Acute and Critical Care

Original Articles

Pulmonary
Agreement between two methods for assessment of maximal inspiratory pressure in patients weaning from mechanical ventilation: Emanuelle Olympia Silva Ribeiro, Rik Gosselink, Lizandra Eveline da Silva Moura, Raissa Farias Correia, Wagner Souza Leite, Maria das Graças Rodrigues de Araújo, Armele Dornelas de Andrade, Daniella Cunha Brandão, Shirley Lima Campos; Acute Crit Care. 2022;37(4):592-600. Published online October 27, 2022; DOI: https://doi.org/10.4266/acc.2022.00325

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Abstract PDF: Background
Respiratory muscle strength in patients with an artificial airway is commonly assessed as the maximal inspiratory pressure (MIP) and is measured using analogue or digital manometers. Recently, new electronic loading devices have been proposed to measure respiratory muscle strength. This study evaluates the agreement between the MIPs measured by a digital manometer and those according to an electronic loading device in patients being weaned from mechanical ventilation. Methods: In this prospective study, the standard MIP was obtained using a protocol adapted from Marini, in which repetitive inspiratory efforts were performed against an occluded airway with a one-way valve and were recorded with a digital manometer for 40 seconds (MIPDM). The MIP measured using the electronic loading device (MIPELD) was obtained from repetitively tapered flow resistive inspirations sustained for at least 2 seconds during a 40-second test. The agreement between the results was verified by a Bland-Altman analysis. Results: A total of 39 subjects (17 men, 55.4±17.7 years) was enrolled. Although a strong correlation between MIPDM and MIPELD (R=0.73, P<0.001) was observed, the Bland-Altman analysis showed a high bias of –47.4 (standard deviation, 22.3 cm H2O; 95% confidence interval, –54.7 to –40.2 cm H2O). Conclusions: The protocol of repetitively tapering flow resistive inspirations to measure the MIP with the electronic loading device is not in agreement with the standard protocol using one-way valve inspiratory occlusion when applied in poorly cooperative patients being weaned from mechanical ventilation.

Ethics
Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission: Youjin Chang, Kyoung Ran Kim, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim; Acute Crit Care. 2021;36(4):351-360. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00283

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Background
It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception.
Methods
A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state.
Results
A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group were 64%, 22%, and 57%, respectively; their 6-month mortality rates were 100%, 46%, and 81%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3, odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892–8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260–19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162–17.121; P=0.029).
Conclusions
The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization.

Citations

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Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study
Carla Marchini Dias da Silva, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Jr
Journal of Critical Care.2024; 79: 154468. CrossRef
Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit
Michele M. Iguina, Aunie M. Danyalian, Ilko Luque, Umair Shaikh, Sanaz B. Kashan, Dionne Morgan, Daniel Heller, Mauricio Danckers
Journal of Palliative Care.2023; 38(2): 126. CrossRef
Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
Internal and Emergency Medicine.2023; 18(4): 1191. CrossRef
Can the intensivists predict the outcomes of critically ill patients on the appropriateness of intensive care unit admission for limited intensive care unit resources ?
SeungYong Park
Acute and Critical Care.2021; 36(4): 388. CrossRef

Review Article

Rapid response system
Rapid response systems in Korea: Bo Young Lee, Sang-Bum Hong; Acute Crit Care. 2019;34(2):108-116. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00535

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Abstract PDF

The inpatient treatment process is becoming more and more complicated with advanced treatments, aging of the patient population, and multiple comorbidities. During the process, patients often experience unexpected deterioration, about half of which might be preventable. Early identification of patient deterioration and the proper response are priorities in most healthcare facilities. A rapid response system (RRS) is a safety net to identify antecedents of these adverse events and to respond in a timely manner. The RRS has become an essential part of the medical system worldwide, supported by all major quality improvement organizations. An RRS consists of a trigger system and response team and needs constant assessment and process improvement. Although the effectiveness and cost-benefit of RRS remain controversial, according to previous studies, it may be beneficial by decreasing in-hospital cardiac arrest and mortality. Since the first implementation of RRS in Korea in 2008, it has been developed in over 15 medical centers and continues to expand. Recent accreditation standards and an RRS pilot program by the Korean government will promote the proliferation of RRSs in Korea.

