Acute and Critical Care

Review Articles

Trauma
Abdominal compartment syndrome in critically ill patients: Hyunseok Jang, Naa Lee, Euisung Jeong, Yunchul Park, Younggoun Jo, Jungchul Kim, Dowan Kim; Acute Crit Care. 2023;38(4):399-408. Published online November 29, 2023; DOI: https://doi.org/10.4266/acc.2023.01263

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Abstract PDF: Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.

Pulmonary
Critical care management of pulmonary arterial hypertension in pregnancy: the pre-, peri- and post-partum stages: Vorakamol Phoophiboon, Monvasi Pachinburavan, Nicha Ruamsap, Natthawan Sanguanwong, Nattapong Jaimchariyatam; Acute Crit Care. 2021;36(4):286-293. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00458

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The mortality rate of pulmonary hypertension in pregnancy is 25%–56%. Pulmonary arterial hypertension is the highest incidence among this group, especially in young women. Despite clear recommendation of pregnancy avoidance, certain groups of patients are initially diagnosed during the gestational age step into the third trimester. While the presence of right ventricular failure in early gestation is usually trivial, it can be more severe in the late trimester. Current evidence shows no consensus in the management and serious precautions for each stage of the pre-, peri- and post-partum periods of this specific group. Pulmonary hypertension-targeted drugs, mode of delivery, type of anesthesia, and some avoidances should be planned among a multidisciplinary team to enhance maternal and fetal survival opportunities. Sudden circulatory collapse from cardiac decompensation during the peri- and post-partum phases is detrimental, and mechanical support such as extracorporeal membrane oxygenation should be considered for mitigating hemodynamics and extending cardiac recovery time. Our review aims to explain the pathophysiology of pulmonary arterial hypertension and summarize the current evidence for critical management and precautions in each stage of pregnancy.

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Maternal Outcomes Among Pregnant Women With Congenital Heart Disease–Associated Pulmonary Hypertension
Qian Zhang, Fang Zhu, Guocheng Shi, Chen Hu, Weituo Zhang, Puzhen Huang, Chunfeng Zhu, Hong Gu, Dong Yang, Qiangqiang Li, Yonghua Niu, Hao Chen, Ruixiang Ma, Ziyi Pan, Huixian Miao, Xin Zhang, Genxia Li, Yabing Tang, Guyuan Qiao, Yichen Yan, Zhongqun Zhu,
Circulation.2023; 147(7): 549. CrossRef
Pregnancy in Patients with Pulmonary Arterial Hypertension in Light of New ESC Guidelines on Pulmonary Hypertension
Karolina Barańska-Pawełczak, Celina Wojciechowska, Wojciech Jacheć
International Journal of Environmental Research and Public Health.2023; 20(5): 4625. CrossRef
Pregnancy in Severe Pulmonary Hypertension: A Case Report and Literature Analysis
一人王
Advances in Clinical Medicine.2023; 13(10): 16433. CrossRef
Effects of maternal pulmonary arterial hypertension on fetal hemodynamics and maternal‐fetal outcome in late pregnancy
Yuan Yuan Xing, Yanping Ruan, Huai Qin, Lei Zhao, Qing Zhao, Yun Wei, Jie Chen, Xiaohai Ma
Echocardiography.2023; 40(12): 1339. CrossRef
Clinical Analysis in 82 Pregnant Women with the Severity of Pulmonary Hypertension
安芬李
Advances in Clinical Medicine.2023; 13(11): 18492. CrossRef

Case Reports

Pulmonary
Central extracorporeal membrane oxygenation and early rehabilitation for persistent severe pulmonary hypertension following pulmonary endarterectomy: Gil Myeong Seong, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Jae Won Lee, Sung-Ho Jung, Duck-Woo Park, Jae Seung Lee; Acute Crit Care. 2019;34(2):158-164. Published online November 7, 2018; DOI: https://doi.org/10.4266/acc.2016.01032

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Abstract PDF

Chronic thromboembolic pulmonary hypertension is potentially curable with a pulmonary endarterectomy. However, approximately 20% of patients have persistent pulmonary hypertension after pulmonary endarterectomy, which is a major risk factor for postoperative death. Here, we report a 34-year-old woman who suffered persistent severe pulmonary hypertension following a successful pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) and atrial septostomy were successfully performed as rescue treatments, and active rehabilitation during ECMO was prescribed to facilitate recovery.

