Acute and Critical Care

ACC review series 2026: sepsis 1

Managing sepsis in the era of precision medicine: a narrative review: Ho Jin Yong, Sung Min Kim, Dohhyung Kim; Acute Crit Care. 2026;41(2):189-200. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.000884

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Abstract PDF: For decades, the management of sepsis has adopted protocolized care bundles. However, the plateau in global survival rates suggests that the "one-size-fits-all" paradigm exemplified by early goal-directed therapy has reached its limits. The physiological and biological heterogeneity of sepsis necessitates a fundamental shift toward precision medicine. This review examines the transition from empirical resuscitation to individualized care across four critical domains. First, fluid strategy is evolving from aggressive loading to dynamic stewardship. Current evidence favors balanced crystalloids over saline and advocates restrictive dosing guided by dynamic responsiveness indices and venous congestion assessments to prevent iatrogenic harm. Second, hemodynamic support is shifting toward a catecholamine‑sparing strategy. To mitigate the metabolic and immunologic toxicities of high-dose norepinephrine, multimodal vasopressors, such as vasopressin and angiotensin II, are used to target specific biological phenotypes, such as high-renin states. Third, antibiotic management balances rapid administration with rigorous stewardship through pharmacokinetic optimization, including continuous infusions, diagnostic pauses for stable patients, and short-course regimens. Finally, corticosteroid therapy is moving beyond universal debate toward targeted application. Emerging data support their use in specific responder phenotypes, notably severe community-acquired pneumonia and distinct transcriptomic endotypes. In conclusion, modern critical care is moving beyond rigid protocols toward a personalized framework. By integrating bedside biomarkers and clinical phenotypes, clinicians can deliver “the right drug, at the right dose, for the right patient," thereby optimizing outcomes in sepsis and septic shock.

Original Articles

Infection
Early prognostication of septic shock in Korean adults aged 80 years and over: serum albumin combined with Sequential Organ Failure Assessment score: Sang-Min Kim, Seung Mok Ryoo, Woon Yong Kwon, Kyuseok Kim, Tae Ho Lim, Sung Pil Chung, Sung-Hyuk Choi, Won Young Kim; Acute Crit Care. 2026;41(2):304-314. Published online May 11, 2026; DOI: https://doi.org/10.4266/acc.005625

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Abstract PDF Supplementary Material: Background
Septic shock requires careful risk stratification in patients aged 80 and over. Serum albumin levels reflect host status and, when combined with the severity of organ dysfunction, may enhance early prognostication. Here, we evaluated whether combining albumin levels with the Sequential Organ Failure Assessment (SOFA) score upon emergency department (ED) arrival can improve risk classification. Methods: We conducted an observational study from October 2015 to May 2022 using a prospective multicenter registry of septic shock from 12 EDs in the Korean Shock Society. We included 1,300 (18.8%) patients with septic shock aged ≥80 years. The SOFA score was calculated in the ED at the time of septic shock recognition. Patients were divided into three groups according to albumin levels (cutoff, 3.5 g/dl) and the initial SOFA score (cutoff, 7): A, normal albumin with low SOFA score; B, high SOFA with normal albumin or low SOFA with low albumin; and C, low albumin with high SOFA score. The primary outcome was 28-day mortality. Results: Groups A, B, and C included 175, 592, and 533 patients, with 28-day mortality rates of 12.0%, 26.9%, and 49.3%, respectively. Adjusted odds ratios (95% CI) for mortality were 3.02 (1.76–5.18) for group B and 5.80 (3.38–9.97) for group C vs. group A. Conclusions: Combining the SOFA score with the albumin level allows early classification of patients aged ≥80 years with septic shock in the ED, facilitating treatment discussions, particularly decision-making with patients and their families.

Trauma
Predictive value of elevated interleukin-33 levels for multi-organ dysfunction syndrome in trauma patients in South Korea: a prospective observational study: Sanghyun An, In Sik Shin, Myoung Jun Kim, Da Kyung Kim, Md Habibur Rahman, Cheol-Su Kim, Kwangmin Kim; Acute Crit Care. 2025;40(4):594-604. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.002500

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Abstract PDF Supplementary Material: Background
Multi-organ distress syndrome (MODS) causes morbidity in patients with trauma. This study evaluates the effectiveness of interleukin-33 (IL-33), which reflects tissue damage and the inflammatory response, as a MODS indicator in patients with trauma.
Methods
Patients with trauma admitted to our trauma center between July 2022 and July 2023 were included. IL-33 levels were measured in blood samples for 4 days. Correlations with clinical and laboratory indicators, including initial IL-33 levels, were analyzed to identify independent predictors of MODS.
Results
Among the 87 patients enrolled, 20 developed MODS. Initial IL-33 levels were elevated in the MODS group, compared with the non-MODS group. In the non-MODS group, IL-33 levels increased on day 1 and then declined, whereas in the MODS group, IL-33 levels were highest at admission (day 0) and decreased continuously through day 3. In patients with detectable initial IL-33 levels, the measured levels correlated with higher Abbreviated Injury Scale 5 scores and the Injury Severity Score (ISS). A logistic regression analysis revealed the ISS and delta neutrophil index as factors contributing to MODS progression.
Conclusions
The findings suggest that initial IL-33 levels are elevated in the MODS group, compared with non-MODS group, and exhibit a rapidly declining trend, showing an initial association with MODS that was not maintained in a multivariate analysis. These findings suggest that IL-33 might have relevance in assessing trauma severity; however, further validation is required before it can be considered a biomarker for MODS.

Pediatrics
Weight variability at pediatric intensive care unit admission and adverse outcomes in critically ill children: Jae Hwa Jung, Yoon Hee Kim, Min Jung Kim, Mireu Park, Hamin Kim, Kyung Won Kim, Myung Hyun Sohn, Soo Yeon Kim; Acute Crit Care. 2025;40(4):605-613. Published online November 28, 2025; DOI: https://doi.org/10.4266/acc.001550

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Abstract PDF Supplementary Material: Background
Body weight can fluctuate during critical illness due to factors such as fluid shifts, nutritional status, the type of acute illness, and underlying comorbidities. We investigated the association between acute body weight variability (WV) and clinical outcomes in critically ill pediatric patients.
Methods
We retrospectively analyzed data from patients aged 1 month to 18 years who were admitted to the pediatric intensive care unit (PICU) of a university-affiliated tertiary hospital between August 2017 and July 2021. WV was defined as the percentage difference between the measured body weight at PICU admission and the usual body weight, obtained either from recent hospital records or caregiver reports. Associations between WV and clinical outcomes, including PICU mortality and ventilator-free days (VFDs), were assessed.
Results
Of the 926 patients, 74 (8.0%) died. Median WV was significantly higher in non-survivors than in survivors (8.7% vs. 0.0%; P<0.001). Increased WV was independently associated with higher mortality (hazard ratio [HR], 1.102; 95% CI, 1.073–1.131) and fewer VFDs (odds ratio [OR], 0.599; 95% CI, 0.524–0.684). Combining WV with Pediatric Index of Mortality 3 score significantly improved mortality prediction over either parameter alone (area under the curve, 0.888; P=0.047).
Conclusions
Higher WV at PICU admission is independently associated with adverse clinical outcomes, including increased mortality and fewer VFDs. WV could complement existing mortality prediction models in pediatric critical care.

