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Acute and Critical Care(ACC) update

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수록정보
수록범위 : 33권1호(2018)~33권3호(2018) |수록논문 수 : 33
Acute and Critical Care(ACC)
33권3호(2018년 08월) 수록논문
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KCI등재

1Deep Learning in the Medical Domain: Predicting Cardiac Arrest Using Deep Learning

저자 : Youngnam Lee , Joon-myoung Kwon , Yeha Lee , Hyunho Park , Hug

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 117-120 (4 pages)

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With the wider adoption of electronic health records, the rapid response team initially believed that mortalities could be significantly reduced but due to low accuracy and false alarms, the healthcare system is currently fraught with many challenges. Rule-based methods (e.g., Modified Early Warning Score) and machine learning (e.g., random forest) were proposed as a solution but not effective. In this article, we introduce the DeepEWS (Deep learning based Early Warning Score), which is based on a novel deep learning algorithm. Relative to the standard of care and current solutions in the marketplace, there is high accuracy, and in the clinical setting even when we consider the number of alarms, the accuracy levels are superior.

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2Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units

저자 : Soo Jin Na , Tae Sun Ha , Younsuck Koh , Gee Young Suh , Shin

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 121-129 (9 pages)

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Background: The objective of this study was to investigate the characteristics and clinical outcomes of critically ill cancer patients admitted to intensive care units (ICUs) in Korea. Methods: This was a retrospective cohort study that analyzed prospective collected data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study, which is a nationwide, multicenter, and prospective study that considered 5,063 patients from 22 ICUs in Korea over a period of 7 months. Among them, patients older than 18 years of age who were diagnosed with solid or hematologic malignancies prior to admission to the ICU were included in the present study. Results: During the study period, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. Six hundred fifty-eight (79%) had solid tumors and 175 (21%) had hematologic malignancies, respectively. Respiratory problems (30.1%) was the most common reason leading to ICU admission. Patients with hematologic malignancies had higher Sequential Organ Failure Assessment (12 vs. 8, P<0.001) and SAPS3 (71 vs. 69, P<0.001) values and were more likely to be associated with chemotherapy, steroid therapy, and immunocompromised status versus patients with solid tumors. The use of inotropes/vasopressors, mechanical ventilation, and/or continuous renal replacement therapy was more frequently required in hematologic malignancy patients. Mortality rates in the ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) were higher in hematologic malignancy patients than in solid tumor patients. Conclusions: Cancer patients accounted for one-third of all patients admitted to the studied ICUs in Korea. Clinical characteristics were different according to the type of malignancy. Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.

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3Timing and Associated Factors for Sepsis-3 in Severe Trauma Patients: A 3-Year Single Trauma Center Experience

저자 : Seungwoo Chung , Donghwan Choi , Jayun Cho , Yo Huh , Jonghwan

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 130-134 (5 pages)

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Background: We hypothesized that the recent change of sepsis definition by sepsis-3 would facilitate the measurement of timing of sepsis for trauma patients presenting with initial systemic inflammatory response syndrome. Moreover, we investigated factors associated with sepsis according to the sepsis-3 definition. Methods: Trauma patients in a single level I trauma center were retrospectively reviewed from January 2014 to December 2016. Exclusion criteria were younger than 18 years, Injury Severity Score (ISS) <15, length of stay <8 days, transferred from other hospitals, uncertain trauma history, and incomplete medical records. A binary logistic regression test was used to identify the risk factors for sepsis-3. Results: A total of 3,869 patients were considered and, after a process of exclusion, 422 patients were reviewed. Fifty patients (11.85%) were diagnosed with sepsis. The sepsis group presented with higher mortality (14 [28.0%] vs. 17 [4.6%], P<0.001) and longer intensive care unit stay (23 days [range, 11 to 35 days] vs. 3 days [range, 1 to 9 days], P<0.001). Multi-variate analysis demonstrated that, in men, high lactate level and red blood cell transfusion within 24 hours were risk factors for sepsis. The median timing of sepsis-3 was at 8 hospital days and 4 postoperative days. The most common focus was the respiratory system. Conclusions: Sepsis defined by sepsis-3 remains a critical issue in severe trauma patients. Male patients with higher ISS, lactate level, and red blood cell transfusion should be cared for with caution. Reassessment of sepsis should be considered at day 8 of hospital stay or day 4 postoperatively.

