Acute and Critical Care

Original Articles

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

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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

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.

Nephrology
Impact of intradialytic hypotension on mortality following the transition from continuous renal replacement therapy to intermittent hemodialysis: Seong Geun Kim, Donghwan Yun, Jinwoo Lee, Yong Chul Kim, Dong Ki Kim, Kook-Hwan Oh, Kwon Wook Joo, Yon Su Kim, Seung Seok Han; Acute Crit Care. 2023;38(1):86-94. Published online October 26, 2022; DOI: https://doi.org/10.4266/acc.2022.00948

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Background
The transition of dialysis modalities from continuous renal replacement therapy (CRRT) to intermittent hemodialysis (iHD) is frequently conducted during the recovery phase of critically ill patients with acute kidney injury. Herein, we addressed the occurrence of intradialytic hypotension (IDH) after this transition, and its association with the mortality risk.
Methods
A total of 541 patients with acute kidney injury who attempted to transition from CRRT to iHD at Seoul National University Hospital, Korea from 2010 to 2020 were retrospectively collected. IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg or a decrease in systolic blood pressure ≥30 mm Hg during the first session of iHD. Odds ratios (ORs) of outcomes, such as in-hospital mortality and weaning from RRT, were measured using a logistic regression model after adjusting for multiple variables.
Results
IDH occurred in 197 patients (36%), and their mortality rate (44%) was higher than that of those without IDH (19%; OR, 2.64; 95% confidence interval [CI], 1.70–4.08). For patients exhibiting IDH, the iHD sessions delayed successful weaning from RRT (OR, 0.62; 95% CI, 0.43–0.90) compared with sessions on those without IDH. Factors such as low blood pressure, high pulse rate, low urine output, use of mechanical ventilations and vasopressors, and hypoalbuminemia were associated with IDH risk.
Conclusions
IDH occurrence following the transition from CRRT to iHD is associated with high mortality and delayed weaning from RRT.

Citations

Citations to this article as recorded by

Cumulative impact of hypotension during intermittent hemodialysis on kidney recovery in critically ill patients with AKI-D
Jae Ho Kim, Joonhee Yoon, Ji-Eun Kim, Seongho Jo, Yuri Lee, Ji Won Kim, Seun Deuk Hwang, Seoung Woo Lee, Joon Ho Song, Kipyo Kim
Journal of Critical Care.2025; 85: 154944. CrossRef
The Relationship between Dialysis Adequacy and Blood Pressure and Number of Intradialytic Hypotensive Episodes in Haemodialysis Patients
Ömer Bingölbali, Semra Oğuz
Black Sea Journal of Health Science.2024; 7(5): 189. CrossRef

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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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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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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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

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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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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

Epidemiology
Postextubation respiratory events in patients admitted to the intensive care unit: a prospective pilot study using overnight respiratory polygraphy: Ye Jin Lee, Jinwoo Lee, Sang-Min Lee, Jaeyoung Cho; Acute Crit Care. 2020;35(4):271-278. Published online November 12, 2020; DOI: https://doi.org/10.4266/acc.2020.00479

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Background
Before the main trial in which respiratory polygraphy will be used to evaluate postextubation sleep apnea in critically ill patients, we performed a prospective pilot study to ensure that any issues with the conduct of the trial would be identified.
Methods
In the present study, 13 adult patients who had received mechanical ventilation for ≥24 hours were prospectively recruited. Among the patients, 10 successfully completed respiratory polygraphy on the first or second night after extubation. Data regarding the types and doses of corticosteroids, analgesics, sedatives, and muscle relaxants as well as the methods of oxygen delivery were recorded.
Results
During the night of respiratory polygraphy, all 10 patients received supplemental oxygen (low-flow oxygen, n=5; high-flow oxygen, n=5), and seven patients received intravenous corticosteroids. Three of the 10 patients had a respiratory event index (REI) ≥5/hr. All respiratory events were obstructive episodes. None of the patients receiving high-flow oxygen therapy had an REI ≥5/hr. Two of the seven patients who received corticosteroids and one of the other three patients who did not receive this medication had an REI ≥5/hr. Although low- or high-flow oxygen therapy was provided, all patients had episodes of oxygen saturation (SpO2) <90%. Two of the three patients with an REI ≥5/hr underwent in-laboratory polysomnography. The patients’ Apnea-Hypopnea Index and REI obtained via polysomnography and respiratory polygraphy, respectively, were similar.
Conclusions
In a future trial to evaluate postextubation sleep apnea in critically ill patients, pre-stratification based on the use of corticosteroids and high-flow oxygen therapy should be considered.

