Acute and Critical Care

Guideline

Meta-analysis
Early management of adult sepsis and septic shock: Korean clinical practice guidelines: Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, Ala Woo, Sua Kim, Dae-Hwan Bae, Sung Wook Kang, Sun Hyo Park, Gee Young Suh, Sunghoon Park; Acute Crit Care. 2024;39(4):445-472. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00920

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Abstract PDF Supplementary Material: Background
Despite recent advances and global improvements in sepsis recognition and supportive care, mortality rates remain high, and adherence to sepsis bundle components in Korea is low. To address this, the Korean Sepsis Alliance, affiliated with the Korean Society of Critical Care Medicine, developed the first sepsis treatment guidelines for Korea based on a comprehensive systematic review and meta-analysis.
Methods
A de novo method was used to develop the guidelines. Methodologies included determining key questions, conducting a literature search and selection, assessing the risk of bias, synthesizing evidence, and developing recommendations. The certainty of evidence and the strength of recommendations were determined using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Draft recommendations underwent internal and external review processes and public hearings. The development of these guidelines was supported by a research grant from the Korean Disease Control and Prevention Agency.
Results
In these guidelines, we focused on early treatments for adult patients with sepsis and septic shock. Through the guideline development process, 12 key questions and their respective recommendations were formulated. These include lactate measurement, fluid therapies, target blood pressure, antibiotic administration, use of vasopressors and dobutamine, extracorporeal membrane oxygenation, and echocardiography.
Conclusions
These guidelines aim to support medical professionals in making appropriate decisions about treating adult sepsis and septic shock. We hope these guidelines will increase awareness of sepsis and reduce its mortality rate.

Review Article

Trauma
Abdominal compartment syndrome in critically ill patients: Hyunseok Jang, Naa Lee, Euisung Jeong, Yunchul Park, Younggoun Jo, Jungchul Kim, Dowan Kim; Acute Crit Care. 2023;38(4):399-408. Published online November 29, 2023; DOI: https://doi.org/10.4266/acc.2023.01263

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Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.

Citations

Citations to this article as recorded by

International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome
Prashant Nasa, Robert D. Wise, Marije Smit, Stefan Acosta, Scott D’Amours, William Beaubien–Souligny, Zsolt Bodnar, Federico Coccolini, Neha S. Dangayach, Wojciech Dabrowski, Juan Duchesne, Janeth C. Ejike, Goran Augustin, Bart De Keulenaer, Andrew W. Kir
World Journal of Emergency Surgery.2024;[Epub] CrossRef

Corrigendum

CPR/Resuscitation
Corrigendum to: Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards: Chul Park; Acute Crit Care. 2020;35(3):228-235. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2019.00598.e1; Corrects: Acute Crit Care 2019;34(3):212

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Original Article

CPR/Resuscitation
Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards: Chul Park; Acute Crit Care. 2019;34(3):212-218. Published online August 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00598; Correction in: Acute Crit Care 2020;35(3):228

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12 Web of Science
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Abstract PDF

Background
Peri-intubation cardiac arrest (PICA) following emergent endotracheal intubation (ETI) is a rare, however, potentially preventable type of cardiac arrest. Limited published data have described factors associated with inpatient PICA and patient outcomes. The aim of this study was to identify risk factors associated with PICA among hospitalized patients emergently intubated at a general ward as compared to non-PICA inpatients. In addition, we identified a difference of clinical outcomes in patients between PICA and other types of inpatient cardiac arrest (OTICA).
Methods
We conducted a retrospective observational study of patients at two institutions between January 2016 to December 2017. PICA was defined in patients emergently intubated who experienced cardiac arrest within 20 minutes after ETI. The non-PICA group consisted of inpatients emergently intubated without cardiac arrest. Risk factors for PICA were identified through univariate and multivariate logistic regression analysis. Clinical outcomes were compared between PICA and OTICA.
Results
Fifteen episodes of PICA occurred during the study period, accounting for 3.6% of all inpatient arrests. Intubation-related shock index, number of intubation attempts, pre-ETI vasopressor use, and neuromuscular blocking agent (NMBA) use, especially succinylcholine, were independently associated with PICA. Clinical outcomes of intensive care unit and hospital length of stay, survival to discharge, and neurologic outcome at hospital discharge were not significantly different between PICA and OTICA.
Conclusions
We identified four independent risk factors for PICA, and preintubation hemodynamic stabilization and avoidance of NMBA were possibly correlated with a decreased PICA risk. Clinical outcomes of PICA were similar to those of OTICA.

