Acute and Critical Care

Volume 29 (2); May 2014

Editorial

Pulmonary/Surgery
Is Percutaneous Dilatational Tracheostomy Safe to Perform in the Intensive Care Unit?: Jae Hwa Cho; Korean J Crit Care Med. 2014;29(2):57-58. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.57

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Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by a Neurointensivist Compared with Conventional Surgical Tracheostomy in Neurosurgery Intensive Care Unit
John Kwon, Yong Oh Kim, Jeong-Am Ryu
Journal of Neurointensive Care.2019; 2(2): 64. CrossRef

Review

Hematology
Severe Fever with Thrombocytopenia Syndrome: Seung Jin Yoo, Sang Taek Heo, Keun Hwa Lee; Korean J Crit Care Med. 2014;29(2):59-63. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.59

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Abstract PDF

Severe fever with thrombocytopenia syndrome (SFTS) is a newly emerging infectious disease, caused by a novel species of Phlebovirus of Bunyaviridae family, in China, South Korea, and Japan. SFTS is primarily known as a tick-borne disease, and human-to-human transmission is also possible in contact with infectious blood. Common clinical manifestations include fever, thrombocytopenia, and leukopenia as initial symptoms, and multiple organ dysfunction and failure manifest with disease progression. Whereas disease mortality is reported to be 12% to 30% in China, a recent report of cumulative SFTS cases indicated 47% in Korea. Risk factors associated with SFTS were age, presence of neurologic disturbance, serum enzyme levels, and elevated concentrations of certain cytokines. Diagnosis of SFTS is based on viral isolation, viral identification by polymerase chain reaction, and serologic identification of specific immunoglobulin G. Therapeutic guideline has not been formulated, but conservative management is the mainstream of treatment to prevent disease progression and fatal complications.

Citations

Citations to this article as recorded by

The first discovery of severe fever with thrombocytopenia syndrome virus in Taiwan
Tsai-Lu Lin, Shan-Chia Ou, Ken Maeda, Hiroshi Shimoda, Jacky Peng-Wen Chan, Wu-Chun Tu, Wei-Li Hsu, Chi-Chung Chou
Emerging Microbes & Infections.2020; 9(1): 148. CrossRef
Epidemiology of severe fever and thrombocytopenia syndrome virus infection and the need for therapeutics for the prevention
Norbert John C. Robles, Hae Jung Han, Su-Jin Park, Young Ki Choi
Clinical and Experimental Vaccine Research.2018; 7(1): 43. CrossRef
Two Treatment Cases of Severe Fever and Thrombocytopenia Syndrome with Oral Ribavirin and Plasma Exchange
In Park, Hye In Kim, Ki Tae Kwon
Infection & Chemotherapy.2017; 49(1): 72. CrossRef

Original Articles

Pulmonary/Surgery
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by Intensive Care Trainee: Daesang Lee, Chi Ryang Chung, Sung Bum Park, Jeong Am Ryu, Joongbum Cho, Jeong Hoon Yang, Chi Min Park, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2014;29(2):64-69. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.64

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Abstract PDF

Background
Percutaneous dilatational tracheostomy (PDT) performed by an intensivist in critically ill patients is currently popular. Many studies support the safety and feasibility of PDT. However, there is limited data on the safety and feasibility of PDT performed by intensive care trainees.
Methods
To evaluate the safety and feasibility of PDT performed by intensive care trainees and to compare these with those performed by intensivists, we retrospectively analyzed the clinical characteristics and adverse events of all prospectively registered patients who underwent PDT by ICT or intensivists in intensive care units (ICUs) from August 2010 to August 2013.
Results
In the study period, 203 patients underwent PDT in ICUs; 139 (68%) by trainees and 64 (32%) by intensivists. There were no statistically significant differences in clinical characteristics including demographics, laboratory findings, and parameters of mechanical ventilation between the two groups. Procedure times and outcomes of the patients were not different between the two groups. The majority of complications observed in 24 hours after PDT were bleeding; however, there was no significant difference between the two groups (trainee 10.8% vs. intensivist 9.4%, p = 0.758). There was no procedure-related death in the two groups.
Conclusions
PDT performed by intensive care trainees was safe and feasible. However, further well-designed studies should be conducted to confirm our results.

