Acute and Critical Care

Inflammation and Sepsis: Ji Young Yoon, Jae Young Kwon; Korean J Crit Care Med. 2010;25(1):1-8.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.1

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Despite the development of modern intensive care and new antimicrobial agents, the mortality of the patients with severe sepsis and septic shock remains high. The poor outcome is considered to be a consequence of an overactive systemic inflammatory response. Sepsis is now defined as systemic inflammatory response syndrome (SIRS) in which there is an identifiable focus of infection. As a consequence of the overactive SIRS response, the function of various organ systems may be compromised, resulting in multiple organ dysfunction syndrome (MODS) and death. Systemic inflammation is a consequence of activation of the innate immune system. It is characterized by intravascular release of pro-inflammatory cytokines and other vasoactive mediators, and the concurrent activation of the innate immune cells. In addition to the pro-inflammatory reactions, the host's anti-inflammatory mechanisms are also activated and aimed at counteracting the inflammatory response. The balance between pro- and anti-inflammatory reactions is critical for the outcome of the patient. Understanding the mechanisms of acute inflammatory responses in critical ill patients is necessary for the development of urgently needed therapeutics. The aim of this review is to provide a description of the key components and mechanisms involved in the inflammatory response in patients with SIRS and sepsis.

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The Subspecialty Certification for Critical Care Medicine in Korea: Dong Chan Kim; Korean J Crit Care Med. 2009;24(3):117-123.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.117

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The Korean Society of Critical Care Medicine (KSCCM) has introduced the Subspecialty System for Critical Care Medicine in Korea under the auspices of the Korean Academy of Medical Sciences (KAMS) in March 2008. Nine medical societies that included the Korean Association of Internal Medicine, the Korean Academy of Tuberculosis and Respiratory Diseases, the Korean Society of Anesthesiology, the Korean Neurological Association, the Korean Neurosurgical Society, the Korean Surgical Society, the Korean Society of Emergency Medicine, the Korean Society for Thoracic and Cardiovascular Surgery and the Korean Pediatric Society participated to the new critical care subspecialty. The Board of Critical Care should be certified again every 5 year after achieving the required qualification by the KSCCM. This paper summarizes the Subspecialty Certification System for Critical Care Medicine in Korea.

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Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit
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PLOS ONE.2021; 16(10): e0259092. CrossRef

The Role of the Coagulation and Fibrinolytic Pathway in Acute Lung Injury: Sang Hyun Kwak; Korean J Crit Care Med. 2009;24(2):53-58.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.53

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Abstract PDF: Acute lung injury (ALI) is a common, life-threatening cause of acute respiratory failure, which is ultimately caused by a variety of local and systemic insults. Alterations in the coagulation and fibrinolysis profiles are present in almost all the patients suffering with ALI. The classic histologic findings in ALI patients include alveolar fibrin formation and microthrombi in the pulmonary vasculature. Decreased circulating levels of protein C and increased concentrations of thrombomodulin are present in patients with septic and nonseptic ALI. The circulating and pulmonary concentrations of plasminogen activator inhibitor-1 (PAI-1) are increased in the setting of ALI, and the degree of elevation in the PAI-1 level directly correlates with mortality. The need for new specific therapies has led a number of investigators to examine the role of altered coagulation and fibrinolysis in the pathogenesis of ALI. This review summarizes the current understanding of coagulation and fibrinolysis in ALI with an emphasis on the pathways that could be potential therapeutic targets, including the tissue factor pathway, the protein C pathway and the modulation of fibrinolysis via plasminogen activator inhibitor-1.

