Acute and Critical Care

Volume 27 (2); May 2012

Original Articles

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

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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

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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

Comparison of the Pattern in Semi-Quantitative Sputum Cultures Based on Different Endotracheal Suction Techniques: Jiwoong Oh, Kum Whang, Hyenho Jung, Jongtaek Park; Korean J Crit Care Med. 2012;27(2):70-74.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.70

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Abstract PDF

BACKGROUND
The endotracheal suction was one of the critical requirements for severe neurosurgical patients in the prevention of the airway-obstruction, pneumonia, atelectasis, and so on. There were two types of suction methods, closed and open. In the literature, many reported the comparison of the two methods with variable factors, yet, it was still controversial. In this study, we compared the two types of endotracheal suction methods based on the pattern of the sputum cultivation, which was not discussed in the previous studies.
METHODS
In 2010, 85 patients who had intubation tube for more than 10 days were evaluated in this study. A total of 55 patients were managed with an open suction method, while the other 30 patients were managed with a closed suction method. All patients' sputum culture was reported semi-quantitatively, and had been classified into 3 different groups, according to the culture pattern. The control group was defined in which the bacterial count was not increased, whereas the non-control group was those with bacterial count increased. We investigated patients' age, gender, disease-type, suction techniques and the pattern of sputum cultivation.
RESULTS
The non-control group was 45.45% in the open suction group, while it was 16.67% in the closed suction group. On the other hand, more control group was observed in the closed suction group (36.67%), than in the open suction group (25.45%) (p < 0.05). There was no statistically significant difference in the analysis based on the pattern of sputum cultivation, age, gender, and disease-type.
CONCLUSIONS
We suggest that the closed suction methods were more effective in the management of endotracheal tube, according to the pattern of sputum culture.

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A Closed-Suction Catheter with a Pressure Valve Can Reduce Tracheal Mucosal Injury in Intubated Patients
Jin-Heon Jeong, Sung-Jin Nam, Young-Jae Cho, Yeon Joo Lee, Se Joong Kim, In-Ae Song, Sang-Heon Park, Young-Tae Jeon
Korean Journal of Critical Care Medicine.2014; 29(1): 7. CrossRef

Assessment and Training of Teamwork and Leadership for Critical Care Nurses: A Pilot Study: Hyun Jin Kim, Sang Mo Je, Hyun Soo Chung, Sung Phil Chung, Hahn Shick Lee; Korean J Crit Care Med. 2012;27(2):75-81.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.75

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Abstract PDF: BACKGROUND
Teamwork and leadership training have been shown to improve subsequent resuscitation performance in a variety of clinical situations. Critical care nurses, in addition to those who may be part of resuscitation team leaders and members, have also the need for such training. This study examines the teamwork and leadership skills of critical care nurses and their perceptions of the need for teamwork and leadership training.
METHODS
We developed a pilot, interactive 3-hour teamwork, and the leadership training program based on the objectives and teaching methods of the Advanced Life Support (ACLS) course. Participants completed a 1-hour lecture, and discussion for team roles and obstacles, 30 min of script-based role play in resuscitation team training, and finally, a 2-hour simulation-based team training program. Before the completion of the course, participants were anonymously surveyed on the perceived educational value of the teamwork and leadership program. Expert raters reviewed videos of simulated resuscitation events in the course, and scored each video by two existing checklist for the team dynamic.
RESULTS
Fifty-one nurses voluntarily participated and six videotaped simulation were rated by an expert rater. Most of the students believed the course was delivered at an appropriate level for them, and that it is a necessary training in their continuing professional education. The video rated average scores were from 68.5 to 72.9 according to the checklists.
CONCLUSIONS
Critical care nurses can learn teamwork and leadership skills from appropriately designed programs, and believe it is a necessity in their training.

