Intensive Care Units In Korea Research Articles

Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study

Early nutritional support for inpatients reduces admission rates to intensive care units in Korea: a single-center case-control study

Early Sepsis-Associated Acute Kidney Injury and Obesity.

The prevalence of obesity is increasing in the intensive care unit (ICU). Although obesity is a known risk factor for chronic kidney disease, its association with early sepsis-associated acute kidney injury (SA-AKI) and their combined association with patient outcomes warrant further investigation. To explore the association between obesity, early SA-AKI incidence, and clinical outcomes in patients with sepsis. This nationwide, prospective cohort study analyzed patients aged 19 years or older who had sepsis and were admitted to 20 tertiary hospital ICUs in Korea between September 1, 2019, and December 31, 2021. Patients with preexisting stage 3A to 5 chronic kidney disease and those with missing body mass index (BMI) values were excluded. Sepsis and hospitalization in the ICU. The primary outcome was SA-AKI incidence within 48 hours of ICU admission, and secondary outcomes were mortality and clinical recovery (survival to discharge within 30 days). Patients were categorized by BMI (calculated as weight in kilograms divided by height in meters squared), and data were analyzed by logistic regression adjusted for key characteristics and clinical factors. Multivariable fractional polynomial regression models and restricted cubic spline models were used to analyze the clinical outcomes with BMI as a continuous variable. Of the 4041 patients (median age, 73 years [IQR, 63-81 years]; 2349 [58.1%] male) included in the study, 1367 (33.8%) developed early SA-AKI. Obesity was associated with a higher incidence of SA-AKI compared with normal weight (adjusted odds ratio [AOR], 1.40; 95% CI, 1.15-1.70), as was every increase in BMI of 10 (OR, 1.75; 95% CI, 1.47-2.08). While obesity was associated with lower in-hospital mortality in patients without SA-AKI compared with their counterparts without obesity (ie, underweight, normal weight, overweight) (AOR, 0.72; 95% CI, 0.54-0.94), no difference in mortality was observed in those with SA-AKI (AOR, 0.85; 95% CI, 0.65-1.12). Although patients with obesity without SA-AKI had a greater likelihood of clinical recovery than their counterparts without obesity, clinical recovery was less likely among those with both obesity and SA-AKI. In this cohort study of patients with sepsis, obesity was associated with a higher risk of early SA-AKI and the presence of SA-AKI modified the association of obesity with clinical outcomes.

Comparative assessment of nutritional characteristics of critically ill patients at admission and discharge from the neurosurgical intensive care unit in Korea: a comparison study

Comparative assessment of nutritional characteristics of critically ill patients at admission and discharge from the neurosurgical intensive care unit in Korea: a comparison study

Effects of nutritional status and support on the survival of COVID-19 patients in a single tertiary-center intensive care unit in Korea: a case-control study

Effects of nutritional status and support on the survival of COVID-19 patients in a single tertiary-center intensive care unit in Korea: a case-control study

Comparison of a volume-based feeding protocol with standard feeding for trauma patients in intensive care units in Korea: a retrospective cohort study

Comparison of a volume-based feeding protocol with standard feeding for trauma patients in intensive care units in Korea: a retrospective cohort study

Knowledge Evaluation of Oral Diseases and Perception of Cooperation with Dental Experts for Oral Care of Nurses in Intensive Care Units in Korea: A Preliminary Study

The aim of this study was to identify the status of education and knowledge concerning oral diseases for oral care as they relate to intensive care unit (ICU) nurses, as well as to investigate the perception of oral care education and practice, as led by dental experts. This study conducted a self-report survey consisting of 33 questions on education and knowledge about oral diseases, as well as perception of dental expert-led education and practice, targeting 240 nurses in the ICU. Finally, 227 questionnaires were analyzed, and 75.3% of the participants were staff nurses, and 41.4% were in the medical ICU. In the area of education and knowledge of major oral diseases, more than 50% of the respondents treating gingivitis, periodontitis, and dental caries did not complete dental education, and it was found that more than half of the respondents were unable to distinguish diseases of the mouth. It was recognized that more than half of nurses required dental expert-led education and practice. In this study, the education and knowledge of oral diseases of ICU nurses were found to be insufficient, and the need for the cooperation of dental experts was high. Therefore, collaboration to improve oral care practical guidelines for realistically applicable ICU patients will be needed.

