Acute and Critical Care

Editorial

Ethics
Will implementation of the Life-sustaining Treatment Decisions Act reduce the incidence of cardiopulmonary resuscitation?: In-Ae Song; Acute Crit Care. 2022;37(2):256-257. Published online May 30, 2022; DOI: https://doi.org/10.4266/acc.2022.00668

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Review Article

Basic Science and Research
Review of remimazolam and sedatives in the intensive care unit: Hey-Ran Choi, In-Ae Song; Acute Crit Care. 2022;37(2):151-158. Published online May 30, 2022; DOI: https://doi.org/10.4266/acc.2022.00619

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Remimazolam is a novel intravenous ultra-short acting benzodiazepine that has the potential of being a safe and effective new sedative for use in intensive care unit (ICU) settings. Because remimazolam metabolizes rapidly by being hydrolyzed to an inactive metabolite (CNS 7054) through non-specific tissue esterase activity, specific dosing adjustment for older adults and for patients with renal or hepatic impairment patients (except for those with severe hepatic impairment) is not required. In addition, research has shown that remimazolam may be reversed by administration of flumazenil, as its half time was sufficiently short compared to flumazenil. It shows a lower incidence of cardiorespiratory depression, less injection pain, and no fatal complications such as propofol infusion syndrome and malignant hyperthermia of inhalational anesthetics. Future studies to study the suitability of remimazolam for managing the sedation of ICU patients who need sedation for a long time over several days is required.

Citations

Citations to this article as recorded by

Clinical applications and pharmacological characteristics of remimazolam, a short-acting sedative: a narrative review
Kyung Mi Kim
Journal of the Korean Medical Association.2026; 69(4): 335. CrossRef
Effect and hemodynamics of remimazolam besylate on sedation of mechanically ventilated patients: a propensity score-matched study
Wenjie Xie, Xiaoyu Fang, Zhaokun Shi, Wei Wu, Miao Wu, Handong Zou, Shasha Wang, Huifang Wan, Guang Li, Wenfang Xia, Wenwei Gao, Zhenwen Li, Zhou Liu, Lingxia Qin, Guijun Jiang, Lu Wang, Liying Zhan
BMC Anesthesiology.2026;[Epub] CrossRef
Remimazolam Versus Midazolam for Sedation in Mechanically Ventilated Patients with Severe Pneumonia: A Randomized Controlled Trial
Haobo Kong, Jingjing Pan, Min Liang, Shufeng Yu, Xuehui Fang Xuehui
Journal of Intensive Care Medicine.2026;[Epub] CrossRef
Age‑stratified median effective dose (ED₅₀) of remimazolam besylate for successful gastroscope insertion without body movement in geriatric patients
Si-Qi Hao, Zhe Ma, Fang-Yu Zhang, Yi-Xin Hu, Li-Xin An
BMC Anesthesiology.2026;[Epub] CrossRef
Seizure adequacy and safety of remimazolam in electroconvulsive therapy for patients with psychiatric disorders: a double-blind randomized crossover trial
Tianqi Shen, Xingxing Yin, Yongming Zhang, Feng Wang, Haipeng Wang, Xiufang Shi, Yanmiao Qiu, Jia Li, Xinhong Du
BMC Psychiatry.2026;[Epub] CrossRef
Efficacy of remimazolam besylate versus propofol on hemodynamics during anesthetic induction in elderly patients undergoing bronchoscopy: a randomized controlled trial
Danni Li, Yang Cheng, YuanYuan Zhou, Siyi Wei, Dan Fan
BMC Anesthesiology.2026;[Epub] CrossRef
Consensus statement for managing patients with ARDS in low-resource settings: a Delphi study
Pedja Kovacevic, Jesús Villar, Boris Tomic, Fabio Silvio Taccone, Giacomo Grasselli, Luigi Camporota, Marlies Ostermann, Ivan Palibrk, Rajesh Mishra, Sasa Dragic, Jose Diaz-Gomez, Danica Momcicevic, Ali Ait Hssain, Biljana Zlojutro, Jihad Mallat, Milka Ja
Annals of Intensive Care.2026; 16: 100144. CrossRef
The Psychiatric Domain of Post-Intensive Care Syndrome: A Review for the Intensivist
Allison Rhodes, Christopher Wilson, Dimitar Zelenkov, Kathryne Adams, Janelle O. Poyant, Xuan Han, Anthony Faugno, Cristina Montalvo
Journal of Intensive Care Medicine.2025; 40(12): 1223. CrossRef
Con: Remimazolam: The New Miracle Cure for Critically Ill Patients
Rayssa Becerra Orjuela, Juan G. Ripoll
Journal of Cardiothoracic and Vascular Anesthesia.2025; 39(4): 1082. CrossRef
Optimizing Pediatric Sedation: Evaluating Remimazolam and Dexmedetomidine for Safety and Efficacy in Clinical Practice
Vera Scheckenbach, Frank Fideler
Pediatric Drugs.2025; 27(2): 181. CrossRef
Comparison of remimazolam–flumazenil versus propofol on delayed emergence from anaesthesia in major spine surgery: protocol for a multicentre, single-blinded, randomised controlled trial
Jingjing Sun, Wei Luo, Liang Wen, Yanying Xiao, Ruping Dai
BMJ Open.2025; 15(8): e097541. CrossRef
The degree of respiratory depression according to the effect-site concentration in remimazolam target-controlled infusion
Soo Jung Park, Sang Kee Min, Gyubin Choi, Ji Eun Kim, Ha Yeon Kim
European Journal of Anaesthesiology.2024; 41(10): 728. CrossRef
Remimazolam Anesthesia for a Pediatric Patient With Glutaric Aciduria Type I: A Case Report
Tomoko Tsuruno, Hiroki Tateiwa, Yuki Hashimoto, Yoshifumi Katsumata, Takashi Kawano
Cureus.2024;[Epub] CrossRef
Remimazolam – Update zu Grundlagen und klinischem Potenzial
Vera Scheckenbach, Berthold Drexler
Die Anaesthesiologie.2024; 73(9): 617. CrossRef
Remimazolam: A New Ingress in Cardiac Surgical Intensive Care Unit
Minati Choudhury, Poonam Malhotra Kapoor
Journal of Cardiac Critical Care TSS.2023; 7: 133. CrossRef
Safety and efficacy of remimazolam tosilate combined with low-dose fentanyl for procedural sedation in obese patients undergoing gastroscopy: study protocol for a single-centre, double-blind, randomised controlled trial
Lijuan Yan, Xiao Wang, Zhenyi Chen, Ningning Wu, Hao Li, Bin Yang
BMJ Open.2023; 13(12): e079095. CrossRef
Remimazolam: An Updated Review of a New Sedative and Anaesthetic
Qinxue Hu, Xing Liu, Chengli Wen, Duo Li, Xianying Lei
Drug Design, Development and Therapy.2022; Volume 16: 3957. CrossRef
National analysis of applied sedation in critical care patients
Grace Pamela López Pérez , Melani Dayana Carrera Casa , Gissela Lizbeth Amancha Moyulema , Yadira Nathaly Chicaiza Quilligana , Ana Belén Guamán Tacuri , Joselyn Mireya Iza Arias
Salud, Ciencia y Tecnología.2022; 2: 234. CrossRef

