Acute and Critical Care

Most-read articles are from the articles published in 2022 during the last three month.

Original Article

Epidemiology
Mortality rates among adult critical care patients with unusual or extreme values of vital signs and other physiological parameters: a retrospective study: Charles Harding, Marybeth Pompei, Dmitriy Burmistrov, Francesco Pompei; Acute Crit Care. 2024;39(2):304-311. Published online May 13, 2024; DOI: https://doi.org/10.4266/acc.2023.01361

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Abstract PDF: Background
We evaluated relationships of vital signs and laboratory-tested physiological parameters with in-hospital mortality, focusing on values that are unusual or extreme even in critical care settings. Methods: We retrospectively studied Philips Healthcare–MIT eICU data (207 U.S. hospitals, 20142015), including 166,959 adult-patient critical care admissions. Analyzing most-deranged (worst) value measured in the first admission day, we investigated vital signs (body temperature, heart rate, mean arterial pressure, and respiratory rate) as well as albumin, bilirubin, blood pH via arterial blood gas (ABG), blood urea nitrogen, creatinine, FiO2 ABG, glucose, hematocrit, PaO2 ABG, PaCO2 ABG, sodium, 24-hour urine output, and white blood cell count (WBC). Results: In-hospital mortality was ≥50% at extremes of low blood pH, low and high body temperature, low albumin, low glucose, and low heart rate. Near extremes of blood pH, temperature, glucose, heart rate, PaO2 , and WBC, relatively. Small changes in measured values correlated with several-fold mortality rate increases. However, high mortality rates and abrupt mortality increases were often hidden by the common practice of thresholding or binning physiological parameters. The best predictors of in-hospital mortality were blood pH, temperature, and FiO2 (scaled Brier scores: 0.084, 0.063, and 0.049, respectively). Conclusions: In-hospital mortality is high and sharply increasing at extremes of blood pH, body temperature, and other parameters. Common-practice thresholding obscures these associations. In practice, vital signs are sometimes treated more casually than laboratory-tested parameters. Yet, vitals are easier to obtain and we found they are often the best mortality predictors, supporting perspectives that vitals are undervalued.

Guideline

Pharmacology
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit: Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha; Acute Crit Care. 2022;37(1):1-25. Published online February 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00094; Correction in: Acute Crit Care 2023;38(1):149

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Abstract PDF

We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.

