Acute and Critical Care

Original Articles

Trauma
Role of platelet-to-lymphocyte ratio at the time of arrival to the emergency room as a predictor of short-term mortality in trauma patients with severe trauma team activation: Jae Kwang Kim, Kyung Hoon Sun; Acute Crit Care. 2024;39(1):146-154. Published online February 15, 2024; DOI: https://doi.org/10.4266/acc.2023.01319

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Abstract PDF: Background
Platelet-to-Lymphocyte ratio (PLR) has been studied as a prognostic factor for various diseases and traumas. This study examined the utility of PLR as a tool for predicting 30-day mortality in patients experiencing severe trauma. Methods: This study included 139 patients who experienced trauma and fulfilled ≥1 criteria for activation of the hospital’s severe trauma team. Patients were divided into non-survivor and survivor groups. Mean PLR values were compared between the groups, the optimal PLR cut-off value was determined, and mortality and survival analyses were performed. Statistical analyses were performed using SPSS ver. 26.0. The threshold of statistical significance was P<0.05. Results: There was a significant difference in mean (±standard deviation) PLR between the non-survivor (n=36) and survivor (n=103) groups (53.4±30.1 vs. 89.9±53.3, respectively; P<0.001). Receiver operating characteristic (ROC) curve analysis revealed an optimal PLR cut-off of 65.35 (sensitivity, 0.621; specificity, 0.694, respectively; area under the ROC curve, 0.742), and Kaplan-Meier survival analysis revealed a significant difference in mortality rate between the two groups. Conclusions: PLR can be calculated quickly and easily from a routine complete blood count, which is often performed in the emergency department for individuals who experience trauma. The PLR is useful for predicting 30-day mortality in trauma patients with severe trauma team activation.

Pediatrics
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt: Aya Osama Mohammed, Hanaa I. Rady; Acute Crit Care. 2024;39(1):70-77. Published online February 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00654

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Abstract PDF: Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022. Methods: This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories. Results: In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE). Conclusions: The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

Cardiology
A comparative study of stored arterial versus venous blood collected using the acute normovolemic hemodilution method in coronary artery bypass grafting patients in Iran: Mojtaba Mansouri, Alireza Yazdani, Gholamreza Masoumi, Mohsen Mirmohammadsadeghi, Amir Mirmohammadsadeghi; Acute Crit Care. 2023;38(3):353-361. Published online June 15, 2023; DOI: https://doi.org/10.4266/acc.2022.01382

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Abstract PDF: Background
In the present study, arterial and venous blood was collected from patients who were candidates for elective coronary artery bypass grafting (CABG); the blood was stored for 28 days and cellular, biomechanical, and hematological changes in blood were compared to determine whether stored arterial blood is superior to stored venous blood.
Methods
The present follow-up comparative study included 60 patients >18 years of age, with hemoglobin >14 mg/dl and ejection fraction >40% who were candidates for CABG. After induction of anesthesia, 250 ml of arterial or venous blood was drawn from patients (arterial blood group and venous blood group). Laboratory blood samples were taken at specified times from the collected blood and re-injected into the patients after CABG.
Results
Significant differences were observed in pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), bicarbonate (HCO3), and glucose values at several time points between the groups. Other parameters such as urea and creatinine did not show any significant differences between the groups.
Conclusions
Twenty-eight days of storage can have a negative effect on some of the cellular, biochemical, and hematological components of arterial and venous blood; however, the quality of stored arterial blood and venous blood does not differ significantly.

Review Article

Trauma
Damage control strategy in bleeding trauma patients: Maru Kim, Hangjoo Cho; Acute Crit Care. 2020;35(4):237-241. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00941

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Abstract PDF

Hemorrhagic shock is a main cause of death in severe trauma patients. Bleeding trauma patients have coagulopathy on admission, which may even be aggravated by incorrectly directed resuscitation. The damage control strategy is a very urgent and essential aspect of management considering the acute coagulopathy of trauma and the physiological status of bleeding trauma patients. This strategy has gained popularity over the past several years. Patients in extremis cannot withstand prolonged definitive surgical repair. Therefore, an abbreviated operation, referred to as damage control surgery (DCS), is needed. In addition to DCS, the likelihood of survival should be maximized for patients in extremis by providing appropriate critical care, including permissive hypotension, hemostatic resuscitation, minimization of crystalloid use, early use of tranexamic acid, and avoidance of hypothermia and hypocalcemia. This review presents an overview of the evolving strategy of damage control in bleeding trauma patients.

