Acute and Critical Care

Volume 29 (3); August 2014

Editorial

Cardiology
Is Extracorporeal Membrane Oxygenation Necessary for Community Hospitals?: Ki Dong Yoo; Korean J Crit Care Med. 2014;29(3):145-146. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.145

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Abstract PDF: No abstract available.

Review

Pharmacology
Assessment and Treatment of Pain in Adult Intensive Care Unit Patients: Jun Mo Park, Ji Hyun Kim; Korean J Crit Care Med. 2014;29(3):147-159. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.147

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Abstract PDF

In most cases, patients admitted to an intensive care unit (ICU) have suffered from severe trauma, undergone major surgery or been treated for a serious medical illness. Although they often experience more intense pain than general ward patients, they are frequently unable to communicate their experiences to health care providers, thus preventing accurate assessment and treatment of their pain. If appropriate measures are not taken to treat pain in critically ill patients, stress response or sympathetic overstimulation can lead to complications. The short-term consequences of untreated pain include higher energy expenditure and immunomodulation. Longer-term, untreated pain increases the risk of post-traumatic stress disorder. Because pain is quite subjective, the accurate assessment of pain is very difficult in the patients with impaired communication ability. The current most valid and reliable behavioral pain scales used to assess pain in adult ICU patients are the Behavioral Pain Scale and the Critical-Care Pain Observation Tool. Once pain has been accurately assessed using these methods, various pharmacologic and non-pharmacologic therapies should be performed by the multidisciplinary care team. Accurate assessment and proper treatment of pain in adult ICU patients will improve patients outcome, which reduces the stress response and decreases the risk of post-traumatic stress disorder.

Citations

Citations to this article as recorded by

Nurses’ knowledge, practice, and associated factors of pain assessment in critically ill adult patients at public hospitals, Addis Ababa, Ethiopia
Temesgen Ayenew, Berhanu Melaku, Mihretie Gedfew, Haile Amha, Keralem Anteneh Bishaw
International Journal of Africa Nursing Sciences.2021; 15: 100361. CrossRef
Impact of Pain Management Algorithm on Pain Intensity of Patients with Loss of Consciousness Hospitalized in Intensive Care Unit: A Clinical Trial
Zahra Dehghani, Asadollah Keikhaei, Fariba Yaghoubinia, Aliakbar Keykha, Masoom Khoshfetrat
Medical - Surgical Nursing Journal.2019;[Epub] CrossRef
Ignorance may be Bliss (for Intensivists), but not for ICU Patients!
Atul P. Kulkarni, Sumitra G Bakshi
Indian Journal of Critical Care Medicine.2019; 23(4): 161. CrossRef

Original Articles

Ethics
The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study: Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee; Korean J Crit Care Med. 2014;29(3):160-165. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.160

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Abstract PDF

BACKGROUND
Many terminally ill patients die while receiving life-sustaining treatment. Recently, the discussion of life-sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients.
METHODS
The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively.
RESULTS
Eighty-nine patients were enrolled. Their mean age was 65.8 +/- 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 +/- 1.0 days after the decision for removal of life-sustaining treatment.
CONCLUSIONS
The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.

Citations

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Agreement between Family Members and the Physician’s View in the ICU Environment: Personal Experience as a Factor Influencing Attitudes towards Corresponding Hypothetical Situations
Paraskevi Stamou, Dimitrios Tsartsalis, Georgios Papathanakos, Elena Dragioti, Mary Gouva, Vasilios Koulouras
Healthcare.2023; 11(3): 345. CrossRef
Family's Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study
Hyeon Jin Cho, Jiyeon Kang
Journal of Korean Academy of Nursing.2021; 51(1): 15. CrossRef
Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
Acute and Critical Care.2020; 35(3): 179. CrossRef
Factors Associated With Quality of Death in Korean ICUs As Perceived by Medical Staff: A Multicenter Cross-Sectional Survey
Jun Yeun Cho, Ju-Hee Park, Junghyun Kim, Jinwoo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Sang-Min Lee, Jae-Ho Lee, Choon-Taek Lee, Yeon Joo Lee
Critical Care Medicine.2019; 47(9): 1208. CrossRef
Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea
Jun Yeun Cho, Jinwoo Lee, Sang-Min Lee, Ju-Hee Park, Junghyun Kim, Youlim Kim, Sang Hoon Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
Acute and Critical Care.2018; 33(2): 95. CrossRef

Pharmacology
The Optimal Dose of Midazolam for Promoting Sleep in Critically Ill Patients: A Pilot Study: Se Joong Kim, Jisoo Park, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2014;29(3):166-171. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.166