Pediatrics
Low vitamin C concentrations and prognosis in critically ill children: Min Jung Kim, Yoon Hee Kim, Soo Yeon Kim, Jong Deok Kim, Mireu Park, Hamin Kim, Myung Hyun Sohn, Kyung Won Kim; Acute Crit Care. 2025;40(3):482-490. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.000975

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Abstract PDF

Background
The administration of high-dose vitamins has been focused on in critically ill patients as adjunctive therapy for life-threatening conditions. We evaluated the association between serum vitamin C concentrations and patient prognosis. Methods: We retrospectively reviewed and collected clinical and biochemical data, including thiamine and vitamin C levels, of patients admitted to the pediatric intensive care unit (PICU). Results: In total, 177 patients were admitted to the PICU during the study period, and 63 children were enrolled in this study. The most common reason for PICU admission was sepsis (33.3%). The median thiamine and vitamin C levels were 3.6 µg/dl (interquartile range [IQR], 2.9–4.5 µg/dl) and 2.84 µg/ml (IQR, 1.61–4.55 µg/ml), respectively. Thiamine deficiency was observed in 10 patients (15.9%), and 17 (27.0%) had vitamin C deficiency. There were no differences in the vitamin levels according to the reason for PICU admission. Vitamin C levels were affected by nutritional status. The length of stay in the PICU and duration of mechanical ventilation were longer in patients with vitamin C deficiency than in those without (P=0.035 and P=0.010, respectively). The serum delta neutrophil index and C-reactive protein and lactate levels increased in the vitamin C-deficient group (P=0.028 and P=0.039, respectively). There was a significant difference in Pediatric Index of Mortality 3 scores according to vitamin C levels but not in mortality directly. Conclusions: Vitamin C deficiency was associated with elevated inflammatory marker levels, increased mechanical ventilation durations, and PICU admission. Our results support the potential benefits of vitamin C administration in critically ill children.

Citations

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Clinical Characteristics and Outcomes of Pediatric Vitamin C Deficiency
Thanaporn Trangkanont, Maneerat Puwanant, Thirachit Chotsampancharoen
Nutrients.2025; 17(23): 3755. CrossRef

Neurology
Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea: Min Kim, Ji Sung Lee, Seong-Joon Lee, So Young Park, Jungyun Seo, Ji Man Hong, Hee-Kwon Park, Jae-Kwan Cha, Jeffrey L. Saver, Jin Soo Lee; Acute Crit Care. 2025;40(2):282-292. Published online April 11, 2025; DOI: https://doi.org/10.4266/acc.004248

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Abstract PDF Supplementary Material

Background
The effectiveness of intravenous tissue plasminogen activator (IV tPA) in patients with large-vessel occlusion (LVO) receiving endovascular treatment (EVT) for acute ischemic stroke (AIS) has been questioned. We investigated IV tPA effectiveness in real-world AIS patients, including those with intracranial LVO receiving EVT.
Methods
We identified patients with AIS who presented to hospital with National Institutes of Health Stroke Scale ≥4 within 8 hours of symptom onset from the institutional stroke registry. The association of IV tPA use with effectiveness and safety outcomes was analyzed in overall enrolled AIS patients; LVO patients; and patients treated with EVT. The effect of IV tPA was assessed using multiple logistic regression.
Results
Among the 654 patients meeting study entry criteria, 238 (36.4%) received IV tPA and 416 (63.6%) did not. Multiple logistic regression analysis and shift analysis revealed IV tPA was associated with improved outcomes in overall enrolled AIS population, LVO, and EVT-treated subgroups. Among EVT-treated patients, IV tPA was associated with higher likelihood of ambulatory or better outcome (modified Rankin Scale 0–3) with odds ratio of 1.95 (P=0.03).
Conclusions
In this real-world study, IV tPA use was associated with improved outcomes for patients with AIS, including among LVO patients treated and not treated with EVT, in the contemporary mechanical thrombectomy era.

Citations

Citations to this article as recorded by

Clinical variable-based decision-support model for rapid differentiation of hemorrhagic and ischemic stroke at emergency department presentation in South Korea
Jae-Woo Kim, Jin-Heon Jeong, Moon-Ku Han, Sang-Hoon Han, Ka Hyun Kim, Seung Park, Dong-Ick Shin, Kyu Sun Yum
Acute and Critical Care.2026; 41(2): 364. CrossRef
SMART-M24: A Prognostic Nomogram for Long-Term Mortality in Acute Ischemic Stroke Beyond 24 H from Symptom Onset
Soo-Hyun Park, Ji Sung Lee, Tae Jung Kim, Mi Sun Oh, Ji-Woo Kim, Kyungbok Lee, Kyung-Ho Yu, Byung-Chul Lee, Byung-Woo Yoon, Sang-Bae Ko
Translational Stroke Research.2025; 16(6): 1975. CrossRef
Knowledge and experience of local emergency care staff on stroke recognition and acute care in the United Arab Emirates
Mohammed Alkuwaiti, Azhar Talal, Emad Masuadi, Ghada Albluwi, Abdulla Alkuwaiti, David Olukolade Alao
International Journal of Emergency Medicine.2025;[Epub] CrossRef

Surgery
Biomarkers to predict mortality in patients with Fournier’s gangrene admitted to the intensive care unit after surgery in South Korea: In Sik Shin, Seong Chan Gong, Sanghyun An, Kwangmin Kim; Acute Crit Care. 2023;38(4):452-459. Published online November 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00766

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Abstract PDF

Background
The use of biomarkers to predict patient outcomes may be crucial for patients admitted to the intensive care unit (ICU) following surgery because biomarkers guide clinicians in tailoring treatment plans accordingly. Therefore, we aimed to identify potential biomarkers to predict the prognosis of patients with Fournier’s gangrene (FG) admitted to the ICU after surgery.
Methods
We enrolled patients with FG admitted to our Hospital between January 2013 and December 2022. We retrospectively analyzed patient characteristics, factors related to management, scores known to be associated with the prognosis of FG, and laboratory data.
Results
The study population included 28 survivors and 13 nonsurvivors. The initial serum lactate level taken in the emergency department; white blood cell, neutrophil, and platelet counts; delta neutrophil index and international normalized ratio; albumin, glucose, HCO3, and postoperative lactate levels; and the laboratory risk indicator for necrotizing fasciitis differed between survivors and nonsurvivors. Postoperative lactate and initial albumin levels were independent predictors of mortality in patients with FG. In the receiver operating characteristic curve analysis, the postoperative lactate level was the best indicator of mortality (area under the curve, 0.877; 95% confidence interval, 0.711–1.000). The optimal cutoff postoperative lactate level for predicting mortality was 3.0 mmol/L (sensitivity, 80.0%; specificity, 95.0%).
Conclusions
Postoperative lactate and initial albumin levels could be potential predictors of mortality in patients with FG admitted to the ICU after surgery, and the optimal cutoff postoperative lactate and initial albumin levels to predict mortality were 3.0 mmol/L and 3.05 g/dl, respectively. Large-scale multicenter prospective studies are required to confirm our results.

