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Original Articles
Infection
Risk factors associated with development of coinfection in critically Ill patients with COVID-19
Erica M. Orsini, Gretchen L. Sacha, Xiaozhen Han, Xiaofeng Wang, Abhijit Duggal, Prabalini Rajendram
Acute Crit Care. 2022;37(3):312-321.   Published online August 29, 2022
DOI: https://doi.org/10.4266/acc.2022.00136
  • 3,846 View
  • 203 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
At outset of the coronavirus disease 2019 (COVID-19) pandemic, the significance of bacterial and fungal coinfections in individuals with COVID-19 was unknown. Initial reports indicated that the prevalence of coinfection in the general population was low, but there was uncertainty regarding the risk of coinfection in critically ill patients.
Methods
Nine hundred critically ill adult patients with COVID-19 infection were enrolled in this observational case-control study. Patients with a coinfection (case) and patients without a coinfection (control) were compared using univariate and multivariable analyses. A subgroup analysis was performed on patients with coinfection, dividing them into early (infection within 7 days) and late (infection after 7 days) infection groups.
Results
Two hundred and thirty-three patients (25.9%) had a bacterial or fungal coinfection. Vasopressor use (P<0.001) and severity of illness (higher Acute Physiology and Chronic Health Evaluation III score, P=0.009) were risk factors for the development of a coinfection. Patients with coinfection had higher mortality and length of stay. Vasopressor and corticosteroid use and central line and foley catheter placement were risk factors for late infection (>7 days). There were high rates of drug-resistant infections.
Conclusions
Critically ill patients with COVID-19 are at risk for both community-acquired and hospital-acquired infections throughout their hospitalization for COVID-19. It is important to consider the development of a coinfection in clinically worsening critically ill patients with COVID-19 and consider the likelihood of drug-resistance when choosing an empiric regimen.

Citations

Citations to this article as recorded by  
  • Prevalence and risk factors associated with multidrug-resistant bacteria in COVID-19 patients
    Abdu Aldarhami, Ahmed A. Punjabi, Abdulrahman S. Bazaid, Naif K. Binsaleh, Omar W. Althomali, Subuhi Sherwani, Omar Hafiz, Ali A. Almishaal
    Medicine.2024; 103(10): e37389.     CrossRef
  • Prevalence of secondary infections and association with mortality rates of hospitalized COVID-19 patients
    Khalifa Binkhamis, Alanoud S. Alhaider, Ayah K. Sayed, Yara K. Almufleh, Ghadah A. Alarify, Norah Y. Alawlah
    Annals of Saudi Medicine.2023; 43(4): 243.     CrossRef
  • Blood Stream Infections in COVID-19 Patients From a Tertiary Care Center in Lebanon: Causative Pathogens and Rates of Multi-Drug Resistant Organisms
    Sarah B. Nahhal, Johnny Zakhour, Abdel Hadi Shmoury, Tedy Sawma, Sara F. Haddad, Tamara Abdallah, Nada Kara Zahreddine, Joseph Tannous, Nisrine Haddad, Nesrine Rizk, Souha S. Kanj
    Mayo Clinic Proceedings: Innovations, Quality & Outcomes.2023; 7(6): 556.     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
  • 5,074 View
  • 109 Download
  • 6 Web of Science
  • 6 Crossref
AbstractAbstract PDFSupplementary 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.2024; : rapm-2023-105092.     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
  • 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
Usefulness of Screening Criteria System Used by Medical Alert Team in a General Hospital
Hyejin Joo, So Hee Park, Sang Bum Hong, Chae Man Lim, Younsuck Koh, Young Seok Lee, Jin Won Huh
Korean J Crit Care Med. 2012;27(3):151-156.
DOI: https://doi.org/10.4266/kjccm.2012.27.3.151
  • 3,188 View
  • 61 Download
  • 4 Crossref
AbstractAbstract PDF
BACKGROUND
Rapid response team (RRT) is becoming an essential part of patient safety by the early recognition and management of patients on general hospital wards. In this study, we analyzed the usefulness of screening criteria of RRT used at Asan Medical Center.
METHODS
On a retrospective basis, we reviewed the records of 675 cases in 543 patients that were managed by RRT (called medical alert team in the Asan Medical Center), from July 2011 to December 2011. The medical alert team was acted by requests of attending doctors or nurses or the medical alert system (MAS) criteria composed of abnormal vital sign, neurology, laboratory data and increasing oxygen demand. We investigated the patterns of MAS criteria for targeting the patients who were managed by the medical alert team.
RESULTS
Respiratory distress (RR > 25/min) was the most common item for identifying patients whose condition had worsened. The criteria consist with respiratory distress and abnormal blood pressure (mean BP < 60 mmHg or systolic BP < 90 mmHg) found 70.0% of patients with deteriorated conditions. Vital sign (RR > 25/min, mean BP < 60 mmHg or systolic BP < 90 mmHg, pulse rate, PR > 130/min or < 50/min) and oxygen demand found 79.2% of them. Vital signs, arterial blood gas analysis (ABGA) with lactate level (pH, pO2, pCO2, and lactate) and O2 demand found 98.6% of patient conditions had worsened.
CONCLUSIONS
Vital signs, especially RR > 25/min is useful criteria for detecting patients whose conditions have deteriorated. The addition of ABGA data with lactate levels leads to a more powerful screening tool.

