Long-term mortality of patients discharged from the hospital after successful critical care in the ICU in Korea: a retrospective observational study in a single tertiary care teaching hospital

라세희,신증수,김관호,김재훈,이종석 대한마취통증의학회 2020 Korean Journal of Anesthesiology Vol.73 No.2

Background: The long-term outcomes of patients discharged from the hospital after successful care in intensive care unit (ICU) are not briskly evaluated in Korea. The aim of this study was to assess long-term mortality of patients treated in the ICU and discharged alive from the hospital and to identify predictive factors of mortality. Methods: In 3,679 adult patients discharged alive from the hospital after ICU care between 2006 and 2011, the 1-year mortality rate (primary outcome measure) was investigated. Various factors were entered into multivariate analysis to identify independent factors of 1-year mortality, including sex, age, severity of illness (Acute Physiology and Chronic Health Evaluation [APACHE] II score), mechanical ventilation, malignancy, readmission, type of admission (emergency, elective surgery, and medical), and diagnostic category (trauma and non-trauma). Results: The 1-year mortality rate was 13.4%. Risk factors that were associated with 1-year mortality included age (hazard ratio: 1.03 [95% CI, 1.02–1.04], P < 0.001), APACHE II score (1.03 [1.01–1.04], P < 0.001), mechanical ventilation (1.96 [1.60–2.41], P < 0.001), malignancy (2.31 [1.82–2.94], P < 0.001), readmission (1.65 [1.31–2.07], P < 0.001), emergency surgery (1.66 [1.18–2.34], P = 0.003), ICU admission due to medical causes (4.66 [3.68–5.91], P < 0.001), and non-traumatic diagnostic category (6.04 [1.50–24.38], P = 0.012). Conclusions: The 1-year mortality rate was 13.4%. Old age, high APACHE II score, mechanical ventilation, malignancy, readmission, emergency surgery, ICU admission due to medical causes, and non-traumatic diagnostic category except metabolic/endocrinologic category were associated with 1-year mortality.

환기보조 받는 중환자에서 병상머리 올림 프로토콜 적용이 임상 경과와 경장영양공급에 미치는 효과

라세희,이호선,고신옥,이현심,나성원 대한중환자의학회 2011 Acute and Critical Care Vol.26 No.3

Background: Although head of bed (HOB) elevation is an important strategy to prevent ventilator associated pneumonia (VAP), some observational studies have reported that the application of the semi-recumbent position was lower in patients receiving mechanical ventilator support. We performed this study to assess the effect of implementation of the HOB elevation protocol in the intensive care unit (ICU) on clinical and nutritional outcomes. Methods: We developed a HOB elevation protocol including a flow chart to determine whether the HOB of newly admitted patients to ICU could be elevated. We measured the level of HOB elevation in patients with mechanical ventilator twice a day and 2 days a week for 5 weeks before and after the implementation of the protocol, respectively. Hemodynamic, respiratory and nutritional data were also collected, resulting in 251 observations from 35 patients and 467 observations from 66 patients before and after implementation. Results: After implementing the protocol, the level of HOB elevation (16.7 ± 9.9 vs. 23.6 ±1 2.9, p < 0.0001) and observations of HOB elevation > 30˚ increased significantly (34 vs. 151, p < 0.0001). There was no significant difference in the incidence of VAP. Arterial oxygen tension/fraction of inspired oxygen ratio improved (229 ± 115 vs. 262 ± 129, p = 0.02). Mean arterial blood pressure decreased after the implementation of the protocol, but remained within the normal limits. Calorie intake from tube feeding increased significantly (672 ± 649 vs. 798 ± 670, p = 0.021) and the events of high gastric residual volume (> 100 ml) occurred less frequently after implementing the protocol (50% vs. 17%, p = 0.001)Conclusions: Implementation of the protocol for HOB elevation could improve the level of HOB elevation, oxygenation parameter and enteral nutrition delivery.

