• Quality Improvement in Health Care
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• v.17 no.1
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• pp.79-88
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• 2011

Background : Evidence-based guidelines are now used for enteral nutrition(EN) in neurosurgical intensive care unit patients who mostly depend on EN. This study compared and analyzed the nutritive conditions of patients before and after they underwent guideline based nutritional interventions in order to determine whether using these guidelines improved their calorie supply. Methods : Data on the patients' nutritional requirements, maximum calorie supply through EN, serum albumin level, and total lymphocyte count were collected and analyzed using SAS version 9.1.3. All the statistical analyses were performed at a significance level of P<0.05. Result : The maximum calorie supply through EN was $923.1{\pm}359.7$ kcal before the intervention and $1254.4{\pm}196.3$ kcal after the intervention; this difference was statistically significant(P<0.05). The ratio of nutritional requirements to maximum calorie supply through EN was $55.5{\pm}22.4%$ and $74.2{\pm}13.9%$ before and after the intervention, respectively; this difference was statistically significant(P<0.05). This indicates a 19% increase in the ratio after the nutritional intervention. The serum albumin level also significantly increased from $2.7{\pm}0.6g/dL$ before the intervention to $3.2{\pm}0.4g/dL$ after the intervention(P<0.05). The total lymphocyte count slightly increased from $1267.7{\pm}728.2cells/mm^3$ before the intervention to $1801.9{\pm}1211.5cells/mm^3$ after the intervention; this difference was not statistically significant. Conclusion : The results showed that using the evidence-based feeding guidelines for interventions increased the calorie supply and improved the patients' nutritive conditions from moderate malnutrition to mild malnutrition.

• Tuberculosis and Respiratory Diseases
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• v.68 no.5
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• pp.259-266
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• 2010

Background: Pulmonary tuberculosis (TB), requiring the intensive care unit (ICU) care, has been a high-mortality condition until now. In the present study, we aimed to investigate clinical features and parameters associated with TB mortality. Methods: From August 2003 to December 2008, patients with microbiologically or histologically confirmed pulmonary TB then admitted to the ICU, were retrospectively enrolled into the study. Upon enrollment, their medical records were reviewed. Results: Forty three patients (30 males, 13 females) were included and their mean age was 63.8 years (range: 17~87 years). Twelve patients died, an overall in-hospital mortality of 27.8%. The main reason for the ICU care was dyspnea or hypoxemia requiring mechanical ventilation (n=17). Other diagnoses for ICU care were hemoptysis, monitoring after procedures, neurologic dysfunction, shock, and gastrointestinal bleeding. On univariate analysis, the factors affecting the mortality were malnutrition-related parameters including low body mass index, hypoalbuminemia, lymphocytopenia, and hypocholersterolemia, as well as severity-related variables such as high acute physiology and chronic health evaluation (APACHE) score, number of involved lobes, and high C-reactive protein. In addition, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome contributed to patient fatality. It was shown on multivariate analysis that respiratory failure and hypoalbuminemia were significantly independent variables associated with the mortality. Conclusion: Acute respiratory failure is the most common reason for the ICU care and also the most important factor in predicting poor outcome. In addition, our data suggest that the parameters associated with malnutrition could be possible factors contributing to mortality.

• Journal of Life Science
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• v.20 no.10
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• pp.1458-1467
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• 2010

The present study was retrospectively designed to define whether preoperative levels of leukocytes and D-dimer are potentially useful factors in predicting perioperative outcomes of coronary heart disease (CHD). There was no relationship between preoperative leukocyte counts (Pre-OP leukocyte) and preoperative D-dimer levels (Pre-OP D-dimer). Pre-OP leukocyte counts each had positive correlation with cardiac troponin-I, creatine kinase-MB or C-reactive protein (cardiac markers) levels at preoperative and postoperative periods. Pre-OP D-dimer levels were positively associated with each cardiac marker at the same periods. Pre-OP leukocyte counts positively related with aspartate aminotransferase and alanine aminotransferase (liver markers), whereas Pre-OP D-dimer level positively or negatively correlated with bilirubin (liver marker), creatinine (renal marker) or glucose levels at preoperative and/or postoperative periods. Pre-OP leukocyte and Pre-OP D-dimer were inversely associated with Pre-OP high density lipoprotein cholesterol levels or left ventricular ejection fraction. Pre-OP leukocyte counts each had positive correlation operation duration and postoperative mechanical ventilation-time (PMVT), whereas Pre-OP D-dimer levels had positive relationship with PMVT, intensive care unit-staying period and hospitalization. The retrospective data suggest that Pre-OP leukocyte and Pre-OP D-dimer levels may be clinically useful factors for predicting perioperative outcomes in patients with CHD.

