Skip Navigation
Skip to contents

ACC : Acute and Critical Care

OPEN ACCESS
SEARCH
Search

Search

Page Path
HOME > Search
44 "critical care"
Filter
Filter
Article category
Keywords
Publication year
Authors
Funded articles
Original Articles
Epidemiology
Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital
Jaeyoung Choi, Song-Hee Kim, Ryoung-Eun Ko, Gee Young Suh, Jeong Hoon Yang, Chi-Min Park, Joongbum Cho, Chi Ryang Chung
Acute Crit Care. 2025;40(1):18-28.   Published online February 21, 2025
DOI: https://doi.org/10.4266/acc.002976
  • 905 View
  • 98 Download
AbstractAbstract PDFSupplementary Material
Background
Latency in transferring patients from intensive care units (ICUs) to general wards impedes the optimal allocation of ICU resources, underscoring the urgency of initiatives to reduce it. This study evaluates the extent of ICU transfer latency and assesses the potential benefits of minimizing it.
Methods
Transfer latency was measured as the time between the first transfer request and the actual ICU discharge at a single-center tertiary hospital in 2021. Computer-based simulations and cost analyses were performed to examine how reducing transfer latency could affect average hourly ICU bed occupancy, the proportion of time ICU occupancy exceeds 80%, and hospital costs. The first analysis evaluated all ICU admissions, and the second analysis targeted a subset of ICU admissions with longer transfer latency, those requiring infectious precautions.
Results
A total of 7,623 ICU admissions were analyzed, and the median transfer latency was 5.7 hours. Eliminating transfer latency for all ICU admissions would have resulted in a 32.8% point decrease in the proportion of time ICU occupancy exceeded 80%, and a potential annual savings of $6.18 million. Eliminating transfer latency for patients under infectious precautions would have decreased the time ICU occupancy exceeded 80% by 13.5% points, and reduced annual costs by a potential $1.26 million.
Conclusions
Transfer latency from ICUs to general wards might contribute to high ICU occupancy. Efforts to minimize latency for all admissions, or even for a subset of admissions with particularly long transfer latency, could enable more efficient use of ICU resources.
Trauma
Predictive value of initial lactate levels for mortality and morbidity in critically ill pediatric trauma patients: a retrospective study from a Turkish pediatric intensive care unit
Abdulrahman Özel, Esra Nur İlbeği, Servet Yüce
Acute Crit Care. 2025;40(1):87-94.   Published online February 18, 2025
DOI: https://doi.org/10.4266/acc.003528
  • 513 View
  • 88 Download
AbstractAbstract PDF
Background
This study investigated the relationship between initial lactate levels and both mortality and morbidity in critically ill pediatric trauma patients requiring intensive care.
Methods
This retrospective study at tertiary center’s pediatric intensive care unit from January 2020 to June 2024 aimed to characterize trauma patients and assess admission lactate levels' prognostic value.
Results
A total of 190 critically ill pediatric trauma patients were included in the study. The mortality rate was 7.9%, with most deaths occurring within the first 48 hours of admission. Initial lactate levels ≥6.9 mmol/L demonstrated moderate predictive power (area under the curve [AUC], 0.878) for mortality. Pediatric Risk of Mortality III (PRISM III) score showed good predictive ability (AUC, 0.922), while Pediatric Trauma Scores exhibited variable predictive performance (AUC, 0.863). Higher initial lactate levels were significantly associated with severe brain injury, the need for intubation, and an increased incidence of thoracic or abdominal injuries.
Conclusions
Initial lactate levels and PRISM III score are effective predictors of mortality in critically ill pediatric trauma patients. Lactate levels ≥5 mmol/L upon admission should prompt close monitoring and consideration of aggressive management strategies.
Review Article
Nursing
Promoting patient safety in critically ill patients: nursing interventions in surveillance and prevention of ocular injuries
Anabela Carvalho Raposo, Maria Candida Durao, Maria do Rosário Pinto, Helga Rafael Henriques, Joana Ferreira Teixeira
Acute Crit Care. 2025;40(1):10-17.   Published online February 12, 2025
DOI: https://doi.org/10.4266/acc.005014
  • 1,081 View
  • 117 Download
AbstractAbstract PDF
Corneal surface injuries occur frequently (59.4%) in critically ill patients, and the average time for their appearance is 8 days. Such injuries are primarily related to dry eye, which increases the risk of exposure injury in patients admitted to intensive care units. This can result in a severe ulcer or perforation that results in partial to total loss of vision, decreasing the quality of the patient's life. This is a sensitive nursing care area requiring further investigation. Thus, this review aims to analyse nursing interventions that aim to prevent ocular surface injuries. An integrative literature review was carried out from May to August 2023 in the Medline, CINAHL, Scopus, Web of Science, and PubMed databases using the Whittemore and Knafl methodology. Inclusion and exclusion criteria were subsequently applied to assess the results. After verifying result eligibility, seven documents were identified for data extraction and analysis. The results suggest the importance of recognizing risk factors for ocular injuries in critically ill patients, surveillance as a nursing competency, adequate ocular hygiene and effective lubrication, and managing environmental conditions to prevent corneal injuries. Implementing surveillance and intervention protocols for critically ill patients at risk of corneal injuries requires specialized training for critical care nurses. Specifically, environmental management, including temperature and humidity control, is highlighted as an area that merits further research.
