Acute and Critical Care

Volume 35 (4); November 2020

Review Article

Trauma
Damage control strategy in bleeding trauma patients: Maru Kim, Hangjoo Cho; Acute Crit Care. 2020;35(4):237-241. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00941

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Hemorrhagic shock is a main cause of death in severe trauma patients. Bleeding trauma patients have coagulopathy on admission, which may even be aggravated by incorrectly directed resuscitation. The damage control strategy is a very urgent and essential aspect of management considering the acute coagulopathy of trauma and the physiological status of bleeding trauma patients. This strategy has gained popularity over the past several years. Patients in extremis cannot withstand prolonged definitive surgical repair. Therefore, an abbreviated operation, referred to as damage control surgery (DCS), is needed. In addition to DCS, the likelihood of survival should be maximized for patients in extremis by providing appropriate critical care, including permissive hypotension, hemostatic resuscitation, minimization of crystalloid use, early use of tranexamic acid, and avoidance of hypothermia and hypocalcemia. This review presents an overview of the evolving strategy of damage control in bleeding trauma patients.

Citations

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Current Approaches to the Treatment of Traumatic Shock (Review)
D. A. Ostapchenko, A. I. Gutnikov, L. A. Davydova
General Reanimatology.2021; 17(4): 65. CrossRef

Original Articles

Pulmonary
Clinical characteristics and outcomes of critically Ill patients with COVID-19 in Northeast Ohio: low mortality and length of stay: Francois Abi Fadel, Mohammed Al-Jaghbeer, Sany Kumar, Lori Griffiths, Xiaofeng Wang, Xiaozhen Han, Robert Burton; Acute Crit Care. 2020;35(4):242-248. Published online October 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00619

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Abstract PDF

Background
Published coronavirus disease 2019 (COVID-19) reports suggest higher mortality with increasing age and comorbidities. Our study describes the clinical characteristics and outcomes for all intensive care unit (ICU) patients admitted across the Cleveland Clinic enterprise, a 10-hospital health care system in Northeast Ohio, serving more than 2.7 million people.
Methods
We analyzed the quality data registry for clinical characteristics and outcomes of all COVID-19-confirmed ICU admissions. Differences in outcomes from other health care systems and published cohorts from other parts of the world were delineated.
Results
Across our health care system, 495 COVID-19 patients were admitted from March 15 to June 1, 2020. Mean patient age was 67.3 years, 206 (41.6%) were females, and 289 (58.4%) were males. Mean Acute Physiology Score was 45.3, and mean Acute Physiology and Chronic Health Evaluation III score was 60.5. In total, 215 patients (43.3%) were intubated for a mean duration of 9.2 days. Mean ICU and hospital length of stay were 7.4 and 13.9 days, respectively, while mean ICU and hospital mortality rates were 18.4% and 23.8%.
Conclusions
Our health care system cohort is the fourth largest to be reported. Lower ICU and hospital mortality and length of stay were seen compared to most other published reports. Better preparedness and state-level control of the surge in COVID-19 infections are likely the reasons for these better outcomes. Future research is needed to further delineate differences in mortality and length of stay across health care systems and over time.

