Acute and Critical Care

Volume 28 (4); November 2013

Randomized Controlled Trial

Comparison of Intubation Success Rate and Times Required for Intubation by Glottic Exposure Methods with Glidescope(R): Hyung Seo Jang, Jun Bum Park, Jae Hoon Oh, Chang Sun Kim, Hyuk Joong Choi, Bo Seung Kang, Tae Ho Lim, Hyung Goo Kang; Korean J Crit Care Med. 2013;28(4):241-246.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.241

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Abstract PDF: BACKGROUND
The glottis can be exposed by a Glidescope(R) during endotracheal intubation using either the epiglottis or valleculae elevation method. We compared the epiglottis and valleculae elevation methods for endotracheal intubations performed with a Glidescope(R) using differences in success rate, time spent for tracheal intubation and percent of glottic opening.
METHODS
Forty medical students without experience using a Glidescope(R) participated in this prospective, randomized study in which they intubated a tracheal tube into a manikin. All participants performed tracheal intubation using the 2 forementioned methods. Twenty students exposed the vocal cord by placing the blade tip in the valleculae (valleculae elevation method; VEM). The other 20 students directly elevated the epiglottis with the blade (epiglottis elevation method; EEM). We separated intubating time into 3 parts: turnaround time to exposing the vocal cord, tube passing time and first ventilating time.
RESULTS
The success rate of tracheal intubation using VEM (86.7%, 104/120) was higher than that using EEM (65.8%, 79/120) (p < 0.001). VEM resulted in a lower total intubation time (VEM vs. EEM, 23.5 +/- 5.3 vs. 29.0 +/- 8.7, p = 0.001). The key factor of this difference was the tube passing time (VEM vs. EEM, 7.4 +/- 2.5 vs. 12.8 +/- 7.4, p < 0.001).
CONCLUSIONS
Exposing the vocal cord by using VEM during tracheal intubation with a Glidescope(R) can increase the success rate of tracheal intubation and shorten the time of endotracheal intubation in novices.

Original Articles

Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis: Seung Hwan Lee, Ji Young Jang, Jae Gil Lee; Korean J Crit Care Med. 2013;28(4):247-254.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.247

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Abstract PDF

BACKGROUND
Many studies have shown that serum albumin and prealbumin levels correlate with patient outcomes in critically ill patients. The purpose of this study was to evaluate the clinical significance of prealbumin and albumin levels in patients in the intensive care unit (ICU) after emergency surgery for acute peritonitis.
METHODS
We examined serum albumin and prealbumin as markers for the prediction of patient outcome in 51 patients admitted to the ICU after emergency surgery from January to December in 2012. Biochemical parameters were measured postoperatively. Serum albumin and prealbumin levels were compared between survivors and non-survivors. Patients were also divided according to the occurrence of shock and pulmonary complications (shock group vs. non-shock group, pulmonary complications group vs. non-pulmonary complications group), and outcome analysis was performed for age, American Society of Anesthesiologists (ASA) score, length of ICU stay (IS), length of hospital stay (HS), mechanical ventilation, and APACHE II score. Serum albumin and prealbumin levels were evaluated for any correlation with complications and mortality.
RESULTS
In patients with shock, prealbumin and albumin were significantly decreased (p = 0.047, p = 0.036). Additionally, albumin was significantly decreased in patients with pulmonary complications. Neither albumin nor prealbumin, however, showed a correlation with mortality. Prealbumin showed a correlation with serum albumin, CRP level, and HS (r = 0.511, p < 0.001; r = -0.438, p = 0.002; and r = -0.45, p = 0.001, respectively). Albumin showed a correlation with HS, IS, and APACHE II score (r = -0.404, p = 0.003; r = -0.424, p = 0.002; and r = -0.40, p = 0.006, respectively).
CONCLUSIONS
The initial prealbumin level measured upon admission to the ICU after gastrointestinal emergency surgery can be useful predictor of shock. The initial albumin level was significantly low in patients with shock and pulmonary complications. However, neither prealbumin nor albumin showed a correlation with mortality. Our study also showed that albumin and prealbumin levels are affected by other factors, such as massive hydration and severe inflammation, as reported in previous studies.

