Acute and Critical Care

Volume 26 (3); September 2011

Original Articles

PRISM III in a Pediatric Intensive Care Unit with Multiple Disease Entities: Seung Jun Choi, Cheong Jun Moon, Yoon Hong Chun, Jong Seo Yoon, Hyun Hee Kim, Jin Tack Kim, Joon Sung Lee; Korean J Crit Care Med. 2011;26(3):123-127.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.123

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BACKGROUND
We applied the pediatric risk of mortality (PRISM) III score to study patients in a pediatric intensivecare unit (PICU), where children with various kinds of diseases were hospitalized. We analyzed whether this scoring system was useful to predict patient mortality in the PICU.
METHODS
We retrospectively analyzed the medical records of patients hospitalized in a 5-bed PICU at a tertiary general hospital. Children who were transferred to other hospitals and remained under pediatric intensive care were excluded from this study.
RESULTS
We studied a total of 105 children, which included 63 boys (60%) and 42 girls (40%). The mean age was 4.2 years (range 0-17 years). The children were admitted to the PICU for various conditions, including respiratory disease (31 children), neurological disease (30 children), congenital anomaly or neonatal disease (11 children), hemato-oncological disease (10 children), accident or poisoning (7 children), cardiovascular disease (5 children), sepsis (2 children), and the other miscellaneous diseases (9 children). The mean period of PICU stay was 9 days (range 2-66 days). Out of the 105 patients, 94 survived and 11 died. Thus, the mortality rate was calculated as 10.5%. PRISM III scores of the patients were between 0 and 38, with a mean +/- SD of 5.0 +/- 6.7. In comparison with previous studies on PICU patients with similar PRISM scores, the patients included in our study exhibited a higher mortality. The area under the curve for the prediction of mortality by PRISM III was 0.107. Among the variables included in PRISM III, Glasgow coma scale, pupillary light reflex, and platelet counts were associated with patient mortality.
CONCLUSIONS
In a PICU with a wide spectrum of diseases, PRISM III was not a useful predictor of patient mortality.

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Outcome of High Dose Ampicillin-Sulbactam and Colistin Combination Therapy for Treating Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Acinetobacter baumannii: a Pilot Study
Seong Hee Jeong, Young A Kim, Go-eun Choi, Su Eun Park
Pediatric Infection & Vaccine.2020; 27(1): 45. CrossRef
Outcome of acute respiratory distress syndrome in children: a single center study
Sung Shil Kang, Ra Mee Pae, Eu Kyoung Lee, Kyung Won Bang, Hwan Soo Kim, Yoon Hong Chun, Jong-Seo Yoon, Hyun Hee Kim, Jin Tack Kim, Joon Sung Lee
Allergy, Asthma & Respiratory Disease.2014; 2(4): 266. CrossRef
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

Implementation of the Head of Bed (HOB) Elevation Protocol on Clinical and Nutritional Outcomes in Critically Ill Patients with Mechanical Ventilator Support: Se Hee Na, Hosun Lee, Shin Ok Koh, Hyun Sim Lee, Sung Won Na; Korean J Crit Care Med. 2011;26(3):128-133.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.128

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Abstract PDF

BACKGROUND
Although head of bed (HOB) elevation is an important strategy to prevent ventilator associated pneumonia (VAP), some observational studies have reported that the application of the semi-recumbent position was lower in patients receiving mechanical ventilator support. We performed this study to assess the effect of implementation of the HOB elevation protocol in the intensive care unit (ICU) on clinical and nutritional outcomes.
METHODS
We developed a HOB elevation protocol including a flow chart to determine whether the HOB of newly admitted patients to ICU could be elevated. We measured the level of HOB elevation in patients with mechanical ventilator twice a day and 2 days a week for 5 weeks before and after the implementation of the protocol, respectively. Hemodynamic, respiratory and nutritional data were also collected, resulting in 251 observations from 35 patients and 467 observations from 66 patients before and after implementation.
RESULTS
After implementing the protocol, the level of HOB elevation (16.7 +/- 9.9 vs. 23.6 +/-1 2.9, p < 0.0001) and observations of HOB elevation > 30degrees increased significantly (34 vs. 151, p < 0.0001). There was no significant difference in the incidence of VAP. Arterial oxygen tension/fraction of inspired oxygen ratio improved (229 +/- 115 vs. 262 +/- 129, p = 0.02). Mean arterial blood pressure decreased after the implementation of the protocol, but remained within the normal limits. Calorie intake from tube feeding increased significantly (672 +/- 649 vs. 798 +/- 670, p = 0.021) and the events of high gastric residual volume (> 100 ml) occurred less frequently after implementing the protocol (50% vs. 17%, p = 0.001) CONCLUSIONS: Implementation of the protocol for HOB elevation could improve the level of HOB elevation, oxygenation parameter and enteral nutrition delivery.

