Acute and Critical Care最新文献

{"title":"Refining mortality risk stratification in pediatric sepsis: the roles of PELOD-2, vasoactive-inotropic scores, and procalcitonin in a tertiary hospital in Eastern Indonesia.","authors":"Arya Krisna Manggala, Dyah Kanya Wati, Ida Bagus Gede Suparyatha, I Nyoman Budi Hartawan","doi":"10.4266/acc.002450","DOIUrl":"https://doi.org/10.4266/acc.002450","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a leading cause of mortality and morbidity in children. While the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score is a common predictor of mortality, it does not account for the use of inotropic drugs or sepsis markers, which are addressed by the vasoactive-inotropic score (VIS) and measurements of procalcitonin levels. Combining these components enables faster and more accurate predictions of mortality risks. Therefore, this study aimed to develop a new stratification model of mortality risks by integrating PELOD-2, VIS, and procalcitonin among children with septic shock.</p><p><strong>Methods: </strong>A single-center, three-year, retrospective cohort study was conducted in the pediatric intensive care unit of a tertiary hospital. Children aged 1 month to 18 years and diagnosed with septic shock between 2022 and 2024 received vasoactive and/or inotropic support within 24 hours of diagnosis. PELOD-2 scores and procalcitonin levels were recorded at diagnosis. The cutoff values for PELOD-2, VIS, and procalcitonin were determined using receiver operating characteristic curves. Multivariate analysis was used to generate a final equation and validated with the Hosmer-Lemeshow goodness-of-fit test.</p><p><strong>Results: </strong>A total of 101 children were included, with a mortality rate of 78.2%. The optimal cutoff values were a PELOD-2 score ≥8 (sensitivity, 88.6%; specificity, 72.7%), a VIS score ≥11.5 (sensitivity, 78.5%; specificity, 72.7%), and a procalcitonin level ≥5 ng/ml (sensitivity, 74.7%; specificity, 68.2%). Multivariate analysis revealed significant associations with outcomes: PELOD-2 (adjusted odds ratio [aOR], 12.75; P<0.001), VIS (aOR, 4.686; P=0.02), and procalcitonin (aOR, 4.245; P=0.029). The new mortality risk prediction model achieved a range of 12.8% to 97.39% and exhibited excellent discriminator power (area under the curve, 0.911). The Hosmer-Lemeshow test confirmed good calibration.</p><p><strong>Conclusions: </strong>The new scoring approach that refines stratification of mortality risks by incorporating PELOD-2, VIS, and procalcitonin is a more comprehensive predictor.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of planned in-hospital transfer on physiological indicators, level of consciousness, pain, and restlessness in Iran.","authors":"Mohammad Mahdi Honarmand Jahromi, Ali Ravari, Tayebeh Mirzaei, Zahra Kamiab, Zahra Riahi Paghaleh","doi":"10.4266/acc.004175","DOIUrl":"https://doi.org/10.4266/acc.004175","url":null,"abstract":"<p><strong>Background: </strong>Intra-hospital transfers of critically ill patients from emergency departments (EDs) to intensive care units (ICUs) carry significant risks, with studies indicating over 60% experience preventable complications. This study evaluated the impact of a structured, planned transfer protocol on patient stability and efficiency compared to routine transfers.</p><p><strong>Methods: </strong>A total of 112 hemodynamically stable adult patients requiring transfer from the ED to ICU at our hospital were enrolled after ethical approval. Participants were randomly assigned to an intervention group (n=56), transferred using a predefined protocol (pre-transfer coordination, equipment checks, dedicated ICU-trained nurse, continuous monitoring), or a control group (n=56) receiving routine care. Physiological parameters (blood pressure, arterial oxygen saturation, heart rate, respiratory rate), transfer time, consciousness (4Score), pain (Nonverbal Pain Scale), and agitation (Richmond Agitation-Sedation Scale [RASS]) were assessed pre- and post-transfer. Data were analyzed using SPSS version 18 with independent t-tests and chi-square test.</p><p><strong>Results: </strong>Groups were comparable at baseline in demographics and clinical parameters. Post-transfer, no significant differences were found in physiological indicators, consciousness levels, or pain scores. However, the intervention group showed significantly lower agitation levels (mean RASS, -2.01 vs. -2.64; P=0.04). Crucially, transfer time was significantly reduced in the intervention group (9.4±2.0 vs.16.0±4.0 minutes, P<0.01, minutes, P<0.01).