Acute and Critical Care最新文献

{"title":"Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation: technical note and case series.","authors":"Huong Giang Thi Bui, Van Huy Nguyen, Ngoc Son Do, Quoc Tuan Dang, Xuan Co Dao, The Thach Pham, Cong Tan Nguyen, Ba Cuong Nguyen, Thao Dung Nguyen, Huong Giang Nguyen","doi":"10.4266/acc.002675","DOIUrl":"10.4266/acc.002675","url":null,"abstract":"<p><strong>Background: </strong>Achieving safe and effective closure of large-bore femoral arterial access after venoarterial extracorporeal membrane oxygenation (VA-ECMO) decannulation remains challenging. Percutaneous closure with suture-mediated devices is an established alternative to surgical repair for VA-ECMO decannulation. However, the optimal suture configuration is not well defined, and conventional cross-suture placement may have limitations. This study describes a parallel percutaneous closure technique with the potential to improve outcomes and evaluates its initial feasibility and safety.</p><p><strong>Methods: </strong>This prospective case series included 30 adult patients who underwent bedside decannulation from percutaneous femoral VA-ECMO between March 2024 and March 2025. The closure technique involved deploying two Perclose ProGlide devices (Abbott Vascular) in a parallel configuration. The primary endpoints of technical success and vascular complications were assessed clinically and by duplex Doppler ultrasound 24 hours post-procedure.</p><p><strong>Results: </strong>Technical success was achieved in all 30 patients (100%) without surgical conversion or adjunctive vascular intervention. Duplex ultrasound confirmed normal arterial flow in 23 patients (76.7%). Vascular complications included arterial thrombosis (16.7%), dissection (3.3%), and hematoma (3.3%). No patient required reintervention or developed limb ischemia within 24 hours.</p><p><strong>Conclusions: </strong>This preliminary case series suggests that the parallel percutaneous closure technique is feasible and potentially safe for large-bore femoral decannulation following VA-ECMO. Its bedside application under local anesthesia and low rate of early complications support its utility in critical care. Further studies comparing closure configurations and evaluating long-term outcomes are warranted.</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/PMC13268727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699931","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":"Native valve infective endocarditis caused by Neisseria oralis in South Korea.","authors":"Hyunjoo Oh, Eui Tae Kim, Jeong Rae Yoo","doi":"10.4266/acc.006325","DOIUrl":"10.4266/acc.006325","url":null,"abstract":"","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/PMC13268732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699941","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":"Association of extubation failure rate with patient outcomes.","authors":"Ivan Gur, Roei Tounek, Ronen Zalts, Rona Epshtein, Asaf Miller, Amichai Gutgold","doi":"10.4266/acc.004250","DOIUrl":"10.4266/acc.004250","url":null,"abstract":"<p><strong>Background: </strong>While the propensity of evidence indicates the potential harm of failed extubation attempts, avoidance of any such risk may unnecessarily expose patients to prolonged invasive ventilation. We aimed to study the effects of extubation failure rate (EFR) on patient mortality and ventilation-free days (VFD).</p><p><strong>Methods: </strong>Adult patients admitted to the medical intensive care unit who underwent planned extubation were included. Extubation failure was defined as death or return to invasive positive pressure ventilation within 7 days from extubation. The primary outcome was 30-day mortality and the secondary outcome was VFD. For each calendar month, the average 30-day mortality or VFD was plotted against the EFR, with polynomial regression models of increasing complexity fitted until no further increase in the adjusted R2 could be achieved.</p><p><strong>Results: </strong>Of the 774 patients included in final analysis, 262 (33.8%) failed extubation. Matched by the propensity for extubation failure, the 30-day mortality analysis for both groups showed no significant difference (18.4% vs. 16.2%, P=0.34). The relationship between monthly EFR and 30-day survival or VFD was best described by a quadratic regression model (adjusted R2=0.816 and 0.624, respectively). Based on this model, the optimal EFR was calculated at 33.1% (for 30-day survival) and 28.8% (for VFD).</p><p><strong>Conclusions: </strong>Our data support the notion of an optimal EFR. This optimum may be higher than the minimal failure rate achievable.