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Original Article
Neurosurgery
Role of serum magnesium in post-aneurysmal subarachnoid hemorrhagic hydrocephalus
Moinay Kim, Hyunchul Jung, Seung Bin Kim, Jun Ha Hwang, Hanwool Jeon, Yeongu Chung, Youngbo Shim, Jae Hyun Kim, Joonho Byun, Aiden Cousins, Wonhyoung Park, Jung Cheol Park, Jae Sung Ahn, Seungjoo Lee
Acute Crit Care. 2025;40(4):582-593.   Published online November 28, 2025
DOI: https://doi.org/10.4266/acc.003550
  • 403 View
  • 52 Download
AbstractAbstract PDF
Background
Post-hemorrhagic hydrocephalus (PHH) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), yet the relationship between serum magnesium (Mg) level and PHH remains unclear. To our knowledge, this is the first prospective study to specifically examine the association between admission serum Mg level and PHH in aSAH patients.
Methods
In this prospective, multicenter study (October 2019–October 2024), 131 patients with confirmed aSAH were enrolled from four neuro-intensive care units. Patients were stratified by admission serum Mg level as <2.2 mg/dL or ≥2.2 mg/dL. The primary outcome was PHH incidence; secondary outcomes were cerebral vasospasm (CV), delayed cerebral ischemia (DCI), and 30-day modified Rankin Scale (mRS) score.
Results
Baseline characteristics were similar between groups. Serum Mg ≥2.2 mg/dL was not significantly associated with reduced vasospasm, DCI, or poor functional outcome. However, serum Mg >2.5 mg/dL correlated with lower PHH incidence in univariate analysis (odds ratio, 0.36; P=0.027) but not in multivariate analysis (P=0.136). Independent predictors of PHH were posterior circulation aneurysm, high Fisher grade, and high Hunt and Hess grade. Poor 30-day mRS was independently associated with high Fisher and Hunt and Hess grades.
Conclusions
Admission serum Mg level was not independently associated with PHH, although a potential protective trend was noted at higher levels (>2.5 mg/dL). These findings suggest a possible role of Mg in PHH prevention. Further prospective trials are warranted to clarify the therapeutic potential of Mg and to establish optimal monitoring and correction strategies in aSAH management.
Review Article
Neurosurgery
The role of catecholamines in aneurysmal subarachnoid hemorrhage: a narrative review
Samantha Nalliah, Tariq Janjua, Luis Rafael Moscote-Salazar, Md Yunus, Amit Agrawal
Acute Crit Care. 2025;40(4):513-520.   Published online November 24, 2025
DOI: https://doi.org/10.4266/acc.001525
  • 2,116 View
  • 279 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
The marked release of catecholamines during subarachnoid hemorrhage is an important aspect of the pathobiology following aneurysmal rupture. This narrative review aims to identify how catecholamines influence aneurysmal subarachnoid hemorrhage (aSAH) outcomes. aSAH is a critical neurological condition characterized by hemorrhage into the subarachnoid space, leading to severe neurological deficits and mortality. Catecholamines, including epinephrine, norepinephrine, and dopamine, are the body's stress responses, which can lead to secondary injuries following aSAH. This review was conducted through a targeted literature search of relevant studies examining the relationship between aSAH, catecholamines, and clinical outcomes. Searches were performed in PubMed, Scopus, The Cochrane Library, Medline (Ovid), Embase (Ovid), and CINAHL, including publications up to July 2024. Search terms combined keywords and subject headings related to “subarachnoid hemorrhage” or “aSAH,” “catecholamines,” “epinephrine,” “norepinephrine,” “dopamine,” and outcome-related terms such as “prognosis,” “mortality,” and “neurological outcome.” Articles were selected based on relevance, and key findings were synthesized descriptively to provide a comprehensive overview of current knowledge in this area. Elevated levels of catecholamines are observed following aSAH and are associated with increased sympathetic nervous system activity. This catecholamine surge contributes to pathological processes, including vasospasm, blood-brain barrier disruption, cerebral edema, and neuronal damage. The review highlights the implications of catecholamine levels; where higher concentrations correlate with poorer outcomes and higher mortality rates. Understanding the mechanisms responsible for secondary injury due to catecholamines surge following aSAH shall facilitate the development of therapeutic approaches to prevent secondary brain injury and improve outcomes.

Citations

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  • Glucose/Potassium Ratio, a Novel Biomarker for the Prognosis of Patients with Subarachnoid Hemorrhage: A Review
    Luis E. Fernández-Garza, Valeria A. Fernández-Garza, Daniela Mares-Custodio, Victor Gutiérrez-Ruano, Alexandro Navarrete-Rodríguez, Juan J. Arias-Alzate
    Journal of Vascular Diseases.2025; 4(4): 48.     CrossRef
Original Article
Neurosurgery
The efficacy of therapeutic hypothermia in patients with poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
Seungjoo Lee, Moinay Kim, Min-Yong Kwon, Sae Min Kwon, Young San Ko, Yeongu Chung, Wonhyoung Park, Jung Cheol Park, Jae Sung Ahn, Hanwool Jeon, Jihyun Im, Jae Hyun Kim
Acute Crit Care. 2024;39(2):282-293.   Published online May 30, 2024
DOI: https://doi.org/10.4266/acc.2024.00612
  • 6,285 View
  • 191 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Background
This study evaluates the effectiveness of Therapeutic Hypothermia (TH) in treating poor-grade aneurysmal subarachnoid hemorrhage (SAH), focusing on functional outcomes, mortality, and complications such as vasospasm, delayed cerebral ischemia (DCI), and hydrocephalus.
Methods
Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was conducted across multiple databases, including Medline, Embase, and Cochrane Central, up to November 2023. Nine studies involving 368 patients were selected based on eligibility criteria focusing on TH in poor-grade SAH patients. Data extraction, bias assessment, and evidence certainty were systematically performed.
Results
The primary analysis of unfavorable outcomes in 271 participants showed no significant difference between the TH and standard care groups (risk ratio [RR], 0.87). However, a significant reduction in vasospasm was observed in the TH group (RR, 0.63) among 174 participants. No significant differences were found in DCI, hydrocephalus, and mortality rates in the respective participant groups.
Conclusions
TH did not significantly improve primary unfavorable outcomes in poor-grade SAH patients. However, the reduction in vasospasm rates indicates potential specific benefits. The absence of significant findings in other secondary outcomes and mortality highlights the need for further research to better understand TH's role in treating this patient population.