</p><p><strong>Conclusions: </strong>While planned transfers did not adversely affect physiological stability or consciousness, they significantly reduced patient agitation and halved transfer duration. This demonstrates that structured protocols enhance operational efficiency and may improve the transfer experience. Implementing planned transfer protocols is recommended to optimize intra-hospital patient flow and safety.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of intermediate syndrome after organophosphorus poisoning and its management in Nepal.","authors":"Kishor Khanal, Saroj Poudel","doi":"10.4266/acc.002825","DOIUrl":"https://doi.org/10.4266/acc.002825","url":null,"abstract":"<p><p>Organophosphorus (OP) poisoning is a global public health challenge, is common in agricultural regions, and is associated with high morbidity and mortality. Intermediate syndrome (IMS) is a delayed complication of OP poisoning that usually occurs 24-96 hours post-exposure and is characterized by proximal muscle weakness, cranial nerve palsies, and respiratory failure. The syndrome significantly increases mortality if not identified and managed promptly. This review comprehensively examines the predictors of IMS, including clinical, biochemical, and electrophysiological markers, and evaluates current management strategies. The key predictors are severe initial poisoning, low initial acetylcholinesterase level, and specific electrophysiological abnormalities. Management involves early recognition, antidote administration (atropine and oximes), respiratory support, and emerging therapies like magnesium sulfate. Challenges such as diagnostic uncertainty and resource constraints in low-income settings are discussed, alongside future directions for research and prevention. Understanding these predictors and optimizing management protocols are critical to improving outcomes in IMS following OP poisoning.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation: technical note and case series.","authors":"Huong Giang Thi Bui, Van Huy Nguyen, Ngoc Son Do, Quoc Tuan Dang, Xuan Co Dao, The Thach Pham, Cong Tan Nguyen, Ba Cuong Nguyen, Thao Dung Nguyen, Huong Giang Nguyen","doi":"10.4266/acc.002675","DOIUrl":"https://doi.org/10.4266/acc.002675","url":null,"abstract":"<p><strong>Background: </strong>Achieving safe and effective closure of large-bore femoral arterial access after venoarterial extracorporeal membrane oxygenation (VA-ECMO) decannulation remains challenging. Percutaneous closure with suture-mediated devices is an established alternative to surgical repair for VA-ECMO decannulation. However, the optimal suture configuration is not well defined, and conventional cross-suture placement may have limitations. This study describes a parallel percutaneous closure technique with the potential to improve outcomes and evaluates its initial feasibility and safety.</p><p><strong>Methods: </strong>This prospective case series included 30 adult patients who underwent bedside decannulation from percutaneous femoral VA-ECMO between March 2024 and March 2025. The closure technique involved deploying two Perclose ProGlide devices (Abbott Vascular) in a parallel configuration. The primary endpoints of technical success and vascular complications were assessed clinically and by duplex Doppler ultrasound 24 hours post-procedure.</p><p><strong>Results: </strong>Technical success was achieved in all 30 patients (100%) without surgical conversion or adjunctive vascular intervention. Duplex ultrasound confirmed normal arterial flow in 23 patients (76.7%). Vascular complications included arterial thrombosis (16.7%), dissection (3.3%), and hematoma (3.3%). No patient required reintervention or developed limb ischemia within 24 hours.</p><p><strong>Conclusions: </strong>This preliminary case series suggests that the parallel percutaneous closure technique is feasible and potentially safe for large-bore femoral decannulation following VA-ECMO. Its bedside application under local anesthesia and low rate of early complications support its utility in critical care. Further studies comparing closure configurations and evaluating long-term outcomes are warranted.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Native valve infective endocarditis caused by Neisseria oralis in South Korea.","authors":"Hyunjoo Oh, Eui Tae Kim, Jeong Rae Yoo","doi":"10.4266/acc.006325","DOIUrl":"https://doi.org/10.4266/acc.006325","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of extubation failure rate with patient outcomes.","authors":"Ivan Gur, Roei Tounek, Ronen Zalts, Rona Epshtein, Asaf Miller, Amichai Gutgold","doi":"10.4266/acc.004250","DOIUrl":"https://doi.org/10.4266/acc.004250","url":null,"abstract":"<p><strong>Background: </strong>While the propensity of evidence indicates the potential harm of failed extubation attempts, avoidance of any such risk may unnecessarily expose patients to prolonged invasive ventilation. We aimed to study the effects of extubation failure rate (EFR) on patient mortality and ventilation-free days (VFD).