Citations

Citations to this article as recorded by

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study
Karina Sichieri, Danilo Donizetti Trevisan, Ricardo Luís Barbosa, Silvia Regina Secoli
Sao Paulo Medical Journal.2024;[Epub] CrossRef
Psychiatric Consults Associated With Longer Length of Stay in Trauma Patients—A Retrospective Study
Sanjay Balijepalli, Kathryn Mansuri, Cindy Gonzalez, Oveys Mansuri
Journal of Surgical Research.2024; 293: 46. CrossRef
Sleep in the intensive and intermediate care units: Exploring related factors of delirium, benzodiazepine use and mortality
Adrienne E. van der Hoeven, Denise Bijlenga, Ernst van der Hoeven, Mink S. Schinkelshoek, Floor W. Hiemstra, Laura Kervezee, David J. van Westerloo, Rolf Fronczek, Gert Jan Lammers
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Cross-cultural adaptation and validation of the Indonesian version of the Critical-care Pain Observation Tool
Luthfi Fauzy Asriyanto, Nur Chayati
International Journal of Nursing Sciences.2024; 11(1): 113. CrossRef
Postoperative Psychoses in Patients with Brain Gliomas
O. S. Zaitsev, N. P. Ilyaev, O. A. Maksakova
Psikhiatriya.2024; 21(7): 65. CrossRef
Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines
Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park
Acute and Critical Care.2024; 39(1): 1. CrossRef
Prevalence and risk factors of delirium of older adults after cardiac surgery at the intensive care unit: A retrospective study
Jeong-Ok Ryu, Gwi-Ryung Son Hong
Journal of Korean Gerontological Nursing.2024; 26(1): 113. CrossRef
Factors that influence critical care nurses’ management of sedation for ventilated patients in critical care: A qualitative study
Danielle Macpherson, Anastasia Hutchinson, Melissa J. Bloomer
Intensive and Critical Care Nursing.2024; 83: 103685. CrossRef
Content analysis of NOC outcomes related to mechanical ventilation in people with COVID-19
Erika Silva de Sá, Aline Batista Maurício, Larissa Giardini Bruni, Larissa Gabrielle Dias Vieira, Vinicius Batista Santos, Agueda Maria Ruiz Zimmer Cavalcante, Alba Lucia Bottura Leite de Barros, Viviane Martins da Silva
Revista da Escola de Enfermagem da USP.2024;[Epub] CrossRef
Análise de conteúdo de resultados NOC relacionados à ventilação mecânica em pessoas com COVID-19
Erika Silva de Sá, Aline Batista Maurício, Larissa Giardini Bruni, Larissa Gabrielle Dias Vieira, Vinicius Batista Santos, Agueda Maria Ruiz Zimmer Cavalcante, Alba Lucia Bottura Leite de Barros, Viviane Martins da Silva
Revista da Escola de Enfermagem da USP.2024;[Epub] CrossRef
From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients
Mfonido Ekong, Tejbir Singh Monga, Jean Carlo Daher, Mutyala Sashank, Setareh Reza Soltani, Nkiruka Lauretta Nwangene, Cara Mohammed, Fellipe Feijo Halfeld, Leen AlShelh, Fernanda Ayumi Fukuya, Manju Rai
Cureus.2024;[Epub] CrossRef
End‐of‐life care in the intensive care unit
M. Tanaka Gutiez, N. Efstathiou, R. Innes, V. Metaxa
Anaesthesia.2023; 78(5): 636. CrossRef
The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea
Dong-gon Hyun, Jee Hwan Ahn, Ha-Yeong Gil, Chung Mo Nam, Choa Yun, Jae-Myeong Lee, Jae Hun Kim, Dong-Hyun Lee, Ki Hoon Kim, Dong Jung Kim, Sang-Min Lee, Ho-Geol Ryu, Suk-Kyung Hong, Jae-Bum Kim, Eun Young Choi, JongHyun Baek, Jeoungmin Kim, Eun Jin Kim, T
Journal of Korean Medical Science.2023;[Epub] CrossRef
The relationship between the PRE-DELIRIC score and the prognosis in COVID-19 ICU patients
Bilge Banu Taşdemir Mecit
Journal of Surgery and Medicine.2023; 7(5): 343. CrossRef
Systemic Nonsteroidal Anti-Inflammatories for Analgesia in Postoperative Critical Care Patients: A Systematic Review and Meta-Analysis of Randomized Control Trials
Chen Hsiang Ma, Kimberly B. Tworek, Janice Y. Kung, Sebastian Kilcommons, Kathleen Wheeler, Arabesque Parker, Janek Senaratne, Erika Macintyre, Wendy Sligl, Constantine J. Karvellas, Fernando G. Zampieri, Demetrios Jim Kutsogiannis, John Basmaji, Kimberle
Critical Care Explorations.2023; 5(7): e0938. CrossRef
Pain Control and Sedation in Neuro Intensive Critical Unit
Soo-Hyun Park, Yerim Kim, Yeojin Kim, Jong Seok Bae, Ju-Hun Lee, Wookyung Kim, Hong-Ki Song
Journal of the Korean Neurological Association.2023; 41(3): 169. CrossRef
Preoperative Anxiety and Its Postoperative Associated Factors in Patients Receiving Post Anesthetic Recovery Care at Surgical Intensive Care Unit
Yul Ha Lee, Hye-Ja Park
Journal of Health Informatics and Statistics.2023; 48(3): 267. CrossRef
Diagnostic Value of the Bispectral Index to Assess Sleep Quality after Elective Surgery in Intensive Care Unit
Naricha Chirakalwasan, Pongpol Sirilaksanamanon, Thammasak Thawitsri, Somrat Charuluxananan
Indian Journal of Critical Care Medicine.2023; 27(11): 795. CrossRef
Sedation of patients in intensive care units. Guidelines
V.I. Potievskaya, I.B. Zabolotskikh, I.E. Gridchik, A.I. Gritsan, A.A. Eremenko, I.A. Kozlov, A.L. Levit, V.A. Mazurok, I.V. Molchanov
Anesteziologiya i reanimatologiya.2023; (5): 6. CrossRef
Sedation for Patients with Sepsis: Towards a Personalised Approach
José Miguel Marcos-Vidal, Rafael González, María Merino, Eva Higuera, Cristina García
Journal of Personalized Medicine.2023; 13(12): 1641. CrossRef
Performance, Knowledge, and Barrier Awareness of Medical Staff Regarding the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Critical Care Patients: A Cross-Sectional Study
Hyo-Geun Song, Duckhee Chae, Sung-Hee Yoo
Korean Journal of Adult Nursing.2023; 35(4): 379. CrossRef
ICU-Induced Disability Persists With or Without COVID-19—This Is a Call for F to A Bundle Action*
Heidi Engel
Critical Care Medicine.2022; 50(11): 1665. CrossRef
Actigraphy-Based Assessment of Sleep Parameters in Intensive Care Unit Patients Receiving Respiratory Support Therapy
Jiyeon Kang, Yongbin Kwon
Journal of Korean Critical Care Nursing.2022; 15(3): 115. 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.

