Acute and Critical Care

Case Report

Thoracic Surgery
Early laparoscopic exploration for acute mesenteric ischemia after cardiac surgery: Sue Hyun Kim, Ho Young Hwang, Min Jung Kim, Kyu Joo Park, Ki-Bong Kim; Acute Crit Care. 2020;35(3):213-217. Published online April 19, 2019; DOI: https://doi.org/10.4266/acc.2018.00423

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Acute mesenteric ischemia (AMI) after cardiac surgery is a rare but fatal complication. Early diagnosis and intervention can be lifesaving. We report two cases of patients who underwent early diagnostic laparoscopy for suspicious AMI after cardiac surgery and demonstrated favorable outcomes. An 83-year-old male with severe left ventricular dysfunction underwent off-pump coronary artery bypass grafting. Severe ileus with gaseous distension of the small bowel was developed on the 3rd postoperative day and computed tomographic angiography (CTA) showed pneumatosis intestinalis of small bowel suggestive of AMI. An immediate bedside laparoscopy was performed and it showed preserved perfusion of small bowel. He recovered without complication under supportive medical management. Another 69-year-old male who underwent aortic valve replacement complained of whole abdominal tenderness with severe distension on the 3rd postoperative day. The CTA found segmental non-enhancing bowel wall with air bubbles suggestive of AMI with possible microperforation. A diagnostic laparoscopy demonstrated small-bowel infarction with pus-like fluid collection in the peritoneal cavity. The operation was converted to laparotomy and complete resection of ischemic segments of small bowel was done. He recovered well without any other complications and discharged home on the 35th postoperative day.

Citations

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Original Article

Effect of Clinical Pharmacist Interventions on Prevention of Adverse Drug Events in Surgical Intensive Care Unit: Minkyong Kang, Ahjeong Kim, Yoonsook Cho, Hyangsook Kim, Hyesook Lee, Yong Jae Yu, Hannah Lee, Kyu Joo Park, Hee pyoung Park; Korean J Crit Care Med. 2013;28(1):17-24.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.17

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Abstract PDF

BACKGROUND
A pharmacist's participation in medical rounds in intensive care unit (ICU) is becoming popular nowadays. In this study, we investigated the effect of pharmacologic intervention by a pharmacist's participation in medical round in ICU on prevention of adverse drug events (ADEs).
METHODS
From March 2011 to July 2011, the intervention data were obtained by participating in medical round two or three times a week, and by reviewing electronic medical records of patients admitted to surgical ICU. The incidence, cause, and type of ADEs were noted, respectively. Expected cost avoidance was calculated from interventions, which were considered to be preventive of ADEs. The acceptance rate of pharmacologic interventions was noted.
RESULTS
Among 2781 patients, a total of 159 intervention data were collected in 90 patients. Recommendation for drug dosage adjustment or monitoring in patients with potential overdose and sub-therapeutic dose made up 82% of the total interventions. In 8% of interventions, initiation of drug therapy was recommended. 83% of the interventions were accepted and the acceptance rate of interventions within 24 hrs was 58%. The rate of the interventions, which were considered to be preventive of ADEs was 62%. Expected cost reduction obtained by preventing ADEs was 25,867,083 Won during a 5-month period.
CONCLUSIONS
A pharmacist's participation in physician rounds in ICU was associated with prevention of ADEs and subsequent reduction of the cost in drug therapy.

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Dona Babu, Sally Marotti, Debra Rowett, Renly Lim, Alice Wisdom, Lisa Kalisch Ellett
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A Systematic Review of Outcomes Research in the Hospital Pharmacists’ Interventions in South Korea
So Young Lee, Eun Cho
Korean Journal of Clinical Pharmacy.2019; 29(3): 193. CrossRef
Effects of Medication Reconciliation and Cost Avoidance Analysis by Clinical Pharmacists in a Neurocritical Care Unit
Ui Sang Cho, Young Joo Song, Young Mi Jung, Kyung Suk Choi, Eunsook Lee, Euni Lee, Moon-Ku Han
Journal of Neurocritical Care.2018; 11(2): 110. CrossRef
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Tae Yun Park, Sang-Min Lee, Sung Eun Kim, Ka-Eun Yoo, Go Wun Choi, Yun Hee Jo, Yoonsook Cho, Hyeon Joo Hahn, Jinwoo Lee, A Jeong Kim
The Korean Journal of Critical Care Medicine.2015; 30(2): 82. CrossRef

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