Acute and Critical Care

Original Articles

Thoracic Surgery
Connective tissue disease is associated with the risk of posterior reversible encephalopathy syndrome following lung transplantation in Korea: Tae Jung Kim, Hyun Joo Lee, Samina Park, Sang-Bae Ko, Soo-Hyun Park, Seung Hwan Yoon, Kwon Joong Na, In Kyu Park, Chang Hyun Kang, Young Tae Kim, Sun Mi Choi, Jimyung Park, Joong-Yub Kim, Hong Yeul Lee; Received September 5, 2024 Accepted November 14, 2024 Published online January 7, 2025; DOI: https://doi.org/10.4266/acc.003384 [Epub ahead of print]

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Abstract PDF Supplementary Material: Background
Posterior reversible encephalopathy syndrome (PRES) is a rare complication of lung transplantation with poorly understood risk factors and clinical characteristics. This study aimed to examine the occurrence, risk factors, and clinical data of patients who developed PRES following lung transplantation.
Methods
A retrospective analysis was conducted on 147 patients who underwent lung transplantation between February 2013 and December 2023. The patients were diagnosed with PRES based on the clinical symptoms and radiological findings. We compared the baseline characteristics and clinical information, including primary lung diseases and immunosuppressive therapy related to lung transplantation operations, between the PRES and non-PRES groups.
Results
PRES manifested in 7.5% (n=11) of the patients who underwent lung transplantation, with a median onset of 15 days after operation. Seizures were identified as the predominant clinical manifestation (81.8%, n=9) in the group diagnosed with PRES. All patients diagnosed with PRES recovered fully. Patients with PRES were significantly associated with connective tissue disease-associated interstitial lung disease (45.5% vs. 18.4%, P=0.019, odds ratio=9.808; 95% CI, 1.064–90.386, P=0.044). Nonetheless, no significant variance was observed in the type of immunotherapy, such as the use of calcineurin inhibitors, blood pressure, or acute renal failure subsequent to lung transplantation.
Conclusions
PRES typically manifests shortly after lung transplantation, with seizures being the predominant initial symptom. The presence of preexisting connective tissue disease as the primary lung disease represents a significant risk factor for PRES following lung transplantation.

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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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

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

Letter to the Editor

Rapid response system
Current status of the rapid response system and early warning score: a survey-based analysis: Sang-Hyeon Park, Jeehoon Kang, Tae Jung Kim, Hong Yeul Lee, Hyun-Jai Cho, Sang-Min Lee; Acute Crit Care. 2022;37(4):687-689. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.01144

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PDF Supplementary Material

Original Articles

Pulmonary
Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis: Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee; Acute Crit Care. 2022;37(4):561-570. Published online October 28, 2022; DOI: https://doi.org/10.4266/acc.2022.00444

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Abstract PDF Supplementary Material: Background
Delayed intubation is associated with poor prognosis in patients with respiratory failure. However, the effect of delayed intubation in patients with idiopathic pulmonary fibrosis (IPF) remains unknown. This study aimed to analyze whether timing of intubation after high-concentration oxygen therapy was associated with worse clinical outcomes in IPF patients.
Methods
This retrospective propensity score-matched study enrolled adult patients with IPF who underwent mechanical ventilation between January 2011 and July 2021. Patients were divided into early and delayed intubation groups. Delayed intubation was defined as use of high-concentration oxygen therapy for at least 48 hours before tracheal intubation. The primary outcome was intensive care unit (ICU) mortality, and a conditional logistic regression model was used to evaluate the association between timing of intubation and clinical outcomes.
Results
The median duration of high-concentration oxygen therapy before intubation was 0.5 days in the early intubation group (n=60) and 5.1 days in the delayed intubation group (n=36). The ICU mortality rate was 56.7% and 75% in the early and delayed intubation groups, respectively, before propensity matching (P=0.075). After matching for demographic and clinical covariates, 33 matched pairs were selected. In the propensity-matched cohort, delayed intubation significantly increased the risk of ICU mortality (adjusted odds ratio, 3.99; 95% confidence interval, 1.02–15.63; P=0.046). However, in-hospital mortality did not differ significantly between the groups.
Conclusions
In patients with IPF, delayed intubation after initiation of high-concentration oxygen therapy was significantly associated with increased risk of ICU mortality compared to early intubation.

