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Original Articles
Cardiology
Thoracic fluid content by electrical cardiometry versus diaphragmatic excursion by ultrasound for the prediction of weaning success in patients with lung congestion
Shawky Meselhy Elshaer, Ahmed Mostafa Abdelhamid, Enas Wageh Mahdy, Samar Rafik Amin
Acute Crit Care. 2025;40(4):557-566.   Published online October 15, 2025
DOI: https://doi.org/10.4266/acc.003984
  • 964 View
  • 69 Download
AbstractAbstract PDF
Background
Predicting the weaning outcomes is critical, since premature or delayed extubation is associated with an increased risk of mortality. This study aimed to compare two physiological indices, thoracic fluid content (TFC) and diaphragmatic excursion (DE), for predicting weaning success in mechanically ventilated patients.
Methods
This observational cohort study involved 100 mechanically ventilated patients with congested lungs who were eligible for weaning. Patients’ TFC and DE were measured using electrical cardiometry and ultrasonography, respectively, before starting the spontaneous breathing trial. Following extubation, patients were grouped into successful and failed-weaning groups, with failure defined as reintubation or a need for non-invasive ventilation within 48 hours. Respiratory and cardiovascular variables were compared. The receiver operating characteristic (ROC) curve was used to assess the ability of TFC and DE to predict weaning success.
Results
Successful weaning occurred in 73 patients (73%) and failed weaning occurred in 27 patients (27%). The two groups’ baseline characteristics were comparable; however, TFC and DE were significantly different between the failed- and successful-weaning groups (P<0.001). The area under the ROC curve (AUC) exhibited moderate predictive abilities of both the TFC and DE in predicting weaning success (AUC, 0.805, cutoff <40 kΩ−1 and AUC, 0.774, cutoff >1.45 cm). In the cardiac patient subgroup, TFC exhibited high predictive ability (AUC, 0.861), but DE did not achieve comparable results (AUC, 0.750).
Conclusions
Both TFC and DE are significant predictors for successful weaning from mechanical ventilators. In particular, a TFC of <40 kΩ−1 demonstrated an excellent ability to predict weaning success in patients with low ejection fraction.
Pediatrics
Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India
Sudha Chandelia, Sunil Kishore, Maansi Gangwal, Devika Shanmugasundaram
Acute Crit Care. 2025;40(1):113-121.   Published online February 28, 2025
DOI: https://doi.org/10.4266/acc.002520
  • 2,890 View
  • 158 Download
AbstractAbstract PDF
Background
Pediatric acute respiratory distress syndrome (PARDS) has a mortality rate of up to 75%, which can be up to 90% in high-risk patients. Even with the use of advanced ventilation strategies, mortality remains unacceptably high at 40%. Airway pressure release ventilation (APRV) mode is a new strategy in PARDS. Our aim was to evaluate whether use of APRV mode in severe PARDS was associated with reduced hospital mortality compared to other modes of ventilation.
Methods
This was a retrospective comparative study using data from case files in a pediatric intensive care unit of a university-affiliated tertiary-care hospital. The study period (January 2014 to December 2019) covered three years before routine use of APRV mode to three years after its implementation. We compared severe PARDS patients in two groups: The APRV group (who received APRV as rescue therapy after failing protective ventilation); and The Non-APRV group, who received other modes of ventilation.
Results
A total of 24 patients in each group were analyzed. Overall in-hospital mortality in the APRV group was 79% versus 91% in the Non-APRV group. In-hospital mortality was significantly lower in the APRV group (univariate analysis: hazard ratio [HR], 0.27; 95% CI, 0.14–0.52; P=0.001 and multivariate analysis: HR, 0.03; 95% CI, 0.005–0.17; P=0.001). Survival times were significantly longer in the APRV group (median time to death: 7.5 days in APRV vs. 4.3 days in non-APRV; P=0.001).
Conclusions
Use of rescue APRV mode in severe PARDS may yield lower mortality rates and longer survival times.
Nursing
Nurses’ knowledge, attitude, and perceived barriers toward protective lung strategies of pediatrics mechanically ventilated patients in a tertiary care hospital in Pakistan
Tasnim Zainib, Salma Rattani, Nimira Asif, Hussain Maqbool Ahmed Maqbool
Acute Crit Care. 2025;40(1):128-135.   Published online February 19, 2025
DOI: https://doi.org/10.4266/acc.004761
  • 2,738 View
  • 174 Download
AbstractAbstract PDFSupplementary Material
Background
Protective lung strategies (PLS) are guidelines about recent clinical advances that deliver an air volume compatible with the patient’s lung capacity and are used to treat acute respiratory distress syndrome. These mechanical ventilation guidelines are not implemented within intensive care units (ICUs) despite strong evidence-based recommendations and a dedicated professional staff. Nurses’ familiarity with clinical guidelines can bridge the gap between actual and recommended practice. However, several barriers undermine this process. The objectives of this study were to identify those barriers and explore the knowledge, attitudes, and behavior of ICU nurses regarding the implementation of PLS.
Methods
This was a descriptive, cross-sectional study. The participants were nurses working in the six ICUs of a pediatric tertiary care hospital in Lahore, Pakistan. Using purposive sampling with random selection, the total sample size was 137 nurses. A summative rating scale was used to identify barriers to the implementation of PLS.
Results
Overall, the nurses’ barrier score was high, with a mean of 66.77±5.36. Across all the barriers subscales, attitude was a much more significant barrier (35.74±3.57) to PLS than behavior (6.53±1.96), perceived knowledge (17.42±2.54), and organizational barriers (7.08±1.39). Knowledge-related barriers were also significantly high.
Conclusion
This study identified important barriers to PLS implementation by nurses, including attitudes and knowledge deficits. Understanding those barriers and planning interventions to address them could help to increase adherence to low tidal volume ventilation and improve patient outcomes. Nurses’ involvement in mechanical ventilation management could help to safely deliver air volumes compatible with recommendations.
Guideline
Pulmonary
Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines
Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park
Acute Crit Care. 2024;39(1):1-23.   Published online February 28, 2024
DOI: https://doi.org/10.4266/acc.2024.00052
  • 34,258 View
  • 1,800 Download
  • 2 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Background
Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator.
Methods
Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations.
Results
Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation.
Conclusions
We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.

Citations

Citations to this article as recorded by  
  • Comparison of programmed sedation care with conventional care in patients receiving mechanical ventilation for acute respiratory failure
    Jiantang Wang, Yuntao Li, Yujuan Han, Xinyu Yuan
    Irish Journal of Medical Science (1971 -).2025; 194(1): 289.     CrossRef
  • Clinical predictors of extubation failure in postoperative critically ill patients: a post-hoc analysis of a multicenter prospective observational study
    Jun Hattori, Aiko Tanaka, Junko Kosaka, Osamu Hirao, Nana Furushima, Yuichi Maki, Daijiro Kabata, Akinori Uchiyama, Moritoki Egi, Hiroshi Morimatsu, Satoshi Mizobuchi, Yoshifumi Kotake, Ayumi Shintani, Yukiko Koyama, Takeshi Yoshida, Yuji Fujino
    BMC Anesthesiology.2025;[Epub]     CrossRef
  • Comparison of High Versus Low Positive End-Expiratory Pressure in Mechanically Ventilated Patients With Acute Heart Failure: Rationale and Design of the HELP-AHF Trial
    Junho Hyun, In-Cheol Kim, Ah-ram Kim, Hee Jeong Lee, Sang Eun Lee, Sung-Cheol Yun, Min-Seok Kim
    International Journal of Heart Failure.2025; 7(2): 79.     CrossRef
  • RELAÇÃO DA FORÇA MUSCULAR PERIFÉRICA COM O DESMAME DA VENTILAÇÃO MECÂNICA
    Débora Rillary Duarte Filho, Gabriella Schultz Malagute, Luciana Ferreira Rihs, Priscila Corrêa Cavalcanti
    Revista Saúde Dos Vales.2024;[Epub]     CrossRef
Original Articles
Meta-analysis
Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea
Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim
Acute Crit Care. 2024;39(1):127-137.   Published online February 20, 2024
DOI: https://doi.org/10.4266/acc.2023.01613
  • 7,289 View
  • 202 Download
  • 8 Web of Science
  • 12 Crossref
AbstractAbstract PDFSupplementary Material
Background
The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.
Methods
Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.
Results
The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3–7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5–8; PNI: 35–38) or severe (CONUT: 9–12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0–1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24–1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95–3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09–1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67–2.12; P<0.001).
Conclusions
The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