Original Article
Surgery
Performance evaluation of non-invasive cardiac output monitoring device (HemoVista) based on multi-channel thoracic impedance plethysmography technology
Jaehee Park, Byung-Moon Choi
Acute Crit Care. 2024;39(4):565-572.   Published online November 18, 2024
DOI: https://doi.org/10.4266/acc.2024.00731
  • 1,084 View
  • 142 Download
AbstractAbstract PDF
Background
A non-invasive method of measuring cardiac output (CO) can be beneficial in the care of critically ill patients. HemoVista (BiLab Co., Ltd.) is a medical device that measures CO non-invasively using multi-channel impedance plethysmography technology. The purpose of this study was to exploratively evaluate the performance of HemoVista in critically ill patients undergoing CO monitoring with the FloTrac (Edwards Lifesciences).
Methods
After non-invasively installing the HemoVista sensor in critically ill patients whose CO was monitored with the FloTrac, CO values measured by both devices were collected for 30 minutes. Cardiac output measured by both devices was selected every 10 seconds, creating approximately 360 data pairs per patient. Linear correlation analysis with Pearson correlation coefficients, Bland-Altman analysis, and four-quadrant plot analysis were performed to evaluate the performance of HemoVista.
Results
A total of 7,138 pairs of CO data from the 20 patients were included in the analysis. A significant correlation was observed between the two methods of measuring CO (Pearson's r=0.489, P<0.001). The mean bias was 1.03 L/min, the 95% CI for the limit of agreement was –1.83 L/min to 3.93 L/min and the percentage error was 55.8%. The concordance rate of time-dependent CO between the two devices was 14.6%.
Conclusions
It was observed that the current version of HemoVista has unsuitable performance for use in intensive care units. To be used for critically ill patients, the algorithm must be improved and reevaluated with an enhanced version.
Review Articles
Meta-analysis
The impact of ketamine on outcomes in critically ill patients: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials
Yerkin Abdildin, Karina Tapinova, Assel Nemerenova, Dmitriy Viderman
Acute Crit Care. 2024;39(1):34-46.   Published online February 28, 2024
DOI: https://doi.org/10.4266/acc.2023.00829
  • 8,378 View
  • 390 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
This meta-analysis aims to evaluate the effects of ketamine in critically ill intensive care unit (ICU) patients.
Methods
We searched for randomized controlled trials (RCTs) in PubMed, Scopus, and the Cochrane Library; the search was performed initially in January but was repeated in December of 2023. We focused on ICU patients of any age. We included studies that compared ketamine with other traditional agents used in the ICU. We synthesized evidence using RevMan v5.4 and presented the results as forest plots. We also used trial sequential analysis (TSA) software v. 0.9.5.10 Beta and presented results as TSA plots. For synthesizing results, we used a random-effects model and reported differences in outcomes of two groups in terms of mean difference (MD), standardized MD, and risk ratio with 95% confidence interval. We assessed the risk of bias using the Cochrane RoB tool for RCTs. Our outcomes were mortality, pain, opioid and midazolam requirements, delirium rates, and ICU length of stay.
Results
Twelve RCTs involving 805 ICU patients (ketamine group, n=398; control group, n=407) were included in the meta-analysis. The ketamine group was not superior to the control group in terms of mortality (in five studies with 318 patients), pain (two studies with 129 patients), mean and cumulative opioid consumption (six studies with 494 patients), midazolam consumption (six studies with 304 patients), and ICU length of stay (three studies with 270 patients). However, the model favored the ketamine group over the control group in delirium rate (four studies with 358 patients). This result is significant in terms of conventional boundaries (alpha=5%) but is not robust in sequential analysis. The applicability of the findings is limited by the small number of patients pooled for each outcome.
Conclusions
Our meta-analysis did not demonstrate differences between ketamine and control groups regarding any outcome except delirium rate, where the model favored the ketamine group over the control group. However, this result is not robust as sensitivity analysis and trial sequential analysis suggest that more RCTs should be conducted in the future.