Citations

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Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery
Jin Young Lee, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee
Medicine.2016; 95(35): e4530. CrossRef

Utility of the DECAF Score in Patients Admitted to Emergency Department with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Ji Hyoung Son, Jang Young Lee, Young Mo Yang, Won Young Sung, Sang Won Seo, Jin Cheol Kim, Wonsuk Lee; Korean J Crit Care Med. 2013;28(4):255-265.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.255

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Abstract PDF

BACKGROUND
Exacerbations of chronic obstructive pulmonary disease (COPD) are common and can be fatal. However, it is difficult to predict the in-hospital mortality, severity and prognosis of patients. Prognostic tools are needed to assess exacerbations of COPD in the emergency department. Towards this end, we compared DECAF (dyspnea, eosinopenia, consolidation, acidemia, atrial fibrillation) score with other prognostic tools available in the emergency department.
METHODS
Consecutive patients admitted to the emergency department with exacerbations of COPD were recruited. We compared the DECAF score to CAPS (chronic obstructive pulmonary disease and asthma physiology score), BAP (blood urea nitrogen, altered mental status, pulse)-65 class and CURB (confusion, urea, respiratory rate, blood pressure)-65 score and assessed in-hospital mortality, endotracheal intubation, admission to the intensive care unit and admission to the hospital.
RESULTS
The in-hospital mortality rate was 4.9%. The DECAF score showed excellent discrimination for in-hospital mortality (AUROC = 0.72, p = 0.002), endotracheal intubation (AUROC = 0.92, p < 0.001), admission to the intensive care unit (AUROC = 0.90, p < 0.001) and admission to the hospital (AUROC = 0.83, p < 0.001).
CONCLUSIONS
The DECAF score is a simple and effective prognostic tool for assessing cases involving exacerbation of COPD in the emergency department. Emergency physicians should consider hospital admission if the DECAF score is more than 1 and consider admission to the intensive care unit and endotracheal intubation if the DECAF score is more than 3.

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The v‐DECAF score can predict 90‐day all‐cause mortality in patients with COPD exacerbation requiring invasive mechanical ventilation
Qi‐fang Shi, Ying Sheng, Nian Zhu, Yan Tan, Xiao‐Hong Xie, Shu‐yun Wang, Jin‐fang Cai
The Clinical Respiratory Journal.2019; 13(7): 438. CrossRef
Value of the DECAF score in predicting hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Zagazig University Hospitals, Egypt
Ramadan Nafae, Sameh Embarak, Doaa Mostafa Gad
Egyptian Journal of Chest Diseases and Tuberculosis.2015; 64(1): 35. CrossRef

Body Mass Index and Outcomes in Patients with Severe Sepsis or Septic Shock: Minjung Kathy Chae, Dae Jong Choi, Tae Gun Shin, Kyeongman Jeon, Gee Young Suh, Min Seob Sim, Keun Jeong Song, Yeon Kwon Jeong, Ik Joon Jo; Korean J Crit Care Med. 2013;28(4):266-271.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.266

