Acute and Critical Care

Original Articles

Nursing
Intensive care unit professionals during the COVID-19 pandemic in Spain: social and work-related variables, COVID-19 symptoms, worries, and generalized anxiety levels: Fernando J. García-Hedrera, Fernanda Gil-Almagro, F. Javier Carmona-Monge, Cecilia Peñacoba-Puente, Patricia Catalá-Mesón, Lilian Velasco-Furlong; Acute Crit Care. 2021;36(3):232-241. Published online August 31, 2021; DOI: https://doi.org/10.4266/acc.2021.00213

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Background
The severe acute respiratory syndrome coronavirus 2 outbreak has been identified as a pandemic and global health emergency. It presents as a severe acute respiratory disease. The rapid dissemination of the disease created challenges for healthcare systems and forced healthcare workers (HCWs) to deal with many clinical and nonclinical stresses. The aim of our research is to describe work conditions, symptoms experienced by HCWs, worries about contagion, and generalized anxiety symptoms and compare those findings across regions in Spain. Methods: This cross-sectional study was conducted using an online survey. Critical care units throughout Spain were included. The sample comprised HCWs working in intensive care units from March to May 2020. We assessed work variables, physical symptoms, worries about contagion, and anxiety (generalized anxiety disorder-7 questionnaire). Results: The final sample comprised 448 surveys. Among the respondents, 86.9% (n=389) were nursing professionals, and 84.8% (n=380) were women. All participants cared for coronavirus disease 2019 (COVID-19) patients during the study period. Workload during the pandemic in Madrid was judged to be higher than in other regions (P<0.01). The availability of personal protective equipment was found to be higher in Cataluña. The most frequently experienced symptom was headaches (78.1%). Worries about self-infection and the possibility of infecting others received mean scores of 3.11 and 3.75, respectively. Mean scores for generalized anxiety levels were 11.02, with 58.7% of the professionals presenting with generalized anxiety syndrome during the assessment. Conclusions: In this study, we found high levels of anxiety among HCWs caring directly for COVID-19 patients, which could produce long-term psychological alterations that still need to be assessed.

Citations

Citations to this article as recorded by

Psychological impact of the COVID-19 pandemic on Spanish healthcare workers: a systematic review of prevalence and wave-based patterns
Irene Jaén, Carolina Ausín, Diana Castilla
Current Psychology.2024; 43(25): 22089. CrossRef
The effects of fear of COVID-19 among Spanish healthcare professionals in three years after the pandemic onset via validation of the FCV-19S: a prospective study
Cecilia Peñacoba-Puente, Octavio Luque-Reca, Mark D. Griffiths, Fernando J. García-Hedrera, F. Javier Carmona-Monge, Fernanda Gil-Almagro
Current Psychology.2024;[Epub] CrossRef
From Anxiety to Hardiness: The Role of Self-Efficacy in Spanish CCU Nurses in the COVID-19 Pandemic
Fernanda Gil-Almagro, Fernando José García-Hedrera, Francisco Javier Carmona-Monge, Cecilia Peñacoba-Puente
Medicina.2024; 60(2): 215. CrossRef
Post-Pandemic Insomnia in Healthcare Workers: A Prospective Study including Sociodemographic, Occupational and Psychosocial Variables
Fernanda Gil-Almagro, Francisco Javier Carmona-Monge, Fernando José García-Hedrera, Cecilia Peñacoba-Puente
Journal of Clinical Medicine.2024; 13(12): 3498. CrossRef
Headache and Associated Psychological Variables in Intensive Care Unit Nurses during the COVID-19 Pandemic: A Prospective Study
Fernanda Gil-Almagro, Francisco Javier Carmona-Monge, Fernando José García-Hedrera, Cecilia Peñacoba-Puente
Journal of Clinical Medicine.2024; 13(13): 3767. CrossRef
Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID‐19: A scoping review
Chia‐Hung Lin, Shu‐Fen Siao, You‐Jie Lin, Pin‐Hsien Hsin, Mack Shelley, Yen‐Han Lee
Journal of Nursing Scholarship.2023; 55(1): 79. CrossRef
The impact of pandemics on healthcare providers' workloads: A scoping review
Gemma Doleman, Annemarie De Leo, Dianne Bloxsome
Journal of Advanced Nursing.2023; 79(12): 4434. CrossRef
Critical care medicine training in the age of COVID-19
Walter Mickey
Journal of Osteopathic Medicine.2023; 123(9): 427. CrossRef
The impact of the COVID-19 pandemic on intensive care unit workers: a nationwide survey
Sangeeta Mehta, Christopher Yarnell, Sumesh Shah, Peter Dodek, Jeanna Parsons-Leigh, Robert Maunder, Jessica Kayitesi, Catherine Eta-Ndu, Fran Priestap, Danielle LeBlanc, Jennifer Chen, Kimia Honarmand
Canadian Journal of Anesthesia/Journal canadien d'anesthésie.2022; 69(4): 472. CrossRef

