Acute and Critical Care

Cardiology
Atrial fibrillation of new onset during acute illness: prevalence of, and risk factors for, persistence after hospital discharge: Abarna Ramanathan, John Paul Pearl, Manshi Li, Xiaofeng Wang, Divyajot Sadana, Abhijit Duggal; Acute Crit Care. 2021;36(4):317-321. Published online November 29, 2021; DOI: https://doi.org/10.4266/acc.2021.00577

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Abstract PDF: Background
Atrial fibrillation of new onset during acute illness (AFNOAI) has a variable incidence of 1%–44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years post hospital discharge for critically ill patients.
Methods
This was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1st, 2012, to October 31st, 2015, were screened. Those designated with atrial fibrillation (AF) for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox’s proportional hazards model.
Results
Two-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02–5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02–5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71–3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91–4.37) also showed a trend towards association with AFNOAI persistence.
Conclusions
Our study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient’s individual AFNOAI persistence risk.

Cardiology/Endocrinology
Acute Adrenal Insufficiency Associated with Acute Coronary Syndrome: Youngji Kim, Woojin Jung, Inkuk Cho, Seyeol Yang, Ho Han, Jung Hwan Park; Korean J Crit Care Med. 2014;29(3):226-230. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.226

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Abstract PDF: Acute adrenal insufficiency (AAI) in acute coronary syndrome (ACS) patients is rare and may be frequently underestimated as simple ACS, since symptoms of AAI are nonspecific. Physicians should be fully aware of the possibility of occult AAI combined with ACS, if clinical suspicion is high. Herein, we report a rare case of a 67-year-old female patient with concomitant AAI and drug eluting stent fracture-induced ACS. To our knowledge, there have been no case reports of AAI associated with ACS in Korea.

Extracorporeal Membrane Oxygenation (ECMO) and Iliac Vein Injury: Sang Ook Ha, Jae Seok Park, So Hee Park, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2013;28(3):197-200.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.197

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Abstract PDF: The use of extracorporeal membrane oxygenation (ECMO) has increased after the 2009 pandemic H1N1 infections, and the ECMO-related complications have also increased. Specifically, the mechanical vessel injury due to catheter cannulation seems to be less frequent than other complications, but there is a risk of hemorrhagic shock which requires special attention. We experienced a case of successful management with graft stenting during ECMO operation for iliac vein injury. A 56-year-old female patient with non-small cell lung cancer developed endobronchial obstruction, and ECMO was applied for the ECMO-assisted rigid bronchoscopy. During catheter cannulation, hypovolemic shock was developed due to her right external iliac vein injury. We detected the hemorrhage with bedside ultrasound at an early stage and the hemorrhage was effectively managed with graft stenting on ECMO.

A Case of Successful Natural Stenting in Tracheobronchial Restenosis with Malignant Tumor after Metallic Stenting: Goohyeon Hong, Kyeongman Jeon, Sang Won Um, Won Jung Koh, Gee Young Suh, Man Pyo Chung, O Jung Kwon, Hojoong Kim; Korean J Crit Care Med. 2012;27(2):111-114.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.111

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Abstract PDF: Tracheal tumors are very rare disease, which may cause dyspnea, obstructive pneumonia and life-threatening hypoxemia, depending on the site of the lesion and the severity of the narrowing. Such patients frequently die within hours or days due to suffocation. Patients who expressed upper airway stenosis, should be secured the airways prior to the diagnosis and treatment commonly. Then, treatment plan should be determined. For the relief of such stenosis, various modalities of therapy including surgery, laser photoresection, balloon dilatation and sometimes stent insertion have been used. Tracheobronchial stent insertion has been a good therapeutic option in these patients in point of avoiding morbidities associated with surgery. We report a case of repeated tracheobronchial stenosis by infiltrating tumor mass after metallic stent insertion in a 48-year-old man. The patient was treated successfully by Natural stent insertion with rigid bronchoscopy after removal of previous inserted metallic stent.

Successful Management of Tracheobronchomalacia Associated with Empyema Using a Covered Metallic Tracheobronchial Stent: A Case Report: Young Sik Park, Hyo Jae Kang, Yung Jeong Jeong, Sun Mi Choi, Eun Young Heo, Hyeon Jong Moon, Chang Hoon Lee, Hee Soon Chung, Deog Kyeom Kim; Korean J Crit Care Med. 2011;26(2):105-109.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.105

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Abstract PDF: Tracheobronchomalacia is developed by excessively weakened walls of the trachea and bronchi, and shows dynamic collapse of the airway on expiration and causes dyspnea. Airway stenting or surgical correction of the airway may be helpful. We report a case with tracheobronchomalacia which was combined with chronic empyema and treated successfully with stent insertion.

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