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
Weight variability at pediatric intensive care unit admission and adverse outcomes in critically ill children: Jae Hwa Jung, Yoon Hee Kim, Min Jung Kim, Mireu Park, Hamin Kim, Kyung Won Kim, Myung Hyun Sohn, Soo Yeon Kim; Acute Crit Care. 2025;40(4):605-613. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.001550

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Abstract PDF Supplementary Material: Background
Body weight can fluctuate during critical illness due to factors such as fluid shifts, nutritional status, the type of acute illness, and underlying comorbidities. We investigated the association between acute body weight variability (WV) and clinical outcomes in critically ill pediatric patients.
Methods
We retrospectively analyzed data from patients aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU) of a university-affiliated tertiary hospital between August 2017 and July 2021. WV was defined as the percentage difference between the measured body weight at PICU admission and the usual body weight, obtained either from recent hospital records or caregiver reports. Associations between WV and clinical outcomes, including PICU mortality and ventilator-free days (VFDs), were assessed.
Results
Of the 926 patients, 74 (8.0%) died. Median WV was significantly higher in non-survivors than in survivors (8.7% vs. 0.0%; P<0.001). Increased WV was independently associated with higher mortality (hazard ratio [HR], 1.102; 95% CI, 1.073–1.131) and fewer VFDs (odds ratio [OR], 0.599; 95% CI, 0.524–0.684). Combining WV with Pediatric Index of Mortality 3 score significantly improved mortality prediction over either parameter alone (area under the curve, 0.888; P=0.047).
Conclusions
Higher WV at PICU admission is independently associated with adverse clinical outcomes, including increased mortality and fewer VFDs. WV could complement existing mortality prediction models in pediatric critical care.

Review Article

Nursing
Implementation of a partnership involving parents in the care of critically ill children: an integrative review: Tuti Seniwati, Nani Nurhaeni, Dessie Wanda; Acute Crit Care. 2025;40(4):521-537. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.001896

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Abstract PDF: The admission of a child to an intensive care unit, such as pediatric or neonatal intensive care units, serves as a significant stressor for parents. This condition is exacerbated when the child undergoes treatment in isolation from their parents. One strategy to address this challenge involves positioning parents at the bedside during the child’s care. This study aimed to identify and synthesize qualitative and quantitative research evidence on partnerships involving parents in the care of critically ill children. This research employed an integrative review method, and it was registered with the International Prospective Register of Systematic Reviews as a research-implementation protocol (ID no. CRD42023414924t). Six databases were searched for relevant literature, including ScienceDirect, Scopus, ProQuest, Sage Journals, PubMed, and Google Scholar. The evaluation of article quality used the 2018 version of the Mixed Methods Appraisal Tool, while content analysis was employed for data analysis. The results indicated that 18 articles fulfilled the inclusion requirements, out of the 5,435 articles found during the search phase. The analysis resulted in the discovery of three primary themes: partnership components, partnership outcomes and factors influencing partnerships. These three themes collectively constitute the conceptual model of partnerships in treating children with critical illness. It can be concluded that the active participation of parents in a child's critical care will yield positive outcomes for both the child and the parents. Existing empirical data underscore the significance of comprehending the factors influencing this specific situation.

Original Article

Nutrition
Effect of nutrition support team on 28-day mortality in Korean patients with acute respiratory failure: Inhan Lee, Junghyun Kim, Mihyun Ku, Yurim Choi, Sohyun Park, Jihyeon Bang, Joohae Kim; Acute Crit Care. 2025;40(2):313-321. Published online April 28, 2025; DOI: https://doi.org/10.4266/acc.003312

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Abstract PDF: Background
Providing optimal nutrition to patients with acute respiratory failure is difficult because nutritional requirements vary according to disease severity and comorbidities. In 2021, the National Medical Center initiated a protocol for screening upon admission and regular monitoring by a multidisciplinary nutritional support team (NST), for all patients in the medical intensive care unit (ICU). This study aimed to evaluate the effects of routine NST monitoring and active intervention on the clinical outcomes of patients with acute respiratory failure.
Methods
Patients with acute respiratory failure requiring high-flow nasal cannula, non-invasive ventilation, or mechanical ventilation were included. The primary outcome was 28-day mortality after ICU admission. Secondary outcomes included the supplied/target calorie ratio, supplied/target protein ratio on day 7, and complications.
Results
In total, 152 patients were included in the analysis. The patients were divided into a pre-monitoring (n=96) and post-monitoring groups (n=56). More patients in the post-monitoring group received NST intervention and had earlier initiation of enteral feeding. In survival analysis, 28-day mortality was significantly lower in post-monitoring group (adjusted hazard ratio, 0.42; 95% CI, 0.24–0.74). The ratio of achievement for required calories and protein on day 7 was higher, but not significantly, in the post-monitoring group. No significant differences were observed in the incidence of complications.
Conclusions
Regular NST monitoring in the ICU could have contributed to a reduced risk of 28-day mortality in critically ill patients with acute respiratory failure.

Review Article

Nephrology
Dialysis decision in critically ill patients in intensive care unit: Harin Rhee; Acute Crit Care. 2025;40(1):1-9. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.004896

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Abstract PDF: The 2012 Kidney Disease Improving Global Outcomes guidelines clearly define emergent indications for kidney replacement therapy; however, whether dialysis should be initiated in critically ill patients without these indications remains unclear. This review briefly summarizes the results of recent landmark trials and discusses their limitations originating from a criteria-based approach at a single time point. Moreover, a personalized approach based on each patient’s demand-capacity balance and its future benefits as a platform for kidney support therapy in critically ill patients are discussed.