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Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
Korean Journal of Critical Care Medicine.2012; 27(3): 157. 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

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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.

The Clinical Significance of Weight Change in Mechanical Ventilated, Critically Ill Patients of ICU: Young Sun Seo, You Eun Kim, Seung Jun Lee, Yu Ji Cho, Yi Yeong Jeong, Ho Cheol Kim, Jong Deok Lee, Young Sil Hwang; Korean J Crit Care Med. 2011;26(3):139-144.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.139

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Abstract PDF: BACKGROUND
Critically ill patients may show significant weight change in their course of disease during ICU stay. However, what weight changes occur and their effects on patient outcome have not yet been reported to our knowledge. Therefore, we evaluated weight change in critically ill patients in the medical ICU and the effect this may have on clinical outcome.
METHODS
We measured body weight in patients admitted to the medical ICU daily and evaluated their clinical characteristics and outcome.
RESULTS
Thirty-eight patients (M:F = 30:8, mean age = 65.7 +/- 12.5) were enrolled. Thirteen patients (34.2%) showed weight gain and the mean change was 12.8 +/- 4.2%. In contrast, 25 patients (65.8%) showed weight loss and the mean change was 6.3 +/- 6.9%. Patients who showed weight change over 5% or 10% were 26 (68.4%), and 12 (31.6%), respectively, and their mortality rates were 61.5% and 75%, respectively, showing no statistical significance (p > 0.05). However, when the degree of weight change was stratified with < 5%, 5-10% and > 10%, it was associated with death (p = 0.002). Factors like ICU stay, day of mechanical ventilation, initial APACHE II and SOFA score, body mass index (BMI) and serum albumin were not associated with more than 5% change of weight. BMI at admission was only associated with > 10% change of weight (p < 0.05).
CONCLUSIONS
The majority of critically ill patients showed a significant weight change during their ICU stay and these patients may have a tendency to have worse clinical outcome.

Relationship between Patient Height and Depth of Central Venous Catheter: Dong Jun Lee, Ui Jae Im, Ki Tae Kim; Korean J Crit Care Med. 2011;26(3):145-150.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.145

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Abstract PDF: BACKGROUND
Location of the tip of a central venous catheter (CVC) within the pericardium has been associated with potentially lethal cardiac tamponade. The purpose of this study was to show the relationship between the height of patients and the depth of CVC.
METHODS
We enrolled 262 adult patients into this study. All patients were divided to three groups according to the height; Group S, M and L. Central venous catheterization was performed through the right subclavian vein and the CVC was fixed at the depth of 15 cm from the skin. The distance between the CVC tips and the carina was measured by chest X-ray and was analyzed.
RESULTS
The mean (SD) tip position placed via the right subclavian vein was 0.04 (1.6) cm above the carina; Group S, 0.01 (1.8) above the carina, Group M, 0.16 (1.4) above the carina, and Group L, 0.16 (1.8) below the carina. CVC locations could be predicted with a margin of error between 3.1 cm below the carina and 3.2 cm above the carina in 95% of patients. There was no significance difference among the three groups.
CONCLUSIONS
The relationship between the height of patient and the depth of CVC was low. Because many of the CVC tips were positioned below the carina regardless the height of patients on routine 15 cm-length method, it is recommended not to use the routine 15 cm method with right subclavian CVC placement as far as possible.