Citations

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Revolutionizing Gangrene Therapy: Nanoparticle-Based Interventions and Biomarker Applications
Elizabeth Rani Edwin, Silpa Jayaprakash, Yamuna Gopi, Praveen Madhaiyan, Punniyakoti V. Thanikachalam, Pavithra Bharathy
Biomedical Materials & Devices.2026; 4(2): 1572. CrossRef
Diagnostic Accuracy of Red Cell Distribution Width-Derived Indices for Predicting In-Hospital Mortality in Scrotal Fournier’s Gangrene: A Retrospective Cohort Study
Rıdvan Kayar, Kemal Kayar, İlker Artuk, Samet Demir, Emre Tokuc, Metin Öztürk
Surgical Infections.2026; 27(3): 201. CrossRef
Risk Factors for Mortality in Patients With Necrotizing Fasciitis: A Systematic Review and Meta‐Analysis
Rui Zhang, Zheng Xu, Qi Han, Guosheng Wang, Srijoni Sengupta
International Journal of Clinical Practice.2026;[Epub] CrossRef
Successful Surgical Management of Fournier’s Gangrene: A Case Report
Nurzhan Isabekov, Karakoz Amantayeva, Gulbarshyn Eskali
Australian Journal of Biomedical Research.2026; 2(2): aubm019. CrossRef
A Retrospective Evaluation of Cases of Necrotizing Fasciitis Presenting to the Emergency Department
Gürkan Altuntaş, Mümin Murat Yazıcı, İsmail Ataş, Meryem Kaçan, Özlem Bilir
Hamidiye Medical Journal.2025; 6(2): 78. CrossRef
Integrative Management Strategies for Improved Outcomes in Fournier’s Gangrene: A Case Series Analysis from India
Awadhesh Kumar Pandey, Nasrin Habeeb, Aadithyaraj Kunnummal Thilakan, Rahul Sherkhane, Arun Kumar Dwivedi
Journal of Wound Management and Research.2025; 21(3): 148. CrossRef
Predictive value of elevated interleukin-33 levels for multi-organ dysfunction syndrome in trauma patients in South Korea: a prospective observational study
Sanghyun An, In Sik Shin, Myoung Jun Kim, Da Kyung Kim, Md Habibur Rahman, Cheol-Su Kim, Kwangmin Kim
Acute and Critical Care.2025; 40(4): 594. CrossRef
Predictors of in-hospital mortality in Fournier gangrene at four Korean tertiary hospitals: a multicenter retrospective cohort study
In Sik Shin, Sung Woo Jang, Chan Hee Park, Jeong Woo Lee, Hui-Jae Bang, Kwangmin Kim
Journal of Acute Care Surgery.2025; 15(3): 99. CrossRef
Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review
Pavan Shet, Ashmit Daiyan Mustafa, Karan Varshney, Lavina Rao, Sameen Sawdagar, Florence McLennan, Siraaj Ansari, Darshan Shet, Niveshan Sivathamboo, Sian Campbell
Surgical Infections.2024; 25(4): 261. CrossRef

Letter to the Editor

Thoracic surgery
Reply to comment on “Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study”: Hye-Bin Kim, Sungwon Na, Hyo Chae Paik, Hyeji Joo, Jeongmin Kim; Acute Crit Care. 2023;38(2):236-237. Published online May 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00556

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PDF

Erratum

Surgery
Erratum to "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(2):250-250. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01515.e1; Corrects: Acute Crit Care 2023;38(1):21

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Original Article

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; Correction in: Acute Crit Care 2023;38(2):250

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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.

Citations

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The Efficacy of IgM-Enriched Immunoglobulin (eIg) Administration for Treatment of Sepsis and Septic Shock in Adult Surgical Patients: A Single-Center, Retrospective, Observational Study
Serena Spanò, Gabriella Licitra, Giada Cucciolini, Etrusca Brogi, Rita Martinelli, Francesco Cundari, Maria Giovanna Curci, Federico Coccolini, Stefano Busani, Giorgio Berlot, Mattia Bixio, Gianni Biancofiore, Francesco Corradi, Francesco Forfori
Journal of Clinical Medicine.2026; 15(4): 1526. CrossRef
USING INTRAVENOUS IMMUNOGLOBULIN IN A PATIENT WITH SEPTIC SHOCK AND MULTIPLE COMORBIDITIES: A REVIEW BASED ON A CLINICAL CASE
Nataliya Matolynets, Jacek Rolinski, Khrystyna Lishchuk-Yakymovych, Yaroslav Tolstyak
Proceeding of the Shevchenko Scientific Society. Medical Sciences.2023;[Epub] CrossRef

Case Report

Cardiology
Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report: Sangshin Park, Min Kim, Dae In Lee, Ju-Hee Lee, Sangmin Kim, Sang Yeub Lee, Jang-Whan Bae, Kyung-Kuk Hwang, Dong-Woon Kim, Myeong-Chan Cho, Dae-Hwan Bae; Acute Crit Care. 2024;39(1):194-198. Published online May 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01158

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Abstract PDF Supplementary Material

The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.

Citations

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Mechanical Circulatory Support in Paraganglioma Induced Cardiogenic Shock and Intestinal Ischemia: Lessons from a Complex Case and Narrative Review
Alessio Giordano, Letizia Canu, Manuela Mastronardi, Luisa Petrone, Clotilde Sparano, Mauro Marzano, Carlo Bergamini, Paolo Prosperi
Journal of Clinical Medicine.2025; 14(16): 5882. CrossRef
ECMO‐Assisted Da Vinci Robotic Surgery for Pheochromocytoma‐Induced Acute Catecholamine Cardiomyopathy: A Case Report
Qi Wang, Jiayan Xin, Xiaoqiong Cui, Liya Hu, Meng Ning, Wenqing Gao, Yingwu Liu
Clinical Case Reports.2025;[Epub] CrossRef
Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review
Johanna K. R. von Mackensen, Vanessa I. T. Zwaans, Ahmed El Shazly, Karel M. Van Praet, Roland Heck, Christoph T. Starck, Felix Schoenrath, Evgenij V. Potapov, Joerg Kempfert, Stephan Jacobs, Volkmar Falk, Leonhard Wert
Journal of Clinical Medicine.2024; 13(2): 473. CrossRef
Pheochromocytoma-induced cardiogenic shock requiring ECMO: cardiovascular recovery prior to surgical resection
Toby Adrian Redler, Zohra Mohtat-Nasri, Brielle Williams, Philip Townend
BMJ Case Reports.2024; 17(12): e262827. CrossRef

Original Articles

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

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An Atypical Presentation of Morel–Lavallée Syndrome Following Blunt Trauma
Shreya Nair , Anoop V Pillai, Riju Ramachandran
Cureus.2026;[Epub] CrossRef
Pelvic packing – status 2024
Axel Gänsslen, Tim Pohlemann, Jan Lindahl, Jan Erik Madsen
Archives of Orthopaedic and Trauma Surgery.2025;[Epub] CrossRef
Operatively treated high-energy blunt pelvic ring injuries and surgical site infections – A retrospective assessment based on a prospective registry
Elvin Gurbanov, Ulysse Coneys, Elisabeth Andereggen, Alexandre Ansorge, Vanessa Morello, Axel Gamulin
Injury.2025; 56(3): 112209. CrossRef
Timing of planned reoperation after damage control surgery in patients with trauma: a systematic review and meta-analysis
Dongmin Seo, Hye Young Woo, Inhae Heo, Kyoungwon Jung, Hohyung Jung
World Journal of Emergency Surgery.2025;[Epub] CrossRef
Angioembolization Has Similar Efficacy and Lower Total Charges than Preperitoneal Pelvic Packing in Patients With Pelvic Ring or Acetabulum Fractures
Aaron Singh, Travis Kotzur, Ezekial Koslosky, Rishi Gonuguntla, Lorenzo Canseco, David Momtaz, Ali Seifi, Case Martin
Journal of Orthopaedic Trauma.2024; 38(5): 254. CrossRef
Factors Associated With Pelvic Infection After Pre-Peritoneal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures
Jennifer E. Baker, Husayn A. Ladhani, Caitlyn McCall, Chelsea R. Horwood, Nicole L. Werner, Barry Platnick, Clay Cothren Burlew
Surgical Infections.2024; 25(5): 399. CrossRef
Comparison of Conventional versus Modified Preperitoneal Pelvic Packing in Patients with Bleeding Pelvic Fractures: A Single-Center Retrospective Pilot Study
Sebeom Jeon, Byungchul Yu, Gil Jae Lee, Min A Lee, Jungnam Lee, Kang Kook Choi
Journal of Clinical Medicine.2024; 13(14): 4062. CrossRef
Current Management of Hemodynamically Unstable Patients with Pelvic Fracture
Kevin Harrell, Chelsea Horwood, Clay Cothren Burlew
Current Surgery Reports.2023; 11(4): 92. CrossRef
Open Fixation After Preperitoneal Pelvic Packing Is Associated With a High Surgical Site Infection Rate
Ye Joon Kim, Bryan L. Scott, Fredric M. Pieracci, Ernest E. Moore, Cyril Mauffrey, Joshua A. Parry
Journal of Orthopaedic Trauma.2023; 37(11): 547. CrossRef
Extraperitoneal pelvic packing in trauma – a review
Sajad Ahmad Salati
Polish Journal of Surgery.2022; 95(3): 46. CrossRef

