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Volume 36 (4); November 2021
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Review Articles
Pulmonary
High-flow nasal cannula for respiratory failure in adult patients
SeungYong Park
Acute Crit Care. 2021;36(4):275-285.   Published online November 30, 2021
DOI: https://doi.org/10.4266/acc.2021.01571
  • 17,607 View
  • 959 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract PDF
The high-flow nasal cannula (HFNC) has been recently used in several clinical settings for oxygenation in adults. In particular, the advantages of HFNC compared with low-flow oxygen systems or non-invasive ventilation include enhanced comfort, increased humidification of secretions to facilitate expectoration, washout of nasopharyngeal dead space to improve the efficiency of ventilation, provision of a small positive end-inspiratory pressure effect, and fixed and rapid delivery of an accurate fraction of inspired oxygen (FiO2) by minimizing the entrainment of room air. HFNC has been successfully used in critically ill patients with several conditions, such as hypoxemic respiratory failure, hypercapneic respiratory failure (exacerbation of chronic obstructive lung disease), post-extubation respiratory failure, pre-intubation oxygenation, and others. However, the indications are not absolute, and much of the proven benefit remains subjective and physiologic. This review discusses the practical application and clinical uses of HFNC in adults, including its unique respiratory physiologic effects, device settings, and clinical indications.

Citations

Citations to this article as recorded by  
  • Asymmetrical high-flow nasal cannula performs similarly to standard interface in patients with acute hypoxemic post-extubation respiratory failure: a pilot study
    Annalisa Boscolo, Tommaso Pettenuzzo, Francesco Zarantonello, Nicolò Sella, Elisa Pistollato, Alessandro De Cassai, Sabrina Congedi, Irene Paiusco, Giacomo Bertoldo, Silvia Crociani, Francesca Toma, Giulia Mormando, Giulia Lorenzoni, Dario Gregori, Paolo
    BMC Pulmonary Medicine.2024;[Epub]     CrossRef
  • Recommendations from The Medical Education Editor
    Mark Lavercombe
    Respirology.2024; 29(4): 266.     CrossRef
  • Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines
    Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park
    Acute and Critical Care.2024; 39(1): 1.     CrossRef
  • Clinical Practice of High-Flow Nasal Cannula Therapy in ARDS Patients: A Cross-Sectional Survey of Respiratory Therapists
    Mohammed Alyami, Abdulelah Aldhahir, Abdullah Alqarni, Khalid Salwi, Abdullah Sarhan, Mohammed Almeshari, Nowaf Alobaidi, Jaber Alqahtani, Rayan Siraj, Abdullah Alsulayyim, Saeed Alghamdi, Ahmed Alasimi, Omar Alqarni, Mansour Majrshi, Hassan Alwafi
    Journal of Multidisciplinary Healthcare.2024; Volume 17: 1401.     CrossRef
  • The Impact of High-Flow Nasal Cannula Therapy on Acute Respiratory Distress Syndrome Patients: A Systematic Review
    Ahmed M Abdelbaky, Wael G Elmasry , Ahmed H. Awad, Sarrosh Khan, Maryam Jarrahi
    Cureus.2023;[Epub]     CrossRef
  • High-Flow Oxygen Therapy in the Perioperative Setting and Procedural Sedation: A Review of Current Evidence
    Lou’i Al-Husinat, Basil Jouryyeh, Ahlam Rawashdeh, Abdelrahman Alenaizat, Mohammad Abushehab, Mohammad Wasfi Amir, Zaid Al Modanat, Denise Battaglini, Gilda Cinnella
    Journal of Clinical Medicine.2023; 12(20): 6685.     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
  • Transnasal High-Flow Oxygen Therapy versus Noninvasive Positive Pressure Ventilation in the Treatment of COPD with Type II Respiratory Failure: A Meta-Analysis
    Wei Liu, Mingli Zhu, Liuqin Xia, Xiangying Yang, Pei Huang, Yanming Sun, Ye Shen, Jianping Ma, Gang Chen
    Computational and Mathematical Methods in Medicine.2022; 2022: 1.     CrossRef
  • Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis
    Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
    Acute and Critical Care.2022; 37(4): 561.     CrossRef
  • Effect of high-flow oxygen versus T-piece ventilation strategies during spontaneous breathing trials on weaning failure among patients receiving mechanical ventilation: a randomized controlled trial
    Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee
    Critical Care.2022;[Epub]     CrossRef
Pulmonary
Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages
Vorakamol Phoophiboon, Monvasi Pachinburavan, Nicha Ruamsap, Natthawan Sanguanwong, Nattapong Jaimchariyatam
Acute Crit Care. 2021;36(4):286-293.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00458
  • 6,523 View
  • 431 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDF
The mortality rate of pulmonary hypertension in pregnancy is 25%–56%. Pulmonary arterial hypertension is the highest incidence among this group, especially in young women. Despite clear recommendation of pregnancy avoidance, certain groups of patients are initially diagnosed during the gestational age step into the third trimester. While the presence of right ventricular failure in early gestation is usually trivial, it can be more severe in the late trimester. Current evidence shows no consensus in the management and serious precautions for each stage of the pre-, peri- and post-partum periods of this specific group. Pulmonary hypertension-targeted drugs, mode of delivery, type of anesthesia, and some avoidances should be planned among a multidisciplinary team to enhance maternal and fetal survival opportunities. Sudden circulatory collapse from cardiac decompensation during the peri- and post-partum phases is detrimental, and mechanical support such as extracorporeal membrane oxygenation should be considered for mitigating hemodynamics and extending cardiac recovery time. Our review aims to explain the pathophysiology of pulmonary arterial hypertension and summarize the current evidence for critical management and precautions in each stage of pregnancy.

