Acute and Critical Care

Sang Bum Hong

20 Articles

Cardiology/Pulmonary
Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation: Jin Jeon, Jin Won Huh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2014;29(3):212-216. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.212

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Acute respiratory distress syndrome (ARDS) is a severe lung disease associated with high mortality despite recent advances in management. Significant advances in extracorporeal membrane oxygenation (ECMO) devices and management allow short-term support for patients with acute reversible respiratory failure and can serve as a bridge to transplantation in patients with irreversible respiratory failure. When ARDS does not respond to conventional treatment, ECMO and the interventional lung assist membrane (iLA) are the most widely used complementary treatment options. Here, we report a clinical case of an adult patient who required prolonged duration venovenous (VV)-ECMO for severe ARDS resulting in improvement while waiting for lung transplantation.

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Treatment of acute respiratory failure: extracorporeal membrane oxygenation
Jin-Young Kim, Sang-Bum Hong
Journal of the Korean Medical Association.2022; 65(3): 157. CrossRef

Extracorporeal Membrane Oxygenation (ECMO) and Iliac Vein Injury: Sang Ook Ha, Jae Seok Park, So Hee Park, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2013;28(3):197-200.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.197

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Abstract PDF: The use of extracorporeal membrane oxygenation (ECMO) has increased after the 2009 pandemic H1N1 infections, and the ECMO-related complications have also increased. Specifically, the mechanical vessel injury due to catheter cannulation seems to be less frequent than other complications, but there is a risk of hemorrhagic shock which requires special attention. We experienced a case of successful management with graft stenting during ECMO operation for iliac vein injury. A 56-year-old female patient with non-small cell lung cancer developed endobronchial obstruction, and ECMO was applied for the ECMO-assisted rigid bronchoscopy. During catheter cannulation, hypovolemic shock was developed due to her right external iliac vein injury. We detected the hemorrhage with bedside ultrasound at an early stage and the hemorrhage was effectively managed with graft stenting on ECMO.

A Case of Pumpless Interventional Lung Assist Application in a Tuberculosis Destroyed Lung Patient with Severe Hypercapnic Respiratory Failure: So Hee Park, Sang Ook Ha, Jae Seok Park, Sang Bum Hong, Tae Sun Shim, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2013;28(3):192-196.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.192

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Abstract PDF: Pumpless extracorporeal interventional lung assist (iLA) is a rescue therapy allowing effective carbon dioxide removals and lung protective ventilator settings. Herein, we report the use of a pumpless extracorporeal iLA in a tuberculosis destroyed lung (TDL) patient with severe hypercapnic respiratory failures. A 35-year-old male patient with TDL was intubated due to CO2 retention and altered mentality. After 11 days, Ventilator Associated Pneumonia (VAP) had developed. Despite the maximal mechanical ventilator support, his severe respiratory acidosis was not corrected. We applied the iLA for the management of refractory hypercapnia with respiratory acidosis. This case suggests that the iLA is an effective rescue therapy for TDL patients with ventilator refractory hypercapnia.

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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Abstract 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

A Case of iLA Application in a Patient with Refractory Asthma Who Is Nonresponsive to Conventional Mechanical Ventilation: A Case Report: Young Seok Lee, Hyejin Joo, Jae Young Moon, Jin Won Huh, Yeon Mok Oh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2012;27(2):108-110.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.108

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Abstract PDF

Refractory asthma with hypercapnia is a near-fatal disease. Pumpless Extracorporeal Interventional Lung Assist (iLA) may be considered as an alternative therapy for the disease as it removes the carbon dioxide effectively. Nevertheless, clinical outcome studies regarding iLA in patients suffering from refractory asthma have rarely been applied. Here, we reported our experience with iLA for the treatment of refractory asthma with hypercapnia. In our case, the patient had refractory asthma which was not controlled with medical treatment or mechanical ventilation. We applied iLA since hypercapnia was not resolved despite mechanical ventilation. After iLA implantation effectively reduced the carbon dioxide, the clinical condition of our patient improved. In conclusion, iLA is a useful tool for patient suffering from refractory asthma with hypercapnia.