Citations

Citations to this article as recorded by

Comparison of Conventional Surgical Tracheostomy and Percutaneous Dilatational Tracheostomy in the Neurosurgical Intensive Care Unit
Sungdae Lim, Hyun Park, Ja Myoung Lee, Kwangho Lee, Won Heo, Soo-Hyun Hwang
Korean Journal of Neurotrauma.2022; 18(2): 246. CrossRef
Prediction of successful de-cannulation of tracheostomised patients in medical intensive care units
Chul Park, Ryoung-Eun Ko, Jinhee Jung, Soo Jin Na, Kyeongman Jeon
Respiratory Research.2021;[Epub] CrossRef
Severe pain-related adverse events of percutaneous dilatational tracheostomy performed by a neurointensivist compared with conventional surgical tracheostomy in neurocritically ill patients
Yong Oh Kim, Chi Ryang Chung, Chi-Min Park, Gee Young Suh, Jeong-Am Ryu
BMC Neurology.2020;[Epub] CrossRef
Is percutaneous dilatational tracheostomy with bronchoscopic guidance better than without?
Jinsun Chang, Hong-Joon Shin, Yong-Soo Kwon, Yu-Il Kim, Sung-Chul Lim, Tae-Ok Kim
Acute and Critical Care.2020; 35(2): 127. CrossRef
Safety and feasibility of ultrasound-guided insertion of peripherally inserted central catheter performed by an intensive care trainee
Yongwoo Lee, Jeong-Am Ryu, Yong Oh Kim, Eunmi Gil, Young-Mok Song
Journal of Neurocritical Care.2020; 13(1): 41. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by a Neurointensivist Compared with Conventional Surgical Tracheostomy in Neurosurgery Intensive Care Unit
John Kwon, Yong Oh Kim, Jeong-Am Ryu
Journal of Neurointensive Care.2019; 2(2): 64. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents
Sung-Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2014; 29(3): 183. CrossRef
Is Percutaneous Dilatational Tracheostomy Safe to Perform in the Intensive Care Unit?
Jae Hwa Cho
Korean Journal of Critical Care Medicine.2014; 29(2): 57. CrossRef

Cardiology/Neurology
Efficacy of Electroencephalographic Monitoring for the Evaluation of Intracranial Injury during Extracorporeal Membrane Oxygenation Support in Neonates and Infants: In Seok Jeong, Young Jong Woo, Do Wan Kim, Nan Yeol Kim, Hwa Jin Cho, Jae Sook Ma; Korean J Crit Care Med. 2014;29(2):70-76. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.70

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Abstract PDF

Background
Neurological complications are a serious concern during extracorporeal membrane oxygenation (ECMO) support in neonates and infants. However, evaluating brain injury during ECMO has limitations. Herein, we report our experience with bedside electroencephalographic monitoring during ECMO support and compared this to post-ECMO brain imaging studies and immediate neurologic outcomes.
Methods
We retrospectively reviewed the data for 18 children who underwent ECMO. From these subjects, we reviewed the medical records of 10 subjects who underwent bedside EEG monitoring during ECMO support. We collected data on patient demographics, clinical details of the ECMO course, electroencephalographic monitoring, brain imaging results, and neurologic outcomes.
Results
The median age was 4 months (range: 7 days-22 months), the median weight was 5 (3.6-12) kg, and the median length of ECMO therapy was 86 (27-206) hours. Eight patients (80%) were weaned successfully, and seven (70%) survived to discharge. Those with normal to mildly abnormal electroencephalographic findings had non-specific to mildly abnormal brain computed tomography findings and no neurologic impairment. Those patients with a moderately to severely abnormal electroencephalograph had markedly abnormal brain computed tomography findings and remained neurologically impaired.
Conclusions
Normal electroencephalographic findings are closely related to normal or mild neurologic impairment. Our results indicate that electroencephalographic monitoring during ECMO support can be a feasible tool for evaluating brain injury although further prospective studies are needed.

