• 대한영양사협회학술지
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• 제1권1호
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• pp.21-30
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• 1995

Critically ill patients admitted in ICU and NCU were studied with respect to their nutritional status and support to them at initial period, and the effect of nutritional support after 3 weeks. The nutritional support was supplied to these patients with the enteral and parenteral nutrition. The results of biochemical test and status of nutritional support on 52(29 males, 23 females) critically ill patients were based on medical records and the anthropometry was measured on 28 patients. The subjects were in mild malnutrition. Their initial calorie intakes were 85% of BEE, 57% of total energy requirements and 49% of protein requirement were provided. Two groups, one group of serum albumin level more than 3.5g/dl and the other group of serum albumin level less than 3.5g/dl, were significant different in total calorie and protein intakes. After 3 weeks, inappropriate nutritional support in the group of normal nutrition results in significant decreasing of serum albumin level but, there were no changes in the group of malnutrition. Nutritional support is one of the mainstays in the management of these critically ill patients and is aimed at preventing malnutrition. Therefore, timely nutritional support is heavily required in cases of critically ill patients whether their initial nutritional status is normal or not.

• Tuberculosis and Respiratory Diseases
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• 제72권2호
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• pp.117-123
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• 2012

Optimal level of sedation and analgesia is important for the comfort and safety of critically ill patients. However, suboptimal sedation is relatively common in the intensive care unit (ICU) and it could cause prolonged mechanical ventilation and ICU stay, also increase delirium and ICU acquired weakness and resultant decreased survival. Therefore, accurate assessment of the level of sedation and analgesia, maintaining adequate level of sedation, and daily evaluation of each patient and following adjustment could be important treatment strategy in critically ill patients. Recently, the strategy for sedation in the ICU is changing toward the direction of lowering sedation level or even "no sedation" with concurrent use of analgesics and the use of ultra short acting analgesics could be helpful in some patients. Clinicians should be aware of the importance of algorithmic approach including daily interruption of sedative and assessment of sedation level and especially in the patients under mechanical ventilation, organizational approaches such as the 'ABCDE' bundle could improve the management of critically ill patients.

• 중환자간호학회지
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• 제3권1호
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• pp.79-88
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• 2010

Optimal nutrition serves to maintain normal organ function and to preserve body energy stores to guarantee survival during times of shortage of food. Adequate nutrition of intensive care unit (ICU) patients improves outcome, while malnutrition is strongly associated with increased morbidity and mortality rates among critically ill patients. Previously published researches showed that trials of nutritional support in critical illness rarely fulfill basic quality requirements. Nutrition support plays a vital role in the prevention and treatment of nutritional deficiencies in at-risk, critically ill patients. This paper reviewed the challenges in determining critically ill patients' nutrition requirements including nutrition assessment, determination of caloric requirements then providing them with adequate nutrition support while in the ICU with the guidelines published by Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Nutrition support can be effectively enhanced by using the guidelines.

• Clinical Nutrition Research
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• 제12권2호
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• pp.91-98
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• 2023

Adequate nutritional support is crucial in preventing complications and improving outcomes in critically ill patients. Extracorporeal membrane oxygenation (ECMO) is a mode of supportive care for patients with respiratory and/or cardiac failure. ECMO patients frequently exhibit a hypermetabolic state characterized by protein catabolism and insulin resistance, which can lead to malnutrition. Nutritional therapy is a vital component of intensive care, but its optimal administration for ECMO patients is unknown. This case report aims to provide insights into effective nutritional management for critically ill patients undergoing ECMO therapy. The patient was a 72-year-old male with a history of gastric and lung cancer who underwent a lobectomy complicated by bronchopleural fistula, postoperative bleeding, pneumonia, and acute respiratory distress syndrome (ARDS). The patient's nutritional status was assessed indicating a high risk of malnutrition, using the modified Nutrition Risk in the Critically Ill (mNUTRIC) Score. Nutritional support was administered based on the recommendations of European Society for Clinical Nutrition and Metabolism (ESPEN) and the American Society for Parenteral and Enteral Nutrition (ASPEN), with energy requirements set at 25-30 kcal/kg/d and protein requirements set at 1.2-2.0 g/kg/day. The patient received parenteral nutrition until the enteral nutrition target amount was reached, with zinc supplements for wound healing. The study highlights the need for further research on proactive and effective nutritional support for ECMO patients to improve compliance and prognosis.