Citations

Citations to this article as recorded by

Risk factors for peri-intubation cardiac arrest: A systematic review and meta-analysis
Ting-Hao Yang, Shih-Chieh Shao, Yi-Chih Lee, Chien-Han Hsiao, Chieh-Ching Yen
Biomedical Journal.2024; 47(3): 100656. CrossRef
Patient Safety in Anesthesiology: Progress, Challenges, and Prospects
Wafaa Harfaoui, Mustapha Alilou, Ahmed Rhassane El Adib, Saad Zidouh, Aziz Zentar, Brahim Lekehal, Lahcen Belyamani, Majdouline Obtel
Cureus.2024;[Epub] CrossRef
Reverse shock index (RSI) as a predictor of post-intubation cardiac arrest (PICA)
Mehdi Torabi, Ghazal Soleimani Mahani, Moghaddameh Mirzaee
International Journal of Emergency Medicine.2023;[Epub] CrossRef
Incidence and factors associated with out-of-hospital peri-intubation cardiac arrest: a secondary analysis of the CURASMUR trial
Cédric Gil-Jardiné, Patricia Jabre, Frederic Adnet, Thomas Nicol, Patrick Ecollan, Bertrand Guihard, Cyril Ferdynus, Valery Bocquet, Xavier Combes
Internal and Emergency Medicine.2022; 17(2): 611. CrossRef
Risk factors associated with peri-intubation cardiac arrest in the emergency department
Ting-Hao Yang, Kuan-Fu Chen, Shi-Ying Gao, Chih-Chuan Lin
The American Journal of Emergency Medicine.2022; 58: 229. CrossRef
Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis
I-Wen Chen, Yu-Yu Li, Kuo-Chuan Hung, Ying-Jen Chang, Jen-Yin Chen, Ming-Chung Lin, Kuei-Fen Wang, Chien-Ming Lin, Ping-Wen Huang, Cheuk-Kwan Sun
Medicine.2022; 101(33): e30032. CrossRef
Peri-Intubation Cardiorespiratory Arrest Risk in Pediatric Patients: A Systematic Review
Rohit S. Loomba, Riddhi Patel, Elizabeth Kunnel, Enrique G. Villarreal, Juan S. Farias, Saul Flores
Journal of Pediatric Intensive Care.2022;[Epub] CrossRef
Comparison of Suction Rates Between a Standard Yankauer, a Commercial Large-Bore Suction Device, and a Makeshift Large-Bore Suction Device
Dhimitri A. Nikolla, Briana King, Andrew Heslin, Jestin N. Carlson
The Journal of Emergency Medicine.2021; 61(3): 265. CrossRef
Emergency Airway Management Outside the Operating Room: Current Evidence and Management Strategies
Kunal Karamchandani, Jonathan Wheelwright, Ae Lim Yang, Nathaniel D. Westphal, Ashish K. Khanna, Sheila N. Myatra
Anesthesia & Analgesia.2021; 133(3): 648. CrossRef
Further Validation of a Novel Acute Myocardial Infarction Risk Stratification (nARS) System for Patients with Acute Myocardial Infarction
Shinnosuke Sawano, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, Takunori Tsukui, Masaru Seguchi, Hiroshi Wada, Shin-ichi Momomura, Hideo Fujita
International Heart Journal.2020; 61(3): 463. CrossRef
Corrigendum to: Risk factors associated with inpatient cardiac arrest during emergency endotracheal intubation at general wards
Chul Park
Acute and Critical Care.2020; 35(3): 228. CrossRef

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