No abstract available.
Ventilators, Mechanical*

No abstract available.
Humans

BACKGROUND: Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock. METHODS: Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated. RESULTS: The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004). CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.
Adult ; Anti-Bacterial Agents ; Compliance ; Critical Pathways ; Diagnosis ; Education ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intensive Care Units ; Interdisciplinary Communication ; Mortality ; Resuscitation* ; Sepsis* ; Shock, Septic

No abstract available.
Respiratory Insufficiency* ; Ventilators, Mechanical* ; Weaning*

Pulmonary thromboembolism (PTE) is a serious postoperative complication. Prompt diagnosis of PTE is important but it is difficult because clinical manifestations of PTE are not obvious in most cases. A 59 year-old woman received cholecystectomy and choledocholithotomy under general anesthesia. At the 9th postoperative day, syncope, hypoxemia and hypotension were developed suddenly and the patient was transfered to intensive care unit. PTE was suspected with hemodynamic monitoring from pulmonary arterial catheter and echocardiography and diagnosed with lung perfusion scan and venogram of lower extremities. Proper cardiopulmonary support was done and the patient was recovered and discharged in improved condition. In conclusion, if a patient have syncopal attack with shock in postoperative period, PTE must be thought to be an one of possible causes of syncope and thoroughly investigated.
Anesthesia, General ; Anoxia ; Catheters ; Cholecystectomy ; Diagnosis ; Echocardiography ; Female ; Hemodynamics ; Humans ; Hypotension ; Intensive Care Units ; Lower Extremity ; Lung ; Middle Aged ; Perfusion ; Postoperative Complications ; Postoperative Period ; Pulmonary Embolism* ; Shock ; Syncope

BACKGROUND: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). METHODS: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. RESULTS: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). CONCLUSIONS: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.
Humans ; Informed Consent* ; Intensive Care Units* ; Korea ; Life Support Care ; Proxy ; Retrospective Studies ; Spouses ; Tertiary Care Centers ; Thorax ; Withholding Treatment

The loss of Substantial portion of critically ill patient'a tidal volume through a broncho-pleural fistula may significantly alter the intrapulmonary distribution of ventilation, ventilation-perfusion matching and arterial blood gases. Prompt localization of surgical closure of bronchopleural fistu1a remains the treatment of Choice in most Patients. We had a chance to use a Univent tube with movable blocker to the patienta of breach-opleural fistula whith developed durinf esophageal bougienation. The endotracheal tube has two compartment, a large lumen for conventional air passage and a small lumen where a movable tube is placed. Intubation a accomplished by ordinary technique, advancement of the bronchial tube to the right lowers bronchus being guided by fiheroptic bronchoscopy.
Bronchi ; Bronchoscopy ; Critical Illness ; Fistula* ; Gases ; Humans ; Intubation ; Tidal Volume ; Ventilation

