Acute and Critical Care

Hormonal Changes in Critical Condition: Heung Bum Lee, Chi Ryang Chung; Korean J Crit Care Med. 2010;25(3):123-129.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.123

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When disease or trauma progresses to a critical state, the reaction of the endocrine system in creating homeostasis is essential for survival. The association between the severity of hormonal changes and outcome in terms of morbidity and mortality has led to the challenge of development of several endocrine treatments. During sepsis, nitric oxide-mediated apoptosis is observed in the neurons and glial cells of the cerebrovascular centers of the autonomic nervous system. It is probably one of the components of the circulatory dysfunction of sepsis. The regulation of different organs was neither linear nor independent however organs were found to behave as biological oscillators coupled to each other through neurological or hormonal communication pathways. Sepsis, because of systemic inflammatory responsive syndrome, disrupts these communication pathways and leads to organ failures. Endocrine hormonal issues related to the intensive care setting are common challenges to ICU specialists. Disruptions of the endocrine system in sepsis are characterized by 1) an increase in cortisol plasma levels with a loss of the circadian rhythm of its secretion; 2) hyperglycemia due to insulin resistance and rise in hyperglycemic hormones secretion; 3) relative vasopressin deficiency; and 4) euthyroid sick syndrome or non-thyroidal illness syndrome. This article discusses the dynamic changes of four main endocrine axes: hypothalamic-pituitary-adrenal axis, insulin, vasopressin and thyroid during grave states of disease, when a patient is in critical condition.

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The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia
Ki Tae Kim, Byung Kook Lee, Hyoung Youn Lee, Geo Sung Lee, Yong Hun Jung, Kyung Woon Jeung, Hyun Ho Ryu, Byoeng Jo Chun, Jeong Mi Moon
Korean Journal of Critical Care Medicine.2012; 27(4): 255. CrossRef

The Risk Factors of Postoperative Respiratory Insufficiency after Prolonged Robotic Radical Prostatectomy: Jin Young Lee, Ji Young Lee, Sung Jin Hong, Byung Ho Lee, Ou Kyoung Kwon, Young Hee Kim; Korean J Crit Care Med. 2010;25(3):130-135.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.130

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Abstract PDF

BACKGROUND
Robotic radical prostatectomy is performed in elderly patients and requires extreme changes in the patient's position and is often associated with a long surgery time. This study reviewed the pulmonary complications occurring after a robotic radical prostatectomy and analyzed the potential risk factors.
METHODS
The medical records of all patients who had undergone robotic radical prostatectomy at our institution were reviewed. Among the 80 total patients, 58 were capable of spontaneous respiration at the end of surgery (Group I), whereas 22 patients required assisted ventilation (Group II). A comparison between the two groups was made in terms of the demographic characteristics, coexisting diseases, anesthesia and operation time, amount of intraoperative blood loss and transfused blood products.
RESULTS
The mean age of the patients was 67.2 +/- 7.3 years. The mean operation time was 384.1 +/- 203.4 min (range, 195-1,180 min). The anesthesia and operation time, amount of intraoperative blood loss and number of transfused patients were all significantly higher in Group II. Univariate analysis revealed age, body mass index, intraoperative blood loss and transfusion, anesthesia and operation time to be related to postoperative respiratory insufficiency. Multivariate analysis revealed intraoperative transfusion and operation time to be predictive risk factors.
CONCLUSIONS
Prolonged laparoscopic surgery in a steep Trendelenburg position has a high likelihood of postoperative respiratory insufficiency, with the intraoperative transfusion and a longer operation time being possible contributing factors.

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Features of the mechanics of respiration and gas exchange during robot-assisted radical prostatectomy. Review
Ildar I. Lutfarakhmanov, I. A. Melnikova, E. Yu. Syrchin, V. F. Asadullin, Yu. A. Korelov, P. I. Mironov
Annals of Critical Care.2021; (1): 75. CrossRef

Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients: Sungwon Na, Hosun Lee, Shin Ok Koh, Ai Soon Park, A Reum Han; Korean J Crit Care Med. 2010;25(3):136-143.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.136

