• Journal of Chest Surgery
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• 제27권2호
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• pp.122-127
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• 1994

A retrospective study of 737 consecutive patients surviving the first 24 hours who underwent valve replacement surgery from July 1980 to June 1993 was undertaken to determine the prevalence, variables that could be used to predict outcome and results of therapy for postoperative acute renal failure[ARF]. Twenty-one patients[2.8 %] developed acute renal failure. Positive risk factors noted in the development of postoperative renal failure included age, New York Heart Association class III & IV, endocarditis and elevated preoperative concentration of serum creatinine. The duration of cardiopulmonary bypass, aortic cross-clamping and the total duration of the operation also closely correlated with the incidence of ARF. The mortality rate for established ARF was 38.1% and ARF was associated with a significant increase in the length of hospitalization, ventilator support and intensive care unit stay. The incidence and mortality rate of oliguric renal failure was 38.1% and 85.7%. The highest mortality rate was associated with two or more postoperative complications and serum creatinine value exceeded 5 mg/dl. We concluded that therapy should be aimed at prevention of oliguric renal failure, or at least its conversion to nonoliguric renal failure, and early institution of renal replacement therapy with intensive support probably gives the best chance for survival.

• Journal of Trauma and Injury
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• 제37권1호
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• pp.6-12
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• 2024

Purpose: Open pelvic bone fractures are relatively rare and are considered more severe than closed fractures. This study aimed to compare the clinical outcomes of open and closed severe pelvic bone fractures. Methods: Patients with severe pelvic bone fractures (pelvic Abbreviated Injury Scale score, ≥4) admitted at a single level I trauma center between 2016 and 2020 were retrospectively analyzed. Patients aged <16 years and those with incomplete medical records were excluded from the study. The patients were divided into open and closed fracture groups, and their demographics, treatment, and clinical outcomes were compared before and after 1:2 propensity score matching. Results: Of the 321 patients, 24 were in the open fracture group and 297 were in the closed fracture group. The open fracture group had more infections (37.5% vs. 5.7%, P<0.001) and longer stays in the intensive care unit (median 11 days, interquartile range [IQR] 6-30 days vs. median 5 days, IQR 2-13 days; P=0.005), but mortality did not show a statistically significant difference (20.8% vs. 15.5%, P=0.559) before matching. After 1:2 propensity score matching, the infection rate was significantly higher in the open fracture group (37.5% vs. 6.3%, P=0.002), whereas the length of intensive care unit stay (median 11 days, IQR 6-30 days vs. median 8 days, IQR 4-19 days; P=0.312) and mortality (20.8% vs. 27.1%, P=0.564) were not significantly different. Conclusions: The open pelvic fracture group had more infections than the closed pelvic fracture group, but mortality was not significantly different. Aggressive treatment of pelvic bone fractures is important regardless of the fracture type, and efforts to reduce infection are important in open pelvic bone fractures.

• Clinical and Experimental Pediatrics
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• 제64권7호
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• pp.364-369
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• 2021

Background: As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve, it is crucially important for pediatricians to be aware of the differences in demographic and clinical features between COVID-19 and influenza A and B infections. Purpose: This study analyzed and compared the clinical features and laboratory findings of COVID-19 and influenza A and B infections in children. Methods: This retrospective study evaluated the medical data of 206 pediatric COVID-19 and 411 pediatric seasonal influenza A or B patients. Results: COVID-19 patients were older than seasonal influenza patients (median [interquartile range], 7.75 [2-14] years vs. 4 [2-6] years). The frequency of fever and cough in COVID-19 patients was lower than that of seasonal influenza patients (80.6% vs. 94.4%, P<0.001 and 22.8 % vs. 71.5%, P<0.001, respectively). Ageusia (4.9%) and anosmia (3.4%) were present in only COVID-19 patients. Leukopenia, lymphopenia, and thrombocytopenia were encountered more frequently in influenza patients than in COVID-19 patients (22.1% vs. 8.5%, P=0.029; 17.6% vs. 5.6%, P=0.013; and 13.2% vs. 5.6%, P=0.048, respectively). Both groups showed significantly elevated monocyte levels in the complete blood count (70.4% vs. 69.9%, P=0.511). Major chest x-ray findings in COVID-19 patients included mild diffuse ground-glass opacity and right lower lobe infiltrates. There were no statistically significant intergroup differences in hospitalization or mortality rates; however, the intensive care unit admission rate was higher among COVID-19 patients (2.4% vs. 0.5%, P=0.045). Conclusion: In this study, pediatric COVID-19 patients showed a wide range of clinical presentations ranging from asymptomatic/mild to severe illness. We found no intergroup differences in hospitalization rates, oxygen requirements, or hospital length of stay; however, the intensive care unit admission rate was higher among COVID-19 patients.

