Acute and Critical Care

Volume 32 (4); November 2017

Review Article

Pulmonary
Patient-Ventilator Dyssynchrony: Elvira-Markela Antonogiannaki, Dimitris Georgopoulos, Evangelia Akoumianaki; Korean J Crit Care Med. 2017;32(4):307-322. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00535

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In mechanically ventilated patients, assisted mechanical ventilation (MV) is employed early, following the acute phase of critical illness, in order to eliminate the detrimental effects of controlled MV, most notably the development of ventilator-induced diaphragmatic dysfunction. Nevertheless, the benefits of assisted MV are often counteracted by the development of patient-ventilator dyssynchrony. Patient-ventilator dyssynchrony occurs when either the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration, respectively, or if the magnitude of mechanical assist does not respond to the patient’s respiratory demand. As patient-ventilator dyssynchrony has been associated with several adverse effects and can adversely influence patient outcome, every effort should be made to recognize and correct this occurrence at bedside. To detect patient-ventilator dyssynchronies, the physician should assess patient comfort and carefully inspect the pressure- and flow-time waveforms, available on the ventilator screen of all modern ventilators. Modern ventilators offer several modifiable settings to improve patient-ventilator interaction. New proportional modes of ventilation are also very helpful in improving patient-ventilator interaction.

Citations

Citations to this article as recorded by

Acute Respiratory Failure in Severe Acute Brain Injury
Zachary Robateau, Victor Lin, Sarah Wahlster
Critical Care Clinics.2024; 40(2): 367. CrossRef
Quantifiable identification of flow-limited ventilator dyssynchrony with the deformed lung ventilator model
Deepak K. Agrawal, Bradford J. Smith, Peter D. Sottile, George Hripcsak, David J. Albers
Computers in Biology and Medicine.2024; 173: 108349. CrossRef
Gastric Pressure Monitoring Unveils Abnormal Patient–Ventilator Interaction Related to Active Expiration: A Retrospective Observational Study
Evangelia Akoumianaki, Katerina Vaporidi, Vaia Stamatopoulou, Stella Soundoulounaki, Meropi Panagiotarakou, Eumorfia Kondili, Dimitris Georgopoulos
Anesthesiology.2024; 141(3): 541. CrossRef
A novel application of spectrograms with machine learning can detect patient ventilator dyssynchrony
Ishmael Obeso, Benjamin Yoon, David Ledbetter, Melissa Aczon, Eugene Laksana, Alice Zhou, R. Andrew Eckberg, Keith Mertan, Robinder G. Khemani, Randall Wetzel
Biomedical Signal Processing and Control.2023; 86: 105251. CrossRef
Effects of Neurally Adjusted Ventilation Assist (NAVA) and conventional modes of mechanical ventilation on diaphragm functions: A randomized controlled trial
Vijay Hadda, Sourabh Pahuja, Saurabh Mittal, Karan Madan, Maroof A Khan, Anant Mohan, Randeep Guleria
Heart & Lung.2022; 53: 36. CrossRef
Reverse Triggering: An Introduction to Diagnosis, Management, and Pharmacologic Implications
Brian Murray, Andrea Sikora, Jason R. Mock, Thomas Devlin, Kelli Keats, Rebecca Powell, Thomas Bice
Frontiers in Pharmacology.2022;[Epub] CrossRef
Attention-based convolutional long short-term memory neural network for detection of patient-ventilator asynchrony from mechanical ventilation
Dingfu Chen, Kangwei Lin, Ziheng Deng, Dayu Li, Qingxu Deng
Biomedical Signal Processing and Control.2022; 78: 103923. CrossRef
Tracheotomy in ventilator-dependent patients with COVID-19: a cross-sectional study of analgesia and sedative requirements
Brianne Wiemann, Jessica Mitchell, Preeyaporn Sarangarm, Richard Miskimins
Journal of International Medical Research.2022;[Epub] CrossRef
An interpretable 1D convolutional neural network for detecting patient-ventilator asynchrony in mechanical ventilation
Qing Pan, Lingwei Zhang, Mengzhe Jia, Jie Pan, Qiang Gong, Yunfei Lu, Zhongheng Zhang, Huiqing Ge, Luping Fang
Computer Methods and Programs in Biomedicine.2021; 204: 106057. CrossRef
Accuracy of Algorithms and Visual Inspection for Detection of Trigger Asynchrony in Critical Patients : A Systematic Review
Monique Bandeira, Alícia Almeida, Lívia Melo, Pedro Henrique de Moura, Emanuelle Olympia Ribeiro Silva, Jakson Silva, Armèle Dornelas de Andrade, Daniella Brandão, Shirley Campos, Robert Boots
Critical Care Research and Practice.2021; 2021: 1. CrossRef
Patient–Ventilator Dyssynchrony in Critically Ill Patients
Bruno De Oliveira, Nahla Aljaberi, Ahmed Taha, Baraa Abduljawad, Fadi Hamed, Nadeem Rahman, Jihad Mallat
Journal of Clinical Medicine.2021; 10(19): 4550. CrossRef
Patient–ventilator asynchrony in acute brain-injured patients: a prospective observational study
Xu-Ying Luo, Xuan He, Yi-Min Zhou, Yu-Mei Wang, Jing-Ran Chen, Guang-Qiang Chen, Hong-Liang Li, Yan-Lin Yang, Linlin Zhang, Jian-Xin Zhou
Annals of Intensive Care.2020;[Epub] CrossRef

