Acute and Critical Care

Kyeongman Jeon

14 Articles

Cardiology/Pulmonary
Complicated Pulmonary Pseudocyst Following Traumatic Lung Injury Rescued by Extracorporeal Membrane Oxygenation: Sung Bum Park, Dae Sang Lee, Jeong Am Ryu, Jong Ho Cho, Yang Hyun Cho, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Gee Young Suh, Chi Min Park; Korean J Crit Care Med. 2014;29(3):201-206. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.201

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Abstract PDF: Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma that usually appears immediately in children or young adults and is characterized by a single or multiple pulmonary cystic lesions on chest radiography and has spontaneous resolution of the radiologic manifestations. However, we experienced a case of a delayed complicated pulmonary pseudocyst in a 17-year-old boy following severe traumatic acute respiratory distress syndrome rescued by Veno-venous extracorporeal membrane oxygenation (ECMO). In this case, the pseudocyst appeared on the 12th day after trauma and transformed into an infected cyst. Veno-venous ECMO was successfully maintained for 20 days without anticoagulation.

Cardiology
Use of Extracorporeal Membrane Oxygenation for Optimal Organ Donation: Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Chi Min Park, Gee Young Suh; Korean J Crit Care Med. 2014;29(3):194-196. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.194

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We report a case of extracorporeal membrane oxygenation (ECMO) support for donor organ preservation in a brain-dead patient following out-of-hospital cardiac arrest. A 43-year-old male patient was referred to the emergency department after an out-of-hospital cardiac arrest caused by ventricular fibrillation. Spontaneous circulation was restored after 8 minutes of cardiopulmonary resuscitation. ECMO was implemented because of hemodynamic deterioration. The patient then underwent coronary angiography and was implanted with a drug-eluting stent because of occlusion at the proximal portion of the right coronary artery. After 144 hours, brain death was established, and ECMO support for optimal oxygen delivery was sustained until organ retrieval after consent for donation was received from the family. Liver and kidneys were successfully transplanted to three recipients, respectively.

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Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination
Sung Wook Chang, Sun Han, Jung Ho Ko, Jae-Wook Ryu
Korean Journal of Critical Care Medicine.2016; 31(2): 169. CrossRef
The Use of Extracorporeal Circulation in Suspected Brain Dead Organ Donors with Cardiopulmonary Collapse
Hyun Lee, Yang Hyun Cho, Kiick Sung, Jeong Hoon Yang, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh
Journal of Korean Medical Science.2015; 30(12): 1911. CrossRef

Gastroenterology/Pulmonary
Respiratory Complications Associated with Insertion of Small-Bore Feeding Tube in Critically Ill Patients: Jeong Am Ryu, Joongbum Cho, Sung Bum Park, Daesang Lee, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Gee Young Suh, Chi Min Park; Korean J Crit Care Med. 2014;29(2):131-136. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.131

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Abstract PDF

Small-bore flexible feeding tubes decrease the risk of ulceration of the nose, pharynx, and stomach compared with large-bore and more rigid tubes. However, small-bore feeding tubes have more respiratory system complications, such as pneumothorax, hydropneumothorax, bronchopleural fistula, and pneumonia, which are associated with significant morbidity and mortality. Thus, it is important to confirm the correct position of feeding tubes. Chest X-ray is the gold standard to detect tracheal malpositioning of the feeding tube. We present three cases in which intubated patients exhibited an altered mental state. An assistant guide wire was used at the insertion of small-bore feeding tubes. These conditions are thought to be potential risk factors for tracheobronchial malpositioning of feeding tubes.

