Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00948
J. Cho
{"title":"Should We Measure Vitamin D Level","authors":"J. Cho","doi":"10.4266/KJCCM.2016.00948","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00948","url":null,"abstract":"","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131563031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00703
Y. Kawano, T. Nishida, A. Togawa, Yuhei Irie, K. Hoshino, N. Matsumoto, H. Ishikura
Background: The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation. Methods: We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1). Stool cultures were routinely performed in addition from January to September 2014 (phase 2). Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2. Results: We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6%) patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days) were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376), third-generation cephalosporins (24.2 vs. 29.5, p = 0.724), tazobactam/piperacillin (44.6 vs. 57.3, p = 0.489), and carbapenems (73 vs. 55.5, p = 0.222). Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively). Conclusions: Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation.
背景:在非疫情情况下，监测识别广谱产β -内酰胺酶肠杆菌科(ESBLE)携带者的有效性存在争议。我们通过痰和尿培养对已经接受主动监测的重症监护病房(ICU)患者进行了额外的粪便培养，以检测ESBL-E。我们的目的是评估粪便培养在非爆发情况下筛查ESBL-E的功效。方法:我们在ICU进行回顾性队列研究。2013年1月至9月(第1期)进行痰液和尿液培养，用于监测ESBL-E。2014年1月至9月(第2期)常规进行粪便培养。调查并比较第1期和第2期的抗菌药物使用密度值和临床结果。结果:我们在1期和2期分别确定了512例和478例患者。2期65例(13.6%)患者粪便中发现ESBL-E。氟喹诺酮类药物(7 vs. 10, p = 0.376)、第三代头孢菌素(24.2 vs. 29.5, p = 0.724)、他唑巴坦/哌西林(44.6 vs. 57.3, p = 0.489)和碳青霉烯类药物(73 vs. 55.5, p = 0.222)的抗菌药物使用密度值(以每1000个床位日定义的每日剂量表示)在两期之间无显著差异。两组ICU死亡率和住院时间差异无统计学意义(分别为11.5%对9.8%，p = 0.412, 9天对10天，p = 0.28)。结论:粪便培养在改善广谱抗菌药物的使用密度、临床结果和ICU住院时间方面似乎无效，在非疫情情况下不建议用于监测ESBL-E。
{"title":"Surveillance of Extended-Spectrum β-Lactamase-producing Enterobacteriaceae Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis","authors":"Y. Kawano, T. Nishida, A. Togawa, Yuhei Irie, K. Hoshino, N. Matsumoto, H. Ishikura","doi":"10.4266/KJCCM.2016.00703","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00703","url":null,"abstract":"Background: The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation. Methods: We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1). Stool cultures were routinely performed in addition from January to September 2014 (phase 2). Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2. Results: We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6%) patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days) were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376), third-generation cephalosporins (24.2 vs. 29.5, p = 0.724), tazobactam/piperacillin (44.6 vs. 57.3, p = 0.489), and carbapenems (73 vs. 55.5, p = 0.222). Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively). Conclusions: Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120964612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00276
Hyun-Jung Kim, M. Sohn, E. Choi
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeungnam University Hospital, Regional Respiratory Center, Yeungnam University College of Medicine, Daegu, Korea
{"title":"Prevalence and Related Factors of Vitamin D Deficiency in Critically Ill Patients","authors":"Hyun-Jung Kim, M. Sohn, E. Choi","doi":"10.4266/KJCCM.2016.00276","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00276","url":null,"abstract":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeungnam University Hospital, Regional Respiratory Center, Yeungnam University College of Medicine, Daegu, Korea","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"552 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116397107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00934
N. Glassford, R. Bellomo
Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.
