Acute and Critical Care

Guideline

Pharmacology
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit: Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha; Acute Crit Care. 2022;37(1):1-25. Published online February 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00094; Correction in: Acute Crit Care 2023;38(1):149

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We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.

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Review Article

Neurology
Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines: Seung Yong Park, Heung Bum Lee; Acute Crit Care. 2019;34(2):117-125. Published online April 17, 2019; DOI: https://doi.org/10.4266/acc.2019.00451

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Delirium is an acute, confusional state characterized by altered consciousness and a reduced ability to focus, sustain, or shift attention. It is associated with a number of complex underlying medical conditions and can be difficult to recognize. Many critically ill patients (e.g., up to 80% of patients in the intensive care unit [ICU]) experience delirium due to underlying medical or surgical health problems, recent surgical or other invasive procedures, medications, or various noxious stimuli (e.g., underlying psychological stressors, mechanical ventilation, noise, light, patient care interactions, and drug-induced sleep disruption or deprivation). Delirium is associated with a longer duration of mechanical ventilation and ICU admittance as well as an increased risk of death, disability, and long-term cognitive dysfunction. Therefore, the early recognition of delirium is important and ICU medical staff should devote careful attention to both watching for the occurrence of delirium and its prevention and management. This review presents a brief overview of delirium and an update of the literature with reference to the 2018 Society of Critical Care Medicine Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.

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Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study
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Sustained adherence to a delirium guideline five years after implementation in an intensive care setting: A retrospective cohort study
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Impact of critical care pharmacist‐led interventions on pain, agitation, and delirium in mechanically ventilated adults: A systematic review
Mitchell S. Buckley, Russel J. Roberts, Melanie J. Yerondopoulos, Audrey K. Bushway, Grace C. Korkames, Sandra L. Kane‐Gill
JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY.2023;[Epub] CrossRef
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Stefania Renzi, Nicola Gitti, Simone Piva
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Medicina Crítica.2023; 37(1): 35. CrossRef
Effect of using eye masks and earplugs in preventing delirium in intensive care patients: A single‐blinded, randomized, controlled trial
Gülşen Kiliç, Sultan Kav
Nursing in Critical Care.2023;[Epub] CrossRef
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Jean-Pierre Bénézech
La Revue de l'Infirmière.2022; 71(277): 42. CrossRef
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Kristin Salottolo, Richard Meinig, Landon Fine, Michael Kelly, Robert Madayag, Francie Ekengren, Allen Tanner, David Bar-Or
JAAOS: Global Research and Reviews.2022;[Epub] CrossRef
O papel do enfermeiro na prevenção do delirium no paciente adulto/idoso crítico
Cláudia Oliveira, Cátia Filipa Garnacho Martins Nobre, Rita Margarida Dourado Marques, Maria Manuela Madureira Lebre Mendes, Patrícia Cruz Pontífice Sousa
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Yosuke Morimoto, Tsubasa Watanabe, Masato Oikawa, Masatoshi Hanada, Motohiro Sekino, Tetsuya Hara, Ryo Kozu
Scientific Reports.2022;[Epub] CrossRef
The Age-adjusted Charlson Comorbidity Index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study
Jing Liu, Jianli Li, Jinhua He, Huanhuan Zhang, Meinv Liu, Junfang Rong
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The Effects of Pain, Agitation, Delirium, Immobility, and Sleep Disruption Education on Novice Nurses in Adult Intensive Care Units
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Pain Assessment with the BPS and CCPOT Behavioral Pain Scales in Mechanically Ventilated Patients Requiring Analgesia and Sedation
Katarzyna Wojnar-Gruszka, Aurelia Sega, Lucyna Płaszewska-Żywko, Stanisław Wojtan, Marcelina Potocka, Maria Kózka
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Complex Hallucinations in Hospitalized Rehabilitation Patients With COVID-19
Mari Tobita, Shan-Pin Fanchiang, Aida Saldivar, Sarah Taylor, Barry Jordan
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Mu‐Hsing Ho, Lee‐Fen Yu, Pu‐Hung Lin, Hui‐Chen (Rita) Chang, Victoria Traynor, Wen‐Cheng Huang, Jed Montayre, Kee‐Hsin Chen
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INCIDENCIA DE DELIRIO SEGÚN EL REGIMEN DE VISITAS EN UNA UNIDAD DE CUIDADOS INTENSIVOS
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Neurologic Manifestations of Systemic Disease: Sleep Disorders
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Melissa L.P. Mattison
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Guideline

Pulmonary
Clinical Practice Guideline of Acute Respiratory Distress Syndrome: Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi, The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group; Korean J Crit Care Med. 2016;31(2):76-100. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.76

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There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

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Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19
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Treatment of acute respiratory failure: invasive mechanical ventilation
Young Sam Kim
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Treatment of acute respiratory failure: extracorporeal membrane oxygenation
Jin-Young Kim, Sang-Bum Hong
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Prolonged glucocorticoid treatment in acute respiratory distress syndrome – Authors' reply
Rob Mac Sweeney, Daniel F McAuley
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Gianfranco Umberto Meduri, Andreas Schwingshackl, Greet Hermans
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Original Articles

Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy: Jae Young Moon, Hee Young Lee, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2012;27(1):16-23.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.16

