Acute and Critical Care

Guideline

Korean clinical practice guidelines for rehabilitation in critically ill patients and post-intensive care syndrome: Chi Ryang Chung, Hye Ju Yeo, Jong Geol Do, Yoonju Na, Eunjeong Choi, Jiyeon Kang, Jeong-Yi Kwon, Hyun Jung Kim, Jinyoung Park, Hak-Jae Lee, Myung Hun Jang, Seung-Tak Kang, Kyung Hyup Koo, Young Seok Kim, Won Kim, Tae-Yoon Kim, Jiyoun Park, Jaewon Beom, Kyung Cheon Seo, Hyun-woo Sun, Woochul Son, Myung-Jun Shin, So Young Ahn, Song I Lee, Min-Hyung Rhee, Yu Hui Won, Myungeun Yoo, Yu Jin Im, Sun Ju Chang, Ye Rim Chang, Mi-Kyeong Jeon, Jin Hee Jung, Yumi Ha, Sung Eun Hyun, Suk-Kyung Hong, Gee Young Suh; Acute Crit Care. 2026;41(3):439-465. Published online August 31, 2026; DOI: https://doi.org/10.4266/acc.006630

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Abstract PDF Supplementary Material: Background
Survivors of critical illness commonly experience persistent physical, cognitive, and psychological impairments, collectively known as post–intensive care syndrome. Although intensive care unit (ICU) rehabilitation is now recognized as an important part of recovery after critical illness, rehabilitation practices remain inconsistent, and clinical practice guidelines adapted to the Korean healthcare context have not been available.
Methods
These clinical practice guidelines were developed de novo by a multidisciplinary panel comprising critical care physicians, rehabilitation specialists, nurses, and allied health professionals. The panel prioritized 15 key clinical questions addressing adult, pediatric, and neonatal ICU (NICU) rehabilitation. Systematic literature searches were conducted in Medline via PubMed, Embase, the Cochrane Library, and KoreaMed, and the final searches for all 15 questions were completed by November 30, 2024. The certainty of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Final recommendations were approved through a structured consensus process requiring at least 70% panel agreement.
Results
The panel issued 15 recommendations across major rehabilitation domains, including early structured rehabilitation, criteria for withholding or discontinuing therapy, adjunctive modalities, rehabilitation frequency, inspiratory muscle training, swallowing rehabilitation, cognitive and occupational therapy, nutritional support, neonatal and pediatric ICU rehabilitation, and post-ICU follow-up care. Thirteen recommendations were conditional, whereas two were strong, mainly because they addressed patient safety.
Conclusions
These guidelines provide evidence-informed recommendations for rehabilitation in critically ill patients across adult, pediatric, and NICUs in Korea. They are designed to standardize practice, improve patient safety, support patient-centered functional recovery beyond survival, and identify priorities for future research.

Original Article

Epidemiology
A nationwide 1-day point-prevalence study on rehabilitation practices for intensive care unit patients in South Korea: Jiyeon Kang, Myung-Jun Shin, Suk-Kyung Hong, Min-Hyung Rhee, Jinhee Jung, Jiwon Hong; Acute Crit Care. 2026;41(3):528-541. Published online August 31, 2026; DOI: https://doi.org/10.4266/acc.006225

