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Original Article
Infection
Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India
Naveen Paliwal, Pooja Bihani, Rishabh Jaju, Sadik Mohammed, Prabhu Prakash, Vidya Tharu
Acute Crit Care. 2024;39(4):535-544.   Published online November 12, 2024
DOI: https://doi.org/10.4266/acc.2024.00101
  • 12,889 View
  • 303 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Background
Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay.
Methods
A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant.
Results
The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004)
Conclusions
The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.

Citations

Citations to this article as recorded by  
  • Simulation-based training for fascial plane blocks: A scoping review mapped to the Kirkpatrick evaluation framework
    Naveen Paliwal, Dinker Pai, Satyajeet Misra, Devishree Das, Rishabh Jaju, Soma Ganesh R. Neethirajan, Pooja Bihani
    Indian Journal of Anaesthesia.2026; 70(1): 115.     CrossRef
  • Evaluation of a multidisciplinary simulation training curriculum for local anesthetic systemic toxicity management: a quasi-experimental study using the Kirkpatrick model in India
    Pooja Bihani, Naveen Paliwal, Rishabh Jaju, Vikas Rajpurohit
    Anesthesia and Pain Medicine.2025; 20(2): 166.     CrossRef
  • Impact of simulation-based training on difficult airway management among anesthesia trainees and nurses as real team
    Naveen Paliwal, Pooja Bihani, Geethanjali Ramachandra, Dinker Pai, Rishabh Jaju, Vivek Chakole
    Journal of Anaesthesiology Clinical Pharmacology.2025; 41(4): 641.     CrossRef
  • Actual Preoperative Fasting Duration and its Impact on Hunger, Thirst, Blood Glucose, and Parental Satisfaction in Pediatric Patients: A Prospective Observational Study
    Pooja Bihani, Kamal Kishore Chitara, Priyakshi Borah, Naveen Paliwal, Rishabh Jaju, Veswudu Swuro
    Journal of Indian Association of Pediatric Surgeons.2025; 30(5): 642.     CrossRef
  • H-ER-O-S: A Quality Improvement Initiative to Reduce Ventilator-Associated Pneumonia in a Level IIIb Neonatal Intensive Care Unit of a Tertiary Care Public Hospital
    Shaik Mohammed Munthakheem, Amol Kalyanrao Joshi, Laxmikant Sheshrao Deshmukh, Atul C. Londhe
    Indian Pediatrics.2025;[Epub]     CrossRef
  • Bridging the Evidence to Practice Gaps in Public Hospitals: Lessons from a VAP Reduction Quality Improvement Initiative
    Praveen Kumar
    Indian Pediatrics.2025;[Epub]     CrossRef
Review Article
Nursing
Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review
Daniela Fradinho Almeida, Maria do Rosário Pinto, Maria Candida Durao, Helga Rafael Henriques, Joana Ferreira Teixeira
Acute Crit Care. 2024;39(3):341-349.   Published online August 12, 2024
DOI: https://doi.org/10.4266/acc.2024.00528
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AbstractAbstract PDF
Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%–0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20–30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.
Original Articles
Pulmonary
Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart for Intensive Care-IV database analysis
Chiwon Ahn, Yeonkyung Park, Yoonseok Oh
Acute Crit Care. 2024;39(1):179-185.   Published online February 15, 2024
DOI: https://doi.org/10.4266/acc.2023.01165
  • 11,908 View
  • 285 Download
  • 1 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
Pneumonia frequently leads to intensive care unit (ICU) admission and is associated with a high mortality risk. This study aimed to assess the impact of early bronchoscopy administered within 3 days of ICU admission on mortality in patients with pneumonia using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database.
Methods
A single-center retrospective analysis was conducted using the MIMIC-IV data from 2008 to 2019. Adult ICU-admitted patients diagnosed with pneumonia were included in this study. The patients were stratified into two cohorts based on whether they underwent early bronchoscopy. The primary outcome was the 28-day mortality rate. Propensity score matching was used to balance confounding variables.
Results
In total, 8,916 patients with pneumonia were included in the analysis. Among them, 783 patients underwent early bronchoscopy within 3 days of ICU admission, whereas 8,133 patients did not undergo early bronchoscopy. The primary outcome of the 28-day mortality between two groups had no significant difference even after propensity matched cohorts (22.7% vs. 24.0%, P=0.589). Patients undergoing early bronchoscopy had prolonged ICU (P<0.001) and hospital stays (P<0.001) and were less likely to be discharged to home (P<0.001).
Conclusions
Early bronchoscopy in severe pneumonia patients in the ICU did not reduce mortality but was associated with longer hospital stays, suggesting it was used in more severe cases. Therefore, when considering bronchoscopy for these patients, it's important to tailor the decision to each individual case, thoughtfully balancing the possible advantages with the related risks.

Citations

Citations to this article as recorded by  
  • Bronchoscopy in intensive care: to whom, when, why? (literature review)
    O.Yu. Usenko, A.V. Sydiuk, O.Ye. Sydiuk, V.V. Antonenko, S.I. Chechil
    EMERGENCY MEDICINE.2025; 21(3): 328.     CrossRef
  • Toilet bronchoscopy in respiratory ICU: a randomized controlled clinical trial
    Mohamed F. Abdelghany, Atef F.M. Al Karn, Shaimaa A. Mohammed, Sahar F. Youssif
    The Egyptian Journal of Chest Diseases and Tuberculosis.2025; 74(3): 300.     CrossRef
  • Bronchoscopy in Chronic Obstructive Pulmonary Disease
    Yang Rui, Zhe Chen, Yuting Wang, Enjian Zhong, Yin Sheng, Tao Li, Tomoya Kawaguchi
    Respiratory Endoscopy.2025; 3(2): 79.     CrossRef
Nursing
Effect of fourth hourly oropharyngeal suctioning on ventilator-associated events in patients requiring mechanical ventilation in intensive care units of a tertiary care center in South India: a randomized controlled trial
Khanjana Borah, Lakshmi Ramamoorthy, Muthapillai Senthilnathan, Rajeswari Murugesan, Hmar Thiak Lalthanthuami, Rani Subramaniyan
Acute Crit Care. 2023;38(4):460-468.   Published online November 24, 2023
DOI: https://doi.org/10.4266/acc.2022.01501
  • 6,226 View
  • 276 Download
AbstractAbstract PDF
Background
Mechanical ventilation (MV) is a necessary life-saving measure for critically ill patients. Ventilator-associated events (VAEs) are potentially avoidable complications associated with MV that can double the rate of death. Oral care and oropharyngeal suctioning, although neglected procedures, play a vital role in the prevention of VAE.
Methods
A randomized controlled trial was conducted in the intensive care units to compare the effect of fourth hourly oropharyngeal suctioning with the standard oral care protocol on VAE among patients on MV. One hundred twenty mechanically ventilated patients who were freshly intubated and expected to be on ventilator support for the next 72 hours were randomly allocated to the control or intervention groups. The intervention was fourth hourly oropharyngeal suctioning along with the standard oral care procedure. The control group received standard oral care (i.e., thrice a day) and on-demand oral suctioning. On the 3rd and 7th days following the intervention, endotracheal aspirates were sent to rule out ventilator-associated pneumonia.
Results
Both groups were homogenous at baseline with respect to their clinical characteristics. The intervention group had fewer VAEs (56.7%) than the control group (78.3%) which was significant at P<0.01. A significant reduction in the status of “positive culture” on ET aspirate also been observed following the 3rd day of the intervention (P<0.001).
Conclusions
One of the most basic preventive strategies is providing oral care. Oropharyngeal suctioning is also an important component of oral care that prevents microaspiration. Hence, fourth-hourly oropharyngeal suctioning with standard oral care significantly reduces the incidence of VAE.
Pulmonary
Combining reservoir mask oxygenation with high-flow nasal cannula in the treatment of hypoxemic respiratory failure among patients with COVID-19 pneumonia: a retrospective cohort study
Ivan Gur, Ronen Zalts, Yaniv Dotan, Khitam Hussain, Ami Neuberger, Eyal Fuchs
Acute Crit Care. 2023;38(4):435-441.   Published online November 23, 2023
DOI: https://doi.org/10.4266/acc.2023.00451
  • 8,628 View
  • 131 Download
  • 1 Web of Science
AbstractAbstract PDFSupplementary Material
Background
Concerns regarding positive-pressure-ventilation for the treatment of coronavirus disease 2019 (COVID-19) hypoxemia led the search for alternative oxygenation techniques. This study aimed to assess one such method, dual oxygenation, i.e., the addition of a reservoir mask (RM) on top of a high-flow nasal cannula (HFNC).
Methods
In this retrospective cohort study, the records of all patients hospitalized with COVID-19 during 2020–2022 were reviewed. Patients over the age of 18 years with hypoxemia necessitating HFNC were included. Exclusion criteria were positive-pressure-ventilation for any indication other than hypoxemic respiratory failure, transfer to another facility while still on HFNC and “do-not-intubate/resuscitate” orders. The primary outcome was mortality within 30 days from the first application of HFNC. Secondary outcomes were intubation and admission to the intensive care unit.
Results
Of 659 patients included in the final analysis, 316 were treated with dual oxygenation and 343 with HFNC alone. Propensity for treatment was estimated based on background diagnoses, laboratories and vital signs upon admission, gender and glucocorticoid dose. Inverse probability of treatment weighted regression including age, body mass index, Sequential Organ Failure Assessment (SOFA) score and respiratory rate oxygenation index showed treatment with dual oxygenation to be associated with lower 30-day mortality (adjusted hazard ratio, 0.615; 95% confidence interval, 0.469–0.809). Differences in the secondary outcomes did not reach statistical significance.
Conclusions
Our study suggests that the addition of RM on top of HFNC may be associated with decreased mortality in patients with severe COVID-19 hypoxemia.
Pulmonary
Risk factors for mortality in intensive care unit patients with Stenotrophomonas maltophilia pneumonia in South Korea
Yong Hoon Lee, Jaehee Lee, Byunghyuk Yu, Won Kee Lee, Sun Ha Choi, Ji Eun Park, Hyewon Seo, Seung Soo Yoo, Shin Yup Lee, Seung-Ick Cha, Chang Ho Kim, Jae Yong Park
Acute Crit Care. 2023;38(4):442-451.   Published online November 21, 2023
DOI: https://doi.org/10.4266/acc.2023.00682
  • 5,769 View
  • 137 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Background
Stenotrophomonas maltophilia has been increasingly recognized as an opportunistic pathogen associated with high morbidity and mortality. Data on the prognostic factors associated with S. maltophilia pneumonia in patients admitted to intensive care unit (ICU) are lacking.
Methods
We conducted a retrospective analysis of data from 117 patients with S. maltophilia pneumonia admitted to the ICUs of two tertiary referral hospitals in South Korea between January 2011 and December 2022. To assess risk factors associated with in-hospital mortality, multivariable logistic regression analyses were performed.
Results
The median age of the study population was 71 years. Ventilator-associated pneumonia was 76.1% of cases, and the median length of ICU stay before the first isolation of S. maltophilia was 15 days. The overall in-hospital mortality rate was 82.1%, and factors independently associated with mortality were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00–1.09; P=0.046), Sequential Organ Failure Assessment (SOFA) score (OR, 1.21; 95%; CI, 1.02–1.43; P=0.025), corticosteroid use (OR, 4.19; 95% CI, 1.26–13.91; P=0.019), and polymicrobial infection (OR, 95% CI 0.07–0.69). However, the impact of appropriate antibiotic therapy on mortality was insignificant. In a subgroup of patients who received appropriate antibiotic therapy (n=58), antibiotic treatment modality-related variables, including combination or empirical therapy, also showed no significant association with survival.
Conclusions
Patients with S. maltophilia pneumonia in ICU have high mortality rates. Older age, higher SOFA score, and corticosteroid use were independently associated with increased in-hospital mortality, whereas polymicrobial infection was associated with lower mortality. The effect of appropriate antibiotic therapy on prognosis was insignificant.

