Acute and Critical Care

From articles published in Acute and Critical Care during the past two years (2023 ~ ).

Review Article

Infection
Microbial infections in burn patients: Souvik Roy, Preeti Mukherjee, Sutrisha Kundu, Debashrita Majumder, Vivek Raychaudhuri, Lopamudra Choudhury; Acute Crit Care. 2024;39(2):214-225. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01571

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Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.

Citations

Citations to this article as recorded by

Postacute Overview of Burn Injuries
Tuba Sengul, Holly Kirkland-Kyhn, Asiye Gul
Nursing Clinics of North America.2025; 60(1): 15. CrossRef
Phage treatment of multidrug-resistant bacterial infections in humans, animals, and plants: The current status and future prospects
Omor Faruk, Zilhas Ahmed Jewel, Sanjoy Bairagi, Mohammad Rasheduzzaman, Hindol Bagchi, Akber Subahan Mahbub Tuha, Imran Hossain, Ayon Bala, Sarafat Ali
Infectious Medicine.2025; 4(1): 100168. CrossRef
Lavandula dentata leaves as potential natural antibiofilm agents against Pseudomonas aeruginosa
Maram M. Aboulwafa, Nada M. Mostafa, Fadia S. Youssef, Omayma A. Eldahshan, Abdel Nasser B. Singab
Scientific Reports.2025;[Epub] CrossRef
Larval zebrafish burn wound infection model reveals conserved innate immune responses against diverse pathogenic fungi
Nayanna M. Mercado Soto, Adam Horn, Nancy P. Keller, Anna Huttenlocher, Andrew S. Wagner, Gustavo H. Goldman
mBio.2025;[Epub] CrossRef
Unveiling the potential antibacterial action of acetylcysteine for managing Staphylococcus aureus wound infections: in vitro and in vivo study
Rehab Ahmed, Engy Elekhnawy
World Journal of Microbiology and Biotechnology.2025;[Epub] CrossRef
Management and Prevention of Multidrug-Resistant Bacteria in War Casualties
Diana Isabela Costescu Strachinaru, Céline Ragot, Anke Stoefs, Nicolas Donat, Pierre-Michel François, Peter Vanbrabant, Alexia Verroken, Frédéric Janvier, Patrick Soentjens
Tropical Medicine and Infectious Disease.2025; 10(5): 128. CrossRef
Comprehensive Management of Severe Burn Injuries: A Multidisciplinary Approach from Resuscitation to Rehabilitation
Maryum Merchant, Scott B. Hu, Chris Miller, Tamana Ahmadi, Edwin Garcia, Malcolm I. Smith
Emergency Care and Medicine.2025; 2(2): 26. CrossRef
Contribution of icaADBC genes in biofilm production ability of Staphylococcus aureus clinical isolates collected from hospitalized patients at a burn center in North of Iran
Mostafa Alibegli, Aliakbar bay, Amirabbas Fazelnejad, Pouria Nourmohammadi Ghezelghaye, Hossein Jafari Soghondikolaei, Hamid Reza Goli
BMC Microbiology.2025;[Epub] CrossRef
MvfR Shapes Pseudomonas aeruginosa Interactions in Polymicrobial Contexts: Implications for Targeted Quorum-Sensing Inhibition
Kelsey M. Wheeler, Myung Whan Oh, Julianna Fusco, Aishlinn Mershon, Erin Kim, Antonia De Oliveira, Laurence G. Rahme
Cells.2025; 14(10): 744. CrossRef
Phloxine B-loaded polymersomes enable eradication of Pseudomonas aeruginosa and Staphylococcus aureus in antimicrobial photodynamic therapy
Nicola Cusick, Holger Schönherr
RSC Advances.2025; 15(24): 18815. CrossRef
Enhancing clinical outcomes in burn and surgical intensive care unit patients
Mahta Moghaddam Ahmadi, Moein Moghaddam Ahmadi
Burns.2024; 50(8): 2137. CrossRef
Development of a Stringent Ex Vivo-Burned Porcine Skin Wound Model to Screen Topical Antimicrobial Agents
Ping Chen, Eliza A. Sebastian, S. L. Rajasekhar Karna, Kai P. Leung
Antibiotics.2024; 13(12): 1159. CrossRef
The SOS Response Activation and the Risk of Antibiotic Resistance Enhancement in Proteus spp. Strains Exposed to Subinhibitory Concentrations of Ciprofloxacin
Agnieszka Zabłotni, Marek Schmidt, Małgorzata Siwińska
International Journal of Molecular Sciences.2024; 26(1): 119. CrossRef

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

Citations to this article as recorded by

A case of cerebrospinal fluid (CSF) leak and pneumocephalus in a 52-year-old with a pituitary adenoma
Barbara Magid, Lauren Titone, Tyler Wise
Visual Journal of Emergency Medicine.2025; 38: 102153. CrossRef
A Rare Case of Post-lumbar Discectomy Pneumocephalus: An Anatomically Informed Case Report
Yasir H Elhassan, Mustafa Alhasan, Yasser S Abdulghani
Cureus.2025;[Epub] CrossRef
Etiology of Intracranial Pneumocephalus: A Retrospective Comparative Study of Traumatic and Iatrogenic Causes in Emergency Patients
Mehdi Hekimoğlu, Hıdır Özer
Medical Records.2025; 7(2): 476. CrossRef
Spontaneous extensive pneumocephalus following frontal sinus defect
Kaavya Venkatesh, Nitin Mukerji, Devasmitha Venkataraman
BMJ Case Reports.2025; 18(5): e263987. CrossRef
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
Pro-Con Debate: Air or Saline for Loss-of-Resistance Technique of Interlaminar Epidural Access with Fluoroscopy-Guided Pain Medicine Procedures
David Hao, Kirk Bonner, Taylor Burnham, Milan P. Stojanovic
Anesthesia & Analgesia.2024;[Epub] CrossRef
Pneumocephalus After Lumbar Epidural Steroid Injection: A Rare Complication With Spontaneous Resolution
Yasser Hegazy, Natalie N Balassiano, Ishank Gupta, Roger Stern, Muhammad Ghallab
Cureus.2024;[Epub] 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

Review Article

Cardiology
Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it: Seung-Jae Joo; Acute Crit Care. 2023;38(3):251-260. Published online August 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00955

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Abstract PDF

Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin-aldosterone system which are known to reduce cardiovascular mortality of patients with AMI were not introduced. In the reperfusion era, beta-blockers’ benefit has not been clearly shown except in patients with reduced ejection fraction (EF; ≤40%). In the era of the early reperfusion therapy for AMI, a number of patients with mildly reduced EF (>40%, <50%) or preserved EF (≥50%) become increasing. However, because no randomized clinical trials are available until now, the benefit and the optimal duration of oral treatment with beta-blockers in patients with mildly reduced or preserved EF are questionable. Registry data have not showed the association of oral beta-blocker therapy with decreased mortality in survivors without heart failure or left ventricular systolic dysfunction after AMI. In the Korea Acute Myocardial Infarction Registry-National Institute of Health of in-hospital survivors after AMI, the benefit of beta-blocker therapy at discharge was shown in patients with reduced or mildly reduced EF, but not in those with preserved EF, which provides new information about beta-blocker therapy in patients without reduced EF. However, clinical practice can be changed when the results of appropriate randomized clinical trials are available. Ongoing clinical trials may help to answer the unresolved issues of beta-blocker therapy in patients with AMI.

