Acute and Critical Care

Original Articles

Meta-analysis
Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study: Heemoon Park, Sung Yoon Lim, Sebin Kim, Hyung-Sook Kim, Soyeon Kim, Ho Il Yoon, Young-Jae Cho; Acute Crit Care. 2022;37(3):382-390. Published online July 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00220

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Background
Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes.
Methods
This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22).
Results
In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044).
Conclusions
The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.

Citations

Citations to this article as recorded by

Effect of nutrition support team on 28-day mortality in Korean patients with acute respiratory failure
Inhan Lee, Junghyun Kim, Mihyun Ku, Yurim Choi, Sohyun Park, Jihyeon Bang, Joohae Kim
Acute and Critical Care.2025; 40(2): 313. CrossRef
Nutritional support for patients with abdominal surgical pathology: the view of a surgeon and an anesthesiologist — opponents or allies?
Natalya P. Shen, Svetlana Yu. Mukhacheva
Clinical nutrition and metabolism.2023; 3(4): 181. CrossRef
Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study
Chan-Hee Park, Hak-Jae Lee, Suk-Kyung Hong, Yang-Hee Jun, Jeong-Woo Lee, Nak-Jun Choi, Kyu-Hyouck Kyoung
Annals of Clinical Nutrition and Metabolism.2022; 14(2): 66. CrossRef

Liver
Bleeding complications associated with the molecular adsorbent recirculating system: a retrospective study: Seon Woo Yoo, Min-Jong Ki, Dal Kim, Seul Ki Kim, SeungYong Park, Hyo Jin Han, Heung Bum Lee; Acute Crit Care. 2021;36(4):322-331. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00276

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Abstract PDF

Background
The molecular adsorbent recirculating system (MARS) is a hepatic replacement system that supports excretory liver function in patients with liver failure. However, since MARS has been employed in our hospital, bleeding complications have occurred in many patients during or after MARS. The objective of this study was to determine how MARS affects coagulopathy and identify specific factors associated with bleeding complications.
Methods
We retrospectively analyzed data from 17 patients undergoing a total of 41 MARS sessions. Complete blood count, coagulation profiles, and blood chemistry values were compared before and after MARS. To identify pre-MARS factors associated with increased bleeding after MARS, we divided patients into bleeder and non-bleeder groups and compared their pre-MARS laboratory values.
Results
MARS significantly reduced bilirubin and creatinine levels. MARS also increased prothrombin time and reduced platelet and fibrinogen, thus negatively impacting coagulation. Pre-MARS hemoglobin was significantly lower in the bleeder group than in the non-bleeder group (P=0.015). When comparing the upper and lower 33% of MARS sessions based on the hemoglobin reduction rate, hemoglobin reduction was significantly greater in MARS sessions involving patients with low pre-MARS international normalized ratio of prothrombin time (PT-INR) and factor V (P=0.038 and P=0.023, respectively).
Conclusions
MARS could appears to alter coagulation-related factors such as factor V and increase the risk of bleeding complications particularly in patient with low hemoglobin. However, individual differences among patients were large, and various factors, such as low hemoglobin, PT-INR, and factor V levels, appear to be involved.

Citations

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Fractionated plasma separation and adsorption integrated with continuous veno‐venous hemofiltration in patients with acute liver failure: A single center experience from China
Jianhua Dong, Li Huang, Chuan Li, Bian Wu, Xi Yang, Yongchun Ge
Journal of Clinical Apheresis.2024;[Epub] CrossRef
Crosslinked Bifunctional Particles for the Removal of Bilirubin in Hyperbilirubinemia Cases
María del Prado Garrido, Ana Maria Borreguero, Maria Jesús Ramos, Manuel Carmona, Francisco Javier Redondo Calvo, Juan Francisco Rodriguez
Materials.2023; 16(8): 2999. CrossRef
The Effect of Molecular Adsorbent Recirculating System in Patients With Liver Failure: A Case Series of 44 Patients
Shahin Isha, Anna S. Jenkins, Abby J. Hanson, Parthkumar H. Satashia, Sai Abhishek Narra, Gunjan D. Mundhra, Mohammed Mustafa Hasan, Ashrita Donepudi, Abishek Giri, Patrick W. Johnson, Dolores Villar, Christan Santos, Juan Canabal, Philip Lowman, Pablo Mo
Transplantation Proceedings.2023; 55(9): 2126. CrossRef
Extracorporeal organ support and the kidney
Maria-Jimena Muciño-Bermejo
Frontiers in Nephrology.2022;[Epub] CrossRef

Review Article

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

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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.

Citations

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More is not better: The role of the leukocyte filter in ex vivo lung perfusion
Olivia Hough, Andrea Mariscal, Haruchika Yamamoto, Henna Mangat, Hemant Gokhale, Manyin Chen, Hongchao Shan, Stephen Juvet, Prodipto Pal, Marcelo Cypel, Mingyao Liu, Shaf Keshavjee
The Journal of Thoracic and Cardiovascular Surgery.2026;[Epub] CrossRef
The Spectrum of Mitral Regurgitation in Lung Transplant Recipients: A Systematic Review
George Bcharah, Juan M. Farina, J. Asher Jenkins, Rawan M. Zeineddine, Andrew G. Saleeb, Estefana Bcharah, Kenan A. Shawwaf, Brian W. Hardaway, Pedro Reck dos Santos, Jonathan D’Cunha, Ashraf Omar
Transplantation.2025; 109(9): e455. CrossRef
Post-operative management of children after lung transplantation
Nicolaus Schwerk, Julia Carlens, Harald Köditz, Fabio Ius, Nicholas Avdimiretz, Don Hayes, Melinda Solomon
JHLT Open.2025; 9: 100301. CrossRef
Caring for Heart and Lung Transplant Patients
Brigitte Hollander, Antonio Rubino, Jasvir Pamar, Florian Falter
Journal of Intensive Care Medicine.2025;[Epub] CrossRef
Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study
Eun-Young Kim, Seung-Hyun Yong, Min-Dong Sung, A-La Woo, Young-Mok Park, Ha-Eun Kim, Su-Jin Jung, Song-Yee Kim, Jin-Gu Lee, Young-Sam Kim, Hyo-Chae Paik, Moo-Suk Park
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
Journal of Chest Surgery.2022; 55(4): 338. CrossRef
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
Yonsei Medical Journal.2020; 61(7): 606. CrossRef
A proof-of principal study using phase-contrast imaging for the detection of large airway pathologies after lung transplantation
Stephan Umkehrer, Carmela Morrone, Julien Dinkel, Laura Aigner, Maximilian F. Reiser, Julia Herzen, Ali Ö. Yildirim, Franz Pfeiffer, Katharina Hellbach
Scientific Reports.2020;[Epub] CrossRef

Original Articles

Pulmonary
The Use of Lung Ultrasound in a Surgical Intensive Care Unit: Hyung Koo Kang, Hyo Jin So, Deok Hee Kim, Hyeon-Kyoung Koo, Hye Kyeong Park, Sung-Soon Lee, Hoon Jung; Korean J Crit Care Med. 2017;32(4):323-332. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00318

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Abstract PDF

Background
Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU).
Methods
This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016.
Results
The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively.
Conclusions
LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.

