Acute and Critical Care

Original Articles

Epidemiology
Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital: Jaeyoung Choi, Song-Hee Kim, Ryoung-Eun Ko, Gee Young Suh, Jeong Hoon Yang, Chi-Min Park, Joongbum Cho, Chi Ryang Chung; Acute Crit Care. 2025;40(1):18-28. Published online February 21, 2025; DOI: https://doi.org/10.4266/acc.002976

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Background
Latency in transferring patients from intensive care units (ICUs) to general wards impedes the optimal allocation of ICU resources, underscoring the urgency of initiatives to reduce it. This study evaluates the extent of ICU transfer latency and assesses the potential benefits of minimizing it.
Methods
Transfer latency was measured as the time between the first transfer request and the actual ICU discharge at a single-center tertiary hospital in 2021. Computer-based simulations and cost analyses were performed to examine how reducing transfer latency could affect average hourly ICU bed occupancy, the proportion of time ICU occupancy exceeds 80%, and hospital costs. The first analysis evaluated all ICU admissions, and the second analysis targeted a subset of ICU admissions with longer transfer latency, those requiring infectious precautions.
Results
A total of 7,623 ICU admissions were analyzed, and the median transfer latency was 5.7 hours. Eliminating transfer latency for all ICU admissions would have resulted in a 32.8% point decrease in the proportion of time ICU occupancy exceeded 80%, and a potential annual savings of $6.18 million. Eliminating transfer latency for patients under infectious precautions would have decreased the time ICU occupancy exceeded 80% by 13.5% points, and reduced annual costs by a potential $1.26 million.
Conclusions
Transfer latency from ICUs to general wards might contribute to high ICU occupancy. Efforts to minimize latency for all admissions, or even for a subset of admissions with particularly long transfer latency, could enable more efficient use of ICU resources.

Citations

Citations to this article as recorded by

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

Epidemiology
Postextubation respiratory events in patients admitted to the intensive care unit: a prospective pilot study using overnight respiratory polygraphy: Ye Jin Lee, Jinwoo Lee, Sang-Min Lee, Jaeyoung Cho; Acute Crit Care. 2020;35(4):271-278. Published online November 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00479

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Abstract PDF Supplementary Material

Background
Before the main trial in which respiratory polygraphy will be used to evaluate postextubation sleep apnea in critically ill patients, we performed a prospective pilot study to ensure that any issues with the conduct of the trial would be identified.
Methods
In the present study, 13 adult patients who had received mechanical ventilation for ≥24 hours were prospectively recruited. Among the patients, 10 successfully completed respiratory polygraphy on the first or second night after extubation. Data regarding the types and doses of corticosteroids, analgesics, sedatives, and muscle relaxants as well as the methods of oxygen delivery were recorded.
Results
During the night of respiratory polygraphy, all 10 patients received supplemental oxygen (low-flow oxygen, n=5; high-flow oxygen, n=5), and seven patients received intravenous corticosteroids. Three of the 10 patients had a respiratory event index (REI) ≥5/hr. All respiratory events were obstructive episodes. None of the patients receiving high-flow oxygen therapy had an REI ≥5/hr. Two of the seven patients who received corticosteroids and one of the other three patients who did not receive this medication had an REI ≥5/hr. Although low- or high-flow oxygen therapy was provided, all patients had episodes of oxygen saturation (SpO2) <90%. Two of the three patients with an REI ≥5/hr underwent in-laboratory polysomnography. The patients’ Apnea-Hypopnea Index and REI obtained via polysomnography and respiratory polygraphy, respectively, were similar.
Conclusions
In a future trial to evaluate postextubation sleep apnea in critically ill patients, pre-stratification based on the use of corticosteroids and high-flow oxygen therapy should be considered.

Citations

Citations to this article as recorded by

Effect of sleep quality on weaning from mechanical ventilation: A scoping review
Hana Locihová, Darja Jarošová, Karolína Šrámková, Jana Slonková, Renáta Zoubková, Klára Maternová, Karel Šonka
The Journal of Critical Care Medicine.2025; 11(1): 23. CrossRef
Sleep assessment in critically ill adults: A systematic review and meta-analysis
Ellaha Kakar, Matthijs Priester, Pascale Wessels, Arjen J.C. Slooter, M. Louter, M. van der Jagt
Journal of Critical Care.2022; 71: 154102. CrossRef

Pulmonary
Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire: Jae Kyoung Kim, Ju-Hee Park, Jaeyoung Cho, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2020;35(3):164-168. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00339

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Abstract PDF Supplementary Material

Background
Sleep disorders are common in critically ill patients. Unfortunately, sleep assessment is challenging in many intensive care units (ICUs). The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple subjective tool that has been validated and used in many countries. This study aimed to evaluate the reliability of the Korean version of the RCSQ (K-RCSQ).
Methods
This prospective, cross-sectional, observational study was conducted in the ICUs of two hospitals. In total, 52 consenting patients answered questionnaires regarding their previous night’s sleep (K-RCSQ) and the noise they experienced (range, 0–100).
Results
The K-RCSQ showed excellent internal consistency of 0.960 by Cronbach’s alpha. The mean total score of the K-RCSQ was 41.9±28.9 (range, 0–100). The mean perceived ICU noise score was 40.7±28.1 (range, 0–90). There was a significant linear correlation between noise score and average K-RCSQ score (r=–0.37, P<0.001).
Conclusions
The K-RCSQ demonstrated excellent reliability (internal consistency). This simple tool may help assess sleep quality in critically ill patients and improve the quality of ICU care.