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Racial inequality in COVID-treatment and in-hospital length of stay in the US over time
Benjamin M. Althouse, Charlotte Baker, Peter D. Smits, Samuel Gratzl, Ryan H. Lee, Brianna M. Goodwin Cartwright, Michael Simonov, Michael D. Wang, Nicholas L. Stucky
Frontiers in Public Health.2023;[Epub] CrossRef
Effects of race on the outcome of COVID-19 in hospitalized patients
Getahun Abate, Aniruddh Kapoor, Edward Charbek, Bryan Beck, Qian Wang, Grace C. Wang, Mackenzie Steck, Jason Zoglman, Robin R. Chambeg, Sharon Frey, Daniel F. Hoft, Timothy L. Wiemken
Journal of the National Medical Association.2022; 114(1): 56. CrossRef
Hospital length of stay for COVID-19 patients: A systematic review and meta-analysis
Yousef Alimohamadi, Elahe Mansouri Yekta, Mojtaba Sepandi, Maedeh Sharafoddin, Maedeh Arshadi, Elahe Hesari
Multidisciplinary Respiratory Medicine.2022;[Epub] CrossRef
Learning from the First Wave of the Pandemic in England, Wales, and Northern Ireland
David Pilcher, Matthew Durie
American Journal of Respiratory and Critical Care Medicine.2021; 203(5): 532. CrossRef
Epidemiology, outcomes, and utilization of intensive care unit resources for critically ill COVID-19 patients in Libya: A prospective multi-center cohort study
Muhammed Elhadi, Ahmed Alsoufi, Abdurraouf Abusalama, Akram Alkaseek, Saedah Abdeewi, Mohammed Yahya, Alsnosy Mohammed, Mohammed Abdelkabir, Mohammed Huwaysh, Emad Amkhatirah, Kamel Alshorbaji, Samer Khel, Marwa Gamra, Abdulmueti Alhadi, Taha Abubaker, Mo
PLOS ONE.2021; 16(4): e0251085. CrossRef
A Multicenter Evaluation of Survival After In-Hospital Cardiac Arrest in Coronavirus Disease 2019 Patients
Abhishek Bhardwaj, Mahmoud Alwakeel, Talha Saleem, Saira Afzal, Sura Alqaisi, Aisha R. Saand, Hanan Al. Najjar, Lori Griffiths, Xiaozhen Han, Xiaofeng Wang, Silvia Perez-Protto, Benjamin S. Abella, David F. Gaieski, Abhijit Duggal, Francois Abi Fadel
Critical Care Explorations.2021; 3(5): e0425. CrossRef
Overcoming gaps: regional collaborative to optimize capacity management and predict length of stay of patients admitted with COVID-19
Michael G Usher, Roshan Tourani, Gyorgy Simon, Christopher Tignanelli, Bryan Jarabek, Craig E Strauss, Stephen C Waring, Niall A M Klyn, Burke T Kealey, Rabindra Tambyraja, Deepti Pandita, Karyn D Baum
JAMIA Open.2021;[Epub] CrossRef
Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study
Abbas Al Mutair, Alyaa Elhazmi, Saad Alhumaid, Gasmelseed Ahmad, Ali Rabaan, Mohammed Alghadeer, Hiba Chagla, Raghavendra Tirupathi, Amit Sharma, Kuldeep Dhama, Khulud Alsalman, Zainab Alalawi, Ziyad Aljofan, Alya Al Mutairi, Mohammed Alomari, Mansour Awa
Medicina.2021; 57(9): 878. CrossRef
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

Infection
Risk factors for intensive care unit admission and mortality in hospitalized COVID-19 patients: Ahmed Ayaz, Ainan Arshad, Hajra Malik, Haris Ali, Erfan Hussain, Bushra Jamil; Acute Crit Care. 2020;35(4):249-254. Published online November 11, 2020; DOI: https://doi.org/10.4266/acc.2020.00381

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Abstract PDF

Background
This study investigated the clinical features and outcome of hospitalized coronavirus disease 2019 (COVID-19) patients admitted to our quaternary care hospital.
Methods
In this retrospective cohort study, we included all adult patients with COVID-19 infection admitted to a quaternary care hospital in Pakistan from March 1 to April 15, 2020. The extracted variables included demographics, comorbidities, presenting symptoms, laboratory tests and radiological findings during admission. Outcome measures included in-hospital mortality and length of stay.
Results
Sixty-six COVID-19 patients were hospitalized during the study period. Sixty-one percent were male and 39% female; mean age was 50.6±19.1 years. Fever and cough were the most common presenting symptoms. Serial chest X-rays showed bilateral pulmonary opacities in 33 (50%) patients. The overall mortality was 14% and mean length of stay was 8.4±8.9 days. Ten patients (15%) required intensive care unit (ICU) care during admission, of which six (9%) were intubated. Age ≥60 years, diabetes, ischemic heart disease, ICU admission, neutrophil to lymphocyte ratio ≥3.3, and international normalized ratio ≥1.2 were associated with increased risk of mortality.
Conclusions
We found a mortality rate of 14% in hospitalized COVID-19 patients. COVID-19 cases are still increasing exponentially around the world and may overwhelm healthcare systems in many countries soon. Our findings can be used for early identification of patients who may require intensive care and aggressive management in order to improve outcomes.