Citations

Citations to this article as recorded by  
  • Ketamine sedation in critically ill patients: Past, present and future
    Sameer Sharif, Jay Prakash, Bram Rochwerg
    Indian Journal of Anaesthesia.2024; 68(8): 674.     CrossRef
  • Opioid-Free Using Ketamine versus Opioid-Sparing Anesthesia during the Intraoperative Period in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial
    Hoon Choi, Jaewon Huh, Minju Kim, Seok Whan Moon, Kyung Soo Kim, Wonjung Hwang
    Journal of Personalized Medicine.2024; 14(8): 881.     CrossRef
Trauma
Abdominal compartment syndrome in critically ill patients
Hyunseok Jang, Naa Lee, Euisung Jeong, Yunchul Park, Younggoun Jo, Jungchul Kim, Dowan Kim
Acute Crit Care. 2023;38(4):399-408.   Published online November 29, 2023
DOI: https://doi.org/10.4266/acc.2023.01263
  • 12,026 View
  • 3,764 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.

Citations

Citations to this article as recorded by  
  • International cross-sectional survey on current and updated definitions of intra-abdominal hypertension and abdominal compartment syndrome
    Prashant Nasa, Robert D. Wise, Marije Smit, Stefan Acosta, Scott D’Amours, William Beaubien–Souligny, Zsolt Bodnar, Federico Coccolini, Neha S. Dangayach, Wojciech Dabrowski, Juan Duchesne, Janeth C. Ejike, Goran Augustin, Bart De Keulenaer, Andrew W. Kir
    World Journal of Emergency Surgery.2024;[Epub]     CrossRef
Original Articles
Nursing
The effects of environmental interventions for delirium in critically ill surgical patients
Hak-Jae Lee, Yoon-Joong Jung, Nak-Joon Choi, Suk-Kyung Hong
Acute Crit Care. 2023;38(4):479-487.   Published online November 28, 2023
DOI: https://doi.org/10.4266/acc.2023.00990
  • 3,143 View
  • 120 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
Delirium occurs at high rates among patients in intensive care units and increases the risk of morbidity and mortality. The purpose of this study was to investigate the effects of environmental interventions on delirium.
Methods
This prospective cohort study enrolled 192 patients admitted to the surgical intensive care unit (SICU) during the pre-intervention (June 2013 to October 2013) and post-intervention (June 2014 to October 2014) periods. Environmental interventions involved a cognitive assessment, an orientation, and a comfortable environment including proper sleep conditions. The primary outcomes were the prevalence, duration, and onset of delirium.
Results
There were no statistically significant differences in incidence rate, time of delirium onset, general characteristics, and mortality between the pre-intervention and post-intervention groups. The durations of delirium were 14.4±19.1 and 7.7±7.3 days in the pre-intervention and post-intervention groups, respectively, a significant reduction (P=0.027). The lengths of SICU stay were 20.0±22.9 and 12.6±8.7 days for the pre-intervention and post-intervention groups, respectively, also a significant reduction (P=0.030).
Conclusions
The implementation of an environmental intervention program reduced the duration of delirium and length of stay in the SICU for critically ill surgical patients.

Citations

Citations to this article as recorded by  
  • The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic review
    Marli Lopo Vitorino, Adriana Henriques, Graça Melo, Helga Rafael Henriques
    Intensive and Critical Care Nursing.2025; 89: 103976.     CrossRef
  • Reasons influencing the nurses’ prioritization process while preventing and managing delirium: findings from a qualitative study
    Luisa Sist, Nikita Valentina Ugenti, Stefania Chiappinotto, Rossella Messina, Paola Rucci, Alvisa Palese
    Aging Clinical and Experimental Research.2024;[Epub]     CrossRef
Infection
Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes
Ahlem Trifi, Selim Sellaouti, Asma Mehdi, Lynda Messaoud, Eya Seghir, Badis Tlili, Sami Abdellatif
Acute Crit Care. 2023;38(4):425-434.   Published online November 28, 2023
DOI: https://doi.org/10.4266/acc.2023.00773
  • 2,930 View
  • 68 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Background
Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients.
Methods
A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints.
Results
Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013–2019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post–COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3–26.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3–4.0), and invasive procedures (OR, 20.7; 95% CI, 5.3–64.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004).
Conclusions
During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor.

