Acute and Critical Care

Sungwon Na

7 Articles

Pharmacology
Green Urine after Propofol Infusion in the Intensive Care Unit: Min Jeong Lee, Hyun Jeong Lee, Jeong Min Kim, Shin Ok Koh, Eun Ho Kim, Sungwon Na; Korean J Crit Care Med. 2014;29(4):328-330. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.328

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Urine discoloration occurs in the intensive care unit (ICU) due to many causes such as medications, metabolic disorders, and infections. Propofol is advocated as one of the first line sedatives in the ICU, but it is not well known to the intensivists that propofol can induce urine color change. We experienced two cases of green urine after propofol infusion. Propofol should be warranted as the cause of urine discoloration during ICU stay.

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An unusual instance of propofol-triggered green urine in anesthesia management: A case report
Madhusoodan M Gonenavar, Sudhanshu Shukla, Tejashree Sridhar, Rashmi Prasad, Rudresh Tabali
MGM Journal of Medical Sciences.2024; 11(1): 165. CrossRef
Propofol-Associated Urine Discoloration: Systematic Literature Review
Ana Lasica, Cinzia Cortesi, Gregorio P. Milani, Mario G. Bianchetti, Federica M. Schera, Pietro Camozzi, Sebastiano A.G. Lava
Pharmacology.2023; 108(5): 415. CrossRef
Green urine after general anesthesia with propofol: different responses in the same patient -A case report-
Go Eun Kim, Dae Yoon Kim, Doek Kyu Yoo, Jong-Hwan Lee, Sangmin Maria Lee, Jeong Jin Min
Anesthesia and Pain Medicine.2017; 12(1): 32. CrossRef

Pulmonary
Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index: Sarah Soh, Jin Ha Park, Jeong Min Kim, Min Jung Lee, Shin Ok Koh, Hyo Chae Paik, Moo Suk Park, Sungwon Na; Korean J Crit Care Med. 2014;29(4):273-280. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.273

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Abstract PDF: BACKGROUND
Weaning from mechanical ventilation is difficult in the intensive care unit (ICU). Many controversial questions remain unanswered concerning the predictors of weaning failure. This study investigates patient characteristics and delayed weaning after lung transplantation.
METHODS
This study retrospectively reviewed the medical records of 17 lung transplantation patients from October 2012 to December 2013. Patients able to be weaned from mechanical ventilation within 8 days after surgery were assigned to an early group (n = 9), and the rest of the patients were assigned to the delayed group (n=8). Patients' intraoperative and postoperative characteristics were collected and analyzed, and conventional weaning predictors, including rapid shallow breathing index (RSBI), were also assessed.
RESULTS
The results of the early group showed a significantly shorter ICU stay in addition to a shorter hospitalization overall. Notably, the early group had a higher body mass index (BMI) than the delayed group (20.7 vs. 16.9, p = 0.004). In addition, reopening occurred more frequently in the delayed group (1/9 vs. 5/8, p = 0.05). During spontaneous breathing trials, tidal volume (TV) and arterial oxygen tension were significantly higher in the early group compared to the delayed weaning group, but differences in RSBI and respiratory rate (RR) between groups were not statistically significant.
CONCLUSIONS
Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.

Infection
Implementing a Sepsis Resuscitation Bundle Improved Clinical Outcome: A Before-and-After Study: Jeongmin Kim, Sungwon Na, Young Chul Yoo, Shin Ok Koh; Korean J Crit Care Med. 2014;29(4):250-256. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.250

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Abstract PDF

BACKGROUND
Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock.
METHODS
Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated.
RESULTS
The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004).
CONCLUSIONS
Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.

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Hypotension Prediction Index and Incidence of Perioperative Hypotension: A Single-Center Propensity-Score-Matched Analysis
Julian Runge, Jessica Graw, Carla D. Grundmann, Thomas Komanek, Jan M. Wischermann, Ulrich H. Frey
Journal of Clinical Medicine.2023; 12(17): 5479. CrossRef
Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension
Carla D. Grundmann, Jan M. Wischermann, Philipp Fassbender, Petra Bischoff, Ulrich H. Frey
Acta Anaesthesiologica Scandinavica.2021; 65(10): 1404. CrossRef
Barriers to Clinical Practice Guideline Implementation for Septic Patients in the Emergency Department
Elizabeth N. Reich, Karen L. Then, James A. Rankin
Journal of Emergency Nursing.2018; 44(6): 552. CrossRef

A Case of Burkholderia cepacia Pneumonia after Lung Transplantation in a Recipient without Cystic Fibrosis: Jin Sun Cho, Sungwon Na, Moo Suk Park, Yun So, Bahn Lee, Shin Ok Koh, Hyo Chae Paik; Korean J Crit Care Med. 2013;28(3):187-191.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.187

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Abstract PDF

Burkholderia cepacia is a highly virulent pathogen known to cause opportunistic infections in immunocompromised patients. It accelerates lung disease and causes necrotizing pneumonia with associated severe sepsis, known as cepacia syndrome. In particular, lung transplant recipients infected with Burkholderia cepacia show higher mortality after lung transplantation than those who are not infected with this organism. Due to broad-spectrum antibiotic resistance, a combination therapy should be used according to the results of the susceptibility test. This bacterial infection is rare in Korea, and no case was reported in lung transplant recipients. However, we report a case of pneumonia caused by Burkholderia cepacia after lung transplantation. As Burkholderia cepacia was grown from a sputum culture, the patient was treated initially with a combination of meropenem and trimethoprim/sulfamethoxazole and then ceftazidime and trimethoprim/sulfamethoxazole as a result of leukopenia. After antibiotics treatment for 20 days, sputum cultures became negative for Burkholderia cepacia and the patient successfully recovered.

