Acute and Critical Care

Review Article

Nursing
Theoretical definition of nurse–conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis: Arezoo Mohamadkhani Ghiasvand, Meimanat Hosseini, Foroozan Atashzadeh-Shoorideh; Acute Crit Care. 2023;38(1):8-20. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01039

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Providing critical nursing care for conscious mechanically ventilated patients is mediated via effective communication. This study aimed to identify and map the antecedents, attributes, consequences, and definition of nurse–conscious mechanically ventilated patient communication (N-CMVPC). This scoping review was conducted by searching the Cochrane Library and the CINAHL, EMBASE, PubMed, Web of Science, and Scopus databases, between 2001 and 2021. The keywords queried included "nurses," "mechanically ventilated patients," "mechanical ventilation," "intubated patients," "communication," "interaction," "relationships," "nurse–patient communication," "nurse–patient relations," "intensive care units," and "critical care." Studies related to communication with healthcare personnel or family members were excluded. The results indicated that N-CMVPC manifests as a set of attributes in communication experiences, emotions, methods, and behaviors of the nurse and the patient and is classified into three main themes, nurse communication, patient communication, and quantitative-qualitative aspects. N-CMVPC is a complex, multidimensional, and multi-factor concept. It is often nurse-controlled and can express itself as questions, sentences, or commands in the context of experiences, feelings, and positive or negative behaviors involving the nurse and the patient.

Citations

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A Study on Nurses' Communication Experiences with Intubation Patients
Ye Rim Kim, Hye Ree Park, Mee Kyung Shin
The Korean Journal of Rehabilitation Nursing.2023; 26(1): 28. CrossRef

Original Articles

Pediatrics
Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience: Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli; Acute Crit Care. 2022;37(4):644-653. Published online November 11, 2022; DOI: https://doi.org/10.4266/acc.2022.00395

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Abstract PDF

Background
Pediatric intensive care units (PICUs), where children with critical illnesses are treated, require considerable manpower and technological infrastructure in order to keep children alive and free from sequelae. Methods: In this retrospective comparative cohort study, hospital records of patients aged 1 month to 18 years who died in the study PICU between January 2015 and December 2019 were reviewed. Results: A total of 2,781 critically ill children were admitted to the PICU. The mean±standard deviation age of 254 nonsurvivors was 64.34±69.48 months. The mean PICU length of stay was 17 days (range, 1–205 days), with 40 children dying early (<1 day of PICU admission). The majority of nonsurvivors (83.9%) had comorbid illnesses. Children with early mortality were more likely to have neurological findings (62.5%), hypotension (82.5%), oliguria (47.5%), acidosis (92.5%), coagulopathy (30.0%), and cardiac arrest (45.0%) and less likely to have terminal illnesses (52.5%) and chronic illnesses (75.6%). Children who died early had a higher mean age (81.8 months) and Pediatric Risk of Mortality (PRISM) III score (37). In children who died early, the first three signs during ICU admission were hypoglycemia in 68.5%, neurological symptoms in 43.5%, and acidosis in 78.3%. Sixty-seven patients needed continuous renal replacement therapy, 51 required extracorporeal membrane oxygenation support, and 10 underwent extracorporeal cardiopulmonary resuscitation. Conclusions: We found that rates of neurological findings, hypotension, oliguria, acidosis, coagulation disorder, and cardiac arrest and PRISM III scores were higher in children who died early compared to those who died later.

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Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience
Zeynep Karakaya, Merve Boyraz, Seyma Koksal Atis, Servet Yuce, Muhterem Duyu
Journal of Pediatric Intensive Care.2023;[Epub] CrossRef

Pulmonary
The feasibility and safety of percutaneous dilatational tracheostomy without endotracheal guidance in the intensive care unit: Ji Eun Kim, Dong Hyun Lee; Acute Crit Care. 2022;37(1):101-107. Published online February 17, 2022; DOI: https://doi.org/10.4266/acc.2021.00906

