Pub Date : 2016-02-29DOI: 10.4266/KJCCM.2016.31.1.49
Bora Lee, Nar Hyun Min, S. Ham, S. Na, Jeongmin Kim
Neurological complications following liver transplantation are more common than after other organ transplants. These complications include seizure in about 8% of cases, which is associated with morbidity and mortality. Seizure should be treated immediately, and the process of differential diagnosis has to be performed appropriately in order to avoid permanent neurologic deficit. We herein report a case of status epilepticus after liver transplantation. The status epilepticus was treated promptly and the cause of seizure was assessed. The patient was discharged without any complication.
{"title":"Non-Convulsive Status Epilepticus following Liver Transplantation","authors":"Bora Lee, Nar Hyun Min, S. Ham, S. Na, Jeongmin Kim","doi":"10.4266/KJCCM.2016.31.1.49","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.49","url":null,"abstract":"Neurological complications following liver transplantation are more common than after other organ transplants. These complications include seizure in about 8% of cases, which is associated with morbidity and mortality. Seizure should be treated immediately, and the process of differential diagnosis has to be performed appropriately in order to avoid permanent neurologic deficit. We herein report a case of status epilepticus after liver transplantation. The status epilepticus was treated promptly and the cause of seizure was assessed. The patient was discharged without any complication.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"31 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":"115395966","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.2016.31.1.44
S. Jeong, S. Um, Hyun C. Lee, K. Jeon, Kyungjong Lee, G. Suh, M. Chung, Hojoong Kim, O. Kwon, Yoon-La Choi
We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.
{"title":"Successful Treatment with Empirical Erlotinib in a Patient with Respiratory Failure Caused by Extensive Lung Adenocarcinoma","authors":"S. Jeong, S. Um, Hyun C. Lee, K. Jeon, Kyungjong Lee, G. Suh, M. Chung, Hojoong Kim, O. Kwon, Yoon-La Choi","doi":"10.4266/KJCCM.2016.31.1.44","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.44","url":null,"abstract":"We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"75 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":"124522305","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.2016.31.1.4
Jinwoo Lee
Lung ultrasound (LUS) is an emerging tool for intensivists to diagnose and monitor thoracic diseases of critically ill patients. It is easily applied at the bedside in real time and is free of radiation hazards. In the intensive care units (ICUs) lung ultrasound can be used to diagnose pneumothorax and interstitial syndrome. It can also be used to monitor changes in the lung. However, the major limitations of LUS is that it is highly operator dependent and cannot be applied in patients with thoracic dressings, subcutaenous emphysema or pleural calcifications. This article reviews the basic principles of lung ultrasound and discusses how it can be used in ICUs.
{"title":"Lung Ultrasound in Critically Ill Patients","authors":"Jinwoo Lee","doi":"10.4266/KJCCM.2016.31.1.4","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.4","url":null,"abstract":"Lung ultrasound (LUS) is an emerging tool for intensivists to diagnose and monitor thoracic diseases of critically ill patients. It is easily applied at the bedside in real time and is free of radiation hazards. In the intensive care units (ICUs) lung ultrasound can be used to diagnose pneumothorax and interstitial syndrome. It can also be used to monitor changes in the lung. However, the major limitations of LUS is that it is highly operator dependent and cannot be applied in patients with thoracic dressings, subcutaenous emphysema or pleural calcifications. This article reviews the basic principles of lung ultrasound and discusses how it can be used in ICUs.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"54 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":"128509999","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.2016.31.1.25
Junghyun Kim, Jung Kyu Lee, S. M. Choi, Jinwoo Lee, Y. Park, Chang-Hoon Lee, J. Yim, C. Yoo, Young Whan Kim, S. Han, Sang Min Lee