Citations

Citations to this article as recorded by

Lung Ultrasound in the Critically Ill
Jin Sun Cho
The Korean Journal of Critical Care Medicine.2017; 32(4): 356. CrossRef

Surgery
Clinical Outcome and Prognosis of Patients Admitted to the Surgical ICU after Abdomen Surgery: Yun Su Sim, Jin Hwa Lee, Jung Hyun Chang, Yon Ju Ryu; Korean J Crit Care Med. 2015;30(1):1-7. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.1

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Abstract PDF

Background
Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications, unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. Methods: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. Results: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion [p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortality in univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. Conclusions: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered important predictors of mortality.

Citations

Citations to this article as recorded by

Perioperative predictors of critical care admission following emergency surgical procedures: a comprehensive evaluation of anesthesia management
Şebnem Çimen, Büşra Eroğlu, Afra Buse Kavacık Bulut, Burak Uçaner, Ela Erten
Perioperative Medicine.2026;[Epub] CrossRef
The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients
Anastasiya Shchatsko, Laura N. Purcell, Christopher J. Tignanelli, Anthony Charles
The American Surgeon™.2021; 87(8): 1230. CrossRef

Case Reports

Vascular surgery
Guide Wire Entrapment during Central Venous Catheterization: Kyung Woo Kim, Jun Hyun Kim, Se Hyeok Park, Ji Yeon Kim, Sang Il Lee, Kyung Tae Kim, Jang Su Park, Jung Won Kim, Won Joo Choe; Korean J Crit Care Med. 2014;29(2):137-140. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.137

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Abstract PDF: We experienced a case of venous vessel wall entrapment between the introducer needle and the guide wire during an attempt to perform right internal jugular vein (IJV) catheterization. The guide wire was introduced with no resistance but could not be withdrawn. We performed ultrasonography and C-arm fluoroscopy to confirm the entrapment location. We assumed the introducer needle penetrated the posterior vessel wall during the puncture and that only the guide wire entered the vein; an attempt to retract the wire pinched the vein wall between the needle tip and the guide wire. Careful examination with various diagnostic tools to determine the exact cause of entrapment is crucial for reducing catastrophic complications and achieving better outcomes during catheterization procedures.

Cardiology
Isolated Chylopericardium after Mitral Valve Replacement: the First Description of Adult Heart Disease in Korea: Su Wan Kim, Seogjae Lee; Korean J Crit Care Med. 2014;29(2):123-125. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.123

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Abstract PDF: Isolated chylopericardium as a complication of cardiac surgery is very rare. Two cases of chylopericardium have been previously reported in Korea; both patients suffered from chylopericardium after a corrective cardiac surgery for a congenital heart disease such as atrial or ventricular septal defect. We report a case of chylopericardium in a 55-year-old mitral valve replacement patient. The reason for chylopericardium was unclear, but it might have been related with the damaged lymph nodes and blunt dissection of the thymus. While most chylopericardium cases require surgical intervention, we managed this chylopericardium case with a low-fat diet for 3 days.

Original Article

How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition: Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho; Korean J Crit Care Med. 2013;28(4):280-286.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.280

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Abstract PDF

BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Citations

Citations to this article as recorded by

Safety and Feasibility of Ultrasound-guided Peripherally Inserted Central Catheterization for Chemo-Delivery
Tak-Joong Song, Shin-Seok Yang, Woo-Sung Yoon
Journal of Surgical Ultrasound.2019; 6(1): 14. CrossRef
Single Center Experience of Ultrasonography-guided Bedside Procedures for Surgical Patients
Dooreh Kim, Dae Hyun Cho, Yun Tae Jung, Jae Gil Lee
Journal of Surgical Ultrasound.2018; 5(2): 61. CrossRef
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho
The Korean Journal of Critical Care Medicine.2015; 30(4): 280. CrossRef

Case Reports

Treatment of Carbon Monoxide Poisoning with Therapeutic Hypothermia: Young Hwan Lee, You Dong Sohn, Seung Min Park, Won Wong Lee, Ji Yun Ahn, Hee Cheol Ahn; Korean J Crit Care Med. 2013;28(3):218-220.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.218

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Abstract PDF

Carbon monoxide (CO) is a well-known chemical asphyxiant, which causes tissue hypoxia with prominent neurological injury. Therapeutic hypothermia (TH) has been shown to be an effective neuroprotective method in post-cardiac arrest patients. A 26-year-old man presented to the emergency department with severe CO poisoning. On arrival, the patient was comatose. His vital signs were blood pressure, 130/80 mm Hg; heart rate, 126/min; respiratory rate, 26/min; body temperature, 36degrees C; and O2 saturation, 94%. Initial carboxyhemoglobin was 45.2%. Because there was no available hyperbaric chamber in our local area, he was intubated and treated with TH. The target temperature was 33 +/- 1degrees C for 24 hours using an external cooling device. The patient was then allowed to reach normothermia by 0.15-0.25degrees C/hr. The patient was discharged after normal neurological exams on day 11 at the hospital. TH initiated after exposure to CO may be an effective prophylactic method for preventing neurological sequelae.

Citations

Citations to this article as recorded by

Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect
Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi
The Korean Journal of Critical Care Medicine.2015; 30(4): 272. CrossRef

Extracorporeal Membrane Oxygenation (ECMO) and Iliac Vein Injury: Sang Ook Ha, Jae Seok Park, So Hee Park, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2013;28(3):197-200.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.197

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Abstract PDF: The use of extracorporeal membrane oxygenation (ECMO) has increased after the 2009 pandemic H1N1 infections, and the ECMO-related complications have also increased. Specifically, the mechanical vessel injury due to catheter cannulation seems to be less frequent than other complications, but there is a risk of hemorrhagic shock which requires special attention. We experienced a case of successful management with graft stenting during ECMO operation for iliac vein injury. A 56-year-old female patient with non-small cell lung cancer developed endobronchial obstruction, and ECMO was applied for the ECMO-assisted rigid bronchoscopy. During catheter cannulation, hypovolemic shock was developed due to her right external iliac vein injury. We detected the hemorrhage with bedside ultrasound at an early stage and the hemorrhage was effectively managed with graft stenting on ECMO.

Occurrence of Acquired Tracheoesophageal Fistula Due to Excess Endotracheal Tube Cuff Volumes: A Case Report: Myeong Soo Kim, Eun Jeong Koh, Ha Young Choi; Korean J Crit Care Med. 2013;28(2):146-151.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.146

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Abstract PDF

Endotracheal tube cuff volume and pressure require constant monitoring to prevent tracheal injury. Acquired tracheoesophageal fistula is common from complications of mechanical ventilation as a result of pressured necrosis of the tracheoesophageal wall by endotracheal tube cuff. It still represents a life-threatening condition, especially when the diagnosis is being delayed. We present our modest experience through an acquired TEF patient who had an excessively enlarged cuff diameter on chest radiogram in order to consider the potential of using radiological-measured cuff diameter as a simple technique for predicting tracheal damages. Although the cuff pressure was monitored with a manometer by the medical team, it was possible that the tube cuff was excessively enlarged. Proper procedures for preventing the tracheal damage by cuffs include the following: monitoring of endotracheal cuff pressure and volume, observation of cuff size on the chest radiogram, and being mindful and attentive for possibilities of misjudgements by manometer or medical teams.

