Acute and Critical Care

Original Article

Hematology
Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units: Soo Jin Na, Tae Sun Ha, Younsuck Koh, Gee Young Suh, Shin Ok Koh, Chae-Man Lim, Won-Il Choi, Young-Joo Lee, Seok Chan Kim, Gyu Rak Chon, Je Hyeong Kim, Jae Yeol Kim, Jaemin Lim, Sunghoon Park, Ho Cheol Kim, Jin Hwa Lee, Ji Hyun Lee, Jisook Park, Juhee Cho, Kyeongman Jeon; Acute Crit Care. 2018;33(3):121-129. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00143

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Background
The objective of this study was to investigate the characteristics and clinical outcomes of critically ill cancer patients admitted to intensive care units (ICUs) in Korea.
Methods
This was a retrospective cohort study that analyzed prospective collected data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study, which is a nationwide, multicenter, and prospective study that considered 5,063 patients from 22 ICUs in Korea over a period of 7 months. Among them, patients older than 18 years of age who were diagnosed with solid or hematologic malignancies prior to admission to the ICU were included in the present study.
Results
During the study period, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. Six hundred fifty-eight (79%) had solid tumors and 175 (21%) had hematologic malignancies, respectively. Respiratory problems (30.1%) was the most common reason leading to ICU admission. Patients with hematologic malignancies had higher Sequential Organ Failure Assessment (12 vs. 8, P<0.001) and SAPS3 (71 vs. 69, P<0.001) values and were more likely to be associated with chemotherapy, steroid therapy, and immunocompromised status versus patients with solid tumors. The use of inotropes/ vasopressors, mechanical ventilation, and/or continuous renal replacement therapy was more frequently required in hematologic malignancy patients. Mortality rates in the ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) were higher in hematologic malignancy patients than in solid tumor patients.
Conclusions
Cancer patients accounted for one-third of all patients admitted to the studied ICUs in Korea. Clinical characteristics were different according to the type of malignancy. Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.

Citations

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Case Reports

Cardiology
Life-Threatening Acute Fulminant Myocarditis Following a Coffee Diet Program: Jung Hyun Kim, Hee Kyung Kim, Kyu Hyun Han, Bo Hye Kim, Hak Su Kim, Sun Young Shin, Eun Kyung Kim, Hye Cheol Jeong, Ji Hyun Lee; Korean J Crit Care Med. 2014;29(2):119-122. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.119

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Abstract PDF: Myocarditis is an inflammatory disease of the myocardium caused by various infectious or noninfectious triggers. Although viral infections are important causes of myocarditis, some drugs or toxins can also cause myocarditis. We report a case of life-threatening fulminant myocarditis which followed an extensive coffee diet program. Despite medical treatment, the patient was not able to maintain hemodynamic stability. She was supported by extracorporeal membrane oxygenation and completely recovered 3 months later.

Cardiology
Successful Use of a Peripheral Extracorporeal Membrane Oxygenator in a Patient with Chronic Heart Failure and Pneumonia: Ji Hyun Lee, Yang Hyun Cho, Gee Young Suh, Jeong Hoon Yang; Korean J Crit Care Med. 2014;29(1):52-56. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.52

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Abstract PDF: Myocardial dysfunction can occur during severe sepsis and may accelerate in the condition of chronic decompensated heart failure. A 26-year-old female in remission from non-Hodgkin’s lymphoma presented with shock due to chronic heart failure combined with pneumonia. The patient was initially stabilized using a peripheral extracorporeal membrane oxygenator (ECMO) with antibiotics therapy, followed by left ventricular venting due to pulmonary edema that was complicated by left ventricular distension. Here, we report the successful application of ECMO to a patient with pneumonia underlying doxorubicin-induced cardiomyopathy. Although septic conditions remained unclear indication of ECMO, it might be considered a valuable therapeutic option in patients with chronic heart failure.

A Case of Anaphylactoid Reaction to Gadolinium Contrast Media and Propranolol Complicated with Acute Respiratory Distress Syndrome (ARDS): A Case Report: Jung Hyun Kim, Kyung Ho Kim, Hye Cheol Jeong, Eun Kyung Kim, Ji Hyun Lee; Korean J Crit Care Med. 2012;27(3):187-190.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.187

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2 Crossref

Abstract PDF

Anaphylaxis/anaphylactoid reaction is a medical emergency. In rare cases, acute respiratory distress syndrome (ARDS) can complicate this disorder. This is a case report of an anaphylactoid reaction complicated with ARDS that was successfully treated using extracorporeal membrane oxygenation (ECMO). A 52-year-old female patient developed sudden dyspnea immediately after she received gadolinium contrast injection and 80 mg of oral propranolol. She progressed rapidly to a state of shock and her chest radiograph showed pulmonary edema. The shock and pulmonary edema did not respond to epinephrine or steroid injection. On the next day, the permeability edema worsened and laboratory test revealed extreme hemoconcentration. The oxygenation goal was not achieved with mechanical ventilation alone, thus ECMO was applied as well. The patient showed clinical improvements on the 3rd day and was weaned from ECMO on the 4th day. She was completely recovered from shock and respiratory distress by day 5. The patient was discharged from hospital without further complications.

Citations

Citations to this article as recorded by

Extracorporeal Life Support use during Severe Anaphylaxis: A Systematic Review and Pooled Analysis of Individual Patient Data
Eduardo Saadi Neto, Ronna L. Campbell, Autumn Brogan, Fernanda Bellolio, Aidan F. Mullan, Danielle Gerberi, Nguyen Ba Cuong, Alexander S. Finch
Journal of Cardiothoracic and Vascular Anesthesia.2026;[Epub] CrossRef
Acute Respiratory Distress Syndrome Due to Gadolinium Administration
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A Case of Bilateral Vocal Cord Paralysis Due to Subglottic Pressure Injury after Endotracheal Intubation: A Case Report: Gyu Sik Choi, Sang Hoon Kim, Jae Hyung Lee, You Lim Kim, Ji Hyun Lee, Young Woo Jang, Eun Sun Cheong, Jong Kwan Jung, Byoung Hoon Lee; Korean J Crit Care Med. 2011;26(3):191-195.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.191

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Abstract PDF: Bilateral vocal cord paralysis may occur as a result of mechanical injury during neck surgery, nerve compression by endotracheal intubation or mass, trauma, and neuromuscular diseases. However, only a few cases of bilateral vocal cord paralysis have occurred following short-term endotracheal intubation. We report a case of bilateral vocal cord paralysis subsequent to extubation after endotracheal intubation and mechanical ventilation due to severe pneumonia for 2 days.

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