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Abstract PDF

BACKGROUND
The aim of this study was to investigate the association between body mass index (BMI) and survival in patients with severe sepsis or septic shock.
METHODS
We analyzed the sepsis registry of patients presenting to the emergency department (ED) of a tertiary urban hospital and meeting the criteria for severe sepsis or septic shock from August 2008 to March 2012. We categorized patients into the underweight group (BMI < 18.5 kg/m2), the normal weight group (18.5 < or = BMI < 25 kg/m2) and the obese group (BMI > or = 25 kg/m2). Then, we analyzed the registry to evaluate the relation between obesity and in-hospital mortality.
RESULTS
A total of 770 adult patients with severe sepsis and septic shock were analyzed. In-hospital mortality rate of the underweight group (n = 86), the normal weight group (n = 489) and the obese group (n = 195) was 22.1%, 15.3% and 16.4%, respectively. In a multivariate regression analysis, the underweight group had a significant association with in-hospital mortality compared with the normal weight group (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.68-1.87; p = 0.028). The obese group showed no significant difference in mortality (OR, 2.04; 95% CI, 1.08-3.86; p = 0.65).
CONCLUSIONS
The underweight patients showed significantly higher mortality than the normal weight patients with severe sepsis and septic shock.

Citations

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Association of body mass index with mortality of sepsis or septic shock: an updated meta-analysis
Le Bai, Jingyi Huang, Dan Wang, Dongwei Zhu, Qi Zhao, Tingyuan Li, Xianmei Zhou, Yong Xu
Journal of Intensive Care.2023;[Epub] CrossRef
Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years
Sung Jin Park, Dong Heon Kim, Chang In Choi, Sung Pil Yun, Jae Hun Kim, Hyung Il Seo, Hong Jae Jo, Tae Yong Jun
Annals of Surgical Treatment and Research.2016; 91(1): 45. CrossRef

Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock: Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim; Korean J Crit Care Med. 2013;28(4):272-279.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.272

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Abstract PDF: BACKGROUND
Clinical findings, medical history and laboratory findings in patients with acute pyelonephritis are insufficient to predict the occurrence of septic shock and to assess its severity and prognosis. Early imaging may not only aid in diagnosing acute pyelonephritis, but also help in assessing the risk factors associated with septic shock.
METHODS
In this retrospective study, we reviewed the medical records and collected the data of 200 patients from January to December, 2011. All patients were over 18 years old; showed symptoms of fever, chills, muscle pain and flank pain; demonstrated more than 10 white blood cells in urinalysis; and were diagnosed with acute pyelonephritis after computed tomography (CT) scan. Patients were classified into two groups: patients with septic shock (group 1) and patients without septic shock (group 2), and the clinical, laboratory and CT findings of the two groups were then compared.
RESULTS
Out of all 200 patients, there were 32 patients (16%) who had acute pyelonephritis with septic shock. The acute pyelonephritis with septic shock group (group 1) showed increased bacteremia compared with the other group (53.1% vs. 24.4%, p = 0.002). Laboratory findings showed that group 1 patients had higher serum creatinine (1.67 +/- 1.03 mg/dl vs. 1.14 +/- 0.98 mg/dl, p = 0.022) and hsCRP (8.36 +/- 5.29 mg/dl vs. 5.27 +/- 3.53 mg/dl, p = 0.000) than group 2 patients. The findings of kidney CT showed statistically significant differences in global renal enlargement (31.3% vs. 18.7%, p = 0.005), pelvicalyceal wall thickening (37.5% vs. 13.1%, p = 0.005) and poor excretion of contrast (25% vs. 2.4%, p = 0.000). The results of the logistic regression test showed that there were significant differences in bacteremia serum creatinine, C-reactive protein, pelvicalyceal wall thickening and poor excretion of contrast.
CONCLUSIONS
Computed tomography can predict the possibility of septic shock by identifying the range of renal lesions in patients with acute pyelonephritis. It can therefore allow initial aggressive treatment that can contribute to decreases in mortality and morbidity in patients with acute pyelonephritis.