Meta-analysis
Comparison of mNUTRIC-S2 and mNUTRIC scores to assess nutritional risk and predict intensive care unit mortality: So Jeong Kim, Hong Yeul Lee, Sun Mi Choi, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2022;37(4):618-626. Published online October 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00612

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Abstract PDF Supplementary Material

Background
Nutritional status is associated with mortality. The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is one of the most commonly used nutritional risk assessment tools in intensive care units (ICUs). The purpose of this study was to compare the mortality predictive ability of the mNUTRIC score to that of the mNUTRIC-S2 score, which uses the Simplified Acute Physiology Score (SAPS) II instead of the Acute Physiology and Chronic Health Evaluation (APACHE) II.
Methods
This retrospective cohort analysis included patients admitted to the ICU between January and September 2020. Each patient’s electronic medical records were reviewed. The model discrimination for predicting ICU mortality was assessed by the area under the receiver operating characteristic (ROC) curve, and a Cox regression model was performed to confirm the relationship between the groups and mortality.
Results
In total, 220 patients were enrolled. The ROC curve for predicting ICU mortality was 0.64 for the mNUTRIC score versus 0.67 for the mNUTRIC-S2 score. The difference between the areas was 0.03 (95% confidence interval [CI], –0.01 to 0.06; P=0.09). Patients with mNUTRIC-S2 score ≥5 had a greater risk of ICU mortality (hazard ratio [HR], 3.64; 95% CI, 1.85–7.14; P<0.001); however, no such relationship was observed with mNUTRIC score (HR, 1.69; 95% CI, 0.62–4.62; P=0.31).
Conclusions
The mNUTRIC-S2 score was significantly associated with ICU mortality. A cutoff score of 5 was selected as most appropriate.

Citations

Citations to this article as recorded by

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study
Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim
Acute and Critical Care.2024; 39(1): 127. CrossRef
Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis
Amit Kumar, Archana Kumari, Jay Prakash, Pradip K Bhattacharya, Saket Verma, Priyanka Shrivastava, Khushboo Saran, Kunal Raj, Hemant N Ray
Indian Journal of Critical Care Medicine.2024; 28(5): 495. CrossRef

Pulmonary
Effect of prone positioning on gas exchange according to lung morphology in patients with acute respiratory distress syndrome: Na Young Kim, Si Mong Yoon, Jimyung Park, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee; Acute Crit Care. 2022;37(3):322-331. Published online July 29, 2022; DOI: https://doi.org/10.4266/acc.2022.00367

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Abstract PDF Supplementary Material

Background
There are limited data on the clinical effects of prone positioning according to lung morphology. We aimed to determine whether the gas exchange response to prone positioning differs according to lung morphology.
Methods
This retrospective study included adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS). The lung morphology of ARDS was assessed by chest computed tomography scan and classified as “diffuse” or “focal.” The primary outcome was change in partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio after the first prone positioning session: first, using the entire cohort, and second, using subgroups of patients with diffuse ARDS matched 2 to 1 with patients with focal ARDS at baseline.
Results
Ninety-five patients were included (focal ARDS group, 23; diffuse ARDS group, 72). Before prone positioning, the focal ARDS group showed worse oxygenation than the diffuse ARDS group (median PaO2/FiO2 ratio, 79.9 mm Hg [interquartile range (IQR)], 67.7–112.6 vs. 104.0 mm Hg [IQR, 77.6–135.7]; P=0.042). During prone positioning, the focal ARDS group showed a greater improvement in the PaO2/FiO2 ratio than the diffuse ARDS group (median, 55.8 mm Hg [IQR, 11.1–109.2] vs. 42.8 mm Hg [IQR, 11.6–83.2]); however, the difference was not significant (P=0.705). Among the PaO2/FiO2-matched cohort, there was no significant difference in change in PaO2/FiO2 ratio after prone positioning between the groups (P=0.904).
Conclusions
In patients with moderate-to-severe ARDS, changes in PaO2/FiO2 ratio after prone positioning did not differ according to lung morphology. Therefore, prone positioning can be considered as soon as indicated, regardless of ARDS lung morphology.

