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Volume 28 (1); February 2013
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Review Articles
Intensivist Physician Staffing in Intensive Care Units
Sunghoon Park, Gee Young Suh
Korean J Crit Care Med. 2013;28(1):1-9.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.1
  • 3,546 View
  • 80 Download
  • 2 Crossref
AbstractAbstract PDF
Despite a shortage of intensivists, there is an increased need for intensivist staffing in intensive care units (ICUs). Western studies showed that the survival rate of critically ill patients improved and the length of ICU stay decreased in "closed" or "high-intensity" ICU, where intensivists dedicated themselves to the ICU and were primary physicians. This system was also associated with an increased compliance of evidence-based medicine and a decreased medical error. The Leapfrog Group and American College of Critical Care Medicine recommend the implementation of intensivist staffing system in the ICU. Although there are still barriers to implement this system, such as the economic burden to hospitals and conflicts among medical staff, intensivist staffing in the ICU is important in terms of timely diagnosis and treatment and multidisciplinary team approach. The presence of intensivists may also increase the efficacy of ICU systems and save treatment cost. Although the "24 hours/7 days intensivist staffing" system may be ideal, recent data showed that high-intensity ICU system during daytime is not inferior to 24-hour intensivist staffing system in terms of hospital mortality. It is especially important to large-scale academic hospitals, where many severely ill patients are treated. However, few ICUs have intensivists who are committed to caring for ICU patients in Korea. Therefore, we have to try to expand this system throughout the whole country. Additionally, the definition of ICU standard, the role of intensivists, and the policy of financial reward also need to be clarified more clearly.

Citations

Citations to this article as recorded by  
  • Effects of the presence of a pediatric intensivist on treatment in the pediatric intensive care unit
    Jung Eun Kwon, Da Eun Roh, Yeo Hyang Kim
    Acute and Critical Care.2020; 35(2): 87.     CrossRef
  • Intensivist as a Surgeon: The Role of a Surgeon in Critical Care Medicine
    Kyung Sook Hong
    The Ewha Medical Journal.2017; 40(2): 61.     CrossRef
New Definition of Acute Respiratory Distress Syndrome
Je Hyeong Kim
Korean J Crit Care Med. 2013;28(1):10-16.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.10
  • 4,072 View
  • 191 Download
  • 4 Crossref
AbstractAbstract PDF
Acute respiratory distress syndrome (ARDS) is a common disorder associated with significant mortality and morbidity. The American-European Consensus Conference (AECC) definition of ARDS, established in 1994, has advanced the knowledge of ARDS by allowing the acquisition of clinical and epidemiological data, which in turn have led to improvements in care for patients with ARDS. However, after 18 years of applied research, a number of issues regarding various criteria of AECC definition have emerged. For these reason, and because all disease definitions should be reviewed periodically, the European Society of Intensive Care Medicine convened an international expert panel to revise the ARDS definition from September 30 to October 2, 2011, Berlin, Germany, with endorsement from American Thoracic Society and the Society of Critical Care Medicine. This consensus discussion, following empirical evaluation and consensus revision, addressed some of the limitations of the AECC definition by incorporating current data, physiologic concepts, and clinical trials to develop a new definition of ARDS (Berlin definition). The Berlin definition should facilitate case recognition and better match treatment options to severity in both the research trials and clinical practice.

