• Tuberculosis and Respiratory Diseases
• /
• 제61권1호
• /
• pp.46-53
• /
• 2006

연구배경: IAP의 증가는 혈류량을 감소시켜 여러 장기에 영향을 준다. IAH는 IAP가 12 mmHg 이상 또는 APP가 60 mmHg 이하로, ACS는 IAP가 20 mmHg 이상이면서 동시에 하나 이상의 장기 손상이 있는 경우로 각각 정의한다. 저자들은 중환자에서 IAH 및 ACS의 유병률과 이들이 환자의 예후에 미치는 영향을 고찰하고자 하였다. 방 법: 고려대학교 의료원 중환자실에 입원하는 내과계 환자를 대상으로 하여, APACHE II 및 III 점수, SAPS II 점수를 기록하였다. IAP는 삼중관 요도관을 통하여, 입원 7일째까지 매일 3회 측정하였고, 환자가 사망하거나 일반 병실로 전실 또는 요도관을 제거할 때까지 계속하였다. 환자의 예후는 28일을 기준으로 판단하였다. 결 과: 총 111명 대상 환자들의 입원 1일 IAH 및 ACS의 유병률은 각각 47.7%, 15.3%였다. 사망군과 생존군 사이에 IAH의 유병률은 유의한 차이가 없었으나, ACS는 사망군에서 더 높았다 (p=0.004). 사망군에서 IAP는 더 높았고 (p=0.012), APP는 유의하게 낮았다 (p<0.001). 결 론: 중환자에서 입원 1일에 측정한 IAP의 증가, APP의 감소 및 ACS 발생은 환자의 사망과 연관이 있을 것으로 판단된다.

• Journal of Trauma and Injury
• /
• 제24권2호
• /
• pp.105-110
• /
• 2011

Purpose: Chest injuries in multiple trauma patients are major predisposing factor for increased length of stay in intensive care unit, prolonged mechanical ventilator, and respiratory complications such as pneumonia. The aim of this study is the evaluation of lung injury score as a risk factor for prolonged management in intensive care unit (ICU). Methods: Between June to August in 2011, 46 patients admitted to shock and trauma center in our hospital and 24 patients had associated chest damage without traumatic brain injury. Retrospectively, we calculated injury severity score (ISS), lung injury score, and the number of fractured ribs and performed nonparametric correlation analysis with length of stay in ICU and mechanical ventilator support. Results: Calculated lung injury score(<48 hours) was median 1(0-3) and ISS was median 30(8-38) in study population. They had median 2(0-14) fractured ribs. There were 2 bilateral fractures and 2 flail chest. Ventilator support was needed in 11(45.8%) of them for median 39 hours(6-166). The ISS of ventilator support group was median 34(24-34) and lung injury score was median 1.7(1.3-2.5). Tracheostomy was performed in one patient and it was only complicated case and ICU stay days was median 9(4-16). In correlation analysis, Lung injury score and ISS were significant with the length of stay in ICU but the number of fractured ribs and lung injury score were predicting factors for prolonged mechanical ventilator support. Conclusion: Lung injury score could be a possible prognostic factor for the prediction of increased length of stay in ICU and need for mechanical ventilator support.

