Acute and Critical Care

Volume 37 (4); November 2022

Review Articles

Neurosurgery
Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention: Kwang Wook Jo; Acute Crit Care. 2022;37(4):483-490. Published online November 10, 2022; DOI: https://doi.org/10.4266/acc.2022.01291

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Traumatic brain injury (TBI) is a critical cause of disability and death worldwide. Many studies have been conducted aimed at achieving favorable neurologic outcomes by reducing secondary brain injury in TBI patients. However, ground-breaking outcomes are still insufficient so far. Because mild-to-moderate hypothermia (32°C–35°C) has been confirmed to help neurological recovery for recovered patients after circulatory arrest, it has been recognized as a major neuroprotective treatment plan for TBI patients. Thereafter, many clinical studies about the effect of therapeutic hypothermia (TH) on severe TBI have been conducted. However, efficacy and safety have not been demonstrated in many large-scale randomized controlled studies. Rather, some studies have demonstrated an increase in mortality rate due to complications such as pneumonia, so it is not highly recommended for severe TBI patients. Recently, some studies have shown results suggesting TH may help reperfusion/ischemic injury prevention after surgery in the case of mass lesions, such as acute subdural hematoma, and it has also been shown to be effective in intracranial pressure control. In conclusion, TH is still at the center of neuroprotective therapeutic studies regarding TBI. If proper measures can be taken to mitigate the many adverse events that may occur during the course of treatment, more positive efficacy can be confirmed. In this review, we look into adverse events that may occur during the process of the induction, maintenance, and rewarming of targeted temperature management and consider ways to prevent and address them.

Citations

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Blood pressure variability and functional outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction
Jae Wook Jung, Ilmo Kang, Jin Park, Sang‐Beom Jeon
European Journal of Neurology.2025;[Epub] CrossRef
State-of-the-art for automated machine learning predicts outcomes in poor-grade aneurysmal subarachnoid hemorrhage using routinely measured laboratory & radiological parameters: coagulation parameters and liver function as key prognosticators
Ali Haider Bangash, Jayro Toledo, Muhammed Amir Essibayi, Neil Haranhalli, Rafael De la Garza Ramos, David J. Altschul, Stavropoula Tjoumakaris, Reza Yassari, Robert M. Starke, Redi Rahmani
Neurosurgical Review.2025;[Epub] CrossRef
Trends and hotspots in research of traumatic brain injury from 2000 to 2022: A bibliometric study
Yan-rui Long, Kai Zhao, Fu-chi Zhang, Yu Li, Jun-wen Wang, Hong-quan Niu, Jin Lei
Neurochemistry International.2024; 172: 105646. CrossRef
Targeted temperature control following traumatic brain injury: ESICM/NACCS best practice consensus recommendations
Andrea Lavinio, Jonathan P. Coles, Chiara Robba, Marcel Aries, Pierre Bouzat, Dara Chean, Shirin Frisvold, Laura Galarza, Raimund Helbok, Jeroen Hermanides, Mathieu van der Jagt, David K. Menon, Geert Meyfroidt, Jean-Francois Payen, Daniele Poole, Frank R
Critical Care.2024;[Epub] CrossRef
A review on targeted temperature management for cardiac arrest and traumatic brain injury
Hiroshi Ito, Sanae Hosomi, Takeshi Nishida, Youhei Nakamura, Jiro Iba, Hiroshi Ogura, Jun Oda
Frontiers in Neuroscience.2024;[Epub] CrossRef
Intracranial pressure trends and clinical outcomes after decompressive hemicraniectomy in malignant middle cerebral artery infarction
Jae Wook Jung, Ilmo Kang, Jin Park, Seungjoo Lee, Sang-Beom Jeon
Annals of Intensive Care.2024;[Epub] CrossRef
Severe traumatic brain injury in adults: a review of critical care management
Siobhan McLernon
British Journal of Neuroscience Nursing.2023; 19(6): 206. CrossRef

Pulmonary
Asynchronies during invasive mechanical ventilation: narrative review and update: Santiago Nicolás Saavedra, Patrick Valentino Sepúlveda Barisich, José Benito Parra Maldonado, Romina Belén Lumini, Alberto Gómez-González, Adrián Gallardo; Acute Crit Care. 2022;37(4):491-501. Published online November 30, 2022; DOI: https://doi.org/10.4266/acc.2022.01158

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Abstract PDF Supplementary Material

Invasive mechanical ventilation is a frequent therapy in critically ill patients in critical care units. To achieve favorable outcomes, patient and ventilator interaction must be adequate. However, many clinical situations could attempt against this principle and generate a mismatch between these two actors. These asynchronies can lead the patient to worst outcomes; that is why it is vital to recognize and treat these entities as soon as possible. Early detection and recognition of the different asynchronies could favor the reduction of the days of mechanical ventilation, the days of hospital stay, and intensive care and improve clinical results.

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Does patient-ventilator asynchrony really matter?
Mattia Docci, Antenor Rodrigues, Sebastian Dubo, Matthew Ko, Laurent Brochard
Current Opinion in Critical Care.2025; 31(1): 21. CrossRef
Ability to identify patient-ventilator asynchronies in intensive care unit professionals: A multicenter cross-sectional analytical study
Andrés Mauricio Enríquez Popayán, Iván Ignacio Ramírez, Juan Felipe Zúñiga, Ruvistay Gutierrez-Arias, Mayda Alejandra Jiménez Pérez, Henry Mauricio Parada-Gereda, Luis Fernando Pardo Cocuy, Ana Lucia Rangel Colmenares, Nubia Castro Chaparro, Ana Pinza Ort
The Journal of Critical Care Medicine.2025; 11(2): 157. CrossRef
Advances in the Study of Patient Self-inflicted Lung Injury
Guinan Sun, Jinjin Tian, Xueqin Zhang, Dandan Li
International Journal of Biology and Life Sciences.2024; 7(1): 11. CrossRef
Patient Self-Inflicted Lung Injury—A Narrative Review of Pathophysiology, Early Recognition, and Management Options
Peter Sklienka, Michal Frelich, Filip Burša
Journal of Personalized Medicine.2023; 13(4): 593. CrossRef
Actualización sobre sedoanalgesia en paciente bajo ventilación mecánica
Onan Emanuel Gregorio
Revista de Postgrados de Medicina.2022; 1(1): 27. CrossRef

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

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Abstract PDF Supplementary Material

Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

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Lung Ultrasound—A Supplementary Tool for the Diagnosis of Pulmonary Tuberculosis in Children
Vinita Rathi, Raveena Rawat, Sumit Kumar, Amol Srivastava, Anupama Tandon
Journal of Clinical Ultrasound.2025; 53(4): 700. CrossRef
Focus ultrasound in patients with ST-elevation myocardial infarction during initial physical examination
A. V. Kostin, D. V. Skrypnik
Medical alphabet.2024; (22): 35. CrossRef

