Acute and Critical Care

Volume 24 (2); August 2009

Review

The Role of the Coagulation and Fibrinolytic Pathway in Acute Lung Injury: Sang Hyun Kwak; Korean J Crit Care Med. 2009;24(2):53-58.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.53

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Abstract PDF: Acute lung injury (ALI) is a common, life-threatening cause of acute respiratory failure, which is ultimately caused by a variety of local and systemic insults. Alterations in the coagulation and fibrinolysis profiles are present in almost all the patients suffering with ALI. The classic histologic findings in ALI patients include alveolar fibrin formation and microthrombi in the pulmonary vasculature. Decreased circulating levels of protein C and increased concentrations of thrombomodulin are present in patients with septic and nonseptic ALI. The circulating and pulmonary concentrations of plasminogen activator inhibitor-1 (PAI-1) are increased in the setting of ALI, and the degree of elevation in the PAI-1 level directly correlates with mortality. The need for new specific therapies has led a number of investigators to examine the role of altered coagulation and fibrinolysis in the pathogenesis of ALI. This review summarizes the current understanding of coagulation and fibrinolysis in ALI with an emphasis on the pathways that could be potential therapeutic targets, including the tissue factor pathway, the protein C pathway and the modulation of fibrinolysis via plasminogen activator inhibitor-1.

Original Articles

A Comparison of Adaptive Support Ventilation (ASV) and Conventional Volume-Controlled Ventilation on Respiratory Mechanics in Acute Lung Injury/ARDS: Ik Su Choi, Jung Eun Choi, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2009;24(2):59-63.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.59

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Abstract PDF

BACKGROUND
ASV is a closed-loop ventilation system that guarantees a user-set minimum per-minute volume in intubated patients, whether paralyzed or with spontaneous breathing. Here, we tested the effects of ASV onrespiratory mechanics and compared them with volume-controlled ventilation (VCV).
METHODS
Thirteen patients meeting the criteria for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) were enrolled. All patients were paralyzed to eliminate spontaneous breathing. We started with VCV (VCV1), then used ASV followed by VCV modes (VCV2), maintaining minute volume as much as that of VCV1.
RESULTS
During ASV, compared with VCV1, the inspiratory and expiratory tidal volumes and expiratory resistance increased. Conversely, the total respiratory rate and maximum pressure decreased. No changes in the arterial blood gases, heart rate, or mean systemic pressure were noted during the trial.
CONCLUSIONS
In ALI/ARDS patients, although no differences were observed in the arterial blood gas analysis between the two modes, ASV provided better respiratory mechanics in terms of peak airway pressure and tidal volume than VCV.

Citations

Citations to this article as recorded by

Comparison of adaptive support ventilation and synchronized intermittent mandatory ventilation in patients with acute respiratory distress syndrome: A randomized clinical trial
Babak Alikiaii, Saeed Abbasi, Hamideh Yari, Mojtaba Akbari, Parviz Kashefi
Journal of Research in Medical Sciences.2022; 27(1): 6. CrossRef
Comparing the Effect of Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mandatory Ventilation (SIMV) on Respiratory Parameters in Neurosurgical ICU Patients
Mohammadreza Ghodrati, Alireza Pournajafian, Ali Khatibi, Mohammad Niakan, Mohammad Hosein Hemadi, Mohammad Mahdi Zamani
Anesthesiology and Pain Medicine.2016;[Epub] CrossRef
Adaptive support ventilation for complete ventilatory support in acute respiratory distress syndrome: A pilot, randomized controlled trial
Ritesh Agarwal, Arjun Srinivasan, Ashutosh N. Aggarwal, Dheeraj Gupta
Respirology.2013; 18(7): 1108. CrossRef
Advanced Ventilator Modes and Techniques
Carl F. Haas, Kimberly A. Bauser
Critical Care Nursing Quarterly.2012; 35(1): 27. CrossRef
Evaluation of Respiratory Parameters in Patients with Acute Lung Injury Receiving Adaptive Support Ventilation
Keu Sung Lee, Wou Young Chung, Yun Jung Jung, Joo Hun Park, Seung Soo Sheen, Sung Chul Hwang, Kwang Joo Park
Tuberculosis and Respiratory Diseases.2011; 70(1): 36. CrossRef

Development of Assessment Tools for Performance and Leadership of a Cardiopulmonary Resuscitation Team: Sung Pil Chung, Junho Cho, Yoo Seok Park, Hyung Goo Kang, Seung Whan Kim, Chan Woong Kim, Yoo Sang Yoon, Keun Jeong Song, Hoon Lim, Gyu Chong Cho, Young Hwan Choi; Korean J Crit Care Med. 2009;24(2):64-68.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.64

