Acute and Critical Care

Volume 38 (2); May 2023

Review Article

Ethics
Impact of institutional case volume on intensive care unit mortality: Christine Kang, Ho Geol Ryu; Acute Crit Care. 2023;38(2):151-159. Published online May 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00689

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The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.

Citations

Citations to this article as recorded by

Case volume and specialization in critically ill emergency patients: a nationwide cohort study in Japanese ICUs
Jun Fujinaga, Takanao Otake, Takehide Umeda, Toshio Fukuoka
Journal of Intensive Care.2024;[Epub] CrossRef
Association of Intensive Care Unit Case Volume With Mortality and Cost in Sepsis Based on a Japanese Nationwide Medical Claims Database Study
Takehiko Oami, Taro Imaeda, Taka‑aki Nakada, Tuerxun Aizimu, Nozomi Takahashi, Toshikazu Abe, Yasuo Yamao, Satoshi Nakagawa, Hiroshi Ogura, Nobuaki Shime, Yutaka Umemura, Asako Matsushima, Kiyohide Fushimi
Cureus.2024;[Epub] CrossRef

Original Articles

Meta-analysis
Comparison of safety and efficacy between therapeutic or intermediate versus prophylactic anticoagulation for thrombosis in COVID-19 patients: a systematic review and meta-analysis: Hyeon-Jeong Lee, Hye Jin Jang, Won-Il Choi, Joonsung Joh, Junghyun Kim, Jungeun Park, Miyoung Choi; Acute Crit Care. 2023;38(2):160-171. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01424; Correction in: Acute Crit Care 2023;38(4):516

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Abstract PDF Supplementary Material

Background
Patients with coronavirus disease 2019 (COVID-19) infections often have macrovascular or microvascular thrombosis and inflammation, which are known to be associated with a poor prognosis. Heparin has been hypothesized that administration of heparin with treatment dose rather than prophylactic dose for prevention of deep vein thrombosis in COVID-19 patients. Methods: Studies comparing therapeutic or intermediate anticoagulation with prophylactic anticoagulation in COVID-19 patients were eligible. Mortality, thromboembolic events, and bleeding were the primary outcomes. PubMed, Embase, the Cochrane Library, and KMbase were searched up to July 2021. A meta-analysis was performed using random-effect model. Subgroup analysis was conducted according to disease severity. Results: Six randomized controlled trials (RCTs) with 4,678 patients and four cohort studies with 1,080 patients were included in this review. In the RCTs, the therapeutic or intermediate anticoagulation was associated with significant reductions in the occurrence of thromboembolic events (5 studies, n=4,664; relative risk [RR], 0.72; P=0.01), and a significant increase in bleeding events (5 studies, n=4,667; RR, 1.88; P=0.004). In the moderate patients, therapeutic or intermediate anticoagulation was more beneficial than prophylactic anticoagulation in terms of thromboembolic events, but showed significantly higher bleeding events. In the severe patients, the incidence of thromboembolic and bleeding events in the therapeutic or intermediate. Conclusions: The study findings suggest that prophylactic anticoagulant treatment should be used in patients with moderate and severe COVID-19 infection groups. Further studies are needed to determine more individualized anticoagulation guidance for all COVID-19 patients.

Citations

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The Community Pharmacy as a Study Center for the Epidemiological Analysis of the Population Vaccination against SARS-CoV-2: Evaluation of Vaccine Safety and Pharmaceutical Service
Jacopo Raffaele Dibenedetto, Michela Cetrone, Marina Antonacci, Domenico Pio Cannone, Stefania Antonacci, Pasquale Bratta, Francesco Leonetti, Domenico Tricarico
Pharmacy.2024; 12(1): 16. CrossRef
Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review
Alexandra Beurton, Emma J. Kooistra, Audrey De Jong, Helmut Schiffl, Mercedes Jourdain, Bruno Garcia, Damien Vimpère, Samir Jaber, Peter Pickkers, Laurent Papazian
Current Obesity Reports.2024; 13(3): 545. CrossRef

Pulmonary
Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France: Pierre Basse, Louis Morisson, Romain Barthélémy, Nathan Julian, Manuel Kindermans, Magalie Collet, Benjamin Huot, Etienne Gayat, Alexandre Mebazaa, Benjamin G. Chousterman; Acute Crit Care. 2023;38(2):172-181. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01494

