RESUMO
Background@#Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. @*Methods@#From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. @*Results@#Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). @*Conclusion@#In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.
RESUMO
Gastric variceal bleeding has a poor prognosis and a high mortality rate. Balloon-occluded retrograde transvenous obliteration has traditionally been applied in the treatment of gastric varix. Recently, plug-assisted retrograde transvenous obliteration (PARTO) has been widely and popularly applied for the treatment of gastric varix. There have been no reports of cases in which PARTO was performed in patients with both gastrorenal shunt and gastrocaval shunt. We report a case in which PARTO was performed on a patient with gastric varix who had both a gastrorenal shunt and a gastrocaval shunt.
RESUMO
Oral care is easily neglected in patients in an intensive care unit (ICU) because they are often intubated or have altered mental status. Although care workers pay careful attention to the mouth, tooth loss often occurs in the ICU. Here we report 3 cases of dental bridge loss undetected by the ICU staff. One patient was under mechanical ventilation via an endotracheal tube after emergency intubation, whilst 2 patients were drowsy but not intubated. Consecutive chest X-rays revealed dental bridge loss in all 3 cases, but this was not identified immediately. Along with other critical management approaches, these cases demonstrate how an initial evaluation of the oral cavity, with special attention to the number of teeth, and the existence of dental prosthetics is essential to preventing potential deleterious complications. The number of teeth and the existence of dental prosthetics must be documented in ICU patients.
RESUMO
In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist.The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of “no-touch time,” circulatory death was declared.Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.
RESUMO
Purpose@#The severity of a patient’s medical condition, changing pharmacodynamics and pharmacokinetics, and variability in medication highlight the importance of pharmacological intervention by intensive care unit (ICU) specialized pharmacists. @*Methods@#Retrospective observations of ICU interventions (omission, changes in medicine, side effects, changes in administration route and dosage, redundancy, and nutritional care) performed between April 2017 and March 2018, determined by an interdisciplinary team (including a specialized ICU pharmacist and a surgical intensivist) on their surgical ICU round, were analyzed. Medicinal prescriptions were screened weekly during the surgical ICU round, and interventions were made if any corrections were necessary. Two days later another team including a surgical intensivist, a pharmacist, and a nutritionist evaluated the patients’ nutritional status (performed weekly). @*Results@#In the 23-bed ICU, the average number of patients whose prescriptions were examined was 22.38 per surgical round. There were 382 interventions made over 1 year, which was 9.68 interventions per day. The interventions were for nutritional care (161 cases, 42.2%), followed by changes in administration route and dosage (94 cases, 24.6%), omission (59 cases, 15.5%), redundancy (40 cases, 10.4%), changes in medicine (15 cases, 3.9%), and side effects (13 cases, 3.4%). @*Conclusion@#The conditions of patients admitted to ICU are typically unstable. Pharmacological interventions suggested by a specialized pharmacist may help control the changing medical condition of patients in ICU. A higher participation of pharmacists specialized in working in an interdisciplinary ICU team-based system could lead to safer treatments.
RESUMO
In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist.The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of “no-touch time,” circulatory death was declared.Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.
RESUMO
Purpose@#The severity of a patient’s medical condition, changing pharmacodynamics and pharmacokinetics, and variability in medication highlight the importance of pharmacological intervention by intensive care unit (ICU) specialized pharmacists. @*Methods@#Retrospective observations of ICU interventions (omission, changes in medicine, side effects, changes in administration route and dosage, redundancy, and nutritional care) performed between April 2017 and March 2018, determined by an interdisciplinary team (including a specialized ICU pharmacist and a surgical intensivist) on their surgical ICU round, were analyzed. Medicinal prescriptions were screened weekly during the surgical ICU round, and interventions were made if any corrections were necessary. Two days later another team including a surgical intensivist, a pharmacist, and a nutritionist evaluated the patients’ nutritional status (performed weekly). @*Results@#In the 23-bed ICU, the average number of patients whose prescriptions were examined was 22.38 per surgical round. There were 382 interventions made over 1 year, which was 9.68 interventions per day. The interventions were for nutritional care (161 cases, 42.2%), followed by changes in administration route and dosage (94 cases, 24.6%), omission (59 cases, 15.5%), redundancy (40 cases, 10.4%), changes in medicine (15 cases, 3.9%), and side effects (13 cases, 3.4%). @*Conclusion@#The conditions of patients admitted to ICU are typically unstable. Pharmacological interventions suggested by a specialized pharmacist may help control the changing medical condition of patients in ICU. A higher participation of pharmacists specialized in working in an interdisciplinary ICU team-based system could lead to safer treatments.
RESUMO
Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis (PVT). Additionally, hepatic arterial infusion chemotherapy has been used as a treatment option for advanced HCC. Here, we report a case of sustained partial response in a patient with advanced HCC with PVT after hepatic arterial infusion chemotherapy and radiation therapy.
