Acute and Critical Care

Original Articles

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

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

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

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

Citations

Citations to this article as recorded by

Impact of reductive ventilatory strategies on mechanical power in severely burned patients undergoing pressure-controlled ventilation
Claudio Luciano Franck, Bernardo Gomes Doelinger, Ester Lopes Correa Dos Santos, Elisa de Hollanda Calderari
Burns Open.2026; 14: 100445. CrossRef
Mechanical power and mortality: analysis of a prospective cohort of ventilated patients
Yudiel Pérez Yero, Ariel Sosa Remón, Jhossmar Cristians Auza-Santivañez, Arian Jesús Cuba Naranjo, Dasha María García Arias, Ana Esperanza Jeréz Alvarez, Mileydys Saborit García, Osman Arteaga Iriarte, Jose Bernardo Antezana-Muñoz
Multidisciplinar (Montevideo).2025; 3: 198. CrossRef
Associations of mechanical power, ventilatory ratio, and other respiratory indices with mortality in patients with acute respiratory distress syndrome undergoing pressure-controlled mechanical ventilation
Tae Wan Kim, Chi Ryang Chung, Miryeo Nam, Ryoung-Eun Ko, Gee Young Suh
Frontiers in Medicine.2025;[Epub] CrossRef
The association of frailty and mechanical power with hospital mortality in critically ill patients: a retrospective study based on the MIMIC-IV and eICU database
Jiacheng Shen, Kun Fang, Yu Qiu, Li Li
European Journal of Medical Research.2025;[Epub] CrossRef
Mechanical power in mechanical ventilation and its association with ventilator-induced lung injury: A systematic review
Tomasz Urbankowski, Raman Pasledni, Marek Darowski
Respiratory Medicine.2025; 250: 108525. CrossRef
Perioperative Ventilation in Neurosurgical Patients: Considerations and Challenges
Ida Giorgia Iavarone, Patricia R.M. Rocco, Pedro Leme Silva, Shaurya Taran, Sarah Wahlster, Marcus J. Schultz, Nicolo’ Antonino Patroniti, Chiara Robba
Current Anesthesiology Reports.2024; 14(4): 512. CrossRef

Pulmonary
Cinematic virtual reality for anxiety management in mechanically ventilated patients: a feasibility and pilot study: Alexander C. Haley, David A. Wacker; Acute Crit Care. 2022;37(2):230-236. Published online February 4, 2022; DOI: https://doi.org/10.4266/acc.2021.00843

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10 Web of Science
13 Crossref

Abstract PDF

Background
Mechanically ventilated patients experience anxiety for many reasons. Pharmacological treatments such as benzodiazepines are commonly employed to manage anxiety; however, these therapies often cause undesired side effects. Additional therapies for anxiety management are needed. We sought to determine whether cell phone-based virtual reality therapy could feasibly be used for anxiety management in mechanically ventilated patients.
Methods
Mechanically ventilated subjects underwent at least one session of virtual reality therapy in which they were shown a cinematic video of an outdoor green space or blue space with 360° visual range of motion. Goal session duration was 5 minutes. The primary outcome was incidence of predefined patient safety events, including self-extubation and accidental removal of tubes or lines.
Results
Ten subjects underwent a total of 18 virtual reality sessions. Fifteen sessions lasted the planned 5 minutes, one session was extended at participant request, and two sessions were terminated early at participant request. There were no occurrences of the predefined safety events, and no occurrences of cybersickness. Use of a visual analog scale to measure anxiety level was feasible for this pilot study, demonstrating feasibility of this scale for future, larger scale studies.
Conclusions
Virtual reality therapy shows potential as a means of managing anxiety in patients undergoing mechanical ventilation, and further rigorous exploration with this protocol is feasible.

