• Title/Summary/Keyword: 중환자실 환자

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The SOFA Score to Evaluate Organ Failure and Prognosis in the Intensive Care Unit Patients (중환자실에 입원한 환자의 장기부전 및 예후 평가를 위한 SOFA 점수체계의 의의)

  • Kim, Su Ho;Lee, Myung Goo;Park, Sang Myeon;Park, Young Bum;Jang, Seung Hun;Kim, Cheol Hong;Jeon, Man Jo;Shin, Tae Rim;Eom, Kwang Seok;Hyun, In-Gyu;Jung, Ki-Suck;Lee, Seung-Joon
    • Tuberculosis and Respiratory Diseases
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    • v.57 no.4
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    • pp.329-335
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    • 2004
  • Background : The Sequential Organ Failure Assessment (SOFA) score can help to assess organ failure over time and is useful to evaluate morbidity. The aim of this study is to evaluate the performance of SOFA score as a descriptor of multiple organ failure in critically ill patients in a local unit hospital, and to compare with APACHE III scoring system. Methods : This study was carried out prospectively. A total of ninety one patients were included who admitted to the medical intensive care unit (ICU) in Chuncheon Sacred Heart Hospital from May 1 through June 30, 2000. We excluded patients with a length of stay in the ICU less than 2 days following scheduled procedure, admissions for ECG monitoring, other department and patients transferred to other hospital. The SOFA score and APACHE III score were calculated on admission and then consecutively every 24 hours until ICU discharge. Results : The ICU mortality rate was 20%. The non-survivors had a higher SOFA score within 24 hours after admission. The number of organ failure was associated with increased mortality. The evaluation of a subgroup of 74 patients who stayed in the ICU for at least 48 hours showed that survivors and non-survivors followed a different course. In this subgroup, the total SOFA score increased in 81% of the non-survivors but in only 21% of the survivors. Conversely, the total SOFA score decreased in 48% of the survivors compared with 6% of the non-survivors. The non-survivors also had a higher APACHE III score within 24 hours and there was a correlation between SOFA score and APACHE III score. Conclusion : The SOFA score is a simple, but effective method to assess organ failure and to predict mortality in critically ill patients. Regular and repeated scoring enables patient's condition and clinical course to be monitored and better understood. The SOFA score well correlates with APACHE III score.

Circadian Rhythm of Urinary Free Cortisol in Brain Injuryed Patients (뇌손상 환자의 요중 Free Cortisol의 Circadian Rhythm)

  • Min, Soon
    • Journal of Korean Biological Nursing Science
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    • v.3 no.1
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    • pp.1-10
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    • 2001
  • 뇌손상이라고 하는 과도한 stress를 받았을 때 free cortisol의 분비되는 양과 urinary free cortisol의 circadian 리듬에 어떻게 영향을 주는지 확인하기 위하여 시도하였다. 연구대상은 대조군은 건강한 젊은 여성 6명과 실험군응 CT상 뇌에 손상을 받은 4명의 여성으로 30대 환자이었다. 담당의사와 중환자실 관리책임자의 동의하에서 시도되었으며, 실험기간은 2000년 7월 1일에서 7월 10일까지였다. 대조군과 실험군의 뇨를 채취하여 뇨중 free cortisol 농도의 circadian rhythm을 알아보기 위해 채뇨 후 분석하였다. 채뇨는 뇌손상을 받고 응급실을 통해 신경외과 중환자실에 입원한 지 5시간 이내에 해당된 환자로 24시간 유지되는 foley catherization 상태하에서 12:00부터 3일동안 72시간을 2시간 간격으로 채뇨하였고, 대조군은 오전 12시부터 24시간 동안 2시간 간격으로 채뇨하였다. 측정방법으로는 cortisol의 정량은 solid-phase radioimmuoassay 방법을 이용하였으며, 분석재료는 Coat-A-Count(R) Cortisol kit(DPC, U.S.A.)을 사용하여 DPC사의 측정방법을 따랐다. 연구대상자의 free cortisol의 총량은 대조군에서는 $42.8{\mu}g$이었고, 실험군은 1일에 $991.2{\mu}g$, 2일에 $809{\mu}g$, 3일에 $544.2{\mu}g$으로 대조군과 통계적으로 유의한 차이를 나타내(p<.05), 실험군에서 현저하게 증가된 양상을 보였고, 시간이 지나면서 점점 감소하는 경향을 나타냈다. 시간별로 t-검정으로 분석한 결과로는 모든 시간대에서 대조군과 실험군의 평균치는 통계적으로 유의한 차이를 나타냈다. Free cortisol의 circadian에서는 대조군에서는 정상인의 cortisol의 circadian의 경우와 같은 리듬을 보였으나, 손상을 받은 실험군의 경우 분비량은 현저하게 증가했음을 보여주었다. 최고치가 제1일에 18:00과 다음날 10:00에 나타나 최고치가 2회 나타났으며, 제2일에도 제1일과 마찬가지로 18:00에 나타났고, 제3일에는 24:00에 나타나 제1일보다 제2일에는 최고치가 한 번 나타난 리듬을 보여주었고, 분비량은 2일에 감소하였다. 제3일에는 최고치가 8시간 지연된 나타난 리듬의 변화를 보여주었다. 최저치는 제1일, 제2일, 제3일 모두 24:00에 나타난 리듬을 보여주었다. 이상의 결과에서 실험군인 뇌손상 환자군에서는 뇌손상이 과도한 stress로 작용하여 환자의 free cortisol 분비량과 circadian 리듬에도 영향을 주는 것으로 나타났다. 그러므로 뇌손상환자를 간호하는 간호사는 스트레스상태인 것을 인지하여 환자 개개인에 필요한 간호를 해야 할 것으로 사료된다.

