Acute and Critical Care

Erratum

Surgery
Erratum to “Adjuvant intravenous immunoglobulin administration on postoperative critically ill patients with secondary 250 peritonitis: a retrospective study”: Young Un Choi, Jun Gi Kim, Ji Young Jang, Tae Hwa Go, Kwangmin Kim, Keum Seok Bae, Hongjin Shim; Acute Crit Care. 2023;38(2):250-250. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01515.e1

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Original Articles

Surgery
Adjuvant intravenous immunoglobulin administration on postoperative critically ill patients with secondary peritonitis: a retrospective study: Young Un Choi, Jun Gi Kim, Ji Young Jang, Tae Hwa Go, Kwangmin Kim, Keum Seok Bae, Hongjin Shim; Acute Crit Care. 2023;38(1):21-30. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01515

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Abstract PDF: Background
The use of intravenous immunoglobulin (IVIG) in sepsis patients from bowel perforation is still debatable. However, few studies have evaluated the effect of IVIG as an adjuvant therapy after source control. This study aimed to analyze the effect of IVIG in critically ill patients who underwent surgery due to secondary peritonitis.
Methods
In total, 646 medical records of surgical patients who were treated for secondary peritonitis were retrospectively analyzed. IVIG use, initial clinical data, and changes in Sequential Organ Failure Assessment (SOFA) score over the 7-day admission in the intensive care unit for sepsis check, base excess, and delta neutrophil index (DNI) were analyzed. Mortalities and periodic profiles were assessed. Propensity scoring matching as comparative analysis was performed in the IVIG group and non-IVIG group.
Results
General characteristics were not different between the two groups. The survival curve did not show a significantly reduced mortality in the IVIG. Moreover, the IVIG group did not have a lower risk ratio for mortality than the non-IVIG group. However, when the DNI were compared during the first 7 days, the reduction rate in the IVIG group was statistically faster than in the non-IVIG group (P<0.01).
Conclusions
The use of IVIG was significantly associated with faster decrease in DNI which means faster reduction of inflammation. Since the immune system is rapidly activated, the additional use of IVIG after source control surgery in abdominal sepsis patients, especially those with immunocompromised patients can be considered. However, furthermore clinical studies are needed.

Trauma
Determination of risk factors associated with surgical site infection in patients undergoing preperitoneal pelvic packing for unstable pelvic fracture: Kang Min Kim, Myoung Jun Kim, Jae Sik Chung, Ji Wool Ko, Young Un Choi, Hongjin Shim, Ji Young Jang, Keum Seok Bae, Kwangmin Kim; Acute Crit Care. 2022;37(2):247-255. Published online April 22, 2022; DOI: https://doi.org/10.4266/acc.2021.01396

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Abstract PDF

Background
Several recent studies have shown that preperitoneal pelvic packing (PPP) effectively produces hemostasis in patients with unstable pelvic fractures. However, few studies have examined the rate of surgical site infections (SSIs) in patients undergoing PPP following an unstable pelvic fracture. The purpose of the present study was to evaluate factors associated with SSI in such patients.
Methods
We retrospectively reviewed the medical charts of 188 patients who developed hemorrhagic shock due to pelvic fracture between April 2012 and May 2021. Forty-four patients were enrolled in this study.
Results
SSI occurred in 15 of 44 patients (34.1%). The SSIs occurred more frequently in cases of repacking during the second-look surgery (0 vs. 4 [26.7%], P=0.010) and combined bladder-urethra injury (1 [3.4%] vs. 4 [26.7%], P=0.039). The incidence of SSIs was not significantly different between patients undergoing depacking within or after 48 hours (12 [41.4%] vs. 5 [33.3%], P=0.603). The mean time to diagnosis of SSI was 8.1±3.9 days from PPP. The most isolated organism was Staphylococcus epidermidis.
Conclusions
Repacking and combined bladder-urethra injury are potential risk factors for SSI in patients with unstable pelvic fracture. Close observation is recommended for up to 8 days in patients with these risk factors. Further, 48 hours after PPP, removing the packed gauze on cessation of bleeding and not performing repacking can help prevent SSI. Additional analyses are necessary with a larger number of patients with the potential risk factors identified in this study.

Citations

Citations to this article as recorded by

Current Management of Hemodynamically Unstable Patients with Pelvic Fracture
Kevin Harrell, Chelsea Horwood, Clay Cothren Burlew
Current Surgery Reports.2023; 11(4): 92. CrossRef

Nutrition
Effectiveness of a multidisciplinary team for nutrition support in a trauma intensive care unit: Eunsuk Oh, Hongjin Shim, Hyon Ju Yon, Jin Sil Moon, Dae Ryong Kang, Ji Young Jang; Acute Crit Care. 2020;35(3):142-148. Published online August 19, 2020; DOI: https://doi.org/10.4266/acc.2020.00318

