Acute and Critical Care

Original Articles

Pulmonary
Effects of high-flow nasal cannula in patients with mild to moderate hypercapnia: a prospective observational study: Kyung Hun Nam, Hyung Koo Kang, Sung-Soon Lee, So-Hee Park, Sung Wook Kang, Jea Jun Hwang, So Young Park, Won Young Kim, Hee Jung Suh, Eun Young Kim, Ga Jin Seo, Younsuck Koh, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim; Acute Crit Care. 2021;36(3):249-255. Published online July 26, 2021; DOI: https://doi.org/10.4266/acc.2020.01102

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Background
Evidence for using high-flow nasal cannula (HFNC) in hypercapnia is still limited. Most of the clinical studies had been conducted retrospectively, and there had been conflicting reports for the effects of HFNC on hypercapnia correction in prospective studies. Therefore, more evidence is needed to understand the effect of the HFNC in hypercapnia.
Methods
We conducted a multicenter prospective observational study after applying HFNC to 45 hospitalized subjects who had moderate hypercapnia (arterial partial pressure of carbon dioxide [PaCO2], 43–70 mm Hg) without severe respiratory acidosis (pH <7.30). The primary outcome was a change in PaCO2 level in the first 24 hours of HFNC use. The secondary outcomes were changes in other parameters of arterial blood gas analysis, changes in respiration rates, and clinical outcomes.
Results
There was a significant decrease in PaCO2 in the first hour of HFNC application (-3.80 mm Hg; 95% confidence interval, -6.35 to -1.24; P<0.001). Reduction of PaCO2 was more prominent in subjects who did not have underlying obstructive lung disease. There was a correction in pH, but no significant changes in respiratory rate, bicarbonate, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio. Mechanical ventilation was not required for 93.3% (42/45) of our study population.
Conclusions
We suggest that HFNC could be a safe alternative for oxygen delivery in hypercapnia patients who do not need immediate mechanical ventilation. With HFNC oxygenation, correction of hypercapnia could be expected, especially in patients who do not have obstructive lung diseases.

Citations

Citations to this article as recorded by

Safety and efficacy of high flow nasal canula in patients with mild hypercapnia
Mohammed A. Ibrahim, Magdy Emara, Mohammed Shehta
The Egyptian Journal of Bronchology.2023;[Epub] CrossRef
Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
High-flow nasal cannula: Evaluation of the perceptions of various performance aspects among Chinese clinical staff and establishment of a multidimensional clinical evaluation system
Ruoxuan Wen, Xingshuo Hu, Tengchen Wei, Kaifei Wang, Zhimei Duan, Zhanqi Zhao, Lixin Xie, Fei Xie
Frontiers in Medicine.2022;[Epub] CrossRef
The Application Progress of HFNC in Respiratory Diseases
迪吴
Advances in Clinical Medicine.2022; 12(11): 10617. CrossRef

Infection
Relationship between low hemoglobin levels and mortality in patients with septic shock: Sung Min Jung, Youn-Jung Kim, Seung Mok Ryoo, Won Young Kim; Acute Crit Care. 2019;34(2):141-147. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00465

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Background
Hemoglobin levels are a critical parameter for oxygen delivery in patients with shock. On comparing target hemoglobin levels upon transfusion initiation, the correlation between the severity of decrease in hemoglobin levels and patient outcomes remains unclear. We evaluated the association between initial hemoglobin levels and mortality in patients with septic shock treated with protocol-driven resuscitation bundle therapy at an emergency department.
Methods
Data of adult patients diagnosed with septic shock between June 2012 and December 2016 were extracted from a prospectively compiled septic shock registry at a single academic medical center. Patients were classified into four groups according to initial hemoglobin levels: ≥9.0 g/dl, 8.0−8.9 g/dl, 7.0−7.9 g/dl, and <7.0 g/dl. The primary endpoint was 90-day mortality.
Results
In total, 2,265 patients (male, 58.3%; median age, 70.0 years [interquartile range, 60 to 78 years]) with septic shock were included. For the four groups, 90-day mortality rates were as follows: 29.1%, 43.0%, 46.5%, and 46.9% for ≥9.0 g/dl (n=1,808), 8.0−8.9 g/dl (n=217), 7.0−7.9 g/dl (n=135), and <7.0 g/dl (n=105), respectively (P<0.001). Multivariate logistic regression showed that initial hemoglobin levels were an independent factor associated with 90-day mortality and mortality proportionally increased with decreasing hemoglobin levels (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.36 to 2.61 for 8.0−8.9 g/dl; OR, 1.97; 95% CI, 1.31 to 2.95 for 7.0–7.9 g/dl; and OR, 2.35; 95% CI, 1.52 to 3.63 for <7.0 g/dl).
Conclusions
Low hemoglobin levels (<9.0 g/dl) were observed in approximately 20% of patients with septic shock, and the severity of decrease in these levels correlated with mortality.