RESUMO
PURPOSE@#To evaluate effectiveness of percutaneous transluminal angioplasty (PTA) for transposed brachiobasilic arteriovenous fistula (tBBAVF), and to analyze the factors influencing patency after PTA.@*MATERIALS AND METHODS@#In 101 patients who underwent operation for tBBAVF from January 2006 to February 2008, we identified 42 patients undergoing PTA. We conducted a retrospective analysis of sequential PTAs in these patients from 2006 to 2017.@*RESULTS@#A total of 100 PTAs were performed. The technical success rate was 93% and the clinical success was 100%. Only ruptures occurred in 12% as minor complications. Primary patency rate was 61%, 29%, 7%, and secondary patency was 91%, 82%, 59% at 6, 12, and 24 months, respectively. Primary patency rate was lower in tBBAVF with rupture (p = 0.024). Secondary patency rate was significantly lower in the diabetes (p = 0.002).@*CONCLUSION@#Repetitive PTAs in tBBAVF are acceptable due to excellent secondary patency. Primary patency of tBBAVF is low in patients with rupture. Diabetes itself has a significant effect on secondary patency.
RESUMO
PURPOSE@#To evaluate the effectiveness of pelvic arterial embolization (PAE) for intractable postpartum hemorrhage (PPH) after hysterectomy.@*MATERIALS AND METHODS@#From March 2011 to December 2017, 14 patients who received PAE for PPH that persisted after total abdominal hysterectomy were included (mean age, 33.6 years; range, 26–37 years). The delivery type, cause of PPH, and angiographic findings were investigated. The technical and clinical success rates and clinical outcomes were evaluated.@*RESULTS@#Of 14 patients, 8 patients (57%) had positive angiographic findings for bleeding; contrast extravasation (n = 6), and pseudoaneurysm (n = 2). Remnant uterine artery (UA) was the most common bleeding focus (n = 4), followed by vaginal artery (n = 2), left lateral sacral artery (n = 1), and left internal pudendal artery (n = 1). Technical and clinical success rates were 100% and 93% (13/14), respectively. In 1 patient, bleeding was not controlled after initial selective embolization and the entire anterior divisions of both internal iliac arteries were embolized with gelfoam.@*CONCLUSION@#PAE for persistent PPH after hysterectomy is a safe and effective treatment. Remnant UA was the most common bleeding site and all patients recovered without any significant sequelae after embolization.
RESUMO
BACKGROUND: This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. METHODS: Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. RESULTS: From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. CONCLUSION: The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.
Assuntos
Humanos , Morte Encefálica , Coreia (Geográfico) , Corpo Clínico Hospitalar , Estudos Retrospectivos , Estatística como Assunto , Obtenção de Tecidos e Órgãos , Doadores de Tecidos , TransplanteRESUMO
BACKGROUND: For phosphate control, patient education is essential due to the limited clearance of phosphate by dialysis. However, well-designed randomized controlled trials about dietary and phosphate binder education have been scarce. METHODS: We enrolled maintenance hemodialysis patients and randomized them into an education group (n = 48) or a control group (n = 22). We assessed the patients’ drug compliance and their knowledge about the phosphate binder using a questionnaire. RESULTS: The primary goal was to increase the number of patients who reached a calcium-phosphorus product of lower than 55. In the education group, 36 (75.0%) patients achieved the primary goal, as compared with 16 (72.7%) in the control group (P = 0.430). The education increased the proportion of patients who properly took the phosphate binder (22.9% vs. 3.5%, P = 0.087), but not to statistical significance. Education did not affect the amount of dietary phosphate intake per body weight (education vs. control: −1.18 ± 3.54 vs. −0.88 ± 2.04 mg/kg, P = 0.851). However, the dietary phosphate-to-protein ratio tended to be lower in the education group (−0.64 ± 2.04 vs. 0.65 ± 3.55, P = 0.193). The education on phosphate restriction affected neither the Patient-Generated Subjective Global Assessment score (0.17 ± 4.58 vs. −0.86 ± 3.86, P = 0.363) nor the level of dietary protein intake (−0.03 ± 0.33 vs. −0.09 ± 0.18, P = 0.569). CONCLUSION: Education did not affect the calcium-phosphate product. Education on the proper timing of phosphate binder intake and the dietary phosphate-to-protein ratio showed marginal efficacy.
Assuntos
Humanos , Peso Corporal , Complacência (Medida de Distensibilidade) , Diálise , Dieta , Proteínas Alimentares , Educação , Hiperfosfatemia , Educação de Pacientes como Assunto , Fosfatos , Diálise RenalRESUMO
BACKGROUND: Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition. METHODS: A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated. RESULTS: The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001). CONCLUSION: Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.