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Transatrial balloon atrial septostomy to facilitate weaning off venoarterial ECMO after pulmonary endarterectomy
Koray Ak, Gökhan Arslanhan, Yakup Tire, Sinan Tosun, Alper Kararmaz, İsmail Hanta, Bedrettin Yıldızeli
The International Journal of Artificial Organs.2022; 45(10): 883. CrossRef
Cardiac Rehabilitation in Heart Failure
Kyeong-hyeon Chun, Seok-Min Kang
International Journal of Heart Failure.2021; 3(1): 1. CrossRef

Neurosurgery
Severe Rhabdomyolysis in Phacomatosis Pigmentovascularis Type IIb associated with Sturge-Weber Syndrome: Bongjin Lee, Hyung Joo Jeong, Yu Hyeon Choi, Chong Won Choi, June Dong Park; Korean J Crit Care Med. 2015;30(4):329-335. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.329

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Abstract PDF

Phacomatosis pigmentovascularis (PPV) is a rare syndrome characterized by concurrent nevus flammeus (capillary malformation) and pigmentary nevus. According to current research, the major pathophysiologic mechanism in PPV is venous dysplasia with resultant compensatory collateral channels and venous hypertension. Arterial involvement is rare. We herein report our experience on renovascular hypertension, intermittent claudication, and severe rhabdomyolysis due to diffuse stenosis of multiple arteries in a patient with PPV type IIb associated with SWS.

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Oral healthcare management of a child with phakomatosis pigmentovascularis associated with bilateral Sturge‐Weber syndrome
Mariana Leonel Martins, Aline Dos Santos Letieri, Michele Machado Lenzi, Michelle Agostini, Gloria Fernanda Castro
Special Care in Dentistry.2019; 39(3): 324. CrossRef

Cardiology
Catecholamine-Induced Cardiomyopathy associated with Neuroblastoma and Treated with Extracorporeal Membrane Oxygenation as a Bridge to Recovery: Junggu Yi, Si Oh Kim, Jun-mo Park, Sung-hye Byun, Hoon Jung, Seong Wook Hong; Korean J Crit Care Med. 2015;30(4):299-302. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.299

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Abstract PDF

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.

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COVID-19 and cardiovascular disease: manifestations, pathophysiology, vaccination, and long-term implication
Adel Abdel Moneim, Marwa A. Radwan, Ahmed I. Yousef
Current Medical Research and Opinion.2022; 38(7): 1071. CrossRef

Cardiology/Pharmacology
Effective Postoperative Use of Dexmedetomidine in a Child with Severe Pulmonary Arterial Hypertension Secondary to Congenital Ventricular Septal Defect: Yong-In Kim; Korean J Crit Care Med. 2015;30(1):34-37. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.34

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Abstract PDF: Although α2-adrenoceptor agonists are widely used as postoperative sedatives in adults, the postoperative effects in pediatric patients with secondary pulmonary arterial hypertension (PAH) due to congenital heart disease are not well known. We experienced a case of successful ventilator weaning with continuous intravenous administration of dexmedetomidine (DEX) after surgical correction in a 46-month-old child with congenital ventricular septal defect (VSD) with severe PAH. She underwent VSD closure on cardiopulmonary bypass (CPB). After successful weaning from the CPB, hemodynamics and oxygenation were stabilized on DEX and nitroglycerin in the intensive care unit. The patient was successfully weaned from the ventilator 46 hours after surgery. The transthoracic echocardiogram two weeks after surgery showed a closed VSD with no residual shunt and trivial tricuspid regurgitation (Vmax = 2.5 m/sec) without PAH.

