Acute and Critical Care

Volume 37 (2); May 2022

Review Articles

Infection
Oxygen therapy for sepsis and prevention of complications: Hayk Minasyan; Acute Crit Care. 2022;37(2):137-150. Published online March 17, 2022; DOI: https://doi.org/10.4266/acc.2021.01200

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Patients with sepsis have a wide range of respiratory disorders that can be treated with oxygen therapy. Experimental data in animal sepsis models show that oxygen therapy significantly increases survival, while clinical data on the use of different oxygen therapy protocols are ambiguous. Oxygen therapy, especially hyperbaric oxygenation, in patients with sepsis can aggravate existing oxidative stress and contribute to the development of disseminated intravascular coagulation. The purpose of this article is to compare experimental and clinical data on oxygen therapy in animals and humans, to discuss factors that can influence the results of oxygen therapy for sepsis treatment in humans, and to provide some recommendations for reducing oxidative stress and preventing disseminated intravascular coagulation during oxygen therapy.

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OPTIMAL PAO2 IS 130-160 MMHG IN THE FIRST WEEK FOR SEPSIS PATIENTS IN ICU: A RETROSPECTIVE COHORT STUDY BASED ON MIMIC-IV DATABASE
Haoran Chen, Xinyi Tang, Xiaomin Li, Yongpeng Xie
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Sequential respiratory support in septic patients undergoing continuous renal replacement therapy: A study based on MIMIC-III database
Chunxia Wang, Jianli Zheng, Yilin Zhao, Tiantian Liu, Yucai Zhang
Heliyon.2024; 10(6): e27563. CrossRef
Hyperbaric Oxygenation: Can It Be a Novel Supportive Method in Acute Kidney Injury? Data Obtained from Experimental Studies
Sanjin Kovacevic, Nikola Mitovic, Predrag Brkic, Milan Ivanov, Maja Zivotic, Zoran Miloradovic, Jelena Nesovic Ostojic
Cells.2024; 13(13): 1119. CrossRef
Hyperoxia in Sepsis and Septic Shock: A Comprehensive Review of Clinical Evidence and Therapeutic Implications
Sharayu Paunikar, Vivek Chakole
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Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS?
Florian Blanchard, Arthur James, Mona Assefi, Natacha Kapandji, Jean-Michel Constantin
Expert Review of Respiratory Medicine.2023; 17(1): 41. CrossRef
Current data regarding homeostasis of tissues oxygenation in pathophysiological and therapeutic circumstances
Constantin Munteanu, Mihaela Antonina Călin, Dragoș Manea, Cristina Popescu, Mădălina Iliescu, Elena Valentina Ionescu, Liliana Stanciu, Mihaela Minea, Carmen Oprea, Doinița Oprea, Mariana Rotariu, Gelu Onose
Balneo and PRM Research Journal.2023; 14(Vol.14, no): 565. CrossRef
Current data regarding homeostasis of tissues oxygenation in pathophysiological and therapeutic circumstances
Constantin Munteanu, Mihaela Antonina Călin, Dragoș Manea, Cristina Popescu, Mădălina Iliescu, Elena Valentina Ionescu, Liliana Stanciu, Mihaela Minea, Carmen Oprea, Doinița Oprea, Mariana Rotariu, Gelu Onose
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Basic science and research
Review of remimazolam and sedatives in the intensive care unit: Hey-Ran Choi, In-Ae Song; Acute Crit Care. 2022;37(2):151-158. Published online May 30, 2022; DOI: https://doi.org/10.4266/acc.2022.00619

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Abstract PDF

Remimazolam is a novel intravenous ultra-short acting benzodiazepine that has the potential of being a safe and effective new sedative for use in intensive care unit (ICU) settings. Because remimazolam metabolizes rapidly by being hydrolyzed to an inactive metabolite (CNS 7054) through non-specific tissue esterase activity, specific dosing adjustment for older adults and for patients with renal or hepatic impairment patients (except for those with severe hepatic impairment) is not required. In addition, research has shown that remimazolam may be reversed by administration of flumazenil, as its half time was sufficiently short compared to flumazenil. It shows a lower incidence of cardiorespiratory depression, less injection pain, and no fatal complications such as propofol infusion syndrome and malignant hyperthermia of inhalational anesthetics. Future studies to study the suitability of remimazolam for managing the sedation of ICU patients who need sedation for a long time over several days is required.

