Glutathione peroxidase-1 regulates ASK1-dependent apoptosis via interaction with TRAF2 in RIPK3-negative cancer cells

Lee Sunmi,Lee Eun-Kyung,Kang Dong Hoon,Lee Jiyoung,Hong Soo Hyun,Jeong Woojin,Kang Sang Won 생화학분자생물학회 2021 Experimental and molecular medicine Vol.53 No.-

Glutathione peroxidase (GPx) is a selenocysteine-containing peroxidase enzyme that defends mammalian cells against oxidative stress, but the role of GPx signaling is poorly characterized. Here, we show that GPx type 1 (GPx1) plays a key regulatory role in the apoptosis signaling pathway. The absence of GPx1 augmented TNF-α-induced apoptosis in various RIPK3-negative cancer cells by markedly elevating the level of cytosolic H 2 O 2 , which is derived from mitochondria. At the molecular level, the absence of GPx1 led to the strengthened sequential activation of sustained JNK and caspase-8 expression. Two signaling mechanisms are involved in the GPx1-dependent regulation of the apoptosis pathway: (1) GPx1 regulates the level of cytosolic H 2 O 2 that oxidizes the redox protein thioredoxin 1, blocking ASK1 activation, and (2) GPx1 interacts with TRAF2 and interferes with the formation of the active ASK1 complex. Inducible knockdown of GPx1 expression impaired the tumorigenic growth of MDA-MB-231 cells (>70% reduction, P = 0.0034) implanted in mice by promoting apoptosis in vivo. Overall, this study reveals the apoptosis-related signaling function of a GPx family enzyme highly conserved in aerobic organisms.

Slide Session : OS-105 ; Critical Care : Body Mass Index as a Predictor of Acute Kidney Injury in Critically 3 Patients

( Sunmi Ju ),( Tae Won Lee ),( Wan Chul Kim ),( Seung Hun Lee ),( Seung Jun Lee ),( Yu Ji Cho ),( Yi Yeong Jeong ),( Jong Deog Lee ),( Young Sil Hwang ),( Ho Cheol Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Some studies suggest the existence of an “obesity paradox” in the intensive care unit (ICU). However, reports relating renal function and body mass index (BMI) are limited and controversial. This study aimed to examine the infiuence of BMI on acute kidney injury (AKI) in critically ill patients. Methods: We retrospectively analyzed the prospectively collected data from patients admitted to the ICU at Gyeongsang National University Hospital in Korea from December 2011 to May 2014. Patients were stratified to three classes according to their BMI (“underweight” <18.5 kg/m2, “normal” 18.5-24.9 kg/m2, and “overweight” =25 kg/m2). The occurrence of AKI was defined by Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria, and the impact of BMI on AKI was analyzed. Results: A total 468 patients in the ICU were analyzed, and AKI occurred in 82 (17.5%) patients. The mean BMI was 21.5 ± 4.0 kg/m2; 102 patients (21.8%) were classified as “underweight,” 286 patients (61.1%) were classified as “normal,” and 80 patients (17.1%) were classified as “overweight.” The adjusted analysis showed significantly higher risk of AKI in the overweight group compared to the underweight group (odds ratio, 3.95; 95% confidence interval, 1.74-9). Additional risk factors for AKI in critically ill patients included comorbid liver cirrhosis, septic shock, and acute respiratory distress syndrome. Conclusions: BMI is a possible predictor of AKI in ICU patients, as this study indicated that AKI occurs more frequently in overweight patients than in underweight patients.

Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital

Lee, Tae Won,Hong, Jeong Woo,Yoo, Jung-Wan,Ju, Sunmi,Lee, Seung Hun,Lee, Seung Jun,Cho, Yu Ji,Jeong, Yi Yeong,Lee, Jong Deog,Kim, Ho Cheol The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4

Background: Potentially harmful unplanned extubation (UE) may occur in patients on mechanical ventilation (MV) in an intensive care unit (ICU) setting. This study aimed to evaluate the clinical characteristics of UE and its impact on clinical outcomes in patients with MV in a medical ICU (MICU). Methods: We retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014. Results: A total of 468 patients were admitted to the MICU, of whom 450 were on MV. Of the patients on MV, 30 (6.7%) experienced UE; 13 (43.3%) required reintubation after UE, whereas 17 (56.7%) did not require reintubation. Patients who required reintubation had a significantly longer MV duration and ICU stay than did those not requiring reintubation ($19.4{\pm}15.1days$ vs. $5.9{\pm}5.9days$ days and $18.1{\pm}14.2days$ vs. $7.1{\pm}6.5days$, respectively; p<0.05). In addition, mortality rate was significantly higher among patients requiring reintubation than among those not requiring reintubation (54.5% vs. 5.9%; p=0.007). These two groups of patients exhibited no significant differences, within 2 hours after UE, in the fraction of inspired oxygen, blood pressure, heart rate, respiratory rate, and pH. Conclusion: Although reintubation may not always be required in patients with UE, it is associated with a poor outcome after UE.

