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Review Article
Surgery
Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review
Hanan Elkalawy, Pavan Sekhar, Wael Abosena
Acute Crit Care. 2023;38(4):409-424.   Published online November 30, 2023
DOI: https://doi.org/10.4266/acc.2023.00703
  • 170 View
  • 30 Download
AbstractAbstract PDF
Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.
Original Articles
Gastroenterology
The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients
Rahul Sharma, Ravi Kant Dogra, Jyoti Pathania, Arti Sharma
Acute Crit Care. 2023;38(1):134-141.   Published online February 22, 2023
DOI: https://doi.org/10.4266/acc.2022.00955
  • 978 View
  • 66 Download
  • 1 Citations
AbstractAbstract PDF
Background
Although gastric reserve volume (GRV) is a surrogate marker of gastrointestinal dysfunction and feeding intolerance, there is ambiguity in its estimation due to problems associated with its measurement. Introduction of point-of-care ultrasound as a tool for anesthetists kindled interest in its use for GRV estimation. Methods: In this prospective observational study, we recruited 57 critically ill patients and analyzed 586 samples of GRV obtained by both ultrasonography (USG) and manual aspiration. Results: The analysis showed that USG-guided GRV was significantly correlated (r=0.788, P<0.001) and in positive agreement with manual aspiration based on Bland-Altman plot, with a mean difference of 8.50±14.84 (95% confidence interval, 7.389–9.798). The upper and lower limits of agreement were 37.7 and –20.5, respectively, within the ±1.96 standard deviation (P<0.001). The respective sensitivity and positive predictive value, specificity and negative predictive value, and area under the curve of USG for feeding intolerance were 66.67%, 98.15%, and 0.82%, with 96.49% diagnostic accuracy. Conclusions: Ultrasonographic estimation of GRV was positively, significantly correlated and in agreement with the manual aspiration method and estimated feeding intolerance earlier. Routine use of gastric USG could avoid clinical situations where feeding status is unclear and there is high risk of aspiration and could become a standard practice of critical care.

