Acute and Critical Care最新文献

{"title":"Trends and management of acute respiratory failure in hospitalized patients: a multicenter retrospective study in South Korea.","authors":"Won Jin Yang, Yong Jun Choi, Kyung Soo Chung, Ji Soo Choi, Bo Mi Jung, Jae Hwa Cho","doi":"10.4266/acc.004728","DOIUrl":"10.4266/acc.004728","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory failure (ARF) is the leading cause of hospitalization and is associated with in-hospital mortality. This study aimed to elucidate the epidemiology and clinical outcomes of ARF.</p><p><strong>Methods: </strong>We retrospectively screened patients admitted to three hospitals in South Korea between January 2018 and December 2022. We included individuals aged 18 years, diagnosed with either type 1 ARF (arterial oxygen partial pressure [PaO2] <60 mm Hg) or type 2 ARF (arterial carbon dioxide partial pressure (PaCO2) >45 mm Hg) with a pH of <7.35, or diagnosed with the combined-type ARF.</p><p><strong>Results: </strong>Among the 768,700 hospitalized patients, 33,278 (4.3%) developed ARF. The most common cause of ARF was sepsis (15,757 patients, 47.3%), and the most frequent comorbidity was malignancy (15,403 patients, 43.6%). Among ARF patients, 15,671 (47.1%) required intensive care unit transfer, while 8,980 (27.0%) experienced in-hospital mortality. Over 5 years, the proportion of ARF patients aged 80 years and older has shown a consistent annual increase (coefficient, 0.085 and Ptrend <0.001). Concurrently, the in-hospital mortality rate exhibited an upward trend, increasing from 25.5% in 2018 to 29.3% in 2022 (coefficient, 1.017 and Ptrend<0.001). Among the respiratory support methods used for patients with ARF over the 5-year period, high-flow nasal cannula usage steadily increased (coefficient, 4.137 and Ptrend<0.001), whereas the use of invasive mechanical ventilation declined (coefficient, -0.983 and Ptrend<0.001).</p><p><strong>Conclusions: </strong>ARF frequency and in-hospital mortality rates are increasing, driven by various etiologies. Despite these trends, research on the epidemiology and individualized treatments for older patients is limited, highlighting the need for nationwide prospective multicenter studies.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 2","pages":"171-185"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267569","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":"Anesthesiological management in endovascular mechanical thrombectomy: a propensity score-matched retrospective analysis in Italy.","authors":"Antonio Romanelli, Aniello Iovino, Antonella Langone, Rosa Napoletano, Giulia Frauenfelder, Flora Minichino, Liliana D'Ambrosio, Miriam Caterino, Raffaele Tortora, Renato Gammaldi, Paolo Barone, Renato Saponiero, Daniele Giuseppe Romano","doi":"10.4266/acc.003000","DOIUrl":"10.4266/acc.003000","url":null,"abstract":"<p><strong>Background: </strong>Endovascular mechanical thrombectomy (EMT) can be performed with general anesthesia (GA) or using non-GA techniques. Several meta-analyses on the topic have reported discordant main outcomes. The aim of this retrospective single-center study was to analyze the relationship between clinical outcomes and anesthesiological management (GA vs. non-GA) in patients who underwent EMT for acute anterior ischemic stroke (AIS).</p><p><strong>Methods: </strong>We performed a propensity score-matched (PSM) analysis of patients who underwent EMT for acute AIS from January 2018 to December 2021. For PSM, we chose covariates influencing clinical decisions about anesthesiological management. Comparisons between groups were performed with the chi-square test for categorical variables and Student t-test or the Mann-Whitney U-test for continuous variables as appropriate. The relationships between anesthesiological management and clinical outcomes were analyzed using logistic regression, and results are reported as odds ratios with 95% confidence intervals. A two-sided P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>From 194 observations (78 in the GA group, 116 in the non-GA group), after PSM, we obtained 70 data pairs. Both anesthesiological approaches resulted in similar rates of in-hospital mortality, 90-day functional independence, full recanalization, procedural complications, and intracerebral hemorrhage (ICH). Performing EMT with GA was unrelated to the in-hospital and 90-day death rates, 90-day functional independence, full recanalization rate, procedural complications, and ICH (P>0.05).</p><p><strong>Conclusions: </strong>Anesthesiological management did not influence clinical outcomes of EMT for acute AIS. Physiological stability during EMT may impact outcomes more significantly than anesthesiological management. Further studies on this topic are needed.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"252-263"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016748","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":"Using machine learning techniques for early prediction of tracheal intubation in patients with septic shock: a multi-center study in South Korea.","authors":"Ji Han Heo, Taegyun Kim, Tae Gun Shin, Gil Joon Suh, Woon Yong Kwon, Hayoung Kim, Heesu Park, Heejun Kim, Sol Han","doi":"10.4266/acc.004776","DOIUrl":"10.4266/acc.004776","url":null,"abstract":"<p><strong>Background: </strong>Patients with septic shock frequently require tracheal intubation in the emergency department (ED). However, the criteria for tracheal intubation are subjective, based on physician experience, or require serial evaluations over relatively long intervals to make accurate predictions, which might not be feasible in the ED. We used supervised learning approaches and features routinely available during the initial stages of evaluation and resuscitation to stratify the risks of tracheal intubation within a 24-hour time window.