{"title":"The Complexities of Intravenous Fluid Research: Questions of Scale, Volume, and Accumulation","authors":"N. Glassford, R. Bellomo","doi":"10.4266/KJCCM.2016.00934","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00934","url":null,"abstract":"Despite near ubiquity, information regarding fluids consumption at a health care systems level, and patient exposure at an individual level, is surprisingly limited in the medical literature. The epidemiology of the foundational medical intervention of intravenous fluid administration is incredibly complex, with millions of patients being exposed internationally every year. Fluid is being given for different reasons, to different targets, following different triggers, by different specialties in different countries, and any observations that can be made are thought to have limited external validity to other jurisdictions and patient groups. The independent effects of fluid administration and fluid accumulation are very hard to separate from other markers of illness severity and aspects of the process of care. Fluid accumulation can result in organ injury, even when the fluid is being given to purportedly ameliorate or prevent such injury, and if it were independently associated with mortality then would be an easily accessible and modifiable risk factor for subsequent morbidity or death. Despite their ubiquity, it is clear that we have limited understanding of the effects of the intravenous fluids we use daily in the most vulnerable of patient groups. The research agenda in this field is large and urgent.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128473959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00325
K. Lee, S. Choi, Y. Jeon, Raing Kyu Kim, D. Um
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.
{"title":"Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage","authors":"K. Lee, S. Choi, Y. Jeon, Raing Kyu Kim, D. Um","doi":"10.4266/KJCCM.2016.00325","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00325","url":null,"abstract":"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.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122801483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00451
G. Choi, M. Kang
{"title":"Successful Use of Extracorporeal Membrane Oxygenation in Diffuse Alveolar Hemorrhage Secondary to Systemic Lupus Erythematosus","authors":"G. Choi, M. Kang","doi":"10.4266/KJCCM.2016.00451","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00451","url":null,"abstract":"","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125061962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00024
Sang-Hoon Lee, B. Park, J. H. Song, S. Kim, K. Chung, E. Y. Kim, J. Jung, Y. S. Kim, S. K. Kim, Joon Chang, M. Park
Background: Despite many ongoing, prospective studies on the topic, sepsis still remains one of the main causes of death in hospital. The hormone insulin-like growth factor 1 (IGF-1) has a similar molecular structure to that of insulin. IGF-1 exerts anabolic effects and plays important roles in both normal physiology and pathologic processes. Previous studies have observed low serum IGF-1 level in patients with critical illnesses. Here, we evaluated changes in IGF-1 level based on survival of septic patients. Methods: We evaluated 140 patients with sepsis and septic shock (21 with sepsis and 119 with septic shock) admitted to the intensive care unit of a university-affiliated hospital in Korea. Serum IGF-1 level was measured on days 0, 1, 3, and 7. Patients with liver disease were excluded from this study. All data were analyzed using SPSS version 20 (SPSS Inc., Chicago, IL, USA). Results: Patients with septic shock had significantly lower serum IGF-1 level on days 1 and 3 than patients without septic shock (p = 0.002 and p = 0.007, respectively). Generally, there was a negative relationship between IGF-1 and serum cortisol levels; however, this relationship was only significant on day 3 (p = 0.029). Furthermore, renin showed significantly negative correlation with IGF-1 on day 3 (p = 0.038). IGF-1 level did not show significant difference between survivors and non-survivors. Conclusions: Our results showed that IGF-1 was associated with septic shock, and that the IGF-1 axis is severely disrupted in septic patients. Additionally, serum cortisol and renin levels were associated with IGF-1 level.
