Acute and Critical Care

Original Articles

Pediatrics
Acute severe hepatitis in children following extrahepatic infection in South Korea: etiology, clinical course, and outcomes: Sanghoon Lee, Young Ok Kim, Seo-Hee Kim; Acute Crit Care. 2025;40(1):122-127. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.000600

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Abstract PDF: Background
Acute hepatitis can occur in association with systemic diseases outside the liver. Acute severe hepatitis with markedly elevated transaminase levels following extrahepatic infection has been reported in children. However, research on this condition remains limited. This study aimed to investigate its etiology, clinical course, and outcomes.
Methods
We retrospectively reviewed data from 2013 to 2020 for children under 12 years old with elevated liver enzymes following systemic infection. Acute severe hepatitis was defined as serum transaminase levels exceeding 1,000 IU/L in the absence of underlying liver disease. We analyzed hepatitis-associated pathogens, liver enzyme trends, and factors influencing recovery.
Results
A total of 39 patients were included in this study. The most common age group was 7–12 months (54.8%), and 53.8% were male. Respiratory infections were the most common (61.5%), followed by gastrointestinal infections (23.1%), meningitis (10.3%), and urinary tract infections (5.1%). The median peak alanine transaminase (ALT) level was 1,515.8±424.2 IU/L, with a median time to peak ALT of 4.2±2.3 days from symptom onset. ALT levels normalized within 21 days in 71.8% of patients and within 28 days in 94.9%. Younger age was associated with delayed ALT normalization, whereas hepatoprotective agent use was associated with faster normalization.
Conclusions
Acute severe hepatitis can develop following respiratory and other systemic infections. Younger children were more susceptible and had a more prolonged disease course.

Infection
The association between defecation frequency and mortality in critically ill patients with suspected sepsis in Israel: Michael Roimi, Anat Shrot, Roy Ilan, Avraham Tenenbaum, Danny Epstein, Yaron Bar-Lavie; Acute Crit Care. 2025;40(1):38-45. Published online February 18, 2025; DOI: https://doi.org/10.4266/acc.000696

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Abstract PDF: Background
The pivotal role of the gastrointestinal (GI) tract in sepsis is well recognized. This study aimed to evaluate the associations between defecation frequency as a basic assessment of GI function and the clinical outcomes of intensive care unit patients with suspected sepsis.
Methods
This retrospective, single-center study included patients suspected of having sepsis. The number of defecations and consecutive days without defecation during the 72 hours preceding the suspected infection were assessed. The primary outcome was 30-day all-cause mortality. Multivariate regression analysis adjusting for potential confounders was employed to establish the associations between GI function and clinical outcomes.
Results
The final analysis included 1,306 patients with a median age of 56.2 years (interquartile range [IQR], 39.6–69.1); 919 (70.4%) were male, and the median Acute Physiology and Chronic Health Evaluation II score was 22.0 (IQR, 17.0–27.0). The median Sequential Organ Failure Assessment score at the time of suspected infection was 5.0 (IQR, 3.0–7.0). Mortality rates were 20.3%, 28.0%, and 34.3% for patients with 0–2, 3–5, and >5 defecations, respectively (P<0.001). There was a strong correlation between the number of defecations and mortality (r=0.7, P=0.01). In multivariate analyses, each defecation was independently associated with increased mortality (adjusted odds ratio [aOR], 1.07; 95% CI, 1.01–1.12; P=0.01), while each consecutive day without a defecation was associated with reduced mortality (aOR, 0.83; 95% CI, 0.73–0.96; P=0.01).
Conclusions
A higher number of defecations in the 72 hours preceding suspected sepsis is associated with increased 30-day all-cause mortality, suggesting a potential association with GI tract dysfunction.

Pediatrics
Early detection of bloodstream infection in critically ill children using artificial intelligence: Hye-Ji Han, Kyunghoon Kim, June Dong Park; Acute Crit Care. 2024;39(4):611-620. Published online November 22, 2024; DOI: https://doi.org/10.4266/acc.2024.00752

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Abstract PDF

Background
Despite the high mortality associated with bloodstream infection (BSI), early detection of this condition is challenging in critical settings. The objective of this study was to create a machine learning tool for rapid recognition of BSI in critically ill children.
Methods
Data were extracted from a derivative cohort comprising patients who underwent at least one blood culture during hospitalization in the pediatric intensive care unit (PICU) of a tertiary hospital from January 2020 to June 2023 for model development. Data from another tertiary hospital were utilized for external validation. Variables selected for model development were age, white blood cell count with segmented neutrophil count, C-reactive protein, bilirubin, liver enzymes, glucose, body temperature, heart rate, and respiratory rate. Algorithms compared were extra trees, random forest, light gradient boosting, extreme gradient boosting, and CatBoost.
Results
We gathered 1,806 measurements and recorded 290 hospitalizations from 263 patients in the derivative cohort. Median age on admission was 43 months, with an interquartile range of 10–118.75 months, and a male predominance was observed (n=160, 55.2%). Candida albicans was the most prevalent pathogen, and median duration to confirm BSI was 3 days (range, 3–4). Patients with BSI experienced significantly higher in-hospital mortality and prolonged stays in the PICU than patients without BSI. Random forest classifier achieved the highest area under the receiver operating characteristic curve of 0.874 (0.762 for the validation set).
Conclusions
We developed a machine learning model that predicts BSI with acceptable performance. Further research is necessary to validate its effectiveness.

Citations

Citations to this article as recorded by

Early diagnosis and prognostic prediction of secondary bloodstream infections caused by Acinetobacter baumannii in critically ill patients by machine-learning algorithms
Hengxin Chen, Wenjia Gan, Xianling Zhou, Pingjuan Liu, Tangdan Ding, Hongxu Xu, Peisong Chen, Yili Chen
Frontiers in Cellular and Infection Microbiology.2026;[Epub] CrossRef

Infection
Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India: Naveen Paliwal, Pooja Bihani, Rishabh Jaju, Sadik Mohammed, Prabhu Prakash, Vidya Tharu; Acute Crit Care. 2024;39(4):535-544. Published online November 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00101

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Abstract PDF

Background
Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay.
Methods
A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant.
Results
The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004)
Conclusions
The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.

Citations

Citations to this article as recorded by

H-ER-O-S: A Quality Improvement Initiative to Reduce Ventilator-Associated Pneumonia in a Level IIIb Neonatal Intensive Care Unit of a Tertiary Care Public Hospital
Shaik Mohammed Munthakheem, Amol Kalyanrao Joshi, Laxmikant Sheshrao Deshmukh, Atul C. Londhe
Indian Pediatrics.2026; 63(2): 81. CrossRef
Bridging the Evidence to Practice Gaps in Public Hospitals: Lessons from a VAP Reduction Quality Improvement Initiative
Praveen Kumar
Indian Pediatrics.2026; 63(2): 77. CrossRef
Simulation-based training for fascial plane blocks: A scoping review mapped to the Kirkpatrick evaluation framework
Naveen Paliwal, Dinker Pai, Satyajeet Misra, Devishree Das, Rishabh Jaju, Soma Ganesh R. Neethirajan, Pooja Bihani
Indian Journal of Anaesthesia.2026; 70(1): 115. CrossRef
Evaluation of a multidisciplinary simulation training curriculum for local anesthetic systemic toxicity management: a quasi-experimental study using the Kirkpatrick model in India
Pooja Bihani, Naveen Paliwal, Rishabh Jaju, Vikas Rajpurohit
Anesthesia and Pain Medicine.2025; 20(2): 166. CrossRef
Impact of simulation-based training on difficult airway management among anesthesia trainees and nurses as real team
Naveen Paliwal, Pooja Bihani, Geethanjali Ramachandra, Dinker Pai, Rishabh Jaju, Vivek Chakole
Journal of Anaesthesiology Clinical Pharmacology.2025; 41(4): 641. CrossRef
Actual Preoperative Fasting Duration and its Impact on Hunger, Thirst, Blood Glucose, and Parental Satisfaction in Pediatric Patients: A Prospective Observational Study
Pooja Bihani, Kamal Kishore Chitara, Priyakshi Borah, Naveen Paliwal, Rishabh Jaju, Veswudu Swuro
Journal of Indian Association of Pediatric Surgeons.2025; 30(5): 642. CrossRef

Review Article

Infection
Microbial infections in burn patients: Souvik Roy, Preeti Mukherjee, Sutrisha Kundu, Debashrita Majumder, Vivek Raychaudhuri, Lopamudra Choudhury; Acute Crit Care. 2024;39(2):214-225. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01571

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Abstract PDF

Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.

