Acute and Critical Care

Volume 32 (3); August 2017

Original Articles

Rapid response system
Rapid Response Systems Reduce In-Hospital Cardiopulmonary Arrest: A Pilot Study and Motivation for a Nationwide Survey: Yeonhee Park, Jong-Joon Ahn, Byung Ju Kang, Young Seok Lee, Sang-Ook Ha, Jin-Soo Min, Woo-Hyun Cho, Se-Hee Na, Dong-Hyun Lee, Seung-Yong Park, Goo-Hyeon Hong, Hyun-Jung Kim, Sangwoo Shim, Jung-Hyun Kim, Seok-Jeong Lee, So-Young Park, Jae Young Moon; Korean J Crit Care Med. 2017;32(3):231-239. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00024

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Background
Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest. The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs) and the current level of cardiopulmonary arrest rate in tertiary hospitals. Methods: This was a retrospective study based on data from 14 tertiary hospitals. Cardiopulmonary resuscitation (CPR) rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present. Results: Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009). Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854). National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001). High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001) and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001). Conclusions: RRSs may be a feasible option to reduce the CPR rate. The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics.

Citations

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Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023
Kimia Honarmand, Randy S. Wax, Daleen Penoyer, Geoffery Lighthall, Valerie Danesh, Bram Rochwerg, Michael L. Cheatham, Daniel P. Davis, Michael DeVita, James Downar, Dana Edelson, Alison Fox-Robichaud, Shigeki Fujitani, Raeann M. Fuller, Helen Haskell, Ma
Critical Care Medicine.2024; 52(2): 314. CrossRef
2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 4. Adult advanced life support
Jaehoon Oh, Kyoung-Chul Cha, Jong-Hwan Lee, Seungmin Park, Dong-Hyeok Kim, Byung Kook Lee, Jung Soo Park, Woo Jin Jung, Dong Keon Lee, Young Il Roh, Tae Youn Kim, Sung Phil Chung, Young-Min Kim, June Dong Park, Han-Suk Kim, Mi Jin Lee, Sang-Hoon Na, Gyu C
Clinical and Experimental Emergency Medicine.2021; 8(S): S26. CrossRef
Intensivists' Direct Management without Residents May Improve the Survival Rate Compared to High-Intensity Intensivist Staffing in Academic Intensive Care Units: Retrospective and Crossover Study Design
Jin Hyoung Kim, Jihye Kim, SooHyun Bae, Taehoon Lee, Jong-Joon Ahn, Byung Ju Kang
Journal of Korean Medical Science.2020;[Epub] CrossRef
Influence of the Rapid Response Team Activation via Screening by Nurses on Unplanned Intensive Care Unit Admissions
Ye-Ji Huh, Seongmi Moon, Eun Kyeung Song, Minyoung Kim
Korean Journal of Adult Nursing.2020; 32(5): 539. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef

Trauma
Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study: Ha Nee Jang, Hyun Oh Park, Tae Won Yang, Jun Ho Yang, Sung Hwan Kim, Seong Ho Moon, Joung Hun Byun, Chung Eun Lee, Jong Woo Kim, Dong Hun Kang, Kyeong Hee Baek; Korean J Crit Care Med. 2017;32(3):240-246. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00360

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Background
Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma. Methods: This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. Results: Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%). Conclusions: Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.

Citations

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Bibliometric and visual analysis of severe trauma literature in the past 20 years
Panpan Chang, Rui Li, Zhongqing Wang, Wei Chong, Tianbing Wang
MedComm – Future Medicine.2024;[Epub] CrossRef
Assessment of the Initial Risk Factors for Mortality among Patients with Severe Trauma on Admission to the Emergency Department
Hyun Oh Park, Jun Young Choi, In Seok Jang, Jong Duk Kim, Jae Won Choi, Chung Eun Lee
The Korean Journal of Thoracic and Cardiovascular Surgery.2019; 52(6): 400. CrossRef
The thorax trauma severity score and the trauma and injury severity score
Seong Ho Moon, Jong Woo Kim, Joung Hun Byun, Sung Hwan Kim, Jun Young Choi, In Seok Jang, Chung Eun Lee, Jun Ho Yang, Dong Hun Kang, Ki Nyun Kim, Hyun Oh Park
Medicine.2017; 96(42): e8317. CrossRef

Infection
Clinical Application of the Quick Sepsis-Related Organ Failure Assessment Score at Intensive Care Unit Admission in Patients with Bacteremia: A Single-Center Experience of Korea: Hae Jung Na, Eun Suk Jeong, Insu Kim, Won-Young Kim, Kwangha Lee; Korean J Crit Care Med. 2017;32(3):247-255. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00241

