Acute and Critical Care

Original Articles

Infection
Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea: Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh; Acute Crit Care. 2025;40(4):548-556. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.003575

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Abstract PDF Supplementary Material: Background
Emergency department (ED) overcrowding poses a global challenge, particularly for critically ill patients requiring intensive care unit (ICU) admission. Although delays in ICU transfer increase mortality in critically ill populations, the optimal timing for septic shock remains uncertain.
Methods
We conducted a target trial emulation using a prospective cohort of 815 septic shock patients from 19 Korean hospitals. Delayed ICU transfer was defined using restricted cubic splines. The primary outcome was in-hospital mortality. Multivariable logistic regression and inverse probability treatment weighting were used to adjust for confounders of age, sex, comorbidities, severity of illness, and mechanical ventilation use. Subgroup analyses were performed to assess the effect across patient characteristics.
Results
The median time of ED-to-ICU transfer was 6.7 hours (interquartile range, 4.7–11.4), and only 7% of patients were transferred within 3 hours. ICU transfer within 3 hours was associated with significantly lower in-hospital mortality (odds ratio, 0.48; 95% CI, 0.24–0.94) compared to later transfers. Mortality risk increased with elapsing time up to 6 hours and then plateaued. The benefit of early ICU transfer was consistent across subgroups but was particularly pronounced in patients requiring extracorporeal membrane oxygenation or continuous renal replacement therapy (P for interaction=0.02).
Conclusions
Early ICU transfer within 3 hours significantly reduces mortality in patients with septic shock, with the greatest benefit observed in those requiring advanced organ support. These findings highlight the need for system-wide strategies to reduce ED boarding time and prioritize timely ICU admission for septic shock management.

Infection
Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia: Priyo Sasmito, Satriya Pranata, Rian Adi Pamungkas, Etika Emaliyawati, Nisa Arifani; Acute Crit Care. 2024;39(4):545-553. Published online November 27, 2024; DOI: https://doi.org/10.4266/acc.2023.01473

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Background
Good sepsis management is key to successful sepsis therapy and optimal patient outcomes. Objectives: This study aimed to determine obstacles among nurses and doctors to implementing the hour-1 sepsis bundle in a secondary hospital in Indonesia.
Methods
This was a qualitative study with a phenomenological approach. Data were obtained from one-on-one in-depth interviews with 13 doctors and nurses in the intensive care unit and emergency department who were purposively sampled. Data were analyzed using content analysis.
Results
Five main themes were revealed in the analysis: incomplete implementation of the hour-1 sepsis bundle, lack of knowledge about the hour-1 sepsis bundle, cost issues, lack of supporting facilities, and lack of coordination among health workers.
Conclusions
Optimizing regional health laboratories, optimizing the use of quick Sequential Organ Failure Assessment (qSOFA) and SOFA, and creating a series of sepsis protocols within the hospital are some solutions that secondary hospitals can implement to ensure appropriate management of sepsis cases. Involvement of health policyholders and hospital management is needed to address these challenges.

Citations

Citations to this article as recorded by

Association between 1-h bundle and clinical outcomes in patients with sepsis: A systematic review and meta-analysis
Shukun Hong, Hongye Wang, Jian Liu, Lujun Qiao
Intensive and Critical Care Nursing.2025; : 104241. CrossRef

Epidemiology
Red blood cell transfusion for critically ill patients admitted through the emergency department in South Korea: Tae Sung Kim, Yongil Cho, Hyuk Joong Choi, Joonbum Park, Wonhee Kim, Chiwon Ahn, Joon Young Kim; Acute Crit Care. 2024;39(4):517-525. Published online November 5, 2024; DOI: https://doi.org/10.4266/acc.2024.00577

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Abstract PDF

Background
Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.
Methods
This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.
Results
Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.
Conclusions
Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.