Citations

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Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study
Yoon Hae Ahn, Jinwoo Lee, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Haein Lee, Chae-Man Lim, Sang-Min Lee, Hong Yeul Lee, Chae-Man Lim, Sang-Bum Hong, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Su
Journal of Intensive Care.2023;[Epub] CrossRef
Findings from a decade of experience following implementation of a Rapid Response System into an Asian hospital
Augustine Tee, Bryan Peide Choo, Roshni Sadashiv Gokhale, Xiqin Wang, Mashithah Mansor, Hong Choon Oh, Daryl Jones
Resuscitation Plus.2023; 16: 100461. CrossRef
Development of a comprehensive model for the role of the rapid response team nurse
Youn-Hui Won, Jiyeon Kang
Intensive and Critical Care Nursing.2022; 68: 103136. CrossRef
Characteristics and outcomes of patients screened by rapid response team who transferred to the intensive care unit
Song-I. Lee, Jeong Suk Koh, Yoon Joo Kim, Da Hyun Kang, Jeong Eun Lee
BMC Emergency Medicine.2022;[Epub] CrossRef
Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study
Dong-gon Hyun, Su Yeon Lee, Jee Hwan Ahn, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Sunghoon Park, Jeongwon Heo, Jae-myeong Lee, Kyung Cha
Critical Care.2022;[Epub] CrossRef
Korean nurses’ perception and performance on communication with physicians in clinical deterioration
Bo-Gyeong Jin, Kyoungrim Kang, Hyun-Jin Cho
Medicine.2022; 101(38): e30570. CrossRef
Clinical Nurses’ Intention to Use Defibrillators in South Korea: A Path Analysis
Dongchoon Uhm, Gye-Hyun Jung
Healthcare.2022; 11(1): 61. CrossRef
Rapid Response System Should Be Enhanced at Non-general Ward Locations: a Retrospective Multicenter Cohort Study in Korea
Byung Ju Kang, Sang-Bum Hong, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Jae Young Moon, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jong-Joon Ahn
Journal of Korean Medical Science.2021;[Epub] CrossRef
Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study
Jinmi Lee, Yujung Shin, Eunjoo Choi, Sunhui Choi, Jeongsuk Son, Youn Kyung Jung, Sang-Bum Hong, Tai-Heng Chen
PLOS ONE.2021; 16(2): e0247066. CrossRef
A multicentre validation study of the deep learning-based early warning score for predicting in-hospital cardiac arrest in patients admitted to general wards
Yeon Joo Lee, Kyung-Jae Cho, Oyeon Kwon, Hyunho Park, Yeha Lee, Joon-Myoung Kwon, Jinsik Park, Jung Soo Kim, Man-Jong Lee, Ah Jin Kim, Ryoung-Eun Ko, Kyeongman Jeon, You Hwan Jo
Resuscitation.2021; 163: 78. CrossRef
Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
Sang Hyuk Kim, Ji Young Hong, Youlim Kim
Journal of Korean Medical Science.2021;[Epub] CrossRef
Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study
Sang Hyuk Kim, Hye Suk Choi, Eun Suk Jin, Hayoung Choi, Hyun Lee, Sang-Hwa Lee, Chang Youl Lee, Myung Goo Lee, Youlim Kim
Scientific Reports.2021;[Epub] CrossRef
A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea
Su Yeon Lee, Jee Hwan Ahn, Byung Ju Kang, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jae Young Moon, Sang-Bum Hong, Amit Bahl
PLOS ONE.2021; 16(10): e0258221. CrossRef
Incorporating a real-time automatic alerting system based on electronic medical records could improve rapid response systems: a retrospective cohort study
Seung-Hun You, Sun-Young Jung, Hyun Joo Lee, Sulhee Kim, Eunjin Yang
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2021;[Epub] CrossRef
Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
Mi-Jung Yoon, Jin-Hee Park
Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491. CrossRef
Early Warning Score and Cancer Patients at End-of-Life
Jae-woo Lee, Ye-Seul Kim, Yonghwan Kim, Hyo-Sun Yoo, Hee-Taik Kang
Korean Journal of Clinical Geriatrics.2021; 22(2): 67. CrossRef
Effectiveness of a daytime rapid response system in hospitalized surgical ward patients
Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh
Acute and Critical Care.2020; 35(2): 77. CrossRef
Current State and Strategy for Establishing a Digitally Innovative Hospital: Memorial Review Article for Opening of Yongin Severance Hospital
Soo-Jeong Kim, Ji Woong Roh, Sungwon Kim, Jin Young Park, Donghoon Choi
Yonsei Medical Journal.2020; 61(8): 647. CrossRef
Bleeding management after implementation of the Hemorrhage Code (Code H) at the Hospital Israelita Albert Einstein, São Paulo, Brazil
Michele Jaures, Neila Maria Marques Negrini Pigatti, Roseny dos Reis Rodrigues, Fernanda Paulino Fernandes, João Carlos de Campos Guerra
Einstein (São Paulo).2020;[Epub] CrossRef
Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef
Effect of a rapid response system on code rates and in-hospital mortality in medical wards
Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Sulhee Kim, Eunjin Yang, Hyun Joo Lee, Hannah Lee, Ho Geol Ryu, Seung-Young Oh, Eun Jin Ha, Sang-Bae Ko, Jaeyoung Cho
Acute and Critical Care.2019; 34(4): 246. CrossRef
Evidence revealed the effects of rapid response system
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Original Articles