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Interventional lung assist and extracorporeal membrane oxygenation in a patient with near-fatal asthma
Seok Jeong Lee, Yong Sung Cha, Chun Sung Byun, Sang-Ha Kim, Myoung Kyu Lee, Suk Joong Yong, Won-Yeon Lee
The American Journal of Emergency Medicine.2017; 35(2): 374.e3. CrossRef
Pumpless extracorporeal interventional lung assist for bronchiolitis obliterans after allogenic peripheral blood stem cell transplantation for acute lymphocytic leukemia
Yeon-Hee Park, Chae-Uk Chung, Jae-Woo Choi, Sang-Ok Jung, Sung-Soo Jung, Jeong-Eun Lee, Ju-Ock Kim, Jae-Young Moon
Yeungnam University Journal of Medicine.2015; 32(2): 98. CrossRef

Clinical Characteristics and Prognosis of Patients with Intracranial Hemorrhage during Mechanical Ventilation: Go Woon Kim, Jin Won Huh, Younsuck Koh, Chae Man Lim, Sang Bum Hong; Korean J Crit Care Med. 2012;27(2):94-101.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.94

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Abstract PDF: BACKGROUND
Intracranial hemorrhage is a serious disease associated with high mortality and morbidity, and develops suddenly without warning. Although there were known risk factors, it is difficult to prevent brain hemorrhage from critically ill patients in the intensive care unit (ICU). There are several reports that brain hemorrhage, in critically ill patients, occurred in connection with respiratory diseases. The aim of our study is to describe the baseline characteristics and prognosis of patients with intracranial hemorrhage during mechanical ventilation in the ICU.
METHODS
We retrospectively reviewed the medical records of 56 patients, who developed intracranial hemorrhage in a medical ICU, from May 2008 to December 2011. During the mechanical ventilation in the ICU, patients were implemented with a weaning process, following ACCP (American College of Chest Physicians) criteria. Also, we compared patients with brain hemorrhage to those without brain hemorrhage.
RESULTS
Thirty two of the 56 patients (57.1%) were male, and median ages were 63 (17-90) years. The common type of brain hemorrhage confirmed was intracerebral hemorrhage/intraventricular hemorrhage (52.2%). The duration from mechanical ventilation to brain hemorrhage was 6 (0-58) days. Overall hospital mortality was 57.1%, and ICU mortality was 44.6%. The most common cause of death was brain hemorrhage (40.6%). In comparison to patients without brain hemorrhage, study patients showed less use of anticoagulants and lower ventilator pressure. Our study showed that the use of vasopressor, systolic blood pressure, peak airway pressure, and platelet count were associated with brain hemorrhage.
CONCLUSIONS
Intracranial hemorrhage showed high mortality in critically ill patients with mechanical ventilation. In the future, large case-control study will be needed to evaluate the risk factors of cerebral hemorrhage.

Structure of Intensive Care Unit and Clinical Outcomes in Critically Ill Patients with Influenza A/H1N1 2009: Jaehwa Cho, Hun Jae Lee, Sang Bum Hong, Gee Young Suh, Moo Suk Park, Seok Chan Kim, Sang Hyun Kwak, Myung Goo Lee, Jae Min Lim, Huyn Kyung Lee, Younsuck Koh; Korean J Crit Care Med. 2012;27(2):65-69.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.65

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Abstract PDF

BACKGROUND
During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients.
METHODS
This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors.
RESULTS
Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026).
CONCLUSIONS
In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.

