Acute and Critical Care

Original Articles

Infection
Evaluating the use of the respiratory-rate oxygenation index as a predictor of high-flow nasal cannula oxygen failure in COVID-19: Scott Weerasuriya, Savvas Vlachos, Ahmed Bobo, Namitha Birur Jayaprabhu, Lauren Matthews, Adam R Blackstock, Victoria Metaxa; Acute Crit Care. 2023;38(1):31-40. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01081

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Abstract PDF Supplementary Material: Background
It can be challenging for clinicians to predict which patients with respiratory failure secondary to coronavirus disease 2019 (COVID-19) will fail on high-flow nasal cannula (HFNC) oxygen and require escalation of therapy. This study set out to evaluate the association between the respiratory rate-oxygenation index (ROX) and HFNC failure in such patients and to assess whether ROX trajectory correlates with treatment failure.
Methods
This was a single-centre, retrospective, observational study of patients with COVID-19 requiring HFNC, conducted over a 3-month period. ROX was calculated as “pulse-oximetry oxygen saturation (SpO2) over the fractional inspired oxygen concentration (FiO2)/respiratory rate” for each patient at 2, 4, and 12 hours from starting HFNC. HFNC failure was defined as escalation to continuous positive airway pressure ventilation or invasive mechanical ventilation (IMV). Time-to-event analyses were performed to account for the longitudinal data set and time-dependent variables.
Results
We included 146 patients. Ninety-three (63.7%) experienced HFNC failure, with 53 (36.3%) requiring IMV. Higher ROX values were associated with a lower subhazard of HFNC failure on time-to-HFNC failure analysis (subhazard ratio, 0.29; 95% confidence interval [CI], 0.18–0.46; P<0.001). This remained true after controlling for informative censoring. Median ROX values changed differentially over time, increasing in the HFNC success group (0.06 per hour; 95% CI, 0.05–0.08; P<0.001) but not in the HFNC failure group (0.004 per hour; 95% CI, –0.05 to 0.08; P=0.890).
Conclusions
A higher ROX is associated with a lower risk of HFNC failure. Monitoring ROX trajectory over time may help identify patients at risk of treatment failure. This has potential clinical applications; however, future prospective studies are required.

Pulmonary
Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure: Türkay Akbaş, Harun Güneş; Acute Crit Care. 2023;38(1):49-56. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01011

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Background
The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. Methods: This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020. Results: One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients’ mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0±7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/ FiO2 ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017–1.317; P=0.026), admission PaO2/FiO2 ratio (OR, 0.989; 95% CI, 0.978–0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650–47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021–1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056–0.514; P=0.002) emerged as predictors of 90-day mortality. Conclusions: APACHE II scores, the PaO2/FiO2 ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.

Citations

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COPD Exacerbation: Why It Is Important to Avoid ICU Admission
Irene Prediletto, Gilda Giancotti, Stefano Nava
Journal of Clinical Medicine.2023; 12(10): 3369. CrossRef

Pulmonary
The role of diaphragmatic thickness measurement in weaning prediction and its comparison with rapid shallow breathing index: a single-center experience: Lokesh Kumar Lalwani, Manjunath B Govindagoudar, Pawan Kumar Singh, Mukesh Sharma, Dhruva Chaudhry; Acute Crit Care. 2022;37(3):347-354. Published online July 25, 2022; DOI: https://doi.org/10.4266/acc.2022.00108

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Abstract PDF Supplementary Material: Background
Acute respiratory failure (ARF) is commonly managed with invasive mechanical ventilation (IMV). The majority of the time that a patient spends on IMV is in the process of weaning. Prediction of the weaning outcome is of paramount importance, as untimely/delayed extubation is associated with a high risk of mortality. Diaphragmatic ultrasonography is a promising tool in the intensive care unit, and its utility in predicting the success of weaning remains understudied.
Methods
In this prospective-observational study, we recruited 54 ARF patients on IMV, along with 50 healthy controls. During a spontaneous breathing trial, all subjects underwent diaphragmatic ultrasonography along with a rapid shallow breathing index (RSBI) assessment.
Results
The mean age was 41.8±17.0 and 37.6±10.5 years among the cases and control group, respectively. Demographic variables were broadly similar in the two groups. The most common cause of ARF was obstructive airway disease. The average duration of IMV was 5.41±2.81 days. Out of 54 subjects, 45 were successfully weaned, while nine patients failed weaning. Age, body mass index, and severity of disease were similar in the successful and failed weaning patients. The sensitivity in predicting successful weaning of percent change in diaphragmatic thickness (Δtdi%) >29.71% was high (93.33%), while specificity was 66.67%. The sensitivity and specificity of mean diaphragmatic thickness (tdi) end-expiratory >0.178 cm was 60.00% and 77.78%, respectively. RSBI at 1 minute of <93.75 had an equally high sensitivity (93.33%) but a lower specificity (22.22%). Similar results were also found for RSBI measured at 5 minutes.
Conclusions
During the weaning assessment, the purpose is to minimize both premature as well as delayed extubation. We found that diaphragmatic ultrasonography, in particular Δtdi%, is better than RSBI in predicting weaning outcomes.