Ethics
Characteristics and Outcomes of Potentially Inappropriate Admissions to the Intensive Care Unit: Sooim Sin, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2019;34(1):46-52. Published online February 28, 2019; DOI: https://doi.org/10.4266/acc.2018.00388

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Abstract PDF Supplementary Material

Background
Admission of patients perceived as potentially inappropriate for intensive care is a very sensitive and controversial issue. We aimed to evaluate the use of medical resources in the intensive care unit (ICU) and outcomes of patients according to a physician’s judgment of appropriateness. Methods: ICU physicians classified patients who were admitted to the medical ICU of a tertiary hospital as appropriate or inappropriate for intensive care within 24 hours of admission. Patient outcomes including mortality were analyzed according to appropriateness. Additionally, the usage and duration of mechanical ventilation (MV), renal replacement therapy (RRT), and extracorporeal membrane oxygenation (ECMO) were analyzed according to appropriateness. Results: In total, 105 patients (male, 55.4%; mean age, 62 years) were included. Twelve (11.4%) patients were considered inappropriate for intensive care based on guidance published by the Society of Critical Care Medicine through a questionnaire survey of physicians. There was no significant difference between patients considered inappropriate or appropriate for ICU admission regarding the use and duration of MV, RRT, and ECMO. In contrast, the ICU, in-hospital, 28-day, 90-day, and total mortality rates were significantly higher among patients with inappropriate admission than among patients with appropriate admission (ICU mortality: 50.0% vs. 25.8%, P=0.008; in-hospital mortality: 58.3% vs. 43.0%, P=0.028; 28-day mortality: 58.3% vs. 33.3%, P=0.019; 90-day mortality: 66.7% vs. 44.1%, P=0.023). Conclusions: Despite higher mortality, the amount of medical resources used for patients considered potentially inappropriate for intensive care did not differ from the resources used for patients considered suitable for ICU care.

Citations

Citations to this article as recorded by

Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study
Carla Marchini Dias da Silva, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Jr
Journal of Critical Care.2024; 79: 154468. CrossRef
Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
Internal and Emergency Medicine.2023; 18(4): 1191. CrossRef
Performance and Sociodemographic Determinants of Excess Outpatient Demand of Rural Residents in China: A Cross-Sectional Study
Yanchen Liu, Yingchun Chen, Xueyan Cheng, Yan Zhang
International Journal of Environmental Research and Public Health.2020; 17(16): 5963. CrossRef

Ethics
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 Crit Care. 2018;33(2):95-101. Published online May 31, 2018; DOI: https://doi.org/10.4266/acc.2017.00612

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Background
Providing palliative care to dying patients in the intensive care unit (ICU) has recently received much attention. Evaluating the quality of dying and death (QODD) is important for appropriate comfort care in the ICU. This study aimed to validate the Korean version of the QODD questionnaire.
Methods
This study included decedents in the ICUs of three tertiary teaching hospitals and one secondary hospital from June 2016 to May 2017. ICU staff members were asked to complete the translated QODD questionnaire and the visual analogue scale (VAS) questionnaire within 48 hours of patient death. The validation process consisted of evaluating construct validity, internal consistency, and interrater reliability.
Results
We obtained 416 completed questionnaires describing 255 decedents. The QODD score was positively correlated with the 100-VAS score (Pearson correlation coefficient, 0.348; P<0.001). An evaluation of the internal consistency presented favorable results (calculated Cronbach’s alpha if a given item exceeded 0.8 in all items). The interrater reliability revealed no concordance between doctors and nurses.
Conclusions
The QODD questionnaire was successfully translated and validated in Korean medical ICUs. We hope further studies that use this valuable instrument will be conducted in Korea.

