Acute and Critical Care

Original Articles

Pulmonary
Reduction of PaCO₂ by high-flow nasal cannula in acute hypercapnic respiratory failure patients receiving conventional oxygen therapy: Hyun Woo Lee, Sun Mi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee; Acute Crit Care. 2019;34(3):202-211. Published online August 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00563

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Background
It has been suggested that a high-flow nasal cannula (HFNC) could help to remove carbon dioxide (CO₂) from anatomical dead spaces, but evidence to support that is lacking. The objective of this study was to elucidate whether use of an HFNC could reduce the arterial partial pressure of CO₂ (PaCO₂) in patients with acute hypercapnic respiratory failure who are receiving conventional oxygen (O₂) therapy.
Methods
A propensity score-matched observational study was conducted to evaluate patients treated with an HFNC for acute hypercapnic respiratory failure from 2015 to 2016. The hypercapnia group was defined as patients with a PaCO₂ >50 mm Hg and arterial pH <7.35.
Results
Eighteen patients in the hypercapnia group and 177 patients in the nonhypercapnia group were eligible for the present study. Eighteen patients in each group were matched by propensity score. Decreased PaCO₂ and consequent pH normalization over time occurred in the hypercapnia group (P=0.002 and P=0.005, respectively). The initial PaCO₂ level correlated linearly with PaCO₂ removal after the use of an HFNC (R²=0.378, P=0.010). The fraction of inspired O₂ used in the intensive care unit was consistently higher for 48 hours in the nonhypercapnia group. Physiological parameters such as respiratory rate and arterial partial pressure of O₂ improved over time in both groups.
Conclusions
Physiological parameters can improve after the use of an HFNC in patients with acute hypercapnic respiratory failure given low-flow O₂ therapy via a facial mask. Further studies are needed to identify which hypercapnic patients might benefit from an HFNC.

Citations

Citations to this article as recorded by

Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in patients with head and neck cancer
Jun-Young Jo, Jungpil Yoon, Heeyoon Jang, Wook-Jong Kim, Seungwoo Ku, Seong-Soo Choi
Acute and Critical Care.2024; 39(1): 61. CrossRef
Efficacy and safety of high-flow nasal cannula therapy in elderly patients with acute respiratory failure
J.M. Carratalá, S. Diaz-Lobato, B. Brouzet, P. Más-Serrano, J.L.S. Rocamora, A.G. Castro, A.G. Varela, S.M. Alises
Pulmonology.2023;[Epub] CrossRef
Successful noninvasive ventilation in a severely acidotic and hypercapnic comatose COVID-19 patient with multiple comorbidities: a case report
Joseph Abraham Poonuraparampil, Habib Md Reazaul Karim, Manu P Kesavankutty, Porika Prashanth Nayak
Acute and Critical Care.2022; 37(1): 120. CrossRef
Comparison of Conventional Oxygen Therapy With High-Flow Nasal Oxygenation in the Management of Hypercapnic Respiratory Failure
Jitendra Pratap Singh, Deepak Malviya, Samiksha Parashar, Soumya Sankar Nath, Archana Gautam, Neha Shrivastava
Cureus.2022;[Epub] CrossRef
Current Considerations in Emergency Airway Management
Andrew Pirotte, Vivek Panchananam, Matthew Finley, Austin Petz, Tom Herrmann
Current Emergency and Hospital Medicine Reports.2022; 10(4): 73. CrossRef
S/F and ROX indices in predicting failure of high‐flow nasal cannula in children
Ji Hye Kim, Dong In Suh, June Dong Park
Pediatrics International.2022;[Epub] CrossRef
Nasal High‐flow Oxygen Versus Conventional Oxygen Therapy for Acute Severe Asthma Patients: A Pilot Randomized Controlled Trial
Onlak Ruangsomboon, Chok Limsuwat, Nattakarn Praphruetkit, Apichaya Monsomboon, Tipa Chakorn, Brian C. Hiestand
Academic Emergency Medicine.2021; 28(5): 530. CrossRef
Flow Field Analysis of Adult High-Flow Nasal Cannula Oxygen Therapy
Jingen Xia, Jiaqi Chang, Jixiang Liang, Yixuan Wang, Na Wang, Bo Xiao
Complexity.2021; 2021: 1. CrossRef
Treatment of Severe Acute on Chronic Liver Failure
Aarshi Vipani, Christina C. Lindenmeyer, Vinay Sundaram
Journal of Clinical Gastroenterology.2021; 55(8): 667. CrossRef
Efficacy of High-Flow Nasal Cannula Oxygen Therapy in Patients with Mild Hypercapnia
Lingling Su, Qinyu Zhao, Taotao Liu, Yujun Xu, Weichun Li, Aiping Zhang
Lung.2021; 199(5): 447. CrossRef
High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study
SooHyun Bae, Minkyu Han, Changyoung Kim, Hyeji Lee, Jong-Joon Ahn, Jin Hyoung Kim, Byung Ju Kang
Journal of Korean Medical Science.2020;[Epub] CrossRef
High-flow nasal cannula oxygen therapy as an emerging option for respiratory failure: the present and the future
Lucia Spicuzza, Matteo Schisano
Therapeutic Advances in Chronic Disease.2020; 11: 204062232092010. CrossRef
Impact of High-Flow Nasal Cannula on Arterial Blood Gas Parameters in the Emergency Department
Emre Şancı, Feride Ercan Coşkun, Basak Bayram
Cureus.2020;[Epub] CrossRef

