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Original Articles
Pulmonary
Incidence and risk factors associated with progression to severe pneumonia among adults with non-severe Legionella pneumonia
Jin-Young Huh, Sang-Ho Choi, Kyung-Wook Jo, Jin Won Huh, Sang-Bum Hong, Tae Sun Shim, Chae-Man Lim, Younsuck Koh
Acute Crit Care. 2022;37(4):543-549.   Published online October 21, 2022
DOI: https://doi.org/10.4266/acc.2022.00521
  • 2,559 View
  • 103 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
Legionella species are important causative organisms of severe pneumonia. However, data are limited on predictors of progression to severe Legionella pneumonia (LP). Therefore, the risk factors for LP progression from non-severe to the severe form were investigated in the present study. Methods: This was a retrospective cohort study that included adult LP patients admitted to a 2,700-bed referral center between January 2005 and December 2019. Results: A total of 155 patients were identified during the study period; 58 patients (37.4%) initially presented with severe pneumonia and 97 (62.6%) patients with non-severe pneumonia. Among the 97 patients, 28 (28.9%) developed severe pneumonia during hospitalization and 69 patients (71.1%) recovered without progression to severe pneumonia. Multivariate logistic regression analysis showed platelet count ≤150,000/mm3 (odds ratio [OR], 2.923; 95% confidence interval [CI], 1.100–8.105; P=0.034) and delayed antibiotic treatment >1 day (OR, 3.092; 95% CI, 1.167–8.727; P=0.026) were significant independent factors associated with progression to severe pneumonia. Conclusions: A low platelet count and delayed antibiotic treatment were significantly associated with the progression of non-severe LP to severe LP.

Citations

Citations to this article as recorded by  
  • Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia
    Elliott Worku, Dominic Adam Worku, Salim Surani
    Case Reports in Infectious Diseases.2023; 2023: 1.     CrossRef
  • Short- and long-term prognosis of patients with community-acquired Legionella or pneumococcal pneumonia diagnosed by urinary antigen testing
    Leyre Serrano, Luis Alberto Ruiz, Silvia Perez-Fernandez, Pedro Pablo España, Ainhoa Gomez, Beatriz Gonzalez, Ane Uranga, Sonia Castro, Milagros Iriberri, Rafael Zalacain
    International Journal of Infectious Diseases.2023; 134: 106.     CrossRef
  • Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia
    Chunhong Bu, Shuai Lei, Linguang Chen, Yanqiu Xie, Guoli Zheng, Liwei Hua
    Frontiers in Medicine.2023;[Epub]     CrossRef
Pediatrics
Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit
Song-I Lee, Younsuck Koh, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim
Acute Crit Care. 2022;37(3):372-381.   Published online August 4, 2022
DOI: https://doi.org/10.4266/acc.2022.00066
  • 3,643 View
  • 230 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Background
Korea is rapidly becoming a super aging society and is facing the increased burden of critical care for the elderly people. Traditionally, far-advanced age has been regarded as a triage criterion for intensive care unit (ICU) admission. We evaluated how the characteristics and prognostic factors of very elderly patients (≥85 years) admitted to the ICU changed over the last decade.
Methods
We retrospectively evaluated the data of patients admitted to the ICU over 11 years (2007–2017). The clinical characteristics and outcomes of the very elderly-patients group were evaluated. Factors associated with mortality were assessed by a cox regression analysis.
Results
Comparing the first half (2007–2012) and the second half (2013–2017) of the study period, the proportion of very elderly group increased from 603/47,657 (1.3%), to 697/37,756 (1.8%) (P<0.001). Among 1,294 very elderly patients, 1,274 patients were analyzed excluding hopeless discharge (n=20). The non-surgical reasons for ICU admission (67.0% vs. 76.1%, P<0.001) and the percentage of patients with co-morbidities (78.3% vs. 82.7%, P=0.048) were increased. Nevertheless, the hospital mortality decreased (21.3% vs. 14.9%, P=0.001). High creatinine levels, use of vasopressors and ventilator weaning failure were associated with in-hospital mortality.
Conclusions
The proportion of very elderly people in the ICU increased over the last decade. The non-surgical causes of ICU admission increased compared with the surgical causes. Despite an increasement in ICU admissions of very elderly patients, in-hospital mortality of very elderly ICU patients decreased.

