Acute and Critical Care

Volume 31 (2); May 2016

Editorial

Cardiology
The Future of Research on Extracorporeal Membrane Oxygenation (ECMO): Ji Young Lee; Korean J Crit Care Med. 2016;31(2):73-75. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.73

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Guideline

Pulmonary
Clinical Practice Guideline of Acute Respiratory Distress Syndrome: Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi, The Korean Society of Critical Care Medicine and the Korean Academy of Tuberculosis and Respiratory Diseases Consensus Group; Korean J Crit Care Med. 2016;31(2):76-100. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.76

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Abstract PDF

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

Citations

Citations to this article as recorded by

Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong
Acute and Critical Care.2024; 39(1): 91. CrossRef
Predicting factors associated with prolonged intensive care unit stay of patients with COVID-19
Won Ho Han, Jae Hoon Lee, June Young Chun, Young Ju Choi, Youseok Kim, Mira Han, Jee Hee Kim
Acute and Critical Care.2023; 38(1): 41. CrossRef
Treatment of acute respiratory failure: invasive mechanical ventilation
Young Sam Kim
Journal of the Korean Medical Association.2022; 65(3): 151. CrossRef
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
Prolonged glucocorticoid treatment in acute respiratory distress syndrome – Authors' reply
Rob Mac Sweeney, Daniel F McAuley
The Lancet.2017; 389(10078): 1516. CrossRef
Prolonged Glucocorticoid Treatment in ARDS: Impact on Intensive Care Unit-Acquired Weakness
Gianfranco Umberto Meduri, Andreas Schwingshackl, Greet Hermans
Frontiers in Pediatrics.2016;[Epub] CrossRef

Original Articles

Thoracic Surgery
Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah’s Witnesses: a Comparative Study with Non-Jehovah’s Witnesses: Tae Sik Kim, Jong Hyun Lee, Chan-Young Na; Korean J Crit Care Med. 2016;31(2):101-110. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.101

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Abstract PDF

Background:
We compared the clinical outcomes of cardiac valve surgery in adult Jehovah’s Witness patients refusing blood transfusion to those in non-Jehovah’s Witness patients without any transfusion limitations.
Methods
From 2005 to 2014, 25 Jehovah’s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery.
Results
The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups.
Conclusions
Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.

Citations

Citations to this article as recorded by

Optimising bloodless cardiovascular surgery for Jehovah’s Witnesses and beyond
Matti Jubouri, Fatemeh Hedayat, Sakina Abrar, Sophie L. Mellor, Louise J. Brown, Amer Harky
Coronary Artery Disease.2022; 33(1): 52. CrossRef
Outcomes of perioperative management in Jehovah's Witness patients undergoing surgeries with a risk of bleeding: a retrospective, single-center, observational study
Keum Young So, Sang Hun Kim
Medical Biological Science and Engineering.2022; 5(1): 6. CrossRef

Policy
Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey: Jun Wan Lee, Jae Young Moon, Seok Wha Youn, Yong Sup Shin, Sang Il Park, Dong Chan Kim, Younsuk Koh; Korean J Crit Care Med. 2016;31(2):111-117. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.111; Correction in: Acute Crit Care 2016;31(3):262

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Abstract PDF

Background:
Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea.
Methods
An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS).
Results
Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues.
Conclusions
Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist’s role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.

Citations

Citations to this article as recorded by

Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study
Jaeyoung Choi, Esther Park, Ah Young Choi, Meong Hi Son, Joongbum Cho
Journal of Korean Medical Science.2023;[Epub] CrossRef
Willingness to pay for family education and counselling services provided by critical care advanced practice nurses
Chung Mee Ko, Chin Kang Koh, Sangho Kwon
International Journal of Nursing Practice.2019;[Epub] CrossRef
Intensivist as a Surgeon: The Role of a Surgeon in Critical Care Medicine
Kyung Sook Hong
The Ewha Medical Journal.2017; 40(2): 61. CrossRef

Case Reports

Pharmacology
Recurrent Desaturation Events due to Opioid-Induced Chest Wall Rigidity after Low Dose Fentanyl Administration: Sung Yeon Ham, Bo Ra Lee, Taehoon Ha, Jeongmin Kim, Sungwon Na; Korean J Crit Care Med. 2016;31(2):118-122. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.118

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Abstract PDF

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.