Body Mass Index as a Predictor of Acute Kidney Injury in Critically Ill Patients: A Retrospective Single-Center Study

( Sunmi Ju ),( Tae Won Lee ),( Jung-wan Yoo ),( Seung Jun Lee ),( Yu Ji Cho ),( Yi Yeong Jeong ),( Jong Deog Lee ),( Ju-young Kim ),( Gi Dong Lee ),( Ho Cheol Kim ) 대한결핵 및 호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.4

Background: The aim of this study was to examine the influence of body mass index (BMI) on the development of acute kidney injury (AKI) in critically ill patients in intensive care unit (ICU). Methods: Data of patients admitted to medical ICU from December 2011 to May 2014 were retrospectively analyzed. Patients were classified into three groups according to their BMI: underweight (<18.5 kg/m²), normal (18.5-24.9 kg/m²), and overweight (≥25 kg/m²). The incidence of AKI was compared among these groups and factors associated with the development of AKI were analyzed. AKI was defined according to the Risk, Injury, Failure, Loss of kidney function, and End-stage (RIFLE) kidney disease criteria. Results: A total of 468 patients were analyzed. Their mean BMI was 21.5±3.9 kg/m², including 102 (21.8%) underweight, 286 (61.1%) normal-weight, and 80 (17.1%) overweight patients. Overall, AKI occurred in 82 (17.5%) patients. The overweight group had significantly (p<0.001) higher incidence of AKI (36.3%) than the underweight (9.8%) or normal group (15.0%). In addition, BMI was significantly higher in patients with AKI than that in those without AKI (23.4±4.2 vs. 21.1±3.7, p<0.001). Multivariate analysis showed that BMI was significantly associated with the development of AKI (odds ratio, 1.893; 95% confidence interval, 1.224-2.927). Conclusion: BMI may be associated with the development of AKI in critically ill patients.

Genotypic variation of embryo dent of rice grains

Yunjoo Lee,Gileung Lee,Rihua Piao,Sunmi Jang,Hee-Jong Koh 한국육종학회 2013 한국육종학회 심포지엄 Vol.2013 No.07

As the market demand on functionality rice has been increasing, embryo rice in which embryo residue remains even after milling has come to comsumers’ attention because rice embryo contains several functionality components. Consequently, development of rice varieties for higher rate of embryo adhesion to grains after milling has become one of the breeding objectives for quality improvement. In this study, we observed embryo dent of 49 commercial varieties and analyzed the relationship between embryo dent and grain size and shape. Embryo dent of rice grains varied 0.27 (Keunnun)~0.59 (Daerip 1) mm. Varieties Jinbu, Jinbo, Heugseol, Obong, Unkwang, and Cheongnam showed relatively deeper embryo dent, suggesting that they will be applicable in breeding for embryo rice. Embryo dent was correlated positively with grain width (r=0.53**) and grain size(r=0.34*), and negatively with grain width/length ratio (r= -0.38**). Strategies for breeding embryo rice were discussed in relation to embryo dent, grain size and shape.

Body Mass Index as a Predictor of Acute Kidney Injury in Critically Ill Patients: A Retrospective Single-Center Study

Ju, Sunmi,Lee, Tae Won,Yoo, Jung-Wan,Lee, Seung Jun,Cho, Yu Ji,Jeong, Yi Yeong,Lee, Jong Deog,Kim, Ju-young,Lee, Gi Dong,Kim, Ho Cheol The Korean Academy of Tuberculosis and Respiratory 2018 Tuberculosis and Respiratory Diseases Vol.81 No.4

