Acute and Critical Care

Original Articles

Pulmonary
Association between nutritional risk scores and timing of endotracheal intubation in COVID-19-associated acute respiratory distress syndrome: a single-center cohort study in South Korea: Hyojin Jang, Wanho Yoo, Kwangha Lee; Acute Crit Care. 2025;40(4):538-547. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.003900

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Abstract PDF: Background
The optimal timing of endotracheal intubation in patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) remains uncertain, and delayed intubation is associated with worse outcomes. Nutritional status, known to affect respiratory function and immune response, may help identify patients at risk of rapid deterioration. This study aimed to evaluate whether nutritional risk scores can predict early intubation in COVID-19-associated ARDS.
Methods
We retrospectively analyzed 247 patients with COVID-19-associated ARDS admitted to a tertiary hospital intensive care unit. Nutritional status at admission was assessed using the modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the Prognostic Nutritional Index (PNI). Early intubation was defined as occurring within 24 hours of hospital admission. Receiver operating characteristic curves and multivariate logistic regression were used to evaluate predictive performance
Results
Of 247 patients, 193 (78.1%) required mechanical ventilation, and 133 (68.9%) underwent early intubation. The mNUTRIC score showed moderate discriminatory performance (area under the curve [AUC], 0.705), while PNI performed poorly (AUC, 0.401). In a multivariate analysis adjusted for illness severity, only Acute Physiology and Chronic Health Evaluation II (OR, 1.206, P<0.001) and SOFA scores (OR, 1.270, P=0.028) were independent predictors of early intubation. The mNUTRIC score was not independently associated (P>0.05), suggesting its value is derived from component severity.
Conclusions
The predictive power of the mNUTRIC score for early intubation in COVID-19 ARDS was primarily driven by its embedded illness severity components. Nevertheless, the score demonstrated practical utility as a single, composite marker for rapid, holistic evaluation of patient risk.

Infection
Prognostic value of novel indices combining Shock Index, Reverse Shock Index, age, and oxygen saturation for predicting mortality in COVID-19 patients in Iran at emergency department triage: a cross-sectional study: Mehdi Torabi, Atefe Noroozpour, Neda Naeemi Bafghi, Moghaddameh Mirzaee; Acute Crit Care. 2025;40(3):425-434. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.005040

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Abstract PDF: Background
The objective of the study was to investigate the role of the Shock Index (SI), the Reverse Shock Index (RSI) along with oxygen saturation in predicting mortality in coronavirus disease 2019 (COVID-19).
Methods
This cross-sectional study was conducted at an academic hospital over a period of 6 months and involved patients over the age of 18 who had been diagnosed with COVID-19 via positive polymerase chain reaction tests. The data were recorded anonymously using a checklist. The study focused on indices such as the SI and RSI, both alone and in conjunction with age and oxygen saturation, to predict hospital mortality. Statistical analysis was conducted using SPSS software.
Results
The study involved 500 COVID-19 patients with a 14.4% mortality rate. Key differences were found between survival and mortality groups in terms of age, vital signs except diastolic blood pressure, length of stay, and a series of laboratory tests. Logistic regression showed gender, oxygen saturation, hemoglobin, direct bilirubin, lactate dehydrogenase, D-dimer, and Age SI/oxygen saturation (SpO2) and RSI×SpO2/Age indices significantly associated with hospital mortality. Receiver operating characteristic analysis indicated Age SI/SpO2 and RSI×SpO2/Age as effective mortality predictors, exhibiting an area under the curve of 0.80 and achieving a sensitivity, specificity, and accuracy of over 70%.
Conclusions
The combination of SI, the RSI along with hypoxia, and age has been identified as a potentially more significant role in ruling out hospital mortality in COVID-19 patients than vital signs alone, given the established role of hypoxia as a major risk factor in such cases.

Pulmonary
Increased red cell distribution width predicts mortality in COVID-19 patients admitted to a Dutch intensive care unit: Anthony D. Mompiere, Jos L.M.L. le Noble, Manon Fleuren-Janssen, Kelly Broen, Frits van Osch, Norbert Foudraine; Acute Crit Care. 2024;39(3):359-368. Published online August 22, 2024; DOI: https://doi.org/10.4266/acc.2023.01137

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Abstract PDF

Background
Abnormal red blood cell distribution width (RDW) is associated with poor cardiovascular, respiratory, and coronavirus disease 2019 (COVID-19) outcomes. However, whether RDW provides prognostic insights regarding COVID-19 patients admitted to the intensive care unit (ICU) was unknown. Here, we retrospectively investigated the association of RDW with 30-day and 90- day mortalities, duration of mechanical ventilation, and length of ICU and hospital stay in patients with COVID-19.
Methods
This study included 321 patients with COVID-19 aged >18 years who were admitted to the ICU between March 2020 and July 2022. The outcomes were mortality, duration of mechanical ventilation, and length of stay. RDW >14.5% was assessed in blood samples within 24 hours of admission.
Results
The mortality rate was 30.5%. Multivariable Cox regression analysis showed an association between increased RDW and 30-day mortality (hazard ratio [HR], 3.64; 95% CI, 1.54–8.65), 90-day mortality (HR, 3.66; 95% CI, 1.59–8.40), and shorter duration of invasive ventilation (2.7 ventilator-free days, P=0.033).
Conclusions
Increased RDW in COVID-19 patients at ICU admission was associated with increased 30-day and 90-day mortalities, and shorter duration of invasive ventilation. Thus, RDW can be used as a surrogate biomarker for clinical outcomes in COVID-19 patients admitted to the ICU.

Citations

Citations to this article as recorded by

Red Blood Cell Distribution Width Is Not a Predictor of Hospital Mortality in Elderly and Nonelderly COVID‐19‐Infected Patients: A Prospective Study at a Brazilian Quaternary University Hospital
Helena Duani, Máderson Alvares de Souza Cabral, Carla Jorge Machado, Thalyta Nogueira Fonseca, Milena Soriano Marcolino, Vandack Alencar Nobre, Cecilia Gómez Ravetti, Paula Frizera Vassallo, Unaí Tupinambás, Muhammad Abu Bakr Shabbir
Canadian Journal of Infectious Diseases and Medical Microbiology.2025;[Epub] CrossRef
Association of red blood cell distribution width with short- and long-term all-cause mortality in patients with acute pancreatitis and sepsis
Qingzhou Song, Xuanlin Wu, Firooz Ahmad Taheri, Linghou Meng, Wentao Wang, Xianwei Mo
BMC Gastroenterology.2025;[Epub] CrossRef
Association Between Red Cell Distribution Width and Mortality in Patients with Klebsiella pneumoniae Bloodstream Infection: A Cohort Study
Yingxiu Huang, Ting Ao, Ming Hu, Peng Zhen
Infection and Drug Resistance.2025; Volume 18: 5961. CrossRef

Review Article

Pulmonary
Beyond survival: understanding post-intensive care syndrome: Lovish Gupta, Maazen Naduthra Subair, Jaskaran Munjal, Bhupinder Singh, Vasu Bansal, Vasu Gupta, Rohit Jain; Acute Crit Care. 2024;39(2):226-233. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01158

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Abstract PDF

Post-intensive care syndrome (PICS) refers to persistent or new onset physical, mental, and neurocognitive complications that can occur following a stay in the intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive deficits including memory, executive, and attention impairments; post-traumatic stress disorder; and other mood disorders. PICS can last long after hospital admission and can cause significant physical, emotional, and financial stress for patients and their families. Several modifiable risk factors, such as duration of sepsis, delirium, and mechanical ventilation, are associated with PICS. However, due to limited awareness about PICS, these factors are often overlooked. The objective of this paper is to highlight the pathophysiology, clinical features, diagnostic methods, and available preventive and treatment options for PICS.

Citations

Citations to this article as recorded by

Bodily and Cognitive Experience in Patients With Sepsis and Delirium or Subsyndromal Delirium
Evelyn Álvarez Espinoza, Natalia Castillo‐Núñez, Pablo Olivares Araya, Renata Francisca Olate Barnech, Valentina Vallejos Salfate
Nursing in Critical Care.2026;[Epub] CrossRef
Post–intensive care syndrome: From diagnosis to treatment
Claudia Denke, Karin Steinecke, Henning Krampe, Désirée J. Boehnke, Björn Weiß, Claudia Spies
Deutsches Ärzteblatt international.2026;[Epub] CrossRef
Post-COVID microvascular dysfunction in hospitalized COVID-19 survivors is associated with acute disease severity and persistent cognitive complaints
Noa van der Knaap, Simona Klinkhammer, Alida A. Postma, Johanna M.A. Visser-Meily, Janneke Horn, Caroline M. van Heugten, Paulien H.M. Voorter, Merel M. van der Thiel, Gerhard S. Drenthen, Walter H. Backes, Frank van Rosmalen, Susanne van Santen, Bas C.T.
Journal of the Neurological Sciences.2025; 472: 123464. CrossRef
Comparing virtual reality with traditional methods in cognitive rehabilitation in PICS syndrome
A. Despoti, I. Patsaki, A. Alexandropoulou, E. Magkouti, D. Tzoumi, N. Leventakis, G. Roussou, Α. Papathanasiou, N. Dimitriadi, P. Presvelou, S. Nanas, E. Karatzanos
Applied Neuropsychology: Adult.2025; : 1. CrossRef
Prevalence of Post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis
Temesgen Ayenew, Menberu Gete, Mihretie Gedfew, Addisu Getie, Abebe Dilie Afenigus, Afework Edmealem, Haile Amha, Girma Alem, Bekele Getenet Tiruneh, Mengistu Abebe Messelu, Ramya Iyadurai
PLOS One.2025; 20(5): e0323311. CrossRef
Acute stress disorder in patients with traumatic spinal cord injury: risk factors and coping strategies
Haohua Shi, Yufang Su, Chunyan Pan
Frontiers in Psychiatry.2025;[Epub] CrossRef
Supporting Post-ICU Recovery: A Narrative Review for General Practitioners
Charikleia S. Vrettou, Athina G. Mantelou
Diseases.2025; 13(6): 183. CrossRef
Delirium as a Precursor to Postintensive Care Syndrome
Jenna Woodford
Physician Assistant Clinics.2025; 10(4): 729. CrossRef
The effects of restricted visitation on delirium incidence in the intensive care units of a tertiary hospital in South Korea
Leerang Lim, Christine Kang, Minseob Kim, Jinwoo Lee, Hong Yeul Lee, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
Acute and Critical Care.2025; 40(3): 452. CrossRef
The Mediating Effects of Sleep Quality and Fatigue on Post‐Intensive Care Syndrome Among Intensive Care Unit Survivors
Hui‐Fang Yeh, Tzu‐Yu Tseng, Ling‐Hua Wang, Chia‐Lun Lo, Jun‐Yih Chen, Hui‐Ju Cheng, Yu‐Hua Lin
International Journal of Nursing Practice.2025;[Epub] CrossRef
Factors Associated with Post-Intensive Care Syndrome in Patients Attending a Hospital in Northern Colombia: A Quantitative and Correlational Study
Jorge Luis Herrera Herrera, Yolima Judith Llorente Pérez, Edinson Oyola López, Gustavo Edgardo Jiménez Hernández
Nursing Reports.2025; 15(9): 311. CrossRef
Sleep Quality Assessment in Intensive Care Units: Comparing Actigraphy and the Richards Campbell Sleep Questionnaire—A Pilot Study in the Moroccan Context
Abdelmajid Lkoul, Keltouma Oumbarek, Youssef Bouchriti, Asmaa Jniene, Tarek Dendane
Clocks & Sleep.2025; 7(3): 49. CrossRef
Predictors of Post-Intensive Care Syndrome in ICU Survivors After Discharge: An Observational Study
Francesco Gravante, Paolo Iovino, Francesca Trotta, Beatrice Meucci, Marco Abagnale, Stefano Bambi, Gianluca Pucciarelli
Journal of Clinical Medicine.2025; 14(17): 6043. CrossRef
From Resuscitation to Rehabilitation: The Post-Intensive Care Syndrome Continuum in Sepsis Care
Matthew Sherman, Perry Lim, Tariq Cheema, Briana DiSilvio, Perry Tiberio
Journal of Clinical Medicine.2025; 14(23): 8374. CrossRef
Supplementation with GPR120 (Ffar4) ligand omega-3 does not improve survival in murine sepsis models
Susana Castelo Branco Ramos Nakandakari, Eric Isaac Elliott, Renan Fudoli Lins Vieira, Thaiane da Silva Rios, Andin Fosam, Isadora Carolina Betim Pavan, Maíra Maftoum Costa, Luiz Guilherme Salvino da Silva, Camila de Oliveira Ramos, Giovana Rios Gonçalves
American Journal of Physiology-Endocrinology and Metabolism.2025; 329(5): E663. CrossRef
“Lost in Transition”: Informational Needs of Sepsis Survivors and Their Relatives Across the Care Trajectory—A Qualitative Study
Frank Vahl, Susanne Ullmann, Lea Draeger, Lena Kannengießer, Mathias W. Pletz, Claudia T. Matthaeus-Kraemer, Carolin Fleischmann-Struzek
Journal of Clinical Medicine.2025; 15(1): 91. CrossRef

