalik Saleem, Lindsay R. Semler, Emily C. Capellari, Michael J. Brenner
    Annals of Otology, Rhinology & Laryngology.2023; 132(8): 938.     CrossRef
  • Nutrition Therapy by Nutrition Support Team: A Comparison of Multi-Chamber Bag and Customized Parenteral Nutrition in Hospitalized Patients
    Seunghyun Cheon, Sang-Hyeon Oh, Jung-Tae Kim, Han-Gon Choi, Hyojung Park, Jee-Eun Chung
    Nutrients.2023; 15(11): 2531.     CrossRef
  • Consultation pattern changes of parenteral nutrition with a multidisciplinary nutrition support team in a recently opened hospital in Korea: a retrospective cohort study
    Kyoung Won Yoon, Hyo Jin Kim, Yujeong Im, Seul Gi Nam, Joo Yeon Lee, Hyo Gee Lee, Joong-Min Park
    Annals of Clinical Nutrition and Metabolism.2023; 15(2): 57.     CrossRef
  • Lipid emulsion treatment of cardiotoxicity caused by calcium channel blocker and beta-blocker
    Ju-Tae Sohn
    The American Journal of Emergency Medicine.2022; 58: 331.     CrossRef
  • Physician Compliance with Nutrition Support Team Recommendations: Effects on the Outcome of Treatment for Critically Ill Patients
    Hyon-Ju Yon, Eun-Suk Oh, Ji Young Jang, Ji Yun Jang, Hongjin Shim
    Journal of Acute Care Surgery.2022; 12(1): 1.     CrossRef
  • Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations
    Yunjin Sohn, Taisun Hyun
    Korean Journal of Community Nutrition.2022; 27(2): 121.     CrossRef
  • Lipid emulsion dosage used for resuscitation after drug toxicity
    Ju-Tae Sohn
    The American Journal of Emergency Medicine.2022; 59: 168.     CrossRef
  • Intensive care management of traumatic brain injury: How can mnemonics help?
    Biljana Damnjanović, Jovana Stanisavljević, Adi Hadžibegović, Ivan Rović, Đuro Šijan, Nemanja Jovanović, Sanja Ratković, Marija Milenković
    Serbian Journal of Anesthesia and Intensive Therapy.2022; 44(5-6): 105.     CrossRef
  • 救急・集中治療領域 重症患者における栄養管理
    信人 中西, 穣治 小谷
    The Japanese Journal of SURGICAL METABOLISM and NUTRITION.2022; 56(6): 229.     CrossRef
  • Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome
    Nobuto Nakanishi, Rie Tsutsumi, Kanako Hara, Masafumi Matsuo, Hiroshi Sakaue, Jun Oto
    Journal of Clinical Medicine.2021; 10(4): 614.     CrossRef
  • Lack of evidence for a nutritional support team in a trauma intensive care unit?
    Jae Hwa Cho
    Acute and Critical Care.2020; 35(3): 205.     CrossRef
Basic science and research
Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients
Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee
Acute Crit Care. 2020;35(3):149-155.   Published online August 31, 2020
DOI: https://doi.org/10.4266/acc.2020.00297
  • 4,921 View
  • 116 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
Although the measuring free cortisol is ideal for assessment of hypothalamicpituitary-adrenal function, it is not routinely measured. Salivary cortisol correlates well with the biologically active free cortisol. Therefore, this study measured the morning basal as well as adrenocorticotropic hormone-stimulated salivary cortisol levels in mechanically ventilated patients and compared the results with non-critically ill patients.
Methods
We prospectively enrolled 49 mechanically ventilated patients and 120 patients from the outpatient clinic. Serum and saliva samples were collected between 8 AM and 10 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. The salivary samples were insufficient in 15 mechanically ventilated patients (30.6%), and these patients were excluded from the final analysis.
Results
Mechanically ventilated patients (n=34) were significantly older and had lower body mass index and serum albumin levels and higher serum creatinine levels than non-critically ill patients (n=120). After adjustment for these parameters, both basal and stimulated salivary and serum cortisol levels were higher in mechanically ventilated patients. The increase in cortisol was not significantly different between the two groups. Serum cortisol levels showed a positive correlation with salivary cortisol levels. Among mechanically ventilated patients, both basal serum and salivary cortisol levels were lower in survivors than in non-survivors.
Conclusions
Both basal total serum and salivary cortisol levels were elevated in mechanically ventilated patients and in non-survivors.