Pulmonary
Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study: Joohae Kim, Sun Mi Choi, Jinwoo Lee, Young Sik Park, Chang Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee; Korean J Crit Care Med. 2017;32(2):154-163. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00976

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29 Web of Science
32 Crossref

Abstract PDF

Background
Acute respiratory distress syndrome (ARDS) remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE) inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS) blockage on the prognosis of patients with ARDS.
Methods
We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU) at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching.
Results
A total of 182 patients were included in the study. Thirty-seven patients (20.3%) took ACE inhibitor or angiotensin receptor blocker (ARB) during ICU admission, and 145 (79.7%) did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166). The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013) and longer ICU stay (32.1 vs. 20.2 days, P < 0.001). In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001).
Conclusions
ACE inhibitor or ARB may have beneficial effect on ARDS patients.

Citations

Citations to this article as recorded by

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A propensity score‐matching analysis of angiotensin‐converting enzyme inhibitor and angiotensin receptor blocker exposure on in‐hospital mortality in patients with acute respiratory failure
Yi‐Peng Fang, Xin Zhang
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.2022; 42(5): 387. CrossRef
The Renin-Angiotensin System as a Component of Biotrauma in Acute Respiratory Distress Syndrome
Katharina Krenn, Verena Tretter, Felix Kraft, Roman Ullrich
Frontiers in Physiology.2022;[Epub] CrossRef
ACE2-like enzyme B38-CAP suppresses abdominal sepsis and severe acute lung injury
Takafumi Minato, Tomokazu Yamaguchi, Midori Hoshizaki, Satoru Nirasawa, Jianbo An, Saori Takahashi, Josef M. Penninger, Yumiko Imai, Keiji Kuba, Yu Ru Kou
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Tidal Volume–Dependent Activation of the Renin-Angiotensin System in Experimental Ventilator-Induced Lung Injury*
Xinjun Mao, Katharina Krenn, Thomas Tripp, Verena Tretter, Roman Reindl-Schwaighofer, Felix Kraft, Bruno K. Podesser, Yi Zhu, Marko Poglitsch, Oliver Domenig, Dietmar Abraham, Roman Ullrich
Critical Care Medicine.2022; 50(9): e696. CrossRef
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International Journal of Chronic Obstructive Pulmonary Disease.2022; Volume 17: 2001. CrossRef
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Rukhsana Gul, Uh-Hyun Kim, Assim A. Alfadda
European Journal of Pharmacology.2021; 890: 173656. CrossRef
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Murat Oz, Dietrich Ernst Lorke, Nadine Kabbani
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Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis
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Thorax.2021; 76(5): 479. CrossRef
Evaluation of expression of VDR-associated lncRNAs in COVID-19 patients
Mohammad Taheri, Lina Moallemi Rad, Bashdar Mahmud Hussen, Fwad Nicknafs, Arezou Sayad, Soudeh Ghafouri-Fard
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Mechanisms of Damage to the Cardiovascular System in COVID-19
Alexandr Y. Fisun, Yuriy V. Lobzin, Dmitry V. Cherkashin, Vadim V. Tyrenko, Konstantin N. Tkachenko, Vasilii A. Kachnov, Gennadiy G. Kutelev, Ignat V. Rudchenko, Alexey D. Sobolev
Annals of the Russian academy of medical sciences.2021; 76(3): 287. CrossRef
Coronavirus Disease 2019 (COVID-19) Infection and Renin Angiotensin System Blockers
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Andrew M. South, Debra I. Diz, Mark C. Chappell
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COVID-19: The Influence of ACE Genotype and ACE-I and ARBs on the Course of SARS-CoV-2 Infection in Elderly Patients

