• Tuberculosis and Respiratory Diseases
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• v.73 no.2
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• pp.100-106
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• 2012

Background: There are a plethora of literatures showing that high-intensity intensive care unit (ICU) physician staffing is associated with reduced ICU mortality. However, it is not widely used in ICUs because of limited budgets and resources. We created a critical care team (CCT) to improve outcomes in an open general ICU and evaluated its effectiveness based on patients' outcomes. Methods: We conducted this prospective, observational study in an open, general ICU setting, during a period ranging from March of 2009 to February of 2010. The CCT consisted of five teaching staffs. It provided rapid medical services within three hours after calls or consultation. Results: We analyzed the data of 830 patients (157 patients of the CCT group and 673 patients of the non-CCT one). Patients of the CCT group presented more serious conditions than those of the non-CCT group (acute physiologic and chronic health evaluation II [APACHE II] 20.2 vs. 15.8, p<0.001; sequential organ failure assessment [SOFA] 5.5 vs. 4.6, p=0.003). The CCT group also had significantly more patients on mechanical ventilation than those in the non-CCT group (45.9% vs. 23.9%, p<0.001). Success rate of weaning was significantly higher in the CCT group than that of the non-CCT group (61.1% vs. 44.7%, p=0.021). On a multivariate logistic regression analysis, the increased ICU mortality was associated with the older age, non-CCT, higher APACHE II score, higher SOFA score and mechanical ventilation (p<0.05). Conclusion: Although the CCT did not provide full-time services in an open general ICU setting, it might be associated with a reduced ICU mortality. This is particularly the case with patients on mechanical ventilation.

• Clinical and Experimental Pediatrics
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• v.63 no.1
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• pp.20-24
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• 2020

Background: Predicting the prognosis of patients admitted to the pediatric intensive care unit (PICU) is very important in determining further management and resource allocation. The prognostication of critically ill children can be challenging; hence, accurate methods for predicting outcomes are needed. Purpose: To evaluate the role of microalbuminuria at admission as a prognostic marker in comparison to standard Pediatric Risk of Mortality (PRISM) and Pediatric Logistic Organ Dysfunction (PELOD) mortality scores in children admitted to the PICU. Methods: This cross-sectional study was conducted from January 2015 to October 2016. Eighty-four patients aged 1 month to 18 years admitted to the PICU of teaching hospitals for more than 24 hours were enrolled by convenience sampling method. Microalbuminuria was estimated by spot urinary albumin-creatinine ratio. PRISM and PELOD scores were calculated using an online calculator. Outcome measures were PICU length of stay, inotrope usage, multiorgan dysfunction, and survival. ACR was compared with mortality scores for predicting survival. Results: Microalbuminuria was present in 79.8% with a median value of 85 mg/g (interquartile range, 41.5-254 mg/g). A positive correlation was found between albumin-creatinine ratio and PICU length of stay (P=0.013, r=0.271). Albumin-creatinine ratio was significantly associated with organ dysfunction (P=0.004) and need for inotropes (P=0.006). Eight deaths were observed in the PICU. The area under the curve for mortality for albumin-creatinine ratio (0.822) was comparable to that for PRISM (0.928) and PELOD (0.877). Albumin-creatinine ratio >109 mg/g predicted mortality with a sensitivity of 87.5% and specificity of 63.2%. Conclusion: Microalbuminuria is a good predictor of PICU outcomes comparable with mortality scores.

• Journal of Chest Surgery
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• v.26 no.5
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• pp.365-372
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• 1993

We analyzed the patients who were admitted to Surgical Intensive Care Unit[SICU] of Kyungpook National University Hospital from January 1987 through December 1991. The results were as followings: The total number of patients for 5 years was 2446 and 1553[63.5%] were male,893[36.5%] were female. The average age was 34.1 years old and the greatest age group was the 1-9 age group.The number of the patients in the Department of Thoracic and Cardiovascular Surgery, which was the highest among all departments,was 1608 [65.7%].Congenital Heart disease was the most common among all diseases.The patients who had undergone any kinds of operations were 89.9% of all patients.The averge stay in SICU was 5.2 days.The overall mortality rate was 12.1% ,which included hopelessly discharged patients and the highest mortality rate occurred in the patients over 80 years old.The highest cause of death was cardiac problem[30.4%]. The next was sepsis.The proportion of patients who had received a mechanical ventilatory support was 35.7% and 52% of those patients belonged to the department of thoracic and cardiovascular surgery.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.375-380
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• 2002

