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Editorial
Rapid response system
Transforming rapid response team through artificial intelligence
Kwangha Lee
Acute Crit Care. 2025;40(1):136-137.   Published online February 28, 2025
DOI: https://doi.org/10.4266/acc.000425
  • 649 View
  • 56 Download
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Original Articles
Pulmonary
Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh
Acute Crit Care. 2024;39(1):91-99.   Published online January 26, 2024
DOI: https://doi.org/10.4266/acc.2023.00871
  • 3,049 View
  • 183 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality.
Methods
We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed.
Results
A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579).
Conclusions
MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

Citations

Citations to this article as recorded by  
  • Mechanical power and mortality: analysis of a prospective cohort of ventilated patients
    Yudiel Pérez Yero, Ariel Sosa Remón, Jhossmar Cristians Auza-Santivañez, Arian Jesús Cuba Naranjo, Dasha María García Arias, Ana Esperanza Jeréz Alvarez, Mileydys Saborit García, Osman Arteaga Iriarte, Jose Bernardo Antezana-Muñoz
    Multidisciplinar (Montevideo).2025; 3: 198.     CrossRef
  • Associations of mechanical power, ventilatory ratio, and other respiratory indices with mortality in patients with acute respiratory distress syndrome undergoing pressure-controlled mechanical ventilation
    Tae Wan Kim, Chi Ryang Chung, Miryeo Nam, Ryoung-Eun Ko, Gee Young Suh
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Perioperative Ventilation in Neurosurgical Patients: Considerations and Challenges
    Ida Giorgia Iavarone, Patricia R.M. Rocco, Pedro Leme Silva, Shaurya Taran, Sarah Wahlster, Marcus J. Schultz, Nicolo’ Antonino Patroniti, Chiara Robba
    Current Anesthesiology Reports.2024; 14(4): 512.     CrossRef
Pulmonary/Policy
Association between the National Health Insurance coverage benefit extension policy and clinical outcomes of ventilated patients: a retrospective study
Wanho Yoo, Saerom Kim, Soohan Kim, Eunsuk Jeong, Kwangha Lee
Acute Crit Care. 2022;37(1):53-60.   Published online February 22, 2022
DOI: https://doi.org/10.4266/acc.2021.01389
  • 5,582 View
  • 182 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
This study aimed to investigate the association between the Korean National Health Insurance coverage benefit extension policy and clinical outcomes of patients who were ventilated owing to various respiratory diseases.
Methods
Data from 515 patients (male, 69.7%; mean age, 69.8±12.1 years; in-hospital mortality rate, 28.3%) who were hospitalized in a respiratory intensive care unit were retrospectively analyzed over 5 years.
Results
Of total enrolled patients, 356 (69.1%) had one benefit items under this policy during their hospital stay. They had significantly higher medical expenditure (total: median, 23,683 vs. 12,742 U.S. dollars [USD], P<0.001), out-of-pocket (median, 5,932 vs. 4,081 USD; P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (median, 26.0% vs. 32.2%; P<0.001). Patients without benefit items associated with higher in-hospital mortality (hazard ratio [HR], 2.794; 95% confidence interval [CI], 1.980–3.941; P<0.001). In analysis of patients with benefit items, patients with three items (“cancer,” “tuberculosis,” and “disability”) had significantly lower out-of-pocket medical expenditure (3,441 vs. 6,517 USD, P<0.001), and a lower percentage of out-of-pocket medical expenditure relative to total medical expenditure (17.2% vs. 27.7%, P<0.001). They were associated with higher in-hospital mortality (HR, 3.904; 95% CI, 2.533–6.039; P<0.001).
Conclusions
Our study showed patients with benefit items had more medical resources and associated improved in-hospital survival. Patients with the aforementioned three benefit items had lower out-of-pocket medical expenditure due to the implementation of this policy, but higher in-hospital mortality.