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Abstract PDF

BACKGROUND
The assessment tools for leadership and performance of resuscitation teams are have not been developed. We evaluated the checklists for resuscitation team performance and teamwork.
METHODS
We developed two checklists for team dynamics (D1, D2) and two checklists for team performances (P1, P2). The videotaped mock resuscitation before and after a 2-hr Advanced Cardiovascular Life Support (ACLS) training were also evaluated by two emergency physicians and two nurses using the four checklists. The validity and agreement between assessors were determined. Internal consistency was determined using Cronbach-alpha.
RESULTS
There were no significant differences in scores by expert consensus and the checklist score. The average scores between different assessors were different except for the D1 and D2 between doctors. The Cronbach-alpha for internal consistency were within acceptable ranges in the checklists D2 and P2.
CONCLUSIONS
This study suggests that the D2 and P2 checklists are provisionally acceptable due to relatively high validity, agreement, and internal consistency. However, further research is needed to develop validated checklists for resuscitation teams.

Citations

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Effects of communication team training on clinical competence in Korean Advanced Life Support: A randomized controlled trial
Soyeon Yun, Hyeoun‐Ae Park, Sang‐Hoon Na, Hee Je Yun
Nursing & Health Sciences.2024;[Epub] CrossRef
Focused and Corrective Feedback Versus Structured and Supported Debriefing in a Simulation-Based Cardiac Arrest Team Training
Ji-Hoon Kim, Young-Min Kim, Seong Heui Park, Eun A Ju, Se Min Choi, Tai Yong Hong
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare.2017; 12(3): 157. CrossRef
Nurses' Cardiopulmonary Resuscitation Performance during the First 5 minutes in In-Situ Simulated Cardiac Arrest
Eun Jung Kim, Kyeong Ryong Lee, Myung Hyun Lee, Jiyoung Kim
Journal of Korean Academy of Nursing.2012; 42(3): 361. CrossRef
Assessment and Training of Teamwork and Leadership for Critical Care Nurses: A Pilot Study
Hyun Jin Kim, Sang Mo Je, Hyun Soo Chung, Sung Phil Chung, Hahn Shick Lee
Korean Journal of Critical Care Medicine.2012; 27(2): 75. CrossRef

Evaluating the Relationship between the Scoring Systems of Intensive Care Units (ICUs) and the Duration of Mechanical Ventilation after Liver Transplantation: Jeong Eun Kim, Sang Hoon Lee, Jong Ho Choi; Korean J Crit Care Med. 2009;24(2):69-74.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.69

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Abstract PDF: BACKGROUND
Postoperative mechanical ventilation in liver transplant patient has an important role for reducing respiratory complications and multi-organ failure in intensive care unit (ICU). Yet there are no specific indications for predicting the duration of postoperative mechanical ventilation. Thus, we evaluated the correlation between the duration of mechanical ventilation and scoring systems such as the Acute Physiology and Chronic health Evaluation (APACHE) II score, the Sequential Organ Failure Assessment (SOFA) score, the Model for End-stage Liver Disease (MELD) score and the risk index.
METHODS
We retrospectively studied 183 patients who underwent living donor liver transplantation and we divided them into three groups based on the duration of mechanical ventilation: Group 1: <8 hr, Group 2: 8-12 hr and Group 3: >12 hr. We analyzed the correlation coefficients among the duration of mechanical ventilation, the risk index, and the SOFA, APACHE II and MELD scores.
RESULTS
The MELD and preoperative SOFA scores were significantly higher in group 3 (p = 0.003, p = 0.027). The MELD and SOFA scores were correlated with the duration of mechanical ventilation for all the patients (correlation coefficient = 0.22, 0.20, p = 0.003, 0.007, respectively). Yet the APACHE II score shows no correlation.
CONCLUSIONS
We found that the MELD and SOFA scores were correlated with the duration of mechanical ventilation in liver transplant patients. Thus, these scoring systems may be useful to determine the duration of mechanical ventilation.