Background: Sternal infection after open heart surgery is a serious complication associated with high rate of mortality. We reviewed the effect of improved operating room and intensive care unit un the sternal infection by analyzing the incidence and condition of that around the movement of operating room and intensive care unit in July 1997. Material and method: We reviewed a total of 453 patients. Group I contains 237 patients who underwent open heart surgery between January 1997 and December 1978 before we moved the intensive care unit and of operating room, and Group II contains 216 patients who underwent open heart surgery between January 2000 and July 2001 after we moved. We only included adult patients over age 15 who underwent cardiopulmonary bypass through median sternotomy and excluded the mortality cases except sternal infections in this study. Result: Sternal infection developed in 18 patients(8.0%) in Group I, and in only 1 patient(0.49%) in Group II. Emergency operation, cardiopulmonary bypass time, operation tilde, transfusion, tracheostomy, and reoperation are significantly associated with sternal infection among the known risk factors. The logistic regression analysis containing those six factors revealed that the movement of intensive care unit and operating roots is effective on the decreasing sternal infection(p=0.029, 95% confidence interval 0.011 ∼ 0.788). Conclusion: Although there have been studies on manly risk factors associated with the sternal infection after open heart surgery, we think that the improvement of operting room and intensive care unit is a method for decreasing the incidence of sternal infection.

• Tuberculosis and Respiratory Diseases
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• v.79 no.3
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• pp.158-164
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• 2016

Background: One to three percent of cases of acute tuberculosis (TB) require monitoring in the intensive care unit (ICU). The purpose of this study is to establish and determine the mortality rate and discuss the causes of high mortality in these cases, and to evaluate the clinical and laboratory findings of TB patients admitted to the pulmonary ICU. Methods: The data of patients admitted to the ICU of Yedikule Chest Diseases and Chest Surgery Education and Research Hospital due to active TB were retrospectively evaluated. Demographic characteristics, medical history, and clinical and laboratory findings were evaluated. Results: Thirty-five TB patients (27 males) with a median age of 47 years were included, of whom 20 died within 30 days (57%). The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were significantly higher, and albumin and $PaO_2/FIO_2$ levels were significantly lower, and shock, multiple organ failure, the need for invasive mechanical ventilation and drug resistance were more common in the patients who died. The mortality risk was 7.58 times higher in the patients requiring invasive mechanical ventilation. The SOFA score alone was a significant risk factor affecting survival. Conclusion: The survival rate is low in cases of tuberculosis treated in an ICU. The predictors of mortality include the requirement of invasive mechanical ventilation and multiple organ failure. Another factor specific to TB patients is the presence of drug resistance, which should be taken seriously in countries where there is a high incidence of the disease. Finding new variables that can be established with new prospective studies may help to decrease the high mortality rate.

• Tuberculosis and Respiratory Diseases
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• v.85 no.2
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• pp.195-201
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• 2022

Background: The aim of this study was to evaluate the long-term (5-year) clinical outcomes of patients who received intensive care unit (ICU) treatment using Korean nationwide data. Methods: All patients aged >18 years with ICU admission according to Korean claims data from January 2008 to December 2010 were enrolled. These enrolled patients were followed up until December 2015. The primary outcome was ICU mortality. Results: Among all critically ill patients admitted to the ICU (n=323,765), patients with cancer showed higher ICU mortality (18.6%) than those without cancer (13.2%, p<0.001). However, there was no significant difference in ICU mortality at day 28 among patients without cancer (14.5%) and those with cancer (lung cancer or hematologic malignancies) (14.3%). Compared to patients without cancer, hazard ratios of those with cancer for ICU mortality at 5 years were: 1.90 (1.87-1.94) for lung cancer; 1.44 (1.43-1.46) for other solid cancers; and 3.05 (2.95-3.16) for hematologic malignancies. Conclusion: This study showed that the long-term survival rate of patients with cancer was significantly worse than that of general critically ill patients. However, short term outcomes of critically ill patients with cancer were not significantly different from those of general patients, except for those with lung cancer or hematologic malignancies.

• Acute and Critical Care
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• v.33 no.4
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• pp.216-221
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• 2018

Background: In this study, we analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE IV, Simplified Acute Physiology Score (SAPS) 3, and Mortality Probability Model $(MPM)_0$ III in order to determine which system best implements data related to the severity of medical intensive care unit (ICU) patients. Methods: The present study was a retrospective investigation analyzing the discrimination and calibration of APACHE II, APACHE IV, SAPS 3, and $MPM_0$ III when used to evaluate medical ICU patients. Data were collected for 788 patients admitted to the ICU from January 1, 2015 to December 31, 2015. All patients were aged 18 years or older with ICU stays of at least 24 hours. The discrimination abilities of the three systems were evaluated using c-statistics, while calibration was evaluated by the Hosmer-Lemeshow test. A severity correction model was created using logistics regression analysis. Results: For the APACHE IV, SAPS 3, $MPM_0$ III, and APACHE II systems, the area under the receiver operating characteristic curves was 0.745 for APACHE IV, resulting in the highest discrimination among all four scoring systems. The value was 0.729 for APACHE II, 0.700 for SAP 3, and 0.670 for $MPM_0$ III. All severity scoring systems showed good calibrations: APACHE II (chi-square, 12.540; P=0.129), APACHE IV (chi-square, 6.959; P=0.541), SAPS 3 (chi-square, 9.290; P=0.318), and $MPM_0$ III (chi-square, 11.128; P=0.133). Conclusions: APACHE IV provided the best discrimination and calibration abilities and was useful for quality assessment and predicting mortality in medical ICU patients.