Basic science and research
Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review: Christantie Effendy, Yodang Yodang, Sarah Amalia, Erna Rochmawati; Acute Crit Care. 2022;37(4):516-526. Published online October 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00745

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Abstract PDF

The provision of palliative care in the intensive care unit (ICU) is increasing. While some scholars have suggested the goals of palliative care to not be aligned with the ICU, some evidence show benefits of the integration. This review aimed to explore and synthesize research that identified barriers and facilitators in the provision of palliative care in the ICU. This review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines based on population, concept, and context. We searched for eligible studies in five electronic databases (Scopus, PubMed, ProQuest, Science Direct, and Sage) and included studies on the provision of palliative care (concept) in the ICU (context) that were published in English between 2005–2021. We describe the provision of palliative care in terms of barriers and facilitators. We also describe the study design and context. A total of 14 papers was included. Several barriers and facilitators in providing palliative care in the ICU were identified and include lack of capabilities, family boundaries, practical issues, cultural differences. Facilitators of the provision of palliative care in an ICU include greater experience and supportive behaviors, i.e., collaborations between health care professionals. This scoping review demonstrates the breadth of barriers and facilitators of palliative care in the ICU. Hospital management can consider findings of the current review to better integrate palliative care in the ICU.

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How the nursing work environment moderates the relationship between clinical judgment and person-centered care among intensive care unit nurses
Mi Hwa Seo, Eun A. Kim, Hae Ran Kim, Mohammad Jamil Rababa
PLOS ONE.2025; 20(1): e0316654. CrossRef
Triggers for Palliative Care consultation and its modalities in non-malignant mechanically ventilated patients in the Intensive Care Unit: A prospective observational study
Mansi Suresh, Souvik Chaudhuri, Krithika Rao, Pratibha Todur
Clinical Epidemiology and Global Health.2025; 32: 101914. CrossRef
Knowledge, attitudes, and self-efficacy regarding palliative care among Palestinian nurses in intensive care units
Bilal Awad, Ahmad Batran, Malakeh Z. Malak, Ahmad Ayed, Anas Shehadeh, Bahaa Alassoud, Moath Abu Ejheisheh
BMC Nursing.2025;[Epub] CrossRef
Palliative care outcomes in adult intensive care units: candidate quality outcome indicator items a scoping review protocol
Heru Suwardianto, Christantie Effendy, Sri Setiyarini
Salud, Ciencia y Tecnología.2025; 5: 1698. CrossRef
A necessidade dos cuidados paliativos na Unidade de Terapia Intensiva (UTI)
Larissa Kênia de Oliveira Barros Dos Santos, Isabella Rodrigues Ribeiro, João Pedro Manduca Ferreira, Victor Hugo Oliveira Moraes, Érika Aguiar Lara Pereira
Cuadernos de Educación y Desarrollo.2024;[Epub] CrossRef
End-of-life Care in the Intensive Care Unit and Ethics of Withholding/Withdrawal of Life-sustaining Treatments
Andrea Cortegiani, Mariachiara Ippolito, Sebastiano Mercadante
Anesthesiology Clinics.2024; 42(3): 407. CrossRef
What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review
Nabat Almalki, Breidge Boyle, Peter O’Halloran
BMC Palliative Care.2024;[Epub] CrossRef
Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer
Irene Giannubilo, Linda Battistuzzi, Eva Blondeaux, Tommaso Ruelle, Francesca Benedetta Poggio, Giulia Buzzatti, Alessia D’Alonzo, Federica Della Rovere, Maria Maddalena Latocca, Chiara Molinelli, Maria Grazia Razeti, Simone Nardin, Luca Arecco, Marta Per
BMC Palliative Care.2024;[Epub] CrossRef
Palliative Care in the Intensive Care Unit: The Standard of Care
Clareen Wiencek
AACN Advanced Critical Care.2024; 35(2): 112. CrossRef
Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review
Naveen Salins, Vijay Shree Dhyani, Mebin Mathew, Ashmitha Prasad, Arathi Prahallada Rao, Anuja Damani, Krithika Rao, Shreya Nair, Vishal Shanbhag, Shwethapriya Rao, Shivakumar Iyer, Roop Gursahani, Raj Kumar Mani, Sushma Bhatnagar, Srinagesh Simha
Intensive Care Medicine.2024; 50(9): 1438. CrossRef
Barriers and Facilitators of Early Palliative Care in the Trajectory of People Living with Chronic Condition: A Mini Review Using Socio-ecological Framework to Inform Public Health Strategy
Hartiah Haroen, Sidik Maulana, Alia Harlasgunawan, Sri Rahmawati, Alvi Riansyah, Faizal Musthofa, Jerico Pardosi
Journal of Multidisciplinary Healthcare.2024; Volume 17: 4189. CrossRef
Shared Decision-making in Palliative and End‑of‑life Care in the Cardiac Intensive Care Unit
Sarah Godfrey, Alexis Barnes, Jing Gao, Jason N Katz, Sarah Chuzi
US Cardiology Review.2024;[Epub] CrossRef
Assessing IoT integration in ICUs’ settings and management: a cross-country analysis among local healthcare organizations
Anna Roberta Gagliardi, Luca Carrubbo, Shai Rozenes, Adi Fux, Daniela Siano
Digital Policy, Regulation and Governance.2024;[Epub] CrossRef
Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model
Stephanie A. Meddick‐Dyson, Jason W. Boland, Mark Pearson, Sarah Greenley, Rutendo Gambe, John R. Budding, Fliss E. M. Murtagh
Intensive Care Medicine.2024; 50(11): 1778. CrossRef
Healthcare Professionals’ Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children’s Hospital in Scotlan
Satyajit Ray, Emma Victoria McLorie, Jonathan Downie
Healthcare.2023; 11(17): 2438. CrossRef

Original Articles

Infection
Validation of presepsin measurement for mortality prediction of sepsis: a preliminary study: Seung Min Baik, Jin Park, Tae Yoon Kim, Se Hong Choi, Kyung Sook Hong; Acute Crit Care. 2022;37(4):527-532. Published online August 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00150

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Abstract PDF

Background
Sepsis and septic shock remain the leading causes of death in critically ill patients worldwide. Various biomarkers are available to determine the prognosis and therapeutic effects of sepsis. In this study, we investigated the effectiveness of presepsin as a sepsis biomarker.
Methods
Patients admitted to the intensive care unit with major or minor diagnosis of sepsis were categorized into survival and non-survival groups. The white blood cell count and serum C-reactive protein, procalcitonin, and presepsin levels were measured in all patients.
Results
The study included 40 patients (survival group, 32; non-survival group, 8; mortality rate, 20%). The maximum serum presepsin levels measured during intensive care unit admission were significantly higher in the non-survival group (median [interquartile range]: 4,205.5 pg/ml [1,155.8–10,094.0] vs. 741.5 pg/ml [520.0–1,317.5], P<0.05). No statistically significant intergroup differences were observed in the maximum, minimum, and mean values of the white blood cell count, as well as serum C-reactive protein, and procalcitonin levels. Based on the receiver operating characteristic curve, the area under the curve for presepsin as a predictor of sepsis mortality was 0.764. At a cut-off value of 1,898.5 pg/ml, the sensitivity and specificity of presepsin for prediction of sepsis-induced mortality were 75.0% and 87.5%, respectively.
Conclusions
Early diagnosis of sepsis and prediction of sepsis-induced mortality are important for prompt initiation of treatment. Presepsin may serve as an effective biomarker for prediction of sepsis-induced mortality and for evaluation of treatment effectiveness.