Citations

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Maram M. Aboulwafa, Nada M. Mostafa, Fadia S. Youssef, Omayma A. Eldahshan, Abdel Nasser B. Singab
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Maryum Merchant, Scott B. Hu, Chris Miller, Tamana Ahmadi, Edwin Garcia, Malcolm I. Smith
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Kelsey M. Wheeler, Myung Whan Oh, Julianna Fusco, Aishlinn Mershon, Erin Kim, Antonia De Oliveira, Laurence G. Rahme
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Journal of Burns and Wound Research.2025; : 56. CrossRef
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Original Articles

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

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
Study of the gut microbiome as a novel target for prevention of hospital-associated infections in intensive care unit patients: Suzan Ahmed Elfiky, Shwikar Mahmoud Ahmed, Ahmed Mostafa Elmenshawy, Gehad Mahmoud Sultan, Sara Lotfy Asser; Acute Crit Care. 2023;38(1):76-85. Published online February 23, 2023; DOI: https://doi.org/10.4266/acc.2022.01116

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Abstract PDF

Background
Hospital-acquired infections (HAIs) are increasing due to the spread of multi-drugresistant organisms. Gut dysbiosis in an intensive care unit (ICU) patients at admission showed an altered abundance of some bacterial genera associated with the occurrence of HAIs and mortality. In the present study, we investigated the pattern of the gut microbiome in ICU patients at admission to correlate it with the development of HAIs during ICU stay.
Methods
Twenty patients admitted to an ICU with a cross-matched control group of 30 healthy subjects of matched age and sex. Quantitative SYBR green real-time polymerase chain reaction was done for the identification and quantitation of selected bacteria.
Results
Out of those twenty patients, 35% developed ventilator-associated pneumonia during their ICU stay. Gut microbiome analysis showed a significant decrease in Firmicutes and Firmicutes to Bacteroidetes ratio in ICU patients in comparison to the control and in patients who developed HAIs in comparison to the control group and patients who did not develop HAIs. There was a statistically significant increase in Bacteroides in comparison to the control group. There was a statistically significant decrease in Bifidobacterium and Faecalibacterium prausnitzii and an increase in Lactobacilli in comparison to the control group with a negative correlation between Acute Physiology and Chronic Health Evaluation (APACHE) II score and Firmicutes to Bacteroidetes and Prevotella to Bacteroides ratios.
Conclusions
Gut dysbiosis of patients at the time of admission highlights the importance of identification of the microbiome of patients admitted to the ICU as a target for preventing of HAIs

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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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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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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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Udit Chauhan, Khanak K. Nandolia, Rahul Dev
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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
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Original Articles

Trauma
Determination of risk factors associated with surgical site infection in patients undergoing preperitoneal pelvic packing for unstable pelvic fracture: Kang Min Kim, Myoung Jun Kim, Jae Sik Chung, Ji Wool Ko, Young Un Choi, Hongjin Shim, Ji Young Jang, Keum Seok Bae, Kwangmin Kim; Acute Crit Care. 2022;37(2):247-255. Published online April 22, 2022; DOI: https://doi.org/10.4266/acc.2021.01396

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Abstract PDF

Background
Several recent studies have shown that preperitoneal pelvic packing (PPP) effectively produces hemostasis in patients with unstable pelvic fractures. However, few studies have examined the rate of surgical site infections (SSIs) in patients undergoing PPP following an unstable pelvic fracture. The purpose of the present study was to evaluate factors associated with SSI in such patients.
Methods
We retrospectively reviewed the medical charts of 188 patients who developed hemorrhagic shock due to pelvic fracture between April 2012 and May 2021. Forty-four patients were enrolled in this study.
Results
SSI occurred in 15 of 44 patients (34.1%). The SSIs occurred more frequently in cases of repacking during the second-look surgery (0 vs. 4 [26.7%], P=0.010) and combined bladder-urethra injury (1 [3.4%] vs. 4 [26.7%], P=0.039). The incidence of SSIs was not significantly different between patients undergoing depacking within or after 48 hours (12 [41.4%] vs. 5 [33.3%], P=0.603). The mean time to diagnosis of SSI was 8.1±3.9 days from PPP. The most isolated organism was Staphylococcus epidermidis.
Conclusions
Repacking and combined bladder-urethra injury are potential risk factors for SSI in patients with unstable pelvic fracture. Close observation is recommended for up to 8 days in patients with these risk factors. Further, 48 hours after PPP, removing the packed gauze on cessation of bleeding and not performing repacking can help prevent SSI. Additional analyses are necessary with a larger number of patients with the potential risk factors identified in this study.

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Shreya Nair , Anoop V Pillai, Riju Ramachandran
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Axel Gänsslen, Tim Pohlemann, Jan Lindahl, Jan Erik Madsen
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Operatively treated high-energy blunt pelvic ring injuries and surgical site infections – A retrospective assessment based on a prospective registry
Elvin Gurbanov, Ulysse Coneys, Elisabeth Andereggen, Alexandre Ansorge, Vanessa Morello, Axel Gamulin
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Angioembolization Has Similar Efficacy and Lower Total Charges than Preperitoneal Pelvic Packing in Patients With Pelvic Ring or Acetabulum Fractures
Aaron Singh, Travis Kotzur, Ezekial Koslosky, Rishi Gonuguntla, Lorenzo Canseco, David Momtaz, Ali Seifi, Case Martin
Journal of Orthopaedic Trauma.2024; 38(5): 254. CrossRef
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Jennifer E. Baker, Husayn A. Ladhani, Caitlyn McCall, Chelsea R. Horwood, Nicole L. Werner, Barry Platnick, Clay Cothren Burlew
Surgical Infections.2024; 25(5): 399. CrossRef
Comparison of Conventional versus Modified Preperitoneal Pelvic Packing in Patients with Bleeding Pelvic Fractures: A Single-Center Retrospective Pilot Study
Sebeom Jeon, Byungchul Yu, Gil Jae Lee, Min A Lee, Jungnam Lee, Kang Kook Choi
Journal of Clinical Medicine.2024; 13(14): 4062. CrossRef
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Kevin Harrell, Chelsea Horwood, Clay Cothren Burlew
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Open Fixation After Preperitoneal Pelvic Packing Is Associated With a High Surgical Site Infection Rate
Ye Joon Kim, Bryan L. Scott, Fredric M. Pieracci, Ernest E. Moore, Cyril Mauffrey, Joshua A. Parry
Journal of Orthopaedic Trauma.2023; 37(11): 547. CrossRef
Extraperitoneal pelvic packing in trauma – a review
Sajad Ahmad Salati
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Infection
Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review: Sofia R. Valdoleiros, Cristina Torrão, Laura S. Freitas, Diana Mano, Celina Gonçalves, Carla Teixeira; Acute Crit Care. 2022;37(1):61-70. Published online January 26, 2022; DOI: https://doi.org/10.4266/acc.2021.01151

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Abstract PDF Supplementary Material

Background
Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU).
Methods
A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines.
Results
An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality.
Conclusions
Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.

