Acute and Critical Care

Original Article

Nursing
Comparison of the clinimetric properties of the two versions of the HACOR scale for predicting noninvasive ventilation failure in Brazilian patients: Matheus Pereira Nunes da Silva, Adriana Claudia Lunardi; Acute Crit Care. 2025;40(2):322-329. Published online May 28, 2025; DOI: https://doi.org/10.4266/acc.000175

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Abstract PDF: Background
Scales that detect noninvasive ventilation (NIV) failure need to have adequate clinimetric properties to be reliable. This study aimed to compare the clinimetric properties of the Heart rate, Acidosis, Consciousness, Oxygenation, Respiratory rate (HACOR) and updated HACOR scales when applied to hypoxemic adult patients undergoing NIV. Methods: This prospective study applied the HACOR and updated HACOR scales to hypoxemic patients after one hour of NIV in an emergency department setting. A second application of the scales was performed after ten minutes to assess reliability (intraclass correlation coefficient), measurement error (standard error of measurement and minimum detectable difference), ceiling and floor effects, convergent validity by correlation (Pearson’s r) with peripheral oximetry saturation (SpO2), and predictive validity (area under the receiver operating characteristic [ROC] curve) for the outcome of needing invasive mechanical ventilation. Results: Sixty patients were included in this study (59.45±17.48 years; Simplified Acute Physiology Score III, 56.1±13.95; 30% with respiratory disease and 25% with cardiovascular disease). After 1 hour of NIV, patients had a HACOR score of 3 (interquartile range [IQR], 1.0–5.0) and an updated HACOR score of 5 (IQR, 3.0–8.87). Clinimetric properties were adequate for both versions of the HACOR scale but were superior for the updated version, including predictive validity (ROC [95% CI], 0.78 [0.64–0.91] vs. 0.73 [0.57–0.89]) and the absence of the ceiling effect. Conclusions: Both versions of the HACOR scale demonstrated adequate clinimetric properties for predicting NIV failure, with the updated HACOR version showing superior predictive validity and no ceiling effect compared with the original version.

Review Article

Nephrology
Dialysis decision in critically ill patients in intensive care unit: Harin Rhee; Acute Crit Care. 2025;40(1):1-9. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.004896

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Abstract PDF: The 2012 Kidney Disease Improving Global Outcomes guidelines clearly define emergent indications for kidney replacement therapy; however, whether dialysis should be initiated in critically ill patients without these indications remains unclear. This review briefly summarizes the results of recent landmark trials and discusses their limitations originating from a criteria-based approach at a single time point. Moreover, a personalized approach based on each patient’s demand-capacity balance and its future benefits as a platform for kidney support therapy in critically ill patients are discussed.

Original Articles

Pediatrics
Effects of rescue airway pressure release ventilation on mortality in severe pediatric acute respiratory distress syndrome: a retrospective comparative analysis from India: Sudha Chandelia, Sunil Kishore, Maansi Gangwal, Devika Shanmugasundaram; Acute Crit Care. 2025;40(1):113-121. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.002520

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Abstract PDF: Background
Pediatric acute respiratory distress syndrome (PARDS) has a mortality rate of up to 75%, which can be up to 90% in high-risk patients. Even with the use of advanced ventilation strategies, mortality remains unacceptably high at 40%. Airway pressure release ventilation (APRV) mode is a new strategy in PARDS. Our aim was to evaluate whether use of APRV mode in severe PARDS was associated with reduced hospital mortality compared to other modes of ventilation.
Methods
This was a retrospective comparative study using data from case files in a pediatric intensive care unit of a university-affiliated tertiary-care hospital. The study period (January 2014 to December 2019) covered three years before routine use of APRV mode to three years after its implementation. We compared severe PARDS patients in two groups: The APRV group (who received APRV as rescue therapy after failing protective ventilation); and The Non-APRV group, who received other modes of ventilation.
Results
A total of 24 patients in each group were analyzed. Overall in-hospital mortality in the APRV group was 79% versus 91% in the Non-APRV group. In-hospital mortality was significantly lower in the APRV group (univariate analysis: hazard ratio [HR], 0.27; 95% CI, 0.14–0.52; P=0.001 and multivariate analysis: HR, 0.03; 95% CI, 0.005–0.17; P=0.001). Survival times were significantly longer in the APRV group (median time to death: 7.5 days in APRV vs. 4.3 days in non-APRV; P=0.001).
Conclusions
Use of rescue APRV mode in severe PARDS may yield lower mortality rates and longer survival times.

