Acute and Critical Care

Volume 33 (3); August 2018

Review Article

Rapid response system
Deep Learning in the Medical Domain: Predicting Cardiac Arrest Using Deep Learning: Youngnam Lee, Joon-myoung Kwon, Yeha Lee, Hyunho Park, Hugh Cho, Jinsik Park; Acute Crit Care. 2018;33(3):117-120. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00290

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With the wider adoption of electronic health records, the rapid response team initially believed that mortalities could be significantly reduced but due to low accuracy and false alarms, the healthcare system is currently fraught with many challenges. Rule-based methods (e.g., Modified Early Warning Score) and machine learning (e.g., random forest) were proposed as a solution but not effective. In this article, we introduce the DeepEWS (Deep learning based Early Warning Score), which is based on a novel deep learning algorithm. Relative to the standard of care and current solutions in the marketplace, there is high accuracy, and in the clinical setting even when we consider the number of alarms, the accuracy levels are superior.

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Evaluation of optimal scene time interval for out-of-hospital cardiac arrest using a deep neural network
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Short-term load forecasting based on CEEMDAN and Transformer
Peng Ran, Kun Dong, Xu Liu, Jing Wang
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Artificial Intelligence in Resuscitation: A Scoping Review
Dmitriy Viderman, Yerkin Abdildin, Kamila Batkuldinova, Rafael Badenes, Federico Bilotta
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Prediction of Out-of-Hospital Cardiac Arrest Survival Outcomes Using a Hybrid Agnostic Explanation TabNet Model
Hung Viet Nguyen, Haewon Byeon
Mathematics.2023; 11(9): 2030. CrossRef
Enhancing breast cancer diagnosis with deep learning and evolutionary algorithms: A comparison of approaches using different thermographic imaging treatments
Alberto Nogales, Fernando Pérez-Lara, Álvaro J. García-Tejedor
Multimedia Tools and Applications.2023; 83(14): 42955. CrossRef
Machine learning pre-hospital real-time cardiac arrest outcome prediction (PReCAP) using time-adaptive cohort model based on the Pan-Asian Resuscitation Outcome Study
Hansol Chang, Ji Woong Kim, Weon Jung, Sejin Heo, Se Uk Lee, Taerim Kim, Sung Yeon Hwang, Sang Do Shin, Won Chul Cha, Marcus Ong
Scientific Reports.2023;[Epub] CrossRef
Attempting cardiac arrest prediction using artificial intelligence on vital signs from Electronic Health Records
Bassel Soudan, Fetna F. Dandachi, Ali Bou Nassif
Smart Health.2022; 25: 100294. CrossRef
BERT Learns From Electroencephalograms About Parkinson’s Disease: Transformer-Based Models for Aid Diagnosis
Alberto Nogales, Alvaro J. Garcia-Tejedor, Ana M. Maitin, Antonio Perez-Morales, Maria Dolores Del Castillo, Juan Pablo Romero
IEEE Access.2022; 10: 101672. CrossRef
Artificial intelligence decision points in an emergency department
Hansol Chang, Won Chul Cha
Clinical and Experimental Emergency Medicine.2022; 9(3): 165. CrossRef
Development of Prediction Models for Acute Myocardial Infarction at Prehospital Stage with Machine Learning Based on a Nationwide Database
Arom Choi, Min Joung Kim, Ji Min Sung, Sunhee Kim, Jayoung Lee, Heejung Hyun, Hyeon Chang Kim, Ji Hoon Kim, Hyuk-Jae Chang
Journal of Cardiovascular Development and Disease.2022; 9(12): 430. CrossRef
Short-Term Load Forecasting Based on Ceemdan and Transformer
Peng Ran, Kun Dong, Xu Liu, Jing Wang
SSRN Electronic Journal .2022;[Epub] CrossRef
A survey of deep learning models in medical therapeutic areas
Alberto Nogales, Álvaro J. García-Tejedor, Diana Monge, Juan Serrano Vara, Cristina Antón
Artificial Intelligence in Medicine.2021; 112: 102020. CrossRef
A predictive framework in healthcare: Case study on cardiac arrest prediction
Samaneh Layeghian Javan, Mohammad Mehdi Sepehri
Artificial Intelligence in Medicine.2021; 117: 102099. CrossRef
Development of Prediction Models for Acute Myocardial Infarction at Prehospital Stage with Machine Learning Based on a Nationwide Database (Preprint)
Arom Choi, Min Joung Kim, Ji Min Sung, Sunhee Kim, Jayong Lee, Heejung Hyun, Ji Hoon Kim, Hyuk-Jae Chang
JMIR Medical Informatics.2021;[Epub] CrossRef
Predicting in-hospital mortality in adult non-traumatic emergency department patients: a retrospective comparison of the Modified Early Warning Score (MEWS) and machine learning approach
Kuan-Han Wu, Fu-Jen Cheng, Hsiang-Ling Tai, Jui-Cheng Wang, Yii-Ting Huang, Chih-Min Su, Yun-Nan Chang
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Cardioinformatics: the nexus of bioinformatics and precision cardiology
Bohdan B Khomtchouk, Diem-Trang Tran, Kasra A Vand, Matthew Might, Or Gozani, Themistocles L Assimes
Briefings in Bioinformatics.2020; 21(6): 2031. CrossRef
Development of a Real-Time Risk Prediction Model for In-Hospital Cardiac Arrest in Critically Ill Patients Using Deep Learning: Retrospective Study
Junetae Kim, Yu Rang Park, Jeong Hoon Lee, Jae-Ho Lee, Young-Hak Kim, Jin Won Huh
JMIR Medical Informatics.2020; 8(3): e16349. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef

Original Articles

Hematology
Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units: Soo Jin Na, Tae Sun Ha, Younsuck Koh, Gee Young Suh, Shin Ok Koh, Chae-Man Lim, Won-Il Choi, Young-Joo Lee, Seok Chan Kim, Gyu Rak Chon, Je Hyeong Kim, Jae Yeol Kim, Jaemin Lim, Sunghoon Park, Ho Cheol Kim, Jin Hwa Lee, Ji Hyun Lee, Jisook Park, Juhee Cho, Kyeongman Jeon; Acute Crit Care. 2018;33(3):121-129. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00143

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Background
The objective of this study was to investigate the characteristics and clinical outcomes of critically ill cancer patients admitted to intensive care units (ICUs) in Korea.
Methods
This was a retrospective cohort study that analyzed prospective collected data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study, which is a nationwide, multicenter, and prospective study that considered 5,063 patients from 22 ICUs in Korea over a period of 7 months. Among them, patients older than 18 years of age who were diagnosed with solid or hematologic malignancies prior to admission to the ICU were included in the present study.
Results
During the study period, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. Six hundred fifty-eight (79%) had solid tumors and 175 (21%) had hematologic malignancies, respectively. Respiratory problems (30.1%) was the most common reason leading to ICU admission. Patients with hematologic malignancies had higher Sequential Organ Failure Assessment (12 vs. 8, P<0.001) and SAPS3 (71 vs. 69, P<0.001) values and were more likely to be associated with chemotherapy, steroid therapy, and immunocompromised status versus patients with solid tumors. The use of inotropes/ vasopressors, mechanical ventilation, and/or continuous renal replacement therapy was more frequently required in hematologic malignancy patients. Mortality rates in the ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) were higher in hematologic malignancy patients than in solid tumor patients.
Conclusions
Cancer patients accounted for one-third of all patients admitted to the studied ICUs in Korea. Clinical characteristics were different according to the type of malignancy. Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.

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Outcomes of Acute Respiratory Failure in Patients With Cancer in the United States
Kiyan Heybati, Jiawen Deng, Archis Bhandarkar, Fangwen Zhou, Cameron Zamanian, Namrata Arya, Mohamad Bydon, Philippe R. Bauer, Ognjen Gajic, Allan J. Walkey, Hemang Yadav
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Predictors of ICU mortality in patients with hemoblastosis and infectious complications
A.V. Lyanguzov, A.S. Luchinin, S.V. Ignatyev, I.V. Paramonov
Anesteziologiya i reanimatologiya.2023; (1): 33. CrossRef
Effect of the underlying malignancy on critically ill septic patient's outcome
Man‐Yee Man, Hoi‐Ping Shum, Sin‐Man Lam, Jacky Li, Wing‐Wa Yan, Mei‐Wan Yeung
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Impacts of Corticosteroid Therapy at Acute Stage of Hospital-Onset Clostridioides difficile Infections
Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
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Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy
Da Woon Kim, Geum Suk Jang, Kyoung Suk Jung, Hyuk Jae Jung, Hyo Jin Kim, Harin Rhee, Eun Young Seong, Sang Heon Song
Kidney Research and Clinical Practice.2022; 41(6): 717. CrossRef
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Lama H. Nazer, Maria A. Lopez-Olivo, Anne Rain Brown, John A. Cuenca, Michael Sirimaturos, Khader Habash, Nada AlQadheeb, Heather May, Victoria Milano, Amy Taylor, Joseph L. Nates
Critical Care Explorations.2022; 4(9): e0757. CrossRef
Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study
Jigeeshu Divatia, Amit M Narkhede, Harish K Chaudhari, Ujwal Dhundi, Natesh Prabu Ravisankar, Satish Sarode
Indian Journal of Critical Care Medicine.2021; 25(12): 1421. CrossRef