Original Article

Nutrition
Higher caloric intake through enteral nutrition is associated with lower hospital mortality rates in patients with candidemia and shock in Taiwan: Chen-Yu Wang, Tsai-Jung Wang, Yu-Cheng Wu, Chiann-Yi Hsu; Acute Crit Care. 2024;39(4):573-582. Published online November 20, 2024; DOI: https://doi.org/10.4266/acc.2024.00843

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Abstract PDF

Background
Candidemia is associated with markedly high intensive care unit (ICU) mortality rates. Although the Impact of Early Enteral vs. Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA-2) trial indicated that early enteral nutrition (EN) did not reduce 28-day mortality rates among critically ill patients with shock, the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend avoiding EN in cases of uncontrolled shock. Whether increased caloric intake from EN positively impacts clinical outcomes in patients with candidemia and shock remains unclear.
Methods
We retrospectively collected data from a tertiary medical center between January 2015 and December 2018. We enrolled patients who developed shock within the first 7 days following ICU admission and received a diagnosis of candidemia during their ICU stay. Patients with an ICU stay shorter than 48 hours were excluded.
Results
The study included 106 patients, among whom the hospital mortality rate was 77.4% (82 patients). The median age of the patients was 71 years, and the median Acute Physiology and Chronic Health Evaluation II score was 29. The Cox regression model revealed that a higher 7-day average caloric intake through EN (hazard ratio, 0.61; 95% CI, 0.44–0.83) was significantly associated with lower hospital mortality rates. Our findings suggest EN as the preferred feeding route for critically ill patients with shock.
Conclusions
Increased caloric intake through EN may be associated with lower hospital mortality rates in patients with candidemia and shock.

Citations

Citations to this article as recorded by

Importance of Enteral Feeding: Enhancing Patient Care through Interventional Radiology
Abdifatah Omar, Hyeonseon Kim, Michelle Mai, Michelle Bae, Aaron Maxwell, Daehee Kim
Seminars in Interventional Radiology.2025; 42(01): 002. CrossRef
The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea
Hyun-Jun Park, Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee
Acute and Critical Care.2025; 40(2): 304. CrossRef

Review Article

Basic science and research
Critical illness-related corticosteroid insufficiency: latest pathophysiology and management guidelines: Fremita Chelsea Fredrick, Anish Kumar Reddy Meda, Bhupinder Singh, Rohit Jain; Acute Crit Care. 2024;39(3):331-340. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00647

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Abstract PDF

Intensive care unit (ICU) admissions in the United States exceed 5.7 million annually, often leading to complications such as post-intensive care syndrome and high mortality rates. Among these challenges, critical illness-related corticosteroid insufficiency (CIRCI) requires emphasis due to its complex, multiple-cause pathophysiology and varied presentations. CIRCI, characterized by adrenal insufficiency during critical illness, presents in up to 30% of ICU patients and may manifest as an exaggerated inflammatory response. Factors such as dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, altered cortisol metabolism, tissue corticosteroid resistance, and drug-induced suppression contribute to CIRCI. Diagnosis is a complex process, relying on a comprehensive assessment including clinical presentation, laboratory findings, and dynamic stimulatory testing. Treatment involves intensive medical care and exacting glucocorticoid therapy. Recent guidelines advocate for individualized approaches tailored to patient presentation and etiology. Understanding the pathophysiology and treatment of CIRCI is vital for clinicians managing critically ill patients and striving to improve outcomes. This research paper aims to explore the latest developments in the pathophysiology and management of CIRCI.

Citations

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Sepsis-associated encephalopathy: Unraveling molecular mechanisms, emerging therapeutics, and translational frontiers
Xinlong Zhang, Kaizong Huang, Zixin Wu, Rui Ding, Junming Han, Yuan Zhang, Yaping Lu, Yingmei Lu, Yanna Si
Pharmacology & Therapeutics.2026; 278: 108971. CrossRef
Physiological Influence of Licorice Extract on Some Hormonal and Biochemical Parameters Alterations Induced by Glucocorticoid in Male Rats
Sohier Syame, Safinaz Badie
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Adrenal Insufficiency After Glucocorticoid Use in the Pediatric Intensive Care Unit
Ashley N. Radig, Vanessa A. Curtis, Erik Westlund, Christina L. Cifra
Journal of Intensive Care Medicine.2025; 40(12): 1285. CrossRef
Recognizing and managing critical illness-related corticosteroid insufficiency in pediatric critical care
Ja Hye Kim
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A consensus blood transcriptomic framework for sepsis
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Cortisol Testing in Septic Shock: An Evaluation of Diagnostic Performance and Predictors of Corticosteroid Use in a Middle Eastern Cohort
Fayez Alshamsi, Saeed Alkaabi, Maryam Nasser Mohamedali Alfadli, Naser Abdulla Naser Salem Alshkeili, Sultan Majed Ibrahim Alhosani, Adnan Agha
Diagnostics.2025; 15(20): 2588. CrossRef

Guideline

Pulmonary
Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines: Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park; Acute Crit Care. 2024;39(1):1-23. Published online February 28, 2024; DOI: https://doi.org/10.4266/acc.2024.00052

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Abstract PDF Supplementary Material

Background
Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator.
Methods
Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations.
Results
Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation.
Conclusions
We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.

Citations

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Comparison of programmed sedation care with conventional care in patients receiving mechanical ventilation for acute respiratory failure
Jiantang Wang, Yuntao Li, Yujuan Han, Xinyu Yuan
Irish Journal of Medical Science (1971 -).2025; 194(1): 289. CrossRef
Clinical predictors of extubation failure in postoperative critically ill patients: a post-hoc analysis of a multicenter prospective observational study
Jun Hattori, Aiko Tanaka, Junko Kosaka, Osamu Hirao, Nana Furushima, Yuichi Maki, Daijiro Kabata, Akinori Uchiyama, Moritoki Egi, Hiroshi Morimatsu, Satoshi Mizobuchi, Yoshifumi Kotake, Ayumi Shintani, Yukiko Koyama, Takeshi Yoshida, Yuji Fujino
BMC Anesthesiology.2025;[Epub] CrossRef
Comparison of High Versus Low Positive End-Expiratory Pressure in Mechanically Ventilated Patients With Acute Heart Failure: Rationale and Design of the HELP-AHF Trial
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International Journal of Heart Failure.2025; 7(2): 79. CrossRef
RELAÇÃO DA FORÇA MUSCULAR PERIFÉRICA COM O DESMAME DA VENTILAÇÃO MECÂNICA
Débora Rillary Duarte Filho, Gabriella Schultz Malagute, Luciana Ferreira Rihs, Priscila Corrêa Cavalcanti
Revista Saúde Dos Vales.2024;[Epub] CrossRef