Citations

Citations to this article as recorded by  
  • Gastrointestinal function in critically ill patients
    Annika Reintam Blaser, Kaspar F. Bachmann, Adam M. Deane
    Current Opinion in Clinical Nutrition & Metabolic Care.2023; 26(5): 463.     CrossRef
Liver
Alcohol use disorder in the intensive care unit a highly morbid condition, but chemical dependency discussion improves outcomes
Kristin Colling, Alexandra K. Kraft, Melissa L. Harry
Acute Crit Care. 2023;38(1):122-133.   Published online January 10, 2023
DOI: https://doi.org/10.4266/acc.2022.00584
  • 1,508 View
  • 64 Download
AbstractAbstract PDF
Background
Alcohol use disorders (AUD) are common in patients admitted to intensive care units (ICU) and increase the risk for worse outcomes. In this study, we describe factors associated with patient mortality after ICU admission and the effect of chemical dependency (CD) counseling on outcomes in the year following ICU admission. Methods: We retrospectively reviewed patient demographics, hospital data, and documentation of CD counseling by medical providers for all ICU patients with AUD admitted to our institution between January 2017 and March 2019. Primary outcomes were in-hospital and 1-year mortality. Results: Of the 527 patients with AUD requiring ICU care, median age was 56 years (range, 18–86). Both in-hospital (12%) and 1-year mortality rates (27%) were high. Rural patients, comorbidities, older age, need for mechanical ventilation, and complications were associated with increased risk of in-hospital and 1-year mortality. CD counseling was documented for 73% of patients, and 50% of these patients accepted alcohol treatment or resources prior to discharge. CD evaluation and acceptance was associated with a significantly decreased rate of readmission for liver or alcohol-related issues (36% vs. 58%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.27–0.61) and 1-year mortality (7% vs. 19.5%; OR, 0.32; 95% CI, 0.16–0.64). CD evaluation alone, regardless of patient acceptance, was associated with a significantly decreased 1-year post-discharge mortality rate (12% vs. 23%; OR, 0.44; 95% CI, 0.25–0.77). Conclusions: ICU patients with AUD had high in-hospital and 1-year mortality. CD evaluation, regardless of patient acceptance, was associated with a significant decrease in 1-year mortality
Nutrition
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
  • 2,679 View
  • 227 Download
  • 2 Citations
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
Neurology
Muscle Growth and Anabolism in Intensive Care Survivors (GAINS) trial: a pilot randomised controlled trial
Matthew H Anstey, Rashmi Rauniyar, Ethan Fitzclarence, Natalie Tran, Emma Osnain, Bianca Mammana, Angela Jacques, Robert N Palmer, Andrew Chapman, Bradley Wibrow
Acute Crit Care. 2022;37(3):295-302.   Published online June 27, 2022
DOI: https://doi.org/10.4266/acc.2021.01767
  • 3,366 View
  • 262 Download
AbstractAbstract PDFSupplementary Material
Background
To explore the feasibility, safety, and potential benefits of administration of the anabolic steroid nandrolone to patients in the recovery phase from critical illness weakness.
Methods
In this phase II, double blind, randomized, controlled trial, adult critically ill patients admitted to one of two tertiary Intensive Care Units in Western Australia for longer than 7 days with significant weakness were enrolled. Patients received nandrolone (200 mg males, 100 mg females) intramuscularly or placebo weekly for up to 3 weeks in addition to standard care. The primary outcome measures were improvement in grip strength, Medical Research Council muscle strength sum score, and functional activity level (Chelsea critical care assessment tool [CPAx]).
Results
A total of 22 patients was enrolled between September 2017 and May 2019. No significant adverse events were detected. Median grip strength change was non-significantly greater in the nandrolone group (8.5 vs. 13.0, P=0.185), while hospital length of stay (36 vs. 26 days, P=0.023) and duration of mechanical ventilation (377 vs. 168, P=0.032) were lower. The discharge CPAx and intensive care unit mobility scores were higher in the nandrolone group, although there was no difference in the change in CPAx score (17.0 vs. 17.7, P=0.865). There were no changes in ultrasound-detected muscle thickness between the two groups.
Conclusions
In patients with prolonged critical illness, nandrolone appears to be safe. However, a larger study, potentially combined with resistance exercise, is needed to definitively address the potential benefits of nandrolone.
Infection
Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review
Sofia R. Valdoleiros, Cristina Torrão, Laura S. Freitas, Diana Mano, Celina Gonçalves, Carla Teixeira
Acute Crit Care. 2022;37(1):61-70.   Published online January 26, 2022
DOI: https://doi.org/10.4266/acc.2021.01151
  • 4,304 View
  • 237 Download
  • 6 Citations
AbstractAbstract PDFSupplementary Material
Background
Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU). Methods: A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines. Results: An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality. Conclusions: Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.

