Acute and Critical Care

Original Articles

Rapid response system
Impact of the National Early Warning Score-based sepsis response system on hospital-onset sepsis in a tertiary hospital in South Korea: Dong-gon Hyun, Sohyeon Lee, Sunhui Choi, Jeongsuk Son, So-Hee Park, Sang-Bum Hong, Chae-Man Lim; Acute Crit Care. 2025;40(2):186-196. Published online May 20, 2025; DOI: https://doi.org/10.4266/acc.000625

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Background
The effectiveness of electronic medical record-based alert systems, response protocols for sepsis diagnosis, and treatment in hospitalized patients remains unclear. This study aimed to determine whether the introduction of an electronic medical record-based sepsis response protocol (SRP) along with a 24/7 operating rapid response system affects the prognosis for patients with hospital-onset sepsis.
Methods
In August 2022, a SRP based on the National Early Warning Score was implemented in the electronic medical record system at Asan Medical Center. We retrospectively analyzed patients screened by the detection system for 1 year after the SRP implementation. Patients of the first 6 months (preliminary group) and those of the second 6 months (SRP group) were matched 1:1 based on propensity scores. The primary outcome was 30-day mortality.
Results
Of the 608 hospitalized patients screened by the system, 176 were assigned to each group after 1:1 propensity score matching. Patients in the SRP group were significantly more likely to receive blood cultures (58.5%) compared with the preliminary group (45.5%) (P=0.019). The SRP group showed a lower 30-day mortality risk (hazard ratio, 0.56; 95% CI, 0.36–0.86; P=0.017) compared to the preliminary group. A restricted cubic spline curve showed that SRP survival benefit began to manifest after the first 4 months (P=0.036).
Conclusions
Alongside an existing rapid response system, the National Early Warning Score-based SRP in the electronic medical record reduced mortality for hospital-onset sepsis within 1 year.

Citations

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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 Le
Acute and Critical Care.2025; 40(3): 413. CrossRef

Epidemiology
Pediatric septic shock estimation using deep learning and electronic medical records: Ji Weon Lee, Bongjin Lee, June Dong Park; Acute Crit Care. 2024;39(3):400-407. Published online August 1, 2024; DOI: https://doi.org/10.4266/acc.2024.00031

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Abstract PDF

Background
Diagnosing pediatric septic shock is difficult due to the complex and often impractical traditional criteria, such as systemic inflammatory response syndrome (SIRS), which result in delays and higher risks. This study aims to develop a deep learning-based model using SIRS data for early diagnosis in pediatric septic shock cases.
Methods
The study analyzed data from pediatric patients (<18 years old) admitted to a tertiary hospital from January 2010 to July 2023. Vital signs, lab tests, and clinical information were collected. Septic shock cases were identified using SIRS criteria and inotrope use. A deep learning model was trained and evaluated using the area under the receiver operating characteristics curve (AUROC) and area under the precision-recall curve (AUPRC). Variable contributions were analyzed using the Shapley additive explanation value.
Results
The analysis, involving 9,616,115 measurements, identified 34,696 septic shock cases (0.4%). Oxygen supply was crucial for 41.5% of the control group and 20.8% of the septic shock group. The final model showed strong performance, with an AUROC of 0.927 and AUPRC of 0.879. Key influencers were age, oxygen supply, sex, and partial pressure of carbon dioxide, while body temperature had minimal impact on estimation.
Conclusions
The proposed deep learning model simplifies early septic shock diagnosis in pediatric patients, reducing the diagnostic workload. Its high accuracy allows timely treatment, but external validation through prospective studies is needed.