Citations

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Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level: A Multicenter Observational Study
Kyung Hun Yoo, Gil Joon Suh, Woon Yong Kwon, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Kyuseok Kim, Yoo Seok Park, Tae Gun Shin, Byuk Sung Ko, Tae Ho Lim, Yongil Cho
Journal of Korean Medical Science.2026;[Epub] CrossRef

Nursing
Differences in the psychological preparedness of emergency nurses for caring for victims of violence against women according to nurse gender: a nationwide cross-sectional questionnaire survey in Japan: Akane Kato; Acute Crit Care. 2024;39(4):630-639. Published online October 23, 2024; DOI: https://doi.org/10.4266/acc.2024.00654

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Abstract PDF

Background
With the increasing incidence of violence against women (VAW), emergency department (ED) nurses should be trained to respond appropriately to victims of VAW (VVAW). However, the psychological preparedness of nurses caring for VVAW and its relationship to nurse gender remains unclear in Japan.
Methods
A nationwide self-administered questionnaire survey was conducted among 430 randomly selected certified emergency nurses. The questionnaire was a Japanese translation of the evaluation tools from the World Health Organization (WHO) curriculum "Caring for women subjected to violence: a WHO curriculum for training healthcare providers."
Results
The final sample included 104 participants, and the effective response rate was 24.2%. More than 60% of nurses had experience in caring for VVAW; however, only 10% had received training concerning VAW. The mean number of VVAW cared for by these nurses was 6.2 (standard deviation, 6.1) with no significant difference in nurse gender (P=0.52, effect size [ES]=0.09). Male nurses had a higher mean score of psychological preparedness than female nurses (22.6 vs. 20.4; P=0.03, ES=0.22); moreover, female nurses scored lower than male nurses on all items of the psychological preparedness evaluation. Less than half of the participants reported having institutional support systems.
Conclusions
Establishing an education program for all emergency nurses, providing support to ensure the psychological preparedness of female emergency nurses, and ensuring improvement of facilities nationwide are essential for enhancing nursing care for VVAW in Japanese EDs.

Citations

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Measurement of Dehumanization, Self-Dehumanization, and Empathy as Mediating Factors Among Healthcare Professionals
Aikaterini Roupa, Athina Patelarou, Konstantinos Giakoumidakis, Kyriaki Fousiani, Marianna Miliaraki, Eirini Stratidaki, Evridiki Patelarou
Healthcare.2025; 13(1): 75. CrossRef

Case Report

Neurology
Abducens paralysis—a rare complication of spinal anesthesia at an emergency department: a case report: Mustafa Korkut, Cihan Bedel; Acute Crit Care. 2024;39(3):441-443. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2021.01697

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Abstract PDF

The sixth cranial nerve (CN VI) is a rare site of complication associated with spinal anesthesia and can produce secondary symptoms of ocular muscle palsy. A 38-year-old man was admitted to the emergency department with complaint of diplopia and limited lateral gaze in the first week after endoscopic urological surgery under spinal anesthesia. Isolated unilateral CN VI palsy was considered after excluding differential diagnoses. Ocular palsy and diplopia regressed with conservative treatment during follow-up, and the patient was discharged. This article aims to show that CN VI palsy is a rare complication of spinal anesthesia, which can be observed in the emergency department.

Citations

Citations to this article as recorded by

Cranial Nerve Six Palsy After Vaginal Delivery with Epidural Anesthesia: A Case Report
Jennifer Olivarez, Scott Gutovitz, Caylyne Arnold
The Journal of Emergency Medicine.2024; 66(3): e338. CrossRef

Original Articles

Nursing
The effect of time management education on critical care nurses’ prioritization: a randomized clinical trial: Fatemeh Vizeshfar, Mahnaz Rakhshan, Fatemeh Shirazi, Roya Dokoohaki; Acute Crit Care. 2022;37(2):202-208. Published online April 28, 2022; DOI: https://doi.org/10.4266/acc.2021.01123

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Abstract PDF

Background
Nurses are at the forefront of patient care, and time management skills can increase their ability to make decisions faster. This study aimed to assess the effect of a time management workshop on prioritization and time management skills among nurses of emergency and intensive care units.
Methods
This randomized clinical trial was performed with 215 nurses. The educational intervention about time management was held in the form of a workshop for the intervention group. The time management questionnaire was completed by both groups before, immediately after, and 3 months after the intervention.
Results
Most participants were female (n=191, 88%), with a mean age of 31.82 years (range, 22–63 years). Additionally, the participants’ work experience ranged from 1 to 30 years (mean±standard deviation, 8.00±7.15 years). After the intervention, the mean score of time management increased significantly in the intervention group, but no significant difference was observed in this regard in the control group. The results also revealed a significant difference between the intervention and control groups regarding the mean score of time management 3 months after the intervention (P<0.001).
Conclusions
Time management training helped nurses adjust the time required to perform and prioritize various tasks.