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Abstract PDF: Background
Early rehabilitation is important in critical care, but nationwide data on rehabilitation practices in Korean intensive care units (ICUs) are lacking. This study reports the findings of a 1-day point-prevalence survey to assess current ICU rehabilitation practices and associated ICU characteristics. Methods: A nationwide, 1-day point-prevalence survey was conducted on December 18, 2024, across 116 ICUs with a 24-hour follow-up. Data were collected at the ICU level and included ICU characteristics, staffing and equipment, the total number of admitted patients, the number of patients receiving rehabilitation, types and frequency of interventions, and reasons for non-provision. Results: Complete data were obtained for 1,529 patients from 116 ICUs. Among them, 374 patients (24.5%) received at least one rehabilitation intervention on the survey day. A total of 968 recorded rehabilitation interventions were delivered, of which 70.5% were physical and 23.1% respiratory rehabilitation. Most physical rehabilitation consisted of in-bed activities, while out-ofbed mobilization accounted for only 7.3% of all recorded rehabilitation interventions. Both the overall rehabilitation rate and out-of-bed mobilization were significantly higher in ICUs within larger hospitals and those with specialized rehabilitation personnel. Conclusions: Rehabilitation was delivered to 24.5% of ICU patients present on the survey day, with out-of-bed mobilization representing a small proportion of recorded rehabilitation interventions. These findings describe rehabilitation delivery at the population level of surveyed ICU inpatients rather than uptake among medically eligible patients. Broader implementation of ICU rehabilitation may require institutional and systemic support, including dedicated rehabilitation personnel, reduced ICU workload burden, and consideration of appropriate reimbursement structures.

Review Articles

Pulmonary
Challenges and strategies for the identification and correction of patient–ventilator asynchronies in daily practice: a scoping review: Andrés Mauricio Enríquez Popayán, Katerina Vaporidi, Henry Mauricio Parada-Gereda, Lluís Blanch; Acute Crit Care. 2026;41(3):493-505. Published online August 31, 2026; DOI: https://doi.org/10.4266/acc.006050

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Abstract PDF Supplementary Material: Patient–ventilator asynchronies (PVA) are associated with adverse clinical outcomes, including prolonged ventilatory support and increased mortality both in the intensive care unit (ICU) and at the hospital level. Despite their clinical relevance, the detection and management of PVA remain challenging in daily practice because of multiple factors, such as the lack of continuous monitoring and the low recognition by healthcare professionals. The aim of this review is to map and synthesize the available evidence on the main challenges in the identification and management of PVA and to describe the strategies proposed to overcome them. We conducted a scoping review following Joanna Briggs Institute guidance and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PubMed/ Medline, Scopus, ScienceDirect, LILACS, and the Cochrane Library were searched from inception to April 2025. Two reviewers independently screened records and selected eligible studies. Data were charted using a standardized extraction form, and findings were synthesized descriptively. The identified challenges were categorized into three main groups, and the proposed strategies were classified according to the type of challenge addressed. The scoping review included 33 studies published between 2000 and 2025. Of these, 18 provided explanatory evidence, whereas 16 described strategies for addressing challenges in daily clinical practice. Overall, this scoping review identified 15 distinct challenges. This review highlights the multifaceted challenges affecting the recognition and management of PVA in adult ICU patients. By mapping challenges across clinical, structural, and cultural domains and summarizing strategies to address them, this review provides professionals with a practical framework to improve patient–ventilator interaction.

Nursing
Decisions about palliative care and social determinants of health in intensive care units: a scoping review: Hyeyoung Yun, Jung Yeon Kim, Eugene Han, Yeonsoo Jang; Acute Crit Care. 2026;41(3):515-527. Published online August 31, 2026; DOI: https://doi.org/10.4266/acc.005000

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Abstract PDF Supplementary Material: Social determinants of health (SDoH) play important roles not only in a patient's health status but also in access to palliative care, the family's decision-making process, and the formation of patient values and preferences. In this scoping review, we analyze the social determinants that influence palliative care decision-making and examine the relationship between palliative care decisions and SDoH in the intensive care unit (ICU). We conducted a literature search of five databases including the search terms “Intensive care units,” “palliative care,” and “social determinants of health.” The search was limited to English publications from January 2015 to March 2025. Out of a total of 3,575 studies, we selected 20 for further review. Of those 20 studies, some reported that SDoH such as age, race, financial status, religion, sex, region or country, education level, and language proficiency affected decisions regarding ICU palliative care and whether to discontinue life support treatment. The reviewed studies of SDoH-related palliative care in the ICUs focused on aspects of palliative care associated with treatment withholding and withdrawing life support treatment. This study underscores the importance of integrating SDoH with clinical indicators in decision-making processes for palliative care in the ICU. Although establishing definitive relationships between SDoH and ICU palliative care decisions remains challenging, our findings highlight the potential impacts of social factors on care planning. Further research across various clinical settings is essential to clarify this relationship to develop more comprehensive and equitable palliative care strategies.

