Pub Date : 2015-08-01DOI: 10.4266/KJCCM.2015.30.3.218
Jin Park, Seung Yeob Lee, H. Choi, Y. Choi, Young Joo Lee
Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with highdose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.
{"title":"Management of Cyanide Intoxication with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy","authors":"Jin Park, Seung Yeob Lee, H. Choi, Y. Choi, Young Joo Lee","doi":"10.4266/KJCCM.2015.30.3.218","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.218","url":null,"abstract":"Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with highdose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"119 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116274728","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.109
Namo Kim, Kwan Hyung Kim, Jeongmin Kim, S. Choi, S. Na
Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.
{"title":"Early Extracorporeal Membrane Oxygenation for Massive Aspiration during Anesthesia Induction","authors":"Namo Kim, Kwan Hyung Kim, Jeongmin Kim, S. Choi, S. Na","doi":"10.4266/KJCCM.2015.30.2.109","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.109","url":null,"abstract":"Although the incidence is not high in the general surgical population, pulmonary aspiration of gastric contents can result in serious long-term morbidity and mortality. We report a case of early use of extracorporeal membrane oxygenation (ECMO) to correct severe hypoxemia refractory to conventional mechanical ventilation in a patient with massive aspiration of gastric contents immediately followed by acute lung injury during general anesthesia induction. A 64-year-old woman diagnosed with stomach cancer was scheduled for elective diagnostic laparoscopy. Although there was no sign of gastrointestinal tract obstruction and midnight Nil per Os (NPO) was performed before the operation, pulmonary aspiration occurred during the induction of anesthesia. Despite the endotracheal intubation with mechanical ventilation, severe hypoxemia with hypercapnea persisted. Medical team agreed with applying veno-venous (VV) ECMO, and her blood gas analysis results became stable. ECMO was weaned successfully 9 days after the first aspiration event had occurred. Based on this case, early application of extracorporeal life support can have survival benefits.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115606175","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.73
J. Park, S. Koh, J. Cho, S. Na
Background: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). Methods: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. Results: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient’s loss of decision-making capacity. Decisions were made most frequently by the patient’s son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). Conclusions: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.
{"title":"Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units","authors":"J. Park, S. Koh, J. Cho, S. Na","doi":"10.4266/KJCCM.2015.30.2.73","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.73","url":null,"abstract":"Background: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). Methods: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. Results: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient’s loss of decision-making capacity. Decisions were made most frequently by the patient’s son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). Conclusions: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"140 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115750153","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.128
B. Kang, Min Gu Kim, Jwa Hoon Kim, Mingee Lee, Sang-beom Jeon, Ha Il Kim, J. Huh
Wernicke’s encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke’s encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke’s encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.
{"title":"A Critical Case of Wernicke's Encephalopathy Induced by Hyperemesis Gravidarum","authors":"B. Kang, Min Gu Kim, Jwa Hoon Kim, Mingee Lee, Sang-beom Jeon, Ha Il Kim, J. Huh","doi":"10.4266/KJCCM.2015.30.2.128","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.128","url":null,"abstract":"Wernicke’s encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke’s encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke’s encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"40 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120859120","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.132
Do Wan Kim, Kyeong Ryeol Cheon, D. Cho, K. Lee, H. Cho, I. Jeong
Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potas sium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradi ated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complica tions associated with transfusions during ECMO.
