• Journal of Korean Critical Care Nursing
• /
• v.16 no.2
• /
• pp.67-80
• /
• 2023

Purpose : The 2020 Dietary Guidelines Advisory Committee specifically noted that meal frequency is associated with risks for cardiovascular disease, type 2 diabetes, and all-cause mortality, although the current evidence on meal frequency is conflicting. As meal frequency itself is affected by various factors, the aim of the study was not only to examine its relationships with cardiometabolic risk but also to identify the mediating effects of dietary quality. Methods : This study used a descriptive correlational design. In all 8,141 healthy adults participated in the study. Measurements included meal frequency, cardiometabolic risk, and diet quality. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and process macro bootstrapping model 4. Results : The meal frequency was 3.52±0.61 times per day, the risk of cardiovascular metabolic diseases was 0.01±0.61 points, and the diet quality was 62.08±13.87 points. In mediation analysis, the effect of meal frequency on cardiometabolic risk score was completely mediated by diet quality. Conclusion : Improved diet quality in healthy adults should be considered when designing meal frequency interventions aimed at reducing their cardiometabolic risk, as the effect of meal frequency support on cardiometabolic risk was found to be mediated by diet quality.

• Journal of The Korean Society of Emergency Medicine
• /
• v.29 no.5
• /
• pp.415-422
• /
• 2018

Objective: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). Methods: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. Results: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. Conclusion: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.

• Tuberculosis and Respiratory Diseases
• /
• v.60 no.5
• /
• pp.548-553
• /
• 2006

Background : Alcoholic ketoacidosis(AKA) is a metabolic disturbance that is caused by prolonged and excessive alcohol consumption. Though the prognosis is reportedly good, its outcome is unclear in some cases that are combined with multi-organ failure. There are few reports of an analysis of cases admitted to an intensive care unit(ICU) Method: Cases of AKA admitted to the ICU over the last 5 years were retrospectively analyzed. Severe AKA was characterized by multi-organ failure that required treatment in an ICU Results : All patients were males with a history of excessive alcohol consumption. Five of them (50%) mainly complained of gastrointestinal symptoms (nausea, vomiting, diarrhea), showing metabolic acidosis with an increased asmolar and anion gap. Rhabdomyolysis with acute renal failure was the most common combined organ failure. Mechanical ventilation was performed in 80%. Six patients died and 4 patients survived. In the surviving patients, the arterial blood gas analysis(ABGA) was normalized within 12 hours after admission. Conclusion : In severe AKA patients, rhabdomyolysis with acute renal failure was the most common complication. The mortality rate was high and death from shock occurred within 3 days.

• Journal of Trauma and Injury
• /
• v.29 no.4
• /
• pp.161-166
• /
• 2016

Purpose: Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography. Methods: This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015. Results: Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%). Conclusion: The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.

• Journal of Trauma and Injury
• /
• v.33 no.1
• /
• pp.38-42
• /
• 2020

Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown. Methods: In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy. Results: The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay. Conclusions: PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.

• Nutrition Research and Practice
• /
• v.5 no.5
• /
• pp.450-454
• /
• 2011

The beneficial effects of total parenteral nutrition (TPN) in improving the nutritional status of malnourished patients during hospital stays have been well established. However, recent randomized trials and meta-analyses have reported an increased rate of TPN-associated complications and mortality in critically ill patients. The increased risk of complications during TPN therapy has been linked to the development of hyperglycemia, especially during the first few days of TPN therapy. This retrospective study was conducted to determine whether the amount of dextrose from TPN in the 1st week in the intensive care unit (ICU) was related to the development of hyperglycemia and the clinical outcome. We included 88 non-diabetic critically ill patients who stayed in the medical ICU for more than two days. The subjects were 65 ${\pm}$ 16 years old, and the mean APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission was 20.9${\pm}$7.1. The subjects received 2.3${\pm}$1.4 g/kg/day of dextrose intravenously. We divided the subjects into two groups according to the mean blood glucose (BG) level during the 1st week of ICU stay: <140 mg/dl vs ${\geq}$ 140 mg/dl. Baseline BG and the amount of dextrose delivered via TPN were significantly higher in the hyperglycemia group than those in the normoglycemia group. Mortality was higher in the hyperglycemia group than in the normoglycemia group (42.4% vs 12.8%, P=0.008). The amount of dextrose from TPN was the only significant variable in the multiple linear regression analysis, which included age, APACHE II score, baseline blood glucose concentration and dextrose delivery via TPN as independent variables. We concluded that the amount of dextrose delivered via TPN might be associated with the development of hyperglycemia in critically ill patients without a history of diabetes mellitus. The amount of dextrose in TPN should be decided and adapted carefully to maintain blood glucose within the target range.