• Korean Journal of Radiology
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• 제23권9호
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• pp.878-888
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• 2022

Objective: To investigate the clinical impact of a quality improvement program including dedicated emergency radiology personnel (QIP-DERP) on the management of emergency surgical patients in the emergency department (ED). Materials and Methods: This retrospective study identified all adult patients (n = 3667) who underwent preoperative body CT, for which written radiology reports were generated, and who subsequently underwent non-elective surgery between 2007 and 2018 in the ED of a single urban academic tertiary medical institution. The study cohort was divided into periods before and after the initiation of QIP-DERP. We matched the control group patients (i.e., before QIP-DERP) to the QIP-DERP group patients using propensity score (PS), with a 1:2 matching ratio for the main analysis and a 1:1 ratio for sub-analyses separately for daytime (8:00 AM to 5:00 PM on weekdays) and after-hours. The primary outcome was timing of emergency surgery (TES), which was defined as the time from ED arrival to surgical intervention. The secondary outcomes included ED length of stay (LOS) and intensive care unit (ICU) admission rate. Results: According to the PS-matched analysis, compared with the control group, QIP-DERP significantly decreased the median TES from 16.7 hours (interquartile range, 9.4-27.5 hours) to 11.6 hours (6.6-21.9 hours) (p < 0.001) and the ICU admission rate from 33.3% (205/616) to 23.9% (295/1232) (p < 0.001). During after-hours, the QIP-DERP significantly reduced median TES from 19.9 hours (12.5-30.1 hours) to 9.6 hours (5.7-19.1 hours) (p < 0.001), median ED LOS from 9.1 hours (5.6-16.5 hours) to 6.7 hours (4.9-11.3 hours) (p < 0.001), and ICU admission rate from 35.5% (108/304) to 22.0% (67/304) (p < 0.001). Conclusion: QIP-DERP implementation improved the quality of emergency surgical management in the ED by reducing TES, ED LOS, and ICU admission rate, particularly during after-hours.

• Journal of Nutrition and Health
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• 제48권3호
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• pp.211-220
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• 2015

본 연구는 지속적 신대체요법을 받은 급성 신손상 환자 239명을 대상으로 영양공급 충족률이 환자의 임상적인 결과에 미치는 영향을 알아보고자 수행하였으며 대상자의 영양요구량 및 실제공급량을 조사하여 영양공급 충족률에 따른 임상결과를 비교하였다. 대상자의 평균 에너지 충족률이 68.06%, 평균 단백질 충족률이 43.13%로 나타났고 체중 당 에너지 공급량은 16.62 kcal/kg/일, 단백질 공급량은 0.63 g/kg/일로 지침에서 권장하는 요구량에 미치지 못하는 수준이었다. 에너지 충족률 70%, 단백질 충족률 50% 기준으로 두 군간 임상결과의 차이를 관찰한 결과 에너지 충족률이 높은 군에서 총 재원일수, 중환자실 재원일수와 지속적 신대체요법 적용일수, APACHE II score가 유의하게 감소하는 것으로 분석되었고 단백질 충족률이 높은 군에서는 총 재원일수, 중환자실 재원일수, 지속적 신대체요법 적용일수, APACHE II score 이외에 사망률도 유의하게 감소한 것으로 분석되었다. 생화학적 검사 결과의 경우 에너지 충족률 70% 이상 충족군에서는 헤마토크릿 수치가, 단백질 충족률 50% 이상 충족군에서는 총 임파구수, 헤마토크릿 수치가 유의하게 개선된 것으로 나타났다. 사망환자를 제외하고 영양공급량과 임상결과를 나타내는 항목의 상관관계를 분석한 결과 에너지 공급량과 중환자실 재원일수가 의미 있는 음의 상관관계를 가지는 것으로 나타났으며 영양공급량과 생화학적 검사 결과의 상관관계를 파악한 결과 에너지 공급량에 따라서는 유의한 상관계수가 도출되지 않았고 단백질 공급량과는 따라서는 헤마토크릿과 칼슘이 유의한 양의 상관관계를 가지는 것으로 나타났다. 본 연구 결과 영양공급 충족률이 높은 군에서 임상적인 결과 및 영양상태와 관련한 생화학적 검사결과가 개선되는 것으로 나타나 요구량에 적정한 영양공급이 환자의 치료에 긍정적인 영향을 준다는 것을 확인할 수 있었다. 이를 위해서 의료진의 타당한 영양처방이 중요하겠으며 영양지원의 체계적인 관리를 위해 다학제적인 접근과 함께 영양공급의 적정성을 지속적으로 모니터링하는 것이 중요하겠다.

