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- Volume 16 (2); November 2001
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Original Articles
- Primary Pulmonary Hypertension
- Sang Do Lee
- Korean J Crit Care Med. 2001;16(2):55-64.
- 1,279 View
- 81 Download
- The Inhaled Nitric Oxide in Acute Respiratory Distress Syndrome: from a Bedside to a Bench
- Younsuck Koh
- Korean J Crit Care Med. 2001;16(2):65-74.
- 2,199 View
- 24 Download
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Abstract
PDF - Because inhaled nitric oxide (NO) induces selective vasodilation of well-ventilated lung regions diverting pulmonary artery blood flow towards these well-ventilated alveoli, it has been applied to some of ARDS patients, who show severe hypoxemia despite of positive pressure ventilation with moderate to high positive end-expiratory pressure. The beneficial effect of inhaled NO on oxygenation was lower than 5 ppm of inhaled NO and the maximum effect was about 10 ppm in patients with ARDS according to the studies. Combinations of inhaled NO with various therapies, such as the use of intravenous almitrine or phenylephrine, and prone positioning may produce additive effects on oxygenation. Approximately 65% of patients had response to inhaled NO in studies of critically ill patients with ARDS who were ventilated with less than 40 ppm of inhaled NO. However, there was no survival benefit by inhaled NO in a multicenter phase 2 trial with 177 patients of non-septic ARDS. It is unclear whether inhaled NO exerts detrimental or beneficial effects in the pathogenesis of ARDS. Laboratory studies suggest that inhaled NO has important effects in reducing some forms of lung and tissue injury. If these effects are clinically significant, early and continued therapy with inhaled NO could potentially reduce the severity of some forms of lung injury. In contrast, NO and nitrite interacted with neutrophil myeloperoxidase to stimulate oxidative reactions during inflammation. In summary, NO inhalation would be acceptable as a rescue therapy in severe ARDS without serious complications related to the application. In addition, the effect of inhaled NO on the pathophysiology of ARDS should be elucidated.
- Management of Patient with Renal Failure in Intensive Care Unit
- Jong Hoon Chung
- Korean J Crit Care Med. 2001;16(2):75-79.
- 2,226 View
- 10 Download
- Transfusion Therapy
- Tae Hoon Ahn
- Korean J Crit Care Med. 2001;16(2):80-88.
- 1,307 View
- 6 Download
- Lung Injury Due to Mechanical Ventilation: from Barotrauma to Biotrauma
- Gee Young Suh, O Jung Kwon
- Korean J Crit Care Med. 2001;16(2):89-95.
- 1,607 View
- 13 Download
- Neuromuscular Dysfunction in Patients Using Neuromuscular Blocking Agents
- Jae Young Kwon
- Korean J Crit Care Med. 2001;16(2):96-99.
- 1,379 View
- 8 Download
- Hemorrhagic Complications in Intensive Care Unit
- Myung Ju Ahn
- Korean J Crit Care Med. 2001;16(2):100-111.
- 1,494 View
- 7 Download
- Detection and Treatment of Arrthymias in the Critically Ill
- Yong Woo Hong
- Korean J Crit Care Med. 2001;16(2):112-114.
- 1,427 View
- 24 Download
- Continuous Renal Replacement Therapy (CRRT)
- Jang Won Seo, Jung Sik Park
- Korean J Crit Care Med. 2001;16(2):115-118.
- 1,557 View
- 62 Download
- Monitoring of Arterial and Central Venous Pressure in Critically Ill Patients
- Sang Hyun Kwak
- Korean J Crit Care Med. 2001;16(2):119-131.
- 1,873 View
- 10 Download
- Monitoring of Respiratory Mechanics during Mechanical Ventilation
- Jae Yeol Kim
- Korean J Crit Care Med. 2001;16(2):132-137.
- 2,013 View
- 45 Download
- The Distribution of Medical Personnel and Medical Equipments in the Intensive Care Units in Korea
- Shin Ok Koh, Pyung Hwan Park, Myoung Hoon Kong, Yong Lak Kim
- Korean J Crit Care Med. 2001;16(2):138-143.
- 1,724 View
- 60 Download
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Abstract
PDF
- BACKGROUND
Not much of the fund is invested in the intensive care unit (ICU) in Korean hospitals since the cost of ICU care is set too low compared to the other medical fields as well as to the other part of the world. This study is designed to support the base of an ICU standard guideline in Korea.
METHODS
The questionnaire were sent to 73 ICUs and 24 neonatal ICUs (NICU) of 30 hospitals. Twenty-two of them were teaching hospitals and 8 of them were general hospitals.
RESULTS
The ratios of ICU bed number to total bed number were 5.0% and 6.0% in teaching hospital and general hospital respectively. The ratios of NICU bed to total bed were 3.4% and 2.0% in teaching hospital and general hospital respectively. Intensivists were kept in 24.6% of ICU and 36.4% of NICU. Residents were kept in 43.1% of ICU and 45.5% of NICU. The utilization of ICU service was 90% for teaching hospital and 86% for general hospital. The utilization of NICU was 89% for teaching hospital and 3% of general hospital. Nurse to patient ratios varied widely. Most ICUs in teaching hospital showed the nurse to patients ratio of 1 : 4 which was about 32% of total ICU. Most NICUs in teaching hospital showed the nurse to patients ratio of 1 : 5 which was around 20% of total NICU. Most of the ICUs were equipped with central piping system for oxygen and compressed air supply, vacuum system and all the necessary medical gadgets such as mechanical ventilators, ECG monitors, defibrillators, pulse oximeters and infusion pumps.