{"title":"Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation","authors":"Do Wan Kim, Kyeong Ryeol Cheon, D. Cho, K. Lee, H. Cho, I. Jeong","doi":"10.4266/KJCCM.2015.30.2.132","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.132","url":null,"abstract":"Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potas sium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradi ated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complica tions associated with transfusions during ECMO.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128562670","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.115
H. Shin, Ho-Seong Han, Taeseung Lee, D. Park, K. Jung, Kyuseok Kim
Hemorrhagic shock is one of the most common causes of death in patients with multiple trauma and therefore rapid control of bleeding is the main strategy to save these patients. Resuscitative balloon occlusion of the aorta (REBOA) has been applied in several trauma cases and because of the effectiveness of this procedure it has been adopted in the trauma field. Herein, we report the first successful case of REBOA in Korea performed on a 46-year-old man with hemorrhagic shock after a fall from a height of 14-stories. The patient visited our hospital emergency room with hypovolemic shock, we performed Resuscitative Endovascular Balloon Occlusion of the Aorta under bed side blind technique. His vital sign was stabilized after procedure, then we could performed endovascular bleeding control. The patient was discharged on his 33rd in-hospital day without invasive procedure and major scar.
{"title":"Resuscitative Endovascular Balloon Occlusion of the Aorta in a Trauma Patient with Hypovolemic Shock","authors":"H. Shin, Ho-Seong Han, Taeseung Lee, D. Park, K. Jung, Kyuseok Kim","doi":"10.4266/KJCCM.2015.30.2.115","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.115","url":null,"abstract":"Hemorrhagic shock is one of the most common causes of death in patients with multiple trauma and therefore rapid control of bleeding is the main strategy to save these patients. Resuscitative balloon occlusion of the aorta (REBOA) has been applied in several trauma cases and because of the effectiveness of this procedure it has been adopted in the trauma field. Herein, we report the first successful case of REBOA in Korea performed on a 46-year-old man with hemorrhagic shock after a fall from a height of 14-stories. The patient visited our hospital emergency room with hypovolemic shock, we performed Resuscitative Endovascular Balloon Occlusion of the Aorta under bed side blind technique. His vital sign was stabilized after procedure, then we could performed endovascular bleeding control. The patient was discharged on his 33rd in-hospital day without invasive procedure and major scar.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116013060","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.135
Samina Park, Hyun Joo Lee, C. Kang, Y. T. Kim
A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient’s respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.
{"title":"Successful Management of Airway Emergency in a Patient with Esophageal Cancer","authors":"Samina Park, Hyun Joo Lee, C. Kang, Y. T. Kim","doi":"10.4266/KJCCM.2015.30.2.135","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.135","url":null,"abstract":"A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient’s respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125064385","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.103
Hwa Young Lee, Hea Yon Lee, S. Shin, K. S. Shin, B. Lee, H. Kim, S. Lee, S. Kim
Colonization of the pre-transplant lung by multidrug-resistant bacteria affects shortand long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.
{"title":"Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii","authors":"Hwa Young Lee, Hea Yon Lee, S. Shin, K. S. Shin, B. Lee, H. Kim, S. Lee, S. Kim","doi":"10.4266/KJCCM.2015.30.2.103","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.103","url":null,"abstract":"Colonization of the pre-transplant lung by multidrug-resistant bacteria affects shortand long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124821578","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.119
Hyo Jin Kim, Y. Cho, G. Suh, Jeong Hoon Yang, K. Jeon
We report a case of subclavian artery laceration caused by the removal of a pigtail pleural drainage catheter in a patient with a pneumothorax. The patient was successfully resuscitated through diagnostic angiography with subsequent balloon occlusion and primary repair of the injured subclavian artery. Although pigtail drainage of a pneumothorax is known to be safe and effective, proper insertion and removal techniques should be emphasized to reduce the risk of complications.
