Acute and Critical Care

Volume 37 (3); August 2022

Review Article

Neurology
Transient splenial lesions of the corpus callosum and infectious diseases: Kyu Sun Yum, Dong-Ick Shin; Acute Crit Care. 2022;37(3):269-275. Published online August 17, 2022; DOI: https://doi.org/10.4266/acc.2022.00864

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Transient splenial lesion of the corpus callosum can be observed in various diseases such as cancer, drug use, metabolic disorders, and cerebrovascular disorders, as well as in patients with infectious diseases. During the coronavirus disease 2019 (COVID-19) pandemic, there were increasing reports of these lesions being detected on brain imaging tests performed in patients with neurological symptoms. On brain magnetic resonance imaging, findings suggestive of cytotoxic edema are observed in the splenium; these are known to disappear with improvement of clinical symptoms. Cytokinopathy caused by infection increases the permeability of the blood–brain barrier and activates the glial cells of the brain to induce cytotoxic edema. Most patients have a good prognosis. The causes, mechanism, diagnosis, treatment and prognosis of transient splenial lesions of the corpus callosum will be summarized in this review.

Citations

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Case report: Re-evaluating reversibility of cytotoxic lesions of the corpus callosum
Victoria Vold, Stein-Helge Hansen Tingvoll, Mona K. Beyer, Kaja Nordengen
Frontiers in Neuroimaging.2025;[Epub] CrossRef
Reenvisioning Cytotoxic Lesions of Corpus Callosum in Light of Coronavirus Disease-2019: Review with Related Concepts
Udit Chauhan, Khanak K. Nandolia, Rahul Dev
Journal of Medical Evidence.2025; 6(2): 149. CrossRef
Tuberculous Meningitis in a Child: A Rare Presentation of Cytotoxic Lesion of the Corpus Callosum
Ny Thi Hong Tran, Nhung Thi Hong Nguyen, Uyen Phuong Vo, Julie Huynh
Tropical Medicine and Infectious Disease.2025; 10(4): 96. CrossRef
COVID‐19‐Associated Cytotoxic Lesions of the Corpus Callosum in Chinese Patients: A Retrospective Study
Chenyi Wan, Menghua Li, Yanyan Yu, Si Luo, Daojun Hong, Meihong Zhou, Yu Zhu
Brain and Behavior.2025;[Epub] CrossRef
A 10-year-old girl with meningitis retention syndrome and reversible splenial lesion: A case report
Chung-Hao Wang, Chi-Nan Huang, Pei-Wei Wang
Pediatrics & Neonatology.2024; 65(2): 204. CrossRef
Legionella‐induced dysarthria and rhabdomyolysis with acute renal failure achieving recovery
Husam El Sharu, Soban Ahmad, Hunter Coore
Clinical Case Reports.2024;[Epub] CrossRef
Rickettsial infection causing non-aneurysmal subarachnoid hemorrhage with transient corpus callosum lesion
Zahraa Noureddine El Moussaoui, Zahraa Saker, Hasan Rahhal, Ali Nasserdine, Mahmoud Younes
Journal of Medicine, Surgery, and Public Health.2024; 2: 100093. CrossRef
Cytotoxic lesions of the corpus callosum due to FOLFIRINOX chemotherapy
Mafalda Soares, Sara Rosa, Sofia Bettencourt, Rita Ferreira, Mariana Sardinha, Margarida Dias, Bruno Cunha
Brain Disorders.2024; 15: 100157. CrossRef
Contrasting association pattern of plasma low-density lipoprotein with white matter integrity in APOE4 carriers versus non-carriers
Zhenyao Ye, Yezhi Pan, Rozalina G. McCoy, Chuan Bi, Chen Mo, Li Feng, Jiaao Yu, Tong Lu, Song Liu, J. Carson Smith, Minxi Duan, Si Gao, Yizhou Ma, Chixiang Chen, Braxton D. Mitchell, Paul M. Thompson, L. Elliot Hong, Peter Kochunov, Tianzhou Ma, Shuo Chen
Neurobiology of Aging.2024; 143: 41. CrossRef

Original Articles

Neurology
Early assessment of aspiration risk in acute stroke by fiberoptic endoscopy in critically ill patients: Mohamed Saad Abdelaziz Elsyaad, Akram Muhammad Fayed, Mohamed Mostafa Abdel Salam Megahed, Nesrine Hazem Hamouda, Ahmed Moustafa Elmenshawy; Acute Crit Care. 2022;37(3):276-285. Published online June 27, 2022; DOI: https://doi.org/10.4266/acc.2021.01375

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Background
Fiberoptic endoscopic evaluation of swallowing (FEES) has been recommended to assess aspiration in stroke. This study aimed to determine the diagnostic and prognostic roles of FEES in the early assessment of aspiration, intensive care unit (ICU) stay and mortality in acute stroke patients.
Methods
Fifty-two patients with acute stroke admitted to the Alexandria Main University Hospital were included. Complete examinations and assessment of aspiration using the 8-point penetration-aspiration scale (PAS) with FEES protocol were performed.
Results
The patients were classified into three groups: normal with no or low risk of aspiration (n=15, 27.3%; PAS level 1), low to moderate risk (n=8, 14.5%; PAS level 2–4), and high risk (n=32, 58.2%; PAS ≥5). There was high incidence of aspiration pneumonia, prolonged ICU stay, and mortality in both moderate- and high-risk groups (P=0.001, P<0.001, and P<0.001, respectively). The PAS score predicted aspiration pneumonia (hospital-acquired pneumonia) with sensitivity and specificity of 80.0% and 76.0%, respectively (negative predictive value [NPV], 76.0; positive predictive value [PPV], 80.0; 95% confidence interval [CI], 0.706–0.940) and mortality with sensitivity and specificity of 88.46% and 68.97% (NPV, 87.0; PPV, 71.9; 95% CI, 0.749–0.951). The PAS score could predict the length of ICU stay with sensitivity and specificity of 70.21% and 87.50, respectively (NPV, 33.3; PPV, 97.1; 95% CI, 0.605–0.906).
Conclusions
The standard FEES protocol using PAS score is a useful tool to assess aspiration in acute stroke patients and could be used to predict length of ICU stay and mortality.

Citations

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Approach to Patients with Dysphagia: Clinical Insights
Min-Su Kim
Brain Sciences.2025; 15(5): 478. CrossRef
Aspiration Pneumonia
Di Pan, Samuel Chung, Erik Nielsen, Michael S. Niederman
Seminars in Respiratory and Critical Care Medicine.2024; 45(02): 237. CrossRef
Intensive care unit-acquired dysphagia – change in feeding route after a standardized dysphagia assessment in neurocritical care patients
Sarah Christina Reitz, Joanna Marly, Vanessa Neef, Jürgen Konczalla, Marcus Czabanka, Christian Grefkes-Hermann, Christian Foerch, Sriramya Lapa
Scientific Reports.2024;[Epub] CrossRef
The use of videofluoroscopy (VFS) and fibreoptic endoscopic evaluation of swallowing (FEES) in the investigation of oropharyngeal dysphagia in stroke patients: A narrative review
K. Helliwell, V.J. Hughes, C.M. Bennion, A. Manning-Stanley
Radiography.2023; 29(2): 284. CrossRef

Nursing
Improving mobility in the intensive care unit with a protocolized, early mobilization program: observations of a single center before-and-after the implementation of a multidisciplinary program: Laptin Ho, Joe Hin Cheung Tsang, Emmanuel Cheung, Wing Yan Chan, Ka Wai Lee, Sweetie R Lui, Chung Yau Lee, Alfred Lok Hang Lee, Philip Koon Ngai Lam; Acute Crit Care. 2022;37(3):286-294. Published online June 29, 2022; DOI: https://doi.org/10.4266/acc.2021.01564