</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/PMC13268738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699879","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":"Direct and indirect effects of the COVID-19 pandemic on mortality and critical care utilization in South Korea.","authors":"Mindong Sung, Hye Jin Jang, Soyul Han, Sungho Won, Bora Lee, Young Sam Kim","doi":"10.4266/acc.003375","DOIUrl":"10.4266/acc.003375","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic has had unprecedented global impact, with significant effects on mortality and healthcare utilization. This study evaluated the direct and indirect impacts of COVID-19 on mortality and healthcare utilization in South Korea, a country that implemented strict public health measures.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using national databases from January 2015 through May 2022. The study compared mortality patterns and intensive care unit (ICU) utilization during the epidemic period (2020-2021) with the reference period (2015-2019). We analyzed excess mortality using a random-coefficient Poisson regression model and examined cause-specific mortality patterns for pneumonia, cardiovascular disease, and cancer. ICU admission trends were assessed using annual percent change (APC) and average annual percent change (AAPC) analyses.</p><p><strong>Results: </strong>The study revealed a distinctive two-phase pattern in COVID-19-related excess mortality: minimal excess deaths until June 2021, followed by a significant increase culminating in 18,068 excess deaths (P-score, 68.39%) during the fifth wave in March 2022. COVID-19 deaths accounted for approximately 45% of excess deaths during this period. Analysis of cause-specific mortality demonstrated temporal shifts in cardiovascular disease and pneumonia deaths from their typical January peaks to March-April 2022. Cardiovascular disease showed significant excess mortality during the fifth wave (z=6.18, P<0.001), while pneumonia mortality was below expected levels when accounting for pre-existing trends. Case fatality rate declined from an initial 9.50% to below 1% by 2022, despite increased case numbers. ICU admissions for non-COVID patients showed a consistent declining trend, with the most substantial decrease (-11.48%) observed in April 2020 during the first epidemic wave.</p><p><strong>Conclusions: </strong>These findings suggest that COVID-19 affected population health through both direct viral infection and indirect effects on healthcare systems and utilization patterns. The study highlights the importance of maintaining critical care capacity for all patient groups during public health emergencies and the need for strategies to balance resource allocation.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521955","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":"Feasibility and accuracy of continuous glucose monitoring in surgical intensive care unit patients : a single-center pilot study in South Korea.","authors":"Hyojun Park, Eunmi Gil, Joon Ho Lee, Chi-Min Park","doi":"10.4266/acc.004975","DOIUrl":"10.4266/acc.004975","url":null,"abstract":"<p><strong>Background: </strong>Continuous glucose monitoring (CGM) technology offers potential advantages over intermittent point-of-care testing in critically ill patients by providing real-time glucose trends and automated alerts. However, its accuracy and feasibility in intensive care settings require validation before widespread implementation.</p><p><strong>Methods: </strong>We conducted a single-center observational pilot study, evaluating CGM feasibility in 11 surgical intensive care unit (ICU) patients, including nine post-liver transplant recipients. The G6 CGM system was applied for continuous monitoring. CGM readings were paired with point-of-care glucose measurements for accuracy assessment. Performance metrics included the mean absolute relative difference (MARD), bias, standard deviation of relative differences (SDRD), Surveillance Error Grid (SEG) analysis, and International Organization for Standardization (ISO) 15197:2013 criteria compliance.</p><p><strong>Results: </strong>During a median monitoring period of 5 days (interquartile range [IQR], 3-9), we analyzed 326 paired glucose measurements. CGM demonstrated acceptable accuracy, with a MARD of 13.5% (95% CI, 11.43%-15.76%), bias of 2.79% (95% CI, -2.48 to 7.27%), and SDRD of 18.69% (95% CI, 13.75%-23.65%). SEG analysis confirmed 99.1% of readings were in clinically acceptable zones A and B. ISO 15197:2013 criteria showed 62.9% of measurements were within ±15 mg/dl or ±15%. The median patient-level mean glucose was 199.0 mg/dl (IQR, 162.0-248.0), reflecting substantial hyperglycemic exposure in patients receiving high-dose methylprednisolone despite protocolized insulin therapy targeting a range of 140-180 mg/dl.</p><p><strong>Conclusions: </strong>CGM was feasible and acceptably accurate in ICU patients. Persistent hyperglycemia despite protocolized care indicates that CGM-derived data may help to identify opportunities for future protocol improvement. Its potential impact on the time-in-target range, hypoglycemia, and clinical outcomes should be evaluated in future multicenter studies.