Citations

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Ailyn Oliquiano, Rowena Cuevillas
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Francine Antoinette Ocampo, Brianne Genevieve McIntyre, Debbie Massey, Rosemary Saunders
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Espen Løver Thu, Stian Voldsund, Kristoffer Sand
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Rabia Arpacı, Zehra Can Karabörklü, Derya Tanriverdi
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Time management training and its effect on head nurses’ work-family conflict
Mansoura Aid Abed El Salam, Samah Faisal Fakhry, Samah Mohamed Elsayed
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Emek Bakanoğlu Kalkavan, Elif Nur Şahin, Esranur Dilek
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Mahnaz Zali, Azad Rahmani, Kelly Powers, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani
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Critical care nurses’ experiences of caring challenges during post-resuscitation period: a qualitative content analysis
Mahnaz Zali, Azad Rahmani, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani, Arman Azadi, Mansour Ghafourifard
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Michael Sebastian, Maddalena De Maria, Rosario Caruso, Gennaro Rocco, Cristina Di Pasquale, Arianna Magon, Gianluca Conte, Alessandro Stievano
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Maria Antoniadou, Rallis Antoniadis
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H Angelin Santhakumari , Annamalai Manjula, Arjunan Porkodi , Adithya. A. Venkat
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Loly Mohamed Shawky Elbus, Mohamed Gamal Mostafa, Fatma Zaghloul Mahmoud, Mostafa shaban, Seham Aly Mahmoud
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Nurses and Managers’ Time Management Skills Assessment: A National Survey in the Italian Healthcare Setting
Lucia Filomeno, Yassin Chaoui, Antonietta Scinicariello, Andrea Minciullo, Sofia Di Mario
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Prioritization skills for nurses
Kelly Moseley, Lori Hammond
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Exploring the association between internet addiction and time management among undergraduate nursing students
Heba Fakieh Mansy Ali, Marwa Abd-El-Gawad Mousa, Mohamed Hussein Ramadan Atta, Shadia Ramadan Morsy
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Impact of time management program on stress and coping strategies adopted by nursing students with regard to academic performance
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Perceived clinical competence and predictive role of time management in nursing students
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Infection
Incidence and risk factors associated with early death in patients with emergency department septic shock: Matthew S. Reaven, Nigel L. Rozario, Maggie S. J. McCarter, Alan C. Heffner; Acute Crit Care. 2022;37(2):193-201. Published online February 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00857

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Abstract PDF

Background
Limited research has explored early mortality among patients presenting with septic shock. The objective of this study was to determine the incidence and factors associated with early death following emergency department (ED) presentation of septic shock.
Methods
A prospective registry of patients enrolled in an ED septic shock clinical pathway was used to identify patients. Patients were compared across demographic, comorbid, clinical, and treatment variables by death within 72 hours of ED presentation.
Results
Among the sample of 2,414 patients, overall hospital mortality was 20.6%. Among patients who died in the hospital, mean and median time from ED presentation to death were 4.96 days and 2.28 days, respectively. Death at 24, 48, and 72 hours occurred in 5.5%, 9.5%, and 11.5% of patients, respectively. Multivariate regression analysis demonstrated that the following factors were independently associated with early mortality: age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03–1.05), malignancy (OR, 1.53; 95% CI, 1.11–2.11), pneumonia (OR, 1.39; 95% CI, 1.02–1.88), urinary tract infection (OR, 0.63; 95% CI, 0.44–0.89), first shock index (OR, 1.85; 95% CI, 1.27–2.70), early vasopressor use (OR, 2.16; 95% CI, 1.60–2.92), initial international normalized ratio (OR, 1.14; 95% CI, 1.07–1.27), initial albumin (OR, 0.55; 95% CI, 0.44–0.69), and first serum lactate (OR, 1.21; 95% CI, 1.16–1.26).
Conclusions
Adult septic shock patients experience a high rate of early mortality within 72 hours of ED arrival. Recognizable clinical factors may aid the identification of patients at risk of early death.

