Acute and Critical Care

Review Article

Nursing
Nurse-led glycemic control protocols in intensive care units: a scoping review: Eugene Han, Eunhye Park, Eui Geum Oh; Received August 16, 2025 Accepted October 8, 2025 Published online December 19, 2025; DOI: https://doi.org/10.4266/acc.003225 [Epub ahead of print]

124 View
1 Download

Abstract PDF Supplementary Material: Nurse-led glycemic management in critical care settings has been demonstrated to reduce the incidence of dysglycemia, including hyperglycemia and hypoglycemia, while stabilizing glycemic variability, contributing to enhanced patient outcomes. This scoping review aimed to identify nurse-led glycemic management protocols in intensive care units, analyze their components (e.g., target glucose range, monitoring frequency, and implementation methods), and evaluate their effectiveness. Seven databases, including PubMed and CINAHL, were searched for studies published between January 2015 and April 2025. Studies were selected using predefined inclusion criteria, and two independent reviewers evaluated methodological quality using the JBI critical appraisal tool. Ultimately, seven quasi-experimental studies were included. Most protocols employed continuous intravenous insulin infusions (n=5), whereas others focused on hypoglycemia management (n=2). The target glucose levels ranged from 100–180 mg/dl, and the monitoring intervals varied from 15 minutes to 4 hours depending on the protocol type. All protocols excluded patients on oral diets and those receiving intermittent enteral nutrition. Four studies used printed guidelines with manual adjustments, whereas three employed computerized decision-support systems. The studies indicated that nurse-led glycemic control management was associated with reductions in both glycemic variability and in the incidence of hyper- and hypoglycemia. These findings highlight the need for evidence-based updates to nurse-led glycemic control protocols in critical care for safe and effective management through a multidisciplinary approach.

Original Articles

Pediatrics
Weight variability at pediatric intensive care unit admission and adverse outcomes in critically ill children: Jae Hwa Jung, Yoon Hee Kim, Min Jung Kim, Mireu Park, Hamin Kim, Kyung Won Kim, Myung Hyun Sohn, Soo Yeon Kim; Acute Crit Care. 2025;40(4):605-613. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.001550

348 View
57 Download

Abstract PDF Supplementary Material: Background
Body weight can fluctuate during critical illness due to factors such as fluid shifts, nutritional status, the type of acute illness, and underlying comorbidities. We investigated the association between acute body weight variability (WV) and clinical outcomes in critically ill pediatric patients.
Methods
We retrospectively analyzed data from patients aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU) of a university-affiliated tertiary hospital between August 2017 and July 2021. WV was defined as the percentage difference between the measured body weight at PICU admission and the usual body weight, obtained either from recent hospital records or caregiver reports. Associations between WV and clinical outcomes, including PICU mortality and ventilator-free days (VFDs), were assessed.
Results
Of the 926 patients, 74 (8.0%) died. Median WV was significantly higher in non-survivors than in survivors (8.7% vs. 0.0%; P<0.001). Increased WV was independently associated with higher mortality (hazard ratio [HR], 1.102; 95% CI, 1.073–1.131) and fewer VFDs (odds ratio [OR], 0.599; 95% CI, 0.524–0.684). Combining WV with Pediatric Index of Mortality 3 score significantly improved mortality prediction over either parameter alone (area under the curve, 0.888; P=0.047).
Conclusions
Higher WV at PICU admission is independently associated with adverse clinical outcomes, including increased mortality and fewer VFDs. WV could complement existing mortality prediction models in pediatric critical care.

Infection
Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea: Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh; Acute Crit Care. 2025;40(4):548-556. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.003575

808 View
89 Download
1 Web of Science

Abstract PDF Supplementary Material: Background
Emergency department (ED) overcrowding poses a global challenge, particularly for critically ill patients requiring intensive care unit (ICU) admission. Although delays in ICU transfer increase mortality in critically ill populations, the optimal timing for septic shock remains uncertain.
Methods
We conducted a target trial emulation using a prospective cohort of 815 septic shock patients from 19 Korean hospitals. Delayed ICU transfer was defined using restricted cubic splines. The primary outcome was in-hospital mortality. Multivariable logistic regression and inverse probability treatment weighting were used to adjust for confounders of age, sex, comorbidities, severity of illness, and mechanical ventilation use. Subgroup analyses were performed to assess the effect across patient characteristics.
Results
The median time of ED-to-ICU transfer was 6.7 hours (interquartile range, 4.7–11.4), and only 7% of patients were transferred within 3 hours. ICU transfer within 3 hours was associated with significantly lower in-hospital mortality (odds ratio, 0.48; 95% CI, 0.24–0.94) compared to later transfers. Mortality risk increased with elapsing time up to 6 hours and then plateaued. The benefit of early ICU transfer was consistent across subgroups but was particularly pronounced in patients requiring extracorporeal membrane oxygenation or continuous renal replacement therapy (P for interaction=0.02).
Conclusions
Early ICU transfer within 3 hours significantly reduces mortality in patients with septic shock, with the greatest benefit observed in those requiring advanced organ support. These findings highlight the need for system-wide strategies to reduce ED boarding time and prioritize timely ICU admission for septic shock management.

Review Article

Nutrition
Intensive care unit-acquired muscle atrophy and weakness in critical illness: a review of long-term recovery strategies: Nobuto Nakanishi; Acute Crit Care. 2025;40(3):361-372. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.001450

9,234 View
443 Download
1 Crossref

Abstract PDF

Intensive care unit (ICU)-acquired muscle atrophy and weakness are key contributors to post-intensive care syndrome (PICS), which can lead to long-term functional impairments. Although the ICU survival rate has improved, many patients continue to experience persistent functional impairments that hinder their reintegration into society. This review summarizes a series of observational and interventional studies conducted as part of the Muscle Atrophy Zero Project, focusing on the etiology, assessment, and prevention of ICU-acquired muscle atrophy and weakness. The project findings highlight the critical role of inflammation, particularly neutrophil infiltration, in the pathogenesis of muscle atrophy. Muscle damage can be assessed using ultrasound, bioelectrical impedance analysis, and urinary titin. Among them, ultrasound demonstrates high diagnostic accuracy for detecting low muscularity, and urinary titin has emerged as a promising biomarker of muscle degradation. Preventive strategies include early rehabilitation, neuromuscular electrical stimulation, vibration therapy, and nutritional support, especially protein supplementation. These multimodal interventions have shown efficacy in mitigating ICU-acquired muscle atrophy and weakness. However, follow-up systems for PICS remain underdeveloped. A continual multimodal intervention approach that combines physical rehabilitation with nutritional therapy is essential. The development of structured follow-up programs is vitally needed to confront the long-term challenges posed by PICS.

Citations

Citations to this article as recorded by

Nursing-based precision assessment of nutrition and muscle status without ultrasound: a prospective observational study in mechanically ventilated neurosurgical patients
Chenliang Pan, Dingding Xu, Zixin Wang, Jia Wen, Lili Ma, Yajuan Zhang
Frontiers in Medicine.2026;[Epub] CrossRef

Original Articles

Epidemiology
Post-traumatic stress disorder, anxiety, and depression in North African intensive care unit survivors: a prospective observational study: Imen Ben Saida, Marwa Zghidi, Safa Fathallah, Mohamed Boussarsar; Acute Crit Care. 2025;40(3):402-412. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.000150

5,671 View
103 Download
1 Crossref

Abstract PDF Supplementary Material

Background
Survivors of critical illness often face significant physical and psychological challenges, including post-traumatic stress disorder (PTSD), anxiety, and depression, which can severely impact their quality of life. This study aimed to evaluate the prevalence and associated factors of PTSD, anxiety, and depression among intensive care unit (ICU) survivors 3 months after discharge, and investigate the prevalence and determinants of post-intensive care syndrome–related neuropsychiatric disorders (PICS-ND).
Methods
This is a prospective observational analytical study carried out in a medical ICU. Three months after discharge from the ICU, survivors were contacted by telephone to complete the Impact Event Scale-Revised and Hospital Anxiety and Depression Scale questionnaires. Univariate and multivariate analyses were performed to identify variables that were independently and significantly associated with outcomes.
Results
A total of 114 survivors was enrolled. At 3 months, PTSD, anxiety, and depression were prevalent in 21.9%, 21.0%, and 9.6% of patients, respectively. Associated factors were younger age, female, physical restraint, and critical illness polyneuropathy and myopathy (CIPNM) for PTSD; unmarried, low Charlson index, and physical restraint for anxiety; and younger age and CIPNM for depression. PICS-ND, a composite measure of neuropsychiatric morbidity, was present in 28.9% of patients, with younger age, female, and physical restraint identified as associated factors.
Conclusions
PTSD, anxiety, depression, and PICS-ND were common among ICU survivors at 3 months. Various factors, including younger age, female, unmarried, lower Charlson index, physical restraint, and CIPNM, were associated with these psychological outcomes.

Citations

Citations to this article as recorded by

Effect of high-dose baclofen on post-traumatic stress disorder symptoms five years after hospitalization among critically ill patients with unhealthy alcohol use
Marwan Bouras, Karim Asehnoune, Yann Robert-Valli, Pierre-Joachim Mahe, Jean Reignier, Adel Maamar, Jean-Claude Lacherade, Maud Jonas, Boris Jung, Martine Ferrandiere, Samir Jaber, Laurent Flet, Mikael Moriconi, Sigismond Lasocki, Roland Smonig, Christoph
Scientific Reports.2026;[Epub] CrossRef

Pulmonary
Characteristics and management of mechanically ventilated patients in South Korea compared with other high-income Asian countries and regions: Kyung Hun Nam, Kyeongman Jeon, Suk-Kyung Hong, Ah Young Leem, Jee Hwan Ahn, Hang Jea Jang, Ki Sup Byun, So Hee Park, Sojung Park, Yoon Mi Shin, Jisoo Park, Sung Wook Kang, Jin Hyoung Kim, Jinkyeong Park, Deokkyu Kim, Bo young Lee, Woo Hyun Cho, Kwangha Lee, Song I Lee, Tai Sun Park, Yun Jung Jung, Sang-Hyun Kwak, Sang-Beom Jeon, Sung Hyun Kim, Won Jai Jung, Sang-Min Lee, Sunghoon Park, Yun Su Sim, Young-Jae Cho, Younsuck Koh; Acute Crit Care. 2025;40(3):413-424. Published online August 21, 2025; DOI: https://doi.org/10.4266/acc.003336

2,565 View
84 Download

Abstract PDF: Background
This study investigated the characteristics of mechanically ventilated patients in South Korean intensive care units (ICUs). Methods: We conducted a subgroup analysis of a multinational observational study. Data from 271 mechanically ventilated patients in South Korean ICUs were analyzed for demographics, ventilation practices, and mortality, and were compared with those of 327 patients from other high-income Asian countries. Results: South Korean patients were older (mean age: 67 vs. 62 years, P<0.001) and had lower ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (255.5 vs. 306.2, P<0.001). South Korean ICUs exhibited higher patient-to-nurse ratios (2.6 vs. 1.9, P<0.001) and more beds per unit (20.5 vs. 16.0, P=0.017). The use of sufficient positive end-expiratory pressure for patients (PEEP) for acute respiratory distress syndrome (ARDS) was less frequent in South Korea (62.2% vs. 91.2%, P=0.005). Mortality rates were similar between South Korean patients and those in other high-income Asian countries (38.0% vs. 34.2%, P=0.401). Significant mortality predictors in South Korea included age ≥65 years (odds ratio [OR], 4.03; P=0.039) and a Sequential Organ Failure Assessment score ≥8 (OR, 2.36; P=0.031). The presence of respiratory therapists was associated with reduced mortality (OR, 0.52; P=0.034). Conclusions: Despite higher age and patient-to-nurse ratios in South Korean ICUs, outcomes were comparable to those in other high-income Asian countries. The suboptimal use of sufficient PEEP with ARDS indicates potential areas for improvement. Additionally, the beneficial impact of respiratory therapists on mortality rates warrants further investigation.

Epidemiology
Impact of medical crisis on the critical care system in South Korea: Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-kyung Kim, Dong Hyun Lee, Suk-Kyung Hong; Acute Crit Care. 2025;40(3):393-401. Published online August 21, 2025; DOI: https://doi.org/10.4266/acc.000575

4,499 View
95 Download

Abstract PDF Supplementary Material: Background
The ongoing medical crisis in Korea has severely impacted the operational environment of intensive care units (ICU), posing significant challenges to quality care for critically ill patients. This study aimed to evaluate the effects of the ongoing crisis on ICUs.
Methods
A survey was conducted in July 2024 among intensivists in charge of ICUs at institutions accredited by the Korean Society of Critical Care Medicine for critical care. The survey compared data from January 2024 (pre-crisis) and June 2024 (post-crisis) on the number ICU beds, staffing composition, work hours, and the number and roles of nurse practitioners.
Results
Among the total of 71 participating ICUs, 22 experienced a reduction in the number of operational beds, with a median decrease of six beds per unit, totaling 127 beds across these ICUs. The numbers of residents and interns decreased from an average of 2.3 to 0.1 per ICU, and the average weekly working hours of intensivists increased from 62.3 to 78.8 hours. Nurse practitioners helped fill staffing gaps, with their numbers rising from 150 to 242 across ICUs, and their scope of practice expanded accordingly.
Conclusions
The medical crisis has led to major changes in the critical care system, including staffing shortages, increased workloads, and an expanded role for nurse practitioners. This is a critical moment to foster interest and engage in active discussions aimed at creating a sustainable and resilient ICU system.