Citations

Citations to this article as recorded by

Beta-Blockers in Patients With Myocardial Infarction: A Meta-Analysis
Mushood Ahmed, Areeba Ahsan, Aimen Shafiq, Hasan Ahmad, Raheel Ahmed, Jamal S. Rana, Marat Fudim, Gregg C. Fonarow
American Journal of Therapeutics.2025;[Epub] CrossRef
Neuroimmune Interactions and Their Role in Immune Cell Trafficking in Cardiovascular Diseases and Cancer
Yutang Wang, Jack C. Anesi, Indu S. Panicker, Darcy Cook, Prapti Bista, Yan Fang, Ernesto Oqueli
International Journal of Molecular Sciences.2025; 26(6): 2553. CrossRef
Elevated serum amylase concentrations are associated with worse in-hospital outcomes among patients with acute myocardial infarction
Marijana Mikacic, Marko Kumric, Iva Rancic Vidic, Duska Glavas, Tina Ticinovic Kurir, Josko Bozic, Josip Andelo Borovac
BMC Cardiovascular Disorders.2025;[Epub] CrossRef
Cardiac arrhythmia following acute myocardial infarction: a retrospective analysis of 27,648 hospitalized patients in a tertiary heart hospital
Nidal Asaad, Ayman El-Menyar, Rajvir Singh, Betsy Varughese, Shahul Hameed Khan, Hajar AlBinali, Jassim Al Suwaidi
Monaldi Archives for Chest Disease.2025;[Epub] CrossRef
Beta-Adrenergic Blockers for Acute Myocardial Infarction: 50 years of Expert Opinions in Cecil Textbook of Medicine
Peter Manu, Gheorghe-Andrei Dan
American Journal of Therapeutics.2025; 32(3): e274. CrossRef
Prognostic impact of changes in left ventricular ejection fraction and wall motion score index in patients with myocardial infarction
Min-Wook Bae, Seong-guen Moon, Kyung-Tae Jung, Won-Ho Kim, Sang-Hyun Park, Jihun Ahn, Jin-Yong Hwang, Seok Kyu Oh, Seung Ho Hur, Myung Ho Jung, Kyu-Sun Lee
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef
In-hospital cardiac arrest after STEMI: prevention strategies and post-arrest care
Walker Boyd, Wesley Young, Mehmet Yildiz, Timothy D. Henry, Kari Gorder
Expert Review of Cardiovascular Therapy.2024; 22(8): 379. CrossRef
Association between Inflammation and New-Onset Atrial Fibrillation in Acute Coronary Syndromes
Ruxandra-Maria Băghină, Simina Crișan, Silvia Luca, Oana Pătru, Mihai-Andrei Lazăr, Cristina Văcărescu, Alina Gabriela Negru, Constantin-Tudor Luca, Dan Gaiță
Journal of Clinical Medicine.2024; 13(17): 5088. CrossRef
Use of Early Intravenous Beta Blockers in Patients with Acute ST-Segment Elevation Myocardial Infarction Without Heart Failure—Revival or Requiem?
Azka Latif, Xiaoming Jia
Cardiovascular Drugs and Therapy.2024; 38(5): 973. CrossRef
Progress in Disease Modeling for Myocardial Infarction and Coronary Artery Disease: Bridging In Vivo and In Vitro Approaches
Riya Kar, Debabrata Mukhopadhyay, Ramcharan Singh Angom
Hearts.2024; 5(4): 429. CrossRef
Optimal duration of medical therapy for patients with acute myocardial infarction
Ki Yung Boo, Seung-Jae Joo, Jae-Geun Lee, Joon-Hyouk Choi, Song-Yi Kim, Geum Ko, Hae Eun Yun, Myung Ho Jeong
Medicine.2024; 103(48): e40697. CrossRef

Original Articles

Pulmonary
Factors influencing sleep quality in the intensive care unit: a descriptive pilot study in Korea: Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2023;38(3):278-285. Published online August 11, 2023; DOI: https://doi.org/10.4266/acc.2023.00514

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Abstract PDF Supplementary Material

Background
As sleep disturbances are common in the intensive care unit (ICU), this study assessed the sleep quality in the ICU and identified barriers to sleep.
Methods
Patients admitted to the ICUs of a tertiary hospital between June 2022 and December 2022 who were not mechanically ventilated at enrollment were included. The quality of sleep (QoS) at home was assessed on a visual analog scale as part of an eight-item survey, while the QoS in the ICU was evaluated using the Korean version of the Richards-Campbell Sleep Questionnaire (K-RCSQ). Good QoS was defined by a score of ≥50.
Results
Of the 30 patients in the study, 19 reported a QoS score <50. The Spearman correlation coefficient showed no meaningful relationship between the QoS at home and the overall K-RCSQ QoS score in the ICU (r=0.16, P=0.40). The most common barriers to sleep were physical discomfort (43%), being awoken for procedures (43%), and feeling unwell (37%); environmental factors including noise (30%) and light (13%) were also identified sources of sleep disruption. Physical discomfort (median [interquartile range]: 32 [28.0–38.0] vs. 69 [42.0–80.0], P=0.004), being awoken for procedures (36 [20.0–48.0] vs. 54 [36.0–80.0], P=0.04), and feeling unwell (31 [18.0–42.0] vs. 54 [40.0–76.0], P=0.01) were associated with lower K-RCSQ scores.
Conclusions
In the ICU, physical discomfort, patient care interactions, and feeling unwell were identified as barriers to sleep.

Citations

Citations to this article as recorded by

Effects of nursing interventions applied at night on sleep quality and sleep effort of patients in the intensive care unit
Aynur Bahar, Mina Güner Muşluoğlu, Hilal Uygur
Psychology, Health & Medicine.2025; : 1. CrossRef
Impact of Noninvasive Ventilation on Quality of Sleep among Patients Admitted to the Critical Care Unit
Margiben T Bhatt, Aiswarya Kunjappan, Madhura M Reddy, Samruddha S Prabhu, Vani Lakshmi R
Indian Journal of Critical Care Medicine.2025; 29(5): 424. CrossRef
Sleep Quality and Its Associated Factors among Adult Patients Admitted in the Intensive Care Units of Public Hospitals in Addis Ababa, Ethiopia
Taye Mezgebu Ashine, Birehanu Melaku Kassaye, Asefu Woldestadik, Kasie Gebeyehu Tiruneh, Tadesse Sahle Adeba, Edmialem Getahun Mesfin, Tamrat Alate Woldeyohannis, Asaminew Habtamu Sane
SAGE Open Nursing.2025;[Epub] CrossRef
Factors Predicting Sleep Quality in Sepsis Survivors: A Cross-Sectional Study
Kewalin Pongsuwun, Wimolrat Puwarawuttipanit, Ruttanaporn Kongkar, Yong Rongrungruang
Pacific Rim International Journal of Nursing Research.2025; 29(3): 619. CrossRef
Quieting the ICU: Pathway to Recovery, by Enhancing Sleep through Non Pharmacological Intervention: A Comparative Analysis
Shivakumar Shivanna, Swapna Mandala Babu, Deepak CP
Indian Journal of Critical Care Medicine.2025; 29(S1): S198. CrossRef
Comparing single-patient and multi-patient room intensive care units: a multicenter cohort study on architectural differences and clinical significance in South Korea
Daun Jeong, Donghyoun Lee, Kyoung Won Yoon, Hyo Jin Kim, Sun Young Choi, Chi-Min Park
Acute and Critical Care.2025; 40(2): 160. CrossRef
Could fever dreams influence sleep in intensive care units?
Jeng Swen Ng, Sheryn Tan, Sanjana Santhosh, Brandon Stretton, Joshua Kovoor, Aashray Gupta, Stephen Bacchi
Acute and Critical Care.2024; 39(2): 327. CrossRef
Effects of ICU diaries on psychological disorders and sleep quality in critically ill patients and their family members: A systematic review and meta-analysis
Wenjie Huang, Yang Gao, Lingjun Zhou, Xiaojuan Xiao, Hong Xu, Lizhou Lu, Jinhao Deng, Juan Wu
Sleep Medicine.2024; 122: 84. CrossRef
Nursing‐Based Sleep Promotion Intervention Effectiveness for Post Cardiac Surgery Patients: Systematic Review
Issa M. Hweidi, Omar H. Jebreel, Hossam N. Alhawatmeh, Mohamad I. Jarrah, Awwad A. Abu‐Awwad, Mohammed I. Hweidi
Journal of Clinical Nursing.2024; 33(12): 4528. CrossRef
Nursing Sleep Promotion in Intensive Care Unit
Orlando Fernandes, Válter Gonçalves, Leonardo Ribeiro, Elsa Sousa, Michelle Viríssimo, Abel Viveiros, Ana Alves
European Journal of Theoretical and Applied Sciences.2024; 2(6): 238. CrossRef
Different nursing interventions on sleep quality among critically ill patients: A systematic review and network meta-analysis
Daijin Huang, Yumei Li, Jing Ye, Chang Liu, Dongyan Shen, Yunhui Lv
Medicine.2023; 102(52): e36298. CrossRef

Pulmonary
Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure: Türkay Akbaş, Harun Güneş; Acute Crit Care. 2023;38(1):49-56. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01011

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Abstract PDF

Background
The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure.
Methods
This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020.
Results
One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients’ mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0±7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/ FiO2 ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017–1.317; P=0.026), admission PaO2/FiO2 ratio (OR, 0.989; 95% CI, 0.978–0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650–47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021–1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056–0.514; P=0.002) emerged as predictors of 90-day mortality.
Conclusions
APACHE II scores, the PaO2/FiO2 ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.

