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

Guidelines
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
  • 2,485 View
  • 472 Download
AbstractAbstract PDFSupplementary 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.
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
  • 15,149 View
  • 1,596 Download
  • 11 Web of Science
  • 22 Crossref
AbstractAbstract 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  
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    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
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  • 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
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
  • 13,952 View
  • 853 Download
  • 12 Web of Science
  • 15 Crossref
AbstractAbstract 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  
  • 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
    Experimental Cell Research.2024; 434(2): 113873.     CrossRef
  • Oral administration of lysozyme protects against injury of ileum via modulating gut microbiota dysbiosis after severe traumatic brain injury
    Weijian Yang, Caihua Xi, Haijun Yao, Qiang Yuan, Jun Zhang, Qifang Chen, Gang Wu, Jin Hu
    Frontiers in Cellular and Infection Microbiology.2024;[Epub]     CrossRef
  • Pulmonary Effects of Traumatic Brain Injury in Mice: A Gene Set Enrichment Analysis
    Wei-Hung Chan, Shih-Ming Huang, Yi-Lin Chiu
    International Journal of Molecular Sciences.2024; 25(5): 3018.     CrossRef
  • Beyond the brain: General intensive care considerations in pediatric neurocritical care
    Thao L. Nguyen, Dennis W. Simon, Yi-Chen Lai
    Seminars in Pediatric Neurology.2024; : 101120.     CrossRef
  • Ventilatory targets following brain injury
    Shaurya Taran, Sarah Wahlster, Chiara Robba
    Current Opinion in Critical Care.2023; 29(2): 41.     CrossRef
  • Uncertainty in Neurocritical Care: Recognizing Its Relevance for Clinical Decision Making
    Luis Rafael Moscote-Salazar, William A. Florez-Perdomo, Tariq Janjua
    Indian Journal of Neurotrauma.2023;[Epub]     CrossRef
  • 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
    ACS Nano.2023; 17(14): 13121.     CrossRef
  • 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
    Acta Colombiana de Cuidado Intensivo.2023;[Epub]     CrossRef
  • Modulation of MAPK/NF-κB Pathway and NLRP3 Inflammasome by Secondary Metabolites from Red Algae: A Mechanistic Study
    Asmaa Nabil-Adam, Mohamed L. Ashour, Mohamed Attia Shreadah
    ACS Omega.2023; 8(41): 37971.     CrossRef
  • 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
    Journal of Trauma and Acute Care Surgery.2023; 95(4): 592.     CrossRef
  • 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
    Acute and Critical Care.2022; 37(2): 266.     CrossRef
  • Allocation of Donor Lungs in Korea
    Hye Ju Yeo
    Journal of Chest Surgery.2022; 55(4): 274.     CrossRef
  • Mapping brain endophenotypes associated with idiopathic pulmonary fibrosis genetic risk
    Ali-Reza Mohammadi-Nejad, Richard J. Allen, Luke M. Kraven, Olivia C. Leavy, R. Gisli Jenkins, Louise V. Wain, Dorothee P. Auer, Stamatios N. Sotiropoulos
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  • Use of bedside ultrasound in the evaluation of acute dyspnea: a comprehensive review of evidence on diagnostic usefulness
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Case Report
Neurosurgery
What should an intensivist know about pneumocephalus and tension pneumocephalus?
Bhushan Sudhakar Wankhade, Maged Mohsen Kamel Beniamein, Zeyad Faoor Alrais, Jyoti Ittoop Mathew, Ghaya Zeyad Alrais
Acute Crit Care. 2023;38(2):244-248.   Published online April 13, 2022
DOI: https://doi.org/10.4266/acc.2021.01102
  • 12,708 View
  • 349 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract 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
  • 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
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
  • 4,542 View
  • 261 Download
AbstractAbstract PDF
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.
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
  • 8,725 View
  • 2,250 Download
AbstractAbstract 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.