Neurology
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 Crit Care. 2025;40(3):452-461. Published online August 21, 2025; DOI: https://doi.org/10.4266/acc.000500

2,406 View
51 Download

Abstract PDF Supplementary Material: Background
Delirium is a common but serious complication in critically ill patients. Family visitation has been shown to reduce delirium; however, during the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) restricted regular visitation to prevent the spread of infection. This study aimed to evaluate the association between visitation policies and incidence of delirium in the ICUs. Methods: This was a retrospective before-and-after study conducted in medical and surgical ICUs at a tertiary hospital. Adult patients admitted to an ICU during one of two periods were included: before the COVID-19 pandemic (June 2017 to May 2019) with regular visitation and during the pandemic (June 2020 to May 2022) with prohibited visitation. Delirium was assessed using the Confusion Assessment Method for the ICU. The primary outcome was association between delirium incidence and visitation policy. Results: Totals of 1,566 patients from the pre-COVID-19 period and 1,404 patients from the COVID-19 period were analyzed. The incidence of delirium was higher during the COVID-19 period (48.1% vs. 38.4%, P<0.001). After adjusting for relevant variables, the restricted visitation policy during COVID-19 remained a risk factor for delirium (odds ratio, 1.37; 95% CI, 1.13–1.65; P=0.001). Conclusions: Complete restriction of ICU visitations during the COVID-19 pandemic was associated with a significant increase in delirium incidence. These findings suggest the importance of visitation policies on patient outcomes and suggest the need for alternative strategies, such as video visitation, to mitigate the adverse effects of visitation restrictions during pandemics.

Nutrition
The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea: Hyun-Jun Park, Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2025;40(2):304-312. Published online May 30, 2025; DOI: https://doi.org/10.4266/acc.000700

4,423 View
60 Download

Abstract PDF: Background
While enteral feeding intolerance (EFI) is associated with worse clinical outcomes in critically ill patients, the relationship between the number of days of EFI and mortality outcomes remains unclear.
Methods
We retrospectively analyzed adult patients admitted to the medical intensive care unit (ICU) with septic shock at a tertiary referral center. EFI was defined as the presence of vomiting, abdominal distension, pain, diarrhea, or radiographic evidence of ileus. EFI status was assessed daily, and we evaluated the prognostic impact of total number of EFI days during the first 3 days of enteral feeding on clinical outcomes.
Results
A total of 94 patients were included in the analysis, with 77 (81.9%) experiencing EFI. During the first 3 days of enteral feeding, 25 patients (26.6%) experienced EFI for 1 day, 22 patients (23.4%) experienced EFI for 2 days, and 30 patients (31.9%) experienced EFI for all 3 days. The total number of EFI days was identified as an independent risk factor of 90-day mortality (adjusted hazard ratio, 1.400; 95% CI 1.021–1.919). Higher total EFI days was significantly associated with increased ICU mortality (P for trend=0.036), in-hospital mortality (P for trend=0.007), 30-day mortality (P for trend=0.004), and 90-day mortality (P for trend=0.006).
Conclusions
An increase in the total number of EFI days was significantly associated with mortality outcomes in patients with septic shock, suggesting that EFI may serve as a useful indicator for predicting outcomes in this population.

Epidemiology
Comparing single-patient and multi-patient room intensive care units: a multicenter cohort study on architectural differences and clinical significance in South Korea: Daun Jeong, Donghyoun Lee, Kyoung Won Yoon, Hyo Jin Kim, Sun Young Choi, Chi-Min Park; Acute Crit Care. 2025;40(2):160-170. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.004968

8,607 View
124 Download
1 Web of Science
1 Crossref

Abstract PDF

Background
The design of intensive care units (ICUs) is increasingly acknowledged as a crucial factor affecting patient outcomes. Transitioning from multi-bed patient rooms (MPRs) to single-bed patient rooms (SPRs) aims to improve infection control, patient privacy, and quality of care. However, concerns remain regarding potential patient isolation and reduced staff situational awareness. This study aims to evaluate clinical outcomes in SPR-structured ICUs compared to mixed SPR and MPR ICUs.
Methods
This multicenter retrospective cohort study was conducted across three university-affiliated tertiary hospitals between April 2022 and August 2023. The study population included ICU patients aged ≥18 years, excluding those admitted to cardiac and neonatal ICUs. Outcomes assessed included ICU mortality and severity scores based on Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores.
Results
This study included 3,179 ICU patients across three sites: site A consisted exclusively of SPRs, while sites B and C had mixed SPR and MPR arrangements. ICU mortality rates were 8.3%, 15.2%, and 9.7% for sites A, B, and C, respectively (P<0.001). Propensity score matching and logistic regression analysis demonstrated that SPRs were associated with significantly reduced ICU mortality (adjusted odds ratio, 0.54; 95% CI, 0.40–0.73).
Conclusions
SPRs were associated with a protective effect, reducing ICU mortality. Clinical outcomes in ICUs appear to be influenced by structural design improvements alongside other clinical factors.

Citations

Citations to this article as recorded by

Survival improvement through well-designed intensive care unit architecture
Dong Hyun Lee
Acute and Critical Care.2025; 40(2): 349. CrossRef

Epidemiology
Trends and management of acute respiratory failure in hospitalized patients: a multicenter retrospective study in South Korea: Won Jin Yang, Yong Jun Choi, Kyung Soo Chung, Ji Soo Choi, Bo Mi Jung, Jae Hwa Cho; Acute Crit Care. 2025;40(2):171-185. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.004728

5,127 View
135 Download

Abstract PDF Supplementary Material: Background
Acute respiratory failure (ARF) is the leading cause of hospitalization and is associated with in-hospital mortality. This study aimed to elucidate the epidemiology and clinical outcomes of ARF.
Methods
We retrospectively screened patients admitted to three hospitals in South Korea between January 2018 and December 2022. We included individuals aged 18 years, diagnosed with either type 1 ARF (arterial oxygen partial pressure [PaO2] <60 mm Hg) or type 2 ARF (arterial carbon dioxide partial pressure (PaCO2) >45 mm Hg) with a pH of <7.35, or diagnosed with the combined-type ARF.
Results
Among the 768,700 hospitalized patients, 33,278 (4.3%) developed ARF. The most common cause of ARF was sepsis (15,757 patients, 47.3%), and the most frequent comorbidity was malignancy (15,403 patients, 43.6%). Among ARF patients, 15,671 (47.1%) required intensive care unit transfer, while 8,980 (27.0%) experienced in-hospital mortality. Over 5 years, the proportion of ARF patients aged 80 years and older has shown a consistent annual increase (coefficient, 0.085 and Ptrend <0.001). Concurrently, the in-hospital mortality rate exhibited an upward trend, increasing from 25.5% in 2018 to 29.3% in 2022 (coefficient, 1.017 and Ptrend<0.001). Among the respiratory support methods used for patients with ARF over the 5-year period, high-flow nasal cannula usage steadily increased (coefficient, 4.137 and Ptrend<0.001), whereas the use of invasive mechanical ventilation declined (coefficient, –0.983 and Ptrend<0.001).
Conclusions
ARF frequency and in-hospital mortality rates are increasing, driven by various etiologies. Despite these trends, research on the epidemiology and individualized treatments for older patients is limited, highlighting the need for nationwide prospective multicenter studies.

Cardiology
Clinical decision guidance by an automated, brachial cuff-based cardiac output assessment in patients with shock under treatment: a pilot study in Athens, Greece: Dimitrios Xanthis, Panagiotis Kanatas, Dimitrios Mouziouras, Antonios A. Argyris, Pavlos Vernikos, Georgia Mastakoura, Elpida Athanasopoulou, Theodore G. Papaioannou, Athanase D. Protogerou; Acute Crit Care. 2025;40(2):273-281. Published online May 23, 2025; DOI: https://doi.org/10.4266/acc.001728

1,680 View
46 Download

Abstract PDF: Background
Cardiac output (CO) estimation in patients in intensive care units (ICUs) by a non-invasive, automated, oscillometric, cuff-based apparatus (Mobil-O-Graph [MG]) is reproducible with acceptable accuracy versus thermodilution. In this pilot study, we tested the hypothesis that clinical decisions based on the MG device are in agreement with those based on invasive measurements using a Swan-Ganz catheter (SGC). Methods: Hemodynamic monitoring using an SGC and an MG was performed on 20 consenting critically ill patients in shock and under treatment, hospitalized in ICU. Retrospectively, three ICU physicians were asked to determine the need for blood transfusion, inotropes, fluids, diuretics, oxygen, and vasoconstrictive agents. Decisions (defined as “need for action” or “no action”) were based: (i) on SGC-acquired data and standard ICU monitoring (SIM); (ii) on MG-acquired data and SIM; (iii) SIM only. The decisions were compared using Cohen’s kappa agreement coefficient and Wilcoxon’s nonparametric test. Results: The overall number of decisions, as well as the subanalysis of “need for action” decisions, based either on information from an SGC or MG, were comparable. The significant positive kappa agreement coefficients indicated moderate to strong agreement. MG-derived decisions agreed with SGC-derived decisions to a significantly higher degree compared with SIM-based decisions. Conclusions: Clinical decisions in the ICU setting based on MG data were in acceptable agreement with SGC-based decisions. Larger studies are required to confirm this finding. MG devices may provide a simple, operator-independent, low-cost, first-line bedside method for simultaneous continuous monitoring of blood pressure and CO levels in critically ill patients outside the ICU.

Pulmonary
Closed intensive care units and sepsis patient outcomes: a secondary analysis of data from a multicenter prospective observational study in South Korea: Kyeongman Jeon, Jin Hyoung Kim, Kyung Chan Kim, Heung Bum Lee, Hongyeul Lee, Song I Lee, Jin-Won Huh, Won Gun Kwack, Youjin Chang, Yun-Seong Kang, Won Yeon Lee, Je Hyeong Kim; Acute Crit Care. 2025;40(2):209-220. Published online May 22, 2025; DOI: https://doi.org/10.4266/acc.004128

3,964 View
88 Download

Abstract PDF: Background
Sepsis is a leading cause of intensive care unit (ICU) admission. However, few studies have evaluated how the ICU model affects the outcomes of patients with sepsis.
Methods
This post hoc analysis of data from the Management of Severe Sepsis in Asia’s Intensive Care Units II study included 537 patients with sepsis admitted to 27 ICUs in Korea. The outcome measures of interest were compared between the closed ICU group, patients admitted under the full responsibility of an intensivist as the primary attending physician, and the open ICU group. The association between a closed ICU and ICU mortality was evaluated using a logistic regression analysis.
Results
Altogether, 363 and 174 enrolled patients were treated in open and closed ICUs, respectively. Compliance with the sepsis bundles did not differ between the two groups; however, the closed ICU group had a higher rate of renal replacement therapy and shorter duration of ventilator support. The closed ICU group also had a lower ICU mortality rate than the open ICU group (24.7% vs. 33.1%). In a logistic regression analysis, management in the closed ICU was significantly associated with a decreased ICU mortality rate even after adjusting for potential confounding factors (adjusted odds ratio, 0.576; 95% CI, 0.342–0.970), and that association was observed for up to 90 days.
Conclusions
Sepsis management in closed ICUs was significantly associated with improved ICU survival and decreased length of ICU stay, even though the compliance rates for the sepsis bundles did not differ between open and closed ICUs.

Infection
Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome: Moiz Salahuddin, Rameesha Khalid, Sadaf Hanif, Filza Naeem, Rameen Aijaz, Akbar Shoukat Ali; Acute Crit Care. 2025;40(2):235-243. Published online May 22, 2025; DOI: https://doi.org/10.4266/acc.004008

4,362 View
85 Download
1 Web of Science
1 Crossref

Abstract PDF

Background
The mortality of severe dengue infections is approximately 23%. In the management of dengue shock syndrome (DSS), aggressive fluid resuscitation is recommended. The primary objective of our study was to assess the factors associated with 30-day mortality in DSS patients.
Methods
Adult patients >18 years old, who were admitted with DSS were included. DSS was diagnosed in patients who required vasopressors or had lactic acidosis >4 mmol/L. Patients were divided into three different groups based on cumulative fluid balance at death or extubation: group I (<3.5 L), group II (3.5–8.0 L), and group III (>8.0 L).
Results
A total of 135 patients with DSS was included, with an overall 30-day mortality of 74.8%. The average Sequential Organ Failure Assessment (SOFA) score on intensive care unit admission was 12.2. Mechanical ventilation was required in 112 patients (83.0%), with 61 patients (45.2%) being intubated without a noninvasive ventilation trial. Respiratory failure was the most common reason for requiring intubation (65 patients, 48.2%). In survivors, the median cumulative fluid balance was 1,493 ml (interquartile range [IQR], 0–4,501 ml), whereas that in the mortality group was 7,797 ml (IQR, 3,700–13,600 ml). On multivariate analysis, SOFA score (odds ratio [OR], 1.220; 95% CI, 1.011–1.472; P=0.038) and having received >8.0 L cumulative fluid balance (OR, 6.682; 95% CI, 1.808–24.689; P=0.004) were associated with increased risk of mortality.
Conclusions
DSS patients have high mortality rates. High SOFA scores and >8.0 L cumulative fluid balance may indicate worse outcomes.