Citations

Citations to this article as recorded by  
  • Depression during the COVID pandemic in La Manouba Governorate, Tunisia: A community survey
    Mauro G Carta, Viviane Kovess, Amina Aissa, Amine Larnaout, Yosra Zgueb, Lubna A Alnasser, Maria Francesca Moro, Federica Sancassiani, Elisa Cantone, Salsabil Rjaibi, Nada Zoghlami, Mejdi Zid, Hajer Aounallah-Skhiri, Uta Ouali
    International Journal of Social Psychiatry.2024; 70(6): 1128.     CrossRef
  • Multidrug-Resistant Klebsiella pneumoniae Strains in a Hospital: Phylogenetic Analysis to Investigate Local Epidemiology
    Maria Vittoria Ristori, Fabio Scarpa, Daria Sanna, Marco Casu, Nicola Petrosillo, Umile Giuseppe Longo, De Florio Lucia, Silvia Spoto, Rosa Maria Chiantia, Alessandro Caserta, Raffaella Rosy Vescio, Flavio Davini, Lucrezia Bani, Elisabetta Riva, Massimo C
    Microorganisms.2024; 12(12): 2541.     CrossRef
CPR/Resuscitation
Percent fluid overload for prediction of fluid de-escalation in critically ill patients in Saudi Arabia: a prospective observational study
Reham A. Alharbi, Namareq F. Aldardeer, Emily L. G. Heaphy, Ahmad H. Alabbasi, Amjad M. Albuqami, Hassan Hawa
Acute Crit Care. 2023;38(2):209-216.   Published online May 16, 2023
DOI: https://doi.org/10.4266/acc.2022.01550
  • 3,869 View
  • 157 Download
AbstractAbstract PDFSupplementary Material
Background
Percent fluid overload greater than 5% is associated with increased mortality. The appropriate time for fluid deresuscitation depends on the patient's radiological and clinical findings. This study aimed to assess the applicability of percent fluid overload calculations for evaluating the need for fluid deresuscitation in critically ill patients.
Methods
This was a single-center, prospective, observational study of critically ill adult patients requiring intravenous fluid administration. The study's primary outcome was median percent fluid accumulation on the day of fluid deresuscitation or intensive care unit (ICU) discharge, whichever came first.
Results
A total of 388 patients was screened between August 1, 2021, and April 30, 2022. Of these, 100 with a mean age of 59.8±16.2 years were included for analysis. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15.4±8.0. Sixty-one patients (61.0%) required fluid deresuscitation during their ICU stay, while 39 (39.0%) did not. Median percent fluid accumulation on the day of deresuscitation or ICU discharge was 4.5% (interquartile range [IQR], 1.7%–9.1%) and 5.2% (IQR, 2.9%–7.7%) in patients requiring deresuscitation and those who did not, respectively. Hospital mortality occurred in 25 (40.9%) of patients with deresuscitation and six (15.3%) patients who did not require it (P=0.007).
Conclusions
The percent fluid accumulation on the day of fluid deresuscitation or ICU discharge was not statistically different between patients who required fluid deresuscitation and those who did not. A larger sample size is needed to confirm these findings.
Infection
Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19
Scott Weerasuriya, Savvas Vlachos, Ahmed Bobo, Namitha Birur Jayaprabhu, Lauren Matthews, Adam R Blackstock, Victoria Metaxa
Acute Crit Care. 2023;38(1):31-40.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01081
  • 3,059 View
  • 131 Download
AbstractAbstract PDFSupplementary Material
Background
It can be challenging for clinicians to predict which patients with respiratory failure secondary to coronavirus disease 2019 (COVID-19) will fail on high-flow nasal cannula (HFNC) oxygen and require escalation of therapy. This study set out to evaluate the association between the respiratory rate-oxygenation index (ROX) and HFNC failure in such patients and to assess whether ROX trajectory correlates with treatment failure.
Methods
This was a single-centre, retrospective, observational study of patients with COVID-19 requiring HFNC, conducted over a 3-month period. ROX was calculated as “pulse-oximetry oxygen saturation (SpO2) over the fractional inspired oxygen concentration (FiO2)/respiratory rate” for each patient at 2, 4, and 12 hours from starting HFNC. HFNC failure was defined as escalation to continuous positive airway pressure ventilation or invasive mechanical ventilation (IMV). Time-to-event analyses were performed to account for the longitudinal data set and time-dependent variables.
Results
We included 146 patients. Ninety-three (63.7%) experienced HFNC failure, with 53 (36.3%) requiring IMV. Higher ROX values were associated with a lower subhazard of HFNC failure on time-to-HFNC failure analysis (subhazard ratio, 0.29; 95% confidence interval [CI], 0.18–0.46; P<0.001). This remained true after controlling for informative censoring. Median ROX values changed differentially over time, increasing in the HFNC success group (0.06 per hour; 95% CI, 0.05–0.08; P<0.001) but not in the HFNC failure group (0.004 per hour; 95% CI, –0.05 to 0.08; P=0.890).
Conclusions
A higher ROX is associated with a lower risk of HFNC failure. Monitoring ROX trajectory over time may help identify patients at risk of treatment failure. This has potential clinical applications; however, future prospective studies are required.
Review Article
Nursing
Theoretical definition of nurse–conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis
Arezoo Mohamadkhani Ghiasvand, Meimanat Hosseini, Foroozan Atashzadeh-Shoorideh
Acute Crit Care. 2023;38(1):8-20.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01039
  • 5,423 View
  • 233 Download
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Providing critical nursing care for conscious mechanically ventilated patients is mediated via effective communication. This study aimed to identify and map the antecedents, attributes, consequences, and definition of nurse–conscious mechanically ventilated patient communication (N-CMVPC). This scoping review was conducted by searching the Cochrane Library and the CINAHL, EMBASE, PubMed, Web of Science, and Scopus databases, between 2001 and 2021. The keywords queried included "nurses," "mechanically ventilated patients," "mechanical ventilation," "intubated patients," "communication," "interaction," "relationships," "nurse–patient communication," "nurse–patient relations," "intensive care units," and "critical care." Studies related to communication with healthcare personnel or family members were excluded. The results indicated that N-CMVPC manifests as a set of attributes in communication experiences, emotions, methods, and behaviors of the nurse and the patient and is classified into three main themes, nurse communication, patient communication, and quantitative-qualitative aspects. N-CMVPC is a complex, multidimensional, and multi-factor concept. It is often nurse-controlled and can express itself as questions, sentences, or commands in the context of experiences, feelings, and positive or negative behaviors involving the nurse and the patient.

