• Tuberculosis and Respiratory Diseases
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• v.87 no.3
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• pp.338-348
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• 2024

Background: Increasing age has been observed among patients admitted to the intensive care unit (ICU). Age traditionally considered a risk factor for ICU mortality. We investigated how the epidemiology and clinical outcomes of older ICU patients have changed over a decade. Methods: We analyzed patients admitted to the ICU at a university hospital in Seoul, South Korea. We defined patients aged 65 and older as older patients. Changes in age groups and mortality risk factors over the study period were analyzed. Results: A total of 32,322 patients were enrolled who aged ≥65 years admitted to the ICUs between January 1, 2007, and December 31, 2017. Patients aged ≥65 years accounted for 35% and of these, the older (O, 65 to 74 years) comprised 19,630 (66.5%), very older (VO, 75 to 84 years) group 8,573 (29.1%), and very very older (VVO, ≥85 years) group 1,300 (4.4%). The mean age of ICU patients over the study period increased (71.9±5.6 years in 2007 vs. 73.2±6.1 years in 2017) and the proportions of the VO and VVO group both increased. Over the period, the proportion of female increased (37.9% in 2007 vs. 43.3% in 2017), and increased ICU admissions for medical reasons (39.7% in 2007 vs. 40.2% in 2017). In-hospital mortality declined across all older age groups, from 10.3% in 2007 to 7.6% in 2017. Hospital length of stay (LOS) decreased in all groups, but ICU LOS decreased only in the O and VO groups. Conclusion: The study indicates a changing demographic in ICUs with an increase in older patients, and suggests a need for customized ICU treatment strategies and resources.

• Journal of Korean Critical Care Nursing
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• v.14 no.3
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• pp.141-156
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• 2021

Purpose : This study aimed to systematically review the preventive interventions for delirium in Korean intensive care unit (ICU) patients and evaluate their efficacy. Methods : For this systematic review and meta-analysis, we searched the literature and selected studies from data sources that included the RISS, KISS, National Central Library, National Assembly Library, DBpia, Science on, MEDLINE, and Cochrane Library. We used Cochrane's revised tool for risk of bias in randomized trials and non-randomized studies of intervention tools to assess the quality of the selected studies. The effect size of the intervention was calculated as odds ratio (OR) and standardized mean difference (SMD). Results : Preventive interventions reported in 23 studies with a total of 4,799 ICU patients were effective in reducing the occurrence of delirium (OR=0.64, 95% CI : 0.49~0.91, p=.011), but not the duration (SMD=-0.22, 95% CI : -0.51~0.08, p=.148). As a result of a subgroup analysis, non-pharmacological interventions were effective in reducing the occurrence of delirium (OR=0.66, 95% CI : 0.47~0.94, p=.020), while pharmacological interventions had no effect (OR=0.68, 95% CI : 0.33~1.40, p=.295). Among the non-pharmacological interventions, multi-component intervention had the largest effect size (OR=0.38, 95% CI : 0.26~0.55, p<.001). Conclusion : Non-pharmacological interventions were effective in reducing the occurrence of delirium. We recommend the development and application of multi-component interventions to prevent delirium in the Korean ICU patients.

• Journal of Korean Critical Care Nursing
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• v.15 no.3
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• pp.115-127
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• 2022

Purpose : This study aimed to investigate sleep parameters and to identify differences according to respiratory support therapy, sedation, and pain medication in intensive care unit (ICU) patients. Methods : In this observational study, sleep parameters were measured using actigraphy. We observed 45 sleep events in 30 ICU patients receiving respiratory support therapy. We measured the sleep parameters, time, efficiency, and wakefulness after sleep onset (WASO). The differences in sleep parameters according to the respiratory support therapy were analyzed using the Mann-Whitney U test. Results : The average daily sleep time of the participants was 776.66±276.71 minutes, of which more than 60% accounted for daytime sleep. During night sleep, the duration of WASO was 156.93±107.91 minutes, and the frequency of WASO was 26.02±25.82 times. The high flow nasal cannula (HFNC) group had a significantly shorter night sleep time (𝑥²=7.86, p =.049), a greater number of WASO (𝑥²=5.69, p =.128), and a longer WASO duration (𝑥²=8.75, p =.033) than groups of other respiratory therapies. Conclusion : ICU patients on respiratory support therapy experienced sleep disturbances such as disrupted circadian rhythm and sleep fragmentation. Among respiratory support regimens, HFNC was associated with poor sleep parameters, which appears to be associated with the insufficient use of analgesics. The results of this study warrant the development of interventions that can improve sleep in ICU patients receiving respiratory support, including HFNC.

