Acute and Critical Care

The End-of-Life Care in the Intensive Care Unit: Jae Young Moon, Yong Sup Shin; Korean J Crit Care Med. 2013;28(3):163-172.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.163

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The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient's autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient's death in imminent. To improve understanding EOL care of terminally ill patients, we summarize 'Recommendations for EOL care in the ICU by the American College of Critical Care Medicine' and 'Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science'. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.

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A Scoping Review of End-Of-Life Care Education Programs for Critical Care Nurses
Eugene HAN, Sumi CHOI, Ki Young YUN, Sung Ha KIM, Sanghee KIM, Hye Young YUN
Korean Journal of Medical Ethics.2023; 26(3): 185. CrossRef
Comparison of the Characteristics Among Deceased Do-Not-Attempt-Resuscitation (DNAR) Cancer Patients in Hospice and Oncology Wards
Nan Song, Ja Yun Choi
Asian Oncology Nursing.2020; 20(1): 10. CrossRef
Relationship of ICU Nurses' Difficulties in End-of-Life Care to Moral Distress, Burnout and Job Satisfaction
Kkot Bi Jeon, Mihyun Park
Journal of Korean Academy of Nursing Administration.2019; 25(1): 42. CrossRef
Difficulties in End-of-Life Care and Educational Needs of Intensive Care Unit Nurses: A Mixed Methods Study
Hyun Sook Kim, Eun Kyoung Choi, Tae Hee Kim, Hye Young Yun, Eun Ji Kim, Jin Ju Hong, Jeong A Hong, Geon Ah Kim, R.N. Sung Ha Kim
The Korean Journal of Hospice and Palliative Care.2019; 22(2): 87. CrossRef
Factors Influencing Performance of End-of-life Care by ICU Nurses
Mun Jung Ko, So-Hyun Moon
Journal of Korean Academy of Psychiatric and Mental Health Nursing.2016; 25(4): 327. CrossRef
Development of an Electronic Document for DNR Informed Consent based on the Electronic Medical Record System
Ji-Kyeong Park
The Korean Journal of Health Service Management.2016; 10(3): 99. CrossRef
Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
The Korean Journal of Critical Care Medicine.2015; 30(2): 73. CrossRef
Application of Animation Mobile Electronic Informed Consent in Inpatient of Long-term Care Hospital: Focused on DNR Informed Consent
Ji-Kyeong Park, Ji-On Kim
Journal of Digital Convergence.2015; 13(11): 187. CrossRef

Clinical Characteristics in Patients with Carbapenem-Resistant Acinetobacter baumannii Isolates from Tracheal Secretions: Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee; Korean J Crit Care Med. 2013;28(3):173-179.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.173

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Abstract PDF: BACKGROUND
This study was conducted to evaluate the clinical characteristics and outcomes of mechanically ventilated patients with carbapenem-resistant Acinetobacter baumannii (CRAB) isolates from tracheal secretions in a medical intensive care unit (ICU) of a university hospital.
METHODS
We conducted a retrospective study from January 2009 to June 2012.
RESULTS
Among the patients who had isolates cultured from tracheal secretions, 130 patients (34.8%) had CRAB isolates. Their mean age was 65 +/- 14 yr and 74.6% were male. The ICU and hospital mortality was 51.5% and 60.0%, respectively. According to physician's clinical decision, antibiotics were changed in order to cover CRAB in 75 (57.7%) patients. The total duration of antibiotics use was 12.2 +/- 8.1 days. Of patients with antibiotics change to cover CRAB, 70 patients (93.3%) had Clinical Pulmonary Infection Score of 6 and over. However, there was no significant difference in hospital mortality between patients with antibiotics change against CRAB and those without change. In multivariable analysis, only Acute Physiology and Chronic Health Evaluation II score was related to hospital mortality of patients with CRAB.
CONCLUSIONS
In this study, changing antibiotics to cover CRAB by physician's clinical decision only did not influence hospital mortality; further studies would be necessary to investigate how to use antibiotics against CRAB isolates cultured from tracheal secretions.

Malignant Cerebral Infarction after Pulmonary Resection for Lung Cancer: In Ae Song, Sang Min Jung, Dong Jin Kim, Sang Heon Park; Korean J Crit Care Med. 2013;28(3):180-183.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.180

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Abstract PDF: Malignant cerebral infarction as postoperative complication after pulmonary resection occurs rarely, but can be rather serious. We report a case of 81-year-old man who suffered from malignant cerebral infarctions after pulmonary resection for lung cancer. He had a history of well-controlled hypertensions, but no evidences of arrhythmia, and neither stenosis nor atheroma in the carotid arteries and intracranial arteries. There were no specific events during his operation except that an inadvertent left carotid artery puncture occurred during the central line insertion. In intensive care unit (ICU), he had a delayed recovery of consciousness and dysarthria with right hemiplegia. Computed tomography revealed malignant middle cerebral infarctions due to the occlusion of left middle cerebral artery. It could be the thromboembolism due to pulmonary resections or carotid artery punctures in the patient without high risk factors.