Citations

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The Morphometric Study of Main Bronchus in Korean Cadaver
Ik Sung Kim, Chang Ho Song
Korean Journal of Physical Anthropology.2017; 30(1): 7. CrossRef
Total Unilateral Obstruction by Sputum Immediately after Tracheal Bougienage
Kyunam Kim, Jonghun Jun, Miae Jeong, Songlark Choi, Youngsun Lee
Korean Journal of Critical Care Medicine.2014; 29(1): 32. CrossRef

Rhabdomyolysis Induced by Microembolism with Intra-Aortic Balloon Pump (IABP) Use in a Patient after Coronary Artery Bypass Graft (CABG) - A Case Report -: Sun Kyung Min, Eun Gu Hwang, Yong In L Kim; Korean J Crit Care Med. 2013;28(1):56-58.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.56

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Abstract PDF: A fifty seven-year-old man visited the outpatient department with chest pain and claudication. Coronary angiogram showed coronary artery diseases (3-vessel diseases) and CABG was planned. However, lower extremity angiogram showed stenosis of both common iliac arteries and stent implantation of both iliac arteries were done before CABG. He underwent CABG and IABP was inserted for weaning from cardiopulmonary bypass. After CABG, ischemic change on ends of feet was noted with red-brown colored urine and hyperkalemia. Blood myoglobin level was over 3,000 ng/ml. Microembolism of his lower body was revealed by multiple uptakes on the whole body bone scan study. After management by massive hydration and alkalization of urine with sodium bicarbonate, he was recovered without renal replacement therapy and discharged in good condition.

Transient Dilation of the Membranous Trachea after Endotracheal Intubation: A Case Report: Seung Choi, Eun Woo Lee, Myung Ho Yun, Jae Young Park, Cheol Hwan Kim, Jae Won Beom, Gun Park; Korean J Crit Care Med. 2012;27(1):55-58.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.55

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Abstract PDF: Endotracheal intubation is a quick, simple and safe procedure for airway management and is used in various medical procedures. Many endotracheal tubes have a cuff system, which prevents aspiration and allows positive pressure ventilation. However excessive inflation of the cuff can cause mucosal ischemia with tracheal dilation which may result in tracheal rupture, or even death. Fortunately, mucosal ischemia of the trachea can be treated successfully with well-timed control of cuff pressure. It is essential for medical practitioners to be aware of these complications and to be able to manage them effectively if they arise. We present a case of diverticular-like dilation of the lower trachea detected by fiberoptic bronchoscopy that eventually improved in the hemoptysis patient after endotracheal intubation.

Knotting of Pulmonary Artery Catheter During Tricuspid Valve Surgery: A Case Report: Kyung Chen Lee, Wol Seon Jung, Yong Beom Kim, Ji Yeon Lee; Korean J Crit Care Med. 2012;27(1):45-48.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.45

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Abstract PDF

The use of pulmonary artery catheter can be helpful in managing patients after cardiac surgery. Nevertheless, there is a risk of serious complications, such as knotting. A 61 year old man underwent tricuspid valve replacement under cardiopulmonary bypass (CPB). After implantation of a stented tissue valve in the tricuspid valve, repositioning of the catheter was performed. After weaning from CPB, an abnormal pattern of pulmonary artery pressure was suddenly observed on the monitor. Resistance was met when removing the catheter with the balloon deflated, at a 20 cm distance from the tip of the catheter. Chest radiography showed a knot in the catheter within the right brachiocephalic vein. Superior vena cava opened and the distal part of the catheter with the knot was successfully removed.

Citations

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Ionic conductivity evolution of isotropic crystal with double strained interfaces
Chao Feng, Jipeng Fei, Kechun Wen, Weiqiang Lv, Zuoxiang Zhang, Minda Zou, Fei Yang, Muhammad Waqas, Weidong He
Solid State Ionics.2017; 303: 167. CrossRef

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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Abstract PDF

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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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
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
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
A case of transfusion-related acute lung injury induced by anti-human leukocyte antigen antibodies in acute leukemia
Sun Mi Jin, Moon Ju Jang, Ji Young Huh, Myoung Hee Park, Eun Young Song, Doyeun Oh
The Korean Journal of Hematology.2012; 47(4): 302. CrossRef

Original Article

Relationship between Patient Height and Depth of Central Venous Catheter: Dong Jun Lee, Ui Jae Im, Ki Tae Kim; Korean J Crit Care Med. 2011;26(3):145-150.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.145

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Abstract PDF: BACKGROUND
Location of the tip of a central venous catheter (CVC) within the pericardium has been associated with potentially lethal cardiac tamponade. The purpose of this study was to show the relationship between the height of patients and the depth of CVC.
METHODS
We enrolled 262 adult patients into this study. All patients were divided to three groups according to the height; Group S, M and L. Central venous catheterization was performed through the right subclavian vein and the CVC was fixed at the depth of 15 cm from the skin. The distance between the CVC tips and the carina was measured by chest X-ray and was analyzed.
RESULTS
The mean (SD) tip position placed via the right subclavian vein was 0.04 (1.6) cm above the carina; Group S, 0.01 (1.8) above the carina, Group M, 0.16 (1.4) above the carina, and Group L, 0.16 (1.8) below the carina. CVC locations could be predicted with a margin of error between 3.1 cm below the carina and 3.2 cm above the carina in 95% of patients. There was no significance difference among the three groups.
CONCLUSIONS
The relationship between the height of patient and the depth of CVC was low. Because many of the CVC tips were positioned below the carina regardless the height of patients on routine 15 cm-length method, it is recommended not to use the routine 15 cm method with right subclavian CVC placement as far as possible.

Case Reports

Knotting and Kinking of the Guidewire during Central Venous Catheterization: A Case Report: Deokkyu Kim, Ji Hye Lee, Dong Chan Kim, Hyungsun Lim, Seonghoon Ko, Ji Seon Son; Korean J Crit Care Med. 2011;26(1):38-40.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.38

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Abstract PDF: Central venous catheterization is often necessary to manage critically ill patients in the intensive care unit and some surgical patients in the operating room. However, this procedure can lead to various complications. We experienced a case of subclavian venous catheterization that was complicated by looping, kinking, knotting, and entrapment of the guidewire. We were able to identify the extravascular looping and knotting of the guidewire under fluoroscopy and consequently removed it successfully. We suggest that a guidewire should be confirmed by fluoroscopic imaging if it has become entrapped.

Delayed Pleural Effusion after Right Subclavian Vein Catheterization: A Case Report: Ji Ung Kim, Ji Hyun Cheon, Il Soo Kim, Sun Kwang Kim, Sung Hyun Ko, Sea Won Lee, Sang Hee Kim, Su Hong Kim; Korean J Crit Care Med. 2010;25(3):190-193.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.190

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Abstract PDF: Central venous catheterization is commonly used for supplying large amounts of fluids, total parenteral nutrition and for monitoring central venous pressure. Numerous complications exist with the technique, including pneumothorax, arterial puncture with vessel injury, catheter embolus, mediastinal hematoma, hydrothorax, and the thrombus of the vein. We reported an uncommon case of pleural effusion, due to catheter tip migration and penetration, which occurred 4 days after central venous catheterization.