Citations

Citations to this article as recorded by  
  • Associations between chronic work stress and plasma chromogranin A/catestatin among healthy workers
    Xin Liu, Weimin Dang, Hui Liu, Yao Song, Ying Li, Weixian Xu
    Journal of Occupational Health.2022;[Epub]     CrossRef
Pulmonary
Clinical outcomes of difficult-to-wean patients with ventilator dependency at intensive care unit discharge
Jung Mo Lee, Sun-Min Lee, Joo Han Song, Young Sam Kim
Acute Crit Care. 2020;35(3):156-163.   Published online August 19, 2020
DOI: https://doi.org/10.4266/acc.2020.00199
  • 4,733 View
  • 154 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Background
Ventilator-dependent patients in the intensive care unit (ICU) who are difficult to wean from invasive mechanical ventilation (IMV) have been increasing in number. However, data on the clinical outcomes of difficult-to-wean patients are lacking. We aimed to evaluate clinical outcomes in patients discharged from the ICU with tracheostomy and ventilator dependency.
Methods
We retrospectively investigated clinical course and survival in patients requiring home mechanical ventilation (HMV) with a tracheostomy and difficulty weaning from IMV during medical ICU admission from September 2013 through August 2016 at Severance Hospital, Yonsei University, Seoul, Korea.
Results
Of 84 difficult-to-wean patients who were started on HMV in the medical ICU, 72 survived, were discharged from the ICU, and were included in this analysis. HMV was initiated after a median of 23 days of IMV, and the successful weaning rate was 46% (n=33). In-hospital mortality rate was significantly lower in the successfully weaned group than the unsuccessfully weaned group (0% vs. 23.1%, respectively; P=0.010). Weaning rates were similar according to primary diagnosis, but high body mass index (BMI), low Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score at ICU admission, and absence of neuromuscular disease were associated with weaning success. After a median follow-up of 4.6 months (range, 1–27 months) for survivors, 3-month (n=64) and 6-month (n=59) survival rates were 82.5% and 72.2%, respectively. Survival rates were higher in the successfully weaned group than the unsuccessfully weaned group at 3 months (96.4% vs. 69.0%; P=0.017) and 6 months (84.0% vs. 62.1%; P=0.136) following ICU discharge.
Conclusions
In summary, 46% of patients who started HMV were successfully weaned from the ventilator in general wards. High BMI, low APACHE II score, and absence of neuromuscular disease were factors associated with weaning success.

Citations

Citations to this article as recorded by  
  • Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge
    Won-Young Kim, Moon Seong Baek
    Journal of Personalized Medicine.2021; 11(12): 1257.     CrossRef
  • Year 2020 in review - Post‑acute intensive care
    J Djakow
    Anesteziologie a intenzivní medicína.2020; 31(6): 305.     CrossRef
Pulmonary
Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire
Jae Kyoung Kim, Ju-Hee Park, Jaeyoung Cho, Sang-Min Lee, Jinwoo Lee
Acute Crit Care. 2020;35(3):164-168.   Published online August 31, 2020
DOI: https://doi.org/10.4266/acc.2020.00339
  • 4,895 View
  • 101 Download
  • 6 Web of Science
  • 6 Crossref
AbstractAbstract PDFSupplementary Material
Background
Sleep disorders are common in critically ill patients. Unfortunately, sleep assessment is challenging in many intensive care units (ICUs). The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple subjective tool that has been validated and used in many countries. This study aimed to evaluate the reliability of the Korean version of the RCSQ (K-RCSQ).
Methods
This prospective, cross-sectional, observational study was conducted in the ICUs of two hospitals. In total, 52 consenting patients answered questionnaires regarding their previous night’s sleep (K-RCSQ) and the noise they experienced (range, 0–100).
Results
The K-RCSQ showed excellent internal consistency of 0.960 by Cronbach’s alpha. The mean total score of the K-RCSQ was 41.9±28.9 (range, 0–100). The mean perceived ICU noise score was 40.7±28.1 (range, 0–90). There was a significant linear correlation between noise score and average K-RCSQ score (r=–0.37, P<0.001).
Conclusions
The K-RCSQ demonstrated excellent reliability (internal consistency). This simple tool may help assess sleep quality in critically ill patients and improve the quality of ICU care.