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Xiaofeng Wang, Shuo Li, Da Huo, Shilin Wang, Wenlong Wang, Hongxia He, Qian Zhang, Jiantao Li, Xu Wang
International Journal of Surgery.2024; 110(4): 2025. CrossRef
Incidence and clinical outcomes of bacterial superinfections in critically ill patients with COVID-19
Si Mong Yoon, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
Frontiers in Medicine.2023;[Epub] CrossRef
Difference in determinants of ICU admission and death among COVID-19 hospitalized patients in two epidemic waves in Portugal: possible impact of healthcare burden and hospital bed occupancy on clinical management and outcomes, March–December 2020
Vasco Ricoca Peixoto, André Vieira, Pedro Aguiar, Carlos Carvalho, Daniel Thomas, Paulo Sousa, Carla Nunes, Alexandre Abrantes
Frontiers in Public Health.2023;[Epub] CrossRef
Early Death Among COVID-19 Patients: A Cross-sectional Analysis of the First 10,000 COVID-19 Deaths from the Indian State of Tamil Nadu
Zarin Pilakkadavath, Janice M. Weinberg, Serin Kuriakose, Shahul H. Ebrahim, Lekha D. Bhat, Bindhya Vijayan, Salman Khan, Soji D. Jose, Premini Rajeev, Jinbert L. Azariah, Shaffi Fazaludeen Koya
Dr. Sulaiman Al Habib Medical Journal.2023; 5(4): 151. CrossRef
Global prevalence of COVID-19-induced acute respiratory distress syndrome: systematic review and meta-analysis
Abere Woretaw Azagew, Zerko Wako Beko, Yohannes Mulu Ferede, Habtamu Sewunet Mekonnen, Hailemichael Kindie Abate, Chilot Kassa Mekonnen
Systematic Reviews.2023;[Epub] CrossRef
Drinking patterns, alcoholic beverage types, and esophageal cancer risk in Africa: a comprehensive systematic review and meta-analysis
Eugene Jamot Ndebia, Gabriel Tchuente Kamsu
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The clinical association between Periodontitis and COVID-19
Shipra Gupta, Ritin Mohindra, Mohita Singla, Sagar Khera, Vaibhav Sahni, Poonam Kanta, Roop Kishor Soni, Amit Kumar, Krishan Gauba, Kapil Goyal, Mini P. Singh, Arnab Ghosh, Kamal Kajal, Varun Mahajan, Ashish Bhalla, Timo Sorsa, Ismo Räisänen
Clinical Oral Investigations.2022; 26(2): 1361. CrossRef
Prothrombin time, international normalized rate and in-hospital mortality in COVID-19
Panagiotis PALIOGIANNIS, Angelo ZINELLU, Arduino A. MANGONI, Antonio PAZZOLA, Francesco L. BANDIERA, Antonio SPANO, Chiara SANNA, Valentina SCANO, Sara S. FOIS, Verdiana MUSCAS, Elena MASOTTO, Stefano DORE, Vito FIORE, Pietro PIRINA, Ciriaco CARRU, Alessa
Minerva Respiratory Medicine.2022;[Epub] CrossRef
Patterns of presentation, prevalence and associated factors of mortality in ICU among adult patients during the pandemic of COVID 19: A retrospective cross-sectional study
Shimelis Seid, Habtu Adane, Getachew Mekete
Annals of Medicine and Surgery.2022; 77: 103618. CrossRef
