• 제목/요약/키워드: Pediatric Care Unit

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소아 중환자실에 입실한 소아 종양/혈액 질환 환자의 예후 및 위험인자 (Outcome and risk factors of pediatric hemato-oncology patients admitted in pediatric intensive care unit)

  • 김보은;하은주;배근욱;김성국;임호준;서종진;박성종
    • Clinical and Experimental Pediatrics
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    • 제52권10호
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    • pp.1153-1160
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    • 2009
  • 목 적:최근 다양한 치료 방법의 발전과 지지요법의 발달로, 소아 종양/혈액 질환 환자의 생존율이 향상되었으나, 적극적이고 다양한 치료를 하게 되면서 이와 관련된 여러 합병증으로 소아 중환자실에 입실하는 경우 또한 많아졌다. 이에 본 연구에서는 소아 중환자실에 입실한 소아 종양/혈액 질환 환자의 임상양상과 사망률을 살펴보고, 소아 종양/혈액 질환 환자에게 적합한 중증도 측정 체계와 사망률에 영향을 미치는 위험 요인에 대해 알아보고자 했다. 방 법:2005년 9월부터 2008년 7월까지 서울아산병원 소아 중환자실에 입실한 소아 종양/혈액 질환 환자 중 3일 이상 재실한 환자를 대상으로 후향적으로 의무기록을 조사했다. 생존군과 비생존군으로 나누어 나이, 성별, 재실 일수에 대하여 조사했고, 기저 질환과 중환자실 입원 이유, 인공호흡기 적용 여부, 투석 및 승압제 투여 여부, CRP 및 ANC에 따른 사망률을 알아보았다. 또, 생존군과 비생존군의 OSF number, SOFA score, PRISM III score, O-PRISM score를 비교하고, 점수에 따른 사망률을 알아보았다. 결 과:총 88예 중 30예가 사망하여 사망률은 34.1%이었다. 남아가 49예, 여아가 39예이었고, 평균 나이는 $7.0{\pm}5.7$세, 평균 재원일수는 $18.1{\pm}22.2$일로 이었다. 기저 질환은 혈액 질환이 68예(77.3%)로 가장 많았으며, 중환자실 입실 이유는 호흡기능 부전이 35예(39.8%)로 가장 많았고, 패혈쇼크가 19예(21.6%)이었다. CRP는 생존군에서 $9.1{\pm}9.0$, 비생존군에서 $16.4{\pm}11.2$로, 비생존군에서 유의하게 높았고(P<0.01), 비생존군에서 인공호흡기 치료나 투석이 필요했던 경우가 많았으며(P<0.01), 조혈모세포 이식을 받은 군의 사망률이 유의하게 높았다(P<0.05). 중증도 측정 체계 중에서는 initial OSF number, highest OSF number, SOFA score, PRISM III score가 비생존군에서 의미있는 증가를 보였고(P<0.01), 이들을 수용자 작업특성곡선을 사용하여 비교하였을 때, highest OSF number가 곡선하면적 0.845로 가장 높았고, 중환자실 입실 24시간 이내에 측정한 PRSIM III score와 SOFA score의 곡선하면적이 각각 0.723, 0.751로 유의한 결과를 보였다. 총 21예에서 조혈모세포 이식을 받았으며 이들의 O-PRISM score는 비생존군에서 높은 경향을 보였으나, 통계적으로 유의하지는 않았다. 결 론: 본 연구에서 소아 중환자실 입실한 소아 종양/혈액 질환 환자 사망의 위험인자로는 CRP, 인공호흡기 치료, 투석, 조혈모세포 이식이 있었으며, 예후 예측지표로는 highest OSF number, PRISIM III score, SOFA score가 의미 있는 것으로 분석되었다.