Citations

Citations to this article as recorded by  
  • How do I manage a patient with Stenotrophomonas maltophilia infection?
    Roberta Monardo, Maria F. Mojica, Marco Ripa, Samuel L. Aitken, Robert A. Bonomo, David van Duin
    Clinical Microbiology and Infection.2025; 31(8): 1291.     CrossRef
  • Antimicrobial Resistance of Non-Fermenting Gram-Negative Bacilli in a Multidisciplinary Hospital in Romania
    Miruna-Maria Apetroaei, Mihaela Cristina Negulescu, Sorina Hîncu, Adriana Tăerel, Manuela Ghica, Andreea Letiția Arsene, Denisa Ioana Udeanu
    Biomedicines.2025; 13(9): 2255.     CrossRef
  • Stenotrophomonas maltophilia Outbreak in an ICU: Investigation of Possible Routes of Transmission and Implementation of Infection Control Measures
    Maria Luisa Cristina, Marina Sartini, Gianluca Ottria, Elisa Schinca, Giulia Adriano, Leonello Innocenti, Marco Lattuada, Stefania Tigano, David Usiglio, Filippo Del Puente
    Pathogens.2024; 13(5): 369.     CrossRef
  • Establishment and evaluation of a rapid method for the detection of bacterial pneumonia in hospitalized patients via multiplex PCR–capillary electrophoresis (MPCE)
    Jie Wang, Pei Zhao, Mengchuan Zhao, Duoxiao Zhang, Shan Chen, Ying Liu, Yuan Gao, Yanqing Tie, Zhishan Feng, Siu-Kei Chow
    Microbiology Spectrum.2024;[Epub]     CrossRef
  • A systematic review of factors associated with poor prognosis despite appropriate antibiotics usage for pneumonia
    Akihiko Goto, Kentaro Ishikawa, Kosaku Komiya
    Respiratory Investigation.2024; 62(6): 1215.     CrossRef
Pulmonary
Incidence and risk factors associated with progression to severe pneumonia among adults with non-severe Legionella pneumonia
Jin-Young Huh, Sang-Ho Choi, Kyung-Wook Jo, Jin Won Huh, Sang-Bum Hong, Tae Sun Shim, Chae-Man Lim, Younsuck Koh
Acute Crit Care. 2022;37(4):543-549.   Published online October 21, 2022
DOI: https://doi.org/10.4266/acc.2022.00521
  • 7,305 View
  • 148 Download
  • 6 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Background
Legionella species are important causative organisms of severe pneumonia. However, data are limited on predictors of progression to severe Legionella pneumonia (LP). Therefore, the risk factors for LP progression from non-severe to the severe form were investigated in the present study.
Methods
This was a retrospective cohort study that included adult LP patients admitted to a 2,700-bed referral center between January 2005 and December 2019.
Results
A total of 155 patients were identified during the study period; 58 patients (37.4%) initially presented with severe pneumonia and 97 (62.6%) patients with non-severe pneumonia. Among the 97 patients, 28 (28.9%) developed severe pneumonia during hospitalization and 69 patients (71.1%) recovered without progression to severe pneumonia. Multivariate logistic regression analysis showed platelet count ≤150,000/mm3 (odds ratio [OR], 2.923; 95% confidence interval [CI], 1.100–8.105; P=0.034) and delayed antibiotic treatment >1 day (OR, 3.092; 95% CI, 1.167–8.727; P=0.026) were significant independent factors associated with progression to severe pneumonia.
Conclusions
A low platelet count and delayed antibiotic treatment were significantly associated with the progression of non-severe LP to severe LP.

Citations

Citations to this article as recorded by  
  • Understanding the Correlation between Blood Profile and the Duration of Hospitalization in Pediatric Bronchopneumonia Patients: A Cross-Sectional Original Article
    Dessika Listiarini, Dev Desai, Yanuar Wahyu Hidayat, Kevin Alvaro Handoko
    The Journal of Critical Care Medicine.2024; 10(3): 254.     CrossRef
  • An Investigation of Mortality Associated With Comorbid Pneumonia and Thrombocytopenia in a Rural Southwest Missouri Hospital System
    Tabitha Ranson , Hannah Rourick , Rajbir Sooch , Nicole Ford, Nova Beyersdorfer, Kerry Johnson, John Paulson
    Cureus.2024;[Epub]     CrossRef
  • Legionella Pneumonia Undetected by Repeated Urinary Antigen Testing With Ribotest® Legionella
    Yasushi Murakami, Mika Morosawa, Yasuhiro Nozaki, Yoshio Takesue
    Cureus.2024;[Epub]     CrossRef
  • Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia
    Elliott Worku, Dominic Adam Worku, Salim Surani
    Case Reports in Infectious Diseases.2023; 2023: 1.     CrossRef
  • Short- and long-term prognosis of patients with community-acquired Legionella or pneumococcal pneumonia diagnosed by urinary antigen testing
    Leyre Serrano, Luis Alberto Ruiz, Silvia Perez-Fernandez, Pedro Pablo España, Ainhoa Gomez, Beatriz Gonzalez, Ane Uranga, Sonia Castro, Milagros Iriberri, Rafael Zalacain
    International Journal of Infectious Diseases.2023; 134: 106.     CrossRef
  • Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia
    Chunhong Bu, Shuai Lei, Linguang Chen, Yanqiu Xie, Guoli Zheng, Liwei Hua
    Frontiers in Medicine.2023;[Epub]     CrossRef
Pulmonary
The frequency and seasonal distribution of viral infection in patients with community-acquired pneumonia and its impact on the prognosis
Kyung Jun Kim, Doh Hyung Kim
Acute Crit Care. 2022;37(4):550-560.   Published online October 6, 2022
DOI: https://doi.org/10.4266/acc.2022.00682
  • 5,933 View
  • 143 Download
  • 6 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Background
Studies on the effects of viral coinfection on bacterial pneumonia are still scarce in South Korea. This study investigates the frequency and seasonal distribution of virus infection and its impact on the prognosis in patients with community-acquired pneumonia (CAP).
Methods
The medical records of CAP patients with definite etiology, such as viruses and bacteria, were retrospectively reviewed. Their epidemiologic and clinical characteristics, microbiologic test results, the severity of illness, and 30-day mortality were analyzed.
Results
Among 150 study subjects, 68 patients (45.3%) had viral infection alone, 47 (31.3%) had bacterial infection alone, and 35 (23.3%) had viral-bacterial coinfection, respectively. Among 103 patients with viral infections, Influenza A virus (44%) was the most common virus, followed by rhinovirus (19%), influenza B (13%), and adenovirus (6%). The confusion-urea-respiratory rateblood pressure-age of 65 (CURB-65) score of the viral-bacterial coinfection was higher than that of the viral infection (median [interquartile range]: 2.0 [1.0–4.0] vs. 2.0 [0.3–3.0], P=0.029). The 30-day mortality of the viral infection alone group (2.9%) was significantly lower than that of bacterial infection alone (19.1%) and viral-bacterial coinfection (25.7%) groups (Bonferroni-corrected P<0.05). Viral-bacterial coinfection was the stronger predictor of 30-day mortality in CAP (odds ratio [OR], 18.9; 95% confidence interval [CI], 3.0–118.3; P=0.002) than bacterial infection alone (OR, 6.3; 95% CI, 1.1–36.4; P=0.041), compared to viral infection alone on the multivariate analysis.
Conclusions
The etiology of viral infection in CAP is different according to regional characteristics. Viral-bacterial coinfection showed a worse prognosis than bacterial infection alone in patients with CAP.