Citations

Citations to this article as recorded by  
  • Progress of Brain Hypothermia Treatment for Severe Subarachnoid Hemorrhage—177 Cases Experienced and a Narrative Review
    Hitoshi Kobata
    Therapeutic Hypothermia and Temperature Management.2025; 15(3): 113.     CrossRef
  • State-of-the-art for automated machine learning predicts outcomes in poor-grade aneurysmal subarachnoid hemorrhage using routinely measured laboratory & radiological parameters: coagulation parameters and liver function as key prognosticators
    Ali Haider Bangash, Jayro Toledo, Muhammed Amir Essibayi, Neil Haranhalli, Rafael De la Garza Ramos, David J. Altschul, Stavropoula Tjoumakaris, Reza Yassari, Robert M. Starke, Redi Rahmani
    Neurosurgical Review.2025;[Epub]     CrossRef
  • Targeted temperature management in acute brain injury
    Arjun Joshi, Mark Earl
    Anaesthesia & Intensive Care Medicine.2025; 26(10): 639.     CrossRef
Case Report
Neurosurgery
A point-of-care evaluation after visual loss following paraclinoid aneurysm repair: the role of sonographic and pupillometer assessment
Giacomo Bertolini, Ernesto Migliorino, Diego Mazzatenta, Carlo Bortolotti, Raffaele Aspide
Acute Crit Care. 2025;40(1):144-149.   Published online July 5, 2022
DOI: https://doi.org/10.4266/acc.2022.00045
  • 6,218 View
  • 104 Download
AbstractAbstract PDF
Visual complications represent common deficits following surgical or endovascular repair of paraclinoid aneurysms. Different etiologies should be investigated to prevent devastating consequences. Herein we present a point-of-care evaluation to investigate sudden visual loss after coiling of paraclinoid aneurysms. A 20-year-old male was admitted for a sudden headache. Head computed tomography showed a subarachnoid hemorrhage and subsequent angiography revealed a 9-mm left supraclinoid aneurysm of the internal carotid artery treated with endovascular coil embolization. Thirty minutes after intensive care unit admission, the patient reported a left amaurosis. To exclude secondary etiologies, an immediate evaluation with point-of-care devices (color-doppler and B-mode ultrasound and automated pupillometry) was performed. Sonographic evaluations were negative for ischemic/thrombotic events and neurologic pupil index within physiological ranges provide evidence of third cranial nerve responsiveness. The symptomatology resolved progressively over 120 minutes with low-dose steroid therapy, 30° head-of-bed elevation, and blood pressure management. Visual deficits can occur after endovascular procedure and should be investigated. Suspected visual loss is a neurological emergency that deserves a prompt evaluation. Ultrasound and automated pupillometry have proved to be an effective, rapid, reliable, and non-invasive combination for a clinical decision-making strategy in the management of post-procedural acute visual deficits.
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
  • 13,513 View
  • 434 Download
  • 4 Web of Science
  • 6 Crossref
AbstractAbstract 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  
  • A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation
    David Silveira Marinho, Denise Menezes Brunetta, Luciana Maria de Barros Carlos, Luany Elvira Mesquita Carvalho, Jessica Silva Miranda
    Brazilian Journal of Anesthesiology (English Edition).2025; 75(2): 844583.     CrossRef
  • Targeting Inflammation After Hemorrhagic Shock as a Molecular and Experimental Journey to Improve Outcomes: A Review
    Kenneth Meza Monge, Astrid Ardon-Lopez, Akshay Pratap, Juan-Pablo Idrovo
    Cureus.2025;[Epub]     CrossRef
  • Comprehensive meta-analysis of emergency trauma outcomes: trends, interventions, and survival rates
    Aiming Li, Qiaoyan Feng, Ye Zhao, Xianhuan Zhang, Weijie Jiang
    Frontiers in Public Health.2025;[Epub]     CrossRef
  • Hypovolemic shock in adults. Guidelines of the All-Russian Public Organization “Federation of Anesthesiologists and Reanimatologists”
    Igor B. Zabolotskikh, E. V. Grigoryev, V. S. Afonchikov, A. Yu. Bulanov, S. V. Grigoryev, A. N. Kuzovlev, V. V. Kuzkov, R. E. Lakhin, K. M. Lebedinskii, O. V. Orlova, E. V. Roitman, S. V. Sinkov, N. P. Shen, A. V. Schegolev
    Annals of Critical Care.2024; (4): 7.     CrossRef
  • Navigating Hemorrhagic Shock: Biomarkers, Therapies, and Challenges in Clinical Care
    Kenneth Meza Monge, Caleb Rosa, Christopher Sublette, Akshay Pratap, Elizabeth J. Kovacs, Juan-Pablo Idrovo
    Biomedicines.2024; 12(12): 2864.     CrossRef
  • 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
Neurosurgery
The RAP Index during Intracranial Pressure Monitoring as a Clinical Guiding for Surgically Treated Aneurysmal Subarachnoid Hemorrhage: Consecutive Series of Single Surgeon
Sung-Chul Jin, Byung Sam Choi, Jung-Soo Kim
Acute Crit Care. 2019;34(1):71-78.   Published online February 28, 2019
DOI: https://doi.org/10.4266/acc.2019.00437
  • 10,146 View
  • 153 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract PDF
Background
It is well known that assessing the RAP index along with intracranial pressure (ICP) monitoring in traumatic brain injury patients is helpful. We will discuss the usefulness of this assessment tool as a clinical guide for surgically treated poor grade aneurysmal subarachnoid hemorrhage (SAH).
Methods
This retrospective study included 35 patients with aneurysmal SAH who presented with World Federation of Neurosurgical Societies (WFNS) grade V SAH and received surgical treatment from January 2013 to December 2018. Emergency surgical clipping, hematoma removal, extraventricular drainage, and if needed, wide decompressive craniectomy were combined as the proper surgical treatments. Outcomes were assessed based on in-hospital survival and the Glasgow outcome scale score at 14-day follow-up. We compared the mortality rate of two groups of seven patients: ICP monitoring only (n=5) and ICP monitoring combined with the RAP index (n=2).
Results
The in-hospital 14-day mortality rate by brain lesion was 48.5% (n=17). Seven patients had real-time ICP monitoring. Before 2018, three of five patients with poor WFNS grade who received real-time ICP monitoring only died. There were no deaths in the group of two patients receiving real-time ICP monitoring and the RAP index.
Conclusions
Our data indicate that combining the RAP index and ICP monitoring can be used as markers for critical intracranial physiological parameters in poor grade WFNS patients.