Citations

Citations to this article as recorded by

Subphenotypes of Acute Respiratory Distress Syndrome: Advancing Towards Precision Medicine
Andrea R. Levine, Carolyn S. Calfee
Tuberculosis and Respiratory Diseases.2024; 87(1): 1. CrossRef

Neurology
The effects of hypomagnesemia on delirium in middle-aged and older adult patients admitted to medical intensive care units: Joong-Yub Kim, Hyo Jin Lee, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee, Tae Yun Park; Acute Crit Care. 2022;37(3):407-414. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00164

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Abstract PDF

Background
In critically ill patients, the most common manifestation of brain dysfunction is delirium, which is independently associated with higher morbidity and mortality. While electrolyte imbalance is one of the precipitating factors, the impact of hypomagnesemia on the incidence of delirium remains unknown.
Methods
We retrospectively analyzed patients admitted to the medical intensive care unit (ICU) of a tertiary referral center between January and June 2020. Patients with ICU stay ≥48 hours and aged 40–85 years were included. The primary outcome was cumulative incidence of delirium in the ICU. Patients were divided into two groups based on serum magnesium level at ICU admission. Multivariable Cox proportional hazards regression analysis was performed, and covariates were selected using the least absolute shrinkage and selection operator (LASSO) method.
Results
A total of 109 patients included 43 (39.4%) women and had a median age of 69.0 years (interquartile range [IQR], 60.0–76.0 years). The median magnesium level was 1.7 mg/dl (IQR, 1.5–1.9 mg/dl), and the cumulative incidence of delirium was 32.1% (35 patients). Hypomagnesemia was independently associated with delirium (adjusted hazard ratio [aHR], 2.12; 95% confidence interval [CI], 1.03–4.38), along with prior use of immunosuppressants (aHR, 3.08; 95% CI, 1.46–6.48) or benzodiazepines (aHR, 4.02; 95% CI, 1.54–10.50), body mass index (aHR, 0.93; 95% CI, 0.84–1.02), and alcohol history (aHR, 1.68; 95% CI, 0.74–3.80).
Conclusions
In critically ill adults, hypomagnesemia increases the risk of delirium by more than two-fold compared to patients with normal magnesium level.

Citations

Citations to this article as recorded by

Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults
Suleyman Emre Kocyigit, Bilal Katipoglu
Acta Clinica Belgica.2024; 79(3): 160. CrossRef
Postoperative Delirium Following Posterior Lumbar Spinal Fusion: Epidemiology, Risk Factors, and Associated Complications
Ashley Knebel, Manjot Singh, Rhea Rasquinha, Mohammad Daher, Joseph E. Nassar, John Hanna, Bassel G. Diebo, Alan H. Daniels
World Neurosurgery.2024; 191: e753. CrossRef
Hypomagnesemia and incident delirium in hospitalized older persons
Virginia Boccardi, Sara Ercolani, Rocco Serra, Valentina Bubba, Alessandro Piccolo, Michela Scamosci, Alfredo Villa, Carmelinda Ruggiero, Patrizia Mecocci
Aging Clinical and Experimental Research.2023; 35(4): 847. CrossRef

Neurology
Association of natural light exposure and delirium according to the presence or absence of windows in the intensive care unit: Hyo Jin Lee, Eunhye Bae, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2021;36(4):332-341. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00556

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Abstract PDF Supplementary Material

Background
Patients in the intensive care unit (ICU) have increased risks of delirium, which is associated with worse outcomes. As pharmacologic treatments for delirium are ineffective, prevention is important. Nonpharmacologic preventive strategies include exposure to natural light and restoring circadian rhythm. We investigated the effect of exposure to natural light through windows on delirium in the ICU.
Methods
This retrospective cohort study assessed all patients admitted to the medical ICU of a university-affiliated hospital between January and June 2020 for eligibility. The ICU included 12 isolation rooms, six with and six without windows. Patients with ICU stays of >48 hours were included and were divided into groups based on their admission to a single room with (window group) or without windows (windowless group). The primary outcome was the cumulative incidence of delirium. The secondary outcomes were the numbers of delirium- and mechanical ventilation-free days, ICU and hospital length of stay, and in-ICU and 28-day mortalities.
Results
Of the 150 included patients (window group: 83 [55.3%]; windowless group: 67 [44.7%]), the cumulative incidence of delirium was significantly lower in the window group than in the windowless group (21.7% vs. 43.3%; relative risk, 1.996; 95% confidence interval [CI], 1.220–3.265). Other secondary outcomes did not differ between groups. Admission to a room with a window was independently associated with a decreased risk of delirium (adjusted odds ratio, 0.318; 95% CI, 0.125–0.805).
Conclusions
Exposure to natural light through windows was associated with a lower incidence of delirium in the ICU.

