Acute and Critical Care

Corrigendum

Pharmacology
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit: Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha; Acute Crit Care. 2023;38(1):149-149. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.00094.e1; Corrects: Acute Crit Care 2022;37(1):1

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Can we make a safer sedation?
M.S. Danilov, I.S. Simutis, A.S. Korotaev, D.S. Salygina, V.A. Ratnikov, V.A. Kashchenko
Anesteziologiya i reanimatologiya.2023; (4): 49. CrossRef

Guideline

Pharmacology
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit: Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha; Acute Crit Care. 2022;37(1):1-25. Published online February 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00094; Correction in: Acute Crit Care 2023;38(1):149

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Abstract PDF

We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.

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Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study
Karina Sichieri, Danilo Donizetti Trevisan, Ricardo Luís Barbosa, Silvia Regina Secoli
Sao Paulo Medical Journal.2024;[Epub] CrossRef
End‐of‐life care in the intensive care unit
M. Tanaka Gutiez, N. Efstathiou, R. Innes, V. Metaxa
Anaesthesia.2023; 78(5): 636. CrossRef
The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea
Dong-gon Hyun, Jee Hwan Ahn, Ha-Yeong Gil, Chung Mo Nam, Choa Yun, Jae-Myeong Lee, Jae Hun Kim, Dong-Hyun Lee, Ki Hoon Kim, Dong Jung Kim, Sang-Min Lee, Ho-Geol Ryu, Suk-Kyung Hong, Jae-Bum Kim, Eun Young Choi, JongHyun Baek, Jeoungmin Kim, Eun Jin Kim, T
Journal of Korean Medical Science.2023;[Epub] CrossRef
The relationship between the PRE-DELIRIC score and the prognosis in COVID-19 ICU patients
Bilge Banu Taşdemir Mecit
Journal of Surgery and Medicine.2023; 7(5): 343. CrossRef
Systemic Nonsteroidal Anti-Inflammatories for Analgesia in Postoperative Critical Care Patients: A Systematic Review and Meta-Analysis of Randomized Control Trials
Chen Hsiang Ma, Kimberly B. Tworek, Janice Y. Kung, Sebastian Kilcommons, Kathleen Wheeler, Arabesque Parker, Janek Senaratne, Erika Macintyre, Wendy Sligl, Constantine J. Karvellas, Fernando G. Zampieri, Demetrios Jim Kutsogiannis, John Basmaji, Kimberle
Critical Care Explorations.2023; 5(7): e0938. CrossRef
Pain Control and Sedation in Neuro Intensive Critical Unit
Soo-Hyun Park, Yerim Kim, Yeojin Kim, Jong Seok Bae, Ju-Hun Lee, Wookyung Kim, Hong-Ki Song
Journal of the Korean Neurological Association.2023; 41(3): 169. CrossRef
ICU-Induced Disability Persists With or Without COVID-19—This Is a Call for F to A Bundle Action*
Heidi Engel
Critical Care Medicine.2022; 50(11): 1665. CrossRef
Actigraphy-Based Assessment of Sleep Parameters in Intensive Care Unit Patients Receiving Respiratory Support Therapy
Jiyeon Kang, Yongbin Kwon
Journal of Korean Critical Care Nursing.2022; 15(3): 115. CrossRef

Case Report

Pharmacology
Successful treatment of propofol-related infusion syndrome in critically ill patient receiving low-dose propofol infusion: a case report: Nahyeon Park, Tae Sun Ha; Acute Crit Care. 2023;38(1):144-148. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00829

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Propofol is widely used to sedate agitated patients in intensive care units. However, it can cause a rare but fatal complication, propofol-related infusion syndrome (PRIS). The pathophysiology of PRIS is not clear, and there is no definitive diagnosis and treatment. We report a successfully treated case of PRIS in a critically ill patient receiving low-dose propofol infusion. A 59-year-old male patient complaining of sudden chest pain repeatedly collapsed in an ambulance and the emergency room, and veno-arterial extracorporeal membrane oxygenation was delivered. He was diagnosed with a total occluded left anterior descending coronary artery in coronary angiography. On day 20, he showed arrhythmia, increased creatinine kinase (CK), and increased CK-MB and troponin I, accompanied by unstable hemodynamic status despite high-dose vasopressors. He was administered propofol for 20 days at an average dose of 1.3 mg/kg/hr owing to issues with agitation and ventilator synchrony. We strongly suspected PRIS and immediately discontinued propofol infusion, and he was successfully treated with aggressive supportive care. PRIS can occur in patients administered propofol for a prolonged period at low doses. Thus, clinicians should use propofol with caution for PRIS and change to alternative sedatives for long-term sedation.