Citations

Citations to this article as recorded by  
  • Chronicles of change for the future: The imperative of continued data collection in French ICUs
    Takashi Tagami
    Anaesthesia Critical Care & Pain Medicine.2023; 42(5): 101294.     CrossRef
  • We need a comprehensive intensive care unit management strategy for older patients
    Dong-Ick Shin
    Acute and Critical Care.2022; 37(3): 468.     CrossRef
Ethics
Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission
Youjin Chang, Kyoung Ran Kim, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim
Acute Crit Care. 2021;36(4):351-360.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00283
  • 5,004 View
  • 136 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Background
It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception.
Methods
A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state.
Results
A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group were 64%, 22%, and 57%, respectively; their 6-month mortality rates were 100%, 46%, and 81%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3, odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892–8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260–19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162–17.121; P=0.029).
Conclusions
The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization.

Citations

Citations to this article as recorded by  
  • Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study
    Carla Marchini Dias da Silva, Bruno Adler Maccagnan Pinheiro Besen, Antônio Paulo Nassar Jr
    Journal of Critical Care.2024; 79: 154468.     CrossRef
  • Characteristics, ICU Interventions, and Clinical Outcomes of Patients With Palliative Care Triggers in a Mixed Community-Based Intensive Care Unit
    Michele M. Iguina, Aunie M. Danyalian, Ilko Luque, Umair Shaikh, Sanaz B. Kashan, Dionne Morgan, Daniel Heller, Mauricio Danckers
    Journal of Palliative Care.2023; 38(2): 126.     CrossRef
  • Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients
    Carla Marchini Dias Silva, Janaina Naiara Germano, Anna Karolyne de Araujo Costa, Giovanna Alves Gennari, Pedro Caruso, Antonio Paulo Nassar Jr
    Internal and Emergency Medicine.2023; 18(4): 1191.     CrossRef
  • Can the intensivists predict the outcomes of critically ill patients on the appropriateness of intensive care unit admission for limited intensive care unit resources ?
    SeungYong Park
    Acute and Critical Care.2021; 36(4): 388.     CrossRef
Pulmonary
Effects of high-flow nasal cannula in patients with mild to moderate hypercapnia: a prospective observational study
Kyung Hun Nam, Hyung Koo Kang, Sung-Soon Lee, So-Hee Park, Sung Wook Kang, Jea Jun Hwang, So Young Park, Won Young Kim, Hee Jung Suh, Eun Young Kim, Ga Jin Seo, Younsuck Koh, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim
Acute Crit Care. 2021;36(3):249-255.   Published online July 26, 2021
DOI: https://doi.org/10.4266/acc.2020.01102
  • 6,201 View
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  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Evidence for using high-flow nasal cannula (HFNC) in hypercapnia is still limited. Most of the clinical studies had been conducted retrospectively, and there had been conflicting reports for the effects of HFNC on hypercapnia correction in prospective studies. Therefore, more evidence is needed to understand the effect of the HFNC in hypercapnia.
Methods
We conducted a multicenter prospective observational study after applying HFNC to 45 hospitalized subjects who had moderate hypercapnia (arterial partial pressure of carbon dioxide [PaCO2], 43–70 mm Hg) without severe respiratory acidosis (pH <7.30). The primary outcome was a change in PaCO2 level in the first 24 hours of HFNC use. The secondary outcomes were changes in other parameters of arterial blood gas analysis, changes in respiration rates, and clinical outcomes.
Results
There was a significant decrease in PaCO2 in the first hour of HFNC application (-3.80 mm Hg; 95% confidence interval, -6.35 to -1.24; P<0.001). Reduction of PaCO2 was more prominent in subjects who did not have underlying obstructive lung disease. There was a correction in pH, but no significant changes in respiratory rate, bicarbonate, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio. Mechanical ventilation was not required for 93.3% (42/45) of our study population.
Conclusions
We suggest that HFNC could be a safe alternative for oxygen delivery in hypercapnia patients who do not need immediate mechanical ventilation. With HFNC oxygenation, correction of hypercapnia could be expected, especially in patients who do not have obstructive lung diseases.

