Acute and Critical Care

Original Articles

Nursing
Early postoperative 6-minute walk test in cardiac surgery patients: an observational study assessing safety, feasibility, and predictors of completion in India: Prasanth Jayaraman, Puvaneswari Kanagaraj, Shrinivas Hittalamani; Acute Crit Care. 2025;40(4):614-626. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.000050

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Abstract PDF Supplementary Material: Background
Early mobilization after cardiac surgery is crucial for enhancing recovery, minimizing complications, and promoting timely discharge. The 6-minute walk test (6MWT) is a validated measure of functional capacity; however, its use during the early postoperative period—particularly in Intensive care Unit (ICU) settings in India—remains underexplored. This study assesses the safety, feasibility, and functional performance outcomes of the 6MWT administered on postoperative days (PODs) 2 to 4 and identifies factors associated with test completion.
Methods
A cohort-based observational study was conducted in a tertiary care ICU between June and September 2021. In total, 150 cardiac surgery patients aged 30–70 years were enrolled. Inclusion required hemodynamic stability, no vasopressor/inotropic support, and ambulation from POD 2. The 6MWT was administered per the American Thoracic Society guidelines. Clinical, demographic, and physiological parameters were recorded and analyzed using descriptive statistics, paired t-tests, and regression analyses.
Results
Of the 150 patients, 140 completed the test. The mean age was 52±14 years, and 75% of participants were male. Mean walking distances improved from 78.14 m (21.7% of predicted) on POD 2 to 193.51 m (53.75%) on POD 4. Completion rates increased from 40.0% to 99.2%. Physiological responses remained within safe limits, and no serious adverse events occurred. The regression analyses identified education, diet, and oxygen saturation as positive predictors and comorbidities, being female, oxygen use, and physical occupation as negative predictors.
Conclusions
The 6MWT is a safe, feasible, and informative tool for assessing early functional recovery in stable post-cardiac surgery ICU patients to aid individualized rehabilitation and discharge planning.

Surgery
Classification of postoperative fever patients in the intensive care unit following intra-abdominal surgery: a machine learning-based cluster analysis using the Medical Information Mart for Intensive Care (MIMIC)-IV database, developed in the United States: Sang Mok Lee, Hongjin Shim; Acute Crit Care. 2025;40(2):293-303. Published online April 30, 2025; DOI: https://doi.org/10.4266/acc.004464

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Background
Postoperative fever is common. However, it can sometimes indicate severe complications such as sepsis or pneumonia. Intensive care unit (ICU) patients who have undergone abdominal surgery have a higher risk of postoperative fever due the physical severity of this type of surgery. Nevertheless, determining when more aggressive or invasive management of fever is necessary remains a challenge.
Methods
We analyzed the Medical Information Mart for Intensive Care (MIMIC)-IV and MIMIC-IV-Note databases, which are open critical care big databases from a single institute in the United States. From this, we selected ICU patients who developed fever after intra-abdominal surgery and classified these patients into two groups using cluster analysis based on diverse variables from the MIMIC-IV databases. Following this cluster analysis, we assessed differences among the identified groups.
Results
Of 2,858 ICU stays after intra-abdominal surgery, 331 postoperative fever cases were identified. These patients were clustered into two groups. Group A included older patients with a higher mortality rate, while group B consisted of younger patients with a lower mortality rate.
Conclusions
Postoperative ICU patients with a fever could be classified into two distinct groups, a high-risk group and low-risk group. The high-risk patient group was characterized by older age, higher Sequential Organ Failure Assessment (SOFA) score, and more unstable hemodynamic status, indicating the need for aggressive management. Clustering postoperative fever patients by clinical variables can support medical decision-making and targeted treatment to improve patient outcomes.