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Clinical usefulness of capnographic monitoring when inserting a feeding tube in critically ill patients: retrospective cohort study
Jeong-Am Ryu, Kyoungjin Choi, Jeong Hoon Yang, Dae-Sang Lee, Gee Young Suh, Kyeongman Jeon, Joongbum Cho, Chi Ryang Chung, Insuk Sohn, Kiyoun Kim, Chi-Min Park
BMC Anesthesiology.2016;[Epub] CrossRef
Nutritional Assessment of ICU Inpatients with Tube Feeding
Yu-Jin Kim, Jung-Sook Seo
Journal of the Korean Dietetic Association.2015; 21(1): 11. CrossRef
Respiratory Complications of Small-Bore Feeding Tube Insertion in Critically Ill Patients
Kyoung-Jin Choi, Jeong-Am Ryu, Chi-Min Park
JOURNAL OF ACUTE CARE SURGERY.2015; 5(1): 28. CrossRef

Body Mass Index and Outcomes in Patients with Severe Sepsis or Septic Shock: Minjung Kathy Chae, Dae Jong Choi, Tae Gun Shin, Kyeongman Jeon, Gee Young Suh, Min Seob Sim, Keun Jeong Song, Yeon Kwon Jeong, Ik Joon Jo; Korean J Crit Care Med. 2013;28(4):266-271.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.266

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Abstract PDF

BACKGROUND
The aim of this study was to investigate the association between body mass index (BMI) and survival in patients with severe sepsis or septic shock.
METHODS
We analyzed the sepsis registry of patients presenting to the emergency department (ED) of a tertiary urban hospital and meeting the criteria for severe sepsis or septic shock from August 2008 to March 2012. We categorized patients into the underweight group (BMI < 18.5 kg/m2), the normal weight group (18.5 < or = BMI < 25 kg/m2) and the obese group (BMI > or = 25 kg/m2). Then, we analyzed the registry to evaluate the relation between obesity and in-hospital mortality.
RESULTS
A total of 770 adult patients with severe sepsis and septic shock were analyzed. In-hospital mortality rate of the underweight group (n = 86), the normal weight group (n = 489) and the obese group (n = 195) was 22.1%, 15.3% and 16.4%, respectively. In a multivariate regression analysis, the underweight group had a significant association with in-hospital mortality compared with the normal weight group (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.68-1.87; p = 0.028). The obese group showed no significant difference in mortality (OR, 2.04; 95% CI, 1.08-3.86; p = 0.65).
CONCLUSIONS
The underweight patients showed significantly higher mortality than the normal weight patients with severe sepsis and septic shock.

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Association of body mass index with mortality of sepsis or septic shock: an updated meta-analysis
Le Bai, Jingyi Huang, Dan Wang, Dongwei Zhu, Qi Zhao, Tingyuan Li, Xianmei Zhou, Yong Xu
Journal of Intensive Care.2023;[Epub] CrossRef
Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years
Sung Jin Park, Dong Heon Kim, Chang In Choi, Sung Pil Yun, Jae Hun Kim, Hyung Il Seo, Hong Jae Jo, Tae Yong Jun
Annals of Surgical Treatment and Research.2016; 91(1): 45. CrossRef

Airway Obstruction and Respiratory Failure Due to Aspergillus Tracheobronchitis: Yousang Ko, So Yeon Lim, Gee Young Suh, Kyeongman Jeon, Seo Goo Han; Korean J Crit Care Med. 2013;28(1):67-71.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.67

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Abstract PDF

Invasive aspergillosis is a serious threat and a leading cause of death in immunocompromised patients. Aspergillus tracheobronchitis is an infrequent but severe form of invasive pulmonary aspergillos in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We report an extraordinary case of acute airway obstruction and respiratory failure due to Aspergillus tracheobronchitis in an immunocompromised patient. Fiberoptic bronchoscopy revealed extensive obstruction of both the main and lobar bronchus with yellowish nodules strongly adhered to the bronchial wall; both histologic examination and culture of these nodules revealed Aspergillus fumigatus. Even with early detection of an intraluminal growth of Aspergillus and prompt institution of antifungal therapy, the patient died of refractory hypoxemia a few days later. This report shows that Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis.

