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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.
척추후측만곡을 동반한 만성폐쇄성폐질환 환자에게 Nasal Mask BiPAP을 이용한 호흡보조
고신옥,방은치,전성식,박병학,남용택,이원영 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.6
Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU. (Korean J Anesthesiol 1997; 33: 1207∼1211)
고신옥,오흥근 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.4
Major fracture of the intrathoracic airway following chest trauma is a potentially lethal injury which can be repaired successfully if the diagnosis is made early. Cough, dyspnea, cyanosis, hemoptyala, mediastinal emphysema or pneumathorax, and a deterioration of the patient's clinical condition out of proportion to the apparant closed chest injury should alert the clinician to the possibility of this entity. This report describes the patients who admitted to the intensive care unit for ventilator support and left main bronchus rupture was recognized after 21-trauma-way with the aid of bronchogram. After then pneumonetomy was done and transferred to the general ward after weaing from the ventiltor support. From the above report it can he concluded that the bronchogram with the aid of fiberoptic bronchoscope is easentially necessary for the diagnosis of the major airway injury.
기계환기보조받는 중환자에게 Midazolam 지속적 주입에 의한 진정
고신옥,방은치,남상범 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.5
Background: Midazolam is distinguished from other benzodiazepines by its water solubility, rapid onset, short duration, and lack of accumulation of active metabolites. These pharmacokinetic cbaracteristics support its use by continuous infusion. We evaluated the continuous infusion dose of midazolain for adequate sedation of ventilated patients with hemodynamic and respiratory monitoring. Methods: We started continuous infusion of midazolam at a rate of 0.5∼1.0 ㎍/kg/minute after bolus injection of 3.0 to 5.0 mg and adjusted infusion dose monitoring sedation scale in the 15 patients. Blood pressure, heart rate and central venous pressure were monitored before and 30 minute, 1, 2, 3 and 6 hours after midazolam infusion. Arterial blood gases were measured and peak inspiratory pressure was monitored. We evaluated liver and kidney function before start of infusion and after discontinuation of midazolam infusion. Results: The mean loading dose, infusion rate and total dose of midazolam were 4.1±0.9 mg, 1.2±0.4g/kg/minute and 251.9±84.0 mg. The mean duration of infusion was 59.0±37.0 hours. After infusion, systolic and diastolic blood pressure and heart rate and central venous pressure remained stable when compared with those of the preinfusion state. Arterial blood gas and peak inspiratory pressure remained unchanged. The function of liver and kidney did not deteriorate after infusion. Conclusions: Continuous infusion of midazolam at a rate of 1.2±0.4 ㎍/kg/minute after 4.1±0.9 mg intravenous bolus injection was a safe and effective method for sedation of ventilated patients in intensive care unit without hemodynamic disturbance.