Acute and Critical Care

Young Joo Lee

13 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

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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.

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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

Successful Brain Dead Donor Management with CRRT: A Case Report: Sang Hyun Lim, Young Joo Lee, Han Bum Joe, Jae Moung Lee, In Kyung Lee; Korean J Crit Care Med. 2012;27(4):286-289.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.286

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Abstract PDF

Brain death results in adverse pathophysiologic effects in many brain-dead donors with cardiovascular instability. We experienced a brain-dead donor with continuous renal replacement therapy (CRRT) who was in a severe metabolic, electrolyte derangement and poor pulmonary function. The thirty-nine-year-old male patient with subarachnoid hemorrhage and intraventricular hemorrhage was admitted into the intensive care unit (ICU). After sudden cardiac arrest, he went into a coma state and was referred to as a potential organ donor. When he was transferred, his vital sign was unstable even under the high dose of inotropics and vasopressors. Even with aggressive treatment, the level of blood sugar was 454 mg/dl, serum K+ 7.1 mEq/L, lactate 5.33 mmol/L and PaO2/FiO2 60.3. We decided to start CRRT with the mode of continuous venovenous hemodiafiltration (CVVHDF). After 12 hours of CRRT, vital sign was maintained well without vasopressors, and blood sugar, serum potassium and lactate levels returned to 195 of PaO2/FiO2. Therefore, he was able to donate his two kidneys and his liver.

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Activation Policy for Brain-dead Organ Donation
Young-Joo Lee
The Ewha Medical Journal.2015; 38(1): 1. CrossRef

Thyroid Hormonal Changes in Brain Death Donors: Jae Myeong Lee, Young Joo Lee; Korean J Crit Care Med. 2011;26(3):157-161.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.157

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Abstract PDF

BACKGROUND
We analyzed thyroid hormone values in brain death patients to determine the need for thyroid hormone replacement therapy.
METHODS
We analyzed 111 brain death donors (77 males and 34 females, mean age, 41.1 years (range; 8 months -72 years) in Ajou University Hospital from 2000 to 2010.
RESULTS
The mean values of thyroid hormones were T3; 72.5 ng/dl (normal range [NR] 60-181 ng/dl), T4; 5.0 microg/dl (NR 4.5-10.9 microg/dl), free T4 1.0 ng/dl (NR 0.8-1.5 ng/dl), and TSH 1.5 microIU/ml (NR 0.35-5.5 microIU/ml), respectively. However, the values of T4 (correlation coefficient -0.264, p = 0.005), free T4 (correlation coefficient -0.305, p = 0.001) and TSH (correlation -0.206, p = 0.031) significantly decreased based on the increase of interval from the brain death-inducing event to the evaluation time (hereafter, interval). The patients with greater than 8 days of interval (N = 30) showed significantly low thyroid hormone values compared to patients with less than 8 days of interval (N = 81); T3 (70.3 ng/dl vs. 77.0 ng/dl, p = 0.242), T4 (4.7 ng/dl vs. 5.3 ng/dl, p = 0.015), free T4 (0.8 ng/dl vs. 1.2 ng/dl, p = 0.006) and TSH (1.0 microIU/ml vs. 2.0 microIU/ml, p = 0.000), respectively.
CONCLUSIONS
As the intervals from the brain death-inducing events increased, all thyroid hormone values of brain death donors except T3 significantly decreased. Therefore, we recommend that careful consideration should be given to the interval from brain death-inducing event for the evaluation of thyroid hormone status of brain death patients.

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Identification of Hemodynamic Risk Factors for Apnea Test Failure During Brain Death Determination
Jin Joo Kim, Eun Young Kim
Transplantation Proceedings.2019; 51(6): 1655. CrossRef

Clinical Characteristics of Acute Brain Swelling in Patients Successfully Resuscitated from Non-traumatic Out-of-hospital Cardiac Arrest: Wonhyun Ryu, Young Joo Lee, Eun Jung Park, Yoon Seok Jung, Young Gi Min; Korean J Crit Care Med. 2010;25(4):219-223.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.219