Citations

Citations to this article as recorded by  
  • The effect of socioeconomic status, insurance status, and insurance coverage benefits on mortality in critically ill patients admitted to the intensive care unit
    Moo Suk Park
    Acute and Critical Care.2022; 37(1): 118.     CrossRef
Editorial
Pulmonary
Rapid communication for effective medical resource allocation in the COVID-19 pandemic
Kwangha Lee
Acute Crit Care. 2021;36(3):262-263.   Published online August 31, 2021
DOI: https://doi.org/10.4266/acc.2021.01046
  • 3,934 View
  • 92 Download
  • 1 Web of Science
  • 1 Crossref
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Citations

Citations to this article as recorded by  
  • Comparison of clinical characteristics and hospital mortality in critically ill patients without COVID-19 before and during the COVID-19 pandemic: a multicenter, retrospective, propensity score-matched study
    Sua Kim, Hangseok Choi, Jae Kyeom Sim, Won Jai Jung, Young Seok Lee, Je Hyeong Kim
    Annals of Intensive Care.2022;[Epub]     CrossRef
Erratum
Pulmonary
Erratum to “Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study”
Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho
Acute Crit Care. 2021;36(2):172-172.   Published online May 28, 2021
DOI: https://doi.org/10.4266/acc.2020.00164.e1
Corrects: Acute Crit Care 2020;35(4):255
  • 4,024 View
  • 67 Download
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Original Articles
Pulmonary
Development of a prognostic scoring system in patients with pneumonia requiring ventilator care for more than 4 days: a single-center observational study
Yeseul Oh, Yewon Kang, Kwangha Lee
Acute Crit Care. 2021;36(1):46-53.   Published online February 17, 2021
DOI: https://doi.org/10.4266/acc.2020.00787
  • 6,893 View
  • 131 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
The aim of the present study was to develop a prognostic model using demographic characteristics, comorbidities, and clinical variables measured on day 4 of mechanical ventilation (MV) for patients with prolonged acute mechanical ventilation (PAMV; MV for >96 hours).
Methods
Data from 437 patients (70.9% male; median age, 68 years) were obtained over a period of 9 years. All patients were diagnosed with pneumonia. Binary logistic regression identified factors predicting mortality at 90 days after the start of MV. A PAMV prognosis score was calculating ß-coefficient values and assigning points to variables.
Results
The overall 90-day mortality rate was 47.1%. Five factors (age ≥65 years, body mass index <18.5 kg/m2, hemato-oncologic diseases as comorbidities, requirement for vasopressors on day 4 of MV and requirement for neuromuscular blocking agents on day 4 of MV) were identified as prognostic indicators. Each factor was valued as +1 point, and used to develop a PAMV prognosis score. This score showed acceptable discrimination (area under the receiver operating characteristic curve of 0.695 for mortality, 95% confidence interval 0.650–0.738, p<0.001), and calibration (Hosmer–Lemeshow chi-square=6.331, with df 7 and p=0.502). The cutoff value for predicting mortality based on the maximum Youden index was ≤2 (sensitivity, 87.5%; specificity, 41.3%). For patients with PAMV scores ≤1, 2, 3 and ≥4, the 90-day mortality rates were 29.2%, 45.7%, 67.9%, and 90.9%, respectively (P<0.001).
Conclusions
Our study developed a PAMV prognosis score for predicting 90-day mortality. Further research is needed to validate the utility of this score.

Citations

Citations to this article as recorded by  
  • Ability of the modified NUTRIC score to predict mortality in patients requiring short-term versus prolonged acute mechanical ventilation: a retrospective cohort study
    Wanho Yoo, Hyojin Jang, Hayoung Seong, Saerom Kim, Soo Han Kim, Eun-Jung Jo, Jung Seop Eom, Kwangha Lee
    Therapeutic Advances in Respiratory Disease.2024;[Epub]     CrossRef
  • Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
    Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong
    Acute and Critical Care.2024; 39(1): 91.     CrossRef
Pulmonary
Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study
Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho
Acute Crit Care. 2020;35(4):255-262.   Published online November 9, 2020
DOI: https://doi.org/10.4266/acc.2020.00164
Correction in: Acute Crit Care 2021;36(2):172
  • 7,886 View
  • 255 Download
  • 8 Web of Science
  • 10 Crossref
AbstractAbstract PDF
Background
The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs.
Methods
Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included.
Results
A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups.
Conclusions
In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Citations