Citations

Citations to this article as recorded by

Sleep assessment in critically ill adults: A systematic review and meta-analysis
Ellaha Kakar, Matthijs Priester, Pascale Wessels, Arjen J.C. Slooter, M. Louter, M. van der Jagt
Journal of Critical Care.2022; 71: 154102. CrossRef

Pulmonary
Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire: Jae Kyoung Kim, Ju-Hee Park, Jaeyoung Cho, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2020;35(3):164-168. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00339

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Background
Sleep disorders are common in critically ill patients. Unfortunately, sleep assessment is challenging in many intensive care units (ICUs). The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple subjective tool that has been validated and used in many countries. This study aimed to evaluate the reliability of the Korean version of the RCSQ (K-RCSQ).
Methods
This prospective, cross-sectional, observational study was conducted in the ICUs of two hospitals. In total, 52 consenting patients answered questionnaires regarding their previous night’s sleep (K-RCSQ) and the noise they experienced (range, 0–100).
Results
The K-RCSQ showed excellent internal consistency of 0.960 by Cronbach’s alpha. The mean total score of the K-RCSQ was 41.9±28.9 (range, 0–100). The mean perceived ICU noise score was 40.7±28.1 (range, 0–90). There was a significant linear correlation between noise score and average K-RCSQ score (r=–0.37, P<0.001).
Conclusions
The K-RCSQ demonstrated excellent reliability (internal consistency). This simple tool may help assess sleep quality in critically ill patients and improve the quality of ICU care.

Citations

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Effects of nursing interventions applied at night on sleep quality and sleep effort of patients in the intensive care unit
Aynur Bahar, Mina Güner Muşluoğlu, Hilal Uygur
Psychology, Health & Medicine.2025; : 1. CrossRef
Iliopsoas plane block does not improve pain after primary total hip arthroplasty in the presence of multimodal analgesia: a single institution randomized controlled trial
Ji Yeong Kim, Jong Seok Lee, Ji Young Kim, Eun Jang Yoon, Wootaek Lee, Seungyeon Lee, Do-Hyeong Kim
Regional Anesthesia & Pain Medicine.2024; : rapm-2023-105092. CrossRef
A Randomized Controlled Trial to Evaluate the Analgesic Effectiveness of Periarticular Injections and Pericapsular Nerve Group Block for Patients Undergoing Total Hip Arthroplasty
Bora Lee, Tae Sung Lee, Jaewon Jang, Hyun Eom Jung, Kwan Kyu Park, Yong Seon Choi
Journal of Personalized Medicine.2024; 14(4): 377. 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
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 and Critical Care.2023; 38(3): 278. CrossRef
Psychometric properties of a Thai version of the Richards‐Campbell sleep questionnaire
Nuanprae Kitisin, Pawit Somnuke, Napat Thikom, Nattaya Raykateeraroj, Nisa Poontong, Chayanan Thanakiattiwibun, Karuna Wongtangman
Nursing in Critical Care.2022; 27(6): 885. CrossRef
Sleep assessment in critically ill adults: A systematic review and meta-analysis
Ellaha Kakar, Matthijs Priester, Pascale Wessels, Arjen J.C. Slooter, M. Louter, M. van der Jagt
Journal of Critical Care.2022; 71: 154102. CrossRef
Comparison of pharmacologic therapies alone versus operative techniques in combination with pharmacologic therapies for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial
Hyun-Chang Kim, Young Song, Jong Seok Lee, Myeong Eun Jeong, Yongmin Lee, Jin Hong Lim, Do-Hyeong Kim
International Journal of Surgery.2022; 104: 106763. CrossRef

Basic science and research
Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients: Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2020;35(3):149-155. Published online August 31, 2020; DOI: https://doi.org/10.4266/acc.2020.00297

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Background
Although the measuring free cortisol is ideal for assessment of hypothalamicpituitary-adrenal function, it is not routinely measured. Salivary cortisol correlates well with the biologically active free cortisol. Therefore, this study measured the morning basal as well as adrenocorticotropic hormone-stimulated salivary cortisol levels in mechanically ventilated patients and compared the results with non-critically ill patients.
Methods
We prospectively enrolled 49 mechanically ventilated patients and 120 patients from the outpatient clinic. Serum and saliva samples were collected between 8 AM and 10 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. The salivary samples were insufficient in 15 mechanically ventilated patients (30.6%), and these patients were excluded from the final analysis.
Results
Mechanically ventilated patients (n=34) were significantly older and had lower body mass index and serum albumin levels and higher serum creatinine levels than non-critically ill patients (n=120). After adjustment for these parameters, both basal and stimulated salivary and serum cortisol levels were higher in mechanically ventilated patients. The increase in cortisol was not significantly different between the two groups. Serum cortisol levels showed a positive correlation with salivary cortisol levels. Among mechanically ventilated patients, both basal serum and salivary cortisol levels were lower in survivors than in non-survivors.
Conclusions
Both basal total serum and salivary cortisol levels were elevated in mechanically ventilated patients and in non-survivors.

