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Original Articles
Epidemiology
Comparing single-patient and multi-patient room intensive care units: a multicenter cohort study on architectural differences and clinical significance in South Korea
Daun Jeong, Donghyoun Lee, Kyoung Won Yoon, Hyo Jin Kim, Sun Young Choi, Chi-Min Park
Acute Crit Care. 2025;40(2):160-170.   Published online May 28, 2025
DOI: https://doi.org/10.4266/acc.004968
  • 8,521 View
  • 124 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
The design of intensive care units (ICUs) is increasingly acknowledged as a crucial factor affecting patient outcomes. Transitioning from multi-bed patient rooms (MPRs) to single-bed patient rooms (SPRs) aims to improve infection control, patient privacy, and quality of care. However, concerns remain regarding potential patient isolation and reduced staff situational awareness. This study aims to evaluate clinical outcomes in SPR-structured ICUs compared to mixed SPR and MPR ICUs.
Methods
This multicenter retrospective cohort study was conducted across three university-affiliated tertiary hospitals between April 2022 and August 2023. The study population included ICU patients aged ≥18 years, excluding those admitted to cardiac and neonatal ICUs. Outcomes assessed included ICU mortality and severity scores based on Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores.
Results
This study included 3,179 ICU patients across three sites: site A consisted exclusively of SPRs, while sites B and C had mixed SPR and MPR arrangements. ICU mortality rates were 8.3%, 15.2%, and 9.7% for sites A, B, and C, respectively (P<0.001). Propensity score matching and logistic regression analysis demonstrated that SPRs were associated with significantly reduced ICU mortality (adjusted odds ratio, 0.54; 95% CI, 0.40–0.73).
Conclusions
SPRs were associated with a protective effect, reducing ICU mortality. Clinical outcomes in ICUs appear to be influenced by structural design improvements alongside other clinical factors.

Citations

Citations to this article as recorded by  
  • Survival improvement through well-designed intensive care unit architecture
    Dong Hyun Lee
    Acute and Critical Care.2025; 40(2): 349.     CrossRef
Pulmonary
Closed intensive care units and sepsis patient outcomes: a secondary analysis of data from a multicenter prospective observational study in South Korea
Kyeongman Jeon, Jin Hyoung Kim, Kyung Chan Kim, Heung Bum Lee, Hongyeul Lee, Song I Lee, Jin-Won Huh, Won Gun Kwack, Youjin Chang, Yun-Seong Kang, Won Yeon Lee, Je Hyeong Kim
Acute Crit Care. 2025;40(2):209-220.   Published online May 22, 2025
DOI: https://doi.org/10.4266/acc.004128
  • 3,922 View
  • 88 Download
AbstractAbstract PDF
Background
Sepsis is a leading cause of intensive care unit (ICU) admission. However, few studies have evaluated how the ICU model affects the outcomes of patients with sepsis.
Methods
This post hoc analysis of data from the Management of Severe Sepsis in Asia’s Intensive Care Units II study included 537 patients with sepsis admitted to 27 ICUs in Korea. The outcome measures of interest were compared between the closed ICU group, patients admitted under the full responsibility of an intensivist as the primary attending physician, and the open ICU group. The association between a closed ICU and ICU mortality was evaluated using a logistic regression analysis.
Results
Altogether, 363 and 174 enrolled patients were treated in open and closed ICUs, respectively. Compliance with the sepsis bundles did not differ between the two groups; however, the closed ICU group had a higher rate of renal replacement therapy and shorter duration of ventilator support. The closed ICU group also had a lower ICU mortality rate than the open ICU group (24.7% vs. 33.1%). In a logistic regression analysis, management in the closed ICU was significantly associated with a decreased ICU mortality rate even after adjusting for potential confounding factors (adjusted odds ratio, 0.576; 95% CI, 0.342–0.970), and that association was observed for up to 90 days.
Conclusions
Sepsis management in closed ICUs was significantly associated with improved ICU survival and decreased length of ICU stay, even though the compliance rates for the sepsis bundles did not differ between open and closed ICUs.
Epidemiology
Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital
Jaeyoung Choi, Song-Hee Kim, Ryoung-Eun Ko, Gee Young Suh, Jeong Hoon Yang, Chi-Min Park, Joongbum Cho, Chi Ryang Chung
Acute Crit Care. 2025;40(1):18-28.   Published online February 21, 2025
DOI: https://doi.org/10.4266/acc.002976
  • 3,900 View
  • 175 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
Latency in transferring patients from intensive care units (ICUs) to general wards impedes the optimal allocation of ICU resources, underscoring the urgency of initiatives to reduce it. This study evaluates the extent of ICU transfer latency and assesses the potential benefits of minimizing it.
Methods
Transfer latency was measured as the time between the first transfer request and the actual ICU discharge at a single-center tertiary hospital in 2021. Computer-based simulations and cost analyses were performed to examine how reducing transfer latency could affect average hourly ICU bed occupancy, the proportion of time ICU occupancy exceeds 80%, and hospital costs. The first analysis evaluated all ICU admissions, and the second analysis targeted a subset of ICU admissions with longer transfer latency, those requiring infectious precautions.
Results
A total of 7,623 ICU admissions were analyzed, and the median transfer latency was 5.7 hours. Eliminating transfer latency for all ICU admissions would have resulted in a 32.8% point decrease in the proportion of time ICU occupancy exceeded 80%, and a potential annual savings of $6.18 million. Eliminating transfer latency for patients under infectious precautions would have decreased the time ICU occupancy exceeded 80% by 13.5% points, and reduced annual costs by a potential $1.26 million.
Conclusions
Transfer latency from ICUs to general wards might contribute to high ICU occupancy. Efforts to minimize latency for all admissions, or even for a subset of admissions with particularly long transfer latency, could enable more efficient use of ICU resources.

Citations

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  • Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea
    Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh
    Acute and Critical Care.2025; 40(4): 548.     CrossRef
Review Article
Nursing
Promoting patient safety in critically ill patients: nursing interventions in surveillance and prevention of ocular injuries
Anabela Carvalho Raposo, Maria Candida Durao, Maria do Rosário Pinto, Helga Rafael Henriques, Joana Ferreira Teixeira
Acute Crit Care. 2025;40(1):10-17.   Published online February 12, 2025
DOI: https://doi.org/10.4266/acc.005014
  • 8,755 View
  • 254 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Corneal surface injuries occur frequently (59.4%) in critically ill patients, and the average time for their appearance is 8 days. Such injuries are primarily related to dry eye, which increases the risk of exposure injury in patients admitted to intensive care units. This can result in a severe ulcer or perforation that results in partial to total loss of vision, decreasing the quality of the patient's life. This is a sensitive nursing care area requiring further investigation. Thus, this review aims to analyse nursing interventions that aim to prevent ocular surface injuries. An integrative literature review was carried out from May to August 2023 in the Medline, CINAHL, Scopus, Web of Science, and PubMed databases using the Whittemore and Knafl methodology. Inclusion and exclusion criteria were subsequently applied to assess the results. After verifying result eligibility, seven documents were identified for data extraction and analysis. The results suggest the importance of recognizing risk factors for ocular injuries in critically ill patients, surveillance as a nursing competency, adequate ocular hygiene and effective lubrication, and managing environmental conditions to prevent corneal injuries. Implementing surveillance and intervention protocols for critically ill patients at risk of corneal injuries requires specialized training for critical care nurses. Specifically, environmental management, including temperature and humidity control, is highlighted as an area that merits further research.

Citations

Citations to this article as recorded by  
  • Lens on eye care in intensive care units: deficiencies, training, and improvement recommendations – a descriptive observational study
    Ayşegül Tuğba Yıldız, Özlem Ceyhan
    BMC Nursing.2025;[Epub]     CrossRef
  • Ocular Surface Disorders in ICU Patients: Evidence-Based Nursing Prevention Strategies
    Weiwei Ni, Xinwei Jiao
    Translational Vision Science & Technology.2025; 14(12): 21.     CrossRef
Original Articles
Pediatrics
A deep learning model for estimating sedation levels using heart rate variability and vital signs: a retrospective cross-sectional study at a center in South Korea
You Sun Kim, Bongjin Lee, Wonjin Jang, Yonghyuk Jeon, June Dong Park
Acute Crit Care. 2024;39(4):621-629.   Published online November 25, 2024
DOI: https://doi.org/10.4266/acc.2024.01200
Retraction in: Acute Crit Care 2025;40(3):512
  • 4,667 View
  • 40 Download
  • 3 Web of Science
  • 2 Crossref
Surgery
Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea
Jae Hoon Lee, Jee Hee Kim, Ki Ho You, Won Ho Han
Acute Crit Care. 2024;39(4):554-564.   Published online November 25, 2024
DOI: https://doi.org/10.4266/acc.2024.00808
  • 4,721 View
  • 166 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Background
In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs.
Methods
This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality.
Results
Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU.
Conclusions
Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.

Citations

Citations to this article as recorded by  
  • Long‐Term Outcomes and Predictors in Cancer‐Related Stroke Using the Linked Data Set
    Tae Jung Kim, Ji Sung Lee, Mi Sun Oh, Soo‐Hyun Park, Kyung‐Ho Yu, Byung‐Chul Lee, Byung‐Woo Yoon, Sang‐Bae Ko
    Journal of the American Heart Association.2025;[Epub]     CrossRef
  • Impact of medical crisis on the critical care system in South Korea
    Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-kyung Kim, Dong Hyun Lee, Suk-Kyung Hong
    Acute and Critical Care.2025; 40(3): 393.     CrossRef
  • Patient outcomes associated with merging two paediatric cardiac intensive care units into one: A retrospective study
    Sacha Mairet-Mabboux, Thibault Blache, Anthony Facchin, Catherine Koffel, Arnaud Ferraris, Christopher Blakeley, Vincent Piriou, Roland Henaine, Marc Lilot
    Archives of Cardiovascular Diseases.2025;[Epub]     CrossRef
  • The efficacy of intensivist-led closed-system intensive care units in improving outcomes for cancer patients requiring emergent surgical intervention
    Eun Young Kim
    Acute and Critical Care.2024; 39(4): 640.     CrossRef
Trauma
Factors associated with unplanned intensive care unit readmission among trauma patients in Republic of Korea
Yongwoong Lee, Byung Hee Kang
Acute Crit Care. 2024;39(4):583-592.   Published online November 22, 2024
DOI: https://doi.org/10.4266/acc.2024.00584
  • 2,813 View
  • 158 Download
  • 1 Crossref
AbstractAbstract PDF
Background
In trauma patients, unplanned intensive care unit (ICU) readmission (UIR) is associated with poor clinical outcomes. In this study, we aimed to analyze associated factors for UIR in trauma patients.
Methods
This retrospective study was conducted on trauma patients admitted to the ICU at a trauma center from January 2016 to December 2022. Clinical information at admission, the first ICU hospitalization, first discharge from the ICU, and reasons for readmission were collected. Patients who were successfully discharge from the ICU were compared to UIR patients. Logistic regression was performed to determine the factors with a significant impact on ICU readmission.
Results
Here, 5,529 patients were admitted to the ICU over 7 years, and 212 patients (3.8%) experienced UIR. Among patients who experienced UIR, 9 (4.2%) died. In the UIR patients, hospital stay (20 days [interquartile range, 13–35] vs. 45 days [28–67], P<0.001), total ICU stay (5 days [3– 11] vs. 17 days [9–35], P<0.001), and complications during the first ICU hospitalization were significantly higher. The most common reason for UIR was respiratory problem (53.8%). In multivariable analysis, cervical spine operation during the first ICU hospitalization (odds ratio, 6.56; 95% CI, 3.62–11.91; P<0.001), renal replacement therapy (RRT; 3.52, 2.06–5.99, P<0.001), and massive blood transfusion protocol (MTP; 1.74, 1.08–2.81, P=0.023) were most highly related with UIR.
Conclusions
Because UIR patients had poor outcomes, trauma patients who underwent cervical spine operation, RRT, or MTP require monitoring in the general ward, especially for respiratory problems.

