Acute and Critical Care

Volume 30 (2); May 2015

Editorial

Endocrinology
Is Body Mass Index a Useful Prognostic Factor for Critically Ill Patients?: Seongwook Jeong; Korean J Crit Care Med. 2015;30(2):61-62. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.61

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Abstract PDF: No abstract available.

Review

Psychology/Neurology
Intensive Care Unit Delirium: Yongsuk Kim, Sung Jin Hong; Korean J Crit Care Med. 2015;30(2):63-72. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.63

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Abstract PDF: Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU) patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition’s high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.

Original Articles

Ethics
Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units: Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na; Korean J Crit Care Med. 2015;30(2):73-81. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.73

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Abstract PDF Supplementary Material

Background
The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). Methods: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. Results: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient’s loss of decision-making capacity. Decisions were made most frequently by the patient’s son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). Conclusions: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.

Citations

Citations to this article as recorded by

Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
Acute and Critical Care.2020; 35(3): 179. CrossRef
Family-Clinician Communication About End-of-Life Care in Korea
Minjeong Jo, Yang-Sook Yoo, George Knafl, Marcia Van Riper, Linda Beeber, Mi-Kyung Song
Journal of Hospice & Palliative Nursing.2017; 19(6): 597. CrossRef

Pharmacology
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; Korean J Crit Care Med. 2015;30(2):82-88. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.82

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Abstract PDF

Background
Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. Methods: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. Results: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). Conclusions: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.

Citations

Citations to this article as recorded by

Characterization of drug‐related problems and evaluation of pharmacist interventions in the cardiovascular intensive care settings in Thailand
Phannita Wattanaruengchai, Junporn Kongwatcharapong, Surakit Nathisuwan
JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY.2023; 6(5): 488. 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

Pulmonary
The Adequacy of a Conventional Mechanical Ventilator as a Ventilation Method during Cardiopulmonary Resuscitation: A Manikin Study: Hong Joon Ahn, Kun Dong Kim, Won Joon Jeong, Jun Wan Lee, In Sool Yoo, Seung Ryu; Korean J Crit Care Med. 2015;30(2):89-94. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.89

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Abstract PDF

BACKGROUND
We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). Background: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). Methods: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (Plimit). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (Ppeak) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a Ppeak of ≤ 50 cmH2O. Results: In Model 1, Vt and Ppeak were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and Ppeak levels were 17%, and the Ppeak adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and Ppeak levels were 85%; the Ppeak adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of Plimit. Conclusions: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.

Citations

Citations to this article as recorded by

Humans vs. Machines: Mechanical Compression Devices and Their Appropriate Application in the Management of Cardiac Arrest
Emilia Clementi, Anirudh Chitale, Brian J. O’Neil, Anthony T. Lagina
Current Emergency and Hospital Medicine Reports.2023; 11(4): 133. CrossRef
Manual vs. mechanical ventilation in patients with advanced airway during CPR
Muthapillai Senthilnathan, Ramya Ravi, Srinivasan Suganya, Ranjith Kumar Sivakumar
Indian Heart Journal.2022; 74(5): 428. CrossRef
Effects of Changes in Inspiratory Time on Inspiratory Flowrate and Airway Pressure during Cardiopulmonary Resuscitation: A Manikin-Based Study
Jung Ju Lee, Su Yeong Pyo, Ji Han Lee, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Suk Woo Lee, Young Min Kim, Hyun Seok Chai
Kosin Medical Journal.2021; 36(2): 100. CrossRef
Changes in peak inspiratory flow rate and peak airway pressure with endotracheal tube size during chest compression
Jung Wan Kim, Jin Woong Lee, Seung Ryu, Jung Soo Park, InSool Yoo, Yong Chul Cho, Hong Joon Ahn
World Journal of Emergency Medicine.2020; 11(2): 97. CrossRef
Mechanical Ventilation During Resuscitation: How Manual Chest Compressions Affect a Ventilator’s Function
Tillmann Speer, Wolfgang Dersch, Björn Kleine, Christian Neuhaus, Clemens Kill
Advances in Therapy.2017; 34(10): 2333. CrossRef

Case Reports

Infection
Polymyxin B Immobilized Fiber Hemoperfusion in Refractory Intra-abdominal Septic Shock: Hae Wone Chang, Young-Jae Cho, Sang-Hyun Park, Moonsuk Kim; Korean J Crit Care Med. 2015;30(2):95-102. Published online May 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.95

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Abstract PDF: The effects of direct hemoperfusion with polymyxin B immobilized fiber (PMX) treatment for septic shock have been recently reported. However, little evidence of a true benefit on clinical outcomes, including mortality, is available. Herein, we report three cases of intra-abdominal infection associated with refractory septic shock Case 1 was Escherichia coli peritonitis after a colectomy. PMX treatment improved the hemodynamic parameters and lactic acid levels of the patient. In case 2, secondary peritonitis was associated with septic or cardiogenic shock. Septic cardiomyopathy was assumed to be the cause of shock. 24 hours after the use of PMX, cardiac contractility assessed by echocardiography returned to baseline. In case 3, a patient with Burkitt’s lymphoma and neutropenia was found to be gastroenteritis and Klebsiella pneumoniae bacteremia. Intravenous meropenem was administered for 3 days. Hemodynamic parameters improve after the twice use of PMXOverall, the change of serial sequential organ failure assessment score (SOFA) was more significant in surgical cases as compared to the medical case at 72 hours after PMX administration. All patients were discharged from the hospital. In addition to early resuscitation efforts and infection source control, PMX treatment may be beneficial to patients with refractory intra-abdominal infection associated with septic shock.