Citations

Citations to this article as recorded by  
  • Current status of treatment of acute respiratory failure in Korea
    Yong Jun Choi, Jae Hwa Cho
    Journal of the Korean Medical Association.2022; 65(3): 124.     CrossRef
  • The Utility of Non-Invasive Nasal Positive Pressure Ventilation for Acute Respiratory Distress Syndrome in Near Drowning Patients
    June Hyeong Kim, Kyung Hoon Sun, Yong Jin Park
    Journal of Trauma and Injury.2019; 32(3): 136.     CrossRef
  • Case Series of Transfusion-Related Acute Lung Injury in a Tertiary Hospital and a Practical Comparison with the New Diagnostic Criteria
    Kwang Seob Lee, Sinyoung Kim, Juhye Roh, Seung Jun Choi, Hyun Ok Kim
    The Korean Journal of Blood Transfusion.2019; 30(3): 219.     CrossRef
  • Application of the Berlin definition in children with acute respiratory distress syndrome
    Soo Yeon Kim, Yoon Hee Kim, In Suk Sol, Min Jung Kim, Seo Hee Yoon, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
    Allergy, Asthma & Respiratory Disease.2016; 4(4): 257.     CrossRef
Original Articles
Effect of Clinical Pharmacist Interventions on Prevention of Adverse Drug Events in Surgical Intensive Care Unit
Minkyong Kang, Ahjeong Kim, Yoonsook Cho, Hyangsook Kim, Hyesook Lee, Yong Jae Yu, Hannah Lee, Kyu Joo Park, Hee pyoung Park
Korean J Crit Care Med. 2013;28(1):17-24.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.17
  • 3,715 View
  • 96 Download
  • 4 Crossref
AbstractAbstract PDF
BACKGROUND
A pharmacist's participation in medical rounds in intensive care unit (ICU) is becoming popular nowadays. In this study, we investigated the effect of pharmacologic intervention by a pharmacist's participation in medical round in ICU on prevention of adverse drug events (ADEs).
METHODS
From March 2011 to July 2011, the intervention data were obtained by participating in medical round two or three times a week, and by reviewing electronic medical records of patients admitted to surgical ICU. The incidence, cause, and type of ADEs were noted, respectively. Expected cost avoidance was calculated from interventions, which were considered to be preventive of ADEs. The acceptance rate of pharmacologic interventions was noted.
RESULTS
Among 2781 patients, a total of 159 intervention data were collected in 90 patients. Recommendation for drug dosage adjustment or monitoring in patients with potential overdose and sub-therapeutic dose made up 82% of the total interventions. In 8% of interventions, initiation of drug therapy was recommended. 83% of the interventions were accepted and the acceptance rate of interventions within 24 hrs was 58%. The rate of the interventions, which were considered to be preventive of ADEs was 62%. Expected cost reduction obtained by preventing ADEs was 25,867,083 Won during a 5-month period.
CONCLUSIONS
A pharmacist's participation in physician rounds in ICU was associated with prevention of ADEs and subsequent reduction of the cost in drug therapy.

Citations

Citations to this article as recorded by  
  • What is impacting clinical pharmacists’ participation in an interprofessional ward round: a thematic analysis of a national survey
    Dona Babu, Sally Marotti, Debra Rowett, Renly Lim, Alice Wisdom, Lisa Kalisch Ellett
    Journal of Interprofessional Care.2024; 38(3): 444.     CrossRef
  • A Systematic Review of Outcomes Research in the Hospital Pharmacists’ Interventions in South Korea
    So Young Lee, Eun Cho
    Korean Journal of Clinical Pharmacy.2019; 29(3): 193.     CrossRef
  • Effects of Medication Reconciliation and Cost Avoidance Analysis by Clinical Pharmacists in a Neurocritical Care Unit
    Ui Sang Cho, Young Joo Song, Young Mi Jung, Kyung Suk Choi, Eunsook Lee, Euni Lee, Moon-Ku Han
    Journal of Neurocritical Care.2018; 11(2): 110.     CrossRef
  • Pharmacotherapeutic Problems and Pharmacist Interventions in a Medical Intensive Care Unit
    Tae Yun Park, Sang-Min Lee, Sung Eun Kim, Ka-Eun Yoo, Go Wun Choi, Yun Hee Jo, Yoonsook Cho, Hyeon Joo Hahn, Jinwoo Lee, A Jeong Kim
    The Korean Journal of Critical Care Medicine.2015; 30(2): 82.     CrossRef
Implementation of Therapeutic Hypothermia after Pediatric Out-of Hospital Cardiac Arrest in One Tertiary Emergency Center
Woo Jin Kim, Jin Joo Kim, Jae Ho Jang, Sung Youl Hyun, Hyuk Jun Yang, Gun Lee
Korean J Crit Care Med. 2013;28(1):25-32.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.25
  • 3,084 View
  • 36 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Cardiac arrest in infants and children is rare than adults yet, it is critical. The efficacy and feasibility of therapeutic hypothermia after cardiac arrest in adults is proved through many studies however, there are few data on pediatric out-of hospital cardiac arrest. We analyzed several variables in pediatric therapeutic hypothermia after out-of hospital cardiac arrest.
METHODS
Infants and children (1 to 17 years old), who were admitted to our emergency intensive care units following the return of spontaneous circulation after out-of hospital cardiac arrest from Jan 2008 to Apr 2012, were included in this study. Basal patients' characteristics and variables about therapeutic hypothermia were analyzed.
RESULTS
A total of seventy-six patients visited our emergency center after a pediatric cardiac arrest during the study period. Among this, sixty-three patients received pediatric advanced life support, twenty one patients were admitted to intensive care units and nine patients received therapeutic hypothermia. Overall, the survival discharge was 7.9% (5 of 63). Among the admitted patients, 3 patients (14.3%) had a good Cerebral Performance Category (CPC). Two patients received endovascular cooling and seven patients received surface cooling. The mean time from the induction of therapeutic hypothermia to reaching the temperature with in the therapeutic range was 193.9 minutes. There were no critical adverse events during induction, maintenance and the rewarming period of therapeutic hypothermia.
CONCLUSIONS
Therapeutic hypothermia after pediatric out-of hospital cardiac arrest was performed safely and effectively in one emergency center. The standardized pediatric therapeutic hypothermia protocol should be established in order to be used widely in pediatric intensive care units. Further, larger studies are needed on the subject of pediatric therapeutic hypothermia.