Citations

Citations to this article as recorded by  
  • Unplanned intensive care unit admissions in trauma patients: A critical appraisal
    Amlan Swain, Deb Sanjay Nag, Jayanta Kumar Laik, Seelora Sahu, Mrunalkant Panchal, Shivani Srirala
    World Journal of Critical Care Medicine.2025;[Epub]     CrossRef
Rapid response system
Development and implementation of an artificial intelligence–enhanced care model to improve patient safety in hospital wards in Spain
Alejandro Huete-Garcia, Sara Rodriguez-Lopez
Acute Crit Care. 2024;39(4):488-498.   Published online November 18, 2024
DOI: https://doi.org/10.4266/acc.2024.00759
  • 8,615 View
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  • 2 Web of Science
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AbstractAbstract PDF
Background
Early detection of critical events in hospitalized patients improves clinical outcomes and reduces mortality rates. Traditional early warning score systems, such as the National Early Warning Score 2 (NEWS2), effectively identify at-risk patients. Integrating artificial intelligence (AI) could enhance the predictive accuracy and operational efficiency of such systems. The study describes the development and implementation of an AI-enhanced early warning system based on a modified NEWS2 scale with laboratory parameters (mNEWS2-Lab) and evaluates its ability to improve patient safety in hospital wards.
Methods
For this retrospective cohort study of 3,790 adults admitted to hospital wards, data were collected before and after implementing the mNEWS2-Lab protocol with and without AI enhancement. The study used a multivariate prediction model with statistical analyses such as Fisher's chi-square test, relative risk (RR), RR reduction, and various AI models (logistic regression, decision trees, neural networks). The economic cost of the intervention was also analyzed.
Results
The mNEWS2-Lab reduced critical events from 6.15% to 2.15% (RR, 0.35; P<0.001), representing a 65% risk reduction. AI integration further reduced events to 1.59% (RR, 0.26; P<0.001) indicating a 10% additional risk reduction and enhancing early warning accuracy by 15%. The intervention was cost-effective, resulting in substantial savings by reducing critical events in hospitalized patients.
Conclusions
The mNEWS2-Lab scale, particularly when integrated with AI models, is a powerful and cost-effective tool for the early detection and prevention of critical events in hospitalized patients.

Citations

Citations to this article as recorded by  
  • Bridging the last mile in AI-driven patient safety: the missing link of trainee readiness
    Rafay Ullah Khan, Nabiah Shakeel, Mohammed Hammad Jaber Amin
    Annals of Medicine & Surgery.2026; 88(1): 1104.     CrossRef
  • Artificial intelligence and pediatric acute kidney injury: a mini-review and white paper
    Jieji Hu, Rupesh Raina
    Frontiers in Nephrology.2025;[Epub]     CrossRef
Epidemiology
Red blood cell transfusion for critically ill patients admitted through the emergency department in South Korea
Tae Sung Kim, Yongil Cho, Hyuk Joong Choi, Joonbum Park, Wonhee Kim, Chiwon Ahn, Joon Young Kim
Acute Crit Care. 2024;39(4):517-525.   Published online November 5, 2024
DOI: https://doi.org/10.4266/acc.2024.00577
  • 6,861 View
  • 189 Download
  • 1 Crossref
AbstractAbstract PDF
Background
Red blood cells (RBCs) are a limited resource, and the adverse effects of transfusion must be considered. Multiple randomized controlled trials on transfusion thresholds have been conducted, leading to the establishment of a restrictive transfusion strategy. This study aimed to investigate the status of RBC transfusions in critically ill patients.
Methods
This cohort study was conducted at five university hospitals in South Korea. From December 18, 2022, to November 30, 2023, 307 nontraumatic, anemic patients admitted to intensive care units through the emergency departments were enrolled. We determined whether patients received RBC transfusion, transfusion triggers, and the clinical results.
Results
Of the 154 patients who received RBC transfusions, 71 (46.1%) had a hemoglobin level of 7 or higher. Triggers other than hemoglobin level included increased lactate levels in 75 patients (48.7%), tachycardia in 47 patients (30.5%), and hypotension in 46 patients (29.9%). The 28-day mortality rate was not significantly reduced in the group that received transfusions compared to the non-transfusion group (21.4% vs. 26.8%, P=0.288). There was no difference in the intensive care unit and hospital length of stay or the proportion of survival to discharge between the two groups. The prognosis showed the same pattern in various subgroups.
Conclusions
Despite the large number of RBC transfusions used in contradiction to the restrictive strategy, there was no notable difference in the prognosis of critically ill patients. To minimize unnecessary RBC transfusions, the promotion of transfusion guidelines and research on transfusion criteria that reflect individual patient conditions are required.

Citations

Citations to this article as recorded by  
  • Red Blood Cell Transfusion Beyond Restrictive Thresholds in Patients With Septic Shock and an Elevated Lactate Level: A Multicenter Observational Study
    Kyung Hun Yoo, Gil Joon Suh, Woon Yong Kwon, Sung-Hyuk Choi, Sung Phil Chung, Won Young Kim, Kyuseok Kim, Yoo Seok Park, Tae Gun Shin, Byuk Sung Ko, Tae Ho Lim, Yongil Cho
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
Nursing
The Glasgow Coma Scale and Full Outline of Unresponsiveness score evaluation to predict patient outcomes with neurological illnesses in intensive care units in West Bank: a prospective cross-sectional study
Wourod Mahmoud Omar, Imad Rasheed Abu Khader, Salam Bani Hani, Mohammed ALBashtawy
Acute Crit Care. 2024;39(3):408-419.   Published online August 30, 2024
DOI: https://doi.org/10.4266/acc.2024.00570
  • 25,727 View
  • 457 Download
  • 3 Web of Science
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AbstractAbstract PDF
Background
Determining the clinical neurological state of the patient is essential for making decisions and forecasting results. The Glasgow Coma Scale and the Full Outline of Unresponsiveness (FOUR) Scale are commonly used tools for measuring behavioral consciousness. This study aims to compare scales among patients with neurological disorders in intensive care units (ICUs) in the West Bank.
Methods
A prospective cross-sectional design was employed. All patients admitted to ICUs who met inclusion criteria were involved in this study. Data were collected from from An-Najah National University, Al-Watani, and Rafedia Hospital. Both tools were used to collect data.
Results
A total of 84 patients were assessed, 69.0% of the patients were male, and the average length of stay was 6.4 days. The mean score on the Glasgow Coma scale was 11.2 on admission 11.6 after 48 hours, and 12.2 on discharge. The mean FOUR Scale score was 12.2 on admission, 12.4 after 48 hours, and 12.5 at discharge.
Conclusions
This study indicates that both the Glasgow Coma Scale and the FOUR scale are effective in predicting outcomes for neurologically deteriorated critically ill patients. However, the FOUR scale proved to be more reliable when assessing outcomes in ICU patients.

Citations

Citations to this article as recorded by  
  • The impact of The Quality and Safety Education (QSEN) program on the knowledge, skills, and attitudes of junior nurses
    Salam AlRatrout, Imad Abu Khader, Mohammed ALBashtawy, Mohammed Asia, Abdullah Alkhawaldeh, Salam Bani Hani, Majed Sulaiman Alamri
    PLOS ONE.2025; 20(1): e0317448.     CrossRef
  • Advanced neuromonitoring techniques for medical and neurological ICU patients
    Reza Eshraghi, Mohammad Sepehr Yazdani, Ashkan Bahrami, Reza Amani-Beni, Bahar Darouei, Majid Mokhtari, Seyed MohammadReza Hashemian
    Brain Research Bulletin.2025; 230: 111513.     CrossRef
  • Role of transcranial Doppler ultrasound in early assessment of acute post-traumatic brain injury
    Ahmed Mohamed Ekbal Ghoneim, Safaa Kamal Mohamed, Waleed Abdelhamid Hetta, Mona Gamalludin Alkaphoury
    Medicine.2025; 104(42): e45171.     CrossRef
Nursing
A study to assess the psychosocial needs of patient family members in the intensive care unit in India
Lalthlanawmi Renthlei, Ronur Srikantasastry Ramesh, Mahalakshmy Thulasingam, Manjini Jeyaram Kumari
Acute Crit Care. 2024;39(3):420-429.   Published online August 30, 2024
DOI: https://doi.org/10.4266/acc.2023.01116
  • 6,101 View
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  • 1 Crossref
AbstractAbstract PDF
Background
Admission to an intensive care unit (ICU) is considered a mental crisis for patients and their families as they are unprepared for such a stressful and difficult situation. Hence, the objectives of this study are to assess the psychosocial needs of patient family members in the ICU in various dimensions such as assurance, proximity, information, support, and comfort; and to associate their psychosocial needs with their socio-demographic variables and clinical variables of the patient.
Methods
This was a cross-sectional analytical study conducted between December 2021 and January 2022 among 188 family members of patients admitted to the ICU using a convenience sampling technique in a tertiary hospital in Puducherry, India. The modified Critical Care Family Needs Inventory (CCFNI) questionnaire was administered to all consenting family members to determine their needs.
Results
The overall most important need among the five dimensions of modified CCFNI scores identified by the family members is the need for assurance (2.71±0.38). Using analysis of variance, statistical significances were found as follows. Education and comfort (F-statistic and P-value): 2.76 (0.029); relationship with the patient and assurance: 2.61 (0.036); relationship with the patient and support: 2.44 (0.048); level of consciousness and comfort: 4.63 (0.010); ICU visit restriction and assurance: 3.28 (0.022); ICU visit restriction and comfort: 8.08 (<0.001).
Conclusions
Since family members are essential members of the treatment teams, nurses should concentrate on reassuring them, assisting them in emerging from crises through appropriate communication, offering support, and attending to their needs.