A Sheared Catheter Fragment in the Wrist after Arterial Cannulation Attempt: A Case Report: Sue Young Lee, Hyo Seok Na, Mi Hyun Kim, Chong Soo Kim, Young Tae Jeon, Jung Won Hwang, Sang Hwan Do; Korean J Crit Care Med. 2010;25(2):118-121.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.118

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6 Crossref

Abstract PDF

Continuous measurement of arterial pressure is frequently required in the perioperative management of critically ill patients and major surgeries. The complications following arterial cannulation include hematoma, thrombosis, ischemia, infection, aneurysm formation at the site of catheter insertion, and so on. The authors report a case of the sheared catheter during the arterial cannulation and the subsequent surgical removal of its remnant.

Citations

Citations to this article as recorded by

Retained Arterial Catheter Fragment: A Rare Complication of Invasive Blood Pressure Monitoring
Sunil Rajan, Gayathri Sreekumar, Mahesh Madhu, Kajol Nilesh Amin
Journal of Indian College of Anaesthesiologists.2026; 5(1): 73. CrossRef
Sonography-Guided Endovascular Retrieval of Fractured Angiocatheter in Brachial Artery: A Case Report
Yen-Yang Chen
Vascular and Endovascular Surgery.2025; 59(4): 424. CrossRef
Fracture and Intravascular Retention of a Radial Arterial Catheter Following Reinsertion of the Introducer Needle: Point‐of‐Care Ultrasonography‐Guided Localization and Surgical Retrieval
Takuya Shiraishi, Masashi Yoshida
Clinical Case Reports.2025;[Epub] CrossRef
Fracture of an Intravenous Cannula in the Hand: A Case Report
Seungho Woo, Sangun Nah, Giwoon Kim, Sangsoo Han
Journal of Emergency Nursing.2023; 49(2): 156. CrossRef
Iatrogenic catheter sheath shearing during radial artery cannulation
Il-Seok Kim, Ho Kyun Shin, Dae Yu Kim
Korean Journal of Anesthesiology.2013; 65(6 Suppl): S12. CrossRef
A retained catheter fragment in radial artery caused by accidental catheter transection during arterial catheter removal
Seung-Ki Moon, Jae-Chul Gong, Jun-Hyun Kim, Kyu Chang Lee, Hye Young Kim, Eun Kyung Choi, Myeong Jong Lee
Journal of Anesthesia.2012; 26(4): 625. CrossRef

Atelectasis of Dependent Lungs during Fistula Closure in a Patient with Tracheopleural Fistula: A Case Report: Hong Soo Jung, Yeon Soo Jeon, Jin Woo Choi, Jin Deok Joo, Yong Shin Kim, Dae Woo Kim, Jang Hyeok In, Joo Seon Park; Korean J Crit Care Med. 2009;24(2):106-110.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.106

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Abstract PDF: Atelectasis is a fairly common complication in patients undergoing general anesthesia. However, atelectasis caused secretion plugs in patients with tracheopleural fistula is less common than other airway fistulas such as trachea and bronchus. Anesthesiologists should make every effort for thorough preoperative preparation to prevent atelectasis and using appropriate and aggressive treatment, including tracheal or bronchial clearing and end expiratory positive pressure. We report a case of an intraoperative occurrence of atelectasis of the lower lobe of a dependent lung in a patient with a tracheopleural fistula during single lung ventilation for primary closure.

Dilutional Hyponatremia during Hysteroscopic Myomectomy: A Case Report: Si Young Ok, Seung Hwa Ryoo, Young Hee Baek, Sang Ho Kim; Korean J Crit Care Med. 2009;24(2):102-105.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.102

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Abstract PDF: Hysteroscopy is utilized for making the diagnosis and treating a series of uterine disease. It's advantages are more accurate removal of lesion, a short operating time, low morbidity and rapid postoperative recovery. However, serious complications can happen following hysteroscopic surgery. The complications can be divided into the procedure-related, media-related and postoperative events. The procedure-related complications include cervical laceration, uterine perforation, bowel and bladder injury, and hemorrhage. The media-related complications include hyponatremia, gas embolism and excessive fluid absorption. The postoperative events include endometritis and postoperative synechiae. We experienced hyponatermia with pulmonary edema due to excessive fuid absorption in a 52-year-old woman who underwent elective hysteroscopic myomectomy under general anesthesia. She was treated with oxygen therapy, normal saline and furosemide and she recovered without sequelae.

Original Articles

Medicolegal Aspects on Central Venous Catheterization Related Injury: Hyuna Bae, Sungeun Kim, Seokbae Lee, Rack Kyung Chung; Korean J Crit Care Med. 2006;21(1):42-50.

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Abstract PDF: BACKGROUND
We describe the characteristics of malpractice claims related to central venous catheterization and identify causes and potential preventability of such claims. METHODS: A retrospective study was performed by reviewing records at Lawnb and Lx CD-rom. The records on closed malpractice claim related to central venous catheterization were abstracted from the files available for analysis. The records were reviewed and were analysed to determine the factors associated with a successful defense.
RESULTS
Twelve closed claim cases, related to central venous cathetertization were reviewed in the data for malpractice. Catheter-related complications were pneumothorax, hemothorax, cardiac tamponade, pyothorax, hematoma due to arterial puncture, pseudoaneurysm. Almost cases resulted in indemnity payment and verdict for patient. CONCLUSIONS: Although malpractice claims related to central venous catheterization were uncommon, they resulted in high rate and amount of indemnity payments. In pediatric patient, catheterization should be performed with attention. Clinicians should consider the underlying disease of patients and do any pretreatment if needed. Post-procedural radiologic confirmation can improve patient outcome and is also associated with decreased indemnity risk. Informed consent is also important.

The Carina as a Landmark for Evaluation of Adequate Central Catheter Tip Position with Computerized Tomography: Il Woo Shin, Mi Young Park, Ju Young Choi, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2006;21(1):37-41.

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Abstract PDF: BACKGROUND
The aim of this study was to determine whether the carina can be used as a landmark for evaluation of adequate central catheter tip position, and to examine the relationship between easily measurable body size and variable anatomical parameter.
METHODS
The SVC dimensions and relationship to radiographic landmarks were retrospectively determined from computerized tomography (CT) scans of 200 patients. The CT findings were assessed in terms of SVC length (SVCL), the distance between the carina and the right atrium inlet (CAL), and the sternal length (STL). Pearson's correlation and a regression test for height versus SVCL, STL versus SVCL and CAL were performed.
RESULTS
The median length of the SVC was 4.2 cm (range; 1.6 to 7.2 cm) and the distance between the carina and the right atrium inlet was 2.4 cm (range; 0.8 to 5.6 cm). With the regression test, height was correlated with SVCL (r(2)=0.09), and STL was correlated with both SVCL (r(2)=0.12) and STL (r(2)=0.04).
CONCLUSIONS
The carina was located always above the right atrium inlet. The carina was a reliable, simple anatomical landmark for the determination of correct placement with computerized tomography.

Case Report

Intracardiac Knotting of a Balloon-tipped, Flow-directed Pulmonary Artery Catheter: A Case Report: Bong Chul Choi, Mee Young Chung, Chang Jae Kim, Jun Seuk Chea, Byung Ho Lee; Korean J Crit Care Med. 2005;20(2):178-182.

