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Purpose: To investigate whether the obesity survival paradox, where obesity is associated with improved survival, exists for pneumonia supported with extracorporeal membrane oxygenation (ECMO)., Materials and Methods: Between January 2014 and December 2015, 223 patients with acute respiratory failure who underwent ECMO in 11 hospitals in South Korea were enrolled retrospectively, and data relating to pneumonia cases were analyzed. Patients were divided into groups according to their pre-treatment body mass index (BMI): obese (BMI ≥ 25 kg/m 2 ) and non-obese (BMI < 25 kg/m 2 ). The BMI cut-off was adopted from the World Health Organization for Asian populations., Results: In total, 84 patients had pneumonia: obese group, 26; non-obese group, 58 (mean BMI, 27.8 vs. 21.4, p < 0.001). Pre-ECMO parameters and rescue therapy did not differ between the groups. The rate of successful weaning from ECMO was not different between the groups (76.9% vs. 72.4%, p = 0.753), but survival-to-discharge (73.1% vs. 36.2%, p = 0.002) and 6-month survival (69.2% vs. 36.2%, p = 0.005) rates were higher in the obese group. After adjusting for age and the pre-treatment PaO 2 /FiO 2 ratio, low BMI was significantly associated with 6-month mortality (odds ratio 3.28, 95% confidence interval: 1.06-11.03, p = 0.044)., Conclusions: An obesity survival paradox exists in pneumonia supported with ECMO., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To evaluate unbiased information on the characteristics, procedures, and outcomes of intensive care unit (ICU) admissions in a long-term nationwide study., Materials and Methods: Cohort study of all ICU admissions in patients >18years of age in Korea between August 1, 2009 and September 30, 2014 (1,553,673 ICU admissions in 1,265,509 patients)., Results: From August 2009 to September 2014, the age-standardized ICU admission rate was 744.6 per 100,000 person-years (869.5 per 100,000 person-years in men and 622.0 per 100,000 person-years in women). The overall in-hospital mortality was 13.8% (14.1% in men and 13.5% in women). Among all Koreans, the ICU mortality rate was 102.9 per 100,000 person-years (122.5 per 100,000 person years in men and 83.8 per 100,000 person years in women). The median ICU and hospital length of stay were 4 and 13days, respectively. The median cost per ICU admission was $5051, which increased steadily over the study period. There were marked differences by gender in ICU admission rates, aggressive support, and outcomes., Conclusions: Our study identified increasing trends in ICU admissions and utilization of advance life support systems that add to the burden of care in a developed society., (Copyright © 2017 Elsevier Inc. All rights reserved.)

To evaluate the appropriateness of the screening strategy for healthcare personnel (HCP) during a hospital-associated Middle East Respiratory Syndrome (MERS) outbreak, we performed a serologic investigation in 189 rRT-PCR-negative HCP exposed and assigned to MERS patients. Although 20%-25% of HCP experienced MERS-like symptoms, none of them showed seroconversion by plaque reduction neutralization test (PRNT). Infect Control Hosp Epidemiol 2017;38:234-238.

