Acute and Critical Care

Volume 33 (1); February 2018

Review

Surgery
Reducing Unnecessary Testing in the Intensive Care Unit by Choosing Wisely: Ruth M. Kleinpell, J. Christopher Farmer, Stephen M. Pastores; Acute Crit Care. 2018;33(1):1-6. Published online February 28, 2018; DOI: https://doi.org/10.4266/acc.2018.00052

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Overuse of laboratory and X-ray testing is common in the intensive care unit (ICU). This review highlights focused strategies for critical care clinicians as outlined by the Critical Care Societies Collaborative (CCSC) as part of the American Board of Internal Medicine Foundation’s Choosing Wisely® campaign. The campaign aims to promote the use of judicious testing and decrease unnecessary treatment measures in the ICU. The CCSC outlines five specific recommendations for reducing unnecessary testing in the ICU. First, reduce the use of daily or regular interval diagnostic testing. Second, do not transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 mg/dl. Third, do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of ICU stay. Fourth, do not deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation. Finally, do not continue life support for patients at high risk of death without offering patients and their families the alternative of comfort focused care. A number of strategies can be used to reduce unnecessary testing in the ICU, including educational campaigns, audit and feedback, and implementing prompts in the electronic ordering system to allow only acceptable indications when ordering routine testing. Greater awareness of the lack of outcome benefit and associated costs can prompt clinicians to be more mindful of ordering tests and procedures in order to reduce unnecessary testing in the ICU.

Citations

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Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review
Luigi Devis, Emilie Catry, Patrick M. Honore, Alexandre Mansour, Giuseppe Lippi, François Mullier, Mélanie Closset
Annals of Intensive Care.2024;[Epub] CrossRef
Blood gas sampling in the intensive care unit: A prospective before-and-after interventional study on the effect of an educational program on blood gas testing frequency
Benjamin Cunanan, Haindavi Muppa, Liliana Orellana, Samantha Bates, Forbes McGain
Australian Critical Care.2024;[Epub] CrossRef
Cost analysis of hospitals performing continuous albuterol in non-intensive care settings
Adjoa A. Andoh,, Charmaine B. Lo,, Junxin Shi,, Ryan S. Bode,, Samantha W. Gee,, Julie C. Leonard,
Journal of Asthma.2023; 60(2): 314. CrossRef
What blood conservation practices are effective at reducing blood sampling volumes and other clinical sequelae in intensive care? A systematic review
Samantha Keogh, Saira Mathew, Amanda J. Ullman, Claire M. Rickard, Fiona Coyer
Australian Critical Care.2023; 36(6): 1129. CrossRef
Towards net zero: critical care
Heather Baid, Eleanor Damm, Louise Trent, Forbes McGain
BMJ.2023; : e069044. CrossRef
Effect of a Performance Feedback Dashboard on Hospitalist Laboratory Test Utilization
Caroline McCormick, Sarvpreet Ahluwalia, Ankur Segon
American Journal of Medical Quality.2023; 38(6): 273. CrossRef
Availability of Multiple Organ Failure Score Components in Surgical Patients
Maxwell C. Braasch, Bachar N. Halimeh, Christopher A. Guidry
Surgical Infections.2022; 23(2): 178. CrossRef
Impact of Blood Sampling on Anemia in the PICU: A Prospective Cohort Study
Tine François, Michaël Sauthier, Julien Charlier, Jessica Dessureault, Marisa Tucci, Karen Harrington, Laurence Ducharme-Crevier, Sally Al Omar, Jacques Lacroix, Geneviève Du Pont-Thibodeau
Pediatric Critical Care Medicine.2022; 23(6): 435. CrossRef
Predicting Abnormal Laboratory Blood Test Results in the Intensive Care Unit Using Novel Features Based on Information Theory and Historical Conditional Probability: Observational Study
Camilo E Valderrama, Daniel J Niven, Henry T Stelfox, Joon Lee
JMIR Medical Informatics.2022; 10(6): e35250. CrossRef
Implementation and Impact of Choosing Wisely Recommendations in Oncology
Sonieya Nagarajah, Melanie Lynn Powis, Rouhi Fazelzad, Monika K. Krzyzanowska, Vishal Kukreti
JCO Oncology Practice.2022; 18(10): 703. CrossRef
Blood loss from laboratory testing, anemia, and red blood cell transfusion in the intensive care unit: a retrospective study
Nicholas L. Jackson Chornenki, Tyler E. James, Rebecca Barty, Yang Liu, Bram Rochwerg, Nancy M. Heddle, Deborah M. Siegal
Transfusion.2020; 60(2): 256. CrossRef
Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review
Madison Foster, Justin Presseau, Nicola McCleary, Kelly Carroll, Lauralyn McIntyre, Brian Hutton, Jamie Brehaut
Implementation Science.2020;[Epub] CrossRef
Labordiagnostik in der Intensivmedizin
S. Petros, L. Weidhase
Medizinische Klinik - Intensivmedizin und Notfallmedizin.2020; 115(7): 539. CrossRef
Labordiagnostik in der Intensivmedizin
Sirak Petros, Lorenz Weidhase
Wiener klinisches Magazin.2020; 23(6): 298. CrossRef

