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2 "Jeong Ha Mok"
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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
  • 5,305 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
Clinical Characteristics in Patients with Carbapenem-Resistant Acinetobacter baumannii Isolates from Tracheal Secretions
Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee
Korean J Crit Care Med. 2013;28(3):173-179.
DOI: https://doi.org/10.4266/kjccm.2013.28.3.173
  • 2,883 View
  • 90 Download
AbstractAbstract PDF
BACKGROUND
This study was conducted to evaluate the clinical characteristics and outcomes of mechanically ventilated patients with carbapenem-resistant Acinetobacter baumannii (CRAB) isolates from tracheal secretions in a medical intensive care unit (ICU) of a university hospital.
METHODS
We conducted a retrospective study from January 2009 to June 2012.
RESULTS
Among the patients who had isolates cultured from tracheal secretions, 130 patients (34.8%) had CRAB isolates. Their mean age was 65 +/- 14 yr and 74.6% were male. The ICU and hospital mortality was 51.5% and 60.0%, respectively. According to physician's clinical decision, antibiotics were changed in order to cover CRAB in 75 (57.7%) patients. The total duration of antibiotics use was 12.2 +/- 8.1 days. Of patients with antibiotics change to cover CRAB, 70 patients (93.3%) had Clinical Pulmonary Infection Score of 6 and over. However, there was no significant difference in hospital mortality between patients with antibiotics change against CRAB and those without change. In multivariable analysis, only Acute Physiology and Chronic Health Evaluation II score was related to hospital mortality of patients with CRAB.
CONCLUSIONS
In this study, changing antibiotics to cover CRAB by physician's clinical decision only did not influence hospital mortality; further studies would be necessary to investigate how to use antibiotics against CRAB isolates cultured from tracheal secretions.

ACC : Acute and Critical Care