Review Article

Pulmonary
High-flow nasal cannula for respiratory failure in adult patients: SeungYong Park; Acute Crit Care. 2021;36(4):275-285. Published online November 30, 2021; DOI: https://doi.org/10.4266/acc.2021.01571

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Abstract PDF

The high-flow nasal cannula (HFNC) has been recently used in several clinical settings for oxygenation in adults. In particular, the advantages of HFNC compared with low-flow oxygen systems or non-invasive ventilation include enhanced comfort, increased humidification of secretions to facilitate expectoration, washout of nasopharyngeal dead space to improve the efficiency of ventilation, provision of a small positive end-inspiratory pressure effect, and fixed and rapid delivery of an accurate fraction of inspired oxygen (FiO2) by minimizing the entrainment of room air. HFNC has been successfully used in critically ill patients with several conditions, such as hypoxemic respiratory failure, hypercapneic respiratory failure (exacerbation of chronic obstructive lung disease), post-extubation respiratory failure, pre-intubation oxygenation, and others. However, the indications are not absolute, and much of the proven benefit remains subjective and physiologic. This review discusses the practical application and clinical uses of HFNC in adults, including its unique respiratory physiologic effects, device settings, and clinical indications.

Citations

Citations to this article as recorded by

Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
Transnasal High-Flow Oxygen Therapy versus Noninvasive Positive Pressure Ventilation in the Treatment of COPD with Type II Respiratory Failure: A Meta-Analysis
Wei Liu, Mingli Zhu, Liuqin Xia, Xiangying Yang, Pei Huang, Yanming Sun, Ye Shen, Jianping Ma, Gang Chen
Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
Association between timing of intubation and mortality in patients with idiopathic pulmonary fibrosis
Eunhye Bae, Jimyung Park, Sun Mi Choi, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
Acute and Critical Care.2022; 37(4): 561. CrossRef
Effect of high-flow oxygen versus T-piece ventilation strategies during spontaneous breathing trials on weaning failure among patients receiving mechanical ventilation: a randomized controlled trial
Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee
Critical Care.2022;[Epub] CrossRef

Original Article

Pulmonary
Protecting Postextubation Respiratory Failure and Reintubation by High-Flow Nasal Cannula Compared to Low-Flow Oxygen System: Single Center Retrospective Study and Literature Review: Minhyeok Lee, Ji Hye Kim, In Beom Jeong, Ji Woong Son, Moon Jun Na, Sun Jung Kwon; Acute Crit Care. 2019;34(1):60-70. Published online February 28, 2019; DOI: https://doi.org/10.4266/acc.2018.00311

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Abstract PDF Supplementary Material

Background
Use of a high-flow nasal cannula (HFNC) reduced postextubation respiratory failure (PERF) and reintubation rate compared to use of a low-flow oxygen system (LFOS) in low-risk patients. However, no obvious conclusion was reached for high-risk patients. Here, we sought to present the current status of HFNC use as adjunctive oxygen therapy in a clinical setting and to elucidate the nature of the protective effect following extubation.
Methods
The medical records of 855 patients who were admitted to the intensive care unit of single university hospital during a period of 5.5 years were analyzed retrospectively, with only 118 patients ultimately included in the present research. The baseline characteristics of these patients and the occurrence of PERF and reintubation along with physiologic changes were analyzed.
Results
Eighty-four patients underwent HFNC, and the remaining 34 patients underwent conventional LFOS after extubation. Physicians preferred HFNC to LFOS in the face of highrisk features including old age, neurologic disease, moderate to severe chronic obstructive pulmonary disease, a long duration of mechanical ventilation, low baseline arterial partial pressure of oxygen to fraction of inspired oxygen ratio, and a high baseline alveolar–arterial oxygen difference. The reintubation rate at 72 hours after extubation was not different (9.5% vs. 8.8%; P=1.000). Hypoxic respiratory failure was slightly higher in the nonreintubation group than in the reintubation group (31.9% vs. 6.7%; P=0.058). Regarding physiologic effects, heart rate was only stabilized after 24 hours of extubation in the HFNC group.
Conclusions
No difference was found in the occurrence of PERF and reintubation between both groups. It is worth noting that similar PERF and reintubation ratios were shown in the HFNC group in those with certain exacerbating risk factors versus not. Caution is needed regarding delayed reintubation in the HFNC group.