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of negative-pressure room utilization in the emergency department on hospitalized pneumonia patients during the COVID-19 pandemic in Thailand.","authors":"Teeravit Danrungrot, Theerapon Tangsuwanaruk, Wachira Wongtanasarasin, Borwon Wittayachamnankul","doi":"10.4266/acc.003350","DOIUrl":"10.4266/acc.003350","url":null,"abstract":"<p><strong>Background: </strong>During the coronavirus disease 2019 (COVID-19) outbreak, negative-pressure rooms were implemented to isolate high-risk COVID-19 patients. This study compared pneumonia patient outcomes before and after their implementation, focusing on in-hospital mortality as the primary outcome.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult pneumonia patients admitted to a tertiary hospital in Northern Thailand, excluding those with trauma-related illness, out-of-hospital cardiac arrest/in-hospital cardiac arrest, or incomplete data. The primary outcome was in-hospital mortality, and the outcomes were door-to-first doctor contact time, door-to-antibiotic time, emergency department (ED) length of stay (LOS), intensive care unit (ICU) admission, and 30-day mortality.</p><p><strong>Results: </strong>Data from 220 pneumonia patients (104 pre-pandemic, 116 pandemic) were analyzed. Of these, 58.6% were elderly males with comorbidities like hypertension and diabetes. Door-to-first doctor contact time was longer during the pandemic (median, 1 vs. 0 minutes; P<0.001), as was ED LOS (median, 5.9 vs. 4.1 hours; P<0.001). Door-to-antibiotic time was also longer in unadjusted comparisons (median, 60.0 vs 36.5 minutes; P<0.001), but the difference was attenuated and not statistically significant after adjustment (adjusted mean difference, 14.2 minutes; P=0.071). No significant differences in in-hospital mortality, 30-day mortality, or ICU admissions were observed.</p><p><strong>Conclusions: </strong>Negative-pressure rooms led to increased door-to-doctor contact time and ED LOS during COVID-19, although without significant differences in mortality. These findings highlight the need to improve ED workflows for future pandemic preparedness.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521985","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":"Hybrid mini-surgical percutaneous dilatation tracheostomy under fiberoptic guidance with supraglottic cuff placement: overcoming difficult neck anatomy.","authors":"Veswudu Swuro, Aspari Mahammad Azeez, Dalim Kumar Baidya, Habib Md Reazaul Karim","doi":"10.4266/acc.005275","DOIUrl":"10.4266/acc.005275","url":null,"abstract":"","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521964","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":"Personalized treatment approaches in neurocritical care.","authors":"Jae Hyun Kim, Chang-Hyun Kim, Hanwool Jeon, Hyun-Chul Jung, Seungjoo Lee","doi":"10.4266/acc.003050","DOIUrl":"10.4266/acc.003050","url":null,"abstract":"<p><p>Acute brain injuries-including traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage-exhibit profound pathophysiological heterogeneity, yet are often managed using standardized treatment protocols. While evidence-based guidelines have improved outcomes at a population level, they frequently overlook patient-specific variations in cerebral compliance, autoregulation, and metabolic reserve. This review explores the evolving paradigm of personalized neurocritical care, which integrates dynamic multimodal monitoring, individualized intracranial pressure management strategies, and real-time physiological indices such as pressure reactivity index, cerebral perfusion pressure optimization, and waveform analytics. We highlight the role of noninvasive modalities including quantitative pupillometry, transcranial Doppler, optic nerve sheath diameter ultrasound, near-infrared spectroscopy, and electroencephalography as adjuncts when invasive monitoring is limited or contraindicated. Furthermore, we examine tissue-level monitoring using brain oxygen tension and cerebral microdialysis and emerging blood-based biomarkers such as glial fibrillary acidic protein and neurofilament light. These tools provide granular insight into evolving secondary injury processes. In parallel, advances in artificial intelligence (AI) and machine learning enable deep phenotyping, predictive modeling, and integration of high-dimensional data including imaging, physiology, and omics-based profiles. The development of digital twin models further supports individualized simulation and therapeutic planning. While challenges remain in implementation, data harmonization, and resource availability, the convergence of physiologic monitoring, molecular profiling, and computational modeling offers a transformative pathway toward precision medicine in neurocritical care.