Acute and Critical Care

Original Articles

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

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

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

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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

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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.

Pulmonary
Extravascular lung water index, pulmonary vascular permeability index, and global end-diastolic volume index in mechanically ventilated COVID-19 patients requiring prone position ventilation: a preliminary retrospective study: Rosanna Carmela De Rosa, Antonio Romanelli, Michele Gallifuoco, Giovanni Messina, Marianne Di Costanzo, Antonio Corcione; Acute Crit Care. 2022;37(4):571-579. Published online November 10, 2022; DOI: https://doi.org/10.4266/acc.2022.00423

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Abstract PDF

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

Citations

Citations to this article as recorded by

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

Pulmonary
Effect of prone positioning on gas exchange according to lung morphology in patients with acute respiratory distress syndrome: Na Young Kim, Si Mong Yoon, Jimyung Park, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee; Acute Crit Care. 2022;37(3):322-331. Published online July 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00367

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Background
There are limited data on the clinical effects of prone positioning according to lung morphology. We aimed to determine whether the gas exchange response to prone positioning differs according to lung morphology.
Methods
This retrospective study included adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS). The lung morphology of ARDS was assessed by chest computed tomography scan and classified as “diffuse” or “focal.” The primary outcome was change in partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio after the first prone positioning session: first, using the entire cohort, and second, using subgroups of patients with diffuse ARDS matched 2 to 1 with patients with focal ARDS at baseline.
Results
Ninety-five patients were included (focal ARDS group, 23; diffuse ARDS group, 72). Before prone positioning, the focal ARDS group showed worse oxygenation than the diffuse ARDS group (median PaO2/FiO2 ratio, 79.9 mm Hg [interquartile range (IQR)], 67.7–112.6 vs. 104.0 mm Hg [IQR, 77.6–135.7]; P=0.042). During prone positioning, the focal ARDS group showed a greater improvement in the PaO2/FiO2 ratio than the diffuse ARDS group (median, 55.8 mm Hg [IQR, 11.1–109.2] vs. 42.8 mm Hg [IQR, 11.6–83.2]); however, the difference was not significant (P=0.705). Among the PaO2/FiO2-matched cohort, there was no significant difference in change in PaO2/FiO2 ratio after prone positioning between the groups (P=0.904).
Conclusions
In patients with moderate-to-severe ARDS, changes in PaO2/FiO2 ratio after prone positioning did not differ according to lung morphology. Therefore, prone positioning can be considered as soon as indicated, regardless of ARDS lung morphology.

Citations

Citations to this article as recorded by

Imaging and pulmonary function techniques in ARDS diagnosis and management: current insights and challenges
Denise Battaglini, Marcus J. Schultz, Gustavo A. Cortes Puentes, John J. Marini, Patricia R. M. Rocco
Critical Care.2025;[Epub] CrossRef
Predicting early prone position ventilation responsiveness in patients with acute respiratory distress syndrome based on electrical impedance tomography: a prospective study
Yongran Wu, Azhen Wang, Chengchao Peng, Yaqi Ouyang, Jiali Su, Xiaobo Yang, Huaqing Shu, Hong Qi, Haiyan Huang, Le Yang, Xiaojing Zou, You Shang
Critical Care.2025;[Epub] CrossRef
Subphenotypes of Acute Respiratory Distress Syndrome: Advancing Towards Precision Medicine
Andrea R. Levine, Carolyn S. Calfee
Tuberculosis and Respiratory Diseases.2024; 87(1): 1. CrossRef

Nephrology
Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis: Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda, Shoki Yamauchi, Hideta Takushi, Tadashi Iraha, Koji Idomari; Acute Crit Care. 2022;37(3):398-406. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00192

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Abstract PDF

Background
Severe acute pancreatitis (SAP) is a systemic inflammatory disease, and it can often complicate into acute kidney injury (AKI) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). This study aimed to evaluate the clinical effectiveness of blood purification using a polymethylmethacrylate (PMMA) hemofilter.
Methods
We retrospectively examined 54 patients, who were diagnosed with SAP according to the Japanese criteria from January 2011 to December 2019.
Results
Of a total of 54 SAP patients, 26 patients progressively developed AKI and required continuous hemodialysis with a PMMA membrane hemofilter (PMMA-CHD). Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score were significantly higher in patients requiring PMMA-CHD than in patients not requiring hemodialysis. The lung injury scores were also significantly higher in patients requiring PMMA-CHD. Of the 26 patients, 16 patients developed ALI/ARDS and required mechanical ventilation. A total of seven patients developed severe ALI/ARDS and received additional intermittent hemodiafiltration using a PMMA hemofilter (PMMA-HDF). Although the length of intensive care unit stay was significantly longer in patients with severe ALI/ARDS, blood purification therapy was discontinued in all the patients. The survival rates at the time of discharge were 92.3% and 92.9% in patients with and without PMMA-CHD, respectively. These real mortality ratios were obviously lower than the estimated mortality ratios predicted by APACHE II scores.
Conclusions
These finding suggest that the blood purification using a PMMA hemofilter would be effective for the treatment of AKI and ALI/ARDS in SAP patients.