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Current perspective of lung transplantation
Hyo Chae Paik
Journal of the Korean Medical Association.2016; 59(2): 119. CrossRef

Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients: Sungwon Na, Hosun Lee, Shin Ok Koh, Ai Soon Park, A Reum Han; Korean J Crit Care Med. 2010;25(3):136-143.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.136

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Abstract PDF

BACKGROUND
Nutrition delivery is frequently interrupted or delayed by physicians' ordering patterns. We conducted this study to investigate the effect of physician compliance with tube feeding (TF) protocol on the nutritional and clinical outcomes in acute lung injury (ALI) patients.
METHODS
After implementing a TF protocol, 71 ALI patients with mechanical ventilation (MV) for > or = 7 days were observed. A dietician assessed the nutritional status of the patients and established individualized nutrition plans according to the protocol. If the physicians followed the dietician's recommendation within 48 hours, the patients were classified under the compliant group (Group 1).
RESULTS
Forty patients (56.3%) were classified into Group 1. Prealbumin was comparable in both groups at ICU admission but higher in Group 1 at the time of discharge from the ICU (228 +/- 81 vs 157 +/- 77 mg/dl, p = 0.025). Nitrogen balance was only improved in Group 1. The time to reach calorie goal was shorter and non-feeding days were reduced in Group 1. The proportion of parenteral nutrition to nutritional support days was lower and delivered calories on the 4th and 7th day of TF were higher in Group 1 (p < 0.001). ICU mortality/stay and hospital mortality failed to show differences but hospital stay was prolonged in the noncompliant group (Group 2) (p = 0.023). Arterial oxygen tension and PaO2/FiO2 were maintained during the 1st week of ICU stay in Group 1 but were decreased in Group 2.
CONCLUSIONS
Physicians' compliance with the TF protocol contributed to the likelihood of nutritional improvement and a shorter hospital stay in ALI patients with prolonged MV.

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Nutritional Assessment of ICU Inpatients with Tube Feeding
Yu-Jin Kim, Jung-Sook Seo
Journal of the Korean Dietetic Association.2015; 21(1): 11. CrossRef
Identifying Barriers to Implementing Nutrition Recommendations
Nancy Stamp, Anne M. Davis
Topics in Clinical Nutrition.2013; 28(3): 249. CrossRef

Successful Heart Transplantation after Dobutamine, Glucose-insulin-potassium, and Hormone Therapy in a Hemodynamically Unstable Cadaveric Heart Donor: A Case Report: So Yeon Kim, Shin Ok Koh, Young Chul Yoo, Ha Kyoung Kim, Tae Jin Yun, Eun Ji Chang, Sungwon Na; Korean J Crit Care Med. 2010;25(2):89-92.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.89

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Abstract PDF

The major limitation to heart transplantation is the shortage of donor organs. In order to increase the cardiac donor pool, it is important to maintain stable hemodynamics and closely monitor cardiac function in cadaveric organ donors or potent donors. Recently, management of a potential cardiac donor pool has focused on aggressive hemodynamic management protocols and dobutamine stress echocardiography. In our case, management with low dose dobutamine, glucose-insulin-potassium (GIK), and hormone therapy reversed heart failure following brain death and the heart was successfully transplanted. We suggest that aggressive hemodynamic management with low-dose dobutamine, GIK, and hormone therapy can result in the recruitment of more cadaveric hearts in marginal conditions.

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Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination
Eun Young Kim, Ji Hyun Kim
The Korean Journal of Critical Care Medicine.2016; 31(3): 236. CrossRef

Hormonal Changes of the Brain-Dead Organ Donors: A 3-Year Experience: Yong Seon Choi, Sungwon Na, Seung Youn Kang, Shin Ok Koh; Korean J Crit Care Med. 2008;23(1):30-35.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.30

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Abstract PDF

BACKGROUND
Success of transplantation is critically dependent upon the quality of the donor organ and optimal management. Recently, hormonal replacement therapy has been reported to result in rapid recovery of cardiac function and enable significantly more organs to be transplanted, while some other studies show conflicting results. The aim of this study is to comprehensively evaluate changes in basal circulating hormonal levels of the brain-dead organ donors.
METHODS
We reviewed the records of all brain-dead patients between January, 2004, and June, 2007. Hemodynamic variables, plasma hormone levels were recorded at following time points: admission to the ICU (T1, baseline), 30 minutes (min) after first apnea test (T2), 30 min after second apnea test (T3), before operation for harvesting (T4). Hormonal measurements included cortisol, adrenocorticotrophic hormone, triiodothyronine (T(3)), thyroxine, free thyroxine, thyroid-stimulating hormone, growth hormone, and testosterone.
RESULTS
Nineteen patients were included in this study. Comparisons of hemodynamic parameters and hormonal levels to baseline values revealed no significant changes throughout the study period. When the patients were divided into 2 groups according to the requirement of norepinephrine (either>0.05 or < or =0.05microgram/kg/min), patients requiring >0.05microgram/kg/min of norepinephrine had T(3) level below the normal range at significantly more time points of measurement (7 vs. 0).
CONCLUSION
In this comprehensive assessment of hormonal levels in brain-dead organ donors, we could not observe any significant changes during the ICU stay. Replacement therapy of T(3) may be considered in patients requiring >0.05microgram/kg/min of norepinephrine.

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Alterations in neuroendocrine axes in brain-dead patients
Türkay Akbaş, Ayhan Öztürk
Hormones.2023; 22(4): 539. CrossRef

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