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Volume 32 (2); May 2017
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Reviews
Status Epilepticus and Beyond: A Clinical Review of Status Epilepticus and an Update on Current Management Strategies in Super-refractory Status Epilepticus
Roy Poblete, Gene Sung
Korean J Crit Care Med. 2017;32(2):89-105.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00252
  • 22,287 View
  • 1,907 Download
  • 5 Citations
AbstractAbstract PDF
Status epilepticus and refractory status epilepticus represent some of the most complex conditions encountered in the neurological intensive care unit. Challenges in management are common as treatment options become limited and prolonged hospital courses are accompanied by complications and worsening patient outcomes. Antiepileptic drug treatments have become increasingly complex. Rational polytherapy should consider the pharmacodynamics and kinetics of medications. When seizures cannot be controlled with medical therapy, alternative treatments, including early surgical evaluation can be considered; however, evidence is limited. This review provides a brief overview of status epilepticus, and a recent update on the management of refractory status epilepticus based on evidence from the literature, evidence-based guidelines, and experiences at our institution.

Citations

Citations to this article as recorded by  
  • Proanthocyanidin from Vitis vinifera attenuates memory impairment due to convulsive status epilepticus
    Opeyemi Samson Osuntokun, Gbola Olayiwola, Damilare Adedayo Adekomi, Ibukun Peter Oyeyipo, Abiodun Oladele Ayoka
    Epilepsy & Behavior.2021; 124: 108333.     CrossRef
  • Effect of Sodium Valproate Treatment on the Cardiac Index in New Cases with Status Epilepticus
    Mohammad Radgoudarzi, Mohammad Vafaee-Shahi, Fatemeh Naderi
    The Open Neurology Journal.2021; 15(1): 59.     CrossRef
  • Electroconvulsive Therapy in Super Refractory Status Epilepticus: Case Series with a Defined Protocol
    Beatriz García-López, Ana Isabel Gómez-Menéndez, Fernando Vázquez-Sánchez, Eva Pérez-Cabo, Francisco Isidro-Mesas, Arturo Zabalegui-Pérez, Ignacio Muñoz-Siscart, María Carmen Lloria-Gil, Raúl Soto-Cámara, Jerónimo J. González-Bernal, Josefa González-Santo
    International Journal of Environmental Research and Public Health.2020; 17(11): 4023.     CrossRef
  • Correlation of serum S100B levels with brain magnetic resonance imaging abnormalities in children with status epilepticus
    Prastiya Indra Gunawan, Darto Saharso, Dian Purnama Sari
    Korean Journal of Pediatrics.2019; 62(7): 281.     CrossRef
  • Clinico-Etiological Profile of Pediatric Refractory Status Epilepticus at a Public Hospital in India
    KC Sadik, Devendra Mishra, Monica Juneja, Urmila Jhamb
    Journal of Epilepsy Research.2019; 9(1): 36.     CrossRef
Basic science and research
The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores
Neil J. Glassford, Rinaldo Bellomo
Korean J Crit Care Med. 2017;32(2):106-123.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00192
  • 10,952 View
  • 288 Download
  • 4 Citations
AbstractAbstract PDF
Urinary examination has formed part of patient assessment since the earliest days of medicine. Current definitions of oliguria are essentially arbitrary, but duration and intensity of oliguria have been associated with an increased risk of mortality, and this risk is not completely attributable to the development of concomitant acute kidney injury (AKI) as defined by changes in serum creatinine concentration. The increased risk of death associated with the development of AKI itself may be modified by directly or indirectly by progressive fluid accumulation, due to reduced elimination and increased fluid administration. None of the currently extant major illness severity scoring systems or outcome prediction models use modern definitions of AKI or oliguria, or any values representative of fluid volumes variables. Even if a direct relationship with mortality is not observed, then it is possible that fluid balance or fluid volume variables mediate the relationship between illness severity and mortality in the renal and respiratory physiological domains. Fluid administration and fluid balance may then be an important, easily modifiable therapeutic target for future investigation. These relationships require exploration in large datasets before being prospectively validated in groups of critically ill patients from differing jurisdictions to improve prognostication and mortality prediction.

