Acute and Critical Care

Original Article

Pulmonary
Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation: Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh; Acute Crit Care. 2024;39(1):91-99. Published online January 26, 2024; DOI: https://doi.org/10.4266/acc.2023.00871

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Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality.
Methods
We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed.
Results
A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579).
Conclusions
MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

Citations

Citations to this article as recorded by

Mechanical power and mortality: analysis of a prospective cohort of ventilated patients
Yudiel Pérez Yero, Ariel Sosa Remón, Jhossmar Cristians Auza-Santivañez, Arian Jesús Cuba Naranjo, Dasha María García Arias, Ana Esperanza Jeréz Alvarez, Mileydys Saborit García, Osman Arteaga Iriarte, Jose Bernardo Antezana-Muñoz
Multidisciplinar (Montevideo).2025; 3: 198. CrossRef
Perioperative Ventilation in Neurosurgical Patients: Considerations and Challenges
Ida Giorgia Iavarone, Patricia R.M. Rocco, Pedro Leme Silva, Shaurya Taran, Sarah Wahlster, Marcus J. Schultz, Nicolo’ Antonino Patroniti, Chiara Robba
Current Anesthesiology Reports.2024; 14(4): 512. CrossRef

Corrigendum

Infection
Corrigendum to “Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study”: Keum-Ju Choi, Soo Kyun Jung, Kyung Chan Kim, Eun Jin Kim; Acute Crit Care. 2023;38(2):249-249. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.00941.e1; Corrects: Acute Crit Care 2023;38(1):57

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Original Articles

Infection
Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study: Keum-Ju Choi, Soo Kyun Jung, Kyung Chan Kim, Eun Jin Kim; Acute Crit Care. 2023;38(1):57-67. Published online February 7, 2023; DOI: https://doi.org/10.4266/acc.2022.00941; Correction in: Acute Crit Care 2023;38(2):249

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Abstract PDF

Background
The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19.
Methods
This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group).
Results
Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039).
Conclusions
Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.

Citations

Citations to this article as recorded by

The relationship between steroid treatment and mortality in patients with COVID-19 followed up in an intensive care unit
Huseyin Ali Ozturk, Fatih Necip Arici
PeerJ.2025; 13: e18606. CrossRef
Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit
Francesco Ferro, Gaetano La Rocca, Elena Elefante, Nazzareno Italiano, Michele Moretti, Rosaria Talarico, Erika Pelati, Katia Valentini, Chiara Baldini, Roberto Mozzo, Luigi De Simone, Marta Mosca
International Journal of Molecular Sciences.2024; 25(13): 7273. CrossRef
Comparative Efficacy of Inhaled and Intravenous Corticosteroids in Managing COVID-19-Related Acute Respiratory Distress Syndrome
Ahmed A. Abdelkader, Bshra A. Alsfouk, Asmaa Saleh, Mohamed E. A. Abdelrahim, Haitham Saeed
Pharmaceutics.2024; 16(7): 952. CrossRef
Dosage and utilization of dexamethasone in the management of COVID-19: A critical review
Imran Sethi, Asim Shaikh, Musa Sethi, Hira Khalid Chohan, Sheraz Younus, Syed A Khan, Salim Surani
World Journal of Virology.2024;[Epub] CrossRef

Pulmonary
Experience of percutaneous tracheostomy in critically ill COVID-19 patients: Eun Jin Kim, Eun-Hyung Yoo, Chi Young Jung, Kyung Chan Kim; Acute Crit Care. 2020;35(4):263-270. Published online November 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00444

