Acute and Critical Care

Original Articles

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

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

Citations

Citations to this article as recorded by

Patient outcomes associated with merging two paediatric cardiac intensive care units into one: A retrospective study
Sacha Mairet-Mabboux, Thibault Blache, Anthony Facchin, Catherine Koffel, Arnaud Ferraris, Christopher Blakeley, Vincent Piriou, Roland Henaine, Marc Lilot
Archives of Cardiovascular Diseases.2026; 119(4): 291. CrossRef
Long‐Term Outcomes and Predictors in Cancer‐Related Stroke Using the Linked Data Set
Tae Jung Kim, Ji Sung Lee, Mi Sun Oh, Soo‐Hyun Park, Kyung‐Ho Yu, Byung‐Chul Lee, Byung‐Woo Yoon, Sang‐Bae Ko
Journal of the American Heart Association.2025;[Epub] CrossRef
Impact of medical crisis on the critical care system in South Korea
Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-kyung Kim, Dong Hyun Lee, Suk-Kyung Hong
Acute and Critical Care.2025; 40(3): 393. CrossRef
The efficacy of intensivist-led closed-system intensive care units in improving outcomes for cancer patients requiring emergent surgical intervention
Eun Young Kim
Acute and Critical Care.2024; 39(4): 640. CrossRef

Nephrology
Incidence of hypothermia in critically ill patients receiving continuous renal replacement therapy in Siriraj Hospital, Thailand: Thonnarat Pornsirirat, Nualnapa Kasemvilawan, Patcharavalia Pattanacharoenwong, Saisunee Arpibanwana, Hatairat Kondon, Thummaporn Naorungroj; Acute Crit Care. 2024;39(3):379-389. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00038

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Abstract PDF Supplementary Material

Background
Hypothermia is a relatively common complication in patients receiving continuous renal replacement therapy (CRRT). However, few studies have reported the factors associated with hypothermia.
Methods
A retrospective cohort study was performed in five intensive care units (ICUs) to evaluate the incidence of hypothermia and the predictive factors for developing hypothermia during CRRT, with hypothermia defined as a time-weighted average temperature <36 °C.
Results
From January 2020 to December 2021, 300 patients were enrolled. Hypothermia developed in 23.7% of them within the first 24 hours after CRRT initiation. Compared to non-hypothermic patients, hypothermic patients were older and had lower body weight, more frequent acidemia, and higher ICU and 30-day mortality rates. In the multivariate analysis, age >70 years (odds ratio [OR], 2.59; 95% CI, 1.38–4.98; P=0.004), higher positive fluid balance on the day before CRRT (OR, 1.11; 95% CI, 1.02–1.22; P=0.02), and CRRT dose (OR, 1.003; 95% CI, 1.00–1.01; P=0.04) were significantly associated with hypothermia. Conversely, a higher body weight was independently associated with mitigated risk of hypothermia (OR, 0.89; 95% CI, 0.81–0.97; P=0.01). Moreover, a higher coefficient of variance of temperature was associated with greater ICU mortality (OR, 1.41; 95% CI, 1.13–1.78; P=0.003).
Conclusions
Hypothermia during CRRT is a relatively common occurrence, and factors associated with hypothermia onset in the first 24 hours include older age, lower body weight, higher positive fluid balance on the day before CRRT, and higher CRRT dose. Greater temperature variability was associated with increased ICU mortality.

