Pub Date : 2016-05-31DOI: 10.4266/KJCCM.2016.31.2.73
J. Lee
Since extracorporeal membrane oxygenation (ECMO) was introduced as a treatment modality for respiratory failure in 1972 by Hill et al.,[1] it has provided support to patients with inadequate oxygen delivery for days to weeks. Clinicians have used ECMO to increase oxygen delivery in severe lung disease, ineffective cardiac output from circulatory failure, or combined cardiopulmonary failure. ECMO has typically been applied in rescue situations that were refractory to conventional therapy.[2] Recently, researchers in the U.S., Germany, and Taiwan reported a rapid increase in the use of ECMO in their countries.[3-5] Diseases such as the H1N1 pandemic influenza,[6] the development of ECMO technology,[7] and the publication of randomized clinical trials have likely contributed to an increase in the use of ECMO.[8] In contrast to the growing worldwide use of ECMO, evidence of its use in critical care situations is still lacking.[9] In particular, there is not much evidence supporting ECMO use in adult patients with Acute Respiratory Distress Syndrome (ARDS) and there is a paucity of rigorous experiments on its use in these patients.[10] Only 4 randomized clinical trials on the use of extracorporeal life support in ARDS have been previously reported.[11-14] Most of the existing publications on ECMO use are observational studies of a retrospective review, clinical experiences, and clinical reports. Last year, the Korean Journal of Critical Care Medicine (KJCCM) published 11 papers which described the use of ECMO. Most of them were clinical reports of various clinical situations related to ECMO use, and one publication was an original article of a retrospective review. Publications such as clinical or case reports may not provide direct evidence, however they can provide important information and influence clinicians to consider new or different treatments in certain clinical situations. This issue of KJCCM includes two new case reports on the use of ECMO. The first case report describes a transient complication of ECMO that was corrected in a neonate,[15] and the second is a case on ECMO use in aspiration pneumonia in a single lung.[16] Both cases are conceivable situations for clinicians similar to previous case reports published in this journal. A key question is how to organize such case reports or series so that they provide findings that are close to evidence. To cite one example, ECMO complications can arise either from patient factors or ECMO circuit components. Due to the diversity in indi-
{"title":"The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)","authors":"J. Lee","doi":"10.4266/KJCCM.2016.31.2.73","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.73","url":null,"abstract":"Since extracorporeal membrane oxygenation (ECMO) was introduced as a treatment modality for respiratory failure in 1972 by Hill et al.,[1] it has provided support to patients with inadequate oxygen delivery for days to weeks. Clinicians have used ECMO to increase oxygen delivery in severe lung disease, ineffective cardiac output from circulatory failure, or combined cardiopulmonary failure. ECMO has typically been applied in rescue situations that were refractory to conventional therapy.[2] Recently, researchers in the U.S., Germany, and Taiwan reported a rapid increase in the use of ECMO in their countries.[3-5] Diseases such as the H1N1 pandemic influenza,[6] the development of ECMO technology,[7] and the publication of randomized clinical trials have likely contributed to an increase in the use of ECMO.[8] In contrast to the growing worldwide use of ECMO, evidence of its use in critical care situations is still lacking.[9] In particular, there is not much evidence supporting ECMO use in adult patients with Acute Respiratory Distress Syndrome (ARDS) and there is a paucity of rigorous experiments on its use in these patients.[10] Only 4 randomized clinical trials on the use of extracorporeal life support in ARDS have been previously reported.[11-14] Most of the existing publications on ECMO use are observational studies of a retrospective review, clinical experiences, and clinical reports. Last year, the Korean Journal of Critical Care Medicine (KJCCM) published 11 papers which described the use of ECMO. Most of them were clinical reports of various clinical situations related to ECMO use, and one publication was an original article of a retrospective review. Publications such as clinical or case reports may not provide direct evidence, however they can provide important information and influence clinicians to consider new or different treatments in certain clinical situations. This issue of KJCCM includes two new case reports on the use of ECMO. The first case report describes a transient complication of ECMO that was corrected in a neonate,[15] and the second is a case on ECMO use in aspiration pneumonia in a single lung.[16] Both cases are conceivable situations for clinicians similar to previous case reports published in this journal. A key question is how to organize such case reports or series so that they provide findings that are close to evidence. To cite one example, ECMO complications can arise either from patient factors or ECMO circuit components. Due to the diversity in indi-","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"1 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":"124528840","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.2016.31.2.123
S. Shin, Hyun Lee, Aeng Ja Choi, Kylie Hae-Jin Chang, G. Suh, C. Chung
Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.
{"title":"Use of Polymyxin B Hemoperfusion in a Patient with Septic Shock and Septic Cardiomyopathy Who Was Placed on Extracorporeal Membrane Oxygen Support","authors":"S. Shin, Hyun Lee, Aeng Ja Choi, Kylie Hae-Jin Chang, G. Suh, C. Chung","doi":"10.4266/KJCCM.2016.31.2.123","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.123","url":null,"abstract":"Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"17 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":"132784907","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.2016.31.2.140
J. Hwang, J. H. Song, Y. S. Lee, K. Chung, S. Kim, E. Y. Kim, J. Jung, Y. Kang, Y. S. Kim, Joon Chang, M. Park
Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 μg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support-albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.
