Acute and Critical Care

Volume 31 (1); February 2016

Editorial

Neurology/Pulmonary
Recent Trend in Therapeutic Hypothermia and Early-Onset Pneumonia in Cardiac Arrest: Deokkyu Kim; Korean J Crit Care Med. 2016;31(1):1-3. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.1

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Recent Trend in Therapeutic Hypothermia and Early-Onset Pneumonia in Cardiac Arrest
Deokkyu Kim
Korean Journal of Critical Care Medicine.2016; 31(1): 1. CrossRef

Review

Pulmonary
Lung Ultrasound in Critically Ill Patients: Jinwoo Lee; Korean J Crit Care Med. 2016;31(1):4-9. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.4

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Abstract PDF

Lung ultrasound (LUS) is an emerging tool for intensivists to diagnose and monitor thoracic diseases of critically ill patients. It is easily applied at the bedside in real time and is free of radiation hazards. In the intensive care units (ICUs) lung ultrasound can be used to diagnose pneumothorax and interstitial syndrome. It can also be used to monitor changes in the lung. However, the major limitations of LUS is that it is highly operator dependent and cannot be applied in patients with thoracic dressings, subcutaenous emphysema or pleural calcifications. This article reviews the basic principles of lung ultrasound and discusses how it can be used in ICUs.

Citations

Citations to this article as recorded by

Utilizing Point of Care Ultrasound for Ventilation Liberation: A State-of-the-Art Narrative Review
Haneen Mallah, Ahmad AL-Tanjy, Muhannad Mahmoud, Lina Alkhdour, Leen Amro, Abdallah Alshurafa, Mu’taz Alshaikh Hasan, Bashar Alzghoul
JAP Academy Journal.2024;[Epub] CrossRef
A comparative study between high-flow nasal oxygen therapy and venturi mask oxygen therapy for postoperative laparoscopic bariatric surgery patients with atelectasis: a randomized clinical trial
Asmaa Ahmed Nabeeh Negmeldin Abdelr Allam, Mayar Hassan Sayed Ahmed Elsersi, Galal Adel Mohamed Abdelreheem Elkady, Amr Fouad Hafez, Mohamed Abdelsalam Aly Algendy
Ain-Shams Journal of Anesthesiology.2022;[Epub] CrossRef
Efficacy of transalveolar pressure measurement as a monitoring parameter for lung recruitment in postcardiac surgery hypoxic patients
Ibrahim Mabrouk Ibrahim, Ahmed Yousef, Amal Sabry, Ayman Khalifa
Egyptian Journal of Anaesthesia.2021; 37(1): 145. CrossRef
Postoperative care of cardiac surgery patients: A protocolized approach towards enhanced recovery versus the conventional approach
Moustafa Ibrahim Abd EL-Aal Halwag, Mahar Ahmed Doghiem, Moustafa Abdelaziz Moustafa, Hossam Ossama Ahmed Sorour
Egyptian Journal of Anaesthesia.2021; 37(1): 410. CrossRef

Original Articles

Thoracic Surgery
Outcome of External Ventricular Drainage according to the Operating Place: the Intensive Care Unit versus Operating Room: Si On Kim, Won Jun Song, Yu Sam Won, Jae Young Yang, Chun Sik Choi; Korean J Crit Care Med. 2016;31(1):10-16. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.10

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Abstract PDF: Background:
External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups.
Methods
We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015.
Results
A total of 75 patients (45 men and 30 women, mean age: 58.7 ± 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 ± 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group.
Conclusions
If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.

Neurology/Infection
Effect of Antibiotic Prophylaxis on Early-Onset Pneumonia in Cardiac Arrest Patients Treated with Therapeutic Hypothermia: Soo Jung Kim, Jung Kyu Lee, Deog Kyeom Kim, Jong Hwan Shin, Ki Jeong Hong, Eun Young Heo; Korean J Crit Care Med. 2016;31(1):17-24. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.17

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Abstract PDF

Background:
Infectious complications frequently occur after cardiac arrest and may be even more frequent after therapeutic hypothermia. Pneumonia is the most common infectious complication associated with therapeutic hypothermia, and it is unclear whether prophylactic antibiotics administered during this intervention can decrease the development of early-onset pneumonia. We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia.
Methods
We retrospectively reviewed the medical records of patients who were admitted for therapeutic hypothermia after resuscitation for out-of-hospital cardiac arrest between January 2010 and July 2015. Patients who died within the first 72 hours or presented with pneumonia at the time of admission were excluded. Early-onset pneumonia was defined as pneumonia that developed within 5 days of admission. Prophylactic antibiotic therapy was defined as the administration of any parenteral antibiotics within the first 24 hours without any evidence of infection.
Results
Of the 128 patients admitted after cardiac arrest, 68 were analyzed and 48 (70.6%) were treated with prophylactic antibiotics within 24 hours. The frequency of early-onset pneumonia was not significantly different between the prophylactic antibiotic group and the control group (29.2% vs 30.0%, respectively, p = 0.945). The most commonly used antibiotic was third-generation cephalosporin, and the class of prophylactic antibiotics did not influence early-onset pneumonia.
Conclusion
Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.