Citations

Citations to this article as recorded by  
  • Perceived Needs of Families of Critically Ill Patients
    Destiny R. Brady, Jennifer R. O’Neill, Joann M. Condon
    Critical Care Nursing Clinics of North America.2025;[Epub]     CrossRef
Pulmonary
Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia
Khaoula Ben Ismail, Fatma Essafi, Imen Talik, Najla Ben Slimene, Ines Sdiri, Boudour Ben Dhia, Takoua Merhbene
Acute Crit Care. 2023;38(3):271-277.   Published online August 21, 2023
DOI: https://doi.org/10.4266/acc.2023.00591
  • 4,430 View
  • 139 Download
AbstractAbstract PDF
Background
In this study, we explored whether awake prone position (PP) can impact prognosis of severe hypoxemia coronavirus disease 2019 (COVID-19) patients.
Methods
This was a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. Patients were divided into two groups: group G1, patients who benefited from a vigilant and effective PP (>4 hours minimum/24) and group G2, control group. We compared demographic, clinical, paraclinical and evolutionary data.
Results
Three hundred forty-nine patients were hospitalized during the study period, 273 met the inclusion criteria. PP was performed in 192 patients (70.3%). The two groups were comparable in terms of demographic characteristics, clinical severity and modalities of oxygenation at intensive care unit (ICU) admission. The mean PaO2/ FIO2 ratios were 141 and 128 mm Hg, respectively (P=0.07). The computed tomography scan was comparable with a critical >75% in 48.5% (G1) versus 54.2% (G2). The median duration of the daily PP session was 13±7 hours per day. The average duration of spontaneous PP days was 7 days (4–19). Use of invasive ventilation was lower in the G1 group (27% vs. 56%, P=0.002). Healthcare-associated infections were significantly lower in G1 (42.1% vs. 82%, P=0.01). Duration of total mechanical ventilation and length of ICU stay were comparable between the two groups. Mortality was significantly higher in G2 (64% vs. 28%, P=0.02).
Conclusions
Our study confirmed that awake PP can improve prognosis in COVID-19 patients. Randomized controlled trials are needed to confirm this result.
Review Article
Ethics
Impact of institutional case volume on intensive care unit mortality
Christine Kang, Ho Geol Ryu
Acute Crit Care. 2023;38(2):151-159.   Published online May 31, 2023
DOI: https://doi.org/10.4266/acc.2023.00689
  • 7,666 View
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  • 6 Web of Science
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AbstractAbstract PDF
The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.

Citations

Citations to this article as recorded by  
  • Volume-outcome relationship in pediatric blunt liver and spleen injuries: A multicenter retrospective cohort study
    Susumu Matsushime, Akira Kuriyama, Morihiro Katsura
    Journal of Pediatric Surgery Open.2025; 10: 100194.     CrossRef
  • Association Between Nurse Staffing Coverage and Patient Outcomes in a Context of Prepandemic Structural Understaffing: A Patient‐Unit‐Level Analysis
    Maria-Eulàlia Juvé-Udina, Jordi Adamuz, Maribel González-Samartino, Marta Tapia-Pérez, Emilio Jiménez-Martínez, Carme Berbis-Morello, Oliver Polushkina-Merchanskaya, Adelaida Zabalegui, María-Magdalena López-Jiménez, Claire Su-Yeon Park
    Journal of Nursing Management.2025;[Epub]     CrossRef
  • Data-Driven Quality of Care in the ICU: A Concise Review
    Giulliana M. Moralez, Filipe Amado, Vincent X. Liu, Sing Chee Tan, Geert Meyfroidt, Robert D. Stevens, David Pilcher, Jorge I. F. Salluh
    Critical Care Medicine.2025; 53(12): e2720.     CrossRef
  • Data Science to Improve ICU Benchmarking
    Jorge I. F. Salluh, Giulliana M. Moralez, Filipe Amado, Gaston Burghi
    Critical Care Medicine.2025; 53(11): e2356.     CrossRef
  • Case volume and specialization in critically ill emergency patients: a nationwide cohort study in Japanese ICUs
    Jun Fujinaga, Takanao Otake, Takehide Umeda, Toshio Fukuoka
    Journal of Intensive Care.2024;[Epub]     CrossRef
  • Association of Intensive Care Unit Case Volume With Mortality and Cost in Sepsis Based on a Japanese Nationwide Medical Claims Database Study
    Takehiko Oami, Taro Imaeda, Taka‑aki Nakada, Tuerxun Aizimu, Nozomi Takahashi, Toshikazu Abe, Yasuo Yamao, Satoshi Nakagawa, Hiroshi Ogura, Nobuaki Shime, Yutaka Umemura, Asako Matsushima, Kiyohide Fushimi
    Cureus.2024;[Epub]     CrossRef
Original Articles
Epidemiology
Risk factors for hospital mortality in intensive care unit survivors: a retrospective cohort study
Luiza Gabriella Antonio e Silva, Claudia Maria Dantas de Maio Carrilho, Thalita Bento Talizin, Lucienne Tibery Queiroz Cardoso, Edson Lopes Lavado, Cintia Magalhães Carvalho Grion
Acute Crit Care. 2023;38(1):68-75.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01375
  • 8,537 View
  • 274 Download
  • 9 Web of Science
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AbstractAbstract PDF
Background
Deaths can occur after a patient has survived treatment for a serious illness in an intensive care unit (ICU). Mortality rates after leaving the ICU can be considered indicators of health care quality. This study aims to describe risk factors and mortality of surviving patients discharged from an ICU in a university hospital.
Methods
Retrospective cohort study carried out from January 2017 to December 2018. Data on age, sex, length of hospital stay, diagnosis on admission to the ICU, hospital discharge outcome, presence of infection, and Simplified Acute Physiology Score (SAPS) III prognostic score were collected. Infected patients were considered as those being treated for an infection on discharge from the ICU. Patients were divided into survivors and non-survivors on leaving the hospital. The association between the studied variables was performed using the logistic regression model.
Results
A total of 1,025 patients who survived hospitalization in the ICU were analyzed, of which 212 (20.7%) died after leaving the ICU. When separating the groups of survivors and non-survivors according to hospital outcome, the median age was higher among non-survivors. Longer hospital stays and higher SAPS III values were observed among non-survivors. In the logistic regression, the variables age, length of hospital stay, SAPS III, presence of infection, and readmission to the ICU were associated with hospital mortality.
Conclusions
Infection on ICU discharge, ICU readmission, age, length of hospital stay, and SAPS III increased risk of death in ICU survivors.

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    Michelle Carmen Paulus, Imre Willemijn Kehinde Kouw, Yente Florine Niké Boelens, Anoek Jacqueline Hubertine Hermans, Bert Strookappe, Arthur Raymond Hubert van Zanten
    Clinical Nutrition.2025; 46: 119.     CrossRef
  • Depression or anxiety and long-term mortality among adult survivors of intensive care unit: a population-based cohort study
    Kyung Hun Yoo, Juncheol Lee, Jaehoon Oh, Nayeon Choi, Tae Ho Lim, Hyunggoo Kang, Byuk Sung Ko, Yongil Cho
    Critical Care.2025;[Epub]     CrossRef
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    Su Hwan Lee, Sunghoon Park
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  • Physical and Cognitive Impairments at ICU Discharge are Associated with High Long-Term Mortality in ICU Survivors with Solid Malignancies: A Retrospective Cohort Study
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    Therapeutics and Clinical Risk Management.2025; Volume 21: 1121.     CrossRef
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    Medicine.2025; 104(34): e43990.     CrossRef
  • End‐of‐Life Care Experiences, Attitudes and Perceptions of Intensive Care Clinicians in Middle Eastern Countries: A Systematic Integrative Review
    Khalidah Mobarki, Ping Guo, Misbah Ismail Mobarki, Nikolaos Efstathiou
    Nursing in Critical Care.2025;[Epub]     CrossRef
  • Analysis of the infectious agent’s structure and antibiotic resistance parameters in patients in intensive care units of a multidisciplinary hospital
    O. I. Butranova, S. K. Zyryanov, A. A. Gorbacheva, G A. Putsman
    Kachestvennaya Klinicheskaya Praktika = Good Clinical Practice.2024; (4): 4.     CrossRef
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    Yihai Zhai, Danxiu Lan, Siying Lv, Liqin Mo
    Frontiers in Medicine.2024;[Epub]     CrossRef
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    Alfredo José Mansur
    Arquivos Brasileiros de Cardiologia.2023;[Epub]     CrossRef
Trauma
Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma
Kangho Lee, Dongyeon Ryu, Hohyun Kim, Sungjin Park, Sangbong Lee, Chanik Park, Gilhwan Kim, Sunhyun Kim, Nahyeon Lee
Acute Crit Care. 2023;38(1):95-103.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01046
  • 6,254 View
  • 126 Download
AbstractAbstract PDF
Background
In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE).
Methods
We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs.
Results
The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage.
Conclusions
In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.
Review Article
Nursing
Theoretical definition of nurse–conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis
Arezoo Mohamadkhani Ghiasvand, Meimanat Hosseini, Foroozan Atashzadeh-Shoorideh
Acute Crit Care. 2023;38(1):8-20.   Published online February 27, 2023
DOI: https://doi.org/10.4266/acc.2022.01039
  • 11,872 View
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AbstractAbstract PDFSupplementary Material
Providing critical nursing care for conscious mechanically ventilated patients is mediated via effective communication. This study aimed to identify and map the antecedents, attributes, consequences, and definition of nurse–conscious mechanically ventilated patient communication (N-CMVPC). This scoping review was conducted by searching the Cochrane Library and the CINAHL, EMBASE, PubMed, Web of Science, and Scopus databases, between 2001 and 2021. The keywords queried included "nurses," "mechanically ventilated patients," "mechanical ventilation," "intubated patients," "communication," "interaction," "relationships," "nurse–patient communication," "nurse–patient relations," "intensive care units," and "critical care." Studies related to communication with healthcare personnel or family members were excluded. The results indicated that N-CMVPC manifests as a set of attributes in communication experiences, emotions, methods, and behaviors of the nurse and the patient and is classified into three main themes, nurse communication, patient communication, and quantitative-qualitative aspects. N-CMVPC is a complex, multidimensional, and multi-factor concept. It is often nurse-controlled and can express itself as questions, sentences, or commands in the context of experiences, feelings, and positive or negative behaviors involving the nurse and the patient.

Citations

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  • Optimizing infection control: Evaluating nurses' knowledge and practices for preventing infections in mechanically ventilated patients
    Safar awadh alotaibi, Maha AlOtaibi, Hadiya Nassar Alrashedi, Huda Ali S Alasmari, Abdelaziz Hendy, Rasha Kadri Ibrahim
    Infection, Disease & Health.2025; 30(3): 194.     CrossRef
  • Interaction Experiences of Family Members With Their Unconscious Relatives on Mechanical Ventilation in the Intensive Care Unit: A Phenomenological Qualitative Study
    Hülya Koçyiğit Kavak, Suna Demirci
    Nursing in Critical Care.2025;[Epub]     CrossRef
  • Communication Methods Used with Conscious Intubated Patients: Scoping Review
    Mahuya Karmakar, Santhna Letchmi Panduragan, Faridah Mohd Said
    The Open Nursing Journal.2024;[Epub]     CrossRef
  • A Study on Nurses' Communication Experiences with Intubation Patients
    Ye Rim Kim, Hye Ree Park, Mee Kyung Shin
    The Korean Journal of Rehabilitation Nursing.2023; 26(1): 28.     CrossRef
  • The Application of Augmentative and Alternative Communication in Intubated Patients in the Intensive Care Unit: A Scoping Review
    Mee-Kyung Shin, Hyejin Jeon
    The Korean Journal of Rehabilitation Nursing.2023; 26(2): 97.     CrossRef
Original Articles
Ethics
Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission
Youjin Chang, Kyoung Ran Kim, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim
Acute Crit Care. 2021;36(4):351-360.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00283
  • 8,014 View
  • 162 Download
  • 5 Web of Science
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AbstractAbstract PDFSupplementary Material
Background
It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception.
Methods
A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state.
Results
A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group were 64%, 22%, and 57%, respectively; their 6-month mortality rates were 100%, 46%, and 81%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3, odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892–8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260–19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162–17.121; P=0.029).
Conclusions
The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization.

