In spite of improvement in cardiopulmonary resuscitation (CPR) techniques, post-CPR mortality and brain injury rates have not changed significantly. The post-cardiac arrest syndrome has been suggested to be the major reason for the high mortality rate after CPR. Post-cardiac arrest syndrome, including brain injury, myocardial dysfunction, and septic shock-like syndrome after CPR, result in complicated multiple organ failure. Physicians who work in the ICU should have a good understanding of thepathophysiology of post-cardiac arrest syndrome. Recently, therapeutic hypothermia treatment for protection of brain injuries has been applied as a therapeutic regimen in spite of various side effects during the hypothermic procedure. Finally, therapeutic hypothermic treatment to reduce brain injury in post-cardiac arrest syndrome patients is strongly recommended to physiciansmanaging CPR. I would like to briefly review the therapeutic hypothermic procedure for the management of post-cardiac arrest syndrome.
BACKGROUND The prognosis of hemato-oncology (HMO) patients admitted to the intensive care unit (ICU) is poor and predicting the mortality is important for decision making at the time of ICU admission and for administering aggressive treatment. METHODS We retrospectively reviewed 309 patients who were admitted to the medical ICU (MICU) at Samsung Medical Center from July in 2005 to June in 2006. We calculated their Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score at the time of ICU admission and we investigated the relationship between the two scoring systems and the hospital mortality. RESULTS Among the 309 patients, the hospital mortality was 41.2%, and the mean SAPS II/SOFA score at ICU admission was 45.4 +/- 19.5/8.1 +/- 4.6. Seventy-nine (25.6%) patients had hemato-oncological diseases. Their hospital mortality was 65.8%, and the mean SAPS II/SOFA score at the time of ICU admission was 53.9 +/- 18.6/9.7 +/- 4.4, which was higher than that of the non-HMO patients (p = 0.00). The area under the receiver operating characteristic (ROC) curves for the SAPS II/SOFA score for predicting the mortality was 0.794 +/- 0.05/0.785 +/- 0.051 (p = 0.00/p = 0.00) for the HMO patients. There was no significant difference in discrimination ability between the two scoring systems (p > 0.05). None of the HMO patients with a SAPS II/SOFA score of 70/14 or higher survived. CONCLUSIONS Both the SAPS II and SOFA scores at the time of ICU admission were similarly effective for predicting the hospital mortality. The two scoring systems could be useful tools for decision making at the time of ICU admission and for administering aggressive treatment.
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Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock Jin Kyeong Park, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh The Korean Journal of Critical Care Medicine.2011; 26(1): 13. CrossRef
BACKGROUND Blood pressure is clinically used for monitoring shock patients and as a therapeutic indicator for them.
Non-invasive blood pressure measurement has weak points such as the use of a cuff and it is a discontinuous measurement.
A method of measuring the blood pressure by using the PWTT (pulse wave transit time) has been studied to make up for those weak points. If blood pressure monitoring can be done by using the difference of the PWTT between different points in the body, then this method will be a quite useful to monitor the BP of seriously ill patients. This study aimed to verify whether or not the PWTT has a significant correlation with the blood pressure of shock patients who received vasopressor infusion and whether this method is clinically applicable. METHODS The study subjects were 20 shock patients who were hospitalized in intensive care units and they had received vasopressor, and we measured the PWTT and we analyzed its correlation with the SBP (systolic blood pressure) and DBP (diastolic blood pressure), as measured by non-invasive monitoring. We then determined the effects of the PWTT on the SBP and DBP. RESULTS From the results of correlation analysis between the PWTT and the SBP and DBP, the SBP displayed a statistically significant negative correlation with the PWTT of 18 patients, while no significant correlation between the PWTT and DBP was observed. At the same time, from the results of the regression analysis of the blood pressures and the PWTT of each patient, it was found that the PWTT had a negative effect on the SBP of all the patients, except two. CONCLUSIONS The PWTT has a negative correlation with the SBP of the patients who received vasopressor infusion.
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Development of Blood Pressure Simulator for Test of the Arm-type Automatic Blood Pressure Monitor S.H. Kim, S.U. Yun, M.H. Cho, S.J. Lee, M.H. Lim, S.Y. Seo, G.R. Jeon Journal of Sensor Science and Technology.2015; 24(4): 239. CrossRef
BACKGROUND This study was performed to evaluate whether blood glucose concentrations have a significant influence on acid-base balance. METHODS We studied 157 adult patients who underwent intra-abdominal operations under general anesthesia.
Postoperative blood samples were withdrawn from radial artery and blood glucose concentrations, gas values, and chemistry values were measured. All patients were divided into three groups according to the postoperative blood glucose level. The group 1 contained the patients who had postoperative blood glucose level lower than 126 mg/dl, the group 2, the patients with glucose level higher than 126 mg/dl, lower than 180 mg/dl, and the group 3, the patients with glucose level higher than 180 mg/dl. RESULTS Metabolic acidosis rate was significantly higher in group 3 than in group 1, group 2 and arterial blood pH was significantly lower in group 3 than that in group 1, group 2. Regression analysis showed that [H+] was correlated with blood glucose level. Strong ion difference (SID) was significantly lower in group 3 than group 1 and PaCO2 level was significantly lower in group 2 and group 3 than that in group 1. In regression analysis, there was a negative correlation between blood glucose concentration and SID.