Neurosurgery
A low preoperative platelet-to-white blood cell ratio is associated with acute kidney injury following cerebral aneurysm treatment in South Korea: Seung-Woon Lim, Woo-Young Jo, Hee-Pyoung Park; Acute Crit Care. 2025;40(1):59-68. Published online February 21, 2025; DOI: https://doi.org/10.4266/acc.003120

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Abstract PDF Supplementary Material: Background
Inflammation is involved in the pathophysiology of postoperative acute kidney injury (AKI). We investigated whether preoperative platelet-to-white blood cell ratio (PWR), a novel serum biomarker of systemic inflammation, was associated with postoperative AKI following cerebral aneurysm treatment. We also compared the discrimination power of preoperative PWR with those of other preoperative systemic inflammatory indices in predicting postoperative AKI.
Methods
Perioperative data including preoperative systemic inflammatory indices and cerebral aneurysm-related variables were retrospectively analyzed in 4,429 cerebral aneurysm patients undergoing surgical clipping or endovascular coiling. Based on the cutoff value of preoperative PWR, patients were divided into the high PWR (≥39.04, n=1,924) and low PWR (<39.04, n=2,505) groups. After propensity score matching (PSM), 1,168 patients in each group were included in the data analysis. AKI was defined according to the Kidney Disease Improving Global Outcomes guidelines.
Results
Postoperative AKI occurred more frequently in the low PWR group than in the high PWR group before PSM (45 [1.8%] vs. 7 [0.4%], P<0.001) and after (17 [1.5%] vs. 5 [0.4%], P=0.016). A low preoperative PWR was predictive of postoperative AKI before PSM (odds ratio [95% CI], 3.93 [1.74–8.87]; P<0.001) and after (3.44 [1.26–9.34], P=0.016). Preoperative PWR showed the highest area under the curve for postoperative AKI (0.713 [0.644–0.782], P<0.001), followed by preoperative platelet-to-neutrophil ratio (0.694 [0.619–0.769], P<0.001), neutrophil percentage-to-albumin ratio (0.671 [0.592–0.750], P<0.001), white blood cell-to-hemoglobin ratio (0.665 [0.579–0.750], P<0.001), neutrophil-to-lymphocyte ratio (0.648 [0.569–0.728], P<0.001), and systemic inflammatory index (0.615 [0.532–0.698], P=0.004).
Conclusions
A low preoperative PWR was associated with postoperative AKI following cerebral aneurysm treatment.

Nursing
Nurses’ knowledge, attitude, and perceived barriers toward protective lung strategies of pediatrics mechanically ventilated patients in a tertiary care hospital in Pakistan: Tasnim Zainib, Salma Rattani, Nimira Asif, Hussain Maqbool Ahmed Maqbool; Acute Crit Care. 2025;40(1):128-135. Published online February 19, 2025; DOI: https://doi.org/10.4266/acc.004761

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Abstract PDF Supplementary Material: Background
Protective lung strategies (PLS) are guidelines about recent clinical advances that deliver an air volume compatible with the patient’s lung capacity and are used to treat acute respiratory distress syndrome. These mechanical ventilation guidelines are not implemented within intensive care units (ICUs) despite strong evidence-based recommendations and a dedicated professional staff. Nurses’ familiarity with clinical guidelines can bridge the gap between actual and recommended practice. However, several barriers undermine this process. The objectives of this study were to identify those barriers and explore the knowledge, attitudes, and behavior of ICU nurses regarding the implementation of PLS.
Methods
This was a descriptive, cross-sectional study. The participants were nurses working in the six ICUs of a pediatric tertiary care hospital in Lahore, Pakistan. Using purposive sampling with random selection, the total sample size was 137 nurses. A summative rating scale was used to identify barriers to the implementation of PLS.
Results
Overall, the nurses’ barrier score was high, with a mean of 66.77±5.36. Across all the barriers subscales, attitude was a much more significant barrier (35.74±3.57) to PLS than behavior (6.53±1.96), perceived knowledge (17.42±2.54), and organizational barriers (7.08±1.39). Knowledge-related barriers were also significantly high.
Conclusion
This study identified important barriers to PLS implementation by nurses, including attitudes and knowledge deficits. Understanding those barriers and planning interventions to address them could help to increase adherence to low tidal volume ventilation and improve patient outcomes. Nurses’ involvement in mechanical ventilation management could help to safely deliver air volumes compatible with recommendations.

Surgery
Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea: Jae Hoon Lee, Jee Hee Kim, Ki Ho You, Won Ho Han; Acute Crit Care. 2024;39(4):554-564. Published online November 25, 2024; DOI: https://doi.org/10.4266/acc.2024.00808

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Abstract PDF Supplementary Material

Background
In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs.
Methods
This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality.
Results
Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU.
Conclusions
Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.

Citations

Citations to this article as recorded by

The efficacy of intensivist-led closed-system intensive care units in improving outcomes for cancer patients requiring emergent surgical intervention
Eun Young Kim
Acute and Critical Care.2024; 39(4): 640. CrossRef

Nephrology
A clinical risk score for predicting acute kidney injury in sepsis patients receiving normal saline in Northern Thailand: a retrospective cohort study: Phaweesa Chawalitpongpun, Sukrit Kanchanasurakit, Nattha Sanhatham, Warinda Sasom, Siriwan Thanommim, Araya Senpradit, Wuttikorn Siriplabpla; Acute Crit Care. 2024;39(3):369-378. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00514