Citations

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Using machine learning techniques for early prediction of tracheal intubation in patients with septic shock: a multi-center study in South Korea
Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han
Acute and Critical Care.2025; 40(2): 221. CrossRef
Evaluation of the Diagnosis and Antibiotic Therapy of Sepsis in the Emergency Department: A Retrospective Observational Study
Eszter Varga, Sándor Somodi, Máté Molnár, Dóra Ujvárosy, Krisztina Gaál, Attila Vaskó, Zoltán Szabó, Ildikó Bácskay, István Lekli, Adina Fésüs
Biomedicines.2025; 13(7): 1566. CrossRef
Phenotype-specific dynamics of serum albumin and their impact on sepsis mortality
Gianni Turcato, Arian Zaboli, Lucia Filippi, Paolo Ferretto, Daniela Milazzo, Michael Maggi, Alessandro Cipriano, Massimo Marchetti, Lorenzo Ghiadoni, Christian J. Wiedermann
Biomarkers in Medicine.2025; 19(13): 529. CrossRef
Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study
Sang Won Park, Na Young Yeo, Seonguk Kang, Taejun Ha, Tae-Hoon Kim, DooHee Lee, Dowon Kim, Seheon Choi, Minkyu Kim, DongHoon Lee, DoHyeon Kim, Woo Jin Kim, Seung-Joon Lee, Yeon-Jeong Heo, Da Hye Moon, Seon-Sook Han, Yoon Kim, Hyun-Soo Choi, Dong Kyu Oh, S
Journal of Korean Medical Science.2024;[Epub] CrossRef
Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy
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Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock
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Review Articles

CPR/Resuscitation
Critical emergency medicine and the resuscitative care unit: Maria Mermiri, Georgios Mavrovounis, Dimitrios Chatzis, Ioannis Mpoutsikos, Aristea Tsaroucha, Maria Dova, Zacharoula Angelopoulou, Dimitrios Ragias, Athanasios Chalkias, Ioannis Pantazopoulos; Acute Crit Care. 2021;36(1):22-28. Published online January 28, 2021; DOI: https://doi.org/10.4266/acc.2020.00521

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Abstract PDF

Critical emergency medicine is the medical field concerned with management of critically ill patients in the emergency department (ED). Increased ED stay due to intensive care unit (ICU) overcrowding has a negative impact on patient care and outcome. It has been proposed that implementation of critical care services in the ED can negate this effect. Two main Critical Emergency Medicine models have been proposed, the “resource intensivist” and “ED-ICU” models. The resource intensivist model is based on constant presence of an intensivist in the traditional ED setting, while the ED-ICU model encompasses the notion of a separate ED-based unit, with monitoring and therapeutic capabilities similar to those of an ICU. Critical emergency medicine has the potential to improve patient care and outcome; however, establishment of evidence-based protocols and a multidisciplinary approach in patient management are of major importance.

Citations

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Material and human resources invested in a program aimed at potentially critical trauma patients in the emergency department
Alejandro Arturo Caballo Manuel, Carlos García Fuentes, Jesús Barea Mendoza, Susana Bermejo-Aznáres, Mario Chico-Fernández
Medicina Intensiva (English Edition).2025; 49(4): 245. CrossRef
Recursos humanos y materiales dirigidos en un programa de atención al paciente traumático potencialmente grave en urgencias
Alejandro Arturo Caballo Manuel, Carlos García Fuentes, Jesús Barea Mendoza, Susana Bermejo-Aznáres, Mario Chico-Fernández
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Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department
Felice Urso, Daniele Catalano, Ileana Suprina Petrovic, Enrico Boero, Paola Berchialla, Luigi Vetrugno, Daniela Silengo
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Critical Care Research and Practice.2022; 2022: 1. CrossRef

Rapid response system
Rapid response systems in Korea: Bo Young Lee, Sang-Bum Hong; Acute Crit Care. 2019;34(2):108-116. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00535

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Abstract PDF

The inpatient treatment process is becoming more and more complicated with advanced treatments, aging of the patient population, and multiple comorbidities. During the process, patients often experience unexpected deterioration, about half of which might be preventable. Early identification of patient deterioration and the proper response are priorities in most healthcare facilities. A rapid response system (RRS) is a safety net to identify antecedents of these adverse events and to respond in a timely manner. The RRS has become an essential part of the medical system worldwide, supported by all major quality improvement organizations. An RRS consists of a trigger system and response team and needs constant assessment and process improvement. Although the effectiveness and cost-benefit of RRS remain controversial, according to previous studies, it may be beneficial by decreasing in-hospital cardiac arrest and mortality. Since the first implementation of RRS in Korea in 2008, it has been developed in over 15 medical centers and continues to expand. Recent accreditation standards and an RRS pilot program by the Korean government will promote the proliferation of RRSs in Korea.