Original Articles

Pulmonary
Global and Regional Ventilation during High Flow Nasal Cannula in Patients with Hypoxia: Dong Hyun Lee, Eun Young Kim, Ga Jin Seo, Hee Jung Suh, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim; Acute Crit Care. 2018;33(1):7-15. Published online January 22, 2018; DOI: https://doi.org/10.4266/acc.2017.00507; Correction in: Acute Crit Care 2021;36(2):173

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Background
High flow nasal cannula (HFNC) is known to increase global ventilation volume in healthy subjects. We sought to investigate the effect of HFNC on global and regional ventilation patterns in patients with hypoxia.
Methods
Patients were randomized to receive one of two oxygen therapies in sequence: nasal cannula (NC) followed by HFNC or HFNC followed by NC. Global and regional ventilation was assessed using electric impedance tomography.
Results
Twenty-four patients participated. Global tidal variation (TV) in the lung was higher during HFNC (NC, 2,241 ± 1,381 arbitrary units (AU); HFNC, 2,543 ± 1,534 AU; P < 0.001). Regional TVs for four iso-gravitational quadrants of the lung were also all higher during HFNC than NC. The coefficient of variation for the four quadrants of the lung was 0.90 ± 0.61 during NC and 0.77 ± 0.48 during HFNC (P = 0.035). Within the four gravitational layers of the lung, regional TVs were higher in the two middle layers during HFNC when compared to NC. Regional TV values in the most ventral and dorsal layers of the lung were not higher during HFNC compared with NC. The coefficient of variation for the four gravitational layers of the lung were 1.00 ± 0.57 during NC and 0.97 ± 0.42 during HFNC (P = 0.574).
Conclusions
In patients with hypoxia, ventilation of iso-gravitational regions of the lung during HFNC was higher and more homogenized compared with NC. However, ventilation of gravitational layers increased only in the middle layers. (Clinical trials registration number: NCT02943863).

Citations

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High-flow nasal cannulae for respiratory support in adult intensive care patients
Sharon R Lewis, Philip E Baker, Roses Parker, Andrew F Smith
Cochrane Database of Systematic Reviews.2021;[Epub] CrossRef
Failure of High-Flow Nasal Cannula Therapy in Pneumonia and Non-Pneumonia Sepsis Patients: A Prospective Cohort Study
Eunhye Kim, Kyeongman Jeon, Dong Kyu Oh, Young-Jae Cho, Sang-Bum Hong, Yeon Joo Lee, Sang-Min Lee, Gee Young Suh, Mi-Hyeon Park, Chae-Man Lim, Sunghoon Park
Journal of Clinical Medicine.2021; 10(16): 3587. CrossRef
High-flow nasal cannulae for respiratory support in adult intensive care patients
Sharon R Lewis, Philip E Baker, Roses Parker, Andrew F Smith
Cochrane Database of Systematic Reviews.2017;[Epub] CrossRef

Neurology
The Effect of Electrical Muscle Stimulation and In-bed Cycling on Muscle Strength and Mass of Mechanically Ventilated Patients: A Pilot Study: Kyeongyoon Woo, Jeongmin Kim, Hye Bin Kim, Hyunwoo, Choi, Kibum Kim, Donghyung Lee, Sungwon Na; Acute Crit Care. 2018;33(1):16-22. Published online February 14, 2017; DOI: https://doi.org/10.4266/acc.2017.00542