• Tuberculosis and Respiratory Diseases
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• v.70 no.4
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• pp.323-329
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• 2011

Background: Although patients with tuberculous-destroyed lung (TDL) account for a significant proportion of those with chronic airflow obstruction, it is difficult to distinguish patients with airway obstruction due to TDL from patients with pure chronic obstructive pulmonary disease (COPD) on initial presentation with dyspnea. We investigated clinical features differing between (i) patients with TDL and airway obstruction and (ii) those with COPD admitted to the intensive care unit (ICU) due to dyspnea. Methods: We reviewed the medical records of patients with TDL who had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of <70% on a pulmonary function test (PFT; best value closest to admission) and patients with COPD without a history of pulmonary tuberculosis (TB) who were admitted to the ICU. Ultimately, 16 patients with TDL and 16 with COPD were compared, excluding patients with co-morbidities. Results: The mean ages of the patients with TDL and COPD were 63.7 and 71.2 years, respectively. Mean FVC% (50.4% vs. 71.9%; p<0.01) and mean FEV1% (39.1% vs. 58.4%; p<0.01) were significantly lower in the TDL group than in the COPD group. More frequent consolidation with TB (68.8% vs. 31.3%; p=0.03) and more tracheostomies (50.0% vs. 0.0%; p=0.02) were observed in the TDL than in the COPD group. Conclusion: Upon ICU admission, patients with TDL had TB pneumonia more frequently, more diminished PFT results, and more tracheostomies than patients with COPD.

• Journal of Korean Critical Care Nursing
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• v.5 no.1
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• pp.1-11
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• 2012

Purpose:The purpose of this study was to examine the effects of video-centered information among family members intensive care unit (ICU). Methods: A quasi-experimental, nonequivalent control group, pretest-posttest design was used. Participants (n=86) were family members who were the main caregivers for the patient in ICU. An experimental group (n=43) watched a video while the control group (n=43) was provided a leaflet. Levels of environmental stress, anxiety and nursing need satisfaction were measured by questionnaires before and after the interventions. Data were analyzed with ${\chi}^2$ test, paired t-test, independent t-test, Fisher's exact test and ANCOVA. Results: There were no differences in environmental stress (F=1.88, $p$=.065), and anxiety (t=0.37, $p$=.711) between 2 groups, but there was a significant difference in nursing need satisfaction (t=3.01, $p$=.004). Conclusion: Providing video-centered information would be an effective nursing intervention by improving nursing need satisfaction among family, the main caregivers members of patients in ICU.

• Journal of Korean Critical Care Nursing
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• v.8 no.1
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• pp.1-10
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• 2015

This study was conducted to examine the relationship among the error risk of high-alert medication, attitudes to single-person checking of medication, and medication safety activities. The participants were 60 nurses working in the intensive care unit. Data were analyzed using descriptive analysis, t-test, analysis of variance, and Pearson's correlation coefficient. The mean scores of the knowledge and certainty of high-alert medication were $0.71{\pm}0.11$ and $2.74{\pm}0.59$, respectively. The mean score of the error risk of high-alert medication was $1.63{\pm}0.24$ and that of attitudes to single checking medication was $3.32{\pm}0.49$. The error risk of high-alert medication had a positive correlation with nurses' attitudes to single checking medication (r = .258, p = .047), which is correlated with the scores for certainty of knowledge (r = .284, p = .028). Based on the results of this study, continuing education for high-alert medication and the development of an accurate protocol for single checking medication are needed to improve the stability of high-alert medication.