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Abstract PDF: The occurrence of knots and loops is a potential hazard of a balloon-tipped, flow-directed pulmonary artery (PA) catheter placement if excessive catheter length is passed into the right atrium or ventricle. Knotting of a balloon-tipped, flow-directed PA catheter leading to difficulty in its removal is a rare but serious complication. A case of knotted catheter in right atrium in a patient undergoing aortic valve replacement is presented. By passing a spring guidewire into PA catheter, we have untied the loose knotted catheter under simple fluoroscopic guidance in the intensive care unit.

Original Articles

Subclavian Vein Catheterization by Using 24-Gauge Peripheral Angiocatheter in Pediatric Cadiovascular Surgical Patients: Jin Mo Kim, Young Ho Jang, Jae Hong Park; Korean J Crit Care Med. 2005;20(2):159-164.

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Abstract PDF: BACKGROUND
Central venous catheterization (CVP) often leads to unacceptable complications, especially in pediatrics. To reduce these complications, we modified the venipucture by using 24-gauge peripheral angiocatheter (24-AG) in pediatric patients. METHODS: A 24-AG attached to a 3 cc syringe instead of a thin-wall steel needle in the commercial CVP kit was inserted and advanced in the direction of the inmominate vein with 45degrees angle. When blood was observed in the syrige, the 24-AG was more advanced into the subclavian vein and the 24-AG stylet was removed. A J-guide wire was inserted through lumen of the angiocather. The following procedure was the same as the Sheldinger technique. RESULTS: 202 pediatric patients received subclavian venipuncture by the method mentioned above. The overall success rate was 96.5%. The rate of success for the first attempt was 85.6% and the average number of venipuncture was 1.3+/-0.1. The overall complications was 6.4%, including hematoma formation (1.5%), pneumothorax (1.5%), bleeding at the puncture site (1.0%), mild hemothorax (0.5%) and pleural puncture without pneumothorax (2.0%). CONCLUSIONS: The subclavian venepuncture by using 24-gauge peripheral angiocatheter was reliable and useful technique in pediatric patients. The overall complications by this method was reduced compared to other reports.

Clinical Findings of Critical Illness Polyneuropathy in Patients with Mechanical Ventilator Treatment: Sung Soon Lee, Jae Yong Chin, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2005;20(1):38-43.

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Abstract PDF: BACKGROUND
Critical illness polyneuropathy (CIP) is a primary distal axonal degeneration of motor and sensory fibers leading to severe limb weakness and difficulty in weaning from ventilator in critically ill patients. The object of this study is to evaluate the clinical findings of CIP and the risk factors associated with CIP development in patients with mechanical ventilator treatment. METHODS: We examined 40 patients, between March 2002 to February 2003, who manifested muscular weakness and received mechanical ventilation (MV) more than three days, prospectively. Nerve conduction velocity (NCV) and electromyography (EMG) were performed in all patients in the ICU. We examined the use of drugs (neuromuscular blocking agents, corticosteroid, and aminoglycoside), duration of MV and weaning, and APACHE II score. RESULTS: We observed 40 patients who showed muscular weakness, 9 patients were diagnosed as CIP. NCV study demonstrated decreased action potential amplitude, predominantly in motor nerve, distal part. There was no significant difference in duration of MV and weaning, drug use, APACHE II score between the groups with CIP and without CIP. CONCLUSIONS: CIP is an important neuromuscular complication of the patients in ICU. We should consider the possibility of the development of CIP in patients who showed muscular weakness and difficult weaning in critically ill patients.

Case Reports

Severe Postoperative Delirium Lasting for Three Weeks: A Case Report: Jun Rho Yoon, Tae Kwan Kim, Su Jung Yoon, Yee Suk Kim, Si Hyun Kim, Man Gyu Kim, Jeong Ju Seo; Korean J Crit Care Med. 2004;19(1):42-46.

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Abstract PDF: Postoperative delirium in the intensive care unit is a serious problem that has recently attracted much attention. We present a 73-year-old female patient who was admitted by multiple fractures induced by an accident. We started general anesthesia for the operation of open reduction and internal fixation. After the discontinuation of general anesthesia, the patient was transported to the intensive care unit. The symptoms of delirium were developed and controlled with medications including haloperidols, benzodiazepines, and vitamins. The patient was recovered three weeks after the management and received two other operations, but delirium did not be developed again. She was discharged from the hospital without complications.

Retropharyngeal Dissection during Nasotracheal Intubation: A Case Report: Hyun Ju Jung, Sie Hyun You, Jong Bun Kim, Young Moon Han, Kuhn Park; Korean J Crit Care Med. 2003;18(2):84-88.

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Abstract PDF: Nasotracheal intubation is commonly performed for oropharyngeal or facial surgery. Although retropharyngeal dissection is a rare complication of nasotracheal intubation, serious sequelae may result. We report a case of a traumatic retropharyngeal dissection during nasotracheal intubation without untoward sequelae.

Right Internal Jugular Venous Thrombosis Occurred after Long-term Placement of Hemodialysis Catheter Inserted Via Right Subclavian Vein: A Case Report: Mi Young Park, Il Woo Shin, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2003;18(2):80-83.

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Abstract PDF: Central venous catheter-related venous thrombosis is one of the most important complications occurred after central venous catheterization. Forty six year old man had end-stage renal failure due to diabetes mellitus. Temporary hemodialysis catheter was inserted via right subclavian vein. Thirty days after hemodialysis catheter insertion, the patient presented with right neck swelling and difficulty to aspirate blood from hemodialysis catheter. Venography showed right internal jugular vein thrombosis. We report a case in which a patient developed right internal jugular vein thrombosis after long-term placement of temporary hemodialysis catheter.

Original Article

The Effect of Discharge Decision-Making of the Intensivist on Readmission to the Intensive Care Unit: Dong Woo Han, One Chul Kang, So Young Ban, Shin Ok Koh; Korean J Crit Care Med. 2003;18(2):74-79.

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Abstract PDF: BACKGROUND
Patients readmitted to intensive care unit (ICU) have significantly higher mortality. The role of intensivists to judge when to discharge from ICU may be important. We performed this study to assess the effect of intensivist's discharge decision-making on readmission to ICU. METHODS: Data were collected prospectively from patients admitted to ICUs (group 1). Another data were collected retrospectively from the patients' record (group 2). Discharge of the patients in group 1 were based on intensivist's discharge decision-making but not in group 2. We encouraged deep breathing and expectoration to patients of group 1 at risk of pulmonary complication during ICU stay and used a guideline for making discharge decisions. Readmission cause, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple organ dysfunction syndrome (MODS) score of readmitted patients were evaluated. RESULTS: Readmission rate of group 1 was lower than that of group 2 (p<0.05). The mortality of readmitted patients in each group was higher than that of non-readmitted patients (p<0.05). Respiratory disease was the major cause of readmission. In non-survivors of readmitted patients, APACHE III score on initial discharge and readmission, MODS score on initial admission, discharge and readmission were higher than those of survivors (p<0.05). CONCLUSIONS: Readmission rate was lower when intensivists participated in discharge decision- making. ICU readmission was associated with higher hospital mortality and longer ICU stay. MODS and APACHE III score at first discharge and readmission were significant prognostic factors of the outcome in readmitted patients.