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Abstract PDF

Background
Coronavirus disease 2019 (COVID-19) is a highly contagious disease that causes respiratory failure. Tracheostomy is an essential procedure in critically ill COVID-19 patients; however, it is an aerosol-generating technique and thus carries the risk of infection transmission. We report our experience with percutaneous tracheostomy and its safety in a real medical setting.
Methods
During the COVID-19 outbreak, 13 critically ill patients were admitted to the intensive care unit (ICU) at Daegu Catholic University Medical Center between February 24 and April 30, 2020. Seven of these patients underwent percutaneous tracheostomy using Ciaglia Blue Rhino. The medical environment, percutaneous tracheostomy method, and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) results were retrospectively reviewed. After treatment, the COVID-19 infection status of healthcare personnel was investigated by RT-PCR.
Results
The ICU contained negative pressure cohort areas and isolation rooms, and healthcare personnel wore a powered air-purifying respirator system. We performed seven cases of percutaneous tracheostomy in the same way as in patients without COVID-19. Five patients (71.4%) tested positive for COVID-19 by RT-PCR at the time of tracheostomy. The median cycle threshold value for the RNA-dependent RNA polymerase was 30.60 (interquartile range [IQR], 25.50–36.56) in the upper respiratory tract and 35.04 (IQR, 28.40–36.74) in the lower respiratory tract. All healthcare personnel tested negative for COVID-19 by RT-PCR.
Conclusions
Percutaneous tracheostomy was performed with conventional methods in the negative pressure cohort area. It was safe to perform percutaneous tracheostomy in an environment of COVID-19 infection.

Citations

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Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry
Christopher M. Kapp, Ardian Latifi, David Feller-Kopman, Joshua H. Atkins, Esther Ben Or, David Dibardino, Andrew R. Haas, Jeffrey Thiboutot, Christoph T. Hutchinson
Journal of Intensive Care Medicine.2022; 37(2): 240. CrossRef
Percutaneous Tracheostomy in Respiratory Failure Due to COVID-19
Samuel E. Cohen, Angelena R. Lopez, Philip K. Ng, Oren A. Friedman, George E. Chaux
Journal of Bronchology & Interventional Pulmonology.2022; 29(2): 125. CrossRef
Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019 (COVID-19)
You Shang, Jianfeng Wu, Jinglun Liu, Yun Long, Jianfeng Xie, Dong Zhang, Bo Hu, Yuan Zong, Xuelian Liao, Xiuling Shang, Renyu Ding, Kai Kang, Jiao Liu, Aijun Pan, Yonghao Xu, Changsong Wang, Qianghong Xu, Xijing Zhang, Jicheng Zhang, Ling Liu, Jiancheng Z
Journal of Intensive Medicine.2022; 2(4): 199. CrossRef
Commentary: Coronavirus disease 2019 (COVID-19) tracheostomies—The “how” but not the “why” or “when”
Benjamin Wei, Peter Abraham
JTCVS Techniques.2021; 6: 190. CrossRef
Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals
Phillip Staibano, Marc Levin, Tobial McHugh, Michael Gupta, Doron D. Sommer
JAMA Otolaryngology–Head & Neck Surgery.2021; 147(7): 646. CrossRef
Tracheostomy in COVID Times
Yatin Mehta, Gaurav Kochar
Journal of Cardiac Critical Care TSS.2021; 5(02): 082. CrossRef
Tracheostomy in Mechanically Ventilated Patients With SARS-CoV-2-ARDS: Focus on Tracheomalacia
Marcello Guarnieri, Patrizia Andreoni, Hedwige Gay, Riccardo Giudici, Maurizio Bottiroli, Michele Mondino, Gianpaolo Casella, Osvaldo Chiara, Oscar Morelli, Serena Conforti, Thomas Langer, Roberto Fumagalli
Respiratory Care.2021; 66(12): 1797. CrossRef

Epidemiology
Characteristics, management and clinical outcomes of patients with sepsis: a multicenter cohort study in Korea: Kyeongman Jeon, Soo Jin Na, Dong Kyu Oh, Sunghoon Park, Eun Young Choi, Seok Chan Kim, Gil Myeong Seong, Jeongwon Heo, Youjin Chang, Won Gun Kwack, Byung Ju Kang, Won-Il Choi, Kyung Chan Kim, So Young Park, Sang Hyun Kwak, Yoon Mi Shin, Heung Bum Lee, So Hee Park, Jae Hwa Cho, Beongki Kim, Chae‐Man Lim; Acute Crit Care. 2019;34(3):179-191. Published online July 1, 2019; DOI: https://doi.org/10.4266/acc.2019.00514