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Con: Remimazolam: The New Miracle Cure for Critically Ill Patients
Rayssa Becerra Orjuela, Juan G. Ripoll
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Optimizing Pediatric Sedation: Evaluating Remimazolam and Dexmedetomidine for Safety and Efficacy in Clinical Practice
Vera Scheckenbach, Frank Fideler
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The degree of respiratory depression according to the effect-site concentration in remimazolam target-controlled infusion
Soo Jung Park, Sang Kee Min, Gyubin Choi, Ji Eun Kim, Ha Yeon Kim
European Journal of Anaesthesiology.2024; 41(10): 728. CrossRef
“The Psychiatric Domain of Post-Intensive Care Syndrome: A Review for the Intensivist”
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Remimazolam Anesthesia for a Pediatric Patient With Glutaric Aciduria Type I: A Case Report
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Minati Choudhury, Poonam Malhotra Kapoor
Journal of Cardiac Critical Care TSS.2023; 7: 133. CrossRef
Safety and efficacy of remimazolam tosilate combined with low-dose fentanyl for procedural sedation in obese patients undergoing gastroscopy: study protocol for a single-centre, double-blind, randomised controlled trial
Lijuan Yan, Xiao Wang, Zhenyi Chen, Ningning Wu, Hao Li, Bin Yang
BMJ Open.2023; 13(12): e079095. CrossRef
Remimazolam: An Updated Review of a New Sedative and Anaesthetic
Qinxue Hu, Xing Liu, Chengli Wen, Duo Li, Xianying Lei
Drug Design, Development and Therapy.2022; Volume 16: 3957. 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
Salud, Ciencia y Tecnología.2022; 2: 234. CrossRef

Original Articles

Pulmonary
Association of pulmonary arterial pressure with volume status in patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: Tae Hwa Hong, Hyoung Soo Kim, Sunghoon Park; Acute Crit Care. 2022;37(2):159-167. Published online March 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00927

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Abstract PDF Supplementary Material: Background
Data on pulmonary hemodynamic parameters in patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) are scarce.
Methods
The associations between pulmonary artery catheter parameters for the first 7 days of ECMO, fluid balance, and hospital mortality were investigated in adult patients (aged ≥19 years) who received venovenous ECMO for refractory ARDS between 2015 and 2017.
Results
Twenty patients were finally included in the analysis (median age, 56.0 years; interquartile range, 45.5–68.0 years; female, n=10). A total of 140 values were collected for each parameter (i.e., 7 days×20 patients). Net fluid balance was weakly but significantly correlated with systolic and diastolic pulmonary arterial pressures (PAPs; r=0.233 and P=0.011; r=0.376 and P<0.001, respectively). Among the mechanical ventilation parameters, above positive end-expiratory pressure was correlated with systolic PAP (r=0.191 and P=0.025), and static compliance was negatively correlated with diastolic PAP (r=−0.169 and P=0.048). Non-survivors had significantly higher systolic PAPs than in survivors. However, in multivariate analysis, there was no significant association between mean systolic PAP and hospital mortality (odds ratio, 1.500; 95% confidence interval, 0.937–2.404; P=0.091).
Conclusions
Systolic PAP was weakly but significantly correlated with net fluid balance during the early ECMO period in patients with refractory ARDS receiving ECMO.

Infection
Comparison of critically ill COVID-19 and influenza patients with acute respiratory failure: Mehmet Yildirim, Burcin Halacli, Mehmet Yasir Pektezel, Berrin Er, Ismail Tuna Geldigitti, Gulay Tok, Ebru Ortac Ersoy, Arzu Topeli; Acute Crit Care. 2022;37(2):168-176. Published online March 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00920

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Abstract PDF

Background
Coronavirus disease 2019 (COVID-19) is one of the biggest pandemic causing acute respiratory failure (ARF) in the last century. Seasonal influenza carries high mortality, as well. The aim of this study was to compare features and outcomes of critically-ill COVID-19 and influenza patients with ARF.
Methods
Patients with COVID-19 and influenza admitted to intensive care unit with ARF were retrospectively analyzed.
Results
Fifty-four COVID-19 and 55 influenza patients with ARF were studied. Patients with COVID-19 had 32% of hospital mortality, while those with influenza had 47% (P=0.09). Patients with influenza had higher Eastern Cooperative Oncology Group, Clinical Frailty Scale, Acute Physiology and Chronic Health Evaluation II and admission Sequential Organ Failure Assessment (SOFA) scores than COVID-19 patients (P<0.01). Secondary bacterial infection, admission acute kidney injury, procalcitonin level above 0.2 ng/ml were the independent factors distinguishing influenza from COVID-19 while prone positioning differentiated COVID-19 from influenza. Invasive mechanical ventilation (odds ratio [OR], 42.16; 95% confidence interval [CI], 9.45–187.97), admission SOFA score more than 4 (OR, 5.92; 95% CI, 1.85–18.92), malignancy (OR, 4.95; 95% CI, 1.13–21.60), and age more than 65 years (OR, 3.31; 95% CI, 0.99–11.03) were found to be independent risk factors for hospital mortality.
Conclusions
There were few differences in clinical features of critically-ill COVID-19 and influenza patients. Influenza cases had worse performance status and disease severity. There was no significant difference in hospital mortality rates between COVID-19 and influenza patients.