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Abstract PDF

BACKGROUND
The number of cardiac arrest patients who are resuscitated has increased with the development of emergency medical services. Brain swelling is often found in these patients, following return of spontaneous circulation. This study identifies risk factors for brain swelling, describes it's frequency, analyzes the effect of brain swelling on neurological outcome, and compares the results with other studies.
METHODS
A retrospective analysis had been conducted on cardiac arrest patients who visited the emergency room at a university hospital during a 24 month period since 2007. Thirty-seven successfully resuscitated patients were divided into 2 groups based on computed tomography findings; these groups consisted of 14 patients with brain swelling and 23 patients without brain swelling. Comparative studies were conducted on post-lab findings and several additional factors.
RESULTS
The 14 patients with brain swelling were significantly younger and showed a higher clinical performance category score than patients without brain swelling. Initial serum lactic acid levels showed good correlation with brain swelling.
CONCLUSIONS
An urgent CT should be conducted and aggressive treatment pursued when brain swelling is suspected, after consideration of various prognostic factors.

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Cerebral Edema After Cardiopulmonary Resuscitation: A Therapeutic Target Following Cardiac Arrest?
Erik G. Hayman, Akil P. Patel, W. Taylor Kimberly, Kevin N. Sheth, J. Marc Simard
Neurocritical Care.2018; 28(3): 276. CrossRef
Prognostic values of gray matter to white matter ratios on early brain computed tomography in adult comatose patients after out-of-hospital cardiac arrest of cardiac etiology
Byung Kook Lee, Kyung Woon Jeung, Kyoung Hwan Song, Yong Hun Jung, Wook Jin Choi, Soo Hyun Kim, Chun Sung Youn, In Soo Cho, Dong Hun Lee
Resuscitation.2015; 96: 46. CrossRef

The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock: Jung Hwan Ahn, Sang Cheon Choi, Young Gi Min, Yoon Seok Jung, Sung Hee Chung, Young Joo Lee; Korean J Crit Care Med. 2009;24(3):134-139.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.134

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Abstract PDF

BACKGROUND
The lactate concentration should be used to examine the severity of sepsis or any state of shock. This study was conducted to investigate the prognostic power of the lactate clearance, as adjusted for time, between the survivors and nonsurvivors of patients with severe sepsis or septic shock.
METHODS
The study was performed on 67 patients over 16 years old and who were admitted to the intensive care unit (ICU) with severe sepsis or septic shock. They were divided into the survivors (n = 37) and nonsurvivors (n = 30). The blood lactate concentrations were assayed at intervals ranging from 8 to 24 hours and the APACHE III scoring was done daily for 2 weeks or until discharge or death. The lactate clearance, as adjusted for time, was defined using the following formula: [(the maximal lactate concentration - the normal lactate concentration)/the time to normalize the lactate concentration] x 1,000.
RESULTS
There were no significant differences of age, gender and the length of the ICU stay between the survivors and non-survivors. There were significant difference of the time to measuring the maximal serum lactate concentration (3.2 +/- 12.3 hours vs. 28.8 +/- 64.6 hours, respectively; p = 0.037), the lactate clearance, as adjusted for time (132.27 +/- 112.88 mol/L . hour vs. 59.67 +/- 72.60 mol/L . hour, respectively; p = 0.002), the lactate clearance during 24 hours (46.0 +/- 26.3% vs. 22.6 +/- 45.6%, respectively; p = 0.018) and the APACHE III score (67.6 +/- 22.7 vs. 83.9 +/- 21.6, respectively; p = 0.005) between the survivors and non-survivors. The lactate clearance, as adjusted for time and the APACHE III score were the predictive factors for survival on the logistic regression analysis (odd ratio 0.987; p = 0.028 vs. odd ratio 1.046; p = 0.006).
CONCLUSIONS
Lactate clearance, as adjusted for time, could be used as a prognostic index, as well as the APACHE III score, for patients with severe sepsis or septic shock.

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Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate
Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon
The Korean Journal of Critical Care Medicine.2011; 26(2): 78. CrossRef

The Effects of Propofol on Blood-Brain Barrier Disruption with Mannitol Infusion in Cervical Sympathetic Nerve Blocked Rats: Jin Young Lee, Soo Han Yoon, Jae Hyung Kim, Yun Jeong Chae, Young Joo Lee, Jin Soo Kim, Bong Ki Moon; Korean J Crit Care Med. 2002;17(2):95-99.