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Case Report

Infection
The first case of abdominal mycotic aneurysm caused by K1 hypervirulent Klebsiella pneumoniae in a healthy adult: Misun Kim, Jeong Rae Yoo, Hyunjoo Oh, Young Ree Kim, Keun Hwa Lee, Sang Taek Heo; Acute Crit Care. 2021;36(4):390-394. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00010

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Abstract PDF

Incidence of hypervirulent Klebsiella pneumoniae (hvKp) infection has been steadily increasing in the Asia-Pacific rim. The characteristic of hvKp infection is its ability to cause multiple site infections and unpredictable metastatic spread in the community. We describe the first case of mycotic aneurysm caused by hvKp serotype K1 in a previously healthy man and review the literature. Of a total of 13 cases, including our case, three cases were related to hvKp. Among patients with hvKp, the level of mycotic aneurysm in most patients was the infrarenal aorta, and they underwent an aortic graft or coil embolization. All strains were susceptible to most antimicrobial agents, except ampicillin. Early detection of hvKp can help to prevent the metastatic spread of pathogens and be useful for optimal patient care and epidemiologic research.

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Review Article

Infection
Identification and infection control of carbapenem-resistant Enterobacterales in intensive care units: Jongyoun Yi, Kye-Hyung Kim; Acute Crit Care. 2021;36(3):175-184. Published online August 12, 2021; DOI: https://doi.org/10.4266/acc.2021.00409

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Abstract PDF

Infections with multidrug-resistant organisms among patients in intensive care units (ICUs) are associated with high mortality. Among multidrug-resistant organisms, carbapenem-resistant Enterobacterales (CRE) harbor important pathogens for healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infections. Risk factors for CRE colonization include underlying comorbid conditions, prior antibiotics exposure, prior use of healthcare facilities, device use, and longer ICU stay. The mortality rate due to invasive CRE infection is 22%–49%, and CRE colonization is associated with an approximately 10-fold increased risk of CRE infection. Infection control measures include hand hygiene, contact precautions, minimizing the use of devices, and environmental control. Additionally, implementing active surveillance of CRE carriage should be considered in ICU settings.

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Moon Seong Baek, Jong Ho Kim, Joung Ha Park, Tae Wan Kim, Hae In Jung, Young Suk Kwon
Scientific Reports.2024;[Epub] CrossRef
Investigation of Intestinal Colonization and Infection of Carbapenem Resistant Enterobacteriaceae in Intensive Care Unit Patients and Analysis of Influencing Factors
丽红王
Advances in Clinical Medicine.2024; 14(05): 315. CrossRef
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A.O. Bykov, E.M. Shifman, D.N. Protsenko, S.V. Yakovlev, B.Z. Belotserkovskiy, O.G. Ni, A.N. Kruglov, A.A. Bryleva, M.I. Matyash, E.S. Larin
Russian Journal of Anesthesiology and Reanimatology.2024; (5): 41. CrossRef
Occurrence of blaNDM-1, blaNDM-5, blaNDM-7, and blaKPC-2 genes in clinical isolates of enterobacterales with high genetic variability, from colonization and infection in patients with or without COVID-19, from a hospital in Brazil
Lamartine Rodrigues Martins, Maria Izabely Silva Pimentel, Érica Maria de Oliveira, Moacir Batista Jucá, Elizabeth Maria Bispo Beltrão, Ana Catarina de Souza Lopes
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Kedišaletše Moloto, Mae Newton-Foot, Andrew Whitelaw, Angela Dramowski, Tsegaye Alemeyhu
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Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study
Małgorzata Timler, Wojciech Timler, Ariadna Bednarz, Łukasz Zakonnik, Remigiusz Kozłowski, Dariusz Timler, Michał Marczak
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Seung Hye Lee, Chan Hee Kim, Hee Young Lee, Kun Hee Park, Su Ha Han
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Microbiology Spectrum.2022;[Epub] CrossRef

Original Articles

Infection
Clinical features and outcomes of critically ill patients with Elizabethkingia meningoseptica: an emerging pathogen: Abdullah Umair, Nosheen Nasir; Acute Crit Care. 2021;36(3):256-261. Published online July 26, 2021; DOI: https://doi.org/10.4266/acc.2020.01158

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Abstract PDF

Background
Elizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucosenon- fermentative, Gram-negative bacillus that was first defined by Elizabeth O. King in 1959. It has emerged as an opportunistic pathogen that has infected patients in extreme age groups and immunocompromised individuals, especially in intensive care settings. There has been an increased interest in this pathogen due to its increasing occurrence around the world, ubiquitous nature, and inherent capacity for antimicrobial resistance.
Methods
We describe an observational study at a tertiary care center in Karachi, Pakistan, based on patients admitted between January 2013 and December 2018, with E. meningoseptica infections. All patients were confirmed to have a positive clinical culture specimen for E. meningoseptica along with symptoms and signs consistent with infection. Data were collected on a structured proforma from the Hospital Information Management Systems.
Results
Sixteen patients with E. meningoseptica that met the criteria for infection were identified, 13 of whom required admission. Eight patients had bacteremia in addition to confirmed E. meningoseptica infection. Two of the isolates were multi-drug resistant and only sensitive to minocycline. Nine out of 13 patients that were admitted required intubation and mechanical ventilation. The median length of hospital stay was 13 days, and five out of the 13 patients died during the hospital stay.
Conclusions
This is the largest case series to date reporting E. meningoseptica infections and highlights the importance of this organism as an emerging nosocomial pathogen.

Citations

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Elizabethkingia meningoseptica Meningitis in Neonates: Clinical Profile, Resistance Patterns, and Outcomes
Dinesh Munian, Sourav Nandi, Arindam Ghosh, Prasanta Nayak, Piyali Dey
Journal of Neonatology.2026; 40(1): 26. CrossRef
Emergence and clonal transmission of Elizabethkingia meningoseptica in adult and paediatric intensive care units: An integrated clinical, microbiological, and genomic analysis
Debasish Biswal, Sharmila Sengupta, Ripenmeet Salhotra, Pankhuri Kumari, Maninder Dhaliwal, Sadia Khan, Aayush Chawla, Veena Raghunathan, Sandeep Mangla
Indian Journal of Medical Microbiology.2026; 59: 101032. CrossRef
Clinical and microbiological features of positive blood culture episodes caused by non-fermenting gram-negative bacilli other than Pseudomonas and Acinetobacter species (2020–2023)
Roberto Casale, Matteo Boattini, Sara Comini, Paulo Bastos, Silvia Corcione, Francesco Giuseppe De Rosa, Gabriele Bianco, Cristina Costa
Infection.2025; 53(1): 183. CrossRef
Elizabethkingia meningoseptica in Dubai, United Arab Emirates: A 7-year multicenter study
Hawra Ali Hussain Alsayed, Narjes Saheb Sharif-Askari, Fatemeh Saheb Sharif-Askari, Rabih Halwani
American Journal of Infection Control.2025; 53(3): 326. CrossRef
“Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates
Prajnha U.P., Anisha Maria Fernandes, Suchitra Shenoy M., Sinchana Bhat
F1000Research.2025; 13: 1367. CrossRef
Evaluation of Conventional Polymerase Chain Reaction for Accurate Species Identification of Elizabethkingia Compared to Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry
Sailaxmi Mahapatra, Ashoka Mahapatra, Sushree Sarathi, Bijayini Behera, Sarita Mohapatra
Cureus.2025;[Epub] CrossRef
Genomic and Pan-Genomic Characterization of Elizabethkingia meningoseptica Reveals Resistance Gene Profiles, Phylogenetic Clusters, and Functional Landscape
Zheng Zhou, Wenqing Xiang, Chao Fang, Hongqiang Shen
Current Microbiology.2025;[Epub] CrossRef
A Retrospective Study on the Antimicrobial Susceptibility Patterns of Elizabethkingia meningoseptica Specimens Among Adult Patients
Ruchita Sahu, Basanti Kumari Pathi, Kumudini Panigrahi, Smrutisree Mohapatra, Jyoti Prakash Sahoo
Cureus.2025;[Epub] CrossRef
Elizabethkingia meningoseptica Outbreak in NICU: An Observational Study on a Debilitating Neuroinfection in Neonates
Manish Swami, Praneetha Mude, Shrutiprajna Kar, Sushree Sarathi, Ashoka Mohapatra, Usha Devi, Pankaj K. Mohanty, Tapas K. Som, Behera Bijayini, Tanushree Sahoo
Pediatric Infectious Disease Journal.2024; 43(1): 63. CrossRef
Clinical Characteristics and Risk Factors for Infection and Death in Critically Ill Patients with Pulmonary Infection with Elizabethkingia Spp.
Mengwen Feng, Min Huang, Yuanyuan Fan, Genyan Liu, Suming Zhou, Jing Zhou
Infection and Drug Resistance.2024; Volume 17: 2673. CrossRef
Mortality Risk and Antibiotic Therapy for Patients with Infections Caused by Elizabethkingia Species—A Meta-Analysis
Chienhsiu Huang, Sufang Kuo, Lichen Lin
Medicina.2024; 60(9): 1529. CrossRef
“Unmasking the Uncommon”: A case series of multi-drug resistant Elizabethkingia meningoseptica causing late-onset sepsis and meningitis in preterm neonates
Prajnha U.P., Anisha Maria Fernandes, Suchitra Shenoy M., Sinchana Bhat
F1000Research.2024; 13: 1367. CrossRef
Multi-Drug-Resistant Elizabethkingia meningoseptica: A Rare Cause of Late-Onset Sepsis in a Preterm Neonate
Abdul Wasey Hashmi, Muhammad Ahmad, Muhammad Muneeb Israr, Ibtesam e Fajar, Farid Adnan
Cureus.2023;[Epub] CrossRef
Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains
Despoina Koulenti, Kalwaje Eswhara Vandana, Jordi Rello
Current Opinion in Infectious Diseases.2023; 36(6): 545. CrossRef
Epidemiological, clinical, and laboratory features of patients infected with Elizabethkingia meningoseptica at a tertiary hospital in Hefei City, China
Yajuan Li, Tingting Liu, Cuixiao Shi, Bo Wang, Tingting Li, Ying Huang, Yuanhong Xu, Ling Tang
Frontiers in Public Health.2022;[Epub] CrossRef