Original Articles

Infection
Comparative evaluation of tocilizumab and itolizumab for treatment of severe COVID-19 in India: a retrospective cohort study: Abhyuday Kumar, Neeraj Kumar, Arunima Pattanayak, Ajeet Kumar, Saravanan Palavesam, Pradhan Manigowdanahundi Nagaraju, Rekha Das; Acute Crit Care. 2024;39(2):234-242. Published online April 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00983; Correction in: Acute Crit Care 2024;39(4):652

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Abstract PDF: Background
Itolizumab downregulates the synthesis of proinflammatory cytokines and adhesion molecules by inhibiting CD6 leading to lower levels of interferon-γ, interleukin-6, and tumor necrotic factor-α and reduced T-cell infiltration at inflammatory sites. This study aims to compare the effects of tocilizumab and itolizumab in the management of severe coronavirus disease 2019 (COVID-19).
Methods
The study population was adults (>18 years) with severe COVID-19 pneumonia admitted to the intensive care unit receiving either tocilizumab or itolizumab during their stay. The primary outcome was clinical improvement (CI), defined as a two-point reduction on a seven-point ordinal scale in the status of the patient from initiating the drug or live discharge. The secondary outcomes were time until CI, improvement in PO2 /FiO2 ratio, best PO2 /FiO2 ratio, need for mechanical ventilation after administration of study drugs, time to discharge, and survival days.
Results
Of the 126 patients included in the study, 92 received tocilizumab and 34 received itolizumab. CI was seen in 46.7% and 61.7% of the patients in the tocilizumab and itolizumab groups, respectively and was not statistically significant (P=0.134). The PO2 /FiO2 ratio was significantly better with itolizumab compared to tocilizumab (median [interquartile range]: 315 [200–380] vs. 250 [150–350], P=0.043). The incidence of serious adverse events due to the study drugs was significantly higher with itolizumab compared to tocilizumab (14.7% vs. 3.3%, P=0.032).
Conclusions
The CI with itolizumab is similar to tocilizumab. Better oxygenation can be achieved with itolizumab and it can be a substitute for tocilizumab in managing severe COVID-19.

Pulmonary
Factors related to lung function outcomes in critically ill COVID-19 patients in South Korea: Tae Hun Kim, Myung Jin Song, Sung Yoon Lim, Yeon Joo Lee, Young-Jae Cho; Acute Crit Care. 2024;39(1):100-107. Published online February 20, 2024; DOI: https://doi.org/10.4266/acc.2023.00668

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Abstract PDF Supplementary Material: Background
New variants of the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic continue to emerge. However, little is known about the effect of these variants on clinical outcomes. This study evaluated the risk factors for poor pulmonary lung function test (PFT).
Methods
The study retrospectively analyzed 87 patients in a single hospital and followed up by performing PFTs at an outpatient clinic from January 2020 to December 2021. COVID-19 variants were categorized as either a non-delta variant (November 13, 2020–July 6, 2021) or the delta variant (July 7, 2021–January 29, 2022).
Results
The median age of the patients was 62 years, and 56 patients (64.4%) were male. Mechanical ventilation (MV) was provided for 52 patients, and 36 (41.4%) had restrictive lung defects. Forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO ) were lower in patients on MV. Male sex (odds ratio [OR], 0.228) and MV (OR, 4.663) were significant factors for decreased DLCO . The duration of MV was associated with decreased FVC and DLCO . However, the type of variant did not affect the decrease in FVC (P=0.750) and DLCO (P=0.639).
Conclusions
Among critically ill COVID-19 patients, 40% had restrictive patterns with decreased DLCO . The reduction of PFT was associated with MV, type of variants.

Review Article

Pulmonary
Prolonged intensive care: muscular functional, and nutritional insights from the COVID-19 pandemic: Miguel Ángel Martínez-Camacho, Robert Alexander Jones-Baro, Alberto Gómez-González, Dalia Sahian Lugo-García, Pía Carolina Gallardo Astorga, Andrea Melo-Villalobos, Bárbara Kassandra Gonzalez-Rodriguez, Ángel Augusto Pérez-Calatayud; Acute Crit Care. 2024;39(1):47-60. Published online February 2, 2024; DOI: https://doi.org/10.4266/acc.2023.01284

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Abstract PDF: During the coronavirus disease 2019 (COVID-19) pandemic, clinical staff learned how to manage patients enduring extended stays in an intensive care unit (ICU). COVID-19 patients requiring critical care in an ICU face a high risk of experiencing prolonged intensive care (PIC). The use of invasive mechanical ventilation in individuals with severe acute respiratory distress syndrome can cause numerous complications that influence both short-term and long-term morbidity and mortality. Those risks underscore the importance of proactively addressing functional complications. Mitigating secondary complications unrelated to the primary pathology of admission is imperative in minimizing the risk of PIC. Therefore, incorporating strategies to do that into daily ICU practice for both COVID-19 patients and those critically ill from other conditions is significantly important.

Original Articles

Epidemiology
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt: Aya Osama Mohammed, Hanaa I. Rady; Acute Crit Care. 2024;39(1):70-77. Published online February 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00654

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Abstract PDF: Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022.
Methods
This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories.
Results
In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE).
Conclusions
The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

Nursing
Effectiveness of massage and range of motion exercises on muscle strength and intensive care unit-acquired weakness in Iranian patients with COVID-19: a randomized parallel-controlled trial: Mohammad Ali Zakeri, Adnan Rashid Aziz, Elham Rahiminezhad, Mahlagha Dehghan; Acute Crit Care. 2024;39(1):78-90. Published online December 13, 2023; DOI: https://doi.org/10.4266/acc.2023.00416

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Abstract PDF Supplementary Material

Background
Muscle weakness is prevalent in intensive care patients. This study focused on comparing the effects of massage and range of motion (ROM) exercises on muscle strength and intensive care unit-acquired weakness (ICU-AW) among patients with coronavirus disease 2019 (COVID-19).
Methods
This study was a randomized clinical trial that recruited patients (n=45) with COVID-19 admitted to the ICU and divided them into three groups (ROM exercises, massage, and control). We evaluated muscle strength and ICU-AW in the arms and legs using a hand dynamometer. The Medical Research Council sum score was determined before and after the intervention.
Results
The study findings were that 0%, 20%, and 100% of the participants in the ROM exercises, massage, and control groups had ICU-AW on the 7th day of ICU admission. The ROM exercise group had greater muscle strength in the hands and legs than the massage and control groups, and the massage group had greater muscle strength than the control group.
Conclusions
Massage and ROM exercises could improve muscle strength and reduce ICU-AW in COVID-19 patients admitted to the ICU.

Citations

Citations to this article as recorded by

Rehabilitation in critically ill patients with COVID-19 infection: A systematic review and meta-analysis
Julie C. Reid, Joanna S. Semrau, Heather K. O'Grady, Jen Hoogenes, Jeniszka Gill, Hibaa Hasan, Sophie von Teichman, Yelena Bogdanova, Shannon McKenney, Olivia Sokol, Tania J. Pereira, Vanessa Campes Dannenberg, Christopher Farley, Jose Colleti Junior, Ama
Australian Critical Care.2026; 39(1): 101500. CrossRef
Interventions for adult survivors discharged from the intensive care unit: a scoping review
Tong Wu, Fanghong Yan, Guoli Zhang, Rongrong Zhao, Guotian Peng, Ruiyi Sun, Yuxia Ma, Lin Han, Jinping Liu
BMJ Open.2025; 15(8): e096634. CrossRef
Physical Therapist-Led Therapeutic Exercise and Mobility in Adult Intensive Care Units: A Scoping Review of Operational Definitions, Dose Progression, Safety, and Documentation
Kyeongbong Lee
Journal of Clinical Medicine.2025; 14(24): 8948. CrossRef

Infection
Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes: Ahlem Trifi, Selim Sellaouti, Asma Mehdi, Lynda Messaoud, Eya Seghir, Badis Tlili, Sami Abdellatif; Acute Crit Care. 2023;38(4):425-434. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00773

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Abstract PDF Supplementary Material

Background
Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients.
Methods
A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints.
Results
Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013–2019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post–COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3–26.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3–4.0), and invasive procedures (OR, 20.7; 95% CI, 5.3–64.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004).
Conclusions
During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor.