Citations

Citations to this article as recorded by  
  • Influence of the Rapid Response Team Activation via Screening by Nurses on Unplanned Intensive Care Unit Admissions
    Ye-Ji Huh, Seongmi Moon, Eun Kyeung Song, Minyoung Kim
    Korean Journal of Adult Nursing.2020; 32(5): 539.     CrossRef
  • Early Experience of Medical Alert System in a Rural Training Hospital: a Pilot Study
    Maru Kim
    The Korean Journal of Critical Care Medicine.2017; 32(1): 47.     CrossRef
  • Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in‐hospital cardiac arrest
    HyunSoo Oh, KangIm Lee, WhaSook Seo
    Journal of Advanced Nursing.2016; 72(5): 1122.     CrossRef
  • A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock
    Jung-Wan Yoo, Ju Ry Lee, Youn Kyung Jung, Sun Hui Choi, Jeong Suk Son, Byung Ju Kang, Tai Sun Park, Jin-Won Huh, Chae-Man Lim, Younsuck Koh, Sang Bum Hong
    The Korean Journal of Internal Medicine.2015; 30(4): 471.     CrossRef
Case Reports
H1N1 Influenza/A Associated ARDS Recovered without Mechanical Ventilatory Support: A Case Report
Byung Ook Lee, Jae Hee Lee, Sung Woon Park, Bo Min Kim, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Jae Yeol Kim
Korean J Crit Care Med. 2011;26(2):114-116.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.114
  • 2,311 View
  • 18 Download
AbstractAbstract PDF
An eighteen year-old female visited the ER in our hospital with fever of 38.5degrees C for 2 days. She also had cough, myalgia, and dyspnea. Chest PA and lung HRCT showed mild pulmonary edema at both hilar areas. However, she had severe hypoxia (PaO2; 58 mmHg in room air). RT-PCR for H1N1 influenza/A of pharyngeal swab was positive. Tamiflu (150 mg/d) with broad-spectrum antibiotics was prescribed. Two days later, her dyspnea aggravated and chest PA showed diffuse bilateral infiltration. PaO2 dropped to 70 mmHg (O2 10 L/min by face mask with reservoir bag). She was transferred to the MICU and the Tamiflu dose was doubled (300 mg/day). Mechanical ventilator was set aside to prepare respiratory failure. Fortunately, her symptoms and oxygenation improved and she was discharged with full recovery. Although, most cases of ARDS require mechanical ventilatory support, early and adequate dose of Tamiflu may avoid it in the case of ARDS developed by H1N1 influenza/A.
Acute Respiratory Distress Syndrome with Chemical Pneumonitis after Aspiration of Activated Charcoal: A Case Report
Suhyun Kim, Na Ree Kang, In Sohn, Heon Lee, Yoon Kyung Lee, Sook Hee Song
Korean J Crit Care Med. 2010;25(2):112-117.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.112
  • 3,479 View
  • 71 Download
  • 2 Crossref
AbstractAbstract PDF
Charcoal has been commonly used for enteral detoxication although it causes few adverse effects. The major causes of morbidity and mortality secondary to activated charcoal therapy are pulmonary aspiration, gastrointestinal complication, and fluid and electrolyte abnormalities. Aspiration of charcoal is associated with pulmonary compromise due to increased microvascular permeability with concomitant lung edema, surfactant depletion, atelectasis, and obliterative bronchiolitis. Herein we report the case of a patient with acute respiratory distress syndrome with chemical pneumonitis after aspiration of activated charcoal in sorbitol with a review of the related literatures.