Citations

Citations to this article as recorded by

Iliopsoas plane block does not improve pain after primary total hip arthroplasty in the presence of multimodal analgesia: a single institution randomized controlled trial
Ji Yeong Kim, Jong Seok Lee, Ji Young Kim, Eun Jang Yoon, Wootaek Lee, Seungyeon Lee, Do-Hyeong Kim
Regional Anesthesia & Pain Medicine.2025; 50(3): 257. CrossRef
Effects of nursing interventions applied at night on sleep quality and sleep effort of patients in the intensive care unit
Aynur Bahar, Mina Güner Muşluoğlu, Hilal Uygur
Psychology, Health & Medicine.2025; 30(9): 1947. CrossRef
Effects of a Multimodal Intervention on Sleep Quality and Duration in Intensive Care Unit Patients
Jieun Nam, Sukhee Ahn
Journal of Korean Critical Care Nursing.2025; 18(1): 70. CrossRef
Calidad del sueño en pacientes ingresados en una unidad de cuidados intermedios
Paula Itxaso Sirera-Pérez, Adriana Martín-Sanjoaquín, Beatriz Juandeaburre-Pedroarena, Itziar Luquin-Iturmendi, Rosana Goñi-Viguria
Enfermería Clínica.2025; 35(3): 102157. CrossRef
Sleep quality in patients admitted to an intermediate care unit
Paula Itxaso Sirera-Pérez, Adriana Martín-Sanjoaquín, Beatriz Juandeaburre-Pedroarena, Itziar Luquin-Iturmendi, Rosana Goñi-Viguria
Enfermería Clínica (English Edition).2025; 35(3): 102157. CrossRef
Sleep Quality and Disruptive Factors in Intensive Care Units: A Comparison Between Mechanically Ventilated and Spontaneously Breathing Patients
Öznur Erbay Dalli, Nermin Kelebek Girgin
Nursing in Critical Care.2025;[Epub] CrossRef
Translation and Validation of the Richards–Campbell Sleep Questionnaire for Intensive Care Unit Patients in Morocco: Reliability and Validity Assessment
Abdelmajid Lkoul, Keltouma Oum’barek, Mohamed Amine Baba, Asmaa Jniene, Tarek Dendane
Clocks & Sleep.2025; 7(3): 31. CrossRef
A Randomized Controlled Trial to Evaluate the Analgesic Effectiveness of Periarticular Injections and Pericapsular Nerve Group Block for Patients Undergoing Total Hip Arthroplasty
Bora Lee, Tae Sung Lee, Jaewon Jang, Hyun Eom Jung, Kwan Kyu Park, Yong Seon Choi
Journal of Personalized Medicine.2024; 14(4): 377. CrossRef
Nursing‐Based Sleep Promotion Intervention Effectiveness for Post Cardiac Surgery Patients: Systematic Review
Issa M. Hweidi, Omar H. Jebreel, Hossam N. Alhawatmeh, Mohamad I. Jarrah, Awwad A. Abu‐Awwad, Mohammed I. Hweidi
Journal of Clinical Nursing.2024; 33(12): 4528. CrossRef
Factors influencing sleep quality in the intensive care unit: a descriptive pilot study in Korea
Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee
Acute and Critical Care.2023; 38(3): 278. CrossRef
Psychometric properties of a Thai version of the Richards‐Campbell sleep questionnaire
Nuanprae Kitisin, Pawit Somnuke, Napat Thikom, Nattaya Raykateeraroj, Nisa Poontong, Chayanan Thanakiattiwibun, Karuna Wongtangman
Nursing in Critical Care.2022; 27(6): 885. CrossRef
Sleep assessment in critically ill adults: A systematic review and meta-analysis
Ellaha Kakar, Matthijs Priester, Pascale Wessels, Arjen J.C. Slooter, M. Louter, M. van der Jagt
Journal of Critical Care.2022; 71: 154102. CrossRef
Comparison of pharmacologic therapies alone versus operative techniques in combination with pharmacologic therapies for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial
Hyun-Chang Kim, Young Song, Jong Seok Lee, Myeong Eun Jeong, Yongmin Lee, Jin Hong Lim, Do-Hyeong Kim
International Journal of Surgery.2022; 104: 106763. CrossRef

Rapid response system
Effect of a rapid response system on code rates and in-hospital mortality in medical wards: Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Sulhee Kim, Eunjin Yang, Hyun Joo Lee, Hannah Lee, Ho Geol Ryu, Seung-Young Oh, Eun Jin Ha, Sang-Bae Ko, Jaeyoung Cho; Acute Crit Care. 2019;34(4):246-254. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00668