Background: The aim of this study was to examine the influence of body mass index (BMI) on the development of acute kidney injury (AKI) in critically ill patients in intensive care unit (ICU). Methods: Data of patients admitted to medical ICU from December 2011 to May 2014 were retrospectively analyzed. Patients were classified into three groups according to their BMI: underweight (< $18.5kg/m^2$), normal ($18.5-24.9kg/m^2$), and overweight (${\geq}25kg/m^2$). The incidence of AKI was compared among these groups and factors associated with the development of AKI were analyzed. AKI was defined according to the Risk, Injury, Failure, Loss of kidney function, and End-stage (RIFLE) kidney disease criteria. Results: A total of 468 patients were analyzed. Their mean BMI was $21.5{\pm}3.9kg/m^2$, including 102 (21.8%) underweight, 286 (61.1%) normal-weight, and 80 (17.1%) overweight patients. Overall, AKI occurred in 82 (17.5%) patients. The overweight group had significantly (p<0.001) higher incidence of AKI (36.3%) than the underweight (9.8%) or normal group (15.0%). In addition, BMI was significantly higher in patients with AKI than that in those without AKI ($23.4{\pm}4.2$ vs. $21.1{\pm}3.7$, p<0.001). Multivariate analysis showed that BMI was significantly associated with the development of AKI (odds ratio, 1.893; 95% confidence interval, 1.224-2.927). Conclusion: BMI may be associated with the development of AKI in critically ill patients.

