Song I. Lee

Purpose : Survivors of critical illness commonly experience persistent physical, cognitive, and psychological impairments, collectively known as post-intensive care syndrome. Although intensive care unit (ICU) rehabilitation is now recognized as an important part of recovery after critical illness, rehabilitation practices remain inconsistent, and clinical practice guidelines adapted to the Korean healthcare context have not been available.Methods : These clinical practice guidelines were developed de novo by a multidisciplinary panel comprising critical care physicians, rehabilitation specialists, nurses, and allied health professionals. The panel prioritized 15 key clinical questions addressing adult, pediatric, and neonatal ICU (NICU) rehabilitation. Systematic literature searches were conducted in Medline via PubMed, Embase, the Cochrane Library, and KoreaMed, and the final searches for all 15 questions were completed by November 30, 2024. The certainty of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Final recommendations were approved through a structured consensus process requiring at least 70% panel agreement.Results : The panel issued 15 recommendations across major rehabilitation domains, including early structured rehabilitation, criteria for withholding or discontinuing therapy, adjunctive modalities, rehabilitation frequency, inspiratory muscle training, swallowing rehabilitation, cognitive and occupational therapy, nutritional support, neonatal and pediatric ICU rehabilitation, and post-ICU follow-up care. Thirteen recommendations were conditional, whereas two were strong, mainly because they addressed patient safety.Conclusion : These guidelines provide evidence-informed recommendations for rehabilitation in critically ill patients across adult, pediatric, and NICUs in Korea. They are designed to standardize practice, improve patient safety, support patient-centered functional recovery beyond survival, and identify priorities for future research.

Background: Survivors of critical illness commonly experience persistent physical, cognitive, and psychological impairments, collectively known as post–intensive care syndrome. Although intensive care unit (ICU) rehabilitation is now recognized as an important part of recovery after critical illness, rehabilitation practices remain inconsistent, and clinical practice guidelines adapted to the Korean healthcare context have not been available.Methods: These clinical practice guidelines were developed de novo by a multidisciplinary panel comprising critical care physicians, rehabilitation specialists, nurses, and allied health professionals. The panel prioritized 15 key clinical questions addressing adult, pediatric, and neonatal ICU (NICU) rehabilitation. Systematic literature searches were conducted in Medline via PubMed, Embase, the Cochrane Library, and KoreaMed, and the final searches for all 15 questions were completed by November 30, 2024. The certainty of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Final recommendations were approved through a structured consensus process requiring at least 70% panel agreement.Results: The panel issued 15 recommendations across major rehabilitation domains, including early structured rehabilitation, criteria for withholding or discontinuing therapy, adjunctive modalities, rehabilitation frequency, inspiratory muscle training, swallowing rehabilitation, cognitive and occupational therapy, nutritional support, neonatal and pediatric ICU rehabilitation, and post-ICU follow-up care. Thirteen recommendations were conditional, whereas two were strong, mainly because they addressed patient safety.Conclusions: These guidelines provide evidence-informed recommendations for rehabilitation in critically ill patients across adult, pediatric, and NICUs in Korea. They are designed to standardize practice, improve patient safety, support patient-centered functional recovery beyond survival, and identify priorities for future research.

Objective: Survivors of critical illness commonly experience persistent physical, cognitive, and psychological impairments, collectively known as post-intensive care syndrome. Although intensive care unit (ICU) rehabilitation is now recognized as an important part of recovery after critical illness, rehabilitation practices remain inconsistent, and clinical practice guidelines adapted to the Korean healthcare context have not been available.Methods: These clinical practice guidelines were developed de novo by a multidisciplinary panel comprising critical care physicians, rehabilitation specialists, nurses, and allied health professionals. The panel prioritized 15 key clinical questions addressing adult, pediatric, and neonatal ICU (NICU) rehabilitation. Systematic literature searches were conducted in Medline via PubMed, Embase, the Cochrane Library, and KoreaMed, and the final searches for all 15 questions were completed by November 30, 2024. The certainty of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Final recommendations were approved through a structured consensus process requiring at least 70% panel agreement.Results: The panel issued 15 recommendations across major rehabilitation domains, including early structured rehabilitation, criteria for withholding or discontinuing therapy, adjunctive modalities, rehabilitation frequency, inspiratory muscle training, swallowing rehabilitation, cognitive and occupational therapy, nutritional support, neonatal and pediatric ICU rehabilitation, and post-ICU follow-up care. Thirteen recommendations were conditional, whereas two were strong, mainly because they addressed patient safety.Conclusion: These guidelines provide evidence-informed recommendations for rehabilitation in critically ill patients across adult, pediatric, and NICUs in Korea. They are designed to standardize practice, improve patient safety, support patient-centered functional recovery beyond survival, and identify priorities for future research.