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Abstract PDF: Background
Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units (ICUs). Although it is thought to be safe and easily performed at the bedside, PDT usually requires endotracheal guidance, such as bronchoscopy. Here, we assessed the clinical outcomes and safety of PDT conducted without endotracheal guidance.
Methods
In the ICU and coronary ICU at a tertiary hospital, PDT was routinely performed without endotracheal guidance by a single medical intensivist using the Griggs technique PDT kit (Portex Percutaneous Tracheostomy Kit). We retrospectively reviewed the electronic medical records of patients who underwent PDT without endotracheal guidance.
Results
From January 1 to December 31, 2018, 78 patients underwent PDT without endotracheal guidance in the ICU and coronary ICU. The mean age of these subjects was 71.9±11.5 years, and 29 (37.2%) were female. The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at 24 hours after admission was 25.9±5.8. Fifty patients (64.1%) were on mechanical ventilation during PDT. Failure of the initial PDT attempt occurred in 4 patients (5.1%). In two of them, PDT was aborted and converted to surgical tracheostomy; in the other two patients, PDT was reattempted after endotracheal reintubation, with success. Minor bleeding at the tracheostomy site requiring gauze changes was observed in five patients (6.4%). There were no airway problems requiring therapeutic interventions or procedure-related sequelae.
Conclusions
PDT without endotracheal guidance can be considered safe and feasible.

Pulmonary
Safety and feasibility of hybrid tracheostomy: Daeun Kang, In Beom Jeong, Sun Jung Kwon, Ji Woong Son, Gwan Woo Ku; Acute Crit Care. 2021;36(4):369-373. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00801

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Abstract PDF: Background
Percutaneous dilatational tracheostomy (PDT) is widely used in intensive care units, but this conventional method has some disadvantages, such as requirement of a lot of equipment and experts at the site. Especially, in situations where the patient is isolated due to an infectious disease, difficulties in using the equipment may occur, and the number of exposed persons may increase. In this paper, we introduce hybrid tracheostomy that combines the advantages of surgical tracheostomy and PDT and describe our experiences.
Methods
Data from 55 patients who received hybrid tracheostomy without bronchoscopy from January 2020 to February 2021 were collected and reviewed retrospectively. Hybrid tracheostomy was performed at the bedside by a single thoracic surgeon. The hybrid tracheostomy method was as follows: after the skin was incised and the trachea was exposed, only the extent of the endotracheal tube that could not be removed was withdrawn, and then tracheostomy was performed by the Seldinger method using a PDT kit.
Results
The average age was 66.5 years, and the proportion of men was 69.1%. Among the patients, 21.8% were taking antiplatelet drugs and 14.5% were taking anticoagulants. The average duration of the procedure was 13.3 minutes. There was no major bleeding, and there was one case of paratracheal placement of the tracheostomy tube.
Conclusions
In most patients, the procedure can be safely performed without any major complications. However, patients with a short neck, a neck burn or patients who have received radiation therapy to the neck should be treated with conventional methods.

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

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Abstract PDF Supplementary Material

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

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Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit
Michele M. Iguina, Aunie M. Danyalian, Ilko Luque, Umair Shaikh, Sanaz B. Kashan, Dionne Morgan, Daniel Heller, Mauricio Danckers
Journal of Palliative Care.2023; 38(2): 126. CrossRef
Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
Internal and Emergency Medicine.2023; 18(4): 1191. CrossRef
Can the intensivists predict the outcomes of critically ill patients on the appropriateness of intensive care unit admission for limited intensive care unit resources ?
SeungYong Park
Acute and Critical Care.2021; 36(4): 388. CrossRef

Nursing
How do physicians and nurses differ in their perceived barriers to effective enteral nutrition in the intensive care unit?: Masoumeh Mirhosiny, Mansour Arab, Parvin Mangolian Shahrbabaki; Acute Crit Care. 2021;36(4):342-350. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00185