Citations

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Breaking new ground: machine learning enhances survival forecasts in hypercapnic respiratory failure
Zhongxiang Liu, Bingqing Zuo, Jianyang Lin, Zhixiao Sun, Hang Hu, Yuan Yin, Shuanying Yang
Frontiers in Medicine.2025;[Epub] CrossRef
Efficacy and safety of medroxyprogesterone acetate on noninvasive ventilation -treated exacerbated COPD patients: a double-blind randomized clinical trial
Mohsen Gholinataj Jelodar, Mohammadreza Malek-Ahmadi, Adeleh Sahebnasagh, Farhad Mohammadi, Fatemeh Saghafi
BMC Pulmonary Medicine.2025;[Epub] CrossRef
From acute phase to rehabilitation: bridging the gap and improving the pathway for Chronic Obstructive Pulmonary Diseases patients (Summary of a Pulmonologists’ Audit - September-December 2024)
Michele Vitacca, Massimiliano Beccaria, Luca Bianchi, Paolo Ceruti, Maurizio Marvisi, Monia Betti, Michela Bezzi, Francesco Tursi
Multidisciplinary Respiratory Medicine.2025;[Epub] CrossRef
Construction and validation of a nomogram prediction model for death risk in patients with chronic obstructive pulmonary disease complicated by hypercapnic respiratory failure in the intensive care unit
Ye Zhang, Hao Chen, Shiyu Hu, Chengshui Chen, Wenyu Chen
Respiratory Medicine.2025; 245: 108188. CrossRef
Antibiotics in COPD exacerbations requiring mechanical ventilation: a dogma to be re-evaluated
Sebastian Osorio-Rico, Daniel Perez-Marin, John Cardeño-Sanchez
Internal and Emergency Medicine.2024; 19(5): 1505. CrossRef
Opportunities and perspectives of small molecular phosphodiesterase inhibitors in neurodegenerative diseases
Qi Li, Qinghong Liao, Shulei Qi, He Huang, Siyu He, Weiping Lyu, Jinxin Liang, Huan Qin, Zimeng Cheng, Fan Yu, Xue Dong, Ziming Wang, Lingfei Han, Yantao Han
European Journal of Medicinal Chemistry.2024; 271: 116386. CrossRef
Development and Validation of an In-Hospital Mortality Prediction Model for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Wenjie Sun, Yeshan Li, Shuxin Tan
International Journal of Chronic Obstructive Pulmonary Disease.2024; Volume 19: 1303. CrossRef
Value of diaphragmatic ultrasound parameters in assessing weaning outcomes and survival in ventilator-dependent intensive care unit patients
Liuhua Pan
American Journal of Translational Research.2024; 16(12): 7830. CrossRef
COPD Exacerbation: Why It Is Important to Avoid ICU Admission
Irene Prediletto, Gilda Giancotti, Stefano Nava
Journal of Clinical Medicine.2023; 12(10): 3369. CrossRef

Case Report

Pulmonary
A fatal case report of invasive pulmonary aspergillosis and mucormycosis coinfection in an immunocompetent patient with coronavirus disease 2019 in Korea: Jin Hyoung Kim, Misung Kim, Soyeoun Lim, Sun Young Park, Yangjin Jegal, Taehoon Lee, Byung Ju Kang; Acute Crit Care. 2023;38(3):382-388. Published online June 27, 2022; DOI: https://doi.org/10.4266/acc.2021.01340

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Abstract PDF

Systemic glucocorticoid treatment is highly recommended in critically ill coronavirus disease 2019 (COVID-19) patients. However, secondary fungal infections are of concern in such patients. Here, we describe the first case of COVID-19-associated invasive pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) coinfection in a COVID-19 positive immunocompetent patient in Korea. A 69-year-old man was admitted to our hospital with COVID-19 pneumonia. He had no underlying comorbidities and was not taking medications. He received remdesivir, dexamethasone, and antibiotic therapy under mechanical ventilation. Although his condition improved temporarily, multiple cavities were observed on chest computed tomography, and Aspergillus fumigatus was cultured from tracheal aspiration culture. He was diagnosed with probable CAPA and received voriconazole therapy. However, his condition was not significantly improved despite having received voriconazole therapy for 4 weeks. After release from COVID-19 quarantine, he underwent bronchoscopy examination and was then finally diagnosed with CAPA and CAM coinfection on bronchoscopic biopsy. Antifungal treatment was changed to liposomal amphotericin B. However, his progress deteriorated, and he died 4 months after admission. This case highlights that clinical suspicion and active checkups are required to diagnose secondary fungal infections in immunocompetent COVID-19 patients who receive concurrent glucocorticoid therapy.

Citations

Citations to this article as recorded by

Incidence and Temporal Dynamics of Combined Infections in SARS-CoV-2-Infected Patients With Risk Factors for Severe Complications
Sin Young Ham, Seungjae Lee, Min-Kyung Kim, Jaehyun Jeon, Eunyoung Lee, Subin Kim, Jae-Phil Choi, Hee-Chang Jang, Sang-Won Park
Journal of Korean Medical Science.2025;[Epub] CrossRef
Mucormycosis coinfection in patients with proven aspergillosis
Hyeon Mu Jang, Ji Yeun Kim, Joon Seon Song, Euijin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sang-Ho Choi, Sang-Oh Lee, Yang Soo Kim, Sung-Han Kim
Medical Mycology.2025;[Epub] CrossRef
Mixed Aspergillosis and Mucormycosis Infections in Patients with COVID-19: Case Series and Literature Review
Elahe Sasani, Farzad Pakdel, Sadegh Khodavaisy, Mohammadreza Salehi, Amir Salami, Marjan Sohrabi, Pouyan Aminishakiba, Iman Amirafzali, Arezoo Salami Khaneshan
Mycopathologia.2024;[Epub] CrossRef
Prevalence of co‐existent COVID‐19‐associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID‐19‐associated pulmonary mucormycosis (CAPM)
Valliappan Muthu, Ritesh Agarwal, Shivaprakash Mandya Rudramurthy, Deepak Thangaraju, Manoj Radhakishan Shevkani, Atul K. Patel, Prakash Srinivas Shastri, Ashwini Tayade, Sudhir Bhandari, Vishwanath Gella, Jayanthi Savio, Surabhi Madan, Vinaykumar Hallur,
Mycoses.2024;[Epub] CrossRef
Aspergillosis coinfection in patients with proven mucormycosis
Sang Hyun Ra, Ji Yeun Kim, Joon Seon Song, Hyeon Mu Jang, Euijin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Sung-Han Kim
Medical Mycology.2024;[Epub] CrossRef
Successful treatment of mixed pulmonary Aspergillus and Mucor infection using intrabronchial amphotericin B infusion: a case report and literature review
Fei-Xiang Ling, Dong-Ming Qu, Ye-Quan Lu, Rou Li, Lei Zhao
BMC Pulmonary Medicine.2024;[Epub] CrossRef
The impact of pulmonary tuberculosis on SARS-CoV-2 infection: a nationwide cohort study
Sang Hwan Lee, Yun Jin Kim, Jaehoon Oh, Hyunggoo Kang, Kyung Hun Yoo, Byuk Sung Ko, Tae Ho Lim, Bo-Guen Kim, Hyun Lee, Sang-Heon Kim, Jang Won Sohn, Ho Joo Yoon, Hayoung Choi, Yongil Cho, Dong Won Park
Frontiers in Medicine.2024;[Epub] CrossRef
Dual Disseminated Aspergillosis and Mucormycosis Diagnosed at Autopsy: A Report of Two Cases of Coinfection and a Review of the Literature
Jason Murray, Zhen A. Lu, Karin Miller, Alex Meadows, Marissa Totten, Sean X. Zhang
Journal of Fungi.2023; 9(3): 357. CrossRef
COVID-19 and Fungal infections: a double debacle
Sara Mina, Hajar Yaakoub, Cédric Annweiler, Vincent Dubée, Nicolas Papon
Microbes and Infection.2022; 24(8): 105039. CrossRef

Review Articles

Basic science and research
Sex or gender differences in treatment outcomes of sepsis and septic shock: Seung Yeon Min, Ho Jin Yong, Dohhyung Kim; Acute Crit Care. 2024;39(2):207-213. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2024.00591

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Gender disparities in intensive care unit (ICU) treatment approaches and outcomes are evident. However, clinicians often pay little attention to the importance of biological sex and sociocultural gender in their treatment courses. Previous studies have reported that differences between sexes or genders can significantly affect the manifestation of diseases, diagnosis, clinicians' treatment decisions, scope of treatment, and treatment outcomes in the intensive care field. In addition, numerous reports have suggested that immunomodulatory effects of sex hormones and differences in gene expression from X chromosomes between genders might play a significant role in treatment outcomes of various diseases. However, results from clinical studies are conflicting. Recently, the need for customized treatment based on physical, physiological, and genetic differences between females and males and sociocultural characteristics of society have been increasingly emphasized. However, interest in and research into this field are remarkably lacking in Asian countries, including South Korea. Through this review, we hope to enhance our awareness of the importance of sex and gender in intensive care treatment and research by briefly summarizing several principal issues, mainly focusing on sex and sex hormone-based outcomes in patients admitted to the ICU with sepsis and septic shock.