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Factors associated with the quality of dying and death and missed nursing care
Shahin Gahramani, Mokhtar Mahmoudi, Nouri, Sina Valiee
International Journal of Palliative Nursing.2024; 30(4): 190. CrossRef
A systematic review of instruments measuring the quality of dying and death in Asian countries
Shuo Xu, Yue Fang, Hanzhang Chen, Kang Sun, Chen Zhang, Yang Liu
Quality of Life Research.2023; 32(7): 1831. CrossRef
Translation, Validity and Internal Consistency of the Quality of Dying and Death Questionnaire for Brazilian families of patients that died from cancer: a cross-sectional and methodological study
Bianca Sakamoto Ribeiro Paiva, Talita Caroline de Oliveira Valentino, Mirella Mingardi, Marco Antonio de Oliveira, Julia Onishi Franco, Michelle Couto Salerno, Helena Palocci, Tais Cruz de Melo, Carlos Eduardo Paiva
Sao Paulo Medical Journal.2023;[Epub] CrossRef
Russian nurses’ readiness for transcultural care of palliative patients
Nataliya Kasimovskaya, Natalia Geraskina, Elena Fomina, Svetlana Ivleva, Maria Krivetskaya, Nina Ulianova, Marina Zhosan
BMC Palliative Care.2023;[Epub] CrossRef
Change in perception of the quality of death in the intensive care unit by healthcare workers associated with the implementation of the “well-dying law”
Ye Jin Lee, Soyeon Ahn, Jun Yeun Cho, Tae Yun Park, Seo Young Yun, Junghyun Kim, Jee-Min Kim, Jinwoo Lee, Sang-Min Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
Intensive Care Medicine.2022; 48(3): 281. CrossRef
Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses
Haeyoung Lee, Seung-Hye Choi
Healthcare.2021; 9(1): 40. CrossRef
Validation of the Chinese Version of the Quality of Dying and Death Questionnaire for Family Members of ICU Patients
Xing-ping Han, Xu Mei, Jing Zhang, Ting-ting Zhang, Ai-ni Yin, Fang Qiu, Meng-jie Liu
Journal of Pain and Symptom Management.2021; 62(3): 599. CrossRef
Validation of the Quality of Dying and Death Questionnaire among the Chinese populations
Ying Wang, Mandong Liu, Wallace Chi Ho Chan, Jing Zhou, Iris Chi
Palliative and Supportive Care.2021; 19(6): 694. CrossRef
The quality of dying and death for patients in intensive care units: a single center pilot study
Yanghwan Choi, Myoungrin Park, Da Hyun Kang, Jooseon Lee, Jae Young Moon, Heejoon Ahn
Acute and Critical Care.2019; 34(3): 192. 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

Rapid response system
Epidemiology and Clinical Characteristics of Rapid Response Team Activations: Sei Won Kim, Hwa Young Lee, Mi Ra Han, Yong Suk Lee, Eun Hyoung Kang, Eun Ju Jang, Keum Sook Jeun, Seok Chan Kim; Korean J Crit Care Med. 2017;32(2):124-132. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00199

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Abstract PDF

Background
To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available.
Methods
In Seoul St. Mary’s Hospital, the St. Mary’s Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016.
Results
The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation.
Conclusions
Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.

Citations

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Development of a comprehensive model for the role of the rapid response team nurse
Youn-Hui Won, Jiyeon Kang
Intensive and Critical Care Nursing.2022; 68: 103136. CrossRef
Failure mode and effect analysis (FMEA) to identify and mitigate failures in a hospital rapid response system (RRS)
Ehsan Ullah, Mirza Mansoor Baig, Hamid GholamHosseini, Jun Lu
Heliyon.2022; 8(2): e08944. CrossRef
Neurological Emergencies in Patients Hospitalized With Nonneurological Illness
Sang-Beom Jeon, Han-Bin Lee, Yong Seo Koo, Hyunjo Lee, Jung Hwa Lee, Bobin Park, Soh Hyun Choi, Suyeon Jeong, Jun Young Chang, Sang-Bum Hong, Chae-Man Lim, Sang-Ahm Lee
Journal of Patient Safety.2021; 17(8): e1332. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef

Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy: Jae Young Moon, Hee Young Lee, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2012;27(1):16-23.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.16

