Acute and Critical Care最新文献

{"title":"Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion.","authors":"Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, Sua Kim","doi":"10.4266/acc.003425","DOIUrl":"10.4266/acc.003425","url":null,"abstract":"<p><p>Shock is a state of circulatory failure characterized by impaired tissue perfusion due to a mismatch between oxygen delivery and consumption. While macrocirculation serves as a conduit to sustain blood flow toward the microcirculatory networks, it is the microcirculation that ultimately ensures the delivery of oxygen and nutrients to maintain cellular and organ function. The maintenance of proper macrocirculation is essential, but it does not necessarily indicate adequate microcirculation or recovery from shock. Thus, assessment of the microcirculation is also required to confirm effective tissue oxygenation. A comprehensive evaluation of both circulatory levels is crucial for accurate diagnosis and prognostication in patients with shock. This review explores a diverse range of clinical, biochemical, and device-based indicators that reflect the perfusion status of patients in shock. By examining their physiological significance and clinical relevance, we aim to provide a comprehensive framework for the hemodynamic assessment of critically ill patients and support the use of multidimensional strategies in shock management.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 2","pages":"201-212"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220097","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":"Comparative prognostic performance of nutritional assessment tools in critically ill surgical patients after emergency surgery for sepsis or septic shock: a single-center retrospective study in South Korea.","authors":"Sung Bak An, Dong Woo Shin","doi":"10.4266/acc.001170","DOIUrl":"10.4266/acc.001170","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is prevalent in critically ill patients. Although various nutritional assessment tools are used in intensive care units (ICUs), their comparative prognostic performance in critically ill surgical patients requiring postoperative ICU care after emergency surgery for sepsis or septic shock remains uncertain. We compared the performance of four tools in predicting ICU mortality.</p><p><strong>Methods: </strong>We retrospectively analyzed 218 adult critically ill surgical patients requiring postoperative ICU care after emergency surgery for sepsis or septic shock (January 2015-July 2025). Nutritional status was assessed within 24 hours of ICU admission using the Global Leadership Initiative on Malnutrition (GLIM), modified Nutrition Risk in the Critically Ill (mNUTRIC), Nutritional Risk Screening 2002 (NRS-2002), and Malnutrition Universal Screening Tool (MUST). The primary outcome was ICU mortality. Discriminative performance was evaluated using the area under the receiver operating characteristic curve and incremental value over a baseline model (age, sex, Acute Physiology and Chronic Health Evaluation [APACHE] II score, and Sequential Organ Failure Assessment [SOFA] score).</p><p><strong>Results: </strong>The mNUTRIC score showed the highest crude discrimination for ICU mortality, followed by MUST and GLIM, whereas NRS-2002 demonstrated limited discriminatory ability. When added to the baseline clinical model, MUST and GLIM improved mortality prediction, unlike mNUTRIC. Higher risk categories in MUST and GLIM were associated with increased ICU mortality.</p><p><strong>Conclusions: </strong>Prognostic performance varies among nutritional assessment tools. MUST and GLIM provide prognostic information beyond conventional severity scores, whereas the prognostic value of mNUTRIC is largely driven by disease severity, supporting their use for risk stratification in critically ill surgical patients.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 2","pages":"399-410"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220115","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":"Risk factors for chest trauma associated with prehospital mechanical chest compression after non-traumatic out-of-hospital cardiac arrest in a South Korean regional registry.","authors":"June-Sung Kim, Hannah Park, Won Young Kim","doi":"10.4266/acc.002225","DOIUrl":"10.4266/acc.002225","url":null,"abstract":"<p><strong>Background: </strong>Mechanical chest compression devices are increasingly used during cardiopulmonary resuscitation, particularly in the prehospital setting, where maintaining high-quality manual chest compressions is challenging. In this study, we aimed to determine whether prehospital exposure to mechanical chest compression is independently associated with increased risk of compression-related chest trauma among out-of-hospital cardiac arrest (OHCA) survivors.</p><p><strong>Methods: </strong>We retrospectively analyzed patients from our prospective OHCA registry who achieved sustained return of spontaneous circulation and underwent chest computed tomography (CT) between March 2019 and June 2023. Chest trauma was identified on imaging and categorized as rib fractures, lung contusion, pneumothorax, pneumomediastinum, hematoma, sternal fracture, or hemothorax. Multivariate logistic regression was performed to identify factors associated with chest trauma.</p><p><strong>Results: </strong>Among 634 included patients, 614 (97%) underwent chest CT, and 277 (45.1%) had evidence of chest trauma. Patients with chest trauma were more likely to be female, be older, have lower body mass index, undergo longer resuscitation, and receive prehospital mechanical chest compression. Rib fractures were the most common injury, followed by sternal fracture. Multivariate analysis showed that the use of mechanical compression in the prehospital setting was an independent risk factor for compression-related chest trauma (adjusted odds ratio, 2.33; 95% CI, 1.45- 3.74).</p><p><strong>Conclusions: </strong>Exposure to mechanical chest compression in the prehospital setting was independently associated with an increased risk of compression-related chest trauma among OHCA survivors.