Citations

Citations to this article as recorded by  
  • Management of oliguria
    Marlies Ostermann, Andrew D. Shaw, Michael Joannidis
    Intensive Care Medicine.2023; 49(1): 103.     CrossRef
  • Nomenclature and diagnostic criteria for acute kidney injury – 2020 consensus of the Taiwan AKI-task force
    Shao-Yu Yang, Terry Ting-Yu Chiou, Chih-Chung Shiao, Hugo You-Hsien Lin, Ming-Jen Chan, Che-Hsiung Wu, Chiao-Yin Sun, Wei-Jie Wang, Yen-Ta Huang, Vin-Cent Wu, Yung-Chang Chen, Ji-Tsung Fang, Shang-Jyh Hwang, Heng-Chih Pan
    Journal of the Formosan Medical Association.2022; 121(4): 749.     CrossRef
  • Haemodynamic frailty – A risk factor for acute kidney injury in the elderly
    Neil G. Docherty, Christian Delles, Patrick D’Haese, Anita T. Layton, Carlos Martínez-Salgado, Benjamin A. Vervaet, Francisco J. López-Hernández
    Ageing Research Reviews.2021; 70: 101408.     CrossRef
  • Does Fluid Type and Amount Affect Kidney Function in Critical Illness?
    Neil J. Glassford, Rinaldo Bellomo
    Critical Care Clinics.2018; 34(2): 279.     CrossRef
Original Articles
Rapid response system
Epidemiology and Clinical Characteristics of Rapid Response Team Activations
Sei Won Kim, Hwa Young Lee, Mi Ra Han, Yong Suk Lee, Eun Hyoung Kang, Eun Ju Jang, Keum Sook Jeun, Seok Chan Kim
Korean J Crit Care Med. 2017;32(2):124-132.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00199
  • 6,368 View
  • 203 Download
  • 4 Citations
AbstractAbstract PDF
Background
To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available.
Methods
In Seoul St. Mary’s Hospital, the St. Mary’s Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016.
Results
The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation.
Conclusions
Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.

Citations

Citations to this article as recorded by  
  • Development of a comprehensive model for the role of the rapid response team nurse
    Youn-Hui Won, Jiyeon Kang
    Intensive and Critical Care Nursing.2022; 68: 103136.     CrossRef
  • Failure mode and effect analysis (FMEA) to identify and mitigate failures in a hospital rapid response system (RRS)
    Ehsan Ullah, Mirza Mansoor Baig, Hamid GholamHosseini, Jun Lu
    Heliyon.2022; 8(2): e08944.     CrossRef
  • Neurological Emergencies in Patients Hospitalized With Nonneurological Illness
    Sang-Beom Jeon, Han-Bin Lee, Yong Seo Koo, Hyunjo Lee, Jung Hwa Lee, Bobin Park, Soh Hyun Choi, Suyeon Jeong, Jun Young Chang, Sang-Bum Hong, Chae-Man Lim, Sang-Ahm Lee
    Journal of Patient Safety.2021; 17(8): e1332.     CrossRef
  • Rapid response systems in Korea
    Bo Young Lee, Sang-Bum Hong
    Acute and Critical Care.2019; 34(2): 108.     CrossRef
Rapid response system
A Pilot Study of the Effectiveness of Medical Emergency System Implementation at a Single Center in Korea
Su Hwan Lee, Ah Young Leem, Youngok Nho, Young Ah Kim, Kyung Duck Kim, Young Sam Kim, Se Kyu Kim, Kyung Soo Chung
Korean J Crit Care Med. 2017;32(2):133-141.   Published online May 16, 2017
DOI: https://doi.org/10.4266/kjccm.2016.01011
  • 5,205 View
  • 107 Download
  • 1 Citations
AbstractAbstract PDF
Background
An automatic alarm system was developed was developed for unexpected vital sign instability in admitted patients to reduce staffing needs and costs related to rapid response teams. This was a pilot study of the automatic alarm system, the medical emergency system (MES), and the aim of this study was to determine the effectiveness of the MES before expanding this system to all departments.
Methods
This retrospective, observational study compared the performance of patients admitted to the pulmonary department at a single center using patient data from three 3-month periods (before implementation of the MES: December 2013-February 2014; after implementation of the MES: December 2014-February 2015 and December 2015-February 2016).
Results
A total of 571 patients were admitted to the pulmonary department during the three observation periods. During this pilot study, the MES automatically issued 568 alarms for 415 admitted patients. There was no significant difference in the rate of cardiopulmonary resuscitation (CPR) before and after application of the MES. The mortality rate also did not change. However, it appeared that CPR was prevented in four patients admitted from the general ward to the intensive care unit (ICU) during MES implementation. The median length of hospital stay and median length of ICU stay were not significantly different before and after MES implementation.
Conclusions
Although we did not find a significant improvement in outcomes upon MES implementation, the CPR rate and mortality rate did not increase despite increased comorbidities. This was a small pilot study, and, based on these results, we believe that the MES may have significant effects in longer-term and larger-scale studies.