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

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

Review Articles

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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Abstract PDF

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

Enhancing clinical outcomes in burn and surgical intensive care units patients
Mahta Moghaddam Ahmadi, Moein Moghaddam Ahmadi
Burns.2024;[Epub] CrossRef

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.

Pulmonary
Asynchronies during invasive mechanical ventilation: narrative review and update: Santiago Nicolás Saavedra, Patrick Valentino Sepúlveda Barisich, José Benito Parra Maldonado, Romina Belén Lumini, Alberto Gómez-González, Adrián Gallardo; Acute Crit Care. 2022;37(4):491-501. Published online November 30, 2022; DOI: https://doi.org/10.4266/acc.2022.01158

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Abstract PDF Supplementary Material

Invasive mechanical ventilation is a frequent therapy in critically ill patients in critical care units. To achieve favorable outcomes, patient and ventilator interaction must be adequate. However, many clinical situations could attempt against this principle and generate a mismatch between these two actors. These asynchronies can lead the patient to worst outcomes; that is why it is vital to recognize and treat these entities as soon as possible. Early detection and recognition of the different asynchronies could favor the reduction of the days of mechanical ventilation, the days of hospital stay, and intensive care and improve clinical results.

Citations

Citations to this article as recorded by

Patient Self-Inflicted Lung Injury—A Narrative Review of Pathophysiology, Early Recognition, and Management Options
Peter Sklienka, Michal Frelich, Filip Burša
Journal of Personalized Medicine.2023; 13(4): 593. CrossRef
Actualización sobre sedoanalgesia en paciente bajo ventilación mecánica
Onan Emanuel Gregorio
Revista de Postgrados de Medicina.2022; 1(1): 27. CrossRef

Neurosurgery
Brain-lung interaction: a vicious cycle in traumatic brain injury: Ariana Alejandra Chacón-Aponte, Érika Andrea Durán-Vargas, Jaime Adolfo Arévalo-Carrillo, Iván David Lozada-Martínez, Maria Paz Bolaño-Romero, Luis Rafael Moscote-Salazar, Pedro Grille, Tariq Janjua; Acute Crit Care. 2022;37(1):35-44. Published online February 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01193

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Abstract PDF

The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the “blast injury” theory or “double hit” model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury.

