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연명치료중단과 유보 결정에 대한 한국 중환자 전담의사 인식과 실행
김소윤 ( So Yoon Kim ),강현희 ( Hyun Hee Kang ),고윤석 ( Youn Suck Koh ),고신옥 ( Shin Ok Koh ) 한국의료윤리학회 2009 한국의료윤리학회지 Vol.12 No.1
Purpose: This study was performed to evaluate both the attitudes and practices of critical care physicians in Korean ICUs regarding end-of-life care decisions as well as the factors that influence those attitudes and practices. Methods: A questionnaire was developed and delivered to 100 members of the Korean Society of Critical Care Medicine in September 2007. The questionnaire was divided into six parts including personal information, decision-making processes, the withdrawing and withholding of life-sustaining treatment, informed consent, consultation with ethics committees, and guidelines. Results: Eighty eight responses from 53 different institutions were received. The results of the questionnaire include the following. There was a significant difference between the attitude and practices of respondents concerning family consent and patient`s consent. Attitudes toward patient and family consent differed significantly according to the clinical experiences of the respondents (p<.05). There was a significant difference between the attitudes and practices of respondents concerning how often caregivers effectively communicated with patients and family members. Attitudes toward family participation in decision-making processes differed significantly according to the respondents` gender. There was also a significance difference between the attitudes and practices of respondents regarding the withdrawal of life-sustaining treatment. Attitudes and practices on this issue varied according to the type of ICU where the respondents worked and their medical specialty. Practices concerning informed consent for "do not resuscitate" orders varied significantly according to respondent`s age and type of ICU. Finally, attitudes on the participation of ethics committees in decision-making processes varied significantly according to respondent`s clinical experiences (p<.05). Conclusions: This study found significant differences in the attitudes and practices of critical care physicians in Korean ICUs concerning end-of-life care decisions and the withdrawing and withholding of life-sustaining treatment. The study also found that the factors influencing these attitudes and practices include age, specialty, clinical experiences, and the types of ICU in which physicians work. However, there are some limitations in generalizing these findings.
중환자실에서 지속성 신대체요법을 받은 신부전 환자의 칼로리와 단백질 공급 현황
이호선 ( Ho Sun Lee ),박무석 ( Moo Suk Park ),나성원 ( Sung Won Na ),이재길 ( Jae Gil Lee ),유태현 ( Tae Hyun Yoo ),고신옥 ( Shin Ok Koh ) 대한영양사협회 2009 대한영양사협회 학술지 Vol.15 No.4
Forty-two percent of the patients with renal failure that requires continuous renal replacement therapy (CRRT) have been reported to have severe malnutrition, and preexisting malnutrition is a statistically significant and independent predictor of negative hospital outcomes. We performed this study to evaluate the appropriateness of the calorie and protein provided for the critically ill patients who require CRRT. One hundred forty-nine patients who received CRRT were enrolled. The demographic data, the length of the ICU stay and the mortality were recorded. The calorie/protein intake and the blood urea nitrogen (BUN), albumin and creatinine levels were used as nutritional parameters. The mean daily calorie intake during CRRT was 16.1±7.4 kcal/kg, which was 64% of the recommended intake. Only 10% of the patients received the recommended caloric intake and the ratio of the enteral and parenteral calories was 26%/74%. The mean protein intake was 0.58±0.34 g/kg, which was 38% of the recommended intake. The calorie and protein intakes at the termination of CRRT were significantly increased compared to the initial day of treatment, but they stayed under the recommended intake. The BUN, creatinine and albumin levels were significantly increased in the survival group (odds ratio for albumin: 2.73; creatinine: 2.43). A strategy to increase the nutrition provision is needed to improve the nutritional statuses and clinical outcomes of the critically ill patients who require CRRT.
침상각도 상승 교육에 대한 중환자실 간호사의 지식, 인식 및 수행 정도
이현심 (Lee, Hyun Sim),박영우 (Park, Young Woo),김정연 (Kim, Jung Yeon),이은숙 (Lee, Eun Sook),박애순 (Park, Ai Soon),한아름 (Han, A Reum),김은아 (Kim, Eun A),이호선 (Lee, Ho Sun),고신옥 (Koh, Shin Ok) 병원간호사회 2008 임상간호연구 Vol.14 No.3
Purpose: This study was conducted to examine the differences of knowledge, perception, and performance between the points of time before and after ICU nurses had the backrest elevation education. Method: The study subjects were 58 nurses at a medical and surgical ICU of one general Y hospital located in Seoul. They received the education, including backrest elevation guideline and related education materials. Data were collected from May 11 throughout August 12, 2007 with a structured questionnaire. Results: 1) There were significant differences in the mean scores of knowledge(2.21 at pre-education, 5.24 at post-education), perception(36.96 at pre-education, 53.36 at post-education), and performance(32.08 at pre-education, 43.51 at post-education), 2) There was a significant correlation between nurse's perception and performance (p=.000). 3) The nurse's perception regarding the importance of the back rest elevation education was significantly effective on their performance (p=.000). Conclusion: The backrest elevation education would contribute to improve ICU nurse's knowledge, perception and performance. The more the nurses would consider the importance of this education, the better they would perform the nursing intervention of backrest elevation.