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
  • 13,057 View
  • 2,247 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary 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
Pulmonary
Prolonged intensive care: muscular functional, and nutritional insights from the COVID-19 pandemic
Miguel Ángel Martínez-Camacho, Robert Alexander Jones-Baro, Alberto Gómez-González, Dalia Sahian Lugo-García, Pía Carolina Gallardo Astorga, Andrea Melo-Villalobos, Bárbara Kassandra Gonzalez-Rodriguez, Ángel Augusto Pérez-Calatayud
Acute Crit Care. 2024;39(1):47-60.   Published online February 2, 2024
DOI: https://doi.org/10.4266/acc.2023.01284
  • 1,432 View
  • 115 Download
AbstractAbstract PDF
During the coronavirus disease 2019 (COVID-19) pandemic, clinical staff learned how to manage patients enduring extended stays in an intensive care unit (ICU). COVID-19 patients requiring critical care in an ICU face a high risk of experiencing prolonged intensive care (PIC). The use of invasive mechanical ventilation in individuals with severe acute respiratory distress syndrome can cause numerous complications that influence both short-term and long-term morbidity and mortality. Those risks underscore the importance of proactively addressing functional complications. Mitigating secondary complications unrelated to the primary pathology of admission is imperative in minimizing the risk of PIC. Therefore, incorporating strategies to do that into daily ICU practice for both COVID-19 patients and those critically ill from other conditions is significantly important.
Trauma
Abdominal compartment syndrome in critically ill patients
Hyunseok Jang, Naa Lee, Euisung Jeong, Yunchul Park, Younggoun Jo, Jungchul Kim, Dowan Kim
Acute Crit Care. 2023;38(4):399-408.   Published online November 29, 2023
DOI: https://doi.org/10.4266/acc.2023.01263
  • 4,648 View
  • 2,079 Download
AbstractAbstract PDF
Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.
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
  • 1,102 View
  • 96 Download
AbstractAbstract 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.
Basic science and research
Brain–computer interface in critical care and rehabilitation
Eunseo Oh, Seyoung Shin, Sung-Phil Kim
Acute Crit Care. 2024;39(1):24-33.   Published online January 12, 2024
DOI: https://doi.org/10.4266/acc.2023.01382
  • 1,312 View
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AbstractAbstract PDF
This comprehensive review explores the broad landscape of brain–computer interface (BCI) technology and its potential use in intensive care units (ICUs), particularly for patients with motor impairments such as quadriplegia or severe brain injury. By employing brain signals from various sensing techniques, BCIs offer enhanced communication and motor rehabilitation strategies for patients. This review underscores the concept and efficacy of noninvasive, electroencephalogram-based BCIs in facilitating both communicative interactions and motor function recovery. Additionally, it highlights the current research gap in intuitive “stop” mechanisms within motor rehabilitation protocols, emphasizing the need for advancements that prioritize patient safety and individualized responsiveness. Furthermore, it advocates for more focused research that considers the unique requirements of ICU environments to address the challenges arising from patient variability, fatigue, and limited applicability of current BCI systems outside of experimental settings.
Original Articles
Pulmonary
Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in Korean patients with head and neck cancer
Jun-Young Jo, Jungpil Yoon, Heeyoon Jang, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi
Acute Crit Care. 2024;39(1):61-69.   Published online January 26, 2024
DOI: https://doi.org/10.4266/acc.2022.01543
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AbstractAbstract PDFSupplementary Material
Background
Although preoxygenation is an essential procedure for safe endotracheal intubation, in some cases securing sufficient time for tracheal intubation may not be possible. Patients with head and neck cancer might have a difficult airway and need a longer time for endotracheal intubation. We hypothesized that the extended apneic period with preoxygenation via a high-flow nasal cannula (HFNC) is beneficial to patients who undergo head and neck surgery compared with preoxygenation with a simple mask. Methods: The study was conducted as a single-center, single-blinded, prospective, randomized controlled trial. Patients were divided into groups based on one of the two preoxygenation methods: HFNC group or simple facemask (mask group). Preoxygenation was performed for 5 minutes with each method, and endotracheal intubation for all patients was performed using a video laryngoscope. Oxygen partial pressures of the arterial blood were compared at the predefined time points. Results: For the primary outcome, the mean arterial oxygen partial pressure (PaO2 ) immediately after intubation was 454.2 mm Hg (95% confidence interval [CI], 416.9–491.5 mm Hg) in the HFNC group and 370.7 mm Hg (95% CI, 333.7–407.4 mm Hg) in the mask group (P=0.002). The peak PaO2 at 5 minutes after preoxygenation was not statistically different between the groups (P=0.355). Conclusions: Preoxygenation with a HFNC extending to the apneic period before endotracheal intubation may be beneficial in patients with head and neck cancer.
