Acute and Critical Care

Original Articles

Infection
Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea: Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh; Acute Crit Care. 2025;40(4):548-556. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.003575

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Abstract PDF Supplementary Material: Background
Emergency department (ED) overcrowding poses a global challenge, particularly for critically ill patients requiring intensive care unit (ICU) admission. Although delays in ICU transfer increase mortality in critically ill populations, the optimal timing for septic shock remains uncertain.
Methods
We conducted a target trial emulation using a prospective cohort of 815 septic shock patients from 19 Korean hospitals. Delayed ICU transfer was defined using restricted cubic splines. The primary outcome was in-hospital mortality. Multivariable logistic regression and inverse probability treatment weighting were used to adjust for confounders of age, sex, comorbidities, severity of illness, and mechanical ventilation use. Subgroup analyses were performed to assess the effect across patient characteristics.
Results
The median time of ED-to-ICU transfer was 6.7 hours (interquartile range, 4.7–11.4), and only 7% of patients were transferred within 3 hours. ICU transfer within 3 hours was associated with significantly lower in-hospital mortality (odds ratio, 0.48; 95% CI, 0.24–0.94) compared to later transfers. Mortality risk increased with elapsing time up to 6 hours and then plateaued. The benefit of early ICU transfer was consistent across subgroups but was particularly pronounced in patients requiring extracorporeal membrane oxygenation or continuous renal replacement therapy (P for interaction=0.02).
Conclusions
Early ICU transfer within 3 hours significantly reduces mortality in patients with septic shock, with the greatest benefit observed in those requiring advanced organ support. These findings highlight the need for system-wide strategies to reduce ED boarding time and prioritize timely ICU admission for septic shock management.

Nutrition
The impact of enteral feeding intolerance on the prognosis of patients with septic shock in South Korea: Hyun-Jun Park, Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2025;40(2):304-312. Published online May 30, 2025; DOI: https://doi.org/10.4266/acc.000700

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Abstract PDF: Background
While enteral feeding intolerance (EFI) is associated with worse clinical outcomes in critically ill patients, the relationship between the number of days of EFI and mortality outcomes remains unclear.
Methods
We retrospectively analyzed adult patients admitted to the medical intensive care unit (ICU) with septic shock at a tertiary referral center. EFI was defined as the presence of vomiting, abdominal distension, pain, diarrhea, or radiographic evidence of ileus. EFI status was assessed daily, and we evaluated the prognostic impact of total number of EFI days during the first 3 days of enteral feeding on clinical outcomes.
Results
A total of 94 patients were included in the analysis, with 77 (81.9%) experiencing EFI. During the first 3 days of enteral feeding, 25 patients (26.6%) experienced EFI for 1 day, 22 patients (23.4%) experienced EFI for 2 days, and 30 patients (31.9%) experienced EFI for all 3 days. The total number of EFI days was identified as an independent risk factor of 90-day mortality (adjusted hazard ratio, 1.400; 95% CI 1.021–1.919). Higher total EFI days was significantly associated with increased ICU mortality (P for trend=0.036), in-hospital mortality (P for trend=0.007), 30-day mortality (P for trend=0.004), and 90-day mortality (P for trend=0.006).
Conclusions
An increase in the total number of EFI days was significantly associated with mortality outcomes in patients with septic shock, suggesting that EFI may serve as a useful indicator for predicting outcomes in this population.

Infection
Neutrophil-to-lymphocyte-to-albumin ratio as a prognostic marker for mortality in sepsis and septic shock in Vietnam: Nguyen Van Viet Thang, Le Thi Luyen, Nguyen Thi Tuong Vi, Pham Dang Hai; Acute Crit Care. 2025;40(2):244-251. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.003576

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Abstract PDF

Background
Sepsis and septic shock are life-threatening global health challenges associated with high mortality rates. Early identification of high-risk patients is critical for improving outcomes. In the present study, the association between the neutrophil-to-lymphocyte-to-albumin ratio (NLAR) and mortality in septic patients was evaluated.
Methods
A retrospective study was performed at a tertiary hospital in Vietnam. Patients ≥18 years of age diagnosed with sepsis or septic shock based on the Sepsis-3 criteria were included. Exclusion criteria included recent corticosteroid use within 7 days, autoimmune diseases, hematological disorders, and active cancer within 5 years. NLAR was calculated from complete blood counts and albumin levels within the first 24 hours of intensive care unit admission. Receiver operating characteristic (ROC) curves were used to determine the predictive ability of NLAR for in-hospital mortality.
Results
The present study included 141 patients with a mean age of 72 years. Non-survivors were significantly older with higher rates of mechanical ventilation. NLAR was significantly elevated in non-survivors compared with survivors (0.88 [0.57–1.24] vs. 0.44 [0.28–0.77], P<0.001). In ROC analysis, the area under the curve for NLAR was 0.70 (P<0.001). Using a cutoff value of 0.56, NLAR showed a sensitivity of 77.8% and a specificity of 61.5% for predicting in-hospital mortality.
Conclusions
Elevated NLAR on admission was associated with a higher mortality rate in sepsis patients. NLAR could be used as an early prognostic marker for sepsis mortality.

Citations

Citations to this article as recorded by

Altered albumin/neutrophil to lymphocyte ratio are associated with all-cause and cardiovascular mortality for advanced cardiovascular-kidney-metabolic syndrome
Xiaoshuang Yin, Jinmei Zou, Jing Yang
Frontiers in Nutrition.2025;[Epub] CrossRef
The Neutrophil-to-Albumin Ratio (NAR) Reflects the Severity of the Post-CABG Inflammatory Response and Is Associated with a Pre-Existing Pro-Inflammatory Monocyte Profile
Mikhail A. Popov, Siarhei A. Dabravolski, Vladislav V. Dontsov, Sergei A. Vzvarov, Evgeniy G. Agafonov, Dmitriy I. Zybin, Alexandra K. Kharabet, Olga V. Radchenkova, Dmitriy R. Saveliev, Victoria P. Pronina, Svetlana S. Verkhova, Nikita G. Nikiforov, Yego
Life.2025; 15(12): 1790. CrossRef
Neutrophil Extracellular Traps in Sepsis and Sepsis-Related Organ Dysfunction
Wenbo Yan, Xiyuan Xu, Xiaojuan Li, Yushu Ma, Lining Guo, Jingping Yang, Zhipeng Jin, Jie Zhang, Tiewei Li
ImmunoTargets and Therapy.2025; Volume 14: 1373. CrossRef

Pulmonary
Using machine learning techniques for early prediction of tracheal intubation in patients with septic shock: a multi-center study in South Korea: Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han; Acute Crit Care. 2025;40(2):221-234. Published online April 30, 2025; DOI: https://doi.org/10.4266/acc.004776

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Background
Patients with septic shock frequently require tracheal intubation in the emergency department (ED). However, the criteria for tracheal intubation are subjective, based on physician experience, or require serial evaluations over relatively long intervals to make accurate predictions, which might not be feasible in the ED. We used supervised learning approaches and features routinely available during the initial stages of evaluation and resuscitation to stratify the risks of tracheal intubation within a 24-hour time window.
Methods
We retrospectively analyzed the data of patients diagnosed with septic shock based on the SEPSIS-3 criteria across 21 university hospital EDs in the Republic of Korea. A principal component analysis revealed a complex, non-linear decision boundary with respect to the application of tracheal intubation within a 24-hour time window. Stratified five-fold cross validation and a grid search were used with extreme gradient boost. Shapley values were calculated to explain feature importance and preferences.
Results
In total, data for 4,762 patients were analyzed; within that population, 1,486 (31%) were intubated within a 24-hour window, and 3,276 (69%) were not. The area under the receiver operating characteristic curve and F1 scores for intubation within a 24-hour window were 0.829 (95% CI, 0.801–0.878) and 0.654 (95% CI, 0.627–0.681), respectively. The Shapley values identified lactate level after initial fluids, suspected lung infection, initial pH, Sequential Organ Failure Assessment score at enrollment, and respiratory rate at enrollment as important features for prediction.
Conclusions
An extreme gradient boosting machine can moderately discriminate whether intubation is warranted within 24 hours of the recognition of septic shock in the ED.

Citations

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Methodological development study: Dynamic mask attention graph neural network for mechanical ventilation in elderly intensive care unit patients
Yi Xie, Ni Xie, Jiao Guo
DIGITAL HEALTH.2025;[Epub] CrossRef

Basic science and research
Impact of tadalafil on cardiovascular and organ dysfunction induced by experimental sepsis: Marcelo Almeida Nakashima, Gabrielle Delfrate, Lucas Braga Albino, Gustavo Ferreira Alves, Junior Garcia Oliveira, Daniel Fernandes; Acute Crit Care. 2025;40(1):46-58. Published online February 12, 2025; DOI: https://doi.org/10.4266/acc.002904

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Abstract PDF: Background
Sepsis is a life-threatening condition that affects the cardiovascular and renal systems. Severe hypotension during sepsis compromises tissue perfusion, which can lead to multiple organ dysfunction and death. Phosphodiesterase 5 (PDE5) degrades intracellular cyclic guanosine monophosphate (cGMP) levels which promotes vasodilatation in specific sites. Our previous studies show that inhibiting cGMP production in early sepsis increases mortality, implying a protective role for cGMP production. Then, we hypothesized that cGMP increased by tadalafil (PDE5 inhibitor) could improve microcirculation and prevent sepsis-induced organ dysfunction.
Methods
Rats were submitted to cecal ligation and puncture (CLP) sepsis model and treated with tadalafil (2 mg/kg, s.c.) 8 hours after the procedure. Hemodynamic, inflammatory and biochemical assessments were performed 24 hours after sepsis induction. Moreover, the effect of tadalafil on the survival of septic rats was evaluated for 5 days.
Results
Tadalafil treatment improves basal renal blood flow during sepsis and preserves it during noradrenaline infusion. Sepsis induces hypotension, impaired response to noradrenaline, and increased cardiac and renal neutrophil infiltration, in addition to increased levels of plasma nitric oxide and lactate. None of these dysfunctions were changed by tadalafil. Additionally, tadalafil treatment did not increase the survival rate of septic rats.
Conclusions
Tadalafil improved microcirculation of septic animals; however, no beneficial effects were observed on macrocirculation and inflammation parameters. Then, the potential benefit of tadalafil in the prognosis of sepsis should be evaluated within a therapeutic strategy covering all sepsis injury mechanisms.