Citations

Citations to this article as recorded by  
  • Bacterial meningitis in adults: a retrospective study among 148 patients in an 8-year period in a university hospital, Finland
    Sakke Niemelä, Laura Lempinen, Eliisa Löyttyniemi, Jarmo Oksi, Jussi Jero
    BMC Infectious Diseases.2023;[Epub]     CrossRef
  • Bacterial meningitis in children with an abnormal craniocerebral structure
    Jiali Pan, Wei Xu, Wenliang Song, Tao Zhang
    Frontiers in Pediatrics.2023;[Epub]     CrossRef
  • Fieber in der Intensivmedizin
    Jan-Hendrik Naendrup, Boris Böll, Jorge Garcia Borrega
    Intensivmedizin up2date.2023; 19(01): 17.     CrossRef
  • Neurosurgical management of penetrating brain injury during World War I: A historical cohort
    Rayan Fawaz, Mathilde Schmitt, Philémon Robert, Nathan Beucler, Jean-Marc Delmas, Nicolas Desse, Aurore Sellier, Arnaud Dagain
    Neurochirurgie.2023; 69(3): 101439.     CrossRef
  • Etiology and Outcomes of Healthcare-Associated Meningitis and Ventriculitis—A Single Center Cohort Study
    Hana Panic, Branimir Gjurasin, Marija Santini, Marko Kutlesa, Neven Papic
    Infectious Disease Reports.2022; 14(3): 420.     CrossRef
  • Healthcare-associated central nervous system infections
    Mariachiara Ippolito, Antonino Giarratano, Andrea Cortegiani
    Current Opinion in Anaesthesiology.2022; 35(5): 549.     CrossRef
Ethics
Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission
Youjin Chang, Kyoung Ran Kim, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim
Acute Crit Care. 2021;36(4):351-360.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00283
  • 4,424 View
  • 126 Download
  • 3 Citations
AbstractAbstract PDFSupplementary Material
Background
It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception.
Methods
A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state.
Results
A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group were 64%, 22%, and 57%, respectively; their 6-month mortality rates were 100%, 46%, and 81%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3, odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892–8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260–19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162–17.121; P=0.029).
Conclusions
The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization.

Citations

Citations to this article as recorded by  
  • Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit
    Michele M. Iguina, Aunie M. Danyalian, Ilko Luque, Umair Shaikh, Sanaz B. Kashan, Dionne Morgan, Daniel Heller, Mauricio Danckers
    Journal of Palliative Care.2023; 38(2): 126.     CrossRef
  • Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
    Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
    Internal and Emergency Medicine.2023; 18(4): 1191.     CrossRef
  • Can the intensivists predict the outcomes of critically ill patients on the appropriateness of intensive care unit admission for limited intensive care unit resources ?
    SeungYong Park
    Acute and Critical Care.2021; 36(4): 388.     CrossRef
Review Article
Epidemiology
Influence of sarcopenia focused on critically ill patients
Belgin Akan
Acute Crit Care. 2021;36(1):15-21.   Published online February 2, 2021
DOI: https://doi.org/10.4266/acc.2020.00745
  • 5,863 View
  • 252 Download
  • 11 Citations
AbstractAbstract PDF
A systemic review was performed to evaluate the epidemiological, pathophysiological, and clinical features of sarcopenia, the relationship of sarcopenia with critical illness and its impact on mortality, and diagnostic methods and treatment modalities. Generally, in the presence of critical illness, sarcopenia is not included in the treatment approach strategies. An intensivist should be aware that sarcopenia may be present in critically ill patients. Although the main modalities against sarcopenia are early mobilization and nutritional support, they can only prevent its development and may have positive effects on prognosis rather than treating the existing sarcopenia.

