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Original Article
- Epidemiology
- Trends and management of acute respiratory failure in hospitalized patients: a multicenter retrospective study in South Korea
- Won Jin Yang, Yong Jun Choi, Kyung Soo Chung, Ji Soo Choi, Bo Mi Jung, Jae Hwa Cho
- Acute Crit Care. 2025;40(2):171-185. Published online May 28, 2025
- DOI: https://doi.org/10.4266/acc.004728
- 7,757 View
- 212 Download
- 1 Crossref
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Abstract
PDF
Supplementary Material - Background
Acute respiratory failure (ARF) is the leading cause of hospitalization and is associated with in-hospital mortality. This study aimed to elucidate the epidemiology and clinical outcomes of ARF.
Methods
We retrospectively screened patients admitted to three hospitals in South Korea between January 2018 and December 2022. We included individuals aged 18 years, diagnosed with either type 1 ARF (arterial oxygen partial pressure [PaO2] <60 mm Hg) or type 2 ARF (arterial carbon dioxide partial pressure (PaCO2) >45 mm Hg) with a pH of <7.35, or diagnosed with the combined-type ARF.
Results
Among the 768,700 hospitalized patients, 33,278 (4.3%) developed ARF. The most common cause of ARF was sepsis (15,757 patients, 47.3%), and the most frequent comorbidity was malignancy (15,403 patients, 43.6%). Among ARF patients, 15,671 (47.1%) required intensive care unit transfer, while 8,980 (27.0%) experienced in-hospital mortality. Over 5 years, the proportion of ARF patients aged 80 years and older has shown a consistent annual increase (coefficient, 0.085 and Ptrend <0.001). Concurrently, the in-hospital mortality rate exhibited an upward trend, increasing from 25.5% in 2018 to 29.3% in 2022 (coefficient, 1.017 and Ptrend<0.001). Among the respiratory support methods used for patients with ARF over the 5-year period, high-flow nasal cannula usage steadily increased (coefficient, 4.137 and Ptrend<0.001), whereas the use of invasive mechanical ventilation declined (coefficient, –0.983 and Ptrend<0.001).
Conclusions
ARF frequency and in-hospital mortality rates are increasing, driven by various etiologies. Despite these trends, research on the epidemiology and individualized treatments for older patients is limited, highlighting the need for nationwide prospective multicenter studies. -
Citations
Citations to this article as recorded by
- Assessing respiratory muscle effort during noninvasive respiratory support in acute hypoxemic respiratory failure: A State-of-the Art Review from physiology to bedside
Brigitta Fazzini, Roberto Tonelli, Rik Gosselink, Alberto Lucchini, Alessandro Galazzi, Ema Swingwood, Dani Marti, Emanuele Rezoagli, Frederique Paulus, Marcus J. Schultz, Patricia R.M. Rocco, Denise Battaglini
Intensive and Critical Care Nursing.2026; 97: 104490. CrossRef
- Assessing respiratory muscle effort during noninvasive respiratory support in acute hypoxemic respiratory failure: A State-of-the Art Review from physiology to bedside
Guideline
- Meta-analysis
- Early management of adult sepsis and septic shock: Korean clinical practice guidelines
- Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, Ala Woo, Sua Kim, Dae-Hwan Bae, Sung Wook Kang, Sun Hyo Park, Gee Young Suh, Sunghoon Park
- Acute Crit Care. 2024;39(4):445-472. Published online November 18, 2024
- DOI: https://doi.org/10.4266/acc.2024.00920
- 44,989 View
- 1,837 Download
- 10 Web of Science
- 14 Crossref
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Abstract
PDFSupplementary Material
- Background
Despite recent advances and global improvements in sepsis recognition and supportive care, mortality rates remain high, and adherence to sepsis bundle components in Korea is low. To address this, the Korean Sepsis Alliance, affiliated with the Korean Society of Critical Care Medicine, developed the first sepsis treatment guidelines for Korea based on a comprehensive systematic review and meta-analysis.
Methods
A de novo method was used to develop the guidelines. Methodologies included determining key questions, conducting a literature search and selection, assessing the risk of bias, synthesizing evidence, and developing recommendations. The certainty of evidence and the strength of recommendations were determined using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Draft recommendations underwent internal and external review processes and public hearings. The development of these guidelines was supported by a research grant from the Korean Disease Control and Prevention Agency.
Results
In these guidelines, we focused on early treatments for adult patients with sepsis and septic shock. Through the guideline development process, 12 key questions and their respective recommendations were formulated. These include lactate measurement, fluid therapies, target blood pressure, antibiotic administration, use of vasopressors and dobutamine, extracorporeal membrane oxygenation, and echocardiography.