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Abstract PDF

Background
We evaluated clinical and nutritional outcomes according to multidisciplinary team involvement in nutrition support in a regional trauma intensive care unit (TICU).
Methods
We retrospectively compared the outcomes for 339 patients admitted to the TICU for >5 days depending on nutrition support team (NST) involvement (n=176) and non-NST involvement (n=163).
Results
The mean age and injury severity score (ISS) were 57.3±16.7 years and 18.6±9.7, respectively. Fifty-three patients (15.6%) had shock on admission and 182 (53.7%) underwent surgery during TICU admission. Some patients were admitted to neurosurgery (46%), general surgery (35.4%), and other (18.6%) departments. There were significant differences in the ISS, Acute Physiology and Chronic Health Evaluation (APACHE) II score, shock on TICU admission, and initial laboratory results. After propensity score matching, the total delivered/required caloric ratio and total delivered/required protein ratio were significantly higher in the NST group than in the non-NST group (calorie: 80.4% vs. 66.7%, P=0.007; protein: 93.1% vs. 68.3%, P<0.001). The NST group had an adequate protein supply more frequently than the non-NST group (protein: 48.0% vs. 25.8%, P=0.002). There was no significant difference in survival, even after adjustment for risk factors using Cox proportional hazard analysis.
Conclusions
The results of our study suggest that multidisciplinary team involvement in nutrition support in TICU patients may improve nutritional, but not clinical, outcomes.

Citations

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Nutrition support teams: Institution, evolution, and innovation
Albert Barrocas, Denise Baird Schwartz, Bruce R. Bistrian, Peggi Guenter, Charles Mueller, Ronni Chernoff, Jeanette M. Hasse
Nutrition in Clinical Practice.2023; 38(1): 10. CrossRef
Nutrition Therapy by Nutrition Support Team: A Comparison of Multi-Chamber Bag and Customized Parenteral Nutrition in Hospitalized Patients
Seunghyun Cheon, Sang-Hyeon Oh, Jung-Tae Kim, Han-Gon Choi, Hyojung Park, Jee-Eun Chung
Nutrients.2023; 15(11): 2531. CrossRef
Lipid emulsion treatment of cardiotoxicity caused by calcium channel blocker and beta-blocker
Ju-Tae Sohn
The American Journal of Emergency Medicine.2022; 58: 331. CrossRef
Physician Compliance with Nutrition Support Team Recommendations: Effects on the Outcome of Treatment for Critically Ill Patients
Hyon-Ju Yon, Eun-Suk Oh, Ji Young Jang, Ji Yun Jang, Hongjin Shim
Journal of Acute Care Surgery.2022; 12(1): 1. CrossRef
Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations
Yunjin Sohn, Taisun Hyun
Korean Journal of Community Nutrition.2022; 27(2): 121. CrossRef
Lipid emulsion dosage used for resuscitation after drug toxicity
Ju-Tae Sohn
The American Journal of Emergency Medicine.2022; 59: 168. CrossRef
Intensive care management of traumatic brain injury: How can mnemonics help?
Biljana Damnjanović, Jovana Stanisavljević, Adi Hadžibegović, Ivan Rović, Đuro Šijan, Nemanja Jovanović, Sanja Ratković, Marija Milenković
Serbian Journal of Anesthesia and Intensive Therapy.2022; 44(5-6): 105. CrossRef
Multidisciplinary Difficult Airway Team Characteristics, Airway Securement Success, and Clinical Outcomes: A Systematic Review
Vinciya Pandian, Talha U. Ghazi, Marielle Qiaoshu He, Ergest Isak, Abdulmalik Saleem, Lindsay R. Semler, Emily C. Capellari, Michael J. Brenner
Annals of Otology, Rhinology & Laryngology.2022; : 000348942211231. CrossRef
救急・集中治療領域重症患者における栄養管理
信人中西, 穣治小谷
The Japanese Journal of SURGICAL METABOLISM and NUTRITION.2022; 56(6): 229. CrossRef
Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome
Nobuto Nakanishi, Rie Tsutsumi, Kanako Hara, Masafumi Matsuo, Hiroshi Sakaue, Jun Oto
Journal of Clinical Medicine.2021; 10(4): 614. CrossRef
Lack of evidence for a nutritional support team in a trauma intensive care unit?
Jae Hwa Cho
Acute and Critical Care.2020; 35(3): 205. CrossRef

Image in Critical Care

Trauma
Trauma-Induced Retroperitoneal Paraganglioma Rupture Which Was Misunderstood as a Massive Retroperitoneal Hemorrhage: Hongjin Shim, Ji Young Jang, Yeong Ju Kim, Jung Soo Lim, Keum Seok Bae; Acute Crit Care. 2018;33(2):114-116. Published online April 26, 2018; DOI: https://doi.org/10.4266/acc.2017.00234