• Korean Journal of Adult Nursing
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• v.12 no.2
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• pp.175-183
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• 2000

The study was done by applying a phenomenological study, which is qualitative research methods, in order to understand the meaning of the lived experiences, to confirm and describe the meaning structure, and to prepare nursing interventive strategies centering around the meanings of the inpatients' families in the intensive care units. In the study, the family members were the main important nursing providers for in the inpatients' who were admitted in the neurosurgical intensive care unit in K-university hospital and who agreed to participate in the study after being given on explanation about the purpose of the study. The data were collected from the seven participants who had feelings of trust and intimacy favorable toward the researcher as they were families of patients who had been cared for by the researcher in the ICU where the researcher has been assigned. The data were collected from April to October, 1999. The participants described their experiences as candidly as possible. The researcher described closely the lived experiences with their own words and the observations of the researcher. A tape recorder was used with the consent of the participants to prevent nursing information and communication. The analysis of the data was made through the phenomenological analytic method suggested by Giorgi; as an unit of description, which include the participants' expressions and the researcher's observations, the analysis was used based on the data described from the expressions of the participants and the details of observations of the researcher. The conclusions of the study were as follows : The meanings of the lived experience of the inpatients' families in the ICU was confirmed by indepth interviews and observations including these of the participatants : (1) Psychological impact: confusion, impatience, surprise, insensibility; (2) Physical suffering: fatigue, discomfort, indigestion; (3) Psychological suffering: heartbreaking emotion, anxiety, annoyance, fear, compassion, grief; (4) Economical suffering: economical difficulties; (5) Psychological disagreement: escape from reality, personnel avoidance, grudge, powerlessness, carefulness, transposition of life-tract, abandonment, role-crisis, hope, lack of understanding, regret, feeling of ambivalence(progressive process, medical personnel interest); (6) Psychological dependency; self-reliance group support, family support, religious support; (7) Psychological acceptance; acquaintance, gratitude, reassurance; The study will offer better understanding of experiences therefore, based on the experiences confirmed by the study, it may facilitate more appropriate nursing interventive strategies for health maintenance and to prevent occurrence of possible problems with the inpatients' families in the ICUs.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.3
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• pp.1650-1662
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• 2014

This study aimed to develop smartphone application contents for the medication reconciliation of high-alert medications and to evaluate the satisfaction for this application. The xcode 4.5 and ios 6.1 SDK(software development kit) were used for constructing screen of the system. After implementation during 4 weeks, thirty five ICU(Intensive Care Unit) nurses were asked function related, contents related, and usage related satisfaction using 12 items. And differences of satisfaction according to the number of daily use and the frequency of use were evaluated. Data were analyzed using descriptive analysis, ANOVA with the SPSS 18.0. We developed the formula for drug dosage calculation, the alarming procedure, and the information of the high alert medication. In the satisfaction items, the mean score of 'This application is helpful to perform drug dosage calculation' was 3.14. However, 'I satisfy this application' was relatively low as 2.94. There were no differences in satisfaction according to the daily use and frequency of use. Based on the results of this study, more advanced smartphone application for medication reconciliation of high-alert medications will provide an important platform for patient safety.

• Journal of Trauma and Injury
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• v.26 no.2
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• pp.47-52
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• 2013

Purpose: Injury severity score (ISS), a widely used scoring system, is used to define the severity of trauma in multiple-trauma patients. Nevertheless, ISS cut-off value for predicting the outcome of multiple-trauma patients has not been confirmed. Thus, this study was performed to determine the more useful method for predicting the outcome for multiple-trauma patients: the ISS or the number of anatomical Abbreviated injury scale (AIS) injury regions. Methods: for 195 consecutive patients who a regional emergency medical center, we analyzed the ISS and the number of anatomical AIS injury region. The patients were divided into four groups based on the ISS and the number of anatomical AIS regions. We compared intensive-care-unit (ICU) admission days and hospitalization days and ICU stay ratio (ICU admission days/hospitalization days) between the four groups. Results: In the groups with an ISS more than 17, the results were not significantly different statistically the group with 2 anatomical AIS injury regions and more than 3 anatomical AIS injury regions. Also, in the group with an ISS of 17 or less, the results were the same as those for patients with an ISS more than 17 (p>0.05). Among the patients with 2 anatomical AIS injury regions, patients with an ISS more than 17 patients had more ICU admission days and a higher ICU stay ratio than patients with an ISS 17 or less. Also, Among the patients with 3 anatomical AIS injury regions, the results were the same as those for patients with 2 anatomical AIS injury regions. Conclusion: Patients with high ISS, regardless of the number of anatomical AIS injury regions had significantly longer ICU stays and higher ICU admission ratio. Thus, the ISS may be a better method than the number of anatomical AIS injury regions for predicting the outcomes for multiple-trauma patients.