Citations

Citations to this article as recorded by  
  • Safety and efficacy of high flow nasal canula in patients with mild hypercapnia
    Mohammed A. Ibrahim, Magdy Emara, Mohammed Shehta
    The Egyptian Journal of Bronchology.2023;[Epub]     CrossRef
  • Current status of treatment of acute respiratory failure in Korea
    Yong Jun Choi, Jae Hwa Cho
    Journal of the Korean Medical Association.2022; 65(3): 124.     CrossRef
  • High-flow nasal cannula: Evaluation of the perceptions of various performance aspects among Chinese clinical staff and establishment of a multidimensional clinical evaluation system
    Ruoxuan Wen, Xingshuo Hu, Tengchen Wei, Kaifei Wang, Zhimei Duan, Zhanqi Zhao, Lixin Xie, Fei Xie
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • The Application Progress of HFNC in Respiratory Diseases
    迪 吴
    Advances in Clinical Medicine.2022; 12(11): 10617.     CrossRef
Erratum
Pulmonary
Erratum to “Global and regional ventilation during high flow nasal cannula in patients with hypoxia”
Dong Hyun Lee, Eun Young Kim, Ga Jin Seo, Hee Jung Suh, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim
Acute Crit Care. 2021;36(2):173-173.   Published online May 28, 2021
DOI: https://doi.org/10.4266/acc.2017.00507.e1
Corrects: Acute Crit Care 2018;33(1):7
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  • 64 Download
PDF
Case Report
Pulmonary
Central extracorporeal membrane oxygenation and early rehabilitation for persistent severe pulmonary hypertension following pulmonary endarterectomy
Gil Myeong Seong, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Jae Won Lee, Sung-Ho Jung, Duck-Woo Park, Jae Seung Lee
Acute Crit Care. 2019;34(2):158-164.   Published online November 7, 2018
DOI: https://doi.org/10.4266/acc.2016.01032
  • 5,924 View
  • 122 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Chronic thromboembolic pulmonary hypertension is potentially curable with a pulmonary endarterectomy. However, approximately 20% of patients have persistent pulmonary hypertension after pulmonary endarterectomy, which is a major risk factor for postoperative death. Here, we report a 34-year-old woman who suffered persistent severe pulmonary hypertension following a successful pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) and atrial septostomy were successfully performed as rescue treatments, and active rehabilitation during ECMO was prescribed to facilitate recovery.

Citations

Citations to this article as recorded by  
  • Transatrial balloon atrial septostomy to facilitate weaning off venoarterial ECMO after pulmonary endarterectomy
    Koray Ak, Gökhan Arslanhan, Yakup Tire, Sinan Tosun, Alper Kararmaz, İsmail Hanta, Bedrettin Yıldızeli
    The International Journal of Artificial Organs.2022; 45(10): 883.     CrossRef
  • Cardiac Rehabilitation in Heart Failure
    Kyeong-hyeon Chun, Seok-Min Kang
    International Journal of Heart Failure.2021; 3(1): 1.     CrossRef
Original Articles
Basic science and research
Anti-inflammatory Role of Mesenchymal Stem Cells in an Acute Lung Injury Mouse Model
Jin Won Huh, Won Young Kim, Yun Young Park, Chae-Man Lim, Younsuck Koh, Mi-Jung Kim, Sang-Bum Hong
Acute Crit Care. 2018;33(3):154-161.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2018.00619
  • 6,135 View
  • 189 Download
  • 9 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
Background
Mesenchymal stem cells (MSCs) attenuate injury in various lung injury models through paracrine effects. We hypothesized that intratracheal transplantation of allogenic MSCs could attenuate lipopolysaccharide (LPS)-induced acute lung injury (ALI) in mice, mediated by anti-inflammatory responses.
Methods
Six-week-old male mice were randomized to either the control or the ALI group. ALI was induced by intratracheal LPS instillation. Four hours after LPS instillation, MSCs or phosphate-buffered saline was randomly intratracheally administered. Neutrophil count and protein concentration in bronchoalveolar lavage fluid (BALF); lung histology; levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and macrophage inflammatory protein-2; and the expression of proliferation cell nuclear antigen (PCNA), caspase-3, and caspase-9 were evaluated at 48 hours after injury.
Results
Treatment with MSCs attenuated lung injury in ALI mice by decreasing protein level and neutrophil recruitment into the BALF and improving the histologic change. MSCs also decreased the protein levels of proinflammatory cytokines including IL-1β, IL-6, and TNF-α, but had little effect on the protein expression of PCNA, caspase-3, and caspase-9.
Conclusions
Intratracheal injection of bone marrow-derived allogenic MSCs attenuates LPSinduced ALI via immunomodulatory effects.

