Acute and Critical Care最新文献

{"title":"Challenges and strategies for the identification and correction of patient-ventilator asynchronies in daily practice: a scoping review.","authors":"Andrés Mauricio Enríquez Popayán, Katerina Vaporidi, Henry Mauricio Parada-Gereda, Lluís Blanch","doi":"10.4266/acc.006050","DOIUrl":"10.4266/acc.006050","url":null,"abstract":"<p><p>Patient-ventilator asynchronies (PVA) are associated with adverse clinical outcomes, including prolonged ventilatory support and increased mortality both in the intensive care unit (ICU) and at the hospital level. Despite their clinical relevance, the detection and management of PVA remain challenging in daily practice because of multiple factors, such as the lack of continuous monitoring and the low recognition by healthcare professionals. The aim of this review is to map and synthesize the available evidence on the main challenges in the identification and management of PVA and to describe the strategies proposed to overcome them. We conducted a scoping review following Joanna Briggs Institute guidance and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PubMed/ Medline, Scopus, ScienceDirect, LILACS, and the Cochrane Library were searched from inception to April 2025. Two reviewers independently screened records and selected eligible studies. Data were charted using a standardized extraction form, and findings were synthesized descriptively. The identified challenges were categorized into three main groups, and the proposed strategies were classified according to the type of challenge addressed. The scoping review included 33 studies published between 2000 and 2025. Of these, 18 provided explanatory evidence, whereas 16 described strategies for addressing challenges in daily clinical practice. Overall, this scoping review identified 15 distinct challenges. This review highlights the multifaceted challenges affecting the recognition and management of PVA in adult ICU patients. By mapping challenges across clinical, structural, and cultural domains and summarizing strategies to address them, this review provides professionals with a practical framework to improve patient-ventilator interaction.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"493-505"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931681","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":"Decisions about palliative care and social determinants of health in intensive care units: a scoping review.","authors":"Hyeyoung Yun, Jung Yeon Kim, Eugene Han, Yeonsoo Jang","doi":"10.4266/acc.005000","DOIUrl":"10.4266/acc.005000","url":null,"abstract":"<p><p>Social determinants of health (SDoH) play important roles not only in a patient's health status but also in access to palliative care, the family's decision-making process, and the formation of patient values and preferences. In this scoping review, we analyze the social determinants that influence palliative care decision-making and examine the relationship between palliative care decisions and SDoH in the intensive care unit (ICU). We conducted a literature search of five databases including the search terms \"Intensive care units,\" \"palliative care,\" and \"social determinants of health.\" The search was limited to English publications from January 2015 to March 2025. Out of a total of 3,575 studies, we selected 20 for further review. Of those 20 studies, some reported that SDoH such as age, race, financial status, religion, sex, region or country, education level, and language proficiency affected decisions regarding ICU palliative care and whether to discontinue life support treatment. The reviewed studies of SDoH-related palliative care in the ICUs focused on aspects of palliative care associated with treatment withholding and withdrawing life support treatment. This study underscores the importance of integrating SDoH with clinical indicators in decision-making processes for palliative care in the ICU. Although establishing definitive relationships between SDoH and ICU palliative care decisions remains challenging, our findings highlight the potential impacts of social factors on care planning. Further research across various clinical settings is essential to clarify this relationship to develop more comprehensive and equitable palliative care strategies.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"515-527"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279137","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 nationwide 1-day point-prevalence study on rehabilitation practices for intensive care unit patients in South Korea.","authors":"Jiyeon Kang, Myung-Jun Shin, Suk-Kyung Hong, Min-Hyung Rhee, Jinhee Jung, Jiwon Hong","doi":"10.4266/acc.006225","DOIUrl":"10.4266/acc.006225","url":null,"abstract":"<p><strong>Background: </strong>Early rehabilitation is important in critical care, but nationwide data on rehabilitation practices in Korean intensive care units (ICUs) are lacking. This study reports the findings of a 1-day point-prevalence survey to assess current ICU rehabilitation practices and associated ICU characteristics.