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Original Articles

Rapid response system
Epidemiology and Clinical Characteristics of Rapid Response Team Activations: Sei Won Kim, Hwa Young Lee, Mi Ra Han, Yong Suk Lee, Eun Hyoung Kang, Eun Ju Jang, Keum Sook Jeun, Seok Chan Kim; Korean J Crit Care Med. 2017;32(2):124-132. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00199

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Abstract PDF

Background
To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available.
Methods
In Seoul St. Mary’s Hospital, the St. Mary’s Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016.
Results
The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation.
Conclusions
Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.

Citations

Citations to this article as recorded by

Development of a comprehensive model for the role of the rapid response team nurse
Youn-Hui Won, Jiyeon Kang
Intensive and Critical Care Nursing.2022; 68: 103136. CrossRef
Failure mode and effect analysis (FMEA) to identify and mitigate failures in a hospital rapid response system (RRS)
Ehsan Ullah, Mirza Mansoor Baig, Hamid GholamHosseini, Jun Lu
Heliyon.2022; 8(2): e08944. CrossRef
Neurological Emergencies in Patients Hospitalized With Nonneurological Illness
Sang-Beom Jeon, Han-Bin Lee, Yong Seo Koo, Hyunjo Lee, Jung Hwa Lee, Bobin Park, Soh Hyun Choi, Suyeon Jeong, Jun Young Chang, Sang-Bum Hong, Chae-Man Lim, Sang-Ahm Lee
Journal of Patient Safety.2021; 17(8): e1332. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef

How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition: Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho; Korean J Crit Care Med. 2013;28(4):280-286.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.280

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Abstract PDF

BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Citations

Citations to this article as recorded by

Safety and Feasibility of Ultrasound-guided Peripherally Inserted Central Catheterization for Chemo-Delivery
Tak-Joong Song, Shin-Seok Yang, Woo-Sung Yoon
Journal of Surgical Ultrasound.2019; 6(1): 14. CrossRef
Single Center Experience of Ultrasonography-guided Bedside Procedures for Surgical Patients
Dooreh Kim, Dae Hyun Cho, Yun Tae Jung, Jae Gil Lee
Journal of Surgical Ultrasound.2018; 5(2): 61. CrossRef
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho
The Korean Journal of Critical Care Medicine.2015; 30(4): 280. CrossRef

Analysis of Prognostic Factors Early in Emergency Department (ED) and Late in Intensive Care Unit (ICU) of the Critically Ill Patients Admitted in the ICU via ED: Ru Bi Jeong, Jung Hwan An, Hyun Min Jun, Sung Min Jeong, Tae Yong Shin, Young Sik Kim, Young Rock Ha; Korean J Crit Care Med. 2012;27(4):237-248.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.237

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Abstract PDF: BACKGROUND
Many critically ill patients in the ED are hospitalized to the ICU, but most prognosis predicting systems have been developed based on the physiochemical variables of the critically ill in the ICU. The objective of this study is to identify prognostic predictors early in the ED when compared with well-known predictors in the ICU and estimate their predictive abilities.
METHODS
An observational prospective study was performed in an urban ED. Information of all the critically ill patients admitted to the ICU via the ED including vital signs, laboratory results, and physiochemical scoring systems were checked during 6 months and divided into the early stage for the ED and the late stage in the ICU. Poor outcome was defined as 28-days mortality. After checking for significant predictors among them through univariate analysis, we identified the most discriminating predictors in each stage using logistic regression and a decision tree analysis.
RESULTS
A total of 246 patients were enrolled. In univariate analysis, the significant predictors including central venous pressure, fraction of inspired oxygen (FiO2), pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2), albumin, mortality in emergency department sepsis, acute physiology and chronic health evaluation II, simplified acute physiology score II, and sequential organ failure assessment scores were identified in the early stage, while PaO2/FiO2, base excess, unmeasured anion, albumin, anion gap, albumin-corrected anion gap, APACHEII, SAPSII, SOFA, and rapid emergency medicine score were identified in the late stage. Through a decision tree analysis, PaO2/FiO2 and SAPSII were revealed as the most discriminating predictors in the ED and ICU, respectively.
CONCLUSIONS
The prognosis discriminating predictor in critical patients was different between the ED and ICU. Emergency physicians should pay more attention to the critical patients having low PaO2/FiO2.