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Background
Early intensive care unit (ICU) protocolized rehabilitative programs have been described previously, yet with differing starting time points and mostly on mechanically ventilated patients. We extended the concept to all admitted ICU patients and investigate the efficacy of early mobilization in improving mobility of the critically ill, address issues surrounding the timing and intensity of an early rehabilitative program.
Methods
Prospective cohorts of patients admitted consecutively before-and-after (control, n=92; intervention, n=90) the introduction of an early mobilization program in a single center, general hospital ICU. Improvement in mobility as assessed by ICU mobility score, on ICU admission and upon ICU discharge, was measured as a primary outcome.
Results
Those receiving early mobilization in the intensive care unit had higher ICU mobility score (2.63; 95% confidence interval, 0.65–4.61; P<0.001) upon discharge from the intensive care, with earlier out of bed mobilization on day 5 compared to the control group of day 21 (P<0.001). No differences were found in terms of mortality, intensive care hospitalization and subsequent hospitalization duration after discharge from ICU.
Conclusions
Here, we report that improvement in mobility score earlier in the course of intensive care hospitalization with the introduction of a protocolized early rehabilitative program.

Citations

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Accelerating Postoperative Recovery: The Impact of Early Mobility Protocols in Surgical Intensive Care Unit (SICU) Patients After Open Cholecystectomy
Binu Xavier, Sasi Vaithilingan, Latha R
Cureus.2025;[Epub] CrossRef
Early mobilization and its impact on recovery in ICU patients with severe COVID-19: A randomized controlled trial
J Saravankumar, Rathna Paramaswamy, Buvanesh Annadurai, Iswarya S, Santhana Lakshmi S S, Surya Vishnuram, Jeslin G N, Shenbaga Sundaram Subramanian, Senthilkumar N
Fizjoterapia Polska.2024; 24(4): 222. CrossRef
Early Active Mobilization during Mechanical Ventilation in the ICU

New England Journal of Medicine.2023; 388(6): 572. CrossRef
Yoğun Bakım Hastası İçin Erken Mobilizasyonun Önemi
Ebubekir Kaplan, Aylin Aktaş Özakgül, Özkan Sir
Sakarya Üniversitesi Holistik Sağlık Dergisi.2023; 6(3): 510. CrossRef

Neurology
Muscle Growth and Anabolism in Intensive Care Survivors (GAINS) trial: a pilot randomised controlled trial: Matthew H Anstey, Rashmi Rauniyar, Ethan Fitzclarence, Natalie Tran, Emma Osnain, Bianca Mammana, Angela Jacques, Robert N Palmer, Andrew Chapman, Bradley Wibrow; Acute Crit Care. 2022;37(3):295-302. Published online June 27, 2022; DOI: https://doi.org/10.4266/acc.2021.01767

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Background
To explore the feasibility, safety, and potential benefits of administration of the anabolic steroid nandrolone to patients in the recovery phase from critical illness weakness.
Methods
In this phase II, double blind, randomized, controlled trial, adult critically ill patients admitted to one of two tertiary Intensive Care Units in Western Australia for longer than 7 days with significant weakness were enrolled. Patients received nandrolone (200 mg males, 100 mg females) intramuscularly or placebo weekly for up to 3 weeks in addition to standard care. The primary outcome measures were improvement in grip strength, Medical Research Council muscle strength sum score, and functional activity level (Chelsea critical care assessment tool [CPAx]).
Results
A total of 22 patients was enrolled between September 2017 and May 2019. No significant adverse events were detected. Median grip strength change was non-significantly greater in the nandrolone group (8.5 vs. 13.0, P=0.185), while hospital length of stay (36 vs. 26 days, P=0.023) and duration of mechanical ventilation (377 vs. 168, P=0.032) were lower. The discharge CPAx and intensive care unit mobility scores were higher in the nandrolone group, although there was no difference in the change in CPAx score (17.0 vs. 17.7, P=0.865). There were no changes in ultrasound-detected muscle thickness between the two groups.
Conclusions
In patients with prolonged critical illness, nandrolone appears to be safe. However, a larger study, potentially combined with resistance exercise, is needed to definitively address the potential benefits of nandrolone.

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High vs low protein intake in chronic critical illness: A systematic review and meta-analysis
Sílvia Castro, A. Tomé, C. Granja, A. Macedo, A. Binnie
Clinical Nutrition ESPEN.2025; 65: 249. CrossRef
Muscle growth and anabolism in intensive care survivors (GAINS 2.0): Protocol for a multi-centre randomised; placebo controlled clinical trial of nandrolone in deconditioned adults recovering from critical illness
Matthew Anstey, Ed Litton, Maryam Habibi, Lisa Van der Lee, Robert Palmer, Natalie Tran, Bianca Mammana, Stacey Scheepers, Annamaria Palermo, Xavier Fiorilla, Bhaumik Mevavala, Adrian Regli, Angela Jacques, Bradley Wibrow, Francesco Sessa
PLOS ONE.2025; 20(2): e0315170. CrossRef

Infection
In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19: Yong Sub Na, Jin Hyoung Kim, Moon Seong Baek, Won-Young Kim, Ae-Rin Baek, Bo young Lee, Gil Myeong Seong, Song-I Lee; Acute Crit Care. 2022;37(3):303-311. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00017

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Abstract PDF

Background
Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly.
Methods
This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Republic of Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis.
Results
The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis.
Conclusions
The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.