Citations

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  • Characteristics of potentially inappropriate, and inappropriately prolonged, ICU admissions in dying ICU patients: A retrospective cohort study
    Sandra Lussier, Carys Jones, Stephen Thornhill, Ary Serpa Neto, Daryl Jones
    Anaesthesia and Intensive Care.2025;[Epub]     CrossRef
  • Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study
    Carla Marchini Dias da Silva, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Jr
    Journal of Critical Care.2024; 79: 154468.     CrossRef
  • Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit
    Michele M. Iguina, Aunie M. Danyalian, Ilko Luque, Umair Shaikh, Sanaz B. Kashan, Dionne Morgan, Daniel Heller, Mauricio Danckers
    Journal of Palliative Care.2023; 38(2): 126.     CrossRef
  • Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
    Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
    Internal and Emergency Medicine.2023; 18(4): 1191.     CrossRef
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    SeungYong Park
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Nursing
Effect of modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients
Suphannee Triamvisit, Wassana Wongprasert, Chalermwoot Puttima, Matchima Na Chiangmai, Nawaphan Thienjindakul, Laksika Rodkul, Chumpon Jetjumnong
Acute Crit Care. 2021;36(4):294-299.   Published online November 23, 2021
DOI: https://doi.org/10.4266/acc.2021.00983
  • 17,756 View
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  • 1 Web of Science
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AbstractAbstract PDF
Background
Care bundles for ventilator-associated pneumonia (VAP) have been shown to minimize the rate of VAP in critically ill patients. Standard care bundles may need to be modified in resource-constrained situations. The goal of this study was to see if our modified VAP-care bundles lowered the risk of VAP in neurosurgical patients.
Methods
A prospective cohort study was conducted in mechanically ventilated neurosurgical patients. The VAP bundle was adjusted in the cohort group by increasing the frequency of intermittent endotracheal tube cuff pressure monitoring to six times a day while reducing oral care with 0.12% chlorhexidine to three times a day. The rate of VAP was compared to the historical control group.
Results
A total of 146 and 145 patients were enrolled in control and cohort groups, respectively. The mean age of patients was 52±16 years in both groups (P=0.803). The admission Glasgow coma scores were 7.79±2.67 and 7.80±2.77 in control and cohort group, respectively (P=0.969). VAP was found in nine patients in control group but only one patient in cohort group. The occurrence rate of VAP was significantly reduced in cohort group compared to control group (0.88/1,000 vs. 6.84/1,000 ventilator days, P=0.036).
Conclusions
The modified VAP bundle is effective in lowering the VAP rate in critically ill neurosurgical patients. It requires low budget and manpower and can be employed in resource-constrained settings.

Citations

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  • Impact of Modified Ventilator‐Associated Pneumonia Prevention Bundle on Clinical Parameters and Outcomes Among Mechanically Ventilated Patients: An Interventional Study
    Yuvaraj Arumugam, Judie Arulappan, Sivakumar M. Nandakumar
    Nursing in Critical Care.2026;[Epub]     CrossRef
  • Pharmacotherapy interventions in ventilator care bundles for preventing VAP in adults: A literature review
    Neilsen Gazo, Cherie Chu
    Journal of Mechanical Ventilation.2025; 6(2): 88.     CrossRef
  • Ventilator-Associated Pneumonia (VAP) in Neurocritical Patients: The Hidden Dialog of Brain and Infection
    Alejandro Rodríguez, Laura Claverias, Ignacio Martín-Loeches, Frederic Gómez Bertomeu, Ester Picó Plana, Sara Rosich, Vanessa Blázquez, Dennis H. Céspedes Torrez, Ruth Lau, María Bodí
    Biomedicines.2025; 13(12): 3112.     CrossRef
Pulmonary
Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing
Mabrouk Bahloul, Sana Kharrat, Malek Hafdhi, Anis Maalla, Olfa Turki, Kamilia Chtara, Rania Ammar, Basma Suissi, Chokri Ben Hamida, Hedi Chelly, Khaiereddine Ben Mahfoudh, Mounir Bouaziz
Acute Crit Care. 2021;36(3):208-214.   Published online August 12, 2021
DOI: https://doi.org/10.4266/acc.2021.00500
  • 8,532 View
  • 223 Download
  • 9 Web of Science
  • 11 Crossref
AbstractAbstract PDF
Background
In this study, we explored whether early application of the prone position (PP) can improve severe hypoxemia and respiratory failure in coronavirus disease 2019 (COVID-19) patients with spontaneous breathing.
Methods
This is a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. All vital parameters were recorded in real time for all patients. Moreover, the results of chest computed tomography (CT), when available, were analyzed.
Results
PP was applied in 21 patients who were breathing spontaneously. The application of PP was associated with a significant increase in oxygen saturation measured by pulse oximetry (SpO2) from 82%±12% to 96%±3% (P<0.001) 1 hour later. Moreover, PP was associated with a significant reduction in respiratory rate from 31±10 to 21±4 breaths/min (P<0.001). Furthermore, the number of patients who exhibited signs of respiratory distress after PP was reduced from 10 (47%) to 3 (14%) (P=0.04). Early PP application also led to a clear improvement on CT imaging. It was not, however, associated with a reduction in mortality rate or in the use of invasive mechanical ventilation (P>0.05 for both).
Conclusions
Our study confirmed that the early application of PP can improve hypoxemia and tachypnea in COVID-19 patients with spontaneous breathing. Randomized controlled trials are needed to confirm the beneficial effects of PP in COVID-19 patients with spontaneous breathing.

Citations

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  • From pandemic onset to present: five years of insights into ARDS caused by COVID-19
    Esteban Ortiz-Prado, Juan S. Izquierdo-Condoy, Jorge Vasconez-Gonzalez, Andrés López-Cortés, Camila Salazar-Santoliva, Alfonso Roberto Vargas Michay, Jorge Luis Vélez-Paéz, Luis Unigarro
    Expert Review of Respiratory Medicine.2025; 19(8): 843.     CrossRef
  • The effect of prone position on oxygen saturation, blood gas parameters, and respiratory rate in intensive care patients with COVID-19-induced ARDS
    Veysel Tekin, Medet Korkmaz
    Scientific Reports.2025;[Epub]     CrossRef
  • Awake prone positioning for patients with COVID-19-related respiratory failure: a systematic review and meta-analysis
    Mara Graziani, Andrea Galeazzo Rigutini, Diletta Bartolini, Laura Traballi, Lorenzo Luzi, Rossana Regina, Francesco Bossi, Carla Caponi, Cecilia Becattini
    Internal and Emergency Medicine.2024; 19(1): 147.     CrossRef
  • Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
    Gustavo Adolfo Vásquez-Tirado, Edinson Dante Meregildo-Rodríguez, Martha Genara Asmat-Rubio, María José Salazar-Castillo, Claudia Vanessa Quispe-Castañeda, María del Carmen Cuadra-Campos
    Critical Care Science.2024;[Epub]     CrossRef
  • Prone positioning in awake patients without ventilatory support does not alter major clinical outcomes in severe COVID-19: results from a retrospective observational cohort study, systematic review and meta-analysis
    Raíssa S. Freire, Camila M. S. S. Barros, Jefferson Valente, Cássia da Luz Goulart, Anna G. R. Santos, Fernando H. Fonseca, Sabrina T. Saenz, Andiana S. Dias, Maria G. A. Rodrigues, Bernardo Maia Silva, Eduardo Fernandes, Nadia Cubas-Vega, Vanderson Sampa
    Expert Review of Respiratory Medicine.2024; 18(3-4): 219.     CrossRef
  • Pronação consciente em pacientes com COVID-19 não intubados e com síndrome do desconforto respiratório agudo: revisão sistemática e metanálise
    Gustavo Adolfo Vásquez-Tirado, Edinson Dante Meregildo-Rodríguez, Martha Genara Asmat-Rubio, María José Salazar-Castillo, Claudia Vanessa Quispe-Castañeda, María del Carmen Cuadra-Campos
    Critical Care Science.2024;[Epub]     CrossRef
  • Awake prone positioning for COVID-19 acute hypoxemic respiratory failure in Tunisia
    Khaoula Ben Ismail, Fatma Essafi, Imen Talik, Najla Ben Slimene, Ines Sdiri, Boudour Ben Dhia, Takoua Merhbene
    Acute and Critical Care.2023; 38(3): 271.     CrossRef
  • Gravity-induced ischemia in the brain-and prone positioning for COVID-19 patients breathing spontaneously
    J. Howard Jaster, Giulia Ottaviani
    Acute and Critical Care.2022; 37(1): 131.     CrossRef
  • Gravity-induced ischemia in the brain and prone positioning for COVID-19 patients breathing spontaneously: still far from the truth!
    Mabrouk Bahloul, Sana Kharrat, Kamilia Chtara, Hedi Chelly, Chokri Ben Hamida, Mounir Bouaziz
    Acute and Critical Care.2022; 37(1): 134.     CrossRef
  • A Case of COVID-19 with Acute Exacerbation after Anti-Inflammatory Treatment
    Yugo Ashino, Yoichi Shirato, Masahiro Yaegashiwa, Satoshi Yamanouchi, Noriko Miyakawa, Kokichi Ando, Yumiko Sakurada, Haorile Chagan Yasutan, Toshio Hattori
    Reports.2022; 5(2): 24.     CrossRef
  • Efficacy and safety of prone position in COVID-19 patients with respiratory failure: a systematic review and meta-analysis
    Hyeon-Jeong Lee, Junghyun Kim, Miyoung Choi, Won-Il Choi, Joonsung Joh, Jungeun Park, Joohae Kim
    European Journal of Medical Research.2022;[Epub]     CrossRef
Nursing
Association between perception of caring behaviors and self-efficacy in patients with cardiovascular disease at coronary care units: a cross-sectional study
Leila Kargar, Zahra Khademian, Masoume Rambod
Acute Crit Care. 2021;36(2):118-125.   Published online April 29, 2021
DOI: https://doi.org/10.4266/acc.2020.00752
  • 10,015 View
  • 208 Download
  • 9 Web of Science
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AbstractAbstract PDF
Background
Assessing and improving patient self-efficacy are among the major roles of nurses. Nurses are also responsible for providing direct patient care, and they play a major role in improving patient care quality. Therefore, it is essential to evaluate nurses’ care-giving behaviors. This study aimed to determine the association between caring behaviors and self-efficacy in patients with cardiovascular disease.
Methods
In this cross-sectional study, 400 patients with cardiovascular disease who were admitted to hospitals in Jahrom, southern Iran, were selected through a stratified sampling. The Caring Behaviors Inventory and the Strategies Used by People to Promote Health questionnaires were used to collect data. Data were analyzed using descriptive statistics, Kolmogorov-Smirnov test and Spearman correlation coefficient in SPSS ver. 22.
Results
Results showed significant relationships between perception of caring behaviors and self-efficacy (r=0.16, P=0.001) as well as subscales of respectful deference to others (r=0.12, P=0.01), assurance of human presence (r=0.12, P=0.02), and positive connectedness (r=0.18, P=0.001). Additionally, among the subscales of caring behaviors, “attentive to others’ experience,” with a mean of 5.17±1.10, was the highest priority and “positive connectedness,” with a mean of 4.81±1.31, was the lowest priority for patients. The mean self-efficacy score was 73.94±29.78, and 169 patients (43.2%) had low self-efficacy.
Conclusions
Given the positive relationship between perception of caring behaviors and self-efficacy in patients with cardiovascular disease, self-efficacy could be improved by paying more attention to patient care priorities and improving patient perception of caring behaviors.