Citations to this article as recorded by  
  • Early Mobilization in Surgical Intensive Care Unit: A Review
    Hamdiye Banu Katran, Esma Kandemir, Ümmügülsüm Sezer
    Hemşirelik Bilimi Dergisi.2025; 8(1): 110.     CrossRef
  • Sedation and analgesia strategies for non-invasive mechanical ventilation: A systematic review and meta-analysis
    Baolu Yang, Leyi Gao, Zhaohui Tong
    Heart & Lung.2024; 63: 42.     CrossRef
  • Effect of Music Therapy and Sound Isolation on the Comfort of Mechanically Ventilated Patients
    Sinem Çalışkan, Esra Akın, Mehmet Uyar
    Turkish Journal of Intensive Care.2024; 22(1): 83.     CrossRef
  • Remifentanil vs. dexmedetomidine for cardiac surgery patients with noninvasive ventilation intolerance: a multicenter randomized controlled trial
    Guang-wei Hao, Jia-qing Wu, Shen-ji Yu, Kai Liu, Yan Xue, Qian Gong, Rong-cheng Xie, Guo-guang Ma, Ying Su, Jun-yi Hou, Yi-jie zhang, Wen-jun Liu, Wei Li, Guo-wei Tu, Zhe Luo
    Journal of Intensive Care.2024;[Epub]     CrossRef
  • Challenges in Non-Invasive Ventilation: Understanding the Causes of NIV Failure and Complications
    Erdem Yalçınkaya, Emel Eryüksel, Sait Karakurt, Hüseyin Arıkan, Sehnaz Olgun, Umut Sabri Kasapoğlu
    OSMANGAZİ JOURNAL OF MEDICINE.2024;[Epub]     CrossRef
  • 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
    Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
    Acute and Critical Care.2022; 37(1): 1.     CrossRef
  • Comfort During Non-invasive Ventilation
    Gianmaria Cammarota, Rachele Simonte, Edoardo De Robertis
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • Current status of treatment of acute respiratory failure in Korea
    Yong Jun Choi, Jae Hwa Cho
    Journal of the Korean Medical Association.2022; 65(3): 124.     CrossRef
  • Treatment of acute respiratory failure: noninvasive mechanical ventilation
    Sunghoon Park
    Journal of the Korean Medical Association.2022; 65(3): 144.     CrossRef
  • Dexmedetomidine-Induced Aortic Contraction Involves Transactivation of the Epidermal Growth Factor Receptor in Rats
    Soo Hee Lee, Seong-Chun Kwon, Seong-Ho Ok, Seung Hyun Ahn, Sung Il Bae, Ji-Yoon Kim, Yeran Hwang, Kyeong-Eon Park, Mingu Kim, Ju-Tae Sohn
    International Journal of Molecular Sciences.2022; 23(8): 4320.     CrossRef
Pulmonary
Sequential Organ Failure Assessment score as a predictor of mortality in ventilated patients with multidrug-resistant bacteremia
Yeseul Oh, Jiyeon Roh, Jaemin Lee, Hyun Sung Chung, Kwangha Lee, Min Ki Lee
Acute Crit Care. 2020;35(3):169-178.   Published online August 31, 2020
DOI: https://doi.org/10.4266/acc.2020.00143
  • 5,880 View
  • 124 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
The occurrence of multidrug-resistant (MDR) bacteremia in ventilated patients may be associated with a high mortality rate. We evaluated whether Sequential Organ Failure Assessment (SOFA) score on the day of bacteremia could predict 90-day mortality in these patients.
Methods
Data were obtained retrospectively from 202 patients (male, 60.4%; median age, 64 years) hospitalized at a single university-affiliated tertiary care hospital. All adult patients who had were ventilated and had one of the following six MDR bacteremias between March 2011 and February 2018 were enrolled: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant Gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), or vancomycin-resistant Enterococcus faecium.
Results
The overall 90-day mortality rate after the day of bacteremia was 59.9%. The areas under the receiver operating characteristic curves for the SOFA and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were 0.732 (95% confidence interval [CI], 0.666 to 0.792; P<0.001) and 0.662 (95% CI, 0.593 to 0.727; P<0.001), respectively, with no difference between the two (P=0.059). Also, the cutoff value of the SOFA score was 9 (based on Youden’s index). Multivariate Cox regression analysis showed that this cut-off value was significantly associated with higher mortality rate (hazard ratio, 2.886; 95% CI, 1.946 to 4.221; P<0.001).
Conclusions
SOFA score measured on the day of bacteremia may be a useful prognostic indicator of 90-day mortality in ventilated patients with MDR bacteremia.