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Abstract PDF

BACKGROUND
Nutrition delivery is frequently interrupted or delayed by physicians' ordering patterns. We conducted this study to investigate the effect of physician compliance with tube feeding (TF) protocol on the nutritional and clinical outcomes in acute lung injury (ALI) patients.
METHODS
After implementing a TF protocol, 71 ALI patients with mechanical ventilation (MV) for > or = 7 days were observed. A dietician assessed the nutritional status of the patients and established individualized nutrition plans according to the protocol. If the physicians followed the dietician's recommendation within 48 hours, the patients were classified under the compliant group (Group 1).
RESULTS
Forty patients (56.3%) were classified into Group 1. Prealbumin was comparable in both groups at ICU admission but higher in Group 1 at the time of discharge from the ICU (228 +/- 81 vs 157 +/- 77 mg/dl, p = 0.025). Nitrogen balance was only improved in Group 1. The time to reach calorie goal was shorter and non-feeding days were reduced in Group 1. The proportion of parenteral nutrition to nutritional support days was lower and delivered calories on the 4th and 7th day of TF were higher in Group 1 (p < 0.001). ICU mortality/stay and hospital mortality failed to show differences but hospital stay was prolonged in the noncompliant group (Group 2) (p = 0.023). Arterial oxygen tension and PaO2/FiO2 were maintained during the 1st week of ICU stay in Group 1 but were decreased in Group 2.
CONCLUSIONS
Physicians' compliance with the TF protocol contributed to the likelihood of nutritional improvement and a shorter hospital stay in ALI patients with prolonged MV.

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Nutritional Assessment of ICU Inpatients with Tube Feeding
Yu-Jin Kim, Jung-Sook Seo
Journal of the Korean Dietetic Association.2015; 21(1): 11. CrossRef
Identifying Barriers to Implementing Nutrition Recommendations
Nancy Stamp, Anne M. Davis
Topics in Clinical Nutrition.2013; 28(3): 249. CrossRef

The Values of the Pediatric Logistic Organ Dysfunction (PELOD) Score and the Pediatric Index of Mortality (PIM) 2 Score in Emergency Department and Intensive Care Unit: Si Kyoung Jeong, Woon Jeong Lee, Yun Joo Moon, Seon Hee Woo, Yeon Young Kyong, Se Min Choi, Won Jung Jeong, Kyu Nam Park; Korean J Crit Care Med. 2010;25(3):144-148.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.144

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Abstract PDF

BACKGROUND
This study was conducted to compare two models of the pediatric logistic organ dysfunction (PELOD) score and the pediatric index of mortality (PIM) 2 score in the emergency department (ED) and intensive care unit (ICU).
METHODS
90 pediatric patients who were admitted to the ICU in ED from January 2003 to December 2008 were enrolled in this study. PELOD score and PIM 2 score calculations were performed in the ED and ICU. We classified these patients into either the survivor or non-survivor groups and analyzed the clinical variables between two groups. We used Hosmer-Lemeshow goodness-of-fit tests to evaluate calibration, receiver operating characteristic (ROC) curves and standardized mortality ratio (SMR).
RESULTS
Among the 90 pediatric patients, 56 (62.2%) were male, and 9 (10.0%) patients died. Expected mortalities were PIM 2 = 10.35, PELOD = 8.33 in ED and PIM 2 = 8.84, PELOD = 8.26 in ICU. PIM 2 showed fit calibration (x(2) = 6.228, p = 0.622) in the ED. In the ICU, both PELOD and PIM 2 showed calibration (x(2) = 4.625, p = 0.185) and (x(2) = 7.616, p = 0.472), respectively. PIM 2 in ED showed the best discrimination, with area under the curve (AUC) = 0.949 (95% CI, 0.881-0.984).
CONCLUSIONS
PIM 2 score in ED was fit. Also, PELOD and PIM 2 score in ICU was fit. But PELOD in ED was unfit.

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Usefulness of Thrombocytopenia and Changes in Platelet Counts as Prognostic Markers in Pediatric Intensive Care Units
Yoon Hee Kim, Hyun Bin Park, Min Jung Kim, Hwan Soo Kim, Hee Seon Lee, Yoon Ki Han, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
Korean Journal of Critical Care Medicine.2013; 28(2): 93. CrossRef

The Effect of Itraconazole Pretreatment in Lipopolysaccharide-Induced Acute Lung Injury in Rats: Tae Rim Shin, Young Man Lee, Younsuck Koh; Korean J Crit Care Med. 2010;25(3):149-154.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.149

