Acute and Critical Care

Case Report

Rapid response system
Successful percutaneous coronary intervention with extracorporeal membrane oxygenation support after right coronary artery dissection in an eisenmenger syndrome patient: Byung Gyu Kim, Sung Woo Cho, Jong Chun Nah; Acute Crit Care. 2020;35(1):46-50. Published online November 6, 2018; DOI: https://doi.org/10.4266/acc.2017.00024

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The presentation of coronary artery disease in a patient with Eisenmenger syndrome (ES) is relatively rare. Cardiogenic shock due to coronary artery dissection during percutaneous coronary intervention (PCI) can be more critical in these patients. Here, we report a case of successful PCI under mechanical circulation support in a patient with ES who experienced potentially fatal right coronary artery dissection. This case emphasizes that use of extracorporeal membrane oxygenation (ECMO) can lead to successful management of critical complication during PCI, and that the immediate decision to apply of ECMO is important in ES patients who face impending cardiogenic shock with acute heart failure.

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Blunt traumatic right coronary artery dissection presenting with second-degree atrioventricular block and late-onset severe cardiogenic shock
Maria Paparoupa, Lenard Conradi, Malte Lennart Warncke, Lennart Well, Christoph Burdelski, Christopher Cramer, Hanno Grahn, Mathias Kubik, Stefan Kluge
BMC Cardiovascular Disorders.2022;[Epub] CrossRef
Successful Implementation of Extracorporeal Membrane Oxygenation Support as a Bridge to Heart-Lung Transplantation in an Eisenmenger’s Syndrome Patient With Paradoxical Coronary Embolism
James Zhang, Sumit Patel, Leonardo Clavijo, David Laughrun
Journal of Investigative Medicine High Impact Case Reports.2019; 7: 232470961984657. CrossRef

Original Articles

Pharmacology
Pharmacotherapeutic Problems and Pharmacist Interventions in a Medical Intensive Care Unit: Tae Yun Park, Sang-Min Lee, Sung Eun Kim, Ka-Eun Yoo, Go Wun Choi, Yun Hee Jo, Yoonsook Cho, Hyeon Joo Hahn, Jinwoo Lee, A Jeong Kim; Korean J Crit Care Med. 2015;30(2):82-88. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.82

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Abstract PDF

Background
Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. Methods: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. Results: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). Conclusions: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.

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Characterization of drug‐related problems and evaluation of pharmacist interventions in the cardiovascular intensive care settings in Thailand
Phannita Wattanaruengchai, Junporn Kongwatcharapong, Surakit Nathisuwan
JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY.2023; 6(5): 488. CrossRef
A Systematic Review of Outcomes Research in the Hospital Pharmacists’ Interventions in South Korea
So Young Lee, Eun Cho
Korean Journal of Clinical Pharmacy.2019; 29(3): 193. CrossRef

Trauma
Traumatic Liver Injury: Factors Associated with Mortality: Youn Suk Chai, Jae Kwang Lee, Seok Jin Heo, Yeong Ki Lee, Yong Woo Lee, Young Hwa Jo, Seong Soo Park, Hyun Jin Kim, In Gu Kang; Korean J Crit Care Med. 2014;29(4):320-327. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.320

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Abstract PDF: BACKGROUND
We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients.
METHODS
From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study.
RESULTS
Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006).
CONCLUSIONS
In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.

Effect of Clinical Pharmacist Interventions on Prevention of Adverse Drug Events in Surgical Intensive Care Unit: Minkyong Kang, Ahjeong Kim, Yoonsook Cho, Hyangsook Kim, Hyesook Lee, Yong Jae Yu, Hannah Lee, Kyu Joo Park, Hee pyoung Park; Korean J Crit Care Med. 2013;28(1):17-24.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.17

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Abstract PDF

BACKGROUND
A pharmacist's participation in medical rounds in intensive care unit (ICU) is becoming popular nowadays. In this study, we investigated the effect of pharmacologic intervention by a pharmacist's participation in medical round in ICU on prevention of adverse drug events (ADEs).
METHODS
From March 2011 to July 2011, the intervention data were obtained by participating in medical round two or three times a week, and by reviewing electronic medical records of patients admitted to surgical ICU. The incidence, cause, and type of ADEs were noted, respectively. Expected cost avoidance was calculated from interventions, which were considered to be preventive of ADEs. The acceptance rate of pharmacologic interventions was noted.
RESULTS
Among 2781 patients, a total of 159 intervention data were collected in 90 patients. Recommendation for drug dosage adjustment or monitoring in patients with potential overdose and sub-therapeutic dose made up 82% of the total interventions. In 8% of interventions, initiation of drug therapy was recommended. 83% of the interventions were accepted and the acceptance rate of interventions within 24 hrs was 58%. The rate of the interventions, which were considered to be preventive of ADEs was 62%. Expected cost reduction obtained by preventing ADEs was 25,867,083 Won during a 5-month period.
CONCLUSIONS
A pharmacist's participation in physician rounds in ICU was associated with prevention of ADEs and subsequent reduction of the cost in drug therapy.

