Acute and Critical Care

Psychology of Intentive Care Unit Staffs: Moo Suk Lee, Soo In Lee; Korean J Crit Care Med. 1999;14(2):79-84.

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Abstract PDF: No abstract available.

Psychotherapy of Intensive Care Unit Patients: Chang Yoon Kim; Korean J Crit Care Med. 1999;14(2):85-91.

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Abstract PDF: No abstract available.

Ethical Aspects in the Critical Care Medicine: Sang Ik Hwang; Korean J Crit Care Med. 1999;14(2):92-96.

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Abstract PDF: No abstract available.

Role of Critical Care Physician: Jeong Soo Shin; Korean J Crit Care Med. 1999;14(2):97-100.

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Abstract PDF: No abstract available.

A Study on the Practical Application for Medical Law to the Critical Care Medicine: Hyun Ho Shin; Korean J Crit Care Med. 1999;14(2):101-109.

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Abstract PDF: No abstract available.

Septic Shock: Joong Woo Lee; Korean J Crit Care Med. 1999;14(2):110-120.

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Sepsis and Cachexia: Kyoung Min Lee; Korean J Crit Care Med. 1999;14(2):121-125.

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Abstract PDF: No abstract available.

Effects of Blood-Brain Barrier Disruption on Cerebral Oxygen Balance: Doo Ik Lee, Young Kyu Choi, Dong Ok Kim, Keon Sik Kim, Ok Young Shin, Moo Il Kwon; Korean J Crit Care Med. 1999;14(2):126-130.

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Abstract PDF: BACKGOUND: Disruption of the blood-brain barrier (BBB) can alter the internal milieu and may increase the release of excitatory amino acid neurotransmitters or catecholamines, which may affect metabolic rate or coupling. This study was performed to evaluate whether disruption of BBB by unilateral intracarotid injection of hyperosmolar mannitol would alter oxygen supply/consumption balance in the ipsilateral cortex.
METHODS
Rats were anesthetized with 1.4% isoflurane using mechanical ventilation via tracheostomy. 25% mannitol was administered at a rate of 0.25 mlxkg-1s-1 for 30 s through unilateral internal carotid artery. The BBB transfer coefficient (Ki) of 14C-alpha-aminoisobutyric acid was measured in one group (N=7) after administering mannitol. Regional cerebral blood flow (rCBF), regional arterial and venous O2 saturation and O2 consumption were measured in another group using a 14C-iodoantipyrine and microspectrophotometry (N=7).
RESULTS
Vital signs were similar before and after administering mannitol. Ki was significantly higher in the ipsilateral cortex (IC) than in the contralateral cortex (CC), (22.3+/-8.4 vs 4.4+/-1.1 microliterxg-1min-1). rCBF was similar between IC (105+/-21 mlxg-1min-1) and the CC (93+/-20). Venous O2 saturation was lower in the IC (43+/-7%) than in the CC (55+/-4). O2 consumption was higher in the IC (9.6+/-3.0 mlx100 g-1min-1) than in the CC (6.7+/-1.5).
CONCLUSIONS
Our data suggested that increasing permeability of the BBB increased cerebral O2 consumption and deteriorated cerebral oxygen balance.

Effects of Mg2+ Intravenous Pretreatment on Brain Energy Metabolism in Acute Ischemic-Reperfusion Model in Cats: 31P and 1H Magnetic Resonance Spectroscopic Study: Eun Ha Suk, Ji Young Kang, Sung Kwan Chun, Pyung Hwan Park, Kun Ho Lim, Jung Hee Lee, Tae Hwan Lim; Korean J Crit Care Med. 1999;14(2):132-136.

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Abstract PDF: BACKGOUND: This study was purposed to evaluate the effects of Mg2+ pretreatment on cerebral ischemic injury in cats.
METHODS
Global cerebral ischemia was induced by ligation of both innominate arteries following ligation of inferior vena cava under lowered mean blood pressure for 20 minutes followed by 3 hrs of reperfusion. Ten cats were divided into 2 groups: Group 1 (n=5) is the control group, for group 2 (n=5) (Mg2+ group), the animals were pretreated with 90 mg/kg of Mg2+ intravenously before subjected to ischemia.
RESULTS
Phosphocreatine/inorganic phosphate (Pcr/Pi) and pH decreased after ischemia and did not recovered during reperfusion. And there were no significant differences between the two groups. The ratios of lactate/N-acetyl aspartate (Lac/NAA) and lactate/creatine (Lac/Cr) increased after ischemia and not recovered during reperfusion. But the ratios were higher for the group 2 than the group 1 during reperfusion (p<0.05). For the Mg2+ group, blood pressure during reperfusion was lower than the control group.
CONCLUSIONS
Mg2+ intravenous pretreatment had no protective effect on this global cerebral ischemia animal model. Even it deteriorated brain energy metabolism by lowering blood pressure.