Original Articles

Trauma
Bedside peripherally inserted central catheter placement in trauma intensive care unit in South Korea: a comparative analysis of safety and tip positioning accuracy: Jung Rae Cho, Hancheol Jo, Dae Sung Ma, Dong Hun Kim; Acute Crit Care. 2026;41(3):631-640. Published online August 31, 2026; DOI: https://doi.org/10.4266/acc.002964

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Abstract PDF: Background
Transporting critically ill trauma patients for fluoroscopy-guided peripherally inserted central catheter (PICC) placement poses substantial risks. This study evaluated the clinical outcomes of bedside PICC insertion using a surface anatomical landmark-based measurement in a trauma intensive care unit (ICU). Methods: This retrospective cohort study included trauma ICU patients who underwent PICC insertion between September 2023 and August 2024 at a regional trauma center. Insertion location was categorized as bedside or fluoroscopy-guided. Outcomes included optimal tip positioning, aberrant-course malposition, complication rates, and catheter dwell time. Multivariable linear regression identified factors associated with PICC duration. Results: Among 282 PICC procedures (171 bedside, 111 fluoroscopy), the bedside group had significantly higher injury severity scores and more frequent mechanical ventilation. Using the cmbased carina-distance criterion, optimal tip positioning was achieved in 73.1% of bedside and 65.5% of evaluable fluoroscopy-guided insertions (P=0.184). However, using the vertebral body unit-based radiologic criterion, target-zone achievement was lower in the bedside group than in the fluoroscopy group (48.5% vs. 64.9%). Initial aberrant-course malposition occurred in nine bedside insertions (5.3%) and in no fluoroscopy-guided insertions, and all were corrected before clinical use. Overall complication rates were comparable (17.5% vs. 18.0%, P=0.919). Conclusions: Bedside PICC insertion using a surface anatomical measurement method may be a feasible transport-free option for selected critically ill trauma ICU patients.

Epidemiology
Admission characteristics and factors associated with outcomes in elderly patients aged 75 years and older in a level 3 ICU in Nepal: a 4-year registry-based retrospective study: Kishor Khanal, Saroj Poudel, Sunidhi Aryal, Rabin Bhurtel, Anup Ghimire, Ashim Regmi; Acute Crit Care. 2026;41(3):542-549. Published online August 19, 2026; DOI: https://doi.org/10.4266/acc.002912

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Abstract PDF: Background
The global rise in elderly populations has led to increasing admissions of older adults to intensive care units (ICUs). Understanding predictors of mortality in the very elderly is essential, particularly in low- and middle-income countries (LMICs) where ICU resources are limited. Methods: This retrospective observational study analyzed 1,028 ICU patients aged ≥75 years admitted to a level 3 ICU in Nepal. Demographics, comorbidities, frailty score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, interventions, and outcomes were collected. Univariate analysis, bivariate analysis, and multivariate logistic regression were used for statistical analysis to determine independent predictors of ICU mortality. Results: The cohort had a mean age of 82±5 years and 58.1% were male. ICU mortality was 17.5%. Non-survivors were older and had higher APACHE II scores, more comorbidities, and a greater requirement for mechanical ventilation and vasopressors than survivors. Logistic regression identified age (adjusted odds ratio [aOR], 1.05), comorbidity burden (aOR, 1.40), APACHE II score (aOR, 1.08), mechanical ventilation (aOR, 2.10), and the use of vasopressors (aOR, 1.80) as independent predictors of mortality. Frailty, sex, aggressiveness of therapy, and primary system involvement were not independently associated with ICU mortality. Conclusions: Age, comorbidity burden, and organ support requirements strongly predicted mortality among elderly ICU patients in Nepal. These findings support early risk stratification, prognostic assessment, and informed clinical discussions in resource-limited ICU settings.