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Death due to Aspergillus Tracheobronchitis: An Autopsy Case
Tack Kune You, Byung Ha Choi, Bong Woo Lee, Young Shik Choi
Korean Journal of Legal Medicine.2018; 42(4): 164. CrossRef

A Case of Purulent Pericarditis Complicated by Klebsiella pneumoniae Sepsis - A Case Report -: Byeong Ho Jeong, Seungmin Chung, Hee Jin Kwon, Kyeongman Jeon; Korean J Crit Care Med. 2013;28(1):51-55.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.51

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Abstract PDF: Although the incidence of purulent pericarditis has decreased significantly in the modern antibiotic era, purulent pericarditis remains a life-threatening disease. Therefore, a high index of clinical suspicion should be maintained to diagnose this life-threatening illness at an early stage. We report an extraordinary case of purulent pericarditis, caused by Klebsiella pneumoniae bacteremia, which developed during the recovery of septic shock with urinary tract infection. Despite of early diagnosis and pericardial drainage, in addition to adequate antibiotics, the patient subsequently developed multiple organ failure leading to death. The case highlights that purulent pericarditis is a rare yet possible disorder complicated from septic shock with bacteremia in the antibiotic era. Therefore, purulent pericarditis should always be considered as a possible complication, especially in patients with K. pneumoniae bacteremia and progressive cardiomegaly.

Favorable Outcomes in Septic Shock Patients without Hyperlactatemia or Severe Organ Failure: Sung Jong Roh, Tae Gun Shin, Kyeongman Jeon, Gee Young Suh, Min Seob Sim, So Yeon Lim, Mun Ju Kang, Keun Jeong Song, Yeon Kwon Jeong, Ik Joon Jo; Korean J Crit Care Med. 2012;27(4):224-229.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.224

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Abstract PDF: BACKGROUND
Septic shock is a pathophysiologic state of circulatory failure with tissue hypoperfusion. However, it is usually defined as sepsis-induced hypotension not responding to fluid resuscitation, regardless of the objective findings of tissue hypoperfusion such as lactic acidosis or organ failures. Numerous patients with sepsis-induced hypotension present to the emergency department without hyperlactemia or severe organ failure. Hence, we investigated the clinical characteristics and outcomes of patients with septic shock according to the presence of hyperlactatemia or significant organ failure.
METHODS
We conducted a retrospective observational study of adult patients presenting with septic shock in the emergency department of a tertiary care hospital between August 2008 and July 2010. Initial serum lactate was categorized low (<2.5 mmol/L) and high (> or =2.5 mmol/L). Organ failure was assessed by the Sequential Organ Failure Assessment (SOFA) score. Primary outcome measurement was in-hospital mortality.
RESULTS
A total of 227 patients were enrolled. There were 88 (38.8%) patients in the low lactate group, and 139 (61.2%) patients in the high lactate group. Patients with low lactate levels showed a lower mortality rate (6.8% compared with 25.1% of those with high lactate level). The low lactate group showed less rapid heart rate, less severe organ failures and shorter length of stay in the intensive care unit. During the early goal-directed therapy, they required a smaller amount of fluid administration and a lower dose of norepinephrine although other hemodynamic variables were similarly maintained. In particular, if patients showed less severe organ dysfunction (SOFA score < 8) in the low lactate group (n = 45), in-hospital mortality was 0% (adjusted mortality was 1.3% [95% confidence interval = 0.3-5.0]).
CONCLUSION
Patients with septic shock, who were enrolled according to the traditional definition, showed a very favorable outcome if they did not have hyperlactatemia or significant organ failure.

A Case of Successful Natural Stenting in Tracheobronchial Restenosis with Malignant Tumor after Metallic Stenting: Goohyeon Hong, Kyeongman Jeon, Sang Won Um, Won Jung Koh, Gee Young Suh, Man Pyo Chung, O Jung Kwon, Hojoong Kim; Korean J Crit Care Med. 2012;27(2):111-114.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.111

