Acute and Critical Care

Original Articles

Surgery
Feasibility and accuracy of continuous glucose monitoring in surgical intensive care unit patients : a single-center pilot study in South Korea: Hyojun Park, Eunmi Gil, Joon Ho Lee, Chi-Min Park; Received October 21, 2025 Accepted December 31, 2025 Published online March 27, 2026; DOI: https://doi.org/10.4266/acc.004975 [Epub ahead of print]

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Abstract PDF Supplementary Material: Background
Continuous glucose monitoring (CGM) technology offers potential advantages over intermittent point-of-care testing in critically ill patients by providing real-time glucose trends and automated alerts. However, its accuracy and feasibility in intensive care settings require validation before widespread implementation.
Methods
We conducted a single-center observational pilot study, evaluating CGM feasibility in 11 surgical intensive care unit (ICU) patients, including nine post–liver transplant recipients. The G6 CGM system was applied for continuous monitoring. CGM readings were paired with point-of-care glucose measurements for accuracy assessment. Performance metrics included the mean absolute relative difference (MARD), bias, standard deviation of relative differences (SDRD), Surveillance Error Grid (SEG) analysis, and International Organization for Standardization (ISO) 15197:2013 criteria compliance.
Results
During a median monitoring period of 5 days (interquartile range [IQR], 3–9), we analyzed 326 paired glucose measurements. CGM demonstrated acceptable accuracy, with a MARD of 13.5% (95% CI, 11.43%–15.76%), bias of 2.79% (95% CI, –2.48 to 7.27%), and SDRD of 18.69% (95% CI, 13.75%–23.65%). SEG analysis confirmed 99.1% of readings were in clinically acceptable zones A and B. ISO 15197:2013 criteria showed 62.9% of measurements were within ±15 mg/dl or ±15%. The median patient-level mean glucose was 199.0 mg/dl (IQR, 162.0–248.0), reflecting substantial hyperglycemic exposure in patients receiving high-dose methylprednisolone despite protocolized insulin therapy targeting a range of 140–180 mg/dl.
Conclusions
CGM was feasible and acceptably accurate in ICU patients. Persistent hyperglycemia despite protocolized care indicates that CGM-derived data may help to identify opportunities for future protocol improvement. Its potential impact on the time-in-target range, hypoglycemia, and clinical outcomes should be evaluated in future multicenter studies.

Epidemiology
Comparing single-patient and multi-patient room intensive care units: a multicenter cohort study on architectural differences and clinical significance in South Korea: Daun Jeong, Donghyoun Lee, Kyoung Won Yoon, Hyo Jin Kim, Sun Young Choi, Chi-Min Park; Acute Crit Care. 2025;40(2):160-170. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.004968

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Background
The design of intensive care units (ICUs) is increasingly acknowledged as a crucial factor affecting patient outcomes. Transitioning from multi-bed patient rooms (MPRs) to single-bed patient rooms (SPRs) aims to improve infection control, patient privacy, and quality of care. However, concerns remain regarding potential patient isolation and reduced staff situational awareness. This study aims to evaluate clinical outcomes in SPR-structured ICUs compared to mixed SPR and MPR ICUs.
Methods
This multicenter retrospective cohort study was conducted across three university-affiliated tertiary hospitals between April 2022 and August 2023. The study population included ICU patients aged ≥18 years, excluding those admitted to cardiac and neonatal ICUs. Outcomes assessed included ICU mortality and severity scores based on Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores.
Results
This study included 3,179 ICU patients across three sites: site A consisted exclusively of SPRs, while sites B and C had mixed SPR and MPR arrangements. ICU mortality rates were 8.3%, 15.2%, and 9.7% for sites A, B, and C, respectively (P<0.001). Propensity score matching and logistic regression analysis demonstrated that SPRs were associated with significantly reduced ICU mortality (adjusted odds ratio, 0.54; 95% CI, 0.40–0.73).
Conclusions
SPRs were associated with a protective effect, reducing ICU mortality. Clinical outcomes in ICUs appear to be influenced by structural design improvements alongside other clinical factors.

