Acute and Critical Care

Case Reports

CPR/Resuscitation
Acute aortic dissection developed after cardiopulmonary resuscitation: transesophageal echocardiographic observations and proposed mechanism of injury: Dong Keon Lee, Kyung Sik Kang, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang; Acute Crit Care. 2019;34(3):228-231. Published online April 26, 2018; DOI: https://doi.org/10.4266/acc.2015.00633

7,950 View
153 Download
7 Web of Science
8 Crossref

There has been no report about aortic dissection due to cardiopulmonary resuscitation (CPR). We present here a case of acute aortic dissection as a rare complication of CPR and propose the potential mechanism of injury on the basis of transesophageal echocardiographic observations. A 54-year-old man presented with cardiac arrest after choking and received 19 minutes of CPR in the emergency department. Transesophageal echocardiography (TEE) during CPR revealed a focal separation of the intimal layer at the descending thoracic aorta without evidence of aortic dissection. After restoration of spontaneous circulation, hemorrhagic cardiac tamponade developed. Follow-up TEE to investigate the cause of cardiac tamponade revealed aortic dissection of the descending thoracic aorta. Hemorrhagic cardiac tamponade was thought to be caused by myocardial hemorrhage from CPR.

Citations

Citations to this article as recorded by

Thoracic Aortic Rupture Post Cardiopulmonary Resuscitation in a Patient With Previous Thoracic Aneurysm Repair
Aniekeme S Etuk, Olanrewaju F Adeniran , Bernard I Nkwocha, Nformbuh Asangmbeng, Mina Jacob
Cureus.2023;[Epub] CrossRef
Cardiac Arrest as an Uncommon Manifestation of Late Type A Aortic Dissection Associated with Transcatheter Aortic Valve Replacement
Jan Naar, Dagmar Vondrakova, Andreas Kruger, Marek Janotka, Iva Zemanova, Martin Syrucek, Petr Neuzil, Petr Ostadal
Journal of Clinical Medicine.2023; 12(16): 5318. CrossRef
Blunt Thoracic Aortic Injury and Contemporary Management Strategy
Ranjan Dahal, Yogesh Acharya, Alan H. Tyroch, Debabrata Mukherjee
Angiology.2022; 73(6): 497. CrossRef
Resuscitative endovascular occlusion of the aorta (REBOA) as a mechanical method for increasing the coronary perfusion pressure in non-traumatic out-of-hospital cardiac arrest patients
Dong-Hyun Jang, Dong Keon Lee, You Hwan Jo, Seung Min Park, Young Taeck Oh, Chang Woo Im
Resuscitation.2022; 179: 277. CrossRef
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; 19(3): 388. CrossRef
Intra-arrest transesophageal echocardiography during cardiopulmonary resuscitation
Sung Oh Hwang, Woo Jin Jung, Young-Il Roh, Kyoung-Chul Cha
Clinical and Experimental Emergency Medicine.2022; 9(4): 271. CrossRef
Intra-arrest transoesophageal echocardiographic findings and resuscitation outcomes
Woo Jin Jung, Kyoung-Chul Cha, Yong Won Kim, Yoon Seop Kim, Young-Il Roh, Sun Ju Kim, Hye Sim Kim, Sung Oh Hwang
Resuscitation.2020; 154: 31. CrossRef
Aortic Rupture as a Complication of Cardiopulmonary Resuscitation
Prashanth Venkatesh, Edward J. Schenck
JACC: Case Reports.2020; 2(8): 1150. CrossRef

Surgery
Critical Illness Neuromyopathy Complicating Cardiac Surgery: Wan Ki Baek, Young Sam Kim, Joung Taek Kim, Byoung-Nam Yoon; Acute Crit Care. 2018;33(1):51-56. Published online July 11, 2017; DOI: https://doi.org/10.4266/acc.2016.00255

6,390 View
151 Download
2 Crossref

Abstract PDF

Critical illness neuromyopathy (CINM) is a sporadically reported disease in the setting of an intensive care unit developing in the process of managing a critical illness. The disease primarily affects the motor and sensory axons and results in severe limb weakness rendering ventilator weaning extremely difficult. We report a case of CINM after cardiac valve surgery. Quadriplegia developed after the operation and resolved slowly over the following 2 months. The patient was discharged home free of neurologic symptoms.