Trauma
Timing and Associated Factors for Sepsis-3 in Severe Trauma Patients: A 3-Year Single Trauma Center Experience: Seungwoo Chung, Donghwan Choi, Jayun Cho, Yo Huh, Jonghwan Moon, Junsik Kwon, Kyoungwon Jung, John-Cook Jong Lee, Byung Hee Kang; Acute Crit Care. 2018;33(3):130-134. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00122

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Background
We hypothesized that the recent change of sepsis definition by sepsis-3 would facilitate the measurement of timing of sepsis for trauma patients presenting with initial systemic inflammatory response syndrome. Moreover, we investigated factors associated with sepsis according to the sepsis-3 definition.
Methods
Trauma patients in a single level I trauma center were retrospectively reviewed from January 2014 to December 2016. Exclusion criteria were younger than 18 years, Injury Severity Score (ISS) <15, length of stay <8 days, transferred from other hospitals, uncertain trauma history, and incomplete medical records. A binary logistic regression test was used to identify the risk factors for sepsis-3.
Results
A total of 3,869 patients were considered and, after a process of exclusion, 422 patients were reviewed. Fifty patients (11.85%) were diagnosed with sepsis. The sepsis group presented with higher mortality (14 [28.0%] vs. 17 [4.6%], P<0.001) and longer intensive care unit stay (23 days [range, 11 to 35 days] vs. 3 days [range, 1 to 9 days], P<0.001). Multivariate analysis demonstrated that, in men, high lactate level and red blood cell transfusion within 24 hours were risk factors for sepsis. The median timing of sepsis-3 was at 8 hospital days and 4 postoperative days. The most common focus was the respiratory system.
Conclusions
Sepsis defined by sepsis-3 remains a critical issue in severe trauma patients. Male patients with higher ISS, lactate level, and red blood cell transfusion should be cared for with caution. Reassessment of sepsis should be considered at day 8 of hospital stay or day 4 postoperatively.

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Identifying biomarkers deciphering sepsis from trauma-induced sterile inflammation and trauma-induced sepsis
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Aisha Bakhtiar, Syed Jawad Haider Kazmi, Muhammad Sohaib Asghar, Muhammad Nadeem Khurshaidi, Salman Mazhar, Noman A Khan, Nisar Ahmed, Farah Yasmin, Rabail Yaseen, Maira Hassan
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Yo Huh, Junsik Kwon, Jonghwan Moon, Byung Hee Kang, Sora Kim, Jayoung Yoo, Seoyoung Song, Kyoungwon Jung
Journal of Korean Medical Science.2021;[Epub] CrossRef
The impact of infection complications after trauma differs according to trauma severity
Akira Komori, Hiroki Iriyama, Takako Kainoh, Makoto Aoki, Toshio Naito, Toshikazu Abe
Scientific Reports.2021;[Epub] CrossRef
Gene Expression–Based Diagnosis of Infections in Critically Ill Patients—Prospective Validation of the SepsisMetaScore in a Longitudinal Severe Trauma Cohort
Simone Thair, Caspar Mewes, José Hinz, Ingo Bergmann, Benedikt Büttner, Stephan Sehmisch, Konrad Meissner, Michael Quintel, Timothy E. Sweeney, Purvesh Khatri, Ashham Mansur
Critical Care Medicine.2021; 49(8): e751. CrossRef
Immunometabolic signatures predict risk of progression to sepsis in COVID-19
Ana Sofía Herrera-Van Oostdam, Julio E. Castañeda-Delgado, Juan José Oropeza-Valdez, Juan Carlos Borrego, Joel Monárrez-Espino, Jiamin Zheng, Rupasri Mandal, Lun Zhang, Elizabeth Soto-Guzmán, Julio César Fernández-Ruiz, Fátima Ochoa-González, Flor M. Trej
PLOS ONE.2021; 16(8): e0256784. CrossRef
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Fernanda Mas-Celis, Jimena Olea-López, Javier Alberto Parroquin-Maldonado
Archives of Medical Research.2021; 52(8): 808. CrossRef
New automated analysis to monitor neutrophil function point-of-care in the intensive care unit after trauma
Lillian Hesselink, Roy Spijkerman, Emma de Fraiture, Suzanne Bongers, Karlijn J. P. Van Wessem, Nienke Vrisekoop, Leo Koenderman, Luke P. H. Leenen, Falco Hietbrink
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Cardiology
Changes in the Characteristics and Long-term Mortality Rates of Intensive Care Unit Patients from 2003 to 2010: A Nationwide Population-Based Cohort Study Performed in the Republic of Korea: Jeongwon Heo, Yoonki Hong, Seon-Sook Han, Woo Jin Kim, Jae-Woo Kwon, Ki Won Moon, Jae Hoon Jeong, Young-Ju Kim, Seung-Hwan Lee, Seung-Joon Lee; Acute Crit Care. 2018;33(3):135-145. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00164