Citations

Citations to this article as recorded by

Prognostic value of hemoglobin in patients with sepsis: A systematic review and meta-analysis
Jin Zhu, Yanyan Dong, Pengda Liao, Xin Yin, Jianzhuo He, Liheng Guo
Heart & Lung.2024; 64: 93. CrossRef
Acute blood loss anemia in hospitalized patients is associated with adverse outcomes: An analysis of the Nationwide Inpatient Sample
Dhweeja Dasarathy, Amy H. Attaway
The American Journal of the Medical Sciences.2024; 367(4): 243. CrossRef
Ceftriaxone-induced severe hemolytic anemia, renal calculi, and cholecystolithiasis in a 3-year-old child: a case report and literature review
Enfu Tao, Huangjia Zhou, Meili Zheng, Yisha Zhao, Junfen Zhou, Junhui Yuan, Tianming Yuan, Changhua Zheng
Frontiers in Pharmacology.2024;[Epub] CrossRef
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Ethan A. T. Strickler, Joshua Thomas, Johnson P. Thomas, Bruce Benjamin, Rittika Shamsuddin
Scientific Reports.2023;[Epub] CrossRef
Blood count derangements after sepsis and association with post-hospital outcomes
Scott J. Denstaedt, Jennifer Cano, Xiao Qing Wang, John P. Donnelly, Sarah Seelye, Hallie C. Prescott
Frontiers in Immunology.2023;[Epub] CrossRef
Potential therapeutic effect of Carica papaya leaves extract on immune response, biochemical and hematological mechanisms on cecal ligation and puncture model of sepsis in rats: an in vivo study
Juveria Usmani, Mohd Wasim, Mohd Nazam Ansari, Mohammed Jaseem Hassan, Manju Sharma, Razi Ahmad
3 Biotech.2023;[Epub] CrossRef
Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis
Myeong Namgung, Chiwon Ahn, Yeonkyung Park, Il-Youp Kwak, Jungguk Lee, Moonho Won
Clinical and Experimental Emergency Medicine.2023; 10(2): 157. CrossRef
Predictive Rule for Mortality of Inpatients With Escherichia coli Bacteremia: Chi-Square Automatic Interaction Detector Decision Tree Analysis Model
Yudai Nakanishi, Sayato Fukui, Akihiro Inui, Daiki Kobayashi, Mizue Saita, Toshio Naito
Cureus.2023;[Epub] CrossRef
A Predictive Rule for COVID-19 Pneumonia Among COVID-19 Patients: A Classification and Regression Tree (CART) Analysis Model
Sayato Fukui, Akihiro Inui, Takayuki Komatsu, Kanako Ogura, Yutaka Ozaki, Manabu Sugita, Mizue Saita, Daiki Kobayashi, Toshio Naito
Cureus.2023;[Epub] CrossRef
Applying artificial neural network in predicting sepsis mortality in the emergency department based on clinical features and complete blood count parameters
Beata Pui Kwan Wong, Rex Pui Kin Lam, Carrie Yuen Ting Ip, Ho Ching Chan, Lingyun Zhao, Michael Chun Kai Lau, Tat Chi Tsang, Matthew Sik Hon Tsui, Timothy Hudson Rainer
Scientific Reports.2023;[Epub] CrossRef
Preexisting Clinical Frailty Is Associated With Worse Clinical Outcomes in Patients With Sepsis*
Hong Yeul Lee, Jinwoo Lee, Yoon Sun Jung, Woon Yong Kwon, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee
Critical Care Medicine.2022; 50(5): 780. CrossRef
Clinical assessment of neutrophil gelatinase-associated lipocalin as a potential diagnostic marker for neonatal sepsis: a prospective cohort study
Dina Midan, Fady El-Gendy, Dalia Abo ELAlla, Mayada Kotb
Annals of Medicine.2022; 54(1): 1725. CrossRef
A Decrease in Hb and Hypoproteinemia: Possible Predictors of Complications in Neonates with Late-Onset Sepsis in a Developing Country
Na Cai, Wei Liao, Zhiqiang Chen, Min Tao, Sheng Chen
International Journal of General Medicine.2022; Volume 15: 6583. CrossRef
Impact of 1-Hour Bundle Achievement in Septic Shock
Byuk Sung Ko, Sung-Hyuk Choi, Tae Gun Shin, Kyuseok Kim, You Hwan Jo, Seung Mok Ryoo, Yoo Seok Park, Woon Yong Kwon, Han Sung Choi, Sung Phil Chung, Gil Joon Suh, Hyunggoo Kang, Tae Ho Lim, Donghee Son, Won Young Kim
Journal of Clinical Medicine.2021; 10(3): 527. CrossRef
The Effect of Haematocrit on Measurement of the Mid-Infrared Refractive Index of Plasma in Whole Blood
David J. Rowe, Daniel R. Owens, Suzanne L. Parker, Saul N. Faust, James S. Wilkinson, Goran Z. Mashanovich
Biosensors.2021; 11(11): 417. CrossRef
Early Hemoglobin Status as a Predictor of Long-Term Mortality for Sepsis Patients in Intensive Care Units
Desheng Qi, Milin Peng
Shock.2021; 55(2): 215. CrossRef
Immature granulocyte and mean platelet volume as a predictor of 30-day postoperative mortality in patients with sepsis caused by peritonitis
RudiHartono Sinaga, Arie Utariani, Puspa Wardhani, Hardiono Hardiono
Bali Journal of Anesthesiology.2020; 4(4): 166. CrossRef