Citations

Citations to this article as recorded by

Current Approaches to the Treatment of Traumatic Shock (Review)
D. A. Ostapchenko, A. I. Gutnikov, L. A. Davydova
General Reanimatology.2021; 17(4): 65. CrossRef

Original Articles

Trauma
The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury: Young Hoon Park, Dong Hyun Ryu, Byung Kook Lee, Dong Hun Lee; Acute Crit Care. 2019;34(4):255-262. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00640

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Abstract PDF

Background
Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI.
Methods
This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT.
Results
Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients.
Conclusions
The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.

Citations

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Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial
Yoshinori Kosaki, Takashi Hongo, Mineji Hayakawa, Daisuke Kudo, Shigeki Kushimoto, Takashi Tagami, Hiromichi Naito, Atsunori Nakao, Tetsuya Yumoto
World Journal of Emergency Surgery.2024;[Epub] CrossRef

Trauma
Risk factor, monitoring, and treatment for snakebite induced coagulopathy: a multicenter retrospective study: Yong Jun Jeon, Jong Wan Kim, SungGil Park, Dong Woo Shin; Acute Crit Care. 2019;34(4):269-275. Published online November 18, 2019; DOI: https://doi.org/10.4266/acc.2019.00591; Correction in: Acute Crit Care 2020;35(1):56

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Abstract PDF

Background
Snakebite can cause various complications, including coagulopathy. The clinical features of snakebite-associated coagulopathy differ from those of disseminated intravascular coagulation (DIC) caused by other diseases and its treatment is controversial.
Methods
We retrospectively reviewed the medical records of patients hospitalized for snakebite between January 2006 and September 2018.
Results
A total of 226 patients were hospitalized due to snakebite. Their median hospital stay was 4.0 days (interquartile range, 2.0 to 7.0 days). Five patients arrived at hospital with shock and one patient died. Twenty-one patients had overt DIC according to the International Society of Thrombosis and Hemostasis scoring system. Two patients developed major bleeding complications. Initial lower cholesterol level at presentation was associated with the development of overt DIC. International normalization ratio (INR) exceeding the laboratory’s measurement limit was recorded as late as 4 to 5 days after the bite. Higher antivenom doses (≥18,000 units) and transfusion of fresh frozen plasma (FFP) or cryoprecipitate did not affect prolonged INR duration or hospital stay in the overt DIC patients without bleeding.
Conclusions
Initial lower cholesterol level may be a risk factor for overt DIC following snakebite. Although patients lack apparent symptoms, the risk of coagulopathy should be assessed for at least 4 to 5 days following snakebite. Higher antivenom doses and transfusion of FFP or cryoprecipitate may be unbeneficial for coagulopathic patients without bleeding.

Citations

Citations to this article as recorded by

A simple mortality risk prediction score for viper envenoming in India (VENOMS): A model development and validation study
Maya Gopalakrishnan, Suman Saurabh, Pramod Sagar, Chanaveerappa Bammigatti, Tarun Kumar Dutta, Nicholas R. Casewell
PLOS Neglected Tropical Diseases.2022; 16(2): e0010183. CrossRef
Attempt for a Recombinant Thrombomodulin Alpha Treatment in a Rat Disseminated Intravascular Coagulation Model Using Yamakagashi (Rhabdophis tigrinus) Venom
Akihiko Yamamoto, Takashi Ito, Toru Hifumi
Toxins.2022; 14(5): 322. CrossRef
Coagulopathy following Crotaliπae snakebites in northeast Florida
Satish Maharaj, Karan Seegobin, Simone Chang
Blood Coagulation & Fibrinolysis.2022; 33(4): 220. CrossRef
Unmasking the ties of snake bite poisoning and COVID-19
Anjuman Chander, Tanvir Samra, Sekar Loganathan, Varun Mahajan
Ain-Shams Journal of Anesthesiology.2022;[Epub] CrossRef
Venom induced consumption coagulopathy and performance of 20-min whole blood clotting test for its detection in viperid envenomation
Bayye Rajkumar, Kolar Vishwanath Vinod, Rakhee Kar, Premkumar Ramasubramani
Journal of the Royal College of Physicians of Edinburgh.2022; 52(3): 232. CrossRef
The effect of myocardial injury on the clinical course of snake envenomation in South Korea
J. M. Moon, Y. J. Koo, B. J. Chun, K. H. Park, Y. S. Cho, J. C. Kim, S. D. Lee, Y. R. Min, H. S. Park
Clinical Toxicology.2021; 59(4): 286. CrossRef

