Acute and Critical Care

Pulmonary
The feasibility and safety of percutaneous dilatational tracheostomy without endotracheal guidance in the intensive care unit: Ji Eun Kim, Dong Hyun Lee; Acute Crit Care. 2022;37(1):101-107. Published online February 17, 2022; DOI: https://doi.org/10.4266/acc.2021.00906

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Background
Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units (ICUs). Although it is thought to be safe and easily performed at the bedside, PDT usually requires endotracheal guidance, such as bronchoscopy. Here, we assessed the clinical outcomes and safety of PDT conducted without endotracheal guidance.
Methods
In the ICU and coronary ICU at a tertiary hospital, PDT was routinely performed without endotracheal guidance by a single medical intensivist using the Griggs technique PDT kit (Portex Percutaneous Tracheostomy Kit). We retrospectively reviewed the electronic medical records of patients who underwent PDT without endotracheal guidance.
Results
From January 1 to December 31, 2018, 78 patients underwent PDT without endotracheal guidance in the ICU and coronary ICU. The mean age of these subjects was 71.9±11.5 years, and 29 (37.2%) were female. The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at 24 hours after admission was 25.9±5.8. Fifty patients (64.1%) were on mechanical ventilation during PDT. Failure of the initial PDT attempt occurred in 4 patients (5.1%). In two of them, PDT was aborted and converted to surgical tracheostomy; in the other two patients, PDT was reattempted after endotracheal reintubation, with success. Minor bleeding at the tracheostomy site requiring gauze changes was observed in five patients (6.4%). There were no airway problems requiring therapeutic interventions or procedure-related sequelae.
Conclusions
PDT without endotracheal guidance can be considered safe and feasible.

Citations

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Safety of percutaneous dilatational tracheostomy performed by intensivists versus surgeons: A retrospective cohort study
Asaf Miller, Roee Noy, Omri Simchon, Natalia Gvozdev, Yotam Shkedy, Danny Epstein
World Journal of Surgery.2024; 48(9): 2283. CrossRef

Pulmonary
Erratum to “Global and regional ventilation during high flow nasal cannula in patients with hypoxia”: Dong Hyun Lee, Eun Young Kim, Ga Jin Seo, Hee Jung Suh, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim; Acute Crit Care. 2021;36(2):173-173. Published online May 28, 2021; DOI: https://doi.org/10.4266/acc.2017.00507.e1; Corrects: Acute Crit Care 2018;33(1):7

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Ethics
Concept of care shock during intensive care unit discharge process: Dong Hyun Lee; Acute Crit Care. 2021;36(2):162-163. Published online March 3, 2021; DOI: https://doi.org/10.4266/acc.2021.00199

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Pulmonary
Global and Regional Ventilation during High Flow Nasal Cannula in Patients with Hypoxia: Dong Hyun Lee, Eun Young Kim, Ga Jin Seo, Hee Jung Suh, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim; Acute Crit Care. 2018;33(1):7-15. Published online January 22, 2018; DOI: https://doi.org/10.4266/acc.2017.00507; Correction in: Acute Crit Care 2021;36(2):173

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Abstract PDF

Background
High flow nasal cannula (HFNC) is known to increase global ventilation volume in healthy subjects. We sought to investigate the effect of HFNC on global and regional ventilation patterns in patients with hypoxia.
Methods
Patients were randomized to receive one of two oxygen therapies in sequence: nasal cannula (NC) followed by HFNC or HFNC followed by NC. Global and regional ventilation was assessed using electric impedance tomography.
Results
Twenty-four patients participated. Global tidal variation (TV) in the lung was higher during HFNC (NC, 2,241 ± 1,381 arbitrary units (AU); HFNC, 2,543 ± 1,534 AU; P < 0.001). Regional TVs for four iso-gravitational quadrants of the lung were also all higher during HFNC than NC. The coefficient of variation for the four quadrants of the lung was 0.90 ± 0.61 during NC and 0.77 ± 0.48 during HFNC (P = 0.035). Within the four gravitational layers of the lung, regional TVs were higher in the two middle layers during HFNC when compared to NC. Regional TV values in the most ventral and dorsal layers of the lung were not higher during HFNC compared with NC. The coefficient of variation for the four gravitational layers of the lung were 1.00 ± 0.57 during NC and 0.97 ± 0.42 during HFNC (P = 0.574).
Conclusions
In patients with hypoxia, ventilation of iso-gravitational regions of the lung during HFNC was higher and more homogenized compared with NC. However, ventilation of gravitational layers increased only in the middle layers. (Clinical trials registration number: NCT02943863).

Citations

Citations to this article as recorded by

High-flow nasal cannulae for respiratory support in adult intensive care patients
Sharon R Lewis, Philip E Baker, Roses Parker, Andrew F Smith
Cochrane Database of Systematic Reviews.2021;[Epub] CrossRef
Failure of High-Flow Nasal Cannula Therapy in Pneumonia and Non-Pneumonia Sepsis Patients: A Prospective Cohort Study
Eunhye Kim, Kyeongman Jeon, Dong Kyu Oh, Young-Jae Cho, Sang-Bum Hong, Yeon Joo Lee, Sang-Min Lee, Gee Young Suh, Mi-Hyeon Park, Chae-Man Lim, Sunghoon Park
Journal of Clinical Medicine.2021; 10(16): 3587. CrossRef
High-flow nasal cannulae for respiratory support in adult intensive care patients
Sharon R Lewis, Philip E Baker, Roses Parker, Andrew F Smith
Cochrane Database of Systematic Reviews.2017;[Epub] CrossRef

Cardiology
Cardiac Arrest due to Recurrent Ventricular Fibrillation Triggered by Unifocal Ventricular Premature Complexes in a Silent Myocardial Infarction: Dong Hyun Lee, Seul Lee, Hyo Jin Jung, Soo Jin Kim, Jeong Min Seo, Jae Hyuk Choi, Jong Sung Park; Korean J Crit Care Med. 2014;29(4):331-335. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.331

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Abstract PDF: A 51-year-old male patient was referred for a sudden out-of-hospital cardiac arrest. Upon arrival, he was conscious and had no chest pain complaints. There was no abnormality in initial electrocardiographic and echocardiographic examinations. However, episodes of recurrent ventricular fibrillation (VF) were documented on rhythm monitoring. Each VF episode was triggered by an isolated monomorphic ventricular premature complex (VPC). Suspecting idiopathic VF, emergency radiofrequency catheter ablation was planned for the VPCs. However, when coronary angiography was performed to exclude silent ischemia, the results showed a total occlusion of the right coronary artery posterolateral branch, which is thought to supply the left ventricular inferior and septal wall. After successful reperfusion, VF episodes and the triggering VPCs disappeared. We are documenting this case to emphasize the potential for silent myocardial infarction to cause out-of-hospital sudden cardiac arrest even in a patient without any symptom or sign of acute coronary syndrome.

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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Abstract PDF

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.

Citations

Citations to this article as recorded by

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

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