• 대한간호학회지
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• 제37권4호
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• pp.431-441
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• 2007

Purpose: The purpose of this study was to identify the relationship among family stress, family meaning and family adaptation of families with high risk neonates. Method: The date was collected on the basis of self- report questionnaires (August 2004 to March 2005); Tow-hundred twelve parents, who had high risk neonates in C hospital's neonatal intensive care unit, participated on request. Results: Family sense of coherence, family meaning, social support, family stress, marital communication and patient condition had a significant, direct effect on family adaptation. Family cohesion, religion, confidence in the health professional, and length of stay had a significant, direct effect on family meaning. Conclusion: The results of this study suggest the consequences associated with high risk neonates may be alleviated by a family support intervention designed to improve parental communication skills as well as to maintain family cohesiveness. Medical care could also encourage more emotional support of parents towards their neonate.

• Journal of Chest Surgery
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• 제56권6호
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• pp.374-386
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• 2023

Background: The heightened morbidity and mortality associated with repeat cardiac surgery are well documented. Redo median sternotomy (MS) and minimally invasive valve surgery are options for patients with prior cardiac surgery who require mitral valve surgery (MVS). We conducted a systematic review and meta-analysis comparing the outcomes of redo MS and minimally invasive MVS (MIMVS) in this population. Methods: We searched PubMed, EMBASE, and Scopus for studies comparing outcomes of redo MS and MIMVS for MVS. To calculate risk ratios (RRs) for binary outcomes and weighted mean differences (MDs) for continuous data, we employed a random-effects model. Results: We included 12 retrospective observational studies, comprising 4157 participants (675 for MIMVS; 3482 for redo MS). Reductions in mortality (RR, 0.54; 95% confidence interval [CI], 0.37-0.80), length of hospital stay (MD, -4.23; 95% CI, -5.77 to -2.68), length of intensive care unit (ICU) stay (MD, -2.02; 95% CI, -3.17 to -0.88), and new-onset acute kidney injury (AKI) risk (odds ratio, 0.34; 95% CI, 0.19 to 0.61) were statistically significant and favored MIMVS (p<0.05). No significant differences were observed in aortic cross-clamp time, cardiopulmonary bypass time, or risk of perioperative stroke, new-onset atrial fibrillation, surgical site infection, or reoperation for bleeding (p>0.05). Conclusion: The current literature, which primarily consists of retrospective comparisons, underscores certain benefits of MIMVS over redo MS. These include decreased mortality, shorter hospital and ICU stays, and reduced AKI risk. Given the lack of high-quality evidence, prospective randomized control trials with adequate power are necessary to investigate long-term outcomes.

• Journal of Trauma and Injury
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• 제34권3호
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• pp.155-161
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• 2021

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has necessitated a redistribution of resources to meet hospitals' service needs. This study investigated the impact of COVID-19 on a regional trauma center in South Korea. Methods: We retrospectively reviewed cases of polytrauma at a single regional trauma center in South Korea between January 20 and September 30, 2020 (the COVID-19 period) and compared them to cases reported during the same time frame (January 20 to September 30) between 2016 and 2019 (the pre-COVID-19 period). The primary outcome was in-hospital mortality, and secondary outcomes included the number of daily admissions, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Results: The mean number of daily admissions decreased by 15% during the COVID-19 period (4.0±2.0 vs. 4.7±2.2, p=0.010). There was no difference in mechanisms of injury between the two periods. For patients admitted during the COVID-19 period, the hospital LOS was significantly shorter (10 days [interquartile range (IQR) 4-19 days] vs. 16 days [IQR 8-28 days], p<0.001); however, no significant differences in ICU LOS and mortality were found. Conclusions: The observations at Regional Trauma Center, Pusan National University Hospital corroborate anecdotal reports that there has been a decline in the number of patients admitted to hospitals during the COVID-19 period. In addition, patients admitted during the COVID-19 pandemic had a significantly shorter hospital LOS than those admitted before the COVID-19 pandemic. These preliminary data warrant validation in larger, multi-center studies.