CPR/Resuscitation
Utility of the early lactate area score as a prognostic marker for septic shock patients in the emergency department: Gina Yu, Seung Joon Yoo, Sang-Hun Lee, June Sung Kim, Sungmin Jung, Youn-Jung Kim, Won Young Kim, Seung Mok Ryoo; Acute Crit Care. 2019;34(2):126-132. Published online April 12, 2019; DOI: https://doi.org/10.4266/acc.2018.00283

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Abstract PDF

Background
The current Surviving Sepsis Campaign guidelines recommend the remeasurement of lactate levels if the initial lactate level is elevated; however, the prognostic value of lactate kinetics is limited and inconsistent. We attempted to determine the efficacy of the lactate area score (calculated from repeated lactate measurements during initial resuscitation) as a prognostic marker of septic shock in the emergency department (ED).
Methods
We performed a retrospective study of adult patients with septic shock in the ED of a single tertiary medical center. Serial lactate levels were measured five times within 12 hours. We also compared the initial lactate level, maximum lactate level, and lactate area score. The lactate area score was defined as the sum of the area under the curve measured at 2, 4, 6, and 12 hours following the initial measurement.
Results
A total of 362 patients were enrolled in this study, and the overall 28-day mortality was 31.8%. The lactate area score of serial lactate levels as well as the initial (median [interquartile range], 4.9 [3.4 to 10.5]; P=0.003) and maximum (7.3 [4.2 to 13.2]; P<0.001) lactate levels were significantly higher in the non-survivor group. However, in multivariate analysis, only the lactate area score (odds ratio, 1.013; 95% confidence interval, 1.007 to 1.019) was significantly associated with 28-day mortality.
Conclusions
The early lactate area score may be a possible prognostic marker for predicting the 28-day mortality of adult septic shock patients. Further prospective interventional studies should be conducted to validate our results.

