Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines

하태순,오동규,이학재,장유진,정인석,심윤수,홍석경,박성훈,서지영,박소영 대한중환자의학회 2024 Acute and Critical Care Vol.39 No.1

Background: Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator.Methods: Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations. Results: Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation. Conclusions: We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.

지연성 뇌출혈을 동반한 외상성 경동맥해면정맥동루

하태순,박치민,이대상,유정암,정치량,양정훈,전경만,서지영 대한외상중환자외과학회 2016 Journal of Acute Care Surgery Vol.6 No.1

Traumatic carotid-cavernous fistula (TCCF) is a pathologic communication between the internal carotid artery and cavernous sinus, and is associated with craniomaxillofacial trauma. TCCF are very rare, occurring in 0.17∼0.27% of craniomaxillofacial trauma cases. We describe a 76-year-old woman treated for multiple fractures including the skull base, left temporal bone, right tibia and fibula, left clavicle, and fifth and seventh rib fractures. She developed symptoms of TCCF two weeks after the initial trauma. We successfully treated her by endovascular occlusion of the internal carotid artery. (J Acute Care Surg 2016;6:29-33)

내면화된 수치심과 사회불안의 관계에서 탈중심화, 사후반추와 자기자비의 조절된 매개효과

하태순,구훈정 한국인지행동치료학회 2017 인지행동치료 Vol.17 No.3

본 연구에서는 선행연구에 근거하여 부정적인 자기 평가 태도와 관련된 특질개념으로서의 내면화된 수치심은 상황적 변인으로서의 사후반추 사고를 촉발하여 사회 불안장애로 이어질 것이라는 이론적 가정하에, 내면화된 수치심이 사회불안에 이르는 경로에서 사후반추 사고가 매개 효과를 보일 것이라고 가정하고, 이를 검증하였다. 또한, ‘탈중심화’와 ‘자기자비’가 사후반추 사고의 매개 효과를 조절 효과를 보이는지 검증하였다. 이를 알아보기 위하여 대학생 370명을 대상으로 내면화된 수치심, 사후반추, 사회불안 그리고 탈중심화와 자기자비를 측정하는 자기 보고 설문지를 실시하였다. 본 연구의 결과는 다음과 같다. 첫째, 사후반추 사고는 내면화된 수치심과 사회불안의 관계에서 부분 매개역할을 하는 것으로 나타났다. 둘째, 탈중심화와 자기자비 각각 내면화된 수치심이 사회불안으로 가는 직접 경로에서는 유의한 조절 효과를 보이지 않았지만, 사후반추 사고를 매개로 하여 사회불안에 미치는 간접 경로에서 모두 유의한 조절 효과를 보이는 것으로 나타났다. 본 연구는 사후반추 사고라는 상황적 매개 변인을 발굴하고, 이의 영향력을 조절해 줄 수 있는 보호 요인을 발굴함으로써, 치료적 장면에서 효율적으로 활용하는 데에 대한 경험적 근거를 제공하였다. 본 연구의 시사점과 향후 연구에 대한 제 안점을 논의하였다. This study examined a possible pathway to better understand the relationships between Internalized Shame and Social Anxiety through Post-Event Rumination, Decentering, and Self-Compassion. In specific, the first aim of this study is to examine the mediating effects of the Post-Event Rumination that occurs at the path where ‘Internalized Shame’, which causes one to perceive oneself as worthless and as an inappropriate existence, causes ‘Social Anxiety’. The second aim of this study is to verify the moderated effects of ‘Decentering’ and ‘Self-Compassion’ that are assumed to operate on the path where Internalized Shame has a direct effect on Social Anxiety and to operate on a mediated indirect path that affects Post-Event Rumination. The self-report questionnaires regarding Internalized Shame, Social Anxiety, Post-Event Rumination, Decentering, and Self-Compassion were completed by 370 undergraduate students. The results of this study using the Process Models 8 and 15 of Hayes were confirmed as follows. First, Post-Event Rumination partially mediated the relationship between Internalized Shame and Social Anxiety. The mediating effects of Post-Event Rumination in the relationship Internalized Shame and Social Anxiety were moderated by Decentering and Self-Compassion. More specifically, Decentering acted as a protection factor on the path where Internalized Shame caused Post-Event Rumination, and that Self-Compassion acted as a protection factor on the path towards Social Anxiety after Post-Event Rumination started. In conclusion, Social Anxiety benefits from intervention targeting the Decentering and Self-Compassion by reducing the mediating effects of Post-Event Rumination. The implications of this research study and points of proposal for follow up research were also discussed.