• 중환자간호학회지
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• 제11권3호
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• pp.12-22
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• 2018

Purpose : This methodological study develops an oral health assessment tool for critically ill patients. Method : From February 15 to April 30, 2014, this study was conducted to test the validity and reliability of the tool at two general hospitals and three medical and surgical intensive care units (ICUs) in Seoul, Korea. Results : The result of the intraclass correlation coefficient to test the between-observer reliability by analyzing the oral health assessment scores before and after oral nursing care showed that .93 of before oral care and .90 of after oral care. The correlation coefficient values of .68 (p<.001) and .71 (p<.001) before and after providing oral nursing care, respectively, indicated the presence of a statistically significant correlation between the tool and the criterion. Using the paired t-test, the differentiated validity of the tool was tested in patients who had developed pneumonia after entering the ICU. A statistically significant difference in scores was found between the time of entering the ICU and that of developing pneumonia (t=-8.73, p<.001), which provided evidence for the differentiated validity of the tool. Conclusions : Since the validity and reliability of the tool developed in this study were verified, this tool can be used to assess the oral health conditions of critically ill patients.

• 한국의료질향상학회지
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• 제30권1호
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• pp.15-32
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• 2024

Purpose: The number of severely ill patients requiring post-acute care has been increasing. Careful discharge planning minimizes unplanned emergency room visits and readmissions. This study aimed to survey the knowledge, experience, confidence, and obstacles faced by medical residents and fellows regarding the discharge process of severely ill patients. Methods: A survey consisting of 27 questions was sent electronically to residents and fellows who had experience in discharging severely ill patients from a tertiary hospital in Korea. The survey was conducted over a two-week period from September 29, 2022. Results: A total of 98 residents and fellows responded to the survey. Of these, 94% experienced difficulties related to the discharge process. The main obstacle was changes in the patient's condition during discharge planning (92.3%). Although 95% of the respondents acknowledged the need for providing discharge information, only 53.1% of the residents and fellows practiced this. Only 42.9% of the respondents and 20.4% of residents and fellows explained local community healthcare and welfare resources to patients because of a lack of relevant knowledge (69.7%) and feeling no responsibility to explain (40.4%). Conclusion: This study revealed that residents and fellows experienced difficulties in devising discharge plans and providing post-acute care related information, despite recognizing the importance of these. These gaps result from the lack of a discharge planning curriculum regarding critically ill patients and appropriate training in the discharge process. This suggests that an integrated discharge planning curriculum should be developed and adopted in residents' training programs for the differentiated treatment of critically ill patients.

• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.84-93
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• 2024

Objective : We aimed to examine trends in critically ill neurology-neurosurgery (NNS) patients who were admitted to the intensive care unit (ICU) in South Korea and identify risk factors for in-hospital mortality after ICU admission in NNS patients. Methods : This nationwide population-based retrospective cohort study enrolled adult NNS adult patients admitted to the ICU from 2010 to 2019 extracted from the National Health Insurance Service in South Korea. The critically ill NNS patients were defined as those whose main admission departments were neurology or neurosurgery at ICU admission. The number of ICU admission, age, and total cost for hospitalization from 2010 to 2019 in critically ill NNS patients were examined as trend information. Moreover, multivariable logistic regression modeling was used to identify risk factors for in-hospital mortality among critically ill NNS patients. Results : We included 845474 ICU admission cases for 679376 critically ill NNS patients in South Korea between January 1, 2010 to December 31, 2019. The total number of ICU admissions among NNS patients was 79522 in 2010, which increased to 91502 in 2019. The mean age rose from 62.8 years (standard deviation [SD], 15.6) in 2010 to 66.6 years (SD, 15.2) in 2019, and the average total cost for hospitalization per each patient consistently increased from 6206.1 USD (SD, 5218.5) in 2010 to 10745.4 USD (SD, 10917.4) in 2019. In-hospital mortality occurred in 75455 patients (8.9%). Risk factors strongly associated with increased in-hospital mortality were the usage of mechanical ventilator (adjusted odds ratio [aOR], 19.83; 95% confidence interval [CI], 19.42-20.26; p<0.001), extracorporeal membrane oxygenation (aOR, 3.49; 95% CI, 2.42-5.02; p<0.001), and continuous renal replacement therapy (aOR, 6.47; 95% CI, 6.02-6.96; p<0.001). In addition, direct admission to ICU from the emergency room (aOR, 1.38; 95% CI, 1.36-1.41; p<0.001) and brain cancer as the main diagnosis (aOR, 1.30; 95% CI, 1.22-1.39; p<0.001) are also potential risk factors for increased in-hospital mortality. Conclusion : In South Korea, the number of ICU admissions increased among critically ill NNS patients from 2010 to 2019. The average age and total costs for hospitalization also increased. Some potential risk factors are found to increase in-hospital mortality among critically ill NNS patients.