Citations

Citations to this article as recorded by  
  • High prevalence of pre-existing sarcopenia in critically ill patients with hematologic malignancies admitted to the intensive care unit for sepsis or septic shock
    Antoine Herault, Emilie Lévêque, Simon Draye-Carbonnier, Pierre Decazes, Alexandra Zduniak, Romain Modzelewski, Julie Libraire, Najate Achamrah, Anne-Lise Ménard, Pascal Lenain, Nathalie Contentin, Maximilien Grall, Stéphane Leprêtre, Emilie Lemasle, Hélè
    Clinical Nutrition ESPEN.2023; 55: 373.     CrossRef
  • Acute Changes in Body Muscle Mass and Fat Depletion in Hospitalized Young Trauma Patients: A Descriptive Retrospective Study
    Hassan Al-Thani, Bianca M. Wahlen, Ayman El-Menyar, Mohammad Asim, Lena Ribhi Nassar, Mohamed Nadeem Ahmed, Syed Nabir, Monira Mollazehi, Husham Abdelrahman
    Diseases.2023; 11(3): 120.     CrossRef
  • Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment
    I.A. Osuna-Padilla, N.C. Rodríguez-Moguel, S. Rodríguez-Llamazares, C.E. Orsso, C.M. Prado, M.A. Ríos-Ayala, O. Villanueva-Camacho, A. Aguilar-Vargas, L.E. Pensado-Piedra, F. Juárez-Hernández, C.M. Hernández-Cárdenas
    Clinical Nutrition.2022; 41(12): 2910.     CrossRef
  • A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults
    Bethan Jenkins, Philip C. Calder, Luise V. Marino
    Clinical Nutrition ESPEN.2022; 49: 92.     CrossRef
  • The Diagnostic Value of Ultrasound of the Rectus Femoris for the diagnosis of Sarcopenia in adults: A systematic review
    I. Nies, L.L.G.C. Ackermans, M. Poeze, T.J. Blokhuis, Jan A. Ten Bosch
    Injury.2022; 53: S23.     CrossRef
  • Intra-Aortic Balloon Pump Placement in the Axillary Artery: Where are We?
    Gustavo André Boeing Boros, Claudia Yanet San Martin de Bernoche, Pedro Felipe Gomes Nicz
    ABC: Heart Failure & Cardiomyopathy.2022; 2(2): 209.     CrossRef
  • Current practice and barriers in the implementation of ultrasound-based assessment of muscle mass in Japan: A nationwide, web-based cross-sectional study
    Keishi Nawata, Nobuto Nakanishi, Shigeaki Inoue, Keibun Liu, Masafumi Nozoe, Yuko Ono, Isamu Yamada, Hajime Katsukawa, Joji Kotani, Supat Chupradit
    PLOS ONE.2022; 17(11): e0276855.     CrossRef
  • A scoping review considering potential biomarkers or functional measures of gastrointestinal dysfunction and enteral feeding intolerance in critically ill adults
    Bethan Jenkins, Philip C. Calder, Luise V. Marino
    Clinical Nutrition ESPEN.2022; 52: 331.     CrossRef
  • ICU Acquired Weakness in patients with respiratory failure
    Sergei A. Andreichenko, Mikhail V. Bychinin, Dmitriy I. Korshunov, Tatiana V. Klypa
    Journal of Clinical Practice.2021; 12(2): 5.     CrossRef
  • Predicting outcome in abdominal sepsis: putting the puzzle together
    Catherine S. Reid, Vanessa M. Banz, Joerg C. Schefold, Markus M. Luedi
    Journal of Cachexia, Sarcopenia and Muscle.2021; 12(5): 1119.     CrossRef
  • Ultrasound assessment of muscle mass has potential to identify patients with low muscularity at intensive care unit admission: A retrospective study
    Yuta Arai, Nobuto Nakanishi, Yuko Ono, Shigeaki Inoue, Joji Kotani, Masafumi Harada, Jun Oto
    Clinical Nutrition ESPEN.2021; 45: 177.     CrossRef
Original Articles
Infection
Risk factors for intensive care unit admission and mortality in hospitalized COVID-19 patients
Ahmed Ayaz, Ainan Arshad, Hajra Malik, Haris Ali, Erfan Hussain, Bushra Jamil
Acute Crit Care. 2020;35(4):249-254.   Published online November 11, 2020
DOI: https://doi.org/10.4266/acc.2020.00381
  • 6,552 View
  • 213 Download
  • 18 Citations
AbstractAbstract PDF
Background
This study investigated the clinical features and outcome of hospitalized coronavirus disease 2019 (COVID-19) patients admitted to our quaternary care hospital.
Methods
In this retrospective cohort study, we included all adult patients with COVID-19 infection admitted to a quaternary care hospital in Pakistan from March 1 to April 15, 2020. The extracted variables included demographics, comorbidities, presenting symptoms, laboratory tests and radiological findings during admission. Outcome measures included in-hospital mortality and length of stay.
Results
Sixty-six COVID-19 patients were hospitalized during the study period. Sixty-one percent were male and 39% female; mean age was 50.6±19.1 years. Fever and cough were the most common presenting symptoms. Serial chest X-rays showed bilateral pulmonary opacities in 33 (50%) patients. The overall mortality was 14% and mean length of stay was 8.4±8.9 days. Ten patients (15%) required intensive care unit (ICU) care during admission, of which six (9%) were intubated. Age ≥60 years, diabetes, ischemic heart disease, ICU admission, neutrophil to lymphocyte ratio ≥3.3, and international normalized ratio ≥1.2 were associated with increased risk of mortality.
Conclusions
We found a mortality rate of 14% in hospitalized COVID-19 patients. COVID-19 cases are still increasing exponentially around the world and may overwhelm healthcare systems in many countries soon. Our findings can be used for early identification of patients who may require intensive care and aggressive management in order to improve outcomes.