Citations

Citations to this article as recorded by

Single Versus Shared ICU Rooms and the Risk of Unplanned Extubation: A Real-World Cohort Showing Tube Displacement as an Early Signal
Beatriz Amaral Costa Savino, Danilo Franco Guidi, Silvia Helena Ferraz Planard, Viviane Perin, Bruno Augusto Goulart Campos
Cureus.2026;[Epub] CrossRef
Survival improvement through well-designed intensive care unit architecture
Dong Hyun Lee
Acute and Critical Care.2025; 40(2): 349. CrossRef

Epidemiology
Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital: Jaeyoung Choi, Song-Hee Kim, Ryoung-Eun Ko, Gee Young Suh, Jeong Hoon Yang, Chi-Min Park, Joongbum Cho, Chi Ryang Chung; Acute Crit Care. 2025;40(1):18-28. Published online February 21, 2025; DOI: https://doi.org/10.4266/acc.002976

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Abstract PDF Supplementary Material

Background
Latency in transferring patients from intensive care units (ICUs) to general wards impedes the optimal allocation of ICU resources, underscoring the urgency of initiatives to reduce it. This study evaluates the extent of ICU transfer latency and assesses the potential benefits of minimizing it.
Methods
Transfer latency was measured as the time between the first transfer request and the actual ICU discharge at a single-center tertiary hospital in 2021. Computer-based simulations and cost analyses were performed to examine how reducing transfer latency could affect average hourly ICU bed occupancy, the proportion of time ICU occupancy exceeds 80%, and hospital costs. The first analysis evaluated all ICU admissions, and the second analysis targeted a subset of ICU admissions with longer transfer latency, those requiring infectious precautions.
Results
A total of 7,623 ICU admissions were analyzed, and the median transfer latency was 5.7 hours. Eliminating transfer latency for all ICU admissions would have resulted in a 32.8% point decrease in the proportion of time ICU occupancy exceeded 80%, and a potential annual savings of $6.18 million. Eliminating transfer latency for patients under infectious precautions would have decreased the time ICU occupancy exceeded 80% by 13.5% points, and reduced annual costs by a potential $1.26 million.
Conclusions
Transfer latency from ICUs to general wards might contribute to high ICU occupancy. Efforts to minimize latency for all admissions, or even for a subset of admissions with particularly long transfer latency, could enable more efficient use of ICU resources.

Citations

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Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea
Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh
Acute and Critical Care.2025; 40(4): 548. CrossRef

Brief Communication

Intensivist/Policy
Experience of augmenting critical care capacity in Daegu during COVID-19 incident in South Korea: Je Hyeong Kim, Suk-Kyung Hong, Younghwan Kim, Ho Geol Ryu, Chi-Min Park, Young Seok Lee, Sung Jin Hong; Acute Crit Care. 2020;35(2):110-114. Published online May 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00275

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Citations

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From trauma surgery to acute care surgery: a 4-year observational study at a single trauma center in Korea
Jung-Woo Woo, Jae Yool Jang, Yo Seok Cho, Hongkyung Shin, Chan Yong Park
Journal of Trauma and Injury.2025; 38(4): 382. CrossRef
The Activities and Roles of Trauma Surgeons in the Treatment of COVID-19 Patients
Younghwan Kim, Seok Hwa Youn
Journal of Acute Care Surgery.2023; 13(2): 43. CrossRef
Inhalation of Origanum majorana L. essential oil while working reduces perceived stress and anxiety levels of nurses in a COVID-19 intensive care unit: a randomized controlled trial
Sang Wook Lee, You Kyoung Shin, Jeong-Min Lee, Geun Hee Seol
Frontiers in Psychiatry.2023;[Epub] CrossRef
What happened during the period from senior medical students’ withdrawal of their applications to take the Korean Medical Licensing Examination in August 2020 to their taking the licensing examination in February 2021
Sun Huh
Journal of Educational Evaluation for Health Professions.2022; 19: 3. CrossRef
Comparison of clinical characteristics and hospital mortality in critically ill patients without COVID-19 before and during the COVID-19 pandemic: a multicenter, retrospective, propensity score-matched study
Sua Kim, Hangseok Choi, Jae Kyeom Sim, Won Jai Jung, Young Seok Lee, Je Hyeong Kim
Annals of Intensive Care.2022; 12(1): 57. CrossRef
Correlation Between Third Dose of COVID-19 Vaccines and Regional Case Fatality Rates During the Omicron Wave in Korea
Youngook Jang, In Joong Kim, Sung-Sil Moon, Sun Bean Kim, Jacob Lee
Journal of Korean Medical Science.2022;[Epub] CrossRef
Socioeconomic disparity and the risk of contracting COVID-19 in South Korea: an NHIS-COVID-19 database cohort study
Tak Kyu Oh, Jae-Wook Choi, In-Ae Song
BMC Public Health.2021;[Epub] CrossRef
Association of Intensive Care Unit Patient Load and Demand With Mortality Rates in US Department of Veterans Affairs Hospitals During the COVID-19 Pandemic
Dawn M. Bravata, Anthony J. Perkins, Laura J. Myers, Greg Arling, Ying Zhang, Alan J. Zillich, Lindsey Reese, Andrew Dysangco, Rajiv Agarwal, Jennifer Myers, Charles Austin, Ali Sexson, Samuel J. Leonard, Sharmistha Dev, Salomeh Keyhani
JAMA Network Open.2021; 4(1): e2034266. CrossRef
Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit
Sung Jun Ko, Jaeyoung Cho, Sun Mi Choi, Young Sik Park, Chang-Hoon Lee, Chul-Gyu Yoo, Jinwoo Lee, Sang-Min Lee, Robert Jeenchen Chen
PLOS ONE.2021; 16(10): e0259092. CrossRef