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Abstract PDF Supplementary Material: Background
Normal saline is commonly used for resuscitation in sepsis patients but has a high chloride content, potentially increasing the risk of acute kidney injury (AKI). This study evaluated risk factors and developed a predictive risk score for AKI in sepsis patients treated with normal saline.
Methods
This retrospective cohort study utilized the medical and electronic health records of sepsis patients who received normal saline between January 2018 and May 2020. Predictors of AKI used to construct the predictive risk score were identified through multivariate logistic regression models, with discrimination and calibration assessed using the area under the receiver operating characteristic curve (AUROC) and the expected-to-observed (E/O) ratio. Internal validation was conducted using bootstrapping techniques.
Results
AKI was reported in 211 of 735 patients (28.7%). Eight potential risk factors, including norepinephrine, the Acute Physiology and Chronic Health Evaluation II score, serum chloride, respiratory failure with invasive mechanical ventilation, nephrotoxic antimicrobial drug use, history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers use, history of liver disease, and serum creatinine were used to create the NACl RENAL-Cr score. The model demonstrated good discrimination and calibration (AUROC, 0.79; E/O, 1). The optimal cutoff was 2.5 points, with corresponding sensitivity, specificity, positive predictive value, and negative predictive value scores of 71.6%, 72.5%, 51.2%, and 86.4%, respectively.
Conclusions
The NACl RENAL-Cr score, consisting of eight critical variables, was used to predict AKI in sepsis patients who received normal saline. This tool can assist healthcare professionals when deciding on sepsis treatment and AKI monitoring.

Nephrology
Incidence of hypothermia in critically ill patients receiving continuous renal replacement therapy in Siriraj Hospital, Thailand: Thonnarat Pornsirirat, Nualnapa Kasemvilawan, Patcharavalia Pattanacharoenwong, Saisunee Arpibanwana, Hatairat Kondon, Thummaporn Naorungroj; Acute Crit Care. 2024;39(3):379-389. Published online August 12, 2024; DOI: https://doi.org/10.4266/acc.2024.00038

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Abstract PDF Supplementary Material: Background
Hypothermia is a relatively common complication in patients receiving continuous renal replacement therapy (CRRT). However, few studies have reported the factors associated with hypothermia.
Methods
A retrospective cohort study was performed in five intensive care units (ICUs) to evaluate the incidence of hypothermia and the predictive factors for developing hypothermia during CRRT, with hypothermia defined as a time-weighted average temperature <36 °C.
Results
From January 2020 to December 2021, 300 patients were enrolled. Hypothermia developed in 23.7% of them within the first 24 hours after CRRT initiation. Compared to non-hypothermic patients, hypothermic patients were older and had lower body weight, more frequent acidemia, and higher ICU and 30-day mortality rates. In the multivariate analysis, age >70 years (odds ratio [OR], 2.59; 95% CI, 1.38–4.98; P=0.004), higher positive fluid balance on the day before CRRT (OR, 1.11; 95% CI, 1.02–1.22; P=0.02), and CRRT dose (OR, 1.003; 95% CI, 1.00–1.01; P=0.04) were significantly associated with hypothermia. Conversely, a higher body weight was independently associated with mitigated risk of hypothermia (OR, 0.89; 95% CI, 0.81–0.97; P=0.01). Moreover, a higher coefficient of variance of temperature was associated with greater ICU mortality (OR, 1.41; 95% CI, 1.13–1.78; P=0.003).
Conclusions
Hypothermia during CRRT is a relatively common occurrence, and factors associated with hypothermia onset in the first 24 hours include older age, lower body weight, higher positive fluid balance on the day before CRRT, and higher CRRT dose. Greater temperature variability was associated with increased ICU mortality.

Epidemiology
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt: Aya Osama Mohammed, Hanaa I. Rady; Acute Crit Care. 2024;39(1):70-77. Published online February 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00654

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Abstract PDF: Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022.
Methods
This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories.
Results
In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE).
Conclusions
The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

Review Article

CPR/Resuscitation
Plasma biomarkers for brain injury in extracorporeal membrane oxygenation: Shrey Kapoor, Anna Kolchinski, Aaron M. Gusdon, Lavienraj Premraj, Sung-Min Cho; Acute Crit Care. 2023;38(4):389-398. Published online November 29, 2023; DOI: https://doi.org/10.4266/acc.2023.01368

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Abstract PDF: Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with refractory cardiorespiratory failure. Despite its benefits, ECMO carries a significant risk of neurological complications, including acute brain injury (ABI). Although standardized neuromonitoring and neurological care have been shown to improve early detection of ABI, the inability to perform neuroimaging in a timely manner is a major limitation in the accurate diagnosis of neurological complications. Therefore, blood-based biomarkers capable of detecting ongoing brain injury at the bedside are of great clinical significance. This review aims to provide a concise review of the current literature on plasma biomarkers for ABI in patients on ECMO support.