Citations

Citations to this article as recorded by  
  • Evaluation of the Sofa Score in Predicating Outcome of Sepsis Patients Admitted to a Tertiary Care Center in Nepal
    Sharad Khanal, Birendra Kumar Yadav, Aabishkar Subedi
    International Journal of Innovative Science and Research Technology (IJISRT).2024; : 1295.     CrossRef
  • Predictive value of IL-8 for mortality risk in elderly sepsis patients of emergency department
    Xiangqun Zhang, Junyu Wang, Shubin Guo
    Cytokine.2024; 184: 156774.     CrossRef
  • Serial evaluation of the serum lactate level with the SOFA score to predict mortality in patients with sepsis
    Heemoon Park, Jinwoo Lee, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee, Hong Yeul Lee
    Scientific Reports.2023;[Epub]     CrossRef
  • The value of admission Troponin I to predict outcomes in suspected infections in elderly patients admitted in Internal Medicine: results from the SOFA-T collaboration, a multi-center study
    N. Tarquinio, G. Viticchi, V. Zaccone, M. Martino, A. Fioranelli, P. Morciano, G. Moroncini, C. Di Pentima, A. Martini, C. Nitti, A. Salvi, M. Burattini, L. Falsetti
    Internal and Emergency Medicine.2021; 16(4): 981.     CrossRef
Editorial
Basic science and research
Critical Care Research Using “Big Data”: A Reality in the Near Future
Kwangha Lee
Acute Crit Care. 2018;33(4):269-270.   Published online November 30, 2018
DOI: https://doi.org/10.4266/acc.2018.00346
  • 5,147 View
  • 101 Download
PDF
Original Articles
Pulmonary
Clinical Application of Modified Burns Wean Assessment Program Scores at First Spontaneous Breathing Trial in Weaning Patients from Mechanical Ventilation
Eun Suk Jeong, Kwangha Lee
Acute Crit Care. 2018;33(4):260-268.   Published online November 30, 2018
DOI: https://doi.org/10.4266/acc.2018.00276
  • 9,914 View
  • 293 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
The purpose of this study was to evaluate the clinical application of modified Burns Wean Assessment Program (m-BWAP) scoring at first spontaneous breathing trial (SBT) as a predictor of successful liberation from mechanical ventilation (MV) in patients with endotracheal intubation.
Methods
Patients requiring MV for more than 72 hours and undergoing more than one SBT in a medical intensive care unit (ICU) were prospectively enrolled over a 3-year period. The m-BWAP score at first SBT was obtained by a critical care nursing practitioner.
Results
A total of 103 subjects were included in this study. Their median age was 69 years (range, 22 to 87 years) and 72 subjects (69.9%) were male. The median duration from admission to first SBT was 5 days (range, 3 to 26 days), and the rate of final successful liberation from MV was 84.5% (n=87). In the total group of patients, the successful liberation from MV group at first SBT (n=65) had significantly higher m-BWAP scores than did the unsuccessful group (median, 60; range, 43 to 80 vs. median, 53; range, 33 to 70; P<0.001). Also, the area under the m-BWAP curve for predicting successful liberation of MV was 0.748 (95% confidence interval, 0.650 to 0.847), while the cutoff value based on Youden’s index was 53 (sensitivity, 76%; specificity, 64%).
Conclusions
The present data show that the m-BWAP score represents a good predictor of weaning success in patients with an endotracheal tube in place at first SBT.

