• 중환자간호학회지
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• 제17권3호
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• pp.14-24
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• 2024

Purpose : This study aimed to investigate the difference in compliance with the sepsis bundle and mortality rates according to the body temperature of patients with sepsis in general wards identified using a rapid response system (RRS). Methods : A retrospective observational study of 1,083 patients with sepsis in general wards identified using the RRS from July 2018 to December 2022 was performed at a tertiary care hospital in South Korea. The patients were classified into hypothermia (<36℃), normothermia (36-38℃), and hyperthermia (>38℃) groups according to their body temperature at the time of RRS activation. Results : A total of 1,083 sepsis patients were analyzed, comprising 17 cases of hypothermia, 624 cases of normothermia, and 442 cases of hyperthermia. There were statistically significant differences among the body temperature groups in the rate of compliance with the sepsis bundle within 1 h (hypothermia: 64.7% vs. normothermia: 49.5% vs. hyperthermia: 60.4%, p =.010), the rate of compliance with the overall sepsis bundle, including lactate re-measurement (64.7% vs. 49.5% vs. 60.4%, p =.001), and the rate of blood culture testing (94.1% vs. 85.9% vs. 92.8%, p =.002). The 28-day mortality rates in the hypothermia, normothermia, and hyperthermia groups were 29.4%, 32.4%, and 16.5%, respectively (p <.001). Conclusion : There were statistically significant differences in compliance with the sepsis bundle and mortality rates according to body temperature. Patients with sepsis and normothermia showed lower compliance with the sepsis bundle and higher mortality rates. Therefore, it is recommended to develop strategies for the early recognition of patients with sepsis and normothermia and to improve compliance with the sepsis bundle.

• 임상간호연구
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• 제26권2호
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• pp.198-206
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• 2020

Purpose: The rapid response team is a patient safety system that detects symptoms and signs of deteriorating inpatients and provides intervention and treatment. This study analyzed the factors influencing the activation time of the team. Methods: This is a descriptive correlation study that analyzed the electronic medical records of patients activated by the rapid response team. The collection period was from January 2014 to December 2017. We analyzed 278 pieces of data activated by the rapid response team for patients aged 16 years or older at C University S Hospital in Seoul. We employed the SPSS 23.0 program for data analysis. Results: The reasons for activation of the rapid response team were oxygen saturation of less than 90.0%, other causes, and change in consciousness. The most common diagnosis of activated patients was respiratory failure (32.4%). The average activation time was 153.43±286.05 min. The activation time was shortest during convulsions (13.29±7.32 min). For patients with a history of kidney disease (B=0.58, p=.008), in case of surgery (B=0.55, p<.001), if the first symptom is mediated by the physician (B=0.53, p=.007) the active time is often extended. On the other hand, activation time is reduced when consciousness changes (B=-0.51, p=.002), especially when oxygen saturation is below 90.0% (B=-0.64, p<.001). Conclusion: Based on the results of the study, it is expected that patients deteriorating in the general ward would be recognized early, which will help in the effective activation of the rapid response team.

• 한국의료질향상학회지
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• 제27권2호
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• pp.18-29
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• 2021

Purpose: Patients with hematologic malignancy (HM) typically have a high mortality rate when their condition deteriorates. The chronic progressive course of the disease makes it difficult to assess the effect of intervention on acute events. We investigated the effectiveness of a rapid response team (RRT) on in-hospital mortality in patients with HM. Methods: We retrospectively analyzed the data of patients with HM who admitted to the medical intensive care unit between 2006 and 2015. Clinical outcomes before and after RRT implementation were evaluated. Results: A total of 228 patients in the pre-RRT period and 781 patients in the post-RRT period were included. The overall in-hospital mortality was 55.4%. Patients in the post-RRT period had improved survival; however, they required more vasopressor therapy, continuous renal replacement therapy, and extracorporeal membrane oxygenation. Multivariate analysis revealed that in-hospital mortality was associated with RRT activation (hazard ratio [HR], 0.634; 95% confidence interval [CI], 0.498-0.807; p < .001), neurological disease (HR, 2.007; 95% CI, 1.439-2.800; p < .001), sequential organ failure assessment score (HR, 1.085; 95% CI, 1.057-1.112; p < .001), need for continuous renal replacement therapy (HR, 1.608; 95% CI, 1.206-1.895; p< .001), mechanical ventilation (HR, 1.512; 95% CI, 1.206-1.895; p< .001), vasopressor (HR, 1.598; 95% CI, 1.105-2.311; p = .013), and extracorporeal membrane oxygenation (HR, 1.728; 95% CI, 1.105-2.311; p = .030). Conclusion: RRT activation may be associated with improved survival in patients with HM.

