Acute and Critical Care

Volume 18 (2); December 2003

Review Article

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.

Original Article

The Effect of Discharge Decision-Making of the Intensivist on Readmission to the Intensive Care Unit: Dong Woo Han, One Chul Kang, So Young Ban, Shin Ok Koh; Korean J Crit Care Med. 2003;18(2):74-79.

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Abstract PDF: BACKGROUND
Patients readmitted to intensive care unit (ICU) have significantly higher mortality. The role of intensivists to judge when to discharge from ICU may be important. We performed this study to assess the effect of intensivist's discharge decision-making on readmission to ICU. METHODS: Data were collected prospectively from patients admitted to ICUs (group 1). Another data were collected retrospectively from the patients' record (group 2). Discharge of the patients in group 1 were based on intensivist's discharge decision-making but not in group 2. We encouraged deep breathing and expectoration to patients of group 1 at risk of pulmonary complication during ICU stay and used a guideline for making discharge decisions. Readmission cause, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple organ dysfunction syndrome (MODS) score of readmitted patients were evaluated. RESULTS: Readmission rate of group 1 was lower than that of group 2 (p<0.05). The mortality of readmitted patients in each group was higher than that of non-readmitted patients (p<0.05). Respiratory disease was the major cause of readmission. In non-survivors of readmitted patients, APACHE III score on initial discharge and readmission, MODS score on initial admission, discharge and readmission were higher than those of survivors (p<0.05). CONCLUSIONS: Readmission rate was lower when intensivists participated in discharge decision- making. ICU readmission was associated with higher hospital mortality and longer ICU stay. MODS and APACHE III score at first discharge and readmission were significant prognostic factors of the outcome in readmitted patients.

Case Reports

Right Internal Jugular Venous Thrombosis Occurred after Long-term Placement of Hemodialysis Catheter Inserted Via Right Subclavian Vein: A Case Report: Mi Young Park, Il Woo Shin, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2003;18(2):80-83.

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Abstract PDF: Central venous catheter-related venous thrombosis is one of the most important complications occurred after central venous catheterization. Forty six year old man had end-stage renal failure due to diabetes mellitus. Temporary hemodialysis catheter was inserted via right subclavian vein. Thirty days after hemodialysis catheter insertion, the patient presented with right neck swelling and difficulty to aspirate blood from hemodialysis catheter. Venography showed right internal jugular vein thrombosis. We report a case in which a patient developed right internal jugular vein thrombosis after long-term placement of temporary hemodialysis catheter.

Retropharyngeal Dissection during Nasotracheal Intubation: A Case Report: Hyun Ju Jung, Sie Hyun You, Jong Bun Kim, Young Moon Han, Kuhn Park; Korean J Crit Care Med. 2003;18(2):84-88.

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Abstract PDF: Nasotracheal intubation is commonly performed for oropharyngeal or facial surgery. Although retropharyngeal dissection is a rare complication of nasotracheal intubation, serious sequelae may result. We report a case of a traumatic retropharyngeal dissection during nasotracheal intubation without untoward sequelae.

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