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Narrative review of factors associated with SARS-CoV-2 coinfection in Middle Eastern countries and the need to vaccinate against preventable diseases
Majid Alshamrani, Fayssal Farahat, Ali Albarrak, Aiman El-Saed, Atef M. Shibl, Ziad A. Memish, Mostafa Mousa, Hammam Haridy, Abdulhakeem Althaqafi
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Association between PaO2/(FiO2*PEEP) ratio and in-hospital mortality in COVID-19 patients: A reanalysis of published data from Peru using PaO2/(FiO2*PEEP) ratio in place of PaO2/FaO2 ratio
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Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis
Chiu-Ying Hsiao, Heng-Chih Pan, Vin-Cent Wu, Ching-Chun Su, Tzu-Hsuan Yeh, Min-Hsiang Chuang, Kuan-Chieh Tu, Hsien-Yi Wang, Wei-Chih Kan, Chun-Chi Yang, Jui-Yi Chen
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Comparison of Clinical Features and Outcomes between SARS-CoV-2 and Non-SARS-CoV-2 Respiratory Viruses Associated Acute Respiratory Distress Syndrome: Retrospective Analysis
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Pulmonary
The role of nafamostat mesilate as a regional anticoagulant during extracorporeal membrane oxygenation: Jae Ha Lee, Jin Han Park, Ji Hoon Jang, Se Hun Kim, Sung Yong Hong, Woon Heo, Dong-Hwan Lee, Hye Sook Choi, Ki Hoon Kim, Hang-Jea Jang; Acute Crit Care. 2022;37(2):177-184. Published online April 20, 2022; DOI: https://doi.org/10.4266/acc.2021.01312

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Abstract PDF

Background
Anticoagulation during extracorporeal membrane oxygenation (ECMO) usually is required to prevent thrombosis. The aim of this study was to investigate the usefulness of nafamostat mesilate (NM) as a regional anticoagulant during veno-arterial ECMO (VA-ECMO) treatment.
Methods
We retrospectively reviewed the medical records of 16 patients receiving VA-ECMO and NM from January 2017 to June 2020 at Haeundae Paik Hospital. We compared clinical and laboratory data, including activated partial thromboplastin time (aPTT), which was measured simultaneously in patients and the ECMO site, to estimate the efficacy of regional anticoagulation.
Results
The median patient age was 68.5 years, and 56.3% of patients were men. Cardiovascular disease was the most common primary disease (75.0%) requiring ECMO treatment, followed by respiratory disease (12.5%). The median duration of ECMO treatment was 7.5 days. Among 16 patients, seven were switched to NM after first using heparin as an anticoagulation agent, and nine received only NM. When comparing aPTT values in the NM group between patients and the ECMO site, that in patients was significantly lower than that at the ECMO site (73.57 vs. 79.25 seconds; P=0.010); in contrast, no difference was observed in the heparin group.
Conclusions
NM showed efficacy as a regional anticoagulation method by sustaining a lower aPTT value compared to that measured at the ECMO site. NM should be considered as a safer regional anticoagulation method in VA-ECMO for patients at high risk of bleeding.

Citations

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Catheter diameter and infection control are important in neonatal continuous kidney replacement therapy: a single-center retrospective study
Hiroki Otsuka, Masaya Kibe, Chie Ishihara, Takuya Tokuhisa
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Anticoagulation with Nafamostat Mesilate During Impella Support: A Case Report
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Comparison of regional citrate anticoagulation and nafamostat mesylate anticoagulation during plasma exchange for children at high bleeding risk: a retrospective study
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Anticoagulation in Chronic Kidney Disease
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Anticoagulation and associated complications in veno-arterial extracorporeal membrane oxygenation in adult patients: A systematic review and meta-analysis
Ruan Vlok, Hergen Buscher, Anthony Delaney, Tessa Garside, Gabrielle McDonald, Richard Chatoor, John Myburgh, Priya Nair
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Anticoagulants in adult extracorporeal membrane oxygenation: alternatives to standardized anticoagulation with unfractionated heparin
Shu Tang, Liqing Xu, Hui Li, Zhanshen Wu, Qiang Wen
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Nephrology
Measured versus estimated creatinine clearance in critically ill patients with acute kidney injury: an observational study: Sara Kadivarian, Fatemeh Heydarpour, Hasanali Karimpour, Foroud Shahbazi; Acute Crit Care. 2022;37(2):185-192. Published online April 22, 2022; DOI: https://doi.org/10.4266/acc.2021.01256

