Acute and Critical Care

Original Articles

Rapid response system
Analysis of avoidable cardiopulmonary resuscitation incidents with a part-time rapid response system in place: Jun Yeun Cho, Dong Seon Lee, Yun Young Choi, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee; Acute Crit Care. 2021;36(2):109-117. Published online April 16, 2021; DOI: https://doi.org/10.4266/acc.2020.01095

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Background
Although a rapid response system (RRS) can reduce the incidence of cardiopulmonary resuscitation (CPR) in general wards, avoidable CPR cases still occur. This study aimed to investigate the incidence and causes of avoidable CPR.
Methods
We retrospectively reviewed the medical records of all adult patients who received CPR between April 2013 and March 2016 (35 months) at a tertiary teaching hospital where a part-time RRS was introduced in October 2012. Four experts reviewed all of the CPR cases and determined whether each event was avoidable.
Results
A total of 192 CPR cases were identified, and the incidence of CPR was 0.190 per 1,000 patient admissions. Of these, 56 (29.2%) were considered potentially avoidable, with the most common cause being doctor error (n=32, 57.1%), followed by delayed do-not-resuscitate (DNR) placement (n=12, 21.4%) and procedural complications (n=5, 8.9%). The percentage of avoidable CPR was significantly lower in the RRS operating time group than in the RRS non-operating time group (20.7% vs. 35.5%; P=0.026). Among 44 avoidable CPR events (excluding cases related to DNR issues), the rapid response team intervened in only three cases (6.8%), and most of the avoidable CPR cases (65.9%) occurred during the non-operating time.
Conclusions
A significant number of avoidable CPR events occurred with a well-functioning, part-time RRS in place. However, RRS operation does appear to lower the occurrence of avoidable CPR. Thus, it is necessary to extend RRS operation time and modify RRS activation criteria. Moreover, policy and cultural changes are needed prior to implementing a full-time RRS.

Citations

Citations to this article as recorded by

Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act
Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
Acute and Critical Care.2022; 37(2): 237. CrossRef
A Review of the Commercially Available ECG Detection and Transmission Systems—The Fuzzy Logic Approach in the Prevention of Sudden Cardiac Arrest
Michał Lewandowski
Micromachines.2021; 12(12): 1489. 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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Abstract PDF Supplementary Material

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.

Citations

Citations to this article as recorded by

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

CPR/Resuscitation
APACHE II Score Immediately after Cardiac Arrest as a Predictor of Good Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Targeted Temperature Management: Sang-Il Kim, Youn-Jung Kim, You-Jin Lee, Seung Mok Ryoo, Chang Hwan Sohn, Dong Woo Seo, Yoon-Seon Lee, Jae Ho Lee, Kyoung Soo Lim, Won Young Kim; Acute Crit Care. 2018;33(2):83-88. Published online May 31, 2018; DOI: https://doi.org/10.4266/acc.2017.00514

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Abstract PDF

Background
This study assessed the association between the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score and good neurological outcome in comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management (TTM).
Methods
Data from survivors of cardiac arrest who received TTM between January 2011 and June 2016 were retrospectively analyzed. The initial APACHE II score was determined using the data immediately collected after return of spontaneous circulation rather than within 24 hours after being admitted to the intensive care unit. Good neurological outcome, defined as Cerebral Performance Category 1 or 2 on day 28, was the primary outcome of this study.
Results
Among 143 survivors of cardiac arrest who received TTM, 62 (43.4%) survived, and 34 (23.8%) exhibited good neurological outcome on day 28. The initial APACHE II score was significantly lower in the patients with good neurological outcome than in those with poor neurological outcome (23.71 ± 4.39 vs. 27.62 ± 6.16, P = 0.001). The predictive ability of the initial APACHE II score for good neurological outcome, assessed using the area under the receiver operating characteristic curve, was 0.697 (95% confidence interval [CI], 0.599 to 0.795; P = 0.001). The initial APACHE II score was associated with good neurological outcome after adjusting for confounders (odds ratio, 0.878; 95% CI, 0.792 to 0.974; P = 0.014).
Conclusions
In the present study, the APACHE II score calculated in the immediate post-cardiac arrest period was associated with good neurological outcome. The initial APACHE II score might be useful for early identification of good neurological outcome.