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Background
The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19). Methods: This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count. Results: Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002). Conclusions: In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

Citations

Citations to this article as recorded by

Bidirectional pressure: a mini review of ventilator-lung-kidney interactions
Avnee Kumar, Katie Epler, Sean DeWolf, Laura Barnes, Mark Hepokoski
Frontiers in Physiology.2024;[Epub] CrossRef

Pulmonary
The role of ROX index–based intubation in COVID-19 pneumonia: a cross-sectional comparison and retrospective survival analysis: Sara Vergis, Sam Philip, Vergis Paul, Manjit George, Nevil C Philip, Mithu Tomy; Acute Crit Care. 2023;38(2):182-189. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.00206

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Abstract PDF: Background
Coronavirus disease 2019 (COVID-19) patients with acute respiratory failure who experience delayed initiation of invasive mechanical ventilation have poor outcomes. The lack of objective measures to define the timing of intubation is an area of concern. We investigated the effect of timing of intubation based on respiratory rate-oxygenation (ROX) index on the outcomes of COVID-19 pneumonia. Methods: This was a retrospective cross-sectional study performed in a tertiary care teaching hospital in Kerala, India. Patients with COVID-19 pneumonia who were intubated were grouped into early intubation (within 12 hours of ROX index <4.88) or delayed intubation (12 hours or more hours after ROX <4.88). Results: A total of 58 patients was included in the study after exclusions. Among them, 20 patients were intubated early, and 38 patients were intubated 12 hours after ROX index <4.88. The mean age of the study population was 57±14 years, and 55.0% of the patients were male; diabetes mellitus (48.3%) and hypertension (50.0%) were the most common comorbidities. The early intubation group had 88.2% successful extubation, while only 11.8% of the delayed group had successful extubation (P<0.001). Survival was also significantly more frequent in the early intubation group. Conclusions: Early intubation within 12 hours of ROX index <4.88 was associated with improved extubation and survival in patients with COVID-19 pneumonia.

CPR/Resuscitation
Prognostic significance of respiratory quotient in patients undergoing extracorporeal cardiopulmonary resuscitation in Korea: Yun Im Lee, Ryoung-Eun Ko, Soo Jin Na, Jeong-Am Ryu, Yang Hyun Cho, Jeong Hoon Yang, Chi Ryang Chung, Gee Young Suh; Acute Crit Care. 2023;38(2):190-199. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01438

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Abstract PDF

Background
Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known. Methods: Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia. Results: During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ. Conclusions: In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.

Citations

Citations to this article as recorded by

Risk factors for neurological disability outcomes in patients under extracorporeal membrane oxygenation following cardiac arrest: An observational study
Amir Vahedian-Azimi, Ibrahim Fawzy Hassan, Farshid Rahimi-Bashar, Hussam Elmelliti, Anzila Akbar, Ahmed Labib Shehata, Abdulsalam Saif Ibrahim, Ali Ait Hssain
Intensive and Critical Care Nursing.2024; 83: 103674. CrossRef
What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study
Amir Vahedian-Azimi, Ibrahim Fawzy Hassan, Farshid Rahimi-Bashar, Hussam Elmelliti, Anzila Akbar, Ahmed Labib Shehata, Abdulsalam Saif Ibrahim, Ali Ait Hssain
International Journal of Emergency Medicine.2024;[Epub] CrossRef
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest and in-hospital cardiac arrest with return of spontaneous circulation: be careful when comparing apples to oranges
Hwa Jin Cho, In Seok Jeong, Jan Bělohlávek
Acute and Critical Care.2023; 38(2): 242. CrossRef

Pulmonary
Evaluating diaphragmatic dysfunction and predicting non-invasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease in India: Nupur B Patel, Gaurav Jain, Udit Chauhan, Ajeet Singh Bhadoria, Saurabh Chandrakar, Haritha Indulekha; Acute Crit Care. 2023;38(2):200-208. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01060