Hospital length of stay for COVID-19 patients: A systematic review and meta-analysis
Yousef Alimohamadi, Elahe Mansouri Yekta, Mojtaba Sepandi, Maedeh Sharafoddin, Maedeh Arshadi, Elahe Hesari
Multidisciplinary Respiratory Medicine.2022;[Epub] CrossRef
Evaluation of the models generated from clinical features and deep learning-based segmentations: Can thoracic CT on admission help us to predict hospitalized COVID-19 patients who will require intensive care?
Mutlu Gülbay, Aliye Baştuğ, Erdem Özkan, Büşra Yüce Öztürk, Bökebatur Ahmet Raşit Mendi, Hürrem Bodur
BMC Medical Imaging.2022;[Epub] CrossRef
Characterization and determinant factors of critical illness and in-hospital mortality of COVID-19 patients: A retrospective cohort of 1,792 patients in Kenya
Isinta M Elijah, Endawoke Amsalu, Xuening Jian, Mingyang Cao, Eric K Mibei, Danvas O Kerosi, Francis G Mwatsahu, Wei Wang, Faith Onyangore, Youxin Wang
Biosafety and Health.2022; 4(5): 330. CrossRef
SARS-CoV-2-Infection (COVID-19): Clinical Course, Viral Acute Respiratory Distress Syndrome (ARDS) and Cause(s) of Death
Giuliano Pasquale Ramadori
Medical Sciences.2022; 10(4): 58. CrossRef
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Hannah N. Marmor, Mindy Pike, Zhiguo (Alex) Zhao, Fei Ye, Stephen A. Deppen, Julio Croda
PLOS Global Public Health.2022; 2(11): e0001187. CrossRef
Risk factors of early mortality among COVID-19 deceased patients in Addis Ababa COVID-19 care centers, Ethiopia
Taye Ashine Mezgebu, Migbar Mekonnen Sibhat, Melsew Tsegaw Getnet, Kassie Tiruneh Gebeyehu, Wuletaw Zewde Chane, Edmialem Mesfin Getahun, Asaminew Sane Habtamu, Hailu Beyene Asmare, Melke Mengistie Ambaw, Zivanai Cuthbert Chapanduka
PLOS ONE.2022; 17(9): e0275131. CrossRef
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Liqin Shi, Jiahao Ren, Yujia Wang, Huifen Feng, Fang Liu, Haiyan Yang
Vaccines.2022; 11(1): 89. CrossRef
Outcomes of nutritionally at-risk Coronavirus Disease 2019 (COVID 19) patients admitted in a tertiary government hospital: A follow-up study of the MalnutriCoV study
Ramon B. Larrazabal, Harold Henrison C. Chiu, Lia Aileen M. Palileo-Villanueva
Clinical Nutrition ESPEN.2021; 43: 239. CrossRef
Prognostic value of neutrophil‐to‐lymphocyte ratio in COVID‐19 patients: A systematic review and meta‐analysis
Juan R. Ulloque‐Badaracco, W. Ivan Salas‐Tello, Ali Al‐kassab‐Córdova, Esteban A. Alarcón‐Braga, Vicente A. Benites‐Zapata, Jorge L. Maguiña, Adrian V. Hernandez
International Journal of Clinical Practice.2021;[Epub] CrossRef
A meta-analysis on the risk factors adjusted association between cardiovascular disease and COVID-19 severity
Jie Xu, Wenwei Xiao, Xuan Liang, Li Shi, Peihua Zhang, Ying Wang, Yadong Wang, Haiyan Yang
BMC Public Health.2021;[Epub] CrossRef
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