Original Articles

Pulmonary
The Use of Lung Ultrasound in a Surgical Intensive Care Unit: Hyung Koo Kang, Hyo Jin So, Deok Hee Kim, Hyeon-Kyoung Koo, Hye Kyeong Park, Sung-Soon Lee, Hoon Jung; Korean J Crit Care Med. 2017;32(4):323-332. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00318

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Abstract PDF

Background
Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU).
Methods
This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016.
Results
The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively.
Conclusions
LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.

Citations

Citations to this article as recorded by

Lung Ultrasound in the Critically Ill
Jin Sun Cho
The Korean Journal of Critical Care Medicine.2017; 32(4): 356. CrossRef

Hematology
Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage: Soon Chang Park, Seok Ran Yeom, Sang Kyoon Han, Young Mo Jo, Hyung Bin Kim; Korean J Crit Care Med. 2017;32(4):333-339. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00787

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Abstract PDF

Background
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
Methods
A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
Results
Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
Conclusions
This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.

Citations

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Role of recombinant factor VIIa in the clinical management of severe postpartum hemorrhage: consensus among European experts
D. Surbek, J. Blatný, M. Wielgos, N. Acs, H. Edwards, O. Erez, J. L. Bartha, H. Madar, F. J. Mercier, D. Schlembach, G. C. Di Renzo
The Journal of Maternal-Fetal & Neonatal Medicine.2024;[Epub] CrossRef
Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage
Camila Caram-Deelder, Hellen McKinnon Edwards, Jarmila A. Zdanowicz, Thomas van den Akker, Camilla Birkegård, Jan Blatný, Johanna G. van der Bom, Giuseppe Colucci, Derek van Duuren, Nan van Geloven, Dacia D. C. A. Henriquez, Marian Knight, Lars Korsholm,
Journal of Clinical Medicine.2024; 13(9): 2656. CrossRef
Thromboembolic events in severe postpartum hemorrhage treated with recombinant activated factor VII: a systematic literature review and meta-analysis
Johanna G. van der Bom, Frédéric J. Mercier, Damaris Bausch-Fluck, Mads Nordentoft, Morten Medici, Rezan Abdul-Kadir
Research and Practice in Thrombosis and Haemostasis.2024; 8(5): 102533. CrossRef
Coagulation management and transfusion in massive postpartum hemorrhage
Christina Massoth, Manuel Wenk, Patrick Meybohm, Peter Kranke
Current Opinion in Anaesthesiology.2023; 36(3): 281. CrossRef
Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care
Sibylle Kietaibl, Aamer Ahmed, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa, Giedrius Barauskas, Edoardo De Robertis, David Faraoni, Daniela C. Filipescu, Dietmar Fries, Anne Godier, Thorsten Haas, Matthias Jacob, Marcus D. Lancé, Juan V. Llau, Jens Me
European Journal of Anaesthesiology.2023; 40(4): 226. CrossRef