Citations

Citations to this article as recorded by

Quadriplegia after Mitral Valve Replacement in an Infective Endocarditis Patient with Cervical Spine Spondylitis
Ji Min Lee, Seon Yeong Heo, Dong Kyu Kim, Jong Pil Jung, Chang Ryul Park, Yong Jik Lee, Gwan Sic Kim
Journal of Chest Surgery.2021; 54(3): 218. CrossRef
Perforated Toxic Megacolon: The Dreaded Complication in IBD
Kanmani Murugesu, PremanandanN Sivadasan, Michael Arvind, WilsonLiew Wei Xin
World Journal of Colorectal Surgery.2020; 9(4): 70. CrossRef

Trauma
Long-term extracorporeal membrane oxygenation after severe blunt traumatic lung injury in a child: Ok Jeong Lee, Yang Hyun Cho, Jinwook Hwang, Inae Yoon, Young-Ho Kim, Joongbum Cho; Acute Crit Care. 2019;34(3):223-227. Published online February 10, 2017; DOI: https://doi.org/10.4266/acc.2016.00472

27,187 View
183 Download
3 Web of Science
2 Crossref

Abstract PDF

Managing acute respiratory distress syndrome (ARDS) after severe blunt traumatic lung injury can be challenging. In cases where patients are refractory to conventional therapy, extracorporeal membrane oxygenation (ECMO) should be considered. In addition, the heparin-coated circuit can reduce hemorrhagic complications in patients with multiple traumas. Although prolonged ECMO may be necessary, excellent outcomes are frequently associated. In this study, we report long-term support with venovenous-ECMO applied in a child with severe blunt trauma in Korea. This 10-year-old and 30-kg male with severe blunt thoracic trauma after a car accident developed severe ARDS a few days later, and ECMO was administered for 33 days. Because of pulmonary hemorrhage during ECMO support, heparin was stopped for 3 days and then restarted. He was weaned from ECMO successfully and has been able to run without difficulty for the 2 years since discharge.

Citations

Citations to this article as recorded by

Traumatic main airway rupture successfully rescued by extracorporeal membrane oxygenation: A case report
Lijun Cao, Jun Xu, Linfeng Tang, Yuli Zhou, Xianhua Xiang
Experimental and Therapeutic Medicine.2023;[Epub] CrossRef
Extracorporeal membrane oxygenation in trauma patients: a systematic review
Changtian Wang, Lei Zhang, Tao Qin, Zhilong Xi, Lei Sun, Haiwei Wu, Demin Li
World Journal of Emergency Surgery.2020;[Epub] CrossRef

Cardiology
Recurrent Pulseless Ventricular Tachycardia Induced by Commotio Cordis Treated with Therapeutic Hypothermia: Sanghyun Lee, Hyunggoo Kang, Taeho Lim, Jaehoon Oh, Chiwon Ahn, Juncheal Lee, Changsun Kim; Korean J Crit Care Med. 2015;30(4):349-353. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.349

7,378 View
75 Download

Abstract PDF: The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33°C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.

Original Articles

Comparison of Hemodynamic Changes by the Thoracic Electrical Bioimpedance Device during Endotracheal Intubation or Insertion of Laryngeal Mask Airway in General Anesthesia: Han Mok You, Jin Mo Kim, Jae Kyu Cheun; Korean J Crit Care Med. 1998;13(1):67-72.