Auscultation is a noninvasive, real-time method of assessing respiratory diseases; however, its accuracy can vary depending on the clinician’s experi

Accurate muscle mass assessment is essential in critical care, but no consensus exists on the optimal method because of invasiveness and limited feasibilit

Objective: The objective of this study was to evaluate the effects of dexmedetomidine on respiratory and hemodynamic parameters in patients receiving high-flow nasal cannula therapy. Methods: This retrospective observational study included 206 adult patients who received dexmedetomidine during high-flow nasal cannula therapy between November 2019 and September 2023. Patients in whom dexmedetomidine was initiated during mechanical ventilation and those with incomplete data were excluded. Dexmedetomidine was administered intravenously at a median dose of 0.2 (0.2–0.3) mcg/kg/h for 3.0 (2.0–5.0) days. Primary outcomes were changes in respiratory rate and the partial pressures of carbon dioxide and oxygen. Secondary outcomes included hemodynamic changes, adverse events, and discontinuation of dexmedetomidine. Results: Respiratory rate and the partial pressure of carbon dioxide remained stable over 24 h, whereas the partial pressure of oxygen significantly increased at 3 h (p = 0.007). Dexmedetomidine led to significant reductions in systolic blood pressure and heart rate (p < 0.001). Hypotension occurred in 31.6% of patients, and vasopressors were required in 28.2%. Dexmedetomidine was discontinued in 26.7% of patients because of adverse events. Conclusions: Dexmedetomidine administration was associated with improved oxygenation without compromising respiratory drive in patients receiving high-flow nasal cannula, although careful monitoring is warranted because of potential hemodynamic effects.

The Life-Sustaining Treatment (LST) Decision-Making Act is a South Korean law that aims to empower patients by providing them with more autonomy in end-of-

Background: Acute skeletal muscle wasting is a common complication among critically ill patients and contributes to prolonged stays in the intensive care unit (ICU) and poor outcomes. Although bedside ultrasound of the rectus femoris cross-sectional area (RFcsa) is useful for assessing muscle loss, data on its incidence and predictors in medical ICU populations are limited. Our study aimed to determine the incidence of significant muscle wasting (≥10% reduction in RFcsa) and to identify modifiable predictors, particularly early rehabilitation. Methods: This retrospective cohort study was conducted at a tertiary academic hospital in South Korea. Seventy-six adult ICU patients who underwent serial ultrasound assessments of RFcsa within 48 h of admission and again on day 7 were included. Patients were categorized based on whether they experienced a ≥ 10% reduction in RFcsa. Clinical characteristics, interventions, and outcomes were compared between groups. Multivariate logistic regression identified predictors of significant muscle loss, ICU mortality, and in-hospital mortality. Results: A significant reduction in RFcsa (≥10%) was observed in 53.9% of patients (n = 41/76). These patients had longer ICU stays (median 15.0 vs. 10.0 d, p = 0.001) and were less likely to receive Level 3 or higher ICU-level rehabilitation (4.9% vs. 20.0%, p = 0.042). Multivariate analysis revealed that Level 3 or higher rehabilitation was independently associated with reduced muscle wasting (OR: 0.183; 95% CI: 0.035–0.970; p = 0.046). Multivariable analyses revealed that increased total bilirubin and decreased albumin levels were associated with ICU mortality. In-hospital mortality, however, was independently associated with a higher Charlson comorbidity index, elevated bilirubin and C-reactive protein levels, and low albumin. A decrease in RFcsa of at least 10% was not significantly associated with either outcome. Conclusions: More than half of the patients in the ICU experienced significant muscle loss within the first week of being admitted. Receiving structured rehabilitation at Level 3 or higher was independently associated with reduced muscle wasting. This suggests that early mobilization strategies may help preserve muscle mass in critically ill patients.

Introduction: Sepsis is a life-threatening condition, especially for patients in the intensive care unit (ICU), where early identification of the prognosis is critical. This study aimed to evaluate the prognostic value of inflammatory markers, clinical scores, and specific laboratory findings for predicting ICU and in-hospital mortality in sepsis patients. Methods: A retrospective cohort study was conducted on adult patients with sepsis who were admitted to the ICU of a university hospital between September 2019 and December 2022. To minimize selection bias, all eligible patients during the study period were consecutively included. Data were extracted from electronic medical records and included demographics, clinical characteristics, inflammatory markers, and clinical scores such as the Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS), Eastern Cooperative Oncology Group (ECOG) performance status, Simplified Acute Physiology Score 3 (SAPS 3), and Sequential Organ Failure Assessment (SOFA). The primary outcomes were ICU and in-hospital mortality. Univariate and multivariate Cox regression analyses were performed to identify predictors of mortality. Results: A total of 213 ICU patients with sepsis were included in the study. The patients were 62.0% male with a mean age of 73.1 ± 12.6 years. The ICU and in-hospital mortality rates were 29.6% and 36.6%, respectively. Non-survivors had higher clinical severity scores and poorer nutritional and perfusion profiles than survivors. Multivariate analysis revealed that elevated lactate levels (a marker of tissue hypoperfusion) and higher SAPS 3 scores were independently associated with ICU mortality. For in-hospital mortality, lower albumin levels and higher SAPS 3 scores were significant predictors. Conclusions: High lactate and SAPS 3 scores were independent predictors of mortality, while higher albumin levels showed a potential protective effect. Early identification of these factors may aid in the management of sepsis.