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Impact of nutrition‐related laboratory tests on mortality of patients who are critically ill using artificial intelligence: A focus on trace elements, vitamins, and cholesterol
Dong Jin Park, Seung Min Baik, Hanyoung Lee, Hoonsung Park, Jae‐Myeong Lee
Nutrition in Clinical Practice.2025; 40(3): 723. CrossRef
Predicting outcomes in patients with sepsis-associated encephalopathy using prefrontal functional connectivity analysis
Tae Jung Kim, Jae-Myoung Kim, Ji Sung Lee, Soo-Hyun Park, Jihyun Cha, Hyeon-Min Bae, Sang-Bae Ko
Scientific Reports.2025;[Epub] CrossRef
The Potential Role of Presepsin in Predicting Severe Infection in Patients with Diabetic Foot Ulcers
Eun Yeong Ha, Il Rae Park, Seung Min Chung, Young Nam Roh, Chul Hyun Park, Tae-Gon Kim, Woong Kim, Jun Sung Moon
Journal of Clinical Medicine.2024; 13(8): 2311. CrossRef
Combined estimation of presepsin and gelsolin might improve the diagnostic validity of clinical scoring to predict and stratify sepsis in non-sepsis surgical ICU patient
Hany A. Shehab, Ahmed M Eid, Yehya Shahin Dabour
Egyptian Journal of Anaesthesia.2024; 40(1): 262. CrossRef

Infection
The prognostic impact of rheumatoid arthritis in sepsis: a population-based analysis: Lavi Oud, John Garza; Acute Crit Care. 2022;37(4):533-542. Published online October 6, 2022; DOI: https://doi.org/10.4266/acc.2022.00787

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Abstract PDF Supplementary Material

Background
Rheumatoid arthritis (RA) is associated with increased risk of sepsis and higher infection-related mortality compared to the general population. However, the evidence on the prognostic impact of RA in sepsis has been inconclusive. We aimed to estimate the population-level association of RA with short-term mortality in sepsis.
Methods
We used statewide data to identify hospitalizations aged ≥18 years in Texas with sepsis, with and without RA during 2014–2017. Hierarchical logistic models with propensity adjustment (primary model), propensity score matching, and multivariable logistic regression without propensity adjustment were used to estimate the association of RA with short-term mortality among sepsis hospitalizations.
Results
Among 283,025 sepsis hospitalizations, 7,689 (2.7%) had RA. Compared to sepsis hospitalizations without RA, those with RA were older (aged ≥65 years, 63.9% vs. 56.4%) and had higher burden of comorbidities (mean Deyo comorbidity index, 3.2 vs. 2.7). Short-term mortality of sepsis hospitalizations with and without RA was 26.8% vs. 31.4%. Following adjustment for confounders, short-term mortality was lower among RA patients (adjusted odds ratio [aOR], 0.910; 95% confidence interval [CI], 0.856–0.967), with similar findings on alternative models. On sensitivity analyses, short-term mortality was lower in RA patients among sepsis hospitalizations aged ≥65 years and those with septic shock, but not among those admitted to intensive care unit (ICU; aOR, 0.990; 95% CI, 0.909–1.079).
Conclusions
RA was associated, unexpectedly, with lower short-term mortality in septic patients. However, this “protective” association was driven by those patients without ICU admission. Further studies are warranted to confirm these findings and to examine the underlying mechanisms.

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Decreased in-hospital mortality in shock patients with rheumatoid arthritis compared to those without: a retrospective analysis of a critical care database
Jin Wan, Xiaoyu Cao, Yaran Yang
Clinical Rheumatology.2025; 44(2): 615. CrossRef
LGR4 (GPR48): The Emerging Inter-Bridge in Osteoimmunology
Wonbong Lim
Biomedicines.2025; 13(3): 607. CrossRef
Genetic associations between autoimmune diseases and the risks of severe sepsis and 28-day mortality: a two-sample Mendelian randomization study
Xin Tie, Yanjie Zhao, Jing Su, Xing Liu, Tongjuan Zou, Wanhong Yin
Frontiers in Medicine.2024;[Epub] CrossRef
Evolving Paradigms in Sepsis Management: A Narrative Review
Min-Ji Kim, Eun-Joo Choi, Eun-Jung Choi
Cells.2024; 13(14): 1172. CrossRef

Pulmonary
Incidence and risk factors associated with progression to severe pneumonia among adults with non-severe Legionella pneumonia: Jin-Young Huh, Sang-Ho Choi, Kyung-Wook Jo, Jin Won Huh, Sang-Bum Hong, Tae Sun Shim, Chae-Man Lim, Younsuck Koh; Acute Crit Care. 2022;37(4):543-549. Published online October 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00521

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Abstract PDF

Background
Legionella species are important causative organisms of severe pneumonia. However, data are limited on predictors of progression to severe Legionella pneumonia (LP). Therefore, the risk factors for LP progression from non-severe to the severe form were investigated in the present study.
Methods
This was a retrospective cohort study that included adult LP patients admitted to a 2,700-bed referral center between January 2005 and December 2019.
Results
A total of 155 patients were identified during the study period; 58 patients (37.4%) initially presented with severe pneumonia and 97 (62.6%) patients with non-severe pneumonia. Among the 97 patients, 28 (28.9%) developed severe pneumonia during hospitalization and 69 patients (71.1%) recovered without progression to severe pneumonia. Multivariate logistic regression analysis showed platelet count ≤150,000/mm3 (odds ratio [OR], 2.923; 95% confidence interval [CI], 1.100–8.105; P=0.034) and delayed antibiotic treatment >1 day (OR, 3.092; 95% CI, 1.167–8.727; P=0.026) were significant independent factors associated with progression to severe pneumonia.
Conclusions
A low platelet count and delayed antibiotic treatment were significantly associated with the progression of non-severe LP to severe LP.

