Acute and Critical Care

Original Article

Rapid response system
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 Crit Care. 2019;34(4):246-254. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00668

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Background
To determine the effects of implementing a rapid response system (RRS) on code rates and in-hospital mortality in medical wards.
Methods
This retrospective study included adult patients admitted to medical wards at Seoul National University Hospital between July 12, 2016 and March 12, 2018; the sample comprised 4,224 patients admitted 10 months before RRS implementation and 4,168 patients admitted 10 months following RRS implementation. Our RRS only worked during the daytime (7 AM to 7 PM) on weekdays. We compared code rates and in-hospital mortality rates between the preintervention and postintervention groups.
Results
There were 62.3 RRS activations per 1,000 admissions. The most common reasons for RRS activation were tachypnea or hypopnea (44%), hypoxia (31%), and tachycardia or bradycardia (21%). Code rates from medical wards during RRS operating times significantly decreased from 3.55 to 0.96 per 1,000 admissions (adjusted odds ratio [aOR], 0.29; 95% confidence interval [CI], 0.10 to 0.87; P=0.028) after RRS implementation. However, code rates from medical wards during RRS nonoperating times did not differ between the preintervention and postintervention groups (2.60 vs. 3.12 per 1,000 admissions; aOR, 1.23; 95% CI, 0.55 to 2.76; P=0.614). In-hospital mortality significantly decreased from 56.3 to 42.7 per 1,000 admissions after RRS implementation (aOR, 0.79; 95% CI, 0.64 to 0.97; P=0.024).
Conclusions
Implementation of an RRS was associated with significant reductions in code rates during RRS operating times and in-hospital mortality in medical wards.

Citations

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Letter to the Editor

Neurology
Implication of Neurological Pupil Index for Monitoring of Brain Edema: Tae Jung Kim, Sang-Bae Ko; Acute Crit Care. 2018;33(1):57-60. Published online February 28, 2018; DOI: https://doi.org/10.4266/acc.2017.00213

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5 Citations

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Citations

Citations to this article as recorded by

Quantitative assessments of pupillary light reflexes in neurocritically ill patients
Tae Jung Kim
Journal of Neurocritical Care.2022; 15(2): 79. CrossRef
Automated Quantitative Pupillometry in the Critically Ill
Petra Opic, Stephan Rüegg, Stephan Marsch, Stephan Sebastian Gut, Raoul Sutter
Neurology.2021; 97(6): e629. CrossRef
Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes
Tae Jung Kim, Soo-Hyun Park, Hae-Bong Jeong, Eun Jin Ha, Won Sang Cho, Hyun-Seung Kang, Jung Eun Kim, Sang-Bae Ko
Neurocritical Care.2020; 33(2): 575. CrossRef
Eyeing up the injured brain: automated pupillometry and optic nerve sheath diameter
Federico Romagnosi, Filippo Bongiovanni, Mauro Oddo
Current Opinion in Critical Care.2020; 26(2): 115. CrossRef
Objective Pupillometry as an Adjunct to Prediction and Assessment for Oculomotor Nerve Injury and Recovery: Potential for Practical Applications
Salah G. Aoun, Babu G. Welch, Michaela Cortes, Sonja E. Stutzman, Matthew C. MacAllister, Tarek Y. El Ahmadieh, Mohamed Osman, Stephen A. Figueroa, Jonathan A. White, Hunt H. Batjer, Daiwai M. Olson
World Neurosurgery.2019; 121: e475. CrossRef

Case Report

Liver
Brain Oxygen Monitoring via Jugular Venous Oxygen Saturation in a Patient with Fulminant Hepatic Failure: Yerim Kim, Chi Kyung Kim, Seunguk Jung, Sang-Bae Ko; Korean J Crit Care Med. 2016;31(3):251-255. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00143

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210 Download
2 Citations

Abstract PDF

Fulminant hepatic failure (FHF) is often accompanied by a myriad of neurologic complications, which are associated with high morbidity and mortality. Although appropriate neuromonitoring is recommended for early diagnosis and to minimize secondary brain injury, individuals with FHF usually have a high chance of coagulopathy, which limits the ability to use invasive neuromonitoring. Jugular bulb venous oxygen saturation (JvO₂) monitoring is well known as a surrogate direct measures of global brain oxygen use. We report the case of a patient with increased intracranial pressure due to FHF, in which JvO₂ was used for appropriate brain oxygen monitoring.

Citations

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Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study
Seon Woo Yoo, Min-Jong Ki, Dal Kim, Seul Ki Kim, SeungYong Park, Hyo Jin Han, Heung Bum Lee
Acute and Critical Care.2021; 36(4): 322. CrossRef
Neurological Monitoring in Acute Liver Failure
Alexandra S. Reynolds, Benjamin Brush, Thomas D. Schiano, Kaitlin J. Reilly, Neha S. Dangayach
Hepatology.2019; 70(5): 1830. CrossRef

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