Acute and Critical Care

Definition and Epidemiology of ARDS: Chul Min Ahn; Korean J Crit Care Med. 1997;12(2):103-110.

1,506 View
8 Download

Abstract PDF: No abstract available.

Pathophysiology and Pathogenesis of Acute Respiratory Distress Syndrome: Sung Soo Park; Korean J Crit Care Med. 1997;12(2):111-120.

1,900 View
8 Download

Abstract PDF: No abstract available.

Respiratory Dynamics in Acute Respiratory Distress Syndrome: Pyung Hwan Park; Korean J Crit Care Med. 1997;12(2):121-124.

1,856 View
21 Download

Abstract PDF: No abstract available.

Conventional and New Management of ARDS: Youn Suck Koh; Korean J Crit Care Med. 1997;12(2):125-130.

1,402 View
5 Download

Abstract PDF: No abstract available.

Hymodynamic Management for Cardiac Transplantation: Byung Moon Ham; Korean J Crit Care Med. 1997;12(2):131-136.

1,745 View
7 Download

Abstract PDF: No abstract available.

Intratracheal Pulmonary Ventilation (ITPV): Ka Young Rhee, Kook Hyun Lee; Korean J Crit Care Med. 1997;12(2):137-142.

1,712 View
15 Download

Abstract PDF: No abstract available.

An Anthropometric Measurements of the Upper Airway Using Fiberoptic Laryngoscope in Korean Adults: Sang Kyi Lee, Chun Won Yoo; Korean J Crit Care Med. 1997;12(2):143-150.

2,203 View
10 Download

Abstract PDF: Introduction: An anthropometric distance is crucial for an easy endotracheal intubation and correct placement of endotracheal tube in the trachea. There may be a racial difference of the anthropometric measurement. So we measured the anthropometric distances of the upper airway in Korean adult patients.
METHODS
A standard anesthetic induction and maintenance was performed in 100 adult patients following endotracheal intubation. Various anthropometric measurements were determined while the patients head were in a neutral position. Thyromental and sternomental distance were measured. A distance from upper central incisor to carina or cricoid cartilage was directly measured using fiberoptic laryngoscope. However, the length from upper central incisor to midtrachea & the cricoid cartilage-carina distance were indirectly calculated from the above measured distances. Correlation analyses were also performed between age, height, or weight and the above measured anthropometric distances.
RESULTS
The mean distances from upper central incisor to carina, cricoid cartilage or midtrachea were 25.5+/-1.8, 13.9+/-1.9, or 19.8+/-1.8cm respectively. The mean distance from cricoid cartilage to carina was 11.6+/-1.4cm. Thyromental and thyrosternal distance were 6.6+/-0.9 and 15.7+/-1.5cm respectively. All mean anthropometric distances of male were longer than those of female patients. Thirty-eight patients (38%) had the thyromental distance < or = 6cm while one patient (1%) had thyrosternal distance < or = 12.5cm. A good correlation (r< or =0.6) was observed between height and upper central incisor-carina distance.
CONCLUSIONS
This study suggests that these measured anthropometric data are useful for an easy endotracheal intubation and accurate endotracheal placement in the trachea.

Effect of Positive End-Expiratory Pressure on Intraocular Pressure in the Critically Ill and Mechanically Ventilated Patients: Ju Tae Sohn, Heon Young Ahn, Ji Hong Bae, Heon Keun Lee, Sang Hwy Lee, Young Kyun Chung; Korean J Crit Care Med. 1997;12(2):151-158.

2,448 View
16 Download

Abstract PDF: BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation.
METHODS
Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order.
RESULTS
IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed.
CONCLUSIONS
The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.

A Case of Rupture of Right Common Iliac Artery and Vein during Lumbar Discectomy: A case report: Yeon Jang, Seung Eun Ji, Eun Jung Cho, Soo Seog Park, Soo Young Jung, Ho Kyung Song; Korean J Crit Care Med. 1997;12(2):159-162.

1,529 View
22 Download

Abstract PDF: Intraabdominal vascular complications associated with lumbar disc surgery are rare but have potentially fatal consequences. Clinical manifestations of such injuries may be extremely variable and confused with anesthetic complications, myocardial infarction, or pulmonary embolism. So, the presence of vascular injury may not be recognized immediately. Recently, we experienced a case of extensive retroperitoneal hemorrhage during lumbar disc surgery. The patient was a 35 year-old healthy female. During operation, unexplained profound hypotension and tachycardia developed, but abnormal bleeding was not seen in the operative wound. Emergency CT of the abdomen was performed, and huge retroperitoneal hematoma was confirmed by the CT scan. Immediate abdominal exploration revealed the injury to right common iliac artery and vein. The patient underwent primary repair of lacerated artery and vein. Postoperative recovery was uneventful. We think awareness of the likelihood of vascular complications related to disc surgery is quite important for early diagnosis and management of these life-threatening complications.

Early Detection of Pulmonary Edema by Pulse Oximeter during Cesarean Section: Case report: Dong Ai An; Korean J Crit Care Med. 1997;12(2):163-168.

5,416 View
42 Download

Abstract PDF: This case showed that pulse oximeter was helpful for early detection of pulmonary edema during Cesarean section in a parturient woman with preoperative ritodrine treatment. Though arterial oxygen saturation ( Sp02 ) by pulse oximeter was low before the induction of anesthesia, the woman was anesthetized due to emergency situation. SpO2 was continuously low during the operation, so pulmonary edema was suspected. After the operaton, pulmonary edema was diagnosed on the chest x-ray. On the ECG, anteroseptal wall ischemia was detected. Supplementary O2 and diuretics therapy were performed. On the 3rd postoperative day, arterial blood gas analysis was within normal range. Four days after the operation, ECG was normalized and chest x-ray finding was much improved. 10 days later, chest x-ray finding was normalized.