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Background
We evaluated the clinical usefulness of the quick Sepsis-Related Organ Failure Assessment (qSOFA) score (based on the 2016 definition of sepsis) at intensive care unit admission in Korean patients with bacteremia. Methods: We retrospectively analyzed clinical data from 236 patients between March 2011 and February 2016. In addition to the qSOFA, the Modified Early Warning score (MEWS) and systemic inflammatory response syndrome (SIRS) criteria were calculated. Results: The patients’ median age was 69 years, and 61.0% were male. Of the patients, 127 (53.8%) had a qSOFA score ≥2 points. They had significantly higher rates of septic shock, thrombocytopenia, and hyperlactatemia, and increased requirements for ventilator care, neuromuscular blocking agents, vasopressors, and hemodialysis within 72 hours after intensive care unit admission. They also had a significantly higher 28-day mortality rate. When analyzed using common thresholds (MEWS ≥5 and ≥2 SIRS criteria), patients with a MEWS ≥5 had the same results as those with a qSOFA score ≥2 (P < 0.05). However, patients with ≥2 SIRS criteria showed no significant differences. Conclusions: Our results show that a qSOFA score ≥2 at admission is a useful screening tool for predicting disease severity and medical resource usage within 72 hours after admission, and for predicting 28-day mortality rates in patients with bacteremia. In addition, qSOFA scores may be more useful than SIRS criteria in terms of prognostic utility.

Citations

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A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review
Magnolia Cardona, Claudia C. Dobler, Eyza Koreshe, Daren K. Heyland, Rebecca H. Nguyen, Joan P.Y. Sim, Justin Clark, Alex Psirides
Journal of Critical Care.2021; 66: 33. CrossRef
Consensus recommendation: Indications and methods for microbiological wound diagnostics
Axel Kramer, Ojan Assadian, Jürgen Bohnert, Georg Daeschlein, Joachim Dissemond, Veronika Gerber, Peter Hinz, Adam Junka, Simon Kim, Roald Papke, Christian Willy
Wound Medicine.2018; 23: 53. CrossRef

Nephrology
Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study: Ki Hyun Park, Jung-ho Shin, Jin Ho Hwang, Su Hyun Kim; Korean J Crit Care Med. 2017;32(3):256-264. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00136

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Abstract PDF

Background
Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT. Methods: A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status. Results: A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037). Conclusions: Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.