Pulmonary
Minimum observation time to determine ventilator liberation success and its associated factors in tracheostomized patients in intensive and high-care units in Japan: a single-center retrospective study: Toshiharu Nakama, Kenichi Satoh, Mitsunobu Toyosaki, Katsuya Takemura, Gen Ouchi, Takehiro Umemura; Acute Crit Care. 2026;41(3):550-563. Published online August 19, 2026; DOI: https://doi.org/10.4266/acc.000338

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Abstract PDF Supplementary Material: Background
Time-based criteria for mechanical ventilation (MV) liberation in tracheostomized patients undergoing T-tube trials with ventilator discontinuation are inconsistent. We aimed to define the minimum post-liberation observation time and identify factors associated with successful liberation. Methods: This single-center retrospective cohort study included adults with tracheostomy who received MV in the intensive care unit and high-care unit of a Japanese hospital from November 14, 2019, to August 31, 2024. We measured maximum endurance time (MET) without MV, MV liberation success, and the shortest MET when success first exceeded 80% (mini-MET). Time to miniMET was assessed by Kaplan-Meier median survival time (MST), and competing risk analysis treating in-hospital death as a competing event was performed. Predictors were screened by univariate C-index, and survival tree cutoffs were examined using logistic regression sensitivity analyses. Results: Among 160 patients, MV liberation success increased with MET from 65% to 94% at 168 hours. The MST to achieve the mini-MET, which was identified as 4 hours, was 7 days (95% CI, 5–10 days). Mechanical power normalized by dynamic compliance (MPCdyn) ≤454.72 J/min and albumin >2.3 g/dl were associated with success. MST was 3 days when both were satisfied. In a covariate-adjusted model, low MPCdyn plus high albumin remained associated with success. Replacing MPCdyn with driving pressure yielded similar findings. Conclusions: Four hours may be a practical minimum post-liberation observation time, whereas 48 hours may be a conservative option. Stratification by MPCdyn or driving pressure plus albumin can support consistent MV liberation decisions after tracheostomy

Neurology
Evaluation for delirium and cognitive function in intensive care unit: reliability and validity of the Jikei Command following Scale in Japan: Masachika Niimi, Yuki Hasegawa, Kensuke Taguchi, Hiroshi Ito, Kenji Higuchi, Masahiro Abo; Acute Crit Care. 2026;41(3):621-630. Published online July 23, 2026; DOI: https://doi.org/10.4266/acc.000936

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Abstract PDF: Background
We developed a novel evaluation for delirium and cognitive function named Jikei Command following Scale (JCoS). The objective of this study was to examine the reliability and validity of the JCoS. Methods: JCoS consists of 8 subitems (1, hand holding and releasing; 2, plantar dorsiflexion; 3, eye opening and closing; 4, visual pursuit; 5, mouth opening; 6, neck movement; 7, two-step command; and 8, movement sustainment). Fifty patients in the intensive care unit (ICU) participated in this study. Cronbach's alpha coefficient of JCoS total score was used for internal consistency. Intraclass correlation coefficient (ICC case 2) was used for inter-examiner reliability. The kappa coefficients for each subitem score were calculated. Concurrent validity was examined by correlation with Confusion Assessment Method for the ICU (CAM-ICU) and intensive care delirium screening checklist (ICDSC). Mini-Mental State Examination (MMSE) 2 weeks after leaving the ICU was used for predictive validity. Results: The Cronbach's alpha coefficient of the JCoS Score was 0.967. The ICC (2,1) of the JCoS Score was 0.933. The kappa coefficients of each subitem were 0.668 for 1, 0.534 for 2, 0.346 for 3, 0.721 for 4, 0.474 for 5, 0.625 for 6, 0.724 for 7, and 0.709 for 8. Correlation coefficient between JCoS and the ICDSC was –0.843, and the correlation ratio between JCoS and CAM-ICU was –0.881. Correlation coefficient between JCoS and MMSE was 0.632. Conclusions: These results suggest that JCoS has sufficient reliability and validity for evaluating about delirium and cognitive function in ICU.

