Skip Navigation
Skip to contents

ACC : Acute and Critical Care

OPEN ACCESS
SEARCH
Search

Previous issues

Page Path
HOME > Issue > Previous issues
10 Previous issues
Filter
Filter
Article category
Keywords
Authors
Volume 19 (1); June 2004
Prev issue Next issue
Review
Sedation in the Intensive Care Unit
Jong Hun Jun
Korean J Crit Care Med. 2004;19(1):1-7.
  • 1,546 View
  • 25 Download
AbstractAbstract PDF
No abstract available.
Original Articles
Influence of Collapse and Re-ventilation of Lung on the Development of Pulmonary Edema
Sang Hyun Kwak, Won Jong Jin, Hong Beom Bae, Seong Wook Jeong, Sung Su Chung, Chang Young Jeong
Korean J Crit Care Med. 2004;19(1):8-19.
  • 1,942 View
  • 15 Download
AbstractAbstract PDF
BACKGROUND
This study was to clarify the influence of collapse and re-ventilation of lung on the development of pulmonary edema in rabbit. METHODS: Animals were randomly assigned to one of three groups: Sham group receiving two lung ventilation (n=14), Collapse group receiving collapse of right lung (n=14), Reventilation group receiving collapse of right lung for 3 hours followed by reventilation of collapsed right lung for 3 hours (n=14). The lung of rabbits were ventilated with 50% oxygen through the tracheostomy. Right main bronchus was secured by thoracotomy in all animal. Collapse and reventilation were performed using by bulldog forcep. Mean arterial pressure, heart rate, arterial oxygen tension (PaO2), peripheral blood leukocyte and platelet counts were recorded at 0, 1, 2, 3, 4, 5 and 6 hour after the start of experiment. The wet to dry (W/D) weight ratio of lung, lung injury score and leukocyte counts, percentage of polymorphonuclear leukocyte (PMNL), concentration of albumin, and interleukin-8 (IL-8) in bronchoalveolar lavage fluid (BALF) were measured 6 hour after the start of experiment in both lung. RESULTS: W/D weight ratio of lung, lung injury score and leukocyte counts, percentage of PMNL, concentration of albumin and IL-8 in BALF were significantly increased in both lung of reventilation group. And the degree of increases is more significant in right than left lung. CONCLUSIONS: These findings suggest that reventilation of collapsed lung causes the bilateral pulmonary edema in rabbit mainly by activating neutrophil and IL-8 responses, which may play a central role in non cardiogenic pulmonary edema.
Effects of Sevoflurane and Ischemic Preconditioning on Neurologic Injury and Bcl-2 Family Protein mRNA Expression after Transient Spinal Ischemia in the Rats
Soon Hwan Kang, Eun Soo Kim, Seung Hoon Baek, Jae Young Kwon
Korean J Crit Care Med. 2004;19(1):20-31.
  • 1,372 View
  • 6 Download
AbstractAbstract PDF
BACKGROUND
Spinal cord injury occurring as the result of surgical repair of thoracic and thoracoabdominal aortic disease remains a devastating complication. Anesthetic and ischemic preconditioning have been known to prevent ischemic injury. The purpose of this study was to elucidate the effects of sevoflurane and ischemic preconditioning (IPC) on neurologic outcome, DNA fragmentation and Bcl-2 protein gene expression in transient spinal ischemia. METHODS: Rats were anesthetized with enflurane or sevoflurane, divided by 5 groups: Sevoflurane group and enflurane group (13 minutes of ischemia), Control group, Rapid group, Delayed group (15 minutes of ischemia). Spinal ischemia was produced by both induced hypotension and thoracic aortic cross clamping. Neurologic scores were assessed at the time of recovery and 1, 2, 3, 24 hours after transient spinal ischemia. After 24 hours, rats were euthenized and spinal cords were removed for the assay of DNA fragmentation. Other groups of rats received 5 minutes of ischemia, and after 1, 6, 24, 48 and 72 hours, spinal cords were removed for the assay of Bcl-2 family protein mRNA and DNA fragmentation. RESULTS: The neurologic injury and DNA fragmentation of sevoflurane group were significantly lesser than enflurane group. 5 minutes of IPC caused increase in Bcl-xl protein mRNA transcription at 48 and 72 hours reperfusion. There were no significant changes in neurologic injury, Bcl-2 family mRNA transcription and DNA fragmentation between control group, rapid group, and delayed group. CONCLUSIONS: Sevoflurane was effective in preventing neurologic injury after 13 minutes of transient spinal ischemia. However, rapid and delayed ischemic preconditioning did not potentiated neuroprotective action of sevoflurane during 15 minutes of spinal ischemia.
Predictive Factors for the Mortality of Cardiovascular Patients at Coronary Care Unit
