Acute and Critical Care

Original Articles

Pulmonary
Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation: Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh; Acute Crit Care. 2024;39(1):91-99. Published online January 26, 2024; DOI: https://doi.org/10.4266/acc.2023.00871

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Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

Citations

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Perioperative Ventilation in Neurosurgical Patients: Considerations and Challenges
Ida Giorgia Iavarone, Patricia R.M. Rocco, Pedro Leme Silva, Shaurya Taran, Sarah Wahlster, Marcus J. Schultz, Nicolo’ Antonino Patroniti, Chiara Robba
Current Anesthesiology Reports.2024;[Epub] CrossRef

Pulmonary
Effects of high-flow nasal cannula in patients with mild to moderate hypercapnia: a prospective observational study: Kyung Hun Nam, Hyung Koo Kang, Sung-Soon Lee, So-Hee Park, Sung Wook Kang, Jea Jun Hwang, So Young Park, Won Young Kim, Hee Jung Suh, Eun Young Kim, Ga Jin Seo, Younsuck Koh, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim; Acute Crit Care. 2021;36(3):249-255. Published online July 26, 2021; DOI: https://doi.org/10.4266/acc.2020.01102

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Abstract PDF

Background
Evidence for using high-flow nasal cannula (HFNC) in hypercapnia is still limited. Most of the clinical studies had been conducted retrospectively, and there had been conflicting reports for the effects of HFNC on hypercapnia correction in prospective studies. Therefore, more evidence is needed to understand the effect of the HFNC in hypercapnia.
Methods
We conducted a multicenter prospective observational study after applying HFNC to 45 hospitalized subjects who had moderate hypercapnia (arterial partial pressure of carbon dioxide [PaCO2], 43–70 mm Hg) without severe respiratory acidosis (pH <7.30). The primary outcome was a change in PaCO2 level in the first 24 hours of HFNC use. The secondary outcomes were changes in other parameters of arterial blood gas analysis, changes in respiration rates, and clinical outcomes.
Results
There was a significant decrease in PaCO2 in the first hour of HFNC application (-3.80 mm Hg; 95% confidence interval, -6.35 to -1.24; P<0.001). Reduction of PaCO2 was more prominent in subjects who did not have underlying obstructive lung disease. There was a correction in pH, but no significant changes in respiratory rate, bicarbonate, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio. Mechanical ventilation was not required for 93.3% (42/45) of our study population.
Conclusions
We suggest that HFNC could be a safe alternative for oxygen delivery in hypercapnia patients who do not need immediate mechanical ventilation. With HFNC oxygenation, correction of hypercapnia could be expected, especially in patients who do not have obstructive lung diseases.

Citations

Citations to this article as recorded by

Oxygénothérapie nasale à haut débit et insuffisance respiratoire aiguë hypercapnique
C. Girault, E. Artaud-Macari, G. Jolly, D. Carpentier, A. Cuvelier, G. Béduneau
Revue des Maladies Respiratoires.2024; 41(7): 498. CrossRef
Safety and efficacy of high flow nasal canula in patients with mild hypercapnia
Mohammed A. Ibrahim, Magdy Emara, Mohammed Shehta
The Egyptian Journal of Bronchology.2023;[Epub] CrossRef
Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
High-flow nasal cannula: Evaluation of the perceptions of various performance aspects among Chinese clinical staff and establishment of a multidimensional clinical evaluation system
Ruoxuan Wen, Xingshuo Hu, Tengchen Wei, Kaifei Wang, Zhimei Duan, Zhanqi Zhao, Lixin Xie, Fei Xie
Frontiers in Medicine.2022;[Epub] CrossRef
The Application Progress of HFNC in Respiratory Diseases
迪吴
Advances in Clinical Medicine.2022; 12(11): 10617. CrossRef

Erratum

Pulmonary
Erratum to “Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study”: Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho; Acute Crit Care. 2021;36(2):172-172. Published online May 28, 2021; DOI: https://doi.org/10.4266/acc.2020.00164.e1; Corrects: Acute Crit Care 2020;35(4):255

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Original Articles

Pulmonary
Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study: Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho; Acute Crit Care. 2020;35(4):255-262. Published online November 9, 2020; DOI: https://doi.org/10.4266/acc.2020.00164; Correction in: Acute Crit Care 2021;36(2):172

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Abstract PDF

Background
The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs.
Methods
Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included.
Results
A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups.
Conclusions
In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Citations