1,707 View
7 Download

Abstract PDF: Introduction: we measured the hemodynamic changes by the thoracic electrical bioimpedance (TEB) device during induction of anesthesia, endotracheal intubation or insertion of layngeal mask airway (LMA). This TEB device is safe, reliable and estimate continuously and invasively hemodynamic variables.
METHODS
We measured the cardiovascular response of endotracheal intubation or that of LMA insertion in thirty ASA class I patients. General anesthesia was induced with injection of fentany 1 microgram/kg, thiopetal sodium 5 mg/kg and vecuronium 1 mg/kg intravenously. Controlled ventilation was for 3 minutes with inhalation of 50% nitrous oxide and 1.5 vol% of enflurane before tracheal intubation or LMA insertion in all patients. The patient was randomly assinged to either tracheal intubation group (ET group) or laryngeal mask airway group (LMA group). Heart rate (HR), mean arterial pressure (MAP), systemic vascular resistance (SVR), stroke index (SI) and cardic index (CI) were measured to pre-induction, pre-intubation, 1 minute after intubation, 2 minute, 3 minute, 5 minute, 7 minute.
RESULTS
MAP and SVR were decreased effectively LMA group than ET group during 1 minute after intubation, 2 minute, 3 minute, 5 minute, 7 minute (p<0.05). HR was decreased effectively LMA group than ET group between pre-induction and 1 minute after intubation, between 1 minute after intubation and 2 minute after intubation (p<0.05). But, SI and CI were no difference between ET group and LMA group during induction of anesthesia and intubation (p<0.05).
CONCLUSION
The insertion of LMA is beneficial for certain patients than endotracheal tube to avoid harmful cardiovascular response in the management of airway during anesthesia.

VAP (Ventilator-associated Pneumonia) in Patients with Pulmonary Contusion: Jong Hyun Jeong, Sung Youl Hyun, Jin Joo Kim, Jae Hyuk Kim, Yong Su Lim, Jin Seong Cho, Sung Yeon Hwang, Hyuk Jun Yang; Korean J Crit Care Med. 2010;25(4):224-229.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.224

2,995 View
31 Download

Abstract PDF: BACKGROUND
This study was conducted to determine the incidence, risk factors, and outcome of ventilator-associated pneumonia in patients with pulmonary contusion.
METHODS
The study was conducted at an urban teaching hospital emergency department with an annual volume of 80,000 patient visits. A retrospective analysis was conducted on thoracic injury patients admitted between Jan 2007 and Dec 2009. Among 122 patients investigated, 30 patients were excluded. Patient data included basal characteristics and information related to development of ventilator-associated pneumonia and ultimate mortality. Statistical methods included the Chi-square test and the Mann-Whitney test. Study data were stored and processed using Microsoft Office Excel 2007 & SPSS 18.0 for Windows.
RESULTS
Ventilator-associated pneumonia developed in 46 patients (50%). The patients with ventilator-associated pneumonia were more likely to have a longer duration of hospitalization, longer length of ICU stay, longer duration of mechanical ventilation, a low initial GCS, a higher APACHE II score, and were more likely to require emergency intubation or tracheostomy. Factors associated with mortality included longer duration of hospitalization, longer duration of mechanical ventilation, low intial GCS and the need for dialysis.
CONCLUSIONS
Ventilator-associated pneumonia in the patients with pulmonary contusion was not relevant to mortality, but was relevant to longer hospitalization, length of ICU stay and duration of mechanical ventilation.

Randomized Controlled Trial

Post-thoracotomy Analgesia & ICU Length of Stay: Comparison of Thoracic Epidrual Morphine Infusion and Lumbar Epidural Plus Intravenous Morphine Infusion: Seok Hwa Yoon, Jung Hyun Lee, Hee Suk Yoon, Yoon Hee Kim, Myung Hoon Na, Seung Pyung Lim; Korean J Crit Care Med. 2007;22(2):77-82.

2,070 View
28 Download

Abstract PDF: BACKGROUND
Length of stay in ICU after thoracotomy is related to postoperative pulmonary function and complication which are affected by postoperative pain. For the post-thoracotomy pain control, epidural morphine is commonly used. Although total dose-requirement for analgesia of lumbar epidural morphine is more than the thoracic, lumbar epidural morphine could be substituted the thoracic. Our study compared the effect of patient controlled analgesia using thoracic epidural morphine (TEA group) and lumbar epidural analgesia with patient controlled intravenous analgesia using morphine (LEA+IV group).
METHODS
Sixty patients were randomly assigned into one of the two groups. The epidural taps were done before the induction. In all the patients morphine 0.2 mg/ml was administered via the epidural catheter at the end of surgery. In TEA group, basal infusion rate was 0.1 mg/hr and bolus dose was 0.02 mg. In LEA+IV group, basal infusion rate of epidural morphine was 0.1 mg/hr, patient controlled intravenous analgesia with morphine started when patients arrived at ICU, and basal infusion rate of intravenous morphine was 1.0 mg/hr and bolus dose was 0.8 mg. Pain score, side effect, postoperative length of stay in ICU and hospital were observed.
RESULTS
There were no significant differences between two groups in pain score, side effects, length of stay in ICU and hospital.
CONCLUSIONS
Lumbar epidural analgesia with patient controlled intravenous analgesia using morphine showed similar postoperative analgesia and length of stay in ICU and hospital compared to thoracic epidural analgesia with morphine, so that can substitute the thoracic epidural analgesia.

