Acute and Critical Care

Review Article

August 17, 2022

Transient splenial lesions of the corpus callosum and infectious diseases

Kyu Sun Yum, Dong-Ick Shin

Acute Crit Care. 2022;37(3):269-275.

▪ Transient splenial lesion of the corpus callosum is associated with various diseases including infections.
▪ Transient splenial lesions of the corpus callosum can be diagnosed using brain magnetic resonance imaging examination.
▪ Transient splenial lesions of the corpus callosum have also been observed in some patients with coronavirus disease 2019 (COVID-19).

Original Article

June 27, 2022

Early assessment of aspiration risk in acute stroke by fiberoptic endoscopy in critically ill patients

Mohamed Saad Abdelaziz Elsyaad, Akram Muhammad Fayed, Mohamed Mostafa Abdel Salam Megahed, Nesrine Hazem Hamouda, Ahmed Moustafa Elmenshawy

Acute Crit Care. 2022;37(3):276-285.

▪ In acute stroke dysphagia is considered an indicator of poor prognosis that may lead to an increased risk of aspiration pneumonia.
▪ Fiberoptic endoscopic evaluation of swallowing has been recommended, as a useful complementary tool for studying swallowing in acute stroke.

Original Article

June 29, 2022

Improving mobility in the intensive care unit with a protocolized, early mobilization program: observations of a single center before-and-after the implementation of a multidisciplinary program

Laptin Ho, Joe Hin Cheung Tsang, Emmanuel Cheung, Wing Yan Chan, Ka Wai Lee, Sweetie R Lui, Chung Yau Lee, Alfred Lok Hang Lee, Philip Koon Ngai Lam

Acute Crit Care. 2022;37(3):286-294.

▪ Protocolized early mobilization in the intensive care is effective in improving patient mobility scores.
▪ Median time taken for patients to mobilize out-of-bed is 5 days after intensive care unit admission.
▪ Tolerability of early mobilization in critically ill patients is high and without major adverse events.

Original Article

June 27, 2022

Muscle Growth and Anabolism in Intensive Care Survivors (GAINS) trial: a pilot randomised controlled trial

Matthew H Anstey, Rashmi Rauniyar, Ethan Fitzclarence, Natalie Tran, Emma Osnain, Bianca Mammana, Angela Jacques, Robert N Palmer, Andrew Chapman, Bradley Wibrow

Acute Crit Care. 2022;37(3):295-302.

▪ The use of nandrolone was safe in patients in the recovery phase of prolonged critical illness (>7 days) in this pilot, randomized, controlled trial.
▪ There was no benefit of nandrolone in terms of muscle strength after 3 weeks, but a non-significant trend was observed towards improved physical functioning based on 36-item short form survey.
▪ A larger study is needed to definitively address the potential benefits of nandrolone in a similar cohort.

Original Article

July 5, 2022

In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19

Yong Sub Na, Jin Hyoung Kim, Moon Seong Baek, Won-Young Kim, Ae-Rin Baek, Bo young Lee, Gil Myeong Seong, Song-I Lee

Acute Crit Care. 2022;37(3):303-311.

▪ The in-hospital mortality of elderly patients with severe coronavirus disease 2019 (COVID-19) was 25.5%.
▪ The non-survivor group had more underlying diseases, and their initial frailty scale and severity scores tended to be higher than those in the survivor group.
▪ The Sequential Organ Failure Assessment (SOFA) score demonstrated the best performance in predicting the in-hospital mortality of elderly patients with severe COVID-19.
▪ Clinical frailty scale and SOFA scores were associated with in-hospital mortality in multivariate analyses, and these may assist in treatment decision-making.

Original Article

August 29, 2022

Risk factors associated with development of coinfection in critically Ill patients with COVID-19

Erica M. Orsini, Gretchen L. Sacha, Xiaozhen Han, Xiaofeng Wang, Abhijit Duggal, Prabalini Rajendram

Acute Crit Care. 2022;37(3):312-321.

▪ Bacterial and fungal coinfections occur more commonly in critically ill patients with coronavirus disease 2019 (COVID-19) than non-critically ill hospitalized patients.
▪ Clinicians should maintain a high index of suspicion for hospital-acquired infections in COVID-19 patients with increased severity of illness, indwelling medical devices, and prolonged hospital length of stay.

Original Article

July 29, 2022

Effect of prone positioning on gas exchange according to lung morphology in patients with acute respiratory distress syndrome

Na Young Kim, Si Mong Yoon, Jimyung Park, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee

Acute Crit Care. 2022;37(3):322-331.

▪ Changes in the partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio and respiratory compliance after prone position did not differ according to the lung morphology of ARDS.
▪ Prone position can be considered as soon as possible, regardless of the morphological phenotype in patients with moderate-to-severe ARDS.
▪ In a multivariable Cox proportional hazard regression analysis of patients with moderate-to-severe ARDS, the improvement in PaO2/FiO2 ratio after prone position was independently associated with mortality.