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Abstract PDF

Background
Patients hospitalized in intensive care units are susceptible to chronic malnutrition from changes in protein and energy metabolism in response to trauma. Therefore, nutritional support, especially enteral nutrition, is one of the most important treatment measures for these patients. However, there are several barriers in the hospitals in treating patients with enteral nutrition. This study was performed to compare the perceptions of care providers (physicians and nurses) on the barriers to enteral nutrition in intensive care units.
Methods
This was a cross-sectional descriptive and analytic study. This study included 263 nurses and 104 physicians in the intensive care units of XXXX southeast hospitals. A questionnaire of enteral nutrition barriers in intensive care units was used. IBM SPSS ver. 19 was used to analyze data.
Results
There was a significant difference between the two groups in the three subscales of intensive care units (P=0.034), dietician support (p=0.001>) and critical care provider attitudes and behavior (P=0.031). There was also a significant difference between having completed educational courses and the score of enteral nutrition barriers in the two groups (P<0.05); the people who received an educational course had a better perception of enteral nutrition barriers.
Conclusions
Physicians and nurses agreed with the perception of enteral nutrition barriers, but there was a difference in their perception on some barriers. Strategies such as in-service training and increasing the knowledge and skills of physicians and nurses can reduce these differences.

Citations

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Adequacy of protein and calorie delivery according to the expected calculated targets: a day‐by‐day assessment in critically ill patients undergoing enteral feeding
Adam Fabiani, Lorella Dreas, Enzo Mazzaro, Elena Trampus, Michela Zanetti, Antonella Calabretti, Giuseppe Gatti, Gianfranco Sanson
Journal of Human Nutrition and Dietetics.2023; 36(3): 697. CrossRef
Barriers to Delivery of Enteral Nutrition in Intensive Care Settings in Saudi Arabia: A Comparative Study of the Perceptions of Health Care Providers Working in Adult and Paediatric ICUs
Sara Zaher
Risk Management and Healthcare Policy.2022; Volume 15: 2357. CrossRef

Nursing
Intensive care unit professionals during the COVID-19 pandemic in Spain: social and work-related variables, COVID-19 symptoms, worries, and generalized anxiety levels: Fernando J. García-Hedrera, Fernanda Gil-Almagro, F. Javier Carmona-Monge, Cecilia Peñacoba-Puente, Patricia Catalá-Mesón, Lilian Velasco-Furlong; Acute Crit Care. 2021;36(3):232-241. Published online August 31, 2021; DOI: https://doi.org/10.4266/acc.2021.00213

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Abstract PDF

Background
The severe acute respiratory syndrome coronavirus 2 outbreak has been identified as a pandemic and global health emergency. It presents as a severe acute respiratory disease. The rapid dissemination of the disease created challenges for healthcare systems and forced healthcare workers (HCWs) to deal with many clinical and nonclinical stresses. The aim of our research is to describe work conditions, symptoms experienced by HCWs, worries about contagion, and generalized anxiety symptoms and compare those findings across regions in Spain. Methods: This cross-sectional study was conducted using an online survey. Critical care units throughout Spain were included. The sample comprised HCWs working in intensive care units from March to May 2020. We assessed work variables, physical symptoms, worries about contagion, and anxiety (generalized anxiety disorder-7 questionnaire). Results: The final sample comprised 448 surveys. Among the respondents, 86.9% (n=389) were nursing professionals, and 84.8% (n=380) were women. All participants cared for coronavirus disease 2019 (COVID-19) patients during the study period. Workload during the pandemic in Madrid was judged to be higher than in other regions (P<0.01). The availability of personal protective equipment was found to be higher in Cataluña. The most frequently experienced symptom was headaches (78.1%). Worries about self-infection and the possibility of infecting others received mean scores of 3.11 and 3.75, respectively. Mean scores for generalized anxiety levels were 11.02, with 58.7% of the professionals presenting with generalized anxiety syndrome during the assessment. Conclusions: In this study, we found high levels of anxiety among HCWs caring directly for COVID-19 patients, which could produce long-term psychological alterations that still need to be assessed.

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Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID‐19: A scoping review
Chia‐Hung Lin, Shu‐Fen Siao, You‐Jie Lin, Pin‐Hsien Hsin, Mack Shelley, Yen‐Han Lee
Journal of Nursing Scholarship.2023; 55(1): 79. CrossRef
The impact of pandemics on healthcare providers' workloads: A scoping review
Gemma Doleman, Annemarie De Leo, Dianne Bloxsome
Journal of Advanced Nursing.2023;[Epub] CrossRef
Critical care medicine training in the age of COVID-19
Walter Mickey
Journal of Osteopathic Medicine.2023; 123(9): 427. CrossRef
The impact of the COVID-19 pandemic on intensive care unit workers: a nationwide survey
Sangeeta Mehta, Christopher Yarnell, Sumesh Shah, Peter Dodek, Jeanna Parsons-Leigh, Robert Maunder, Jessica Kayitesi, Catherine Eta-Ndu, Fran Priestap, Danielle LeBlanc, Jennifer Chen, Kimia Honarmand
Canadian Journal of Anesthesia/Journal canadien d'anesthésie.2022; 69(4): 472. CrossRef