Case Reports

Pulmonary Embolism Detected in the Postanesthesia Care Unit Following Operation of Long Bone Fracture: A Case Report: Yun Jeong Chae, Young Ju Lee, Jin Soo Kim, Han Bum Cho; Korean J Crit Care Med. 2003;18(1):33-38.

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Abstract PDF: Clinical manifestations of pulmonary embolism are nonspecific during anesthesia. A 44 years old female received elective operation for right tibio-fibular fracture under spinal anesthesia. During operation, the patient received oxygen supply 5 L/min via mask with oxygen. On arrival of postanesthetic care unit, oxygen saturation of pulse oxymeter (SpO2) was 89% and with the 100% oxygen 10 L/min by mask, SpO2 went up rapidly to 100%. When the patient breathed under room air, SpO2 suddenly decreased to 80%. Chest x-ray at that time was non-contributory. Under the suspicion of pulmonary embolism, the patient was transferred to intensive care unit (ICU), and low molecular weight heparin (LMWH) treatment was started. LMWH was changed to regular heparin on the second day of ICU admission after conclusive diagnosis with spiral computed tomography and lung perfusion scan. The patient's oxygenation progressively improved and on the 10th day of ICU, the patient was transferred to general ward and she was discharged without any sequelae on the 23th day postoperatively.

Airway Partial Obstruction by Internal Hermiation of Armored Endotracheal Tube: A case report: Mijeung Gwak, Hyun Sook Hwang, Eun Ha Suk, Pyung Hwan Park; Korean J Crit Care Med. 2002;17(1):29-33.

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Abstract PDF: During general anesthesia, intubation with kink-resistant armored tubes permit the anesthesiologist to work some distance from the surgical field during operation on the head and neck or with patients whose unusual position may kink and obstruct a tube not so reinforced. But armored tubes are still subject to number of hazards, including herniation of the intra-luminal cuff or layer into the lumen of the tube. So extra care is required in their use. We report a case of intraluminal herniation of armored tube accompanied with peak inspiratory pressure during general anesthesia.

Recurrent Intracerebral Hemorrhage after Extubation in a Hypertensive Patient: A case report: Jun Hak Lee, Hyo Sin Lim, Kyung Hee Nam, Su Jong Lee, Ki Nam Lee, Jun Il Moon; Korean J Crit Care Med. 1999;14(2):176-180.

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Abstract PDF: Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.

Original Article

Incidence of Pulmonary Aspiration in Patients with Tracheostomy: Keon Sik Kim, Dong Soo Kim, Wha Ja Kang, Young Kyu Choi, Ok Young Shin, Doo Ik Lee, Moo Il Kwon; Korean J Crit Care Med. 1999;14(2):161-166.

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Abstract PDF: BACKGOUND: Patients with tracheostomy tubes have altered glottic closure in deglutition that may result in aspiration and may cause dangerous pulmonary complication including bronchopneumonia and atelectasis. The incidence of pulmonary aspiration in patients with tracheosomy may be high but difficult to determine because investigators often apply different criteria. The present study was prepared to document the incidence of aspiration in patients with tracheostomy using a simple dye-marker test.
METHODS
Thirty six surgical and medical patients (14 male and 22 female) in ICU with tracheostomy tube (high volume, low pressure cuffed tube) were included in this study. Mental status (presence of response to verbal command), the presence of nasogastric tube and the presence of ventilatory support were recorded in each patients to evaluate the effect of these factors on the incidence of aspiration. 1% solution of methylene blue dye was applied on the both side of posterior tongue and then any evidence of the blue dye-marker obtained microscopically on secretion through the tracheostomy tube at every 2 hours during 72 hours was considered the positive evidence of aspiration.
RESULTS
Aspiration was detected by a positive methylene blue dye test in 11 of the 36 patients (30.5%) and average length of time before blue dye was obtained on tracheal secretion was 8.2 7.3 hours.The presence of response to verbal command, nasogastric tube and ventilatory support had no apparent effect on the incidence of aspiration.
CONCLUSIONS
This observation suggests that a simple test using dye-maker is helpful to detect aspiration in patients with tracheostomy. Tracheostomy should be done under discreet decision because the high incidence of aspiration in trcheostomized patients.

Case Reports

Postoperative Unstable Angina Pectoris Occured in the Recovery Room: Case report: Myoung Oak Kim; Korean J Crit Care Med. 1999;14(1):52-57.

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Abstract PDF: The leading cause of death after anesthesia and operations is cardiac complications, defined as myocardial infarction, unstable angina, congestive heart failure. We experienced a case of transient chest pain mimicking to myocardial ischemia after total intravenous anesthesia using propofol. The patient was 56 year-old female who underwent metatarsal osteotomy and distal soft tissue procedure. There was no specific abnormality on preoperative laboratory tests. Anesthesia induction and intraoperative course were completely uneventful. Immediately after transfered to the recovery room, the patient revealed transient cyanosis and complained anterior chest pain with tightness after fully awakening. In the study of electrocardiogram, there were ST abnormality in II, III, AVF and then T inversion in II, III, AVL, AVF, V2-6 leads. In the simultaneous study of echocardiogram, there was hypokinetic wall movement in the distal septum area. After treatment of nitroglycerine, the pain was subsided and the patient was discharged without any sequelae.

Misconception of Bilateral Vocal Cord Paralysis as Laryngeal Spasm after Endotracheal Extubation: Bong Jae Lee, Jae Yong Jeong, Doo Ik Lee, Dong Soo Kim; Korean J Crit Care Med. 1999;14(1):47-51.

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Abstract PDF: We recently experienced an unexpected episode of bilateral vocal cord paralysis following endotracheal extubation after uvulopalatopharyngoplasty and tonsillectomy in 64-year-old man. The patient had no any other clinical manifestations regarding larynx or vocal cord except sleep apnea syndrome prior to this operation. The surgical procedure lasted almost 120 minutes and surgery and anesthesia was uneventful. After restoration of his spontaneous respiration, we tried extubation as usual method. Regardless his effort of spontaneous respiration for several times, he was suddenly apneic and showed declining of arterial oxygen saturation on the pulse oximeter (SpO2). Then we tried reintubation as a decision of laryngeal spasm. This alternative episode of extubation and reintubation was tried again and the causative factor of this respiratory impairment was confirmed as bilateral vocal cord paralysis by fiberoptic bronchoscopic examination in the operating room. Almost two thirds of vocal cord function was restored after six months of operation.

Delayed Development of Pulmonary Embolism after Total Hip Replacement: A case report: Hyun Kyo Lim, Young Bok Lee, Kwang Ho Lee, Chun Gyung Kim, Kyoung Min Lee, Chong Kweon Chung; Korean J Crit Care Med. 1998;13(2):239-242.

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Abstract PDF: Though anticoagulant therapy has been shown to improve outcomes dramatically, pulmonary embolism is a potentially fatal disease. A 82 years old female underwent elective operation for left femur neck fracture under general anesthesia. At the twenty-two postoperative days, she suddenly developed cyanosis with hypotension. She was transferred to intensive care unit and pulmonary embolism was diagnosed by pulmonary perfusion scan and echocardiography. Despite of diagnosis and treatment of pulmonaly embolism, she expired 29 hours after onset of symptom.