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Abstract PDF

Background
Acute kidney injury (AKI) commonly occurs in critically ill patients. Estimation of renal function and antibiotics dose adjustment in patients with AKI is a challenging issue.
Methods
Urinary creatinine clearance was measured in a 6-hour urine collection from patients with acute kidney injuries. The correlations between different formulas including the modified Cockcroft-Gault, modification of diet in renal disease, chronic kidney disease-epidemiology collaboration, Jelliffe, kinetic-glomerular filtration rate (GFR), Brater, and Chiou formulas were considered. The pattern of the prescribed antimicrobial agents was also compared with the patterns in the available resources.
Results
Ninety-five patients with acute kidney injuries were included in the research. The mean age of the participants was 63.11±17.58 years old. The most patients (77.89%) were in stage 1 of AKI according to the Acute Kidney Injury Network criteria, followed by stage 2 (14.73%) and stage 3 (7.36), respectively. None of the formulations had a high or very high correlation with the measured creatinine clearance. In stage 1, Chiou (r=0.26), and in stage 2 and 3, kinetic-GFR (r=0.76 and r=0.37) had the highest correlation coefficient. Antibiotic over- and under-dosing were frequently observed in the study.
Conclusions
The results showed that none of the static methods can predict the measured creatinine clearance in the critically ill patients. The dynamic methods such as kinetic-GFR can be helpful for patients who do not receive diuretics and vasopressors. Further studies are needed to confirm our results.

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Association between phase angle and daily creatinine excretion changes in critically ill patients: an approach to muscle mass
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Acta Anaesthesiologica Scandinavica.2023; 67(2): 213. CrossRef
Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma
Kangho Lee, Dongyeon Ryu, Hohyun Kim, Sungjin Park, Sangbong Lee, Chanik Park, Gilhwan Kim, Sunhyun Kim, Nahyeon Lee
Acute and Critical Care.2023; 38(1): 95. CrossRef

Infection
Incidence and risk factors associated with early death in patients with emergency department septic shock: Matthew S. Reaven, Nigel L. Rozario, Maggie S. J. McCarter, Alan C. Heffner; Acute Crit Care. 2022;37(2):193-201. Published online February 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00857

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Abstract PDF

Background
Limited research has explored early mortality among patients presenting with septic shock. The objective of this study was to determine the incidence and factors associated with early death following emergency department (ED) presentation of septic shock.
Methods
A prospective registry of patients enrolled in an ED septic shock clinical pathway was used to identify patients. Patients were compared across demographic, comorbid, clinical, and treatment variables by death within 72 hours of ED presentation.
Results
Among the sample of 2,414 patients, overall hospital mortality was 20.6%. Among patients who died in the hospital, mean and median time from ED presentation to death were 4.96 days and 2.28 days, respectively. Death at 24, 48, and 72 hours occurred in 5.5%, 9.5%, and 11.5% of patients, respectively. Multivariate regression analysis demonstrated that the following factors were independently associated with early mortality: age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03–1.05), malignancy (OR, 1.53; 95% CI, 1.11–2.11), pneumonia (OR, 1.39; 95% CI, 1.02–1.88), urinary tract infection (OR, 0.63; 95% CI, 0.44–0.89), first shock index (OR, 1.85; 95% CI, 1.27–2.70), early vasopressor use (OR, 2.16; 95% CI, 1.60–2.92), initial international normalized ratio (OR, 1.14; 95% CI, 1.07–1.27), initial albumin (OR, 0.55; 95% CI, 0.44–0.69), and first serum lactate (OR, 1.21; 95% CI, 1.16–1.26).
Conclusions
Adult septic shock patients experience a high rate of early mortality within 72 hours of ED arrival. Recognizable clinical factors may aid the identification of patients at risk of early death.

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Nursing
The effect of time management education on critical care nurses’ prioritization: a randomized clinical trial: Fatemeh Vizeshfar, Mahnaz Rakhshan, Fatemeh Shirazi, Roya Dokoohaki; Acute Crit Care. 2022;37(2):202-208. Published online April 28, 2022; DOI: https://doi.org/10.4266/acc.2021.01123

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Abstract PDF

Background
Nurses are at the forefront of patient care, and time management skills can increase their ability to make decisions faster. This study aimed to assess the effect of a time management workshop on prioritization and time management skills among nurses of emergency and intensive care units.
Methods
This randomized clinical trial was performed with 215 nurses. The educational intervention about time management was held in the form of a workshop for the intervention group. The time management questionnaire was completed by both groups before, immediately after, and 3 months after the intervention.
Results
Most participants were female (n=191, 88%), with a mean age of 31.82 years (range, 22–63 years). Additionally, the participants’ work experience ranged from 1 to 30 years (mean±standard deviation, 8.00±7.15 years). After the intervention, the mean score of time management increased significantly in the intervention group, but no significant difference was observed in this regard in the control group. The results also revealed a significant difference between the intervention and control groups regarding the mean score of time management 3 months after the intervention (P<0.001).
Conclusions
Time management training helped nurses adjust the time required to perform and prioritize various tasks.

