Acute and Critical Care

Case Reports

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

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

Air Embolism in the Left Ventricle after the Removal of a Central Venous Catheter: Duk Song Cho, Moo Hyun Kim, Dong Hyun Lee, Hye Won Lee, Eun Bin Kim, Seok Hyun Kim, Hyo Jin Jung, Soo Jin Kim, Hyun Jeong Kim; Korean J Crit Care Med. 2013;28(4):318-322.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.318

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Air embolism is a rare, potentially critical complication that can induce death. Central venous catheterization, which is commonly used for critically ill patients, is a possible cause of air embolism. We experienced a severe air embolism with abnormal air in left ventricle after CVC removal in a patient who was treated for eosinophilic pneumonia. Although the neurologic symptoms were severe, the patient was successfully treated with immediate hyperbaric oxygen therapy and the neurologic deficit was minimal.

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Lethal coronary air embolism caused by the removal of a double-lumen hemodialysis catheter: a case report
Sung Ha Mun, Dong Ai An, Hyun Jung Choi, Tae Hee Kim, Jung Woo Pin, Dong Chan Ko
Korean Journal of Anesthesiology.2016; 69(3): 296. CrossRef

Randomized Controlled Trial

Central Venous Catheter-related Infection in Major Burn Patients: Comparison of Subclavian Vein and Femoral Vein: Young Ho Jang, Yong Hoon Son, Sang Kyu Kim, Joon Mo Park, Mi Young Lee, Jin Mo Kim; Korean J Crit Care Med. 2011;26(4):245-249.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.245

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Abstract PDF

BACKGROUND
A central venous catheter (CVC) is usually inserted in patients with severe burns and the selection of the CVC is often difficult due to widespread burned skin. We investigated the incidences of colonization and catheter-related blood stream infection (CRBSI) according to the insertion site of the CVC in major burn patients METHODS: In 63 adult massive burn patients in the intensive care unit, 93 CVCs (47 polyurethane standard CVCs and 46 Oligon anti-mocrobial CVCs) were randomly inserted via the subclavian vein (SCV group, n = 66) or femoral vein (FEV group, n = 27). All catheter tips removed were routinely cultured. Bacterial findings from the burn wound and peripheral blood were also monitored in all patients RESULTS: There was no significant difference in the average insertion length of the CVC (14.3 +/- 6.8 days in SCV and 13.6 +/- 3.8 days in FEV) between the two groups. There were no significant differences in CVC colonization (48.5% in SCV and 63.0% in FEV) and CRBSI (7.6% in SCV and 11.1% in FEV) between the two groups. Logistic analysis found that the use of polyurethane standard CVC is significantly associated with increased risk of CVC colonization (odds ratio = 2.68) CONCLUSIONS: The placement of the CVC via the femoral vein does not increase the incidence of CVC colonization in massive burn patients. The use of Oligon anti-microbial CVC may be helpful to reduce CVC colonization in major burn patients.

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An Ounce of Prevention Saves Tons of Lives: Infection in Burns
Nishant Merchant, Karen Smith, Marc G. Jeschke
Surgical Infections.2015; 16(4): 380. CrossRef

Original Article

Comparison of Impedance Cardiography with Thermodilution of Hemodynamic Parameters in Critically Ill Patients: Hyung Goo Kang, Sang Won Chung, Ki Hyun Byun, In Byung Kim; Korean J Crit Care Med. 2006;21(2):77-82.

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Abstract PDF: BACKGROUND
To evaluate the feasibility of noninvasive hemodynamic monitoring (impedance cardiography, ICG) in critically ill patients, we compared this technique with simultaneous invasive monitoring with a pulmonary artery thermodilution catheter.
METHODS
A prospective observational study was done comparing invasive monitoring and noninvasive monitoring in 12 critically ill patients. The cardiac output (CO), the stroke volume (SV) and the systemic vascular resistance (SVR) measured by using a standard thermodilution pulmonary artery catheter technique were compared with the corresponding measurements simultaneously using an ICG.
RESULTS
The value of CO, SV and SVR measured by ICG were closely correlated to those by the thermodilution methods [r: 0.659 (p<0.01), 0.536 (p<0.01), 0.738 (p<0.01)].
CONCLUSIONS
ICG can provide hemodynamic information previously available only by invasive monitoring with a thermodilution catheter.

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