• Journal of Korean Clinical Nursing Research
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• v.26 no.2
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• pp.207-216
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• 2020

Purpose: The purpose of this study was to investigate the motor subtypes of delirium in patients in a Surgical Intensive Care Unit (SICU), and identify the factors related to the characteristics of patients according to the motor subtypes of delirium. Methods: Data were collected in the SICU of a tertiary hospital in ^⁎ city from October 2018 to June 2019. Delirium was detected using the Confusion Assessment Method for the ICU (CAM-ICU) and motor subtypes of delirium were measured with the Delirium Motor Subtype Scale (DMSS)-4. Patients' characteristics were obtained by using the electronic medical records. Descriptive statistics were used to analyze the data. Results: Among 1,112 patients, 172 patients showed delirium (15.5%). After excluding dementia patients and patients refusing to participate in the study, 126 patients included in the final analysis. Delirium patients were classified as hyperactive delirium (32.5%), hypoactive delirium (42.9%), mixed delirium (11.9%), and non-motor subtype delirium (12.7%). Conclusion: The study results suggest that hypoactive delirium is the most prevalent motor subtype of delirium in SICU. More application of ventilators, more administration of sedatives, more use of catheters, and higher nursing severity were reported for hypoactive delirium cases than hyperactive ones. Therefore, it is necessary to assess early the motor subtypes of delirium using structured tools and develop appropriate nursing interventions suitable for each subtype of delirium.

• Journal of Yeungnam Medical Science
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• v.40 no.2
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• pp.187-192
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• 2023

Background: This study aimed to present the short- and midterm outcomes after complete atrioventricular canal defect (CAVC) repair using a single-patch technique. Methods: This study included 30 children who underwent surgical correction of the CAVC using a single-patch technique. Results: The median age of the patients was 5.7 months (interquartile range [IQR], 5.0-7.5 months), and 23 patients (76.7%) had type A CAVC. Fourteen patients (46.7%) were female and 17 (56.7%) had been diagnosed with Down syndrome. The in-hospital mortality rate was 0%. No deaths were observed during a median follow-up of 4 years (IQR, 3.5-5.0 years). Patients without Down syndrome were associated with late moderate mitral regurgitation (MR) (p=0.02). Late MR less than moderate degree was observed in 96.6%, 78.5%, and 50% of patients after 2, 4, and 5 years of follow-up, respectively, while late tricuspid valve regurgitation less than moderate degree was observed in 96.7%, 85.9%, and 59.0% of patients after 2, 4, and 6 years of follow-up, respectively. After a median follow-up of 4 years, only one patient had required surgical repair of a left ventricular outflow tract obstruction, which occurred 26 months after the first operation. Multivariable logistic regression analysis adjusted for the type of CAVC, sex, Down syndrome, age, and weight revealed that the absence of Down syndrome was a risk factor for late moderate MR (MR-2) (odds ratio, 0.05; 95% confidence interval, 0.006-0.50; p=0.01). Conclusion: A single-patch technique for CAVC surgical repair is a safe method with acceptable short- and midterm results.

• Perinatology
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• v.29 no.4
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• pp.175-179
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• 2018

Pneumatocele (PC) is a thin-walled cyst of the lung that can occur at all ages and with various etiologies. However, there is no fully accepted consensus for the management of PC in a neonatal intensive care unit. Although the management of PC is generally expectant, it is difficult to decide how long conservative management should be maintained, especially under Korea's medical care environment and the parents' worry and anxiety. We report a male neonate, born at $27^{+5}weeks$ gestation, weighing 1,000 g, who had a post infectious PC caused by methicillin-resistant Staphylococcus aureus sepsis. We treated conservatively for about 100 days (roughly 14 weeks), but unfortunately after a few days of chest retraction, acute exacerbation occurred, video assisted thoracoscopic surgery (VATS) was deemed necessary and performed. The purpose of this publication is to describe the clinical course, aggravation and relief after VATS management with a review of the literature.