Citations

Citations to this article as recorded by

Neurological monitoring in ECMO patients: current state of practice, challenges and lessons
Hassan Aboul-Nour, Ammar Jumah, Hafsa Abdulla, Amreeta Sharma, Bradley Howell, Namita Jayaprakash, Jayna Gardner-Gray
Acta Neurologica Belgica.2023; 123(2): 341. CrossRef
Neurological Monitoring and Complications of Pediatric Extracorporeal Membrane Oxygenation Support
Ahmed S. Said, Kristin P. Guilliams, Melania M. Bembea
Pediatric Neurology.2020; 108: 31. CrossRef

Quality Improvement
Successful Implementation of a Rapid Response System in the Department of Internal Medicine: Yeon Joo Lee, Jin Joo Park, Yeonyee E Yoon, Jin Won Kim, Jong Sun Park, Taeyun Kim, Jae Hyuk Lee, Jung Won Suh, You Hwan Jo, Sangheon Park, Kyuseok Kim, Young Jae Cho; Korean J Crit Care Med. 2014;29(2):77-82. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.77

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Background
A rapid response system (RRS) aims to prevent unexpected patient death due to clinical errors and is becoming an essential part of intensive care. We examined the activity and outcomes of RRS for patients admitted to our institution’s department of internal medicine.
Methods
We retrospectively reviewed patients detected by the RRS and admitted to the medical intensive care unit (MICU) from October 2012 through August 2013. We studied the overall activity of the RRS and compared patient outcomes between those admitted via the RRS and those admitted conventionally.
Results
A total of 4,849 alert lists were generated from 2,505 medical service patients. The RRS was activated in 58 patients: A (Admit to ICU), B (Borderline intervention), C (Consultation), and D (Do not resuscitate) in 26 (44.8%), 21 (36.2%), 4 (6.9%), and 7 (12.1%) patients, respectively. Low oxygen saturation was the most common criterion for RRS activation. MICU admission via the RRS resulted in a shorter ICU stay than that via conventional admission (6.2 vs. 9.9 days, p = 0.018).
Conclusions
An RRS can be successfully implemented in medical services. ICU admission via the RRS resulted in a shorter ICU stay than that via conventional admission. Further study is required to determine long-term outcomes.

Citations

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Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
Sang Hyuk Kim, Ji Young Hong, Youlim Kim
Journal of Korean Medical Science.2021;[Epub] CrossRef
Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
Mi-Jung Yoon, Jin-Hee Park
Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef
Effect of a rapid response system on code rates and in-hospital mortality in medical wards
Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Sulhee Kim, Eunjin Yang, Hyun Joo Lee, Hannah Lee, Ho Geol Ryu, Seung-Young Oh, Eun Jin Ha, Sang-Bae Ko, Jaeyoung Cho
Acute and Critical Care.2019; 34(4): 246. CrossRef
Differences in the Clinical Characteristics of Rapid Response System Activation in Patients Admitted to Medical or Surgical Services
Yeon Joo Lee, Dong Seon Lee, Hyunju Min, Yun Young Choi, Eun Young Lee, Inae Song, Yeonyee E. Yoon, Jin Won Kim, Jong Sun Park, Young-Jae Cho, Jae Hyuk Lee, Jung-Won Suh, You Hwan, Kyuseok Kim, Sangheon Park
Journal of Korean Medical Science.2017; 32(4): 688. CrossRef

