Acute and Critical Care

Volume 25 (2); June 2010

Review

Antioxidants in Sepsis: Jae Yeol Kim; Korean J Crit Care Med. 2010;25(2):57-60.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.57

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Oxidant byproducts, such as superoxide anion (O2-) and hydrogen peroxide are produced as a consequence of normal aerobic metabolism. Because they are highly reactive with other biologic molecules, such as protein, DNA, and lipids, they are called as reactive oxygen species (ROS). Fortunately, our body is equipped with numerous potent endogenous antioxidants. Oxidative stress is caused by an imbalance between the production of ROS and the biologic scavenger system, antioxidants. Oxidative-induced damage has been considered to be one of the underlying mechanisms that contribute to multiple organ failure in sepsis. Both enzymatic and nonenzymatic antioxidants have been widely tested in human and animals with sepsis. However, the disappointing results of N-acetylcysteine (NAC), which is the most extensively tested antioxidant may reflect the inability to reestablish a redox balance in the setting of sepsis in patients. Still, three antioxidants demonstrated clinical benefits and reached level A evidence; selenium improves clinical outcome (infections, organ failure); glutamine reduces infectious complication in large-sized trials; and omega-3-fatty acids have significant anti-inflammatory effects. Other antioxidants are still on the clinical benchmark level, awaiting well-designed clinical trial.

Citations

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The Crucial Role of Xanthine Oxidase in CKD Progression Associated with Hypercholesterolemia
You-Jin Kim, Se-Hyun Oh, Ji-Sun Ahn, Ju-Min Yook, Chan-Duck Kim, Sun-Hee Park, Jang-Hee Cho, Yong-Lim Kim
International Journal of Molecular Sciences.2020; 21(20): 7444. CrossRef
Design of an accelerator-driven subcritical dual fluid reactor for transmutation of actinides
Sang-in Bak, Seung-Woo Hong, Yacine Kadi
The European Physical Journal Plus.2019;[Epub] CrossRef
Effect of Intravenous High-Dose Selenium Supplementation in Patients with Systemic Inflammatory Response Syndrome: A Pilot Study
Mi-Jeoung Kim, Ki-Jong Lee, In-Myung Oh, Dong-Hyun Oh, Kyoung-Hwa Yoo, Ju-Sang Park, Eun-Jeong Jang, Sang-Jong Park, Sang-Woon Park, Sang-Jung Kim, Hyun Wook Baik
Korean Journal of Medicine.2013; 84(4): 531. CrossRef
Effects of Atractylodis Rhizoma Pharmacopuncture on an Acute Gastric Mucosal Lesion Induced by Compound 48/80 in Rats
Yun-Kyu Lee, Jae-Soo Kim, Seong-Chul Lim
Journal of Pharmacopuncture.2012; 15(1): 12. CrossRef
Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock
Jin Kyeong Park, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh
The Korean Journal of Critical Care Medicine.2011; 26(1): 13. CrossRef

Randomized Controlled Trial

The Efficacy of Early Goal-directed Therapy in Septic Shock Patients in the Emergency Department: Severe Sepsis Campaign: Hyung Jin Shin, Kang Hyun Lee, Sung Oh Hwang, Hyun Kim, Tae Yong Shin, Sang Chul Kim; Korean J Crit Care Med. 2010;25(2):61-70.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.61

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Abstract PDF

BACKGROUND
Early goal-directed therapy (EGDT) has been used for patients with severe sepsis and septic shock in the emergency department (ED). In 2003, international management guidelines for severe sepsis and septic shock were developed under the auspices of the Surviving Sepsis Campaign (SSC); however, EGDT based on the SSC was not fully evaluated in the ED. The purpose of this study was to evaluate the efficacy of EGDT based on the SSC in the ED in Korea.
METHODS
We randomly assigned patients who arrived at our ED in septic shock to receive EGDT before admission to the intensive care unit between May 2007 and July 2007, and we retrospectively assigned patients in septic shock to receive standard therapy between May 2006 and July 2006. The in-hospital mortality for 24 hours and 28 days, the MODS, SAPS II, and APACHE II scores were obtained and compared between the study groups.
RESULTS
Of the 60 enrolled patients, 30 were assigned to EGDT and 30 were assigned to standard therapy. There was no significant difference between the groups with respect to the baseline characteristics. In-hospital mortality at 28 days was 13% in the group assigned to EGDT as compared to 40% in the group assigned to standard therapy (p = 0.020) and in-hospital mortality at 24 hours was 0% and 13%, respectively (p = 0.038).
CONCLUSIONS
EGDT provides significant benefits with respect to outcome in patients in septic shock.