Citations

Citations to this article as recorded by

Predictors and outcomes of high-flow nasal cannula failure following extubation: A multicentre observational study
Amit Kansal, Shekhar Dhanvijay, Andrew Li, Jason Phua, Matthew Edward Cove, Wei Jun Dan Ong, Ser Hon Puah, Vicky Ng, Qiao Li Tan, Julipie Sumampong Manalansan, Michael Sharey Nocon Zamora, Michael Camba Vidanes, Juliet Tolentino Sahagun, Juvel Taculod, Ad
Annals of the Academy of Medicine, Singapore.2021; 50(6): 467. CrossRef
Flow Field Analysis of Adult High-Flow Nasal Cannula Oxygen Therapy
Jingen Xia, Jiaqi Chang, Jixiang Liang, Yixuan Wang, Na Wang, Bo Xiao
Complexity.2021; 2021: 1. CrossRef

Review

Pulmonary
Lung Ultrasound (in the Critically Ill) Superior to CT: the Example of Lung Sliding: Daniel A. Lichtenstein; Korean J Crit Care Med. 2017;32(1):1-8. Published online February 14, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00955

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11 Citations

Abstract PDF

This review article shows the potential of lung ultrasound in the critically ill (LUCI) to study lung sliding and describes the optimal equipment for its assessment. Then, it analyses the integration of lung sliding within lung ultrasound then whole body critical ultrasound. It describes the place of lung sliding in the BLUE-protocol (bedside lung ultrasound in emergency) (lung and venous ultrasound for diagnosing acute respiratory failure), the FALLS-protocol (fluid administration limited by lung sonography) (the role of lung sliding in circulatory failure), and the SESAME-protocol (sequential assessment of sonography assessing mechanism or origin of severe shock of indistinct cause) (whole body ultrasound in cardiac arrest). In the LUCIFLR project (LUCI favoring limitation of radiations), the consideration of lung sliding allows drastic reduction in irradiation and costs. In conclusion, lung sliding is proposed as a gold standard for indicating the presence of the lung at the chest wall and its correct expansion.

Citations

Citations to this article as recorded by

Transthoracic needle biopsy for diagnosis of lung cancer
Dongil Park
Journal of the Korean Medical Association.2023; 66(3): 160. CrossRef
Determinants of point-of-care ultrasound lung sliding amplitude in mechanically ventilated patients
David N. Briganti, Christine E. Choi, Julien Nguyen, Charles W. Lanks
The Ultrasound Journal.2023;[Epub] CrossRef
Early detection of delayed pneumothorax using lung ultrasound after transthoracic needle lung biopsy: A prospective pilot study
Jeong Suk Koh, Chaeuk Chung, Ju Ock Kim, Sung Soo Jung, Hee Sun Park, Jeong Eun Lee, Da Hyun Kang, Yoonjoo Kim, Dongil Park
The Clinical Respiratory Journal.2022; 16(5): 413. CrossRef
Usefulness of Lung Ultrasound Follow‐up in Patients Who Have Recovered From Coronavirus Disease 2019
Yale Tung‐Chen, Milagros Martí de Gracia, Maria Luz Parra‐Gordo, Aurea Díez‐Tascón, Sergio Agudo‐Fernández, Silvia Ossaba‐Vélez
Journal of Ultrasound in Medicine.2021; 40(9): 1971. CrossRef
The role of lung ultrasound in COVID-19 disease
Dirk-André Clevert, Paul S. Sidhu, Adrian Lim, Caroline Ewertsen, Vladimir Mitkov, Maciej Piskunowicz, Paolo Ricci, Núria Bargallo, Adrian P. Brady
Insights into Imaging.2021;[Epub] CrossRef
Point-of-Care Ultrasound in Acute Care Nephrology
Nithin Karakala, Daniel Córdoba, Kiran Chandrashekar, Arnaldo Lopez-Ruiz, Luis A. Juncos
Advances in Chronic Kidney Disease.2021; 28(1): 83. CrossRef
YEARS Algorithm Versus Wells’ Score
Ahmed Abdelaal Ahmed Mahmoud M. Alkhatip, Maria Donnelly, Lindi Snyman, Patrick Conroy, Mohamed Khaled Hamza, Ian Murphy, Andrew Purcell, David McGuire
Critical Care Medicine.2020; 48(5): 704. CrossRef
Sonographische Bildgebung der Lunge bei COVID-19
M. Schmid, F. Escher, D.-A. Clevert
Der Radiologe.2020; 60(10): 919. CrossRef
Current Misconceptions in Lung Ultrasound
Daniel A. Lichtenstein
Chest.2019; 156(1): 21. CrossRef
Role of thoracic ultrasound in children with chronic kidney disease
SaneyaAbd El-Halim Fahmy, NaglaaAbd El-Moneam Abd Allah, AmiraI Al-Masry, Eman Sobh
The Scientific Journal of Al-Azhar Medical Faculty, Girls.2019; 3(3): 693. CrossRef
Novel approaches to ultrasonography of the lung and pleural space: where are we now?
Daniel Lichtenstein
Breathe.2017; 13(2): 100. CrossRef