Pulmonary
The Effect of Positive End-Expiratory Pressure on Air Leakage: Comparison of Cuff Designs: Junyong In, Gyung Serk Shim, Seunghyun Chung; Korean J Crit Care Med. 2014;29(1):3-6. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.3

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Abstract PDF

Background
Recently developed taper-shaped cuffs (TG cuffs) of endotracheal tubes (ETTs) are known to have a more potent sealing effect than cylindrical high-volume low-pressure cuffs (HL cuffs) of conventional ETTs. The aim of this study was to compare TG cuffs with HL cuffs of ETTs in a bench-top model with regard to air leakage under various positive end-expiratory pressures (PEEP).
Methods
HL cuffs and TG cuffs made from PVC were included (HL group vs. TG group). A model trachea with an internal diameter (ID) of 22 mm was attached to a test lung. The test lung was ventilated using an anesthesia respirator with volume controlled mode and PEEPs of 0, 5, 10, or 15 cm H₂O. Using spirometry, percentages of expired to inspired tidal volumes (TVe/i) were calculated as a measure of air leakage.
Results
With regard to PEEPs, the HL group showed significantly higher air leakage compared to the TG group (p < 0.0001), and a higher PEEP resulted in greater air leakage (p < 0.0001). Air leakage with higher PEEP was greater in the HL group than in the TG group at ID 7.0 mm and 7.5 mm (p = 0.0467, p = 0.0045)
Conclusions
This study shows the superior sealing ability of the TG cuff during ventilation at various PEEPs.

Citations

Citations to this article as recorded by

Impact of Low‐Volume, Low‐Pressure Tracheostomy Cuffs on Acute Mucosal Injury in Swine
Alexandra J. Berges, Ioan A. Lina, Rafael Ospino, Hsiu‐Wen Tsai, Dacheng Ding, Jessica M. Izzi, Alexander T. Hillel
Otolaryngology–Head and Neck Surgery.2022; 167(4): 716. CrossRef
Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support
Marc R. Mendler, Claudia Weber, Mohammad A. Hassan, Li Huang, Benjamin Mayer, Helmut D. Hummler
Neonatology.2017; 111(2): 100. CrossRef

Case Reports

Malfunction due to Kinking and Bending of a Double Lumen Central Venous Catheter : A Case Report: Kyung Bong Yoon, Won Oak Kim, Jae Ho Cha, Ki Young Lee; Korean J Crit Care Med. 2006;21(2):131-134.

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Abstract PDF: Central venous catheters provide an important means of vascular access and are increasingly used. Catheter occlusion refers to the inability to infuse or withdraw fluids from a catheter and could be caused by either thrombotic or nonthrombotic origin. We report an unusual malfunction of double lumen central venous catheter due to kinking and bending of the catheter at the opening site of proximal lumen.

Airway Partial Obstruction by Internal Hermiation of Armored Endotracheal Tube: A case report: Mijeung Gwak, Hyun Sook Hwang, Eun Ha Suk, Pyung Hwan Park; Korean J Crit Care Med. 2002;17(1):29-33.

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Abstract PDF: During general anesthesia, intubation with kink-resistant armored tubes permit the anesthesiologist to work some distance from the surgical field during operation on the head and neck or with patients whose unusual position may kink and obstruct a tube not so reinforced. But armored tubes are still subject to number of hazards, including herniation of the intra-luminal cuff or layer into the lumen of the tube. So extra care is required in their use. We report a case of intraluminal herniation of armored tube accompanied with peak inspiratory pressure during general anesthesia.

Original Article

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.

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Abstract 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.