Guideline

Meta-analysis
Early management of adult sepsis and septic shock: Korean clinical practice guidelines: Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, Ala Woo, Sua Kim, Dae-Hwan Bae, Sung Wook Kang, Sun Hyo Park, Gee Young Suh, Sunghoon Park; Acute Crit Care. 2024;39(4):445-472. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00920

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Background
Despite recent advances and global improvements in sepsis recognition and supportive care, mortality rates remain high, and adherence to sepsis bundle components in Korea is low. To address this, the Korean Sepsis Alliance, affiliated with the Korean Society of Critical Care Medicine, developed the first sepsis treatment guidelines for Korea based on a comprehensive systematic review and meta-analysis.
Methods
A de novo method was used to develop the guidelines. Methodologies included determining key questions, conducting a literature search and selection, assessing the risk of bias, synthesizing evidence, and developing recommendations. The certainty of evidence and the strength of recommendations were determined using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Draft recommendations underwent internal and external review processes and public hearings. The development of these guidelines was supported by a research grant from the Korean Disease Control and Prevention Agency.
Results
In these guidelines, we focused on early treatments for adult patients with sepsis and septic shock. Through the guideline development process, 12 key questions and their respective recommendations were formulated. These include lactate measurement, fluid therapies, target blood pressure, antibiotic administration, use of vasopressors and dobutamine, extracorporeal membrane oxygenation, and echocardiography.
Conclusions
These guidelines aim to support medical professionals in making appropriate decisions about treating adult sepsis and septic shock. We hope these guidelines will increase awareness of sepsis and reduce its mortality rate.

Citations

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Comparison between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest
Sejoong Ahn, Bo-Yeong Jin, Sukyo Lee, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sang Kuk Han, Phil Cho Choi, Young Hwan Lee, Sang O. Park, Jong Seok Lee, Ki Young Jeong, Sung Hyuk Choi, Young Hoon Yoon, Su Jin Kim, Kap Su Han, Min Seob Sim, Gun Tak Lee, Yo
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Recommendations for the use of biomarkers for the management of adults with sepsis: a scoping review and critical appraisal
Miriam Mateos-Haro, Ana Garcia-Santa-Vinuela, Daniel Molano-Franco, Ivan Solà, Federico Gordo-Vidal, María Cruz Martín-Delgado, Jesus Lopez-Alcalde, Javier Zamora
BMJ Open.2025; 15(7): e090922. CrossRef
Regional Adherence to Early Sepsis Management Bundle and Associated Mortality in Hong Kong Between 2009–2018
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Scientific Reports.2025;[Epub] CrossRef
Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea
Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh
Acute and Critical Care.2025; 40(4): 548. CrossRef
Early Versus Delayed Norepinephrine Initiation in Septic Shock: A Systematic Review and Meta-Analysis of Randomized and Observational Studies
Chibuzo C Manafa, Oluwayemisi E Ekor, Akintunde C Akinboboye, Okelue E Okobi, Gift Ojukwu, Osemwegie O Ugbo, Michael U Mochu, Emasenyie Isikwei, Sergio Hernandez Borges, Miguel Diaz-Miret
Cureus.2025;[Epub] CrossRef
Quality assessment of clinical practice guidelines for sepsis and variations in recommendations
Hong-Yan Li, Shan-Ling Jiang, Jing Wang, Hai-Shan Wang, Li-Hong Wang
BMC Infectious Diseases.2025;[Epub] CrossRef
Evidence-Based Interventions for Sepsis Management in Critically Ill Adults: A Systematic Review
Elsa Jardim Sousa, Michelle de Soresa Virissimo, Abel Mendonça Viveiros, Ana Alves, Valter Gonçalves
European Journal of Medical and Health Research.2025; 3(6): 232. CrossRef

Original Article

Epidemiology
Pediatric septic shock estimation using deep learning and electronic medical records: Ji Weon Lee, Bongjin Lee, June Dong Park; Acute Crit Care. 2024;39(3):400-407. Published online August 1, 2024; DOI: https://doi.org/10.4266/acc.2024.00031

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Abstract PDF

Background
Diagnosing pediatric septic shock is difficult due to the complex and often impractical traditional criteria, such as systemic inflammatory response syndrome (SIRS), which result in delays and higher risks. This study aims to develop a deep learning-based model using SIRS data for early diagnosis in pediatric septic shock cases.
Methods
The study analyzed data from pediatric patients (<18 years old) admitted to a tertiary hospital from January 2010 to July 2023. Vital signs, lab tests, and clinical information were collected. Septic shock cases were identified using SIRS criteria and inotrope use. A deep learning model was trained and evaluated using the area under the receiver operating characteristics curve (AUROC) and area under the precision-recall curve (AUPRC). Variable contributions were analyzed using the Shapley additive explanation value.
Results
The analysis, involving 9,616,115 measurements, identified 34,696 septic shock cases (0.4%). Oxygen supply was crucial for 41.5% of the control group and 20.8% of the septic shock group. The final model showed strong performance, with an AUROC of 0.927 and AUPRC of 0.879. Key influencers were age, oxygen supply, sex, and partial pressure of carbon dioxide, while body temperature had minimal impact on estimation.
Conclusions
The proposed deep learning model simplifies early septic shock diagnosis in pediatric patients, reducing the diagnostic workload. Its high accuracy allows timely treatment, but external validation through prospective studies is needed.

Citations

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Comparison of Pediatric Risk of Mortality-III, Phoenix Sepsis, and pediatric Sequential Organ Failure Assessment scores for predicting septic shock in Vietnamese children with sepsis
Khai Quang Tran, Ngan Tuong Thien Pham, Tri Duc Nguyen, Quan Minh Pham
The Brazilian Journal of Infectious Diseases.2026; 30(1): 104612. CrossRef
Aligning prediction models with clinical information needs: infant sepsis case study
Lusha Cao, Aaron J Masino, Mary Catherine Harris, Lyle H Ungar, Gerald Shaeffer, Alexander Fidel, Elease McLaurin, Lakshmi Srinivasan, Dean J Karavite, Robert W Grundmeier
JAMIA Open.2025;[Epub] CrossRef

Review Article

Basic science and research
Sex or gender differences in treatment outcomes of sepsis and septic shock: Seung Yeon Min, Ho Jin Yong, Dohhyung Kim; Acute Crit Care. 2024;39(2):207-213. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2024.00591

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Abstract PDF

Gender disparities in intensive care unit (ICU) treatment approaches and outcomes are evident. However, clinicians often pay little attention to the importance of biological sex and sociocultural gender in their treatment courses. Previous studies have reported that differences between sexes or genders can significantly affect the manifestation of diseases, diagnosis, clinicians' treatment decisions, scope of treatment, and treatment outcomes in the intensive care field. In addition, numerous reports have suggested that immunomodulatory effects of sex hormones and differences in gene expression from X chromosomes between genders might play a significant role in treatment outcomes of various diseases. However, results from clinical studies are conflicting. Recently, the need for customized treatment based on physical, physiological, and genetic differences between females and males and sociocultural characteristics of society have been increasingly emphasized. However, interest in and research into this field are remarkably lacking in Asian countries, including South Korea. Through this review, we hope to enhance our awareness of the importance of sex and gender in intensive care treatment and research by briefly summarizing several principal issues, mainly focusing on sex and sex hormone-based outcomes in patients admitted to the ICU with sepsis and septic shock.

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High expression of IRF4 mediated by m6A modification promotes immunosuppression in the late phase of sepsis
Ziying Xiong, Wending Zhou, Nengyi Hua, Xuedi Zhang, Chunxiu Ling, Xiao Huang, Xiaolei Liu, Hanhui Zhong, Shuhua Luo, Huiling Zhang, Bowan Huang, Jing Tang
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Impact of substance use disorders on critical care management and health outcomes in septic adolescents
Havell Markus, Gary D. Ceneviva, Neal J. Thomas, Conrad Krawiec
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Trends of cardiovascular disease and sepsis related mortality in the United States, 1999 to 2019: A CDC WONDER Database Analysis
Shehroze Tabassum, Faraz Azhar, Aimen Shafiq, Muneeba Ahsan, Aroma Naeem, Farhan Naeem, Hafeez Ul Hassan Virk, Abdul Mannan Khan Minhas, Dmitry Abramov, M Chadi Alraies
International Journal of Cardiology Cardiovascular Risk and Prevention.2025; 26: 200421. CrossRef
Mitigating Bias in Machine Learning Models with Ethics-Based Initiatives: The Case of Sepsis
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Original Articles

Pulmonary
Are sodium-glucose co-transporter-2 inhibitors associated with improved outcomes in diabetic patients admitted to intensive care units with septic shock?: Nikita Ashcherkin, Abdelmohaymin A. Abdalla, Simran Gupta, Shubhang Bhatt, Claire I. Yee, Rodrigo Cartin-Ceba; Acute Crit Care. 2024;39(2):251-256. Published online May 14, 2024; DOI: https://doi.org/10.4266/acc.2023.01046

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Abstract PDF

Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce organ dysfunction in renal and cardiovascular disease. There are limited data on the role of SGLT2i in acute organ dysfunction. We conducted a study to assess the effect of SGLT2i taken prior to intensive care unit (ICU) admission in diabetic patients admitted with septic shock.
Methods
This retrospective cohort study used electronic medical records and included diabetic patients admitted to the ICU with septic shock. We compared diabetic patients on SGLT2i to those who were not on SGLT2i prior to admission. The primary outcome was in-hospital mortality, and secondary outcomes included hospital and ICU length of stay, use of renal replacement therapy, and 28- and 90-day mortality.
Results
A total of 98 diabetic patients was included in the study, 36 in the SGLT2i group and 62 in the non-SGLT2i group. The Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation III scores were similar in the groups. Inpatient mortality was significantly lower in the SGLT2i group (5.6% vs. 27.4%, P=0.008). There was no significant difference in secondary outcomes.
Conclusions
Our study found that diabetic patients on SGLT2i prior to hospitalization who were admitted to the ICU with septic shock had lower inpatient mortality compared to patients not on SGLT2i.