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Background
There are few studies on intensive care unit (ICU) patients in the Republic of Korea. We analyzed the characteristics and mortality changes of all ICU patients over the last 8 years.
Methods
This study used the cohort of the National Health Insurance Corporation, which provides medical care to all residents of the Republic of Korea. The cohort consists of patients aged 20 years or older between 2003 and 2010 with a history of ICU admission. We analyzed changes in sex, age, household income, number of hospital beds, emergency admissions, and reasons for admission using the Cochran–Armitage trend test. The adjusted hazard ratios (HRs) of mortality according to these variables and year of admission were calculated by Cox proportional hazards regression.
Results
The proportion of patients aged ≥70 years increased over that period, as did their average age (by 3.6 years). During the 8-year study period, the 3-year mortality rate was 32.91%–35.83%. The overall mortality was higher in males and older patients, in those with a lower household income and higher Charlson Comorbidity Index (CCI) score, those admitted to a hospital with a smaller number of beds, and those admitted via the emergency room. There was no significant change in crude mortality rate over the 8-year study period; however, the adjusted HR showed a decreasing trend.
Conclusions
Patients admitted to the ICU were older and had higher CCI score. Nevertheless, there was a temporal trend toward a decrease in the HR of long-term mortality.

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Trends in Mortality after Intensive Care of Patients with Aneurysmal Subarachnoid Hemorrhage in Finland in 2003–2019: A Finnish Intensive Care Consortium study
Jyri J. Virta, Markus Skrifvars, Matti Reinikainen, Stepani Bendel, Ruut Laitio, Sanna Hoppu, Tero Ala-Kokko, Jari Siironen, Rahul Raj
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The Korean Journal of Internal Medicine.2022; 37(3): 618. CrossRef
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Pulmonary
Feasibility of Immediate in-Intensive Care Unit Pulmonary Rehabilitation after Lung Transplantation: A Single Center Experience: Joo Han Song, Ji-Eun Park, Sang Chul Lee, Sarang Kim, Dong Hyung Lee, Eun Kyoung Kim, Song Yee Kim, Ji Cheol Shin, Jin Gu Lee, Hyo Chae Paik, Moo Suk Park; Acute Crit Care. 2018;33(3):146-153. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00129

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Background
Physical function may influence perioperative outcomes of lung transplantation. We investigated the feasibility of a pulmonary rehabilitation program initiated in the immediate postoperative period at an intensive care unit (ICU) for patients who underwent lung transplantation.
Methods
We retrospectively evaluated 22 patients who received pulmonary rehabilitation initiated in the ICU within 2 weeks after lung transplantation at our institution from March 2015 to February 2016. Levels of physical function were graded at the start of pulmonary rehabilitation and then weekly throughout rehabilitation according to criteria from our institutional pulmonary rehabilitation program: grade 1, bedside (G1); grade 2, dangling (G2); grade 3, standing (G3); and grade IV, gait (G4).
Results
The median age of patients was 53 years (range, 25 to 73 years). Fourteen patients (64%) were males. The initial level of physical function was G1 in nine patients, G2 in seven patients, G3 in four patients, and G4 in two patients. Patients started pulmonary rehabilitation at a median of 7.5 days (range, 1 to 29 days) after lung transplantation. We did not observe any rehabilitation-related complications during follow-up. The final level of physical function was G1 in six patients, G3 in two patients, and G4 in 14 patients. Fourteen of the 22 patients were able to walk with or without assistance, and 13 of them maintained G4 until discharge; the eight remaining patients never achieved G4.
Conclusions
Our results suggest the feasibility of early pulmonary rehabilitation initiated in the ICU within a few days after lung transplantation.