Case Reports

Infection/Cardiology
Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumocystis jirovecii Pneumonia: Case Report and Literature Review: Dong Won Park, Dae Hyun Lim, Bongyoung Kim, Ji Young Yhi, Ji-Yong Moon, Sang-Heon Kim, Tae-Hyung Kim, Jang Won Shon, Ho Joo Yoon, Dong Ho Shin, Hyunjoo Pai; Korean J Crit Care Med. 2016;31(2):162-168. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.162

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Abstract PDF

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.

Citations

Citations to this article as recorded by

Extracorporeal life support for immune reconstitution inflammatory syndrome in HIV patients with Pneumocystis jirovecii pneumonia
Kollengode Ramanathan, Julian K. Svasti, Graeme MacLaren
Journal of Artificial Organs.2018; 21(3): 371. CrossRef

Genetic
Lethal Hyperammonemia due to Ornithine Transcarbamylase Deficiency in a Patient with Severe Septic Shock: Ji An Hwang, Joo Han Song, Young Seok Lee, Kyung Soo Chung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park; Korean J Crit Care Med. 2016;31(2):140-145. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.140

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Abstract PDF: Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 μg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support–albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.

Pulmonary
Successful Treatment with Empirical Erlotinib in a Patient with Respiratory Failure Caused by Extensive Lung Adenocarcinoma: Suk Hyeon Jeong, Sang-Won Um, Hyun Lee, Kyeongman Jeon, Kyung Jong Lee, Gee Young Suh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Yoon La Choi; Korean J Crit Care Med. 2016;31(1):44-48. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.44

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Abstract PDF

We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.

Citations

Citations to this article as recorded by

Lung cancer with superior vena cava syndrome diagnosed by intravascular biopsy using EBUS-TBNA
Daegeun Lee, Seong Mi Moon, Dongwuk Kim, Juwon Kim, Haseong Chang, Bumhee Yang, Suk Hyeon Jeong, Kyung Jong Lee
Respiratory Medicine Case Reports.2016; 19: 177. CrossRef

A Case of Pumpless Interventional Lung Assist Application in a Tuberculosis Destroyed Lung Patient with Severe Hypercapnic Respiratory Failure: So Hee Park, Sang Ook Ha, Jae Seok Park, Sang Bum Hong, Tae Sun Shim, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2013;28(3):192-196.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.192

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Abstract PDF: Pumpless extracorporeal interventional lung assist (iLA) is a rescue therapy allowing effective carbon dioxide removals and lung protective ventilator settings. Herein, we report the use of a pumpless extracorporeal iLA in a tuberculosis destroyed lung (TDL) patient with severe hypercapnic respiratory failures. A 35-year-old male patient with TDL was intubated due to CO2 retention and altered mentality. After 11 days, Ventilator Associated Pneumonia (VAP) had developed. Despite the maximal mechanical ventilator support, his severe respiratory acidosis was not corrected. We applied the iLA for the management of refractory hypercapnia with respiratory acidosis. This case suggests that the iLA is an effective rescue therapy for TDL patients with ventilator refractory hypercapnia.