갑상선 절제술을 받은 환자에서 P6 Acupressure의 술 후 오심, 구토에 대한 예방 효과

라세희 ( Se Hee Na ),김나영 ( Na Young Kim ),길혜금 ( Hae Keum Kil ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4

Background: Postoperative nausea and vomiting (PONV) is a common problem in patients recovering from anesthesia and surgery. P6 point is the acupressure point for prevention of postoperative nausea and vomiting. We evaluated the efficacy of acupressure at the P6 point in 94 patients undergoing thyroidectomy in a randomized, prospective and placebo-controlled study. Methods: Ninety-four female patients, aged 18 to 60, scheduled for elective thyroidectomy, were randomized to have either placebo band or acupressure band (Sea-Band(R) UK Ltd., Leicestershire, England, UK) applied to the P6 point of both hands before induction of anesthesia. The acupressure bands removed 24 h later. Postoperative nausea and vomiting was evaluated 1, 6 and 24 h following surgery. In addition, the need for rescue antiemetic medication during 24 h was registered. Results: The incidence of postoperative nausea was lower in acupressure group at 0-1 h (16.7% vs. 39.1%; P=0.015) and at 6-24 h (0% vs. 15.2%; P=0.05). The need for rescue antiemetic medication was also lower at 0-1 h (4.2% vs. 23.9%; P=0.006), at 1-6 h (6.2% vs. 20.9%; P=0.039) and at 6-24 h (0% vs. 13%; P=0.012). Conclusions: In patients undergoing thyroidectomy, nausea and need of rescue antiemetic medication were reduced by acupressure at the P6 point. (Korean J Anesthesiol 2009;56:413~8)

중환자에서 질병 중증도와 영양 상태가 예후에 미치는 효과

안서희,라세희,장철호,임현선,이덕철,신증수 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.2

Background: Malnutrition is common in hospitalized patients, especially in critically ill patients and affects their mortality and morbidity. However, the correlation between malnutrition and poor outcome is not fully understood. Our hypothesis is that the nutritional effect on the patient’s prognosis would differ depending on the severity of the disease. Methods: 3,758 patients admitted to the intensive care unit (ICU) were observed retrospectively. Patients were divided into well, moderate and severe groups, according to their nutritional status as assessed by their serum albumin level and total lymphocyte count (TLC). The severity of the disease was assessed by the Acute Physiologic and Chronic Health Evaluation (APACHE II score). All patients were followed clinically until discharge or death and ICU days, hospital days, ventilator days, and mortality rates were recorded. Results: Depending on the definition used, the prevalence of hospital malnutrition is reported to be 68.3%. Hospital days, ICU days, as well as ventilator days of moderate and severe groups were longer than the well group. In patients exhibiting mild severity of disease, moderate and severe malnutrition groups have 3-5 times the mortality rate than the well group. Conclusions: Malnutrition affects the prognosis of patients who have an APACHE II score ranging from 4-29 points. Active nutritional support may be more effective for patients with a disease of mild severity.

Undiagnosed light chain systemic amyloidosis: does it matter to anesthesiologists?-a case report-

김관호,이우경,라세희,이종석 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.5

Light chain systemic amyloidosis is rare but may accompany laryngeal or pulmonary involvement, which may increase the risk in airway management. We present a case of a patient planned for resection of cervical epidural mass. The patient had face and neck ecchymoses and purpuras with an unknown cause. Mask ventilation and intubation were successful, but the operation was cancelled to evaluate bleeding from facial skin lesions. A diagnosis of light chain systemic amyloidosis prompted evaluation of involvement of other organs and treatment. This case shows the importance of preoperative evaluation and careful airway management in patients with systemic amyloidosis.

국내 일 병원 중환자실에서 관찰한 섬망 환자의 예후

손정현,박진영,라세희,신증수,손인정,오주영,안지선,안석균,김재진 대한신경정신의학회 2014 신경정신의학 Vol.53 No.6

Objectives The purpose of this study is to evaluate the impact of delirium on clinical outcomes in intensive care unit (ICU) patients in a Korean general hospital. Methods All patients admitted to ICU from March 1, 2013 to October 31, 2013 were assessed by Confusion Assessment Method adapted for use in the ICU for delirium daily, and consistently comatose patients were excluded for analysis. Differences in clinical outcomes (mortality, length of hospital stay, length of ICU stay) were analyzed between delirious patients and non-delirious patients. Subsequently, the impact of delirium on clinical outcomes was analyzed with adjusting for covariates including surgery, age, emergent admission, presence of surgery, and severity of illness. Results The analysis included 129 delirious patients and 469 non-delirious patients. As primary outcome, mortality, length of stay (hospital day, ICU-stay) were significantly high in the delirious group. The association remained the same after adjusting for the covariates. Conclusion The results correspond with those of previous research studies conducted in foreign ICU. Based on this observation that delirium also has an impact on clinical outcomes in Korean ICU, integrative and in-depth investigation on ICU delirium will be needed. 중환자실 재실 중 섬망을 경험하는 환자는 다른 인자들의영향을 통제한 후에도 퇴원시 사망률이 높고, 재실 기간 및입원 기간이 더 길어 본 연구의 가설과 일치하는 결과를 보였다. 이 결과는 국외 연구들에서 보고되어 온 바와 일치하며, 국내 종합병원 중환자실 환경의 환자군을 대상으로 하여그 상관관계를 처음으로 확인하였다는 의의가 있다. 이러한결과는 향후 국내 의료 환경에서 발생하는 섬망에 대한 탐색과 이에 대한 적절한 중재를 연구하는 데 기초 자료로서 활용될 것으로 기대한다.