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A population-based observational study of patients with pulmonary disorders in intensive care unit
Hyun Woo Lee, Eunjeong Ji, Soyeon Ahn, Hye-Joo Yang, Seo-Young Yoon, Tae Yeon Park, Yeon Joo Lee, Jinwoo Lee, Sang-Min Lee, Seung-Hye Choi, Young-Jae Cho
The Korean Journal of Internal Medicine.2020; 35(6): 1411. CrossRef
Novel respiratory infectious diseases in Korea
Hyun Jung Kim
Yeungnam University Journal of Medicine.2020; 37(4): 286. CrossRef
Impact of the mother–nurse partnership programme on mother and infant outcomes in paediatric cardiac intensive care unit
Ju-Yeon Uhm, Hee Soon Kim
Intensive and Critical Care Nursing.2019; 50: 79. CrossRef
Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey
Jun Wan Lee, Jae Young Moon, Seok Wha Youn, Yong Sup Shin, Sang Il Park, Dong Chan Kim, Younsuk Koh
Korean Journal of Critical Care Medicine.2016; 31(2): 111. CrossRef
Critical Care In Korea: Present and Future
Chae-Man Lim, Sang-Hyun Kwak, Gee Young Suh, Younsuck Koh
Journal of Korean Medical Science.2015; 30(11): 1540. CrossRef
Intensivist Physician Staffing in Intensive Care Units
Sunghoon Park, Gee Young Suh
Korean Journal of Critical Care Medicine.2013; 28(1): 1. CrossRef

Initiation of Continuous Renal Replacement Therapy and Clinical Outcome in Septic Shock Patients with Acute Kidney Injury: Seung Mok Ryoo, Won Young Kim, Sang Sik Choi, Jin Won Huh, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2012;27(1):29-35.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.29

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Abstract PDF: BACKGROUND
Initiation of renal replacement therapy (RRT) in critically ill septic shock patients with acute kidney injury is highly subjective and may influence outcome. The aim of this study is to evaluate the relationship between initiation of RRT and 28 day mortality in patients with severe sepsis and septic shock (SSSS).
METHODS
All patients diagnosed with SSSS and treated at the medical intensive care unit (ICU) in university-affiliated hospital from January 2005 to December 2006 were reviewed. Initiation of RRT was stratified into "early" and "late" by RIFLE (Risk, Injury, Failure, Loss, and End-stage) criteria and blood urea nitrogen (BUN) at the time RRT began. The primary outcome was death after 28 days from any cause.
RESULTS
Of the 326 patients diagnosed with SSSS and admitted into the medical ICU during the study period, 78 patients received RRT. Mean age was 61.5 +/- 14.7 years old and 54 patients were male (69.2%). The initiation of RRT was categorized into early (Risk, and Injury) and late (Failure) by RIFLE criteria and also categorized into early (BUN < 75 mg/dl) and late (BUN > or = 75 mg/dl). When the relationship between RIFLE criteria and 28 day mortality was compared, no significant difference was shown (70.8% vs. 73.3%, p = 0.81). The initiation of RRT by BUN also showed no significant difference in 28 day mortality (77.3% vs. 69.6%, p = 0.50).
CONCLUSIONS
Initiation of RRT, stratified into "early" and "late" by RIFLE and BUN, showed no significant difference in 28 day mortality regarding patient with SSSS.

Extracorporeal Membrane Oxygenation as a Bridge to Definitive Airway Security in 3 Severe Acute Extrinsic Airway Compression Patients: A Case Report: Jiwon Lyu, Jin Won Huh, Chae Man Lim, Youn Suck Koh, Sang Bum Hong; Korean J Crit Care Med. 2011;26(1):29-33.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.29

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Abstract PDF: Extracorporeal membrane oxygenation (ECMO) has been used for cardiac and respiratory failure for over 30 years. Recently, however, ECMO has emerged as a useful means of short-term support in the management of hypoxic patients for nontraditional indications. Here, we report the use of veno-venous ECMO as a bridge to support a patient with severe airway obstruction because of tumor compression. Case 1: A patient with extrinsic airway compression secondary to a large metastatic cancer on neck was successfully managed using ECMO. Case 2: The successful use of ECMO to support a patient with extrinsic airway compression secondary to a recurred thyroid cancer. Case 3: A pregnant woman with airway obstruction secondary to metastatic lymphadenopathy of lung cancer who underwent successful tracheal stent insertion. The 3 patients were successfully weaned off ECMO without any complication. Although these conditions are uncommon indications, ECMO is a potential option for such life-threatening conditions.

Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock: Jin Kyeong Park, Sang Bum Hong, Chae Man Lim, Younsuck Koh, Jin Won Huh; Korean J Crit Care Med. 2011;26(1):13-17.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.13

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Abstract PDF: BACKGROUND
A dramatic decrease in circulating lymphocyte number is observed after septic shock. In this study, we assessed whether circulating lymphocyte subpopulations influence the severity and prognosis of septic shock.
METHODS
133 patients (median 65 years, range 27-88; male 63.2%) receiving intensive care for septic shock were enrolled in this study. Flow cytometry phenotyping of circulating lymphocyte subpopulations, including helper T cells, suppressor T cells, total B cells, and natural killer (NK) cells, was performed within 24 hours after the diagnosis of septic shock. After measuring the white blood cell (WBC) and differential leukocyte count, the lymphocyte subsets were analyzed. The following data were recorded: general characteristics, severity of illness as assessed by the Sequential Organ Failure Assessment (SOFA) score, and 28-day mortality.
RESULTS
The overall mortality rate at 28 days was 33.8%. SOFA score was negatively correlated with the T cell count (r = -0.175) and helper T cell count (r = -0.223). However, only low a helper T cell count was associated with the severity of septic shock (odds ratio 0.995, 95% confidence interval 0.992-0.999, p = 0.014). Using multiple logistic regression analysis for 28-day mortality, there was no significant prognostic factor among the lymphocyte subset.
CONCLUSIONS
The low helper T cell count appeared to be associated with severity, but did not show significant association with mortality.

Physiologic Effect and Safety of Pumpless Extracorporeal Interventional Lung Assist in Korean Patients with Acute Respiratory Failure: Woo Hyun Cho, Kwangha Lee, Jin Won Huh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2010;25(4):235-240.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.235

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Abstract PDF

BACKGROUND
Pumpless interventional lung assist (iLA) uses an extracorporeal gas exchange system without any complex blood pumping technology, and has been shown to reduce CO2 tension and permit protective lung ventilation. The feasibility and safety of iLA were demonstrated in previous studies, but there has been no experience with iLA in Korea. The purpose of this study was to evaluate the feasibility of the iLA device in terms of physiologic efficacy and safety in Korean patients with acute respiratory failure.
METHODS
iLA was implemented in patients with acute respiratory failure who satisfied the predefined criteria of our study. Initiation of iLA followed an algorithm for implementation, ventilator care, and monitoring. Following insertion of arterial and venous cannulas under ultrasound guidance, the physiologic and respiratory variables and incidence of adverse events were monitored.
RESULTS
iLA was implemented in 5 patients and the duration of iLA ranged from 7 hours to 171 hours. At 24 hours after implementation, the mean changes in pH, PaCO2, and PaO2/FiO2 ranged from 7.204 to 7.393, from 68.4 mm Hg to 33 mm Hg, and from 128.7 mm Hg to 165 mm Hg, respectively. During iLA therapy, one adverse event was observed, which presented with hematochezia without hemodynamic change.
CONCLUSIONS
iLA treatment produced effective removal of carbon dioxide and allowed for protective ventilation in severe respiratory failure. An iLA system can easily be installed by percutaneous cannulation, without procedural complications, and without significant adverse events necessitating discontinuation of iLA after implementation.