Citations

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Electrochemical Detection of Biomarkers Via Affinity Binding with Functionalized Nanocomposite for Assessment of Tissue-Perfusion
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Role of lactate level in predicting admission need to intensive care unit and short term outcomes in patients with acute gastrointestinal bleeding
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Serial evaluation of the serum lactate level with the SOFA score to predict mortality in patients with sepsis
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Scientific Reports.2023;[Epub] CrossRef
Using time-course as an essential factor to accurately predict sepsis-associated mortality among patients with suspected sepsis
Shih-Chieh Yen, Chin-Chieh Wu, Yi-Ju Tseng, Chih-Huang Li, Kuan-Fu Chen
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Increased normalized lactate load is associated with higher mortality in both sepsis and non-sepsis patients: an analysis of the MIMIC-IV database
Han Chen, Shu-Rong Gong, Rong-Guo Yu
BMC Anesthesiology.2022;[Epub] CrossRef
An integrated wearable microneedle array for the continuous monitoring of multiple biomarkers in interstitial fluid
Farshad Tehrani, Hazhir Teymourian, Brian Wuerstle, Jonathan Kavner, Ravi Patel, Allison Furmidge, Reza Aghavali, Hamed Hosseini-Toudeshki, Christopher Brown, Fangyu Zhang, Kuldeep Mahato, Zhengxing Li, Abbas Barfidokht, Lu Yin, Paul Warren, Nickey Huang,
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Association between normalized lactate load and mortality in patients with septic shock: an analysis of the MIMIC-III database
Han Chen, Shu-Rong Gong, Rong-Guo Yu
BMC Anesthesiology.2021;[Epub] CrossRef
Mortality prediction using a novel combination of biomarkers in the first day of sepsis in intensive care units
Junkun Liu, Chengwen Bai, Binbin Li, Aijun Shan, Fei Shi, Can Yao, Yu Zhang, Jin Wang, Weibu Chen, Manying Xie, Dehui Deng
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A Graphene-Based Enzymatic Biosensor Using a Common-Gate Field-Effect Transistor for L-Lactic Acid Detection in Blood Plasma Samples
Ariadna Schuck, Hyo Eun Kim, Júlia Konzen Moreira, Priscila Schmidt Lora, Yong-Sang Kim
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Usefulness of presepsin in predicting the prognosis of patients with sepsis or septic shock: a retrospective cohort study
Jeong Suk Koh, Yoon Joo Kim, Da Hyun Kang, Jeong Eun Lee, Song-I Lee
Yeungnam University Journal of Medicine.2021; 38(4): 318. CrossRef
Non-enzymatic lactic acid sensor based on AuPtNPs functionalized MoS2 nanosheet as electrode modified materials
Haolin Xiao, Liangli Cao, Huishan Qin, Shanshan Wei, Miao Gu, Feijun Zhao, Zhencheng Chen
Journal of Electroanalytical Chemistry.2021; 903: 115806. CrossRef
Early lactate area scores and serial blood lactate levels as prognostic markers for patients with septic shock: a systematic review
Rozita Khodashahi, Soroush Sarjamee
Infectious Diseases.2020; 52(7): 451. CrossRef
Recent lactate findings: is repeated serum lactate testing necessary in septic shock patients?
Moo Suk Park
Acute and Critical Care.2019; 34(2): 155. CrossRef

Case Report

Cardiology
Acute fulminant myocarditis following influenza vaccination requiring extracorporeal membrane oxygenation: Youn-Jung Kim, Jun-Il Bae, Seung Mok Ryoo, Won Young Kim; Acute Crit Care. 2019;34(2):165-169. Published online November 7, 2018; DOI: https://doi.org/10.4266/acc.2017.00045

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Abstract PDF

The inactivated influenza vaccination is generally safe with mostly mild side effects. We report a rare but fatal adverse event following influenza vaccination. A previously healthy 27-yearold woman who received the influenza vaccination 3 days before presenting to the emergency department had rapidly aggravating dyspnea and mental deterioration. She was diagnosed as having acute fulminant myocarditis with refractory cardiogenic shock, which was successfully managed with veno-arterial extracorporeal membrane oxygenation. The cardiac function of the patient recovered in 3 weeks.

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Active surveillance for adverse events of influenza vaccine safety in elderly cancer patients using self-controlled tree-temporal scan statistic analysis
Na-Young Jeong, Chung-Jong Kim, Sang Min Park, Ye-Jee Kim, Joongyub Lee, Nam-Kyong Choi
Scientific Reports.2023;[Epub] CrossRef
The Incidence of Myocarditis Following an Influenza Vaccination: A Population-Based Observational Study
Wen-Hwa Wang, Kai-Che Wei, Yu-Tung Huang, Kuang-Hua Huang, Tung-Han Tsai, Yu-Chia Chang
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Myocarditis and autoimmunity
Akira Matsumori
Expert Review of Cardiovascular Therapy.2023; 21(6): 437. CrossRef
Cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) imaging in the diagnosis and follow-up of patients with acute myocarditis and chronic inflammatory cardiomyopathy
Federico Caobelli, Jordi Broncano Cabrero, Nicola Galea, Philip Haaf, Christian Loewe, Julian A. Luetkens, Giuseppe Muscogiuri, Marco Francone
The International Journal of Cardiovascular Imaging.2023; 39(11): 2221. CrossRef
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Clinically Suspected Myocarditis Temporally Related to COVID-19 Vaccination in Adolescents and Young Adults: Suspected Myocarditis After COVID-19 Vaccination
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Onyedika J. Ilonze, Maya E. Guglin
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Original Articles

