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Evaluating the Relationship between the Scoring Systems of Intensive Care Units (ICUs) and the Duration of Mechanical Ventilation after Liver Transplantation
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Jeong Eun Kim, Sang Hoon Lee, Jong Ho Choi
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Korean J Crit Care Med. 2009;24(2):69-74.
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DOI: https://doi.org/10.4266/kjccm.2009.24.2.69
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 Abstract
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- BACKGROUND
Postoperative mechanical ventilation in liver transplant patient has an important role for reducing respiratory complications and multi-organ failure in intensive care unit (ICU). Yet there are no specific indications for predicting the duration of postoperative mechanical ventilation. Thus, we evaluated the correlation between the duration of mechanical ventilation and scoring systems such as the Acute Physiology and Chronic health Evaluation (APACHE) II score, the Sequential Organ Failure Assessment (SOFA) score, the Model for End-stage Liver Disease (MELD) score and the risk index.
METHODS
We retrospectively studied 183 patients who underwent living donor liver transplantation and we divided them into three groups based on the duration of mechanical ventilation: Group 1: <8 hr, Group 2: 8-12 hr and Group 3: >12 hr. We analyzed the correlation coefficients among the duration of mechanical ventilation, the risk index, and the SOFA, APACHE II and MELD scores.
RESULTS
The MELD and preoperative SOFA scores were significantly higher in group 3 (p = 0.003, p = 0.027). The MELD and SOFA scores were correlated with the duration of mechanical ventilation for all the patients (correlation coefficient = 0.22, 0.20, p = 0.003, 0.007, respectively).
Yet the APACHE II score shows no correlation.
CONCLUSIONS
We found that the MELD and SOFA scores were correlated with the duration of mechanical ventilation in liver transplant patients. Thus, these scoring systems may be useful to determine the duration of mechanical ventilation.
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Management of Brain Injury after Post-cardiac Arrest Syndrome
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Jong Ho Choi
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Korean J Crit Care Med. 2009;24(1):1-3.
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DOI: https://doi.org/10.4266/kjccm.2009.24.1.1
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Abstract
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- In spite of improvement in cardiopulmonary resuscitation (CPR) techniques, post-CPR mortality and brain injury rates have not changed significantly. The post-cardiac arrest syndrome has been suggested to be the major reason for the high mortality rate after CPR. Post-cardiac arrest syndrome, including brain injury, myocardial dysfunction, and septic shock-like syndrome after CPR, result in complicated multiple organ failure. Physicians who work in the ICU should have a good understanding of thepathophysiology of post-cardiac arrest syndrome. Recently, therapeutic hypothermia treatment for protection of brain injuries has been applied as a therapeutic regimen in spite of various side effects during the hypothermic procedure. Finally, therapeutic hypothermic treatment to reduce brain injury in post-cardiac arrest syndrome patients is strongly recommended to physiciansmanaging CPR. I would like to briefly review the therapeutic hypothermic procedure for the management of post-cardiac arrest syndrome.
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The Effects of Chemotherapeutic Agents on Renal Function during Continuous Hyperthermic Peritoneal Perfusion
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Jong Ho Choi, Eun Sung Kim
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Korean J Crit Care Med. 2002;17(1):19-24.
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Abstract
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- BACKGROUND
Continuous hyperthermic peritoneal perfusion (CHPP) has been introduced to improve the survival of the advanced cancer patients. It is a technique that allows uniform delivery of cytotoxic agents and heat to the peritoneal surface. However CHPP - induced acute changes of body temperature and intraabdominal pressure could produce various abnormal physiologic responses, especially hypoperfusion and hypoxia. These factors may further contribute to the renal dysfunction. Moreover, transperitoneal absorption of drugs resulting in systemic toxicity and certain anticancer drugs have an inherent nephrotoxicity. The aim of the present study was to investigate the effect of anticancer drugs on the kidney in the ovarian cancer patients after CHPP.
METHODS
CHPP with anticancer agents in warm saline was performed in 54 patients with cancer of the ovary at temperature 47 degrees C for 90 minutes under general anesthesia. Forty nine patients were given carboplatin and 5 patients were received cisplatin intraperitoneally at an equi-toxic dose. To clarify the effect of cisplatin and carboplatin on the kidney, serum creatinine and blood urea nitrogen (BUN) were measured before anesthesia, 1, 3 and 7th day after surgery in both agents.
RESULTS
There were no significant changes of creatinine level on 1, 3 and 7 days postoperatively compared to preoperative creatinine in carboplatin patients. In carboplatin patients, postoperative BUN levels were decreased significantly on 1 and 3 days, but they were within normal range. BUN level of postoperative 7 day showed no significant change. In cisplatin patient, there was insignificant increase of BUN and creatinine levels on 1, 3 and 7 days postoperatively.
CONCLUSIONS
These results suggest that carboplatin did not suppress renal function until 7 days after CHPP. Cisplatin markedly increased the creatinine and BUN until 7 days postoperatively, but there was no statistical significance.
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