Surgery
Association between postoperative fluid balance and mortality and morbidity in critically ill patients with complicated intra-abdominal infections: a retrospective study: Joohyun Sim, Jae Young Kwak, Yun Tae Jung; Acute Crit Care. 2020;35(3):189-196. Published online August 19, 2020; DOI: https://doi.org/10.4266/acc.2020.00031

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Abstract PDF Supplementary Material

Background
Postoperative fluid overload may increase the risk of developing pulmonary complications and other adverse outcomes. We evaluated the impact of excessive fluid administration on postoperative outcomes in critically ill patients.
Methods
We reviewed the medical records of 320 patients admitted to intensive care unit (ICU) after emergency abdominal surgery for complicated intra-abdominal infection (cIAI) between January 2013 and December 2018. The fluid balance data of the patients were reviewed for a maximum of 7 days. The patients were grouped based on average daily fluid balance with a cutoff value of 20 ml/kg/day. Propensity score matching was performed to reduce the underlying differences between the groups.
Results
Patients with an average daily fluid balance of ≥20 ml/kg/day were associated with higher rates of 30-day mortality (11.8% vs. 2.4%; P=0.036) than those with lower fluid balance (<20 ml/kg/day). Kaplan-Meier survival curves for 30-day mortality in these groups also showed a better survival rate in the lower fluid balance group with a statistical significance (P=0.020). The percentage of patients who developed pulmonary consolidation during ICU stay (47.1% vs. 24.7%; P=0.004) was higher in the fluid-overloaded group. Percentages of newly developed pleural effusion (61.2% vs. 57.7%; P=0.755), reintubation (18.8% vs. 10.6%; P=0.194), and infectious complications (55.3% vs. 49.4%; P=0.539) showed no significant differences between the two groups.
Conclusions
Postoperative fluid overload in patients who underwent emergency surgery for cIAI was associated with higher 30-day mortality and more frequent occurrence of pulmonary consolidation. Postoperative fluid balance should be adjusted carefully to avoid adverse clinical outcomes.

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In Response
Ehab S. Farag, Yufei Li, Maged Y. Argalious, Ye Rin Koh, Christopher A. Troianos
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Complications during Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 and Non-COVID-19 Patients with Acute Respiratory Distress Syndrome
Andrea Bruni, Caterina Battaglia, Vincenzo Bosco, Corrado Pelaia, Giuseppe Neri, Eugenio Biamonte, Francesco Manti, Annachiara Mollace, Annalisa Boscolo, Michele Morelli, Paolo Navalesi, Domenico Laganà, Eugenio Garofalo, Federico Longhini
Journal of Clinical Medicine.2024; 13(10): 2871. CrossRef
Fluid balance following laparotomy for hollow viscus perforation: A study of morbidity and mortality
James Tankel, David Chayen, Sharon Einav
Surgery in Practice and Science.2023; 12: 100146. CrossRef
Risk of fluid accumulation after cardiac surgery
Atte Koskinen, Jenni Aittokallio, Jarmo Gunn, Joonas Lehto, Arto Relander, Emma Viikinkoski, Tuija Vasankari, Juho Jalkanen, Maija Hollmén, Tuomas O. Kiviniemi
JTCVS Open.2023; 16: 602. CrossRef
Loop diuretics in adult intensive care patients with fluid overload: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis
Sine Wichmann, Marija Barbateskovic, Ning Liang, Theis Skovsgaard Itenov, Rasmus Ehrenfried Berthelsen, Jane Lindschou, Anders Perner, Christian Gluud, Morten Heiberg Bestle
Annals of Intensive Care.2022;[Epub] CrossRef
Goal directed fluid removal with furosemide versus placebo in intensive care patients with fluid overload: A trial protocol for a randomised, blinded trial (GODIF trial)
Sine Wichmann, Theis S. Itenov, Rasmus E. Berthelsen, Theis Lange, Anders Perner, Christian Gluud, Pia Lawson‐Smith, Lars Nebrich, Jørgen Wiis, Anne C. Brøchner, Thomas Hildebrandt, Meike T. Behzadi, Kristian Strand, Finn H. Andersen, Thomas Strøm, Mikko
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Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial
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Diagnostics.2021; 11(8): 1444. CrossRef

Infection
A Retrospective Study Investigating Risks of Acute Respiratory Distress Syndrome and Mortality Following Human Metapneumovirus Infection in Hospitalized Adults: Hyunjung Hwang, Yujin Kim, Jeong-Woong Park, Sung Hwan Jeong, Sun Young Kyung; Korean J Crit Care Med. 2017;32(2):182-189. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00038

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Abstract PDF Supplementary Material

Background
Human metapneumovirus (hMPV) is a relatively recently identified respiratory virus that induces respiratory symptoms similar to those of respiratory syncytial virus infection in children. The characteristics of hMPV-infected adults are unclear because few cases have been reported.
Methods
We conducted a retrospective review of hospitalized adult patients with a positive multiplex real-time polymerase chain reaction assay result from 2012 to 2016 at a single tertiary referral hospital in South Korea. We analyzed clinical characteristics of the enrolled patients and divided patients into an acute respiratory distress syndrome (ARDS) group and a non-ARDS group.
Results
In total, 110 adults were reviewed in this study. Their mean age was 61.4 years, and the majority (n = 105, 95.5%) had comorbidities or were immunocompromised. Most of the patients had pneumonia on chest X-ray (n = 88, 93.6%), 22 (20.0%) had ARDS, and 12 (10.9%) expired during hospitalization. The mortality rate for patients with ARDS was higher than that of the other patients (36.4% vs. 5.7%, P = 0.001). The risk factor for hMPV-associated ARDS was heart failure (odds ratio, 5.24; P = 0.044) and laboratory values were increased blood urea nitrogen and increased C-reactive protein. The acquisition site of infection was divided into community vs. nosocomial; 43 patients (39.1%) had a nosocomial infection. The risk factors for nosocomial infection were an immunocompromised state, malignancy and immunosuppressive treatment.
Conclusions
These data suggest that hMPV is one of the important respiratory pathogens important respiratory pathogen that causes pneumonia/ARDS in elderly, immunocompromised individuals and that it may be transmitted via the nosocomial route.

