Acute and Critical Care

Original Articles

Pulmonary
Factors influencing sleep quality in the intensive care unit: a descriptive pilot study in Korea: Yoon Hae Ahn, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2023;38(3):278-285. Published online August 11, 2023; DOI: https://doi.org/10.4266/acc.2023.00514

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Background
As sleep disturbances are common in the intensive care unit (ICU), this study assessed the sleep quality in the ICU and identified barriers to sleep.
Methods
Patients admitted to the ICUs of a tertiary hospital between June 2022 and December 2022 who were not mechanically ventilated at enrollment were included. The quality of sleep (QoS) at home was assessed on a visual analog scale as part of an eight-item survey, while the QoS in the ICU was evaluated using the Korean version of the Richards-Campbell Sleep Questionnaire (K-RCSQ). Good QoS was defined by a score of ≥50.
Results
Of the 30 patients in the study, 19 reported a QoS score <50. The Spearman correlation coefficient showed no meaningful relationship between the QoS at home and the overall K-RCSQ QoS score in the ICU (r=0.16, P=0.40). The most common barriers to sleep were physical discomfort (43%), being awoken for procedures (43%), and feeling unwell (37%); environmental factors including noise (30%) and light (13%) were also identified sources of sleep disruption. Physical discomfort (median [interquartile range]: 32 [28.0–38.0] vs. 69 [42.0–80.0], P=0.004), being awoken for procedures (36 [20.0–48.0] vs. 54 [36.0–80.0], P=0.04), and feeling unwell (31 [18.0–42.0] vs. 54 [40.0–76.0], P=0.01) were associated with lower K-RCSQ scores.
Conclusions
In the ICU, physical discomfort, patient care interactions, and feeling unwell were identified as barriers to sleep.

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Different nursing interventions on sleep quality among critically ill patients: A systematic review and network meta-analysis
Daijin Huang, Yumei Li, Jing Ye, Chang Liu, Dongyan Shen, Yunhui Lv
Medicine.2023; 102(52): e36298. CrossRef

Ethics
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 Crit Care. 2019;34(3):192-201. Published online April 8, 2019; DOI: https://doi.org/10.4266/acc.2018.00374

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Background
To identify the necessary care for dying patients in intensive care units (ICUs), we designed a retrospective study to evaluate the quality of dying and death (QODD) experienced by the surrogates of patients with medical illness who died in the ICU of a tertiary referral hospital.
Methods
To achieve our objective, the authors compared the QODD scores as appraised by the relatives of patients who died of cancer under hospice care with those who died in the ICU. For this study, a Korean version of the QODD questionnaire was developed, and individual interviews were also conducted.
Results
Sixteen people from the intensive care group and 23 people from the hospice care group participated in the survey and completed the questionnaire. The family members of patients who died in the ICU declined participation at a high rate (50%), with the primary reason being to avoid bringing back painful memories (14 people, 87.5%). The relatives of the intensive care group obtained an average total score on the 17-item QODD questionnaire, which was significantly lower than that of the relatives of the hospice group (48.7±15.5 vs. 60.3±14.8, P=0.03).
Conclusions
This work implies that there are unmet needs for the care of dying patients and for the QODD in tertiary hospital ICUs. This result suggests that shared decision making for advance care planning should be encouraged and that education on caring for dying patients should be provided to healthcare professionals to improve the QODD in Korean ICUs.

Citations

Citations to this article as recorded by

Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021
Seung Hwan Kim, Ji Hwan Jang, Young Zoon Kim, Kyu Hong Kim, Taek Min Nam
Journal of Korean Neurosurgical Society.2024; 67(1): 73. CrossRef
Family Members’ Feedback on the “Quality of Death” of Adult Patients Who Died in Intensive Care Units and the Factors Affecting the Death Quality: A Systematic Review and Meta-Analysis
Kazuaki Naya, Hideaki Sakuramoto, Gen Aikawa, Akira Ouchi, Shun Yoshihara, Yuma Ota, Saiko Okamoto, Ayako Fukushima, Haruyoshi Hirashima
Cureus.2024;[Epub] CrossRef
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
Quality of dying and death in intensive care units: family satisfaction
Fur-Hsing Wen, Ming Chu Chiang, Chung-Chi Huang, Tsung-Hui Hu, Wen-Chi Chou, Li-Pang Chuang, Siew Tzuh Tang
BMJ Supportive & Palliative Care.2023; 13(e3): e1217. CrossRef
Development of an End-of-Life Nursing Care Protocol for Intensive Care Units
Jungeun Kim, Hye Young Yun, Euni Ji Kim, Hyunsook Kim, Geon Ah Kim, Sung Ha Kim, Jayoung Koo, Ju Youn Park, Aisoon Park, Eugene Han, So Yeon Kim, Jihye Jeong, Sanghee Kim
Journal of Hospice & Palliative Nursing.2022; 24(4): E159. CrossRef
Nurses’ perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: a cross-sectional study
Dan-dan Xu, Dan Luo, Jie Chen, Ji-li Zeng, Xiao-lin Cheng, Jin Li, Juan-juan Pei, Fen Hu
BMC Palliative Care.2022;[Epub] CrossRef
The Quality of Dying and Death of Advanced Cancer Patients in Palliative Care and Its Association With Place of Death and Quality of Care
Daniel Gutiérrez-Sánchez, Rafael Gómez-García, María Luisa Martín Roselló, Antonio I. Cuesta-Vargas
Journal of Hospice & Palliative Nursing.2021; 23(3): 264. CrossRef
The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective
Tera Cushman, David B. Waisel, Miriam M. Treggiari
Anesthesia & Analgesia.2021; 133(3): 663. CrossRef
Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
Wan-Na Sun, Hsin-Tien Hsu, Nai-Ying Ko, Yu-Tung Huang
International Journal of Environmental Research and Public Health.2020; 17(12): 4443. 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.