Management of Brain Injury after Post-cardiac Arrest Syndrome: Jong Ho Choi; Korean J Crit Care Med. 2009;24(1):1-3.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.1

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Abstract PDF: In spite of improvement in cardiopulmonary resuscitation (CPR) techniques, post-CPR mortality and brain injury rates have not changed significantly. The post-cardiac arrest syndrome has been suggested to be the major reason for the high mortality rate after CPR. Post-cardiac arrest syndrome, including brain injury, myocardial dysfunction, and septic shock-like syndrome after CPR, result in complicated multiple organ failure. Physicians who work in the ICU should have a good understanding of thepathophysiology of post-cardiac arrest syndrome. Recently, therapeutic hypothermia treatment for protection of brain injuries has been applied as a therapeutic regimen in spite of various side effects during the hypothermic procedure. Finally, therapeutic hypothermic treatment to reduce brain injury in post-cardiac arrest syndrome patients is strongly recommended to physiciansmanaging CPR. I would like to briefly review the therapeutic hypothermic procedure for the management of post-cardiac arrest syndrome.

Evaluating and Managing Hyponatremia: Minwook Yoo, Ozan Akca, Evelyn Bediako; Korean J Crit Care Med. 2008;23(2):67-74.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.67

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Abstract PDF

Although hyponatremia is a common electrolyte disorder, its evaluation and management are not well defined. When diagnosed, hyponatremia should be categorized based on four criteria: volume status, urinary Na+, serum K+, and acid-base balance. This approach helps to determine what the cause of hyponatremia is and how it should be treated. Initially, hypovolemic hyponatremia, including cerebral salt wasting syndrome (CSWS), is treated by volume resuscitation and salt supplementation. Euvolemic hyponatremia, including the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), is treated by fluid restriction and salt supplementation, and hypervolemic hyponatremia is treated by fluid restriction and salt restriction. Hyponatremia can be managed well using these primary treatments and medications.

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Pharmacotherapy of the Failing Heart and Shock: Jin Mo Kim, Yong Cheol Lee; Korean J Crit Care Med. 2008;23(1):1-5.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.1

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No abstract available.

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In vitro investigation of antioxidant and anti-apoptotic activities of Korean wild edible vegetable extracts and their correlation with apoptotic gene expression in HepG2 cells
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The Application of Functional Genomics to Acute Lung Injury: Sang Bum Hong; Korean J Crit Care Med. 2007;22(2):65-70.

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Biotrauma in Ventilator Induced Lung Injury: Sang Hyun Kwak, Seok Jai Kim; Korean J Crit Care Med. 2006;21(1):1-7.

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Clinical Significance of Hypercapnia during Mechanical Ventilation: Younsuck Koh; Korean J Crit Care Med. 2005;20(2):105-113.

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Evaluation and Management of Perioperative Hypertension: Keon Hee Ryu; Korean J Crit Care Med. 2005;20(1):1-13.

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Oxidative Stress; Reactive Oxygen Species and Nitric Oxide: Dong Gun Lim; Korean J Crit Care Med. 2004;19(2):81-85.

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Sedation in the Intensive Care Unit: Jong Hun Jun; Korean J Crit Care Med. 2004;19(1):1-7.

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Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease: Tae Hun An; Korean J Crit Care Med. 2003;18(2):67-73.

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Abstract PDF: Patients with severe chronic obstructive pulmonary disease (COPD) may require mechanical ventilation following cardiac or general surgery, in connection with thoracic surgery such as lobectomy, wedge resection, lung reduction or bullectomy, during an episode of acute respiratory failure (ARF) secondary to a disease other than COPD such as sepsis, drug overdose, or trauma or for acute-on-chronic respiratory failure (the COPD exacerbation) where acute illness, usually presumed to be infectious in nature, destabilizes the characteristically compensated state. Ventilatory intervention is often life-saving when patients with asthma or COPD experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choice, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. This review will only briefly cover noninvasive ventilation and focus primarily on the management of the intubated, mechanically ventilated patient with COPD, with particular emphasis on factors unique to this patient population such as the propensity for dynamic hyperinflation and auto-PEEP, barotrauma, difficult weaning and the prognosis following mechanical ventilation.

Perioperative Pulmonary Management: Koing Bo Kwun; Korean J Crit Care Med. 2003;18(1):7-19.

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Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Sung Ho Yoon; Korean J Crit Care Med. 2003;18(1):1-6.

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