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Juby Mary Chacko, Achamma Varghese, Nirmala Rajesh
IP Journal of Paediatrics and Nursing Science.2023; 6(1): 48. CrossRef
Perceived clinical competence and predictive role of time management in nursing students
Maryam Behdarvand, Mehrnaz Ahmadi, Nasrin Khajeali
Nurse Education in Practice.2023; 72: 103789. CrossRef
Examining the impact of time management and resilience training on work-family conflict among Iranian female nurses: a randomized controlled trial
Sedigheh Peykar, Hakimeh Vahedparast, Tayebeh Gharibi, Razieh Bagherzadeh
BMC Nursing.2023;[Epub] CrossRef

Epidemiology
Hearing screening outcomes in pediatric critical care survivors: a 1-year report: Pattita Suwannatrai, Chanapai Chaiyakulsil; Acute Crit Care. 2022;37(2):209-216. Published online March 8, 2022; DOI: https://doi.org/10.4266/acc.2021.00899

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Background
Hearing loss is a potentially serious complication that can occur after surviving a critical illness. Study on screening for hearing problems in pediatric critical care survivors beyond the neonatal period is lacking. This study aimed to identify the prevalence of abnormal hearing screening outcomes using transitory evoked otoacoustic emission (TEOAE) screening in children who survived critical illness and to find possible associating factors for abnormal hearing screening results.
Methods
This study was a single-center, prospective, observational study. All children underwent otoscopy to exclude external and middle ear abnormalities before undergoing TEOAE screening. The screening was conducted before hospital discharge. Descriptive statistics, chi-square, and logistic regression tests were used for data analysis.
Results
A total of 92 children were enrolled. Abnormal TEOAE responses were identified in 26 participants (28.3%). Children with abnormal responses were significantly younger than those with normal responses with a median age of 10.0 months and 43.5 months, respectively (P<0.001). Positive association with abnormal responses was found in children younger than 12 months of age (adjusted odds ratio [OR], 3.07; 95% confidence interval [CI], 1.06–8.90) and children with underlying genetic conditions (adjusted OR, 6.95; 95% CI, 1.49–32.54).
Conclusions
Our study demonstrates a high prevalence of abnormal TEOAE screening responses in children surviving critical illness, especially in patients younger than 12 months of age. More extensive studies should be performed to identify the prevalence and associated risk factors of hearing problems in critically ill children.

Citations

Citations to this article as recorded by

Hearing loss assessment by pure tone audiometry amongst the survivors of intensive care unit: A prospective observational cohort study
Sai Saran, Abhishek Bahadur Singh, Avinash Agrawal, Saumitra Misra, Suhail Sarwar Siddiqui, Ayush Lohiya, Prabhaker Misra
Journal of Critical Care.2025; 87: 155042. CrossRef
Physiological and electrophysiological evaluation of the hearing system in low birth weight neonates treated with cholestin: a cohort study
Nastaran Khosravi, Malihah Mazaheryazdi, Majid Kalani, Nasrin Khalesi, Zinat Shakeri, Saeedeh Archang, Maryam Archang
The Egyptian Journal of Otolaryngology.2023;[Epub] CrossRef

Epidemiology
Early postoperative arrhythmias after pediatric congenital heart disease surgery: a 5-year audit from a lower- to middle-income country: Sidra Ishaque, Saleem Akhtar, Asma Akbar Ladak, Russell Seth Martins, Muhammad Kamran Younis Memon, Alisha Raza Kazmi, Fatima Mahmood, Anwar ul Haque; Acute Crit Care. 2022;37(2):217-223. Published online February 3, 2022; DOI: https://doi.org/10.4266/acc.2020.00990

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Abstract PDF

Background
Arrhythmias are known complication after surgery for congenital heart disease (CHD). This study aimed to identify and discuss their immediate prevalence, diagnosis and management at a tertiary care hospital in Pakistan.
Methods
A retrospective study was conducted at a tertiary care hospital in Pakistan between January 2014 and December 2018. All pediatric (<18 years old) patients admitted to the intensive care unit and undergoing continuous electrocardiographic monitoring after surgery for CHD were included in this study. Data pertaining to the incidence, diagnosis, and management of postoperative arrhythmias were collected.
Results
Amongst 812 children who underwent surgery for CHD, 185 (22.8%) developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia, observed in 120 patients (64.9%), followed by complete heart block (CHB) in 33 patients (17.8%). The highest incidence of early postoperative arrhythmia was seen in patients with atrioventricular septal defects (64.3%) and transposition of the great arteries (36.4%). Patients were managed according to the Pediatric Advanced Life Support guidelines. JET resolved successfully within 24 hours in 92% of patients, while 16 (48%) patients with CHB required a permanent pacemaker.
Conclusions
More than one in five pediatric patients suffered from early postoperative arrhythmias in our setting. Further research exploring predictive factors and the development of better management protocols of patients with CHB are essential for reducing the morbidity and mortality associated with postoperative arrhythmia.