Airway Obstruction with Armored Tracheostomy Tube by Swelling of Inner Layer: A case report: Chang Young Jeong, Sang Hyun Kwak, Sung Su Chung, Hyon Jeong Lee, Tae Yob Kim; Korean J Crit Care Med. 1997;12(2):169-172.

1,852 View
20 Download

Abstract PDF: One of the reasons for insertion of endotracheal tube is to provide a patent airway. Unfortunately, the tube itself may become the cause of airway obstruction. Especially, armored tube is known to be most effective in maintenance of airway patency. However, airway obstruction has been reported by a varity of causes even though armored tube was used. We experienced airway obstruction with armored tracheostomy tube by swelling of inner layer near the cuff. The tube was reused one and had been disinfected with ethylene oxide. Therefore, to prevent complication such as airway obstruction by use of armored tubes, it is desirable to avoid reusal of armored tube and to examine the lumen as well as cuff before intubation when reused.

Anesthetic Experience of Hemorrhagic Shock Patient with Rh-, AB Blood Type without Blood Transfusion: Sang Kyi Lee, Woo Sun Kim; Korean J Crit Care Med. 1997;12(2):173-176.

1,506 View
15 Download

Abstract PDF: Blood loss is usually replaced with crystalloid or colloid solutions until a predetermined minimal hematocrit is reached. But in severe blood loss, blood transfusion is indicated for maintenance of oxygen-carrying capacity, coagulation factors and intravascular volume. Jehovah's witness patients refuse blood transfusion, but some patients with rare blood type may even not have the chance of blood transfusion. Commonly utilized and effective alternatives to blood transfusion are acute hemodilution, autotransfusion and other blood salvage techniques. We report a case of successful anesthetic management in patient of hemorrhagic shock with rare blood type (Rh-, AB type) without blood trasfusion.

Anesthesia for Cesarean Section in Two Pregnant Women with Peripartum Cardiomyopathy: A report of two cases: Yong In Kang, Kyung Sook Cho, Su Yeon Kim, Myoung Hee Kim, Hyun Sook Lee; Korean J Crit Care Med. 1997;12(2):177-182.

1,519 View
28 Download

Abstract PDF: Peripartum cardiomyopathy (PPCM) is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first 6 months after delivery. Mortality from PPCM ranges from 25% to 50% and cause of death is usually chronic congestive heart failure or thromboembolic complications. We experienced 2 patients with PPCM. One was a twin pregnant woman and PPCM was developed after cesarean section. In the other case, PPCM was combined with aspiration pneumonia in the preterm labor patient. They were treated with diuretics and cardiotonic drugs and recovered to normal cardiac function within 7 to 10 days. Prognosis is related to recovery of left ventricular function, which usually occurs within 6 months postpartum. Early diagnosis and appropriate treatment of PPCM improve outcome.

Pulmonary Edema due to Upper Airway Obstruction after Neck Mass Excision of the Patient with Cerebral Palsy: Moon Seok Chang, Hun Cho, Hae Ja Lim, Seong Ho Chang, Nan Suk Kim; Korean J Crit Care Med. 1997;12(2):183-186.

1,607 View
8 Download

Abstract PDF: Because the emergence from anesthesia may be delayed in the patient with the cerebral palsy, extubation must be delayed until consciousness is recovered completely. Postoperative pulmonary edema has several causes and one of them, upper airway obstruction is rare. We had experienced pulmonary edema due to upper airway obstruction after neck mass excision in the patient with cerebral palsy, who was 21-year-old, 50 kg, male and normal preoperative laboratory data. There was no significant change in blood volume during operation for 1 hour. After operation, the patient breathed spontaneously and the endotracheal tube was extubated in the operating room. When the patient was transfered to the recovery room, he had cyanosis, intercostal and substernal retraction, and the pulse oximeter showed very low oxygen saturation. We supplied oxygen to the patient and reintubated him, and recognized the pinkish frothy sputum by suction of the endotracheal tube. On the portable chest X-ray film of the patient at the moment, hazy increased density on both lung fields indicating pulmonary edema, but the heart size was not increased. By routine treatment for pulmonary edema, the symtoms and signs of the patient were improved. He had stayed for 1 day in the SICU and then transfered to the general ward.

Profound Hypothermia and Circulatory Arrest for Adult PDA Surgery: Case report: Seung Hun Baek, Sang Wook Shin, Hae Kyu Kim, Seong Wan Baik, Inn Se Kim, Kyoo Sub Chung; Korean J Crit Care Med. 1997;12(2):187-191.

1,693 View
11 Download

Abstract PDF: Correction of a calcified patent ductus arteriosus (PDA) is a difficult surgical procedure. Simple ligation or division of PDA is not possible if diffuse circumferential calcification is present. Several techniques using cardiopulmonary bypass and closure of PDA from within the aorta or pulmonary artery have been introduced. And the surgical procedure is performed under profound hypothermia and circulatory arrest. Total ischemia time should be less than 30 minutes, which is free from the organ damage by the circulatory arrest. Barbiturates, calcium channel blockers and steroids are used for brain protection. We experienced successful use of these techniques for adult female patch closure of PDA and reviewed the anesthetic considerations of the profound hypothermia and circulatory arrest for cardiac surgery.

Previous issues