Acute and Critical Care

Volume 26 (1); March 2011

Review

Hemodynamic Monitoring and Treatment Strategy of Acute Heart Failure: Chul Soo Park; Korean J Crit Care Med. 2011;26(1):1-5.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.1

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Acute heart failure (AHF) has emerged as a major public health problem over the past 2 decades and AHF represents a period of high risk for patients, during which time the patients are more susceptible to have fatal outcomes or be re-hospitalized, compared to periods of chronic stable heart failure. The goals of AHF treatment are symptomatic relief and hemodynamic stabilization, which need accurate assessment of volume status and cardiac function of patients. Until now, there is a paucity of controlled clinical data to define optimal treatment for patients with AHF and most guidelines published by the American Heart Association or European Society of Cardiology have been generated by the consensus opinions of experts. In these guidelines, routine invasive hemodynamic monitoring of AHF patients is not recommended because there have not been any reports showing survival benefit in patients monitored with pulmonary artery catheters. At present, treatment strategies based on clinical characteristics such as pulmonary congestion and tissue hypoperfusion rather than invasive hemodynamic monitoring is widely accepted. In this article, we discuss an optimal management plan including appropriate assessment of the hemodynamic status of patients and treatment of AHF.

Citations

Citations to this article as recorded by

Thoracic aortic aneurysms exerting high extrinsic pressure on the airway
Hanna Jung, Young Woo Do, Sang Yub Lee, Youngok Lee, Tak Hyuk Oh, Gun Jik Kim
Journal of Cardiothoracic Surgery.2019;[Epub] CrossRef
Relationship of Temperature and Humidity with the Number of Daily Emergency Department Visits for Acute Heart Failure: Results from a Single Institute from 2008-2010
Sang Hyun Ha, Bong Gun Song, Na Kyoung Lee, Chang Shin Choi, Chong Kun Hong, Jun Ho Lee, Seong Youn Hwang
Korean Journal of Critical Care Medicine.2012; 27(3): 165. CrossRef

Original Articles

Metabolic Syndrome as a Risk Factor for Atrial Fibrillation in Patients with Acute Myocardial Infarction: Woo Seung Shin, Mi Youn Park, You Mi Hwang, Hui Kyung Jeon, Man Young Lee, Jong Min Lee, Byoung Joo Shim, Sung Sik Kim, Seung Jae Lee, Yong Seog Oh, Tai Ho Rho, Ki Bae Seung; Korean J Crit Care Med. 2011;26(1):6-12.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.6

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Abstract PDF

BACKGROUND
Atrial fibrillation (AF) has been linked to an increased risk for in-hospital and long-term mortality rates in patients with acute myocardial infarction (AMI). Obesity and metabolic syndrome (MS) are known to play an important role in cardiovascular morbidity and mortality. However, it is uncertain whether obesity and MS increase the risk of AF in patients with AMI. Therefore, we investigated independent risk factors for the occurrence of new-onset AF in patients with AMI who received optimal percutaneous coronary intervention (PCI).
METHODS
We prospectively analyzed the association between MS and the incidence of cardiac arrhythmia in 146 patients with AMI who underwent PCI. Twenty-four-hour Holter monitoring was performed 3 days after AMI. We divided the patients into two different groups based on the development of AF and analysed their obesity based on body mass index (BMI) (kg/m2) and evaluated the existence of MS, as well as visceral obesity with fat computed tomography.
RESULTS
Seventy-five patients (51.4%) were obese (BMI > or = 25) and 64 (44%) had MS. AF occurred in 33 (22.6%) patients. Age, MS, and visceral obesity were significantly associated with AF (p = 0.001, p = 0.003, and p = 0.03, respectively). There was no difference between obese and non-obese patients in the incidence of AF and VT. Multivariate analysis revealed that age and MS were independent risk factors of post-AMI AF.
CONCLUSIONS
MS is an important and modifiable risk factor for new-onset AF especially in patients with AMI who underwent PCI.