Citations

Citations to this article as recorded by

Evolution of the Role of Blood Purification in Multi-Organ Support Therapy for Severe Acute Pancreatitis
绪杰张
Advances in Clinical Medicine.2026; 16(01): 1074. CrossRef
Extracorporeal pediatric renal replacement therapy: diversifying application beyond kidney failure
Rahul Chanchlani, David Askenazi, Benan Bayrakci, Akash Deep, Jolyn Morgan, Tara M. Neumayr
Pediatric Nephrology.2025; 40(4): 923. CrossRef
Advances in Renal Replacement Therapy: The Role of Polymethyl Methacrylate Membranes in Acute Critically Ill Patients
Eleonora Balzani, Sergio Lassola, Hannah Wozniak, Giacomo Bellani, Silvia De Rosa
Blood Purification.2025; : 1. CrossRef
Impact of early blood purification on serum inflammatory mediators and hemorheology in severe acute pancreatitis
Jing Xiao, Bo Li
Hereditas.2025;[Epub] CrossRef
A Retrospective Study on the Start and End of Continuous Hemodialysis Using a Polymethylmethacrylate Hemofilter for Severe Acute Pancreatitis
Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda
Internal Medicine.2024; 63(16): 2241. CrossRef
Evaluation of the therapeutic efficiency and efficacy of blood purification in the treatment of severe acute pancreatitis
Hongwei Huang, Zhongshi Huang, Menghua Chen, Ken Okamoto, Chiara Lazzeri
PLOS ONE.2024; 19(1): e0296641. CrossRef
Enhancing Immune Protection in Hemodialysis Patients: Role of the Polymethyl Methacrylate Membrane
Rossana Franzin, Alessandra Stasi, Gianvito Caggiano, Elena Squiccimarro, Vincenzo Losappio, Marco Fiorentino, Carlo Alfieri, Giovanni Stallone, Loreto Gesualdo, Giuseppe Castellano
Blood Purification.2023; 52(Suppl. 1): 49. CrossRef

Pulmonary
Association of pulmonary arterial pressure with volume status in patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: Tae Hwa Hong, Hyoung Soo Kim, Sunghoon Park; Acute Crit Care. 2022;37(2):159-167. Published online March 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00927

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Abstract PDF Supplementary Material

Background
Data on pulmonary hemodynamic parameters in patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) are scarce.
Methods
The associations between pulmonary artery catheter parameters for the first 7 days of ECMO, fluid balance, and hospital mortality were investigated in adult patients (aged ≥19 years) who received venovenous ECMO for refractory ARDS between 2015 and 2017.
Results
Twenty patients were finally included in the analysis (median age, 56.0 years; interquartile range, 45.5–68.0 years; female, n=10). A total of 140 values were collected for each parameter (i.e., 7 days×20 patients). Net fluid balance was weakly but significantly correlated with systolic and diastolic pulmonary arterial pressures (PAPs; r=0.233 and P=0.011; r=0.376 and P<0.001, respectively). Among the mechanical ventilation parameters, above positive end-expiratory pressure was correlated with systolic PAP (r=0.191 and P=0.025), and static compliance was negatively correlated with diastolic PAP (r=−0.169 and P=0.048). Non-survivors had significantly higher systolic PAPs than in survivors. However, in multivariate analysis, there was no significant association between mean systolic PAP and hospital mortality (odds ratio, 1.500; 95% confidence interval, 0.937–2.404; P=0.091).
Conclusions
Systolic PAP was weakly but significantly correlated with net fluid balance during the early ECMO period in patients with refractory ARDS receiving ECMO.

