Acute and Critical Care

Volume 35 (3); August 2020

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

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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.

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Trisomy 13, home health-care and multidisciplinary approach: Case report
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Revista Paulista de Pediatria.2025;[Epub] CrossRef
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
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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
Volume Targeted Algorithms. Are they a one-size-fits-all approach to noninvasive ventilation?
David Troxell
Journal of Mechanical Ventilation.2024; 5(2): 69. CrossRef
Clinical evidence and technical aspects of innovative technology and monitoring of chronic NIV in COPD: a narrative review
F. Soleimani, D.W. Donker, E. Oppersma, M.L. Duiverman
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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
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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; 17(12): 1141. 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

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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.

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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
Interprofessional interventions that impact collaboration and quality of care across inpatient trauma care continuum: A scoping review
Alexandra Lapierre, Mélanie Bérubé, Marianne Giroux, Pier-Alexandre Tardif, Valérie Turcotte, Éric Mercier, Andréane Richard-Denis, David Williamson, Lynne Moore
Injury.2024; 55(11): 111873. 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
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Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations
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Lipid emulsion dosage used for resuscitation after drug toxicity
Ju-Tae Sohn
The American Journal of Emergency Medicine.2022; 59: 168. CrossRef
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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

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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.

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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

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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

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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

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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.

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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
Nursing‐Based Sleep Promotion Intervention Effectiveness for Post Cardiac Surgery Patients: Systematic Review
Issa M. Hweidi, Omar H. Jebreel, Hossam N. Alhawatmeh, Mohamad I. Jarrah, Awwad A. Abu‐Awwad, Mohammed I. Hweidi
Journal of Clinical Nursing.2024;[Epub] 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

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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.

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Evaluation of the Sofa Score in Predicating Outcome of Sepsis Patients Admitted to a Tertiary Care Center in Nepal
Sharad Khanal, Birendra Kumar Yadav, Aabishkar Subedi
International Journal of Innovative Science and Research Technology (IJISRT).2024; : 1295. CrossRef
Predictive value of IL-8 for mortality risk in elderly sepsis patients of emergency department
Xiangqun Zhang, Junyu Wang, Shubin Guo
Cytokine.2024; 184: 156774. CrossRef
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

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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.

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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 factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park
Acute and Critical Care.2024; 39(2): 294. 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
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Isabel Schulmeyer, Markus A. Weigand, Monika Heinzel-Gutenbrunner, Marco Gruss
Die Anaesthesiologie.2022; 71(12): 930. CrossRef
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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
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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

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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.

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James Tankel, David Chayen, Sharon Einav
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Atte Koskinen, Jenni Aittokallio, Jarmo Gunn, Joonas Lehto, Arto Relander, Emma Viikinkoski, Tuija Vasankari, Juho Jalkanen, Maija Hollmén, Tuomas O. Kiviniemi
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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

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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.

Citations

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Brian O’Gara, Christina Boncyk, Andreas Meiser, Angela Jerath, Martin Bellgardt, Matthieu Jabaudon, Jeremy R. Beitler, Christopher G. Hughes
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Michal Pruski, Susan O’Connell, Laura Knight, Rhys Morris
Applied Health Economics and Health Policy.2024;[Epub] CrossRef
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V. Likhvantsev, G. Landoni, N. Ermokhina, M. Yadgarov, L. Berikashvili, K. Kadantseva, O. Grebenchikov, L. Okhinko, A. Kuzovlev
Medicina Intensiva.2023; 47(5): 267. CrossRef
Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis
V. Likhvantsev, G. Landoni, N. Ermokhina, M. Yadgarov, L. Berikashvili, K. Kadantseva, O. Grebenchikov, L. Okhinko, A. Kuzovlev
Medicina Intensiva (English Edition).2023; 47(5): 267. CrossRef
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Khaled Ahmed Yassen, Matthieu Jabaudon, Hussah Abdullah Alsultan, Haya Almousa, Dur I Shahwar, Fatimah Yousef Alhejji, Zainab Yaseen Aljaziri
Journal of Clinical Medicine.2023; 12(3): 1069. CrossRef
Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial
Sara Martínez-Castro, Berta Monleón, Jaume Puig, Carolina Ferrer Gomez, Marta Quesada, David Pestaña, Alberto Balvis, Emilio Maseda, Alejandro Suárez de la Rica, Ana Monero Feijoo, Rafael Badenes
Journal of Personalized Medicine.2023; 13(6): 925. CrossRef
Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis
Sean Cuninghame, Angela Jerath, Kevin Gorsky, Asaanth Sivajohan, Conall Francoeur, Davinia Withington, Lisa Burry, Brian H. Cuthbertson, Beverley A. Orser, Claudio Martin, Adrian M. Owen, Marat Slessarev, Martin Chapman, Damon Scales, Julie Nardi, Beth Li
British Journal of Anaesthesia.2023; 131(2): 314. CrossRef
Experiencia y revisión de la literatura del uso del dispositivo Anesthetic Conserving Device (AnaConDa) durante la pandemia en pacientes con neumonía por COVID-19 en un hospital público
María Guadalupe Morales Hernández, Marcelo Díaz Conde, Ixchel Magaña Matienzo
Medicina Crítica.2023; 37(4): 334. CrossRef
Sedation of patients in intensive care units. Guidelines
V.I. Potievskaya, I.B. Zabolotskikh, I.E. Gridchik, A.I. Gritsan, A.A. Eremenko, I.A. Kozlov, A.L. Levit, V.A. Mazurok, I.V. Molchanov
Anesteziologiya i reanimatologiya.2023; (5): 6. CrossRef
Inhaled volatile anesthetics in the intensive care unit
Erin D Wieruszewski, Mariam ElSaban, Patrick M Wieruszewski, Nathan J Smischney
World Journal of Critical Care Medicine.2023;[Epub] CrossRef
Prospects of inhalation sedation in intensive care
O.A. Grebenchikov, V.V. Kulabukhov, A.K. Shabanov, O.V. Ignatenko, V.V. Antonova, R.A. Cherpakov, I.V. Redkin, E.A. Boeva, A.N. Kuzovlev
Anesteziologiya i reanimatologiya.2022; (3): 84. CrossRef
National analysis of applied sedation in critical care patients
Grace Pamela López Pérez , Melani Dayana Carrera Casa , Gissela Lizbeth Amancha Moyulema , Yadira Nathaly Chicaiza Quilligana , Ana Belén Guamán Tacuri , Joselyn Mireya Iza Arias
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Editorial