Citations

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Impact of Metabolic Syndrome on Procedural Outcomes in Patients With Atrial Fibrillation Undergoing Catheter Ablation
Sanghamitra Mohanty, Prasant Mohanty, Luigi Di Biase, Rong Bai, Agnes Pump, Pasquale Santangeli, David Burkhardt, Joseph G. Gallinghouse, Rodney Horton, Javier E. Sanchez, Shane Bailey, Jason Zagrodzky, Andrea Natale
Journal of the American College of Cardiology.2012; 59(14): 1295. CrossRef

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; Korean J Crit Care Med. 2011;26(1):13-17.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.13

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Abstract PDF: BACKGROUND
A dramatic decrease in circulating lymphocyte number is observed after septic shock. In this study, we assessed whether circulating lymphocyte subpopulations influence the severity and prognosis of septic shock.
METHODS
133 patients (median 65 years, range 27-88; male 63.2%) receiving intensive care for septic shock were enrolled in this study. Flow cytometry phenotyping of circulating lymphocyte subpopulations, including helper T cells, suppressor T cells, total B cells, and natural killer (NK) cells, was performed within 24 hours after the diagnosis of septic shock. After measuring the white blood cell (WBC) and differential leukocyte count, the lymphocyte subsets were analyzed. The following data were recorded: general characteristics, severity of illness as assessed by the Sequential Organ Failure Assessment (SOFA) score, and 28-day mortality.
RESULTS
The overall mortality rate at 28 days was 33.8%. SOFA score was negatively correlated with the T cell count (r = -0.175) and helper T cell count (r = -0.223). However, only low a helper T cell count was associated with the severity of septic shock (odds ratio 0.995, 95% confidence interval 0.992-0.999, p = 0.014). Using multiple logistic regression analysis for 28-day mortality, there was no significant prognostic factor among the lymphocyte subset.
CONCLUSIONS
The low helper T cell count appeared to be associated with severity, but did not show significant association with mortality.

Association of Hyperlactatemia and IL-6 Hypercytokinemia after Cardiopulmonary Bypass: A Preliminary Report: Sang Hoon Yoon, Seung Zhoo Yoon, Hye Won Shin, Sung Uk Choi, Choon Hak Lim; Korean J Crit Care Med. 2011;26(1):18-23.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.18

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Abstract PDF: BACKGROUND
In cardiac surgery with cardiopulmonary bypass (CPB), hyperlactatemia (HL) is common and is associated with postoperative morbidity and mortality. At present, the cause of HL during CPB is proposed to be tissue hypoxia. Tissue perfusion and oxygen delivery can be impaired to varying degrees during CPB. Although surgery involving CPB apparatus is associated with increased pro-inflammatory mediators, such as TNF-alpha and IL-6, tissue hypoxia that occurs during CPB may be an additionally potent stimulus to inflammation. We hypothesized that hypoxic patients during CPB that experience elevated serum lactate levels, may be related to higher serum cytokine level after CPB than normoxic patients during CPB with normal serum lactate levels.
METHODS
Levels of TNF-alpha and IL-6 were measured by ELISA in a) Time 1; before initiation of CPB, b) Time 2; 30 min after aortic de-clamping, c) Time 3; 24 hrs after aortic de-clamping. Levels of lactate was measured at a) Time A; before initiation of CPB, b) Time B; 30 min after aortic de-clamping. Postoperative ICU stay, intubation time and oxygen index were evaluated as postoperative morbidity scale.
RESULTS
There were no statistical differences between HL (n = 43, lactate > or =3 mMol/L at time B) and normal lactate group (NL) (n = 63, lactate <3 mMol/L at time B) in demographic data, preoperative left ventricular ejection fraction, CPB time, and aortic cross-clamp time. Level of IL-6 in HL at time 3 was higher than that of NL. The ICU stay and intubation time were longer in HL. The oxygen index on 1st postoperative day was lower in HL.
CONCLUSIONS
Our results suggest that hyperlactatemia after weaning from CPB may be related to IL-6 hypercytokinemia, and therefore related to postoperative morbidity.

Case Reports

Acute Pulmonary Embolism Due to Free-floating Right Atrial Thrombus in a Patient with Multiple Myeloma: A Case Report: Youn Yi Jo, Yong Seon Choi, Sa Ra So, Shin Ok Koh; Korean J Crit Care Med. 2011;26(1):24-28.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.24

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Abstract PDF: Although venous thrombosis is one of the most frequent complications of malignant disease including multiple myeloma, massive pulmonary embolism is an uncommon complication. Free-floating intracardiac thrombus has been rarely reported as a cause of acute pulmonary embolism in patients with multiple myeloma. We report a case presenting acute pulmonary embolism due to free-floating right atrial thrombus in a patient with multiple myeloma.

