Acute and Critical Care

Erratum

Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey: Jun Wan Lee, Jae Young Moon, Seok Wha Youn, Yong Sup Shin, Sang Il Park, Dong Chan Kim, Younsuk Koh; Korean J Crit Care Med. 2016;31(3):262-262. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.111.e01; Corrects: Acute Crit Care 2016;31(2):111

4,926 View
80 Download
1 Crossref

PDF

Citations

Citations to this article as recorded by

Challenges experienced by health care professionals working in resource-poor intensive care settings in the Limpopo province of South Africa
Hulisani Malelelo-Ndou, Dorah U. Ramathuba, Khathutshelo G. Netshisaulu
Curationis.2019;[Epub] CrossRef

Original Articles

Policy
Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey: Jun Wan Lee, Jae Young Moon, Seok Wha Youn, Yong Sup Shin, Sang Il Park, Dong Chan Kim, Younsuk Koh; Korean J Crit Care Med. 2016;31(2):111-117. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.111; Correction in: Acute Crit Care 2016;31(3):262

8,363 View
113 Download
3 Crossref

Abstract PDF

Background:
Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea.
Methods
An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS).
Results
Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues.
Conclusions
Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist’s role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.

Citations

Citations to this article as recorded by

Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study
Jaeyoung Choi, Esther Park, Ah Young Choi, Meong Hi Son, Joongbum Cho
Journal of Korean Medical Science.2023;[Epub] CrossRef
Willingness to pay for family education and counselling services provided by critical care advanced practice nurses
Chung Mee Ko, Chin Kang Koh, Sangho Kwon
International Journal of Nursing Practice.2019;[Epub] CrossRef
Intensivist as a Surgeon: The Role of a Surgeon in Critical Care Medicine
Kyung Sook Hong
The Ewha Medical Journal.2017; 40(2): 61. CrossRef

Pulmonary
The Adequacy of a Conventional Mechanical Ventilator as a Ventilation Method during Cardiopulmonary Resuscitation: A Manikin Study: Hong Joon Ahn, Kun Dong Kim, Won Joon Jeong, Jun Wan Lee, In Sool Yoo, Seung Ryu; Korean J Crit Care Med. 2015;30(2):89-94. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.89

6,493 View
141 Download
5 Crossref

Abstract PDF

BACKGROUND
We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). Background: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). Methods: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (Plimit). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (Ppeak) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a Ppeak of ≤ 50 cmH2O. Results: In Model 1, Vt and Ppeak were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and Ppeak levels were 17%, and the Ppeak adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and Ppeak levels were 85%; the Ppeak adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of Plimit. Conclusions: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.

Citations

Citations to this article as recorded by

Humans vs. Machines: Mechanical Compression Devices and Their Appropriate Application in the Management of Cardiac Arrest
Emilia Clementi, Anirudh Chitale, Brian J. O’Neil, Anthony T. Lagina
Current Emergency and Hospital Medicine Reports.2023; 11(4): 133. CrossRef
Manual vs. mechanical ventilation in patients with advanced airway during CPR
Muthapillai Senthilnathan, Ramya Ravi, Srinivasan Suganya, Ranjith Kumar Sivakumar
Indian Heart Journal.2022; 74(5): 428. CrossRef
Effects of Changes in Inspiratory Time on Inspiratory Flowrate and Airway Pressure during Cardiopulmonary Resuscitation: A Manikin-Based Study
Jung Ju Lee, Su Yeong Pyo, Ji Han Lee, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Suk Woo Lee, Young Min Kim, Hyun Seok Chai
Kosin Medical Journal.2021; 36(2): 100. CrossRef
Changes in peak inspiratory flow rate and peak airway pressure with endotracheal tube size during chest compression
Jung Wan Kim, Jin Woong Lee, Seung Ryu, Jung Soo Park, InSool Yoo, Yong Chul Cho, Hong Joon Ahn
World Journal of Emergency Medicine.2020; 11(2): 97. CrossRef
Mechanical Ventilation During Resuscitation: How Manual Chest Compressions Affect a Ventilator’s Function
Tillmann Speer, Wolfgang Dersch, Björn Kleine, Christian Neuhaus, Clemens Kill
Advances in Therapy.2017; 34(10): 2333. CrossRef

Pulmonary
The Usefulness of Intensivist-Performed Bedside Drainage of Pleural Effusion via Ultrasound-Guided Pigtail Catheter: Joo Won Min, Joon Young Ohm, Byung Seok Shin, Jun Wan Lee, Sang Il Park, Seok Hwa Yoon, Yong Sup Shin, Dong Il Park, Chaeuk Chung, Jae Young Moon; Korean J Crit Care Med. 2014;29(3):177-182. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.177

4,699 View
46 Download

Abstract PDF: BACKGROUND
There has been little data reporting the usefulness of intensivist-performed bedside drainage of pleural effusion via ultrasound (US)-guided pigtail catheter. The objective of this study is to clarify the usefulness and safety of these methods in comparison with radiologist-performed procedures.
METHODS
Data of patients with pleural effusion treated with US-guided pigtail catheter drainage were analyzed. All procedures were performed from September 2012 to September. 2013 by a well-trained intensivist or radiologist.
RESULTS
Pleural effusion was drained in 25 patients in 33 sessions. A radiologist performed 21 sessions, and an intensivist performed 12 sessions. Procedures during mechanical ventilation were performed in 15 (71.4%) patients by a radiologist and in 10 (83.3%) by an intensivist (p = 0.678). The success rate was not significantly different in radiologist- and intensivist-performed procedures, 95.2% (20/21) and 83.3% (10/12), respectively (p = 0.538). The average duration for procedures (including in-hospital transfer) was longer in radiologist-performed cases (p = 0.001). Although the results are limited because of the small population size, aggravation of oxygenation, CO2 retention, and decrease of mean arterial blood pressure were not statistically different in the groups. Pigtail-associated complications including hemothorax, pneumothorax, hepatic perforation, empyema, kink in the catheter, and subcutaneous hematoma were not found.
CONCLUSIONS
Intensivist-performed bedside drainage of pleural effusion via ultrasound (US)-guided pigtail catheter is useful and safe and may be recommended in some patients in an intensive care unit.

Case Report

Blunt Splenic Injury by Gunshot: Young Hoon Sul, Sang Il Lee, Kwang Sik Cheon, Jae Young Moon, Jun Wan Lee, In Sang Song; Korean J Crit Care Med. 2013;28(4):340-343.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.340

2,794 View
28 Download

Abstract PDF: Trauma is frequently not purely penetrating or purely blunt. Such mixed trauma can result from the mechanism of injury. Recently, we encountered a patient who accidentally shot himself with a shotgun. He had a 15 x 8-cm-sized penetrating injury on left flank that did not penetrate into the peritoneal cavity and a blunt splenic injury with hemoperitoneum. Surgical and interventional treatments were performed for each injury. We present this case with a review of the related literature.

First
Prev
Page of 1
Next
Last

Search