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Abstract PDF

BACKGROUND
Despite the fact that a randomized controlled trial did not support the use of ketoconazole for treatment of acute lung injury (ALI), there is evidence that pretreatment with ketoconazole might prevent ALI in critically ill patients. An in vitro study showed, however, that itraconazole was a more potent inhibitor of thromboxane and leukotriene formation than was ketoconazole. We investigated the effect of itraconazole pretreatment in lipopolysaccharide (LPS)-induced ALI in rats.
METHODS
Twenty-one pathogen free, male Sprague-Dawley rats were administered either saline or LPS (5 mg/kg of body weight) intratracheally, with or without intraperitoneal pretreatment of itraconazole (2.5 mg/kg). Six hours after saline or LPS treatment (7 h after itraconazole pretreatment), samples were obtained.
RESULTS
Compared with the saline group, LPS group had increased total cell count, polymorphonuclear leukocyte differential count, protein, lactate dehydrogenase (LDH) and cytokines in BAL fluid. Itraconazole pretreatment decreased polymrphonuclear leukocyte differential count, protein and LDH in BAL fluid compared with those of LPS-treated rats without itraconazole pretreatment. Itraconazole pretreatment also decreased the elevated BAL fluid levels of interleukin-1beta (IL-1beta) and cytokine-induced neutrophil chemoattractant (CINC) by LPS. There was, however, no difference in the BAL fluid tumor necrosis factor alpha (TNF-alpha) level in terms of itraconazole pretreatment in LPS-treated rats. Histopathologic features of LPS-induced ALI were attenuated by itraconazole pretreatment.
CONCLUSIONS
These results suggest that itraconazole pretreatment attenuated LPS-induced ALI in rats. Decreases in levels of IL-1beta and CINC would likely be associated with attenuation of LPS-induced ALI in rats by itraconazole pretreatment.

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Itraconazole-Loaded Ufasomes: Evaluation, Characterization, and Anti-Fungal Activity against Candida albicans
Sara M. Hashem, Mary K. Gad, Hend M. Anwar, Neveen M. Saleh, Rehab N. Shamma, Noha I. Elsherif
Pharmaceutics.2022; 15(1): 26. CrossRef

Spontaneous Pneumomediastinum and Subcutaneous Emphysema in Children Infected with H1N1 Virus: A Case Report: Bo Geum Choi, Hye Jung Yun, Yeo Hyang Kim, Myung Chul Hyun; Korean J Crit Care Med. 2010;25(3):155-158.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.155

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Abstract PDF: Spontaneous pneumomediastinum (SPM) is a rare condition in children which is triggered by respiratory infection and inflammation, although it occurs most commonly in asthmatics. It is caused by alveolar rupture and dissection of air into the mediastinum and hilum, and the prognosis is usually benign. We report two cases of SPM and subcutaneous emphysema complicating pneumonia in children with severe H1N1 infection. The patients were admitted to the intensive care unit and treated with oxygen, inhalation of a bronchodilator, intravenous systemic corticosteroid (methyprednisolone, 2 mg/kg/day for 5 days) and antibiotics, together with antiviral therapy. On day 4 after admission, there was no further evidence of SPM. SPM associated with severe H1N1 infection in children resolves with aggressive supportive care, without progression to pneumothorax. We should remain aware of this air leak complication in children with severe respiratory infection.

Reexpansion Pulmonary Edema Following the Early Decompression of Pneumothorax Occurred after Anesthetic Induction in a Patient with Lung Bulla: A Case Report: Hye Jin Jeung, Hyun Jung Lee, Seok Jai Kim, Sang Hyun Kwak; Korean J Crit Care Med. 2010;25(3):159-162.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.159

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Abstract PDF: When a rapidly re-expanding lung has been in a state of collapse for more than several days, pulmonary edema sometimes occurs. This is called reexpansion pulmonary edema. In general, it most commonly occurs in patients with a large pneumothorax of long duration. In this case, a 15 year old female patient with a 2.3 cm sized bulla in the right lung developed right pneumothorax after anesthetic induction. Although early drainage by closed thoracostomy was performed, right pulmonary edema eventually occurred. It is unusual that vigorous reexpansion pulmonary edema developed even though early decompression was performed within one hour after development of pneumothorax.