Citations

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Stephen Twumasi, Richard Owusu Ansah, Allwell Adofo Ayirebi, Daniel Nii Martey Antonio, Yaw Ansiri Asafoakaa, Emmanuel Tawiah, Angela Opoku
Reviews in Medical Virology.2025;[Epub] CrossRef
hMPV co-infections: Distinct immunopathogenic mechanisms and clinical implications of viral and bacterial pathogenesis
Syed Sib Tul Hassan Shah, Iqra Naeem, Nabeel Khalid Bhutta, Gao Han, Fatima Noor
Folia Microbiologica.2025; 70(6): 1111. CrossRef
A Case of Metapneumovirus Pneumonia-Related Acute Respiratory Distress Syndrome in a Young Adult Patient
Tae Wan Kim, Won-Young Kim
The Korean Journal of Medicine.2024; 99(2): 111. CrossRef
Human Metapneumovirus Pneumonia Precipitating Acute Respiratory Distress Syndrome in an Adult Patient
Dena H Tran, Muhammad Sameed, Ellen T Marciniak, Avelino C Verceles
Cureus.2021;[Epub] CrossRef
Outcomes of severe human metapneumovirus-associated community-acquired pneumonia in adults
Sang-Ho Choi, Sang-Bum Hong, Jin Won Huh, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sung-Han Kim, Heungsup Sung, Hyun Jung Koo, Kyung-Hyun Do, Sang-Oh Lee, Chae-Man Lim, Yang Soo Kim, Jun Hee Woo, Younsuck Koh
Journal of Clinical Virology.2019; 117: 1. CrossRef

Review Article

Surgery
Management of Critical Burn Injuries: Recent Developments: David J. Dries, John J. Marini; Korean J Crit Care Med. 2017;32(1):9-21. Published online February 17, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00969

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Abstract PDF

Background
Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries.
Methods
A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association.
Results
The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed, but no new “gold standard” for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems.
Conclusion
Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.

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Original Articles

Thoracic surgery
Outcome of External Ventricular Drainage according to the Operating Place: the Intensive Care Unit versus Operating Room: Si On Kim, Won Jun Song, Yu Sam Won, Jae Young Yang, Chun Sik Choi; Korean J Crit Care Med. 2016;31(1):10-16. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.10

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Abstract PDF: Background:
External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups.
Methods
We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015.
Results
A total of 75 patients (45 men and 30 women, mean age: 58.7 ± 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 ± 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group.
Conclusions
If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.

Infection
Experience with Elizabethkingia meningoseptica Infection in Adult Patients at a Tertiary Hospital: Hyun Don Joo, Sun Young Ann, Sung Hyeok Ryou, Youn Seup Kim, Jong Wan Kim, Doh Hyung Kim; Korean J Crit Care Med. 2015;30(4):241-248. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.241

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Abstract PDF

Background
Few reports have documented the clinical characteristics and treatment outcomes of adult patients with Elizabethkingia meningoseptica infection.
Methods
Medical records of patients over 18 years of age and suspected of having an E. meningoseptica infection from March 1, 2006 to February 28, 2013 were reviewed retrospectively. Their clinical characteristics, antimicrobial susceptibility results, and treatment outcomes were analyzed.
Results
E. meningoseptica was isolated from 30 patients. Median age was 68.5 years, and infections were more frequent in males (17, 56.7%). The most common isolation source was sputum (23, 76.7%), and pneumonia was the most common condition (21, 70%) after excluding two cases of colonization. This bacterium was most susceptible to minocycline (27, 90%) and fluoroquinolones, including levofloxacin (20, 66.7%) and ciprofloxacin (18, 60%). The mortality rate due directly to E. meningoseptica infection was 20% (6/30), and uncontrolled pneumonia was the only cause of death. After isolating E. meningoseptica, the numbers of patients with pneumonia (9/9, 100% vs. 12/21, 57.1%), history of hemodialysis (5/9, 55.6% vs. 3/21, 14.3%), tracheostomy (8/9, 88.9 vs. 10/21, 47.6%), and median Charlson comorbidity index score (6 [range, 3–9] vs. 4 [range, 0–9]) were significantly higher in non-survivors than those in survivors (p < 0.05, for each). However, only 12 (40%) patients received appropriate antibiotics.
Conclusions
E. meningoseptica infection most commonly presented as pneumonia in adults with severe underlying diseases. Despite the high mortality rate, the rate of appropriate antibiotic use was notably low.

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Elizabethkingia meningosepticum Isolated from Pleural Fluid: A Diagnostic Dilemma
Abha Sharma, Shweta Gupta, Tanisha Bharara, Shalini Dewan Duggal, Pragnya Paramita Jena, Renu Gur
The Indian Journal of Chest Diseases and Allied Sciences.2022; 61(2): 91. CrossRef

Case Report

Infection
Polymyxin B Immobilized Fiber Hemoperfusion in Refractory Intra-abdominal Septic Shock: Hae Wone Chang, Young-Jae Cho, Sang-Hyun Park, Moonsuk Kim; Korean J Crit Care Med. 2015;30(2):95-102. Published online May 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.95

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Abstract PDF: The effects of direct hemoperfusion with polymyxin B immobilized fiber (PMX) treatment for septic shock have been recently reported. However, little evidence of a true benefit on clinical outcomes, including mortality, is available. Herein, we report three cases of intra-abdominal infection associated with refractory septic shock Case 1 was Escherichia coli peritonitis after a colectomy. PMX treatment improved the hemodynamic parameters and lactic acid levels of the patient. In case 2, secondary peritonitis was associated with septic or cardiogenic shock. Septic cardiomyopathy was assumed to be the cause of shock. 24 hours after the use of PMX, cardiac contractility assessed by echocardiography returned to baseline. In case 3, a patient with Burkitt’s lymphoma and neutropenia was found to be gastroenteritis and Klebsiella pneumoniae bacteremia. Intravenous meropenem was administered for 3 days. Hemodynamic parameters improve after the twice use of PMXOverall, the change of serial sequential organ failure assessment score (SOFA) was more significant in surgical cases as compared to the medical case at 72 hours after PMX administration. All patients were discharged from the hospital. In addition to early resuscitation efforts and infection source control, PMX treatment may be beneficial to patients with refractory intra-abdominal infection associated with septic shock.