Original Articles

Pulmonary
Outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation and continuous renal replacement therapy in the United States: Carlos R Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob, Atul Bhatnagar, Asif Saberi; Acute Crit Care. 2023;38(3):308-314. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00115

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Abstract PDF

Background
Coronavirus disease 2019 (COVID-19) infection is associated with significant morbidity and mortality. Some patients develop severe acute respiratory distress syndrome and kidney failure requiring the combination of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).
Methods
Retrospective cohort study of 127 consecutive patients requiring combined ECMO and CRRT support in intensive care units at an ECMO center in Marietta, GA, United States.
Results
Sixty and 67 patients with and without COVID-19, respectively, required ECMO-CRRT support. After adjusting for confounding variables, patients with COVID-19 had increased mortality at 30 days (hazard ratio [HR], 5.19; 95% confidence interval [CI], 2.51–10.7; P<0.001) and 90 days (HR, 6.23; 95% CI, 2.60–14.9; P<0.001).
Conclusions
In this retrospective study, patients with COVID-19 who required ECMO-CRRT had increased mortality when compared to patients without COVID-19.

Citations

Citations to this article as recorded by

Factors associated with post-hospitalization dialysis dependence in ECMO patients who required continuous renal replacement therapy
Carlos Rodrigo Franco Palacios, Rudiona Hoxhaj, Catlyn Thigpen, Jeffrey Jacob
Renal Failure.2024;[Epub] CrossRef

Cardiology
Evaluation of neopterin levels and kynurenine pathway in patients with acute coronary syndrome: Ibrahim Kember, Sonia Sanajou, Bilge Kilicarslan, Gözde Girgin, Terken Baydar; Acute Crit Care. 2023;38(3):325-332. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00024

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Abstract PDF

Background
Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis.
Methods
High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls.
Results
The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction.
Conclusions
The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.

Citations

Citations to this article as recorded by

Assessment of Inflammatory and Oxidative Stress Biomarkers for Predicting of Patients with Asymptomatic Carotid Artery Stenosis
Abdullah Burak Karaduman, Sinem Ilgın, Özlem Aykaç, Mehmetcan Yeşilkaya, Serkan Levent, Atilla Özcan Özdemir, Gozde Girgin
Journal of Clinical Medicine.2025; 14(3): 755. CrossRef
Kynurenines as a Novel Target for the Treatment of Inflammatory Disorders
Adrian Mor, Anna Tankiewicz-Kwedlo, Marianna Ciwun, Janina Lewkowicz, Dariusz Pawlak
Cells.2024; 13(15): 1259. CrossRef
Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease
Armand N. Yazdani, Michaela Pletsch, Abraham Chorbajian, David Zitser, Vikrant Rai, Devendra K. Agrawal
Expert Review of Cardiovascular Therapy.2023; 21(10): 675. CrossRef
Evaluation of Neopterin as a Neuroinflammatory Marker for Peripheral Neuropathy in Type 2 Diabetic Patients
Israa Abdelmalik Salem, Sura Ahmed Abdulsattar, Haider Fadhil Alrubaye
Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ).2023; 5(1S): S183. CrossRef

Nephrology
Radiomic analysis of abdominal organs during sepsis of digestive origin in a French intensive care unit: Louis Boutin, Louis Morisson, Florence Riché, Romain Barthélémy, Alexandre Mebazaa, Philippe Soyer, Benoit Gallix, Anthony Dohan, Benjamin G Chousterman; Acute Crit Care. 2023;38(3):343-352. Published online August 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00136

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Abstract PDF Supplementary Material: Background
Sepsis is a severe and common cause of admission to the intensive care unit (ICU). Radiomic analysis (RA) may predict organ failure and patient outcomes. The objective of this study was to assess a model of RA and to evaluate its performance in predicting in-ICU mortality and acute kidney injury (AKI) during abdominal sepsis.
Methods
This single-center, retrospective study included patients admitted to the ICU for abdominal sepsis. To predict in-ICU mortality or AKI, elastic net regularized logistic regression and the random forest algorithm were used in a five-fold cross-validation set repeated 10 times.
Results
Fifty-five patients were included. In-ICU mortality was 25.5%, and 76.4% of patients developed AKI. To predict in-ICU mortality, elastic net and random forest models, respectively, achieved areas under the curve (AUCs) of 0.48 (95% confidence interval [CI], 0.43–0.54) and 0.51 (95% CI, 0.46–0.57) and were not improved combined with Simplified Acute Physiology Score (SAPS) II. To predict AKI with RA, the AUC was 0.71 (95% CI, 0.66–0.77) for elastic net and 0.69 (95% CI, 0.64–0.74) for random forest, and these were improved combined with SAPS II, respectively; AUC of 0.94 (95% CI, 0.91–0.96) and 0.75 (95% CI, 0.70–0.80) for elastic net and random forest, respectively.
Conclusions
This study suggests that RA has poor predictive performance for in-ICU mortality but good predictive performance for AKI in patients with abdominal sepsis. A secondary validation cohort is needed to confirm these results and the assessed model.