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Comparison of the nutritional indicators of critically Ill patients on extracorporeal membrane oxygen (ECMO) (체외막산소화장치 (ECMO) 적용 중환자의 영양지표 비교)

  • Shin, Nah-Mee;Ha, Suk Yeon;Cho, Yoon Soo
    • Journal of Nutrition and Health
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    • v.54 no.5
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    • pp.489-500
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    • 2021
  • Purpose: This study aimed at investigating the nutritional status, nutritional support, and nutritional indicators of critically ill patients on extracorporeal membrane oxygen (ECMO) in intensive care units (ICU). Methods: This descriptive study obtained data from the medical records of 37 patients who were treated using ECMO at a university hospital in Korea. The patients were admitted to the Korea University Anam Hospital ICU with acute or serious damage to vital organs from January 1, 2014 to June 30, 2016. Results: Although 32 patients (86.5%) were at a high risk of malnutrition, 26 patients (70.3%) were considered normal in terms of nutritional status by the nutritionist at the beginning of their ICU stay. However, after two weeks, nine patients had passed away and only one patient maintained normal status. Parenteral nutrition was started first but took 4.25 ± 6.95 days till initiation. Only eight patients (21.6%) were able to meet their requirement for both calories and protein. The group provided with adequate calorie and protein showed significantly longer use of the ECMO and respirator and longer ICU and total hospital stay than their counterparts. Normal levels of serum albumin and protein of the group at low-risk for malnutrition on the day of initiation of ECMO, which were significantly higher than the high-risk group, declined by the last day of ECMO leading to a lack of significant differences between the two groups. Conclusion: Considering that the nutritional indicators of patients deteriorated as the days on ECMO increased, more aggressive nutritional management to ensure adequate nutritional support should be emphasized from the beginning and throughout the ICU stay.

Clinical Analysis of Ventilator-Associated Pneumonia in Chest Trauma (흉부외상에 의한 인공호흡기치료 환자에서 발생한 폐렴의 임상분석)