Citations

Citations to this article as recorded by

Storage duration of packed red blood cells transfused during veno-venous extracorporeal membrane oxygenation is associated with elevated pulmonary artery pressure and lung injury in a sheep model
Fergal T. Temple, Gabriela Simonova, Margaret R. Passmore, Samuel R. Foley, Sara D. Diab, Kimble R. Dunster, Charles I. McDonald, Kiran Shekar, Yoke-Lin Fung, John-Paul Tung, John F. Fraser
Critical Care.2025;[Epub] CrossRef

Infection
Comparison of critically ill COVID-19 and influenza patients with acute respiratory failure: Mehmet Yildirim, Burcin Halacli, Mehmet Yasir Pektezel, Berrin Er, Ismail Tuna Geldigitti, Gulay Tok, Ebru Ortac Ersoy, Arzu Topeli; Acute Crit Care. 2022;37(2):168-176. Published online March 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00920

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Abstract PDF

Background
Coronavirus disease 2019 (COVID-19) is one of the biggest pandemic causing acute respiratory failure (ARF) in the last century. Seasonal influenza carries high mortality, as well. The aim of this study was to compare features and outcomes of critically-ill COVID-19 and influenza patients with ARF.
Methods
Patients with COVID-19 and influenza admitted to intensive care unit with ARF were retrospectively analyzed.
Results
Fifty-four COVID-19 and 55 influenza patients with ARF were studied. Patients with COVID-19 had 32% of hospital mortality, while those with influenza had 47% (P=0.09). Patients with influenza had higher Eastern Cooperative Oncology Group, Clinical Frailty Scale, Acute Physiology and Chronic Health Evaluation II and admission Sequential Organ Failure Assessment (SOFA) scores than COVID-19 patients (P<0.01). Secondary bacterial infection, admission acute kidney injury, procalcitonin level above 0.2 ng/ml were the independent factors distinguishing influenza from COVID-19 while prone positioning differentiated COVID-19 from influenza. Invasive mechanical ventilation (odds ratio [OR], 42.16; 95% confidence interval [CI], 9.45–187.97), admission SOFA score more than 4 (OR, 5.92; 95% CI, 1.85–18.92), malignancy (OR, 4.95; 95% CI, 1.13–21.60), and age more than 65 years (OR, 3.31; 95% CI, 0.99–11.03) were found to be independent risk factors for hospital mortality.
Conclusions
There were few differences in clinical features of critically-ill COVID-19 and influenza patients. Influenza cases had worse performance status and disease severity. There was no significant difference in hospital mortality rates between COVID-19 and influenza patients.

Citations

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Narrative review of factors associated with SARS-CoV-2 coinfection in Middle Eastern countries and the need to vaccinate against preventable diseases
Majid Alshamrani, Fayssal Farahat, Ali Albarrak, Aiman El-Saed, Atef M. Shibl, Ziad A. Memish, Mostafa Mousa, Hammam Haridy, Abdulhakeem Althaqafi
Journal of Infection and Public Health.2025; 18(1): 102600. CrossRef
Differences in clinical characteristics between coronavirus disease 2019 (COVID-19) and influenza: a systematic review and meta-analysis
Yingying Han, Jia Guo, Xingzhao Li, Zhuan Zhong
npj Primary Care Respiratory Medicine.2025;[Epub] CrossRef
Global geographic and socioeconomic disparities in COVID-associated acute kidney injury: a systematic review and meta-analysis
Danyang Dai, Pedro Franca Gois, Digby Simpson, Souhayel Hedfi, Sally Shrapnel, Jason Donald Pole
Journal of Global Health.2025;[Epub] CrossRef
Comparison of Clinical Characteristics and Outcomes in Intensive Care Units Between Patients with Coronavirus Disease 2019 (COVID-19) and Patients with Influenza: A Systematic Review and Meta-Analysis
Zhuan Zhong, Xin Wang, Jia Guo, Xingzhao Li, Yingying Han
Journal of Intensive Care Medicine.2024; 39(9): 840. CrossRef
Association between PaO2/(FiO2*PEEP) ratio and in-hospital mortality in COVID-19 patients: A reanalysis of published data from Peru using PaO2/(FiO2*PEEP) ratio in place of PaO2/FaO2 ratio
Youli Chen, Huangen Li, Jinhuang Lin, Zhiwei Su, Tianlai Lin
Medicine.2024; 103(40): e39931. CrossRef
Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis
Chiu-Ying Hsiao, Heng-Chih Pan, Vin-Cent Wu, Ching-Chun Su, Tzu-Hsuan Yeh, Min-Hsiang Chuang, Kuan-Chieh Tu, Hsien-Yi Wang, Wei-Chih Kan, Chun-Chi Yang, Jui-Yi Chen
Frontiers in Medicine.2023;[Epub] CrossRef
Comparison of Clinical Features and Outcomes between SARS-CoV-2 and Non-SARS-CoV-2 Respiratory Viruses Associated Acute Respiratory Distress Syndrome: Retrospective Analysis
Manbong Heo, Jong Hwan Jeong, Sunmi Ju, Seung Jun Lee, Yi Yeong Jeong, Jong Deog Lee, Jung-Wan Yoo
Journal of Clinical Medicine.2022; 11(8): 2246. CrossRef