Citations

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Quadriceps Muscle Layer Thickness and its association with frailty in critically ill patients: A prospective observational study
Vijay Sundarsingh, R. Manoj Kumar, Manjunath Kulkarni, Debasis Pradhan, Pramela Renisha Rodrigues, Nishanth Baliga, Mamata Prasad, Pooja Yadav, Monish Thomas, Tania Eltrida Pinto
Journal of Critical Care.2025; 85: 154930. CrossRef
Prevalence of New Frailty at Hospital Discharge in Severe COVID-19 Survivors and Its Associated Factors
Jong Hwan Jeong, Manbong Heo, Sunghoon Park, Su Hwan Lee, Onyu Park, Taehwa Kim, Hye Ju Yeo, Jin Ho Jang, Woo Hyun Cho, Jung-Wan Yoo
Tuberculosis and Respiratory Diseases.2025; 88(2): 361. CrossRef
Biological age and clinical frailty scale measured at intensive care unit admission as predictors of hospital mortality among the critically ill in Western Australia: a retrospective cohort study
Nicholas Phillip Anthony, Kwok Ming Ho
Acute and Critical Care.2025; 40(2): 264. CrossRef
Navigating the nexus between senior tourism and healthy aging: a post-neoliberal perspective
Yangyang Jiang, Guohong Yu
Asia Pacific Journal of Marketing and Logistics.2025;[Epub] CrossRef
Risk factors for progressing to critical illness in patients with hospital-acquired COVID-19
Kyung-Eui Lee, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
The Korean Journal of Internal Medicine.2024; 39(3): 477. CrossRef
Omicron, Long-COVID, and the Safety of Elective Surgery for Adults and Children: Joint Guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services
Philip S. Barie, Mary E. Brindle, Rachel G. Khadaroo, Tara L. Klassen, Jared M. Huston
Surgical Infections.2023; 24(1): 6. CrossRef
Evaluation of risk scores as predictors of mortality and hospital length of stay for older COVID‐19 patients
Banu Buyukaydin, Tahsin Karaaslan, Omer Uysal
AGING MEDICINE.2023; 6(1): 56. CrossRef
Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes
Joy E. van Son, Elisabeth C. P. Kahn, Jessica M. van der Bol, Dennis G. Barten, Laura C. Blomaard, Carmen van Dam, Jacobien Ellerbroek, Steffy W. M. Jansen, Anita Lekx, Carolien M. J. van der Linden, Roy Looman, Huub A. A. M. Maas, Francesco U. S. Mattace
European Geriatric Medicine.2023;[Epub] CrossRef
Neurological Manifestations and Complications of the Central Nervous System as Risk Factors and Predictors of Mortality in Patients Hospitalized with COVID-19: A Cohort Study
Ana Luisa Corona-Nakamura, Martha Judith Arias-Merino, Rayo Morfín-Otero, Guillermo Rodriguez-Zavala, Alfredo León-Gil, Juan Ramsés Camarillo-Escalera, Idarmis Brisseida Reyes-Cortés, María Gisela Valdovinos-Ortega, Erick René Nava-Escobar, Ana María de l
Journal of Clinical Medicine.2023; 12(12): 4065. CrossRef
Modified Early Warning Score: Clinical Deterioration of Mexican Patients Hospitalized with COVID-19 and Chronic Disease
Nicolás Santiago González, María de Lourdes García-Hernández, Patricia Cruz-Bello, Lorena Chaparro-Díaz, María de Lourdes Rico-González, Yolanda Hernández-Ortega
Healthcare.2023; 11(19): 2654. CrossRef
Risk Factors and Predictive Model for Mortality of Hospitalized COVID-19 Elderly Patients from a Tertiary Care Hospital in Thailand
Mallika Chuansangeam, Bunyarat Srithan, Pattharawin Pattharanitima, Pawit Phadungsaksawasdi
Medicines.2023; 10(11): 59. CrossRef

Infection
Risk factors associated with development of coinfection in critically Ill patients with COVID-19: Erica M. Orsini, Gretchen L. Sacha, Xiaozhen Han, Xiaofeng Wang, Abhijit Duggal, Prabalini Rajendram; Acute Crit Care. 2022;37(3):312-321. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00136

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Abstract PDF

Background
At outset of the coronavirus disease 2019 (COVID-19) pandemic, the significance of bacterial and fungal coinfections in individuals with COVID-19 was unknown. Initial reports indicated that the prevalence of coinfection in the general population was low, but there was uncertainty regarding the risk of coinfection in critically ill patients.
Methods
Nine hundred critically ill adult patients with COVID-19 infection were enrolled in this observational case-control study. Patients with a coinfection (case) and patients without a coinfection (control) were compared using univariate and multivariable analyses. A subgroup analysis was performed on patients with coinfection, dividing them into early (infection within 7 days) and late (infection after 7 days) infection groups.
Results
Two hundred and thirty-three patients (25.9%) had a bacterial or fungal coinfection. Vasopressor use (P<0.001) and severity of illness (higher Acute Physiology and Chronic Health Evaluation III score, P=0.009) were risk factors for the development of a coinfection. Patients with coinfection had higher mortality and length of stay. Vasopressor and corticosteroid use and central line and foley catheter placement were risk factors for late infection (>7 days). There were high rates of drug-resistant infections.
Conclusions
Critically ill patients with COVID-19 are at risk for both community-acquired and hospital-acquired infections throughout their hospitalization for COVID-19. It is important to consider the development of a coinfection in clinically worsening critically ill patients with COVID-19 and consider the likelihood of drug-resistance when choosing an empiric regimen.

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The subsets of blood circulating T-cells associated with the development and prognosis of coinfection in patients with critical COVID-19
Xingming Li, Hongqiong Peng, Yunchuan Wang, Shiying He, Xueting Yang, Jiayue Chen
Frontiers in Immunology.2025;[Epub] CrossRef
Prevalence and risk factors associated with multidrug-resistant bacteria in COVID-19 patients
Abdu Aldarhami, Ahmed A. Punjabi, Abdulrahman S. Bazaid, Naif K. Binsaleh, Omar W. Althomali, Subuhi Sherwani, Omar Hafiz, Ali A. Almishaal
Medicine.2024; 103(10): e37389. CrossRef
Prevalence of secondary infections and association with mortality rates of hospitalized COVID-19 patients
Khalifa Binkhamis, Alanoud S. Alhaider, Ayah K. Sayed, Yara K. Almufleh, Ghadah A. Alarify, Norah Y. Alawlah
Annals of Saudi Medicine.2023; 43(4): 243. CrossRef
Blood Stream Infections in COVID-19 Patients From a Tertiary Care Center in Lebanon: Causative Pathogens and Rates of Multi-Drug Resistant Organisms
Sarah B. Nahhal, Johnny Zakhour, Abdel Hadi Shmoury, Tedy Sawma, Sara F. Haddad, Tamara Abdallah, Nada Kara Zahreddine, Joseph Tannous, Nisrine Haddad, Nesrine Rizk, Souha S. Kanj
Mayo Clinic Proceedings: Innovations, Quality & Outcomes.2023; 7(6): 556. CrossRef

Pulmonary
Effect of prone positioning on gas exchange according to lung morphology in patients with acute respiratory distress syndrome: Na Young Kim, Si Mong Yoon, Jimyung Park, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee; Acute Crit Care. 2022;37(3):322-331. Published online July 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00367

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Background
There are limited data on the clinical effects of prone positioning according to lung morphology. We aimed to determine whether the gas exchange response to prone positioning differs according to lung morphology.
Methods
This retrospective study included adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS). The lung morphology of ARDS was assessed by chest computed tomography scan and classified as “diffuse” or “focal.” The primary outcome was change in partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio after the first prone positioning session: first, using the entire cohort, and second, using subgroups of patients with diffuse ARDS matched 2 to 1 with patients with focal ARDS at baseline.
Results
Ninety-five patients were included (focal ARDS group, 23; diffuse ARDS group, 72). Before prone positioning, the focal ARDS group showed worse oxygenation than the diffuse ARDS group (median PaO2/FiO2 ratio, 79.9 mm Hg [interquartile range (IQR)], 67.7–112.6 vs. 104.0 mm Hg [IQR, 77.6–135.7]; P=0.042). During prone positioning, the focal ARDS group showed a greater improvement in the PaO2/FiO2 ratio than the diffuse ARDS group (median, 55.8 mm Hg [IQR, 11.1–109.2] vs. 42.8 mm Hg [IQR, 11.6–83.2]); however, the difference was not significant (P=0.705). Among the PaO2/FiO2-matched cohort, there was no significant difference in change in PaO2/FiO2 ratio after prone positioning between the groups (P=0.904).
Conclusions
In patients with moderate-to-severe ARDS, changes in PaO2/FiO2 ratio after prone positioning did not differ according to lung morphology. Therefore, prone positioning can be considered as soon as indicated, regardless of ARDS lung morphology.

Citations

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Subphenotypes of Acute Respiratory Distress Syndrome: Advancing Towards Precision Medicine
Andrea R. Levine, Carolyn S. Calfee
Tuberculosis and Respiratory Diseases.2024; 87(1): 1. CrossRef

Meta-analysis
Association of nutrition risk screening 2002 and Malnutrition Universal Screening Tool with COVID-19 severity in hospitalized patients in Iran: Ghazaleh Eslamian, Sohrab Sali, Mansour Babaei, Karim Parastouei, Dorsa Arman Moghadam; Acute Crit Care. 2022;37(3):332-338. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2021.01830

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Abstract PDF

Background
Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran.
Methods
In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity.
Results
In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21–2.56; P=0.021).
Conclusions
Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.