• Journal of Trauma and Injury
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• 제18권1호
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• pp.47-52
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• 2005

Background: This study was undertaken to evaluate the clinical pattern of the patients with penetrating torso injury. We retrospectively analyzed the clinical symptoms, mechanism of injury, injury type including injured organ, and ultimate outcome of treatment. Our purpose of the study was to establish guideline of management in penetrating torso injury. Methods: This study consists of an analysis of a consecutive series of 94 patients with penetrating injury of trunk treated at one general hospital during 7year period (from January 1995 to April 2003) who was admitted through in our emergency department. All data were collected from the medical records and entered in a database for analysis on the following: age, sex, mechanism of injury, vital sign at admission, clinical outcome including hospital mortality, length of hospital stay, length of intensive care unit stay, requirement of crystalloid fluid and blood product. Results: Among 94 patients, there were 68 men and 26 women, with ages ranging from 19 to 82 years (average 38.2 years). The most frequent mechanism of injury was violence by others including rob (n=54, 57.4%) followed by suicidal attempt (n=24, 25.5%) and accidental injury (n=16, 17.0%). No injury was inflicted from gun. In 37 patients, systolic blood pressure at admission was under 90mmHg. The time interval from injury to admission, and from admission to operation was 57.8minutes and 4hour 12minutes each. Laparotomy was required in 70 patients, thoracotomy in 5 patients, and 3 patients required thoracotomy and laparotomy. Among 94 patients, an average of 1.7 organs were injured. The small bowel and colon were the organs most commonly wounded followed by liver, mesentery, pleura. Of the 94 patients, 6 died for an overall mortality rate of 6.4%, and two of them were not related with hemorrhage. The average length of hospital stay was 18.1 days, and 40 patients required ICU care. Conclusion: Of the 94 patients who were admitted from penetrating torso injury, no patient was injured from firearm. Overall mortality rate was 6.4%. In our hospital, firearm injury was relative rare.

• 대한지역사회영양학회지
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• 제27권2호
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• pp.121-131
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• 2022

본 연구에서는 충북대학교병원 NST의 중재활동 효과를 확인하기 위하여 중환자실에 7일 이상 입원하여 EN/PN을 공급 받은 성인 환자 176명을 대상으로 의무기록을 후향적으로 분석하였다. NST 자문 의뢰 여부에 따라 NST 의뢰군과 미의뢰군으로 분류하였고, NST 의뢰군은 자문순응 여부에 따라 자문순응군과 비순응군으로 분류하였다. NST 의뢰율은 56.8%, NST 자문 회신에 대한 순응율은 47.0%이었으며, 신경과의 NST 의뢰율이 93.8%로 가장 높았고, 자문순응 비율도 60%로 높았다. 진료과 및 주진단명에 따라 NST 의뢰율과 자문순응 비율에 큰 차이를 나타냈다. NST 의뢰군은 미의뢰군에 비해, 자문순응군은 비순응군에 비해 열량 및 단백질 공급률이 높았으며, 목표열량 도달 비율이 높았다. 또한 자문순응군은 비순응군에 비해 목표열량에 도달하는 기간도 유의적으로 짧았다. 중환자실 입실 시 보다 퇴실 시 영양상태가 전반적으로 악화된 것으로 나타났으며, 모든 집단에서 혈청 알부민과 헤모글로 빈 수치가 유의적으로 낮아졌으나, 자문순응군의 감소폭은 자문비순응군의 감소폭보다 적었다. 또한 퇴실 시 NST 의뢰군, 비의뢰군, 자문비순응군의 심한 영양불량은 입실 시에 비해 유의적으로 증가하였으나, 자문순응군은 입실 시와 퇴실 시에 차이가 없었다. 중환자실 재원기간은 NST 의뢰군이 미의뢰군보다 더 길었으나 자문순응군은 비순응군보다 유의적으로 짧게 나타났다. 결과적으로 NST 자문에 순응하여 제공된 영양지원은 중환자의 생화학적 지표에 긍정적인 효과를 나타내고, 재원기간 중 발생할 수 있는 영양불량을 지연시키고, 중환자실 재원 기간 또한 유의하게 단축시키는 것으로 나타났다. 따라서 NST 자문에 대한 순응률을 증가시키기 위해 중환자실 의료진과 NST와의 효과적인 의사소통이 필요할 것으로 생각되며, 중환자실 입실 초기부터 NST에 의한 중재활동이 진행될 수 있도록 자문 의뢰시스템의 개선이 필요할 것으로 생각된다. 또한 적절한 영양공급의 중요성 및 필요성에 대한 의료진 대상의 교육을 지속적으로 시행하여 영양공급 및 지원절차에 대한 프로토콜이 정착되어야 할 것으로 생각된다.