How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition: Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho; Korean J Crit Care Med. 2013;28(4):280-286.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.280

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Abstract PDF

BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Citations

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Safety and Feasibility of Ultrasound-guided Peripherally Inserted Central Catheterization for Chemo-Delivery
Tak-Joong Song, Shin-Seok Yang, Woo-Sung Yoon
Journal of Surgical Ultrasound.2019; 6(1): 14. CrossRef
Single Center Experience of Ultrasonography-guided Bedside Procedures for Surgical Patients
Dooreh Kim, Dae Hyun Cho, Yun Tae Jung, Jae Gil Lee
Journal of Surgical Ultrasound.2018; 5(2): 61. CrossRef
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho
The Korean Journal of Critical Care Medicine.2015; 30(4): 280. CrossRef

Randomized Controlled Trial

Guidewire-Assisted Nasogastric Tube Insertion in Intubated Patients in an Emergency Center: Jin Go, Hyunjong Kim, Seunghwan Kim, Je Sung You, Min Joung Kim, Hyun Soo Chung, Sung Phil Chung, Hahn Shick Lee; Korean J Crit Care Med. 2013;28(4):287-292.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.287

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Abstract PDF: BACKGROUND
The purpose of this study is to identify the usefulness of guidewire-assisted nasogastric tube insertion in intubated patients with cervical spine immobilization or unstable vital signs in an emergency center.
METHODS
Thirty-four intubated patients in an emergency center were enrolled in the study. Patients were randomly allocated to the control group or the guidewire group. All patient necks were kept in neutral position during the procedure. In the control group, the nasogastric tube was inserted with the conventional method. A guidewire-supporting nasogastric tube was used in the guidewire group. The success rates of the first attempts and overall were recorded along with complications.
RESULTS
The first attempt success rate was 88.2% in the guidewire group compared with 35.2% in the control group (p < 0.001). The overall success rate was 94.2% in the guidewire group and 52.9% in the control group (p = 0.017). Five cases of self-limiting nasal bleeding were reported in the guidewire group, and two cases occurred in the control group. No statistical differences were identified between groups.
CONCLUSIONS
Guidewire-assisted nasogastric tube insertion is a simple and useful method in intubated patients with cervical spine immobilization or unstable vital signs.

Original Articles

The Relation between Neurologic Prognosis and Optic Nerve Sheath Diameter Measured in Initial Brain Computed Tomography of Cardiac Arrest and Hanging Patients: Kun Dong Kim, Hong Joon Ahn, Byul Nim Hee Cho, Sang Min Jeong, Joon Wan Lee, Yeon Ho You, In Sool Yoo, Won Joon Jeong; Korean J Crit Care Med. 2013;28(4):293-299.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.293

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Abstract PDF: BACKGROUND
Early prediction of neurologic outcome is important to patients treated with therapeutic hypothermia after hypoxic brain injury. Hypoxic brain injury patients may have poor neurologic prognosis due to increased intracranial pressure. Increased intracranial pressure can be detected by optic nerve sheath diameter (ONSD) measurement in computed tomography (CT) or ultrasound. In this study, we evaluate the relation between neurologic prognosis and optic nerve sheath diameter measured in brain CT of hypoxic brain injury patients.
METHODS
We analyzed the patient clinical data by retrospective chart review. We measured the ONSD in initial brain CT. We also measured and calculated the gray white matter ratio (GWR) in CT scan. We split the patients into two groups based on neurologic outcome, and clinical data, ONSD, and GWR were compared in the two groups.
RESULTS
Twenty-four patients were included in this study (age: 52.6 +/- 18.3, 18 males). The mean ONSD of the poor neurologic outcome group was larger than that of the good neurologic outcome group (6.07 mm vs. 5.39 mm, p = 0.003). The GWR of the good neurologic outcome group was larger than that of the poor outcome group (1.09 vs. 1.28, p = 0.000). ONSD was a good predictor of neurologic outcome (area under curve: 0.848), and an ONSD cut off > or = 5.575 mm had a sensitivity of 86.7% and a specificity of 77.8%.
CONCLUSIONS
ONSD measured on the initial brain CT scan can predict the neurologic prognosis in cardiac arrest and hanging patients treated with therapeutic hypothermia.

