Acute and Critical Care

Original Article

Nursing
The Inter-Rater Reliability of Simplified Acute Physiology Score 3 (SAPS3) among Intensive Care Unit Nurses: Jun Hyun Kim, Ji Yeon Kim, Wonil Kim, Kyung Woo Kim, Sang-il Lee, Kyung-Tae Kim, Jang Su Park, Won Joo Choe, Jung Won Kim; Korean J Crit Care Med. 2015;30(1):8-12. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.8

Abstract PDF: Background
Simplified acute physiology score 3 (SAPS3) was developed in 2005 to evaluate intensive care unit (ICU) performance and to predict patient mortality or disease severity. The score is usually calculated by doctors, but it requires substantial human resources. And many nurse-lead studies use this scoring system. In the present study, we examined the inter-rater reliability of SAPS3 among nurses in an ICU. Methods: Five ICU nurses who worked in an ICU for a mean length of 7.8 years were educated for 2 hours about SAPS3 score and its components. Each nurse scored 26 patients, and the intraclass correlation coefficient (ICC) of the total scores and each subset were evaluated. Results: The ICC (95% confidence interval) of SAPS3 score was 0.89 (0.82-0.95), that of subset I was 0.90 (0.82-0.95), subset II was 0.54 (0.35-0.73), and subset III was 0.95 (0.91-0.97). The ICC of predicted mortality was 0.91 (0.85-0.96). Conclusions: The ICC of SAPS3 score and predicted mortality among ICU nurses were reliable. According to these ICC values, SAPS3 score is a reliable scale to be used by nurses. The ICC of subset II was lower than those of the other subsets, suggesting that education of SAPS3 should focus on the definition of each subset II component.

Case Reports

Pulmonary
Lobar Bronchial Rupture with Persistent Atelectasis after Blunt Trauma: Jun Hyun Kim, Kyung Woo Kim, Chu Sung Cho, Sang Il Lee, Ji Yeon Kim, Kyung Tae Kim, Won Joo Choe, Jang Su Park, Jung Won Kim; Korean J Crit Care Med. 2014;29(4):344-347. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.344

Abstract PDF: Rupture limited to the lobar bronchus from blunt trauma is especially rare, and the symptoms are light so diagnosis is difficult. In a patient who visited the hospital complaining of shortness of breath after falling down, atelectasis continued in the chest x-ray. Four days after visiting the hospital, a left upper lobar bronchial rupture was diagnosed through a bronchoscopy and 3 dimensional chest computerized tomography. When diagnosis is delayed in the case of a rupture limited to the lobar bronchus, bronchial obstruction can occur from the formation of granulation tissue, so regular monitoring is important. Therefore, when atelectasis continues after blunt trauma, it is important to differentially diagnose a lobar bronchial rupture through tests such as bronchoscopy.

Vascular Surgery
Guide Wire Entrapment during Central Venous Catheterization: Kyung Woo Kim, Jun Hyun Kim, Se Hyeok Park, Ji Yeon Kim, Sang Il Lee, Kyung Tae Kim, Jang Su Park, Jung Won Kim, Won Joo Choe; Korean J Crit Care Med. 2014;29(2):137-140. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.137

Abstract PDF: We experienced a case of venous vessel wall entrapment between the introducer needle and the guide wire during an attempt to perform right internal jugular vein (IJV) catheterization. The guide wire was introduced with no resistance but could not be withdrawn. We performed ultrasonography and C-arm fluoroscopy to confirm the entrapment location. We assumed the introducer needle penetrated the posterior vessel wall during the puncture and that only the guide wire entered the vein; an attempt to retract the wire pinched the vein wall between the needle tip and the guide wire. Careful examination with various diagnostic tools to determine the exact cause of entrapment is crucial for reducing catastrophic complications and achieving better outcomes during catheterization procedures.

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