Citations

Citations to this article as recorded by  
  • Impact of tracheostomy on clinical outcomes in ventilated patients with severe pneumonia: a propensity-matched cohort study
    Hayoung Seong, Hyojin Jang, Wanho Yoo, Saerom Kim, Soo Han Kim, Kwangha Lee
    The Korean Journal of Internal Medicine.2025; 40(2): 286.     CrossRef
  • Clinical prediction scores predicting weaning failure from invasive mechanical ventilation: Role and limitations
    Anish Gupta, Omender Singh, Deven Juneja
    World Journal of Critical Care Medicine.2024;[Epub]     CrossRef
  • What do we know about experiencing end-of-life in burn intensive care units? A scoping review
    André Filipe Ribeiro, Sandra Martins Pereira, Rui Nunes, Pablo Hernández-Marrero
    Palliative and Supportive Care.2023; 21(4): 741.     CrossRef
  • Effect of a Japanese Version of the Burns Wean Assessment Program e-Learning Materials on Ventilator Withdrawal for Intensive Care Unit Nurses
    Rika KIMURA, Naoko HAYASHI, Akemi UTSUNOMIYA
    Journal of Nursing Research.2023; 31(4): e287.     CrossRef
  • The Effect of Nursing Interventions Based on Burns Wean Assessment Program on Successful Weaning from Mechanical Ventilation
    Maryam Sepahyar, Shahram Molavynejad, Mohammad Adineh, Mohsen Savaie, Elham Maraghi
    Iranian Journal of Nursing and Midwifery Research.2021; 26(1): 34.     CrossRef
  • Value of modified Burns Wean Assessment Program scores in the respiratory intensive care unit: An Egyptian study
    Nermeen A. Abdelaleem, Sherif A.A. Mohamed, Azza S. Abd ElHafeez, Hassan A. Bayoumi
    Multidisciplinary Respiratory Medicine.2020;[Epub]     CrossRef
  • Protecting Postextubation Respiratory Failure and Reintubation by High-Flow Nasal Cannula Compared to Low-Flow Oxygen System: Single Center Retrospective Study and Literature Review
    Minhyeok Lee, Ji Hye Kim, In Beom Jeong, Ji Woong Son, Moon Jun Na, Sun Jung Kwon
    Acute and Critical Care.2019; 34(1): 60.     CrossRef
Infection
Current Status and Survival Impact of Infectious Disease Consultation for Multidrug-Resistant Bacteremia in Ventilated Patients: A Single-Center Experience in Korea
Insu Kim, Won-Young Kim, Eun Suk Jeoung, Kwangha Lee
Acute Crit Care. 2018;33(2):73-82.   Published online April 26, 2018
DOI: https://doi.org/10.4266/acc.2017.00591
  • 7,575 View
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  • 5 Web of Science
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AbstractAbstract PDF
Background
We evaluated the current status and survival impact of infectious disease consultation (IDC) in ventilated patients with multidrug-resistant (MDR) bacteremia.
Methods
One hundred sixty-one consecutive patients from a single tertiary care hospital were enrolled over a 5-year period. Patients with at least one of the following six MDR bacteremias were included: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), and vancomycin-resistant Enterococcus faecium.
Results
Median patient age was 66 years (range, 18 to 95), and 57.8% of subjects were male. The 28-day mortality after the day of blood culture was 52.2%. An IDC was requested for 96 patients based on a positive blood culture (59.6%). Patients without IDC had significantly higher rate of hemato-oncologic diseases as a comorbidity (36.9% vs. 11.5%, P < 0.001). Patients without an IDC had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (median, 20; range, 8 to 38 vs. median, 16; range, 5 to 34, P < 0.001) and Sequential Organ Failure Assessment (SOFA) score (median, 9; range, 2 to 17 vs. median, 7; range, 2 to 20; P = 0.020) on the day of blood culture and a higher 28-day mortality rate (72.3% vs. 38.5%, P < 0.001). In patients with SOFA ≥9 (cut-off level based on Youden’s index) on the day of blood culture and gram-negative bacteremia, IDC was also significantly associated with lower 28-day mortality (hazard ratio [HR], 0.298; 95% confidence interval [CI], 0.167 to 0.532 and HR, 0.180; 95% CI, 0.097 to 0.333; all P < 0.001] based on multivariate Cox regression analysis.
Conclusions
An IDC for MDR bacteremia was requested less often for ventilated patients with greater disease severity and higher 28- day mortality after blood was drawn. In patients with SOFA ≥9 on the day of blood culture and gram-negative bacteremia, IDC was associated with improved 28-day survival after blood draw for culture.