Original Article

Infection
Extended-Spectrum beta-Lactamase and Multidrug Resistance in Urinary Sepsis Patients Admitted to the Intensive Care Unit: Bumjoon Kim, Sung Gyun Kim, Seung Soon Lee, Tae Seok Kim, Yong Il Hwang, Seung Hun Jang, Joo Hee Kim, Ki Suck Jung, Sunghoon Park; Korean J Crit Care Med. 2014;29(4):257-265. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.257

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Abstract PDF

BACKGROUND
The role of extended-spectrum beta-lactamase (ESBL)-producing or multidrug-resistant (MDR) organisms in patients with sepsis secondary to urinary traction infection (UTI) has not been investigated extensively in the intensive care unit (ICU) setting.
METHODS
Patients with UTI sepsis admitted to the ICU were retrospectively enrolled in this study (January 2009-December 2012). We investigated the impact of ESBL-producing and ESBL-negative MDR organisms on hospital outcome.
RESULTS
In total, 94 patients were enrolled (median age, 73.0 years; female, 81.9%), and ESBL-producing and ESBL-negative MDR organisms accounted for 20.2% (n = 19) and 30.9% (n = 29), respectively. Both patients with ESBL-producing and ESBL-negative MDR organisms were more likely to experience a delay in adequate antibiotic therapy than those with non-ESBL/non-MDR organisms (p < 0.001 and p = 0.032, respectively). However, only patients with ESBL-producing organisms showed a higher mortality rate (ESBL vs. ESBL-negative MDR vs. non-ESBL/non-MDR, 31.6% vs. 10.3%.vs. 10.9%, respectively). In multivariate analyses, ESBL production was significantly associated with hospital mortality (odds ratio, 11.547; 95micro confidence interval, 1.047-127.373), and prior admission was a significant predictor of ESBL production.
CONCLUSIONS
Although both ESBL-producing and ESBL-negative MDR organisms are associated with delayed administration of appropriate antibiotics, only ESBL production is a significant predictor of hospital mortality among patients with UTI sepsis in the ICU setting.

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Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: a case–control study
Franco Castillo-Tokumori, Claudia Irey-Salgado, Germán Málaga
International Journal of Infectious Diseases.2017; 55: 16. CrossRef

Case Report

Infection
Incidentally Discovered Deep Neck Infection in a Septic Patient: Jin Beom Cho, Ki Young Sung; Korean J Crit Care Med. 2014;29(2):105-109. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.105

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Abstract PDF: We incidentally discovered a case of deep neck infection during the treatment of a patient who presented with complaints of decreased consciousness, abdominal distension, and electrolyte imbalance. The patient had neither clinical symptoms nor radiologic findings indicative of deep neck infection; rather, the findings indicated intra-abdominal sepsis and adrenal crisis, for which the symptomatic treatment was provided. When the expected improvement was not observed, we retrospectively reviewed the patient's test records and discovered deep neck infection. Empiric parenteral antibiotic therapy and infection source control, as appropriate for this patient, were administered within 72 hours of hospital admission, without which the condition may have proved fatal. In this report we discuss the best approach for the management of unresolved infectious disease and review the clinical features of deep neck infection.

Original Article

Exhaled Nitric Oxide in Patients with Ventilator Associated Pneumonia: Hyun Jung Kwak, Sang Heon Kim, Tae Hyung Kim, Ho Joo Yoon, Dong Ho Shin, Sung Soo Park, Jang Won Sohn; Korean J Crit Care Med. 2012;27(2):82-88.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.82

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Abstract PDF

BACKGROUND
Fraction of exhaled nitric oxide (FENO) is known as a marker of inflammation in asthma, cystic fibrosis and exacerbation of COPD. However, its importance has not been established in patients using mechanical ventilation. We assessed whether FENO is elevated in patients with ventilator associated pneumonia (VAP), and physiologic or pathologic factors affecting levels of FENO in patients with mechanical ventilation.
METHODS
All patients (over 18-year-old) using mechanical ventilation were included, and among them, VAP patients were diagnosed on the basis of clinical pulmonary infection score (CPIS). We measured FENO in air collected during the end-expiratory pause via an off-line method. We compared the levels of FENO between patients with VAP and without, and assessed the relationship between FENO and other physiologic or pathologic characteristics; age, gender, PaO2, oxygenation index, CPIS.
RESULTS
A total of 43 patients (23 male, mean age 67.7 +/- 10.7) in an ICU were enrolled; 19 of them were VAP-patients (10 male, mean age 64.8 +/- 12.9). The level of FENO in the VAP-patients was substantially higher than in the non-VAP group (55.8 +/- 25.3 ppb Vs. 31.8 +/- 13.5 ppb, p < 0.001). CPIS on day 1 and day 3, and duration of mechanical ventilation, were associated with the level of FENO, but oxygenation index, PaO2, PaO2/FiO2, and the mean PEEP were not.
CONCLUSIONS
FENO may be useful for the diagnosis of VAP, and is related to CPIS, as well as the duration of mechanical ventilation.

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Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study
Andreas Kofoed, Mathias Hindborg, Jeppe Hjembæk-Brandt, Christian Dalby Sørensen, Mette Kolpen, Morten H Bestle
Journal of Breath Research.2023; 17(4): 046014. CrossRef
Clinical Application of Exhaled Nitric Oxide Measurements in a Korean Population
Woo-Jung Song, Ji-Won Kwon, Eun-Jin Kim, Sang-Min Lee, Sae-Hoon Kim, So-Yeon Lee, Sang-Heon Kim, Heung-Woo Park, Yoon-Seok Chang, Woo Kyung Kim, Jung Yeon Shim, Ju-Hee Seo, Byoung-Ju Kim, Hyo Bin Kim, Dae Jin Song, Gwang Cheon Jang, An-Soo Jang, Jung-Won
Allergy, Asthma & Immunology Research.2015; 7(1): 3. CrossRef
Exhaled breath analysis in the differentiation of pneumonia from acute pulmonary oedema
Silvie Prazakova, Nadine Elias, Paul S Thomas, Deborah H Yates
Pulmonology and Respiratory Research.2015; 3(1): 3. CrossRef

Randomized Controlled Trial

Central Venous Catheter-related Infection in Major Burn Patients: Comparison of Subclavian Vein and Femoral Vein: Young Ho Jang, Yong Hoon Son, Sang Kyu Kim, Joon Mo Park, Mi Young Lee, Jin Mo Kim; Korean J Crit Care Med. 2011;26(4):245-249.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.245

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Abstract PDF

BACKGROUND
A central venous catheter (CVC) is usually inserted in patients with severe burns and the selection of the CVC is often difficult due to widespread burned skin. We investigated the incidences of colonization and catheter-related blood stream infection (CRBSI) according to the insertion site of the CVC in major burn patients METHODS: In 63 adult massive burn patients in the intensive care unit, 93 CVCs (47 polyurethane standard CVCs and 46 Oligon anti-mocrobial CVCs) were randomly inserted via the subclavian vein (SCV group, n = 66) or femoral vein (FEV group, n = 27). All catheter tips removed were routinely cultured. Bacterial findings from the burn wound and peripheral blood were also monitored in all patients RESULTS: There was no significant difference in the average insertion length of the CVC (14.3 +/- 6.8 days in SCV and 13.6 +/- 3.8 days in FEV) between the two groups. There were no significant differences in CVC colonization (48.5% in SCV and 63.0% in FEV) and CRBSI (7.6% in SCV and 11.1% in FEV) between the two groups. Logistic analysis found that the use of polyurethane standard CVC is significantly associated with increased risk of CVC colonization (odds ratio = 2.68) CONCLUSIONS: The placement of the CVC via the femoral vein does not increase the incidence of CVC colonization in massive burn patients. The use of Oligon anti-microbial CVC may be helpful to reduce CVC colonization in major burn patients.