Review Articles

Meta-analysis
The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials: Yerkin Abdildin, Karina Tapinova, Assel Nemerenova, Dmitriy Viderman; Acute Crit Care. 2024;39(1):34-46. Published online February 28, 2024; DOI: https://doi.org/10.4266/acc.2023.00829

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Abstract PDF

Background
This meta-analysis aims to evaluate the effects of ketamine in critically ill intensive care unit (ICU) patients.
Methods
We searched for randomized controlled trials (RCTs) in PubMed, Scopus, and the Cochrane Library; the search was performed initially in January but was repeated in December of 2023. We focused on ICU patients of any age. We included studies that compared ketamine with other traditional agents used in the ICU. We synthesized evidence using RevMan v5.4 and presented the results as forest plots. We also used trial sequential analysis (TSA) software v. 0.9.5.10 Beta and presented results as TSA plots. For synthesizing results, we used a random-effects model and reported differences in outcomes of two groups in terms of mean difference (MD), standardized MD, and risk ratio with 95% confidence interval. We assessed the risk of bias using the Cochrane RoB tool for RCTs. Our outcomes were mortality, pain, opioid and midazolam requirements, delirium rates, and ICU length of stay.
Results
Twelve RCTs involving 805 ICU patients (ketamine group, n=398; control group, n=407) were included in the meta-analysis. The ketamine group was not superior to the control group in terms of mortality (in five studies with 318 patients), pain (two studies with 129 patients), mean and cumulative opioid consumption (six studies with 494 patients), midazolam consumption (six studies with 304 patients), and ICU length of stay (three studies with 270 patients). However, the model favored the ketamine group over the control group in delirium rate (four studies with 358 patients). This result is significant in terms of conventional boundaries (alpha=5%) but is not robust in sequential analysis. The applicability of the findings is limited by the small number of patients pooled for each outcome.
Conclusions
Our meta-analysis did not demonstrate differences between ketamine and control groups regarding any outcome except delirium rate, where the model favored the ketamine group over the control group. However, this result is not robust as sensitivity analysis and trial sequential analysis suggest that more RCTs should be conducted in the future.

Citations

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Ketamine use in adult intensive care unit: a narrative review of emerging applications, efficacy challenges, and safety concerns
Siyao Zeng, Zhipeng Yao, Chunming Guan, Shanpeng Cui, Zhen Quan, Yue Li, Junbo Zheng, Hongliang Wang
Emergency and Critical Care Medicine.2025; 5(3): 153. CrossRef
The effect of low-dose ketamine compared to morphine on the severity of acute pain in emergency situations: a systematic review and meta-analysis
Jun Zhang, Bin Ma
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2025;[Epub] CrossRef
Sedation and analgesia strategies in the neuro intensive care unit
Zachary I Merhavy, Tereque Raeburn, Gloria M Torres-Ayala, Melissa A McCulloch, Thomas C Varkey
World Journal of Critical Care Medicine.2025;[Epub] CrossRef
Ketamine sedation in critically ill patients: Past, present and future
Sameer Sharif, Jay Prakash, Bram Rochwerg
Indian Journal of Anaesthesia.2024; 68(8): 674. CrossRef
Opioid-Free Using Ketamine versus Opioid-Sparing Anesthesia during the Intraoperative Period in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial
Hoon Choi, Jaewon Huh, Minju Kim, Seok Whan Moon, Kyung Soo Kim, Wonjung Hwang
Journal of Personalized Medicine.2024; 14(8): 881. CrossRef

Surgery
Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review: Hanan Elkalawy, Pavan Sekhar, Wael Abosena; Acute Crit Care. 2023;38(4):409-424. Published online November 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00703

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Abstract PDF

Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

Citations

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Nursing-based precision assessment of nutrition and muscle status without ultrasound: a prospective observational study in mechanically ventilated neurosurgical patients
Chenliang Pan, Dingding Xu, Zixin Wang, Jia Wen, Lili Ma, Yajuan Zhang
Frontiers in Medicine.2026;[Epub] CrossRef
Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients
Ana Maria Dumitriu, Cristian Cobilinschi, Bogdan Dumitriu, Sebastian Vâlcea, Raluca Ungureanu, Angela Popa, Rǎzvan Ene, Radu Țincu, Ioana Marina Grințescu, Liliana Mirea
Nutrients.2025; 17(3): 380. CrossRef
Potential diagnostic tools for intensive care unit acquired weakness: A systematic review
Chen Xin, Yubiao Gai, Lili Wei, Yanqiu Wang, Yuhong Luo, Binru Han
International Journal of Nursing Studies Advances.2025; 8: 100301. CrossRef
Relação entre a perda de massa magra, força muscular e capacidade funcional de pacientes críticos vítimas de trauma
Tamine Vitória Pereira Moraes, Renato Valduga , Priscilla Flávia de Melo Fernandes, Guilherme Duprat Ceniccola
Health Residencies Journal.2025;[Epub] CrossRef
Development and validation of machine learning-based risk prediction models for ICU-acquired weakness: a prospective cohort study
Yimei Zhang, Yu Wang, Jingran Yang, Qinglan Li, Min Zhou, Jiafei Lu, Qiulan Hu, Fang Ma
European Journal of Medical Research.2025;[Epub] CrossRef
Diagnostic Innovations to Combat Antibiotic Resistance in Critical Care: Tools for Targeted Therapy and Stewardship
Ahmed D. Alatawi, Helal F. Hetta, Mostafa A. Sayed Ali, Yasmin N. Ramadan, Amirah B. Alaqyli, Wareef K. Alansari, Nada H. Aldhaheri, Talidah A. Bin Selim, Shahad A. Merdad, Maram O. Alharbi, Wejdan Alhumaidi Hmdan Alatawi, Abdelazeem M. Algammal
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Early skeletal muscle loss and clinical outcomes in critically ill patients in the medical intensive care unit: A retrospective cohort study
Soyun Kim, Da Hyun Kang, Dukki Kim, Soyoung Ahn, Mi Ra Lee, Song Lee, Masoud Rahmati
PLOS One.2025; 20(12): e0338315. CrossRef
The role of bioimpedance in determining protein intake after ICU care
Cristian Deana, Alessia Marin, Michele Umbrello, Daniele Guerino Biasucci, Laura Di Meo, Luigi Vetrugno
Clinical Nutrition Open Science.2025; 64: 230. CrossRef
Characteristics of the Cerebrospinal Fluid in Septic Patients with Critical Illness Polyneuropathy - A Retrospective Cohort Study
Yanyang Zhang, Jinfu Ma, Qing Zhao, Hui Liu
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Construction and evaluation of acquired weakness nomogram model in patients with mechanical ventilation in intensive care unit
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Original Articles