Jerzy Sieńko, Maciej Kotowski, Anna Bogacz, Kacper Lechowicz, Sylwester Drożdżal, Jakub Rosik, Marek Sietnicki, Magdalena Sieńko, Katarzyna Kotfis
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Coronavirus Disease 2019 and Hypertension: The Role of Angiotensin-Converting Enzyme 2 and the Renin-Angiotensin System
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Pulmonary/Quality Improvement
Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea: Junghyun Kim, Jungkyu Lee, Sunmi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee; Korean J Crit Care Med. 2016;31(1):25-33. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.25

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Abstract PDF

Background:
The number of elderly patients admitted to intensive care units (ICUs) is growing with the increasing proportion of elderly persons in the Korean general population. It is often difficult to make decisions about ICU care for elderly patients, especially when they are in their 90s. Data regarding the proportion of elderly patients in their 90s along with their clinical characteristics in ICU are scarce.
Methods
The records of Korean patients ≥ 90 years old who were admitted to the medical ICU in a tertiary referral hospital between January 2005 and December 2014 were retrospectively reviewed. We compared the trend in ICU use and characteristics of these elderly patients between 2005-2009 and 2010-2014.
Results
Among 6,186 referred patients, 55 aged ≥ 90 years were admitted to the medical ICU from 2005 to 2014. About 58.2% of these patients were male, and their mean age was 92.7 years. Their median Charlson comorbidity index score was 2 (IQR 1-3) and their mean APACHE II score was 25.0 (IQR 19.0-34.0). The most common reason for ICU care was acute respiratory failure. There were no differences in the survival rates between the earlier and more recent cohorts. However, after excluding patients who had specified “do not resuscitate” (DNR), the more recent group showed a significantly higher survival rate (53.8% mortality for the earlier group and 0% mortality for the recent group). Among the survivors, over half were discharged to their homes. More patients in the recent cohort (n=26 [78.8%]) specified DNR than in the earlier cohort (n=7 [35.0%], p=0.004). The number and proportion of patients ≥ 90 years old among patients using ICU during the 2005-2014 study period did not differ.
Conclusions
The use of ICU care by elderly patients ≥ 90 years old was consistent from 2005-2014. The overall mortality rate tended to decrease, but this was not statistically significant. However, the proportion of patients specifying DNR was higher among more recent patients, and the recent group showed an even better survivorship after sensitivity analysis excluded patients specifying DNR.