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4Changes in the Characteristics and Long-term Mortality Rates of Intensive Care Unit Patients from 2003 to 2010: A Nationwide Population-Based Cohort Study Performed in the Republic of Korea

저자 : Jeongwon Heo , Yoonki Hong , Seon-sook Han , Woo Jin Kim , Jae

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 135-149 (15 pages)

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Background: There are few studies on intensive care unit (ICU) patients in the Republic of Korea. We analyzed the characteristics and mortality changes of all ICU patients over the last 8 years. Methods: This study used the cohort of the National Health Insurance Corporation, which provides medical care to all residents of the Republic of Korea. The cohort consists of patients aged 20 years or older between 2003 and 2010 with a history of ICU admission. We analyzed changes in sex, age, household income, number of hospital beds, emergency admissions, and reasons for admission using the Cochran-Armitage trend test. The adjusted hazard ratios (HRs) of mortality according to these variables and year of admission were calculated by Cox proportional hazards regression. Results: The proportion of patients aged ≥70 years increased over that period, as did their average age (by 3.6 years). During the 8-year study period, the 3-year mortality rate was 32.91%-35.83%. The overall mortality was higher in males and older patients, in those with a lower household income and higher Charlson Comorbidity Index (CCI) score, those admitted to a hospital with a smaller number of beds, and those admitted via the emergency room. There was no significant change in crude mortality rate over the 8-year study period; however, the adjusted HR showed a decreasing trend. Conclusions: Patients admitted to the ICU were older and had higher CCI score. Nevertheless, there was a temporal trend toward a decrease in the HR of long-term mortality.

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5Feasibility of Immediate in-Intensive Care Unit Pulmonary Rehabilitation after Lung Transplantation: A Single Center Experience

저자 : Joo Han Song , Ji-eun Park , Sang Chul Lee , Sarang Kim , Dong

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 146-153 (8 pages)

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Background: Physical function may influence perioperative outcomes of lung transplantation. We investigated the feasibility of a pulmonary rehabilitation program initiated in the immediate postoperative period at an intensive care unit (ICU) for patients who underwent lung transplantation. Methods: We retrospectively evaluated 22 patients who received pulmonary rehabilitation initiated in the ICU within 2 weeks after lung transplantation at our institution from March 2015 to February 2016. Levels of physical function were graded at the start of pulmonary rehabilitation and then weekly throughout rehabilitation according to criteria from our institutional pulmonary rehabilitation program: grade 1, bedside (G1); grade 2, dangling (G2); grade 3, standing (G3); and grade IV, gait (G4). Results: The median age of patients was 53 years (range, 25 to 73 years). Fourteen patients (64%) were males. The initial level of physical function was G1 in nine patients, G2 in seven patients, G3 in four patients, and G4 in two patients. Patients started pulmonary rehabilitation at a median of 7.5 days (range, 1 to 29 days) after lung transplantation. We did not observe any rehabilitation-related complications during follow-up. The final level of physical function was G1 in six patients, G3 in two patients, and G4 in 14 patients. Fourteen of the 22 patients were able to walk with or without assistance, and 13 of them maintained G4 until discharge; the eight remaining patients never achieved G4. Conclusions: Our results suggest the feasibility of early pulmonary rehabilitation initiated in the ICU within a few days after lung transplantation.

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6Anti-inflammatory Role of Mesenchymal Stem Cells in an Acute Lung Injury Mouse Model

저자 : Jin Won Huh , Won Young Kim , Yun Young Park , Chae-man Lim ,

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 154-162 (9 pages)

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Background: Mesenchymal stem cells (MSCs) attenuate injury in various lung injury models through paracrine effects. We hypothesized that intratracheal transplantation of allogenic MSCs could attenuate lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice, mediated by anti-inflammatory responses. Methods: Six-week-old male mice were randomized to either the control or the ALI group. ALI was induced by intratracheal LPS instillation. Four hours after LPS instillation, MSCs or phosphate-buffered saline was randomly intratracheally administered. Neutrophil count and protein concentration in bronchoalveolar lavage fluid (BALF); lung histology; levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and macrophage inflammatory protein-2; and the expression of proliferation cell nuclear antigen (PCNA), caspase-3, and caspase-9 were evaluated at 48 hours after injury. Results: Treatment with MSCs attenuated lung injury in ALI mice by decreasing protein level and neutrophil recruitment into the BALF and improving the histologic change. MSCs also decreased the protein levels of proinflammatory cytokines including IL-1β, IL-6, and TNF-α, but had little effect on the protein expression of PCNA, caspase-3, and caspase-9. Conclusions: Intratracheal injection of bone marrow-derived allogenic MSCs attenuates LPS-induced ALI via immunomodulatory effects.

