Purpose
Tracheostomy is a procedure which requires careful selection of tracheostomy tube size, because it can significantly impact patient outcomes. However, in situations where radiological imaging is unavailable for measuring the tracheal inner diameter (ID), it can be estimated using the patient's height, weight, and sex. This study aimed to develop a method for estimating tracheal ID.
Methods
A retrospective study was conducted on 468 adult patients who underwent chest computed tomography and chest X-ray at the National Medical Center from 2019 to 2021. Tracheal ID at the level of the jugular notch was measured and cross-checked. The correlation of the patient's body size and sex was then checked with tracheal ID and a regression equation was obtained to estimate tracheal ID.
Results
Height showed the greatest correlation with tracheal ID, followed by either ideal body weight (IBW) or adjusted body weight (ABW). The regression equation to estimate tracheal ID was as follows: “Expected ID of the trachea (mm)” = [11.0781 + (1.9682 for Male or 1 for Female)] + [7.3767 × height (cm)] - {0.8022 × [√ IBW (kg) for healthy weight or ABW (kg) for obese]}. The equation was applied to determine appropriate tracheostomy tube sizes.
Conclusion
Tracheal ID can be estimated using patient sex, height, and either IBW or ABW. By providing a practical method for estimating tracheal ID, the derived regression equation can serve as a valuable tool for healthcare professionals in emergency situations, which may reduce tracheostomy complication rates and deliver better patient outcomes.

Purpose
The national rate of pressure injury (PI) in the intensive care unit (ICU) 2016-2018 was 5.97%, while at one hospital in Honolulu, Hawaii it averaged 13%. The Braden scale is the gold standard PI risk assessment tool. Researchers have reported the Braden scale has limited value in the ICU setting and consider tissue perfusion to be the better indicator. The aim was to determine if tissue perfusion, as measured by noninvasive transcutaneous tissue oxygen levels, was a predictor of PI risk development.
Methods
Electronic medical records of 161 patients admitted from January 1, 2017 to June 30, 2019 were retrospectively reviewed. Patients’ characteristics were summarized using descriptive statistics. Bivariate associations with the development of PI were examined using Fisher’s exact test for the categorical variables, and Wilcoxon rank-sum test for the continuous variables. A multivariable logistic model was fitted for the development of PI with adjustments for potential confounders.
Results
Of 161 patients, 125 met the inclusion criteria. Length of stay, Acute Physiology and Chronic Health Evaluation II score, use of vasopressors, and the Braden score were statistically significant predictors of PI risk development; tissue perfusion was not significant.
Conclusion
ICU patients have a higher mortality and severity of illness. The Braden score guides implementation of PI preventative measures. The relationship between tissue perfusion and PI development may warrant further research. A broader clinical picture to incorporate the Braden scale and other risk factors in PI development such as Acute Physiology and Chronic Health Evaluation II score and use of vasopressors should be considered.

Purpose
Critically ill patients often require multidisciplinary treatment for both acute illnesses and pre-existing medical conditions. Since different medical conditions are managed in the intensive care unit (ICU), consultation is often required. This study aimed to identify the frequency and type of consultation required and analyze changes in consultation patterns after the introduction of intensivist-directed care in the surgical ICU (SICU).
Methods
Between June 2006 and December 2013, a retrospective cohort study was conducted to identify the frequency and type of consultation at 3 different ICUs. Consultations for patients who were admitted to the ICUs for more than 48 consecutive hours were included. The pattern of consultations in each ICU was investigated. In addition, the pattern of consultations before and after the implementation of intensivist-directed care in the SICU was compared.
Results
During the study, 11,053 consultations were requested for 7,774 critically ill patients in a total of 3 ICUs. Consultations with the Departments of Cardiology, Infectious Diseases, and Pulmonology were requested most frequently in the SICU. However, after the implementation of the intensivist-directed care approach, there was an increase in the frequency of consultation requests to the Department of Neurology, followed by the Departments of Cardiology, and Infectious Diseases.
Conclusion
Analysis of consultation patterns is an important method of assessing the complexity and severity of illnesses, and of evaluating the needs of available health system resources. Based on our findings, we suggest the development of an appropriate protocol for frequently consulted services.