Citations

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Understanding the Correlation between Blood Profile and the Duration of Hospitalization in Pediatric Bronchopneumonia Patients: A Cross-Sectional Original Article
Dessika Listiarini, Dev Desai, Yanuar Wahyu Hidayat, Kevin Alvaro Handoko
The Journal of Critical Care Medicine.2024; 10(3): 254. CrossRef
An Investigation of Mortality Associated With Comorbid Pneumonia and Thrombocytopenia in a Rural Southwest Missouri Hospital System
Tabitha Ranson , Hannah Rourick , Rajbir Sooch , Nicole Ford, Nova Beyersdorfer, Kerry Johnson, John Paulson
Cureus.2024;[Epub] CrossRef
Legionella Pneumonia Undetected by Repeated Urinary Antigen Testing With Ribotest® Legionella
Yasushi Murakami, Mika Morosawa, Yasuhiro Nozaki, Yoshio Takesue
Cureus.2024;[Epub] CrossRef
Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia
Elliott Worku, Dominic Adam Worku, Salim Surani
Case Reports in Infectious Diseases.2023; 2023: 1. CrossRef
Short- and long-term prognosis of patients with community-acquired Legionella or pneumococcal pneumonia diagnosed by urinary antigen testing
Leyre Serrano, Luis Alberto Ruiz, Silvia Perez-Fernandez, Pedro Pablo España, Ainhoa Gomez, Beatriz Gonzalez, Ane Uranga, Sonia Castro, Milagros Iriberri, Rafael Zalacain
International Journal of Infectious Diseases.2023; 134: 106. CrossRef
Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia
Chunhong Bu, Shuai Lei, Linguang Chen, Yanqiu Xie, Guoli Zheng, Liwei Hua
Frontiers in Medicine.2023;[Epub] CrossRef

Pulmonary
The frequency and seasonal distribution of viral infection in patients with community-acquired pneumonia and its impact on the prognosis: Kyung Jun Kim, Doh Hyung Kim; Acute Crit Care. 2022;37(4):550-560. Published online October 6, 2022; DOI: https://doi.org/10.4266/acc.2022.00682

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Abstract PDF

Background
Studies on the effects of viral coinfection on bacterial pneumonia are still scarce in South Korea. This study investigates the frequency and seasonal distribution of virus infection and its impact on the prognosis in patients with community-acquired pneumonia (CAP).
Methods
The medical records of CAP patients with definite etiology, such as viruses and bacteria, were retrospectively reviewed. Their epidemiologic and clinical characteristics, microbiologic test results, the severity of illness, and 30-day mortality were analyzed.
Results
Among 150 study subjects, 68 patients (45.3%) had viral infection alone, 47 (31.3%) had bacterial infection alone, and 35 (23.3%) had viral-bacterial coinfection, respectively. Among 103 patients with viral infections, Influenza A virus (44%) was the most common virus, followed by rhinovirus (19%), influenza B (13%), and adenovirus (6%). The confusion-urea-respiratory rateblood pressure-age of 65 (CURB-65) score of the viral-bacterial coinfection was higher than that of the viral infection (median [interquartile range]: 2.0 [1.0–4.0] vs. 2.0 [0.3–3.0], P=0.029). The 30-day mortality of the viral infection alone group (2.9%) was significantly lower than that of bacterial infection alone (19.1%) and viral-bacterial coinfection (25.7%) groups (Bonferroni-corrected P<0.05). Viral-bacterial coinfection was the stronger predictor of 30-day mortality in CAP (odds ratio [OR], 18.9; 95% confidence interval [CI], 3.0–118.3; P=0.002) than bacterial infection alone (OR, 6.3; 95% CI, 1.1–36.4; P=0.041), compared to viral infection alone on the multivariate analysis.
Conclusions
The etiology of viral infection in CAP is different according to regional characteristics. Viral-bacterial coinfection showed a worse prognosis than bacterial infection alone in patients with CAP.

Citations

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Clinical characteristics of pathogens in children with community-acquired pneumonia were analyzed via targeted next-generation sequencing detection
Junhua Zhao, Mingfeng Xu, Zheng Tian, Yu Wang
PeerJ.2025; 13: e18810. CrossRef
Comparing viral, bacterial, and coinfections in community-acquired pneumonia, a retrospective cohort study
Frederike Waldeck, Solveig Lemmel, Marcus Panning, Nadja Käding, Andreas Essig, Gernot Rohde, Mathias W. Pletz, Martin Witzenrath, Sebastien Boutin, Jan Rupp
International Journal of Infectious Diseases.2025; 154: 107841. CrossRef
Viral non-SARS-CoV-2 etiology of community-acquired pneumonia (CAP) in Southeast Asia: a review and pooled analysis
Su Myat Han, Puah Ser Hon, Ho Ying Na, Trevor Tan Hwee Yong, Paul Anantharajah Tambyah, Yeo Tsin Wen
IJID Regions.2025; 15: 100672. CrossRef
Seasonal Patterns of Common Respiratory Viral Infections in Immunocompetent and Immunosuppressed Patients
Fotis Theodoropoulos, Anika Hüsing, Ulf Dittmer, Karl-Heinz Jöckel, Christian Taube, Olympia E. Anastasiou
Pathogens.2024; 13(8): 704. CrossRef

Pulmonary
Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis: Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee; Acute Crit Care. 2022;37(4):561-570. Published online October 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00444

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Abstract PDF Supplementary Material: Background
Delayed intubation is associated with poor prognosis in patients with respiratory failure. However, the effect of delayed intubation in patients with idiopathic pulmonary fibrosis (IPF) remains unknown. This study aimed to analyze whether timing of intubation after high-concentration oxygen therapy was associated with worse clinical outcomes in IPF patients.
Methods
This retrospective propensity score-matched study enrolled adult patients with IPF who underwent mechanical ventilation between January 2011 and July 2021. Patients were divided into early and delayed intubation groups. Delayed intubation was defined as use of high-concentration oxygen therapy for at least 48 hours before tracheal intubation. The primary outcome was intensive care unit (ICU) mortality, and a conditional logistic regression model was used to evaluate the association between timing of intubation and clinical outcomes.
Results
The median duration of high-concentration oxygen therapy before intubation was 0.5 days in the early intubation group (n=60) and 5.1 days in the delayed intubation group (n=36). The ICU mortality rate was 56.7% and 75% in the early and delayed intubation groups, respectively, before propensity matching (P=0.075). After matching for demographic and clinical covariates, 33 matched pairs were selected. In the propensity-matched cohort, delayed intubation significantly increased the risk of ICU mortality (adjusted odds ratio, 3.99; 95% confidence interval, 1.02–15.63; P=0.046). However, in-hospital mortality did not differ significantly between the groups.
Conclusions
In patients with IPF, delayed intubation after initiation of high-concentration oxygen therapy was significantly associated with increased risk of ICU mortality compared to early intubation.

