Acute and Critical Care

Original Article

Ethics
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 Crit Care. 2020;35(3):179-188. Published online August 10, 2020; DOI: https://doi.org/10.4266/acc.2020.00136

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Background
This study examined the experience of withholding or withdrawing life-sustaining treatment in patients hospitalized in the intensive care units (ICUs) of a tertiary care center. It also considers the role that intensivists play in the decision-making process regarding the withdrawal of life-sustaining treatment.
Methods
We retrospectively analyzed the medical records of 227 patients who decided to withhold or withdraw life-sustaining treatment while hospitalized at Ewha Womans University Medical Center Mokdong between April 9 and December 31, 2018.
Results
The 227 hospitalized patients included in the analysis withheld or withdrew from life-sustaining treatment. The department in which life-sustaining treatment was withheld or withdrawn most frequently was hemato-oncology (26.4%). Among these patients, the most common diagnosis was gastrointestinal tract cancer (29.1%). A majority of patients (64.3%) chose not to receive any life-sustaining treatment. Of the 80 patients in the ICU, intensivists participated in the decision to withhold or withdraw life-sustaining treatment in 34 cases. There were higher proportions of treatment withdrawal and ICU-to-ward transfers among the cases in whom intensivists participated in decision making compared to those cases in whom intensivists did not participate (50.0% vs. 4.3% and 52.9% vs. 19.6%, respectively).
Conclusions
Through their participation in end-of-life discussions, intensivists can help patients’ families to make decisions about withholding or withdrawing life-sustaining treatment and possibly avoiding futile treatments for these patients.

Citations

Citations to this article as recorded by

Dying in the ICU
Isabel Schulmeyer, Markus A. Weigand, Monika Heinzel-Gutenbrunner, Marco Gruss
Die Anaesthesiologie.2022; 71(12): 930. CrossRef
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
Factors Influencing the Initiative Behavior of Intensive Care Unit Nurses toward End-of-Life Decision Making: A Cross-Sectional Study
Jingying Huang, Haiou Qi, Yiting Zhu, Minyan Zhang
Journal of Palliative Medicine.2022; 25(12): 1802. CrossRef
Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database
Yunji Lee, Minjeong Jo, Taehwa Kim, Kyoungsun Yun
BMJ Open.2021; 11(8): e049711. CrossRef

Letter to the Editor

Neurology
Posterior Reversible Encephalopathy Syndrome after Hypovolemic Shock Which Is Required Differential Diagnosis with Delirium in the Intensive Care Unit: Seo In Lee, Gyeong Seon Choi, Jin Park, Young-Joo Lee, Kyung Sook Hong; Acute Crit Care. 2018;33(4):282-285. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00262

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Citations

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Clinical features and prognostic analysis of posterior reversible encephalopathy syndrome in children
Ting Deng, Xinyu Zhang, Xiaoling Peng, Hailun Peng, Ling He, Yue Hu
International Journal of Developmental Neuroscience.2022; 82(4): 349. CrossRef

Original Article

Hematology
Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units: Soo Jin Na, Tae Sun Ha, Younsuck Koh, Gee Young Suh, Shin Ok Koh, Chae-Man Lim, Won-Il Choi, Young-Joo Lee, Seok Chan Kim, Gyu Rak Chon, Je Hyeong Kim, Jae Yeol Kim, Jaemin Lim, Sunghoon Park, Ho Cheol Kim, Jin Hwa Lee, Ji Hyun Lee, Jisook Park, Juhee Cho, Kyeongman Jeon; Acute Crit Care. 2018;33(3):121-129. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00143

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Abstract PDF

Background
The objective of this study was to investigate the characteristics and clinical outcomes of critically ill cancer patients admitted to intensive care units (ICUs) in Korea.
Methods
This was a retrospective cohort study that analyzed prospective collected data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study, which is a nationwide, multicenter, and prospective study that considered 5,063 patients from 22 ICUs in Korea over a period of 7 months. Among them, patients older than 18 years of age who were diagnosed with solid or hematologic malignancies prior to admission to the ICU were included in the present study.
Results
During the study period, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. Six hundred fifty-eight (79%) had solid tumors and 175 (21%) had hematologic malignancies, respectively. Respiratory problems (30.1%) was the most common reason leading to ICU admission. Patients with hematologic malignancies had higher Sequential Organ Failure Assessment (12 vs. 8, P<0.001) and SAPS3 (71 vs. 69, P<0.001) values and were more likely to be associated with chemotherapy, steroid therapy, and immunocompromised status versus patients with solid tumors. The use of inotropes/ vasopressors, mechanical ventilation, and/or continuous renal replacement therapy was more frequently required in hematologic malignancy patients. Mortality rates in the ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) were higher in hematologic malignancy patients than in solid tumor patients.
Conclusions
Cancer patients accounted for one-third of all patients admitted to the studied ICUs in Korea. Clinical characteristics were different according to the type of malignancy. Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.

Citations

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A.V. Lyanguzov, A.S. Luchinin, S.V. Ignatyev, I.V. Paramonov
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Effect of the underlying malignancy on critically ill septic patient's outcome
Man‐Yee Man, Hoi‐Ping Shum, Sin‐Man Lam, Jacky Li, Wing‐Wa Yan, Mei‐Wan Yeung
Asia-Pacific Journal of Clinical Oncology.2022; 18(4): 473. CrossRef
Impacts of Corticosteroid Therapy at Acute Stage of Hospital-Onset Clostridioides difficile Infections
Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
Infection and Drug Resistance.2022; Volume 15: 5387. CrossRef
Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy
Da Woon Kim, Geum Suk Jang, Kyoung Suk Jung, Hyuk Jae Jung, Hyo Jin Kim, Harin Rhee, Eun Young Seong, Sang Heon Song
Kidney Research and Clinical Practice.2022; 41(6): 717. CrossRef
A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs
Lama H. Nazer, Maria A. Lopez-Olivo, Anne Rain Brown, John A. Cuenca, Michael Sirimaturos, Khader Habash, Nada AlQadheeb, Heather May, Victoria Milano, Amy Taylor, Joseph L. Nates
Critical Care Explorations.2022; 4(9): e0757. CrossRef
Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study
Jigeeshu Divatia, Amit M Narkhede, Harish K Chaudhari, Ujwal Dhundi, Natesh Prabu Ravisankar, Satish Sarode
Indian Journal of Critical Care Medicine.2021; 25(12): 1421. CrossRef

Letter to the Editor

Pulmonary
Experiences Using Airway Pressure Release Ventilation for Pneumonia with Severe Hypercapnia or Postoperative Pulmonary Edema: Kyung Sook Hong, Young-Joo Lee; Korean J Crit Care Med. 2017;32(1):83-87. Published online February 28, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00906

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Case Report

Toxicology
Management of Cyanide Intoxication with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy: Jin Park, Seung-Yeob Lee, Hyun-Sik Choi, Yoon Hee Choi, Young-Joo Lee; Korean J Crit Care Med. 2015;30(3):218-221. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.218

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Abstract PDF

Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with high-dose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.

Citations

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Cyanogenic glycoside amygdalin influences functions of human osteoblasts in vitro
Radoslav Omelka, Veronika Kovacova, Vladimira Mondockova, Birgit Grosskopf, Adriana Kolesarova, Monika Martiniakova
Journal of Environmental Science and Health, Part B.2021; 56(2): 109. CrossRef

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