Pub Date : 2016-08-30DOI: 10.4266/KJCCM.2016.00318
T. Park, Y. Oh, Sang-Bum Hong, C. Lim, Y. Koh, Je-Hwan Lee, Jung-Hee Lee, K. Lee, J. Huh
Background: Administering extracorporeal membrane oxygenation (ECMO) to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. Methods: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015. Results: A total of 15 patients (9 men; median age 45 years) with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding). The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56). Conclusions: Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.
背景:在过去十年中，对急性呼吸窘迫综合征危重患者进行体外膜氧合(ECMO)治疗的人数大幅增加，但对血液系统恶性肿瘤患者进行ECMO治疗的风险尤其高。在这里，我们报告了血液恶性肿瘤和严重急性呼吸衰竭患者接受ECMO治疗的临床结果。方法:回顾性分析2010年3月至2015年4月在某三级转诊医院重症监护室接受ECMO治疗的恶性血液病合并严重急性呼吸衰竭患者的病历。结果:共15例患者(男性9例;在研究期间，血液恶性肿瘤和严重急性呼吸衰竭患者接受ECMO治疗。急性生理和慢性健康评估II评分、Murray肺损伤评分和呼吸体外膜氧合生存预测评分的中位值分别为29、3.3和-2。7例患者接受静脉-静脉ECMO, 8例患者接受静脉-动脉ECMO。ECMO的中位持续时间为2天。3例患者成功脱机ECMO。4例患者出现出血并发症(肺出血1例，颅内出血1例，胃肠道出血2例)。ECMO启动后患者最长生存期为59天。静脉-静脉ECMO组和静脉-动脉ECMO组的生存率无显著差异(10.0 vs. 10.5天;P = 0.56)。结论:恶性血液病合并严重急性呼吸衰竭患者经ECMO治疗后预后较差。在这些患者中，仔细和适当地选择体外膜肺栓塞的候选人是必要的。
{"title":"Extracorporeal Membrane Oxygenation Support in Adult Patients with Hematologic Malignancies and Severe Acute Respiratory Failure","authors":"T. Park, Y. Oh, Sang-Bum Hong, C. Lim, Y. Koh, Je-Hwan Lee, Jung-Hee Lee, K. Lee, J. Huh","doi":"10.4266/KJCCM.2016.00318","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00318","url":null,"abstract":"Background: Administering extracorporeal membrane oxygenation (ECMO) to critically ill patients with acute respiratory distress syndrome has substantially increased over the last decade, however administering ECMO to patients with hematologic malignancies may carry a particularly high risk. Here, we report the clinical outcomes of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO. Methods: We performed a retrospective review of the medical records of patients with hematologic malignancies and severe acute respiratory failure who were treated with ECMO at the medical intensive care unit of a tertiary referral hospital between March 2010 and April 2015. Results: A total of 15 patients (9 men; median age 45 years) with hematologic malignancies and severe acute respiratory failure received ECMO therapy during the study period. The median values of the Acute Physiology and Chronic Health Evaluation II score, Murray Lung Injury Score, and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score were 29, 3.3, and -2, respectively. Seven patients received venovenous ECMO, whereas 8 patients received venoarterial ECMO. The median ECMO duration was 2 days. Successful weaning of ECMO was achieved in 3 patients. Hemorrhage complications developed in 4 patients (1 pulmonary hemorrhage, 1 intracranial hemorrhage, and 2 cases of gastrointestinal bleeding). The longest period of patient survival was 59 days after ECMO initiation. No significant differences in survival were noted between venovenous and venoarterial ECMO groups (10.0 vs. 10.5 days; p = 0.56). Conclusions: Patients with hematologic malignancies and severe acute respiratory failure demonstrate poor outcomes after ECMO treatment. Careful and appropriate selection of candidates for ECMO in these patients is necessary.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116381798","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 : 2016-08-30DOI: 10.4266/KJCCM.2016.31.2.129
E. Gil, T. Ha, G. Suh, C. Chung, C. Park
Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.