Case Reports

The Use of Thiopental Sodium with BIS Monitoring in Hypoxic Brain Damage: Jae Young Kwon, Sul Ki Song, Kyung Hoon Kim, Sang Wook Shin, Seong Wan Baik; Korean J Crit Care Med. 2000;15(1):52-55.

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Abstract PDF: Hypoxemia is a common and potentially serious postoperative complication. Hypoxic encephalopahty may occur in prolonged hypoxemia. This condition needs brain protection. There are many brain protective methods. The primary cental nervous system protective mechanism of the barbiturates is attributed to their ability to decrease the cerebral metabolic rate, thus improving the ratio of oxygen (O2) supply to O2 demand. The electroencephalogram-derived bispectral index system (BIS) is a promising new method to predict probability of recovery of consciousness. We experienced two cases of hypoxic brain damage in recovery room. The patients were treated with thiopental and monitored with BIS. The use of thiopental as brain protection during complete global ischemia after cardiac arrest was not effective.

Anesthetic Management for Sequential Bronchoalveolar Lavage in a Patient with Pulmonary Alveolar Proteinosis: A case report: You Seong Jeong, Hee Joo Kim, Jae Hwan Kim, Myoung Hoon Kong, Mi Kyeong Lee, Nan Suk Kim, Young Seok Choi, Sang Ho Lim; Korean J Crit Care Med. 1998;13(2):243-248.

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Abstract PDF: Pulmonary alveolar proteinosis is a rare disease of unknown etiology characterized by the remittent or progressive accumulation of lipid-rich proteinaceous material within the alveolar space in the absence of inflammatory response. The removal of lipoproteinaceous material from the alveolar can the only means of effectively treating the progressive hypoxemia in pulmonary alveolar proteinosis. Bronchoalveolar lavage using a double-lumen endotracheal tube is an accepted modality for treatment of pulmonary alveolar proteinosis. We had utilized sequential bronchoalveolar lavage successfully for the treatment of a 51 year-old male patient with pulmonary alveolar proteinosis. There was no hypoxemia and unstable hemodynamics during the procedure. We conclude that the procedure will be safely performed by careful monitoring.

Original Article

Reliable Verification of Endotracheal Tube Location by Pilot Balloon Compression Technique of Tracheal Tube: Sang Kyi Lee; Korean J Crit Care Med. 1998;13(2):218-223.

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Abstract PDF: BACKGOUND: Correct placement of an endotacheal tube (ETT) is crucial, and an ideal test for confirmation of proper ETT placement should be simple and quick to perform, reliable, safe, inexpensive, and repeatable. Palpation of the ETT cuff at the suprasternal notch has been used by clinicians for many years, however the effectiveness of the technique has never been documented. So the author evaluated an efficacy of the pilot balloon compression technique to verify the correct location of an ETT.
METHODS
After anesthetic induction and confirmation of orotracheal intubation, the patient's head is placed in a neutral position. The ETT is withdrawn or advanced while gentle, repeated pressure is applied with the fingers at the pilot balloon. Simultaneously, the suprasternal notch is palpated in the other hand. When the cuff maximally distends from the pressure applied at the pilot balloon, the ETT is secured. After securing the ETT, the distances from its tip to the upper incisor and the carina were measured by means of fiberoptic laryngoscopy.
RESULTS
Endobroncheal intubation was noted in three patients (3%). Average distance from the tip of the ETT to upper incisor in men was 23.9 cm (range, 21.7~26.9) and in women 22.5 cm (range, 20.0~26.0). Average distance to the carina in men was 2.6 cm (range, -0.5~5.0) and in women 1.8 cm (range, -0.6~4.4).
CONCLUSIONS
In this study, location of the ETT was not reliably confirmed by the technique. So the technique should need some modification. When maximal sensation of the ETT cuff is palpated 2.4~3.3 cm in men and 3.2~3.7 cm in women above the suprastenal notch, the location of the ETT tip is theoretically reliable. However, the technique should not be used to verify endotracheal intubation itself.

Case Reports

Airway Obstruction with Armored Tracheostomy Tube by Swelling of Inner Layer: A case report: Chang Young Jeong, Sang Hyun Kwak, Sung Su Chung, Hyon Jeong Lee, Tae Yob Kim; Korean J Crit Care Med. 1997;12(2):169-172.