Purpose
Acute care surgery (ACS) has been shown to improve patient outcome and treatment efficiency in the U.S. ACS was introduced to the Department of Surgery, Yonsei University College of Medicine, Seoul to solve the problems associated with delays in surgical evaluation of non-trauma patients who needed emergency surgery, and to offer exposure to a wide variety of surgical cases to general surgical fellows and residents. The objective of this study was to describe the 10-year experience of the ACS department in a single center.
Methods
A retrospective chart review was conducted at the Department of Surgery, Yonsei University College of Medicine, Seoul, for all patients admitted from March 2008 to February 2018. Patients were grouped into either the trauma or non-trauma group, and were further classified according to their diagnosis, and the type of operations they had undergone.
Results
There was a total of 2,805 patients, including 1,001 trauma patients and 1,804 non-trauma patients. The average hospital length of stay was 14 days and the total in-hospital mortality rate was 3.6%. Trauma mechanisms included blunt (92.6%), penetrating (7.0%) and burn (0.4%) trauma. The majority of non-trauma patients were admitted for appendicitis (37.1%), followed by cholecystitis (21.7%). There was a total of 1,561 operations conducted. The most frequent operations were appendectomy (38.3%) and cholecystectomy (19.5%), followed by adhesiolysis (7.8%).
Conclusion
A working ACS department has been implemented in a Korean medical center.

Citations

• Development of an ICT Laparoscopy System with Motion-Tracking Technology for Solo Laparoscopic Surgery: A Feasibility Study
  Miso Lee, Jinwoo Oh, Taegeon Kang, Suhyun Lim, Munhwan Jo, Min-Jae Jeon, Hoyul Lee, Inhwan Hwang, Shinwon Kang, Jin-Hee Moon, Jae-Seok Min
  Applied Sciences.2024; 14(11): 4622.     CrossRef
• Difficult Small Bowel Bleeding in Surgical View
  Jung Min Bae
  Journal of Acute Care Surgery.2024; 14(2): 41.     CrossRef
• Clinical significance of acute care surgery system as a part of hospital medical emergency team for hospitalized patients
  Kyoung Won Yoon, Kyoungjin Choi, Keesang Yoo, Eunmi Gil, Chi-Min Park
  Annals of Surgical Treatment and Research.2023; 104(1): 43.     CrossRef

Purpose
The occurrence of trauma-related delirium following postoperative abdominal surgery is associated with a poor prognosis. The purpose of this study was to identify predictive risk factors for trauma-related delirium.
Methods
Trauma patient data from a regional trauma center were retrospectively collected from August 2015 to December 2016. The primary inclusion criteria were patients diagnosed with traumarelated delirium following abdominal trauma surgery. Head trauma patients and those under 18 years of age were excluded from this study. A multivariate logistic regression analysis was performed to identify the risk factors associated with trauma-related delirium.
Results
Of the 255 trauma patients who met the inclusion criteria, 32 (12.5%) were diagnosed with delirium. The mean values for the age of the patients, Injury Severity Score, Glasgow Coma Scale score, and length of intensive care unit stay were 52.1 ± 17.8 years, 16.9, 14, and 7.1 days, respectively. Among the measured parameters, age [odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01-1.06; p = 0.022)], sex (OR, 0.125; 0.03-0.55; p = 0.006), hemoglobin level (OR, 0.875; CI, 0.68-0.98; p = 0.03), length of stay in the intensive care unit (OR, 1.12; CI, 1.03-1.22; p = 0.01), and having an abdominal operation (OR, 2.92; CI, 1.10-7.23; p = 0.011) showed strong correlations with trauma-related delirium.
Conclusion
This study showed that abdominal surgery was strongly associated with delirium in patients with traumatic abdominal injury. Thus, changes in consciousness should be carefully monitored following surgery.

Citations

• Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience
  Tariq Alanezi, Abdulmajeed Altoijry, Aued Alanazi, Ziyad Aljofan, Talal Altuwaijri, Kaisor Iqbal, Sultan AlSheikh, Nouran Molla, Mansour Altuwaijri, Abdullah Aloraini, Fawaz Altuwaijri, Mohammed Yousef Aldossary
  Healthcare.2024; 12(2): 131.     CrossRef