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Early goal-directed resuscitation for patients with severe sepsis and septic shock: a meta-analysis and trial sequential analysis
Li-bing Jiang, Mao Zhang, Shou-yin Jiang, Yue-feng MA
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2016;[Epub] CrossRef
The Prognostic Factors of Pneumonia with Septic Shock in Patients Presenting to the Emergency Department
Jong Won Kim, Jin Joo Kim, Hyuk Jun Yang, Yong Su Lim, Jin Seong Cho, In Cheol Hwang, Sang Hyun Han
The Korean Journal of Critical Care Medicine.2015; 30(4): 258. CrossRef
Implementing a Sepsis Resuscitation Bundle Improved Clinical Outcome: A Before-and-After Study
Jeongmin Kim, Sungwon Na, Young Chul Yoo, Shin Ok Koh
Korean Journal of Critical Care Medicine.2014; 29(4): 250. CrossRef
A Case of Purulent Pericarditis Complicated byKlebsiella pneumoniaeSepsis - A Case Report -
Byeong-Ho Jeong, Seungmin Chung, Hee Jin Kwon, Kyeongman Jeon
Korean Journal of Critical Care Medicine.2013; 28(1): 51. CrossRef

Original Articles

Effect of Admission Time to the Medical Intensive Care Unit on Acute Critical Patient Outcomes: Taejin Park, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2010;25(2):71-75.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.71

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Abstract PDF

BACKGROUND
The initial management of acute critical patients is important. However, not all hospital facilities and staff are available during off-duty time. We determined the effects of intensive care unit (ICU) admission time on patient outcomes.
METHODS
This retrospective cohort study was conducted in a 28-bed medical ICU in 1 tertiary university hospital. Patients who were admitted between 1 March 2009 and 31 August 2009 were divided according to the time of admission into the "duty time group" (9 AM-5 PM on weekdays) and the "off-duty time group" (5 PM-9 AM on weekdays and at any time on weekends). The baseline characteristics and clinical outcomes were compared between these two groups. The primary endpoint of this study was hospital mortality; the secondary endpoints were ICU mortality and length of ICU stay, hospital length of stay, and mechanical ventilation time.
RESULTS
Two hundred eight (64.8%) of 321 enrolled patients were admitted during off-duty time. The baseline characteristics between the 2 groups were not significantly different. Hospital mortality was 37 (32.7%) in the "duty time group" and 82 (38.4%) in the "off-duty time group" (p = 0.237). There were no significant differences in secondary endpoints between the two groups.
CONCLUSIONS
Off-duty time admission to the ICU had no effect on hospital and ICU mortality, length of hospital and ICU stay, and mechanical ventilation time compared to duty time admission.

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Validity and Reliability of the Korean Version of the Partners In Health Scale (PIH-K)
Mi-Kyeong Jeon, Jung-Won Ahn, Yeon-Hwan Park, Mi-Kyoung Lee
Journal of Korean Critical Care Nursing.2019; 12(2): 1. CrossRef
Analysis of Risk Factors to Predict Intensive Care Unit Transfer in Medical in-Patients
Ju Ry Lee, Hye Ran Choi
Journal of Korean Biological Nursing Science.2014; 16(4): 259. CrossRef
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 Journal of Critical Care Medicine.2012; 27(3): 151. CrossRef

The Effect of Emergency Department Treatment Time on Outcomes in Acute Stroke Patients: Dong Wook Lee, Eui Chung Kim, Ok Jun Kim, Sung Wook Choi, Young Tae Park, Yun Kyung Cho; Korean J Crit Care Med. 2010;25(2):76-82.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.76