Citations

Citations to this article as recorded by  
  • Exploring Cerebrospinal Compensatory Zones Using a Noninvasive Approach
    Sérgio Brasil, Marek Czosnyka, Wellingson S. Paiva, Gustavo Frigieri
    Neurocritical Care.2025; 43(3): 834.     CrossRef
  • Continuous monitoring methods of cerebral compliance and compensatory reserve: a scoping review of human literature
    Abrar Islam, Logan Froese, Tobias Bergmann, Alwyn Gomez, Amanjyot Singh Sainbhi, Nuray Vakitbilir, Kevin Y Stein, Izabella Marquez, Younis Ibrahim, Frederick A Zeiler
    Physiological Measurement.2024; 45(6): 06TR01.     CrossRef
  • Multimodal Neurologic Monitoring in Children With Acute Brain Injury
    Jennifer C. Laws, Lori C. Jordan, Lindsay M. Pagano, John C. Wellons, Michael S. Wolf
    Pediatric Neurology.2022; 129: 62.     CrossRef
  • Intracranial pressure: current perspectives on physiology and monitoring
    Gregory W. J. Hawryluk, Giuseppe Citerio, Peter Hutchinson, Angelos Kolias, Geert Meyfroidt, Chiara Robba, Nino Stocchetti, Randall Chesnut
    Intensive Care Medicine.2022; 48(10): 1471.     CrossRef
  • The application value of CT radiomics features in predicting pressure amplitude correlation index in patients with severe traumatic brain injury
    Jiaqi Liu, Yingchi Shan, Guoyi Gao
    Frontiers in Neurology.2022;[Epub]     CrossRef
Trauma
Usefulness of Rotational Thromboelastometry as a Mortality Predictor of Hyperfibrinolysis in Patients with Severe Trauma
Ji Soo Kim, Il Jae Wang, Seok Ran Yeom, Suck Ju Cho, Jae Hun Kim, June Pill Seok, Seong Hwa Lee, Byung Gwan Bae, Mun Ki Min
Acute Crit Care. 2018;33(3):162-169.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2018.00199
  • 10,809 View
  • 204 Download
  • 8 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Background
Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma.
Methods
Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed.
Results
During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P<0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality.
Conclusions
Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma.

Citations

Citations to this article as recorded by  
  • Paraneoplastic Hyperfibrinolysis in Oesophageal Adenocarcinoma: A Case Report
    Yuhui Zhou, William Gelson, Rebecca Brais, Martin Besser
    Cureus.2025;[Epub]     CrossRef
  • Prognostic value of admission ROTEM in trauma: enhancing 30-day all-cause mortality prediction using machine learning
    Villiam V. Kildal, Martin Dahlberg, Carl Henrik Ek, Anders Oldner, Agneta Wikman, Carl Magnus Wahlgren, Mattias Günther
    European Journal of Trauma and Emergency Surgery.2025;[Epub]     CrossRef
  • A comparative analysis of tranexamic acid dosing strategies in traumatic major hemorrhage
    Finn Gunn, Rheanna Stevenson, Ateeq Almuwallad, Andrea Rossetto, Paul Vulliamy, Karim Brohi, Ross Davenport
    Journal of Trauma and Acute Care Surgery.2024; 96(2): 216.     CrossRef
  • A retrospective validation of ROTEM algorithms for detecting hyperfibrinolysis demonstrates poor agreement for prediction of in-hospital mortality and transfusion requirement in a general, non-cardiac, surgical population
    Leon Rosebery, Matthew Miller, Peter Loizou, Shir Jing Ho, Keith J. Adkins, Kush Deshpande
    Thrombosis Research.2023; 229: 170.     CrossRef
  • Questions about COVID-19 associated coagulopathy: possible answers from the viscoelastic tests
    Vittorio Pavoni, Lara Gianesello, Maddalena Pazzi, Pietro Dattolo, Domenico Prisco
    Journal of Clinical Monitoring and Computing.2022; 36(1): 55.     CrossRef
  • Clinical value of early assessment of hyperfibrinolysis by rotational thromboelastometry during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands
    Marije Tahitu, Paul I. Ramler, Ada Gillissen, Camila Caram‐Deelder, Dacia D. C. A. Henriquez, Moniek P. M. de Maat, Johannes J. Duvekot, Jeroen Eikenboom, Kitty W. M. Bloemenkamp, Thomas van den Akker, Johanna G. van der Bom
    Acta Obstetricia et Gynecologica Scandinavica.2022; 101(1): 145.     CrossRef
  • ROTEM diagnostic capacity for measuring fibrinolysis in neonatal sepsis
    Maria Lampridou, Rozeta Sokou, Andreas G. Tsantes, Martha Theodoraki, Aikaterini Konstantinidi, Georgios Ioakeimidis, Stefanos Bonovas, Marianna Politou, Serena Valsami, Zoe Iliodromiti, Theodora Boutsikou, Nicoletta Iacovidou, Georgios Nikolopoulos, Argi
    Thrombosis Research.2020; 192: 103.     CrossRef
  • The Immunologic Effect of Early Intravenous Two and Four Gram Bolus Dosing of Tranexamic Acid Compared to Placebo in Patients With Severe Traumatic Bleeding (TAMPITI): A Randomized, Double-Blind, Placebo-Controlled, Single-Center Trial
    Philip C. Spinella, Kimberly A. Thomas, Isaiah R. Turnbull, Anja Fuchs, Kelly Bochicchio, Douglas Schuerer, Stacey Reese, Adrian A. Coleoglou Centeno, Christopher B. Horn, Jack Baty, Susan M. Shea, M. Adam Meledeo, Anthony E. Pusateri, Jerrold H. Levy, An
    Frontiers in Immunology.2020;[Epub]     CrossRef
Case Report
Pulmonary
Negative Pressure Pulmonary Hemorrhage after Laryngospasm during the Postoperative Period
In Soo Han, Bo Mi Han, Soo Yeon Jung, Jun Rho Yoon, Eun Yong Chung
Acute Crit Care. 2018;33(3):191-195.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2016.00689
  • 11,590 View
  • 179 Download
  • 8 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Negative pressure pulmonary hemorrhage (NPPH) is an uncommon complication of upper airway obstruction. Severe negative intrathoracic pressure after upper airway obstruction can increase pulmonary capillary mural pressure, which results in mechanical stress on the pulmonary capillaries, causing NPPH. We report a case of acute NPPH caused by laryngospasm in a 25-year-old man during the postoperative period. Causative factors of NPPH include negative pulmonary pressure, allergic rhinitis, smoking, inhaled anesthetics, and positive airway pressure due to coughing. The patient’s symptoms resolved rapidly, within 24 hours, with supportive care.