Basic science and research
Anti-inflammatory Role of Mesenchymal Stem Cells in an Acute Lung Injury Mouse Model: Jin Won Huh, Won Young Kim, Yun Young Park, Chae-Man Lim, Younsuck Koh, Mi-Jung Kim, Sang-Bum Hong; Acute Crit Care. 2018;33(3):154-161. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00619

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Background
Mesenchymal stem cells (MSCs) attenuate injury in various lung injury models through paracrine effects. We hypothesized that intratracheal transplantation of allogenic MSCs could attenuate lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice, mediated by anti-inflammatory responses.
Methods
Six-week-old male mice were randomized to either the control or the ALI group. ALI was induced by intratracheal LPS instillation. Four hours after LPS instillation, MSCs or phosphate-buffered saline was randomly intratracheally administered. Neutrophil count and protein concentration in bronchoalveolar lavage fluid (BALF); lung histology; levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and macrophage inflammatory protein-2; and the expression of proliferation cell nuclear antigen (PCNA), caspase-3, and caspase-9 were evaluated at 48 hours after injury.
Results
Treatment with MSCs attenuated lung injury in ALI mice by decreasing protein level and neutrophil recruitment into the BALF and improving the histologic change. MSCs also decreased the protein levels of proinflammatory cytokines including IL-1β, IL-6, and TNF-α, but had little effect on the protein expression of PCNA, caspase-3, and caspase-9.
Conclusions
Intratracheal injection of bone marrow-derived allogenic MSCs attenuates LPSinduced ALI via immunomodulatory effects.

Citations

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Stem Cell‐based therapies for COVID‐19‐related acute respiratory distress syndrome
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Journal of Cellular and Molecular Medicine.2022; 26(9): 2483. CrossRef
Development of a physiomimetic model of acute respiratory distress syndrome by using ECM hydrogels and organ-on-a-chip devices
Esther Marhuenda, Alvaro Villarino, Maria Narciso, Linda Elowsson, Isaac Almendros, Gunilla Westergren-Thorsson, Ramon Farré, Núria Gavara, Jorge Otero
Frontiers in Pharmacology.2022;[Epub] CrossRef
Advances in mesenchymal stromal cell therapy for acute lung injury/acute respiratory distress syndrome
Chang Liu, Kun Xiao, Lixin Xie
Frontiers in Cell and Developmental Biology.2022;[Epub] CrossRef
Auxiliary role of mesenchymal stem cells as regenerative medicine soldiers to attenuate inflammatory processes of severe acute respiratory infections caused by COVID-19
Peyvand Parhizkar Roudsari, Sepideh Alavi-Moghadam, Moloud Payab, Forough Azam Sayahpour, Hamid Reza Aghayan, Parisa Goodarzi, Fereshteh Mohamadi-jahani, Bagher Larijani, Babak Arjmand
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The Role of MSC Therapy in Attenuating the Damaging Effects of the Cytokine Storm Induced by COVID-19 on the Heart and Cardiovascular System
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Frontiers in Cardiovascular Medicine.2020;[Epub] CrossRef

CPR/Resuscitation
APACHE II Score Immediately after Cardiac Arrest as a Predictor of Good Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Targeted Temperature Management: Sang-Il Kim, Youn-Jung Kim, You-Jin Lee, Seung Mok Ryoo, Chang Hwan Sohn, Dong Woo Seo, Yoon-Seon Lee, Jae Ho Lee, Kyoung Soo Lim, Won Young Kim; Acute Crit Care. 2018;33(2):83-88. Published online May 31, 2018; DOI: https://doi.org/10.4266/acc.2017.00514