Citations

Citations to this article as recorded by  
  • Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study
    Davide Fiore Bavaro, Nicolò De Gennaro, Alessandra Belati, Lucia Diella, Roberta Papagni, Luisa Frallonardo, Michele Camporeale, Giacomo Guido, Carmen Pellegrino, Maricla Marrone, Alessandro Dell’Erba, Loreto Gesualdo, Nicola Brienza, Salvatore Grasso, Gi
    Antibiotics.2023; 12(4): 712.     CrossRef
  • The role of infectious disease consultations in the management of patients with fever in a long-term care facility
    Soo-youn Moon, Kyoung Ree Lim, Jun Seong Son, Ali Amanati
    PLOS ONE.2023; 18(9): e0291421.     CrossRef
  • Impact of infectious diseases consultation among patients with infections caused by gram-negative rod bacteria: a systematic literature review and meta-analysis
    Shinya Hasegawa, Satoshi Kakiuchi, Joseph Tholany, Takaaki Kobayashi, Alexandre R. Marra, Marin L. Schweizer, Riley J. Samuelson, Hiroyuki Suzuki
    Infectious Diseases.2022; 54(8): 618.     CrossRef
  • Infectious Disease Consults of Pseudomonas aeruginosa Bloodstream Infection and Impact on Health Outcomes
    Swetha Ramanathan, Fritzie S Albarillo, Margaret A Fitzpatrick, Katie J Suda, Linda Poggensee, Amanda Vivo, Martin E Evans, Makoto Jones, Nasia Safdar, Chris Pfeiffer, Bridget Smith, Geneva Wilson, Charlesnika T Evans
    Open Forum Infectious Diseases.2022;[Epub]     CrossRef
  • Timeliness of Infectious Diseases Referral and Inappropriate Antibiotic Usage Post-Referral in an Asian Tertiary Hospital
    Liang En Wee, Aidan Lyanzhiang Tan, Limin Wijaya, Maciej Piotr Chlebicki, Julian Thumboo, Ban Hock Tan
    Tropical Medicine and Infectious Disease.2019; 4(4): 137.     CrossRef
Infection
Clinical Application of the Quick Sepsis-Related Organ Failure Assessment Score at Intensive Care Unit Admission in Patients with Bacteremia: A Single-Center Experience of Korea
Hae Jung Na, Eun Suk Jeong, Insu Kim, Won-Young Kim, Kwangha Lee
Korean J Crit Care Med. 2017;32(3):247-255.   Published online August 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00241
  • 7,811 View
  • 187 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
We evaluated the clinical usefulness of the quick Sepsis-Related Organ Failure Assessment (qSOFA) score (based on the 2016 definition of sepsis) at intensive care unit admission in Korean patients with bacteremia. Methods: We retrospectively analyzed clinical data from 236 patients between March 2011 and February 2016. In addition to the qSOFA, the Modified Early Warning score (MEWS) and systemic inflammatory response syndrome (SIRS) criteria were calculated. Results: The patients’ median age was 69 years, and 61.0% were male. Of the patients, 127 (53.8%) had a qSOFA score ≥2 points. They had significantly higher rates of septic shock, thrombocytopenia, and hyperlactatemia, and increased requirements for ventilator care, neuromuscular blocking agents, vasopressors, and hemodialysis within 72 hours after intensive care unit admission. They also had a significantly higher 28-day mortality rate. When analyzed using common thresholds (MEWS ≥5 and ≥2 SIRS criteria), patients with a MEWS ≥5 had the same results as those with a qSOFA score ≥2 (P < 0.05). However, patients with ≥2 SIRS criteria showed no significant differences. Conclusions: Our results show that a qSOFA score ≥2 at admission is a useful screening tool for predicting disease severity and medical resource usage within 72 hours after admission, and for predicting 28-day mortality rates in patients with bacteremia. In addition, qSOFA scores may be more useful than SIRS criteria in terms of prognostic utility.

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  • A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review
    Magnolia Cardona, Claudia C. Dobler, Eyza Koreshe, Daren K. Heyland, Rebecca H. Nguyen, Joan P.Y. Sim, Justin Clark, Alex Psirides
    Journal of Critical Care.2021; 66: 33.     CrossRef
  • Consensus recommendation: Indications and methods for microbiological wound diagnostics
    Axel Kramer, Ojan Assadian, Jürgen Bohnert, Georg Daeschlein, Joachim Dissemond, Veronika Gerber, Peter Hinz, Adam Junka, Simon Kim, Roald Papke, Christian Willy
    Wound Medicine.2018; 23: 53.     CrossRef
Editorial
Infection
Sepsis in Immunocompromised Patients: Current Status in Korea
Kwangha Lee
Korean J Crit Care Med. 2015;30(4):239-240.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.239
  • 6,311 View
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AbstractAbstract PDF
No abstract available.
Erratum
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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The title of page 189 should be corrected.
Original Articles
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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AbstractAbstract PDF
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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AbstractAbstract 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.

Citations

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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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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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AbstractAbstract 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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  • 16 Crossref
AbstractAbstract 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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    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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