Citations

Citations to this article as recorded by

Burden of Healthcare-Associated Infections on Mortality Among COVID-19 Hospitalized Patients
Corina Voinea, Elena Mocanu, Elena Dantes, Sanda Jurja, Ana-Maria Neculai, Aurora Craciun, Sorin Rugina
Journal of Clinical Medicine.2025; 14(23): 8279. CrossRef
Depression during the COVID pandemic in La Manouba Governorate, Tunisia: A community survey
Mauro G Carta, Viviane Kovess, Amina Aissa, Amine Larnaout, Yosra Zgueb, Lubna A Alnasser, Maria Francesca Moro, Federica Sancassiani, Elisa Cantone, Salsabil Rjaibi, Nada Zoghlami, Mejdi Zid, Hajer Aounallah-Skhiri, Uta Ouali
International Journal of Social Psychiatry.2024; 70(6): 1128. CrossRef
Multidrug-Resistant Klebsiella pneumoniae Strains in a Hospital: Phylogenetic Analysis to Investigate Local Epidemiology
Maria Vittoria Ristori, Fabio Scarpa, Daria Sanna, Marco Casu, Nicola Petrosillo, Umile Giuseppe Longo, De Florio Lucia, Silvia Spoto, Rosa Maria Chiantia, Alessandro Caserta, Raffaella Rosy Vescio, Flavio Davini, Lucrezia Bani, Elisabetta Riva, Massimo C
Microorganisms.2024; 12(12): 2541. CrossRef

Pulmonary
Combining reservoir mask oxygenation with high-flow nasal cannula in the treatment of hypoxemic respiratory failure among patients with COVID-19 pneumonia: a retrospective cohort study: Ivan Gur, Ronen Zalts, Yaniv Dotan, Khitam Hussain, Ami Neuberger, Eyal Fuchs; Acute Crit Care. 2023;38(4):435-441. Published online November 23, 2023; DOI: https://doi.org/10.4266/acc.2023.00451

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Abstract PDF Supplementary Material: Background
Concerns regarding positive-pressure-ventilation for the treatment of coronavirus disease 2019 (COVID-19) hypoxemia led the search for alternative oxygenation techniques. This study aimed to assess one such method, dual oxygenation, i.e., the addition of a reservoir mask (RM) on top of a high-flow nasal cannula (HFNC).
Methods
In this retrospective cohort study, the records of all patients hospitalized with COVID-19 during 2020–2022 were reviewed. Patients over the age of 18 years with hypoxemia necessitating HFNC were included. Exclusion criteria were positive-pressure-ventilation for any indication other than hypoxemic respiratory failure, transfer to another facility while still on HFNC and “do-not-intubate/resuscitate” orders. The primary outcome was mortality within 30 days from the first application of HFNC. Secondary outcomes were intubation and admission to the intensive care unit.
Results
Of 659 patients included in the final analysis, 316 were treated with dual oxygenation and 343 with HFNC alone. Propensity for treatment was estimated based on background diagnoses, laboratories and vital signs upon admission, gender and glucocorticoid dose. Inverse probability of treatment weighted regression including age, body mass index, Sequential Organ Failure Assessment (SOFA) score and respiratory rate oxygenation index showed treatment with dual oxygenation to be associated with lower 30-day mortality (adjusted hazard ratio, 0.615; 95% confidence interval, 0.469–0.809). Differences in the secondary outcomes did not reach statistical significance.
Conclusions
Our study suggests that the addition of RM on top of HFNC may be associated with decreased mortality in patients with severe COVID-19 hypoxemia.

Pediatric
Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit: Fevzi Kahveci, Buse Önen Ocak, Emrah Gün, Anar Gurbanov, Hacer Uçmak, Ayşen Durak Aslan, Ayşegül Ceran, Hasan Özen, Burak Balaban, Edin Botan, Zeynep Şıklar, Merih Berberoğlu, Tanıl Kendirli; Acute Crit Care. 2023;38(3):371-379. Published online August 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00038

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Abstract PDF

Background
Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA.
Methods
This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis.
Results
The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, P<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae.
Conclusions
Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic.

Citations

Citations to this article as recorded by

Covid 19 and diabetes in children: advances and strategies
Zhaoyuan Wu, Jinling Wang, Rahim Ullah, Minghao Chen, Ke Huang, Guanping Dong, Junfen Fu
Diabetology & Metabolic Syndrome.2024;[Epub] CrossRef
Impact of the COVID-19 Pandemic on Diabetic Ketoacidosis Patients Treated in a Pediatric Intensive Care Unit: A Single-Center Cross-Sectional Study
Eva Perak, Dina Mrcela, Josko Markic
Medicina.2024; 60(11): 1775. CrossRef

Pulmonary
Outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation and continuous renal replacement therapy in the United States: Carlos R Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob, Atul Bhatnagar, Asif Saberi; Acute Crit Care. 2023;38(3):308-314. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00115

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Abstract PDF

Background
Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidity and mortality. Some patients develop severe acute respiratory distress syndrome and kidney failure requiring the combination of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).
Methods
Retrospective cohort study of 127 consecutive patients requiring combined ECMO and CRRT support in intensive care units at an ECMO center in Marietta, GA, United States.
Results
Sixty and 67 patients with and without COVID-19, respectively, required ECMO-CRRT support. After adjusting for confounding variables, patients with COVID-19 had increased mortality at 30 days (hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.51–10.7; P<0.001) and 90 days (HR, 6.23; 95% CI, 2.60–14.9; P<0.001).
Conclusions
In this retrospective study, patients with COVID-19 who required ECMO-CRRT had increased mortality when compared to patients without COVID-19.

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Higher mortality in Extracorporeal Membrane Oxygenation patients during the COVID-19 pandemic compared with H1N1 influenza: implications for future pandemics
Harriet J. Caterson, Lauren Troy, Moin Ahmed, Paul Torzillo, Rebecca Davis, Stuart Duffin, Paul Forrest, Timothy Southwood, Richard Totaro, Helen Jo, Edmund Lau, Emma Gray
Respiratory Medicine.2025; 248: 108311. CrossRef
Factors associated with post-hospitalization dialysis dependence in ECMO patients who required continuous renal replacement therapy
Carlos Rodrigo Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob
Renal Failure.2024;[Epub] CrossRef

Pulmonary
Mechanically ventilated COVID-19 patients admitted to the intensive care unit in the United States with or without respiratory failure secondary to COVID-19 pneumonia: a retrospective comparison of characteristics and outcomes: Jesse A. Johnson, Kashka F. Mallari, Vincent M. Pepe, Taylor Treacy, Gregory McDonough, Phue Khaing, Christopher McGrath, Brandon J. George, Erika J. Yoo; Acute Crit Care. 2023;38(3):298-307. Published online August 23, 2023; DOI: https://doi.org/10.4266/acc.2022.01123

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Background
There is increasing heterogeneity in the clinical phenotype of patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19,) and reasons for mechanical ventilation are not limited to COVID pneumonia. We aimed to compare the characteristics and outcomes of intubated patients admitted to the ICU with the primary diagnosis of acute hypoxemic respiratory failure (AHRF) from COVID-19 pneumonia to those patients admitted for an alternative diagnosis.
Methods
Retrospective cohort study of adults with confirmed SARS-CoV-2 infection admitted to nine ICUs between March 18, 2020, and April 30, 2021, at an urban university institution. We compared characteristics between the two groups using appropriate statistics. We performed logistic regression to identify risk factors for death in the mechanically ventilated COVID-19 population.
Results
After exclusions, the final sample consisted of 319 patients with respiratory failure secondary to COVID pneumonia and 150 patients intubated for alternative diagnoses. The former group had higher ICU and hospital mortality rates (57.7% vs. 36.7%, P<0.001 and 58.9% vs. 39.3%, P<0.001, respectively). Patients with AHRF secondary to COVID-19 pneumonia also had longer ICU and hospital lengths-of-stay (12 vs. 6 days, P<0.001 and 20 vs. 13.5 days, P=0.001). After risk-adjustment, these patients had 2.25 times higher odds of death (95% confidence interval, 1.42–3.56; P=0.001).
Conclusions
Mechanically ventilated COVID-19 patients admitted to the ICU with COVID-19-associated respiratory failure are at higher risk of hospital death and have worse ICU utilization outcomes than those whose reason for admission is unrelated to COVID pneumonia.

Citations

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Novel Approaches of Inhalational Therapy for COVID-19: Drugs to Vaccines
Pratiksha Bramhe, Suchita Waghmare, Nilesh Rarokar, Lata Potey, Bhupendra Dibbe, Prafulla Sable, Pramod Khedekar, Vidya Sabale, Bhupendra Prajapati
Coronaviruses.2025;[Epub] CrossRef
Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study
Lenka Doubravská, Miroslava Htoutou Sedláková, Kateřina Fišerová, Olga Klementová, Radovan Turek, Kateřina Langová, Milan Kolář
Antibiotics.2024; 13(2): 192. CrossRef

Pulmonary
Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia: Khaoula Ben Ismail, Fatma Essafi, Imen Talik, Najla Ben Slimene, Ines Sdiri, Boudour Ben Dhia, Takoua Merhbene; Acute Crit Care. 2023;38(3):271-277. Published online August 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00591

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Abstract PDF: Background
In this study, we explored whether awake prone position (PP) can impact prognosis of severe hypoxemia coronavirus disease 2019 (COVID-19) patients.
Methods
This was a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. Patients were divided into two groups: group G1, patients who benefited from a vigilant and effective PP (>4 hours minimum/24) and group G2, control group. We compared demographic, clinical, paraclinical and evolutionary data.
Results
Three hundred forty-nine patients were hospitalized during the study period, 273 met the inclusion criteria. PP was performed in 192 patients (70.3%). The two groups were comparable in terms of demographic characteristics, clinical severity and modalities of oxygenation at intensive care unit (ICU) admission. The mean PaO2/ FIO2 ratios were 141 and 128 mm Hg, respectively (P=0.07). The computed tomography scan was comparable with a critical >75% in 48.5% (G1) versus 54.2% (G2). The median duration of the daily PP session was 13±7 hours per day. The average duration of spontaneous PP days was 7 days (4–19). Use of invasive ventilation was lower in the G1 group (27% vs. 56%, P=0.002). Healthcare-associated infections were significantly lower in G1 (42.1% vs. 82%, P=0.01). Duration of total mechanical ventilation and length of ICU stay were comparable between the two groups. Mortality was significantly higher in G2 (64% vs. 28%, P=0.02).
Conclusions
Our study confirmed that awake PP can improve prognosis in COVID-19 patients. Randomized controlled trials are needed to confirm this result.

