Acute and Critical Care

Volume 23 (1); June 2008

Review

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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Abstract PDF

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
Hwang Kyung-A, Hwang Yu-Jin, Park Dong-Sik, Kim Jaehyun, Om Ae-Son
Food Chemistry.2011; 125(2): 483. CrossRef

Original Articles

Variations in Pulse Oximetry Plethysmographic Waveform Amplitude and Hemodynamic Assessment Induced by Passive Leg Raising in Spontaneously Breathing Adult Volunteers: Jai Woog Ko, Sang Weon Chung, Yo Seob Park, Kyo Joon Lee, Dong Seok Moon, In Byung Kim; Korean J Crit Care Med. 2008;23(1):6-12.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.6

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Abstract PDF: BACKGROUND
In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsivenss is a difficult challenge. Our objective was to test whether the respiratory changes in pulse oxymetry plethysmographic waveform amplitude (POP) and in stroke volume (deltaSV) could predict fluid responsiveness to passive leg raising (PLR) in normal volunteers.
METHODS
We investigated 25 normal volunteers. We assessed hemodynamic status (HR, SBP, MAP, CI and SVI) and calculated the respiratory variation in pulse oximetry plethysmographic waveform amplitude at supine and after PLR. We attached a pulse oximeter of 25 spontaneously breathing volunteers as several time points: after 1 min and 5 min in supine position and during PLR at 60degrees. Heart rate, non-invasive blood pressures (mean arterial pressure, systolic blood pressure), maximal POP (POPmax), minimal POP (POPmin) and deltaPOP defined as (POPmax-POPmin)/[(POPmax+POPmin)/2] were recorded using monitor.
RESULTS
Comparing to supine and PLR, systolic blood pressure and mean arterial pressure were not different, but the change in cardiac index, stroke volume and respiratory variation in POP were significant different. In response group (> or =10% in deltaCI), the change in cardiac index, stroke volume and respiratory variation in POP were significant greater.
CONCLUSION
PLR induces a significant decrement of variation in POP amplitude among spontaneouely breathing volunteers. We suppose that the changes in stroke volume and the respiratory variation in pulse oximetry plethysmographic waveform amplitude induced by PLR predict fluid responsiveness in spontaneous breathing patients.

Causes of Fever in the ICU - A Prospective, Cohort Study: Eun Ju Jeon, Hye Min Lee, Sung Gun Cho, Hyung Koo Kang, Hee Won Kwak, Ju Han Song, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Jae Yeol Kim; Korean J Crit Care Med. 2008;23(1):13-17.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.13

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Abstract PDF

BACKGROUND
Fever develops in 70% of ICU patients. In the present study, we tried to figure out causes of fever and the prognosis of febrile patients in the ICU in a prospective, cohort method.
METHODS
From February to June 2007, patients admitted to medical ICU were daily screened and those who developed fever were enrolled. 237 consecutive admissions of 237 patients over a 5-month period were analyzed. Clinical parameters, including demographic data, underlying diseases, duration of ICU stay, causes of fever and final outcome were analyzed.
RESULTS
Fever (core temperature > or =38.3degrees C) was present in 8% of admission, and it was caused by infective (84.2%) and non-infective processes (15.8%). Most fever occurred within first 5 days in the course of the admission (68.4%) and most lasted less than 5 days (57.9%). The median Acute Physiology and Chronic Health Evaluation (APACHE) III score at the time of fever was 43 (+/-19). Those with infectious fever had no significant differences in terms of severity of diseases in comparison with those with non-infectious cause of fever. The most common cause of infective fever was pneumonia (n=11). Prolonged fever (> or =5 days), all of which was caused by infection, occurred in 11 patients. Those with prolonged fever had higher mortality rate than short duration of fever (37.5% vs 0%, p<0.05).
CONCLUSION
Infection, especially pneumonia is common cause of fever in the ICU. Prolonged fever is associated with high mortality rate.

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The Value of Procalcitonin and the SAPS II and APACHE III Scores in the Differentiation of Infectious and Non-infectious Fever in the ICU: A Prospective, Cohort Study
Eun Ju Jeon, Jae Woo Jung, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Ae Ja Park, Jae Yeol Kim
Journal of Korean Medical Science.2010; 25(11): 1633. CrossRef

Retrospective Analysis of the Postoperative Patients Admitted to General Surgical-Medical Intensive Care Unit: Jun Rho Yoon, Choon Hak Lim, Mi Jung Kim; Korean J Crit Care Med. 2008;23(1):18-24.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.18

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Abstract PDF

BACKGROUND
The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU.
METHODS
Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus' suggestion which defines the kinds of treatment done exclusively in ICU. Patients' demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed.
RESULTS
255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group.
CONCLUSION
Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.

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Retrospective investigation of anesthetic management and outcome in patients with deep neck infections
Tae Kwane Kim, Hye Jin Yoon, Yuri Ko, Yuna Choi, Ui Jin Park, Jun Rho Yoon
Anesthesia and Pain Medicine.2019; 14(3): 347. CrossRef

Change of Antibiotics Resistance Pattern of Microorganism Cultured in Tracheal Aspirate in Mechanical Ventilated Patients after Antibiotics Restriction Policy: Jeong Eun Ma, Soo Kyong Kim, Min Kyung Kang, Yi Yeong Jeong, Ho Cheol Kim, Jong Deok Lee, Young Sil Hwang; Korean J Crit Care Med. 2008;23(1):25-29.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.25