Citations

Citations to this article as recorded by

Comment on “Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome”
Hinpetch Daungsupawong, Viroj Wiwanitkit
Acute and Critical Care.2025; 40(4): 630. CrossRef

Nutrition
Effect of nutrition support team on 28-day mortality in Korean patients with acute respiratory failure: Inhan Lee, Junghyun Kim, Mihyun Ku, Yurim Choi, Sohyun Park, Jihyeon Bang, Joohae Kim; Acute Crit Care. 2025;40(2):313-321. Published online April 28, 2025; DOI: https://doi.org/10.4266/acc.003312

2,681 View
55 Download

Abstract PDF: Background
Providing optimal nutrition to patients with acute respiratory failure is difficult because nutritional requirements vary according to disease severity and comorbidities. In 2021, the National Medical Center initiated a protocol for screening upon admission and regular monitoring by a multidisciplinary nutritional support team (NST), for all patients in the medical intensive care unit (ICU). This study aimed to evaluate the effects of routine NST monitoring and active intervention on the clinical outcomes of patients with acute respiratory failure.
Methods
Patients with acute respiratory failure requiring high-flow nasal cannula, non-invasive ventilation, or mechanical ventilation were included. The primary outcome was 28-day mortality after ICU admission. Secondary outcomes included the supplied/target calorie ratio, supplied/target protein ratio on day 7, and complications.
Results
In total, 152 patients were included in the analysis. The patients were divided into a pre-monitoring (n=96) and post-monitoring groups (n=56). More patients in the post-monitoring group received NST intervention and had earlier initiation of enteral feeding. In survival analysis, 28-day mortality was significantly lower in post-monitoring group (adjusted hazard ratio, 0.42; 95% CI, 0.24–0.74). The ratio of achievement for required calories and protein on day 7 was higher, but not significantly, in the post-monitoring group. No significant differences were observed in the incidence of complications.
Conclusions
Regular NST monitoring in the ICU could have contributed to a reduced risk of 28-day mortality in critically ill patients with acute respiratory failure.

Pediatrics
Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India: Sudha Chandelia, Sunil Kishore, Maansi Gangwal, Devika Shanmugasundaram; Acute Crit Care. 2025;40(1):113-121. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.002520

2,903 View
158 Download

Abstract PDF: Background
Pediatric acute respiratory distress syndrome (PARDS) has a mortality rate of up to 75%, which can be up to 90% in high-risk patients. Even with the use of advanced ventilation strategies, mortality remains unacceptably high at 40%. Airway pressure release ventilation (APRV) mode is a new strategy in PARDS. Our aim was to evaluate whether use of APRV mode in severe PARDS was associated with reduced hospital mortality compared to other modes of ventilation.
Methods
This was a retrospective comparative study using data from case files in a pediatric intensive care unit of a university-affiliated tertiary-care hospital. The study period (January 2014 to December 2019) covered three years before routine use of APRV mode to three years after its implementation. We compared severe PARDS patients in two groups: The APRV group (who received APRV as rescue therapy after failing protective ventilation); and The Non-APRV group, who received other modes of ventilation.
Results
A total of 24 patients in each group were analyzed. Overall in-hospital mortality in the APRV group was 79% versus 91% in the Non-APRV group. In-hospital mortality was significantly lower in the APRV group (univariate analysis: hazard ratio [HR], 0.27; 95% CI, 0.14–0.52; P=0.001 and multivariate analysis: HR, 0.03; 95% CI, 0.005–0.17; P=0.001). Survival times were significantly longer in the APRV group (median time to death: 7.5 days in APRV vs. 4.3 days in non-APRV; P=0.001).
Conclusions
Use of rescue APRV mode in severe PARDS may yield lower mortality rates and longer survival times.

Nursing
Nurses’ knowledge, attitude, and perceived barriers toward protective lung strategies of pediatrics mechanically ventilated patients in a tertiary care hospital in Pakistan: Tasnim Zainib, Salma Rattani, Nimira Asif, Hussain Maqbool Ahmed Maqbool; Acute Crit Care. 2025;40(1):128-135. Published online February 19, 2025; DOI: https://doi.org/10.4266/acc.004761

2,747 View
174 Download

Abstract PDF Supplementary Material: Background
Protective lung strategies (PLS) are guidelines about recent clinical advances that deliver an air volume compatible with the patient’s lung capacity and are used to treat acute respiratory distress syndrome. These mechanical ventilation guidelines are not implemented within intensive care units (ICUs) despite strong evidence-based recommendations and a dedicated professional staff. Nurses’ familiarity with clinical guidelines can bridge the gap between actual and recommended practice. However, several barriers undermine this process. The objectives of this study were to identify those barriers and explore the knowledge, attitudes, and behavior of ICU nurses regarding the implementation of PLS.
Methods
This was a descriptive, cross-sectional study. The participants were nurses working in the six ICUs of a pediatric tertiary care hospital in Lahore, Pakistan. Using purposive sampling with random selection, the total sample size was 137 nurses. A summative rating scale was used to identify barriers to the implementation of PLS.
Results
Overall, the nurses’ barrier score was high, with a mean of 66.77±5.36. Across all the barriers subscales, attitude was a much more significant barrier (35.74±3.57) to PLS than behavior (6.53±1.96), perceived knowledge (17.42±2.54), and organizational barriers (7.08±1.39). Knowledge-related barriers were also significantly high.
Conclusion
This study identified important barriers to PLS implementation by nurses, including attitudes and knowledge deficits. Understanding those barriers and planning interventions to address them could help to increase adherence to low tidal volume ventilation and improve patient outcomes. Nurses’ involvement in mechanical ventilation management could help to safely deliver air volumes compatible with recommendations.

Pediatrics
Hyper- and hypomagnesemia as an initial predictor of outcomes in septic pediatric patients in Egypt: Aya Osama Mohamed; Acute Crit Care. 2025;40(1):105-112. Published online February 4, 2025; DOI: https://doi.org/10.4266/acc.000480

3,356 View
158 Download

Abstract PDF: Background
Critically ill septic children are susceptible to electrolyte abnormalities, including magnesium disturbance, which can easily be neglected. This study examined the potential correlation between serum magnesium levels upon admission to the pediatric intensive care unit (PICU) and the outcomes of critically ill septic patients.
Methods
This prospective study, conducted from May 2023 to November 2023, included 76 children with sepsis who underwent clinical and lab assessments that included initial magnesium levels. The outcome of sepsis was documented. Predictors of mortality were identified through multivariate logistic regression models, with discrimination and calibration assessed using the area under the curve (AUC).
Results
The median magnesium level upon PICU admission was 2.0 mg/dl (range 1.1–4.9), and it was slightly higher in non-survivors than survivors (2.1 mg/dl; interquartile range [IQR], 1.9–2.5 vs. 2.0; IQR, 1.8–2.6, respectively), Hypermagnesemia was observed to have a negative effect on critically ill septic patients. It was also found that hypermagnesemia was associated with low C-reactive protein levels (P=0.043). With a cutoff of 5.5, the pediatric Sequential Organ Failure Assessment score strongly predicted mortality (AUC=0.717, P<0.001), with a sensitivity of 64.3% and specificity of 68.8%.
Conclusions
As an initial predictor of mortality, the serum magnesium level cannot be used alone; however, hypermagnesemia has a negative impact on critically ill septic patients. Thus, healthcare professionals should be cautious with magnesium administration.

Infection
Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia: Priyo Sasmito, Satriya Pranata, Rian Adi Pamungkas, Etika Emaliyawati, Nisa Arifani; Acute Crit Care. 2024;39(4):545-553. Published online November 27, 2024; DOI: https://doi.org/10.4266/acc.2023.01473

16,576 View
370 Download
1 Crossref

Abstract PDF

Background
Good sepsis management is key to successful sepsis therapy and optimal patient outcomes. Objectives: This study aimed to determine obstacles among nurses and doctors to implementing the hour-1 sepsis bundle in a secondary hospital in Indonesia.
Methods
This was a qualitative study with a phenomenological approach. Data were obtained from one-on-one in-depth interviews with 13 doctors and nurses in the intensive care unit and emergency department who were purposively sampled. Data were analyzed using content analysis.
Results
Five main themes were revealed in the analysis: incomplete implementation of the hour-1 sepsis bundle, lack of knowledge about the hour-1 sepsis bundle, cost issues, lack of supporting facilities, and lack of coordination among health workers.
Conclusions
Optimizing regional health laboratories, optimizing the use of quick Sequential Organ Failure Assessment (qSOFA) and SOFA, and creating a series of sepsis protocols within the hospital are some solutions that secondary hospitals can implement to ensure appropriate management of sepsis cases. Involvement of health policyholders and hospital management is needed to address these challenges.

Citations

Citations to this article as recorded by

Association between 1-h bundle and clinical outcomes in patients with sepsis: A systematic review and meta-analysis
Shukun Hong, Hongye Wang, Jian Liu, Lujun Qiao
Intensive and Critical Care Nursing.2025; : 104241. CrossRef

Pediatrics
A deep learning model for estimating sedation levels using heart rate variability and vital signs: a retrospective cross-sectional study at a center in South Korea: You Sun Kim, Bongjin Lee, Wonjin Jang, Yonghyuk Jeon, June Dong Park; Acute Crit Care. 2024;39(4):621-629. Published online November 25, 2024; DOI: https://doi.org/10.4266/acc.2024.01200; Retraction in: Acute Crit Care 2025;40(3):512

4,714 View
40 Download
3 Web of Science
2 Crossref

Surgery
Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea: Jae Hoon Lee, Jee Hee Kim, Ki Ho You, Won Ho Han; Acute Crit Care. 2024;39(4):554-564. Published online November 25, 2024; DOI: https://doi.org/10.4266/acc.2024.00808

4,757 View
166 Download
3 Web of Science
4 Crossref

Abstract PDF Supplementary Material

Background
In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs.
Methods
This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality.
Results
Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU.
Conclusions
Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.

Citations

Citations to this article as recorded by

Long‐Term Outcomes and Predictors in Cancer‐Related Stroke Using the Linked Data Set
Tae Jung Kim, Ji Sung Lee, Mi Sun Oh, Soo‐Hyun Park, Kyung‐Ho Yu, Byung‐Chul Lee, Byung‐Woo Yoon, Sang‐Bae Ko
Journal of the American Heart Association.2025;[Epub] CrossRef
Impact of medical crisis on the critical care system in South Korea
Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-kyung Kim, Dong Hyun Lee, Suk-Kyung Hong
Acute and Critical Care.2025; 40(3): 393. CrossRef
Patient outcomes associated with merging two paediatric cardiac intensive care units into one: A retrospective study
Sacha Mairet-Mabboux, Thibault Blache, Anthony Facchin, Catherine Koffel, Arnaud Ferraris, Christopher Blakeley, Vincent Piriou, Roland Henaine, Marc Lilot
Archives of Cardiovascular Diseases.2025;[Epub] CrossRef
The efficacy of intensivist-led closed-system intensive care units in improving outcomes for cancer patients requiring emergent surgical intervention
Eun Young Kim
Acute and Critical Care.2024; 39(4): 640. CrossRef

Trauma
Factors associated with unplanned intensive care unit readmission among trauma patients in Republic of Korea: Yongwoong Lee, Byung Hee Kang; Acute Crit Care. 2024;39(4):583-592. Published online November 22, 2024; DOI: https://doi.org/10.4266/acc.2024.00584

2,845 View
158 Download
2 Crossref

Abstract PDF

Background
In trauma patients, unplanned intensive care unit (ICU) readmission (UIR) is associated with poor clinical outcomes. In this study, we aimed to analyze associated factors for UIR in trauma patients.
Methods
This retrospective study was conducted on trauma patients admitted to the ICU at a trauma center from January 2016 to December 2022. Clinical information at admission, the first ICU hospitalization, first discharge from the ICU, and reasons for readmission were collected. Patients who were successfully discharge from the ICU were compared to UIR patients. Logistic regression was performed to determine the factors with a significant impact on ICU readmission.
Results
Here, 5,529 patients were admitted to the ICU over 7 years, and 212 patients (3.8%) experienced UIR. Among patients who experienced UIR, 9 (4.2%) died. In the UIR patients, hospital stay (20 days [interquartile range, 13–35] vs. 45 days [28–67], P<0.001), total ICU stay (5 days [3– 11] vs. 17 days [9–35], P<0.001), and complications during the first ICU hospitalization were significantly higher. The most common reason for UIR was respiratory problem (53.8%). In multivariable analysis, cervical spine operation during the first ICU hospitalization (odds ratio, 6.56; 95% CI, 3.62–11.91; P<0.001), renal replacement therapy (RRT; 3.52, 2.06–5.99, P<0.001), and massive blood transfusion protocol (MTP; 1.74, 1.08–2.81, P=0.023) were most highly related with UIR.
Conclusions
Because UIR patients had poor outcomes, trauma patients who underwent cervical spine operation, RRT, or MTP require monitoring in the general ward, especially for respiratory problems.