Citations

Citations to this article as recorded by

Prediction performance of scoring systems after out-of-hospital cardiac arrest: A systematic review and meta-analysis
Boldizsár Kiss, Rita Nagy, Tamás Kói, Andrea Harnos, István Ferenc Édes, Pál Ábrahám, Henriette Mészáros, Péter Hegyi, Endre Zima, Jignesh K. Patel
PLOS ONE.2024; 19(2): e0293704. CrossRef
Predicting the survivals and favorable neurologic outcomes after targeted temperature management by artificial neural networks
Wei-Ting Chiu, Chen-Chih Chung, Chien-Hua Huang, Yu-san Chien, Chih-Hsin Hsu, Cheng-Hsueh Wu, Chen-Hsu Wang, Hung-Wen Chiu, Lung Chan
Journal of the Formosan Medical Association.2022; 121(2): 490. CrossRef
Artificial neural network-boosted Cardiac Arrest Survival Post-Resuscitation In-hospital (CASPRI) score accurately predicts outcome in cardiac arrest patients treated with targeted temperature management
Szu-Yi Chou, Oluwaseun Adebayo Bamodu, Wei-Ting Chiu, Chien-Tai Hong, Lung Chan, Chen-Chih Chung
Scientific Reports.2022;[Epub] CrossRef
Novel Approaches to Risk Stratification of In-Hospital Cardiac Arrest
Jason J. Yang, Xiao Hu, Noel G. Boyle, Duc H. Do
Current Cardiovascular Risk Reports.2021;[Epub] CrossRef

Pulmonary
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 J Crit Care Med. 2014;29(3):183-188. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.183

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Abstract PDF

BACKGROUND
Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to surgical tracheostomy in intensive care units (ICU), and is widely used for critically ill patients who need prolonged mechanical ventilation. Few studies have reported on PDT performed in critically ill patients taking antiplatelet agents. Our goals are to assess not only the feasibility and safety of PDT, but also bleeding complications in the patients receiving such therapy.
METHODS
In a single institution, PDTs were performed by pulmonologists at the medical ICU bedside using the single tapered dilator technique and assisted by flexible bronchoscopy to confirm a secure puncture site. From March 2011 to February 2013, the patients' demographic and clinical data, procedural parameters, outcomes and complications were analyzed and compared complications between patients taking antiplatelet agents and those not.
RESULTS
PDTs were performed for 138 patients; the median age was 72 years, mean body mass index was 20.3 +/- 4.8 kg/m2, and mean acute physiology and chronic health evaluation II score was 24.4 +/- 9.4. Overall, the procedural success rate was 100% and the total procedural time was 25 +/- 8.5 min. There were no periprocedural life-threatening complications, and no statistical difference in the incidence of bleeding complications between patients who had taken antiplatelet agents and those had not (p = 0.657).
CONCLUSIONS
PDT performed in critically ill patients taking antiplatelet agents was a feasible procedure and was implemented without additional bleeding complications.

Citations

Citations to this article as recorded by

Open tracheostomy in patients with dual platelet aggregation inhibitors
Lorena Zapata-Contreras, Carlos Eduardo Hoyos-Cuervo, María Cristina Florián-Pérez
Colombian Journal of Anesthesiology.2019; 47(3): 189. CrossRef
Safety of Percutaneous Dilatational Tracheotomy in Patients on Dual Antiplatelet Therapy and Anticoagulation
Enzo Lüsebrink, Konstantin Stark, Mattis Bertlich, Danny Kupka, Christopher Stremmel, Clemens Scherer, Thomas J. Stocker, Mathias Orban, Tobias Petzold, Nikolaus Kneidinger, Hans-Joachim Stemmler, Steffen Massberg, Martin Orban
Critical Care Explorations.2019; 1(10): e0050. 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
Comparison of outcomes between vertical and transverse skin incisions in percutaneous tracheostomy for critically ill patients: a retrospective cohort study
Sung Yoon Lim, Won Gun Kwack, Youlim Kim, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Critical Care.2018;[Epub] CrossRef

Pharmacology
The Optimal Dose of Midazolam for Promoting Sleep in Critically Ill Patients: A Pilot Study: Se Joong Kim, Jisoo Park, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2014;29(3):166-171. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.166