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Abstract PDF

Background
This study assessed the association between the initial Acute Physiology and Chronic Health Evaluation (APACHE) II score and good neurological outcome in comatose survivors of out-of-hospital cardiac arrest who received targeted temperature management (TTM).
Methods
Data from survivors of cardiac arrest who received TTM between January 2011 and June 2016 were retrospectively analyzed. The initial APACHE II score was determined using the data immediately collected after return of spontaneous circulation rather than within 24 hours after being admitted to the intensive care unit. Good neurological outcome, defined as Cerebral Performance Category 1 or 2 on day 28, was the primary outcome of this study.
Results
Among 143 survivors of cardiac arrest who received TTM, 62 (43.4%) survived, and 34 (23.8%) exhibited good neurological outcome on day 28. The initial APACHE II score was significantly lower in the patients with good neurological outcome than in those with poor neurological outcome (23.71 ± 4.39 vs. 27.62 ± 6.16, P = 0.001). The predictive ability of the initial APACHE II score for good neurological outcome, assessed using the area under the receiver operating characteristic curve, was 0.697 (95% confidence interval [CI], 0.599 to 0.795; P = 0.001). The initial APACHE II score was associated with good neurological outcome after adjusting for confounders (odds ratio, 0.878; 95% CI, 0.792 to 0.974; P = 0.014).
Conclusions
In the present study, the APACHE II score calculated in the immediate post-cardiac arrest period was associated with good neurological outcome. The initial APACHE II score might be useful for early identification of good neurological outcome.

Citations

Citations to this article as recorded by

Prediction performance of scoring systems after out-of-hospital cardiac arrest: A systematic review and meta-analysis
Boldizsár Kiss, Rita Nagy, Tamás Kói, Andrea Harnos, István Ferenc Édes, Pál Ábrahám, Henriette Mészáros, Péter Hegyi, Endre Zima, Jignesh K. Patel
PLOS ONE.2024; 19(2): e0293704. CrossRef
Predicting the survivals and favorable neurologic outcomes after targeted temperature management by artificial neural networks
Wei-Ting Chiu, Chen-Chih Chung, Chien-Hua Huang, Yu-san Chien, Chih-Hsin Hsu, Cheng-Hsueh Wu, Chen-Hsu Wang, Hung-Wen Chiu, Lung Chan
Journal of the Formosan Medical Association.2022; 121(2): 490. CrossRef
Artificial neural network-boosted Cardiac Arrest Survival Post-Resuscitation In-hospital (CASPRI) score accurately predicts outcome in cardiac arrest patients treated with targeted temperature management
Szu-Yi Chou, Oluwaseun Adebayo Bamodu, Wei-Ting Chiu, Chien-Tai Hong, Lung Chan, Chen-Chih Chung
Scientific Reports.2022;[Epub] CrossRef
Novel Approaches to Risk Stratification of In-Hospital Cardiac Arrest
Jason J. Yang, Xiao Hu, Noel G. Boyle, Duc H. Do
Current Cardiovascular Risk Reports.2021;[Epub] CrossRef

Infection/Hematology
The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition: Byuk Sung Ko, Hyun Young Cho, Seung Mok Ryoo, Myung Chun Kim, Woong Jung, Sung Hyuk Park, Chang Min Lee, Won Young Kim; Korean J Crit Care Med. 2016;31(4):334-341. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00339

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Abstract PDF

Background
The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock.
Methods
We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality.
Results
Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]).
Conclusions
Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

Citations

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Which Septic Shock Patients With Non-Overt DIC Progress to DIC After Admission? Point-of-Care Thromboelastography Testing
Sang-Min Kim, Sang-Il Kim, Gina Yu, Youn-Jung Kim, Won Young Kim
Shock.2022; 57(2): 168. CrossRef
Dysregulated haemostasis in thrombo-inflammatory disease
Paula A. Klavina, Gemma Leon, Annie M. Curtis, Roger J.S. Preston
Clinical Science.2022; 136(24): 1809. CrossRef
Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan
Eman Mahmoud Qasim Emleek, Amani Anwar Khalil
Biological Research For Nursing.2021; 23(4): 689. CrossRef
Features of Development and Course of Disseminated Intravascular Coagulation Syndrome During Surgical Interventions in Children with Oncological Diseases
N. P. Leonov, V. V. Schukin, G. A. Novichkova, M. A. Maschan, F. I. Ataullakhanov, S. S. Yashin, A. M. Zeynalov, Е. A. Spiridonova
General Reanimatology.2020; 16(3): 54. CrossRef
Relationship between low hemoglobin levels and mortality in patients with septic shock
Sung Min Jung, Youn-Jung Kim, Seung Mok Ryoo, Won Young Kim
Acute and Critical Care.2019; 34(2): 141. CrossRef

