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Acute and Critical Care(ACC) update

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수록정보
수록범위 : 33권1호(2018) |수록논문 수 : 12
Acute and Critical Care(ACC)
33권1호(2018년 02월) 수록논문
최근 권호 논문
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KCI등재

1Reducing Unnecessary Testing in the Intensive Care Unit by Choosing Wisely

저자 : Ruth M. Kleinpell , J. Christopher Farmer , Stephen M. Pastores

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 1-6 (6 pages)

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Overuse of laboratory and X-ray testing is common in the intensive care unit (ICU). This review highlights focused strategies for critical care clinicians as outlined by the Critical Care Societies Collaborative (CCSC) as part of the American Board of Internal Medicine Foundation's Choosing Wisely® campaign. The campaign aims to promote the use of judicious testing and decrease unnecessary treatment measures in the ICU. The CCSC outlines five specific recommendations for reducing unnecessary testing in the ICU. First, reduce the use of daily or regular interval diagnostic testing. Second, do not transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 mg/dl. Third, do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of ICU stay. Fourth, do not deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation. Finally, do not continue life support for patients at high risk of death without offering patients and their families the alternative of comfort focused care. A number of strategies can be used to reduce unnecessary testing in the ICU, including educational campaigns, audit and feedback, and implementing prompts in the electronic ordering system to allow only acceptable indications when ordering routine testing. Greater awareness of the lack of outcome benefit and associated costs can prompt clinicians to be more mindful of ordering tests and procedures in order to reduce unnecessary testing in the ICU.

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2Global and Regional Ventilation during High Flow Nasal Cannula in Patients with Hypoxia

저자 : Dong Hyun Lee , Eun Young Kim , Ga Jin Seo , Hee Jung Suh , Ji

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 7-15 (9 pages)

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Background: High flow nasal cannula (HFNC) is known to increase global ventilation volume in healthy subjects. We sought to investigate the effect of HFNC on global and regional ventilation patterns in patients with hypoxia. Methods: Patients were randomized to receive one of two oxygen therapies in sequence: nasal cannula (NC) followed by HFNC or HFNC followed by NC. Global and regional ventilation was assessed using electric impedance tomography. Results: Twenty-four patients participated. Global tidal variation (TV) in the lung was higher during HFNC (NC, 2,241 ± 1,381 arbitrary units (AU); HFNC, 2,543 ± 1,534 AU; P < 0.001). Regional TVs for four iso-gravitational quadrants of the lung were also all higher during HFNC than NC. The coefficient of variation for the four quadrants of the lung was 0.90 ± 0.61 during NC and 0.77 ± 0.48 during HFNC (P = 0.035). Within the four gravitational layers of the lung, regional TVs were higher in the two middle layers during HFNC when compared to NC. Regional TV values in the most ventral and dorsal layers of the lung were not higher during HFNC compared with NC. The coefficient of variation for the four gravitational layers of the lung were 1.00 ± 0.57 during NC and 0.97 ± 0.42 during HFNC (P = 0.574). Conclusions: In patients with hypoxia, ventilation of iso-gravitational regions of the lung during HFNC was higher and more homogenized compared with NC. However, ventilation of gravitational layers increased only in the middle layers. (Clinical trials registration number: NCT02943863).

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3The Effect of Electrical Muscle Stimulation and In-bed Cycling on Muscle Strength and Mass of Mechanically Ventilated Patients: A Pilot Study

저자 : Kyeongyoon Woo , Jeongmin Kim , Hye Bin Kim , Hyunwoo Choi , K

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 16-22 (7 pages)

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Background: Critically ill patients experience muscle weakness, which leads to functional disability. Both functional electrical stimulation (FES) and in-bed cycling can be an alternative measure for intensive care unit (ICU) patients who are not feasible for active exercise. The aim of this study was to examine whether FES and in-bed cycling have a positive effect on muscle mass in ICU patients. Methods: Critically ill patients who received mechanical ventilation for at least 24 hours were included. After passive range of motion exercise, in-bed cycling was applied for 20 minutes, and FES was applied for 20 minutes on the left leg. The right leg received in-bed cycling and the left leg received both FES and in-bed cycling. Thigh circumferences and rectus femoris cross-sectional area (CSA) were assessed with ultrasonography before and after the intervention. Muscle strength was assessed by Medical Research Council scale. Results: A total of 10 patients were enrolled in this study as a pilot study. Before and after the intervention, the CSA of right rectus femoris increased from 5.08 ± 1.51 cm2 to 6.01 ± 2.21 cm2, which was statistically significant (P = 0.003). The thigh circumference was also increased and statistically significant (P = 0.006). There was no difference between left and right in regard to FES application. There is no significant change in muscle strength before and after the intervention (right and left, P = 0.317 and P = 0.368, respectively). Conclusions: In-bed cycling increased thigh circumferences rectus femoris CSA. Adding FES did not show differences.