Pulmonary
Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study: Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho; Acute Crit Care. 2020;35(4):255-262. Published online November 9, 2020; DOI: https://doi.org/10.4266/acc.2020.00164; Correction in: Acute Crit Care 2021;36(2):172

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Abstract PDF

Background
The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs.
Methods
Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included.
Results
A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups.
Conclusions
In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Citations

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Sedation and analgesia strategies for non-invasive mechanical ventilation: A systematic review and meta-analysis
Baolu Yang, Leyi Gao, Zhaohui Tong
Heart & Lung.2024; 63: 42. CrossRef
Effect of Music Therapy and Sound Isolation on the Comfort of Mechanically Ventilated Patients
Sinem Çalışkan, Esra Akın, Mehmet Uyar
Turkish Journal of Intensive Care.2024; 22(1): 83. CrossRef
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
Acute and Critical Care.2022; 37(1): 1. CrossRef
Comfort During Non-invasive Ventilation
Gianmaria Cammarota, Rachele Simonte, Edoardo De Robertis
Frontiers in Medicine.2022;[Epub] CrossRef
Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
Treatment of acute respiratory failure: noninvasive mechanical ventilation
Sunghoon Park
Journal of the Korean Medical Association.2022; 65(3): 144. CrossRef
Dexmedetomidine-Induced Aortic Contraction Involves Transactivation of the Epidermal Growth Factor Receptor in Rats
Soo Hee Lee, Seong-Chun Kwon, Seong-Ho Ok, Seung Hyun Ahn, Sung Il Bae, Ji-Yoon Kim, Yeran Hwang, Kyeong-Eon Park, Mingu Kim, Ju-Tae Sohn
International Journal of Molecular Sciences.2022; 23(8): 4320. CrossRef

Pulmonary
Experience of percutaneous tracheostomy in critically ill COVID-19 patients: Eun Jin Kim, Eun-Hyung Yoo, Chi Young Jung, Kyung Chan Kim; Acute Crit Care. 2020;35(4):263-270. Published online November 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00444

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Abstract PDF

Background
Coronavirus disease 2019 (COVID-19) is a highly contagious disease that causes respiratory failure. Tracheostomy is an essential procedure in critically ill COVID-19 patients; however, it is an aerosol-generating technique and thus carries the risk of infection transmission. We report our experience with percutaneous tracheostomy and its safety in a real medical setting.
Methods
During the COVID-19 outbreak, 13 critically ill patients were admitted to the intensive care unit (ICU) at Daegu Catholic University Medical Center between February 24 and April 30, 2020. Seven of these patients underwent percutaneous tracheostomy using Ciaglia Blue Rhino. The medical environment, percutaneous tracheostomy method, and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) results were retrospectively reviewed. After treatment, the COVID-19 infection status of healthcare personnel was investigated by RT-PCR.
Results
The ICU contained negative pressure cohort areas and isolation rooms, and healthcare personnel wore a powered air-purifying respirator system. We performed seven cases of percutaneous tracheostomy in the same way as in patients without COVID-19. Five patients (71.4%) tested positive for COVID-19 by RT-PCR at the time of tracheostomy. The median cycle threshold value for the RNA-dependent RNA polymerase was 30.60 (interquartile range [IQR], 25.50–36.56) in the upper respiratory tract and 35.04 (IQR, 28.40–36.74) in the lower respiratory tract. All healthcare personnel tested negative for COVID-19 by RT-PCR.
Conclusions
Percutaneous tracheostomy was performed with conventional methods in the negative pressure cohort area. It was safe to perform percutaneous tracheostomy in an environment of COVID-19 infection.