Trauma
Acute Physiology and Chronic Health Evaluation II Score and Sequential Organ Failure Assessment Score as Predictors for Severe Trauma Patients in the Intensive Care Unit: Min A Lee, Kang Kook Choi, Byungchul Yu, Jae Jeong Park, Youngeun Park, Jihun Gwak, Jungnam Lee, Yang Bin Jeon, Dae Sung Ma, Gil Jae Lee; Korean J Crit Care Med. 2017;32(4):340-346. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00255

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Abstract PDF

Background
The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Sequential Organ Failure Assessment (SOFA) scoring system are widely used for critically ill patients. We evaluated whether APACHE II score and SOFA score predict the outcome for trauma patients in the intensive care unit (ICU).
Methods
We retrospectively analyzed trauma patients admitted to the ICU in a single trauma center between January 2014 and December 2015. The APACHE II score was figured out based on the data acquired from the first 24 hours of admission; the SOFA score was evaluated based on the first 3 days in the ICU. A total of 241 patients were available for analysis. Injury Severity score, APACHE II score, and SOFA score were evaluated.
Results
The overall survival rate was 83.4%. The non-survival group had a significantly high APACHE II score (24.1 ± 8.1 vs. 12.3 ± 7.2, P < 0.001) and SOFA score (7.7 ± 1.7 vs. 4.3 ± 1.9, P < 0.001) at admission. SOFA score had the highest areas under the curve (0.904). During the first 3 days, SOFA score remained high in the non-survival group. In the non-survival group, cardiovascular system, neurological system, renal system, and coagulation system scores were significantly higher.
Conclusions
In ICU trauma patients, both SOFA and APACHE II scores were good predictors of outcome, with the SOFA score being the most effective. In trauma ICU patients, the trauma scoring system should be complemented, recognizing that multi-organ failure is an important factor for mortality.

Citations

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Identification of TRIM52 as a potential biomarker in mortality risk assessment in patients with sepsis
Ke Wang, Zhubin Yang, Chun Xiang Wu, Ju Cao
Human Immunology.2024; 85(6): 111174. CrossRef
Cell-free DNA as diagnostic and prognostic biomarkers for adult sepsis: a systematic review and meta-analysis
Awirut Charoensappakit, Kritsanawan Sae-khow, Pongpera Rattanaliam, Nuntanuj Vutthikraivit, Monvasi Pecheenbuvan, Suwasin Udomkarnjananun, Asada leelahavanichkul
Scientific Reports.2023;[Epub] CrossRef
Evaluation of the sequential organ failure assessment score and newly introduced criteria – Traumasis - in traffic collision patients
Sion Jo, Taeoh Jeong, Boyoung Park
The American Journal of Emergency Medicine.2022; 51: 98. CrossRef
Predictive value of Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for the short-term prognosis of emergency trauma patients: a retrospective study
Zhejun Yu, Feng Xu, Du Chen
BMJ Open.2021; 11(3): e041882. CrossRef
Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties
Joseph D. Bozzay, Patrick F. Walker, David W. Schechtman, Faraz Shaikh, Laveta Stewart, M. Leigh Carson, David R. Tribble, Carlos J. Rodriguez, Matthew J. Bradley
Journal of Trauma and Acute Care Surgery.2021; 91(2S): S247. CrossRef

Pediatric
Serum Albumin as a Biomarker of Poor Prognosis in the Pediatric Patients in Intensive Care Unit: Young Suh Kim, In Suk Sol, Min Jung Kim, Soo Yeon Kim, Jong Deok Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim; Korean J Crit Care Med. 2017;32(4):347-355. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00437

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Abstract PDF Supplementary Material