Citations

Citations to this article as recorded by  
  • Sevoflurane-Induced Diffuse Alveolar Hemorrhage: A Descriptive Analysis of All Cases Reported in the Literature
    Wesam F. Mousa, Omar W. Mousa, Mohamad W. Mousa, Huda Hamoda, Ahmad Weam, Ahmad Mulla, Nashwa Noreldin
    Current Anesthesiology Reports.2025;[Epub]     CrossRef
  • When extubation turns fatal: Delayed hemoptysis from negative pressure pulmonary hemorrhage
    Mohammed AbuBaha, Hossam Salameh, Wael Hashem, Hasan Khalili, Bara Abubaha, Mohammad Bdair, Hatem M. Taha
    Respiratory Medicine Case Reports.2025; 58: 102312.     CrossRef
  • A Complex Presentation of Acute Postoperative Negative-Pressure Pulmonary Edema: A Case Report and Review of Literature
    Larri Rudman, Javier B Chambi-Torres, Farah Chohan, Mohammad Aftab, Xinyu Cao, George Michel
    Cureus.2023;[Epub]     CrossRef
  • Laryngospasm Causing Recurrent Negative Pressure Alveolar Hemorrhage Resembling Acute Exacerbation of Interstitial Lung Disease: A Case Report
    Haruna Yamaki, Masaru Ejima, Nozomi Sato, Kei Aoyagi, Tatsushi Kozawa, Seishi Higashi, Koji Takayama, Satoko Hanada, Reiko Taki
    Respiratory Endoscopy.2023; 1(2): 95.     CrossRef
  • Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report
    Hyung Joon Park, Seung Ho Park, Un Tak Woo, Sang Yun Cho, Woo Jae Jeon, Woo Jong Shin
    World Journal of Clinical Cases.2021; 9(6): 1408.     CrossRef
  • Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report
    Yumin Jo, Jagyung Hwang, Jieun Lee, Hansol Kang, Boohwi Hong
    Journal of Medical Case Reports.2021;[Epub]     CrossRef
  • Incidence of negative-pressure pulmonary edema following sugammadex administration during anesthesia emergence: A pilot audit of 27,498 general anesthesia patients and literature review
    Chia-Li Kao, Chuan-Yi Kuo, Yi-Kai Su, Kuo-Chuan Hung
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Original Articles
Hematology
Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage
Soon Chang Park, Seok Ran Yeom, Sang Kyoon Han, Young Mo Jo, Hyung Bin Kim
Korean J Crit Care Med. 2017;32(4):333-339.   Published online November 30, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00787
  • 12,881 View
  • 372 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
Methods
A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
Results
Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
Conclusions
This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.

Citations

Citations to this article as recorded by  
  • Clinical practice guidelines for management of disseminated intravascular coagulation in Japan 2024: part 4—trauma, burn, obstetrics, acute pancreatitis/liver failure, and others
    Mineji Hayakawa, Yoshinobu Seki, Takayuki Ikezoe, Kazuma Yamakawa, Kohji Okamoto, Shigeki Kushimoto, Yuichiro Sakamoto, Yuki Itagaki, Yuki Takahashi, Hiroyasu Ishikura, Toshihiko Mayumi, Toshihisa Tamura, Kenji Nishio, Yu Kawazoe, Ayami Shigeno, Yudai Tak
    International Journal of Hematology.2025; 121(5): 633.     CrossRef
  • Role of recombinant factor VIIa in the clinical management of severe postpartum hemorrhage: consensus among European experts
    D. Surbek, J. Blatný, M. Wielgos, N. Acs, H. Edwards, O. Erez, J. L. Bartha, H. Madar, F. J. Mercier, D. Schlembach, G. C. Di Renzo
    The Journal of Maternal-Fetal & Neonatal Medicine.2024;[Epub]     CrossRef
  • Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage
    Camila Caram-Deelder, Hellen McKinnon Edwards, Jarmila A. Zdanowicz, Thomas van den Akker, Camilla Birkegård, Jan Blatný, Johanna G. van der Bom, Giuseppe Colucci, Derek van Duuren, Nan van Geloven, Dacia D. C. A. Henriquez, Marian Knight, Lars Korsholm,
    Journal of Clinical Medicine.2024; 13(9): 2656.     CrossRef
  • Thromboembolic events in severe postpartum hemorrhage treated with recombinant activated factor VII: a systematic literature review and meta-analysis
    Johanna G. van der Bom, Frédéric J. Mercier, Damaris Bausch-Fluck, Mads Nordentoft, Morten Medici, Rezan Abdul-Kadir
    Research and Practice in Thrombosis and Haemostasis.2024; 8(5): 102533.     CrossRef
  • GUIDELINES FOR APPROPRIATE TRANSFUSION IN PATIENTS WITH MASSIVE BLEEDING (SECOND EDITION)
    Masanori Matsumoto, Tomohiko Sato, Makoto Aoki, Yosuke Inoue, Tatsuki Uemura, Kenji Okada, Satoru Ogawa, Nobuyuki Katori, Shigeki Kushimoto, Nobuyuki Saito, Keita Shibahashi, Hideyuki Shimizu, Sho Takakura, Jun Takeda, Takahiro Tamura, Kimitoshi Nishiwaki
    Japanese Journal of Transfusion and Cell Therapy.2024; 71(6): 750.     CrossRef
  • Coagulation management and transfusion in massive postpartum hemorrhage
    Christina Massoth, Manuel Wenk, Patrick Meybohm, Peter Kranke
    Current Opinion in Anaesthesiology.2023; 36(3): 281.     CrossRef
  • Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care
    Sibylle Kietaibl, Aamer Ahmed, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa, Giedrius Barauskas, Edoardo De Robertis, David Faraoni, Daniela C. Filipescu, Dietmar Fries, Anne Godier, Thorsten Haas, Matthias Jacob, Marcus D. Lancé, Juan V. Llau, Jens Me
    European Journal of Anaesthesiology.2023; 40(4): 226.     CrossRef
Neurosurgery
Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage
Na Rae Yang, Kyung Sook Hong, Eui Kyo Seo
Korean J Crit Care Med. 2017;32(2):190-196.   Published online May 31, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00857
  • 7,969 View
  • 90 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC.
Methods
We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC.
Results
Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024).
Conclusions
AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.

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  • Role of serum magnesium in post-aneurysmal subarachnoid hemorrhagic hydrocephalus
    Moinay Kim, Hyunchul Jung, Seung Bin Kim, Jun Ha Hwang, Hanwool Jeon, Yeongu Chung, Youngbo Shim, Jae Hyun Kim, Joonho Byun, Aiden Cousins, Wonhyoung Park, Jung Cheol Park, Jae Sung Ahn, Seungjoo Lee
    Acute and Critical Care.2025; 40(4): 582.     CrossRef
  • Rare or Overlooked Cases of Acute Acalculous Cholecystitis in Young Patients with Central Nervous System Lesion
    Seong-Hun Kim, Min-Gyu Lim, Jun-Sang Han, Chang-Hwan Ahn, Tae-Du Jung
    Healthcare.2023; 11(10): 1378.     CrossRef
  • Acute cholecystitis as a rare and overlooked complication in stroke patients
    Myung Chul Yoo, Seung Don Yoo, Jinmann Chon, Young Rok Han, Seung Ah Lee
    Medicine.2019; 98(9): e14492.     CrossRef
  • Acute Acalculous Cholecystitis in Neurological Patients; Clinical Review, Risk Factors, and Possible Mechanism
    See Won Um, Hak Cheol Ko, Seung Hwan Lee, Hee Sup Shin, Jun Seok Koh
    Journal of Neurointensive Care.2019; 2(2): 77.     CrossRef
Case Reports
Obstetric/Emergency
Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage
Kwang Ho Lee, Seong Jin Choi, Yeong Gwan Jeon, Raing Kyu Kim, Dae Ja Um
Korean J Crit Care Med. 2016;31(4):359-363.   Published online November 30, 2016
DOI: https://doi.org/10.4266/kjccm.2016.00325
  • 14,073 View
  • 106 Download
  • 1 Crossref
AbstractAbstract PDF
Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.

