Acute and Critical Care

Review Article

Trauma
Abdominal compartment syndrome in critically ill patients: Hyunseok Jang, Naa Lee, Euisung Jeong, Yunchul Park, Younggoun Jo, Jungchul Kim, Dowan Kim; Acute Crit Care. 2023;38(4):399-408. Published online November 29, 2023; DOI: https://doi.org/10.4266/acc.2023.01263

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Abstract PDF: Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.

Original Articles

Infection
Ability of a modified Sequential Organ Failure Assessment score to predict mortality among sepsis patients in a resource-limited setting: Bodin Khwannimit, Rungsun Bhurayanontachai, Veerapong Vattanavanit; Acute Crit Care. 2022;37(3):363-371. Published online August 4, 2022; DOI: https://doi.org/10.4266/acc.2021.01627

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Copyright © 2022 The Korean Society of Critical Care Medicine This is an Open Access article distributed under the terms of Creative Attributions Non- Commercial License (https://creativecommons. org/li-censes/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. https://www.accjournal.org 363 INTRODUCTION Sepsis is a life-threatening condition and constitutes major health care problems around the world [1,2]. Sepsis was associated with nearly 20% of all global deaths, and the majority of sepsis cases occurred in low- or middle-income countries [1]. In 2017, the World Health Organization recommended actions to reduce the global burden of sepsis [2]. Sepsis has been defined as acute life-threatening organ dysfunction due to dysregulation of host responses to Background: Some variables of the Sequential Organ Failure Assessment (SOFA) score are not routinely measured in sepsis patients, especially in countries with limited resources. Therefore, this study was conducted to evaluate the accuracy of the modified SOFA (mSOFA) and compared its ability to predict mortality in sepsis patients to that of the original SOFA score.
Methods
Sepsis patients admitted to the medical intensive care unit of Songklanagarind Hospital between 2011 and 2018 were retrospectively analyzed. The primary outcome was all-cause in-hospital mortality.
Results
A total of 1,522 sepsis patients were enrolled. The mean SOFA and mSOFA scores were 9.7±4.3 and 8.8±3.9, respectively. The discrimination of the mSOFA score was significantly higher than that of the SOFA score for all-cause in-hospital mortality (area under the receiver operating characteristic curve, 0.891 [95% confidence interval, 0.875–0.907] vs. 0.879 [0.862–0.896]; P<0.001), all-cause intensive care unit (ICU) mortality (0.880 [0.863–0.898] vs. 0.871 [0.853–0.889], P=0.01) and all-cause 28-day mortality (0.887 [0.871–0.904] vs. 0.874 [0.856–0.892], P<0.001). The ability of mSOFA score to predict all-cause in-hospital and 28-day mortality was higher than that of the SOFA score within the subgroups of sepsis according to age, sepsis severity and serum lactate levels. The mSOFA score was demonstrated to have a performance similar to the original SOFA score regarding the prediction of mortality in sepsis patients with cirrhosis or hepatic dysfunction.
Conclusions
The mSOFA score was a good alternative to the original SOFA core in predicting mortality among sepsis patients admitted to the ICU.

Citations

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Effects of prior antiplatelet and/or nonsteroidal anti-inflammatory drug use on mortality in patients undergoing abdominal surgery for abdominal sepsis
Se Hun Kim, Ki Hoon Kim
Surgery.2023; 174(3): 611. CrossRef

Trauma
Acute Physiology and Chronic Health Evaluation II Score and Sequential Organ Failure Assessment Score as Predictors for Severe Trauma Patients in the Intensive Care Unit: Min A Lee, Kang Kook Choi, Byungchul Yu, Jae Jeong Park, Youngeun Park, Jihun Gwak, Jungnam Lee, Yang Bin Jeon, Dae Sung Ma, Gil Jae Lee; Korean J Crit Care Med. 2017;32(4):340-346. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00255