Original Article

July 5, 2022

Association of nutrition risk screening 2002 and Malnutrition Universal Screening Tool with COVID-19 severity in hospitalized patients in Iran

Ghazaleh Eslamian, Sohrab Sali, Mansour Babaei, Karim Parastouei, Dorsa Arman Moghadam

Acute Crit Care. 2022;37(3):332-338.

▪ Although coronavirus disease 2019 (COVID-19) is related to a catabolic inflammatory condition, the majority of patients with COVID-19 were not malnourished in this study.
▪ Malnutrition was associated with a higher chance of extremely severe COVID-19.
▪ It is not obvious that severe COVID-19 causes malnutrition or it is a risk factor for disease severity.

Original Article

August 29, 2022

The fourth wave: vaccination status and intensive care unit mortality at a large hospital system in New York City

Pranai Tandon, Evan Leibner, Anna Hackett, Katherine Maguire, Kayla Leonardi, Matthew A. Levin, Roopa Kohli-Seth

Acute Crit Care. 2022;37(3):339-346.

▪ Patients requiring intensive care, in-hospital mortality was high across all levels of vaccination status.
▪ Up-to-date vaccination remains the best and safest way to protect against serious illness and death from coronavirus disease 2019 (COVID-19).

Original Article

July 25, 2022

The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience

Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry

Acute Crit Care. 2022;37(3):347-354.

▪ A diaphragmatic ultrasound for the weaning assessment is feasible and provides real-time physiological data.
▪ The percent change in diaphragmatic thickness measurement is superior to the conventional rapid shallow breathing index measurement in predicting weaning success.

Original Article

August 18, 2022

Early mechanical ventilation for grade IV hepatic encephalopathy is associated with increased mortality among patients with cirrhosis: an exploratory study

Saad Saffo, Guadalupe Garcia-Tsao

Acute Crit Care. 2022;37(3):355-362.

▪ Patients with cirrhosis and grade IV hepatic encephalopathy often undergo endotracheal intubation and mechanical ventilation early in their hospital course to prevent aspiration events.
▪ However, these individuals often have underlying multisystem dysfunction which makes them uniquely susceptible to the many risks of mechanical ventilation.
▪ Our study demonstrates that the use of endotracheal intubation and mechanical ventilation for airway protection among patients with cirrhosis and grade IV hepatic encephalopathy is associated with increased in-hospital mortality after adjusting for possible confounding variables.

Original Article

August 4, 2022

Ability of a modified Sequential Organ Failure Assessment score to predict mortality among sepsis patients in a resource-limited setting

Bodin Khwannimit, Rungsun Bhurayanontachai, Veerapong Vattanavanit

Acute Crit Care. 2022;37(3):363-371.

▪ The Sequential Organ Failure Assessment (SOFA) score is associated with morbidity and mortality in sepsis patients, and the third international consensus proposed new criteria for sepsis (Sepsis-3) outlines the new sepsis criterion using SOFA substituted for Systemic Inflammatory Response Syndrome.
▪ Some variables of the SOFA score are not routinely measured in sepsis patients, especially in countries with limited resources. Serum bilirubin was the most common missing variable required for SOFA score calculation.
▪ The performance of modified SOFA omitting the liver component was similar to that of the original SOFA in predicting all-cause in-hospital, intensive care unit, and 28-day mortality.

Original Article

August 4, 2022

Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit

Song-I Lee, Younsuck Koh, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim

Acute Crit Care. 2022;37(3):372-381.

▪ The proportion of very elderly patients in the intensive care unit (ICU) increased from 1.3% to 1.8%.
▪ Non-surgical causes of ICU admission and the number of patients with underlying diseases were increased, and in-hospital mortality decreased from 2007 through 2017.
▪ High creatinine levels, use of vasopressors and ventilator weaning failure in the ICU were significantly associated with death in patients aged ≥85 years.

Original Article

July 19, 2022

Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study

Heemoon Park, Sung Yoon Lim, Sebin Kim, Hyung-Sook Kim, Soyeon Kim, Ho Il Yoon, Young-Jae Cho

Acute Crit Care. 2022;37(3):382-390.

▪ Early enteral nutrition through protocolized nutritional support may supply more nutrition to improve clinical outcomes.
▪ The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” may improve enteral nutrition supply and mortality of critically ill patients without increasing complications.

Original Article

August 5, 2022

The incidence of phlebitis development of high concentration of continuous amiodarone infusion with in-line filter compared to the low concentration without in-line filter: a retrospective propensity score-matched analysis

Sirichai Cheewatanakornkul, Piyanai Vattanaprasan, Supattra Uppanisakorn, Rungsun Bhurayanontachai

Acute Crit Care. 2022;37(3):391-397.