Citations

Citations to this article as recorded by

Unplanned intensive care unit admissions in trauma patients: A critical appraisal
Amlan Swain, Deb Sanjay Nag, Jayanta Kumar Laik, Seelora Sahu, Mrunalkant Panchal, Shivani Srirala
World Journal of Critical Care Medicine.2025;[Epub] CrossRef
Circulation-first trauma resuscitation and mortality: A 9-year single-center retrospective study
Donghwan Choi, Kyoungwon Jung
Journal of Trauma and Acute Care Surgery.2025;[Epub] CrossRef

Pediatrics
Post–intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post–intensive-care clinic: Chanapai Chaiyakulsil; Acute Crit Care. 2024;39(4):600-610. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.01011

3,060 View
171 Download

Abstract PDF Supplementary Material: Background
Long-term survival data for critically ill children discharged to post-intensive care clinics are scarce, especially in Asia. The main objective of this study was to assess the prevalence of post–intensive-care morbidity among pediatric intensive care unit (PICU) survivors at 1 month and 1 year after hospital discharge and to identify the associated risk factors.
Methods
We conducted a retrospective chart review of all children aged 1 month to 15 years who were admitted to the PICU for >48 hours from July 2019 to July 2022 and visited a post–intensive-care clinic 1 month and 1 year after hospital discharge. Post-intensive care morbidity was defined using the Pediatric Cerebral Performance Category (PCPC). Descriptive statistics, univariate, and multivariate analyses were conducted.
Results
A total of 111 children visited the clinic at 1 month, and 100 of these children visited the clinic at 1 year. Only 39 of 111 children (35.2%) had normal PCPC assessments at 1 month, while 54 of 100 (54.0%) were normal at 1 year. Baseline developmental delays were significantly associated with any degree of disability and at least moderate disability at both time points. Mechanical ventilation for >7 days was associated with at least moderate disability at both time points, while PICU stay >7 days was significantly associated with moderate disability at 1 month and any degree of disability at 1 year.
Conclusions
A substantial percentage of PICU survivors had persistent disabilities even 1 year after critical illness. A structured multidisciplinary post–intensive-care follow-up plan is warranted to provide optimal care for such children.

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

12,994 View
305 Download
5 Web of Science
6 Crossref

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

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
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.2025;[Epub] CrossRef
Bridging the Evidence to Practice Gaps in Public Hospitals: Lessons from a VAP Reduction Quality Improvement Initiative
Praveen Kumar
Indian Pediatrics.2025;[Epub] CrossRef

Epidemiology
Red blood cell transfusion for critically ill patients admitted through the emergency department in South Korea: Tae Sung Kim, Yongil Cho, Hyuk Joong Choi, Joonbum Park, Wonhee Kim, Chiwon Ahn, Joon Young Kim; Acute Crit Care. 2024;39(4):517-525. Published online November 5, 2024; DOI: https://doi.org/10.4266/acc.2024.00577

6,906 View
190 Download
1 Crossref

Abstract PDF

Background
Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.
Methods
This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.
Results
Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.
Conclusions
Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.

Citations

Citations to this article as recorded by

Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level: A Multicenter Observational Study
Kyung Hun Yoo, Gil Joon Suh, Woon Yong Kwon, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Kyuseok Kim, Yoo Seok Park, Tae Gun Shin, Byuk Sung Ko, Tae Ho Lim, Yongil Cho
Journal of Korean Medical Science.2026;[Epub] CrossRef

Nursing
A study to assess the psychosocial needs of patient family members in the intensive care unit in India: Lalthlanawmi Renthlei, Ronur Srikantasastry Ramesh, Mahalakshmy Thulasingam, Manjini Jeyaram Kumari; Acute Crit Care. 2024;39(3):420-429. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2023.01116

6,168 View
291 Download
1 Crossref

Abstract PDF

Background
Admission to an intensive care unit (ICU) is considered a mental crisis for patients and their families as they are unprepared for such a stressful and difficult situation. Hence, the objectives of this study are to assess the psychosocial needs of patient family members in the ICU in various dimensions such as assurance, proximity, information, support, and comfort; and to associate their psychosocial needs with their socio-demographic variables and clinical variables of the patient.
Methods
This was a cross-sectional analytical study conducted between December 2021 and January 2022 among 188 family members of patients admitted to the ICU using a convenience sampling technique in a tertiary hospital in Puducherry, India. The modified Critical Care Family Needs Inventory (CCFNI) questionnaire was administered to all consenting family members to determine their needs.
Results
The overall most important need among the five dimensions of modified CCFNI scores identified by the family members is the need for assurance (2.71±0.38). Using analysis of variance, statistical significances were found as follows. Education and comfort (F-statistic and P-value): 2.76 (0.029); relationship with the patient and assurance: 2.61 (0.036); relationship with the patient and support: 2.44 (0.048); level of consciousness and comfort: 4.63 (0.010); ICU visit restriction and assurance: 3.28 (0.022); ICU visit restriction and comfort: 8.08 (<0.001).
Conclusions
Since family members are essential members of the treatment teams, nurses should concentrate on reassuring them, assisting them in emerging from crises through appropriate communication, offering support, and attending to their needs.

Citations

Citations to this article as recorded by

Perceived Needs of Families of Critically Ill Patients
Destiny R. Brady, Jennifer R. O’Neill, Joann M. Condon
Critical Care Nursing Clinics of North America.2025;[Epub] CrossRef

Epidemiology
The impact of age on mortality in the intensive care unit: a retrospective cohort study in Malaysia: Abdul Jabbar Ismail, W Mohd Nazaruddin W Hassan, Mohd Basri Mat Nor, Wan Fadzlina Wan Muhd Shukeri; Acute Crit Care. 2024;39(3):390-399. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00640

7,305 View
257 Download
4 Web of Science
4 Crossref

Abstract PDF

Background
Age is a significant consideration for intensive care unit (ICU) admission. However, the reported associations between increasing age and mortality vary across studies, and data in the local context of Malaysia are lacking. The objective of the present study was to determine the impact of increasing age on ICU mortality.
Methods
A retrospective cohort study of ICU patients was conducted between January 2020 and November 2023 at a university hospital in Malaysia. Patients were classified into two categories according to age (years) and into four groups according to National Library of Medicine Medical Subject Headings (MeSH): young adult (19–24), adult (25–44), middle age (45–64), and elderly (≥65). The Cochran-Armitage test for trend and Cox proportional hazards regression analyses were performed to evaluate the impact of increasing age on ICU mortality.
Results
A total of 1,661 patients was analyzed. The Cochran-Armitage test showed a significant positive association between ICU mortality rate and age group (Z=−4.86, P<0.01) or MeSH category (Z=−5.36, P<0.01). After adjusting for other confounders, the strongest predictor for ICU mortality in the Cox proportional hazards regression analyses was age, with the elderly age group having the highest adjusted hazard ratio of 4.777 (95% CI, 1.128–20.231; P=0.03).
Conclusions
Age had a significant impact on ICU mortality in our cohort of critically ill patients.

Citations

Citations to this article as recorded by

Intubation in Eosinophilic Lung Disease: Predictors, Outcomes, and Characteristics from a National Inpatient Sample Analysis
Michel Al Achkar, Nadim Zaidan, Chloe Lahoud, Zaineb Zubair, Jessica Schwartz, Erica Abidor, Chris Kaspar, Halim El Hage
Medicina.2025; 61(4): 556. CrossRef
Ranking Nursing Diagnoses by Predictive Relevance for Intensive Care Unit Transfer Risk in Adult and Pediatric Patients: A Machine Learning Approach with Random Forest
Manuele Cesare, Mario Cesare Nurchis, Gianfranco Damiani, Antonello Cocchieri
Healthcare.2025; 13(11): 1339. CrossRef
A retrospective study of multivariable analysis of predictive values of lactate-related ratios on 28-day mortality in intensive care units
Veysel Dinç, Döndü Genç Moralar, Oğuz Özakin, Serpil Şehirlioğlu
Medicine.2025; 104(39): e44605. CrossRef
Early Mortality Prediction in Intensive Care Unit Patients Based on Serum Metabolomic Fingerprint
Rúben Araújo, Luís Ramalhete, Cristiana P. Von Rekowski, Tiago A. H. Fonseca, Luís Bento, Cecília R. C. Calado
International Journal of Molecular Sciences.2024; 25(24): 13609. CrossRef

Review Article

Nursing
Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review: Daniela Fradinho Almeida, Maria do Rosário Pinto, Maria Candida Durao, Helga Rafael Henriques, Joana Ferreira Teixeira; Acute Crit Care. 2024;39(3):341-349. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00528

17,952 View
542 Download

Abstract PDF: Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%–0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20–30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.

Original Article

Nursing
Sleep, anxiety, depression, and stress in critically ill patients: a descriptive study in a Portuguese intensive care unit: Rui Domingues Silva, Abílio Cardoso Teixeira, José António Pinho, Pedro Marcos, José Carlos Santos; Acute Crit Care. 2024;39(2):312-320. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2023.01256

9,206 View
242 Download
6 Web of Science
7 Crossref

Abstract PDF

Background
Sleep disorders are common among patients admitted to intensive care units (ICUs). This study aimed to assess the perceptions of sleep quality, anxiety, depression, and stress reported by ICU patients and the relationships between these perceptions and patient variables.
Methods
This cross-sectional study used consecutive non-probabilistic sampling to select participants. All patients admitted for more than 72 hours of ICU hospitalization at a Portuguese hospital between March and June 2020 were asked to complete the “Richard Campbell Sleep Questionnaire” and “Anxiety, depression, and Stress Assessment Questionnaire.” The resulting data were analyzed using descriptive statistics, Pearson’s correlation coefficient, Student t-tests for independent samples, and analysis of variance. The significance level for rejecting the null hypothesis was set to α ≤0.05.
Results
A total of 52 patients admitted to the ICU for at least 72 hours was recruited. The mean age of the participants was 64 years (standard deviation, 14.6); 32 (61.5%) of the participants were male. Approximately 19% had psychiatric disorders. The prevalence of self-reported poor sleep was higher in women (t[50]=2,147, P=0.037) and in participants with psychiatric problems, although this difference was not statistically significant (t[50]=–0.777, P=0.441). Those who reported having sleep disorders before hospitalization had a worse perception of their sleep.
Conclusions
Sleep quality perception was worse in female ICU patients, those with psychiatric disorders, and those with sleep alterations before hospitalization. Implementing early interventions and designing nonpharmacological techniques to improve sleep quality of ICU patients is essential.

Citations

Citations to this article as recorded by

Effectiveness of psychological nursing interventions for depression, anxiety and mental health resilience: A systematic review and meta-analysis
Xiaodong Wang, Rongfang He, Jiacheng Long, Juan Chen, Monica Karunakaran, Vishnu Shankar Hariharan, Rajan Rushendar, Luwei Xiang
Archives of Psychiatric Nursing.2026; 60: 152042. CrossRef
The Impact of Environmental Stressors on Sleep Quality and Patient Experience in the Intensive Care Unit
Meyreme Aksoy, Zeliha Büyükbayram Genç, Muhammed Ismail Güner
Nursing in Critical Care.2026;[Epub] CrossRef
Frailty and fear of death among geriatric patients in critical care units: A mixed methods study
Eman Arafa Hassan, Shimmaa Mohamed Elsayed, Heba Hashem Monged, Basma Taher Abdelwahab
Nursing in Critical Care.2025;[Epub] CrossRef
Effects of a Multimodal Intervention on Sleep Quality and Duration in Intensive Care Unit Patients
Jieun Nam, Sukhee Ahn
Journal of Korean Critical Care Nursing.2025; 18(1): 70. CrossRef
Sleep Quality and Its Associated Factors among Adult Patients Admitted in the Intensive Care Units of Public Hospitals in Addis Ababa, Ethiopia
Taye Mezgebu Ashine, Birehanu Melaku Kassaye, Asefu Woldestadik, Kasie Gebeyehu Tiruneh, Tadesse Sahle Adeba, Edmialem Getahun Mesfin, Tamrat Alate Woldeyohannis, Asaminew Habtamu Sane
Sage Open Nursing.2025;[Epub] CrossRef
Environmental Factors Affecting Sleep Quality in Intensive Care Unit Patients in Southern Morocco: An Assessment Study
Abdelmajid Lkoul, Keltouma Oumbarek, Youssef Bouchriti, Asmaa Jniene, Tarek Dendane
Advances in Respiratory Medicine.2025; 93(3): 14. CrossRef
Prevalence of poor sleep quality among critical care unit nurses: a systematic review and meta-analysis
Neda Sanaie, Sogand Sarmadi, Akbar Zare-Kaseb
BMC Nursing.2025;[Epub] CrossRef

Review Article

Basic science and research
Sex or gender differences in treatment outcomes of sepsis and septic shock: Seung Yeon Min, Ho Jin Yong, Dohhyung Kim; Acute Crit Care. 2024;39(2):207-213. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2024.00591

13,084 View
404 Download
14 Web of Science
19 Crossref

Abstract PDF

Gender disparities in intensive care unit (ICU) treatment approaches and outcomes are evident. However, clinicians often pay little attention to the importance of biological sex and sociocultural gender in their treatment courses. Previous studies have reported that differences between sexes or genders can significantly affect the manifestation of diseases, diagnosis, clinicians' treatment decisions, scope of treatment, and treatment outcomes in the intensive care field. In addition, numerous reports have suggested that immunomodulatory effects of sex hormones and differences in gene expression from X chromosomes between genders might play a significant role in treatment outcomes of various diseases. However, results from clinical studies are conflicting. Recently, the need for customized treatment based on physical, physiological, and genetic differences between females and males and sociocultural characteristics of society have been increasingly emphasized. However, interest in and research into this field are remarkably lacking in Asian countries, including South Korea. Through this review, we hope to enhance our awareness of the importance of sex and gender in intensive care treatment and research by briefly summarizing several principal issues, mainly focusing on sex and sex hormone-based outcomes in patients admitted to the ICU with sepsis and septic shock.