背景:尽管有许多正在进行的前瞻性研究，败血症仍然是医院死亡的主要原因之一。激素胰岛素样生长因子1 (IGF-1)具有与胰岛素相似的分子结构。IGF-1具有合成代谢作用，在正常生理和病理过程中都起着重要作用。以往的研究发现，重症患者血清IGF-1水平较低。在这里，我们基于脓毒症患者的生存评估了IGF-1水平的变化。方法:我们评估了韩国某大学附属医院重症监护室收治的140例败血症和脓毒性休克患者(21例败血症和119例脓毒性休克)。于第0、1、3、7天测定血清IGF-1水平。有肝脏疾病的患者被排除在本研究之外。所有数据均使用SPSS version 20 (SPSS Inc.， Chicago, IL, USA)进行分析。结果:脓毒性休克患者血清IGF-1水平在第1天和第3天明显低于非脓毒性休克患者(p = 0.002和p = 0.007)。总体而言，IGF-1与血清皮质醇水平呈负相关;然而，这种关系仅在第3天显著(p = 0.029)。肾素与IGF-1在第3天呈显著负相关(p = 0.038)。IGF-1水平在幸存者和非幸存者之间无显著差异。结论:我们的研究结果表明IGF-1与脓毒性休克有关，并且在脓毒症患者中IGF-1轴严重破坏。此外，血清皮质醇和肾素水平与IGF-1水平相关。
{"title":"Changes in Insulin-like Growth Factor-1 Level in Patients with Sepsis and Septic Shock","authors":"Sang-Hoon Lee, B. Park, J. H. Song, S. Kim, K. Chung, E. Y. Kim, J. Jung, Y. S. Kim, S. K. Kim, Joon Chang, M. Park","doi":"10.4266/KJCCM.2016.00024","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00024","url":null,"abstract":"Background: Despite many ongoing, prospective studies on the topic, sepsis still remains one of the main causes of death in hospital. The hormone insulin-like growth factor 1 (IGF-1) has a similar molecular structure to that of insulin. IGF-1 exerts anabolic effects and plays important roles in both normal physiology and pathologic processes. Previous studies have observed low serum IGF-1 level in patients with critical illnesses. Here, we evaluated changes in IGF-1 level based on survival of septic patients. Methods: We evaluated 140 patients with sepsis and septic shock (21 with sepsis and 119 with septic shock) admitted to the intensive care unit of a university-affiliated hospital in Korea. Serum IGF-1 level was measured on days 0, 1, 3, and 7. Patients with liver disease were excluded from this study. All data were analyzed using SPSS version 20 (SPSS Inc., Chicago, IL, USA). Results: Patients with septic shock had significantly lower serum IGF-1 level on days 1 and 3 than patients without septic shock (p = 0.002 and p = 0.007, respectively). Generally, there was a negative relationship between IGF-1 and serum cortisol levels; however, this relationship was only significant on day 3 (p = 0.029). Furthermore, renin showed significantly negative correlation with IGF-1 on day 3 (p = 0.038). IGF-1 level did not show significant difference between survivors and non-survivors. Conclusions: Our results showed that IGF-1 was associated with septic shock, and that the IGF-1 axis is severely disrupted in septic patients. Additionally, serum cortisol and renin levels were associated with IGF-1 level.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116874788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00339
B. Ko, H. Cho, S. Ryoo, M. Kim, Woong Jung, Sung Hyuk Park, Chang Min Lee, W. Kim
Background: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. Methods: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. Results: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). Conclusions: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.
背景:在急诊科(EDs)就诊的感染性休克患者中，公开性弥散性血管内凝血(DIC)的患病率和预后价值尚不清楚，特别是在感染性休克的新定义发布之后。本研究的目的是探讨感染性休克中DIC的患病率和预后价值。方法:回顾性分析大学附属三级医院急诊16个月期间391例感染性休克患者的临床资料。脓毒性休克定义为液体无反应性低血压，需要血管加压药物维持平均动脉压为65 mmHg或更高，血清乳酸水平≥2 mmol/L。公开性DIC定义为国际血栓与止血学会(ISTH)评分≥5分。主要终点为28天死亡率。结果:391例脓毒性休克患者中，290例纳入本研究。根据ISTH评分，平均年龄65.6岁，28天死亡率26.9%，显性DIC患病率为17.6% (n = 51)。非幸存者的DIC评分中位数高于幸存者(5.0 vs. 2.0, p = 0.001)。明显DIC患者的死亡率明显高于无DIC患者(28.2% vs. 13.7%， p = 0.005)。多变量logistic回归分析发现DIC与28天死亡率独立相关(优势比2.689[95%可信区间1.390-5.201])。结论:使用ISTH DIC的标准，发现感染性休克时明显DIC在急诊科患者中很常见，当伴有感染性休克时，其死亡率较高。在感染性休克患者出现急诊科的初始治疗期间，需要努力识别明显DIC的存在。
{"title":"The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition","authors":"B. Ko, H. Cho, S. Ryoo, M. Kim, Woong Jung, Sung Hyuk Park, Chang Min Lee, W. Kim","doi":"10.4266/KJCCM.2016.00339","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00339","url":null,"abstract":"Background: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. Methods: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. Results: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). Conclusions: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"74 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132227638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00927
O. Hamzaoui, J. Teboul
Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.
