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 o 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.
IntroductIonDelirium management is still a very complex problem, and therefore the range of pharmacological treatment is limited and the effects of nonpharmacological interventions are controversial [1,2].Antipsychotic drugs help to manage some specific symptoms of hyperactive delirium, known as intensive care unit (ICU) psychosis [3].Anxiety and pain can cause delirium, while medications used to relieve these two symptoms can also induce delirium [4,5].Therefore, it is very difficult to maintain a proper balance.The effects of nonpharmacological treatments have also been controversial.
Delirium is an important syndrome in intensive care unit (ICU) patients, however, its characteristics are still unclear. Many evidences showed that this syndrome can be related to the autonomic instability. In this study, we aimed to investigate the possible alterations of autonomic nervous system (ANS) in delirium patients in ICU. Electrocardiography (ECG) of every ICU patient was measured during routine daily ICU care, and the data were gathered to evaluate the heart rate variability (HRV). HRV of total 60 patients were analyzed in time, frequency and non-linear domains. As a result, we found that heart rates of delirium patients were more variable and irregular than non-delirium patients. These findings may facilitate early detection and prevention of delirium in ICU.
There is a growing interest in research aimed at better understanding the disease status or predicting the prognosis of patients with simple blood tests associated with systemic inflammation. The neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) can be used as factors to determine the prognosis of patients in various clinical situations. However, reference values for these attributes based on large, healthy populations have yet to be determined. From January 2014 to December 2016, data from routine blood analyses were collected from healthy patients in the checkup center of a tertiary hospital in Seoul, South Korea. Retrospective data review was then performed on an electronic medical record system. Data were treated anonymously as only age, sex, body mass index, medical history including cancer diagnosis, medications, and smoking status were considered. After the initial screen, we had a collection of 12,160 samples from patients without any medical history, including cancer treatment. This patient pool consisted of 6268 (51.5%, median age 47 years) and 5892 (48.5%, median age 46 years) male and female patients, respectively. The mean NLR across all ages was 1.65 (0.79), and the values for men and women were 1.63 (0.76) and 1.66 (0.82), respectively. The mean LMR, PLR, and MPV were 5.31 (1.68), 132.40 (43.68), and 10.02 (0.79), respectively. This study provides preliminary reference data on LMR, PLR, and MPV from different age and sex groups in South Korea. The results suggest that different cutoff values should be applied to the various patient populations.
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.
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.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 (APACHE II score), mechanical ventilation, malignancy, readmission, type of admission (emergency, elective surgery, and medical), and diagnostic category (trauma and non-trauma).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).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.
BACKGROUND Caregivers are often advised to give additional antipyretic doses if fever persists or recurs before the next dose time. In previous studies, there is no consistent evidence. In clinical guideline, there is no recommended doses in alternative antipyretics treatment. OBJECTIVE To evaluate more appropriate time intervals for alternative therapy using large-scale patient-generated health data. METHODS Participants were youth (aged 6-144 months) and their caregiver used the Fever Coach mobile application between February 2015 to December 2019. One case was referred to a single record for 72 hours after the first antipyretic record input. Baseline means the temperature record closest to the first antipyretic dose. In total, 138,117 cases with alternative antipyretics were selected for final analysis. Area under the curve (AUC) calculated by the area under the temperature curve from baseline for certain hours was used for efficacy analysis. We counted cases with low body temperature records (<36.0℃) to estimate adverse effects. RESULTS In total 138,117 cases, mean age was 29.58 months, and mean baseline temperature was 38.77℃. The time interval between the first and the second antipyretics was 2-3 h in 44,669 (32.34%), 3-4 h in 48,472 (35.09%), and 4-5 h in 44,976 (32.56%) cases. Within 2 h of the first dose, the 2-3 h interval group continued to have fever >38.0℃. The reduction in body temperature from baseline was -0.33℃, -0.54℃, and -0.62℃ in the 2-3 h, 3-4 h, and 4-5 h interval groups, respectively (P < .001, Effect Size 0.041). Within 6 h, the AUC was -201.59 at 2-3 h interval, -165.62 in 3-4 h interval, and -164.32 in 4-5 h intervals (P < .001, Effect Size 0.014). The area under the curve for alternative therapy with 2-3 h intervals was significantly higher than other interval. The mean body temperature of each hour was drawn and acetaminophen with ibuprofen/dexibuprofen showed the fastest and largest antipyretic effects. Within 12 h, 0.89%, 0.50%, and 0.40% cases had low body temperature (<36.0℃) in the 2-3 h, 3-4 h, and 4-5 h interval groups, respectively (P < .001, Effect Size 0.001). CONCLUSIONS In this study, using large-scale patient-generated health data, antipyretic effects were higher at 2-3h interval in alternating therapy. However, education programs and proper care are needed to avoid overdosing.