The Usefulness of a Triage Kit for Detecting Abused Drugs: Myoung Kwan Kwak, Won Young Kim, Hui Dong Kang, Jae Ho Lee, Bum Jin Oh, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2009;24(2):75-79.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.75

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Abstract PDF

BACKGROUND
The recovery and outcome of intoxicated patients depends on the kind of drugs they took and the total time of their initial management. The purpose of this study is to evaluate the usefulness of a Triage drug kit for detecting abused drugs.
METHODS
From 2003 Feb. to 2003 July, we studied the patients who visited the emergency department with suspicious drug intoxication. In this case, we used a Triage drug kit for 134 patients with drug intoxication or who were clinically suspected of taking illegal drugs, with 30 of the patients initially admitting the substance they had used. The kit is an immunoassay kit for qualitative testing drug metabolites in urine. To compare with those cases of the preceding year, we studied 104 patients with drug intoxication that was detected between February 2002 and July 2002.
RESULTS
Overall, 60% of the 30 cases who did not know what substance they abused and tested positive for, and 33% of the 27 cases with suspected intoxication confirmed their substance abuse. The positive rate for benzodiazepine use was the highest (46.7%), and there were no positive results regarding amphetamine, methamphetamine or cocaine. An appropriate antidote was administered significantly more frequently in the group for which we used the kit.
CONCLUSIONS
A Triage drug kit is probably useful for diagnosing acute drug intoxication and for identifying the causative substance. However, the time required to decide whether or not a patient should be admitted is not reduced. If the kit can detect the frequently abused drugs in Korea, it will be helpful for treating drug intoxicated patients.

Citations

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Clinical features of adolescents with suicide attempt and the factors associated with their outcomes: poisoning versus non-poisoning
Myoung Hoon Lee, Jae Ho Jang, Jin-Seong Cho, Woo Sung Choi, Jea Yeon Choi
Pediatric Emergency Medicine Journal.2020; 7(2): 85. CrossRef
Evaluation of the Triage TOX Drug Screen Assay for Detection of 11 Drugs of Abuse and Therapeutic Drugs
Hae In Bang, Mi-Ae Jang, Yong-Wha Lee
Annals of Laboratory Medicine.2017; 37(6): 522. CrossRef

A Preliminary Study on the Effect of "Low-dose" Glucocorticoid Therapy for Patients with Persistent Acute Respiratory Distress Syndrome: Hae Seong Nam, Maeng Real Park, So Young Park, So Yeon Lim, Su A Kim, Jae Uk Song, Kyeongman Jeon, Hojoong Kim, O Jung Kwon, Gee Young Suh; Korean J Crit Care Med. 2009;24(2):80-86.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.80

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Abstract PDF

BACKGROUND
The role of glucocorticoids for treating persistent acute respiratory distress syndrome (ARDS) is matter of debate. In the previous studies, the side effects of moderate doses of glucocorticoids might have negated positive effects of glucocorticoids. This study aimed at determining the feasibility of administering "low-dose" glucocorticoid to treat the patients who suffer with persistent ARDS.
METHODS
We retrospectively reviewed the medical records of twelve patients with ARDS of at least seven days' duration and who were treated with "low-dose" glucocorticoid (starting dose of 1 mg/kg) between June 2007 to December 2008. The patients were divided by whether or not they were successfully weaned from the ventilator after glucocorticoid therapy. The baseline characteristics and physiologic parameters were recorded for up to 7 days after starting glucocorticoid therapy.
RESULTS
Five patients (42%) were included in the weaned group. There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups on the day of ARDS. Yet the weaned group had a significantly lower Sequential Organ Failure Assessment (SOFA) score, as compared to that of the failed group [3 (3-6) vs 8 (5-12), p = 0.009)] at start of glucocorticoid treatment. After 3 days of glucocorticoid therapy, there was significant improvement in the PEEP, the PaO2/FIO2 ratio, the PCO2, the SOFA score and the Murray Lung Injury Score of the weaned group, as compared to that of the failed group. There were no major neuromuscular side effects from the therapy.
CONCLUSIONS
This study suggests that the "low-dose" glucocorticoid therapy is feasible and that the SOFA score and the physiologic parameters may assist in determining whether or not to initiate and to continue glucocorticoid therapy for the patients who are suffering with persistent ARDS.

