Acute and Critical Care

Original Articles

Pediatrics
Post–intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post–intensive-care clinic: Chanapai Chaiyakulsil; Acute Crit Care. 2024;39(4):600-610. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.01011

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Abstract PDF Supplementary Material: Background
Long-term survival data for critically ill children discharged to post-intensive care clinics are scarce, especially in Asia. The main objective of this study was to assess the prevalence of post–intensive-care morbidity among pediatric intensive care unit (PICU) survivors at 1 month and 1 year after hospital discharge and to identify the associated risk factors.
Methods
We conducted a retrospective chart review of all children aged 1 month to 15 years who were admitted to the PICU for >48 hours from July 2019 to July 2022 and visited a post–intensive-care clinic 1 month and 1 year after hospital discharge. Post-intensive care morbidity was defined using the Pediatric Cerebral Performance Category (PCPC). Descriptive statistics, univariate, and multivariate analyses were conducted.
Results
A total of 111 children visited the clinic at 1 month, and 100 of these children visited the clinic at 1 year. Only 39 of 111 children (35.2%) had normal PCPC assessments at 1 month, while 54 of 100 (54.0%) were normal at 1 year. Baseline developmental delays were significantly associated with any degree of disability and at least moderate disability at both time points. Mechanical ventilation for >7 days was associated with at least moderate disability at both time points, while PICU stay >7 days was significantly associated with moderate disability at 1 month and any degree of disability at 1 year.
Conclusions
A substantial percentage of PICU survivors had persistent disabilities even 1 year after critical illness. A structured multidisciplinary post–intensive-care follow-up plan is warranted to provide optimal care for such children.

Epidemiology
Implementation and effectiveness of a delirium care protocol in Thai critically ill children: Chanapai Chaiyakulsil, Thananya Thadahirunchot; Acute Crit Care. 2023;38(4):488-497. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00045

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1 Web of Science
4 Crossref

Background
Delirium in critically ill children can result in long-term morbidity. Our main objectives were to evaluate the effectiveness of a new protocol on the reduction, prevalence, and duration of delirium and to identify associated risk factors.
Methods
The effectiveness of the protocol was evaluated by a chart review in all critically ill children aged 1 month to 15 years during the study period. A Cornell Assessment of Pediatric Delirium score ≥9 was considered positive for delirium. Data on delirium prevalence and duration from the pre-implementation and post-implementation phases were compared. Univariate and multivariate analyses were used to identify the risk factors of delirium.
Results
A total of 120 children was analyzed (58 children in the pre-implementation group and 62 children in the post-implementation group). Fifty children (41.7%) screened positive for delirium. Age less than 2 years, delayed development, use of mechanical ventilation, and pediatric intensive care unit (PICU) stay >7 days were significantly associated with delirium. The proportion of children screened positive was not significantly different after the implementation (before, 39.7% vs. after, 43.5%; P=0.713). Subgroup analyses revealed a significant reduction in the duration of delirium in children with admission diagnosis of cardiovascular problems and after cardiothoracic surgery.
Conclusions
The newly implemented protocol was able to reduce the duration of delirium in children with admission diagnosis of cardiovascular problems and after cardiothoracic surgery. More studies should be conducted to reduce delirium to prevent long-term morbidity after PICU discharge.

Citations

Citations to this article as recorded by

Risk Factors for Delirium in Pediatric Intensive Care Units: A Systematic Review and Meta-Analysis
Zhiwen Zhang, Peng Zhou
Pediatric Neurology.2026; 180: 146. CrossRef
Pediatric Delirium in Pediatric Intensive Care Setting: A Review of Recognition and Prevalence
Patricia Savrimuthu, Putri Yubbu
Malaysian Journal of Paediatrics and Child Health.2025; 31(1): 33. CrossRef
Non-pharmacological interventions for delirium in critically ill children: a scoping review
Max Zilezinski, Natascha-Elisabeth Denninger, Antje Tannen, Jan Kottner
BMJ Open.2025; 15(9): e094529. CrossRef
The growing significance of delirium in children
Roberta Esteves Vieira de Castro, Yu Kawai, Alexandria Barry, Dickey Catherine Fuchs, Elizabeth Engstrom, Kristina A. Betters, Heidi A. B. Smith
Critical Care Science.2025;[Epub] CrossRef