Cardiology
Inter-Hospital Transportation of Patients on Extracorporeal Life Support: A Single Center Experience: Yang Hyun Cho, Ji Hyuk Yang, Jin Ho Choi, Jeong Hoon Yang, Kyeongman Jeon, Chi Ryang Chung, Gee Young Suh; Korean J Crit Care Med. 2014;29(2):83-87. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.83

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Abstract PDF

Background
Extracorporeal life support (ECLS) is an effective life-saving tool for patients in refractory cardiac or respiratory failure. Although transportation of patients on ECLS is challenging, it is necessary in some instances. We report our initial experience of transporting patients on ECLS.
Methods
The study period was between January 2004 and August 2013. We reviewed our ECLS database and identified four patients who were transported to our institution on ECLS. We excluded patients who were not transported by our ECLS team.
Results
There were no clinically significant events during transportation. ECLS indications included acute respiratory distress syndrome in two patients, stress-induced cardiomyopathy induced by pneumonia sepsis in one patient, and cardiac arrest caused by amyloid cardiomyopathy in another patient. One patient was transported by helicopter and three patients were transported in an oversized ambulance. Three patients were successfully weaned off ECLS and discharged without significant complications.
Conclusions
Inter-hospital transport can be safely performed by an experienced ECLS team. Successful transport may improve patient outcome and the ECLS programs of both referring and referral hospitals.

Citations

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Outcomes of Urgent Interhospital Transportation for Extracorporeal Membrane Oxygenation Patients
Jun Tae Yang, Hyoung Soo Kim, Kun Il Kim, Ho Hyun Ko, Jung Hyun Lim, Hong Kyu Lee, Yong Joon Ra
Journal of Chest Surgery.2022; 55(6): 452. CrossRef
Outcomes of transported and in-house patients on extracorporeal life support: a propensity score-matching study
Heemoon Lee, Kiick Sung, Gee Young Suh, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Keumhee Chough Carriere, Joong Hyun Ahn, Yang Hyun Cho
European Journal of Cardio-Thoracic Surgery.2019;[Epub] CrossRef
Inter-Facility Transport on Extracorporeal Life Support: Clinical Outcomes and Comparative Analysis with In-house Patients
Tae Hee Hong, Heemoon Lee, Jae Jun Jung, Yang Hyun Cho, Kiick Sung, Ji-Hyuk Yang, Young-Tak Lee, Su Hyun Cho, R.N.
The Korean Journal of Thoracic and Cardiovascular Surgery.2017; 50(5): 363. CrossRef

Trauma
Mortality and Morbidity in Severely Traumatized Elderly Patients: Byungchul Yu, Min Chung, Giljae Lee, Jungnam Lee; Korean J Crit Care Med. 2014;29(2):88-92. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.88

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Background
As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe outcomes from injuries compared with the young. In this study, we examined the relationship between mortality and complications with age.
Methods
This study was a retrospective review of 256 major trauma patients (Injury Severity Score > 15) admitted to an emergency center over a two- year period. Age-dependent mortality and complications were evaluated.
Results
Of 256 patients, 209 (81.6%) were male and the mean age was 47.2 years. There was a trend between increasing age and increasing mortality, but this was not statistically significant. Increasing age was correlated with frequency of complications.
Conclusions
Age was confirmed to be an independent predictor of mortality in major trauma. We documented that elderly trauma patients suffer from complications more frequently compared with their younger counterparts. Appropriate and specific triage and management guidelines for elderly trauma patients are needed.