Citations

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Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry
Christopher M. Kapp, Ardian Latifi, David Feller-Kopman, Joshua H. Atkins, Esther Ben Or, David Dibardino, Andrew R. Haas, Jeffrey Thiboutot, Christoph T. Hutchinson
Journal of Intensive Care Medicine.2022; 37(2): 240. CrossRef
Percutaneous Tracheostomy in Respiratory Failure Due to COVID-19
Samuel E. Cohen, Angelena R. Lopez, Philip K. Ng, Oren A. Friedman, George E. Chaux
Journal of Bronchology & Interventional Pulmonology.2022; 29(2): 125. CrossRef
Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019 (COVID-19)
You Shang, Jianfeng Wu, Jinglun Liu, Yun Long, Jianfeng Xie, Dong Zhang, Bo Hu, Yuan Zong, Xuelian Liao, Xiuling Shang, Renyu Ding, Kai Kang, Jiao Liu, Aijun Pan, Yonghao Xu, Changsong Wang, Qianghong Xu, Xijing Zhang, Jicheng Zhang, Ling Liu, Jiancheng Z
Journal of Intensive Medicine.2022; 2(4): 199. CrossRef
Commentary: Coronavirus disease 2019 (COVID-19) tracheostomies—The “how” but not the “why” or “when”
Benjamin Wei, Peter Abraham
JTCVS Techniques.2021; 6: 190. CrossRef
Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals
Phillip Staibano, Marc Levin, Tobial McHugh, Michael Gupta, Doron D. Sommer
JAMA Otolaryngology–Head & Neck Surgery.2021; 147(7): 646. CrossRef
Tracheostomy in COVID Times
Yatin Mehta, Gaurav Kochar
Journal of Cardiac Critical Care TSS.2021; 5(02): 082. CrossRef

Epidemiology
Postextubation respiratory events in patients admitted to the intensive care unit: a prospective pilot study using overnight respiratory polygraphy: Ye Jin Lee, Jinwoo Lee, Sang-Min Lee, Jaeyoung Cho; Acute Crit Care. 2020;35(4):271-278. Published online November 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00479

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Abstract PDF Supplementary Material

Background
Before the main trial in which respiratory polygraphy will be used to evaluate postextubation sleep apnea in critically ill patients, we performed a prospective pilot study to ensure that any issues with the conduct of the trial would be identified.
Methods
In the present study, 13 adult patients who had received mechanical ventilation for ≥24 hours were prospectively recruited. Among the patients, 10 successfully completed respiratory polygraphy on the first or second night after extubation. Data regarding the types and doses of corticosteroids, analgesics, sedatives, and muscle relaxants as well as the methods of oxygen delivery were recorded.
Results
During the night of respiratory polygraphy, all 10 patients received supplemental oxygen (low-flow oxygen, n=5; high-flow oxygen, n=5), and seven patients received intravenous corticosteroids. Three of the 10 patients had a respiratory event index (REI) ≥5/hr. All respiratory events were obstructive episodes. None of the patients receiving high-flow oxygen therapy had an REI ≥5/hr. Two of the seven patients who received corticosteroids and one of the other three patients who did not receive this medication had an REI ≥5/hr. Although low- or high-flow oxygen therapy was provided, all patients had episodes of oxygen saturation (SpO2) <90%. Two of the three patients with an REI ≥5/hr underwent in-laboratory polysomnography. The patients’ Apnea-Hypopnea Index and REI obtained via polysomnography and respiratory polygraphy, respectively, were similar.
Conclusions
In a future trial to evaluate postextubation sleep apnea in critically ill patients, pre-stratification based on the use of corticosteroids and high-flow oxygen therapy should be considered.

Citations

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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

Pulmonary
Predictive value of the negative inspiratory force index as a predictor of weaning success: a crosssectional study: Phuong Hoang Vu, Viet Duc Tran, Minh Cuong Duong, Quyet Thang Cong, Thu Nguyen; Acute Crit Care. 2020;35(4):279-285. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00598