Pulmonary
Extravascular lung water index, pulmonary vascular permeability index, and global end-diastolic volume index in mechanically ventilated COVID-19 patients requiring prone position ventilation: a preliminary retrospective study: Rosanna Carmela De Rosa, Antonio Romanelli, Michele Gallifuoco, Giovanni Messina, Marianne Di Costanzo, Antonio Corcione; Acute Crit Care. 2022;37(4):571-579. Published online November 10, 2022; DOI: https://doi.org/10.4266/acc.2022.00423

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Abstract PDF

Background
There is a lack of data on extravascular lung water index (EVLWi), pulmonary vascular permeability index (PVPi), and global end-diastolic volume index (GEDVi) during prone position ventilation (PPV) in coronavirus disease 2019 (COVID-19) patients. The objectives of this study were to analyze trends in EVLWi, PVPi, and GEDVi during PPV and the relationships between these parameters and PaO2/FiO2.
Methods
In this preliminary retrospective observational study, we performed transpulmonary thermodilution (TPTD) in seven mechanically ventilated COVID-19 patients without cardiac and pulmonary comorbidities requiring PPV for 18 hours, at specific times (30 minutes pre-PPV, 18 hours after PPV, and 3 hours after supination). EVLWi, PVPi and GEDVi were measured. The relationships between PaO2/FiO2 and EVLWi, and PVPi and GEDVi values, in the supine position were analyzed by linear regression. Correlation and determination coefficients were calculated.
Results
EVLWi was significantly different between three time points (analysis of variance, P=0.004). After 18 hours in PPV, EVLWi was lower compared with values before PPV (12.7±0.9 ml/kg vs. 15.3±1.5 ml/kg, P=0.002). Linear regression showed that only EVLWi was correlated with PaO2/FiO2 (β =–5.757; 95% confidence interval, –10.835 to –0.679; r=–0.58; R2 =0.34; F-test P=0.029).
Conclusions
EVLWi was significantly reduced after 18 hours in PPV and values measured in supine positions were correlated with PaO2/FiO2. This relationship can help clinicians discriminate whether deterioration in gas exchange is related to fluid overload or disease progression. Further clinical research should evaluate the role of TPTD parameters as markers to stratify disease severity and guide clinical management.

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Determining Extracellular Water Effects in Mild and Severe COVID-19 Pneumonia Clinical Course by using the Bioimpedance Method
Zuhal Cavus, Ayse Vahaboglu, Ulku Aygen Turkmen, Habibe Vural, Dondu Genc Moralar
Medical Bulletin of Haseki.2023; 61(2): 81. CrossRef

Pulmonary
An algorithm to predict the need for invasive mechanical ventilation in hospitalized COVID-19 patients: the experience in Sao Paulo: Eduardo Atsushi Osawa, Alexandre Toledo Maciel; Acute Crit Care. 2022;37(4):580-591. Published online September 8, 2022; DOI: https://doi.org/10.4266/acc.2022.00283

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Background
We aimed to characterize patients hospitalized for coronavirus disease 2019 (COVID-19) and identify predictors of invasive mechanical ventilation (IMV).
Methods
We performed a retrospective cohort study in patients with COVID-19 admitted to a private network in Sao Paulo, Brazil from March to October 2020. Patients were compared in three subgroups: non-intensive care unit (ICU) admission (group A), ICU admission without receiving IMV (group B) and IMV requirement (group C). We developed logistic regression algorithm to identify predictors of IMV.
Results
We analyzed 1,650 patients, the median age was 53 years (42–65) and 986 patients (59.8%) were male. The median duration from symptom onset to hospital admission was 7 days (5–9) and the main comorbidities were hypertension (42.4%), diabetes (24.2%) and obesity (15.8%). We found differences among subgroups in laboratory values obtained at hospital admission. The predictors of IMV (odds ratio and 95% confidence interval [CI]) were male (1.81 [1.11– 2.94], P=0.018), age (1.03 [1.02–1.05], P<0.001), obesity (2.56 [1.57–4.15], P<0.001), duration from symptom onset to admission (0.91 [0.85–0.98], P=0.011), arterial oxygen saturation (0.95 [0.92– 0.99], P=0.012), C-reactive protein (1.005 [1.002–1.008], P<0.001), neutrophil-to-lymphocyte ratio (1.046 [1.005–1.089], P=0.029) and lactate dehydrogenase (1.005 [1.003–1.007], P<0.001). The area under the curve values were 0.860 (95% CI, 0.829–0.892) in the development cohort and 0.801 (95% CI, 0.733–0.870) in the validation cohort.
Conclusions
Patients had distinct clinical and laboratory parameters early in hospital admission. Our prediction model may enable focused care in patients at high risk of IMV.

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Predictive Models of Patient Severity in Intensive Care Units Based on Serum Cytokine Profiles: Advancing Rapid Analysis
Cristiana P. Von Rekowski, Tiago A. H. Fonseca, Rúben Araújo, Ana Martins, Iola Pinto, M. Conceição Oliveira, Gonçalo C. Justino, Luís Bento, Cecília R. C. Calado
Applied Sciences.2025; 15(9): 4823. CrossRef
Intelligent alert system for predicting invasive mechanical ventilation needs via noninvasive parameters: employing an integrated machine learning method with integration of multicenter databases
Guang Zhang, Qingyan Xie, Chengyi Wang, Jiameng Xu, Guanjun Liu, Chen Su
Medical & Biological Engineering & Computing.2024; 62(11): 3445. CrossRef

Pulmonary
Agreement between two methods for assessment of maximal inspiratory pressure in patients weaning from mechanical ventilation: Emanuelle Olympia Silva Ribeiro, Rik Gosselink, Lizandra Eveline da Silva Moura, Raissa Farias Correia, Wagner Souza Leite, Maria das Graças Rodrigues de Araújo, Armele Dornelas de Andrade, Daniella Cunha Brandão, Shirley Lima Campos; Acute Crit Care. 2022;37(4):592-600. Published online October 27, 2022; DOI: https://doi.org/10.4266/acc.2022.00325

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Background
Respiratory muscle strength in patients with an artificial airway is commonly assessed as the maximal inspiratory pressure (MIP) and is measured using analogue or digital manometers. Recently, new electronic loading devices have been proposed to measure respiratory muscle strength. This study evaluates the agreement between the MIPs measured by a digital manometer and those according to an electronic loading device in patients being weaned from mechanical ventilation.
Methods
In this prospective study, the standard MIP was obtained using a protocol adapted from Marini, in which repetitive inspiratory efforts were performed against an occluded airway with a one-way valve and were recorded with a digital manometer for 40 seconds (MIPDM). The MIP measured using the electronic loading device (MIPELD) was obtained from repetitively tapered flow resistive inspirations sustained for at least 2 seconds during a 40-second test. The agreement between the results was verified by a Bland-Altman analysis.
Results
A total of 39 subjects (17 men, 55.4±17.7 years) was enrolled. Although a strong correlation between MIPDM and MIPELD (R=0.73, P<0.001) was observed, the Bland-Altman analysis showed a high bias of –47.4 (standard deviation, 22.3 cm H2O; 95% confidence interval, –54.7 to –40.2 cm H2O).
Conclusions
The protocol of repetitively tapering flow resistive inspirations to measure the MIP with the electronic loading device is not in agreement with the standard protocol using one-way valve inspiratory occlusion when applied in poorly cooperative patients being weaned from mechanical ventilation.