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Abstract PDF: BACKGROUND
Stroke is a disease that leads to a long period of disability and death. Accordingly, the initial treatment is so influential on the prognosis of a patient that shortening the time to initial treatment after hospital admission has a very important role in the entire treatment regimen. This study aimed to demonstrate the effect of the Emergency Department treatment time at Bundang CHA Hospital for acute stroke patients to improve the treatment regimen through six sigma activities.
METHODS
The outcomes for 246 patients with suspected acute strokes who were admitted to the Emergency Department of Bundang CHA Hospital, the flow of the emergency department process divided into 11 phases, and the duration of each phase were determined. Patients were classified as before and after six sigma activities and compared.
RESULTS
The five phases statistically demonstrated the effect of meaningful improvement in the duration of visit-receiving CT prescriptions, visit-receiving lab prescriptions, consult request-arriving to the emergency department, visit-CT angiography results, and visit-the issue of hospital admissions. In the next 2 phases, the sigma level also improved by 0.71sigma and 0.06sigma. However, the total emergency department stay time was not statistically meaningful. The time required time was increased and the sigma level was decreased by 0.19sigma.
CONCLUSIONS
The result of six sigma activities showed the effect of the treatment system improvement with a partial decrease in the duration of each phase, but the total emergency department stay time was not improved owing to environmental factors. For better results, continuous improvement of the treatment system and expansion of hospital facilities will be required.

Epidemiological Characteristics Based on the Underlying Diseases for the Deaths Related to Pandemic H1N1 Influenza in Korea: Hagyung Lee, Yung A Kang, Hyun Su Kim, Su Yeun Shin, Jun Heung Kim, Jin Seok Kim, Sang Bum Hong; Korean J Crit Care Med. 2010;25(2):83-88.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.83

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Abstract PDF

BACKGROUND
Since May 2009, a pandemic influenza A (H1N1) virus has emerged and spread nationwide. We describe the epidemiological characteristics of the confirmed deaths related with the 2009 H1N1 influenza pandemic in Korea from May 2009 to mid December 2009.
METHODS
This study was based on an analysis of the reports from the deaths of confirmed cases pandemic H1N1 virus until 7 December 2009 in Korea. These reports were compiled by the epidemic intelligence team at the Korea Centers for Disease Control & Prevention (KCDC) or at the provinces. The epidemic intelligence team used an identical, well-defined investigate form for reviewing the medical records and for interviewing the physicians in charge of the cases.
RESULTS
The first confirmed death occurred on August 15, 2009. Until December 7, 2009, 139 deaths had been reported. Eighty cases (57.6%) were individuals more than 60 years old. Sixty two cases (47.0%) were dead within 7 days from the onset of symptoms. One hundred three cases (74%) had underlying diseases, and cancer was the most common underlying disease. The proportion of patients using antivial medications before confirmation among the patients with underlying diseases was greater than the proportion of patients using antivial medications among the patients with no underlying diseases.
CONCLUSIONS
During the evaluation period, serious underlying diseases were present in nearly three quarters of the cases of confirmed death. We suggest that health providers consider using antiviral drugs before confirmation of pandemic H1N1 in hospitalized patients, and especially in those with underlying diseases.

Citations

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Clinical Features of Hospitalized Patients with Community Acquired Pneumonia during 2009 Influenza A (H1N1) Pandemic
Myung Jae Yun, Seong Tae Lee, Hye Jin Oh, Seung June Lee, Sook Hee Song, In Sohn, Jae Phil Choi, Su Hyun Kim
The Korean Journal of Critical Care Medicine.2011; 26(3): 162. CrossRef
Pandemic Influenza (H1N1 2009) among Pregnant Korean Women
Baek-Nam Kim, Yee Gyung Kwak, Chi-Sook Moon, Yeon-Sook Kim, Eu Suk Kim, Kkot Sil Lee, Chang-Seop Lee, Ji-An Hur
Infection & Chemotherapy.2011; 43(1): 55. CrossRef
A Fatal Case in Pregnant Woman Infected by H1N1 2009 in Korea
Ji An Hur
Infection and Chemotherapy.2011; 43(2): 225. CrossRef