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"33-46"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851037","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":"Revolutionizing non-traumatic acute care: a review of the role of artificial intelligence and machine learning in triaging and diagnosis.","authors":"Omofolarin Debellotte, Rachel Melissa Salins, Pragnya Bandari, Maria Gabriela Cerdas, Aijaz Ul Haq, Shaheen Haidrus, Misha Imtiaz, Anietom Ifechukwu Chelsea, Shaik Mohammed Yezdan Ali, Hameeda Abdul Wahab Baloch, Humza Faisal Siddiqui","doi":"10.4266/acc.002200","DOIUrl":"10.4266/acc.002200","url":null,"abstract":"<p><p>Acute care settings, including emergency medicine and intensive care units, comprise a substantial portion of healthcare and are essential in the prompt management of conditions that can prove fatal. Critical care conditions require timely management that can be delayed by high patient volumes and the need for complex clinical decision making. Artificial intelligence (AI) tools have been created to enhance diagnostic accuracy and optimize workflow to improve patient care. This narrative review discusses the current status of AI in acute care, with a focus on its applications in triaging and diagnosis. AI-enhanced electrocardiogram analysis, identification of myocardial infarction and acute coronary syndrome, and heart failure risk stratification led to better patient-specific management and improved results. AI models successfully determined and aided in the timely management of various acute conditions, including pneumonia, pulmonary embolism, and respiratory failure. The AI algorithms used accurately determined sepsis onset and course, superseding traditionally used clinical tools and leading to early diagnosis and reduced sepsis mortality. These models showed high sensitivity and specificity in diagnosing and triaging neurological conditions, including altered levels of consciousness, seizures, and intracranial hemorrhages. AI that involved advanced machine learning imaging software led to faster and more accurate stroke diagnosis. Diagnostic tools assisted by AI improved the detection and classification of acute pancreatitis, appendicitis, and gastrointestinal bleeding. AI has shown promising results in optimizing management in acute care settings. However, critical issues in data standardization, ethical considerations, and clinical workflow integration need to be addressed to enable clinical implementation.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"68-86"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849988","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":"Nurse-led glycemic control protocols in intensive care units: a scoping review.","authors":"Eugene Han, Eunhye Park, Eui Geum Oh","doi":"10.4266/acc.003225","DOIUrl":"10.4266/acc.003225","url":null,"abstract":"<p><p>Nurse-led glycemic management in critical care settings has been demonstrated to reduce the incidence of dysglycemia, including hyperglycemia and hypoglycemia, while stabilizing glycemic variability, contributing to enhanced patient outcomes. This scoping review aimed to identify nurse-led glycemic management protocols in intensive care units, analyze their components (e.g., target glucose range, monitoring frequency, and implementation methods), and evaluate their effectiveness. Seven databases, including PubMed and CINAHL, were searched for studies published between January 2015 and April 2025. Studies were selected using predefined inclusion criteria, and two independent reviewers evaluated methodological quality using the JBI critical appraisal tool. Ultimately, seven quasi-experimental studies were included. Most protocols employed continuous intravenous insulin infusions (n=5), whereas others focused on hypoglycemia management (n=2). The target glucose levels ranged from 100-180 mg/dl, and the monitoring intervals varied from 15 minutes to 4 hours depending on the protocol type. All protocols excluded patients on oral diets and those receiving intermittent enteral nutrition. Four studies used printed guidelines with manual adjustments, whereas three employed computerized decision-support systems. The studies indicated that nurse-led glycemic control management was associated with reductions in both glycemic variability and in the incidence of hyper- and hypoglycemia. These findings highlight the need for evidence-based updates to nurse-led glycemic control protocols in critical care for safe and effective management through a multidisciplinary approach.</p>","PeriodicalId":44118,"journal":{"name":"Acute and Critical Care","volume":" ","pages":"58-67"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851085","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}