• Journal of Trauma and Injury
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• v.36 no.4
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• pp.329-336
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• 2023

Purpose: In this study, we aimed to compare the characteristics of patients with trauma by age group in a single center in Korea to identify the clinical characteristics and analyze the risk factors affecting mortality. Methods: Patients aged ≥18 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022 were included. The accident mechanism, severity of the injury, and outcomes were compared by classifying the patients into group A (18-64 years), group B (65-79 years), and group C (≥80 years). In addition, logistic regression analysis was performed to identify factors affecting death. Results: The most common injury mechanism was traffic accidents in group A (40.9%) and slipping in group B (37.0%) and group C (56.2%). Although group A had the highest intensive care unit admission rate (38.0%), group C had the highest mortality rate (9.5%). In the regression analysis, 3 to 8 points on the Glasgow Coma Scale had the highest odds ratio for mortality, and red blood cell transfusion within 24 hours, intensive care unit admission, age, and Injury Severity Score were the predictors of death. Conclusions: For patients with trauma, the mechanism, injured body region, and severity of injury differed among the age groups. The high mortality rate of elderly patients suggests the need for different treatment approaches for trauma patients according to age. Identifying factors affecting clinical patterns and mortality according to age groups can help improve the prognosis of trauma patients in the future.

• Tuberculosis and Respiratory Diseases
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• v.83 no.2
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• pp.167-174
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• 2020

Background: The purpose of this study was to investigate the effect of early tracheostomy on clinical outcomes in patients requiring prolonged acute mechanical ventilation (≥96 hours). Methods: Data from 575 patients (69.4% male; median age, 68 years), hospitalized in the medical intensive care unit (ICU) of a university-affiliated tertiary care hospital March 2008-February 2017, were retrospectively evaluated. Early and late tracheostomy were designated as 2-10 days and >10 days after translaryngeal intubation, respectively. Results: The 90-day cumulative mortality rate was 47.5% (n=273) and 258 patients (44.9%) underwent tracheostomy. In comparison with the late group (n=115), the early group (n=125) had lower 90-day mortality (31.2% vs. 47.8%, p=0.012), shorter stays in hospital and ICU, shorter ventilator length of stay (median, 43 vs. 54; 24 vs. 33; 23 vs. 28 days; all p<0.001), and a higher rate of transfer to secondary care hospitals with post-intensive care settings (67.2% vs. 43.5% p<0.001). Also, the total medical costs of the early group were lower during hospital stays than those of the late group (26,609 vs. 36,973 USD, p<0.001). Conclusion: Early tracheostomy was associated with lower 90-day mortality, shorter ventilator length of stay and shorter lengths of stays in hospital and ICU, as well as lower hospital costs than late tracheostomy.

• Journal of Korean Neurosurgical Society
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• v.66 no.1
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• pp.95-104
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• 2023

Objective : Hypernatremia is a common complication encountered during the treatment of neurocritically ill patients. However, it is unclear whether clinical outcomes correlate with the severity of hypernatremia in such patients. Therefore, we investigated the impact of hypernatremia on mortality of these patients, depending on the degree of hypernatremia. Methods : Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, patients who were hospitalized in the ICU for more than 5 days and whose serum sodium levels were obtained during ICU admission were included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. We classified the patients into four subgroups according to the severity of hypernatremia and performed propensity score matching analysis. Results : Among 1146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were included in the analysis. The hypernatremia group had higher rates of in-hospital mortality and 28-day mortality in both overall and matched population (both p<0.001 and p=0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR], 4.58; 95% confidence interval [CI], 2.15-9.75 and adjusted OR, 6.93; 95% CI, 3.46-13.90, respectively) and 28-day mortality (adjusted OR, 3.51; 95% CI, 1.54-7.98 and adjusted OR, 10.60; 95% CI, 5.10-21.90, respectively) compared with the absence of hypernatremia. However, clinical outcomes, including in-hospital mortality and 28-day mortality, were not significantly different between the group without hypernatremia and the group with mild hypernatremia (p=0.720 and p=0.690, respectively). The mortality rates of patients with moderate and severe hypernatremia were significantly higher in both overall and matched population. Interestingly, the mild hypernatremia group of matched population showed the best survival rate. Conclusion : Moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, the prognosis of patients with mild hypernatremia was similar with that of patients without hypernatremia. Therefore, mild hypernatremia may be allowed during treatment of intracranial hypertension using hyperosmolar therapy.

