Acute and Critical Care

Original Articles

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

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

Citations

Citations to this article as recorded by

Outcomes of Acute Respiratory Failure in Patients With Cancer in the United States
Kiyan Heybati, Jiawen Deng, Archis Bhandarkar, Fangwen Zhou, Cameron Zamanian, Namrata Arya, Mohamad Bydon, Philippe R. Bauer, Ognjen Gajic, Allan J. Walkey, Hemang Yadav
Mayo Clinic Proceedings.2024; 99(4): 578. CrossRef
Characteristics and outcomes of cancer patients admitted to intensive care units in cancer specialized hospitals in China
Wensheng Liu, Dongmin Zhou, Li Zhang, Mingguang Huang, Rongxi Quan, Rui Xia, Yong Ye, Guoxing Zhang, Zhuping Shen
Journal of Cancer Research and Clinical Oncology.2024;[Epub] CrossRef
Short-term and long-term outcomes of critically ill patients with solid malignancy: a retrospective cohort study
Su Yeon Lee, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim, Jee Hwan Ahn
The Korean Journal of Internal Medicine.2024; 39(6): 957. CrossRef
Predictors of ICU mortality in patients with hemoblastosis and infectious complications
A.V. Lyanguzov, A.S. Luchinin, S.V. Ignatyev, I.V. Paramonov
Anesteziologiya i reanimatologiya.2023; (1): 33. CrossRef
Effect of the underlying malignancy on critically ill septic patient's outcome
Man‐Yee Man, Hoi‐Ping Shum, Sin‐Man Lam, Jacky Li, Wing‐Wa Yan, Mei‐Wan Yeung
Asia-Pacific Journal of Clinical Oncology.2022; 18(4): 473. CrossRef
Impacts of Corticosteroid Therapy at Acute Stage of Hospital-Onset Clostridioides difficile Infections
Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
Infection and Drug Resistance.2022; Volume 15: 5387. CrossRef
Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy
Da Woon Kim, Geum Suk Jang, Kyoung Suk Jung, Hyuk Jae Jung, Hyo Jin Kim, Harin Rhee, Eun Young Seong, Sang Heon Song
Kidney Research and Clinical Practice.2022; 41(6): 717. CrossRef
A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs
Lama H. Nazer, Maria A. Lopez-Olivo, Anne Rain Brown, John A. Cuenca, Michael Sirimaturos, Khader Habash, Nada AlQadheeb, Heather May, Victoria Milano, Amy Taylor, Joseph L. Nates
Critical Care Explorations.2022; 4(9): e0757. CrossRef
Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study
Jigeeshu Divatia, Amit M Narkhede, Harish K Chaudhari, Ujwal Dhundi, Natesh Prabu Ravisankar, Satish Sarode
Indian Journal of Critical Care Medicine.2021; 25(12): 1421. CrossRef

Ethics
Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units: Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na; Korean J Crit Care Med. 2015;30(2):73-81. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.73

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Abstract PDF Supplementary Material

Background
The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). Methods: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. Results: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient’s loss of decision-making capacity. Decisions were made most frequently by the patient’s son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). Conclusions: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.

Citations

Citations to this article as recorded by

Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
Acute and Critical Care.2020; 35(3): 179. CrossRef
Family-Clinician Communication About End-of-Life Care in Korea
Minjeong Jo, Yang-Sook Yoo, George Knafl, Marcia Van Riper, Linda Beeber, Mi-Kyung Song
Journal of Hospice & Palliative Nursing.2017; 19(6): 597. CrossRef

Case Report

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

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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

Hematology/Obstetric
Acute Myeloid Leukemia in Suspected Sepsis after Caesarean Section: Myoung Hwa Kim, Sung Won Na, Shin Ok Koh, Eun Jung Kim, Hye Jin Yoon, Yong Jae Lee, Hee Young Cho; Korean J Crit Care Med. 2014;29(2):99-104. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.99

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Abstract PDF: The incidence of acute leukemia during pregnancy is extremely rare, and often it is not easy to differentiate it from other diseases associated with pregnancy such as sepsis or hemorrhage. Pregnancy itself is not known to affect the natural course of leukemia; however, complications of leukemia like anemia, infections, and coagulopathy can adversely influence both the fetus and the mother. In this case, a pregnant patient misdiagnosed with septic shock and severe leukocytosis was correctly diagnosed with acute myeloid leukemia after surgical delivery.