Epidemiology
Incidence and associated factors of pediatric post-intensive care syndrome using the VSCAREMD model: Paweethida Tippayawong, Chanapai Chaiyakulsil; Acute Crit Care. 2022;37(4):627-635. Published online October 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00234

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5 Web of Science
5 Crossref

Abstract PDF

Background
The VSCAREMD model is used for evaluating vaccination, sleep, and parental care burden, which includes daily activity and social interaction, rehabilitation requirements, hearing, mood, and development. It has been proposed to detect post-intensive care syndrome (PICS) in children. This study aimed to outline the incidence of PICS in children using the VSCAREMD model and to describe the associated factors.
Methods
All children ages 1 month to 15 years and admitted to the intensive care unit for at least 48 hours were evaluated using the VSCAREMD model within 1 week of intensive care discharge. Abnormal findings were assorted into four domains: physical, cognitive, mental, and social. Descriptive statistics were performed using chi-square, univariate, and multivariate analyses.
Results
A total of 78 of 95 children (82.1%) had at least one abnormal domain. Physical, cognitive, mental, and social morbidity were found in 64.2%, 26.3%, 13.7%, and 38.9% of the children, respectively. Prolonged intensive care unit stay greater than 7 days was associated with dysfunction in physical (adjusted odds ratio [aOR], 3.80; 95% confidence interval [CI], 1.31–11.00), cognitive (aOR, 10.11; 95% CI, 3.01–33.89), and social domains (aOR, 5.01; 95% CI, 2.01–12.73). Underlying medical conditions were associated with cognitive (aOR, 13.63; 95% CI, 2.64– 70.26) and social morbidity (aOR, 2.81; 95% CI, 1.06–7.47).
Conclusions
The incidence of PICS using the VSCAREMD model was substantially high and associated with prolonged intensive care. This model could help evaluate PICS in children.

Citations

Citations to this article as recorded by

Post-traumatic stress disorder in children after discharge from the pediatric intensive care unit: a scoping review
Maoting Tang, Ping Lei Chui, Mei Chan Chong, Xianliang Liu
European Child & Adolescent Psychiatry.2025; 34(2): 483. CrossRef
Post intensive care syndrome in paediatrics PICS-p: symptoms, severity and prevalence
Patrycja Krystyna Mazurek, Anna Aftyka
Pielegniarstwo XXI wieku / Nursing in the 21st Century.2025; 24(1): 83. CrossRef
Prevalence of Post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis
Temesgen Ayenew, Menberu Gete, Mihretie Gedfew, Addisu Getie, Abebe Dilie Afenigus, Afework Edmealem, Haile Amha, Girma Alem, Bekele Getenet Tiruneh, Mengistu Abebe Messelu, Ramya Iyadurai
PLOS One.2025; 20(5): e0323311. CrossRef
Pain, Analgesia, Sedation, and the Developing Brain
Callie Marshall, Christopher McPherson
Pediatric Clinics of North America.2025; 72(5): 877. CrossRef
Post–intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post–intensive-care clinic
Chanapai Chaiyakulsil
Acute and Critical Care.2024; 39(4): 600. CrossRef

Trauma
Mortality and Morbidity in Severely Traumatized Elderly Patients: Byungchul Yu, Min Chung, Giljae Lee, Jungnam Lee; Korean J Crit Care Med. 2014;29(2):88-92. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.88

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71 Download
4 Crossref

Abstract PDF

Background
As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe outcomes from injuries compared with the young. In this study, we examined the relationship between mortality and complications with age.
Methods
This study was a retrospective review of 256 major trauma patients (Injury Severity Score > 15) admitted to an emergency center over a two- year period. Age-dependent mortality and complications were evaluated.
Results
Of 256 patients, 209 (81.6%) were male and the mean age was 47.2 years. There was a trend between increasing age and increasing mortality, but this was not statistically significant. Increasing age was correlated with frequency of complications.
Conclusions
Age was confirmed to be an independent predictor of mortality in major trauma. We documented that elderly trauma patients suffer from complications more frequently compared with their younger counterparts. Appropriate and specific triage and management guidelines for elderly trauma patients are needed.

