Acute and Critical Care

Dong In Suh

5 Articles

Cardiology/Pediatric
Effectiveness of Bradycardia as a Single Parameter in the Pediatric Acute Response System: Yu Hyeon Choi, Hyeon Seung Lee, Bong Jin Lee, Dong In Suh, June Dong Park; Korean J Crit Care Med. 2014;29(4):297-303. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.297

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BACKGROUND
Various tools for the acute response system (ARS) predict and prevent acute deterioration in pediatric patients. However, detailed criteria have not been clarified. Thus we evaluated the effectiveness of bradycardia as a single parameter in pediatric ARS.
METHODS
This retrospective study included patients who had visited a tertiary care children's hospital from January 2012 to June 2013, in whom ARS was activated because of bradycardia. Patient's medical records were reviewed for clinical characteristics, cardiologic evaluations, and reversible causes that affect heart rate.
RESULTS
Of 271 cases, 261 (96%) had ARS activation by bradycardia alone with favorable outcomes. Evaluations and interventions were performed in 165 (64.5%) and 13 cases (6.6%) respectively. All patients in whom ARS was activated owing to bradycardia and another criteria underwent evaluation, unlike those with bradycardia alone (100.0% vs. 63.2%, p = 0.016). Electrocardiograms were evaluated in 233 (86%) cases: arrhythmias were due to borderline QT prolongation and atrioventricular block (1st and 2nd-degree) in 25 cases (9.2%). Bradycardia-related causes were reversible in 202 patients (74.5%). Specific causes were different in departments at admission. Patients admitted to the hemato-oncology department required ARS activation during the night (69.3%, p = 0.03), those to the endocrinology department required ARS activation because of medication (72.4%, p < 0.001), and those to the gastroenterology department had low body mass indexes (32%, p = 0.01).
CONCLUSIONS
Using bradycardia alone in pediatric ARS is not useful, because of its low specificity and poor predictive ability for deterioration. However, bradycardia can be applied to ARS concurrently with other parameters.

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Effect of Diurnal Variation of Heart Rate and Respiratory Rate on Activation of Rapid Response System and Clinical Outcome in Hospitalized Children
Lia Kim, Kyoung Sung Yun, June Dong Park, Bongjin Lee
Children.2023; 10(1): 167. CrossRef
Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea
Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park
Acute and Critical Care.2023; 38(4): 498. CrossRef
Pediatric triage modifications based on vital signs: a nationwide study
Bongjin Lee, June Dong Park, Young Ho Kwak, Do Kyun Kim
Clinical and Experimental Emergency Medicine.2022; 9(3): 224. CrossRef

A Case of Exertional Heat Stroke with Acute Hepatic Failure Treated with Plasma Exchange: A Case Report: Young Joo Han, Jae Wook Choi, Woo Jin Chung, Dong In Suh, June Dong Park; Korean J Crit Care Med. 2012;27(2):130-133.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.130

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Abstract PDF

Heat stroke is a hyperthermia-induced systemic inflammatory response which may cause multiorgan dysfunction syndrome. We report a case of exertional heat stroke with acute hepatic failure in an 11-year-old boy. He initially presented hyperthermia and unconsciousness, which occurred after heavy exercise. His neurological state improved after terminating the hyperthermia by intensive cooling therapy. However, 24 hours after the initial recovery, his neurological state deteriorated again as acute hepatic injury progressed rapidly. We applied 4 times of total plasma exchange as an immunotherapy for systemic inflammatory response syndrome and acute hepatic failure expecting it to remove endogenous inflammatory factors and hepatotoxic cytokines. Following the plasma exchange, his mental state became normal and serial laboratory findings indicated improvement. He made a complete recovery without sequelae. We experienced successful treatment regarding exertional heat stroke with acute hepatic failure using plasma exchange.