Review Article

Ethics
When ethics is not enough: institutional governance of critical care allocation under crisis conditions: Ho Kyung Sung, Ungki Jung, Kyungdo Lee; Acute Crit Care. 2026;41(2):213-225. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.001872

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Abstract PDF Supplementary Material

Ethical principles such as maximizing benefit, fairness, and procedural justice are frequently invoked in discussions on critical care resource allocation during public health emergencies. The coronavirus disease 2019 (COVID-19) pandemic, however, demonstrated that the mere presence of ethical principles does not ensure their operation in real-world crisis settings. In Lombardy and New York, allocation decisions defaulted to individual clinicians under extreme pressure. This review examines the institutional and governance prerequisites for ethical allocation of critical care resources during surge conditions. Rather than proposing normative allocation criteria, we analyze how ethical principles are translated—or fail to be translated—into practice through institutional arrangements. Using Ontario, Canada, as an empirical reference point, we conduct a comparative analysis of crisis standards of care, governance structures, regional coordination mechanisms, data infrastructures, and legal protections that support collective decision-making in critical care. We propose a multilevel analytical framework comprising three interdependent levels: national and governance, hospital and regional operations, and individual clinical application. Across international experiences, failures in critical care allocation arise when key functions are absent or misaligned across these levels, concentrating ethical, legal, and emotional burdens on frontline clinicians. Applying this framework to the Korean context, we identify structural gaps in crisis standard activation, governance authority, coordination mechanisms, and institutional decision-making capacity, indicating that ethical allocation is not solely a moral challenge, but a systems-level governance problem requiring institutional preparedness beyond ethical consensus.

Citations

Citations to this article as recorded by

Towards Distributive Justice in Life-Sustaining Care: Navigating the Structural Determinants of Patient Preference
Ungki Jung, Ho Kyung Sung, Kyungdo Lee
Korean Journal of Medical Ethics.2026; 29(2): 99. CrossRef

Original Articles

Nutrition
Comparative prognostic performance of nutritional assessment tools in critically ill surgical patients after emergency surgery for sepsis or septic shock: a single-center retrospective study in South Korea: Sung Bak An, Dong Woo Shin; Acute Crit Care. 2026;41(2):399-410. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.001170

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Abstract PDF: Background
Malnutrition is prevalent in critically ill patients. Although various nutritional assessment tools are used in intensive care units (ICUs), their comparative prognostic performance in critically ill surgical patients requiring postoperative ICU care after emergency surgery for sepsis or septic shock remains uncertain. We compared the performance of four tools in predicting ICU mortality. Methods: We retrospectively analyzed 218 adult critically ill surgical patients requiring postoperative ICU care after emergency surgery for sepsis or septic shock (January 2015–July 2025). Nutritional status was assessed within 24 hours of ICU admission using the Global Leadership Initiative on Malnutrition (GLIM), modified Nutrition Risk in the Critically Ill (mNUTRIC), Nutritional Risk Screening 2002 (NRS-2002), and Malnutrition Universal Screening Tool (MUST). The primary outcome was ICU mortality. Discriminative performance was evaluated using the area under the receiver operating characteristic curve and incremental value over a baseline model (age, sex, Acute Physiology and Chronic Health Evaluation [APACHE] II score, and Sequential Organ Failure Assessment [SOFA] score). Results: The mNUTRIC score showed the highest crude discrimination for ICU mortality, followed by MUST and GLIM, whereas NRS-2002 demonstrated limited discriminatory ability. When added to the baseline clinical model, MUST and GLIM improved mortality prediction, unlike mNUTRIC. Higher risk categories in MUST and GLIM were associated with increased ICU mortality. Conclusions: Prognostic performance varies among nutritional assessment tools. MUST and GLIM provide prognostic information beyond conventional severity scores, whereas the prognostic value of mNUTRIC is largely driven by disease severity, supporting their use for risk stratification in critically ill surgical patients.