Background: Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest.The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs) and the current level of cardiopulmonary arrest rate in tertiary hospitals.Methods: This was a retrospective study based on data from 14 tertiary hospitals.Cardiopulmonary resuscitation (CPR) rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present.Results: Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009).Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854).National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001).High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001) and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001).Conclusions: RRSs may be a feasible option to reduce the CPR rate.The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics.
Department of Nursing Science, International University of Korea²Department of Physical Therapy, International University of Korea(Received March 10, 2013: Revised April 2, 2013: Accepted March 2, 2013)AbstractPurpose. The purpose of this study was to contribute to the development of the sexual education program by examining status of Sexual Violence Consciousness and Cognition of Sexual Violence of University studentsMethods. The subjects were 240 University students located in J-city. Data were collected during the period from Nov. 12, 2012 to Nov. 13, 2012. For the data analysis, SPSS 12.0 K program was utilized to get frequency number, percentage, average, standard deviation and t-test. Results. The results present different degrees of man and women's cause of sexual violence cognition and consciousness were as following ; The several scores of women higher more than man parts were ‘Think of the woman as a sexual target(t=3.86, p<0.001)’,‘Men's sexual urges(t=3.98, p<0.001)’, ‘The low status of women in society (t=3.85, p<0.001)’, ‘Male-dominated society and culture(t=5.62, p<0.001)’, ‘Acceptance of men aggression and activism(t=5.19, p<0.001)’,‘Weak punishment (t=7.25, p<0.001)’and Man higher more than women parts were ‘overexposure of women(t=3.88, p<0.001)’.Conclusion. Results suggest that sexual education program should strategies to increase a positive Consciousness and Cognition of Sexual Violence in their education programs in order to improve Consciousness and Cognition of Sexual Violence in University students.
Abstract Caregivers are often advised to use additional antipyretic agents if fever persists before the next dosing time. However, no consistent evidence or guidelines have been reported. This study was to evaluate appropriate time intervals for alternating antipyretic therapy based on the antipyretic effect and incidence of low body temperature using large-scale patient-generated health data. Participants were children and their caregivers, who used the Fever Coach mobile application between February 2015 and December 2019. One case was referred to as a single record for up to 72 h after the first antipyretic record. Of the total 138,117 cases, the mean age was 29.58 months, and the mean baseline temperature was 38.77°C. The reduction in body temperature from baseline was -0.33°C, -0.54°C, and -0.62°C in the 2-3 hours, 3-4 hours, and 4-5 hours interval groups, respectively (P<.001, effect size 0.041). Within 6 hours, the area under the temperature curve from baseline was -201.59 in the 2-3 hours interval, -165.62 in the 3-4 hours interval, and -164.32 in the 4-5 hours interval groups (P<.001, effect size 0.014). In this study using large-scale patient-generated health data, antipyretic effects were greatest at the 2-3 hours interval for alternating therapy. Digitalized patient-generated health data could be used as a proper reference for real-world health guidelines.
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