Citations

Citations to this article as recorded by  
  • Epidemiological and Survival Trends of Pediatric Cardiac Arrests in Emergency Departments in Korea: A Cross-sectional, Nationwide Report
    Jae Yun Ahn, Mi Jin Lee, Hyun Kim, Han Deok Yoon, Hye Young Jang
    Journal of Korean Medical Science.2015; 30(9): 1354.     CrossRef
Blood Gases during Cardiopulmonary Resuscitation in Predicting Arrest Cause between Primary Cardiac Arrest and Asphyxial Arrest
Sei Jong Bae, Byung Kook Lee, Ki Tae Kim, Kyung Woon Jeung, Hyoung Youn Lee, Yong Hun Jung, Geo Sung Lee, Sun Pyo Kim, Seung Joon Lee
Korean J Crit Care Med. 2013;28(1):33-40.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.33
  • 2,655 View
  • 23 Download
AbstractAbstract PDF
BACKGROUND
If acid-base status and electrolytes on blood gases during cardiopulmonary resuscitation (CPR) differ between the arrest causes, this difference may aid in differentiating the arrest cause. We sought to assess the ability of blood gases during CPR to predict the arrest cause between primary cardiac arrest and asphyxial arrest.
METHODS
A retrospective study was conducted on adult out-of-hospital cardiac arrest patients for whom blood gas analysis was performed during CPR on emergency department arrival. Patients were divided into two groups according to the arrest cause: a primary cardiac arrest group and an asphyxial arrest group. Acid-base status and electrolytes during CPR were compared between the two groups.
RESULTS
Presumed arterial samples showed higher potassium in the asphyxial arrest group (p < 0.001). On the other hand, presumed venous samples showed higher potassium (p = 0.001) and PCO2 (p < 0.001) and lower pH (p = 0.008) and oxygen saturation (p = 0.01) in the asphyxial arrest group. Multiple logistic regression analyses revealed that arterial potassium (OR 5.207, 95% CI 1.430-18.964, p = 0.012) and venous PCO2 (OR 1.049, 95% CI 1.021-1.078, p < 0.001) were independent predictors of asphyxial arrest. Receiver operating characteristic curve analyses indicated an optimal cut-off value for arterial potassium of 6.1 mEq/L (sensitivity 100% and specificity 86.4%) and for venous PCO2 of 70.9 mmHg (sensitivity 84.6% and specificity 65.9%).
CONCLUSIONS
The present study indicates that blood gases during CPR can be used to predict the arrest cause. These findings should be confirmed through further studies.
Case Reports
Endocarditis Caused by Community-Acquired Klebsiella pneumoniae Infection - A Case Report -
Ji Ae Hwang, Charles Her, Yang Wook Kim
Korean J Crit Care Med. 2013;28(1):41-45.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.41
  • 3,288 View
  • 1,225 Download
  • 3 Crossref
AbstractAbstract PDF
In community-acquired Klebsiella pneumoniae infection, pyogenic liver abscess is common as a primary site of infection, particularly in Asia, that can progress to bacteremia. Diabetes mellitus is a usual predisposing factor. Pneumonia as primary site of infection by community-acquired Klebsiella pneumoniae infection is not common but carries a poor outcome. Early administration of appropriate antibiotics is extremely important to avoid the development of bacteremia and septicemia. An infective endocarditis caused by community-acquired Klebsiella pneumoniae infection is very rare; particularly, such a case of endocarditis in which pneumonia was the primary site of infection has never been reported previously. In this report we described a case of community-acquired Klebsiella pneumoniae infection that started with pneumonia and progressed to bacteremia, leading to endocarditis, liver abscess, and other systemic septic complications. Delayed administration of appropriate antibiotics may have played a role in this case.