  • Yun, Ju-Sik;Oh, Bong-Suk;Ryu, Sang-Woo;Jang, Won-Chae
    • Journal of Chest Surgery
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    • v.41 no.6
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    • pp.736-741
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    • 2008
  • Background: Pneumonia continues to be the most common major infection in trauma patients. Despite the advances in prevention, diagnosis, and treatment for pneumonia, it remains a major cause of morbidity and mortality. The aim of this retrospective study is to identify the risk factors and clinical features of ventilator-associated pneumonia among chest trauma patients. Material and Method: The study population consisted of 78 mechanically ventilated patients admitted to the ICU of Chonnam National University Hospital between January, 2001, and December, 2006. The patients were divided into two groups: those with pneumonia (Group I) and without pneumonia (Group II). Clinical predictors of the occurrence and mortality for ventilator associated pneumonia were analyzed. Result: There were 57 men and 21 women, with a mean age of $48.3{\pm}19.9$ years. Almost half of the patients, 48.7% (38 of 78), had pneumonia. The mortality rate was 21.0% (8 of 38) in Group I and 2.5% (1 of 40) in Group II. The predictors of ventilator-associated pneumonia were the duration of mechanical ventilation (17.4 days vs 6.5 days, p<0.001), the mean stay in the ICU (21.7 days vs 9.7 days, p<0.001), the use of inotropics due to hemodynamic instability (63.1% vs 25.0%, p=0.001), and the serum level of CRP ($11.3{\pm}7.8$ vs $6.4{\pm}7.3$, p=0.006). Conclusion: Posttraumatic ventilator-associated pneumonia was significantly related with the duration of mechanical ventilation, the mean stay in ICU, and the use of inotropics due to hemodynamic instability. The serum level of CRP at admission was higher in the pneumonia group. Morbidity and mortality can be reduced by early identification of predictive factors for developing pneumonia in chest trauma patients.

Clinical Aspects of Bacteremia in Medical and Surgical Intensive Care Units (내과 및 외과계 중환자실 환자 균혈증의 임상적 고찰)

  • Kim, Eun-Ok;Lim, Chae-Man;Lee, Jae-Kyoon;Mung, Sung-Jae;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Park, Pyung-Hwan;Choi, Jong-Moo;Pai, Chik-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.535-547
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    • 1995
  • Background: Intensive care units(ICUs) probably represent the single largest identifiable source of infection within the hospital. Although there are several studies on ICU infections in respect to their bacteriology or mortality rate for individual types of ICU, few studies have compared ICU infections between different types of ICU. The aim of this study was to identify clinical differences in bacteremia between medical ICU(MICU) and surgical ICU(SICU) patients. Methods: 256 patients with bacteremia were retrospectively evaluated. Medical records were reviewed to obtain the clinical and bacteriologic informations. Results: 1) The mean age of the patients with bacteremia of MICU($58.6{\pm}17.2\;yr$) was greater than that of all MICU patients($54.3{\pm}17.1\;yr$)(p<0.01), but there was no significant difference in SICU patients(patients with bacteremia of SICU: $56.3{\pm}18.6\;yr$, all SICU patients: $62.0{\pm}16.8$)(p>0.05). ICU stay was longer(MICU patients: $23.4{\pm}40.8$ day, SICU patients: $30.3{\pm}26.8$ day) than the mean stay of all patients($6.8{\pm}15.5$ day)(p<0.05, respectively). Bacteremia of both ICU patients developed past the average day of ICU stay(all MICU patients: 7.9 day, all SICU patients: 6.0 day, MICU bacteremia: 19th day, SICU bacteremia: 17th day of ICU stay)(p<0.05, respectively). 2) There were no significant differences in mean age, sex, and length of stay of both ICU patients with bacteremia. 3) Use of antibiotics or steroid, use of percutaneous devices and invasive procedures before development of bacteremia were more frequent in SICU patients than in MICU patients(prior antibiotics use: MICU 45%, SICU 63%, p<0.05; steroid use: MICU 14%, SICU 36%, p<0.01; use of percutaneous devices: MICU 19%, SICU 39%, p<0.01; invasive procedures: MICU 19%, SICU 61 %, p<0.01). 4) The prevalence of community acquired infections was significantly higher in MICU patients than in SICU patients(MICU 42%, SICU 9%)(p<0.01), whereas SICU patients showed higher prevalence of ICU-acquired infection than MICU patients(MICU 48%, SICU 78%)(p<0.01). 5) There were no differences in causative organisms, primary sites of infection and time interval to bacteremia between both ICUs. 6) There were no significant differences in outcome according to pathogenic organisms or primary sites of infection. 7) The mortality rate was higher in patients with bacteremia than without bacteremia(MICU mortality rate: patients with bacteremia 72.5%, patients without bacteremia 36.0%, p<0.01; SICU mortality rate: patients with bacteremia 40.3%, patients without bacteremia 8.5%, p<0.05), and the mortality rate of MICU bacteremia was significantly higher compared with that of SICU bacteremia(MICU 72.5%, SICU 40.3%)(p<0.01). Conclusion: ICU patients with bacteremia stayed longer before the development of bacteremia, and showed higher mortality than the overall ICU population. The incidence of bacteremia was higher in MICU patients than SICU patients. MICU patients with bacteremia showed higher prevalence of liver diseases and acute respiratory failure, community-acquired bacteremia and greater mortality rate than SICU patients with bacteremia. SICU patients with bacteremia, on the other hand, showed higher prevalence of trauma, prior use of immunosuppressive agents, invasive procedures, and ICU-acquired bacteremia, and lower mortality rate than MICU patients with bacteremia.