Lack of evidence for a nutritional support team in a trauma intensive care unit?: Jae Hwa Cho; Acute Crit Care. 2020;35(3):205-206. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00647

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How do physicians and nurses differ in their perceived barriers to effective enteral nutrition in the intensive care unit?
Masoumeh Mirhosiny, Mansour Arab, Parvin Mangolian Shahrbabaki
Acute and Critical Care.2021; 36(4): 342. CrossRef

Case Reports

Cardiology
Percutaneous bicaval dual lumen cannula for extracorporeal life support: Woojung Kim, Hye Won Kwon, Jooncheol Min, Sungkyu Cho, Jae Gun Kwak, June Dong Park, Woong-Han Kim; Acute Crit Care. 2020;35(3):207-212. Published online September 23, 2019; DOI: https://doi.org/10.4266/acc.2019.00584

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Abstract 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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Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients
Soo Hee Lee, Sunmin Kim, Ju-Tae Sohn
Pediatric Emergency Care.2023; 39(1): 53. CrossRef
Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review
Soo Hee Lee, Ju-Tae Sohn
Korean Journal of Anesthesiology.2023; 76(3): 171. CrossRef

Thoracic Surgery
Early laparoscopic exploration for acute mesenteric ischemia after cardiac surgery: Sue Hyun Kim, Ho Young Hwang, Min Jung Kim, Kyu Joo Park, Ki-Bong Kim; Acute Crit Care. 2020;35(3):213-217. Published online April 19, 2019; DOI: https://doi.org/10.4266/acc.2018.00423

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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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The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review
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Journal of Personalized Medicine.2024; 14(2): 167. CrossRef
Gastrointestinal complications after cardiac surgery
Klara Schwarzova, Sameer Damle, Frank William Sellke, Michael Phillip Robich
Trauma Surgery & Acute Care Open.2024; 9(1): e001324. CrossRef
The role of bed-side laparoscopy in the management of acute mesenteric ischemia of recent onset in post-cardiac surgery patients admitted to ICU
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European Journal of Trauma and Emergency Surgery.2022; 48(1): 87. CrossRef
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Letters to the Editor

Pulmonary
COVID-19 patients: when and whom to ventilate?: Tusharindra Lal, Mrinal Sircar; Acute Crit Care. 2020;35(3):218-219. Published online August 19, 2020; DOI: https://doi.org/10.4266/acc.2020.00451

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Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
Acute and Critical Care.2021; 36(3): 223. CrossRef

Rapid response system
Is the use of automated artificial manual breathing unit resuscitators justified during a pandemic mechanical ventilator crisis?: Kamna Kakkar, Bhavna Gupta; Acute Crit Care. 2020;35(3):220-222. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00311

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Recent advances in low-cost, portable automated resuscitator systems to fight COVID-19
Vishal Kumar, Ravinder Kumar, Mohit Kumar, Gurpreet Singh Wander, Vivek Gupta, Ashish Sahani
Health and Technology.2022; 12(1): 181. CrossRef
Design for the Automation of an AMBU Spur II Manual Respirator
Carles Domènech-Mestres, Elena Blanco-Romero, Albert de la Fuente-Morató, Manuel Ayala-Chauvin
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Data automated bag breathing unit for COVID-19 ventilator shortages
Aleksandra B. Gruslova, Nitesh Katta, Andrew G. Cabe, Scott F. Jenney, Jonathan W. Valvano, Tim B. Phillips, Austin B. McElroy, Robert K. LaSalle, Aydin Zahedivash, Van N. Truskett, Nishi Viswanathan, Marc D. Feldman, Richard B. Wettstein, Thomas E. Milne
Intensive Care Medicine Experimental.2021;[Epub] CrossRef

Infection
Veno-arterial extracorporeal membrane oxygenation may be useful in critically ill COVID-19 patients with suspected cardiac injury: Eunyoung Heo, Se Jin Oh, Hyun Woo Lee, Jung-Kyu Lee, Deog Kyeom Kim, Sang-Won Park; Acute Crit Care. 2020;35(3):223-225. Published online August 10, 2020; DOI: https://doi.org/10.4266/acc.2020.00262

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