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Abstract PDF

BACKGROUND
In order to promote the dignity of terminal patients, and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The aim of this study was to assess the current perception of the guideline among internal medicine residents and to identify barriers to the application of the guidelines.
METHODS
The study was designed prospectively on the basis of data from e-mail survey. We surveyed 98 medical residents working in 19 medical centers.
RESULTS
75.5% of respondents agreed with withdrawing (WD) of LST and 33.3% (33/98) of respondents were unaware of the guideline. Although 58.1% of all respondents had taken an EOL care class in medical school, about 30% of residents did feel uncomfortable with communicating with patients and surrogates. The most important obstacle for decision of WD of LST was the resident's psychological stress. 39.8% of medical residents felt guilty or failure after a patient's death, and 41.8% became often or always depressed in a patient's dying.
CONCLUSIONS
In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the medical training program in the hospitals and the more concern of educational leaders are urgent.

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Moral Distress Regarding End-of-Life Care Among Healthcare Personnel in Korean University Hospitals: Features and Differences Between Physicians and Nurses
Eun Kyung Choi, Jiyeon Kang, Hye Youn Park, Yu Jung Kim, Jinui Hong, Shin Hye Yoo, Min Sun Kim, Bhumsuk Keam, Hye Yoon Park
Journal of Korean Medical Science.2023;[Epub] CrossRef
The Effects of South Korean Social Workers' Professional Resources on their Understanding of a Patient's Right to End‐of‐Life Care Decisions in Long‐term Care Facilities
Sooyoun Han
Asian Social Work and Policy Review.2016; 10(2): 200. CrossRef
A Study of Social Workers’ Understanding of Elderly Patients’ and Family Caregivers’ Rights to End-of-Life Care Decisions and of Their Own Roles in the Process
Sooyoun Han
The Korean Journal of Hospice and Palliative Care.2015; 18(1): 42. 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

Safety and Feasibility of Percutaneous Tracheostomy Performed by Medical Intensivists: Hongseok Yoo, So Yeon Lim, Chi Min Park, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2011;26(4):261-266.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.261

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Abstract PDF

BACKGROUND
Tracheostomy is one of the most commonly performed surgical procedures in the intensive care unit (ICU). After its introduction, percutaneous dilatational tracheostomy (PDT) has been recognized in western countries as a reliable alternative to surgical tracheostomy. However, data on the safety and feasibility of PDT performed by medical intensivists are limited in Korea.
METHODS
To evaluate the safety and feasibility of PDT performed by medical intensivists and to compare with those of surgical tracheostomy (ST), we retrospectively analyzed the clinical characteristics of all prospectively registered patients who underwent either PDT or ST in medical ICU from December 2010 to July 2011.
RESULTS
A total of 81 patients underwent tracheostomy over the study period: PDT in 56 (69%) and ST in 25 (31%). One patient in whom major bleeding developed during PDT underwent ST as a substitute for PDT. There were no differences in the demographics, laboratory findings, and parameters of mechanical ventilation between the two groups. Procedure time was significantly shorter in the PDT group (20 [IQR 18-30] min) than that in the ST group (38 [27.5-57.5] min) (p < 0.001). The major complication observed in 24 hours after PDT was bleeding in 6 (11%) patients of the PDT group and 4 (16%) patients of the ST group (p = 0.489). However, surgical interventions for major bleeding were required in 2 patients who underwent.
CONCLUSIONS
PDT performed by medical intensivists was safe and feasible. However, immediate surgical assistance should be available when required.

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Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by a Neurointensivist Compared with Conventional Surgical Tracheostomy in Neurosurgery Intensive Care Unit
John Kwon, Yong Oh Kim, Jeong-Am Ryu
Journal of Neurointensive Care.2019; 2(2): 64. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Is Percutaneous Dilatational Tracheostomy Safe to Perform in the Intensive Care Unit?
Jae Hwa Cho
Korean Journal of Critical Care Medicine.2014; 29(2): 57. CrossRef
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents
Sung-Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2014; 29(3): 183. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by Intensive Care Trainee
Daesang Lee, Chi Ryang Chung, Sung Bum Park, Jeong-Am Ryu, Joongbum Cho, Jeong Hoon Yang, Chi-Min Park, Gee Young Suh, Kyeongman Jeon
Korean Journal of Critical Care Medicine.2014; 29(2): 64. CrossRef
A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy
Ji Young Park, Taehoon Lee, Hongyeul Lee, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2013; 28(3): 184. 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.

Citations

Citations to this article as recorded by

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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.

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