Case Reports

Successful Heart Transplantation after Dobutamine, Glucose-insulin-potassium, and Hormone Therapy in a Hemodynamically Unstable Cadaveric Heart Donor: A Case Report: So Yeon Kim, Shin Ok Koh, Young Chul Yoo, Ha Kyoung Kim, Tae Jin Yun, Eun Ji Chang, Sungwon Na; Korean J Crit Care Med. 2010;25(2):89-92.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.89

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Abstract PDF

The major limitation to heart transplantation is the shortage of donor organs. In order to increase the cardiac donor pool, it is important to maintain stable hemodynamics and closely monitor cardiac function in cadaveric organ donors or potent donors. Recently, management of a potential cardiac donor pool has focused on aggressive hemodynamic management protocols and dobutamine stress echocardiography. In our case, management with low dose dobutamine, glucose-insulin-potassium (GIK), and hormone therapy reversed heart failure following brain death and the heart was successfully transplanted. We suggest that aggressive hemodynamic management with low-dose dobutamine, GIK, and hormone therapy can result in the recruitment of more cadaveric hearts in marginal conditions.

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Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination
Eun Young Kim, Ji Hyun Kim
The Korean Journal of Critical Care Medicine.2016; 31(3): 236. CrossRef

Neurogenic-stunned Myocardium and Pulmonary Edema Following a Ruptured Cerebral Aneurysm: A Case Report: Sung Ha Mun, Won Joon Choi, Jeong Min Mok, Jae Young Yang, Chul Ho Woo; Korean J Crit Care Med. 2010;25(2):93-97.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.93

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Abstract PDF

We report a case of neurogenic cardiopulmonary instability with pulmonary edema occurring after an aneurysmal subarachnoid hemorrhage. The patient's pre-operative Glasgow coma scale score was 6 and the PA chest radiograph showed increased diffuse haziness in the right lung field. The patient presented with severe hypotension and low oxygen saturation during surgery. Cardiac damage was documented by increased CK-MB troponin-T levels, and ischemic ECG findings. Reversible cardiac failure associated with subarachnoid hemorrhage may be due to a neurogenic-stunned myocardium. The patient underwent clipping of the aneurysm and recovered with minimal neurologic impairment and normal cardiac function.

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A Retrospective Study about Characteristics of Out-of-hospital Cardiac Arrest Caused by Non-traumatic Subarachnoid Hemorrhage
Min Seob Sim, Ki Dong Sung, Mun Ju Kang, Ji Ung Na, Tae Gun Shin, Ik Joon Jo, Hyoung Gon Song, Keun Jeong Song, Yeon Kwon Jeong
The Korean Journal of Critical Care Medicine.2011; 26(3): 151. CrossRef

Negative Pressure Pulmonary Edema and Hemorrhage after Extubation: A Case Report: Yoon Suk Ra, Chi Hyo Kim, Jong In Han, Dong Yeon Kim; Korean J Crit Care Med. 2010;25(2):98-103.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.98

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Abstract PDF

Negative pressure pulmonary edema (NPPE) is a rare complication of acute airway obstruction which develops after endotracheal extubation. The proposed mechanism is generation of very low negative pressure during laryngospasm by inspiratory efforts, which leads to alveolar exudation and hemorrhage. The diagnosis of NPPE is confirmed by clinical findings of tachypnea, pink prothy sputum in the endotracheal tube, hypoxemia on arterial blood gas analysis, and distinctive radiologic findings. NPPE is usually self-limited within 48 hours when diagnosed early and treated appropriately. We report three patients who recovered from NPPE without complications.