Citations

Citations to this article as recorded by

Beyond the usual: A focus on infrequent complications of CRRT
Gonzalo Ramírez-Guerrero, Cristian Pedreros-Rosales, David Ballesteros, Mitchell Rosner, Claudio Ronco
Journal of Critical Care.2026; 91: 155270. CrossRef
Critical care nurses’ knowledge, attitude, and practice regarding hypothermia management during continuous renal replacement therapy: a cross-sectional study
Qingqing Sheng, Yufeng Tan, Xiaoqun Huang, Tingting He, Xiaoxia Li, Yao Huang, Liting Zeng, Xinning Wang, Mengmeng Xu, Shuqin Zhang, Lihua Chen
BMC Nursing.2026;[Epub] CrossRef
Development of a predictive score for hypothermia risk during continuous kidney replacement therapy in critically ill patients
Panisara Chummano, Thongkran Thongkam, Naphat Chansatchanali, Yutthasat Sonprasom, Wachiranun Sirikul, Konlawij Trongtrakul
Renal Failure.2026;[Epub] CrossRef
Development and validation of a LASSO-based predictive model for inadvertent hypothermia in ICU patients
Xueting Wang, Yuxuan Chen, Lan Hua, Dongmei Wang, Xia Zhang, Lianhong Wang
Frontiers in Medicine.2025;[Epub] CrossRef

Epidemiology
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt: Aya Osama Mohammed, Hanaa I. Rady; Acute Crit Care. 2024;39(1):70-77. Published online February 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00654

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Abstract PDF: Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022.
Methods
This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories.
Results
In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE).
Conclusions
The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

Nephrology
Impact of intradialytic hypotension on mortality following the transition from continuous renal replacement therapy to intermittent hemodialysis: Seong Geun Kim, Donghwan Yun, Jinwoo Lee, Yong Chul Kim, Dong Ki Kim, Kook-Hwan Oh, Kwon Wook Joo, Yon Su Kim, Seung Seok Han; Acute Crit Care. 2023;38(1):86-94. Published online October 26, 2022; DOI: https://doi.org/10.4266/acc.2022.00948

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Abstract PDF

Background
The transition of dialysis modalities from continuous renal replacement therapy (CRRT) to intermittent hemodialysis (iHD) is frequently conducted during the recovery phase of critically ill patients with acute kidney injury. Herein, we addressed the occurrence of intradialytic hypotension (IDH) after this transition, and its association with the mortality risk.
Methods
A total of 541 patients with acute kidney injury who attempted to transition from CRRT to iHD at Seoul National University Hospital, Korea from 2010 to 2020 were retrospectively collected. IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg or a decrease in systolic blood pressure ≥30 mm Hg during the first session of iHD. Odds ratios (ORs) of outcomes, such as in-hospital mortality and weaning from RRT, were measured using a logistic regression model after adjusting for multiple variables.
Results
IDH occurred in 197 patients (36%), and their mortality rate (44%) was higher than that of those without IDH (19%; OR, 2.64; 95% confidence interval [CI], 1.70–4.08). For patients exhibiting IDH, the iHD sessions delayed successful weaning from RRT (OR, 0.62; 95% CI, 0.43–0.90) compared with sessions on those without IDH. Factors such as low blood pressure, high pulse rate, low urine output, use of mechanical ventilations and vasopressors, and hypoalbuminemia were associated with IDH risk.
Conclusions
IDH occurrence following the transition from CRRT to iHD is associated with high mortality and delayed weaning from RRT.