Citations

Citations to this article as recorded by

Feasibility, effectiveness and patient experience of virtual reality technology in intensive care units patients: a mixed-methods systematic review
Guiling Liao, Zhiqun Liu, Huan Wan
International Journal of Nursing Studies Advances.2026; : 100506. CrossRef
Perspectives of intensive care professionals on psychological stressors, support strategies, and the potential of virtual reality in critical care
Tjasa Savoric, Kaja Antlej, Sylvester Arnab, Rand Butcher, Ashwin Subramaniam
Australian Critical Care.2026; 39(2): 101551. CrossRef
Extended reality in anesthesia: a narrative review
Sung Hee Han, Kristen L Kiroff, Sakura Kinjo
Korean Journal of Anesthesiology.2025; 78(2): 105. CrossRef
Effects of Virtual Reality Meditation on Sleep and Delirium in ICU Patients
Soogyeong Kim, Jiyeon Kang
CIN: Computers, Informatics, Nursing.2025;[Epub] CrossRef
Utilizing virtual and augmented reality in intensive care medicine: A mini review
Yuhan Liu, Yanqi Liu, Mengyao Yuan, Changsong Wang
Journal of Translational Critical Care Medicine.2025;[Epub] CrossRef
Virtual reality for relaxation in intensive care unit patients: feasibility, acceptability and intervention adaptation
Ann Louise Hanifa, Pia Dreyer, Søren Aagaard, Anna Holm
Pilot and Feasibility Studies.2025;[Epub] CrossRef
Virtual Reality in Preclinical and Clinical Education—An Insight into Current Advancements and Future Perspectives
Adam Brachet, Maciej Biskupski, Gabriela Hunek, Jakub Rusek, Aleksandra Bełżek, Alicja Forma, Grzegorz Teresiński, Robert Sitarz, Robert Karpiński, Jacek Baj
Applied Sciences.2025; 15(24): 12941. CrossRef
Virtual reality for delirium prevention in mechanically ventilated ICU patients: a narrative review
Jiaxin Li, Mengyao Su, Yuhao Zhao, Yuxin Zhu, Yuna Hu, Huijie Zhao, Liming Li
Frontiers in Medicine.2025;[Epub] CrossRef
Opportunities for Managing Pain and Anxiety in the Intensive Care Unit Using Virtual Reality: Perspectives from Bedside Care Providers
Isabella P. Garito, Samantha Lewis-Fung, Brenna Lawson, Hannah Gabrielle Gray, Christopher Smith, Lora Appel
Journal of Medical Extended Reality.2024; 1(1): 53. CrossRef
Immersive Virtual Reality Use in Medical Intensive Care: Mixed Methods Feasibility Study
Brian W Locke, Te-yi Tsai, C Mahony Reategui-Rivera, Aileen S Gabriel, Aref Smiley, Joseph Finkelstein
JMIR Serious Games.2024; 12: e62842. CrossRef
Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial
Hannah Gabrielle Gray, Danielle Tchao, Samantha Lewis-Fung, Susanna Pardini, Laurence R Harris, Lora Appel
JMIR Research Protocols.2023; 12: e41523. CrossRef
Virtual and augmented reality in intensive care medicine: a systematic review
Dominika Kanschik, Raphael Romano Bruno, Georg Wolff, Malte Kelm, Christian Jung
Annals of Intensive Care.2023;[Epub] CrossRef
A study to assess the communication and level of anxiety among mechanically ventilated conscious patients in intensive care units of sree mookambika medical college hospital at kanyakumari district
Derlin A. Ahisha, Retnam C. Ajitha
i-manager's Journal on Nursing.2023; 13(2): 20. CrossRef

Analysis of the Description of Ventilator Parameters in Recent Papers Relating Artificial Ventilation Using Anesthesia Machine: Jiyeon Sim, Hee Yeon Park, Wonsik Ahn; Korean J Crit Care Med. 2007;22(1):7-14.

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Abstract PDF: BACKGROUND
Procedures in medical papers should be described in sufficient detail to allow other researchers to reproduce the results. The apparatus including anesthesia machine should be given, too. Anesthesia machine has dramatically improved as bioengineering has developed. There are several ventilator settings in modern anesthesia machines. However, it seems that only a few ventilator settings are described even though modern ventilators are used in research. The purpose of this study is to investigate that how many ventilator parameters were described in the papers of the Korean Journal of Anesthesiology from 2001 to 2006. METHODS: All of papers with human general anesthesia were reviewed except case reports, and papers regarding only induction or intubation procedures. Recruited articles were grouped into papers with strongly related to respiratory parameters (STP), and into ones with slightly related to them based on the research topics. The description of following categories was counted in each paper; the type of anesthesia machine, tidal volume, respiratory rate, inspiratory:expiratory ratio, mode of ventilation, pressure set in pressure targeted ventilation, positive end expiratory pressure, inspiratory pause, and inspiratory rising rate. RESULTS: The description rate of each parameters in STP were 36% in the type of anesthesia machine, 66% in tidal volume, 54% in respiratory rate, and 24% in inspiratory:expiratory ratio. The other settings were seldomly mentioned. CONCLUSIONS: Description on the ventilator parameters was sometimes missed. We should describe adequate ventilator settings to reproduce the results because the modern anesthesia machine has additional ventilator options.

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