Surgery
Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study: Hye-Bin Kim, Sungwon Na, Hyo Chae Paik, Hyeji Joo, Jeongmin Kim; Acute Crit Care. 2021;36(2):99-108. Published online April 5, 2021; DOI: https://doi.org/10.4266/acc.2020.01144

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Abstract PDF

Background
Lung transplantation (LT) is an accepted therapeutic modality for end-stage lung disease patients. Intensive care unit (ICU) readmission is a risk factor for mortality after LT, for which consistent risk factors have not been elucidated. Thus, we investigated the risk factors for ICU readmission during index hospitalization after LT, particularly regarding the posttransplant condition of LT patients.
Methods
In this retrospective study, we investigated all adult patients undergoing LT between October 2012 and August 2017 at our institution. We collected perioperative data from electronic medical records such as demographics, comorbidities, laboratory findings, ICU readmission, and in-hospital mortality.
Results
We analyzed data for 130 patients. Thirty-two patients (24.6%) were readmitted to the ICU 47 times during index hospitalization. At the initial ICU discharge, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR], 1.464; 95% confidence interval [CI], 1.083−1.978; P=0.013) and pH (OR, 0.884; 95% CI, 0.813−0.962; P=0.004; when the pH value increases by 0.01) were related to ICU readmission using multivariable regression analysis and were still significant after adjusting for confounding factors. Thirteen patients (10%) died during the hospitalization period, and the number of ICU readmissions was a significant risk factor for in-hospital mortality. The most common causes of ICU readmission and in-hospital mortality were infection-related.
Conclusions
The SOFA score and pH were associated with increased risk of ICU readmission. Early postoperative management of these factors and thorough posttransplantation infection control can reduce ICU readmission and improve the prognosis of LT patients.

Citations

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Epidemiology of medical emergency team calls in patients undergoing lung transplantation
Judit Orosz, Vinodh Bhagyalakshmi Nanjayya, Greg Snell, Bronwyn Levvey, Helen Shingles, Samantha Ennis, David Pilcher, Daryl Jones
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Pharmacology
Inhalation sedation for postoperative patients in the intensive care unit: initial sevoflurane concentration and comparison of opioid use with propofol sedation: Seungho Jung, Sungwon Na, Hye Bin Kim, Hye Ji Joo, Jeongmin Kim; Acute Crit Care. 2020;35(3):197-204. Published online August 10, 2020; DOI: https://doi.org/10.4266/acc.2020.00213

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Abstract PDF

Background
Although the use of volatile sedatives in the intensive care unit (ICU) is increasing in Europe, it remains infrequent in Asia. Therefore, there are no clinical guidelines available. This study investigates the proper initial concentration of sevoflurane, a volatile sedative that induces a Richmond agitation-sedation scale (RASS) score of –2 to –3, in patients who underwent head and neck surgery with tracheostomy. We also compared the amount of postoperative opioid consumption between volatile and intravenous (IV) sedation.
Methods
We planned a prospective study to determine the proper initial sevoflurane concentration and a retrospective analysis to compare postoperative opioid consumption between volatile sedation and propofol sedation. Patients scheduled for head and neck surgery with tracheostomy and subsequent postoperative sedation in the ICU were enrolled.
Results
In this prospective study, the effective dose 50 (ED50) of initial end-tidal sevoflurane concentration was 0.36% (95% confidence interval [CI], 0.20 to 0.60%), while the ED 95 was 0.69% (95% CI, 0.60 to 0.75%) based on isotonic regression methods. In this retrospective study, remifentanil consumption during postoperative sedation was significantly lower in the sevoflurane group (2.52±1.00 µg/kg/hr, P=0.001) than it was in the IV propofol group (3.66±1.30 µg/kg/hr).
Conclusions
We determined the proper initial end-tidal concentration setting of sevoflurane for patients with tracheostomy who underwent head and neck surgery. Postoperative sedation with sevoflurane appears to be a valid and safe alternative to IV sedation with propofol.

Citations

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Sedación inhalatoria y su impacto en el uso de opioides en pacientes adultos críticamente enfermos sometidos a ventilación mecánica invasiva
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Sedation, Analgesia, and Neuromuscular Blockade
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Inhaled sedation versus propofol in respiratory failure in the ICU (INSPiRE-ICU2): study protocol for a multicenter randomized controlled trial
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José Alberto Leal Gámez, Jorge Rosendo Sánchez Medina, Reyna Isabel Azua Guevara
Medicina Crítica.2025; 39(1): 14. CrossRef
Volatile Anesthetic Sedation for Critically Ill Patients
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Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis
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Khaled Ahmed Yassen, Matthieu Jabaudon, Hussah Abdullah Alsultan, Haya Almousa, Dur I Shahwar, Fatimah Yousef Alhejji, Zainab Yaseen Aljaziri
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Review Article

Basic Science and Research
Two-photon intravital imaging of leukocyte migration during inflammation in the respiratory system: Young Min Kim, Soi Jeong, Young Ho Choe, Young-Min Hyun; Acute Crit Care. 2019;34(2):101-107. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00542

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Abstract PDF

Two-photon intravital imaging is a powerful method by which researchers are able to directly observe biological phenomena in live organisms. Researchers in various biomedical research fields have applied two-photon imaging to a variety of target organs by utilizing this technology’s ability to penetrate to significant depths with minimal phototoxicity. The mouse respiratory system in inflammation models is a good example, as two-photon intravital imaging can provide insights as to how the immune system is activated in response to inflammation within the respiratory system. Inflammation models can be generated via influenza viral, bacterial, or lipopolysaccharide injection. To exteriorize the lungs or trachea, thoracotomy or tracheotomy is performed, respectively; the appropriate combination of inflammation induction and organ exposure is selected depending on the study purpose. On the other hand, visualizing the movement of leukocytes is also an important component; to this end, immune cell populations of interest are either labeled via the genetic attachment of fluorescent proteins or stained with antibodies or dyes. With the proper selection of methods at each step, twophoton intravital imaging can yield visual evidence regarding immune responses to inflammation.

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Case Report

Pulmonary
Lung injury associated with inhalation of effective microorganism blends: Jee-min Kim, Yoon Jin Kwak, Ho Il Yoon; Acute Crit Care. 2020;35(2):122-126. Published online April 8, 2019; DOI: https://doi.org/10.4266/acc.2018.00332

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Abstract PDF: Since 2009, effective microorganisms (EMs) have been supplied by the local government to the citizens of Seongnam, Korea, for various environment-protective uses including manufacturing detergents, cosmetics and humidifier disinfectants. A 68-year-old man who had placed an EM blends into a humidifier for inhalation visited the emergency room with complaints of fever and dyspnea. He was in a shock state with hypoxia. Chest computed tomography revealed diffuse ground-glass opacities that were dominant in the bilateral upper lobes. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy was performed. Bronchoalveolar lavage fluid analysis and biopsy findings were consistent with alveolar hemorrhage. All microbiological and virological test results were negative. His symptoms and radiographic opacities had improved markedly after several days of conservative care, and he was discharged healthy after 1 week of hospital stay.

Review Articles

Pulmonary
Critical Care before Lung Transplantation: Jin Gu Lee, Moo Suk Park, Su Jin Jeong, Song Yee Kim, Sungwon Na, Jeongmin Kim, Hyo Chae Paik; Acute Crit Care. 2018;33(4):197-205. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00367

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Abstract PDF

Lung transplantation is widely accepted as the only viable treatment option for patients with end-stage lung disease. However, the imbalance between the number of suitable donor lungs available and the number of possible candidates often results in intensive care unit (ICU) admission for the latter. In the ICU setting, critical care is essential to keep these patients alive and to successfully bridge to lung transplantation. Proper management in the ICU is also one of the key factors supporting long-term success following transplantation. Critical care includes the provision of respiratory support such as mechanical ventilation (MV) and extracorporeal life support (ECLS). Accordingly, a working knowledge of the common critical care issues related to these unique patients and the early recognition and management of problems that arise before and after transplantation in the ICU setting are crucial for long-term success. In this review, we discuss the management and selection of candidates for lung transplantation as well as existing respiratory support strategies that involve MV and ECLS in the ICU setting.