Conclusions
These guidelines aim to support medical professionals in making appropriate decisions about treating adult sepsis and septic shock. We hope these guidelines will increase awareness of sepsis and reduce its mortality rate. -
Citations
Citations to this article as recorded by- Artificial intelligence-driven cluster analysis for identifying clinical phenotypes in suspected sepsis patients in the emergency department
Daun Jeong, Jong Rul Park, Seung Jin Maeng, Jung Won Choi, Gun Tak Lee, Sung Yeon Hwang, Chulhong Kim, Jong Eun Park, Tae Gun Shin
BMC Emergency Medicine.2026;[Epub] CrossRef - Care Pathway and Outcomes in Pediatric Septic Shock: A Narrative Review from Emergency Department Recognition to PICU Management
Efrossini Briassouli, George Briassoulis
Children.2026; 13(5): 622. CrossRef - Early prognostication of septic shock in Korean adults aged 80 years and over: serum albumin combined with Sequential Organ Failure Assessment score
Sang-Min Kim, Seung Mok Ryoo, Woon Yong Kwon, Kyuseok Kim, Tae Ho Lim, Sung Pil Chung, Sung-Hyuk Choi, Won Young Kim
Acute and Critical Care.2026; 41(2): 304. CrossRef - Implementation of an AI-Based Clinical Decision Support System Predicting In-Hospital Cardiac Arrest in General Wards: A Multicenter Staggered-Implementation Study in Secondary Hospitals in Korea
Minjeong Kim, Dongjoon Yoo, Eunbi Noh, Yongwook Jeong, Minsoo Kim, Kyung-Jae Cho, Mincheol Kim, You Dong Sohn, Gyu Chong Cho
Diagnostics.2026; 16(11): 1682. CrossRef - Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion
Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, Sua Kim
Acute and Critical Care.2026; 41(2): 201. CrossRef - Evaluating Adherence to the 2021 Surviving Sepsis Campaign Guidelines for Sepsis and Septic Shock Management in Intensive Care Units: A Prospective Observational Study
Vinod Kumar Mugada, Greshma Ratna Priyanka Saragadam, Aishwarya Rajana, Ramanjaneyulu Arikitamula
Prague Medical Report.2026; 127(2): 81. CrossRef - Comparison between norepinephrine plus epinephrine and norepinephrine plus vasopressin after return of spontaneous circulation in patients with out-of-hospital cardiac arrest
Sejoong Ahn, Bo-Yeong Jin, Sukyo Lee, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sang Kuk Han, Phil Cho Choi, Young Hwan Lee, Sang O. Park, Jong Seok Lee, Ki Young Jeong, Sung Hyuk Choi, Young Hoon Yoon, Su Jin Kim, Kap Su Han, Min Seob Sim, Gun Tak Lee, Yo
Scientific Reports.2025;[Epub] CrossRef - Recommendations for the use of biomarkers for the management of adults with sepsis: a scoping review and critical appraisal
Miriam Mateos-Haro, Ana Garcia-Santa-Vinuela, Daniel Molano-Franco, Ivan Solà, Federico Gordo-Vidal, María Cruz Martín-Delgado, Jesus Lopez-Alcalde, Javier Zamora
BMJ Open.2025; 15(7): e090922. CrossRef - Regional Adherence to Early Sepsis Management Bundle and Associated Mortality in Hong Kong Between 2009–2018
Jack Zhenhe Zhang, Chun Hei Chan, Lok Ching Chang, Lok Ching Sandra Chiu, Pauline Yeung Ng, Manimala Dharmangadan, Eunise Ho, Steven Ling, Man Yee Man, Ka Man Fong, Ting Liong, Alwin Wai Tak Yeung, Ka Fai Au, Jacky Ka Hing Chan, Michele Tang, Katy Hoi Ki
Open Forum Infectious Diseases.2025;[Epub] CrossRef - Outcomes of septic shock from urinary and non-urinary sources in nonagenarians and centenarians admitted to intensive care units
Je Min Suh, Laurence Weinberg, Nattaya Raykateeraroj, Jerry Lim, Angelina Yoon, David Pilcher, Dong-Kyu Lee
Scientific Reports.2025;[Epub] CrossRef - Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea
Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh
Acute and Critical Care.2025; 40(4): 548. CrossRef - Early Versus Delayed Norepinephrine Initiation in Septic Shock: A Systematic Review and Meta-Analysis of Randomized and Observational Studies
Chibuzo C Manafa, Oluwayemisi E Ekor, Akintunde C Akinboboye, Okelue E Okobi, Gift Ojukwu, Osemwegie O Ugbo, Michael U Mochu, Emasenyie Isikwei, Sergio Hernandez Borges, Miguel Diaz-Miret
Cureus.2025;[Epub] CrossRef - Quality assessment of clinical practice guidelines for sepsis and variations in recommendations
Hong-Yan Li, Shan-Ling Jiang, Jing Wang, Hai-Shan Wang, Li-Hong Wang
BMC Infectious Diseases.2025;[Epub] CrossRef - Evidence-Based Interventions for Sepsis Management in Critically Ill Adults: A Systematic Review
Elsa Jardim Sousa, Michelle de Soresa Virissimo, Abel Mendonça Viveiros, Ana Alves, Valter Gonçalves
European Journal of Medical and Health Research.2025; 3(6): 232. CrossRef
- Artificial intelligence-driven cluster analysis for identifying clinical phenotypes in suspected sepsis patients in the emergency department
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