Acute and Critical Care

Original Articles

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.

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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

Pharmacology
Pharmacotherapeutic Problems and Pharmacist Interventions in a Medical Intensive Care Unit: Tae Yun Park, Sang-Min Lee, Sung Eun Kim, Ka-Eun Yoo, Go Wun Choi, Yun Hee Jo, Yoonsook Cho, Hyeon Joo Hahn, Jinwoo Lee, A Jeong Kim; Korean J Crit Care Med. 2015;30(2):82-88. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.82

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Abstract PDF

Background
Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. Methods: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. Results: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). Conclusions: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.

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Characterization of drug‐related problems and evaluation of pharmacist interventions in the cardiovascular intensive care settings in Thailand
Phannita Wattanaruengchai, Junporn Kongwatcharapong, Surakit Nathisuwan
JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY.2023; 6(5): 488. CrossRef
A Systematic Review of Outcomes Research in the Hospital Pharmacists’ Interventions in South Korea
So Young Lee, Eun Cho
Korean Journal of Clinical Pharmacy.2019; 29(3): 193. CrossRef

Determination of the Cause of Pleural Effusion in ICU Patients with Thoracentesis: Tae Yun Park, Jinwoo Lee, Young Sik Park, Chang Hoon Lee, Jae Joon Yim, Chul Gyu Yoo, Young Whan Kim, Sung Koo Han, Seok Chul Yang, Sang Min Lee; Korean J Crit Care Med. 2012;27(4):249-254.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.249

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Abstract PDF

BACKGROUND
Pleural effusion is a common and important problem in the intensive care unit (ICU). However, only few studies have focused on the etiology of pleural effusion in the ICU. The aim of this study is to elucidate the etiology of pleural effusion in ICU patients in a tertiary care hospital.
METHODS
Patients with pleural effusion in the medical ICU (MICU) and in the emergency ICU (EICU) were studied retrospectively from January 1, 2006 to December 31, 2009. The etiology and profile of pleural effusion were analyzed.
RESULTS
Of 1,592 patients admitted to the MICU and EICU during the study period, 78 patients (4.8%) underwent thoracentesis. The mean age was 66.8 +/- 13.3 years, and 52 (66.7%) were men. Parapneumonic effusion (32/78, 41%) was the leading cause of all effusions; malignancy- and heart failure-related effusions accounted for 15 (19.2%) and 14 (17.7%) cases, respectively. Fifteen patients (19.2%) had tube insertion after thoracentesis; in these patients, parapneumonic effusion or empyema was the most common reason for drainage (9/15, 60%). Pneumothorax developed after thoracentesis in 2 patients.
CONCLUSIONS
Diagnostic thoracentesis was performed in 4.8% of patients admitted to the ICU; one-fifth of these cases required therapeutic drainage. Parapneumonic effusion was the most common cause of pleural effusion in the ICU in this study.

Citations

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Prevalence, causes, and clinical implications of pleural effusion in pulmonary ICU and correlation with patient outcomes
Mohamed Farrag, Ahmed El Masry, Amr M. Shoukri, Mona ElSayed
Egyptian Journal of Bronchology.2018; 12(2): 247. CrossRef

Case Report

A Case of Respiratory Syncytial Virus Related Acute Respiratory Distress Syndrome: A Case Report: Jinwoo Lee, Tae Yun Park, Eun Sun Kim, Keun Bum Chung, Kyoung Hee Kim, Sang Min Lee, Jae Joon Yim, Seok Chul Yang, Young Whan Kim, Sung Koo Han, Seonyang Park, Chul Gyu Yoo; Korean J Crit Care Med. 2011;26(1):41-44.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.41

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Abstract PDF: Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in children. Although previously considered as children's virus, the increasing number of patients who receive immunosuppression after transplantation of bone marrow and solid organs highlighted the role of RSV as a pathogen for opportunistic infection. We report a case of community-acquired respiratory syncytial virus pneumonia in a patient with newly diagnosed leukemia, resulting in acute respiratory distress syndrome (ARDS).

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