• 대한영상의학회지
• /
• 제82권4호
• /
• pp.923-935
• /
• 2021

목적 흉부 외상에 의해 발생한 혈흉에 대해 동맥 색전술의 임상적 효용성을 보고하고자 한다. 대상과 방법 2015년부터 2019년까지 68명의(남자 56명; 평균 나이 58.2세) 흉부 출혈에 대한 동맥색전술을 시행 받은 환자가 포함되었다. 후향적으로 환자군의 특징, 혈관조영술 소견, 색전술에 사용한 기법, 기술적 및 임상적 성공률과 합병증을 조사하였다. 결과 출혈 부위는 늑간동맥(50%)이 가장 많았고, 그다음은 내흉동맥(29.5%)이었다. 한 명을 제외한 나머지 환자에서는 즉각적인 출혈 정지로 정의된 기술적 성공을 획득할 수 있었다. 첫 동맥 색전술 이후 네 명의 환자에서 지연 출혈 또는 혈흉의 증가 소견이 있었고, 이에 대해 반복적 동맥 색전술을 시행하여 성공적인 결과를 얻었다. 동맥 색전술 후 지혈 목적의 개흉술이 필요하지 않은 것으로 정의된 임상적 성공은 92.6%로 보고되었다. 다섯 명의 환자는 지혈을 위해 색전술 후 개흉술을 시행하였다. 뇌경색이나 사지 마비와 같은 동맥 색전술과 관련한 주요 합병증은 발생하지 않았다. 결론 외상성 흉벽 및 흉곽 내 장기 손상에 의한 동맥 출혈에 대해 시행하는 동맥 색전술은 안전하고 효과적인 최소 침습적 시술이다. 외상성 혈흉 환자에서 응급 수술을 필요로 하지 않는 혈흉만 있거나, 또는 동반된 복부나 골반 손상의 지혈을 위해 응급 동맥 색전술을 시행하는 경우, 흉부 영역의 동맥 색전술을 고려할 수 있다.

• 대한간호학회지
• /
• 제42권3호
• /
• pp.396-404
• /
• 2012

Purpose: The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities. Methods: The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit. Results: The mean age was 62.24 (${\pm}17.28$) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(${\pm}2.94$) and they had on average 4.01(${\pm}1.35$) risk factors. In the multiple logistic regression, body mass index (odds ratio=1.14) and leg swelling (odds ratio=6.05) were significant predictors of deep vein thrombosis. Conclusion: Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.

• 성인간호학회지
• /
• 제26권5호
• /
• pp.573-583
• /
• 2014

Purpose: Cardiac arrest has multiple characteristics that need to be approached as an integrated method according to the various changes in the body system. This study was performed to develop a useful guideline for early detection of cardiac arrest by revealing the attributes of cardiac arrest through a concept analysis. Methods: This study was conducted according to the Walker and Avant's concept analysis method. Systematic literature review and in-depth interview with nurses who experienced cardiac arrest situation were conducted. Based on the literature reviews and in-depth interviews with nurses, the attributes and the empirical referents of the concept of cardiac arrest were elicited. Results: The definable attributes of cardiac arrest were 1) loss of consciousness, 2) abnormal respiratory condition, 3) abnormal cardiovascular signs. Cardiac arrest was found to occur by several antecedents such as cardiac problem, non-cardiac problem, or general problem, whereas ischemia and re-perfusion injury, which can lead to multiple organ failure and death, were derived as consequences. Conclusion: In this study, the concept analysis eliciting attributes and empirical referents is found to be useful as a guideline for understanding and managing cardiac arrest. Based on these findings, clinical providers are expected to make a precise and rapid decision on cardiac arrest and respond quickly, which may increase survival rate of the patients underwent the arrest event.

• 대한간호학회지
• /
• 제36권4호
• /
• pp.621-629
• /
• 2006

Purpose. The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. Methods. The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. Results. The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. Conclusions. The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation methods. This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.

• Tuberculosis and Respiratory Diseases
• /
• 제70권3호
• /
• pp.191-198
• /
• 2011

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in the intensive care unit (ICU), with an incidence ranging from 8% to 38%. Patients who acquire VAP have higher mortality rates and longer ICU and hospital stays. Because there are other potential causes of fever, leukocytosis, and pulmonary infiltrates, clinical diagnosis of VAP is overly sensitive. The only alternative approach to the clinical diagnosis of VAP is the Clinical Pulmonary Infection Score (CPIS). Employing quantitative cultures of respiratory secretions in the diagnosis of VAP leads to less antibiotic use and probably to lower mortality. With respect to microbiologic diagnosis, however, it is not clear that the use of invasive sampling using bronchoscopy is associated with better outcomes. Delayed administration of antibiotic therapy is associated with an increased mortality, and inadequate antibiotic therapy is also associated with higher mortality. Therefore, prompt initiation of adequate antibiotic therapy is a cornerstone of the treatment of VAP. The initial antibiotic therapy should be based on the most common organisms in each hospital and the most likely pathogens for that specific patient. When final cultures and susceptibilities are available, de-escalation to less broad spectrum antibiotics should be done. Since clinical improvement usually takes 2 to 3 days, clinical responses to the initial empirical therapy should be evaluated by day 3. A short course of antibiotic therapy appears to be equivalent to a traditional course of more than 14 days, except when treating non-fermenting gram-negative organisms. If patients receive initially adequate antibiotic therapy, efforts should be made to shorten the duration of therapy to as short as 7 days, provided that the etiologic pathogen is not a non-fermenting gram-negative organism.