</p><p><strong>Methods: </strong>Adult patients admitted to the medical intensive care unit who underwent planned extubation were included. Extubation failure was defined as death or return to invasive positive pressure ventilation within 7 days from extubation. The primary outcome was 30-day mortality and the secondary outcome was VFD. For each calendar month, the average 30-day mortality or VFD was plotted against the EFR, with polynomial regression models of increasing complexity fitted until no further increase in the adjusted R2 could be achieved.</p><p><strong>Results: </strong>Of the 774 patients included in final analysis, 262 (33.8%) failed extubation. Matched by the propensity for extubation failure, the 30-day mortality analysis for both groups showed no significant difference (18.4% vs. 16.2%, P=0.34). The relationship between monthly EFR and 30-day survival or VFD was best described by a quadratic regression model (adjusted R2=0.816 and 0.624, respectively). Based on this model, the optimal EFR was calculated at 33.1% (for 30-day survival) and 28.8% (for VFD).</p><p><strong>Conclusions: </strong>Our data support the notion of an optimal EFR. This optimum may be higher than the minimal failure rate achievable.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct and indirect effects of the COVID-19 pandemic on mortality and critical care utilization in South Korea.","authors":"Mindong Sung, Hye Jin Jang, Soyul Han, Sungho Won, Bora Lee, Young Sam Kim","doi":"10.4266/acc.003375","DOIUrl":"https://doi.org/10.4266/acc.003375","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic has had unprecedented global impact, with significant effects on mortality and healthcare utilization. This study evaluated the direct and indirect impacts of COVID-19 on mortality and healthcare utilization in South Korea, a country that implemented strict public health measures.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using national databases from January 2015 through May 2022. The study compared mortality patterns and intensive care unit (ICU) utilization during the epidemic period (2020-2021) with the reference period (2015-2019). We analyzed excess mortality using a random-coefficient Poisson regression model and examined cause-specific mortality patterns for pneumonia, cardiovascular disease, and cancer. ICU admission trends were assessed using annual percent change (APC) and average annual percent change (AAPC) analyses.</p><p><strong>Results: </strong>The study revealed a distinctive two-phase pattern in COVID-19-related excess mortality: minimal excess deaths until June 2021, followed by a significant increase culminating in 18,068 excess deaths (P-score, 68.39%) during the fifth wave in March 2022. COVID-19 deaths accounted for approximately 45% of excess deaths during this period. Analysis of cause-specific mortality demonstrated temporal shifts in cardiovascular disease and pneumonia deaths from their typical January peaks to March-April 2022. Cardiovascular disease showed significant excess mortality during the fifth wave (z=6.18, P<0.001), while pneumonia mortality was below expected levels when accounting for pre-existing trends. Case fatality rate declined from an initial 9.50% to below 1% by 2022, despite increased case numbers. ICU admissions for non-COVID patients showed a consistent declining trend, with the most substantial decrease (-11.48%) observed in April 2020 during the first epidemic wave.</p><p><strong>Conclusions: </strong>These findings suggest that COVID-19 affected population health through both direct viral infection and indirect effects on healthcare systems and utilization patterns. The study highlights the importance of maintaining critical care capacity for all patient groups during public health emergencies and the need for strategies to balance resource allocation.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and accuracy of continuous glucose monitoring in surgical intensive care unit patients : a single-center pilot study in South Korea.","authors":"Hyojun Park, Eunmi Gil, Joon Ho Lee, Chi-Min Park","doi":"10.4266/acc.004975","DOIUrl":"https://doi.org/10.4266/acc.004975","url":null,"abstract":"<p><strong>Background: </strong>Continuous glucose monitoring (CGM) technology offers potential advantages over intermittent point-of-care testing in critically ill patients by providing real-time glucose trends and automated alerts. However, its accuracy and feasibility in intensive care settings require validation before widespread implementation.