A Retrospective Study about Characteristics of Out-of-hospital Cardiac Arrest Caused by Non-traumatic Subarachnoid Hemorrhage: Min Seob Sim, Ki Dong Sung, Mun Ju Kang, Ji Ung Na, Tae Gun Shin, Ik Joon Jo, Hyoung Gon Song, Keun Jeong Song, Yeon Kwon Jeong; Korean J Crit Care Med. 2011;26(3):151-156.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.151

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Abstract PDF: BACKGROUND
Subarachnoid hemorrhage is a fatal disease relatively common in the East Asian population. It can lead to cardiac arrest in several pathologic processes. We attempted to elucidate the characteristics of out-of-hospital cardiac arrest caused by non-traumatic subarachnoid hemorrhage.
METHODS
We conducted a retrospective, observational study in which patients who had visited Samsung medical center emergency room for out-of-hospital cardiac arrest from January, 1999 to December 2008 were enrolled. A total of 218 OHCA patients who had achieved ROSC were investigated by review of medical charts. Excluding those who had worn trauma, we analyzed 22 patients who had been diagnosed for SAH by brain non-contrast CT scan.
RESULTS
Median age of aneurysmal SAH-induced OHCA patients was 61 (IQR 54-67) years. Fourteen patients (64%) were female and 15 patients (68%) were witnessed. Besides, 7 patients (32%) had complained of headache before collapse. We also found 11 patients (50%) had been diagnosed with hypertension previously. All of them showed unshockable rhythm (asystole 60%, PEA 40%) initially. Their median duration of ACLS was 10 minutes. Majority of patients died within 24 hours and survivors showed poor neurologic outcome.
CONCLUSIONS
Subarachnoid hemorrhage is a relatively uncommon cause of cardiac arrest, and the outcome of OHCA induced by SAH is very poor. However, emergency physicians have to consider the possibility of SAH when trying to determine the cause of arrest, especially when treating patients who have the characteristics described above.

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.

Citations

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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 Features of Hospitalized Patients with Community Acquired Pneumonia during 2009 Influenza A (H1N1) Pandemic: Myung Jae Yun, Seong Tae Lee, Hye Jin Oh, Seung June Lee, Sook Hee Song, In Sohn, Jae Phil Choi, Su Hyun Kim; Korean J Crit Care Med. 2011;26(3):162-170.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.162

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Abstract PDF: BACKGROUND
A new influenza A(H1N1) virus emerged and spread globally in 2009, and the rapid progression of pneumonia often required ICU care. We describe the cause analysis and clinical aspects of community acquired pneumonia during the period of the pandemic H1N1 influenza A.
METHODS
We reviewed the medical records of 48 adult cases of community acquired pneumonia in which patients were admitted to a public health hospital in Seoul from August to November in 2009. The patients had confirmed H1N1 influenza A based on RT-PCR assay.
RESULTS
Thirteen cases of the 48 (27.1%) were 2009 H1N1 RT-PCR positive patients and three (6.3%) of these cases were mixed viral and bacterial pneumonia patients. The mean age was younger and the PSI score was lower in H1N1 patients. Chest radiographic findings of ground glass opacity and interstitial marking were remarkable in H1N1 patients. Major complication events with ICU care or death occurred in 23.1% of the H1N1 positive group and 48.6% of the H1N1 negative group (p=0.202). The major complication group of H1N1 patients had a higher PSI score, lower platelet count, higher CRP and higher mixed bacterial co-infection.
CONCLUSIONS
If patients were younger and showed a radiologic finding of interstitial marking or ground glass opacity, we could consider H1N1 influenza as the cause of community acquired pneumonia. A high PSI score, thrombocytopenia, increased CRP and bacterial co-infection were predictable factors of major complication.

Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit: Jae Wook Choi, Woo Jin Chung, Young Joo Han, Ju Kyung Lee, Dong In Suh, June Dong Park, Young Yull Koh; Korean J Crit Care Med. 2011;26(3):171-176.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.171

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Abstract PDF

BACKGROUND
The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pediatric intensive care unit.
METHODS
We retrospectively analyzed 96 patients who required CRRT at a pediatric intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT.
RESULTS
Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6-72.9 kg. 16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pediatric Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 +/- 8.9 and the degree of fluid overload at CRRT (FO%) was 12.9 +/- 16.0. The PRISM III score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically significant hemorrhage occurred in 10 patients (10.4%).
CONCLUSIONS
Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT.

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Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single-Center Study
Moon-yeon Oh, Byong Sop Lee, Seong-Hee Oh, Hee Jin Jang, Hyun-Jeong Do, Ellen Ai-Rhan Kim, Ki-Soo Kim, Joo Hoon Lee, Young Seo Park, Beom-Hee Lee, Han-Wook Yoo
Neonatal Medicine.2014; 21(4): 244. CrossRef

Case Reports

A Case of Acute on Chronic Salicylate Poisoned Elderly Patient with Early Utilization of Continuous Venovenous Hemodiafiltration: A Case Report: Ji Sook Lee, Woo Chan Jeon, Young Gi Min, Won Hyun Ryu, Yoon Seok Jung, Sang Cheon Choi; Korean J Crit Care Med. 2011;26(3):177-180.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.177

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Abstract PDF: Salicylate poisonings are divided into acute and chronic syndromes. The most challenging aspect of the management of aspirin-poisoning may be recognition of subtle signs and symptoms of chronic, unintentional overdose. Chronic poisoning typically occurs in elderly as a result of unintentional overdosing on salicylates used to treat chronic conditions. Treatment is directed toward preventing intestinal absorption of the drugs and enhanced elimination. After the first-line treatments, aspirin overdose with its complications of hemodynamic, electrolyte and acid-base issues, is best managed by prompt hemodialysis. We report a case of a 87-year-old woman, who presented with acute on chronic salicylate poisoning. After early continuous venovenous hemodiafiltration, old woman made a good recovery from the salicylism but suffered paralytic ileus caused by aspirin enteroliths. Physician can decide a prompt hemodialysis for salicylate-poisoned patients, who worsen clinical courses despite of first-line therapies.

Transient Hypoglycemia-induced Hemiparesis Mimicking Stroke: A Case Report: Seong Hwa Lee, Ji Ho Ryu, Yong In Kim, Maeng Real Park, Mun Ki Min, Sun Min Hwang; Korean J Crit Care Med. 2011;26(3):181-183.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.181

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Abstract PDF

Hypoglycemia is caused by poor oral intake, excessive exercise, alcohol abuse and inaccurate use of a hypoglycemic agent or insulin in patients that have history of diabetes mellitus (DM), especially in the elderly. Severe hypoglycemia has a variety of different symptoms or signs from focal neurologic deficits to severe coma, or death. It can be difficult to differentiate hypoglycemia-induced symptoms or signs, and stroke or cardiovascular disease in acute setting. Transient hypoglycemic hemiparesis is an infrequent case in the emergency department (ED), which is frequently misdiagnosed for stroke. When patients with decreased mental status or hemiparesis are admitted to the ED, a routine blood sugar test is essential. Hypoglycemic hemiparesis if unrecognized can result in permanent neurological damage. Therefore, it is important to detect hypoglycemia early and treat it appropriately.

Citations

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Consideration of Prognostic Factors in Hypoglycemic Encephalopathy
Ik-Kwon Seo, Woo-Ik Choi, Sang-Chan Jin, Hyuk-Won Chang
Korean Journal of Critical Care Medicine.2012; 27(4): 209. CrossRef

A Case of Acute Lung Injury after Transfusion during Cesarean Section: A Case Report: Hee Jong Lee, Mi Ae Jeong, Ji Seon Jeong, Min Kyu Han, Jong Hun Jun; Korean J Crit Care Med. 2011;26(3):184-187.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.184

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Abstract PDF

Transfusion-related acute lung injury (TRALI) is a serious complication following the transfusion of blood products. TRALI is under-diagnosed and under-reported because of a lack of awareness. TRALI occurs within 6 hours of transfusion in the majority of cases and its presentation is similar to other forms of acute lung injury. We report on the case of a 34-year-old pregnant woman who suffered from TRALI after transfusion during Cesarean section.