Citations

Citations to this article as recorded by  
  • The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats
    Georgios Geropoulos, Kyriakos Psarras, Maria Papaioannou, Vasileios Geropoulos, Argyri Niti, Christina Nikolaidou, Georgios Koimtzis, Nikolaos Symeonidis, Efstathios T. Pavlidis, Georgios Koliakos, Theodoros E. Pavlidis, Ioannis Galanis
    Journal of Personalized Medicine.2024; 14(1): 121.     CrossRef
  • Cyclic Phytosphingosine-1-Phosphate Primed Mesenchymal Stem Cells Ameliorate LPS-Induced Acute Lung Injury in Mice
    Youngheon Park, Jimin Jang, Jooyeon Lee, Hyosin Baek, Jaehyun Park, Sang-Ryul Cha, Se Bi Lee, Sunghun Na, Jae-Woo Kwon, Seok-Ho Hong, Se-Ran Yang
    International Journal of Stem Cells.2023; 16(2): 191.     CrossRef
  • Mesenchymal stem cells and their derived exosomes to combat Covid–19
    Maryam Yousefi Dehbidi, Nima Goodarzi, Mohammad H. Azhdari, Mohammad Doroudian
    Reviews in Medical Virology.2022;[Epub]     CrossRef
  • Stem Cell‐based therapies for COVID‐19‐related acute respiratory distress syndrome
    Hoi Wa Ngai, Dae Hong Kim, Mohamed Hammad, Margarita Gutova, Karen Aboody, Christopher D. Cox
    Journal of Cellular and Molecular Medicine.2022; 26(9): 2483.     CrossRef
  • Development of a physiomimetic model of acute respiratory distress syndrome by using ECM hydrogels and organ-on-a-chip devices
    Esther Marhuenda, Alvaro Villarino, Maria Narciso, Linda Elowsson, Isaac Almendros, Gunilla Westergren-Thorsson, Ramon Farré, Núria Gavara, Jorge Otero
    Frontiers in Pharmacology.2022;[Epub]     CrossRef
  • Advances in mesenchymal stromal cell therapy for acute lung injury/acute respiratory distress syndrome
    Chang Liu, Kun Xiao, Lixin Xie
    Frontiers in Cell and Developmental Biology.2022;[Epub]     CrossRef
  • Auxiliary role of mesenchymal stem cells as regenerative medicine soldiers to attenuate inflammatory processes of severe acute respiratory infections caused by COVID-19
    Peyvand Parhizkar Roudsari, Sepideh Alavi-Moghadam, Moloud Payab, Forough Azam Sayahpour, Hamid Reza Aghayan, Parisa Goodarzi, Fereshteh Mohamadi-jahani, Bagher Larijani, Babak Arjmand
    Cell and Tissue Banking.2020; 21(3): 405.     CrossRef
  • The Role of MSC Therapy in Attenuating the Damaging Effects of the Cytokine Storm Induced by COVID-19 on the Heart and Cardiovascular System
    Georgina M. Ellison-Hughes, Liam Colley, Katie A. O'Brien, Kirsty A. Roberts, Thomas A. Agbaedeng, Mark D. Ross
    Frontiers in Cardiovascular Medicine.2020;[Epub]     CrossRef
Pulmonary
Global and Regional Ventilation during High Flow Nasal Cannula in Patients with Hypoxia
Dong Hyun Lee, Eun Young Kim, Ga Jin Seo, Hee Jung Suh, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim
Acute Crit Care. 2018;33(1):7-15.   Published online January 22, 2018
DOI: https://doi.org/10.4266/acc.2017.00507
Correction in: Acute Crit Care 2021;36(2):173
  • 8,209 View
  • 250 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
High flow nasal cannula (HFNC) is known to increase global ventilation volume in healthy subjects. We sought to investigate the effect of HFNC on global and regional ventilation patterns in patients with hypoxia.
Methods
Patients were randomized to receive one of two oxygen therapies in sequence: nasal cannula (NC) followed by HFNC or HFNC followed by NC. Global and regional ventilation was assessed using electric impedance tomography.
Results
Twenty-four patients participated. Global tidal variation (TV) in the lung was higher during HFNC (NC, 2,241 ± 1,381 arbitrary units (AU); HFNC, 2,543 ± 1,534 AU; P < 0.001). Regional TVs for four iso-gravitational quadrants of the lung were also all higher during HFNC than NC. The coefficient of variation for the four quadrants of the lung was 0.90 ± 0.61 during NC and 0.77 ± 0.48 during HFNC (P = 0.035). Within the four gravitational layers of the lung, regional TVs were higher in the two middle layers during HFNC when compared to NC. Regional TV values in the most ventral and dorsal layers of the lung were not higher during HFNC compared with NC. The coefficient of variation for the four gravitational layers of the lung were 1.00 ± 0.57 during NC and 0.97 ± 0.42 during HFNC (P = 0.574).
Conclusions
In patients with hypoxia, ventilation of iso-gravitational regions of the lung during HFNC was higher and more homogenized compared with NC. However, ventilation of gravitational layers increased only in the middle layers. (Clinical trials registration number: NCT02943863).

