Acute and Critical Care.2025;40(3):505-506. doi:10.4266/acc.003100
Acute and Critical Care
2014 (29, 4) to Present ISSN: 2586-6052
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Dopamine in cardiogenic shock: a silent star?
Acute and Critical Care.2025;40(3):507-508. doi:10.4266/acc.004200
A simplified physicochemical approach to acid-base disorders: perioperative practical application
Acute and Critical Care.2025;40(3):509-511. doi:10.4266/acc.001125
Acute and Critical Care.2025;40(3):512-512. doi:10.4266/acc.2024.01200.r1
Impact of medical crisis on the critical care system in South Korea
Acute and Critical Care.2025;40(3):393-401. doi:10.4266/acc.000575
Background:
The ongoing medical crisis in Korea has severely impacted the operational environment of intensive care units (ICU), posing significant challenges to quality care for critically ill patients. This study aimed to evaluate the effects of the ongoing crisis on ICUs.
Methods:
A survey was conducted in July 2024 among intensivists in charge of ICUs at institutions accredited by the Korean Society of Critical Care Medicine for critical care. The survey compared data from January 2024 (pre-crisis) and June 2024 (post-crisis) on the number ICU beds, staffing composition, work hours, and the number and roles of nurse practitioners.
Results:
Among the total of 71 participating ICUs, 22 experienced a reduction in the number of operational beds, with a median decrease of six beds per unit, totaling 127 beds across these ICUs. The numbers of residents and interns decreased from an average of 2.3 to 0.1 per ICU, and the average weekly working hours of intensivists increased from 62.3 to 78.8 hours. Nurse practitioners helped fill staffing gaps, with their numbers rising from 150 to 242 across ICUs, and their scope of practice expanded accordingly.
Conclusions
The medical crisis has led to major changes in the critical care system, including staffing shortages, increased workloads, and an expanded role for nurse practitioners. This is a critical moment to foster interest and engage in active discussions aimed at creating a sustainable and resilient ICU system.
Acute and Critical Care.2025;40(3):361-372. doi:10.4266/acc.001450
Intensive care unit (ICU)-acquired muscle atrophy and weakness are key contributors to post-intensive care syndrome (PICS), which can lead to long-term functional impairments. Although the ICU survival rate has improved, many patients continue to experience persistent functional impairments that hinder their reintegration into society. This review summarizes a series of observational and interventional studies conducted as part of the Muscle Atrophy Zero Project, focusing on the etiology, assessment, and prevention of ICU-acquired muscle atrophy and weakness. The project findings highlight the critical role of inflammation, particularly neutrophil infiltration, in the pathogenesis of muscle atrophy. Muscle damage can be assessed using ultrasound, bioelectrical impedance analysis, and urinary titin. Among them, ultrasound demonstrates high diagnostic accuracy for detecting low muscularity, and urinary titin has emerged as a promising biomarker of muscle degradation. Preventive strategies include early rehabilitation, neuromuscular electrical stimulation, vibration therapy, and nutritional support, especially protein supplementation. These multimodal interventions have shown efficacy in mitigating ICU-acquired muscle atrophy and weakness. However, follow-up systems for PICS remain underdeveloped. A continual multimodal intervention approach that combines physical rehabilitation with nutritional therapy is essential. The development of structured follow-up programs is vitally needed to confront the long-term challenges posed by PICS.
Nursing delirium management to promoting critically ill patients’ safety: an umbrella review
Acute and Critical Care.2025;40(3):373-392. doi:10.4266/acc.005221
Delirium is an acute disorder characterized by changes in the patient’s cognitive function, which another neurocognitive or pre-existing disease cannot explain. It produces adverse outcomes for critically ill patients and their families related to adverse events associated with the accidental removal of medical devices that increase the risk of the patient and the length of stay at the hospital, manifested by agitation and confusion behaviors. Five reviewers conducted An Umbrella Review from May to August 2023 through research in the databases Medline, CINAHL, Scopus, Web of Science, Cochrane Database of Systematic Reviews and articles obtained through research in other sources. After verifying their eligibility, we obtained 22 systematic reviews and meta-analyses for data extraction and analysis. From the results obtained, the importance of the implementation of surveillance interventions and systematic evaluation of the presence of delirium is highlighted, with particular emphasis on the use of the scale, Confusion Assessment Method, followed by the implementation of multicomponent interventions, pharmacological or not, highlighting the use of dexmedetomidine and family as support, as well early mobilization for the management of delirium. Managing delirium in critically ill patients based on Meyer and Lavin's theory, is an area sensitive to nursing care with an impact on the prevention of complications and consequent promotion of the safety of these patients, which also translates into positive results for the family and health organizations, reducing morbidity, mortality, length of stay and health costs.