Basic Science and Research
Developing consensus-based indicators for intensive care unit capacity and capability in South Korea: a modified Delphi study: Jeehye Lee, Ho Kyung Sung, Min-hwan Oh, Jin Young Kim, KyoungHo Kim, Jae Young Moon; Acute Crit Care. 2026;41(2):282-294. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.000676

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Abstract PDF Supplementary Material: Background
Intensive care units (ICUs) are essential components of modern healthcare systems, but South Korea lacks capability-based standards for ICU classification. Critically ill patients are frequently assigned based on bed availability rather than clinical need, creating mismatches between patient acuity and ICU capability. The aim of this study was to develop consensus-based indicators for assessing ICU capacity and capability in South Korea. Methods: A modified Delphi study was conducted with 24 multidisciplinary experts, including members of the Korean Society of Critical Care Medicine (SCCM) Standardization Committee. Based on a systematic review of international ICU frameworks (SCCM, European Society of Intensive Care Medicine, Australian and New Zealand Intensive Care Society), 42 candidate indicators across six domains were evaluated over three rounds (April–July 2025). Consensus was defined as a content validity ratio ≥ a preset critical threshold and ≥75% expert agreement. Results: The response rates were 79.2%–91.7% across rounds. The final framework comprises 29 indicators across four domains: Capacity (staffing, facilities, bed management), Capability (life support, specialized care), Human resources (physician and allied health coverage), and Space and equipment infrastructure (monitoring and safety systems). The experts prioritized functional capabilities over structural metrics: nurse-to-bed ratios were rated more important than physician numbers, and 24/7 service availability was prioritized over personnel counts. Ward support, education, and research indicators did not reach consensus. Conclusions: This study establishes the first expert consensus framework for ICU capability assessment in South Korea. The 29 indicators provide a foundation for a capability-oriented classification system that prioritizes patient safety and efficient resource allocation. Future research should validate these indicators against clinical outcomes and explore real-time ICU capacity monitoring strategies.

Cardiology
Right ventricular strain assessed by two-dimensional speckle tracking echocardiography and mortality in acute respiratory distress syndrome: a systematic review and meta-analysis: Eleni Xourgia, Dimitrios E. Katsaros, Ilias I. Siempos, Anastasia Kotanidou, Christina Routsi; Acute Crit Care. 2026;41(3):578-587. Published online May 19, 2026; DOI: https://doi.org/10.4266/acc.006025

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Abstract PDF Supplementary Material: Background
We investigated differences in right ventricular cardiac strain between survivor and non-survivor acute respiratory distress syndrome (ARDS) patients as measured by speckle tracking echocardiography. Methods: We conducted a systematic search of PubMed and Scopus for relevant articles reporting data on all-cause mortality and right cardiac speckle tracking echocardiography in ARDS patients. We considered studies published up to May 4, 2025. The primary objectives of the meta-analysis were right ventricular global and free-wall strain. A random effects model was used. Results: We included six studies with a total population of 359 individuals. While right ventricular global longitudinal strain of intubated ARDS patients (mean difference [95% CI], –2.30 [–4.13 to –0.47], P=0.01) was greater among non-survivors, free-wall strain (mean difference [95% CI], –2.78 [–6.83 to 1.27], P=0.18) was similar among groups. Among classic right ventricular echocardiographic indices, S prime and fractional area of change were lower among non-survivors, while still within normal range, while tricuspid annular plane systolic excursion was similar between groups. When exploring heterogeneity, we observed that removing outlier studies indicated consistently worse baseline right ventricular function among both strain and non-strain parameters. Conclusions: Although right ventricular function appears to be worse among non-survivor ARDS patients, results vary due to high heterogeneity among published studies. The role of right ventricular speckle tracking echocardiography as a non-invasive bedside means of quantifying myocardial dysfunction and predicting patient outcomes remains to be explored further in future trials.