Citations

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  • Persephin as a diagnostic marker of acute brain injury in critically ill newborns: a clinical trial
    A. A. Zadvornov, E. V. Grigoriev
    Fundamental and Clinical Medicine.2021; 6(3): 15.     CrossRef
Pulmonary
Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust
Sun Mi Choi, Jiwon Koh, Sang-Min Lee, Jinwoo Lee
Korean J Crit Care Med. 2016;31(2):173-177.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.173
  • 65,535 View
  • 139 Download
AbstractAbstract PDF
Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.
Neurosurgery/Hematology
Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis
Hyun Jin Baek, Doo Hyuk Lee, Kyu Hyung Han, Young Min Kim, Hyunbeom Kim, Byeongwook Cho, Inkuk Lee, Kanghyun Choi, Hojin Yong, Goohyeon Hong
Korean J Crit Care Med. 2016;31(2):134-139.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.134
  • 23,013 View
  • 273 Download
  • 2 Crossref
AbstractAbstract PDF
In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.

Citations

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  • Abdominal mass in a septic infant: Case of a fatal intraluminal intestinal hematoma
    Mana Taweevisit, Paul Scott Thorner
    Pediatric Hematology Oncology Journal.2021; 6(3): 139.     CrossRef
  • Perforated Mesenteric Cyst with Sepsis and Neurological Complication in a 9 Month Old Child
    Mandal KC, Saha D, Halder P, Chakraborty P, Debnath B, Mukhopadhyay B
    Asploro Journal of Pediatrics and Child Health.2020; 2(1): 30.     CrossRef
Neurosurgery
Delayed Traumatic Subarachnoid Hemorrhage in a Polytraumatized Patient with Disseminated Intravascular Coagulation
Jiwoong Oh, Wonyeon Lee, Ji Young Jang, Pilyoung Jung, Sohyun Kim, Jongyeon Kim, Jinsu Pyen, Kum Whang, Sungmin Cho
Korean J Crit Care Med. 2015;30(4):336-342.   Published online November 30, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.4.336
  • 12,433 View
  • 149 Download
  • 1 Crossref
AbstractAbstract PDF
The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multipletrauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and antithrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.

Citations

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  • Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments?
    Bedriye Müge Sönmez, Emirhan Temel, Murat Doğan İşcanlı, Fevzi Yılmaz, Uğur Gülöksüz, Selçuk Parlak, Özhan Merzuk Uçkun
    Journal of the National Medical Association.2019; 111(2): 210.     CrossRef
Trauma/Vascular surgery
Resuscitative Endovascular Balloon Occlusion of the Aorta in a Trauma Patient with Hypovolemic Shock
Hong Kyung Shin, Ho-Seong Han, Taeseung Lee, Do-Joong Park, Kyuwhan Jung, Kyuseok Kim
Korean J Crit Care Med. 2015;30(2):115-118.   Published online May 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.2.115
  • 20,392 View
  • 98 Download
  • 3 Crossref
AbstractAbstract PDF
Hemorrhagic shock is one of the most common causes of death in patients with multiple trauma and therefore rapid control of bleeding is the main strategy to save these patients. Resuscitative balloon occlusion of the aorta (REBOA) has been applied in several trauma cases and because of the effectiveness of this procedure it has been adopted in the trauma field. Herein, we report the first successful case of REBOA in Korea performed on a 46-year-old man with hemorrhagic shock after a fall from a height of 14-stories. The patient visited our hospital emergency room with hypovolemic shock, we performed Resuscitative Endovascular Balloon Occlusion of the Aorta under bed side blind technique. His vital sign was stabilized after procedure, then we could performed endovascular bleeding control. The patient was discharged on his 33rd in-hospital day without invasive procedure and major scar.

Citations

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  • Nurses’ Knowledge Regarding Management of Hypovolemic Shock: A Cross-Sectional Study
    Maher Atiyah
    Academia Open.2024;[Epub]     CrossRef
  • Implementation of resuscitative endovascular balloon occlusion of the aorta at the Korean Regional Trauma Center
    Youngeun Park, Byungchul Yu, Giljae Lee, Jungnam Lee, Kangkook Choi, Ahram Han
    Hong Kong Journal of Emergency Medicine.2021; 28(3): 129.     CrossRef
  • Case Series of Zone III Resuscitative Endovascular Balloon Occlusion of the Aorta in Traumatic Shock Patients
    Byungchul Yu, Gil Jae Lee, Kang Kook Choi, Min A Lee, Jihun Gwak, Youngeun Park, Jung Nam Lee
    Journal of Trauma and Injury.2020; 33(3): 162.     CrossRef
Pulmonary
Diffuse Alveolar Hemorrhage Confirmed by Bronchoalveolar Lavage in a Patient with Hemoptysis after Sildenafil Use for Erectile Dysfunction
Kyoung Min Moon, Sun Young Jung, Min Soo Han, Yongseon Cho, Young Min Rah, Jong Woo Kim
Korean J Crit Care Med. 2015;30(1):31-33.   Published online February 28, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.1.31
  • 20,246 View
  • 140 Download
  • 1 Crossref
AbstractAbstract PDF
A 81-year-old man was referred for respiratory failure by emergency medical technicians. He admitted at intensive care unit for ventilator treatment. Several hours before admission, he took sildenafil 100 mg for erectile dysfunction without prescription. The episodes of hemoptysis occurred several hours later. Computed tomography revealed multifocal diffuse ground-glass attenuation in both lungs. And the more we performed bronchoalveolar lavage, the more the color of it was turned into red. We treated him with empirical antibiotics and tranexamic acid, and hemoptysis was stopped in one day after admission. But in the 5th admission day, he died from sepsis combined with pneumonia caused by Acinetobacter baumannii abruptly.

Citations

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  • Transient haemoptysis after taking sildenafil
    Suheyla Karaduman, Azmaeen Zarif, Alesia Talpeka, Muhammed Haseeb
    BMJ Case Reports.2024; 17(7): e258050.     CrossRef
Gastroenterology
Successful Bridging Hemostasis Using a Sengstaken-Blakemore Tube in Massive Rectal Variceal Bleeding
Kyung Su Kim, Gil Joon Suh, Woon Yong Kwon
Korean J Crit Care Med. 2014;29(3):237-240.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.237
  • 11,193 View
  • 113 Download
  • 2 Crossref
AbstractAbstract PDF
Life-threatening rectal variceal bleeding is a rare complication of liver cirrhosis. Various therapeutic interventions including endoscopic variceal ligation and percutaneous transvenous obliteration have been proposed to control significant rectal variceal bleeding. However, these definite hemostasis modalities are not readily available and require an experienced endoscopist or interventional radiologist. Therefore, bridging therapy to control active bleeding is necessary especially in patients with massive bleeding. We report a case of massive rectal variceal bleeding in which a Sengstaken-Blakemore tube was effective at stopping the bleeding until percutaneous transvenous obliteration could be performed.