Citations

Citations to this article as recorded by

Predicting mortality in elderly trauma patients: a review of the current literature
Jarva Chow, Catherine M. Kuza
Current Opinion in Anaesthesiology.2022; 35(2): 160. CrossRef
Activities of Daily Living and Determinant Factors among Older Adult Subjects with Lower Body Fracture after Discharge from Hospital: A Prospective Study
Nurul Izzah Ibrahim, Mohd Sharkawi Ahmad, Mohamed S Zulfarina, Sharifah Nurul Aqilah Sayed Mohd Zaris, Isa Naina Mohamed, Norazlina Mohamed, Sabarul Afian Mokhtar, Ahmad Nazrun Shuid
International Journal of Environmental Research and Public Health.2018; 15(5): 1002. CrossRef
Geriatric Trauma Protocol
Renee Cortez
Journal of Trauma Nursing.2018; 25(4): 218. CrossRef
Predictive Factors of Dependency in Activities of Daily Living Following Limb Trauma in the Elderly
Azade Safa, Negin Masoudi Alavi, Masoumeh Abedzadeh-Kalahroudi
Trauma Monthly.2016;[Epub] CrossRef

Gender Differences in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Sukwon Hahn; Korean J Crit Care Med. 2012;27(4):230-236.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.230

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22 Download

Abstract PDF: BACKGROUND
Limited data are available for gender-based differences among patients with acute myocardial infarction (AMI) undergoing coronary revascularization in Korea. The purpose of this study is to identify gender-based differences in clinical characteristics, risk factors and outcomes among Korean patients undergoing percutaneous coronary intervention (PCI).
METHODS
Patients with AMI undergoing PCI between Jan 2009 and Sep 2011 were included (n = 457) in the study. Clinical characteristics and cardiovascular risk factors as well as major adverse cardiac events (MACE), including death after PCI, were compared between women (n = 134) and men (n = 323).
RESULTS
Women were older (69.8 +/- 10.7 vs. 60.0 +/- 11.7 years, p < .001) and had more comorbidities, such as diabetes (44.0% vs. 32.8%, p = .025) and hypertension (64.9% vs. 48.9%, p = .002) compared to men. Women were less likely to have a smoking history (p < .001). There were no significant differences in all causes of death and in MACE between women and men. By the multivariate analysis, age, HDL-cholesterol and left ventricle ejection fraction are associated with mortality and MACE.
CONCLUSIONS
In this study, women did not emerge as an independent predictor for MACE; however, they were older and had a higher incidence of hypertension and diabetes than men.

Association of Hyperlactatemia and IL-6 Hypercytokinemia after Cardiopulmonary Bypass: A Preliminary Report: Sang Hoon Yoon, Seung Zhoo Yoon, Hye Won Shin, Sung Uk Choi, Choon Hak Lim; Korean J Crit Care Med. 2011;26(1):18-23.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.18

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Abstract PDF: BACKGROUND
In cardiac surgery with cardiopulmonary bypass (CPB), hyperlactatemia (HL) is common and is associated with postoperative morbidity and mortality. At present, the cause of HL during CPB is proposed to be tissue hypoxia. Tissue perfusion and oxygen delivery can be impaired to varying degrees during CPB. Although surgery involving CPB apparatus is associated with increased pro-inflammatory mediators, such as TNF-alpha and IL-6, tissue hypoxia that occurs during CPB may be an additionally potent stimulus to inflammation. We hypothesized that hypoxic patients during CPB that experience elevated serum lactate levels, may be related to higher serum cytokine level after CPB than normoxic patients during CPB with normal serum lactate levels.
METHODS
Levels of TNF-alpha and IL-6 were measured by ELISA in a) Time 1; before initiation of CPB, b) Time 2; 30 min after aortic de-clamping, c) Time 3; 24 hrs after aortic de-clamping. Levels of lactate was measured at a) Time A; before initiation of CPB, b) Time B; 30 min after aortic de-clamping. Postoperative ICU stay, intubation time and oxygen index were evaluated as postoperative morbidity scale.
RESULTS
There were no statistical differences between HL (n = 43, lactate > or =3 mMol/L at time B) and normal lactate group (NL) (n = 63, lactate <3 mMol/L at time B) in demographic data, preoperative left ventricular ejection fraction, CPB time, and aortic cross-clamp time. Level of IL-6 in HL at time 3 was higher than that of NL. The ICU stay and intubation time were longer in HL. The oxygen index on 1st postoperative day was lower in HL.
CONCLUSIONS
Our results suggest that hyperlactatemia after weaning from CPB may be related to IL-6 hypercytokinemia, and therefore related to postoperative morbidity.

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