Acute and Critical Care

Original Articles

Pulmonary
Characteristics and management of mechanically ventilated patients in South Korea compared with other high-income Asian countries and regions: Kyung Hun Nam, Kyeongman Jeon, Suk-Kyung Hong, Ah Young Leem, Jee Hwan Ahn, Hang Jea Jang, Ki Sup Byun, So Hee Park, Sojung Park, Yoon Mi Shin, Jisoo Park, Sung Wook Kang, Jin Hyoung Kim, Jinkyeong Park, Deokkyu Kim, Bo young Lee, Woo Hyun Cho, Kwangha Lee, Song I Lee, Tai Sun Park, Yun Jung Jung, Sang-Hyun Kwak, Sang-Beom Jeon, Sung Hyun Kim, Won Jai Jung, Sang-Min Lee, Sunghoon Park, Yun Su Sim, Young-Jae Cho, Younsuck Koh; Acute Crit Care. 2025;40(3):413-424. Published online August 21, 2025; DOI: https://doi.org/10.4266/acc.003336

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Abstract PDF: Background
This study investigated the characteristics of mechanically ventilated patients in South Korean intensive care units (ICUs). Methods: We conducted a subgroup analysis of a multinational observational study. Data from 271 mechanically ventilated patients in South Korean ICUs were analyzed for demographics, ventilation practices, and mortality, and were compared with those of 327 patients from other high-income Asian countries. Results: South Korean patients were older (mean age: 67 vs. 62 years, P<0.001) and had lower ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (255.5 vs. 306.2, P<0.001). South Korean ICUs exhibited higher patient-to-nurse ratios (2.6 vs. 1.9, P<0.001) and more beds per unit (20.5 vs. 16.0, P=0.017). The use of sufficient positive end-expiratory pressure for patients (PEEP) for acute respiratory distress syndrome (ARDS) was less frequent in South Korea (62.2% vs. 91.2%, P=0.005). Mortality rates were similar between South Korean patients and those in other high-income Asian countries (38.0% vs. 34.2%, P=0.401). Significant mortality predictors in South Korea included age ≥65 years (odds ratio [OR], 4.03; P=0.039) and a Sequential Organ Failure Assessment score ≥8 (OR, 2.36; P=0.031). The presence of respiratory therapists was associated with reduced mortality (OR, 0.52; P=0.034). Conclusions: Despite higher age and patient-to-nurse ratios in South Korean ICUs, outcomes were comparable to those in other high-income Asian countries. The suboptimal use of sufficient PEEP with ARDS indicates potential areas for improvement. Additionally, the beneficial impact of respiratory therapists on mortality rates warrants further investigation.

Pulmonary
Closed intensive care units and sepsis patient outcomes: a secondary analysis of data from a multicenter prospective observational study in South Korea: Kyeongman Jeon, Jin Hyoung Kim, Kyung Chan Kim, Heung Bum Lee, Hongyeul Lee, Song I Lee, Jin-Won Huh, Won Gun Kwack, Youjin Chang, Yun-Seong Kang, Won Yeon Lee, Je Hyeong Kim; Acute Crit Care. 2025;40(2):209-220. Published online May 22, 2025; DOI: https://doi.org/10.4266/acc.004128

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Abstract PDF: Background
Sepsis is a leading cause of intensive care unit (ICU) admission. However, few studies have evaluated how the ICU model affects the outcomes of patients with sepsis.
Methods
This post hoc analysis of data from the Management of Severe Sepsis in Asia’s Intensive Care Units II study included 537 patients with sepsis admitted to 27 ICUs in Korea. The outcome measures of interest were compared between the closed ICU group, patients admitted under the full responsibility of an intensivist as the primary attending physician, and the open ICU group. The association between a closed ICU and ICU mortality was evaluated using a logistic regression analysis.
Results
Altogether, 363 and 174 enrolled patients were treated in open and closed ICUs, respectively. Compliance with the sepsis bundles did not differ between the two groups; however, the closed ICU group had a higher rate of renal replacement therapy and shorter duration of ventilator support. The closed ICU group also had a lower ICU mortality rate than the open ICU group (24.7% vs. 33.1%). In a logistic regression analysis, management in the closed ICU was significantly associated with a decreased ICU mortality rate even after adjusting for potential confounding factors (adjusted odds ratio, 0.576; 95% CI, 0.342–0.970), and that association was observed for up to 90 days.
Conclusions
Sepsis management in closed ICUs was significantly associated with improved ICU survival and decreased length of ICU stay, even though the compliance rates for the sepsis bundles did not differ between open and closed ICUs.

Infection
In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19: Yong Sub Na, Jin Hyoung Kim, Moon Seong Baek, Won-Young Kim, Ae-Rin Baek, Bo young Lee, Gil Myeong Seong, Song-I Lee; Acute Crit Care. 2022;37(3):303-311. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00017

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11 Web of Science
13 Crossref

Abstract PDF

Background
Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly.
Methods
This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Republic of Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis.
Results
The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis.
Conclusions
The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.

Citations

Citations to this article as recorded by

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Journal of Critical Care.2025; 85: 154930. CrossRef
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Joy E. van Son, Elisabeth C. P. Kahn, Jessica M. van der Bol, Dennis G. Barten, Laura C. Blomaard, Carmen van Dam, Jacobien Ellerbroek, Steffy W. M. Jansen, Anita Lekx, Carolien M. J. van der Linden, Roy Looman, Huub A. A. M. Maas, Francesco U. S. Mattace
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Case Report

Pulmonary
A fatal case report of invasive pulmonary aspergillosis and mucormycosis coinfection in an immunocompetent patient with coronavirus disease 2019 in Korea: Jin Hyoung Kim, Misung Kim, Soyeoun Lim, Sun Young Park, Yangjin Jegal, Taehoon Lee, Byung Ju Kang; Acute Crit Care. 2023;38(3):382-388. Published online June 27, 2022; DOI: https://doi.org/10.4266/acc.2021.01340

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9 Web of Science
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Abstract PDF

Systemic glucocorticoid treatment is highly recommended in critically ill coronavirus disease 2019 (COVID-19) patients. However, secondary fungal infections are of concern in such patients. Here, we describe the first case of COVID-19-associated invasive pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) coinfection in a COVID-19 positive immunocompetent patient in Korea. A 69-year-old man was admitted to our hospital with COVID-19 pneumonia. He had no underlying comorbidities and was not taking medications. He received remdesivir, dexamethasone, and antibiotic therapy under mechanical ventilation. Although his condition improved temporarily, multiple cavities were observed on chest computed tomography, and Aspergillus fumigatus was cultured from tracheal aspiration culture. He was diagnosed with probable CAPA and received voriconazole therapy. However, his condition was not significantly improved despite having received voriconazole therapy for 4 weeks. After release from COVID-19 quarantine, he underwent bronchoscopy examination and was then finally diagnosed with CAPA and CAM coinfection on bronchoscopic biopsy. Antifungal treatment was changed to liposomal amphotericin B. However, his progress deteriorated, and he died 4 months after admission. This case highlights that clinical suspicion and active checkups are required to diagnose secondary fungal infections in immunocompetent COVID-19 patients who receive concurrent glucocorticoid therapy.

Citations

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Incidence and Temporal Dynamics of Combined Infections in SARS-CoV-2-Infected Patients With Risk Factors for Severe Complications
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