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Basic science and research
Anti-inflammatory Role of Mesenchymal Stem Cells in an Acute Lung Injury Mouse Model: Jin Won Huh, Won Young Kim, Yun Young Park, Chae-Man Lim, Younsuck Koh, Mi-Jung Kim, Sang-Bum Hong; Acute Crit Care. 2018;33(3):154-161. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00619

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Background
Mesenchymal stem cells (MSCs) attenuate injury in various lung injury models through paracrine effects. We hypothesized that intratracheal transplantation of allogenic MSCs could attenuate lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice, mediated by anti-inflammatory responses.
Methods
Six-week-old male mice were randomized to either the control or the ALI group. ALI was induced by intratracheal LPS instillation. Four hours after LPS instillation, MSCs or phosphate-buffered saline was randomly intratracheally administered. Neutrophil count and protein concentration in bronchoalveolar lavage fluid (BALF); lung histology; levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and macrophage inflammatory protein-2; and the expression of proliferation cell nuclear antigen (PCNA), caspase-3, and caspase-9 were evaluated at 48 hours after injury.
Results
Treatment with MSCs attenuated lung injury in ALI mice by decreasing protein level and neutrophil recruitment into the BALF and improving the histologic change. MSCs also decreased the protein levels of proinflammatory cytokines including IL-1β, IL-6, and TNF-α, but had little effect on the protein expression of PCNA, caspase-3, and caspase-9.
Conclusions
Intratracheal injection of bone marrow-derived allogenic MSCs attenuates LPSinduced ALI via immunomodulatory effects.

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Frontiers in Cardiovascular Medicine.2020;[Epub] CrossRef

Trauma
Usefulness of Rotational Thromboelastometry as a Mortality Predictor of Hyperfibrinolysis in Patients with Severe Trauma: Ji Soo Kim, Il Jae Wang, Seok Ran Yeom, Suck Ju Cho, Jae Hun Kim, June Pill Seok, Seong Hwa Lee, Byung Gwan Bae, Mun Ki Min; Acute Crit Care. 2018;33(3):162-169. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00199

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Abstract PDF

Background
Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma.
Methods
Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed.
Results
During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P<0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality.
Conclusions
Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma.

Citations

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A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage
Finn Gunn, Rheanna Stevenson, Ateeq Almuwallad, Andrea Rossetto, Paul Vulliamy, Karim Brohi, Ross Davenport
Journal of Trauma and Acute Care Surgery.2024; 96(2): 216. CrossRef
A retrospective validation of ROTEM algorithms for detecting hyperfibrinolysis demonstrates poor agreement for prediction of in-hospital mortality and transfusion requirement in a general, non-cardiac, surgical population
Leon Rosebery, Matthew Miller, Peter Loizou, Shir Jing Ho, Keith J. Adkins, Kush Deshpande
Thrombosis Research.2023; 229: 170. CrossRef
Questions about COVID-19 associated coagulopathy: possible answers from the viscoelastic tests
Vittorio Pavoni, Lara Gianesello, Maddalena Pazzi, Pietro Dattolo, Domenico Prisco
Journal of Clinical Monitoring and Computing.2022; 36(1): 55. CrossRef
Clinical value of early assessment of hyperfibrinolysis by rotational thromboelastometry during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands
Marije Tahitu, Paul I. Ramler, Ada Gillissen, Camila Caram‐Deelder, Dacia D. C. A. Henriquez, Moniek P. M. de Maat, Johannes J. Duvekot, Jeroen Eikenboom, Kitty W. M. Bloemenkamp, Thomas van den Akker, Johanna G. van der Bom
Acta Obstetricia et Gynecologica Scandinavica.2022; 101(1): 145. CrossRef
ROTEM diagnostic capacity for measuring fibrinolysis in neonatal sepsis
Maria Lampridou, Rozeta Sokou, Andreas G. Tsantes, Martha Theodoraki, Aikaterini Konstantinidi, Georgios Ioakeimidis, Stefanos Bonovas, Marianna Politou, Serena Valsami, Zoe Iliodromiti, Theodora Boutsikou, Nicoletta Iacovidou, Georgios Nikolopoulos, Argi
Thrombosis Research.2020; 192: 103. CrossRef
The Immunologic Effect of Early Intravenous Two and Four Gram Bolus Dosing of Tranexamic Acid Compared to Placebo in Patients With Severe Traumatic Bleeding (TAMPITI): A Randomized, Double-Blind, Placebo-Controlled, Single-Center Trial
Philip C. Spinella, Kimberly A. Thomas, Isaiah R. Turnbull, Anja Fuchs, Kelly Bochicchio, Douglas Schuerer, Stacey Reese, Adrian A. Coleoglou Centeno, Christopher B. Horn, Jack Baty, Susan M. Shea, M. Adam Meledeo, Anthony E. Pusateri, Jerrold H. Levy, An
Frontiers in Immunology.2020;[Epub] CrossRef