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Abstract PDF: BACKGROUND
Blood brain barrier disruption (BBBD)increases therapeutic agents delivery to brain diseases.Increasing the delivery of therapeutic drugs to the brainimproves out come f or patients with brain tumors.Cervical sympathetic chain block can increase the degree of mannitol induced blood brain barrier disruption in rats.Anesthetic agents may modify hyperosmolar blood brain barrier disruption.Therefore we evaluated the effecfs of pentobarbital and propofol on mannitol induced blood brain barrier disruption(BBBD)in cervical sympathetic nerve blocked rats.
METHODS
14 male Sprague-Dawley rats were divided into 2 groups.Intravenous pentobarbital (group 1,n=7)and propofol (group 2,n=7)were administrated.Rats was blocked with 0.5% bupivacaine on right cervical sympathetic chain.All rats received 37degrees C,25%mannitol (1.75 g/kg) via right carotid artery.BBBD was estimated by Evans blue staining in cerebral hemisphere.
RESULTS
Both groups showed BBBD in right side hemisphere and there was no significant difference between group 1 and group 2 in right side hemisphere.
CONCLUSIONS
The results suggest that propofol could be used to be anesthetics for BBBD in cervical sympathetic blocked rats.

Prognostic Implication of Serial Blood Lactate Concentrations in SIRS Patient: Young Joo Lee, Jong Seok Park, Bong Ki Moon, Hee Jung Wang; Korean J Crit Care Med. 2001;16(2):144-150.

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Abstract PDF: Introduction: Lactic acid in circulating blood should provide an index between balance of oxygen consumption and metabolic rate in sepsis or any state of shock. The purpose of the study was to determine the prognostic power of the lactate, the time factor of the blood lactate levels between survivors and non-survivors and the correlation between APACHE III score and blood lactate level in SIRS patients.
METHOD
The study was performed on 99 patients over 16 years old who were admitted to the SICU with the criteria of SIRS. The blood lactate concentrations were assayed with arterial blood drawn in intervals ranging from 4 to 24 hours and the APACHE III scoring was done in the first 24 hours of SICU admission and daily until discharge or death for 2 weeks. The highest lactate level of the day was recorded. They were divided into two groups, survivors (n=61) and non-survivors (n=38), according to the outcome.
RESULT
There were significant difference of the first day (D1) as well as peak lactate level between the survivors and the non-survivors (3.02 3.05 vs 7.41 4.78, 3.24 2.70 vs 7.82 4.88 mmol/L). Significant difference of the lactate as well as APACHE III were identified between the survivors and the non-survivors during a 14-days of observation period. Significant correlations were shown between lactate and APACHE III while the study was being conducted. The peak lactate presented superior to the D1 lactate in mortality prediction.
CONCLUSION
Blood lactate concentration could be used as a prognostic index as well as APACHE III score. Serial blood lactate concentration assays are necessary to predict the outcome.

Perioperative Intensive Care for Liver Transplantation: Shin Hwang, Dong Lak Choi, Cheol Soo Ahn, Dong Eun Park, Sun Hyung Joo, Jang Yong Jeon, Kyeong Mo Kim, Yang Won Nah, Kwang Min Park, Young Joo Lee, Sung Gyu Lee; Korean J Crit Care Med. 2001;16(1):5-10.

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Abstract PDF: Many liver recipients have required intensive care, which is individualized and customized to each recipient. Prerequisites qualifying this care are wide comprehension of characteristics of end-stage liver disease and mechanisms of surgical procedures and immunologic knowledge. We present our principles of intensive care and experience from more than 300 cases of liver transplantation. There are roughly two types of liver transplantation, cadaveric and living-donor. These two types are different in their postoperative courses as following; severity of preservation injury, graft-size matching and morphologic liver regeneration and risk of vascular and biliary complications. Intensive care for liver recipients should be directed toward preventive and protective care along reasonable prediction of its clinical course. We described our experience about following subjects: management of hepatorenal syndrome, fulminant hepatic failure, acute renal failure, pneumonia, disturbance of consciousness, prophylaxis of viral hepatitis B, tumor recurrence, use of antibiotics, induction of liver function recovery, maintenance of vital signs, electrolyte balance, diet and infection control, nutritional support. The most important factor is the state of transplanted liver graft in determination of posttransplant course. If the graft functions well, many problems will be solved spontaneously. If not, intensive care will be required. Most of operative complications are related to the surgery itself, so that comprehension to surgical procedures to each recipient should be preceded for early detection and proper management. To achieve a favorable posttransplant course, all factors including maintenance of vital signs, elimination of obstacles to hepatic recovery, appropriate immunosuppression and solution of surgical complications should be met altogether. Of course, every member of liver transplantation team should pay durable attention and dedication to each liver recipient.

