Acute and Critical Care

Jong Joon Ahn

3 Articles

Ventricular Fibrillation Soon after Endobronchial Epinephrine Application in a Young Man: A Case Report: Young Min Shin, Jong Hyung Kim, Hyung Wook Kim, Bo Sik Choi, Jin Gyu Jeong, Jung Won Hwang, Kwang Won Seo, Jong Joon Ahn, Seung Won Ra; Korean J Crit Care Med. 2011;26(4):276-280.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.276

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Ventricular fibrillation and cardiac arrest rarely occur after local application of epinephrine. Local and superficial application of epinephrine is a common hemostatic method during bronchoscopy, especially after biopsies. Although high plasma levels following endobronchial application of epinephrine have been observed in previous animal studies, there is no report of ventricular fibrillation after a usual dose of endobronchial application of epinephrine during bronchoscopy. We present a case of endobronchial epinephrine-induced ventricular fibrillation and cardiac arrest in a 31-year-old man with no previous history of cardiac disease.

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Stress Related Cardiomyopathy during Flexible Bronchoscopy
Jung Ar Shin, Ji Yoon Ha, Sang Yong Kim, Byoung Kwon Lee, Hyung Jung Kim, Chul Min Ahn, Yoon Soo Chang
Korean Journal of Critical Care Medicine.2013; 28(2): 127. CrossRef

Alteration of Lung Mechanics Depending on Expiratory Sensitivity (ESENS) during Pressure Support Ventilation: Kwang Won Seo, Gyu Rak Chon, Jong Joon Ahn, Yangjin Jega, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2006;21(1):8-16.

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Abstract PDF: BACKGROUND
To evaluate effects of 5 expiratory sensitivity (ESENS) levels (5%; 15%; 25%; 35%; 45%) on lung mechanics and the effects depending on the two P(0.1) levels (<3 cm H2O; > or =3 cm H2O).
METHODS
Prospective, randomized, physiologic study for intubated adult patients during weaning from mechanical ventilation. Patients were randomly submitted to the 5 settings of ESENS in the Galileo ventilator (Galileo Gold, Hamilton Medical AG, Switzerland). Physiologic variables were continuously measured using a Bicore CP-100 pulmonary mechanics monitor (CP-100, Bicore, USA).
RESULTS
Thirteen patients, ten men and three women, with a mean age of 65.2+/-16.1 yr were studied. Tidal volume (V(T)) decreased significantly from ESENS 5% to 45%. With increasing levels of ESENS, respiratory rates (RR) steadily increased from ESENS 5% to 35% and 45%. Shallow breath index (F/V(T)) increased significantly from ESENS 5% to 45%. Inspiratory time (T(I)) decreased gradually significantly from ESENS 5% to 45%. RR and F/V(T) increased from ESENS 5% to 15% and 45% and V(T) decreased gradually in patients with P(0.1)<3 cm H2O group, but not in patients with P(0.1)> or =3 cm H2O.
CONCLUSIONS
The proper adjustment of expiratory sensitivity (ESENS) levels improved patient-ventilator synchrony and decreased respiratory rates and shallow breath index, especially in P(0.1)<3 cm H2O during PSV in ventilator weaning patients. Lower ESENS level would be more appropriate in terms of lung mechanics in patients with less than 3 cm H2O of P(0.1).

The Effect of Low-dose Dopamine on Splanchnic and Renal Blood Flow in Patients with Septic Shock under the Treatment of Norepinephrine: Jong Joon Ahn, Tae Hyung Kim, Ki Man Lee, Tae Sun Shim, Chae Man Lim, Sang Do Lee, Woo Sung Kim, Dong Soon Kim, Won Dong Kim, Younsuck Koh; Korean J Crit Care Med. 2001;16(1):36-41.

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Abstract PDF: BACKGROUND
Norepinephrine, which is frequently administered as a vasopressor to the patients with septic shock, can decrease splanchnic and renal blood flows and aggravate splanchnic and renal ischemia. The low-dose dopamine (LDD) has been frequently combined with norepinephrine to ameliorate renal and splanchnic hypoperfusion in patients with septic shock. However, the effect of the LDD on the splanchnic and renal blood flow has not been fully elucidated. This investigation was carried out to determine the effect of the LDD on the splanchnic and renal blood flow in the patients with septic shock under the treatment of norepinephrine.
METHODS
Eleven patients with septic shock were included in this study. All of them were under the norepinephrine treatment as the mean arterial pressure (MAP) was less than 70 mm Hg in spite of the adequate fluid resuscitation. With stabilization of MAP, the LDD (2 g/kg/min) was administered for two hours in each patients. Hemodynamics, gastric intramucosal pH (pHi), gastric regional PCO2 (rPCO2), rPCO2 - PaCO2, urine volume, urine sodium excretion and creatinine clearance were compared between with and without the LDD infusion. Diuretics was not used during the study period.
RESULTS
Age of patients (n=11) was 64 12 and the APACHE III score was 84 17. The mortality rate of the subjects was 64%. Dosage of norepinephrine was 0.55 0.63 g/kg/min during the study period. There were no significant differences in hemodynamics (central venous pressure, cardiac output, pulmonary artery occlusion pressure, mixed venous gas), pHi, rPCO2, rPCO2 - PaCO2 depending on the concomitant infusion of the LDD. The volume of urine tended to increase (P=0.074) after concomitant LDD, but the changes in urine sodium excretion and creatinine clearance were not significantly different.
CONCLUSIONS
The combined infusion of the LDD with norepinephrine did not improve splanchnic and renal blood flow in the patients with septic shock.

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