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A Case of Pumpless Extracorporeal Interventional Lung Assist for Severe Respiratory Failure - A Case Report -
Young-Jae Cho, Ji Yeon Seo, Yu Jung Kim, Jae-Ho Lee, Choon-Taek Lee
Korean Journal of Critical Care Medicine.2012; 27(2): 120. CrossRef
A Case of iLA Application in a Patient with Refractory Asthma Who Is Nonresponsive to Conventional Mechanical Ventilation - A Case Report -
Young Seok Lee, Hyejin Joo, Jae Young Moon, Jin Won Huh, Yeon-Mok Oh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Korean Journal of Critical Care Medicine.2012; 27(2): 108. CrossRef

Epidemiological Characteristics Based on the Underlying Diseases for the Deaths Related to Pandemic H1N1 Influenza in Korea: Hagyung Lee, Yung A Kang, Hyun Su Kim, Su Yeun Shin, Jun Heung Kim, Jin Seok Kim, Sang Bum Hong; Korean J Crit Care Med. 2010;25(2):83-88.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.83

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Abstract PDF

BACKGROUND
Since May 2009, a pandemic influenza A (H1N1) virus has emerged and spread nationwide. We describe the epidemiological characteristics of the confirmed deaths related with the 2009 H1N1 influenza pandemic in Korea from May 2009 to mid December 2009.
METHODS
This study was based on an analysis of the reports from the deaths of confirmed cases pandemic H1N1 virus until 7 December 2009 in Korea. These reports were compiled by the epidemic intelligence team at the Korea Centers for Disease Control & Prevention (KCDC) or at the provinces. The epidemic intelligence team used an identical, well-defined investigate form for reviewing the medical records and for interviewing the physicians in charge of the cases.
RESULTS
The first confirmed death occurred on August 15, 2009. Until December 7, 2009, 139 deaths had been reported. Eighty cases (57.6%) were individuals more than 60 years old. Sixty two cases (47.0%) were dead within 7 days from the onset of symptoms. One hundred three cases (74%) had underlying diseases, and cancer was the most common underlying disease. The proportion of patients using antivial medications before confirmation among the patients with underlying diseases was greater than the proportion of patients using antivial medications among the patients with no underlying diseases.
CONCLUSIONS
During the evaluation period, serious underlying diseases were present in nearly three quarters of the cases of confirmed death. We suggest that health providers consider using antiviral drugs before confirmation of pandemic H1N1 in hospitalized patients, and especially in those with underlying diseases.

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Clinical Features of Hospitalized Patients with Community Acquired Pneumonia during 2009 Influenza A (H1N1) Pandemic
Myung Jae Yun, Seong Tae Lee, Hye Jin Oh, Seung June Lee, Sook Hee Song, In Sohn, Jae Phil Choi, Su Hyun Kim
The Korean Journal of Critical Care Medicine.2011; 26(3): 162. CrossRef
Pandemic Influenza (H1N1 2009) among Pregnant Korean Women
Baek-Nam Kim, Yee Gyung Kwak, Chi-Sook Moon, Yeon-Sook Kim, Eu Suk Kim, Kkot Sil Lee, Chang-Seop Lee, Ji-An Hur
Infection & Chemotherapy.2011; 43(1): 55. CrossRef
A Fatal Case in Pregnant Woman Infected by H1N1 2009 in Korea
Ji An Hur
Infection and Chemotherapy.2011; 43(2): 225. CrossRef

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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Abstract 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.

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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

Multicenter Prospective Observational Study about the Usage Patterns of Sedatives, Analgesics and Neuromuscular Blocking Agents in the Patients Requiring More Than 72 Hours Mechanical Ventilation in Intensive Care Units of Korea: Hang Jea Jang, Seung Won Ra, Bum Jin Oh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2009;24(3):145-151.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.145

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Abstract PDF

BACKGROUND
To investigate the usage patterns of sedatives, analgesics and neuromuscular blocking agents (NMBAs) in patients requiring mechanical ventilation more than 72 hours in intensive care units (ICUs) of Korea.
METHODS
A total of 536 patients continuing mechanical ventilation more than 72 hours had been enrolled among the twenty-one ICUs of Korea from May 2003 to July 2003. Data about mechanical ventilation, the use of sedatives, analgesics, and NMBAs were prospectively collected for four weeks. We analyzed the patterns of using these drugs and effects on outcomes.
RESULTS
More than half of the patients (50.4%) received sedative drug alone. Most commonly used sedatives and analgesics were midazolam and morphine. NMBAs were administered in 41% of the patients. Volume controlled ventilation mode was associated with more frequent use of NMBAs. There were no significant differences in outcome variables among the usage patterns of sedatives, analgesics and NMBAs.
CONCLUSIONS
Our investigation shows that analgesics were much less frequently used in the intensive care units of Korea compared with the use of sedatives. And the use of NMBAs were quite a common.