A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy: Ji Young Park, Taehoon Lee, Hongyeul Lee, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2013;28(3):184-186.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.184

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Abstract PDF: Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in the critical care medicine for patients who need prolonged mechanical ventilation. Traditionally, PDT has been facilitated by bronchoscopy via the endotracheal tube. However, there are risks for blocking the view of correct puncture site on the trachea or being extubated unintentionally, which lead to loss of the airway. These complications are possibly due to insufficient bronchoscopic visualizations via endotracheal tube during the procedure. Using laryngeal mask airways (LMA) during PDT may overcome these problems and could provide a safer alternative method with superior visualizations of the trachea and larynx. We report a case of percutaneous tracheostomy being performed successfully under bronchoscopy with LMA in the intensive care unit.

A Case of Burkholderia cepacia Pneumonia after Lung Transplantation in a Recipient without Cystic Fibrosis: Jin Sun Cho, Sungwon Na, Moo Suk Park, Yun So, Bahn Lee, Shin Ok Koh, Hyo Chae Paik; Korean J Crit Care Med. 2013;28(3):187-191.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.187

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Abstract PDF

Burkholderia cepacia is a highly virulent pathogen known to cause opportunistic infections in immunocompromised patients. It accelerates lung disease and causes necrotizing pneumonia with associated severe sepsis, known as cepacia syndrome. In particular, lung transplant recipients infected with Burkholderia cepacia show higher mortality after lung transplantation than those who are not infected with this organism. Due to broad-spectrum antibiotic resistance, a combination therapy should be used according to the results of the susceptibility test. This bacterial infection is rare in Korea, and no case was reported in lung transplant recipients. However, we report a case of pneumonia caused by Burkholderia cepacia after lung transplantation. As Burkholderia cepacia was grown from a sputum culture, the patient was treated initially with a combination of meropenem and trimethoprim/sulfamethoxazole and then ceftazidime and trimethoprim/sulfamethoxazole as a result of leukopenia. After antibiotics treatment for 20 days, sputum cultures became negative for Burkholderia cepacia and the patient successfully recovered.

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Current perspective of lung transplantation
Hyo Chae Paik
Journal of the Korean Medical Association.2016; 59(2): 119. CrossRef

A Case of Pumpless Interventional Lung Assist Application in a Tuberculosis Destroyed Lung Patient with Severe Hypercapnic Respiratory Failure: So Hee Park, Sang Ook Ha, Jae Seok Park, Sang Bum Hong, Tae Sun Shim, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2013;28(3):192-196.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.192

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Abstract PDF: Pumpless extracorporeal interventional lung assist (iLA) is a rescue therapy allowing effective carbon dioxide removals and lung protective ventilator settings. Herein, we report the use of a pumpless extracorporeal iLA in a tuberculosis destroyed lung (TDL) patient with severe hypercapnic respiratory failures. A 35-year-old male patient with TDL was intubated due to CO2 retention and altered mentality. After 11 days, Ventilator Associated Pneumonia (VAP) had developed. Despite the maximal mechanical ventilator support, his severe respiratory acidosis was not corrected. We applied the iLA for the management of refractory hypercapnia with respiratory acidosis. This case suggests that the iLA is an effective rescue therapy for TDL patients with ventilator refractory hypercapnia.

Extracorporeal Membrane Oxygenation (ECMO) and Iliac Vein Injury: Sang Ook Ha, Jae Seok Park, So Hee Park, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2013;28(3):197-200.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.197

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Abstract PDF: The use of extracorporeal membrane oxygenation (ECMO) has increased after the 2009 pandemic H1N1 infections, and the ECMO-related complications have also increased. Specifically, the mechanical vessel injury due to catheter cannulation seems to be less frequent than other complications, but there is a risk of hemorrhagic shock which requires special attention. We experienced a case of successful management with graft stenting during ECMO operation for iliac vein injury. A 56-year-old female patient with non-small cell lung cancer developed endobronchial obstruction, and ECMO was applied for the ECMO-assisted rigid bronchoscopy. During catheter cannulation, hypovolemic shock was developed due to her right external iliac vein injury. We detected the hemorrhage with bedside ultrasound at an early stage and the hemorrhage was effectively managed with graft stenting on ECMO.

