Acute and Critical Care

Original Article

Neurology
The effects of restricted visitation on delirium incidence in the intensive care units of a tertiary hospital in South Korea: Leerang Lim, Christine Kang, Minseob Kim, Jinwoo Lee, Hong Yeul Lee, Seung-Young Oh, Ho Geol Ryu, Hannah Lee; Acute Crit Care. 2025;40(3):452-461. Published online August 21, 2025; DOI: https://doi.org/10.4266/acc.000500

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Abstract PDF Supplementary Material: Background
Delirium is a common but serious complication in critically ill patients. Family visitation has been shown to reduce delirium; however, during the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) restricted regular visitation to prevent the spread of infection. This study aimed to evaluate the association between visitation policies and incidence of delirium in the ICUs. Methods: This was a retrospective before-and-after study conducted in medical and surgical ICUs at a tertiary hospital. Adult patients admitted to an ICU during one of two periods were included: before the COVID-19 pandemic (June 2017 to May 2019) with regular visitation and during the pandemic (June 2020 to May 2022) with prohibited visitation. Delirium was assessed using the Confusion Assessment Method for the ICU. The primary outcome was association between delirium incidence and visitation policy. Results: Totals of 1,566 patients from the pre-COVID-19 period and 1,404 patients from the COVID-19 period were analyzed. The incidence of delirium was higher during the COVID-19 period (48.1% vs. 38.4%, P<0.001). After adjusting for relevant variables, the restricted visitation policy during COVID-19 remained a risk factor for delirium (odds ratio, 1.37; 95% CI, 1.13–1.65; P=0.001). Conclusions: Complete restriction of ICU visitations during the COVID-19 pandemic was associated with a significant increase in delirium incidence. These findings suggest the importance of visitation policies on patient outcomes and suggest the need for alternative strategies, such as video visitation, to mitigate the adverse effects of visitation restrictions during pandemics.

Review Article

Ethics
Impact of institutional case volume on intensive care unit mortality: Christine Kang, Ho Geol Ryu; Acute Crit Care. 2023;38(2):151-159. Published online May 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00689

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The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.

Citations

Citations to this article as recorded by

Regionalization of Critical Care in Community Settings
Sharon S. Leung, Peter P. Semczuk
Critical Care Clinics.2026; 42(2): 329. CrossRef
Trends of Standardized Mortality Ratio and its Correlation with Admission Patient Volume in Different Intensive Care Units
Yu Qiu, Zhuang Liu, Jing Bai, Mengya Zhao, Haizhou Zhuang, Xiaojun Ji, Jingfeng Liu, Xiuming Xi, Jin Lin, Meili Duan
Journal of Intensive Care Medicine.2026;[Epub] CrossRef
Volume-outcome relationship in pediatric blunt liver and spleen injuries: A multicenter retrospective cohort study
Susumu Matsushime, Akira Kuriyama, Morihiro Katsura
Journal of Pediatric Surgery Open.2025; 10: 100194. CrossRef
Association Between Nurse Staffing Coverage and Patient Outcomes in a Context of Prepandemic Structural Understaffing: A Patient‐Unit‐Level Analysis
Maria-Eulàlia Juvé-Udina, Jordi Adamuz, Maribel González-Samartino, Marta Tapia-Pérez, Emilio Jiménez-Martínez, Carme Berbis-Morello, Oliver Polushkina-Merchanskaya, Adelaida Zabalegui, María-Magdalena López-Jiménez, Claire Su-Yeon Park
Journal of Nursing Management.2025;[Epub] CrossRef
Data-Driven Quality of Care in the ICU: A Concise Review
Giulliana M. Moralez, Filipe Amado, Vincent X. Liu, Sing Chee Tan, Geert Meyfroidt, Robert D. Stevens, David Pilcher, Jorge I. F. Salluh
Critical Care Medicine.2025; 53(12): e2720. CrossRef
Data Science to Improve ICU Benchmarking
Jorge I. F. Salluh, Giulliana M. Moralez, Filipe Amado, Gaston Burghi
Critical Care Medicine.2025; 53(11): e2356. CrossRef
Case volume and specialization in critically ill emergency patients: a nationwide cohort study in Japanese ICUs
Jun Fujinaga, Takanao Otake, Takehide Umeda, Toshio Fukuoka
Journal of Intensive Care.2024;[Epub] CrossRef
Association of Intensive Care Unit Case Volume With Mortality and Cost in Sepsis Based on a Japanese Nationwide Medical Claims Database Study
Takehiko Oami, Taro Imaeda, Taka‑aki Nakada, Tuerxun Aizimu, Nozomi Takahashi, Toshikazu Abe, Yasuo Yamao, Satoshi Nakagawa, Hiroshi Ogura, Nobuaki Shime, Yutaka Umemura, Asako Matsushima, Kiyohide Fushimi
Cureus.2024;[Epub] CrossRef

Original Article

Basic science and research
Feasibility study of incident dark-field video microscope for measuring microcirculatory variables in the mouse dorsal skinfold chamber model: Christine Kang, Ah-Reum Cho, Hyeon Jeong Lee, Hyae Jin Kim, Eun-Jung Kim, Soeun Jeo, Jeong-Min Hong, Daehoan Moon; Acute Crit Care. 2021;36(1):29-36. Published online February 26, 2021; DOI: https://doi.org/10.4266/acc.2020.00969

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Abstract PDF Supplementary Material

Background
Despite the importance of microcirculation in organ function, monitoring microcirculation is not a routine practice. With developments in microscopic technology, incident dark field (IDF) microscopy (Cytocam) has allowed visualization of the microcirculation. Dorsal skinfold chamber (DSC) mouse model has been used to investigate microcirculation physiology. By employing Cytocam-IDF imaging with DSC model to assess microcirculatory alteration in lipopolysaccharide (LPS)-induced endotoxemia, we attempted to validate availability of Cytocam-IDF imaging of microcirculation.
Methods
DSC was implanted in eight BALB/c mice for each group; control and sepsis. Both groups were given 72 hours to recover from surgery. The sepsis group had an additional 24-hour period of recovery post-LPS injection (4 mg/kg). Subsequently, a video of the microcirculation was recorded using Cytocam. Data on microcirculatory variables were obtained. Electron microscopy was implemented using lanthanum fixation to detect endothelial glycocalyx degradation.
Results
The microcirculatory flow index was significantly lower (control, 2.8±0.3; sepsis, 2.1±0.8; P=0.033) and heterogeneity index was considerably higher (control, 0.10±0.15; sepsis, 0.53±0.48; P=0.044) in the sepsis group than in the control group. Electron microscopy revealed glycocalyx demolishment in the sepsis group.
Conclusions
Cytocam showed reliable ability for observing changes in the microcirculation under septic conditions in the DSC model. The convenience and good imaging quality and the automatic analysis software available for Cytocam-IDF imaging, along with the ability to perform real-time in vivo experiments in the DSC model, are expected to be helpful in future microcirculation investigations.

Citations

Citations to this article as recorded by

Sedation with propofol and isoflurane differs in terms of microcirculatory parameters: A randomized animal study using dorsal skinfold chamber mouse model
Christine Kang, Ah-Reum Cho, Haekyu Kim, Jae-Young Kwon, Hyeon Jeong Lee, Eunsoo Kim
Microvascular Research.2024; 153: 104655. CrossRef

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