Citations

Citations to this article as recorded by  
  • High-flow nasal cannulae for respiratory support in adult intensive care patients
    Sharon R Lewis, Philip E Baker, Roses Parker, Andrew F Smith
    Cochrane Database of Systematic Reviews.2021;[Epub]     CrossRef
  • Failure of High-Flow Nasal Cannula Therapy in Pneumonia and Non-Pneumonia Sepsis Patients: A Prospective Cohort Study
    Eunhye Kim, Kyeongman Jeon, Dong Kyu Oh, Young-Jae Cho, Sang-Bum Hong, Yeon Joo Lee, Sang-Min Lee, Gee Young Suh, Mi-Hyeon Park, Chae-Man Lim, Sunghoon Park
    Journal of Clinical Medicine.2021; 10(16): 3587.     CrossRef
  • High-flow nasal cannulae for respiratory support in adult intensive care patients
    Sharon R Lewis, Philip E Baker, Roses Parker, Andrew F Smith
    Cochrane Database of Systematic Reviews.2017;[Epub]     CrossRef
Hematology/Cardiology
Extracorporeal Membrane Oxygenation Support in Adult Patients with Hematologic Malignancies and Severe Acute Respiratory Failure
Tai Sun Park, You Na Oh, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Je-Hwan Lee, Jung-Hee Lee, Kyoo-Hyung Lee, Jin Won Huh
Korean J Crit Care Med. 2016;31(3):243-250.   Published online August 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00318
  • 8,827 View
  • 142 Download
  • 3 Crossref
AbstractAbstract PDF
Background
Administering extracorporeal membrane oxygenation (ECMO) to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO.
Methods
We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015.
Results
A total of 15 patients (9 men; median age 45 years) with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding). The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56).
Conclusions
Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.