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Abstract PDF

BACKGROUND
Many critically ill patients treated in the intensive care unit (ICU) experience sleep disruption. Midazolam is commonly used for the sedation of critically ill patients. This pilot study is aimed to identify the optimal dose of midazolam for achieving sound sleep in critically ill patients.
METHODS
This prospective study was conducted in the medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hours to assess the quantity and quality of sleep in patients sedated with midazolam.
RESULTS
A total of five patients were enrolled. Median total sleep time was 494.0 (IQR: 113.5-859.0) min. The majority of sleep was stage 1 (median 82.0 [IQR 60.5-372.5] min) and 2 (median 88.0 [60.5-621.0] min) with scant REM (median 10.0 [6.0-50.5] min) and no stage 3 (0.0 min) sleep. The median number of wakings in 1 hour was 16.1 (IQR: 7.6-28.6). The dose of midazolam showed a positive correlation with total sleep time (r = 0.975, p = 0.005).
CONCLUSIONS
The appropriate quantity of sleep in critically ill patients was achieved with a continuous infusion of 0.02-0.03 mg/kg/h midazolam. However, the quality of sleep was poor. Further study is required for the promotion of quality sleep in such patients.

Citations

Citations to this article as recorded by

Effect of prolonged sedation with dexmedetomidine, midazolam, propofol, and sevoflurane on sleep homeostasis in rats
Brian H. Silverstein, Anjum Parkar, Trent Groenhout, Zuzanna Fracz, Anna M. Fryzel, Christopher W. Fields, Amanda Nelson, Tiecheng Liu, Giancarlo Vanini, George A. Mashour, Dinesh Pal
British Journal of Anaesthesia.2023;[Epub] CrossRef
Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire
Jae Kyoung Kim, Ju-Hee Park, Jaeyoung Cho, Sang-Min Lee, Jinwoo Lee
Acute and Critical Care.2020; 35(3): 164. CrossRef
Sedation in Critically Ill Patients
Mark Oldham, Margaret A. Pisani
Critical Care Clinics.2015; 31(3): 563. CrossRef

Case Report

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 J Crit Care Med. 2013;28(3):184-186.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.184

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Abstract PDF: Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in the critical care medicine for patients who need prolonged mechanical ventilation. Traditionally, PDT has been facilitated by bronchoscopy via the endotracheal tube. However, there are risks for blocking the view of correct puncture site on the trachea or being extubated unintentionally, which lead to loss of the airway. These complications are possibly due to insufficient bronchoscopic visualizations via endotracheal tube during the procedure. Using laryngeal mask airways (LMA) during PDT may overcome these problems and could provide a safer alternative method with superior visualizations of the trachea and larynx. We report a case of percutaneous tracheostomy being performed successfully under bronchoscopy with LMA in the intensive care unit.

Original Article

Clinical Feature and Prognostic Factors of Emphysematous Pyelonephritis: Won Soek Yang, Won Young Kim, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2012;27(2):89-93.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.89

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Abstract PDF

BACKGROUND
Emphysematous pyelonephritis (EPN) is a rare and potentially life-threatening condition that requires prompt evaluation and management. However, its clinical presentation and outcomes vary widely. This study was conducted to ascertain the clinical features and prognostic factors regarding EPN.
METHODS
All patients diagnosed with EPN radiologically and treated at the emergency department in the university-affiliated, tertiary-referral center, from January 1999 to December 2009 were evaluated. The patients' demographic and clinical characteristics, computed tomographic findings, treatment, and outcomes were analyzed retrospectively.
RESULTS
Overall 14 patients diagnosed with EPN were admitted. There were 12 females and 2 males. A history of diabetes was found in 12 (85.7%) patients and was the most common comorbidity. The chief complaint among patients was flank pain (42.9%). Severe sepsis or septic shock was noted in 10 (71.4%) patients. Thirteen cases had unilateral involvement and one case had bilateral involvement. More than half of patients had Escherichia.coli in culture. Mean serum levels of HbA1c, creatinine, C-reactive protein (CRP) were 9.4 +/- 2.7, 2.4 +/- 1.4 mg/dl, and 22.4 +/- 13.1 mg/dl. Eight (57.1%) patients received antibiotic treatment alone and four (28.6%) patients received the concurrent percutaneous drainage as well as antibiotics. Hospital mortality was 7.1%. A higher initial serum CRP level (20.3 vs. 49.8 mg/dl, p = 0.02) and HbA1c level (8.7 vs. 16.4, p = 0.01) was associated with hospital mortality.
CONCLUSIONS
Antibiotics alone provide a high success rate for the treatment of EPN. Higher serum CRP and HbA1c level was associated with a higher mortality rate in patients with EPN.

