Acute and Critical Care

Original Articles

Rapid response system
Impact of the National Early Warning Score-based sepsis response system on hospital-onset sepsis in a tertiary hospital in South Korea: Dong-gon Hyun, Sohyeon Lee, Sunhui Choi, Jeongsuk Son, So-Hee Park, Sang-Bum Hong, Chae-Man Lim; Acute Crit Care. 2025;40(2):186-196. Published online May 20, 2025; DOI: https://doi.org/10.4266/acc.000625

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Background
The effectiveness of electronic medical record-based alert systems, response protocols for sepsis diagnosis, and treatment in hospitalized patients remains unclear. This study aimed to determine whether the introduction of an electronic medical record-based sepsis response protocol (SRP) along with a 24/7 operating rapid response system affects the prognosis for patients with hospital-onset sepsis.
Methods
In August 2022, a SRP based on the National Early Warning Score was implemented in the electronic medical record system at Asan Medical Center. We retrospectively analyzed patients screened by the detection system for 1 year after the SRP implementation. Patients of the first 6 months (preliminary group) and those of the second 6 months (SRP group) were matched 1:1 based on propensity scores. The primary outcome was 30-day mortality.
Results
Of the 608 hospitalized patients screened by the system, 176 were assigned to each group after 1:1 propensity score matching. Patients in the SRP group were significantly more likely to receive blood cultures (58.5%) compared with the preliminary group (45.5%) (P=0.019). The SRP group showed a lower 30-day mortality risk (hazard ratio, 0.56; 95% CI, 0.36–0.86; P=0.017) compared to the preliminary group. A restricted cubic spline curve showed that SRP survival benefit began to manifest after the first 4 months (P=0.036).
Conclusions
Alongside an existing rapid response system, the National Early Warning Score-based SRP in the electronic medical record reduced mortality for hospital-onset sepsis within 1 year.

Citations

Citations to this article as recorded by

Sepsis precoz detectada mediante el National Early Warning Score (NEWS) por enfermería
Narcisa de Jesus Marcillo Peralta, Doris Grace Alvario Pillajo, Wilmer Mauricio Arguello Pazmiño , Cecilia Maribel Fiallos Miranda, Elsa Patricia Guerrero Romero
Arandu UTIC.2026; 13(1): 949. CrossRef
Collective agency in the implementation of computerized clinical decision support: an interpretive description study
Manasha Fernando, Sundresan Naicker, Bridget Abell, Steven M. McPhail, Zephanie Tyack
JBI Evidence Implementation.2026;[Epub] CrossRef
Characteristics and management of mechanically ventilated patients in South Korea compared with other high-income Asian countries and regions
Kyung Hun Nam, Kyeongman Jeon, Suk-Kyung Hong, Ah Young Leem, Jee Hwan Ahn, Hang Jea Jang, Ki Sup Byun, So Hee Park, Sojung Park, Yoon Mi Shin, Jisoo Park, Sung Wook Kang, Jin Hyoung Kim, Jinkyeong Park, Deokkyu Kim, Bo young Lee, Woo Hyun Cho, Kwangha Le
Acute and Critical Care.2025; 40(3): 413. 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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316 Download
7 Web of Science
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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

Management of hypercapnic acute respiratory failure with high-flow nasal cannula therapy: A narrative review
Christophe Girault, Elise Artaud-Macari, Pierre-Louis Declercq, Jean-Pierre Frat, Jean-Damien Ricard, Arnaud W. Thille, Gaëtan Béduneau
Annals of Intensive Care.2026; 16: 100053. CrossRef
A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease
Oguzhan Haciosman, Huseyin Ergenc, Adem Az, Yunus Dogan, Ozgur Sogut
The American Journal of Emergency Medicine.2025; 87: 38. CrossRef
Successful Asymmetric Nasal High-Flow Therapy in CO₂ Narcosis Triggered by Pneumonia in an Elderly Patient: A Case Report
Keita Takahashi, Shigeto Ishikawa, Akari Kusaka, Hiroyuki Takeuchi, Tomohiko Akahoshi
Cureus.2025;[Epub] CrossRef
Gas composition and pressure in the hypopharynx during high-flow oxygen therapy through a nasal cannula in healthy volunteers with different breathing patterns
Andrey I. Yaroshetskiy, Anna P. Krasnoshchekova, Fedor D. Tkachenko, Alina V. Rubashchenko, Daniil D. Zubarev, Vasiliy D. Konanykhin, Maxim I. Savelenok, Maxim M. Nosenko, Zamira M. Merzhoeva, Sergey N. Avdeev
BMC Anesthesiology.2025;[Epub] CrossRef
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

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