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7Usefulness of Rotational Thromboelastometry as a Mortality Predictor of Hyperfibrinolysis in Patients with Severe Trauma

저자 : Ji Soo Kim , Il Jae Wang , Seok Ran Yeom , Suck Ju Cho , Jae H

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 162-169 (8 pages)

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Background: Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma. Methods: Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed. Results: During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P<0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality. Conclusions: Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma.

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8Validation of Pediatric Index of Mortality 3 for Predicting Mortality among Patients Admitted to a Pediatric Intensive Care Unit

저자 : Jae Hwa Jung , In Suk Sol , Min Jung Kim , Yoon Hee Kim , Kyun

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 170-177 (8 pages)

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Background: The objective of this study was to evaluate the usefulness of the newest version of the pediatric index of mortality (PIM) 3 for predicting mortality and validating PIM 3 in Korean children admitted to a single intensive care unit (ICU). Methods: We enrolled children at least 1 month old but less than 18 years of age who were admitted to the medical ICU between March 2009 and February 2015. Performances of the pediatric risk of mortality (PRISM) III, PIM 2, and PIM 3 were evaluated by assessing the area under the receiver operating characteristic (ROC) curve, conducting the Hosmer-Lemeshow test, and calculating the standardized mortality ratio (SMR). Results: In total, 503 children were enrolled; the areas under the ROC curve for PRISM III, PIM 2, and PIM 3 were 0.775, 0.796, and 0.826, respectively. The area under the ROC curve was significantly greater for PIM 3 than for PIM 2 (P<0.001) and PRISM III (P=0.016). There were no significant differences in the Hosmer-Lemeshow test results for PRISM III (P=0.498), PIM 2 (P=0.249), and PIM 3 (P=0.337). The SMR calculated using PIM 3 (1.11) was closer to 1 than PIM 2 (0.84). Conclusions: PIM 3 showed better prediction of the risk of mortality than PIM 2 for the Korean pediatric population admitted in the ICU.

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9Specification of Subject Sex in Oncology-Related Animal Studies

저자 : Sukyo Lee , Won Jun Kim , Yeong Jeon , Choon Hak Lim , Kyung S

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 178-184 (7 pages)

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Background: Growing evidence for clinically significant differences between the sexes has attracted the attention of researchers. However, failures to report a test animal sex and balance the sex ratios of study samples remain widespread in preclinical investigations. We analyzed the sex-reporting rate and sex distributions of test animals in published oncology studies. Methods: We selected five oncology journals included in the Scientific Citation Index (SCI) based on impact factors. We identified preclinical investigations with in vivo mouse experiments published in 2015 for inclusion in our study sample. We classified each article by whether or not it reported test subject sex, and by which sex was included. We also recorded whether there were justifications for using one particular sex in single-sex studies (e.g., anatomical reasons) and whether sex-based analyses were conducted for both-sex studies. Results: We surveyed a total of 382 articles. Half (50.3%) failed to report test animal sex. Among articles that did report sex, 91.7% were single-sex studies, of which 69.4% did not provide any justifications for using the sex included in the study. Relatively few studies 15.7 studies included animals of both sexes, and only 2.3 studies conducted sex-based analyses. These findings are consistent with those of previous research that used other methods to collect data from the literature such as text mining, but our analysis of the provision of justifications for using one sex versus the other is a novel feature. Conclusions: Many researchers overlook test subject sex as a factor, but test animal sex should be reported in all preclinical investigations to enhance the reproducibility of research and avoid faulty conclusions drawn from one-sided studies.

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10Artificial Intelligence Is around Us. Let's Pick Up!

저자 : Jaehwa Cho

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 3호 발행 연도 : 2018 페이지 : pp. 185-186 (2 pages)

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