BACKGROUND: Admission blood glucose (BG) level is a predictor of mortality in critically ill patients with various conditions. However, limited data are available regarding this relationship in critically ill patients with cardiovascular diseases according to diabetic status. METHODS: A total of 1,780 patients (595 with diabetes) who were admitted to cardiac intensive care unit (CICU) were enrolled from a single center registry. Admission BG level was defined as maximal serum glucose level within 24 hours of admission. Patients were divided by admission BG level: group 1 (< 7.8 mmol/L), group 2 (7.8–10.9 mmol/L), group 3 (11.0–16.5 mmol/L), and group 4 (≥ 16.6 mmol/L). RESULTS: A total of 105 patients died in CICU (62 non-diabetic patients [5.2%] and 43 diabetic patients [7.9%]; P = 0.105). The CICU mortality rate increased with admission BG level (1.7%, 4.8%, 10.3%, and 18.8% from group 1 to group 4, respectively; P < 0.001). On multivariable analysis, hypertension, mechanical ventilator, continuous renal replacement therapy, acute physiology and chronic health evaluation II (APACHE II) score, and admission BG level significantly influenced CICU mortality in non-diabetic patients (group 1 vs. group 3: hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.47–7.44; P = 0.004; group 1 vs. group 4: HR, 6.56; 95% CI, 2.76–15.58; P < 0.001). However, in diabetic patients, continuous renal replacement therapy and APACHE II score influenced CICU mortality but not admission BG level. CONCLUSION: Admission BG level was associated with increased CICU mortality in critically ill, non-diabetic patients admitted to CICU but not in diabetic patients.
APACHE ; Blood Glucose ; Cardiovascular Diseases ; Critical Care ; Critical Illness ; Diabetes Mellitus ; Humans ; Hypertension ; Intensive Care Units ; Mortality ; Prognosis ; Renal Replacement Therapy ; Ventilators, Mechanical

No abstract available.
Anaplasmosis* ; Animals ; Humans* ; Korea* ; Scrub Typhus* ; Seasons*

Knowledge of clinical demographics and outcomes of mechanically ventilated patients is important but there are few prospectively collected data in Korea. The objective of the present study was to describe the current status of mechanically ventilated patients in Korea as of 2010. We analyzed the data of Korean patients (275 patients in 12 Korean intensive care units [ICU]) participating in a multinational prospective cohort study on mechanical ventilation. The most common indication for mechanical ventilation was pneumonia (23%). Pressure-limited ventilation modes were preferred over volume-cycled ventilation modes. Non-invasive positive pressure ventilation was used in only seven (2%) patients as the initial ventilatory support. Median duration of mechanical ventilation was 7 days and ICU mortality was 36%. The multiple logistic regression model revealed that the Simplified Acute Physiology Score II (SAPS II) score at ICU admission (odds ratio [OR], 1.034; 95% confidence interval [CI], 1.001-1.036; P=0.033), peak pressure (OR, 1.054; 95% CI, 1.016-1.095; P=0.006), and the number of failed organs (OR, 2.132; 95% CI, 1.634-2.781; P<0.001) were independently associated with ICU mortality. This study provides a snapshot of current practice of mechanical ventilation in Korea.
Acute Disease ; Aged ; Cohort Studies ; Demography ; Female ; Hospital Mortality ; Humans ; Intensive Care Units/*statistics & numerical data ; Length of Stay ; Male ; Middle Aged ; Odds Ratio ; Prognosis ; Prospective Studies ; Republic of Korea ; *Respiration, Artificial ; Respiratory Insufficiency/*diagnosis/epidemiology/mortality ; Sepsis/etiology ; Severity of Illness Index