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Baris Afsar, Rengin Elsurer Afsar, Katherine Tuttle, Krista L. Lentine
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Laura Prideaux, Megan Sandeman, Hayley Stratton, Anthony D Kelleher, Simon Smith, Josh Hanson
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High-density lipoprotein: a biomarker and therapeutic target in sepsis
Mohan Li, Marina Barros-Pinkelnig, Sesmu M. Arbous, Christina Christoffersen, Patrick C. N. Rensen, Sander Kooijman
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Immunology
Patterns of inflammatory immune responses in patients with septic shock receiving vitamin C, hydrocortisone, and thiamine: clustering analysis in Korea: Seung-Hun You, Oh Joo Kweon, Sun-Young Jung, Moon Seong Baek, Won-Young Kim; Acute Crit Care. 2023;38(3):286-297. Published online August 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00507

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Background
Sepsis is characterized by heterogeneous immune responses that may evolve during the course of illness. This study identified inflammatory immune responses in septic patients receiving vitamin C, hydrocortisone, and thiamine.
Methods
This was a single-center, post-hoc analysis of 95 patients with septic shock who received the vitamin C protocol. Blood samples were drawn on days 1–2, 3–4, and 6–8 after shock onset. Group-based multi-trajectory modeling was used to identify immune trajectory groups.
Results
The median age was 78 years (interquartile range, 70–84 years), and 56% were male. Clustering analysis identified group 1 (n=41), which was characterized by lower interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-10 levels, and these levels remained stationary or mildly increased until day 7. Conversely, group 2 (n=54) expressed initially higher IL-6, TNF-α, and IL-10 levels that decreased rapidly by day 4. There was a nonsignificant increase in lymphocyte count and a decrease in C-reactive protein level until day 7 in group 2. The intensive care unit mortality rate was significantly lower in group 2 (39.0% vs. 18.5%, P=0.03). Group 2 also had a significantly higher decrease in the mean (standard deviation) vasopressor dose (norepinephrine equivalent: –0.09±0.16 μg/kg/min vs. –0.23±0.31 μg/kg/min, P<0.001) and Sequential Organ Failure Assessment score (0±5 vs. –4±3, P=0.002) between days 1 and 4.
Conclusions
There may be different subphenotypes in septic patients receiving the vitamin C protocol.

Citations

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Micronutrients as therapy in critical illness
Christian Stoppe, Ellen Dresen, Angelique de Man
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Infection
The prognostic impact of rheumatoid arthritis in sepsis: a population-based analysis: Lavi Oud, John Garza; Acute Crit Care. 2022;37(4):533-542. Published online October 6, 2022; DOI: https://doi.org/10.4266/acc.2022.00787

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Background
Rheumatoid arthritis (RA) is associated with increased risk of sepsis and higher infection-related mortality compared to the general population. However, the evidence on the prognostic impact of RA in sepsis has been inconclusive. We aimed to estimate the population-level association of RA with short-term mortality in sepsis.
Methods
We used statewide data to identify hospitalizations aged ≥18 years in Texas with sepsis, with and without RA during 2014–2017. Hierarchical logistic models with propensity adjustment (primary model), propensity score matching, and multivariable logistic regression without propensity adjustment were used to estimate the association of RA with short-term mortality among sepsis hospitalizations.
Results
Among 283,025 sepsis hospitalizations, 7,689 (2.7%) had RA. Compared to sepsis hospitalizations without RA, those with RA were older (aged ≥65 years, 63.9% vs. 56.4%) and had higher burden of comorbidities (mean Deyo comorbidity index, 3.2 vs. 2.7). Short-term mortality of sepsis hospitalizations with and without RA was 26.8% vs. 31.4%. Following adjustment for confounders, short-term mortality was lower among RA patients (adjusted odds ratio [aOR], 0.910; 95% confidence interval [CI], 0.856–0.967), with similar findings on alternative models. On sensitivity analyses, short-term mortality was lower in RA patients among sepsis hospitalizations aged ≥65 years and those with septic shock, but not among those admitted to intensive care unit (ICU; aOR, 0.990; 95% CI, 0.909–1.079).
Conclusions
RA was associated, unexpectedly, with lower short-term mortality in septic patients. However, this “protective” association was driven by those patients without ICU admission. Further studies are warranted to confirm these findings and to examine the underlying mechanisms.

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Decreased in-hospital mortality in shock patients with rheumatoid arthritis compared to those without: a retrospective analysis of a critical care database
Jin Wan, Xiaoyu Cao, Yaran Yang
Clinical Rheumatology.2025; 44(2): 615. CrossRef
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Wonbong Lim
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Genetic associations between autoimmune diseases and the risks of severe sepsis and 28-day mortality: a two-sample Mendelian randomization study
Xin Tie, Yanjie Zhao, Jing Su, Xing Liu, Tongjuan Zou, Wanhong Yin
Frontiers in Medicine.2024;[Epub] CrossRef
Evolving Paradigms in Sepsis Management: A Narrative Review
Min-Ji Kim, Eun-Joo Choi, Eun-Jung Choi
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Infection
Validation of presepsin measurement for mortality prediction of sepsis: a preliminary study: Seung Min Baik, Jin Park, Tae Yoon Kim, Se Hong Choi, Kyung Sook Hong; Acute Crit Care. 2022;37(4):527-532. Published online August 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00150

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Background
Sepsis and septic shock remain the leading causes of death in critically ill patients worldwide. Various biomarkers are available to determine the prognosis and therapeutic effects of sepsis. In this study, we investigated the effectiveness of presepsin as a sepsis biomarker.
Methods
Patients admitted to the intensive care unit with major or minor diagnosis of sepsis were categorized into survival and non-survival groups. The white blood cell count and serum C-reactive protein, procalcitonin, and presepsin levels were measured in all patients.
Results
The study included 40 patients (survival group, 32; non-survival group, 8; mortality rate, 20%). The maximum serum presepsin levels measured during intensive care unit admission were significantly higher in the non-survival group (median [interquartile range]: 4,205.5 pg/ml [1,155.8–10,094.0] vs. 741.5 pg/ml [520.0–1,317.5], P<0.05). No statistically significant intergroup differences were observed in the maximum, minimum, and mean values of the white blood cell count, as well as serum C-reactive protein, and procalcitonin levels. Based on the receiver operating characteristic curve, the area under the curve for presepsin as a predictor of sepsis mortality was 0.764. At a cut-off value of 1,898.5 pg/ml, the sensitivity and specificity of presepsin for prediction of sepsis-induced mortality were 75.0% and 87.5%, respectively.
Conclusions
Early diagnosis of sepsis and prediction of sepsis-induced mortality are important for prompt initiation of treatment. Presepsin may serve as an effective biomarker for prediction of sepsis-induced mortality and for evaluation of treatment effectiveness.

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Georgios Tavoulareas, Olga Kontakou-Zoniou, Nikolaos Antonakos, Elisavet Tasouli, George Adamis, Nikolaos Kakavoulis, Evangelos Michelakis, Ilias Skopelitis, Konstantina Dakou, Christos Psarrakis, Panagiotis Koufargyris, Myrto Astriti, Styliani Sympardi,
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Impact of nutrition‐related laboratory tests on mortality of patients who are critically ill using artificial intelligence: A focus on trace elements, vitamins, and cholesterol
Dong Jin Park, Seung Min Baik, Hanyoung Lee, Hoonsung Park, Jae‐Myeong Lee
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Tae Jung Kim, Jae-Myoung Kim, Ji Sung Lee, Soo-Hyun Park, Jihyun Cha, Hyeon-Min Bae, Sang-Bae Ko
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Mert Canbaz, Günseli Orhun, Özlem Polat, İlkay Anaklı, Abdurrahman Fatih Aydın, Serhat Kılınç, Perihan Ergin Özcan, Figen Esen
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Prognostic value of laboratory markers and clinical scores for mortality in intensive care unit patients with sepsis
So-yun Kim, Dukki Kim, Hyekyeong Ju, Song I. Lee, Ying Amanda Wang
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Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee
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Hany A. Shehab, Ahmed M Eid, Yehya Shahin Dabour
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Infection
Incidence and risk factors associated with early death in patients with emergency department septic shock: Matthew S. Reaven, Nigel L. Rozario, Maggie S. J. McCarter, Alan C. Heffner; Acute Crit Care. 2022;37(2):193-201. Published online February 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00857

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Background
Limited research has explored early mortality among patients presenting with septic shock. The objective of this study was to determine the incidence and factors associated with early death following emergency department (ED) presentation of septic shock.
Methods
A prospective registry of patients enrolled in an ED septic shock clinical pathway was used to identify patients. Patients were compared across demographic, comorbid, clinical, and treatment variables by death within 72 hours of ED presentation.
Results
Among the sample of 2,414 patients, overall hospital mortality was 20.6%. Among patients who died in the hospital, mean and median time from ED presentation to death were 4.96 days and 2.28 days, respectively. Death at 24, 48, and 72 hours occurred in 5.5%, 9.5%, and 11.5% of patients, respectively. Multivariate regression analysis demonstrated that the following factors were independently associated with early mortality: age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03–1.05), malignancy (OR, 1.53; 95% CI, 1.11–2.11), pneumonia (OR, 1.39; 95% CI, 1.02–1.88), urinary tract infection (OR, 0.63; 95% CI, 0.44–0.89), first shock index (OR, 1.85; 95% CI, 1.27–2.70), early vasopressor use (OR, 2.16; 95% CI, 1.60–2.92), initial international normalized ratio (OR, 1.14; 95% CI, 1.07–1.27), initial albumin (OR, 0.55; 95% CI, 0.44–0.69), and first serum lactate (OR, 1.21; 95% CI, 1.16–1.26).
Conclusions
Adult septic shock patients experience a high rate of early mortality within 72 hours of ED arrival. Recognizable clinical factors may aid the identification of patients at risk of early death.

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Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han
Acute and Critical Care.2025; 40(2): 221. CrossRef
Evaluation of the Diagnosis and Antibiotic Therapy of Sepsis in the Emergency Department: A Retrospective Observational Study
Eszter Varga, Sándor Somodi, Máté Molnár, Dóra Ujvárosy, Krisztina Gaál, Attila Vaskó, Zoltán Szabó, Ildikó Bácskay, István Lekli, Adina Fésüs
Biomedicines.2025; 13(7): 1566. CrossRef
Phenotype-specific dynamics of serum albumin and their impact on sepsis mortality
Gianni Turcato, Arian Zaboli, Lucia Filippi, Paolo Ferretto, Daniela Milazzo, Michael Maggi, Alessandro Cipriano, Massimo Marchetti, Lorenzo Ghiadoni, Christian J. Wiedermann
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Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study
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Journal of Korean Medical Science.2024;[Epub] CrossRef
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Ugo Giulio Sisto, Stefano Di Bella, Elisa Porta, Giorgia Franzoi, Franco Cominotto, Elena Guzzardi, Nicola Artusi, Caterina Anna Giudice, Eugenia Dal Bo, Nicholas Collot, Francesca Sirianni, Savino Russo, Gianfranco Sanson
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Chiwon Ahn, Gina Yu, Tae Gun Shin, Youngsuk Cho, Sunghoon Park, Gee Young Suh
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Qiong Ding, Yingjie Su, Changluo Li, Ning Ding
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Infection
Serum lactate levels in cirrhosis and non-cirrhosis patients with septic shock: Surat Tongyoo, Kamonlawat Sutthipool, Tanuwong Viarasilpa, Chairat Permpikul; Acute Crit Care. 2022;37(1):108-117. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00332

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Background
In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients.
Methods
This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality.
Results
Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and <10%, respectively, among non-cirrhosis patients. Among patients with cirrhosis, the cut-off values predicting in-hospital mortality were >5 mmol/L, >5 mmol/L, and <20%, respectively. Neither lactate level nor lactate clearance was an independent risk factor for in-hospital mortality among cirrhotic and non-cirrhotic septic shock patients.
Conclusions
The initial lactate level and lactate at 6 hours were significantly higher in cirrhosis patients than in non-cirrhosis patients.