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Pub Date : 2016-11-30DOI: 10.4266/KJCCM.2016.00269
J. Lim, P. Kang, Dooli Kim
Most coagulation factors are synthesized in the liver. Hence, the levels of most coagulation factors are decreased in cases of chronic liver disease. Chronic liver disease was previously considered as an acquired bleeding disorder, and basic laboratory tests of anticoagulation, including prothrombin time and activated partialthromboplastin time (aPTT), were used to assess the risk of bleeding.[1] However, a new hypothesis states that the coagulation system is rebalanced in chronic liver disease, with a decrease in the levels of natural anticoagulant factors, such as protein C and anti-thrombin, and a decrease in the levels of most of the coagulation factors under physiologic conditions.[1] Moreover, patients with chronic liver disease are considered to be procoagulant in many reports.[2,3] This could be explained by the increased levels of factor VIII mediated by the von Willebrand factor.[4,5] Consequently, patients with chronic liver disease are more likely to be at increased risk of venous or arterial thrombosis.[6-8] Here, we report a case of acute pulmonary thromboembolism that developed during adult liver transplantation (LT), which was managed successfully with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support. A 61-year-old woman with a 1-year history of hepatitis B liver cirrhosis (LC) was scheduled to undergo elective adult-to-adult living donor LT. In addition to LC, she was also diagnosed with diabetes mellitus. Preoperative transthoracic echocardiography indicated normal biventricular and valvular function, with a left ventricular ejection fraction (LVEF) of 71%. Abdominal and pelvic computed tomography showed a large amount of ascites and esophageal varix with a cirrhotic liver. The laboratory findings were not remarkable, except for the low platelet count (65,000/ dL), and slightly elevated aspartate transaminase levels (57 IU/L) and total bilirubin levels (2.5 mg/dL). A skin incision was made with the patient under general anesthesia with stable
{"title":"Successful Extracorporeal Membrane Oxygenation Support for Acute Pulmonary Thromboembolism during Adult Liver Transplantation","authors":"J. Lim, P. Kang, Dooli Kim","doi":"10.4266/KJCCM.2016.00269","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00269","url":null,"abstract":"Most coagulation factors are synthesized in the liver. Hence, the levels of most coagulation factors are decreased in cases of chronic liver disease. Chronic liver disease was previously considered as an acquired bleeding disorder, and basic laboratory tests of anticoagulation, including prothrombin time and activated partialthromboplastin time (aPTT), were used to assess the risk of bleeding.[1] However, a new hypothesis states that the coagulation system is rebalanced in chronic liver disease, with a decrease in the levels of natural anticoagulant factors, such as protein C and anti-thrombin, and a decrease in the levels of most of the coagulation factors under physiologic conditions.[1] Moreover, patients with chronic liver disease are considered to be procoagulant in many reports.[2,3] This could be explained by the increased levels of factor VIII mediated by the von Willebrand factor.[4,5] Consequently, patients with chronic liver disease are more likely to be at increased risk of venous or arterial thrombosis.[6-8] Here, we report a case of acute pulmonary thromboembolism that developed during adult liver transplantation (LT), which was managed successfully with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support. A 61-year-old woman with a 1-year history of hepatitis B liver cirrhosis (LC) was scheduled to undergo elective adult-to-adult living donor LT. In addition to LC, she was also diagnosed with diabetes mellitus. Preoperative transthoracic echocardiography indicated normal biventricular and valvular function, with a left ventricular ejection fraction (LVEF) of 71%. Abdominal and pelvic computed tomography showed a large amount of ascites and esophageal varix with a cirrhotic liver. The laboratory findings were not remarkable, except for the low platelet count (65,000/ dL), and slightly elevated aspartate transaminase levels (57 IU/L) and total bilirubin levels (2.5 mg/dL). A skin incision was made with the patient under general anesthesia with stable","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124887078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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