Citations

Citations to this article as recorded by  
  • Extracorporeal membrane oxygenation in patients with hematologic malignancies: a systematic review and meta-analysis
    Jackie Jia Lin Sim, Saikat Mitra, Ryan Ruiyang Ling, Chuen Seng Tan, Bingwen Eugene Fan, Graeme MacLaren, Kollengode Ramanathan
    Annals of Hematology.2022; 101(7): 1395.     CrossRef
  • Extracorporeal Membrane Oxygenation with rituximab‐combined chemotherapy in AIDS‐associated primary cardiac lymphoma: A case report
    Hoyuri Fuseya, Takuro Yoshimura, Minako Tsutsumi, Yosuke Nakaya, Mirei Horiuchi, Masahiro Yoshida, Yoshiki Hayashi, Takafumi Nakao, Takeshi Inoue, Takahisa Yamane
    Clinical Case Reports.2021;[Epub]     CrossRef
  • Extracorporeal Life Support in Adult Patients with Hematologic Malignancies and Acute Circulatory and/or Respiratory Failure
    Sungbin Cho, Won Chul Cho, Ju Yong Lim, Pil Je Kang
    The Korean Journal of Thoracic and Cardiovascular Surgery.2019; 52(1): 25.     CrossRef
Ethics
Effect of Timing of Do-Not-Resuscitate Orders on the Clinical Outcome of Critically Ill Patients
Moon Seong Baek, Younsuck Koh, Sang-Bum Hong, Chae-Man Lim, Jin Won Huh
Korean J Crit Care Med. 2016;31(3):229-235.   Published online August 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00178
  • 11,413 View
  • 152 Download
  • 11 Crossref
AbstractAbstract PDF
Background
Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU.
Methods
We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission.
Results
Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001).
Conclusions
Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.

Citations

Citations to this article as recorded by  
  • Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study
    Song-I Lee, Ye-Rin Ju, Da Hyun Kang, Jeong Eun Lee
    BMC Palliative Care.2024;[Epub]     CrossRef
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    I. Vagliano, N. Dormosh, M. Rios, T.T. Luik, T.M. Buonocore, P.W.G. Elbers, D.A. Dongelmans, M.C. Schut, A. Abu-Hanna
    Journal of Biomedical Informatics.2023; 146: 104504.     CrossRef
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    Ting-Yu Hsu, Pei-Ming Wang, Po-Chun Chuang, Yan-Ren Lin, Yuan-Jhen Syue, Tsung-Cheng Tsai, Chao-Jui Li
    Healthcare.2022; 10(3): 434.     CrossRef
  • Early DNR in Older Adults Hospitalized with SARS-CoV-2 Infection During Initial Pandemic Surge
    Shalin Shah, Alex Makhnevich, Jessica Cohen, Meng Zhang, Allison Marziliano, Michael Qiu, Yan Liu, Michael A. Diefenbach, Maria Carney, Edith Burns, Liron Sinvani
    American Journal of Hospice and Palliative Medicine®.2022; 39(12): 1491.     CrossRef
  • The Impact of Signing Do-Not-Resuscitate Orders on the Use of Non-Beneficial Life-Sustaining Treatments for Intensive Care Unit Patients: A Retrospective Study
    Shang-Sin Shiu, Ting-Ting Lee, Ming-Chen Yeh, Yu-Chi Chen, Shu-He Huang
    International Journal of Environmental Research and Public Health.2022; 19(15): 9521.     CrossRef
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    WaleedTharwat Aletreby, AhmedF Mady, MohammedA Al-Odat, AhmedN Balshi, AnasA Mady, AdamM Al-Odat, AmiraM Elshayeb, AhmedF Mostafa, ShereenA Abd Elsalam, KrizL Odchigue
    Saudi Journal of Medicine and Medical Sciences.2022; 10(3): 192.     CrossRef
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    Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
    Acute and Critical Care.2020; 35(3): 179.     CrossRef
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    Gulcan Bakan, Mert Ozen, Arife Azak, Bulent Erdur
    International Emergency Nursing.2020; 53: 100934.     CrossRef
  • Do‐Not‐Resuscitate Orders in Older Adults During Hospitalization: A Propensity Score–Matched Analysis
    Karishma Patel, Liron Sinvani, Vidhi Patel, Andrzej Kozikowski, Christopher Smilios, Meredith Akerman, Kinga Kiszko, Sutapa Maiti, Negin Hajizadeh, Gisele Wolf‐Klein, Renee Pekmezaris
    Journal of the American Geriatrics Society.2018; 66(5): 924.     CrossRef
  • Changes in Life-sustaining Treatment in Terminally Ill Cancer Patients after Signing a Do-Not-Resuscitate Order
    Hyun A Kim, Jeong Yun Park
    The Korean Journal of Hospice and Palliative Care.2017; 20(2): 93.     CrossRef
  • The Authors Reply
    Jeong Uk Lim, Jongmin Lee, Jick Hwan Ha, Hyeon Hui Kang, Sang Haak Lee, Hwa Sik Moon
    The Korean Journal of Critical Care Medicine.2017; 32(4): 377.     CrossRef
Case Reports
Infection
Septic Shock due to Unusual Pathogens, Comamonas testosteroni and Acinetobacter guillouiae in an Immune Competent Patient
Hyun Jung Kim, Yunkyoung Lee, Kyunghwan Oh, Sang-Ho Choi, Heungsup Sung, Jin Won Huh
Korean J Crit Care Med. 2015;30(3):180-183.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.180
  • 21,224 View
  • 85 Download
  • 6 Crossref
AbstractAbstract PDF
Comamonas testosteroni and Acinetobacter guillouiae are gram-negative bacilli of low virulence that are widely distributed in nature and normal flora. Despite their common occurrence in environments, they rarely cause infectious disease. We experienced a case of septic shock by C. testosterone and A. guillouiae, and isolated them by 16S ribosomal RNA sequencing method from the blood cultures of a previous healthy female during postoperative supportive care. This is the first case of septic shock required ventilator care and continuous renal replacement therapy due to these organisms in Korea.