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Impact of substance use disorders on critical care management and health outcomes in septic adolescents
Havell Markus, Gary D. Ceneviva, Neal J. Thomas, Conrad Krawiec
Annals of Intensive Care.2025;[Epub] CrossRef
Trends of cardiovascular disease and sepsis related mortality in the United States, 1999 to 2019: A CDC WONDER Database Analysis
Shehroze Tabassum, Faraz Azhar, Aimen Shafiq, Muneeba Ahsan, Aroma Naeem, Farhan Naeem, Hafeez Ul Hassan Virk, Abdul Mannan Khan Minhas, Dmitry Abramov, M Chadi Alraies
International Journal of Cardiology Cardiovascular Risk and Prevention.2025; 26: 200421. CrossRef
Mitigating Bias in Machine Learning Models with Ethics-Based Initiatives: The Case of Sepsis
John D. Banja, Yao Xie, Jeffrey R. Smith, Shaheen Rana, Andre L. Holder
The American Journal of Bioethics.2025; : 1. CrossRef
Sex differences on the effect of hemoadsorption during cardiac surgery – A REMOVE trial post-hoc analysis
Tulio Caldonazo, Torsten Doenst, Luca Fazzini, Hristo Kirov, Stefan Hagel, Thomas Lehmann, Shekhar Saha, Rodrigo Sandoval Boburg, Sebastian Freiburger, Christian Jörg Rustenbach, Mateo Marin-Cuartas, Mahmoud Diab
International Journal of Cardiology.2025; 435: 133371. CrossRef
Clinical predictors of hospital-acquired bloodstream infections: A healthcare system analysis
Harjinder Singh, Radhika Sheth, Mehakmeet Bhatia, Abdullah Muhammad, Candi Bachour, David Metcalf, Vivek Kak
Spartan Medical Research Journal.2024;[Epub] CrossRef
Impact of metabolic syndrome on cardiovascular, inflammatory and hematological parameters in female mice subjected to severe sepsis
Leonardo Berto-Pereira, Raquel Pires Nakama, Lucas Felipe dos Santos, Aparecida Donizette Malvezi, Isabella Ramos Trevizani Thihara, Lucas Sobral de Rossi, Fabricio Seidy Ribeiro Inoue, Wander Rogério Pavanelli, Priscila Cassolla, Phileno Pinge-Filho, Mar
Biochemical and Biophysical Research Communications.2024; 739: 150966. CrossRef

Surgery
Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review: Hanan Elkalawy, Pavan Sekhar, Wael Abosena; Acute Crit Care. 2023;38(4):409-424. Published online November 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00703

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Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

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Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients
Ana Maria Dumitriu, Cristian Cobilinschi, Bogdan Dumitriu, Sebastian Vâlcea, Raluca Ungureanu, Angela Popa, Rǎzvan Ene, Radu Țincu, Ioana Marina Grințescu, Liliana Mirea
Nutrients.2025; 17(3): 380. CrossRef
Potential diagnostic tools for intensive care unit acquired weakness: A systematic review
Chen Xin, Yubiao Gai, Lili Wei, Yanqiu Wang, Yuhong Luo, Binru Han
International Journal of Nursing Studies Advances.2025; 8: 100301. CrossRef
Characteristics of the Cerebrospinal Fluid in Septic Patients with Critical Illness Polyneuropathy - A Retrospective Cohort Study
Yanyang Zhang, Jinfu Ma, Qing Zhao, Hui Liu
The Journal of Critical Care Medicine.2024; 10(2): 130. CrossRef
Advancing critical care recovery: The pivotal role of machine learning in early detection of intensive care unit-acquired weakness
Georges Khattar, Elie Bou Sanayeh
World Journal of Clinical Cases.2024; 12(21): 4455. CrossRef
Construction and evaluation of acquired weakness nomogram model in patients with mechanical ventilation in intensive care unit
Chen Lu, Jiang Wenjuan
DIGITAL HEALTH.2024;[Epub] CrossRef
A scoping review of preclinical intensive care unit-acquired weakness models
Qingmei Yu, Jiamei Song, Luying Yang, Yanmei Miao, Leiyu Xie, Xinglong Ma, Peng Xie, Shaolin Chen
Frontiers in Physiology.2024;[Epub] CrossRef

Original Article

Nursing
Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan: Khaldoun Mohammad Hamdan, Ahmad M. Al-Bashaireh, Mohammad Al-Dalahmeh, Ahmad Rajeh Saifan, Maha Alkaid Albqoor, Abeer M. Shaheen; Acute Crit Care. 2023;38(4):469-478. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00430

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Background
There is a growing need for palliative care globally due to the rapid aging of the population and improvement in cancer survival rates. Adequate knowledge and a positive attitude are vital for palliative care nurses. The study’s purpose was to examine nurses’ knowledge and attitudes toward palliative care.
Methods
A cross-sectional design with convenience sampling was used. The study included 182 intensive care unit (ICU) nurses from Jordanian hospitals in all sectors. Self-administered questionnaires were used to assess nurses' knowledge and attitudes toward palliative care. Descriptive statistics, analysis of variance, and the Kruskal-Wallis H test were used to analyze the data.
Results
We measured nurses’ knowledge using the Palliative Care Quiz for Nursing, and we measured nurses' attitudes using the Frommelt Attitude Toward Care of the Dying scale. The mean total knowledge and attitude scores were 8.88 (standard deviation [SD], 2.52) and 103.14 (SD, 12.31), respectively. The lowest level of knowledge was in psychosocial and spiritual care (mean, 0.51±0.70). The percentage of nurses with unfavorable attitudes was 53.3%. Significant differences in knowledge and attitude levels were observed according to educational level, experience, and hospital type.
Conclusions
ICU nurses have insufficient knowledge and inappropriate attitudes toward palliative care. Knowledge of psychological and spiritual aspects of palliative care was particularly lacking as were appropriate attitudes towards communication with dying patients. Improving knowledge and attitudes toward palliative care in nursing schools and hospitals would help overcome this problem.

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Core competency in palliative care among intensive care unit nurses: A latent profile analysis
Qin Guan, Xiaoling Zhu, Zhipeng Xue, Mengyun Peng
Nursing in Critical Care.2025;[Epub] CrossRef
Knowledge, attitudes, and self-efficacy regarding palliative care among Palestinian nurses in intensive care units
Bilal Awad, Ahmad Batran, Malakeh Z. Malak, Ahmad Ayed, Anas Shehadeh, Bahaa Alassoud, Moath Abu Ejheisheh
BMC Nursing.2025;[Epub] CrossRef
Soulful support: Exploring critical care nurses' spiritual caregiving towards end‐of‐life scenario
Ayman Mohamed El‐Ashry, Sameh Eltyebani, Shimmaa Mohamed Elsayed, Mahmoud Abdelwahab Khedr, Mona Metwally El‐Sayed, Mohamed Adel Ghoneam, Haitham Mokhtar Mohamed Abdallah
Nursing in Critical Care.2025;[Epub] CrossRef
Palliative Care Knowledge, Attitudes, and Self-Competence of Nurses Working in Hospital Settings
Mona Ibrahim Hebeshy, Darcy Copeland
Journal of Palliative Care.2025;[Epub] CrossRef
Investigation of the Relationship between Personality Traits of Intensive Care Nurses and Their Attitudes and Behaviours towards End-of-life Care
Fırat Demir, Cansu Polat Dünya, İlknur Özkan
Sağlık Bilimleri Üniversitesi Hemşirelik Dergisi.2024; 6(3): 243. CrossRef
Knowledge and attitude towards palliative care and associated factors among nurse: a cross-sectional descriptive study
Saeedeh Rafiee, Ismail Azizi-Fini, Zahra-Sadat Banihashemi, Safoura Yadollahi
BMC Nursing.2024;[Epub] CrossRef