Citations

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Fentanyl-Induced Rigid Chest Syndrome in Critically Ill Patients
Alison J. Tammen, Donald Brescia, Dan Jonas, Jeremy L. Hodges, Philip Keith
Journal of Intensive Care Medicine.2023; 38(2): 196. CrossRef
Effects of fentanyl overdose-induced muscle rigidity and dexmedetomidine on respiratory mechanics and pulmonary gas exchange in sedated rats
Philippe Haouzi, Nicole Tubbs
Journal of Applied Physiology.2022; 132(6): 1407. CrossRef
Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review
Kunal Karamchandani, Rajeev Dalal, Jina Patel, Puneet Modgil, Ashley Quintili
Current Anesthesiology Reports.2021; 11(2): 107. CrossRef
A Case of Masseter Muscle Rigidity during Awake Intubation under Remifentanil Infusion
Tomoki YAMAGA, Takeshi NEGITA, Masayo SUGIURA, Nobuyuki KIMURA
THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA.2019; 39(3): 274. CrossRef
Opioids and Chest Wall Rigidity During Mechanical Ventilation
Jeffrey P. Roan, Navin Bajaj, Field A. Davis, Natalie Kandinata
Annals of Internal Medicine.2018; 168(9): 678. CrossRef

Cardiology
Use of Polymyxin B Hemoperfusion in a Patient with Septic Shock and Septic Cardiomyopathy Who Was Placed on Extracorporeal Membrane Oxygen Support: Sun Hye Shin, Hyun Lee, Aeng Ja Choi, Kylie Hae Jin Chang, Gee Young Suh, Chi Ryang Chung; Korean J Crit Care Med. 2016;31(2):123-128. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.123

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Abstract PDF: Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.

Infection
Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient: Eunmi Gil, Tae Sun Ha, Gee Young Suh, Chi Ryang Chung, Chi-Min Park; Korean J Crit Care Med. 2016;31(2):129-133. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.129; Correction in: Acute Crit Care 2016;31(3):263

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Abstract PDF

Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.

Citations

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Aspergillus fumigatus cholangitis in a patient with cholangiocarcinoma: case report and review of the literature
Kathrin Rothe, Sebastian Rasch, Nina Wantia, Alexander Poszler, Joerg Ulrich, Christoph Schlag, Wolfgang Huber, Roland M. Schmid, Dirk H. Busch, Tobias Lahmer
Infection.2021; 49(1): 159. CrossRef

Neurosurgery/Hematology
Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis: Hyun Jin Baek, Doo Hyuk Lee, Kyu Hyung Han, Young Min Kim, Hyunbeom Kim, Byeongwook Cho, Inkuk Lee, Kanghyun Choi, Hojin Yong, Goohyeon Hong; Korean J Crit Care Med. 2016;31(2):134-139. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.134

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Abstract PDF

In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.

Citations

Citations to this article as recorded by

Abdominal mass in a septic infant: Case of a fatal intraluminal intestinal hematoma
Mana Taweevisit, Paul Scott Thorner
Pediatric Hematology Oncology Journal.2021; 6(3): 139. CrossRef
Perforated Mesenteric Cyst with Sepsis and Neurological Complication in a 9 Month Old Child
Mandal KC, Saha D, Halder P, Chakraborty P, Debnath B, Mukhopadhyay B
Asploro Journal of Pediatrics and Child Health.2020; 2(1): 30. CrossRef

Genetic
Lethal Hyperammonemia due to Ornithine Transcarbamylase Deficiency in a Patient with Severe Septic Shock: Ji An Hwang, Joo Han Song, Young Seok Lee, Kyung Soo Chung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park; Korean J Crit Care Med. 2016;31(2):140-145. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.140

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Abstract PDF: Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 μg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support–albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.

Pulmonary
Lung Transplantation for Chronic Humidifier Disinfectant-Associated Lung Injury: Won-Young Kim, So-Woon Kim, Kyung-Wook Jo, Sae Hoon Choi, Hyung Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Sang-Bum Hong; Korean J Crit Care Med. 2016;31(2):146-151. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.146

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Abstract PDF

In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient’s clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.

