Acute and Critical Care

Kwangha Lee

6 Articles

Pulmonary
Erratum: Patients with Acute Respiratory Distress Syndrome Caused by Scrub Typhus: Clinical Experiences of Eight Patients: Sun Young Kim, Hang Jea Jang, Hyunkuk Kim, Kyunghwa Shin, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee; Korean J Crit Care Med. 2014;29(4):348-348. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.348; Corrects: Acute Crit Care 2014;29(3):189

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Abstract PDF: The title of page 189 should be corrected.

Pulmonary
Patients with Acute Respiratory Distress Syndrome Caused by Scrub Typhus: Clinical Experiences of Eight Patients: Sun Young Kim, Hang Jea Jang, Hyunkuk Kim, Kyunghwa Shin, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee; Korean J Crit Care Med. 2014;29(3):189-193. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.189; Correction in: Acute Crit Care 2014;29(4):348

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BACKGROUND
The aim of this study is to describe the clinical course and outcome of patients who were diagnosed with acute respiratory distress syndrome (ARDS) caused by scrub typhus and who received ventilator care in the intensive care units (ICU) of two university hospitals.
METHODS
We performed a retrospective analysis of all adult ventilated patients who were diagnosed with ARDS caused by scrub typhus.
RESULTS
Eleven (1.7%) of 632 scrub typhus patients were diagnosed with ARDS (median age 72; seven were male). Eight patients had underlying diseases, the most common of which was hypertension (four patients). Eight patients (72.7%) were admitted in November. The most common chief complaints of the patients were fever and rash (63.6%). All patients had skin eschar and rash; seven were treated for shock. On the day of diagnosis with ARDS, the median Acute Physiology and Chronic Health Evaluation score was 20 (range 11-28) and Sequential Organ Failure Assessment score was 7 (range 4-14). All patients had PaO2/FiO2 < 200 mmHg, high serum aspartate aminotransferase level (> 40 IU/L), and hypoalbuminemia (< 3.3 g/dl). Nine patients were treated with doxycycline on the day of admission. Their median lengths of stay in the ICU and hospital were 10 (range 4-65) and 14 (4-136) days, respectively. The mortality rate during treatment in the hospital was 36.4%.
CONCLUSIONS
In our study, the risk of ARDS among patients diagnosed with scrub typhus was at least 1.7%, with a hospital mortality rate of 36.4%.

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Rapid Recovery of Acute Respiratory Distress Syndrome in Scrub Typhus, With Pulse Methylprednisolone and Therapeutic Plasma Exchange
Thilina Rathnasekara, Lanka Wijekoon, Hemal Senanayake, Sisira Siribaddana
Cureus.2022;[Epub] CrossRef

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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Abstract PDF

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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Agreement between Family Members and the Physician’s View in the ICU Environment: Personal Experience as a Factor Influencing Attitudes towards Corresponding Hypothetical Situations
Paraskevi Stamou, Dimitrios Tsartsalis, Georgios Papathanakos, Elena Dragioti, Mary Gouva, Vasilios Koulouras
Healthcare.2023; 11(3): 345. CrossRef
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

Clinical Characteristics in Patients with Carbapenem-Resistant Acinetobacter baumannii Isolates from Tracheal Secretions: Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee; Korean J Crit Care Med. 2013;28(3):173-179.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.173