Citations

Citations to this article as recorded by  
  • Clinical characteristics of pathogens in children with community-acquired pneumonia were analyzed via targeted next-generation sequencing detection
    Junhua Zhao, Mingfeng Xu, Zheng Tian, Yu Wang
    PeerJ.2025; 13: e18810.     CrossRef
  • Comparing viral, bacterial, and coinfections in community-acquired pneumonia, a retrospective cohort study
    Frederike Waldeck, Solveig Lemmel, Marcus Panning, Nadja Käding, Andreas Essig, Gernot Rohde, Mathias W. Pletz, Martin Witzenrath, Sebastien Boutin, Jan Rupp
    International Journal of Infectious Diseases.2025; 154: 107841.     CrossRef
  • Viral non-SARS-CoV-2 etiology of community-acquired pneumonia (CAP) in Southeast Asia: a review and pooled analysis
    Su Myat Han, Puah Ser Hon, Ho Ying Na, Trevor Tan Hwee Yong, Paul Anantharajah Tambyah, Yeo Tsin Wen
    IJID Regions.2025; 15: 100672.     CrossRef
  • Pathogen detection by multiplex PCR: A comparative study of pneumonia panel, bacterial culture, and respiratory panel in Japanese patients
    Osamu Hataji, Kengo Ushiro, Remi Inoue, Kentaro Nakanishi, Seiya Esumi, Yuki Fujiura, Yuta Suzuki, Tadashi Sakaguchi, Kentaro Ito, Yoichi Nishii, Tomohito Tarukawa, Hajime Fujimoto, Taro Yasuma, Osamu Taguchi, Miho Nishio, Natsue Maeda, Haruka Nishimura,
    Respiratory Investigation.2025; 63(5): 974.     CrossRef
  • Time-dependent predictive performance of inflammatory markers for 30-day all-cause mortality in patients with suspected infection in a Japanese emergency department: a retrospective cohort study
    Moeko Omiya, Toshihiko Takada, Tetsuhiro Yano, Kotaro Fujii, Ryuto Fujiishi, Shunichi Fukuhara
    BMJ Open.2025; 15(12): e103082.     CrossRef
  • Seasonal Patterns of Common Respiratory Viral Infections in Immunocompetent and Immunosuppressed Patients
    Fotis Theodoropoulos, Anika Hüsing, Ulf Dittmer, Karl-Heinz Jöckel, Christian Taube, Olympia E. Anastasiou
    Pathogens.2024; 13(8): 704.     CrossRef
Neurology
Early assessment of aspiration risk in acute stroke by fiberoptic endoscopy in critically ill patients
Mohamed Saad Abdelaziz Elsyaad, Akram Muhammad Fayed, Mohamed Mostafa Abdel Salam Megahed, Nesrine Hazem Hamouda, Ahmed Moustafa Elmenshawy
Acute Crit Care. 2022;37(3):276-285.   Published online June 27, 2022
DOI: https://doi.org/10.4266/acc.2021.01375
  • 10,663 View
  • 281 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Fiberoptic endoscopic evaluation of swallowing (FEES) has been recommended to assess aspiration in stroke. This study aimed to determine the diagnostic and prognostic roles of FEES in the early assessment of aspiration, intensive care unit (ICU) stay and mortality in acute stroke patients.
Methods
Fifty-two patients with acute stroke admitted to the Alexandria Main University Hospital were included. Complete examinations and assessment of aspiration using the 8-point penetration-aspiration scale (PAS) with FEES protocol were performed.
Results
The patients were classified into three groups: normal with no or low risk of aspiration (n=15, 27.3%; PAS level 1), low to moderate risk (n=8, 14.5%; PAS level 2–4), and high risk (n=32, 58.2%; PAS ≥5). There was high incidence of aspiration pneumonia, prolonged ICU stay, and mortality in both moderate- and high-risk groups (P=0.001, P<0.001, and P<0.001, respectively). The PAS score predicted aspiration pneumonia (hospital-acquired pneumonia) with sensitivity and specificity of 80.0% and 76.0%, respectively (negative predictive value [NPV], 76.0; positive predictive value [PPV], 80.0; 95% confidence interval [CI], 0.706–0.940) and mortality with sensitivity and specificity of 88.46% and 68.97% (NPV, 87.0; PPV, 71.9; 95% CI, 0.749–0.951). The PAS score could predict the length of ICU stay with sensitivity and specificity of 70.21% and 87.50, respectively (NPV, 33.3; PPV, 97.1; 95% CI, 0.605–0.906).
Conclusions
The standard FEES protocol using PAS score is a useful tool to assess aspiration in acute stroke patients and could be used to predict length of ICU stay and mortality.

Citations

Citations to this article as recorded by  
  • Approach to Patients with Dysphagia: Clinical Insights
    Min-Su Kim
    Brain Sciences.2025; 15(5): 478.     CrossRef
  • Aspiration Pneumonia
    Di Pan, Samuel Chung, Erik Nielsen, Michael S. Niederman
    Seminars in Respiratory and Critical Care Medicine.2024; 45(02): 237.     CrossRef
  • Intensive care unit-acquired dysphagia – change in feeding route after a standardized dysphagia assessment in neurocritical care patients
    Sarah Christina Reitz, Joanna Marly, Vanessa Neef, Jürgen Konczalla, Marcus Czabanka, Christian Grefkes-Hermann, Christian Foerch, Sriramya Lapa
    Scientific Reports.2024;[Epub]     CrossRef
  • The use of videofluoroscopy (VFS) and fibreoptic endoscopic evaluation of swallowing (FEES) in the investigation of oropharyngeal dysphagia in stroke patients: A narrative review
    K. Helliwell, V.J. Hughes, C.M. Bennion, A. Manning-Stanley
    Radiography.2023; 29(2): 284.     CrossRef
Infection
Comparison of critically ill COVID-19 and influenza patients with acute respiratory failure
Mehmet Yildirim, Burcin Halacli, Mehmet Yasir Pektezel, Berrin Er, Ismail Tuna Geldigitti, Gulay Tok, Ebru Ortac Ersoy, Arzu Topeli
Acute Crit Care. 2022;37(2):168-176.   Published online March 11, 2022
DOI: https://doi.org/10.4266/acc.2021.00920
  • 9,529 View
  • 260 Download
  • 8 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
Coronavirus disease 2019 (COVID-19) is one of the biggest pandemic causing acute respiratory failure (ARF) in the last century. Seasonal influenza carries high mortality, as well. The aim of this study was to compare features and outcomes of critically-ill COVID-19 and influenza patients with ARF.
Methods
Patients with COVID-19 and influenza admitted to intensive care unit with ARF were retrospectively analyzed.
Results
Fifty-four COVID-19 and 55 influenza patients with ARF were studied. Patients with COVID-19 had 32% of hospital mortality, while those with influenza had 47% (P=0.09). Patients with influenza had higher Eastern Cooperative Oncology Group, Clinical Frailty Scale, Acute Physiology and Chronic Health Evaluation II and admission Sequential Organ Failure Assessment (SOFA) scores than COVID-19 patients (P<0.01). Secondary bacterial infection, admission acute kidney injury, procalcitonin level above 0.2 ng/ml were the independent factors distinguishing influenza from COVID-19 while prone positioning differentiated COVID-19 from influenza. Invasive mechanical ventilation (odds ratio [OR], 42.16; 95% confidence interval [CI], 9.45–187.97), admission SOFA score more than 4 (OR, 5.92; 95% CI, 1.85–18.92), malignancy (OR, 4.95; 95% CI, 1.13–21.60), and age more than 65 years (OR, 3.31; 95% CI, 0.99–11.03) were found to be independent risk factors for hospital mortality.
Conclusions
There were few differences in clinical features of critically-ill COVID-19 and influenza patients. Influenza cases had worse performance status and disease severity. There was no significant difference in hospital mortality rates between COVID-19 and influenza patients.

Citations

Citations to this article as recorded by  
  • Narrative review of factors associated with SARS-CoV-2 coinfection in Middle Eastern countries and the need to vaccinate against preventable diseases
    Majid Alshamrani, Fayssal Farahat, Ali Albarrak, Aiman El-Saed, Atef M. Shibl, Ziad A. Memish, Mostafa Mousa, Hammam Haridy, Abdulhakeem Althaqafi
    Journal of Infection and Public Health.2025; 18(1): 102600.     CrossRef
  • Differences in clinical characteristics between coronavirus disease 2019 (COVID-19) and influenza: a systematic review and meta-analysis
    Yingying Han, Jia Guo, Xingzhao Li, Zhuan Zhong
    npj Primary Care Respiratory Medicine.2025;[Epub]     CrossRef
  • Global geographic and socioeconomic disparities in COVID-associated acute kidney injury: a systematic review and meta-analysis
    Danyang Dai, Pedro Franca Gois, Digby Simpson, Souhayel Hedfi, Sally Shrapnel, Jason Donald Pole
    Journal of Global Health.2025;[Epub]     CrossRef
  • Comparison of Clinical Characteristics and Outcomes in Intensive Care Units Between Patients with Coronavirus Disease 2019 (COVID-19) and Patients with Influenza: A Systematic Review and Meta-Analysis
    Zhuan Zhong, Xin Wang, Jia Guo, Xingzhao Li, Yingying Han
    Journal of Intensive Care Medicine.2024; 39(9): 840.     CrossRef
  • Association between PaO2/(FiO2*PEEP) ratio and in-hospital mortality in COVID-19 patients: A reanalysis of published data from Peru using PaO2/(FiO2*PEEP) ratio in place of PaO2/FaO2 ratio
    Youli Chen, Huangen Li, Jinhuang Lin, Zhiwei Su, Tianlai Lin
    Medicine.2024; 103(40): e39931.     CrossRef
  • Acute kidney injury in patients with COVID-19 compared to those with influenza: a systematic review and meta-analysis
    Chiu-Ying Hsiao, Heng-Chih Pan, Vin-Cent Wu, Ching-Chun Su, Tzu-Hsuan Yeh, Min-Hsiang Chuang, Kuan-Chieh Tu, Hsien-Yi Wang, Wei-Chih Kan, Chun-Chi Yang, Jui-Yi Chen
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Comparison of Clinical Features and Outcomes between SARS-CoV-2 and Non-SARS-CoV-2 Respiratory Viruses Associated Acute Respiratory Distress Syndrome: Retrospective Analysis
    Manbong Heo, Jong Hwan Jeong, Sunmi Ju, Seung Jun Lee, Yi Yeong Jeong, Jong Deog Lee, Jung-Wan Yoo
    Journal of Clinical Medicine.2022; 11(8): 2246.     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
  • 13,566 View
  • 255 Download
  • 3 Web of Science
  • 4 Crossref
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
Nursing
Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients
Suphannee Triamvisit, Wassana Wongprasert, Chalermwoot Puttima, Matchima Na Chiangmai, Nawaphan Thienjindakul, Laksika Rodkul, Chumpon Jetjumnong
Acute Crit Care. 2021;36(4):294-299.   Published online November 23, 2021
DOI: https://doi.org/10.4266/acc.2021.00983
  • 17,755 View
  • 620 Download
  • 1 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
Care bundles for ventilator-associated pneumonia (VAP) have been shown to minimize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bundles lowered the risk of VAP in neurosurgical patients.
Methods
A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of intermittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group.
Results
A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occurrence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036).
Conclusions
The modified VAP bundle is effective in lowering the VAP rate in critically ill neurosurgical patients. It requires low budget and manpower and can be employed in resource-constrained settings.

