Acute and Critical Care

Surgery
Clinical Outcome and Prognosis of Patients Admitted to the Surgical ICU after Abdomen Surgery: Yun Su Sim, Jin Hwa Lee, Jung Hyun Chang, Yon Ju Ryu; Korean J Crit Care Med. 2015;30(1):1-7. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.1

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Background
Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. Methods: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. Results: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. Conclusions: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.

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The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients
Anastasiya Shchatsko, Laura N. Purcell, Christopher J. Tignanelli, Anthony Charles
The American Surgeon.2021; 87(8): 1230. CrossRef

Nursing
The Inter-Rater Reliability of Simplified Acute Physiology Score 3 (SAPS3) among Intensive Care Unit Nurses: Jun Hyun Kim, Ji Yeon Kim, Wonil Kim, Kyung Woo Kim, Sang-il Lee, Kyung-Tae Kim, Jang Su Park, Won Joo Choe, Jung Won Kim; Korean J Crit Care Med. 2015;30(1):8-12. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.8

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Abstract PDF: Background
Simplified acute physiology score 3 (SAPS3) was developed in 2005 to evaluate intensive care unit (ICU) performance and to predict patient mortality or disease severity. The score is usually calculated by doctors, but it requires substantial human resources. And many nurse-lead studies use this scoring system. In the present study, we examined the inter-rater reliability of SAPS3 among nurses in an ICU. Methods: Five ICU nurses who worked in an ICU for a mean length of 7.8 years were educated for 2 hours about SAPS3 score and its components. Each nurse scored 26 patients, and the intraclass correlation coefficient (ICC) of the total scores and each subset were evaluated. Results: The ICC (95% confidence interval) of SAPS3 score was 0.89 (0.82-0.95), that of subset I was 0.90 (0.82-0.95), subset II was 0.54 (0.35-0.73), and subset III was 0.95 (0.91-0.97). The ICC of predicted mortality was 0.91 (0.85-0.96). Conclusions: The ICC of SAPS3 score and predicted mortality among ICU nurses were reliable. According to these ICC values, SAPS3 score is a reliable scale to be used by nurses. The ICC of subset II was lower than those of the other subsets, suggesting that education of SAPS3 should focus on the definition of each subset II component.

Thoracic Surgery
Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access: Pil Young Jung, Hoon Ryu, Jae Hung Jung, Eunbi Lee, Joong Hwan Oh, Chun Sung Byun, Il Hwan Park; Korean J Crit Care Med. 2015;30(1):13-17. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.13; Correction in: Acute Crit Care 2015;30(4):365

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Abstract PDF

Background
Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. Methods: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. Results: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). Conclusions: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.

Citations

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Internal jugular vein versus subclavian vein as the percutaneous insertion site for totally implantable venous access devices: a meta-analysis of comparative studies
Shaoyong Wu, Jingxiu Huang, Zongming Jiang, Zhimei Huang, Handong Ouyang, Li Deng, Wenqian Lin, Jin Guo, Weian Zeng
BMC Cancer.2016;[Epub] CrossRef

Thoracic Surgery
A Rare Case of Massive Hemothorax due to Central Venous Catheterization Treated with Angiographic Stent Implantation: Jung-Min Bae; Korean J Crit Care Med. 2015;30(1):18-21. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.18

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Abstract PDF: In critically ill patients, centeral venous catheterization is a widely used procedure for fluid resuscitation, massive transfusion, total parenteral nutrition, central venous pressure monitoring and hemodialysis. However, many complications are associated with central venous catheterization. Among these complications, hemothorax is rare but fatal. We recently experienced a 32-year-old female diagnosed with hemothorax due to subclavian catheterization who was successfully treated with angiographic intervention. There are no absolute indications of surgery or interventional treatment in such cases. Multicenter studies and consensus are necessary to determine the proper treatment for hemothorax due to central venous catheterization. Angiographic treatment is rarely used for this uncommon complication of subclavian catheterization. We describe a rare case with a review of the literature.

Cardiology
Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization: Hyun Jeong Lee, Namo Kim, Hyelin Lee, Jae Kwang Shim, Jong Wook Song; Korean J Crit Care Med. 2015;30(1):22-26. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.22

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Abstract PDF

We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.

Citations

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The Concept and Building of a Simulation Device to Check the Cardiac Output Measurement Through the Pulmonary Artery Catheter
Caio Francisco Ternus de Abreu, Bernardo Ternus de Abreu
Biomedical Materials & Devices.2023;[Epub] CrossRef

Cardiology/Thoracic Surgery
Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma: Chun Sung Byun, Il Hwan Park, Tae Hoon Kim, Eunbi Lee, Joong Hwan Oh; Korean J Crit Care Med. 2015;30(1):27-30. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.27

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Abstract PDF: Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.

Pulmonary
Diffuse Alveolar Hemorrhage Confirmed by Bronchoalveolar Lavage in a Patient with Hemoptysis after Sildenafil Use for Erectile Dysfunction: Kyoung Min Moon, Sun Young Jung, Min Soo Han, Yongseon Cho, Young Min Rah, Jong Woo Kim; Korean J Crit Care Med. 2015;30(1):31-33. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.31

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Abstract PDF: A 81-year-old man was referred for respiratory failure by emergency medical technicians. He admitted at intensive care unit for ventilator treatment. Several hours before admission, he took sildenafil 100 mg for erectile dysfunction without prescription. The episodes of hemoptysis occurred several hours later. Computed tomography revealed multifocal diffuse ground-glass attenuation in both lungs. And the more we performed bronchoalveolar lavage, the more the color of it was turned into red. We treated him with empirical antibiotics and tranexamic acid, and hemoptysis was stopped in one day after admission. But in the 5th admission day, he died from sepsis combined with pneumonia caused by Acinetobacter baumannii abruptly.