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Abstract PDF

Background
Baseline diaphragmatic dysfunction (DD) at the initiation of non-invasive ventilation (NIV) correlates positively with subsequent intubation. We investigated the utility of DD detected 2 hours after NIV initiation in estimating NIV failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods: In a prospective-cohort design, we enrolled 60 consecutive patients with AECOPD initiated on NIV at intensive care unit admission, and NIV failure events were noted. The DD was assessed at baseline (T1 timepoint) and 2 hours after initiating NIV (T2 timepoint). We defined DD as ultrasound-assessed change in diaphragmatic thickness (ΔTDI) <20% (predefined criteria [PC]) or its cut-off that predicts NIV failure (calculated criteria [CC]) at both timepoints. A predictive-regression analysis was reported. Results: In total, 32 patients developed NIV failure, nine within 2 hours of NIV and remaining in next 6 days. The ∆TDI cut-off that predicted NIV failure (DD-CC) at T1 was ≤19.04% (area under the curve [AUC], 0.73; sensitivity, 50%; specificity, 85.71%; accuracy; 66.67%), while that at T2 was ≤35.3% (AUC, 0.75; sensitivity, 95.65%; specificity, 57.14%; accuracy, 74.51%; hazard ratio, 19.55). The NIV failure rate was 35.1% in those with normal diaphragmatic function by PC (T2) versus 5.9% by CC (T2). The odds ratio for NIV failure with DD criteria ≤35.3 and <20 at T2 was 29.33 and 4.61, while that for ≤19.04 and <20 at T1 was 6, respectively. Conclusions: The DD criterion of ≤35.3 (T2) had a better diagnostic profile compared to baseline and PC in prediction of NIV failure.

Citations

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The Application of Diaphragm Ultrasound in Chronic Obstructive Pulmonary Disease: A Narrative Review
Heng Mu, Qunxia Zhang
COPD: Journal of Chronic Obstructive Pulmonary Disease.2024;[Epub] CrossRef
Advancing healthcare through thoracic ultrasound research in older patients
Simone Scarlata, Chukwuma Okoye, Sonia Zotti, Fulvio Lauretani, Antonio Nouvenne, Nicoletta Cerundolo, Adriana Antonella Bruni, Monica Torrini, Alberto Finazzi, Tessa Mazzarone, Marco Lunian, Irene Zucchini, Lorenzo Maccioni, Daniela Guarino, Silvia Fabbr
Aging Clinical and Experimental Research.2023; 35(12): 2887. CrossRef

CPR/Resuscitation
Percent fluid overload for prediction of fluid de-escalation in critically ill patients in Saudi Arabia: a prospective observational study: Reham A. Alharbi, Namareq F. Aldardeer, Emily L. G. Heaphy, Ahmad H. Alabbasi, Amjad M. Albuqami, Hassan Hawa; Acute Crit Care. 2023;38(2):209-216. Published online May 16, 2023; DOI: https://doi.org/10.4266/acc.2022.01550

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Abstract PDF Supplementary Material: Background
Percent fluid overload greater than 5% is associated with increased mortality. The appropriate time for fluid deresuscitation depends on the patient's radiological and clinical findings. This study aimed to assess the applicability of percent fluid overload calculations for evaluating the need for fluid deresuscitation in critically ill patients. Methods: This was a single-center, prospective, observational study of critically ill adult patients requiring intravenous fluid administration. The study's primary outcome was median percent fluid accumulation on the day of fluid deresuscitation or intensive care unit (ICU) discharge, whichever came first. Results: A total of 388 patients was screened between August 1, 2021, and April 30, 2022. Of these, 100 with a mean age of 59.8±16.2 years were included for analysis. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15.4±8.0. Sixty-one patients (61.0%) required fluid deresuscitation during their ICU stay, while 39 (39.0%) did not. Median percent fluid accumulation on the day of deresuscitation or ICU discharge was 4.5% (interquartile range [IQR], 1.7%–9.1%) and 5.2% (IQR, 2.9%–7.7%) in patients requiring deresuscitation and those who did not, respectively. Hospital mortality occurred in 25 (40.9%) of patients with deresuscitation and six (15.3%) patients who did not require it (P=0.007). Conclusions: The percent fluid accumulation on the day of fluid deresuscitation or ICU discharge was not statistically different between patients who required fluid deresuscitation and those who did not. A larger sample size is needed to confirm these findings.