Exhaled Nitric Oxide in Patients with Ventilator Associated Pneumonia: Hyun Jung Kwak, Sang Heon Kim, Tae Hyung Kim, Ho Joo Yoon, Dong Ho Shin, Sung Soo Park, Jang Won Sohn; Korean J Crit Care Med. 2012;27(2):82-88.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.82

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Abstract PDF

BACKGROUND
Fraction of exhaled nitric oxide (FENO) is known as a marker of inflammation in asthma, cystic fibrosis and exacerbation of COPD. However, its importance has not been established in patients using mechanical ventilation. We assessed whether FENO is elevated in patients with ventilator associated pneumonia (VAP), and physiologic or pathologic factors affecting levels of FENO in patients with mechanical ventilation.
METHODS
All patients (over 18-year-old) using mechanical ventilation were included, and among them, VAP patients were diagnosed on the basis of clinical pulmonary infection score (CPIS). We measured FENO in air collected during the end-expiratory pause via an off-line method. We compared the levels of FENO between patients with VAP and without, and assessed the relationship between FENO and other physiologic or pathologic characteristics; age, gender, PaO2, oxygenation index, CPIS.
RESULTS
A total of 43 patients (23 male, mean age 67.7 +/- 10.7) in an ICU were enrolled; 19 of them were VAP-patients (10 male, mean age 64.8 +/- 12.9). The level of FENO in the VAP-patients was substantially higher than in the non-VAP group (55.8 +/- 25.3 ppb Vs. 31.8 +/- 13.5 ppb, p < 0.001). CPIS on day 1 and day 3, and duration of mechanical ventilation, were associated with the level of FENO, but oxygenation index, PaO2, PaO2/FiO2, and the mean PEEP were not.
CONCLUSIONS
FENO may be useful for the diagnosis of VAP, and is related to CPIS, as well as the duration of mechanical ventilation.

Citations

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Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study
Andreas Kofoed, Mathias Hindborg, Jeppe Hjembæk-Brandt, Christian Dalby Sørensen, Mette Kolpen, Morten H Bestle
Journal of Breath Research.2023; 17(4): 046014. CrossRef
Clinical Application of Exhaled Nitric Oxide Measurements in a Korean Population
Woo-Jung Song, Ji-Won Kwon, Eun-Jin Kim, Sang-Min Lee, Sae-Hoon Kim, So-Yeon Lee, Sang-Heon Kim, Heung-Woo Park, Yoon-Seok Chang, Woo Kyung Kim, Jung Yeon Shim, Ju-Hee Seo, Byoung-Ju Kim, Hyo Bin Kim, Dae Jin Song, Gwang Cheon Jang, An-Soo Jang, Jung-Won
Allergy, Asthma & Immunology Research.2015; 7(1): 3. CrossRef
Exhaled breath analysis in the differentiation of pneumonia from acute pulmonary oedema
Silvie Prazakova, Nadine Elias, Paul S Thomas, Deborah H Yates
Pulmonology and Respiratory Research.2015; 3(1): 3. CrossRef

Clinical Feature and Prognostic Factors of Emphysematous Pyelonephritis: Won Soek Yang, Won Young Kim, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2012;27(2):89-93.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.89

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Abstract PDF

BACKGROUND
Emphysematous pyelonephritis (EPN) is a rare and potentially life-threatening condition that requires prompt evaluation and management. However, its clinical presentation and outcomes vary widely. This study was conducted to ascertain the clinical features and prognostic factors regarding EPN.
METHODS
All patients diagnosed with EPN radiologically and treated at the emergency department in the university-affiliated, tertiary-referral center, from January 1999 to December 2009 were evaluated. The patients' demographic and clinical characteristics, computed tomographic findings, treatment, and outcomes were analyzed retrospectively.
RESULTS
Overall 14 patients diagnosed with EPN were admitted. There were 12 females and 2 males. A history of diabetes was found in 12 (85.7%) patients and was the most common comorbidity. The chief complaint among patients was flank pain (42.9%). Severe sepsis or septic shock was noted in 10 (71.4%) patients. Thirteen cases had unilateral involvement and one case had bilateral involvement. More than half of patients had Escherichia.coli in culture. Mean serum levels of HbA1c, creatinine, C-reactive protein (CRP) were 9.4 +/- 2.7, 2.4 +/- 1.4 mg/dl, and 22.4 +/- 13.1 mg/dl. Eight (57.1%) patients received antibiotic treatment alone and four (28.6%) patients received the concurrent percutaneous drainage as well as antibiotics. Hospital mortality was 7.1%. A higher initial serum CRP level (20.3 vs. 49.8 mg/dl, p = 0.02) and HbA1c level (8.7 vs. 16.4, p = 0.01) was associated with hospital mortality.
CONCLUSIONS
Antibiotics alone provide a high success rate for the treatment of EPN. Higher serum CRP and HbA1c level was associated with a higher mortality rate in patients with EPN.