• Journal of Korean Critical Care Nursing
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• v.17 no.2
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• pp.1-11
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• 2024

Purpose : This study aimed to determine the mortality rate among elderly patients admitted to the intensive care unit (ICU) for acute drug intoxication resulting from suicide attempts. It also compared the characteristics of survivors and decedents to identify factors associated with mortality. Methods : This retrospective descriptive study included 150 patients aged 65 years or older who were admitted to the ICU of a tertiary university hospital in Gwangju due to acute drug intoxication, with the period spanning January 1, 2018 to December 31, 2020. The collected data were analyzed using descriptive statistics, independent t-tests, Chi-squared tests, Fisher's exact test, and multiple logistic regression analysis. Results : The mortality rate among elderly individuals admitted to the ICU for acute drug intoxication was 19.3%. The likelihood of death was significantly higher in patients with an acute physiology and chronic health examination (APACHE) III score of 70 or above (OR=23.75, 95% CI=3.78-149.46, p<.001) and those with metabolic acidosis on initial acid-base results (OR=3.73, 95% CI=1.12-12.43, p=.032). Conclusion : These findings underscore the need for developing and implementing systematic education and targeted nursing interventions for ICU nurses caring for acutely drug-intoxicated elderly adults, particularly considering the APACHE III score and the presence of metabolic acidosis.

• Journal of Korean Critical Care Nursing
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• v.15 no.3
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• pp.88-100
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• 2022

Purpose : This study aimed to identify risk factors for unplanned reintubation after planned extubation and to analyze the clinical outcomes in patients admitted to the intensive care unit after cardiac surgery. Methods : The study examined patients who underwent intubation and planned extubation admitted to the intensive care unit after cardiac surgery between January 1, 2017, and December 31, 2021. The reintubation group comprised 58 patients underwent unplanned reintubation within 7 days of planned extubation. The maintenance group comprised 116 patients who did not undergo reintubation and were matched with the reintubation group using the rational for matching criteria. Data were collected retrospectively from electronic medical records. We used the independent t-test, Mann-Whitney U test, 𝑥²-test, Fisher's exact test, and logistic regression analysis with SPSS/WIN 27.0. Results : The multivariate logistic regression analysis demonstrated that albumin (odds ratio [OR]=0.38, 95% confidence interval [CI]=0.20-0.72), surgery time (OR=1.54, 95% CI=1.20-1.97), PaO₂ before extubation (OR=0.85 per 10 mmHg, 95% CI=0.75-0.97), postoperative arrhythmia (OR=2.82, 95% CI=1.22-6.51), reoperation due to bleeding (OR=4.65, 95% CI=1.27-17.07), and postoperative acute renal failure (OR=2.97, 95% CI=1.09-8.04) were risk factors for unplanned reintubation. The reintubation group had a higher in-hospital mortality rate (𝑥²=33.74, p<.001), longer intensive care unit stay (Z=-7.81, p<.001), and longer hospital stay than the maintenance group (Z=-8.29, p<.001). Conclusion : These results identified risk factors and clinical outcomes of unplanned reintubation after planned extubation after cardiac surgery. These findings should be considered when developing and managing an intervention program to prevent and reduce the incidence of unplanned reintubation.

• Journal of Korean Critical Care Nursing
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• v.3 no.1
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• pp.79-88
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• 2010

Optimal nutrition serves to maintain normal organ function and to preserve body energy stores to guarantee survival during times of shortage of food. Adequate nutrition of intensive care unit (ICU) patients improves outcome, while malnutrition is strongly associated with increased morbidity and mortality rates among critically ill patients. Previously published researches showed that trials of nutritional support in critical illness rarely fulfill basic quality requirements. Nutrition support plays a vital role in the prevention and treatment of nutritional deficiencies in at-risk, critically ill patients. This paper reviewed the challenges in determining critically ill patients' nutrition requirements including nutrition assessment, determination of caloric requirements then providing them with adequate nutrition support while in the ICU with the guidelines published by Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Nutrition support can be effectively enhanced by using the guidelines.