Citations

Citations to this article as recorded by  
  • Maternal Outcomes Among Pregnant Women With Congenital Heart Disease–Associated Pulmonary Hypertension
    Qian Zhang, Fang Zhu, Guocheng Shi, Chen Hu, Weituo Zhang, Puzhen Huang, Chunfeng Zhu, Hong Gu, Dong Yang, Qiangqiang Li, Yonghua Niu, Hao Chen, Ruixiang Ma, Ziyi Pan, Huixian Miao, Xin Zhang, Genxia Li, Yabing Tang, Guyuan Qiao, Yichen Yan, Zhongqun Zhu,
    Circulation.2023; 147(7): 549.     CrossRef
  • Pregnancy in Patients with Pulmonary Arterial Hypertension in Light of New ESC Guidelines on Pulmonary Hypertension
    Karolina Barańska-Pawełczak, Celina Wojciechowska, Wojciech Jacheć
    International Journal of Environmental Research and Public Health.2023; 20(5): 4625.     CrossRef
  • Pregnancy in Severe Pulmonary Hypertension: A Case Report and Literature Analysis
    一人 王
    Advances in Clinical Medicine.2023; 13(10): 16433.     CrossRef
  • Effects of maternal pulmonary arterial hypertension on fetal hemodynamics and maternal‐fetal outcome in late pregnancy
    Yuan Yuan Xing, Yanping Ruan, Huai Qin, Lei Zhao, Qing Zhao, Yun Wei, Jie Chen, Xiaohai Ma
    Echocardiography.2023; 40(12): 1339.     CrossRef
  • Clinical Analysis in 82 Pregnant Women with the Severity of Pulmonary Hypertension
    安芬 李
    Advances in Clinical Medicine.2023; 13(11): 18492.     CrossRef
Original Articles
Nursing
Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients
Suphannee Triamvisit, Wassana Wongprasert, Chalermwoot Puttima, Matchima Na Chiangmai, Nawaphan Thienjindakul, Laksika Rodkul, Chumpon Jetjumnong
Acute Crit Care. 2021;36(4):294-299.   Published online November 23, 2021
DOI: https://doi.org/10.4266/acc.2021.00983
  • 7,434 View
  • 386 Download
AbstractAbstract PDF
Background
Care bundles for ventilator-associated pneumonia (VAP) have been shown to minimize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bundles lowered the risk of VAP in neurosurgical patients.
Methods
A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of intermittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group.
Results
A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occurrence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036).
Conclusions
The modified VAP bundle is effective in lowering the VAP rate in critically ill neurosurgical patients. It requires low budget and manpower and can be employed in resource-constrained settings.
Infection
Association of vitamin D deficiency with COVID-19 severity and mortality in Iranian people: a prospective observational study
Alireza Fatemi, Seyed Hossein Ardehali, Ghazaleh Eslamian, Morvarid Noormohammadi, Shirin Malek
Acute Crit Care. 2021;36(4):300-307.   Published online November 29, 2021
DOI: https://doi.org/10.4266/acc.2021.00605
  • 5,734 View
  • 128 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract PDF
Background
As the coronavirus disease 2019 (COVID-19) pandemic continues to escalate, it is important to identify the prognostic factors related to increased mortality and disease severity. To assess the possible associations of vitamin D level with disease severity and survival, we studied 248 hospitalized COVID-19 patients in a single center in a prospective observational study from October 2020 to May 2021 in Tehran, Iran.
Methods
Patients who had a record of their 25-hydroxyvitamin D level measured in the previous year before testing positive with COVID-19 were included. Serum 25-hydroxyvitamin D level was measured upon admission in COVID-19 patients. The associations between clinical outcomes of patients and 25-hydroxyvitamin D level were assessed by adjusting for potential confounders and estimating a multivariate logistic regression model.
Results
The median (interquartile range) age of patients was 60 years (44–74 years), and 53% were male. The median serum 25-hydroxyvitamin D level prior to admission decreased with increasing COVID-19 severity (P=0.009). Similar findings were obtained when comparing median serum 25-hydroxyvitamin D on admission between moderate and severe patients (P=0.014). A univariate logistic regression model showed that vitamin D deficiency prior to COVID-19 was associated with a significant increase in the odds of mortality (odds ratio, 2.01; P=0.041). The Multivariate Cox model showed that vitamin D deficiency on admission was associated with a significant increase in risk for mortality (hazard ratio, 2.35; P=0.019).
Conclusions
Based on our results, it is likely that deficient vitamin D status is associated with increased mortality in COVID-19 patients. Thus, evaluating vitamin D level in COVID-19 patients is warranted.