Extracorporeal Membrane Oxygenation as a Bridge to Definitive Airway Security in 3 Severe Acute Extrinsic Airway Compression Patients: A Case Report: Jiwon Lyu, Jin Won Huh, Chae Man Lim, Youn Suck Koh, Sang Bum Hong; Korean J Crit Care Med. 2011;26(1):29-33.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.29

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Abstract PDF: Extracorporeal membrane oxygenation (ECMO) has been used for cardiac and respiratory failure for over 30 years. Recently, however, ECMO has emerged as a useful means of short-term support in the management of hypoxic patients for nontraditional indications. Here, we report the use of veno-venous ECMO as a bridge to support a patient with severe airway obstruction because of tumor compression. Case 1: A patient with extrinsic airway compression secondary to a large metastatic cancer on neck was successfully managed using ECMO. Case 2: The successful use of ECMO to support a patient with extrinsic airway compression secondary to a recurred thyroid cancer. Case 3: A pregnant woman with airway obstruction secondary to metastatic lymphadenopathy of lung cancer who underwent successful tracheal stent insertion. The 3 patients were successfully weaned off ECMO without any complication. Although these conditions are uncommon indications, ECMO is a potential option for such life-threatening conditions.

Stress-induced Cardiomyopathy Following Cesarean Delivery with Hemorrhagic Shock: A Case Report: Youn Yi Jo, Ja Young Kwon, Yoon Seong Jang, Yong Seon Choi; Korean J Crit Care Med. 2011;26(1):34-37.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.34

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Abstract PDF: Stress-induced cardiomyopathy is a recently described acute and transient cardiomyopathy with typical left ventricular apical ballooning mimicking the clinical scenario of an acute myocardial infarction. Cesarean delivery causes intense emotional and physical stresses, which may precipitate stress-induced cardiomyopathy. We report a case presenting stress-induced cardiomyopathy occurring during ICU care in the early postpartum period following cesarean delivery.

Knotting and Kinking of the Guidewire during Central Venous Catheterization: A Case Report: Deokkyu Kim, Ji Hye Lee, Dong Chan Kim, Hyungsun Lim, Seonghoon Ko, Ji Seon Son; Korean J Crit Care Med. 2011;26(1):38-40.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.38

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Abstract PDF: Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.

A Case of Respiratory Syncytial Virus Related Acute Respiratory Distress Syndrome: A Case Report: Jinwoo Lee, Tae Yun Park, Eun Sun Kim, Keun Bum Chung, Kyoung Hee Kim, Sang Min Lee, Jae Joon Yim, Seok Chul Yang, Young Whan Kim, Sung Koo Han, Seonyang Park, Chul Gyu Yoo; Korean J Crit Care Med. 2011;26(1):41-44.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.41

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Abstract PDF: Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection in children. Although previously considered as children's virus, the increasing number of patients who receive immunosuppression after transplantation of bone marrow and solid organs highlighted the role of RSV as a pathogen for opportunistic infection. We report a case of community-acquired respiratory syncytial virus pneumonia in a patient with newly diagnosed leukemia, resulting in acute respiratory distress syndrome (ARDS).

The Benefit of Braille for Successful Weaning off Mechanical Ventilation in Congenital Blindness and Hearing Impairment: A Case Report: So Young Yang, Yong Seon Choi, Jin Ha Park, Shin Ok Koh; Korean J Crit Care Med. 2011;26(1):45-48.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.45

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Abstract PDF: To achieve adequate depth of sedation and assess the severity of pain in mechanically ventilated patients in the intensive care unit, appropriate communication with the patients is necessary. Communication is also important for successful weaning from the mechanical ventilator as well as weaning predictors, such as respiratory muscle capacity. Here, we present a case report of a 39-year-old man with congenial blindness and hearing impairment who successfully weaned off ventilator support using Braille to communicate under an optimal level of sedation and analgesia after septic shock management.

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