{"title":"Subclavian Artery Laceration Caused by Pigtail Catheter Removal in a Patient with Pneumothorax","authors":"Hyo Jin Kim, Y. Cho, G. Suh, Jeong Hoon Yang, K. Jeon","doi":"10.4266/KJCCM.2015.30.2.119","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.119","url":null,"abstract":"We report a case of subclavian artery laceration caused by the removal of a pigtail pleural drainage catheter in a patient with a pneumothorax. The patient was successfully resuscitated through diagnostic angiography with subsequent balloon occlusion and primary repair of the injured subclavian artery. Although pigtail drainage of a pneumothorax is known to be safe and effective, proper insertion and removal techniques should be emphasized to reduce the risk of complications.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134114644","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 : 2015-05-31DOI: 10.4266/KJCCM.2015.30.2.61
Seongtae Jeong
Body mass index (BMI) is a measure of body fat calculated by dividing weight by the square of height. Since the index was devised by Adolphe Quetelet and is defined by dividing one’s body mass by the square of one’s height (kg/m), BMI has been commonly used as proxy measure of excess body fat. According to the literature, higher BMI was strongly associated with higher mortality in the general population.[1-4] However, critically ill patients’ relative mortality risks associated with overweight or obesity are still subject to debate although underweight has been established as a strong predictor of their deaths.[5-8] Several large-scale prospective studies have assessed the association between BMI and mortality in critically ill patients using (identical) cut off values. However, most of these studies were conducted on western populations.[9,10] The results of these studies cannot be generalized to Asian populations because of variations in body compositions and body fat distribution. Indeed, Asians have lower BMI but higher levels of body fat than Caucasians.[11] In the local research context, Lim SY et al claimed that BMI was not significantly associated with mortality in critically ill patients and that mortality risk in critically ill patients was more associated with failed extubation and severity of illness.[8] In their retrospective study, BMI values were classified into three categories: underweight 30.0 kg/m). Their findings showed that the Cox-proportional hazard ratios with exact partial likelihood to handle tied failures for hospital mortality comparing the BMI caretories with the reference category were 1.13 (0.88 to 1.44), 1.03 (0.84 to 1.26), 0.96 (0.76 to 1.22), and 0.68 (0.43 to 1.08) respectively, none of which were statistically significant. Nonetheless, a graded inverse association between BMI and mortality rate was evident. In other words, the lowest mortality rate was observed in the highest BMI group when surgical patients were excluded, and their findings were further explained by experimental evidence that adipocyte-secreted hormones such as
{"title":"Is Body Mass Index a Useful Prognostic Factor for Critically Ill Patients","authors":"Seongtae Jeong","doi":"10.4266/KJCCM.2015.30.2.61","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.2.61","url":null,"abstract":"Body mass index (BMI) is a measure of body fat calculated by dividing weight by the square of height. Since the index was devised by Adolphe Quetelet and is defined by dividing one’s body mass by the square of one’s height (kg/m), BMI has been commonly used as proxy measure of excess body fat. According to the literature, higher BMI was strongly associated with higher mortality in the general population.[1-4] However, critically ill patients’ relative mortality risks associated with overweight or obesity are still subject to debate although underweight has been established as a strong predictor of their deaths.[5-8] Several large-scale prospective studies have assessed the association between BMI and mortality in critically ill patients using (identical) cut off values. However, most of these studies were conducted on western populations.[9,10] The results of these studies cannot be generalized to Asian populations because of variations in body compositions and body fat distribution. Indeed, Asians have lower BMI but higher levels of body fat than Caucasians.[11] In the local research context, Lim SY et al claimed that BMI was not significantly associated with mortality in critically ill patients and that mortality risk in critically ill patients was more associated with failed extubation and severity of illness.[8] In their retrospective study, BMI values were classified into three categories: underweight 30.0 kg/m). Their findings showed that the Cox-proportional hazard ratios with exact partial likelihood to handle tied failures for hospital mortality comparing the BMI caretories with the reference category were 1.13 (0.88 to 1.44), 1.03 (0.84 to 1.26), 0.96 (0.76 to 1.22), and 0.68 (0.43 to 1.08) respectively, none of which were statistically significant. Nonetheless, a graded inverse association between BMI and mortality rate was evident. In other words, the lowest mortality rate was observed in the highest BMI group when surgical patients were excluded, and their findings were further explained by experimental evidence that adipocyte-secreted hormones such as","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"47 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129968546","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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