Citations

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Identity change and the transition to university: Implications for cortisol awakening response, psychological well‐being and academic performance
Siobhán M. Griffin, Alžběta Lebedová, Tegan Cruwys, Grace McMahon, Aoife Marie Foran, Magdalena Skrodzka, Stephen Gallagher, Annie T. Ginty, Orla T. Muldoon
Applied Psychology: Health and Well-Being.2025;[Epub] CrossRef
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Ayaka Adachi, Kentaro Fujiwara, Hiroko Watayo, Ailing Hu, Takuji Yamaguchi, Hisae Iida, Asuka Ishiyama, Masahiro Shimizu, Shuko Nojiri, Hiroyuki Koga, Hiroyuki Kobayashi, Geoffrey J. Lane, Atsuyuki Yamataka, Kazuto Suda
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Associations between chronic work stress and plasma chromogranin A/catestatin among healthy workers
Xin Liu, Weimin Dang, Hui Liu, Yao Song, Ying Li, Weixian Xu
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Rapid response system
Effectiveness of a daytime rapid response system in hospitalized surgical ward patients: Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh; Acute Crit Care. 2020;35(2):77-86. Published online May 13, 2020; DOI: https://doi.org/10.4266/acc.2019.00661

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Background
Clinical deteriorations during hospitalization are often preventable with a rapid response system (RRS). We aimed to investigate the effectiveness of a daytime RRS for surgical hospitalized patients.
Methods
A retrospective cohort study was conducted in 20 general surgical wards at a 1,779-bed University hospital from August 2013 to July 2017 (August 2013 to July 2015, pre-RRS-period; August 2015 to July 2017, post-RRS-period). The primary outcome was incidence of cardiopulmonary arrest (CPA) when the RRS was operating. The secondary outcomes were the incidence of total and preventable cardiopulmonary arrest, in-hospital mortality, the percentage of “do not resuscitate” orders, and the survival of discharged CPA patients.
Results
The relative risk (RR) of CPA per 1,000 admissions during RRS operational hours (weekdays from 7 AM to 7 PM) in the post-RRS-period compared to the pre-RRS-period was 0.53 (95% confidence interval [CI], 0.25 to 1.13; P=0.099) and the RR of total CPA regardless of RRS operating hours was 0.76 (95% CI, 0.46 to 1.28; P=0.301). The preventable CPA after RRS implementation was significantly lower than that before RRS implementation (RR, 0.31; 95% CI, 0.11 to 0.88; P=0.028). There were no statistical differences in in-hospital mortality and the survival rate of patients with in-hospital cardiac arrest. Do-not-resuscitate decisions significantly increased during after RRS implementation periods compared to pre-RRS periods (RR, 1.91; 95% CI, 1.40 to 2.59; P<0.001).
Conclusions
The day-time implementation of the RRS did not significantly reduce the rate of CPA whereas the system effectively reduced the rate of preventable CPA during periods when the system was operating.

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Development and Validation of a Machine Learning Algorithm Using Clinical Pages to Predict Imminent Clinical Deterioration
Bryan D. Steitz, Allison B. McCoy, Thomas J. Reese, Siru Liu, Liza Weavind, Kipp Shipley, Elise Russo, Adam Wright
Journal of General Internal Medicine.2024; 39(1): 27. CrossRef
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
Development and Validation of a Deep Learning Model for Prediction of Adult Physiological Deterioration
Supreeth P. Shashikumar, Joshua Pei Le, Nathan Yung, James Ford, Karandeep Singh, Atul Malhotra, Shamim Nemati, Gabriel Wardi
Critical Care Explorations.2024; 6(9): e1151. CrossRef
Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
Annals of Surgical Treatment and Research.2023; 104(1): 43. CrossRef
The associations between rapid response systems and their components with patient outcomes: A scoping review
Rebecca J. Piasecki, Cheryl R. Dennison Himmelfarb, Kelly T. Gleason, Rachel M. Justice, Elizabeth A. Hunt
International Journal of Nursing Studies Advances.2023; 5: 100134. CrossRef
Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act
Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
Acute and Critical Care.2022; 37(2): 237. CrossRef
Estructura y función de los equipos de respuesta rápida para la atención de adultos en contextos hospitalarios de alta complejidad: Revisión sistemática de alcance
Juliana Vanessa Rincón-López, Diego Larrotta-Castillo, Kelly Estrada-Orozco, Hernando Gaitán-Duarte
Revista Colombiana de Obstetricia y Ginecología.2021; 72(2): 171. CrossRef
Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
Sang Hyuk Kim, Ji Young Hong, Youlim Kim
Journal of Korean Medical Science.2021;[Epub] CrossRef
Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
Mi-Jung Yoon, Jin-Hee Park
Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491. 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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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