Citations

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    Si Mong Yoon, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
    Frontiers in Medicine.2023;[Epub]     CrossRef
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    Vasco Ricoca Peixoto, André Vieira, Pedro Aguiar, Carlos Carvalho, Daniel Thomas, Paulo Sousa, Carla Nunes, Alexandre Abrantes
    Frontiers in Public Health.2023;[Epub]     CrossRef
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    Zarin Pilakkadavath, Janice M. Weinberg, Serin Kuriakose, Shahul H. Ebrahim, Lekha D. Bhat, Bindhya Vijayan, Salman Khan, Soji D. Jose, Premini Rajeev, Jinbert L. Azariah, Shaffi Fazaludeen Koya
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    Abere Woretaw Azagew, Zerko Wako Beko, Yohannes Mulu Ferede, Habtamu Sewunet Mekonnen, Hailemichael Kindie Abate, Chilot Kassa Mekonnen
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    Panagiotis PALIOGIANNIS, Angelo ZINELLU, Arduino A. MANGONI, Antonio PAZZOLA, Francesco L. BANDIERA, Antonio SPANO, Chiara SANNA, Valentina SCANO, Sara S. FOIS, Verdiana MUSCAS, Elena MASOTTO, Stefano DORE, Vito FIORE, Pietro PIRINA, Ciriaco CARRU, Alessa
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    Shimelis Seid, Habtu Adane, Getachew Mekete
    Annals of Medicine and Surgery.2022; 77: 103618.     CrossRef
  • Hospital length of stay for COVID-19 patients: A systematic review and meta-analysis
    Yousef Alimohamadi, Elahe Mansouri Yekta, Mojtaba Sepandi, Maedeh Sharafoddin, Maedeh Arshadi, Elahe Hesari
    Multidisciplinary Respiratory Medicine.2022;[Epub]     CrossRef
  • Evaluation of the models generated from clinical features and deep learning-based segmentations: Can thoracic CT on admission help us to predict hospitalized COVID-19 patients who will require intensive care?
    Mutlu Gülbay, Aliye Baştuğ, Erdem Özkan, Büşra Yüce Öztürk, Bökebatur Ahmet Raşit Mendi, Hürrem Bodur
    BMC Medical Imaging.2022;[Epub]     CrossRef
  • Characterization and determinant factors of critical illness and in-hospital mortality of COVID-19 patients: A retrospective cohort of 1,792 patients in Kenya
    Isinta M Elijah, Endawoke Amsalu, Xuening Jian, Mingyang Cao, Eric K Mibei, Danvas O Kerosi, Francis G Mwatsahu, Wei Wang, Faith Onyangore, Youxin Wang
    Biosafety and Health.2022; 4(5): 330.     CrossRef
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    Giuliano Pasquale Ramadori
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  • Risk factors for SARS-CoV-2 related mortality and hospitalization before vaccination: A meta-analysis
    Hannah N. Marmor, Mindy Pike, Zhiguo (Alex) Zhao, Fei Ye, Stephen A. Deppen, Julio Croda
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  • Risk factors of early mortality among COVID-19 deceased patients in Addis Ababa COVID-19 care centers, Ethiopia
    Taye Ashine Mezgebu, Migbar Mekonnen Sibhat, Melsew Tsegaw Getnet, Kassie Tiruneh Gebeyehu, Wuletaw Zewde Chane, Edmialem Mesfin Getahun, Asaminew Sane Habtamu, Hailu Beyene Asmare, Melke Mengistie Ambaw, Zivanai Cuthbert Chapanduka
    PLOS ONE.2022; 17(9): e0275131.     CrossRef
  • Comorbid Asthma Increased the Risk for COVID-19 Mortality in Asia: A Meta-Analysis
    Liqin Shi, Jiahao Ren, Yujia Wang, Huifen Feng, Fang Liu, Haiyan Yang
    Vaccines.2022; 11(1): 89.     CrossRef