Pulmonary
Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France: Pierre Basse, Louis Morisson, Romain Barthélémy, Nathan Julian, Manuel Kindermans, Magalie Collet, Benjamin Huot, Etienne Gayat, Alexandre Mebazaa, Benjamin G. Chousterman; Acute Crit Care. 2023;38(2):172-181. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01494

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Background
The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19).
Methods
This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count.
Results
Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002).
Conclusions
In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

Citations

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Early Driving Pressure Is Associated with Major Adverse Kidney Events at 30 Days in ARDS Patients with SARS-CoV-2
Gustavo Casas-Aparicio, Adrián E. Caballero-Islas, Antonio León-Ortiz, David Escamilla-Illescas, Yovanna Rueda-Escobedo, Carlos Ascención-López, Diana Hernández-Quino, Aimee Flores-Vargas, Jesús Sosa-Chombo, Abraham Tolentino-de La Mora, Ana Saucedo-Prune
Journal of Clinical Medicine.2025; 14(8): 2783. CrossRef
PEEP-AKI-COVID ICU: Effect of positive end-expiratory pressure on acute kidney injury development in patients with COVID-19-associated acute respiratory distress syndrome: an ancillary analysis of the COVID-ICU study
Léo Poirot, Lionel Tchatat Wangueu, Isaure Breteau, Matthieu Petit, Matthieu Schmidt, Florent Bavozet, Alain Mercat, Pierre Asfar, François Beloncle, Julien Demiselle, Tài Pham, Arthur Pavot, Xavier Monnet, Christian Richard, Alexandre Demoule, Martin Dre
Journal of Intensive Care.2025;[Epub] CrossRef
Bidirectional pressure: a mini review of ventilator-lung-kidney interactions
Avnee Kumar, Katie Epler, Sean DeWolf, Laura Barnes, Mark Hepokoski
Frontiers in Physiology.2024;[Epub] CrossRef
Renal venous flow in different regions of the kidney are different and reflecting different etiologies of venous reflux disorders in septic acute kidney injury: a prospective cohort study
Rongping Chen, Hui Lian, Hua Zhao, Xiaoting Wang
Intensive Care Medicine Experimental.2024;[Epub] CrossRef

Meta-analysis
Comparison of safety and efficacy between therapeutic or intermediate versus prophylactic anticoagulation for thrombosis in COVID-19 patients: a systematic review and meta-analysis: Hyeon-Jeong Lee, Hye Jin Jang, Won-Il Choi, Joonsung Joh, Junghyun Kim, Jungeun Park, Miyoung Choi; Acute Crit Care. 2023;38(2):160-171. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01424; Correction in: Acute Crit Care 2023;38(4):516

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Abstract PDF Supplementary Material

Background
Patients with coronavirus disease 2019 (COVID-19) infections often have macrovascular or microvascular thrombosis and inflammation, which are known to be associated with a poor prognosis. Heparin has been hypothesized that administration of heparin with treatment dose rather than prophylactic dose for prevention of deep vein thrombosis in COVID-19 patients.
Methods
Studies comparing therapeutic or intermediate anticoagulation with prophylactic anticoagulation in COVID-19 patients were eligible. Mortality, thromboembolic events, and bleeding were the primary outcomes. PubMed, Embase, the Cochrane Library, and KMbase were searched up to July 2021. A meta-analysis was performed using random-effect model. Subgroup analysis was conducted according to disease severity.
Results
Six randomized controlled trials (RCTs) with 4,678 patients and four cohort studies with 1,080 patients were included in this review. In the RCTs, the therapeutic or intermediate anticoagulation was associated with significant reductions in the occurrence of thromboembolic events (5 studies, n=4,664; relative risk [RR], 0.72; P=0.01), and a significant increase in bleeding events (5 studies, n=4,667; RR, 1.88; P=0.004). In the moderate patients, therapeutic or intermediate anticoagulation was more beneficial than prophylactic anticoagulation in terms of thromboembolic events, but showed significantly higher bleeding events. In the severe patients, the incidence of thromboembolic and bleeding events in the therapeutic or intermediate.
Conclusions
The study findings suggest that prophylactic anticoagulant treatment should be used in patients with moderate and severe COVID-19 infection groups. Further studies are needed to determine more individualized anticoagulation guidance for all COVID-19 patients.

Citations

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COVID-19: a vascular nightmare unfolding
Qinan Yin, Youjin Huang, Hulin Wang, Yin Wang, Xuefei Huang, Yujie Song, Yueyuan Wang, Lizhu Han, Bian Yuan
Frontiers in Immunology.2025;[Epub] CrossRef
The Community Pharmacy as a Study Center for the Epidemiological Analysis of the Population Vaccination against SARS-CoV-2: Evaluation of Vaccine Safety and Pharmaceutical Service
Jacopo Raffaele Dibenedetto, Michela Cetrone, Marina Antonacci, Domenico Pio Cannone, Stefania Antonacci, Pasquale Bratta, Francesco Leonetti, Domenico Tricarico
Pharmacy.2024; 12(1): 16. CrossRef
Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review
Alexandra Beurton, Emma J. Kooistra, Audrey De Jong, Helmut Schiffl, Mercedes Jourdain, Bruno Garcia, Damien Vimpère, Samir Jaber, Peter Pickkers, Laurent Papazian
Current Obesity Reports.2024; 13(3): 545. CrossRef

Pulmonary
The role of ROX index–based intubation in COVID-19 pneumonia: a cross-sectional comparison and retrospective survival analysis: Sara Vergis, Sam Philip, Vergis Paul, Manjit George, Nevil C Philip, Mithu Tomy; Acute Crit Care. 2023;38(2):182-189. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.00206

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Abstract PDF: Background
Coronavirus disease 2019 (COVID-19) patients with acute respiratory failure who experience delayed initiation of invasive mechanical ventilation have poor outcomes. The lack of objective measures to define the timing of intubation is an area of concern. We investigated the effect of timing of intubation based on respiratory rate-oxygenation (ROX) index on the outcomes of COVID-19 pneumonia.
Methods
This was a retrospective cross-sectional study performed in a tertiary care teaching hospital in Kerala, India. Patients with COVID-19 pneumonia who were intubated were grouped into early intubation (within 12 hours of ROX index <4.88) or delayed intubation (12 hours or more hours after ROX <4.88).
Results
A total of 58 patients was included in the study after exclusions. Among them, 20 patients were intubated early, and 38 patients were intubated 12 hours after ROX index <4.88. The mean age of the study population was 57±14 years, and 55.0% of the patients were male; diabetes mellitus (48.3%) and hypertension (50.0%) were the most common comorbidities. The early intubation group had 88.2% successful extubation, while only 11.8% of the delayed group had successful extubation (P<0.001). Survival was also significantly more frequent in the early intubation group.
Conclusions
Early intubation within 12 hours of ROX index <4.88 was associated with improved extubation and survival in patients with COVID-19 pneumonia.

Infection
Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19: Scott Weerasuriya, Savvas Vlachos, Ahmed Bobo, Namitha Birur Jayaprabhu, Lauren Matthews, Adam R Blackstock, Victoria Metaxa; Acute Crit Care. 2023;38(1):31-40. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01081

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Abstract PDF Supplementary Material: Background
It can be challenging for clinicians to predict which patients with respiratory failure secondary to coronavirus disease 2019 (COVID-19) will fail on high-flow nasal cannula (HFNC) oxygen and require escalation of therapy. This study set out to evaluate the association between the respiratory rate-oxygenation index (ROX) and HFNC failure in such patients and to assess whether ROX trajectory correlates with treatment failure.
Methods
This was a single-centre, retrospective, observational study of patients with COVID-19 requiring HFNC, conducted over a 3-month period. ROX was calculated as “pulse-oximetry oxygen saturation (SpO2) over the fractional inspired oxygen concentration (FiO2)/respiratory rate” for each patient at 2, 4, and 12 hours from starting HFNC. HFNC failure was defined as escalation to continuous positive airway pressure ventilation or invasive mechanical ventilation (IMV). Time-to-event analyses were performed to account for the longitudinal data set and time-dependent variables.
Results
We included 146 patients. Ninety-three (63.7%) experienced HFNC failure, with 53 (36.3%) requiring IMV. Higher ROX values were associated with a lower subhazard of HFNC failure on time-to-HFNC failure analysis (subhazard ratio, 0.29; 95% confidence interval [CI], 0.18–0.46; P<0.001). This remained true after controlling for informative censoring. Median ROX values changed differentially over time, increasing in the HFNC success group (0.06 per hour; 95% CI, 0.05–0.08; P<0.001) but not in the HFNC failure group (0.004 per hour; 95% CI, –0.05 to 0.08; P=0.890).
Conclusions
A higher ROX is associated with a lower risk of HFNC failure. Monitoring ROX trajectory over time may help identify patients at risk of treatment failure. This has potential clinical applications; however, future prospective studies are required.

Infection
Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19: Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim; Acute Crit Care. 2023;38(1):41-48. Published online February 22, 2023; DOI: https://doi.org/10.4266/acc.2022.01235

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Abstract PDF

Background
Predicting the length of stay (LOS) for coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) is essential for efficient use of ICU resources. We analyzed the clinical characteristics of patients with severe COVID-19 based on their clinical care and determined the predictive factors associated with prolonged LOS.
Methods
We included 96 COVID-19 patients who received oxygen therapy at a high-flow nasal cannula level or above after ICU admission during March 2021 to February 2022. The demographic characteristics at the time of ICU admission and results of severity analysis (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation [APACHE] II), blood tests, and ICU treatments were analyzed using a logistic regression model. Additionally, blood tests (C-reactive protein, D-dimer, and the PaO2 to FiO2 ratio [P/F ratio]) were performed on days 3 and 5 of ICU admission to identify factors associated with prolonged LOS.
Results
Univariable analyses showed statistically significant results for SOFA score at the time of ICU admission, C-reactive protein level, high-dose steroids, mechanical ventilation (MV) care, continuous renal replacement therapy, extracorporeal membrane oxygenation, and prone position. Multivariable analysis showed that MV care and P/F ratio on hospital day 5 were independent factors for prolonged ICU LOS. For D-dimer, no significant variation was observed at admission; however, after days 3 and 5 days of admission, significant between-group variation was detected.
Conclusions
MV care and P/F ratio on hospital day 5 are independent factors that can predict prolonged LOS for COVID-19 patients.