Citations

Citations to this article as recorded by

Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock
Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim
Korean Journal of Critical Care Medicine.2013; 28(4): 272. CrossRef

Case Reports

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 J Crit Care Med. 2012;27(2):120-125.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.120

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Abstract PDF: Pumpless extracorporeal interventional lung assist (iLA) is a promising respiratory rescue system permitting protective lung ventilation for severe respiratory failure. Herein, we report a case of prolonged iLA support with regards to a patient exhibiting severe hypercapnic respiratory failure. A 51-year-old female patient with metastatic endometrial carcinoma developed progressive hospital-acquired pneumonia and was intubated in order to restore respiratory failure. Despite maximal mechanical ventilator care, her clinical condition deteriorated due to severe respiratory acidosis. The iLA was performed for the management of refractory hypercapnia. The total duration of iLA support was 23 days without any vascular complications, however, she could not survive because of oxygenation failure.

Successful Recovery after Drowning by Early Prone Ventilatory Positioning and Use of Nitric Oxide Gas: A Case Report: Joo Myung Lee, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2011;26(3):196-199.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.196

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Abstract PDF: Drowning is the third leading cause of unintentional accidental death globally. The most serious pathophysiologic consequence of drowning is hypoxemia from acute respiratory distress syndrome. Herein, we report a drowning victim who presented with hypothermia and cardiac arrest, followed by acute respiratory distress syndrome, rhabdomyolysis (with acute kidney injury), and disseminated intravascular coagulopathy. Aided by advanced cardiac life support and mechanical ventilation in a prone position, the patient fully recovered after two days of hospitalization. Recovery was largely attributed to early prone ventilatory positioning and use of nitric oxide gas.

Original Article

The Usefulness of a Triage Kit for Detecting Abused Drugs: Myoung Kwan Kwak, Won Young Kim, Hui Dong Kang, Jae Ho Lee, Bum Jin Oh, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2009;24(2):75-79.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.75

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Abstract PDF

BACKGROUND
The recovery and outcome of intoxicated patients depends on the kind of drugs they took and the total time of their initial management. The purpose of this study is to evaluate the usefulness of a Triage drug kit for detecting abused drugs.
METHODS
From 2003 Feb. to 2003 July, we studied the patients who visited the emergency department with suspicious drug intoxication. In this case, we used a Triage drug kit for 134 patients with drug intoxication or who were clinically suspected of taking illegal drugs, with 30 of the patients initially admitting the substance they had used. The kit is an immunoassay kit for qualitative testing drug metabolites in urine. To compare with those cases of the preceding year, we studied 104 patients with drug intoxication that was detected between February 2002 and July 2002.
RESULTS
Overall, 60% of the 30 cases who did not know what substance they abused and tested positive for, and 33% of the 27 cases with suspected intoxication confirmed their substance abuse. The positive rate for benzodiazepine use was the highest (46.7%), and there were no positive results regarding amphetamine, methamphetamine or cocaine. An appropriate antidote was administered significantly more frequently in the group for which we used the kit.
CONCLUSIONS
A Triage drug kit is probably useful for diagnosing acute drug intoxication and for identifying the causative substance. However, the time required to decide whether or not a patient should be admitted is not reduced. If the kit can detect the frequently abused drugs in Korea, it will be helpful for treating drug intoxicated patients.

Citations

Citations to this article as recorded by

Clinical features of adolescents with suicide attempt and the factors associated with their outcomes: poisoning versus non-poisoning
Myoung Hoon Lee, Jae Ho Jang, Jin-Seong Cho, Woo Sung Choi, Jea Yeon Choi
Pediatric Emergency Medicine Journal.2020; 7(2): 85. CrossRef
Evaluation of the Triage TOX Drug Screen Assay for Detection of 11 Drugs of Abuse and Therapeutic Drugs
Hae In Bang, Mi-Ae Jang, Yong-Wha Lee
Annals of Laboratory Medicine.2017; 37(6): 522. CrossRef

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