{"title":"Lethal Hyperammonemia due to Ornithine Transcarbamylase Deficiency in a Patient with Severe Septic Shock","authors":"J. Hwang, J. H. Song, Y. S. Lee, K. Chung, S. Kim, E. Y. Kim, J. Jung, Y. Kang, Y. S. Kim, Joon Chang, M. Park","doi":"10.4266/KJCCM.2016.31.2.140","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.140","url":null,"abstract":"Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 μg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support-albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.","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":"133362131","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.2016.31.2.118
S. Ham, Bora Lee, T. Ha, Jeongmin Kim, S. Na
Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-yearold female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.
{"title":"Recurrent Desaturation Events due to Opioid-Induced Chest Wall Rigidity after Low Dose Fentanyl Administration","authors":"S. Ham, Bora Lee, T. Ha, Jeongmin Kim, S. Na","doi":"10.4266/KJCCM.2016.31.2.118","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.118","url":null,"abstract":"Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-yearold female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"70 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":"123610291","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.2016.31.2.162
D. Park, D. Lim, Bongyoung Kim, J. Yhi, Ji-Yong Moon, Sang-Heon Kim, Tae Hyung Kim, J. Shon, H. Yoon, D. H. Shin, H. Pai
Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIVinfected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
{"title":"Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumocystis jirovecii Pneumonia: Case Report and Literature Review","authors":"D. Park, D. Lim, Bongyoung Kim, J. Yhi, Ji-Yong Moon, Sang-Heon Kim, Tae Hyung Kim, J. Shon, H. Yoon, D. H. Shin, H. Pai","doi":"10.4266/KJCCM.2016.31.2.162","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.162","url":null,"abstract":"Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIVinfected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"29 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":"114221254","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.2016.31.2.173
S. Choi, Jiwon Koh, Sang Min Lee, Jinwoo Lee
Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.
{"title":"Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust","authors":"S. Choi, Jiwon Koh, Sang Min Lee, Jinwoo Lee","doi":"10.4266/KJCCM.2016.31.2.173","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.173","url":null,"abstract":"Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"82 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":"124916253","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.2016.31.2.146
Won‐Young Kim, So Woon Kim, Kyung-Wook Jo, Saerown Choi, Hyung Ryul Kim, Yong-Hee Kim, D. K. Kim, Seung-Il Park, Sang-Bum Hong
In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient``s clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.
{"title":"Lung Transplantation for Chronic Humidifier Disinfectant-Associated Lung Injury","authors":"Won‐Young Kim, So Woon Kim, Kyung-Wook Jo, Saerown Choi, Hyung Ryul Kim, Yong-Hee Kim, D. K. Kim, Seung-Il Park, Sang-Bum Hong","doi":"10.4266/KJCCM.2016.31.2.146","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.146","url":null,"abstract":"In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient``s clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"47 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":"115833371","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.2016.31.2.156
J. Jo, Y. G. Ryu
A patient had undergone left pneumonectomy for lung cancer and had an increased risk of fatal complications such as pneumonia, including acute respiratory distress syndrome (ARDS). The treatment effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for ARDS of postpneumonectomy patient are uncertain. A 74-year-old man with one lung experienced aspiration pneumonia while swallowing pills after the operation, and his condition progressed to ARDS within a day. He was successfully treated with VV-ECMO support and intensive care unit care.
{"title":"Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer","authors":"J. Jo, Y. G. Ryu","doi":"10.4266/KJCCM.2016.31.2.156","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.2.156","url":null,"abstract":"A patient had undergone left pneumonectomy for lung cancer and had an increased risk of fatal complications such as pneumonia, including acute respiratory distress syndrome (ARDS). The treatment effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for ARDS of postpneumonectomy patient are uncertain. A 74-year-old man with one lung experienced aspiration pneumonia while swallowing pills after the operation, and his condition progressed to ARDS within a day. He was successfully treated with VV-ECMO support and intensive care unit care.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"6 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":"133338416","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 : 2016-02-29DOI: 10.4266/KJCCM.2016.31.1.58
S. Youn, J. Lee, K. Jung, Jonghwan Moon, Y. Huh, Younghwan Kim
For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.