전투약이 체외순환중 평균동맥압 및 관유량에 미치는 영향
고신옥,오흥근,정화성 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.3
This study was performed ot compare the effect of premedicant with triflupromazine, one of the phemothiazine derivatives, and more common drugs such as morphine, hydroxyzine or atropine on flow rate and mean arterial pressure. A total of 54 cases who had open heart surgery for acquired or cngenital heart diseases were divided into 3 groups depending on the main premedicants. Group Ⅰ : 22 cases had triflupromazine, pethidine, hydroxyzine and atropine in divided doses. These cases were induced with a small amount of thiopental, morphine and succinylcholine and maintained with either nitrous oxide(50%), oxygen, gallmine and methoxyflurane in analgesic concentrations or with morphine fractionation. Group Ⅱ : 26 cases were given morphine, hydroxyzine and atropine as premedicants. Anesthesia was induced with thiopental, morphine and diazepam and maintained with morphine, nitrous oxide and oxygen. Group Ⅲ : 6 cases were premedicated with hydroxyzine and atropine only and maintained with halothane. After induction, surface cooling was begun using a blanket, combined with internal cooling during bypass. In guroups Ⅰ and Ⅲ rectal temperature was maintained between 28 and 32℃. In group Ⅱ, however, temperature was lower than other groups. After the main intracardiac procedures, rewarming was performed with combined surface and internal techniques. In most case a bypass time of longer than 1 hour was required with the longest times in group Ⅲ, 129.80±21.49min. in duration. The longest anesthetic time was in the child group of group Ⅲ, 430±45.82min. in duration. Urine output during bypass in subgroup of methoxyflurane and morphine of group Ⅰ was 8.95±0.33 and 12.15±0.36㏄/㎏/hr. In group Ⅱ the subgroup maintained with morphine in the adult and child and halothane, outputs were 11.63±0.14, 19.79±0.26 and 8.43±0.33㏄/㎏/hr. respectively. In group Ⅲ maintained with halothane, output was 8.64±0.22㎖/㎏/hr. Mean arterial pressure(MAP) during bypass in most cases was maintained between 50 to 100 torr. In group Ⅰ, the methoxyflurane subgroup, pressures were lower than in any other group, and higher flow rate was required than in any other group. Average MAP during cross clamp on the aorta of group Ⅰ-methoxyflurane, group Ⅱ-morphine adult, group Ⅲ were 56.61±12.47, 78.79±17.33, and 74.06±19.09mmHg respectively. MAP below 50 torr immediately after beginning bypass was more frequent in group Ⅱ(34.8%) than in other groups, and MAP above 100torr after aorta clamping was observed more in group Ⅱ(65.2%) and in group Ⅲ(50%) than in group Ⅰ(10.05%). Time to extubation was longer in group Ⅱ, the morphine subgroup, than in other gorups 19.02±1.26 hours in the adult group and 20.05±2.69 hours in the child group. Post-op recovery in ICU averaged 4.17±0.65 days being longer in group Ⅰ, the morphine subgroup, than in other groups. With this experience, we may conclude that group Ⅰ with triflupromazine premedicants, as compared with the other groups. showed less esophageal and rectal temperature gradients during cooling and rewarming states, less acid base imbalance, better urine output, lower requirement of vasopressors or dilators to keep MAP with more flow rate in reasonable range during bypass and shorter time to extubation after surgery.
개방성 동맥관 절단술시 Sodium Nitroprusside 저혈압마취례 보고
고신옥,오흥근,이예철,김인세 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.3
Sodium nidroprusside has recently come. into widespread usage, not only for the treatment of severe hypertension but also for induced hypotension during surgery. Induced hypotension was produced during general anesthesia by the infusion of sodium nidruopsside in 0. 0l% solution, in two patients undergoing ligation and division of patent ductus arteriosua with pulmonary hypertension. In these cases, no acidotic tendency or CN toxicity were seen and conditions were satisfactory for correction of the PDA.
고신옥,방은치,이세실 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.2
Background: To maintain adequate oxygen delivery and oxygen consumption is essential to care of the critically ill patients. The authors undertook this study to evaluate the patterns of oxygen delivery and oxygen consumption in hemodynamically unstable patients. Methods: Twenty hemodynamically unstable patients were studied, Pulmonary artery catheters were inserted and the hemodynamic variables including oxygen delivery and oxygen consumption were calculated immediately, and 1, 8, 24 hours, respectively after catheterization, and immediately before catheter removal. Patients were divided into survivor and nonsurvivor groups, and the hemodynamic data were compared. The same patients were divided into septic and nonseptic patient groups and same study was done. Results: There were no statistical differences in oxygen delivery and oxygen consumption between the survivors and the nonsurvivors, and the septic and the nonseptic patients. But oxygen delivery and oxygen consumption of the survivors were higher than those of the nonsurvivors. Conclusions: Although we could not find statistical significance, we concluded that supranormal level of oxygen delivery and oxygen consumption could improve the outcome of critically ill patients.