• Journal of Trauma and Injury
• /
• v.30 no.4
• /
• pp.166-172
• /
• 2017

Purpose: Thoracic traumas represent 10-15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major causes of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and hemodynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI. Methods: This is a retrospective clinical analysis of patients who had undergone emergency cardiac surgery in our trauma center from January 2014 to December 2016. Demographics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed. Results: The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were performed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital cardiopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4). Conclusions: This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it suggests prehospital CPR and EDT are significantly responsible for high mortality in TCI.

• Tuberculosis and Respiratory Diseases
• /
• v.83 no.3
• /
• pp.248-254
• /
• 2020

Background: Although few studies have reported improved clinical outcomes with the administration of vitamin B1 and C in critically ill patients with septic shock or severe pneumonia, its clinical impact on patients with sepsis-related acute respiratory distress syndrome (ARDS) remains unclear. The purpose of this study was to evaluate the association with vitamin B and C supplementation and clinical outcomes in patients with ARDS. Methods: Patients with ARDS requiring invasive mechanical ventilation, admitted to the medical intensive care unit (ICU) were included in this study. Clinical outcomes were compared between patients administered with vitamin B1 (200 mg/day) and C (2 g/day) June 2018-May 2019 (the supplementation group) and those who did not receive vitamin B1 and C administration June 2017-May 2018 (the control group). Results: Seventy-nine patients were included. Thirty-three patients received vitamin B1 and C whereas 46 patients did not. Steroid administration was more frequent in patients receiving vitamin B1 and C supplementation than in those without it. There were no significant differences in the mortality between the patients who received vitamin B1 and C and those who did not. There were not significant differences in ventilator and ICU-free days between each of the 21 matched patients. Conclusion: Vitamin B1 and C supplementation was not associated with reduced mortality rates, and ventilator and ICU-free days in patients with sepsis-related ARDS requiring invasive mechanical ventilation.

• Journal of Chest Surgery
• /
• v.49 no.1
• /
• pp.15-21
• /
• 2016

Background: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was $61.2{\pm}17.5years$ (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.

• Clinical and Experimental Pediatrics
• /
• v.64 no.7
• /
• pp.313-321
• /
• 2021

Here we describe the neurodevelopmental outcomes of very low birth weight (VLBW) infants (birth weight ≤1,500 g) at 3 years of age in the Neonatal Research Network of Japan (NRNJ) database in the past decade and review the methodological issues identified in follow-up studies. The follow-up protocol for children at 3 years of chronological age in the NRNJ consists of physical and comprehensive neurodevelopmental assessments in each participating center. Neurodevelopmental impairment (NDI)-moderate to severe neurological disability-is defined as cerebral palsy (CP) with a Gross Motor Function Classification System score ≥2, visual impairment such as uni- or bilateral blindness, hearing impairment requiring hearing amplification, or cognitive impairment with a developmental quotient (DQ) of Kyoto Scale of Psychological Development score <70 or judgment as delayed by pediatricians. We used death or NDI as an unfavorable outcome in all study subjects and NDI in survivors using number of assessed infants as the denominator. Follow-up data were collected from 49% of survivors in the database. Infants with follow-up data had lower birth weights and were of younger gestational age than those without follow-up data. Mortality rates of 40,728 VLBW infants born between 2003 and 2012 were 8.2% before discharge and 0.7% after discharge. The impairment rates in the assessed infants were 7.1% for CP, 1.8% for blindness, 0.9% for hearing impairment, 15.9% for a DQ <70, and 19.1% for NDI. The mortality or NDI rate in all study subjects, including infants without follow-up data, was 17.4%, while that in the subjects with outcome data was 32.5%. The NRNJ follow-up study results suggested that children born with a VLBW remained at high risk of NDI in early childhood. It is important to establish a network follow-up protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.