Citations

Citations to this article as recorded by  
  • Double trouble: an unusual case of Klebsiella pneumoniae invasive syndrome with liver abscess, gallbladder empyema and infective endocarditis
    Ze Chen Lee, Chu Ee Seow, Petrick Periyasamy
    BMC Infectious Diseases.2024;[Epub]     CrossRef
  • Infective endocarditis caused by Klebsiella pneumoniae in a patient with non ST elevation myocardial infarction
    M.Yu. Zhilinskiy, N.V. Mukhina, I.S. Komarova, S.A. Rachina, N.A. Cherkasova, A.B. Borisov, L.V. Fedina, S.M. Nasrulloeva
    Clinical Microbiology and Antimicrobial Chemotherapy.2023; 25(1): 100.     CrossRef
  • Infective endocarditis byKlebsiellaspecies: a systematic review
    Petros Ioannou, Eugenia Miliara, Stella Baliou, Diamantis P. Kofteridis
    Journal of Chemotherapy.2021; 33(6): 365.     CrossRef
Severe Hypernatremia with Craniopharyngioma - A Case Report -
Jun Bum Park, Se Hun Park, Eun Hui Seo, Hyun Seok Park, Jin Kyu Jeong
Korean J Crit Care Med. 2013;28(1):46-50.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.46
  • 4,294 View
  • 132 Download
AbstractAbstract PDF
Hypernatremia, defined as a rise in the serum sodium concentration to a value exceeding 145 mM/L, is a common electrolyte disorder. Diabetes insipidus is a common cause of hypernatremia, caused by impaired production or reduced responses to vasopressin. The resultant morbidity may be inconsequential, serious, or even life-threatening. However, hypernatremia rarely occurs during anesthesia and surgery. A 45-year-old female patient with craniopharyngioma was scheduled for tumor resection. Hypernatremia (serum sodium, 170 mM/L) occurred suddenly at the end of the surgery. To treat hypernatremia, 0.45% normal saline was used. Although serum sodium concentration was reduced faster than expected, the patient did not have any complications.
A Case of Purulent Pericarditis Complicated by Klebsiella pneumoniae Sepsis - A Case Report -
Byeong Ho Jeong, Seungmin Chung, Hee Jin Kwon, Kyeongman Jeon
Korean J Crit Care Med. 2013;28(1):51-55.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.51
  • 3,020 View
  • 39 Download
AbstractAbstract PDF
Although the incidence of purulent pericarditis has decreased significantly in the modern antibiotic era, purulent pericarditis remains a life-threatening disease. Therefore, a high index of clinical suspicion should be maintained to diagnose this life-threatening illness at an early stage. We report an extraordinary case of purulent pericarditis, caused by Klebsiella pneumoniae bacteremia, which developed during the recovery of septic shock with urinary tract infection. Despite of early diagnosis and pericardial drainage, in addition to adequate antibiotics, the patient subsequently developed multiple organ failure leading to death. The case highlights that purulent pericarditis is a rare yet possible disorder complicated from septic shock with bacteremia in the antibiotic era. Therefore, purulent pericarditis should always be considered as a possible complication, especially in patients with K. pneumoniae bacteremia and progressive cardiomegaly.
Rhabdomyolysis Induced by Microembolism with Intra-Aortic Balloon Pump (IABP) Use in a Patient after Coronary Artery Bypass Graft (CABG) - A Case Report -
Sun Kyung Min, Eun Gu Hwang, Yong In L Kim
Korean J Crit Care Med. 2013;28(1):56-58.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.56
  • 2,772 View
  • 26 Download
AbstractAbstract PDF
A fifty seven-year-old man visited the outpatient department with chest pain and claudication. Coronary angiogram showed coronary artery diseases (3-vessel diseases) and CABG was planned. However, lower extremity angiogram showed stenosis of both common iliac arteries and stent implantation of both iliac arteries were done before CABG. He underwent CABG and IABP was inserted for weaning from cardiopulmonary bypass. After CABG, ischemic change on ends of feet was noted with red-brown colored urine and hyperkalemia. Blood myoglobin level was over 3,000 ng/ml. Microembolism of his lower body was revealed by multiple uptakes on the whole body bone scan study. After management by massive hydration and alkalization of urine with sodium bicarbonate, he was recovered without renal replacement therapy and discharged in good condition.
