Acute and Critical Care

Original Article

Pulmonary
Using machine learning techniques for early prediction of tracheal intubation in patients with septic shock: a multi-center study in South Korea: Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han; Acute Crit Care. 2025;40(2):221-234. Published online April 30, 2025; DOI: https://doi.org/10.4266/acc.004776

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Background
Patients with septic shock frequently require tracheal intubation in the emergency department (ED). However, the criteria for tracheal intubation are subjective, based on physician experience, or require serial evaluations over relatively long intervals to make accurate predictions, which might not be feasible in the ED. We used supervised learning approaches and features routinely available during the initial stages of evaluation and resuscitation to stratify the risks of tracheal intubation within a 24-hour time window.
Methods
We retrospectively analyzed the data of patients diagnosed with septic shock based on the SEPSIS-3 criteria across 21 university hospital EDs in the Republic of Korea. A principal component analysis revealed a complex, non-linear decision boundary with respect to the application of tracheal intubation within a 24-hour time window. Stratified five-fold cross validation and a grid search were used with extreme gradient boost. Shapley values were calculated to explain feature importance and preferences.
Results
In total, data for 4,762 patients were analyzed; within that population, 1,486 (31%) were intubated within a 24-hour window, and 3,276 (69%) were not. The area under the receiver operating characteristic curve and F1 scores for intubation within a 24-hour window were 0.829 (95% CI, 0.801–0.878) and 0.654 (95% CI, 0.627–0.681), respectively. The Shapley values identified lactate level after initial fluids, suspected lung infection, initial pH, Sequential Organ Failure Assessment score at enrollment, and respiratory rate at enrollment as important features for prediction.
Conclusions
An extreme gradient boosting machine can moderately discriminate whether intubation is warranted within 24 hours of the recognition of septic shock in the ED.

Citations

Citations to this article as recorded by

Early prediction of renal replacement therapy within 24 hours after septic shock recognition in the emergency department using machine learning: a retrospective analysis of a prospectively collected multicenter registry
Sangun Nah, Tae Ho Lim, Sung Phil Chung, Gil Joon Suh, Sung-Hyuk Choi, Woon Yong Kwon, Won Young Kim, Kyuseok Kim, Sangchun Choi, Je Sung You, Han Sung Choi, Tae Gun Shin, Sangsoo Han
BMC Emergency Medicine.2026;[Epub] CrossRef
Methodological development study: Dynamic mask attention graph neural network for mechanical ventilation in elderly intensive care unit patients
Yi Xie, Ni Xie, Jiao Guo
DIGITAL HEALTH.2025;[Epub] CrossRef

Image in Critical Care

CPR/Resuscitation
Surgical decontamination in ferrous sulfate intoxication: Jung-In Ko, Kyung Su Kim, Gil Joon Suh, Seong-Ho Kong, Yoon Sun Jung; Acute Crit Care. 2019;34(3):232-234. Published online April 24, 2019; DOI: https://doi.org/10.4266/acc.2018.00409

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Original Article

CPR/Resuscitation
Comparison between Gel Pad Cooling Device and Water Blanket during Target Temperature Management in Cardiac Arrest Patients: Yoon Sun Jung, Kyung Su Kim, Gil Joon Suh, Jun-Hwi Cho; Acute Crit Care. 2018;33(4):246-251. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00192

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177 Download
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Abstract PDF Supplementary Material