Citations

Citations to this article as recorded by  
  • Rapid response systems in Korea
    Bo Young Lee, Sang-Bum Hong
    Acute and Critical Care.2019; 34(2): 108.     CrossRef
Infection
Implications of Plasma Renin Activity and Plasma Aldosterone Concentration in Critically Ill Patients with Septic Shock
Kyung Soo Chung, Joo Han Song, Won Jai Jung, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park
Korean J Crit Care Med. 2017;32(2):142-153.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00094
  • 7,277 View
  • 208 Download
  • 9 Citations
AbstractAbstract PDFSupplementary Material
Background
The renin-angiotensin-aldosterone system is closely associated with volume status and vascular tone in septic shock. The present study aimed to assess whether plasma renin activity (PRA) and plasma aldosterone concentration (PAC) measurements compared with conventional severity indicators are associated with mortality in patients with septic shock.
Methods
We evaluated 105 patients who were admitted for septic shock. Plasma levels of the biomarkers PRA and PAC, the PAC/PRA ratio, C-reactive protein (CRP) level, and cortisol level on days 1, 3, and 7 were serially measured. During the intensive care unit stay, relevant clinical information and laboratory results were recorded.
Results
Patients were divided into two groups according to 28-day mortality: survivors (n = 59) and non-survivors (n = 46). The survivor group showed lower PRA, PAC, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score than did the non-survivor group (all P < 0.05). The SOFA score was positively correlated with PRA (r = 0.373, P < 0.001) and PAC (r = 0.316, P = 0.001). According to receiver operating characteristic analysis, the areas under the curve of PRA and PAC to predict 28-day mortality were 0.69 (95% confidence interval [CI], 0.58 to 0.79; P = 0.001) and 0.67 (95% CI, 0.56 to 0.77; P = 0.003), respectively, similar to the APACHE II scores and SOFA scores. In particular, the group with PRA value ≥3.5 ng ml-1 h-1 on day 1 showed significantly greater mortality than did the group with PRA value <3.5 ng ml-1 h-1 (log-rank test, P < 0.001). According to multivariate analysis, SOFA score (hazard ratio, 1.11; 95% CI, 1.01 to 1.22), PRA value ≥3.5 ng ml-1 h-1 (hazard ratio, 3.25; 95% CI, 1.60 to 6.60), previous history of cancer (hazard ratio, 3.44; 95% CI, 1.72 to 6.90), and coronary arterial occlusive disease (hazard ratio, 2.99; 95% CI, 1.26 to 7.08) were predictors of 28-day mortality.
Conclusions
Elevated PRA is a useful biomarker to stratify the risk of critically ill patients with septic shock and is a prognostic predictor of 28-day mortality.