Review

Cardiology
Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation: Hyoung Soo Kim, Sunghoon Park; Korean J Crit Care Med. 2017;32(1):22-28. Published online February 28, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00983

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Abstract PDF

Extracorporeal membrane oxygenation (ECMO) is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs)/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.

Citations

Citations to this article as recorded by

Oxygenation During Venoarterial Extracorporeal Membrane Oxygenation: Physiology, Current Evidence, and a Pragmatic Approach to Oxygen Titration
Lavienraj Premraj, Alastair Brown, John F. Fraser, Vincent Pellegrino, David Pilcher, Aidan Burrell
Critical Care Medicine.2024; 52(4): 637. CrossRef
A Comprehensive Review of Extra Corporeal Membrane Oxygenation: The Lifeline in Critical Moments
Sindhu Geetha, Neeta Verma, Vivek Chakole
Cureus.2024;[Epub] CrossRef
Veno-arterial extracorporeal membrane oxygenation without allogeneic blood transfusion: An observational cohort study
Alison Grazioli, Michael Plazak, Siamak Dahi, Joseph Rabin, Ashley Menne, Mehrdad Ghoreishi, Bradley Taylor, Seth Perelman, Michael Mazzeffi
Perfusion.2023; 38(7): 1519. CrossRef
A value-based approach to optimize red blood cell transfusion in patients receiving extracorporeal membrane oxygenation
Yasuhiro Shudo, Nathalie Cheng, Hao He, Corinne Rosenberg, William Hiesinger, Eric Hadhazy, John Shepard, Purnima Krishna, Josh Resnik, Robyn Fong, Charles Hill, Joe L Hsu, Paul M Maggio, Sang-Ick Chang, Jack H Boyd, Y Joseph Woo
Perfusion.2023; 38(8): 1682. CrossRef
ECMO Retrieval Program: What Have We Learned So Far
Ihor Krasivskyi, Clara Großmann, Marit Dechow, Ilija Djordjevic, Borko Ivanov, Stephen Gerfer, Walid Bennour, Elmar Kuhn, Anton Sabashnikov, Navid Mader, Kaveh Eghbalzadeh, Thorsten Wahlers
Life.2023; 13(1): 157. CrossRef
Haematological Trends and Transfusion during Adult Extracorporeal Membrane Oxygenation: A Single Centre Study
Elliott T. Worku, April M. Win, Dinesh Parmar, Chris Anstey, Kiran Shekar
Journal of Clinical Medicine.2023; 12(7): 2629. CrossRef
Extracorporeal Membrane Oxygenation Patient Outcomes Following Restrictive Blood Transfusion Protocol
Jacob A. Braaten, Bridget S. Dillon, Jillian K. Wothe, Conner P. Olson, Elizabeth R. Lusczek, Kristiana J. Sather, Gregory J. Beilman, Melissa E. Brunsvold
Critical Care Explorations.2023; 5(12): e1020. CrossRef
Neonatal extra corporeal membrane oxygenation
Suneel Kumar Pooboni
Indian Journal of Thoracic and Cardiovascular Surgery.2021; 37(4): 411. CrossRef
Point-of-care testing of plasma free hemoglobin and hematocrit for mechanical circulatory support
Dong Ah Shin, Jung Chan Lee, Heean Shin, Young-Jae Cho, Hee Chan Kim
Scientific Reports.2021;[Epub] CrossRef
Systematic review and meta-analysis of the clinical effectiveness of point-of-care testing for anticoagulation management during ECMO
Federica Jiritano, Dario Fina, Roberto Lorusso, Hugo ten Cate, Mariusz Kowalewski, Matteo Matteucci, Raffaele Serra, Pasquale Mastroroberto, Giuseppe Filiberto Serraino
Journal of Clinical Anesthesia.2021; 73: 110330. CrossRef
Blood transfusion strategies and ECMO during the COVID-19 pandemic
David Koeckerling, Daniel Pan, N Lakmal Mudalige, Oluwatobiloba Oyefeso, Joseph Barker
The Lancet Respiratory Medicine.2020; 8(5): e40. CrossRef
Life-threatening antineutrophil cytoplasmic antibody–associated vasculitis after influenza A H1N1 infection requiring veno-venous extracorporeal membrane oxygenation
Frantzeska G. Frantzeskaki, Stavros Dimopoulos, Dimitrios Konstantonis, Pelagia Katsibri, Kostantinos Kostopanagiotou, Maria Theodorakopoulou, Chrysi Diakaki, Dimitrios Dougenis, Dimitrios Boumpas, Andreas Karabinis, Apostolos Armaganidis, Iraklis Tsangar
Perfusion.2020; 35(6): 546. CrossRef
Case Report: Successful Use of Extracorporeal Therapies After ECMO Resuscitation in a Pediatric Kidney Transplant Recipient
Andrey Rybalko, Anna Pytal, Mikhail Kaabak, Nadejda Rappoport, Anuar Bidzhiev, Vasilii Lastovka
Frontiers in Pediatrics.2020;[Epub] CrossRef