Two Cases of Spontaneous Pneumomediastinum Complicating Viral Pneumonia Caused by Influenza A Virus, (H1N1 Subtype): A Case Report: Jae Woong Tae, Eun Jin Kim, Woo Jin Jang, Min Jeong Kim, Hae Ri Chon, Eun Soo Jeong, Young Min Koh; Korean J Crit Care Med. 2010;25(3):163-167.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.163

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Abstract PDF: Influenza A virus, (H1N1 Subtype), was identified as the cause of outbreaks of febrile respiratory infection in Mexico, the US, Canada and elsewhere during the spring of 2009. In Korea, a novel virus infection showing many variable complications was also pandemic. We report two cases of spontaneous pneumomediastinum, complicating viral pneumonia, caused by Influenza A virus, (H1N1 Subtype).

The Management of Heparin-induced Thrombocytopenia with Thrombosis after Open Heart Surgery: A Case Report: Jae Bum Kim, Sae Young Choi, Nam Hee Park; Korean J Crit Care Med. 2010;25(3):168-171.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.168

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Abstract PDF: Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated adverse reaction to heparin therapy. It is caused by antibodies binding to a complex of heparin and platelet factor 4, and this leads to platelet activation, excessive thrombin generation and often thrombosis. HIT with thrombosis (HITT) can lead to limb amputation, stroke, myocardial infarction and death. We report here on a case of a HITT patient who was successfully managed with argatroban therapy. Further knowledge is need about the ideal medical management for HITT.

Induced Hypertension Using Phenylephrine in Patients with Acute Ischemic Stroke: A Case Report: Sang Beom Jeon, Hoyon Sohn; Korean J Crit Care Med. 2010;25(3):172-175.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.172

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Abstract PDF

Decreased cerebral perfusion is associated with a poor prognosis for a patient suffering from acute ischemic stroke. Induced hypertension may improve the cerebral perfusion and stroke symptoms. However, there is not enough clinical evidence to support this therapy and it is rarely performed in daily practice. Here we report three patients with acute ischemic stroke and cerebral hypoperfusion who were successfully treated with induced hypertension using intravenous phenylephrine. Phenylephrine infusion may be a treatment option for patients suffering from acute ischemic stroke and cerebral hypoperfusion.

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Therapeutic Use and Chronic Abuse of CNS Stimulants and Anabolic Drugs
Daniela Coliță, Cezar-Ivan Coliță, Dirk Hermann, Eugen Coliță, Thorsten Doeppner, Ion Udristoiu, Aurel Popa-Wagner
Current Issues in Molecular Biology.2022; 44(10): 4902. CrossRef

A Case of Uremic Pericarditis and Cardiac Tamponade That Developed after Ethylene Glycol Poisoning: A Case Report: Ki Ju Kim, Jung Gil Park, Han Jun Ryu, Yeoun Su Jung, Sung Ho Kim, Bong Ryeol Lee, Byung Chun Jung, Hyun Jae Kang; Korean J Crit Care Med. 2010;25(3):176-181.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.176

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Ethylene glycol is commonly incorporated into automotive antifreeze agents and a variety of other commercial products. Ethylene glycol poisoning can cause life-threatening metabolic acidosis, cardiopulmonary failure, and renal failure that may be fatal. We present an unusual case of a patient who ingested a large amount of ethylene glycol for the purpose of suicide and developed multiorgan damage, including acute renal failure followed by uremic pericarditis and cardiac tamponade. This unusual complication was effectively managed with echocardiography-guided percutaneous pericardiocentesis and continuous catheter drainage for 3 days. After intensive hemodialysis and supportive care, the patient made a good recovery with near normal cardiac and renal function. Physicians should be aware of the possibility of acute pericarditis and cardiac tamponade in cases of acute renal failure caused by ethylene glycol poisoning.

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Deneysel Etilen Glikol Zehirlenmesi Oluşturulan Ratlarda Myokardiyal Etkilerin Araştırılması*,**
Burak DOĞAN, Vehbi GÜNEŞ
Erciyes Üniversitesi Veteriner Fakültesi Dergisi.2020; 17(3): 275. CrossRef

Acute Mercury Vapor Inhalation Toxicity after Burning Charms: A Case Report: Hong Yeul Lee, Gyoung Hoon Kang, Ki Ho Nam, Mi Hye Kim, Bock Hyun Jung, Hui Dong Kang, Se Hyun Oh, Jaemin Lim; Korean J Crit Care Med. 2010;25(3):182-185.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.182

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Abstract PDF: Cinnabar is the mineral with mercury in combination with sulfur, and it has been used to make charms in China and Korea. If cinnabar is overheated, mercury vapor that is extremely hazardous or sometimes fatal can be released. We experienced 5 patients of a family who were exposed to mercury vapor when they burnt charms. One of them developed severe acute respiratory failure and the patient needed mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Despite treatment with cortiocosteroid, D-penicillamine, ECMO and plasmapheresis, the radiologic findings of a patient worsened and he died.