Citations

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  • Impact of Modified Ventilator‐Associated Pneumonia Prevention Bundle on Clinical Parameters and Outcomes Among Mechanically Ventilated Patients: An Interventional Study
    Yuvaraj Arumugam, Judie Arulappan, Sivakumar M. Nandakumar
    Nursing in Critical Care.2026;[Epub]     CrossRef
  • Pharmacotherapy interventions in ventilator care bundles for preventing VAP in adults: A literature review
    Neilsen Gazo, Cherie Chu
    Journal of Mechanical Ventilation.2025; 6(2): 88.     CrossRef
  • Ventilator-Associated Pneumonia (VAP) in Neurocritical Patients: The Hidden Dialog of Brain and Infection
    Alejandro Rodríguez, Laura Claverias, Ignacio Martín-Loeches, Frederic Gómez Bertomeu, Ester Picó Plana, Sara Rosich, Vanessa Blázquez, Dennis H. Céspedes Torrez, Ruth Lau, María Bodí
    Biomedicines.2025; 13(12): 3112.     CrossRef
Pulmonary
Development of a prognostic scoring system in patients with pneumonia requiring ventilator care for more than 4 days: a single-center observational study
Yeseul Oh, Yewon Kang, Kwangha Lee
Acute Crit Care. 2021;36(1):46-53.   Published online February 17, 2021
DOI: https://doi.org/10.4266/acc.2020.00787
  • 8,762 View
  • 134 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
The aim of the present study was to develop a prognostic model using demographic characteristics, comorbidities, and clinical variables measured on day 4 of mechanical ventilation (MV) for patients with prolonged acute mechanical ventilation (PAMV; MV for >96 hours).
Methods
Data from 437 patients (70.9% male; median age, 68 years) were obtained over a period of 9 years. All patients were diagnosed with pneumonia. Binary logistic regression identified factors predicting mortality at 90 days after the start of MV. A PAMV prognosis score was calculating ß-coefficient values and assigning points to variables.
Results
The overall 90-day mortality rate was 47.1%. Five factors (age ≥65 years, body mass index <18.5 kg/m2, hemato-oncologic diseases as comorbidities, requirement for vasopressors on day 4 of MV and requirement for neuromuscular blocking agents on day 4 of MV) were identified as prognostic indicators. Each factor was valued as +1 point, and used to develop a PAMV prognosis score. This score showed acceptable discrimination (area under the receiver operating characteristic curve of 0.695 for mortality, 95% confidence interval 0.650–0.738, p<0.001), and calibration (Hosmer–Lemeshow chi-square=6.331, with df 7 and p=0.502). The cutoff value for predicting mortality based on the maximum Youden index was ≤2 (sensitivity, 87.5%; specificity, 41.3%). For patients with PAMV scores ≤1, 2, 3 and ≥4, the 90-day mortality rates were 29.2%, 45.7%, 67.9%, and 90.9%, respectively (P<0.001).
Conclusions
Our study developed a PAMV prognosis score for predicting 90-day mortality. Further research is needed to validate the utility of this score.

Citations

Citations to this article as recorded by  
  • Ability of the modified NUTRIC score to predict mortality in patients requiring short-term versus prolonged acute mechanical ventilation: a retrospective cohort study
    Wanho Yoo, Hyojin Jang, Hayoung Seong, Saerom Kim, Soo Han Kim, Eun-Jung Jo, Jung Seop Eom, Kwangha Lee
    Therapeutic Advances in Respiratory Disease.2024;[Epub]     CrossRef
  • Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
    Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong
    Acute and Critical Care.2024; 39(1): 91.     CrossRef
Case Report
Pulmonary
Recurrent Aspiration Pneumonia due to Anterior Cervical Osteophyte
Jae Jun Lee, Ji Young Hong, Jun Han Jung, Jun Hyeok Yang, Jun-Young Sohn
Korean J Crit Care Med. 2017;32(1):74-78.   Published online February 28, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00409
  • 12,886 View
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  • 2 Web of Science
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AbstractAbstract PDF
A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.

Citations

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  • Diffuse idiopathic skeletal hyperostosis of the cervical spine causing dysphagia and airway obstruction: an updated systematic review
    Netanja I. Harlianto, Jonneke S. Kuperus, Firdaus A.A. Mohamed Hoesein, Pim A. de Jong, Jacob A. de Ru, F. Cumhur Öner, Jorrit-Jan Verlaan
    The Spine Journal.2022; 22(9): 1490.     CrossRef
  • An unusual presentation of thoracic diffuse idiopathic skeletal hyperostosis (DISH) and video-assisted thoracoscopic surgery (VATS)
    Suthipas Pongmanee, Borvornsake Rojdumrongrattana, Noparoot Kritworakarn, Peem Sarasombath, Wongthawat Liawrungrueang
    International Journal of Surgery Case Reports.2022; 93: 106993.     CrossRef
Original Article
Infection
High-dose Sulbactam Treatment for Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Acinetobacter Baumannii
In Beom Jeong, Moon Jun Na, Ji Woong Son, Do Yeon Jo, Sun Jung Kwon
Korean J Crit Care Med. 2016;31(4):308-316.   Published online November 30, 2016
DOI: https://doi.org/10.4266/kjccm.2015.00703
  • 35,778 View
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AbstractAbstract PDF
Background
Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP.
Methods
Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed.
Results
Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality.
Conclusions
High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.

Citations

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  • Acinetobacter baumannii treatment strategies: a review of therapeutic challenges and considerations
    Christine J. Kubin, Christopher Garzia, Anne-Catrin Uhlemann, Pranita D. Tamma
    Antimicrobial Agents and Chemotherapy.2025;[Epub]     CrossRef
  • A Randomized Controlled Trial of Colistin Combined with Sulbactam: 9 g per Day versus 12 g per Day in the Treatment of Extensively Drug-Resistant Acinetobacter baumannii Pneumonia: An Interim Analysis
    Chutchawan Ungthammakhun, Vasin Vasikasin, Dhitiwat Changpradub
    Antibiotics.2022; 11(8): 1112.     CrossRef
  • Meropenem/colistin versus meropenem/ampicillin–sulbactam in the treatment of carbapenem-resistant pneumonia
    Hossein Khalili, Lida Shojaei, Mostafa Mohammadi, Mohammad-Taghi Beigmohammadi, Alireza Abdollahi, Mahsa Doomanlou
    Journal of Comparative Effectiveness Research.2018; 7(9): 901.     CrossRef
Case Report
Pulmonary/Thoracic surgery
Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer
Jangwhan Jo, Yang Gi Ryu
Korean J Crit Care Med. 2016;31(2):156-161.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.156
  • 10,483 View
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AbstractAbstract PDF
A patient had undergone left pneumonectomy for lung cancer and had an increased risk of fatal complications such as pneumonia, including acute respiratory distress syndrome (ARDS). The treatment effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for ARDS of postpneumonectomy patient are uncertain. A 74-year-old man with one lung experienced aspiration pneumonia while swallowing pills after the operation, and his condition progressed to ARDS within a day. He was successfully treated with VV-ECMO support and intensive care unit care.

Citations

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  • The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
    Ji Young Lee
    Korean Journal of Critical Care Medicine.2016; 31(2): 73.     CrossRef
Original Article
Neurology/Infection
Effect of Antibiotic Prophylaxis on Early-Onset Pneumonia in Cardiac Arrest Patients Treated with Therapeutic Hypothermia
Soo Jung Kim, Jung Kyu Lee, Deog Kyeom Kim, Jong Hwan Shin, Ki Jeong Hong, Eun Young Heo
Korean J Crit Care Med. 2016;31(1):17-24.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.17
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  • 4 Crossref
AbstractAbstract PDF
Background:
Infectious complications frequently occur after cardiac arrest and may be even more frequent after therapeutic hypothermia. Pneumonia is the most common infectious complication associated with therapeutic hypothermia, and it is unclear whether prophylactic antibiotics administered during this intervention can decrease the development of early-onset pneumonia. We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia.
Methods
We retrospectively reviewed the medical records of patients who were admitted for therapeutic hypothermia after resuscitation for out-of-hospital cardiac arrest between January 2010 and July 2015. Patients who died within the first 72 hours or presented with pneumonia at the time of admission were excluded. Early-onset pneumonia was defined as pneumonia that developed within 5 days of admission. Prophylactic antibiotic therapy was defined as the administration of any parenteral antibiotics within the first 24 hours without any evidence of infection.
Results
Of the 128 patients admitted after cardiac arrest, 68 were analyzed and 48 (70.6%) were treated with prophylactic antibiotics within 24 hours. The frequency of early-onset pneumonia was not significantly different between the prophylactic antibiotic group and the control group (29.2% vs 30.0%, respectively, p = 0.945). The most commonly used antibiotic was third-generation cephalosporin, and the class of prophylactic antibiotics did not influence early-onset pneumonia.
Conclusion
Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.