Citations

Citations to this article as recorded by  
  • Renin Kinetics Are Superior to Lactate Kinetics for Predicting In-Hospital Mortality in Hypotensive Critically Ill Patients*
    Maniraj Jeyaraju, Michael T. McCurdy, Andrea R. Levine, Prasad Devarajan, Michael A. Mazzeffi, Kristin E. Mullins, Michaella Reif, David N. Yim, Christopher Parrino, Allison S. Lankford, Jonathan H. Chow
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    Martin Harazim, Kaiquan Tan, Marek Nalos, Martin Matejovic
    Biomedical Papers.2022;[Epub]     CrossRef
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    Andrew Owen, Jaimin M. Patel, Dhruv Parekh, Mansoor N. Bangash
    Frontiers in Cardiovascular Medicine.2022;[Epub]     CrossRef
  • Renin as a Marker of Tissue Perfusion, Septic Shock and Mortality in Septic Patients: A Prospective Observational Study
    Patrycja Leśnik, Lidia Łysenko, Małgorzata Krzystek-Korpacka, Ewa Woźnica-Niesobska, Magdalena Mierzchała-Pasierb, Jarosław Janc
    International Journal of Molecular Sciences.2022; 23(16): 9133.     CrossRef
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    Mojdeh S. Heavner, Michael T. McCurdy, Michael A. Mazzeffi, Samuel M. Galvagno, Kenichi A. Tanaka, Jonathan H. Chow
    Journal of Intensive Care Medicine.2021; 36(6): 635.     CrossRef
  • Treatment of Renin-Angiotensin-Aldosterone System Dysfunction With Angiotensin II in High-Renin Septic Shock
    Jonathan H. Chow, Marianne Wallis, Allison S. Lankford, Zackary Chancer, Rolf N. Barth, Joseph R. Scalea, John C. LaMattina, Michael A. Mazzeffi, Michael T. McCurdy
    Seminars in Cardiothoracic and Vascular Anesthesia.2021; 25(1): 67.     CrossRef
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    Andrea CARSETTI, Elena BIGNAMI, Andrea CORTEGIANI, Katia DONADELLO, Abele DONATI, Giuseppe FOTI, Giacomo GRASSELLI, Stefano ROMAGNOLI, Massimo ANTONELLI, Elvio DE BLASIO, Francesco FORFORI, Fabio GUARRACINO, Sabino SCOLLETTA, Luigi TRITAPEPE, Luigia SCUDE
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    Brian Trethowan, Christopher J. Michaud, Sarah Fifer
    Critical Care Medicine.2020; 48(10): e912.     CrossRef
  • Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients*
    Patrick J. Gleeson, Ilaria Alice Crippa, Wasineenart Mongkolpun, Federica Zama Cavicchi, Tess Van Meerhaeghe, Serge Brimioulle, Fabio Silvio Taccone, Jean-Louis Vincent, Jacques Creteur
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Pulmonary
Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study
Joohae Kim, Sun Mi 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. 2017;32(2):154-163.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00976
  • 9,627 View
  • 179 Download
  • 32 Citations
AbstractAbstract PDF
Background
Acute respiratory distress syndrome (ARDS) remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE) inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS) blockage on the prognosis of patients with ARDS.
Methods
We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU) at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching.
Results
A total of 182 patients were included in the study. Thirty-seven patients (20.3%) took ACE inhibitor or angiotensin receptor blocker (ARB) during ICU admission, and 145 (79.7%) did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166). The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013) and longer ICU stay (32.1 vs. 20.2 days, P < 0.001). In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001).
Conclusions
ACE inhibitor or ARB may have beneficial effect on ARDS patients.

Citations

Citations to this article as recorded by  
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    PLOS ONE.2023; 18(1): e0280280.     CrossRef
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    Murat Oz, Dietrich Ernst Lorke, Nadine Kabbani
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    Thorax.2021; 76(5): 479.     CrossRef
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  • COVID-19: The Influence of ACE Genotype and ACE-I and ARBs on the Course of SARS-CoV-2 Infection in Elderly Patients


    Jerzy Sieńko, Maciej Kotowski, Anna Bogacz, Kacper Lechowicz, Sylwester Drożdżal, Jakub Rosik, Marek Sietnicki, Magdalena Sieńko, Katarzyna Kotfis
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    International Journal of Hypertension.2020; 2020: 1.     CrossRef
  • Role of Renin-Angiotensin System in Acute Lung Injury Caused by Viral Infection