Citations

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Computational methods for studying relationship between nutritional status and respiratory viral diseases: a systematic review
Zakir Hussain, Malaya Dutta Borah, Rezaul Karim Ahmed
Artificial Intelligence Review.2024;[Epub] CrossRef
A Novel Facet of In-Hospital Food Consumption Associated with Hospital Mortality in Patients with Scheduled Admission—Addition of a Study Protocol to Test the Existence of Effects of COVID-19 in the Same Study in the Post-COVID-19 Period
Hiroyo Miyata, Ayako Tsunou, Yoko Hokotachi, Teruyoshi Amagai
Nutrients.2024; 16(14): 2327. CrossRef
Predictive value of multiple variable models including nutritional risk score (NRS 2002) on mortality and length of stay of patients with covid-19 infections. The INCOVO study
Ghadamieh Fatemeh, Ginette Fotsing, Pedro Marques-Vidal, Peter Kopp, Mohammed Barigou
Clinical Nutrition ESPEN.2023; 55: 357. CrossRef

Epidemiology
The fourth wave: vaccination status and intensive care unit mortality at a large hospital system in New York City: Pranai Tandon, Evan Leibner, Anna Hackett, Katherine Maguire, Kayla Leonardi, Matthew A. Levin, Roopa Kohli-Seth; Acute Crit Care. 2022;37(3):339-346. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00675

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Background
We aim to describe the demographics and outcomes of patients with severe disease with the Omicron variant. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus continues to mutate, and the availability of vaccines and boosters continue to rise, it is important to understand the health care burden of new variants. We analyze patients admitted to intensive care units (ICUs) in a large Academic Health System during New York City’s fourth surge beginning on November 27, 2021.
Methods
All patients admitted to an ICU were included in the primary analysis. Key demographics and outcomes were retrospectively compared between patients stratified by vaccination status. Univariate and multivariate logistic regression was used to identify risk factors for in-hospital mortality.
Results
In-hospital mortality for all admitted patients during the fourth wave was significantly lower than in previous waves. However, among patients requiring intensive care, in-hospital mortality was high across all levels of vaccination status. In a multivariate model older age was associated with increased in-hospital mortality, vaccination status of overdue for booster was associated with decreased in hospital mortality, and vaccination status of up-to-date with vaccination showed a trend to reduced mortality.
Conclusions
In-hospital mortality of patients with severe respiratory failure from coronavirus disease 2019 (COVID-19) remains high despite decreasing overall mortality. Vaccination against SARS-CoV-2 was protective against mortality. Vaccination remains the best and safest way to protect against serious illness and death from COVID-19. It remains unclear that any other treatment will have success in changing the natural history of the disease.

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Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey
Tobias Lahmer, Jon Salmanton-García, Francesco Marchesi, Shaimaa El-Ashwah, Marcio Nucci, Caroline Besson, Federico Itri, Ozren Jaksic, Natasha Čolović, Barbora Weinbergerová, Guldane Cengiz Seval, Tatjana Adžić-Vukičević, Tomáš Szotkowski, Uluhan Sili, M
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Clinical outcomes of immunomodulation therapy in immunocompromised patients with severe Covid-19 and high oxygen requirement
Avigayil Goldstein, Ami Neuberger, Yazeed Qassem Darawsha, Khetam Hussein, Tali Shafat, Daniel Grupel, Jacob strahilevitz, Sarah Israel, Ariel Weil, Ronen Ben-Ami, Meital Elbaz, Ronza Najjar-Debbiny, Jihad Bishara, Amir Shlomai, Michal Landes
Scientific Reports.2024;[Epub] CrossRef
Outcomes of Elderly Patients Hospitalized with the SARS-CoV-2 Omicron B.1.1.529 Variant: A Systematic Review
Roxana Manuela Fericean, Cristian Oancea, Akash Reddy Reddyreddy, Ovidiu Rosca, Felix Bratosin, Vlad Bloanca, Cosmin Citu, Satish Alambaram, Neeharika Gayatri Vasamsetti, Catalin Dumitru
International Journal of Environmental Research and Public Health.2023; 20(3): 2150. CrossRef

Pulmonary
The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience: Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry; Acute Crit Care. 2022;37(3):347-354. Published online July 25, 2022; DOI: https://doi.org/10.4266/acc.2022.00108

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Background
Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied.
Methods
In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment.
Results
The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes.
Conclusions
During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.

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Point-of-Care Ultrasound, an Integral Role in the Future of Enhanced Recovery After Surgery?
Peter Van de Putte, An Wallyn, Rosemary Hogg, Lars Knudsen, Kariem El-Boghdadly
Anesthesia & Analgesia.2025; 140(5): 1114. CrossRef
A Muscle-Driven Spine Model for Predictive Simulations in the Design of Spinal Implants and Lumbar Orthoses
Robin Remus, Andreas Lipphaus, Marisa Ritter, Marc Neumann, Beate Bender
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Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care
Marta Rafael Marques, José Manuel Pereira, José Artur Paiva, Gonzalo García de Casasola‐Sánchez, Yale Tung‐Chen
Journal of Ultrasound in Medicine.2024; 43(2): 223. CrossRef
Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis
Diego Poddighe, Marine Van Hollebeke, Yasir Qaiser Choudhary, Débora Ribeiro Campos, Michele R. Schaeffer, Jan Y. Verbakel, Greet Hermans, Rik Gosselink, Daniel Langer
Critical Care.2024;[Epub] CrossRef
Ultrasonographic evaluation of diaphragm thickness and excursion: correlation with weaning success in trauma patients: prospective cohort study
Golnar Sabetian, Mandana Mackie, Naeimehossadat Asmarian, Mahsa Banifatemi, Gregory A. Schmidt, Mansoor Masjedi, Shahram Paydar, Farid Zand
Journal of Anesthesia.2024; 38(3): 354. CrossRef
Diaphragm muscle parameters as a predictive tool for weaning critically ill patients from mechanical ventilation: a systematic review and meta-analysis study
Yashar Iran Pour, Afrooz Zandifar
European Journal of Translational Myology.2024;[Epub] CrossRef
Diaphragm dysfunction as a prognostic criterion of external respiratory impairment and necessary extracorporeal membrane oxygenation in patients with chronic heart failure
V.S. Shabaev, V.A. Mazurok, L.Z. Biktasheva, L.G. Vasilyeva, K.Yu. Kozhieva, I.A. Danilova, N.A. Osipova
Russian Journal of Anesthesiology and Reanimatology.2024; (6): 38. CrossRef
Diaphragmatic ultrasound: A new frontier in weaning from mechanical ventilation
Manoj Kamal, Saikat Sengupta
Indian Journal of Anaesthesia.2023; 67(Suppl 4): S205. CrossRef

Liver
Early mechanical ventilation for grade IV hepatic encephalopathy is associated with increased mortality among patients with cirrhosis: an exploratory study: Saad Saffo, Guadalupe Garcia-Tsao; Acute Crit Care. 2022;37(3):355-362. Published online August 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00528