Case Report

Basic science and research
COVID-19–related acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation and programmed multi-level ventilation: a case report: Filip Depta, Anton Turčan, Pavol Török, Petra Kapraľová, Michael A. Gentile; Acute Crit Care. 2022;37(3):470-473. Published online January 21, 2022; DOI: https://doi.org/10.4266/acc.2021.01109

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Abstract PDF

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

Citations

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

Original Articles

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

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

Citations

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Structure defining of ultrapotent neutralizing nanobodies against MERS-CoV with novel epitopes on receptor binding domain
Sen Ma, Doudou Zhang, Qiwei Wang, Linjing Zhu, Xilin Wu, Sheng Ye, Yaxin Wang, Julie Overbaugh
PLOS Pathogens.2024; 20(8): e1012438. CrossRef
Does COVID-19 Vaccine Impact the Soul? A Pre-post Vaccination Comparison of Health Care Workers’ Infection Control Practices and Perspectives
Imran Khalid, Muhammad Ali Akhtar, Manahil Imran, Maryam Imran, Musaab Ahmed Mujalli, Moayad Sami Qashqari, Abeer N Alshukairi, Amina Nisar, Tabindeh Jabeen Khalid
Infectious Diseases in Clinical Practice.2023;[Epub] CrossRef
Advances in mRNA and other vaccines against MERS-CoV
Wanbo Tai, Xiujuan Zhang, Yang Yang, Jiang Zhu, Lanying Du
Translational Research.2022; 242: 20. CrossRef

Pediatric
Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children: Soo Yeon Kim, Byuhree Kim, Sun Ha Choi, Jong Deok Kim, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim; Acute Crit Care. 2018;33(4):222-229. Published online November 29, 2018; DOI: https://doi.org/10.4266/acc.2018.00136

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Background
The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS.
Methods
Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality.
Results
PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001).
Conclusions
Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

Citations

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A single‐center PICU present status survey of pediatric sepsis‐related acute respiratory distress syndrome
Liang Zhou, Shaojun Li, Tian Tang, Xiu Yuan, Liping Tan
Pediatric Pulmonology.2022; 57(9): 2003. CrossRef
Comparison of Prognostic Factors Between Direct and Indirect Pediatric ARDS
Da Hyun Kim, Eun Ju Ha, Seong Jong Park, Won Kyoung Jhang
Respiratory Care.2020; 65(12): 1823. CrossRef

Pulmonary
Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study: Joohae Kim, Sun Mi Choi, Jinwoo Lee, Young Sik Park, Chang Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee; Korean J Crit Care Med. 2017;32(2):154-163. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00976

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Background
Acute respiratory distress syndrome (ARDS) remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE) inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS) blockage on the prognosis of patients with ARDS.
Methods
We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU) at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching.
Results
A total of 182 patients were included in the study. Thirty-seven patients (20.3%) took ACE inhibitor or angiotensin receptor blocker (ARB) during ICU admission, and 145 (79.7%) did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166). The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013) and longer ICU stay (32.1 vs. 20.2 days, P < 0.001). In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001).
Conclusions
ACE inhibitor or ARB may have beneficial effect on ARDS patients.

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Case Reports

Trauma
Long-term extracorporeal membrane oxygenation after severe blunt traumatic lung injury in a child: Ok Jeong Lee, Yang Hyun Cho, Jinwook Hwang, Inae Yoon, Young-Ho Kim, Joongbum Cho; Acute Crit Care. 2019;34(3):223-227. Published online February 10, 2017; DOI: https://doi.org/10.4266/acc.2016.00472

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Abstract PDF

Managing acute respiratory distress syndrome (ARDS) after severe blunt traumatic lung injury can be challenging. In cases where patients are refractory to conventional therapy, extracorporeal membrane oxygenation (ECMO) should be considered. In addition, the heparin-coated circuit can reduce hemorrhagic complications in patients with multiple traumas. Although prolonged ECMO may be necessary, excellent outcomes are frequently associated. In this study, we report long-term support with venovenous-ECMO applied in a child with severe blunt trauma in Korea. This 10-year-old and 30-kg male with severe blunt thoracic trauma after a car accident developed severe ARDS a few days later, and ECMO was administered for 33 days. Because of pulmonary hemorrhage during ECMO support, heparin was stopped for 3 days and then restarted. He was weaned from ECMO successfully and has been able to run without difficulty for the 2 years since discharge.