KCI등재

4The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study

저자 : Jaesub Park , Seung-taek Oh , Sunyoung Park , Won-jung Choi ,

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 23-33 (11 pages)

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Background: Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient's clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown. Methods: The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation. Results: There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor's mental health, was significantly reduced and pain tended to decrease. Conclusions: Increasing the physician's awareness of the patient's mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

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5The Effects of Flecainide Acetate on Inflammatory-Immune Response in Lipopolysaccharide-Stimulated Neutrophils and on Mortality in Septic Rats

저자 : Shi Young Chung , Jinyoung Kim hong Bum Bae , Tran Duc Tin , Wan J

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 34-41 (8 pages)

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Background: Flecainide acetate is a drug used primarily for cardiac arrhythmia. Some studies also imply that flecainide acetate has the potential to regulate inflammatory-immune responses; however, its mechanism of action is contended. We determined the effects of flecainide acetate on lipopolysaccharide (LPS)-stimulated human neutrophils in vitro and on mortality in a septic rat model. Methods: Neutrophils from human blood were cultured with varying concentrations of flecainide acetate (1 μM, 10 μM, or 100 μM) with or without LPS (100 ng/ml). To assess neutrophil activation, the protein levels of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6 and IL-8 were measured after a 4-hour culture period. To assess the intracellular signaling pathways, the levels of phosphorylation of p38 mitogen-activated protein kinase (p38), extracellular signal-regulated kinase (ERK) 1/2, and c-Jun N-terminal kinase (JNK) were measured after a 30-minute culture period, and the nuclear translocation of nuclear factor (NF)-κB was measured after a 1-hour culture period. Additionally, the survival rate was investigated in a rat sepsis model. Results: Flecainide acetate down-regulated the activation of proinflammatory cytokines, including TNF-α and IL-6 and IL-8, and intracellular signaling pathways including ERK 1/2 and NF-κB. Flecainide acetate also improved the survival rate in the rat sepsis model. Conclusions: Collectively, these findings indicate that flecainide acetate can improve survival in a rat sepsis model by attenuating LPS-induced neutrophil responses. We therefore suggest that flecainide acetate plays an important role in modulating inflammatory-immune responses.

KCI등재

6New Name of the Journal

저자 : Chae-man Lim

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 42-42 (1 pages)

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7Rehabilitation and Intensive Care Unit

저자 : Deokkyu Kim

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 43-45 (3 pages)

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8Termination of Idiopathic Sustained Monomorphic Ventricular Tachycardia by Synchronized Electrical Cardioversion during Pregnancy

저자 : Sungmin Lee

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 46-50 (5 pages)

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The most common cardiac complications detected during pregnancy are an arrhythmia. However, idiopathic continuous monomorphic ventricular tachycardia (VT) during pregnancy is unusual. A 31-year-old pregnant woman presented at 20 weeks of gestation with progressive palpitation and episodes of agitation. An initial 12-lead electrocardiogram (ECG) showed normal sinus rhythm. However, 30 minutes after presenting at the emergency room, she complained of chest pain. A subsequent ECG showed wide complex monomorphic VT. We attempted to administer an antiarrhythmic drug, but the patient refused any medication because of concerns regarding possible adverse effects on the fetus. Therefore, we performed synchronized electrical cardioversion eight times. After the eighth synchronized cardioversion at 200 J, the ECG showed successful restoration of sinus rhythm. The condition of the fetus was monitored via ultrasonography and cardiotocography, and no adverse events were observed. We present the case of a successful synchronized electrical cardioversion performed in a woman at 20 weeks of gestation because of sustained symptomatic VT.

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9Critical Illness Neuromyopathy Complicating Cardiac Surgery

저자 : Wan Ki Baek , Young Sam Kim , Joung Taek Kim , Byoung-nam Yoon

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 51-56 (6 pages)

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Critical illness neuromyopathy (CINM) is a sporadically reported disease in the setting of an intensive care unit developing in the process of managing a critical illness. The disease primarily affects the motor and sensory axons and results in severe limb weakness rendering ventilator weaning extremely difficult. We report a case of CINM after cardiac valve surgery. Quadriplegia developed after the operation and resolved slowly over the following 2 months. The patient was discharged home free of neurologic symptoms.

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10Implication of Neurological Pupil Index for Monitoring of Brain Edema

저자 : Tae Jung Kim , Sang-bae Ko

발행기관 : 대한중환자의학회 간행물 : Acute and Critical Care(ACC) 33권 1호 발행 연도 : 2018 페이지 : pp. 57-60 (4 pages)

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