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of patients diagnosed with septic shock based on the SEPSIS-3 criteria across 21 university hospital EDs in the Republic of Korea. A principal component analysis revealed a complex, non-linear decision boundary with respect to the application of tracheal intubation within a 24-hour time window. Stratified five-fold cross validation and a grid search were used with extreme gradient boost. Shapley values were calculated to explain feature importance and preferences.</p><p><strong>Results: </strong>In total, data for 4,762 patients were analyzed; within that population, 1,486 (31%) were intubated within a 24-hour window, and 3,276 (69%) were not. The area under the receiver operating characteristic curve and F1 scores for intubation within a 24-hour window were 0.829 (95% CI, 0.801-0.878) and 0.654 (95% CI, 0.627-0.681), respectively. The Shapley values identified lactate level after initial fluids, suspected lung infection, initial pH, Sequential Organ Failure Assessment score at enrollment, and respiratory rate at enrollment as important features for prediction.</p><p><strong>Conclusions: </strong>An extreme gradient boosting machine can moderately discriminate whether intubation is warranted within 24 hours of the recognition of septic shock in the ED.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"221-234"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051548","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":"Biological age and clinical frailty scale measured at intensive care unit admission as predictors of hospital mortality among the critically ill in Western Australia: a retrospective cohort study.","authors":"Nicholas Phillip Anthony, Kwok Ming Ho","doi":"10.4266/acc.000200","DOIUrl":"10.4266/acc.000200","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a widely accepted predictor of health outcomes in patients including the critically ill. Biological age is also increasingly recognized as a determinant of chronic health outcomes. Whether these factors are independently predictive of mortality among the critically ill is unknown. We assessed whether biological age, measured as PhenoAge at Intensive Care Unit (ICU) admission, predicts mortality in critically ill patients independent of the Clinical Frailty Scale (CFS).</p><p><strong>Methods: </strong>This single-center retrospective cohort study included adult patients with available CFS and PhenoAge data at admission to ICU, excluding patients with incomplete records for key variables. The Levine PhenoAge model was used to estimate each patient's biological age (PhenoAge). PhenoAge was then calibrated to generate a regression residual to reflect excessive biological age unexplained by chronological age.</p><p><strong>Results: </strong>Of the 1,073 critically ill adult patients analyzed, 117 died (10.9%) before hospital discharge. PhenoAge and CFS were significantly correlated (correlation coefficient, 0.235; P=0.001). PhenoAge (receiver operating characteristic curve [AUROC], 0.622) and its residuals (AUROC, 0.627) and CFS (AUROC, 0.601) were predictive of hospital mortality, with no significant differences in their ability to differentiate between survivors and non-survivors (paired comparison to CFS: P=0.586 and P=0.537, respectively). PhenoAge interacted with frailty in its effect on mortality (P=0.004) which was particularly prominent among those who were not clinically frail (CFS ≤3).</p><p><strong>Conclusions: </strong>PhenoAge and CFS, both measured at ICU admission, independently predicted hospital mortality. PhenoAge showed a notable interaction with frailty, particularly in non-frail patients.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 2","pages":"264-272"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267547","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":"Neutrophil-to-lymphocyte-to-albumin ratio as a prognostic marker for mortality in sepsis and septic shock in Vietnam.","authors":"Nguyen Van Viet Thang, Le Thi Luyen, Nguyen Thi Tuong Vi, Pham Dang Hai","doi":"10.4266/acc.003576","DOIUrl":"10.4266/acc.003576","url":null,"abstract":"<p><strong>Background: </strong>Sepsis and septic shock are life-threatening global health challenges associated with high mortality rates. Early identification of high-risk patients is critical for improving outcomes. In the present study, the association between the neutrophil-to-lymphocyte-to-albumin ratio (NLAR) and mortality in septic patients was evaluated.</p><p><strong>Methods: </strong>A retrospective study was performed at a tertiary hospital in Vietnam. Patients ≥18 years of age diagnosed with sepsis or septic shock based on the Sepsis-3 criteria were included. Exclusion criteria included recent corticosteroid use within 7 days, autoimmune diseases, hematological disorders, and active cancer within 5 years. NLAR was calculated from complete blood counts and albumin levels within the first 24 hours of intensive care unit admission. Receiver operating characteristic (ROC) curves were used to determine the predictive ability of NLAR for in-hospital mortality.</p><p><strong>Results: </strong>The present study included 141 patients with a mean age of 72 years. Non-survivors were significantly older with higher rates of mechanical ventilation. NLAR was significantly elevated in non-survivors compared with survivors (0.88 [0.57-1.24] vs. 0.44 [0.28-0.77], P<0.001). In ROC analysis, the area under the curve for NLAR was 0.70 (P<0.001). Using a cutoff value of 0.56, NLAR showed a sensitivity of 77.8% and a specificity of 61.5% for predicting in-hospital mortality.