  • Outcomes of nutritionally at-risk Coronavirus Disease 2019 (COVID 19) patients admitted in a tertiary government hospital: A follow-up study of the MalnutriCoV study
    Ramon B. Larrazabal, Harold Henrison C. Chiu, Lia Aileen M. Palileo-Villanueva
    Clinical Nutrition ESPEN.2021; 43: 239.     CrossRef
  • Prognostic value of neutrophil‐to‐lymphocyte ratio in COVID‐19 patients: A systematic review and meta‐analysis
    Juan R. Ulloque‐Badaracco, W. Ivan Salas‐Tello, Ali Al‐kassab‐Córdova, Esteban A. Alarcón‐Braga, Vicente A. Benites‐Zapata, Jorge L. Maguiña, Adrian V. Hernandez
    International Journal of Clinical Practice.2021;[Epub]     CrossRef
  • A meta-analysis on the risk factors adjusted association between cardiovascular disease and COVID-19 severity
    Jie Xu, Wenwei Xiao, Xuan Liang, Li Shi, Peihua Zhang, Ying Wang, Yadong Wang, Haiyan Yang
    BMC Public Health.2021;[Epub]     CrossRef
  • Comparison of characteristics and ventilatory course between coronavirus disease 2019 and Middle East respiratory syndrome patients with acute respiratory distress syndrome
    Imran Khalid, Romaysaa M Yamani, Maryam Imran, Muhammad Ali Akhtar, Manahil Imran, Rumaan Gul, Tabindeh Jabeen Khalid, Ghassan Y Wali
    Acute and Critical Care.2021; 36(3): 223.     CrossRef
Pulmonary
Clinical characteristics and outcomes of critically Ill patients with COVID-19 in Northeast Ohio: low mortality and length of stay
Francois Abi Fadel, Mohammed Al-Jaghbeer, Sany Kumar, Lori Griffiths, Xiaofeng Wang, Xiaozhen Han, Robert Burton
Acute Crit Care. 2020;35(4):242-248.   Published online October 12, 2020
DOI: https://doi.org/10.4266/acc.2020.00619
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AbstractAbstract PDF
Background
Published coronavirus disease 2019 (COVID-19) reports suggest higher mortality with increasing age and comorbidities. Our study describes the clinical characteristics and outcomes for all intensive care unit (ICU) patients admitted across the Cleveland Clinic enterprise, a 10-hospital health care system in Northeast Ohio, serving more than 2.7 million people.
Methods
We analyzed the quality data registry for clinical characteristics and outcomes of all COVID-19-confirmed ICU admissions. Differences in outcomes from other health care systems and published cohorts from other parts of the world were delineated.
Results
Across our health care system, 495 COVID-19 patients were admitted from March 15 to June 1, 2020. Mean patient age was 67.3 years, 206 (41.6%) were females, and 289 (58.4%) were males. Mean Acute Physiology Score was 45.3, and mean Acute Physiology and Chronic Health Evaluation III score was 60.5. In total, 215 patients (43.3%) were intubated for a mean duration of 9.2 days. Mean ICU and hospital length of stay were 7.4 and 13.9 days, respectively, while mean ICU and hospital mortality rates were 18.4% and 23.8%.
Conclusions
Our health care system cohort is the fourth largest to be reported. Lower ICU and hospital mortality and length of stay were seen compared to most other published reports. Better preparedness and state-level control of the surge in COVID-19 infections are likely the reasons for these better outcomes. Future research is needed to further delineate differences in mortality and length of stay across health care systems and over time.