Background
Target temperature management (TTM) improves neurological outcomes for comatose survivors of out-of-hospital cardiac arrest. We compared the efficacy and safety of a gel pad cooling device (GP) and a water blanket (WB) during TTM.
Methods
We performed a retrospective analysis in a single hospital, wherein we measured the time to target temperature (<34°C) after initiation of cooling to evaluate the effectiveness of the cooling method. The temperature farthest from 33°C was selected every hour during maintenance. Generalized estimation equation analysis was used to compare the absolute temperature differences from 33°C during the maintenance period. If the selected temperature was not between 32°C and 34°C, the hour was considered a deviation from the target. We compared the deviation rates during hypothermia maintenance to evaluate the safety of the different methods.
Results
A GP was used for 23 patients among of 53 patients, and a WB was used for the remaining. There was no difference in baseline temperature at the start of cooling between the two patient groups (GP, 35.7°C vs. WB, 35.6°C; P=0.741). The time to target temperature (134.2 minutes vs. 233.4 minutes, P=0.056) was shorter in the GP patient group. Deviation from maintenance temperature (2.0% vs. 23.7%, P<0.001) occurred significantly more frequently in the WB group. The mean absolute temperature difference from 33°C during the maintenance period was 0.19°C (95% confidence interval [CI], 0.17°C to 0.21°C) in the GP group and 0.76°C (95% CI, 0.71°C to 0.80°C) in the WB group. GP significantly decreased this difference by 0.59°C (95% CI, 0.44°C to 0.75°C; P<0.001).
Conclusions
The GP was superior to the WB for strict temperature control during TTM.

Citations

Citations to this article as recorded by

Evaluation of a lightweight water circulation cooling blanket for the prevention of exertional heat stroke
Xin Li, Xin Wang, Rui Yan, Qing Song, Bo Ning, Shuyuan Liu, Qian Wang
Journal of Thermal Biology.2025; 129: 104130. CrossRef
Hydrogels for Climate Change Mitigation: Applications in Water Harvesting, Passive Cooling, and Environmental Solutions
Julia Gałęziewska, Weronika Kruczkowska, Katarzyna Helena Grabowska, Żaneta Kałuzińska-Kołat, Elżbieta Płuciennik
Gels.2025; 11(11): 924. CrossRef
Efficacy and safety of the Arctic Sun device for hypoxic-ischemic encephalopathy in adult patients following cardiopulmonary resuscitation: A systematic review and meta-analysis
Saurabh C. Sharda, Mandip Singh Bhatia, Rohit R. Jakhotia, Ashish Behera, Atul Saroch, Ashok Kumar Pannu, Mohan Kumar H
Brain Circulation.2023; 9(3): 185. CrossRef
Factors influencing deviation from target temperature during targeted temperature management in postcardiac arrest patients
Kanae Ochiai, Yasuhiro Otomo
Open Heart.2023; 10(2): e002459. CrossRef
Water Temperature Variability Is Associated with Neurologic Outcomes in Out-of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management at 33°C
Seok Jin Ryu, Dong Hun Lee, Byung Kook Lee, Kyung Woon Jeung, Yong Hun Jung, Jung Soo Park, Jin Hong Min, Dong Ki Kim
Therapeutic Hypothermia and Temperature Management.2022; 12(2): 74. CrossRef
Comparison of hydrogel pad and water-circulating blanket cooling methods for targeted temperature management: A propensity score-matched analysis from a prospective multicentre registry
Kyoung Tak Keum, Yong Hwan Kim, Jun Ho Lee, Seong Jun Ahn, Seong Youn Hwang, Joo Suk Oh, Su Jin Kim, Soo Hyun Kim, Kyung Woon Jeung
Resuscitation.2021; 169: 78. CrossRef
Use of a Servo-Controlled Cooling Gel Pad System to Regulate Body Temperature in Critically Ill Children
Gema Pérez, Gema Manrique, Julia García, Sara de la Mata, Débora Sanz, Jesús López-Herce
Pediatric Critical Care Medicine.2020; 21(12): e1094. CrossRef
Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef

Case Reports

Infection
Toxic Shock Syndrome following Tattooing: Ki Young Jeong, Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon; Korean J Crit Care Med. 2015;30(3):184-190. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.184

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Abstract PDF

Toxic shock syndrome (TSS) is a rare but life-threatening illness that is mainly caused by toxigenic strains of Staphylococcus aureus. Although TSS is classically known to be associated with tampon use, the number of TSS cases with non-menstrual causes such as skin and soft tissue infection has been increasing. Tattooing can result in several complications such as localized and systemic infections, inflammatory skin eruptions and neoplasms. We recently experienced a 26-year-old man diagnosed with typical TSS following tattooing. He complained of fever, chills and erythematous rash at tattoo site. Subsequently, the patient developed sign of shock. The skin cultures on the tattoo site were positive for methicillin-sensitive Staphylococcus aureus. The patient was successfully treated with vasopressor infusion and intravenous antibiotics and was discharged without complications. On discharge from the hospital 7 days later, desquamations on the tattoo site, fingers and toes were observed.