CONCLUSIONS
The distribution of medical personnel as well as medical equipments were varied widely. The variation existed between teaching hospital and general hospital as well as within the teaching hospitals. We need to establish a standard, which grades the level of ICU according to the number of keeping physician, nurse-patients ratio, and the types of medical equipments they have.
- Prognostic Implication of Serial Blood Lactate Concentrations in SIRS Patient
- Young Joo Lee, Jong Seok Park, Bong Ki Moon, Hee Jung Wang
- Korean J Crit Care Med. 2001;16(2):144-150.
- 1,505 View
- 106 Download
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Abstract
PDF
- Introduction: Lactic acid in circulating blood should provide an index between balance of oxygen consumption and metabolic rate in sepsis or any state of shock. The purpose of the study was to determine the prognostic power of the lactate, the time factor of the blood lactate levels between survivors and non-survivors and the correlation between APACHE III score and blood lactate level in SIRS patients.
METHOD
The study was performed on 99 patients over 16 years old who were admitted to the SICU with the criteria of SIRS. The blood lactate concentrations were assayed with arterial blood drawn in intervals ranging from 4 to 24 hours and the APACHE III scoring was done in the first 24 hours of SICU admission and daily until discharge or death for 2 weeks. The highest lactate level of the day was recorded. They were divided into two groups, survivors (n=61) and non-survivors (n=38), according to the outcome.
RESULT
There were significant difference of the first day (D1) as well as peak lactate level between the survivors and the non-survivors (3.02 3.05 vs 7.41 4.78, 3.24 2.70 vs 7.82 4.88 mmol/L). Significant difference of the lactate as well as APACHE III were identified between the survivors and the non-survivors during a 14-days of observation period. Significant correlations were shown between lactate and APACHE III while the study was being conducted. The peak lactate presented superior to the D1 lactate in mortality prediction.
CONCLUSION
Blood lactate concentration could be used as a prognostic index as well as APACHE III score. Serial blood lactate concentration assays are necessary to predict the outcome.
- Acute Respiratory Distress Syndrome after Severe Hypothermia and Hypotension Due to Near Drowning
- Ho Dong Park, Bon Nyeo Koo, Dong Woo Han, Seung Tak Han, Shin Ok Koh
- Korean J Crit Care Med. 2001;16(2):151-155.
- 2,112 View
- 31 Download
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Abstract
PDF
- The increase in short-term survival of near-drowning victims after an acute submersion episode has resulted in an increase of major complications. Two major complications are the development of acute respiratory distress syndrome and persistent hypoxic-ischemic central nervous system injury. A 43-year-old male patient was presented with acute respiratory distress syndrome after near drowning. He was severely hypothermic and hypotensive when he arrived to emergency department. His body temperature was 24oC. There was no pulse and no spontaneous respiration. He was treated with advanced life support measure. He was intubated and vasoactive drugs such as epinephrine and norepinephrine were used. On ICU admission, his blood pressure and pulse rate were 80/40 mmHg, 170 beats/min respectively. His oxygen saturation was 40~60% with 100% oxygen. We applied 16~30 cmH2O of PEEP with low tidal volume for recruitment. Patient was flipped over to prone position. Solu-medrol 1.0 g was infused. The blood pressure restored to 140/50 mmHg, and the pulse rate was normalized to 100 beats/min. The dose of vasopressors and inotropes were reduced and stopped 5 hour after the arrival. When the oxygenation has improved, the position was changed to supine and PEEP was lowered. Eventually weaning was successful. Brain MRI and EEG showed global atrophy of cerebral cortex and moderate diffuse brain dysfunction respectively. He received tracheostomy since he was semi-comatose. He was transferred to general ward on 39th ICU day.
- Successful Weaning after Diaphragmatic Plication in an Infant with Phrenic Nerve Palsy Resulting from Removal of Cavernous Lymphangioma
- Jang Ho Roh, Dong Woo Han, Shin Ok Koh, Yong Taek Nam
- Korean J Crit Care Med. 2001;16(2):156-159.
- 1,482 View
- 7 Download
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Abstract
PDF
- Phrenic nerve palsy is a well-known complication following cardiac surgery in children. The incidence is approximately 1~2%. In infants and young children, it often causes a life-threatening respiratory distress. They must be treated with mechanical ventilation in the ICU. Many patients with phrenic nerve injury who is impossible to wean from a ventilator are candidates of diaphragmatic plication. Diaphragmatic plication is performed to restore the normal pulmonary parenchymal volume by replacing the diaphragm to its proper location. This is a case of 2-months-old infant who had phrenic nerve palsy after the removal of cavernous lymphangioma of the chest. He underwent 4 operations to remove the mass and to have pericardiotomy. We tried to wean him from the ventilator but failed several times in the ICU. After 4th operation, right diaphragmatic elevation was noted from the chest X ray. Phrenic nerve palsy was confirmed with fluoroscopy and he underwent diaphragmatic plication on 42 days after his 4th operation. Three days after the diaphragmatic plication, weaning was successfully carried out.
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