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Thomas N. Smith, Chansong Choi, Puru Rattan, Laura Piccolo Serafim, Blake A. Kassmeyer, Ryan J. Lennon, Ognjen Gajic, Jody C. Olson, Patrick S. Kamath, Alice Gallo De Moraes, Douglas A. Simonetto
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Infection
Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis: Balaram Krishna J Hanumanthu, Anika Sasidharan Nair, Adarsh Katamreddy, Jason S Gilbert, Jee Young You, Obiageli Lynda Offor, Ankit Kushwaha, Ankita Krishnan, Marzio Napolitano, Leonidas Palaidimos, Joaquin Morante, Seema S. Tekwani, Suchita Mehta, Aanchal Gupta, Harmeen Goraya, Mengyang Sun, Robert T. Faillace, Perminder Gulani; Acute Crit Care. 2021;36(3):215-222. Published online July 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00234

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Background
Patients with sepsis are at risk for developing sepsis-induced cardiomyopathy (SIC). Previous studies offer inconsistent results regarding the association of SIC and mortality. This study sought to assess whether SIC is linked to mortality in patients with sepsis and to evaluate predictors of the development of SIC.
Methods
In this retrospective study, patients admitted to the medical intensive care unit with a diagnosis of sepsis in the absence of acute coronary syndrome were included. SIC was identified using transthoracic echo and was defined by a new onset decline in left ventricular ejection fraction (LVEF) ≤50%, or ≥10% decline in LVEF compared to baseline in patients with a history of heart failure with reduced ejection fraction. Multivariable logistic regression analysis was performed using the R software program.
Results
Of the 359 patients in the final analysis, 19 (5.3%) had SIC. Eight (42.1%) of the 19 patients in the SIC group and 60 (17.6%) of the 340 patients in the non-SIC group died during hospitalization. SIC was associated with an increased risk for all-cause in-hospital mortality (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.15–18.69; P=0.03). Independent predictors for the development of SIC were albumin level (OR, 0.47; 95% CI, 0.23–0.93; P=0.03) and culture positivity (OR, 8.47; 95% CI, 2.24–55.61; P=0.006). Concomitant right ventricular hypokinesis was noted in 13 (68.4%) of the 19 SIC patients.
Conclusions
SIC was associated with an increased risk for all-cause in-hospital mortality. Low albumin level and culture positivity were independent predictors of SIC.

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SSRN Electronic Journal .2022;[Epub] CrossRef

Review Articles

Meta-analysis
The efficacy of vitamin C, thiamine, and corticosteroid therapy in adult sepsis patients: a systematic review and meta-analysis: Manoj Kumar Reddy Somagutta, Maria Kezia Lourdes Pormento, Muhammad Adnan Khan, Alaa Hamdan, Namrata Hange, Manish KC, Sukrut Pagad, Molly Sanjay Jain, Sivasthikka Lingarajah, Vishal Sharma, Jaspreet Kaur, Bernard Emuze, Erkan Batti, Obumneme Jude Iloeje; Acute Crit Care. 2021;36(3):185-200. Published online June 30, 2021; DOI: https://doi.org/10.4266/acc.2021.00108

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Abstract PDF Supplementary Material

Previous studies have suggested favorable outcomes of hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT) therapy in patients with sepsis. However, similar results have not been duplicated in sequential studies. This meta-analysis aimed to reevaluate the value of HAT treatment in patients with sepsis. Electronic databases were searched up until October 2020 for any studies that compared the effect of HAT versus non-HAT use in patients with sepsis. Data from 15 studies (eight randomized controlled trials [RCTs] and seven cohort studies) involving 67,349 patients were included. The results from the RCTs show no significant benefit of triple therapy on hospital mortality (risk ratio [RR], 0.99; P=0.92; I²=0%); intensive care unit (ICU) mortality (RR, 0.77; P=0.20; I²=58%); ICU length of stay (weighted mean difference [WMD], 0.11; P=0.86; I² =37%) or hospital length of stay (WMD: 0.57; P=0.49; I²=17%), and renal replacement therapy (RR, 0.64; P=0.44; I²=39%). The delta Sequential Organ Failure Assessment (SOFA) score favored treatment after a sensitivity analysis (WMD, –0.72; P=0.01; I²=32%). However, a significant effect was noted for the duration of vasopressor use (WMD, –25.49; P<0.001; I²=46%). The results from cohort studies have also shown no significant benefit of HAT therapy on hospital mortality, ICU mortality, ICU length of stay, length of hospital stay, the delta SOFA score, the use of renal replacement therapy, or vasopressor duration. HAT therapy significantly reduced the duration of vasopressor use and improved the SOFA score but appeared not to have significant benefits in other outcomes for patients with sepsis. Further RCTs can help understand its benefit exclusively.

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The Interplay Between Nutrition and Microbiota and the Role of Probiotics and Symbiotics in Pediatric Infectious Diseases
María Slöcker-Barrio, Jesús López-Herce Cid, María José Solana-García
Nutrients.2025; 17(7): 1222. CrossRef
MiR-143-5p serves as a diagnostic biomarker in patients with sepsis and regulates sepsis-induced inflammation and cardiac dysfunction
Yaqi Wu, Le Gu, Xu Huang
Hereditas.2025;[Epub] CrossRef
Effect of intravenous vitamin C on adult septic patients: a systematic review and meta-analysis
Huoyan Liang, Qingqing Mu, Wenju Sun, Liming Liu, Simin Qiu, Zili Xu, Yuqing Cui, Yan Yan, Tongwen Sun
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Insights Into Thiamine Supplementation in Patients With Septic Shock
Nara Aline Costa, Amanda Gomes Pereira, Clara Sandra Araujo Sugizaki, Nayane Maria Vieira, Leonardo Rufino Garcia, Sérgio Alberto Rupp de Paiva, Leonardo Antonio Mamede Zornoff, Paula Schmidt Azevedo, Bertha Furlan Polegato, Marcos Ferreira Minicucci
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Deven Juneja, Ravi Jain
Indian Journal of Critical Care Medicine.2022; 26(2): 224. CrossRef
Is it time to reconsider the administration of thiamine alone or in combination with vitamin C in critically ill patients? A meta-analysis of clinical trial studies
Nafiseh Shokri-mashhadi, Ali Aliyari, Zahra Hajhashemy, Saeed Saadat, Mohammad Hossein Rouhani
Journal of Intensive Care.2022;[Epub] CrossRef
Parenteral Vitamin C in Patients with Severe Infection: A Systematic Review
Arnav Agarwal, John Basmaji, Shannon M. Fernando, Fang Zhou Ge, Yingqi Xiao, Haseeb Faisal, Kimia Honarmand, Mathieu Hylands, Vincent Lau, Kimberley Lewis, Rachel Couban, François Lamontagne, Neill K. J. Adhikari
NEJM Evidence.2022;[Epub] CrossRef
Unanswered questions on the use of hydrocortisone, ascorbic acid, and thiamine therapy in sepsis and septic shock
David Ragoonanan, Nicolas Tran, Veeshal Modi, Paige Morgan Nickelsen
American Journal of Health-System Pharmacy.2022; 79(19): 1626. CrossRef
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Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
Infection and Drug Resistance.2022; Volume 15: 5387. CrossRef
The impact of vitamin C-containing treatment on the mortality of patients with sepsis: A systematic review and meta-analysis of randomized controlled trials
Ching-Yi Chen, Chien-Tung Chiu, Ho-Sheng Lee, Chih-Cheng Lai
Journal of Infection and Public Health.2022; 15(12): 1514. CrossRef
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Deven Juneja, Anish Gupta, Sahil Kataria, Omender Singh
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Current role of high dose vitamin C in sepsis management: A concise review
Deven Juneja, Prashant Nasa, Ravi Jain
World Journal of Critical Care Medicine.2022; 11(6): 349. CrossRef
HYDROCORTISONE, ASCORBIC ACID, AND THIAMINE THERAPY DECREASE RENAL OXIDATIVE STRESS AND ACUTE KIDNEY INJURY IN MURINE SEPSIS
John Kim, Allan Stolarski, Qiuyang Zhang, Katherine Wee, Daniel Remick
Shock.2022; 58(5): 426. CrossRef
Early administration of Vitamin C in patients with sepsis or septic shock in emergency departments: A multicenter, double blinded, randomized controlled trial: The C-EASIE trial protocol
Stefanie Vandervelden, Lina Wauters, Jan Breuls, Steffen Fieuws, Philippe Vanhove, Ives Hubloue, Magali Bartiaux, Jacques Creteur, François Stifkens, Koen Monsieurs, Didier Desruelles, Elisa Panada
PLOS ONE.2021; 16(11): e0259699. CrossRef
Hydrocortisone, ascorbic acid, and thiamine (HAT) for sepsis and septic shock: a meta-analysis with sequential trial analysis
Weilan Na, Huili Shen, Yichu Li, Dong Qu
Journal of Intensive Care.2021;[Epub] CrossRef

Infection
Up-to-date information on polymyxin B-immobilized fiber column direct hemoperfusion for septic shock: Chieko Mitaka, Makio Kusaoi, Izumi Kawagoe, Daizoh Satoh; Acute Crit Care. 2021;36(2):85-91. Published online April 4, 2021; DOI: https://doi.org/10.4266/acc.2021.00150

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Abstract PDF

Endotoxin adsorption therapy by polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) has been used for the treatment of septic shock patients. Endotoxin, an outer membrane component of Gram-negative bacteria, plays an important role in the pathogenesis of septic shock. Endotoxin triggers a signaling cascade for leukocytes, macrophage, and endothelial cells to secrete various mediators including cytokines and nitric oxide, leading to septic shock and multiple organ dysfunction syndrome. PMX-DHP directly adsorbed not only endotoxin but also monocytes and anandamide. It reduced blood levels of inflammatory cytokines such as interleukin (IL)-1, IL-6, tumor necrosis factor-alpha and IL-17A, adhesion molecules, plasminogen activator inhibitor 1, and high mobility group box-1. As a result, PMX-DHP increased blood pressure and reduced the dose of vasoactive-inotropic agents. PMX-DHP improved monocyte human leukocyte antigen-DR expression in patients with severe sepsis and septic shock. A post hoc analysis of EUPHRATES (Evaluating the Use of Polymyxin B Hemoperfusion in Randomized Controlled Trial of Adults Treated for Endotoxemia and Septic Shock) trial has shown that PMX-DHP significantly reduced 28-day mortality compared with the control group in septic shock patients with endotoxin activity assay level between 0.60 and 0.89. Longer duration of PMX-DHP may be another strategy to bring out the beneficial effects of PMX-DHP. Further studies are needed to confirm the efficacy of PMX-DHP treatment for septic shock.