Original Article

Thoracic Surgery
Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah’s Witnesses: a Comparative Study with Non-Jehovah’s Witnesses: Tae Sik Kim, Jong Hyun Lee, Chan-Young Na; Korean J Crit Care Med. 2016;31(2):101-110. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.101

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Abstract PDF

Background:
We compared the clinical outcomes of cardiac valve surgery in adult Jehovah’s Witness patients refusing blood transfusion to those in non-Jehovah’s Witness patients without any transfusion limitations.
Methods
From 2005 to 2014, 25 Jehovah’s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery.
Results
The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups.
Conclusions
Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.

Citations

Citations to this article as recorded by

Optimising bloodless cardiovascular surgery for Jehovah’s Witnesses and beyond
Matti Jubouri, Fatemeh Hedayat, Sakina Abrar, Sophie L. Mellor, Louise J. Brown, Amer Harky
Coronary Artery Disease.2022; 33(1): 52. CrossRef
Outcomes of perioperative management in Jehovah's Witness patients undergoing surgeries with a risk of bleeding: a retrospective, single-center, observational study
Keum Young So, Sang Hun Kim
Medical Biological Science and Engineering.2022; 5(1): 6. CrossRef

Case Report

Cardiology/Pediatric
Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation: Do Wan Kim, Kyeong Ryeol Cheon, Duck Cho, Kyo Seon Lee, Hwa Jin Cho, In Seok Jeong; Korean J Crit Care Med. 2015;30(2):132-134. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.132

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Abstract PDF

Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

Citations

Citations to this article as recorded by

Transfusion-associated graft-versus-host disease, transfusion-associated hyperkalemia, and potassium filtration: advancing safety and sufficiency of the blood supply
Kenneth E. Nollet, Alain M. Ngoma, Hitoshi Ohto
Transfusion and Apheresis Science.2022; 61(2): 103408. CrossRef
Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients
Morgan Burke, Pranava Sinha, Naomi L. C. Luban, Nikki Gillum Posnack
Frontiers in Pediatrics.2021;[Epub] CrossRef
Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease
Sejong Chun, Minh-Trang Thi Phan, Saetbyul Hong, Jehoon Yang, Yeup Yoon, Sangbin Han, Jungwon Kang, Mark H. Yazer, Jaehyun Kim, Duck Cho, Senthilnathan Palaniyandi
PLOS ONE.2020; 15(3): e0229724. CrossRef
Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Chonnam Medical Journal.2017; 53(2): 110. CrossRef
Blood Transfusion Strategies in Patients Supported by Extracorporeal Membrane Oxygenation
Yoon Hee Kim
The Korean Journal of Critical Care Medicine.2015; 30(3): 139. CrossRef

Original Article

Low Blood Selenium Concentrations in Critically Ill Children with Systemic Inflammatory Response Syndrome and Respiratory Dysfunction: Young A Kim, Eun Ju Ha, Won Kyoung Jhang, Seong Jong Park; Korean J Crit Care Med. 2013;28(2):86-92.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.86