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Abstract PDF

BACKGROUND
Many critically ill patients treated in the intensive care unit (ICU) experience sleep disruption. Midazolam is commonly used for the sedation of critically ill patients. This pilot study is aimed to identify the optimal dose of midazolam for achieving sound sleep in critically ill patients.
METHODS
This prospective study was conducted in the medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hours to assess the quantity and quality of sleep in patients sedated with midazolam.
RESULTS
A total of five patients were enrolled. Median total sleep time was 494.0 (IQR: 113.5-859.0) min. The majority of sleep was stage 1 (median 82.0 [IQR 60.5-372.5] min) and 2 (median 88.0 [60.5-621.0] min) with scant REM (median 10.0 [6.0-50.5] min) and no stage 3 (0.0 min) sleep. The median number of wakings in 1 hour was 16.1 (IQR: 7.6-28.6). The dose of midazolam showed a positive correlation with total sleep time (r = 0.975, p = 0.005).
CONCLUSIONS
The appropriate quantity of sleep in critically ill patients was achieved with a continuous infusion of 0.02-0.03 mg/kg/h midazolam. However, the quality of sleep was poor. Further study is required for the promotion of quality sleep in such patients.

Citations

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Effect of prolonged sedation with dexmedetomidine, midazolam, propofol, and sevoflurane on sleep homeostasis in rats
Brian H. Silverstein, Anjum Parkar, Trent Groenhout, Zuzanna Fracz, Anna M. Fryzel, Christopher W. Fields, Amanda Nelson, Tiecheng Liu, Giancarlo Vanini, George A. Mashour, Dinesh Pal
British Journal of Anaesthesia.2024; 132(6): 1248. CrossRef
Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire
Jae Kyoung Kim, Ju-Hee Park, Jaeyoung Cho, Sang-Min Lee, Jinwoo Lee
Acute and Critical Care.2020; 35(3): 164. CrossRef
Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
Salmaan Kanji, Alexandru Mera, Brian Hutton, Lisa Burry, Erin Rosenberg, Erika MacDonald, Vanessa Luks
BMJ Open.2016; 6(7): e012108. CrossRef
Sedation in Critically Ill Patients
Mark Oldham, Margaret A. Pisani
Critical Care Clinics.2015; 31(3): 563. CrossRef

Emergency
Interruption of Chest Compression for Central Venous Catheterization during Cardiopulmonary Resuscitation: Yong Oh Kim, Hyun Soo Park; Korean J Crit Care Med. 2014;29(3):172-176. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.172

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Abstract PDF

BACKGROUND
Peripheral venous catheterization (PVC) is a less invasive and time consuming technique than central venous catheterization (CVC); however, for patients in circulatory collapse or receiving cardiopulmonary resuscitation (CPR), PVC cannot be achieved easily. CVC can provide not only a more effective administration route for medication, but also important hemodynamic information. Owing to the possibility of CPR interruptions and complications, CVC is recommended only after the failure of PVC. This observational study is aimed to evaluate the risks and benefits of CVC during CPR.
METHODS
This retrospective observational study was performed in the emergency department (ED) of a university hospital. Adult patients without a pulse on arrival were consecutively enrolled if subclavian CVC was performed at the beginning of CPR. Patients who already had an established intravenous route or had severe chest injuries on arrival were excluded. Closed-circuit television was used to evaluate the frequency of compression interruption. The incidence of iatrogenic pneumothorax, an acute mechanical complication associated with subclavian CVC, was investigated using chest X-ray after CPR.
RESULTS
During a 6-month period, 35 patients underwent CPR and 31 of these received subclavian CVC. Among the patients, one patient experienced iatrogenic pneumothorax (3.8%), and 13 CPR interruptions occurred in 10 subjects during subclavian CVC.
CONCLUSIONS
During CPR in 31 patients, one iatrogenic pneumothorax was caused by subclavian CVC, and CPR interruptions were observed in approximately 30% of cases.