성폭력 형사사건에서 피해자 진술의 신빙성과 경험칙에 관한 연구

이선미 ( Lee Sunmi ),박용철 ( Park Yong Chul ),서용성 사법정책연구원 2020 연구보고서 Vol.2020 No.2

본 연구는 성폭력 형사사건에서 유죄 입증의 중요 증거 중 하나인 피해자 진술의 신빙성 판단을 위한 기준으로서의 경험칙에 관한 비교법적 연구 및 국내 판례와 하급심 판결문 분석을 주요 내용으로 한다. 제1부는 비교법적 연구에, 제2부는 국내 판례 및 하급심 판결문 분석에 초점을 맞추었으며, 서로 독립적으로 구성되어 있다. 제1부(박용철 초빙연구위원 집필)는 성폭력 사건에서 피해자 진술의 신빙성 평가 중 ‘특히 진술 내용이 경험칙에 부합하는지 여부’에 기반한 평가에 대하여 보통법계 국가들을 중심으로 한 비교법적 연구이다. 여타의 형사사건과 비교할 때 목격자와 같은 직접증거가 절대적으로 부족한 성폭력 형사사건에서 유죄 입증의 중요 증거 중 하나인 피해자 진술의 신빙성 판단을 위한 법관의 기준으로 우리 판례상 제시되고 있는 경험칙에 대한 일반적 논의 내용을 확인하고 비교법적 연구를 통하여 주로 보통법계 국가에서 직업 법관 또는 배심원이 사용하고 있는 경험 및 경험칙의 내용에는 어떠한 것들이 있는지 살펴본다. 성폭력 형사사건에서의 피해자 진술의 신빙성을 판단하기 위한 법관의 경험칙은 실체를 알 수 없는 일반인의 ‘통념’의 수준에 그치는 것이 아니라, 고도의 개연성이 있거나 과학법칙에 준할 정도의 확실성을 갖춘 것이어야 한다. 성폭력 형사사건에서의 피해자 진술의 신빙성 판단에 있어 경험칙은 진술의 합리성 등을 판단하는 기준으로 활용되는데 이 판단 기준이 자의적이거나 불확실할 수는 없는 것이다. 따라서 경험칙이라는 용어를 이해하기 위해서 성폭력 형사사건의 피해자 진술 신빙성 판단에 있어 배심원의 역할을 강조하는 동시에 제한하고 있는 보통법계 국가의 상황은 여러 가지로 시사하는 점이 많다. 배심원이 사실관계 확인을 위해서 활용하는 경험은 법관의 경험칙에 비하여 자의적이거나 주관이 개입되었을 여지가 많다. 따라서 성폭력 형사사건에 있어 보통법 국가들의 법원은 배심원 설명의 형태로 배심원들의 자의적인 경험의 적용을 사전에 방지하기 위하여 각종 편견 배제의 요청을 하고 있는데 이는 성인지 감수성을 설시한 최근 법원의 입장과 공통되는 측면이 있다. 법원이 성폭력 피해자 진술 판단 기준으로 제시하고 있는 법관의 경험칙은 법관이 주관적인 사고 형성 과정을 통해 습득한 내용과 수많은 동종 사건을 판단함에 있어 간접적으로 경험하게 된 사건 내용에 기반한 내용의 집합체이다. 그러한 기준은 모든 성폭력 범죄사건에다 유용한 잣대로 기능할 수는 없다. 절대적으로 자연과학법칙에 달하는 정도의 엄격한 확실성을 가질 것을 요구하나 필연적으로 그렇지 않은 경험칙을 갖고 피고인과 피해자 진술의 신빙성을 판단하는 것에는 근본적인 한계가 있을 수밖에 없다. 따라서 성폭력 범죄사건에서 제시할 수 있는 경험칙은 편견을 갖지 않는 신중한 판단을 요구하게 된다. 그러한 측면에서 성폭력 형사사건에 있어 성인지 감수성의 요구는 법관이 사실 관계를 판단함에 있어 가능한 모든 편견을 배제하고 피해자의 상황을 이해하여 그러한 진술의 근원을 찾으려는 노력의 일환이라 할 것이다. 제2부(이선미 연구위원 집필)는 성폭력 사건에서 피해자 진술의 신빙성 평가 중 ‘진술 내용이 경험칙에 부합하는지 여부’에 관한 평가의 현재 상황을 되돌아보고 비판적으로 검토해 보는 것을 주된 내용으로 한다. 피해자 진술의 신빙성을 판단하는 것은 증거로서의 증명력 유무를 판단하는 문제일 뿐만 아니라 그 진술을 내용으로 하는 서류의 증거능력을 예외적으로 인정하기 위한 요건에 해당하는지 여부를 판단하는 문제이기도 하다. 피해자 진술의 신빙성을 판단하기 위한 요건에 관하여는 판례를 통해 법리가 형성·발전되어 왔다. 특히 진술의 내적 요소, 즉 내용의 측면에서는 그것이 경험칙에 부합하여야 한다는 요건이 제시되고 있다. 경험칙의 의미나 내용에 관하여는 판례가 특별히 제시하고 있지 않으나, 적어도 경험칙은 단순한 개연성을 넘어서 고도의 개연성을 가지는 명제의 수준에까지 도달하여야 한다. 2016년까지 판결이 선고된 성폭력 사건들 중에서 사건명 및 검색어를 이용하여 선별한 판결문 474건을 대상으로 하여, 현재 법원이 성폭력 사건에 있어서 선언하고 있는 경험칙의 내용 등을 살펴본다. 이를 통해 볼 때, 판결문에서 경험칙이라는 이름으로 제시되는 명제는 크게 몇 가지의 범주로 나누어 볼 수는 있으나, 그 내용이 매우 다양하고도 구체적인 것을 알 수 있다. 그리고 법원이 어느 사건에서 경험칙이라고 제시하는 명제가 다른 사건 에서 내지는 동일 사건의 다른 심급에서도 반드시 그대로 받아들여지고 있는 것은 아니다. 그렇다면, 법원이 현재 성폭력 사건에 있어서 인식하고 있는 경험칙이 과연 진정한 경험칙에 해당하는지 되돌아볼 필요가 있다. 성폭력 사건에서의 경험칙으로 여겨지는 몇 가지 명제를 대상으로 하여 보건대, 그 명제를 구성하는 사실관계에 따라 분석 대상 판결들에서 유·무죄 결론이 유의미하게 달라지는 정도까지 이른다고 보기 어렵다. 성폭력 사건에서의 경험칙은 관념적으로 제시되어서는 안 되고 과학적이고 실증적인 방법으로 발견되고 검증되어야 한다. 특히 피해자의 인식과 의지가 개입되는 사정을 경험칙의 내용으로 하는 경우, 일반적인 피해자라는 개념을 상정하여 선언하는 경험칙으로는 피해자 진술의 신빙성을 제대로 판단하기 어렵다. 성폭력 사건마다 서로 다른 개별적인 상황과 사람에 대한 이해의 폭과 깊이를 확대하기 위한 노력이야말로 우리 대법원이 성폭력 사건의 재판에 있어서 갖추기를 요구하는 ‘성인지 감수성’이다. The subject of this study is the experience rules as a criterion for determining the credibility of victim statements, which is one of the main evidences of criminal cases in sexual violence. This study is consisted of two independent parts; the first part focuses on comparative legal studies in regards to the experience rules, and the second part focuses on the analysis of Korean Supreme Court’s precedents and lower court judgments of criminal cases in sexual violence. Part 1 by Yong Chul Park is a comparative legal study mainly focusing on common law countries in the assessment of the credibility of victim statements in sexual violence cases, in particular on whether the statement is consistent with the experience rules. This study confirms the general discussion of experience rule presented in criminal cases as the basis of judges for determining the reliability of the victim’s statement, one of the important evidence of guilt in a sexual assault criminal case, which is