Citations

Citations to this article as recorded by

Physical Performance as a Predictor of Length of Hospital Stay in Patients Undergoing Open-Heart Surgery: A Multicenter Prospective Study
Wararat Tavonudomgit, Kornanong Yuenyongchaiwat, Lucksanaporn Mahawong, Khanistha Wattanananont, Chitima Kulchanarat, Sasipa Buranapuntalug, Opas Satdhabudha
Medical Sciences.2026; 14(2): 334. CrossRef
Nomogram predictive model for the incidence and risk factors of persistent fever after cardiovascular surgery
Feng Zang, Guangxu Mao, Ziyao Quan, Yongfeng Shao, Sheng Zhao, Liyun Wang, Zhanjie Li, Zhongqiu You, Lu Liu, Wensen Chen
BMC Surgery.2025;[Epub] CrossRef
BODY TEMPERATURE MANAGEMENT IN PERIOPERATIVE AND INTENSIVE CARE: CLINICAL STRATEGIES FOR IMPROVING PATIENT OUTCOMES
Marta Nowocień, Karolina Witek, Joanna Kaźmierczak, Anna Mandecka, Kornela Kotucha-Cyl, Weronika Komala, Natalia Guzik, Joanna Gerlach, Dorota Plechawska
International Journal of Innovative Technologies in Social Science.2025;[Epub] CrossRef

Pharmacology
Inhalation sedation for postoperative patients in the intensive care unit: initial sevoflurane concentration and comparison of opioid use with propofol sedation: Seungho Jung, Sungwon Na, Hye Bin Kim, Hye Ji Joo, Jeongmin Kim; Acute Crit Care. 2020;35(3):197-204. Published online August 10, 2020; DOI: https://doi.org/10.4266/acc.2020.00213

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Abstract PDF

Background
Although the use of volatile sedatives in the intensive care unit (ICU) is increasing in Europe, it remains infrequent in Asia. Therefore, there are no clinical guidelines available. This study investigates the proper initial concentration of sevoflurane, a volatile sedative that induces a Richmond agitation-sedation scale (RASS) score of –2 to –3, in patients who underwent head and neck surgery with tracheostomy. We also compared the amount of postoperative opioid consumption between volatile and intravenous (IV) sedation.
Methods
We planned a prospective study to determine the proper initial sevoflurane concentration and a retrospective analysis to compare postoperative opioid consumption between volatile sedation and propofol sedation. Patients scheduled for head and neck surgery with tracheostomy and subsequent postoperative sedation in the ICU were enrolled.
Results
In this prospective study, the effective dose 50 (ED50) of initial end-tidal sevoflurane concentration was 0.36% (95% confidence interval [CI], 0.20 to 0.60%), while the ED 95 was 0.69% (95% CI, 0.60 to 0.75%) based on isotonic regression methods. In this retrospective study, remifentanil consumption during postoperative sedation was significantly lower in the sevoflurane group (2.52±1.00 µg/kg/hr, P=0.001) than it was in the IV propofol group (3.66±1.30 µg/kg/hr).
Conclusions
We determined the proper initial end-tidal concentration setting of sevoflurane for patients with tracheostomy who underwent head and neck surgery. Postoperative sedation with sevoflurane appears to be a valid and safe alternative to IV sedation with propofol.