Gastroenterology
The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients: Rahul Sharma, Ravi Kant Dogra, Jyoti Pathania, Arti Sharma; Acute Crit Care. 2023;38(1):134-141. Published online February 22, 2023; DOI: https://doi.org/10.4266/acc.2022.00955

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Abstract PDF

Background
Although gastric reserve volume (GRV) is a surrogate marker of gastrointestinal dysfunction and feeding intolerance, there is ambiguity in its estimation due to problems associated with its measurement. Introduction of point-of-care ultrasound as a tool for anesthetists kindled interest in its use for GRV estimation.
Methods
In this prospective observational study, we recruited 57 critically ill patients and analyzed 586 samples of GRV obtained by both ultrasonography (USG) and manual aspiration.
Results
The analysis showed that USG-guided GRV was significantly correlated (r=0.788, P<0.001) and in positive agreement with manual aspiration based on Bland-Altman plot, with a mean difference of 8.50±14.84 (95% confidence interval, 7.389–9.798). The upper and lower limits of agreement were 37.7 and –20.5, respectively, within the ±1.96 standard deviation (P<0.001). The respective sensitivity and positive predictive value, specificity and negative predictive value, and area under the curve of USG for feeding intolerance were 66.67%, 98.15%, and 0.82%, with 96.49% diagnostic accuracy.
Conclusions
Ultrasonographic estimation of GRV was positively, significantly correlated and in agreement with the manual aspiration method and estimated feeding intolerance earlier. Routine use of gastric USG could avoid clinical situations where feeding status is unclear and there is high risk of aspiration and could become a standard practice of critical care.

Citations

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Assessing gastrointestinal system dysfunction in intensive care
Kaspar F. Bachmann, Varsha M. Asrani, Annika Reintam Blaser
Current Opinion in Critical Care.2025; 31(2): 172. CrossRef
Interoperator reproducibility of ultrasound assessment of gastric residual volume in critically Ill patients
Mahmoud M.A. Mohamed, Aya M.A.A. Galeel, Mohamed A. Megahed, Dina H.E. Zidan
Research and Opinion in Anesthesia & Intensive Care.2025; 12(3): 263. CrossRef
Correlación de volumen residual gástrico medido y ultrasonido gástrico para identificar intolerancia gástrica en pacientes neurocríticos con nutrición enteral en la unidad de cuidados intensivos
Mauricio Pérez-Macías, Roxana Vázquez-Ramírez, Marcela Pinedo-Lechuga
Medicina Crítica.2024; 38(2): 102. CrossRef
Is pre-extubation fasting in ICU justified? Insights from a prospective observational study using gastric ultrasound
Mohd Saif Khan, Barun Ram, Amit Kumar, Kamel Bousselmi, Priyesh Kumar, Dumini Soren, Priyanka Shrivastava, Naveen Kumar
Trends in Anaesthesia and Critical Care.2024; 58: 101497. CrossRef
Early initiation of gastric tube feeding: ultrasound assessment. A prospective interventional study
Islam M. Elbardan, Ahmed A. Alla Ossman, Nada El Kayal, Assem A. ElRazek Abd-Rabih
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Gastrointestinal function in critically ill patients
Annika Reintam Blaser, Kaspar F. Bachmann, Adam M. Deane
Current Opinion in Clinical Nutrition & Metabolic Care.2023; 26(5): 463. CrossRef

Liver
Alcohol use disorder in the intensive care unit a highly morbid condition, but chemical dependency discussion improves outcomes: Kristin Colling, Alexandra K. Kraft, Melissa L. Harry; Acute Crit Care. 2023;38(1):122-133. Published online January 10, 2023; DOI: https://doi.org/10.4266/acc.2022.00584

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Abstract PDF

Background
Alcohol use disorders (AUD) are common in patients admitted to intensive care units (ICU) and increase the risk for worse outcomes. In this study, we describe factors associated with patient mortality after ICU admission and the effect of chemical dependency (CD) counseling on outcomes in the year following ICU admission.
Methods
We retrospectively reviewed patient demographics, hospital data, and documentation of CD counseling by medical providers for all ICU patients with AUD admitted to our institution between January 2017 and March 2019. Primary outcomes were in-hospital and 1-year mortality.
Results
Of the 527 patients with AUD requiring ICU care, median age was 56 years (range, 18–86). Both in-hospital (12%) and 1-year mortality rates (27%) were high. Rural patients, comorbidities, older age, need for mechanical ventilation, and complications were associated with increased risk of in-hospital and 1-year mortality. CD counseling was documented for 73% of patients, and 50% of these patients accepted alcohol treatment or resources prior to discharge. CD evaluation and acceptance was associated with a significantly decreased rate of readmission for liver or alcohol-related issues (36% vs. 58%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.27–0.61) and 1-year mortality (7% vs. 19.5%; OR, 0.32; 95% CI, 0.16–0.64). CD evaluation alone, regardless of patient acceptance, was associated with a significantly decreased 1-year post-discharge mortality rate (12% vs. 23%; OR, 0.44; 95% CI, 0.25–0.77).
Conclusions
ICU patients with AUD had high in-hospital and 1-year mortality. CD evaluation, regardless of patient acceptance, was associated with a significant decrease in 1-year mortality

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Meta-analysis
Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study: Heemoon Park, Sung Yoon Lim, Sebin Kim, Hyung-Sook Kim, Soyeon Kim, Ho Il Yoon, Young-Jae Cho; Acute Crit Care. 2022;37(3):382-390. Published online July 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00220

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Background
Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes.
Methods
This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22).
Results
In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044).
Conclusions
The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.