Citations

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Effect of rigorous fluid management using monitoring of ECW ratio by bioelectrical impedance analysis in critically ill postoperative patients: A prospective, single-blind, randomized controlled study
Yoon Ji Chung, Gyeo Ra Lee, Hye Sung Kim, Eun Young Kim
Clinical Nutrition.2024; 43(9): 2164. CrossRef
Nutritional management of children with acute kidney injury—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce
Molly R. Wong Vega, Dana Cerminara, An Desloovere, Fabio Paglialonga, José Renken-Terhaerdt, Johan Vande Walle, Vanessa Shaw, Stella Stabouli, Caroline Elizabeth Anderson, Dieter Haffner, Christina L. Nelms, Nonnie Polderman, Leila Qizalbash, Jetta Tuokko
Pediatric Nephrology.2023; 38(11): 3559. CrossRef
Ratio of Overhydration and Extracellular Water Versus Ratio of Extracellular Water and Body Cell Mass in the Assessment of Fluid Status in Patients With Acute Kidney Injury Requiring Kidney Replacement Therapy: A Cohort Study
Buyun Wu, Sufeng Zhang, Junfeng Wang, Wenyan Yan, Min Gao, Yifei Ge, Kang Liu, Xueqiang Xu, Xiangbao Yu, Yamei Zhu, Xianrong Xu, Changying Xing, Huijuan Mao
Journal of Renal Nutrition.2022; 32(2): 152. CrossRef
Towards Artefact-Free Bio-Impedance Measurements: Evaluation, Identification and Suppression of Artefacts at Multiple Frequencies
Kanika Dheman, Philipp Mayer, Manuel Eggimann, Michele Magno, Simone Schuerle
IEEE Sensors Journal.2022; 22(1): 589. CrossRef
The Use of Bioelectrical Impedance Analysis Measures for Predicting Clinical Outcomes in Critically Ill Children
Zi-Hong Xiong, Xue-Mei Zheng, Guo-Ying Zhang, Meng-Jun Wu, Yi Qu
Frontiers in Nutrition.2022;[Epub] CrossRef
Applying bio-impedance vector analysis (BIVA) to adjust ultrafiltration rate in critically ill patients on continuous renal replacement therapy: A randomized controlled trial
Farin Rashid Farokhi, Effat Kalateh, Shadi Shafaghi, Antoine Guillaume Schneider, Seyed Mehdi Mortazavi, Hamidreza Jamaati, Seyed Mohammad Reza Hashemian
Journal of Critical Care.2022; 72: 154146. CrossRef
Ultrafiltration in critically ill patients treated with kidney replacement therapy
Raghavan Murugan, Rinaldo Bellomo, Paul M. Palevsky, John A. Kellum
Nature Reviews Nephrology.2021; 17(4): 262. CrossRef
Kidney Replacement Therapy for Fluid Management
Vikram Balakumar, Raghavan Murugan
Critical Care Clinics.2021; 37(2): 433. CrossRef
Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury
Justina Karpavičiūtė, Inga Skarupskienė, Vilma Balčiuvienė, Rūta Vaičiūnienė, Edita Žiginskienė, Inga Arūnė Bumblytė
Medicina.2021; 57(6): 518. CrossRef
Usefulness of bioelectrical impedance analysis and ECW ratio as a guidance for fluid management in critically ill patients after operation
Yoon Ji Chung, Eun Young Kim
Scientific Reports.2021;[Epub] CrossRef
Bioimpedance as a measure of fluid status in critically ill patients: A systematic review
Janne M. Madsen, Sine Wichmann, Morten H. Bestle, Theis S. Itenov
Acta Anaesthesiologica Scandinavica.2021; 65(9): 1155. CrossRef
Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness
Hanneke Pierre Franciscus Xaverius Moonen, Arthur Raymond Hubert Van Zanten
Current Opinion in Critical Care.2021; 27(4): 344. CrossRef
Hepatocyte growth factor and soluble cMet levels in plasma are prognostic biomarkers of mortality in patients with severe acute kidney injury
Lilin Li, Jung Nam An, Jeonghwan Lee, Dong Jin Shin, Shi Mao Zhu, Jin Hyuk Kim, Dong Ki Kim, Dong-Ryeol Ryu, Sejoong Kim, Jung Pyo Lee
Kidney Research and Clinical Practice.2021; 40(4): 596. CrossRef
Wireless, Artefact Aware Impedance Sensor Node for Continuous Bio-Impedance Monitoring
Kanika Dheman, Philipp Mayer, Michele Magno, Simone Schuerle
IEEE Transactions on Biomedical Circuits and Systems.2020; 14(5): 1122. CrossRef
Usefulness of Bioelectrical Impedance Analysis as a Guidance of Fluid Management in Critically Ill Patients after Major Abdomen Surgery; a Single Center, Prospective Cohort Study
Yoon Ji Chung, Eun Young Kim
Surgical Metabolism and Nutrition.2020; 11(2): 53. CrossRef
Update on body composition tools in clinical settings: computed tomography, ultrasound, and bioimpedance applications for assessment and monitoring
Kathleen L. Price, Carrie P. Earthman
European Journal of Clinical Nutrition.2019; 73(2): 187. CrossRef
Relative Association of Overhydration and Muscle Wasting with Mortality in Hemodialysis Patients: Assessment by Bioelectrical Impedance Analysis
Eunju Kim, Sang Oh Seo, Yu Bum Choi, Mi Jung Lee, Jeong Eun Lee, Hyung Jong Kim
The Korean Journal of Medicine.2018; 93(6): 548. CrossRef

Nephrology
The Association of Preoperative Body Mass Index with Acute Kidney Injury in Liver Transplantation Recipients: A Retrospective Study: Ju Yeon Park, Jung-Hyun Park, Su Sung Lee, Hyun-Su Ri, Hye-jin Kim, Yun Mi Choi, Yoon Ji Choi, Ji-Uk Yoon; Korean J Crit Care Med. 2017;32(3):265-274. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00178

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Background
Liver transplantation (LT) is a complicated procedure with a high incidence of postoperative acute kidney injury (AKI). Previous studies indicate that even transient or mild post-LT AKI can result in critical conditions, including prolonged stays in hospitals and intensive care units and increased morbidity and mortality. The aim of this study was to investigate the association between body mass index (BMI) and occurrence of AKI in LT recipients. Methods: Medical data from 203 patients who received LT surgery from January 2010 to August 2016 in a single university hospital setting were retrospectively collected and analyzed. Patients were classified as either underweight (BMI <20 kg/m²) or normal weight (20 ≤ BMI < 30 kg/m²). Demographic data, anesthetic methods, complications, and perioperative laboratory test values of each patient were assessed. Propensity analyses and logistic regression were performed to evaluate the association between BMI and post-LT AKI. Results: There was no significant difference in occurrence of post-LT AKI between underweight and normal weight patients. The underweight patient group had significantly longer hospital stay compared with the normal weight patient group (P = 0.023). Conclusions: BMI classification was neither a positive nor negative predictor of postoperative AKI occurrence. However, patients with lower BMI had significantly longer hospital stay compared with their counterparts. Although our study was limited by its retrospective design, our observations suggest that lower BMI might play a role in post-LT AKI.