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TLR2 and NLRP3 Orchestrate Regulatory Roles in Escherichia coli Infection-Induced Septicemia in Mouse Models
Zhiguo Gong, Wei Mao, Jiamin Zhao, Peipei Ren, Zhuoya Yu, Yunjie Bai, Chao Wang, Yuze Liu, Shuang Feng, Surong Hasi
Journal of Innate Immunity.2024; 16(1): 513. CrossRef
Methods of Extracorporeal Hemocorrection in Sepsis (Review)
V. A. Kovzel, L. A. Davydova, A. V. Karzin, S. V. Tsarenko, V. Yu. Baturova, A. A. Polupan, A. I. Gutnikov
General Reanimatology.2023; 19(2): 68. CrossRef
Modifications of peripheral perfusion in patients with vasopressor-dependent septic shock treated with polymyxin B-direct hemoperfusion
Motohiro Sekino, Yu Murakami, Shuntaro Sato, Ryosuke Shintani, Shohei Kaneko, Naoya Iwasaki, Hiroshi Araki, Taiga Ichinomiya, Ushio Higashijima, Tetsuya Hara
Scientific Reports.2023;[Epub] CrossRef
Rhabdomyolysis secondary to hypervirulent Klebsiella pneumoniae infection: A case report
Naoko Niimi, Keiko Taga, Taiju Miyagami, Toshio Naito, Chieko Mitaka
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Endotoxin Activity in Patients With Extracorporeal Membrane Oxygenation Life Support: An Observational Pilot Study
Chen-Tse Lee, Chih-Hsien Wang, Wing-Sum Chan, Yun-Yi Tsai, Tzu-Jung Wei, Chien-Heng Lai, Ming-Jiuh Wang, Yih-Sharng Chen, Yu-Chang Yeh
Frontiers in Medicine.2021;[Epub] CrossRef

Case Report

Gastroenterology
Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock: Saad Saffo, James Farrell, Anil Nagar; Acute Crit Care. 2021;36(3):264-268. Published online March 11, 2021; DOI: https://doi.org/10.4266/acc.2020.01067

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Abstract PDF

Esophageal perforations occur traumatically or spontaneously and are typically associated with high mortality rates. Early recognition and prompt management are essential. We present the case of a 76-year-old man who was admitted to the medical intensive care unit with fulminant Clostridium difficile colitis, shock, and multi-organ failure. After an initial period of improvement, his condition rapidly deteriorated despite aggressive medical management, and he required mechanical ventilation. Radiography after endotracheal intubation showed interval development of pneumomediastinum and bilateral hydropneumothorax with tension physiology. Chest tube placement resulted in the drainage of multiple liters of dark fluid, and pleural fluid analysis was notable for polymicrobial empyemas. Despite the unusual presentation, esophageal perforation was suspected. Endoscopy ultimately confirmed circumferential separation of the distal esophagus from the stomach, and bedside endoscopic stenting was performed with transient improvement. Two weeks after admission, he developed mediastinitis complicated by recurrent respiratory failure and passed away. This report further characterizes our patient’s unique presentation and briefly highlights the clinical manifestations, management options, and outcomes of esophageal perforations.

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Ippei Yamana, Takahisa Fujikawa, Yuichiro Kawamura, Suguru Hasegawa
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Original Articles

Epidemiology
Characteristics, management and clinical outcomes of patients with sepsis: a multicenter cohort study in Korea: Kyeongman Jeon, Soo Jin Na, Dong Kyu Oh, Sunghoon Park, Eun Young Choi, Seok Chan Kim, Gil Myeong Seong, Jeongwon Heo, Youjin Chang, Won Gun Kwack, Byung Ju Kang, Won-Il Choi, Kyung Chan Kim, So Young Park, Sang Hyun Kwak, Yoon Mi Shin, Heung Bum Lee, So Hee Park, Jae Hwa Cho, Beongki Kim, Chae‐Man Lim; Acute Crit Care. 2019;34(3):179-191. Published online July 1, 2019; DOI: https://doi.org/10.4266/acc.2019.00514

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Abstract PDF

Background
Mortality rates associated with sepsis have increased progressively in Korea, but domestic epidemiologic data remain limited. The objective of this study was to investigate the characteristics, management and clinical outcomes of sepsis patients in Korea.
Methods
This study is a multicenter retrospective cohort study. A total of 64,021 adult patients who visited an emergency department (ED) within one of the 19 participating hospitals during a 1-month period were screened for eligibility. Among these, patients diagnosed with sepsis based on the third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were included in the study.
Results
Using the Sepsis-3 criteria, 977 sepsis patients were identified, among which 36.5% presented with septic shock. The respiratory system (61.8%) was the most common site of infection. The pathogen involved was identified in 444 patients (45.5%) and multi-drug resistance (MDR) pathogens were isolated in 171 patients. Empiric antibiotic therapy was appropriate in 68.6% of patients, but the appropriateness was significantly reduced in infections associated with MDR pathogens as compared with non-MDR pathogens (58.8% vs. 76.0%, P<0.001). Hospital mortality was 43.2% and 18.5% in sepsis patients with and without shock, respectively. Of the 703 patients who survived to discharge, 61.5% were discharged to home and 38.6% were transferred to other hospitals or facilities.
Conclusions
This study found the prevalence of sepsis in adult patients visiting an ED in Korea was 1.5% (15.2/1,000 patients). Patients with sepsis, especially septic shock, had a high mortality and were often referred to step-down centers after acute and critical care.

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Acute and Critical Care.2025; 40(2): 209. CrossRef
Evaluating the diagnostic performance of adult sepsis event criteria in the emergency department: impact of including isolated serum lactate elevations
Hyojun Park, Ryoung-Eun Ko, Hyo-Seok Oh, Jae Young Moon, Youjin Chang, Gee Young Suh
Journal of Intensive Care.2025;[Epub] CrossRef
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The Korean Journal of Internal Medicine.2025; 40(6): 990. CrossRef
The 6-hour window: is the sepsis transfer guideline enough?
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Open Forum Infectious Diseases.2025;[Epub] CrossRef
Early Versus Delayed Norepinephrine Initiation in Septic Shock: A Systematic Review and Meta-Analysis of Randomized and Observational Studies
Chibuzo C Manafa, Oluwayemisi E Ekor, Akintunde C Akinboboye, Okelue E Okobi, Gift Ojukwu, Osemwegie O Ugbo, Michael U Mochu, Emasenyie Isikwei, Sergio Hernandez Borges, Miguel Diaz-Miret
Cureus.2025;[Epub] CrossRef
Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study
Sang Won Park, Na Young Yeo, Seonguk Kang, Taejun Ha, Tae-Hoon Kim, DooHee Lee, Dowon Kim, Seheon Choi, Minkyu Kim, DongHoon Lee, DoHyeon Kim, Woo Jin Kim, Seung-Joon Lee, Yeon-Jeong Heo, Da Hye Moon, Seon-Sook Han, Yoon Kim, Hyun-Soo Choi, Dong Kyu Oh, S
Journal of Korean Medical Science.2024;[Epub] CrossRef
Deficits in blood culture collection in the emergency department if sepsis is suspected: results of a retrospective cohort study
Charlotte Berninghausen, Frank Schwab, Alexander Gropmann, Bernd A. Leidel, Rajan Somasundaram, Lydia Hottenbacher, Petra Gastmeier, Sonja Hansen
Infection.2024; 52(4): 1385. CrossRef
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Joong-Yub Kim, Hong Yeul Lee, Jinwoo Lee, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
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Young Seok Lee, Seungbong Han, Ye Eun Lee, Jaehwa Cho, Young Kyun Choi, Sun-Young Yoon, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Chae-Man Lim, Jae Young Moon, Sang‑Bum Hong, Suk‑Kyung Hong, Gee Young Suh, Kyeongman Jeon, Ryoung‑Eun Ko, Young‑Jae Cho, Yeon
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ChatGPT Predicts In-Hospital All-Cause Mortality for Sepsis: In-Context Learning with the Korean Sepsis Alliance Database
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Healthcare Informatics Research.2024; 30(3): 266. CrossRef
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Jiwon Lee, Hee-Ju Kim
Clinical Nursing Research.2024; 33(8): 610. CrossRef
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Critical Care.2024;[Epub] CrossRef
Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia
Priyo Sasmito, Satriya Pranata, Rian Adi Pamungkas, Etika Emaliyawati, Nisa Arifani
Acute and Critical Care.2024; 39(4): 545. CrossRef
Early management of adult sepsis and septic shock: Korean clinical practice guidelines
Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, A
Acute and Critical Care.2024; 39(4): 445. CrossRef
Platelet indices in critically ill septic patients as a predictor of mortality
Rehab Salah Taha, Mohamed Elsayed Afandy, Abdelaziz Hamid Elbadawi, Mohamed Samir Abd El Ghafar
Egyptian Journal of Anaesthesia.2023; 39(1): 56. CrossRef
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Hyung-Jun Kim, Dong Kyu Oh, Sung Yoon Lim, Young-Jae Cho, Sunghoon Park, Gee Young Suh, Chae-Man Lim, Yeon Joo Lee
Journal of Korean Medical Science.2023;[Epub] CrossRef
HYPOTENSION AT THE TIME OF SEPSIS RECOGNITION IS NOT ASSOCIATED WITH INCREASED MORTALITY IN SEPSIS PATIENTS WITH NORMAL LACTATE LEVELS
Ji Hwan Kim, Yong Kyun Kim, Dong Kyu Oh, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Sung Yun Lim, Yeon Joo Lee, Young-Jae Cho, Mi-Hyeon Park, Sang-Bum Hong, Chae-Man Lim, Sunghoon Park
Shock.2023; 59(3): 360. CrossRef
Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
Clinical and Experimental Emergency Medicine.2023; 10(2): 157. CrossRef
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Se Hun Kim, Ki Hoon Kim
Surgery.2023; 174(3): 611. CrossRef
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BMC Infectious Diseases.2023;[Epub] CrossRef
Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
Clinical Characteristics and Outcomes of Neutropenic Sepsis: A Multicenter Cohort Study
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Shock.2022; 57(5): 659. CrossRef
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Dong-gon Hyun, Su Yeon Lee, Jee Hwan Ahn, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Sunghoon Park, Jeongwon Heo, Jae-myeong Lee, Kyung Cha
Critical Care.2022;[Epub] CrossRef
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Epidemiology and Vaccinal Prevention.2021; 20(3): 107. CrossRef
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Tuberculosis and Respiratory Diseases.2021; 84(4): 317. CrossRef
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Jong Hwan Jeong, Manbong Heo, Seung Jun Lee, Yi Yeong Jeong, Jong Deog Lee, Jung-Wan Yoo
Diagnostics.2021; 11(12): 2344. CrossRef
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Critical Care Explorations.2021; 3(8): e0448. CrossRef
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Mi-Hee Kim, Jung-Hyun Choi
Infection & Chemotherapy.2020; 52(1): 1. CrossRef
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Critical Care Medicine.2020; 48(10): 1462. CrossRef
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Infection
Relationship between low hemoglobin levels and mortality in patients with septic shock: Sung Min Jung, Youn-Jung Kim, Seung Mok Ryoo, Won Young Kim; Acute Crit Care. 2019;34(2):141-147. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00465