Citations

Citations to this article as recorded by

Predicting mortality in elderly trauma patients: a review of the current literature
Jarva Chow, Catherine M. Kuza
Current Opinion in Anaesthesiology.2022; 35(2): 160. CrossRef
Activities of Daily Living and Determinant Factors among Older Adult Subjects with Lower Body Fracture after Discharge from Hospital: A Prospective Study
Nurul Izzah Ibrahim, Mohd Sharkawi Ahmad, Mohamed S Zulfarina, Sharifah Nurul Aqilah Sayed Mohd Zaris, Isa Naina Mohamed, Norazlina Mohamed, Sabarul Afian Mokhtar, Ahmad Nazrun Shuid
International Journal of Environmental Research and Public Health.2018; 15(5): 1002. CrossRef
Geriatric Trauma Protocol
Renee Cortez
Journal of Trauma Nursing.2018; 25(4): 218. CrossRef
Predictive Factors of Dependency in Activities of Daily Living Following Limb Trauma in the Elderly
Azade Safa, Negin Masoudi Alavi, Masoumeh Abedzadeh-Kalahroudi
Trauma Monthly.2016;[Epub] CrossRef

Case Reports

Neurosurgery
Therapeutic Hypothermia after Decompressive Craniectomy in Malignant Cerebral Infarction: Jun Young Chang, Jeong Ho Hong, Jin Heon Jeong, Sung Jin Nam, Ji Hwan Jang, Jae Seung Bang, Moon Ku Han; Korean J Crit Care Med. 2014;29(2):93-98. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.93

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Abstract PDF

Decompressive hemicraniectomy followed by subsequent therapeutic hypothermia can reduce mortality in patients with malignant cerebral infarction without significantly increasing risk. We report three cases of malignant cerebral infarction treated with hemicraniectomy followed by hypothermia. Case 1 received elective decompressive surgery and hypothermia. Case 2 developed subsequent cerebral infarction with uncal herniation. Therefore, emergent decompressive surgery and hypothermia was performed in this case. Despite surgery and hyperosmolar therapy, case 3 received hypothermia treatment for refractory increased intracranial pressure. All patients survived with a score of 4 or 5 on the modified Rankin scale. Therefore, we suggest that application of hypothermia after hemicraniectomy is safe and feasible. Several possible modifications can be made to improve the management strategy in order to increase the benefits of hypothermia treatment.

Citations

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Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect
Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi
The Korean Journal of Critical Care Medicine.2015; 30(4): 272. CrossRef

Hematology/Obstetric
Acute Myeloid Leukemia in Suspected Sepsis after Caesarean Section: Myoung Hwa Kim, Sung Won Na, Shin Ok Koh, Eun Jung Kim, Hye Jin Yoon, Yong Jae Lee, Hee Young Cho; Korean J Crit Care Med. 2014;29(2):99-104. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.99

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Abstract PDF: The incidence of acute leukemia during pregnancy is extremely rare, and often it is not easy to differentiate it from other diseases associated with pregnancy such as sepsis or hemorrhage. Pregnancy itself is not known to affect the natural course of leukemia; however, complications of leukemia like anemia, infections, and coagulopathy can adversely influence both the fetus and the mother. In this case, a pregnant patient misdiagnosed with septic shock and severe leukocytosis was correctly diagnosed with acute myeloid leukemia after surgical delivery.

Infection
Incidentally Discovered Deep Neck Infection in a Septic Patient: Jin Beom Cho, Ki Young Sung; Korean J Crit Care Med. 2014;29(2):105-109. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.105

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Abstract PDF: We incidentally discovered a case of deep neck infection during the treatment of a patient who presented with complaints of decreased consciousness, abdominal distension, and electrolyte imbalance. The patient had neither clinical symptoms nor radiologic findings indicative of deep neck infection; rather, the findings indicated intra-abdominal sepsis and adrenal crisis, for which the symptomatic treatment was provided. When the expected improvement was not observed, we retrospectively reviewed the patient's test records and discovered deep neck infection. Empiric parenteral antibiotic therapy and infection source control, as appropriate for this patient, were administered within 72 hours of hospital admission, without which the condition may have proved fatal. In this report we discuss the best approach for the management of unresolved infectious disease and review the clinical features of deep neck infection.