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Background
Unresponsive patients with toxic-metabolic encephalopathies often undergo endotracheal intubation for the primary purpose of preventing aspiration events. However, among patients with pre-existing systemic comorbidities, mechanical ventilation itself may be associated with numerous risks such as hypotension, aspiration, delirium, and infection. Our primary aim was to determine whether early mechanical ventilation for airway protection was associated with increased mortality in patients with cirrhosis and grade IV hepatic encephalopathy.
Methods
The National Inpatient Sample was queried for hospital stays due to grade IV hepatic encephalopathy among patients with cirrhosis between 2016 and 2019. After applying our exclusion criteria, including cardiopulmonary failure, data from 1,975 inpatient stays were analyzed. Patients who received mechanical ventilation within 2 days of admission were compared to those who did not. Univariable and multivariable logistic regression analyses were performed to identify clinical factors associated with in-hospital mortality.
Results
Of 162 patients who received endotracheal intubation during the first 2 hospital days, 64 (40%) died during their hospitalization, in comparison to 336 (19%) of 1,813 patients in the comparator group. In multivariable logistic regression analysis, mechanical ventilation was the strongest predictor of in-hospital mortality in our primary analysis (adjusted odds ratio, 3.00; 95% confidence interval, 2.14–4.20; P<0.001) and in all sensitivity analyses.
Conclusions
Mechanical ventilation for the sole purpose of airway protection among patients with cirrhosis and grade IV hepatic encephalopathy may be associated with increased in-hospital mortality. Future studies are necessary to confirm and further characterize our findings.

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Development and validation of a nomogram for predicting in-hospital mortality of intensive care unit patients with liver cirrhosis
Xiao-Wei Tang, Wen-Sen Ren, Shu Huang, Kang Zou, Huan Xu, Xiao-Min Shi, Wei Zhang, Lei Shi, Mu-Han Lü
World Journal of Hepatology.2024; 16(4): 625. CrossRef
Review article: Evaluation and care of the critically ill patient with cirrhosis
Iva Kosuta, Madhumita Premkumar, K. Rajender Reddy
Alimentary Pharmacology & Therapeutics.2024; 59(12): 1489. CrossRef
Using machine learning methods to predict 28-day mortality in patients with hepatic encephalopathy
Zhe Zhang, Jian Wang, Wei Han, Li Zhao
BMC Gastroenterology.2023;[Epub] CrossRef
Experience in Non-invasive Ventilation in Grade 3 Hepatic Encephalopathy
İlhan Ocak, Mustafa Çolak, Erdem Kınacı
Istanbul Medical Journal.2023; 24(3): 295. CrossRef

Infection
Ability of a modified Sequential Organ Failure Assessment score to predict mortality among sepsis patients in a resource-limited setting: Bodin Khwannimit, Rungsun Bhurayanontachai, Veerapong Vattanavanit; Acute Crit Care. 2022;37(3):363-371. Published online August 4, 2022; DOI: https://doi.org/10.4266/acc.2021.01627

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Background
Some variables of the Sequential Organ Failure Assessment (SOFA) score are not routinely measured in sepsis patients, especially in countries with limited resources. Therefore, this study was conducted to evaluate the accuracy of the modified SOFA (mSOFA) and compared its ability to predict mortality in sepsis patients to that of the original SOFA score.
Methods
Sepsis patients admitted to the medical intensive care unit of Songklanagarind Hospital between 2011 and 2018 were retrospectively analyzed. The primary outcome was all-cause in-hospital mortality.
Results
A total of 1,522 sepsis patients were enrolled. The mean SOFA and mSOFA scores were 9.7±4.3 and 8.8±3.9, respectively. The discrimination of the mSOFA score was significantly higher than that of the SOFA score for all-cause in-hospital mortality (area under the receiver operating characteristic curve, 0.891 [95% confidence interval, 0.875–0.907] vs. 0.879 [0.862–0.896]; P<0.001), all-cause intensive care unit (ICU) mortality (0.880 [0.863–0.898] vs. 0.871 [0.853–0.889], P=0.01) and all-cause 28-day mortality (0.887 [0.871–0.904] vs. 0.874 [0.856–0.892], P<0.001). The ability of mSOFA score to predict all-cause in-hospital and 28-day mortality was higher than that of the SOFA score within the subgroups of sepsis according to age, sepsis severity and serum lactate levels. The mSOFA score was demonstrated to have a performance similar to the original SOFA score regarding the prediction of mortality in sepsis patients with cirrhosis or hepatic dysfunction.
Conclusions
The mSOFA score was a good alternative to the original SOFA core in predicting mortality among sepsis patients admitted to the ICU.

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SOFA in sepsis: with or without GCS
Lu Wang, Xudong Ma, Guanghua Zhou, Sifa Gao, Wei Pan, Jieqing Chen, Longxiang Su, Huaiwu He, Yun Long, Zhi Yin, Ting Shu, Xiang Zhou, Yongjun Liu, Yan Kang, Jing Yan, Erzhen Chen, Bin Xiong, Bingyu Qin, Kejian Qian, Wei Fang, Mingyan Zhao, Xiaochun Ma, Xi
European Journal of Medical Research.2024;[Epub] CrossRef
Effects of prior antiplatelet and/or nonsteroidal anti-inflammatory drug use on mortality in patients undergoing abdominal surgery for abdominal sepsis
Se Hun Kim, Ki Hoon Kim
Surgery.2023; 174(3): 611. CrossRef

Epidemiology
Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit: Song-I Lee, Younsuck Koh, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim; Acute Crit Care. 2022;37(3):372-381. Published online August 4, 2022; DOI: https://doi.org/10.4266/acc.2022.00066

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Background
Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.
Methods
We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis.
Results
Comparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.
Conclusions
The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.

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Clinical characteristics and outcome of very old (≥90 years) critically ill patients with need for intensive care after surgical intervention
Jöran Lücke, Franziska Stallbaum, Rikus Daniels, Pauline Theile, Jakob Izbicki, Anastasios D. Giannou, Stefan Wolter, Anna Duprée, Oliver Mann, Jakob Müller, Stefan Kluge, Matthias Reeh, Kevin Roedl
Frontiers in Medicine.2025;[Epub] CrossRef
Chronicles of change for the future: The imperative of continued data collection in French ICUs
Takashi Tagami
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We need a comprehensive intensive care unit management strategy for older patients
Dong-Ick Shin
Acute and Critical Care.2022; 37(3): 468. CrossRef

Meta-analysis
Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study: Heemoon Park, Sung Yoon Lim, Sebin Kim, Hyung-Sook Kim, Soyeon Kim, Ho Il Yoon, Young-Jae Cho; Acute Crit Care. 2022;37(3):382-390. Published online July 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00220

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Background
Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes.
Methods
This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22).
Results
In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044).
Conclusions
The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.