Original Articles

Surgery
Association of Immediate Postoperative Temperature in the Surgical Intensive Care Unit with 1-Year Mortality: Retrospective Analysis Using Digital Axillary Thermometers: Jiwook Kim, Tak Kyu Oh, Jaebong Lee, Saeyeon Kim, In-Ae Song; Acute Crit Care. 2019;34(1):53-59. Published online January 9, 2019; DOI: https://doi.org/10.4266/acc.2019.00255

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Abstract PDF Supplementary Material

Background
Postoperative body temperature is closely associated with prognosis although there is limited research regarding this association at postoperative intensive care unit (ICU) admission. Furthermore, no studies have used digital axillary thermometers to measure postoperative body temperature. This study investigated the association between mortality and postoperative temperature measured using a digital axillary thermometer within 10 minutes after ICU admission. Methods: This retrospective observational study evaluated data from adult patients admitted to an ICU after elective or emergency surgery. The primary outcome was 1-year mortality after ICU admission. Multivariable logistic regression analysis with restricted cubic splines was used to evaluate the association between temperature and outcomes. Results: We evaluated data from 5,868 patients admitted between January 1, 2013 and May 31, 2016, including 5,311 patients (90.5%) who underwent noncardiovascular surgery and 557 patients (9.5%) who underwent cardiovascular surgery. Deviation from the median temperature (36.6°C) was associated with increases in 1-year mortality (≤ 36.6°C: linear coefficient, –0.531; P<0.001 and ≥36.6°C: spline coefficient, 0.756; P<0.001). Similar statistically significant results were observed in the noncardiovascular surgery group, but not in the cardiovascular surgery group. Conclusions: An increase or decrease in body temperature (vs. 36.6°C) measured using digital axillary thermometers within 10 minutes of postoperative ICU admission was associated with increased 1-year mortality. However, no significant association was observed after cardiovascular surgery. These results suggest that postoperative temperature is associated with longterm mortality in patients admitted to the surgical ICU in the postoperative period.