Cardiology/Pulmonary
One Hundred Seven Days of ECMO as a Bridge to Lung Transplantation: The Longest Duration Among Elderly Patients: Eun Jung Kim, Hyo Chae Paik, Moo Suk Park, Myung Hwa Kim, Shin Ok Koh, You Jin Lee, Sungwon Na; Korean J Crit Care Med. 2014;29(1):48-51. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.48

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Abstract PDF

Extracorporeal membrane oxygenation (ECMO) is a means for supporting adequate gas exchange in patients with severe respiratory failure and is the only therapeutic option for ventilation-refractory patients awaiting lung transplantation. Moreover, defining the patients likely to benefit from ECMO as a bridge to transplantation has recently become a point of interest. Here, we report a case of prolonged ECMO support to a patient awaiting lung transplantation. A 66-year-old woman was diagnosed with acute interstitial pneumonia and was placed on veno-venous (VV) ECMO due to unsatisfactory gas exchange despite maximal ventilator care. She underwent bilateral lung transplantation after 99 days of ECMO and was successfully weaned from it on the 107th ECMO day. This is the longest period of ECMO support to be reported among elderly patients.

Citations

Citations to this article as recorded by

Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)–Numerical Investigation of the Connection to the Common Iliac Veins
N. B. Steuer, K. Hugenroth, T. Beck, J. Spillner, R. Kopp, S. Reinartz, T. Schmitz-Rode, U. Steinseifer, G. Wagner, J. Arens
Cardiovascular Engineering and Technology.2020; 11(4): 362. CrossRef
One hundred forty six days on extracorporeal membrane oxygenation (ECMO): Our longest ECMO run
Ahmad Said Abdalmohsen Ali, Mohamed Yosri, Mohamed Abouelwafa, Mahmoud Saad, Kareem Zaki, Shady Mashhour, Husam Salah, Tarek Mohsen, Amaany Abozeid, Mohamed Khaled, Akram Abdelbary, Alia Abdelfattah
The Egyptian Journal of Critical Care Medicine.2018; 6(3): 113. CrossRef
Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation
Jin Jeon, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Korean Journal of Critical Care Medicine.2014; 29(3): 212. CrossRef

A Case of Burkholderia cepacia Pneumonia after Lung Transplantation in a Recipient without Cystic Fibrosis: Jin Sun Cho, Sungwon Na, Moo Suk Park, Yun So, Bahn Lee, Shin Ok Koh, Hyo Chae Paik; Korean J Crit Care Med. 2013;28(3):187-191.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.187

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Abstract PDF

Burkholderia cepacia is a highly virulent pathogen known to cause opportunistic infections in immunocompromised patients. It accelerates lung disease and causes necrotizing pneumonia with associated severe sepsis, known as cepacia syndrome. In particular, lung transplant recipients infected with Burkholderia cepacia show higher mortality after lung transplantation than those who are not infected with this organism. Due to broad-spectrum antibiotic resistance, a combination therapy should be used according to the results of the susceptibility test. This bacterial infection is rare in Korea, and no case was reported in lung transplant recipients. However, we report a case of pneumonia caused by Burkholderia cepacia after lung transplantation. As Burkholderia cepacia was grown from a sputum culture, the patient was treated initially with a combination of meropenem and trimethoprim/sulfamethoxazole and then ceftazidime and trimethoprim/sulfamethoxazole as a result of leukopenia. After antibiotics treatment for 20 days, sputum cultures became negative for Burkholderia cepacia and the patient successfully recovered.

Citations

Citations to this article as recorded by

Current perspective of lung transplantation
Hyo Chae Paik
Journal of the Korean Medical Association.2016; 59(2): 119. CrossRef

Review Article

ICU Acquired Weakness: Sung Won Na, Shin Ok Koh; Korean J Crit Care Med. 2011;26(4):203-207.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.203

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Abstract PDF: Critical care has focused on recovery from acute organ failure and resuscitation. Neuromuscular abnormalities related to critical illness is not uncommon in critically ill patients, but they were relatively underestimated and unnoticed. Intensive care unit acquired weakness (ICUAW) leading to severe functional impairments in ICU survivors can be divided into two disease entities: critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Electrophysiologic study, muscle biopsy and physical examination are helpful to diagnose ICUAW. Several researches and reviews identified many risk factors including systemic inflammation, corticosteroids, hyperglycemia, and immobility. Additional research is needed to identify the pathogenesis of this disorder and to testify its preventive or therapeutic modalities.