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Change in management and outcome of mechanical ventilation in Korea: a prospective observational study
Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong
The Korean Journal of Internal Medicine.2022; 37(3): 618. CrossRef
Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission
Hye Ran Kwak, Jiyeon Kang
Korean Journal of Adult Nursing.2015; 27(3): 347. CrossRef
Clinical Demographics and Outcomes in Mechanically Ventilated Patients in Korean Intensive Care Units
Byeong-Ho Jeong, Gee Young Suh, Jin Young An, Moo Suk Park, Jin Hwa Lee, Myung-Goo Lee, Je Hyeong Kim, Yun Seong Kim, Hye Sook Choi, Kyung Chan Kim, Won-Yeon Lee, Younsuck Koh
Journal of Korean Medical Science.2014; 29(6): 864. CrossRef

A Comparison of Adaptive Support Ventilation (ASV) and Conventional Volume-Controlled Ventilation on Respiratory Mechanics in Acute Lung Injury/ARDS: Ik Su Choi, Jung Eun Choi, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2009;24(2):59-63.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.59

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Abstract PDF

BACKGROUND
ASV is a closed-loop ventilation system that guarantees a user-set minimum per-minute volume in intubated patients, whether paralyzed or with spontaneous breathing. Here, we tested the effects of ASV onrespiratory mechanics and compared them with volume-controlled ventilation (VCV).
METHODS
Thirteen patients meeting the criteria for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) were enrolled. All patients were paralyzed to eliminate spontaneous breathing. We started with VCV (VCV1), then used ASV followed by VCV modes (VCV2), maintaining minute volume as much as that of VCV1.
RESULTS
During ASV, compared with VCV1, the inspiratory and expiratory tidal volumes and expiratory resistance increased. Conversely, the total respiratory rate and maximum pressure decreased. No changes in the arterial blood gases, heart rate, or mean systemic pressure were noted during the trial.
CONCLUSIONS
In ALI/ARDS patients, although no differences were observed in the arterial blood gas analysis between the two modes, ASV provided better respiratory mechanics in terms of peak airway pressure and tidal volume than VCV.

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Comparison of adaptive support ventilation and synchronized intermittent mandatory ventilation in patients with acute respiratory distress syndrome: A randomized clinical trial
Babak Alikiaii, Saeed Abbasi, Hamideh Yari, Mojtaba Akbari, Parviz Kashefi
Journal of Research in Medical Sciences.2022; 27(1): 6. CrossRef
Comparing the Effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation (SIMV) on Respiratory Parameters in Neurosurgical ICU Patients
Mohammadreza Ghodrati, Alireza Pournajafian, Ali Khatibi, Mohammad Niakan, Mohammad Hosein Hemadi, Mohammad Mahdi Zamani
Anesthesiology and Pain Medicine.2016;[Epub] CrossRef
Adaptive support ventilation for complete ventilatory support in acute respiratory distress syndrome: A pilot, randomized controlled trial
Ritesh Agarwal, Arjun Srinivasan, Ashutosh N. Aggarwal, Dheeraj Gupta
Respirology.2013; 18(7): 1108. CrossRef
Advanced Ventilator Modes and Techniques
Carl F. Haas, Kimberly A. Bauser
Critical Care Nursing Quarterly.2012; 35(1): 27. CrossRef
Evaluation of Respiratory Parameters in Patients with Acute Lung Injury Receiving Adaptive Support Ventilation
Keu Sung Lee, Wou Young Chung, Yun Jung Jung, Joo Hun Park, Seung Soo Sheen, Sung Chul Hwang, Kwang Joo Park
Tuberculosis and Respiratory Diseases.2011; 70(1): 36. CrossRef