Efficacies of Somatosensory Evoked Potential and Diffusion-Weighted Magnetic Resonance Imaging as Predictors of Prognosis for Patients Experiencing Coma after Cardiac Arrest: Sang Hee Chae, Soo Hyun Kim, Se Min Choi, Seung Pill Choi, Kyu Nam Park; Korean J Crit Care Med. 2013;28(4):300-308.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.300

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Abstract PDF

BACKGROUND
The aim of this study was to examine the efficacies of somatosensory evoked potential (SEP) and diffusion-weighted magnetic resonance imaging (DWI) in predicting the clinical prognosis of comatose patients following cardiac arrest.
METHODS
Forty-one patients resuscitated from out-of hospital cardiac arrest (OHCA) were retrospectively studied. After return of spontaneous circulation (ROSC), SEP was conducted between one and three days after resuscitation, and DWI was conducted within five days of resuscitation. SEP was classified into three grades: normal, delayed conduction or unilateral loss of the N20 peak, and bilateral loss of the N20 peak. Bilateral loss of the N20 peak was considered a predictor of poor prognosis. For DWI, diffuse signal intensity (SI) abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex was taken as a predictor of poor prognosis. For patient clinical prognosis, the Glasgow-Pittsburgh Cerebral Performance Category (CPC) was used to evaluate neurological results at the time of discharge. Resulting CPC scores of 1 and 2 were considered as a favorable prognosis, and scores of 3, 4, and 5 were considered as a poor prognosis. Sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of poor prognosis were analyzed for each test individually and for the combination of the two tests.
RESULTS
Among the 41 subject patients, 31 underwent SEP, 30 underwent DWI, and 20 underwent both tests. The prognosis predictor of SEP (bilateral loss of the N20 peak) predicted poor prognosis with 56.5% sensitivity, 100% specificity, 100% positive predictive value, and 44.4% negative predictive value. The prognosis predictor of DWI (diffuse SI abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex) predicted poor prognosis with 85% sensitivity, 100% specificity, 100% predictive value, and 76.9% predictive value. For patients who underwent both tests, the sensitivity and negative predictive value for the prediction of poor prognosis increased to 92.3% and 87.5%, respectively, and the specificity and positive predictive value were maintained at 100%.
CONCLUSIONS
The accuracy of poor prognosis prediction for patients in prolonged comas after resuscitation is enhanced by combining the results of SEP and DWI along with the individual results of each test.

Citations

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The Effect of Transcranial Direct Current Stimulation and Functional Electrical Stimulation on the Lower Limb Function of Stroke Patients
Xiao-Hua Zhang, Tao Gu, Xuan-Wei Liu, Ping Han, Hui-Lan Lv, Yu-Long Wang, Peng Xiao
Frontiers in Neuroscience.2021;[Epub] CrossRef

Case Reports

Intraoperative Fluid Management in Combined Liver-Kidney Transplantation: Jong Hae Kim, Bo Reum Lim, Jin Yong Jung; Korean J Crit Care Med. 2013;28(4):309-313.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.309

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Abstract PDF

A review of the literature regarding combined liver-kidney transplantation (CLKT) does not provide adequate central venous pressure (CVP) values that would allow for unimpaired hepatic venous outflow and early renal allograft diuresis during the procedure. We report a case of fluid management of CLKT based on the limited literature available in a 59-year-old male with liver cirrhosis and end-stage renal disease. During the preanhepatic phase, CVP was maintained at 5 mmHg. Following portal vein clamping, CVP was reduced to below 5 mmHg until venovenous bypass was initiated. From the neohepatic phase to 1 hour before renal allograft reperfusion, CVP was slowly increased to 10 mmHg. Within an hour before renal allograft reperfusion, maximal crystalloid hydration was used to increase CVP to 15 mmHg. The urine output was replaced to maintain CVP at 8 to 10 mmHg until the end of the surgery. The postoperative course was uneventful. In conclusion, fluid management tailored to each phase yielded beneficial results in a patient with CLKT.