Citations

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Traumatic main airway rupture successfully rescued by extracorporeal membrane oxygenation: A case report
Lijun Cao, Jun Xu, Linfeng Tang, Yuli Zhou, Xianhua Xiang
Experimental and Therapeutic Medicine.2023;[Epub] CrossRef
Extracorporeal membrane oxygenation in trauma patients: a systematic review
Changtian Wang, Lei Zhang, Tao Qin, Zhilong Xi, Lei Sun, Haiwei Wu, Demin Li
World Journal of Emergency Surgery.2020;[Epub] CrossRef

Cardiology/Pulmonary
Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation: Jin Jeon, Jin Won Huh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2014;29(3):212-216. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.212

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Abstract PDF

Acute respiratory distress syndrome (ARDS) is a severe lung disease associated with high mortality despite recent advances in management. Significant advances in extracorporeal membrane oxygenation (ECMO) devices and management allow short-term support for patients with acute reversible respiratory failure and can serve as a bridge to transplantation in patients with irreversible respiratory failure. When ARDS does not respond to conventional treatment, ECMO and the interventional lung assist membrane (iLA) are the most widely used complementary treatment options. Here, we report a clinical case of an adult patient who required prolonged duration venovenous (VV)-ECMO for severe ARDS resulting in improvement while waiting for lung transplantation.

Citations

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

Cardiology/Pulmonary
Complicated Pulmonary Pseudocyst Following Traumatic Lung Injury Rescued by Extracorporeal Membrane Oxygenation: Sung Bum Park, Dae Sang Lee, Jeong Am Ryu, Jong Ho Cho, Yang Hyun Cho, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Gee Young Suh, Chi Min Park; Korean J Crit Care Med. 2014;29(3):201-206. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.201

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Abstract PDF: Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma that usually appears immediately in children or young adults and is characterized by a single or multiple pulmonary cystic lesions on chest radiography and has spontaneous resolution of the radiologic manifestations. However, we experienced a case of a delayed complicated pulmonary pseudocyst in a 17-year-old boy following severe traumatic acute respiratory distress syndrome rescued by Veno-venous extracorporeal membrane oxygenation (ECMO). In this case, the pseudocyst appeared on the 12th day after trauma and transformed into an infected cyst. Veno-venous ECMO was successfully maintained for 20 days without anticoagulation.

Original Article

Pulmonary
Patients with Acute Respiratory Distress Syndrome Caused by Scrub Typhus: Clinical Experiences of Eight Patients: Sun Young Kim, Hang Jea Jang, Hyunkuk Kim, Kyunghwa Shin, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee; Korean J Crit Care Med. 2014;29(3):189-193. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.189; Correction in: Acute Crit Care 2014;29(4):348

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Abstract PDF

BACKGROUND
The aim of this study is to describe the clinical course and outcome of patients who were diagnosed with acute respiratory distress syndrome (ARDS) caused by scrub typhus and who received ventilator care in the intensive care units (ICU) of two university hospitals.
METHODS
We performed a retrospective analysis of all adult ventilated patients who were diagnosed with ARDS caused by scrub typhus.
RESULTS
Eleven (1.7%) of 632 scrub typhus patients were diagnosed with ARDS (median age 72; seven were male). Eight patients had underlying diseases, the most common of which was hypertension (four patients). Eight patients (72.7%) were admitted in November. The most common chief complaints of the patients were fever and rash (63.6%). All patients had skin eschar and rash; seven were treated for shock. On the day of diagnosis with ARDS, the median Acute Physiology and Chronic Health Evaluation score was 20 (range 11-28) and Sequential Organ Failure Assessment score was 7 (range 4-14). All patients had PaO2/FiO2 < 200 mmHg, high serum aspartate aminotransferase level (> 40 IU/L), and hypoalbuminemia (< 3.3 g/dl). Nine patients were treated with doxycycline on the day of admission. Their median lengths of stay in the ICU and hospital were 10 (range 4-65) and 14 (4-136) days, respectively. The mortality rate during treatment in the hospital was 36.4%.
CONCLUSIONS
In our study, the risk of ARDS among patients diagnosed with scrub typhus was at least 1.7%, with a hospital mortality rate of 36.4%.