The Characteristics and Prognostic Factors of Severe Sepsis in Patients Who Were Admitted to a Medical Intensive Care Unit of a Tertiary Hospital: Suk Kyung Hong, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2009;24(1):28-32.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.28

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Abstract PDF

BACKGROUND
Severe sepsis is a major cause of morbidity and mortality in intensive care units. This study aimed to evaluate the prevalence, characteristics, outcomes and prognostic factors of severe sepsis in a medical intensive care unit (MICU) of a tertiary care hospital in Korea.
METHODS
We retrospectively reviewed the medical chart of 249 patients who were admitted to a medical intensive care unit with severe sepsis.
RESULTS
From January 2000 to December 2001, 3410 patients were admitted to the ICU. The prevalence of severe sepsis was 7.3%. The mortality of severe sepsis was 64.6%. The prognostic factors for severe sepsis were the number of organ systems that acutely failed (p = 0.036) and an admission route from general wards (p = 0.018). There was no difference in the outcome of severe sepsis according to infectious organisms (p = 0.24) and the site of infections (p = 0.38).
CONCLUSIONS
Severe sepsis in the MICU is a common, expensive and often fatal condition. We expect that early rescucitation and recovery from acute organ system failure will improve the outcome of severe sepsis.

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Kang-Gyun Park, Young-Bin Yu, Keundol Yook, Sang-Ha Kim, Sunghyun Kim, Young Kwon Kim
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Kang-Gyun Park, Sang-Ha Kim, Jong-Tae Choi, Sunghyun Kim, Young-Kwon Kim, Young-Bin Yu
The Korean Journal of Clinical Laboratory Science.2017; 49(4): 407. 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
Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea
S. J. Lim, J. Y. Choi, S. J. Lee, Y. J. Cho, Y. Y. Jeong, H. C. Kim, J. D. Lee, Y. S. Hwang
Infection.2014; 42(5): 875. CrossRef
Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards
Ju Ry Lee, Hye Ran Choi
Journal of Korean Academy of Nursing.2014; 44(2): 219. CrossRef
Utility of Serum Procalcitonin for Diagnosis of Sepsis and Evaluation of Severity
Taejin Park, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
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The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock
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The Korean Journal of Critical Care Medicine.2009; 24(3): 134. CrossRef

Do-not-resuscitate Order in Patients, Who Were Deceased in a Medical Intensive Care Unit of an University Hospital in Korea: Kwangha Lee, Hang Jea Jang, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2008;23(2):84-89.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.84

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Abstract PDF

BACKGROUND
Do-not-resuscitate (DNR) in the event of a cardiac arrest is the most common and important discussion between a patient's family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the changes in therapeutic levels after DNR orders, and the cases of violated DNR codes in patients who had died in a Korean medical intensive care unit (ICU) between 1 January 2006 and 30 June 2006.
METHODS
The charts of patients who had died in the medical ICU were retrospectively reviewed.
RESULTS
One hundred two patients were enrolled. The ICU and hospital lengths of stay of the patients were 12.4 +/- 14.0 and 23.2 +/- 21.1 days, respectively. Hematologic malignancy (24.5%) accounted for the most common premorbid diagnosis before ICU admission. Seventy-five patients (73.5%) had DNR orders. The DNR order was suggested by the physician in 96% of the patients. There was no significant difference in the clinical parameters and the performance of a DNR order. Eighty-four percent of the patients with a DNR order had received the order within 3 days death. The withholding of additional therapy or withdrawing of current therapy occurred in 57.3% of the patients. The DNR order was violated in 9 cases (12%).
CONCLUSIONS
DNR orders are well-accepted by the patient's family in the ICU. However, DNR orders are initiated when patient death is imminent.