Citations

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  • Use of TC-325 Hemostatic Powder as a Rescue Monotherapy for Management of Rectal Variceal Bleed
    Amel Tabet Aoul, Vamsee Mupparuju, Jonathan Cirillo, Sreekanth Chandrupatla, Jeffrey Jordan, Maria Castano, Olugbenga Oyesanmi
    ACG Case Reports Journal.2024; 11(6): e01391.     CrossRef
  • Anorectal emergencies: WSES-AAST guidelines
    Antonio Tarasconi, Gennaro Perrone, Justin Davies, Raul Coimbra, Ernest Moore, Francesco Azzaroli, Hariscine Abongwa, Belinda De Simone, Gaetano Gallo, Giorgio Rossi, Fikri Abu-Zidan, Vanni Agnoletti, Gianluigi de’Angelis, Nicola de’Angelis, Luca Ansaloni
    World Journal of Emergency Surgery.2021;[Epub]     CrossRef
Cardiology/Neurology
Intracranial Hemorrhage Identified in the Early Stage after Applying Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation
Yong Hwan Kim, Kyoung Yul Lee, Seong Youn Hwang
Korean J Crit Care Med. 2014;29(3):197-200.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.197
  • 6,356 View
  • 51 Download
AbstractAbstract PDF
Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation, but neurologic complications may develop. Cardiac arrest is a fairly common complication following severe intracranial hemorrhage; this complication is encountered both out-of-hospital and in-hospital with variable frequency. To prevent cerebral complications, to detect the cause of cardiac arrest, and to guide further treatment, early neuroimaging study is needed. Herein, we report a case of intracranial hemorrhage identified after extracorporeal cardiopulmonary resuscitation, in which the cause of the hemorrhage was not clear.
Hematology/Pulmonary
Delayed Hemolytic Uremic Syndrome Presenting as Diffuse Alveolar Hemorrhage
Ji Young Hong, Ji Ye Jung, Young Ae Kang, Yoon Sung Bae, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park
Korean J Crit Care Med. 2014;29(1):43-47.   Published online February 28, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.1.43
  • 9,819 View
  • 142 Download
  • 5 Crossref
AbstractAbstract PDF
Hemolytic uremic syndrome (HUS) is defined by the triad of mechanical intravascular hemolytic anemia with schistocytosis, thrombocytopenia and acute renal failure. Pulmonary involvement in HUS is known to be rare. We present the case of a 25-year-old male with diffuse alveolar hemorrhage and myocarditis followed by atypical hemolytic uremic syndrome. In this case, successful treatments included steroid pulse therapy for the fatal alveolar hemorrhage and plasma exchange for the hemolytic uremic syndrome.

Citations

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  • Development and pilot implementation of Iranian Hemolytic Uremic Syndrome Registry
    Mina Lazem, Nakysa Hooman, Abbas Sheikhtaheri
    Orphanet Journal of Rare Diseases.2022;[Epub]     CrossRef
  • Lessons learned from hemolytic uremic syndrome registries: recommendations for implementation
    Mina Lazem, Abbas Sheikhtaheri, Nakysa Hooman
    Orphanet Journal of Rare Diseases.2021;[Epub]     CrossRef
  • The Prevalence and Incidence of Atypical Hemolytic Uremic Syndrome in Iran: A Systematic Review and Meta-Analysis Protocol Study
    Nakysa Hooman, Mahnaz Sadeghian, Fariba Jahangiri, Soudabeh Hosseini
    Journal of Comprehensive Pediatrics.2017;[Epub]     CrossRef
  • Subcapsular liver hematoma as a complication of an atypical hemolytic uremic syndrome
    Emanuel Ferreira, Nuno Oliveira, Maria Marques, Helena Pinto, Ana Santos, Armando Carreira, Mário Campos
    Nefrología (English Edition).2015; 35(3): 337.     CrossRef
  • Subcapsular liver hematoma as a complication of an atypical hemolytic uremic syndrome
    Emanuel Ferreira, Nuno Oliveira, Maria Marques, Helena Pinto, Ana Santos, Armando Carreira, Mário Campos
    Nefrología.2015; 35(3): 337.     CrossRef
Splenic Hemorrhage with Hemoperitoneum Caused by a Snakebite
Ji Young Yhi, Yoomi Yeo, Ji Yeoun Kim, Il Hwan Oh, Soon Woo Hwang, Sang Ki Lee, Dong Shin Kwak, Ji Yoon Choi, Jeong Eun Kim, Joon Sung Park
Korean J Crit Care Med. 2013;28(4):336-339.
DOI: https://doi.org/10.4266/kjccm.2013.28.4.336
  • 4,194 View
  • 139 Download
  • 4 Crossref
AbstractAbstract PDF
In Asia, snakebites are estimated to affect 4 million people every year, and of these, 100,000 people are estimated to die. In Korea, snakebites occur frequently from the spring to the fall, but their importance is often overlooked. Fatal complications, including acute respiratory distress and acute kidney injury, can occur, and in some cases, severe hemorrhage results from coagulopathy. There have been only a few cases of snakebite-induced liver or intestinal bleeding, but to our knowledge, spontaneous bleeding from the spleen has not been previously reported. Here, we report the case of a 61-year-old male who visited the emergency room with abrupt abdominal pain due to hemoperitoneum associated with splenic hemorrhage after a snakebite.