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Abstract PDF Supplementary Material

Background
Hemoglobin levels are a critical parameter for oxygen delivery in patients with shock. On comparing target hemoglobin levels upon transfusion initiation, the correlation between the severity of decrease in hemoglobin levels and patient outcomes remains unclear. We evaluated the association between initial hemoglobin levels and mortality in patients with septic shock treated with protocol-driven resuscitation bundle therapy at an emergency department.
Methods
Data of adult patients diagnosed with septic shock between June 2012 and December 2016 were extracted from a prospectively compiled septic shock registry at a single academic medical center. Patients were classified into four groups according to initial hemoglobin levels: ≥9.0 g/dl, 8.0−8.9 g/dl, 7.0−7.9 g/dl, and <7.0 g/dl. The primary endpoint was 90-day mortality.
Results
In total, 2,265 patients (male, 58.3%; median age, 70.0 years [interquartile range, 60 to 78 years]) with septic shock were included. For the four groups, 90-day mortality rates were as follows: 29.1%, 43.0%, 46.5%, and 46.9% for ≥9.0 g/dl (n=1,808), 8.0−8.9 g/dl (n=217), 7.0−7.9 g/dl (n=135), and <7.0 g/dl (n=105), respectively (P<0.001). Multivariate logistic regression showed that initial hemoglobin levels were an independent factor associated with 90-day mortality and mortality proportionally increased with decreasing hemoglobin levels (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.36 to 2.61 for 8.0−8.9 g/dl; OR, 1.97; 95% CI, 1.31 to 2.95 for 7.0–7.9 g/dl; and OR, 2.35; 95% CI, 1.52 to 3.63 for <7.0 g/dl).
Conclusions
Low hemoglobin levels (<9.0 g/dl) were observed in approximately 20% of patients with septic shock, and the severity of decrease in these levels correlated with mortality.

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Infection
Application of Sepsis-3 Criteria to Korean Patients with Critical Illnesses: Jae Yeol Kim, Hwan Il Kim, Gee Young Suh, Sang Won Yoon, Tae-Yop Kim, Sang Haak Lee, Jae Young Moon, Jae-Young Kwon, Sungwon Na, Ho Geol Ryu, Jisook Park, Younsuck Koh; Acute Crit Care. 2019;34(1):30-37. Published online January 29, 2019; DOI: https://doi.org/10.4266/acc.2018.00318; Correction in: Acute Crit Care 2019;34(2):172

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Abstract PDF

Background
The 2016 Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM) task force for Sepsis-3 devised new definitions for sepsis, sepsis with organ dysfunction and septic shock. Although Sepsis-3 was data-driven, evidence-based approach, East Asian descents comprised minor portions of the project population. Methods: We selected Korean participants from the fever and antipyretics in critically ill patients evaluation (FACE) study, a joint study between Korea and Japan. We calculated the concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria and evaluated mortality rates of sepsis, sepsis with organ dysfunction, and septic shock by Sepsis-3 criteria using the selected data. Results: Korean participants of the FACE study were 913 (383 with sepsis and 530 without sepsis by Sepsis-2 criteria). The concordance rate for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria was 55.4%. The intensive care unit (ICU) and 28-day mortality rates of sepsis, sepsis with organ dysfunction, and septic shock patients according to Sepsis-3 criteria were 26.2% and 31.0%, 27.5% and 32.5%, and 40.8% and 43.4%, respectively. The quick Sequential Organ Failure Assessment (qSOFA) was inferior not only to SOFA but also to systemic inflammatory response syndrome (SIRS) for predicting ICU and 28-day mortality. Conclusions: The concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria were low. Mortality rate for septic shock in Koreans was consistent with estimates made by the 2016 SCCM/ESICM task force. SOFA and SIRS were better than qSOFA for predicting ICU and 28-day mortality in Korean ICU patients.

Citations

Citations to this article as recorded by

Evaluating the diagnostic performance of adult sepsis event criteria in the emergency department: impact of including isolated serum lactate elevations
Hyojun Park, Ryoung-Eun Ko, Hyo-Seok Oh, Jae Young Moon, Youjin Chang, Gee Young Suh
Journal of Intensive Care.2025;[Epub] CrossRef
HYPOTENSION AT THE TIME OF SEPSIS RECOGNITION IS NOT ASSOCIATED WITH INCREASED MORTALITY IN SEPSIS PATIENTS WITH NORMAL LACTATE LEVELS
Ji Hwan Kim, Yong Kyun Kim, Dong Kyu Oh, Kyeongman Jeon, Ryoung-Eun Ko, Gee Young Suh, Sung Yun Lim, Yeon Joo Lee, Young-Jae Cho, Mi-Hyeon Park, Sang-Bum Hong, Chae-Man Lim, Sunghoon Park
Shock.2023; 59(3): 360. CrossRef
The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis
Mark E. Nunnally, Ricard Ferrer, Greg S. Martin, Ignacio Martin-Loeches, Flavia R. Machado, Daniel De Backer, Craig M. Coopersmith, Clifford S. Deutschman, Massimo Antonelli, Judith Hellman, Sameer Jog, Jozef Kesecioglu, Ishaq Lat, Mitchell M. Levy
Intensive Care Medicine Experimental.2021;[Epub] CrossRef

Case Reports

Genetic
Lethal Hyperammonemia due to Ornithine Transcarbamylase Deficiency in a Patient with Severe Septic Shock: Ji An Hwang, Joo Han Song, Young Seok Lee, Kyung Soo Chung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park; Korean J Crit Care Med. 2016;31(2):140-145. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.140

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Abstract PDF: Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 μg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support–albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.

Cardiology
Use of Polymyxin B Hemoperfusion in a Patient with Septic Shock and Septic Cardiomyopathy Who Was Placed on Extracorporeal Membrane Oxygen Support: Sun Hye Shin, Hyun Lee, Aeng Ja Choi, Kylie Hae Jin Chang, Gee Young Suh, Chi Ryang Chung; Korean J Crit Care Med. 2016;31(2):123-128. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.123

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Abstract PDF: Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.

Infection
Polymyxin B Immobilized Fiber Hemoperfusion in Refractory Intra-abdominal Septic Shock: Hae Wone Chang, Young-Jae Cho, Sang-Hyun Park, Moonsuk Kim; Korean J Crit Care Med. 2015;30(2):95-102. Published online May 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.95

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Abstract PDF: The effects of direct hemoperfusion with polymyxin B immobilized fiber (PMX) treatment for septic shock have been recently reported. However, little evidence of a true benefit on clinical outcomes, including mortality, is available. Herein, we report three cases of intra-abdominal infection associated with refractory septic shock Case 1 was Escherichia coli peritonitis after a colectomy. PMX treatment improved the hemodynamic parameters and lactic acid levels of the patient. In case 2, secondary peritonitis was associated with septic or cardiogenic shock. Septic cardiomyopathy was assumed to be the cause of shock. 24 hours after the use of PMX, cardiac contractility assessed by echocardiography returned to baseline. In case 3, a patient with Burkitt’s lymphoma and neutropenia was found to be gastroenteritis and Klebsiella pneumoniae bacteremia. Intravenous meropenem was administered for 3 days. Hemodynamic parameters improve after the twice use of PMXOverall, the change of serial sequential organ failure assessment score (SOFA) was more significant in surgical cases as compared to the medical case at 72 hours after PMX administration. All patients were discharged from the hospital. In addition to early resuscitation efforts and infection source control, PMX treatment may be beneficial to patients with refractory intra-abdominal infection associated with septic shock.

Original Article

Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock: Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim; Korean J Crit Care Med. 2013;28(4):272-279.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.272

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Abstract PDF: BACKGROUND
Clinical findings, medical history and laboratory findings in patients with acute pyelonephritis are insufficient to predict the occurrence of septic shock and to assess its severity and prognosis. Early imaging may not only aid in diagnosing acute pyelonephritis, but also help in assessing the risk factors associated with septic shock.
METHODS
In this retrospective study, we reviewed the medical records and collected the data of 200 patients from January to December, 2011. All patients were over 18 years old; showed symptoms of fever, chills, muscle pain and flank pain; demonstrated more than 10 white blood cells in urinalysis; and were diagnosed with acute pyelonephritis after computed tomography (CT) scan. Patients were classified into two groups: patients with septic shock (group 1) and patients without septic shock (group 2), and the clinical, laboratory and CT findings of the two groups were then compared.
RESULTS
Out of all 200 patients, there were 32 patients (16%) who had acute pyelonephritis with septic shock. The acute pyelonephritis with septic shock group (group 1) showed increased bacteremia compared with the other group (53.1% vs. 24.4%, p = 0.002). Laboratory findings showed that group 1 patients had higher serum creatinine (1.67 +/- 1.03 mg/dl vs. 1.14 +/- 0.98 mg/dl, p = 0.022) and hsCRP (8.36 +/- 5.29 mg/dl vs. 5.27 +/- 3.53 mg/dl, p = 0.000) than group 2 patients. The findings of kidney CT showed statistically significant differences in global renal enlargement (31.3% vs. 18.7%, p = 0.005), pelvicalyceal wall thickening (37.5% vs. 13.1%, p = 0.005) and poor excretion of contrast (25% vs. 2.4%, p = 0.000). The results of the logistic regression test showed that there were significant differences in bacteremia serum creatinine, C-reactive protein, pelvicalyceal wall thickening and poor excretion of contrast.
CONCLUSIONS
Computed tomography can predict the possibility of septic shock by identifying the range of renal lesions in patients with acute pyelonephritis. It can therefore allow initial aggressive treatment that can contribute to decreases in mortality and morbidity in patients with acute pyelonephritis.