환자간호실무 표준에 관한 연구 (A Study on the Patient Care Standard)

  • 윤석희;강채원;전미수;김용순;김명욱;박성애;김혜자;이병숙;정면숙;전명희
    • 대한간호
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    • 제31권1호
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    • pp.68-87
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    • 1992
  • The purpose of this study is to develop a patient care standard which is the basis of unit based quality assurance. The subjects were 570 nurses of 6 hospitals is Seoul. Patient Care Standards were developed from 3 times of clinical Nurses Association's workshop & the joint meeting of Clinical Nurses Association & the Korean Nurses Academic Socity of Nursing Administration. Respondents were instructed to rate of the 2 types of 5 - point Likert type questionnaire(one is the level of perceived importance, the other is the level of actual performance) Findings of this study were as follows 1. As a results of reliability analysis, each questionnaire ranged from $\alpha$=0.79 to 0.94

    2. The Correlations between the levels of perceived importance & actual performances were ranged from r=.40 to 0.72(P=.00) 3. There were significant differences in the level of percevied importance according to the several variables. $\circled1$ Chemotherapy unit; df=5, F=4.06, P=.000/hospital $\circled2$ Pediatric unit; df=5, F=2.8, P=.02/hospital $\circled3$ OBGY ; df=5, F=4.20, P=.00/hospital $\circled4$ ICU ; df=5, F=2.83, P=.02/hospital df=3, F=5.38, P=.00/age df=3, F=6.22, P=.00/total duration. $\circled5$ GS ; df=3, F=3.37, P=.02/total duration 4. There were significant difference in the level of actual performance according to the several variables. $\circled1$ Chemotherapy unit; df=5, F=2.89, P=.02/hospital df=3, F=3.07, P=.03/age df=3, F=3.61, P=.02/total duration $\circled2$ OBGY ; df=5, F=15.48, P=.00/hospilal df=3, F=7.83, p=.00/total duration $\circled3$ GS ; df=5, F=6.70, P=.00/hospital df=3, F=4.49, P=.01/age df=3, F=5.99, P=.00/total duration $\circled4$ ICU ; df=5, F=2.96, P=.02/hospital df=3, F=4.39, P=.0l/age df=3, F=5.20, P=.00/total duration

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  • 신생아 간호단위 간호중재 분석 - 3차 개정 Nursing Intervention Classification(NIC)을 적용하여 - (A Survey of the Nursing Interventions Performed by Neonatal Nursing Unit Nurses Using the NIC)

    • 오원옥;석민현;윤영미
      • Child Health Nursing Research
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      • 제7권2호
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      • pp.161-178
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      • 2001
    • The purpose of this study was to identify nursing interventions performed by neonatal nursing unit nurses. For data collection this study used the taxonomy of Nursing Intervention Classification(NIC : 486 nursing intervention) which was modified by McCloskey & Bulecheck(2000). The new 58 nursing interventions was translated into Korean, and then modified by pannel group, which consist of clinical experts and nursing scholars and finally the 419 nursing interventions was selected. The data were collected from 112 nurses. 168 nursing interventions were performed at least monthly by 50% or more of the nurses. The high frequency of performed nursing interventions were Family domain. 37 nursing interventions were performed at least once a day. The nursing interventions receiving the highest item mean score were neonatal care, neonatal monitoring, photo-therapy; neonate, bottle feeding and temperature regulation. 56 nursing interventions were rarely performed by 90% or more of the nurses. Most of them were in the behavioral domain. The rarely used interventions were urinary bladder training, art therapy, religious addiction prevention, religious ritual enhancement and bladder irrigation. Therefore, neonatal nursing units nurses used interventions in the Physiological: basic domain most often on a daily basis and the interventions in the behavioral domain least often. These findings will help in building of a standardized language for the neonatal nursing units and enhance the quality of nursing care. Further study will be needed to classify each intervention class and nursing activity and validate NIC in pediatric care unit.

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    간호대학생을 위한 시뮬레이션 기반의 아동간호 인수인계에 관한 동영상 실습교육과 시뮬레이션 실습교육의 효과 (Utilizing Video vs Simulation Practice for Handoff Education of Nursing Students in Pediatric Nursing)