The purpose of this study was to investigate the clinical aspects of patients satisfying the Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor severity criteria, focusing on their treatment response to empirical antibiotics. In total, 381 community-acquired pneumonia (CAP) patients who did not require mechanical ventilation or vasopressors at admission were enrolled, and 50 (13.1%) satisfied the minor severity criteria (i.e. , minor severe CAP [minor-SCAP]). The rates of new complication events and clinical treatment failure were significantly higher in the minor-SCAP group than in the control group (30.0% vs 2.1%, P < 0.001, and 42.0% vs 10.6%, P < 0.001, respectively), and the time to reach clinical stability was longer in the minor-SCAP group (8 days vs 3 days, P < 0.001). In a multivariate model, minor severity criteria (> or = 3) were significantly associated with treatment failure (odds ratio, 2.838; 95% confidence interval, 1.216 to 6.626), and for predicting treatment failure the value of the area under the receiver operating characteristic curve for minor criteria was 0.731, similar to other established scoring methods. The IDSA/ATS minor severity criteria can predict delayed treatment response and clinical treatment failure.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Area Under Curve ; Community-Acquired Infections/*diagnosis/drug therapy/mortality ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Kaplan-Meier Estimate ; Length of Stay ; Male ; Middle Aged ; Odds Ratio ; Pneumonia/*diagnosis/drug therapy/mortality ; Predictive Value of Tests ; ROC Curve ; *Severity of Illness Index

BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.
Adult ; APACHE ; Critical Illness ; Health Facility Size ; Humans ; Influenza, Human ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Pandemics ; Retrospective Studies ; Risk Factors

The nodular bronchiectatic form of nontuberculous mycobacterial (NTM) lung disease and diffuse panbronchiolits (DPB) show similar clinical and radiographic findings. The present study was performed to clarify the clinicoradiographic similarities as well as the differences between NTM lung disease and DPB. The initial clinicoradiographic features of 78 patients with the nodular bronchiectatic form of NTM lung disease (41 patients with Mycobacterium avium complex infection and 37 patients with Mycobacterium abscessus infection) were compared with those of 35 patients with DPB. Old age, female sex, a history of tuberculosis treatment, and hemoptysis were related to NTM lung disease while exertional dyspnea, coarse crackles, history of sinusitis, obstructive abnormalities in pulmonary function tests, and hypoxemia were related to DPB. The number of lobes involved with bronchiolitis and bronchiectasis on chest computed tomography were more numerous in DPB patients. There is considerable overlap in the clinical and radiographic appearances of the nodular bronchiectatic form of NTM lung disease and DPB, although some clinicoradiographic features differ between two diseases. The correct diagnosis, including aggressive microbiologic evaluation, should be made for the appropriate management of patients presenting with bilateral bronchiectasis and bronchiolitis.
Adult ; Age Factors ; Aged ; Bronchiectasis/*diagnosis/radiography ; Bronchiolitis/*diagnosis/radiography ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases/*diagnosis/microbiology/radiography ; Male ; Middle Aged ; Mycobacterium Infections/*diagnosis/radiography ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection/diagnosis/radiography ; Respiratory Function Tests ; Sex Factors ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/therapy

The nodular bronchiectatic form of nontuberculous mycobacterial (NTM) lung disease and diffuse panbronchiolits (DPB) show similar clinical and radiographic findings. The present study was performed to clarify the clinicoradiographic similarities as well as the differences between NTM lung disease and DPB. The initial clinicoradiographic features of 78 patients with the nodular bronchiectatic form of NTM lung disease (41 patients with Mycobacterium avium complex infection and 37 patients with Mycobacterium abscessus infection) were compared with those of 35 patients with DPB. Old age, female sex, a history of tuberculosis treatment, and hemoptysis were related to NTM lung disease while exertional dyspnea, coarse crackles, history of sinusitis, obstructive abnormalities in pulmonary function tests, and hypoxemia were related to DPB. The number of lobes involved with bronchiolitis and bronchiectasis on chest computed tomography were more numerous in DPB patients. There is considerable overlap in the clinical and radiographic appearances of the nodular bronchiectatic form of NTM lung disease and DPB, although some clinicoradiographic features differ between two diseases. The correct diagnosis, including aggressive microbiologic evaluation, should be made for the appropriate management of patients presenting with bilateral bronchiectasis and bronchiolitis.
Adult ; Age Factors ; Aged ; Bronchiectasis/*diagnosis/radiography ; Bronchiolitis/*diagnosis/radiography ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases/*diagnosis/microbiology/radiography ; Male ; Middle Aged ; Mycobacterium Infections/*diagnosis/radiography ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection/diagnosis/radiography ; Respiratory Function Tests ; Sex Factors ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/therapy