Effectiveness of Left Infrascapular Skin Temperature Monitoring in the ICU: Young Joo Lee, Hyun Jue Gill, Kuem Hee Chung, Jeong Yeon Hong, Bong Ki Moon, Myoung Eun Kim, Min Hyup Choi, Young Seok Lee; Korean J Crit Care Med. 1998;13(2):229-233.

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Abstract PDF: BACKGOUND: Many sites are used to measure the body temperature and each site has different physiologic and practical importance. Several types of skin temperature monitoring have been used as simple, inexpensive and viable alternatives in many settings. In the operating area, it is difficult to insert a temperature probe during operation. The object of this study was to compare the difference and the correlation between the temperature of the left infrascapular skin region and temperatures of axilla, nasopharynx and rectum, METHODS: Forty-two adult patients who were admitted at surgical ICU were studied. After covering the bed with insulator and sheets, patients were placed in supine position. Temperature monitoring was done at the same time using four temperature probes from two bedside patient monitors in the same patient. The temperatures were measured twice at 30 minutes after application of the temperature probe at 10 minute intervals and the average temperature was recorded.
RESULTS
The differences between skin temperature and rectal, nasopharyngeal, and axillary temperatures were -0.64+/-0.21degrees C (p<0.05), -0.40+/-0.21degrees C, and 0.24+/-0.21degrees C respectively. The lineal correlation between skin temperature and rectal, nasopharyngeal, and axillary temperatures were 0.839, 0.854, and 0.819, respectively (p<0.001).
CONCLUSION
This study suggests that the monitoring of the skin temperature at the left infrascapular skin region is well correlated with the nasopharyngeal, rectal and axillary temperatures. And it will be an easy, simple and safe method which can be used for the patients who are alert but need continuous temperature monitoring in the intensive care unit and as well as for the patients who are in the middle of operation.

Volume Changes under Isotonic Condition Containing Thiopental in Brain Astrocytoma Cells: Young Seok Lee, Bong Ki Moon, Sang Gun Han, Young Joo Lee, Jeong Yeon Hong, Kyeong Jin Lee, Soo Han Yoon, Keum Hee Chung, Hyun Jue Gill; Korean J Crit Care Med. 1998;13(2):194-197.

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Abstract PDF: BACKGOUND: Cell volume regulation is especially important in the brain because the brain is confined within a non-compliant vault and cannot tolerate significant perturbations in cell size. Cerebral cell volume regulation mechanisms are activated by sustained disturbances in plasma osmolality. The constancy of cell volume under physiological conditions is generally thought to reflex a balance between influx and efflux of solute and is therefore critically dependent on the properties of the plasma membrane. Cell volume regulation have not been described under isoosmotic solution. The object of the study was to know the effects of thiopental on cell volume change in isoosmotic condition.
METHODS
We made isoosmotic solution without thiopental (Group 1) and isoosmotic solution with 22.9 mM (Group 2), 16.8 mM (Group 3), 13.3 mM (Group 4) thiopental, separately, in order to study changes in cell volume under isoosmotic solution. We put cultured human brain astrocytoma cells into isoosmotic solution for each group and calculated cell volume using Coulter Counter after 30 minutes.
RESULTS
Cell volume was shown to be 5084+/-8580 (micrometer3)in Group 1, 501+/-854 (micrometer3) in Group 2, 1183+/-3839 (micrometer3) in Group 3, and 624+/-1100 (micrometer3) in Group 4. We discovered that cells in Group 2,3,4 were shrunk relative to cells in Group 1 (p<0.01). And there were significant differences in cell volume among thiopental groups.
CONCLUSIONS
Thiopental may has an effect on cell membrane properties and decrease cell volume under isoosmotic solution in brain astrocytoma cell.

Evaluation of Weaning Criteria from Mechanical Ventilatory Support: Young Joo Lee, Haeng Jae Kim, Taeg Hwan Bae, Sang Kun Han, Keum Hee Chung, Jang Wun Yun, Jae Woo Jin, Chol Kim; Korean J Crit Care Med. 1998;13(1):79-84.