Case Report

Endocarditis Caused by Community-Acquired Klebsiella pneumoniae Infection - A Case Report -: Ji Ae Hwang, Charles Her, Yang Wook Kim; Korean J Crit Care Med. 2013;28(1):41-45.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.41

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Abstract PDF

In community-acquired Klebsiella pneumoniae infection, pyogenic liver abscess is common as a primary site of infection, particularly in Asia, that can progress to bacteremia. Diabetes mellitus is a usual predisposing factor. Pneumonia as primary site of infection by community-acquired Klebsiella pneumoniae infection is not common but carries a poor outcome. Early administration of appropriate antibiotics is extremely important to avoid the development of bacteremia and septicemia. An infective endocarditis caused by community-acquired Klebsiella pneumoniae infection is very rare; particularly, such a case of endocarditis in which pneumonia was the primary site of infection has never been reported previously. In this report we described a case of community-acquired Klebsiella pneumoniae infection that started with pneumonia and progressed to bacteremia, leading to endocarditis, liver abscess, and other systemic septic complications. Delayed administration of appropriate antibiotics may have played a role in this case.

Citations

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Double trouble: an unusual case of Klebsiella pneumoniae invasive syndrome with liver abscess, gallbladder empyema and infective endocarditis
Ze Chen Lee, Chu Ee Seow, Petrick Periyasamy
BMC Infectious Diseases.2024;[Epub] CrossRef
Infective endocarditis due to Klebciella pneumonia
Masoume Mesgarian, Mehrangiz Zanganeh, Mino Shafiei, Hoda Kermsetji, Sahr Shador
Medical Sciences Journal of Islamic Azad University.2024; 34(4): 456. CrossRef
Infective endocarditis caused by Klebsiella pneumoniae in a patient with non ST elevation myocardial infarction
M.Yu. Zhilinskiy, N.V. Mukhina, I.S. Komarova, S.A. Rachina, N.A. Cherkasova, A.B. Borisov, L.V. Fedina, S.M. Nasrulloeva
Clinical Microbiology and Antimicrobial Chemotherapy.2023; 25(1): 100. CrossRef
Infective endocarditis byKlebsiellaspecies: a systematic review
Petros Ioannou, Eugenia Miliara, Stella Baliou, Diamantis P. Kofteridis
Journal of Chemotherapy.2021; 33(6): 365. CrossRef

Original Article

Favorable Outcomes in Septic Shock Patients without Hyperlactatemia or Severe Organ Failure: Sung Jong Roh, Tae Gun Shin, Kyeongman Jeon, Gee Young Suh, Min Seob Sim, So Yeon Lim, Mun Ju Kang, Keun Jeong Song, Yeon Kwon Jeong, Ik Joon Jo; Korean J Crit Care Med. 2012;27(4):224-229.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.224

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Abstract PDF

BACKGROUND
Septic shock is a pathophysiologic state of circulatory failure with tissue hypoperfusion. However, it is usually defined as sepsis-induced hypotension not responding to fluid resuscitation, regardless of the objective findings of tissue hypoperfusion such as lactic acidosis or organ failures. Numerous patients with sepsis-induced hypotension present to the emergency department without hyperlactemia or severe organ failure. Hence, we investigated the clinical characteristics and outcomes of patients with septic shock according to the presence of hyperlactatemia or significant organ failure.
METHODS
We conducted a retrospective observational study of adult patients presenting with septic shock in the emergency department of a tertiary care hospital between August 2008 and July 2010. Initial serum lactate was categorized low (<2.5 mmol/L) and high (> or =2.5 mmol/L). Organ failure was assessed by the Sequential Organ Failure Assessment (SOFA) score. Primary outcome measurement was in-hospital mortality.
RESULTS
A total of 227 patients were enrolled. There were 88 (38.8%) patients in the low lactate group, and 139 (61.2%) patients in the high lactate group. Patients with low lactate levels showed a lower mortality rate (6.8% compared with 25.1% of those with high lactate level). The low lactate group showed less rapid heart rate, less severe organ failures and shorter length of stay in the intensive care unit. During the early goal-directed therapy, they required a smaller amount of fluid administration and a lower dose of norepinephrine although other hemodynamic variables were similarly maintained. In particular, if patients showed less severe organ dysfunction (SOFA score < 8) in the low lactate group (n = 45), in-hospital mortality was 0% (adjusted mortality was 1.3% [95% confidence interval = 0.3-5.0]).
CONCLUSION
Patients with septic shock, who were enrolled according to the traditional definition, showed a very favorable outcome if they did not have hyperlactatemia or significant organ failure.

Citations

Citations to this article as recorded by

Evaluating the diagnostic performance of adult sepsis event criteria in the emergency department: impact of including isolated serum lactate elevations
Hyojun Park, Ryoung-Eun Ko, Hyo-Seok Oh, Jae Young Moon, Youjin Chang, Gee Young Suh
Journal of Intensive Care.2025;[Epub] CrossRef

Case Report

Skin Necrosis after High Dose Vasopressor Infusion in Septic Shock: Two Case Reports: Ah Reum Cho, Jeung Il Kim, Eun Jung Kim, Seung Min Son; Korean J Crit Care Med. 2012;27(3):182-186.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.182

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Abstract PDF

Survival sepsis campaign recommends that vasopressor therapy is required to maintain mean arterial pressure (MAP) > or = 65 mmHg. However, the absolute maximum dose of vasopressor is difficult to determine. Herein, we report 2 cases of severe skin necrosis after high dose vasopressor infusion to maintain the recommended MAP in septic shock. In our first case, norepinephrine 1.0-2.0 microg/kg/min and vasopressin 0.03-0.1 U/min were infused for 5 days; in the second case, dopamine 10-20 microg/kg/min and norepinephrine 0.25-2.5 microg/kg/min were infused for 7 days. Severe ischemic skin lesions, which required amputations, developed in both cases. The clinical appearance of the skin lesions in the 2 cases was different because of the unique distribution of target receptors for different vasopressors. Thus, when high dose vasopressors are required to achieve recommended MAP, extra vigilance is required. Further studies for dose adjustment are needed.

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Original Articles

Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate: Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2011;26(2):78-82.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.78

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Abstract PDF: BACKGROUND
Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis and septic shock. However, there are only a few studies on the association of serum lactate levels and prognosis in septic shock patients with initial low lactate levels.
METHODS
To evaluate whether initial and follow-up lactate levels associated with mortality in septic shock patients with low lactate level, we conducted a retrospective observational study of patients with septic shock, who were hospitalized through the emergency department in February-July 2008. Initial lactate level was stratified as low (<4 mmol/L) or high (> or =4 mmol/L). The primary outcome was 28-day mortality and multiple logistic regression analysis was used to adjust for potential confounders in the association between lactate clearance and mortality.
RESULTS
Of 90 patients hospitalized with septic shock during the study period, 68 (76%) patients had low initial lactate. Mortality at 28 days was 18% in patients with low lactate level. In these patients, initial lactate level was not associated with mortality (p = 0.590). However, increased lactate at follow-up and lactate clearance were associated with mortality (p = 0.006, p = 0.002, respectively). In a multiple logistic regression analysis, increased mortality rate independently associated with age (OR 1.162, 95% CI 1.041-1.298) and lactate clearance (OR 0.654, 95% CI 0.498-0.859).
CONCLUSIONS
In septic shock patients with a low lactate level, lactate clearance independently associated with a decreased mortality rate. Therefore, lactate clearance could be useful for predicting the outcome in these patients.

Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock: Jin Kyeong Park, Sang Bum Hong, Chae Man Lim, Younsuck Koh, Jin Won Huh; Korean J Crit Care Med. 2011;26(1):13-17.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.13

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Abstract PDF: BACKGROUND
A dramatic decrease in circulating lymphocyte number is observed after septic shock. In this study, we assessed whether circulating lymphocyte subpopulations influence the severity and prognosis of septic shock.
METHODS
133 patients (median 65 years, range 27-88; male 63.2%) receiving intensive care for septic shock were enrolled in this study. Flow cytometry phenotyping of circulating lymphocyte subpopulations, including helper T cells, suppressor T cells, total B cells, and natural killer (NK) cells, was performed within 24 hours after the diagnosis of septic shock. After measuring the white blood cell (WBC) and differential leukocyte count, the lymphocyte subsets were analyzed. The following data were recorded: general characteristics, severity of illness as assessed by the Sequential Organ Failure Assessment (SOFA) score, and 28-day mortality.
RESULTS
The overall mortality rate at 28 days was 33.8%. SOFA score was negatively correlated with the T cell count (r = -0.175) and helper T cell count (r = -0.223). However, only low a helper T cell count was associated with the severity of septic shock (odds ratio 0.995, 95% confidence interval 0.992-0.999, p = 0.014). Using multiple logistic regression analysis for 28-day mortality, there was no significant prognostic factor among the lymphocyte subset.
CONCLUSIONS
The low helper T cell count appeared to be associated with severity, but did not show significant association with mortality.

Review Article

Current Insights into Sepsis Treatments: Chang Youl Lee; Korean J Crit Care Med. 2010;25(4):207-211.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.207

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Abstract PDF

Sepsis is a common illness of intensive care unit patients that carries high morbidity and mortality, and increases hospital costs. Although mortality from sepsis remains high when compared with other critical illnesses, it has declined over the last few decades due to several adjunctive therapies and focused care programs or guidelines. In 2004, an international guideline was published that the bedside clinician could use to improve the outcomes in severe cases of sepsis and septic shock. Several landmark studies recently demonstrated that therapeutic strategies may substantially reduce mortality. The Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock: 2008 was updated using a new evidence-based methodology system for assessing the quality of evidence and the strengths of recommendations. Evidence-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improving the outcomes of critically ill patients. This article discusses the guidelines and current insights into sepsis treatment.