Citations

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Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19
Marcella M Musumeci, Bruno Valle Pinheiro2, Luciana Dias Chiavegato1, Danielle Silva Almeida Phillip1, Flavia R Machado3, Fabrício Freires3, Osvaldo Shigueomi Beppu1, Jaquelina Sonoe Ota Arakaki1, Roberta Pulcheri Ramos1
Jornal Brasileiro de Pneumologia.2023; : e20230131. CrossRef
The distorted memories of patients treated in the intensive care unit during the COVID-19 pandemic: A qualitative study
Gisela Vogel, Ulla Forinder, Anna Sandgren, Christer Svensen, Eva Joelsson-Alm
Intensive and Critical Care Nursing.2023; 79: 103522. CrossRef

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

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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
Investigation of antibiotic resistance against pathogens isolated from respiratory samples in intensive care units after SARS-CoV-2 pandemic
Ayşe Çapar, Derya Özyiğitoğlu, Şeyma Başlılar
BMC Infectious Diseases.2025;[Epub] 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
Extravascular lung water index, pulmonary vascular permeability index, and global end-diastolic volume index in mechanically ventilated COVID-19 patients requiring prone position ventilation: a preliminary retrospective study: Rosanna Carmela De Rosa, Antonio Romanelli, Michele Gallifuoco, Giovanni Messina, Marianne Di Costanzo, Antonio Corcione; Acute Crit Care. 2022;37(4):571-579. Published online November 10, 2022; DOI: https://doi.org/10.4266/acc.2022.00423

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Abstract PDF

Background
There is a lack of data on extravascular lung water index (EVLWi), pulmonary vascular permeability index (PVPi), and global end-diastolic volume index (GEDVi) during prone position ventilation (PPV) in coronavirus disease 2019 (COVID-19) patients. The objectives of this study were to analyze trends in EVLWi, PVPi, and GEDVi during PPV and the relationships between these parameters and PaO2/FiO2.
Methods
In this preliminary retrospective observational study, we performed transpulmonary thermodilution (TPTD) in seven mechanically ventilated COVID-19 patients without cardiac and pulmonary comorbidities requiring PPV for 18 hours, at specific times (30 minutes pre-PPV, 18 hours after PPV, and 3 hours after supination). EVLWi, PVPi and GEDVi were measured. The relationships between PaO2/FiO2 and EVLWi, and PVPi and GEDVi values, in the supine position were analyzed by linear regression. Correlation and determination coefficients were calculated.
Results
EVLWi was significantly different between three time points (analysis of variance, P=0.004). After 18 hours in PPV, EVLWi was lower compared with values before PPV (12.7±0.9 ml/kg vs. 15.3±1.5 ml/kg, P=0.002). Linear regression showed that only EVLWi was correlated with PaO2/FiO2 (β =–5.757; 95% confidence interval, –10.835 to –0.679; r=–0.58; R2 =0.34; F-test P=0.029).
Conclusions
EVLWi was significantly reduced after 18 hours in PPV and values measured in supine positions were correlated with PaO2/FiO2. This relationship can help clinicians discriminate whether deterioration in gas exchange is related to fluid overload or disease progression. Further clinical research should evaluate the role of TPTD parameters as markers to stratify disease severity and guide clinical management.

Citations

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Determining Extracellular Water Effects in Mild and Severe COVID-19 Pneumonia Clinical Course by using the Bioimpedance Method
Zuhal Cavus, Ayse Vahaboglu, Ulku Aygen Turkmen, Habibe Vural, Dondu Genc Moralar
Medical Bulletin of Haseki.2023; 61(2): 81. CrossRef

Pulmonary
An algorithm to predict the need for invasive mechanical ventilation in hospitalized COVID-19 patients: the experience in Sao Paulo: Eduardo Atsushi Osawa, Alexandre Toledo Maciel; Acute Crit Care. 2022;37(4):580-591. Published online September 8, 2022; DOI: https://doi.org/10.4266/acc.2022.00283

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Abstract PDF

Background
We aimed to characterize patients hospitalized for coronavirus disease 2019 (COVID-19) and identify predictors of invasive mechanical ventilation (IMV).
Methods
We performed a retrospective cohort study in patients with COVID-19 admitted to a private network in Sao Paulo, Brazil from March to October 2020. Patients were compared in three subgroups: non-intensive care unit (ICU) admission (group A), ICU admission without receiving IMV (group B) and IMV requirement (group C). We developed logistic regression algorithm to identify predictors of IMV.
Results
We analyzed 1,650 patients, the median age was 53 years (42–65) and 986 patients (59.8%) were male. The median duration from symptom onset to hospital admission was 7 days (5–9) and the main comorbidities were hypertension (42.4%), diabetes (24.2%) and obesity (15.8%). We found differences among subgroups in laboratory values obtained at hospital admission. The predictors of IMV (odds ratio and 95% confidence interval [CI]) were male (1.81 [1.11– 2.94], P=0.018), age (1.03 [1.02–1.05], P<0.001), obesity (2.56 [1.57–4.15], P<0.001), duration from symptom onset to admission (0.91 [0.85–0.98], P=0.011), arterial oxygen saturation (0.95 [0.92– 0.99], P=0.012), C-reactive protein (1.005 [1.002–1.008], P<0.001), neutrophil-to-lymphocyte ratio (1.046 [1.005–1.089], P=0.029) and lactate dehydrogenase (1.005 [1.003–1.007], P<0.001). The area under the curve values were 0.860 (95% CI, 0.829–0.892) in the development cohort and 0.801 (95% CI, 0.733–0.870) in the validation cohort.
Conclusions
Patients had distinct clinical and laboratory parameters early in hospital admission. Our prediction model may enable focused care in patients at high risk of IMV.

Citations

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Predictive Models of Patient Severity in Intensive Care Units Based on Serum Cytokine Profiles: Advancing Rapid Analysis
Cristiana P. Von Rekowski, Tiago A. H. Fonseca, Rúben Araújo, Ana Martins, Iola Pinto, M. Conceição Oliveira, Gonçalo C. Justino, Luís Bento, Cecília R. C. Calado
Applied Sciences.2025; 15(9): 4823. CrossRef
Intelligent alert system for predicting invasive mechanical ventilation needs via noninvasive parameters: employing an integrated machine learning method with integration of multicenter databases
Guang Zhang, Qingyan Xie, Chengyi Wang, Jiameng Xu, Guanjun Liu, Chen Su
Medical & Biological Engineering & Computing.2024; 62(11): 3445. CrossRef

Epidemiology
The fourth wave: vaccination status and intensive care unit mortality at a large hospital system in New York City: Pranai Tandon, Evan Leibner, Anna Hackett, Katherine Maguire, Kayla Leonardi, Matthew A. Levin, Roopa Kohli-Seth; Acute Crit Care. 2022;37(3):339-346. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00675

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Abstract PDF

Background
We aim to describe the demographics and outcomes of patients with severe disease with the Omicron variant. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus continues to mutate, and the availability of vaccines and boosters continue to rise, it is important to understand the health care burden of new variants. We analyze patients admitted to intensive care units (ICUs) in a large Academic Health System during New York City’s fourth surge beginning on November 27, 2021.
Methods
All patients admitted to an ICU were included in the primary analysis. Key demographics and outcomes were retrospectively compared between patients stratified by vaccination status. Univariate and multivariate logistic regression was used to identify risk factors for in-hospital mortality.
Results
In-hospital mortality for all admitted patients during the fourth wave was significantly lower than in previous waves. However, among patients requiring intensive care, in-hospital mortality was high across all levels of vaccination status. In a multivariate model older age was associated with increased in-hospital mortality, vaccination status of overdue for booster was associated with decreased in hospital mortality, and vaccination status of up-to-date with vaccination showed a trend to reduced mortality.
Conclusions
In-hospital mortality of patients with severe respiratory failure from coronavirus disease 2019 (COVID-19) remains high despite decreasing overall mortality. Vaccination against SARS-CoV-2 was protective against mortality. Vaccination remains the best and safest way to protect against serious illness and death from COVID-19. It remains unclear that any other treatment will have success in changing the natural history of the disease.

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Changing epidemiology of SARS-CoV-2 positivity rates in a diverse population of children and adults during variant evolution and progressive vaccination eligibility in New York City
Priya D. Velu, Charlene Thomas, Sophie Rand, Eddie Imada, Claudio Zanettini, Jin-Young Han, Zachary Grinspan, Erika L. Abramson, Luigi Marchionni, Melissa M. Cushing, Karen P. Acker
BMC Infectious Diseases.2025;[Epub] CrossRef
Need for ICU and outcome of critically ill patients with COVID-19 and haematological malignancies: results from the EPICOVIDEHA survey
Tobias Lahmer, Jon Salmanton-García, Francesco Marchesi, Shaimaa El-Ashwah, Marcio Nucci, Caroline Besson, Federico Itri, Ozren Jaksic, Natasha Čolović, Barbora Weinbergerová, Guldane Cengiz Seval, Tatjana Adžić-Vukičević, Tomáš Szotkowski, Uluhan Sili, M
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Clinical outcomes of immunomodulation therapy in immunocompromised patients with severe Covid-19 and high oxygen requirement
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Outcomes of Elderly Patients Hospitalized with the SARS-CoV-2 Omicron B.1.1.529 Variant: A Systematic Review
Roxana Manuela Fericean, Cristian Oancea, Akash Reddy Reddyreddy, Ovidiu Rosca, Felix Bratosin, Vlad Bloanca, Cosmin Citu, Satish Alambaram, Neeharika Gayatri Vasamsetti, Catalin Dumitru
International Journal of Environmental Research and Public Health.2023; 20(3): 2150. CrossRef

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

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Abstract 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.

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Xingming Li, Hongqiong Peng, Yunchuan Wang, Shiying He, Xueting Yang, Jiayue Chen
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Bacterial and Fungal Coinfections in COVID-19 Inpatients at a Tertiary Hospital in Surabaya, Indonesia, from November 2020 to February 2022
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Review Article

Neurology
Transient splenial lesions of the corpus callosum and infectious diseases: Kyu Sun Yum, Dong-Ick Shin; Acute Crit Care. 2022;37(3):269-275. Published online August 17, 2022; DOI: https://doi.org/10.4266/acc.2022.00864

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Abstract PDF

Transient splenial lesion of the corpus callosum can be observed in various diseases such as cancer, drug use, metabolic disorders, and cerebrovascular disorders, as well as in patients with infectious diseases. During the coronavirus disease 2019 (COVID-19) pandemic, there were increasing reports of these lesions being detected on brain imaging tests performed in patients with neurological symptoms. On brain magnetic resonance imaging, findings suggestive of cytotoxic edema are observed in the splenium; these are known to disappear with improvement of clinical symptoms. Cytokinopathy caused by infection increases the permeability of the blood–brain barrier and activates the glial cells of the brain to induce cytotoxic edema. Most patients have a good prognosis. The causes, mechanism, diagnosis, treatment and prognosis of transient splenial lesions of the corpus callosum will be summarized in this review.