Citations

Citations to this article as recorded by  
  • The close association of micronutrients with COVID-19
    Aimin Zhang, Yue Yin, Jiashu Tian, Xialin Wang, Zhihong Yue, Lin Pei, Li Liu, Li Qin, Mei Jia, Hui Wang, Qingwei Ma, Wei-bo Gao, Lin-Lin Cao
    Heliyon.2024; 10(7): e28629.     CrossRef
  • The bounds of meta-analytics and an alternative method
    Ramalingam Shanmugam, Mohammad Tabatabai, Derek Wilus, Karan P Singh
    Epidemiology and Health.2024; : e2024016.     CrossRef
  • Systematic Mendelian randomization study of the effect of gut microbiome and plasma metabolome on severe COVID-19
    Han Yan, Si Zhao, Han-Xue Huang, Pan Xie, Xin-He Cai, Yun-Dan Qu, Wei Zhang, Jian-Quan Luo, Longbo Zhang, Xi Li
    Frontiers in Immunology.2023;[Epub]     CrossRef
  • Risk Factors Associated with Severity and Death from COVID-19 in Iran: A Systematic Review and Meta-Analysis Study
    Ahmad Mehri, Sahar Sotoodeh Ghorbani, Kosar Farhadi-Babadi, Elham Rahimi, Zahra Barati, Niloufar Taherpour, Neda Izadi, Fatemeh Shahbazi, Yaser Mokhayeri, Arash Seifi, Saeid Fallah, Rezvan Feyzi, Koorosh Etemed, Seyed Saeed Hashemi Nazari
    Journal of Intensive Care Medicine.2023; 38(9): 825.     CrossRef
  • Vitamin D: A Role Also in Long COVID-19?
    Luigi Barrea, Ludovica Verde, William B. Grant, Evelyn Frias-Toral, Gerardo Sarno, Claudia Vetrani, Florencia Ceriani, Eloisa Garcia-Velasquez, José Contreras-Briceño, Silvia Savastano, Annamaria Colao, Giovanna Muscogiuri
    Nutrients.2022; 14(8): 1625.     CrossRef
Nephrology
COVID-19–induced acute kidney injury in critically ill patients: epidemiology, risk factors, and outcome
Ahlem Trifi, Sami Abdellatif, Yosri Masseoudi, Asma Mehdi, Oussama Benjima, Eya Seghir, Fatma Cherif, Yosr Touil, Bedis Jeribi, Foued Daly, Cyrine Abdennebi, Adel Ammous, Salah Ben Lakhal
Acute Crit Care. 2021;36(4):308-316.   Published online November 22, 2021
DOI: https://doi.org/10.4266/acc.2021.00934
  • 5,610 View
  • 123 Download
  • 7 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Background
The kidney represents a potential target for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Acute kidney injury (AKI) can occur through several mechanisms and includes intrinsic tissue injury by direct viral invasion. Clinical data about the clinical course of AKI are lacking. We aimed to investigate the proportion, risk factors, and prognosis of AKI in critical patients affected with coronavirus disease 2019 (COVID-19).
Methods
A case/control study conducted in two intensive care units of a tertiary teaching hospital from September to December 2020.
Results
Among 109 patients, 75 were male (69%), and the median age was 64 years (interquartile range [IQR], 57–71 years); 48 (44%) developed AKI within 4 days (IQR, 1–9). Of these 48 patients, 11 (23%), 9 (19%), and 28 (58%) were classified as stage 1, 2, and 3, respectively. Eight patients received renal replacement therapy. AKI patients were older and had more frequent sepsis, acute respiratory distress syndrome, and rhabdomyolysis; higher initial urea and creatinine; more marked inflammatory syndrome and hematological disorders; and required more frequent mechanical ventilation and vasopressors. An elevated level of D-dimers (odds ratio [OR], 12.83; 95% confidence interval [CI], 1.9–85) was an independent factor of AKI. Sepsis was near to significance (OR, 5.22; 95% CI, 0.94–28; P=0.058). Renal recovery was identified in three patients. AKI, hypoxemia with the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen <70, and vasopressors were identified as mortality factors.
Conclusions
AKI occurred in almost half the patients with critical COVID-19. A high level of D-dimers and sepsis contributed significantly to its development. AKI significantly worsened the prognosis in these patients.

