Ensuring the stability of central venous catheter placement for treating patients hospitalized in an intensive care unit is very important. Although PICC requires an ultrasound and fluoroscopy machine, it is difficult to use a fluoroscopy machine for PICC insertion in the intensive care unit. This study analyzed the cases of the insertion of a PICC under ultrasonic guidance at the bedsides in the intensive care unit to determine the usefulness of PICC in the intensive care unit.

A retrospective study was conducted on patients hospitalized in the surgical intensive care unit and received PICC using ultrasonography at their bedsides from October 2015 to January 2018.

One hundred and twenty patients were collected. The number of successful PICCs stood at 105 patients, which was equal to 87.5%. Among them, 65 and 55 cases had left and right insertion, respectively; the corresponding success rate was 81.8%, and 92.3%. No statistically significant difference in success rates was observed between the left and right, as well as in the success rates depending on the presence of shock, sepsis, acute kidney injury, and mechanical ventilation. In the failed 15 cases, seven cases were due to the course of the procedure and eight cases were confirmed have been malpositioned after insertion.

PICC at the bedside in an intensive care unit is a safe method for central venous catheterization without severe complications and death. The insertion sites, left or right, are equally acceptable. Further study of the cases of malposition will be necessary.

Creatine kinase (CK) elevation is caused by rhabdomyolysis, intense exercise, muscle damage, and several drugs. This study evaluated the clinical significance of elevated serum CK levels in patients with an intensive care unit (ICU) and their effects on muscle strength.

The database of 179 patients, who were examined with CK at least once among patients in the Samsung Medical Center ICU database, was reviewed retrospectively. Forty- eight patients with a myocardial infarction were excluded and 131 patients were analyzed. The clinical features of patients with an elevated CK of more than 2,000 IU/L (more than 10 times the normal value) and those who did not were compared.

The ICU stay days were longer in the high elevation group than the other group (8.6 days vs. 21.7 days, p=0.002). The high elevation group was more likely to go to other treatment centers than home after discharge (14.6% vs. 60.0%, p=0.007). When the Medical Research Council scale was measured, the score of the high elevation group was lower than that of the other group (17.2 vs. 13.3, p=0.006).

Patients with high CK levels were more likely to receive invasive treatment in the ICU, so their muscle strength may decrease with increasing ICU stay and were less likely to be discharged home because of difficulties in living alone. Therefore, in patients with high CK, anticipating long-term treatment in an ICU, minimizing muscle loss, and maintaining functional muscle strength through active rehabilitation will be helpful for the prognosis of the patient.

To assess the prevalence of multidrug-resistant organisms (MDROs) in inter-hospital transferred critically ill patients.

This is a retrospective study. The study population comprised patients who were transferred from other hospitals or health care units into the medical or surgical intensive care unit of Samsung Medical Center from January 2012 to December 2014. We evaluated the acquisition of clinically significant MDROs including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria, and carbapenem-resistant Gram-negative bacteria (CRGNB).

Three hundred and twenty-one patients were included in this study. One hundred and fifty-one patients (47.0%) had at least one species of MDRO, 21.5% in MRSA, 27.1% in VRE, 15.6% in CRGNB, and 3.7% in ESBL. The prevalence of MDROs was significantly higher in male (52.7%), patients with diabetes (61.6%), patients with combined infectious diseases (51.6%), and medical patients (49.3%). Patients with MRSA had significantly longer length of stay than the patients without MRSA. The patients with CRGNB had higher mortality than the patients without CRGNB.

The prevalence of MDROs in inter-hospital transferred critically ill patients was very high. Patients with MDROs in this study had longer hospital stay and higher mortality. These patients require more attention for isolation and hygiene protocols, and antibiotic choices.

This study evaluates respiratory complications related to nasogastric feeding tube insertion in intensive care units (ICU).

This was a retrospective, observational study undertaken in adult intensive care units between August 1, 2014 and October 31, 2014. Critically ill patients who had small-bore feeding tubes for enteral feeding inserted in ICUs comprised the study sample. Information collected by medical record review included demographics, clinical characteristics, and data related to the feeding tube insertion (mechanical ventilator, artificial airway, Glasgow Coma scale, confusion assessment method for the ICU, sedative drug use, postplacement X-ray, and complications).

Two hundred and seventy-six patients were included in the study sample. The median age was 64, and male patients were 67% of the sample. One hundred and eighty-nine patients (69%) were treated with a mechanical ventilator and 215 patients (78%) needed an endotracheal tube or tracheal cannula during feeding tube insertion. Twelve feeding tubes (4%) were inserted into patients' tracheobronchial trees and four pneumothoraxes (1.4%) were checked by postplacement X-ray.

Respiratory complications associated with feeding tube insertion are not rare. Such complications can lead to significant morbidity and mortality. Practitioners should be cognizant of the potential risks of feeding tube insertion. Standard protocol should be considered to minimize the risk.

This study identifies risks for pressure ulcer in patients admitted to surgical intensive care units because of severe traumatic injuries with injury severity scores of 15 or higher.

Data was collected from records of patients admitted from January 1, 2011, to December 31, 2013. The analysis addressed general characteristics, trauma-related characteristics, and treatment-related characteristics of pressure ulcers. Descriptive statistics include the raw numbers, percentages, and the standard deviations. Hypothesis tests including t-tests, chi-square tests, and multi-regression analyses were performed using SPSS ver.dow 12.0.

Two hundred and fifty-nine patients were admitted to surgical intensive care units with severe trauma injuries. Of those, 44 patients (17.0%) had a pressure ulcer. The mean pressure ulcer duration was 8.4 days. The most common pressure ulcer was the second phase ulcer at 51.9%. Risk factors were found to be age (p<0.001), shock (p<0.021), and the fixture device (p<0.020).

Early nursing interventions are necessary to prevent a pressure ulcer in patients with severe trauma injuries admitted to surgical intensive care units.