Local complications are related to poor long-term outcome in patients undergoing curative gastrectomy for advanced gastric cancer

하태순,조규석,신응진,류승완,Ryu Keun Won,김민찬,형우진,김찬영,이혁준,신동우,이준호 대한종양외과학회 2022 Korean Journal of Clinical Oncology Vol.18 No.1

Purpose: The present study was performed to investigate the effects of local complications (LC) on long-term survival and cancer recurrence in patients undergoing curative gastrectomy for gastric cancer. Methods: We analyzed 2,627 patients after curative gastrectomy for gastric cancer between January 2001 and December 2006. Patients were classified into groups no complications (NC), LC, or systemic complications (SC). Results: Among the 2,627 patients, 475 patients developed complications (LC group [n=374, 14.2%] and SC group [n=101, 3.9%]). The 5-year cancer-specific survival rate was significantly poorer in the LC group compared to the NC and SC groups (LC, 78.0%; NC, 85.4%; SC, 80.2%; P=0.007). The occurrence of LC was identified as a significant independent prognostic factor for overall and cancer-specific survival (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.46–2.97; P=0.001 and HR, 1.77; 95% CI, 1.12–2.81; P=0.015). The tumor recurrence rates were higher in the LC group than the in other two groups (LC, 23.5%; NC, 15.4%; SC, 15.8%; P<0.001). The occurrence of LC was an independent predictor of tumor recurrence in patients undergoing curative gastrectomy for gastric cancer (HR, 1.55; 95% CI, 1.11–2.17; P=0.011). Conclusion: LC are associated with adverse long-term outcomes in patients after curative gastrectomy for advanced gastric cancer.

Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient

길은미,하태순,서지영,정치량,박치민 대한중환자의학회 2016 Acute and Critical Care Vol.31 No.2

Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.

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

Soo Jin Na,하태순,서지영,고신옥,Chae-Man Lim,Won-Il Choi, M.D., Ph.D.,Young-Joo Lee,Seok Chan Kim,전규락,Je Hyeong Kim,김재열,Jae Min Lim,Sunghoon Park,김호철,Jin Hwa Lee, M.D., Ph.D.,Ji-Hyun Lee, M.D., Ph.D.,Jisook Pa 대한중환자의학회 2018 Acute and Critical Care Vol.33 No.3

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.

2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit

서이준,이학재,하은진,하태순 대한중환자의학회 2022 Acute and Critical Care Vol.37 No.1

We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.

Implementing a multidisciplinary care bundle to reduce colon surgical site infections

Chi-Min Park,하태순,Woo Yong Lee,Doo Ryeon Chung,Yoon Ah Park,최종림,Na Yeon Jeong 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.5

Purpose: The aim of this study was to investigate how rates of surgical site infections (SSI) were changed over 2 years after applying colon SSI bundle in patients who underwent colon surgery. Methods: The multidisciplinary working group developed a care bundle consisting of 8 components, including several recommendations of Surgical Care Improvement Project and monitoring of medical/surgical hand washing. We implemented the care bundle for each patient who underwent colon surgery from April 2013 to December 2014. Results: Overall bundle compliance was 87.9% before implementation, 88.2% in 2013, and 90.5% in 2014. In particular, compliance of the following 3 components was substantial improved during the project period; discontinuation of prophylactic antimicrobial agent within 24 hours of surgery (from 88.3% to 100%), surgical hand washing (from 50.0% to 78.9%), and medical hand washing (from 74.7% to 82.8%). The rate of SSI was 8.0% (12/150) during 3 months before implementation, 3.3% (16/480) from April to December in 2013, and 2.3% (14/607) in 2014. Conclusion: After implementation of multidisciplinary care bundle, the compliance of each component was increased and rates of SSIs were significantly decreased compared to those before the quality improvement project.

다발성 외상으로 인한 심한 폐 좌상과 스트레스성 심근병 환자에서 체외막형 산화기의 치료 경험

이대상 ( Dae Sang Lee ),길은미 ( Eun Mi Gil ),이아란 ( A Lan Lee ),하태순 ( Tae Sun Ha ),정치량 ( Chi Ryang Chung ),박치민 ( Chi Min Park ),조양현 ( Yang Hyun Cho ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.4

A 55 year-old man hit a vehicle while riding a bicycle. He was diagnosed as left hemopneumothorax, multiple rib fracture, cerebral hemorrhage, and skull fracture. Initially he suffered from hypoxia requiring 100% oxygen with a mechanical ventilator. Finally he became hypotensive. Venovenous extracorporeal membrane oxygenation (ECMO) was initiated to support patient’s gas exchange. Because hypotension and left ventricular dysfuction persisted, we converted the mode of support to veno-arterio-venous ECMO. Over four days of intensive care, we could wean off ECMO. The patient went to rehabilitation facility after 45 days of hospitalization. Although trauma and bleeding are considered as relative contraindication of ECMO, careful decision making and management may enable us to use ECMO for trauma-related refractory heart and/or lung failure. [ J Trauma Inj 2014; 27: 229-32 ]