</p><p><strong>Conclusions: </strong>Elevated NLAR on admission was associated with a higher mortality rate in sepsis patients. NLAR could be used as an early prognostic marker for sepsis mortality.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 2","pages":"244-251"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267551","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":"Survival improvement through well-designed intensive care unit architecture.","authors":"Dong Hyun Lee","doi":"10.4266/acc.001500","DOIUrl":"10.4266/acc.001500","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"40 2","pages":"349-350"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267553","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 ventricular unloading strategies in venoarterial extracorporeal membrane oxygenation patients: how much do we truly understand?","authors":"Jihyuk Chung, Su Yong Kim, Juhyun Lee, Yang Hyun Cho","doi":"10.4266/acc.005064","DOIUrl":"10.4266/acc.005064","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037839","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":"Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in Korea.","authors":"Min Kim, Ji Sung Lee, Seong-Joon Lee, So Young Park, Jungyun Seo, Ji Man Hong, Hee-Kwon Park, Jae-Kwan Cha, Jeffrey L Saver, Jin Soo Lee","doi":"10.4266/acc.004248","DOIUrl":"10.4266/acc.004248","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of intravenous tissue plasminogen activator (IV tPA) in patients with large-vessel occlusion (LVO) receiving endovascular treatment (EVT) for acute ischemic stroke (AIS) has been questioned. We investigated IV tPA effectiveness in real-world AIS patients, including those with intracranial LVO receiving EVT.</p><p><strong>Methods: </strong>We identified patients with AIS who presented to hospital with National Institutes of Health Stroke Scale ≥4 within 8 hours of symptom onset from the institutional stroke registry. The association of IV tPA use with effectiveness and safety outcomes was analyzed in overall enrolled AIS patients; LVO patients; and patients treated with EVT. The effect of IV tPA was assessed using multiple logistic regression.</p><p><strong>Results: </strong>Among the 654 patients meeting study entry criteria, 238 (36.4%) received IV tPA and 416 (63.6%) did not. Multiple logistic regression analysis and shift analysis revealed IV tPA was associated with improved outcomes in overall enrolled AIS population, LVO, and EVT-treated subgroups. Among EVT-treated patients, IV tPA was associated with higher likelihood of ambulatory or better outcome (modified Rankin Scale 0-3) with odds ratio of 1.95 (P=0.03).</p><p><strong>Conclusions: </strong>In this real-world study, IV tPA use was associated with improved outcomes for patients with AIS, including among LVO patients treated and not treated with EVT, in the contemporary mechanical thrombectomy era.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028937","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":"Characteristics and associated risk factors of exposure keratopathy among ventilated patients in intensive care units in Jordan","authors":"Sajeda Al-Tamimi, Mohammad Y N Saleh, Al-Mutez Gharaibeh, Farah Al-A'mar, Rasmieh Al-Amer","doi":"10.4266/acc.003648","DOIUrl":"10.4266/acc.003648","url":null,"abstract":"<p><strong>Background: </strong>Exposure keratopathy is the most common ocular surface disorder in ventilated patients due to poor eyelid closure, decreased blink reflex, and the inability to produce tears. Healthcare providers in intensive care units (ICUs) play a significant role in preventing exposure keratopathy through appropriate eyelid taping and eye ointments.</p><p><strong>Methods: </strong>This is a cross-sectional study to describe the characteristics and factors associated with exposure keratopathy in all mechanically ventilated patients admitted to an adult ICU between February and June 2023. Patients were examined for corneal changes using a corneal fluorescein staining test with a cobalt blue filter indirect ophthalmoscope.</p><p><strong>Results: </strong>Of 156 ventilated patients included in this study, 42.3% had exposure keratopathy, 13.5% had lagophthalmos, and 26.9% of patients had chemosis. For patients with a Glasgow Coma Scale (GCS) score of 3, the odds ratio of exposure keratopathy was 21.47 (95% confidence interval [CI], 2.82-163.05). The use of inotropes increased the odds ratio to 35.55 (95% CI, 3.41-369.90), whereas a hospital stay >7.23 days increased the odds ratio to 43.59 (95% CI, 15.66-1,316.32).</p><p><strong>Conclusions: </strong>The frequency of exposure keratopathy is high and is underestimated in ventilated patients, with lower GCS and increased hospital length of stay as the main risk factors. Prioritizing eye care in ventilated patients with low GCS scores or prolonged ICU stays is essential to reduce exposure keratopathy.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052708","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":"Neuroleptic malignant syndrome requiring intensive care unit admission in two patients with SARS-CoV-2 infection in Portugal.","authors":"Marina Costa, Ana Raquel Covas, Fábio Neves Correia, Sara Bernardo, Pedro Silveira","doi":"10.4266/acc.004632","DOIUrl":"10.4266/acc.004632","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031959","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}