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8 "Yun Su Sim"
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Guideline
Pulmonary
Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines
Tae Sun Ha, Dong Kyu Oh, Hak-Jae Lee, Youjin Chang, In Seok Jeong, Yun Su Sim, Suk-Kyung Hong, Sunghoon Park, Gee Young Suh, So Young Park
Acute Crit Care. 2024;39(1):1-23.   Published online February 28, 2024
DOI: https://doi.org/10.4266/acc.2024.00052
  • 3,931 View
  • 677 Download
AbstractAbstract PDFSupplementary Material
Background
Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator. Methods: Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations. Results: Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation. Conclusions: We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.
Original Article
Pulmonary
Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh
Acute Crit Care. 2024;39(1):91-99.   Published online January 26, 2024
DOI: https://doi.org/10.4266/acc.2023.00871
  • 1,035 View
  • 103 Download
AbstractAbstract PDFSupplementary Material
Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.
Erratum
Pulmonary
Erratum to “Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study”
Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho
Acute Crit Care. 2021;36(2):172-172.   Published online May 28, 2021
DOI: https://doi.org/10.4266/acc.2020.00164.e1
Corrects: Acute Crit Care 2020;35(4):255
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  • 60 Download
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Original Article
Pulmonary
Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study
Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho
Acute Crit Care. 2020;35(4):255-262.   Published online November 9, 2020
DOI: https://doi.org/10.4266/acc.2020.00164
Correction in: Acute Crit Care 2021;36(2):172
  • 6,290 View
  • 232 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs.
Methods
Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included.
Results
A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups.
Conclusions
In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Citations

Citations to this article as recorded by  
  • Sedation and analgesia strategies for non-invasive mechanical ventilation: A systematic review and meta-analysis
    Baolu Yang, Leyi Gao, Zhaohui Tong
    Heart & Lung.2024; 63: 42.     CrossRef
  • Effect of Music Therapy and Sound Isolation on the Comfort of Mechanically Ventilated Patients
    Sinem Çalışkan, Esra Akın, Mehmet Uyar
    Turkish Journal of Intensive Care.2024; 22(1): 83.     CrossRef
  • 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
    Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
    Acute and Critical Care.2022; 37(1): 1.     CrossRef
  • Comfort During Non-invasive Ventilation
    Gianmaria Cammarota, Rachele Simonte, Edoardo De Robertis
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • Current status of treatment of acute respiratory failure in Korea
    Yong Jun Choi, Jae Hwa Cho
    Journal of the Korean Medical Association.2022; 65(3): 124.     CrossRef
  • Treatment of acute respiratory failure: noninvasive mechanical ventilation
    Sunghoon Park
    Journal of the Korean Medical Association.2022; 65(3): 144.     CrossRef
  • Dexmedetomidine-Induced Aortic Contraction Involves Transactivation of the Epidermal Growth Factor Receptor in Rats
    Soo Hee Lee, Seong-Chun Kwon, Seong-Ho Ok, Seung Hyun Ahn, Sung Il Bae, Ji-Yoon Kim, Yeran Hwang, Kyeong-Eon Park, Mingu Kim, Ju-Tae Sohn
    International Journal of Molecular Sciences.2022; 23(8): 4320.     CrossRef
Guideline
Pulmonary
Clinical Practice Guideline of Acute Respiratory Distress Syndrome
Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi, The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group
Korean J Crit Care Med. 2016;31(2):76-100.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.76
  • 16,784 View
  • 351 Download
  • 6 Crossref
AbstractAbstract PDF
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Citations

Citations to this article as recorded by  
  • Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
    Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong
    Acute and Critical Care.2024; 39(1): 91.     CrossRef
  • Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19
    Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim
    Acute and Critical Care.2023; 38(1): 41.     CrossRef
  • Treatment of acute respiratory failure: invasive mechanical ventilation
    Young Sam Kim
    Journal of the Korean Medical Association.2022; 65(3): 151.     CrossRef
  • Treatment of acute respiratory failure: extracorporeal membrane oxygenation
    Jin-Young Kim, Sang-Bum Hong
    Journal of the Korean Medical Association.2022; 65(3): 157.     CrossRef
  • Prolonged glucocorticoid treatment in acute respiratory distress syndrome – Authors' reply
    Rob Mac Sweeney, Daniel F McAuley
    The Lancet.2017; 389(10078): 1516.     CrossRef
  • Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness
    Gianfranco Umberto Meduri, Andreas Schwingshackl, Greet Hermans
    Frontiers in Pediatrics.2016;[Epub]     CrossRef
Original Articles
Surgery
Clinical Outcome and Prognosis of Patients Admitted to the Surgical ICU after Abdomen Surgery
Yun Su Sim, Jin Hwa Lee, Jung Hyun Chang, Yon Ju Ryu
Korean J Crit Care Med. 2015;30(1):1-7.   Published online February 28, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.1.1
  • 7,445 View
  • 152 Download
  • 1 Crossref
AbstractAbstract PDF
Background
Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. Methods: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. Results: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. Conclusions: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.

