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4 "Eun Jung Kim"
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Original Article
Ethics
The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
Korean J Crit Care Med. 2014;29(3):160-165.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.160
  • 5,306 View
  • 61 Download
  • 5 Crossref
AbstractAbstract PDF
BACKGROUND
Many terminally ill patients die while receiving life-sustaining treatment. Recently, the discussion of life-sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients.
METHODS
The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively.
RESULTS
Eighty-nine patients were enrolled. Their mean age was 65.8 +/- 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 +/- 1.0 days after the decision for removal of life-sustaining treatment.
CONCLUSIONS
The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.

Citations

Citations to this article as recorded by  
  • Agreement between Family Members and the Physician’s View in the ICU Environment: Personal Experience as a Factor Influencing Attitudes towards Corresponding Hypothetical Situations
    Paraskevi Stamou, Dimitrios Tsartsalis, Georgios Papathanakos, Elena Dragioti, Mary Gouva, Vasilios Koulouras
    Healthcare.2023; 11(3): 345.     CrossRef
  • Family's Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study
    Hyeon Jin Cho, Jiyeon Kang
    Journal of Korean Academy of Nursing.2021; 51(1): 15.     CrossRef
  • Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
    Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
    Acute and Critical Care.2020; 35(3): 179.     CrossRef
  • Factors Associated With Quality of Death in Korean ICUs As Perceived by Medical Staff: A Multicenter Cross-Sectional Survey
    Jun Yeun Cho, Ju-Hee Park, Junghyun Kim, Jinwoo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Sang-Min Lee, Jae-Ho Lee, Choon-Taek Lee, Yeon Joo Lee
    Critical Care Medicine.2019; 47(9): 1208.     CrossRef
  • Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea
    Jun Yeun Cho, Jinwoo Lee, Sang-Min Lee, Ju-Hee Park, Junghyun Kim, Youlim Kim, Sang Hoon Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
    Acute and Critical Care.2018; 33(2): 95.     CrossRef
Case Reports
Hematology/Obstetric
Acute Myeloid Leukemia in Suspected Sepsis after Caesarean Section
Myoung Hwa Kim, Sung Won Na, Shin Ok Koh, Eun Jung Kim, Hye Jin Yoon, Yong Jae Lee, Hee Young Cho
Korean J Crit Care Med. 2014;29(2):99-104.   Published online May 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.2.99
  • 5,949 View
  • 72 Download
AbstractAbstract PDF
The incidence of acute leukemia during pregnancy is extremely rare, and often it is not easy to differentiate it from other diseases associated with pregnancy such as sepsis or hemorrhage. Pregnancy itself is not known to affect the natural course of leukemia; however, complications of leukemia like anemia, infections, and coagulopathy can adversely influence both the fetus and the mother. In this case, a pregnant patient misdiagnosed with septic shock and severe leukocytosis was correctly diagnosed with acute myeloid leukemia after surgical delivery.
Cardiology/Pulmonary
One Hundred Seven Days of ECMO as a Bridge to Lung Transplantation: The Longest Duration Among Elderly Patients
Eun Jung Kim, Hyo Chae Paik, Moo Suk Park, Myung Hwa Kim, Shin Ok Koh, You Jin Lee, Sungwon Na
Korean J Crit Care Med. 2014;29(1):48-51.   Published online February 28, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.1.48
  • 4,558 View
  • 75 Download
  • 3 Crossref
AbstractAbstract PDF
Extracorporeal membrane oxygenation (ECMO) is a means for supporting adequate gas exchange in patients with severe respiratory failure and is the only therapeutic option for ventilation-refractory patients awaiting lung transplantation. Moreover, defining the patients likely to benefit from ECMO as a bridge to transplantation has recently become a point of interest. Here, we report a case of prolonged ECMO support to a patient awaiting lung transplantation. A 66-year-old woman was diagnosed with acute interstitial pneumonia and was placed on veno-venous (VV) ECMO due to unsatisfactory gas exchange despite maximal ventilator care. She underwent bilateral lung transplantation after 99 days of ECMO and was successfully weaned from it on the 107th ECMO day. This is the longest period of ECMO support to be reported among elderly patients.