• 중환자간호학회지
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• 제16권3호
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• pp.11-23
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• 2023

Purpose : This study investigates the experiences of patients in intensive care units (ICUs), and the factors influencing these experiences. Method : We used a cross-sectional survey design to analyze previously collected cohort data from 891 patients who spent over 24 hours in 19 ICUs across four university hospitals in Busan, South Korea between June 2019 and July 2020. Within a week of ICU discharge, participants completed the Korean version of the Intensive Care Experience Questionnaire, covering four areas: "awareness of surroundings," "frightening experiences," "satisfaction with care," and "recall of experiences." We used multiple linear regression to identify factors associated with the ICU experience. Results : Low income (𝛽 = -.08, p = .016), unplanned hospitalization (𝛽 = -.09, p = .006), sedation (𝛽 = -.16, p < .001), and delirium (𝛽 = -.15, p < .001) reduce patients' awareness of their surroundings. Frightening experiences are associated with being female (𝛽 = -.07, p = .027), experiencing delirium(𝛽= -.15, p<.001), and longer stays in the ICU (𝛽= -.14, p <.001). Using sedatives decreases satisfaction with care (𝛽 = -.08, p = .048). Living alone (𝛽 = -.08, p = .013) and using painkillers (𝛽 = -.08, p = .020) reduces recall of experiences. Conclusion : Negative ICU experiences are significantly associated with being female, living alone, lower income, unplanned admission, using sedatives and painkillers, delirium, and longer stays in the ICU. Thus, improving ICU experiences requires interventions that address modifiable factors, such as delirium, medication, and length of ICU stays.

• 디지털융복합연구
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• 제19권4호
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• pp.467-475
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• 2021

목적: 병동에서 급성악화 환자가 발생할 때 환자에게 집중치료가 필요한지 여부에 대한 결정은 환자의 예후를 향상시키기 위해서는 매우 중요하나, 특히 사용 가능한 ICU 자원이 제한적일 때는 ICU 전동 여부를 결정하기에는 어려움이 있다. 따라서 본 연구는 일반병동 급성 악화 환자를 대상으로 중환자실 전동 위험요인을 확인하고자 한다. 연구방법: 후향적 조사연구로서 대상자는 일 상급종합병원 일반병동에 입원한 18세 이상의 성인 환자 중 악화상태를 보여 신속대응팀에 의뢰된 환자 2,945명을 대상으로 하였다. 중환자실 전동 위험요인을 파악하기 위해 다변량 로지스틱 회귀분석을 시행하였다. 연구결과: 다변량 로지스틱 회귀분석 결과 입원시 고형암을 진단받은 경우 (odds ratio [OR] 0.39, 95% CI 0.32-0.47), 악화원인이 호흡문제인 경우 (OR 1.51, 95% CI 1.17-1.95), MEWS (OR 1.22, 95% CI 1.17-1.28)와 SpO2/FiO2 score (OR 2.41, 95% CI 2.23-2.60)가 중환자실 전동 위험요인으로 나타났다. 결론: 본 연구 결과는 중환자실 전동 위험이 높은 환자의 조기 예측을 가능하게 하여 환자의 예후를 향상시키는데 도움이 될 것으로 사료된다.