Citations

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Association of Body Mass Index and Acute Kidney Injury Incidence and Outcome: A Systematic Review and Meta-Analysis
Jiarong Lan, Guangxing Xu, Yongfu Zhu, Congze Lin, Ziyou Yan, Sisi Shao
Journal of Renal Nutrition.2023; 33(3): 397. CrossRef
Association of overweight with postoperative acute kidney injury among patients receiving orthotopic liver transplantation: an observational cohort study
Jian Zhou, Lin Lyu, Lin Zhu, Yongxin Liang, He Dong, Haichen Chu
BMC Nephrology.2020;[Epub] CrossRef

Pulmonary
The Ability of the Acute Physiology and Chronic Health Evaluation (APACHE) IV Score to Predict Mortality in a Single Tertiary Hospital: Jae Woo Choi, Young Sun Park, Young Seok Lee, Yeon Hee Park, Chaeuk Chung, Dong Il Park, In Sun Kwon, Ju Sang Lee, Na Eun Min, Jeong Eun Park, Sang Hoon Yoo, Gyu Rak Chon, Young Hoon Sul, Jae Young Moon; Korean J Crit Care Med. 2017;32(3):275-283. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00990

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Abstract PDF

Background
The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. Methods: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). Results: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). Conclusions: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.

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Circadian rhythms of vital signs are associated with in-hospital mortality in critically ill patients: A retrospective observational study
Zhengning Yang, Xiaoxia Xie, Xu Zhang, Lan Li, Ruoxue Bai, Hui Long, Yanna Ma, Zhenliang Hui, Yujie Qi, Jun Chen
Chronobiology International.2023; 40(3): 262. CrossRef
Characteristics and outcomes of patients admitted to adult intensive care units in Hong Kong: a population retrospective cohort study from 2008 to 2018
Lowell Ling, Chun Ming Ho, Pauline Yeung Ng, King Chung Kenny Chan, Hoi Ping Shum, Cheuk Yan Chan, Alwin Wai Tak Yeung, Wai Tat Wong, Shek Yin Au, Kit Hung Anne Leung, Jacky Ka Hing Chan, Chi Keung Ching, Oi Yan Tam, Hin Hung Tsang, Ting Liong, Kin Ip Law
Journal of Intensive Care.2021;[Epub] CrossRef
Evaluation and Validation of Four Scoring Systems: the APACHE IV, SAPS III, MPM0 II, and ICMM in Critically Ill Cancer Patients

Indian Journal of Critical Care Medicine.2020; 24(4): 263. CrossRef

Case Reports

Cardiology/Pulmonary
Successful Rescue Therapy with Pumpless Extracorporeal Carbon Dioxide Removal in a Patient with Persistent Air Leakage due to Empyema: Jaeyoung Cho, Yeon Joo Lee, Jae-Ho Lee, Choon-Taek Lee, Young-Jae Cho; Korean J Crit Care Med. 2017;32(3):284-290. Published online November 14, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00185

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Abstract PDF: A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.

Neurology
Clozapine Induced Neuroleptic Malignant Syndrome: Yong Suk Jo, Hyung Ah Jo, Byung Chul Yu, Jung Hoon Shin, Kook-Hwan Oh; Korean J Crit Care Med. 2017;32(3):291-294. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00052

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Abstract PDF

Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.

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Toxicity and Adverse Effects in Clozapine-Related Presentations to a Medical Toxicology Service in Western Sydney
Pramod Chandru, Naren Gunja
Journal of Medical Toxicology.2023; 19(4): 374. CrossRef

Editorial

Basic science and research
Challenges to Overcome Barriers against Successful Implementation of Rapid Response Systems: Eun Young Choi; Korean J Crit Care Med. 2017;32(3):295-296. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00451

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Letters to the Editor

Neurosurgery
Endovascular Stenting for the Treatment of an Initially Asymptomatic Patient with Traumatic Carotid Artery Dissection: So Hui Yun, Jong Cook Park; Korean J Crit Care Med. 2017;32(3):297-301. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00010

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Immunology
An Ofloxacin-Induced Anaphylaxis through an IgG4-Mediated but Not IgE-Mediated Basophil Activation Mechanism: Ji Hye Kim, Dae-Hong Seo, Ga-Young Ban, Eun-Mi Yang, Yoo Seob Shin, Young-Min Ye, Hae-Sim Park; Korean J Crit Care Med. 2017;32(3):302-305. Published online August 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00108

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Citations

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A CASE PRESENTATION ON OFLOXACIN INDUCED DERMAL HYPERSENSITIVITY REACTION
BHAVANAM DIVYA, LEDO THANKACHAN
International Journal of Pharmacy and Pharmaceutical Sciences.2022; : 53. CrossRef

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