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    Aan Nuraeni, Firman Sugiharto, Anastasia Anna, Ristina Mirwanti, Yanny Trisyani, Etika Emaliyawati, Indah Lingga
    Patient Preference and Adherence.2025; Volume 19: 1475.     CrossRef
  • Compassionate care in nursing: The role of simulation-based compassionate care on nurse's caring behavior, self-efficacy and compassion competency
    Rasha Mohammed Hussien, Tahani Khalil, Abdulqadir J. Nashwan, Hani Al-Najjar, Mahmoud Abdelwahab Khedr
    Nurse Education in Practice.2025; 87: 104470.     CrossRef
  • Caring behavior: perspectives from nurses and parents of hospitalized children
    Mehri Ansariniaki, Seifollah Alaei, Mojtaba Khoshdast Kakhki, Majid Mirmohammadkhani
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    Atallah Alenezi, Fahad M. Alhowaymel, Abdulaziz F. Abaoud, Mona Hamdy Mostafa
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  • Effectiveness of educational interventions for nurses caring for patients with chronic kidney disease in improving nurse outcomes: A systematic review
    Yoke‐Yee Samantha Tai, Yu Hui Foo, Jeanette Ignacio
    Journal of Clinical Nursing.2024; 33(3): 951.     CrossRef
  • Self-efficacy in increasing physical activity of coronary heart disease patients: a cross-sectional study
    Mulyanti Roberto Muliantino, Nindy Zumratul Qadri, Esi Afriyanti, Rika Sarfika
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    Aidah Sanad Alqarni, Eddieson Pasay-An, Awad Eid Alshammari, Ferdinand Gonzales, Lorraine Estadilla, Kawther Eltayeb Ahmed, Lizy Sonia Benjamin, Andrew Ngo, Hanan Awad Moawad Elmashad, Dawlat Ahmed mahmoud Gharib, Salman Amish Alshammari
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    Claudia Yanina Castillo
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  • A Scoping Review of Predictors Associated with Self-Efficacy Among Patients with Coronary Heart Disease
    Firman Sugiharto, Aan Nuraeni, Yanny Trisyani, Azalia Putri, Nuraulia Armansyah, Asroful Zamroni
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  • The mediating role of psychological capital on the relationship between authentic leadership and nurses’ caring behavior: a cross-sectional study
    Guowen Zhang, Wen Tian, Ying Zhang, Juanjuan Chen, Xiaohong Zhang, Wenfeng Lin, Huiping Li, Liqin Sun, Baozhen Cheng, Hui Ding, Guiqi Song
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  • Clinical Effectiveness of Nursing Care Delivery Models for Patients Following Hip Elective Surgery: Comparative Study
    Zhangrou Rao†, Hui Shi†*, Zhezhen Jiang†, Jing Hu, Lanping Hu, Manjuan Xu, Regis Ernest Mendame Ehya, Guy-Armel Bounda*
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  • The Effect of Education Based on Human Care Theory on Caring Behaviors and Job Involvement of Nurses in Intensive Care Units
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Surgery
Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study
Hye-Bin Kim, Sungwon Na, Hyo Chae Paik, Hyeji Joo, Jeongmin Kim
Acute Crit Care. 2021;36(2):99-108.   Published online April 5, 2021
DOI: https://doi.org/10.4266/acc.2020.01144
  • 8,561 View
  • 150 Download
  • 7 Web of Science
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AbstractAbstract PDF
Background
Lung transplantation (LT) is an accepted therapeutic modality for end-stage lung disease patients. Intensive care unit (ICU) readmission is a risk factor for mortality after LT, for which consistent risk factors have not been elucidated. Thus, we investigated the risk factors for ICU readmission during index hospitalization after LT, particularly regarding the posttransplant condition of LT patients.
Methods
In this retrospective study, we investigated all adult patients undergoing LT between October 2012 and August 2017 at our institution. We collected perioperative data from electronic medical records such as demographics, comorbidities, laboratory findings, ICU readmission, and in-hospital mortality.
Results
We analyzed data for 130 patients. Thirty-two patients (24.6%) were readmitted to the ICU 47 times during index hospitalization. At the initial ICU discharge, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR], 1.464; 95% confidence interval [CI], 1.083−1.978; P=0.013) and pH (OR, 0.884; 95% CI, 0.813−0.962; P=0.004; when the pH value increases by 0.01) were related to ICU readmission using multivariable regression analysis and were still significant after adjusting for confounding factors. Thirteen patients (10%) died during the hospitalization period, and the number of ICU readmissions was a significant risk factor for in-hospital mortality. The most common causes of ICU readmission and in-hospital mortality were infection-related.
Conclusions
The SOFA score and pH were associated with increased risk of ICU readmission. Early postoperative management of these factors and thorough posttransplantation infection control can reduce ICU readmission and improve the prognosis of LT patients.

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    Bettina Weingard, Sören L. Becker, Sophie Schneitler, Franziska C. Trudzinski, Robert Bals, Heinrike Wilkens, Frank Langer
    Infection.2025; 53(5): 1677.     CrossRef
  • ICU Readmission and In-Hospital Mortality Rates for Patients Discharged from the ICU—Risk Factors and Validation of a New Predictive Model: The Worse Outcome Score (WOScore)
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Nursing
Challenges of the patient transition process from the intensive care unit: a qualitative study
Kobra Ghorbanzadeh, Abbas Ebadi, Mohammadali Hosseini, Sadat Seyed Bagher Madah, Hamidreza Khankeh
Acute Crit Care. 2021;36(2):133-142.   Published online January 28, 2021
DOI: https://doi.org/10.4266/acc.2020.00626
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  • 22 Web of Science
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AbstractAbstract PDF
Background
The transition of patients from the intensive care unit (ICU) to the general ward is challenging. This study aimed to explain the challenges that patients face during the transition process.
Methods
In this qualitative research of conventional content analysis, data collection was conducted between February 2018 and July 2019 in educational hospitals. After obtaining informed consent, purposive sampling was performed with 22 nurses, intensive care physicians, anesthesiologists, and patients and their families using in-depth semi-structured interviews until data saturation.
Results
The content analysis yielded three main themes in the challenges patients face during the transition process from the ICU: mixed feelings regarding transition (happiness/hope, worry/uncertainty, abandonment); care break (different atmosphere, the difference between the program and the quality of care, assigning care to the patient and family, and care culture and beliefs); and search for support and information (ineffective communication, self-care capacity of patient and family, ineffective and disrupted training, and weak follow-up programs), which inflicts care shock in the patients.
Conclusions
The results showed that patients and their families were in a state of care shock during the ICU transition process and were sometimes disconcerted. It is necessary to design and implement care models according to the needs and challenges patients face during the transition period from ICU (patient-centered), based on the evidence available, and after considering the field of medicine and the accessibility of care in the country. The transition process can be improved and enhanced by obtaining knowledge about ICU care and related challenges as well as organizing a learning environment.

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Basic science and research
Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients
Jung Hee Kim, Yoon Ji Kim, Sang-Min Lee, Jinwoo Lee
Acute Crit Care. 2020;35(3):149-155.   Published online August 31, 2020
DOI: https://doi.org/10.4266/acc.2020.00297
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AbstractAbstract PDF
Background
Although the measuring free cortisol is ideal for assessment of hypothalamicpituitary-adrenal function, it is not routinely measured. Salivary cortisol correlates well with the biologically active free cortisol. Therefore, this study measured the morning basal as well as adrenocorticotropic hormone-stimulated salivary cortisol levels in mechanically ventilated patients and compared the results with non-critically ill patients.
Methods
We prospectively enrolled 49 mechanically ventilated patients and 120 patients from the outpatient clinic. Serum and saliva samples were collected between 8 AM and 10 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit. The salivary samples were insufficient in 15 mechanically ventilated patients (30.6%), and these patients were excluded from the final analysis.
Results
Mechanically ventilated patients (n=34) were significantly older and had lower body mass index and serum albumin levels and higher serum creatinine levels than non-critically ill patients (n=120). After adjustment for these parameters, both basal and stimulated salivary and serum cortisol levels were higher in mechanically ventilated patients. The increase in cortisol was not significantly different between the two groups. Serum cortisol levels showed a positive correlation with salivary cortisol levels. Among mechanically ventilated patients, both basal serum and salivary cortisol levels were lower in survivors than in non-survivors.
Conclusions
Both basal total serum and salivary cortisol levels were elevated in mechanically ventilated patients and in non-survivors.

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Rapid response system
Effectiveness of a daytime rapid response system in hospitalized surgical ward patients
Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh
Acute Crit Care. 2020;35(2):77-86.   Published online May 13, 2020
DOI: https://doi.org/10.4266/acc.2019.00661
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  • 237 Download
  • 8 Web of Science
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AbstractAbstract PDFSupplementary Material
Background
Clinical deteriorations during hospitalization are often preventable with a rapid response system (RRS). We aimed to investigate the effectiveness of a daytime RRS for surgical hospitalized patients.
Methods
A retrospective cohort study was conducted in 20 general surgical wards at a 1,779-bed University hospital from August 2013 to July 2017 (August 2013 to July 2015, pre-RRS-period; August 2015 to July 2017, post-RRS-period). The primary outcome was incidence of cardiopulmonary arrest (CPA) when the RRS was operating. The secondary outcomes were the incidence of total and preventable cardiopulmonary arrest, in-hospital mortality, the percentage of “do not resuscitate” orders, and the survival of discharged CPA patients.
Results
The relative risk (RR) of CPA per 1,000 admissions during RRS operational hours (weekdays from 7 AM to 7 PM) in the post-RRS-period compared to the pre-RRS-period was 0.53 (95% confidence interval [CI], 0.25 to 1.13; P=0.099) and the RR of total CPA regardless of RRS operating hours was 0.76 (95% CI, 0.46 to 1.28; P=0.301). The preventable CPA after RRS implementation was significantly lower than that before RRS implementation (RR, 0.31; 95% CI, 0.11 to 0.88; P=0.028). There were no statistical differences in in-hospital mortality and the survival rate of patients with in-hospital cardiac arrest. Do-not-resuscitate decisions significantly increased during after RRS implementation periods compared to pre-RRS periods (RR, 1.91; 95% CI, 1.40 to 2.59; P<0.001).
Conclusions
The day-time implementation of the RRS did not significantly reduce the rate of CPA whereas the system effectively reduced the rate of preventable CPA during periods when the system was operating.