Cardiology
A comparative study of stored arterial versus venous blood collected using the acute normovolemic hemodilution method in coronary artery bypass grafting patients in Iran: Mojtaba Mansouri, Alireza Yazdani, Gholamreza Masoumi, Mohsen Mirmohammadsadeghi, Amir Mirmohammadsadeghi; Acute Crit Care. 2023;38(3):353-361. Published online June 15, 2023; DOI: https://doi.org/10.4266/acc.2022.01382

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Abstract PDF: Background
In the present study, arterial and venous blood was collected from patients who were candidates for elective coronary artery bypass grafting (CABG); the blood was stored for 28 days and cellular, biomechanical, and hematological changes in blood were compared to determine whether stored arterial blood is superior to stored venous blood.
Methods
The present follow-up comparative study included 60 patients >18 years of age, with hemoglobin >14 mg/dl and ejection fraction >40% who were candidates for CABG. After induction of anesthesia, 250 ml of arterial or venous blood was drawn from patients (arterial blood group and venous blood group). Laboratory blood samples were taken at specified times from the collected blood and re-injected into the patients after CABG.
Results
Significant differences were observed in pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), bicarbonate (HCO3), and glucose values at several time points between the groups. Other parameters such as urea and creatinine did not show any significant differences between the groups.
Conclusions
Twenty-eight days of storage can have a negative effect on some of the cellular, biochemical, and hematological components of arterial and venous blood; however, the quality of stored arterial blood and venous blood does not differ significantly.

Nephrology
Epidemiology and outcome of an acute kidney injuries in the polytrauma victims admitted at the apex trauma center in Dubai: Bhushan Sudhakar Wankhade, Zeyad Faoor Alrais, Ghaya Zeyad Alrais, Ammar Mohamed Abdel Hadi, Gopala Arun Kumar Naidu, Mohammed Shahid Abbas, Ahmed Tarek Youssef Aboul Kheir, Hasan Hadad, Sundareswaran Sharma, Mohammad Sait; Acute Crit Care. 2023;38(2):217-225. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2023.00388

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Abstract PDF

Background
Polytrauma from road accidents is a common cause of hospital admissions and deaths, frequently leading to acute kidney injury (AKI) and impacting patient outcomes.
Methods
This retrospective, single-center study included polytrauma victims with an Injury Severity Score (ISS) >25 at a tertiary healthcare center in Dubai.
Results
The incidence of AKI in polytrauma victims is 30.5%, associated with higher Carlson comorbidity index (P=0.021) and ISS (P=0.001). Logistic regression shows a significant relationship between ISS and AKI (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.150–1.233; P<0.05). The main causes of trauma-induced AKI are hemorrhagic shock (P=0.001), need for massive transfusion (P<0.001), rhabdomyolysis (P=0.001), and abdominal compartment syndrome (ACS; P<0.001). On multivariate logistic regression AKI can be predicated by higher ISS (OR, 1.08; 95% CI, 1.00–1.17; P=0.05) and low mixed venous oxygen saturation (OR, 1.13; 95% CI, 1.05–1.22; P<0.001). The development of AKI after polytrauma increases length of stay (LOS)-hospital (P=0.006), LOS-intensive care unit (ICU; P=0.003), need for mechanical ventilation (MV) (P<0.001), ventilator days (P=0.001), and mortality (P<0.001).
Conclusions
After polytrauma, the occurrence of AKI leads to prolonged hospital and ICU stays, increased need for mechanical ventilation, more ventilator days, and a higher mortality rate. AKI could significantly impact their prognosis.

Citations

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Normotensive trauma patients with renal injuries: Hidden candidates for massive transfusion
Xin‐Hong Lin, Pi‐Chieh Lin, Ching‐Hua Tsai, Wei‐Ti Su, Shiun‐Yuan Hsu, Ching‐Hua Hsieh
Hong Kong Journal of Emergency Medicine.2025;[Epub] CrossRef

Pulmonary
Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France: Pierre Basse, Louis Morisson, Romain Barthélémy, Nathan Julian, Manuel Kindermans, Magalie Collet, Benjamin Huot, Etienne Gayat, Alexandre Mebazaa, Benjamin G. Chousterman; Acute Crit Care. 2023;38(2):172-181. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01494

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Abstract PDF Supplementary Material

Background
The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19).
Methods
This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count.
Results
Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9–12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12–4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11–18]) and the no-WRF group (9 G/L [8–11]) (P=0.002).
Conclusions
In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

Citations

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Early Driving Pressure Is Associated with Major Adverse Kidney Events at 30 Days in ARDS Patients with SARS-CoV-2
Gustavo Casas-Aparicio, Adrián E. Caballero-Islas, Antonio León-Ortiz, David Escamilla-Illescas, Yovanna Rueda-Escobedo, Carlos Ascención-López, Diana Hernández-Quino, Aimee Flores-Vargas, Jesús Sosa-Chombo, Abraham Tolentino-de La Mora, Ana Saucedo-Prune
Journal of Clinical Medicine.2025; 14(8): 2783. CrossRef
Bidirectional pressure: a mini review of ventilator-lung-kidney interactions
Avnee Kumar, Katie Epler, Sean DeWolf, Laura Barnes, Mark Hepokoski
Frontiers in Physiology.2024;[Epub] CrossRef
Renal venous flow in different regions of the kidney are different and reflecting different etiologies of venous reflux disorders in septic acute kidney injury: a prospective cohort study
Rongping Chen, Hui Lian, Hua Zhao, Xiaoting Wang
Intensive Care Medicine Experimental.2024;[Epub] CrossRef