Citations

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  • Hypothermia as a potential remedy for canine and feline acute spinal cord injury: a review
    Igor Šulla, Slavomír Horňák, Vladimír Balik
    Acta Veterinaria Brno.2022; 91(2): 189.     CrossRef
  • Prophylactic antibiotic use following cardiac arrest: A systematic review and meta-analysis
    Keith Couper, Ryan Laloo, Richard Field, Gavin D. Perkins, Matthew Thomas, Joyce Yeung
    Resuscitation.2019; 141: 166.     CrossRef
  • A review of novel trends in management of canine spinal cord injury
    Igor Šulla, Slavomír Horňák, Valent Ledecký, Vladimír Balik
    Acta Veterinaria Brno.2019; 88(2): 207.     CrossRef
  • Management of post-cardiac arrest syndrome
    Youngjoon Kang
    Acute and Critical Care.2019; 34(3): 173.     CrossRef
Case Report
Anesthesiology/Pediatric
Aspiration Pneumonia in a Pediatric Patient under General Anesthesia despite Adequate Preoperative Fasting
Sang-Il Yoon, Jong-Man Kang
Korean J Crit Care Med. 2015;30(4):313-317.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.313
  • 65,535 View
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AbstractAbstract PDF
Aspiration pneumonia rarely occurs during general anesthesia; however, it can result in fatal pulmonary complications. To reduce aspiration pneumonia, a preoperative fasting time of 8 hours is recommended. A 4-year-old boy with ankyloglossia was scheduled for frenotomy. He completed preoperative fasting time and had no digestive symptoms. Pulmonary aspiration due to unexpected massive vomiting occurred during anesthesia induction. The patient’s airway was immediately secured by endotracheal tube. The vomitus in the airway tract was removed by fiberoptic bronchoscopy. Abdomen radiograph taken after this event showed paralytic ileus which can cause aspiration of gastric contents. We describe a case of pneumonia caused by aspiration of gastric contents in a pediatric patient who followed fasting instructions and who was scheduled for outpatient surgery.

Citations

Citations to this article as recorded by  
  • Factors associated with bronchopulmonary aspiration: a national-based study
    Jaqueline Helena Tanner, Cristina Mara Zamarioli, Magda Machado de Miranda Costa, Heiko Thereza Santana, Ana Clara Ribeiro Bello dos Santos, Cleide Felicia de Mesquita Ribeiro, Fernanda Raphael Escobar Gimenes
    Revista Brasileira de Enfermagem.2022;[Epub]     CrossRef
Original Articles
Pulmonary
The Prognostic Factors of Pneumonia with Septic Shock in Patients Presenting to the Emergency Department
Jong Won Kim, Jin Joo Kim, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, In Cheol Hwang, Sang Hyun Han
Korean J Crit Care Med. 2015;30(4):258-264.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.258
  • 15,902 View
  • 207 Download
  • 10 Crossref
AbstractAbstract PDF
Background
Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department.
Methods
From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined.
Results
Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35–4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01–1.08), leukopenia (OR, 3.63; 95% CI, 1.48–8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41–4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30–6.38).
Conclusions
A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.

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  • Look at the COVID-19 Pandemic with an Open Mind

    Archives of Health Science.2021; : 1.     CrossRef
  • The Myth of Septic Complications of Acute Pneumonia
    Igor Klepikov
    Journal of Biomedical Research & Environmental Sciences.2021; 2(8): 741.     CrossRef
  • Will the pill help defeat the coronavirus?
    Igor Klepikov
    Journal of Clinical Intensive Care and Medicine.2021; 6(1): 001.     CrossRef
  • Psychoanalysis of the doctrine of acute pneumonia
    Klepikov Igor
    International Journal of Clinical Microbiology and Biochemical Technology.2021; 4(1): 032.     CrossRef
  • COVID-19 Pandemic: The Causative Agent is New, The Problem is Old
    Igor Klepikov, Sasho Stoleski
    International Journal of Coronaviruses.2021; 3(1): 14.     CrossRef
  • Let’s evaluate the pandemic in terms of facts, not impressions
    Igor Klepikov
    Journal of Lung, Pulmonary & Respiratory Research.2021; 8(2): 62.     CrossRef
  • Non-bacteremic pneumococcal pneumonia: general characteristics and early predictive factors for poor outcome
    Leyre Serrano, Luis A. Ruiz, Lorea Martinez-Indart, Pedro P. España, Ainhoa Gómez, Ane Uranga, Marta García, Borja Santos, Amaia Artaraz, Rafael Zalacain
    Infectious Diseases.2020; 52(9): 603.     CrossRef
  • Acute Lung Inflammation: Old Illusions of the New Version
    Igor Klepikov
    International Journal of Research Studies in Medical and Health Sciences.2020; 5(7): 1.     CrossRef
  • As Evidenced by the Statistics of the Pandemic
    I. Klepikov, Jose Luis Turabian
    International Journal of Coronaviruses.2020; 2(2): 1.     CrossRef
  • Do you really want to improve the results of treatment for acute pneumonia?
    Klepikov Igor
    Journal of Clinical Intensive Care and Medicine.2019; 4(4): 023.     CrossRef
Infection
Experience with Elizabethkingia meningoseptica Infection in Adult Patients at a Tertiary Hospital
Hyun Don Joo, Sun Young Ann, Sung Hyeok Ryou, Youn Seup Kim, Jong Wan Kim, Doh Hyung Kim
Korean J Crit Care Med. 2015;30(4):241-248.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.241
  • 13,320 View
  • 241 Download
  • 1 Crossref
AbstractAbstract PDF
Background
Few reports have documented the clinical characteristics and treatment outcomes of adult patients with Elizabethkingia meningoseptica infection.
Methods
Medical records of patients over 18 years of age and suspected of having an E. meningoseptica infection from March 1, 2006 to February 28, 2013 were reviewed retrospectively. Their clinical characteristics, antimicrobial susceptibility results, and treatment outcomes were analyzed.
Results
E. meningoseptica was isolated from 30 patients. Median age was 68.5 years, and infections were more frequent in males (17, 56.7%). The most common isolation source was sputum (23, 76.7%), and pneumonia was the most common condition (21, 70%) after excluding two cases of colonization. This bacterium was most susceptible to minocycline (27, 90%) and fluoroquinolones, including levofloxacin (20, 66.7%) and ciprofloxacin (18, 60%). The mortality rate due directly to E. meningoseptica infection was 20% (6/30), and uncontrolled pneumonia was the only cause of death. After isolating E. meningoseptica, the numbers of patients with pneumonia (9/9, 100% vs. 12/21, 57.1%), history of hemodialysis (5/9, 55.6% vs. 3/21, 14.3%), tracheostomy (8/9, 88.9 vs. 10/21, 47.6%), and median Charlson comorbidity index score (6 [range, 3–9] vs. 4 [range, 0–9]) were significantly higher in non-survivors than those in survivors (p < 0.05, for each). However, only 12 (40%) patients received appropriate antibiotics.
Conclusions
E. meningoseptica infection most commonly presented as pneumonia in adults with severe underlying diseases. Despite the high mortality rate, the rate of appropriate antibiotic use was notably low.

Citations

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  • Elizabethkingia meningosepticum Isolated from Pleural Fluid: A Diagnostic Dilemma
    Abha Sharma, Shweta Gupta, Tanisha Bharara, Shalini Dewan Duggal, Pragnya Paramita Jena, Renu Gur
    The Indian Journal of Chest Diseases and Allied Sciences.2022; 61(2): 91.     CrossRef
Case Reports
Pulmonary
Successful Immunoglobulin Treatment in Severe Cryptogenic Organizing Pneumonia Caused by Dermatomyositis
Dong Hoon Lee, Jee Hyun Yeo, Young Il Kim, Seung Jun Gim, Jang Won Sohn, Ji Young Yhi
Korean J Crit Care Med. 2015;30(3):212-217.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.212
  • 10,777 View
  • 105 Download
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AbstractAbstract PDF
In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.

Citations

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  • A Case Report of Steroid-Resistant Cryptogenic Organizing Pneumonia Managed with Intravenous Immunoglobulins
    Christian Akem Dimala, Urvi Patel, Benjamin Lloyd, Anthony Donato, William B. Kimmel, Robert Hallowell, Caitlyn Moss, Tun-Chieh Chen
    Case Reports in Pulmonology.2021; 2021: 1.     CrossRef
Cardiology/Anesthesiology
Early Extracorporeal Membrane Oxygenation for Massive Aspiration during Anesthesia Induction
Namo Kim, Kwan Hyung Kim, Jeong Min Kim, Su Youn Choi, Sungwon Na
Korean J Crit Care Med. 2015;30(2):109-114.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.109
  • 9,893 View
  • 105 Download
  • 2 Crossref
AbstractAbstract PDF
Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.

Citations

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  • Massive aspiration syndrome: a possible indication for “emergent” veno-venous extracorporeal membrane oxygenation?: a case report
    Emiliano Gamberini, Venerino Poletti, Emanuele Russo, Alessandro Circelli, Marco Benni, Giovanni Scognamiglio, Domenico Pietro Santonastaso, Costanza Martino, Linda Domenichini, Romina Biondi, Giorgia Bastoni, Etrusca Brogi, Luca Ansaloni, Federico Coccol
    Journal of Medical Case Reports.2021;[Epub]     CrossRef
  • Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer
    Jangwhan Jo, Yang Gi Ryu
    Korean Journal of Critical Care Medicine.2016; 31(2): 156.     CrossRef
Liver/Infection
Chylous Ascites in a Patient with Sepsis Caused by Bilateral Pneumonia
Yong Dae Lee, Young Hyun Lee, Hye Sook Choi
Korean J Crit Care Med. 2014;29(3):217-221.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.217
  • 18,249 View
  • 101 Download
  • 2 Crossref
AbstractAbstract PDF
Chylous ascites is a rare form of ascites characterized by milky peritoneal fluid rich in triglycerides due to the accumulation of chyle in the peritoneal cavity. This affliction occurs as a result of a disruption of lymph flow associated with traumatic injury or obstruction of the lymphatic system. There are various causes of chylous ascites, such as lymphatic anomalies, malignancy, cirrhosis, infection, trauma, surgery, and nephrotic syndrome. We report a rare case of an 81-year-old male with sepsis caused by bilateral pneumonia who presented with chylous ascites.