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Optimizing the prelung transplant candidate
John Pagteilan, Scott Atay
Current Opinion in Organ Transplantation.2024; 29(1): 37. CrossRef
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Recipient Management before Lung Transplantation
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Outcomes of Patients on the Lung Transplantation Waitlist in Korea: A Korean Network for Organ Sharing Data Analysis
Hye Ju Yeo, Dong Kyu Oh, Woo Sik Yu, Sun Mi Choi, Kyeongman Jeon, Mihyang Ha, Jin Gu Lee, Woo Hyun Cho, Young Tae Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation
Nam Eun Kim, Ala Woo, Song Yee Kim, Ah Young Leem, Youngmok Park, Se Hyun Kwak, Seung Hyun Yong, Kyungsoo Chung, Moo Suk Park, Young Sam Kim, Ha Eun Kim, Jin Gu Lee, Hyo Chae Paik, Su Hwan Lee
Respiratory Research.2021;[Epub] CrossRef

Pulmonary
Critical Care after Lung Transplantation: Song Yee Kim, Su Jin Jeong, Jin Gu Lee, Moo Suk Park, Hyo Chae Paik, Sungwon Na, Jeongmin Kim; Acute Crit Care. 2018;33(4):206-215. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00360

24,963 View
795 Download
12 Web of Science
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Abstract PDF

Since the first successful lung transplantation in 1983, there have been many advances in the field. Nevertheless, the latest data from the International Society for Heart and Lung Transplantation revealed that the risk of death from transplantation is 9%. Various aspects of postoperative management, including mechanical ventilation, could affect intensive care unit stay, hospital stay, and immediate postoperative morbidity and mortality. Complications such as reperfusion injury, graft rejection, infection, and dehiscence of anastomosis increase fatal adverse side effects immediately after surgery. In this article, we review the possible immediate complications after lung transplantation and summarize current knowledge on prevention and treatment.

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More is not better: The role of the leukocyte filter in ex vivo lung perfusion
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The Spectrum of Mitral Regurgitation in Lung Transplant Recipients: A Systematic Review
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Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study
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Journal of Fungi.2023; 9(5): 527. CrossRef
Nontuberculous mycobacterial infection after lung transplantation: A single-center experience in South Korea
Youngmok Park, Nam Eun Kim, Se Hyun Kwak, Moo Suk Park, Su Jin Jeong, Jin Gu Lee, Hyo Chae Paik, Song Yee Kim, Young Ae Kang
Journal of Microbiology, Immunology and Infection.2022; 55(1): 123. CrossRef
Medical Complications of Lung Transplantation
Moo Suk Park
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Roles of electrical impedance tomography in lung transplantation
Hui Jiang, Yijiao Han, Xia Zheng, Qiang Fang
Frontiers in Physiology.2022;[Epub] CrossRef
Perioperative anidulafungin combined with triazole prophylaxis for the prevention of early invasive candidiasis in lung transplant recipients
Emily Sartain, Kelly Schoeppler, Barrett Crowther, Joshua B. Smith, Maheen Z. Abidi, Todd J. Grazia, Mark Steele, Terri Gleason, Krista Porter, Alice Gray
Transplant Infectious Disease.2021;[Epub] CrossRef
The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients—A Retrospective Cohort Study in South Korea
Yae-Jee Baek, Yun-Suk Cho, Moo-Hyun Kim, Jong-Hoon Hyun, Yu-Jin Sohn, Song-Yee Kim, Su-Jin Jeong, Moo-Suk Park, Jin-Gu Lee, Hyo-Chae Paik
Journal of Fungi.2021; 7(8): 639. CrossRef
Panel-Reactive and Donor-Specific Antibodies before Lung Transplantation can Affect Outcomes in Korean Patients Receiving Lung Transplantation
Sung Woo Moon, Moo Suk Park, Jin Gu Lee, Hyo Chae Paik, Young Tae Kim, Hyun Joo Lee, Samina Park, Sun Mi Choi, Do Hyung Kim, Woo Hyun Cho, Hye Ju Yeo, Seung-il Park, Se Hoon Choi, Sang-Bum Hong, Tae Sun Shim, Kyung-Wook Jo, Kyeongman Jeon, Byeong-Ho Jeong
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A proof-of principal study using phase-contrast imaging for the detection of large airway pathologies after lung transplantation
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Letter to the Editor

Neurology/Obstetric
Myotonic Dystrophy Confirmed after Cesarean Section: Seung Hyun Kim, Jeongmin Kim, Taehoon Ha, Sungwon Na; Korean J Crit Care Med. 2017;32(1):81-82. Published online February 17, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00864

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Maternal health and obstetric complications of genetic neuromuscular disorders in pregnancy: A systematic review
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European Journal of Obstetrics & Gynecology and Reproductive Biology.2025; 304: 152. CrossRef

Original Article

Neurology
The Effect of Electrical Muscle Stimulation and In-bed Cycling on Muscle Strength and Mass of Mechanically Ventilated Patients: A Pilot Study: Kyeongyoon Woo, Jeongmin Kim, Hye Bin Kim, Hyunwoo, Choi, Kibum Kim, Donghyung Lee, Sungwon Na; Acute Crit Care. 2018;33(1):16-22. Published online February 14, 2017; DOI: https://doi.org/10.4266/acc.2017.00542

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Abstract PDF

Background
Critically ill patients experience muscle weakness, which leads to functional disability. Both functional electrical stimulation (FES) and in-bed cycling can be an alternative measure for intensive care unit (ICU) patients who are not feasible for active exercise. The aim of this study was to examine whether FES and in-bed cycling have a positive effect on muscle mass in ICU patients.
Methods
Critically ill patients who received mechanical ventilation for at least 24 hours were included. After passive range of motion exercise, in-bed cycling was applied for 20 minutes, and FES was applied for 20 minutes on the left leg. The right leg received in-bed cycling and the left leg received both FES and in-bed cycling. Thigh circumferences and rectus femoris cross-sectional area (CSA) were assessed with ultrasonography before and after the intervention. Muscle strength was assessed by Medical Research Council scale.
Results
A total of 10 patients were enrolled in this study as a pilot study. Before and after the intervention, the CSA of right rectus femoris increased from 5.08 ± 1.51 cm² to 6.01 ± 2.21 cm² , which was statistically significant (P = 0.003). The thigh circumference was also increased and statistically significant (P = 0.006). There was no difference between left and right in regard to FES application. There is no significant change in muscle strength before and after the intervention (right and left, P = 0.317 and P = 0.368, respectively).
Conclusions
In-bed cycling increased thigh circumferences rectus femoris CSA. Adding FES did not show differences.

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Nutrition in Clinical Practice.2018; 33(6): 772. CrossRef

Case Reports

Neurosurgery/Hematology
Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis: Hyun Jin Baek, Doo Hyuk Lee, Kyu Hyung Han, Young Min Kim, Hyunbeom Kim, Byeongwook Cho, Inkuk Lee, Kanghyun Choi, Hojin Yong, Goohyeon Hong; Korean J Crit Care Med. 2016;31(2):134-139. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.134

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Abstract PDF

In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.