Citations

Citations to this article as recorded by

Sedación inhalatoria y su impacto en el uso de opioides en pacientes adultos críticamente enfermos sometidos a ventilación mecánica invasiva
Daniel Molano Franco, Mario Gómez, Edgar Beltran, Víctor Nieto, David Andrade Fonseca, Carmen Quiñonez, Isabella Ruiz, Ana Rocio Morales, Fernando Soler, Carola Gimenez-Esparza
Acta Colombiana de Cuidado Intensivo.2026; 26(1): 100573. CrossRef
Sedation, Analgesia, and Neuromuscular Blockade
Diana Morales Castro, Federico Carlos Carini, Eddy Fan
Clinics in Chest Medicine.2026; 47(3): 463. CrossRef
Alpha-lipoic acid alleviates oxidative stress and brain damage in patients with sevoflurane anesthesia
Kailun Gao, Ying Wu, Yan Zhang, Pei Dang, Huanjia Xue, Teng Li, Meiyan Zhou, Liwei Wang, Yangzi Zhu
Frontiers in Pharmacology.2025;[Epub] CrossRef
Inhaled sedation versus propofol in respiratory failure in the ICU (INSPiRE-ICU2): study protocol for a multicenter randomized controlled trial
Brian O’Gara, Alexis L. Serra, Joshua A. Englert, Alisha Sachdev, Robert L. Owens, Steven Y. Chang, Pauline K. Park, Daniel Talmor, Ida Sverud, Peter Sackey, Jeremy R. Beitler
Trials.2025;[Epub] CrossRef
Optimal Sedation in Ventilated Patients with Cardiovascular Surgery and/or Shock
Federico C. Carini, Ezequiel Lillo, Gisela Vecchio, Sergio Giannasi, Diana Morales Castro
Critical Care Clinics.2025; 41(4): 833. CrossRef
Comparación de sevoflurano y propofol en sedación de pacientes críticos con ventilación mecánica invasiva
José Alberto Leal Gámez, Jorge Rosendo Sánchez Medina, Reyna Isabel Azua Guevara
Medicina Crítica.2025; 39(1): 14. CrossRef
Volatile Anesthetic Sedation for Critically Ill Patients
Brian O’Gara, Christina Boncyk, Andreas Meiser, Angela Jerath, Martin Bellgardt, Matthieu Jabaudon, Jeremy R. Beitler, Christopher G. Hughes
Anesthesiology.2024; 141(1): 163. CrossRef
Sedaconda ACD-S for Sedation with Volatile Anaesthetics in Intensive Care: A NICE Medical Technologies Guidance
Michal Pruski, Susan O’Connell, Laura Knight, Rhys Morris
Applied Health Economics and Health Policy.2024; 22(6): 805. CrossRef
The sevoflurane concentration for light sedation in critically ill patients: A protocol for experimental study
Wilasinee Jitpakdee, Chawika Pisitsak, Sunthiti Morakul, Sahawat Thertchanakun, Tananchai Petnak
Clinical Critical Care.2024;[Epub] CrossRef
Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis
V. Likhvantsev, G. Landoni, N. Ermokhina, M. Yadgarov, L. Berikashvili, K. Kadantseva, O. Grebenchikov, L. Okhinko, A. Kuzovlev
Medicina Intensiva.2023; 47(5): 267. CrossRef
Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis
V. Likhvantsev, G. Landoni, N. Ermokhina, M. Yadgarov, L. Berikashvili, K. Kadantseva, O. Grebenchikov, L. Okhinko, A. Kuzovlev
Medicina Intensiva (English Edition).2023; 47(5): 267. CrossRef
Inhaled Sedation with Volatile Anesthetics for Mechanically Ventilated Patients in Intensive Care Units: A Narrative Review
Khaled Ahmed Yassen, Matthieu Jabaudon, Hussah Abdullah Alsultan, Haya Almousa, Dur I Shahwar, Fatimah Yousef Alhejji, Zainab Yaseen Aljaziri
Journal of Clinical Medicine.2023; 12(3): 1069. CrossRef
Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial
Sara Martínez-Castro, Berta Monleón, Jaume Puig, Carolina Ferrer Gomez, Marta Quesada, David Pestaña, Alberto Balvis, Emilio Maseda, Alejandro Suárez de la Rica, Ana Monero Feijoo, Rafael Badenes
Journal of Personalized Medicine.2023; 13(6): 925. CrossRef
Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis
Sean Cuninghame, Angela Jerath, Kevin Gorsky, Asaanth Sivajohan, Conall Francoeur, Davinia Withington, Lisa Burry, Brian H. Cuthbertson, Beverley A. Orser, Claudio Martin, Adrian M. Owen, Marat Slessarev, Martin Chapman, Damon Scales, Julie Nardi, Beth Li
British Journal of Anaesthesia.2023; 131(2): 314. CrossRef
Experiencia y revisión de la literatura del uso del dispositivo Anesthetic Conserving Device (AnaConDa) durante la pandemia en pacientes con neumonía por COVID-19 en un hospital público
María Guadalupe Morales Hernández, Marcelo Díaz Conde, Ixchel Magaña Matienzo
Medicina Crítica.2023; 37(4): 334. CrossRef
Sedation of patients in intensive care units. Guidelines
V.I. Potievskaya, I.B. Zabolotskikh, I.E. Gridchik, A.I. Gritsan, A.A. Eremenko, I.A. Kozlov, A.L. Levit, V.A. Mazurok, I.V. Molchanov
Russian Journal of Anesthesiology and Reanimatology.2023; (5): 6. CrossRef
Inhaled volatile anesthetics in the intensive care unit
Erin D Wieruszewski, Mariam ElSaban, Patrick M Wieruszewski, Nathan J Smischney
World Journal of Critical Care Medicine.2023;[Epub] CrossRef
Prospects of inhalation sedation in intensive care
O.A. Grebenchikov, V.V. Kulabukhov, A.K. Shabanov, O.V. Ignatenko, V.V. Antonova, R.A. Cherpakov, I.V. Redkin, E.A. Boeva, A.N. Kuzovlev
Anesteziologiya i reanimatologiya.2022; (3): 84. CrossRef
National analysis of applied sedation in critical care patients
Grace Pamela López Pérez , Melani Dayana Carrera Casa , Gissela Lizbeth Amancha Moyulema , Yadira Nathaly Chicaiza Quilligana , Ana Belén Guamán Tacuri , Joselyn Mireya Iza Arias
Salud, Ciencia y Tecnología.2022; 2: 234. CrossRef