Outcome after Admission to Intensive Care Unit Following Out-of-Hospital Cardiac Arrest: Comparison between Cardiac Etiology and Non-Cardiac Etiology: Hwan Seok Kang, Hun Jae Lee, Jae Hwa Cho, Jin Hui Paik, Ji Hye Kim, Jun Sig Kim, Seung Baik Han; Korean J Crit Care Med. 2010;25(4):212-218.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.212

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Abstract PDF

BACKGROUND
To evaluate the post-resuscitation intensive care unit outcome of patients who initially survived out-of-hospital cardiac arrest (OHCA).
METHODS
We retrospectively analyzed patients who were admitted to the ICU after OHCA in a tertiary hospital between January, 2005 and December, 2009. We compared the patients' clinical data, the factors associated with admission and the prognosis of patients in cardiac and non-cardiac groups.
RESULTS
Sixty-four patients were included in this study. Thirty-four patients were in the cardiac group and thirty patients were in the non-cardiac group. The mean age was 57.3 +/- 15.1 years of age in the cardiac group and 61.9 +/- 15.7 years of age in the non-cardiac group (p = 0.235). The collapse-to-start of the CPR interval was 5.9 +/- 3.8 min in the cardiac group and 6.0 +/- 3.2 min in the non-cardiac group (p = 0.851). The complaint of chest pain occurred in 12 patients (35.3%) in the cardiac group and 1 patient (3.3%) in the non-cardiac group (p = 0.011). The time duration for making a decision for admission was 285.2 +/- 202.2 min in the cardiac group and 327.7 +/- 264.1 min in the non-cardiac group (p = 0.471). The regional wall motion abnormality and ejection fraction decrease were significant in the cardiac group (p = 0.002, 0.030). Grade 5 CPC was present in 8 patients (23.5%) in the cardiac group and 14 patients (46.7%) in the non-cardiac group.
CONCLUSIONS
The key symptom that could initially differentiate the two groups was chest pain. The time duration for making an admission decision was long in both groups. The CPC score of the cardiac group was lower than that for the non-cardiac group.

Citations

Citations to this article as recorded by

Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef

The Effect of Emergency Department Treatment Time on Outcomes in Acute Stroke Patients: Dong Wook Lee, Eui Chung Kim, Ok Jun Kim, Sung Wook Choi, Young Tae Park, Yun Kyung Cho; Korean J Crit Care Med. 2010;25(2):76-82.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.76

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Abstract PDF: BACKGROUND
Stroke is a disease that leads to a long period of disability and death. Accordingly, the initial treatment is so influential on the prognosis of a patient that shortening the time to initial treatment after hospital admission has a very important role in the entire treatment regimen. This study aimed to demonstrate the effect of the Emergency Department treatment time at Bundang CHA Hospital for acute stroke patients to improve the treatment regimen through six sigma activities.
METHODS
The outcomes for 246 patients with suspected acute strokes who were admitted to the Emergency Department of Bundang CHA Hospital, the flow of the emergency department process divided into 11 phases, and the duration of each phase were determined. Patients were classified as before and after six sigma activities and compared.
RESULTS
The five phases statistically demonstrated the effect of meaningful improvement in the duration of visit-receiving CT prescriptions, visit-receiving lab prescriptions, consult request-arriving to the emergency department, visit-CT angiography results, and visit-the issue of hospital admissions. In the next 2 phases, the sigma level also improved by 0.71sigma and 0.06sigma. However, the total emergency department stay time was not statistically meaningful. The time required time was increased and the sigma level was decreased by 0.19sigma.
CONCLUSIONS
The result of six sigma activities showed the effect of the treatment system improvement with a partial decrease in the duration of each phase, but the total emergency department stay time was not improved owing to environmental factors. For better results, continuous improvement of the treatment system and expansion of hospital facilities will be required.

Case Report

Hemothorax in an Uncontrolled Anticoagulated Patient: Fight or Flight?: A Case Report: Soon Ho Chon, Sung Ho Shinn, Chul Burm Lee; Korean J Crit Care Med. 2009;24(1):37-38.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.37

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Abstract PDF: Hemothorax in a patient on anticoagulant therapy for atrial fibrillation after blunt trauma is not an uncommon event. However, massive hemothorax in such a patient with an extremely uncontrolled and high international normalized ratio (INR) may pose a serious dilemma. We report a case of a patient under anticoagulant therapy for atrial fibrillation who underwent an emergent thoracotomy for massive hemothorax with an INR of 9.57.

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