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Transfusion-related acute lung injury in a parturient diagnosed with myelodysplastic syndrome - A case report -
Tae-Yun Sung, Young Seok Jee, Seok-jin Lee, Hwang Ju You, Ki Soon Jeong, Po-Soon Kang
Anesthesia and Pain Medicine.2019; 14(1): 35. CrossRef
A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion
Ki Sul Chang, Dae Won Jun, Youngil Kim, Hyunwoo Oh, Min Koo Kang, Junghoon Lee, Intae Moon
The Korean Journal of Blood Transfusion.2015; 26(3): 309. CrossRef
Transfusion-Related Acute Lung Injury after Stored Packed Red Blood Cell Transfusion - A Case Report -
Ho-Hyun Kim, Dong-Kyu Lee, Chan-Yong Park, Jae-Kyoon Ju, Jung-Chul Kim
Korean Journal of Critical Care Medicine.2013; 28(2): 141. CrossRef
A case of transfusion-related acute lung injury induced by anti-human leukocyte antigen antibodies in acute leukemia
Sun Mi Jin, Moon Ju Jang, Ji Young Huh, Myoung Hee Park, Eun Young Song, Doyeun Oh
The Korean Journal of Hematology.2012; 47(4): 302. CrossRef

A Case of Parainfluenza Virus Related Acute Respiratory Distress Syndrome in Immune Competent Adult Patient: A Case Report: Jae Hee Lee, In Won Park, Jae Yeol Kim, Jong Wook Shin, Byoung Whui Choi, Jae Chol Choi; Korean J Crit Care Med. 2011;26(3):188-190.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.188

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Abstract PDF: ParaiParainfluenza virus is a common cause of respiratory illness among infants and young children. Although it causes severe pneumonia in immunocompromised patients, it seldom does this in immunocompetent adults. We report the case of a 51-year-old woman with no significant past medical history who presented acute respiratory distress syndrome caused by parainfluenza virus. The diagnosis was made based on reverse transcriptase-polymerase chain reaction (RT-PCR) of a respiratory specimen. The patient was successfully treated with antiviral agent combined with steroids.

A Case of Bilateral Vocal Cord Paralysis Due to Subglottic Pressure Injury after Endotracheal Intubation: A Case Report: Gyu Sik Choi, Sang Hoon Kim, Jae Hyung Lee, You Lim Kim, Ji Hyun Lee, Young Woo Jang, Eun Sun Cheong, Jong Kwan Jung, Byoung Hoon Lee; Korean J Crit Care Med. 2011;26(3):191-195.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.191

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Abstract PDF: Bilateral vocal cord paralysis may occur as a result of mechanical injury during neck surgery, nerve compression by endotracheal intubation or mass, trauma, and neuromuscular diseases. However, only a few cases of bilateral vocal cord paralysis have occurred following short-term endotracheal intubation. We report a case of bilateral vocal cord paralysis subsequent to extubation after endotracheal intubation and mechanical ventilation due to severe pneumonia for 2 days.

Successful Recovery after Drowning by Early Prone Ventilatory Positioning and Use of Nitric Oxide Gas: A Case Report: Joo Myung Lee, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2011;26(3):196-199.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.196

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Abstract PDF: Drowning is the third leading cause of unintentional accidental death globally. The most serious pathophysiologic consequence of drowning is hypoxemia from acute respiratory distress syndrome. Herein, we report a drowning victim who presented with hypothermia and cardiac arrest, followed by acute respiratory distress syndrome, rhabdomyolysis (with acute kidney injury), and disseminated intravascular coagulopathy. Aided by advanced cardiac life support and mechanical ventilation in a prone position, the patient fully recovered after two days of hospitalization. Recovery was largely attributed to early prone ventilatory positioning and use of nitric oxide gas.

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