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A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage
Han Min Lee, Jae-Seok Park, Jae Yun Kim, Ji Yeon Lee, Byung Kyu Ahn, Hyo-Wook Gil, Jae-Sung Choi
Tuberculosis and Respiratory Diseases.2012; 72(2): 177. CrossRef
Acute Respiratory Distress Syndrome with Chemical Pneumonitis after Aspiration of Activated Charcoal - A Case Report -
Suhyun Kim, Na Ree Kang, In Sohn, Heon Lee, Yoon Kyung Lee, Sook Hee Song
The Korean Journal of Critical Care Medicine.2010; 25(2): 112. CrossRef

Case Reports

Two Cases of Postintubation Tracheoesophageal Fistula in Patients with a History of Tracheostomy: Case Report: Seung Chan Kim, Kyung Won Ha, Joon Ho Wang, Se Jin Kim, Won Hak Kim, So Hee Jeong, Woo Sung Lee, Sang Don Han, Gyu Rak Chon; Korean J Crit Care Med. 2009;24(2):87-91.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.87

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Abstract PDF

Common causes of acquired tracheoesophageal (T-E) fistula are blunt trauma on the neck or chest, malignancy, long-term mechanical ventilation, and post-intubation injury. Most of the cases are fatal due to severe respiratory infection. We experienced two cases of post-intubation T-E fistula in patients with a history of tracheostomy that developed earlier than usual. One case was caused by excessive cuff pressure and the other by avulsion injury during endotracheal intubation. We can get instructions from these cases that how to prevent T-E fistula because it is hard to treat and causes severe outcomes.

Citations

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Occurrence of Acquired Tracheoesophageal Fistula Due to Excess Endotracheal Tube Cuff Volumes - A Case Report -
Myeong Soo Kim, Eun Jeong Koh, Ha Young Choi
Korean Journal of Critical Care Medicine.2013; 28(2): 146. CrossRef
Acquired Tracheoesophageal Fistula through Esophageal Diverticulum in Patient Who Had a Prolonged Tracheostomy Tube - A Case Report -
Jae Hwan Jung, Ji Sung Kim, Yong Kyun Kim
Annals of Rehabilitation Medicine.2011; 35(3): 436. CrossRef

Dantrolene and Post-operative Hyperthermia: A Case Report: Ja Kyung Koo, Cheol Hong Kim, Ah Leum Lim, Se Ah Kwon, Ji Young Park, Soon Jae Lee, In Gyu Hyun, Je Hyun Yoo; Korean J Crit Care Med. 2009;24(2):92-98.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.92

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Abstract PDF: Malignant hyperthermia is a rare, fatal pharmacogenetic disorder that occurs during general anesthesia following exposure to a depolarizing muscle relaxant, such as succinylcholine, or volatile anesthetics. Clinical findings in malignant hyperthermia include muscle rigidity, sinus tachycardia, increased CO2 production, skin cyanosis with mottling, and marked hyperthermia. For treatment, cooling techniques must be accompanied by discontinuation of the provocative medication. Furthermore, dantrolene administration is the mainstay of treatment for malignant hyperthermia, and should be initiated as soon as the diagnosis is suspected. We recently experienced a case with post-operative fever of 41.0degrees C refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration, in a patient with methicillin-sensitive Staphylococcus aureus monoarthritis of the knee and rapid progression of diffuse septic pneumonia requiring mechanical ventilation.

A Case of Valproic Acid Overdose Treated with Continuous Veno-Venous Hemodiafiltration: A Case Report: Sang Cheon Choi, Jung Hwan Ahn, Yoon Seok Jung, Young Gi Min; Korean J Crit Care Med. 2009;24(2):99-101.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.99

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Abstract PDF: Valproic acid intoxication is a fairly common clinical problem that can result in serious complications. Traditionally the treatment of valproic acid overdose has been limited to supportive measures, but high blood levels may require extracorporeal removal, and publications on this experience are scarce. This case demonstrated continuous veno-venous hemodiafiltration successfully used in patient with severe valproic acid overdose who was hemodynamically unstable.

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

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

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

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

Cardiac Arrest after Aortic Cross Clamping during Surgery for an Abdominal Aortic Aneurysm in a Patient with Coronary Artery Disease and Aortic Regurgitation: A Case Report: Woo Jae Jeon, Jae Hang Shim, Jin Bum Hong, Kyoung Hun Kim, Sang Yun Cho; Korean J Crit Care Med. 2009;24(2):111-114.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.111

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Abstract PDF: Patients with chronic aortic regurgitation have a hemodynamically fragile equilibrium; increased afterload during infrarenal aortic cross-clamping and acute decompensation. The tolerance of patients with severe coronary artery disease to the stress of infrarenal aortic cross-clamping differs from patients without overt coronary artery disease. Therefore, careful anesthetic management is needed during infrarenal aortic cross-clamping in patients with aortic regurgitation and coronary artery disease. We describe the anesthetic management of a man with an infrarenal aortic aneurysm that underwent cardiac arrest after aortic-cross clamping for aortoiliac bypass surgery.

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