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Original Article
Infection
A Retrospective Study Investigating Risks of Acute Respiratory Distress Syndrome and Mortality Following Human Metapneumovirus Infection in Hospitalized Adults
Hyunjung Hwang, Yujin Kim, Jeong-Woong Park, Sung Hwan Jeong, Sun Young Kyung
Korean J Crit Care Med. 2017;32(2):182-189.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00038
  • 6,224 View
  • 85 Download
  • 1 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Background
Human metapneumovirus (hMPV) is a relatively recently identified respiratory virus that induces respiratory symptoms similar to those of respiratory syncytial virus infection in children. The characteristics of hMPV-infected adults are unclear because few cases have been reported.
Methods
We conducted a retrospective review of hospitalized adult patients with a positive multiplex real-time polymerase chain reaction assay result from 2012 to 2016 at a single tertiary referral hospital in South Korea. We analyzed clinical characteristics of the enrolled patients and divided patients into an acute respiratory distress syndrome (ARDS) group and a non-ARDS group.
Results
In total, 110 adults were reviewed in this study. Their mean age was 61.4 years, and the majority (n = 105, 95.5%) had comorbidities or were immunocompromised. Most of the patients had pneumonia on chest X-ray (n = 88, 93.6%), 22 (20.0%) had ARDS, and 12 (10.9%) expired during hospitalization. The mortality rate for patients with ARDS was higher than that of the other patients (36.4% vs. 5.7%, P = 0.001). The risk factor for hMPV-associated ARDS was heart failure (odds ratio, 5.24; P = 0.044) and laboratory values were increased blood urea nitrogen and increased C-reactive protein. The acquisition site of infection was divided into community vs. nosocomial; 43 patients (39.1%) had a nosocomial infection. The risk factors for nosocomial infection were an immunocompromised state, malignancy and immunosuppressive treatment.
Conclusions
These data suggest that hMPV is one of the important respiratory pathogens important respiratory pathogen that causes pneumonia/ARDS in elderly, immunocompromised individuals and that it may be transmitted via the nosocomial route.

Citations

Citations to this article as recorded by  
  • A Case of Metapneumovirus Pneumonia-Related Acute Respiratory Distress Syndrome in a Young Adult Patient
    Tae Wan Kim, Won-Young Kim
    The Korean Journal of Medicine.2024; 99(2): 111.     CrossRef
  • Human Metapneumovirus Pneumonia Precipitating Acute Respiratory Distress Syndrome in an Adult Patient
    Dena H Tran, Muhammad Sameed, Ellen T Marciniak, Avelino C Verceles
    Cureus.2021;[Epub]     CrossRef
  • Outcomes of severe human metapneumovirus-associated community-acquired pneumonia in adults
    Sang-Ho Choi, Sang-Bum Hong, Jin Won Huh, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sung-Han Kim, Heungsup Sung, Hyun Jung Koo, Kyung-Hyun Do, Sang-Oh Lee, Chae-Man Lim, Yang Soo Kim, Jun Hee Woo, Younsuck Koh
    Journal of Clinical Virology.2019; 117: 1.     CrossRef
Case Report
Pulmonary/Cardiology
Successful Use of Extracorporeal Membrane Oxygenation in Diffuse Alveolar Hemorrhage Secondary to Systemic Lupus Erythematosus
Gyu Ho Choi, Mi Il Kang
Korean J Crit Care Med. 2016;31(4):364-368.   Published online November 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00451
  • 8,025 View
  • 132 Download
AbstractAbstract PDF
Diffuse alveolar hemorrhage (DAH) is an uncommon complication in patients with systemic lupus erythematosus (SLE), and mortality remains high. In recent years, cases of DAH due to SLE treated with extracorporeal membrane oxygenation (ECMO) have rarely been reported. The authors present a case of a 43-year-old woman with SLE who had rapidly aggravating dyspnea and hemoptysis. She was diagnosed as having DAH with refractory respiratory failure and was successfully managed with veno-venous ECMO. We propose ECMO as a useful salvage therapy in patients with alveolar hemorrhage secondary to SLE who are failing conventional ventilatory support.
Guideline
Pulmonary
Clinical Practice Guideline of Acute Respiratory Distress Syndrome
Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi, The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group
Korean J Crit Care Med. 2016;31(2):76-100.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.76
  • 16,559 View
  • 351 Download
  • 6 Crossref
AbstractAbstract PDF
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Citations