Citations

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Enhancing postoperative arrhythmia diagnosis: An observational study of atrial ECG recording techniques
Matija Bakoš, Dražen Belina, Toni Matić, Tomo Svaguša
Journal of Electrocardiology.2025; 89: 153895. CrossRef
Prevalence and risk factors analysis of early postoperative arrhythmia after congenital heart surgery in pediatric patients
Ketut Putu Yasa, Arinda Agung Katritama, I. Komang Adhi Parama Harta, I. Wayan Sudarma
Journal of Arrhythmia.2024; 40(2): 356. CrossRef
Surgery for congenital heart disease in Pakistan—the challenges and solutions
Mahim Akmal Malik, Asad Saulat Fatimi, Alizeh Sonia Fatimi, Shirin Gul Suhail, Abdul Malik Sheikh
Indian Journal of Thoracic and Cardiovascular Surgery.2024;[Epub] CrossRef
Computer-Based Simulation for Pediatric Cardiovascular Disease Management: A Policy Brief
Arezoo Abasi, Haleh Ayatollahi
Global Pediatric Health.2024;[Epub] CrossRef
Improvements in Accuracy and Confidence in Rhythm Identification After Cardiac Surgery Using the AtriAmp Signals
Diane H. Brown, Xiao Zhang, Awni M. Al-Subu, Nicholas H. Von Bergen
Journal of Intensive Care Medicine.2023; 38(9): 809. CrossRef

Epidemiology
Determining the diagnostic value of tracheal intubation by palpation and auscultation methods compared to the chest X-ray method in children: Gholamreza Masoumi, Mojtaba Mansouri, Omid Fathali; Acute Crit Care. 2022;37(2):224-229. Published online February 3, 2022; DOI: https://doi.org/10.4266/acc.2021.00787

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Abstract PDF: Background
It is important to determine the proper location of tracheal tube for proper ventilation. In this study, we compared the diagnostic value of tracheal intubation with two methods of palpation and auscultation with chest X-ray (CXR) method in pediatric.
Methods
In this interventional study, 80 patients under 6 years of age were included. After tracheal intubation appropriate depth of tracheal tube was determined by auscultation and recorded, then by palpation depth of tracheal tube determined and tube was fixed. The length of the tube was calculated with the standard formula based on age. After surgery, CXR was taken and, according to the landmark, the distance from the end of the tube to the anterior lower tooth was recorded.
Results
Interclass correlation coefficient (ICC) between the palpation method and the standard method in the number of fixing tracheal intubation was 0.573, which shows the average and significant correlation between these two methods in determining the fixed number of tracheal intubation. ICC between the auscultation and the standard method in fixing tracheal intubation number was 0.430, which shows the average and significant agreement between these two methods in determining the fixed number of tracheal intubation. There is no significant relationship between sex and the average number of fixing tracheal intubation in all methods.
Conclusions
This study has shown that both palpation and auscultation methods are appropriate, but with a slightly higher palpation ICC, the palpation can be considered relatively better.

Pulmonary
Cinematic virtual reality for anxiety management in mechanically ventilated patients: a feasibility and pilot study: Alexander C. Haley, David A. Wacker; Acute Crit Care. 2022;37(2):230-236. Published online February 4, 2022; DOI: https://doi.org/10.4266/acc.2021.00843

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Abstract PDF

Background
Mechanically ventilated patients experience anxiety for many reasons. Pharmacological treatments such as benzodiazepines are commonly employed to manage anxiety; however, these therapies often cause undesired side effects. Additional therapies for anxiety management are needed. We sought to determine whether cell phone-based virtual reality therapy could feasibly be used for anxiety management in mechanically ventilated patients.
Methods
Mechanically ventilated subjects underwent at least one session of virtual reality therapy in which they were shown a cinematic video of an outdoor green space or blue space with 360° visual range of motion. Goal session duration was 5 minutes. The primary outcome was incidence of predefined patient safety events, including self-extubation and accidental removal of tubes or lines.
Results
Ten subjects underwent a total of 18 virtual reality sessions. Fifteen sessions lasted the planned 5 minutes, one session was extended at participant request, and two sessions were terminated early at participant request. There were no occurrences of the predefined safety events, and no occurrences of cybersickness. Use of a visual analog scale to measure anxiety level was feasible for this pilot study, demonstrating feasibility of this scale for future, larger scale studies.
Conclusions
Virtual reality therapy shows potential as a means of managing anxiety in patients undergoing mechanical ventilation, and further rigorous exploration with this protocol is feasible.