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Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock
Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim
Korean Journal of Critical Care Medicine.2013; 28(4): 272. CrossRef

Clinical Characteristics and Prognosis of Patients with Intracranial Hemorrhage during Mechanical Ventilation: Go Woon Kim, Jin Won Huh, Younsuck Koh, Chae Man Lim, Sang Bum Hong; Korean J Crit Care Med. 2012;27(2):94-101.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.94

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Abstract PDF: BACKGROUND
Intracranial hemorrhage is a serious disease associated with high mortality and morbidity, and develops suddenly without warning. Although there were known risk factors, it is difficult to prevent brain hemorrhage from critically ill patients in the intensive care unit (ICU). There are several reports that brain hemorrhage, in critically ill patients, occurred in connection with respiratory diseases. The aim of our study is to describe the baseline characteristics and prognosis of patients with intracranial hemorrhage during mechanical ventilation in the ICU.
METHODS
We retrospectively reviewed the medical records of 56 patients, who developed intracranial hemorrhage in a medical ICU, from May 2008 to December 2011. During the mechanical ventilation in the ICU, patients were implemented with a weaning process, following ACCP (American College of Chest Physicians) criteria. Also, we compared patients with brain hemorrhage to those without brain hemorrhage.
RESULTS
Thirty two of the 56 patients (57.1%) were male, and median ages were 63 (17-90) years. The common type of brain hemorrhage confirmed was intracerebral hemorrhage/intraventricular hemorrhage (52.2%). The duration from mechanical ventilation to brain hemorrhage was 6 (0-58) days. Overall hospital mortality was 57.1%, and ICU mortality was 44.6%. The most common cause of death was brain hemorrhage (40.6%). In comparison to patients without brain hemorrhage, study patients showed less use of anticoagulants and lower ventilator pressure. Our study showed that the use of vasopressor, systolic blood pressure, peak airway pressure, and platelet count were associated with brain hemorrhage.
CONCLUSIONS
Intracranial hemorrhage showed high mortality in critically ill patients with mechanical ventilation. In the future, large case-control study will be needed to evaluate the risk factors of cerebral hemorrhage.

Effects of APACHE II Score and Initial Nutritional Status on Prognosis of the Critically Ill Patients: Seohui Ahn, Se Hee Na, Chul Ho Chang, Hyunsun Lim, Duk Chul Lee, Cheung Soo Shin; Korean J Crit Care Med. 2012;27(2):102-107.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.102

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Abstract PDF

BACKGROUND
Malnutrition is common in hospitalized patients, especially in critically ill patients and affects their mortality and morbidity. However, the correlation between malnutrition and poor outcome is not fully understood. Our hypothesis is that the nutritional effect on the patient's prognosis would differ depending on the severity of the disease.
METHODS
3,758 patients admitted to the intensive care unit (ICU) were observed retrospectively. Patients were divided into well, moderate and severe groups, according to their nutritional status as assessed by their serum albumin level and total lymphocyte count (TLC). The severity of the disease was assessed by the Acute Physiologic and Chronic Health Evaluation (APACHE II score). All patients were followed clinically until discharge or death and ICU days, hospital days, ventilator days, and mortality rates were recorded.
RESULTS
Depending on the definition used, the prevalence of hospital malnutrition is reported to be 68.3%. Hospital days, ICU days, as well as ventilator days of moderate and severe groups were longer than the well group. In patients exhibiting mild severity of disease, moderate and severe malnutrition groups have 3-5 times the mortality rate than the well group.
CONCLUSIONS
Malnutrition affects the prognosis of patients who have an APACHE II score ranging from 4-29 points. Active nutritional support may be more effective for patients with a disease of mild severity.