Citations

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  • An investigation of clinical characteristics and antimicrobial agent susceptibility patterns in clinical Comamonas testosteroni isolates: An increasingly prevalent nosocomial pathogen
    Bahadır Orkun Ozbay, Adalet Aypak, Aliye Bastug, Ömer Aydos, İpek Mumcuoglu, Sevim Gayenur Büyükberber, Ayşe Müge Karcıoğlu, Hurrem Bodur
    Infectious Diseases Now.2023; 53(2): 104622.     CrossRef
  • Bullfrogs (Lithobates catesbeianus) as a Potential Source of Foodborne Disease
    Andrea P. Zepeda-Velazquez, Fabián-Ricardo Gómez-De-Anda, Luis F. Aguilar-Mendoza, Nayeli Shantal Castrejón-Jiménez, Juan Carlos Hernández-González, Jorge A. Varela-Guerrero, Jorge-Luis de-la-Rosa-Arana, Vicente Vega-Sánchez, Nydia E. Reyes-Rodríguez
    Journal of Food Protection.2023; 86(4): 100067.     CrossRef
  • The Emergence of the Genus Comamonas as Important Opportunistic Pathogens
    Michael P. Ryan, Ludmila Sevjahova, Rachel Gorman, Sandra White
    Pathogens.2022; 11(9): 1032.     CrossRef
  • A rare case of peritoneal dialysis‐associated peritonitis caused by Comamonas testosteroni
    Roman Kuźniewicz, Mirosław Śnit, Dariusz Szczyra
    Seminars in Dialysis.2022; 35(6): 556.     CrossRef
  • The complex pattern of codon usage evolution in the family Comamonadaceae
    Eugenio Jara, María A. Morel, Guillermo Lamolle, Susana Castro-Sowinski, Diego Simón, Andrés Iriarte, Héctor Musto
    Ecological Genetics and Genomics.2018; 6: 1.     CrossRef
  • First microbiota assessments of children's paddling pool waters evaluated using 16S rRNA gene-based metagenome analysis
    Toko Sawabe, Wataru Suda, Kenshiro Ohshima, Masahira Hattori, Tomoo Sawabe
    Journal of Infection and Public Health.2016; 9(3): 362.     CrossRef
Infection
Polymyxin B Hemoperfusion in Pneumonic Septic Shock Caused by Gram-Negative Bacteria
Jung-Wan Yoo, Su Yeon Park, Jin Jeon, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Korean J Crit Care Med. 2015;30(3):171-175.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.171
  • 4,812 View
  • 84 Download
AbstractAbstract PDF
Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.
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
  • 6,525 View
  • 98 Download
  • 3 Crossref
AbstractAbstract 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