Original Article

Implementation of the Head of Bed (HOB) Elevation Protocol on Clinical and Nutritional Outcomes in Critically Ill Patients with Mechanical Ventilator Support: Se Hee Na, Hosun Lee, Shin Ok Koh, Hyun Sim Lee, Sung Won Na; Korean J Crit Care Med. 2011;26(3):128-133.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.128

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Abstract PDF

BACKGROUND
Although head of bed (HOB) elevation is an important strategy to prevent ventilator associated pneumonia (VAP), some observational studies have reported that the application of the semi-recumbent position was lower in patients receiving mechanical ventilator support. We performed this study to assess the effect of implementation of the HOB elevation protocol in the intensive care unit (ICU) on clinical and nutritional outcomes.
METHODS
We developed a HOB elevation protocol including a flow chart to determine whether the HOB of newly admitted patients to ICU could be elevated. We measured the level of HOB elevation in patients with mechanical ventilator twice a day and 2 days a week for 5 weeks before and after the implementation of the protocol, respectively. Hemodynamic, respiratory and nutritional data were also collected, resulting in 251 observations from 35 patients and 467 observations from 66 patients before and after implementation.
RESULTS
After implementing the protocol, the level of HOB elevation (16.7 +/- 9.9 vs. 23.6 +/-1 2.9, p < 0.0001) and observations of HOB elevation > 30degrees increased significantly (34 vs. 151, p < 0.0001). There was no significant difference in the incidence of VAP. Arterial oxygen tension/fraction of inspired oxygen ratio improved (229 +/- 115 vs. 262 +/- 129, p = 0.02). Mean arterial blood pressure decreased after the implementation of the protocol, but remained within the normal limits. Calorie intake from tube feeding increased significantly (672 +/- 649 vs. 798 +/- 670, p = 0.021) and the events of high gastric residual volume (> 100 ml) occurred less frequently after implementing the protocol (50% vs. 17%, p = 0.001) CONCLUSIONS: Implementation of the protocol for HOB elevation could improve the level of HOB elevation, oxygenation parameter and enteral nutrition delivery.

Citations

Citations to this article as recorded by

Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
Korean Journal of Critical Care Medicine.2012; 27(3): 157. CrossRef

Case Reports

The Benefit of Braille for Successful Weaning off Mechanical Ventilation in Congenital Blindness and Hearing Impairment: A Case Report: So Young Yang, Yong Seon Choi, Jin Ha Park, Shin Ok Koh; Korean J Crit Care Med. 2011;26(1):45-48.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.45

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Abstract PDF: To achieve adequate depth of sedation and assess the severity of pain in mechanically ventilated patients in the intensive care unit, appropriate communication with the patients is necessary. Communication is also important for successful weaning from the mechanical ventilator as well as weaning predictors, such as respiratory muscle capacity. Here, we present a case report of a 39-year-old man with congenial blindness and hearing impairment who successfully weaned off ventilator support using Braille to communicate under an optimal level of sedation and analgesia after septic shock management.

Acute Pulmonary Embolism Due to Free-floating Right Atrial Thrombus in a Patient with Multiple Myeloma: A Case Report: Youn Yi Jo, Yong Seon Choi, Sa Ra So, Shin Ok Koh; Korean J Crit Care Med. 2011;26(1):24-28.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.24

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Abstract PDF: Although venous thrombosis is one of the most frequent complications of malignant disease including multiple myeloma, massive pulmonary embolism is an uncommon complication. Free-floating intracardiac thrombus has been rarely reported as a cause of acute pulmonary embolism in patients with multiple myeloma. We report a case presenting acute pulmonary embolism due to free-floating right atrial thrombus in a patient with multiple myeloma.

Original Article

Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients: Sungwon Na, Hosun Lee, Shin Ok Koh, Ai Soon Park, A Reum Han; Korean J Crit Care Med. 2010;25(3):136-143.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.136

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Abstract PDF

BACKGROUND
Nutrition delivery is frequently interrupted or delayed by physicians' ordering patterns. We conducted this study to investigate the effect of physician compliance with tube feeding (TF) protocol on the nutritional and clinical outcomes in acute lung injury (ALI) patients.
METHODS
After implementing a TF protocol, 71 ALI patients with mechanical ventilation (MV) for > or = 7 days were observed. A dietician assessed the nutritional status of the patients and established individualized nutrition plans according to the protocol. If the physicians followed the dietician's recommendation within 48 hours, the patients were classified under the compliant group (Group 1).
RESULTS
Forty patients (56.3%) were classified into Group 1. Prealbumin was comparable in both groups at ICU admission but higher in Group 1 at the time of discharge from the ICU (228 +/- 81 vs 157 +/- 77 mg/dl, p = 0.025). Nitrogen balance was only improved in Group 1. The time to reach calorie goal was shorter and non-feeding days were reduced in Group 1. The proportion of parenteral nutrition to nutritional support days was lower and delivered calories on the 4th and 7th day of TF were higher in Group 1 (p < 0.001). ICU mortality/stay and hospital mortality failed to show differences but hospital stay was prolonged in the noncompliant group (Group 2) (p = 0.023). Arterial oxygen tension and PaO2/FiO2 were maintained during the 1st week of ICU stay in Group 1 but were decreased in Group 2.
CONCLUSIONS
Physicians' compliance with the TF protocol contributed to the likelihood of nutritional improvement and a shorter hospital stay in ALI patients with prolonged MV.