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Review Article
Rapid response system
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute Crit Care. 2019;34(2):108-116.   Published online May 31, 2019
DOI: https://doi.org/10.4266/acc.2019.00535
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  • 456 Download
  • 32 Web of Science
  • 33 Crossref
AbstractAbstract PDF
The inpatient treatment process is becoming more and more complicated with advanced treatments, aging of the patient population, and multiple comorbidities. During the process, patients often experience unexpected deterioration, about half of which might be preventable. Early identification of patient deterioration and the proper response are priorities in most healthcare facilities. A rapid response system (RRS) is a safety net to identify antecedents of these adverse events and to respond in a timely manner. The RRS has become an essential part of the medical system worldwide, supported by all major quality improvement organizations. An RRS consists of a trigger system and response team and needs constant assessment and process improvement. Although the effectiveness and cost-benefit of RRS remain controversial, according to previous studies, it may be beneficial by decreasing in-hospital cardiac arrest and mortality. Since the first implementation of RRS in Korea in 2008, it has been developed in over 15 medical centers and continues to expand. Recent accreditation standards and an RRS pilot program by the Korean government will promote the proliferation of RRSs in Korea.

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    Byung Ju Kang, Sang-Bum Hong, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Jae Young Moon, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jong-Joon Ahn
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
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    Sang Hyuk Kim, Ji Young Hong, Youlim Kim
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    Sang Hyuk Kim, Hye Suk Choi, Eun Suk Jin, Hayoung Choi, Hyun Lee, Sang-Hwa Lee, Chang Youl Lee, Myung Goo Lee, Youlim Kim
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Original Article
Rapid response system
Rapid Response Systems Reduce In-Hospital Cardiopulmonary Arrest: A Pilot Study and Motivation for a Nationwide Survey
Yeonhee Park, Jong-Joon Ahn, Byung Ju Kang, Young Seok Lee, Sang-Ook Ha, Jin-Soo Min, Woo-Hyun Cho, Se-Hee Na, Dong-Hyun Lee, Seung-Yong Park, Goo-Hyeon Hong, Hyun-Jung Kim, Sangwoo Shim, Jung-Hyun Kim, Seok-Jeong Lee, So-Young Park, Jae Young Moon
Korean J Crit Care Med. 2017;32(3):231-239.   Published online August 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00024
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AbstractAbstract PDFSupplementary Material
Background
Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest. The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs) and the current level of cardiopulmonary arrest rate in tertiary hospitals. Methods: This was a retrospective study based on data from 14 tertiary hospitals. Cardiopulmonary resuscitation (CPR) rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present. Results: Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009). Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854). National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001). High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001) and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001). Conclusions: RRSs may be a feasible option to reduce the CPR rate. The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics.

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Review Article
Cardiology/Surgery/Basic science and research
The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation
Neil J Glassford, Rinaldo Bellomo
Korean J Crit Care Med. 2016;31(4):276-299.   Published online November 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00934
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AbstractAbstract PDF
Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.

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Original Articles
Pulmonary/Quality Improvement
Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea
Junghyun Kim, Jungkyu Lee, Sunmi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee
Korean J Crit Care Med. 2016;31(1):25-33.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.25
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AbstractAbstract PDF
Background:
The number of elderly patients admitted to intensive care units (ICUs) is growing with the increasing proportion of elderly persons in the Korean general population. It is often difficult to make decisions about ICU care for elderly patients, especially when they are in their 90s. Data regarding the proportion of elderly patients in their 90s along with their clinical characteristics in ICU are scarce.
Methods
The records of Korean patients ≥ 90 years old who were admitted to the medical ICU in a tertiary referral hospital between January 2005 and December 2014 were retrospectively reviewed. We compared the trend in ICU use and characteristics of these elderly patients between 2005-2009 and 2010-2014.
Results
Among 6,186 referred patients, 55 aged ≥ 90 years were admitted to the medical ICU from 2005 to 2014. About 58.2% of these patients were male, and their mean age was 92.7 years. Their median Charlson comorbidity index score was 2 (IQR 1-3) and their mean APACHE II score was 25.0 (IQR 19.0-34.0). The most common reason for ICU care was acute respiratory failure. There were no differences in the survival rates between the earlier and more recent cohorts. However, after excluding patients who had specified “do not resuscitate” (DNR), the more recent group showed a significantly higher survival rate (53.8% mortality for the earlier group and 0% mortality for the recent group). Among the survivors, over half were discharged to their homes. More patients in the recent cohort (n=26 [78.8%]) specified DNR than in the earlier cohort (n=7 [35.0%], p=0.004). The number and proportion of patients ≥ 90 years old among patients using ICU during the 2005-2014 study period did not differ.
Conclusions
The use of ICU care by elderly patients ≥ 90 years old was consistent from 2005-2014. The overall mortality rate tended to decrease, but this was not statistically significant. However, the proportion of patients specifying DNR was higher among more recent patients, and the recent group showed an even better survivorship after sensitivity analysis excluded patients specifying DNR.

Citations

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  • Evaluating the effect of age on postoperative and clinical outcomes in patients admitted to the intensive care unit after gastrointestinal cancer surgery
    Jee Yeon Lee, Hyejeong Park, Mi Kyoung Kim, Im-kyung Kim
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Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis
Seung Hwan Lee, Ji Young Jang, Jae Gil Lee
Korean J Crit Care Med. 2013;28(4):247-254.
DOI: https://doi.org/10.4266/kjccm.2013.28.4.247
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AbstractAbstract PDF
BACKGROUND
Many studies have shown that serum albumin and prealbumin levels correlate with patient outcomes in critically ill patients. The purpose of this study was to evaluate the clinical significance of prealbumin and albumin levels in patients in the intensive care unit (ICU) after emergency surgery for acute peritonitis.
METHODS
We examined serum albumin and prealbumin as markers for the prediction of patient outcome in 51 patients admitted to the ICU after emergency surgery from January to December in 2012. Biochemical parameters were measured postoperatively. Serum albumin and prealbumin levels were compared between survivors and non-survivors. Patients were also divided according to the occurrence of shock and pulmonary complications (shock group vs. non-shock group, pulmonary complications group vs. non-pulmonary complications group), and outcome analysis was performed for age, American Society of Anesthesiologists (ASA) score, length of ICU stay (IS), length of hospital stay (HS), mechanical ventilation, and APACHE II score. Serum albumin and prealbumin levels were evaluated for any correlation with complications and mortality.
RESULTS
In patients with shock, prealbumin and albumin were significantly decreased (p = 0.047, p = 0.036). Additionally, albumin was significantly decreased in patients with pulmonary complications. Neither albumin nor prealbumin, however, showed a correlation with mortality. Prealbumin showed a correlation with serum albumin, CRP level, and HS (r = 0.511, p < 0.001; r = -0.438, p = 0.002; and r = -0.45, p = 0.001, respectively). Albumin showed a correlation with HS, IS, and APACHE II score (r = -0.404, p = 0.003; r = -0.424, p = 0.002; and r = -0.40, p = 0.006, respectively).
CONCLUSIONS
The initial prealbumin level measured upon admission to the ICU after gastrointestinal emergency surgery can be useful predictor of shock. The initial albumin level was significantly low in patients with shock and pulmonary complications. However, neither prealbumin nor albumin showed a correlation with mortality. Our study also showed that albumin and prealbumin levels are affected by other factors, such as massive hydration and severe inflammation, as reported in previous studies.

Citations

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  • Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery
    Jin Young Lee, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee
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Review Article
The End-of-Life Care in the Intensive Care Unit
Jae Young Moon, Yong Sup Shin
Korean J Crit Care Med. 2013;28(3):163-172.
DOI: https://doi.org/10.4266/kjccm.2013.28.3.163
  • 5,225 View
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AbstractAbstract PDF
The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient's autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient's death in imminent. To improve understanding EOL care of terminally ill patients, we summarize 'Recommendations for EOL care in the ICU by the American College of Critical Care Medicine' and 'Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science'. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.

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Original Articles
Usefulness of Screening Criteria System Used by Medical Alert Team in a General Hospital
Hyejin Joo, So Hee Park, Sang Bum Hong, Chae Man Lim, Younsuck Koh, Young Seok Lee, Jin Won Huh
Korean J Crit Care Med. 2012;27(3):151-156.
DOI: https://doi.org/10.4266/kjccm.2012.27.3.151
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AbstractAbstract PDF
BACKGROUND
Rapid response team (RRT) is becoming an essential part of patient safety by the early recognition and management of patients on general hospital wards. In this study, we analyzed the usefulness of screening criteria of RRT used at Asan Medical Center.
METHODS
On a retrospective basis, we reviewed the records of 675 cases in 543 patients that were managed by RRT (called medical alert team in the Asan Medical Center), from July 2011 to December 2011. The medical alert team was acted by requests of attending doctors or nurses or the medical alert system (MAS) criteria composed of abnormal vital sign, neurology, laboratory data and increasing oxygen demand. We investigated the patterns of MAS criteria for targeting the patients who were managed by the medical alert team.
RESULTS
Respiratory distress (RR > 25/min) was the most common item for identifying patients whose condition had worsened. The criteria consist with respiratory distress and abnormal blood pressure (mean BP < 60 mmHg or systolic BP < 90 mmHg) found 70.0% of patients with deteriorated conditions. Vital sign (RR > 25/min, mean BP < 60 mmHg or systolic BP < 90 mmHg, pulse rate, PR > 130/min or < 50/min) and oxygen demand found 79.2% of them. Vital signs, arterial blood gas analysis (ABGA) with lactate level (pH, pO2, pCO2, and lactate) and O2 demand found 98.6% of patient conditions had worsened.
CONCLUSIONS
Vital signs, especially RR > 25/min is useful criteria for detecting patients whose conditions have deteriorated. The addition of ABGA data with lactate levels leads to a more powerful screening tool.

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  • Influence of the Rapid Response Team Activation via Screening by Nurses on Unplanned Intensive Care Unit Admissions
    Ye-Ji Huh, Seongmi Moon, Eun Kyeung Song, Minyoung Kim
    Korean Journal of Adult Nursing.2020; 32(5): 539.     CrossRef
  • Early Experience of Medical Alert System in a Rural Training Hospital: a Pilot Study
    Maru Kim
    The Korean Journal of Critical Care Medicine.2017; 32(1): 47.     CrossRef
  • Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in‐hospital cardiac arrest
    HyunSoo Oh, KangIm Lee, WhaSook Seo
    Journal of Advanced Nursing.2016; 72(5): 1122.     CrossRef
  • A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock
    Jung-Wan Yoo, Ju Ry Lee, Youn Kyung Jung, Sun Hui Choi, Jeong Suk Son, Byung Ju Kang, Tai Sun Park, Jin-Won Huh, Chae-Man Lim, Younsuck Koh, Sang Bum Hong
    The Korean Journal of Internal Medicine.2015; 30(4): 471.     CrossRef
Effects of APACHE II Score and Initial Nutritional Status on Prognosis of the Critically Ill Patients
Seohui Ahn, Se Hee Na, Chul Ho Chang, Hyunsun Lim, Duk Chul Lee, Cheung Soo Shin
Korean J Crit Care Med. 2012;27(2):102-107.
DOI: https://doi.org/10.4266/kjccm.2012.27.2.102
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AbstractAbstract PDF
BACKGROUND
Malnutrition is common in hospitalized patients, especially in critically ill patients and affects their mortality and morbidity. However, the correlation between malnutrition and poor outcome is not fully understood. Our hypothesis is that the nutritional effect on the patient's prognosis would differ depending on the severity of the disease.
METHODS
3,758 patients admitted to the intensive care unit (ICU) were observed retrospectively. Patients were divided into well, moderate and severe groups, according to their nutritional status as assessed by their serum albumin level and total lymphocyte count (TLC). The severity of the disease was assessed by the Acute Physiologic and Chronic Health Evaluation (APACHE II score). All patients were followed clinically until discharge or death and ICU days, hospital days, ventilator days, and mortality rates were recorded.
RESULTS
Depending on the definition used, the prevalence of hospital malnutrition is reported to be 68.3%. Hospital days, ICU days, as well as ventilator days of moderate and severe groups were longer than the well group. In patients exhibiting mild severity of disease, moderate and severe malnutrition groups have 3-5 times the mortality rate than the well group.
CONCLUSIONS
Malnutrition affects the prognosis of patients who have an APACHE II score ranging from 4-29 points. Active nutritional support may be more effective for patients with a disease of mild severity.