Review Article

Pulmonary
Critical Care after Lung Transplantation: Song Yee Kim, Su Jin Jeong, Jin Gu Lee, Moo Suk Park, Hyo Chae Paik, Sungwon Na, Jeongmin Kim; Acute Crit Care. 2018;33(4):206-215. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00360

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Abstract PDF

Since the first successful lung transplantation in 1983, there have been many advances in the field. Nevertheless, the latest data from the International Society for Heart and Lung Transplantation revealed that the risk of death from transplantation is 9%. Various aspects of postoperative management, including mechanical ventilation, could affect intensive care unit stay, hospital stay, and immediate postoperative morbidity and mortality. Complications such as reperfusion injury, graft rejection, infection, and dehiscence of anastomosis increase fatal adverse side effects immediately after surgery. In this article, we review the possible immediate complications after lung transplantation and summarize current knowledge on prevention and treatment.

Citations

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More is not better: The role of the leukocyte filter in ex vivo lung perfusion
Olivia Hough, Andrea Mariscal, Haruchika Yamamoto, Henna Mangat, Hemant Gokhale, Manyin Chen, Hongchao Shan, Stephen Juvet, Prodipto Pal, Marcelo Cypel, Mingyao Liu, Shaf Keshavjee
The Journal of Thoracic and Cardiovascular Surgery.2026; 171(6): 1361. CrossRef
The Spectrum of Mitral Regurgitation in Lung Transplant Recipients: A Systematic Review
George Bcharah, Juan M. Farina, J. Asher Jenkins, Rawan M. Zeineddine, Andrew G. Saleeb, Estefana Bcharah, Kenan A. Shawwaf, Brian W. Hardaway, Pedro Reck dos Santos, Jonathan D’Cunha, Ashraf Omar
Transplantation.2025; 109(9): e455. CrossRef
Post-operative management of children after lung transplantation
Nicolaus Schwerk, Julia Carlens, Harald Köditz, Fabio Ius, Nicholas Avdimiretz, Don Hayes, Melinda Solomon
JHLT Open.2025; 9: 100301. CrossRef
Caring for Heart and Lung Transplant Patients
Brigitte Hollander, Antonio Rubino, Jasvir Pamar, Florian Falter
Journal of Intensive Care Medicine.2025;[Epub] CrossRef
Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study
Eun-Young Kim, Seung-Hyun Yong, Min-Dong Sung, A-La Woo, Young-Mok Park, Ha-Eun Kim, Su-Jin Jung, Song-Yee Kim, Jin-Gu Lee, Young-Sam Kim, Hyo-Chae Paik, Moo-Suk Park
Journal of Fungi.2023; 9(5): 527. CrossRef
Nontuberculous mycobacterial infection after lung transplantation: A single-center experience in South Korea
Youngmok Park, Nam Eun Kim, Se Hyun Kwak, Moo Suk Park, Su Jin Jeong, Jin Gu Lee, Hyo Chae Paik, Song Yee Kim, Young Ae Kang
Journal of Microbiology, Immunology and Infection.2022; 55(1): 123. CrossRef
Medical Complications of Lung Transplantation
Moo Suk Park
Journal of Chest Surgery.2022; 55(4): 338. CrossRef
Roles of electrical impedance tomography in lung transplantation
Hui Jiang, Yijiao Han, Xia Zheng, Qiang Fang
Frontiers in Physiology.2022;[Epub] CrossRef
Perioperative anidulafungin combined with triazole prophylaxis for the prevention of early invasive candidiasis in lung transplant recipients
Emily Sartain, Kelly Schoeppler, Barrett Crowther, Joshua B. Smith, Maheen Z. Abidi, Todd J. Grazia, Mark Steele, Terri Gleason, Krista Porter, Alice Gray
Transplant Infectious Disease.2021;[Epub] CrossRef
The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients—A Retrospective Cohort Study in South Korea
Yae-Jee Baek, Yun-Suk Cho, Moo-Hyun Kim, Jong-Hoon Hyun, Yu-Jin Sohn, Song-Yee Kim, Su-Jin Jeong, Moo-Suk Park, Jin-Gu Lee, Hyo-Chae Paik
Journal of Fungi.2021; 7(8): 639. CrossRef
Panel-Reactive and Donor-Specific Antibodies before Lung Transplantation can Affect Outcomes in Korean Patients Receiving Lung Transplantation
Sung Woo Moon, Moo Suk Park, Jin Gu Lee, Hyo Chae Paik, Young Tae Kim, Hyun Joo Lee, Samina Park, Sun Mi Choi, Do Hyung Kim, Woo Hyun Cho, Hye Ju Yeo, Seung-il Park, Se Hoon Choi, Sang-Bum Hong, Tae Sun Shim, Kyung-Wook Jo, Kyeongman Jeon, Byeong-Ho Jeong
Yonsei Medical Journal.2020; 61(7): 606. CrossRef
A proof-of principal study using phase-contrast imaging for the detection of large airway pathologies after lung transplantation
Stephan Umkehrer, Carmela Morrone, Julien Dinkel, Laura Aigner, Maximilian F. Reiser, Julia Herzen, Ali Ö. Yildirim, Franz Pfeiffer, Katharina Hellbach
Scientific Reports.2020;[Epub] CrossRef