Citations

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An Ounce of Prevention Saves Tons of Lives: Infection in Burns
Nishant Merchant, Karen Smith, Marc G. Jeschke
Surgical Infections.2015; 16(4): 380. CrossRef

Original Article

Ventriculostomy-related Infections in the Neurosurgical Intensive Care Unit: The Risk Factors and the Outcomes: Jung Hwan Lee, Seung Heon Cha, Jae Il Lee, Dong Wan Kang, Jun Kyoung Ko, In Ho Han, Won Ho Cho, Byung Kwan Choi, Chang Hwa Choi; Korean J Crit Care Med. 2011;26(4):208-211.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.208

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Abstract PDF

BACKGROUND
This study was performed to analyze the risk factors for ventriculostomy-related infections (VRIs) in the neurosurgical intensive care unit (NSICU) and the relationship between these risk factors and the patients' outcomes.
METHODS
We collected demographic, clinical, laboratory and microbiological data from all 146 consecutive adult patients who underwent ventriculostomy in the NSICU from January 2007 to December 2008. We excluded patients with ventriculostomy performed for the draining of intraventricular abscess, infection of ventriculoperitoneal shunt (V-P shunt) or previous ventriculitis. VRI was defined by positive culture from cerebrospinal fluid (CSF) obtained via the ventricular catheter.
RESULTS
VRIs were diagnosed in 26 (17.8%) of 146 patients. On average, the patients with VRIs stayed longer in the NSICU than patients without VRIs (mean duration 20 days vs. 11.9 days). All VRIs occurred in patients who had a low Acute Physiology and Chronic Health Evaluation (APACHE) IV score. In addition, the duration required to maintain ventriculostomy was longer in patients with VRIs. However, sex, mortality, the cause of ventriculosotmy, the level of consciousness, combined systemic infections, number of catheters, and performing urokinase irrigation or antibiotics irrigation via the ventriculostomy catheter were not associated with VRIs.
CONCLUSIONS
VRIs were associated with longer ICU stay. However, VRIs did not influence the overall mortality rate of patients undergoing ventriculostomy in the NSICU. Because the long duration required for maintaining ventriculostomy was the risk factor of VRI, early removal of ventriculostomy catheter must be considered.

Citations

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Ventriculostomy related infection in intensive care unit: Diagnostic criteria and related conditions
Sergio Castaño Ávila, Esther Corral Lozano, Javier Maynar Moliner, Fernando Fonseca San Miguel, Elena Usón García, Yolanda Poveda Hernández, Sara Cabañes Daro-Francés, Goiatz Balziskueta Flórez, Noemi Legaristi Martínez, Amaia Quintano Rodero, Ana Tejero
Journal of Acute Disease.2016; 5(2): 143. CrossRef

Randomized Controlled Trial

The Efficacy of Early Goal-directed Therapy in Septic Shock Patients in the Emergency Department: Severe Sepsis Campaign: Hyung Jin Shin, Kang Hyun Lee, Sung Oh Hwang, Hyun Kim, Tae Yong Shin, Sang Chul Kim; Korean J Crit Care Med. 2010;25(2):61-70.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.61

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Abstract PDF

BACKGROUND
Early goal-directed therapy (EGDT) has been used for patients with severe sepsis and septic shock in the emergency department (ED). In 2003, international management guidelines for severe sepsis and septic shock were developed under the auspices of the Surviving Sepsis Campaign (SSC); however, EGDT based on the SSC was not fully evaluated in the ED. The purpose of this study was to evaluate the efficacy of EGDT based on the SSC in the ED in Korea.
METHODS
We randomly assigned patients who arrived at our ED in septic shock to receive EGDT before admission to the intensive care unit between May 2007 and July 2007, and we retrospectively assigned patients in septic shock to receive standard therapy between May 2006 and July 2006. The in-hospital mortality for 24 hours and 28 days, the MODS, SAPS II, and APACHE II scores were obtained and compared between the study groups.
RESULTS
Of the 60 enrolled patients, 30 were assigned to EGDT and 30 were assigned to standard therapy. There was no significant difference between the groups with respect to the baseline characteristics. In-hospital mortality at 28 days was 13% in the group assigned to EGDT as compared to 40% in the group assigned to standard therapy (p = 0.020) and in-hospital mortality at 24 hours was 0% and 13%, respectively (p = 0.038).
CONCLUSIONS
EGDT provides significant benefits with respect to outcome in patients in septic shock.

Citations

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Early goal-directed resuscitation for patients with severe sepsis and septic shock: a meta-analysis and trial sequential analysis
Li-bing Jiang, Mao Zhang, Shou-yin Jiang, Yue-feng MA
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2016;[Epub] CrossRef
The Prognostic Factors of Pneumonia with Septic Shock in Patients Presenting to the Emergency Department
Jong Won Kim, Jin Joo Kim, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, In Cheol Hwang, Sang Hyun Han
The Korean Journal of Critical Care Medicine.2015; 30(4): 258. CrossRef
Implementing a Sepsis Resuscitation Bundle Improved Clinical Outcome: A Before-and-After Study
Jeongmin Kim, Sungwon Na, Young Chul Yoo, Shin Ok Koh
Korean Journal of Critical Care Medicine.2014; 29(4): 250. CrossRef
A Case of Purulent Pericarditis Complicated byKlebsiella pneumoniaeSepsis - A Case Report -
Byeong-Ho Jeong, Seungmin Chung, Hee Jin Kwon, Kyeongman Jeon
Korean Journal of Critical Care Medicine.2013; 28(1): 51. CrossRef

Original Articles

The Characteristics and Prognostic Factors of Severe Sepsis in Patients Who Were Admitted to a Medical Intensive Care Unit of a Tertiary Hospital: Suk Kyung Hong, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2009;24(1):28-32.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.28

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Abstract PDF

BACKGROUND
Severe sepsis is a major cause of morbidity and mortality in intensive care units. This study aimed to evaluate the prevalence, characteristics, outcomes and prognostic factors of severe sepsis in a medical intensive care unit (MICU) of a tertiary care hospital in Korea.
METHODS
We retrospectively reviewed the medical chart of 249 patients who were admitted to a medical intensive care unit with severe sepsis.
RESULTS
From January 2000 to December 2001, 3410 patients were admitted to the ICU. The prevalence of severe sepsis was 7.3%. The mortality of severe sepsis was 64.6%. The prognostic factors for severe sepsis were the number of organ systems that acutely failed (p = 0.036) and an admission route from general wards (p = 0.018). There was no difference in the outcome of severe sepsis according to infectious organisms (p = 0.24) and the site of infections (p = 0.38).
CONCLUSIONS
Severe sepsis in the MICU is a common, expensive and often fatal condition. We expect that early rescucitation and recovery from acute organ system failure will improve the outcome of severe sepsis.

Citations

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An Evaluation of the Rapid Antimicrobial Susceptibility Test by VITEK MS and VITEK 2 Systems in Blood Culture
Kang-Gyun Park, Young-Bin Yu, Keundol Yook, Sang-Ha Kim, Sunghyun Kim, Young Kwon Kim
The Korean Journal of Clinical Laboratory Science.2017; 49(3): 279. CrossRef
An Evaluation of Vitek MS System for Rapid Identification of Bacterial Species in Positive Blood Culture
Kang-Gyun Park, Sang-Ha Kim, Jong-Tae Choi, Sunghyun Kim, Young-Kwon Kim, Young-Bin Yu
The Korean Journal of Clinical Laboratory Science.2017; 49(4): 407. CrossRef
A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock
Jung-Wan Yoo, Ju Ry Lee, Youn Kyung Jung, Sun Hui Choi, Jeong Suk Son, Byung Ju Kang, Tai Sun Park, Jin-Won Huh, Chae-Man Lim, Younsuck Koh, Sang Bum Hong
The Korean Journal of Internal Medicine.2015; 30(4): 471. CrossRef
Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea
S. J. Lim, J. Y. Choi, S. J. Lee, Y. J. Cho, Y. Y. Jeong, H. C. Kim, J. D. Lee, Y. S. Hwang
Infection.2014; 42(5): 875. CrossRef
Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards
Ju Ry Lee, Hye Ran Choi
Journal of Korean Academy of Nursing.2014; 44(2): 219. CrossRef
Utility of Serum Procalcitonin for Diagnosis of Sepsis and Evaluation of Severity
Taejin Park, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Tuberculosis and Respiratory Diseases.2011; 70(1): 51. CrossRef
Clinical Guideline for the Diagnosis and Treatment of Gastrointestinal Infections