Citations

Citations to this article as recorded by  
  • Acute kidney injury in adult patients with COVID-19: an integrative review
    Ana Clara Alcântara Mendes Pereira, Jéssica Cristina Almeida, Beatriz Regina Lima de Aguiar, Elaine Barros Ferreira, Priscilla Roberta Silva Rocha
    Acta Paulista de Enfermagem.2024;[Epub]     CrossRef
  • Lesão renal aguda em pacientes adultos com COVID-19: revisão integrativa
    Ana Clara Alcântara Mendes Pereira, Jéssica Cristina Almeida, Beatriz Regina Lima de Aguiar, Elaine Barros Ferreira, Priscilla Roberta Silva Rocha
    Acta Paulista de Enfermagem.2024;[Epub]     CrossRef
  • Impact of COVID-19 in patients hospitalized with stress cardiomyopathy: A nationwide analysis
    Adrija Hajra, Aaqib Malik, Dhrubajyoti Bandyopadhyay, Akshay Goel, Ameesh Isath, Rahul Gupta, Suraj Krishnan, Devesh Rai, Chayakrit Krittanawong, Salim S. Virani, Gregg C. Fonarow, Carl J. Lavie
    Progress in Cardiovascular Diseases.2023; 76: 25.     CrossRef
  • Prior bariatric surgery and risk of poor in-hospital outcomes in COVID-19: findings from a National Inpatient Sample
    Daniel Sungku Rim, Byung Sik Kim, Kavita Sharma, Jeong-Hun Shin, Dong Wook Kim
    Surgery for Obesity and Related Diseases.2023; 19(12): 1435.     CrossRef
  • Clinical Features and Outcomes of Acute Kidney Injury in Critically Ill COVID-19 Patients: A Retrospective Observational Study
    Nabil Bouguezzi, Imen Ben Saida, Radhouane Toumi, Khaoula Meddeb, Emna Ennouri, Amir Bedhiafi, Dhouha Hamdi, Mohamed Boussarsar
    Journal of Clinical Medicine.2023; 12(15): 5127.     CrossRef
  • Acute Kidney Injury in Coronavirus Disease and Association with Thrombosis
    Anand Narayanan, Patrick Cunningham, Malavika Mehta, Theodore Lang, Mary Hammes
    American Journal of Nephrology.2023; 54(3-4): 156.     CrossRef
  • Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19
    Sin-Young Kim, Dae-Young Hong, Jong-Won Kim, Sang-O Park, Kyeong-Ryong Lee, Kwang-Je Baek
    Medicina.2022; 58(6): 727.     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
Cardiology
Atrial fibrillation of new onset during acute illness: prevalence of, and risk factors for, persistence after hospital discharge
Abarna Ramanathan, John Paul Pearl, Manshi Li, Xiaofeng Wang, Divyajot Sadana, Abhijit Duggal
Acute Crit Care. 2021;36(4):317-321.   Published online November 29, 2021
DOI: https://doi.org/10.4266/acc.2021.00577
  • 3,951 View
  • 121 Download
AbstractAbstract PDF
Background
Atrial fibrillation of new onset during acute illness (AFNOAI) has a variable incidence of 1%–44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years post hospital discharge for critically ill patients.
Methods
This was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1st, 2012, to October 31st, 2015, were screened. Those designated with atrial fibrillation (AF) for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox’s proportional hazards model.
Results
Two-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02–5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02–5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71–3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91–4.37) also showed a trend towards association with AFNOAI persistence.
Conclusions
Our study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient’s individual AFNOAI persistence risk.
Liver
Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study
Seon Woo Yoo, Min-Jong Ki, Dal Kim, Seul Ki Kim, SeungYong Park, Hyo Jin Han, Heung Bum Lee
Acute Crit Care. 2021;36(4):322-331.   Published online November 16, 2021
DOI: https://doi.org/10.4266/acc.2021.00276
  • 4,052 View
  • 95 Download
  • 3 Web of Science
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AbstractAbstract PDF
Background
The molecular adsorbent recirculating system (MARS) is a hepatic replacement system that supports excretory liver function in patients with liver failure. However, since MARS has been employed in our hospital, bleeding complications have occurred in many patients during or after MARS. The objective of this study was to determine how MARS affects coagulopathy and identify specific factors associated with bleeding complications.
Methods
We retrospectively analyzed data from 17 patients undergoing a total of 41 MARS sessions. Complete blood count, coagulation profiles, and blood chemistry values were compared before and after MARS. To identify pre-MARS factors associated with increased bleeding after MARS, we divided patients into bleeder and non-bleeder groups and compared their pre-MARS laboratory values.
Results
MARS significantly reduced bilirubin and creatinine levels. MARS also increased prothrombin time and reduced platelet and fibrinogen, thus negatively impacting coagulation. Pre-MARS hemoglobin was significantly lower in the bleeder group than in the non-bleeder group (P=0.015). When comparing the upper and lower 33% of MARS sessions based on the hemoglobin reduction rate, hemoglobin reduction was significantly greater in MARS sessions involving patients with low pre-MARS international normalized ratio of prothrombin time (PT-INR) and factor V (P=0.038 and P=0.023, respectively).
Conclusions
MARS could appears to alter coagulation-related factors such as factor V and increase the risk of bleeding complications particularly in patient with low hemoglobin. However, individual differences among patients were large, and various factors, such as low hemoglobin, PT-INR, and factor V levels, appear to be involved.