Citations

Citations to this article as recorded by

Evaluating the effect of age on postoperative and clinical outcomes in patients admitted to the intensive care unit after gastrointestinal cancer surgery
Jee Yeon Lee, Hyejeong Park, Mi Kyoung Kim, Im-kyung Kim
Surgery.2022; 172(4): 1270. CrossRef
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 and Critical Care.2022; 37(3): 372. CrossRef

Determination of the Cause of Pleural Effusion in ICU Patients with Thoracentesis: Tae Yun Park, Jinwoo Lee, Young Sik Park, Chang Hoon Lee, Jae Joon Yim, Chul Gyu Yoo, Young Whan Kim, Sung Koo Han, Seok Chul Yang, Sang Min Lee; Korean J Crit Care Med. 2012;27(4):249-254.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.249

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Abstract PDF

BACKGROUND
Pleural effusion is a common and important problem in the intensive care unit (ICU). However, only few studies have focused on the etiology of pleural effusion in the ICU. The aim of this study is to elucidate the etiology of pleural effusion in ICU patients in a tertiary care hospital.
METHODS
Patients with pleural effusion in the medical ICU (MICU) and in the emergency ICU (EICU) were studied retrospectively from January 1, 2006 to December 31, 2009. The etiology and profile of pleural effusion were analyzed.
RESULTS
Of 1,592 patients admitted to the MICU and EICU during the study period, 78 patients (4.8%) underwent thoracentesis. The mean age was 66.8 +/- 13.3 years, and 52 (66.7%) were men. Parapneumonic effusion (32/78, 41%) was the leading cause of all effusions; malignancy- and heart failure-related effusions accounted for 15 (19.2%) and 14 (17.7%) cases, respectively. Fifteen patients (19.2%) had tube insertion after thoracentesis; in these patients, parapneumonic effusion or empyema was the most common reason for drainage (9/15, 60%). Pneumothorax developed after thoracentesis in 2 patients.
CONCLUSIONS
Diagnostic thoracentesis was performed in 4.8% of patients admitted to the ICU; one-fifth of these cases required therapeutic drainage. Parapneumonic effusion was the most common cause of pleural effusion in the ICU in this study.

Citations

Citations to this article as recorded by

Prevalence, causes, and clinical implications of pleural effusion in pulmonary ICU and correlation with patient outcomes
Mohamed Farrag, Ahmed El Masry, Amr M. Shoukri, Mona ElSayed
Egyptian Journal of Bronchology.2018; 12(2): 247. CrossRef

Case Reports

A Case of Respiratory Syncytial Virus Related Acute Respiratory Distress Syndrome: A Case Report: Jinwoo Lee, Tae Yun Park, Eun Sun Kim, Keun Bum Chung, Kyoung Hee Kim, Sang Min Lee, Jae Joon Yim, Seok Chul Yang, Young Whan Kim, Sung Koo Han, Seonyang Park, Chul Gyu Yoo; Korean J Crit Care Med. 2011;26(1):41-44.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.41

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Abstract PDF: Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in children. Although previously considered as children's virus, the increasing number of patients who receive immunosuppression after transplantation of bone marrow and solid organs highlighted the role of RSV as a pathogen for opportunistic infection. We report a case of community-acquired respiratory syncytial virus pneumonia in a patient with newly diagnosed leukemia, resulting in acute respiratory distress syndrome (ARDS).

Acute Respiratory Failure from Invasive Pulmonary Aspergillosis in an Immunocompetent Adult: A Case Report: Jong Sun Park, Jae Joon Yim, Seok Chul Yang, Chul Gyu Yoo, Young Whan Kim, Sung Koo Han, Young Soo Shim, Sang Min Lee; Korean J Crit Care Med. 2009;24(3):172-175.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.172

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Abstract PDF: Invasive pulmonary aspergillosis has traditionally been known as a disease of an immunocompromised host. We report here on a case of an immunocompetent 73-year-old male who presented with dyspnea and he was finally diagnosed as suffering with invasive pulmonary aspergillosis. He died from progressive respiratory failure and secondary bacterial sepsis despite of voriconazole treatment. Invasive pulmonary aspergillosis should be considered as one of the differential diagnoses in patients with atypical pneumonia that does not respond to the usual antibiotics therapy, and even if the patient does not have an obvious history of an immunosuppressive status. An early suspicion with prompt treatment is important to improve the patient outcome.

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