Nephrology
Epidemiology and outcome of an acute kidney injuries in the polytrauma victims admitted at the apex trauma center in Dubai: Bhushan Sudhakar Wankhade, Zeyad Faoor Alrais, Ghaya Zeyad Alrais, Ammar Mohamed Abdel Hadi, Gopala Arun Kumar Naidu, Mohammed Shahid Abbas, Ahmed Tarek Youssef Aboul Kheir, Hasan Hadad, Sundareswaran Sharma, Mohammad Sait; Acute Crit Care. 2023;38(2):217-225. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2023.00388

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Abstract PDF: Background
Polytrauma from road accidents is a common cause of hospital admissions and deaths, frequently leading to acute kidney injury (AKI) and impacting patient outcomes. Methods: This retrospective, single-center study included polytrauma victims with an Injury Severity Score (ISS) >25 at a tertiary healthcare center in Dubai. Results: The incidence of AKI in polytrauma victims is 30.5%, associated with higher Carlson comorbidity index (P=0.021) and ISS (P=0.001). Logistic regression shows a significant relationship between ISS and AKI (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.150–1.233; P<0.05). The main causes of trauma-induced AKI are hemorrhagic shock (P=0.001), need for massive transfusion (P<0.001), rhabdomyolysis (P=0.001), and abdominal compartment syndrome (ACS; P<0.001). On multivariate logistic regression AKI can be predicated by higher ISS (OR, 1.08; 95% CI, 1.00–1.17; P=0.05) and low mixed venous oxygen saturation (OR, 1.13; 95% CI, 1.05–1.22; P<0.001). The development of AKI after polytrauma increases length of stay (LOS)-hospital (P=0.006), LOS-intensive care unit (ICU; P=0.003), need for mechanical ventilation (MV) (P<0.001), ventilator days (P=0.001), and mortality (P<0.001). Conclusions: After polytrauma, the occurrence of AKI leads to prolonged hospital and ICU stays, increased need for mechanical ventilation, more ventilator days, and a higher mortality rate. AKI could significantly impact their prognosis.

Trauma
Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India: Nishant Agrawal, Shivakumar S Iyer, Vishwanath Patil, Sampada Kulkarni, Jignesh N Shah, Prashant Jedge; Acute Crit Care. 2023;38(2):226-233. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2023.00570

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Abstract PDF

Background
This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. Methods: We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson’s correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01. Results: In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively. Conclusions: The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

Citations

Citations to this article as recorded by

Development of a Novel Neurological Score Combining GCS and FOUR Scales for Assessment of Neurosurgical Patients with Traumatic Brain Injury: GCS-FOUR Scale
Ali Ansari, Sina Zoghi, Amirabbas Khoshbooei, Mohammad Amin Mosayebi, Maryam Feili, Omid Yousefi, Amin Niakan, Seyed Amin Kouhpayeh, Reza Taheri, Hosseinali Khalili
World Neurosurgery.2024; 182: e866. CrossRef
Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury
Indu Kapoor, Hemanshu Prabhakar, Arvind Chaturvedi, Charu Mahajan, Abraham L Chawnchhim, Tej P Sinha
Indian Journal of Critical Care Medicine.2024; 28(3): 256. CrossRef
Machine learning for the prediction of in-hospital mortality in patients with spontaneous intracerebral hemorrhage in intensive care unit
Baojie Mao, Lichao Ling, Yuhang Pan, Rui Zhang, Wanning Zheng, Yanfei Shen, Wei Lu, Yuning Lu, Shanhu Xu, Jiong Wu, Ming Wang, Shu Wan
Scientific Reports.2024;[Epub] CrossRef
The assessment of consciousness status in primary brainstem hemorrhage (PBH) patients can be achieved by monitoring changes in basic vital signs
Shiyi Zuo, Yuting Feng, Juan Sun, Guofang Liu, Hanxu Cai, Xiaolong Zhang, Zhian Hu, Yong Liu, Zhongxiang Yao
Geriatric Nursing.2024; 59: 498. CrossRef

Letters to the Editor

Thoracic Surgery
Comment on “Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study”: Maida Qazi, Mahnoor Amin; Acute Crit Care. 2023;38(2):234-235. Published online January 26, 2023; DOI: https://doi.org/10.4266/acc.2022.01214

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Citations

Citations to this article as recorded by

Reply to comment on “Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study”
Hye-Bin Kim, Sungwon Na, Hyo Chae Paik, Hyeji Joo, Jeongmin Kim
Acute and Critical Care.2023; 38(2): 236. CrossRef

Thoracic Surgery
Reply to comment on “Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study”: Hye-Bin Kim, Sungwon Na, Hyo Chae Paik, Hyeji Joo, Jeongmin Kim; Acute Crit Care. 2023;38(2):236-237. Published online May 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00556