Citations

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Comparison of Pediatric Risk of Mortality-III, Phoenix Sepsis, and pediatric Sequential Organ Failure Assessment scores for predicting septic shock in Vietnamese children with sepsis
Khai Quang Tran, Ngan Tuong Thien Pham, Tri Duc Nguyen, Quan Minh Pham
The Brazilian Journal of Infectious Diseases.2026; 30(1): 104612. CrossRef
Aligning prediction models with clinical information needs: infant sepsis case study
Lusha Cao, Aaron J Masino, Mary Catherine Harris, Lyle H Ungar, Gerald Shaeffer, Alexander Fidel, Elease McLaurin, Lakshmi Srinivasan, Dean J Karavite, Robert W Grundmeier
JAMIA Open.2025;[Epub] CrossRef

Review Article

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

Citations to this article as recorded by

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
Risk Factors and Prediction Model for ICU-Acquired Weakness in Severe Acute Pancreatitis: A Retrospective Cohort Study
Lu Li, Jing Liu, HuanQi Ji, Chao Wu, Yang Li, Qian Yang, HongJuan Lang
Journal of Inflammation Research.2026; Volume 19: 1. 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
Diagnostics.2025; 15(17): 2244. CrossRef
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 I 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
The Journal of Critical Care Medicine.2024; 10(2): 130. CrossRef
Advancing critical care recovery: The pivotal role of machine learning in early detection of intensive care unit-acquired weakness
Georges Khattar, Elie Bou Sanayeh
World Journal of Clinical Cases.2024; 12(21): 4455. CrossRef
Construction and evaluation of acquired weakness nomogram model in patients with mechanical ventilation in intensive care unit
Chen Lu, Jiang Wenjuan
DIGITAL HEALTH.2024;[Epub] CrossRef
A scoping review of preclinical intensive care unit-acquired weakness models
Qingmei Yu, Jiamei Song, Luying Yang, Yanmei Miao, Leiyu Xie, Xinglong Ma, Peng Xie, Shaolin Chen
Frontiers in Physiology.2024;[Epub] CrossRef

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

Citations to this article as recorded by

Enteral Feeding Intolerance in Adult Patients Receiving Mechanical Ventilation: A Comprehensive Review
Annette M. Bourgault, Jennifer Carroll Simmons, Jan Powers, Lillian Aguirre, Mary Lou Sole
Critical Care Nurse.2026; 46(1): 23. CrossRef
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
Research and Opinion in Anesthesia & Intensive Care.2024; 11(4): 270. CrossRef
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

Exhaled Nitric Oxide in Patients with Ventilator Associated Pneumonia: Hyun Jung Kwak, Sang Heon Kim, Tae Hyung Kim, Ho Joo Yoon, Dong Ho Shin, Sung Soo Park, Jang Won Sohn; Korean J Crit Care Med. 2012;27(2):82-88.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.82

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Abstract PDF

BACKGROUND
Fraction of exhaled nitric oxide (FENO) is known as a marker of inflammation in asthma, cystic fibrosis and exacerbation of COPD. However, its importance has not been established in patients using mechanical ventilation. We assessed whether FENO is elevated in patients with ventilator associated pneumonia (VAP), and physiologic or pathologic factors affecting levels of FENO in patients with mechanical ventilation.
METHODS
All patients (over 18-year-old) using mechanical ventilation were included, and among them, VAP patients were diagnosed on the basis of clinical pulmonary infection score (CPIS). We measured FENO in air collected during the end-expiratory pause via an off-line method. We compared the levels of FENO between patients with VAP and without, and assessed the relationship between FENO and other physiologic or pathologic characteristics; age, gender, PaO2, oxygenation index, CPIS.
RESULTS
A total of 43 patients (23 male, mean age 67.7 +/- 10.7) in an ICU were enrolled; 19 of them were VAP-patients (10 male, mean age 64.8 +/- 12.9). The level of FENO in the VAP-patients was substantially higher than in the non-VAP group (55.8 +/- 25.3 ppb Vs. 31.8 +/- 13.5 ppb, p < 0.001). CPIS on day 1 and day 3, and duration of mechanical ventilation, were associated with the level of FENO, but oxygenation index, PaO2, PaO2/FiO2, and the mean PEEP were not.
CONCLUSIONS
FENO may be useful for the diagnosis of VAP, and is related to CPIS, as well as the duration of mechanical ventilation.