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Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure
Vimal Master Sankar Raj, Amanda Alladin, Brent Pfeiffer, Chryso Katsoufis, Marissa Defreitas, Alicia Edwards-Richards, Jayanthi Chandar, Wacharee Seeherunvong, Gwenn McLaughlin, Gaston Zilleruelo, Carolyn L. Abitbol
Pediatric Nephrology.2013; 28(6): 971. CrossRef

Atelectasis and the Risk Factors in the Patients Admitted to Pediatric Intensive Care Unit: Woo Jin Chung, Jae Wook Choi, Young Ju Han, Ju Kyung Lee, Dong In Suh, Young Yull Koh, June Dong Park; Korean J Crit Care Med. 2011;26(4):238-244.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.238

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Abstract PDF: BACKGROUND
Atelectasis is a state of a collapsed and non-aerated region of the lung parenchyma, which is otherwise normal. This condition is usually associated with pulmonary disorders. The purpose of this study is to analyze the incidence and risk factors of atelectasis in patients admitted to the pediatric intensive care unit (PICU).
METHODS
We retrospectively analyzed the clinical characteristics and chest radiography of 280 PICU patients under 18 years old. We analyzed the incidence and pattern of atelectasis and compared the incidence according to the phase and mode of mechanical ventilation. We compared the incidence of ventilator care need and respiratory disease in 93 atelectasis patients.
RESULTS
Atelectasis incidence was 33.2%. The age (4.9 +/- 4.4 years) was younger and the admission-duration (17.8 +/- 25.1 days) was significantly longer in atelectasis patients (p < 0.01). Ventilator care need and respiratory disease in atelectasis patients (86.0%, 66.7% respectively) was significantly higher than in non-atelectasis patients (62.6%, 43.3% respectively) (p < 0.01). Atelectasis incidence in ventilator-required patients and respiratory-diagnosed patients (40.6%, 43.4% respectively) was significantly higher than that in non ventilator-required patients and non respiratory-diagnosed patients (15.7%, 22.6% respectively) (p < 0.01). Atelectasis was more common in the right upper lobe (55.6%) and during or after ventilator care (62.6%) (p < 0.05). Atelectasis incidence in ventilator care did not differ between the assist-control and intermittent mandatory ventilation modes.
CONCLUSIONS
In the PICU, atelectasis incidence was higher in patients with ventilator care and respiratory disease. Atelectasis was more common in the right upper lobe and in the phase after ventilator initiation. Atelectasis incidence in ventilator care did not differ between ventilation modes.

Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit: Jae Wook Choi, Woo Jin Chung, Young Joo Han, Ju Kyung Lee, Dong In Suh, June Dong Park, Young Yull Koh; Korean J Crit Care Med. 2011;26(3):171-176.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.171

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Abstract PDF

BACKGROUND
The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pediatric intensive care unit.
METHODS
We retrospectively analyzed 96 patients who required CRRT at a pediatric intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT.
RESULTS
Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6-72.9 kg. 16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pediatric Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 +/- 8.9 and the degree of fluid overload at CRRT (FO%) was 12.9 +/- 16.0. The PRISM III score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically significant hemorrhage occurred in 10 patients (10.4%).
CONCLUSIONS
Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT.

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Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single-Center Study
Moon-yeon Oh, Byong Sop Lee, Seong-Hee Oh, Hee Jin Jang, Hyun-Jeong Do, Ellen Ai-Rhan Kim, Ki-Soo Kim, Joo Hoon Lee, Young Seo Park, Beom-Hee Lee, Han-Wook Yoo
Neonatal Medicine.2014; 21(4): 244. CrossRef

A Case of Severe Acute Exacerbation of Bronchial Asthma Treated with Low Minute Ventilation: A Case Report: Young Joo Han, Dong In Suh, Young Seung Lee, June Dong Park; Korean J Crit Care Med. 2010;25(4):257-262.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.257

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Abstract PDF: We report a case of severe status asthmaticus in a 3-year-old boy who required mechanical ventilatory support. He initially presented with rapidly progressing respiratory distress and spontaneous air leaks. Although he was intubated and received mechanical ventilation, dynamic hyperinflation and air leaks were aggravated. We applied the volume control mode, providing sufficient tidal volume (10 ml/kg), a reduced respiratory rate (25/minute), and a prolonged expiratory time (1.8 seconds) to overcome dynamic hyperinflation. After allowing full expiration of trapped air, his over-expanded lung volumes were decreased and the air leaks resolved. He made a complete recovery without sequelae. Dynamic hyperinflation in asthmatic patients occurs from incomplete exhalation throughout narrowed airways. Controlled hypoventilation or permissive hypercapnia is an important lung-protective ventilator strategy and is beneficial in reducing dynamic hyperinflation. We suggest a controlled hypoventilation strategy with a prolonged expiratory time for patients in severe status asthmaticus with dynamic hyperinflation.

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