Citations

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  • Hemoperitoneum after a Bothrops snakebite: Case report
    Adriana Baqueiro Abad Ribeiro, Marcelo Larami Santoro, Marcelo Ribeiro Duarte, Cristiana Cruz Virgulino, Gerson Sobrinho Salvador de Oliveira, Francisco Oscar de Siqueira França
    Toxicon.2024; 237: 107350.     CrossRef
  • Disseminated intravascular coagulation like syndrome and cerebral hemorrhage caused by snake venom: a case report
    Sung Min Lee, Kyung Hoon Sun
    Medical Biological Science and Engineering.2024; 7(1): 64.     CrossRef
  • Delayed Splenic Rupture: A Rare Complication of Snakebites
    Tae-Youn Kim, Young-Il Roh, Kyoung-Chul Cha, Sung Oh Hwang, Woo Jin Jung
    Wilderness & Environmental Medicine.2021; 32(1): 78.     CrossRef
  • Splenic rupture and subsequent splenectomy in a young healthy victim following Russell's viper bite
    Subramanian Senthilkumaran, Pradeep Vijayakumar, Ravi Savania, Rajendran Vaiyapuri, Namasivayam Elangovan, Ketan Patel, Steven A. Trim, Ponniah Thirumalaikolundusubramanian, Sakthivel Vaiyapuri
    Toxicon.2021; 204: 9.     CrossRef
Original Article
Clinical Characteristics and Prognosis of Patients with Intracranial Hemorrhage during Mechanical Ventilation
Go Woon Kim, Jin Won Huh, Younsuck Koh, Chae Man Lim, Sang Bum Hong
Korean J Crit Care Med. 2012;27(2):94-101.
DOI: https://doi.org/10.4266/kjccm.2012.27.2.94
  • 11,160 View
  • 89 Download
AbstractAbstract PDF
BACKGROUND
Intracranial hemorrhage is a serious disease associated with high mortality and morbidity, and develops suddenly without warning. Although there were known risk factors, it is difficult to prevent brain hemorrhage from critically ill patients in the intensive care unit (ICU). There are several reports that brain hemorrhage, in critically ill patients, occurred in connection with respiratory diseases. The aim of our study is to describe the baseline characteristics and prognosis of patients with intracranial hemorrhage during mechanical ventilation in the ICU.
METHODS
We retrospectively reviewed the medical records of 56 patients, who developed intracranial hemorrhage in a medical ICU, from May 2008 to December 2011. During the mechanical ventilation in the ICU, patients were implemented with a weaning process, following ACCP (American College of Chest Physicians) criteria. Also, we compared patients with brain hemorrhage to those without brain hemorrhage.
RESULTS
Thirty two of the 56 patients (57.1%) were male, and median ages were 63 (17-90) years. The common type of brain hemorrhage confirmed was intracerebral hemorrhage/intraventricular hemorrhage (52.2%). The duration from mechanical ventilation to brain hemorrhage was 6 (0-58) days. Overall hospital mortality was 57.1%, and ICU mortality was 44.6%. The most common cause of death was brain hemorrhage (40.6%). In comparison to patients without brain hemorrhage, study patients showed less use of anticoagulants and lower ventilator pressure. Our study showed that the use of vasopressor, systolic blood pressure, peak airway pressure, and platelet count were associated with brain hemorrhage.
CONCLUSIONS
Intracranial hemorrhage showed high mortality in critically ill patients with mechanical ventilation. In the future, large case-control study will be needed to evaluate the risk factors of cerebral hemorrhage.
Case Reports
Usability of Esophageal Doppler for Monitoring of Concealed Retroperitoneal Hemorrhage during Laparoscopy Assisted Subtotal Gastrectomy
Sung Ha Mun, Seung Hwan Lee, Min Young No
Korean J Crit Care Med. 2012;27(2):134-138.
DOI: https://doi.org/10.4266/kjccm.2012.27.2.134
  • 3,137 View
  • 29 Download
AbstractAbstract PDF
Hemodynamic monitoring is an essential element in the management of perioperative patients. In addition, anesthesiologists routinely used blood pressure (invasive or non invasive), heart rate, urinary output and central venous pressure as monitoring modalities. Esophageal doppler monitoring, as a minimally invasive hemodynamic assessment tool, has a good correlation with pulmonary artery catheterization in measuring cardiac output. We experienced a case of concealed retroperitoneal hemorrhage in a patient who underwent a laparoscopic subtotal gastrectomy. When surgeons tried to close trocar sites, the patient's blood pressure dropped rapidly. At laparoscopy, we could not find gross bleeding. However, we could detect hypovolemia by esophageal doppler monitoring (CardioQ, Deltex(TM), UK). The procedure was converted to open laparotomy. Thereafter, we could find retroperitoneal hemorrhage, and vascular repair was done successfully. The patient recovered without any other complications.
Massive Diffuse Alveolar Hemorrhage Caused by the Aspiration of Gastric Contents during Induction of Anesthesia in Patients with Adhesive Ileus: A Case Report
Ji Seon Jeong, Jong Hun Jun, Hyo Jin Song, Hee Koo Yoo
Korean J Crit Care Med. 2012;27(2):115-119.
DOI: https://doi.org/10.4266/kjccm.2012.27.2.115
  • 5,165 View
  • 88 Download
AbstractAbstract PDF
Aspiration pneumonitis is best defined as an acute lung injury, following the aspiration of regurgitated gastric contents. Major cause of pulmonary aspiration, during anesthesia, is gastric contents. Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute respiratory distress syndrome (ARDS). However, there was no report of massive alveolar hemorrhage associated with aspiration pneumonitis. A 63-year-old man, who had undergone a total gastrectomy and received adjuvant chemotherapy, four months ago, was scheduled for adhesiolysis of the small bowel. The patient occurred aspiration of gastric contents, during induction of anesthesia, and subsequently, hypoxia developed during surgery. The patient moved to an intensive care unit (ICU), without extubation. Mechanical ventilation with PEEP was performed in an ICU. However, the patient died by ARDS and massive alveolar hemorrhage.
Original Article
A Retrospective Study about Characteristics of Out-of-hospital Cardiac Arrest Caused by Non-traumatic Subarachnoid Hemorrhage
Min Seob Sim, Ki Dong Sung, Mun Ju Kang, Ji Ung Na, Tae Gun Shin, Ik Joon Jo, Hyoung Gon Song, Keun Jeong Song, Yeon Kwon Jeong
Korean J Crit Care Med. 2011;26(3):151-156.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.151
  • 3,310 View
  • 31 Download
AbstractAbstract PDF
BACKGROUND
Subarachnoid hemorrhage is a fatal disease relatively common in the East Asian population. It can lead to cardiac arrest in several pathologic processes. We attempted to elucidate the characteristics of out-of-hospital cardiac arrest caused by non-traumatic subarachnoid hemorrhage.
METHODS
We conducted a retrospective, observational study in which patients who had visited Samsung medical center emergency room for out-of-hospital cardiac arrest from January, 1999 to December 2008 were enrolled. A total of 218 OHCA patients who had achieved ROSC were investigated by review of medical charts. Excluding those who had worn trauma, we analyzed 22 patients who had been diagnosed for SAH by brain non-contrast CT scan.
RESULTS
Median age of aneurysmal SAH-induced OHCA patients was 61 (IQR 54-67) years. Fourteen patients (64%) were female and 15 patients (68%) were witnessed. Besides, 7 patients (32%) had complained of headache before collapse. We also found 11 patients (50%) had been diagnosed with hypertension previously. All of them showed unshockable rhythm (asystole 60%, PEA 40%) initially. Their median duration of ACLS was 10 minutes. Majority of patients died within 24 hours and survivors showed poor neurologic outcome.
CONCLUSIONS
Subarachnoid hemorrhage is a relatively uncommon cause of cardiac arrest, and the outcome of OHCA induced by SAH is very poor. However, emergency physicians have to consider the possibility of SAH when trying to determine the cause of arrest, especially when treating patients who have the characteristics described above.
Case Reports
Diffuse Alveolar Hemorrhage Subsequently Developed after Recovery from Severe Acute Lung Injury Caused by H1N1 Influenza Infection: A Case Report
Kyung Ah Lim, Ye Rym Lee, Soo Yeon Cho, Du Hwan Choe, Jae Soo Koh, Byoung Jun Lee, Hye Ryoun Kim, Cheol Hyeon Kim, Jae Cheol Lee
Korean J Crit Care Med. 2010;25(4):271-275.
DOI: https://doi.org/10.4266/kjccm.2010.25.4.271
  • 3,230 View
  • 21 Download
AbstractAbstract PDF
Severe acute lung injury (ALI), leading to respiratory failure caused by H1N1 infection, developed in a 34-year-old man during a work-up for non-small cell lung cancer. Although he fully recovered through instant treatment with oseltamivir, mechanical ventilation was required again, 7 days later, due to subsequent diffuse alveolar hemorrhage (DAH). Finally, his condition improved and he was able to move out of the intensive care unit. However, multiple pulmonary metastatic nodules appeared over a period of one month, suggesting the aggressive nature of lung cancer. Although he was discharged after chemotherapy, his prognosis seemed poor, considering the rapidity of growth of the lung cancer. It is important to recognize that DAH can occur after acute lung injury caused by influenza virus.
Hyperthermia Plus Tachycardia Is Predictive of Fatal Outcome in Pontine Hemorrhage: A Case Report
Dong Woong Eom, Kyoung Dong Jeon, Jung Soo Kim
Korean J Crit Care Med. 2010;25(4):263-265.
DOI: https://doi.org/10.4266/kjccm.2010.25.4.263
  • 5,026 View
  • 21 Download
  • 1 Crossref
AbstractAbstract PDF
Pontine hemorrhage is characterized by high mortality and morbidity. We report a case of pontine hemorrhage treated by extraventricular drainage (EVD) of cerebrospinal fluid (CSF) and control of intracranial pressure (ICP) at the neuro-intensive care unit (NICU). The patient's ICP was well controlled, but hyperthermia with tachycardia developed 8 hours after admission, and the patient expired with sudden cardiac arrest. A literature review revealed that high fever (>39degrees C) developing within 24 hours after onset of hemorrhage with tachycardia (>110 beat/min) is a clinical indicator for high probability of death. Therefore, it is important that not only ICP and neurological changes but also vital signs, especially body temperature and heart rate, be monitored in pontine hemorrhage patients.

