Acute and Critical Care

Sang Hyun Kwak

15 Articles

Pharmacology/Pulmonary
Comparison of Morphine and Remifentanil on the Duration of Weaning from Mechanical Ventilation: Jae Myeong Lee, Seong Heon Lee, Sang Hyun Kwak, Hyeon Hui Kang, Sang Haak Lee, Jae Min Lim, Mi Ae Jeong, Young Joo Lee, Chae Man Lim; Korean J Crit Care Med. 2014;29(4):281-287. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.281; Correction in: Acute Crit Care 2016;31(4):381

6,065 View
123 Download
1 Crossref

BACKGROUND
A randomized, multicenter, open-label, parallel group study was performed to compare the effects of remifentanil and morphine as analgesic drugs on the duration of weaning time from mechanical ventilation (MV).
METHODS
A total of 96 patients with MV in 6 medical and surgical intensive care units were randomly assigned to either, remifentanil (0.1-0.2 mcg/kg/min, n = 49) or morphine (0.8-35 mg/hr, n = 47) from the weaning start. The weaning time was defined as the total ventilation time minus the sum of controlled mode duration.
RESULTS
Compared with the morphine group, the remifentanil-based analgesic group showed a tendency of shorter weaning time (mean 143.9 hr, 89.7 hr, respectively: p = 0.069). Secondary outcomes such as total ventilation time, successful weaning rate at the 7th of MV day was similar in both groups. There was also no difference in the mortality rate at the 7th and 28th hospital day. Kaplan-Meyer curve for weaning was not different between the two groups.
CONCLUSIONS
Remifentanil usage during the weaning phase tended to decrease weaning time compared with morphine usage.

Citations

Citations to this article as recorded by

Comparison between remifentanil and other opioids in adult critically ill patients
Shuguang Yang, Huiying Zhao, Huixia Wang, Hua Zhang, Youzhong An
Medicine.2021; 100(38): e27275. CrossRef

Pharmacology/Anesthesiology
Lipid Emulsion in the Successful Resuscitation of Local Anesthetic Toxicity after Ankle Block: Sang Hee Park, Sang Hyun Kwak, Kyung Yeon Yoo, Hyun Jung Lee, Keun Bae Yook, Seok Jai Kim; Korean J Crit Care Med. 2014;29(3):234-236. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.234

6,237 View
96 Download

Abstract PDF: Unexpected occurrence of local anesthetic toxicity is not rare and can cause fatal complications that do not respond to any known drug of intervention. Recently, the successful use of lipid emulsion for local anesthetic toxicity has been reported and recommended as a rescue method for cardiac or neurologic complications. We report a case of seizure attack and respiratory arrest successfully recovered with the use of intravenous lipid emulsion. Clinicians must be aware of the beneficial role of lipid emulsion in cases of local anesthetic toxicity.

Structure of Intensive Care Unit and Clinical Outcomes in Critically Ill Patients with Influenza A/H1N1 2009: Jaehwa Cho, Hun Jae Lee, Sang Bum Hong, Gee Young Suh, Moo Suk Park, Seok Chan Kim, Sang Hyun Kwak, Myung Goo Lee, Jae Min Lim, Huyn Kyung Lee, Younsuck Koh; Korean J Crit Care Med. 2012;27(2):65-69.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.65

3,224 View
33 Download
6 Crossref

Abstract PDF

BACKGROUND
During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients.
METHODS
This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors.
RESULTS
Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026).
CONCLUSIONS
In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.