• 부모자녀건강학회지
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• 제3권2호
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• pp.81-93
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• 2000

The role of the neonatal nurse specialist has been well established over the past decade and now reform in 21st century. Neonatal nurse specialists responsibilities in caring for critically and long-term chronically ill infants and their families are very important. Neonatal nurse specialists have a two fold responsibility in caring for these infants. First, through acquiring advanced practice education in complex neonatal care and diagnostic skills, neonatal nurse specialists meet the physiologic needs of the infant. Second, neonatal nurse specialists provide a more holistic approach to their care through evaluating the family in treatment plans and involving the family in discharge planning for the infant. In some institutions, neonatal nurse specialists are directly involved in institutional and/or home follow-up care and case management also. It is the neonatal nurse specialists responsibility to function collaboratively with the multidisciplinary team in managing critically or chronically ill infants from admission to discharge. The role of the neonatal nurse specialist case manager can be described as one that focuses on individualized care of the infant, while providing continuity of care to both the infant and family. The neonatal nurse specialist's role will vary depending on the neonatal intensive care unit(NICU). Therefore, the multidisciplinary collaborative approach to long-term management of infants in the NICU is extremely important to provide successful transition to home or to long-term rehabilitative care facilities because care for the chronically ill infant is complex and multifaceted. I suggest the role of neonatal nurse specialist in 21st century are as follows. 1. Diagnostic/patient assessment 2. Management of patient health/illness 3. Administering/monitoring therapeutic interventions and regimens 4. Monitoring/ensuring quality of health care practices 5. Organization and work role 6. Helping role 7. Teaching/coaching role 8. Management of rapidly changing situations 9. Consulting role The advanced practice nursing model of care delivered by neonatal nurse specialist's in the NICU incorporates medical and nursing role functions and emphasizes holism, caring, and a health perspective for critically and chronically ill neonates and their families.

• 중환자간호학회지
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• 제14권2호
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• pp.24-41
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• 2021

Purpose : The aim of this integrative review was to describe communication experiences and needs among the critically ill with an artificial airway and evaluate relevant intervention studies. Methods : Using the method employed by Whittemore and Knafl (2005), we searched for papers on PubMed, CINAHL, and Web of Science published from January 1, 2015 to September 25, 2020. A total of 26 papers (11 descriptive studies, 15 experimental ones) were identified and evaluated. Results : Communication experiences while having an artificial airway, identified either by patients' recall or direct observation, were predominantly negative. However, positive experiences were reported in patients with improvements in physical conditions and functions. Patients' communication needs were diverse, encompassing physical, psycho-emotional, social, spiritual, and medical issues. Interventions tested included alternative and augmentative communication strategies, communication intervention packages, and voice restorative devices. Physical, psychosocial, and communication-related patient outcomes were evaluated using various methods including self-report surveys, interviews, and observations. Conclusions : The findings from this review represent the state of science regarding communication of the critically ill whose vocal abilities are inhibited by the presence of an artificial airway. Future studies with rigorous experimental designs and measures are warranted to better understand and support the complex needs of this highly vulnerable patient population.

• Tuberculosis and Respiratory Diseases
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• 제69권6호
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• pp.480-482
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• 2010

Rectus sheath hematoma (RSH) is a rare condition caused by hemorrhage into the rectus sheath. It is usually associated with severe cough, abdominal surgery, coagulopathy, and anticoagulation treatment. RSH can be difficult to diagnose and can be misdiagnosed as acute appendicitis, as diverticulitis, or as an ovarian mass. Although RSH usually presents as a benign condition, it can be life threatening, especially in the critically-ill patient. Here, we report a case of fatal RSH due to hypovolemic shock in a critically-ill 73-year-old woman, who had received heparin treatment due to acute myocardial infarction in the intensive care unit and who had been successfully treated by conservative management.