Review Article

Cardiology
Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation: review with updated evidence: Yongwhan Lim, Min Chul Kim, In-Seok Jeong; Acute Crit Care. 2024;39(4):473-487. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.00801

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Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to treat medically refractory cardiogenic shock and cardiac arrest, and its usage has increased exponentially over time. Although VA-ECMO has many advantages over other mechanical circulatory supports, it has the unavoidable disadvantage of increasing retrograde arterial flow in the afterload, which causes left ventricular (LV) overload and can lead to undesirable consequences during VA-ECMO treatment. Weak or no antegrade flow without sufficient opening of the aortic valve increases the LV end-diastolic pressure, and that can cause refractory pulmonary edema, blood stagnation, thrombosis, and refractory ventricular arrhythmia. This hemodynamic change is also related to an increase in myocardial energy consumption and poor recovery, making LV unloading an essential management issue during VA-ECMO treatment. The principal factors in effective LV unloading are its timing, indications, and modalities. In this article, we review why LV unloading is required, when it is indicated, and how it can be achieved.

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Routine Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation—A Therapeutic Conundrum
Alice Bottussi, Jacopo D'Andria Ursoleo, Enrica Piazza, Edoardo Mongardini, Fabrizio Monaco
Journal of Cardiothoracic and Vascular Anesthesia.2025; 39(3): 860. CrossRef
Transaortic Catheter Venting for Left Ventricular Unloading in Veno-Arterial Extracorporeal Life Support: A Porcine Cardiogenic Shock Model
Sang Yoon Kim, Hyoung Woo Chang, Jae Hang Lee, Jae Hyun Jeon, Yoohwa Hwang, Hwan Hee Park, Dong Jung Kim
Medicina.2025; 61(4): 552. CrossRef
Left Heart Venting or Unloading Strategies for VA-ECMO Patients: Indications, Timing, and Techniques: A Narrative Review
YeongEun Jo, Jiae Seong, Hwa-Jin Cho, Do Wan Kim, Yongwhan Lim, Yang Hyun Cho, Seunghwan Song, Min Chul Kim, Inseok Jeong
Journal of Cardiovascular Intervention.2025;[Epub] CrossRef
Strategies of Revascularization and Mechanical Circulatory Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Systematic Review With Updated Evidence
Yongwhan Lim, Min Chul Kim, Seok Oh, Joon Ho Ahn, Seung Hun Lee, Dae Young Hyun, Kyung Hoon Cho, Doo Sun Sim, Young Joon Hong, Juhan Kim, Youngkeun Ahn
Journal of Cardiovascular Intervention.2025;[Epub] CrossRef
Left ventricular unloading strategies in venoarterial extracorporeal membrane oxygenation patients: how much do we truly understand?
Jihyuk Chung, Su Yong Kim, Juhyun Lee, Yang Hyun Cho
Acute and Critical Care.2025; 40(2): 357. CrossRef

Original Article

Cardiology
Risk factors for cannula-associated arterial thrombosis following extracorporeal membrane oxygenation support: a retrospective study: Ngan Hoang Kim Trieu, Xuan Thi Phan, Linh Thanh Tran, Huy Minh Pham, Dai Quang Huynh, Tuan Manh Nguyen, Anh Tuan Mai, Quan Quoc Minh Du, Bach Xuan Nguyen, Thao Thi Ngoc Pham; Acute Crit Care. 2023;38(3):315-324. Published online August 23, 2023; DOI: https://doi.org/10.4266/acc.2023.00500

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Background
Hemostatic dysfunction during extracorporeal membrane oxygenation (ECMO) due to blood-circuit interaction and the consequences of shear stress imposed by flow rates lead to rapid coagulation cascade and thrombus formation in the ECMO system and blood vessels. We aimed to identify the incidence and risk factors for cannula-associated arterial thrombosis (CaAT) post-decannulation.
Methods
A retrospective study of patients undergoing arterial cannula removal following ECMO was performed. We evaluated the incidence of CaAT and compared the characteristics, ECMO machine parameters, cannula sizes, number of blood products transfused during ECMO, and daily hemostasis parameters in patients with and without CaAT. Multivariate analysis identified the risk factors for CaAT.
Results
Forty-seven patients requiring venoarterial ECMO (VA-ECMO) or hybrid methods were recruited for thrombosis screening. The median Sequential Organ Failure Assessment score was 11 (interquartile range, 8–13). CaAT occurred in 29 patients (61.7%), with thrombosis in the superficial femoral artery accounting for 51.7% of cases. The rate of limb ischemia complications in the CaAT group was 17.2%. Multivariate analysis determined that the ECMO flow rate–body surface area (BSA) ratio (100 ml/min/m2) was an independent factor for CaAT, with an odds ratio of 0.79 (95% confidence interval, 0.66–0.95; P=0.014).
Conclusions
We found that the incidence of CaAT was 61.7% following successful decannulation from VA-ECMO or hybrid modes, and the ECMO flow rate–BSA ratio was an independent risk factor for CaAT. We suggest screening for arterial thrombosis following VA-ECMO, and further research is needed to determine the risks and benefits of such screening.

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Machine learning‐based prediction of bleeding risk in extracorporeal membrane oxygenation patients using transfusion as a surrogate marker
Tadashi Kamio, Masaru Ikegami, Megumi Mizuno, Seiichiro Ishii, Hayato Tajima, Yoshihito Machida, Kiyomitsu Fukaguchi
Transfusion.2025;[Epub] CrossRef
Peripheral VA-ECMO: from Evolving Indications to Perioperative Implications
Ngan Hoang Kim Trieu, Huy Minh Pham, Dai Quang Huynh, Linh Thanh Tran, Ngoc Tu Nguyen, Anh Tuan Mai, Thao Thi Ngoc Pham
Anesthesiology and Perioperative Science.2025;[Epub] CrossRef
Has the role of veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock following acute myocardial infarction been fully determined? A case report
Kha Minh Nguyen, Hai Phuong Nguyen Tran, Vi Tuong Dang, Sy Van Hoang, Josip Andelo Borovac, Dmitry Duplyakov, Chiara De Biase, Pok-Tin Tang
European Heart Journal - Case Reports.2024;[Epub] CrossRef
Vaskuläre Komplikationen unter venoarterieller extrakorporaler Membranoxygenierung
J. Ajouri, N. Abdal-Daem, V. Scriba, A. A. Peivandi, R. M. Muellenbach, Y. D. Sagban, T. A. Sagban
Gefässchirurgie.2024; 29(7): 410. CrossRef
Assessment of percutaneous closure for decannulation of veno-arterial extracorporeal membrane oxygenation: A retrospective study
Diana Martins-Fernandes, João Rocha-Neves, Ana Rita Ferreira, Hélio Martins, Sérgio Gaião, José Artur Paiva
The Journal of Vascular Access.2024;[Epub] CrossRef

Review Article

Trauma
Mobilization phases in traumatic brain injury: Tommy Alfandy Nazwar, Ivan Triangto, Gutama Arya Pringga, Farhad Bal’afif, Donny Wisnu Wardana; Acute Crit Care. 2023;38(3):261-270. Published online August 1, 2023; DOI: https://doi.org/10.4266/acc.2023.00640

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Mobilization in traumatic brain injury (TBI) have shown the improvement of length of stay, infection, long term weakness, and disability. Primary damage as a result of trauma’s direct effect (skull fracture, hematoma, contusion, laceration, and nerve damage) and secondary damage caused by trauma’s indirect effect (microvasculature damage and pro-inflammatory cytokine) result in reduced tissue perfusion & edema. These can be facilitated through mobilization, but several precautions must be recognized as mobilization itself may further deteriorate patient’s condition. Very few studies have discussed in detail regarding mobilizing patients in TBI cases. Therefore, the scope of this review covers the detail of physiological effects, guideline, precautions, and technique of mobilization in patients with TBI.