CPR/Resuscitation
Validation of Pediatric Index of Mortality 3 for Predicting Mortality among Patients Admitted to a Pediatric Intensive Care Unit: Jae Hwa Jung, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn; Acute Crit Care. 2018;33(3):170-177. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00150

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Abstract PDF

Background
The objective of this study was to evaluate the usefulness of the newest version of the pediatric index of mortality (PIM) 3 for predicting mortality and validating PIM 3 in Korean children admitted to a single intensive care unit (ICU).
Methods
We enrolled children at least 1 month old but less than 18 years of age who were admitted to the medical ICU between March 2009 and February 2015. Performances of the pediatric risk of mortality (PRISM) III, PIM 2, and PIM 3 were evaluated by assessing the area under the receiver operating characteristic (ROC) curve, conducting the Hosmer-Lemeshow test, and calculating the standardized mortality ratio (SMR).
Results
In total, 503 children were enrolled; the areas under the ROC curve for PRISM III, PIM 2, and PIM 3 were 0.775, 0.796, and 0.826, respectively. The area under the ROC curve was significantly greater for PIM 3 than for PIM 2 (P<0.001) and PRISM III (P=0.016). There were no significant differences in the Hosmer-Lemeshow test results for PRISM III (P=0.498), PIM 2 (P=0.249), and PIM 3 (P=0.337). The SMR calculated using PIM 3 (1.11) was closer to 1 than PIM 2 (0.84).
Conclusions
PIM 3 showed better prediction of the risk of mortality than PIM 2 for the Korean pediatric population admitted in the ICU.