Citations to this article as recorded by  
  • 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
    Acute and Critical Care.2024; 39(1): 91.     CrossRef
  • Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19
    Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim
    Acute and Critical Care.2023; 38(1): 41.     CrossRef
  • Treatment of acute respiratory failure: invasive mechanical ventilation
    Young Sam Kim
    Journal of the Korean Medical Association.2022; 65(3): 151.     CrossRef
  • Treatment of acute respiratory failure: extracorporeal membrane oxygenation
    Jin-Young Kim, Sang-Bum Hong
    Journal of the Korean Medical Association.2022; 65(3): 157.     CrossRef
  • Prolonged glucocorticoid treatment in acute respiratory distress syndrome – Authors' reply
    Rob Mac Sweeney, Daniel F McAuley
    The Lancet.2017; 389(10078): 1516.     CrossRef
  • Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness
    Gianfranco Umberto Meduri, Andreas Schwingshackl, Greet Hermans
    Frontiers in Pediatrics.2016;[Epub]     CrossRef
Case Reports
Cardiology/Obstetric
Successful Application of Extracorporeal Membrane Oxygenation for a Patient with Clinical Amniotic Fluid Embolism
Hye Seon Kang, Hwa Young Lee, Hea Yon Lee, Seok Chan Kim
Korean J Crit Care Med. 2015;30(4):303-307.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.303
  • 5,565 View
  • 98 Download
  • 3 Crossref
AbstractAbstract PDF
Amniotic fluid embolism (AFE) is a rare but potentially fatal complication that occurs acutely during pregnancy or within 12 h of delivery. The management of AFE focuses initially on supportive measures for cardiopulmonary stabilization. Extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical treatment in order to prevent additional hypoxia and subsequent organ failure. We present a 41-year-old woman with clinical AFE who developed acute respiratory distress syndrome and was treated successfully with extracorporeal membrane oxygenation.

Citations

Citations to this article as recorded by  
  • Extracorporeal Therapies for Amniotic Fluid Embolism
    Julien Viau-Lapointe, Niall Filewod
    Obstetrics & Gynecology.2019; 134(5): 989.     CrossRef
  • Venous Air Embolism Not Amniotic Fluid Embolism
    Charles Her
    Korean Journal of Critical Care Medicine.2016; 31(1): 68.     CrossRef
  • Urgent Application of Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism
    Moo Suk Park
    The Korean Journal of Critical Care Medicine.2016; 31(3): 179.     CrossRef
Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia
Youjin Chang, Sang Oh Lee, Tae Sun Shim, Sae Hoon Choi, Hyung Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Sang-Bum Hong
Korean J Crit Care Med. 2015;30(3):196-201.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.196
  • 494 View
  • 0 Download
  • 2 Crossref
AbstractAbstract PDF
Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO) made it possible to consider lung transplantation (LTPL) in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.

Citations

Citations to this article as recorded by  
  • Lung transplantation for acute respiratory distress syndrome: a retrospective European cohort study
    Jens Gottlieb, Philipp M. Lepper, Cristina Berastegui, Beatriz Montull, Alexandra Wald, Jasvir Parmar, Jesper M. Magnusson, Felix Schönrath, Tanel Laisaar, Sebastian Michel, Hillevi Larsson, Robin Vos, Assad Haneya, Tim Sandhaus, Erik Verschuuren, Jérôme
    European Respiratory Journal.2022; 59(6): 2102078.     CrossRef
  • Comment on “Lung Transplantation for Elderly Patients With End-Stage COVID-19 Pneumonia”
    Michael K. Hsin, See Ching Chan, Huiqing Lin
    Annals of Surgery.2021; 274(6): e829.     CrossRef
Infection
Kawasaki Disease with Acute Respiratory Distress Syndrome after Intravenous Immunoglobulin Infusion
Yu Hyeon Choi, Bong Jin Lee, June Dong Park, Seung Hyo Kim
Korean J Crit Care Med. 2014;29(4):336-340.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.336
  • 6,269 View
  • 78 Download
  • 1 Crossref
AbstractAbstract PDF
Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.