    Yan-Lei Gao, Yue Du, Chao Zhang, Cheng Cheng, Hai-Yan Yang, Yue-Fei Jin, Guang-Cai Duan, Shuai-Yin Chen
    Infection and Drug Resistance.2020; Volume 13: 3715.     CrossRef
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    Jaroslav Hrenak, Fedor Simko
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    Ertan Yetkin, Gökay Taylan, Kenan Yalta
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Rapid response system
Demographic Changes in Intensive Care Units in Korea over the Last Decade and Outcomes of Elderly Patients: A Single-Center Retrospective Study
Jeong Uk Lim, Jongmin Lee, Jick Hwan Ha, Hyeon Hui Kang, Sang Haak Lee, Hwa Sik Moon
Korean J Crit Care Med. 2017;32(2):164-173.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00668
  • 5,563 View
  • 109 Download
  • 3 Citations
AbstractAbstract PDF
Background
Aging is a significant issue worldwide, and Korea is one of the most rapidly aging countries. Along with the demographic transition, the age structure of intensive care unit (ICU) patients changes as well.
Methods
The aim of this study was to analyze the change in age distribution of the ICU patients over the last 10 years and its effect on clinical outcomes. Single-center, retrospective analysis of all patients aged ≥18 years admitted to either the medical or surgical ICU at St. Paul’s Hospital, The Catholic University of Korea, between January 2005 and December 2014 was conducted. For clinical outcome, in-hospital mortality, duration of ICU stay, and hospital stay were analyzed. Cost analysis was performed to show the economic burden of each age strata.
Results
A total of 10,366 ICU patients were admitted to the chosen ICUs during the study period. The proportion of elderly patients aged ≥65 years increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of the very elderly patients aged ≥80 years increased from 12.8% to 20.7%. However, this increased proportion of elderly patients did not lead to increased in-hospital mortality. The percent of ICU treatment days attributable to elderly patients increased from 51.1% in year 2005 to 64.0% in 2014. The elderly ICU patients were associated with higher in-hospital mortality compared to younger age groups.
Conclusions
The proportion of elderly patients admitted to ICUs increased over the last decade. However, overall in-hospital mortality has not increased during the same period.

Citations

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  • 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
  • Retrospective Analysis of Long-Term Survival in Very Elderly (age ≥80) Critically Ill Patients of a Medical Intensive Care Unit at a Tertiary Care Hospital in Korea
    Seung Hun Lee, Ju-Young Kim, Tae Hoon Kim, Sun Mi Ju, Jung-Wan Yoo, Seung Jun Lee, Yu Ji Cho, Yi Yeong Jeong, Jong Deog Lee, Ho Cheol Kim
    Tuberculosis and Respiratory Diseases.2020; 83(3): 242.     CrossRef
  • Should Very Old Patients Be Admitted to the Intensive Care Units?
    Jun Kwon Cha, In-Ae Song
    The Korean Journal of Critical Care Medicine.2017; 32(4): 376.     CrossRef
Pulmonary
Evaluation of Respiratory Dynamics in an Asymmetric Lung Compliance Model
So Hui Yun, Ho-Jin Lee, Yong-Hun Lee, Jong Cook Park
Korean J Crit Care Med. 2017;32(2):174-181.   Published online April 14, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00738
  • 5,706 View
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  • 1 Citations
AbstractAbstract PDF
Background
Unilateral lung hyperinflation develops in lungs with asymmetric compliance, which can lead to vital instability. The aim of this study was to investigate the respiratory dynamics and the effect of airway diameter on the distribution of tidal volume during mechanical ventilation in a lung model with asymmetric compliance.
Methods
Three groups of lung models were designed to simulate lungs with a symmetric and asymmetric compliance. The lung model was composed of two test lungs, lung1 and lung2. The static compliance of lung1 in C15, C60, and C120 groups was manipulated to be 15, 60, and 120 mL/cmH2O, respectively. Meanwhile, the static compliance of lung2 was fixed at 60 mL/cmH2O. Respiratory variables were measured above (proximal measurement) and below (distal measurement) the model trachea. The lung model was mechanically ventilated, and the airway internal diameter (ID) was changed from 3 to 8 mm in 1-mm increments.
Results
The mean ± standard deviation ratio of volumes distributed to each lung (VL1/VL2) in airway ID 3, 4, 5, 6, 7, and 8 were in order, 0.10 ± 0.05, 0.11 ± 0.03, 0.12 ± 0.02, 0.12 ± 0.02, 0.12 ± 0.02, and 0.12 ± 0.02 in the C15 group; 1.05 ± 0.16, 1.01 ± 0.09, 1.00 ± 0.07, 0.97 ± 0.09, 0.96 ± 0.06, and 0.97 ± 0.08 in the C60 group; and 1.46 ± 0.18, 3.06 ± 0.41, 3.72 ± 0.37, 3.78 ± 0.47, 3.77 ± 0.45, and 3.78 ± 0.60 in the C120 group. The positive end-expiratory pressure (PEEP) of lung1 was significantly increased at airway ID 3 mm (1.65 cmH2O) in the C15 group; at ID 3, 4, and 5 mm (2.21, 1.06, 0.95 cmH2O) in the C60 group; and ID 3, 4, and 5 mm (2.92, 1.84, 1.41 cmH2O) in the C120 group, compared to ID 8 mm (p < 0.05).
Conclusions
In the C15 and C120 groups, the tidal volume was unevenly distributed to both lungs in a positive relationship with lung compliance. In the C120 group, the uneven distribution of tidal volume was improved when the airway ID was equal to or less than 4 mm, but a significant increase of PEEP was observed.