</p><p><strong>Methods: </strong>A nationwide, 1-day point-prevalence survey was conducted on December 18, 2024, across 116 ICUs with a 24-hour follow-up. Data were collected at the ICU level and included ICU characteristics, staffing and equipment, the total number of admitted patients, the number of patients receiving rehabilitation, types and frequency of interventions, and reasons for non-provision.</p><p><strong>Results: </strong>Complete data were obtained for 1,529 patients from 116 ICUs. Among them, 374 patients (24.5%) received at least one rehabilitation intervention on the survey day. A total of 968 recorded rehabilitation interventions were delivered, of which 70.5% were physical and 23.1% respiratory rehabilitation. Most physical rehabilitation consisted of in-bed activities, while out-ofbed mobilization accounted for only 7.3% of all recorded rehabilitation interventions. Both the overall rehabilitation rate and out-of-bed mobilization were significantly higher in ICUs within larger hospitals and those with specialized rehabilitation personnel.</p><p><strong>Conclusions: </strong>Rehabilitation was delivered to 24.5% of ICU patients present on the survey day, with out-of-bed mobilization representing a small proportion of recorded rehabilitation interventions. These findings describe rehabilitation delivery at the population level of surveyed ICU inpatients rather than uptake among medically eligible patients. Broader implementation of ICU rehabilitation may require institutional and systemic support, including dedicated rehabilitation personnel, reduced ICU workload burden, and consideration of appropriate reimbursement structures.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"528-541"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931546","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":"Admission characteristics and factors associated with outcomes in elderly patients aged 75 years and older in a level 3 ICU in Nepal: a 4-year registry-based retrospective study.","authors":"Kishor Khanal, Saroj Poudel, Sunidhi Aryal, Rabin Bhurtel, Anup Ghimire, Ashim Regmi","doi":"10.4266/acc.002912","DOIUrl":"10.4266/acc.002912","url":null,"abstract":"<p><strong>Background: </strong>The global rise in elderly populations has led to increasing admissions of older adults to intensive care units (ICUs). Understanding predictors of mortality in the very elderly is essential, particularly in low- and middle-income countries (LMICs) where ICU resources are limited.</p><p><strong>Methods: </strong>This retrospective observational study analyzed 1,028 ICU patients aged ≥75 years admitted to a level 3 ICU in Nepal. Demographics, comorbidities, frailty score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, interventions, and outcomes were collected. Univariate analysis, bivariate analysis, and multivariate logistic regression were used for statistical analysis to determine independent predictors of ICU mortality.</p><p><strong>Results: </strong>The cohort had a mean age of 82±5 years and 58.1% were male. ICU mortality was 17.5%. Non-survivors were older and had higher APACHE II scores, more comorbidities, and a greater requirement for mechanical ventilation and vasopressors than survivors. Logistic regression identified age (adjusted odds ratio [aOR], 1.05), comorbidity burden (aOR, 1.40), APACHE II score (aOR, 1.08), mechanical ventilation (aOR, 2.10), and the use of vasopressors (aOR, 1.80) as independent predictors of mortality. Frailty, sex, aggressiveness of therapy, and primary system involvement were not independently associated with ICU mortality.</p><p><strong>Conclusions: </strong>Age, comorbidity burden, and organ support requirements strongly predicted mortality among elderly ICU patients in Nepal. These findings support early risk stratification, prognostic assessment, and informed clinical discussions in resource-limited ICU settings.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"542-549"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799061","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":"Evaluation for delirium and cognitive function in intensive care unit: reliability and validity of the Jikei Command following Scale in Japan.","authors":"Masachika Niimi, Yuki Hasegawa, Kensuke Taguchi, Hiroshi Ito, Kenji Higuchi, Masahiro Abo","doi":"10.4266/acc.000936","DOIUrl":"10.4266/acc.000936","url":null,"abstract":"<p><strong>Background: </strong>We developed a novel evaluation for delirium and cognitive function named Jikei Command following Scale (JCoS). The objective of this study was to examine the reliability and validity of the JCoS.