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Abstract PDF

Background
Critically ill patients experience muscle weakness, which leads to functional disability. Both functional electrical stimulation (FES) and in-bed cycling can be an alternative measure for intensive care unit (ICU) patients who are not feasible for active exercise. The aim of this study was to examine whether FES and in-bed cycling have a positive effect on muscle mass in ICU patients.
Methods
Critically ill patients who received mechanical ventilation for at least 24 hours were included. After passive range of motion exercise, in-bed cycling was applied for 20 minutes, and FES was applied for 20 minutes on the left leg. The right leg received in-bed cycling and the left leg received both FES and in-bed cycling. Thigh circumferences and rectus femoris cross-sectional area (CSA) were assessed with ultrasonography before and after the intervention. Muscle strength was assessed by Medical Research Council scale.
Results
A total of 10 patients were enrolled in this study as a pilot study. Before and after the intervention, the CSA of right rectus femoris increased from 5.08 ± 1.51 cm² to 6.01 ± 2.21 cm² , which was statistically significant (P = 0.003). The thigh circumference was also increased and statistically significant (P = 0.006). There was no difference between left and right in regard to FES application. There is no significant change in muscle strength before and after the intervention (right and left, P = 0.317 and P = 0.368, respectively).
Conclusions
In-bed cycling increased thigh circumferences rectus femoris CSA. Adding FES did not show differences.

Citations

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Assisted mobilisation in critical patients with COVID-19
M. Polastri, F. Daniele, F. Tagariello
Pulmonology.2024; 30(2): 152. CrossRef
Ultrasound for measurement of skeletal muscle mass quantity and muscle composition/architecture in critically ill patients: A scoping review on studies' aims, methods, and findings
Júlia Lima, Estéfani Foletto, Rafaella C.B. Cardoso, Charlles Garbelotto, Aline P. Frenzel, Juliana U. Carneiro, Larissa S. Carpes, Thiago G. Barbosa-Silva, Maria Cristina Gonzalez, Flávia M. Silva
Clinical Nutrition.2024; 43(1): 95. CrossRef
Current Concepts in Early Mobilization of Critically Ill Patients Within the Context of Neurologic Pathology
Thaís Ferreira Lopes Diniz Maia, Paulo André Freire Magalhães, Dasdores Tatiana Silva Santos, Jorge Luiz de Brito Gomes, Paulo Adriano Schwingel, Aline de Freitas Brito
Neurocritical Care.2024;[Epub] CrossRef
Human skeletal muscle size with ultrasound imaging: a comprehensive review
Masatoshi Naruse, Scott Trappe, Todd A. Trappe
Journal of Applied Physiology.2022; 132(5): 1267. CrossRef
Rehabilitation Therapy after the COVID-19 Era: Focused on Cardiopulmonary Rehabilitation
Hyung Ik Shin
Annals of CardioPulmonary Rehabilitation.2021; 1(1): 17. CrossRef
Rehabilitation Programs for Bedridden Patients with Prolonged Immobility: A Scoping Review Protocol
Vitor Parola, Hugo Neves, Filipa Margarida Duque, Rafael A. Bernardes, Remy Cardoso, Carla A. Mendes, Liliana B. Sousa, Paulo Santos-Costa, Cândida Malça, Rúben Durães, Pedro Parreira, João Apóstolo, Arménio Cruz
International Journal of Environmental Research and Public Health.2021; 18(22): 12033. CrossRef
Non-paretic lower limb muscle wasting during acute phase is associated with dependent ambulation in patients with stroke
Masafumi Nozoe, Masashi Kanai, Hiroki Kubo, Miho Yamamoto, Shinichi Shimada, Kyoshi Mase
Journal of Clinical Neuroscience.2020; 74: 141. CrossRef
Intensive Care Unit-Acquired Weakness: Not Just Another Muscle Atrophying Condition
Heta Lad, Tyler M. Saumur, Margaret S. Herridge, Claudia C. dos Santos, Sunita Mathur, Jane Batt, Penney M. Gilbert
International Journal of Molecular Sciences.2020; 21(21): 7840. CrossRef
Problems with Rehabilitation for Critically ill Patients
Masaji Nishimura
The Japanese Journal of Rehabilitation Medicine.2019; 56(1): 48. CrossRef
Exploring the Potential Effectiveness of Combining Optimal Nutrition With Electrical Stimulation to Maintain Muscle Health in Critical Illness: A Narrative Review
Selina M. Parry, Lee‐anne S. Chapple, Marina Mourtzakis
Nutrition in Clinical Practice.2018; 33(6): 772. CrossRef

Neurology
The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study: Jaesub Park, Seung-Taek Oh, Sunyoung Park, Won-Jung Choi, Cheung Soo Shin, Se Hee Na, Jae-Jin Kim, Jooyoung Oh, Jin Young Park; Acute Crit Care. 2018;33(1):23-33. Published online February 6, 2018; DOI: https://doi.org/10.4266/acc.2017.00584