Citations

Citations to this article as recorded by

Ultrafiltration Rate in Prolonged Intermittent Kidney Replacement Therapy in Critically Ill Patients: A Randomized Controlled Trial
Vijay Kalathia, Snehal Gaikwad, Vipul Chakurkar, Sagar Kulkarni, Meetali Bidaye, Valentine Lobo
Hemodialysis International.2026;[Epub] CrossRef
Quantifying Predictive Uncertainty in Hemodialysis: A Dynamic Ensemble Selection Framework Based on Interval Quality
Hsuan-Ming Lin, JrJung Lyu
Journal of Medical and Biological Engineering.2026; 46(3): 338. CrossRef
Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D
Jae Ho Kim, Joonhee Yoon, Ji-Eun Kim, Seongho Jo, Yuri Lee, Ji Won Kim, Seun Deuk Hwang, Seoung Woo Lee, Joon Ho Song, Kipyo Kim
Journal of Critical Care.2025; 85: 154944. CrossRef
A pilot feasibility study of continuous cardiac output and blood pressure monitoring during intermittent hemodialysis in patients recovering from severe acute kidney injury
Sofia Spano, Akinori Maeda, Joey Lam, Anis Chaba, Atthaphong Phongphithakchai, Yukiko Hikasa, Nuttapol Pattamin, Nuanprae Kitisin, Emily See, Peter Mount, Rinaldo Bellomo
Journal of Critical Care.2025; 88: 155086. CrossRef
A holistic framework for intradialytic hypotension prediction using generative adversarial networks-based data balancing
Hsuan-Ming Lin, JrJung Lyu
BMC Medical Informatics and Decision Making.2025;[Epub] CrossRef
Hemoglobin variability predicts mortality in acute kidney injury patients undergoing continuous renal replacement therapy: a multi-database cohort study
Yumin Huang, Ran Jiang, Kang Liu, Jinghang Li, Rongrong Sheng, Wei Xu, Huijuan Mao, Buyun Wu
Renal Failure.2025;[Epub] CrossRef
Proceedings of the University of Alabama at Birmingham Continuous Renal Replacement Therapy Academy (2023–2024)
William Beaubien-Souligny, Melissa Thompson Bastin, J. Pedro Teixeira, Jorge Cerda, Michael J. Connor, Amanda Dijanic Zeidman, Pranav S. Garimella, Luis Juncos, Arnaldo Lopez-Ruiz, Ravindra Mehta, Thiago Reis, Lilia Rizo-Topete, Samuel A. Silver, J. Ricar
Kidney360.2025; 6(10): 1798. CrossRef
The Relationship between Dialysis Adequacy and Blood Pressure and Number of Intradialytic Hypotensive Episodes in Haemodialysis Patients
Ömer Bingölbali, Semra Oğuz
Black Sea Journal of Health Science.2024; 7(5): 189. CrossRef

Case Reports

Nephrology
Continuous renal replacement therapy increased plasma cholinesterase activity in a case of acute organophosphate poisoning: In Ho Kwon, Jinwoo Jeong, Yuri Choi; Acute Crit Care. 2022;37(4):669-671. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00780

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Abstract PDF

Extracorporeal removal of organophosphate from blood has been proposed, but the efficacy of hemodialysis and hemoperfusion has not been established. We report a case of organophosphate poisoning in which continuous renal replacement therapy (CRRT) was applied with conventional indications and was found to increase plasma cholinesterase levels by hemodiafiltration. A 73-year-old male was found unconscious at home and was brought to the emergency department by ambulance. An empty bottle of Supracide insecticide, of which the active ingredient is methidathion, was found beside him. CRRT was initiated because he showed signs of oliguria and acidosis with an unstable hemodynamic condition. Although his condition improved temporarily after CRRT initiation, it subsequently deteriorated, and he died despite maximal supportive effort. His prefilter plasma cholinesterase levels remained at <200 U/L for 3 days, while his postfilter levels were 358 U/L 1 hour after CRRT initiation and they were 689 U/L 18 hours later. Our case suggests that CRRT might play a role in treating organophosphate poisoning by possibly eliminating organophosphate.

Citations

Citations to this article as recorded by

Utilization of Renal Replacement Therapy and Its Impact on the Emergency Department Length of Stay in South Korean Emergency Medical Centers
Ji Eun Kim, Jinwoo Jeong, Yuri Choi, Hyung Jun Moon
Medicina.2026; 62(7): 1273. CrossRef
Advancements in bioscavenger mediated detoxification of organophosphorus poisoning
Hexi Li, Cong Lu, Zhenmin Liu, Fengshun Xiang, Bo Liu, Hongjuan Wang, Jie Chang, Li Pan, Youwei Chen, Jingfei Chen
Toxicology Research.2024;[Epub] CrossRef

Vascular surgery/Nephrology
Spontaneous Lumbar Artery Bleeding and Retroperitoneal Hematoma in a Patient Treated with Continuous Renal Replacement Therapy: Jin Kyung Park, Sung Ho Kim, Hee Jin Kim, Duk Hyun Lee; Korean J Crit Care Med. 2015;30(4):318-322. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.318; Correction in: Acute Crit Care 2016;31(1):71