Case Report

Neurology
Posterior Reversible Encephalopathy Syndrome in a Critically Ill Postoperative Patient: Min Ae Keum, Hyo Keun No, Choong Wook Lee, Sang-Beom Jeon, Suk-Kyung Hong; Korean J Crit Care Med. 2015;30(1):46-51. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.46

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Abstract PDF: Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.

Original Articles

Surgery
Clinical Outcome and Prognosis of Patients Admitted to the Surgical ICU after Abdomen Surgery: Yun Su Sim, Jin Hwa Lee, Jung Hyun Chang, Yon Ju Ryu; Korean J Crit Care Med. 2015;30(1):1-7. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.1

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Abstract PDF

Background
Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. Methods: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. Results: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. Conclusions: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.

Citations

Citations to this article as recorded by

Perioperative predictors of critical care admission following emergency surgical procedures: a comprehensive evaluation of anesthesia management
Şebnem Çimen, Büşra Eroğlu, Afra Buse Kavacık Bulut, Burak Uçaner, Ela Erten
Perioperative Medicine.2026;[Epub] CrossRef
The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients
Anastasiya Shchatsko, Laura N. Purcell, Christopher J. Tignanelli, Anthony Charles
The American Surgeon™.2021; 87(8): 1230. CrossRef

Malignant Cerebral Infarction after Pulmonary Resection for Lung Cancer: In Ae Song, Sang Min Jung, Dong Jin Kim, Sang Heon Park; Korean J Crit Care Med. 2013;28(3):180-183.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.180

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Abstract PDF: Malignant cerebral infarction as postoperative complication after pulmonary resection occurs rarely, but can be rather serious. We report a case of 81-year-old man who suffered from malignant cerebral infarctions after pulmonary resection for lung cancer. He had a history of well-controlled hypertensions, but no evidences of arrhythmia, and neither stenosis nor atheroma in the carotid arteries and intracranial arteries. There were no specific events during his operation except that an inadvertent left carotid artery puncture occurred during the central line insertion. In intensive care unit (ICU), he had a delayed recovery of consciousness and dysarthria with right hemiplegia. Computed tomography revealed malignant middle cerebral infarctions due to the occlusion of left middle cerebral artery. It could be the thromboembolism due to pulmonary resections or carotid artery punctures in the patient without high risk factors.