Citations

Citations to this article as recorded by

High expression of IRF4 mediated by m6A modification promotes immunosuppression in the late phase of sepsis
Ziying Xiong, Wending Zhou, Nengyi Hua, Xuedi Zhang, Chunxiu Ling, Xiao Huang, Xiaolei Liu, Hanhui Zhong, Shuhua Luo, Huiling Zhang, Bowan Huang, Jing Tang
Anesthesiology and Perioperative Science.2026;[Epub] CrossRef
Impact of substance use disorders on critical care management and health outcomes in septic adolescents
Havell Markus, Gary D. Ceneviva, Neal J. Thomas, Conrad Krawiec
Annals of Intensive Care.2025;[Epub] CrossRef
Trends of cardiovascular disease and sepsis related mortality in the United States, 1999 to 2019: A CDC WONDER Database Analysis
Shehroze Tabassum, Faraz Azhar, Aimen Shafiq, Muneeba Ahsan, Aroma Naeem, Farhan Naeem, Hafeez Ul Hassan Virk, Abdul Mannan Khan Minhas, Dmitry Abramov, M Chadi Alraies
International Journal of Cardiology Cardiovascular Risk and Prevention.2025; 26: 200421. CrossRef
Mitigating Bias in Machine Learning Models with Ethics-Based Initiatives: The Case of Sepsis
John D. Banja, Yao Xie, Jeffrey R. Smith, Shaheen Rana, Andre L. Holder
The American Journal of Bioethics.2025; : 1. CrossRef
Sex differences on the effect of hemoadsorption during cardiac surgery – A REMOVE trial post-hoc analysis
Tulio Caldonazo, Torsten Doenst, Luca Fazzini, Hristo Kirov, Stefan Hagel, Thomas Lehmann, Shekhar Saha, Rodrigo Sandoval Boburg, Sebastian Freiburger, Christian Jörg Rustenbach, Mateo Marin-Cuartas, Mahmoud Diab
International Journal of Cardiology.2025; 435: 133371. CrossRef
Predicting the clinical evolution of septic patients from routinely collected data and vital signs variability using machine learning
Ilaria Mentasti, Marta Carrara, Manuela Ferrario
Physiological Measurement.2025; 46(7): 075009. CrossRef
Biomarker-based assessment for predicting sepsis-induced coagulopathy and outcomes in intensive care
Shams ElDoha Galal ElDin Zaiema, Ayat Allah Gamal Ahmed Mohamed Ibrahim Wahab, Manal Fawzy Ghozlan, Yasmin Nabil ElSakhawy, Aya Ali Mahmoud Bayoumy, Heba Samy Agamy
Academia Medicine.2025;[Epub] CrossRef
Effects of Pomegranate on Wound Healing
Ilkay Halicioglu, Nilgün Isiksacan, Firat Baytekin, Mehmet Kulus, Emre gulbagci, Öznur Inan, Mehmet E Gunes
Cureus.2025;[Epub] CrossRef
Sex differences in preterm cytokine and inflammasome responses and modulation by exogenous sex steroids
Matthew McGovern, Lynne A. Kelly, Rebecca Finnegan, John F. Murphy, John Kelleher, Ashanty M. Melo, Catherine M. Greene, Eleanor J. Molloy
Pediatric Research.2025;[Epub] CrossRef
Transcapillary PO2 Gradients in Contracting Muscle of Rat Model of Sepsis
Narumi Fukuzaki, Kazuki Hotta, Kota Izawa, Naoki Hitosugi, Miki Sakamoto, Rin Kataoka, Shuri Arai, Kentaro Kamiya, Atsuhiko Matsunaga
Journal of Vascular Research.2025; 62(5): 266. CrossRef
Sex differences in sepsis outcomes across the lifespan: a population-based cohort study in Germany
Norman Rose, Islam Agrama, Irit Nachtigall, Mathias W. Pletz, Jenny Rosendahl, Ha-Yeun Chung, Christina E. Zielinski, Diana Dudziak, Melissa Spoden, Patrik Dröge, Stefan Hagel, Carolin Fleischmann-Struzek
Critical Care.2025;[Epub] CrossRef
Sex-related differences in antimicrobial dosing for sepsis: Bridging the equity gap
Helena Barrasa, Goiatz Balziskueta, Jordi Rello
Journal of Intensive Medicine.2025; 5(4): 301. CrossRef
Capsaicin attenuates sepsis‑associated encephalopathy by inhibiting neuroinflammation and apoptosis whilst activating mitophagy through the BNIP3/NIX pathway
Silun Zhang, Nanbo Luo, Hanxi Wu, Junfa Chen, Yonghan Jiang, Lifei Xiao, Hanlin Liang, Qingsheng Xue, Yan Luo, Buwei Yu, Yuqiang Liu, Zhiheng Liu
Molecular Medicine Reports.2025; 32(6): 1. CrossRef
Preoperative testosterone replacement therapy is associated with increased rates of periprosthetic joint infection, acute kidney injury, and emergency department utilization after total shoulder arthroplasty: a propensity-score matched analysis
Alexander E. White, Argen Omurzakov, Arsen M. Omurzakov, Christian E. Athanasian, Christopher M. Brusalis, Michelle E. Kew, Michael C. Fu, Lawrence V. Gulotta, Samuel A. Taylor
Journal of Shoulder and Elbow Surgery.2025;[Epub] CrossRef
Preoperative Testosterone Replacement Therapy Is Associated With Increased Complication Risk After Total Knee Arthroplasty: A Propensity-Matched Analysis of 13,250 Patients
Argen Omurzakov, Arsen M. Omurzakov, Pravjit Bhatti, Eytan M. Debbi, Elizabeth B. Gausden, Brian P. Chalmers
The Journal of Arthroplasty.2025;[Epub] CrossRef
Epidemiology of severe acute respiratory infections in South Korea: a nationwide surveillance study
Da Hyun Kang, So-yun Kim, Hyekyeong Ju, Sunju Lee, Young Seok Lee, Jae Young Moon, Dong Keun Kim, Hye Ri Choi, Jee Eun Rhee, Song I Lee
BMC Pulmonary Medicine.2025;[Epub] CrossRef
Impact of sex on outcomes in septic shock patients treated with hydrocortisone
Hebatallah A. M. Moustafa, Mina Montasser, Islam Ahmed, Azza E. A. Mansy, Tamer Habib
Scientific Reports.2025;[Epub] CrossRef
Clinical predictors of hospital-acquired bloodstream infections: A healthcare system analysis
Harjinder Singh, Radhika Sheth, Mehakmeet Bhatia, Abdullah Muhammad, Candi Bachour, David Metcalf, Vivek Kak
Spartan Medical Research Journal.2024;[Epub] CrossRef
Impact of metabolic syndrome on cardiovascular, inflammatory and hematological parameters in female mice subjected to severe sepsis
Leonardo Berto-Pereira, Raquel Pires Nakama, Lucas Felipe dos Santos, Aparecida Donizette Malvezi, Isabella Ramos Trevizani Thihara, Lucas Sobral de Rossi, Fabricio Seidy Ribeiro Inoue, Wander Rogério Pavanelli, Priscila Cassolla, Phileno Pinge-Filho, Mar
Biochemical and Biophysical Research Communications.2024; 739: 150966. CrossRef

Original Article

CPR/Resuscitation
Effects of ketamine on the severity of depression and anxiety following postoperative mechanical ventilation: a single-blind randomized clinical trial in Iran: Seyedbabak Mojaveraghili, Fatemeh Talebi, Sima Ghorbanoghli, Shahram Moghaddam, Hamidreza Shakouri, Ruzbeh Shamsamiri, Fatemeh Mehravar; Acute Crit Care. 2024;39(2):243-250. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01186

7,900 View
134 Download

Abstract PDF: Background
In this study, we compare the effects of ketamine and the combination of midazolam and morphine on the severity of depression and anxiety in mechanically ventilated patients after discharge from the intensive care unit (ICU).
Methods
This randomized single-blind clinical trial included 50 patients who were candidates for craniotomy and postoperative mechanical ventilation in the ICU of 5 Azar Teaching Hospital in Gorgan City, North Iran, from 2021 to 2022. Patients were allocated to two groups by quadruple block randomization. In group A, 0.5 mg/kg of ketamine was infused over 15 minutes after craniotomy and then continued at a dose of 5 µ/kg/min during mechanical ventilation. In group B, midazolam was infused at a dose of 2–3 mg/hr and morphine at a dose of 3–5 mg/hr. After patients were discharged from the ICU, if their Glasgow Coma Scale scores were ≥14, Beck’s anxiety and depression inventories were completed by a psychologist within 2 weeks, 2 months, and 6 months after discharge.
Results
The mean scores of depression at 2 months (P=0.01) and 6 months (P=0.03) after discharge were significantly lower in the ketamine group than in the midazolam and morphine group. The mean anxiety scores were significantly lower in the ketamine group 2 weeks (P=0.006) and 6 months (P=0.002) after discharge.
Conclusions
Ketamine is an effective drug for preventing and treating anxiety and depression over the long term in patients discharged from the ICU. However, further larger volume studies are required to validate these results.

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

23,461 View
806 Download
13 Web of Science
16 Crossref

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

Ethics
Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea: Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park; Acute Crit Care. 2024;39(2):294-303. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01130

5,945 View
159 Download
3 Web of Science
5 Crossref

Abstract PDF Supplementary Material

Background
The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization.
Methods
We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not.
Results
Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family.
Conclusions
The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.

Citations

Citations to this article as recorded by

Awareness, attitudes, and educational needs regarding the life-sustaining treatment decision-making act in Korea among healthcare providers and medical students: a comparative analysis
Jooseon Lee, So-yun Kim, Duk-ki Kim, Green Hong, Song I Lee
BMC Medical Ethics.2026;[Epub] CrossRef
Cardiac arrest after hanging: A scoping review
Thomas Fisher, Clodagh Beattie, Quentin Otto, Joanna Hooper, Jerry P. Nolan, Jasmeet Soar
Resuscitation.2025; 207: 110510. CrossRef
Determinants of Limiting Life-Sustaining Treatment in Critically Ill COVID-19 Patients: A Multicenter Study in Korean Intensive Care Units
I Re Heo, Tae Hoon Kim, Won Jai Jung, Gil Myeong Seong, Sun Jung Kwon, Jae Young Moon, Song-I Lee, Do Sik Moon, Tae-Ok Kim, Chul Park, Eun Young Choi, Jung-Wan Yoo, Sunghoon Park, Ae Rin Baek, Sung Yoon Lim, Jung Soo Kim, Jongmin Lee, Chi Ryang Chung, San
Tuberculosis and Respiratory Diseases.2025; 88(3): 557. CrossRef
Public Perspectives on Palliative and Hospice Care: Social Media Content Analysis Using Topic Modeling and Multiclass Sentiment Analysis
Aeri Kim, Kyungmi Woo
Journal of Medical Internet Research.2025; 27: e70836. CrossRef
End-of-life care among Koreans in critical care and community-dwelling Korean Americans: A cross-cultural scoping review
Soo Hyun Kim, Changhwan Kim, Erh-Chi Hsu, Zackary Berger, Hae-Ra Han, Binu Koirala, Jung Kwak, Katherine A. Ornstein, Rebecca Wright
Palliative and Supportive Care.2025;[Epub] CrossRef

Pulmonary
Are sodium-glucose co-transporter-2 inhibitors associated with improved outcomes in diabetic patients admitted to intensive care units with septic shock?: Nikita Ashcherkin, Abdelmohaymin A. Abdalla, Simran Gupta, Shubhang Bhatt, Claire I. Yee, Rodrigo Cartin-Ceba; Acute Crit Care. 2024;39(2):251-256. Published online May 14, 2024; DOI: https://doi.org/10.4266/acc.2023.01046

9,800 View
207 Download
3 Web of Science
3 Crossref

Abstract PDF

Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce organ dysfunction in renal and cardiovascular disease. There are limited data on the role of SGLT2i in acute organ dysfunction. We conducted a study to assess the effect of SGLT2i taken prior to intensive care unit (ICU) admission in diabetic patients admitted with septic shock.
Methods
This retrospective cohort study used electronic medical records and included diabetic patients admitted to the ICU with septic shock. We compared diabetic patients on SGLT2i to those who were not on SGLT2i prior to admission. The primary outcome was in-hospital mortality, and secondary outcomes included hospital and ICU length of stay, use of renal replacement therapy, and 28- and 90-day mortality.
Results
A total of 98 diabetic patients was included in the study, 36 in the SGLT2i group and 62 in the non-SGLT2i group. The Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation III scores were similar in the groups. Inpatient mortality was significantly lower in the SGLT2i group (5.6% vs. 27.4%, P=0.008). There was no significant difference in secondary outcomes.
Conclusions
Our study found that diabetic patients on SGLT2i prior to hospitalization who were admitted to the ICU with septic shock had lower inpatient mortality compared to patients not on SGLT2i.