Citations

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  • Disorders of Lymphatic Architecture and Flow in Critical Illness
    Maxim Itkin, Jiri Horak, Jose L. Pascual, Cherylee W. J. Chang, Deacon Lile, Beverly Tomita, Gary Alan Bass, Stephen J. Kovach, Lewis J. Kaplan
    Critical Care Medicine.2025; 53(3): e665.     CrossRef
  • Diagnostic and management problems of chylous effusion in a patient with newly-diagnosed tuberculosis
    Dicky Febrianto, Usman Hadi
    Current Internal Medicine Research and Practice Surabaya Journal.2021; 2(2): 35.     CrossRef
Cardiology
Successful Use of a Peripheral Extracorporeal Membrane Oxygenator in a Patient with Chronic Heart Failure and Pneumonia
Ji Hyun Lee, Yang Hyun Cho, Gee Young Suh, Jeong Hoon Yang
Korean J Crit Care Med. 2014;29(1):52-56.   Published online February 28, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.1.52
  • 6,561 View
  • 51 Download
AbstractAbstract PDF
Myocardial dysfunction can occur during severe sepsis and may accelerate in the condition of chronic decompensated heart failure. A 26-year-old female in remission from non-Hodgkin’s lymphoma presented with shock due to chronic heart failure combined with pneumonia. The patient was initially stabilized using a peripheral extracorporeal membrane oxygenator (ECMO) with antibiotics therapy, followed by left ventricular venting due to pulmonary edema that was complicated by left ventricular distension. Here, we report the successful application of ECMO to a patient with pneumonia underlying doxorubicin-induced cardiomyopathy. Although septic conditions remained unclear indication of ECMO, it might be considered a valuable therapeutic option in patients with chronic heart failure.
A Case of Bilateral Knee Septic Arthritis Caused by Pneumococcal Bacteremia
Yo Han Park, Jong Chan Lee, Junhyeon Cho, Jinyong Park, Myeungcheol Shin
Korean J Crit Care Med. 2013;28(3):230-233.
DOI: https://doi.org/10.4266/kjccm.2013.28.3.230
  • 3,858 View
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  • 1 Crossref
AbstractAbstract PDF
Pneumococcus can cause pneumonia, sinusitis, infective endocarditis, meningitis and primary bacteremia. However, few reports in the literature show bilateral septic arthritis with pneumococcal bacteremia. We report on a case of a 78-year old woman who presented with fever, pain and swelling in both knees. Both knee fluid aspirates were purulent with thick viscosity, and the gram stain revealed gram positive cocci in chains. The patient underwent emergent washing and arthroscopic debridement, followed with empirical antibiotics treatment. Two out of two blood cultures were positive for penicillin-susceptible Streptococcus pneumonia. Synovial fluid cultures were also positive for S. pneumoniae. The patient was treated with intravenous ceftriaxone for 4 weeks. Bilateral knee septic arthritis with pneumococcal bacteremia is rarely reported. Here we report on the case with a review of the literature.

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  • Analysis of Characteristics and Prognosis of Healthcare-Associated Secondary Bloodstream Infection
    Ju Yeon Song, Ihn Sook Jeong, Sookyung Hyun
    Korean Journal of Healthcare-Associated Infection Control and Prevention.2017; 22(2): 43.     CrossRef
A Case of Burkholderia cepacia Pneumonia after Lung Transplantation in a Recipient without Cystic Fibrosis
Jin Sun Cho, Sungwon Na, Moo Suk Park, Yun So, Bahn Lee, Shin Ok Koh, Hyo Chae Paik
Korean J Crit Care Med. 2013;28(3):187-191.
DOI: https://doi.org/10.4266/kjccm.2013.28.3.187
  • 5,612 View
  • 75 Download
  • 1 Crossref
AbstractAbstract PDF
Burkholderia cepacia is a highly virulent pathogen known to cause opportunistic infections in immunocompromised patients. It accelerates lung disease and causes necrotizing pneumonia with associated severe sepsis, known as cepacia syndrome. In particular, lung transplant recipients infected with Burkholderia cepacia show higher mortality after lung transplantation than those who are not infected with this organism. Due to broad-spectrum antibiotic resistance, a combination therapy should be used according to the results of the susceptibility test. This bacterial infection is rare in Korea, and no case was reported in lung transplant recipients. However, we report a case of pneumonia caused by Burkholderia cepacia after lung transplantation. As Burkholderia cepacia was grown from a sputum culture, the patient was treated initially with a combination of meropenem and trimethoprim/sulfamethoxazole and then ceftazidime and trimethoprim/sulfamethoxazole as a result of leukopenia. After antibiotics treatment for 20 days, sputum cultures became negative for Burkholderia cepacia and the patient successfully recovered.

Citations

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  • Current perspective of lung transplantation
    Hyo Chae Paik
    Journal of the Korean Medical Association.2016; 59(2): 119.     CrossRef
A Case of Purulent Pericarditis Complicated by Klebsiella pneumoniae Sepsis - A Case Report -
Byeong Ho Jeong, Seungmin Chung, Hee Jin Kwon, Kyeongman Jeon
Korean J Crit Care Med. 2013;28(1):51-55.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.51
  • 3,694 View
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AbstractAbstract PDF
Although the incidence of purulent pericarditis has decreased significantly in the modern antibiotic era, purulent pericarditis remains a life-threatening disease. Therefore, a high index of clinical suspicion should be maintained to diagnose this life-threatening illness at an early stage. We report an extraordinary case of purulent pericarditis, caused by Klebsiella pneumoniae bacteremia, which developed during the recovery of septic shock with urinary tract infection. Despite of early diagnosis and pericardial drainage, in addition to adequate antibiotics, the patient subsequently developed multiple organ failure leading to death. The case highlights that purulent pericarditis is a rare yet possible disorder complicated from septic shock with bacteremia in the antibiotic era. Therefore, purulent pericarditis should always be considered as a possible complication, especially in patients with K. pneumoniae bacteremia and progressive cardiomegaly.
Five Successful Experiences in the Treatment of Charcoal Aspiration with Bronchoscopic Toilet: A Case Report
Young Il Kim, Jae Seok Park, Jae Sung Choi, Sung Shik Jou, Hyo Wook Gil, Sae Yong Hong
Korean J Crit Care Med. 2012;27(3):202-206.
DOI: https://doi.org/10.4266/kjccm.2012.27.3.202
  • 4,722 View
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AbstractAbstract PDF
Although activated charcoal is an effective treatment for most toxic ingestions, aspiration of activated charcoal can be fatal. Here, we report that in 5 charcoal aspiration cases, bronchoscopy with suction and lavage was an effective way to remove charcoal from the lungs. Patients showed high APACHE II scores (range: 10-29), and either low PO2 levels, or low CO2 retention. After bronchoscopic removal of the aspirated charcoal, symptoms of hypoxia, CO2 retention, localized wheezing, and pneumonic infiltration as determined by chest radiography, improved in most patients. We report 5 cases of successful treatment of charcoal aspiration with bronchoscopic toilet.
Original Article
Exhaled Nitric Oxide in Patients with Ventilator Associated Pneumonia
Hyun Jung Kwak, Sang Heon Kim, Tae Hyung Kim, Ho Joo Yoon, Dong Ho Shin, Sung Soo Park, Jang Won Sohn
Korean J Crit Care Med. 2012;27(2):82-88.
DOI: https://doi.org/10.4266/kjccm.2012.27.2.82
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AbstractAbstract PDF
BACKGROUND
Fraction of exhaled nitric oxide (FENO) is known as a marker of inflammation in asthma, cystic fibrosis and exacerbation of COPD. However, its importance has not been established in patients using mechanical ventilation. We assessed whether FENO is elevated in patients with ventilator associated pneumonia (VAP), and physiologic or pathologic factors affecting levels of FENO in patients with mechanical ventilation.
METHODS
All patients (over 18-year-old) using mechanical ventilation were included, and among them, VAP patients were diagnosed on the basis of clinical pulmonary infection score (CPIS). We measured FENO in air collected during the end-expiratory pause via an off-line method. We compared the levels of FENO between patients with VAP and without, and assessed the relationship between FENO and other physiologic or pathologic characteristics; age, gender, PaO2, oxygenation index, CPIS.
RESULTS
A total of 43 patients (23 male, mean age 67.7 +/- 10.7) in an ICU were enrolled; 19 of them were VAP-patients (10 male, mean age 64.8 +/- 12.9). The level of FENO in the VAP-patients was substantially higher than in the non-VAP group (55.8 +/- 25.3 ppb Vs. 31.8 +/- 13.5 ppb, p < 0.001). CPIS on day 1 and day 3, and duration of mechanical ventilation, were associated with the level of FENO, but oxygenation index, PaO2, PaO2/FiO2, and the mean PEEP were not.
CONCLUSIONS
FENO may be useful for the diagnosis of VAP, and is related to CPIS, as well as the duration of mechanical ventilation.