Citations

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Reversing Persistent PTEN Activation after Traumatic Brain Injury Fuels Long‐Term Axonal Regeneration via Akt/mTORC1 Signaling Cascade
Ziyu Shi, Leilei Mao, Shuning Chen, Zhuoying Du, Jiakun Xiang, Minghong Shi, Yana Wang, Yuqing Wang, Xingdong Chen, Zhi‐Xiang Xu, Yanqin Gao
Advanced Science.2025;[Epub] CrossRef
Falls in a single brain rehabilitation center: a 3-year retrospective chart review
Yoo Jin Choo, Jun Sung Moon, Gun Woo Lee, Wook-Tae Park, Min Cheol Chang
Frontiers in Neurology.2025;[Epub] CrossRef
Effects of using conventional assistive devices on spatiotemporal gait parameters of adults with neurological disorders: A systematic review protocol
Jordana de Paula Magalhães, Sheridan Ayessa Ferreira de Brito, Merrill Landers, Aline Alvim Scianni, Poliana do Amaral Yamaguchi Benfica, Carolina Luisa de Almeida Soares, Christina Danielli Coelho de Morais Faria, Anne E. Martin
PLOS ONE.2025; 20(4): e0321019. CrossRef
Acute orthostatic responses during early mobilisation of patients with acquired brain injury - Innowalk pro versus standing frame
Matthijs F Wouda, Espen I Bengtson, Ellen Høyer, Alhed P Wesche, Vivien Jørgensen
Journal of Rehabilitation and Assistive Technologies Engineering.2024;[Epub] CrossRef
Aktuelle Aspekte der intensivmedizinischen Versorgung bei Schädel-Hirn-Trauma – Teil 2
André Hagedorn, Helge Haberl, Michael Adamzik, Alexander Wolf, Matthias Unterberg
AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie.2024; 59(07/08): 466. CrossRef

Original Articles

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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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

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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
Traumatic brain injury in companion animals: Pathophysiology and treatment
Molly Wart, Thomas H. Edwards, Julie A. Rizzo, Geoffrey W. Peitz, Armi Pigott, Jonathan M. Levine, Nicholas D. Jeffery
Topics in Companion Animal Medicine.2024; 63: 100927. CrossRef

Epidemiology
Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study: Luiza Gabriella Antonio e Silva, Claudia Maria Dantas de Maio Carrilho, Thalita Bento Talizin, Lucienne Tibery Queiroz Cardoso, Edson Lopes Lavado, Cintia Magalhães Carvalho Grion; Acute Crit Care. 2023;38(1):68-75. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01375

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Background
Deaths can occur after a patient has survived treatment for a serious illness in an intensive care unit (ICU). Mortality rates after leaving the ICU can be considered indicators of health care quality. This study aims to describe risk factors and mortality of surviving patients discharged from an ICU in a university hospital.
Methods
Retrospective cohort study carried out from January 2017 to December 2018. Data on age, sex, length of hospital stay, diagnosis on admission to the ICU, hospital discharge outcome, presence of infection, and Simplified Acute Physiology Score (SAPS) III prognostic score were collected. Infected patients were considered as those being treated for an infection on discharge from the ICU. Patients were divided into survivors and non-survivors on leaving the hospital. The association between the studied variables was performed using the logistic regression model.
Results
A total of 1,025 patients who survived hospitalization in the ICU were analyzed, of which 212 (20.7%) died after leaving the ICU. When separating the groups of survivors and non-survivors according to hospital outcome, the median age was higher among non-survivors. Longer hospital stays and higher SAPS III values were observed among non-survivors. In the logistic regression, the variables age, length of hospital stay, SAPS III, presence of infection, and readmission to the ICU were associated with hospital mortality.
Conclusions
Infection on ICU discharge, ICU readmission, age, length of hospital stay, and SAPS III increased risk of death in ICU survivors.

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Feasibility challenges in protein supplementation research: Insights from the convalescence of functional outcomes after intensive care unit stay in a Randomised Controlled Trial
Michelle Carmen Paulus, Imre Willemijn Kehinde Kouw, Yente Florine Niké Boelens, Anoek Jacqueline Hubertine Hermans, Bert Strookappe, Arthur Raymond Hubert van Zanten
Clinical Nutrition.2025; 46: 119. CrossRef
Depression or anxiety and long-term mortality among adult survivors of intensive care unit: a population-based cohort study
Kyung Hun Yoo, Juncheol Lee, Jaehoon Oh, Nayeon Choi, Tae Ho Lim, Hyunggoo Kang, Byuk Sung Ko, Yongil Cho
Critical Care.2025;[Epub] CrossRef
Analysis of the infectious agent’s structure and antibiotic resistance parameters in patients in intensive care units of a multidisciplinary hospital
O. I. Butranova, S. K. Zyryanov, A. A. Gorbacheva, G A. Putsman
Kachestvennaya Klinicheskaya Praktika = Good Clinical Practice.2024; (4): 4. CrossRef
Interpretability-based machine learning for predicting the risk of death from pulmonary inflammation in Chinese intensive care unit patients
Yihai Zhai, Danxiu Lan, Siying Lv, Liqin Mo
Frontiers in Medicine.2024;[Epub] CrossRef
Escore para Avaliação de Prognóstico em Pacientes com Endocardite Infecciosa
Alfredo José Mansur
Arquivos Brasileiros de Cardiologia.2023;[Epub] CrossRef

Gastroenterology
The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients: Rahul Sharma, Ravi Kant Dogra, Jyoti Pathania, Arti Sharma; Acute Crit Care. 2023;38(1):134-141. Published online February 22, 2023; DOI: https://doi.org/10.4266/acc.2022.00955

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Background
Although gastric reserve volume (GRV) is a surrogate marker of gastrointestinal dysfunction and feeding intolerance, there is ambiguity in its estimation due to problems associated with its measurement. Introduction of point-of-care ultrasound as a tool for anesthetists kindled interest in its use for GRV estimation.
Methods
In this prospective observational study, we recruited 57 critically ill patients and analyzed 586 samples of GRV obtained by both ultrasonography (USG) and manual aspiration.
Results
The analysis showed that USG-guided GRV was significantly correlated (r=0.788, P<0.001) and in positive agreement with manual aspiration based on Bland-Altman plot, with a mean difference of 8.50±14.84 (95% confidence interval, 7.389–9.798). The upper and lower limits of agreement were 37.7 and –20.5, respectively, within the ±1.96 standard deviation (P<0.001). The respective sensitivity and positive predictive value, specificity and negative predictive value, and area under the curve of USG for feeding intolerance were 66.67%, 98.15%, and 0.82%, with 96.49% diagnostic accuracy.
Conclusions
Ultrasonographic estimation of GRV was positively, significantly correlated and in agreement with the manual aspiration method and estimated feeding intolerance earlier. Routine use of gastric USG could avoid clinical situations where feeding status is unclear and there is high risk of aspiration and could become a standard practice of critical care.

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Assessing gastrointestinal system dysfunction in intensive care
Kaspar F. Bachmann, Varsha M. Asrani, Annika Reintam Blaser
Current Opinion in Critical Care.2025; 31(2): 172. CrossRef
Correlación de volumen residual gástrico medido y ultrasonido gástrico para identificar intolerancia gástrica en pacientes neurocríticos con nutrición enteral en la unidad de cuidados intensivos
Mauricio Pérez-Macías, Roxana Vázquez-Ramírez, Marcela Pinedo-Lechuga
Medicina Crítica.2024; 38(2): 102. CrossRef
Is pre-extubation fasting in ICU justified? Insights from a prospective observational study using gastric ultrasound
Mohd Saif Khan, Barun Ram, Amit Kumar, Kamel Bousselmi, Priyesh Kumar, Dumini Soren, Priyanka Shrivastava, Naveen Kumar
Trends in Anaesthesia and Critical Care.2024; 58: 101497. CrossRef
Early initiation of gastric tube feeding: ultrasound assessment. A prospective interventional study
Islam M. Elbardan, Ahmed A. Alla Ossman, Nada El Kayal, Assem A. ElRazek Abd-Rabih
Research and Opinion in Anesthesia & Intensive Care.2024; 11(4): 270. CrossRef
Gastrointestinal function in critically ill patients
Annika Reintam Blaser, Kaspar F. Bachmann, Adam M. Deane
Current Opinion in Clinical Nutrition & Metabolic Care.2023; 26(5): 463. CrossRef

Review Article

Pulmonary
Beyond survival: understanding post-intensive care syndrome: Lovish Gupta, Maazen Naduthra Subair, Jaskaran Munjal, Bhupinder Singh, Vasu Bansal, Vasu Gupta, Rohit Jain; Acute Crit Care. 2024;39(2):226-233. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01158

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Abstract PDF

Post-intensive care syndrome (PICS) refers to persistent or new onset physical, mental, and neurocognitive complications that can occur following a stay in the intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive deficits including memory, executive, and attention impairments; post-traumatic stress disorder; and other mood disorders. PICS can last long after hospital admission and can cause significant physical, emotional, and financial stress for patients and their families. Several modifiable risk factors, such as duration of sepsis, delirium, and mechanical ventilation, are associated with PICS. However, due to limited awareness about PICS, these factors are often overlooked. The objective of this paper is to highlight the pathophysiology, clinical features, diagnostic methods, and available preventive and treatment options for PICS.