Review Article

Infection
Identification and infection control of carbapenem-resistant Enterobacterales in intensive care units: Jongyoun Yi, Kye-Hyung Kim; Acute Crit Care. 2021;36(3):175-184. Published online August 12, 2021; DOI: https://doi.org/10.4266/acc.2021.00409

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Abstract PDF

Infections with multidrug-resistant organisms among patients in intensive care units (ICUs) are associated with high mortality. Among multidrug-resistant organisms, carbapenem-resistant Enterobacterales (CRE) harbor important pathogens for healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infections. Risk factors for CRE colonization include underlying comorbid conditions, prior antibiotics exposure, prior use of healthcare facilities, device use, and longer ICU stay. The mortality rate due to invasive CRE infection is 22%–49%, and CRE colonization is associated with an approximately 10-fold increased risk of CRE infection. Infection control measures include hand hygiene, contact precautions, minimizing the use of devices, and environmental control. Additionally, implementing active surveillance of CRE carriage should be considered in ICU settings.

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Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study
Małgorzata Timler, Wojciech Timler, Ariadna Bednarz, Łukasz Zakonnik, Remigiusz Kozłowski, Dariusz Timler, Michał Marczak
International Journal of Environmental Research and Public Health.2023; 20(3): 1960. CrossRef
Epidemiology and prevention of hospital-acquired carbapenem-resistant Enterobacterales infection in hospitalized patients, Northeast Ethiopia
Agumas Shibabaw, Zenawork Sahle, Yeshi Metaferia, Asgdew Atlaw, Behailu Adenew, Alemu Gedefie, Mihret Tilahun, Endris Ebrahim, Yeshimebet Kassa, Habtu Debash, Shu-Hua Wang
IJID Regions.2023; 7: 77. CrossRef
Gut microbiota alterations in critically Ill patients with carbapenem-resistant Enterobacteriaceae colonization: A clinical analysis
Moon Seong Baek, Seungil Kim, Won-Young Kim, Mi-Na Kweon, Jin Won Huh
Frontiers in Microbiology.2023;[Epub] CrossRef
ESKAPE and Beyond: The Burden of Coinfections in the COVID-19 Pandemic
Miguel Ángel Loyola-Cruz, Luis Uriel Gonzalez-Avila, Arturo Martínez-Trejo, Andres Saldaña-Padilla, Cecilia Hernández-Cortez, Juan Manuel Bello-López, Graciela Castro-Escarpulli
Pathogens.2023; 12(5): 743. CrossRef
Aztreonam: clinical and pharmacological characteristics at the present stage
D.A. Popov, N.A. Zubareva, A.A. Parshakov
Clinical Microbiology and Antimicrobial Chemotherapy.2023; 25(1): 19. CrossRef
Prevalence and risk factors for colonisation and infection with carbapenem-resistant Enterobacterales in intensive care units: A prospective multicentre study
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Intensive and Critical Care Nursing.2023; 79: 103491. CrossRef
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Seung Hye Lee, Chan Hee Kim, Hee Young Lee, Kun Hee Park, Su Ha Han
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American Journal of Infection Control.2022; 50(10): 1145. CrossRef
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Microbiology Spectrum.2022;[Epub] CrossRef

Original Articles

Pulmonary
Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study: Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho; Acute Crit Care. 2020;35(4):255-262. Published online November 9, 2020; DOI: https://doi.org/10.4266/acc.2020.00164; Correction in: Acute Crit Care 2021;36(2):172

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Abstract PDF

Background
The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs.
Methods
Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included.
Results
A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups.
Conclusions
In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Citations