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Abstract PDF: Tracheal tumors are very rare disease, which may cause dyspnea, obstructive pneumonia and life-threatening hypoxemia, depending on the site of the lesion and the severity of the narrowing. Such patients frequently die within hours or days due to suffocation. Patients who expressed upper airway stenosis, should be secured the airways prior to the diagnosis and treatment commonly. Then, treatment plan should be determined. For the relief of such stenosis, various modalities of therapy including surgery, laser photoresection, balloon dilatation and sometimes stent insertion have been used. Tracheobronchial stent insertion has been a good therapeutic option in these patients in point of avoiding morbidities associated with surgery. We report a case of repeated tracheobronchial stenosis by infiltrating tumor mass after metallic stent insertion in a 48-year-old man. The patient was treated successfully by Natural stent insertion with rigid bronchoscopy after removal of previous inserted metallic stent.

Safety and Feasibility of Percutaneous Tracheostomy Performed by Medical Intensivists: Hongseok Yoo, So Yeon Lim, Chi Min Park, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2011;26(4):261-266.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.261

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Abstract PDF

BACKGROUND
Tracheostomy is one of the most commonly performed surgical procedures in the intensive care unit (ICU). After its introduction, percutaneous dilatational tracheostomy (PDT) has been recognized in western countries as a reliable alternative to surgical tracheostomy. However, data on the safety and feasibility of PDT performed by medical intensivists are limited in Korea.
METHODS
To evaluate the safety and feasibility of PDT performed by medical intensivists and to compare with those of surgical tracheostomy (ST), we retrospectively analyzed the clinical characteristics of all prospectively registered patients who underwent either PDT or ST in medical ICU from December 2010 to July 2011.
RESULTS
A total of 81 patients underwent tracheostomy over the study period: PDT in 56 (69%) and ST in 25 (31%). One patient in whom major bleeding developed during PDT underwent ST as a substitute for PDT. There were no differences in the demographics, laboratory findings, and parameters of mechanical ventilation between the two groups. Procedure time was significantly shorter in the PDT group (20 [IQR 18-30] min) than that in the ST group (38 [27.5-57.5] min) (p < 0.001). The major complication observed in 24 hours after PDT was bleeding in 6 (11%) patients of the PDT group and 4 (16%) patients of the ST group (p = 0.489). However, surgical interventions for major bleeding were required in 2 patients who underwent.
CONCLUSIONS
PDT performed by medical intensivists was safe and feasible. However, immediate surgical assistance should be available when required.

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Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by a Neurointensivist Compared with Conventional Surgical Tracheostomy in Neurosurgery Intensive Care Unit
John Kwon, Yong Oh Kim, Jeong-Am Ryu
Journal of Neurointensive Care.2019; 2(2): 64. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Is Percutaneous Dilatational Tracheostomy Safe to Perform in the Intensive Care Unit?
Jae Hwa Cho
Korean Journal of Critical Care Medicine.2014; 29(2): 57. CrossRef
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents
Sung-Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2014; 29(3): 183. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by Intensive Care Trainee
Daesang Lee, Chi Ryang Chung, Sung Bum Park, Jeong-Am Ryu, Joongbum Cho, Jeong Hoon Yang, Chi-Min Park, Gee Young Suh, Kyeongman Jeon
Korean Journal of Critical Care Medicine.2014; 29(2): 64. CrossRef
A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy
Ji Young Park, Taehoon Lee, Hongyeul Lee, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Korean Journal of Critical Care Medicine.2013; 28(3): 184. CrossRef

Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate: Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2011;26(2):78-82.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.78