Original Article

The Effect of Epidural Block on Renal Function in Patients Undergoing Subtotal Gastrectomy with General Anesthesia: Moon Seok Chang; Korean J Crit Care Med. 2005;20(1):44-48.

2,457 View
36 Download

Abstract PDF: BACKGROUND
Epidural block is widly used for anesthesia or analgesia, so many researches has been done in the field of cardiovascular system. And we reported the effects of epidural block on renal function in patients undergoing total abdominal hysterectomy with general anesthesia. In this research I evaluated the effect of epidural anesthesia on renal function in patients undergoing subtotal gastrectomy with general anesthesia. The earlier was in lumbar level and the later was in thoracic level. METHODS: We studied 15 patient who were in ASA 1 or 2. The epidural catheter was inserted via 17 gauge Tuohy needle through the T10-T11 intervertebral space of the patients before general anesthesia. Anesthesia for all the patients were maintained with isoflurane, nitrous oxide and oxygen. We measured urine output and hemodynamic profiles such as mean arterial pressure, pulse, CVP, cardiac output during 2 hours of general anesthesia period. And then we injected 10ml of 0.15% bupivacaine to the epidural space and measured the same parameters as those of general anesthesia period during another 2 hours of epidural anesthesia combined with general anesthesia. We also compared urine output and renal function (creatinine clearance, Na clearance, fractional excretion of Na and free water clearance) between each of the two periods. RESULTS: Mean arterial pressure and pulse were lower after epidural injection than before (p<0.05), but Cardiac output and CVP were not significantly different between two periods. Renal function data were not significantly different between the two periods.
CONCLUSIONS
Renal function was maintained during sympathetic block by thoracic epidural anesthesia combined with general anesthesia.

Case Report

An Experience of Right Pneumonectomy in a Lung Cancer Patient with Poor Pulmonary Function Test within the Conventional Criteria of Contraindication to Surgery: Intraoperative Re-evaluation of Pulmonary Function: A case report: Jin Young Chon, Sung Jin Hong, Ung Jin, Hae Jin Lee, Yong Woo Choi, Se Ho Moon, Sun Hee Lee, Man Seok Bae; Korean J Crit Care Med. 1999;14(2):167-175.

1,461 View
68 Download

Abstract PDF: Usually FEV1 lower than 1 liter is considered as a contraindication to pneumonectomy. Therefore sometimes, the curative operations of the resectable lung cancer can not be performed in case of poor pulmonary functions. The usual criteria on the performance of pneumonectomy on high risk patients based on the preoperative assessment of pulmonary function may not predict the operative outcome with accuracy in the postoperative period. Nowadays, there are some arguing points about applying the values of preoperative PFTs to pulmonary resection surgery. We performed a right pneumonectomy for stage IIIb lung cancer in a patient with poor lung function test; FVC 2.17 L, FEV1 0.97 L, FEV1/FVC 44%, FEF 25~75% 0.42 L/sec, MVV 28 L/min, TLC 5.18 L, RV 2.99, DLCO 13.46. After the temporary ligation of right main pulmonary artery during 30 minutes, arterial blood gas and percutaneous oxygen saturation with the controlled ventilation with room air (FiO2=0.21) confirmed the hemodynamic and oxygenation stabilities, twice. After successful surgery, the patient was tolerated for 4 months. And the follow up PFTs at postoperative 3 months and 18 days showed as follows; FVC 1.20 L, FEV1 0.63 L, FEV1/FVC 53%, FEF 25~75% 0.31 L/sec, MVV 25 L/min, TLC 3.80 L, RV 2.33 L, DLCO 8.04. Through the intraoperative re-evaluation of pulmonary function in a patient with poor preoperative PFTs,had been conventionally considered as a contraindication to pneumonectomy, we report a successful surgery and anesthetic management with the literatures reviewed.

First
Prev
Page of 1
Next
Last

Search