Citations

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Combined liver and kidney transplantation: Our experience and review of literature
KusumaRamachandra Halemani, N Bhadrinath
Indian Journal of Anaesthesia.2017; 61(1): 68. CrossRef

Sedation with Dexmedetomidine during Tracheostomy in Severe Tracheal Stenotic Patients: Injung Jun, Kye Min Kim, Sang Seok Lee, Byung Hoon Yoo, Yoo Yong Lee, Yun Hee Lim, Se Jin Song, Mun Cheol Kim; Korean J Crit Care Med. 2013;28(4):314-317.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.314

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Abstract PDF

In patients with severely compromised airways, a tracheostomy is usually performed under local anesthesia. Dexmedetomidine can be a better choice of sedative for such patients because it causes minimal respiratory depression. We report two cases of patients with severe stenosis of the airways who underwent sedation with dexmedetomidine during tracheostomy under local anesthesia. In the first case, recurrent laryngeal cancer caused laryngeal stenosis, and the narrowest laryngeal width was less than 3 mm. In the second case, the tracheostomy opening site was narrowed to a diameter of 3.4 mm in a patient with a history of total laryngectomy. For both patients, sedation was induced by dexmedetomidine infusion and the tracheostomy was performed successfully under local anesthesia without any events. Dexmedetomidine seems to be an effective and safe sedative for tracheostomies in patients with critical airways. The management and implications of sedation with dexmedetomidine in the patients with severe stenotic airways are discussed.

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Dexmedetomidine and emergency front of neck access for acute stridor in advanced laryngeal carcinoma: Anesthetic challenges
Neelakshi Koul, Uma Hariharan, Amit Kumar, Nidhi Yadav, VijayKumar Nagpal
Journal of Indian College of Anaesthesiologists.2022; 1(1): 30. CrossRef
Comment contrôler les voies aériennes en présence de masses cervicomédiastinales ?
Fabien Espitalier, Marc Laffon
Le Praticien en Anesthésie Réanimation.2015; 19(4): 172. CrossRef

Air Embolism in the Left Ventricle after the Removal of a Central Venous Catheter: Duk Song Cho, Moo Hyun Kim, Dong Hyun Lee, Hye Won Lee, Eun Bin Kim, Seok Hyun Kim, Hyo Jin Jung, Soo Jin Kim, Hyun Jeong Kim; Korean J Crit Care Med. 2013;28(4):318-322.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.318

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Abstract PDF

Air embolism is a rare, potentially critical complication that can induce death. Central venous catheterization, which is commonly used for critically ill patients, is a possible cause of air embolism. We experienced a severe air embolism with abnormal air in left ventricle after CVC removal in a patient who was treated for eosinophilic pneumonia. Although the neurologic symptoms were severe, the patient was successfully treated with immediate hyperbaric oxygen therapy and the neurologic deficit was minimal.

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Lethal coronary air embolism caused by the removal of a double-lumen hemodialysis catheter: a case report
Sung Ha Mun, Dong Ai An, Hyun Jung Choi, Tae Hee Kim, Jung Woo Pin, Dong Chan Ko
Korean Journal of Anesthesiology.2016; 69(3): 296. CrossRef

Postoperative Acute Cerebral Infarction Occurring after General Anesthesia: Seong Ho Ok, Seong Min Yang, Woochan Kim, Il Woo Shin, Heon Keun Lee, Young Kyun Chung, Ju Tae Sohn; Korean J Crit Care Med. 2013;28(4):323-326.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.323

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Abstract PDF: The common predisposing risk factors for perioperative stroke include: previous stroke, atrial fibrillation, old age (> 75 years), carotid stenosis, and diabetes mellitus. An endoscopic sinus surgery was performed in a 49-year-old male with chronic paranasal sinusitis and nasal polyps. The vital signs, physical and laboratory examinations, and electrocardiography on admission were within the normal limit. Anesthesia was maintained with nitrous oxide in oxygen and 6% desflurane. The operation and anesthesia were uneventful with the exception of transient intraoperative hypotension. The patient recovered fully from the anesthesia (modified Aldrete score: 10) in the recovery room. However, he developed right arm weakness and dysarthria in the general ward 7 hours after the operation. We report a rare case of multifocal acute cerebral infarctions found on the postoperative magnetic resonance imaging in a noncardiac surgical patient.