Citations

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Abdominal mass in a septic infant: Case of a fatal intraluminal intestinal hematoma
Mana Taweevisit, Paul Scott Thorner
Pediatric Hematology Oncology Journal.2021; 6(3): 139. CrossRef
Perforated Mesenteric Cyst with Sepsis and Neurological Complication in a 9 Month Old Child
Mandal KC, Saha D, Halder P, Chakraborty P, Debnath B, Mukhopadhyay B
Asploro Journal of Pediatrics and Child Health.2020; 2(1): 30. CrossRef

Pharmacology
Recurrent Desaturation Events due to Opioid-Induced Chest Wall Rigidity after Low Dose Fentanyl Administration: Sung Yeon Ham, Bo Ra Lee, Taehoon Ha, Jeongmin Kim, Sungwon Na; Korean J Crit Care Med. 2016;31(2):118-122. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.118

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Abstract PDF

Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.

Citations

Citations to this article as recorded by

Fentanyl-Induced Chest Wall Rigidity Causing Recurrent Ventilator Dyssynchrony in the Intensive Care Unit: A Case Report
Abdiwali Hussein, Fathi Yusuf
International Medical Case Reports Journal.2026; Volume 19: 1. CrossRef
Life-threatening fentanyl overdose beyond medullary depression in breathing
Annick Judenherc-Haouzi, Tristan Lewis, Amanda Reinhardt, Philippe Haouzi
American Journal of Physiology-Regulatory, Integrative and Comparative Physiology.2025; 328(3): R408. CrossRef
Fentanyl-Induced Rigid Chest Syndrome in Critically Ill Patients
Alison J. Tammen, Donald Brescia, Dan Jonas, Jeremy L. Hodges, Philip Keith
Journal of Intensive Care Medicine.2023; 38(2): 196. CrossRef
Effects of fentanyl overdose-induced muscle rigidity and dexmedetomidine on respiratory mechanics and pulmonary gas exchange in sedated rats
Philippe Haouzi, Nicole Tubbs
Journal of Applied Physiology.2022; 132(6): 1407. CrossRef
Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review
Kunal Karamchandani, Rajeev Dalal, Jina Patel, Puneet Modgil, Ashley Quintili
Current Anesthesiology Reports.2021; 11(2): 107. CrossRef
A Case of Masseter Muscle Rigidity during Awake Intubation under Remifentanil Infusion
Tomoki YAMAGA, Takeshi NEGITA, Masayo SUGIURA, Nobuyuki KIMURA
THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA.2019; 39(3): 274. CrossRef
Opioids and Chest Wall Rigidity During Mechanical Ventilation
Jeffrey P. Roan, Navin Bajaj, Field A. Davis, Natalie Kandinata
Annals of Internal Medicine.2018; 168(9): 678. CrossRef

Neurology/Liver
Non-Convulsive Status Epilepticus following Liver Transplantation: Bora Lee, Nar Hyun Min, Sung Yeon Ham, Sungwon Na, Jeongmin Kim; Korean J Crit Care Med. 2016;31(1):49-53. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.49

9,691 View
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Abstract

Neurological complications following liver transplantation are more common than after other organ transplants. These complications include seizure in about 8% of cases, which is associated with morbidity and mortality. Seizure should be treated immediately, and the process of differential diagnosis has to be performed appropriately in order to avoid permanent neurologic deficit. We herein report a case of status epilepticus after liver transplantation. The status epilepticus was treated promptly and the cause of seizure was assessed. The patient was discharged without any complication.

Citations

Citations to this article as recorded by

Neurological Complications After Pediatric Liver and Kidney Transplantation: A Comprehensive Review of Acute Symptomatic Seizures
Konstantin Semash, Timur Dzhanbekov, Mansur Nasirov, Bakhtiyorjon Umarov, Navruz Qambarov, Bakhtiyor Khamdamov
Pediatric Transplantation.2026;[Epub] CrossRef
Early postoperative seizures in liver and kidney recipients
O. M. Tsirulnikova, A. V. Syrkina, I. A. Miloserdov, I. E. Pashkova, S. Yu. Oleshkevich, I. B. Komarova
Russian Journal of Transplantology and Artificial Organs.2021; 23(2): 158. CrossRef

Original Article

Pulmonary/Cardiology
Perioperative Risk Factors associated with Immediate Postoperative Extracorporeal Membrane Oxygenation in Lung Transplants: Ha Yeon Kim, Sungwon Na, Hyo Chae Paik, Jonglin Ha, Jeongmin Kim; Korean J Crit Care Med. 2015;30(4):286-294. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.286

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Abstract PDF

Background
Extracorporeal membrane oxygenation (ECMO) is administered for a few days after lung transplantation (LTx) in recipients who are expected to have early graft dysfunction. Despite its life-saving potential, immediate postoperative ECMO has life-threatening complications such as postoperative bleeding. We investigated the risk factors related to the use of immediate postoperative ECMO.
Methods
We retrospectively reviewed the records of 60 LTx patients who were at our institution from October 2012 to May 2015. Perioperative variables associated with postoperative ECMO were compared between the two groups.
Results
There were 26 patients who received postoperative ECMO (ECMO group) and 34 patients who did not (control group). Multivariate regression analysis revealed preoperative ECMO (odds ratio [OR] 12.55, 95% confidence intervals [CI] 1.34 – 117.24, p = 0.027) and lower peripheral pulse oxymetry saturation (SpO₂) at the end of surgery (OR 0.71, 95% CI 0.54 – 0.95, p = 0.019) were independent risk factors for postoperative ECMO in LTx patients. The incidences of complications, such as re-operation, tracheostomy, renal failure and postoperative atrial fibrillation, were higher in the ECMO group. There was no difference in the duration of postoperative intensive care unit stay or postoperative 30-day mortality between the two groups.
Conclusions
The preoperative ECMO and lower SpO₂ at the end of surgery were associated with postoperative ECMO. Further, postoperative adverse events were higher in the ECMO group compared with the control group. This study suggests that determination of postoperative ECMO requires careful consideration because of the risks of postoperative ECMO in LTx patients.

Citations

Citations to this article as recorded by

The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
Ji Young Lee
Korean Journal of Critical Care Medicine.2016; 31(2): 73. CrossRef

Case Reports

Gastroenterology
Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit?: Taehyun Kim, Seong Min Kim, Sung Birm Sohn, Yeon Ho Lee, Sang Youn Lim, Jae Kyeom Sim; Korean J Crit Care Med. 2015;30(3):231-233. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.231

41,398 View
244 Download
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Abstract PDF

Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.

Citations

Citations to this article as recorded by

Nasogastric Tube Syndrome in the Neurosurgical Intensive Care Unit: A Case Report
Revikrishnan Sreekumar, Anjane S. Surendran, Manikandan Sethuraman
Journal of Neuroanaesthesiology and Critical Care.2026;[Epub] CrossRef
Nasogastric tube syndrome: A Meta-summary of case reports
Deven Juneja, Prashant Nasa, Gunjan Chanchalani, Ravi Jain
World Journal of Clinical Cases.2024; 12(1): 119. CrossRef

Neurology/Liver
Fixed Pupillary Light Reflex due to Peripheral Neuropathy after Liver Transplantation: Kwan Hyung Kim, Namo Kim, Sungwon Na, Jaewon Jang, Jeongmin Kim; Korean J Crit Care Med. 2015;30(3):191-195. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.191

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Abstract PDF: A 46- year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.

Cardiology/Anesthesiology
Early Extracorporeal Membrane Oxygenation for Massive Aspiration during Anesthesia Induction: Namo Kim, Kwan Hyung Kim, Jeong Min Kim, Su Youn Choi, Sungwon Na; Korean J Crit Care Med. 2015;30(2):109-114. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.109

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Abstract PDF

Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.