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Abstract PDF

Background
The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Sequential Organ Failure Assessment (SOFA) scoring system are widely used for critically ill patients. We evaluated whether APACHE II score and SOFA score predict the outcome for trauma patients in the intensive care unit (ICU).
Methods
We retrospectively analyzed trauma patients admitted to the ICU in a single trauma center between January 2014 and December 2015. The APACHE II score was figured out based on the data acquired from the first 24 hours of admission; the SOFA score was evaluated based on the first 3 days in the ICU. A total of 241 patients were available for analysis. Injury Severity score, APACHE II score, and SOFA score were evaluated.
Results
The overall survival rate was 83.4%. The non-survival group had a significantly high APACHE II score (24.1 ± 8.1 vs. 12.3 ± 7.2, P < 0.001) and SOFA score (7.7 ± 1.7 vs. 4.3 ± 1.9, P < 0.001) at admission. SOFA score had the highest areas under the curve (0.904). During the first 3 days, SOFA score remained high in the non-survival group. In the non-survival group, cardiovascular system, neurological system, renal system, and coagulation system scores were significantly higher.
Conclusions
In ICU trauma patients, both SOFA and APACHE II scores were good predictors of outcome, with the SOFA score being the most effective. In trauma ICU patients, the trauma scoring system should be complemented, recognizing that multi-organ failure is an important factor for mortality.

Citations

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Cell-free DNA as diagnostic and prognostic biomarkers for adult sepsis: a systematic review and meta-analysis
Awirut Charoensappakit, Kritsanawan Sae-khow, Pongpera Rattanaliam, Nuntanuj Vutthikraivit, Monvasi Pecheenbuvan, Suwasin Udomkarnjananun, Asada leelahavanichkul
Scientific Reports.2023;[Epub] CrossRef
Evaluation of the sequential organ failure assessment score and newly introduced criteria – Traumasis - in traffic collision patients
Sion Jo, Taeoh Jeong, Boyoung Park
The American Journal of Emergency Medicine.2022; 51: 98. CrossRef
Predictive value of Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for the short-term prognosis of emergency trauma patients: a retrospective study
Zhejun Yu, Feng Xu, Du Chen
BMJ Open.2021; 11(3): e041882. CrossRef
Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties
Joseph D. Bozzay, Patrick F. Walker, David W. Schechtman, Faraz Shaikh, Laveta Stewart, M. Leigh Carson, David R. Tribble, Carlos J. Rodriguez, Matthew J. Bradley
Journal of Trauma and Acute Care Surgery.2021; 91(2S): S247. CrossRef

The Analysis of Prognostic Factors in Patients with Decompensated Liver Cirrhosis Admitted to the Medical Intensive Care Unit: Gil Jae Lee, Jung Nam Lee, Iris Naheah Kim, Keon Kuk Kim, Woon Kee Lee, Jeong Heum Baek, Sang Tae Choi, Won Suk Lee, Byung Chul Yu, Yeon Jeong Park; Korean J Crit Care Med. 2013;28(2):101-107.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.101

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Abstract PDF: BACKGROUND
Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU.
METHODS
From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver's operating characteristics curve (AUC).
RESULTS
The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality.
CONCLUSIONS
The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.

A Preliminary Study on the Effect of "Low-dose" Glucocorticoid Therapy for Patients with Persistent Acute Respiratory Distress Syndrome: Hae Seong Nam, Maeng Real Park, So Young Park, So Yeon Lim, Su A Kim, Jae Uk Song, Kyeongman Jeon, Hojoong Kim, O Jung Kwon, Gee Young Suh; Korean J Crit Care Med. 2009;24(2):80-86.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.80

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Abstract PDF

BACKGROUND
The role of glucocorticoids for treating persistent acute respiratory distress syndrome (ARDS) is matter of debate. In the previous studies, the side effects of moderate doses of glucocorticoids might have negated positive effects of glucocorticoids. This study aimed at determining the feasibility of administering "low-dose" glucocorticoid to treat the patients who suffer with persistent ARDS.
METHODS
We retrospectively reviewed the medical records of twelve patients with ARDS of at least seven days' duration and who were treated with "low-dose" glucocorticoid (starting dose of 1 mg/kg) between June 2007 to December 2008. The patients were divided by whether or not they were successfully weaned from the ventilator after glucocorticoid therapy. The baseline characteristics and physiologic parameters were recorded for up to 7 days after starting glucocorticoid therapy.
RESULTS
Five patients (42%) were included in the weaned group. There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups on the day of ARDS. Yet the weaned group had a significantly lower Sequential Organ Failure Assessment (SOFA) score, as compared to that of the failed group [3 (3-6) vs 8 (5-12), p = 0.009)] at start of glucocorticoid treatment. After 3 days of glucocorticoid therapy, there was significant improvement in the PEEP, the PaO2/FIO2 ratio, the PCO2, the SOFA score and the Murray Lung Injury Score of the weaned group, as compared to that of the failed group. There were no major neuromuscular side effects from the therapy.
CONCLUSIONS
This study suggests that the "low-dose" glucocorticoid therapy is feasible and that the SOFA score and the physiologic parameters may assist in determining whether or not to initiate and to continue glucocorticoid therapy for the patients who are suffering with persistent ARDS.