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Rapid Recovery of Acute Respiratory Distress Syndrome in Scrub Typhus, With Pulse Methylprednisolone and Therapeutic Plasma Exchange
Thilina Rathnasekara, Lanka Wijekoon, Hemal Senanayake, Sisira Siribaddana
Cureus.2022;[Epub] CrossRef

Review Article

New Definition of Acute Respiratory Distress Syndrome: Je Hyeong Kim; Korean J Crit Care Med. 2013;28(1):10-16.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.10

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Abstract PDF

Acute respiratory distress syndrome (ARDS) is a common disorder associated with significant mortality and morbidity. The American-European Consensus Conference (AECC) definition of ARDS, established in 1994, has advanced the knowledge of ARDS by allowing the acquisition of clinical and epidemiological data, which in turn have led to improvements in care for patients with ARDS. However, after 18 years of applied research, a number of issues regarding various criteria of AECC definition have emerged. For these reason, and because all disease definitions should be reviewed periodically, the European Society of Intensive Care Medicine convened an international expert panel to revise the ARDS definition from September 30 to October 2, 2011, Berlin, Germany, with endorsement from American Thoracic Society and the Society of Critical Care Medicine. This consensus discussion, following empirical evaluation and consensus revision, addressed some of the limitations of the AECC definition by incorporating current data, physiologic concepts, and clinical trials to develop a new definition of ARDS (Berlin definition). The Berlin definition should facilitate case recognition and better match treatment options to severity in both the research trials and clinical practice.

Citations

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Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
The Utility of Non-Invasive Nasal Positive Pressure Ventilation for Acute Respiratory Distress Syndrome in Near Drowning Patients
June Hyeong Kim, Kyung Hoon Sun, Yong Jin Park
Journal of Trauma and Injury.2019; 32(3): 136. CrossRef
Case Series of Transfusion-Related Acute Lung Injury in a Tertiary Hospital and a Practical Comparison with the New Diagnostic Criteria
Kwang Seob Lee, Sinyoung Kim, Juhye Roh, Seung Jun Choi, Hyun Ok Kim
The Korean Journal of Blood Transfusion.2019; 30(3): 219. CrossRef
Application of the Berlin definition in children with acute respiratory distress syndrome
Soo Yeon Kim, Yoon Hee Kim, In Suk Sol, Min Jung Kim, Seo Hee Yoon, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
Allergy, Asthma & Respiratory Disease.2016; 4(4): 257. CrossRef

Case Reports

Massive Diffuse Alveolar Hemorrhage Caused by the Aspiration of Gastric Contents during Induction of Anesthesia in Patients with Adhesive Ileus: A Case Report: Ji Seon Jeong, Jong Hun Jun, Hyo Jin Song, Hee Koo Yoo; Korean J Crit Care Med. 2012;27(2):115-119.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.115

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Abstract PDF: Aspiration pneumonitis is best defined as an acute lung injury, following the aspiration of regurgitated gastric contents. Major cause of pulmonary aspiration, during anesthesia, is gastric contents. Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome (ARDS). However, there was no report of massive alveolar hemorrhage associated with aspiration pneumonitis. A 63-year-old man, who had undergone a total gastrectomy and received adjuvant chemotherapy, four months ago, was scheduled for adhesiolysis of the small bowel. The patient occurred aspiration of gastric contents, during induction of anesthesia, and subsequently, hypoxia developed during surgery. The patient moved to an intensive care unit (ICU), without extubation. Mechanical ventilation with PEEP was performed in an ICU. However, the patient died by ARDS and massive alveolar hemorrhage.

A Case of Parainfluenza Virus Related Acute Respiratory Distress Syndrome in Immune Competent Adult Patient: A Case Report: Jae Hee Lee, In Won Park, Jae Yeol Kim, Jong Wook Shin, Byoung Whui Choi, Jae Chol Choi; Korean J Crit Care Med. 2011;26(3):188-190.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.188

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Abstract PDF: ParaiParainfluenza virus is a common cause of respiratory illness among infants and young children. Although it causes severe pneumonia in immunocompromised patients, it seldom does this in immunocompetent adults. We report the case of a 51-year-old woman with no significant past medical history who presented acute respiratory distress syndrome caused by parainfluenza virus. The diagnosis was made based on reverse transcriptase-polymerase chain reaction (RT-PCR) of a respiratory specimen. The patient was successfully treated with antiviral agent combined with steroids.

