Acute and Critical Care

Volume 24 (1); April 2009

Review

Management of Brain Injury after Post-cardiac Arrest Syndrome: Jong Ho Choi; Korean J Crit Care Med. 2009;24(1):1-3.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.1

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Abstract PDF: In spite of improvement in cardiopulmonary resuscitation (CPR) techniques, post-CPR mortality and brain injury rates have not changed significantly. The post-cardiac arrest syndrome has been suggested to be the major reason for the high mortality rate after CPR. Post-cardiac arrest syndrome, including brain injury, myocardial dysfunction, and septic shock-like syndrome after CPR, result in complicated multiple organ failure. Physicians who work in the ICU should have a good understanding of thepathophysiology of post-cardiac arrest syndrome. Recently, therapeutic hypothermia treatment for protection of brain injuries has been applied as a therapeutic regimen in spite of various side effects during the hypothermic procedure. Finally, therapeutic hypothermic treatment to reduce brain injury in post-cardiac arrest syndrome patients is strongly recommended to physiciansmanaging CPR. I would like to briefly review the therapeutic hypothermic procedure for the management of post-cardiac arrest syndrome.

Original Articles

The Prognostic Utility of the Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) Score for Hemato-Oncology Patients Admitted to the Intensive Care Unit: Sunghoon Park, Won Jung Koh, Man Pyo Chung, Hojoong Kim, O Jung Kwon, Won Ki Kang, Chul Won Jung, Jin Seok Ahn, Gee Young Suh; Korean J Crit Care Med. 2009;24(1):4-10.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.4

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Abstract PDF

BACKGROUND
The prognosis of hemato-oncology (HMO) patients admitted to the intensive care unit (ICU) is poor and predicting the mortality is important for decision making at the time of ICU admission and for administering aggressive treatment.
METHODS
We retrospectively reviewed 309 patients who were admitted to the medical ICU (MICU) at Samsung Medical Center from July in 2005 to June in 2006. We calculated their Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score at the time of ICU admission and we investigated the relationship between the two scoring systems and the hospital mortality.
RESULTS
Among the 309 patients, the hospital mortality was 41.2%, and the mean SAPS II/SOFA score at ICU admission was 45.4 +/- 19.5/8.1 +/- 4.6. Seventy-nine (25.6%) patients had hemato-oncological diseases. Their hospital mortality was 65.8%, and the mean SAPS II/SOFA score at the time of ICU admission was 53.9 +/- 18.6/9.7 +/- 4.4, which was higher than that of the non-HMO patients (p = 0.00). The area under the receiver operating characteristic (ROC) curves for the SAPS II/SOFA score for predicting the mortality was 0.794 +/- 0.05/0.785 +/- 0.051 (p = 0.00/p = 0.00) for the HMO patients. There was no significant difference in discrimination ability between the two scoring systems (p > 0.05). None of the HMO patients with a SAPS II/SOFA score of 70/14 or higher survived.
CONCLUSIONS
Both the SAPS II and SOFA scores at the time of ICU admission were similarly effective for predicting the hospital mortality. The two scoring systems could be useful tools for decision making at the time of ICU admission and for administering aggressive treatment.

Citations

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Association of Peripheral Lymphocyte Subset with the Severity and Prognosis of Septic Shock
Jin Kyeong Park, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh
The Korean Journal of Critical Care Medicine.2011; 26(1): 13. CrossRef

A Study on Estimating the Blood Pressure by Using the Pulse Wave Transit Time in Shock Patients Who Received Vasopressor Drugs: Gyeong Nam Park, Won Young Sung, Sang Won Seo, Sung Youp Hong, Young Mo Yang, Jang Young Lee, Nak Jin Sung, Hee Bum Yang; Korean J Crit Care Med. 2009;24(1):11-16.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.11