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Abstract PDF: Introduction: A number of indices have been proposed as accurate predictors of weaning, but several studies have questioned the accuracy of these weaning indices in predicting the capability of independent breathing. The purpose of the study was to assess six standard bedside weaning criteria of mechanically ventilated patients in Surgical intensive care unit (SICM).
METHOD
: The study was performed on 72 SICU patients who were mechanically ventilated. According to the outcome of weaning, they were divided into two groups, weaning success (n=62) and weaning failure (n=10) group. All subjects should have PaO2 above 60 mm Hg at an FIO2 of 0.4 and PEEP of 3~5 cm H2O in the extubated patients and no PEEP in the tracheostomy patients. Six bedside weaning criteria were tidal volume above 5 ml/kg, respiratory rate below 25/min, vital capacity above 10 ml/kg, maximum inspiratory pressure below -20 cm H2O, minute volume below 10 L/min and PaO2/FIO2 above 200. Weaning failure was regarded as follows; changes of systolic blood pressure 20 mm Hg or diastolic pressure 10 mm Hg, changes of pulse rate 20 beat per minute, respiratory rate above 30 per minute or increased respiratory rate above 10 per minute, PaO2 below 60 mm Hg or PaCO2 above 55 mm Hg, and presence of paradoxical respiratory pattern.
RESULTS
PaO2/FIO2 and minute volume (VE) were showed statistically significant difference between two groups (P=0.048, P=0.003 respectively). Linear discriminant function was D=-1.422-0.005-xPaO2/FIO2+0.336xVE.
CONCLUSION
Our study demonstrates that PaO2/FIO2 and minute volume accurately predicts the weaning outcome in the surgical patients with mechanical support.

Statistical Analysis of the Patients in the ICU by Using the APACHE II Scoring System: Young Joo Lee, Keum Hee Chung, Hyun Jue Gill, Kyung Jin Lee, Sang Hyun Kim, Chang Whan Cho, Young Suk Lee; Korean J Crit Care Med. 1998;13(1):73-78.

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Abstract PDF: Introduction: The APACHE II scoring system has been promulgated as a useful tool in the assessment of the severity of disease and prognosis for patients with acute-on-chronic medical conditions. The purpose of this study was to assess the statistical association of APACHE II score and multiple variables in ICU patients.
METHODS
Prospective data on 803 ICU patients for validation of the APACHE II system were analysed. We evaluated the relationship between APACHE II scores within the first 24 hours of ICU admission and multiple variables that included days in the ICU, mortality rate and age. The patients were classified as operation and nonoperation, survival and nonsurvival groups.
RESULT
1) The APACHE II score was significantly higher in the 153 nonsurvivals (23.97+/-10.98) than in the 651 survivals (11.51+/-6.14) (p<0.05). 2) The mean APACHE II score of the nonoperation group (14.52+/-9.29) was significantly higher than operation group (12.40+/-7.30) (p<0.05). 3) The overall mortality rate was 17.8%. 4) All patients with an APACHE II score over 40 died.
CONCLUSION
The APACHE II score is statistically related with the mortality of critically ill patients.

The Effect of Cervical Sympathetic Nerve Block on Blood-brain Barrier Disruption with Mannitol Infusion in Rats: Bong Ki Moon, Soo Han Yoon, Young Joo Lee, Chul Ryung Hur, Chang Ho Kim, Sung Jung Lee, Young Seok Lee; Korean J Crit Care Med. 1997;12(1):69-74.

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Abstract PDF: BACKGOUND: The barrier can be altered by a number of insults to the brain (e.g., hypertension, freezing, trauma, drug). But the effect of the blood brain barrier distruction immediately after the neural change is unknown. In the present study, we focused on the BBBD after cervical sympathetic chain block.
METHODS
13 male Sprague-Dawley rats were divided into 2 groups. Group 1 (N=7) was blocked with 0.5% bupivacaine on the right cervical sympathetic chain and group 2 (N=6) was blocked with 0.5% bupivacaine on the bilateral cervical sympathetic chain. All rats received 37degrees C, 25% mannitol (1.75 g/kg) via right carotid artery and then, the effect of cervical sympathetic chain block on blood-brain barrier disruption of four cerebral compartment using 99mTc-human serum albumin and Evans blue was evaluated.
RESULTS
Both groups showed blood-brain barrier disruption and there was no significant difference between group 1 and group 2 in the anterior and posterior hemisphere of the right side brain. But group 2 showed significant blood-brain barrier disruption than group 1 in anterior and posterior hemisphere of the left brain (p<0.01).
CONCLUSIONS
This results suggest that cervical sympathetic chain block can increase the degree of mannitol-induced blood-brain barrier disruption via neural arch or blood flow change.

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