Acute and Critical Care最新文献

{"title":"Performance evaluation of non-invasive cardiac output monitoring device (HemoVista) based on multi-channel thoracic impedance plethysmography technology.","authors":"Jaehee Park, Byung-Moon Choi","doi":"10.4266/acc.2024.00731","DOIUrl":"10.4266/acc.2024.00731","url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"565-572"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669596","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":"Early management of adult sepsis and septic shock: Korean clinical practice guidelines.","authors":"Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, Ala Woo, Sua Kim, Dae-Hwan Bae, Sung Wook Kang, Sun Hyo Park, Gee Young Suh, Sunghoon Park","doi":"10.4266/acc.2024.00920","DOIUrl":"10.4266/acc.2024.00920","url":null,"abstract":"<p><strong>Background: </strong>Despite recent advances and global improvements in sepsis recognition and supportive care, mortality rates remain high, and adherence to sepsis bundle components in Korea is low. To address this, the Korean Sepsis Alliance, affiliated with the Korean Society of Critical Care Medicine, developed the first sepsis treatment guidelines for Korea based on a comprehensive systematic review and meta-analysis.</p><p><strong>Methods: </strong>A de novo method was used to develop the guidelines. Methodologies included determining key questions, conducting a literature search and selection, assessing the risk of bias, synthesizing evidence, and developing recommendations. The certainty of evidence and the strength of recommendations were determined using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Draft recommendations underwent internal and external review processes and public hearings. The development of these guidelines was supported by a research grant from the Korean Disease Control and Prevention Agency.</p><p><strong>Results: </strong>In these guidelines, we focused on early treatments for adult patients with sepsis and septic shock. Through the guideline development process, 12 key questions and their respective recommendations were formulated. These include lactate measurement, fluid therapies, target blood pressure, antibiotic administration, use of vasopressors and dobutamine, extracorporeal membrane oxygenation, and echocardiography.</p><p><strong>Conclusions: </strong>These guidelines aim to support medical professionals in making appropriate decisions about treating adult sepsis and septic shock. We hope these guidelines will increase awareness of sepsis and reduce its mortality rate.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"39 4","pages":"445-472"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773386","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":"Red blood cell transfusion for critically ill patients admitted through the emergency department in South Korea.","authors":"Tae Sung Kim, Yongil Cho, Hyuk Joong Choi, Joonbum Park, Wonhee Kim, Chiwon Ahn, Joon Young Kim","doi":"10.4266/acc.2024.00577","DOIUrl":"10.4266/acc.2024.00577","url":null,"abstract":"<p><strong>Background: </strong>Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.</p><p><strong>Methods: </strong>This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.</p><p><strong>Results: </strong>Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.</p><p><strong>Conclusions: </strong>Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"517-525"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669625","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":"Isolated reversible mydriasis was associated with the use of nebulized ipratropium bromide: a case series using quantitative pupilometer in Korea.","authors":"Soo-Hyun Park, Tae Jung Kim, Sang-Bae Ko","doi":"10.4266/acc.2024.00983","DOIUrl":"10.4266/acc.2024.00983","url":null,"abstract":"<p><strong>Background: </strong>Abnormal pupillary reactivity is a neurological emergency requiring prompt evaluation to identify its underlying causes. Although isolated unilateral mydriasis without accompanying neurological abnormalities is rare, it has occasionally been associated with nebulizer use. We aimed to quantitatively assess pupillary changes using a pupillometer in cases of isolated mydriasis, which has not been described in previous studies.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who developed unilateral mydriasis after using an ipratropium bromide nebulizer using a prospectively collected database in the intensive care unit (ICU) between April 2019 and August 2020. An automated pupillometer (NPi-100 or NPi-200) was used for quantitative pupillary assessment. The Neurological Pupil index (NPi) value at the time of unilateral mydriasis was assessed, and the latency before and after the application of the ipratropium bromide nebulizer was measured.</p><p><strong>Results: </strong>Five patients with isolated mydriasis were identified (mean age, 68 years; male, 60.0%), none of whom had neurological abnormalities other than pupillary light reflex abnormalities. A quantitative pupillometer examination revealed that the affected pupil was larger (5.67 mm vs. 3.20 mm) and had lower NPi values (0.60 vs. 3.40) than the unaffected side. These abnormalities resolved spontaneously without treatment (pupil size, 3.40 mm; NPi, 3.90). The affected pupil had a prolonged latency of 0.38 seconds (vs. 0.28 seconds), which improved to 0.30 seconds with the resolution of the anisocoria.</p><p><strong>Conclusions: </strong>In the ICU setting, it is important to keep in mind the ipratropium bromide nebulizer as the benign cause of unilateral mydriasis. Further, an automated pupilometer may be a useful tool for evaluating unilateral mydriasis.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"593-599"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716426","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":"Challenges of implementing the hour-1 sepsis bundle: a qualitative study from a secondary hospital in Indonesia.","authors":"Priyo Sasmito, Satriya Pranata, Rian Adi Pamungkas, Etika Emaliyawati, Nisa Arifani","doi":"10.4266/acc.2023.01473","DOIUrl":"10.4266/acc.2023.01473","url":null,"abstract":"<p><strong>Background: </strong>Good sepsis management is key to successful sepsis therapy and optimal patient outcomes. Objectives: This study aimed to determine obstacles among nurses and doctors to implementing the hour-1 sepsis bundle in a secondary hospital in Indonesia.