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Abstract PDF

Background
Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient’s clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown.
Methods
The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation.
Results
There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor’s mental health, was significantly reduced and pain tended to decrease.
Conclusions
Increasing the physician’s awareness of the patient’s mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

Citations

Citations to this article as recorded by

Adaptation and Validation of a Chart‐Based Delirium Detection Tool for the ICU (CHART‐DEL‐ICU)
Karla D. Krewulak, Carmen Hiploylee, E. W. Ely, Henry T. Stelfox, Sharon K. Inouye, Kirsten M. Fiest
Journal of the American Geriatrics Society.2021; 69(4): 1027. CrossRef

Infection
The Effects of Flecainide Acetate on Inflammatory-Immune Response in Lipopolysaccharide-Stimulated Neutrophils and on Mortality in Septic Rats: Shi Young Chung, Jinyoung Kim, Hong Bum Bae, Tran Duc Tin, Wan Ju, Sang Hyun Kwak; Acute Crit Care. 2018;33(1):34-41. Published online February 28, 2018; DOI: https://doi.org/10.4266/acc.2017.00577

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Abstract PDF

Background
Flecainide acetate is a drug used primarily for cardiac arrhythmia. Some studies also imply that flecainide acetate has the potential to regulate inflammatory-immune responses; however, its mechanism of action is contended. We determined the effects of flecainide acetate on lipopolysaccharide (LPS)-stimulated human neutrophils in vitro and on mortality in a septic rat model.
Methods
Neutrophils from human blood were cultured with varying concentrations of flecainide acetate (1 μM, 10 μM, or 100 μM) with or without LPS (100 ng/ml). To assess neutrophil activation, the protein levels of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 and IL-8 were measured after a 4-hour culture period. To assess the intracellular signaling pathways, the levels of phosphorylation of p38 mitogen-activated protein kinase (p38), extracellular signal-regulated kinase (ERK) 1/2, and c-Jun N-terminal kinase (JNK) were measured after a 30-minute culture period, and the nuclear translocation of nuclear factor (NF)-κB was measured after a 1-hour culture period. Additionally, the survival rate was investigated in a rat sepsis model.
Results
Flecainide acetate down-regulated the activation of proinflammatory cytokines, including TNF-α and IL-6 and IL-8, and intracellular signaling pathways including ERK 1/2 and NF-κB. Flecainide acetate also improved the survival rate in the rat sepsis model.
Conclusions
Collectively, these findings indicate that flecainide acetate can improve survival in a rat sepsis model by attenuating LPS-induced neutrophil responses. We therefore suggest that flecainide acetate plays an important role in modulating inflammatoryimmune responses.

Citations

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Persistence is key: unresolved immune dysfunction is lethal in both COVID-19 and non-COVID-19 sepsis
Andy Y. An, Arjun Baghela, Peter Zhang, Reza Falsafi, Amy H. Lee, Uriel Trahtemberg, Andrew J. Baker, Claudia C. dos Santos, Robert E. W. Hancock
Frontiers in Immunology.2023;[Epub] CrossRef

Editorials

Basic science and research
New Name of the Journal: Chae-Man Lim; Acute Crit Care. 2018;33(1):42-42. Published online February 28, 2018; DOI: https://doi.org/10.4266/acc.2018.00094

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Acute and Critical Care will be indexed in PubMed, PubMed Central, Emerging Sources Citation Index, and Scopus
Jae Hwa Cho
Acute and Critical Care.2019; 34(3): 219. CrossRef

Basic science and research
Rehabilitation and Intensive Care Unit: Deokkyu Kim; Acute Crit Care. 2018;33(1):43-45. Published online February 28, 2018; DOI: https://doi.org/10.4266/acc.2018.00080

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Case Reports

Pulmonary
Termination of Idiopathic Sustained Monomorphic Ventricular Tachycardia by Synchronized Electrical Cardioversion during Pregnancy: Sungmin Lee; Acute Crit Care. 2018;33(1):46-50. Published online February 20, 2017; DOI: https://doi.org/10.4266/acc.2016.00115

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Abstract PDF: The most common cardiac complications detected during pregnancy are an arrhythmia. However, idiopathic continuous monomorphic ventricular tachycardia (VT) during pregnancy is unusual. A 31-year-old pregnant woman presented at 20 weeks of gestation with progressive palpitation and episodes of agitation. An initial 12-lead electrocardiogram (ECG) showed normal sinus rhythm. However, 30 minutes after presenting at the emergency room, she complained of chest pain. A subsequent ECG showed wide complex monomorphic VT. We attempted to administer an antiarrhythmic drug, but the patient refused any medication because of concerns regarding possible adverse effects on the fetus. Therefore, we performed synchronized electrical cardioversion eight times. After the eighth synchronized cardioversion at 200 J, the ECG showed successful restoration of sinus rhythm. The condition of the fetus was monitored via ultrasonography and cardiotocography, and no adverse events were observed. We present the case of a successful synchronized electrical cardioversion performed in a woman at 20 weeks of gestation because of sustained symptomatic VT.