Citations

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  • Is It Essential to Consider Respiratory Dynamics?
    Youngjoon Kang
    The Korean Journal of Critical Care Medicine.2017; 32(2): 223.     CrossRef
Infection
A Retrospective Study Investigating Risks of Acute Respiratory Distress Syndrome and Mortality Following Human Metapneumovirus Infection in Hospitalized Adults
Hyunjung Hwang, Yujin Kim, Jeong-Woong Park, Sung Hwan Jeong, Sun Young Kyung
Korean J Crit Care Med. 2017;32(2):182-189.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00038
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  • 2 Citations
AbstractAbstract PDFSupplementary Material
Background
Human metapneumovirus (hMPV) is a relatively recently identified respiratory virus that induces respiratory symptoms similar to those of respiratory syncytial virus infection in children. The characteristics of hMPV-infected adults are unclear because few cases have been reported.
Methods
We conducted a retrospective review of hospitalized adult patients with a positive multiplex real-time polymerase chain reaction assay result from 2012 to 2016 at a single tertiary referral hospital in South Korea. We analyzed clinical characteristics of the enrolled patients and divided patients into an acute respiratory distress syndrome (ARDS) group and a non-ARDS group.
Results
In total, 110 adults were reviewed in this study. Their mean age was 61.4 years, and the majority (n = 105, 95.5%) had comorbidities or were immunocompromised. Most of the patients had pneumonia on chest X-ray (n = 88, 93.6%), 22 (20.0%) had ARDS, and 12 (10.9%) expired during hospitalization. The mortality rate for patients with ARDS was higher than that of the other patients (36.4% vs. 5.7%, P = 0.001). The risk factor for hMPV-associated ARDS was heart failure (odds ratio, 5.24; P = 0.044) and laboratory values were increased blood urea nitrogen and increased C-reactive protein. The acquisition site of infection was divided into community vs. nosocomial; 43 patients (39.1%) had a nosocomial infection. The risk factors for nosocomial infection were an immunocompromised state, malignancy and immunosuppressive treatment.
Conclusions
These data suggest that hMPV is one of the important respiratory pathogens important respiratory pathogen that causes pneumonia/ARDS in elderly, immunocompromised individuals and that it may be transmitted via the nosocomial route.

