| ACC review series 2026: sepsis 1 |
Managing sepsis in the era of precision medicine: a narrative review |
| Ho Jin Yong, Sung Min Kim, Dohhyung Kim |
| DOI: http://doi.org/10.4266/acc.000884 |
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For decades, the management of sepsis has adopted protocolized care bundles. However, the plateau in global survival rates suggests that the "one-size-fits-all" paradigm exemplified by early goal-directed therapy has reached its limits. The physiological and biological heterogeneity of sepsis necessitates a fundamental shift toward precision medicine. This review examines the transition from empirical resuscitation to individualized care across four critical... |
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| Review Articles |
CPR/Resuscitation
Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion |
| Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, Sua Kim |
| DOI: http://doi.org/10.4266/acc.003425 |
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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... |
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Ethics
When ethics is not enough: institutional governance of critical care allocation under crisis conditions |
| Ho Kyung Sung, Ungki Jung, Kyungdo Lee |
| DOI: http://doi.org/10.4266/acc.001872 |
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Ethical principles such as maximizing benefit, fairness, and procedural justice are frequently invoked in discussions on critical care resource allocation during public health emergencies. The coronavirus disease 2019 (COVID-19) pandemic, however, demonstrated that the mere presence of ethical principles does not ensure their operation in real-world crisis settings. In Lombardy and New York, allocation decisions defaulted to individual clinicians under... |
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Neurosurgery
Interdisciplinary collaboration in neurocritical care management |
| Hyunchul Jung, Seung Bin Kim, Seungjoo Lee, Moinay Kim |
| DOI: http://doi.org/10.4266/acc.003275 |
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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... |
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Anesthesiology
Rehabilitating the diaphragm: an integrated approach to intensive care unit-acquired dysfunction in critical illness—a narrative review |
| Ricardo Arriagada, Aaron Pagan, Daniela Nisticò, Francesca Gualdi, Valentina Fassone, Nicolò Antonino Patroniti, Patricia RM Rocco, Denise Battaglini |
| DOI: http://doi.org/10.4266/acc.004375 |
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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... |
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Pediatrics
From scores to signals: evolution and innovations in pediatric early warning systems |
| Wonjin Jang, Bongjin Lee |
| DOI: http://doi.org/10.4266/acc.004475 |
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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... |
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Pharmacology
Predictors of intermediate syndrome after organophosphorus poisoning and its management in Nepal |
| Kishor Khanal, Saroj Poudel |
| DOI: http://doi.org/10.4266/acc.002825 |
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Organophosphorus (OP) poisoning is a global public health challenge, is common in agricultural regions, and is associated with high morbidity and mortality. Intermediate syndrome (IMS) is a delayed complication of OP poisoning that usually occurs 24–96 hours post-exposure and is characterized by proximal muscle weakness, cranial nerve palsies, and respiratory failure. The syndrome significantly increases mortality if not identified and... |
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| Original Articles |
Epidemiology
The functional landscape of critical care: a nationwide study of volume, capability, and institutional variation in South Korea |
| Ho Kyung Sung, Jeehye Lee, Min-hwan Oh, Jin Young Kim, Young Kyun Choi, Jae Young Moon |
| DOI: http://doi.org/10.4266/acc.004225 |
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Background: In Korea, intensive care units (ICUs) are defined mainly by administrative categories, which do not reflect functional capability. This study examined the relationship between hospital capacity and functional performance by analyzing nationwide patterns of volume, capability, and institutional variation. Methods: We analyzed adult emergency department-to-ICU admissions in 378 hospitals from 2016 to 2023. Admission and life-support intervention (LSI) volumes were... |
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Basic Science and Research
Developing consensus-based indicators for intensive care unit capacity and capability in South Korea: a modified Delphi study |
| Jeehye Lee, Ho Kyung Sung, Min-hwan Oh, Jin Young Kim, KyoungHo Kim, Jae Young Moon |
| DOI: http://doi.org/10.4266/acc.000676 |
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Background: Intensive care units (ICUs) are essential components of modern healthcare systems, but South Korea lacks capability-based standards for ICU classification. Critically ill patients are frequently assigned based on bed availability rather than clinical need, creating mismatches between patient acuity and ICU capability. The aim of this study was to develop consensus-based indicators for assessing ICU capacity and capability in... |
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Pulmonary
Association of extubation failure rate with patient outcomes |
| Ivan Gur, Roei Tounek, Ronen Zalts, Rona Epshtein, Asaf Miller, Amichai Gutgold |
| DOI: http://doi.org/10.4266/acc.004250 |
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Background: 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). Methods: Adult patients admitted to the medical intensive care unit who underwent planned extubation were included.... |
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Infection
Early prognostication of septic shock in Korean adults aged 80 years and over: serum albumin combined with Sequential Organ Failure Assessment score |
| Sang-Min Kim, Seung Mok Ryoo, Woon Yong Kwon, Kyuseok Kim, Tae Ho Lim, Sung Pil Chung, Sung-Hyuk Choi, Won Young Kim |
| DOI: http://doi.org/10.4266/acc.005625 |
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Background: Septic shock requires careful risk stratification in patients aged 80 and over. Serum albumin levels reflect host status and, when combined with the severity of organ dysfunction, may enhance early prognostication. Here, we evaluated whether combining albumin levels with the Sequential Organ Failure Assessment (SOFA) score upon emergency department (ED) arrival can improve risk classification. Methods: We conducted an... |