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Abstract PDF: One of the reasons for insertion of endotracheal tube is to provide a patent airway. Unfortunately, the tube itself may become the cause of airway obstruction. Especially, armored tube is known to be most effective in maintenance of airway patency. However, airway obstruction has been reported by a varity of causes even though armored tube was used. We experienced airway obstruction with armored tracheostomy tube by swelling of inner layer near the cuff. The tube was reused one and had been disinfected with ethylene oxide. Therefore, to prevent complication such as airway obstruction by use of armored tubes, it is desirable to avoid reusal of armored tube and to examine the lumen as well as cuff before intubation when reused.

Early Detection of Pulmonary Edema by Pulse Oximeter during Cesarean Section: Case report: Dong Ai An; Korean J Crit Care Med. 1997;12(2):163-168.

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Abstract PDF: This case showed that pulse oximeter was helpful for early detection of pulmonary edema during Cesarean section in a parturient woman with preoperative ritodrine treatment. Though arterial oxygen saturation ( Sp02 ) by pulse oximeter was low before the induction of anesthesia, the woman was anesthetized due to emergency situation. SpO2 was continuously low during the operation, so pulmonary edema was suspected. After the operaton, pulmonary edema was diagnosed on the chest x-ray. On the ECG, anteroseptal wall ischemia was detected. Supplementary O2 and diuretics therapy were performed. On the 3rd postoperative day, arterial blood gas analysis was within normal range. Four days after the operation, ECG was normalized and chest x-ray finding was much improved. 10 days later, chest x-ray finding was normalized.

Original Articles

An Anthropometric Measurements of the Upper Airway Using Fiberoptic Laryngoscope in Korean Adults: Sang Kyi Lee, Chun Won Yoo; Korean J Crit Care Med. 1997;12(2):143-150.

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Abstract PDF: Introduction: An anthropometric distance is crucial for an easy endotracheal intubation and correct placement of endotracheal tube in the trachea. There may be a racial difference of the anthropometric measurement. So we measured the anthropometric distances of the upper airway in Korean adult patients.
METHODS
A standard anesthetic induction and maintenance was performed in 100 adult patients following endotracheal intubation. Various anthropometric measurements were determined while the patients head were in a neutral position. Thyromental and sternomental distance were measured. A distance from upper central incisor to carina or cricoid cartilage was directly measured using fiberoptic laryngoscope. However, the length from upper central incisor to midtrachea & the cricoid cartilage-carina distance were indirectly calculated from the above measured distances. Correlation analyses were also performed between age, height, or weight and the above measured anthropometric distances.
RESULTS
The mean distances from upper central incisor to carina, cricoid cartilage or midtrachea were 25.5+/-1.8, 13.9+/-1.9, or 19.8+/-1.8cm respectively. The mean distance from cricoid cartilage to carina was 11.6+/-1.4cm. Thyromental and thyrosternal distance were 6.6+/-0.9 and 15.7+/-1.5cm respectively. All mean anthropometric distances of male were longer than those of female patients. Thirty-eight patients (38%) had the thyromental distance < or = 6cm while one patient (1%) had thyrosternal distance < or = 12.5cm. A good correlation (r< or =0.6) was observed between height and upper central incisor-carina distance.
CONCLUSIONS
This study suggests that these measured anthropometric data are useful for an easy endotracheal intubation and accurate endotracheal placement in the trachea.

Differences of Incidence and Severity of Sore Throat and Hoarseness between the Methods of Airway Security: Yeoung Hwan Choi, Hee Chung Kim; Korean J Crit Care Med. 1997;12(1):43-48.

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Abstract PDF: Introduction: The sore throat and hoarseness are common complications during the postoperative period. We investigated differences of incidence and severity of sore throat and hoarseness according to methods of airway security.
METHODS
One hundred twelve patients, in ASA physical status class 1~2, were included in this study (58 males and 54 females). They were divided into three groups: group 1 (n=42), intubated with endotracheal tube lubricated with normal saline; group 2 (n=40), intubated with endotracheal tube lubricated with 5% lidocaine ointment; group 3 (n=30), inserted with laryngeal mask airway (LMA) for airway security.
RESULTS
The incidence of sore throat and hoarseness were 78.6% and 54.8% in group 1, 35% and 30% in group 2, and 33.3% and 20.0% in group 3.
CONCLUSIONS
Both 5% lidocaine-lubricated endotracheal tube and laryngeal mask airway showed tendency of decreased incidence of postoperative sore throat and hoarseness but there are no statistical significance.

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