Management of Upper Extremity Deep Vein Thrombosis with a Superior Vena Cava Filter - A Case Report -
Wooil Kwon, Ho Geol Ryu, Hannah Lee, Yongjae Yoo
Korean J Crit Care Med. 2013;28(1):59-63.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.59
  • 2,743 View
  • 26 Download
AbstractAbstract PDF
Upper extremity deep vein thrombosis (UEDVT) is relatively uncommon and superior vena cava (SVC) filter placements are not often encountered due to strict indication. A 33-year old male with underlying protein C/S deficiency and secondary liver cirrhosis was admitted because of hematemesis. The patient was conservatively managed, but underwent elective splenectomy to prevent aggravation of gastric varix. During postoperative care, the patient underwent cholecystectomy for acalculous cholecystitis. During the postoperative course, UEDVT was detected and heparinization was initiated. The patient experienced repeated attacks of severe dyspnea, which was accompanied by chest pain that lasted for 3 to 10 minutes. Repeated episodes of pulmonary thromboembolism were suspected and SVC filter was placed. Warfarin treatment was initiated and the SVC filter was removed about one month later. The case highlights the clinical significance of UEDVT and reports rare case of SVC filter placement. Intensivists should have comprehensive understanding of UEDVT and its management.
Hypertensive Crisis during Removal of Retroperitoneal Mass in a Patient with Undiagnosed Paraganglioma - A Case Report -
Hee Young Kim, Joo Yun Kim, Hae Kyu Kim, Seung Hoon Baek
Korean J Crit Care Med. 2013;28(1):64-66.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.64
  • 2,879 View
  • 37 Download
AbstractAbstract PDF
Paragangliomas have been reported on multiple locations. A diagnosis of a catecholamine-secreting tumor was considered only after induction of anesthesia, when BP (blood pressure) increased. A 61-year-old male patient was referred for removal of a retroperitoneal mass suspected hemangiopericytoma. He was on medications for hypertension. There was a surge of ABP (arterial blood pressure) to 186/117 mmHg when the tumor was manipulated at the beginning of the surgery, and this was treated by bolus of diltiazem. After resection of the tumor, ABP dropped to 57/36 mmHg. In order to improve the patient's hemodynamic parameters, crystalloid fluid was given, and ephedrine was administered intravenously. Persistent hypotension was treated with titrated vasopressors (epinephrine and norepinephrine). When paraganglioma is suspected due to a sudden hypertensive crisis during surgery, the surgeon must decide whether to proceed with the surgical procedure or to stop and restart the surgery after proper management of the crisis.
Airway Obstruction and Respiratory Failure Due to Aspergillus Tracheobronchitis
Yousang Ko, So Yeon Lim, Gee Young Suh, Kyeongman Jeon, Seo Goo Han
Korean J Crit Care Med. 2013;28(1):67-71.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.67
  • 3,041 View
  • 38 Download
  • 1 Crossref
AbstractAbstract PDF
Invasive aspergillosis is a serious threat and a leading cause of death in immunocompromised patients. Aspergillus tracheobronchitis is an infrequent but severe form of invasive pulmonary aspergillos in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We report an extraordinary case of acute airway obstruction and respiratory failure due to Aspergillus tracheobronchitis in an immunocompromised patient. Fiberoptic bronchoscopy revealed extensive obstruction of both the main and lobar bronchus with yellowish nodules strongly adhered to the bronchial wall; both histologic examination and culture of these nodules revealed Aspergillus fumigatus. Even with early detection of an intraluminal growth of Aspergillus and prompt institution of antifungal therapy, the patient died of refractory hypoxemia a few days later. This report shows that Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis.

Citations

Citations to this article as recorded by  
  • Death due to Aspergillus Tracheobronchitis: An Autopsy Case
    Tack Kune You, Byung Ha Choi, Bong Woo Lee, Young Shik Choi
    Korean Journal of Legal Medicine.2018; 42(4): 164.     CrossRef

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