Citations

Citations to this article as recorded by  
  • Optimizing infection control: Evaluating nurses' knowledge and practices for preventing infections in mechanically ventilated patients
    Safar awadh alotaibi, Maha AlOtaibi, Hadiya Nassar Alrashedi, Huda Ali S Alasmari, Abdelaziz Hendy, Rasha Kadri Ibrahim
    Infection, Disease & Health.2025;[Epub]     CrossRef
  • Communication Methods Used with Conscious Intubated Patients: Scoping Review
    Mahuya Karmakar, Santhna Letchmi Panduragan, Faridah Mohd Said
    The Open Nursing Journal.2024;[Epub]     CrossRef
  • A Study on Nurses' Communication Experiences with Intubation Patients
    Ye Rim Kim, Hye Ree Park, Mee Kyung Shin
    The Korean Journal of Rehabilitation Nursing.2023; 26(1): 28.     CrossRef
  • The Application of Augmentative and Alternative Communication in Intubated Patients in the Intensive Care Unit: A Scoping Review
    Mee-Kyung Shin, Hyejin Jeon
    The Korean Journal of Rehabilitation Nursing.2023; 26(2): 97.     CrossRef
Original Article
Epidemiology
Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events
Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang
Acute Crit Care. 2022;37(4):654-666.   Published online October 26, 2022
DOI: https://doi.org/10.4266/acc.2022.00976
  • 5,004 View
  • 226 Download
  • 3 Web of Science
  • 6 Crossref
AbstractAbstract PDFSupplementary Material
Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance.
Methods
This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF).
Results
The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex.
Conclusions
The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