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Abstract PDF

Background
Identifying when intubated patients are ready to be extubated remains challenging. The negative inspiratory force (NIF) is a recommended predictor of weaning success. However, little is known about the role of NIF in the weaning process for the Asian surgical intensive population, especially for the Vietnamese population. Here, we aimed to investigate the cutoff threshold and predictive value of the NIF index for predicting the success of ventilator weaning in Vietnamese surgical intensive care patients.
Methods
A cross-sectional study was conducted at the Surgical Intensive Care Unit of Viet Duc Hospital from October 2016 to August 2017. A total of 64 patients aged 16–70 years undergoing ventilatory support through an orotracheal tube satisfied the criteria for readiness to begin weaning. The correlation between the NIF index with outcomes of the weaning process was analyzed. Specificity (Sp), sensitivity (Se), positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curve, and area under the curve (AUC) were calculated.
Results
The success rate of the entire weaning process was 67.2% (43/64). The median NIF values were –26.0 cm H₂O (interquartile range [IQR], –28.0 to –25.0) in the successful weaning group and –24.0 cm H₂O (IQR, –25.0 to –23.0) in the weaning failure group (P<0.001). According to ROC analysis, an NIF value ≤–25 cm H₂O predicted weaning success (AUC, 0.836) with 91% Se, 62% Sp, 83% PPV, and 77% NPV.
Conclusions
An NIF cutoff threshold ≤–25 cm H₂O can be used as predictor of weaning success in Vietnamese surgical intensive care patients.

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Pendelluft as a predictor of weaning in critically ill patients: An observational cohort study
Danqiong Wang, Yaxin Ning, Linya He, Keqi Pan, Xiaohua Xiong, Shanshan Jing, Jianhua Hu, Jian Luo, Dehua Ye, Zubing Mei, Weiwen Zhang
Frontiers in Physiology.2023;[Epub] CrossRef
Morphological and Functional Alterations of Respiratory Muscle Performance and Spirometry Parameters in Patients with Congestive Heart Failure
V. S. Shabaev, I. V. Orazmagomedova, V. A. Mazurok, A. V. Berezina, A. E. Bautin, L. G. Vasilyeva, D. A. Aleksandrova
General Reanimatology.2023; 19(5): 39. CrossRef
Diaphragmatic dysfunction in patients with chronic heart failure
V.S. Shabaev, I.V. Orazmagomedova, V.A. Mazurok, A.V. Berezina, A.E. Bautin, L.G. Vasilyeva, D.A. Aleksandrova
Anesteziologiya i reanimatologiya.2023; (5): 44. CrossRef
Biosignal-Based Digital Biomarkers for Prediction of Ventilator Weaning Success
Ji Eun Park, Tae Young Kim, Yun Jung Jung, Changho Han, Chan Min Park, Joo Hun Park, Kwang Joo Park, Dukyong Yoon, Wou Young Chung
International Journal of Environmental Research and Public Health.2021; 18(17): 9229. CrossRef

Basic science and research
Therapeutic hypothermia reduces inflammation and oxidative stress in the liver after asphyxial cardiac arrest in rats: Yoonsoo Park, Ji Hyeon Ahn, Tae-Kyeong Lee, Bora Kim, Hyun-Jin Tae, Joon Ha Park, Myoung Cheol Shin, Jun Hwi Cho, Moo-Ho Won; Acute Crit Care. 2020;35(4):286-295. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00304

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Abstract PDF

Background
Few studies have evaluated the effects of hypothermia on cardiac arrest (CA)-induced liver damage. This study aimed to investigate the effects of hypothermic therapy on the liver in a rat model of asphyxial cardiac arrest (ACA).
Methods
Rats were subjected to 5-minute ACA followed by return of spontaneous circulation (RoSC). Body temperature was controlled at 33°C±0.5°C or 37°C±0.5°C for 4 hours after RoSC in the hypothermia group and normothermia group, respectively. Liver tissues in each group were collected at 6 hours, 12 hours, 1 day, and 2 days after RoSC. To examine hepatic inflammation, mast cells were stained with toluidine blue. Superoxide anion radical production was evaluated using dihydroethidium fluorescence straining and expression of endogenous antioxidants (superoxide dismutase 1 [SOD1] and SOD2) was examined using immunohistochemistry.
Results
There were significantly more mast cells in the livers of the normothermia group with ACA than in the hypothermia group with ACA. Gradual increase in superoxide anion radical production was found with time in the normothermia group with ACA, but production was significantly suppressed in the hypothermia group with ACA relative to the normothermia group with ACA. SOD1 and SOD2 levels were higher in the hypothermia group with ACA than in the normothermia group with ACA.
Conclusions
Experimental hypothermic treatment after ACA significantly inhibited inflammation and superoxide anion radical production in the rat liver, indicating that this treatment enhanced or maintained expression of antioxidants. Our findings suggest that hypothermic therapy after CA can reduce mast cell-mediated inflammation through regulation of oxidative stress and the expression of antioxidants in the liver.