Foreign Body Removal at Right Main Bronchus in A Neonate: Hyun Su Ri, Sang Wook Shin, Seung Hoon Baek, Hyae Jin Kim, Sun Jae Lee, Seong Wan Baik; Korean J Crit Care Med. 2013;28(3):201-203.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.201

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Abstract PDF: Foreign body in the airway could be a life-threatening risk, especially for young pediatric patients. A 6-day old male patient with foreign body, which was located deep in the right main bronchus was being admitted. Although we tried three times to remove it with rigid bronchoscopic forceps under the general anesthesia, we failed. Before switching to surgical treatment, we changed the Trendelenburg position and tapped his back several times in order to alter the foreign body toward the forcep. Finally we were able to catch and extract the foreign body successfully. We suggest that back percussion with the Trendelenburg position is a useful solution to remove a foreign body within a deep airway.

A Case of Patient with Eisenmenger Syndrome Admitted to Intensive Care Unit Due to Septic Shock Complicated with Newlydiagnosed Down Syndrome and Moyamoya Disease: Seok Jeong Lee, Hye Won Kang, Jung Won Huh, Seo Woo Kim, Hyoung Won Cho, Yon Ju Ryu, Jin Hwa Lee, Jung Hyun Chang; Korean J Crit Care Med. 2013;28(3):204-209.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.204

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Abstract PDF: Eisenmenger syndrome is a severe form of pulmonary arterial hypertension related to congenital cardiac defects. Many patients die at a young age from such complications. The treatment of primary pulmonary hypertension is being applied to Eisenmenger syndrome such as endothelin receptor antagonists, phosphodiesterase-5 blockers, and prostacyclin. We experienced a case of 29-year female with ventricular septal defect-related Eisenmenger syndrome complicated with Down syndrome and Moyamoya disease, who was admitted to intensive care unit due to enteritis-associated septic shock. After the combination treatment with iloprost and sildenafil within the intensive care unit, the patient was able to wean mechanical ventilation without further applications of invasive rescue therapy such as extracorporeal membrane oxygenator. She was later discharged with bosentan. She maintained bosentan therapy for 34 months continuously without aggravations of symptom but eventually died with intracranial hemorrhage, a complication of Moyamoya disease. To our knowledge, this is the first case report of Eisenmenger syndrome accompanied by mosaic Down syndrome and Moyamoya disease.

A Case of Hemoperitoneum due to Spontaneous Rupture of Visceral Artery Aneurysm after Ingestion of Puffer Fish: Do Won Lee, Hae Kyu Kim, Hyun Jung Lee, Jung Min Hong, Jae Young Kwon; Korean J Crit Care Med. 2013;28(3):210-213.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.210

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Abstract PDF: Ingestion of puffer fish can cause intoxication, which produces a wide range of symptoms due to the presence of neurotoxins, such as tetrodotoxin, in puffer fish. Abdominal pain is just one of the symptoms that should be treated with symptomatic and supportive therapy. This study reports a case of a 56-year-old male patient with abdominal pain, who was admitted to the emergency room with a diagnosis of puffer fish poisoning. In this case, the abdominal pain did not improve, but rather, the symptoms worsened. Finally, the cause of the abdominal pain was found to be hemoperitoneum due to active bleeding at the greater omentum, as observed on abdominal computed tomography; the source of bleeding was the right colic artery branch. Embolization was performed successfully, and the post-intervention course was uneventful. The patient was discharged without any complications within 13 days after admission.

Pyriform Sinus Perforation in a Child after Falling with a Spoon Handle in the Mouth: Joongbum Cho, Mi Ran Park, Jihyun Kim, Han Sin Jeong, Kangmo Ahn; Korean J Crit Care Med. 2013;28(3):214-217.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.214

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Abstract PDF: Pyriform sinus perforation is uncommon in children and most cases are secondary to iatrogenic causes such as endotracheal intubations. Due to this rarity, the management of these injuries is controversial. We report a case of pyriform sinus perforation in a 14-month-old boy who fell down with a spoon handle in the mouth and was successfully treated by transoral laryngomicrosurgery. Two hours after falling down, the patient had breathing difficulties and started vomiting. A chest X-ray showed subcutaneous emphysema and pneumomediastium. Esophagogram revealed leakage of contrast media at the hypopharynx. Although air leakage was reduced the next day, his fever became frequent even with conservative management of antibiotics. On the 4th hospital day, closure of pyriform sinus perforation was done by transoral laryngomicrosurgery. The patient became apyrexial by the 2nd post-operative day. On the 21th hospital day, the child was able to consume food orally without problems and was allowed to go home.

