Acute and Critical Care最新文献

{"title":"Characteristics and management of mechanically ventilated patients in South Korea compared with other high-income Asian countries and regions.","authors":"Kyung Hun Nam, Kyeongman Jeon, Suk-Kyung Hong, Ah Young Leem, Jee Hwan Ahn, Hang Jea Jang, Ki Sup Byun, So Hee Park, Sojung Park, Yoon Mi Shin, Jisoo Park, Sung Wook Kang, Jin Hyoung Kim, Jinkyeong Park, Deokkyu Kim, Bo Young Lee, Woo Hyun Cho, Kwangha Lee, Song I Lee, Tai Sun Park, Yun Jung Jung, Sang-Hyun Kwak, Sang-Beom Jeon, Sung Hyun Kim, Won Jai Jung, Sang-Min Lee, Sunghoon Park, Yun Su Sim, Young-Jae Cho, Younsuck Koh","doi":"10.4266/acc.003336","DOIUrl":"10.4266/acc.003336","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the characteristics of mechanically ventilated patients in South Korean intensive care units (ICUs).</p><p><strong>Methods: </strong>We conducted a subgroup analysis of a multinational observational study. Data from 271 mechanically ventilated patients in South Korean ICUs were analyzed for demographics, ventilation practices, and mortality, and were compared with those of 327 patients from other high-income Asian countries.</p><p><strong>Results: </strong>South Korean patients were older (mean age: 67 vs. 62 years, P<0.001) and had lower ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (255.5 vs. 306.2, P<0.001). South Korean ICUs exhibited higher patient-to-nurse ratios (2.6 vs. 1.9, P<0.001) and more beds per unit (20.5 vs. 16.0, P=0.017). The use of sufficient positive end-expiratory pressure for patients (PEEP) for acute respiratory distress syndrome (ARDS) was less frequent in South Korea (62.2% vs. 91.2%, P=0.005). Mortality rates were similar between South Korean patients and those in other high-income Asian countries (38.0% vs. 34.2%, P=0.401). Significant mortality predictors in South Korea included age ≥65 years (odds ratio [OR], 4.03; P=0.039) and a Sequential Organ Failure Assessment score ≥8 (OR, 2.36; P=0.031). The presence of respiratory therapists was associated with reduced mortality (OR, 0.52; P=0.034).</p><p><strong>Conclusions: </strong>Despite higher age and patient-to-nurse ratios in South Korean ICUs, outcomes were comparable to those in other high-income Asian countries. The suboptimal use of sufficient PEEP with ARDS indicates potential areas for improvement. Additionally, the beneficial impact of respiratory therapists on mortality rates warrants further investigation.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"413-424"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A simplified physicochemical approach to acid-base disorders: perioperative practical application.","authors":"Gabriel Henrique Reis, Lais Mendes Viana, Victor Toledo Guillarducci, Marina Ayres Delgado","doi":"10.4266/acc.001125","DOIUrl":"10.4266/acc.001125","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"509-511"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of medical crisis on the critical care system in South Korea.","authors":"Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-Kyung Kim, Dong Hyun Lee, Suk-Kyung Hong","doi":"10.4266/acc.000575","DOIUrl":"10.4266/acc.000575","url":null,"abstract":"<p><strong>Background: </strong>The ongoing medical crisis in Korea has severely impacted the operational environment of intensive care units (ICU), posing significant challenges to quality care for critically ill patients. This study aimed to evaluate the effects of the ongoing crisis on ICUs.</p><p><strong>Methods: </strong>A survey was conducted in July 2024 among intensivists in charge of ICUs at institutions accredited by the Korean Society of Critical Care Medicine for critical care. The survey compared data from January 2024 (pre-crisis) and June 2024 (post-crisis) on the number ICU beds, staffing composition, work hours, and the number and roles of nurse practitioners.</p><p><strong>Results: </strong>Among the total of 71 participating ICUs, 22 experienced a reduction in the number of operational beds, with a median decrease of six beds per unit, totaling 127 beds across these ICUs. The numbers of residents and interns decreased from an average of 2.3 to 0.1 per ICU, and the average weekly working hours of intensivists increased from 62.3 to 78.8 hours. Nurse practitioners helped fill staffing gaps, with their numbers rising from 150 to 242 across ICUs, and their scope of practice expanded accordingly.</p><p><strong>Conclusions: </strong>The medical crisis has led to major changes in the critical care system, including staffing shortages, increased workloads, and an expanded role for nurse practitioners. This is a critical moment to foster interest and engage in active discussions aimed at creating a sustainable and resilient ICU system.