Citations

Citations to this article as recorded by

Uncertainty in Neurocritical Care: Recognizing Its Relevance for Clinical Decision-Making
Luis Rafael Moscote-Salazar, William A. Florez-Perdomo, Tariq Janjua
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Manejo postoperatorio de resección de tumores cerebrales en la unidad de cuidado intensivo
Andrés Felipe Naranjo Ramírez, Álvaro de Jesús Medrano Areiza, Bryan Arango Sánchez, Juan Carlos Arango Martínez, Luis Fermín Naranjo Atehortúa
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Effects of positive end-expiratory pressure on intracranial pressure, cerebral perfusion pressure, and brain oxygenation in acute brain injury: Friend or foe? A scoping review
Greta Zunino, Denise Battaglini, Daniel Agustin Godoy
Journal of Intensive Medicine.2024; 4(2): 247. CrossRef
Acute brain injury increases pulmonary capillary permeability via sympathetic activation-mediated high fluid shear stress and destruction of the endothelial glycocalyx layer
Na Zhao, Chao Liu, Xinxin Tian, Juan Yang, Tianen Wang
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Oral administration of lysozyme protects against injury of ileum via modulating gut microbiota dysbiosis after severe traumatic brain injury
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Seminars in Pediatric Neurology.2024; 49: 101120. CrossRef
Research Progress of Hemorrhagic Stroke Combined with Stroke-Associated Pneumonia
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Modeling of the brain-lung axis using organoids in traumatic brain injury: an updated review
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Targeted Nanocarriers Co-Opting Pulmonary Intravascular Leukocytes for Drug Delivery to the Injured Brain
Jia Nong, Patrick M. Glassman, Jacob W. Myerson, Viviana Zuluaga-Ramirez, Alba Rodriguez-Garcia, Alvin Mukalel, Serena Omo-Lamai, Landis R. Walsh, Marco E. Zamora, Xijing Gong, Zhicheng Wang, Kartik Bhamidipati, Raisa Y. Kiseleva, Carlos H. Villa, Colin F
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Modulation of MAPK/NF-κB Pathway and NLRP3 Inflammasome by Secondary Metabolites from Red Algae: A Mechanistic Study
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American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma clinical protocol for management of acute respiratory distress syndrome and severe hypoxemia
Jason A. Fawley, Christopher J. Tignanelli, Nicole L. Werner, George Kasotakis, Samuel P. Mandell, Nina E. Glass, David J. Dries, Todd W. Costantini, Lena M. Napolitano
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The role of cardiac dysfunction and post-traumatic pulmonary embolism in brain-lung interactions following traumatic brain injury
Mabrouk Bahloul, Karama Bouchaala, Najeh Baccouche, Kamilia Chtara, Hedi Chelly, Mounir Bouaziz
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Allocation of Donor Lungs in Korea
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Mapping brain endophenotypes associated with idiopathic pulmonary fibrosis genetic risk
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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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Abstract PDF Supplementary Material: 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.

Review Articles

Meta-analysis
The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials: Yerkin Abdildin, Karina Tapinova, Assel Nemerenova, Dmitriy Viderman; Acute Crit Care. 2024;39(1):34-46. Published online February 28, 2024; DOI: https://doi.org/10.4266/acc.2023.00829