심박변이도를 이용한 중환자실 입원 환자의 자율신경계 일중변동성에 대한 예비연구

오주영,조동래,김종인,박재섭,허재석,김재진,라세희,신증수,이보름,박진영,Oh, Jooyoung,Cho, Dongrae,Kim, Jongin,Park, Jaesub,Heo, Jaeseok,Kim, Jae-Jin,Na, Se Hee,Shin, Cheung Soo,Lee, Boreom,Park, Jin Young 대한생물정신의학회 2017 생물정신의학 Vol.24 No.1

Objectives A normal circadian rhythm of autonomic nervous system function stands for the daily change of sympathetic and parasympathetic modulation, which can be measured by heart rate variability (HRV). Generally, patients in the intensive care unit (ICU) are prone to sleep-wake cycle dysregulation, therefore, it may have an influence on the circadian rhythm of autonomic nervous system. This study was designed to interpret possible dysregulation of autonomic nervous system in ICU patients by using HRV. Methods HRV was assessed every 3 hours in 21 ICU patients during a 7-minute period. The statistical differences of HRV features between the morning (AM 6 : 00-PM 12 : 00), and the afternoon (PM 12 : 00-PM 18 : 00) periods were evaluated in time domain and frequency domain. Results Patients showed significantly increased normalized power of low frequencey (nLF), absolute power of low frequencey (LF)/absolute power of high frequencey (HF) in the afternoon period as compared to the morning period. However, normalized power of high frequency (nHF) was significantly decreased in the afternoon period. There was no statistically significant difference between the morning period and the afternoon period in the time domain analysis. Conclusions The increased sympathetic tone in the afternoon period supports possible dysregulation in the circadian rhythm of autonomic nervous system in ICU patients. Future studies can help to interpret the association between autonomic dysregulation and negative outcomes of ICU patients.

임상연구 : 무체외순환 관상동맥 우회술에서 6% Hydroxyethyl Starch (HES) 130/0.4와 6% HES 200/0.5가 조직 산소화와 수술 후 출혈에 미치는 영향

김창석 ( Chang Seok Kim ),곽영란 ( Young Lan Kwak ),김대희 ( Dae Hee Kim ),라세희 ( Se Hee Na ),심재광 ( Jae Kwang Shim ),방서욱 ( Sou Ouk Bang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

Background: Hydroxyethyl starch (HES) effectively restores plasma volume and thereby enhances microcirculation and tissue oxygenation at the expense of coagulation impairment. These effects are related to molecular weight, substitution and C2:C6 ratio. But, most of the studies regarding coagulation impairment in cardiac surgeries were performed in patients undergoing cardiopulmonary bypass which significantly causes coagulation derangements. Therefore, we have evaluated the effects of 2 different HES solutions on tissue oxygenation and postoperative bleeding in patients undergoing off-pump coronary artery bypass surgery (OPCAB). Methods: Forty four patients were prospectively enrolled. After the induction of anesthesia, either HES 130/0.4 (V group) or 200/0.5 (H group) were infused for fluid therapy to maintain predetermined urine output, cardiac index and filling pressure up to 16 h after the surgery. Tissue oxygenation profiles and respiratory parameters were recorded after induction of anesthesia, completion of distal anastomosis and sternum closure, upon admission at intensive care unit, and 4 h thereafter. The amounts of chest tube drainage, transfusion and fluid balance were measured up to 16 h after the surgery. Results: Patients` demographic data were similar between the groups. Tissue oxygenation profiles, respiratory parameters, hemodynamics, and time to extubate were not different between the groups. However, chest tube drainage and transfusion requirements were significantly less in the V group. Conclusions: In OPCAB, 6% HES 130/0.4 causes less postoperative bleeding and transfusion requirement and has a comparable efficacy on hemodynamic stability, pulmonary function and tissue oxygenation when compared to 6% HES 200/0.5. (Korean J Anesthesiol 2007; 52: 649~56)