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Abstract PDF

BACKGROUND
Blood pressure is clinically used for monitoring shock patients and as a therapeutic indicator for them. Non-invasive blood pressure measurement has weak points such as the use of a cuff and it is a discontinuous measurement. A method of measuring the blood pressure by using the PWTT (pulse wave transit time) has been studied to make up for those weak points. If blood pressure monitoring can be done by using the difference of the PWTT between different points in the body, then this method will be a quite useful to monitor the BP of seriously ill patients. This study aimed to verify whether or not the PWTT has a significant correlation with the blood pressure of shock patients who received vasopressor infusion and whether this method is clinically applicable.
METHODS
The study subjects were 20 shock patients who were hospitalized in intensive care units and they had received vasopressor, and we measured the PWTT and we analyzed its correlation with the SBP (systolic blood pressure) and DBP (diastolic blood pressure), as measured by non-invasive monitoring. We then determined the effects of the PWTT on the SBP and DBP.
RESULTS
From the results of correlation analysis between the PWTT and the SBP and DBP, the SBP displayed a statistically significant negative correlation with the PWTT of 18 patients, while no significant correlation between the PWTT and DBP was observed. At the same time, from the results of the regression analysis of the blood pressures and the PWTT of each patient, it was found that the PWTT had a negative effect on the SBP of all the patients, except two.
CONCLUSIONS
The PWTT has a negative correlation with the SBP of the patients who received vasopressor infusion.

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Development of Blood Pressure Simulator for Test of the Arm-type Automatic Blood Pressure Monitor
S.H. Kim, S.U. Yun, M.H. Cho, S.J. Lee, M.H. Lim, S.Y. Seo, G.R. Jeon
Journal of Sensor Science and Technology.2015; 24(4): 239. CrossRef

Influence of Blood Glucose Level on Acid-Base Balance: Kyoung Min Lee; Korean J Crit Care Med. 2009;24(1):17-21.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.17

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Abstract PDF

BACKGROUND
This study was performed to evaluate whether blood glucose concentrations have a significant influence on acid-base balance.
METHODS
We studied 157 adult patients who underwent intra-abdominal operations under general anesthesia. Postoperative blood samples were withdrawn from radial artery and blood glucose concentrations, gas values, and chemistry values were measured. All patients were divided into three groups according to the postoperative blood glucose level. The group 1 contained the patients who had postoperative blood glucose level lower than 126 mg/dl, the group 2, the patients with glucose level higher than 126 mg/dl, lower than 180 mg/dl, and the group 3, the patients with glucose level higher than 180 mg/dl.
RESULTS
Metabolic acidosis rate was significantly higher in group 3 than in group 1, group 2 and arterial blood pH was significantly lower in group 3 than that in group 1, group 2. Regression analysis showed that [H+] was correlated with blood glucose level. Strong ion difference (SID) was significantly lower in group 3 than group 1 and PaCO2 level was significantly lower in group 2 and group 3 than that in group 1. In regression analysis, there was a negative correlation between blood glucose concentration and SID. [H+] had a negative correlation with SID and PaCO2 was correlated with SID.
CONCLUSIONS
These findings suggest that blood glucose level affects acid-base balance and a disturbance in SID is accompanied with respiratory compensation.

Citations

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Hidden chronic metabolic acidosis of diabetes type 2 (CMAD): Clues, causes and consequences
Hayder A. Giha
Reviews in Endocrine and Metabolic Disorders.2023; 24(4): 735. CrossRef
A Case of Metformin-Induced Acute Kidney Injury without Lactic Acidosis - A Case Report -
Hae Ryong Jeong, Jeong Im Choi, Jung Hwan Park, Sang Mo Hong, Joon Sung Park, Chang Beom Lee, Yong Soo Park, Dong Sun Kim, Woong Hwan Choi, You Hern Ahn
Korean Journal of Critical Care Medicine.2012; 27(4): 283. CrossRef

Infectious Complications in the Survivors of Out-of-hospital Cardiac Arrest: Seon Hee Woo, Woon Jeong Lee, Se Min Choi, Seung Pill Choi, Kyu Nam Park; Korean J Crit Care Med. 2009;24(1):22-27.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.22

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Abstract PDF: BACKGROUND
Infectious complications commonly occur in the survivors of out-of-hospital cardiac arrest. The aim of our study was to describe the incidence, associated factors and outcome of infectious complications of the survivors of out-of-hospital cardiac arrest.
METHODS
We conducted a retrospective analysis of 75 patients who survived out-of-hospital cardiac arrest. We collected the data on the demographics, the modes of cardiac arrest, the duration of CPR, the dose of epinephrine, the use of hypothermia, new infections, the duration of mechanical ventilation, the length of stay in the intensive care unit (ICU), recovery of consciousness and the mortality.
RESULTS
New infections developed in 46.7% of the patients. Asystole was the most common rhythm (70.7%). The most common infectious complication was pneumonia (40.0%) urinary tract infection developed in 10 cases, vascular catheter local infection developed in 6 cases, primary blood stream infection developed in 3 cases, wound infection developed in 2 cases and pseudomembranous colitis developed in 1 case. The most common pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. Blood cultures were obtained in 36 patients during the first 24 hr and the pathogen was isolated in three. The patients with infection had a longer duration of mechanical ventilation and a longer stay in the ICU (p < 0.001, p = 0.001).
CONCLUSIONS
Infectious complications are common in survivors of out-of-hospital cardiac arrest and these infections are associated with a longer duration of mechanical ventilation and a longer stay in the ICU. The most common infectious complication was pneumonia and the pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus.