Citations

Citations to this article as recorded by

Hypothermia as a potential remedy for canine and feline acute spinal cord injury: a review
Igor Šulla, Slavomír Horňák, Vladimír Balik
Acta Veterinaria Brno.2022; 91(2): 189. CrossRef
Prophylactic antibiotic use following cardiac arrest: A systematic review and meta-analysis
Keith Couper, Ryan Laloo, Richard Field, Gavin D. Perkins, Matthew Thomas, Joyce Yeung
Resuscitation.2019; 141: 166. CrossRef
A review of novel trends in management of canine spinal cord injury
Igor Šulla, Slavomír Horňák, Valent Ledecký, Vladimír Balik
Acta Veterinaria Brno.2019; 88(2): 207. CrossRef
Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef

Pulmonary/Quality Improvement
Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea: Junghyun Kim, Jungkyu Lee, Sunmi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee; Korean J Crit Care Med. 2016;31(1):25-33. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.25

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Abstract PDF

Background:
The number of elderly patients admitted to intensive care units (ICUs) is growing with the increasing proportion of elderly persons in the Korean general population. It is often difficult to make decisions about ICU care for elderly patients, especially when they are in their 90s. Data regarding the proportion of elderly patients in their 90s along with their clinical characteristics in ICU are scarce.
Methods
The records of Korean patients ≥ 90 years old who were admitted to the medical ICU in a tertiary referral hospital between January 2005 and December 2014 were retrospectively reviewed. We compared the trend in ICU use and characteristics of these elderly patients between 2005-2009 and 2010-2014.
Results
Among 6,186 referred patients, 55 aged ≥ 90 years were admitted to the medical ICU from 2005 to 2014. About 58.2% of these patients were male, and their mean age was 92.7 years. Their median Charlson comorbidity index score was 2 (IQR 1-3) and their mean APACHE II score was 25.0 (IQR 19.0-34.0). The most common reason for ICU care was acute respiratory failure. There were no differences in the survival rates between the earlier and more recent cohorts. However, after excluding patients who had specified “do not resuscitate” (DNR), the more recent group showed a significantly higher survival rate (53.8% mortality for the earlier group and 0% mortality for the recent group). Among the survivors, over half were discharged to their homes. More patients in the recent cohort (n=26 [78.8%]) specified DNR than in the earlier cohort (n=7 [35.0%], p=0.004). The number and proportion of patients ≥ 90 years old among patients using ICU during the 2005-2014 study period did not differ.
Conclusions
The use of ICU care by elderly patients ≥ 90 years old was consistent from 2005-2014. The overall mortality rate tended to decrease, but this was not statistically significant. However, the proportion of patients specifying DNR was higher among more recent patients, and the recent group showed an even better survivorship after sensitivity analysis excluded patients specifying DNR.

Citations

Citations to this article as recorded by

Evaluating the effect of age on postoperative and clinical outcomes in patients admitted to the intensive care unit after gastrointestinal cancer surgery
Jee Yeon Lee, Hyejeong Park, Mi Kyoung Kim, Im-kyung Kim
Surgery.2022; 172(4): 1270. CrossRef
Characteristics and prognostic factors of very elderly patients admitted to the intensive care unit
Song-I Lee, Younsuck Koh, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim
Acute and Critical Care.2022; 37(3): 372. CrossRef

Case Reports

Neurology
Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy: Jae Meen Lee, Sun Ha Paek, Hye Ran Park, Kang Hee Lee, Chae Won Shin, Hye Young Park, Hee Pyoung Park, Dong Gyu Kim, Beom Seok Jeon; Korean J Crit Care Med. 2016;31(1):34-38. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.34

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Abstract PDF

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

Citations

Citations to this article as recorded by

Metal-free carboxyl modified g-C3N4 for enhancing photocatalytic degradation activity of organic pollutants through peroxymonosulfate activation in wastewater under solar radiation
Xueting Mei, Shujun Chen, Gangqiang Wang, Wenxing Chen, Wangyang Lu, Bingying Zhang, Yu Fang, Chenxiao Qi
Journal of Solid State Chemistry.2022; 310: 123053. CrossRef

Cardiology
Huge Left Ventricular Thrombus and Apical Ballooning associated with Recurrent Massive Strokes in a Septic Shock Patient: Hyun-Jung Lee, Hack-Lyoung Kim, Doyeon Hwang, Chan-Soon Park, Jae-Sung Lim, Eungyu Kang, Joo-Hee Zo; Korean J Crit Care Med. 2016;31(1):39-43. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.39

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Abstract PDF

The most feared complication of left ventricular thrombus (LVT) is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.

