Acute and Critical Care

Original Article

Pediatrics
Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events: Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang; Acute Crit Care. 2022;37(4):654-666. Published online October 26, 2022; DOI: https://doi.org/10.4266/acc.2022.00976

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Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance. Methods: This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF). Results: The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex. Conclusions: The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

Citations

Citations to this article as recorded by

Predicting cardiac arrest after neonatal cardiac surgery
Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya
Intensive Care Medicine – Paediatric and Neonatal.2024;[Epub] CrossRef
Volumetric regional MRI and neuropsychological predictors of motor task variability in cognitively unimpaired, Mild Cognitive Impairment, and probable Alzheimer's disease older adults
Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer
Experimental Gerontology.2023; 173: 112087. CrossRef
Predicting sepsis using deep learning across international sites: a retrospective development and validation study
Michael Moor, Nicolas Bennett, Drago Plečko, Max Horn, Bastian Rieck, Nicolai Meinshausen, Peter Bühlmann, Karsten Borgwardt
eClinicalMedicine.2023; 62: 102124. CrossRef
A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
Seok Young Song, Won-Kee Choi, Sanggyu Kwak
Medicine.2023; 102(37): e35057. CrossRef
An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
Young Joo Han
Acute and Critical Care.2022; 37(4): 667. CrossRef

Image in Critical Care

Pulmonary
Pneumothorax caused by delayed tracheal rupture in a pediatric patient with acute respiratory distress syndrome: Minyoung Jung, Jong Ho Cho, Ah Young Choi, Minji Kim, Joongbum Cho; Acute Crit Care. 2019;34(2):170-171. Published online February 7, 2019; DOI: https://doi.org/10.4266/acc.2018.00234

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PDF

Case Report

Trauma
Long-term extracorporeal membrane oxygenation after severe blunt traumatic lung injury in a child: Ok Jeong Lee, Yang Hyun Cho, Jinwook Hwang, Inae Yoon, Young-Ho Kim, Joongbum Cho; Acute Crit Care. 2019;34(3):223-227. Published online February 10, 2017; DOI: https://doi.org/10.4266/acc.2016.00472

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Abstract PDF

Managing acute respiratory distress syndrome (ARDS) after severe blunt traumatic lung injury can be challenging. In cases where patients are refractory to conventional therapy, extracorporeal membrane oxygenation (ECMO) should be considered. In addition, the heparin-coated circuit can reduce hemorrhagic complications in patients with multiple traumas. Although prolonged ECMO may be necessary, excellent outcomes are frequently associated. In this study, we report long-term support with venovenous-ECMO applied in a child with severe blunt trauma in Korea. This 10-year-old and 30-kg male with severe blunt thoracic trauma after a car accident developed severe ARDS a few days later, and ECMO was administered for 33 days. Because of pulmonary hemorrhage during ECMO support, heparin was stopped for 3 days and then restarted. He was weaned from ECMO successfully and has been able to run without difficulty for the 2 years since discharge.

Citations

Citations to this article as recorded by

Traumatic main airway rupture successfully rescued by extracorporeal membrane oxygenation: A case report
Lijun Cao, Jun Xu, Linfeng Tang, Yuli Zhou, Xianhua Xiang
Experimental and Therapeutic Medicine.2023;[Epub] CrossRef
Extracorporeal membrane oxygenation in trauma patients: a systematic review
Changtian Wang, Lei Zhang, Tao Qin, Zhilong Xi, Lei Sun, Haiwei Wu, Demin Li
World Journal of Emergency Surgery.2020;[Epub] CrossRef

Original Article

Pulmonary/Surgery
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by Intensive Care Trainee: Daesang Lee, Chi Ryang Chung, Sung Bum Park, Jeong Am Ryu, Joongbum Cho, Jeong Hoon Yang, Chi Min Park, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2014;29(2):64-69. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.64

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Abstract PDF

Background
Percutaneous dilatational tracheostomy (PDT) performed by an intensivist in critically ill patients is currently popular. Many studies support the safety and feasibility of PDT. However, there is limited data on the safety and feasibility of PDT performed by intensive care trainees.
Methods
To evaluate the safety and feasibility of PDT performed by intensive care trainees and to compare these with those performed by intensivists, we retrospectively analyzed the clinical characteristics and adverse events of all prospectively registered patients who underwent PDT by ICT or intensivists in intensive care units (ICUs) from August 2010 to August 2013.
Results
In the study period, 203 patients underwent PDT in ICUs; 139 (68%) by trainees and 64 (32%) by intensivists. There were no statistically significant differences in clinical characteristics including demographics, laboratory findings, and parameters of mechanical ventilation between the two groups. Procedure times and outcomes of the patients were not different between the two groups. The majority of complications observed in 24 hours after PDT were bleeding; however, there was no significant difference between the two groups (trainee 10.8% vs. intensivist 9.4%, p = 0.758). There was no procedure-related death in the two groups.
Conclusions
PDT performed by intensive care trainees was safe and feasible. However, further well-designed studies should be conducted to confirm our results.