Gastroenterology
Successful Bridging Hemostasis Using a Sengstaken-Blakemore Tube in Massive Rectal Variceal Bleeding: Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon; Korean J Crit Care Med. 2014;29(3):237-240. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.237

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Abstract PDF

Life-threatening rectal variceal bleeding is a rare complication of liver cirrhosis. Various therapeutic interventions including endoscopic variceal ligation and percutaneous transvenous obliteration have been proposed to control significant rectal variceal bleeding. However, these definite hemostasis modalities are not readily available and require an experienced endoscopist or interventional radiologist. Therefore, bridging therapy to control active bleeding is necessary especially in patients with massive bleeding. We report a case of massive rectal variceal bleeding in which a Sengstaken-Blakemore tube was effective at stopping the bleeding until percutaneous transvenous obliteration could be performed.

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Anorectal emergencies: WSES-AAST guidelines
Antonio Tarasconi, Gennaro Perrone, Justin Davies, Raul Coimbra, Ernest Moore, Francesco Azzaroli, Hariscine Abongwa, Belinda De Simone, Gaetano Gallo, Giorgio Rossi, Fikri Abu-Zidan, Vanni Agnoletti, Gianluigi de’Angelis, Nicola de’Angelis, Luca Ansaloni
World Journal of Emergency Surgery.2021;[Epub] CrossRef

Repeated Hypothermia for Rebound Cerebral Edema after Therapeutic Hypothermia in Malignant Cerebral Infarction: Jeong Ho Hong, Jin Heon Jeong, Jun Young Chang, Min Ju Yeo, Han Yeong Jeong, Hee Joon Bae, Moon Ku Han; Korean J Crit Care Med. 2013;28(3):221-224.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.221

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Abstract PDF

Malignant cerebral infarction has a high risk of fatal brain edema and increased intracranial pressure with cerebral herniation causing death. One of the major causes of death is a rebound cerebral edema during rewarming phase. A 66-year-old male patient presented with the right hemiplegia and global aphasia due to malignant cerebral infarction in the whole territory of middle cerebral artery with the occlusion of the proximal internal carotid artery. Being refused decompressive hemicraniectomy, he received the therapeutic hypothermia for 6 days. After rewarming for 6 hours, mentality was suddenly decreased and dilated left pupil. Follow-up CT revealed that midline shifting was more aggravated. We decided on repeated hypothermia for rebound cerebral edema and successfully controlled. We report our experience with repeated hypothermia for rebound cerebral edema following therapeutic hypothermia in malignant cerebral infarction.

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Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect
Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi
The Korean Journal of Critical Care Medicine.2015; 30(4): 272. CrossRef
Therapeutic Hypothermia after Decompressive Craniectomy in Malignant Cerebral Infarction
Jun Young Chang, Jeong-Ho Hong, Jin-Heon Jeong, Sung-Jin Nam, Ji-Hwan Jang, Jae Seung Bang, Moon-Ku Han
Korean Journal of Critical Care Medicine.2014; 29(2): 93. CrossRef

Induced Hypertension Using Phenylephrine in Patients with Acute Ischemic Stroke: A Case Report: Sang Beom Jeon, Hoyon Sohn; Korean J Crit Care Med. 2010;25(3):172-175.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.172

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Abstract PDF

Decreased cerebral perfusion is associated with a poor prognosis for a patient suffering from acute ischemic stroke. Induced hypertension may improve the cerebral perfusion and stroke symptoms. However, there is not enough clinical evidence to support this therapy and it is rarely performed in daily practice. Here we report three patients with acute ischemic stroke and cerebral hypoperfusion who were successfully treated with induced hypertension using intravenous phenylephrine. Phenylephrine infusion may be a treatment option for patients suffering from acute ischemic stroke and cerebral hypoperfusion.

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Therapeutic Use and Chronic Abuse of CNS Stimulants and Anabolic Drugs
Daniela Coliță, Cezar-Ivan Coliță, Dirk Hermann, Eugen Coliță, Thorsten Doeppner, Ion Udristoiu, Aurel Popa-Wagner
Current Issues in Molecular Biology.2022; 44(10): 4902. CrossRef

Randomized Controlled Trial

Effects of Alfentanil on Hemodynamic and Catecholamine Responses to Laryngoscopy and Endobronchial Intubation in the Elderly: Kyung Yeon Yoo, Sung Su Chung, Myung Ha Yoon, Seong Wook Jeong, Jeong Il Choi, Chang Young Jeong; Korean J Crit Care Med. 2005;20(2):114-120.