Citations

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Clinical Features and Management of Status Epilepticus in the Pediatric Intensive Care Unit
Ekin Soydan, Yigithan Guzin, Sevgi Topal, Gulhan Atakul, Mustafa Colak, Pinar Seven, Ozlem Sarac Sandal, Gokhan Ceylan, Aycan Unalp, Hasan Agin
Pediatric Emergency Care.2023; 39(3): 142. CrossRef
Evaluation of the Performance of PRISM III and PIM II Scores in a Tertiary Pediatric Intensive Care Unit
Büşra Uzunay Gündoğan, Oğuz Dursun, Nazan Ülgen Tekerek, Levent Dönmez
Turkish Journal of Pediatric Emergency and Intensive Care Medicine.2023; 10(1): 8. CrossRef
Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study
Jaeyoung Choi, Esther Park, Ah Young Choi, Meong Hi Son, Joongbum Cho
Journal of Korean Medical Science.2023;[Epub] CrossRef
Internal validation and evaluation of the predictive performance of models based on the PRISM-3 (Pediatric Risk of Mortality) and PIM-3 (Pediatric Index of Mortality) scoring systems for predicting mortality in Pediatric Intensive Care Units (PICUs)
Zahra Rahmatinejad, Fatemeh Rahmatinejad, Majid Sezavar, Fariba Tohidinezhad, Ameen Abu-Hanna, Saeid Eslami
BMC Pediatrics.2022;[Epub] CrossRef
Performance of Pediatric Risk of Mortality III and Pediatric Index of Mortality III Scores in Tertiary Pediatric Intensive Unit in Saudi Arabia
Ahmed S. Alkhalifah, Abdulaziz AlSoqati, Jihad Zahraa
Frontiers in Pediatrics.2022;[Epub] CrossRef
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 and Critical Care.2022; 37(3): 454. CrossRef
Administrative data in pediatric critical care research—Potential, challenges, and future directions
Nora Bruns, Anna-Lisa Sorg, Ursula Felderhoff-Müser, Christian Dohna-Schwake, Andreas Stang
Frontiers in Pediatrics.2022;[Epub] CrossRef
Development of a machine learning model for predicting pediatric mortality in the early stages of intensive care unit admission
Bongjin Lee, Kyunghoon Kim, Hyejin Hwang, You Sun Kim, Eun Hee Chung, Jong-Seo Yoon, Hwa Jin Cho, June Dong Park
Scientific Reports.2021;[Epub] CrossRef
Meta-Analysis for the Prediction of Mortality Rates in a Pediatric Intensive Care Unit Using Different Scores: PRISM-III/IV, PIM-3, and PELOD-2
Yaping Shen, Juan Jiang
Frontiers in Pediatrics.2021;[Epub] CrossRef
Simplified Pediatric Index of Mortality 3 Score by Explainable Machine Learning Algorithm
Orkun Baloglu, Matthew Nagy, Chidiebere Ezetendu, Samir Q. Latifi, Aziz Nazha
Critical Care Explorations.2021; 3(10): e0561. CrossRef
Performance of Pediatric Index of Mortality in a Tertiary Care PICU in India
Nisha Toteja, Bharat Choudhary, Daisy Khera, Rohit Sasidharan, Prem Prakash Sharma, Kuldeep Singh
Journal of Pediatric Intensive Care.2021;[Epub] CrossRef

Basic science and research
Specification of Subject Sex in Oncology-Related Animal Studies: Sukyo Lee, Won Jun Kim, Yeong Jeon, Choon Hak Lim, Kyung Sun; Acute Crit Care. 2018;33(3):178-184. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2017.00444

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Abstract PDF: Background
Growing evidence for clinically significant differences between the sexes has attracted the attention of researchers. However, failures to report a test animal sex and balance the sex ratios of study samples remain widespread in preclinical investigations. We analyzed the sex-reporting rate and sex distributions of test animals in published oncology studies.
Methods
We selected five oncology journals included in the Scientific Citation Index (SCI) based on impact factors. We identified preclinical investigations with in vivo mouse experiments published in 2015 for inclusion in our study sample. We classified each article by whether or not it reported test subject sex, and by which sex was included. We also recorded whether there were justifications for using one particular sex in single-sex studies (e.g., anatomical reasons) and whether sex-based analyses were conducted for both-sex studies.
Results
We surveyed a total of 382 articles. Half (50.3%) failed to report test animal sex. Among articles that did report sex, 91.7% were single-sex studies, of which 69.4% did not provide any justifications for using the sex included in the study. Relatively few studies 15.7 studies included animals of both sexes, and only 2.3 studies conducted sex-based analyses. These findings are consistent with those of previous research that used other methods to collect data from the literature such as text mining, but our analysis of the provision of justifications for using one sex versus the other is a novel feature.
Conclusions
Many researchers overlook test subject sex as a factor, but test animal sex should be reported in all preclinical investigations to enhance the reproducibility of research and avoid faulty conclusions drawn from one-sided studies.

Editorial

Ethics
Artificial Intelligence Is around Us. Let’s Pick Up!: Jaehwa Cho; Acute Crit Care. 2018;33(3):185-186. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00269

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PDF

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Evidence revealed the effects of rapid response system
Jae Hwa Cho
Acute and Critical Care.2019; 34(4): 282. CrossRef

Case Reports

Basic science and research
Spinal Cord Infarction in a Patient Undergoing Veno-arterial Extracorporeal Membrane Oxygenation: Beomsu Shin, Yang Hyun Cho, Jin-Ho Choi, Jeong Hoon Yang; Acute Crit Care. 2018;33(3):187-190. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2016.00556