Citations

Citations to this article as recorded by  
  • Iliopsoas plane block does not improve pain after primary total hip arthroplasty in the presence of multimodal analgesia: a single institution randomized controlled trial
    Ji Yeong Kim, Jong Seok Lee, Ji Young Kim, Eun Jang Yoon, Wootaek Lee, Seungyeon Lee, Do-Hyeong Kim
    Regional Anesthesia & Pain Medicine.2024; : rapm-2023-105092.     CrossRef
  • A Randomized Controlled Trial to Evaluate the Analgesic Effectiveness of Periarticular Injections and Pericapsular Nerve Group Block for Patients Undergoing Total Hip Arthroplasty
    Bora Lee, Tae Sung Lee, Jaewon Jang, Hyun Eom Jung, Kwan Kyu Park, Yong Seon Choi
    Journal of Personalized Medicine.2024; 14(4): 377.     CrossRef
  • Factors influencing sleep quality in the intensive care unit: a descriptive pilot study in Korea
    Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee
    Acute and Critical Care.2023; 38(3): 278.     CrossRef
  • Psychometric properties of a Thai version of the Richards‐Campbell sleep questionnaire
    Nuanprae Kitisin, Pawit Somnuke, Napat Thikom, Nattaya Raykateeraroj, Nisa Poontong, Chayanan Thanakiattiwibun, Karuna Wongtangman
    Nursing in Critical Care.2022; 27(6): 885.     CrossRef
  • Sleep assessment in critically ill adults: A systematic review and meta-analysis
    Ellaha Kakar, Matthijs Priester, Pascale Wessels, Arjen J.C. Slooter, M. Louter, M. van der Jagt
    Journal of Critical Care.2022; 71: 154102.     CrossRef
  • Comparison of pharmacologic therapies alone versus operative techniques in combination with pharmacologic therapies for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial
    Hyun-Chang Kim, Young Song, Jong Seok Lee, Myeong Eun Jeong, Yongmin Lee, Jin Hong Lim, Do-Hyeong Kim
    International Journal of Surgery.2022; 104: 106763.     CrossRef
Pulmonary
Sequential Organ Failure Assessment score as a predictor of mortality in ventilated patients with multidrug-resistant bacteremia
Yeseul Oh, Jiyeon Roh, Jaemin Lee, Hyun Sung Chung, Kwangha Lee, Min Ki Lee
Acute Crit Care. 2020;35(3):169-178.   Published online August 31, 2020
DOI: https://doi.org/10.4266/acc.2020.00143
  • 4,317 View
  • 110 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
The occurrence of multidrug-resistant (MDR) bacteremia in ventilated patients may be associated with a high mortality rate. We evaluated whether Sequential Organ Failure Assessment (SOFA) score on the day of bacteremia could predict 90-day mortality in these patients.
Methods
Data were obtained retrospectively from 202 patients (male, 60.4%; median age, 64 years) hospitalized at a single university-affiliated tertiary care hospital. All adult patients who had were ventilated and had one of the following six MDR bacteremias between March 2011 and February 2018 were enrolled: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant Gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), or vancomycin-resistant Enterococcus faecium.
Results
The overall 90-day mortality rate after the day of bacteremia was 59.9%. The areas under the receiver operating characteristic curves for the SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 0.732 (95% confidence interval [CI], 0.666 to 0.792; P<0.001) and 0.662 (95% CI, 0.593 to 0.727; P<0.001), respectively, with no difference between the two (P=0.059). Also, the cutoff value of the SOFA score was 9 (based on Youden’s index). Multivariate Cox regression analysis showed that this cut-off value was significantly associated with higher mortality rate (hazard ratio, 2.886; 95% CI, 1.946 to 4.221; P<0.001).
Conclusions
SOFA score measured on the day of bacteremia may be a useful prognostic indicator of 90-day mortality in ventilated patients with MDR bacteremia.