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Abstract PDF: BACKGROUND
Endobronchial intubation should elicit significant circulatory responses. We examined the effects of alfentanil on hemodynamic and catecholamine responses to endobronchial intubation in elderly patients. METHODS: A total of 60 patients aged over 60 years requiring endobronchial intubation were randomized into three groups of 20 patients each. Anesthesia was induced with thiopental 4~6 mg/kg followed by saline (placebo) or alfentanil 10 or 30microgram/kg given as a bolus over 30 s. Succinylcholine 1 mg/kg was given for neuromuscular block. Laryngoscopy and intubation were performed 1 min later. RESULTS: The intubation significantly increased systolic arterial pressure and heart rate. The maximum pressure changes from pre-intubation values in both alfentanil groups (58+/-27 and 33+/-30 mm Hg in 10 and 30microgram/kg, respectively) were significantly lower compared with that of 83+/-35 mm Hg in the control group. The tachycardiac response was not significantly affected by alfentanil 10microgram/kg, but attenuated by alfentanil 30microgram/kg. The plasma norepinephrine concentrations were increased, which was not affected by alfentanil 10microgram/kg, but was significantly attenuated by alfentanil 30microgram/kg. Both doses of alfentanil abolished the increase of plasma epinephrine concentrations. Three patients in the 30microgram/kg group received ephedrine for hypotension. CONCLUSIONS: This study showed that endobronchial intubation elicited significant pressor response, and that alfentanil 30microgram/kg is more efficacious in attenuating the hemodynamic and catecholamine responses, although potential hypotension warrants a caution of its use, in elderly patients.

Case Report

Recurrent Intracerebral Hemorrhage after Extubation in a Hypertensive Patient: A case report: Jun Hak Lee, Hyo Sin Lim, Kyung Hee Nam, Su Jong Lee, Ki Nam Lee, Jun Il Moon; Korean J Crit Care Med. 1999;14(2):176-180.

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Abstract PDF: Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.

Original Article

Intraoperative Carotid Sinus Hypersensitivity and Postoperative Complication of Radical Neck Dissection Retrospective Study: Tae Il Kim, Hae Ja Lim, Seong Ho Chang, Nan Sook Kim; Korean J Crit Care Med. 1998;13(1):49-54.

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Abstract PDF: BACKGOUND: Postoperative complications in the geriatric patients undergoing radical neck dissection are generally considered to be more severe than young patients. The incidence of carotid sinus hypersensitivity in elderly patients is also considered to be higher than the young. The comparison between old (above 65 years) and young (below 65 years) aged groups about intraoperative carotid sinus hypersensitivity and postoperative complication is necessary for safe anesthesia.
METHODS
Sixty five adult patients, of either sex, regardless of age, given radical neck dissection from January 1990 to January 1998, were investigated for the incidence of intraoperative carotid sinus hypersensitivity and postoperative hypertension by way of retrospective chart review. The authors also examined the postoperative complications such as high fever, pulmonary, cardiac and renal complications, cerebrovascular diseases and neurologic injuries.
RESULTS
The incidence of intraoperative carotid sinus hypersensitivity were 28% in elderly patients (n=25), 10% in young patients (n=40) but there was no statistical significance. The incidence of postoperative hypertension were 79.1% in patients with hypertension history, 34.1% in patients without hypertension history and there was statistical significance between the two groups (P=0.001). The incidence of postoperative pulmonary complication were 44% in elderly patients, 20% in young patients, and there was also statistical significance between the two groups (P=0.038). There was no statistical significance in the incidence of postoperative high fever above 38.5degrees C between the two groups (p=0.059).
CONCLUSION
After the radical neck dissection, the geriatric patients had a greater incidence of postoperative pulmonary complications than young patients and the most relating factor to postoperative hypertension was previous history of hypertension. Therefore optimal preoperative preparations for the hypertensive patients and the prevention and immediate treatment of the postoperative pulmonary complications in geriatric patients are very important during the radical neck dissection.

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