Citations

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Prevalence of Toxin Genes and Antibiotic Resistance Profiles of Vibrio vulnificus strains isolated from Jeju Island
Eunok Kang, Man Jae Cho, Ye-Seul Heo, Eun A Koh
Journal of Food Hygiene and Safety.2023; 38(5): 381. CrossRef
Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock
Jin Kyeong Park, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh
The Korean Journal of Critical Care Medicine.2011; 26(1): 13. CrossRef

Randomized Controlled Trial

The Efficacy of Early Goal-directed Therapy in Septic Shock Patients in the Emergency Department: Severe Sepsis Campaign: Hyung Jin Shin, Kang Hyun Lee, Sung Oh Hwang, Hyun Kim, Tae Yong Shin, Sang Chul Kim; Korean J Crit Care Med. 2010;25(2):61-70.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.61

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Abstract PDF

BACKGROUND
Early goal-directed therapy (EGDT) has been used for patients with severe sepsis and septic shock in the emergency department (ED). In 2003, international management guidelines for severe sepsis and septic shock were developed under the auspices of the Surviving Sepsis Campaign (SSC); however, EGDT based on the SSC was not fully evaluated in the ED. The purpose of this study was to evaluate the efficacy of EGDT based on the SSC in the ED in Korea.
METHODS
We randomly assigned patients who arrived at our ED in septic shock to receive EGDT before admission to the intensive care unit between May 2007 and July 2007, and we retrospectively assigned patients in septic shock to receive standard therapy between May 2006 and July 2006. The in-hospital mortality for 24 hours and 28 days, the MODS, SAPS II, and APACHE II scores were obtained and compared between the study groups.
RESULTS
Of the 60 enrolled patients, 30 were assigned to EGDT and 30 were assigned to standard therapy. There was no significant difference between the groups with respect to the baseline characteristics. In-hospital mortality at 28 days was 13% in the group assigned to EGDT as compared to 40% in the group assigned to standard therapy (p = 0.020) and in-hospital mortality at 24 hours was 0% and 13%, respectively (p = 0.038).
CONCLUSIONS
EGDT provides significant benefits with respect to outcome in patients in septic shock.

Citations

Citations to this article as recorded by

Early goal-directed resuscitation for patients with severe sepsis and septic shock: a meta-analysis and trial sequential analysis
Li-bing Jiang, Mao Zhang, Shou-yin Jiang, Yue-feng MA
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2016;[Epub] CrossRef
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
The Korean Journal of Critical Care Medicine.2015; 30(4): 258. CrossRef
Implementing a Sepsis Resuscitation Bundle Improved Clinical Outcome: A Before-and-After Study
Jeongmin Kim, Sungwon Na, Young Chul Yoo, Shin Ok Koh
Korean Journal of Critical Care Medicine.2014; 29(4): 250. CrossRef
A Case of Purulent Pericarditis Complicated byKlebsiella pneumoniaeSepsis - A Case Report -
Byeong-Ho Jeong, Seungmin Chung, Hee Jin Kwon, Kyeongman Jeon
Korean Journal of Critical Care Medicine.2013; 28(1): 51. CrossRef

Original Article

The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock: Jung Hwan Ahn, Sang Cheon Choi, Young Gi Min, Yoon Seok Jung, Sung Hee Chung, Young Joo Lee; Korean J Crit Care Med. 2009;24(3):134-139.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.134

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Abstract PDF

BACKGROUND
The lactate concentration should be used to examine the severity of sepsis or any state of shock. This study was conducted to investigate the prognostic power of the lactate clearance, as adjusted for time, between the survivors and nonsurvivors of patients with severe sepsis or septic shock.
METHODS
The study was performed on 67 patients over 16 years old and who were admitted to the intensive care unit (ICU) with severe sepsis or septic shock. They were divided into the survivors (n = 37) and nonsurvivors (n = 30). The blood lactate concentrations were assayed at intervals ranging from 8 to 24 hours and the APACHE III scoring was done daily for 2 weeks or until discharge or death. The lactate clearance, as adjusted for time, was defined using the following formula: [(the maximal lactate concentration - the normal lactate concentration)/the time to normalize the lactate concentration] x 1,000.
RESULTS
There were no significant differences of age, gender and the length of the ICU stay between the survivors and non-survivors. There were significant difference of the time to measuring the maximal serum lactate concentration (3.2 +/- 12.3 hours vs. 28.8 +/- 64.6 hours, respectively; p = 0.037), the lactate clearance, as adjusted for time (132.27 +/- 112.88 mol/L . hour vs. 59.67 +/- 72.60 mol/L . hour, respectively; p = 0.002), the lactate clearance during 24 hours (46.0 +/- 26.3% vs. 22.6 +/- 45.6%, respectively; p = 0.018) and the APACHE III score (67.6 +/- 22.7 vs. 83.9 +/- 21.6, respectively; p = 0.005) between the survivors and non-survivors. The lactate clearance, as adjusted for time and the APACHE III score were the predictive factors for survival on the logistic regression analysis (odd ratio 0.987; p = 0.028 vs. odd ratio 1.046; p = 0.006).
CONCLUSIONS
Lactate clearance, as adjusted for time, could be used as a prognostic index, as well as the APACHE III score, for patients with severe sepsis or septic shock.

Citations

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Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate
Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon
The Korean Journal of Critical Care Medicine.2011; 26(2): 78. CrossRef

Case Report

Successful Application of Extracorporeal Membrane Oxygenation for 3 Patients in Medical Intensive Care Unit: Case Report: Hye Yun Park, Eun Hae Kang, Hyo Kyoung Choi, Gee Young Suh, O Jung Kwon, Kiick Sung, Young Tak Lee; Korean J Crit Care Med. 2007;22(2):91-95.

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Abstract PDF: Extracorporeal membrane oxygenation (ECMO) is a life-sustaining salvage therapy applied to the patient with acute heart failure or respiratory failure which is considered curable, but uncorrectable by conventional means. Recently, accumulating data has shown the survival benefit of ECMO in patients with acute fatal cardiopulmonary decompensation. Here, we report a series of cases of successful ECMO treatment in patients with acute cardiopulmonary insufficiency. Case 1: A patient with progressive respiratory failure on mechanical ventilation after pneumonectomy was managed satisfactorily using a veno-venous ECMO. Case 2: A veno-arterial ECMO was used to support a patient with vasopressor refractory septic shock. After 5 days of treatment, the patient was successfully weaned from ECMO. Case 3: A patient in cardiac arrest after the orthopedic surgery was resuscitated using a veno-arterial ECMO. Pulmonary angiography on ECMO revealed massive pulmonary thromboembolism and embolectomy was thoroughly performed under the support of ECMO.

Original Article

The Effect of Low-dose Dopamine on Splanchnic and Renal Blood Flow in Patients with Septic Shock under the Treatment of Norepinephrine: Jong Joon Ahn, Tae Hyung Kim, Ki Man Lee, Tae Sun Shim, Chae Man Lim, Sang Do Lee, Woo Sung Kim, Dong Soon Kim, Won Dong Kim, Younsuck Koh; Korean J Crit Care Med. 2001;16(1):36-41.

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Abstract PDF: BACKGROUND
Norepinephrine, which is frequently administered as a vasopressor to the patients with septic shock, can decrease splanchnic and renal blood flows and aggravate splanchnic and renal ischemia. The low-dose dopamine (LDD) has been frequently combined with norepinephrine to ameliorate renal and splanchnic hypoperfusion in patients with septic shock. However, the effect of the LDD on the splanchnic and renal blood flow has not been fully elucidated. This investigation was carried out to determine the effect of the LDD on the splanchnic and renal blood flow in the patients with septic shock under the treatment of norepinephrine.
METHODS
Eleven patients with septic shock were included in this study. All of them were under the norepinephrine treatment as the mean arterial pressure (MAP) was less than 70 mm Hg in spite of the adequate fluid resuscitation. With stabilization of MAP, the LDD (2 g/kg/min) was administered for two hours in each patients. Hemodynamics, gastric intramucosal pH (pHi), gastric regional PCO2 (rPCO2), rPCO2 - PaCO2, urine volume, urine sodium excretion and creatinine clearance were compared between with and without the LDD infusion. Diuretics was not used during the study period.
RESULTS
Age of patients (n=11) was 64 12 and the APACHE III score was 84 17. The mortality rate of the subjects was 64%. Dosage of norepinephrine was 0.55 0.63 g/kg/min during the study period. There were no significant differences in hemodynamics (central venous pressure, cardiac output, pulmonary artery occlusion pressure, mixed venous gas), pHi, rPCO2, rPCO2 - PaCO2 depending on the concomitant infusion of the LDD. The volume of urine tended to increase (P=0.074) after concomitant LDD, but the changes in urine sodium excretion and creatinine clearance were not significantly different.
CONCLUSIONS
The combined infusion of the LDD with norepinephrine did not improve splanchnic and renal blood flow in the patients with septic shock.

Case Report

Continuous Infusion of Ketamine in Mechanically Ventilated Patient in Septic Shock with Status Asthmaticus: Bon Nyeo Koo, Shin Ok Koh, Sung Yong Park, Jae Kwang Shim, Sung Sik Chon; Korean J Crit Care Med. 2000;15(2):108-112.

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Abstract PDF: Ketamine is well known for its analgesic, bronchodilating and sympathetic stimulating effect. Hence, it has been widely used for induction of patients with hypotension or asthma and also for analgesic and sedating purposes in the ICU. We presented a 62 year old female patient with ventilator support in septic shock with refractory asthma whom we managed successfully with continuous intravenous infusion of ketamine postoperatively in the ICU. The patient had a history of asthma but had been asymptomatic recently and was scheduled for an emergent explo-laparotomy under the diagnosis of acute panperitonitis. Before the induction of anesthesia, the patient was in septic shock but no wheezing could be auscultated. After the induction of general anesthesia and endotracheal intubation, wheezing was apparent in both lung fields with a high peak inspiratory pressure. Inotropics, vasopressors and bronchodilators were promptly instituted without any improvement of asthma and the patient had to be transferred to the ICU with intubated after the operation. Clinical symptoms of asthma continued throughout the first day despite using bronchodilators under mechanical ventilation but, after starting the IV infusion of ketamine, there were decrease in the peak inspiratory pressure and wheezing with a subsequent improvement in the arterial blood gas analysis findings. We could also achieve considerable analgesic and sedating effect without any decrease in the blood pressure. The patient's general physical status improved and weaning with extubation was successfully done on the 21st day and was transferred to the general ward on the 28th day.

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