PURPOSE: By achieving informations about sagittal shape and motion of each lumbar segment in normal subjects, we tried to get the standards useful in management of spinal disorders and fractures. MATERIALS AND METHODS: Thirty normal adults without any disorder on their back were adopted. L3 centered thoracolumbar (T-L) X-ray's including standing lateral, AP's in righ-tleft bending, and flexion- extension lateral were checked for each person. Cobb angles of each segment were measured. Statistical analysis was done for comparison by gender and correlation of each factors. RESULTS: Body shape of upper lumbar vertebrae was kyphotic but caudal bodies are changed into lordotic gradually. Disc angle was lordotic in all the discs. Segmetal motion in sagittal plane was greatest at L4-L5 (18.6degrees). However, segmental motion at coronal plane was largest at L3-L4 (12.6degrees). CONCLUSION: We achieved Korean standard of shape and motion of each lumbar segment. Proportion of each factor contributing to total lumbar lordosis was evaluated also.
Adult ; Animals ; Humans ; Lordosis ; Lumbar Vertebrae

This study was conducted to observe effects of two methods of setting positive endexpiratory pressure (PEEP) based on the pressure-volume (PV) curve. After lung injury was induced by oleic acid in six mongrel adult dogs, the inflation PV curve was traced and the lower inflection point (LIP) was measured. The 'PEEP(INF)' was defined as LIP+2 cmH2O. After recruitment maneuver to move the lung physiology to the deflation limb of PV curve, decremental PEEP was applied. The lowest level of PEEP that did not result in a significant drop in PaO2 was defined as the 'PEEP(DEF)'. Arterial blood gases, lung mechanics, hemodynamics, and lung volumes (measured on computed tomography during end-expiratory pause) were measured at PEEP of 0 cmH2O, PEEP(INF) and PEEP(DEF) sequentially. The median PEEP(INF) was 13.4 cm H2O (interquartile range, 12.5-14.3) and median PEEP(DEF) was 12.0 cm H2O (10.0-16.5) (p=0.813). PEEP(DEF) was associated with significantly higher PaO2 and lung volumes, and significantly lower shunt fraction and cardiac index when compared to PEEP(INF) (p<0.05). Setting the PEEP based on the deflation limb of the PV curve was useful in improving oxygenation and lung volumes in a canine lung injury model.
Animals ; Dogs ; Lung/pathology ; *Lung Injury ; Lung Volume Measurements/*methods ; Male ; Oxygen/metabolism ; Positive-Pressure Respiration/*methods ; Pressure ; Pulmonary Gas Exchange ; Radiography, Thoracic/methods ; Tomography, X-Ray Computed/*methods

PURPOSE: Many medical centers routinely culture bronchoscopy samples for Mycobacterium tuberculosis, even when tuberculosis is not strongly suspected. The value of this practice, however, is controversial. We evaluated the role of that procedure in the diagnosis of pulmonary tuberculosis in an intermediate tuberculosis-burden country. PATIENTS AND METHODS: A prospective, observational study was conducted in a tertiary referral center and included 733 consecutive patients who underwent bronchoscopy examination. RESULTS: M. tuberculosis was isolated in 47 patients (6.4%). According to radiographic features, the rate of positive culture for M. tuberculosis was relatively high in patients with atelectasis (5/33, 15.2%) and those with pulmonary infiltrations of suspicious infections (26/183, 14.2%). M. tuberculosis was isolated even in patients with pulmonary masses (9/266, 3.4%) and those with pulmonary nodules (5/175, 2.9%). In 16/47 (34.0%) patients with positive cultures for M. tuberculosis, active pulmonary tuberculosis was not suspected at the time of bronchoscopy. CONCLUSION: These results suggest that routinely culturing for M. tuberculosis during bronchoscopy is still useful in the diagnosis of pulmonary tuberculosis in an intermediate tuberculosis-burden country.
Adult ; Aged ; Bacteriological Techniques/methods ; Bronchoscopy ; Female ; Humans ; Lung/microbiology/pathology ; Lung Neoplasms/microbiology ; Male ; Middle Aged ; Mycobacterium tuberculosis/growth & development/*isolation & purification ; Prospective Studies ; Pulmonary Atelectasis/microbiology ; Reproducibility of Results ; Sensitivity and Specificity ; Tuberculosis, Pulmonary/*diagnosis/microbiology