Trauma
Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma: Kangho Lee, Dongyeon Ryu, Hohyun Kim, Sungjin Park, Sangbong Lee, Chanik Park, Gilhwan Kim, Sunhyun Kim, Nahyeon Lee; Acute Crit Care. 2023;38(1):95-103. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01046

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Abstract PDF: Background
In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE).
Methods
We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs.
Results
The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage.
Conclusions
In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.

Pulmonary
Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure: Türkay Akbaş, Harun Güneş; Acute Crit Care. 2023;38(1):49-56. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01011

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Background
The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure.
Methods
This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020.
Results
One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients’ mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0±7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/ FiO2 ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017–1.317; P=0.026), admission PaO2/FiO2 ratio (OR, 0.989; 95% CI, 0.978–0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650–47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021–1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056–0.514; P=0.002) emerged as predictors of 90-day mortality.
Conclusions
APACHE II scores, the PaO2/FiO2 ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.

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Breaking new ground: machine learning enhances survival forecasts in hypercapnic respiratory failure
Zhongxiang Liu, Bingqing Zuo, Jianyang Lin, Zhixiao Sun, Hang Hu, Yuan Yin, Shuanying Yang
Frontiers in Medicine.2025;[Epub] CrossRef
Efficacy and safety of medroxyprogesterone acetate on noninvasive ventilation -treated exacerbated COPD patients: a double-blind randomized clinical trial
Mohsen Gholinataj Jelodar, Mohammadreza Malek-Ahmadi, Adeleh Sahebnasagh, Farhad Mohammadi, Fatemeh Saghafi
BMC Pulmonary Medicine.2025;[Epub] CrossRef
From acute phase to rehabilitation: bridging the gap and improving the pathway for Chronic Obstructive Pulmonary Diseases patients (Summary of a Pulmonologists’ Audit - September-December 2024)
Michele Vitacca, Massimiliano Beccaria, Luca Bianchi, Paolo Ceruti, Maurizio Marvisi, Monia Betti, Michela Bezzi, Francesco Tursi
Multidisciplinary Respiratory Medicine.2025;[Epub] CrossRef
Construction and validation of a nomogram prediction model for death risk in patients with chronic obstructive pulmonary disease complicated by hypercapnic respiratory failure in the intensive care unit
Ye Zhang, Hao Chen, Shiyu Hu, Chengshui Chen, Wenyu Chen
Respiratory Medicine.2025; 245: 108188. CrossRef
Antibiotics in COPD exacerbations requiring mechanical ventilation: a dogma to be re-evaluated
Sebastian Osorio-Rico, Daniel Perez-Marin, John Cardeño-Sanchez
Internal and Emergency Medicine.2024; 19(5): 1505. CrossRef
Opportunities and perspectives of small molecular phosphodiesterase inhibitors in neurodegenerative diseases
Qi Li, Qinghong Liao, Shulei Qi, He Huang, Siyu He, Weiping Lyu, Jinxin Liang, Huan Qin, Zimeng Cheng, Fan Yu, Xue Dong, Ziming Wang, Lingfei Han, Yantao Han
European Journal of Medicinal Chemistry.2024; 271: 116386. CrossRef
Development and Validation of an In-Hospital Mortality Prediction Model for Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Wenjie Sun, Yeshan Li, Shuxin Tan
International Journal of Chronic Obstructive Pulmonary Disease.2024; Volume 19: 1303. CrossRef
Value of diaphragmatic ultrasound parameters in assessing weaning outcomes and survival in ventilator-dependent intensive care unit patients
Liuhua Pan
American Journal of Translational Research.2024; 16(12): 7830. CrossRef
COPD Exacerbation: Why It Is Important to Avoid ICU Admission
Irene Prediletto, Gilda Giancotti, Stefano Nava
Journal of Clinical Medicine.2023; 12(10): 3369. CrossRef

Pulmonary
Extravascular lung water index, pulmonary vascular permeability index, and global end-diastolic volume index in mechanically ventilated COVID-19 patients requiring prone position ventilation: a preliminary retrospective study: Rosanna Carmela De Rosa, Antonio Romanelli, Michele Gallifuoco, Giovanni Messina, Marianne Di Costanzo, Antonio Corcione; Acute Crit Care. 2022;37(4):571-579. Published online November 10, 2022; DOI: https://doi.org/10.4266/acc.2022.00423