</p><p><strong>Methods: </strong>This was a qualitative study with a phenomenological approach. Data were obtained from one-on-one in-depth interviews with 13 doctors and nurses in the intensive care unit and emergency department who were purposively sampled. Data were analyzed using content analysis.</p><p><strong>Results: </strong>Five main themes were revealed in the analysis: incomplete implementation of the hour-1 sepsis bundle, lack of knowledge about the hour-1 sepsis bundle, cost issues, lack of supporting facilities, and lack of coordination among health workers.</p><p><strong>Conclusions: </strong>Optimizing regional health laboratories, optimizing the use of quick Sequential Organ Failure Assessment (qSOFA) and SOFA, and creating a series of sepsis protocols within the hospital are some solutions that secondary hospitals can implement to ensure appropriate management of sepsis cases. Involvement of health policyholders and hospital management is needed to address these challenges.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"545-553"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733335","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":"Incidence of hypoglycemia in hyperkalemia patients after treatment with insulin and dextrose in the emergency department of a tertiary care hospital in India: a prospective observational study.","authors":"Vivek Chaurasia, Nayer Jamshed, Praveen Aggrawal, Sanjeev Bhoi, Meera Ekka, Tej Prakash Sinha, Akshay Kumar, Prakash Ranjan Mishra, Anand Kumar Das","doi":"10.4266/acc.2024.00661","DOIUrl":"10.4266/acc.2024.00661","url":null,"abstract":"<p><strong>Background: </strong>Hypoglycemia is a serious, often overlooked complication of treating hyperkalemia with insulin and dextrose. If not recognized and managed, it can increase morbidity and mortality. This study aimed to estimate the incidence of hypoglycemia in hyperkalemic patients treated with 10 units of intravenous insulin, 50 ml of 50% dextrose, 10 ml of 10% calcium gluconate, and salbutamol nebulization. Additionally, the timing of hypoglycemia onset and its associated factors were studied.</p><p><strong>Methods: </strong>This prospective observational study included hyperkalemic patients (serum potassium >5.5 mmol/L) who visited the emergency department between January 26, 2020, and August 26, 2021. The primary outcome was hypoglycemia (blood glucose <70 mg/dl) within 3 hours of receiving the standard treatment. Glucose levels were measured hourly for 3 hours. Univariate and multivariate logistic regression identified factors associated with hypoglycemia.</p><p><strong>Results: </strong>Of 100 patients, 69% were male, and the median age was 46 years (IQR, 30-60 years). Hypoglycemia occurred in 44%, and 10% developed severe hypoglycemia (blood glucose <54 mg/dl). The median time for hypoglycemia onset was 2 hours (IQR, 1-2 hours). Low pretreatment blood glucose (<100 mg/dl) was significantly associated with hypoglycemia, according to both univariate and multivariate analyses.</p><p><strong>Conclusions: </strong>The study found a higher incidence of hypoglycemia in hyperkalemia treatment than reported in retrospective studies, suggesting the need for standardized management protocols with integrated glucose monitoring.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"499-506"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733341","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":"The efficacy of intensivist-led closed-system intensive care units in improving outcomes for cancer patients requiring emergent surgical intervention.","authors":"Eun Young Kim","doi":"10.4266/acc.2024.01256","DOIUrl":"10.4266/acc.2024.01256","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"39 4","pages":"640-642"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773387","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":"Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India.","authors":"Naveen Paliwal, Pooja Bihani, Rishabh Jaju, Sadik Mohammed, Prabhu Prakash, Vidya Tharu","doi":"10.4266/acc.2024.00101","DOIUrl":"10.4266/acc.2024.00101","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay.</p><p><strong>Methods: </strong>A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004).</p><p><strong>Conclusions: </strong>The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"535-544"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669626","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":"Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea.","authors":"Jae Hoon Lee, Jee Hee Kim, Ki Ho You, Won Ho Han","doi":"10.4266/acc.2024.00808","DOIUrl":"10.4266/acc.2024.00808","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs.</p><p><strong>Methods: </strong>This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality.</p><p><strong>Results: </strong>Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU.</p><p><strong>Conclusions: </strong>Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"554-564"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733336","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":"Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation: review with updated evidence.","authors":"Yongwhan Lim, Min Chul Kim, In-Seok Jeong","doi":"10.4266/acc.2024.00801","DOIUrl":"10.4266/acc.2024.00801","url":null,"abstract":"<p><p>Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to treat medically refractory cardiogenic shock and cardiac arrest, and its usage has increased exponentially over time. Although VA-ECMO has many advantages over other mechanical circulatory supports, it has the unavoidable disadvantage of increasing retrograde arterial flow in the afterload, which causes left ventricular (LV) overload and can lead to undesirable consequences during VA-ECMO treatment. Weak or no antegrade flow without sufficient opening of the aortic valve increases the LV end-diastolic pressure, and that can cause refractory pulmonary edema, blood stagnation, thrombosis, and refractory ventricular arrhythmia. This hemodynamic change is also related to an increase in myocardial energy consumption and poor recovery, making LV unloading an essential management issue during VA-ECMO treatment. The principal factors in effective LV unloading are its timing, indications, and modalities. In this article, we review why LV unloading is required, when it is indicated, and how it can be achieved.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"473-487"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716642","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}