Citations

Citations to this article as recorded by  
  • Serial evaluation of the serum lactate level with the SOFA score to predict mortality in patients with sepsis
    Heemoon Park, Jinwoo Lee, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee, Hong Yeul Lee
    Scientific Reports.2023;[Epub]     CrossRef
  • The value of admission Troponin I to predict outcomes in suspected infections in elderly patients admitted in Internal Medicine: results from the SOFA-T collaboration, a multi-center study
    N. Tarquinio, G. Viticchi, V. Zaccone, M. Martino, A. Fioranelli, P. Morciano, G. Moroncini, C. Di Pentima, A. Martini, C. Nitti, A. Salvi, M. Burattini, L. Falsetti
    Internal and Emergency Medicine.2021; 16(4): 981.     CrossRef
Ethics
Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
Acute Crit Care. 2020;35(3):179-188.   Published online August 10, 2020
DOI: https://doi.org/10.4266/acc.2020.00136
  • 6,722 View
  • 209 Download
  • 8 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Background
This study examined the experience of withholding or withdrawing life-sustaining treatment in patients hospitalized in the intensive care units (ICUs) of a tertiary care center. It also considers the role that intensivists play in the decision-making process regarding the withdrawal of life-sustaining treatment.
Methods
We retrospectively analyzed the medical records of 227 patients who decided to withhold or withdraw life-sustaining treatment while hospitalized at Ewha Womans University Medical Center Mokdong between April 9 and December 31, 2018.
Results
The 227 hospitalized patients included in the analysis withheld or withdrew from life-sustaining treatment. The department in which life-sustaining treatment was withheld or withdrawn most frequently was hemato-oncology (26.4%). Among these patients, the most common diagnosis was gastrointestinal tract cancer (29.1%). A majority of patients (64.3%) chose not to receive any life-sustaining treatment. Of the 80 patients in the ICU, intensivists participated in the decision to withhold or withdraw life-sustaining treatment in 34 cases. There were higher proportions of treatment withdrawal and ICU-to-ward transfers among the cases in whom intensivists participated in decision making compared to those cases in whom intensivists did not participate (50.0% vs. 4.3% and 52.9% vs. 19.6%, respectively).
Conclusions
Through their participation in end-of-life discussions, intensivists can help patients’ families to make decisions about withholding or withdrawing life-sustaining treatment and possibly avoiding futile treatments for these patients.