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Editorial

Surgery
Identification of risk factors for mortality in COVID-19 patients: Eun Young Kim; Acute Crit Care. 2020;35(4):296-297. Published online November 9, 2020; DOI: https://doi.org/10.4266/acc.2020.00850

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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

Case Reports

CPR/Resuscitation
Fatal airway obstruction due to a ball-valve clot with identical signs of tension pneumothorax: Hisaaki Munakata, Michiko Higashi, Takahiro Tamura, Yushi Ueda Adachi; Acute Crit Care. 2020;35(4):298-301. Published online April 20, 2020; DOI: https://doi.org/10.4266/acc.2019.00570

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Abstract PDF

Endo-tracheal tube obstruction due to an extensive blood clot is a recognized but very rare complication. A ball-valve obstruction in the airway could function as a check valve for the lung and thorax, resulting in tension pneumothorax-like abnormalities. A 47-year-old female patient had undergone implantation of a left ventricular assist device 3 weeks prior. On post-operative day 17, planned thoracentesis was performed for drainage of a pleural effusion. Despite the drainage, the patient’s oxygenation did not improve, and emergency tracheal intubation was conducted. Subsequent computed tomography revealed bilateral pneumothorax. Two days later, the patient’s trachea was extubated without complication, and a mini-tracheostomy tube was placed. Three hours later, reintubation was conducted due to progressive tachypnea. Although successful intubation was confirmed, ventilation became increasingly difficult and finally impossible. Marked increase in pulmonary artery and central venous pressures suggested progression of the previous tension pneumothorax. After emergency extracorporeal membrane oxygenation was initiated, fiberoptic bronchoscopy revealed the presence of a massive clot and ball-valve obstruction of the endotracheal tube. Two weeks later, the patient died due to severe hypoxic brain damage. Diagnosis of ball valve clot is not simple, but intensivists should consider this rare complication.

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Pulmonary
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Abstract PDF: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease characterized by dyspnea and a worsening of the lung function. Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) are defined by a clinically significant respiratory deterioration, that typically develops in less than 1 month, accompanied by new radiologic abnormalities on high-resolution computed tomography, including diffused and bilateral ground-glass opacification, along with an absence of other obvious clinical etiologies. Recently, AE-IPF has gained significant importance as a major cause of mortality and morbidity. However, despite the extremely poor prognosis of the condition, no well-validated therapeutic interventions are currently available. Therefore, novel treatment modalities are being investigated and applied in addition to conventional treatments. Among them, several studies have reported that a direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP), developed for endotoxin removal in septic shock, has an effect on AE-IPF. We describe two cases of PMX-DHP treatment with conflicting results. One patient successfully recovered via a PMX-DHP in severe AE-IPF that required extracorporeal membrane oxygenation (ECMO). PMX-DHP subsequently improved oxygenation (PaO2/FiO2 ratio) and decreased the levels of inflammatory markers (interleukin-6, C-reactive protein, and white blood cells). The patient dramatically recovered without the need for ECMO. PMX-DHP may be considered an alternative therapy in AE-IPF patients requiring mechanical ventilation or ECMO.

Letter to the Editor

Infection
Role of vitamin C in critically ill patients with COVID-19: is it effective?: Siddique Mohyud Din Chaudhary, Robert Matthew Wright, Gabriel Patarroyo-Aponte; Acute Crit Care. 2020;35(4):307-308. Published online October 21, 2020; DOI: https://doi.org/10.4266/acc.2020.00416

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Nutrients.2021; 13(6): 1924. CrossRef

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