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Abstract PDF

Background
To determine the effects of implementing a rapid response system (RRS) on code rates and in-hospital mortality in medical wards.
Methods
This retrospective study included adult patients admitted to medical wards at Seoul National University Hospital between July 12, 2016 and March 12, 2018; the sample comprised 4,224 patients admitted 10 months before RRS implementation and 4,168 patients admitted 10 months following RRS implementation. Our RRS only worked during the daytime (7 AM to 7 PM) on weekdays. We compared code rates and in-hospital mortality rates between the preintervention and postintervention groups.
Results
There were 62.3 RRS activations per 1,000 admissions. The most common reasons for RRS activation were tachypnea or hypopnea (44%), hypoxia (31%), and tachycardia or bradycardia (21%). Code rates from medical wards during RRS operating times significantly decreased from 3.55 to 0.96 per 1,000 admissions (adjusted odds ratio [aOR], 0.29; 95% confidence interval [CI], 0.10 to 0.87; P=0.028) after RRS implementation. However, code rates from medical wards during RRS nonoperating times did not differ between the preintervention and postintervention groups (2.60 vs. 3.12 per 1,000 admissions; aOR, 1.23; 95% CI, 0.55 to 2.76; P=0.614). In-hospital mortality significantly decreased from 56.3 to 42.7 per 1,000 admissions after RRS implementation (aOR, 0.79; 95% CI, 0.64 to 0.97; P=0.024).
Conclusions
Implementation of an RRS was associated with significant reductions in code rates during RRS operating times and in-hospital mortality in medical wards.

Citations

Citations to this article as recorded by

Nurses' decisions to recognize and respond to deterioration not meeting rapid response system activation criteria: A qualitative descriptive study
Gabrielle Burdeu, Bodil Rasmussen, Grainne Lowe, Julie Considine
Applied Nursing Research.2026; 87: 152040. CrossRef
Education, Implementation, and Teams: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations
Robert Greif, Adam Cheng, Cristian Abelairas-Gómez, Katherine S. Allan, Jan Breckwoldt, Andrea Cortegiani, Aaron J. Donoghue, Kathryn J. Eastwood, Barbara Farquharson, Ming-Ju Hsieh, Tracy Kidd, Ying-Chih Ko, Kasper G. Lauridsen, Yiqun Lin, Andrew S. Lock
Resuscitation.2025; 215: 110807. CrossRef
Education, Implementation, and Teams: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations
Robert Greif, Adam Cheng, Cristian Abelairas-Gómez, Katherine S. Allan, Jan Breckwoldt, Andrea Cortegiani, Aaron J. Donoghue, Kathryn J. Eastwood, Barbara Farquharson, Ming-Ju Hsieh, Tracy Kidd, Ying-Chih Ko, Kasper G. Lauridsen, Yiqun Lin, Andrew S. Lock
Circulation.2025;[Epub] CrossRef
The role of emergency medical services in the management of in-hospital emergencies: Causes and outcomes of emergency calls – A descriptive retrospective register-based study
Henna Myrskykari, Timo Iirola, Hilla Nordquist
Australasian Emergency Care.2024; 27(1): 42. CrossRef
Effects of a Rapid Response Team on Patient Outcomes: A Systematic Review
Qiuxia Zhang, Khuan Lee, Zawiah Mansor, Iskasymar Ismail, Yi Guo, Qiao Xiao, Poh Ying Lim
Heart & Lung.2024; 63: 51. CrossRef
Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
Kimia Honarmand, Randy S. Wax, Daleen Penoyer, Geoffery Lighthall, Valerie Danesh, Bram Rochwerg, Michael L. Cheatham, Daniel P. Davis, Michael DeVita, James Downar, Dana Edelson, Alison Fox-Robichaud, Shigeki Fujitani, Raeann M. Fuller, Helen Haskell, Ma
Critical Care Medicine.2024; 52(2): 314. CrossRef
Rapid Response Systems
Bradford D. Winters
Critical Care Clinics.2024; 40(3): 583. CrossRef
Improving sepsis recognition and management
Merrilee I Cox, Hillary Voss
Current Problems in Pediatric and Adolescent Health Care.2021; 51(4): 101001. CrossRef
A Somogy Megyei Kaposi Mór Oktató Kórház által bevezetett gyors reagálású rendszer hatása a kórházi mortalitásra
János Fogas, Rita Koroseczné Pavlin, Krisztina Szabó, Eszter Héra, Imre Repa, Mariann Moizs
Orvosi Hetilap.2021; 162(20): 782. CrossRef
Evidence revealed the effects of rapid response system
Jae Hwa Cho
Acute and Critical Care.2019; 34(4): 282. CrossRef

Case Report

Cardiology/Pulmonary
Successful Rescue Therapy with Pumpless Extracorporeal Carbon Dioxide Removal in a Patient with Persistent Air Leakage due to Empyema: Jaeyoung Cho, Yeon Joo Lee, Jae-Ho Lee, Choon-Taek Lee, Young-Jae Cho; Korean J Crit Care Med. 2017;32(3):284-290. Published online November 14, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00185

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Abstract PDF: A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.

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