Citations

Citations to this article as recorded by  
  • Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study
    Song-I Lee, Ye-Rin Ju, Da Hyun Kang, Jeong Eun Lee
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
    Ae-Rin Baek, Sang-Bum Hong, Soohyun Bae, Hye Kyeong Park, Changhwan Kim, Hyun-Kyung Lee, Woo Hyun Cho, Jin Hyoung Kim, Youjin Chang, Heung Bum Lee, Hyun-Il Gil, Beomsu Shin, Kwang Ha Yoo, Jae Young Moon, Jee Youn Oh, Kyung Hoon Min, Kyeongman Jeon, Moon S
    BMC Medical Ethics.2023;[Epub]     CrossRef
  • Dying in the ICU
    Isabel Schulmeyer, Markus A. Weigand, Monika Heinzel-Gutenbrunner, Marco Gruss
    Die Anaesthesiologie.2022; 71(12): 930.     CrossRef
  • Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act
    Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
    Acute and Critical Care.2022; 37(2): 237.     CrossRef
  • Factors Influencing the Initiative Behavior of Intensive Care Unit Nurses toward End-of-Life Decision Making: A Cross-Sectional Study
    Jingying Huang, Haiou Qi, Yiting Zhu, Minyan Zhang
    Journal of Palliative Medicine.2022; 25(12): 1802.     CrossRef
  • Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database
    Yunji Lee, Minjeong Jo, Taehwa Kim, Kyoungsun Yun
    BMJ Open.2021; 11(8): e049711.     CrossRef
Surgery
Association between postoperative fluid balance and mortality and morbidity in critically ill patients with complicated intra-abdominal infections: a retrospective study
Joohyun Sim, Jae Young Kwak, Yun Tae Jung
Acute Crit Care. 2020;35(3):189-196.   Published online August 19, 2020
DOI: https://doi.org/10.4266/acc.2020.00031
  • 5,381 View
  • 149 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Background
Postoperative fluid overload may increase the risk of developing pulmonary complications and other adverse outcomes. We evaluated the impact of excessive fluid administration on postoperative outcomes in critically ill patients.
Methods
We reviewed the medical records of 320 patients admitted to intensive care unit (ICU) after emergency abdominal surgery for complicated intra-abdominal infection (cIAI) between January 2013 and December 2018. The fluid balance data of the patients were reviewed for a maximum of 7 days. The patients were grouped based on average daily fluid balance with a cutoff value of 20 ml/kg/day. Propensity score matching was performed to reduce the underlying differences between the groups.
Results
Patients with an average daily fluid balance of ≥20 ml/kg/day were associated with higher rates of 30-day mortality (11.8% vs. 2.4%; P=0.036) than those with lower fluid balance (<20 ml/kg/day). Kaplan-Meier survival curves for 30-day mortality in these groups also showed a better survival rate in the lower fluid balance group with a statistical significance (P=0.020). The percentage of patients who developed pulmonary consolidation during ICU stay (47.1% vs. 24.7%; P=0.004) was higher in the fluid-overloaded group. Percentages of newly developed pleural effusion (61.2% vs. 57.7%; P=0.755), reintubation (18.8% vs. 10.6%; P=0.194), and infectious complications (55.3% vs. 49.4%; P=0.539) showed no significant differences between the two groups.
Conclusions
Postoperative fluid overload in patients who underwent emergency surgery for cIAI was associated with higher 30-day mortality and more frequent occurrence of pulmonary consolidation. Postoperative fluid balance should be adjusted carefully to avoid adverse clinical outcomes.

Citations

Citations to this article as recorded by  
  • Fluid balance following laparotomy for hollow viscus perforation: A study of morbidity and mortality
    James Tankel, David Chayen, Sharon Einav
    Surgery in Practice and Science.2023; 12: 100146.     CrossRef
  • Risk of fluid accumulation after cardiac surgery
    Atte Koskinen, Jenni Aittokallio, Jarmo Gunn, Joonas Lehto, Arto Relander, Emma Viikinkoski, Tuija Vasankari, Juho Jalkanen, Maija Hollmén, Tuomas O. Kiviniemi
    JTCVS Open.2023; 16: 602.     CrossRef
  • Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
    Sine Wichmann, Marija Barbateskovic, Ning Liang, Theis Skovsgaard Itenov, Rasmus Ehrenfried Berthelsen, Jane Lindschou, Anders Perner, Christian Gluud, Morten Heiberg Bestle
    Annals of Intensive Care.2022;[Epub]     CrossRef
  • Goal directed fluid removal with furosemide versus placebo in intensive care patients with fluid overload: A trial protocol for a randomised, blinded trial (GODIF trial)
    Sine Wichmann, Theis S. Itenov, Rasmus E. Berthelsen, Theis Lange, Anders Perner, Christian Gluud, Pia Lawson‐Smith, Lars Nebrich, Jørgen Wiis, Anne C. Brøchner, Thomas Hildebrandt, Meike T. Behzadi, Kristian Strand, Finn H. Andersen, Thomas Strøm, Mikko
    Acta Anaesthesiologica Scandinavica.2022; 66(9): 1138.     CrossRef
  • Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial
    Daniel-Mihai Rusu, Ioana Grigoraș, Mihaela Blaj, Ianis Siriopol, Adi-Ionut Ciumanghel, Gigel Sandu, Mihai Onofriescu, Olguta Lungu, Adrian Constantin Covic
    Diagnostics.2021; 11(8): 1444.     CrossRef
Pharmacology
Inhalation sedation for postoperative patients in the intensive care unit: initial sevoflurane concentration and comparison of opioid use with propofol sedation
Seungho Jung, Sungwon Na, Hye Bin Kim, Hye Ji Joo, Jeongmin Kim
Acute Crit Care. 2020;35(3):197-204.   Published online August 10, 2020
DOI: https://doi.org/10.4266/acc.2020.00213
  • 4,796 View
  • 204 Download
  • 4 Web of Science
  • 10 Crossref
AbstractAbstract PDF
Background
Although the use of volatile sedatives in the intensive care unit (ICU) is increasing in Europe, it remains infrequent in Asia. Therefore, there are no clinical guidelines available. This study investigates the proper initial concentration of sevoflurane, a volatile sedative that induces a Richmond agitation-sedation scale (RASS) score of –2 to –3, in patients who underwent head and neck surgery with tracheostomy. We also compared the amount of postoperative opioid consumption between volatile and intravenous (IV) sedation.
Methods
We planned a prospective study to determine the proper initial sevoflurane concentration and a retrospective analysis to compare postoperative opioid consumption between volatile sedation and propofol sedation. Patients scheduled for head and neck surgery with tracheostomy and subsequent postoperative sedation in the ICU were enrolled.
Results
In this prospective study, the effective dose 50 (ED50) of initial end-tidal sevoflurane concentration was 0.36% (95% confidence interval [CI], 0.20 to 0.60%), while the ED 95 was 0.69% (95% CI, 0.60 to 0.75%) based on isotonic regression methods. In this retrospective study, remifentanil consumption during postoperative sedation was significantly lower in the sevoflurane group (2.52±1.00 µg/kg/hr, P=0.001) than it was in the IV propofol group (3.66±1.30 µg/kg/hr).
Conclusions
We determined the proper initial end-tidal concentration setting of sevoflurane for patients with tracheostomy who underwent head and neck surgery. Postoperative sedation with sevoflurane appears to be a valid and safe alternative to IV sedation with propofol.