Citations

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  • Effects of a video-based enteral nutrition education program using QR codes for intensive care unit nurses: a quasi-experimental study
    Won Kee Seo, Hyunjung Kim
    Journal of Korean Biological Nursing Science.2024; 26(1): 16.     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
  • 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
  • Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis
    Seung Hwan Lee, Ji Young Jang, Jae Gil Lee
    Korean Journal of Critical Care Medicine.2013; 28(4): 247.     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
Effect of Cardiac Arrest Team Training Using Script on the Quality of Simulated Resuscitation
Mao Lung Sun, Hyun Jong Kim, Sung Phil Chung, Hahn Shick Lee, Wen Joen Chang
Korean J Crit Care Med. 2012;27(1):5-9.
DOI: https://doi.org/10.4266/kjccm.2012.27.1.5
  • 3,251 View
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AbstractAbstract PDF
BACKGROUND
The purpose of this study was to compare the quality of simulated resuscitation between the conventional simulation training group and the script based training group.
METHODS
This was a retrospective analysis of video clips from a previous study of cardiopulmonary resuscitation (CPR) team simulation training. A total of eighty-four video clips were analyzed. Each video clip belonged to either the conventional group or the script group, of either pre-training or post-training. One of the authors analyzed all the video clips. The qualities of resuscitation team plays were compared in terms of the hands-on compression time, the interval to meaningful measures and the number of utterances of the team leader and members.
RESULTS
The hands-on time of the conventional group improved after training whereas that of the script group deteriorated (22.2 vs -7.0 sec, p = 0.009). The time to defibrillation also improved in the conventional group whereas that of the script group deteriorated (-24.0 vs 33.0 sec, p = 0.002). There were no differences in the utterances of team leaders and members between groups and between pre- and post-training.
CONCLUSIONS
This study suggested that the effect of script-based training on quality of CPR was less useful than that of conventional training using simulation and debriefing. Therefore, CPR team training using a script alone should not be recommended.
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 J Crit Care Med. 2012;27(1):36-44.
DOI: https://doi.org/10.4266/kjccm.2012.27.1.36
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AbstractAbstract PDF
BACKGROUND
Proper nutritional supplement is one of the fundamental management domains for critical ill patients. While it shows positive effect on processing and prognosis of critical ill patients, early enteral nutrition is overlooked. This study explored healthcare professional's level of knowledge perception and performance on early enteral nutrition for critically ill patients. Data was collected from a convenient sample of 319 registered doctors, nurses and nutritionists in ICU at seven university hospitals.
METHODS
A cross-sectional survey design was used. The participants were assessed by questionnaires, specifically designed for the study and verified for the content validity by professional reviewers related with critical ill patients.
RESULTS
While the level of the perception of early enteral nutrition is high, the level of knowledge and performance are relatively low. The nurses showed a statistically significant difference on the level of knowledge, by their educational backgrounds and clinical experiences. Regarding the hospital support system, the doctors showed a significant difference on the level of perception and performance, while the nurses only showed that difference on the level of performance. It was shown that with higher the level of knowledge regarding the early enteral nutrition, the higher the level of performance. Further, the higher the level of perception, the higher the level of performance was observed. The hospital support system and the perception of the healthcare professionals are two most influential factors to affect the performance of the healthcare professionals related with the early enteral nutrition for the critically ill patients.
CONCLUSION
To perform the proper early enteral nutrition, the hospital support system and the level of the healthcare professionals' perception, are two most important factors. Therefore, the efforts to build the hospital support system along with the educational provisions are needed.

Citations

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  • Effects of a video-based enteral nutrition education program using QR codes for intensive care unit nurses: a quasi-experimental study
    Won Kee Seo, Hyunjung Kim
    Journal of Korean Biological Nursing Science.2024; 26(1): 16.     CrossRef
  • Critical Care Nurses’ Perceptions of Enteral Nutrition: A Descriptive Cross-Sectional Study
    Khaled Mohammed Al-Sayaghi, Talal Ali Hussein Saad Alqalah, Sameer Abdulmalik Alkubati, Gamil Ghaleb Alrubaiee, Sultan Abdulwadoud Alshoabi, Masouda Hassan Atrous, Farida Khalil Ibrahim Mohamed, Kamal Dahan Alsultan, Awadia Greeballah Suliman, Moawia Bush
    The Open Nursing Journal.2022;[Epub]     CrossRef
  • Factors Influencing the Occurrence of Diarrhea in Patients Admitted to Intensive Care Units
    Hanna Lee, Rhayun Song
    Journal of Korean Academy of Fundamentals of Nursing.2019; 26(4): 221.     CrossRef
  • Critical Care Nurses’ Perception, Knowledge, and Practices of Enteral Nutrition
    Hyunjung Kim, Eunjin Soun
    Journal of Korean Academy of Fundamentals of Nursing.2016; 23(4): 383.     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
  • 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
The Clinical Significance of Weight Change in Mechanical Ventilated, Critically Ill Patients of ICU
Young Sun Seo, You Eun Kim, Seung Jun Lee, Yu Ji Cho, Yi Yeong Jeong, Ho Cheol Kim, Jong Deok Lee, Young Sil Hwang
Korean J Crit Care Med. 2011;26(3):139-144.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.139
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AbstractAbstract PDF
BACKGROUND
Critically ill patients may show significant weight change in their course of disease during ICU stay. However, what weight changes occur and their effects on patient outcome have not yet been reported to our knowledge. Therefore, we evaluated weight change in critically ill patients in the medical ICU and the effect this may have on clinical outcome.
METHODS
We measured body weight in patients admitted to the medical ICU daily and evaluated their clinical characteristics and outcome.
RESULTS
Thirty-eight patients (M:F = 30:8, mean age = 65.7 +/- 12.5) were enrolled. Thirteen patients (34.2%) showed weight gain and the mean change was 12.8 +/- 4.2%. In contrast, 25 patients (65.8%) showed weight loss and the mean change was 6.3 +/- 6.9%. Patients who showed weight change over 5% or 10% were 26 (68.4%), and 12 (31.6%), respectively, and their mortality rates were 61.5% and 75%, respectively, showing no statistical significance (p > 0.05). However, when the degree of weight change was stratified with < 5%, 5-10% and > 10%, it was associated with death (p = 0.002). Factors like ICU stay, day of mechanical ventilation, initial APACHE II and SOFA score, body mass index (BMI) and serum albumin were not associated with more than 5% change of weight. BMI at admission was only associated with > 10% change of weight (p < 0.05).
CONCLUSIONS
The majority of critically ill patients showed a significant weight change during their ICU stay and these patients may have a tendency to have worse clinical outcome.
Effect of Admission Time to the Medical Intensive Care Unit on Acute Critical Patient Outcomes
Taejin Park, Sang Bum Hong, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2010;25(2):71-75.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.71
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AbstractAbstract PDF
BACKGROUND
The initial management of acute critical patients is important. However, not all hospital facilities and staff are available during off-duty time. We determined the effects of intensive care unit (ICU) admission time on patient outcomes.
METHODS
This retrospective cohort study was conducted in a 28-bed medical ICU in 1 tertiary university hospital. Patients who were admitted between 1 March 2009 and 31 August 2009 were divided according to the time of admission into the "duty time group" (9 AM-5 PM on weekdays) and the "off-duty time group" (5 PM-9 AM on weekdays and at any time on weekends). The baseline characteristics and clinical outcomes were compared between these two groups. The primary endpoint of this study was hospital mortality; the secondary endpoints were ICU mortality and length of ICU stay, hospital length of stay, and mechanical ventilation time.
RESULTS
Two hundred eight (64.8%) of 321 enrolled patients were admitted during off-duty time. The baseline characteristics between the 2 groups were not significantly different. Hospital mortality was 37 (32.7%) in the "duty time group" and 82 (38.4%) in the "off-duty time group" (p = 0.237). There were no significant differences in secondary endpoints between the two groups.
CONCLUSIONS
Off-duty time admission to the ICU had no effect on hospital and ICU mortality, length of hospital and ICU stay, and mechanical ventilation time compared to duty time admission.

Citations

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  • Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study
    Hyun Suk Kim, Jae Do Yang, Se Wung Han, Mi Rin Lee, Da-Sol Kim, Sejin Lee, Seon-Hyeong Kim, Chan-Young Kim
    Annals of Clinical Nutrition and Metabolism.2024; 16(2): 57.     CrossRef
  • Validity and Reliability of the Korean Version of the Partners In Health Scale (PIH-K)
    Mi-Kyeong Jeon, Jung-Won Ahn, Yeon-Hwan Park, Mi-Kyoung Lee
    Journal of Korean Critical Care Nursing.2019; 12(2): 1.     CrossRef
  • Analysis of Risk Factors to Predict Intensive Care Unit Transfer in Medical in-Patients
    Ju Ry Lee, Hye Ran Choi
    Journal of Korean Biological Nursing Science.2014; 16(4): 259.     CrossRef
  • Usefulness of Screening Criteria System Used by Medical Alert Team in a General Hospital
    Hyejin Joo, So Hee Park, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Young Seok Lee, Jin Won Huh
    Korean Journal of Critical Care Medicine.2012; 27(3): 151.     CrossRef
Development of Assessment Tools for Performance and Leadership of a Cardiopulmonary Resuscitation Team
Sung Pil Chung, Junho Cho, Yoo Seok Park, Hyung Goo Kang, Seung Whan Kim, Chan Woong Kim, Yoo Sang Yoon, Keun Jeong Song, Hoon Lim, Gyu Chong Cho, Young Hwan Choi
Korean J Crit Care Med. 2009;24(2):64-68.
DOI: https://doi.org/10.4266/kjccm.2009.24.2.64
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AbstractAbstract PDF
BACKGROUND
The assessment tools for leadership and performance of resuscitation teams are have not been developed. We evaluated the checklists for resuscitation team performance and teamwork.
METHODS
We developed two checklists for team dynamics (D1, D2) and two checklists for team performances (P1, P2). The videotaped mock resuscitation before and after a 2-hr Advanced Cardiovascular Life Support (ACLS) training were also evaluated by two emergency physicians and two nurses using the four checklists. The validity and agreement between assessors were determined. Internal consistency was determined using Cronbach-alpha.
RESULTS
There were no significant differences in scores by expert consensus and the checklist score. The average scores between different assessors were different except for the D1 and D2 between doctors. The Cronbach-alpha for internal consistency were within acceptable ranges in the checklists D2 and P2.
CONCLUSIONS
This study suggests that the D2 and P2 checklists are provisionally acceptable due to relatively high validity, agreement, and internal consistency. However, further research is needed to develop validated checklists for resuscitation teams.