The Risk Factors of Postoperative Respiratory Insufficiency after Prolonged Robotic Radical Prostatectomy: Jin Young Lee, Ji Young Lee, Sung Jin Hong, Byung Ho Lee, Ou Kyoung Kwon, Young Hee Kim; Korean J Crit Care Med. 2010;25(3):130-135.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.130

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Abstract PDF

BACKGROUND
Robotic radical prostatectomy is performed in elderly patients and requires extreme changes in the patient's position and is often associated with a long surgery time. This study reviewed the pulmonary complications occurring after a robotic radical prostatectomy and analyzed the potential risk factors.
METHODS
The medical records of all patients who had undergone robotic radical prostatectomy at our institution were reviewed. Among the 80 total patients, 58 were capable of spontaneous respiration at the end of surgery (Group I), whereas 22 patients required assisted ventilation (Group II). A comparison between the two groups was made in terms of the demographic characteristics, coexisting diseases, anesthesia and operation time, amount of intraoperative blood loss and transfused blood products.
RESULTS
The mean age of the patients was 67.2 +/- 7.3 years. The mean operation time was 384.1 +/- 203.4 min (range, 195-1,180 min). The anesthesia and operation time, amount of intraoperative blood loss and number of transfused patients were all significantly higher in Group II. Univariate analysis revealed age, body mass index, intraoperative blood loss and transfusion, anesthesia and operation time to be related to postoperative respiratory insufficiency. Multivariate analysis revealed intraoperative transfusion and operation time to be predictive risk factors.
CONCLUSIONS
Prolonged laparoscopic surgery in a steep Trendelenburg position has a high likelihood of postoperative respiratory insufficiency, with the intraoperative transfusion and a longer operation time being possible contributing factors.

Citations

Citations to this article as recorded by

Features of the mechanics of respiration and gas exchange during robot-assisted radical prostatectomy. Review
Ildar I. Lutfarakhmanov, I. A. Melnikova, E. Yu. Syrchin, V. F. Asadullin, Yu. A. Korelov, P. I. Mironov
Annals of Critical Care.2021; (1): 75. CrossRef

Retrospective Analysis of the Postoperative Patients Admitted to General Surgical-Medical Intensive Care Unit: Jun Rho Yoon, Choon Hak Lim, Mi Jung Kim; Korean J Crit Care Med. 2008;23(1):18-24.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.18

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Abstract PDF

BACKGROUND
The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU.
METHODS
Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus' suggestion which defines the kinds of treatment done exclusively in ICU. Patients' demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed.
RESULTS
255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group.
CONCLUSION
Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.

Citations

Citations to this article as recorded by

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

Case Report

Severe Postoperative Delirium Lasting for Three Weeks: A Case Report: Jun Rho Yoon, Tae Kwan Kim, Su Jung Yoon, Yee Suk Kim, Si Hyun Kim, Man Gyu Kim, Jeong Ju Seo; Korean J Crit Care Med. 2004;19(1):42-46.

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Abstract PDF: Postoperative delirium in the intensive care unit is a serious problem that has recently attracted much attention. We present a 73-year-old female patient who was admitted by multiple fractures induced by an accident. We started general anesthesia for the operation of open reduction and internal fixation. After the discontinuation of general anesthesia, the patient was transported to the intensive care unit. The symptoms of delirium were developed and controlled with medications including haloperidols, benzodiazepines, and vitamins. The patient was recovered three weeks after the management and received two other operations, but delirium did not be developed again. She was discharged from the hospital without complications.

Original Articles

Perioperative Intensive Care for Liver Transplantation: Shin Hwang, Dong Lak Choi, Cheol Soo Ahn, Dong Eun Park, Sun Hyung Joo, Jang Yong Jeon, Kyeong Mo Kim, Yang Won Nah, Kwang Min Park, Young Joo Lee, Sung Gyu Lee; Korean J Crit Care Med. 2001;16(1):5-10.