Citations

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A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage
Han Min Lee, Jae-Seok Park, Jae Yun Kim, Ji Yeon Lee, Byung Kyu Ahn, Hyo-Wook Gil, Jae-Sung Choi
Tuberculosis and Respiratory Diseases.2012; 72(2): 177. CrossRef
Acute Respiratory Distress Syndrome with Chemical Pneumonitis after Aspiration of Activated Charcoal - A Case Report -
Suhyun Kim, Na Ree Kang, In Sohn, Heon Lee, Yoon Kyung Lee, Sook Hee Song
The Korean Journal of Critical Care Medicine.2010; 25(2): 112. CrossRef

The Prognostic Utility of the Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) Score for Hemato-Oncology Patients Admitted to the Intensive Care Unit: Sunghoon Park, Won Jung Koh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Won Ki Kang, Chul Won Jung, Jin Seok Ahn, Gee Young Suh; Korean J Crit Care Med. 2009;24(1):4-10.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.4

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Abstract PDF

BACKGROUND
The prognosis of hemato-oncology (HMO) patients admitted to the intensive care unit (ICU) is poor and predicting the mortality is important for decision making at the time of ICU admission and for administering aggressive treatment.
METHODS
We retrospectively reviewed 309 patients who were admitted to the medical ICU (MICU) at Samsung Medical Center from July in 2005 to June in 2006. We calculated their Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score at the time of ICU admission and we investigated the relationship between the two scoring systems and the hospital mortality.
RESULTS
Among the 309 patients, the hospital mortality was 41.2%, and the mean SAPS II/SOFA score at ICU admission was 45.4 +/- 19.5/8.1 +/- 4.6. Seventy-nine (25.6%) patients had hemato-oncological diseases. Their hospital mortality was 65.8%, and the mean SAPS II/SOFA score at the time of ICU admission was 53.9 +/- 18.6/9.7 +/- 4.4, which was higher than that of the non-HMO patients (p = 0.00). The area under the receiver operating characteristic (ROC) curves for the SAPS II/SOFA score for predicting the mortality was 0.794 +/- 0.05/0.785 +/- 0.051 (p = 0.00/p = 0.00) for the HMO patients. There was no significant difference in discrimination ability between the two scoring systems (p > 0.05). None of the HMO patients with a SAPS II/SOFA score of 70/14 or higher survived.
CONCLUSIONS
Both the SAPS II and SOFA scores at the time of ICU admission were similarly effective for predicting the hospital mortality. The two scoring systems could be useful tools for decision making at the time of ICU admission and for administering aggressive treatment.

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Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock
Jin Kyeong Park, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh
The Korean Journal of Critical Care Medicine.2011; 26(1): 13. CrossRef

The Characteristics and Prognostic Factors of Severe Sepsis in Patients Who Were Admitted to a Medical Intensive Care Unit of a Tertiary Hospital: Suk Kyung Hong, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2009;24(1):28-32.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.28

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Abstract PDF

BACKGROUND
Severe sepsis is a major cause of morbidity and mortality in intensive care units. This study aimed to evaluate the prevalence, characteristics, outcomes and prognostic factors of severe sepsis in a medical intensive care unit (MICU) of a tertiary care hospital in Korea.
METHODS
We retrospectively reviewed the medical chart of 249 patients who were admitted to a medical intensive care unit with severe sepsis.
RESULTS
From January 2000 to December 2001, 3410 patients were admitted to the ICU. The prevalence of severe sepsis was 7.3%. The mortality of severe sepsis was 64.6%. The prognostic factors for severe sepsis were the number of organ systems that acutely failed (p = 0.036) and an admission route from general wards (p = 0.018). There was no difference in the outcome of severe sepsis according to infectious organisms (p = 0.24) and the site of infections (p = 0.38).
CONCLUSIONS
Severe sepsis in the MICU is a common, expensive and often fatal condition. We expect that early rescucitation and recovery from acute organ system failure will improve the outcome of severe sepsis.