Citations

Citations to this article as recorded by

Sodium-glucose cotransporter-2 inhibitors and sepsis: a story with two tails or with one tail?
Baris Afsar, Rengin Elsurer Afsar, Katherine Tuttle, Krista L. Lentine
Inflammopharmacology.2026;[Epub] CrossRef
Melioidosis in people living with diabetes; clinical presentation, clinical course and implications for patient management
Laura Prideaux, Megan Sandeman, Hayley Stratton, Anthony D Kelleher, Simon Smith, Josh Hanson
Acta Tropica.2025; 263: 107559. CrossRef
High-density lipoprotein: a biomarker and therapeutic target in sepsis
Mohan Li, Marina Barros-Pinkelnig, Sesmu M. Arbous, Christina Christoffersen, Patrick C. N. Rensen, Sander Kooijman
Critical Care.2025;[Epub] CrossRef

Review Article

Meta-analysis
The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials: Yerkin Abdildin, Karina Tapinova, Assel Nemerenova, Dmitriy Viderman; Acute Crit Care. 2024;39(1):34-46. Published online February 28, 2024; DOI: https://doi.org/10.4266/acc.2023.00829

24,130 View
553 Download
4 Web of Science
5 Crossref

Abstract PDF

Background
This meta-analysis aims to evaluate the effects of ketamine in critically ill intensive care unit (ICU) patients.
Methods
We searched for randomized controlled trials (RCTs) in PubMed, Scopus, and the Cochrane Library; the search was performed initially in January but was repeated in December of 2023. We focused on ICU patients of any age. We included studies that compared ketamine with other traditional agents used in the ICU. We synthesized evidence using RevMan v5.4 and presented the results as forest plots. We also used trial sequential analysis (TSA) software v. 0.9.5.10 Beta and presented results as TSA plots. For synthesizing results, we used a random-effects model and reported differences in outcomes of two groups in terms of mean difference (MD), standardized MD, and risk ratio with 95% confidence interval. We assessed the risk of bias using the Cochrane RoB tool for RCTs. Our outcomes were mortality, pain, opioid and midazolam requirements, delirium rates, and ICU length of stay.
Results
Twelve RCTs involving 805 ICU patients (ketamine group, n=398; control group, n=407) were included in the meta-analysis. The ketamine group was not superior to the control group in terms of mortality (in five studies with 318 patients), pain (two studies with 129 patients), mean and cumulative opioid consumption (six studies with 494 patients), midazolam consumption (six studies with 304 patients), and ICU length of stay (three studies with 270 patients). However, the model favored the ketamine group over the control group in delirium rate (four studies with 358 patients). This result is significant in terms of conventional boundaries (alpha=5%) but is not robust in sequential analysis. The applicability of the findings is limited by the small number of patients pooled for each outcome.
Conclusions
Our meta-analysis did not demonstrate differences between ketamine and control groups regarding any outcome except delirium rate, where the model favored the ketamine group over the control group. However, this result is not robust as sensitivity analysis and trial sequential analysis suggest that more RCTs should be conducted in the future.

Citations

Citations to this article as recorded by

Ketamine use in adult intensive care unit: a narrative review of emerging applications, efficacy challenges, and safety concerns
Siyao Zeng, Zhipeng Yao, Chunming Guan, Shanpeng Cui, Zhen Quan, Yue Li, Junbo Zheng, Hongliang Wang
Emergency and Critical Care Medicine.2025; 5(3): 153. CrossRef
The effect of low-dose ketamine compared to morphine on the severity of acute pain in emergency situations: a systematic review and meta-analysis
Jun Zhang, Bin Ma
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2025;[Epub] CrossRef
Sedation and analgesia strategies in the neuro intensive care unit
Zachary I Merhavy, Tereque Raeburn, Gloria M Torres-Ayala, Melissa A McCulloch, Thomas C Varkey
World Journal of Critical Care Medicine.2025;[Epub] CrossRef
Ketamine sedation in critically ill patients: Past, present and future
Sameer Sharif, Jay Prakash, Bram Rochwerg
Indian Journal of Anaesthesia.2024; 68(8): 674. CrossRef
Opioid-Free Using Ketamine versus Opioid-Sparing Anesthesia during the Intraoperative Period in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial
Hoon Choi, Jaewon Huh, Minju Kim, Seok Whan Moon, Kyung Soo Kim, Wonjung Hwang
Journal of Personalized Medicine.2024; 14(8): 881. CrossRef

Original Articles

Epidemiology
Development of a deep learning model for predicting critical events in a pediatric intensive care unit: In Kyung Lee, Bongjin Lee, June Dong Park; Acute Crit Care. 2024;39(1):186-191. Published online February 20, 2024; DOI: https://doi.org/10.4266/acc.2023.01424; Correction in: Acute Crit Care 2024;39(2):330

6,008 View
187 Download
2 Crossref

Abstract PDF

Background
Identifying critically ill patients at risk of cardiac arrest is important because it offers the opportunity for early intervention and increased survival. The aim of this study was to develop a deep learning model to predict critical events, such as cardiopulmonary resuscitation or mortality.
Methods
This retrospective observational study was conducted at a tertiary university hospital. All patients younger than 18 years who were admitted to the pediatric intensive care unit from January 2010 to May 2023 were included. The main outcome was prediction performance of the deep learning model at forecasting critical events. Long short-term memory was used as a deep learning algorithm. The five-fold cross validation method was employed for model learning and testing.
Results
Among the vital sign measurements collected during the study period, 11,660 measurements were used to develop the model after preprocessing; 1,060 of these data points were measurements that corresponded to critical events. The prediction performance of the model was the area under the receiver operating characteristic curve (95% confidence interval) of 0.988 (0.9751.000), and the area under the precision-recall curve was 0.862 (0.700–1.000).
Conclusions
The performance of the developed model at predicting critical events was excellent. However, follow-up research is needed for external validation.

Citations

Citations to this article as recorded by

Impacto de la inteligencia artificial en la predicción de eventos críticos en las unidades de cuidados intensivos: implicaciones para la práctica y la toma de decisiones en enfermería
Joao Andrés Cujilan Guamán, Nicole Elizabeth Chele Sudiaga, Víctor Alfonso Gavilanes Burnhan, Jenny Verónica Tacle Flores, Ruth Alexandra Boza Ruiz
Prohominum.2025; 7(2): 209. CrossRef
Impacto de la inteligencia artificial en la predicción de eventos críticos en las unidades de cuidados intensivos: Implicaciones para la práctica y la toma de decisiones en enfermería
Joao Andrés Cujilan Guamán, Nicole Elizabeth Chele Sudiaga, Víctor Alfonso Gavilanes Burnhan, Jenny Verónica Tacle Flores, Ruth Alexandra Boza Ruiz
Más Vita.2025; 7(2): 58. CrossRef

Trauma
Clinical characteristics and outcomes of obstetric patients transferred directly to intensive care units: Saad Pirzada, Kimberly Boswell, Jerry Yang, Samantha Asuncion, Fernando Albelo, Amanda Tuchler, Lauren Becker, Allison Lankford, Emad Elsamadicy, Quincy K Tran; Acute Crit Care. 2024;39(1):138-145. Published online February 15, 2024; DOI: https://doi.org/10.4266/acc.2023.01375

5,879 View
209 Download
1 Crossref

Abstract PDF Supplementary Material

Background
Medical complications in peripartum patients are uncommon. Often, these patients are transferred to tertiary care centers, but their conditions and outcomes are not well understood. Our study examined peripartum patients transferred to an intensive care unit (ICU) at an academic quaternary center.
Methods
We reviewed charts of adult, non-trauma, interhospital transfer (IHT) peripartum patients sent to an academic quaternary ICU between January 2017 and December 2021. We conducted a descriptive analysis and used multivariable ordinal regression to examine associations of demographic and clinical factors with ICU length of stay (LOS) and hospital length of stay (HLOS).
Results
Of 1,794 IHT peripartum patients, 60 (3.2%) were directly transferred to an ICU. The average was 32 years, with a median Sequential Organ Failure Assessment (SOFA) score of 3 (1–4.25) and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 8 (7–12). Respiratory failure was most common (32%), followed by postpartum hemorrhage (15%) and sepsis (14%). Intubation was required for 24 (41%), and 4 (7%) needed extracorporeal membrane oxygenation. Only 1 (1.7%) died, while 45 (76.3%) were discharged. Median ICU LOS and HLOS were 5 days (212) and 8 days (5–17). High SOFA score was linked to longer HLOS, as was APACHE II.
Conclusions
Transfers of critically ill peripartum patients between hospitals were rare but involved severe medical conditions. Despite this, their outcomes were generally positive. Larger studies are needed to confirm our findings.

Citations

Citations to this article as recorded by

Emergencias neurológicas en pacientes embarazadas. Experiencia de un centro de alta especialidad Ciudad de México
Juan Gustavo Vázquez-Rodríguez, Rocío Margarita Ruíz-Huitrón
Archivos de Medicina de Urgencia de México.2024; 16(3): 172. CrossRef

Pulmonary
Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart for Intensive Care-IV database analysis: Chiwon Ahn, Yeonkyung Park, Yoonseok Oh; Acute Crit Care. 2024;39(1):179-185. Published online February 15, 2024; DOI: https://doi.org/10.4266/acc.2023.01165

12,014 View
290 Download
1 Web of Science
3 Crossref

Abstract PDF

Background
Pneumonia frequently leads to intensive care unit (ICU) admission and is associated with a high mortality risk. This study aimed to assess the impact of early bronchoscopy administered within 3 days of ICU admission on mortality in patients with pneumonia using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database.
Methods
A single-center retrospective analysis was conducted using the MIMIC-IV data from 2008 to 2019. Adult ICU-admitted patients diagnosed with pneumonia were included in this study. The patients were stratified into two cohorts based on whether they underwent early bronchoscopy. The primary outcome was the 28-day mortality rate. Propensity score matching was used to balance confounding variables.
Results
In total, 8,916 patients with pneumonia were included in the analysis. Among them, 783 patients underwent early bronchoscopy within 3 days of ICU admission, whereas 8,133 patients did not undergo early bronchoscopy. The primary outcome of the 28-day mortality between two groups had no significant difference even after propensity matched cohorts (22.7% vs. 24.0%, P=0.589). Patients undergoing early bronchoscopy had prolonged ICU (P<0.001) and hospital stays (P<0.001) and were less likely to be discharged to home (P<0.001).
Conclusions
Early bronchoscopy in severe pneumonia patients in the ICU did not reduce mortality but was associated with longer hospital stays, suggesting it was used in more severe cases. Therefore, when considering bronchoscopy for these patients, it's important to tailor the decision to each individual case, thoughtfully balancing the possible advantages with the related risks.