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Victoria Vold, Stein-Helge Hansen Tingvoll, Mona K. Beyer, Kaja Nordengen
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Reenvisioning Cytotoxic Lesions of Corpus Callosum in Light of Coronavirus Disease-2019: Review with Related Concepts
Udit Chauhan, Khanak K. Nandolia, Rahul Dev
Journal of Medical Evidence.2025; 6(2): 149. CrossRef
Tuberculous Meningitis in a Child: A Rare Presentation of Cytotoxic Lesion of the Corpus Callosum
Ny Thi Hong Tran, Nhung Thi Hong Nguyen, Uyen Phuong Vo, Julie Huynh
Tropical Medicine and Infectious Disease.2025; 10(4): 96. CrossRef
COVID‐19‐Associated Cytotoxic Lesions of the Corpus Callosum in Chinese Patients: A Retrospective Study
Chenyi Wan, Menghua Li, Yanyan Yu, Si Luo, Daojun Hong, Meihong Zhou, Yu Zhu
Brain and Behavior.2025;[Epub] CrossRef
Cytotoxic Lesion of the Corpus Callosum Associated with 5-Fluorouracil: A Case Report and Review of Literature
Maral Martin MİLDANOĞLU, Banu KARAALİOĞLU, Ebru ENGİN DELİPOYRAZ, Mehmet Haluk YÜCEL, Ömer Fatih ÖLMEZ
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Chung-Hao Wang, Chi-Nan Huang, Pei-Wei Wang
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Husam El Sharu, Soban Ahmad, Hunter Coore
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Rickettsial infection causing non-aneurysmal subarachnoid hemorrhage with transient corpus callosum lesion
Zahraa Noureddine El Moussaoui, Zahraa Saker, Hasan Rahhal, Ali Nasserdine, Mahmoud Younes
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Cytotoxic lesions of the corpus callosum due to FOLFIRINOX chemotherapy
Mafalda Soares, Sara Rosa, Sofia Bettencourt, Rita Ferreira, Mariana Sardinha, Margarida Dias, Bruno Cunha
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Original Articles

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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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.

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Respiratory and Pleural Pathogens in Octogenarians Hospitalized with COVID-19: Impact of Secondary Bacterial Pneumonia on Day-5 SOFA and Mortality
Petrinela Daliu, Felix Bratosin, Ovidiu Rosca, Monica Licker, Elena Hogea, Livia Stanga, Camelia Vidita Gurban, Delia Muntean
Microorganisms.2026; 14(1): 164. CrossRef
Quadriceps Muscle Layer Thickness and its association with frailty in critically ill patients: A prospective observational study
Vijay Sundarsingh, R. Manoj Kumar, Manjunath Kulkarni, Debasis Pradhan, Pramela Renisha Rodrigues, Nishanth Baliga, Mamata Prasad, Pooja Yadav, Monish Thomas, Tania Eltrida Pinto
Journal of Critical Care.2025; 85: 154930. CrossRef
Prevalence of New Frailty at Hospital Discharge in Severe COVID-19 Survivors and Its Associated Factors
Jong Hwan Jeong, Manbong Heo, Sunghoon Park, Su Hwan Lee, Onyu Park, Taehwa Kim, Hye Ju Yeo, Jin Ho Jang, Woo Hyun Cho, Jung-Wan Yoo
Tuberculosis and Respiratory Diseases.2025; 88(2): 361. CrossRef
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Yangyang Jiang, Guohong Yu
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Evelyne Towair, Zeina Al Achkar, Romanos Haykal, Ahmad Kassar, Eric Bou Karam, Pascale Salameh, Toufic Chaaban
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Kyung-Eui Lee, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
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Banu Buyukaydin, Tahsin Karaaslan, Omer Uysal
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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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Meta-analysis
Association of nutrition risk screening 2002 and Malnutrition Universal Screening Tool with COVID-19 severity in hospitalized patients in Iran: Ghazaleh Eslamian, Sohrab Sali, Mansour Babaei, Karim Parastouei, Dorsa Arman Moghadam; Acute Crit Care. 2022;37(3):332-338. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2021.01830

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Abstract PDF

Background
Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran.
Methods
In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity.
Results
In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21–2.56; P=0.021).
Conclusions
Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.

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Zakir Hussain, Malaya Dutta Borah, Rezaul Karim Ahmed
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Hiroyo Miyata, Ayako Tsunou, Yoko Hokotachi, Teruyoshi Amagai
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Ghadamieh Fatemeh, Ginette Fotsing, Pedro Marques-Vidal, Peter Kopp, Mohammed Barigou
Clinical Nutrition ESPEN.2023; 55: 357. CrossRef

Case Reports

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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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.

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Incidence and Temporal Dynamics of Combined Infections in SARS-CoV-2-Infected Patients With Risk Factors for Severe Complications
Sin Young Ham, Seungjae Lee, Min-Kyung Kim, Jaehyun Jeon, Eunyoung Lee, Subin Kim, Jae-Phil Choi, Hee-Chang Jang, Sang-Won Park
Journal of Korean Medical Science.2025;[Epub] CrossRef
Mucormycosis coinfection in patients with proven aspergillosis
Hyeon Mu Jang, Ji Yeun Kim, Joon Seon Song, Euijin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sang-Ho Choi, Sang-Oh Lee, Yang Soo Kim, Sung-Han Kim
Medical Mycology.2025;[Epub] CrossRef
Three case reports of pulmonary mucormycosis with a review of the literature
Zhengyang Zhang, Min Wang
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Pathologically Confirmed Dual Coronavirus Disease 2019-Associated Tracheobronchial Aspergillosis and Pulmonary Mucormycosis in a Non-Endemic Region: A Case Report
Keon Oh, Sung-Yeon Cho, Dong-Gun Lee, Dukhee Nho, Dong Young Kim, Hye Min Kweon, Minseung Song, Raeseok Lee
Journal of Clinical Medicine.2025; 14(15): 5526. CrossRef
Mixed Aspergillosis and Mucormycosis Infections in Patients with COVID-19: Case Series and Literature Review
Elahe Sasani, Farzad Pakdel, Sadegh Khodavaisy, Mohammadreza Salehi, Amir Salami, Marjan Sohrabi, Pouyan Aminishakiba, Iman Amirafzali, Arezoo Salami Khaneshan
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Prevalence of co‐existent COVID‐19‐associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID‐19‐associated pulmonary mucormycosis (CAPM)
Valliappan Muthu, Ritesh Agarwal, Shivaprakash Mandya Rudramurthy, Deepak Thangaraju, Manoj Radhakishan Shevkani, Atul K. Patel, Prakash Srinivas Shastri, Ashwini Tayade, Sudhir Bhandari, Vishwanath Gella, Jayanthi Savio, Surabhi Madan, Vinaykumar Hallur,
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Aspergillosis coinfection in patients with proven mucormycosis
Sang Hyun Ra, Ji Yeun Kim, Joon Seon Song, Hyeon Mu Jang, Euijin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Sung-Han Kim
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Successful treatment of mixed pulmonary Aspergillus and Mucor infection using intrabronchial amphotericin B infusion: a case report and literature review
Fei-Xiang Ling, Dong-Ming Qu, Ye-Quan Lu, Rou Li, Lei Zhao
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Sang Hwan Lee, Yun Jin Kim, Jaehoon Oh, Hyunggoo Kang, Kyung Hun Yoo, Byuk Sung Ko, Tae Ho Lim, Bo-Guen Kim, Hyun Lee, Sang-Heon Kim, Jang Won Sohn, Ho Joo Yoon, Hayoung Choi, Yongil Cho, Dong Won Park
Frontiers in Medicine.2024;[Epub] CrossRef
Dual Disseminated Aspergillosis and Mucormycosis Diagnosed at Autopsy: A Report of Two Cases of Coinfection and a Review of the Literature
Jason Murray, Zhen A. Lu, Karin Miller, Alex Meadows, Marissa Totten, Sean X. Zhang
Journal of Fungi.2023; 9(3): 357. CrossRef
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Sara Mina, Hajar Yaakoub, Cédric Annweiler, Vincent Dubée, Nicolas Papon
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Basic science and research
COVID-19–related acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation and programmed multi-level ventilation: a case report: Filip Depta, Anton Turčan, Pavol Török, Petra Kapraľová, Michael A. Gentile; Acute Crit Care. 2022;37(3):470-473. Published online January 21, 2022; DOI: https://doi.org/10.4266/acc.2021.01109

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Abstract PDF

We report a patient with severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) and programmed multi-level ventilation (PMLV). VV ECMO as a treatment modality for severe ARDS has been described multiple times as a rescue therapy for refractory hypoxemia. It is well known that conventional ventilation can cause ventilator-induced lung injury. Protective ventilation during VV ECMO seems to be beneficial, translating to using low tidal volumes, prone positioning with general concept of open lung approach. However, mechanical ventilation is still required as ECMO per se is usually not sufficient to maintain adequate gas exchange due to hyperdynamic state of the patient and limitation of blood flow via VV ECMO. This report describes ventilation strategy using PMLV during “resting” period of the lung. In short, PMLV is a strategy for ventilating non-homogenous lungs that incorporates expiratory time constants and multiple levels of positive end-expiratory pressure. Using this approach, most affected acute lung injury/ARDS areas can be recruited, while preventing overdistension in healthy areas. To our knowledge, case report using such ventilation strategy for lung resting period has not been previously published.

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Treatment of acute respiratory failure: extracorporeal membrane oxygenation
Jin-Young Kim, Sang-Bum Hong
Journal of the Korean Medical Association.2022; 65(3): 157. CrossRef

Original Article

Infection
Association of vitamin D deficiency with COVID-19 severity and mortality in Iranian people: a prospective observational study: Alireza Fatemi, Seyed Hossein Ardehali, Ghazaleh Eslamian, Morvarid Noormohammadi, Shirin Malek; Acute Crit Care. 2021;36(4):300-307. Published online November 29, 2021; DOI: https://doi.org/10.4266/acc.2021.00605

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Abstract PDF

Background
As the coronavirus disease 2019 (COVID-19) pandemic continues to escalate, it is important to identify the prognostic factors related to increased mortality and disease severity. To assess the possible associations of vitamin D level with disease severity and survival, we studied 248 hospitalized COVID-19 patients in a single center in a prospective observational study from October 2020 to May 2021 in Tehran, Iran.
Methods
Patients who had a record of their 25-hydroxyvitamin D level measured in the previous year before testing positive with COVID-19 were included. Serum 25-hydroxyvitamin D level was measured upon admission in COVID-19 patients. The associations between clinical outcomes of patients and 25-hydroxyvitamin D level were assessed by adjusting for potential confounders and estimating a multivariate logistic regression model.
Results
The median (interquartile range) age of patients was 60 years (44–74 years), and 53% were male. The median serum 25-hydroxyvitamin D level prior to admission decreased with increasing COVID-19 severity (P=0.009). Similar findings were obtained when comparing median serum 25-hydroxyvitamin D on admission between moderate and severe patients (P=0.014). A univariate logistic regression model showed that vitamin D deficiency prior to COVID-19 was associated with a significant increase in the odds of mortality (odds ratio, 2.01; P=0.041). The Multivariate Cox model showed that vitamin D deficiency on admission was associated with a significant increase in risk for mortality (hazard ratio, 2.35; P=0.019).
Conclusions
Based on our results, it is likely that deficient vitamin D status is associated with increased mortality in COVID-19 patients. Thus, evaluating vitamin D level in COVID-19 patients is warranted.

