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Volume 37 (4); November 2022
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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
  • 5,434 View
  • 371 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract PDF
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

Citations to this article as recorded by  
  • 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
  • 18,539 View
  • 2,938 Download
  • 1 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • 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
  • Does patient-ventilator asynchrony really matter?
    Mattia Docci, Antenor Rodrigues, Sebastian Dubo, Matthew Ko, Laurent Brochard
    Current Opinion in Critical Care.2024;[Epub]     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
  • 9,101 View
  • 787 Download
AbstractAbstract PDFSupplementary 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.
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
  • 6,325 View
  • 404 Download
  • 8 Web of Science
  • 11 Crossref
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • 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
  • 3,553 View
  • 160 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • 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
  • 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.2024;[Epub]     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
  • 4,502 View
  • 133 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • 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
  • 3,492 View
  • 123 Download
  • 6 Web of Science
  • 6 Crossref
AbstractAbstract 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

Citations to this article as recorded by  
  • 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
  • 2,551 View
  • 119 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract 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

Citations to this article as recorded by  
  • 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
  • 3,070 View
  • 145 Download
AbstractAbstract PDFSupplementary 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
  • 2,928 View
  • 118 Download
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AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • 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
  • 3,486 View
  • 115 Download
  • 1 Web of Science
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AbstractAbstract PDF
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.

Citations

Citations to this article as recorded by  
  • 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.
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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AbstractAbstract PDFSupplementary Material
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.

Citations

Citations to this article as recorded by  
  • 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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  • 1 Web of Science
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AbstractAbstract PDFSupplementary Material
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

Citations to this article as recorded by  
  • 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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AbstractAbstract PDFSupplementary Material
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

Citations to this article as recorded by  
  • 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

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