Pulmonary
Reduction of PaCO₂ by high-flow nasal cannula in acute hypercapnic respiratory failure patients receiving conventional oxygen therapy: Hyun Woo Lee, Sun Mi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee; Acute Crit Care. 2019;34(3):202-211. Published online August 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00563

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Background
It has been suggested that a high-flow nasal cannula (HFNC) could help to remove carbon dioxide (CO₂) from anatomical dead spaces, but evidence to support that is lacking. The objective of this study was to elucidate whether use of an HFNC could reduce the arterial partial pressure of CO₂ (PaCO₂) in patients with acute hypercapnic respiratory failure who are receiving conventional oxygen (O₂) therapy.
Methods
A propensity score-matched observational study was conducted to evaluate patients treated with an HFNC for acute hypercapnic respiratory failure from 2015 to 2016. The hypercapnia group was defined as patients with a PaCO₂ >50 mm Hg and arterial pH <7.35.
Results
Eighteen patients in the hypercapnia group and 177 patients in the nonhypercapnia group were eligible for the present study. Eighteen patients in each group were matched by propensity score. Decreased PaCO₂ and consequent pH normalization over time occurred in the hypercapnia group (P=0.002 and P=0.005, respectively). The initial PaCO₂ level correlated linearly with PaCO₂ removal after the use of an HFNC (R²=0.378, P=0.010). The fraction of inspired O₂ used in the intensive care unit was consistently higher for 48 hours in the nonhypercapnia group. Physiological parameters such as respiratory rate and arterial partial pressure of O₂ improved over time in both groups.
Conclusions
Physiological parameters can improve after the use of an HFNC in patients with acute hypercapnic respiratory failure given low-flow O₂ therapy via a facial mask. Further studies are needed to identify which hypercapnic patients might benefit from an HFNC.

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J.M. Carratalá, S. Diaz-Lobato, B. Brouzet, P. Más-Serrano, J.L.S. Rocamora, A.G. Castro, A.G. Varela, S.M. Alises
Pulmonology.2024; 30(5): 437. CrossRef
Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in patients with head and neck cancer
Jun-Young Jo, Jungpil Yoon, Heeyoon Jang, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi
Acute and Critical Care.2024; 39(1): 61. CrossRef
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Comparison of Conventional Oxygen Therapy With High-Flow Nasal Oxygenation in the Management of Hypercapnic Respiratory Failure
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Ji Hye Kim, Dong In Suh, June Dong Park
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Onlak Ruangsomboon, Chok Limsuwat, Nattakarn Praphruetkit, Apichaya Monsomboon, Tipa Chakorn, Brian C. Hiestand
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Lingling Su, Qinyu Zhao, Taotao Liu, Yujun Xu, Weichun Li, Aiping Zhang
Lung.2021; 199(5): 447. CrossRef
High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study
SooHyun Bae, Minkyu Han, Changyoung Kim, Hyeji Lee, Jong-Joon Ahn, Jin Hyoung Kim, Byung Ju Kang
Journal of Korean Medical Science.2020;[Epub] CrossRef
High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future
Lucia Spicuzza, Matteo Schisano
Therapeutic Advances in Chronic Disease.2020;[Epub] CrossRef
Impact of High-Flow Nasal Cannula on Arterial Blood Gas Parameters in the Emergency Department
Emre Şancı, Feride Ercan Coşkun, Basak Bayram
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Ethics
Characteristics and Outcomes of Potentially Inappropriate Admissions to the Intensive Care Unit: Sooim Sin, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2019;34(1):46-52. Published online February 28, 2019; DOI: https://doi.org/10.4266/acc.2018.00388