Infection/Pulmonary
Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii: Hwa Young Lee, Hea Yon Lee, Sae Bom Shin, Kab Soo Shin, Bong Woo Lee, Hwan Wook Kim, Seok Lee, Seok Chan Kim; Korean J Crit Care Med. 2015;30(2):103-108. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.103

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Abstract PDF: Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.

Cardiology/Anesthesiology
Early Extracorporeal Membrane Oxygenation for Massive Aspiration during Anesthesia Induction: Namo Kim, Kwan Hyung Kim, Jeong Min Kim, Su Youn Choi, Sungwon Na; Korean J Crit Care Med. 2015;30(2):109-114. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.109

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Abstract PDF

Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.

Citations

Citations to this article as recorded by

Massive aspiration syndrome: a possible indication for “emergent” veno-venous extracorporeal membrane oxygenation?: a case report
Emiliano Gamberini, Venerino Poletti, Emanuele Russo, Alessandro Circelli, Marco Benni, Giovanni Scognamiglio, Domenico Pietro Santonastaso, Costanza Martino, Linda Domenichini, Romina Biondi, Giorgia Bastoni, Etrusca Brogi, Luca Ansaloni, Federico Coccol
Journal of Medical Case Reports.2021;[Epub] CrossRef
Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer
Jangwhan Jo, Yang Gi Ryu
Korean Journal of Critical Care Medicine.2016; 31(2): 156. CrossRef

Trauma/Vascular Surgery
Resuscitative Endovascular Balloon Occlusion of the Aorta in a Trauma Patient with Hypovolemic Shock: Hong Kyung Shin, Ho-Seong Han, Taeseung Lee, Do-Joong Park, Kyuwhan Jung, Kyuseok Kim; Korean J Crit Care Med. 2015;30(2):115-118. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.115

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Abstract PDF

Hemorrhagic shock is one of the most common causes of death in patients with multiple trauma and therefore rapid control of bleeding is the main strategy to save these patients. Resuscitative balloon occlusion of the aorta (REBOA) has been applied in several trauma cases and because of the effectiveness of this procedure it has been adopted in the trauma field. Herein, we report the first successful case of REBOA in Korea performed on a 46-year-old man with hemorrhagic shock after a fall from a height of 14-stories. The patient visited our hospital emergency room with hypovolemic shock, we performed Resuscitative Endovascular Balloon Occlusion of the Aorta under bed side blind technique. His vital sign was stabilized after procedure, then we could performed endovascular bleeding control. The patient was discharged on his 33rd in-hospital day without invasive procedure and major scar.

Citations

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Implementation of resuscitative endovascular balloon occlusion of the aorta at the Korean Regional Trauma Center
Youngeun Park, Byungchul Yu, Giljae Lee, Jungnam Lee, Kangkook Choi, Ahram Han
Hong Kong Journal of Emergency Medicine.2021; 28(3): 129. CrossRef
Case Series of Zone III Resuscitative Endovascular Balloon Occlusion of the Aorta in Traumatic Shock Patients
Byungchul Yu, Gil Jae Lee, Kang Kook Choi, Min A Lee, Jihun Gwak, Youngeun Park, Jung Nam Lee
Journal of Trauma and Injury.2020; 33(3): 162. CrossRef

Thoracic Surgery
Subclavian Artery Laceration Caused by Pigtail Catheter Removal in a Patient with Pneumothorax: Hyo Jin Kim, Yang Hyun Cho, Gee Young Suh, Jeong Hoon Yang, Kyeongman Jeon; Korean J Crit Care Med. 2015;30(2):119-122. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.119

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Abstract PDF

We report a case of subclavian artery laceration caused by the removal of a pigtail pleural drainage catheter in a patient with a pneumothorax. The patient was successfully resuscitated through diagnostic angiography with subsequent balloon occlusion and primary repair of the injured subclavian artery. Although pigtail drainage of a pneumothorax is known to be safe and effective, proper insertion and removal techniques should be emphasized to reduce the risk of complications.