Citations

Citations to this article as recorded by  
  • Fractionated plasma separation and adsorption integrated with continuous veno‐venous hemofiltration in patients with acute liver failure: A single center experience from China
    Jianhua Dong, Li Huang, Chuan Li, Bian Wu, Xi Yang, Yongchun Ge
    Journal of Clinical Apheresis.2024;[Epub]     CrossRef
  • Crosslinked Bifunctional Particles for the Removal of Bilirubin in Hyperbilirubinemia Cases
    María del Prado Garrido, Ana Maria Borreguero, Maria Jesús Ramos, Manuel Carmona, Francisco Javier Redondo Calvo, Juan Francisco Rodriguez
    Materials.2023; 16(8): 2999.     CrossRef
  • The Effect of Molecular Adsorbent Recirculating System in Patients With Liver Failure: A Case Series of 44 Patients
    Shahin Isha, Anna S. Jenkins, Abby J. Hanson, Parthkumar H. Satashia, Sai Abhishek Narra, Gunjan D. Mundhra, Mohammed Mustafa Hasan, Ashrita Donepudi, Abishek Giri, Patrick W. Johnson, Dolores Villar, Christan Santos, Juan Canabal, Philip Lowman, Pablo Mo
    Transplantation Proceedings.2023; 55(9): 2126.     CrossRef
  • Extracorporeal organ support and the kidney
    Maria-Jimena Muciño-Bermejo
    Frontiers in Nephrology.2022;[Epub]     CrossRef
Neurology
Association of natural light exposure and delirium according to the presence or absence of windows in the intensive care unit
Hyo Jin Lee, Eunhye Bae, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee
Acute Crit Care. 2021;36(4):332-341.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00556
  • 6,077 View
  • 198 Download
  • 9 Web of Science
  • 11 Crossref
AbstractAbstract PDFSupplementary Material
Background
Patients in the intensive care unit (ICU) have increased risks of delirium, which is associated with worse outcomes. As pharmacologic treatments for delirium are ineffective, prevention is important. Nonpharmacologic preventive strategies include exposure to natural light and restoring circadian rhythm. We investigated the effect of exposure to natural light through windows on delirium in the ICU.
Methods
This retrospective cohort study assessed all patients admitted to the medical ICU of a university-affiliated hospital between January and June 2020 for eligibility. The ICU included 12 isolation rooms, six with and six without windows. Patients with ICU stays of >48 hours were included and were divided into groups based on their admission to a single room with (window group) or without windows (windowless group). The primary outcome was the cumulative incidence of delirium. The secondary outcomes were the numbers of delirium- and mechanical ventilation-free days, ICU and hospital length of stay, and in-ICU and 28-day mortalities.
Results
Of the 150 included patients (window group: 83 [55.3%]; windowless group: 67 [44.7%]), the cumulative incidence of delirium was significantly lower in the window group than in the windowless group (21.7% vs. 43.3%; relative risk, 1.996; 95% confidence interval [CI], 1.220–3.265). Other secondary outcomes did not differ between groups. Admission to a room with a window was independently associated with a decreased risk of delirium (adjusted odds ratio, 0.318; 95% CI, 0.125–0.805).
Conclusions
Exposure to natural light through windows was associated with a lower incidence of delirium in the ICU.

Citations

Citations to this article as recorded by  
  • Geriatric Psychiatric Emergencies
    Michelle A. Fischer, Monica Corsetti
    Emergency Medicine Clinics of North America.2024; 42(1): 135.     CrossRef
  • There’s No Place Like Home: Delirium as a Barrier in Geriatric Trauma
    Abdoulaziz Toure, Roshan Tadi, Mitchell Meagher, Catherine Ting Brown, Hoi Lam, Samantha LaRosa, Launick Saint-Fort, Huda Syed, Nathaniel Harshaw, Katherine Moore, Neelofer Sohail, Lindsey L. Perea
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    Keegan Guidolin, Flora Jung, Sarah Hunter, Han Yan, Marina Englesakis, Stephen Verderber, Sami Chadi, Fayez Quereshy
    HERD: Health Environments Research & Design Journal.2024;[Epub]     CrossRef
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    M Harazim
    Anesteziologie a intenzivní medicína.2024; 35(1): 8.     CrossRef
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    Neil A. Halpern, Elizabeth Scruth, Michelle Rausen, Diana Anderson
    Critical Care Clinics.2023; 39(3): 577.     CrossRef
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    Carlos Machhour Noujeim
    Healthcare in Low-resource Settings.2023;[Epub]     CrossRef
  • Evaluation of the sensory environment in a large tertiary ICU
    Oystein Tronstad, Dylan Flaws, Sue Patterson, Robert Holdsworth, Veronica Garcia-Hansen, Francisca Rodriguez Leonard, Ruth Ong, Stephanie Yerkovich, John F. Fraser
    Critical Care.2023;[Epub]     CrossRef
  • 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
    Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
    Acute and Critical Care.2022; 37(1): 1.     CrossRef
  • Post-acute delirium of COVID-19 infection: Report of two cases
    Dai-Chun Chi, Chih-Pang Chu, TienWei Yang, Hu-Ming Chang
    Taiwanese Journal of Psychiatry.2022; 36(1): 44.     CrossRef
  • The future of intensive care: delirium should no longer be an issue
    Katarzyna Kotfis, Irene van Diem-Zaal, Shawniqua Williams Roberson, Marek Sietnicki, Mark van den Boogaard, Yahya Shehabi, E. Wesley Ely
    Critical Care.2022;[Epub]     CrossRef
  • 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 and Critical Care.2022; 37(3): 407.     CrossRef
Nursing
How do physicians and nurses differ in their perceived barriers to effective enteral nutrition in the intensive care unit?
Masoumeh Mirhosiny, Mansour Arab, Parvin Mangolian Shahrbabaki
Acute Crit Care. 2021;36(4):342-350.   Published online November 16, 2021
DOI: https://doi.org/10.4266/acc.2021.00185
  • 4,344 View
  • 193 Download
  • 4 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Background
Patients hospitalized in intensive care units are susceptible to chronic malnutrition from changes in protein and energy metabolism in response to trauma. Therefore, nutritional support, especially enteral nutrition, is one of the most important treatment measures for these patients. However, there are several barriers in the hospitals in treating patients with enteral nutrition. This study was performed to compare the perceptions of care providers (physicians and nurses) on the barriers to enteral nutrition in intensive care units.
Methods
This was a cross-sectional descriptive and analytic study. This study included 263 nurses and 104 physicians in the intensive care units of XXXX southeast hospitals. A questionnaire of enteral nutrition barriers in intensive care units was used. IBM SPSS ver. 19 was used to analyze data.
Results
There was a significant difference between the two groups in the three subscales of intensive care units (P=0.034), dietician support (p=0.001>) and critical care provider attitudes and behavior (P=0.031). There was also a significant difference between having completed educational courses and the score of enteral nutrition barriers in the two groups (P<0.05); the people who received an educational course had a better perception of enteral nutrition barriers.
Conclusions
Physicians and nurses agreed with the perception of enteral nutrition barriers, but there was a difference in their perception on some barriers. Strategies such as in-service training and increasing the knowledge and skills of physicians and nurses can reduce these differences.