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BACKGROUND
In order to promote the dignity of terminal patients, and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The aim of this study was to assess the current perception of the guideline among internal medicine residents and to identify barriers to the application of the guidelines.
METHODS
The study was designed prospectively on the basis of data from e-mail survey. We surveyed 98 medical residents working in 19 medical centers.
RESULTS
75.5% of respondents agreed with withdrawing (WD) of LST and 33.3% (33/98) of respondents were unaware of the guideline. Although 58.1% of all respondents had taken an EOL care class in medical school, about 30% of residents did feel uncomfortable with communicating with patients and surrogates. The most important obstacle for decision of WD of LST was the resident's psychological stress. 39.8% of medical residents felt guilty or failure after a patient's death, and 41.8% became often or always depressed in a patient's dying.
CONCLUSIONS
In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the medical training program in the hospitals and the more concern of educational leaders are urgent.

Citations

Citations to this article as recorded by

Moral Distress Regarding End-of-Life Care Among Healthcare Personnel in Korean University Hospitals: Features and Differences Between Physicians and Nurses
Eun Kyung Choi, Jiyeon Kang, Hye Youn Park, Yu Jung Kim, Jinui Hong, Shin Hye Yoo, Min Sun Kim, Bhumsuk Keam, Hye Yoon Park
Journal of Korean Medical Science.2023;[Epub] CrossRef
The Effects of South Korean Social Workers' Professional Resources on their Understanding of a Patient's Right to End-of-Life Care Decisions in Long-term Care Facilities
Sooyoun Han
Asian Social Work and Policy Review.2016; 10(2): 200. CrossRef
A Study of Social Workers’ Understanding of Elderly Patients’ and Family Caregivers’ Rights to End-of-Life Care Decisions and of Their Own Roles in the Process
Sooyoun Han
The Korean Journal of Hospice and Palliative Care.2015; 18(1): 42. CrossRef
The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
Korean Journal of Critical Care Medicine.2014; 29(3): 160. CrossRef
The End-of-Life Care in the Intensive Care Unit
Jae Young Moon, Yong Sup Shin
Korean Journal of Critical Care Medicine.2013; 28(3): 163. CrossRef

Adequacy of Epinephrine Administration during Advanced Cardiovascular Life Support in terms of Dosing and Intervals between Doses: Seung Joon Lee, Byung Kook Lee, Kyung Woon Jeung, Hyoung Youn Lee, Tag Heo, Yong Il Min, Jong Geun Yun, Jae Hoon Lim; Korean J Crit Care Med. 2011;26(2):69-77.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.69

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Abstract PDF

BACKGROUND
Consensus guidelines clearly define how epinephrine is administered during cardiopulmonary resuscitation (CPR). In South Korea, it is not known whether epinephrine is administered in accordance with the current advanced cardiovascular life support (ACLS) guidelines during actual practice. We sought to investigate adherence to ACLS guidelines during actual CPR in terms of the dose of epinephrine and the interval between doses.
METHODS
A retrospective review of medical records was performed on 394 adult cardiac arrest patients who received CPR at an emergency room. Data including the duration of CPR, the dose of epinephrine, and the interval between doses was collected from CPR records.
RESULTS
Standard-dose epinephrine (1 mg) was used in 166 of 394 patients (42.1%). In 58.8% of patients, the average between-dose interval was within the 3-5 min recommended in the guidelines, whereas it was shorter than 3 min in 31.4% of patients. As a whole, epinephrine was administered in accordance with the current ACLS guidelines in only 96 of 394 patients (24.4%). Logistic regression analysis revealed the duration of CPR to be an independent factor affecting the use of standard-dose epinephrine and the adequate between-dose interval.
CONCLUSIONS
Epinephrine was not administered according to the ACLS guideline in most patients. A national multi-center study is required to determine whether the poor adherence to the ACLS guideline is a widespread problem. In addition, efforts to improve adherence to the ACLS guideline are required.

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Reply to letter “Improving ROSC with high dose of epinephrine. Are we really?”
Kyung Woon Jeung, Hyun Ho Ryu, Kyung Hwan Song, Byung Kook Lee, Hyoung Youn Lee, Tag Heo, Yong Il Min
Resuscitation.2012; 83(3): e73. CrossRef

Review

Current Insights into Sepsis Treatments: Chang Youl Lee; Korean J Crit Care Med. 2010;25(4):207-211.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.207

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Sepsis is a common illness of intensive care unit patients that carries high morbidity and mortality, and increases hospital costs. Although mortality from sepsis remains high when compared with other critical illnesses, it has declined over the last few decades due to several adjunctive therapies and focused care programs or guidelines. In 2004, an international guideline was published that the bedside clinician could use to improve the outcomes in severe cases of sepsis and septic shock. Several landmark studies recently demonstrated that therapeutic strategies may substantially reduce mortality. The Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock: 2008 was updated using a new evidence-based methodology system for assessing the quality of evidence and the strengths of recommendations. Evidence-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improving the outcomes of critically ill patients. This article discusses the guidelines and current insights into sepsis treatment.

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Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock
Jin Kyeong Park, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh
The Korean Journal of Critical Care Medicine.2011; 26(1): 13. CrossRef

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