    • 박선남;임영순
      • Child Health Nursing Research
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      • 제24권1호
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      • pp.27-36
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      • 2018
    • Purpose: The purpose of this study was to develop a model for handoff education for nursing students based on simulation using video and to identify educational effects of a simulated situation in pediatric care units. Methods: Data were collected from May 1 to 30, 2016. Participants were 84 senior nursing students in Seoul (video group: 43, simulation group: 41). Both groups were given a lecture and pre-briefing on handoff education. The simulation group had nursing practice on resolving health issues for respiratory distress using a high-fidelity baby simulator. The video group watched a video recording of a scenario based simulation, and used a summarized handoff situation to practice patient handoff to another student. Results: There was no significant difference between the two groups for handoff self-confidence, problem solving ability, handoff competence (self-assessment of students), or learning satisfaction. Self-confidence increased significantly in both groups. Handoff competency evaluated by the instructor was higher in the video group compared to the simulation group (t=2.33, p=.022). Conclusion: Nursing student education for handoff practice utilizing a video in the pediatric unit was more cost effective. Therefore, it could be a useful educational method for students in learning patient handoff practices and helpful for related research.

    Respiratory syncytial virus prevention in children with congenital heart disease: who and how?

    • Kim, Nam-Kyun;Choi, Jae-Young
      • Clinical and Experimental Pediatrics
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      • 제54권5호
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      • pp.197-200
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      • 2011
    • Respiratory syncytial virus (RSV) is a major cause of respiratory infection in children. Most of the pediatric population have RSV infection before the age of 2, and recurrent infections are common even within one season. Chronic lung disease, prematurity, along with congenital heart disease (CHD) are major risk factors in severe lower respiratory infection. In hemo-dynamically significant CHD patients with RSV infection, hospitalization is usually needed and the possibility of treatment in intensive care unit and the use of mechanical ventilator support are known to increase. Therefore the prevention of RSV infection in CHD patients is mandatory. The current standard for RSV prevention is immunoprophylaxis by palivizumab. Immunoprophylaxis is recommended monthly in hemodynamically significant CHD patients, up to 5 months. Motabizumab, a second generation drug and newly developing RSV vaccines are also expected to play a key role in RSV prevention in the future. The prophylaxis of RSV infection in CHD patients is cost-effective in both the medical aspect of the patients as well as the socio-economic aspect. Therefore an effort to promote prevention should be made by not only the family of the patients but also by the government.

    Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa

    • Vandenplas, Yvan;Rakhecha, Aditya;Edris, Amira;Shaaban, Bassel;Tawfik, Eslam;Bashiri, Fahad A.;AlAql, Fahd;Alsabea, Hassan;Haddad, Joseph;Barbary, Mohammed El;Salah, Mohamed;Abouelyazid, Mohamed;Kumar, Mudit;Alsaad, Sulaiman
      • Pediatric Gastroenterology, Hepatology & Nutrition
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      • 제22권6호
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      • pp.536-544
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      • 2019
    • Purpose: Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. Methods: The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. Results: A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0-4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development. Conclusion: The results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.

    아동학대로 인해 발생한 중증 단백-에너지 영양실조 환아에서 동반된 구리결핍증 빈혈 1예 (Copper Deficient Anemia in Severe Protein-Energy Malnutrition due to Child Abuse)

    • 변성환;전제덕;장수희
      • Pediatric Gastroenterology, Hepatology & Nutrition
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      • 제10권1호
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      • pp.60-65
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      • 2007
    • 저자들은 가족 내에서 아동학대로 인해 발생한 치명적인 중증 영양실조를 보인 5세 여아에 동반된 빈혈과 구리 결핍증을 WHO 치료 지침과 구리 보충요법으로 호전시킨 1예를 치험하였기에 보고하는 바이다.

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    An 18-year experience of tracheoesophageal fistula and esophageal atresia