Background
Serum albumin as an indicator of the disease severity and mortality is suggested in adult patients, but its role in pediatric patients has not been established. The objectives of this study are to investigate the albumin level as a biomarker of poor prognosis and to compare it with other mortality predictive indices in children in intensive care unit (ICU).
Methods
Medical records of 431 children admitted to the ICU at Severance Hospital from January 1, 2012 to December 31, 2015 were retrospectively analyzed. Children who expired within 24 hours after ICU admission, children with hepatic or renal failure, and those who received albumin replacement before ICU admission were excluded.
Results
The children with hypoalbuminemia had higher 28-day mortality rate (24.60% vs. 9.28%, P < 0.001), Pediatric Index of Mortality (PIM) 3 score (9.23 vs. 8.36, P < 0.001), Pediatric Risk of Mortality (PRISM) III score (7.0 vs. 5.0, P < 0.001), incidence of septic shock (12% vs. 3%, P < 0.001), C-reactive protein (33.0 mg/L vs. 5.8 mg/L, P < 0.001), delta neutrophil index (2.0% vs. 0.6%, P < 0.001), lactate level (1.6 mmol/L vs. 1.2 mmol/L, P < 0.001) and lower platelet level (206,000/μl vs. 341,000/μl, P < 0.001) compared to the children with normal albumin level. PIM 3 (r = 0.219, P < 0.001) and PRISM III (r = 0.375, P < 0.001) were negatively correlated with serum albumin level, respectively.
Conclusions
Our results highlight that hypoalbuminemia can be a biomarker of poor prognosis including mortality in the children in ICU.

Citations

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Prognostic Value of the Lactate/Albumin Ratio for 28-Day Mortality in Pediatric Septic Shock: A Prospective Cohort Study
Duy-Truong Khac Le, Phuong Minh Nguyen, Ly Cong Tran, Viet Trieu Nguyen
Cureus.2024;[Epub] CrossRef
Prognostic factors and models to predict pediatric sepsis mortality: A scoping review
Irene Yuniar, Cut Nurul Hafifah, Sharfina Fulki Adilla, Arifah Nur Shadrina, Anthony Christian Darmawan, Kholisah Nasution, Respati W. Ranakusuma, Eka Dian Safitri
Frontiers in Pediatrics.2023;[Epub] CrossRef
The association between serum albumin and long length of stay of patients with acute heart failure: A retrospective study based on the MIMIC-IV database
Tao Liu, Haochen Xuan, Lili Wang, Xiaoqun Li, Zhihao Lu, Zhaoxuan Tian, Junhong Chen, Chaofan Wang, Dongye Li, Tongda Xu, Chiara Lazzeri
PLOS ONE.2023; 18(2): e0282289. CrossRef
Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS) and Serous Effusions in a Child With Severe Hypoalbuminemia: A Case Report
Zohair El Haddar, Aziza Elouali, Ilham Belga, Maria Rkain, Abdeladim Babakhouya
Cureus.2023;[Epub] CrossRef
Inappropriate empirical antibiotic therapy was an independent risk factor of pediatric persistent S. aureus bloodstream infection
Xingmei Wang, Ziyao Guo, Xi Zhang, Guangli Zhang, Qinyuan Li, Xiaoyin Tian, Dapeng Chen, Zhengxiu Luo
European Journal of Pediatrics.2022; 182(2): 719. CrossRef
Evaluation of models for predicting pediatric fraction unbound in plasma for human health risk assessment
Yejin Esther Yun, Andrea N. Edginton
Journal of Toxicology and Environmental Health, Part A.2021; 84(2): 67. CrossRef
Diabetes Mellitus and Hypertension Increase Risk of Death in Novel Corona Virus Patients Irrespective of Age: a Prospective Observational Study of Co-morbidities and COVID-19 from India
Anirban Gupta, Neelabh Nayan, Ranjith Nair, Krishna Kumar, Aditya Joshi, Shivangi Sharma, Jasdeep Singh, Rajan Kapoor
SN Comprehensive Clinical Medicine.2021; 3(4): 937. CrossRef
Overview of Albumin Physiology and its Role in Pediatric Diseases
Charles B. Chen, Bilasan Hammo, Jessica Barry, Kadakkal Radhakrishnan
Current Gastroenterology Reports.2021;[Epub] CrossRef
The effect of nutritional status on post-operative outcomes in pediatric otolaryngology-head and neck surgery
Jordan Luttrell, Matthew Spence, Hiba Al-Zubeidi, Michael J. Herr, Madhu Mamidala, Anthony Sheyn
International Journal of Pediatric Otorhinolaryngology.2021; 150: 110875. CrossRef