Citations

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  • Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study
    Andreas Kofoed, Mathias Hindborg, Jeppe Hjembæk-Brandt, Christian Dalby Sørensen, Mette Kolpen, Morten H Bestle
    Journal of Breath Research.2023; 17(4): 046014.     CrossRef
  • Clinical Application of Exhaled Nitric Oxide Measurements in a Korean Population
    Woo-Jung Song, Ji-Won Kwon, Eun-Jin Kim, Sang-Min Lee, Sae-Hoon Kim, So-Yeon Lee, Sang-Heon Kim, Heung-Woo Park, Yoon-Seok Chang, Woo Kyung Kim, Jung Yeon Shim, Ju-Hee Seo, Byoung-Ju Kim, Hyo Bin Kim, Dae Jin Song, Gwang Cheon Jang, An-Soo Jang, Jung-Won
    Allergy, Asthma & Immunology Research.2015; 7(1): 3.     CrossRef
  • Exhaled breath analysis in the differentiation of pneumonia from acute pulmonary oedema
    Silvie Prazakova, Nadine Elias, Paul S Thomas, Deborah H Yates
    Pulmonology and Respiratory Research.2015; 3(1): 3.     CrossRef
Case Report
A Case of Parainfluenza Virus Related Acute Respiratory Distress Syndrome in Immune Competent Adult Patient: A Case Report
Jae Hee Lee, In Won Park, Jae Yeol Kim, Jong Wook Shin, Byoung Whui Choi, Jae Chol Choi
Korean J Crit Care Med. 2011;26(3):188-190.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.188
  • 4,033 View
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AbstractAbstract PDF
ParaiParainfluenza virus is a common cause of respiratory illness among infants and young children. Although it causes severe pneumonia in immunocompromised patients, it seldom does this in immunocompetent adults. We report the case of a 51-year-old woman with no significant past medical history who presented acute respiratory distress syndrome caused by parainfluenza virus. The diagnosis was made based on reverse transcriptase-polymerase chain reaction (RT-PCR) of a respiratory specimen. The patient was successfully treated with antiviral agent combined with steroids.
Original Articles
Clinical Features of Hospitalized Patients with Community Acquired Pneumonia during 2009 Influenza A (H1N1) Pandemic
Myung Jae Yun, Seong Tae Lee, Hye Jin Oh, Seung June Lee, Sook Hee Song, In Sohn, Jae Phil Choi, Su Hyun Kim
Korean J Crit Care Med. 2011;26(3):162-170.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.162
  • 3,465 View
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AbstractAbstract PDF
BACKGROUND
A new influenza A(H1N1) virus emerged and spread globally in 2009, and the rapid progression of pneumonia often required ICU care. We describe the cause analysis and clinical aspects of community acquired pneumonia during the period of the pandemic H1N1 influenza A.
METHODS
We reviewed the medical records of 48 adult cases of community acquired pneumonia in which patients were admitted to a public health hospital in Seoul from August to November in 2009. The patients had confirmed H1N1 influenza A based on RT-PCR assay.
RESULTS
Thirteen cases of the 48 (27.1%) were 2009 H1N1 RT-PCR positive patients and three (6.3%) of these cases were mixed viral and bacterial pneumonia patients. The mean age was younger and the PSI score was lower in H1N1 patients. Chest radiographic findings of ground glass opacity and interstitial marking were remarkable in H1N1 patients. Major complication events with ICU care or death occurred in 23.1% of the H1N1 positive group and 48.6% of the H1N1 negative group (p=0.202). The major complication group of H1N1 patients had a higher PSI score, lower platelet count, higher CRP and higher mixed bacterial co-infection.
CONCLUSIONS
If patients were younger and showed a radiologic finding of interstitial marking or ground glass opacity, we could consider H1N1 influenza as the cause of community acquired pneumonia. A high PSI score, thrombocytopenia, increased CRP and bacterial co-infection were predictable factors of major complication.
Implementation of the Head of Bed (HOB) Elevation Protocol on Clinical and Nutritional Outcomes in Critically Ill Patients with Mechanical Ventilator Support
Se Hee Na, Hosun Lee, Shin Ok Koh, Hyun Sim Lee, Sung Won Na
Korean J Crit Care Med. 2011;26(3):128-133.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.128
  • 6,761 View
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  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Although head of bed (HOB) elevation is an important strategy to prevent ventilator associated pneumonia (VAP), some observational studies have reported that the application of the semi-recumbent position was lower in patients receiving mechanical ventilator support. We performed this study to assess the effect of implementation of the HOB elevation protocol in the intensive care unit (ICU) on clinical and nutritional outcomes.
METHODS
We developed a HOB elevation protocol including a flow chart to determine whether the HOB of newly admitted patients to ICU could be elevated. We measured the level of HOB elevation in patients with mechanical ventilator twice a day and 2 days a week for 5 weeks before and after the implementation of the protocol, respectively. Hemodynamic, respiratory and nutritional data were also collected, resulting in 251 observations from 35 patients and 467 observations from 66 patients before and after implementation.
RESULTS
After implementing the protocol, the level of HOB elevation (16.7 +/- 9.9 vs. 23.6 +/-1 2.9, p < 0.0001) and observations of HOB elevation > 30degrees increased significantly (34 vs. 151, p < 0.0001). There was no significant difference in the incidence of VAP. Arterial oxygen tension/fraction of inspired oxygen ratio improved (229 +/- 115 vs. 262 +/- 129, p = 0.02). Mean arterial blood pressure decreased after the implementation of the protocol, but remained within the normal limits. Calorie intake from tube feeding increased significantly (672 +/- 649 vs. 798 +/- 670, p = 0.021) and the events of high gastric residual volume (> 100 ml) occurred less frequently after implementing the protocol (50% vs. 17%, p = 0.001) CONCLUSIONS: Implementation of the protocol for HOB elevation could improve the level of HOB elevation, oxygenation parameter and enteral nutrition delivery.

Citations

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  • Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
    Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
    Korean Journal of Critical Care Medicine.2012; 27(3): 157.     CrossRef
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
  • 3,636 View
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  • 1 Crossref
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
Case Reports
H1N1 Influenza/A Associated ARDS Recovered without Mechanical Ventilatory Support: A Case Report
Byung Ook Lee, Jae Hee Lee, Sung Woon Park, Bo Min Kim, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Jae Yeol Kim
Korean J Crit Care Med. 2011;26(2):114-116.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.114
  • 3,026 View
  • 23 Download
AbstractAbstract PDF
An eighteen year-old female visited the ER in our hospital with fever of 38.5degrees C for 2 days. She also had cough, myalgia, and dyspnea. Chest PA and lung HRCT showed mild pulmonary edema at both hilar areas. However, she had severe hypoxia (PaO2; 58 mmHg in room air). RT-PCR for H1N1 influenza/A of pharyngeal swab was positive. Tamiflu (150 mg/d) with broad-spectrum antibiotics was prescribed. Two days later, her dyspnea aggravated and chest PA showed diffuse bilateral infiltration. PaO2 dropped to 70 mmHg (O2 10 L/min by face mask with reservoir bag). She was transferred to the MICU and the Tamiflu dose was doubled (300 mg/day). Mechanical ventilator was set aside to prepare respiratory failure. Fortunately, her symptoms and oxygenation improved and she was discharged with full recovery. Although, most cases of ARDS require mechanical ventilatory support, early and adequate dose of Tamiflu may avoid it in the case of ARDS developed by H1N1 influenza/A.
Stress-induced Cardiomyopathy Associated with Swine Influenza Infection Which Exacerbated Underlying Emphysema: A Case Report
Sung Gook Song, June Hong Kim, Kook Jin Chun, Jun Kim, Yong Hyun Park, Jeong Su Kim, Ju Hyun Park, Dong Cheul Han, Woo Hyun Cho, Doo Soo Jeon, Yun Seong Kim
Korean J Crit Care Med. 2010;25(4):245-248.
DOI: https://doi.org/10.4266/kjccm.2010.25.4.245
  • 3,309 View
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AbstractAbstract PDF
Stress-induced cardiomyopathy (SICM) is an acute cardiac condition that causes left ventricular apical ballooning which mimicks acute coronary syndrome. The risk of in-hospital mortality with SICM is generally low (1% to 3%) and supportive care is usually sufficient for resolution. Swine-origin influenza A (H1N1, S-OIV) is a recently spreading pandemic and a serious public health problem. Although most S-OIV infections have a mild, self-limited course, clinical cases resulting in fatalities and associated with variable co-morbidities remain as a serious concern in some individuals. Among such serious complications, there have been few reports of SICM caused by S-OIV infection. We herein report, for the first time in the literature, a case with fatal hemodynamic instability secondary to SICM caused by S-OIV infection with viral pneumonia.
A Case of Pseudoaneurysm Developed during Intensive Treatment of Status Asthmaticus: A Case Report
Dong Kim, Jeong Hyun Shin, Dong Hyo No, Hyeong Cheol Cheong, Kyung Hwa Cho, Ki Eun Hwang, Hwi Jung Kim, Eun Taik Jeong, Hak Ryul Kim
Korean J Crit Care Med. 2010;25(4):241-244.
DOI: https://doi.org/10.4266/kjccm.2010.25.4.241
  • 3,282 View
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AbstractAbstract PDF
Pseudoaneurysm formation in the pulmonary vasculature is a rare but fatal condition. Several etiologies have been described including trauma, complication after cardiac or other surgeries, tuberculosis, necrotizing pneumonia, congestive heart disease, atherosclerosis, cancer and vasculitis. We report a case of pseudoaneurysm found in a patient being treated with status asthmaticus, who developed complications of pneumonia and brain abscess secondary to sepsis.
Original Article
VAP (Ventilator-associated Pneumonia) in Patients with Pulmonary Contusion
Jong Hyun Jeong, Sung Youl Hyun, Jin Joo Kim, Jae Hyuk Kim, Yong Su Lim, Jin Seong Cho, Sung Yeon Hwang, Hyuk Jun Yang
Korean J Crit Care Med. 2010;25(4):224-229.
DOI: https://doi.org/10.4266/kjccm.2010.25.4.224
  • 4,097 View
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AbstractAbstract PDF
BACKGROUND
This study was conducted to determine the incidence, risk factors, and outcome of ventilator-associated pneumonia in patients with pulmonary contusion.
METHODS
The study was conducted at an urban teaching hospital emergency department with an annual volume of 80,000 patient visits. A retrospective analysis was conducted on thoracic injury patients admitted between Jan 2007 and Dec 2009. Among 122 patients investigated, 30 patients were excluded. Patient data included basal characteristics and information related to development of ventilator-associated pneumonia and ultimate mortality. Statistical methods included the Chi-square test and the Mann-Whitney test. Study data were stored and processed using Microsoft Office Excel 2007 & SPSS 18.0 for Windows.
RESULTS
Ventilator-associated pneumonia developed in 46 patients (50%). The patients with ventilator-associated pneumonia were more likely to have a longer duration of hospitalization, longer length of ICU stay, longer duration of mechanical ventilation, a low initial GCS, a higher APACHE II score, and were more likely to require emergency intubation or tracheostomy. Factors associated with mortality included longer duration of hospitalization, longer duration of mechanical ventilation, low intial GCS and the need for dialysis.
CONCLUSIONS
Ventilator-associated pneumonia in the patients with pulmonary contusion was not relevant to mortality, but was relevant to longer hospitalization, length of ICU stay and duration of mechanical ventilation.
Case Reports
Two Cases of Spontaneous Pneumomediastinum Complicating Viral Pneumonia Caused by Influenza A Virus, (H1N1 Subtype): A Case Report
Jae Woong Tae, Eun Jin Kim, Woo Jin Jang, Min Jeong Kim, Hae Ri Chon, Eun Soo Jeong, Young Min Koh
Korean J Crit Care Med. 2010;25(3):163-167.
DOI: https://doi.org/10.4266/kjccm.2010.25.3.163
  • 2,956 View
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AbstractAbstract PDF
Influenza A virus, (H1N1 Subtype), was identified as the cause of outbreaks of febrile respiratory infection in Mexico, the US, Canada and elsewhere during the spring of 2009. In Korea, a novel virus infection showing many variable complications was also pandemic. We report two cases of spontaneous pneumomediastinum, complicating viral pneumonia, caused by Influenza A virus, (H1N1 Subtype).
Neurogenic-stunned Myocardium and Pulmonary Edema Following a Ruptured Cerebral Aneurysm: A Case Report
Sung Ha Mun, Won Joon Choi, Jeong Min Mok, Jae Young Yang, Chul Ho Woo
Korean J Crit Care Med. 2010;25(2):93-97.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.93
  • 3,764 View
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  • 1 Crossref
AbstractAbstract PDF
We report a case of neurogenic cardiopulmonary instability with pulmonary edema occurring after an aneurysmal subarachnoid hemorrhage. The patient's pre-operative Glasgow coma scale score was 6 and the PA chest radiograph showed increased diffuse haziness in the right lung field. The patient presented with severe hypotension and low oxygen saturation during surgery. Cardiac damage was documented by increased CK-MB troponin-T levels, and ischemic ECG findings. Reversible cardiac failure associated with subarachnoid hemorrhage may be due to a neurogenic-stunned myocardium. The patient underwent clipping of the aneurysm and recovered with minimal neurologic impairment and normal cardiac function.