{"title":"Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient","authors":"E. Gil, T. Ha, G. Suh, C. Chung, C. Park","doi":"10.4266/KJCCM.2016.31.2.129","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.129","url":null,"abstract":"Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114838948","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 : 2016-08-30DOI: 10.4266/KJCCM.2016.00178
Moon Seong Baek, Y. Koh, Sang-Bum Hong, C. Lim, J. Huh
Background: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. Methods: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. Results: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). Conclusions: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
背景:许多医生在危急情况下不愿与患者或家属讨论不复苏(DNR)命令。在重症监护病房(ICU)，延迟的DNR决定可能导致无意的心肺复苏，患者窘迫和大量费用。我们调查了指定DNR的时间是否会影响内科ICU患者的预后。方法:选取2014年6月1日至2015年5月31日在某内科ICU(13张床位)接受书面DNR医嘱的回顾性患者。将患者分为两组:早期DNR患者在入院后48 h内执行DNR命令，晚期DNR患者在入院后48 h以上执行DNR命令。结果:354例患者入住内科ICU，其中80例(22.6%)患者申请了DNR单。其中37例(46.3%)患者在ICU入院48小时内指定了DNR命令，43例(53.7%)患者在ICU入院48小时后指定了DNR命令。与早期DNR患者相比，晚期DNR患者倾向于保留或撤销维持生命管理(18.9% vs. 37.2%， p = 0.072)。DNR同意书是由家属而不是患者签署的。脓毒性休克是早期和晚期DNR患者住院的最常见原因(54.1%比37.2%，p = 0.131)。两组住院死亡率无差异(83.8%对81.4%，p = 0.779)。晚期DNR患者的ICU住院时间较早期DNR患者长(7.4±8.1∶19.7±19.2,p < 0.001)。结论:内科ICU患者的临床结果不受DNR指定时间的影响。晚期DNR组与ICU住院时间较长以及拒绝或撤销维持生命治疗的倾向相关。然而，需要进一步的研究来明确危重病人临终关怀的指南。
{"title":"Effect of Timing of Do-Not-Resuscitate Orders on the Clinical Outcome of Critically Ill Patients","authors":"Moon Seong Baek, Y. Koh, Sang-Bum Hong, C. Lim, J. Huh","doi":"10.4266/KJCCM.2016.00178","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00178","url":null,"abstract":"Background: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. Methods: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. Results: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). Conclusions: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134298652","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 : 2016-08-30DOI: 10.4266/KJCCM.2016.00297
Jung Soo Kim, Hyunkeun Lim, J. Song, Hyunkeun Lim, K. Song, J. Cho
Background: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. Methods: A face-to-face questionnaire that consisted of a doctor’s preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014. Results: We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists’ difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years. Conclusion: The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.
{"title":"A Pilot Survey of Difficult Intubation and Cannot Intubate, Cannot Ventilate Situations in Korea","authors":"Jung Soo Kim, Hyunkeun Lim, J. Song, Hyunkeun Lim, K. Song, J. Cho","doi":"10.4266/KJCCM.2016.00297","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00297","url":null,"abstract":"Background: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. Methods: A face-to-face questionnaire that consisted of a doctor’s preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014. Results: We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists’ difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years. Conclusion: The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"16 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132797006","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 : 2016-08-30DOI: 10.4266/KJCCM.2016.00213
Jae Ha Lee, H. Jang, Jin Han Park, Yong Kyun Kim, Ho-Ki Min, S. Kim, Hyun-kuk Kim
Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.
{"title":"Use of Extracorporeal Membrane Oxygenation in a Fulminant Course of Amniotic Fluid Embolism Syndrome Immediately after Cesarean Delivery","authors":"Jae Ha Lee, H. Jang, Jin Han Park, Yong Kyun Kim, Ho-Ki Min, S. Kim, Hyun-kuk Kim","doi":"10.4266/KJCCM.2016.00213","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00213","url":null,"abstract":"Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131744791","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 : 2016-08-30DOI: 10.4266/KJCCM.2016.00129
S. Park, M. Park, C. Chung, Ju Sin Kim, S. Park, H. Lee
Background: Colistin (polymyxin E) is active against multidrug-resistant Gram-negative bacteria (MDR-GNB). However, the effectiveness of inhaled colistin is unclear. This study was designed to assess the effectiveness and safety of aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP) caused by MDR-GNB. Methods: In this retrospective longitudinal study, we evaluated the medical records of 63 patients who received aerosolized colistin treatment for VAP caused by MDR-GNB in the medical intensive care unit (MICU) from February 2012 to March 2014. Results: A total of 25 patients with VAP caused by MDR-GNB were included in this study. The negative conversion rate was 84.6% after treatment, and acute kidney injury (AKI) occurred in 11 patients (44%, AKI group). The average length of MICU stay and colistin treatment-related factors, such as daily and total cumulative doses and administration period, were not significantly different between groups. In-hospital mortality tended to be higher in the AKI group (p = 0.07). Multivariate analysis showed that a body mass index less than 18 was an independent risk factor of mortality (odds ratio [OR] = 21.95, 95% confidence interval [CI] 1.59-302.23; p = 0.02). Notably, AKI occurrence was closely related to the administration of more than two nephrotoxic drugs combined with aerosolized colistin (OR = 15.03, 95% CI 1.40-161.76; p = 0.025) and septic shock (OR = 8.10, 95% CI 1.40-161.76; p = 0.04). Conclusions: The use of adjunctive aerosolized colistin treatment appears to be a relatively safe and effective option for the treatment of VAP caused by MDR-GNB. However, more research on the concomitant use of nephrotoxic drugs with aerosolized colistin will be necessary, as this can be an important risk factor of development of AKI.