Citations

Citations to this article as recorded by  
  • Relationship between the geriatric nutritional risk index and sepsis in elderly critically ill patients: a retrospective cohort study
    Yujiao Jin, Tianyun Zhou, Chenshu Hou, Huihui Zhang, Binbin Xu
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • Epidemiology and Microbiology of Healthcare-Associated Infections in Neurosurgery Department: A Cross-Sectional Study
    Renata Jabłońska, Paweł Sokal, Magdalena Zając, Agnieszka Królikowska, Karolina Filipska - Blejder, Irena Wrońska, Robert Ślusarz
    Biological Research For Nursing.2025; 27(4): 544.     CrossRef
  • Prognostic nutritional index as a potential predictor of prognosis in patients with sepsis: a retrospective cohort study
    Mingyuan Pan, Zheng Li, Shanfeng Sheng, Xiao Teng, Yuyang Li
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • The J-shaped association between the ratio of neutrophil counts to prognostic nutritional index and mortality in ICU patients with sepsis: a retrospective study based on the MIMIC database
    Jiaqi Lou, Hong Kong, Ziyi Xiang, Xiaoyu Zhu, Shengyong Cui, Jiliang Li, Guoying Jin, Neng Huang, Xin Le, Youfen Fan, Sida Xu
    Frontiers in Cellular and Infection Microbiology.2025;[Epub]     CrossRef
  • Recurrent Bloodstream Infections Without Sepsis in a Patient With Short Bowel Syndrome on Parenteral Nutrition: A Case of Potential Sepsis Tolerance
    Akiva Brin , Sarah Israel , Sigal Matza-Porges , Zvi Ackerman
    Cureus.2025;[Epub]     CrossRef
  • Dynamic assessment of clinical scales for predicting mortality in septic patients with prolonged ICU stay
    M. Ya. Yadgarov, L. B. Berikashvili, I. V. Kuznetsov, K. K. Kadantseva, A. A. Yakovlev, V. V. Likhvantsev
    Messenger of ANESTHESIOLOGY AND RESUSCITATION.2025; 22(4): 6.     CrossRef
  • The impact of the prognostic significance of the CONUT score on critical care patients in the intensive care unit: a descriptive study
    Melike Yüksel Yavuz, Hüseyin Döngelli, Mehmet Yavuz, Ceyda Anar, Muzaffer Onur Turan, Bünyamin Sertoğullarından
    Nutrición Hospitalaria.2025;[Epub]     CrossRef
  • Can Nutritional Screening Tools Predict the Prognosis of Critically Ill Patients with Sepsis?
    Duygu Kayar Calili, Demet Bolukbasi, Seval Izdes
    Medicina.2025; 61(10): 1846.     CrossRef
  • Prognostic value of the advanced lung cancer inflammation index for 28 day mortality in sepsis associated acute kidney injury
    Mengfei Li, Runbing Xu, Yu Wu, Jiajun Pan, Xinyu Zhang, Miao Jiang
    Scientific Reports.2025;[Epub]     CrossRef
  • Prognostic Nutritional Index and Urea-albumin Ratio: Novel Mortality Predictors for Critically Ill Sepsis Patients
    Tugce Damarsoy, Hasan T Gozdas, Isa Yildiz, Abdullah Demirhan
    Indian Journal of Critical Care Medicine.2025; 29(12): 996.     CrossRef
  • Development and validation of a predictive model for in-hospital mortality from perioperative bacteremia in gastrointestinal surgery
    Yusuke Taki, Shinsuke Sato, Masaya Watanabe, Ko Ohata, Hideyuki Kanemoto, Noriyuki Oba
    European Journal of Clinical Microbiology & Infectious Diseases.2024; 43(11): 2117.     CrossRef
  • Sepsis and Septic Shock Management and Care: A Case Presentation
    Myriam Jean Cadet
    MEDSURG Nursing.2024; 33(5): 214.     CrossRef
Pulmonary
Factors related to lung function outcomes in critically ill COVID-19 patients in South Korea
Tae Hun Kim, Myung Jin Song, Sung Yoon Lim, Yeon Joo Lee, Young-Jae Cho
Acute Crit Care. 2024;39(1):100-107.   Published online February 20, 2024
DOI: https://doi.org/10.4266/acc.2023.00668
  • 3,490 View
  • 112 Download
AbstractAbstract PDFSupplementary Material
Background
New variants of the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic continue to emerge. However, little is known about the effect of these variants on clinical outcomes. This study evaluated the risk factors for poor pulmonary lung function test (PFT).
Methods
The study retrospectively analyzed 87 patients in a single hospital and followed up by performing PFTs at an outpatient clinic from January 2020 to December 2021. COVID-19 variants were categorized as either a non-delta variant (November 13, 2020–July 6, 2021) or the delta variant (July 7, 2021–January 29, 2022).
Results
The median age of the patients was 62 years, and 56 patients (64.4%) were male. Mechanical ventilation (MV) was provided for 52 patients, and 36 (41.4%) had restrictive lung defects. Forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO ) were lower in patients on MV. Male sex (odds ratio [OR], 0.228) and MV (OR, 4.663) were significant factors for decreased DLCO . The duration of MV was associated with decreased FVC and DLCO . However, the type of variant did not affect the decrease in FVC (P=0.750) and DLCO (P=0.639).
Conclusions
Among critically ill COVID-19 patients, 40% had restrictive patterns with decreased DLCO . The reduction of PFT was associated with MV, type of variants.
Pulmonary
Mechanically ventilated COVID-19 patients admitted to the intensive care unit in the United States with or without respiratory failure secondary to COVID-19 pneumonia: a retrospective comparison of characteristics and outcomes
Jesse A. Johnson, Kashka F. Mallari, Vincent M. Pepe, Taylor Treacy, Gregory McDonough, Phue Khaing, Christopher McGrath, Brandon J. George, Erika J. Yoo
Acute Crit Care. 2023;38(3):298-307.   Published online August 23, 2023
DOI: https://doi.org/10.4266/acc.2022.01123
  • 7,408 View
  • 72 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Background
There is increasing heterogeneity in the clinical phenotype of patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19,) and reasons for mechanical ventilation are not limited to COVID pneumonia. We aimed to compare the characteristics and outcomes of intubated patients admitted to the ICU with the primary diagnosis of acute hypoxemic respiratory failure (AHRF) from COVID-19 pneumonia to those patients admitted for an alternative diagnosis.
Methods
Retrospective cohort study of adults with confirmed SARS-CoV-2 infection admitted to nine ICUs between March 18, 2020, and April 30, 2021, at an urban university institution. We compared characteristics between the two groups using appropriate statistics. We performed logistic regression to identify risk factors for death in the mechanically ventilated COVID-19 population.
Results
After exclusions, the final sample consisted of 319 patients with respiratory failure secondary to COVID pneumonia and 150 patients intubated for alternative diagnoses. The former group had higher ICU and hospital mortality rates (57.7% vs. 36.7%, P<0.001 and 58.9% vs. 39.3%, P<0.001, respectively). Patients with AHRF secondary to COVID-19 pneumonia also had longer ICU and hospital lengths-of-stay (12 vs. 6 days, P<0.001 and 20 vs. 13.5 days, P=0.001). After risk-adjustment, these patients had 2.25 times higher odds of death (95% confidence interval, 1.42–3.56; P=0.001).
Conclusions
Mechanically ventilated COVID-19 patients admitted to the ICU with COVID-19-associated respiratory failure are at higher risk of hospital death and have worse ICU utilization outcomes than those whose reason for admission is unrelated to COVID pneumonia.

Citations

Citations to this article as recorded by  
  • Novel Approaches of Inhalational Therapy for COVID-19: Drugs to Vaccines
    Pratiksha Bramhe, Suchita Waghmare, Nilesh Rarokar, Lata Potey, Bhupendra Dibbe, Prafulla Sable, Pramod Khedekar, Vidya Sabale, Bhupendra Prajapati
    Coronaviruses.2025;[Epub]     CrossRef
  • Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study
    Lenka Doubravská, Miroslava Htoutou Sedláková, Kateřina Fišerová, Olga Klementová, Radovan Turek, Kateřina Langová, Milan Kolář
    Antibiotics.2024; 13(2): 192.     CrossRef
Pulmonary
The role of ROX index–based intubation in COVID-19 pneumonia: a cross-sectional comparison and retrospective survival analysis
Sara Vergis, Sam Philip, Vergis Paul, Manjit George, Nevil C Philip, Mithu Tomy
Acute Crit Care. 2023;38(2):182-189.   Published online May 25, 2023
DOI: https://doi.org/10.4266/acc.2022.00206
  • 5,499 View
  • 132 Download
AbstractAbstract PDF
Background
Coronavirus disease 2019 (COVID-19) patients with acute respiratory failure who experience delayed initiation of invasive mechanical ventilation have poor outcomes. The lack of objective measures to define the timing of intubation is an area of concern. We investigated the effect of timing of intubation based on respiratory rate-oxygenation (ROX) index on the outcomes of COVID-19 pneumonia.
Methods
This was a retrospective cross-sectional study performed in a tertiary care teaching hospital in Kerala, India. Patients with COVID-19 pneumonia who were intubated were grouped into early intubation (within 12 hours of ROX index <4.88) or delayed intubation (12 hours or more hours after ROX <4.88).
Results
A total of 58 patients was included in the study after exclusions. Among them, 20 patients were intubated early, and 38 patients were intubated 12 hours after ROX index <4.88. The mean age of the study population was 57±14 years, and 55.0% of the patients were male; diabetes mellitus (48.3%) and hypertension (50.0%) were the most common comorbidities. The early intubation group had 88.2% successful extubation, while only 11.8% of the delayed group had successful extubation (P<0.001). Survival was also significantly more frequent in the early intubation group.
Conclusions
Early intubation within 12 hours of ROX index <4.88 was associated with improved extubation and survival in patients with COVID-19 pneumonia.
Pulmonary
Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure
Türkay Akbaş, Harun Güneş
Acute Crit Care. 2023;38(1):49-56.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01011
  • 12,391 View
  • 339 Download
  • 11 Web of Science
  • 12 Crossref
AbstractAbstract PDF
Background
The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure.
Methods
This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020.
Results
One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients’ mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0±7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/ FiO2 ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017–1.317; P=0.026), admission PaO2/FiO2 ratio (OR, 0.989; 95% CI, 0.978–0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650–47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021–1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056–0.514; P=0.002) emerged as predictors of 90-day mortality.
Conclusions
APACHE II scores, the PaO2/FiO2 ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.

Citations

Citations to this article as recorded by  
  • Breaking new ground: machine learning enhances survival forecasts in hypercapnic respiratory failure
    Zhongxiang Liu, Bingqing Zuo, Jianyang Lin, Zhixiao Sun, Hang Hu, Yuan Yin, Shuanying Yang
    Frontiers in Medicine.2025;[Epub]     CrossRef
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    Mohsen Gholinataj Jelodar, Mohammadreza Malek-Ahmadi, Adeleh Sahebnasagh, Farhad Mohammadi, Fatemeh Saghafi
    BMC Pulmonary Medicine.2025;[Epub]     CrossRef
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    Michele Vitacca, Massimiliano Beccaria, Luca Bianchi, Paolo Ceruti, Maurizio Marvisi, Monia Betti, Michela Bezzi, Francesco Tursi
    Multidisciplinary Respiratory Medicine.2025;[Epub]     CrossRef
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    Ye Zhang, Hao Chen, Shiyu Hu, Chengshui Chen, Wenyu Chen
    Respiratory Medicine.2025; 245: 108188.     CrossRef
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    Madhusudan Barthwal, Sachinkumar S Dole
    Journal of The Association of Physicians of India.2025; 73(8): 104.     CrossRef
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    Iman Fatima, Jaipal Dass, Zakia Rauf Aslam, Muhammad Miraj Khan, Hassan Imtiaz, Havil Stephen Alexander Bakka, Muhammad Aqib Mazhar, Saif Abdulsattar, Areeba Zahid, Inam Rafiq
    Cureus.2025;[Epub]     CrossRef
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    A.S. Serikova, I.Y. Mukatova, S.A. Baidurin, Zh.M. Urazalina
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  • Antibiotics in COPD exacerbations requiring mechanical ventilation: a dogma to be re-evaluated
    Sebastian Osorio-Rico, Daniel Perez-Marin, John Cardeño-Sanchez
    Internal and Emergency Medicine.2024; 19(5): 1505.     CrossRef
  • Opportunities and perspectives of small molecular phosphodiesterase inhibitors in neurodegenerative diseases
    Qi Li, Qinghong Liao, Shulei Qi, He Huang, Siyu He, Weiping Lyu, Jinxin Liang, Huan Qin, Zimeng Cheng, Fan Yu, Xue Dong, Ziming Wang, Lingfei Han, Yantao Han
    European Journal of Medicinal Chemistry.2024; 271: 116386.     CrossRef
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    Wenjie Sun, Yeshan Li, Shuxin Tan
    International Journal of Chronic Obstructive Pulmonary Disease.2024; Volume 19: 1303.     CrossRef
  • Value of diaphragmatic ultrasound parameters in assessing weaning outcomes and survival in ventilator-dependent intensive care unit patients
    Liuhua Pan
    American Journal of Translational Research.2024; 16(12): 7830.     CrossRef
  • COPD Exacerbation: Why It Is Important to Avoid ICU Admission
    Irene Prediletto, Gilda Giancotti, Stefano Nava
    Journal of Clinical Medicine.2023; 12(10): 3369.     CrossRef
Infection
Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19
Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim
Acute Crit Care. 2023;38(1):41-48.   Published online February 22, 2023
DOI: https://doi.org/10.4266/acc.2022.01235
  • 7,183 View
  • 124 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
Predicting the length of stay (LOS) for coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) is essential for efficient use of ICU resources. We analyzed the clinical characteristics of patients with severe COVID-19 based on their clinical care and determined the predictive factors associated with prolonged LOS.
Methods
We included 96 COVID-19 patients who received oxygen therapy at a high-flow nasal cannula level or above after ICU admission during March 2021 to February 2022. The demographic characteristics at the time of ICU admission and results of severity analysis (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation [APACHE] II), blood tests, and ICU treatments were analyzed using a logistic regression model. Additionally, blood tests (C-reactive protein, D-dimer, and the PaO2 to FiO2 ratio [P/F ratio]) were performed on days 3 and 5 of ICU admission to identify factors associated with prolonged LOS.
Results
Univariable analyses showed statistically significant results for SOFA score at the time of ICU admission, C-reactive protein level, high-dose steroids, mechanical ventilation (MV) care, continuous renal replacement therapy, extracorporeal membrane oxygenation, and prone position. Multivariable analysis showed that MV care and P/F ratio on hospital day 5 were independent factors for prolonged ICU LOS. For D-dimer, no significant variation was observed at admission; however, after days 3 and 5 days of admission, significant between-group variation was detected.
Conclusions
MV care and P/F ratio on hospital day 5 are independent factors that can predict prolonged LOS for COVID-19 patients.