A Case of Respiratory Syncytial Virus Related Acute Respiratory Distress Syndrome: A Case Report: Jinwoo Lee, Tae Yun Park, Eun Sun Kim, Keun Bum Chung, Kyoung Hee Kim, Sang Min Lee, Jae Joon Yim, Seok Chul Yang, Young Whan Kim, Sung Koo Han, Seonyang Park, Chul Gyu Yoo; Korean J Crit Care Med. 2011;26(1):41-44.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.41

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Abstract PDF: Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in children. Although previously considered as children's virus, the increasing number of patients who receive immunosuppression after transplantation of bone marrow and solid organs highlighted the role of RSV as a pathogen for opportunistic infection. We report a case of community-acquired respiratory syncytial virus pneumonia in a patient with newly diagnosed leukemia, resulting in acute respiratory distress syndrome (ARDS).

A Case of Prolonged Extracorporeal Membrane Oxygenation Support for Severe Acute Respiratory Distress Syndrome: A Case Report: Byung Hoon Park, Joon Chang, Se Kyu Kim, Young Ae Kang, Ji Young Son, Kyung Jong Lee, Yoe Wun Yoon, Ji Ae Jung, Sak Lee, Moo Suk Park; Korean J Crit Care Med. 2010;25(1):37-42.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.37

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Abstract PDF

When all the conventional treatments have failed for patients with acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) can offer these patients a chance to survive. We report here on a case of successful treatment with prolonged ECMO support for a patient with severe ARDS. A 41-year-old female patient with acute A-viral hepatitis developed pneumonia and progressive ARDS. After tracheostomy, her clinical condition deteriorated despite proper antibiotic administration and other conventional treatments, including the recruitment maneuver and steroid use. Venoarterial ECMO was given for the management of refractory hypoxemia that developed 14 days after the initiation of mechanical ventilation. The duration of ECMO support was 4 weeks, and she was successfully weaned off ECMO and mechanical ventilation.

Citations

Citations to this article as recorded by

Early Extracorporeal Membrane Oxygenation for Massive Aspiration during Anesthesia Induction
Namo Kim, Kwan Hyung Kim, Jeong Min Kim, Su Youn Choi, Sungwon Na
The Korean Journal of Critical Care Medicine.2015; 30(2): 109. CrossRef
Massive Diffuse Alveolar Hemorrhage Caused by the Aspiration of Gastric Contents during Induction of Anesthesia in Patients with Adhesive Ileus - A Case Report -
Ji Seon Jeong, Jong Hun Jun, Hyo Jin Song, Hee Koo Yoo
Korean Journal of Critical Care Medicine.2012; 27(2): 115. CrossRef
Extracorporeal Membrane Oxygenation as a Bridge to Definitive Airway Security in 3 Severe Acute Extrinsic Airway Compression Patients - A Case Report -
Jiwon Lyu, Jin Won Huh, Chae Man Lim, Youn Suck Koh, Sang Bum Hong
The Korean Journal of Critical Care Medicine.2011; 26(1): 29. CrossRef

Original Articles

A Preliminary Study on the Effect of "Low-dose" Glucocorticoid Therapy for Patients with Persistent Acute Respiratory Distress Syndrome: Hae Seong Nam, Maeng Real Park, So Young Park, So Yeon Lim, Su A Kim, Jae Uk Song, Kyeongman Jeon, Hojoong Kim, O Jung Kwon, Gee Young Suh; Korean J Crit Care Med. 2009;24(2):80-86.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.80

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Abstract PDF

BACKGROUND
The role of glucocorticoids for treating persistent acute respiratory distress syndrome (ARDS) is matter of debate. In the previous studies, the side effects of moderate doses of glucocorticoids might have negated positive effects of glucocorticoids. This study aimed at determining the feasibility of administering "low-dose" glucocorticoid to treat the patients who suffer with persistent ARDS.
METHODS
We retrospectively reviewed the medical records of twelve patients with ARDS of at least seven days' duration and who were treated with "low-dose" glucocorticoid (starting dose of 1 mg/kg) between June 2007 to December 2008. The patients were divided by whether or not they were successfully weaned from the ventilator after glucocorticoid therapy. The baseline characteristics and physiologic parameters were recorded for up to 7 days after starting glucocorticoid therapy.
RESULTS
Five patients (42%) were included in the weaned group. There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups on the day of ARDS. Yet the weaned group had a significantly lower Sequential Organ Failure Assessment (SOFA) score, as compared to that of the failed group [3 (3-6) vs 8 (5-12), p = 0.009)] at start of glucocorticoid treatment. After 3 days of glucocorticoid therapy, there was significant improvement in the PEEP, the PaO2/FIO2 ratio, the PCO2, the SOFA score and the Murray Lung Injury Score of the weaned group, as compared to that of the failed group. There were no major neuromuscular side effects from the therapy.
CONCLUSIONS
This study suggests that the "low-dose" glucocorticoid therapy is feasible and that the SOFA score and the physiologic parameters may assist in determining whether or not to initiate and to continue glucocorticoid therapy for the patients who are suffering with persistent ARDS.