[H+] had a negative correlation with SID and PaCO2 was correlated with SID. CONCLUSIONS These findings suggest that blood glucose level affects acid-base balance and a disturbance in SID is accompanied with respiratory compensation.
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A Case of Metformin-Induced Acute Kidney Injury without Lactic Acidosis - A Case Report - Hae Ryong Jeong, Jeong Im Choi, Jung Hwan Park, Sang Mo Hong, Joon Sung Park, Chang Beom Lee, Yong Soo Park, Dong Sun Kim, Woong Hwan Choi, You Hern Ahn Korean Journal of Critical Care Medicine.2012; 27(4): 283. CrossRef
BACKGROUND Infectious complications commonly occur in the survivors of out-of-hospital cardiac arrest. The aim of our study was to describe the incidence, associated factors and outcome of infectious complications of the survivors of out-of-hospital cardiac arrest. METHODS We conducted a retrospective analysis of 75 patients who survived out-of-hospital cardiac arrest. We collected the data on the demographics, the modes of cardiac arrest, the duration of CPR, the dose of epinephrine, the use of hypothermia, new infections, the duration of mechanical ventilation, the length of stay in the intensive care unit (ICU), recovery of consciousness and the mortality. RESULTS New infections developed in 46.7% of the patients.
Asystole was the most common rhythm (70.7%). The most common infectious complication was pneumonia (40.0%) urinary tract infection developed in 10 cases, vascular catheter local infection developed in 6 cases, primary blood stream infection developed in 3 cases, wound infection developed in 2 cases and pseudomembranous colitis developed in 1 case.
The most common pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. Blood cultures were obtained in 36 patients during the first 24 hr and the pathogen was isolated in three. The patients with infection had a longer duration of mechanical ventilation and a longer stay in the ICU (p < 0.001, p = 0.001). CONCLUSIONS Infectious complications are common in survivors of out-of-hospital cardiac arrest and these infections are associated with a longer duration of mechanical ventilation and a longer stay in the ICU. The most common infectious complication was pneumonia and the pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus.
BACKGROUND Severe sepsis is a major cause of morbidity and mortality in intensive care units. This study aimed to evaluate the prevalence, characteristics, outcomes and prognostic factors of severe sepsis in a medical intensive care unit (MICU) of a tertiary care hospital in Korea. METHODS We retrospectively reviewed the medical chart of 249 patients who were admitted to a medical intensive care unit with severe sepsis. RESULTS From January 2000 to December 2001, 3410 patients were admitted to the ICU. The prevalence of severe sepsis was 7.3%. The mortality of severe sepsis was 64.6%. The prognostic factors for severe sepsis were the number of organ systems that acutely failed (p = 0.036) and an admission route from general wards (p = 0.018). There was no difference in the outcome of severe sepsis according to infectious organisms (p = 0.24) and the site of infections (p = 0.38). CONCLUSIONS Severe sepsis in the MICU is a common, expensive and often fatal condition. We expect that early rescucitation and recovery from acute organ system failure will improve the outcome of severe sepsis.
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Hemothorax in a patient on anticoagulant therapy for atrial fibrillation after blunt trauma is not an uncommon event.
However, massive hemothorax in such a patient with an extremely uncontrolled and high international normalized ratio (INR) may pose a serious dilemma. We report a case of a patient under anticoagulant therapy for atrial fibrillation who underwent an emergent thoracotomy for massive hemothorax with an INR of 9.57.
Postinfarction ventricular septal rupture (VSR) is a serious complication following an acute myocardial infarction. We performed repair of a postinfarction posterior VSR; however, the patient developed mitral regurgitation (MR) 2 months later. Geometrical changes caused by ventricular remodeling and recurrent shuntare thought to be the cause of delayed MR.
Topical epinephrine is useful to reduce bleeding during skin grafting. However, even though a clear operative field is obtained, systemic absorption of topical epinephrine can occur and this may cause severe hypertension, arrhythmias, ventricular tachycardia, myocardial ischemia, pulmonary edema, or cardiac arrest. We managed a case of cardiac arrhythmia during general anesthesia, which was induced by gauze soaked in topical epinephrine used for skin grafting of burn wounds. A 26-year-old woman developed premature ventricular complexes and ventricular tachycardia during surgery when epinephrine-soaked gauze was applied to the skin donor and burn wound sites to control oozing. The patient was resuscitated immediately and within 10 minutes the vital signs had normalized. It is recommended that caution is exercised when epinephrine-soaked gauze is applied to a large area of skin.
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Ventricular Fibrillation Soon after Endobronchial Epinephrine Application in a Young Man -A Case Report- Young Min Shin, Jong Hyung Kim, Hyung Wook Kim, Bo Sik Choi, Jin-Gyu Jeong, Jung Won Hwang, Kwang Won Seo, Jong-Joon Ahn, Seung Won Ra The Korean Journal of Critical Care Medicine.2011; 26(4): 276. CrossRef
Cerebral venous sinus thrombosis (CVT) is a rare disease that's associated with a wide variety of clinical signs and symptoms, and CVT is a potentially lethal condition. Iron deficiency anemia (IDA) as the cause of an adult case of CVT is very rare. We report here on a patient with CVT with intracerebral hemorrhage that was caused by IDA, and the patient was treated with hemodilution. We suggest that hemodilution should be considered as another therapeutic option for CVT with cerebral hemorrhage in a patient suffering with IDA.