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"393-401"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional support in critical care: estimating resting energy expenditure in the intensive care unit when indirect calorimetry is limited.","authors":"Jeong Yun Park","doi":"10.4266/acc.003100","DOIUrl":"10.4266/acc.003100","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"505-506"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction: A deep learning model for estimating sedation levels using heart rate variability and vital signs: a retrospective cross-sectional study at a center in South Korea.","authors":"You Sun Kim, Bongjin Lee, Wonjin Jang, Yonghyuk Jeon, June Dong Park","doi":"10.4266/acc.2024.01200.r1","DOIUrl":"10.4266/acc.2024.01200.r1","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"512"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dopamine in cardiogenic shock: a silent star?","authors":"Alaa Rahhal, Amr Salah Omar","doi":"10.4266/acc.004200","DOIUrl":"10.4266/acc.004200","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"507-508"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive care unit-acquired muscle atrophy and weakness in critical illness: a review of long-term recovery strategies.","authors":"Nobuto Nakanishi","doi":"10.4266/acc.001450","DOIUrl":"10.4266/acc.001450","url":null,"abstract":"<p><p>Intensive care unit (ICU)-acquired muscle atrophy and weakness are key contributors to post-intensive care syndrome (PICS), which can lead to long-term functional impairments. Although the ICU survival rate has improved, many patients continue to experience persistent functional impairments that hinder their reintegration into society. This review summarizes a series of observational and interventional studies conducted as part of the Muscle Atrophy Zero Project, focusing on the etiology, assessment, and prevention of ICU-acquired muscle atrophy and weakness. The project findings highlight the critical role of inflammation, particularly neutrophil infiltration, in the pathogenesis of muscle atrophy. Muscle damage can be assessed using ultrasound, bioelectrical impedance analysis, and urinary titin. Among them, ultrasound demonstrates high diagnostic accuracy for detecting low muscularity, and urinary titin has emerged as a promising biomarker of muscle degradation. Preventive strategies include early rehabilitation, neuromuscular electrical stimulation, vibration therapy, and nutritional support, especially protein supplementation. These multimodal interventions have shown efficacy in mitigating ICU-acquired muscle atrophy and weakness. However, follow-up systems for PICS remain underdeveloped. A continual multimodal intervention approach that combines physical rehabilitation with nutritional therapy is essential. The development of structured follow-up programs is vitally needed to confront the long-term challenges posed by PICS.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"361-372"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing delirium management to promoting critically ill patients' safety: an umbrella review.","authors":"Daniela Carvalho Plácido, Maria do Rosário Pinto, Maria Cândida Durão, Helga Rafael Henriques, Joana Ferreira Teixeira","doi":"10.4266/acc.005221","DOIUrl":"10.4266/acc.005221","url":null,"abstract":"<p><p>Delirium is an acute disorder characterized by changes in the patient's cognitive function, which another neurocognitive or pre-existing disease cannot explain. It produces adverse outcomes for critically ill patients and their families related to adverse events associated with the accidental removal of medical devices that increase the risk of the patient and the length of stay at the hospital, manifested by agitation and confusion behaviors. Five reviewers conducted An Umbrella Review from May to August 2023 through research in the databases Medline, CINAHL, Scopus, Web of Science, Cochrane Database of Systematic Reviews and articles obtained through research in other sources. After verifying their eligibility, we obtained 22 systematic reviews and meta-analyses for data extraction and analysis. From the results obtained, the importance of the implementation of surveillance interventions and systematic evaluation of the presence of delirium is highlighted, with particular emphasis on the use of the scale, Confusion Assessment Method, followed by the implementation of multicomponent interventions, pharmacological or not, highlighting the use of dexmedetomidine and family as support, as well early mobilization for the management of delirium. Managing delirium in critically ill patients based on Meyer and Lavin's theory, is an area sensitive to nursing care with an impact on the prevention of complications and consequent promotion of the safety of these patients, which also translates into positive results for the family and health organizations, reducing morbidity, mortality, length of stay and health costs.