• Korean Journal of Adult Nursing
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• v.18 no.2
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• pp.314-322
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• 2006

Purpose: This study was designed to verify effects of perineal care with aroma essential oil on urinary tract infection(UTI) in patients with indwelling urinary catheter. Method: The research design was non equivalent control group pretest-post test design. The data were collected from March to August, 2005 at C university hospital in Seoul. The subjects were 43 patients who had a indwelling catheter in neurosurgery intensive care unit(NSICU). They were assigned to two groups, 21 subjects to the experimental group and 22 subjects to the control group. The experimental group received perineal care with 3% blending essential oil for 4 days. Results: In the experimental group, white blood cells and bacteria in urine were significantly lower than control group. Bacteria in urine culture was lower in the experimental group at post test. Conclusion: Perineal care with aroma essential oil could be an effective intervention to reduce the UTI of patients in NSICU.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.463-469
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• 1991

Post-anastomotic leakage and stenoses remain major complications and are still responsible for many mortalities after esophageal reconstructive procedures. If the hand-suture is used, anastomotic leaks developed frequently than stenoses. But post-anastomotic leakages are more critical than post-anastomotic stenoses. If the stapler is used, anastomotic stenoses will develop frequently and not critical than anastomotic leakages. The stapler suture method is easier and quicker than the hand suture method in the esophageal anastomotic procedures. But the disadvantages of the stapler suture method is that there is not reachable site with anastomotic stapler the thoracic inlet region and the cost is expensive. We have treated 44 cases of the surgical complications after esophageal reconstructive procedure with conservative and surgical treatment for 10 years from January, 1980 to December, 1989. The anastomotic site stenoses were 8 cases in the hand-suture methods and 4 cases in the stapler-suture methods. The anastomotic leaks were 8 cases in hand-suture methods and 5 cases in stapler-suture methods. There were one death in the surgical repair of four post-operative anastomotic stenoses and two deaths in the surgical repair of three post-operative anastomotic leakages. Ever though we consider that there is more anastomotic leakage than stenoses after the hand-suture methods in esophageal reconstructive procedures. the cost with long stay in the intensive care unit to treat anastomotic leakage after the hand-suture, would be more expensive than-the cost of the treatment of the anastomotic stenoses after auto-suture.

• The Korean Journal of Pain
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• v.31 no.4
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• pp.296-304
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• 2018

Epiduroscopy is defined as a percutaneous, minimally invasive endoscopic investigation of the epidural space. Periduroscopy is currently used mainly as a diagnostic tool to directly visualize epidural adhesions in patients with failed back surgery syndrome (FBSS), and as a therapeutic action in patients with low back pain by accurately administering drugs, releasing inflammation, washing the epidural space, and mechanically releasing the scars displayed. Considering epiduroscopy a minimally invasive technique should not lead to underestimating its potential complications. The purpose of this review is to summarize and explain the mechanisms of the side effects strictly related to the technique itself, leaving aside complications considered typical for any kind of extradural procedure (e.g. adverse reactions due to the administration of drugs or bleeding) and not fitting the usual concept of epiduroscopy for which the data on its real usefulness are still lacking. The most frequent complications and side effects of epiduroscopy can be summarized as non-persistent post-procedural low back and/or leg discomfort/pain, transient neurological symptoms (headache, hearing impairment, paresthesia), dural puncture with or without post dural puncture headache (PDPH), post-procedural visual impairment with retinal hemorrhage, encephalopathy resulting in rhabdomyolysis due to a dural tear, intradural cyst, as well as neurogenic bladder and seizures. We also report for first time, to our knowledge, a case of symptomatic pneumocephalus after epiduroscopy, and try to explain the reason for this event and the precautions to avoid this complication.