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Utility of a digital motor speech measurement program using an AI speech recognition module: A pilot study*
Sora Han, Do Hyung Kim, So Young Han, Jaewon Kim, Dae-Hyun Jang
Phonetics and Speech Sciences.2024; 16(4): 53. CrossRef

CPR/Resuscitation
Association between C-reactive protein-to-albumin ratio and 6-month mortality in out-of-hospital cardiac arrest: Hui Hwan Kim, Ji Ho Lee, Dong Hun Lee, Byung Kook Lee; Acute Crit Care. 2022;37(4):601-609. Published online August 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00542

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Background
The inflammatory response that occurs following cardiac arrest can determine the long-term prognosis of patients who survive out-of-hospital cardiac arrest. We evaluated the correlation between C-reactive protein-to-albumin ratio (CAR) following cardiac arrest and long-term mortality.
Methods
The current retrospective observational study examined patients with post-cardiac arrest syndrome (PCAS) treated with targeted temperature management at a single tertiary care hospital. We measured CAR at four time points (at admission and then 24 hours, 48 hours, and 72 hours after) following cardiac arrest. The primary outcome was the patients’ 6-month mortality. We performed multivariable and area under the receiver operating characteristic curve (AUC) analyses to investigate the relationship between CAR and 6-month mortality.
Results
Among the 115 patients, 52 (44.1%) died within 6 months. In the multivariable analysis, CAR at 48 hours (odds ratio [OR], 1.130; 95% confidence interval [CI], 1.027–1.244) and 72 hours (OR, 1.241; 95% CI, 1.059–1.455) after cardiac arrest was independently associated with 6-month mortality. The AUCs of CAR at admission and 24, 48, and 72 hours after cardiac arrest for predicting 6-month mortality were 0.583 (95% CI, 0.489–0.673), 0.622 (95% CI, 0.528–0.710), 0.706 (95% CI, 0.615–0.786), and 0.762 (95% CI, 0.675–0.835), respectively.
Conclusions
CAR at 72 hours after cardiac arrest was an independent predictor for long-term mortality in patients with PCAS.

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C-reactive protein-to-albumin ratio is associated with mortality after transcatheter tricuspid valve repair
Karl Finke, Laura Marx, Jan Althoff, Thorsten Gietzen, Matthieu Schäfer, Jan Wrobel, Philipp von Stein, Jennifer von Stein, Maria Isabel Körber, Stephan Baldus, Roman Pfister, Christos Iliadis
Clinical Research in Cardiology.2025; 114(7): 892. CrossRef
Biomarkers in Cardiac Arrest: A Narrative Review
Rohin Singla, Chelsey Sidaras, Jignesh K. Patel
Therapeutic Advances in Pulmonary and Critical Care Medicine.2025;[Epub] CrossRef
Association of the blood urea nitrogen to serum albumin ratio and 28-day all-cause mortality in patients with cardiac arrest: a retrospective cohort study using the MIMIC-IV database
Gaosheng Zhou, Yayuan Tan, Xueli Li, Yixun Wang, Dingdeng Wang, Min Liu
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef
The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest
Ji Ho Lee, Dong Hun Lee, Byung Kook Lee, Seok Jin Ryu
World Journal of Emergency Medicine.2024; 15(3): 223. CrossRef
Inflammatory response after out‐of‐hospital cardiac arrest—Impact on outcome and organ failure development
Asser M. J. Seppä, Markus B. Skrifvars, Pirkka T. Pekkarinen
Acta Anaesthesiologica Scandinavica.2023; 67(9): 1273. CrossRef
Comparison of Prognostic Performance between Procalcitonin and Procalcitonin-to-Albumin Ratio in Post Cardiac Arrest Syndrome
Ju Hee Yoon, Woo Sung Choi, Yong Su Lim, Jae Ho Jang
Journal of Clinical Medicine.2023; 12(14): 4568. CrossRef
C-reactive protein-to-albumin ratio as a biomarker in patients with sepsis: a novel LASSO-COX based prognostic nomogram
Xin Zhou, Shouzhi Fu, Yisi Wu, Zhenhui Guo, Wankang Dian, Huibin Sun, Youxia Liao
Scientific Reports.2023;[Epub] CrossRef

CPR/Resuscitation
Diet-related complications according to the timing of enteral nutrition support in patients who recovered from out-of-hospital cardiac arrest: a propensity score matched analysis: Gun Woo Kim, Young-Il Roh, Kyoung-Chul Cha, Sung Oh Hwang, Jae Hun Han, Woo Jin Jung; Acute Crit Care. 2022;37(4):610-617. Published online October 27, 2022; DOI: https://doi.org/10.4266/acc.2022.00696

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Background
A proper nutritional plan for resuscitated patients is important in intensive care; however, specific nutritional guidelines have not yet been established. This study aimed to determine the incidence of diet-related complications that were affected by the timing of enteral nutrition in resuscitated patients after cardiac arrest.
Methods
This retrospective and 1:1 propensity score matching study involved patients who recovered after nontraumatic, out-of-hospital cardiac arrest at a tertiary hospital. Patients were divided into an early nutrition support (ENS) group and a delayed nutrition support (DNS) group according to the nutritional support time within 48 hours after admission. The incidence of major clinical complications was compared between the groups.
Results
A total of 46 patients (ENS: 23, DNS: 23) were enrolled in the study. There were no differences in body mass index, comorbidity, and time of cardiopulmonary resuscitation between the two groups. There were 9 patients (ENS: 4, DNS: 5) with aspiration pneumonia; 4 patients (ENS: 2, DNS: 2) with regurgitation; 1 patient (ENS: 0, DNS: 1) with ileus; 21 patients (ENS: 10, DNS: 11) with fever; 13 patients (ENS: 8, DNS: 5) with hypoglycemia; and 20 patients (ENS: 11, DNS: 9) with hyperglycemia. The relative risk of each complication during post-resuscitation care was no different between groups.
Conclusions
There was a similar incidence of diet-related complications during post cardiac arrest care according to the timing of enteral nutrition.