Case Report

Toxicology
Methemoglobinemia Caused by an Inert Ingredient after Intentional Ingestion of Pesticide: Ru Bi Jeong, Chang Hwan Sohn, Dong Woo Seo, Won Young Kim, Seung Mok Ryoo, Bum Jin Oh, Kyoung Soo Lim; Korean J Crit Care Med. 2014;29(4):341-343. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.341

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Abstract PDF: We report two cases of toxic methemoglobinemia caused by an inert ingredient in pesticide product after intentional ingestion of pesticide. First, 51-year-old male visited to the emergency department (ED) after the ingestion of pesticide in a suicide attempt. Initial methemoglobin (MetHb) level was 25.6%. We did not know the cause of methemoglobinemia at that time. Second, 56-year-old female visited to the ED after the ingestion of the same pesticide in a suicide attempt. MetHb level after 30 minutes was 16.1%. The patients were treated with methylene blue. We contacted to the Korean Rural Development Administration and estimated that magnesium nitrate was more likely to cause methemoglobinemia. This report highlights the importance of considering the possibility of methemoglobinemia caused by inert ingredient in pesticide and early antidotal therapy.

Original Articles

Clinical Feature and Prognostic Factors of Emphysematous Pyelonephritis: Won Soek Yang, Won Young Kim, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2012;27(2):89-93.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.89

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Abstract PDF

BACKGROUND
Emphysematous pyelonephritis (EPN) is a rare and potentially life-threatening condition that requires prompt evaluation and management. However, its clinical presentation and outcomes vary widely. This study was conducted to ascertain the clinical features and prognostic factors regarding EPN.
METHODS
All patients diagnosed with EPN radiologically and treated at the emergency department in the university-affiliated, tertiary-referral center, from January 1999 to December 2009 were evaluated. The patients' demographic and clinical characteristics, computed tomographic findings, treatment, and outcomes were analyzed retrospectively.
RESULTS
Overall 14 patients diagnosed with EPN were admitted. There were 12 females and 2 males. A history of diabetes was found in 12 (85.7%) patients and was the most common comorbidity. The chief complaint among patients was flank pain (42.9%). Severe sepsis or septic shock was noted in 10 (71.4%) patients. Thirteen cases had unilateral involvement and one case had bilateral involvement. More than half of patients had Escherichia.coli in culture. Mean serum levels of HbA1c, creatinine, C-reactive protein (CRP) were 9.4 +/- 2.7, 2.4 +/- 1.4 mg/dl, and 22.4 +/- 13.1 mg/dl. Eight (57.1%) patients received antibiotic treatment alone and four (28.6%) patients received the concurrent percutaneous drainage as well as antibiotics. Hospital mortality was 7.1%. A higher initial serum CRP level (20.3 vs. 49.8 mg/dl, p = 0.02) and HbA1c level (8.7 vs. 16.4, p = 0.01) was associated with hospital mortality.
CONCLUSIONS
Antibiotics alone provide a high success rate for the treatment of EPN. Higher serum CRP and HbA1c level was associated with a higher mortality rate in patients with EPN.

Citations

Citations to this article as recorded by

Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock
Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim
Korean Journal of Critical Care Medicine.2013; 28(4): 272. CrossRef

Initiation of Continuous Renal Replacement Therapy and Clinical Outcome in Septic Shock Patients with Acute Kidney Injury: Seung Mok Ryoo, Won Young Kim, Sang Sik Choi, Jin Won Huh, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2012;27(1):29-35.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.29