Citations

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Windows in the ICU and Postoperative Delirium: A Retrospective Cohort Study
Diana C. Anderson, Paige E. Warner, Matthew R. Smith, Marissa L. Albanese, Ariel L. Mueller, John Messervy, B. Christian Renne, Samuel J. Smith
Critical Care Medicine.2025;[Epub] CrossRef
Geriatric Psychiatric Emergencies
Michelle A. Fischer, Monica Corsetti
Emergency Medicine Clinics of North America.2024; 42(1): 135. CrossRef
There’s No Place Like Home: Delirium as a Barrier in Geriatric Trauma
Abdoulaziz Toure, Roshan Tadi, Mitchell Meagher, Catherine Ting Brown, Hoi Lam, Samantha LaRosa, Launick Saint-Fort, Huda Syed, Nathaniel Harshaw, Katherine Moore, Neelofer Sohail, Lindsey L. Perea
Journal of Surgical Research.2024; 293: 89. CrossRef
The Influence of Exposure to Nature on Inpatient Hospital Stays: A Scoping Review
Keegan Guidolin, Flora Jung, Sarah Hunter, Han Yan, Marina Englesakis, Stephen Verderber, Sami Chadi, Fayez Quereshy
HERD: Health Environments Research & Design Journal.2024; 17(2): 360. CrossRef
ICU design analysis: Are we really moving forward?
M Harazim
Anesteziologie a intenzivní medicína.2024; 35(1): 8. CrossRef
Restorative effects of daylight in indoor environments – A systematic literature review
Özge Karaman Madan, Kynthia Chamilothori, Juliëtte van Duijnhoven, Mariëlle P.J. Aarts, Yvonne A.W. de Kort
Journal of Environmental Psychology.2024; 97: 102323. CrossRef
Innovate and renovate: Environmental intensive care unit design
Minnette Markus‐Rodden, Kristen Bell, Maryann Brookes, Georgia Harrison, Jeffrey O'Neill
Nursing in Critical Care.2024;[Epub] CrossRef
Postoperative Delirium and Neurocognitive Disorders: A Comprehensive Review of Pathophysiology, Risk Factors, and Management Strategies
Sharayu Paunikar, Vivek Chakole
Cureus.2024;[Epub] CrossRef
Physical space of thirty pediatric intensive care units in the United States of America: a national survey
Oliver Karam, Aziez Ahmed, Matthew Bizzarro, Clifford Bogue, John S. Giuliano
Frontiers in Pediatrics.2024;[Epub] CrossRef
Exploratory analysis of factors influencing hospital preferences among the Lebanese population: a cross-sectional study
Christian-Joseph El Zouki, Abdallah Chahine, Elie Ghadban, Frederic Harb, Jamale El-Eid, Diala El Khoury
BMJ Open.2024; 14(11): e085727. CrossRef
Reinforcement learning model for optimizing dexmedetomidine dosing to prevent delirium in critically ill patients
Hong Yeul Lee, Soomin Chung, Dongwoo Hyeon, Hyun-Lim Yang, Hyung-Chul Lee, Ho Geol Ryu, Hyeonhoon Lee
npj Digital Medicine.2024;[Epub] CrossRef
Four Decades of Intensive Care Unit Design Evolution and Thoughts for the Future
Neil A. Halpern, Elizabeth Scruth, Michelle Rausen, Diana Anderson
Critical Care Clinics.2023; 39(3): 577. CrossRef
Improving healthcare value: integrating medical practitioners into hospital design in developing countries
Carlos Machhour Noujeim
Healthcare in Low-resource Settings.2023;[Epub] CrossRef
Evaluation of the sensory environment in a large tertiary ICU
Oystein Tronstad, Dylan Flaws, Sue Patterson, Robert Holdsworth, Veronica Garcia-Hansen, Francisca Rodriguez Leonard, Ruth Ong, Stephanie Yerkovich, John F. Fraser
Critical Care.2023;[Epub] CrossRef
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
Acute and Critical Care.2022; 37(1): 1. CrossRef
Post-acute Delirium of COVID-19 Infection
Dai-Chun Chi, Chih-Pang Chu, Tien Wei Yang, Hu-Ming Chang
Taiwanese Journal of Psychiatry.2022; 36(1): 44. CrossRef
The future of intensive care: delirium should no longer be an issue
Katarzyna Kotfis, Irene van Diem-Zaal, Shawniqua Williams Roberson, Marek Sietnicki, Mark van den Boogaard, Yahya Shehabi, E. Wesley Ely
Critical Care.2022;[Epub] CrossRef
The effects of hypomagnesemia on delirium in middle-aged and older adult patients admitted to medical intensive care units
Joong-Yub Kim, Hyo Jin Lee, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee, Tae Yun Park
Acute and Critical Care.2022; 37(3): 407. CrossRef