Psychometric properties of the Korean version of the Palliative Care Nursing Self-Competence scale for infant use

BackgroundDespite the significant advances in neonatal treatment and care over the past 30 years, palliative care in the neonatal intensive care unit has not been fully provided in South Korea. Neonatal nurses are essential professionals in palliative care as they are directly involved in the care, but there is little information on their palliative care competency because no assessment instrument is available in Korea. ObjectivesThe aim of this study was to develop and test the validity and reliability of the Korean version of the Palliative Care Nursing Self-Competence scale for neonatal palliative care. MethodsThis scale for infant care was developed through parallel translation techniques and revised based on cognitive interviews. Survey data were then collected from 220 neonatal nurses who worked in 13 neonatal intensive care units in Korea. Internal consistency reliability, construct validity based on exploratory factor analysis, and criterion-related validity were tested. ResultsThe final version of the scale included 40 items in five domains that explained 53.4% of the variance. Criterion-related validity was confirmed based on a positive correlation with the Korean version of the attitudes towards neonatal palliative care measurement tool. The Cronbach's alpha for the scale was 0.95. ConclusionsThe Korean version of the Palliative Care Nursing Self-Competence scale for infant care has satisfactory construct validity and reliability to measure palliative care self-competence of neonatal nurses in Korea and evaluate an education program in future studies.

Enteral Nutrition Practice and Associated Factors Among Intensive Care Unit Nurses in South Korea

The purpose of this study was to measure enteral nutrition (EN) practice and associated factors among staff nurses in intensive care units in Korea. A total of 224 staff nurses working in 3 university hospital intensive care units were surveyed. Enteral nutrition practice was measured on the basis of Korean guidelines on EN nursing. The mean scores for EN practice was 4.02 ± 0.46 (range: 1-5). The presence of hospital guidelines and department protocols was associated with improved practice. In multiple regression analysis, the greater the level of awareness, the better the practice of EN. The results suggest that nursing practice may be improved by developing and providing guidelines and protocols, offering education, and increasing the level of awareness of EN.

Higher prevalence of rotavirus infection among out-born newborns transferred to a regional neonatal intensive care unit in Korea

BackgroundRotavirus is one of important pathogens which require infection control in nurseries and neonatal intensive care unit (NICU).MethodWe retrospectively reviewed 1,135 out-born newborns who were transferred to a regional tertiary NICU of Chungbuk National University Hospital between January 2012 and December 2016. We assessed the clinical characteristics of newborns based on the results of rotavirus surveillance tests. The prevalence of rotavirus was evaluated according to the year, month, and season.ResultsAmong the 1,135 infants, 213 (18.8%) had positive results in the rotavirus surveillance test. The rotavirus positive group had a significantly higher gestational age, birth weight, and Apgar score. They also had a significantly higher rate of postpartum care centers when compared to the rotavirus negative group (45.5% vs. 12.6%, P < 0.001). Notably, the prevalence of rotavirus was significantly increased from 3.2 to 33.8% when infants were hospitalized 48 h after birth (P < 0.001). During the study period, there were no significant differences in the annual, monthly, or seasonal prevalence of rotavirus infection.Conclusion and discussionThese findings suggest that more active screening for rotavirus infection is necessary, especially for out-born newborns admitted to NICUs 48 h after birth or hospitalized after using postpartum care centers in Korea.

Oral Care Practice, Perception, and Attitude of Nurses in Intensive Care Units in Korea: A Questionnaire Survey.

Background: This cross-sectional study investigated the factors influencing oral care in patients in intensive care units (ICUs) by identifying the current oral care practice status, perceptions, and attitudes of ICU nurses in Korea. Methods: This study surveyed 240 nurses with work experience in the ICU using a self-report questionnaire consisting of 22 items on the status, perception, and attitude towards oral care in the ICU. Results: A total of 227 questionnaires were analyzed. The average age of the participants was 29.79 ± 5.92 years, and the medical ICU was the most type of ICU. The factors affecting the attitude towards oral care and its importance in ICU patients were the experience of working as a nurse (r = 0.336, p < 0.01), ICU work experience (r = 0.218, p < 0.01), and oral care practice frequency (r = 0.167 p < 0.05); these were found to be statistically significant. Conclusions: In this study, the interest of the nurses in oral care practice and education was high, but professional education and the regular implementation of oral care practices were insufficient. To address these problems, it will be necessary to improve oral care practices through dental intervention and education about oral care methods focused on ICU patients.