Citations

Citations to this article as recorded by  
  • Five Successful Experiences in the Treatment of Charcoal Aspiration with Bronchoscopic Toilet - A Case Report -
    Young Il Kim, Jae-Seok Park, Jae Sung Choi, Sung-Shik Jou, Hyo-Wook Gil, Sae-Yong Hong
    Korean Journal of Critical Care Medicine.2012; 27(3): 202.     CrossRef
  • A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage
    Han Min Lee, Jae-Seok Park, Jae Yun Kim, Ji Yeon Lee, Byung Kyu Ahn, Hyo-Wook Gil, Jae-Sung Choi
    Tuberculosis and Respiratory Diseases.2012; 72(2): 177.     CrossRef
Original Article
A Comparison of Adaptive Support Ventilation (ASV) and Conventional Volume-Controlled Ventilation on Respiratory Mechanics in Acute Lung Injury/ARDS
Ik Su Choi, Jung Eun Choi, Sang Bum Hong, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2009;24(2):59-63.
DOI: https://doi.org/10.4266/kjccm.2009.24.2.59
  • 3,239 View
  • 71 Download
  • 5 Crossref
AbstractAbstract PDF
BACKGROUND
ASV is a closed-loop ventilation system that guarantees a user-set minimum per-minute volume in intubated patients, whether paralyzed or with spontaneous breathing. Here, we tested the effects of ASV onrespiratory mechanics and compared them with volume-controlled ventilation (VCV).
METHODS
Thirteen patients meeting the criteria for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) were enrolled. All patients were paralyzed to eliminate spontaneous breathing. We started with VCV (VCV1), then used ASV followed by VCV modes (VCV2), maintaining minute volume as much as that of VCV1.
RESULTS
During ASV, compared with VCV1, the inspiratory and expiratory tidal volumes and expiratory resistance increased. Conversely, the total respiratory rate and maximum pressure decreased. No changes in the arterial blood gases, heart rate, or mean systemic pressure were noted during the trial.
CONCLUSIONS
In ALI/ARDS patients, although no differences were observed in the arterial blood gas analysis between the two modes, ASV provided better respiratory mechanics in terms of peak airway pressure and tidal volume than VCV.