Citations

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  • Nutrition practices in critically ill adults receiving noninvasive ventilation: A quantitative survey of Australian and New Zealand intensive care clinicians
    Kaitlyn Page, Elizabeth Viner Smith, Mark P. Plummer, Emma J. Ridley, Kristy Burfield, Lee-anne S. Chapple
    Australian Critical Care.2024; 37(1): 43.     CrossRef
  • El hambre invisible en la Unidad de Cuidados Intensivos. Estrategias de Cuidado y Consideraciones Esenciales
    Ignacio Zaragoza-García
    Enfermería Intensiva.2024; 35(1): 1.     CrossRef
  • Invisible hunger in the Intensive Care Unit: Care strategies and essential considerations
    I. Zaragoza-García
    Enfermería Intensiva (English ed.).2024; 35(1): 1.     CrossRef
  • Evidence-Based Investigation of Nurses' Nutrition Interventions in Intensive Care Patients Regarding Enteral Nutrition
    Mensure Turan, Zeliha Cengiz, Dilek Olmaz
    Dimensions of Critical Care Nursing.2024; 43(3): 123.     CrossRef
  • Adequacy of protein and calorie delivery according to the expected calculated targets: a day‐by‐day assessment in critically ill patients undergoing enteral feeding
    Adam Fabiani, Lorella Dreas, Enzo Mazzaro, Elena Trampus, Michela Zanetti, Antonella Calabretti, Giuseppe Gatti, Gianfranco Sanson
    Journal of Human Nutrition and Dietetics.2023; 36(3): 697.     CrossRef
  • Barriers to Delivery of Enteral Nutrition in Intensive Care Settings in Saudi Arabia: A Comparative Study of the Perceptions of Health Care Providers Working in Adult and Paediatric ICUs
    Sara Zaher
    Risk Management and Healthcare Policy.2022; Volume 15: 2357.     CrossRef
Ethics
Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission
Youjin Chang, Kyoung Ran Kim, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim
Acute Crit Care. 2021;36(4):351-360.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00283
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AbstractAbstract PDFSupplementary Material
Background
It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception.
Methods
A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state.
Results
A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group were 64%, 22%, and 57%, respectively; their 6-month mortality rates were 100%, 46%, and 81%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3, odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892–8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260–19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162–17.121; P=0.029).
Conclusions
The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization.