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Neurology
Muscle Growth and Anabolism in Intensive Care Survivors (GAINS) trial: a pilot randomised controlled trial: Matthew H Anstey, Rashmi Rauniyar, Ethan Fitzclarence, Natalie Tran, Emma Osnain, Bianca Mammana, Angela Jacques, Robert N Palmer, Andrew Chapman, Bradley Wibrow; Acute Crit Care. 2022;37(3):295-302. Published online June 27, 2022; DOI: https://doi.org/10.4266/acc.2021.01767

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Background
To explore the feasibility, safety, and potential benefits of administration of the anabolic steroid nandrolone to patients in the recovery phase from critical illness weakness.
Methods
In this phase II, double blind, randomized, controlled trial, adult critically ill patients admitted to one of two tertiary Intensive Care Units in Western Australia for longer than 7 days with significant weakness were enrolled. Patients received nandrolone (200 mg males, 100 mg females) intramuscularly or placebo weekly for up to 3 weeks in addition to standard care. The primary outcome measures were improvement in grip strength, Medical Research Council muscle strength sum score, and functional activity level (Chelsea critical care assessment tool [CPAx]).
Results
A total of 22 patients was enrolled between September 2017 and May 2019. No significant adverse events were detected. Median grip strength change was non-significantly greater in the nandrolone group (8.5 vs. 13.0, P=0.185), while hospital length of stay (36 vs. 26 days, P=0.023) and duration of mechanical ventilation (377 vs. 168, P=0.032) were lower. The discharge CPAx and intensive care unit mobility scores were higher in the nandrolone group, although there was no difference in the change in CPAx score (17.0 vs. 17.7, P=0.865). There were no changes in ultrasound-detected muscle thickness between the two groups.
Conclusions
In patients with prolonged critical illness, nandrolone appears to be safe. However, a larger study, potentially combined with resistance exercise, is needed to definitively address the potential benefits of nandrolone.

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High vs low protein intake in chronic critical illness: A systematic review and meta-analysis
Sílvia Castro, A. Tomé, C. Granja, A. Macedo, A. Binnie
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Muscle growth and anabolism in intensive care survivors (GAINS 2.0): Protocol for a multi-centre randomised; placebo controlled clinical trial of nandrolone in deconditioned adults recovering from critical illness
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Infection
Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review: Sofia R. Valdoleiros, Cristina Torrão, Laura S. Freitas, Diana Mano, Celina Gonçalves, Carla Teixeira; Acute Crit Care. 2022;37(1):61-70. Published online January 26, 2022; DOI: https://doi.org/10.4266/acc.2021.01151

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Background
Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU).
Methods
A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines.
Results
An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality.
Conclusions
Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.

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Ethics
Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission: Youjin Chang, Kyoung Ran Kim, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim; Acute Crit Care. 2021;36(4):351-360. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00283

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Background
It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception.
Methods
A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state.
Results
A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group were 64%, 22%, and 57%, respectively; their 6-month mortality rates were 100%, 46%, and 81%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3, odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892–8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260–19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162–17.121; P=0.029).
Conclusions
The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization.

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Review Article

Epidemiology
Influence of sarcopenia focused on critically ill patients: Belgin Akan; Acute Crit Care. 2021;36(1):15-21. Published online February 2, 2021; DOI: https://doi.org/10.4266/acc.2020.00745

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A systemic review was performed to evaluate the epidemiological, pathophysiological, and clinical features of sarcopenia, the relationship of sarcopenia with critical illness and its impact on mortality, and diagnostic methods and treatment modalities. Generally, in the presence of critical illness, sarcopenia is not included in the treatment approach strategies. An intensivist should be aware that sarcopenia may be present in critically ill patients. Although the main modalities against sarcopenia are early mobilization and nutritional support, they can only prevent its development and may have positive effects on prognosis rather than treating the existing sarcopenia.

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Original Articles

Infection
Risk factors for intensive care unit admission and mortality in hospitalized COVID-19 patients: Ahmed Ayaz, Ainan Arshad, Hajra Malik, Haris Ali, Erfan Hussain, Bushra Jamil; Acute Crit Care. 2020;35(4):249-254. Published online November 11, 2020; DOI: https://doi.org/10.4266/acc.2020.00381

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Background
This study investigated the clinical features and outcome of hospitalized coronavirus disease 2019 (COVID-19) patients admitted to our quaternary care hospital.
Methods
In this retrospective cohort study, we included all adult patients with COVID-19 infection admitted to a quaternary care hospital in Pakistan from March 1 to April 15, 2020. The extracted variables included demographics, comorbidities, presenting symptoms, laboratory tests and radiological findings during admission. Outcome measures included in-hospital mortality and length of stay.
Results
Sixty-six COVID-19 patients were hospitalized during the study period. Sixty-one percent were male and 39% female; mean age was 50.6±19.1 years. Fever and cough were the most common presenting symptoms. Serial chest X-rays showed bilateral pulmonary opacities in 33 (50%) patients. The overall mortality was 14% and mean length of stay was 8.4±8.9 days. Ten patients (15%) required intensive care unit (ICU) care during admission, of which six (9%) were intubated. Age ≥60 years, diabetes, ischemic heart disease, ICU admission, neutrophil to lymphocyte ratio ≥3.3, and international normalized ratio ≥1.2 were associated with increased risk of mortality.
Conclusions
We found a mortality rate of 14% in hospitalized COVID-19 patients. COVID-19 cases are still increasing exponentially around the world and may overwhelm healthcare systems in many countries soon. Our findings can be used for early identification of patients who may require intensive care and aggressive management in order to improve outcomes.

