https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/364 2026-04-04T16:13:28Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64378 Title: Impact of a cumulative positive fluid balance during the first three ICU days in patients with sepsis: a propensity score-matched cohort study Authors: Hyun, Dong-gon; Ahn, Jee Hwan; Huh, Jin Won; Hong, Sang-Bum; Koh, Younsuck; Oh, Dong Kyu; Lee, Su Yeon; Park, Mi Hyeon; Lee, Haein; Lim, Chae-Man; Lee, Jae-Myeong(the Korean Sepsis Alliance (KSA) Investigators) Abstract: Background The optimal strategy for fluid management during the first few days of ICU in sepsis patients remains controversial. We aimed to investigate the impact of cumulative fluid balance during the first three days of ICU on the mortality of patients with sepsis.Methods This study analyzed prospectively collected data from the Korean Sepsis Alliance Database, which registered 11,981 sepsis patients from 20 hospitals. We selected three propensity score-matched cohorts consisting of patients with a negative or positive cumulative fluid balance during the first three ICU days: from ICU admission to the first midnight as the D1 cohort, until the second midnight as the D2 cohort, and until the third midnight as the D3 cohort. The propensity score for fluid balance was calculated using covariates including the amount of fluid output during the first three ICU days. The primary outcome was mortality at day 28 in the ICU.Results From a total of 11,981 patients, 2516 patients were included for propensity score matching. After matching in a 1:1 ratio, there were 483, 373, and 392 matched pairs of patients assigned to the D1, D2, and D3 cohorts, respectively. In the D1 cohort, there were no significant differences in mortality at day 28 (hazard ratio [HR], 1.17; 95% confidence interval [CI] 0.85-1.60; P = 0.354) between the two groups. The positive fluid groups in both the D2 (HR, 2.13; 95% CI 1.48-3.06; P < 0.001) and D3 (HR, 1.56; 95% CI 1.10-2.22; P = 0.012) cohorts had significantly higher mortality rates than the negative fluid groups.Conclusions In patients with sepsis, a positive fluid balance on the first ICU day was not associated with mortality at day 28. In contrast, cumulative positive fluid balances on the second and third ICU days were associated with higher mortality at day 28. 2023-10-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64136 Title: Successfully Managing Severe Anemia in a Trauma Patient Who Refused Blood Transfusion: A Case Report Authors: Sanchez, Irene F.; Lee, Han-Young; Lee, Jae-myeong Abstract: BACKGROUND: Surgical management in patients who undergo traumatic blood loss but who refuse blood transfusion can be challenging, but physicians and surgeons must comply with the wishes and beliefs of their patients. This report describes the management of severe anemia, with hemoglobin level of 2.5 g/dL, in a 71-year-old male Korean trauma patient who declined blood transfusion. CASE REPORT: A 71-year-old man was admitted to hospital with severe blood loss following trauma. He declined blood transfusion due to his religious belief as a Jehovah’s Witness. On day 4, the patient’s hemoglobin level dropped from 7.7 to 3.9 g/dL. Despite the need for blood transfusion, the patient refused. Hence, therapeutic strategies, including crystalloid fluid resuscitation, bleeding control, vasopressor support, erythropoietin administration, supplementation with iron, folic acid, and vitamin B12, coagulopathy correction, oxygen consumption reduction, and mechanical ventilation were implemented. Following 16 days of supportive management, the hemoglobin reached 7.4 g/dL. However, it suddenly decreased on day 41 (2.5 g/dL) due to episodes of melena secondary to an actively bleeding gastric ulcer, which was successfully managed with endoscopic hemostasis. Despite increased vasopressor dosage and addition of vasopressin and hydrocortisone, the patient became unresponsive with persistent hypotension. Methylene blue was used as the final therapeutic agent. The patient responded well and subsequently recovered without blood transfusion. CONCLUSIONS: This report has presented the clinical challenges of managing the case of a patient who requires but declines blood transfusion and has highlighted the approach to clinical care while respecting the wishes of the patient. 2023-10-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/63467 Title: The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea Authors: Hyun, Dong-gon; Ahn, Jee Hwan; Gil, Ha-Yeong; Nam, Chung Mo; Yun, Choa; Lee, Jae-Myeong; Kim, Jae Hun; Lee, Dong-Hyun; Kim, Ki Hoon; Kim, Dong Jung; Lee, Sang -Min; Ryu, Ho-Geol; Hong, Suk-Kyung; Kim, Jae -Bum; Choi, Eun Young; Baek, JongHyun; Kim, Jeoungmin; Kim, Eun Jin; Park, Tae Yun; Kim, Je Hyeong; Park, Sunghoon; Park, Chi-Min; Jung, Won Jai; Choi, Nak-Jun; Jang, Hang-Jea; Lee, Su Hwan; Lee, Young Seok; Suh, Gee Young; Choi, Woo-Sung; Lee, Keu Sung; Kim, Hyung Won; Min, Young-Gi; Lee, Seok Jeong; Lim, Chae-Man Abstract: Background Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death (P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.55–0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% CI, 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death. 2023-05-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/63412 Title: Hematic auto-management and extraction for arterial line (HAMEL), a blood-preserving arterial line system: an animal study Authors: Lee, Hanyoung; Lee, Jae-myeong Abstract: Invasive arterial line insertion is a common procedure in the intensive care unit ICU; however, it can cause unnecessary blood loss while procuring blood for laboratory tests. To reduce blood loss resulting from flushing out the arterial line dead space, we developed a new blood-preserving arterial line system: Hematic Auto-Management & Extraction for arterial Line (HAMEL, MUNE Corp.). Five male three-way crossbred pigs were used to evaluate the necessary amount of blood to be withdrawn before sampling to produce accurate results. We then tested whether the traditional sampling method and the HAMEL system showed non-inferior results for blood tests. Blood gas (CG4 + cartridge) and chemistry (CHEM8 + cartridge) analyses were used for comparison. The total unnecessary blood loss in the traditional sampling group was 5 mL/sample. For HAMEL, withdrawing 3 mL of blood before sampling yielded hematocrit and hemoglobin results within 90% confidence interval of traditional sampling group. Most intra-class correlation coefficients between the traditional sampling and HAMEL system groups were > 0.90. When compared to the traditional sampling method, withdrawal of 3 mL with HAMEL was sufficient before blood sampling. Utilization of the HAMEL system was not inferior to the traditional hand-sampling method. In addition, no unnecessary blood loss occurred in the HAMEL system. 2023-04-01T00:00:00Z