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Effect of nutrition support team on 28-day mortality in Korean patients with acute respiratory failure
Inhan Lee, Junghyun Kim, Mihyun Ku, Yurim Choi, Sohyun Park, Jihyeon Bang, Joohae Kim
Acute and Critical Care.2025; 40(2): 313. CrossRef
Nutritional support for patients with abdominal surgical pathology: the view of a surgeon and an anesthesiologist — opponents or allies?
Natalya P. Shen, Svetlana Yu. Mukhacheva
Clinical nutrition and metabolism.2023; 3(4): 181. CrossRef
Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study
Chan-Hee Park, Hak-Jae Lee, Suk-Kyung Hong, Yang-Hee Jun, Jeong-Woo Lee, Nak-Jun Choi, Kyu-Hyouck Kyoung
Annals of Clinical Nutrition and Metabolism.2022; 14(2): 66. CrossRef

Cardiology
The incidence of phlebitis development of high concentration of continuous amiodarone infusion with in-line filter compared to the low concentration without in-line filter: a retrospective propensity score-matched analysis: Sirichai Cheewatanakornkul, Piyanai Vattanaprasan, Supattra Uppanisakorn, Rungsun Bhurayanontachai; Acute Crit Care. 2022;37(3):391-397. Published online August 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00080

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Background
Phlebitis-associated peripheral infusion of intravenous amiodarone is common in clinical practice, with an incidence between 5% and 65%. Several factors, including drug concentration, catheter size, and in-line filter used, are significantly associated with phlebitis occurrence. We performed a retrospective propensity score-matched analysis to find out whether in-line filter will reduce the incidence of amiodarone-induced phlebitis (AIP) in high concentration of amiodarone infusion compared to low concentration without in-line filter.
Methods
Clinical records of all patients who required intravenous amiodarone infusion for cardiac arrhythmias, between January 2017 to December 2019 were retrieved. The incidence of AIP was recorded and subsequently compared among high concentration (2 mg/ml) with an in-line filter and low concentration (1.5 mg/ml) infusion without an in-line filter after a 1 to 2 propensity score matched.
Results
The data indicated that among the 214 cases of amiodarone infusion collected, 28 cases used an in-line filter with high concentration while 186 cases received a low concentration of amiodarone infusion without an in-line filter. After 1:2 propensity score matching, the incidence of phlebitis in the high concentration with in-line filter group was significantly higher than the low concentration without in-line filter group (28.6% vs. 3.6%, P<0.01).
Conclusions
Despite the usage of in-line filter, the high concentration of amiodarone infusion resulted in a higher incidence of peripheral phlebitis. Central venous catheterization for a high concentration of amiodarone infusion is recommended.

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The Effect of Propolis Cream on Phlebitis and Catheter-Related Bloodstream Infections: A Double-Blinded Randomised Clinical Trial
Hassan Pakdaman, Ali Khodadadizadeh, Gholamreza Bazmandegan, Hadi Hasani, Majid Kazemi
Journal of Herbal Medicine.2024; 43: 100829. CrossRef

Nephrology
Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis: Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda, Shoki Yamauchi, Hideta Takushi, Tadashi Iraha, Koji Idomari; Acute Crit Care. 2022;37(3):398-406. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00192

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Background
Severe acute pancreatitis (SAP) is a systemic inflammatory disease, and it can often complicate into acute kidney injury (AKI) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). This study aimed to evaluate the clinical effectiveness of blood purification using a polymethylmethacrylate (PMMA) hemofilter.
Methods
We retrospectively examined 54 patients, who were diagnosed with SAP according to the Japanese criteria from January 2011 to December 2019.
Results
Of a total of 54 SAP patients, 26 patients progressively developed AKI and required continuous hemodialysis with a PMMA membrane hemofilter (PMMA-CHD). Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score were significantly higher in patients requiring PMMA-CHD than in patients not requiring hemodialysis. The lung injury scores were also significantly higher in patients requiring PMMA-CHD. Of the 26 patients, 16 patients developed ALI/ARDS and required mechanical ventilation. A total of seven patients developed severe ALI/ARDS and received additional intermittent hemodiafiltration using a PMMA hemofilter (PMMA-HDF). Although the length of intensive care unit stay was significantly longer in patients with severe ALI/ARDS, blood purification therapy was discontinued in all the patients. The survival rates at the time of discharge were 92.3% and 92.9% in patients with and without PMMA-CHD, respectively. These real mortality ratios were obviously lower than the estimated mortality ratios predicted by APACHE II scores.
Conclusions
These finding suggest that the blood purification using a PMMA hemofilter would be effective for the treatment of AKI and ALI/ARDS in SAP patients.

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Extracorporeal pediatric renal replacement therapy: diversifying application beyond kidney failure
Rahul Chanchlani, David Askenazi, Benan Bayrakci, Akash Deep, Jolyn Morgan, Tara M. Neumayr
Pediatric Nephrology.2025; 40(4): 923. CrossRef
Advances in Renal Replacement Therapy: The Role of Polymethyl Methacrylate Membranes in Acute Critically Ill Patients
Eleonora Balzani, Sergio Lassola, Hannah Wozniak, Giacomo Bellani, Silvia De Rosa
Blood Purification.2025; : 1. CrossRef
A Retrospective Study on the Start and End of Continuous Hemodialysis Using a Polymethylmethacrylate Hemofilter for Severe Acute Pancreatitis
Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda
Internal Medicine.2024; 63(16): 2241. CrossRef
Evaluation of the therapeutic efficiency and efficacy of blood purification in the treatment of severe acute pancreatitis
Hongwei Huang, Zhongshi Huang, Menghua Chen, Ken Okamoto, Chiara Lazzeri
PLOS ONE.2024; 19(1): e0296641. CrossRef
Enhancing Immune Protection in Hemodialysis Patients: Role of the Polymethyl Methacrylate Membrane
Rossana Franzin, Alessandra Stasi, Gianvito Caggiano, Elena Squiccimarro, Vincenzo Losappio, Marco Fiorentino, Carlo Alfieri, Giovanni Stallone, Loreto Gesualdo, Giuseppe Castellano
Blood Purification.2023; 52(Suppl. 1): 49. CrossRef

Neurology
The effects of hypomagnesemia on delirium in middle-aged and older adult patients admitted to medical intensive care units: Joong-Yub Kim, Hyo Jin Lee, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee, Tae Yun Park; Acute Crit Care. 2022;37(3):407-414. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00164

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Background
In critically ill patients, the most common manifestation of brain dysfunction is delirium, which is independently associated with higher morbidity and mortality. While electrolyte imbalance is one of the precipitating factors, the impact of hypomagnesemia on the incidence of delirium remains unknown.
Methods
We retrospectively analyzed patients admitted to the medical intensive care unit (ICU) of a tertiary referral center between January and June 2020. Patients with ICU stay ≥48 hours and aged 40–85 years were included. The primary outcome was cumulative incidence of delirium in the ICU. Patients were divided into two groups based on serum magnesium level at ICU admission. Multivariable Cox proportional hazards regression analysis was performed, and covariates were selected using the least absolute shrinkage and selection operator (LASSO) method.
Results
A total of 109 patients included 43 (39.4%) women and had a median age of 69.0 years (interquartile range [IQR], 60.0–76.0 years). The median magnesium level was 1.7 mg/dl (IQR, 1.5–1.9 mg/dl), and the cumulative incidence of delirium was 32.1% (35 patients). Hypomagnesemia was independently associated with delirium (adjusted hazard ratio [aHR], 2.12; 95% confidence interval [CI], 1.03–4.38), along with prior use of immunosuppressants (aHR, 3.08; 95% CI, 1.46–6.48) or benzodiazepines (aHR, 4.02; 95% CI, 1.54–10.50), body mass index (aHR, 0.93; 95% CI, 0.84–1.02), and alcohol history (aHR, 1.68; 95% CI, 0.74–3.80).
Conclusions
In critically ill adults, hypomagnesemia increases the risk of delirium by more than two-fold compared to patients with normal magnesium level.