Citations

Citations to this article as recorded by

Humidifier Disinfectant-Associated Lung Injury: Six Years after the Tragic Event
Won-Young Kim, Sang-Bum Hong
Tuberculosis and Respiratory Diseases.2017; 80(4): 351. CrossRef

Cardiology/Pediatric
Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia: Seung Jun Choi, Chun-Soo Park, Won Kyoung Jhang, Seong Jong Park; Korean J Crit Care Med. 2016;31(2):152-155. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.152

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Abstract PDF

Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.

Citations

Citations to this article as recorded by

Inadvertent cannulation of the azygos vein during eCPR
Shelina M. Jamal, Deborah S. Fruitman, Kevin M. Lichtenstein, Darren H. Freed, Natalie L. Yanchar
Journal of Pediatric Surgery Case Reports.2021; 71: 101941. CrossRef
Identification of Inadvertent Azygous Vein Cannulation Using Transthoracic Echocardiography During Venoarterial Extracorporeal Membrane Oxygenation Initiation
Bethany G. Runkel, Jason D. Fraser, John M. Daniel, Karina M. Carlson
CASE.2019; 3(2): 67. CrossRef
Successful Extracorporeal Membrane Oxygenation After Incidental Azygos Vein Cannulation in a Neonate With Right-Sided Congenital Diaphragmatic Hernia Interruption of the Inferior Vena Cava and Azygos Continuation
Alessandra Mayer, Genny Raffaeli, Federico Schena, Valeria Parente, Gabriele Sorrentino, Francesco Macchini, Anna Maria Colli, Lucia Mauri, Simona Neri, Irene Borzani, Ernesto Leva, Fabio Mosca, Giacomo Cavallaro
Frontiers in Pediatrics.2019;[Epub] CrossRef
The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
Ji Young Lee
Korean Journal of Critical Care Medicine.2016; 31(2): 73. CrossRef

Pulmonary/Thoracic Surgery
Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer: Jangwhan Jo, Yang Gi Ryu; Korean J Crit Care Med. 2016;31(2):156-161. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.156

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Abstract PDF

A patient had undergone left pneumonectomy for lung cancer and had an increased risk of fatal complications such as pneumonia, including acute respiratory distress syndrome (ARDS). The treatment effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for ARDS of postpneumonectomy patient are uncertain. A 74-year-old man with one lung experienced aspiration pneumonia while swallowing pills after the operation, and his condition progressed to ARDS within a day. He was successfully treated with VV-ECMO support and intensive care unit care.

Citations

Citations to this article as recorded by

The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
Ji Young Lee
Korean Journal of Critical Care Medicine.2016; 31(2): 73. CrossRef

Infection/Cardiology
Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumocystis jirovecii Pneumonia: Case Report and Literature Review: Dong Won Park, Dae Hyun Lim, Bongyoung Kim, Ji Young Yhi, Ji-Yong Moon, Sang-Heon Kim, Tae-Hyung Kim, Jang Won Shon, Ho Joo Yoon, Dong Ho Shin, Hyunjoo Pai; Korean J Crit Care Med. 2016;31(2):162-168. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.162

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Abstract PDF

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.

Citations

Citations to this article as recorded by

Extracorporeal life support for immune reconstitution inflammatory syndrome in HIV patients with Pneumocystis jirovecii pneumonia
Kollengode Ramanathan, Julian K. Svasti, Graeme MacLaren
Journal of Artificial Organs.2018; 21(3): 371. CrossRef

Neurology/Cardiology
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 J Crit Care Med. 2016;31(2):169-172. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.169

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Abstract PDF

The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.

Citations

Citations to this article as recorded by

Outcomes of Extracorporeal Membrane Oxygenation in Children: An 11-Year Single-Center Experience in Korea
Hongsun Kim, Ji-Hyuk Yang, Yang Hyun Cho, Tae-Gook Jun, Kiick Sung, Woosik Han
The Korean Journal of Thoracic and Cardiovascular Surgery.2017; 50(5): 317. CrossRef

Pulmonary
Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust: Sun Mi Choi, Jiwon Koh, Sang-Min Lee, Jinwoo Lee; Korean J Crit Care Med. 2016;31(2):173-177. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.173

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Abstract PDF: Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.

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