Citations

Citations to this article as recorded by  
  • Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19
    Marcella M Musumeci, Bruno Valle Pinheiro2, Luciana Dias Chiavegato1, Danielle Silva Almeida Phillip1, Flavia R Machado3, Fabrício Freires3, Osvaldo Shigueomi Beppu1, Jaquelina Sonoe Ota Arakaki1, Roberta Pulcheri Ramos1
    Jornal Brasileiro de Pneumologia.2023; : e20230131.     CrossRef
  • The distorted memories of patients treated in the intensive care unit during the COVID-19 pandemic: A qualitative study
    Gisela Vogel, Ulla Forinder, Anna Sandgren, Christer Svensen, Eva Joelsson-Alm
    Intensive and Critical Care Nursing.2023; 79: 103522.     CrossRef
Review Article
Pulmonary
Asynchronies during invasive mechanical ventilation: narrative review and update
Santiago Nicolás Saavedra, Patrick Valentino Sepúlveda Barisich, José Benito Parra Maldonado, Romina Belén Lumini, Alberto Gómez-González, Adrián Gallardo
Acute Crit Care. 2022;37(4):491-501.   Published online November 30, 2022
DOI: https://doi.org/10.4266/acc.2022.01158
  • 42,332 View
  • 4,054 Download
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  • 6 Crossref
AbstractAbstract PDFSupplementary Material
Invasive mechanical ventilation is a frequent therapy in critically ill patients in critical care units. To achieve favorable outcomes, patient and ventilator interaction must be adequate. However, many clinical situations could attempt against this principle and generate a mismatch between these two actors. These asynchronies can lead the patient to worst outcomes; that is why it is vital to recognize and treat these entities as soon as possible. Early detection and recognition of the different asynchronies could favor the reduction of the days of mechanical ventilation, the days of hospital stay, and intensive care and improve clinical results.

Citations

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  • PVADet: fast patient-ventilator asynchrony detection on waveforms
    Longxiang Su, Yan Li, Yunping Lan, Qiang Sun, Fuhong Cai, Hongli He, Siyi Yuan, Song Zhang, Xianlong Liu, Elias Baedorf-Kassis, Xiaobo Huang, Yun Long
    Journal of Clinical Monitoring and Computing.2026;[Epub]     CrossRef
  • Does patient-ventilator asynchrony really matter?
    Mattia Docci, Antenor Rodrigues, Sebastian Dubo, Matthew Ko, Laurent Brochard
    Current Opinion in Critical Care.2025; 31(1): 21.     CrossRef
  • Ability to identify patient-ventilator asynchronies in intensive care unit professionals: A multicenter cross-sectional analytical study
    Andrés Mauricio Enríquez Popayán, Iván Ignacio Ramírez, Juan Felipe Zúñiga, Ruvistay Gutierrez-Arias, Mayda Alejandra Jiménez Pérez, Henry Mauricio Parada-Gereda, Luis Fernando Pardo Cocuy, Ana Lucia Rangel Colmenares, Nubia Castro Chaparro, Ana Pinza Ort
    The Journal of Critical Care Medicine.2025; 11(2): 157.     CrossRef
  • Advances in the Study of Patient Self-inflicted Lung Injury
    Guinan Sun, Jinjin Tian, Xueqin Zhang, Dandan Li
    International Journal of Biology and Life Sciences.2024; 7(1): 11.     CrossRef
  • Patient Self-Inflicted Lung Injury—A Narrative Review of Pathophysiology, Early Recognition, and Management Options
    Peter Sklienka, Michal Frelich, Filip Burša
    Journal of Personalized Medicine.2023; 13(4): 593.     CrossRef
  • Actualización sobre sedoanalgesia en paciente bajo ventilación mecánica
    Onan Emanuel Gregorio
    Revista de Postgrados de Medicina.2022; 1(1): 27.     CrossRef
Original Articles
Pulmonary
Agreement between two methods for assessment of maximal inspiratory pressure in patients weaning from mechanical ventilation
Emanuelle Olympia Silva Ribeiro, Rik Gosselink, Lizandra Eveline da Silva Moura, Raissa Farias Correia, Wagner Souza Leite, Maria das Graças Rodrigues de Araújo, Armele Dornelas de Andrade, Daniella Cunha Brandão, Shirley Lima Campos
Acute Crit Care. 2022;37(4):592-600.   Published online October 27, 2022
DOI: https://doi.org/10.4266/acc.2022.00325
  • 8,648 View
  • 251 Download
  • 1 Crossref
AbstractAbstract PDF
Background
Respiratory muscle strength in patients with an artificial airway is commonly assessed as the maximal inspiratory pressure (MIP) and is measured using analogue or digital manometers. Recently, new electronic loading devices have been proposed to measure respiratory muscle strength. This study evaluates the agreement between the MIPs measured by a digital manometer and those according to an electronic loading device in patients being weaned from mechanical ventilation.
Methods
In this prospective study, the standard MIP was obtained using a protocol adapted from Marini, in which repetitive inspiratory efforts were performed against an occluded airway with a one-way valve and were recorded with a digital manometer for 40 seconds (MIPDM). The MIP measured using the electronic loading device (MIPELD) was obtained from repetitively tapered flow resistive inspirations sustained for at least 2 seconds during a 40-second test. The agreement between the results was verified by a Bland-Altman analysis.
Results
A total of 39 subjects (17 men, 55.4±17.7 years) was enrolled. Although a strong correlation between MIPDM and MIPELD (R=0.73, P<0.001) was observed, the Bland-Altman analysis showed a high bias of –47.4 (standard deviation, 22.3 cm H2O; 95% confidence interval, –54.7 to –40.2 cm H2O).
Conclusions
The protocol of repetitively tapering flow resistive inspirations to measure the MIP with the electronic loading device is not in agreement with the standard protocol using one-way valve inspiratory occlusion when applied in poorly cooperative patients being weaned from mechanical ventilation.

Citations

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  • Utility of a digital motor speech measurement program using an AI speech recognition module: A pilot study*
    Sora Han, Do Hyung Kim, So Young Han, Jaewon Kim, Dae-Hyun Jang
    Phonetics and Speech Sciences.2024; 16(4): 53.     CrossRef
Pulmonary
An algorithm to predict the need for invasive mechanical ventilation in hospitalized COVID-19 patients: the experience in Sao Paulo
Eduardo Atsushi Osawa, Alexandre Toledo Maciel
Acute Crit Care. 2022;37(4):580-591.   Published online September 8, 2022
DOI: https://doi.org/10.4266/acc.2022.00283
  • 5,948 View
  • 127 Download
  • 2 Web of Science
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AbstractAbstract PDF
Background
We aimed to characterize patients hospitalized for coronavirus disease 2019 (COVID-19) and identify predictors of invasive mechanical ventilation (IMV).
Methods
We performed a retrospective cohort study in patients with COVID-19 admitted to a private network in Sao Paulo, Brazil from March to October 2020. Patients were compared in three subgroups: non-intensive care unit (ICU) admission (group A), ICU admission without receiving IMV (group B) and IMV requirement (group C). We developed logistic regression algorithm to identify predictors of IMV.
Results
We analyzed 1,650 patients, the median age was 53 years (42–65) and 986 patients (59.8%) were male. The median duration from symptom onset to hospital admission was 7 days (5–9) and the main comorbidities were hypertension (42.4%), diabetes (24.2%) and obesity (15.8%). We found differences among subgroups in laboratory values obtained at hospital admission. The predictors of IMV (odds ratio and 95% confidence interval [CI]) were male (1.81 [1.11– 2.94], P=0.018), age (1.03 [1.02–1.05], P<0.001), obesity (2.56 [1.57–4.15], P<0.001), duration from symptom onset to admission (0.91 [0.85–0.98], P=0.011), arterial oxygen saturation (0.95 [0.92– 0.99], P=0.012), C-reactive protein (1.005 [1.002–1.008], P<0.001), neutrophil-to-lymphocyte ratio (1.046 [1.005–1.089], P=0.029) and lactate dehydrogenase (1.005 [1.003–1.007], P<0.001). The area under the curve values were 0.860 (95% CI, 0.829–0.892) in the development cohort and 0.801 (95% CI, 0.733–0.870) in the validation cohort.
Conclusions
Patients had distinct clinical and laboratory parameters early in hospital admission. Our prediction model may enable focused care in patients at high risk of IMV.

Citations

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  • Predictive Models of Patient Severity in Intensive Care Units Based on Serum Cytokine Profiles: Advancing Rapid Analysis
    Cristiana P. Von Rekowski, Tiago A. H. Fonseca, Rúben Araújo, Ana Martins, Iola Pinto, M. Conceição Oliveira, Gonçalo C. Justino, Luís Bento, Cecília R. C. Calado
    Applied Sciences.2025; 15(9): 4823.     CrossRef
  • Intelligent alert system for predicting invasive mechanical ventilation needs via noninvasive parameters: employing an integrated machine learning method with integration of multicenter databases
    Guang Zhang, Qingyan Xie, Chengyi Wang, Jiameng Xu, Guanjun Liu, Chen Su
    Medical & Biological Engineering & Computing.2024; 62(11): 3445.     CrossRef
Liver
Early mechanical ventilation for grade IV hepatic encephalopathy is associated with increased mortality among patients with cirrhosis: an exploratory study
Saad Saffo, Guadalupe Garcia-Tsao
Acute Crit Care. 2022;37(3):355-362.   Published online August 18, 2022
DOI: https://doi.org/10.4266/acc.2022.00528
  • 7,933 View
  • 224 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Unresponsive patients with toxic-metabolic encephalopathies often undergo endotracheal intubation for the primary purpose of preventing aspiration events. However, among patients with pre-existing systemic comorbidities, mechanical ventilation itself may be associated with numerous risks such as hypotension, aspiration, delirium, and infection. Our primary aim was to determine whether early mechanical ventilation for airway protection was associated with increased mortality in patients with cirrhosis and grade IV hepatic encephalopathy.
Methods
The National Inpatient Sample was queried for hospital stays due to grade IV hepatic encephalopathy among patients with cirrhosis between 2016 and 2019. After applying our exclusion criteria, including cardiopulmonary failure, data from 1,975 inpatient stays were analyzed. Patients who received mechanical ventilation within 2 days of admission were compared to those who did not. Univariable and multivariable logistic regression analyses were performed to identify clinical factors associated with in-hospital mortality.
Results
Of 162 patients who received endotracheal intubation during the first 2 hospital days, 64 (40%) died during their hospitalization, in comparison to 336 (19%) of 1,813 patients in the comparator group. In multivariable logistic regression analysis, mechanical ventilation was the strongest predictor of in-hospital mortality in our primary analysis (adjusted odds ratio, 3.00; 95% confidence interval, 2.14–4.20; P<0.001) and in all sensitivity analyses.
Conclusions
Mechanical ventilation for the sole purpose of airway protection among patients with cirrhosis and grade IV hepatic encephalopathy may be associated with increased in-hospital mortality. Future studies are necessary to confirm and further characterize our findings.