Citations

Citations to this article as recorded by

Massive aspiration syndrome: a possible indication for “emergent” veno-venous extracorporeal membrane oxygenation?: a case report
Emiliano Gamberini, Venerino Poletti, Emanuele Russo, Alessandro Circelli, Marco Benni, Giovanni Scognamiglio, Domenico Pietro Santonastaso, Costanza Martino, Linda Domenichini, Romina Biondi, Giorgia Bastoni, Etrusca Brogi, Luca Ansaloni, Federico Coccol
Journal of Medical Case Reports.2021;[Epub] CrossRef
Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer
Jangwhan Jo, Yang Gi Ryu
Korean Journal of Critical Care Medicine.2016; 31(2): 156. CrossRef

Pharmacology
Green Urine after Propofol Infusion in the Intensive Care Unit: Min Jeong Lee, Hyun Jeong Lee, Jeong Min Kim, Shin Ok Koh, Eun Ho Kim, Sungwon Na; Korean J Crit Care Med. 2014;29(4):328-330. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.328

18,582 View
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Abstract PDF

Urine discoloration occurs in the intensive care unit (ICU) due to many causes such as medications, metabolic disorders, and infections. Propofol is advocated as one of the first line sedatives in the ICU, but it is not well known to the intensivists that propofol can induce urine color change. We experienced two cases of green urine after propofol infusion. Propofol should be warranted as the cause of urine discoloration during ICU stay.

Citations

Citations to this article as recorded by

An unusual instance of propofol-triggered green urine in anesthesia management: A case report
Madhusoodan M Gonenavar, Sudhanshu Shukla, Tejashree Sridhar, Rashmi Prasad, Rudresh Tabali
MGM Journal of Medical Sciences.2024; 11(1): 165. CrossRef
Propofol-Associated Urine Discoloration: Systematic Literature Review
Ana Lasica, Cinzia Cortesi, Gregorio P. Milani, Mario G. Bianchetti, Federica M. Schera, Pietro Camozzi, Sebastiano A.G. Lava
Pharmacology.2023; 108(5): 415. CrossRef
Green urine after general anesthesia with propofol: different responses in the same patient -A case report-
Go Eun Kim, Dae Yoon Kim, Doek Kyu Yoo, Jong-Hwan Lee, Sangmin Maria Lee, Jeong Jin Min
Anesthesia and Pain Medicine.2017; 12(1): 32. CrossRef

Original Articles

Pulmonary
Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index: Sarah Soh, Jin Ha Park, Jeong Min Kim, Min Jung Lee, Shin Ok Koh, Hyo Chae Paik, Moo Suk Park, Sungwon Na; Korean J Crit Care Med. 2014;29(4):273-280. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.273

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Abstract PDF: BACKGROUND
Weaning from mechanical ventilation is difficult in the intensive care unit (ICU). Many controversial questions remain unanswered concerning the predictors of weaning failure. This study investigates patient characteristics and delayed weaning after lung transplantation.
METHODS
This study retrospectively reviewed the medical records of 17 lung transplantation patients from October 2012 to December 2013. Patients able to be weaned from mechanical ventilation within 8 days after surgery were assigned to an early group (n = 9), and the rest of the patients were assigned to the delayed group (n=8). Patients' intraoperative and postoperative characteristics were collected and analyzed, and conventional weaning predictors, including rapid shallow breathing index (RSBI), were also assessed.
RESULTS
The results of the early group showed a significantly shorter ICU stay in addition to a shorter hospitalization overall. Notably, the early group had a higher body mass index (BMI) than the delayed group (20.7 vs. 16.9, p = 0.004). In addition, reopening occurred more frequently in the delayed group (1/9 vs. 5/8, p = 0.05). During spontaneous breathing trials, tidal volume (TV) and arterial oxygen tension were significantly higher in the early group compared to the delayed weaning group, but differences in RSBI and respiratory rate (RR) between groups were not statistically significant.
CONCLUSIONS
Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.

Infection
Implementing a Sepsis Resuscitation Bundle Improved Clinical Outcome: A Before-and-After Study: Jeongmin Kim, Sungwon Na, Young Chul Yoo, Shin Ok Koh; Korean J Crit Care Med. 2014;29(4):250-256. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.250

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Abstract PDF

BACKGROUND
Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock.
METHODS
Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated.
RESULTS
The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004).
CONCLUSIONS
Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.

Citations

Citations to this article as recorded by

Hypotension Prediction Index and Incidence of Perioperative Hypotension: A Single-Center Propensity-Score-Matched Analysis
Julian Runge, Jessica Graw, Carla D. Grundmann, Thomas Komanek, Jan M. Wischermann, Ulrich H. Frey
Journal of Clinical Medicine.2023; 12(17): 5479. CrossRef
Hemodynamic monitoring with Hypotension Prediction Index versus arterial waveform analysis alone and incidence of perioperative hypotension
Carla D. Grundmann, Jan M. Wischermann, Philipp Fassbender, Petra Bischoff, Ulrich H. Frey
Acta Anaesthesiologica Scandinavica.2021; 65(10): 1404. CrossRef
Barriers to Clinical Practice Guideline Implementation for Septic Patients in the Emergency Department
Elizabeth N. Reich, Karen L. Then, James A. Rankin
Journal of Emergency Nursing.2018; 44(6): 552. CrossRef

Case Reports

Sedation with Dexmedetomidine during Tracheostomy in Severe Tracheal Stenotic Patients: Injung Jun, Kye Min Kim, Sang Seok Lee, Byung Hoon Yoo, Yoo Yong Lee, Yun Hee Lim, Se Jin Song, Mun Cheol Kim; Korean J Crit Care Med. 2013;28(4):314-317.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.314

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Abstract PDF

In patients with severely compromised airways, a tracheostomy is usually performed under local anesthesia. Dexmedetomidine can be a better choice of sedative for such patients because it causes minimal respiratory depression. We report two cases of patients with severe stenosis of the airways who underwent sedation with dexmedetomidine during tracheostomy under local anesthesia. In the first case, recurrent laryngeal cancer caused laryngeal stenosis, and the narrowest laryngeal width was less than 3 mm. In the second case, the tracheostomy opening site was narrowed to a diameter of 3.4 mm in a patient with a history of total laryngectomy. For both patients, sedation was induced by dexmedetomidine infusion and the tracheostomy was performed successfully under local anesthesia without any events. Dexmedetomidine seems to be an effective and safe sedative for tracheostomies in patients with critical airways. The management and implications of sedation with dexmedetomidine in the patients with severe stenotic airways are discussed.

Citations

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Dexmedetomidine and Emergency Front of Neck Access for Acute Stridor in Advanced Laryngeal Carcinoma
Neelakshi Koul, Uma Hariharan, Amit Kumar, Nidhi Yadav, Vijay Kumar Nagpal
Journal of Indian College of Anaesthesiologists.2022; 1(1): 30. CrossRef
Comment contrôler les voies aériennes en présence de masses cervicomédiastinales ?
Fabien Espitalier, Marc Laffon
Le Praticien en Anesthésie Réanimation.2015; 19(4): 172. CrossRef

Esophageal-Retroesophageal Right Subclavian Artery Fistula: A Case Report: Jin Ho Choi, Chun Sung Byun, Seong Min Kim, Jung Joo Hwang; Korean J Crit Care Med. 2012;27(3):179-181.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.179

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Abstract PDF: Fistula between retroesophageal subclavian artery and esophagus is rare but a fatal complication. The purpose of this case study is to describe a case of 47-year old male presented with intracranial hemorrhage being required a long stay in the intensive care unit and to demonstrate the importance of surveillance patients requiring prolonged nasogastric tube. Recognition of this aberrant artery is critical for the prevention of these catastrophic events.