Citations

Citations to this article as recorded by  
  • Implementation of the bedside paediatric early warning system, its sustainability in clinical practice and patient outcomes: a quality improvement initiative
    Ruqiah Ali AlZaher, Syed Jamil, Iris Murabi, Eidah Ahmari
    BMJ Open Quality.2025; 14(2): e002454.     CrossRef
  • Predicting cardiac arrest after neonatal cardiac surgery
    Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya
    Intensive Care Medicine – Paediatric and Neonatal.2024;[Epub]     CrossRef
  • Volumetric regional MRI and neuropsychological predictors of motor task variability in cognitively unimpaired, Mild Cognitive Impairment, and probable Alzheimer's disease older adults
    Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer
    Experimental Gerontology.2023; 173: 112087.     CrossRef
  • Predicting sepsis using deep learning across international sites: a retrospective development and validation study
    Michael Moor, Nicolas Bennett, Drago Plečko, Max Horn, Bastian Rieck, Nicolai Meinshausen, Peter Bühlmann, Karsten Borgwardt
    eClinicalMedicine.2023; 62: 102124.     CrossRef
  • A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
    Seok Young Song, Won-Kee Choi, Sanggyu Kwak
    Medicine.2023; 102(37): e35057.     CrossRef
  • An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
    Young Joo Han
    Acute and Critical Care.2022; 37(4): 667.     CrossRef
Review Article
Basic science and research
Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review
Christantie Effendy, Yodang Yodang, Sarah Amalia, Erna Rochmawati
Acute Crit Care. 2022;37(4):516-526.   Published online October 18, 2022
DOI: https://doi.org/10.4266/acc.2022.00745
  • 7,939 View
  • 451 Download
  • 10 Web of Science
  • 13 Crossref
AbstractAbstract PDF
The provision of palliative care in the intensive care unit (ICU) is increasing. While some scholars have suggested the goals of palliative care to not be aligned with the ICU, some evidence show benefits of the integration. This review aimed to explore and synthesize research that identified barriers and facilitators in the provision of palliative care in the ICU. This review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines based on population, concept, and context. We searched for eligible studies in five electronic databases (Scopus, PubMed, ProQuest, Science Direct, and Sage) and included studies on the provision of palliative care (concept) in the ICU (context) that were published in English between 2005–2021. We describe the provision of palliative care in terms of barriers and facilitators. We also describe the study design and context. A total of 14 papers was included. Several barriers and facilitators in providing palliative care in the ICU were identified and include lack of capabilities, family boundaries, practical issues, cultural differences. Facilitators of the provision of palliative care in an ICU include greater experience and supportive behaviors, i.e., collaborations between health care professionals. This scoping review demonstrates the breadth of barriers and facilitators of palliative care in the ICU. Hospital management can consider findings of the current review to better integrate palliative care in the ICU.

