Acute and Critical Care

Mun Ju Kang

3 Articles

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.

Effect of Hydrogel Pad and Conventional Method on the Induction Time of Therapeutic Hypothermia in Patients with Out-of-Hospital Cardiac Arrest: Ga Young Chung, Tae Rim Lee, Dae Jong Choi, Sung Su Lee, Mun Ju Kang, Won Chul Cha, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Yeon Kwon Jeong; Korean J Crit Care Med. 2012;27(4):218-223.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.218

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Abstract PDF: BACKGROUND
Therapeutic hypothermia has been recommended as a standard treatment of cardiac arrest patients after return of spontaneous circulation. There are various methods to drop patient's core body temperature below 33.5degrees C. We compared the cooling rate of the conventional cooling method using cold saline bladder irrigation with the commercial hydrogel pad in out-of-hospital cardiac arrest (OHCA) patients.
METHODS
We collected data retrospectively from the Samsung Medical Center hypothermia database. The conventional method group was cooled with IV infusion of 2,000 ml of 4degrees C cold saline and cold saline bladder irrigation. Patients in the hydrogel pad group had their body temperature lowered with the Artic Sun(R) after receiving 2,000 ml of 4degrees C cold saline intravenously. The induction time was defined as time from cold saline infusion to the esophageal core temperature below 33.5degrees C. The esophageal temperature probe insertion to the target temperature time (ET to target BT time) was defined as the time from the esophageal probe insertion to the core temperature below 33.5degrees C. We compared these times and cooling rates between the two groups.
RESULTS
Eighty one patients were enrolled. Fifty seven patients were included in the hydrogel pad group and 24 patients were in the conventional group. There were no statistical differences of baseline characteristics between the two groups. The induction time of the conventional group (138 min., IQR 98-295) was shorter than that of the hydrogel pad group (190 min., IQR 140-250). The ET to target BT time of the conventional group (106 min., IQR 68-249) was shorter than that of the hydrogel pad group (163 min., IQR 108-222). The cooling rate of the conventional group (0.93degrees C/hr., IQR 0.58-2.08) was lower than that of the hydrogel pad group (1.05degrees C/hr., IQR 0.74-1.96). However, there were no statistical differences in the induction time, the ET to target BT time and the cooling rate between the two groups.
CONCLUSIONS
There was no significant statistical difference of the cooling rate of the hydrogel pad and conventional method on the induction time of therapeutic hypothermia in Patients with OHCA. The conventional cooling method can be used as an effective and efficient way to lower OHCA patient's core body temperature during the induction phase of therapeutic hypothermia.

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; Korean J Crit Care Med. 2011;26(3):151-156.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.151

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Abstract PDF: BACKGROUND
Subarachnoid hemorrhage is a fatal disease relatively common in the East Asian population. It can lead to cardiac arrest in several pathologic processes. We attempted to elucidate the characteristics of out-of-hospital cardiac arrest caused by non-traumatic subarachnoid hemorrhage.
METHODS
We conducted a retrospective, observational study in which patients who had visited Samsung medical center emergency room for out-of-hospital cardiac arrest from January, 1999 to December 2008 were enrolled. A total of 218 OHCA patients who had achieved ROSC were investigated by review of medical charts. Excluding those who had worn trauma, we analyzed 22 patients who had been diagnosed for SAH by brain non-contrast CT scan.
RESULTS
Median age of aneurysmal SAH-induced OHCA patients was 61 (IQR 54-67) years. Fourteen patients (64%) were female and 15 patients (68%) were witnessed. Besides, 7 patients (32%) had complained of headache before collapse. We also found 11 patients (50%) had been diagnosed with hypertension previously. All of them showed unshockable rhythm (asystole 60%, PEA 40%) initially. Their median duration of ACLS was 10 minutes. Majority of patients died within 24 hours and survivors showed poor neurologic outcome.
CONCLUSIONS
Subarachnoid hemorrhage is a relatively uncommon cause of cardiac arrest, and the outcome of OHCA induced by SAH is very poor. However, emergency physicians have to consider the possibility of SAH when trying to determine the cause of arrest, especially when treating patients who have the characteristics described above.

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