Treatment of Carbon Monoxide Poisoning with Therapeutic Hypothermia: Young Hwan Lee, You Dong Sohn, Seung Min Park, Won Wong Lee, Ji Yun Ahn, Hee Cheol Ahn; Korean J Crit Care Med. 2013;28(3):218-220.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.218

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Abstract PDF

Carbon monoxide (CO) is a well-known chemical asphyxiant, which causes tissue hypoxia with prominent neurological injury. Therapeutic hypothermia (TH) has been shown to be an effective neuroprotective method in post-cardiac arrest patients. A 26-year-old man presented to the emergency department with severe CO poisoning. On arrival, the patient was comatose. His vital signs were blood pressure, 130/80 mm Hg; heart rate, 126/min; respiratory rate, 26/min; body temperature, 36degrees C; and O2 saturation, 94%. Initial carboxyhemoglobin was 45.2%. Because there was no available hyperbaric chamber in our local area, he was intubated and treated with TH. The target temperature was 33 +/- 1degrees C for 24 hours using an external cooling device. The patient was then allowed to reach normothermia by 0.15-0.25degrees C/hr. The patient was discharged after normal neurological exams on day 11 at the hospital. TH initiated after exposure to CO may be an effective prophylactic method for preventing neurological sequelae.

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Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect
Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi
The Korean Journal of Critical Care Medicine.2015; 30(4): 272. CrossRef

Repeated Hypothermia for Rebound Cerebral Edema after Therapeutic Hypothermia in Malignant Cerebral Infarction: Jeong Ho Hong, Jin Heon Jeong, Jun Young Chang, Min Ju Yeo, Han Yeong Jeong, Hee Joon Bae, Moon Ku Han; Korean J Crit Care Med. 2013;28(3):221-224.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.221

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Abstract PDF

Malignant cerebral infarction has a high risk of fatal brain edema and increased intracranial pressure with cerebral herniation causing death. One of the major causes of death is a rebound cerebral edema during rewarming phase. A 66-year-old male patient presented with the right hemiplegia and global aphasia due to malignant cerebral infarction in the whole territory of middle cerebral artery with the occlusion of the proximal internal carotid artery. Being refused decompressive hemicraniectomy, he received the therapeutic hypothermia for 6 days. After rewarming for 6 hours, mentality was suddenly decreased and dilated left pupil. Follow-up CT revealed that midline shifting was more aggravated. We decided on repeated hypothermia for rebound cerebral edema and successfully controlled. We report our experience with repeated hypothermia for rebound cerebral edema following therapeutic hypothermia in malignant cerebral infarction.

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Citations to this article as recorded by

Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect
Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi
The Korean Journal of Critical Care Medicine.2015; 30(4): 272. CrossRef
Therapeutic Hypothermia after Decompressive Craniectomy in Malignant Cerebral Infarction
Jun Young Chang, Jeong-Ho Hong, Jin-Heon Jeong, Sung-Jin Nam, Ji-Hwan Jang, Jae Seung Bang, Moon-Ku Han
Korean Journal of Critical Care Medicine.2014; 29(2): 93. CrossRef

Extracorporeal Membrane Oxygenation as a Rescue Therapy in a Patient with Non-Iatrogenic Massive Hemoptysis: Jong Hoo Lee, Su Wan Kim, Yee Hyung Kim; Korean J Crit Care Med. 2013;28(3):225-229.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.225

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Abstract PDF: Despite the advanced technologies of intensive care, massive hemoptysis can still cause death in a small subset of patients. Extracorporeal membrane oxygenation (ECMO) is expected to provide adequate gas exchange, to reduce ventilator-induced lung injuries, and to eventually improve outcomes in these patients. Also, the instability of vital signs due to hemoptysis makes it impossible to perform immediate interventional procedures such as embolization and resectional surgery. In these cases, ECMO may be instituted as a bridge therapy. Herein, we describe the detailed course of our case, with the hopes of helping physicians to decide when to initiate ECMO in patients with massive hemoptysis.

A Case of Bilateral Knee Septic Arthritis Caused by Pneumococcal Bacteremia: Yo Han Park, Jong Chan Lee, Junhyeon Cho, Jinyong Park, Myeungcheol Shin; Korean J Crit Care Med. 2013;28(3):230-233.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.230

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Abstract PDF

Pneumococcus can cause pneumonia, sinusitis, infective endocarditis, meningitis and primary bacteremia. However, few reports in the literature show bilateral septic arthritis with pneumococcal bacteremia. We report on a case of a 78-year old woman who presented with fever, pain and swelling in both knees. Both knee fluid aspirates were purulent with thick viscosity, and the gram stain revealed gram positive cocci in chains. The patient underwent emergent washing and arthroscopic debridement, followed with empirical antibiotics treatment. Two out of two blood cultures were positive for penicillin-susceptible Streptococcus pneumonia. Synovial fluid cultures were also positive for S. pneumoniae. The patient was treated with intravenous ceftriaxone for 4 weeks. Bilateral knee septic arthritis with pneumococcal bacteremia is rarely reported. Here we report on the case with a review of the literature.

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Analysis of Characteristics and Prognosis of Healthcare-Associated Secondary Bloodstream Infection
Ju Yeon Song, Ihn Sook Jeong, Sookyung Hyun
Korean Journal of Healthcare-Associated Infection Control and Prevention.2017; 22(2): 43. CrossRef

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