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Comparing virtual reality with traditional methods in cognitive rehabilitation in PICS syndrome
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Applied Neuropsychology: Adult.2025; : 1. CrossRef
Prevalence of Post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis
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Guideline

Pulmonary
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 Crit Care. 2024;39(1):1-23. Published online February 28, 2024; DOI: https://doi.org/10.4266/acc.2024.00052

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Background
Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator.
Methods
Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations.
Results
Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation.
Conclusions
We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.

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Jiantang Wang, Yuntao Li, Yujuan Han, Xinyu Yuan
Irish Journal of Medical Science (1971 -).2025; 194(1): 289. CrossRef
Clinical predictors of extubation failure in postoperative critically ill patients: a post-hoc analysis of a multicenter prospective observational study
Jun Hattori, Aiko Tanaka, Junko Kosaka, Osamu Hirao, Nana Furushima, Yuichi Maki, Daijiro Kabata, Akinori Uchiyama, Moritoki Egi, Hiroshi Morimatsu, Satoshi Mizobuchi, Yoshifumi Kotake, Ayumi Shintani, Yukiko Koyama, Takeshi Yoshida, Yuji Fujino
BMC Anesthesiology.2025;[Epub] CrossRef
Comparison of High Versus Low Positive End-Expiratory Pressure in Mechanically Ventilated Patients With Acute Heart Failure: Rationale and Design of the HELP-AHF Trial
Junho Hyun, In-Cheol Kim, Ah-ram Kim, Hee Jeong Lee, Sang Eun Lee, Sung-Cheol Yun, Min-Seok Kim
International Journal of Heart Failure.2025; 7(2): 79. CrossRef
RELAÇÃO DA FORÇA MUSCULAR PERIFÉRICA COM O DESMAME DA VENTILAÇÃO MECÂNICA
Débora Rillary Duarte Filho, Gabriella Schultz Malagute, Luciana Ferreira Rihs, Priscila Corrêa Cavalcanti
Revista Saúde Dos Vales.2024;[Epub] CrossRef

Original Articles

Cardiology
Diagnostic accuracy of left ventricular outflow tract velocity time integral versus inferior vena cava collapsibility index in predicting post-induction hypotension during general anesthesia: an observational study: Vibhuti Sharma, Arti Sharma, Arvind Sethi, Jyoti Pathania; Acute Crit Care. 2024;39(1):117-126. Published online February 23, 2024; DOI: https://doi.org/10.4266/acc.2023.00913

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Background
Point of care ultrasound (POCUS) is being explored for dynamic measurements like inferior vena cava collapsibility index (IVC-CI) and left ventricular outflow tract velocity time integral (LVOT-VTI) to guide anesthesiologists in predicting fluid responsiveness in the preoperative period and in treating post-induction hypotension (PIH) with varying accuracy.
Methods
In this prospective, observational study on included 100 adult patients undergoing elective surgery under general anesthesia, the LVOT-VTI and IVC-CI measurements were performed in the preoperative room 15 minutes prior to surgery, and PIH was measured for 20 minutes in the post-induction period.
Results
The incidence of PIH was 24%. The area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the two techniques at 95% confidence interval was 0.613, 30.4%, 93.3%, 58.3%, 81.4%, 73.6% for IVC-CI and 0.853, 83.3%, 80.3%, 57.1%, 93.8%, 77.4% for LVOT-VTI, respectively. In multivariate analysis, the cutoff value for IVC-CI was >51.5 and for LVOT-VTI it was ≤17.45 for predicting PIH with odd ratio [OR] of 8.491 (P=0.025) for IVCCI and OR of 17.427 (P<0.001) for LVOT. LVOT-VTI assessment was possible in all the patients, while 10% of patients were having poor window for IVC measurements.
Conclusions
We recommend the use of POCUS using LVOT-VTI or IVC-CI to predict PIH, to decrease the morbidity of patients undergoing surgery. Out of these, we recommend LVOT-VTI measurements as it has showed a better diagnostic accuracy (77.4%) with no failure rate.

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Frank L. Dini, Valentina Barletta, Piercarlo Ballo, Giovanni Cioffi, Nicola Riccardo Pugliese, Andrea Rossi, Gani Bajraktari, Stefano Ghio, Michael Y. Henein
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Michael Armaneous, John Bouz, Tiffany Ding, Christopher Baker, Alina Kim, Avoumia Mourkus, Charles Schoepflin, Justin Calvert
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The Use of the Perfusion Index to Predict Post-Induction Hypotension in Patients Undergoing General Anesthesia: A Systematic Review and Meta-Analysis
Kuo-Chuan Hung, Shu-Wei Liao, Chia-Li Kao, Yen-Ta Huang, Jheng-Yan Wu, Yao-Tsung Lin, Chien-Ming Lin, Chien-Hung Lin, I-Wen Chen
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Mary Rose Gaylor, David N. Hager, Kathleen Tyson
Critical Care Clinics.2024; 40(3): 523. CrossRef

Meta-analysis
Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea: Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim; Acute Crit Care. 2024;39(1):127-137. Published online February 20, 2024; DOI: https://doi.org/10.4266/acc.2023.01613

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Background
The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.
Methods
Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.
Results
The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3–7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5–8; PNI: 35–38) or severe (CONUT: 9–12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0–1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24–1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95–3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09–1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67–2.12; P<0.001).
Conclusions
The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

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Relationship between the geriatric nutritional risk index and sepsis in elderly critically ill patients: a retrospective cohort study
Yujiao Jin, Tianyun Zhou, Chenshu Hou, Huihui Zhang, Binbin Xu
European Journal of Medical Research.2025;[Epub] CrossRef
Epidemiology and Microbiology of Healthcare-Associated Infections in Neurosurgery Department: A Cross-Sectional Study
Renata Jabłońska, Paweł Sokal, Magdalena Zając, Agnieszka Królikowska, Karolina Filipska - Blejder, Irena Wrońska, Robert Ślusarz
Biological Research For Nursing.2025;[Epub] CrossRef
Development and validation of a predictive model for in-hospital mortality from perioperative bacteremia in gastrointestinal surgery
Yusuke Taki, Shinsuke Sato, Masaya Watanabe, Ko Ohata, Hideyuki Kanemoto, Noriyuki Oba
European Journal of Clinical Microbiology & Infectious Diseases.2024; 43(11): 2117. CrossRef
Sepsis and Septic Shock Management and Care: A Case Presentation
Myriam Jean Cadet
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Trauma
Role of platelet-to-lymphocyte ratio at the time of arrival to the emergency room as a predictor of short-term mortality in trauma patients with severe trauma team activation: Jae Kwang Kim, Kyung Hoon Sun; Acute Crit Care. 2024;39(1):146-154. Published online February 15, 2024; DOI: https://doi.org/10.4266/acc.2023.01319

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Background
Platelet-to-Lymphocyte ratio (PLR) has been studied as a prognostic factor for various diseases and traumas. This study examined the utility of PLR as a tool for predicting 30-day mortality in patients experiencing severe trauma.
Methods
This study included 139 patients who experienced trauma and fulfilled ≥1 criteria for activation of the hospital’s severe trauma team. Patients were divided into non-survivor and survivor groups. Mean PLR values were compared between the groups, the optimal PLR cut-off value was determined, and mortality and survival analyses were performed. Statistical analyses were performed using SPSS ver. 26.0. The threshold of statistical significance was P<0.05.
Results
There was a significant difference in mean (±standard deviation) PLR between the non-survivor (n=36) and survivor (n=103) groups (53.4±30.1 vs. 89.9±53.3, respectively; P<0.001). Receiver operating characteristic (ROC) curve analysis revealed an optimal PLR cut-off of 65.35 (sensitivity, 0.621; specificity, 0.694, respectively; area under the ROC curve, 0.742), and Kaplan-Meier survival analysis revealed a significant difference in mortality rate between the two groups.
Conclusions
PLR can be calculated quickly and easily from a routine complete blood count, which is often performed in the emergency department for individuals who experience trauma. The PLR is useful for predicting 30-day mortality in trauma patients with severe trauma team activation.