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The Effects of Sleep Improvement Intervention on the Sleep Quality and Incidence of Delirium in the Intensive Care Unit Patients (중환자실 환자의 수면증진 중재가 수면의 질 및 섬망발생에 미치는 효과)

  • Lee, Eun-Nam;Cho, Jeong-Lim;Kim, Mae-Ri;Lee, Eun-Ju;Lee, Yeong-Hui;Choi, Eun-Ju;Lee, Hye-Ran
    • Journal of Korean Critical Care Nursing
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    • v.5 no.1
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    • pp.23-33
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    • 2012
  • Purpose: The purpose of this study is to investigate the effect of eye-shields and sleep-inducing music application on sleep quality and incidence of delirium for intensive care unit (ICU) patients. Methods: This study was a untreated control group design with pretest and posttest. The data was collected in the ICU of D University Hospital in Busan, from June to September 2011. Thirteen subjects were assigned to eye-shields and sleep-inducing music intervention and 15 subjects were in the control group. Results: Eye-shields and sleep-inducing music application was effective for improving the quality of sleep in ICU patients. There was no statistically significant difference in the incidence of delirium between the two groups. Conclusion: The sleep improvement intervention with eye-shields and sleep-inducing music would be a meaningful part of nursing intervention programs to enhance the quality of sleep in ICU patients.

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Development and Evaluation of a Nursing Handoff Protocol for Intensive Care Units (중환자실 간호 인수인계 프로토콜의 개발 및 평가)

  • Cho, Young Shin;Kwon, Sun Ju;Yun, Mi Young;Lee, Mi Hwa;An, So Hee;Kong, Yu Jeong
    • Journal of Korean Critical Care Nursing
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    • v.9 no.2
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    • pp.1-12
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    • 2016
  • Purpose: This study aimed to develop a nursing handoff protocol for intensive care units and test its relevance. Methods: This is a methodological research to develop a protocol. A preliminary protocol was developed by composing items and testing content validity through literature review and experts' review. We revised and complemented the preliminary protocol following practical relevance assessment of 38 intensive care unit nurses at a university hospital to test content validity and to assess practical relevance of the final protocol. Results: On the basis of the content validity test for the final protocol, 40 items were adopted. The scores for the practical relevance of the final protocol increased significantly for items such as accuracy of handoff, reduction of handoff-related errors, convenience in using the protocol, reduction in handoff time, and simplification of handoff. Conclusions: The nursing handoff protocol for intensive care units in this study is expected to improve nursing performance with a standardized handoff in intensive care units, promote patient safety, and improve communication among the medical staff.