Citations

Citations to this article as recorded by

Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study
Andreas Kofoed, Mathias Hindborg, Jeppe Hjembæk-Brandt, Christian Dalby Sørensen, Mette Kolpen, Morten H Bestle
Journal of Breath Research.2023; 17(4): 046014. CrossRef
Clinical Application of Exhaled Nitric Oxide Measurements in a Korean Population
Woo-Jung Song, Ji-Won Kwon, Eun-Jin Kim, Sang-Min Lee, Sae-Hoon Kim, So-Yeon Lee, Sang-Heon Kim, Heung-Woo Park, Yoon-Seok Chang, Woo Kyung Kim, Jung Yeon Shim, Ju-Hee Seo, Byoung-Ju Kim, Hyo Bin Kim, Dae Jin Song, Gwang Cheon Jang, An-Soo Jang, Jung-Won
Allergy, Asthma & Immunology Research.2015; 7(1): 3. CrossRef
Exhaled breath analysis in the differentiation of pneumonia from acute pulmonary oedema
Silvie Prazakova, Nadine Elias, Paul S Thomas, Deborah H Yates
Pulmonology and Respiratory Research.2015; 3(1): 3. CrossRef

The S100B Protein Could Be Used as Adjuvant Diagnostic Tool in Acute Ischemic Stroke: Min Hee Jung, Dong Hoon Lee, Chan Woong Kim; Korean J Crit Care Med. 2011;26(4):217-220.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.217

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Abstract PDF: BACKGROUND
In the emergency department, the diagnosis of ischemic stroke is difficult because the diagnostic modalities are limited to non-contrast brain CT and neurologic examination. Serum S100B protein, a bio-marker for ischemic stroke, is needed as an additional diagnostic aid in acute ischemic stroke.
METHODS
We retrospectively reviewed 50 patients diagnosed with ischemic stroke between August 2007 and December 2008 by brain MRI after brain CT and serum S100B measurement in the emergency department. The serum levels of S100B protein were analyzed and the diagnostic sensitivity of non-contrast brain CT combined with abnormal elevation of S100B protein was compared with that of non-contrast brain CT alone.
RESULTS
The overall sensitivity of non-contrast brain CT in the diagnosis of ischemia was 54%. S100B protein in early ischemia had a sensitivity of 58%. However, combining non-contrast brain CT and S100B increased the sensitivity to 74%.
CONCLUSIONS
A biomarker-based diagnostic test would not replace the necessity for CT or other early imaging studies, and before contemplating any reperfusion strategy, neuro-imaging must be performed to rule out intracranial hemorrhage. However, S100B protein, a serum bio-marker, is able to help emergency physicians evaluate patients with suspected ischemic stroke and decide on treatment.

Case Report

Acute Respiratory Failure from Invasive Pulmonary Aspergillosis in an Immunocompetent Adult: A Case Report: Jong Sun Park, Jae Joon Yim, Seok Chul Yang, Chul Gyu Yoo, Young Whan Kim, Sung Koo Han, Young Soo Shim, Sang Min Lee; Korean J Crit Care Med. 2009;24(3):172-175.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.172

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Abstract PDF: Invasive pulmonary aspergillosis has traditionally been known as a disease of an immunocompromised host. We report here on a case of an immunocompetent 73-year-old male who presented with dyspnea and he was finally diagnosed as suffering with invasive pulmonary aspergillosis. He died from progressive respiratory failure and secondary bacterial sepsis despite of voriconazole treatment. Invasive pulmonary aspergillosis should be considered as one of the differential diagnoses in patients with atypical pneumonia that does not respond to the usual antibiotics therapy, and even if the patient does not have an obvious history of an immunosuppressive status. An early suspicion with prompt treatment is important to improve the patient outcome.

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