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DOI: https://doi.org/10.4266/acc.2020.00647
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Acute Crit Care. 2020;35(3):207-212.   Published online September 23, 2019
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AbstractAbstract PDF
Veno-venous extracorporeal membrane oxygenation (ECMO) is a useful mechanical device for pediatric patients with severe respiratory failure. Conventional veno-venous ECMO using double cannulation, however, is not feasible due to size limitations in pediatric patients who have small femoral vessels. Recently, percutaneous bicaval dual-lumen cannula can be inserted using single cannulation via the right internal jugular vein. Herein, we report the case of a pediatric patient with severe respiratory failure who was weaned off the ECMO successfully after treatment with bicaval dual-lumen cannulation for 5 days despite the small body size and immunocompromised condition due to chemotherapy for hemophagocytic lymphohistiocytosis.

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DOI: https://doi.org/10.4266/acc.2018.00423
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  • 5 Web of Science
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AbstractAbstract PDF
Acute mesenteric ischemia (AMI) after cardiac surgery is a rare but fatal complication. Early diagnosis and intervention can be lifesaving. We report two cases of patients who underwent early diagnostic laparoscopy for suspicious AMI after cardiac surgery and demonstrated favorable outcomes. An 83-year-old male with severe left ventricular dysfunction underwent off-pump coronary artery bypass grafting. Severe ileus with gaseous distension of the small bowel was developed on the 3rd postoperative day and computed tomographic angiography (CTA) showed pneumatosis intestinalis of small bowel suggestive of AMI. An immediate bedside laparoscopy was performed and it showed preserved perfusion of small bowel. He recovered without complication under supportive medical management. Another 69-year-old male who underwent aortic valve replacement complained of whole abdominal tenderness with severe distension on the 3rd postoperative day. The CTA found segmental non-enhancing bowel wall with air bubbles suggestive of AMI with possible microperforation. A diagnostic laparoscopy demonstrated small-bowel infarction with pus-like fluid collection in the peritoneal cavity. The operation was converted to laparotomy and complete resection of ischemic segments of small bowel was done. He recovered well without any other complications and discharged home on the 35th postoperative day.

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DOI: https://doi.org/10.4266/acc.2020.00451
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DOI: https://doi.org/10.4266/acc.2020.00311
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DOI: https://doi.org/10.4266/acc.2020.00262
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