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Pulmonary
Clinical characteristics and outcomes of critically Ill patients with COVID-19 in Northeast Ohio: low mortality and length of stay: Francois Abi Fadel, Mohammed Al-Jaghbeer, Sany Kumar, Lori Griffiths, Xiaofeng Wang, Xiaozhen Han, Robert Burton; Acute Crit Care. 2020;35(4):242-248. Published online October 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00619

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Abstract PDF

Background
Published coronavirus disease 2019 (COVID-19) reports suggest higher mortality with increasing age and comorbidities. Our study describes the clinical characteristics and outcomes for all intensive care unit (ICU) patients admitted across the Cleveland Clinic enterprise, a 10-hospital health care system in Northeast Ohio, serving more than 2.7 million people.
Methods
We analyzed the quality data registry for clinical characteristics and outcomes of all COVID-19-confirmed ICU admissions. Differences in outcomes from other health care systems and published cohorts from other parts of the world were delineated.
Results
Across our health care system, 495 COVID-19 patients were admitted from March 15 to June 1, 2020. Mean patient age was 67.3 years, 206 (41.6%) were females, and 289 (58.4%) were males. Mean Acute Physiology Score was 45.3, and mean Acute Physiology and Chronic Health Evaluation III score was 60.5. In total, 215 patients (43.3%) were intubated for a mean duration of 9.2 days. Mean ICU and hospital length of stay were 7.4 and 13.9 days, respectively, while mean ICU and hospital mortality rates were 18.4% and 23.8%.
Conclusions
Our health care system cohort is the fourth largest to be reported. Lower ICU and hospital mortality and length of stay were seen compared to most other published reports. Better preparedness and state-level control of the surge in COVID-19 infections are likely the reasons for these better outcomes. Future research is needed to further delineate differences in mortality and length of stay across health care systems and over time.

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Review Article

Pulmonary
Pulmonary and Physical Rehabilitation in Critically Ill Patients: Myung Hun Jang, Myung-Jun Shin, Yong Beom Shin; Acute Crit Care. 2019;34(1):1-13. Published online February 28, 2019; DOI: https://doi.org/10.4266/acc.2019.00444

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Abstract PDF

Some patients admitted to the intensive care unit (ICU) because of an acute illness, complicated surgery, or multiple traumas develop muscle weakness affecting the limbs and respiratory muscles during acute care in the ICU. This condition is referred to as ICU-acquired weakness (ICUAW), and can be evoked by critical illness polyneuropathy (CIP), critical illness myopathy (CIM), or critical illness polyneuromyopathy (CIPNM). ICUAW is diagnosed using the Medical Research Council (MRC) sum score based on bedside manual muscle testing in cooperative patients. The MRC sum score is the sum of the strengths of the 12 regions on both sides of the upper and lower limbs. ICUAW is diagnosed when the MRC score is less than 48 points. However, some patients require electrodiagnostic studies, such as a nerve conduction study, electromyography, and direct muscle stimulation, to differentiate between CIP and CIM. Pulmonary rehabilitation in the ICU can be divided into modalities intended to remove retained airway secretions and exercise therapies intended to improve respiratory function. Physical rehabilitation, including early mobilization, positioning, and limb exercises, attenuates the weakness that occurs during critical care. To perform mobilization in mechanically ventilated patients, pretreatment by removing secretions is necessary. It is also important to increase the strength of respiratory muscles and to perform lung recruitment to improve mobilization in patients who are weaned from the ventilator. For these reasons, pulmonary rehabilitation is important in addition to physical therapy. Early recognition of CIP, CIM, and CIPNM and early rehabilitation in the ICU might improve patients’ functional recovery and outcomes.

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Original Articles

Basic science and research
Prognostic Implication of Adrenocortical Response during the Course of Critical Illness: Jin Hwa Song, Jung Hee Kim, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2019;34(1):38-45. Published online January 30, 2019; DOI: https://doi.org/10.4266/acc.2018.00339

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Background
Critical illness-related corticosteroid insufficiency (CIRCI) and adrenocorticotropic hormone (ACTH)-cortisol dissociation are hormonal conditions frequently observed in patients in the intensive care unit (ICU). The aim of this study was to evaluate the association between ACTH-cortisol dissociation and clinical outcomes of critically ill patients. Methods: We retrospectively reviewed the medical records of 94 ICU patients who underwent two rapid cosyntropin tests during hospital admission and compared the clinical aspects of patients with and without ACTH-cortisol dissociation. ACTH-cortisol dissociation was defined as plasma ACTH and serum cortisol concentrations of <22 pmol/L and >600 nmol/L, respectively. Results: Dissociation was present in 30 of the 94 patients (31.9%). Patients with ACTH-cortisol dissociation in the initial test had significantly higher hospital mortality rate than those in the control group (55% vs. 25.7%, P=0.013) There was no difference in hospital mortality between patients classified as having CIRCI and those who were not. In multivariate adjusted Cox regression analysis, the mortality risk was higher in the group with ACTH-cortisol dissociation (hazard ratio, 2.98; 95% confidence interval, 1.34 to 6.63; P=0.007). Patients with dissociation in two consecutive stimulation tests showed the highest hospital mortality rate among groups classified according to stimulation test results (100% vs. 31.3%). Conclusions: The hospital mortality was higher in ICU patients diagnosed with ACTH-cortisol dissociation. It is clinically feasible to evaluate the presence of ACTH-cortisol dissociation by analyzing rapid ACTH stimulation test results in critically ill patients.