Nursing
Predictors of delayed extubation post–coronary artery bypass graft and its relationship with length of stay and in-hospital mortality in Jordan: Mohannad Eid Aburuz, Fatma Refaat Ahmed, Haya Ibrahim Ali Abu Maloh, Elham Othman, Ahmed Abdel Hafez, Rawia Gamil, Ahmad Rajeh Saifan; Acute Crit Care. 2026;41(3):692-700. Published online May 19, 2026; DOI: https://doi.org/10.4266/acc.003432

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Abstract PDF: Background
Coronary artery bypass graft (CABG) surgery is an invasive procedure done to resolve symptoms and improve quality of life in patients with coronary artery disease. However, it is a major operation that has its own complications and risks. Delayed extubation (DE) after surgery has been associated with higher-than-average rates of morbidity and mortality. The objective of this study was to determine the incidence and most important predictors of DE following CABG surgery. Methods: This prospective observational study was conducted on 300 adult patients who underwent non-urgent CABG. Data were collected from 4 hospitals in Alexandria, Egypt, by trained research assistants and were analyzed using logistic regression, independent t-test, and Fisher's exact test. Results: Seventy-five participants (25%) developed DE. Patients with age ≥60 years, operation time ≥7 hours, cardiopulmonary bypass time ≥120 minutes, or body mass index ≥28 kg/m2 had a 1.71, 1.88, 2.25, or 2.33 times higher risk of developing DE than those in the counterpoint groups. The only protective variable was the ejection fraction (EF). Patients with EF ≥50% were 21% less likely to develop DE than those with EF less than 50%. Participants who developed DE stayed longer in the intensive care unit (mean±standard deviation [SD], 7.9±1.60 vs. 3.1±1.2; P<0.001) and in the hospital (mean±SD, 22.6±3.1 vs. 15.1±2.9; P<0.001) than those who did not develop DE. Conclusions: Performing CABG as early as possible, controlling body mass index, shortening the operation and cardiopulmonary bypass times, and enhancing EF might decrease the occurrence of postoperative DE and its associated mortality.

Review Article

Pharmacology
Predictors of intermediate syndrome after organophosphorus poisoning and its management in Nepal: Kishor Khanal, Saroj Poudel; Acute Crit Care. 2026;41(2):262-269. Published online April 17, 2026; DOI: https://doi.org/10.4266/acc.002825

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Abstract PDF: Organophosphorus (OP) poisoning is a global public health challenge, is common in agricultural regions, and is associated with high morbidity and mortality. Intermediate syndrome (IMS) is a delayed complication of OP poisoning that usually occurs 24–96 hours post-exposure and is characterized by proximal muscle weakness, cranial nerve palsies, and respiratory failure. The syndrome significantly increases mortality if not identified and managed promptly. This review comprehensively examines the predictors of IMS, including clinical, biochemical, and electrophysiological markers, and evaluates current management strategies. The key predictors are severe initial poisoning, low initial acetylcholinesterase level, and specific electrophysiological abnormalities. Management involves early recognition, antidote administration (atropine and oximes), respiratory support, and emerging therapies like magnesium sulfate. Challenges such as diagnostic uncertainty and resource constraints in low-income settings are discussed, alongside future directions for research and prevention. Understanding these predictors and optimizing management protocols are critical to improving outcomes in IMS following OP poisoning.

Original Articles

Epidemiology
The functional landscape of critical care: a nationwide study of volume, capability, and institutional variation in South Korea: Ho Kyung Sung, Jeehye Lee, Min-hwan Oh, Jin Young Kim, Young Kyun Choi, Jae Young Moon; Acute Crit Care. 2026;41(2):270-281. Published online April 15, 2026; DOI: https://doi.org/10.4266/acc.004225