</p><p><strong>Methods: </strong>JCoS consists of 8 subitems (1, hand holding and releasing; 2, plantar dorsiflexion; 3, eye opening and closing; 4, visual pursuit; 5, mouth opening; 6, neck movement; 7, two-step command; and 8, movement sustainment). Fifty patients in the intensive care unit (ICU) participated in this study. Cronbach's alpha coefficient of JCoS total score was used for internal consistency. Intraclass correlation coefficient (ICC case 2) was used for inter-examiner reliability. The kappa coefficients for each subitem score were calculated. Concurrent validity was examined by correlation with Confusion Assessment Method for the ICU (CAM-ICU) and intensive care delirium screening checklist (ICDSC). Mini-Mental State Examination (MMSE) 2 weeks after leaving the ICU was used for predictive validity.</p><p><strong>Results: </strong>The Cronbach's alpha coefficient of the JCoS Score was 0.967. The ICC (2,1) of the JCoS Score was 0.933. The kappa coefficients of each subitem were 0.668 for 1, 0.534 for 2, 0.346 for 3, 0.721 for 4, 0.474 for 5, 0.625 for 6, 0.724 for 7, and 0.709 for 8. Correlation coefficient between JCoS and the ICDSC was -0.843, and the correlation ratio between JCoS and CAM-ICU was -0.881. Correlation coefficient between JCoS and MMSE was 0.632.</p><p><strong>Conclusions: </strong>These results suggest that JCoS has sufficient reliability and validity for evaluating about delirium and cognitive function in ICU.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"621-630"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563274","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":"Prognostic value of day 10 mobilization status for ambulation at hospital discharge in critically ill patients: a historical cohort study in Japan.","authors":"Tsubasa Watanabe, Masatoshi Hanada, Yudai Yano, Masato Oikawa, Yosuke Morimoto, Takuya Fukushima, Hiroki Nagura, Yasutomo Tanaka, Rina Takeuchi, Terumitsu Sawai, Motohiro Sekino, Ryo Kozu","doi":"10.4266/acc.003775","DOIUrl":"10.4266/acc.003775","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients often have long-lasting limitations in activities of daily living, particularly in walking ability. Although early mobilization increases the likelihood of independent ambulation at hospital discharge, the timing at which different mobilization levels become associated with ambulatory recovery is unclear. This study describes the timing for achieving several mobilization levels and its associations with ambulatory recovery at hospital discharge.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, patients were divided into a regained group, composed of patients whose ambulation recovered to pre-intensive care unit (ICU) admission levels by hospital discharge, and a non-regained group. Multivariable logistic regression analyses and receiver operating characteristic curve analyses were performed to examine the association between the timing of mobilization (standing, marching in place, and assisted walking) and regained ambulation at hospital discharge.</p><p><strong>Results: </strong>In total, 295 patients were included, and 223 (76%) of them had regained ambulation at hospital discharge. The adjusted odds ratio for standing peaked on day 10 after ICU admission (odds ratio, 5.61; 95% CI, 2.21-17.76) and declined thereafter. The optimal cutoff time linking marching in place and walking with assistance to regained ambulation was also day 10 after ICU admission (marching in place: area under the curve [AUC], 0.78; sensitivity, 0.83; specificity, 0.64; and walking with assistance: AUC, 0.79; sensitivity, 0.77; specificity, 0.68).</p><p><strong>Conclusions: </strong>The findings suggest that mobility status on day 10 after ICU admission can serve as a pragmatic marker for identifying patients at risk of poor ambulatory recovery.