Citations

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  • Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study
    Carla Marchini Dias da Silva, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Jr
    Journal of Critical Care.2024; 79: 154468.     CrossRef
  • Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit
    Michele M. Iguina, Aunie M. Danyalian, Ilko Luque, Umair Shaikh, Sanaz B. Kashan, Dionne Morgan, Daniel Heller, Mauricio Danckers
    Journal of Palliative Care.2023; 38(2): 126.     CrossRef
  • Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
    Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
    Internal and Emergency Medicine.2023; 18(4): 1191.     CrossRef
  • Can the intensivists predict the outcomes of critically ill patients on the appropriateness of intensive care unit admission for limited intensive care unit resources ?
    SeungYong Park
    Acute and Critical Care.2021; 36(4): 388.     CrossRef
Nutrition
Associations between systemic inflammation and intestinal permeability with Onodera's prognostic nutritional index in critically ill patients
Seyed Hossein Ardehali, Ghazaleh Eslamian, Shirin Malek
Acute Crit Care. 2021;36(4):361-368.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00178
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AbstractAbstract PDF
Background
Malnutrition is a potentially costly problem in critically ill patients admitted to the intensive care unit (ICU). The aim of this study is to evaluate the relationships between the Onodera’s prognostic nutritional index (OPNI) and intestinal permeability and between OPNI and systemic inflammation in critically ill patients.
Methods
This was a cross-sectional study conducted in the general ICU of a university-affiliated hospital. A total of 162 ICU-hospitalized adult patients admitted between May 2018 and December 2019, was included in the study sample. The OPNI was calculated at admission and categorized as ≤40 or >40. We assessed plasma endotoxin and zonulin concentrations as markers of intestinal permeability as well as serum interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) as markers of systemic inflammation upon admission under stringent conditions. The relationships between these markers and OPNI were assessed after adjusting for potential confounders through estimation of a binary logistic regression model.
Results
Median (interquartile range) hs-CRP, IL-6 zonulin, and endotoxin were significantly greater in the low OPNI subgroup than in the high OPNI subgroup (all P<0.05). Multivariate analyses showed significant association between serum IL-6 (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.64–0.96), serum hs-CRP (OR, 0.77; 95% CI, 0.53–0.92), plasma endotoxin (OR, 0.81; 95% CI, 0.72–0.93), and plasma zonulin (OR, 0.83; 95% CI, 0.75–0.98) levels with OPNI in the overall population.
Conclusions
Our results provide evidence that higher plasma endotoxin, zonulin, IL-6, and hs-CRP levels are associated with progressively lower OPNI in mixed ICU populations, particularly in surgical ICU patients.

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  • Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study
    Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim
    Acute and Critical Care.2024; 39(1): 127.     CrossRef
  • Practical parameters that can be used for nutritional assessment in patients hospitalized in the intensive care unit with the diagnosis of chronic obstructive pulmonary disease
    Ramazan Baldemir, Mustafa Özgür Cirik
    Medicine.2022; 101(24): e29433.     CrossRef
  • Nutritional Status, Body Composition, and Inflammation Profile in Older Patients with Advanced Chronic Kidney Disease Stage 4–5: A Case-Control Study
    Mar Ruperto, Guillermina Barril
    Nutrients.2022; 14(17): 3650.     CrossRef
Pulmonary
Safety and feasibility of hybrid tracheostomy
Daeun Kang, In Beom Jeong, Sun Jung Kwon, Ji Woong Son, Gwan Woo Ku
Acute Crit Care. 2021;36(4):369-373.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00801
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AbstractAbstract PDF
Background
Percutaneous dilatational tracheostomy (PDT) is widely used in intensive care units, but this conventional method has some disadvantages, such as requirement of a lot of equipment and experts at the site. Especially, in situations where the patient is isolated due to an infectious disease, difficulties in using the equipment may occur, and the number of exposed persons may increase. In this paper, we introduce hybrid tracheostomy that combines the advantages of surgical tracheostomy and PDT and describe our experiences.
Methods
Data from 55 patients who received hybrid tracheostomy without bronchoscopy from January 2020 to February 2021 were collected and reviewed retrospectively. Hybrid tracheostomy was performed at the bedside by a single thoracic surgeon. The hybrid tracheostomy method was as follows: after the skin was incised and the trachea was exposed, only the extent of the endotracheal tube that could not be removed was withdrawn, and then tracheostomy was performed by the Seldinger method using a PDT kit.
Results
The average age was 66.5 years, and the proportion of men was 69.1%. Among the patients, 21.8% were taking antiplatelet drugs and 14.5% were taking anticoagulants. The average duration of the procedure was 13.3 minutes. There was no major bleeding, and there was one case of paratracheal placement of the tracheostomy tube.
Conclusions
In most patients, the procedure can be safely performed without any major complications. However, patients with a short neck, a neck burn or patients who have received radiation therapy to the neck should be treated with conventional methods.

Citations

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  • A Modified Technique for Percutaneous Dilatational Tracheostomy
    Zahra Ghotbi, Mehrdad Estakhr, Mehdi Nikandish, Reza Nikandish
    Journal of Intensive Care Medicine.2023; 38(9): 878.     CrossRef
Pulmonary
Under or overpressure: an audit of endotracheal cuff pressure monitoring at the tertiary care center
Biju Viswambharan, Manjini Jeyaram Kumari, Gopala Krishnan, Lakshmi Ramamoorthy
Acute Crit Care. 2021;36(4):374-379.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00024
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AbstractAbstract PDF
Background
Mechanical ventilation is a lifesaving intervention for critically ill patients but can produce the major complication of ventilator-associated pneumonia (VAP). Inappropriately inflated endotracheal tubes cause potential harm due to high or low pressure; this can be prevented through monitoring protocols.
Methods
A cross-sectional study of 348 cuff pressure readings was performed with intubated and mechanically ventilated patients to evaluate the exact proportion of patients in intensive care units (ICUs) where the cuff pressure is optimal and to identify the ICUs where device-based monitoring is available to produce a lower proportion of sub-optimal cuff pressure cases. Every three days, cuff pressure was assessed with a handheld cuff pressure manometer. The corresponding VAP rates of those ICUs were obtained from the hospital infection control department.
Results
Cuff pressure of 40.2% was the lower cutoff for the high category, that of optimal was 35.3%, and the highest cutoff of sub-optimal was 24.4%. This study also showed ICUs that had cuff pressure monitoring devices and protocols. Active measurement protocols had a higher proportion of optimal cuff pressure (58.5%) and a lower proportion of sub-optimal and high cuff pressure (19.5% and 22.0%) compared to ICUs with no device-based monitoring protocols. Furthermore, the VAP rate of ICUs exhibited a weak positive correlation with sub-optimal cuff pressure.
Conclusions
Device-based cuff pressure monitoring is essential in maintaining adequate cuff pressure but often is inadequate, resulting in high readings. Therefore, this study suggests that device-based cuff pressure monitoring be practiced.