Citations

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Gram-Negative Bacteremia With Atypical Neurologic Presentation Following Tattoo Application
Adedolapo O Ojo, Desiree Marquez-Santos, Radmehr Rahemipour, Aniqa Aftabi, Alberto Meléndez-Garcia, Saira Shahab, Richard Steward
Cureus.2025;[Epub] CrossRef
Fatal toxic shock syndrome following tattooing
Kristin Schreiner, Marek Balikowski
Forensic Science, Medicine and Pathology.2025;[Epub] CrossRef
Tattoo-associated toxic shock syndrome: a case report
Takuya Kubo, Tetsuya Yumoto, Hideharu Hagiya, Koji Iio, Hiromichi Naito, Atsunori Nakao
International Journal of Emergency Medicine.2025;[Epub] CrossRef
Systemic infections associated with tattoos or permanent makeup: A systematic review
Jordi Rello, Sofia Tejada, Laura Campogiani, Adenike G. Adebanjo, Antonella Tammaro
Medicina Clínica.2022; 158(4): 159. CrossRef
Heterogenes Spektrum an dermatologischen Komplikationen
Lynhda Nguyen, Jana Witte, Maria Christolouka, Stefan W. Schneider, Katharina Herberger
ästhetische dermatologie & kosmetologie.2022; 14(1): 28. CrossRef
Systemic infections associated with tattoos or permanent makeup: A systematic review
Jordi Rello, Sofia Tejada, Laura Campogiani, Adenike G. Adebanjo, Antonella Tammaro
Medicina Clínica (English Edition).2022; 158(4): 159. CrossRef
Tattoo-associated complications and related topics: A comprehensive review
JamesonM Petrochko, AndrewC Krakowski, Colin Donnelly, JohnB Wilson, JenniferBruno Irick, StanislawP Stawicki
International Journal of Academic Medicine.2019; 5(1): 19. CrossRef
The Risk of Bacterial Infection After Tattooing
Ralf Dieckmann, Ides Boone, Stefan O. Brockmann, Jens A. Hammerl, Annette Kolb-Mäurer, Matthias Goebeler, Andreas Luch, Sascha Al Dahouk
Deutsches Ärzteblatt international.2016;[Epub] CrossRef

Gastroenterology
Successful Bridging Hemostasis Using a Sengstaken-Blakemore Tube in Massive Rectal Variceal Bleeding: Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon; Korean J Crit Care Med. 2014;29(3):237-240. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.237

11,539 View
113 Download
2 Crossref

Abstract PDF

Life-threatening rectal variceal bleeding is a rare complication of liver cirrhosis. Various therapeutic interventions including endoscopic variceal ligation and percutaneous transvenous obliteration have been proposed to control significant rectal variceal bleeding. However, these definite hemostasis modalities are not readily available and require an experienced endoscopist or interventional radiologist. Therefore, bridging therapy to control active bleeding is necessary especially in patients with massive bleeding. We report a case of massive rectal variceal bleeding in which a Sengstaken-Blakemore tube was effective at stopping the bleeding until percutaneous transvenous obliteration could be performed.

Citations

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Use of TC-325 Hemostatic Powder as a Rescue Monotherapy for Management of Rectal Variceal Bleed
Amel Tabet Aoul, Vamsee Mupparuju, Jonathan Cirillo, Sreekanth Chandrupatla, Jeffrey Jordan, Maria Castano, Olugbenga Oyesanmi
ACG Case Reports Journal.2024; 11(6): e01391. CrossRef
Anorectal emergencies: WSES-AAST guidelines
Antonio Tarasconi, Gennaro Perrone, Justin Davies, Raul Coimbra, Ernest Moore, Francesco Azzaroli, Hariscine Abongwa, Belinda De Simone, Gaetano Gallo, Giorgio Rossi, Fikri Abu-Zidan, Vanni Agnoletti, Gianluigi de’Angelis, Nicola de’Angelis, Luca Ansaloni
World Journal of Emergency Surgery.2021;[Epub] CrossRef

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