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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 and Critical Care.2022; 37(1): 1. CrossRef
Comfort During Non-invasive Ventilation
Gianmaria Cammarota, Rachele Simonte, Edoardo De Robertis
Frontiers in Medicine.2022;[Epub] CrossRef
Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
Treatment of acute respiratory failure: noninvasive mechanical ventilation
Sunghoon Park
Journal of the Korean Medical Association.2022; 65(3): 144. CrossRef
Dexmedetomidine-Induced Aortic Contraction Involves Transactivation of the Epidermal Growth Factor Receptor in Rats
Soo Hee Lee, Seong-Chun Kwon, Seong-Ho Ok, Seung Hyun Ahn, Sung Il Bae, Ji-Yoon Kim, Yeran Hwang, Kyeong-Eon Park, Mingu Kim, Ju-Tae Sohn
International Journal of Molecular Sciences.2022; 23(8): 4320. CrossRef

Basic science and research
Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients: Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2020;35(3):149-155. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00297

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Abstract PDF

Background
Although the measuring free cortisol is ideal for assessment of hypothalamicpituitary-adrenal function, it is not routinely measured. Salivary cortisol correlates well with the biologically active free cortisol. Therefore, this study measured the morning basal as well as adrenocorticotropic hormone-stimulated salivary cortisol levels in mechanically ventilated patients and compared the results with non-critically ill patients.
Methods
We prospectively enrolled 49 mechanically ventilated patients and 120 patients from the outpatient clinic. Serum and saliva samples were collected between 8 AM and 10 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. The salivary samples were insufficient in 15 mechanically ventilated patients (30.6%), and these patients were excluded from the final analysis.
Results
Mechanically ventilated patients (n=34) were significantly older and had lower body mass index and serum albumin levels and higher serum creatinine levels than non-critically ill patients (n=120). After adjustment for these parameters, both basal and stimulated salivary and serum cortisol levels were higher in mechanically ventilated patients. The increase in cortisol was not significantly different between the two groups. Serum cortisol levels showed a positive correlation with salivary cortisol levels. Among mechanically ventilated patients, both basal serum and salivary cortisol levels were lower in survivors than in non-survivors.
Conclusions
Both basal total serum and salivary cortisol levels were elevated in mechanically ventilated patients and in non-survivors.

Citations

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Associations between chronic work stress and plasma chromogranin A/catestatin among healthy workers
Xin Liu, Weimin Dang, Hui Liu, Yao Song, Ying Li, Weixian Xu
Journal of Occupational Health.2022;[Epub] CrossRef

Ethics
Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study: Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee; Acute Crit Care. 2020;35(3):179-188. Published online August 10, 2020; DOI: https://doi.org/10.4266/acc.2020.00136

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Abstract PDF

Background
This study examined the experience of withholding or withdrawing life-sustaining treatment in patients hospitalized in the intensive care units (ICUs) of a tertiary care center. It also considers the role that intensivists play in the decision-making process regarding the withdrawal of life-sustaining treatment.
Methods
We retrospectively analyzed the medical records of 227 patients who decided to withhold or withdraw life-sustaining treatment while hospitalized at Ewha Womans University Medical Center Mokdong between April 9 and December 31, 2018.
Results
The 227 hospitalized patients included in the analysis withheld or withdrew from life-sustaining treatment. The department in which life-sustaining treatment was withheld or withdrawn most frequently was hemato-oncology (26.4%). Among these patients, the most common diagnosis was gastrointestinal tract cancer (29.1%). A majority of patients (64.3%) chose not to receive any life-sustaining treatment. Of the 80 patients in the ICU, intensivists participated in the decision to withhold or withdraw life-sustaining treatment in 34 cases. There were higher proportions of treatment withdrawal and ICU-to-ward transfers among the cases in whom intensivists participated in decision making compared to those cases in whom intensivists did not participate (50.0% vs. 4.3% and 52.9% vs. 19.6%, respectively).
Conclusions
Through their participation in end-of-life discussions, intensivists can help patients’ families to make decisions about withholding or withdrawing life-sustaining treatment and possibly avoiding futile treatments for these patients.