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Abstract PDF: BACKGROUND
This study was conducted to evaluate the clinical characteristics and outcomes of mechanically ventilated patients with carbapenem-resistant Acinetobacter baumannii (CRAB) isolates from tracheal secretions in a medical intensive care unit (ICU) of a university hospital.
METHODS
We conducted a retrospective study from January 2009 to June 2012.
RESULTS
Among the patients who had isolates cultured from tracheal secretions, 130 patients (34.8%) had CRAB isolates. Their mean age was 65 +/- 14 yr and 74.6% were male. The ICU and hospital mortality was 51.5% and 60.0%, respectively. According to physician's clinical decision, antibiotics were changed in order to cover CRAB in 75 (57.7%) patients. The total duration of antibiotics use was 12.2 +/- 8.1 days. Of patients with antibiotics change to cover CRAB, 70 patients (93.3%) had Clinical Pulmonary Infection Score of 6 and over. However, there was no significant difference in hospital mortality between patients with antibiotics change against CRAB and those without change. In multivariable analysis, only Acute Physiology and Chronic Health Evaluation II score was related to hospital mortality of patients with CRAB.
CONCLUSIONS
In this study, changing antibiotics to cover CRAB by physician's clinical decision only did not influence hospital mortality; further studies would be necessary to investigate how to use antibiotics against CRAB isolates cultured from tracheal secretions.

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

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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Act on Decisions on Life-Sustaining Treatment and Timing of Referral to Hospice
Han-na Ju, Seung Hun Lee, Yun-Jin Kim, Sang-Yeoup Lee, Jeong-Gyu Lee, Yu-Hyeon Yi, Young-Hye Cho, Young-Jin Tak, Hye-Rim Hwang, Eun-Ju Park, Young-In Lee
Korean Journal of Family Practice.2021; 11(5): 331. CrossRef
Reversals in Decisions about Life-Sustaining Treatment and Associated Factors among Older Patients with Terminal Stage of Cardiopulmonary Disease
Jung-Ja Choi, Su Hyun Kim, Shin-Woo Kim
Journal of Korean Academy of Nursing.2019; 49(3): 329. CrossRef
End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience
Sang Eun Yoon, Eun Mi Nam, Soon Nam Lee
The Korean Journal of Hospice and Palliative Care.2018; 21(2): 51. CrossRef
Intensive Care Nurses’ Experiences of Death of Patients with DNR Orders
Ji Yun Lee, Yong Mi Lee, Jae In Jang
The Korean Journal of Hospice and Palliative Care.2017; 20(2): 122. CrossRef
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 Journal of Critical Care Medicine.2016; 31(1): 25. CrossRef
Clinical Characteristics of Oncologic Patients with DNR Decision at a Tertiary Hospital
Na Young Kang, Jeong Yun Park
The Korean Journal of Hospice and Palliative Care.2016; 19(1): 26. CrossRef
Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
The Korean Journal of Critical Care Medicine.2015; 30(2): 73. CrossRef
Do-not-resuscitation in Terminal Cancer Patient
Jung Hye Kwon
The Korean Journal of Hospice and Palliative Care.2015; 18(3): 179. CrossRef
Research Trend Analysis of Do-Not-Resuscitate Decision: Based on Text Network Analysis
Miji Kim, Sangmi Noh, Eunjung Ryu, Sangmoon Shin
Asian Oncology Nursing.2014; 14(4): 254. CrossRef
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 Journal of Critical Care Medicine.2014; 29(3): 160. CrossRef
The End-of-Life Care in the Intensive Care Unit
Jae Young Moon, Yong Sup Shin
Korean Journal of Critical Care Medicine.2013; 28(3): 163. CrossRef
Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
Jae Young Moon, Hee Young Lee, Chae-Man Lim, Younsuck Koh
Korean Journal of Critical Care Medicine.2012; 27(1): 16. CrossRef
Current status of end-of-life care in Korean hospitals
Younsuck Koh
Journal of the Korean Medical Association.2012; 55(12): 1171. CrossRef
Changes in how ICU nurses perceive the DNR decision and their nursing activity after implementing it
Young-Rye Park, Jin-A Kim, Kisook Kim
Nursing Ethics.2011; 18(6): 802. CrossRef
The Preference for Care Near the End of Life of Korean Nurses
Hyun Sook Kim, Shinmi Kim, Su Jeong Yu, Moungok Kim
The Korean Journal of Hospice and Palliative Care.2010; 13(1): 41. CrossRef
Physician's Role and Obligation in the Withdrawal of Life-sustaining Management
Younsuck Koh
Journal of the Korean Medical Association.2009; 52(9): 871. CrossRef

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