Citations

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Effects of a video-based enteral nutrition education program using QR codes for intensive care unit nurses: a quasi-experimental study
Won Kee Seo, Hyunjung Kim
Journal of Korean Biological Nursing Science.2024; 26(1): 16. CrossRef
The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
Journal of Nutrition and Health.2015; 48(3): 211. CrossRef
Comparison of nutritional status indicators according to feeding methods in patients with acute stroke
Sanghee Kim, Youngsoon Byeon
Nutritional Neuroscience.2014; 17(3): 138. CrossRef
Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis
Seung Hwan Lee, Ji Young Jang, Jae Gil Lee
Korean Journal of Critical Care Medicine.2013; 28(4): 247. CrossRef
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

Case Reports

A Case of iLA Application in a Patient with Refractory Asthma Who Is Nonresponsive to Conventional Mechanical Ventilation: A Case Report: Young Seok Lee, Hyejin Joo, Jae Young Moon, Jin Won Huh, Yeon Mok Oh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2012;27(2):108-110.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.108

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Abstract PDF

Refractory asthma with hypercapnia is a near-fatal disease. Pumpless Extracorporeal Interventional Lung Assist (iLA) may be considered as an alternative therapy for the disease as it removes the carbon dioxide effectively. Nevertheless, clinical outcome studies regarding iLA in patients suffering from refractory asthma have rarely been applied. Here, we reported our experience with iLA for the treatment of refractory asthma with hypercapnia. In our case, the patient had refractory asthma which was not controlled with medical treatment or mechanical ventilation. We applied iLA since hypercapnia was not resolved despite mechanical ventilation. After iLA implantation effectively reduced the carbon dioxide, the clinical condition of our patient improved. In conclusion, iLA is a useful tool for patient suffering from refractory asthma with hypercapnia.

Citations

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Interventional lung assist and extracorporeal membrane oxygenation in a patient with near-fatal asthma
Seok Jeong Lee, Yong Sung Cha, Chun Sung Byun, Sang-Ha Kim, Myoung Kyu Lee, Suk Joong Yong, Won-Yeon Lee
The American Journal of Emergency Medicine.2017; 35(2): 374.e3. CrossRef
Pumpless extracorporeal interventional lung assist for bronchiolitis obliterans after allogenic peripheral blood stem cell transplantation for acute lymphocytic leukemia
Yeon-Hee Park, Chae-Uk Chung, Jae-Woo Choi, Sang-Ok Jung, Sung-Soo Jung, Jeong-Eun Lee, Ju-Ock Kim, Jae-Young Moon
Yeungnam University Journal of Medicine.2015; 32(2): 98. CrossRef

A Case of Successful Natural Stenting in Tracheobronchial Restenosis with Malignant Tumor after Metallic Stenting: Goohyeon Hong, Kyeongman Jeon, Sang Won Um, Won Jung Koh, Gee Young Suh, Man Pyo Chung, O Jung Kwon, Hojoong Kim; Korean J Crit Care Med. 2012;27(2):111-114.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.111

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Abstract PDF: Tracheal tumors are very rare disease, which may cause dyspnea, obstructive pneumonia and life-threatening hypoxemia, depending on the site of the lesion and the severity of the narrowing. Such patients frequently die within hours or days due to suffocation. Patients who expressed upper airway stenosis, should be secured the airways prior to the diagnosis and treatment commonly. Then, treatment plan should be determined. For the relief of such stenosis, various modalities of therapy including surgery, laser photoresection, balloon dilatation and sometimes stent insertion have been used. Tracheobronchial stent insertion has been a good therapeutic option in these patients in point of avoiding morbidities associated with surgery. We report a case of repeated tracheobronchial stenosis by infiltrating tumor mass after metallic stent insertion in a 48-year-old man. The patient was treated successfully by Natural stent insertion with rigid bronchoscopy after removal of previous inserted metallic stent.