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Agata Sobczyńska-Malefora, Aleksander Sulkowski, Laurence Harbige, David Steed, Dominic Jon Harrington
Nutrients.2025; 17(17): 2861. CrossRef
The close association of micronutrients with COVID-19
Aimin Zhang, Yue Yin, Jiashu Tian, Xialin Wang, Zhihong Yue, Lin Pei, Li Liu, Li Qin, Mei Jia, Hui Wang, Qingwei Ma, Wei-bo Gao, Lin-Lin Cao
Heliyon.2024; 10(7): e28629. CrossRef
The bounds of meta-analytics and an alternative method
Ramalingam Shanmugam, Mohammad Tabatabai, Derek Wilus, Karan P. Singh
Epidemiology and Health.2024; 46: e2024016. CrossRef
A Narrative Review of The Modulatory Effects of Vitamins in the Course of Covid-19 Disease
Mohaddeseh Larypoor, Mehdi Shamsi, Mona Maleki, Atefeh Tazari, Mohammad Soroosh Farhadi
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Nutrients.2022; 14(8): 1625. CrossRef

Case Report

Pulmonary
Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report: Joseph Abraham Poonuraparampil, Habib Md Reazaul Karim, Manu P Kesavankutty, Porika Prashanth Nayak; Acute Crit Care. 2022;37(1):120-123. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2020.00983

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Abstract PDF

Effective use of noninvasive ventilation in patients with chronic obstructive pulmonary disease is well-known. However, noninvasive ventilation in patients presenting with altered sensorium and severe acidosis (pH <7.1) has been rarely described. Invasive mechanical ventilation is associated with high mortality in coronavirus disease 2019 (COVID-19), and use of noninvasive ventilation over invasive ventilation is an area of investigation. We report a case of COVID-19-induced acute exacerbation of chronic obstructive pulmonary disease in a 66-year-old male. His past medical history included obstructive sleep apnea, hypertension, cor pulmonale, atrial fibrillation, and amiodarone-induced hypothyroidism. On presentation, he had acute hypercapnic respiratory failure, severe acidosis (partial pressure of carbon dioxide [PCO2], 147 mm Hg; pH, 7.06), and altered mentation. The patient was successfully managed with noninvasive ventilation, avoiding endotracheal intubation, invasive ventilation, and related complications. Although precarious, a trial of noninvasive ventilation can be considered in COVID-19-induced acute exacerbation of chronic obstructive pulmonary disease with hypercapnic respiratory failure, severe acidosis, and altered mentation.

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Original Articles

Infection
Clinical characteristics and outcomes of critically ill COVID-19 patients in Sfax, Tunisia: Mabrouk Bahloul, Sana Kharrat, Kamilia Chtara, Malek Hafdhi, Olfa Turki, Najeh Baccouche, Rania Ammar, Nozha Kallel, Majdi Hsairi, Olfa Chakroun-Walha, Chokri Ben Hamida, Hedi Chelly, Khaiereddine Ben Mahfoudh, Abelhamid Karoui, Hela Karray, Noureddine Rekik, Mounir Bouaziz; Acute Crit Care. 2022;37(1):84-93. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00129

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Abstract PDF

Background
Africa, like the rest of the world, has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. However, only a few studies covering this subject in Africa have been published.
Methods
We conducted a retrospective study of critically ill adult COVID-19 patients—all of whom had a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection— admitted to the intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia).
Results
A total of 96 patients were admitted into our ICU for respiratory distress due to COVID-19 infection. Mean age was 62.4±12.8 years and median age was 64 years. Mean arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was 105±60 and ≤300 in all cases but one. Oxygen support was required for all patients (100%) and invasive mechanical ventilation for 38 (40%). Prone positioning was applied in 67 patients (70%). Within the study period, 47 of the 96 patients died (49%). Multivariate analysis showed that the factors associated with poor outcome were the development of acute renal failure (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.75–25.9), the use of mechanical ventilation (OR, 5.8; 95% CI, 1.54–22.0), and serum cholinesterase (SChE) activity lower than 5,000 UI/L (OR, 5.0; 95% CI, 1.34–19).
Conclusions
In this retrospective cohort study of critically ill patients admitted to the ICU in Sfax, Tunisia, for acute respiratory failure following COVID-19 infection, the mortality rate was high. The development of acute renal failure, the use of mechanical ventilation, and SChE activity lower than 5,000 UI/L were associated with a poor outcome.

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Tomáš Fazekaš, Lucia Kováčik, Morteza Motahari Rad, Xavier Gabaldó Barrios, Simona Mihaela Iftimie, Jordi Camps, Anna Hrabovská
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Minal Shastri, Raj Vekaria, Darshankumar Manubhai Raval, Shashwat Mallik, Shahin Khan
Journal of the Association of Physicians of India.2023; 71(12): 24. CrossRef
Prognostic Value of Serum Cholinesterase Activity in Severe SARS-CoV-2–Infected Patients Requiring Intensive Care Unit Admission
Mabrouk Bahloul, Sana Kharrat, Saba Makni, Najeh Baccouche, Rania Ammar, Aida Eleuch, Lamia Berrajah, Amel Chtourou, Olfa Turki, Chokri Ben Hamida, Hedi Chelly, Kamilia Chtara, Fatma Ayedi, Mounir Bouaziz
The American Journal of Tropical Medicine and Hygiene.2022; 107(3): 534. CrossRef

Nursing
Intensive care unit professionals during the COVID-19 pandemic in Spain: social and work-related variables, COVID-19 symptoms, worries, and generalized anxiety levels: Fernando J. García-Hedrera, Fernanda Gil-Almagro, F. Javier Carmona-Monge, Cecilia Peñacoba-Puente, Patricia Catalá-Mesón, Lilian Velasco-Furlong; Acute Crit Care. 2021;36(3):232-241. Published online August 31, 2021; DOI: https://doi.org/10.4266/acc.2021.00213

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Abstract PDF

Background
The severe acute respiratory syndrome coronavirus 2 outbreak has been identified as a pandemic and global health emergency. It presents as a severe acute respiratory disease. The rapid dissemination of the disease created challenges for healthcare systems and forced healthcare workers (HCWs) to deal with many clinical and nonclinical stresses. The aim of our research is to describe work conditions, symptoms experienced by HCWs, worries about contagion, and generalized anxiety symptoms and compare those findings across regions in Spain.
Methods
This cross-sectional study was conducted using an online survey. Critical care units throughout Spain were included. The sample comprised HCWs working in intensive care units from March to May 2020. We assessed work variables, physical symptoms, worries about contagion, and anxiety (generalized anxiety disorder-7 questionnaire).
Results
The final sample comprised 448 surveys. Among the respondents, 86.9% (n=389) were nursing professionals, and 84.8% (n=380) were women. All participants cared for coronavirus disease 2019 (COVID-19) patients during the study period. Workload during the pandemic in Madrid was judged to be higher than in other regions (P<0.01). The availability of personal protective equipment was found to be higher in Cataluña. The most frequently experienced symptom was headaches (78.1%). Worries about self-infection and the possibility of infecting others received mean scores of 3.11 and 3.75, respectively. Mean scores for generalized anxiety levels were 11.02, with 58.7% of the professionals presenting with generalized anxiety syndrome during the assessment.
Conclusions
In this study, we found high levels of anxiety among HCWs caring directly for COVID-19 patients, which could produce long-term psychological alterations that still need to be assessed.

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Fernanda Gil-Almagro, F. Javier Carmona-Monge, Fernando J. García-Hedrera, Cecilia Peñacoba-Puente
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From Anxiety to Hopelessness: Examining Influential Psychological Processes Affecting Mental Health Status of Spanish Nurses During the COVID-19 Pandemic
Cecilia Peñacoba-Puente, Fernanda Gil-Almagro, Fernando José García-Hedrera, Francisco Javier Carmona-Monge
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Fernanda Gil-Almagro, Francisco Javier Carmona-Monge, Fernando José García-Hedrera, Cecilia Peñacoba-Puente
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Chia‐Hung Lin, Shu‐Fen Siao, You‐Jie Lin, Pin‐Hsien Hsin, Mack Shelley, Yen‐Han Lee
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Pulmonary
Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing: Mabrouk Bahloul, Sana Kharrat, Malek Hafdhi, Anis Maalla, Olfa Turki, Kamilia Chtara, Rania Ammar, Basma Suissi, Chokri Ben Hamida, Hedi Chelly, Khaiereddine Ben Mahfoudh, Mounir Bouaziz; Acute Crit Care. 2021;36(3):208-214. Published online August 12, 2021; DOI: https://doi.org/10.4266/acc.2021.00500

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Abstract PDF

Background
In this study, we explored whether early application of the prone position (PP) can improve severe hypoxemia and respiratory failure in coronavirus disease 2019 (COVID-19) patients with spontaneous breathing.
Methods
This is a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. All vital parameters were recorded in real time for all patients. Moreover, the results of chest computed tomography (CT), when available, were analyzed.
Results
PP was applied in 21 patients who were breathing spontaneously. The application of PP was associated with a significant increase in oxygen saturation measured by pulse oximetry (SpO₂) from 82%±12% to 96%±3% (P<0.001) 1 hour later. Moreover, PP was associated with a significant reduction in respiratory rate from 31±10 to 21±4 breaths/min (P<0.001). Furthermore, the number of patients who exhibited signs of respiratory distress after PP was reduced from 10 (47%) to 3 (14%) (P=0.04). Early PP application also led to a clear improvement on CT imaging. It was not, however, associated with a reduction in mortality rate or in the use of invasive mechanical ventilation (P>0.05 for both).
Conclusions
Our study confirmed that the early application of PP can improve hypoxemia and tachypnea in COVID-19 patients with spontaneous breathing. Randomized controlled trials are needed to confirm the beneficial effects of PP in COVID-19 patients with spontaneous breathing.