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  • Effects of communication team training on clinical competence in Korean Advanced Life Support: A randomized controlled trial
    Soyeon Yun, Hyeoun‐Ae Park, Sang‐Hoon Na, Hee Je Yun
    Nursing & Health Sciences.2024;[Epub]     CrossRef
  • Focused and Corrective Feedback Versus Structured and Supported Debriefing in a Simulation-Based Cardiac Arrest Team Training
    Ji-Hoon Kim, Young-Min Kim, Seong Heui Park, Eun A Ju, Se Min Choi, Tai Yong Hong
    Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare.2017; 12(3): 157.     CrossRef
  • Nurses' Cardiopulmonary Resuscitation Performance during the First 5 minutes in In-Situ Simulated Cardiac Arrest
    Eun Jung Kim, Kyeong Ryong Lee, Myung Hyun Lee, Jiyoung Kim
    Journal of Korean Academy of Nursing.2012; 42(3): 361.     CrossRef
  • Assessment and Training of Teamwork and Leadership for Critical Care Nurses: A Pilot Study
    Hyun Jin Kim, Sang Mo Je, Hyun Soo Chung, Sung Phil Chung, Hahn Shick Lee
    Korean Journal of Critical Care Medicine.2012; 27(2): 75.     CrossRef
Retrospective Analysis of the Postoperative Patients Admitted to General Surgical-Medical Intensive Care Unit
Jun Rho Yoon, Choon Hak Lim, Mi Jung Kim
Korean J Crit Care Med. 2008;23(1):18-24.
DOI: https://doi.org/10.4266/kjccm.2008.23.1.18
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AbstractAbstract PDF
BACKGROUND
The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU.
METHODS
Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus' suggestion which defines the kinds of treatment done exclusively in ICU. Patients' demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed.
RESULTS
255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group.
CONCLUSION
Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.

Citations

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  • Retrospective investigation of anesthetic management and outcome in patients with deep neck infections
    Tae Kwane Kim, Hye Jin Yoon, Yuri Ko, Yuna Choi, Ui Jin Park, Jun Rho Yoon
    Anesthesia and Pain Medicine.2019; 14(3): 347.     CrossRef
A Study on the Health-related Quality of Life after ICU Care
Min Young Kim, Yong Kyung Lee, Seo Rim Park, In Soon Hwang, Sook Ja Lee, Cheung Soo Shin
Korean J Crit Care Med. 2005;20(2):144-151.
  • 2,009 View
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AbstractAbstract PDF
BACKGROUND
This study was designed to analyze the influences of ICU patients' experiences in the ICU setting and the effect of ICU patient families' stress derived from their needs and daily life stress on the patients' quality of life. METHODS: ICU patients' quality of life was evaluated with KQOLS surveying 144 patients alive. The data was classified into 2 groups according to severity of illness and analyzed with an ANOVA. With a t-test, comparative analysis was made to examine deficiency of responses on patient families' needs and patients' quality of life. RESULTS: The patients in the group of higher severity of illness showed lower quality of life. The APACHEII score had a negative correlation with all domains except health status change domain, health status perception domain, and spiritual domain. There was a negative correlation between patients' age and three domains of physical function, role limitation, and social function and a positive correlation between patients' hospital LOS and health status change domain. The families in the group of lower severity of illness showed higher level of deficiency of responses on their needs for medical treatment and nursing information, and emotional support. Also, patients' quality of life in lower daily life stress group was higher than that in higher stress group especially in psychological health domain. CONCLUSIONS: The findings show that ICU patients `quality of life was influenced by not only medical factors but also psychosocial factors and suggest that multidimensional intervention plans are required for improving patients' quality of life and recovering their health.
Energy Deficiency Aggravates Clinical Outcomes of Critically Ill Patients
Hye Kyung Chung, Song Mi Lee, Jae Hoon Lee, Cheung Soo Shin
Korean J Crit Care Med. 2005;20(1):49-53.
  • 3,306 View
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AbstractAbstract PDF
BACKGROUND
Adequate nutrition support reduces infectious complications, mortality and length of hospitalizationin intensive care unit. However, there are multi factors like frequent null per os (NPO) due to examination, intolerance to tube feeding, complication of TPN (total parenteral nutrition) and ineffective recognition by medical staff. The purpose of this study is to identify detrimental effects of cumulative energy deficiency in critically ill patients.
METHODS
The patients who were received tube feeding or total parenteral nutrition for more than 5 days were investigated. Daily and cumulative energy deficiency was tabulated until oral intake was achieved or until they discharged or died. Patients were divided into two groups, severe energy deficient group (>10, 000 kcal) or mild energy deficient group (<5, 000 kcal). Then we compared clinical outcomes between two groups. RESULTS: Total 150 patients were studied. 48 (32%) patients were severe energy deficient group and 42 (28%) patients were mild energy deficient group. Mortality and nosocomial infection were significantly higher in severe energy deficient group than in mild group. Hospital day and ICU day were significantly higher in severe energy deficient group than in mild group. CONCLUSIONS: Severe energy deficiency was very common in critically ill patients and it deteriorated the clinical outcomes such as mortality, nosocomial infection, hospital day and ICU day.
The Distribution of Medical Personnel and Medical Equipments in the Intensive Care Units in Korea
Shin Ok Koh, Pyung Hwan Park, Myoung Hoon Kong, Yong Lak Kim
Korean J Crit Care Med. 2001;16(2):138-143.
  • 2,477 View
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AbstractAbstract PDF
BACKGROUND
Not much of the fund is invested in the intensive care unit (ICU) in Korean hospitals since the cost of ICU care is set too low compared to the other medical fields as well as to the other part of the world. This study is designed to support the base of an ICU standard guideline in Korea.
METHODS
The questionnaire were sent to 73 ICUs and 24 neonatal ICUs (NICU) of 30 hospitals. Twenty-two of them were teaching hospitals and 8 of them were general hospitals.
RESULTS
The ratios of ICU bed number to total bed number were 5.0% and 6.0% in teaching hospital and general hospital respectively. The ratios of NICU bed to total bed were 3.4% and 2.0% in teaching hospital and general hospital respectively. Intensivists were kept in 24.6% of ICU and 36.4% of NICU. Residents were kept in 43.1% of ICU and 45.5% of NICU. The utilization of ICU service was 90% for teaching hospital and 86% for general hospital. The utilization of NICU was 89% for teaching hospital and 3% of general hospital. Nurse to patient ratios varied widely. Most ICUs in teaching hospital showed the nurse to patients ratio of 1 : 4 which was about 32% of total ICU. Most NICUs in teaching hospital showed the nurse to patients ratio of 1 : 5 which was around 20% of total NICU. Most of the ICUs were equipped with central piping system for oxygen and compressed air supply, vacuum system and all the necessary medical gadgets such as mechanical ventilators, ECG monitors, defibrillators, pulse oximeters and infusion pumps.
CONCLUSIONS
The distribution of medical personnel as well as medical equipments were varied widely. The variation existed between teaching hospital and general hospital as well as within the teaching hospitals. We need to establish a standard, which grades the level of ICU according to the number of keeping physician, nurse-patients ratio, and the types of medical equipments they have.
Clinical Survey of Appropriate Cuff Volume and Pressure during General Anesthesia in Pediatric Patients
Dong Suk Chung
Korean J Crit Care Med. 2000;15(2):93-97.
  • 2,082 View
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AbstractAbstract PDF
BACKGROUND
Uncuffed endotracheal tubes are commonly used in pediatrics even when the risk of gastric aspiration is significant. But cuffed endotracheal tubes effectively protect the risk of pulmonary aspiration and completely seal the airway. This study was designed to determine the appropriate cuff volume and pressure with low risk of ischemic injury to children's airway.
METHODS
We intubated cuffed endotracheal tube (internal diameter 4.5, 5.0, 5.5 mm) in 90 surgical pediatric patient from 16 to 118 months of age. After intubation, initial cuff volume and pressure were measured at the level of complete sealing in each group. Each group was administrated 50% nitrous oxide and 67% nitrous oxide and measured cuff pressure at 20 minutes, 40 minutes.
RESULTS
1) The mean initial cuff volume and pressure of 4.5 ID tube were 0.59 +/- 0.16 ml and 14.5 +/- 0.31 cmH2O (n=30). 2) The mean initial cuff volume and pressure of 5.0 ID tube were 1.00 +/- 0.38 ml and 14.3 +/- 3.55 cmH2O (n=30). 3) The mean initial cuff volume and pressure of 5.5 ID tube were 1.06 +/- 0.26 ml and 14.28 +/- 2.01 cmH2O (n=30). 4) The cuff pressure increased significantly in the course of time, but no pressure in three groups was above 30 cmH2O.
CONCLUSIONS
We could determine the appropriate cuff volume of cuffed endotracheal tube in pediatric patients. Also we concluded that nitrous oxide concentration affect little intracuff pressure in brief operation.
Case Report
Successful Coronary Interventions with the Aid of Abciximab (ReoPro (R)) in High-Risk Patients: Report of Two Cases
Woo Suck Park, Myung Ho Jeong, Nam Ho Kim, Young Keun Ahn, Youl Bae, Gwang Chae Gill, Joo Hyung Park, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang
Korean J Crit Care Med. 1998;13(2):254-260.
  • 1,893 View
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AbstractAbstract PDF
Abrupt closure of coronary artery during coronary intervention is one of major limitations especially in high-risk patients. Platelets are responsible for composing acute thrombotic occlusion at the site of therapeutic arterial injury. Abciximab (platelet glycoprotein IIb/IIIa receptor blocker) might be helpful in preventing the acute thrombotic occlusion. We experienced an excellent effects of the drug in two cases of high-risk patients, unsuccessful thrombolytics and PTCA with acute occlusion. With additional use of abciximab we overcame the complications and succeeded in getting normal coronary flow and resultant successful angioplasties.
Original Article
Clinical Study for Monitored Anesthesia Undergoing Ophthalmic Surgery
Jeong Won Lee, Suk Hun Yoon, Tae Seong Kim, Hyun Soo Kim, Kwang Min Kim
Korean J Crit Care Med. 1997;12(1):37-42.
  • 1,937 View
  • 38 Download
AbstractAbstract PDF
Intoduction: The phrase "Monitored Anesthesia Care" refers to instances in which an anesthesiologist has been called upon to provide specific anesthesia services to a particular patient understanding a planned procedure, in connection with which a patient receives local anesthesia. Monitored anesthesia care is being increasingly used in the 1990s for a wide variety of diagnostic and therapeutic procedure. The primary objective in providing monitored anesthesia care is to ensure patient comfort and safety.
METHOD
We classified patients in three groups by premedication and oxygen administration, no premedication and no oxygen administration (group A), premedication and oxygen administration (group B), premedication and no oxygen administration (group C), measured vital signs and SpO2 (peripheral oxygen saturation) from just before operation, and checked the satisfaction score of surgeon and patients.
RESULT
SpO2 and satisfaction score of surgeon and patients are the best at premedication and oxygen administration group.
CONCLUSION
Monitored anesthesia is assumed to give more comfort and safety to patients than local anesthesia alone.
ACC : Acute and Critical Care
© The Korean Society of Critical Care Medicine.
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