Acute and Critical Care

Se Min Choi

3 Articles

Efficacies of Somatosensory Evoked Potential and Diffusion-Weighted Magnetic Resonance Imaging as Predictors of Prognosis for Patients Experiencing Coma after Cardiac Arrest: Sang Hee Chae, Soo Hyun Kim, Se Min Choi, Seung Pill Choi, Kyu Nam Park; Korean J Crit Care Med. 2013;28(4):300-308.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.300

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BACKGROUND
The aim of this study was to examine the efficacies of somatosensory evoked potential (SEP) and diffusion-weighted magnetic resonance imaging (DWI) in predicting the clinical prognosis of comatose patients following cardiac arrest.
METHODS
Forty-one patients resuscitated from out-of hospital cardiac arrest (OHCA) were retrospectively studied. After return of spontaneous circulation (ROSC), SEP was conducted between one and three days after resuscitation, and DWI was conducted within five days of resuscitation. SEP was classified into three grades: normal, delayed conduction or unilateral loss of the N20 peak, and bilateral loss of the N20 peak. Bilateral loss of the N20 peak was considered a predictor of poor prognosis. For DWI, diffuse signal intensity (SI) abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex was taken as a predictor of poor prognosis. For patient clinical prognosis, the Glasgow-Pittsburgh Cerebral Performance Category (CPC) was used to evaluate neurological results at the time of discharge. Resulting CPC scores of 1 and 2 were considered as a favorable prognosis, and scores of 3, 4, and 5 were considered as a poor prognosis. Sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of poor prognosis were analyzed for each test individually and for the combination of the two tests.
RESULTS
Among the 41 subject patients, 31 underwent SEP, 30 underwent DWI, and 20 underwent both tests. The prognosis predictor of SEP (bilateral loss of the N20 peak) predicted poor prognosis with 56.5% sensitivity, 100% specificity, 100% positive predictive value, and 44.4% negative predictive value. The prognosis predictor of DWI (diffuse SI abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex) predicted poor prognosis with 85% sensitivity, 100% specificity, 100% predictive value, and 76.9% predictive value. For patients who underwent both tests, the sensitivity and negative predictive value for the prediction of poor prognosis increased to 92.3% and 87.5%, respectively, and the specificity and positive predictive value were maintained at 100%.
CONCLUSIONS
The accuracy of poor prognosis prediction for patients in prolonged comas after resuscitation is enhanced by combining the results of SEP and DWI along with the individual results of each test.

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The Effect of Transcranial Direct Current Stimulation and Functional Electrical Stimulation on the Lower Limb Function of Stroke Patients
Xiao-Hua Zhang, Tao Gu, Xuan-Wei Liu, Ping Han, Hui-Lan Lv, Yu-Long Wang, Peng Xiao
Frontiers in Neuroscience.2021;[Epub] CrossRef

The Values of the Pediatric Logistic Organ Dysfunction (PELOD) Score and the Pediatric Index of Mortality (PIM) 2 Score in Emergency Department and Intensive Care Unit: Si Kyoung Jeong, Woon Jeong Lee, Yun Joo Moon, Seon Hee Woo, Yeon Young Kyong, Se Min Choi, Won Jung Jeong, Kyu Nam Park; Korean J Crit Care Med. 2010;25(3):144-148.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.144

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Abstract PDF

BACKGROUND
This study was conducted to compare two models of the pediatric logistic organ dysfunction (PELOD) score and the pediatric index of mortality (PIM) 2 score in the emergency department (ED) and intensive care unit (ICU).
METHODS
90 pediatric patients who were admitted to the ICU in ED from January 2003 to December 2008 were enrolled in this study. PELOD score and PIM 2 score calculations were performed in the ED and ICU. We classified these patients into either the survivor or non-survivor groups and analyzed the clinical variables between two groups. We used Hosmer-Lemeshow goodness-of-fit tests to evaluate calibration, receiver operating characteristic (ROC) curves and standardized mortality ratio (SMR).
RESULTS
Among the 90 pediatric patients, 56 (62.2%) were male, and 9 (10.0%) patients died. Expected mortalities were PIM 2 = 10.35, PELOD = 8.33 in ED and PIM 2 = 8.84, PELOD = 8.26 in ICU. PIM 2 showed fit calibration (x(2) = 6.228, p = 0.622) in the ED. In the ICU, both PELOD and PIM 2 showed calibration (x(2) = 4.625, p = 0.185) and (x(2) = 7.616, p = 0.472), respectively. PIM 2 in ED showed the best discrimination, with area under the curve (AUC) = 0.949 (95% CI, 0.881-0.984).
CONCLUSIONS
PIM 2 score in ED was fit. Also, PELOD and PIM 2 score in ICU was fit. But PELOD in ED was unfit.

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Usefulness of Thrombocytopenia and Changes in Platelet Counts as Prognostic Markers in Pediatric Intensive Care Units
Yoon Hee Kim, Hyun Bin Park, Min Jung Kim, Hwan Soo Kim, Hee Seon Lee, Yoon Ki Han, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
Korean Journal of Critical Care Medicine.2013; 28(2): 93. CrossRef

Infectious Complications in the Survivors of Out-of-hospital Cardiac Arrest: Seon Hee Woo, Woon Jeong Lee, Se Min Choi, Seung Pill Choi, Kyu Nam Park; Korean J Crit Care Med. 2009;24(1):22-27.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.22

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Abstract PDF: BACKGROUND
Infectious complications commonly occur in the survivors of out-of-hospital cardiac arrest. The aim of our study was to describe the incidence, associated factors and outcome of infectious complications of the survivors of out-of-hospital cardiac arrest.
METHODS
We conducted a retrospective analysis of 75 patients who survived out-of-hospital cardiac arrest. We collected the data on the demographics, the modes of cardiac arrest, the duration of CPR, the dose of epinephrine, the use of hypothermia, new infections, the duration of mechanical ventilation, the length of stay in the intensive care unit (ICU), recovery of consciousness and the mortality.
RESULTS
New infections developed in 46.7% of the patients. Asystole was the most common rhythm (70.7%). The most common infectious complication was pneumonia (40.0%) urinary tract infection developed in 10 cases, vascular catheter local infection developed in 6 cases, primary blood stream infection developed in 3 cases, wound infection developed in 2 cases and pseudomembranous colitis developed in 1 case. The most common pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. Blood cultures were obtained in 36 patients during the first 24 hr and the pathogen was isolated in three. The patients with infection had a longer duration of mechanical ventilation and a longer stay in the ICU (p < 0.001, p = 0.001).
CONCLUSIONS
Infectious complications are common in survivors of out-of-hospital cardiac arrest and these infections are associated with a longer duration of mechanical ventilation and a longer stay in the ICU. The most common infectious complication was pneumonia and the pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus.

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