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

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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 Article

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

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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.

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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

Case Report

Knotting and Kinking of the Guidewire during Central Venous Catheterization: A Case Report: Deokkyu Kim, Ji Hye Lee, Dong Chan Kim, Hyungsun Lim, Seonghoon Ko, Ji Seon Son; Korean J Crit Care Med. 2011;26(1):38-40.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.38

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Abstract PDF: Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.

Original Article

Analysis of Nutritional Support Status in the Intensive Care Unit: Seong Shin Moon, Hyungsun Lim, Jin Wook Choi, Deok Kyu Kim, Jeong Woo Lee, Seonghoon Ko, Dong Chan Kim; Korean J Crit Care Med. 2009;24(3):129-133.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.129

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Abstract PDF

BACKGROUND
Nutritional support is important in intensive care for critically ill patients in an effort to decrease the mortality and morbidity. This study was conducted to evaluate the propriety of nutritional support and to understand the effect of a nutrition consultationin critically ill patients to assess and analyze nutritional status.
METHODS
Between January and December 2006, patients who were admitted to the intensive care unit (ICU) > or = 7 days and between 20 and 80 years of age were included. Patients transferred to another hospital, patients discharged against medicine advice, and patients with unknown weight were excluded. Two hundred sixty-two patients were enrolled. The demographic data of patients and the state of nutritional support were reviewed by medical records.
RESULTS
Two hundred sixty-two patients stayed in the ICU a mean of 16.0 +/- 9.8 days and received nutrition support for 11.0 +/- 8.4 days. Except 15 patients who did not receivenutritional support, the mean daily calculated caloric requirement of 247 patients was 1,406.2 +/- 253.8 kcal, the mean daily delivered caloric amount was 899.5 +/- 338.7 kcal, and the total delivered/required caloric ratio was 66.4 +/- 28.1%. The total delivered/required caloric ratio of the patients who received a nutritional consultation and the patients who did not receive nutritional consultation were 72.6 +/- 25.8% and 55.9 +/- 33.3%.
CONCLUSIONS
In this study, we identified that critically ill patients received insufficient nutritional support. We recommend continuous monitoring and management for nutritional support by systematic administration of nutritional support teams.

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Analysis of Current Status and Predisposing Factors for Nutritional Support of Patients in Surgical Intensive Care Unit
Byung Chul Kim, In Kyu Lee, Eun Young Kim
Surgical Metabolism and Nutrition.2016; 7(2): 32. CrossRef
The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
Journal of Nutrition and Health.2015; 48(3): 211. CrossRef
Nutritional Assessment of ICU Inpatients with Tube Feeding
Yu-Jin Kim, Jung-Sook Seo
Journal of the Korean Dietetic Association.2015; 21(1): 11. CrossRef
Nutrition-Related Factors Predicted Pressure Ulcers in Intensive Care Unit Patients*
Ha Nee Lee, Jeong Sook Park
Journal of Korean Academy of Fundamentals of Nursing.2014; 21(4): 413. CrossRef
Comparison of nutritional status indicators according to feeding methods in patients with acute stroke
Sanghee Kim, Youngsoon Byeon
Nutritional Neuroscience.2014; 17(3): 138. CrossRef
Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients
Minju Lee, Jiyeon Kang
Korean Journal of Adult Nursing.2014; 26(6): 621. CrossRef
Development and Evaluation of an Enteral Nutrition Protocol for Dysphagia in Patients with Acute Stroke
Sung-Hee Yoo, So-Sun Kim
Journal of Korean Academy of Nursing.2014; 44(3): 280. CrossRef
Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
Korean Journal of Critical Care Medicine.2012; 27(3): 157. CrossRef
Healthcare Professional's Knowledge, Perception and Performance on Early Enteral Nutrition for Critically Ill Patients
Sun Hee Yun, Sun Jung Kim, Eui Geum Oh
Korean Journal of Critical Care Medicine.2012; 27(1): 36. CrossRef
Effects of Nutrition Support Team Services on Outcomes in ICU Patients
Yeon Hwa MO, Jinnie RHEE, Eui-Kyung LEE
YAKUGAKU ZASSHI.2011; 131(12): 1827. CrossRef
Degree of Nutritional Support and Nutritional Status in MICU Patients
Soo Na Chi, Jea Young Ko, Su Ha Lee, Eun Hwa Lim, Kuk Hwan Kown, Mi Seon Yoon, Eun Sook Kim
The Korean Journal of Nutrition.2011; 44(5): 384. CrossRef
Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients
Sungwon Na, Hosun Lee, Shin Ok Koh, Ai Soon Park, A Reum Han
The Korean Journal of Critical Care Medicine.2010; 25(3): 136. CrossRef