Citations

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Extended reality in anesthesia: a narrative review
Sung Hee Han, Kristen L Kiroff, Sakura Kinjo
Korean Journal of Anesthesiology.2025; 78(2): 105. CrossRef
Effects of Virtual Reality Meditation on Sleep and Delirium in ICU Patients
Soogyeong Kim, Jiyeon Kang
CIN: Computers, Informatics, Nursing.2025;[Epub] CrossRef
Opportunities for Managing Pain and Anxiety in the Intensive Care Unit Using Virtual Reality: Perspectives from Bedside Care Providers
Isabella P. Garito, Samantha Lewis-Fung, Brenna Lawson, Hannah Gabrielle Gray, Christopher Smith, Lora Appel
Journal of Medical Extended Reality.2024; 1(1): 53. CrossRef
Immersive Virtual Reality Use in Medical Intensive Care: Mixed Methods Feasibility Study
Brian W Locke, Te-yi Tsai, C Mahony Reategui-Rivera, Aileen S Gabriel, Aref Smiley, Joseph Finkelstein
JMIR Serious Games.2024; 12: e62842. CrossRef
Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial
Hannah Gabrielle Gray, Danielle Tchao, Samantha Lewis-Fung, Susanna Pardini, Laurence R Harris, Lora Appel
JMIR Research Protocols.2023; 12: e41523. CrossRef
Virtual and augmented reality in intensive care medicine: a systematic review
Dominika Kanschik, Raphael Romano Bruno, Georg Wolff, Malte Kelm, Christian Jung
Annals of Intensive Care.2023;[Epub] CrossRef
A study to assess the communication and level of anxiety among mechanically ventilated conscious patients in intensive care units of sree mookambika medical college hospital at kanyakumari district
Derlin A. Ahisha, Retnam C. Ajitha
i-manager's Journal on Nursing.2023; 13(2): 20. CrossRef

Ethics
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 Crit Care. 2022;37(2):237-246. Published online February 24, 2022; DOI: https://doi.org/10.4266/acc.2021.01095

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Abstract PDF Supplementary Material

Background
The Life-Sustaining Treatment (LST) Decisions Act allows withholding and withdrawal of LST, including cardiopulmonary resuscitation (CPR). In the present study, the incidence of CPR before and after implementation of the Act was compared.
Methods
This was a retrospective review involving hospitalized patients who underwent CPR at a single center between February 2016 and January 2020 (pre-implementation period, February 2016 to January 2018; post-implementation period, February 2018 to January 2020). The primary outcome was monthly incidence of CPR per 1,000 admissions. The secondary outcomes were duration of CPR, return of spontaneous circulation (ROSC) rate, 24-hour survival rate, and survival-to-discharge rate. The study outcomes were compared before and after implementation of the Act.
Results
A total of 867 patients who underwent CPR was included in the analysis. The incidence of CPR per 1,000 admissions showed no significant difference before and after implementation of the Act (3.02±0.68 vs. 2.81±0.75, P=0.255). The ROSC rate (67.20±0.11 vs. 70.99±0.12, P=0.008) and survival to discharge rate (20.24±0.09 vs. 22.40±0.12, P=0.029) were higher after implementation of the Act than before implementation.
Conclusions
The incidence of CPR did not significantly change for 2 years after implementation of the Act. Further studies are needed to assess the changes in trends in the decisions of CPR and other LSTs in real-world practice.

Citations

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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
For the Universal Right to Access Quality End-of-Life Care in Korea: Broadening Our Perspective After the 2018 Life-Sustaining Treatment Decisions Act
Hye Yoon Park, Min Sun Kim, Shin Hye Yoo, Jung Lee, In Gyu Song, So Yeon Jeon, Eun Kyung Choi
Journal of Korean Medical Science.2024;[Epub] CrossRef
Changes in Pediatric End-of-Life Process After the Enforcement of the Act on Life-Sustaining Treatment Decisions—The Experience of a Single Children’s Hospital
Da-Eun Roh, Jung-Eun Kwon, Young-Tae Lim, Yeo-Hyang Kim
Healthcare.2024; 12(21): 2156. 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
Will implementation of the Life-sustaining Treatment Decisions Act reduce the incidence of cardiopulmonary resuscitation?
In-Ae Song
Acute and Critical Care.2022; 37(2): 256. CrossRef
Effect of life-sustaining treatment decision law on pediatric in-hospital cardiopulmonary resuscitation rate: A Korean population-based study
Jaeyoung Choi, Ah Young Choi, Esther Park, Meong Hi Son, Joongbum Cho
Resuscitation.2022; 180: 38. CrossRef