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Abstract PDF

Background
This meta-analysis aims to evaluate the effects of ketamine in critically ill intensive care unit (ICU) patients.
Methods
We searched for randomized controlled trials (RCTs) in PubMed, Scopus, and the Cochrane Library; the search was performed initially in January but was repeated in December of 2023. We focused on ICU patients of any age. We included studies that compared ketamine with other traditional agents used in the ICU. We synthesized evidence using RevMan v5.4 and presented the results as forest plots. We also used trial sequential analysis (TSA) software v. 0.9.5.10 Beta and presented results as TSA plots. For synthesizing results, we used a random-effects model and reported differences in outcomes of two groups in terms of mean difference (MD), standardized MD, and risk ratio with 95% confidence interval. We assessed the risk of bias using the Cochrane RoB tool for RCTs. Our outcomes were mortality, pain, opioid and midazolam requirements, delirium rates, and ICU length of stay.
Results
Twelve RCTs involving 805 ICU patients (ketamine group, n=398; control group, n=407) were included in the meta-analysis. The ketamine group was not superior to the control group in terms of mortality (in five studies with 318 patients), pain (two studies with 129 patients), mean and cumulative opioid consumption (six studies with 494 patients), midazolam consumption (six studies with 304 patients), and ICU length of stay (three studies with 270 patients). However, the model favored the ketamine group over the control group in delirium rate (four studies with 358 patients). This result is significant in terms of conventional boundaries (alpha=5%) but is not robust in sequential analysis. The applicability of the findings is limited by the small number of patients pooled for each outcome.
Conclusions
Our meta-analysis did not demonstrate differences between ketamine and control groups regarding any outcome except delirium rate, where the model favored the ketamine group over the control group. However, this result is not robust as sensitivity analysis and trial sequential analysis suggest that more RCTs should be conducted in the future.

Citations

Citations to this article as recorded by

Ketamine sedation in critically ill patients: Past, present and future
Sameer Sharif, Jay Prakash, Bram Rochwerg
Indian Journal of Anaesthesia.2024; 68(8): 674. CrossRef

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

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Abstract PDF Supplementary Material: Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

Original Articles

Nursing
The effect of time management education on critical care nurses’ prioritization: a randomized clinical trial: Fatemeh Vizeshfar, Mahnaz Rakhshan, Fatemeh Shirazi, Roya Dokoohaki; Acute Crit Care. 2022;37(2):202-208. Published online April 28, 2022; DOI: https://doi.org/10.4266/acc.2021.01123

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Abstract PDF

necessiBackground: Nurses are at the forefront of patient care, and time management skills can increase their ability to make decisions faster. This study aimed to assess the effect of a time management workshop on prioritization and time management skills among nurses of emergency and intensive care units.
Methods
This randomized clinical trial was performed with 215 nurses. The educational intervention about time management was held in the form of a workshop for the intervention group. The time management questionnaire was completed by both groups before, immediately after, and 3 months after the intervention.
Results
Most participants were female (n=191, 88%), with a mean age of 31.82 years (range, 22–63 years). Additionally, the participants’ work experience ranged from 1 to 30 years (mean±standard deviation, 8.00±7.15 years). After the intervention, the mean score of time management increased significantly in the intervention group, but no significant difference was observed in this regard in the control group. The results also revealed a significant difference between the intervention and control groups regarding the mean score of time management 3 months after the intervention (P<0.001).
Conclusions
Time management training helped nurses adjust the time required to perform and prioritize various tasks.