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"373-392"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning-based model for detection of intracranial waveforms with poor brain compliance in southern Thailand.","authors":"Thara Tunthanathip, Avika Trakulpanitkit","doi":"10.4266/acc.001425","DOIUrl":"10.4266/acc.001425","url":null,"abstract":"<p><strong>Background: </strong>Intracranial pressure (ICP) waveform analysis provides critical insights into brain compliance and can aid in the early detection of neurological deterioration. Deep learning (DL) has recently emerged as an effective approach for analyzing complex medical signals and imaging data. The aim of the present research was to develop a DL-based model for detecting ICP waveforms indicative of poor brain compliance.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using ICP wave images collected from postoperative hydrocephalus (HCP) patients who underwent ventriculostomy. The images were categorized into normal and poor compliance waveforms. Precision, recall, mean average precision at the 0.5 intersection over union (mAP_0.5), and the area under the receiver operating characteristic curve (AUC) were used to test.</p><p><strong>Results: </strong>The dataset consisted of 2,744 ICP wave images from 21 HCP patients. The best-performing model achieved a precision of 0.97, a recall of 0.96, and a mAP_0.5 of 0.989. The confusion matrix for poor brain compliance waveform detection using the test dataset also demonstrated a high classification accuracy, with true positive and true negative rates of 48.5% and 47.8%, respectively. Additionally, the model demonstrated high accuracy, achieving a mAP_0.5 of 0.994, sensitivity of 0.956, specificity of 0.970, and an AUC of 0.96 in the detection of poor compliance waveforms.</p><p><strong>Conclusions: </strong>The DL-based model successfully detected pathological ICP waveforms, thereby enhancing clinical decision-making. As DL advances, its significance in neurocritical care will help to pave the way for more individualized and data-driven approaches to brain monitoring and management.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"473-481"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaphragm ultrasound for predicting weaning success in post-cardiac surgery acute respiratory distress syndrome patients: a prospective observational study in China.","authors":"Yuan-Qin Huang, Pei Yu, Dou-Dou Xiang, Quan Gan","doi":"10.4266/acc.004320","DOIUrl":"10.4266/acc.004320","url":null,"abstract":"<p><strong>Background: </strong>To explore the value of the diaphragm thickness fraction (TF) and diaphragm mobility (DM) measured by ultrasound for predicting ventilator withdrawal success in patients with acute respiratory distress syndrome (ARDS) after cardiac surgery.</p><p><strong>Methods: </strong>This study included 246 patients undergoing the spontaneous breathing trial. Diaphragmatic function was evaluated by ultrasound, including the diaphragm thickness at the end of calm breathing (thickness of the diaphragm at functional residual capacity [TdiFRC]) and the maximum diaphragm thickness at the end of inspiration (thickness of the diaphragm at full vital capacity [TdiFVC]); TF=(TdiFVC-TdiFRC)/TdiFRC×100%. DM, the oxygenation index (the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen), and the rapid shallow breathing index (RSBI) were measured.</p><p><strong>Results: </strong>Successful liberation from mechanical ventilation was observed in 209 patients. There were no significant differences in the TdiFRC (0.3±0.1 cm vs. 0.3±0.1 cm) or TdiFVC (0.3±0.1 cm vs. 0.2±0.1 cm) between the ventilator withdrawal success group and the ventilator withdrawal failure group (P>0.05). The TF was greater in the ventilator withdrawal success group than in the ventilator withdrawal failure group (40.8%±15.8% vs. 37.7%±9.2%, P<0.01). DM in the ventilator withdrawal success group was greater than that in the ventilator withdrawal failure group (1.5±0.5 cm vs. 1.2±0.4 cm, P=0.040). The RSBI was lower in the ventilator withdrawal success group than in the ventilator withdrawal failure group (74.3±25.6 breaths·min-1·L -1 vs. 89.9±34.5 breaths·min-1·L -1, P<0.01).</p><p><strong>Conclusions: </strong>Diaphragmatic ultrasound can be used to predict the success of ventilator withdrawal in patients with ARDS.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 3","pages":"435-443"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}