No abstract available.
Humans ; Intensive Care Units* ; Critical Care*

Transcutaneous oxygen and carbon dioxide tension (PtcO2 and PtcCO2) measured with a heated electrode was compared with arterial owygen and carbon dioxide tension (PaO2 and PaCO2) in 5 groups of 37 patients admitted to the Intensive Care Unit, Severance hospital, from October 1985 to February, 1986. The results were as follows 1) In the group I (6 neonate patients), the PtcO2 and PtcCO2 index was 0.89. 1.02. The relationship of the two method is given br the regreasion equation(in mmHg) : PaO2= 1.15 (PtcO2) +0.77(r: 0.86 P<0.001) PaCO2=0.87 (PtcCO2) +5.12(r: 0.91 P<0.001) 2) In the group 2(13 mpmsirgocal patients) the PtcO2 and PtCO2 index was 0.71, 1.03. The relationship of the two methods is given by the regression equation(in mmH7) : PaO2 = 1.42(7t707) -0.27 (r: 7.53 p<0.001) rac07=1.73 (7tc007) -7.43 (r: 0.74 p<0.001) 3) In the group 3(8 immediate postopen heart patients) PtCO2 index was 0.20, PtcCO2 index was 1.25. There was no correlation between PtcO2 and PaO2. The relationship of the two method is given by the regression equation(in mmHg) : PaCO2= 0.40(ftcCO2) +2l. 68(r: 0.60 p<0,005) 4) In the Group 4(9 postpen heart patient after extubation) PtCO2 & PtCO2 index was 0.60, 1.05, and the relationship of the two method is given by the regression equation (in mmHg): PaO2 =1.92 (PtcO2)+67.26 (r=0.68 P<0.001) 7aCO2=0.64 (PtcCO2)+14.87 (r=0.66 p<0.001) 5) In the group 5(COPD Patient) the Ptco2 and rtcc09 index was 0.84, 1.04. and th? relationship of the two method is given br the regression equation(in mmHg) PaO2 = 1,10 (PtcO2) +7.35 (r=0.81 p<0.001) PaCO2=0.52 (PtcCO2) +21.59 (r: 0.63 P<0.001) Continuous montiroing can reveal large fluctuations in PaO2 and PaCO2 which would be missed by the use of intermittent arterial samples. The transcutaneous electrode can be employed usefully in the neonate and hemodynamic-allr stable adult patient in Intensive Care Unit. However this method is not recommended to the patients in shock, immediate postoper-ative patient with peripheral vasoconstriction and poor perfusion.
Adult ; Blood Gas Monitoring, Transcutaneous ; Carbon Dioxide ; Electrodes ; Heart ; Hot Temperature ; Humans ; Infant, Newborn ; Intensive Care Units ; Oxygen ; Perfusion ; Shock ; Vasoconstriction

The intensive care unit(ICU) of Severance Hospital was opened on October 18, 1968 with 7 beds and expanded to 19 beds on February 2, 1981. Statistical analysis of the ICU patients has already been reported three time from 1970 to 1981. The following is clinical analysis of 3,498 cases and ventilator cases from March 1981 to February 1984. 1) During the 3 years the total number of patients was 3,498. In 1981 1,053 patients, in 1982 1,179 patients, in 1983 1,256 patients were admitted. 2) Total admission time in the ICU was 17,061 days. The average patient stay in ICU was 4.9days. The majority of the patients (2,675 cases, 76.6%) stayed in ICU less than 5 days. The number of patients stayin in ICU more than 9 days increased every year from 94 cases (8.8%) in 1981 to 130 cases (10.4%) in 1983. 2) The number of pre-teens was 1,090 cases, about 31.2% of the total patients and represented the highest number of patients admitted to the ICU. The mortality in the pre-teen group was the highest of numbered 148, a mortality rate of 13.6%. 4) The number of patients admitted to the cardiothoracic surgery department was 1,591 cases(45.5%) being highest among all department. Out of 100 patients who died, the pediatric service had the highest mortality rate, 29.2%. 5) All ICU patients have been divided into two categories, operative and non-operative cases. The operative cases numbered 1,889 and non-operative 1,609. Mortality rate was 4.9% for the operative cases and 15% for the non-operative. 6) Total mortality was 334 in number, an overall mortality rate of 9.5% in 3 years. It has decreased annually, 131 cases (mortality rate 12.3%) in 1981, 105 case (7.7%) in 1982, 97 cases(7.7%) in 1983. 7) Ventilator cases numbered 1,921 in 3years. Ventilator day increased year by year, 1, 220 days in 1981, 19,904 in 1982, 2,299 days in 1983. Total ventilatior days in 1983 increased 72.9% compared with the number in 1981. 8) The number of deaths under ventilator support was 90 in 1981, 71 in 1982 and 80 in 1983 respectively. Mortality rate has decreased every year: 16.1% in 1981, 11.2% in 1982 and 10.8% in 1983. From the above results, it can be concluded that the total number of ICU patients and ventilator cases are increasing and the attendant mortality rate is decreasing year by year.
Humans ; Critical Care ; Mortality ; Ventilators, Mechanical