Citations

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Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
Ae-Rin Baek, Sang-Bum Hong, Soohyun Bae, Hye Kyeong Park, Changhwan Kim, Hyun-Kyung Lee, Woo Hyun Cho, Jin Hyoung Kim, Youjin Chang, Heung Bum Lee, Hyun-Il Gil, Beomsu Shin, Kwang Ha Yoo, Jae Young Moon, Jee Youn Oh, Kyung Hoon Min, Kyeongman Jeon, Moon S
BMC Medical Ethics.2023;[Epub] CrossRef
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Isabel Schulmeyer, Markus A. Weigand, Monika Heinzel-Gutenbrunner, Marco Gruss
Die Anaesthesiologie.2022; 71(12): 930. CrossRef
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Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
Acute and Critical Care.2022; 37(2): 237. CrossRef
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Jingying Huang, Haiou Qi, Yiting Zhu, Minyan Zhang
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BMJ Open.2021; 11(8): e049711. CrossRef

Pediatric
Effects of the presence of a pediatric intensivist on treatment in the pediatric intensive care unit: Jung Eun Kwon, Da Eun Roh, Yeo Hyang Kim; Acute Crit Care. 2020;35(2):87-92. Published online May 12, 2020; DOI: https://doi.org/10.4266/acc.2019.00752

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Abstract PDF

Background
There are few studies on the effect of intensivist staffing in pediatric intensive care units (PICUs) in Korea. We aimed to evaluate the effect of pediatric intensivist staffing on treatment outcomes in a Korean hospital PICU.
Methods
We analyzed two time periods according to pediatric intensivist staffing: period 1, between November 2015 to January 2017 (no intensivist staffing, n=97) and period 2, between February 2017 to February 2018 (intensivists staffing, n=135).
Results
Median age at admission was 5.4 years (range, 0.7–10.3 years) in period 1 and 3.6 years (0.2–5.1 years) in period 2 (P=0.013). The bed occupancy rate decreased in period 2 (75%; 73%–88%) compared to period 1 (89%; 81%–94%; P=0.015). However, the monthly bed turnover rate increased in period 2 (2.2%; 1.9%–2.7%) compared to period 1 (1.5%, 1.1%– 1.7%; P=0.005). In both periods, patients with chronic neurologic illness were the most common. Patients with cardiovascular problems were more prevalent in period 2 than period 1 (P=0.008). Daytime admission occurred more frequently in period 2 than period 1 (63% vs. 39%, P<0.001). The length of PICU stay, parameters related with mechanical ventilation and tracheostomy, and pediatric Sequential Organ Failure Assessment score were not different between periods. Sudden cardiopulmonary resuscitations occurred in two cases during period 1, but no case occurred during period 2.
Conclusions
Pediatric intensivist staffing in the PICU may affect efficient ICU operations.

Citations

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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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1,240 Download
38 Citations

Abstract PDF

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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Case Report

Cardiology
Extracorporeal membrane oxygenation for takotsubo cardiomyopathy that developed after mitral valve replacement: Jeong-Hyun Choi, In Duk Oh, Eunsil Shin, Sangho Lee, Jong-Mi Jeon, Hyung-Tak Kim, Hyo-Chul Youn; Acute Crit Care. 2020;35(1):51-55. Published online April 12, 2019; DOI: https://doi.org/10.4266/acc.2018.00304

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122 Download
6 Citations

Abstract PDF

Takotsubo cardiomyopathy is a transient systolic and diastolic left ventricular dysfunction that presents several wall-motion abnormalities, while the coronary artery shows normal findings. Because patients with Takotsubo cardiomyopathy present with symptoms similar to acute coronary syndrome, the initial diagnosis and treatment are often difficult. The condition is often precipitated by acute emotional or physical stress and frequently occurs in postmenopausal women. Takotsubo cardiomyopathy may also occur in the perioperative period after cardiac and noncardiac surgery; surgery-associated Takotsubo cardiomyopathy reportedly accounts for 3%–23% of all cases. Of these perioperative cases, cardiothoracic surgery accounted for 16%. However, few cases have been reported in patients undergoing cardiac surgery and managed with extracorporeal membrane oxygenation (ECMO). We report a case of Takotsubo cardiomyopathy managed with ECMO in a patient in the intensive care unit after mitral valve replacement.

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Review Article

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

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1,117 Download
32 Citations

Abstract PDF

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

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