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Infection
Direct and indirect effects of the COVID-19 pandemic on mortality and critical care utilization in South Korea |
| Mindong Sung, Hye Jin Jang, Soyul Han, Sungho Won, Bora Lee, Young Sam Kim |
| DOI: http://doi.org/10.4266/acc.003375 |
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Background: 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. Methods: We conducted a retrospective analysis using national databases from January 2015 through May 2022.... |
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Infection
Impact of negative-pressure room utilization in the emergency department on hospitalized pneumonia patients during the COVID-19 pandemic in Thailand |
| Teeravit Danrungrot, Theerapon Tangsuwanaruk, Wachira Wongtanasarasin, Borwon Wittayachamnankul |
| DOI: http://doi.org/10.4266/acc.003350 |
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Background: 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. Methods: 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... |
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Cardiology
Percutaneous vascular closure technique using parallel closure in extracorporeal membrane oxygenation decannulation: technical note and case series |
| 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: http://doi.org/10.4266/acc.002675 |
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Background: 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... |
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Cardiology
Managing symptomatic intermediate or high-risk pulmonary embolism presenting concomitantly with intracranial bleeding: case series and literature review |
| Pipin Kojodjojo, Keith YC Goh, Chieh Yang Koo, Peter Chang, Philip SS Koh |
| DOI: http://doi.org/10.4266/acc.001075 |
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Background: Managing patients with concomitant intracranial bleeding (ICB) and symptomatic pulmonary embolism (PE) is challenging and there are no guidelines. Methods: 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. Results: Two... |
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CPR/Resuscitation
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 |
| June-sung Kim, Hannah Park, Won Young Kim |
| DOI: http://doi.org/10.4266/acc.002225 |
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Background: 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. Methods: We retrospectively analyzed patients from our... |
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Neurology
Clinical variable-based decision-support model for rapid differentiation of hemorrhagic and ischemic stroke at emergency department presentation in South Korea |
| Jae-Woo Kim, Jin-Heon Jeong, Moon-Ku Han, Sang-Hoon Han, Ka Hyun Kim, Seung Park, Dong-Ick Shin, Kyu Sun Yum |
| DOI: http://doi.org/10.4266/acc.004925 |
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Background: Prompt differentiation between ischemic stroke (IS) and hemorrhagic stroke (HS) is critical because their treatment strategies fundamentally differ. While neuroimaging is essential, clinical decision-making often begins before imaging is completed, and conventional clinical scores have shown inconsistent performance. The objective of this study was therefore to develop and externally validate a machine-learning model that supports HS vs. IS subtype... |
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Surgery
Feasibility and accuracy of continuous glucose monitoring in surgical intensive care unit patients: a single-center pilot study in South Korea |
| Hyojun Park, Eunmi Gil, Joon Ho Lee, Chi-Min Park |
| DOI: http://doi.org/10.4266/acc.004975 |
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Background: 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. Methods: We conducted a single-center observational pilot study, evaluating CGM feasibility in 11 surgical intensive care unit (ICU) patients, including nine post–liver... |
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Refining mortality risk stratification in pediatric sepsis: the roles of PELOD-2, vasoactive-inotropic scores, and procalcitonin in a tertiary hospital in Eastern Indonesia |
| Arya Krisna Manggala, Dyah Kanya Wati, Ida Bagus Gede Suparyatha, I Nyoman Budi Hartawan |
| DOI: http://doi.org/10.4266/acc.002450 |
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Background: 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... |
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Nutrition
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 |
| Sung Bak An, Dong Woo Shin |
| DOI: http://doi.org/10.4266/acc.001170 |
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Background: 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. Methods: We retrospectively analyzed 218 adult critically... |
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Nursing
Effect of planned in-hospital transfer on physiological indicators, level of consciousness, pain, and restlessness in Iran |
| Mohammad Mahdi Honarmand Jahromi, Ali Ravari, Tayebeh Mirzaei, Zahra Kamiab, Zahra Riahi Paghaleh |
| DOI: http://doi.org/10.4266/acc.004175 |
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Background: 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. Methods: A total of 112 hemodynamically stable adult patients requiring transfer from the ED... |
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| Editorials |
Infection
Prioritizing the patient through a continuum of personalized care: insights from the 2026 Surviving Sepsis Campaign guidelines |
| Gyungah Kim, Won-Young Kim |
| DOI: http://doi.org/10.4266/acc.004550 |
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Pulmonary
Rethinking extubation failure as risk calibration in ventilator liberation |
| Jin Sun Cho |
| DOI: http://doi.org/10.4266/acc.004680 |
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| Letters to the Editor |
Infection
Native valve infective endocarditis caused by Neisseria oralis in South Korea |
| Hyunjoo Oh, Eui Tae Kim, Jeong Rae Yoo |
| DOI: http://doi.org/10.4266/acc.006325 |
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Anesthesiology
Impacts of inspired oxygen concentration and arterial oxygen tension on venous and tissue oxygen saturation |
| Kwok Ming Ho |
| DOI: http://doi.org/10.4266/acc.003500 |
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