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Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients
Wen Xu, Yuzhen Qiu, Hongping Qiu, Ming Zhong, Lei Li
International Journal of General Medicine.2024; Volume 17: 127. CrossRef
PROGNOSTIC VALUE OF LOW-DOSE ADRENOCORTICOTROPIC HORMONE TEST IN CRITICALLY ILL PATIENTS
Ahmad B. Abdelrehim, Fatma M. Mohsen, Mostafa A. Haredi, Zeinab Abdel Hameed, Walaa H. Ibrahim
Shock.2023; 59(6): 871. CrossRef
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Lilian Rodrigues Henrique, Daisy Crispim, Tarsila Vieceli, Ariell Freires Schaeffer, Priscila Bellaver, Cristiane Bauermann Leitão, Tatiana Helena Rech, Antonio Palazón-Bru
PLOS ONE.2021; 16(4): e0250035. CrossRef
Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients
Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee
Acute and Critical Care.2020; 35(3): 149. CrossRef

Neurology
The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study: Jaesub Park, Seung-Taek Oh, Sunyoung Park, Won-Jung Choi, Cheung Soo Shin, Se Hee Na, Jae-Jin Kim, Jooyoung Oh, Jin Young Park; Acute Crit Care. 2018;33(1):23-33. Published online February 6, 2018; DOI: https://doi.org/10.4266/acc.2017.00584

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Background
Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient’s clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown.
Methods
The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation.
Results
There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor’s mental health, was significantly reduced and pain tended to decrease.
Conclusions
Increasing the physician’s awareness of the patient’s mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

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Adaptation and Validation of a Chart‐Based Delirium Detection Tool for the ICU (CHART‐DEL‐ICU)
Karla D. Krewulak, Carmen Hiploylee, E. W. Ely, Henry T. Stelfox, Sharon K. Inouye, Kirsten M. Fiest
Journal of the American Geriatrics Society.2021; 69(4): 1027. CrossRef

Review Article

Pulmonary
Patient-Ventilator Dyssynchrony: Elvira-Markela Antonogiannaki, Dimitris Georgopoulos, Evangelia Akoumianaki; Korean J Crit Care Med. 2017;32(4):307-322. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00535

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In mechanically ventilated patients, assisted mechanical ventilation (MV) is employed early, following the acute phase of critical illness, in order to eliminate the detrimental effects of controlled MV, most notably the development of ventilator-induced diaphragmatic dysfunction. Nevertheless, the benefits of assisted MV are often counteracted by the development of patient-ventilator dyssynchrony. Patient-ventilator dyssynchrony occurs when either the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration, respectively, or if the magnitude of mechanical assist does not respond to the patient’s respiratory demand. As patient-ventilator dyssynchrony has been associated with several adverse effects and can adversely influence patient outcome, every effort should be made to recognize and correct this occurrence at bedside. To detect patient-ventilator dyssynchronies, the physician should assess patient comfort and carefully inspect the pressure- and flow-time waveforms, available on the ventilator screen of all modern ventilators. Modern ventilators offer several modifiable settings to improve patient-ventilator interaction. New proportional modes of ventilation are also very helpful in improving patient-ventilator interaction.

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Computer Methods and Programs in Biomedicine.2026; 275: 109203. CrossRef
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Mauro Robertino Del Bono, Luis Felipe Damiani, Gustavo Adrián Plotnikow, Sebastián Consalvo, Emanuel Di Salvo, Gastón Murias
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Computer Methods and Programs in Biomedicine.2025; 263: 108680. CrossRef
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Deepak K. Agrawal, Bradford J. Smith, Peter D. Sottile, George Hripcsak, David J. Albers
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The authors respond
Bruno V Pinheiro, Júlia R Silva, Maycon M Reboredo
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Original Article

Nephrology
Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study: Ki Hyun Park, Jung-ho Shin, Jin Ho Hwang, Su Hyun Kim; Korean J Crit Care Med. 2017;32(3):256-264. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00136

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Abstract PDF

Background
Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT. Methods: A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status. Results: A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037). Conclusions: Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.

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Yoon Ji Chung, Eun Young Kim
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Janne M. Madsen, Sine Wichmann, Morten H. Bestle, Theis S. Itenov
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Hanneke Pierre Franciscus Xaverius Moonen, Arthur Raymond Hubert Van Zanten
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Hepatocyte growth factor and soluble cMet levels in plasma are prognostic biomarkers of mortality in patients with severe acute kidney injury
Lilin Li, Jung Nam An, Jeonghwan Lee, Dong Jin Shin, Shi Mao Zhu, Jin Hyuk Kim, Dong Ki Kim, Dong-Ryeol Ryu, Sejoong Kim, Jung Pyo Lee
Kidney Research and Clinical Practice.2021; 40(4): 596. CrossRef
Wireless, Artefact Aware Impedance Sensor Node for Continuous Bio-Impedance Monitoring
Kanika Dheman, Philipp Mayer, Michele Magno, Simone Schuerle
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Usefulness of Bioelectrical Impedance Analysis as a Guidance of Fluid Management in Critically Ill Patients after Major Abdomen Surgery; a Single Center, Prospective Cohort Study
Yoon Ji Chung, Eun Young Kim
Surgical Metabolism and Nutrition.2020; 11(2): 53. CrossRef
Update on body composition tools in clinical settings: computed tomography, ultrasound, and bioimpedance applications for assessment and monitoring
Kathleen L. Price, Carrie P. Earthman
European Journal of Clinical Nutrition.2019; 73(2): 187. CrossRef
Relative Association of Overhydration and Muscle Wasting with Mortality in Hemodialysis Patients: Assessment by Bioelectrical Impedance Analysis
Eunju Kim, Sang Oh Seo, Yu Bum Choi, Mi Jung Lee, Jeong Eun Lee, Hyung Jong Kim
The Korean Journal of Medicine.2018; 93(6): 548. CrossRef

Case Reports

Surgery
Critical Illness Neuromyopathy Complicating Cardiac Surgery: Wan Ki Baek, Young Sam Kim, Joung Taek Kim, Byoung-Nam Yoon; Acute Crit Care. 2018;33(1):51-56. Published online July 11, 2017; DOI: https://doi.org/10.4266/acc.2016.00255

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Abstract PDF

Critical illness neuromyopathy (CINM) is a sporadically reported disease in the setting of an intensive care unit developing in the process of managing a critical illness. The disease primarily affects the motor and sensory axons and results in severe limb weakness rendering ventilator weaning extremely difficult. We report a case of CINM after cardiac valve surgery. Quadriplegia developed after the operation and resolved slowly over the following 2 months. The patient was discharged home free of neurologic symptoms.