Background: Serum lactate clearance (LC) during initial resuscitation is a potentially useful prognostic marker in patients with severe sepsis or septic shock. However, it is unclear whether LC is also associated with the outcome in septic patients with hepatic dysfunction that may impair lactate elimination, which may contribute to elevated serum lactate levels or decreased LC., Methods: The relationships between LC measured within 6 and 24h after initial resuscitation and hospital mortality were evaluated with multiple logistic regression analysis., Results: Of 770 patients with severe sepsis or septic shock, 208 (27%) with hepatic dysfunction were included in the analysis. The median LC within 6h in survivors (31.4%) was significantly higher than that of non-survivors (9.3%) (P=.010). In addition, the median LC within 24h was also significantly different between groups (51% vs. 12%, P<.001). Low LCs, defined as less than 10% of clearance, at 6 and 24h were associated with in-hospital mortality. After adjusting for potential confounding factors, low LCs at 6 and 24h remained associated with hospital mortality (adjusted OR 4.940, 95% CI 1.762-13.854 at 6h; adjusted OR 5.997, 95% CI 2.149-16.737 at 24h). However, LC at 24h (area under the curve of 0.704) had higher discriminatory power to predict hospital mortality than LC at 6h (area under the curve of 0.608) (P=.033)., Conclusions: LC may be useful for predicting outcomes in septic patients with hepatic dysfunction., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To evaluate risk factors for potential safety events during mobility physical therapy sessions in the medical intensive care unit., Methods: The safety profiles and potential risk factors of 99 patients who were admitted to the medical intensive care unit of a single teaching hospital in Korea between May 1 and December 31, 2013, were retrospectively evaluated., Results: A total of 26 potential safety events (5.0%; 95% confidence interval [CI], 3.4%-7.3%) during 520 mobilization sessions were observed in 17 (17.2%; 95% CI, 10.6%-26.4%) of 99 patients. The common potential safety events were as follows in order of frequency: 11 events of tachypnea or bradypnea (2.1%; 95% CI, 1.1%-3.9%), 6 events of desaturation (1.2 %; 95% CI, 0.5%-2.6%), 4 events of tachypnea or bradycardia (0.8%; 95% CI, 0.3%-2.1%), 4 events of patients' intolerance (0.8%; 95% CI, 0.3%-2.1%), and 1 event of tracheostomy tube removal (0.2%; 95% CI, 0%-1.2%). In multivariate analysis, the use of extracorporeal membrane oxygenation was associated with potential adverse events with an adjusted odds ratio of 5.8 (95% CI, 2.2-15.6), respectively., Conclusion: Early mobility physical therapy performed by a newly established group was feasible for critically ill patients in Korea. However, potential safety events need to be monitored carefully for patients with extracorporeal membrane oxygenation support., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: The risk factors for acquiring an infection with multidrug-resistant (MDR) bacteria in patients with anastomotic leakage after colorectal cancer surgery are poorly understood. We evaluated the risk factors associated with the initial acquisition of MDR pathogens in patients with anastomotic leakage after colorectal cancer surgery., Methods: This study was a retrospective review of prospectively collected data at a university affiliated-tertiary referral hospital in South Korea. From January 2009 to April 2013, a total of 6767 consecutive patients with colorectal cancer who underwent surgery were registered. Of these patients, 190 (2.8%) were diagnosed with anastomotic leakage. Finally, 143 (2.1%) patients with culture test results were included in this study., Results: Of the 143 enrolled patients, 46 (32.2%) were classified in the MDR group. The use of antibiotics for more than 5 days before diagnosis of anastomosis site leakage (p = 0.016) and diabetes mellitus (p = 0.028) was identified as independent risk factors for MDR acquisition by multivariate analysis. The rate of adequate initial empirical antibiotic therapy in the MDR group was lower than in the non-MDR group (35 vs. 75%, p < 0.001). Furthermore, the duration of antibiotic administration after the leak was longer in the MDR group (p = 0.013). Patients in the MDR group also had a longer hospital stay (p = 0.012)., Conclusions: The length of antibiotic administration before the diagnosis of anastomotic leakage and diabetes mellitus were risk factors associated with the acquisition of MDR bacteria in patients with anastomotic leakage after colorectal cancer surgery.

Objectives: The role of extracorporeal membrane oxygenation (ECMO) remains controversial in adult patients with refractory septic shock. We sought to describe the clinical outcomes of adult patients supported by ECMO during septic shock refractory to conventional treatment., Methods: We analysed consecutive adult patients with refractory septic shock, assisted by an ECMO system between January 2005 and December 2013 in a single-centre registry. The primary outcome was survival to hospital discharge., Results: A total of 32 patients (21 males) received ECMO support for refractory septic shock. Of these, 14 patients (43.8%) had undergone cardiopulmonary resuscitation (CPR) and 7 patients (21.9%) did not achieve the return of spontaneous circulation until initiation of ECMO flow. ECMO was weaned off successfully in 13 patients (40.6%) and 7 patients (21.9%) survived to hospital discharge. The survivors had lower peak lactate (4.5 vs 15.1 mmol/l, P = 0.03), lower Sepsis-related Organ Failure Assessment day 3 score (15 vs 18, P = 0.01) and higher peak troponin I (32.8 vs 3.7 ng/ml, P = 0.02) than the non-survivors. None of the patients (31.3%) in whom ECMO was initiated more than 30.5 h after onset of septic shock, survived. In multivariable-adjusted models, CPR [adjusted hazard ratio (HR), 4.61; 95% confidence interval (CI), 1.55-13.69; P = 0.006] was an independent predictor of in-hospital mortality after ECMO in patients with refractory septic shock. Higher peak troponin I > 15 ng/ml (adjusted HR, 0.34; 95% CI, 0.12-0.97; P = 0.04) was associated with a lower risk of in-hospital mortality., Conclusions: Survival to hospital discharge remained low in adult patients with refractory septic shock despite ECMO support. Our findings suggest that implantation of ECMO during refractory septic shock could be considered in patients with severe myocardial injury but should be avoided in patients who have received CPR., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)