Citations

Citations to this article as recorded by

Hypothermia in the intensive care unit after surgery: a registry based retrospective cohort study
Jeremy Weiss, Matthew Durie, Tamishta Hensman, Tess Evans, David Pilcher
BJA Open.2026; 19: 100556. CrossRef
Construction of a nursing assessment framework for patients in anaesthesia recovery period: A modified Delphi study
Lang Peng, Xianxian Zang, Ruili Liu, Ping Bai, Lu Wang, Guoyong Yang
Journal of Advanced Nursing.2024; 80(9): 3653. CrossRef
A prognostic model for 1-month mortality in the postoperative intensive care unit
Mohammad Fathi, Nader Markazi Moghaddam, Saba Naderian Jahromi
Surgery Today.2022; 52(5): 795. CrossRef
Relationship Between First 24-h Mean Body Temperature and Clinical Outcomes of Post-cardiac Surgery Patients
Fei Xu, Cheng Zhang, Chao Liu, Siwei Bi, Jun Gu
Frontiers in Cardiovascular Medicine.2021;[Epub] CrossRef
Rebound hypothermia after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and cardiac arrest in immediate postoperative period: a report of two cases and review of literature
Sohan Lal Solanki, Mrida A. K. Jhingan, Avanish P. Saklani
Pleura and Peritoneum.2020;[Epub] CrossRef
Postoperative Hypothermia
Deokkyu Kim
Acute and Critical Care.2019; 34(1): 79. CrossRef

Epidemiology
Impact of Socioeconomic Status on 30-Day and 1-Year Mortalities after Intensive Care Unit Admission in South Korea: A Retrospective Cohort Study: Tak Kyu Oh, Jihoon Jo, Young-Tae Jeon, In-Ae Song; Acute Crit Care. 2018;33(4):230-237. Published online November 13, 2018; DOI: https://doi.org/10.4266/acc.2018.00514

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Abstract PDF Supplementary Material

Background
Socioeconomic status (SES) is closely associated with health outcomes, including mortality in critically ill patients admitted to intensive care unit (ICU). However, research regarding this issue is lacking, especially in countries where the National Health Insurance System is mainly responsible for health care. This study aimed to investigate how the SES of ICU patients in South Korea is associated with mortality.
Methods
This was a retrospective observational study of adult patients aged ≥20 years admitted to ICU. Associations between SES-related factors recorded at the time of ICU admission and 30-day and 1-year mortalities were analyzed using univariable and multivariable Cox regression analyses.
Results
A total of 6,008 patients were included. Of these, 394 (6.6%) died within 30 days of ICU admission, and 1,125 (18.7%) died within 1 year. Multivariable Cox regression analysis found no significant associations between 30-day mortality after ICU admission and SES factors (P>0.05). However, occupation was significantly associated with 1-year mortality after ICU admission.
Conclusions
Our study shows that 30-day mortality after ICU admission is not associated with SES in the National Health Insurance coverage setting. However, occupation was associated with 1-year mortality after ICU admission.

Citations

Citations to this article as recorded by

Socioeconomic Disparities and the Role of Comorbidity in Hospital Mortality: A Dutch Nationwide Critical Care Cohort Study
Jip W.T.M. de Kok, Daniëlle J.M. Koornneef, Fabian Termorshuizen, Ronny M. Schnabel, Iwan C.C. van der Horst, Nicolette F. de Keizer, Sylvia Brinkman, Bas C.T. van Bussel
Critical Care Medicine.2026;[Epub] CrossRef
Association Between Socioeconomic Status and Outcomes in Critical Care: A Systematic Review and Meta-Analysis
Ryan D. McHenry, Christopher E. J. Moultrie, Tara Quasim, Daniel F. Mackay, Jill P. Pell
Critical Care Medicine.2023; 51(3): 347. CrossRef
The effect of socioeconomic status, insurance status, and insurance coverage benefits on mortality in critically ill patients admitted to the intensive care unit
Moo Suk Park
Acute and Critical Care.2022; 37(1): 118. CrossRef
Association between off-hour admission of critically ill children to intensive care units and mortality in a Japanese registry
Takahiro Kido, Masao Iwagami, Toshikazu Abe, Yuki Enomoto, Hidetoshi Takada, Nanako Tamiya
Scientific Reports.2021;[Epub] CrossRef
Associations Between Socioeconomic Status, Patient Risk, and Short-Term Intensive Care Outcomes
Daniel V. Mullany, David V. Pilcher, Annette J. Dobson
Critical Care Medicine.2021; 49(9): e849. CrossRef
Association of Economic Status and Mortality in Patients with Acute Respiratory Distress Syndrome
Tak Kyu Oh, In-Ae Song, Jae Ho Lee
International Journal of Environmental Research and Public Health.2020; 17(6): 1815. CrossRef
Critical Care Research Using “Big Data”: A Reality in the Near Future
Kwangha Lee
Acute and Critical Care.2018; 33(4): 269. CrossRef

Letter to the Editor

Ethics
Should Very Old Patients Be Admitted to the Intensive Care Units?: Jun Kwon Cha, In-Ae Song; Korean J Crit Care Med. 2017;32(4):376-377. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00521

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