Citations

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  • Human Metapneumovirus Pneumonia Precipitating Acute Respiratory Distress Syndrome in an Adult Patient
    Dena H Tran, Muhammad Sameed, Ellen T Marciniak, Avelino C Verceles
    Cureus.2021;[Epub]     CrossRef
  • Outcomes of severe human metapneumovirus-associated community-acquired pneumonia in adults
    Sang-Ho Choi, Sang-Bum Hong, Jin Won Huh, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Sung-Han Kim, Heungsup Sung, Hyun Jung Koo, Kyung-Hyun Do, Sang-Oh Lee, Chae-Man Lim, Yang Soo Kim, Jun Hee Woo, Younsuck Koh
    Journal of Clinical Virology.2019; 117: 1.     CrossRef
Neurosurgery
Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage
Na Rae Yang, Kyung Sook Hong, Eui Kyo Seo
Korean J Crit Care Med. 2017;32(2):190-196.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00857
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  • 2 Citations
AbstractAbstract PDF
Background
Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC.
Methods
We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC.
Results
Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024).
Conclusions
AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.

Citations

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  • Acute cholecystitis as a rare and overlooked complication in stroke patients
    Myung Chul Yoo, Seung Don Yoo, Jinmann Chon, Young Rok Han, Seung Ah Lee
    Medicine.2019; 98(9): e14492.     CrossRef
  • Acute Acalculous Cholecystitis in Neurological Patients; Clinical Review, Risk Factors, and Possible Mechanism
    See Won Um, Hak Cheol Ko, Seung Hwan Lee, Hee Sup Shin, Jun Seok Koh
    Journal of Neurointensive Care.2019; 2(2): 77.     CrossRef
Thoracic Surgery
Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation
Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Dohyung Kim
Korean J Crit Care Med. 2017;32(2):197-204.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00059
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  • 3 Citations
AbstractAbstract PDF
Background
The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO.
Methods
From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST.
Results
Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST.
Conclusions
The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.

Citations

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  • Assessing Clinical Feasibility and Safety of Percutaneous Dilatational Tracheostomy During Extracorporeal Membrane Oxygenation Support in the Intensive Care Unit
    Tae Hwa Hong, Hyung Won Kim, Hyoung Soo Kim, Sunghoon Park
    Journal of Acute Care Surgery.2022; 12(1): 18.     CrossRef
  • Retrospective analysis of open bedside tracheotomies in a German tertiary care university hospital
    Maximilian Riekert, Matthias Kreppel, Philipp Schminke, Annelies Weckx, Joachim E. Zöller, Volker C. Schick
    Journal of Cranio-Maxillofacial Surgery.2021; 49(2): 140.     CrossRef
  • Otolaryngology during COVID-19: Preventive care and precautionary measures
    Chen Zhao, Alonço Viana, Yan Wang, Hong-quan Wei, Ai-hui Yan, Robson Capasso
    American Journal of Otolaryngology.2020; 41(4): 102508.     CrossRef
Pulmonary
The Role of Transbronchial Lung Biopsy in Diagnosing Pulmonary Mucormycosis in a Critical Care Unit
Yoonki Hong, Jinkyeong Park
Korean J Crit Care Med. 2017;32(2):205-210.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00150
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AbstractAbstract PDF
Background
Pulmonary mucormycosis (PM) is an emerging infectious disease and a life-threatening infection with high mortality. The clinical outcomes of PM have not improved significantly over the last decade because early diagnosis of PM is difficult and antifungal agents show limited activity. We evaluated the clinical manifestations of PM in a Korean tertiary hospital and identified the role of transbronchial lung biopsy (TBLB) in diagnosing PM in patients admitted to an intensive care unit.
Methods
The medical records of adult patients (aged 16 years and older) who met the criteria for proven or probable PM in a Korean tertiary hospital were retrospectively reviewed from January 2003 to December 2013. The clinical features, computed tomographic findings, diagnostic methods, treatment, and outcomes in patients with PM were evaluated.
Results
Of the nine patients, four were male. The median age was 64 years (range, 12 to 73 years). PM was proven and probable in seven and two cases, respectively. Computed tomography findings of PM were unilateral involvement in eight cases (89%), consolidation in eight (89%), ground glass opacity in four (44%), and reverse halo sign in one (11%). Six of nine cases (67%) were diagnosed as PM from TBLB via portable bronchoscopy. There were no complications after TBLB. Mortality rate was 56% (five of nine cases).
Conclusions
TBLB can be an easy and useful technique for diagnosing PM in the intensive care unit.
Case Reports
Neurology/Pulmonary
Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection
Yu Hyeon Choi, Hyung Joo Jeong, Bongjin Lee, Hong Yul An, Eui Jun Lee, June Dong Park
Korean J Crit Care Med. 2017;32(2):211-217.   Published online December 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00283
  • 5,932 View
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  • 3 Citations
AbstractAbstract PDF
Acute cerebral infarctions are rare in children; however they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient’s survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokine-induced vascular inflammation.