Citations

Citations to this article as recorded by  
  • Development and validation of a nomogram for predicting in-hospital mortality of intensive care unit patients with liver cirrhosis
    Xiao-Wei Tang, Wen-Sen Ren, Shu Huang, Kang Zou, Huan Xu, Xiao-Min Shi, Wei Zhang, Lei Shi, Mu-Han Lü
    World Journal of Hepatology.2024; 16(4): 625.     CrossRef
  • Review article: Evaluation and care of the critically ill patient with cirrhosis
    Iva Kosuta, Madhumita Premkumar, K. Rajender Reddy
    Alimentary Pharmacology & Therapeutics.2024; 59(12): 1489.     CrossRef
  • Using machine learning methods to predict 28-day mortality in patients with hepatic encephalopathy
    Zhe Zhang, Jian Wang, Wei Han, Li Zhao
    BMC Gastroenterology.2023;[Epub]     CrossRef
  • Experience in Non-invasive Ventilation in Grade 3 Hepatic Encephalopathy
    İlhan Ocak, Mustafa Çolak, Erdem Kınacı
    Istanbul Medical Journal.2023; 24(3): 295.     CrossRef
Pulmonary
The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience
Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry
Acute Crit Care. 2022;37(3):347-354.   Published online July 25, 2022
DOI: https://doi.org/10.4266/acc.2022.00108
  • 8,456 View
  • 297 Download
  • 8 Web of Science
  • 9 Crossref
AbstractAbstract PDFSupplementary Material
Background
Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied.
Methods
In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment.
Results
The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes.
Conclusions
During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.

Citations

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  • Point-of-Care Ultrasound, an Integral Role in the Future of Enhanced Recovery After Surgery?
    Peter Van de Putte, An Wallyn, Rosemary Hogg, Lars Knudsen, Kariem El-Boghdadly
    Anesthesia & Analgesia.2025; 140(5): 1114.     CrossRef
  • A Muscle-Driven Spine Model for Predictive Simulations in the Design of Spinal Implants and Lumbar Orthoses
    Robin Remus, Andreas Lipphaus, Marisa Ritter, Marc Neumann, Beate Bender
    Bioengineering.2025; 12(3): 263.     CrossRef
  • Diaphragm Ultrasound for Assessing Diaphragmatic Function and Predicting Ventilator Weaning Success: A Review of the Literature
    Gulus Emre, Daniel Acosta, Cameron Baston
    Current Pulmonology Reports.2025;[Epub]     CrossRef
  • Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care
    Marta Rafael Marques, José Manuel Pereira, José Artur Paiva, Gonzalo García de Casasola‐Sánchez, Yale Tung‐Chen
    Journal of Ultrasound in Medicine.2024; 43(2): 223.     CrossRef
  • Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis
    Diego Poddighe, Marine Van Hollebeke, Yasir Qaiser Choudhary, Débora Ribeiro Campos, Michele R. Schaeffer, Jan Y. Verbakel, Greet Hermans, Rik Gosselink, Daniel Langer
    Critical Care.2024;[Epub]     CrossRef
  • Ultrasonographic evaluation of diaphragm thickness and excursion: correlation with weaning success in trauma patients: prospective cohort study
    Golnar Sabetian, Mandana Mackie, Naeimehossadat Asmarian, Mahsa Banifatemi, Gregory A. Schmidt, Mansoor Masjedi, Shahram Paydar, Farid Zand
    Journal of Anesthesia.2024; 38(3): 354.     CrossRef
  • Diaphragm muscle parameters as a predictive tool for weaning critically ill patients from mechanical ventilation: a systematic review and meta-analysis study
    Yashar Iran Pour, Afrooz Zandifar
    European Journal of Translational Myology.2024;[Epub]     CrossRef
  • Diaphragm dysfunction as a prognostic criterion of external respiratory impairment and necessary extracorporeal membrane oxygenation in patients with chronic heart failure
    V.S. Shabaev, V.A. Mazurok, L.Z. Biktasheva, L.G. Vasilyeva, K.Yu. Kozhieva, I.A. Danilova, N.A. Osipova
    Russian Journal of Anesthesiology and Reanimatology.2024; (6): 38.     CrossRef
  • Diaphragmatic ultrasound: A new frontier in weaning from mechanical ventilation
    Manoj Kamal, Saikat Sengupta
    Indian Journal of Anaesthesia.2023; 67(Suppl 4): S205.     CrossRef
Pulmonary/Policy
Association between the National Health Insurance coverage benefit extension policy and clinical outcomes of ventilated patients: a retrospective study
Wanho Yoo, Saerom Kim, Soohan Kim, Eunsuk Jeong, Kwangha Lee
Acute Crit Care. 2022;37(1):53-60.   Published online February 22, 2022
DOI: https://doi.org/10.4266/acc.2021.01389
  • 7,639 View
  • 187 Download
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AbstractAbstract PDF
Background
This study aimed to investigate the association between the Korean National Health Insurance coverage benefit extension policy and clinical outcomes of patients who were ventilated owing to various respiratory diseases.
Methods
Data from 515 patients (male, 69.7%; mean age, 69.8±12.1 years; in-hospital mortality rate, 28.3%) who were hospitalized in a respiratory intensive care unit were retrospectively analyzed over 5 years.
Results
Of total enrolled patients, 356 (69.1%) had one benefit items under this policy during their hospital stay. They had significantly higher medical expenditure (total: median, 23,683 vs. 12,742 U.S. dollars [USD], P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (median, 26.0% vs. 32.2%; P<0.001). Patients without benefit items associated with higher in-hospital mortality (hazard ratio [HR], 2.794; 95% confidence interval [CI], 1.980–3.941; P<0.001). In analysis of patients with benefit items, patients with three items (“cancer,” “tuberculosis,” and “disability”) had significantly lower out-of-pocket medical expenditure (3,441 vs. 6,517 USD, P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (17.2% vs. 27.7%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.904; 95% CI, 2.533–6.039; P<0.001).
Conclusions
Our study showed patients with benefit items had more medical resources and associated improved in-hospital survival. Patients with the aforementioned three benefit items had lower out-of-pocket medical expenditure due to the implementation of this policy, but higher in-hospital mortality.

Citations

Citations to this article as recorded by  
  • Association between health insurance benefit extension policy and long-term outcomes in ventilated pneumonia patients: Analysis of a nationwide dataset
    Wanho Yoo, Hyojin Jang, Min Ki Lee, Yeongdae Kim, Son Jungmin, Kim Jinmi, Kwangha Lee
    Medicine.2025; 104(38): e44687.     CrossRef
  • The effect of socioeconomic status, insurance status, and insurance coverage benefits on mortality in critically ill patients admitted to the intensive care unit
    Moo Suk Park
    Acute and Critical Care.2022; 37(1): 118.     CrossRef
Pulmonary
Under or overpressure: an audit of endotracheal cuff pressure monitoring at the tertiary care center
Biju Viswambharan, Manjini Jeyaram Kumari, Gopala Krishnan, Lakshmi Ramamoorthy
Acute Crit Care. 2021;36(4):374-379.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00024
  • 13,595 View
  • 255 Download
  • 3 Web of Science
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AbstractAbstract PDF
Background
Mechanical ventilation is a lifesaving intervention for critically ill patients but can produce the major complication of ventilator-associated pneumonia (VAP). Inappropriately inflated endotracheal tubes cause potential harm due to high or low pressure; this can be prevented through monitoring protocols.
Methods
A cross-sectional study of 348 cuff pressure readings was performed with intubated and mechanically ventilated patients to evaluate the exact proportion of patients in intensive care units (ICUs) where the cuff pressure is optimal and to identify the ICUs where device-based monitoring is available to produce a lower proportion of sub-optimal cuff pressure cases. Every three days, cuff pressure was assessed with a handheld cuff pressure manometer. The corresponding VAP rates of those ICUs were obtained from the hospital infection control department.
Results
Cuff pressure of 40.2% was the lower cutoff for the high category, that of optimal was 35.3%, and the highest cutoff of sub-optimal was 24.4%. This study also showed ICUs that had cuff pressure monitoring devices and protocols. Active measurement protocols had a higher proportion of optimal cuff pressure (58.5%) and a lower proportion of sub-optimal and high cuff pressure (19.5% and 22.0%) compared to ICUs with no device-based monitoring protocols. Furthermore, the VAP rate of ICUs exhibited a weak positive correlation with sub-optimal cuff pressure.
Conclusions
Device-based cuff pressure monitoring is essential in maintaining adequate cuff pressure but often is inadequate, resulting in high readings. Therefore, this study suggests that device-based cuff pressure monitoring be practiced.

Citations

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  • Assessment of pressure–volume loop, inflation to precise pressure, minimum occlusive volume, and manual palpation techniques for inflation of endotracheal tube cuff: A randomised clinical study
    Soumya Murmu, Jyoti Sharma, Mayank Gupta, Ruhi Sharma, Anju Grewal, Dinesh Kumar Singh
    Indian Journal of Anaesthesia.2025; 69(11): 1221.     CrossRef
  • Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study
    Sujung Park, Young In Kwon, Hyun Joo Kim
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Correlación entre la presión del manguito del tubo endotraqueal y los síntomas laringotraqueales en postoperatorio
    Wedley Peñaloza, Reyes Cruz Manuel Reyes , Evelin Núñez Wong
    Gaceta Médica de la Junta de Beneficencia de Guayaquil.2023; 1(1): 13.     CrossRef
  • Efficacy of using an intravenous catheter to repair damaged expansion lines of endotracheal tubes and laryngeal masks
    Tingting Wang, Jiang Wang, Yao Lu, Xuesheng Liu, Shangui Chen
    BMC Anesthesiology.2022;[Epub]     CrossRef
Nephrology
COVID-19–induced acute kidney injury in critically ill patients: epidemiology, risk factors, and outcome
Ahlem Trifi, Sami Abdellatif, Yosri Masseoudi, Asma Mehdi, Oussama Benjima, Eya Seghir, Fatma Cherif, Yosr Touil, Bedis Jeribi, Foued Daly, Cyrine Abdennebi, Adel Ammous, Salah Ben Lakhal
Acute Crit Care. 2021;36(4):308-316.   Published online November 22, 2021
DOI: https://doi.org/10.4266/acc.2021.00934
  • 9,536 View
  • 146 Download
  • 8 Web of Science
  • 11 Crossref
AbstractAbstract PDF
Background
The kidney represents a potential target for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Acute kidney injury (AKI) can occur through several mechanisms and includes intrinsic tissue injury by direct viral invasion. Clinical data about the clinical course of AKI are lacking. We aimed to investigate the proportion, risk factors, and prognosis of AKI in critical patients affected with coronavirus disease 2019 (COVID-19).
Methods
A case/control study conducted in two intensive care units of a tertiary teaching hospital from September to December 2020.
Results
Among 109 patients, 75 were male (69%), and the median age was 64 years (interquartile range [IQR], 57–71 years); 48 (44%) developed AKI within 4 days (IQR, 1–9). Of these 48 patients, 11 (23%), 9 (19%), and 28 (58%) were classified as stage 1, 2, and 3, respectively. Eight patients received renal replacement therapy. AKI patients were older and had more frequent sepsis, acute respiratory distress syndrome, and rhabdomyolysis; higher initial urea and creatinine; more marked inflammatory syndrome and hematological disorders; and required more frequent mechanical ventilation and vasopressors. An elevated level of D-dimers (odds ratio [OR], 12.83; 95% confidence interval [CI], 1.9–85) was an independent factor of AKI. Sepsis was near to significance (OR, 5.22; 95% CI, 0.94–28; P=0.058). Renal recovery was identified in three patients. AKI, hypoxemia with the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen <70, and vasopressors were identified as mortality factors.
Conclusions
AKI occurred in almost half the patients with critical COVID-19. A high level of D-dimers and sepsis contributed significantly to its development. AKI significantly worsened the prognosis in these patients.