    • Seo, Ju-Hee;Kim, Do-Yeon;Kim, Ai-Rhan;Kim, Dae-Yeon;Kim, Seong-Chul;Kim, In-Koo;Kim, Ki-Soo;Yoon, Chong-Hyun;Pi, Soo-Young
      • Clinical and Experimental Pediatrics
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      • 제53권6호
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      • pp.705-710
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      • 2010
    • Purpose: To determine the clinical manifestations and outcomes of patients with tracheoesophageal fistula (TEF) and esophageal atresia (EA) born at a single neonatal intensive care unit. Methods: A retrospective analysis was conducted for 97 patients with confirmed TEF and EA who were admitted to the neonatal intensive care unit between 1990 and 2007. Results: The rate of prenatal diagnosis was 12%. The average gestational age and birth weight were $37^{+2}$ weeks and $2.5{\pm}0.7kg$, respectively. Thirty-one infants were born prematurely (32%). Type C was the most common. The mean gap between the proximal and distal esophagus was 2 cm. Esophago-esophagostomy was performed in 72 patients at a mean age of 4 days after birth; gastrostomy or duodenostomy were performed in 8 patients. Forty patients exhibited vertebral, anorectal, cardiac, tracheoesophageal, renal, limb (VACTERL) association with at least 2 combined anomalies, and cardiac anomaly was the most common. The most common post-operative complications were esophageal stricture followed by gastroesophageal reflux. Balloon dilatation was performed for 1.3 times in 26 patients at a mean age of 3 months. The mortality and morbidity rates were 24% and 67%, respectively, and the most common cause of death was sepsis. The weight of approximately 40% patients was below the 10th percentile at 2 years of age. Conclusion: Mortality and morbidity rates of patients with TEF and EA are high as compared to those of infants with other neonatal surgical diseases. Further efforts must be taken to reduce mortality and morbidity and improve growth retardation.

    2011-2012년 인플루엔자 국내 유행시기에 신생아 중환자실에서 발생한 A형 인플루엔자 바이러스 집단발병 (Influenza A Outbreak in a Neonatal Intensive Care Unit During the 2011-2012 Influenza Season in Korea)

    • 손옥성;오지은;공섬김;정유진;홍유라
      • Pediatric Infection and Vaccine
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      • 제23권2호
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      • pp.87-93
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      • 2016
    • 목적: 신생아 중환자실(neonatal intensive care unit, NICU)에서 인플루엔자 바이러스 집단 발병의 보고는 흔하지 않으며 그 증상은 다양하다. 저자들은 국내 단일기관 NICU에서 발생한 A형 인플루엔자 바이러스 감염의 집단발병에 대해 보고하고 신생아 특히 미숙아에서의 임상적 특성을 알아보고자 하였다. 방법: 2011-2012년 국내 인플루엔자 바이러스 감염 유행 시기에 고신대학교 복음병원 NICU에 입원한 환자들 중 인플루엔자 바이러스 RT-PCR 검사를 시행한 29명 환자들의 의무기록을 후향적으로 조사하였다. 결과: 대상 환자 중 11명에서 A형 인플루엔자 바이러스 양성이었는데(37.9%), 모두 미숙아였고 이들 중 3명(27%)은 증상이 없었으며 상기도 감염 증상 없이, 발열(18%, 2/11), 호흡곤란(72.7%, 8/11), 소화기 증상(27.3%, 3/11)이 있었다. 증상 소실까지 기간의 중앙값은 5일이었다. 이들은 모두 합병증 없이 생존하여 퇴원하였다. A형 인플루엔자 바이러스 RT-PCR 양성군과 음성군 사이에 검체 채취시 재원기간, CRIB 점수, 기계환기 과거력, 덱사메타손 사용 과거력의 차이가 있었다. 결론: 신생아 특히 미숙아에서 A형 인플루엔자 바이러스 감염의 증상은 비특이적이므로 지역 내 인플루엔자 유행시기에는 NICU 입원 중인 신생아에서 감염질환의 원인 병원체로 인플루엔자 바이러스를 고려해야 한다.

    Nutritional Support Strategies for the Preterm Infant in the Neonatal Intensive Care Unit

    • Hay, William W. Jr.
      • Pediatric Gastroenterology, Hepatology & Nutrition
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      • 제21권4호
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      • pp.234-247
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      • 2018
    • The goal of nutrition of the preterm infant is to "provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same postmenstrual age and to maintain normal concentrations of blood and tissue nutrients" (American Academy of Pediatrics 2014). Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. This continues to be true despite many efforts to increase nutrition of the preterm infants. In contrast, enhanced nutrition of very preterm infants, both intravenous and enteral, beginning right after birth, promotes positive energy and protein balance and improves longer term neurodevelopmental outcomes. The benefits are long lasting too, particularly for prevention of later life chronic diseases.