{"title":"Clinical Effectiveness and Nephrotoxicity of Aerosolized Colistin Treatment in Multidrug-Resistant Gram-Negative Pneumonia","authors":"S. Park, M. Park, C. Chung, Ju Sin Kim, S. Park, H. Lee","doi":"10.4266/KJCCM.2016.00129","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.00129","url":null,"abstract":"Background: Colistin (polymyxin E) is active against multidrug-resistant Gram-negative bacteria (MDR-GNB). However, the effectiveness of inhaled colistin is unclear. This study was designed to assess the effectiveness and safety of aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP) caused by MDR-GNB. Methods: In this retrospective longitudinal study, we evaluated the medical records of 63 patients who received aerosolized colistin treatment for VAP caused by MDR-GNB in the medical intensive care unit (MICU) from February 2012 to March 2014. Results: A total of 25 patients with VAP caused by MDR-GNB were included in this study. The negative conversion rate was 84.6% after treatment, and acute kidney injury (AKI) occurred in 11 patients (44%, AKI group). The average length of MICU stay and colistin treatment-related factors, such as daily and total cumulative doses and administration period, were not significantly different between groups. In-hospital mortality tended to be higher in the AKI group (p = 0.07). Multivariate analysis showed that a body mass index less than 18 was an independent risk factor of mortality (odds ratio [OR] = 21.95, 95% confidence interval [CI] 1.59-302.23; p = 0.02). Notably, AKI occurrence was closely related to the administration of more than two nephrotoxic drugs combined with aerosolized colistin (OR = 15.03, 95% CI 1.40-161.76; p = 0.025) and septic shock (OR = 8.10, 95% CI 1.40-161.76; p = 0.04). Conclusions: The use of adjunctive aerosolized colistin treatment appears to be a relatively safe and effective option for the treatment of VAP caused by MDR-GNB. However, more research on the concomitant use of nephrotoxic drugs with aerosolized colistin will be necessary, as this can be an important risk factor of development of AKI.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127670660","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 : 2016-05-31DOI: 10.4266/KJCCM.2016.31.2.152
S. J. Choi, C. Park, W. Jhang, S. Park
Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
{"title":"Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia","authors":"S. J. Choi, C. Park, W. Jhang, S. Park","doi":"10.4266/KJCCM.2016.31.2.152","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.152","url":null,"abstract":"Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114603371","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 : 2016-05-31DOI: 10.4266/KJCCM.2016.31.2.169
S. Chang, Sun Han, J. Ko, J. Ryu
The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.
{"title":"Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination","authors":"S. Chang, Sun Han, J. Ko, J. Ryu","doi":"10.4266/KJCCM.2016.31.2.169","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.169","url":null,"abstract":"The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129962331","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 : 2016-05-31DOI: 10.4266/KJCCM.2016.31.2.134
H. J. Baek, Doo Hyuk Lee, K. Han, Young Min Kim, Hyunbeom Kim, B. Cho, I. Lee, K. Choi, H. Yong, Goohyeon Hong
{"title":"Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis","authors":"H. J. Baek, Doo Hyuk Lee, K. Han, Young Min Kim, Hyunbeom Kim, B. Cho, I. Lee, K. Choi, H. Yong, Goohyeon Hong","doi":"10.4266/KJCCM.2016.31.2.134","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.134","url":null,"abstract":"","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114832319","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 : 2016-05-31DOI: 10.4266/KJCCM.2016.31.2.101
T. Kim, Jong Hyun Lee, Chan-Young Na
Background: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah``s Witness patients refusing blood transfusion to those in non-Jehovah``s Witness patients without any transfusion limitations. Methods: From 2005 to 2014, 25 Jehovah``s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. Results: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. Conclusions: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
{"title":"Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah’s Witnesses: a Comparative Study with Non-Jehovah’s Witnesses","authors":"T. Kim, Jong Hyun Lee, Chan-Young Na","doi":"10.4266/KJCCM.2016.31.2.101","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.101","url":null,"abstract":"Background: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah``s Witness patients refusing blood transfusion to those in non-Jehovah``s Witness patients without any transfusion limitations. Methods: From 2005 to 2014, 25 Jehovah``s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. Results: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. Conclusions: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129299693","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：