Citations

Citations to this article as recorded by

Comparison between internal jugular vein access using midline catheter and peripheral intravenous access during cardiopulmonary resuscitation in adults
Hyun Seok Chai, Young-Min Kim, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Seok Woo Lee, Hyeon Jeong Park, Ji Han Lee
SAGE Open Medicine.2023;[Epub] CrossRef
Femoral venous oxygen saturation obtained during CPR predicts successful resuscitation in a pig model
Mu Jin Kim, Kyung Woon Jeung, Byung Kook Lee, Sung Soo Choi, Sang Wook Park, Kyung Hwan Song, Sung Min Lee, Yong Il Min
The American Journal of Emergency Medicine.2015; 33(7): 941. CrossRef

Pulmonary
The Usefulness of Intensivist-Performed Bedside Drainage of Pleural Effusion via Ultrasound-Guided Pigtail Catheter: Joo Won Min, Joon Young Ohm, Byung Seok Shin, Jun Wan Lee, Sang Il Park, Seok Hwa Yoon, Yong Sup Shin, Dong Il Park, Chaeuk Chung, Jae Young Moon; Korean J Crit Care Med. 2014;29(3):177-182. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.177

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Abstract PDF: BACKGROUND
There has been little data reporting the usefulness of intensivist-performed bedside drainage of pleural effusion via ultrasound (US)-guided pigtail catheter. The objective of this study is to clarify the usefulness and safety of these methods in comparison with radiologist-performed procedures.
METHODS
Data of patients with pleural effusion treated with US-guided pigtail catheter drainage were analyzed. All procedures were performed from September 2012 to September. 2013 by a well-trained intensivist or radiologist.
RESULTS
Pleural effusion was drained in 25 patients in 33 sessions. A radiologist performed 21 sessions, and an intensivist performed 12 sessions. Procedures during mechanical ventilation were performed in 15 (71.4%) patients by a radiologist and in 10 (83.3%) by an intensivist (p = 0.678). The success rate was not significantly different in radiologist- and intensivist-performed procedures, 95.2% (20/21) and 83.3% (10/12), respectively (p = 0.538). The average duration for procedures (including in-hospital transfer) was longer in radiologist-performed cases (p = 0.001). Although the results are limited because of the small population size, aggravation of oxygenation, CO2 retention, and decrease of mean arterial blood pressure were not statistically different in the groups. Pigtail-associated complications including hemothorax, pneumothorax, hepatic perforation, empyema, kink in the catheter, and subcutaneous hematoma were not found.
CONCLUSIONS
Intensivist-performed bedside drainage of pleural effusion via ultrasound (US)-guided pigtail catheter is useful and safe and may be recommended in some patients in an intensive care unit.

Pulmonary
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents: Sung Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2014;29(3):183-188. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.183

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Abstract PDF

BACKGROUND
Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to surgical tracheostomy in intensive care units (ICU), and is widely used for critically ill patients who need prolonged mechanical ventilation. Few studies have reported on PDT performed in critically ill patients taking antiplatelet agents. Our goals are to assess not only the feasibility and safety of PDT, but also bleeding complications in the patients receiving such therapy.
METHODS
In a single institution, PDTs were performed by pulmonologists at the medical ICU bedside using the single tapered dilator technique and assisted by flexible bronchoscopy to confirm a secure puncture site. From March 2011 to February 2013, the patients' demographic and clinical data, procedural parameters, outcomes and complications were analyzed and compared complications between patients taking antiplatelet agents and those not.
RESULTS
PDTs were performed for 138 patients; the median age was 72 years, mean body mass index was 20.3 +/- 4.8 kg/m2, and mean acute physiology and chronic health evaluation II score was 24.4 +/- 9.4. Overall, the procedural success rate was 100% and the total procedural time was 25 +/- 8.5 min. There were no periprocedural life-threatening complications, and no statistical difference in the incidence of bleeding complications between patients who had taken antiplatelet agents and those had not (p = 0.657).
CONCLUSIONS
PDT performed in critically ill patients taking antiplatelet agents was a feasible procedure and was implemented without additional bleeding complications.

Citations

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Open tracheostomy in patients with dual platelet aggregation inhibitors
Lorena Zapata-Contreras, Carlos Eduardo Hoyos-Cuervo, María Cristina Florián-Pérez
Colombian Journal of Anesthesiology.2019; 47(3): 189. CrossRef
Safety of Percutaneous Dilatational Tracheotomy in Patients on Dual Antiplatelet Therapy and Anticoagulation
Enzo Lüsebrink, Konstantin Stark, Mattis Bertlich, Danny Kupka, Christopher Stremmel, Clemens Scherer, Thomas J. Stocker, Mathias Orban, Tobias Petzold, Nikolaus Kneidinger, Hans-Joachim Stemmler, Steffen Massberg, Martin Orban
Critical Care Explorations.2019; 1(10): e0050. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Comparison of outcomes between vertical and transverse skin incisions in percutaneous tracheostomy for critically ill patients: a retrospective cohort study
Sung Yoon Lim, Won Gun Kwack, Youlim Kim, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Critical Care.2018;[Epub] CrossRef