Citations

Citations to this article as recorded by

A population-based observational study of patients with pulmonary disorders in intensive care unit
Hyun Woo Lee, Eunjeong Ji, Soyeon Ahn, Hye-Joo Yang, Seo-Young Yoon, Tae Yeon Park, Yeon Joo Lee, Jinwoo Lee, Sang-Min Lee, Seung-Hye Choi, Young-Jae Cho
The Korean Journal of Internal Medicine.2020; 35(6): 1411. CrossRef
Novel respiratory infectious diseases in Korea
Hyun Jung Kim
Yeungnam University Journal of Medicine.2020; 37(4): 286. CrossRef
Impact of the mother–nurse partnership programme on mother and infant outcomes in paediatric cardiac intensive care unit
Ju-Yeon Uhm, Hee Soon Kim
Intensive and Critical Care Nursing.2019; 50: 79. CrossRef
Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey
Jun Wan Lee, Jae Young Moon, Seok Wha Youn, Yong Sup Shin, Sang Il Park, Dong Chan Kim, Younsuk Koh
Korean Journal of Critical Care Medicine.2016; 31(2): 111. CrossRef
Critical Care In Korea: Present and Future
Chae-Man Lim, Sang-Hyun Kwak, Gee Young Suh, Younsuck Koh
Journal of Korean Medical Science.2015; 30(11): 1540. CrossRef
Intensivist Physician Staffing in Intensive Care Units
Sunghoon Park, Gee Young Suh
Korean Journal of Critical Care Medicine.2013; 28(1): 1. CrossRef

Effect of Caffeic Acid Phenethyl Ester on Lipopolysaccharide-induced Murine Macrophage Activation: Seong Heon Lee, Mei Li, Dae Wook Lee, Dong Yun Lim, Cheol Won Jeong, Sang Hyun Kwak; Korean J Crit Care Med. 2011;26(3):134-138.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.134

2,830 View
28 Download

Abstract PDF: BACKGROUND
Caffeic acid phenethyl ester (CAPE) is an active component of propolis and is known to have anti-inflammatory properties. This study was performed to evaluate the effects of CAPE on lipopolysaccharide (LPS)-induced murine macrophage activation.
METHODS
Raw 264.7 cells were incubated with varying concentrations of CAPE with or without LPS. The production of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta and macrophage inflammatory protein-2 (MIP-2) and activation of extracellular signal-regulated kinases 1/2 (ERK1/2), c-Jun amino terminal kinases (JNK) and p38 were measured.
RESULTS
CAPE inhibited the production of TNF-alpha, IL-1beta and MIP-2 and attenuated phosphorylation levels of ERK1/2 and p38, but not JNK in RAW264.7 cells stimulated with LPS.
CONCLUSIONS
CAPE can attenuate LPS-induced macrophage responses and we suggest that these effects may play an important role in modulating macrophage-mediated inflammatory responses in vivo.

Reexpansion Pulmonary Edema Following the Early Decompression of Pneumothorax Occurred after Anesthetic Induction in a Patient with Lung Bulla: A Case Report: Hye Jin Jeung, Hyun Jung Lee, Seok Jai Kim, Sang Hyun Kwak; Korean J Crit Care Med. 2010;25(3):159-162.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.159

2,371 View
16 Download

Abstract PDF: When a rapidly re-expanding lung has been in a state of collapse for more than several days, pulmonary edema sometimes occurs. This is called reexpansion pulmonary edema. In general, it most commonly occurs in patients with a large pneumothorax of long duration. In this case, a 15 year old female patient with a 2.3 cm sized bulla in the right lung developed right pneumothorax after anesthetic induction. Although early drainage by closed thoracostomy was performed, right pulmonary edema eventually occurred. It is unusual that vigorous reexpansion pulmonary edema developed even though early decompression was performed within one hour after development of pneumothorax.

The Role of the Coagulation and Fibrinolytic Pathway in Acute Lung Injury: Sang Hyun Kwak; Korean J Crit Care Med. 2009;24(2):53-58.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.53

2,382 View
15 Download

Abstract PDF: Acute lung injury (ALI) is a common, life-threatening cause of acute respiratory failure, which is ultimately caused by a variety of local and systemic insults. Alterations in the coagulation and fibrinolysis profiles are present in almost all the patients suffering with ALI. The classic histologic findings in ALI patients include alveolar fibrin formation and microthrombi in the pulmonary vasculature. Decreased circulating levels of protein C and increased concentrations of thrombomodulin are present in patients with septic and nonseptic ALI. The circulating and pulmonary concentrations of plasminogen activator inhibitor-1 (PAI-1) are increased in the setting of ALI, and the degree of elevation in the PAI-1 level directly correlates with mortality. The need for new specific therapies has led a number of investigators to examine the role of altered coagulation and fibrinolysis in the pathogenesis of ALI. This review summarizes the current understanding of coagulation and fibrinolysis in ALI with an emphasis on the pathways that could be potential therapeutic targets, including the tissue factor pathway, the protein C pathway and the modulation of fibrinolysis via plasminogen activator inhibitor-1.