Citations

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  • Development of laboratory-based risk scores to predict mortality in patients hospitalized with COVID-19
    Mackenzie Scott, Olga Vishnyakova, Lloyd T. Elliott, Gregory Morgan, Selina Casalino, Erika Frangione, Elisa Lapadula, Simona Haller, Shilpa Thakur, Zeeshan Khan, Iris Wong, Romina Nomigolzar, Georgia MacDonald, Saranya Arnoldo, Erin Bearss, Alexandra Bin
    LabMed Discovery.2025; 2(4): 100087.     CrossRef
  • Rising deaths due to sepsis and renal failure: a 22-year analysis of mortality trends in the US from 1999 to 2020
    Shree Rath, Ahmed Hasan, Neha Waseem, Iffat Ambreen Magsi, Laiba Sultan, Pinkey Kumari, Umama Alam, Zaryab Bacha
    International Urology and Nephrology.2025;[Epub]     CrossRef
  • Acute kidney injury in adult patients with COVID-19: an integrative review
    Ana Clara Alcântara Mendes Pereira, Jéssica Cristina Almeida, Beatriz Regina Lima de Aguiar, Elaine Barros Ferreira, Priscilla Roberta Silva Rocha
    Acta Paulista de Enfermagem.2024;[Epub]     CrossRef
  • Lesão renal aguda em pacientes adultos com COVID-19: revisão integrativa
    Ana Clara Alcântara Mendes Pereira, Jéssica Cristina Almeida, Beatriz Regina Lima de Aguiar, Elaine Barros Ferreira, Priscilla Roberta Silva Rocha
    Acta Paulista de Enfermagem.2024;[Epub]     CrossRef
  • Clinical Features and Outcomes of Patients With COVID-19 Infection and Acute Kidney Injury Requiring Hemodialysis in an Intensive Care Unit: A Retrospective Study From a Tertiary Care Center in Eastern India
    Harsh Vardhan, Megha Saigal, Shyama Shyama, Amresh Krishna
    Cureus.2024;[Epub]     CrossRef
  • Impact of COVID-19 in patients hospitalized with stress cardiomyopathy: A nationwide analysis
    Adrija Hajra, Aaqib Malik, Dhrubajyoti Bandyopadhyay, Akshay Goel, Ameesh Isath, Rahul Gupta, Suraj Krishnan, Devesh Rai, Chayakrit Krittanawong, Salim S. Virani, Gregg C. Fonarow, Carl J. Lavie
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  • Prior bariatric surgery and risk of poor in-hospital outcomes in COVID-19: findings from a National Inpatient Sample
    Daniel Sungku Rim, Byung Sik Kim, Kavita Sharma, Jeong-Hun Shin, Dong Wook Kim
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  • Clinical Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 Patients: A Retrospective Observational Study
    Nabil Bouguezzi, Imen Ben Saida, Radhouane Toumi, Khaoula Meddeb, Emna Ennouri, Amir Bedhiafi, Dhouha Hamdi, Mohamed Boussarsar
    Journal of Clinical Medicine.2023; 12(15): 5127.     CrossRef
  • Acute Kidney Injury in Coronavirus Disease and Association with Thrombosis
    Anand Narayanan, Patrick Cunningham, Malavika Mehta, Theodore Lang, Mary Hammes
    American Journal of Nephrology.2023; 54(3-4): 156.     CrossRef
  • Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19
    Sin-Young Kim, Dae-Young Hong, Jong-Won Kim, Sang-O Park, Kyeong-Ryong Lee, Kwang-Je Baek
    Medicina.2022; 58(6): 727.     CrossRef
  • HYDROCORTISONE, ASCORBIC ACID, AND THIAMINE THERAPY DECREASE RENAL OXIDATIVE STRESS AND ACUTE KIDNEY INJURY IN MURINE SEPSIS
    John Kim, Allan Stolarski, Qiuyang Zhang, Katherine Wee, Daniel Remick
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Pulmonary
Effects of high-flow nasal cannula in patients with mild to moderate hypercapnia: a prospective observational study
Kyung Hun Nam, Hyung Koo Kang, Sung-Soon Lee, So-Hee Park, Sung Wook Kang, Jea Jun Hwang, So Young Park, Won Young Kim, Hee Jung Suh, Eun Young Kim, Ga Jin Seo, Younsuck Koh, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim
Acute Crit Care. 2021;36(3):249-255.   Published online July 26, 2021
DOI: https://doi.org/10.4266/acc.2020.01102
  • 11,775 View
  • 306 Download
  • 6 Web of Science
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AbstractAbstract PDF
Background
Evidence for using high-flow nasal cannula (HFNC) in hypercapnia is still limited. Most of the clinical studies had been conducted retrospectively, and there had been conflicting reports for the effects of HFNC on hypercapnia correction in prospective studies. Therefore, more evidence is needed to understand the effect of the HFNC in hypercapnia.
Methods
We conducted a multicenter prospective observational study after applying HFNC to 45 hospitalized subjects who had moderate hypercapnia (arterial partial pressure of carbon dioxide [PaCO2], 43–70 mm Hg) without severe respiratory acidosis (pH <7.30). The primary outcome was a change in PaCO2 level in the first 24 hours of HFNC use. The secondary outcomes were changes in other parameters of arterial blood gas analysis, changes in respiration rates, and clinical outcomes.
Results
There was a significant decrease in PaCO2 in the first hour of HFNC application (-3.80 mm Hg; 95% confidence interval, -6.35 to -1.24; P<0.001). Reduction of PaCO2 was more prominent in subjects who did not have underlying obstructive lung disease. There was a correction in pH, but no significant changes in respiratory rate, bicarbonate, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio. Mechanical ventilation was not required for 93.3% (42/45) of our study population.
Conclusions
We suggest that HFNC could be a safe alternative for oxygen delivery in hypercapnia patients who do not need immediate mechanical ventilation. With HFNC oxygenation, correction of hypercapnia could be expected, especially in patients who do not have obstructive lung diseases.

Citations

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  • A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease
    Oguzhan Haciosman, Huseyin Ergenc, Adem Az, Yunus Dogan, Ozgur Sogut
    The American Journal of Emergency Medicine.2025; 87: 38.     CrossRef
  • Successful Asymmetric Nasal High-Flow Therapy in CO₂ Narcosis Triggered by Pneumonia in an Elderly Patient: A Case Report
    Keita Takahashi, Shigeto Ishikawa, Akari Kusaka, Hiroyuki Takeuchi, Tomohiko Akahoshi
    Cureus.2025;[Epub]     CrossRef
  • Gas composition and pressure in the hypopharynx during high-flow oxygen therapy through a nasal cannula in healthy volunteers with different breathing patterns
    Andrey I. Yaroshetskiy, Anna P. Krasnoshchekova, Fedor D. Tkachenko, Alina V. Rubashchenko, Daniil D. Zubarev, Vasiliy D. Konanykhin, Maxim I. Savelenok, Maxim M. Nosenko, Zamira M. Merzhoeva, Sergey N. Avdeev
    BMC Anesthesiology.2025;[Epub]     CrossRef
  • Oxygénothérapie nasale à haut débit et insuffisance respiratoire aiguë hypercapnique
    C. Girault, E. Artaud-Macari, G. Jolly, D. Carpentier, A. Cuvelier, G. Béduneau
    Revue des Maladies Respiratoires.2024; 41(7): 498.     CrossRef
  • Safety and efficacy of high flow nasal canula in patients with mild hypercapnia
    Mohammed A. Ibrahim, Magdy Emara, Mohammed Shehta
    The Egyptian Journal of Bronchology.2023;[Epub]     CrossRef
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    Yong Jun Choi, Jae Hwa Cho
    Journal of the Korean Medical Association.2022; 65(3): 124.     CrossRef
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    Ruoxuan Wen, Xingshuo Hu, Tengchen Wei, Kaifei Wang, Zhimei Duan, Zhanqi Zhao, Lixin Xie, Fei Xie
    Frontiers in Medicine.2022;[Epub]     CrossRef
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    迪 吴
    Advances in Clinical Medicine.2022; 12(11): 10617.     CrossRef
Pulmonary
Effectiveness of online versus in-person structured training program on arterial blood gas, electrolytes, and ventilatory management of critically ill patients
Gaurav Jain, Bhavna Gupta, Priyanka Gupta, Sagarika Panda, Sameer Sharma, Shalinee Rao
Acute Crit Care. 2021;36(1):54-61.   Published online February 2, 2021
DOI: https://doi.org/10.4266/acc.2020.00759
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AbstractAbstract PDF
Background
Due to the risk of viral transmission during in-person training, a shift toward online platforms is imperative in the current pandemic. Therefore, we compared the effectiveness of an in-person interactive course with a structurally similar online course designed to improve cognitive skills among clinical health professionals in arterial blood gas analysis, management of electrolyte imbalances, and approaches to mechanical ventilation in critically ill patients.
Methods
In an observational, outcome assessor-blinded, cohort trial, group A included participants enrolled prospectively in an online course, while group B included those who took part in an in-person course (retrospective arm). The primary objective was comparison of cognitive skills through a pre and post-test questionnaire. Statistical analysis was performed using Student t-test.
Results
In total, 435 participants were analyzed in group A, while 99 participants were evaluated in group B. The mean pre-test score was 9.48±2.75 and 10.76±2.42, while the mean post-test score was 11.94±1.90 (passing rate, 64.6%) and 12.53±1.63 (passing rate, 73.3%) in groups A and B, respectively. Group B scored significantly higher in both pre-test (P=0.001) and post-test evaluations (P=0.004). The improvement in post-test score was significantly greater (P=0.001) in group A (2.46±2.22) compared to group B (1.77±1.76). The medical specialties fared better in group B, while surgical specialties scored higher in group A. The pre-test vs. post-test scores exhibited a moderate correlation in both groups (P<0.001). The feedback survey showed a Likert score >3.5 for most points in both groups.
Conclusions
The online teaching module exhibited a significant benefit in terms of participant sensitization and knowledge sharing.

Citations

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  • Health Care Simulation as a Training Tool for Epidemic Management
    Marcia A. Corvetto, Fernando R. Altermatt, Francisca Belmar, Eliana Escudero
    Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare.2023; 18(6): 382.     CrossRef
Pulmonary
Clinical characteristics and outcomes of critically Ill patients with COVID-19 in Northeast Ohio: low mortality and length of stay
Francois Abi Fadel, Mohammed Al-Jaghbeer, Sany Kumar, Lori Griffiths, Xiaofeng Wang, Xiaozhen Han, Robert Burton
Acute Crit Care. 2020;35(4):242-248.   Published online October 12, 2020
DOI: https://doi.org/10.4266/acc.2020.00619
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  • 9 Web of Science
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AbstractAbstract PDF
Background
Published coronavirus disease 2019 (COVID-19) reports suggest higher mortality with increasing age and comorbidities. Our study describes the clinical characteristics and outcomes for all intensive care unit (ICU) patients admitted across the Cleveland Clinic enterprise, a 10-hospital health care system in Northeast Ohio, serving more than 2.7 million people.
Methods
We analyzed the quality data registry for clinical characteristics and outcomes of all COVID-19-confirmed ICU admissions. Differences in outcomes from other health care systems and published cohorts from other parts of the world were delineated.
Results
Across our health care system, 495 COVID-19 patients were admitted from March 15 to June 1, 2020. Mean patient age was 67.3 years, 206 (41.6%) were females, and 289 (58.4%) were males. Mean Acute Physiology Score was 45.3, and mean Acute Physiology and Chronic Health Evaluation III score was 60.5. In total, 215 patients (43.3%) were intubated for a mean duration of 9.2 days. Mean ICU and hospital length of stay were 7.4 and 13.9 days, respectively, while mean ICU and hospital mortality rates were 18.4% and 23.8%.
Conclusions
Our health care system cohort is the fourth largest to be reported. Lower ICU and hospital mortality and length of stay were seen compared to most other published reports. Better preparedness and state-level control of the surge in COVID-19 infections are likely the reasons for these better outcomes. Future research is needed to further delineate differences in mortality and length of stay across health care systems and over time.