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Negative pressure pulmonary edema after endotracheal tube extubation during recovery of general anesthesia in a pediatric patient with cerebral palsy
Hyun Jung Kim, Sun Kyung Park
Allergy, Asthma & Respiratory Disease.2022; 10(4): 229. CrossRef

Delayed Splenic Rupture with a 1-month Latent Period after Minor Trauma: A Case Report: Jong Seok Lee, Oh Young Kwon, Han Sung Choi, Hoon Pyo Hong, Young Gwan Ko; Korean J Crit Care Med. 2010;25(2):104-106.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.104

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Abstract PDF

Delayed splenic rupture is a rare complication of blunt abdominal trauma in which the time interval from injury to splenic rupture is > 48 hours. The diagnosis can be challenging if the history of trauma is remote, or initially missed, because symptoms may present subtly and without classic historical associations. We report a case of delayed rupture of the spleen from remote, minor trauma that required an emergency splenectomy.

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Delayed splenic rupture presenting 70 days following blunt abdominal trauma
Nancy Resteghini, Jonpaul Nielsen, Matthew L. Hoimes, Adib R. Karam
Clinical Imaging.2014; 38(1): 73. CrossRef

Airway Obstruction Caused by Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion: A Case Report: Ja Hyun Ku, Eun Su Park, Young Su Lim; Korean J Crit Care Med. 2010;25(2):107-111.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.107

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Abstract PDF: Acute airway obstruction after anterior cervical surgery is rare, but does occur. Airway obstruction due to prevertebral soft tissue swelling is unpredictable, but potentially lethal. We managed a 67-year-old male who developed acute airway obstruction caused by marked prevertebral soft tissue swelling on the first day after anterior cervical discectomy and fusion at the C4-C5 level.

Acute Respiratory Distress Syndrome with Chemical Pneumonitis after Aspiration of Activated Charcoal: A Case Report: Suhyun Kim, Na Ree Kang, In Sohn, Heon Lee, Yoon Kyung Lee, Sook Hee Song; Korean J Crit Care Med. 2010;25(2):112-117.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.112

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Abstract PDF

Charcoal has been commonly used for enteral detoxication although it causes few adverse effects. The major causes of morbidity and mortality secondary to activated charcoal therapy are pulmonary aspiration, gastrointestinal complication, and fluid and electrolyte abnormalities. Aspiration of charcoal is associated with pulmonary compromise due to increased microvascular permeability with concomitant lung edema, surfactant depletion, atelectasis, and obliterative bronchiolitis. Herein we report the case of a patient with acute respiratory distress syndrome with chemical pneumonitis after aspiration of activated charcoal in sorbitol with a review of the related literatures.

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Five Successful Experiences in the Treatment of Charcoal Aspiration with Bronchoscopic Toilet - A Case Report -
Young Il Kim, Jae-Seok Park, Jae Sung Choi, Sung-Shik Jou, Hyo-Wook Gil, Sae-Yong Hong
Korean Journal of Critical Care Medicine.2012; 27(3): 202. CrossRef
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

A Sheared Catheter Fragment in the Wrist after Arterial Cannulation Attempt: A Case Report: Sue Young Lee, Hyo Seok Na, Mi Hyun Kim, Chong Soo Kim, Young Tae Jeon, Jung Won Hwang, Sang Hwan Do; Korean J Crit Care Med. 2010;25(2):118-121.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.118

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Abstract PDF

Continuous measurement of arterial pressure is frequently required in the perioperative management of critically ill patients and major surgeries. The complications following arterial cannulation include hematoma, thrombosis, ischemia, infection, aneurysm formation at the site of catheter insertion, and so on. The authors report a case of the sheared catheter during the arterial cannulation and the subsequent surgical removal of its remnant.

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Fracture of an Intravenous Cannula in the Hand: A Case Report
Seungho Woo, Sangun Nah, Giwoon Kim, Sangsoo Han
Journal of Emergency Nursing.2023; 49(2): 156. CrossRef
Iatrogenic catheter sheath shearing during radial artery cannulation
Il-Seok Kim, Ho Kyun Shin, Dae Yu Kim
Korean Journal of Anesthesiology.2013; 65(6 Suppl): S12. CrossRef
A retained catheter fragment in radial artery caused by accidental catheter transection during arterial catheter removal
Seung-Ki Moon, Jae-Chul Gong, Jun-Hyun Kim, Kyu Chang Lee, Hye Young Kim, Eun Kyung Choi, Myeong Jong Lee
Journal of Anesthesia.2012; 26(4): 625. CrossRef

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