Citations

Citations to this article as recorded by  
  • Comparison of adaptive support ventilation and synchronized intermittent mandatory ventilation in patients with acute respiratory distress syndrome: A randomized clinical trial
    Babak Alikiaii, Saeed Abbasi, Hamideh Yari, Mojtaba Akbari, Parviz Kashefi
    Journal of Research in Medical Sciences.2022; 27(1): 6.     CrossRef
  • Comparing the Effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation (SIMV) on Respiratory Parameters in Neurosurgical ICU Patients
    Mohammadreza Ghodrati, Alireza Pournajafian, Ali Khatibi, Mohammad Niakan, Mohammad Hosein Hemadi, Mohammad Mahdi Zamani
    Anesthesiology and Pain Medicine.2016;[Epub]     CrossRef
  • Adaptive support ventilation for complete ventilatory support in acute respiratory distress syndrome: A pilot, randomized controlled trial
    Ritesh Agarwal, Arjun Srinivasan, Ashutosh N. Aggarwal, Dheeraj Gupta
    Respirology.2013; 18(7): 1108.     CrossRef
  • Advanced Ventilator Modes and Techniques
    Carl F. Haas, Kimberly A. Bauser
    Critical Care Nursing Quarterly.2012; 35(1): 27.     CrossRef
  • Evaluation of Respiratory Parameters in Patients with Acute Lung Injury Receiving Adaptive Support Ventilation
    Keu Sung Lee, Wou Young Chung, Yun Jung Jung, Joo Hun Park, Seung Soo Sheen, Sung Chul Hwang, Kwang Joo Park
    Tuberculosis and Respiratory Diseases.2011; 70(1): 36.     CrossRef
Review
Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease
Tae Hun An
Korean J Crit Care Med. 2003;18(2):67-73.
  • 2,572 View
  • 161 Download
AbstractAbstract PDF
Patients with severe chronic obstructive pulmonary disease (COPD) may require mechanical ventilation following cardiac or general surgery, in connection with thoracic surgery such as lobectomy, wedge resection, lung reduction or bullectomy, during an episode of acute respiratory failure (ARF) secondary to a disease other than COPD such as sepsis, drug overdose, or trauma or for acute-on-chronic respiratory failure (the COPD exacerbation) where acute illness, usually presumed to be infectious in nature, destabilizes the characteristically compensated state. Ventilatory intervention is often life-saving when patients with asthma or COPD experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choice, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. This review will only briefly cover noninvasive ventilation and focus primarily on the management of the intubated, mechanically ventilated patient with COPD, with particular emphasis on factors unique to this patient population such as the propensity for dynamic hyperinflation and auto-PEEP, barotrauma, difficult weaning and the prognosis following mechanical ventilation.
Original Article
The Inhaled Nitric Oxide in Acute Respiratory Distress Syndrome: from a Bedside to a Bench
Younsuck Koh
Korean J Crit Care Med. 2001;16(2):65-74.
  • 2,249 View
  • 24 Download
AbstractAbstract PDF
Because inhaled nitric oxide (NO) induces selective vasodilation of well-ventilated lung regions diverting pulmonary artery blood flow towards these well-ventilated alveoli, it has been applied to some of ARDS patients, who show severe hypoxemia despite of positive pressure ventilation with moderate to high positive end-expiratory pressure. The beneficial effect of inhaled NO on oxygenation was lower than 5 ppm of inhaled NO and the maximum effect was about 10 ppm in patients with ARDS according to the studies. Combinations of inhaled NO with various therapies, such as the use of intravenous almitrine or phenylephrine, and prone positioning may produce additive effects on oxygenation. Approximately 65% of patients had response to inhaled NO in studies of critically ill patients with ARDS who were ventilated with less than 40 ppm of inhaled NO. However, there was no survival benefit by inhaled NO in a multicenter phase 2 trial with 177 patients of non-septic ARDS. It is unclear whether inhaled NO exerts detrimental or beneficial effects in the pathogenesis of ARDS. Laboratory studies suggest that inhaled NO has important effects in reducing some forms of lung and tissue injury. If these effects are clinically significant, early and continued therapy with inhaled NO could potentially reduce the severity of some forms of lung injury. In contrast, NO and nitrite interacted with neutrophil myeloperoxidase to stimulate oxidative reactions during inflammation. In summary, NO inhalation would be acceptable as a rescue therapy in severe ARDS without serious complications related to the application. In addition, the effect of inhaled NO on the pathophysiology of ARDS should be elucidated.

ACC : Acute and Critical Care