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Abstract PDF: BACKGROUND
Selenium is an essential trace-element with antioxidant and immunological function. We studied the relationship between blood selenium concentrations, systemic inflammatory response syndrome (SIRS) and organ dysfunctions in critically ill children.
METHODS
This was a retrospective, observational study of the blood selenium concentrations of critically ill children at the time of a pediatric intensive care unit admission.
RESULTS
A total of 62 patients with a median age of 18 (5-180) months were included in this study. The mean of blood selenium concentration (microg/dl) was 8.49 +/- 2.42. The platelet count (r = -0.378) and PaCO2 (r = -0.403) showed negative correlations with blood selenium concentration, while PaO2/FiO2 (r = 0.359) and PaO2 (r = 0.355) showed positive correlations (p < 0.05, for all variables). Blood selenium concentrations were significantly lower in patients with SIRS than in those patients without SIRS (8.08 +/- 2.42 vs. 9.45 +/- 2.02, p = 0.011). Patients with severe sepsis and septic shock had showed significantly lower blood selenium concentrations than those without SIRS (7.03 +/- 2.73 vs. 9.45 +/- 2.02, p = 0.042). Patients with PaO2/FiO2 < or = 300 had lower blood selenium concentrations than those with PaO2/FiO2 > 300 (7.90 +/- 2.43 vs. 9.54 +/- 2.17, p = 0.018). Blood selenium concentrations were significantly lower in patient with PaO2/FiO2 < or = 200 than in those with PaO2/FiO2 > 300 (7.64 +/- 2.76 vs. 9.54 +/- 2.17, p = 0.018).
CONCLUSIONS
Patients with systemic inflammatory response syndrome or respiratory dysfunction showed significantly low blood selenium concentrations.

Case Report

Transfusion-Related Acute Lung Injury after Stored Packed Red Blood Cell Transfusion: A Case Report: Ho Hyun Kim, Dong Kyu Lee, Chan Yong Park, Jae Kyoon Ju, Jung Chul Kim; Korean J Crit Care Med. 2013;28(2):141-145.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.141

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Abstract PDF

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortalities. Each type of blood product is likely to cause TRALI. Patients with TRALI present with dyspnea/respiratory distress and fever. The symptoms, signs and chest radiological findings in TRALI are similar to transfusion associated circulatory overload. Therefore, it is difficult to distinguish such from circulatory overloads. We report a case of TRALI in a 49-year-old woman after stored packed red blood cell transfusion. The patient developed hypoxemia and pulmonary edema after packed red blood cell transfusion during postoperative period. The patient completely recovered after an oxygen support for 3 days.

Citations

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A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion
Ki Sul Chang, Dae Won Jun, Youngil Kim, Hyunwoo Oh, Min Koo Kang, Junghoon Lee, Intae Moon
The Korean Journal of Blood Transfusion.2015; 26(3): 309. CrossRef

Original Article

Blood Gases during Cardiopulmonary Resuscitation in Predicting Arrest Cause between Primary Cardiac Arrest and Asphyxial Arrest: Sei Jong Bae, Byung Kook Lee, Ki Tae Kim, Kyung Woon Jeung, Hyoung Youn Lee, Yong Hun Jung, Geo Sung Lee, Sun Pyo Kim, Seung Joon Lee; Korean J Crit Care Med. 2013;28(1):33-40.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.33

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Abstract PDF: BACKGROUND
If acid-base status and electrolytes on blood gases during cardiopulmonary resuscitation (CPR) differ between the arrest causes, this difference may aid in differentiating the arrest cause. We sought to assess the ability of blood gases during CPR to predict the arrest cause between primary cardiac arrest and asphyxial arrest.
METHODS
A retrospective study was conducted on adult out-of-hospital cardiac arrest patients for whom blood gas analysis was performed during CPR on emergency department arrival. Patients were divided into two groups according to the arrest cause: a primary cardiac arrest group and an asphyxial arrest group. Acid-base status and electrolytes during CPR were compared between the two groups.
RESULTS
Presumed arterial samples showed higher potassium in the asphyxial arrest group (p < 0.001). On the other hand, presumed venous samples showed higher potassium (p = 0.001) and PCO2 (p < 0.001) and lower pH (p = 0.008) and oxygen saturation (p = 0.01) in the asphyxial arrest group. Multiple logistic regression analyses revealed that arterial potassium (OR 5.207, 95% CI 1.430-18.964, p = 0.012) and venous PCO2 (OR 1.049, 95% CI 1.021-1.078, p < 0.001) were independent predictors of asphyxial arrest. Receiver operating characteristic curve analyses indicated an optimal cut-off value for arterial potassium of 6.1 mEq/L (sensitivity 100% and specificity 86.4%) and for venous PCO2 of 70.9 mmHg (sensitivity 84.6% and specificity 65.9%).
CONCLUSIONS
The present study indicates that blood gases during CPR can be used to predict the arrest cause. These findings should be confirmed through further studies.

