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

36,510 View
1,605 Download
4 Web of Science
8 Crossref

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.

Citations

Citations to this article as recorded by

Comparison between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest
Sejoong Ahn, Bo-Yeong Jin, Sukyo Lee, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sang Kuk Han, Phil Cho Choi, Young Hwan Lee, Sang O. Park, Jong Seok Lee, Ki Young Jeong, Sung Hyuk Choi, Young Hoon Yoon, Su Jin Kim, Kap Su Han, Min Seob Sim, Gun Tak Lee, Yo
Scientific Reports.2025;[Epub] CrossRef
Recommendations for the use of biomarkers for the management of adults with sepsis: a scoping review and critical appraisal
Miriam Mateos-Haro, Ana Garcia-Santa-Vinuela, Daniel Molano-Franco, Ivan Solà, Federico Gordo-Vidal, María Cruz Martín-Delgado, Jesus Lopez-Alcalde, Javier Zamora
BMJ Open.2025; 15(7): e090922. CrossRef
Regional Adherence to Early Sepsis Management Bundle and Associated Mortality in Hong Kong Between 2009–2018
Jack Zhenhe Zhang, Chun Hei Chan, Lok Ching Chang, Lok Ching Sandra Chiu, Pauline Yeung Ng, Manimala Dharmangadan, Eunise Ho, Steven Ling, Man Yee Man, Ka Man Fong, Ting Liong, Alwin Wai Tak Yeung, Ka Fai Au, Jacky Ka Hing Chan, Michele Tang, Katy Hoi Ki
Open Forum Infectious Diseases.2025;[Epub] CrossRef
Outcomes of septic shock from urinary and non-urinary sources in nonagenarians and centenarians admitted to intensive care units
Je Min Suh, Laurence Weinberg, Nattaya Raykateeraroj, Jerry Lim, Angelina Yoon, David Pilcher, Dong-Kyu Lee
Scientific Reports.2025;[Epub] CrossRef
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
Early Versus Delayed Norepinephrine Initiation in Septic Shock: A Systematic Review and Meta-Analysis of Randomized and Observational Studies
Chibuzo C Manafa, Oluwayemisi E Ekor, Akintunde C Akinboboye, Okelue E Okobi, Gift Ojukwu, Osemwegie O Ugbo, Michael U Mochu, Emasenyie Isikwei, Sergio Hernandez Borges, Miguel Diaz-Miret
Cureus.2025;[Epub] CrossRef
Quality assessment of clinical practice guidelines for sepsis and variations in recommendations
Hong-Yan Li, Shan-Ling Jiang, Jing Wang, Hai-Shan Wang, Li-Hong Wang
BMC Infectious Diseases.2025;[Epub] CrossRef
Evidence-Based Interventions for Sepsis Management in Critically Ill Adults: A Systematic Review
Elsa Jardim Sousa, Michelle de Soresa Virissimo, Abel Mendonça Viveiros, Ana Alves, Valter Gonçalves
European Journal of Medical and Health Research.2025; 3(6): 232. CrossRef

Case Report

Cardiology/Pediatric
Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation: Do Wan Kim, Kyeong Ryeol Cheon, Duck Cho, Kyo Seon Lee, Hwa Jin Cho, In Seok Jeong; Korean J Crit Care Med. 2015;30(2):132-134. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.132

10,596 View
105 Download
5 Crossref

Abstract PDF

Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

Citations

Citations to this article as recorded by

Transfusion-associated graft-versus-host disease, transfusion-associated hyperkalemia, and potassium filtration: advancing safety and sufficiency of the blood supply
Kenneth E. Nollet, Alain M. Ngoma, Hitoshi Ohto
Transfusion and Apheresis Science.2022; 61(2): 103408. CrossRef
Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients
Morgan Burke, Pranava Sinha, Naomi L. C. Luban, Nikki Gillum Posnack
Frontiers in Pediatrics.2021;[Epub] CrossRef
Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease
Sejong Chun, Minh-Trang Thi Phan, Saetbyul Hong, Jehoon Yang, Yeup Yoon, Sangbin Han, Jungwon Kang, Mark H. Yazer, Jaehyun Kim, Duck Cho, Senthilnathan Palaniyandi
PLOS ONE.2020; 15(3): e0229724. CrossRef
Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Chonnam Medical Journal.2017; 53(2): 110. CrossRef
Blood Transfusion Strategies in Patients Supported by Extracorporeal Membrane Oxygenation
Yoon Hee Kim
The Korean Journal of Critical Care Medicine.2015; 30(3): 139. CrossRef

Original Article

Cardiology/Neurology
Efficacy of Electroencephalographic Monitoring for the Evaluation of Intracranial Injury during Extracorporeal Membrane Oxygenation Support in Neonates and Infants: In Seok Jeong, Young Jong Woo, Do Wan Kim, Nan Yeol Kim, Hwa Jin Cho, Jae Sook Ma; Korean J Crit Care Med. 2014;29(2):70-76. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.70

7,068 View
48 Download
2 Crossref

Abstract PDF

Background
Neurological complications are a serious concern during extracorporeal membrane oxygenation (ECMO) support in neonates and infants. However, evaluating brain injury during ECMO has limitations. Herein, we report our experience with bedside electroencephalographic monitoring during ECMO support and compared this to post-ECMO brain imaging studies and immediate neurologic outcomes.
Methods
We retrospectively reviewed the data for 18 children who underwent ECMO. From these subjects, we reviewed the medical records of 10 subjects who underwent bedside EEG monitoring during ECMO support. We collected data on patient demographics, clinical details of the ECMO course, electroencephalographic monitoring, brain imaging results, and neurologic outcomes.
Results
The median age was 4 months (range: 7 days-22 months), the median weight was 5 (3.6-12) kg, and the median length of ECMO therapy was 86 (27-206) hours. Eight patients (80%) were weaned successfully, and seven (70%) survived to discharge. Those with normal to mildly abnormal electroencephalographic findings had non-specific to mildly abnormal brain computed tomography findings and no neurologic impairment. Those patients with a moderately to severely abnormal electroencephalograph had markedly abnormal brain computed tomography findings and remained neurologically impaired.
Conclusions
Normal electroencephalographic findings are closely related to normal or mild neurologic impairment. Our results indicate that electroencephalographic monitoring during ECMO support can be a feasible tool for evaluating brain injury although further prospective studies are needed.

Citations

Citations to this article as recorded by

Neurological monitoring in ECMO patients: current state of practice, challenges and lessons
Hassan Aboul-Nour, Ammar Jumah, Hafsa Abdulla, Amreeta Sharma, Bradley Howell, Namita Jayaprakash, Jayna Gardner-Gray
Acta Neurologica Belgica.2023; 123(2): 341. CrossRef
Neurological Monitoring and Complications of Pediatric Extracorporeal Membrane Oxygenation Support
Ahmed S. Said, Kristin P. Guilliams, Melania M. Bembea
Pediatric Neurology.2020; 108: 31. CrossRef

First
Prev
Page of 1
Next
Last

Search