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  • Racial inequality in COVID-treatment and in-hospital length of stay in the US over time
    Benjamin M. Althouse, Charlotte Baker, Peter D. Smits, Samuel Gratzl, Ryan H. Lee, Brianna M. Goodwin Cartwright, Michael Simonov, Michael D. Wang, Nicholas L. Stucky
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Effects of race on the outcome of COVID-19 in hospitalized patients
    Getahun Abate, Aniruddh Kapoor, Edward Charbek, Bryan Beck, Qian Wang, Grace C. Wang, Mackenzie Steck, Jason Zoglman, Robin R. Chambeg, Sharon Frey, Daniel F. Hoft, Timothy L. Wiemken
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    Yousef Alimohamadi, Elahe Mansouri Yekta, Mojtaba Sepandi, Maedeh Sharafoddin, Maedeh Arshadi, Elahe Hesari
    Multidisciplinary Respiratory Medicine.2022;[Epub]     CrossRef
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    David Pilcher, Matthew Durie
    American Journal of Respiratory and Critical Care Medicine.2021; 203(5): 532.     CrossRef
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    Muhammed Elhadi, Ahmed Alsoufi, Abdurraouf Abusalama, Akram Alkaseek, Saedah Abdeewi, Mohammed Yahya, Alsnosy Mohammed, Mohammed Abdelkabir, Mohammed Huwaysh, Emad Amkhatirah, Kamel Alshorbaji, Samer Khel, Marwa Gamra, Abdulmueti Alhadi, Taha Abubaker, Mo
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    Abhishek Bhardwaj, Mahmoud Alwakeel, Talha Saleem, Saira Afzal, Sura Alqaisi, Aisha R. Saand, Hanan Al. Najjar, Lori Griffiths, Xiaozhen Han, Xiaofeng Wang, Silvia Perez-Protto, Benjamin S. Abella, David F. Gaieski, Abhijit Duggal, Francois Abi Fadel
    Critical Care Explorations.2021; 3(5): e0425.     CrossRef
  • Overcoming gaps: regional collaborative to optimize capacity management and predict length of stay of patients admitted with COVID-19
    Michael G Usher, Roshan Tourani, Gyorgy Simon, Christopher Tignanelli, Bryan Jarabek, Craig E Strauss, Stephen C Waring, Niall A M Klyn, Burke T Kealey, Rabindra Tambyraja, Deepti Pandita, Karyn D Baum
    JAMIA Open.2021;[Epub]     CrossRef
  • Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study
    Abbas Al Mutair, Alyaa Elhazmi, Saad Alhumaid, Gasmelseed Ahmad, Ali Rabaan, Mohammed Alghadeer, Hiba Chagla, Raghavendra Tirupathi, Amit Sharma, Kuldeep Dhama, Khulud Alsalman, Zainab Alalawi, Ziyad Aljofan, Alya Al Mutairi, Mohammed Alomari, Mansour Awa
    Medicina.2021; 57(9): 878.     CrossRef
  • Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
    Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
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Review Articles
Pulmonary
Critical Care before Lung Transplantation
Jin Gu Lee, Moo Suk Park, Su Jin Jeong, Song Yee Kim, Sungwon Na, Jeongmin Kim, Hyo Chae Paik
Acute Crit Care. 2018;33(4):197-205.   Published online November 30, 2018
DOI: https://doi.org/10.4266/acc.2018.00367
  • 11,005 View
  • 265 Download
  • 5 Web of Science
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AbstractAbstract PDF
Lung transplantation is widely accepted as the only viable treatment option for patients with end-stage lung disease. However, the imbalance between the number of suitable donor lungs available and the number of possible candidates often results in intensive care unit (ICU) admission for the latter. In the ICU setting, critical care is essential to keep these patients alive and to successfully bridge to lung transplantation. Proper management in the ICU is also one of the key factors supporting long-term success following transplantation. Critical care includes the provision of respiratory support such as mechanical ventilation (MV) and extracorporeal life support (ECLS). Accordingly, a working knowledge of the common critical care issues related to these unique patients and the early recognition and management of problems that arise before and after transplantation in the ICU setting are crucial for long-term success. In this review, we discuss the management and selection of candidates for lung transplantation as well as existing respiratory support strategies that involve MV and ECLS in the ICU setting.

Citations

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  • Optimizing the prelung transplant candidate
    John Pagteilan, Scott Atay
    Current Opinion in Organ Transplantation.2024; 29(1): 37.     CrossRef
  • Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation
    Su Hwan Lee
    Acute and Critical Care.2022; 37(1): 26.     CrossRef
  • Recipient Management before Lung Transplantation
    Hyoung Soo Kim, Sunghoon Park
    Journal of Chest Surgery.2022; 55(4): 265.     CrossRef
  • Outcomes of Patients on the Lung Transplantation Waitlist in Korea: A Korean Network for Organ Sharing Data Analysis
    Hye Ju Yeo, Dong Kyu Oh, Woo Sik Yu, Sun Mi Choi, Kyeongman Jeon, Mihyang Ha, Jin Gu Lee, Woo Hyun Cho, Young Tae Kim
    Journal of Korean Medical Science.2022;[Epub]     CrossRef
  • Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation
    Nam Eun Kim, Ala Woo, Song Yee Kim, Ah Young Leem, Youngmok Park, Se Hyun Kwak, Seung Hyun Yong, Kyungsoo Chung, Moo Suk Park, Young Sam Kim, Ha Eun Kim, Jin Gu Lee, Hyo Chae Paik, Su Hwan Lee
    Respiratory Research.2021;[Epub]     CrossRef
Pulmonary
Patient-Ventilator Dyssynchrony
Elvira-Markela Antonogiannaki, Dimitris Georgopoulos, Evangelia Akoumianaki
Korean J Crit Care Med. 2017;32(4):307-322.   Published online November 30, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00535
  • 45,245 View
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AbstractAbstract PDF
In mechanically ventilated patients, assisted mechanical ventilation (MV) is employed early, following the acute phase of critical illness, in order to eliminate the detrimental effects of controlled MV, most notably the development of ventilator-induced diaphragmatic dysfunction. Nevertheless, the benefits of assisted MV are often counteracted by the development of patient-ventilator dyssynchrony. Patient-ventilator dyssynchrony occurs when either the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration, respectively, or if the magnitude of mechanical assist does not respond to the patient’s respiratory demand. As patient-ventilator dyssynchrony has been associated with several adverse effects and can adversely influence patient outcome, every effort should be made to recognize and correct this occurrence at bedside. To detect patient-ventilator dyssynchronies, the physician should assess patient comfort and carefully inspect the pressure- and flow-time waveforms, available on the ventilator screen of all modern ventilators. Modern ventilators offer several modifiable settings to improve patient-ventilator interaction. New proportional modes of ventilation are also very helpful in improving patient-ventilator interaction.

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    Lingwei Zhang, Xue Feng, Fei Lu, Zepeng Ding, Jiayi Yang, Luping Fang, Gangmin Ning, Shuohui Yuan, Huiqing Ge, Qing Pan
    Computer Methods and Programs in Biomedicine.2026; 275: 109203.     CrossRef
  • Synthesis of ventilator dyssynchrony waveforms using a hybrid generative model and a lung model
    Sagar Deep Deb, Suvakash Dey, Deepak K. Agrawal
    Biomedical Signal Processing and Control.2026; 117: 109452.     CrossRef
  • Optimizing Mechanical Ventilation: A Clinical and Practical Bedside Method for the Identification and Management of Patient–Ventilator Asynchronies in Critical Care
    Vasco Costa, José Pedro Cidade, Inês Medeiros, Pedro Póvoa
    Journal of Clinical Medicine.2025; 14(1): 214.     CrossRef
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    Mauro Robertino Del Bono, Luis Felipe Damiani, Gustavo Adrián Plotnikow, Sebastián Consalvo, Emanuel Di Salvo, Gastón Murias
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  • Ineffective respiratory efforts and their potential consequences during mechanical ventilation
    Mauro Robertino Del Bono, Luis Felipe Damiani, Gustavo Adrián Plotnikow, Sebastián Consalvo, Emanuel Di Salvo, Gastón Murias
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    Bruno V Pinheiro, Júlia R Silva, Maycon M Reboredo
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Case Report
Pulmonary
Successful Treatment with Empirical Erlotinib in a Patient with Respiratory Failure Caused by Extensive Lung Adenocarcinoma
Suk Hyeon Jeong, Sang-Won Um, Hyun Lee, Kyeongman Jeon, Kyung Jong Lee, Gee Young Suh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Yoon La Choi
Korean J Crit Care Med. 2016;31(1):44-48.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.44
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AbstractAbstract PDF
We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.

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  • Lazarus effect in a patient initially empirically treated with osimertinib for EGFR L858R mutant non-small cell lung cancer with leptomeningeal disease: a case report
    Shreya Bhatia, Manuel G. Cortez, Spencer Lessans, Wade T. Iams
    Oncotarget.2024; 15(1): 27.     CrossRef
  • Lung cancer with superior vena cava syndrome diagnosed by intravascular biopsy using EBUS-TBNA
    Daegeun Lee, Seong Mi Moon, Dongwuk Kim, Juwon Kim, Haseong Chang, Bumhee Yang, Suk Hyeon Jeong, Kyung Jong Lee
    Respiratory Medicine Case Reports.2016; 19: 177.     CrossRef
Randomized Controlled Trial
Pharmacology/Pulmonary
Comparison of Morphine and Remifentanil on the Duration of Weaning from Mechanical Ventilation
Jae Myeong Lee, Seong Heon Lee, Sang Hyun Kwak, Hyeon Hui Kang, Sang Haak Lee, Jae Min Lim, Mi Ae Jeong, Young Joo Lee, Chae Man Lim
Korean J Crit Care Med. 2014;29(4):281-287.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.281
Correction in: Acute Crit Care 2016;31(4):381
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  • 143 Download
  • 2 Crossref
AbstractAbstract PDF
BACKGROUND
A randomized, multicenter, open-label, parallel group study was performed to compare the effects of remifentanil and morphine as analgesic drugs on the duration of weaning time from mechanical ventilation (MV).
METHODS
A total of 96 patients with MV in 6 medical and surgical intensive care units were randomly assigned to either, remifentanil (0.1-0.2 mcg/kg/min, n = 49) or morphine (0.8-35 mg/hr, n = 47) from the weaning start. The weaning time was defined as the total ventilation time minus the sum of controlled mode duration.
RESULTS
Compared with the morphine group, the remifentanil-based analgesic group showed a tendency of shorter weaning time (mean 143.9 hr, 89.7 hr, respectively: p = 0.069). Secondary outcomes such as total ventilation time, successful weaning rate at the 7th of MV day was similar in both groups. There was also no difference in the mortality rate at the 7th and 28th hospital day. Kaplan-Meyer curve for weaning was not different between the two groups.
CONCLUSIONS
Remifentanil usage during the weaning phase tended to decrease weaning time compared with morphine usage.