▪ Amiodarone-induced phlebitis is common and associated with morbidity.
▪ The administration of high concentration of amiodarone of 2 mg/ml with an in-line filter did not reduce phlebitis. Central venous catheterization for a high concentration of amiodarone is recommended.
▪ Amiodarone concentration of 1.5 mg/ml is safe and can prevent phlebitis.

Original Article

July 5, 2022

Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis

Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda, Shoki Yamauchi, Hideta Takushi, Tadashi Iraha, Koji Idomari

Acute Crit Care. 2022;37(3):398-406.

▪ Blood purification using polymethylmethacrylate (PMMA) hemofilters could be a potential treatment method for severe acute pancreatitis (SAP), given that PMMA hemofilters could adsorb proinflammatory cytokines.
▪ Continuous hemodialysis using a PMMA hemofilter could improve acute kidney injury (AKI) and pulmonary failure in SAP patients.
▪ Additional intermittent PMMA hemodiafiltration was thought to be effective in patients developing severe lung injury.
▪ Although blood purification therapy is not a standard therapy for SAP patients, it was suspected that the blood purification using a PMMA hemofilter is effective for the treatment of AKI and pulmonary failure in SAP patients.

Original Article

July 5, 2022

The effects of hypomagnesemia on delirium in middle-aged and older adult patients admitted to medical intensive care units

Joong-Yub Kim, Hyo Jin Lee, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee, Tae Yun Park

Acute Crit Care. 2022;37(3):407-414.

▪ In a multivariable Cox proportional hazards regression analysis of critically ill patients aged 40–85 years in the medical intensive care unit (ICU), hypomagnesemia was independently associated with the cumulative incidence of delirium adjusted for body mass index, prior use of immunosuppressants and/or benzodiazepines, and alcohol history.
▪ Hypomagnesemia increases the risk of delirium by more than two-fold compared to patients with normal magnesium level.
▪ Hypomagnesemia is a possible predictive marker of delirium in medical ICU settings, warranting greater attention.

Original Article

June 20, 2022

Cytokine profiles in intensive care unit delirium

Ryan J. Smith, Christian Lachner, Vijay P. Singh, Shubham Trivedi, Biswajit Khatua, Rodrigo Cartin-Ceba

Acute Crit Care. 2022;37(3):415-428.

▪ The cytokine profile seen in intensive care unit delirium appears to be contingent on the condition that precipitates its onset.
▪ In our patient population with sepsis and coronavirus disease 2019 (COVID-19), C-C motif ligand 2, C-X-C motif chemokine ligand (CXCL)10, and tumor necrosis factor-α predominate.
▪ In patients that developed postoperative delirium, granulocyte colony-stimulating factor is elevated and CXCL10 is decreased, relative to the COVID-19 and sepsis groups.
▪ These findings suggest that the delirium syndrome represents a manifestation of distinct pathophysiological processes.

Original Article

June 23, 2022

Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma

Anukoon Kaewborisutsakul, Thara Tunthanathip

Acute Crit Care. 2022;37(3):429-437.

▪ Subdural hematoma (SDH) in pediatric traumatic brain injury is associated with mortality and disability resulting in disease burden in developing nations.
▪ The prognostic factors for traumatic SDH were hypotension, Glasgow coma scale score 3–8, pupillary light reflex, midline shift ≥5 mm, and co-existing intraventricular hemorrhage.
▪ The nomogram is a prediction tool used to help physicians make treatment decisions.

Original Article

August 29, 2022

Cardiopulmonary resuscitation of infants at birth: predictable or unpredictable?

Mohammad Reza Zarkesh, Raheleh Moradi, Azam Orooji

Acute Crit Care. 2022;37(3):438-453.

▪ In the delivery room, timely neonatal cardiopulmonary resuscitation (CPR) could significantly reduce mortality and other neurological disabilities.
▪ Use of Machine Learning-based systems for predicting the need for at-birth CPR can be useful.

Original Article

July 29, 2022

Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2

Eui Jun Lee, Bongjin Lee, You Sun Kim, Yu Hyeon Choi, Young Ho Kwak, June Dong Park

Acute Crit Care. 2022;37(3):454-461.

▪ The predictive performance of both Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2 is good.
▪ There is a difference in performance between the tools based on patient characteristics and groups.

Original Article

August 5, 2022

C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury

Canan Gürsoy, Güven Gürsoy, Semra Gümüş Demirbilek

Acute Crit Care. 2022;37(3):462-467.

▪ This study compared C-reactive protein-albumin ratio (CAR) and procalcitonin (PCT) in predicting intensive care unit (ICU) mortality in traumatic brain injury and shows both are useful markers.
▪ There was a statistically significant difference between PCT and CAR values according to mortality (P=0.041 and P=0.047, respectively).
▪ When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers provide effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

Current Issue: Volume 37(3); Aug 2022

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