absolutely lacking in direct evidence such as witnesses, and examines the details of the experiences or the experiences rule used by professional judges or jurors, mainly in common law countries, through comparative studies. The judge’s experience rule in order to screen the credibility of the victim’s statements in a criminal case of sexual violence should not be limited to the conventional wisdom of the general public, but should be the thing of high probability or of same degree of certainty as the science law. In determining the credibility of victim statements in sexual violence and criminal cases, the experience rule is used as criteria for determining the validity of statements, which cannot be arbitrary or uncertain. Therefore, the term, experience rule suggests many things in common law countries that emphasize the role of jurors in determining the credibility of victim statements in sexual violence and criminal cases. The experience that a jury uses to ascertain facts is more likely to be arbitrary than the judge's experience rule. Thus, courts in the common law countries in criminal cases of sexual violence are requesting the exclusion of various prejudices in advance to prevent arbitrary application of jurors’ experiences in the form of jury instruction. Such contents of jury instruction has some common ground compared with recent court cases noting gender sensitivity. Part 2 by Sunmi Lee focuses on critical reviewing the courts’ current practice of victims’ statements assessment based on the experience rules in sexual violence cases. Judging the credibility of a victim’s statement is not only a matter of evidential value but also a matter of exceptional admissibility of evidence. As regards the requirements for judging the credibility of a victim's statement, Supreme Court’s case law has been formed and developed. The case law in this aspect holds that the content of a statement should be consistent with the experience rules. Although the Supreme Court does not specifically suggest the meaning or content of the experience rules applied in criminal cases of sexual violence, the experience rules in this context must go beyond the simple probability to reach the level of proposition with high probability. Among the judgments of sexual violence rendered in lower courts across the country until the year of 2016, 474 judgments were carefully selected by browsing the case title ‘rape’ and the core keywords ‘credibility’ & ‘the experience rules’. Through these judgments, judges present propositions with very diverse and specific contents as so-called experience rules. In addition, the propositions that the court suggests as the experience rules in one case are not necessarily accepted in other cases or at different levels of the same case. An analysis has been made to find out whether some propositions that are currently considered as the experience rules in sexual violence criminal cases have reached to the extent of high probability, though it turned out not to be successful. The experience rules in criminal cases of sexual violence should not be presented anecdotally, but it should be found and tested using a scientific and empirical manner. Especially, in terms of discussing the experience rules with regard to the victim’s intentions and awareness of his/her surroundings, the judgment that the ‘average victim’ would have acted in a certain way should be ruled out because it is not appropriate to make a judgment how the victim would have behaved in general in determining the credibility of victims’ statements. Courts should try to judge more deeply the individual circumstances of the victim and the person itself. The demand for such efforts is understood by Supreme Court’s judgment on ‘gender sensitivity’.