Citations to this article as recorded by

Sedation and analgesia strategies for non-invasive mechanical ventilation: A systematic review and meta-analysis
Baolu Yang, Leyi Gao, Zhaohui Tong
Heart & Lung.2024; 63: 42. CrossRef
Effect of Music Therapy and Sound Isolation on the Comfort of Mechanically Ventilated Patients
Sinem Çalışkan, Esra Akın, Mehmet Uyar
Turkish Journal of Intensive Care.2024; 22(1): 83. CrossRef
Remifentanil vs. dexmedetomidine for cardiac surgery patients with noninvasive ventilation intolerance: a multicenter randomized controlled trial
Guang-wei Hao, Jia-qing Wu, Shen-ji Yu, Kai Liu, Yan Xue, Qian Gong, Rong-cheng Xie, Guo-guang Ma, Ying Su, Jun-yi Hou, Yi-jie zhang, Wen-jun Liu, Wei Li, Guo-wei Tu, Zhe Luo
Journal of Intensive Care.2024;[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
Comfort During Non-invasive Ventilation
Gianmaria Cammarota, Rachele Simonte, Edoardo De Robertis
Frontiers in Medicine.2022;[Epub] CrossRef
Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
Treatment of acute respiratory failure: noninvasive mechanical ventilation
Sunghoon Park
Journal of the Korean Medical Association.2022; 65(3): 144. CrossRef
Dexmedetomidine-Induced Aortic Contraction Involves Transactivation of the Epidermal Growth Factor Receptor in Rats
Soo Hee Lee, Seong-Chun Kwon, Seong-Ho Ok, Seung Hyun Ahn, Sung Il Bae, Ji-Yoon Kim, Yeran Hwang, Kyeong-Eon Park, Mingu Kim, Ju-Tae Sohn
International Journal of Molecular Sciences.2022; 23(8): 4320. CrossRef

Pulmonary
The Use of Lung Ultrasound in a Surgical Intensive Care Unit: Hyung Koo Kang, Hyo Jin So, Deok Hee Kim, Hyeon-Kyoung Koo, Hye Kyeong Park, Sung-Soon Lee, Hoon Jung; Korean J Crit Care Med. 2017;32(4):323-332. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00318

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Abstract PDF

Background
Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU).
Methods
This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016.
Results
The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively.
Conclusions
LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.

Citations

Citations to this article as recorded by

Lung Ultrasound in the Critically Ill
Jin Sun Cho
The Korean Journal of Critical Care Medicine.2017; 32(4): 356. CrossRef

Causes of Fever in the ICU - A Prospective, Cohort Study: Eun Ju Jeon, Hye Min Lee, Sung Gun Cho, Hyung Koo Kang, Hee Won Kwak, Ju Han Song, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Jae Yeol Kim; Korean J Crit Care Med. 2008;23(1):13-17.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.13

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Abstract PDF

BACKGROUND
Fever develops in 70% of ICU patients. In the present study, we tried to figure out causes of fever and the prognosis of febrile patients in the ICU in a prospective, cohort method.
METHODS
From February to June 2007, patients admitted to medical ICU were daily screened and those who developed fever were enrolled. 237 consecutive admissions of 237 patients over a 5-month period were analyzed. Clinical parameters, including demographic data, underlying diseases, duration of ICU stay, causes of fever and final outcome were analyzed.
RESULTS
Fever (core temperature > or =38.3degrees C) was present in 8% of admission, and it was caused by infective (84.2%) and non-infective processes (15.8%). Most fever occurred within first 5 days in the course of the admission (68.4%) and most lasted less than 5 days (57.9%). The median Acute Physiology and Chronic Health Evaluation (APACHE) III score at the time of fever was 43 (+/-19). Those with infectious fever had no significant differences in terms of severity of diseases in comparison with those with non-infectious cause of fever. The most common cause of infective fever was pneumonia (n=11). Prolonged fever (> or =5 days), all of which was caused by infection, occurred in 11 patients. Those with prolonged fever had higher mortality rate than short duration of fever (37.5% vs 0%, p<0.05).
CONCLUSION
Infection, especially pneumonia is common cause of fever in the ICU. Prolonged fever is associated with high mortality rate.

Citations

Citations to this article as recorded by

The Value of Procalcitonin and the SAPS II and APACHE III Scores in the Differentiation of Infectious and Non-infectious Fever in the ICU: A Prospective, Cohort Study
Eun Ju Jeon, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Ae Ja Park, Jae Yeol Kim
Journal of Korean Medical Science.2010; 25(11): 1633. CrossRef

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