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Ji Min Lee, Seon Yeong Heo, Dong Kyu Kim, Jong Pil Jung, Chang Ryul Park, Yong Jik Lee, Gwan Sic Kim
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Infection
Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient: Eunmi Gil, Tae Sun Ha, Gee Young Suh, Chi Ryang Chung, Chi-Min Park; Korean J Crit Care Med. 2016;31(2):129-133. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.129; Correction in: Acute Crit Care 2016;31(3):263

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Abstract PDF

Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.

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Aspergillus fumigatus cholangitis in a patient with cholangiocarcinoma: case report and review of the literature
Kathrin Rothe, Sebastian Rasch, Nina Wantia, Alexander Poszler, Joerg Ulrich, Christoph Schlag, Wolfgang Huber, Roland M. Schmid, Dirk H. Busch, Tobias Lahmer
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Original Article

Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study: Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin; Korean J Crit Care Med. 2012;27(3):157-164.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.157

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Abstract PDF

BACKGROUND
Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes.
METHODS
This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition.
RESULTS
According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.

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H J Jo, D B Shin, B K Koo, E S Ko, H J Yeo, W H Cho
European Journal of Clinical Nutrition.2017; 71(11): 1360. CrossRef
The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
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Review Article

Hormonal Changes in Critical Condition: Heung Bum Lee, Chi Ryang Chung; Korean J Crit Care Med. 2010;25(3):123-129.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.123

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Abstract PDF

When disease or trauma progresses to a critical state, the reaction of the endocrine system in creating homeostasis is essential for survival. The association between the severity of hormonal changes and outcome in terms of morbidity and mortality has led to the challenge of development of several endocrine treatments. During sepsis, nitric oxide-mediated apoptosis is observed in the neurons and glial cells of the cerebrovascular centers of the autonomic nervous system. It is probably one of the components of the circulatory dysfunction of sepsis. The regulation of different organs was neither linear nor independent however organs were found to behave as biological oscillators coupled to each other through neurological or hormonal communication pathways. Sepsis, because of systemic inflammatory responsive syndrome, disrupts these communication pathways and leads to organ failures. Endocrine hormonal issues related to the intensive care setting are common challenges to ICU specialists. Disruptions of the endocrine system in sepsis are characterized by 1) an increase in cortisol plasma levels with a loss of the circadian rhythm of its secretion; 2) hyperglycemia due to insulin resistance and rise in hyperglycemic hormones secretion; 3) relative vasopressin deficiency; and 4) euthyroid sick syndrome or non-thyroidal illness syndrome. This article discusses the dynamic changes of four main endocrine axes: hypothalamic-pituitary-adrenal axis, insulin, vasopressin and thyroid during grave states of disease, when a patient is in critical condition.

Citations

Citations to this article as recorded by

The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia
Ki Tae Kim, Byung Kook Lee, Hyoung Youn Lee, Geo Sung Lee, Yong Hun Jung, Kyung Woon Jeung, Hyun Ho Ryu, Byoeng Jo Chun, Jeong Mi Moon
Korean Journal of Critical Care Medicine.2012; 27(4): 255. CrossRef

Case Report

Clinical Experience of the Lower Extremity Nerve Block for a Neurocritically Ill Patient Who is Not Able to Communicate:A Case Report: Jun Rho Yoon, Tae Kwan Kim, Je Chun Yu, Yee Suk Kim, In Soo Han, Yong Ju Oh; Korean J Crit Care Med. 2007;22(1):48-51.

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Abstract PDF: A 73-year-old man was scheduled for the surgical reduction of fractured femur which occurred ar 3 months ago by the accident. The mental status of the patient was stuporous (Glasgow coma scale: 5) due to the complication of the head trauma. We performed nerve blocks (femoral, sciatic, lateral femoral cutaneous, and illiohypogastric nerve blocks) for the surgical reduction of left femur with 55 ml of 0.25% ropivacaine. The electroencephalography was monitored continuously during the 4 hour operation as well as monitoring the hemodynamic and respiratory parameters. The operation was performed successfully and the patient recovered uneventfully.

Original Article

Clinical Findings of Critical Illness Polyneuropathy in Patients with Mechanical Ventilator Treatment: Sung Soon Lee, Jae Yong Chin, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2005;20(1):38-43.

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Abstract PDF: BACKGROUND
Critical illness polyneuropathy (CIP) is a primary distal axonal degeneration of motor and sensory fibers leading to severe limb weakness and difficulty in weaning from ventilator in critically ill patients. The object of this study is to evaluate the clinical findings of CIP and the risk factors associated with CIP development in patients with mechanical ventilator treatment. METHODS: We examined 40 patients, between March 2002 to February 2003, who manifested muscular weakness and received mechanical ventilation (MV) more than three days, prospectively. Nerve conduction velocity (NCV) and electromyography (EMG) were performed in all patients in the ICU. We examined the use of drugs (neuromuscular blocking agents, corticosteroid, and aminoglycoside), duration of MV and weaning, and APACHE II score. RESULTS: We observed 40 patients who showed muscular weakness, 9 patients were diagnosed as CIP. NCV study demonstrated decreased action potential amplitude, predominantly in motor nerve, distal part. There was no significant difference in duration of MV and weaning, drug use, APACHE II score between the groups with CIP and without CIP. CONCLUSIONS: CIP is an important neuromuscular complication of the patients in ICU. We should consider the possibility of the development of CIP in patients who showed muscular weakness and difficult weaning in critically ill patients.

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