</p><p><strong>Methods: </strong>We conducted a single-center observational pilot study, evaluating CGM feasibility in 11 surgical intensive care unit (ICU) patients, including nine post-liver transplant recipients. The G6 CGM system was applied for continuous monitoring. CGM readings were paired with point-of-care glucose measurements for accuracy assessment. Performance metrics included the mean absolute relative difference (MARD), bias, standard deviation of relative differences (SDRD), Surveillance Error Grid (SEG) analysis, and International Organization for Standardization (ISO) 15197:2013 criteria compliance.</p><p><strong>Results: </strong>During a median monitoring period of 5 days (interquartile range [IQR], 3-9), we analyzed 326 paired glucose measurements. CGM demonstrated acceptable accuracy, with a MARD of 13.5% (95% CI, 11.43%-15.76%), bias of 2.79% (95% CI, -2.48 to 7.27%), and SDRD of 18.69% (95% CI, 13.75%-23.65%). SEG analysis confirmed 99.1% of readings were in clinically acceptable zones A and B. ISO 15197:2013 criteria showed 62.9% of measurements were within ±15 mg/dl or ±15%. The median patient-level mean glucose was 199.0 mg/dl (IQR, 162.0-248.0), reflecting substantial hyperglycemic exposure in patients receiving high-dose methylprednisolone despite protocolized insulin therapy targeting a range of 140-180 mg/dl.</p><p><strong>Conclusions: </strong>CGM was feasible and acceptably accurate in ICU patients. Persistent hyperglycemia despite protocolized care indicates that CGM-derived data may help to identify opportunities for future protocol improvement. Its potential impact on the time-in-target range, hypoglycemia, and clinical outcomes should be evaluated in future multicenter studies.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of negative-pressure room utilization in the emergency department on hospitalized pneumonia patients during the COVID-19 pandemic in Thailand.","authors":"Teeravit Danrungrot, Theerapon Tangsuwanaruk, Wachira Wongtanasarasin, Borwon Wittayachamnankul","doi":"10.4266/acc.003350","DOIUrl":"https://doi.org/10.4266/acc.003350","url":null,"abstract":"<p><strong>Background: </strong>During the coronavirus disease 2019 (COVID-19) outbreak, negative-pressure rooms were implemented to isolate high-risk COVID-19 patients. This study compared pneumonia patient outcomes before and after their implementation, focusing on in-hospital mortality as the primary outcome.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult pneumonia patients admitted to a tertiary hospital in Northern Thailand, excluding those with trauma-related illness, out-of-hospital cardiac arrest/in-hospital cardiac arrest, or incomplete data. The primary outcome was in-hospital mortality, and the outcomes were door-to-first doctor contact time, door-to-antibiotic time, emergency department (ED) length of stay (LOS), intensive care unit (ICU) admission, and 30-day mortality.</p><p><strong>Results: </strong>Data from 220 pneumonia patients (104 pre-pandemic, 116 pandemic) were analyzed. Of these, 58.6% were elderly males with comorbidities like hypertension and diabetes. Door-to-first doctor contact time was longer during the pandemic (median, 1 vs. 0 minutes; P<0.001), as was ED LOS (median, 5.9 vs. 4.1 hours; P<0.001). Door-to-antibiotic time was also longer in unadjusted comparisons (median, 60.0 vs 36.5 minutes; P<0.001), but the difference was attenuated and not statistically significant after adjustment (adjusted mean difference, 14.2 minutes; P=0.071). No significant differences in in-hospital mortality, 30-day mortality, or ICU admissions were observed.</p><p><strong>Conclusions: </strong>Negative-pressure rooms led to increased door-to-doctor contact time and ED LOS during COVID-19, although without significant differences in mortality. These findings highlight the need to improve ED workflows for future pandemic preparedness.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid mini-surgical percutaneous dilatation tracheostomy under fiberoptic guidance with supraglottic cuff placement: overcoming difficult neck anatomy.","authors":"Veswudu Swuro, Aspari Mahammad Azeez, Dalim Kumar Baidya, Habib Md Reazaul Karim","doi":"10.4266/acc.005275","DOIUrl":"https://doi.org/10.4266/acc.005275","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}