Rapid response system
Effect of a rapid response system on code rates and in-hospital mortality in medical wards: Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Sulhee Kim, Eunjin Yang, Hyun Joo Lee, Hannah Lee, Ho Geol Ryu, Seung-Young Oh, Eun Jin Ha, Sang-Bae Ko, Jaeyoung Cho; Acute Crit Care. 2019;34(4):246-254. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00668

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Abstract PDF

Background
To determine the effects of implementing a rapid response system (RRS) on code rates and in-hospital mortality in medical wards.
Methods
This retrospective study included adult patients admitted to medical wards at Seoul National University Hospital between July 12, 2016 and March 12, 2018; the sample comprised 4,224 patients admitted 10 months before RRS implementation and 4,168 patients admitted 10 months following RRS implementation. Our RRS only worked during the daytime (7 AM to 7 PM) on weekdays. We compared code rates and in-hospital mortality rates between the preintervention and postintervention groups.
Results
There were 62.3 RRS activations per 1,000 admissions. The most common reasons for RRS activation were tachypnea or hypopnea (44%), hypoxia (31%), and tachycardia or bradycardia (21%). Code rates from medical wards during RRS operating times significantly decreased from 3.55 to 0.96 per 1,000 admissions (adjusted odds ratio [aOR], 0.29; 95% confidence interval [CI], 0.10 to 0.87; P=0.028) after RRS implementation. However, code rates from medical wards during RRS nonoperating times did not differ between the preintervention and postintervention groups (2.60 vs. 3.12 per 1,000 admissions; aOR, 1.23; 95% CI, 0.55 to 2.76; P=0.614). In-hospital mortality significantly decreased from 56.3 to 42.7 per 1,000 admissions after RRS implementation (aOR, 0.79; 95% CI, 0.64 to 0.97; P=0.024).
Conclusions
Implementation of an RRS was associated with significant reductions in code rates during RRS operating times and in-hospital mortality in medical wards.

Citations

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Effects of a Rapid Response Team on Patient Outcomes: A Systematic Review
Qiuxia Zhang, Khuan Lee, Zawiah Mansor, Iskasymar Ismail, Yi Guo, Qiao Xiao, Poh Ying Lim
Heart & Lung.2024; 63: 51. CrossRef
Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
Kimia Honarmand, Randy S. Wax, Daleen Penoyer, Geoffery Lighthall, Valerie Danesh, Bram Rochwerg, Michael L. Cheatham, Daniel P. Davis, Michael DeVita, James Downar, Dana Edelson, Alison Fox-Robichaud, Shigeki Fujitani, Raeann M. Fuller, Helen Haskell, Ma
Critical Care Medicine.2024; 52(2): 314. CrossRef
Rapid Response Systems
Bradford D. Winters
Critical Care Clinics.2024; 40(3): 583. CrossRef
The role of emergency medical services in the management of in-hospital emergencies: Causes and outcomes of emergency calls – A descriptive retrospective register-based study
Henna Myrskykari, Timo Iirola, Hilla Nordquist
Australasian Emergency Care.2023;[Epub] CrossRef
Improving sepsis recognition and management
Merrilee I Cox, Hillary Voss
Current Problems in Pediatric and Adolescent Health Care.2021; 51(4): 101001. CrossRef
A Somogy Megyei Kaposi Mór Oktató Kórház által bevezetett gyors reagálású rendszer hatása a kórházi mortalitásra
János Fogas, Rita Koroseczné Pavlin, Krisztina Szabó, Eszter Héra, Imre Repa, Mariann Moizs
Orvosi Hetilap.2021; 162(20): 782. CrossRef
Evidence revealed the effects of rapid response system
Jae Hwa Cho
Acute and Critical Care.2019; 34(4): 282. CrossRef

Case Report

Acute Mercury Vapor Inhalation Toxicity after Burning Charms: A Case Report: Hong Yeul Lee, Gyoung Hoon Kang, Ki Ho Nam, Mi Hye Kim, Bock Hyun Jung, Hui Dong Kang, Se Hyun Oh, Jaemin Lim; Korean J Crit Care Med. 2010;25(3):182-185.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.182

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Abstract PDF: Cinnabar is the mineral with mercury in combination with sulfur, and it has been used to make charms in China and Korea. If cinnabar is overheated, mercury vapor that is extremely hazardous or sometimes fatal can be released. We experienced 5 patients of a family who were exposed to mercury vapor when they burnt charms. One of them developed severe acute respiratory failure and the patient needed mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Despite treatment with cortiocosteroid, D-penicillamine, ECMO and plasmapheresis, the radiologic findings of a patient worsened and he died.

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