Citations

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  • Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study
    Sujung Park, Young In Kwon, Hyun Joo Kim
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Correlación entre la presión del manguito del tubo endotraqueal y los síntomas laringotraqueales en postoperatorio
    Wedley Peñaloza, Reyes Cruz Manuel Reyes, Evelin Núñez Wong
    Revista Gaceta Médica JBG.2023;[Epub]     CrossRef
  • Efficacy of using an intravenous catheter to repair damaged expansion lines of endotracheal tubes and laryngeal masks
    Tingting Wang, Jiang Wang, Yao Lu, Xuesheng Liu, Shangui Chen
    BMC Anesthesiology.2022;[Epub]     CrossRef
Pediatrics
Prognostic factors of pediatric hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit
Da Hyun Kim, Eun Ju Ha, Seong Jong Park, Kyung-Nam Koh, Hyery Kim, Ho Joon Im, Won Kyoung Jhang
Acute Crit Care. 2021;36(4):380-387.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2020.01193
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AbstractAbstract PDF
Background
Pediatric patients who received hematopoietic stem cell transplantation (HSCT) tend to have high morbidity and mortality. While, the prognostic factors of adult patients received bone marrow transplantation were already known, there is little known in pediatric pateints. This study aimed to identify the prognostic factor for pediatric intensive care unit (PICU) mortality of critically ill pediatric patients with HSCT.
Method
Retrospectively reviewed that the medical records of patients who received HSCT and admitted to PICU between January 2010 and December 2019. Mortality was defined a patient who expired within 28 days.
Results
A total of 131 patients were included. There were 63 boys (48.1%) and median age was 11 years (interquartile range, 0–20 years). The most common HSCT type was haploidentical (38.9%) and respiratory failure (44.3%) was the most common reason for PICU admission. Twenty-eight–day mortality was 22.1% (29/131). In comparison between survivors and non-survivors, the number of HSCT received, sepsis, oncological pediatric risk of mortality-III (OPRISM-III), PRISM-III, pediatric sequential organ failure assessment (pSOFA), serum lactate, B-type natriuretic peptide (BNP) and use of mechanical ventilator (MV) and vasoactive inotropics were significant predictors (p<0.05 for all variables). In multivariate logistic regression, number of HSCT received, use of MV, OPRISM-III, PRISM-III and pSOFA were independent risk factors of PICU mortality. Moreover, three scoring systems were significant prognostic factors of 28-day mortality.
Conclusions
The number of HSCT received and use of MV were more accurate predictors in pediatric patients received HSCT.

Citations

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  • Prognostic factors and predictive scores for 6-months mortality of hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit
    Sarah Schober, Silke Huber, Norbert Braun, Michaela Döring, Peter Lang, Michael Hofbeck, Felix Neunhoeffer, Hanna Renk
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • Survival outcomes of pediatric hematopoietic stem cell transplant patients admitted to the intensive care unit: A case–control study from a tertiary care center in Saudi Arabia
    LujainTalib Aljudaibi, MohamedSalaheldin Bayoumy, HassanA Altrabolsi, AbdullahM Alzaydi, Nawaf Aldajani, Nadia Hammad, Ismail Alzahrani, Marwa Elhadidy, IbraheemF Abosoudah
    Journal of Applied Hematology.2022; 13(4): 192.     CrossRef
Editorial
Pulmonary
Can the intensivists predict the outcomes of critically ill patients on the appropriateness of intensive care unit admission for limited intensive care unit resources ?
SeungYong Park
Acute Crit Care. 2021;36(4):388-389.   Published online November 30, 2021
DOI: https://doi.org/10.4266/acc.2021.01641
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PDF

Citations

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  • Comparison of clinical characteristics and hospital mortality in critically ill patients without COVID-19 before and during the COVID-19 pandemic: a multicenter, retrospective, propensity score-matched study
    Sua Kim, Hangseok Choi, Jae Kyeom Sim, Won Jai Jung, Young Seok Lee, Je Hyeong Kim
    Annals of Intensive Care.2022;[Epub]     CrossRef

ACC : Acute and Critical Care