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 2","pages":"356-363"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220221","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":"From scores to signals: evolution and innovations in pediatric early warning systems.","authors":"Wonjin Jang, Bongjin Lee","doi":"10.4266/acc.004475","DOIUrl":"10.4266/acc.004475","url":null,"abstract":"<p><p>Early identification of clinical deterioration in hospitalized children is essential to improve outcomes and prevent critical events. Over the past two decades, structured approaches such as pediatric early warning scores and rapid response systems have provided a framework for systematic risk detection in general wards. More recently, artificial intelligence and continuous monitoring technologies have begun to transform this field, offering the potential for more timely and accurate recognition of subtle changes in patient status. Despite these advances, challenges remain before seamless integration of these technologies into routine clinical decision-making can be achieved. This review explores the evolution of pediatric early warning systems and examines how emerging innovations may shape the future of predictive monitoring and clinical decision support in pediatric care.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 2","pages":"252-261"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220143","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":"Rehabilitating the diaphragm: an integrated approach to intensive care unit-acquired dysfunction in critical illness-a narrative review.","authors":"Ricardo Arriagada, Aaron Pagan, Daniela Nisticò, Francesca Gualdi, Valentina Fassone, Nicolò Antonino Patroniti, Patricia Rm Rocco, Denise Battaglini","doi":"10.4266/acc.004375","DOIUrl":"10.4266/acc.004375","url":null,"abstract":"<p><p>Improved survival in critical illness has increased recognition of intensive care unit (ICU) complications, particularly ICU-acquired weakness, which affects up to 25% of patients. Diaphragm involvement is common and contributes to prolonged ventilation, difficult weaning, and worse outcomes. Dysfunction arises from ventilator-induced injury, sepsis-related myopathy, or both. Although early mobilization and physiotherapy improve recovery, their effectiveness is often limited by respiratory muscle fatigue and dyspnea. Non-invasive ventilation (NIV) reduces the work of breathing, sustains spontaneous effort, and enhances exercise tolerance, thereby facilitating earlier and safer rehabilitation. This review summarizes the current understanding of the pathophysiology of ICU-acquired diaphragm dysfunction. It explores the role of NIV and other respiratory supports as an adjunct to physiotherapy aimed at optimizing recovery in critically ill patients.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 2","pages":"237-251"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220205","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":"Rethinking extubation failure as risk calibration in ventilator liberation.","authors":"Jin Sun Cho","doi":"10.4266/acc.004680","DOIUrl":"10.4266/acc.004680","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 2","pages":"428-431"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220218","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":"Interdisciplinary collaboration in neurocritical care management.","authors":"Hyunchul Jung, Seung Bin Kim, Seungjoo Lee, Moinay Kim","doi":"10.4266/acc.003275","DOIUrl":"10.4266/acc.003275","url":null,"abstract":"<p><p>The complexity of neurocritical care requires a shift from traditional, discipline-specific practice toward a collaborative, interdisciplinary model. This review explores the conceptual and practical framework of interdisciplinary collaboration in neuro-intensive care units, examining the roles of key specialists including neurosurgeons, neurologists, intensivists, pharmacists, nutritionists, and rehabilitation experts. We discuss the benefits of coordinated care in improving patient-centered outcomes, reducing morbidity and mortality, and enhancing intensive care unit efficiency. Emerging evidence supports the integration of neurointensivists, structured communication tools, and team-based decision-making as essential components of modern critical care delivery. This article provides a comprehensive review of current strategies and proposes directions for advancing interdisciplinary practice in neurocritical care settings.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 2","pages":"226-236"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220215","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":"Managing symptomatic intermediate or high-risk pulmonary embolism presenting concomitantly with intracranial bleeding: case series and literature review.","authors":"Pipin Kojodjojo, Keith Yc Goh, Chieh Yang Koo, Peter Chang, Philip Ss Koh","doi":"10.4266/acc.001075","DOIUrl":"10.4266/acc.001075","url":null,"abstract":"<p><strong>Background: </strong>Managing patients with concomitant intracranial bleeding (ICB) and symptomatic pulmonary embolism (PE) is challenging and there are no guidelines.</p><p><strong>Methods: </strong>We identified patients with intermediate or high-risk PE and concomitant ICB referred to our institutional PE response teams. A literature review was performed to evaluate the effectiveness and risks of various treatment strategies for this challenging clinical conundrum.</p><p><strong>Results: </strong>Two patients with subdural hematoma, symptomatic intermediate-high risk PE and deep vein thrombi were identified in our institutions. Both patients were treated with lytic-free mechanical thrombectomy combined with inferior vena cava (IVC) filter implantation. This allowed for an anticoagulation-free period, during which surgical drainage was performed. Anticoagulation was safely started several days after neurosurgery. A literature review identified 148 similar cases. There was significant risk of in-hospital mortality due to PE in patients who were left untreated. Early anticoagulation was associated with elevated risks of hematoma expansion, extracranial bleeding and residual risk of PE mortality. Patients undergoing surgical or lytic-free mechanical thrombectomy all survived to discharge without bleeding complications.</p><p><strong>Conclusions: </strong>Combining thrombolytic-free mechanical thrombectomy with an IVC filter allows for effective PE treatment and temporary avoidance of anticoagulation whilst patients undergo definitive neurosurgery for concomitant ICB. Such an approach seems safer, less invasive and more clinically effective compared to other strategies reported in the literature.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":"41 2","pages":"344-355"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220202","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":"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":"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":2.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699961","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":"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":"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":2.3,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699902","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}