Infection and Chemotherapy.2010; 42(6): 323. CrossRef
The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock
Jung-Hwan Ahn, Sang-Cheon Choi, Young-Gi Min, Yoon-Seok Jung, Sung Hee Chung, Young-Joo Lee
The Korean Journal of Critical Care Medicine.2009; 24(3): 134. CrossRef

Infectious Complications in the Survivors of Out-of-hospital Cardiac Arrest: Seon Hee Woo, Woon Jeong Lee, Se Min Choi, Seung Pill Choi, Kyu Nam Park; Korean J Crit Care Med. 2009;24(1):22-27.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.22

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Abstract PDF: BACKGROUND
Infectious complications commonly occur in the survivors of out-of-hospital cardiac arrest. The aim of our study was to describe the incidence, associated factors and outcome of infectious complications of the survivors of out-of-hospital cardiac arrest.
METHODS
We conducted a retrospective analysis of 75 patients who survived out-of-hospital cardiac arrest. We collected the data on the demographics, the modes of cardiac arrest, the duration of CPR, the dose of epinephrine, the use of hypothermia, new infections, the duration of mechanical ventilation, the length of stay in the intensive care unit (ICU), recovery of consciousness and the mortality.
RESULTS
New infections developed in 46.7% of the patients. Asystole was the most common rhythm (70.7%). The most common infectious complication was pneumonia (40.0%) urinary tract infection developed in 10 cases, vascular catheter local infection developed in 6 cases, primary blood stream infection developed in 3 cases, wound infection developed in 2 cases and pseudomembranous colitis developed in 1 case. The most common pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. Blood cultures were obtained in 36 patients during the first 24 hr and the pathogen was isolated in three. The patients with infection had a longer duration of mechanical ventilation and a longer stay in the ICU (p < 0.001, p = 0.001).
CONCLUSIONS
Infectious complications are common in survivors of out-of-hospital cardiac arrest and these infections are associated with a longer duration of mechanical ventilation and a longer stay in the ICU. The most common infectious complication was pneumonia and the pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus.

The Clinical Features of Patients with Deep Neck Infections Who Were Admitted to the Intensive Care Unit in a Single Emergency Center: Jin Joo Kim, Sung Youl Hyun, Jung Kwon Kim, Yong Su Lim, Jong Hwan Shin, Jin Seong Cho, Ji Ho Ryu, Gun Lee; Korean J Crit Care Med. 2008;23(2):96-101.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.96

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Abstract PDF

BACKGROUND
Deep neck infections are a life-threatening disease that spread to the neck spaces and the mediastinum via neck fascial planes. In spite of using antibiotics, the mortality of deep neck infections is still high. The aim of our study was to analyze the factors related to mortality and morbidity of patients with deep neck infection who were admitted to the intensive care unit.
METHODS
This is a retrospective study of patients with deep neck infections who were admitted to the intensive care unit over a 2 year period between June 2006 and May 2008. The various factors related to mortality and morbidity were analyzed.
RESULTS
Twenty-four patients were included over 2 years. The median age was 58 years. Eighteen patients (75%) were males and six patients were females. Ten patients (41.7%) had underlying diabetes mellitus. The median white blood cell count and C-reactive protein (CRP) were 14,000/mm3 and 24.1 mg/dl, respectively. The most common cause of deep neck infection was of dental origin (62.5%) and the most common complication was mediastinitis (37.5%). The factors related to mortality were underlying diabetes mellitus, pO2, CRP, sequential organ failure assessment (SOFA) score, gas-forming score (GAS), and complications due to mediastinitis.
CONCLUSIONS
It is useful to measure several factors in patients with deep neck infections. The patients with underlying diabetes mellitus, increased CRP, a GAS score of 2, and complications to mediastinitis have a high mortality rate, so active surgical and medical management should be performed.

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Retrospective investigation of anesthetic management and outcome in patients with deep neck infections
Tae Kwane Kim, Hye Jin Yoon, Yuri Ko, Yuna Choi, Ui Jin Park, Jun Rho Yoon
Anesthesia and Pain Medicine.2019; 14(3): 347. CrossRef

Causes of Fever in the ICU - A Prospective, Cohort Study: Eun Ju Jeon, Hye Min Lee, Sung Gun Cho, Hyung Koo Kang, Hee Won Kwak, Ju Han Song, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Jae Yeol Kim; Korean J Crit Care Med. 2008;23(1):13-17.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.13

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Abstract PDF

BACKGROUND
Fever develops in 70% of ICU patients. In the present study, we tried to figure out causes of fever and the prognosis of febrile patients in the ICU in a prospective, cohort method.
METHODS
From February to June 2007, patients admitted to medical ICU were daily screened and those who developed fever were enrolled. 237 consecutive admissions of 237 patients over a 5-month period were analyzed. Clinical parameters, including demographic data, underlying diseases, duration of ICU stay, causes of fever and final outcome were analyzed.
RESULTS
Fever (core temperature > or =38.3degrees C) was present in 8% of admission, and it was caused by infective (84.2%) and non-infective processes (15.8%). Most fever occurred within first 5 days in the course of the admission (68.4%) and most lasted less than 5 days (57.9%). The median Acute Physiology and Chronic Health Evaluation (APACHE) III score at the time of fever was 43 (+/-19). Those with infectious fever had no significant differences in terms of severity of diseases in comparison with those with non-infectious cause of fever. The most common cause of infective fever was pneumonia (n=11). Prolonged fever (> or =5 days), all of which was caused by infection, occurred in 11 patients. Those with prolonged fever had higher mortality rate than short duration of fever (37.5% vs 0%, p<0.05).
CONCLUSION
Infection, especially pneumonia is common cause of fever in the ICU. Prolonged fever is associated with high mortality rate.

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The Value of Procalcitonin and the SAPS II and APACHE III Scores in the Differentiation of Infectious and Non-infectious Fever in the ICU: A Prospective, Cohort Study
Eun Ju Jeon, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Ae Ja Park, Jae Yeol Kim
Journal of Korean Medical Science.2010; 25(11): 1633. CrossRef

Intraoperative Carotid Sinus Hypersensitivity and Postoperative Complication of Radical Neck Dissection Retrospective Study: Tae Il Kim, Hae Ja Lim, Seong Ho Chang, Nan Sook Kim; Korean J Crit Care Med. 1998;13(1):49-54.

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Abstract PDF: BACKGOUND: Postoperative complications in the geriatric patients undergoing radical neck dissection are generally considered to be more severe than young patients. The incidence of carotid sinus hypersensitivity in elderly patients is also considered to be higher than the young. The comparison between old (above 65 years) and young (below 65 years) aged groups about intraoperative carotid sinus hypersensitivity and postoperative complication is necessary for safe anesthesia.
METHODS
Sixty five adult patients, of either sex, regardless of age, given radical neck dissection from January 1990 to January 1998, were investigated for the incidence of intraoperative carotid sinus hypersensitivity and postoperative hypertension by way of retrospective chart review. The authors also examined the postoperative complications such as high fever, pulmonary, cardiac and renal complications, cerebrovascular diseases and neurologic injuries.
RESULTS
The incidence of intraoperative carotid sinus hypersensitivity were 28% in elderly patients (n=25), 10% in young patients (n=40) but there was no statistical significance. The incidence of postoperative hypertension were 79.1% in patients with hypertension history, 34.1% in patients without hypertension history and there was statistical significance between the two groups (P=0.001). The incidence of postoperative pulmonary complication were 44% in elderly patients, 20% in young patients, and there was also statistical significance between the two groups (P=0.038). There was no statistical significance in the incidence of postoperative high fever above 38.5degrees C between the two groups (p=0.059).
CONCLUSION
After the radical neck dissection, the geriatric patients had a greater incidence of postoperative pulmonary complications than young patients and the most relating factor to postoperative hypertension was previous history of hypertension. Therefore optimal preoperative preparations for the hypertensive patients and the prevention and immediate treatment of the postoperative pulmonary complications in geriatric patients are very important during the radical neck dissection.

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