Early Predictors of High-Flow Nasal Cannula Oxygen Therapy Failure in the Emergency Room / 계명의대학술지

High flow nasal cannula (HFNC) oxygen therapy has become a substitute for other non-invasive ventilation (NIV) and mechanical ventilation in patients with respiratory failure. Despite its strong points, HFNC may result in failure of therapy, and delayed intubation leads to poor patient outcomes. This study is aimed to identify the variables that predicts HFNC oxygen therapy failure in order to increment success rate and prevent delayed intubation. The study was conducted in a retrospective manner, enrolling all non-traumatic patients over the age 20 who visited a single university-affiliated tertiary medical center emergency room and were treated with HFNC between March 1, 2016 to Feburary 28, 2017. Patients were classified into two groups: HFNC success group, and HFNC failure group: HFNC failure group was defined as patients who were treated with HFNC, and resulted in intubation and mechanical ventilation, or death. General characteristics, clinical features, and laboratory findings of the two groups were compared. Additionally, univariable logistic regression was done for statistically significant variables, and if the p-value was < 0.05, multivariable logistic regression analysis was conducted. 95 patients were enrolled in the study. Repeated-measure ANOVA was conducted for serial arterial blood gas samples during therapy. 62 patients were successful in the treatment, and the treatment failed in 33 cases. After multivariate logistic regression analysis, variable that showed statistically significant association with HFNC failure was initial hematocrits (p < 0.05). Repeated-measure ANOVA revealed low bicarbonate as a predictor of HFNC failure. Predictors of HFNC therapy failure are initial hematocrits, bicarbonate levels during therapy.

Limitation of Psychiatric Intervention for Suicidal Drug Intoxication Patients in Emergency Room

PURPOSE: This study was designed to determine the factors hindering psychiatric intervention for suicide attempters in the emergency room (ER). METHODS: Participants were 299 patients aged 18 years or older admitted to the ER for suicidal drug overdose between July 2012 and June 2014. Patients were divided into two groups according to whether they had received psychiatric treatment in the ER. Medical histories and follow-up treatments were determined by examining patients' medical records and through phone surveys, and were then compared using χ2-test and Fisher's exact test. In addition, the rate of satisfaction of the treatment group and the reasons for their dissatisfaction were also determined. RESULTS: The treatment and non-treatment groups comprised 135 (45%) and 164 patients (55%), respectively. Factors influencing participation in psychiatric intervention were previous history of suicide attempts (p=0.004), history of psychiatric disorder (p<0.001), time of day (p=0.039), and day of the week (p=0.040) of arrival in the ER. Whether or not the patient received follow-up psychiatric treatment was not significantly relevant (p=0.300). Of the 82 patients who participated in the treatment satisfaction survey, 50.2% reported being unsatisfied, mainly because of unfriendly medical personnel (36.6%), discomfort regarding other people's perceptions (24.4%), and cursory care (14.6%). CONCLUSION: To raise the participation rate of psychiatric consult, cooperation with psychiatry at night and on weekends is required, and incorporation of patients without previous history of suicidal attempt or other psychiatric disorder is important. Resolution of complaints toward psychiatric consult in suicide attempt survivors is also required.

Limitation of Psychiatric Intervention for Suicidal Drug Intoxication Patients in Emergency Room

PURPOSE: This study was designed to determine the factors hindering psychiatric intervention for suicide attempters in the emergency room (ER). METHODS: Participants were 299 patients aged 18 years or older admitted to the ER for suicidal drug overdose between July 2012 and June 2014. Patients were divided into two groups according to whether they had received psychiatric treatment in the ER. Medical histories and follow-up treatments were determined by examining patients' medical records and through phone surveys, and were then compared using χ2-test and Fisher's exact test. In addition, the rate of satisfaction of the treatment group and the reasons for their dissatisfaction were also determined. RESULTS: The treatment and non-treatment groups comprised 135 (45%) and 164 patients (55%), respectively. Factors influencing participation in psychiatric intervention were previous history of suicide attempts (p=0.004), history of psychiatric disorder (p<0.001), time of day (p=0.039), and day of the week (p=0.040) of arrival in the ER. Whether or not the patient received follow-up psychiatric treatment was not significantly relevant (p=0.300). Of the 82 patients who participated in the treatment satisfaction survey, 50.2% reported being unsatisfied, mainly because of unfriendly medical personnel (36.6%), discomfort regarding other people's perceptions (24.4%), and cursory care (14.6%). CONCLUSION: To raise the participation rate of psychiatric consult, cooperation with psychiatry at night and on weekends is required, and incorporation of patients without previous history of suicidal attempt or other psychiatric disorder is important. Resolution of complaints toward psychiatric consult in suicide attempt survivors is also required.