Citations

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A randomised controlled trial of intrapleural balloon intercostal chest drains to prevent drain displacement
Rachel M. Mercer, Eleanor Mishra, Radhika Banka, John P. Corcoran, Cyrus Daneshvar, Rakesh K. Panchal, Tarek Saba, Melanie Caswell, Sarah Johnstone, Daniel Menzies, Sana Ahmer, Mitra Shahidi, Amelia O. Clive, Manish Gautam, Giles Cox, Chris Orton, Judith
European Respiratory Journal.2022; 60(1): 2101753. CrossRef
AN UNUSUAL COMPLICATION OF PIGTAIL CATHETER: COLONIC PENETRATION
Yakup Ülger, Anıl Delik
Gastroenterology Nursing.2021; 44(6): 463. CrossRef
Median Sternotomy for the Management of Life-Threatening Bleeding Resulting from Proximal Upper Extremity Amputation
Hyunseong Kang, Gyu Bum Seo, Su Wan Kim
Journal of Acute Care Surgery.2020; 10(2): 58. CrossRef

Neurology
Multiple System Atrophy Manifested by Bilateral Vocal Cord Palsy as an Initial Sign: Yuri Seo, Soomin Jeung, Heeyoung Yoon, Min-Chul Kim, Nah Kyum Lee, Byeong Zu Ghang, Sun Ju Chung, Younsuck Koh; Korean J Crit Care Med. 2015;30(2):123-127. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.123

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Abstract PDF: A 71-year-old male initially presented with vocal cord palsy and underwent tracheostomy. After thorough examination, urogenital dysfunction, orthostatic hypotension, and Parkinsonism were found, which led to the diagnosis of multiple system atrophy (MSA). After the tracheostomy, bi-level positive airway pressure ventilation was required during the night due to nocturnal hypoxemia. Nighttime hypoxemia is related to central sleep apnea, which is one of the manifestations of MSA. This is the first case of MSA manifested by bilateral vocal cord palsy as an initial sign in Korea. This case supports the notion that MSA should be taken into consideration when vocal cord paralysis is observed.

Neurology/Obstetric
A Critical Case of Wernicke's Encephalopathy Induced by Hyperemesis Gravidarum: Byung Ju Kang, Min Gu Kim, Jwa Hoon Kim, Mingee Lee, Sang-Beom Jeon, Ha Il Kim, Jin Won Huh; Korean J Crit Care Med. 2015;30(2):128-131. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.128

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Abstract PDF

Wernicke’s encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke’s encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke’s encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.

Citations

Citations to this article as recorded by

Wernicke's Encephalopathy in Acute and Chronic Kidney Disease: A Systematic Review
Erik Oudman, Jan W. Wijnia, David Severs, Misha J. Oey, Mirjam van Dam, Maaike van Dorp, Albert Postma
Journal of Renal Nutrition.2024; 34(2): 105. CrossRef
Intrauterine Fetal Demise: A Rare Complication of Wernicke's Encephalopathy Secondary to Hyperemesis Gravidarum
Anthony Pham, Robin Okpara, Nancy Rollins, Roy Jacob
Cureus.2023;[Epub] CrossRef
Wernicke’s encephalopathy in hyperemesis gravidarum: A systematic review
Erik Oudman, Jan W. Wijnia, Misha Oey, Mirjam van Dam, Rebecca C. Painter, Albert Postma
European Journal of Obstetrics & Gynecology and Reproductive Biology.2019; 236: 84. CrossRef

Cardiology/Pediatric
Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation: Do Wan Kim, Kyeong Ryeol Cheon, Duck Cho, Kyo Seon Lee, Hwa Jin Cho, In Seok Jeong; Korean J Crit Care Med. 2015;30(2):132-134. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.132

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Abstract PDF

Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

Citations

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Transfusion-associated graft-versus-host disease, transfusion-associated hyperkalemia, and potassium filtration: advancing safety and sufficiency of the blood supply
Kenneth E. Nollet, Alain M. Ngoma, Hitoshi Ohto
Transfusion and Apheresis Science.2022; 61(2): 103408. CrossRef
Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients
Morgan Burke, Pranava Sinha, Naomi L. C. Luban, Nikki Gillum Posnack
Frontiers in Pediatrics.2021;[Epub] CrossRef
Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease
Sejong Chun, Minh-Trang Thi Phan, Saetbyul Hong, Jehoon Yang, Yeup Yoon, Sangbin Han, Jungwon Kang, Mark H. Yazer, Jaehyun Kim, Duck Cho, Senthilnathan Palaniyandi
PLOS ONE.2020; 15(3): e0229724. CrossRef
Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Chonnam Medical Journal.2017; 53(2): 110. CrossRef
Blood Transfusion Strategies in Patients Supported by Extracorporeal Membrane Oxygenation
Yoon Hee Kim
The Korean Journal of Critical Care Medicine.2015; 30(3): 139. CrossRef

Pulmonary/Thoracic Surgery
Successful Management of Airway Emergency in a Patient with Esophageal Cancer: Samina Park, Hyun Joo Lee, Chang Hyun Kang, Young Tae Kim; Korean J Crit Care Med. 2015;30(2):135-138. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.135

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Abstract PDF

A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient’s respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.

Citations

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An esophageal tumor producing life-threatening tracheal compression in a young adult was resuscitated with a self-inflating resuscitation bag
Rajnish Kumar, Nishant Sahay, Neeraj Kumar, Soumya Singh
Perioperative Care and Operating Room Management.2024; 34: 100365. CrossRef
Thoracic oesophageal cancer as a cause of stridor: a literature review
Robert Munashe Maweni, Venughanan Manikavasagar, Nicholas Sunderland, Sajid Chaudhry
BMJ Case Reports.2018; : bcr-2018-224872. CrossRef

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