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An Evaluation of the Rapid Antimicrobial Susceptibility Test by VITEK MS and VITEK 2 Systems in Blood Culture
Kang-Gyun Park, Young-Bin Yu, Keundol Yook, Sang-Ha Kim, Sunghyun Kim, Young Kwon Kim
The Korean Journal of Clinical Laboratory Science.2017; 49(3): 279. CrossRef
An Evaluation of Vitek MS System for Rapid Identification of Bacterial Species in Positive Blood Culture
Kang-Gyun Park, Sang-Ha Kim, Jong-Tae Choi, Sunghyun Kim, Young-Kwon Kim, Young-Bin Yu
The Korean Journal of Clinical Laboratory Science.2017; 49(4): 407. CrossRef
A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock
Jung-Wan Yoo, Ju Ry Lee, Youn Kyung Jung, Sun Hui Choi, Jeong Suk Son, Byung Ju Kang, Tai Sun Park, Jin-Won Huh, Chae-Man Lim, Younsuck Koh, Sang Bum Hong
The Korean Journal of Internal Medicine.2015; 30(4): 471. CrossRef
Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea
S. J. Lim, J. Y. Choi, S. J. Lee, Y. J. Cho, Y. Y. Jeong, H. C. Kim, J. D. Lee, Y. S. Hwang
Infection.2014; 42(5): 875. CrossRef
Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards
Ju Ry Lee, Hye Ran Choi
Journal of Korean Academy of Nursing.2014; 44(2): 219. CrossRef
Utility of Serum Procalcitonin for Diagnosis of Sepsis and Evaluation of Severity
Taejin Park, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Tuberculosis and Respiratory Diseases.2011; 70(1): 51. CrossRef
Clinical Guideline for the Diagnosis and Treatment of Gastrointestinal Infections

Infection and Chemotherapy.2010; 42(6): 323. CrossRef
The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock
Jung-Hwan Ahn, Sang-Cheon Choi, Young-Gi Min, Yoon-Seok Jung, Sung Hee Chung, Young-Joo Lee
The Korean Journal of Critical Care Medicine.2009; 24(3): 134. CrossRef

Relationship between Change of RBC Shape and Multi-organ Failure in Sepsis: Ho Cheol Kim, Yoo Ji Cho, Hwi Jong Kim, Jong Deok Lee, Young Sil Hwang, Me Ae Kim; Korean J Crit Care Med. 2005;20(1):63-67.

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Abstract PDF: BACKGROUND
Microcirculatory derangement in sepsis plays a crucial role in the impairment of tissue oxygenation that can lead to multi-organ failure and death. The change of RBC rheology in sepsis has been known to be important factors in microcirculatory derangement. Several studies have demonstrated that RBCs have decreased deformability in sepsis. We investigated the relationship between multi-organ failure and spherical index of RBC estimated by flow cytometer in critically ill patients with or without sepsis compared with the relationship in healthy volunteers.
METHODS
Fourteen non-septic critically ill patients, 18 septic patients and 10 healthy volunteers were evaluated. We obtained peripheral venous blood from each patient and analyzed the change of RBC shape using flow cytometer (Becton Dickinson FACSCalibur) within 90 minute. The change of RBC shape was accessed with spherical index (M2/M1). A decrease in M2/M1 was correlated with the sphericity of the RBC and considered to have a lower capacity to alter their shape when placed in microcirculation. Multi-organ failure was accessed with sequential organ failure assessment (SOFA) score. RESULTS: The M2/M1 ratio of healthy volunteers, non-septic patients and septic patients were 2.25+/-0.08, 2.16+/-0.39 and 2.05+/-0.53, respectively. But, there was no significant difference between each group (p>0.05). And, there was no significant correlation between M2/M1 ratio of septic and non- septic patients and SOFA score (p>0.05, r2= -0.13). CONCLUSIONS: In our study, the spherical index of RBC was not associated with multi-organ failure in sepsis. But, further studies may be needed to evaluate the role of RBC rheology in sepsis.

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