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Abstract PDF: Many liver recipients have required intensive care, which is individualized and customized to each recipient. Prerequisites qualifying this care are wide comprehension of characteristics of end-stage liver disease and mechanisms of surgical procedures and immunologic knowledge. We present our principles of intensive care and experience from more than 300 cases of liver transplantation. There are roughly two types of liver transplantation, cadaveric and living-donor. These two types are different in their postoperative courses as following; severity of preservation injury, graft-size matching and morphologic liver regeneration and risk of vascular and biliary complications. Intensive care for liver recipients should be directed toward preventive and protective care along reasonable prediction of its clinical course. We described our experience about following subjects: management of hepatorenal syndrome, fulminant hepatic failure, acute renal failure, pneumonia, disturbance of consciousness, prophylaxis of viral hepatitis B, tumor recurrence, use of antibiotics, induction of liver function recovery, maintenance of vital signs, electrolyte balance, diet and infection control, nutritional support. The most important factor is the state of transplanted liver graft in determination of posttransplant course. If the graft functions well, many problems will be solved spontaneously. If not, intensive care will be required. Most of operative complications are related to the surgery itself, so that comprehension to surgical procedures to each recipient should be preceded for early detection and proper management. To achieve a favorable posttransplant course, all factors including maintenance of vital signs, elimination of obstacles to hepatic recovery, appropriate immunosuppression and solution of surgical complications should be met altogether. Of course, every member of liver transplantation team should pay durable attention and dedication to each liver recipient.

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

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

Case Report

Pulmonary Edema due to Upper Airway Obstruction after Neck Mass Excision of the Patient with Cerebral Palsy: Moon Seok Chang, Hun Cho, Hae Ja Lim, Seong Ho Chang, Nan Suk Kim; Korean J Crit Care Med. 1997;12(2):183-186.

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Abstract PDF: Because the emergence from anesthesia may be delayed in the patient with the cerebral palsy, extubation must be delayed until consciousness is recovered completely. Postoperative pulmonary edema has several causes and one of them, upper airway obstruction is rare. We had experienced pulmonary edema due to upper airway obstruction after neck mass excision in the patient with cerebral palsy, who was 21-year-old, 50 kg, male and normal preoperative laboratory data. There was no significant change in blood volume during operation for 1 hour. After operation, the patient breathed spontaneously and the endotracheal tube was extubated in the operating room. When the patient was transfered to the recovery room, he had cyanosis, intercostal and substernal retraction, and the pulse oximeter showed very low oxygen saturation. We supplied oxygen to the patient and reintubated him, and recognized the pinkish frothy sputum by suction of the endotracheal tube. On the portable chest X-ray film of the patient at the moment, hazy increased density on both lung fields indicating pulmonary edema, but the heart size was not increased. By routine treatment for pulmonary edema, the symtoms and signs of the patient were improved. He had stayed for 1 day in the SICU and then transfered to the general ward.

Original Articles

A Statistical Analysis of Postoperative Deaths in the Hospital: Dong Ai An, Byung Ki Kim, Hack Ju Park, Hang Soo Sohn; Korean J Crit Care Med. 1997;12(1):57-64.

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Abstract PDF: Introduction: Anesthesia deaths are rare, while deaths due to surgical or other risk factors are more frequent. The goal of this analysis is to evaluate risk factors associated with postoperative mortality.
METHODS
We have analyzed 34,200 surgical patients between 1990 and 1996 through records of anesthesia. The following informations were recorded; age of patients, physical status, site of operation, time of death, primary cause of death.
RESULTS
The results are as follows; 1) Of 34,200 surgical patients, 119 died in the hospital. 2) The postoperative mortality rose progressively with age and was highest above 70 years. 3) Within 48 hours, the mortality was 36.1% of total deaths, declined progressively thereafter. The patients who had head operations exceeded 45% of deaths during this period. Eight days after the operation the mortality rate was 34.2% of total deaths and the patients who had an elective operation of the abdomen were 60.8%. 4) 34.2% patients of the total deaths had brain damages. Of these, 79.5% showed physical status V and had an emergency head operation and 47.5% were 50~60 years of age. 17.5% and 13.2% of deaths were due to sepsis and respiratory insufficiency and 48.6% of these two categories were physical status II, III and had an elective operation and 55.5% were above 60 years.
CONCLUSION
The postoperative mortality was highest in the patients who had an emergency head operation and primary cause of death was brain damage. The patients of above 60 years, had a physical status II, III, had an elective abdominal operation were succeptable to sepsis and respiratory insufficieny.