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Abstract PDF

BACKGROUND
To reduce production of resistant bacteria by over-use of antibiotics, an antibiotics restriction policy became effective in several hospitals. However, there are different views on its effect. This study aims to examine antibiotic resistance of pathogenic organisms cultured in tracheal aspirates of the patients who need to maintain mechanical ventilation in medical intensive care unit before and after the antibiotics restriction policy.
METHODS
Before and after 2 years from August 2003, when carried out the antibiotics restriction policy in Gyeongsang university hospital, it was retrospectively investigated the antibiotic resistance pattern of bacteria cultured in tracheal aspirates of the patient who is maintained by mechanical ventilation more than 48 hours in the medical intensive care unit. Restricted antibiotics are ceftazidime, piperacillin/tazobactam, imipenem, meropenem, vancomycin, and teicoplanin.
RESULTS
Before the antibiotics restriction policy, (Sep 2001~Aug 2003) and after, (Sep 2003~Aug 2005), there were 306 and 565 patients applied in each case and the total use of antibiotics, except piperacillin/tazobactam, was reduced and that of cefotaxime and ceftriaxone was increased. There was no significant change in antibiotic resistance among Acinetobacter, Pseudomonas, and Enterobacter species.
CONCLUSION
The result of this study shows that the antibiotics restriction policy does not reduce production of antibiotic resistant bacteria in tracheal aspirate in a medical intensive care unit. However, it is considered that long-term observation may be necessary.

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Clinical Characteristics in Patients with Carbapenem-ResistantAcinetobacter baumanniiIsolates from Tracheal Secretions
Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye-Kyung Park, Min Ki Lee
Korean Journal of Critical Care Medicine.2013; 28(3): 173. CrossRef
Overview of Antibiotic Use in Korea
Baek-Nam Kim
Infection & Chemotherapy.2012; 44(4): 250. CrossRef

Hormonal Changes of the Brain-Dead Organ Donors: A 3-Year Experience: Yong Seon Choi, Sungwon Na, Seung Youn Kang, Shin Ok Koh; Korean J Crit Care Med. 2008;23(1):30-35.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.30

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Abstract PDF

BACKGROUND
Success of transplantation is critically dependent upon the quality of the donor organ and optimal management. Recently, hormonal replacement therapy has been reported to result in rapid recovery of cardiac function and enable significantly more organs to be transplanted, while some other studies show conflicting results. The aim of this study is to comprehensively evaluate changes in basal circulating hormonal levels of the brain-dead organ donors.
METHODS
We reviewed the records of all brain-dead patients between January, 2004, and June, 2007. Hemodynamic variables, plasma hormone levels were recorded at following time points: admission to the ICU (T1, baseline), 30 minutes (min) after first apnea test (T2), 30 min after second apnea test (T3), before operation for harvesting (T4). Hormonal measurements included cortisol, adrenocorticotrophic hormone, triiodothyronine (T(3)), thyroxine, free thyroxine, thyroid-stimulating hormone, growth hormone, and testosterone.
RESULTS
Nineteen patients were included in this study. Comparisons of hemodynamic parameters and hormonal levels to baseline values revealed no significant changes throughout the study period. When the patients were divided into 2 groups according to the requirement of norepinephrine (either>0.05 or < or =0.05microgram/kg/min), patients requiring >0.05microgram/kg/min of norepinephrine had T(3) level below the normal range at significantly more time points of measurement (7 vs. 0).
CONCLUSION
In this comprehensive assessment of hormonal levels in brain-dead organ donors, we could not observe any significant changes during the ICU stay. Replacement therapy of T(3) may be considered in patients requiring >0.05microgram/kg/min of norepinephrine.

Citations

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Alterations in neuroendocrine axes in brain-dead patients
Türkay Akbaş, Ayhan Öztürk
Hormones.2023; 22(4): 539. CrossRef

Case Reports

Anesthetic and Postoperative Intensive Care for Patient with Systemic Lupus Erythematosis and Antiphospholipid Syndrome: A Case Report: Sung Wook Park, Yong Il Kim, Keon Sik Kim, Moo Il Kwon; Korean J Crit Care Med. 2008;23(1):36-39.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.36

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Abstract PDF: The antiphospholipid syndrome (APS) is characterized by vascular thrombosis despite of prolongation of coagulation profile in laboratory findings and pregnancy morbidity in the presence of antiphospholipid antibody. It occurs primarily or secondarily to autoimmune disease. This case report concerns a pelviscopic left ovarian cystectomy in a 32-year-old female with APS and systemic lupus erythematosis. To manage the hypercoagulability, oral warfarin and low molecular weight haparin were given pre- and postoperatively. In perioperative period, we monitored activated clotting time to prevent intraoperative thrombosis and tried to avoid dehydration, hypothermia and infection.

Reversal of Focal Neurologic Deficit due to Preoperative Intracranial Pressure Reduction in a Patient with Early Rebleeding of Cerebral Aneurysm: A Case Report: Hyo Seok Na, Sang Hyun Park, Young Tae Jeon, Song Hwan Do, Hwan Hee Kim, Sang Chul Lee, Hee Pyoung Park; Korean J Crit Care Med. 2008;23(1):40-43.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.40

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Abstract PDF: In the first hours after initial hemorrhage, up to 15% of patients with subarachnoid hemorrhage (SAH) due to aneurysmal rupture may have a sudden episode of clinical deterioration resulting from rebleeding. In patients suffering from an aneurismal rebleeding, the prognosis becomes much poor. Early detection of rebleeding and preoperatively appropriate medical treatment for increased intracranial pressure (IICP) might be crucial to decrease the overall mortality and morbidity rate in a patient with aneurismal rebleeding. We report a case of a successful reversal of focal neurological deficit showed in a patient with abrupt rebleeding of ruptured aneurysm whose intracranial pressure was preoperatively reduced with hyperventilation, and thiopental and mannitol administration under general anesthesia in angiography suite, although the patient ended up in death due to postoperative IICP.

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