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Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults
Suleyman Emre Kocyigit, Bilal Katipoglu
Acta Clinica Belgica.2024; 79(3): 160. CrossRef
Postoperative Delirium Following Posterior Lumbar Spinal Fusion: Epidemiology, Risk Factors, and Associated Complications
Ashley Knebel, Manjot Singh, Rhea Rasquinha, Mohammad Daher, Joseph E. Nassar, John Hanna, Bassel G. Diebo, Alan H. Daniels
World Neurosurgery.2024; 191: e753. CrossRef
Hypomagnesemia and incident delirium in hospitalized older persons
Virginia Boccardi, Sara Ercolani, Rocco Serra, Valentina Bubba, Alessandro Piccolo, Michela Scamosci, Alfredo Villa, Carmelinda Ruggiero, Patrizia Mecocci
Aging Clinical and Experimental Research.2023; 35(4): 847. CrossRef

Neurology
Cytokine profiles in intensive care unit delirium: Ryan J. Smith, Christian Lachner, Vijay P. Singh, Shubham Trivedi, Biswajit Khatua, Rodrigo Cartin-Ceba; Acute Crit Care. 2022;37(3):415-428. Published online June 20, 2022; DOI: https://doi.org/10.4266/acc.2021.01508

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Background
Neuroinflammation causing disruption of the blood-brain barrier and immune cell extravasation into the brain parenchyma may cause delirium; however, knowledge of the exact pathophysiologic mechanism remains incomplete. The purpose of our study was to determine whether cytokine profiles differ depending on whether delirium occurs in the setting of sepsis, coronavirus disease 2019 (COVID-19), or recent surgery.
Methods
This prospective observational cohort study involved 119 critically ill patients admitted to a multidisciplinary intensive care unit (ICU) during 2019 and 2020. Delirium was identified using the validated confusion assessment method for the ICU. Multiple delirium risk factors were collected daily including clinical characteristics, hospital course, lab values, vital signs, surgical exposure, drug exposure, and COVID-19 characteristics. Serums samples were collected within 12 hours of ICU admission and cytokine levels were measured.
Results
The following proinflammatory cytokines were elevated in our delirium population: tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-18, C-C motif ligand (CCL) 2, CCL3, C-X-C motif chemokine ligand (CXCL)1, CXCL10, IL-8, IL-1 receptor antagonist, and IL-10. Analysis of relative cytokine levels in those patients that developed delirium in the setting of sepsis, COVID-19, and recent surgery showed elevations of CCL2, CXCL10, and TNF-α in both the sepsis and COVID-19 group in comparison to the postsurgical population. In the postsurgical group, granulocyte colony-stimulating factor was elevated and CXCL10 was decreased relative to the opposing groups.
Conclusions
We identify several cytokines and precipitating factors known to be associated with delirium. However, our study suggests that the cytokine profile associated with delirium is variable and contingent upon delirium precipitating factors.

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Postoperative sepsis-associated neurocognitive disorder: mechanisms, predictive strategies, and treatment approaches
Zijing Gao, Zhenyu Xu
Frontiers in Medicine.2025;[Epub] CrossRef
Association of postoperative delirium with serum and cerebrospinal fluid proteomic profiles: a prospective cohort study in older hip fracture patients
Lucía Lozano-Vicario, Ángel Javier Muñoz-Vázquez, Robinson Ramírez-Vélez, Arkaitz Galbete-Jiménez, Joaquín Fernández-Irigoyen, Enrique Santamaría, Bernardo Abel Cedeno-Veloz, Fabricio Zambom-Ferraresi, Barbara C. Van Munster, José Ramón Ortiz-Gómez, Ángel
GeroScience.2024; 46(3): 3235. CrossRef
Association of peripheral B cells and delirium: combined single-cell sequencing and Mendelian randomization analysis
Siyou Tan, Sining Pan, Lai Wei, Wenyan Chen, Bingbing Pan, Gaoyin Kong, Jing Chen, Yubo Xie
Frontiers in Neurology.2024;[Epub] CrossRef
Delirium in the ICU: how much do we know? A narrative review
Si Bo Liu, Hong Yu Wu, Mei Li Duan, Rong Li Yang, Chen Hua Ji, Jin Jie Liu, Hongtao Zhao
Annals of Medicine.2024;[Epub] CrossRef
Brain injury biomarkers do not predict delirium in acutely ill older patients: a prospective cohort study
Júlio César Garcia de Alencar, Flávia Barreto Garcez, Agnes Araujo Sardinha Pinto, Lucas Oliveira Junqueira e Silva, Lucas de Moraes Soler, Shirley Steffany Muñoz Fernandez, Victor Van Vaisberg, Luz Marina Gomez Gomez, Sandra Maria Lima Ribeiro, Thiago Ju
Scientific Reports.2023;[Epub] CrossRef
Systemic interleukin-6 inhibition ameliorates acute neuropsychiatric phenotypes in a murine model of acute lung injury
Faizan Anwar, Nicklaus A. Sparrow, Mohammad Harun Rashid, Gena Guidry, Michael M. Gezalian, Eric J. Ley, Maya Koronyo-Hamaoui, Itai Danovitch, E. Wesley Ely, S. Ananth Karumanchi, Shouri Lahiri
Critical Care.2022;[Epub] CrossRef

Neurosurgery
Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma: Anukoon Kaewborisutsakul, Thara Tunthanathip; Acute Crit Care. 2022;37(3):429-437. Published online June 23, 2022; DOI: https://doi.org/10.4266/acc.2021.01795

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Abstract PDF

Background
A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.
Methods
In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King’s Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.
Results
The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0–42.9), Glasgow coma scale scores of 3–8 (OR, 8.2; 95% CI, 1.7–38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6–8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6–7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62–10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003–26.1) were also included.
Conclusions
SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

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Thara Tunthanathip, Nakornchai Phuenpathom, Apisorn Jongjit
The American Journal of Emergency Medicine.2024; 77: 194. CrossRef
Development of a Clinical Nomogram for Predicting Shunt-Dependent Hydrocephalus
Avika Trakulpanitkit, Thara Tunthanathip
Journal of Health and Allied Sciences NU.2024; 14(04): 516. CrossRef
Prediction performance of the machine learning model in predicting mortality risk in patients with traumatic brain injuries: a systematic review and meta-analysis
Jue Wang, Ming Jing Yin, Han Chun Wen
BMC Medical Informatics and Decision Making.2023;[Epub] CrossRef
Development and internal validation of a nomogram to predict massive blood transfusions in neurosurgical operations
Kanisorn Sungkaro, Chin Taweesomboonyat, Anukoon Kaewborisutsakul
Journal of Neurosciences in Rural Practice.2022; 13: 711. CrossRef
Prediction of massive transfusions in neurosurgical operations using machine learning
Chin Taweesomboonyat, Anukoon Kaewborisutsakul, Kanisorn Sungkaro
Asian Journal of Transfusion Science.2022;[Epub] CrossRef

CPR/Resuscitation
Cardiopulmonary resuscitation of infants at birth: predictable or unpredictable?: Mohammad Reza Zarkesh, Raheleh Moradi, Azam Orooji; Acute Crit Care. 2022;37(3):438-453. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2021.01501

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Background
Anticipating the need for at-birth cardiopulmonary resuscitation (CPR) in neonates is very important and complex. Timely identification and rapid CPR for neonates in the delivery room significantly reduce mortality and other neurological disabilities. The aim of this study was to create a prediction system for identifying the need for at-birth CPR in neonates based on Machine Learning (ML) algorithms.
Methods
In this study, 3,882 neonatal medical records were retrospectively reviewed. A total of 60 risk factors was extracted, and five ML algorithms of J48, Naïve Bayesian, multilayer perceptron, support vector machine (SVM), and random forest were compared to predict the need for at-birth CPR in neonates. Two types of resuscitation were considered: basic and advanced CPR. Using five feature selection algorithms, features were ranked based on importance, and important risk factors were identified using the ML algorithms.
Results
To predict the need for at-birth CPR in neonates, SVM using all risk factors reached 88.43% accuracy and F-measure of 88.4%, while J48 using only the four first important features reached 90.89% accuracy and F-measure of 90.9%. The most important risk factors were gestational age, delivery type, presentation, and mother’s addiction.
Conclusions
The proposed system can be useful in predicting the need for CPR in neonates in the delivery room.