Hemolytic Uremic Syndrome Occurred after Esophagectomy: A Case Report: Su Hyeon Park, Sung Tae Jeong, Seok Jai Kim, Hong Beom Bae, Sung Su Chung, Sang Hyun Kwak; Korean J Crit Care Med. 2007;22(1):42-47.

1,741 View
15 Download

Abstract PDF: Hemolytic uremic syndrome is an unusual and uncommon disease in adults but more common in children, which is defined by the triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. We report a 64-year-old man who developed hemolytic uremic syndrome after esophagectomy and esophagogastrostomy due to esophageal cancer. We treated him using continuous renal replacement therapy and plasmapheresis with large volume fresh frozen plasma transfusion for 9 days. We could not find the cause of hemolytic uremic syndrome, and so finally concluded that it is idiopathic. Bleeding continuously without a particular reason after an operation, it needs an early diagnosis and treatment with considering a possibility of the hemolytic uremic syndrome.

Biotrauma in Ventilator Induced Lung Injury: Sang Hyun Kwak, Seok Jai Kim; Korean J Crit Care Med. 2006;21(1):1-7.

1,763 View
18 Download

Abstract PDF: No abstract available.

Vocal Cord Paralysis after the Coronary Artery Bypass Graft: A Case Report: Kwang Su Kim, Seong Wook Jeong, Sang Hyun Kwak, Myung Ha Yoon, Kyung Yeon Yoo, Chang Young Jeong, Sung Su Chung; Korean J Crit Care Med. 2005;20(2):170-173.

1,640 View
21 Download

Abstract PDF: Surgical trauma has long been recognized as the most common cause of unilateral and bilateral vocal cord paralysis. We experienced a case of bilateral vocal cord paralysis after off-pump coronary artery bypass graft. The patient was repeated intubation and extubation after operation in surgical intensive care unit. Fiberoptic bronchoscopy revealed bilateral vocal cord paralysis in the patient. The patient recovered after permanent tracheotomy. We reported a case of vocal cord paralysis after coronary artery bypass graft.

Influence of Collapse and Re-ventilation of Lung on the Development of Pulmonary Edema: Sang Hyun Kwak, Won Jong Jin, Hong Beom Bae, Seong Wook Jeong, Sung Su Chung, Chang Young Jeong; Korean J Crit Care Med. 2004;19(1):8-19.

1,879 View
15 Download

Abstract PDF: BACKGROUND
This study was to clarify the influence of collapse and re-ventilation of lung on the development of pulmonary edema in rabbit. METHODS: Animals were randomly assigned to one of three groups: Sham group receiving two lung ventilation (n=14), Collapse group receiving collapse of right lung (n=14), Reventilation group receiving collapse of right lung for 3 hours followed by reventilation of collapsed right lung for 3 hours (n=14). The lung of rabbits were ventilated with 50% oxygen through the tracheostomy. Right main bronchus was secured by thoracotomy in all animal. Collapse and reventilation were performed using by bulldog forcep. Mean arterial pressure, heart rate, arterial oxygen tension (PaO2), peripheral blood leukocyte and platelet counts were recorded at 0, 1, 2, 3, 4, 5 and 6 hour after the start of experiment. The wet to dry (W/D) weight ratio of lung, lung injury score and leukocyte counts, percentage of polymorphonuclear leukocyte (PMNL), concentration of albumin, and interleukin-8 (IL-8) in bronchoalveolar lavage fluid (BALF) were measured 6 hour after the start of experiment in both lung. RESULTS: W/D weight ratio of lung, lung injury score and leukocyte counts, percentage of PMNL, concentration of albumin and IL-8 in BALF were significantly increased in both lung of reventilation group. And the degree of increases is more significant in right than left lung. CONCLUSIONS: These findings suggest that reventilation of collapsed lung causes the bilateral pulmonary edema in rabbit mainly by activating neutrophil and IL-8 responses, which may play a central role in non cardiogenic pulmonary edema.

Tracheoesophageal Fistula as a Complication after Endotracheal Intubation: A Case Report: Woong Mo Kim, Seong Wook Jeong, Sang Hyun Kwak, Sung Su Chung, Chang Young Jeong; Korean J Crit Care Med. 2003;18(1):39-42.