• 대한임상독성학회지
• /
• 제19권2호
• /
• pp.93-99
• /
• 2021

Purpose: Nutritional status and support in critically ill patients are important factors in determining patient recovery and prognosis. The aim of this study was to analyze the early nutritional status and the methods of nutritional support in critically ill patients with acute poisoning and to evaluate the effect of nutritional status on prognosis. Methods: A retrospective study was conducted in tertiary care teaching hospital from January 2018 to December 2020. in an emergency department of university hospital, 220 patients who were stayed more than 2 days of poisoning in intensive care unit were enrolled. Results: 155 (70.5%) of patients with acute poisoning had low-risk in nutritional risk screening (NRS). Patients with malignancy had higher NRS (low risk 5.2%, moderate risk 18.5%, high risk 13.2%, p=0.024). Patients of 91.4% supplied nutrition via oral route or enteral route. Parenteral route for starting method of nutritional support were higher in patients with acute poisoning of herbicide or pesticide (medicine 3.2%, herbicide 13.8%, pesticide 22.2%, p=0.000). In multivariate logistic regression analysis, herbicide or pesticide intoxication, higher risk in NRS and sequential organ failure assessment over 4.5 were affecting factor on poor recovery at discharge. Conclusion: NRS in patients intoxicated with herbicide or pesticide were higher than that in patients intoxicated with medicine intoxication. Enteral nutrition in patients intoxicated with herbicide or pesticide was less common. Initial NRS was correlated with recovery at discharge in patient with intoxication. It is expected to be helpful in finding patients with high-risk nutritional status in acute poisoning patients and establishing a treatment plan that can actively implement nutritional support.

• Journal of Trauma and Injury
• /
• 제32권2호
• /
• pp.86-92
• /
• 2019

Purpose: There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population. Methods: Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8-12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as $IAP{\geq}12mmHg$. Abdominal compartment syndrome was defined as $IAP{\geq}20mmHg$ plus ${\geq}1$ new organ failure. The main outcome measure was in-hospital mortality. Results: According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with $IAP{\geq}20mmHg$ than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum $IAP{\geq}20mmHg$ exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values. Conclusions: Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.

• 대한화상학회지
• /
• 제23권1호
• /
• pp.1-6
• /
• 2020

Purpose: PL, creatinine and urine output are biomarkers of the suitability and prognosis of fluid therapy in severe burn patients. The purpose of this study is to evaluate the usefulness of predicting mortality by biomarkers and its change during initial fluid therapy for severe burn patients. Methods: A retrograde review was performed on 733 patients from January 2014 to December 2018 who were admitted as severe burn patients to our burn intensive care unit (BICU). Plasma lactate, serum creatinine and urine output were measured at the time of admission to the BICU and after 48 hours. ABSI score, Hangang score, APACHEII, revised Baux index and TBSA were collected after admission. Results: 733 patients were enrolled. PL was the most useful indicators for predicting mortality in burn patients at the time of admission (AUC: 0.813) and after 48 hours (AUC: 0.698). On the other hand, mortality prediction from initial fluid therapy for 48 hours showed different results. Only creatinine showed statistical differences (P<0.05) in mortality prediction. But there were no statistical differences in mortality prediction with PL and UO (P>0.05). Conclusion: In this study, PL was most useful predictor among biomarkers for predicting mortality. Improvement in creatinine levels during the first 48 hours is associated with improved mortality. Therefore, efforts are needed to improve creatinine levels.