Citations

Citations to this article as recorded by

Comparison of Conventional Surgical Tracheostomy and Percutaneous Dilatational Tracheostomy in the Neurosurgical Intensive Care Unit
Sungdae Lim, Hyun Park, Ja Myoung Lee, Kwangho Lee, Won Heo, Soo-Hyun Hwang
Korean Journal of Neurotrauma.2022; 18(2): 246. CrossRef
Prediction of successful de-cannulation of tracheostomised patients in medical intensive care units
Chul Park, Ryoung-Eun Ko, Jinhee Jung, Soo Jin Na, Kyeongman Jeon
Respiratory Research.2021;[Epub] CrossRef
Severe pain-related adverse events of percutaneous dilatational tracheostomy performed by a neurointensivist compared with conventional surgical tracheostomy in neurocritically ill patients
Yong Oh Kim, Chi Ryang Chung, Chi-Min Park, Gee Young Suh, Jeong-Am Ryu
BMC Neurology.2020;[Epub] CrossRef
Is percutaneous dilatational tracheostomy with bronchoscopic guidance better than without?
Jinsun Chang, Hong-Joon Shin, Yong-Soo Kwon, Yu-Il Kim, Sung-Chul Lim, Tae-Ok Kim
Acute and Critical Care.2020; 35(2): 127. CrossRef
Safety and feasibility of ultrasound-guided insertion of peripherally inserted central catheter performed by an intensive care trainee
Yongwoo Lee, Jeong-Am Ryu, Yong Oh Kim, Eunmi Gil, Young-Mok Song
Journal of Neurocritical Care.2020; 13(1): 41. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by a Neurointensivist Compared with Conventional Surgical Tracheostomy in Neurosurgery Intensive Care Unit
John Kwon, Yong Oh Kim, Jeong-Am Ryu
Journal of Neurointensive Care.2019; 2(2): 64. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents
Sung-Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2014; 29(3): 183. CrossRef
Is Percutaneous Dilatational Tracheostomy Safe to Perform in the Intensive Care Unit?
Jae Hwa Cho
Korean Journal of Critical Care Medicine.2014; 29(2): 57. CrossRef

Case Reports

Gastroenterology/Pulmonary
Respiratory Complications Associated with Insertion of Small-Bore Feeding Tube in Critically Ill Patients: Jeong Am Ryu, Joongbum Cho, Sung Bum Park, Daesang Lee, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Gee Young Suh, Chi Min Park; Korean J Crit Care Med. 2014;29(2):131-136. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.131

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Abstract PDF

Small-bore flexible feeding tubes decrease the risk of ulceration of the nose, pharynx, and stomach compared with large-bore and more rigid tubes. However, small-bore feeding tubes have more respiratory system complications, such as pneumothorax, hydropneumothorax, bronchopleural fistula, and pneumonia, which are associated with significant morbidity and mortality. Thus, it is important to confirm the correct position of feeding tubes. Chest X-ray is the gold standard to detect tracheal malpositioning of the feeding tube. We present three cases in which intubated patients exhibited an altered mental state. An assistant guide wire was used at the insertion of small-bore feeding tubes. These conditions are thought to be potential risk factors for tracheobronchial malpositioning of feeding tubes.

Citations

Citations to this article as recorded by

Clinical usefulness of capnographic monitoring when inserting a feeding tube in critically ill patients: retrospective cohort study
Jeong-Am Ryu, Kyoungjin Choi, Jeong Hoon Yang, Dae-Sang Lee, Gee Young Suh, Kyeongman Jeon, Joongbum Cho, Chi Ryang Chung, Insuk Sohn, Kiyoun Kim, Chi-Min Park
BMC Anesthesiology.2016;[Epub] CrossRef
Nutritional Assessment of ICU Inpatients with Tube Feeding
Yu-Jin Kim, Jung-Sook Seo
Journal of the Korean Dietetic Association.2015; 21(1): 11. CrossRef
Respiratory Complications of Small-Bore Feeding Tube Insertion in Critically Ill Patients
Kyoung-Jin Choi, Jeong-Am Ryu, Chi-Min Park
JOURNAL OF ACUTE CARE SURGERY.2015; 5(1): 28. CrossRef

Pyriform Sinus Perforation in a Child after Falling with a Spoon Handle in the Mouth: Joongbum Cho, Mi Ran Park, Jihyun Kim, Han Sin Jeong, Kangmo Ahn; Korean J Crit Care Med. 2013;28(3):214-217.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.214

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Abstract PDF: Pyriform sinus perforation is uncommon in children and most cases are secondary to iatrogenic causes such as endotracheal intubations. Due to this rarity, the management of these injuries is controversial. We report a case of pyriform sinus perforation in a 14-month-old boy who fell down with a spoon handle in the mouth and was successfully treated by transoral laryngomicrosurgery. Two hours after falling down, the patient had breathing difficulties and started vomiting. A chest X-ray showed subcutaneous emphysema and pneumomediastium. Esophagogram revealed leakage of contrast media at the hypopharynx. Although air leakage was reduced the next day, his fever became frequent even with conservative management of antibiotics. On the 4th hospital day, closure of pyriform sinus perforation was done by transoral laryngomicrosurgery. The patient became apyrexial by the 2nd post-operative day. On the 21th hospital day, the child was able to consume food orally without problems and was allowed to go home.

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