Citations

Citations to this article as recorded by

Bronchoscopy in intensive care: to whom, when, why? (literature review)
O.Yu. Usenko, A.V. Sydiuk, O.Ye. Sydiuk, V.V. Antonenko, S.I. Chechil
EMERGENCY MEDICINE.2025; 21(3): 328. CrossRef
Toilet bronchoscopy in respiratory ICU: a randomized controlled clinical trial
Mohamed F. Abdelghany, Atef F.M. Al Karn, Shaimaa A. Mohammed, Sahar F. Youssif
The Egyptian Journal of Chest Diseases and Tuberculosis.2025; 74(3): 300. CrossRef
Bronchoscopy in Chronic Obstructive Pulmonary Disease
Yang Rui, Zhe Chen, Yuting Wang, Enjian Zhong, Yin Sheng, Tao Li, Tomoya Kawaguchi
Respiratory Endoscopy.2025; 3(2): 79. CrossRef

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

6,150 View
213 Download
3 Web of Science
5 Crossref

Abstract PDF Supplementary Material

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

Citations

Citations to this article as recorded by

Mechanical power and mortality: analysis of a prospective cohort of ventilated patients
Yudiel Pérez Yero, Ariel Sosa Remón, Jhossmar Cristians Auza-Santivañez, Arian Jesús Cuba Naranjo, Dasha María García Arias, Ana Esperanza Jeréz Alvarez, Mileydys Saborit García, Osman Arteaga Iriarte, Jose Bernardo Antezana-Muñoz
Multidisciplinar (Montevideo).2025; 3: 198. CrossRef
Associations of mechanical power, ventilatory ratio, and other respiratory indices with mortality in patients with acute respiratory distress syndrome undergoing pressure-controlled mechanical ventilation
Tae Wan Kim, Chi Ryang Chung, Miryeo Nam, Ryoung-Eun Ko, Gee Young Suh
Frontiers in Medicine.2025;[Epub] CrossRef
The association of frailty and mechanical power with hospital mortality in critically ill patients: a retrospective study based on the MIMIC-IV and eICU database
Jiacheng Shen, Kun Fang, Yu Qiu, Li Li
European Journal of Medical Research.2025;[Epub] CrossRef
Mechanical power in mechanical ventilation and its association with ventilator-induced lung injury: A systematic review
Tomasz Urbankowski, Raman Pasledni, Marek Darowski
Respiratory Medicine.2025; 250: 108525. CrossRef
Perioperative Ventilation in Neurosurgical Patients: Considerations and Challenges
Ida Giorgia Iavarone, Patricia R.M. Rocco, Pedro Leme Silva, Shaurya Taran, Sarah Wahlster, Marcus J. Schultz, Nicolo’ Antonino Patroniti, Chiara Robba
Current Anesthesiology Reports.2024; 14(4): 512. CrossRef

Epidemiology
Outcomes of extracorporeal membrane oxygenation support in pediatric hemato-oncology patients: Hong Yul An, Hyoung Jin Kang, June Dong Park; Acute Crit Care. 2024;39(1):108-116. Published online January 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01088

5,808 View
193 Download
1 Web of Science
1 Crossref

Abstract PDF Supplementary Material

Background
In this study, we reviewed the outcomes of pediatric patients with malignancies who underwent hematopoietic stem cell transplantation (HSCT) and extracorporeal membrane oxygenation (ECMO).
Methods
We retrospectively analyzed the records of pediatric hemato-oncology patients treated with chemotherapy or HSCT and who received ECMO in the pediatric intensive care unit (PICU) at Seoul National University Children’s Hospital from January 2012 to December 2020.
Results
Over a 9-year period, 21 patients (14 males and 7 females) received ECMO at a single pediatric institute; 10 patients (48%) received veno-arterial (VA) ECMO for septic shock (n=5), acute respiratory distress syndrome (ARDS) (n=3), stress-induced myopathy (n=1), or hepatopulmonary syndrome (n=1); and 11 patients (52%) received veno-venous (VV) ECMO for ARDS due to pneumocystis pneumonia (n=1), air leak (n=3), influenza (n=1), pulmonary hemorrhage (n=1), or unknown etiology (n=5). All patients received chemotherapy; 9 received anthracycline drugs and 14 (67%) underwent HSCT. Thirteen patients (62%) were diagnosed with malignancies and 8 (38%) were diagnosed with non-malignant disease. Among the 21 patients, 6 (29%) survived ECMO in the PICU and 5 (24%) survived to hospital discharge. Among patients treated for septic shock, 3 of 5 patients (60%) who underwent ECMO and 5 of 10 patients (50%) who underwent VA ECMO survived. However, all the patients who underwent VA ECMO or VV ECMO for ARDS died.
Conclusions
ECMO is a feasible treatment option for respiratory or heart failure in pediatric patients receiving chemotherapy or undergoing HSCT.

Citations

Citations to this article as recorded by

Extracorporeal Membrane Oxygenation in the Management of Tumor Lysis Syndrome in Children: A Review of Cases
Zere Aidynbek, Erken Kakenov, Olga Mironova, Karlygash Ydyrysheva, Tatyana Li, Vitaliy Sazonov
Journal of Clinical Medicine.2025; 14(8): 2771. CrossRef

Review Articles

Basic science and research
Brain–computer interface in critical care and rehabilitation: Eunseo Oh, Seyoung Shin, Sung-Phil Kim; Acute Crit Care. 2024;39(1):24-33. Published online January 12, 2024; DOI: https://doi.org/10.4266/acc.2023.01382

17,448 View
333 Download
4 Web of Science
4 Crossref

Abstract PDF

This comprehensive review explores the broad landscape of brain–computer interface (BCI) technology and its potential use in intensive care units (ICUs), particularly for patients with motor impairments such as quadriplegia or severe brain injury. By employing brain signals from various sensing techniques, BCIs offer enhanced communication and motor rehabilitation strategies for patients. This review underscores the concept and efficacy of noninvasive, electroencephalogram-based BCIs in facilitating both communicative interactions and motor function recovery. Additionally, it highlights the current research gap in intuitive “stop” mechanisms within motor rehabilitation protocols, emphasizing the need for advancements that prioritize patient safety and individualized responsiveness. Furthermore, it advocates for more focused research that considers the unique requirements of ICU environments to address the challenges arising from patient variability, fatigue, and limited applicability of current BCI systems outside of experimental settings.

Citations

Citations to this article as recorded by

Temporal and frequency features play different role in recognizing preparation of voluntary movements from electroencephalogram
Artur Sagatdinov, Mikhail Lipkovich, Veronika Knyazeva, Aleksander Aleksandrov
The European Physical Journal Special Topics.2025; 234(15): 4317. CrossRef
Toward brain-computer interface speller with movement-related cortical potentials as control signals
José Jesús Hernández-Gloria, Andres Jaramillo-Gonzalez, Andrej M. Savić, Natalie Mrachacz-Kersting
Frontiers in Human Neuroscience.2025;[Epub] CrossRef
Flexible brain electronic sensors advance wearable brain-computer interface
Jia Li, Guo Chen, Gang Li, Lujia Xiao, Ruonan Jia, Kun Zhang
npj Biomedical Innovations.2025;[Epub] CrossRef
LPGGNet: Learning from Local–Partition–Global Graph Representations for Motor Imagery EEG Recognition
Nanqing Zhang, Hongcai Jian, Xingchen Li, Guoqian Jiang, Xianlun Tang
Brain Sciences.2025; 15(12): 1257. CrossRef

Surgery
Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review: Hanan Elkalawy, Pavan Sekhar, Wael Abosena; Acute Crit Care. 2023;38(4):409-424. Published online November 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00703

21,079 View
655 Download
7 Web of Science
12 Crossref

Abstract PDF

Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

Citations

Citations to this article as recorded by

Nursing-based precision assessment of nutrition and muscle status without ultrasound: a prospective observational study in mechanically ventilated neurosurgical patients
Chenliang Pan, Dingding Xu, Zixin Wang, Jia Wen, Lili Ma, Yajuan Zhang
Frontiers in Medicine.2026;[Epub] CrossRef
Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients
Ana Maria Dumitriu, Cristian Cobilinschi, Bogdan Dumitriu, Sebastian Vâlcea, Raluca Ungureanu, Angela Popa, Rǎzvan Ene, Radu Țincu, Ioana Marina Grințescu, Liliana Mirea
Nutrients.2025; 17(3): 380. CrossRef
Potential diagnostic tools for intensive care unit acquired weakness: A systematic review
Chen Xin, Yubiao Gai, Lili Wei, Yanqiu Wang, Yuhong Luo, Binru Han
International Journal of Nursing Studies Advances.2025; 8: 100301. CrossRef
Relação entre a perda de massa magra, força muscular e capacidade funcional de pacientes críticos vítimas de trauma
Tamine Vitória Pereira Moraes, Renato Valduga , Priscilla Flávia de Melo Fernandes, Guilherme Duprat Ceniccola
Health Residencies Journal.2025;[Epub] CrossRef
Development and validation of machine learning-based risk prediction models for ICU-acquired weakness: a prospective cohort study
Yimei Zhang, Yu Wang, Jingran Yang, Qinglan Li, Min Zhou, Jiafei Lu, Qiulan Hu, Fang Ma
European Journal of Medical Research.2025;[Epub] CrossRef
Diagnostic Innovations to Combat Antibiotic Resistance in Critical Care: Tools for Targeted Therapy and Stewardship
Ahmed D. Alatawi, Helal F. Hetta, Mostafa A. Sayed Ali, Yasmin N. Ramadan, Amirah B. Alaqyli, Wareef K. Alansari, Nada H. Aldhaheri, Talidah A. Bin Selim, Shahad A. Merdad, Maram O. Alharbi, Wejdan Alhumaidi Hmdan Alatawi, Abdelazeem M. Algammal
Diagnostics.2025; 15(17): 2244. CrossRef
Early skeletal muscle loss and clinical outcomes in critically ill patients in the medical intensive care unit: A retrospective cohort study
Soyun Kim, Da Hyun Kang, Dukki Kim, Soyoung Ahn, Mi Ra Lee, Song Lee, Masoud Rahmati
PLOS One.2025; 20(12): e0338315. CrossRef
The role of bioimpedance in determining protein intake after ICU care
Cristian Deana, Alessia Marin, Michele Umbrello, Daniele Guerino Biasucci, Laura Di Meo, Luigi Vetrugno
Clinical Nutrition Open Science.2025; 64: 230. CrossRef
Characteristics of the Cerebrospinal Fluid in Septic Patients with Critical Illness Polyneuropathy - A Retrospective Cohort Study
Yanyang Zhang, Jinfu Ma, Qing Zhao, Hui Liu
The Journal of Critical Care Medicine.2024; 10(2): 130. CrossRef
Advancing critical care recovery: The pivotal role of machine learning in early detection of intensive care unit-acquired weakness
Georges Khattar, Elie Bou Sanayeh
World Journal of Clinical Cases.2024; 12(21): 4455. CrossRef
Construction and evaluation of acquired weakness nomogram model in patients with mechanical ventilation in intensive care unit
Chen Lu, Jiang Wenjuan
DIGITAL HEALTH.2024;[Epub] CrossRef
A scoping review of preclinical intensive care unit-acquired weakness models
Qingmei Yu, Jiamei Song, Luying Yang, Yanmei Miao, Leiyu Xie, Xinglong Ma, Peng Xie, Shaolin Chen
Frontiers in Physiology.2024;[Epub] CrossRef

Original Articles

Epidemiology
Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea: Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park; Acute Crit Care. 2023;38(4):498-506. Published online November 29, 2023; DOI: https://doi.org/10.4266/acc.2023.01354

4,199 View
112 Download
1 Crossref

Abstract PDF Supplementary Material

Background
Various rapid response systems have been developed to detect clinical deterioration in patients. Few studies have evaluated single-parameter systems in children compared to scoring systems. Therefore, in this study we evaluated a single-parameter system called the acute response system (ARS).
Methods
This retrospective study was performed at a tertiary children’s hospital. Patients under 18 years old admitted from January 2012 to August 2023 were enrolled. ARS parameters such as systolic blood pressure, heart rate, respiratory rate, oxygen saturation, and whether the ARS was activated were collected. We divided patients into two groups according to activation status and then compared the occurrence of critical events (cardiopulmonary resuscitation or unexpected intensive care unit admission). We evaluated the ability of ARS to predict critical events and calculated compliance. We also analyzed the correlation between each parameter that activates ARS and critical events.
Results
The critical events prediction performance of ARS has a specificity of 98.5%, a sensitivity of 24.0%, a negative predictive value of 99.6%, and a positive predictive value of 8.1%. The compliance rate was 15.6%. Statistically significant increases in the risk of critical events were observed for all abnormal criteria except low heart rate. There was no significant difference in the incidence of critical events.
Conclusions
ARS, a single parameter system, had good specificity and negative predictive value for predicting critical events; however, sensitivity and positive predictive value were not good, and medical staff compliance was poor.

Citations

Citations to this article as recorded by

Impact of an independent pediatric rapid response team on pediatric patient safety
Jin Hwan Lyu, Soo Keun Lee, Min Joo Kang, Sumin Lee, Mireu Park, Soo Yeon Kim, Kyung Won Kim, Jong Deok Kim
Archives of Pediatric Critical Care.2024; 2(2): 91. CrossRef

Nursing
The effects of environmental interventions for delirium in critically ill surgical patients: Hak-Jae Lee, Yoon-Joong Jung, Nak-Joon Choi, Suk-Kyung Hong; Acute Crit Care. 2023;38(4):479-487. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00990

8,766 View
201 Download
6 Web of Science
6 Crossref

Abstract PDF

Background
Delirium occurs at high rates among patients in intensive care units and increases the risk of morbidity and mortality. The purpose of this study was to investigate the effects of environmental interventions on delirium.
Methods
This prospective cohort study enrolled 192 patients admitted to the surgical intensive care unit (SICU) during the pre-intervention (June 2013 to October 2013) and post-intervention (June 2014 to October 2014) periods. Environmental interventions involved a cognitive assessment, an orientation, and a comfortable environment including proper sleep conditions. The primary outcomes were the prevalence, duration, and onset of delirium.
Results
There were no statistically significant differences in incidence rate, time of delirium onset, general characteristics, and mortality between the pre-intervention and post-intervention groups. The durations of delirium were 14.4±19.1 and 7.7±7.3 days in the pre-intervention and post-intervention groups, respectively, a significant reduction (P=0.027). The lengths of SICU stay were 20.0±22.9 and 12.6±8.7 days for the pre-intervention and post-intervention groups, respectively, also a significant reduction (P=0.030).
Conclusions
The implementation of an environmental intervention program reduced the duration of delirium and length of stay in the SICU for critically ill surgical patients.