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  • 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/Pulmonary
Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation
Jin Jeon, Jin Won Huh, Chae Man Lim, Younsuck Koh, Sang Bum Hong
Korean J Crit Care Med. 2014;29(3):212-216.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.212
  • 6,109 View
  • 66 Download
  • 1 Crossref
AbstractAbstract PDF
Acute respiratory distress syndrome (ARDS) is a severe lung disease associated with high mortality despite recent advances in management. Significant advances in extracorporeal membrane oxygenation (ECMO) devices and management allow short-term support for patients with acute reversible respiratory failure and can serve as a bridge to transplantation in patients with irreversible respiratory failure. When ARDS does not respond to conventional treatment, ECMO and the interventional lung assist membrane (iLA) are the most widely used complementary treatment options. Here, we report a clinical case of an adult patient who required prolonged duration venovenous (VV)-ECMO for severe ARDS resulting in improvement while waiting for lung transplantation.

Citations

Citations to this article as recorded by  
  • Treatment of acute respiratory failure: extracorporeal membrane oxygenation
    Jin-Young Kim, Sang-Bum Hong
    Journal of the Korean Medical Association.2022; 65(3): 157.     CrossRef
Original Article
Usefulness of Screening Criteria System Used by Medical Alert Team in a General Hospital
Hyejin Joo, So Hee Park, Sang Bum Hong, Chae Man Lim, Younsuck Koh, Young Seok Lee, Jin Won Huh
Korean J Crit Care Med. 2012;27(3):151-156.
DOI: https://doi.org/10.4266/kjccm.2012.27.3.151
  • 3,129 View
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  • 4 Crossref
AbstractAbstract PDF
BACKGROUND
Rapid response team (RRT) is becoming an essential part of patient safety by the early recognition and management of patients on general hospital wards. In this study, we analyzed the usefulness of screening criteria of RRT used at Asan Medical Center.
METHODS
On a retrospective basis, we reviewed the records of 675 cases in 543 patients that were managed by RRT (called medical alert team in the Asan Medical Center), from July 2011 to December 2011. The medical alert team was acted by requests of attending doctors or nurses or the medical alert system (MAS) criteria composed of abnormal vital sign, neurology, laboratory data and increasing oxygen demand. We investigated the patterns of MAS criteria for targeting the patients who were managed by the medical alert team.
RESULTS
Respiratory distress (RR > 25/min) was the most common item for identifying patients whose condition had worsened. The criteria consist with respiratory distress and abnormal blood pressure (mean BP < 60 mmHg or systolic BP < 90 mmHg) found 70.0% of patients with deteriorated conditions. Vital sign (RR > 25/min, mean BP < 60 mmHg or systolic BP < 90 mmHg, pulse rate, PR > 130/min or < 50/min) and oxygen demand found 79.2% of them. Vital signs, arterial blood gas analysis (ABGA) with lactate level (pH, pO2, pCO2, and lactate) and O2 demand found 98.6% of patient conditions had worsened.
CONCLUSIONS
Vital signs, especially RR > 25/min is useful criteria for detecting patients whose conditions have deteriorated. The addition of ABGA data with lactate levels leads to a more powerful screening tool.

Citations

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  • Influence of the Rapid Response Team Activation via Screening by Nurses on Unplanned Intensive Care Unit Admissions
    Ye-Ji Huh, Seongmi Moon, Eun Kyeung Song, Minyoung Kim
    Korean Journal of Adult Nursing.2020; 32(5): 539.     CrossRef
  • Early Experience of Medical Alert System in a Rural Training Hospital: a Pilot Study
    Maru Kim
    The Korean Journal of Critical Care Medicine.2017; 32(1): 47.     CrossRef
  • Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in‐hospital cardiac arrest
    HyunSoo Oh, KangIm Lee, WhaSook Seo
    Journal of Advanced Nursing.2016; 72(5): 1122.     CrossRef
  • A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock
    Jung-Wan Yoo, Ju Ry Lee, Youn Kyung Jung, Sun Hui Choi, Jeong Suk Son, Byung Ju Kang, Tai Sun Park, Jin-Won Huh, Chae-Man Lim, Younsuck Koh, Sang Bum Hong
    The Korean Journal of Internal Medicine.2015; 30(4): 471.     CrossRef

ACC : Acute and Critical Care