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Abstract PDF: BACKGROUND
Initiation of renal replacement therapy (RRT) in critically ill septic shock patients with acute kidney injury is highly subjective and may influence outcome. The aim of this study is to evaluate the relationship between initiation of RRT and 28 day mortality in patients with severe sepsis and septic shock (SSSS).
METHODS
All patients diagnosed with SSSS and treated at the medical intensive care unit (ICU) in university-affiliated hospital from January 2005 to December 2006 were reviewed. Initiation of RRT was stratified into "early" and "late" by RIFLE (Risk, Injury, Failure, Loss, and End-stage) criteria and blood urea nitrogen (BUN) at the time RRT began. The primary outcome was death after 28 days from any cause.
RESULTS
Of the 326 patients diagnosed with SSSS and admitted into the medical ICU during the study period, 78 patients received RRT. Mean age was 61.5 +/- 14.7 years old and 54 patients were male (69.2%). The initiation of RRT was categorized into early (Risk, and Injury) and late (Failure) by RIFLE criteria and also categorized into early (BUN < 75 mg/dl) and late (BUN > or = 75 mg/dl). When the relationship between RIFLE criteria and 28 day mortality was compared, no significant difference was shown (70.8% vs. 73.3%, p = 0.81). The initiation of RRT by BUN also showed no significant difference in 28 day mortality (77.3% vs. 69.6%, p = 0.50).
CONCLUSIONS
Initiation of RRT, stratified into "early" and "late" by RIFLE and BUN, showed no significant difference in 28 day mortality regarding patient with SSSS.

The Usefulness of a Triage Kit for Detecting Abused Drugs: Myoung Kwan Kwak, Won Young Kim, Hui Dong Kang, Jae Ho Lee, Bum Jin Oh, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2009;24(2):75-79.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.75

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Abstract PDF

BACKGROUND
The recovery and outcome of intoxicated patients depends on the kind of drugs they took and the total time of their initial management. The purpose of this study is to evaluate the usefulness of a Triage drug kit for detecting abused drugs.
METHODS
From 2003 Feb. to 2003 July, we studied the patients who visited the emergency department with suspicious drug intoxication. In this case, we used a Triage drug kit for 134 patients with drug intoxication or who were clinically suspected of taking illegal drugs, with 30 of the patients initially admitting the substance they had used. The kit is an immunoassay kit for qualitative testing drug metabolites in urine. To compare with those cases of the preceding year, we studied 104 patients with drug intoxication that was detected between February 2002 and July 2002.
RESULTS
Overall, 60% of the 30 cases who did not know what substance they abused and tested positive for, and 33% of the 27 cases with suspected intoxication confirmed their substance abuse. The positive rate for benzodiazepine use was the highest (46.7%), and there were no positive results regarding amphetamine, methamphetamine or cocaine. An appropriate antidote was administered significantly more frequently in the group for which we used the kit.
CONCLUSIONS
A Triage drug kit is probably useful for diagnosing acute drug intoxication and for identifying the causative substance. However, the time required to decide whether or not a patient should be admitted is not reduced. If the kit can detect the frequently abused drugs in Korea, it will be helpful for treating drug intoxicated patients.

Citations

Citations to this article as recorded by

Clinical features of adolescents with suicide attempt and the factors associated with their outcomes: poisoning versus non-poisoning
Myoung Hoon Lee, Jae Ho Jang, Jin-Seong Cho, Woo Sung Choi, Jea Yeon Choi
Pediatric Emergency Medicine Journal.2020; 7(2): 85. CrossRef
Evaluation of the Triage TOX Drug Screen Assay for Detection of 11 Drugs of Abuse and Therapeutic Drugs
Hae In Bang, Mi-Ae Jang, Yong-Wha Lee
Annals of Laboratory Medicine.2017; 37(6): 522. CrossRef

Case Report

Subcutaneous Emphysema and Pneumothorax Occurred during Patient Transfer to Intensive Care Unit: A Case Report: Yoonki Lee, Won Young Kim; Korean J Crit Care Med. 2004;19(1):52-56.

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Abstract PDF: A 48 years old female patient was scheduled for emergency surgery due to bleeding after intracerebral aneurysmal clipping under general anesthesia. Previously checked chest X-ray taken just a few hours before surgery showed no abnormal finding and she didn't show any sign of pneumothorax or hemothorax including dyspnea, tachypnea or cyanosis. Surgery was uneventful. After the completion of surgery, patient was transferred to the neurosurgical intensive care unit with intubation. During transfer, patient showed bucking and signs of subcutaneous emphysema around chest, shoulder and face. Oxygen saturation was low when she admitted to the neurosurgical intensive care unit, so the ventilator care was started. The patient's oxygenation were getting worse progressively, so we checked chest AP several times and one of the chest X-ray taken at that time revealed no vascular and lung marking on the left lung field suggesting pneumothorax. Emergency chest tube drainage was performed. She recovered dramatically and three days later, ches X-ray showed the complete resorption of the pneumothorax.

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