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Utility of platelet- to lymphocyte ratio as an inflammatory biomarker in major burns. our experience
Dayamí Zaldívar Castillo MD, Néstor Nemer Pérez MD, Carlos Lora Buelvas MD, Adelmo de J González Méndez MD, Freddy J Cruz Reyes MD, Yaqueline Castellanos MD
Journal of Anesthesia & Critical Care: Open Access.2025; 17(1): 1. CrossRef
The predictors of prognostic nutritional index and its association with in-hospital mortality among critically ill geriatric patients
Khalid Elsayed Elsorady, Ahmed Ahmed Mohamed Abotaha, Mohammed Abdelmoaty Ebrahim Shaheen, Hisham Ahmed Hani Mostafa Abdelaziz, Essam Yehia Ali Aggour, Mohamed Elwan Mohamed Mahmoud
Electronic Journal of General Medicine.2025; 22(4): em656. CrossRef
Key laboratory changes in severe trauma, a different pattern for each clinical phenotype
Adrián Marcos-Morales, Jesús Abelardo Barea Mendoza, Marcos Valiente Fernández, Carlos García Fuentes, Fernando Calvo Boyero, Cecilia Cueto-Felgueroso, Judith Gutiérrez Gutiérrez, Francisco de Paula Delgado Moya, Carolina Mudarra Reche, Susana Bermejo Azn
Medicina Intensiva (English Edition).2025; : 502227. CrossRef
Utility of systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio as a predictive biomarker in pediatric traumatic brain injury
Muhammad Arifin Parenrengi, Wihasto Suryaningtyas, Ahmad Data Dariansyah, Budi Utomo, Glenn Otto Taryana, Catur Kusumo, Surya Pratama Brilliantika
Surgical Neurology International.2024; 15: 456. CrossRef

Pulmonary
Risk factors for mortality in intensive care unit patients with Stenotrophomonas maltophilia pneumonia in South Korea: Yong Hoon Lee, Jaehee Lee, Byunghyuk Yu, Won Kee Lee, Sun Ha Choi, Ji Eun Park, Hyewon Seo, Seung Soo Yoo, Shin Yup Lee, Seung-Ick Cha, Chang Ho Kim, Jae Yong Park; Acute Crit Care. 2023;38(4):442-451. Published online November 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00682

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Background
Stenotrophomonas maltophilia has been increasingly recognized as an opportunistic pathogen associated with high morbidity and mortality. Data on the prognostic factors associated with S. maltophilia pneumonia in patients admitted to intensive care unit (ICU) are lacking.
Methods
We conducted a retrospective analysis of data from 117 patients with S. maltophilia pneumonia admitted to the ICUs of two tertiary referral hospitals in South Korea between January 2011 and December 2022. To assess risk factors associated with in-hospital mortality, multivariable logistic regression analyses were performed.
Results
The median age of the study population was 71 years. Ventilator-associated pneumonia was 76.1% of cases, and the median length of ICU stay before the first isolation of S. maltophilia was 15 days. The overall in-hospital mortality rate was 82.1%, and factors independently associated with mortality were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00–1.09; P=0.046), Sequential Organ Failure Assessment (SOFA) score (OR, 1.21; 95%; CI, 1.02–1.43; P=0.025), corticosteroid use (OR, 4.19; 95% CI, 1.26–13.91; P=0.019), and polymicrobial infection (OR, 95% CI 0.07–0.69). However, the impact of appropriate antibiotic therapy on mortality was insignificant. In a subgroup of patients who received appropriate antibiotic therapy (n=58), antibiotic treatment modality-related variables, including combination or empirical therapy, also showed no significant association with survival.
Conclusions
Patients with S. maltophilia pneumonia in ICU have high mortality rates. Older age, higher SOFA score, and corticosteroid use were independently associated with increased in-hospital mortality, whereas polymicrobial infection was associated with lower mortality. The effect of appropriate antibiotic therapy on prognosis was insignificant.

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How do I manage a patient with Stenotrophomonas maltophilia infection?
Roberta Monardo, Maria F. Mojica, Marco Ripa, Samuel L. Aitken, Robert A. Bonomo, David van Duin
Clinical Microbiology and Infection.2025;[Epub] CrossRef
Stenotrophomonas maltophilia Outbreak in an ICU: Investigation of Possible Routes of Transmission and Implementation of Infection Control Measures
Maria Luisa Cristina, Marina Sartini, Gianluca Ottria, Elisa Schinca, Giulia Adriano, Leonello Innocenti, Marco Lattuada, Stefania Tigano, David Usiglio, Filippo Del Puente
Pathogens.2024; 13(5): 369. CrossRef
Establishment and evaluation of a rapid method for the detection of bacterial pneumonia in hospitalized patients via multiplex PCR–capillary electrophoresis (MPCE)
Jie Wang, Pei Zhao, Mengchuan Zhao, Duoxiao Zhang, Shan Chen, Ying Liu, Yuan Gao, Yanqing Tie, Zhishan Feng, Siu-Kei Chow
Microbiology Spectrum.2024;[Epub] CrossRef
A systematic review of factors associated with poor prognosis despite appropriate antibiotics usage for pneumonia
Akihiko Goto, Kentaro Ishikawa, Kosaku Komiya
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Cardiology
Evaluation of neopterin levels and kynurenine pathway in patients with acute coronary syndrome: Ibrahim Kember, Sonia Sanajou, Bilge Kilicarslan, Gözde Girgin, Terken Baydar; Acute Crit Care. 2023;38(3):325-332. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00024

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Background
Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis.
Methods
High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls.
Results
The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction.
Conclusions
The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.

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Abdullah Burak Karaduman, Sinem Ilgın, Özlem Aykaç, Mehmetcan Yeşilkaya, Serkan Levent, Atilla Özcan Özdemir, Gozde Girgin
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Kynurenines as a Novel Target for the Treatment of Inflammatory Disorders
Adrian Mor, Anna Tankiewicz-Kwedlo, Marianna Ciwun, Janina Lewkowicz, Dariusz Pawlak
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Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease
Armand N. Yazdani, Michaela Pletsch, Abraham Chorbajian, David Zitser, Vikrant Rai, Devendra K. Agrawal
Expert Review of Cardiovascular Therapy.2023; 21(10): 675. CrossRef
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Israa Abdelmalik Salem, Sura Ahmed Abdulsattar, Haider Fadhil Alrubaye
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Review Articles

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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Abstract PDF

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.

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Jun Fujinaga, Takanao Otake, Takehide Umeda, Toshio Fukuoka
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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

Nursing
Theoretical definition of nurse–conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis: Arezoo Mohamadkhani Ghiasvand, Meimanat Hosseini, Foroozan Atashzadeh-Shoorideh; Acute Crit Care. 2023;38(1):8-20. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01039

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Providing critical nursing care for conscious mechanically ventilated patients is mediated via effective communication. This study aimed to identify and map the antecedents, attributes, consequences, and definition of nurse–conscious mechanically ventilated patient communication (N-CMVPC). This scoping review was conducted by searching the Cochrane Library and the CINAHL, EMBASE, PubMed, Web of Science, and Scopus databases, between 2001 and 2021. The keywords queried included "nurses," "mechanically ventilated patients," "mechanical ventilation," "intubated patients," "communication," "interaction," "relationships," "nurse–patient communication," "nurse–patient relations," "intensive care units," and "critical care." Studies related to communication with healthcare personnel or family members were excluded. The results indicated that N-CMVPC manifests as a set of attributes in communication experiences, emotions, methods, and behaviors of the nurse and the patient and is classified into three main themes, nurse communication, patient communication, and quantitative-qualitative aspects. N-CMVPC is a complex, multidimensional, and multi-factor concept. It is often nurse-controlled and can express itself as questions, sentences, or commands in the context of experiences, feelings, and positive or negative behaviors involving the nurse and the patient.

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Original Article

Infection
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(1):57-67. Published online February 7, 2023; DOI: https://doi.org/10.4266/acc.2022.00941; Correction in: Acute Crit Care 2023;38(2):249

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Background
The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19.
Methods
This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group).
Results
Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039).
Conclusions
Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.

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