{"title":"Secondary Abdominal Compartment Syndrome Recognized in Operating Room in Severely Injured Patients","authors":"S. Youn, J. Lee, K. Jung, Jonghwan Moon, Y. Huh, Younghwan Kim","doi":"10.4266/KJCCM.2016.31.1.58","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.58","url":null,"abstract":"For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124156926","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 : 2016-02-29DOI: 10.4266/KJCCM.2016.31.1.1
Deokkyu Kim
The ultimate goal of cardiopulmonary resuscitation (CPR) is restoring spontaneous circulation and minimizing neurologic deficits. Since two human studies presented improved neurologic outcome and reduced mortality after cardiac arrest in 2002,[1,2] therapeutic hypothermia (TH) has been recommended consistently in the international CPR guidelines for post-cardiac arrest care.[3-5] TH improves the neurologic outcome due to attenuation of the inflammatory response in the brain.[1] On the other hand, TH can have systemic adverse effect such as high infection rate. Geurts et al.[6] emphasized in a meta-analysis of 23 studies that TH was a risk factor of both pneumonia and sepsis after return of spontaneous circulation in cardiac arrest patients. Even if TH is not used, infection is more common in post-cardiac arrest care,[7] and pneumonia is the most common type of infection in out-of-hospital cardiac arrest (OHCA).[8] The cause of this high incidence of pneumonia in OHCA is that factors such as loss of airway protection, changed mental status, pulmonary contusion by chest compression, emergent airway access, and mechanical ventilation increase the risk of pulmonary infection.[7] Some studies have suggested that post-resuscitation pneumonia could be divided into early-onset and late-onset pneumonia according to onset time and prevalent pathogens; however, the onset time varied from three to seven days depending on the study.[8-11] Perbet et al.[11] reported that TH was an independent risk factor of early-onset pneumonia (EOP), which prolonged mechanical ventilation support and intensive care unit (ICU) stay with unchanged neurologic outcome and ICU mortality in a retrospective and large (641 patients) cohort study. Therefore, intensivists should be aware of management of EOP while conducting HT. Prophylactic antibiotics decreased the incidence of EOP in comatose patients with a variety of causes such as head trauma, intracranial hemorrhage, stroke, or cardiac arrest.[12] In a recently published study, prophylactic antibiotics reduced the incidence of pneumonia in cardiac arrest survivors undergoing TH, but they did not reduce patient mortality.[13] However, the researchers did not distinguish earlyor late-onset pneumonia. Kim et al.[14] have reported that prophylactic antibiotics in OHCA patients undergoing TH does not reduce the incidence of EOP. The authors insisted that the study evaluated the effect of prophylactic antibiotics on EOP for the first time. The incidence of EOP was 29.2% and 30.0% in prophylactic antibiotics and non-antibiotics, respec-
{"title":"Recent Trend in Therapeutic Hypothermia and Early-Onset Pneumonia in Cardiac Arrest","authors":"Deokkyu Kim","doi":"10.4266/KJCCM.2016.31.1.1","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.1","url":null,"abstract":"The ultimate goal of cardiopulmonary resuscitation (CPR) is restoring spontaneous circulation and minimizing neurologic deficits. Since two human studies presented improved neurologic outcome and reduced mortality after cardiac arrest in 2002,[1,2] therapeutic hypothermia (TH) has been recommended consistently in the international CPR guidelines for post-cardiac arrest care.[3-5] TH improves the neurologic outcome due to attenuation of the inflammatory response in the brain.[1] On the other hand, TH can have systemic adverse effect such as high infection rate. Geurts et al.[6] emphasized in a meta-analysis of 23 studies that TH was a risk factor of both pneumonia and sepsis after return of spontaneous circulation in cardiac arrest patients. Even if TH is not used, infection is more common in post-cardiac arrest care,[7] and pneumonia is the most common type of infection in out-of-hospital cardiac arrest (OHCA).[8] The cause of this high incidence of pneumonia in OHCA is that factors such as loss of airway protection, changed mental status, pulmonary contusion by chest compression, emergent airway access, and mechanical ventilation increase the risk of pulmonary infection.[7] Some studies have suggested that post-resuscitation pneumonia could be divided into early-onset and late-onset pneumonia according to onset time and prevalent pathogens; however, the onset time varied from three to seven days depending on the study.[8-11] Perbet et al.[11] reported that TH was an independent risk factor of early-onset pneumonia (EOP), which prolonged mechanical ventilation support and intensive care unit (ICU) stay with unchanged neurologic outcome and ICU mortality in a retrospective and large (641 patients) cohort study. Therefore, intensivists should be aware of management of EOP while conducting HT. Prophylactic antibiotics decreased the incidence of EOP in comatose patients with a variety of causes such as head trauma, intracranial hemorrhage, stroke, or cardiac arrest.[12] In a recently published study, prophylactic antibiotics reduced the incidence of pneumonia in cardiac arrest survivors undergoing TH, but they did not reduce patient mortality.[13] However, the researchers did not distinguish earlyor late-onset pneumonia. Kim et al.[14] have reported that prophylactic antibiotics in OHCA patients undergoing TH does not reduce the incidence of EOP. The authors insisted that the study evaluated the effect of prophylactic antibiotics on EOP for the first time. The incidence of EOP was 29.2% and 30.0% in prophylactic antibiotics and non-antibiotics, respec-","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133159648","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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