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

A Survey of Patients Who Were Admitted for Life-Sustaining Therapy in Nationwide Medical Institutions: Jong Myon Bae, Joo Young Gong, Jae Ran Lee, Dae Seog Heo, Younsuck Koh; Korean J Crit Care Med. 2010;25(1):16-20.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.16

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Abstract PDF

BACKGROUND
The study focused on figuring out the present status and distribution of the underlying diseases of Korean terminally ill patients (TIP) who were on life-support care (LSC) by conducting a nationwide health care survey.
METHODS
The authors of this study requested that the 308 nationwide hospitals that operate intensive care units answer a questionnaire that asked about the number of admitted TIPs and their underlying diseases at 12 Am, 22 July, 2009. The proportion of TIPs among all the admitted patients and the percentages of the TIP's underlying diseases were calculated.
RESULTS
In a total of 83.1% of the eligible hospitals responded, the proportion of TIP was 1.6 of 100 admitted patients. Terminal cancer was the leading underlying disease in the TIPs (42.4%). Five % of the patients on LSC were brain dead. More TIPs were admitted in the national/public or university hospitals than in the private or non-university hospitals.
CONCLUSIONS
Futile treatment seems to be administered to the TIPs in Korean hospitals. The quality of terminal care in Korean hospitals should be improved by the application of socially acceptable LSC guidelines. Timely government health plans, including hospice care, to improve the quality of palliative care should be launched and maintained.

Citations

Citations to this article as recorded by

Attitudes, Perceptions, and Experiences toward End-of-Life Care Decision-Making among Intensive Care Unit Nurses in Korea : An Integrative Review
JiYeon Choi, Youn-Jung Son, Kyounghoon Lee
Journal of Korean Critical Care Nursing.2020; 13(1): 27. 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
A literature review on end-of-life care among Korean Americans
Hye-young K Park, Cristina C Hendrix
International Journal of Palliative Nursing.2018; 24(9): 452. CrossRef
Attitude, Role Perception and Nursing Stress on Life Sustaining Treatment among Intensive Care Unit Nurses
Su Jeong Lee, Hye Young Kim
Korean Journal of Adult Nursing.2017; 29(2): 131. CrossRef
End‐of‐life communication in Korean older adults: With focus on advance care planning and advance directives
Dong Wook Shin, Ji Eun Lee, BeLong Cho, Sang Ho Yoo, SangYun Kim, Jun‐Hyun Yoo
Geriatrics & Gerontology International.2016; 16(4): 407. CrossRef
The Current Status of End-of-Life Care in Korea and Legislation of Well-Dying Act
Ji Eun Lee, Ae Jin Goo, Be Long Cho
Journal of the Korean Geriatrics Society.2016; 20(2): 65. 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
Comparing the Preference for Terminal Care in Nurses and Patients
Dong Soon Kim, AeYoung So, Kyung-Sook Lee, Jung Sook Choi
Journal of muscle and joint health.2013; 20(3): 214. CrossRef
Life-Sustaining Medical Treatment for Terminal Patients in Korea
Dae Seog Heo
Journal of Korean Medical Science.2013; 28(1): 1. 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
Factors Affecting Shared Decision Making at End of Life in Korean Adults
Jo Kae-Hwa, An Gyeong-Ju
Holistic Nursing Practice.2013; 27(6): 329. CrossRef
On the life-sustaining treatment in Korea
Yoon-seong Lee
Journal of the Korean Medical Association.2012; 55(12): 1161. CrossRef
Current status of end-of-life care in Korean hospitals
Younsuck Koh
Journal of the Korean Medical Association.2012; 55(12): 1171. 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
Predictive Factor s for City Dweller s’ Attitudes toward Death with Dignity
Kae Hwa Jo, Gyeong Ju An, Gyun Moo Kim, Yeon Ja Kim
The Korean Journal of Hospice and Palliative Care.2012; 15(4): 193. CrossRef
Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy
Younsuck Koh, Dae-Seog Heo, Young Ho Yun, Jeong-Lim Moon, Hyoung Wook Park, Ji Tae Choung, Hyo Sung Jung, Bark Jang Byun, Yoon-Seong Lee
Journal of the Korean Medical Association.2011; 54(7): 747. CrossRef

Clinical Survey of Patients in the Post-Anesthesia Care Unit: Sung Su Chung, Myung Gi No, Seong Wook Jeong, Sang Hyun Kwak, Woong Mo Im; Korean J Crit Care Med. 1999;14(1):27-30.

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Abstract PDF: BACKGOUND: The purpose of this study was to evaluate characteristics and mortality rates of patients admitted to the post-anesthesia care unit (PACU) for obtaining the better clinical guidances and more advanced therapeutic plan in the future.
METHODS
The medical records of total 425 patients admitted to the PACU from January to December 1998 were reviewed and analyzed according to age, sex, department, duration of stay, mechanical ventilator care, and mortality rates.
RESULTS
Patients admitted PACU were 6% of total anesthesia patients. The ratio of male to female was 1.5:1. Patients of manhood aged from 45 to 64 were 37%, pediatric patients under 15 year-old were 23%. and elderly patients over 64 year-old were 18% of total PACU patients. The ratio of patients with ventilatory support was 42%. Mortality rate of neonate under 1 month of age was about 47%. Total mortality rate was 12%.
CONCLUSIONS
To improve the outcome of the patients in PACU, continuous nutritional and medical support, cardiovascular and pulmonary monitoring, appropriate nursing care, and availability of medical staff were needed.

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