Citations

Citations to this article as recorded by

Spontaneous ventricular thrombosis in patients with inflammatory bowel disease
Stella Pak, Juan Linares, Yan Yatsynovich, David Cha, Dexter Nye, Diana Kaminski, Jillian Costello
Cardiology in the Young.2018; 28(3): 351. CrossRef
Major Trauma induced Left Ventricular Thrombus after Acute Myocardial Infarction
Dong Wook Lee, Ju Hee Ha, Jun Ho Kim, Ki Beom Park, Jae Joon Lee, Han Il Choi, Jin Hee Kim
Journal of Lipid and Atherosclerosis.2016; 5(2): 163. CrossRef

Pulmonary
Successful Treatment with Empirical Erlotinib in a Patient with Respiratory Failure Caused by Extensive Lung Adenocarcinoma: Suk Hyeon Jeong, Sang-Won Um, Hyun Lee, Kyeongman Jeon, Kyung Jong Lee, Gee Young Suh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Yoon La Choi; Korean J Crit Care Med. 2016;31(1):44-48. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.44

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We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.

Citations

Citations to this article as recorded by

Lazarus effect in a patient initially empirically treated with osimertinib for EGFR L858R mutant non-small cell lung cancer with leptomeningeal disease: a case report
Shreya Bhatia, Manuel G. Cortez, Spencer Lessans, Wade T. Iams
Oncotarget.2024; 15(1): 27. CrossRef
Lung cancer with superior vena cava syndrome diagnosed by intravascular biopsy using EBUS-TBNA
Daegeun Lee, Seong Mi Moon, Dongwuk Kim, Juwon Kim, Haseong Chang, Bumhee Yang, Suk Hyeon Jeong, Kyung Jong Lee
Respiratory Medicine Case Reports.2016; 19: 177. CrossRef

Neurology/Liver
Non-Convulsive Status Epilepticus following Liver Transplantation: Bora Lee, Nar Hyun Min, Sung Yeon Ham, Sungwon Na, Jeongmin Kim; Korean J Crit Care Med. 2016;31(1):49-53. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.49

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Abstract

Neurological complications following liver transplantation are more common than after other organ transplants. These complications include seizure in about 8% of cases, which is associated with morbidity and mortality. Seizure should be treated immediately, and the process of differential diagnosis has to be performed appropriately in order to avoid permanent neurologic deficit. We herein report a case of status epilepticus after liver transplantation. The status epilepticus was treated promptly and the cause of seizure was assessed. The patient was discharged without any complication.

Citations

Citations to this article as recorded by

Early postoperative seizures in liver and kidney recipients
O. M. Tsirulnikova, A. V. Syrkina, I. A. Miloserdov, I. E. Pashkova, S. Yu. Oleshkevich, I. B. Komarova
Russian Journal of Transplantology and Artificial Organs.2021; 23(2): 158. CrossRef

Cardiology/Thoracic Surgery
The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture: Ju-Hee Park, Junghyeon Lim, Jaejin Lee, Hee Sung Lee; Korean J Crit Care Med. 2016;31(1):54-57. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.54

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Abstract PDF: Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

Trauma/Surgery
Secondary Abdominal Compartment Syndrome Recognized in Operating Room in Severely Injured Patients: Seok Hwa Youn, John Cook-Jong Lee, Kyoungwon Jung, Jonghwan Moon, Yo Huh, Younghwan Kim; Korean J Crit Care Med. 2016;31(1):58-62. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.58

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Abstract PDF: For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.

Cardiology/Pediatric
Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?: Haemi Lee, Jonghyun Baek, Sangyoung Park, Daelim Jee; Korean J Crit Care Med. 2016;31(1):63-67. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.63

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Abstract PDF: A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.

Letter to the Editor

Cardiology
Venous Air Embolism Not Amniotic Fluid Embolism: Charles Her; Korean J Crit Care Med. 2016;31(1):68-70. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.68

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Erratum

Spontaneous Lumbar Artery Bleeding and Retroperitoneal Hematoma in a Patient Treated with Continuous Renal Replacement Therapy: Jin Kyung Park, Sung Ho Kim, Hee Jin Kim, Duk Hyun Lee; Korean J Crit Care Med. 2016;31(1):71-71. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.71; Corrects: Acute Crit Care 2015;30(4):318

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