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"670-680"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563281","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":"Precision therapy for endotoxic septic shock: a step toward personalized treatment from EUPHAS to TIGRIS.","authors":"Su Hwan Lee","doi":"10.4266/acc.007228","DOIUrl":"10.4266/acc.007228","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"701-707"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931659","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":"Pediatric post-intensive care malnutrition-risk factors and their association with long-term functional outcomes 1 year after discharge: a retrospective cohort study in Thailand.","authors":"Kamolmart Wannaphahoon, Chanapai Chaiyakulsil","doi":"10.4266/acc.005650","DOIUrl":"10.4266/acc.005650","url":null,"abstract":"<p><strong>Background: </strong>Data on the long-term nutritional status of pediatric intensive care unit (PICU) survivors are limited, and the association with functional outcomes is unknown. The primary objectives were to determine the prevalence of post-intensive care malnutrition and its relationship with functional outcomes at 1 month and 1 year after PICU discharge.</p><p><strong>Methods: </strong>A retrospective chart review of all children aged 1 month to 15 years who were admitted to the PICU for >48 hours from July 2019 to January 2024 and had visits to the pediatric post-intensive care clinic at 1 month and 1 year after hospital discharge was conducted. Malnutrition was categorized using the body mass index according to the World Health Organization Growth Reference. Functional outcome was classified using the Pediatric Cerebral Performance Category.</p><p><strong>Results: </strong>A total of 129 children were included in the final analysis. Malnutrition was observed in 46 children (35.6%) at 1 month after discharge and in 29 children (22.5%) at 1 year after discharge. Children with baseline malnutrition were associated with malnutrition at both follow-up time points. Longer ventilator days were observed among children with malnutrition at both time points, and children who had malnutrition at 1 year had longer PICU stays. At least moderate dysfunction was associated with any malnutrition and wasting at 1 year after discharge, but not with overweight.</p><p><strong>Conclusions: </strong>Malnutrition was found in a substantial proportion of PICU survivors, with an association with poor long-term Pediatric Cerebral Performance Category-related functional outcomes. Long-term nutritional follow-up and support should be warranted to optimize outcomes.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"641-653"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931684","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":"Rapid microbiological diagnostics for sepsis in critical care: integrating technological advances with antimicrobial stewardship.","authors":"Kye-Hyung Kim, Jongyoun Yi","doi":"10.4266/acc.003224","DOIUrl":"10.4266/acc.003224","url":null,"abstract":"<p><p>Sepsis is a life-threatening medical emergency in which prompt initiation of targeted antimicrobial therapy is crucial for patient survival. Historically, clinicians have relied on empirical broad-spectrum antibiotics owing to the 48-to-72-hour turnaround time of conventional blood cultures, while traditional host-response biomarkers offer limited pathogen-specific utility. This review highlights the recent paradigm shift in the microbiological diagnostics for sepsis, which is transitioning from conventional methods to rapid diagnostic tests (RDTs). Pre-analytic considerations for blood culture are of paramount importance as the foundation for all downstream RDT applications. We explore the clinical integration of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and highly multiplexed genotypic assays, which provide rapid species identification and limited profiles of genotypic resistance directly from positive blood cultures. The critical need for rapid phenotypic antimicrobial susceptibility testing is addressed, alongside the emerging technologies for culture-independent microbial detection. Crucially, technological advancement alone is insufficient: the true clinical benefits of RDTs would be achieved only when RDTs are coupled with robust diagnostic and antimicrobial stewardship programs. In the context of globally escalating antimicrobial resistance, and with a specific focus on the high prevalence of multidrug-resistant organisms in South Korea, the seamless integration of these advanced diagnostic systems into multidisciplinary clinical workflows underscores the urgency and opportunities of this paradigm shift.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"466-479"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931707","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":"Nutrition as a neglected domain of post-intensive care syndrome in children.","authors":"Insu Choi, Woo Kyung Kim, Hwa Jin Cho","doi":"10.4266/acc.009724","DOIUrl":"10.4266/acc.009724","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 3","pages":"708-710"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931674","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}