1,815 View
22 Download

Abstract PDF: Placement of endotracheal tube, even for extremely short periods, can result in injury to laryngeal and tracheal tissue. This may be clinically insignificant, but in rare cases, it could be life threatening and results in permanent disability. Especially, tracheoesophageal fistula (TEF) is a serious and challenging problem because it may contaminate the tracheobronchial tree and interfere with nutrition. This uncommon but lethal complication has been reported to be associated with certain risk factors in tracheally intubated patients, and better knowledge of these factors could reduce the incidence of post-intubation TEF. We report a case of 49-year old male patient who has acquired TEF caused by endotracheal intubation and positive pressure ventilation.

Thumb Necrosis Following Radial Artery Cannulation: Seok Jai Kim, Seong Wook Jeong, Sang Hyun Kwak, Sung Su Chung, Woong Mo Im; Korean J Crit Care Med. 2002;17(1):25-28.

1,461 View
13 Download

Abstract PDF: Radial artery is frequently chosen for cannulation. Although the method is safe and simple, it can infrequently lead to tissue necrosis. This is a report of one case of amputation due to thumb necrosis developed from the radial artery cannulation in a patient who had open heart surgery. This is a 65 years old female who received a graft interposition of ascending aorta due to dissecting aortic aneurysm. Left radial artery cannulation was carried out after modified Allen's test appeared to be positive. On the 11 th postoperative days, we found that the catheter of left hand was obstructed, and we removed the catheter. On the 9 hrs after removal of catheter, thumb of left hand became color change and edematous with blister. On the 14 th days after removal of catheter, thumb of left hand became worsened to dusky purple to dark color change and pulseless, coldness. On the 20 th days after removal of catheter, amputation of thumb of left hand was performed.

Monitoring of Arterial and Central Venous Pressure in Critically Ill Patients: Sang Hyun Kwak; Korean J Crit Care Med. 2001;16(2):119-131.

1,876 View
10 Download

Abstract PDF: No abstract available.

Clinical Survey of Patients in the Post-Anesthesia Care Unit: Sung Su Chung, Myung Gi No, Seong Wook Jeong, Sang Hyun Kwak, Woong Mo Im; Korean J Crit Care Med. 1999;14(1):27-30.

1,461 View
27 Download

Abstract PDF: BACKGOUND: The purpose of this study was to evaluate characteristics and mortality rates of patients admitted to the post-anesthesia care unit (PACU) for obtaining the better clinical guidances and more advanced therapeutic plan in the future.
METHODS
The medical records of total 425 patients admitted to the PACU from January to December 1998 were reviewed and analyzed according to age, sex, department, duration of stay, mechanical ventilator care, and mortality rates.
RESULTS
Patients admitted PACU were 6% of total anesthesia patients. The ratio of male to female was 1.5:1. Patients of manhood aged from 45 to 64 were 37%, pediatric patients under 15 year-old were 23%. and elderly patients over 64 year-old were 18% of total PACU patients. The ratio of patients with ventilatory support was 42%. Mortality rate of neonate under 1 month of age was about 47%. Total mortality rate was 12%.
CONCLUSIONS
To improve the outcome of the patients in PACU, continuous nutritional and medical support, cardiovascular and pulmonary monitoring, appropriate nursing care, and availability of medical staff were needed.

Airway Obstruction with Armored Tracheostomy Tube by Swelling of Inner Layer: A case report: Chang Young Jeong, Sang Hyun Kwak, Sung Su Chung, Hyon Jeong Lee, Tae Yob Kim; Korean J Crit Care Med. 1997;12(2):169-172.

1,679 View
18 Download

Abstract PDF: One of the reasons for insertion of endotracheal tube is to provide a patent airway. Unfortunately, the tube itself may become the cause of airway obstruction. Especially, armored tube is known to be most effective in maintenance of airway patency. However, airway obstruction has been reported by a varity of causes even though armored tube was used. We experienced airway obstruction with armored tracheostomy tube by swelling of inner layer near the cuff. The tube was reused one and had been disinfected with ethylene oxide. Therefore, to prevent complication such as airway obstruction by use of armored tubes, it is desirable to avoid reusal of armored tube and to examine the lumen as well as cuff before intubation when reused.

Author index