H1N1 Influenza/A Associated ARDS Recovered without Mechanical Ventilatory Support: A Case Report: Byung Ook Lee, Jae Hee Lee, Sung Woon Park, Bo Min Kim, Jae Chol Choi, Jong Wook Shin, In Won Park, Byoung Whui Choi, Jae Yeol Kim; Korean J Crit Care Med. 2011;26(2):114-116.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.114

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Abstract PDF: An eighteen year-old female visited the ER in our hospital with fever of 38.5degrees C for 2 days. She also had cough, myalgia, and dyspnea. Chest PA and lung HRCT showed mild pulmonary edema at both hilar areas. However, she had severe hypoxia (PaO2; 58 mmHg in room air). RT-PCR for H1N1 influenza/A of pharyngeal swab was positive. Tamiflu (150 mg/d) with broad-spectrum antibiotics was prescribed. Two days later, her dyspnea aggravated and chest PA showed diffuse bilateral infiltration. PaO2 dropped to 70 mmHg (O2 10 L/min by face mask with reservoir bag). She was transferred to the MICU and the Tamiflu dose was doubled (300 mg/day). Mechanical ventilator was set aside to prepare respiratory failure. Fortunately, her symptoms and oxygenation improved and she was discharged with full recovery. Although, most cases of ARDS require mechanical ventilatory support, early and adequate dose of Tamiflu may avoid it in the case of ARDS developed by H1N1 influenza/A.

Original Articles

Effect of 6% Hydroxyethyl Starch Solution on Coagulation Function in Patients with Major Burns: In Suk Kwak, Ji Yeong Bae, Kwang Min Kim; Korean J Crit Care Med. 2008;23(2):79-83.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.79

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Abstract PDF: BACKGROUND
Patients with major burns require replacement of intravascular volume. Hydroxyethyl starch (HES) solutions are widely used to replace intravascular volume. Dilution with crystalloids or colloids and corresponding platelet dysfunction are known causes of perioperative bleeding tendencies. The aim of the current study was to evaluate the effect of crystalloid and colloid solutions on platelet function in patients with major burns.
METHODS
Forty patients scheduled for burn surgery were divided into 4 groups. The infusion was started with a Hartman solution infusion (group 1) from 7 A.M. until surgery. HES (6%, Voluven(R)) was infused in the following concentrations: 7 ml/kg (group 2), 10 ml/kg (group 3), and 15 ml/kg (group 4). The bleeding time (BT), prothrombin time (PT), prothrombin time international ratio (PT INR), activated partial thromboplastin time (aPTT), hemoglobin (Hb), platelet function analyzer-100 closing time (PFA CT), and platelet count (Plt) were measured.
RESULTS
Hartmann solution and HES had no significant effect on the BT, PT, PT INR, a PTT, Hb, and Plt. The post-operative PFA CT was significantly higher in group 4 than in group 3. In group 4, the PFA CT was significantly higher post-operatively compared to pre-operatively.
CONCLUSIONS
The use of high dose HES may increase the risk of bleeding tendencies in burn patients.

Clinical Study for Monitored Anesthesia Undergoing Ophthalmic Surgery: Jeong Won Lee, Suk Hun Yoon, Tae Seong Kim, Hyun Soo Kim, Kwang Min Kim; Korean J Crit Care Med. 1997;12(1):37-42.

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Abstract PDF: Intoduction: The phrase "Monitored Anesthesia Care" refers to instances in which an anesthesiologist has been called upon to provide specific anesthesia services to a particular patient understanding a planned procedure, in connection with which a patient receives local anesthesia. Monitored anesthesia care is being increasingly used in the 1990s for a wide variety of diagnostic and therapeutic procedure. The primary objective in providing monitored anesthesia care is to ensure patient comfort and safety.
METHOD
We classified patients in three groups by premedication and oxygen administration, no premedication and no oxygen administration (group A), premedication and oxygen administration (group B), premedication and no oxygen administration (group C), measured vital signs and SpO2 (peripheral oxygen saturation) from just before operation, and checked the satisfaction score of surgeon and patients.
RESULT
SpO2 and satisfaction score of surgeon and patients are the best at premedication and oxygen administration group.
CONCLUSION
Monitored anesthesia is assumed to give more comfort and safety to patients than local anesthesia alone.

The Effects of Mild Hypothermia on the Expression of the Apoptosis-related Proteins following Transient Global Ischemia in Gerbil Hippocampus: Young Min Kim, Kyu Nam Park, Seung Pil Choi, Tai Yong Hong, Se Kyung Kim; Korean J Crit Care Med. 2007;22(1):30-41.

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Abstract PDF: BACKGROUND
The neuroprotective mechanisms of hypothermia remain unclear. Recently, attenuation of apoptosis by hypothermia has been suggested as one of the responsible mechanisms. The aim of this study is to investigate the effects of post-ischemic hypothermia on apoptotic neuronal death as well as expression of some apoptosis-related proteins in a gerbil transient global ischemia model.
METHODS
Following 5 minutes of ischemia, normothermia (NT, 37+/-0.5degrees C) or mild hypothermia (HT, 33+/-0.5degrees C) was immediately induced and maintained for 3 hours. The hippocampal CA1 neurons were examined on day 2, 3, 4, and 7 after ischemia for the survived neuronal densities, DNA nick end labeling and immunohistochemical expressions of Bcl-2, Bax, and caspase 3 in each group. Additionally, DNA gel electrophoresis and western blot analysis for each protein in hippocampus were performed. RESULTS: The neuronal death in CA1 area on day 3, 4, and 7 was significantly reduced in HT group compared to NT group. The number of TUNEL positive cells in HT group was also significantly reduced than NT group on day 3, 4, and 7. DNA laddering of hippocampus on day 4 and 7 also reduced in HT group. Expressions of Bax on days 2, 3 and activated caspase 3 on days 3, 4 were reduced in HT group. Western blots also disclosed a decrease in the intensity of the Bax on day 2 and 3 in HT group compared to NT group. CONCLUSIONS: These results suggest that mild post-ischemic hypothermia attenuates the apoptotic neuronal death through the inhibition of the intrinsic pathway of caspase activation following transient global ischemia and these effects may be related to a reduction of pro-apoptotic events.

The clinical survey of ICU patients (1981. 3.1-1991. 2.28): Kyung Min Kim, Shin Ok Koh, Soon Ho Nam, Jin Ho Kim, Jong Rae Kim, Hung Kun Oh, Kwang Won Park; Korean J Crit Care Med. 1992;7(2):113-119.

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Abstract PDF: No abstract available.

Research activities for postgraduates in anesthesiology: researchtraining programs in Korea-: Kwang Min Kim; Korean J Crit Care Med. 1991;6(1):57-65.

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Abstract PDF: No abstract available.

Electrolyte and Gas Analysis from Dorsal Vein of Hand during General Inhalational Anesthesia: Keon Kang, Se Hun Park, Chul Ho Shin, Soon Eun Park, Young Min Kim, Dae Woo Kim, Young Woo Cho; Korean J Crit Care Med. 2005;20(1):76-81.

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Abstract PDF: BACKGROUND
To assess the acid-base status and to measure PO2 and PCO2, arterial blood gases (ABG) has been checked usually. We compared the venous blood gases (VBG) from dorsal vein of hand to ABG from radial artery, and tried to determine whether venous blood gas analysis (VBGA) could be the alternative of ABGA. METHODS: Thirty patients who needed continuous arterial pressure monitoring were chosen. At the completion of stability of HR and BP after induction of general inhalational anesthesia, the ABG from radial artery and VBG from dorsal vein of hand were compared. RESULTS: Laboratory findings were as follows (mean+/-SD): arterial pH, 7.44+/-0.04; venous pH, 7.43+/-0.04; arterial HCO3-, 25.56+/-2.39 mmol/L; venous HCO3-, 25.51+/-2.09 mmol/L. The mean values of arterial and venous PO2 were significantly different (247.8+/-48.9 mmHg versus 187.8+/-41.6 mmHg), but the arterial and venous PO2 values were significantly correlated (r=0.706). The PCO2 (r= 0.883), pH (r=0.912), and HCO3- (r=0.901) values, and base excesses of arterial and venous blood (r=0.926) were highly correlated. Also, arterial and venous serum electrolyte (sodium, potassium, and calcium) were highly correlated. CONCLUSIONS: Venous blood gas analysis from dorsal vein of hand can be effectively used as the alternative method to evaluate the acid-base status, PO2, and PCO2, instead of ABGA during general inhalational anesthesia.

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