- Pulmonary
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Reduction of PaCO2 by high-flow nasal cannula in acute hypercapnic respiratory failure patients receiving conventional oxygen therapy
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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
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Acute Crit Care. 2019;34(3):202-211. Published online August 31, 2019
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DOI: https://doi.org/10.4266/acc.2019.00563
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Abstract
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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.
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Citations
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- 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
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Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study
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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
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Korean J Crit Care Med. 2017;32(2):154-163. Published online May 31, 2017
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DOI: https://doi.org/10.4266/kjccm.2016.00976
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11,442
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Abstract
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- 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.
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Citations
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- Pulmonary/Quality Improvement
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Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea
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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
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Korean J Crit Care Med. 2016;31(1):25-33. Published online February 29, 2016
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DOI: https://doi.org/10.4266/kjccm.2016.31.1.25
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5,465
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Abstract
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- 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.
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Citations
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- 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
- Basic science and research
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The Anti-Inflammatory Effect of Arginine-Vasopressin on Lipopolysaccharide-Induced IκBα/Nuclear Factor-κB Cascade
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Jisoo Park, Eun Young Eo, Kyoung-Hee Lee, Jong Sun Park, Jae-Ho Lee, Chul-Gyu Yoo, Choon-Taek Lee, Young-Jae Cho
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Korean J Crit Care Med. 2015;30(3):151-157. Published online August 31, 2015
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DOI: https://doi.org/10.4266/kjccm.2015.30.3.151
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Abstract
PDFSupplementary Material
- Background
Arginine vasopressin (AVP) is widely used as a vasopressor agent. Some recent studies have suggested that AVP may exert an immunomodulatory effect. However, the mechanism about the anti-inflammatory effect of AVP is not well known. We investigated the effect of AVP on the ihibitor of kappa B (IκBα)/nuclear factor-kappa B (NF-κB) pathway in RAW 264.7 cells.
Methods Cultured RAW 264.7 cells were pretreated with AVP and stimulated with lipopolysaccharide (LPS). To evaluate the effect of AVP on inflammatory cytokines, the concentration of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were assessed by an enzyme-linked immunosorbent assay technique. The expression of IκBα and nuclear translocation of NF-κB p65 were measured by Western blotting, and IκB kinase (IKK) activity was analyzed by an in vitro immune complex kinase assay. To confirm the AVP effect on IκBα/NF-κB cascade and via V2 receptor, we added tolvaptan (V2 receptor antagonist) after AVP pretreatment.
Results The increase of IL-6 and TNF-α in LPS-stimulated RAW 264.7 cells was suppressed by a treatment with AVP. Pretreatment of AVP inhibited increasing of IKK activity and IκBα degradation induced by LPS in RAW 264.7 cells. Furthermore, LPS induced and NF-κB transcription was inhibited by AVP pretreatment. The observed changes in IKK activity, IκBα degradation and NF-κB transcription by AVP was abolished by tolvaptan treatment.
Conclusions Our results suggest that AVP showed anti-inflammatory effect on LPS-induced IκBα/NF-κB cascade in mouse macrophages via V2 receptors.
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Erin Hendry, Brady McCallister, Dan J. Elman, Roy Freeman, David Borsook, Igor Elman Neuroscience & Biobehavioral Reviews.2024; 158: 105566. CrossRef - Osmoregulatory neurons clockwork is altered during metabolic disorder induced by high energy diet in the Sand rat Psammomys obesus
Hanane Touati, Saliha Ouali-Hassenaoui, Aicha Dekar-Madoui, Nadir Benhafri, Lydia Boumansour, Etienne Challet, Paul Pévet, Patrick Vuillez Biological Rhythm Research.2023; 54(2): 153. CrossRef - Microbial and Host Metabolites at the Backstage of Fever: Current Knowledge about the Co-Ordinate Action of Receptors and Molecules Underlying Pathophysiology and Clinical Implications
Luigi Santacroce, Marica Colella, Ioannis Alexandros Charitos, Marina Di Domenico, Raffaele Palmirotta, Emilio Jirillo Metabolites.2023; 13(3): 461. CrossRef - Birth triggers an inflammatory response in the neonatal periphery and brain
Alexandra Castillo-Ruiz, Carla D. Cisternas, Hannah Sturgeon, Nancy G. Forger Brain, Behavior, and Immunity.2022; 104: 122. CrossRef - Comprehensive biology of antipyretic pathways
Prajitha N, Athira SS, Mohanan PV Cytokine.2019; 116: 120. CrossRef - Oxytocin and Vasopressin Systems in Obesity and Metabolic Health: Mechanisms and Perspectives
Cherlyn Ding, Faidon Magkos Current Obesity Reports.2019; 8(3): 301. CrossRef
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