Influence of Unmeasured Anions Identified by Stewart Principle on the Length of Postoperative Hospital Stay: Kyoung Min Lee, Sung Ho Seo, Seung Yun Lee, Jun Geol Lee, Tae Yop Kim, Ka young Rhee; Korean J Crit Care Med. 2005;20(2):152-158.

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Abstract PDF: BACKGROUND
Calculation of the base excess (BE) and the anion gap (AG) is commonly used to identify the presence and to analyze the cause of metabolic acidosis in critically ill patients. However, the calculation of BE assumes normal water content, electrolytes, and albumin, changes in these values will change the calculated BE. Calculation of the AG does not control for changes in albumin and cannot distinguish plasma concentration changes of negatively charged protein (albumin) from that of other anions. Based on Stewart's physicochemical principles, Gilfix et al developed equations to calculate the BE caused by unmeasured anions (BEua) taking into account changes in free water, chloride, albumin, and PCO2 that theoretically should reflect metabolic changes better than the less complete biochemical measurements. This study was designed to evaluate the influence of BEua and other variables on the length of postoperative hospital stay. METHODS: The data from 100 consecutive patients were collected prospectively in patients who underwent intra-abdominal operations under general anesthesia and admitted to the adult intensive care unit. All samples were routine samples taken from arterial lines postoperatively and analyzed for arterial blood gas, plasma electrolytes, inorganic phosphates and albumin concentrations. BEua was calculated from the equations developed by Gilfix et al. We also calculated AGNa, K (Na++K+-Cl--HCO3-) and AGNa (Na+-Cl--HCO3-). Correlations between the length of postoperative hospital stay and these variables were studied using linear regression analysis.
RESULTS
BEua and BE were significantly correlated with the length of ICU stay (r=0.295, p<0.01 and r=0.249, p<0.05). Neither AGNa, K nor AGNa was correlated with the length of ICU stay. Significant correlation was observed between the length of postoperative hospital stay and BEua (r=0.316, p<0.01), BE (r=0.288, p<0.01), AGNa, K (r=0.284, p<0.01), and AGNa (r=0.263, p<0.05). CONCLUSIONS: In this study BEua was significantly correlated with the length of ICU stay and postoperative hospital stay compared with other variables. This finding suggests that BEua may be used as a more reliable predictor of outcome in ICU patients.

The Effectiveness of Foot -Reflexo- Massage on the Postoperative Pain of Gastrectomy Patients: Houng Hwa Han, Young Ju Lee, Yun Jeong Chae, Jong Sin Eun, Hyun Ho Lee, Jee Won Park; Korean J Crit Care Med. 2005;20(2):136-143.

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Abstract PDF: BACKGROUND
The objects of this study were to determine the effects of foot reflexo massage on the postoperative pain of the subtotal gastrectomy patients according to quasi-experimental research design, and to provide demonstrative data for using the foot reflexo massage as an intervention for pain nursing. METHODS: The foot reflexo massages were performed on 34 subtotal gastrectomy patients after informed consent was obtained. They were divided into two groups, i.e. control group (n=17) and experimental group (n=17). After 6 hours and 12 hours from the subtotal gastrectomy, the massage was carried out on each foot for 10 minutes twice. Visual analogue scale (VAS) was employed as the measurement tools of pain, and the degree of postoperative pain was measured through frequency of prn (pro re nata) analgesia in chart review. RESULTS: The experimental group with foot reflexo massage 6 hours after the operation have significantly less score of postoperative pain than the control group (5.76+/-0.83, 4.35+/-1.0, p=.000). The experimental group with foot reflexo massage 12 hours after the operation have significantly less score of postoperative pain than the control group (5.12+/-0.53, 3.00+/-1.17, p=.000). The experimental group with foot reflexo massage have significantly less frequency of prn analgesics than the control group from six hours to twelve hours after the operation (p=.004). CONCLUSIONS: It is considered foot reflexo massage is effective for reducing postoperative pain of subtotal gastrectomy patients, as well as useful for an immediate nursing intervention.

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