The Characteristics and Prognostic Factors of Severe Sepsis in Patients Who Were Admitted to a Medical Intensive Care Unit of a Tertiary Hospital: Suk Kyung Hong, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2009;24(1):28-32.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.28

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Abstract PDF

BACKGROUND
Severe sepsis is a major cause of morbidity and mortality in intensive care units. This study aimed to evaluate the prevalence, characteristics, outcomes and prognostic factors of severe sepsis in a medical intensive care unit (MICU) of a tertiary care hospital in Korea.
METHODS
We retrospectively reviewed the medical chart of 249 patients who were admitted to a medical intensive care unit with severe sepsis.
RESULTS
From January 2000 to December 2001, 3410 patients were admitted to the ICU. The prevalence of severe sepsis was 7.3%. The mortality of severe sepsis was 64.6%. The prognostic factors for severe sepsis were the number of organ systems that acutely failed (p = 0.036) and an admission route from general wards (p = 0.018). There was no difference in the outcome of severe sepsis according to infectious organisms (p = 0.24) and the site of infections (p = 0.38).
CONCLUSIONS
Severe sepsis in the MICU is a common, expensive and often fatal condition. We expect that early rescucitation and recovery from acute organ system failure will improve the outcome of severe sepsis.

Citations

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An Evaluation of the Rapid Antimicrobial Susceptibility Test by VITEK MS and VITEK 2 Systems in Blood Culture
Kang-Gyun Park, Young-Bin Yu, Keundol Yook, Sang-Ha Kim, Sunghyun Kim, Young Kwon Kim
The Korean Journal of Clinical Laboratory Science.2017; 49(3): 279. CrossRef
An Evaluation of Vitek MS System for Rapid Identification of Bacterial Species in Positive Blood Culture
Kang-Gyun Park, Sang-Ha Kim, Jong-Tae Choi, Sunghyun Kim, Young-Kwon Kim, Young-Bin Yu
The Korean Journal of Clinical Laboratory Science.2017; 49(4): 407. CrossRef
A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock
Jung-Wan Yoo, Ju Ry Lee, Youn Kyung Jung, Sun Hui Choi, Jeong Suk Son, Byung Ju Kang, Tai Sun Park, Jin-Won Huh, Chae-Man Lim, Younsuck Koh, Sang Bum Hong
The Korean Journal of Internal Medicine.2015; 30(4): 471. CrossRef
Intensive care unit-acquired blood stream infections: a 5-year retrospective analysis of a single tertiary care hospital in Korea
S. J. Lim, J. Y. Choi, S. J. Lee, Y. J. Cho, Y. Y. Jeong, H. C. Kim, J. D. Lee, Y. S. Hwang
Infection.2014; 42(5): 875. CrossRef
Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards
Ju Ry Lee, Hye Ran Choi
Journal of Korean Academy of Nursing.2014; 44(2): 219. CrossRef
Utility of Serum Procalcitonin for Diagnosis of Sepsis and Evaluation of Severity
Taejin Park, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Tuberculosis and Respiratory Diseases.2011; 70(1): 51. CrossRef
Clinical Guideline for the Diagnosis and Treatment of Gastrointestinal Infections

Infection and Chemotherapy.2010; 42(6): 323. CrossRef
The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock
Jung-Hwan Ahn, Sang-Cheon Choi, Young-Gi Min, Yoon-Seok Jung, Sung Hee Chung, Young-Joo Lee
The Korean Journal of Critical Care Medicine.2009; 24(3): 134. CrossRef

Case Reports

A Case of Accelerated Idioventricular Rhythm Lasted for 5 Days after Reperfusion in a Patient with Spasm-induce Myocardial Infaction: A Case Report: Kyoung Chan Kim, Il Soo Kim, Wook Kang, Jae Kyoon Kim, Chang Hoon Yu, Su Hong Kim; Korean J Crit Care Med. 2009;24(1):33-36.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.33

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Abstract PDF

A 56-year-old man presented with right coronary arterial spasm accompanied by ST segment elevation in the inferior leads. A reperfusion arrhythmia, accelerated idioventricular rhythm (AIVR), developed 1 hour after a nitroglycerin infusion. The AIVR was sustained for 5 days without hemodynamic instability, and resolved spontaneously during hemodynamic monitoring in the coronary intensive care unit.

