Acute and Critical Care

Eun Jung Kim

2 Articles

Ethics
The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study: Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee; Korean J Crit Care Med. 2014;29(3):160-165. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.160

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BACKGROUND
Many terminally ill patients die while receiving life-sustaining treatment. Recently, the discussion of life-sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients.
METHODS
The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively.
RESULTS
Eighty-nine patients were enrolled. Their mean age was 65.8 +/- 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 +/- 1.0 days after the decision for removal of life-sustaining treatment.
CONCLUSIONS
The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.

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Paraskevi Stamou, Dimitrios Tsartsalis, Georgios Papathanakos, Elena Dragioti, Mary Gouva, Vasilios Koulouras
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Family's Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study
Hyeon Jin Cho, Jiyeon Kang
Journal of Korean Academy of Nursing.2021; 51(1): 15. CrossRef
Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
Acute and Critical Care.2020; 35(3): 179. CrossRef
Factors Associated With Quality of Death in Korean ICUs As Perceived by Medical Staff: A Multicenter Cross-Sectional Survey
Jun Yeun Cho, Ju-Hee Park, Junghyun Kim, Jinwoo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Sang-Min Lee, Jae-Ho Lee, Choon-Taek Lee, Yeon Joo Lee
Critical Care Medicine.2019; 47(9): 1208. CrossRef
Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea
Jun Yeun Cho, Jinwoo Lee, Sang-Min Lee, Ju-Hee Park, Junghyun Kim, Youlim Kim, Sang Hoon Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
Acute and Critical Care.2018; 33(2): 95. CrossRef

Skin Necrosis after High Dose Vasopressor Infusion in Septic Shock: Two Case Reports: Ah Reum Cho, Jeung Il Kim, Eun Jung Kim, Seung Min Son; Korean J Crit Care Med. 2012;27(3):182-186.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.182

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Abstract PDF

Survival sepsis campaign recommends that vasopressor therapy is required to maintain mean arterial pressure (MAP) > or = 65 mmHg. However, the absolute maximum dose of vasopressor is difficult to determine. Herein, we report 2 cases of severe skin necrosis after high dose vasopressor infusion to maintain the recommended MAP in septic shock. In our first case, norepinephrine 1.0-2.0 microg/kg/min and vasopressin 0.03-0.1 U/min were infused for 5 days; in the second case, dopamine 10-20 microg/kg/min and norepinephrine 0.25-2.5 microg/kg/min were infused for 7 days. Severe ischemic skin lesions, which required amputations, developed in both cases. The clinical appearance of the skin lesions in the 2 cases was different because of the unique distribution of target receptors for different vasopressors. Thus, when high dose vasopressors are required to achieve recommended MAP, extra vigilance is required. Further studies for dose adjustment are needed.

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

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