• Journal of Chest Surgery
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• v.38 no.7 s.252
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• pp.483-488
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• 2005

Aortic valve-sparing procedures could reduce valve-related morbidity, but may increase operative risks; therefore, these procedures could not be performed routinely. We attempted to find out the early results while focusing on the operative risks associated with these procedures in our hospital. Material and Method: From May 1996 to July 2003, 26 patients underwent these procedures including 15 patients with Marfan syndrome and 1 patient with Behcet disease. There were 17 men and 9 women with mean age of $37.9\pm19.2$ years (range: 6 months-74 years). Ten patients had ascending aortic dissection, 18 patients had more than moderate degree of aortic valve insufficiency (AI). Two types of valve-sparing procedures were performed: valve reimplantation in 14 and root remodeling in 12 patients. Associated procedures were performed as follows: aortic valve plasty in 6, mitral valve plasty in 5, hemi-arch replacement in 4, total arch replacement in 2, coronary artery bypass surgery in 1 and Maze procedure in 1 patient(s). Result: In four patients, valve-sparing procedures were converted to Bentall procedures during operation. Including these patients, there was no operative deaths, 3 patients underwent re-operation due to bleeding, 1 patient had permanent pacemaker. The median duration of ICU stay was 45.5 hours, the median duration of hospital stay was 10.5 days. In 22 patients excluding 4 converted patients, intraoperative transesophageal echocardiogram (TEE) showed less than mild degree of AI in all except one who had not received intra-operative TEE in the beginning and showed moderate degree of AI at discharge. The mean duration of follow-up was $21.2\pm27.4$ months. All patients were alive except one who died during other departmental surgery. In 3 patients, more than moderate degree of AI was recurred, but there were no reoperation. Conclusion: Aortic valve-sparing procedures could be performed relatively safely in selected patients who had annuloaortic ectasia.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.8-14
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• 2008

Background: Acinetobacter infections are difficult to treat as they often exhibit multiple resistance to the antibiotics that are currently available for the treatment of pneumonia. Colistin is active against gram-negative bacteria, including the multiple drug resistant (MDR) Acinetobacter species. However, intravenous administration of colistin was abandoned because of its nephrotoxicity and neurotoxicity. The aims of this study were to examine the efficacy and safety of colistin administered by aerosol in the treatment of pneumonia caused by MDR Acinetobacter baumannii. Methods: We retrospectively reviewed the medical records of patients admitted to the intensive care unit (ICU) from Dec. 2006 to Aug. 2007 who had been diagnosed as suffering from pneumonia due to MDR Acinetobacter baumannii and had been treated with nebulized colistin. Results: 31 patients received aerosolized colistin. The average duration of the treatment was $14{\pm}7$ days and the daily dose of ranged from 225 mg to 300 mg. All patients received concomitant intravenous antimicrobial agents. The average length of the stay in the ICU was $34{\pm}21$ days and in the hospital $58{\pm}52$ days. The overall microbiological eradication was observed in 25 patients (80.6%). 14 of these (56%) were cured, and 11 (44%) were infected with other microorganisms. The overall crude mortality of the ICU was 48%. Nephrotoxicity and significant bronchial constriction did not occur in any patient during neublized colistin treatment. Conclusion: Nebulized colistin may be a safe and effective option in the treatment of pneumonia due to MDR Acinetobacter baumannii. Its role in therapy warrants further investigation in comparative studies.

• Tuberculosis and Respiratory Diseases
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• v.66 no.2
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• pp.116-121
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• 2009

Background: Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses. Methods: We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission. Results: The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073). Conclusion: Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.55-60
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• 2008

Background: Circulating levels of brain natriuretic peptide (BNP) provide prognostic information for patients with heart failure. The aim of our study was to investigate whether preoperative and postoperative BNP levels could predict postoperative complications and outcomes in patients after coronary artery bypass graft (CABG). Material and Method: Data was collected prospectively on 30 patients (M/F=19/11, age $60.0{\pm}9.6$ years) undergoing conventional CABG during a 1-year period beginning on January 1, 2005. Patients underwent off-pump CABG, and combined surgery was excluded. The BNP assay was performed preoperatively, immediate postoperatively at the intensive care unit (ICU), and 1, 3, 5, and 7days postoperatively. Result: Preoperative BNP levels significantly correlated with preoperative echocardiographic ejection fraction and an ICU stay of 5 days or more (r=-0.4, p=0.028; r=0.39, p=0.031, respectively). A preoperative BNP cut-off value above 263 pg/mL demonstrated high specificity (90.5%) for predicting postoperative complications using the receiver operating characteristics curves. Preoperative and postoperative (7 days) BNP levels were different depending on the abscence (mean BNP=$99{\pm}23\;pg/mL$ vs. $296{\pm}74\;pg/mL$, p<0.05) and presence (mean BNP=$212{\pm}29\;pg/mL$ vs. $408{\pm}23\;pg/mL$, p<0.01). Conclusion: Preoperative BNP levels >263 pg/mL predict postoperative complications in patients receiving CABG.