Acute and Critical Care

Original Article

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

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

Citations

Citations to this article as recorded by

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

Review Article

Infection
Oxygen therapy for sepsis and prevention of complications: Hayk Minasyan; Acute Crit Care. 2022;37(2):137-150. Published online March 17, 2022; DOI: https://doi.org/10.4266/acc.2021.01200

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Abstract PDF

Patients with sepsis have a wide range of respiratory disorders that can be treated with oxygen therapy. Experimental data in animal sepsis models show that oxygen therapy significantly increases survival, while clinical data on the use of different oxygen therapy protocols are ambiguous. Oxygen therapy, especially hyperbaric oxygenation, in patients with sepsis can aggravate existing oxidative stress and contribute to the development of disseminated intravascular coagulation. The purpose of this article is to compare experimental and clinical data on oxygen therapy in animals and humans, to discuss factors that can influence the results of oxygen therapy for sepsis treatment in humans, and to provide some recommendations for reducing oxidative stress and preventing disseminated intravascular coagulation during oxygen therapy.

Citations

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Suraphan Charoentanyarak, Thanapong Chopetgool, Watchara Boonsawat, Kittisak Sawanyawisuth
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Conservative Oxygen Targets in Mechanically Ventilated Patients (OXY-BREATHES): A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Nhan Nguyen, Nghi Bao Tran, Nathalia Alves de Barros e Lyra, Yacin Zawam, David Downes, Vinh Quang Tri Ho, Vy Ngoc Dan Nguyen, Ha Duc Thien Le, Jafar Aljazeeri
Critical Care Medicine.2026;[Epub] CrossRef
OPTIMAL PAO2 IS 130-160 MMHG IN THE FIRST WEEK FOR SEPSIS PATIENTS IN ICU: A RETROSPECTIVE COHORT STUDY BASED ON MIMIC-IV DATABASE
Haoran Chen, Xinyi Tang, Xiaomin Li, Yongpeng Xie
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Pengfei Chen, Haochao Li, Chenyu Liu, Mingjian Chen, Diming Zhao, Liang Chen, Xiangyang Qian, Jundong Pu, Zujun Chen, Yuetang Wang, Liqing Wang
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Cell Reports.2025; 44(8): 116032. CrossRef
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Ezza Ikram, Abaidullah Shaukat, Muhammad Shoaib Qureshi, Muneeb Saifullah, M Afaq Aslam, Abbas Muhammad Mehdi
World Journal of Clinical Infectious Diseases.2025;[Epub] CrossRef
Sequential respiratory support in septic patients undergoing continuous renal replacement therapy: A study based on MIMIC-III database
Chunxia Wang, Jianli Zheng, Yilin Zhao, Tiantian Liu, Yucai Zhang
Heliyon.2024; 10(6): e27563. CrossRef
Hyperbaric Oxygenation: Can It Be a Novel Supportive Method in Acute Kidney Injury? Data Obtained from Experimental Studies
Sanjin Kovacevic, Nikola Mitovic, Predrag Brkic, Milan Ivanov, Maja Zivotic, Zoran Miloradovic, Jelena Nesovic Ostojic
Cells.2024; 13(13): 1119. CrossRef
Hyperoxia in Sepsis and Septic Shock: A Comprehensive Review of Clinical Evidence and Therapeutic Implications
Sharayu Paunikar, Vivek Chakole
Cureus.2024;[Epub] CrossRef
Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS?
Florian Blanchard, Arthur James, Mona Assefi, Natacha Kapandji, Jean-Michel Constantin
Expert Review of Respiratory Medicine.2023; 17(1): 41. CrossRef
Current data regarding homeostasis of tissues oxygenation in pathophysiological and therapeutic circumstances
Constantin Munteanu, Mihaela Antonina Călin, Dragoș Manea, Cristina Popescu, Mădălina Iliescu, Elena Valentina Ionescu, Liliana Stanciu, Mihaela Minea, Carmen Oprea, Doinița Oprea, Mariana Rotariu, Gelu Onose
Balneo and PRM Research Journal.2023; 14(Vol.14, no): 565. CrossRef
Current data regarding homeostasis of tissues oxygenation in pathophysiological and therapeutic circumstances
Constantin Munteanu, Mihaela Antonina Călin, Dragoș Manea, Cristina Popescu, Mădălina Iliescu, Elena Valentina Ionescu, Liliana Stanciu, Mihaela Minea, Carmen Oprea, Doinița Oprea, Mariana Rotariu, Gelu Onose
Balneo and PRM Research Journal.2023; 14(Vol.14, no): 565. CrossRef

