Acute and Critical Care

Original Articles

Pulmonary
Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation: Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong, Won Jun Song, Gee Young Suh; Acute Crit Care. 2024;39(1):91-99. Published online January 26, 2024; DOI: https://doi.org/10.4266/acc.2023.00871

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Abstract PDF Supplementary Material: Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

Thoracic Surgery
Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation: Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Dohyung Kim; Korean J Crit Care Med. 2017;32(2):197-204. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00059

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Background
The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO.
Methods
From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST.
Results
Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×10⁹/L (range, 46 to 434 ×10⁹/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST.
Conclusions
The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.

Citations

Citations to this article as recorded by

Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience
Phillip Staibano, Shahzaib Khattak, Faizan Amin, Paul T. Engels, Doron D. Sommer
Annals of Otology, Rhinology & Laryngology.2023; 132(12): 1520. CrossRef
Does Tracheostomy Improve Outcomes in Those Receiving Venovenous Extracorporeal Membrane Oxygenation?
Joel C. Boudreaux, Marian Urban, Shaun L. Thompson, Anthony W. Castleberry, Michael J. Moulton, Aleem Siddique
ASAIO Journal.2023; 69(6): e240. CrossRef
Tracheostomy in high-risk patients on ECMO: A bedside hybrid dilational technique utilizing a Rummel tourniquet
Britton B. Donato, Marisa Sewell, Megan Campany, Ga-ram Han, Taylor S. Orton, Marko Laitinen, Jacob Hammond, Xindi Chen, Jasmina Ingersoll, Ayan Sen, Jonathan D'Cunha
Surgery Open Science.2023; 16: 248. CrossRef
Assessing Clinical Feasibility and Safety of Percutaneous Dilatational Tracheostomy During Extracorporeal Membrane Oxygenation Support in the Intensive Care Unit
Tae Hwa Hong, Hyung Won Kim, Hyoung Soo Kim, Sunghoon Park
Journal of Acute Care Surgery.2022; 12(1): 18. CrossRef
Retrospective analysis of open bedside tracheotomies in a German tertiary care university hospital
Maximilian Riekert, Matthias Kreppel, Philipp Schminke, Annelies Weckx, Joachim E. Zöller, Volker C. Schick
Journal of Cranio-Maxillofacial Surgery.2021; 49(2): 140. CrossRef
Otolaryngology during COVID-19: Preventive care and precautionary measures
Chen Zhao, Alonço Viana, Yan Wang, Hong-quan Wei, Ai-hui Yan, Robson Capasso
American Journal of Otolaryngology.2020; 41(4): 102508. CrossRef
Tracheostomy while on Extracorporeal Membrane Oxygenation: A Comparison of Percutaneous and Open Procedures
Ismael A. Salas De Armas, Kha Dinh, Bindu Akkanti, Pushan Jani, Reshma Hussain, Lisa Janowiak, Kayla Kutilek, Manish K. Patel, Mehmet H. Akay, Rahat Hussain, Jayeshkumar Patel, Chandni Patel, Yafen Liang, John Zaki, Biswajit Kar, Igor D. Gregoric
The Journal of ExtraCorporeal Technology.2020; 52(4): 266. CrossRef

Cardiology/Pulmonary
Clinical Characteristics of Respiratory Extracorporeal Life Support in Elderly Patients with Severe Acute Respiratory Distress Syndrome: Woo Hyun Cho, Dong Wan Kim, Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Doo Soo Jeon, Yun Seong Kim, Bong Soo Son, Do Hyung Kim; Korean J Crit Care Med. 2014;29(4):266-272. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.266

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Abstract PDF

BACKGROUND
Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS.
METHODS
We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group.
RESULTS
From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock.
CONCLUSIONS
In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.

Citations

Citations to this article as recorded by

Venovenous Extracorporeal Membrane Oxygenation for Negative Pressure Pulmonary Hemorrhage in an Elderly Patient
Kenichiro Ishida, Mitsuhiro Noborio, Nobutaka Iwasa, Taku Sogabe, Yohei Ieki, Yuki Saoyama, Kyosuke Takahashi, Yumiko Shimahara, Daikai Sadamitsu
Case Reports in Critical Care.2015; 2015: 1. CrossRef

Case Reports

Stress-induced Cardiomyopathy Associated with Swine Influenza Infection Which Exacerbated Underlying Emphysema: A Case Report: Sung Gook Song, June Hong Kim, Kook Jin Chun, Jun Kim, Yong Hyun Park, Jeong Su Kim, Ju Hyun Park, Dong Cheul Han, Woo Hyun Cho, Doo Soo Jeon, Yun Seong Kim; Korean J Crit Care Med. 2010;25(4):245-248.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.245

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Abstract PDF: Stress-induced cardiomyopathy (SICM) is an acute cardiac condition that causes left ventricular apical ballooning which mimicks acute coronary syndrome. The risk of in-hospital mortality with SICM is generally low (1% to 3%) and supportive care is usually sufficient for resolution. Swine-origin influenza A (H1N1, S-OIV) is a recently spreading pandemic and a serious public health problem. Although most S-OIV infections have a mild, self-limited course, clinical cases resulting in fatalities and associated with variable co-morbidities remain as a serious concern in some individuals. Among such serious complications, there have been few reports of SICM caused by S-OIV infection. We herein report, for the first time in the literature, a case with fatal hemodynamic instability secondary to SICM caused by S-OIV infection with viral pneumonia.

A Case of Respiratory Failure Caused by Gastropleural Fistula: A Case Report: Woo Hyun Cho, Dong Yup Ryu, Sung Yik Lee, Bo Hyun Kim, Yun Seong Kim; Korean J Crit Care Med. 2005;20(2):183-186.

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Abstract PDF: Gastropleural fistula is a very rare disorder, caused by various conditions, such as trauma and postoperative complication, subphrenic abscess, malignancy, hiatal hernia. The major causes of the gastropleural fistula have changed from trauma and subphrenic abscess to postoperative complication of malignant disorders. We report a case of empyema that developed respiratory failure caused by gastropleural fistula in a middle age woman with review of related articles.

Original Article

Noninvasive Positive Pressure Ventilation: Yun Seong Kim; Korean J Crit Care Med. 2002;17(1):5-11.

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Abstract PDF: No abstract available.

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