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From pandemic onset to present: five years of insights into ARDS caused by COVID-19
Esteban Ortiz-Prado, Juan S. Izquierdo-Condoy, Jorge Vasconez-Gonzalez, Andrés López-Cortés, Camila Salazar-Santoliva, Alfonso Roberto Vargas Michay, Jorge Luis Vélez-Paéz, Luis Unigarro
Expert Review of Respiratory Medicine.2025; 19(8): 843. CrossRef
The effect of prone position on oxygen saturation, blood gas parameters, and respiratory rate in intensive care patients with COVID-19-induced ARDS
Veysel Tekin, Medet Korkmaz
Scientific Reports.2025;[Epub] CrossRef
Awake prone positioning for patients with COVID-19-related respiratory failure: a systematic review and meta-analysis
Mara Graziani, Andrea Galeazzo Rigutini, Diletta Bartolini, Laura Traballi, Lorenzo Luzi, Rossana Regina, Francesco Bossi, Carla Caponi, Cecilia Becattini
Internal and Emergency Medicine.2024; 19(1): 147. CrossRef
Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Gustavo Adolfo Vásquez-Tirado, Edinson Dante Meregildo-Rodríguez, Martha Genara Asmat-Rubio, María José Salazar-Castillo, Claudia Vanessa Quispe-Castañeda, María del Carmen Cuadra-Campos
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Prone positioning in awake patients without ventilatory support does not alter major clinical outcomes in severe COVID-19: results from a retrospective observational cohort study, systematic review and meta-analysis
Raíssa S. Freire, Camila M. S. S. Barros, Jefferson Valente, Cássia da Luz Goulart, Anna G. R. Santos, Fernando H. Fonseca, Sabrina T. Saenz, Andiana S. Dias, Maria G. A. Rodrigues, Bernardo Maia Silva, Eduardo Fernandes, Nadia Cubas-Vega, Vanderson Sampa
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Khaoula Ben Ismail, Fatma Essafi, Imen Talik, Najla Ben Slimene, Ines Sdiri, Boudour Ben Dhia, Takoua Merhbene
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Pulmonary
The Mount Sinai Hospital Institute for critical care medicine response to the COVID-19 pandemic: Jennifer Wang, Evan Leibner, Jaime B. Hyman, Sanam Ahmed, Joshua Hamburger, Jean Hsieh, Neha Dangayach, Pranai Tandon, Umesh Gidwani, Andrew Leibowitz, Roopa Kohli-Seth; Acute Crit Care. 2021;36(3):201-207. Published online August 10, 2021; DOI: https://doi.org/10.4266/acc.2021.00402

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Abstract PDF Supplementary Material

Background
The coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of critically ill patients. This was especially true in New York City. We present a roadmap for hospitals and healthcare systems to prepare for a Pandemic.
Methods
This was a retrospective review of how Mount Sinai Hospital (MSH) was able to rapidly prepare to handle the pandemic. MSH, the largest academic hospital within the Mount Sinai Health System, rapidly expanded the intensive care unit (ICU) bed capacity, including creating new ICU beds, expanded the workforce, and created guidelines.
Results
MSH a 1,139-bed quaternary care academic referral hospital with 104 ICU beds expanded to 1,453 beds (27.5% increase) with 235 ICU beds (126% increase) during the pandemic peak in the first week of April 2020. From March to June 2020, with follow-up through October 2020, MSH admitted 2,591 COVID-19-positive patients, 614 to ICUs. Most admitted patients received noninvasive support including a non-rebreather mask, high flow nasal cannula, and noninvasive positive pressure ventilation. Among ICU patients, 68.4% (n=420) received mechanical ventilation; among the admitted ICU patients, 42.8% (n=263) died, and 47.8% (n=294) were discharged alive.
Conclusions
Flexible bed management initiatives; teamwork across multiple disciplines; and development and implementation of guidelines were critical accommodating the surge of critically ill patients. Non-ICU services and staff were deployed to augment the critical care work force and open new critical care units. This approach to rapidly expand bed availability and staffing across the system helped provide the best care for the patients and saved lives.

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Pulmonary
Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome: Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali; Acute Crit Care. 2021;36(3):223-231. Published online July 30, 2021; DOI: https://doi.org/10.4266/acc.2021.00388

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Abstract PDF

Background
Both coronavirus disease 2019 (COVID-19) and Middle East respiratory syndrome (MERS) can cause acute respiratory distress syndrome (ARDS); however, their ARDS course and characteristics have not been compared, which we evaluate in our study.
Methods
MERS patients with ARDS seen during the 2014 outbreak and COVID-19 patients with ARDS admitted between March and December 2020 in our hospital were included, and their clinical characteristics, ventilatory course, and outcomes were compared.
Results
Forty-nine and 14 patients met the inclusion criteria for ARDS in the COVID-19 and MERS groups, respectively. Both groups had a median of four comorbidities with high Charlson comorbidity index value of 5 points (P>0.22). COVID-19 patients were older, obese, had significantly higher initial C-reactive protein (CRP), more likely to get trial of high-flow oxygen, and had delayed intubation (P≤0.04). The postintubation course was similar between the groups. Patients in both groups experienced a prolonged duration of mechanical ventilation, and majority received paralytics, dialysis, and vasopressor agents (P>0.28). The respiratory and ventilatory parameters after intubation (including tidal volume, fraction of inspired oxygen, peak and plateau pressures) and their progression over 3 weeks were similar (P>0.05). Rates of mortality in the ICU (53% vs. 64%) and hospital (59% vs. 64%) among COVID-19 and MERS patients (P≥0.54) were very high.
Conclusions
Despite some distinctive differences between COVID-19 and MERS patients prior to intubation, the respiratory and ventilatory parameters postintubation were not different. The higher initial CRP level in COVID-19 patients may explain the steroid responsiveness in this population.

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Structure defining of ultrapotent neutralizing nanobodies against MERS-CoV with novel epitopes on receptor binding domain
Sen Ma, Doudou Zhang, Qiwei Wang, Linjing Zhu, Xilin Wu, Sheng Ye, Yaxin Wang, Julie Overbaugh
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Imran Khalid, Muhammad Ali Akhtar, Manahil Imran, Maryam Imran, Musaab Ahmed Mujalli, Moayad Sami Qashqari, Abeer N Alshukairi, Amina Nisar, Tabindeh Jabeen Khalid
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Pulmonary
Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study: John S. Zorbas, Kwok M. Ho, Edward Litton, Bradley Wibrow, Edward Fysh, Matthew H. Anstey; Acute Crit Care. 2021;36(2):143-150. Published online May 4, 2021; DOI: https://doi.org/10.4266/acc.2021.00017

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Abstract PDF

Background
Evidence prior to the coronavirus disease 2019 (COVID-19) pandemic suggested that, compared with conventional ventilation strategies, airway pressure release ventilation (APRV) can improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome. We aimed to assess the association between APRV use and clinical outcomes among adult patients receiving mechanical ventilation for COVID-19 and hypothesized that APRV use would be associated with improved survival compared with conventional ventilation.
Methods
A total of 25 patients with COVID-19 pneumonitis was admitted to intensive care units (ICUs) for invasive ventilation in Perth, Western Australia, between February and May 2020. Eleven of these patients received APRV. The primary outcome was survival to day 90. Secondary outcomes were ventilation-free survival days to day 90, mechanical complications from ventilation, and number of days ventilated.
Results
Patients who received APRV had a lower probability of survival than did those on other forms of ventilation (hazard ratio, 0.17; 95% confidence interval, 0.03–0.89; P=0.036). This finding was independent of indices of severity of illness to predict the use of APRV. Patients who received APRV also had fewer ventilator-free survival days up to 90 days after initiation of ventilation compared to patients who did not receive APRV, and survivors who received APRV had fewer ventilator-free days than survivors who received other forms of ventilation. There were no differences in mechanical complications according to mode of ventilation.
Conclusions
Based on the findings of this study, we urge caution with the use of APRV in COVID-19.

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Comparison of airway pressure release ventilation (APRV) versus biphasic positive airway pressure (BIPAP) ventilation in COVID-19 associated ARDS using transpulmonary pressure monitoring
Sandra Emily Stoll, Tobias Leupold, Hendrik Drinhaus, Fabian Dusse, Bernd W. Böttiger, Alexander Mathes
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Airway Pressure Release Ventilation in COVID-19-Associated Acute Respiratory Distress Syndrome—A Multicenter Propensity Score–Matched Analysis
Jan-Hendrik Naendrup, Jonathan Steinke, Jorge Garcia Borrega, Sandra Emily Stoll, Per Ole Michelsen, Yannick Assion, Alexander Shimabukuro-Vornhagen, Dennis Alexander Eichenauer, Matthias Kochanek, Boris Böll
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Airway Pressure Release Ventilation for Acute Respiratory Failure Due to Coronavirus Disease 2019: A Systematic Review and Meta-Analysis
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Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis
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Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
Acute and Critical Care.2021; 36(3): 223. CrossRef

Review Article

Infection
Evolution of COVID-19 management in critical care: review and perspective from a hospital in the United Kingdom: Avinash Kumar Jha, Sudhindra Gurunath Kulkarni; Acute Crit Care. 2021;36(1):1-14. Published online February 26, 2021; DOI: https://doi.org/10.4266/acc.2020.00864

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Abstract PDF

The unexpected emergence and spread of coronavirus disease 2019 (COVID-19) has been pandemic, with long-lasting effects, and unfortunately, it does not seem to have ended. Integrating advanced planning, strong teamwork, and clinical management have been both essential and rewarding during this time. Understanding the new concepts of this novel disease and accommodating them into clinical practice is an ongoing process, ultimately leading to advanced and highly specific treatment modalities. We conducted a literature review through PubMed, Europe PMC, Scopus, and Google Scholar to incorporate the most updated therapeutic principles. This article provides a concise and panoramic view of the cohort of critically ill patients admitted to the intensive care unit. We conclude that COVID-19 management includes low tidal volume ventilation, early proning, steroids, and a high suspicion for secondary bacterial/fungal infections. Lung ultrasound is emerging as a promising tool in assessing the clinical response. Managing non-clinical factors such as staff burnout, communication/consent issues, and socio-emotional well-being is equally important.

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Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
Acute and Critical Care.2021; 36(3): 223. CrossRef

Original Articles

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
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Benjamin Wei, Peter Abraham
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Tracheostomy in COVID Times
Yatin Mehta, Gaurav Kochar
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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

Infection
Risk factors for intensive care unit admission and mortality in hospitalized COVID-19 patients: Ahmed Ayaz, Ainan Arshad, Hajra Malik, Haris Ali, Erfan Hussain, Bushra Jamil; Acute Crit Care. 2020;35(4):249-254. Published online November 11, 2020; DOI: https://doi.org/10.4266/acc.2020.00381

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241 Download
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22 Crossref

Abstract PDF

Background
This study investigated the clinical features and outcome of hospitalized coronavirus disease 2019 (COVID-19) patients admitted to our quaternary care hospital.
Methods
In this retrospective cohort study, we included all adult patients with COVID-19 infection admitted to a quaternary care hospital in Pakistan from March 1 to April 15, 2020. The extracted variables included demographics, comorbidities, presenting symptoms, laboratory tests and radiological findings during admission. Outcome measures included in-hospital mortality and length of stay.
Results
Sixty-six COVID-19 patients were hospitalized during the study period. Sixty-one percent were male and 39% female; mean age was 50.6±19.1 years. Fever and cough were the most common presenting symptoms. Serial chest X-rays showed bilateral pulmonary opacities in 33 (50%) patients. The overall mortality was 14% and mean length of stay was 8.4±8.9 days. Ten patients (15%) required intensive care unit (ICU) care during admission, of which six (9%) were intubated. Age ≥60 years, diabetes, ischemic heart disease, ICU admission, neutrophil to lymphocyte ratio ≥3.3, and international normalized ratio ≥1.2 were associated with increased risk of mortality.
Conclusions
We found a mortality rate of 14% in hospitalized COVID-19 patients. COVID-19 cases are still increasing exponentially around the world and may overwhelm healthcare systems in many countries soon. Our findings can be used for early identification of patients who may require intensive care and aggressive management in order to improve outcomes.

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