Massive Diffuse Alveolar Hemorrhage Caused by the Aspiration of Gastric Contents during Induction of Anesthesia in Patients with Adhesive Ileus: A Case Report: Ji Seon Jeong, Jong Hun Jun, Hyo Jin Song, Hee Koo Yoo; Korean J Crit Care Med. 2012;27(2):115-119.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.115

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Abstract PDF: Aspiration pneumonitis is best defined as an acute lung injury, following the aspiration of regurgitated gastric contents. Major cause of pulmonary aspiration, during anesthesia, is gastric contents. Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome (ARDS). However, there was no report of massive alveolar hemorrhage associated with aspiration pneumonitis. A 63-year-old man, who had undergone a total gastrectomy and received adjuvant chemotherapy, four months ago, was scheduled for adhesiolysis of the small bowel. The patient occurred aspiration of gastric contents, during induction of anesthesia, and subsequently, hypoxia developed during surgery. The patient moved to an intensive care unit (ICU), without extubation. Mechanical ventilation with PEEP was performed in an ICU. However, the patient died by ARDS and massive alveolar hemorrhage.

A Case of Pumpless Extracorporeal Interventional Lung Assist for Severe Respiratory Failure: A Case Report: Young Jae Cho, Ji Yeon Seo, Yu Jung Kim, Jae Ho Lee, Choon Taek Lee; Korean J Crit Care Med. 2012;27(2):120-125.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.120

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Abstract PDF: Pumpless extracorporeal interventional lung assist (iLA) is a promising respiratory rescue system permitting protective lung ventilation for severe respiratory failure. Herein, we report a case of prolonged iLA support with regards to a patient exhibiting severe hypercapnic respiratory failure. A 51-year-old female patient with metastatic endometrial carcinoma developed progressive hospital-acquired pneumonia and was intubated in order to restore respiratory failure. Despite maximal mechanical ventilator care, her clinical condition deteriorated due to severe respiratory acidosis. The iLA was performed for the management of refractory hypercapnia. The total duration of iLA support was 23 days without any vascular complications, however, she could not survive because of oxygenation failure.

Delayed Anaphylactic Shock to Intravenous Cefotetan in a Pregnant Woman: A Case Report: Ah Reum Cho, Hyeon Jeong Lee, Hye Kyung Park, Young Jae Oh; Korean J Crit Care Med. 2012;27(2):126-129.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.126

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Abstract PDF

Anaphylactic reactions to agents administered intravenously usually occur within minutes. We present an unusual case of a delayed onset anaphylactic shock to intravenous cefotetan in a pregnant woman who underwent an epidural cesarean section. She sustained hypotension, tachycardia, bronchospasm, and rash 90 min after administering intravenous cefotetan. The possibilities of high epidural blocks or amnionic fluid embolisms were excluded by the height of sensory blocks or different presenting symptoms and signs, respectively. Allergic skin tests for exposed materials were performed 6 weeks after discharge and no immediate reactions occurred. However, delayed systemic allergic reactions, such as urticaria, rash, and edema on her face, neck, back, and abdomen, occurred 3 h after skin test to cefotetan.