Original Article

Development of Acute Respiratory Failure on Initiation of Anti-Tuberculosis Medication in Patients with Pulmonary Tuberculosis: Clinical and Radiologic Features of 8 Patients and Literature Review: Su Jin Lim, Donghoon Lew, Haa Na Song, You Eun Kim, Seung Jun Lee, Yu Ji Cho, Yi Yeong Jeong, Mi Jung Park, Kyoung Nyeo Jeon, Ho Cheol Kim, Jong Deog Lee, Young Sil Hwang; Korean J Crit Care Med. 2013;28(2):108-114.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.108

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Abstract PDF: BACKGROUND
Acute respiratory failure can occur paradoxically on initiation of anti-tuberculosis (TB) treatment in patients with pulmonary TB. This study is aimed to analyze the clinical features of anti-TB treatment induced acute respiratory failure.
METHODS
We reviewed the clinical and radiological characteristics of 8 patients with pulmonary tuberculosis (5 men and 3 women; mean age, 55 +/- 15.5 years) who developed acute respiratory failure following initiation of anti-TB medication and thus required mechanical ventilation (MV) in the intensive care unit (ICU).
RESULTS
The interval between initiation of anti-TB medication and development of MV-requiring acute respiratory failure was 2-14 days (mean, 4.4 +/- 4.39 days), and the duration of MV was 1-18 days (mean, 7.1 +/- 7.03 days). At admission, body temperature and serum levels of lactate dehydrogenase and C-reactive protein were increased. Serum levels of protein, albumin and creatinine were 5.8 +/- 0.98, 2.3 +/- 0.5 and 1.8 +/- 2.58 mg/ml, respectively. Radiographs characterized both lung involvements in all patients. Consolidation with the associated nodule was noted in 7 patients, ground glass opacity in 2, and cavitary lesion in 4. Micronodular lesion in the lungs, suggesting miliary tuberculosis lesion, was noted in 1 patient. At ICU admissions, the ranges of the APACHE II and SOFA scores were 17-38 (mean, 28.2 +/- 7.26) and 6-14 (mean, 10.1 +/- 2.74). The mean lung injury score was 2.8 +/- 0.5. Overall, 6 patients died owing to septic shock and multiorgan failure.
CONCLUSIONS
On initiation of treatment for pulmonary TB, acute respiratory failure can paradoxically occur in patients with extensive lung parenchymal involvement and high mortality.

Case Reports

Airway Obstruction and Respiratory Failure Due to Aspergillus Tracheobronchitis: Yousang Ko, So Yeon Lim, Gee Young Suh, Kyeongman Jeon, Seo Goo Han; Korean J Crit Care Med. 2013;28(1):67-71.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.67

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Abstract PDF

Invasive aspergillosis is a serious threat and a leading cause of death in immunocompromised patients. Aspergillus tracheobronchitis is an infrequent but severe form of invasive pulmonary aspergillos in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We report an extraordinary case of acute airway obstruction and respiratory failure due to Aspergillus tracheobronchitis in an immunocompromised patient. Fiberoptic bronchoscopy revealed extensive obstruction of both the main and lobar bronchus with yellowish nodules strongly adhered to the bronchial wall; both histologic examination and culture of these nodules revealed Aspergillus fumigatus. Even with early detection of an intraluminal growth of Aspergillus and prompt institution of antifungal therapy, the patient died of refractory hypoxemia a few days later. This report shows that Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis.

Citations

Citations to this article as recorded by

Death due to Aspergillus Tracheobronchitis: An Autopsy Case
Tack Kune You, Byung Ha Choi, Bong Woo Lee, Young Shik Choi
Korean Journal of Legal Medicine.2018; 42(4): 164. CrossRef

A Fatal Case of Vocal Cord Dysfunction: A Case Report: Eun Ha Cho, Gi Won Cho, Soo Hoon Kwon, Sang Hyuk Im, Hye Ok Kim, Sook Hee Song, Woo Chan Choung, Suhyun Kim; Korean J Crit Care Med. 2012;27(3):191-196.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.191

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Abstract PDF: Vocal cord dysfunction is characterized by the paradoxical adduction of the vocal cord during inspiration, causing relapsing wheezing or stridor, chest tightness, shortness of breath, and coughing. If the patient exhibiting symptoms of asthma is not responsive to treatment, there is a need to test whether vocal cord dysfunction is complicated by asthma. Herein, we report a case of vocal cord dysfunction with acute respiratory failure in old age with underlying disease. The patient presented with resting dyspnea, an audible wheeze, and was first diagnosed with acute exacerbation of bronchial asthma. However, her symptoms were not controlled with medical treatment and laryngoscopy showed paradoxical adduction of the vocal cords. Sudden cardiopulmonary arrest occurred after meal on the day of laryngoscopic examination. Although successful cardiopulmonary resuscitation, the patient developed ventilator-associated pneumonia, and multiple organ failure, eventually leading to death. Because the case was fatal, a report is being issued.