• Journal of The Korea Institute of Healthcare Architecture
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• v.22 no.3
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• pp.27-34
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• 2016

Purpose: The purpose of this paper is to develop a predictive model for patient visibility in Korean ICUs (corridor or continental type). Methods: The measures of static visibility were used to quantify the patient visibility (upper third part of the patient bed) from the nurse station. The measure of space programme and area distribution (patient zone percentage, staff zone percentage and departmental gross square meter per patient bed) were calculated by using AutoCAD and MS Excel programs. Regression analysis was conducted for visibility as dependant variable with independent variables of patient area percentage, staff area percentage as well as departmental gross square meter per bed by using IBM SPSS. Results: (1) Average patient visibility and percentage of patient area in ICU shows a strong negative correlation ($r^2$=0.66), p=0.01. (2) Patient visibility in Korean ICU (corridor or continental type) can be calculated as below with the given conditions: Y= $-1.449(X)+124.3{\pm}6$, Y is the total visibility of the ICU (corridor or continental type) and X is the percentage of patient area in the unit. Conditions:1. Given that the unit has a mixed programme of open bed and closed patient rooms and 2. The unit have a minimum of 20% patient rooms. Implications: This study may contribute to the visibility analysis of existing and future ICU design (corridor or continental type) in Korea to achieve maximum patient visibility and reduced patient mortality.

• Journal of Korean Biological Nursing Science
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• v.11 no.2
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• pp.114-119
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• 2009

Purpose: The effectiveness of an infection control program is important to hospital quality improvement and decreases of mortality rate and prevalence. Methicillin resistant Staphylococcus aureus (MRSA) is the most common pathogen causing nosocomial infection. The aim of the study was to identify the most important risk factors for acquiring an MRSA, to evaluate the MRSA incidence rates after the nursing intervention in Neurosurgery intensive care unit (ICU). Methods: Clinical data were collected prospectively from December 2008 until July 2009 in Neurosurgery ICU. The patients were divided into preintervention and postintervention groups. An infection was defined as an MRSA if it occurred 48 hr after admission to the Unit. Infection control program including hand washing, education of health care workers about MRSA, standard precaution and contact isolation of patients were applied for three month. Results: A total of 85 patients were included in the study. Forty-five patients of S. aurerus were detected. Among 45 of S. aurerus, MRSA were isolated from 38 patients. The incidence MRSA rate of postintervention group was 26.9% while incidence MRSA rate of preintervention group was 66.7%. In total, The incidence MRSA rate was 44.7%. The incidence of MRSA have decreased in the postintervention as compared with the preintervention group. Conclusion: The infection control program for MRSA was effective to decrease the MRSA isolation rate. The health care workers regular hand washing, education of nosocomial infection control is important enough to be emphasized.

• Journal of Korean Academy of Nursing
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• v.43 no.2
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• pp.287-295
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• 2013

Purpose: The purpose of this study was to identify vancomycin-resistant enterococcus (VRE) colonization rate in patients admitted to the intensive care unit (ICU), associated risk factors and clinical outcomes for VRE colonization. Methods: Of the 7,703 patients admitted to the ICUs between January, 2008 and December, 2010, medical records of 554 VRE colonized and 503 uncolonized patients were reviewed retrospectively. To analyzed the impact of colonization on patients' clinical outcomes, 199 VRE colonized patients were matched with 199 uncolonized patients using a propensity score matching method. Results: During the study period, 567 (7.2%) of the 7,703 patients were colonized with VRE. Multivariate analysis identified the following independent risk factors for VRE colonization: use of antibiotics (odds ratio [OR]=3.33), having bedsores (OR=2.92), having invasive devices (OR=2.29), methicillin-resistant Staphylococcus aureus co-colonization (OR=1.84), and previous hospitalization (OR=1.74). VRE colonized patients were more likely to have infectious diseases than uncolonized patients. VRE colonization was associated with prolonged hospitalization and higher mortality. Conclusion: Strict infection control program including preemptive isolation for high-risk group may be helpful. Further research needs to be done to investigate the effects of active surveillance program on the incidence of colonization or infection with VRE in the ICU.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.25 no.2
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• pp.109-119
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• 2018