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Prevalence and Risk Factors of Anxiety, Depression, and Post-Traumatic Stress Disorder in Critical Care Survivors (중환자실 퇴원 환자의 불안, 우울, 외상 후 스트레스 장애 유병률 및 위험요인)

  • Kang, Ji Yeon;An, Geum Ju
    • Journal of Korean Critical Care Nursing
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    • v.13 no.3
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    • pp.62-74
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    • 2020
  • Purpose : This study aimed to investigate the prevalence and risk factors of mental health problems in patients discharged from the intensive care unit (ICU). Methods : This was a secondary analysis study using data from a multicenter prospective cohort of post-ICU patients. We analyzed data of 311 patients enrolled in the primary cohort study who responded to the mental health questionnaire three months after the discharge. Anxiety and depression were measured on the Hospital Anxiety-Depression Scale, and post-traumatic stress disorder (PTSD) was measured on the Posttraumatic Diagnostic Scale. Results : The prevalence of anxiety, depression, and PTSD in patients at three months after ICU discharge were 25.7%, 17.4%, and 18.0%, respectively, and 7.7% of them experienced all three problems. Unemployment (OR=1.99, p=.033) and unplanned ICU admission (OR=2.28, p=.017) were risk factors for depression, while women gender (OR=2.34, p=.009), comorbid diseases (OR=2.88, p=.004), non-surgical ICUs (trauma ICU: OR=7.31, p=.002, medical ICU: OR=3.72, p=.007, neurological ICU: OR=2.95, p=.019) and delirium (OR=2.89, p=.009) were risk factors for PTSD. Conclusion : ICU nurses should proactively monitor risk factors for post-ICU mental health problems. In particular, guidelines on the detection and management of delirium in critically ill patients should be observed.

Critical Thinking Disposition, Medication Error Risk Level of High-alert Medication and Medication Safety Competency among Intensive Care Unit Nurses (중환자실 간호사의 비판적 사고성향, 고위험약물 투약오류 위험수준 및 투약안전역량)

  • Lee, Yoon Hee;Lee, Youngjin;Ahn, Jeong-Ah;Kim, Hee Jun
    • Journal of Korean Critical Care Nursing
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    • v.15 no.2
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    • pp.1-13
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    • 2022
  • Purpose : The study aimed to identify relationship among intensive care unit (ICU) nurses' critical thinking disposition, medication error risk level of high-alert medication, and medication safety competency, as well as the factors affecting medication safety competency. Methods : The participants were 266 ICU nurses of one higher-tier general hospital and one general hospital in Province. The data were collected using structured self-administered questionnaire from August 10 to August 31, 2021. Measurements included the critical thinking disposition questionnaire, nurses's knowledge of high-alert medication questionnaire, the medication safety competency scale. Data were analyzed using hierarchical multiple regressions using SPSS/WIN 28.0. Results : In the multiple regression analysis, the medication safety competence has a statistically significant correlation with the working department, the critical thinking disposition, and medication error risk level of high-alert medication. Conclusion : Based on the results of this study, it is suggested to develop and apply an educational strategy that can strengthen the knowledge and skills of critical thinking disposition and medication error risk level of high-alert medication to improve the ICU nurse's medication safety competency.

Oral Hygiene Care of Endotracheal Intubated Patients in Korean Intensive Care Units : A Scoping Review (기관내관을 적용중인 국내 중환자실 성인 입원환자의 구강간호에 대한 주제범위 문헌고찰 )

  • Lim, Jungeun;Jung, Dukyoo;Yoo, Leeho
    • Journal of Korean Critical Care Nursing
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    • v.17 no.1
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    • pp.68-82
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    • 2024
  • Purpose : This scoping review was designed to identify gaps in knowledge and guide future directions for clinical nursing practices and research on oral hygiene care for endotracheally intubated patients in Korean intensive care units. Methods : We conducted a scoping review using the methodological framework proposed by Arksey and O'Malley. PubMed, CINAHL, RISS, Science On, and DBpia databases were searched. Two reviewers independently selected the studies and extracted data. A total of 445 studies were identified, of which 17 were included in the final analysis. Results : No research has been conducted from 2021 to the present. A total of 12 instruments were utilized in 13 studies to assess the effectiveness of oral hygiene care. All studies investigating the effectiveness of oral hygiene care have consistently documented that chlorhexidine has the most significant effect. The frequency and time of oral hygiene care were each examined in one study. Conclusion : A research study is necessary to develop a measurement tool for assessing the effectiveness of oral hygiene care suitable for endotracheal intubated patients in intensive care units. Interventional studies should be conducted to determine the effects of chlorhexidine and the appropriate frequency and time of oral hygiene care. Thereafter, revision of domestic evidence-based clinical practice guidelines by integrating these results will be necessary.