Citations

Citations to this article as recorded by

The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic review
Marli Lopo Vitorino, Adriana Henriques, Graça Melo, Helga Rafael Henriques
Intensive and Critical Care Nursing.2025; 89: 103976. CrossRef
Delirium in Critically Ill Geriatric Surgical Patients: A Systematic Review of Screening, Risk Factors, Diagnosis, and Management
Zackary Yates, Philip Lee, Nikita Nunes Espat, Ruth Zagales, Nickolas Hernandez, Quratulain Amin, Andrew Ford, Caitlin Tweedie, Adel Elkbuli
Journal of Trauma Nursing.2025; 32(4): 169. CrossRef
The incidence and risk factors of perioperative delirium in elderly patients with hip fracture under the Unaccompanied- Care model
XiaoLing Chen, Yixin Huang, Fengxiang Chen, Xiaole Jiang, Dongze Lin, Fengfei Lin
Journal of Orthopaedic Surgery and Research.2025;[Epub] 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
Clinical Nursing Management of Adult Patients with Delirium in a Hospital Setting—A Systematic Review
Anna Szewczak, Dorota Siwicka, Jadwiga Klukow, Joanna Czerwik-Marcinkowska, Szymon Zmorzynski
Journal of Clinical Medicine.2025; 14(22): 8113. CrossRef
Reasons influencing the nurses’ prioritization process while preventing and managing delirium: findings from a qualitative study
Luisa Sist, Nikita Valentina Ugenti, Stefania Chiappinotto, Rossella Messina, Paola Rucci, Alvisa Palese
Aging Clinical and Experimental Research.2024;[Epub] CrossRef

Epidemiology
Implementation and effectiveness of a delirium care protocol in Thai critically ill children: Chanapai Chaiyakulsil, Thananya Thadahirunchot; Acute Crit Care. 2023;38(4):488-497. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00045

4,771 View
130 Download
1 Web of Science
3 Crossref

Abstract PDF

Background
Delirium in critically ill children can result in long-term morbidity. Our main objectives were to evaluate the effectiveness of a new protocol on the reduction, prevalence, and duration of delirium and to identify associated risk factors.
Methods
The effectiveness of the protocol was evaluated by a chart review in all critically ill children aged 1 month to 15 years during the study period. A Cornell Assessment of Pediatric Delirium score ≥9 was considered positive for delirium. Data on delirium prevalence and duration from the pre-implementation and post-implementation phases were compared. Univariate and multivariate analyses were used to identify the risk factors of delirium.
Results
A total of 120 children was analyzed (58 children in the pre-implementation group and 62 children in the post-implementation group). Fifty children (41.7%) screened positive for delirium. Age less than 2 years, delayed development, use of mechanical ventilation, and pediatric intensive care unit (PICU) stay >7 days were significantly associated with delirium. The proportion of children screened positive was not significantly different after the implementation (before, 39.7% vs. after, 43.5%; P=0.713). Subgroup analyses revealed a significant reduction in the duration of delirium in children with admission diagnosis of cardiovascular problems and after cardiothoracic surgery.
Conclusions
The newly implemented protocol was able to reduce the duration of delirium in children with admission diagnosis of cardiovascular problems and after cardiothoracic surgery. More studies should be conducted to reduce delirium to prevent long-term morbidity after PICU discharge.

Citations

Citations to this article as recorded by

Pediatric Delirium in Pediatric Intensive Care Setting: A Review of Recognition and Prevalence
Patricia Savrimuthu, Putri Yubbu
Malaysian Journal of Paediatrics and Child Health.2025; 31(1): 33. CrossRef
Non-pharmacological interventions for delirium in critically ill children: a scoping review
Max Zilezinski, Natascha-Elisabeth Denninger, Antje Tannen, Jan Kottner
BMJ Open.2025; 15(9): e094529. CrossRef
The growing significance of delirium in children
Roberta Esteves Vieira de Castro, Yu Kawai, Alexandria Barry, Dickey Catherine Fuchs, Elizabeth Engstrom, Kristina A. Betters, Heidi A. B. Smith
Critical Care Science.2025;[Epub] CrossRef

Surgery
Biomarkers to predict mortality in patients with Fournier’s gangrene admitted to the intensive care unit after surgery in South Korea: In Sik Shin, Seong Chan Gong, Sanghyun An, Kwangmin Kim; Acute Crit Care. 2023;38(4):452-459. Published online November 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00766

5,310 View
91 Download
3 Web of Science
7 Crossref

Abstract PDF

Background
The use of biomarkers to predict patient outcomes may be crucial for patients admitted to the intensive care unit (ICU) following surgery because biomarkers guide clinicians in tailoring treatment plans accordingly. Therefore, we aimed to identify potential biomarkers to predict the prognosis of patients with Fournier’s gangrene (FG) admitted to the ICU after surgery.
Methods
We enrolled patients with FG admitted to our Hospital between January 2013 and December 2022. We retrospectively analyzed patient characteristics, factors related to management, scores known to be associated with the prognosis of FG, and laboratory data.
Results
The study population included 28 survivors and 13 nonsurvivors. The initial serum lactate level taken in the emergency department; white blood cell, neutrophil, and platelet counts; delta neutrophil index and international normalized ratio; albumin, glucose, HCO3, and postoperative lactate levels; and the laboratory risk indicator for necrotizing fasciitis differed between survivors and nonsurvivors. Postoperative lactate and initial albumin levels were independent predictors of mortality in patients with FG. In the receiver operating characteristic curve analysis, the postoperative lactate level was the best indicator of mortality (area under the curve, 0.877; 95% confidence interval, 0.711–1.000). The optimal cutoff postoperative lactate level for predicting mortality was 3.0 mmol/L (sensitivity, 80.0%; specificity, 95.0%).
Conclusions
Postoperative lactate and initial albumin levels could be potential predictors of mortality in patients with FG admitted to the ICU after surgery, and the optimal cutoff postoperative lactate and initial albumin levels to predict mortality were 3.0 mmol/L and 3.05 g/dl, respectively. Large-scale multicenter prospective studies are required to confirm our results.

Citations

Citations to this article as recorded by

Revolutionizing Gangrene Therapy: Nanoparticle-Based Interventions and Biomarker Applications
Elizabeth Rani Edwin, Silpa Jayaprakash, Yamuna Gopi, Praveen Madhaiyan, Punniyakoti V. Thanikachalam, Pavithra Bharathy
Biomedical Materials & Devices.2025;[Epub] CrossRef
A Retrospective Evaluation of Cases of Necrotizing Fasciitis Presenting to the Emergency Department
Gürkan Altuntaş, Mümin Murat Yazıcı, İsmail Ataş, Meryem Kaçan, Özlem Bilir
Hamidiye Medical Journal.2025; 6(2): 78. CrossRef
Integrative Management Strategies for Improved Outcomes in Fournier’s Gangrene: A Case Series Analysis from India
Awadhesh Kumar Pandey, Nasrin Habeeb, Aadithyaraj Kunnummal Thilakan, Rahul Sherkhane, Arun Kumar Dwivedi
Journal of Wound Management and Research.2025; 21(3): 148. CrossRef
Diagnostic Accuracy of Red Cell Distribution Width-Derived Indices for Predicting In-Hospital Mortality in Scrotal Fournier’s Gangrene: A Retrospective Cohort Study
Rıdvan Kayar, Kemal Kayar, İlker Artuk, Samet Demir, Emre Tokuc, Metin Öztürk
Surgical Infections.2025;[Epub] CrossRef
Predictive value of elevated interleukin-33 levels for multi-organ dysfunction syndrome in trauma patients in South Korea: a prospective observational study
Sanghyun An, In Sik Shin, Myoung Jun Kim, Da Kyung Kim, Md Habibur Rahman, Cheol-Su Kim, Kwangmin Kim
Acute and Critical Care.2025; 40(4): 594. CrossRef
Predictors of in-hospital mortality in Fournier gangrene at four Korean tertiary hospitals: a multicenter retrospective cohort study
In Sik Shin, Sung Woo Jang, Chan Hee Park, Jeong Woo Lee, Hui-Jae Bang, Kwangmin Kim
Journal of Acute Care Surgery.2025; 15(3): 99. CrossRef
Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review
Pavan Shet, Ashmit Daiyan Mustafa, Karan Varshney, Lavina Rao, Sameen Sawdagar, Florence McLennan, Siraaj Ansari, Darshan Shet, Niveshan Sivathamboo, Sian Campbell
Surgical Infections.2024; 25(4): 261. CrossRef

Pulmonary
Risk factors for mortality in intensive care unit patients with Stenotrophomonas maltophilia pneumonia in South Korea: Yong Hoon Lee, Jaehee Lee, Byunghyuk Yu, Won Kee Lee, Sun Ha Choi, Ji Eun Park, Hyewon Seo, Seung Soo Yoo, Shin Yup Lee, Seung-Ick Cha, Chang Ho Kim, Jae Yong Park; Acute Crit Care. 2023;38(4):442-451. Published online November 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00682

5,805 View
137 Download
5 Web of Science
5 Crossref

Abstract PDF Supplementary Material

Background
Stenotrophomonas maltophilia has been increasingly recognized as an opportunistic pathogen associated with high morbidity and mortality. Data on the prognostic factors associated with S. maltophilia pneumonia in patients admitted to intensive care unit (ICU) are lacking.
Methods
We conducted a retrospective analysis of data from 117 patients with S. maltophilia pneumonia admitted to the ICUs of two tertiary referral hospitals in South Korea between January 2011 and December 2022. To assess risk factors associated with in-hospital mortality, multivariable logistic regression analyses were performed.
Results
The median age of the study population was 71 years. Ventilator-associated pneumonia was 76.1% of cases, and the median length of ICU stay before the first isolation of S. maltophilia was 15 days. The overall in-hospital mortality rate was 82.1%, and factors independently associated with mortality were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00–1.09; P=0.046), Sequential Organ Failure Assessment (SOFA) score (OR, 1.21; 95%; CI, 1.02–1.43; P=0.025), corticosteroid use (OR, 4.19; 95% CI, 1.26–13.91; P=0.019), and polymicrobial infection (OR, 95% CI 0.07–0.69). However, the impact of appropriate antibiotic therapy on mortality was insignificant. In a subgroup of patients who received appropriate antibiotic therapy (n=58), antibiotic treatment modality-related variables, including combination or empirical therapy, also showed no significant association with survival.
Conclusions
Patients with S. maltophilia pneumonia in ICU have high mortality rates. Older age, higher SOFA score, and corticosteroid use were independently associated with increased in-hospital mortality, whereas polymicrobial infection was associated with lower mortality. The effect of appropriate antibiotic therapy on prognosis was insignificant.

Citations

Citations to this article as recorded by

How do I manage a patient with Stenotrophomonas maltophilia infection?
Roberta Monardo, Maria F. Mojica, Marco Ripa, Samuel L. Aitken, Robert A. Bonomo, David van Duin
Clinical Microbiology and Infection.2025; 31(8): 1291. CrossRef
Antimicrobial Resistance of Non-Fermenting Gram-Negative Bacilli in a Multidisciplinary Hospital in Romania
Miruna-Maria Apetroaei, Mihaela Cristina Negulescu, Sorina Hîncu, Adriana Tăerel, Manuela Ghica, Andreea Letiția Arsene, Denisa Ioana Udeanu
Biomedicines.2025; 13(9): 2255. CrossRef
Stenotrophomonas maltophilia Outbreak in an ICU: Investigation of Possible Routes of Transmission and Implementation of Infection Control Measures
Maria Luisa Cristina, Marina Sartini, Gianluca Ottria, Elisa Schinca, Giulia Adriano, Leonello Innocenti, Marco Lattuada, Stefania Tigano, David Usiglio, Filippo Del Puente
Pathogens.2024; 13(5): 369. CrossRef
Establishment and evaluation of a rapid method for the detection of bacterial pneumonia in hospitalized patients via multiplex PCR–capillary electrophoresis (MPCE)
Jie Wang, Pei Zhao, Mengchuan Zhao, Duoxiao Zhang, Shan Chen, Ying Liu, Yuan Gao, Yanqing Tie, Zhishan Feng, Siu-Kei Chow
Microbiology Spectrum.2024;[Epub] CrossRef
A systematic review of factors associated with poor prognosis despite appropriate antibiotics usage for pneumonia
Akihiko Goto, Kentaro Ishikawa, Kosaku Komiya
Respiratory Investigation.2024; 62(6): 1215. CrossRef

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

6,771 View
60 Download
2 Web of Science
2 Crossref

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
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

7,433 View
72 Download
1 Web of Science
2 Crossref

Abstract PDF Supplementary Material

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

Citations to this article as recorded by

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

4,457 View
139 Download

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.

First
Prev
Page of 5
Next
Last

Search