Trauma
Determination of risk factors associated with surgical site infection in patients undergoing preperitoneal pelvic packing for unstable pelvic fracture: Kang Min Kim, Myoung Jun Kim, Jae Sik Chung, Ji Wool Ko, Young Un Choi, Hongjin Shim, Ji Young Jang, Keum Seok Bae, Kwangmin Kim; Acute Crit Care. 2022;37(2):247-255. Published online April 22, 2022; DOI: https://doi.org/10.4266/acc.2021.01396

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Abstract PDF

Background
Several recent studies have shown that preperitoneal pelvic packing (PPP) effectively produces hemostasis in patients with unstable pelvic fractures. However, few studies have examined the rate of surgical site infections (SSIs) in patients undergoing PPP following an unstable pelvic fracture. The purpose of the present study was to evaluate factors associated with SSI in such patients.
Methods
We retrospectively reviewed the medical charts of 188 patients who developed hemorrhagic shock due to pelvic fracture between April 2012 and May 2021. Forty-four patients were enrolled in this study.
Results
SSI occurred in 15 of 44 patients (34.1%). The SSIs occurred more frequently in cases of repacking during the second-look surgery (0 vs. 4 [26.7%], P=0.010) and combined bladder-urethra injury (1 [3.4%] vs. 4 [26.7%], P=0.039). The incidence of SSIs was not significantly different between patients undergoing depacking within or after 48 hours (12 [41.4%] vs. 5 [33.3%], P=0.603). The mean time to diagnosis of SSI was 8.1±3.9 days from PPP. The most isolated organism was Staphylococcus epidermidis.
Conclusions
Repacking and combined bladder-urethra injury are potential risk factors for SSI in patients with unstable pelvic fracture. Close observation is recommended for up to 8 days in patients with these risk factors. Further, 48 hours after PPP, removing the packed gauze on cessation of bleeding and not performing repacking can help prevent SSI. Additional analyses are necessary with a larger number of patients with the potential risk factors identified in this study.

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Pelvic packing – status 2024
Axel Gänsslen, Tim Pohlemann, Jan Lindahl, Jan Erik Madsen
Archives of Orthopaedic and Trauma Surgery.2025;[Epub] CrossRef
Operatively treated high-energy blunt pelvic ring injuries and surgical site infections – A retrospective assessment based on a prospective registry
Elvin Gurbanov, Ulysse Coneys, Elisabeth Andereggen, Alexandre Ansorge, Vanessa Morello, Axel Gamulin
Injury.2025; 56(3): 112209. CrossRef
Angioembolization Has Similar Efficacy and Lower Total Charges than Preperitoneal Pelvic Packing in Patients with Pelvic Ring or Acetabulum Fractures
Aaron Singh, Travis Kotzur, Ezekial Koslosky, Rishi Gonuguntla, Lorenzo Canseco, David Momtaz, Ali Seifi, Case Martin
Journal of Orthopaedic Trauma.2024;[Epub] CrossRef
Factors Associated With Pelvic Infection After Pre-Peritoneal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures
Jennifer E. Baker, Husayn A. Ladhani, Caitlyn McCall, Chelsea R. Horwood, Nicole L. Werner, Barry Platnick, Clay Cothren Burlew
Surgical Infections.2024; 25(5): 399. CrossRef
Comparison of Conventional versus Modified Preperitoneal Pelvic Packing in Patients with Bleeding Pelvic Fractures: A Single-Center Retrospective Pilot Study
Sebeom Jeon, Byungchul Yu, Gil Jae Lee, Min A Lee, Jungnam Lee, Kang Kook Choi
Journal of Clinical Medicine.2024; 13(14): 4062. CrossRef
Current Management of Hemodynamically Unstable Patients with Pelvic Fracture
Kevin Harrell, Chelsea Horwood, Clay Cothren Burlew
Current Surgery Reports.2023; 11(4): 92. CrossRef
Open Fixation After Preperitoneal Pelvic Packing Is Associated With a High Surgical Site Infection Rate
Ye Joon Kim, Bryan L. Scott, Fredric M. Pieracci, Ernest E. Moore, Cyril Mauffrey, Joshua A. Parry
Journal of Orthopaedic Trauma.2023; 37(11): 547. CrossRef
Extraperitoneal pelvic packing in trauma – a review
Sajad Ahmad Salati
Polish Journal of Surgery.2022; 95(3): 46. CrossRef

Editorial

Ethics
Will implementation of the Life-sustaining Treatment Decisions Act reduce the incidence of cardiopulmonary resuscitation?: In-Ae Song; Acute Crit Care. 2022;37(2):256-257. Published online May 30, 2022; DOI: https://doi.org/10.4266/acc.2022.00668

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