Citations

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Anticipating the Need for Advanced Resuscitation in Newborns: A 10-Year Retrospective Case-Control Study
Maria Sousa Dias, Mariana Meneses, Monica Calado Araujo, Joana Moreno, Ana Azevedo, Sara Peixoto, Claudia Ferraz
Pediatric Oncall.2025;[Epub] CrossRef

Epidemiology
Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2: Eui Jun Lee, Bongjin Lee, You Sun Kim, Yu Hyeon Choi, Young Ho Kwak, June Dong Park; Acute Crit Care. 2022;37(3):454-461. Published online July 29, 2022; DOI: https://doi.org/10.4266/acc.2021.01480

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Abstract PDF

Background
Pediatric Index of Mortality 3 (PIM 3) and Pediatric Logistic Organ Dysfunction-2 (PELOD-2) are validated tools for predicting mortality in children. Research suggests that these tools may have different predictive performance depending on patient group characteristics. Therefore, we designed this study to identify the factors that make the mortality rates predicted by the tools different.
Methods
This retrospective study included patients (<18 years) who were admitted to a pediatric intensive care unit from July 2017 to May 2019. After defining the predicted mortality of PIM 3 minus the predicted mortality rate of PELOD-2 as “difference in mortality prediction,” the clinical characteristics significantly related to this were analyzed using multivariable regression analysis. Predictive performance was analyzed through the Hosmer-Lemeshow test and area under the receiver operating characteristic curve (AUROC).
Results
In total, 945 patients (median [interquartile range] age, 3.0 [0.0–8.0] years; girls, 44.7%) were analyzed. The Hosmer-Lemeshow test revealed AUROCs of 0.889 (χ2=10.187, P=0.313) and 0.731 (χ2=6.220, P=0.183) of PIM 3 and PELOD-2, respectively. Multivariable linear regression analysis revealed that oxygen saturation, partial pressure of CO2, base excess, platelet counts, and blood urea nitrogen levels were significant factors. Patient condition-related factors such as cardiac bypass surgery, seizures, cardiomyopathy or myocarditis, necrotizing enterocolitis, cardiac arrest, leukemia or lymphoma after the first induction, bone marrow transplantation, and liver failure were significantly related (P<0.001).
Conclusions
Both tools predicted observed mortality well; however, caution is needed in interpretation as they may show different prediction results in relation to specific clinical characteristics.

Citations

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Characteristics and outcomes in severe and critically ill children with first wave SARS-CoV-2 Omicron infection in Northeast China
Tingting Sun, Yunhan He, Zeyu Wang, Lijie Wang, Chunfeng Liu, Wei Xu, Kai You
Frontiers in Cellular and Infection Microbiology.2025;[Epub] CrossRef
COMPARISON OF PEDIATRIC INDEX OF MORTALITY (PIM)-3 AND PEDIATRIC SEQUENTIAL ORGAN FAILURE ASSESSMENT (pSOFA) SCORES TO PREDICT MORTALITY IN PEDIATRIC INTENSIVE CARE UNIT
ANKIT KUMAR PAWAR, GAURAV KUMAR PRAJAPATI, KANCHAN CHOUBEY, RASHMI RANDA
Asian Journal of Pharmaceutical and Clinical Research.2024; : 81. CrossRef

Trauma
C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury: Canan Gürsoy, Güven Gürsoy, Semra Gümüş Demirbilek; Acute Crit Care. 2022;37(3):462-467. Published online August 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00052

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Abstract PDF

Background
Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI.
Methods
Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively.
Results
The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR.
Conclusions
This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

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One-Year Mortality After Percutaneous Endoscopic Gastrostomy: The Prognostic Role of Nutritional Biomarkers and Care Settings
Nermin Mutlu Bilgiç, Güldan Kahveci, Ekmel Burak Özşenel, Sema Basat
Nutrients.2025; 17(5): 904. CrossRef
Elevation of C-reactive protein and homocysteine levels as reliable biomarkers for assessing injury severity and prognosis in traumatic brain injury
Zi-Yan Wang, Wei Du, Xian-Zhi Liu, Yuan Li, Jun Liu
Scientific Reports.2025;[Epub] CrossRef
Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury
Kathryn S. Gerber, Gemayaret Alvarez, Arsham Alamian, Victoria Behar-Zusman, Charles A. Downs
Journal of Trauma Nursing.2024; 31(2): 72. CrossRef
Association of C-reactive protein/albumin ratio with mortality in patients with Traumatic Brain Injury: A systematic review and meta-analysis
Yuyang Liu, Yaheng Tan, Jun Wan, Qiwen Chen, Yuxin Zheng, Wenhao Xu, Peng Wang, Weelic Chong, Xueying Yu, Yu Zhang
Heliyon.2024; 10(13): e33460. CrossRef

Editorial

Neurology
We need a comprehensive intensive care unit management strategy for older patients: Dong-Ick Shin; Acute Crit Care. 2022;37(3):468-469. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2022.01025

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The impact of instrumented lumbar fusion surgery on psychiatric problems in elderly patients with degenerative spinal stenosis: The observational study
Won Rak Choi, Sang Min Ahn, Seok Hyeon Kim, Keong Yoon Kim, Hee Jung Son, Chang-Nam Kang
Medicine.2024; 103(26): e38719. CrossRef
A comprehensive intensive care for senior citizens: the need for public health policy
Dalmacito A. Cordero Jr
Acute and Critical Care.2022; 37(4): 690. CrossRef

Case Report

Basic science and research
COVID-19–related acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation and programmed multi-level ventilation: a case report: Filip Depta, Anton Turčan, Pavol Török, Petra Kapraľová, Michael A. Gentile; Acute Crit Care. 2022;37(3):470-473. Published online January 21, 2022; DOI: https://doi.org/10.4266/acc.2021.01109

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Abstract PDF

We report a patient with severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) and programmed multi-level ventilation (PMLV). VV ECMO as a treatment modality for severe ARDS has been described multiple times as a rescue therapy for refractory hypoxemia. It is well known that conventional ventilation can cause ventilator-induced lung injury. Protective ventilation during VV ECMO seems to be beneficial, translating to using low tidal volumes, prone positioning with general concept of open lung approach. However, mechanical ventilation is still required as ECMO per se is usually not sufficient to maintain adequate gas exchange due to hyperdynamic state of the patient and limitation of blood flow via VV ECMO. This report describes ventilation strategy using PMLV during “resting” period of the lung. In short, PMLV is a strategy for ventilating non-homogenous lungs that incorporates expiratory time constants and multiple levels of positive end-expiratory pressure. Using this approach, most affected acute lung injury/ARDS areas can be recruited, while preventing overdistension in healthy areas. To our knowledge, case report using such ventilation strategy for lung resting period has not been previously published.

Citations

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Treatment of acute respiratory failure: extracorporeal membrane oxygenation
Jin-Young Kim, Sang-Bum Hong
Journal of the Korean Medical Association.2022; 65(3): 157. CrossRef

Image in critical care

Neurology
Contrast media mimicking subarachnoid hemorrhage after intrathecal injection in a patient with Creutzfeldt-Jakob disease: Taegyun Kim; Acute Crit Care. 2022;37(3):474-476. Published online August 17, 2022; DOI: https://doi.org/10.4266/acc.2022.00339; Correction in: Acute Crit Care 2022;37(4):693

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