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Abstract PDF: BACKGROUND
Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis and septic shock. However, there are only a few studies on the association of serum lactate levels and prognosis in septic shock patients with initial low lactate levels.
METHODS
To evaluate whether initial and follow-up lactate levels associated with mortality in septic shock patients with low lactate level, we conducted a retrospective observational study of patients with septic shock, who were hospitalized through the emergency department in February-July 2008. Initial lactate level was stratified as low (<4 mmol/L) or high (> or =4 mmol/L). The primary outcome was 28-day mortality and multiple logistic regression analysis was used to adjust for potential confounders in the association between lactate clearance and mortality.
RESULTS
Of 90 patients hospitalized with septic shock during the study period, 68 (76%) patients had low initial lactate. Mortality at 28 days was 18% in patients with low lactate level. In these patients, initial lactate level was not associated with mortality (p = 0.590). However, increased lactate at follow-up and lactate clearance were associated with mortality (p = 0.006, p = 0.002, respectively). In a multiple logistic regression analysis, increased mortality rate independently associated with age (OR 1.162, 95% CI 1.041-1.298) and lactate clearance (OR 0.654, 95% CI 0.498-0.859).
CONCLUSIONS
In septic shock patients with a low lactate level, lactate clearance independently associated with a decreased mortality rate. Therefore, lactate clearance could be useful for predicting the outcome in these patients.

Extreme Drug Resistant Acinetobacter Nosocomial Ventilator-Associated Pneumonia Treated Successfully with Tigecycline and Amikacin in Intensive Care Unit: A Case Report: So Yeon Lim, So Young Park, Kyeongman Jeon, Gee Young Suh, Suhyun Kim, Kyong Ran Peck, Doo Ryeon Chung; Korean J Crit Care Med. 2009;24(3):176-180.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.176

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Abstract PDF

Infections due to multidrug resistant Acinetobacter baumannii have become a challenging problem in intensive care units. Tigecycline is a derivative of minocyline, and has provided new hope for the treatment of multidrug-resistant A. baumannii infections. Because isolates showing reduced susceptibility to minocycline or tigecycline have emerged in many countries, empirical combination therapy has become common practice to treat patients infected with extreme drug-resistant A. baumannii. Herein we report a case of extreme drug-resistant A. baumannii infection successfully treated with tigecycline and amikacin.

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Clinical Characteristics in Patients with Carbapenem-ResistantAcinetobacter baumanniiIsolates from Tracheal Secretions
Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye-Kyung Park, Min Ki Lee
Korean Journal of Critical Care Medicine.2013; 28(3): 173. CrossRef

Severe Health-care Associated Pneumonia among the Solid Cancer Patients on Chemotherapy: Maeng Real Park, So Young Park, Kyeongman Jeon, Won Jung Koh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Gee Young Suh, Jin Seok Ahn, Myung Ju Ahn, Ho Yeong Lim; Korean J Crit Care Med. 2009;24(3):140-144.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.140

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Abstract PDF: BACKGROUND
There are only inadequate studies on the characteristics of severe pneumonia in the patients who have solid cancer and who are treated with cytotoxic chemotherapy and also on the usefulness of the various severity index scores.
METHODS
We retrospectively reviewed 31 patients who were treated with cytotoxic chemotherapy because of solid cancer and who were admitted to the medical ICU at Samsung Medical Center from April 2007 to August 2008.
RESULTS
The median age of the 31 patients was 64 years old (34-79). The types of solid cancer were lung cancer (19, 61.3%), gastroesophageal cancer (4, 12.9%), breast cancer (2, 6.5%), liver cancer (1, 3.2%), ovarian cancer (1, 3.2%) and other types of cancer (4, 12.9%). The hospital mortality rate was 64.5%. We were able to determine the pathogen of 19 (61.3%) patients; S. pneumoniae (6), S. aureus (3), Candida species (3), P. aeruginosa (2), K. pneumoniae (1), Pneumocystis jiroveci (1) and others (3). There were no statistically differences of the laboratory data and severity index scores (PSI, CURB-65, APACHE II, SOFA, SAPS 3) between the survivors and nonsurvivors, except the P/F ratio.
CONCLUSIONS
The hospital mortality rate of severe pneumonia in patients who had solid cancer and who received cytotoxic chemotherapy was high. The major pathogen was S. pneumoniae. The severity indexes for general pneumonia were not useful to these patients.