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Abstract PDF

Background
Mortality rates associated with sepsis have increased progressively in Korea, but domestic epidemiologic data remain limited. The objective of this study was to investigate the characteristics, management and clinical outcomes of sepsis patients in Korea.
Methods
This study is a multicenter retrospective cohort study. A total of 64,021 adult patients who visited an emergency department (ED) within one of the 19 participating hospitals during a 1-month period were screened for eligibility. Among these, patients diagnosed with sepsis based on the third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were included in the study.
Results
Using the Sepsis-3 criteria, 977 sepsis patients were identified, among which 36.5% presented with septic shock. The respiratory system (61.8%) was the most common site of infection. The pathogen involved was identified in 444 patients (45.5%) and multi-drug resistance (MDR) pathogens were isolated in 171 patients. Empiric antibiotic therapy was appropriate in 68.6% of patients, but the appropriateness was significantly reduced in infections associated with MDR pathogens as compared with non-MDR pathogens (58.8% vs. 76.0%, P<0.001). Hospital mortality was 43.2% and 18.5% in sepsis patients with and without shock, respectively. Of the 703 patients who survived to discharge, 61.5% were discharged to home and 38.6% were transferred to other hospitals or facilities.
Conclusions
This study found the prevalence of sepsis in adult patients visiting an ED in Korea was 1.5% (15.2/1,000 patients). Patients with sepsis, especially septic shock, had a high mortality and were often referred to step-down centers after acute and critical care.

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Journal of Korean Medical Science.2024;[Epub] CrossRef
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Pre-Sepsis Length of Hospital Stay and Mortality: A Nationwide Multicenter Cohort Study
Joong-Yub Kim, Hong Yeul Lee, Jinwoo Lee, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
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Young Seok Lee, Seungbong Han, Ye Eun Lee, Jaehwa Cho, Young Kyun Choi, Sun-Young Yoon, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Jae Young Moon, Sang‑Bum Hong, Suk‑Kyung Hong, Gee Young Suh, Kyeongman Jeon, Ryoung‑Eun Ko, Young‑Jae Cho, Yeon
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Case Report

Pulmonary
Extraction of Endobronchial Tooth by Flexible Bronchoscopy Using Fishnet Basket in Patients of Intensive Care Unit with Artificial Airway: Kyung Chan Kim; Korean J Crit Care Med. 2014;29(1):38-42. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.38

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Abstract PDF

Foreign body aspiration into the tracheobronchial tree can cause serious problems. Tooth aspiration can occur during emergency endotracheal intubation. However, removal of a tooth from the airway is difficult because of the round shape and smooth surface of the tooth. Here, I report extraction of a tooth from the airway by flexible bronchoscopy using fishnet basket in intensive care patients. The procedure was performed in six patients. All patients were critically ill with an artificial airway (n = 4; endotracheal tube, n = 2; tracheostomy tube). The tooth location was right bronchial tree in three patients and left bronchial tree in three patients. Tooth extraction failed in two patients because the teeth were impacted in the distal bronchus during bronchoscopy. There was no complication such as life threatening arrhythmia or hypoxemia during the procedure. Using flexible bronchoscopy with a fishnet basket, we were able to extract aspirated teeth from patients with an artificial airway.

Citations

Citations to this article as recorded by

Retrieval of Aspirated Teeth in an Adult Polytrauma Patient using Pediatric Flexible Fiberoptic Bronchoscopy Allied with Endoscopic Rat Tooth Alligator Jaw Grasping Forceps
Ali Al Bshabshe, Omprakash Palanivel, Amer Hassan Assiri, Nasser Mohammed Alwadai
Indian Journal of Respiratory Care.2020; 9(2): 236. CrossRef

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