Citations

Citations to this article as recorded by  
  • French national diagnostic and care protocol for Kawasaki disease
    C. Galeotti, F. Bajolle, A. Belot, S. Biscardi, E. Bosdure, E. Bourrat, R. Cimaz, R. Darbon, P. Dusser, O. Fain, V. Hentgen, V. Lambert, A. Lefevre-Utile, C. Marsaud, U. Meinzer, L. Morin, M. Piram, O. Richer, J.-L. Stephan, D. Urbina, I. Kone-Paut
    La Revue de Médecine Interne.2023; 44(7): 354.     CrossRef
Original Article
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
  • 4,336 View
  • 48 Download
  • 1 Crossref
AbstractAbstract 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 Report
Successful Recovery after Drowning by Early Prone Ventilatory Positioning and Use of Nitric Oxide Gas: A Case Report
Joo Myung Lee, Jae Ho Lee, Choon Taek Lee, Young Jae Cho
Korean J Crit Care Med. 2011;26(3):196-199.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.196
  • 2,374 View
  • 17 Download
AbstractAbstract PDF
Drowning is the third leading cause of unintentional accidental death globally. The most serious pathophysiologic consequence of drowning is hypoxemia from acute respiratory distress syndrome. Herein, we report a drowning victim who presented with hypothermia and cardiac arrest, followed by acute respiratory distress syndrome, rhabdomyolysis (with acute kidney injury), and disseminated intravascular coagulopathy. Aided by advanced cardiac life support and mechanical ventilation in a prone position, the patient fully recovered after two days of hospitalization. Recovery was largely attributed to early prone ventilatory positioning and use of nitric oxide gas.
Review
Present and Future of ECMO in ICU
Hyung Gon Je, Sang Kwon Lee
Korean J Crit Care Med. 2011;26(2):51-56.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.51
  • 2,965 View
  • 120 Download
  • 2 Crossref
AbstractAbstract PDF
Extracorporeal Membrane Oxygenation (ECMO) is a variation of cardiopulmonary bypass that temporarily supports tissue oxygenation in patients with life threatening respiratory or cardiac failure. As the ECLS technique becomes safer and simpler following technology advances, and as complications and survival have improved, indication of ECLS has widened. In 2009, a multicentre randomized controlled trial of conventional ventilator support versus extracorporeal life support for severe adult respiratory failure in 180 patients was published (the conventional ventilation or ECMO for severe adult respiratory failure (CESAR) trial). Of patients allocated to ECMO support, 63% survived for six months without disability compared to 47% allocated to conventional ventilation care. This represented the first positive randomized clinical trial on adult ECMO application in acute respiratory distress syndrome patients. In this review, we report on the common terminologies used with ECMO, the practical running mode of ECMO, indications of ECMO application in intensive care unit settings and results of recent clinical trials. In addition, management during ECMO support and common complications of ECMO is outlined. Finally, evolving technologies involved with the progress of ECMO are summarized.

Citations

Citations to this article as recorded by  
  • Successful Use of a Peripheral Extracorporeal Membrane Oxygenator in a Patient with Chronic Heart Failure and Pneumonia
    Ji Hyun Lee, Yang Hyun Cho, Gee Young Suh, Jeong Hoon Yang
    Korean Journal of Critical Care Medicine.2014; 29(1): 52.     CrossRef
  • Fatal Left Ventricular Thrombosis in an Infant Receiving Extracorporeal Membrane Oxygenation Support - A Case Report -
    Hwa Jin Cho, Byung Young Kim, Eun Song Song, Sang-Gi Oh, Bong-Suk Oh, In Seok Jeong
    Korean Journal of Critical Care Medicine.2013; 28(2): 123.     CrossRef
Case Report
Profound Hypothermia and Circulatory Arrest for Adult PDA Surgery: Case report
Seung Hun Baek, Sang Wook Shin, Hae Kyu Kim, Seong Wan Baik, Inn Se Kim, Kyoo Sub Chung
Korean J Crit Care Med. 1997;12(2):187-191.
  • 1,467 View
  • 8 Download
AbstractAbstract PDF
Correction of a calcified patent ductus arteriosus (PDA) is a difficult surgical procedure. Simple ligation or division of PDA is not possible if diffuse circumferential calcification is present. Several techniques using cardiopulmonary bypass and closure of PDA from within the aorta or pulmonary artery have been introduced. And the surgical procedure is performed under profound hypothermia and circulatory arrest. Total ischemia time should be less than 30 minutes, which is free from the organ damage by the circulatory arrest. Barbiturates, calcium channel blockers and steroids are used for brain protection. We experienced successful use of these techniques for adult female patch closure of PDA and reviewed the anesthetic considerations of the profound hypothermia and circulatory arrest for cardiac surgery.

ACC : Acute and Critical Care