Chylopericardial Tamponade in a Patient with Chylothorax after Pulmonary Lobectomy: Jin Sue Jeon, Ho Geol Ryu, Hannah Lee, Da Hye Yoo; Korean J Crit Care Med. 2013;28(4):327-330.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.327

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Abstract PDF

Chylopericardium is a very rare, yet potentially fatal, complication following intrathoracic surgery, and can further lead to other life-threatening complications such as cardiac tamponade. A 54-year-old female underwent right upper lobectomy for lung cancer. Chylothorax developed on the 2nd postoperative day, and was managed conservatively with dietary modification. On the 9th postoperative day, the patient suddenly developed hypotension and severe cardiac dysfunction requiring cardiopulmonary resuscitation followed by VA ECMO. Transthoracic echocardiography revealed a large amount of pericardial effusion. Prompt pericardiocentesis was performed and the aspirated fluid showed features of chyle. Thoracic duct ligation with pericardial window operation was performed because the daily amount of chyle drained did not decrease after 3 weeks. Here, we review etiologies and therapeutic options of chylopericardial tamponade following intrathoracic surgery, which should not be underestimated even when the patient seems to demonstrate a good recovery.

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A Case of Chylopericardium Caused by Chylous Pleural Effusion Inflow from a Damaged Pericardium during Operation for Right Lung Cancer
Masahiro MATSUNO, Kyo HIRAYAMA, Nobuo TSUNOOKA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2023; 84(6): 868. CrossRef
A case of cardiac tamponade caused by chylopericardium after mediastinal lymph node dissection for recurrence of lung cancer
Shinsuke Kitazawa, Kojiro Nakaoka, Naohiro Kobayashi, Shinji Kikuchi, Yukinobu Goto, Yukio Sato
The Journal of the Japanese Association for Chest Surgery.2017; 31(2): 181. CrossRef
Isolated Chylopericardium after Mitral Valve Replacement: the First Description of Adult Heart Disease in Korea
Su Wan Kim, Seogjae Lee
Korean Journal of Critical Care Medicine.2014; 29(2): 123. CrossRef

Disseminated Neonatal Herpes Simplex Virus Infection: Bongjin Lee, Jinsol Hwang, Yu Hyeon Choi, Young Joo Han, Young Hun Choi, June Dong Park; Korean J Crit Care Med. 2013;28(4):331-335.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.331

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Abstract PDF

Disseminated neonatal herpes simplex virus (HSV) infection is one of the most severe neonatal infections, and can have devastating consequences without early proper treatment. However, the administration of acyclovir can often be delayed because the symptoms and signs of HSV infection are non-specific and because HSV polymerase chain reaction (PCR) results may be negative early in the course of HSV infection. We report a case of disseminated neonatal HSV infection that was diagnosed by type 1 HSV PCR on day 8 of admission. Despite delayed administration of acyclovir, the patient was cured and subsequently discharged after 30 days of admission. Fortunately, this patient was treated successfully, but delayed administration of acyclovir has the potential to lead to significant problems. Considering the seriousness of neonatal HSV infection, empirical acyclovir therapy should be considered if HSV infection is suspected.

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A Case of Herpes Simplex Virus Type 2 Encephalitis of a Newborn Delivered by a Mother without Prenatal Screening
Eun Seob Lee, Joon Young Kim, Kon Hee Lee, Jung Won Lee, Yong Ju Lee, Yeon Joung Oh, Ji Seok Bang, Tae-Jung Sung
Korean Journal of Perinatology.2014; 25(3): 195. CrossRef

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