Effect of the Neutrophil Elastase Inhibitor on Acute Lung Injury after Pulmonary Resection for Lung Cancer: A Preliminary Study: So Young Park, Sunghoon Park, Kyeongman Jeon, So Yeon Lim, Maeng Real Park, Sueah Kim, Jae Uk Song, Jhin Gook Kim, O Jung Kwon, Gee Young Suh; Korean J Crit Care Med. 2009;24(3):124-128.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.124

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Abstract PDF: BACKGROUND
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are the leading causes of death after lungresection. Neutrophil elastase is thought to be an important mediator in the pathogenesis of ALI. Sivelestat is a new neutrophil elastase inhibitor which may improve the outcome in patients with ALI/ARDS after lung resection. The objective of this study was to determine whether or not sivelestat can reduce mortality in patients with ALI after pulmonary resection for lung cancer.
METHODS
This study was a retrospective case-control study of twenty three patients who developed ALI/ARDS within seven days of lung resection for lung cancer. The control group (n = 12) received standard care, while the sivelestat group (n = 11) received a continuous infusion of sivelestat (0.2 mg/kg/hr) for seven days in addition to standard care.
RESULTS
There was no significant difference in the baseline characteristics between the control and sivelestat groups, except for heart rate. Six of twelve patients (50%) in the control group survived, while seven of twelve patients (64%) survived in the sivelestat group (p = 0.34). There was also no significant difference between the two groups in the progression to ARDS. In the sivelelestat group, survivors had lower APACHE II and SOFA scores than the patients in the control group.
CONCLUSIONS
There was no additional effect of a neutrophil elastase inhibitor in the treatment of ALI after pulmonary resection for lung cancer.

A Preliminary Study on the Effect of "Low-dose" Glucocorticoid Therapy for Patients with Persistent Acute Respiratory Distress Syndrome: Hae Seong Nam, Maeng Real Park, So Young Park, So Yeon Lim, Su A Kim, Jae Uk Song, Kyeongman Jeon, Hojoong Kim, O Jung Kwon, Gee Young Suh; Korean J Crit Care Med. 2009;24(2):80-86.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.80

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Abstract PDF

BACKGROUND
The role of glucocorticoids for treating persistent acute respiratory distress syndrome (ARDS) is matter of debate. In the previous studies, the side effects of moderate doses of glucocorticoids might have negated positive effects of glucocorticoids. This study aimed at determining the feasibility of administering "low-dose" glucocorticoid to treat the patients who suffer with persistent ARDS.
METHODS
We retrospectively reviewed the medical records of twelve patients with ARDS of at least seven days' duration and who were treated with "low-dose" glucocorticoid (starting dose of 1 mg/kg) between June 2007 to December 2008. The patients were divided by whether or not they were successfully weaned from the ventilator after glucocorticoid therapy. The baseline characteristics and physiologic parameters were recorded for up to 7 days after starting glucocorticoid therapy.
RESULTS
Five patients (42%) were included in the weaned group. There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups on the day of ARDS. Yet the weaned group had a significantly lower Sequential Organ Failure Assessment (SOFA) score, as compared to that of the failed group [3 (3-6) vs 8 (5-12), p = 0.009)] at start of glucocorticoid treatment. After 3 days of glucocorticoid therapy, there was significant improvement in the PEEP, the PaO2/FIO2 ratio, the PCO2, the SOFA score and the Murray Lung Injury Score of the weaned group, as compared to that of the failed group. There were no major neuromuscular side effects from the therapy.
CONCLUSIONS
This study suggests that the "low-dose" glucocorticoid therapy is feasible and that the SOFA score and the physiologic parameters may assist in determining whether or not to initiate and to continue glucocorticoid therapy for the patients who are suffering with persistent ARDS.

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A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage
Han Min Lee, Jae-Seok Park, Jae Yun Kim, Ji Yeon Lee, Byung Kyu Ahn, Hyo-Wook Gil, Jae-Sung Choi
Tuberculosis and Respiratory Diseases.2012; 72(2): 177. CrossRef
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Suhyun Kim, Na Ree Kang, In Sohn, Heon Lee, Yoon Kyung Lee, Sook Hee Song
The Korean Journal of Critical Care Medicine.2010; 25(2): 112. CrossRef

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