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Citations

Citations to this article as recorded by

Acute haemoperitoneum caused by ruptured extra‐adrenal paraganglioma
Jae Im Lee, Su Lim Lee, Kyung Jin Seo
ANZ Journal of Surgery.2021;[Epub] CrossRef
Laparoscopic resection of a ruptured retroperitoneal paraganglioma
Shogo Zuo, Toshio Sawai, Hiromichi Kanehiro, Yasuhiro Kuroda, Masayuki Sho
Journal of Pediatric Surgery Case Reports.2020; 59: 101522. CrossRef

Case Report

Neurosurgery
Delayed Traumatic Subarachnoid Hemorrhage in a Polytraumatized Patient with Disseminated Intravascular Coagulation: Jiwoong Oh, Wonyeon Lee, Ji Young Jang, Pilyoung Jung, Sohyun Kim, Jongyeon Kim, Jinsu Pyen, Kum Whang, Sungmin Cho; Korean J Crit Care Med. 2015;30(4):336-342. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.336

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Abstract PDF

The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multipletrauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and antithrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.

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Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments?
Bedriye Müge Sönmez, Emirhan Temel, Murat Doğan İşcanlı, Fevzi Yılmaz, Uğur Gülöksüz, Selçuk Parlak, Özhan Merzuk Uçkun
Journal of the National Medical Association.2019; 111(2): 210. CrossRef

Original Article

Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis: Seung Hwan Lee, Ji Young Jang, Jae Gil Lee; Korean J Crit Care Med. 2013;28(4):247-254.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.247

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Abstract PDF

BACKGROUND
Many studies have shown that serum albumin and prealbumin levels correlate with patient outcomes in critically ill patients. The purpose of this study was to evaluate the clinical significance of prealbumin and albumin levels in patients in the intensive care unit (ICU) after emergency surgery for acute peritonitis.
METHODS
We examined serum albumin and prealbumin as markers for the prediction of patient outcome in 51 patients admitted to the ICU after emergency surgery from January to December in 2012. Biochemical parameters were measured postoperatively. Serum albumin and prealbumin levels were compared between survivors and non-survivors. Patients were also divided according to the occurrence of shock and pulmonary complications (shock group vs. non-shock group, pulmonary complications group vs. non-pulmonary complications group), and outcome analysis was performed for age, American Society of Anesthesiologists (ASA) score, length of ICU stay (IS), length of hospital stay (HS), mechanical ventilation, and APACHE II score. Serum albumin and prealbumin levels were evaluated for any correlation with complications and mortality.
RESULTS
In patients with shock, prealbumin and albumin were significantly decreased (p = 0.047, p = 0.036). Additionally, albumin was significantly decreased in patients with pulmonary complications. Neither albumin nor prealbumin, however, showed a correlation with mortality. Prealbumin showed a correlation with serum albumin, CRP level, and HS (r = 0.511, p < 0.001; r = -0.438, p = 0.002; and r = -0.45, p = 0.001, respectively). Albumin showed a correlation with HS, IS, and APACHE II score (r = -0.404, p = 0.003; r = -0.424, p = 0.002; and r = -0.40, p = 0.006, respectively).
CONCLUSIONS
The initial prealbumin level measured upon admission to the ICU after gastrointestinal emergency surgery can be useful predictor of shock. The initial albumin level was significantly low in patients with shock and pulmonary complications. However, neither prealbumin nor albumin showed a correlation with mortality. Our study also showed that albumin and prealbumin levels are affected by other factors, such as massive hydration and severe inflammation, as reported in previous studies.

Citations

Citations to this article as recorded by

Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery
Jin Young Lee, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee
Medicine.2016; 95(35): e4530. CrossRef

Case Report

Experiences of Wet Beriberi and Wernicke's Encephalopathy Caused by Thiamine Deficiency in Critically Ill Patients: Ji Young Jang, Hongjin Shim, Jae Gil Lee; Korean J Crit Care Med. 2013;28(2):156-159.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.156

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Abstract PDF

Wet beriberi and Wernicke's encephalopathy (WE) are caused by thiamine deficiency and are potentially lethal and serious diseases. Thiamine deficiency occurs mainly due to poor oral intake or inadequate provision of thiamine in enteral or parenteral nutrition therapy. We report cases of wet beriberi and WE that developed after surgery in a surgical intensive care unit. The first patient, who was diagnosed with wet beriberi, underwent right total mastectomy and radical subtotal gastrectomy, simultaneously. The second was diagnosed with irreversible WE, respectively, due to long-term malnutrition. In both cases, intravenous replacement of thiamine was initiated after the admission to the surgical intensive care unit. However, comatose mentality of the second patient did not improve. As a result, we conclude that, if a patient's clinical feature is suspected to be thiamine deficiency, prompt intravenous thiamine replacement is needed.

Citations

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A Critical Case of Wernicke's Encephalopathy Induced by Hyperemesis Gravidarum
Byung Ju Kang, Min Gu Kim, Jwa Hoon Kim, Mingee Lee, Sang-Beom Jeon, Ha Il Kim, Jin Won Huh
The Korean Journal of Critical Care Medicine.2015; 30(2): 128. CrossRef

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