Pulmonary
Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis: Jick Hwan Ha, Hyewon Lee, Young Jae Park, Hyeon Hui Kang, Hwa Sik Moon, Sang Haak Lee; Korean J Crit Care Med. 2014;29(2):110-113. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.110

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Abstract PDF

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.

Citations

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Obstructive Fibrinous Tracheal Pseudomembrane
Yoann Ammar, Juliette Vella-Boucaud, Claire Launois, Hervé Vallerand, Sandra Dury, François Lebargy, Gaëtan Deslee, Jeanne-Marie Perotin
Anesthesia & Analgesia.2017; 125(1): 172. CrossRef
Obstructive Fibrinous Tracheal Pseudomembrane: An Update
Alberto Manassero, Matteo Bossolasco
Korean Journal of Critical Care Medicine.2014; 29(3): 241. CrossRef

Neurosurgery
Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis: Chul Hee Lee; Korean J Crit Care Med. 2014;29(2):114-118. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.114

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Abstract PDF: A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS) score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week) without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU) in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.

Cardiology
Life-Threatening Acute Fulminant Myocarditis Following a Coffee Diet Program: Jung Hyun Kim, Hee Kyung Kim, Kyu Hyun Han, Bo Hye Kim, Hak Su Kim, Sun Young Shin, Eun Kyung Kim, Hye Cheol Jeong, Ji Hyun Lee; Korean J Crit Care Med. 2014;29(2):119-122. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.119

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Abstract PDF: Myocarditis is an inflammatory disease of the myocardium caused by various infectious or noninfectious triggers. Although viral infections are important causes of myocarditis, some drugs or toxins can also cause myocarditis. We report a case of life-threatening fulminant myocarditis which followed an extensive coffee diet program. Despite medical treatment, the patient was not able to maintain hemodynamic stability. She was supported by extracorporeal membrane oxygenation and completely recovered 3 months later.

Cardiology
Isolated Chylopericardium after Mitral Valve Replacement: the First Description of Adult Heart Disease in Korea: Su Wan Kim, Seogjae Lee; Korean J Crit Care Med. 2014;29(2):123-125. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.123

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Abstract PDF: Isolated chylopericardium as a complication of cardiac surgery is very rare. Two cases of chylopericardium have been previously reported in Korea; both patients suffered from chylopericardium after a corrective cardiac surgery for a congenital heart disease such as atrial or ventricular septal defect. We report a case of chylopericardium in a 55-year-old mitral valve replacement patient. The reason for chylopericardium was unclear, but it might have been related with the damaged lymph nodes and blunt dissection of the thymus. While most chylopericardium cases require surgical intervention, we managed this chylopericardium case with a low-fat diet for 3 days.

Hematology/Vascular Surgery
A Fatal Case of a Large Abdominal Wall Muscle Hematoma Secondary to Low-Molecular-Weight Heparin Injections: Mi Yeon Kim, Hyeon Ju Kang, Min Sun Ryu, Seo Woo Kim, Yon Ju Ryu, Seok Jeong Lee, Jin Hwa Lee, Jung Hyun Chang, Ji Young Hwang; Korean J Crit Care Med. 2014;29(2):126-130. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.126

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Abstract PDF

The use of low-molecular-weight heparin (LMWH) can lead to major life threatening complications, including hematomas. Abdominal wall muscle hematomas are rarely fatal, and encompass a wide spectrum of severity depending on size, etiology, and associated complications; but because of their rarity may be misdiagnosed clinically. We report a fatal case of an 80-year-old female who received LMWH after an episode of pulmonary thromboembolism and was subsequently diagnosed with a large right abdominal wall hematoma complicated with hypovolemic shock and acute kidney injury.

Citations

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Hemorrhage of the Ramus Lumbalis of the Iliolumbar Artery as a Cause for Shock in Blunt Trauma Victims on Therapeutic Anticoagulation
Thomas Patrick Sullivan, Eduardo Smith-Singares, Hajime Imura
Case Reports in Surgery.2021; 2021: 1. CrossRef

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