Physiologic Changes Induced with Lipopolysaccharide in Rats: Kyoung Min Lee, Kwang Ho Lee, Kong Been Im, Jong Taek Park, Young Bok Lee; Korean J Crit Care Med. 1999;14(2):137-142.

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Abstract PDF: BACKGOUND: Bacterial endotoxin or lipopolysaccharide (LPS) is believed to mediate the tissue damage and shock observed in Gram-negative sepsis (GNS) by initiating a cascade of events, including activation of the coagulation, fibrinolytic and complement systems, and release of proinflammatory cytokines. However, the clinical pictures that result from GNS and endotoxin are quite different. The physiologic changes induced with LPS were investigated in this study.
METHODS
Fifty two male Sprague-Dawley rats were injected intraperitoneally with Escherichia coli LPS. Blood samples and bronchoalveolar lavage (BAL) fluid were obtained at baseline and at 2, 4, 8, 16, 24, and 48 hours after injection. Nitrate/nitrite levels were measured from plasma and BAL samples. Lipid peroxide (LPO) levels were measured from plasma. We measured also protein concentration and number of polymorphonuclear leukocytes (PMNL) and macrophages from BAL samples.
RESULTS
Administration of LPS caused significant increase in nitrate/nitrite concentrations of plasma and BAL fluid (p<0.01). ED50 of LPS was 1.76 mg/kg in plasma nitrate/nitrite assay. Plasma LPO levels were increased slightly after administration of LPS, but no statistical significance. Protein concentration was increased significantly (p<0.01) 4 hours after the administration of LPS. LPS induced increase of the number of PMNLs and macrophages of BAL samples significantly (p<0.05).
CONCLUSIONS
LPS increased NO production and alveolar permeability in rats. Also, LPS increased the number of inflammatory cells in the lung.

Evaluation of the Technique of Central Venous Catheterization via the External Jugular Vein: Seong Hoon Ko, Dong Chan Kim, Sang Kyi Lee, He Sun Song; Korean J Crit Care Med. 1999;14(2):143-147.

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Abstract PDF: BACKGOUND: This study was designed to evaluate the effectiveness and feasibility of central venous catheterization via the external jugular vein (EJV). We compared the success rate of left and right EJV catheterization. The influence of the course of left and right external jugular vein on success rate was investigated also.
METHODS
Eighty anesthetized adult surgical patients were studied consecutively. Patients were allocated to left or right EJV catheterization and measured the angles between EJV and clavicle and transverse shoulder line. Catheterization was performed under sterile conditions by Seldinger technique after angiography of EJV and subclavian vein. We analyzed the relationship between the angles and success rate and time for catheterization. We compared the success rate of left and right EJV catheterization.
RESULTS
The overall rate of intrathoracic placement was 74 from 80 catheterization (92.5%). Analysis of success in left and right EJV catheterization did not reveal statistically significant differences. The success rates did not show any correlation with course of EJV. Complications were few and not serious.
CONCLUSIONS
This study indicated that left and right EJVs were good routes for central venous catheterizationan with acceptably high success rate. However, we could not find the predictor of success for central venous catheterization via EJV.

Assessment of Positive Pressure Controlled Ventilation with the Laryngeal Mask Airway: Young Soon Lim, Sang Kyi Lee; Korean J Crit Care Med. 1999;14(2):148-153.

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Abstract PDF: BACKGOUND: Cuff overinflation may cause premature rejection of the laryngeal mask airway (LMA) or provocation of incomplete and ineffective reflex responses. Therefore a previous report recommends that the cuff is inflated to a pressure of 60 cmH2O to minimize side effects. The objective of this study was to assess the possibility of controlled positive pressure ventilation in adults when intra-cuff pressure of LMA was set to 60 cmH2O.
METHODS
We studied 20 adult patients who received general inhalational anesthesia with LMA and mechanical positive pressure ventilation for gynecological operations. The following variables was determined during anesthesia at two time points 3 min after endotracheal intubation and 5 min before neuromuscular blockade: pop-off pressure, tidal volume, peak-air way pressure, plateau pressure, compliance, SpO2, and ETCO2.
RESULTS
Mean compliances measured were normal. Mean airway pressures (peak, plateau) were 13.6 and 15.1 cmH2O at two time points respectively while setting the tidal volume with 10 ml/kg. However, pop-off pressure were 18.3 and 20.1 cmH2O, respectively. Mean tidal volumes without gas leak around the LMA cuff were 14.5 and 14.5 ml/kg, respectively. Mean SpO2 and mean ETCO2 were measured 99.0 and 99.2%, 31.3 and 30.3 mmHg in two time points, respectively.
CONCLUSIONS
The study suggested that controlled mechanical positive pressure ventilation using the laryngeal mask airway with 60 cmH2O intra-cuff pressure were be adequate when pulmonary compliance and airway resistance were normal.