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Abstract PDF

Background
There is a lack of data on extravascular lung water index (EVLWi), pulmonary vascular permeability index (PVPi), and global end-diastolic volume index (GEDVi) during prone position ventilation (PPV) in coronavirus disease 2019 (COVID-19) patients. The objectives of this study were to analyze trends in EVLWi, PVPi, and GEDVi during PPV and the relationships between these parameters and PaO2/FiO2.
Methods
In this preliminary retrospective observational study, we performed transpulmonary thermodilution (TPTD) in seven mechanically ventilated COVID-19 patients without cardiac and pulmonary comorbidities requiring PPV for 18 hours, at specific times (30 minutes pre-PPV, 18 hours after PPV, and 3 hours after supination). EVLWi, PVPi and GEDVi were measured. The relationships between PaO2/FiO2 and EVLWi, and PVPi and GEDVi values, in the supine position were analyzed by linear regression. Correlation and determination coefficients were calculated.
Results
EVLWi was significantly different between three time points (analysis of variance, P=0.004). After 18 hours in PPV, EVLWi was lower compared with values before PPV (12.7±0.9 ml/kg vs. 15.3±1.5 ml/kg, P=0.002). Linear regression showed that only EVLWi was correlated with PaO2/FiO2 (β =–5.757; 95% confidence interval, –10.835 to –0.679; r=–0.58; R2 =0.34; F-test P=0.029).
Conclusions
EVLWi was significantly reduced after 18 hours in PPV and values measured in supine positions were correlated with PaO2/FiO2. This relationship can help clinicians discriminate whether deterioration in gas exchange is related to fluid overload or disease progression. Further clinical research should evaluate the role of TPTD parameters as markers to stratify disease severity and guide clinical management.

Citations

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Determining Extracellular Water Effects in Mild and Severe COVID-19 Pneumonia Clinical Course by using the Bioimpedance Method
Zuhal Cavus, Ayse Vahaboglu, Ulku Aygen Turkmen, Habibe Vural, Dondu Genc Moralar
Medical Bulletin of Haseki.2023; 61(2): 81. CrossRef

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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Abstract PDF

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

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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
A pilot feasibility study of continuous cardiac output and blood pressure monitoring during intermittent hemodialysis in patients recovering from severe acute kidney injury
Sofia Spano, Akinori Maeda, Joey Lam, Anis Chaba, Atthaphong Phongphithakchai, Yukiko Hikasa, Nuttapol Pattamin, Nuanprae Kitisin, Emily See, Peter Mount, Rinaldo Bellomo
Journal of Critical Care.2025; 88: 155086. 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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Abstract PDF Supplementary Material

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.

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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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Abstract PDF Supplementary Material

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

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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

Pulmonary
The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience: Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry; Acute Crit Care. 2022;37(3):347-354. Published online July 25, 2022; DOI: https://doi.org/10.4266/acc.2022.00108

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Abstract PDF Supplementary Material

Background
Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied.
Methods
In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment.
Results
The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes.
Conclusions
During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.

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Point-of-Care Ultrasound, an Integral Role in the Future of Enhanced Recovery After Surgery?
Peter Van de Putte, An Wallyn, Rosemary Hogg, Lars Knudsen, Kariem El-Boghdadly
Anesthesia & Analgesia.2025; 140(5): 1114. CrossRef
A Muscle-Driven Spine Model for Predictive Simulations in the Design of Spinal Implants and Lumbar Orthoses
Robin Remus, Andreas Lipphaus, Marisa Ritter, Marc Neumann, Beate Bender
Bioengineering.2025; 12(3): 263. CrossRef
Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care
Marta Rafael Marques, José Manuel Pereira, José Artur Paiva, Gonzalo García de Casasola‐Sánchez, Yale Tung‐Chen
Journal of Ultrasound in Medicine.2024; 43(2): 223. CrossRef
Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis
Diego Poddighe, Marine Van Hollebeke, Yasir Qaiser Choudhary, Débora Ribeiro Campos, Michele R. Schaeffer, Jan Y. Verbakel, Greet Hermans, Rik Gosselink, Daniel Langer
Critical Care.2024;[Epub] CrossRef
Ultrasonographic evaluation of diaphragm thickness and excursion: correlation with weaning success in trauma patients: prospective cohort study
Golnar Sabetian, Mandana Mackie, Naeimehossadat Asmarian, Mahsa Banifatemi, Gregory A. Schmidt, Mansoor Masjedi, Shahram Paydar, Farid Zand
Journal of Anesthesia.2024; 38(3): 354. CrossRef
Diaphragm muscle parameters as a predictive tool for weaning critically ill patients from mechanical ventilation: a systematic review and meta-analysis study
Yashar Iran Pour, Afrooz Zandifar
European Journal of Translational Myology.2024;[Epub] CrossRef
Diaphragm dysfunction as a prognostic criterion of external respiratory impairment and necessary extracorporeal membrane oxygenation in patients with chronic heart failure
V.S. Shabaev, V.A. Mazurok, L.Z. Biktasheva, L.G. Vasilyeva, K.Yu. Kozhieva, I.A. Danilova, N.A. Osipova
Russian Journal of Anesthesiology and Reanimatology.2024; (6): 38. CrossRef
Diaphragmatic ultrasound: A new frontier in weaning from mechanical ventilation
Manoj Kamal, Saikat Sengupta
Indian Journal of Anaesthesia.2023; 67(Suppl 4): S205. CrossRef