Citations

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  • ICU patients receiving remifentanil do not experience reduced duration of mechanical ventilation: a systematic review of randomized controlled trials and network meta-analyses based on Bayesian theories
    Fangjie Lu, Sirun Qin, Chang Liu, Xunxun Chen, Zhaoqiu Dai, Cong Li
    Frontiers in Medicine.2024;[Epub]     CrossRef
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    Shuguang Yang, Huiying Zhao, Huixia Wang, Hua Zhang, Youzhong An
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Original Articles
Pulmonary
Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index
Sarah Soh, Jin Ha Park, Jeong Min Kim, Min Jung Lee, Shin Ok Koh, Hyo Chae Paik, Moo Suk Park, Sungwon Na
Korean J Crit Care Med. 2014;29(4):273-280.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.273
  • 9,448 View
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AbstractAbstract PDF
BACKGROUND
Weaning from mechanical ventilation is difficult in the intensive care unit (ICU). Many controversial questions remain unanswered concerning the predictors of weaning failure. This study investigates patient characteristics and delayed weaning after lung transplantation.
METHODS
This study retrospectively reviewed the medical records of 17 lung transplantation patients from October 2012 to December 2013. Patients able to be weaned from mechanical ventilation within 8 days after surgery were assigned to an early group (n = 9), and the rest of the patients were assigned to the delayed group (n=8). Patients' intraoperative and postoperative characteristics were collected and analyzed, and conventional weaning predictors, including rapid shallow breathing index (RSBI), were also assessed.
RESULTS
The results of the early group showed a significantly shorter ICU stay in addition to a shorter hospitalization overall. Notably, the early group had a higher body mass index (BMI) than the delayed group (20.7 vs. 16.9, p = 0.004). In addition, reopening occurred more frequently in the delayed group (1/9 vs. 5/8, p = 0.05). During spontaneous breathing trials, tidal volume (TV) and arterial oxygen tension were significantly higher in the early group compared to the delayed weaning group, but differences in RSBI and respiratory rate (RR) between groups were not statistically significant.
CONCLUSIONS
Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.
Thoracic surgery
Clinical Characteristics of the Development of Pneumothorax in Mechanically Ventilated Patients in Intensive Care Units
Wan Chul Kim, Su Jin Lim, Kyong Young Kim, Seung Jun Lee, Yu Ji Cho, Yi Yeong Jeong, Mi Jung Park, Kyoung Nyeo Jeon, Jong Deog Lee, Young Sil Hwang, Ho Cheol Kim
Korean J Crit Care Med. 2014;29(1):13-18.   Published online February 28, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.1.13
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AbstractAbstract PDF
Background
Pneumothorax (PTX) can occur as a complication of positive pressure ventilation in mechanically ventilated patients.
Methods
We retrospectively reviewed the clinical characteristics of patients who developed PTX during mechanical ventilation (MV) in the intensive care unit (ICU).
Results
Of the 326 patients admitted (208 men and 118 women; mean age, 65.3 ± 8.74 years), 15 (4.7%) developed PTX, which was MV-associated in 11 (3.3%) cases (6 men and 5 women; mean age, 68.3 ± 9.12 years) and procedure-associated in 4. Among the patients with MV-associated PTX, the underlying lung diseases were acute respiratory distress syndrome in 7 patients, interstitial lung disease in 2 patients, and chronic obstructive pulmonary disease in 2 patients. PTX diagnosis was achieved by chest radiography alone in 9 patients and chest computed tomography alone in 2 patients. Nine patients were using assist-control mode MV with the mean applied positive end-expiratory pressure, 9 ± 4.6 cmH2O and the mean tidal volume, 361 ± 63.7 ml at the diagnosis of PTX. Two patients died as a result of MV-associated PTX and their systolic pressure was below 80 mmHg and heart rates were less than 80/min. Ten patients were treated by chest tube insertion, and 1 patient was treated by percutaneous pigtail catheter insertion.
Conclusions
PTX can develop in patients undergoing MV, and may cause death. Early recognition and treatment are necessary to prevent hemodynamic compromise in patients who develop PTX.
The Consistency and Clinical Significance between Bronchoscopic Samples and Endotracheal or Tracheostomic Aspirates in Severe Pneumonia Under Mechanical Ventilation
Hye Sung Park, Seo Woo Kim, Yun Su Sim, Ji Hye Kim, Yon Ju Ryu, Jin Hwa Lee, Jung Hyun Chang
Korean J Crit Care Med. 2011;26(2):83-88.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.83
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AbstractAbstract PDF
BACKGROUND
Distal airway bacterial colonization occurs more frequently in patients with endotracheal tubes or tracheostomy of intensive care units (ICU) care. In general, bronchoscopic samples are considered more accurate than transtracheal aspirates. In this study, we evaluated the consistency and clinical significance between bronchoscopic samples and transtracheal aspirates (TTA) in severe pneumonia under mechanical ventilation.
METHODS
We investigated the consistency between bronchoscopic samples and transtracheal aspirates among patients with endotracheal tubes or tracheostomy, retrospectively. Fiberoptic bronchoscopy was performed in 212 patients with mechanical ventilation via endotracheal tube or tracheostomy between January 1st, 2004 and December 31th, 2008 in ICU at Ewha Womans University Hospital. We evaluated consistency in terms of true pathogen according to the arbitrary ICU days progress.
RESULTS
Among the 212 enrolled patients, 113 (53%) had consistency between bronchoscopic samples and transtracheal aspirates. When evaluated alteration trends in consistency according to ICU stay, the consistency was maintained for 5 to 9 ICU days with statistical significance (p< 0.05) since adjusting for age, sex, and combined risk factors. Consistency in sampling status between the endotracheal tube and tracheostomy was also evaluated, however, there was no statistical significance (OR 1.9 vs. 1, 95% CI = 0.997-3.582, p = 0.051).
CONCLUSIONS
Shorter hospital stay (within 9 days of ICU stay) had higher probability of consistency between bronchoscopic samples and TTA samples. TTA may be as confident as bronchoscopic samples in patients of pneumonia under mechanical ventilation with shorter ICU stays, especially less than 10 days.

Citations

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  • Comparison of the Pattern in Semi-Quantitative Sputum Cultures Based on Different Endotracheal Suction Techniques
    Jiwoong Oh, Kum Whang, Hyenho Jung, Jongtaek Park
    Korean Journal of Critical Care Medicine.2012; 27(2): 70.     CrossRef
Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients
Sungwon Na, Hosun Lee, Shin Ok Koh, Ai Soon Park, A Reum Han
Korean J Crit Care Med. 2010;25(3):136-143.
DOI: https://doi.org/10.4266/kjccm.2010.25.3.136
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  • 3 Crossref
AbstractAbstract PDF
BACKGROUND
Nutrition delivery is frequently interrupted or delayed by physicians' ordering patterns. We conducted this study to investigate the effect of physician compliance with tube feeding (TF) protocol on the nutritional and clinical outcomes in acute lung injury (ALI) patients.
METHODS
After implementing a TF protocol, 71 ALI patients with mechanical ventilation (MV) for > or = 7 days were observed. A dietician assessed the nutritional status of the patients and established individualized nutrition plans according to the protocol. If the physicians followed the dietician's recommendation within 48 hours, the patients were classified under the compliant group (Group 1).
RESULTS
Forty patients (56.3%) were classified into Group 1. Prealbumin was comparable in both groups at ICU admission but higher in Group 1 at the time of discharge from the ICU (228 +/- 81 vs 157 +/- 77 mg/dl, p = 0.025). Nitrogen balance was only improved in Group 1. The time to reach calorie goal was shorter and non-feeding days were reduced in Group 1. The proportion of parenteral nutrition to nutritional support days was lower and delivered calories on the 4th and 7th day of TF were higher in Group 1 (p < 0.001). ICU mortality/stay and hospital mortality failed to show differences but hospital stay was prolonged in the noncompliant group (Group 2) (p = 0.023). Arterial oxygen tension and PaO2/FiO2 were maintained during the 1st week of ICU stay in Group 1 but were decreased in Group 2.
CONCLUSIONS
Physicians' compliance with the TF protocol contributed to the likelihood of nutritional improvement and a shorter hospital stay in ALI patients with prolonged MV.