Purpose: The purpose of this study was to investigate the effects of a delirium prevention intervention for patients in neurology and neurosurgery intensive care units (ICUs). Methods: This study was a quasi-experimental study. Participants were 87 patients. The experimental group was provided with nonpharmacologic and multicomponent delirium prevention interventions, consisting of regular delirium assessment, improvement in orientation, early therapeutic intervention, and environmental interventions. The control group was provided with routine intensive care. Data were analyzed using $x^2$ test, Fisher's exact test, and t-test. Results: Both groups were homogeneous. The incidence of delirium and length of hospitalization were significantly lower in the experimental group compared to the control group. ICU stay, mortality and unplanned extubation were lower in the experimental group compared to the control group, but there was no significant difference. Conclusion: Findings indicate that the delirium prevention intervention is effective in reducing incidence of delirium and length of hospitalization. Therefore, this intervention should be helpful in preventing delirium in neurology and neurosurgery ICUs and can be used as a guide in the prevention of delirium in neurological diseases's patients.

• 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.

• The Journal of Korean Oriental Chronic Disease
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• v.10 no.1
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• pp.21-31
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• 2005

We have analyzed 247 patients who were admitted to the 3rd ICU for intensive care between January 2003 and December 2003 to investigate characteristics of ICU patients and obtain better guidance and management in the ICU. The results are as follows: 1) The total number of patients was 247. The proportion of males was 59.1 %, of females was 40.9%, and the ratio of male to female was about 1.45:1. 2) The most prevalent age group is those in their seventies, the proportion is 33.6%. 3) The total admission days was 3,438days, and mean patient stay being 13.9days. 4) The total number of expired patients was 26, the mortality rate was 10.5%. The mortality in distribution by disease was higest in Cerebral infarction, rate was 53.8%. the proportion of raised intracranial pressure was 42.3%, of hemorrhagic transformation was 11.5%. 5) In distribution by admission channel, Oriental hospital E.R. was 60.7%, Oriental hospital ward was 38.5%, and etc. was 0.8%. 6) The number of patients of Cerebral infarction was 146(59.1%), being the highest in distribution by chief disease and the proportion of MCA territory infarction is highest in the Cerebral infarction(61.6%). 7) In distribution by Oriental Medicine therapy, the proportion of Acupuncture treatment was 15.8%, of Acupuncture treatment combination Herb medication was 78.5%, and of Acupuncture, Herb medication plus subcutaneous Acupuncture treatment was 5.7%.

• Journal of Korean Clinical Nursing Research
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• v.20 no.3
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• pp.384-394
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• 2014

Purpose: To improve professional intensive care by analyzing admission causes, causes of death, disease conditions, and treatment processes in patients with hematological malignancies admitted to intensive care units (ICUs) in South Korea. Methods: This was a retrospective study approved by IRB, and conducted on admission with 559 adults, in the hematology ICU of a hospital located in Seoul. The study was carried out from April 2009 to March 2012. Data were analyzed using SAS. Results: Pneumonia was the most frequent cause of ICU admission and death, followed by sepsis. The condition at discharge was death (53.6%), recovery (39.9%), or hopeless (5.1%). Mortality of patients in states of incomplete remission was higher than that of patients with complete remission and of patients with multiple myeloma, severe aplastic anemia, and lymphoma. Conclusion: Results show that pneumonia and sepsis are the most frequent causes of ICU admission and for the death of patients with hematological malignancies. The most frequent status at discharge of patients with hematological malignancies was death (53.6%), with mortality of patients at Incomplete Remission status, of mechanically ventilated patients, and of patients on continuous renal replacement therapy (CRRT) being higher than others.