Citations

Citations to this article as recorded by  
  • Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)–Numerical Investigation of the Connection to the Common Iliac Veins
    N. B. Steuer, K. Hugenroth, T. Beck, J. Spillner, R. Kopp, S. Reinartz, T. Schmitz-Rode, U. Steinseifer, G. Wagner, J. Arens
    Cardiovascular Engineering and Technology.2020; 11(4): 362.     CrossRef
  • One hundred forty six days on extracorporeal membrane oxygenation (ECMO): Our longest ECMO run
    Ahmad Said Abdalmohsen Ali, Mohamed Yosri, Mohamed Abouelwafa, Mahmoud Saad, Kareem Zaki, Shady Mashhour, Husam Salah, Tarek Mohsen, Amaany Abozeid, Mohamed Khaled, Akram Abdelbary, Alia Abdelfattah
    The Egyptian Journal of Critical Care Medicine.2018; 6(3): 113.     CrossRef
  • Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation
    Jin Jeon, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
    Korean Journal of Critical Care Medicine.2014; 29(3): 212.     CrossRef
Skin Necrosis after High Dose Vasopressor Infusion in Septic Shock: Two Case Reports
Ah Reum Cho, Jeung Il Kim, Eun Jung Kim, Seung Min Son
Korean J Crit Care Med. 2012;27(3):182-186.
DOI: https://doi.org/10.4266/kjccm.2012.27.3.182
  • 3,186 View
  • 1,854 Download
  • 4 Crossref
AbstractAbstract PDF
Survival sepsis campaign recommends that vasopressor therapy is required to maintain mean arterial pressure (MAP) > or = 65 mmHg. However, the absolute maximum dose of vasopressor is difficult to determine. Herein, we report 2 cases of severe skin necrosis after high dose vasopressor infusion to maintain the recommended MAP in septic shock. In our first case, norepinephrine 1.0-2.0 microg/kg/min and vasopressin 0.03-0.1 U/min were infused for 5 days; in the second case, dopamine 10-20 microg/kg/min and norepinephrine 0.25-2.5 microg/kg/min were infused for 7 days. Severe ischemic skin lesions, which required amputations, developed in both cases. The clinical appearance of the skin lesions in the 2 cases was different because of the unique distribution of target receptors for different vasopressors. Thus, when high dose vasopressors are required to achieve recommended MAP, extra vigilance is required. Further studies for dose adjustment are needed.

Citations

Citations to this article as recorded by  
  • Lower Extremity Salvage with Thoracodorsal Artery Perforator Free Flap in Condition of Symmetrical Peripheral Gangrene
    Soo Yeon Lim, Gyeong Hoe Kim, Il Hoon Sung, Dong Woo Jang, Jung Soo Yoon, Youn Hwan Kim, Sang Wha Kim
    BioMed Research International.2018; 2018: 1.     CrossRef
  • A tip from the nose: rhinocerebral mucormycosis in a patient with alcoholic liver cirrhosis and cocaine abuse, an uncommon association
    David Avelar Rodriguez, Gabriel Ochoa Virgen, Roberto Carlos Miranda Ackerman
    BMJ Case Reports.2017; : bcr-2017-220730.     CrossRef
  • Upper Extremity Complications and Concerns in Patients With Cardiac Disease
    Hannah A. Dineen, Ryan D. Gentry, Reid W. Draeger
    The Journal of Hand Surgery.2016; 41(3): 470.     CrossRef
  • Understanding Vasoactive Medications
    John M. Allen
    Journal of Infusion Nursing.2014; 37(2): 82.     CrossRef

ACC : Acute and Critical Care