• Tuberculosis and Respiratory Diseases
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• v.80 no.4
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• pp.351-357
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• 2017

In 2011, a cluster of peripartum patients were admitted to the intensive care unit of a tertiary hospital in Seoul with signs and symptoms of severe respiratory distress of unknown etiology. Subsequent epidemiological and animal studies suggested that humidifier disinfectant (HD) might represent the source of this pathology. Epidemiological studies, animal studies, and dose-response analysis demonstrated a strong association between HD use and lung injuries. The diagnostic criteria for HD-associated lung injury (HDALI) was defined on the basis of the clinical, pathological, and radiological attributes of the patients. The clinical spectrum of HDALI appears to range from asymptomatic to full-blown acute respiratory failure, and some patients have required actual lung transplantation for survival. The overall mortality of the exposed population was not significant, although peripartum patients and children who were admitted to the intensive care unit did show high mortality rates. Persistent clinical findings such as diffuse ill-defined centrilobular nodules and restrictive lung dysfunction were observed in some of the survivors. The findings of this review emphasize the importance of assessment of the level of toxicity of chemical inhalants utilized in a home setting, as well as the need to identify and monitor afflicted individuals after inhalational injury.

• Journal of Korean Critical Care Nursing
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• v.14 no.3
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• pp.128-140
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• 2021

Purpose : This study aimed to identify the incidence of peripheral cyanosis and the characteristics and clinical results of patients with therapeutic hypothermia after a cardiac arrest. Methods : Data were collected from April to June 2021 via the electrical medical records of 95 patients with therapeutic hypothermia for 72 hours after a cardiac arrest admitted to an acute care unit at a tertiary hospital between January 1, 2016, and December 31, 2019. The data were analyzed using descriptive statistics and a t-test, Mann-Whitney U test, Chi-squared test, Fisher's exact test, and logistic regression using SPSS/WIN. Results : The incidence of peripheral cyanosis was 20%. In the peripheral cyanosis group, peripheral vascular disease, fibrinogen, vasopressor, infection, disseminated intravascular coagulation, acute physiology, chronic health evaluation II score on the second hospital day, nursing intervention, and mortality on the seventh hospital day were higher. The level of fibrinogen and use of vasopressors affected the occurrence of peripheral cyanosis. Conclusion : Considering the influencing variables, careful observation is necessary for patients with high fibrinogen levels and vasopressor use. These results provide basic data to recognize the need for nursing intervention for peripheral cyanosis and encourage nurses to deliver them during therapeutic hypothermia.

• Journal of Korean Critical Care Nursing
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• v.14 no.3
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• pp.73-86
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• 2021

Purpose : This study aimed to investigate the effects of oropharyngeal sensory stimulation using low-temperature capsaicin on dysphagia, dietary level, aspiration pneumonia, and nutritional status in acute stroke patients with dysphagia admitted to a stroke intensive care unit. Methods : This study used a randomized controlled trial design and 43 participants were randomly assigned to the experimental group (n=21) or control group (n=22). An oropharyngeal sensory stimulation intervention program was constructed based on previous studies. The intervention was provided before meals twice a day for seven days and started with the first meal after hospitalization. In the control group, a solution was made using only bottled water without adding capsaicin solution, and the intervention was provided at the same time, method, and number of times as the experimental group. Results : As a result of the study, dysphagia and dietary level improved in the experimental group that received oropharyngeal sensory stimulation using capsaicin. There were no effects on the nutritional status or aspiration pneumonia. Conclusion : This study provides basic data for the development of an intervention program for patients with dysphagia by presenting a theoretical basis that oropharyngeal sensory stimulation intervention using capsaicin improves dysphagia and dietary levels.

• Journal of Korean Critical Care Nursing
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• v.12 no.1
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• pp.36-45
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• 2019

Purpose : The purpose of this study was to identify status and characteristics of patients who have been readmitted to ICU, and to analyze risk factors associated with the readmission to ICU within 48hours. Method: Data were collected from patient's electronic medical reports from one hospital in B city. Participants were 2,937 patients aged 18 years old or older admitted to the ICU. Data were analyzed using odd ratios (ORs) from multivariate logistic regressions. Results: 2.2% of the 2,937 patients were early readmitted to ICU. Risk factors for early readmission to ICU were existence of respiratory disease, use of mechanical ventilator, and duration of hospitalization (longer). Conclusion: The assessment on the respiratory system of the patient who will be discharged from the ICU was identified as an important nursing activity. Therefore, the respiratory system management and education should be actively conducted. In addition, early ICU readmission may be prevented and decreased if a link was built to share the information on patient condition between the ICU and general wards.