BACKGROUND: Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT. METHODS: A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status. RESULTS: A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037). CONCLUSIONS: Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.
Body Water ; Critical Illness* ; Electric Impedance* ; Humans ; Intensive Care Units ; Male ; Mortality ; Observational Study* ; Prospective Studies* ; Renal Replacement Therapy* ; Survival Rate ; Water

No abstract available.
Rectal Neoplasms*

PURPOSE: This study was to construct a structural equational model for explaining and predicting job stress of intensive care unit (ICU) nurses based on the Integrated model of stress of Ivancevich and Matteson (1980). METHODS: The subjects of this study were 220 nurses at ICU. The data were collected from August 5 to 30, 2013 through self-reporting questionnaire survey. RESULTS: According to the hypothetical model of this study, perceived nursing practice environment, perceived role conflict, perceived transformational leadership and perceived self-esteem showed statistically significant effects on job stress of ICU nurses directly. Professional self-concept indirectly affect job stress of ICU nurses. In conclusion, job stress of ICU nurses was directly influenced by nursing practice environment, role conflict, transformational leadership and self-esteem. Professional self-concept of the relationships among variables did not have a direct impact on job stress. CONCLUSION: Based on the results of this study, it is needed to develop stress management measures and programs considering these variables in order to adequately manage job stress of ICU nurses.
Intensive Care Units* ; Leadership ; Nursing ; Surveys and Questionnaires

Anesthesia, General ; Hemorrhage ; Humans ; Incidence ; Palatine Tonsil ; Postoperative Hemorrhage ; Tonsillectomy

No abstract available.
Heart* ; Thoracic Surgery* ; Thyroid Gland*

BACKGROUND: When one of family members must be treated, the others are required to get various forms of changes including modification of their proper roles in the family. Particularily when he or she can not perform his or her activities of daily living(ADL) owing to functional impairment by himself or herself, there seems to be greater dependence upon his or her family. Accordingly, we tried to give help in the treatment of patients through the comparative analysis concerning functional impairment in both groups on the assumption that there is difference of family function between two family groups which have a patient in family, or not. METHODS: This study was carried out to 83 inpatients in Sun Hospital in Dae Jeon and local rehabilitation clinics in Iksan from 1. July. 1995 to 31. Jun. 1996. We evaluated activites of daily living by using modified Barthel Index(MBI) and classified them into dependent group with 60 points or less(6roup I ), and independent group with more than 60 points(Group II). We also used Family APGAR score and FACES III to evaluate their family functions. RESULTS: MBI scores to evaluate ADL were 42.9+/-15.6 in Group I and 82.1+/-17.9 in Group II. Family APGAR scores were 6.93+/-2.52 in Group I and 7.24+/-17.9 in Group II but there was no significance between two groups. Types of family according to Family APGAR score were highly functional, morderate dysfunctional, and severly dysfunctional one in order of frequency in both groups, but there was no significance in their frequencies in both groups. Types of Family in view of cohesion was disengaged, separated, connected, and enmeshed one in order of frequency in Group I, and separated, disengaged, connected, and enmeshed one in order of frequency in Group II but there was no significance between two groups. Types of family in view of adaptability were rigid, chaotic structured,and flexible one in order of frequency in Group I, and were flexible, structured, rigid, and chaotic one in orders in Group II, which showed significance between two groups. Extremal types of family structure were large in numbers in Group I, but it didnt show significance. CONCLUSIONS: Assuming that there were large numbers of rigid and chaotic family in Group I, it is considered that tne family which has a patient with severely impaired function seems to have weaker adaptability to their family stresses than otherwise. Therefore, it is desirable that physicians who take charge of such patients provide continuous and comprehensive medical care for them including their family with greater concerns and through analysis and assessment of their family functions.
Activities of Daily Living ; Apgar Score ; Daejeon ; Humans ; Inpatients* ; Jeollabuk-do ; Rehabilitation* ; Solar System

No abstract available.
Ectromelia*

BACKGROUND: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. METHODS: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. RESULTS: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. CONCLUSIONS: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.
Abdomen* ; Body Mass Index ; Humans ; Critical Care ; Intensive Care Units ; Length of Stay ; Mortality ; Postoperative Complications ; Prognosis* ; Respiration, Artificial ; Retrospective Studies ; Serum Albumin ; Ventilation

The management of skin and soft tissue defects on the buttock, perineum and lower abdomen has been improved through the development of myocutaneous flap. However, sacrifice of the deep muscles causes some problems such as intraoperative bleeding and functional disabilities of donor sites. And we can not also control the volume of the flap for the skin reliability of myocutaneous flaps. To overcome these disadvantages, we tried perforator-based myocutaneous island flaps for the reconstruction of the sacral, ischial sores or deep wounds of the perineum and lower abdomen. During the dissection of the flap, we could control the volume and shape of the flap exactly depending on the perforators. Clinically, total of 14 cases were treated with 10 parasacral perforator-based myocutaneous island flaps and 4 perforator-based extended myocutaneous island flaps. Parasacral flap is based on the parasacral perforators along the lateral sacral border and, the degree of containing muscles can be easily decided according to the depth of wound. In the cases of the extended myocutaneous flaps, we could design the perforator-based skin flap on the tip of myocutaneous island flap and appropriate volume of skin falp was obtained with the wide arc of rotation. Finally, the donor defect could be closed primarily and there was no significant sequela. There perforator-based myocutaneous island flaps require no significant sacrifice of the muscles and can be easily dissected and applied with the appropriate volumes for the reconstruction of the defect on the buttocks, perineum and lower abdomen.
Abdomen ; Buttocks ; Hemorrhage ; Humans ; Muscles ; Myocutaneous Flap ; Perineum ; Skin ; Surgical Flaps ; Tissue Donors ; Wounds and Injuries*

The reconstruction of pressure sore is often complicated problem due to underlying disease and general condition of the patients. Sometimes, it is too radical to use the muscle or musculocutaneous flap for the patients who has severe systemic disease and can not withstand the lengthy operation or the patients who already recovered from paraplegic condition and has no risk recurrence. To get over these problems, we recently have used the parasacral perforator-based island skin flaps for the sacral pressure sores. This flap is based on the axial pattern perforators originating from the internal pudendal artery and lateral sacarl artery. We performed this operation for 11 sacral sores with reasonable results. There was no significant complication, and duration of operation was relatively short and blood loss was a little. We concluded that this flap was useful for the patient with sacral pressure sore who could be categorized nontraumatic nonparaplegic group(NTNP group) or nontraumatic paraplegic group(NTP group). But this island flap has drawback, which is elimination of sensory nerve within the flap.
Arteries ; Humans ; Myocutaneous Flap ; Pressure Ulcer* ; Recurrence ; Skin*