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Abstract PDF

Spinal cord infarction is an uncommon, but serious disorder characterized by severe motor impairment and bladder and bowel dysfunction. Spinal cord infarction is likely caused by hypoperfusion at the thoraco-lumbar spinal cord due to diverse reasons. An 81-year-old woman without motor or neurologic dysfunction presented with cardiogenic shock due to acute myocardial infarction. We performed veno-arterial extracorporeal membrane oxygenation (VA ECMO) to maintain adequate organ perfusion. Lower limb weakness was noted on day 1 of ECMO support. Although the symptom persisted, we could not carry out further evaluation because of her hemodynamic instability. After removal of ECMO, spinal magnetic resonance imaging was performed and showed a signal abnormality extending from the level of T5 to the conus medullaris. The patient underwent conservative management, but eventually experienced limb paralysis. Herein, we report a case of spinal cord infarction in a patient with myocardial infarction during VA ECMO support.

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In patients supported with peripheral veno-arterial extracorporeal membrane oxygenation, what factors are associated with the development of spinal cord ischaemia?
Alison Zhu, Charis Tan, Richard Chard, Yishay Orr
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Neurological Complications of the Lower Extremities After Femoral Cannulated Extracorporeal Membrane Oxygenation: A Systematic Review
Frauke Johannes, Rahel Frohofer-Vollenweider, Yvonne Teuschl
Journal of Intensive Care Medicine.2023;[Epub] CrossRef
Spinal cord infarction after withdrawal of veno-arterial extracorporeal membrane oxygenation for cardiogenic shock: A case report
Hideya Itagaki, Kohei Suzuki, Tomoya Oizumi, Keiko Nakagawa, Yoshinobu Abe, Tomoyuki Endo
Medicine.2022; 101(45): e31743. CrossRef
Imaging Adult ECMO
Ramya Gaddikeri, Jennifer Febbo, Palmi Shah
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Extracorporeal membrane oxygenation-related spinal cord infarction: A case report
Shih-Chao Chien, Li-Kuo Kuo, Shih-Chun Chien, Yu-Jang Su
Interdisciplinary Neurosurgery.2021; 23: 101028. CrossRef
Spinal Cord Infarction During Femoral Venoarterial Extracorporeal Membrane Oxygenation
Michael Salna, James Beck, Josh Willey, Koji Takeda
The Annals of Thoracic Surgery.2021; 111(4): e279. CrossRef
Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: an Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation
Michael A. Mazzeffi, Vidya K. Rao, Jeffrey Dodd-o, Jose Mauricio Del Rio, Antonio Hernandez, Mabel Chung, Amit Bardia, Rebecca M. Bauer, Joseph S. Meltzer, Sree Satyapriya, Raymond Rector, James G. Ramsay, Jacob Gutsche
Journal of Cardiothoracic and Vascular Anesthesia.2021; 35(12): 3496. CrossRef
Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation
Michael A. Mazzeffi, Vidya K. Rao, Jeffrey Dodd-o, Jose Mauricio Del Rio, Antonio Hernandez, Mabel Chung, Amit Bardia, Rebecca M. Bauer, Joseph S. Meltzer, Sree Satyapriya, Raymond Rector, James G. Ramsay, Jacob Gutsche
Anesthesia & Analgesia.2021; 133(6): 1459. CrossRef
Spinal cord infarction and peripheral extracorporeal membrane oxygenation: a case series
Shivanand Gangahanumaiah, Michael Zhu, Robyn Summerhayes, Silvana F Marasco, Kyriakos Dimitriadis, Milenko Zoran Cankovic, Vasilios Giampatzis, Panagiotis Xaplanteris, Hibba Kurdi, Aiste Monika Jakstaite
European Heart Journal - Case Reports.2021;[Epub] CrossRef

Pulmonary
Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period: In Soo Han, Bo Mi Han, Soo Yeon Jung, Jun Rho Yoon, Eun Yong Chung; Acute Crit Care. 2018;33(3):191-195. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2016.00689

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Abstract PDF

Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.

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Larri Rudman, Javier B Chambi-Torres, Farah Chohan, Mohammad Aftab, Xinyu Cao, George Michel
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Yumin Jo, Jagyung Hwang, Jieun Lee, Hansol Kang, Boohwi Hong
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Incidence of negative-pressure pulmonary edema following sugammadex administration during anesthesia emergence: A pilot audit of 27,498 general anesthesia patients and literature review
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Journal of Clinical Anesthesia.2020; 62: 109728. CrossRef

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