Original Articles

Quality Assessment of Blood Transfusion in Operating Room: Myoung Gil Chae, Byeung Ho Byeun, Dong Hee Kang, Hae Kyu Kim, Seong Wan Baik, Kyoo Sub Chung; Korean J Crit Care Med. 1998;13(2):234-238.

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Abstract PDF: BACKGOUND: Transfusion of red blood cells is a life saving measure in the management of a variety of surgical conditions. A guideline for blood transfusion during elective surgical procedure is necessary to reduce the risks of transfusion-associated complications, excessive blood bank workload, excessive blood request and overtransfusion, and the cost. From this, a program of quality assessment was adopted to improve blood transfusion practice and to establish the guideline for blood transfusion in elective surgery at Pusan National University Hospital.
METHODS
Fifty-six patients undergoing elective surgery was divided 2 groups. Transfusion (T) group was 18 persons. Non-transfusion (NT) group was 38 persons. The preoperative, pre-transfusion, postoperative, and post-transfusion hemoglobin (Hb), hematocrit, mean arterial blood pressure (MAP), heart rate (HR), average amount of transfused red blood cell units, allowable blood loss, and the amount of infused crystalloids and colloids was estimated for 9 months in Pusan National University Hospital.
RESULTS
There were no significant differences in Hb between T & NT group. Hb decreased significantly until postoperative 3rd day in NT group. Platelet count decreased in NT group on postop. 3rd day. There were no significant differences in MAP & HR. One-ninth of T group was overestimated blood loss & 18.4% of NT group was underestimated blood loss. One-third of transfusion patient were overtransfused & 36.2% of transfused RBC was unnecessary. Nearly 90% of patient was transfused packed RBC with FFP concurrently.
CONCLUSIONS
To minimize overtransfusion, transfusion based on intraoperative hematocrit is necessary. If possible, single use of packed RBC is recommended when the blood loss is below allowable blood loss. In massive bleeding above allowable blood loss, combined administration of FFP and packed RBC or transfusion of whole blood will be better.

The Effect of Clonidine Pretreatment on Bupivacaine-induced Cardiac Toxicity in Rabbit: Eun Ju Lee, Jin Young Chon, Yong Woo Choi, Se Ho Moon; Korean J Crit Care Med. 1998;13(2):205-211.

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Abstract PDF: BACKGOUND: Bupivacaine, an amide type local anesthetic, is frequently used for regional anesthesia. Bupivacaine overdose induces cardiac toxicity and directly depresses both cardiac electrophysiology and hemodynamic status. Clonidine, an imidazolin alpha-2-adrenoreceptor agonist, given prophylactically may delay the toxic manifestation of bupivacaine overdose and does not accentuate the subsequent hypotension. We studied the effect of clonidine pretreatment on bupivacaine induced cardiac toxicity.
METHODS
Fourteen rabbits (seven in each group) were anesthetized with ketamine and rompun, and tracheostomy was performed. Spontaneous ventilation with room air was continued throughout the experiment. Electrocardiogram, heart rate, and invasive arterial blood pressure were continuously recorded. Clonidine 5 microgram/kg (clonidine group) or saline (control group) was injected intravenously in randomized fashion. After 15 minutes, an intravenous infusion of bupivacaine was started at 0.3 mg/kg/min. The time of occurrence of the bupivacaine-induced toxic events: first dysrhythmia, 25% and 50% reduction in basal heart rate and mean arterial pressure, and asystole were recorded. At 5, 10, 15, and 20 minutes after bupivacaine infusion, 2 ml of whole blood were withdrawn via femoral arterial catheter for determination of bupivacaine concentration.
RESULTS
The threshold time at the first dysrhythmia was significantly greater in the clonidine group (27.2+/-4.5 min) than control group (19.9+/-1.2 min). The threshold times at the 25 and 50% reduction in basal heart rate were significantly greater in the clonidine group (23.7+/-5.8 min, 33.2+/-5.1 min) than control group (16.6+/-2.9 min, 22.9+/-2.8 min) and in basal mean arterial pressure were significantly greater in the clonidine group (15.6+/-2.6 min, 25.3+/-3.7 min) than control group (9.7+/-2.7 min, 16.3+/-5.8 min). The threshold time at the asystole was significantly greater in the clonidine group (38.2+/-7.7 min) than control group (28.7+/-3.4 min). At 5, 10, 15, and 20 minutes after bupivacaine infusion, there was no significant difference in the plasma bupivacaine concentration between two groups.
CONCLUSION
This study demonstrates that clonidine pretreatment delays the cardiac toxic manifestations of bupivacaine overdose. And plasma bupivacaine concentration was not influenced by clonidine pretreatment.

Case Reports

Cerebral Hemorrhage Following Anesthesia for a Patient with Takayasu's Arteritis: A case report: Keon Hee Ryu, Yoon Ki Lee, Yong Woo Choi, Jai Min Lee, Chang Sung Kim, Soo Kyung Song; Korean J Crit Care Med. 1998;13(1):113-113.

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Abstract PDF: Takayasu's arteritis is a nonspecific inflammatory arteritis involving the aorta and its major branches. Stroke may be an important and predictive complication for the prognosis in such patient. A 48-year-old woman got a bypass operation 3 months ago because of both subclavian artery and left common carotid artery occlusion, but she still suffered from headache, dizziness and tingling sensation and had no pulse of right arm. So, she got a bracheoaxillary bypass reoperation. Anesthesia was performed with enflurane-N2O-O2. At the recovery room, her mental state was deep drowsy and she revealed high blood pressure and abnormal neurological sign. Her brain computed tomography revealed cerebral hemorrhage at left frontotemporal basal ganglion area. Emergent hematoma removal of brain was done. Post- operatively this patient sustained an intracerebral hemorrhage in the initial hemorrhagic site despite immediate reoperation. She was discharged home without improvement at postoperative 5 days. This report is a description of Takayasu's arteritis with massive cerebral hemorrhage following a reoperation of occluded bypass surgery.

A Case of Severe Anemia Due to Anti Ce in Transfused Patient: Young Jae Kim, Kun Moo Lee, Soon Ho Jeong, Young Kyun Choe, Jin Woo Park, Chee Mahn Shin, Ju Yuel Park; Korean J Crit Care Med. 1998;13(1):101-104.

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Abstract PDF: Intraoperative massive bleeding requires fluid therapy and blood transfusion. But transfusion may elicit infection, hemolytic reaction, hemostatic disorder and other complication. Individuals often produce antibodies to the alleles which lack in ABO and Rh system. Such antibodies are responsible for the most serious reaction to transfusions. Antibodies may occur "naturally" or in response to sensitization from a previous transfusion or pregnancy. We report a case of severe anemic patient who had Anti Ce due to previous transfusion and was not transfused for several hours because of incompatible cross-matching. His Rh phenotype is revealed cDE.

Atelectasis Due to Epistaxis Aspiration during Awake Fiberoptic Nasotracheal Intubation: Ju Tae Sohn, Sang Jung Lee, Kyung Il Hwang, Heon Keun Lee, Sang Hwy Lee, Young Kyun Chung; Korean J Crit Care Med. 1998;13(1):91-96.