• Korean Journal of Radiology
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• v.23 no.9
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• pp.878-888
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• 2022

Objective: To investigate the clinical impact of a quality improvement program including dedicated emergency radiology personnel (QIP-DERP) on the management of emergency surgical patients in the emergency department (ED). Materials and Methods: This retrospective study identified all adult patients (n = 3667) who underwent preoperative body CT, for which written radiology reports were generated, and who subsequently underwent non-elective surgery between 2007 and 2018 in the ED of a single urban academic tertiary medical institution. The study cohort was divided into periods before and after the initiation of QIP-DERP. We matched the control group patients (i.e., before QIP-DERP) to the QIP-DERP group patients using propensity score (PS), with a 1:2 matching ratio for the main analysis and a 1:1 ratio for sub-analyses separately for daytime (8:00 AM to 5:00 PM on weekdays) and after-hours. The primary outcome was timing of emergency surgery (TES), which was defined as the time from ED arrival to surgical intervention. The secondary outcomes included ED length of stay (LOS) and intensive care unit (ICU) admission rate. Results: According to the PS-matched analysis, compared with the control group, QIP-DERP significantly decreased the median TES from 16.7 hours (interquartile range, 9.4-27.5 hours) to 11.6 hours (6.6-21.9 hours) (p < 0.001) and the ICU admission rate from 33.3% (205/616) to 23.9% (295/1232) (p < 0.001). During after-hours, the QIP-DERP significantly reduced median TES from 19.9 hours (12.5-30.1 hours) to 9.6 hours (5.7-19.1 hours) (p < 0.001), median ED LOS from 9.1 hours (5.6-16.5 hours) to 6.7 hours (4.9-11.3 hours) (p < 0.001), and ICU admission rate from 35.5% (108/304) to 22.0% (67/304) (p < 0.001). Conclusion: QIP-DERP implementation improved the quality of emergency surgical management in the ED by reducing TES, ED LOS, and ICU admission rate, particularly during after-hours.

• Asian Journal of Business Environment
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• v.7 no.3
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• pp.17-22
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• 2017

Purpose - Clarifying one of the biggest public Hospital Costs and incomes according to patients' case mix. It leads to prepare financial information about pubic medical tariffs and hospital operational costs. Research design, data, and methodology - This study calculates the costs both, with and without taking into account capital costs. This holds for comparison of hoteling based on case mix in all medical procedures. The checklists were reviewed and filled by reviewing accounting documents of the hospital, warehouse exclusion list, and daily books of laundry and CSR. Data was analyzed descriptively by using Excel. Results - In both cases, the hospital is losing in terms of hoteling. Because the buildings and equipment are new, this loss is not tangible. However, this will be revealed when costs of reconstruction and replacement of equipment. The loss rate per day of hospitalization was 569318 Rials for Coronary Care Unit (CCU), 528171 Rials for Post Intensive Care Unit (Post ICU), 474570 Rials for ICU, 233183 Rials for Post CCU and 204803 for Surgical ward. Conclusions - Income of hoteling was lower than its costs. ANOVA showed a strong relationship between case mix and hospital costs as well as case mix and its income. This suggests that optimal case mix can minimize the costs and maximize income.

• Korean Journal of Head & Neck Oncology
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• v.18 no.1
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• pp.71-75
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• 2002

Background and Objectives: The tracheotomy is one of the most essential surgical procedures performed in the intensive care unit (ICU). The tracheal stenosis, as a complication following endotracheal intubation or tracheotomy, has been the subject of considerable recent investigation. Many different methods have been developed to avoid the tracheal stenosis but there is still controversy about the tracheal incisions. We had performed tracheotomy using a vertical elliptical tracheal incision in the ICU to evaluate its efficiency and safety. Materials and Methods: 191 patients who underwent the tracheotomy in the ICU between 1995 and 2000 were reviewed retrospectively by chart records and interviews. Results: The complications were reported such as bleeding, infection, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula and tracheal stenosis. The total numbers of complications were 35 cases (18.3%) and the tracheal stenosis was developed in 4 patients. The characteristics of tracheal stenosis are as follows. Conclusion: The vertical elliptical tracheal incision is the safe and reliable methods in ICU patients compared with other methods, but other factors are also important in preventing the complications.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.630-637
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• 2000

Backgroud: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. Material and Method: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). Result: There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. Conclusion: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.