Citations

Citations to this article as recorded by  
  • Barriers to the Implementation of Prospective Studies Evaluating the Benefits of Early Tube Feeding on Hip Fracture Outcomes: Lessons and Future Directions from a Failed Pilot Study
    Fernando Huyke-Hernández, Megan Sorich, Julie Switzer
    Journal of the American Osteopathic Academy of Orthopedics.2023;[Epub]     CrossRef
  • Nutritional Assessment of ICU Inpatients with Tube Feeding
    Yu-Jin Kim, Jung-Sook Seo
    Journal of the Korean Dietetic Association.2015; 21(1): 11.     CrossRef
  • Identifying Barriers to Implementing Nutrition Recommendations
    Nancy Stamp, Anne M. Davis
    Topics in Clinical Nutrition.2013; 28(3): 249.     CrossRef
Evaluating the Relationship between the Scoring Systems of Intensive Care Units (ICUs) and the Duration of Mechanical Ventilation after Liver Transplantation
Jeong Eun Kim, Sang Hoon Lee, Jong Ho Choi
Korean J Crit Care Med. 2009;24(2):69-74.
DOI: https://doi.org/10.4266/kjccm.2009.24.2.69
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AbstractAbstract PDF
BACKGROUND
Postoperative mechanical ventilation in liver transplant patient has an important role for reducing respiratory complications and multi-organ failure in intensive care unit (ICU). Yet there are no specific indications for predicting the duration of postoperative mechanical ventilation. Thus, we evaluated the correlation between the duration of mechanical ventilation and scoring systems such as the Acute Physiology and Chronic health Evaluation (APACHE) II score, the Sequential Organ Failure Assessment (SOFA) score, the Model for End-stage Liver Disease (MELD) score and the risk index.
METHODS
We retrospectively studied 183 patients who underwent living donor liver transplantation and we divided them into three groups based on the duration of mechanical ventilation: Group 1: <8 hr, Group 2: 8-12 hr and Group 3: >12 hr. We analyzed the correlation coefficients among the duration of mechanical ventilation, the risk index, and the SOFA, APACHE II and MELD scores.
RESULTS
The MELD and preoperative SOFA scores were significantly higher in group 3 (p = 0.003, p = 0.027). The MELD and SOFA scores were correlated with the duration of mechanical ventilation for all the patients (correlation coefficient = 0.22, 0.20, p = 0.003, 0.007, respectively). Yet the APACHE II score shows no correlation.
CONCLUSIONS
We found that the MELD and SOFA scores were correlated with the duration of mechanical ventilation in liver transplant patients. Thus, these scoring systems may be useful to determine the duration of mechanical ventilation.
Effects of Ventilation Modes and Levels of PEEP on Respiratory Mechanics during Controlled Ventilation under General Anesthesia
Jong Cook Park, Sang Hyun Park, Hyun Jun Kwag, Soo Young Park
Korean J Crit Care Med. 2006;21(2):89-94.
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AbstractAbstract PDF
BACKGROUND
Application of PEEP increases lung volume and improves oxygenation. High PEEP levels may cause alveolar overdistension or barotrauma. It was hypothesized that there will be an effect of level of PEEP on respiratory resistance and an effect of ventilatory mode on respiratory compliance. This study aimed to investigate the effects of ventilation modes and levels of PEEP on respiratory mechanics during controlled ventilation under general anesthesia.
METHODS
In 14 mechanically ventilated patients without cardiopulmonary symptoms and signs, we measured the respiratory mechanics using the inspiration interrupter technique during a constant flow. Dynamic and static compliance, airway resistance, visco-elastic tissue and total respiratory system resistance were calculated at 0, 5, 10, 15, and 20 cmH2O of positive end-expiratory pressure (PEEP) in VCV mode, VCV with inspiratory pause mode, and PCV mode, respectively.
RESULTS
The dynamic compliance of the PCV mode was higher than that of the VCV mode. The highest static compliance was at 10 cmH2O PEEP. At 20 cmH2O PEEP, pulmonary compliance was decreased and the tissue resistance was increased.
CONCLUSIONS
These results suggest that the respiratory mechanics including respiratory resistance should be monitored for applying PEEP. Further studies on clinical condition such as acute lung injury and ARDS were needed.
Randomized Controlled Trial
Alteration of Lung Mechanics Depending on Expiratory Sensitivity (ESENS) during Pressure Support Ventilation
Kwang Won Seo, Gyu Rak Chon, Jong Joon Ahn, Yangjin Jega, Sang Bum Hong, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2006;21(1):8-16.
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AbstractAbstract PDF
BACKGROUND
To evaluate effects of 5 expiratory sensitivity (ESENS) levels (5%; 15%; 25%; 35%; 45%) on lung mechanics and the effects depending on the two P(0.1) levels (<3 cm H2O; > or =3 cm H2O).
METHODS
Prospective, randomized, physiologic study for intubated adult patients during weaning from mechanical ventilation. Patients were randomly submitted to the 5 settings of ESENS in the Galileo ventilator (Galileo Gold, Hamilton Medical AG, Switzerland). Physiologic variables were continuously measured using a Bicore CP-100 pulmonary mechanics monitor (CP-100, Bicore, USA).
RESULTS
Thirteen patients, ten men and three women, with a mean age of 65.2+/-16.1 yr were studied. Tidal volume (V(T)) decreased significantly from ESENS 5% to 45%. With increasing levels of ESENS, respiratory rates (RR) steadily increased from ESENS 5% to 35% and 45%. Shallow breath index (F/V(T)) increased significantly from ESENS 5% to 45%. Inspiratory time (T(I)) decreased gradually significantly from ESENS 5% to 45%. RR and F/V(T) increased from ESENS 5% to 15% and 45% and V(T) decreased gradually in patients with P(0.1)<3 cm H2O group, but not in patients with P(0.1)> or =3 cm H2O.
CONCLUSIONS
The proper adjustment of expiratory sensitivity (ESENS) levels improved patient-ventilator synchrony and decreased respiratory rates and shallow breath index, especially in P(0.1)<3 cm H2O during PSV in ventilator weaning patients. Lower ESENS level would be more appropriate in terms of lung mechanics in patients with less than 3 cm H2O of P(0.1).
Case Report
One-lung Ventilation using Wire-guided Endobronchial Blocker and Single Lumen Endotracheal Tube: A Case Report
Hee Zoo Kim, Seung Hwan Oh, Chung Guk Park, Eun Hye Koo, Hye Ran Oh, Mi Kyoung Lee, Sang Ho Lim
Korean J Crit Care Med. 2005;20(1):92-96.
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AbstractAbstract PDF
We had done one-lung ventilation using 9 Fr wire-guided endobronchial blocker and outer diameter 41-mm flexible fiberoptic bronchoscope in ruptured esophageal patient who expected difficult tracheal intubation and in esophageal cancer patient who was in need of mechanical ventilation during and after the operation.
Original Article
Clinical Findings of Critical Illness Polyneuropathy in Patients with Mechanical Ventilator Treatment
Sung Soon Lee, Jae Yong Chin, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2005;20(1):38-43.
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AbstractAbstract PDF
BACKGROUND
Critical illness polyneuropathy (CIP) is a primary distal axonal degeneration of motor and sensory fibers leading to severe limb weakness and difficulty in weaning from ventilator in critically ill patients. The object of this study is to evaluate the clinical findings of CIP and the risk factors associated with CIP development in patients with mechanical ventilator treatment. METHODS: We examined 40 patients, between March 2002 to February 2003, who manifested muscular weakness and received mechanical ventilation (MV) more than three days, prospectively. Nerve conduction velocity (NCV) and electromyography (EMG) were performed in all patients in the ICU. We examined the use of drugs (neuromuscular blocking agents, corticosteroid, and aminoglycoside), duration of MV and weaning, and APACHE II score. RESULTS: We observed 40 patients who showed muscular weakness, 9 patients were diagnosed as CIP. NCV study demonstrated decreased action potential amplitude, predominantly in motor nerve, distal part. There was no significant difference in duration of MV and weaning, drug use, APACHE II score between the groups with CIP and without CIP. CONCLUSIONS: CIP is an important neuromuscular complication of the patients in ICU. We should consider the possibility of the development of CIP in patients who showed muscular weakness and difficult weaning in critically ill patients.
Review Article
Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease
Tae Hun An
Korean J Crit Care Med. 2003;18(2):67-73.
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AbstractAbstract PDF
Patients with severe chronic obstructive pulmonary disease (COPD) may require mechanical ventilation following cardiac or general surgery, in connection with thoracic surgery such as lobectomy, wedge resection, lung reduction or bullectomy, during an episode of acute respiratory failure (ARF) secondary to a disease other than COPD such as sepsis, drug overdose, or trauma or for acute-on-chronic respiratory failure (the COPD exacerbation) where acute illness, usually presumed to be infectious in nature, destabilizes the characteristically compensated state. Ventilatory intervention is often life-saving when patients with asthma or COPD experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choice, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. This review will only briefly cover noninvasive ventilation and focus primarily on the management of the intubated, mechanically ventilated patient with COPD, with particular emphasis on factors unique to this patient population such as the propensity for dynamic hyperinflation and auto-PEEP, barotrauma, difficult weaning and the prognosis following mechanical ventilation.
Randomized Controlled Trial
Comparison of the Efficacy between Ketamine and Morphine on Sedation and Analgesia in Patients with Mechanical Ventilation
Tae Hyung Kim, Chae Man Lim, Tae Sun Shim, Sang Do Lee, Woo Sung Kim, Dong Soon Kim, Won Dong Kim, Younsuck Koh
Korean J Crit Care Med. 2000;15(2):82-87.
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AbstractAbstract PDF
BACKGROUND
While the combination therapy of morphine and benzodiazepine has been recommended as a standard therapy for sedation and analgesia in patients with mechanical ventilation, morphine can suppress respiratory center, and also decrease blood pressure and bowel movement. Because ketamine has analgesic and sedative effects compatible to morphine without depression of the cardiovascular and respiratory systems in addition to the preservation of bowel activity, ketamine may substitute morphine. However, it has not well known such potential advantages of ketamine in patients with mechanical ventilation.
METHODS
Thirty eight patients (male:female=30:8, age=62.6 +/- 11.7 years) with mechanical ventilation were randomized as ketamine and morphine group (n=21 vs. n=17). There was no significant differences in sex, age and APACHE III score at the initiation of mechanical ventilation (ketamine group, morphine group: 79.4 +/- 2.0, 82.0 +/- 20.6). The study duration was 24 h after drug administration and minimum dose, which maintains ventilator-patient synchrony or the status of Ramsay score 3, was used. Ramsay sedation score, hemodynamic variables, respiratory and arterial blood gas variables, and bowel sound were measured at every 4 h. Arterial blood gas analysis was checked at 0, 4, and 24 h.
RESULTS
1) There were no significant differences in Ramsay sedation score and other hemodynamic, respiratory, and arterial blood gas variables in each group. The dose of combined midazolam was not different between two groups (ketamine vs. morphine; 52.1 +/- 11.9 vs. 46.7 +/- 15.1 mg/d; p=0.23). 2) The cases with decreased mean arterial pressure over 25% of the baseline shortly after the drug administration less frequently observed in ketamine group, although the difference did not reach statistical significance (n=2, 9.5% vs. n=5, 29.4%; p=0.12). 3) Bowel movement reduction at 4 h after the drug administration was less in ketamine group (n=1, 4.8% vs. n=6, 35.3%, p=0.03). The difference was not observed at 8 h. 4) Cost of the drug for 24 h was more expensive in ketamine group (dose & cost; 688 506 mg/d & 25,891 7,743 won vs. 40 +/- 18 mg/d, 15,814 +/- 4,853 won; p<0.001).
CONCLUSIONS
Considering the advantages in the hemodynamics and bowel movement, ketamine may substitute morphine for the sedation of patients with mechanical ventilation, if indicated.
Case Report
Oropharyneal Bezoar in a Patient with Amyotrophic Lateral Sclerosis under Mechanical Ventilation: A case report
Cheung Soo Shin, Jin Mo Ahn, Gab Soo Kim, Song Mi Lee
Korean J Crit Care Med. 1998;13(1):97-100.
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AbstractAbstract PDF
Bezoars are not uncommonly found during upper gastrointestinal investigations (UGI), are known to be associated with conditions causing stasis changes in gastrointestinal tract. We described here a curious presentation of an oropharyngea bezoar associated with medication and tube feeding. Only few cases of regurgated esophageal bezoar have been reported. A 54 years old man with amyotropic lateral sclerosis required ventilatory support. Nasogastric tube was placed, enteral feeding with special liquid diet (Geenvia TF) was begun. In addition, almagate was given via the feeding tube. Tracheotomy was done for long term mechanical ventilation support. On the 10th day of ICU stay, he complained of foreign body sensation in oral cavity. We could find a white brown colored 15cm solid mass in deep oropharynx. Some factors including sucralfate and the peripheral neuropathy have been suspected to be ascribed forming the esophageal bezoar. Gastrointestinal motility was decrease in patients with peripheral neuropathy. In this case, aluminum hydroxides, one of the aluminium substance like sucralfate, was given to the patient with the peripheral neuropathy. From this experience, we became to know that it is necessary to use the aluminium compound anti-ulcer drug with caution in the patients with the gastrointestinal depression.
Original Article
Evaluation of Weaning Criteria from Mechanical Ventilatory Support
Young Joo Lee, Haeng Jae Kim, Taeg Hwan Bae, Sang Kun Han, Keum Hee Chung, Jang Wun Yun, Jae Woo Jin, Chol Kim
Korean J Crit Care Med. 1998;13(1):79-84.
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AbstractAbstract PDF
Introduction: A number of indices have been proposed as accurate predictors of weaning, but several studies have questioned the accuracy of these weaning indices in predicting the capability of independent breathing. The purpose of the study was to assess six standard bedside weaning criteria of mechanically ventilated patients in Surgical intensive care unit (SICM).
METHOD
: The study was performed on 72 SICU patients who were mechanically ventilated. According to the outcome of weaning, they were divided into two groups, weaning success (n=62) and weaning failure (n=10) group. All subjects should have PaO2 above 60 mm Hg at an FIO2 of 0.4 and PEEP of 3~5 cm H2O in the extubated patients and no PEEP in the tracheostomy patients. Six bedside weaning criteria were tidal volume above 5 ml/kg, respiratory rate below 25/min, vital capacity above 10 ml/kg, maximum inspiratory pressure below -20 cm H2O, minute volume below 10 L/min and PaO2/FIO2 above 200. Weaning failure was regarded as follows; changes of systolic blood pressure 20 mm Hg or diastolic pressure 10 mm Hg, changes of pulse rate 20 beat per minute, respiratory rate above 30 per minute or increased respiratory rate above 10 per minute, PaO2 below 60 mm Hg or PaCO2 above 55 mm Hg, and presence of paradoxical respiratory pattern.
RESULTS
PaO2/FIO2 and minute volume (VE) were showed statistically significant difference between two groups (P=0.048, P=0.003 respectively). Linear discriminant function was D=-1.422-0.005-xPaO2/FIO2+0.336xVE.
CONCLUSION
Our study demonstrates that PaO2/FIO2 and minute volume accurately predicts the weaning outcome in the surgical patients with mechanical support.
ACC : Acute and Critical Care
© The Korean Society of Critical Care Medicine.
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