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End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience
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Na Young Kang, Jeong Yun Park
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Current status of end-of-life care in Korean hospitals
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Relationship between the Changes of Arterial Blood Gas by Positioning from Prone to Supine and Patients' Survival in ARDS: Mi Young Kim, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2007;22(2):71-76.

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Abstract PDF: BACKGROUND
Prone positioning has been adopted as a strategy to improve oxygenation in patients with refractory acute respiratory distress syndrome (ARDS). After returning to supine position, most of patients show arterial blood gas changes. However, the clinical implications have not been elucidated. This study was aimed to observe the relationship between the arterial blood gas changes followed by changing position from prone to supine and survival of ARDS.
METHODS
We analyzed medical data of 53 ARDS patients, who showed improved arterial oxygenation (defined as the increase in PaO2/FiO2 by > or =20 mmHg within 8~12 hour after prone positioning) in a medical intensive care unit from January, 2000 to July, 2006. The patients were returned to supine position when they showed their PaO2/FiO2 > or =150 mmHg. We compared the arterial blood gas changes between the survivor and the nonsurvivor.
RESULTS
The survivor has significant pH improvement after position change (the survivor 0.01+/-0.06 vs. the nonsurvivor -0.03+/-0.08; p=.03). The PaO2/FiO2 and FiO2 changes were not different between the survivor (14.44 +/-69.68 and -2.2+/-4.3, respectively) and the nonsurvivor (-7.17+/-83.94 and 1.8+/-6.0, respectively; p=.314 and .843). The patients whose PaO2/FiO2 were deteriorated had higher mortality without statistical significance (p=.305). The PaCO2 changes were not different between two groups (-0.05+/-11.46 vs. 3.47+/-17.62, p=.390).
CONCLUSIONS
The early changes in pH differed significantly between the survivor and the nonsurvivor after returning patients to supine position from prone. Whether this marker can be a predictor of survival should be studied further.

The Application of Functional Genomics to Acute Lung Injury: Sang Bum Hong; Korean J Crit Care Med. 2007;22(2):65-70.

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Abstract PDF: No abstract available.

Alteration of Lung Mechanics Depending on Expiratory Sensitivity (ESENS) during Pressure Support Ventilation: Kwang Won Seo, Gyu Rak Chon, Jong Joon Ahn, Yangjin Jega, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2006;21(1):8-16.

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Abstract PDF: BACKGROUND
To evaluate effects of 5 expiratory sensitivity (ESENS) levels (5%; 15%; 25%; 35%; 45%) on lung mechanics and the effects depending on the two P(0.1) levels (<3 cm H2O; > or =3 cm H2O).
METHODS
Prospective, randomized, physiologic study for intubated adult patients during weaning from mechanical ventilation. Patients were randomly submitted to the 5 settings of ESENS in the Galileo ventilator (Galileo Gold, Hamilton Medical AG, Switzerland). Physiologic variables were continuously measured using a Bicore CP-100 pulmonary mechanics monitor (CP-100, Bicore, USA).
RESULTS
Thirteen patients, ten men and three women, with a mean age of 65.2+/-16.1 yr were studied. Tidal volume (V(T)) decreased significantly from ESENS 5% to 45%. With increasing levels of ESENS, respiratory rates (RR) steadily increased from ESENS 5% to 35% and 45%. Shallow breath index (F/V(T)) increased significantly from ESENS 5% to 45%. Inspiratory time (T(I)) decreased gradually significantly from ESENS 5% to 45%. RR and F/V(T) increased from ESENS 5% to 15% and 45% and V(T) decreased gradually in patients with P(0.1)<3 cm H2O group, but not in patients with P(0.1)> or =3 cm H2O.
CONCLUSIONS
The proper adjustment of expiratory sensitivity (ESENS) levels improved patient-ventilator synchrony and decreased respiratory rates and shallow breath index, especially in P(0.1)<3 cm H2O during PSV in ventilator weaning patients. Lower ESENS level would be more appropriate in terms of lung mechanics in patients with less than 3 cm H2O of P(0.1).

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