Editorial

Basic science and research
Lung Ultrasound in the Critically Ill: Jin Sun Cho; Korean J Crit Care Med. 2017;32(4):356-358. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00556

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Case Reports

Neurology
Malignant Syndrome in Parkinson Disease Similar to Severe Infection: Dong Hun Lee, Jeong Mi Moon, Yong Soo Cho; Korean J Crit Care Med. 2017;32(4):359-362. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00087

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Abstract PDF

A 70-year-old woman with Parkinson disease was admitted to the emergency department with altered consciousness, fever and convulsive movements without experiencing withdrawal from antiparkinsonian medication. Six hours after the emergency department visit, the patient had a hyperpyrexia (>40°C) and a systolic blood pressure of 40 mmHg. There was no evidence of bacterial infection based on extensive workups. The patient was discharged without aggravation of Parkinson disease symptoms after treatment that included administration of dantrolene sodium, enforcement of continuous renal replacement therapy and cooling blankets. Malignant syndrome should be suspected if high fever occurs in Parkinson disease patients without evidence of a definitive infection.

Citations

Citations to this article as recorded by

Parkinsonism-Hyperpyrexia Syndrome and Dyskinesia-Hyperpyrexia Syndrome in Parkinson’s Disease: Two Cases and Literature Review
Jian-Yong Wang, Jie-Fan Huang, Shi-Guo Zhu, Shi-Shi Huang, Rong-Pei Liu, Bei-Lei Hu, Jian-Hong Zhu, Xiong Zhang
Journal of Parkinson's Disease.2022; 12(6): 1727. CrossRef

Toxicology
Methidathion Poisoning: Ki Hoon Kim, Se Hun Kim, Charles Her; Korean J Crit Care Med. 2017;32(4):363-369. Published online January 17, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00073

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Abstract PDF

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion’s effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient’s splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.

Citations

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A case report of acute kidney injury following organophosphate methidathion poisoning
Bilel Chefirat, Anissa Zergui, Haciba Rezk-Kallah
Toxicologie Analytique et Clinique.2022; 34(2): 121. CrossRef

Image in Critical Care

Pulmonary
A Pleural Catheter Malposition through Diaphragm to Abdominal Cavity: Won Jai Jung, Sue In Choi, Eun Joo Lee, Sang Yeub Lee, Kwang Ho In; Korean J Crit Care Med. 2017;32(4):370-371. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00290

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Citations

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The Malpositioned Tunneled Pleural Catheter
Olaedo Abana, Uzair Ghori, Ammar Alqaid, Robert Holladay
Journal of Bronchology & Interventional Pulmonology.2021; 28(4): e62. CrossRef

Letters to the Editor

Cardiology
Spontaneous Echo Contrast Mistaken for Left Ventricular Thrombus during Venoarterial Extracorporeal Membrane Oxygenation: Seok In Lee, So Young Lee, Chang Hyu Choi, Kook Yang Park, Chul-Hyun Park; Korean J Crit Care Med. 2017;32(4):372-375. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00220

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Ethics
Should Very Old Patients Be Admitted to the Intensive Care Units?: Jun Kwon Cha, In-Ae Song; Korean J Crit Care Med. 2017;32(4):376-377. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00521

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Ethics
The Authors Reply: Jeong Uk Lim, Jongmin Lee, Jick Hwan Ha, Hyeon Hui Kang, Sang Haak Lee, Hwa Sik Moon; Korean J Crit Care Med. 2017;32(4):377-379. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00521.r1

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