Cardiology/Pharmacology
Effective Postoperative Use of Dexmedetomidine in a Child with Severe Pulmonary Arterial Hypertension Secondary to Congenital Ventricular Septal Defect: Yong-In Kim; Korean J Crit Care Med. 2015;30(1):34-37. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.34

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Abstract PDF: Although α2-adrenoceptor agonists are widely used as postoperative sedatives in adults, the postoperative effects in pediatric patients with secondary pulmonary arterial hypertension (PAH) due to congenital heart disease are not well known. We experienced a case of successful ventilator weaning with continuous intravenous administration of dexmedetomidine (DEX) after surgical correction in a 46-month-old child with congenital ventricular septal defect (VSD) with severe PAH. She underwent VSD closure on cardiopulmonary bypass (CPB). After successful weaning from the CPB, hemodynamics and oxygenation were stabilized on DEX and nitroglycerin in the intensive care unit. The patient was successfully weaned from the ventilator 46 hours after surgery. The transthoracic echocardiogram two weeks after surgery showed a closed VSD with no residual shunt and trivial tricuspid regurgitation (Vmax = 2.5 m/sec) without PAH.

Hematology/Pulmonary
Hemophagocytic Lymphohistiocytosis after Lung Transplantation: Ah Young Leem, Sung Woo Moon, Song Yee Kim, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, Hyo Chae Paik, June Won Cheong, Kyung Soo Chung; Korean J Crit Care Med. 2015;30(1):38-41. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.38

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Abstract PDF: Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal complication after solid organ transplantation. Acquired forms of HLH are described in association with severe sepsis, autoimmune disorders, malignancy, immune-compromised states, infections, and solid organ transplantation. We experienced a case of hemophagocytic lymphohistiocytosis after bilateral lung transplantation. Leukopenia, thrombocytopenia, and hyperbilirubinemia were noted and became aggravated 50 days after transplantation. Diagnosis of HLH was based on clinical and laboratory findings of splenomegaly, cytopenia, elevated ferritin, elevated interleukin-2 receptor, and hemophagocytosis in bone marrow. Other features such as elevated bilirubin, lactate dehydrogenase, and D-dimer which can be present in HLH were also noted. The patient was immediately treated with etoposide and dexamethasone. Despite aggressive therapy, the patient deteriorated and died. Awareness of the diagnostic criteria of HLH after lung transplantation is important for clinicians.

Cardiology/Allergy
Management of Cardiac Arrest following Anaphylactic Reaction to Cisatracurium Using Extracorporeal Membrane Oxygenation: Dae Sung Ma, Tae-Hyun Kim, Min Ae Keum, Dong Kwan Kim, Suk-Kyung Hong; Korean J Crit Care Med. 2015;30(1):42-45. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.42

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Abstract PDF

Anaphylactic reaction during the perioperative period typically exhibits rapid onset, varying clinical manifestations, and an expected mortality rate of 1.5-9%. Neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Here, we report a severe case of anaphylaxis that developed in a 66-year-old man due to cisatracurium administration. And he was successfully managed by extracorporeal membrane oxygenation. Cardiopulmonary resuscitation was performed by extracorporeal membrane oxygenation, and the patient was successfully weaned off 24 hours later.

Citations

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Case report: management of differential diagnosis and treatment of severe anaphylaxis in the setting of spinal anesthesia
Brian M. Osman, Joni M. Maga, Sebastian M. Baquero
Journal of Clinical Anesthesia.2016; 35: 145. CrossRef

Neurology
Posterior Reversible Encephalopathy Syndrome in a Critically Ill Postoperative Patient: Min Ae Keum, Hyo Keun No, Choong Wook Lee, Sang-Beom Jeon, Suk-Kyung Hong; Korean J Crit Care Med. 2015;30(1):46-51. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.46

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Abstract PDF: Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.

Cardiology
Extracorporeal Membrane Oxygenation for Complicated Scrub Typhus: Eun Sun Kim, Jinwoo Lee; Korean J Crit Care Med. 2015;30(1):52-55. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.52

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Abstract PDF: Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi . Although early diagnosis and appropriate antibiotic therapy improve the prognosis for the majority of patients, life-threatening complications are not uncommon. Here, we present a case of successful veno-veno-type extracorporeal membrane oxygenation for scrub typhus-induced complications, including acute respiratory distress syndrome, myocarditis and multi-organ dysfunction. To our knowledge, this is the first case report of successful extracorporeal membrane oxygenation in complicated scrub typhus in Korea.

Toxicology
Polyethylene Glycol (PEG-3350, Colyte) Poisoning due to Intra-Peritoneal Leakage in an Elderly Patient: Jae Hee Chung, Seok Chan Kim, Jun-Gi Kim; Korean J Crit Care Med. 2015;30(1):56-60. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.56

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Abstract PDF

Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.

Citations

Citations to this article as recorded by

Severe hypernatremia and transient azotemia in a cat following inadvertent intravenous administration of a commercial polyethylene glycol solution
Sabrina N. Hoehne, Casey J. Kohen, Birgit Puschner, Ingrid Gennity, Simon P. Hagley, Kate S. Farrell, Karin Unger, Laura A. Cagle, Karl E. Jandrey
Journal of Veterinary Emergency and Critical Care.2019; 29(6): 690. CrossRef

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