Citations

Citations to this article as recorded by  
  • The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients
    Anastasiya Shchatsko, Laura N. Purcell, Christopher J. Tignanelli, Anthony Charles
    The American Surgeon.2021; 87(8): 1230.     CrossRef
The Consistency and Clinical Significance between Bronchoscopic Samples and Endotracheal or Tracheostomic Aspirates in Severe Pneumonia Under Mechanical Ventilation
Hye Sung Park, Seo Woo Kim, Yun Su Sim, Ji Hye Kim, Yon Ju Ryu, Jin Hwa Lee, Jung Hyun Chang
Korean J Crit Care Med. 2011;26(2):83-88.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.83
  • 2,490 View
  • 362 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Distal airway bacterial colonization occurs more frequently in patients with endotracheal tubes or tracheostomy of intensive care units (ICU) care. In general, bronchoscopic samples are considered more accurate than transtracheal aspirates. In this study, we evaluated the consistency and clinical significance between bronchoscopic samples and transtracheal aspirates (TTA) in severe pneumonia under mechanical ventilation.
METHODS
We investigated the consistency between bronchoscopic samples and transtracheal aspirates among patients with endotracheal tubes or tracheostomy, retrospectively. Fiberoptic bronchoscopy was performed in 212 patients with mechanical ventilation via endotracheal tube or tracheostomy between January 1st, 2004 and December 31th, 2008 in ICU at Ewha Womans University Hospital. We evaluated consistency in terms of true pathogen according to the arbitrary ICU days progress.
RESULTS
Among the 212 enrolled patients, 113 (53%) had consistency between bronchoscopic samples and transtracheal aspirates. When evaluated alteration trends in consistency according to ICU stay, the consistency was maintained for 5 to 9 ICU days with statistical significance (p< 0.05) since adjusting for age, sex, and combined risk factors. Consistency in sampling status between the endotracheal tube and tracheostomy was also evaluated, however, there was no statistical significance (OR 1.9 vs. 1, 95% CI = 0.997-3.582, p = 0.051).
CONCLUSIONS
Shorter hospital stay (within 9 days of ICU stay) had higher probability of consistency between bronchoscopic samples and TTA samples. TTA may be as confident as bronchoscopic samples in patients of pneumonia under mechanical ventilation with shorter ICU stays, especially less than 10 days.

Citations

Citations to this article as recorded by  
  • Comparison of the Pattern in Semi-Quantitative Sputum Cultures Based on Different Endotracheal Suction Techniques
    Jiwoong Oh, Kum Whang, Hyenho Jung, Jongtaek Park
    Korean Journal of Critical Care Medicine.2012; 27(2): 70.     CrossRef
Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate
Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon
Korean J Crit Care Med. 2011;26(2):78-82.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.78
  • 2,830 View
  • 19 Download
AbstractAbstract PDF
BACKGROUND
Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis and septic shock. However, there are only a few studies on the association of serum lactate levels and prognosis in septic shock patients with initial low lactate levels.
METHODS
To evaluate whether initial and follow-up lactate levels associated with mortality in septic shock patients with low lactate level, we conducted a retrospective observational study of patients with septic shock, who were hospitalized through the emergency department in February-July 2008. Initial lactate level was stratified as low (<4 mmol/L) or high (> or =4 mmol/L). The primary outcome was 28-day mortality and multiple logistic regression analysis was used to adjust for potential confounders in the association between lactate clearance and mortality.
RESULTS
Of 90 patients hospitalized with septic shock during the study period, 68 (76%) patients had low initial lactate. Mortality at 28 days was 18% in patients with low lactate level. In these patients, initial lactate level was not associated with mortality (p = 0.590). However, increased lactate at follow-up and lactate clearance were associated with mortality (p = 0.006, p = 0.002, respectively). In a multiple logistic regression analysis, increased mortality rate independently associated with age (OR 1.162, 95% CI 1.041-1.298) and lactate clearance (OR 0.654, 95% CI 0.498-0.859).
CONCLUSIONS
In septic shock patients with a low lactate level, lactate clearance independently associated with a decreased mortality rate. Therefore, lactate clearance could be useful for predicting the outcome in these patients.

ACC : Acute and Critical Care