Eun Suk Shin, Myung Ho Jeong, Sang Chun Lim, Myung Ja Choi, Seon Young Jeong, Gill Yup Kim, Eun Jeong Lee, Su Mi Bang, Hyo Ran Lee, Young Joon Hong, Hyung Wook Park, Ju Han Kim, Weon Kim, Young Keun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang
Korean J Crit Care Med. 2004;19(1):32-37.
  • 1,586 View
  • 26 Download
AbstractAbstract PDF
BACKGROUND
Recently the incidence of coronary artery disease has been increased rapidly in Korea. After the introduction of coronary care unit, the mortality rate of cardiovascular patients has been decreased. The predictive factors for mortality in patients admitted at Coronary Care Unit (CCU) are important in the management of acutely ill cardiovascular patients. METHODS: One thousand one hundred and thirty patients (64.8+/-14.5 years), who were admitted at CCU from January 2002 to June 2003, were analyzed. The patients were divided into two groups according to mortality: the survived group (Group I: n=1055, 63.3+/-13.3 years) and the moribund group (Group II: n=75, 64.8+/-14.1 years). Clinical characteristics, risk factors, clinical diagnosis, laboratory, echocardiographic and coronary angiographic findings were compared between the two groups.
RESULTS
The overall mortality at CCU was 6.6%, 75 out of 1130 patients. Age and sex were not different between both groups. Coronary artery disease was the most common cause of admission (886 out of 1130 patients) and death (46 out of 75 patients). Coronary angiographic findings were not different between the two groups. Left ventricular ejection fraction (LVEF) by echocardiogram was higher in Group I than in Group II (53.1+/-15.6% vs. 42.3+/-16.3%, p<0.05). Predictive factors for mortality by multiple logistic regression analysis were low LVEF (OR 11.4, 2.9-21.4 95%CI, p<0.001), no performance of percutaneous coronary intervention (PCI, OR 10.8, 2.5-17.8 95%CI, p<0.001) and clinical diagnosis of aortic dissection (OR 3.8, 1.3-9.8 95%CI, p=0.021).
CONCLUSIONS
The predictive factors for mortality at CCU were low LVEF, no PCI and aortic dissection.
Case Reports
Pulmonary Embolism Detected in the General Ward after Operation: A Case Report
Se Hyun Lew, Jong Hun Jun, Hee Koo Yoo, Yong Ho Kim
Korean J Crit Care Med. 2004;19(1):38-41.
  • 1,689 View
  • 41 Download
AbstractAbstract PDF
Pulmonary embolism is a common medical complication following major orthopedic procedures of the lower extremities and a leading cause of morbidity and mortality. However, the clinical manifestations of pulmonary embolism are nonspecific and it may be difficult to diagnose. An 82 years old female with severe restrictive pulmonary disease received the elective operation for the fracture of left femur neck under combined spinal-epidural anesthesia. During the operation, we sometimes gave her oxygen via face mask and maintained oxygen saturation of more than 80% which was measured by a pulse oxymeter. The operation and anesthesia was performed uneventfully. On the seventh postoperative day, she showed tachycardia suddenly and cardiac arrest later on the electrocardiogram. After cardiopulmonary resuscitation, she was transferred to intensive care unit and checked by a computed tomography and echocardiography. She was diagnosed with pulmonary embolism and deep vein thrombosis and treated with heparin and urokinase. But she did not improve and died.
Severe Postoperative Delirium Lasting for Three Weeks: A Case Report
Jun Rho Yoon, Tae Kwan Kim, Su Jung Yoon, Yee Suk Kim, Si Hyun Kim, Man Gyu Kim, Jeong Ju Seo
Korean J Crit Care Med. 2004;19(1):42-46.
  • 1,739 View
  • 39 Download
AbstractAbstract PDF
Postoperative delirium in the intensive care unit is a serious problem that has recently attracted much attention. We present a 73-year-old female patient who was admitted by multiple fractures induced by an accident. We started general anesthesia for the operation of open reduction and internal fixation. After the discontinuation of general anesthesia, the patient was transported to the intensive care unit. The symptoms of delirium were developed and controlled with medications including haloperidols, benzodiazepines, and vitamins. The patient was recovered three weeks after the management and received two other operations, but delirium did not be developed again. She was discharged from the hospital without complications.
Use of Laryngeal Mask Airway Proseal for Stereotactic Biopsy of Brain Tumor in which Difficult Intubation was Expected under General Anesthesia: A Case Report
Yun Hong Kim, Hyun Soo Kim, Sung Ha Mun, Hyun Seung Lee
Korean J Crit Care Med. 2004;19(1):47-51.
  • 1,600 View
  • 13 Download
AbstractAbstract PDF