Citations

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Nutritional support in the cardiac intensive care unit
Pascal Frederiks, Marijke Peetermans, Alexander Wilmer
European Heart Journal: Acute Cardiovascular Care.2024; 13(4): 373. CrossRef

Meta-analysis
Comparison of mNUTRIC-S2 and mNUTRIC scores to assess nutritional risk and predict intensive care unit mortality: So Jeong Kim, Hong Yeul Lee, Sun Mi Choi, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2022;37(4):618-626. Published online October 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00612

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Background
Nutritional status is associated with mortality. The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is one of the most commonly used nutritional risk assessment tools in intensive care units (ICUs). The purpose of this study was to compare the mortality predictive ability of the mNUTRIC score to that of the mNUTRIC-S2 score, which uses the Simplified Acute Physiology Score (SAPS) II instead of the Acute Physiology and Chronic Health Evaluation (APACHE) II.
Methods
This retrospective cohort analysis included patients admitted to the ICU between January and September 2020. Each patient’s electronic medical records were reviewed. The model discrimination for predicting ICU mortality was assessed by the area under the receiver operating characteristic (ROC) curve, and a Cox regression model was performed to confirm the relationship between the groups and mortality.
Results
In total, 220 patients were enrolled. The ROC curve for predicting ICU mortality was 0.64 for the mNUTRIC score versus 0.67 for the mNUTRIC-S2 score. The difference between the areas was 0.03 (95% confidence interval [CI], –0.01 to 0.06; P=0.09). Patients with mNUTRIC-S2 score ≥5 had a greater risk of ICU mortality (hazard ratio [HR], 3.64; 95% CI, 1.85–7.14; P<0.001); however, no such relationship was observed with mNUTRIC score (HR, 1.69; 95% CI, 0.62–4.62; P=0.31).
Conclusions
The mNUTRIC-S2 score was significantly associated with ICU mortality. A cutoff score of 5 was selected as most appropriate.

Citations

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Bayesian Analysis of Modified Nutrition Risk in Critically Ill (mNUTRIC) Score for Mortality Prediction in Critically Ill Patients
Raj Kumar, Archana Kumari, Vivek Verma, Jay Prakash, Pradip K Bhattacharya, Shio Priye, Khushboo Saran, Kunal Raj, Bram Rochwerg
Indian Journal of Critical Care Medicine.2025; 29(5): 449. CrossRef
Comparison of mNUTRIC Score and mnutric Score with Albumin in Predicting Outcome in CKD Patients
Venkatesh Dhat, Jainab Bhori, Manish Mali, Mahesh R Jarkad, Aishwarya Chavan, Tushar Warke
Indian Journal of Critical Care Medicine.2025; 29(S1): S259. CrossRef
Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study
Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim
Acute and Critical Care.2024; 39(1): 127. CrossRef
Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis
Amit Kumar, Archana Kumari, Jay Prakash, Pradip K Bhattacharya, Saket Verma, Priyanka Shrivastava, Khushboo Saran, Kunal Raj, Hemant N Ray
Indian Journal of Critical Care Medicine.2024; 28(5): 495. CrossRef

Epidemiology
Incidence and associated factors of pediatric post-intensive care syndrome using the VSCAREMD model: Paweethida Tippayawong, Chanapai Chaiyakulsil; Acute Crit Care. 2022;37(4):627-635. Published online October 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00234

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Background
The VSCAREMD model is used for evaluating vaccination, sleep, and parental care burden, which includes daily activity and social interaction, rehabilitation requirements, hearing, mood, and development. It has been proposed to detect post-intensive care syndrome (PICS) in children. This study aimed to outline the incidence of PICS in children using the VSCAREMD model and to describe the associated factors.
Methods
All children ages 1 month to 15 years and admitted to the intensive care unit for at least 48 hours were evaluated using the VSCAREMD model within 1 week of intensive care discharge. Abnormal findings were assorted into four domains: physical, cognitive, mental, and social. Descriptive statistics were performed using chi-square, univariate, and multivariate analyses.
Results
A total of 78 of 95 children (82.1%) had at least one abnormal domain. Physical, cognitive, mental, and social morbidity were found in 64.2%, 26.3%, 13.7%, and 38.9% of the children, respectively. Prolonged intensive care unit stay greater than 7 days was associated with dysfunction in physical (adjusted odds ratio [aOR], 3.80; 95% confidence interval [CI], 1.31–11.00), cognitive (aOR, 10.11; 95% CI, 3.01–33.89), and social domains (aOR, 5.01; 95% CI, 2.01–12.73). Underlying medical conditions were associated with cognitive (aOR, 13.63; 95% CI, 2.64– 70.26) and social morbidity (aOR, 2.81; 95% CI, 1.06–7.47).
Conclusions
The incidence of PICS using the VSCAREMD model was substantially high and associated with prolonged intensive care. This model could help evaluate PICS in children.

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Post-traumatic stress disorder in children after discharge from the pediatric intensive care unit: a scoping review
Maoting Tang, Ping Lei Chui, Mei Chan Chong, Xianliang Liu
European Child & Adolescent Psychiatry.2025; 34(2): 483. CrossRef
Post intensive care syndrome in paediatrics PICS-p: symptoms, severity and prevalence
Patrycja Krystyna Mazurek, Anna Aftyka
Pielegniarstwo XXI wieku / Nursing in the 21st Century.2025; 24(1): 83. CrossRef
Prevalence of Post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis
Temesgen Ayenew, Menberu Gete, Mihretie Gedfew, Addisu Getie, Abebe Dilie Afenigus, Afework Edmealem, Haile Amha, Girma Alem, Bekele Getenet Tiruneh, Mengistu Abebe Messelu, Ramya Iyadurai
PLOS One.2025; 20(5): e0323311. CrossRef
Post–intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post–intensive-care clinic
Chanapai Chaiyakulsil
Acute and Critical Care.2024; 39(4): 600. CrossRef

Epidemiology
Perioperative hemodynamic protective assessment of adaptive support ventilation usage in pediatric surgical patients: Dmytro Dmytriiev, Mykola Melnychenko, Oleksandr Dobrovanov, Oleksandr Nazarchuk, Marian Vidiscak; Acute Crit Care. 2022;37(4):636-643. Published online October 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00297

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Background
The aim of this study was to evaluate the hemodynamic protective effects of perioperative ventilation in pressure-controlled ventilation (PCV) and adaptive support ventilation (ASV) modes based on non-invasive hemodynamic monitoring indicators.
Methods
The study included 32 patients who were scheduled for planned open abdominal surgery. Depending on the chosen ventilation strategy, patients were included in two groups of PCV mode ventilation (n=14) and ASV mode ventilation (n=18). The hemodynamic effects of the ventilation strategies were assessed by estimated continuous cardiac output (esCCO) and cardiac index (esCCI).
Results
Preoperative cardiac output (CO) was 6.1±1.3 L/min in group 1 patients and 6.3±0.8 L/min in group 2 patients, and preoperative cardiac index (CI) was 3.9±0.4 L/min/m2 in group 1 patients and 3.8±0.8 L/min/m2 in group 2 patients. The ejection fraction (EF) in group 1 subjects was 55.4%±0.3%; this rate was 56.5%±0.5% in group 2 subjects. Group 1 patients experienced a 14.7% CO decrease to 5.2±0.7 L/min, a 17.9% CI decrease to 3.2±0.6 L/min/m2 , and a 12.8% mean arterial pressure decrease to 82.3±9.4 mm Hg 30 minutes after the start of surgery. One hour after the start of surgery, the CO mean values of group 2 patients were lower than baseline by 7.9% and differed from the dynamics of patients in group 1, in whom CO was lower than baseline by 13.1%. At the end of the operation, the CO values were lower than baseline by 11.5% and 6.3% in patients of groups 1 and 2, respectively. Our data showed that the changes in EF during and after surgery correlated with CO indicators determined by the esCCO.
Conclusions
In our study, perioperative ventilation in ASV mode was more protective than PCV mode and was characterized by lower tidal volume (16.2%) and driving pressure (12.1%). Hemodynamically-controlled mechanical ventilation reduces the negative impact of cardiopulmonary interactions,