Effect of Positive End-Expiratory Pressure on the Concentration of Sodium and Potassium in Plasma and Urine, Plasma Creatinine and Urine Output in Mechanically Ventilated Patients: Bong Jae Lee, Kyu Suk Suh, Dong Ok Kim, Dong Soo Kim; Korean J Crit Care Med. 1999;14(2):154-160.

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Abstract PDF: BACKGOUND: It has been suggested that the addition of positive end-expiratory pressure (PEEP) to the patients with ventilator support leads to an impairment on renal hemodynamics and water- and sodium-retaining hormonal systems, such as plasma renin activity (PRA), plasma aldosterone, urinary antidiuretic hormone (ADH).
METHODS
To evaluate the effects of 5 cmH2O and 10 cmH2O PEEP on renal function, we measured the plasma concentration of sodium (Na+), potassium (K+) and creatinine, urinary excretion of Na+, K+ and urine output in eight normovolemic male patients requiring ventilator support. Also changes in mean arterial pressure, pulse rate, arterial oxygen tension (PaO2) and carbon dioxide tension (PaCO2) during the experimental period were measured in these patients.
RESULTS
Both 5 and 10 cmH2O PEEP showed no significant effect on the mean arterial pressure, heart rate, PaO2, and PaCO2. Both 5 and 10 cmH2O PEEP showed no significant effect on the plasma concentration of sodium, potassium and creatinine. 5 cmH2O PEEP showed no significant effect on the urinary excretion of sodium, potassium and urine output, but 10 cmH2O PEEP showed significant effect on the urinary excretion of sodium (19% decrease, p<0.05), and urine output (12.5% decrease, p<0.05) respectively.
CONCLUSIONS
10 cmH2O PEEP was revealed to decrease urinary sodium excretion along with urinary output and this phenomenon was likely to relate with water- and sodium-retaining hormonal systems. These results suggested that it was preferable to apply high PEEP cautiously in patients with impaired renal function.

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

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

An Experience of Right Pneumonectomy in a Lung Cancer Patient with Poor Pulmonary Function Test within the Conventional Criteria of Contraindication to Surgery: Intraoperative Re-evaluation of Pulmonary Function: A case report: Jin Young Chon, Sung Jin Hong, Ung Jin, Hae Jin Lee, Yong Woo Choi, Se Ho Moon, Sun Hee Lee, Man Seok Bae; Korean J Crit Care Med. 1999;14(2):167-175.

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Abstract PDF: Usually FEV1 lower than 1 liter is considered as a contraindication to pneumonectomy. Therefore sometimes, the curative operations of the resectable lung cancer can not be performed in case of poor pulmonary functions. The usual criteria on the performance of pneumonectomy on high risk patients based on the preoperative assessment of pulmonary function may not predict the operative outcome with accuracy in the postoperative period. Nowadays, there are some arguing points about applying the values of preoperative PFTs to pulmonary resection surgery. We performed a right pneumonectomy for stage IIIb lung cancer in a patient with poor lung function test; FVC 2.17 L, FEV1 0.97 L, FEV1/FVC 44%, FEF 25~75% 0.42 L/sec, MVV 28 L/min, TLC 5.18 L, RV 2.99, DLCO 13.46. After the temporary ligation of right main pulmonary artery during 30 minutes, arterial blood gas and percutaneous oxygen saturation with the controlled ventilation with room air (FiO2=0.21) confirmed the hemodynamic and oxygenation stabilities, twice. After successful surgery, the patient was tolerated for 4 months. And the follow up PFTs at postoperative 3 months and 18 days showed as follows; FVC 1.20 L, FEV1 0.63 L, FEV1/FVC 53%, FEF 25~75% 0.31 L/sec, MVV 25 L/min, TLC 3.80 L, RV 2.33 L, DLCO 8.04. Through the intraoperative re-evaluation of pulmonary function in a patient with poor preoperative PFTs,had been conventionally considered as a contraindication to pneumonectomy, we report a successful surgery and anesthetic management with the literatures reviewed.

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