Erratum

Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient: Eunmi Gil, Tae Sun Ha, Gee Young Suh, Chi Ryang Chung, Chi-Min Park; Korean J Crit Care Med. 2016;31(3):263-263. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.129.e01; Corrects: Acute Crit Care 2016;31(2):129

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Case Reports

Infection
Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient: Eunmi Gil, Tae Sun Ha, Gee Young Suh, Chi Ryang Chung, Chi-Min Park; Korean J Crit Care Med. 2016;31(2):129-133. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.129; Correction in: Acute Crit Care 2016;31(3):263

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Abstract PDF

Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.

Citations

Citations to this article as recorded by

Aspergillus fumigatus cholangitis in a patient with cholangiocarcinoma: case report and review of the literature
Kathrin Rothe, Sebastian Rasch, Nina Wantia, Alexander Poszler, Joerg Ulrich, Christoph Schlag, Wolfgang Huber, Roland M. Schmid, Dirk H. Busch, Tobias Lahmer
Infection.2021; 49(1): 159. CrossRef

Infection
Disseminated Gastrointestinal Mucormycosis in Immunocompromised Disease: Tae Sun Ha, Chi-Min Park, Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh; Korean J Crit Care Med. 2015;30(4):323-328. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.323

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Abstract PDF

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.

Citations

Citations to this article as recorded by

Gastric Mucormycosis: A Systematic Review with Metadata
Ayman M. Mustafa, Yousif M. Mahmood, Ali H. Hasan, Hoshmand R. Asaad, Dana T. Gharib, Karokh F. Hama Hussein, Karzan M. Hasan, Deari A. Ismaeil, Dilan S. Hiwa, Rawa M. Ali, Khanda A. Anwar, Diyar A. Omar, Mohammed Q. Mustafa
Barw Medical Journal.2024;[Epub] CrossRef
A Fatal Case of Disseminated Intestinal Mucormycosis in a Patient with Vibrio Sepsis
Seungwoo Chung, Hyun-Jung Sung, Jong Won Chang, Ile Hur, Ho Cheol Kim
Journal of Acute Care Surgery.2021; 11(3): 133. CrossRef
Gastric Mucormycosis Followed by Traumatic Cardiac Rupture in an Immunocompetent Patient
Sang Won Lee, Hyun Seok Lee
The Korean Journal of Gastroenterology.2016; 68(2): 99. CrossRef

Infection/Surgery
Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation: Young Kun Lee, Jeong Am Ryu, Jeong Hoon Yang, Chi-Min Park, Gee Young Suh, Kyeongman Jeon, Chi Ryang Chung; Korean J Crit Care Med. 2015;30(3):176-179. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.176

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Abstract PDF: Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.

Original Article

Pulmonary
Factors Affecting Invasive Management after Unplanned Extubation in an Intensive Care Unit: A Lan Lee, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Chi-Min Park, Gee Young Suh; Korean J Crit Care Med. 2015;30(3):164-170. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.164

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Abstract PDF

Background
Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU.
Methods
Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE.
Results
The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE.
Conclusions
To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.

Citations

Citations to this article as recorded by

Re-Intubation Among Critical Care Patients: A Scoping Review
Thandar Soe Sumaiyah Jamaludin, Mohd Said Nurumal, Nur Syila Syahida Syaziman, Syuhada Suhaimi, Muhammad Kamil Che Hasan
INTERNATIONAL JOURNAL OF CARE SCHOLARS.2021; 4(Supp1): 93. CrossRef

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