Citations

Citations to this article as recorded by

Nutritional Assessment of ICU Inpatients with Tube Feeding
Yu-Jin Kim, Jung-Sook Seo
Journal of the Korean Dietetic Association.2015; 21(1): 11. CrossRef
Identifying Barriers to Implementing Nutrition Recommendations
Nancy Stamp, Anne M. Davis
Topics in Clinical Nutrition.2013; 28(3): 249. CrossRef

Case Report

Successful Heart Transplantation after Dobutamine, Glucose-insulin-potassium, and Hormone Therapy in a Hemodynamically Unstable Cadaveric Heart Donor: A Case Report: So Yeon Kim, Shin Ok Koh, Young Chul Yoo, Ha Kyoung Kim, Tae Jin Yun, Eun Ji Chang, Sungwon Na; Korean J Crit Care Med. 2010;25(2):89-92.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.89

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Abstract PDF

The major limitation to heart transplantation is the shortage of donor organs. In order to increase the cardiac donor pool, it is important to maintain stable hemodynamics and closely monitor cardiac function in cadaveric organ donors or potent donors. Recently, management of a potential cardiac donor pool has focused on aggressive hemodynamic management protocols and dobutamine stress echocardiography. In our case, management with low dose dobutamine, glucose-insulin-potassium (GIK), and hormone therapy reversed heart failure following brain death and the heart was successfully transplanted. We suggest that aggressive hemodynamic management with low-dose dobutamine, GIK, and hormone therapy can result in the recruitment of more cadaveric hearts in marginal conditions.

Citations

Citations to this article as recorded by

Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination
Eun Young Kim, Ji Hyun Kim
The Korean Journal of Critical Care Medicine.2016; 31(3): 236. CrossRef

Original Article

Hormonal Changes of the Brain-Dead Organ Donors: A 3-Year Experience: Yong Seon Choi, Sungwon Na, Seung Youn Kang, Shin Ok Koh; Korean J Crit Care Med. 2008;23(1):30-35.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.30

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Abstract PDF

BACKGROUND
Success of transplantation is critically dependent upon the quality of the donor organ and optimal management. Recently, hormonal replacement therapy has been reported to result in rapid recovery of cardiac function and enable significantly more organs to be transplanted, while some other studies show conflicting results. The aim of this study is to comprehensively evaluate changes in basal circulating hormonal levels of the brain-dead organ donors.
METHODS
We reviewed the records of all brain-dead patients between January, 2004, and June, 2007. Hemodynamic variables, plasma hormone levels were recorded at following time points: admission to the ICU (T1, baseline), 30 minutes (min) after first apnea test (T2), 30 min after second apnea test (T3), before operation for harvesting (T4). Hormonal measurements included cortisol, adrenocorticotrophic hormone, triiodothyronine (T(3)), thyroxine, free thyroxine, thyroid-stimulating hormone, growth hormone, and testosterone.
RESULTS
Nineteen patients were included in this study. Comparisons of hemodynamic parameters and hormonal levels to baseline values revealed no significant changes throughout the study period. When the patients were divided into 2 groups according to the requirement of norepinephrine (either>0.05 or < or =0.05microgram/kg/min), patients requiring >0.05microgram/kg/min of norepinephrine had T(3) level below the normal range at significantly more time points of measurement (7 vs. 0).
CONCLUSION
In this comprehensive assessment of hormonal levels in brain-dead organ donors, we could not observe any significant changes during the ICU stay. Replacement therapy of T(3) may be considered in patients requiring >0.05microgram/kg/min of norepinephrine.

Citations

Citations to this article as recorded by

Alterations in neuroendocrine axes in brain-dead patients
Türkay Akbaş, Ayhan Öztürk
Hormones.2023; 22(4): 539. CrossRef

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