Citations

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Nursing core competencies for postresuscitation care in Iran: a qualitative study
Mahnaz Zali, Azad Rahmani, Kelly Powers, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani
BMJ Open.2024; 14(1): e074614. CrossRef
Critical care nurses’ experiences of caring challenges during post-resuscitation period: a qualitative content analysis
Mahnaz Zali, Azad Rahmani, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani, Arman Azadi, Mansour Ghafourifard
BMC Nursing.2024;[Epub] CrossRef
Exploring Burnout among Nursing Students in Bangalore: A t-Distributed Stochastic Neighbor Embedding Analysis and Hierarchical Clustering in Cross-Sectional Data
Michael Sebastian, Maddalena De Maria, Rosario Caruso, Gennaro Rocco, Cristina Di Pasquale, Arianna Magon, Gianluca Conte, Alessandro Stievano
Nursing Reports.2024; 14(3): 1693. CrossRef
A Systemic Model for Resilience and Time Management in Healthcare Academia: Application in a Dental University Setting
Maria Antoniadou, Rallis Antoniadis
Applied Sciences.2024; 14(11): 4918. CrossRef
Impact of Time Optimization Intervention on Work Execution and Burnout among Nurses Working at Intensive Care Unit
Angelin Santhakumari H, Manjula Annamalai, Porkodi Arjunan, Adithya. A. Venka
Salud, Ciencia y Tecnología.2024; 4: 1115. CrossRef
Nurse managers’ managerial innovation and it’s relation to proactivity behavior and locus of control among intensive care nurses
Loly Mohamed Shawky Elbus, Mohamed Gamal Mostafa, Fatma Zaghloul Mahmoud, Mostafa shaban, Seham Aly Mahmoud
BMC Nursing.2024;[Epub] CrossRef
Impact of time management program on stress and coping strategies adopted by nursing students with regard to academic performance
Juby Mary Chacko, Achamma Varghese, Nirmala Rajesh
IP Journal of Paediatrics and Nursing Science.2023; 6(1): 48. CrossRef
Perceived clinical competence and predictive role of time management in nursing students
Maryam Behdarvand, Mehrnaz Ahmadi, Nasrin Khajeali
Nurse Education in Practice.2023; 72: 103789. CrossRef
Examining the impact of time management and resilience training on work-family conflict among Iranian female nurses: a randomized controlled trial
Sedigheh Peykar, Hakimeh Vahedparast, Tayebeh Gharibi, Razieh Bagherzadeh
BMC Nursing.2023;[Epub] CrossRef

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.

Citations

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Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit
Francesco Ferro, Gaetano La Rocca, Elena Elefante, Nazzareno Italiano, Michele Moretti, Rosaria Talarico, Erika Pelati, Katia Valentini, Chiara Baldini, Roberto Mozzo, Luigi De Simone, Marta Mosca
International Journal of Molecular Sciences.2024; 25(13): 7273. CrossRef
Comparative Efficacy of Inhaled and Intravenous Corticosteroids in Managing COVID-19-Related Acute Respiratory Distress Syndrome
Ahmed A. Abdelkader, Bshra A. Alsfouk, Asmaa Saleh, Mohamed E. A. Abdelrahim, Haitham Saeed
Pharmaceutics.2024; 16(7): 952. CrossRef

Pulmonary
Are sodium-glucose co-transporter-2 inhibitors associated with improved outcomes in diabetic patients admitted to intensive care units with septic shock?: Nikita Ashcherkin, Abdelmohaymin A. Abdalla, Simran Gupta, Shubhang Bhatt, Claire I. Yee, Rodrigo Cartin-Ceba; Acute Crit Care. 2024;39(2):251-256. Published online May 14, 2024; DOI: https://doi.org/10.4266/acc.2023.01046

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Abstract PDF: Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to reduce organ dysfunction in renal and cardiovascular disease. There are limited data on the role of SGLT2i in acute organ dysfunction. We conducted a study to assess the effect of SGLT2i taken prior to intensive care unit (ICU) admission in diabetic patients admitted with septic shock. Methods: This retrospective cohort study used electronic medical records and included diabetic patients admitted to the ICU with septic shock. We compared diabetic patients on SGLT2i to those who were not on SGLT2i prior to admission. The primary outcome was in-hospital mortality, and secondary outcomes included hospital and ICU length of stay, use of renal replacement therapy, and 28- and 90-day mortality. Results: A total of 98 diabetic patients was included in the study, 36 in the SGLT2i group and 62 in the non-SGLT2i group. The Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation III scores were similar in the groups. Inpatient mortality was significantly lower in the SGLT2i group (5.6% vs. 27.4%, P=0.008). There was no significant difference in secondary outcomes. Conclusions: Our study found that diabetic patients on SGLT2i prior to hospitalization who were admitted to the ICU with septic shock had lower inpatient mortality compared to patients not on SGLT2i.

Review Article

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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Abstract PDF: 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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