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Review Article
Pulmonary
Pulmonary and Physical Rehabilitation in Critically Ill Patients
Myung Hun Jang, Myung-Jun Shin, Yong Beom Shin
Acute Crit Care. 2019;34(1):1-13.   Published online February 28, 2019
DOI: https://doi.org/10.4266/acc.2019.00444
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  • 34 Citations
AbstractAbstract PDF
Some patients admitted to the intensive care unit (ICU) because of an acute illness, complicated surgery, or multiple traumas develop muscle weakness affecting the limbs and respiratory muscles during acute care in the ICU. This condition is referred to as ICU-acquired weakness (ICUAW), and can be evoked by critical illness polyneuropathy (CIP), critical illness myopathy (CIM), or critical illness polyneuromyopathy (CIPNM). ICUAW is diagnosed using the Medical Research Council (MRC) sum score based on bedside manual muscle testing in cooperative patients. The MRC sum score is the sum of the strengths of the 12 regions on both sides of the upper and lower limbs. ICUAW is diagnosed when the MRC score is less than 48 points. However, some patients require electrodiagnostic studies, such as a nerve conduction study, electromyography, and direct muscle stimulation, to differentiate between CIP and CIM. Pulmonary rehabilitation in the ICU can be divided into modalities intended to remove retained airway secretions and exercise therapies intended to improve respiratory function. Physical rehabilitation, including early mobilization, positioning, and limb exercises, attenuates the weakness that occurs during critical care. To perform mobilization in mechanically ventilated patients, pretreatment by removing secretions is necessary. It is also important to increase the strength of respiratory muscles and to perform lung recruitment to improve mobilization in patients who are weaned from the ventilator. For these reasons, pulmonary rehabilitation is important in addition to physical therapy. Early recognition of CIP, CIM, and CIPNM and early rehabilitation in the ICU might improve patients’ functional recovery and outcomes.

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Original Articles
Basic science and research
Prognostic Implication of Adrenocortical Response during the Course of Critical Illness
Jin Hwa Song, Jung Hee Kim, Sang-Min Lee, Jinwoo Lee
Acute Crit Care. 2019;34(1):38-45.   Published online January 30, 2019
DOI: https://doi.org/10.4266/acc.2018.00339
  • 6,753 View
  • 125 Download
  • 3 Citations
AbstractAbstract PDFSupplementary Material
Background
Critical illness-related corticosteroid insufficiency (CIRCI) and adrenocorticotropic hormone (ACTH)-cortisol dissociation are hormonal conditions frequently observed in patients in the intensive care unit (ICU). The aim of this study was to evaluate the association between ACTH-cortisol dissociation and clinical outcomes of critically ill patients. Methods: We retrospectively reviewed the medical records of 94 ICU patients who underwent two rapid cosyntropin tests during hospital admission and compared the clinical aspects of patients with and without ACTH-cortisol dissociation. ACTH-cortisol dissociation was defined as plasma ACTH and serum cortisol concentrations of <22 pmol/L and >600 nmol/L, respectively. Results: Dissociation was present in 30 of the 94 patients (31.9%). Patients with ACTH-cortisol dissociation in the initial test had significantly higher hospital mortality rate than those in the control group (55% vs. 25.7%, P=0.013) There was no difference in hospital mortality between patients classified as having CIRCI and those who were not. In multivariate adjusted Cox regression analysis, the mortality risk was higher in the group with ACTH-cortisol dissociation (hazard ratio, 2.98; 95% confidence interval, 1.34 to 6.63; P=0.007). Patients with dissociation in two consecutive stimulation tests showed the highest hospital mortality rate among groups classified according to stimulation test results (100% vs. 31.3%). Conclusions: The hospital mortality was higher in ICU patients diagnosed with ACTH-cortisol dissociation. It is clinically feasible to evaluate the presence of ACTH-cortisol dissociation by analyzing rapid ACTH stimulation test results in critically ill patients.