Pulmonary
Diaphragm ultrasound as a better predictor of successful extubation from mechanical ventilation than rapid shallow breathing index
Mohammad Jhahidul Alam, Simanta Roy, Mohammad Azmain Iktidar, Fahmida Khatun Padma, Khairul Islam Nipun, Sreshtha Chowdhury, Ranjan Kumar Nath, Harun-Or Rashid
Acute Crit Care. 2022;37(1):94-100.   Published online January 11, 2022
DOI: https://doi.org/10.4266/acc.2021.01354
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  • 13 Web of Science
  • 15 Crossref
AbstractAbstract PDF
Background
In 3%–19% of patients, reintubation is needed 48–72 hours following extubation, which increases intensive care unit (ICU) morbidity, mortality, and expenses. Extubation failure is frequently caused by diaphragm dysfunction. Ultrasonography can be used to determine the mobility and thickness of the diaphragm. This study looked at the role of diaphragm excursion (DE) and thickening fraction in predicting successful extubation from mechanical ventilation.
Methods
Thirty-one patients were extubated with the advice of an ICU consultant using the ICU weaning regimen and diaphragm ultrasonography was performed. Ultrasound DE and thickening fraction were measured three times: at the commencement of the t-piece experiment, at 10 minutes, and immediately before extubation. All patients' parameters were monitored for 48 hours after extubation. Rapid shallow breathing index (RSBI) was also measured at the same time.
Results
Successful extubation was significantly correlated with DE (P=0.01). Receiver curve analysis for DE to predict successful extubation revealed good properties (area under the curve [AUC], 0.83; P<0.001); sensitivity, 77.8%; specificity, 84.6%, positive predictive value (PPV), 87.5%; negative predictive value (NPV), 73.3% while cut-off value, 11.43 mm. Diaphragm thickening fraction (DTF) also revealed moderate curve properties (AUC, 0.69; P=0.06); sensitivity, 61.1%; specificity, 84.6%; PPV, 87.5%; NPV, 61.1% with cut-off value 22.33% although former one was slightly better. RSBI could not reach good receiver operating characteristic value at cut-off points 100 b/min/L (AUC, 0.58; P=0.47); sensitivity, 66.7%; specificity, 53.8%; PPV, 66.7%; NPV, 53.8%).
Conclusions
To decrease the rate of reintubation, DE and DTF are better indicators of successful extubation. DE outperforms DTF.