Citations

Citations to this article as recorded by  
  • How the nursing work environment moderates the relationship between clinical judgment and person-centered care among intensive care unit nurses
    Mi Hwa Seo, Eun A. Kim, Hae Ran Kim, Mohammad Jamil Rababa
    PLOS ONE.2025; 20(1): e0316654.     CrossRef
  • Triggers for Palliative Care consultation and its modalities in non-malignant mechanically ventilated patients in the Intensive Care Unit: A prospective observational study
    Mansi Suresh, Souvik Chaudhuri, Krithika Rao, Pratibha Todur
    Clinical Epidemiology and Global Health.2025; 32: 101914.     CrossRef
  • A necessidade dos cuidados paliativos na Unidade de Terapia Intensiva (UTI)
    Larissa Kênia de Oliveira Barros Dos Santos, Isabella Rodrigues Ribeiro, João Pedro Manduca Ferreira, Victor Hugo Oliveira Moraes, Érika Aguiar Lara Pereira
    Cuadernos de Educación y Desarrollo.2024;[Epub]     CrossRef
  • End-of-life Care in the Intensive Care Unit and Ethics of Withholding/Withdrawal of Life-sustaining Treatments
    Andrea Cortegiani, Mariachiara Ippolito, Sebastiano Mercadante
    Anesthesiology Clinics.2024; 42(3): 407.     CrossRef
  • What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review
    Nabat Almalki, Breidge Boyle, Peter O’Halloran
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer
    Irene Giannubilo, Linda Battistuzzi, Eva Blondeaux, Tommaso Ruelle, Francesca Benedetta Poggio, Giulia Buzzatti, Alessia D’Alonzo, Federica Della Rovere, Maria Maddalena Latocca, Chiara Molinelli, Maria Grazia Razeti, Simone Nardin, Luca Arecco, Marta Per
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Palliative Care in the Intensive Care Unit: The Standard of Care
    Clareen Wiencek
    AACN Advanced Critical Care.2024; 35(2): 112.     CrossRef
  • Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review
    Naveen Salins, Vijay Shree Dhyani, Mebin Mathew, Ashmitha Prasad, Arathi Prahallada Rao, Anuja Damani, Krithika Rao, Shreya Nair, Vishal Shanbhag, Shwethapriya Rao, Shivakumar Iyer, Roop Gursahani, Raj Kumar Mani, Sushma Bhatnagar, Srinagesh Simha
    Intensive Care Medicine.2024; 50(9): 1438.     CrossRef
  • Barriers and Facilitators of Early Palliative Care in the Trajectory of People Living with Chronic Condition: A Mini Review Using Socio-ecological Framework to Inform Public Health Strategy
    Hartiah Haroen, Sidik Maulana, Alia Harlasgunawan, Sri Rahmawati, Alvi Riansyah, Faizal Musthofa, Jerico Pardosi
    Journal of Multidisciplinary Healthcare.2024; Volume 17: 4189.     CrossRef
  • Shared Decision-making in Palliative and End‑of‑life Care in the Cardiac Intensive Care Unit
    Sarah Godfrey, Alexis Barnes, Jing Gao, Jason N Katz, Sarah Chuzi
    US Cardiology Review.2024;[Epub]     CrossRef
  • Assessing IoT integration in ICUs’ settings and management: a cross-country analysis among local healthcare organizations
    Anna Roberta Gagliardi, Luca Carrubbo, Shai Rozenes, Adi Fux, Daniela Siano
    Digital Policy, Regulation and Governance.2024;[Epub]     CrossRef
  • Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model
    Stephanie A. Meddick‐Dyson, Jason W. Boland, Mark Pearson, Sarah Greenley, Rutendo Gambe, John R. Budding, Fliss E. M. Murtagh
    Intensive Care Medicine.2024; 50(11): 1778.     CrossRef
  • Healthcare Professionals’ Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children’s Hospital in Scotlan
    Satyajit Ray, Emma Victoria McLorie, Jonathan Downie
    Healthcare.2023; 11(17): 2438.     CrossRef
Original Articles
Epidemiology
Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit
Song-I Lee, Younsuck Koh, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim
Acute Crit Care. 2022;37(3):372-381.   Published online August 4, 2022
DOI: https://doi.org/10.4266/acc.2022.00066
  • 5,283 View
  • 263 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Background
Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.
Methods
We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis.
Results
Comparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.
Conclusions
The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.

Citations

Citations to this article as recorded by  
  • Chronicles of change for the future: The imperative of continued data collection in French ICUs
    Takashi Tagami
    Anaesthesia Critical Care & Pain Medicine.2023; 42(5): 101294.     CrossRef
  • We need a comprehensive intensive care unit management strategy for older patients
    Dong-Ick Shin
    Acute and Critical Care.2022; 37(3): 468.     CrossRef
Meta-analysis
Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study
Heemoon Park, Sung Yoon Lim, Sebin Kim, Hyung-Sook Kim, Soyeon Kim, Ho Il Yoon, Young-Jae Cho
Acute Crit Care. 2022;37(3):382-390.   Published online July 19, 2022
DOI: https://doi.org/10.4266/acc.2022.00220
  • 5,034 View
  • 280 Download
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Background
Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes.
Methods
This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22).
Results
In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044).
Conclusions
The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.

Citations

Citations to this article as recorded by  
  • Nutritional support for patients with abdominal surgical pathology: the view of a surgeon and an anesthesiologist — opponents or allies?
    Natalya P. Shen, Svetlana Yu. Mukhacheva
    Clinical nutrition and metabolism.2023; 3(4): 181.     CrossRef
  • Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study
    Chan-Hee Park, Hak-Jae Lee, Suk-Kyung Hong, Yang-Hee Jun, Jeong-Woo Lee, Nak-Jun Choi, Kyu-Hyouck Kyoung
    Annals of Clinical Nutrition and Metabolism.2022; 14(2): 66.     CrossRef

ACC : Acute and Critical Care
TOP