Acute and Critical Care.2025;40(3):402-412. doi:10.4266/acc.000150
Background:
Survivors of critical illness often face significant physical and psychological challenges, including post-traumatic stress disorder (PTSD), anxiety, and depression, which can severely impact their quality of life. This study aimed to evaluate the prevalence and associated factors of PTSD, anxiety, and depression among intensive care unit (ICU) survivors 3 months after discharge, and investigate the prevalence and determinants of post-intensive care syndrome–related neuropsychiatric disorders (PICS-ND).
Methods:
This is a prospective observational analytical study carried out in a medical ICU. Three months after discharge from the ICU, survivors were contacted by telephone to complete the Impact Event Scale-Revised and Hospital Anxiety and Depression Scale questionnaires. Univariate and multivariate analyses were performed to identify variables that were independently and significantly associated with outcomes.
Results:
A total of 114 survivors was enrolled. At 3 months, PTSD, anxiety, and depression were prevalent in 21.9%, 21.0%, and 9.6% of patients, respectively. Associated factors were younger age, female, physical restraint, and critical illness polyneuropathy and myopathy (CIPNM) for PTSD; unmarried, low Charlson index, and physical restraint for anxiety; and younger age and CIPNM for depression. PICS-ND, a composite measure of neuropsychiatric morbidity, was present in 28.9% of patients, with younger age, female, and physical restraint identified as associated factors.
Conclusions
PTSD, anxiety, depression, and PICS-ND were common among ICU survivors at 3 months. Various factors, including younger age, female, unmarried, lower Charlson index, physical restraint, and CIPNM, were associated with these psychological outcomes.
Acute and Critical Care.2025;40(3):452-461. doi:10.4266/acc.000500
Delirium is a common but serious complication in critically ill patients. Family visitation has been shown to reduce delirium; however, during the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) restricted regular visitation to prevent the spread of infection. This study aimed to evaluate the association between visitation policies and incidence of delirium in the ICUs. Methods: This was a retrospective before-and-after study conducted in medical and surgical ICUs at a tertiary hospital. Adult patients admitted to an ICU during one of two periods were included: before the COVID-19 pandemic (June 2017 to May 2019) with regular visitation and during the pandemic (June 2020 to May 2022) with prohibited visitation. Delirium was assessed using the Confusion Assessment Method for the ICU. The primary outcome was association between delirium incidence and visitation policy. Results: Totals of 1,566 patients from the pre-COVID-19 period and 1,404 patients from the COVID-19 period were analyzed. The incidence of delirium was higher during the COVID-19 period (48.1% vs. 38.4%, P<0.001). After adjusting for relevant variables, the restricted visitation policy during COVID-19 remained a risk factor for delirium (odds ratio, 1.37; 95% CI, 1.13–1.65; P=0.001). Conclusions: Complete restriction of ICU visitations during the COVID-19 pandemic was associated with a significant increase in delirium incidence. These findings suggest the importance of visitation policies on patient outcomes and suggest the need for alternative strategies, such as video visitation, to mitigate the adverse effects of visitation restrictions during pandemics.
Acute and Critical Care.2025;40(3):473-481. doi:10.4266/acc.001425
Intracranial pressure (ICP) waveform analysis provides critical insights into brain compliance and can aid in the early detection of neurological deterioration. Deep learning (DL) has recently emerged as an effective approach for analyzing complex medical signals and imaging data. The aim of the present research was to develop a DL-based model for detecting ICP waveforms indicative of poor brain compliance. Methods: A retrospective cohort study was conducted using ICP wave images collected from postoperative hydrocephalus (HCP) patients who underwent ventriculostomy. The images were categorized into normal and poor compliance waveforms. Precision, recall, mean average precision at the 0.5 intersection over union (mAP_0.5), and the area under the receiver operating characteristic curve (AUC) were used to test. Results: The dataset consisted of 2,744 ICP wave images from 21 HCP patients. The best-performing model achieved a precision of 0.97, a recall of 0.96, and a mAP_0.5 of 0.989. The confusion matrix for poor brain compliance waveform detection using the test dataset also demonstrated a high classification accuracy, with true positive and true negative rates of 48.5% and 47.8%, respectively. Additionally, the model demonstrated high accuracy, achieving a mAP_0.5 of 0.994, sensitivity of 0.956, specificity of 0.970, and an AUC of 0.96 in the detection of poor compliance waveforms. Conclusions: The DL-based model successfully detected pathological ICP waveforms, thereby enhancing clinical decision-making. As DL advances, its significance in neurocritical care will help to pave the way for more individualized and data-driven approaches to brain monitoring and management
Country
Republic of Korea
Publisher
Korean Journal of Critical Care Medicine
ElectronicLinks
http://accjournal.orgEditor-in-chief
Moo Suk Park
acc@accjournal.org
Abbreviation
Acute Crit Care
Vernacular Journal Title
ISSN
2586-6052
EISSN
2586-6060
Year Approved
2007
Current Indexing Status
Currently Indexed
Start Year
2014
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