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Successful Recovery after Cardiac Arrest from Medically Intractable Coronary Spasm Induced by Ergonovine, Using Percutaneous Cardiopulmonary Support - A Case Report -
Jeehoon Kang, In-Chang Hwang, Chang-Hwan Yoon
Korean Journal of Critical Care Medicine.2012; 27(4): 269. CrossRef

Hemothorax in an Uncontrolled Anticoagulated Patient: Fight or Flight?: A Case Report: Soon Ho Chon, Sung Ho Shinn, Chul Burm Lee; Korean J Crit Care Med. 2009;24(1):37-38.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.37

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Abstract PDF: Hemothorax in a patient on anticoagulant therapy for atrial fibrillation after blunt trauma is not an uncommon event. However, massive hemothorax in such a patient with an extremely uncontrolled and high international normalized ratio (INR) may pose a serious dilemma. We report a case of a patient under anticoagulant therapy for atrial fibrillation who underwent an emergent thoracotomy for massive hemothorax with an INR of 9.57.

Mitral Regurgitation due to Recurrent Septal Rupture after Repair of a Postinfarction Posterior Ventricular Septal Defect: A Case Report: Chan Beom Park, Ung Jin; Korean J Crit Care Med. 2009;24(1):39-41.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.39

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Abstract PDF: Postinfarction ventricular septal rupture (VSR) is a serious complication following an acute myocardial infarction. We performed repair of a postinfarction posterior VSR; however, the patient developed mitral regurgitation (MR) 2 months later. Geometrical changes caused by ventricular remodeling and recurrent shuntare thought to be the cause of delayed MR.

Topical Epinephrine-soaked Gauze-induced Ventricular Tachycardia during Skin Grafting: A Case Report: Jongyeon Lee, Hyeonjeong Yang, Mingu Kim, Hyunjue Gill, Kuemhee Chung, Sunghee Chung, Jieun Song, Sangwoo Lee; Korean J Crit Care Med. 2009;24(1):42-46.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.42

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Abstract PDF

Topical epinephrine is useful to reduce bleeding during skin grafting. However, even though a clear operative field is obtained, systemic absorption of topical epinephrine can occur and this may cause severe hypertension, arrhythmias, ventricular tachycardia, myocardial ischemia, pulmonary edema, or cardiac arrest. We managed a case of cardiac arrhythmia during general anesthesia, which was induced by gauze soaked in topical epinephrine used for skin grafting of burn wounds. A 26-year-old woman developed premature ventricular complexes and ventricular tachycardia during surgery when epinephrine-soaked gauze was applied to the skin donor and burn wound sites to control oozing. The patient was resuscitated immediately and within 10 minutes the vital signs had normalized. It is recommended that caution is exercised when epinephrine-soaked gauze is applied to a large area of skin.

Citations

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Ventricular Fibrillation Soon after Endobronchial Epinephrine Application in a Young Man -A Case Report-
Young Min Shin, Jong Hyung Kim, Hyung Wook Kim, Bo Sik Choi, Jin-Gyu Jeong, Jung Won Hwang, Kwang Won Seo, Jong-Joon Ahn, Seung Won Ra
The Korean Journal of Critical Care Medicine.2011; 26(4): 276. CrossRef

The Effect of Hemodilution Treatment for Patient with Hemorrhagic Cerebral Venous Thrombosis due to Iron Deficiency Anemia: A Case Report: Mi Hye Lim, Sun Young Oh, Young Hyun Kim, Byoung Soo Shin; Korean J Crit Care Med. 2009;24(1):47-50.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.47

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Abstract PDF: Cerebral venous sinus thrombosis (CVT) is a rare disease that's associated with a wide variety of clinical signs and symptoms, and CVT is a potentially lethal condition. Iron deficiency anemia (IDA) as the cause of an adult case of CVT is very rare. We report here on a patient with CVT with intracerebral hemorrhage that was caused by IDA, and the patient was treated with hemodilution. We suggest that hemodilution should be considered as another therapeutic option for CVT with cerebral hemorrhage in a patient suffering with IDA.

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