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Propofol in ICU Settings: Understanding and Managing Anti-Arrhythmic, Pro-Arrhythmic Effects, and Propofol Infusion Syndrome
Jananthan Paramsothy, Sai Dheeraj Gutlapalli, Vijay Durga Pradeep Ganipineni, Isabelle Mulango, Ikpechukwu J Okorie, Divine Besong Arrey Agbor, Crystal Delp, Hanim Apple, Borislav Kheyson, Jay Nfonoyim, Nidal Isber, Mallikarjuna Yalamanchili
Cureus.2023;[Epub] CrossRef

Original Article

Hematology
Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units: Soo Jin Na, Tae Sun Ha, Younsuck Koh, Gee Young Suh, Shin Ok Koh, Chae-Man Lim, Won-Il Choi, Young-Joo Lee, Seok Chan Kim, Gyu Rak Chon, Je Hyeong Kim, Jae Yeol Kim, Jaemin Lim, Sunghoon Park, Ho Cheol Kim, Jin Hwa Lee, Ji Hyun Lee, Jisook Park, Juhee Cho, Kyeongman Jeon; Acute Crit Care. 2018;33(3):121-129. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00143

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Background
The objective of this study was to investigate the characteristics and clinical outcomes of critically ill cancer patients admitted to intensive care units (ICUs) in Korea.
Methods
This was a retrospective cohort study that analyzed prospective collected data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study, which is a nationwide, multicenter, and prospective study that considered 5,063 patients from 22 ICUs in Korea over a period of 7 months. Among them, patients older than 18 years of age who were diagnosed with solid or hematologic malignancies prior to admission to the ICU were included in the present study.
Results
During the study period, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. Six hundred fifty-eight (79%) had solid tumors and 175 (21%) had hematologic malignancies, respectively. Respiratory problems (30.1%) was the most common reason leading to ICU admission. Patients with hematologic malignancies had higher Sequential Organ Failure Assessment (12 vs. 8, P<0.001) and SAPS3 (71 vs. 69, P<0.001) values and were more likely to be associated with chemotherapy, steroid therapy, and immunocompromised status versus patients with solid tumors. The use of inotropes/ vasopressors, mechanical ventilation, and/or continuous renal replacement therapy was more frequently required in hematologic malignancy patients. Mortality rates in the ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) were higher in hematologic malignancy patients than in solid tumor patients.
Conclusions
Cancer patients accounted for one-third of all patients admitted to the studied ICUs in Korea. Clinical characteristics were different according to the type of malignancy. Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.

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Predictors of ICU mortality in patients with hemoblastosis and infectious complications
A.V. Lyanguzov, A.S. Luchinin, S.V. Ignatyev, I.V. Paramonov
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Effect of the underlying malignancy on critically ill septic patient's outcome
Man‐Yee Man, Hoi‐Ping Shum, Sin‐Man Lam, Jacky Li, Wing‐Wa Yan, Mei‐Wan Yeung
Asia-Pacific Journal of Clinical Oncology.2022; 18(4): 473. CrossRef
Impacts of Corticosteroid Therapy at Acute Stage of Hospital-Onset Clostridioides difficile Infections
Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
Infection and Drug Resistance.2022; Volume 15: 5387. CrossRef
Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy
Da Woon Kim, Geum Suk Jang, Kyoung Suk Jung, Hyuk Jae Jung, Hyo Jin Kim, Harin Rhee, Eun Young Seong, Sang Heon Song
Kidney Research and Clinical Practice.2022; 41(6): 717. CrossRef
A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs
Lama H. Nazer, Maria A. Lopez-Olivo, Anne Rain Brown, John A. Cuenca, Michael Sirimaturos, Khader Habash, Nada AlQadheeb, Heather May, Victoria Milano, Amy Taylor, Joseph L. Nates
Critical Care Explorations.2022; 4(9): e0757. CrossRef
Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study
Jigeeshu Divatia, Amit M Narkhede, Harish K Chaudhari, Ujwal Dhundi, Natesh Prabu Ravisankar, Satish Sarode
Indian Journal of Critical Care Medicine.2021; 25(12): 1421. CrossRef

Erratum

Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient: Eunmi Gil, Tae Sun Ha, Gee Young Suh, Chi Ryang Chung, Chi-Min Park; Korean J Crit Care Med. 2016;31(3):263-263. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.129.e01; Corrects: Acute Crit Care 2016;31(2):129

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Case Reports

Infection
Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient: Eunmi Gil, Tae Sun Ha, Gee Young Suh, Chi Ryang Chung, Chi-Min Park; Korean J Crit Care Med. 2016;31(2):129-133. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.129; Correction in: Acute Crit Care 2016;31(3):263

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Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.

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Aspergillus fumigatus cholangitis in a patient with cholangiocarcinoma: case report and review of the literature
Kathrin Rothe, Sebastian Rasch, Nina Wantia, Alexander Poszler, Joerg Ulrich, Christoph Schlag, Wolfgang Huber, Roland M. Schmid, Dirk H. Busch, Tobias Lahmer
Infection.2021; 49(1): 159. CrossRef

Infection
Disseminated Gastrointestinal Mucormycosis in Immunocompromised Disease: Tae Sun Ha, Chi-Min Park, Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh; Korean J Crit Care Med. 2015;30(4):323-328. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.323

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79 Download
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Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.

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A Fatal Case of Disseminated Intestinal Mucormycosis in a Patient with Vibrio Sepsis
Seungwoo Chung, Hyun-Jung Sung, Jong Won Chang, Ile Hur, Ho Cheol Kim
Journal of Acute Care Surgery.2021; 11(3): 133. CrossRef
Gastric Mucormycosis Followed by Traumatic Cardiac Rupture in an Immunocompetent Patient
Sang Won Lee, Hyun Seok Lee
The Korean Journal of Gastroenterology.2016; 68(2): 99. CrossRef

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