Pulmonary
Patients with Acute Respiratory Distress Syndrome Caused by Scrub Typhus: Clinical Experiences of Eight Patients: Sun Young Kim, Hang Jea Jang, Hyunkuk Kim, Kyunghwa Shin, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee; Korean J Crit Care Med. 2014;29(3):189-193. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.189; Correction in: Acute Crit Care 2014;29(4):348

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Abstract PDF

BACKGROUND
The aim of this study is to describe the clinical course and outcome of patients who were diagnosed with acute respiratory distress syndrome (ARDS) caused by scrub typhus and who received ventilator care in the intensive care units (ICU) of two university hospitals.
METHODS
We performed a retrospective analysis of all adult ventilated patients who were diagnosed with ARDS caused by scrub typhus.
RESULTS
Eleven (1.7%) of 632 scrub typhus patients were diagnosed with ARDS (median age 72; seven were male). Eight patients had underlying diseases, the most common of which was hypertension (four patients). Eight patients (72.7%) were admitted in November. The most common chief complaints of the patients were fever and rash (63.6%). All patients had skin eschar and rash; seven were treated for shock. On the day of diagnosis with ARDS, the median Acute Physiology and Chronic Health Evaluation score was 20 (range 11-28) and Sequential Organ Failure Assessment score was 7 (range 4-14). All patients had PaO2/FiO2 < 200 mmHg, high serum aspartate aminotransferase level (> 40 IU/L), and hypoalbuminemia (< 3.3 g/dl). Nine patients were treated with doxycycline on the day of admission. Their median lengths of stay in the ICU and hospital were 10 (range 4-65) and 14 (4-136) days, respectively. The mortality rate during treatment in the hospital was 36.4%.
CONCLUSIONS
In our study, the risk of ARDS among patients diagnosed with scrub typhus was at least 1.7%, with a hospital mortality rate of 36.4%.

Citations

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Rapid Recovery of Acute Respiratory Distress Syndrome in Scrub Typhus, With Pulse Methylprednisolone and Therapeutic Plasma Exchange
Thilina Rathnasekara, Lanka Wijekoon, Hemal Senanayake, Sisira Siribaddana
Cureus.2022;[Epub] CrossRef

Case Reports

Cardiology
Use of Extracorporeal Membrane Oxygenation for Optimal Organ Donation: Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Chi Min Park, Gee Young Suh; Korean J Crit Care Med. 2014;29(3):194-196. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.194

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Abstract PDF

We report a case of extracorporeal membrane oxygenation (ECMO) support for donor organ preservation in a brain-dead patient following out-of-hospital cardiac arrest. A 43-year-old male patient was referred to the emergency department after an out-of-hospital cardiac arrest caused by ventricular fibrillation. Spontaneous circulation was restored after 8 minutes of cardiopulmonary resuscitation. ECMO was implemented because of hemodynamic deterioration. The patient then underwent coronary angiography and was implanted with a drug-eluting stent because of occlusion at the proximal portion of the right coronary artery. After 144 hours, brain death was established, and ECMO support for optimal oxygen delivery was sustained until organ retrieval after consent for donation was received from the family. Liver and kidneys were successfully transplanted to three recipients, respectively.

Citations

Citations to this article as recorded by

Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination
Sung Wook Chang, Sun Han, Jung Ho Ko, Jae-Wook Ryu
Korean Journal of Critical Care Medicine.2016; 31(2): 169. CrossRef
The Use of Extracorporeal Circulation in Suspected Brain Dead Organ Donors with Cardiopulmonary Collapse
Hyun Lee, Yang Hyun Cho, Kiick Sung, Jeong Hoon Yang, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh
Journal of Korean Medical Science.2015; 30(12): 1911. CrossRef

Cardiology/Neurology
Intracranial Hemorrhage Identified in the Early Stage after Applying Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation: Yong Hwan Kim, Kyoung Yul Lee, Seong Youn Hwang; Korean J Crit Care Med. 2014;29(3):197-200. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.197

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Abstract PDF: Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation, but neurologic complications may develop. Cardiac arrest is a fairly common complication following severe intracranial hemorrhage; this complication is encountered both out-of-hospital and in-hospital with variable frequency. To prevent cerebral complications, to detect the cause of cardiac arrest, and to guide further treatment, early neuroimaging study is needed. Herein, we report a case of intracranial hemorrhage identified after extracorporeal cardiopulmonary resuscitation, in which the cause of the hemorrhage was not clear.