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LC-MS/MS method for the quantitation of cefotetan in human plasma and its application to pharmacokinetic study
Meiyun Shi, Lei Yin, Lanlan Cai, Can Wang, Xidong Liu, Sen Zhao, Yantong Sun, Paul J. Fawcett, Limei Zhao, Yan Yang, Jingkai Gu
Chemical Research in Chinese Universities.2014; 30(6): 900. CrossRef

A Case of Exertional Heat Stroke with Acute Hepatic Failure Treated with Plasma Exchange: A Case Report: Young Joo Han, Jae Wook Choi, Woo Jin Chung, Dong In Suh, June Dong Park; Korean J Crit Care Med. 2012;27(2):130-133.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.130

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Abstract PDF

Heat stroke is a hyperthermia-induced systemic inflammatory response which may cause multiorgan dysfunction syndrome. We report a case of exertional heat stroke with acute hepatic failure in an 11-year-old boy. He initially presented hyperthermia and unconsciousness, which occurred after heavy exercise. His neurological state improved after terminating the hyperthermia by intensive cooling therapy. However, 24 hours after the initial recovery, his neurological state deteriorated again as acute hepatic injury progressed rapidly. We applied 4 times of total plasma exchange as an immunotherapy for systemic inflammatory response syndrome and acute hepatic failure expecting it to remove endogenous inflammatory factors and hepatotoxic cytokines. Following the plasma exchange, his mental state became normal and serial laboratory findings indicated improvement. He made a complete recovery without sequelae. We experienced successful treatment regarding exertional heat stroke with acute hepatic failure using plasma exchange.

Citations

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Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure
Vimal Master Sankar Raj, Amanda Alladin, Brent Pfeiffer, Chryso Katsoufis, Marissa Defreitas, Alicia Edwards-Richards, Jayanthi Chandar, Wacharee Seeherunvong, Gwenn McLaughlin, Gaston Zilleruelo, Carolyn L. Abitbol
Pediatric Nephrology.2013; 28(6): 971. CrossRef

Usability of Esophageal Doppler for Monitoring of Concealed Retroperitoneal Hemorrhage during Laparoscopy Assisted Subtotal Gastrectomy: Sung Ha Mun, Seung Hwan Lee, Min Young No; Korean J Crit Care Med. 2012;27(2):134-138.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.134

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Abstract PDF: Hemodynamic monitoring is an essential element in the management of perioperative patients. In addition, anesthesiologists routinely used blood pressure (invasive or non invasive), heart rate, urinary output and central venous pressure as monitoring modalities. Esophageal doppler monitoring, as a minimally invasive hemodynamic assessment tool, has a good correlation with pulmonary artery catheterization in measuring cardiac output. We experienced a case of concealed retroperitoneal hemorrhage in a patient who underwent a laparoscopic subtotal gastrectomy. When surgeons tried to close trocar sites, the patient's blood pressure dropped rapidly. At laparoscopy, we could not find gross bleeding. However, we could detect hypovolemia by esophageal doppler monitoring (CardioQ, Deltex(TM), UK). The procedure was converted to open laparotomy. Thereafter, we could find retroperitoneal hemorrhage, and vascular repair was done successfully. The patient recovered without any other complications.

Ultrasound Guided Bronchoscopic Balloon Dilatation in the Management of Tracheal Stenosis: A Case Report: Jung Min Hong, Tae Kyun Kim, Ah Reum Cho, Do Won Lee, Yun Hee Han, Jae Young Kwon; Korean J Crit Care Med. 2012;27(2):139-142.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.139

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Abstract PDF: We performed a balloon dilatation without a fluoroscopy monitoring by ultrasound. A 44 year old female patient was presented with subglottic stenosis, due to prolonged intubation. Although she had undergone tracheal resection and end-to-end anastomosis, the tracheal stenosis had recurred. She was scheduled for balloon dilatation. However, fluoroscopic guidance was not available, and thus, we used ultrasonographic monitoring as an alternative method. We performed a transverse scan, just cranial to the suprasternal notch, and we obtained a real time image of the trachea dilated by the balloon. We suggest that ultrasonographic monitoring is a useful adjunct to balloon dilatation in patients with tracheal stenosis.

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