Surgery
Critical Illness Neuromyopathy Complicating Cardiac Surgery: Wan Ki Baek, Young Sam Kim, Joung Taek Kim, Byoung-Nam Yoon; Acute Crit Care. 2018;33(1):51-56. Published online July 11, 2017; DOI: https://doi.org/10.4266/acc.2016.00255

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Abstract PDF

Critical illness neuromyopathy (CINM) is a sporadically reported disease in the setting of an intensive care unit developing in the process of managing a critical illness. The disease primarily affects the motor and sensory axons and results in severe limb weakness rendering ventilator weaning extremely difficult. We report a case of CINM after cardiac valve surgery. Quadriplegia developed after the operation and resolved slowly over the following 2 months. The patient was discharged home free of neurologic symptoms.

Citations

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Quadriplegia after Mitral Valve Replacement in an Infective Endocarditis Patient with Cervical Spine Spondylitis
Ji Min Lee, Seon Yeong Heo, Dong Kyu Kim, Jong Pil Jung, Chang Ryul Park, Yong Jik Lee, Gwan Sic Kim
Journal of Chest Surgery.2021; 54(3): 218. CrossRef
Perforated Toxic Megacolon: The Dreaded Complication in IBD
Kanmani Murugesu, PremanandanN Sivadasan, Michael Arvind, WilsonLiew Wei Xin
World Journal of Colorectal Surgery.2020; 9(4): 70. CrossRef

Letters to the Editor

Neurology
Implication of Neurological Pupil Index for Monitoring of Brain Edema: Tae Jung Kim, Sang-Bae Ko; Acute Crit Care. 2018;33(1):57-60. Published online February 28, 2018; DOI: https://doi.org/10.4266/acc.2017.00213

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Citations

Citations to this article as recorded by

Quantitative assessments of pupillary light reflexes in neurocritically ill patients
Tae Jung Kim
Journal of Neurocritical Care.2022; 15(2): 79. CrossRef
Automated Quantitative Pupillometry in the Critically Ill
Petra Opic, Stephan Rüegg, Stephan Marsch, Stephan Sebastian Gut, Raoul Sutter
Neurology.2021;[Epub] CrossRef
Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes
Tae Jung Kim, Soo-Hyun Park, Hae-Bong Jeong, Eun Jin Ha, Won Sang Cho, Hyun-Seung Kang, Jung Eun Kim, Sang-Bae Ko
Neurocritical Care.2020; 33(2): 575. CrossRef
Eyeing up the injured brain: automated pupillometry and optic nerve sheath diameter
Federico Romagnosi, Filippo Bongiovanni, Mauro Oddo
Current Opinion in Critical Care.2020; 26(2): 115. CrossRef
Objective Pupillometry as an Adjunct to Prediction and Assessment for Oculomotor Nerve Injury and Recovery: Potential for Practical Applications
Salah G. Aoun, Babu G. Welch, Michaela Cortes, Sonja E. Stutzman, Matthew C. MacAllister, Tarek Y. El Ahmadieh, Mohamed Osman, Stephen A. Figueroa, Jonathan A. White, Hunt H. Batjer, Daiwai M. Olson
World Neurosurgery.2019; 121: e475. CrossRef

Surgery
Inadequate Sedation Leads to Unexpected Postoperative Wound Evisceration during a Bedside Endoscopy: Im-kyung Kim, Se Hee Na, Joon Seong Park, Man Ki Ju, Cheung Soo Shin; Acute Crit Care. 2018;33(1):61-63. Published online February 28, 2018; DOI: https://doi.org/10.4266/acc.2017.00297

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Basic science and research
The Meaning in the History of Cover of KJCCM: Sung Jin Hong; Acute Crit Care. 2018;33(1):64-64. Published online February 28, 2018; DOI: https://doi.org/10.4266/acc.2018.00101

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