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  • PROGNOSTIC VALUE OF LOW-DOSE ADRENOCORTICOTROPIC HORMONE TEST IN CRITICALLY ILL PATIENTS
    Ahmad B. Abdelrehim, Fatma M. Mohsen, Mostafa A. Haredi, Zeinab Abdel Hameed, Walaa H. Ibrahim
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Neurology
The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study
Jaesub Park, Seung-Taek Oh, Sunyoung Park, Won-Jung Choi, Cheung Soo Shin, Se Hee Na, Jae-Jin Kim, Jooyoung Oh, Jin Young Park
Acute Crit Care. 2018;33(1):23-33.   Published online February 6, 2018
DOI: https://doi.org/10.4266/acc.2017.00584
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  • 1 Citations
AbstractAbstract PDF
Background
Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient’s clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown.
Methods
The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation.
Results
There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor’s mental health, was significantly reduced and pain tended to decrease.
Conclusions
Increasing the physician’s awareness of the patient’s mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

Citations

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  • Adaptation and Validation of a Chart‐Based Delirium Detection Tool for the ICU (CHART‐DEL‐ICU)
    Karla D. Krewulak, Carmen Hiploylee, E. W. Ely, Henry T. Stelfox, Sharon K. Inouye, Kirsten M. Fiest
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Review
Pulmonary
Patient-Ventilator Dyssynchrony
Elvira-Markela Antonogiannaki, Dimitris Georgopoulos, Evangelia Akoumianaki
Korean J Crit Care Med. 2017;32(4):307-322.   Published online November 30, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00535
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  • 9 Citations
AbstractAbstract PDF
In mechanically ventilated patients, assisted mechanical ventilation (MV) is employed early, following the acute phase of critical illness, in order to eliminate the detrimental effects of controlled MV, most notably the development of ventilator-induced diaphragmatic dysfunction. Nevertheless, the benefits of assisted MV are often counteracted by the development of patient-ventilator dyssynchrony. Patient-ventilator dyssynchrony occurs when either the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration, respectively, or if the magnitude of mechanical assist does not respond to the patient’s respiratory demand. As patient-ventilator dyssynchrony has been associated with several adverse effects and can adversely influence patient outcome, every effort should be made to recognize and correct this occurrence at bedside. To detect patient-ventilator dyssynchronies, the physician should assess patient comfort and carefully inspect the pressure- and flow-time waveforms, available on the ventilator screen of all modern ventilators. Modern ventilators offer several modifiable settings to improve patient-ventilator interaction. New proportional modes of ventilation are also very helpful in improving patient-ventilator interaction.

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    Xu-Ying Luo, Xuan He, Yi-Min Zhou, Yu-Mei Wang, Jing-Ran Chen, Guang-Qiang Chen, Hong-Liang Li, Yan-Lin Yang, Linlin Zhang, Jian-Xin Zhou
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Original Article
Nephrology
Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study
Ki Hyun Park, Jung-ho Shin, Jin Ho Hwang, Su Hyun Kim
Korean J Crit Care Med. 2017;32(3):256-264.   Published online August 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00136
  • 6,494 View
  • 160 Download
  • 16 Citations
AbstractAbstract PDF
Background
Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT. Methods: A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status. Results: A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037). Conclusions: Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.

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ACC : Acute and Critical Care