Citations

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A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage
Han Min Lee, Jae-Seok Park, Jae Yun Kim, Ji Yeon Lee, Byung Kyu Ahn, Hyo-Wook Gil, Jae-Sung Choi
Tuberculosis and Respiratory Diseases.2012; 72(2): 177. CrossRef
Acute Respiratory Distress Syndrome with Chemical Pneumonitis after Aspiration of Activated Charcoal - A Case Report -
Suhyun Kim, Na Ree Kang, In Sohn, Heon Lee, Yoon Kyung Lee, Sook Hee Song
The Korean Journal of Critical Care Medicine.2010; 25(2): 112. CrossRef

Relationship between the Changes of Arterial Blood Gas by Positioning from Prone to Supine and Patients' Survival in ARDS: Mi Young Kim, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2007;22(2):71-76.

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Abstract PDF: BACKGROUND
Prone positioning has been adopted as a strategy to improve oxygenation in patients with refractory acute respiratory distress syndrome (ARDS). After returning to supine position, most of patients show arterial blood gas changes. However, the clinical implications have not been elucidated. This study was aimed to observe the relationship between the arterial blood gas changes followed by changing position from prone to supine and survival of ARDS.
METHODS
We analyzed medical data of 53 ARDS patients, who showed improved arterial oxygenation (defined as the increase in PaO2/FiO2 by > or =20 mmHg within 8~12 hour after prone positioning) in a medical intensive care unit from January, 2000 to July, 2006. The patients were returned to supine position when they showed their PaO2/FiO2 > or =150 mmHg. We compared the arterial blood gas changes between the survivor and the nonsurvivor.
RESULTS
The survivor has significant pH improvement after position change (the survivor 0.01+/-0.06 vs. the nonsurvivor -0.03+/-0.08; p=.03). The PaO2/FiO2 and FiO2 changes were not different between the survivor (14.44 +/-69.68 and -2.2+/-4.3, respectively) and the nonsurvivor (-7.17+/-83.94 and 1.8+/-6.0, respectively; p=.314 and .843). The patients whose PaO2/FiO2 were deteriorated had higher mortality without statistical significance (p=.305). The PaCO2 changes were not different between two groups (-0.05+/-11.46 vs. 3.47+/-17.62, p=.390).
CONCLUSIONS
The early changes in pH differed significantly between the survivor and the nonsurvivor after returning patients to supine position from prone. Whether this marker can be a predictor of survival should be studied further.

Acute Respiratory Distress Syndrome after Severe Hypothermia and Hypotension Due to Near Drowning: Ho Dong Park, Bon Nyeo Koo, Dong Woo Han, Seung Tak Han, Shin Ok Koh; Korean J Crit Care Med. 2001;16(2):151-155.

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Abstract PDF: The increase in short-term survival of near-drowning victims after an acute submersion episode has resulted in an increase of major complications. Two major complications are the development of acute respiratory distress syndrome and persistent hypoxic-ischemic central nervous system injury. A 43-year-old male patient was presented with acute respiratory distress syndrome after near drowning. He was severely hypothermic and hypotensive when he arrived to emergency department. His body temperature was 24oC. There was no pulse and no spontaneous respiration. He was treated with advanced life support measure. He was intubated and vasoactive drugs such as epinephrine and norepinephrine were used. On ICU admission, his blood pressure and pulse rate were 80/40 mmHg, 170 beats/min respectively. His oxygen saturation was 40~60% with 100% oxygen. We applied 16~30 cmH2O of PEEP with low tidal volume for recruitment. Patient was flipped over to prone position. Solu-medrol 1.0 g was infused. The blood pressure restored to 140/50 mmHg, and the pulse rate was normalized to 100 beats/min. The dose of vasopressors and inotropes were reduced and stopped 5 hour after the arrival. When the oxygenation has improved, the position was changed to supine and PEEP was lowered. Eventually weaning was successful. Brain MRI and EEG showed global atrophy of cerebral cortex and moderate diffuse brain dysfunction respectively. He received tracheostomy since he was semi-comatose. He was transferred to general ward on 39th ICU day.

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