A Case of Wernicke's Encephalopathy in a Postoperative Patient with Parenteral Nutrition and Temporary Oral Feeding: A Case Report: Hannah Lee, Eun Hye Lee, Sang Chul Lee, Hee Pyoung Park; Korean J Crit Care Med. 2010;25(3):186-189.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.186

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Abstract PDF

Wernicke's encephalopathy is an acute neurological disorder, caused by thiamine deficiency, which is clinically characterized by a triad of ophthalmoplegia, ataxia and disturbances of consciousness. Most frequently, the encephalopathy is a consequence of chronic alcoholism, but it may occur in other forms of malnutrition or malabsorption, such as in prolonged parenteral nutrition without the addition of thiamine, total gastrectomy, gastrojejunostomy, severe anorexia or hyperemesis gravidarum. Thiamine requirement increases during critical illness and in chronically depleted patients, and its supplementation may influence the outcome of the disease. We report a case of a 73-year-old man, who presented with recurred colon cancer, who was affected by Wernicke's encephalopathy while undergoing oral feeding and parenteral nutrition. This case suggests that we should be more aware of potential thiamine deficiency in critically ill patients, even those undergoing parenteral nutrition and temporary oral feeding.

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Two Cases of Wernicke's Encephalopathy That Developed during Total Parenteral Nutrition in Colon Cancer Patients Treated with 5-Fluorouracil-based Chemotherapy
Kyung Pyo Cho, Jae Sung Lee, Ji Seok Seong, Yong Moon Woo, Young Jun Cho, Beom Jin Jeong, Jee Hoon Sohn, Su-Jung Kim
The Korean Journal of Gastroenterology.2014; 64(3): 158. CrossRef
Experiences of Wet Beriberi and Wernicke's Encephalopathy Caused by Thiamine Deficiency in Critically Ill Patients
Ji Young Jang, Hongjin Shim, Jae Gil Lee
Korean Journal of Critical Care Medicine.2013; 28(2): 156. CrossRef

Delayed Pleural Effusion after Right Subclavian Vein Catheterization: A Case Report: Ji Ung Kim, Ji Hyun Cheon, Il Soo Kim, Sun Kwang Kim, Sung Hyun Ko, Sea Won Lee, Sang Hee Kim, Su Hong Kim; Korean J Crit Care Med. 2010;25(3):190-193.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.190

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Abstract PDF: Central venous catheterization is commonly used for supplying large amounts of fluids, total parenteral nutrition and for monitoring central venous pressure. Numerous complications exist with the technique, including pneumothorax, arterial puncture with vessel injury, catheter embolus, mediastinal hematoma, hydrothorax, and the thrombus of the vein. We reported an uncommon case of pleural effusion, due to catheter tip migration and penetration, which occurred 4 days after central venous catheterization.

Cardiac Transplantation for a Patient with Intra-aortic Balloon Pump and Extracorporeal Membrane Oxygenator due to Cardiogenic Shock after Acute Myocardial Infarction: A Case Report: Jae Hang Lee, Young Ok Lee, Byoung Ju Min, Byung Su Yoo, Ki Bong Kim; Korean J Crit Care Med. 2010;25(3):194-198.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.194

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Abstract PDF: A 66-year-old male patient who suffered from chest pain and dyspnea was admitted to our hospital. He was diagnosed as having an acute myocardial infarction, and recovered from cardiogenic shock after cardiopulmonary-cerebral resuscitation. Under the support of extracorporeal membrane oxygenator (ECMO) he underwent successful percutaneous coronary intervention. After this, an intra-aortic balloon pump (IABP) was inserted to increase coronary perfusion and reduce the impedance to left ventricular ejection. After 6 days, the patient was weaned from ECMO support; however, IABP therapy and infusion of inotropic agents were required to maintain adequate hemodynamic status. One week later, cardiac transplantation was performed successfully without major complications.

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