A Case Report of Rapidly Progressive Empyema Caused by Pulmonary Actinomycosis: A Case Report: Seong Joon Park, Young Chel Ahn, Soo Kyung Park, Min Jung Kim, Se Hun Kang, Hang Jea Jang, Younsuck Koh; Korean J Crit Care Med. 2010;25(4):249-252.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.249

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Abstract PDF: Pulmonary actinomycosis is an indolent and slowly progressive infectious disease, accompanied by pleural effusion and empyema in about 50% of cases. The size of the effusion is usually small, though, and it responds to appropriate antibiotics. We report a case of rapidly progressing, severe empyema leading to respiratory failure that was caused by pulmonary actinomycosis. A 57-year-old man presented with pleuritic chest pain for 5 days. The initial plain chest radiograph and CT scan showed pleural effusion. Gross pus was observed during the thoracentesis and laboratory test of pleural effusion revealed empyema. In spite of empirical antibiotics and chest tube drainage, the empyema rapidly progressed and the patient reached respiratory failure. Mechanical ventilation applied and decortication via video-assisted thoracotomy was performed. Microscopic examination of both the pleural and adjacent lung biopsy specimen revealed actinomycosis.

Original Article

Physiologic Effect and Safety of Pumpless Extracorporeal Interventional Lung Assist in Korean Patients with Acute Respiratory Failure: Woo Hyun Cho, Kwangha Lee, Jin Won Huh, Chae Man Lim, Younsuck Koh, Sang Bum Hong; Korean J Crit Care Med. 2010;25(4):235-240.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.235

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Abstract PDF

BACKGROUND
Pumpless interventional lung assist (iLA) uses an extracorporeal gas exchange system without any complex blood pumping technology, and has been shown to reduce CO2 tension and permit protective lung ventilation. The feasibility and safety of iLA were demonstrated in previous studies, but there has been no experience with iLA in Korea. The purpose of this study was to evaluate the feasibility of the iLA device in terms of physiologic efficacy and safety in Korean patients with acute respiratory failure.
METHODS
iLA was implemented in patients with acute respiratory failure who satisfied the predefined criteria of our study. Initiation of iLA followed an algorithm for implementation, ventilator care, and monitoring. Following insertion of arterial and venous cannulas under ultrasound guidance, the physiologic and respiratory variables and incidence of adverse events were monitored.
RESULTS
iLA was implemented in 5 patients and the duration of iLA ranged from 7 hours to 171 hours. At 24 hours after implementation, the mean changes in pH, PaCO2, and PaO2/FiO2 ranged from 7.204 to 7.393, from 68.4 mm Hg to 33 mm Hg, and from 128.7 mm Hg to 165 mm Hg, respectively. During iLA therapy, one adverse event was observed, which presented with hematochezia without hemodynamic change.
CONCLUSIONS
iLA treatment produced effective removal of carbon dioxide and allowed for protective ventilation in severe respiratory failure. An iLA system can easily be installed by percutaneous cannulation, without procedural complications, and without significant adverse events necessitating discontinuation of iLA after implementation.

Citations

Citations to this article as recorded by

A Case of Pumpless Extracorporeal Interventional Lung Assist for Severe Respiratory Failure - A Case Report -
Young-Jae Cho, Ji Yeon Seo, Yu Jung Kim, Jae-Ho Lee, Choon-Taek Lee
Korean Journal of Critical Care Medicine.2012; 27(2): 120. CrossRef
A Case of iLA Application in a Patient with Refractory Asthma Who Is Nonresponsive to Conventional Mechanical Ventilation - A Case Report -
Young Seok Lee, Hyejin Joo, Jae Young Moon, Jin Won Huh, Yeon-Mok Oh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Korean Journal of Critical Care Medicine.2012; 27(2): 108. CrossRef

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