Corrigendum to “The association between nurse staffing level and length of stay in general ward and intensive care unit in Korea” [Appl. Nurs. Res. Volume 63, February 2022, 151558/YAPNR 151558

Corrigendum to “The association between nurse staffing level and length of stay in general ward and intensive care unit in Korea” [Appl. Nurs. Res. Volume 63, February 2022, 151558/YAPNR 151558

Development of an End-of-Life Nursing Care Protocol for Intensive Care Units: Delphi Survey Method.

Because of the lack of guidelines and standardized protocols for end-of-life nursing care in intensive care units in Korea, many nurses have reported facing difficulties when providing care for patients. This study attempted to develop a standardized end-of-life nursing protocol for use in intensive care units. A draft of the end-of-life nursing care protocol was developed after a literature review. A Delphi survey was carried out twice with 30 experts, and the content validity ratio of the items was investigated. The draft end-of-life nursing care protocol was divided into 3 separate stages with 24 items: 8 initial end-of-life care assessment items, 5 ongoing end-of-life care items, and 11 post–end-of-life care items. The content validity ratios of the first and second rounds were 0.33 or greater in each category, demonstrating the validity of the proposed draft as a standardized protocol. Furthermore, at the suggestion of the experts, an extra item was added in the last stage, resulting in 25 items. The results of this study are expected to help leading hospitals in South Korea outline the roles and range of tasks for end-of-life care in an intensive care unit and thereby resolve difficulties for nurses. Furthermore, this will improve the medical services that family members receive during end-of-life care.

The association between nurse staffing level and length of stay in general ward and intensive care unit in Korea

BackgroundAlthough many studies investigating the relationship between nurse staffing and quality of care have been published, the appropriate nurse-to-patient ratio with patient severity considered remains poorly understood. The aim of this study was to evaluate the impact of nurse staffing levels on length of stay (LOS) in the intensive care unit (ICU) and general ward. MethodsThis study used a retrospective cohort study. The nurse staffing level was classified into nine grades for ICU based on a nurse-to-bed ratio, and eight grades for general wards based on a nurse-to-patient ratio. A generalized estimating equation model was used to evaluate the associations between the nurse staffing level and LOS. Subgroup analysis was conducted to assess these associations according to patient nursing needs at each hospital type. ResultsThis study included 13,135 ICU patients and 263,818 patients admitted to the general ward. In the ICU, the level of nurse staffing (based on the nurse-to-bed ratio) in grade 4 and above (grade 2: <0.63, grade 3: <0.77, grade 4: <0.88) was significantly associated with reduced LOS compared to grade 7 (<1.25). In the general ward, the level of nurse staffing in grade 4 and above was linked to reduced LOS compared to grade 7. ConclusionThe results of this study show that an appropriate nurse-to-patient ratio is associated with a shorter LOS. In particular, hospitals with a higher proportion of severely ill patients require a larger staff of nurses, making it necessary to develop standards for determining nurse staffing level with patient severity taken into account.

Predictors of Nurse-Reported Quality of Care in Neonatal Intensive Care Units in Korea

PurposeThis study aimed to investigate predictors of nurse-reported quality of care (NQoC) in neonatal intensive care units (NICU) in Korea. Design and methodsThe study participants were 217 NICU nurses working in four tertiary general hospitals and three general hospitals across South Korea. Data were collected in February 2019, when a survey was performed to measure nurse-related characteristics, intent to leave, job satisfaction, and NQoC. Collected data were analyzed using t-test, chi-square test, and hierarchical logistic regression on the SPSS WIN 26.0 program. ResultsApproximately 53% of NICU nurses perceived good quality of care. NICU work experience of less than 2 years and 2 to 4 years were associated with increased odds of good NQoC in all regression models. Perceived adequacy of nurse staffing level was significantly associated with increased odds of good NQoC in model 2 (OR 4.90, 95% CI: 1.75–13.70), model 3 (OR 5.01, 95% CI: 1.73–14.50), and model 4 (OR 3.96, 95% CI: 1.29–12.12). Moreover, in model 3, intent to leave was associated with decreased odds of good NQoC (OR 0.83, 95% CI: 0.21–0.71), and job satisfaction was associated with increased odds of good NQoC (OR 5.41, 95% CI: 2.74–10.67) in model 4. ConclusionsNurses' NICU work experience, adequate nurse staffing level, no intent to leave, and job satisfaction were predictors of good NQoC among NICU nurses. Practice implicationImprovement of nurse staffing levels and job satisfaction is a promising strategy to achieve good quality of care in NICUs.

Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses.

The objective of this study was to investigate the factors affecting the quality of dying and death among terminally ill patients in an intensive care unit in Korea using a cross-sectional, online survey. A total of 300 nurses in the intensive care unit who had cared for a terminally ill patient for at least 48 h prior to death in the past six months were chosen to participate. The person-centered critical care nursing (PCCN) score and quality of dying and death (QODD) had a positive correlation. The QODD score increased when the consultation was conducted between the terminally ill patients and their doctors when CPR was not performed within 48 h of death, and when the PCCN score increased. The quality of death of patients is affected by whether they have sufficiently consulted with healthcare providers regarding their death and how much respect they receive. It is important for nurses to practice and improve patient-centered nursing care in order to ensure a good quality of death for terminally ill patients.

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.

BackgroundThe 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.MethodsIn 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).ResultsThe 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).ConclusionsThe 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.

A hierarchical location model for determining capacities of neonatal intensive care units in Korea

Reforming the healthcare delivery system to provide optimum care to sick newborn infants is a critical task in Korea. Motivated by the efforts of the Korean government, we study a capacity allocation model to design an optimal capacity allocation plan for neonatal intensive care units (NICUs). Our model considers the following properties: 1) the hierarchical feature of neonatal care services and 2) the congestion effect in NICU operations. We develop a mathematical model that combines a hierarchical location model with queuing theory. We subsequently apply the proposed model to the problem of allocating capacities to NICUs in Korea. We provide information that can help policymakers draw an initial plan by evaluating various capacity allocation scenarios. We further examine two policy alternatives for improving accessibility to neonatal care. One involves increasing service capacity by adaptively adding resources to NICUs, and the other includes expanding physical service coverage by introducing helicopter transport. The results show that each alternative can contribute toward improving accessibility, and we believe that these findings will have practical implications for developing a better neonatal care system.

An Integrative Review of Family Interventions based on a Philosophy of Family-Centered Care in Neonatal Intensive Care Units

Purpose: The aim of this study is to analyze the characteristics of family interventions based on a philosophy of family-centered care conducted in neonatal intensive care units through an integrative literature review. Methods: We searched the PubMed, CINAHL, RISS, KISS, and DBpia databases; a total of 20 studies, published between January 2013 and May 2018, was selected according to our criteria. Results: Mothers accounted for a greater proportion of participants in family interventions than did fathers. Family interventions described in the studies were categorized into four educational and sixteen non-educational interventions. Among non-educational interventions, skin-to-skin-contact interventions, such as kangaroo care, accounted for the highest proportion. Only one paper employed a theoretical framework. Conclusion: More family interventions based on theoretical frameworks should be conducted as these frameworks serve as guidelines for nursing research. As the stress patterns experienced by parents in neonatal intensive care units showed gender differences, more programs tailored for fathers are needed. Moreover, further research should be conducted to evaluate feasibility as an outcome variable, and studies of family interventions based on a philosophy of family-centered care should be performed more actively in the neonatal intensive care units in Korea.

Radiation exposure of very-low-birth-weight infants in neonatal intensive care units in Korea

To our knowledge, no study has reported the radiation doses of neonates admitted to neonatal intensive care units (NICUs) in Korea. Therefore, we evaluated the radiation frequency and dose of radiation performed in NICUs using mobile X-ray machines. We retrospectively analyzed the number of radiographs and doses among 290 very low-birth-weight infants (VLBWIs) admitted at our hospital between 2011 and 2016. We compared X-ray frequencies and radiation doses according to clinical characteristics and morbidities. The entrance surface doses (ESDs) were calculated using the non-dosimeter dosimetry formula. The median number of radiographs per infant was 26, and about 25% neonates had over 50 radiographs. The number of radiographs taken was higher for infants with low-birth-weight (LBW), respiratory distress syndrome, bronchopulmonary dysplasia, and longer central venous catheterization duration (p &lt; 0.001 for all). The cumulative ESD was 0.18 to 9.89 mGy, and the ESD per radiograph was 0.049 to 0.069 mGy. The LBW and the more severe the neonates’ condition, the greater was the radiation exposure. It is difficult to reduce the number of radiographic examinations, but the quality of examinations must be improved without compromising patient care. Additional studies are needed to minimize the cumulative exposure dose and achieve optimal image quality.

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

BackgroundThe 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.MethodsThis 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.ResultsDuring 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.ConclusionsCancer 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.