Review

Transfusion-related Acute Lung Injury: Miok Kim; Korean J Crit Care Med. 2012;27(1):1-4.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.1

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Abstract PDF

Transfusion-related acute lung injury (TRALI) is a significant cause of iatrogenic injuries in patients. It is also the major cause of transfusion-associated fatalities. Pathophysiologic mechanism is an implicated donor of HLA. Neutrophil antibodies and biologic response modifiers are accumulated in the stored blood products. Pulmonary endothelial activation of the host may be the response from these mediators. Treatment is supportive and will be subjected to other forms of ALL/ARDS. Diverting donors at high risk for alloimmunization may decrease the incidence of such cases.

Citations

Citations to this article as recorded by

Transfusion-related acute lung injury in a parturient diagnosed with myelodysplastic syndrome - A case report -
Tae-Yun Sung, Young Seok Jee, Seok-jin Lee, Hwang Ju You, Ki Soon Jeong, Po-Soon Kang
Anesthesia and Pain Medicine.2019; 14(1): 35. CrossRef
Correlation between Allergic Rhinitis Prevalence and Immune Responses of Children in Ulsan: A Case-control Study
Jiho Lee, Inbo Oh, Ahra Kim, Minho Kim, Chang sun Sim, Yangho Kim
Korean Journal of Environmental Health Sciences.2015; 41(4): 249. CrossRef
Transfusion-Related Acute Lung Injury after Stored Packed Red Blood Cell Transfusion - A Case Report -
Ho-Hyun Kim, Dong-Kyu Lee, Chan-Yong Park, Jae-Kyoon Ju, Jung-Chul Kim
Korean Journal of Critical Care Medicine.2013; 28(2): 141. CrossRef

Case Reports

Multiple Bilateral Perfusion Defects in the Infant with Acute Viral Bronchiolitis: A Case Report: Woo Jin Chung, Jae Wook Choi, Young Ju Han, June Dong Park; Korean J Crit Care Med. 2011;26(4):272-275.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.272

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Abstract PDF: Acute viral bronchiolitis (AVB) is an obstructive lung disease which frequently develops in infants and the most common functional involvement is a V/Q ratio change caused by small airway obstruction. We report a case showing the redistribution of pulmonary blood flow by multiple perfusion scan defects in an infant with AVB. A 15 month-old male infant visited ER due to respiratory difficulty. He manifested decreased lung sound in the left lung field, hyperinflation of the left lung on chest x-ray, and metabolic acidosis in blood gas analysis. A perfusion scan showed multiple perfusion defects of both lungs without the evidence of pulmonary embolism on a following cardiac CT and echocardiography. Human Rhinovirus PCR in a nasopharyngeal aspirate was positive. With supportive care, the symptom was resolved in 4 days. AVB can show multiple perfusion defects by the redistribution of pulmonary blood flow of which the direction is opposite to the usual distribution of pulmonary blood flow in children.

A Case of Acute Lung Injury after Transfusion during Cesarean Section: A Case Report: Hee Jong Lee, Mi Ae Jeong, Ji Seon Jeong, Min Kyu Han, Jong Hun Jun; Korean J Crit Care Med. 2011;26(3):184-187.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.184

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Transfusion-related acute lung injury (TRALI) is a serious complication following the transfusion of blood products. TRALI is under-diagnosed and under-reported because of a lack of awareness. TRALI occurs within 6 hours of transfusion in the majority of cases and its presentation is similar to other forms of acute lung injury. We report on the case of a 34-year-old pregnant woman who suffered from TRALI after transfusion during Cesarean section.

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The Korean Journal of Blood Transfusion.2015; 26(3): 309. CrossRef
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Korean Journal of Critical Care Medicine.2013; 28(2): 141. CrossRef
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