Original Article

Pulmonary
Safety and feasibility of hybrid tracheostomy: Daeun Kang, In Beom Jeong, Sun Jung Kwon, Ji Woong Son, Gwan Woo Ku; Acute Crit Care. 2021;36(4):369-373. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00801

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150 Download
5 Web of Science
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Abstract PDF

Background
Percutaneous dilatational tracheostomy (PDT) is widely used in intensive care units, but this conventional method has some disadvantages, such as requirement of a lot of equipment and experts at the site. Especially, in situations where the patient is isolated due to an infectious disease, difficulties in using the equipment may occur, and the number of exposed persons may increase. In this paper, we introduce hybrid tracheostomy that combines the advantages of surgical tracheostomy and PDT and describe our experiences.
Methods
Data from 55 patients who received hybrid tracheostomy without bronchoscopy from January 2020 to February 2021 were collected and reviewed retrospectively. Hybrid tracheostomy was performed at the bedside by a single thoracic surgeon. The hybrid tracheostomy method was as follows: after the skin was incised and the trachea was exposed, only the extent of the endotracheal tube that could not be removed was withdrawn, and then tracheostomy was performed by the Seldinger method using a PDT kit.
Results
The average age was 66.5 years, and the proportion of men was 69.1%. Among the patients, 21.8% were taking antiplatelet drugs and 14.5% were taking anticoagulants. The average duration of the procedure was 13.3 minutes. There was no major bleeding, and there was one case of paratracheal placement of the tracheostomy tube.
Conclusions
In most patients, the procedure can be safely performed without any major complications. However, patients with a short neck, a neck burn or patients who have received radiation therapy to the neck should be treated with conventional methods.

Citations

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Adding Newer Paradigms to Percutaneous Dilatational Tracheostomy with Ultrasound Guided and Hybrid Techniques: Stretching the Limits
Amandeep Kaur, Shruti Sharma, Udeyana Singh, Parshotam Lal Gautam, Amandeep Parmar, Rohit Verma, Jasmine Kaur, Harjas Singh, Nishant Sharma
Indian Journal of Otolaryngology and Head & Neck Surgery.2026; 78(1): 371. CrossRef
Safe (re)tracheostomy in critically ill patients with previous neck surgery using the minimally-invasive tracheostomy approach
Dennis Christoph Harrer, Patricia Mester, Alexander Gross, Wolfgang Herr, Tobias Schilling, Stephan Schmid, Martina Müller, Vlad Pavel
JTCVS Techniques.2026; 35: 102171. CrossRef
Minimally-invasive tracheostomy (MIT): A care bundle for safety improvement in high-risk critically ill patients
Dennis Christoph Harrer, Patricia Mester, Clara-Larissa Lang, Tanja Elger, Tobias Seefeldt, Lorenz Wächter, Judith Dönz, Nina Doblinger, Muriel Huss, Georgios Athanasoulas, Lea U. Krauß, Johannes Heymer, Wolfgang Herr, Tobias Schilling, Stephan Schmid, Ma
Journal of Clinical Anesthesia.2024; 99: 111631. CrossRef
A Modified Technique for Percutaneous Dilatational Tracheostomy
Zahra Ghotbi, Mehrdad Estakhr, Mehdi Nikandish, Reza Nikandish
Journal of Intensive Care Medicine.2023; 38(9): 878. CrossRef

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