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Abstract PDF

Rupture of the lumbar artery is usually associated with trauma but rarely has been reported in association with anticoagulation. We present a 71-year-old man who developed spontaneous rupture of the lumbar artery leading to a retroperitoneal hematoma while receiving continuous renal replacement therapy (CRRT). The bleeding was confirmed by computed tomography and angiography and was controlled successfully using selective angiographic embolization. We suggest that spontaneous retroperitoneal bleeding should be considered in a case of sudden decrease in hemoglobin in a CRRT patient.

Citations

Citations to this article as recorded by

Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: A Systematic Review
Lahoud Touma, Sarah Cohen, Christophe Cassinotto, Caroline Reinhold, Alan Barkun, Vi Thuy Tran, Olivier Banon, David Valenti, Benoit Gallix, Anthony Dohan
CardioVascular and Interventional Radiology.2019; 42(3): 335. CrossRef
Three cases of spontaneous lumbar artery rupture in hemodialysis patients
Na Kyoung Hwang, Harin Rhee, Il Young Kim, Eun Young Seong, Dong Won Lee, Soo Bong Lee, Ihm Soo Kwak, Chang Won Kim, Sang Heon Song
Hemodialysis International.2017;[Epub] CrossRef

Successful Brain Dead Donor Management with CRRT: A Case Report: Sang Hyun Lim, Young Joo Lee, Han Bum Joe, Jae Moung Lee, In Kyung Lee; Korean J Crit Care Med. 2012;27(4):286-289.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.286

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Abstract PDF

Brain death results in adverse pathophysiologic effects in many brain-dead donors with cardiovascular instability. We experienced a brain-dead donor with continuous renal replacement therapy (CRRT) who was in a severe metabolic, electrolyte derangement and poor pulmonary function. The thirty-nine-year-old male patient with subarachnoid hemorrhage and intraventricular hemorrhage was admitted into the intensive care unit (ICU). After sudden cardiac arrest, he went into a coma state and was referred to as a potential organ donor. When he was transferred, his vital sign was unstable even under the high dose of inotropics and vasopressors. Even with aggressive treatment, the level of blood sugar was 454 mg/dl, serum K+ 7.1 mEq/L, lactate 5.33 mmol/L and PaO2/FiO2 60.3. We decided to start CRRT with the mode of continuous venovenous hemodiafiltration (CVVHDF). After 12 hours of CRRT, vital sign was maintained well without vasopressors, and blood sugar, serum potassium and lactate levels returned to 195 of PaO2/FiO2. Therefore, he was able to donate his two kidneys and his liver.

Citations

Citations to this article as recorded by

Activation Policy for Brain-dead Organ Donation
Young-Joo Lee
The Ewha Medical Journal.2015; 38(1): 1. CrossRef

Original Article

Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit: Jae Wook Choi, Woo Jin Chung, Young Joo Han, Ju Kyung Lee, Dong In Suh, June Dong Park, Young Yull Koh; Korean J Crit Care Med. 2011;26(3):171-176.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.171

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Abstract PDF

BACKGROUND
The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pediatric intensive care unit.
METHODS
We retrospectively analyzed 96 patients who required CRRT at a pediatric intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT.
RESULTS
Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6-72.9 kg. 16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pediatric Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 +/- 8.9 and the degree of fluid overload at CRRT (FO%) was 12.9 +/- 16.0. The PRISM III score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically significant hemorrhage occurred in 10 patients (10.4%).
CONCLUSIONS
Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT.

Citations

Citations to this article as recorded by

Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single-Center Study
Moon-yeon Oh, Byong Sop Lee, Seong-Hee Oh, Hee Jin Jang, Hyun-Jeong Do, Ellen Ai-Rhan Kim, Ki-Soo Kim, Joo Hoon Lee, Young Seo Park, Beom-Hee Lee, Han-Wook Yoo
Neonatal Medicine.2014; 21(4): 244. CrossRef

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