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Abstract PDF Supplementary Material: Background
In Korea, intensive care units (ICUs) are defined mainly by administrative categories, which do not reflect functional capability. This study examined the relationship between hospital capacity and functional performance by analyzing nationwide patterns of volume, capability, and institutional variation. Methods: We analyzed adult emergency department-to-ICU admissions in 378 hospitals from 2016 to 2023. Admission and life-support intervention (LSI) volumes were measured; organ-supportive therapies such as mechanical ventilation and renal replacement therapy were considered LSIs, and the LSI rate (LSI admissions/total admissions) was used as a proxy for functional capability. Generalized additive models assessed non-linear relationships with bed capacity, and residual-based analysis was used to classify hospitals into functional phenotypes. Results: Critical care delivery was highly concentrated; the top 8% of hospitals provided 50% of LSIs. Admission and LSI volumes increased with hospital size but plateaued beyond approximately 1,300 beds, while the LSI rate continued to rise until approximately 1,700 beds. Hospitals of similar size showed wide variation in both volume and capability. Based on residuals, 42.4% of hospitals formed a central reference group, while others were classified as high-volume/high-capability (13.7%), low-volume/high-capability (15.0%), low-volume/low-capability (12.0%), or high-volume/low-capability (16.9%). Conclusions: The relationship between structural capacity and functional performance in Korean ICUs is complex and non-linear. Hospital size alone is insufficient to predict emergency critical care delivery, underscoring the importance of operational models alongside structural resources. These findings provide a foundation for capability-based ICU stratification to guide resource allocation and strengthen system resilience.

Surgery
Feasibility and accuracy of continuous glucose monitoring in surgical intensive care unit patients: a single-center pilot study in South Korea: Hyojun Park, Eunmi Gil, Joon Ho Lee, Chi-Min Park; Acute Crit Care. 2026;41(2):378-386. Published online March 27, 2026; DOI: https://doi.org/10.4266/acc.004975

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Abstract PDF Supplementary Material

Background
Continuous glucose monitoring (CGM) technology offers potential advantages over intermittent point-of-care testing in critically ill patients by providing real-time glucose trends and automated alerts. However, its accuracy and feasibility in intensive care settings require validation before widespread implementation. Methods: We conducted a single-center observational pilot study, evaluating CGM feasibility in 11 surgical intensive care unit (ICU) patients, including nine post–liver transplant recipients. The G6 CGM system was applied for continuous monitoring. CGM readings were paired with point-of-care glucose measurements for accuracy assessment. Performance metrics included the mean absolute relative difference (MARD), bias, standard deviation of relative differences (SDRD), Surveillance Error Grid (SEG) analysis, and International Organization for Standardization (ISO) 15197:2013 criteria compliance. Results: During a median monitoring period of 5 days (interquartile range [IQR], 3–9), we analyzed 326 paired glucose measurements. CGM demonstrated acceptable accuracy, with a MARD of 13.5% (95% CI, 11.43%–15.76%), bias of 2.79% (95% CI, –2.48 to 7.27%), and SDRD of 18.69% (95% CI, 13.75%–23.65%). SEG analysis confirmed 99.1% of readings were in clinically acceptable zones A and B. ISO 15197:2013 criteria showed 62.9% of measurements were within ±15 mg/dl or ±15%. The median patient-level mean glucose was 199.0 mg/dl (IQR, 162.0–248.0), reflecting substantial hyperglycemic exposure in patients receiving high-dose methylprednisolone despite protocolized insulin therapy targeting a range of 140–180 mg/dl. Conclusions: CGM was feasible and acceptably accurate in ICU patients. Persistent hyperglycemia despite protocolized care indicates that CGM-derived data may help to identify opportunities for future protocol improvement. Its potential impact on the time-in-target range, hypoglycemia, and clinical outcomes should be evaluated in future multicenter studies.

Citations

Citations to this article as recorded by

Continuous Glucose Monitoring for Adult ICU Patients: A Meta-Analysis on Its Clinical Effectiveness
Tingkui Fu, Lianhua Ma, Xiuqin Wu
Biological Research For Nursing.2026;[Epub] CrossRef

Review Article

Anesthesiology
Rehabilitating the diaphragm: an integrated approach to intensive care unit-acquired dysfunction in critical illness—a narrative review: Ricardo Arriagada, Aaron Pagan, Daniela Nisticò, Francesca Gualdi, Valentina Fassone, Nicolò Antonino Patroniti, Patricia RM Rocco, Denise Battaglini; Acute Crit Care. 2026;41(2):237-251. Published online March 4, 2026; DOI: https://doi.org/10.4266/acc.004375

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