Cardiology/Pulmonary
Complicated Pulmonary Pseudocyst Following Traumatic Lung Injury Rescued by Extracorporeal Membrane Oxygenation: Sung Bum Park, Dae Sang Lee, Jeong Am Ryu, Jong Ho Cho, Yang Hyun Cho, Chi Ryang Chung, Jeong Hoon Yang, Kyeongman Jeon, Gee Young Suh, Chi Min Park; Korean J Crit Care Med. 2014;29(3):201-206. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.201

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Abstract PDF: Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma that usually appears immediately in children or young adults and is characterized by a single or multiple pulmonary cystic lesions on chest radiography and has spontaneous resolution of the radiologic manifestations. However, we experienced a case of a delayed complicated pulmonary pseudocyst in a 17-year-old boy following severe traumatic acute respiratory distress syndrome rescued by Veno-venous extracorporeal membrane oxygenation (ECMO). In this case, the pseudocyst appeared on the 12th day after trauma and transformed into an infected cyst. Veno-venous ECMO was successfully maintained for 20 days without anticoagulation.

Cardiology/Pulmonary
Dual Extracorporeal Membrane Oxygenation Support for Bridging Lung Transplantation in Acute Exacerbation of Idiopathic Pulmonary Fibrosis: Dong Jung Kim, Yeon Joo Lee, Jun Sung Kim, Sangheon Park, Young Jae Cho; Korean J Crit Care Med. 2014;29(3):207-211. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.207

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Abstract PDF: When patients with severe respiratory failure are treated with venovenous extracorporeal membrane oxygenation (VV-ECMO), severe pulmonary hypertension due to right ventricular (RV) failure is possible. This is a serious complication that requires immediate therapeutic intervention. We report an extraordinary experience of additional venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for RV failure in a patient who was being treated with VV-ECMO as a bridge to lung transplantation. A 61-year-old man was diagnosed with acute exacerbation of idiopathic pulmonary fibrosis. While waiting for lung transplantation, he was placed on VV-ECMO and developed RV failure. After insertion of additional VA ECMO, RV dysfunction was dramatically improved. He underwent heart-lung transplantation after 23 days of dual ECMO support.

Cardiology/Pulmonary
Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation: Jin Jeon, Jin Won Huh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2014;29(3):212-216. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.212

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Abstract PDF

Acute respiratory distress syndrome (ARDS) is a severe lung disease associated with high mortality despite recent advances in management. Significant advances in extracorporeal membrane oxygenation (ECMO) devices and management allow short-term support for patients with acute reversible respiratory failure and can serve as a bridge to transplantation in patients with irreversible respiratory failure. When ARDS does not respond to conventional treatment, ECMO and the interventional lung assist membrane (iLA) are the most widely used complementary treatment options. Here, we report a clinical case of an adult patient who required prolonged duration venovenous (VV)-ECMO for severe ARDS resulting in improvement while waiting for lung transplantation.

Citations

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Treatment of acute respiratory failure: extracorporeal membrane oxygenation
Jin-Young Kim, Sang-Bum Hong
Journal of the Korean Medical Association.2022; 65(3): 157. CrossRef

Liver/Infection
Chylous Ascites in a Patient with Sepsis Caused by Bilateral Pneumonia: Yong Dae Lee, Young Hyun Lee, Hye Sook Choi; Korean J Crit Care Med. 2014;29(3):217-221. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.217

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Abstract PDF

Chylous ascites is a rare form of ascites characterized by milky peritoneal fluid rich in triglycerides due to the accumulation of chyle in the peritoneal cavity. This affliction occurs as a result of a disruption of lymph flow associated with traumatic injury or obstruction of the lymphatic system. There are various causes of chylous ascites, such as lymphatic anomalies, malignancy, cirrhosis, infection, trauma, surgery, and nephrotic syndrome. We report a rare case of an 81-year-old male with sepsis caused by bilateral pneumonia who presented with chylous ascites.

Citations

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Diagnostic and management problems of chylous effusion in a patient with newly-diagnosed tuberculosis
Dicky Febrianto, Usman Hadi
Current Internal Medicine Research and Practice Surabaya Journal.2021; 2(2): 35. CrossRef

Cardiology
Cardiogenic Shock in a Patient with Intermediate Coronary Artery Disease due to Preoperative Spasm: Donghun Shin, Min Jin Lee, Chul Hong Park, Joongkeun Kim, Dae Sung Lee, Jun Hyok Oh; Korean J Crit Care Med. 2014;29(3):222-225. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.222

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Abstract PDF: The best management strategy for angiographically intermediated coronary artery diseases remains controversial. Lesions, when coupled with spasm, can lead to catastrophic results and cardiogenic shock. We report a case of a 62-year-old man who had an intermediate coronary artery disease presenting with cardiogenic shock due to coronary spasm during a preoperative period.

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