Citations

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  • Korean Medical Treatment for Prolonged Central Hyperthermia Following Pontine Hemorrhage: A Case Report
    Chan-sol Yi, Song-won Park, Seungcheol Hong, Youngji Kim, Juyeon Song, Jeong-yun Lee, Gil-cho Shin, Dong-jun Choi
    The Journal of Internal Korean Medicine.2018; 39(5): 1061.     CrossRef
Negative Pressure Pulmonary Edema and Hemorrhage after Extubation: A Case Report
Yoon Suk Ra, Chi Hyo Kim, Jong In Han, Dong Yeon Kim
Korean J Crit Care Med. 2010;25(2):98-103.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.98
  • 4,188 View
  • 44 Download
  • 1 Crossref
AbstractAbstract PDF
Negative pressure pulmonary edema (NPPE) is a rare complication of acute airway obstruction which develops after endotracheal extubation. The proposed mechanism is generation of very low negative pressure during laryngospasm by inspiratory efforts, which leads to alveolar exudation and hemorrhage. The diagnosis of NPPE is confirmed by clinical findings of tachypnea, pink prothy sputum in the endotracheal tube, hypoxemia on arterial blood gas analysis, and distinctive radiologic findings. NPPE is usually self-limited within 48 hours when diagnosed early and treated appropriately. We report three patients who recovered from NPPE without complications.

Citations

Citations to this article as recorded by  
  • Negative pressure pulmonary edema after endotracheal tube extubation during recovery of general anesthesia in a pediatric patient with cerebral palsy
    Hyun Jung Kim, Sun Kyung Park
    Allergy, Asthma & Respiratory Disease.2022; 10(4): 229.     CrossRef
The Care of a Jehovah's Witness with Life-threatening Anemia Refusing Ventilator Care: A Case Report
Ji Hyeon Lee, So Ron Choi, Young Jhoon Chin, Soo Il Lee, Chan Jong Chung, Jong Hwan Lee, Seung Cheol Lee
Korean J Crit Care Med. 2010;25(1):52-55.
DOI: https://doi.org/10.4266/kjccm.2010.25.1.52
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AbstractAbstract PDF
Jehovah's Witnesses refuse the transfusion of blood and blood products, even when it can be lifesaving. Their religious conviction against receiving blood can create a difficult clinical dilemma, particularly in the life threatening situations. We report a case of a 42-year-old female Jehovah's Witness patient who had life-threatening anemia after postpartum hemorrhage. Despite severe anemia, she had a good postoperative recovery without complications.
Original Article
Does Adding Somatostatin to Proton Pump Inhibitor Improve the Outcome of Peptic Ulcer Bleeding?
Insung Kim, Yoon Seon Lee, Byuk Sung Koh, Won Kim, Kyoung Soo Lim
Korean J Crit Care Med. 2008;23(2):75-78.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.75
  • 10,279 View
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  • 2 Crossref
AbstractAbstract PDF
BACKGROUND
Somatostatin has been shown to offer a distinct advantage over antisecretory drugs in the management of peptic ulcer bleeding (PUB). However, rebleeding rates are still high in spite of endoscopic and medical treatment. In this study, we intended to determine whether combined therapy of a proton pump inhibitor (PPI) plus somatostatin is more beneficial than a PPI alone in patients with PUB.
METHODS
We enrolled 90 consecutive patients who presented with PUB between January 2006 and October 2007. All the patients were managed with endoscopic hemostasis and divided into two treatment groups: 1) PPI alone (group A) and 2) PPI plus somatostatin (group B). The primary outcome was rebleeding within 72 hours. The secondary outcomes were rebleeding in 30 days, packed red blood cells (pRBC) transfused, length of hospital stay, need for surgery, and in-hospital mortality.
RESULTS
Forty-five patients in the PPI group (A) and 45 patients in the PPI plus somatostatin group (B) were studied. There was no difference between the two groups with respect to clinical and endoscopic features at admission. After medical treatment, there was no difference between groups A and B in rebleeding at 72 hours (11% vs. 13%, p = NS), rebleeding in 30 days (13% vs. 16%, p = NS), pRBC transfused (mean, 3.2 vs. 4.5 units, p = NS), length of hospital stay (mean, 7.4 vs. 8.4 days, p = NS), and in-hospital mortality (2% vs. 7%, p = NS).
CONCLUSIONS
Combined therapy with PPI and somatostatin did not result in better outcomes than PPI alone.

Citations

Citations to this article as recorded by  
  • The effect of octreotide in acute nonvariceal upper gastrointestinal bleeding: A randomized, double-blind, placebo-controlled trial
    Masoud Abrishami, Payam Peymani, Marziyeh Zare, KamranB Lankarani
    Journal of Research in Pharmacy Practice.2020; 9(2): 94.     CrossRef
  • Octreotide Added to a Proton Pump Inhibitor Versus a Proton Pump Inhibitor Alone in Nonvariceal Upper-Gastrointestinal Bleeds
    Heidi M. Riha, Rachel Wilkinson, Jennifer Twilla, L. Jeff Harris, Lauren A. Kimmons, Mehmet Kocak, Megan A. Van Berkel
    Annals of Pharmacotherapy.2019; 53(8): 794.     CrossRef
Case Reports
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.
  • 2,566 View
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AbstractAbstract 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.
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.
  • 2,313 View
  • 19 Download
AbstractAbstract 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.
ACC : Acute and Critical Care
© The Korean Society of Critical Care Medicine.
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