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Trends in the dynamics of morbidity and mortality from hypertension in the Republic of Kazakhstan from 2010 to 2019
Yeldos Makhambetchin, Aigerim Yessembekova, Ardak Nurbakyttana, Aza Galayeva, Saparkul Arinova
Polski Merkuriusz Lekarski.2024; 52(1): 95. CrossRef
The effect of Sclerosing drugs on the Tunica albuginea (Experimental study)
Kozhakhmet Kuneshov, Shora Seidinov, Nurpeis Tulezhanov, Fazladin Tеmurov, Shkurulla Massadikov
Research Journal of Pharmacy and Technology.2024; : 2846. CrossRef
Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure
Jun-Jun Wang, Zhong Zhou, Li-Ying Zhang
World Journal of Clinical Cases.2023; 11(26): 6040. CrossRef

Epidemiology
Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience: Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli; Acute Crit Care. 2022;37(4):644-653. Published online November 11, 2022; DOI: https://doi.org/10.4266/acc.2022.00395

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Background
Pediatric intensive care units (PICUs), where children with critical illnesses are treated, require considerable manpower and technological infrastructure in order to keep children alive and free from sequelae.
Methods
In this retrospective comparative cohort study, hospital records of patients aged 1 month to 18 years who died in the study PICU between January 2015 and December 2019 were reviewed.
Results
A total of 2,781 critically ill children were admitted to the PICU. The mean±standard deviation age of 254 nonsurvivors was 64.34±69.48 months. The mean PICU length of stay was 17 days (range, 1–205 days), with 40 children dying early (<1 day of PICU admission). The majority of nonsurvivors (83.9%) had comorbid illnesses. Children with early mortality were more likely to have neurological findings (62.5%), hypotension (82.5%), oliguria (47.5%), acidosis (92.5%), coagulopathy (30.0%), and cardiac arrest (45.0%) and less likely to have terminal illnesses (52.5%) and chronic illnesses (75.6%). Children who died early had a higher mean age (81.8 months) and Pediatric Risk of Mortality (PRISM) III score (37). In children who died early, the first three signs during ICU admission were hypoglycemia in 68.5%, neurological symptoms in 43.5%, and acidosis in 78.3%. Sixty-seven patients needed continuous renal replacement therapy, 51 required extracorporeal membrane oxygenation support, and 10 underwent extracorporeal cardiopulmonary resuscitation.
Conclusions
We found that rates of neurological findings, hypotension, oliguria, acidosis, coagulation disorder, and cardiac arrest and PRISM III scores were higher in children who died early compared to those who died later.

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Mortality in children and adolescents with autoimmune inflammatory rheumatic diseases admitted to the pediatric intensive care unit
Tinnapat Buranapattama, Suwannee Phumeetham, Nuntawan Piyaphanee, Maynart Sukharomana, Sirirat Charuvanij
Pediatric Rheumatology.2025;[Epub] CrossRef
Characteristics and Outcomes of Patients Admitted to a Tertiary Pediatric Intensive Care Unit in Western Black Sea Region of Turkey
Hamdi Metin, Akın Seçkin, Eylem Sevinç
Experimental and Applied Medical Science.2024; 5(4): 193. CrossRef
Association between phosphate and 30-day in-hospital mortality in paediatric ICU: a retrospective cohort study
Yiyi Ding, Yaqin Lei, Yufang Zhu, Hongwei Zhang, Yunbin Xiao
BMJ Paediatrics Open.2024; 8(1): e003171. CrossRef
Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience
Zeynep Karakaya, Merve Boyraz, Seyma Koksal Atis, Servet Yuce, Muhterem Duyu
Journal of Pediatric Intensive Care.2023;[Epub] CrossRef
Association between mortality and critical events within 48 hours of transfer to the pediatric intensive care unit
Huan Liang, Kyle A. Carey, Priti Jani, Emily R. Gilbert, Majid Afshar, L. Nelson Sanchez-Pinto, Matthew M. Churpek, Anoop Mayampurath
Frontiers in Pediatrics.2023;[Epub] CrossRef

Epidemiology
Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events: Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang; Acute Crit Care. 2022;37(4):654-666. Published online October 26, 2022; DOI: https://doi.org/10.4266/acc.2022.00976

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Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance.
Methods
This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF).
Results
The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex.
Conclusions
The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

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Ruqiah Ali AlZaher, Syed Jamil, Iris Murabi, Eidah Ahmari
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Predicting cardiac arrest after neonatal cardiac surgery
Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya
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Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer
Experimental Gerontology.2023; 173: 112087. CrossRef
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Medicine.2023; 102(37): e35057. CrossRef
An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
Young Joo Han
Acute and Critical Care.2022; 37(4): 667. CrossRef

Editorial

Epidemiology
An advanced pediatric early warning system: a reliable sentinel, not annoying extra work: Young Joo Han; Acute Crit Care. 2022;37(4):667-668. Published online November 29, 2022; DOI: https://doi.org/10.4266/acc.2022.01445

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Case Report

Nephrology
Continuous renal replacement therapy increased plasma cholinesterase activity in a case of acute organophosphate poisoning: In Ho Kwon, Jinwoo Jeong, Yuri Choi; Acute Crit Care. 2022;37(4):669-671. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00780

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Extracorporeal removal of organophosphate from blood has been proposed, but the efficacy of hemodialysis and hemoperfusion has not been established. We report a case of organophosphate poisoning in which continuous renal replacement therapy (CRRT) was applied with conventional indications and was found to increase plasma cholinesterase levels by hemodiafiltration. A 73-year-old male was found unconscious at home and was brought to the emergency department by ambulance. An empty bottle of Supracide insecticide, of which the active ingredient is methidathion, was found beside him. CRRT was initiated because he showed signs of oliguria and acidosis with an unstable hemodynamic condition. Although his condition improved temporarily after CRRT initiation, it subsequently deteriorated, and he died despite maximal supportive effort. His prefilter plasma cholinesterase levels remained at <200 U/L for 3 days, while his postfilter levels were 358 U/L 1 hour after CRRT initiation and they were 689 U/L 18 hours later. Our case suggests that CRRT might play a role in treating organophosphate poisoning by possibly eliminating organophosphate.

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