Citations

Citations to this article as recorded by  
  • Rapid shallow breathing index predicting extubation outcomes: A systematic review and meta-analysis
    Donghui Jia, Hengyang Wang, Qian Wang, Wenrui Li, Xuhong Lan, Hongfang Zhou, Zhigang Zhang
    Intensive and Critical Care Nursing.2024; 80: 103551.     CrossRef
  • Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care
    Marta Rafael Marques, José Manuel Pereira, José Artur Paiva, Gonzalo García de Casasola‐Sánchez, Yale Tung‐Chen
    Journal of Ultrasound in Medicine.2024; 43(2): 223.     CrossRef
  • The Role of Ultrasonography in the Process of Weaning from Mechanical Ventilation in Critically Ill Patients
    Lou’i Al-Husinat, Basil Jouryyeh, Ahlam Rawashdeh, Chiara Robba, Pedro Silva, Patricia Rocco, Denise Battaglini
    Diagnostics.2024; 14(4): 398.     CrossRef
  • Critical illness-associated limb and diaphragmatic weakness
    Valentine Le Stang, Nicola Latronico, Martin Dres, Michele Bertoni
    Current Opinion in Critical Care.2024; 30(2): 121.     CrossRef
  • Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis
    Diego Poddighe, Marine Van Hollebeke, Yasir Qaiser Choudhary, Débora Ribeiro Campos, Michele R. Schaeffer, Jan Y. Verbakel, Greet Hermans, Rik Gosselink, Daniel Langer
    Critical Care.2024;[Epub]     CrossRef
  • Ultrasonographic Assessment of Diaphragmatic Function and Its Clinical Application in the Management of Patients with Acute Respiratory Failure
    Marina Saad, Stefano Pini, Fiammetta Danzo, Francesca Mandurino Mirizzi, Carmine Arena, Francesco Tursi, Dejan Radovanovic, Pierachille Santus
    Diagnostics.2023; 13(3): 411.     CrossRef
  • The ratio of respiratory rate to diaphragm thickening fraction for predicting extubation success
    Dararat Eksombatchai, Chalermwut Sukkratok, Yuda Sutherasan, Detajin Junhasavasdikul, Pongdhep Theerawit
    BMC Pulmonary Medicine.2023;[Epub]     CrossRef
  • Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis
    Henry M. Parada-Gereda, Adriana L. Tibaduiza, Alejandro Rico-Mendoza, Daniel Molano-Franco, Victor H. Nieto, Wanderley A. Arias-Ortiz, Purificación Perez-Terán, Joan R. Masclans
    Critical Care.2023;[Epub]     CrossRef
  • Value of Diaphragm Ultrasonography for Extubation: A Single-Blinded Randomized Clinical Trial
    T. G. Toledo, M. R. Bacci, Fred A. Luchette
    Critical Care Research and Practice.2023; 2023: 1.     CrossRef
  • Role of diaphragm ultrasound in weaning mechanically ventilated patients: A prospective observational study
    Ravi Saravanan, Krishnamurthy Nivedita, Krishnamoorthy Karthik, Rajagopalan Venkatraman
    Indian Journal of Anaesthesia.2022; 66(8): 591.     CrossRef
  • The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience
    Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry
    Acute and Critical Care.2022; 37(3): 347.     CrossRef
  • Diaphragm ultrasound in weaning from mechanical ventilation: a last step to predict successful extubation?
    Domenica Di Costanzo, Mariano Mazza, Antonio Esquinas
    Acute and Critical Care.2022; 37(4): 681.     CrossRef
  • Sonographic assessment of diaphragmatic thickening and excursion as predictors of weaning success in the intensive care unit: A prospective observational study
    Amandeep Kaur, Shruti Sharma, VikramP Singh, MRavi Krishna, ParshotamL Gautam, Gagandeep Singh
    Indian Journal of Anaesthesia.2022; 66(11): 776.     CrossRef
  • Comparison of assessment of diaphragm function using speckle tracking between patients with successful and failed weaning: a multicentre, observational, pilot study
    Qiancheng Xu, Xiao Yang, Yan Qian, Chang Hu, Weihua Lu, Shuhan Cai, Bo Hu, Jianguo Li
    BMC Pulmonary Medicine.2022;[Epub]     CrossRef
  • Ultrasonographic assessment of diaphragmatic function in preterm infants on non-invasive neurally adjusted ventilatory assist (NIV-NAVA) compared to nasal intermittent positive-pressure ventilation (NIPPV): a prospective observational study
    Mohamed Elkhouli, Liran Tamir-Hostovsky, Jenna Ibrahim, Nehad Nasef, Adel Mohamed
    European Journal of Pediatrics.2022; 182(2): 731.     CrossRef
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
  • 7,048 View
  • 400 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract 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

Citations to this article as recorded by  
  • 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
  • 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
Review Article
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
  • 5,968 View
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AbstractAbstract PDFSupplementary 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.

ACC : Acute and Critical Care