Assuntos
Humanos , Estudos Transversais , Hospitalização , Unidades de Terapia Intensiva , Coreia (Geográfico) , Tempo de Internação , Modelos Logísticos , Desnutrição , Análise Multivariada , Avaliação Nutricional , Estado Nutricional , Prevalência , Fatores de Risco , Taxa de SobrevidaRESUMO
Critically ill and injured patients admitted in the intensive care unit have a range of diseases with various severities. Their conditions should be assessed and the patients should receive specialized nutrition therapy depending on their condition. Like general intensive care, nutrition therapy is upgraded every few years with revised information to provide more idealized nutrition support. The main guidelines in this review are from the Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Their previous 2009 guidelines were revised and published in 2016. This review summarizes the 2016 SCCM/ASPEN guidelines focusing on the changes from the previous 2009 guidelines.
Assuntos
Humanos , Cuidados Críticos , Estado Terminal , Nutrição Enteral , Unidades de Terapia Intensiva , Terapia Nutricional , Apoio NutricionalRESUMO
Transplantation of the horseshoe kidney can be performed en bloc or split into 2 grafts according to the vascular anomaly and the existence of the urinary collecting system in isthmus. From 2011 to 2014, there were 3 horseshoe kidney transplantations in Korea and transplantations were performed at 2 different centers. The transplantations were carried out successfully for all recipients without complications. All recipients have shown good graft kidney function after transplantation. No severe complication was revealed during follow-up period. We described the surgical technique used in the en bloc method to overcome various vascular anomalies and difficulties in choosing cannulation site and postoperative complications. En bloc transplantation of a horseshoe kidney is a useful strategy for patients with end-stage renal disease, and can provide favorable outcomes compared to the transplantation of a normal kidney.
Assuntos
Humanos , Cateterismo , Seguimentos , Rim Fundido , Rim , Falência Renal Crônica , Transplante de Rim , Coreia (Geográfico) , Métodos , Complicações Pós-Operatórias , TransplantesRESUMO
Intervention treatment such as balloon retrograde or anterograde transvenous obliteration has been used for management of refractory hepatic encephalopathy as well as gastric variceal bleeding. Recently, plug-assisted retrograde transvenous obliteration without a help of balloon was newly developed to treat these patients. Here, we report three cases suffering refractory hepatic encephalopathy who were treated with this new technique.
Assuntos
Humanos , Oclusão com Balão , Varizes Esofágicas e Gástricas , Encefalopatia Hepática , Derivação Portossistêmica Cirúrgica , Derivação Esplenorrenal CirúrgicaRESUMO
BACKGROUND: Analyzing the medical expenses of the family members of brain dead organ donors would be helpful in ascertaining better ways of applying national assistance, which is important for promotion of brain dead organ donation. METHODS: We collected data regarding the medical expenses of 119 brain dead organ donors from January 2009 to December 2013 at a single institution that specializes in organ donation. Donation year, cause of brain death, age, and admission days were deemed factors affecting medical expenses, and these were analyzed. Medical expenses were compared with national assistance (maximum of 1.8 million Korean won [KRW]). RESULTS: Average age of donors was 42.7 years, and, in the older age group, there was a lower average for medical expenses (P=0.025). Brain dead organ donations that were consented to within 2 days after the brain death comprised 41.2%, and medical expenses increased as the consent days were delayed (P<0.001). Average medical expense for donor families was 2,161,297 KRW, and the average national assistance to the families was 577,056 KRW. The medical expenses of 73 donors (61.3%) were below the national assistance maximum; 19 (16.0%) had no charges of their own with other insurance coverage. CONCLUSIONS: National assistance for medical expenses to family members of brain dead organ donors is necessary in Korea, where the rate of brain dead organ donation is very low. As 61% of donors were covered below the maximum assistance amount, there could be additional ways to utilize the remaining budget.
Assuntos
Humanos , Morte Encefálica , Orçamentos , Gastos em Saúde , Cobertura do Seguro , Coreia (Geográfico) , Obtenção de Tecidos e Órgãos , Doadores de TecidosRESUMO
Transcatheter arterial chemoembolization (TACE) is suitable treatment method of hepatocellular carcinoma (HCC) for patients with decreased underlying liver function or unresectable disease. But this procedure can induce some embolic events. We report a case of a gallbladder infarction caused by the embolic event in TACE procedure. A 61-year-old man had been going to undergo 6th TACE for marginal recurrence of HCC. After the procedure, gallbladder infarction occurred and was detected by abdominal computed tomography (CT) scan for response evaluation of the treatment at out-patient-clinic. Then, he was treated with oral antibiotics and conservative therapy at out-patient clinic. In 6th week after the event, abdominal CT scan showed improved state of gallbladder.