Stereotactic surgery is a technique allowing the operation of an intracranial lesion without the need for craniotomy. Now stereotactic technique is widely used for aspiration of brain abscess or hemorrhage, biopsy of brain tumor and treatment of movement disorder etc. Because of the frame of stereotactic system, that is fixed on the scalp, laryngoscopic endotracheal intubation may be disturbed. So, in this case, we used laryngeal mask airway Proseal (PLMA(TM)) for maintenance of airway during stereotactic biopsy of brain tumor under general anesthesia. It was easily to insert PLMA(TM) using the introducer at once. The ventilation during the operation was not impeded at all time. There were not excessively changes of vital sign during general anesthesia. We think that PLMA(TM) may be a good alternative method for maintenance of airway during stereotactic surgery under general anesthesia.
Subcutaneous Emphysema and Pneumothorax Occurred during Patient Transfer to Intensive Care Unit: A Case Report
Yoonki Lee, Won Young Kim
Korean J Crit Care Med. 2004;19(1):52-56.
  • 1,745 View
  • 64 Download
AbstractAbstract PDF
A 48 years old female patient was scheduled for emergency surgery due to bleeding after intracerebral aneurysmal clipping under general anesthesia. Previously checked chest X-ray taken just a few hours before surgery showed no abnormal finding and she didn't show any sign of pneumothorax or hemothorax including dyspnea, tachypnea or cyanosis. Surgery was uneventful. After the completion of surgery, patient was transferred to the neurosurgical intensive care unit with intubation. During transfer, patient showed bucking and signs of subcutaneous emphysema around chest, shoulder and face. Oxygen saturation was low when she admitted to the neurosurgical intensive care unit, so the ventilator care was started. The patient's oxygenation were getting worse progressively, so we checked chest AP several times and one of the chest X-ray taken at that time revealed no vascular and lung marking on the left lung field suggesting pneumothorax. Emergency chest tube drainage was performed. She recovered dramatically and three days later, ches X-ray showed the complete resorption of the pneumothorax.
Chest Compression for Post Obstructive Pulmonary Edema: A Case Report
Hee Wan Moon
Korean J Crit Care Med. 2004;19(1):57-60.
  • 1,689 View
  • 12 Download
AbstractAbstract PDF
Post obstructive pulmonary edema (POPE) after anesthesia is a rare, but potentially dangerous pulmonary edema during or after relief of severe total or partial upper airway obstruction. The formation of POPE is believed to be the generation of negative intrapleural and intraalveolar pressures which increase the pulmonary transvascular hydrostatic pressure gradient and cause fluid movement to the interstitium and alveoli. Because of both the rapidity and severity with which POPE can develop, prompt recognition and management are essential. A case of POPE after anesthesia in a 23 year-old healthy male undergoing the primary repair of T12 fracture was presented. The patient was extubated without problem after operation. Arrived at the ICU, the patient showed laryngospasm and low oxygen saturation (around 50%). After the intubation with PEEP and the suction of the big amount of pinky frothy transudates through endotracheal tube, oxygen saturation was kept mid 70 s for over 30 minutes. After about 10 times chest compression with suctioning through endotracheal tube, the patient's oxygen saturation showed mid 90 s. This chest compression for the POPE was not recognized by the reference. Even though I can not tell the advantage or disadvantage of this treatment, I report this case for the future reference. After reviewing the reference, the risk factors, differential diagnosis, management and prevention of POPE are discussed.
Clinical Trial of Tracheal Gas Insufflation to Control Hypercapnia Occured during Laparoscopic Surgery: A Case Report
Seong Sik Kang
Korean J Crit Care Med. 2004;19(1):61-64.
  • 1,558 View
  • 17 Download
AbstractAbstract PDF
Despite numerous benefits of laparoscopic procedures, during carbon dioxide-induced pneumoperitoneum, the serious hypercapnia and respiratory acidosis in hypercapnic patients with decreased pulmonary compliance may be developed. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to controlled mechanical hypoventilation. However, the utility of TGI in hypercapnic management during laparoscopic surgery was not reported yet. We report a case that TGI superimposed on controlled mechanical ventilation corrected hypercapnia induced by carbon dioxide-induced pneumoperitoneum during laparoscopic salphingo-oophorectomy. There was no specific anesthetic problem during operation, patients was discharged uneventfully.

ACC : Acute and Critical Care