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Pulmonary
Septic shock due to invasive pulmonary aspergillosis without conventional risk factors: Kyung Eun Shin, Shinhee Park, Ae-Rin Baek; Acute Crit Care. 2023;38(2):238-241. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2023.00437

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Editorial

CPR/Resuscitation
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest and in-hospital cardiac arrest with return of spontaneous circulation: be careful when comparing apples to oranges: Hwa Jin Cho, In Seok Jeong, Jan Bělohlávek; Acute Crit Care. 2023;38(2):242-243. Published online May 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00731

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Case Report

Neurosurgery
What should an intensivist know about pneumocephalus and tension pneumocephalus?: Bhushan Sudhakar Wankhade, Maged Mohsen Kamel Beniamein, Zeyad Faoor Alrais, Jyoti Ittoop Mathew, Ghaya Zeyad Alrais; Acute Crit Care. 2023;38(2):244-248. Published online April 13, 2022; DOI: https://doi.org/10.4266/acc.2021.01102

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Abstract PDF

Collection of air in the cranial cavity is called pneumocephalus. Although simple pneumocephalus is a benign condition, accompanying increased intracranial pressure can produce a life-threatening condition comparable to tension pneumothorax, which is termed tension pneumocephalus. We report a case of tension pneumocephalus after drainage of a cerebrospinal fluid hygroma. The tension pneumocephalus was treated with decompression craniotomy, but the patient later died due to the complications related to critical care. Traumatic brain injury and neurosurgical intervention are the most common causes of pneumocephalus. Pneumocephalus and tension pneumocephalus are neurosurgical emergencies, and anesthetics and intensive care management like the use of nitrous oxide during anesthesia and positive pressure ventilation have important implications in their development and progress. Clinically, patients can present with various nonspecific neurological manifestations that are indistinguishable from a those of a primary neurological condition. If the diagnosis is questionable, patients should be investigated using computed tomography of the brain. Immediate neurosurgical consultation with decompression is the treatment of choice.

Citations

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Sudden-onset, non-traumatic large volume pneumocephalus following presentation of acute bacterial meningitis
Alexandra Krez, Michael Malinzak, Colby Feeney
BMJ Case Reports.2024; 17(1): e256194. CrossRef
Fatal postoperative tension pneumocephalus after acute subdural hematoma evacuation: a case report
Nikolaos Gkantsinikoudis, Panagiotis Monioudis, Elias Antoniades, Vassilios Tsitouras, Ioannis Magras
International Journal of Neuroscience.2024; : 1. CrossRef
Pneumocephalus; a rare cause of coma
Elisavet Simoulidou, Vivian Georgopoulou, Panagiotis Kalmoukos, Dimitrios Kouroupis, Nikoleta Moscha, Maria Sidiropoulou, Sofia Chatzimichailidou, Konstantinos Petidis, Athina Pyrpasopoulou
The American Journal of Emergency Medicine.2023; 68: 215.e1. CrossRef
Pneumocephalus secondary to epidural analgesia: a case report
Maira Ahmad, Shannay Bellamy, William Ott, Rany Mekhail
Journal of Medical Case Reports.2023;[Epub] CrossRef
Transnasal Endoscopic Treatment of Tension Pneumocephalus Caused by Posttraumatic or Iatrogenic Ethmoidal Damage
Goran Latif Omer, Riccardo Maurizi, Beatrice Francavilla, Kareem Rekawt Hama Rashid, Gianluca Velletrani, Hasan Mustafa Salah, Giulia Marzocchella, Mohammed Ibrahim Mohialdeen Gubari, Stefano Di Girolamo, Rong-San Jiang
Case Reports in Otolaryngology.2023; 2023: 1. CrossRef
Tension pneumocephalus as a complication of surgical evacuation of chronic subdural hematoma: case report and literature review
Mohammed A. Azab, Ahmed Hazem, Brandon Lucke-Wold
Exploration of Neuroprotective Therapy.2023; 3(4): 177. CrossRef

Corrigendum

Infection
Corrigendum to “Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study”: Keum-Ju Choi, Soo Kyun Jung, Kyung Chan Kim, Eun Jin Kim; Acute Crit Care. 2023;38(2):249-249. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.00941.e1; Corrects: Acute Crit Care 2023;38(1):57

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