Citations

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  • Stroke associated with Mycoplasma hominis infection: a case report
    Anthoula C. Tsolaki, Galaktion Konstantinidis, Stavroula Koukou, Fotini Michali, Despina Georgiadou, Thomas Tegos, Nikolaos D. Michalis
    Journal of Medical Case Reports.2021;[Epub]     CrossRef
  • Thrombosis associated with mycoplasma pneumoniae infection (Review)
    Jingwei Liu, Yumei Li
    Experimental and Therapeutic Medicine.2021;[Epub]     CrossRef
  • Multiple anatomic sites of infarction in a pediatric patient with M. pneumoniae infection, a case report
    Devon W. Hahn, Claire E. Atkinson, Matthew Le
    BMC Pediatrics.2021;[Epub]     CrossRef
Thoracic Surgery
Aortic Dissection in a Survivor after Cardiopulmonary Resuscitation
Jeong-Sun Lee, Suk-Kyung Hong
Korean J Crit Care Med. 2017;32(2):218-222.   Published online December 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00416
  • 7,393 View
  • 128 Download
  • 3 Citations
AbstractAbstract PDF
We describe a case of traumatic aortic dissection associated with cardiac compression in a patient with anaphylactic cardiac arrest who underwent cardiopulmonary resuscitation (CPR). A 54-year-old man who was scheduled to undergo surgery for gastric cancer went into cardiac arrest caused by an anaphylactic reaction to prophylactic antibiotics in the operating room. Veno-arterial extracorporeal membrane oxygenation (ECMO) was performed. CPR, including chest compressions, was performed for 35 min, and the patient was transferred to the intensive care unit (ICU) after spontaneous circulation returned. The patient received ECMO for 9 hours until confirmation of normal cardiac function on transthoracic echocardiography (TTE). Twenty days after cardiac arrest, an aortic dissection and fractures in the left fourth and fifth ribs due to chest compression were detected by abdominal computed tomography. The DeBakey type III aortic dissection extended from the distal arch of the thoracic aorta to the proximal level of the renal artery, involving the celiac trunk. It was considered an uncomplicated type B aortic dissection with no sign of malperfusion of the major vessels. This case demonstrates the potential traumatic injuries that can occur after CPR and encourages proper management of mechanical complications in cardiac arrest survivors.

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  • Blunt traumatic aortic dissection death by falling: an autopsy case report
    Gentaro Yamasaki, Marie Sugimoto, Takeshi Kondo, Motonori Takahashi, Mai Morichika, Azumi Kuse, Kanako Nakagawa, Yasuhiro Ueno, Migiwa Asano
    Forensic Science, Medicine and Pathology.2022;[Epub]     CrossRef
  • A Case of an Aortic Dissection After Mechanical Chest Compression by LUCAS
    Karen Ho, David Kopriva, Payam Dehghani
    JACC: Case Reports.2020; 2(12): 1984.     CrossRef
  • Cardiac arrest after topical application of lidocaine during microneedling procedure: A rare case
    Morteza Safi, Isa Khaheshi, Fatemeh Mottaghizadeh, Mohammadreza Tabary, Nasser Malekpour Alamdari
    Dermatologic Therapy.2020;[Epub]     CrossRef
Editorial
Basic science and research
Is It Essential to Consider Respiratory Dynamics?
Youngjoon Kang
Korean J Crit Care Med. 2017;32(2):223-224.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00276
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PDF

ACC : Acute and Critical Care