Free Paper Presentation : OS-95 ; Unplanned Extubation in Mechanically Ventilated Patients in the Medical Intensive Care Unit: Experience in a Single Tertiary Hospital

( Tae Won Lee ),( Ho Cheol Kim ),( Young Sil Hwang ),( Jong Deog Lee ),( Yi Yeong Jeong ),( Yu Ji Cho ),( Seung Jun Lee ),( Seung Hun Lee ),( Sunmi Ju ),( Jeong Woo Hong ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-

Background: Unplanned extubation (UE) can occur in patients with mechanical ventilation (MV) in the intensive care unit (ICU) and can be harmful. This study aimed to evaluate the clinical characteristics of UE and its impact on outcomes in patients on MV in the medical ICU (MICU). Methods: We retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014 at Gyeongsang National University Hospital. Results: A total of 468 patients were admitted to the MICU, of which, 435 were on MV. Of these, 30 patients (6.9%) experienced UE. Fourteen of these patients (56.7%) needed reintubation after UE and 16 (43.7%) did not need reintubation. Continuous positive airway pressure or spontaneous breathing with a T-piece was applied at the time of UE in 20 patients (66.7%). Further, 4 patients (13.4%) received sedative agents. Of the 14 reintubated patients, 9 (64.2%) were reintubated within 48 hours. Patients who needed reintubation had a significantly longer MV duration and ICU stay than those who did not need reintubation (16.9 ± 14.1 vs. 5.6 ± 5.9 days and 6.6 ± 6.4 vs. 16.2 ± 13.1 days, respectively; p < 0.05). In addition, ICU mortality was significantly higher among patients who needed reintubation than among those who did not need reintubation (6.3% vs. 57.1%, p < 0.05). However, these two groups of patients showed no significant differences in FiO2, blood pressure, heart rate, respiratory rate, and pH after UE. Conclusions: UE can occur in patients on MV in the ICU. Although reintubation may not always be required in patients with UE, it is associated with poor outcomes in reintubated patients after UE.

The Korean Academy of Tuberculosis and Respiratory Diseases : Slide Session ; OS-095 : Critical Care ; Unplanned Extubation in Mechanically Ventilated Patients in the Medical Intensive Care Unit: Experience in a Single Tertiary Hospital

( Tae Won Lee ),( Ho Cheol Kim ),( Young Sil Hwang ),( Jong Deog Lee ),( Yi Yeong Jeong ),( Yu Ji Cho ),( Seung Jun Lee ),( Seung Hun Lee ),( Sunmi Ju ),( Jeong Woo Hong ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Unplanned extubation (UE) can occur in patients with mechanical ventilation (MV) in the intensive care unit (ICU) and can be harmful. This study aimed to evaluate the clinical characteristics of UE and its impact on outcomes in patients on MV in the medical ICU (MICU). Methods: We retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014 at Gyeongsang National University Hospital. Results: A total of 468 patients were admitted to the MICU, of which, 435 were onMV. Of these, 30 patients (6.9%) experienced UE. Fourteen of these patients (56.7%) needed reintubation after UE and 16 (43.7%) did not need reintubation. Continuous positive airway pressure or spontaneous breathing with a T-piece was applied at the time of UE in 20 patients (66.7%). Further, 4 patients (13.4%) received sedative agents. Of the 14 reintubated patients, 9 (64.2%) were reintubated within 48 hours. Patients who needed reintubation had a signifi cantly longer MV duration and ICU stay than those who did not need reintubation (16.9 ± 14.1 vs. 5.6 ± 5.9 days and 6.6 ± 6.4 vs. 16.2 ± 13.1 days, respectively; p < 0.05). In addition, ICU mortality was signifi - cantly higher among patients who needed reintubation than among those who did not need reintubation (6.3% vs. 57.1%, p < 0.05). However, these two groups of patients showed no signifi cant differences in fiO2, blood pressure, heart rate, respiratory rate,and pH after UE. Conclusions: UE can occur in patients on MV in the ICU. Although reintubation may not always be required in patients with UE, it is associated with poor outcomes in reintubated patients after UE.

Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital

( Tae Won Lee ),( Jeong Woo Hong ),( Jung Wan Yoo ),( Sunmi Ju ),( Seung Hun Lee ),( Seung Jun Lee ),( Yu Ji Cho ),( Yi Yeong Jeong ),( Jong Deog Lee ),( Ho Cheol Kim ) 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4

Background: Potentially harmful unplanned extubation (UE) may occur in patients on mechanical ventilation (MV) in an intensive care unit (ICU) setting. This study aimed to evaluate the clinical characteristics of UE and its impact on clinical outcomes in patients with MV in a medical ICU (MICU). Methods: We retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014. Results: A total of 468 patients were admitted to the MICU, of whom 450 were on MV. Of the patients on MV, 30 (6.7%) experienced UE; 13 (43.3%) required reintubation after UE, whereas 17 (56.7%) did not require reintubation. Patients who required reintubation had a significantly longer MV duration and ICU stay than did those not requiring reintubation (19.4±15.1 days vs. 5.9±5.9 days days and 18.1±14.2 days vs. 7.1±6.5 days, respectively; p<0.05). In addition, mortality rate was significantly higher among patients requiring reintubation than among those not requiring reintubation (54.5% vs. 5.9%; p=0.007). These two groups of patients exhibited no significant differences, within 2 hours after UE, in the fraction of inspired oxygen, blood pressure, heart rate, respiratory rate, and pH. Conclusion: Although reintubation may not always be required in patients with UE, it is associated with a poor outcome after UE.