Citations

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  • A Retrospective Study about Characteristics of Out-of-hospital Cardiac Arrest Caused by Non-traumatic Subarachnoid Hemorrhage
    Min Seob Sim, Ki Dong Sung, Mun Ju Kang, Ji Ung Na, Tae Gun Shin, Ik Joon Jo, Hyoung Gon Song, Keun Jeong Song, Yeon Kwon Jeong
    The Korean Journal of Critical Care Medicine.2011; 26(3): 151.     CrossRef
Extreme Drug Resistant Acinetobacter Nosocomial Ventilator-Associated Pneumonia Treated Successfully with Tigecycline and Amikacin in Intensive Care Unit: A Case Report
So Yeon Lim, So Young Park, Kyeongman Jeon, Gee Young Suh, Suhyun Kim, Kyong Ran Peck, Doo Ryeon Chung
Korean J Crit Care Med. 2009;24(3):176-180.
DOI: https://doi.org/10.4266/kjccm.2009.24.3.176
  • 3,872 View
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  • 1 Crossref
AbstractAbstract PDF
Infections due to multidrug resistant Acinetobacter baumannii have become a challenging problem in intensive care units. Tigecycline is a derivative of minocyline, and has provided new hope for the treatment of multidrug-resistant A. baumannii infections. Because isolates showing reduced susceptibility to minocycline or tigecycline have emerged in many countries, empirical combination therapy has become common practice to treat patients infected with extreme drug-resistant A. baumannii. Herein we report a case of extreme drug-resistant A. baumannii infection successfully treated with tigecycline and amikacin.

Citations

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  • Clinical Characteristics in Patients with Carbapenem-ResistantAcinetobacter baumanniiIsolates from Tracheal Secretions
    Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye-Kyung Park, Min Ki Lee
    Korean Journal of Critical Care Medicine.2013; 28(3): 173.     CrossRef
Original Article
Severe Health-care Associated Pneumonia among the Solid Cancer Patients on Chemotherapy
Maeng Real Park, So Young Park, Kyeongman Jeon, Won Jung Koh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Gee Young Suh, Jin Seok Ahn, Myung Ju Ahn, Ho Yeong Lim
Korean J Crit Care Med. 2009;24(3):140-144.
DOI: https://doi.org/10.4266/kjccm.2009.24.3.140
  • 3,454 View
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AbstractAbstract PDF
BACKGROUND
There are only inadequate studies on the characteristics of severe pneumonia in the patients who have solid cancer and who are treated with cytotoxic chemotherapy and also on the usefulness of the various severity index scores.
METHODS
We retrospectively reviewed 31 patients who were treated with cytotoxic chemotherapy because of solid cancer and who were admitted to the medical ICU at Samsung Medical Center from April 2007 to August 2008.
RESULTS
The median age of the 31 patients was 64 years old (34-79). The types of solid cancer were lung cancer (19, 61.3%), gastroesophageal cancer (4, 12.9%), breast cancer (2, 6.5%), liver cancer (1, 3.2%), ovarian cancer (1, 3.2%) and other types of cancer (4, 12.9%). The hospital mortality rate was 64.5%. We were able to determine the pathogen of 19 (61.3%) patients; S. pneumoniae (6), S. aureus (3), Candida species (3), P. aeruginosa (2), K. pneumoniae (1), Pneumocystis jiroveci (1) and others (3). There were no statistically differences of the laboratory data and severity index scores (PSI, CURB-65, APACHE II, SOFA, SAPS 3) between the survivors and nonsurvivors, except the P/F ratio.
CONCLUSIONS
The hospital mortality rate of severe pneumonia in patients who had solid cancer and who received cytotoxic chemotherapy was high. The major pathogen was S. pneumoniae. The severity indexes for general pneumonia were not useful to these patients.
Case Report
Dantrolene and Post-operative Hyperthermia: A Case Report
Ja Kyung Koo, Cheol Hong Kim, Ah Leum Lim, Se Ah Kwon, Ji Young Park, Soon Jae Lee, In Gyu Hyun, Je Hyun Yoo
Korean J Crit Care Med. 2009;24(2):92-98.
DOI: https://doi.org/10.4266/kjccm.2009.24.2.92
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AbstractAbstract PDF
Malignant hyperthermia is a rare, fatal pharmacogenetic disorder that occurs during general anesthesia following exposure to a depolarizing muscle relaxant, such as succinylcholine, or volatile anesthetics. Clinical findings in malignant hyperthermia include muscle rigidity, sinus tachycardia, increased CO2 production, skin cyanosis with mottling, and marked hyperthermia. For treatment, cooling techniques must be accompanied by discontinuation of the provocative medication. Furthermore, dantrolene administration is the mainstay of treatment for malignant hyperthermia, and should be initiated as soon as the diagnosis is suspected. We recently experienced a case with post-operative fever of 41.0degrees C refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration, in a patient with methicillin-sensitive Staphylococcus aureus monoarthritis of the knee and rapid progression of diffuse septic pneumonia requiring mechanical ventilation.
Original Article
Clinical Outcomes of Early Vancomycin Administration before Identification of Methicillin-resistant Staphylococcus aureus in Patients with Nosocomial Pneumonia
Yong Woo Seo, Jung Eun Lee, Bo Ram Min, Jae Seok Park, Jeong Eun Kim, Young Yun Jang, Hun Pyo Park, Nam Hee Ryoo, Won Il Choi
Korean J Crit Care Med. 2007;22(1):1-6.
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AbstractAbstract PDF
BACKGROUND
The aim of this study is to determine the clinical outcomes of early vancomycin administration before identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients with nosocomial pneumonia on a ventilator. METHODS: We retrospectively reviewed patients with nosocomial pneumonia in a 20-bed medical ICU during a period of 2 years and 2 months. This study included 52 inpatients, who were admitted for more than 72 hr and had a new or progressive lung infiltrate plus at least two of the following three criteria for pneumonia: abnormal body temperature (>38oC or <35oC), abnormal leukocyte count (>10,000/mm3 or <3,000/mm3), and purulent bronchial secretions. All of the MRSA were identified in tracheal aspirates during mechanical ventilation. RESULTS: A total of 23 patients who received vancomycin prior to identification of MRSA exhibited a 28-day mortality rate of 60%, while 29 patients who received vancomycin after identification of MRSA showed a 28-day mortality rate of 40% (p=0.17). There was no statistically significant difference in severity index and routine laboratory findings between the two groups. CONCLUSIONS: Early vancomycin administration before identification of MRSA does not appear to affect the mortality rate for patients with nosocomial pneumonia.
Case Reports
A Case of Pulmonary Aspiration during the Anesthetic Induction in the Post Total Gastrectomy Patient
Yoon Hee Kim, Sang Soo Kim, Moon Hee Park, Seok Hwa Yoon
Korean J Crit Care Med. 1998;13(1):85-90.
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AbstractAbstract PDF
Pulmonary aspiration of gastric contents is a feared complication of anesthetic procedures. But aspiration of intestinal contents is rare, the influences of the aspirated contents and/or the consequnt events in the airway have not been fully settled in its provacative role for causing an acute pulmonary reaction. We experienced a case of pulmonary aspiration of intestinal content. The patinet who had undergone previous total gastrectomy was planed emergency operation due to intestinal obstructon. Aspiration during anesthetic induction occurred accidentally. Immediate endotracheal intubation and suction were followed. Right chest breathing sound was coarse and then it was getting better. Although supplement of O2 by Y-piece, arterial blood gas analysis of patient revealed pH 7.30, PaCO2 36 mmHg, PaO2 58 mmHg after emegence from anesthesia in the recovery room. Chest X-ray showed the focal air space consolidation in right lower lung and ill defined pulmonary opacity in left mid lung and retrocardiac area. The measured pH of aspiration content was 7.8 and nonpathogenic Gram negative bacilli species were cutured. Frequent suction, encouraging expectoration, antimicrobial agents therapy and O2 supplementation by Y-piece were performed in the ICU. Patient normalized following 24 hrs after the episode of aspiration.
Anesthesia for Cesarean Section in Two Pregnant Women with Peripartum Cardiomyopathy: A report of two cases
Yong In Kang, Kyung Sook Cho, Su Yeon Kim, Myoung Hee Kim, Hyun Sook Lee
Korean J Crit Care Med. 1997;12(2):177-182.
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AbstractAbstract PDF
Peripartum cardiomyopathy (PPCM) is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first 6 months after delivery. Mortality from PPCM ranges from 25% to 50% and cause of death is usually chronic congestive heart failure or thromboembolic complications. We experienced 2 patients with PPCM. One was a twin pregnant woman and PPCM was developed after cesarean section. In the other case, PPCM was combined with aspiration pneumonia in the preterm labor patient. They were treated with diuretics and cardiotonic drugs and recovered to normal cardiac function within 7 to 10 days. Prognosis is related to recovery of left ventricular function, which usually occurs within 6 months postpartum. Early diagnosis and appropriate treatment of PPCM improve outcome.
ACC : Acute and Critical Care
© The Korean Society of Critical Care Medicine.
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