Review

The Subspecialty Certification for Critical Care Medicine in Korea: Dong Chan Kim; Korean J Crit Care Med. 2009;24(3):117-123.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.117

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Abstract PDF

The Korean Society of Critical Care Medicine (KSCCM) has introduced the Subspecialty System for Critical Care Medicine in Korea under the auspices of the Korean Academy of Medical Sciences (KAMS) in March 2008. Nine medical societies that included the Korean Association of Internal Medicine, the Korean Academy of Tuberculosis and Respiratory Diseases, the Korean Society of Anesthesiology, the Korean Neurological Association, the Korean Neurosurgical Society, the Korean Surgical Society, the Korean Society of Emergency Medicine, the Korean Society for Thoracic and Cardiovascular Surgery and the Korean Pediatric Society participated to the new critical care subspecialty. The Board of Critical Care should be certified again every 5 year after achieving the required qualification by the KSCCM. This paper summarizes the Subspecialty Certification System for Critical Care Medicine in Korea.

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Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit
Sung Jun Ko, Jaeyoung Cho, Sun Mi Choi, Young Sik Park, Chang-Hoon Lee, Chul-Gyu Yoo, Jinwoo Lee, Sang-Min Lee, Robert Jeenchen Chen
PLOS ONE.2021; 16(10): e0259092. CrossRef

Original Articles

Effect of Endotoxin on Cerebrospinal Fluid Formation in the Rat: Dong Chan Kim, Yu Jeong Kim, Gi Chul Min; Korean J Crit Care Med. 2001;16(1):48-54.

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Abstract PDF: BACKGROUND
Bacterial lipopolysaccharide (LPS), an endotoxin, can increase nitric oxide (NO) production by expression of an inducible isoforms of nitric oxide synthase (iNOS). Bacterial infections of the central nervous system dilate cerebral vessels and increase cerebral blood flow. We hypothesized that systemic and intraventricular application of bacterial lipopolysaccharide would increase cerebrospinal fluid (CSF) production due to increase in blood flow to choroid plexus caused by NO-induced vasodilation.
METHODS
Ventriculocisternal perfusion was used to measure the production of CSF in pentobarbital-anesthetized rats. The lateral ventricle and cisterna magna were cannulated stereotactically and perfused continuously with artificial CSF with blue dextran 2000 as the indicator. Baseline collections of CSF began after steady state outflow was established; then, endotoxin was administered intravenously or intraventricularly. The baseline rate of CSF production was compared with that measured during 3 hours after endotoxin administration.
RESULTS
The baseline rate of CSF production was 2.6 0.3 (2.2~3.5)microliter/minute in the rat. There were no significant changes in CSF production rate after intravenous or intraventriculr administration of endotoxin.
CONCLUSIONS
We could not observe significant changes in CSF production rate with the ventriculocisternal perfusion method of measuring CSF production after intravenous or intraventriculr administration of endotoxin in the rats.

Evaluation of the Technique of Central Venous Catheterization via the External Jugular Vein: Seong Hoon Ko, Dong Chan Kim, Sang Kyi Lee, He Sun Song; Korean J Crit Care Med. 1999;14(2):143-147.

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Abstract PDF: BACKGOUND: This study was designed to evaluate the effectiveness and feasibility of central venous catheterization via the external jugular vein (EJV). We compared the success rate of left and right EJV catheterization. The influence of the course of left and right external jugular vein on success rate was investigated also.
METHODS
Eighty anesthetized adult surgical patients were studied consecutively. Patients were allocated to left or right EJV catheterization and measured the angles between EJV and clavicle and transverse shoulder line. Catheterization was performed under sterile conditions by Seldinger technique after angiography of EJV and subclavian vein. We analyzed the relationship between the angles and success rate and time for catheterization. We compared the success rate of left and right EJV catheterization.
RESULTS
The overall rate of intrathoracic placement was 74 from 80 catheterization (92.5%). Analysis of success in left and right EJV catheterization did not reveal statistically significant differences. The success rates did not show any correlation with course of EJV. Complications were few and not serious.
CONCLUSIONS
This study indicated that left and right EJVs were good routes for central venous catheterizationan with acceptably high success rate. However, we could not find the predictor of success for central venous catheterization via EJV.

Review

Evaluation of Disorders of Mentation: Dong Chan Kim; Korean J Crit Care Med. 1999;14(1):6-13.

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Abstract PDF: No abstract available.

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