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Abstract PDF: Indication for fiberoptic intubation in an awake patient include almost any abnormality that may hinder the expeditious placement of an endotracheal tube during anesthetic induction. An epistaxis is the most frequent complication of nasotracheal intubation. The patient was admitted for open reduction and internal fixation due to severe mandible fracture. We experienced a case of atelectasis due to epistaxis aspiration during awake fiberoptic nasotracheal intubation in the conscious patient regionally anesthetized by both superior laryngeal nerve block and translaryngeal anesthesia, which is treated by saline irrigation, suction, active coughing and chest percussion.

A Case of Pulmonary Aspiration during the Anesthetic Induction in the Post Total Gastrectomy Patient: Yoon Hee Kim, Sang Soo Kim, Moon Hee Park, Seok Hwa Yoon; Korean J Crit Care Med. 1998;13(1):85-90.

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Abstract PDF: Pulmonary aspiration of gastric contents is a feared complication of anesthetic procedures. But aspiration of intestinal contents is rare, the influences of the aspirated contents and/or the consequnt events in the airway have not been fully settled in its provacative role for causing an acute pulmonary reaction. We experienced a case of pulmonary aspiration of intestinal content. The patinet who had undergone previous total gastrectomy was planed emergency operation due to intestinal obstructon. Aspiration during anesthetic induction occurred accidentally. Immediate endotracheal intubation and suction were followed. Right chest breathing sound was coarse and then it was getting better. Although supplement of O2 by Y-piece, arterial blood gas analysis of patient revealed pH 7.30, PaCO2 36 mmHg, PaO2 58 mmHg after emegence from anesthesia in the recovery room. Chest X-ray showed the focal air space consolidation in right lower lung and ill defined pulmonary opacity in left mid lung and retrocardiac area. The measured pH of aspiration content was 7.8 and nonpathogenic Gram negative bacilli species were cutured. Frequent suction, encouraging expectoration, antimicrobial agents therapy and O2 supplementation by Y-piece were performed in the ICU. Patient normalized following 24 hrs after the episode of aspiration.

Original Article

Intraoperative Carotid Sinus Hypersensitivity and Postoperative Complication of Radical Neck Dissection Retrospective Study: Tae Il Kim, Hae Ja Lim, Seong Ho Chang, Nan Sook Kim; Korean J Crit Care Med. 1998;13(1):49-54.

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Abstract PDF: BACKGOUND: Postoperative complications in the geriatric patients undergoing radical neck dissection are generally considered to be more severe than young patients. The incidence of carotid sinus hypersensitivity in elderly patients is also considered to be higher than the young. The comparison between old (above 65 years) and young (below 65 years) aged groups about intraoperative carotid sinus hypersensitivity and postoperative complication is necessary for safe anesthesia.
METHODS
Sixty five adult patients, of either sex, regardless of age, given radical neck dissection from January 1990 to January 1998, were investigated for the incidence of intraoperative carotid sinus hypersensitivity and postoperative hypertension by way of retrospective chart review. The authors also examined the postoperative complications such as high fever, pulmonary, cardiac and renal complications, cerebrovascular diseases and neurologic injuries.
RESULTS
The incidence of intraoperative carotid sinus hypersensitivity were 28% in elderly patients (n=25), 10% in young patients (n=40) but there was no statistical significance. The incidence of postoperative hypertension were 79.1% in patients with hypertension history, 34.1% in patients without hypertension history and there was statistical significance between the two groups (P=0.001). The incidence of postoperative pulmonary complication were 44% in elderly patients, 20% in young patients, and there was also statistical significance between the two groups (P=0.038). There was no statistical significance in the incidence of postoperative high fever above 38.5degrees C between the two groups (p=0.059).
CONCLUSION
After the radical neck dissection, the geriatric patients had a greater incidence of postoperative pulmonary complications than young patients and the most relating factor to postoperative hypertension was previous history of hypertension. Therefore optimal preoperative preparations for the hypertensive patients and the prevention and immediate treatment of the postoperative pulmonary complications in geriatric patients are very important during the radical neck dissection.

Case Reports

Anesthesia for Cesarean Section in Two Pregnant Women with Peripartum Cardiomyopathy: A report of two cases: Yong In Kang, Kyung Sook Cho, Su Yeon Kim, Myoung Hee Kim, Hyun Sook Lee; Korean J Crit Care Med. 1997;12(2):177-182.

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Abstract PDF: Peripartum cardiomyopathy (PPCM) is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first 6 months after delivery. Mortality from PPCM ranges from 25% to 50% and cause of death is usually chronic congestive heart failure or thromboembolic complications. We experienced 2 patients with PPCM. One was a twin pregnant woman and PPCM was developed after cesarean section. In the other case, PPCM was combined with aspiration pneumonia in the preterm labor patient. They were treated with diuretics and cardiotonic drugs and recovered to normal cardiac function within 7 to 10 days. Prognosis is related to recovery of left ventricular function, which usually occurs within 6 months postpartum. Early diagnosis and appropriate treatment of PPCM improve outcome.

A Case of Rupture of Right Common Iliac Artery and Vein during Lumbar Discectomy: A case report: Yeon Jang, Seung Eun Ji, Eun Jung Cho, Soo Seog Park, Soo Young Jung, Ho Kyung Song; Korean J Crit Care Med. 1997;12(2):159-162.

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Abstract PDF: Intraabdominal vascular complications associated with lumbar disc surgery are rare but have potentially fatal consequences. Clinical manifestations of such injuries may be extremely variable and confused with anesthetic complications, myocardial infarction, or pulmonary embolism. So, the presence of vascular injury may not be recognized immediately. Recently, we experienced a case of extensive retroperitoneal hemorrhage during lumbar disc surgery. The patient was a 35 year-old healthy female. During operation, unexplained profound hypotension and tachycardia developed, but abnormal bleeding was not seen in the operative wound. Emergency CT of the abdomen was performed, and huge retroperitoneal hematoma was confirmed by the CT scan. Immediate abdominal exploration revealed the injury to right common iliac artery and vein. The patient underwent primary repair of lacerated artery and vein. Postoperative recovery was uneventful. We think awareness of the likelihood of vascular complications related to disc surgery is quite important for early diagnosis and management of these life-threatening complications.

Original Article

Differences of Incidence and Severity of Sore Throat and Hoarseness between the Methods of Airway Security: Yeoung Hwan Choi, Hee Chung Kim; Korean J Crit Care Med. 1997;12(1):43-48.

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Abstract PDF: Introduction: The sore throat and hoarseness are common complications during the postoperative period. We investigated differences of incidence and severity of sore throat and hoarseness according to methods of airway security.
METHODS
One hundred twelve patients, in ASA physical status class 1~2, were included in this study (58 males and 54 females). They were divided into three groups: group 1 (n=42), intubated with endotracheal tube lubricated with normal saline; group 2 (n=40), intubated with endotracheal tube lubricated with 5% lidocaine ointment; group 3 (n=30), inserted with laryngeal mask airway (LMA) for airway security.
RESULTS
The incidence of sore throat and hoarseness were 78.6% and 54.8% in group 1, 35% and 30% in group 2, and 33.3% and 20.0% in group 3.
CONCLUSIONS
Both 5% lidocaine-lubricated endotracheal tube and laryngeal mask airway showed tendency of decreased incidence of postoperative sore throat and hoarseness but there are no statistical significance.

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