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What is impacting clinical pharmacists’ participation in an interprofessional ward round: a thematic analysis of a national survey
Dona Babu, Sally Marotti, Debra Rowett, Renly Lim, Alice Wisdom, Lisa Kalisch Ellett
Journal of Interprofessional Care.2024; 38(3): 444. CrossRef
A Systematic Review of Outcomes Research in the Hospital Pharmacists’ Interventions in South Korea
So Young Lee, Eun Cho
Korean Journal of Clinical Pharmacy.2019; 29(3): 193. CrossRef
Effects of Medication Reconciliation and Cost Avoidance Analysis by Clinical Pharmacists in a Neurocritical Care Unit
Ui Sang Cho, Young Joo Song, Young Mi Jung, Kyung Suk Choi, Eunsook Lee, Euni Lee, Moon-Ku Han
Journal of Neurocritical Care.2018; 11(2): 110. CrossRef
Pharmacotherapeutic Problems and Pharmacist Interventions in a Medical Intensive Care Unit
Tae Yun Park, Sang-Min Lee, Sung Eun Kim, Ka-Eun Yoo, Go Wun Choi, Yun Hee Jo, Yoonsook Cho, Hyeon Joo Hahn, Jinwoo Lee, A Jeong Kim
The Korean Journal of Critical Care Medicine.2015; 30(2): 82. CrossRef

Physiologic Effect and Safety of Pumpless Extracorporeal Interventional Lung Assist in Korean Patients with Acute Respiratory Failure: Woo Hyun Cho, Kwangha Lee, Jin Won Huh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2010;25(4):235-240.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.235

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Abstract PDF

BACKGROUND
Pumpless interventional lung assist (iLA) uses an extracorporeal gas exchange system without any complex blood pumping technology, and has been shown to reduce CO2 tension and permit protective lung ventilation. The feasibility and safety of iLA were demonstrated in previous studies, but there has been no experience with iLA in Korea. The purpose of this study was to evaluate the feasibility of the iLA device in terms of physiologic efficacy and safety in Korean patients with acute respiratory failure.
METHODS
iLA was implemented in patients with acute respiratory failure who satisfied the predefined criteria of our study. Initiation of iLA followed an algorithm for implementation, ventilator care, and monitoring. Following insertion of arterial and venous cannulas under ultrasound guidance, the physiologic and respiratory variables and incidence of adverse events were monitored.
RESULTS
iLA was implemented in 5 patients and the duration of iLA ranged from 7 hours to 171 hours. At 24 hours after implementation, the mean changes in pH, PaCO2, and PaO2/FiO2 ranged from 7.204 to 7.393, from 68.4 mm Hg to 33 mm Hg, and from 128.7 mm Hg to 165 mm Hg, respectively. During iLA therapy, one adverse event was observed, which presented with hematochezia without hemodynamic change.
CONCLUSIONS
iLA treatment produced effective removal of carbon dioxide and allowed for protective ventilation in severe respiratory failure. An iLA system can easily be installed by percutaneous cannulation, without procedural complications, and without significant adverse events necessitating discontinuation of iLA after implementation.

Citations

Citations to this article as recorded by

A Case of Pumpless Extracorporeal Interventional Lung Assist for Severe Respiratory Failure - A Case Report -
Young-Jae Cho, Ji Yeon Seo, Yu Jung Kim, Jae-Ho Lee, Choon-Taek Lee
Korean Journal of Critical Care Medicine.2012; 27(2): 120. CrossRef
A Case of iLA Application in a Patient with Refractory Asthma Who Is Nonresponsive to Conventional Mechanical Ventilation - A Case Report -
Young Seok Lee, Hyejin Joo, Jae Young Moon, Jin Won Huh, Yeon-Mok Oh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Korean Journal of Critical Care Medicine.2012; 27(2): 108. CrossRef

Case Report

Successful Coronary Interventions with the Aid of Abciximab (ReoPro (R)) in High-Risk Patients: Report of Two Cases: Woo Suck Park, Myung Ho Jeong, Nam Ho Kim, Young Keun Ahn, Youl Bae, Gwang Chae Gill, Joo Hyung Park, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang; Korean J Crit Care Med. 1998;13(2):254-260.

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Abstract PDF: Abrupt closure of coronary artery during coronary intervention is one of major limitations especially in high-risk patients. Platelets are responsible for composing acute thrombotic occlusion at the site of therapeutic arterial injury. Abciximab (platelet glycoprotein IIb/IIIa receptor blocker) might be helpful in preventing the acute thrombotic occlusion. We experienced an excellent effects of the drug in two cases of high-risk patients, unsuccessful thrombolytics and PTCA with acute occlusion. With additional use of abciximab we overcame the complications and succeeded in getting normal coronary flow and resultant successful angioplasties.

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