Nephrology
Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis: Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda, Shoki Yamauchi, Hideta Takushi, Tadashi Iraha, Koji Idomari; Acute Crit Care. 2022;37(3):398-406. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00192

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Abstract PDF

Background
Severe acute pancreatitis (SAP) is a systemic inflammatory disease, and it can often complicate into acute kidney injury (AKI) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). This study aimed to evaluate the clinical effectiveness of blood purification using a polymethylmethacrylate (PMMA) hemofilter.
Methods
We retrospectively examined 54 patients, who were diagnosed with SAP according to the Japanese criteria from January 2011 to December 2019.
Results
Of a total of 54 SAP patients, 26 patients progressively developed AKI and required continuous hemodialysis with a PMMA membrane hemofilter (PMMA-CHD). Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score were significantly higher in patients requiring PMMA-CHD than in patients not requiring hemodialysis. The lung injury scores were also significantly higher in patients requiring PMMA-CHD. Of the 26 patients, 16 patients developed ALI/ARDS and required mechanical ventilation. A total of seven patients developed severe ALI/ARDS and received additional intermittent hemodiafiltration using a PMMA hemofilter (PMMA-HDF). Although the length of intensive care unit stay was significantly longer in patients with severe ALI/ARDS, blood purification therapy was discontinued in all the patients. The survival rates at the time of discharge were 92.3% and 92.9% in patients with and without PMMA-CHD, respectively. These real mortality ratios were obviously lower than the estimated mortality ratios predicted by APACHE II scores.
Conclusions
These finding suggest that the blood purification using a PMMA hemofilter would be effective for the treatment of AKI and ALI/ARDS in SAP patients.

Citations

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Extracorporeal pediatric renal replacement therapy: diversifying application beyond kidney failure
Rahul Chanchlani, David Askenazi, Benan Bayrakci, Akash Deep, Jolyn Morgan, Tara M. Neumayr
Pediatric Nephrology.2025; 40(4): 923. CrossRef
Advances in Renal Replacement Therapy: The Role of Polymethyl Methacrylate Membranes in Acute Critically Ill Patients
Eleonora Balzani, Sergio Lassola, Hannah Wozniak, Giacomo Bellani, Silvia De Rosa
Blood Purification.2025; : 1. CrossRef
A Retrospective Study on the Start and End of Continuous Hemodialysis Using a Polymethylmethacrylate Hemofilter for Severe Acute Pancreatitis
Kiyohiko Kinjoh, Ryoji Nagamura, Yutaka Sakuda
Internal Medicine.2024; 63(16): 2241. CrossRef
Evaluation of the therapeutic efficiency and efficacy of blood purification in the treatment of severe acute pancreatitis
Hongwei Huang, Zhongshi Huang, Menghua Chen, Ken Okamoto, Chiara Lazzeri
PLOS ONE.2024; 19(1): e0296641. CrossRef
Enhancing Immune Protection in Hemodialysis Patients: Role of the Polymethyl Methacrylate Membrane
Rossana Franzin, Alessandra Stasi, Gianvito Caggiano, Elena Squiccimarro, Vincenzo Losappio, Marco Fiorentino, Carlo Alfieri, Giovanni Stallone, Loreto Gesualdo, Giuseppe Castellano
Blood Purification.2023; 52(Suppl. 1): 49. CrossRef

Pulmonary
Association of pulmonary arterial pressure with volume status in patients with acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: Tae Hwa Hong, Hyoung Soo Kim, Sunghoon Park; Acute Crit Care. 2022;37(2):159-167. Published online March 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00927

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Abstract PDF Supplementary Material: Background
Data on pulmonary hemodynamic parameters in patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) are scarce.
Methods
The associations between pulmonary artery catheter parameters for the first 7 days of ECMO, fluid balance, and hospital mortality were investigated in adult patients (aged ≥19 years) who received venovenous ECMO for refractory ARDS between 2015 and 2017.
Results
Twenty patients were finally included in the analysis (median age, 56.0 years; interquartile range, 45.5–68.0 years; female, n=10). A total of 140 values were collected for each parameter (i.e., 7 days×20 patients). Net fluid balance was weakly but significantly correlated with systolic and diastolic pulmonary arterial pressures (PAPs; r=0.233 and P=0.011; r=0.376 and P<0.001, respectively). Among the mechanical ventilation parameters, above positive end-expiratory pressure was correlated with systolic PAP (r=0.191 and P=0.025), and static compliance was negatively correlated with diastolic PAP (r=−0.169 and P=0.048). Non-survivors had significantly higher systolic PAPs than in survivors. However, in multivariate analysis, there was no significant association between mean systolic PAP and hospital mortality (odds ratio, 1.500; 95% confidence interval, 0.937–2.404; P=0.091).
Conclusions
Systolic PAP was weakly but significantly correlated with net fluid balance during the early ECMO period in patients with refractory ARDS receiving ECMO.

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