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Background
Admission of patients perceived as potentially inappropriate for intensive care is a very sensitive and controversial issue. We aimed to evaluate the use of medical resources in the intensive care unit (ICU) and outcomes of patients according to a physician’s judgment of appropriateness. Methods: ICU physicians classified patients who were admitted to the medical ICU of a tertiary hospital as appropriate or inappropriate for intensive care within 24 hours of admission. Patient outcomes including mortality were analyzed according to appropriateness. Additionally, the usage and duration of mechanical ventilation (MV), renal replacement therapy (RRT), and extracorporeal membrane oxygenation (ECMO) were analyzed according to appropriateness. Results: In total, 105 patients (male, 55.4%; mean age, 62 years) were included. Twelve (11.4%) patients were considered inappropriate for intensive care based on guidance published by the Society of Critical Care Medicine through a questionnaire survey of physicians. There was no significant difference between patients considered inappropriate or appropriate for ICU admission regarding the use and duration of MV, RRT, and ECMO. In contrast, the ICU, in-hospital, 28-day, 90-day, and total mortality rates were significantly higher among patients with inappropriate admission than among patients with appropriate admission (ICU mortality: 50.0% vs. 25.8%, P=0.008; in-hospital mortality: 58.3% vs. 43.0%, P=0.028; 28-day mortality: 58.3% vs. 33.3%, P=0.019; 90-day mortality: 66.7% vs. 44.1%, P=0.023). Conclusions: Despite higher mortality, the amount of medical resources used for patients considered potentially inappropriate for intensive care did not differ from the resources used for patients considered suitable for ICU care.

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Carla Marchini Dias da Silva, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Jr
Journal of Critical Care.2024; 79: 154468. CrossRef
Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
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Basic science and research
Prognostic Implication of Adrenocortical Response during the Course of Critical Illness: Jin Hwa Song, Jung Hee Kim, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2019;34(1):38-45. Published online January 30, 2019; DOI: https://doi.org/10.4266/acc.2018.00339

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Background
Critical illness-related corticosteroid insufficiency (CIRCI) and adrenocorticotropic hormone (ACTH)-cortisol dissociation are hormonal conditions frequently observed in patients in the intensive care unit (ICU). The aim of this study was to evaluate the association between ACTH-cortisol dissociation and clinical outcomes of critically ill patients. Methods: We retrospectively reviewed the medical records of 94 ICU patients who underwent two rapid cosyntropin tests during hospital admission and compared the clinical aspects of patients with and without ACTH-cortisol dissociation. ACTH-cortisol dissociation was defined as plasma ACTH and serum cortisol concentrations of <22 pmol/L and >600 nmol/L, respectively. Results: Dissociation was present in 30 of the 94 patients (31.9%). Patients with ACTH-cortisol dissociation in the initial test had significantly higher hospital mortality rate than those in the control group (55% vs. 25.7%, P=0.013) There was no difference in hospital mortality between patients classified as having CIRCI and those who were not. In multivariate adjusted Cox regression analysis, the mortality risk was higher in the group with ACTH-cortisol dissociation (hazard ratio, 2.98; 95% confidence interval, 1.34 to 6.63; P=0.007). Patients with dissociation in two consecutive stimulation tests showed the highest hospital mortality rate among groups classified according to stimulation test results (100% vs. 31.3%). Conclusions: The hospital mortality was higher in ICU patients diagnosed with ACTH-cortisol dissociation. It is clinically feasible to evaluate the presence of ACTH-cortisol dissociation by analyzing rapid ACTH stimulation test results in critically ill patients.

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Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients
Wen Xu, Yuzhen Qiu, Hongping Qiu, Ming Zhong, Lei Li
International Journal of General Medicine.2024; Volume 17: 127. CrossRef
PROGNOSTIC VALUE OF LOW-DOSE ADRENOCORTICOTROPIC HORMONE TEST IN CRITICALLY ILL PATIENTS
Ahmad B. Abdelrehim, Fatma M. Mohsen, Mostafa A. Haredi, Zeinab Abdel Hameed, Walaa H. Ibrahim
Shock.2023; 59(6): 871. CrossRef
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Lilian Rodrigues Henrique, Daisy Crispim, Tarsila Vieceli, Ariell Freires Schaeffer, Priscila Bellaver, Cristiane Bauermann Leitão, Tatiana Helena Rech, Antonio Palazón-Bru
PLOS ONE.2021; 16(4): e0250035. CrossRef
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Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee
Acute and Critical Care.2020; 35(3): 149. CrossRef

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