Background: The number of elderly patients admitted to intensive care units (ICUs) is growing with the increasing proportion of elderly persons in the Korean general population. It is often difficult to make decisions about ICU care for elderly patients, especially when they are in their 90s. Data regarding the proportion of elderly patients in their 90s along with their clinical characteristics in ICU are scarce. Methods: The records of Korean patients ≥ 90 years old who were admitted to the medical ICU in a tertiary referral hospital between January 2005 and December 2014 were retrospectively reviewed. We compared the trend in ICU use and characteristics of these elderly patients between 2005-2009 and 2010-2014. Results: Among 6,186 referred patients, 55 aged ≥ 90 years were admitted to the medical ICU from 2005 to 2014. About 58.2% of these patients were male, and their mean age was 92.7 years. Their median Charlson comorbidity index score was 2 (IQR 1-3) and their mean APACHE II score was 25.0 (IQR 19.0-34.0). The most common reason for ICU care was acute respiratory failure. There were no differences in the survival rates between the earlier and more recent cohorts. However, after excluding patients who had specified “do not resuscitate” (DNR), the more recent group showed a significantly higher survival rate (53.8% mortality for the earlier group and 0% mortality for the recent group). Among the survivors, over half were discharged to their homes. More patients in the recent cohort (n=26 [78.8%]) specified DNR than in the earlier cohort (n=7 [35.0%], p=0.004). The number and proportion of patients ≥ 90 years old among patients using ICU during the 2005-2014 study period did not differ. Conclusions: The use of ICU care by elderly patients ≥ 90 years old was consistent from 2005-2014. The overall mortality rate tended to decrease, but this was not statistically significant. However, the proportion of patients specifying DNR was higher among more recent patients, and the recent group showed an even better survivorship after sensitivity analysis excluded patients specifying DNR.
{"title":"Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea","authors":"Junghyun Kim, Jung Kyu Lee, S. M. Choi, Jinwoo Lee, Y. Park, Chang-Hoon Lee, J. Yim, C. Yoo, Young Whan Kim, S. Han, Sang Min Lee","doi":"10.4266/KJCCM.2016.31.1.25","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.25","url":null,"abstract":"Background: The number of elderly patients admitted to intensive care units (ICUs) is growing with the increasing proportion of elderly persons in the Korean general population. It is often difficult to make decisions about ICU care for elderly patients, especially when they are in their 90s. Data regarding the proportion of elderly patients in their 90s along with their clinical characteristics in ICU are scarce. Methods: The records of Korean patients ≥ 90 years old who were admitted to the medical ICU in a tertiary referral hospital between January 2005 and December 2014 were retrospectively reviewed. We compared the trend in ICU use and characteristics of these elderly patients between 2005-2009 and 2010-2014. Results: Among 6,186 referred patients, 55 aged ≥ 90 years were admitted to the medical ICU from 2005 to 2014. About 58.2% of these patients were male, and their mean age was 92.7 years. Their median Charlson comorbidity index score was 2 (IQR 1-3) and their mean APACHE II score was 25.0 (IQR 19.0-34.0). The most common reason for ICU care was acute respiratory failure. There were no differences in the survival rates between the earlier and more recent cohorts. However, after excluding patients who had specified “do not resuscitate” (DNR), the more recent group showed a significantly higher survival rate (53.8% mortality for the earlier group and 0% mortality for the recent group). Among the survivors, over half were discharged to their homes. More patients in the recent cohort (n=26 [78.8%]) specified DNR than in the earlier cohort (n=7 [35.0%], p=0.004). The number and proportion of patients ≥ 90 years old among patients using ICU during the 2005-2014 study period did not differ. Conclusions: The use of ICU care by elderly patients ≥ 90 years old was consistent from 2005-2014. The overall mortality rate tended to decrease, but this was not statistically significant. However, the proportion of patients specifying DNR was higher among more recent patients, and the recent group showed an even better survivorship after sensitivity analysis excluded patients specifying DNR.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"19 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":"133983779","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.2016.31.1.68
C. Her
{"title":"Venous Air Embolism Not Amniotic Fluid Embolism","authors":"C. Her","doi":"10.4266/KJCCM.2016.31.1.68","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.68","url":null,"abstract":"","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"7 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":"129130454","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.2016.31.1.39
H. J. Lee, Hack‐Lyoung Kim, D. Hwang, Chan-Soon Park, Jae-Sung Lim, E. Kang, J. Zo
The most feared complication of left ventricular thrombus (LVT) is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.
{"title":"Huge Left Ventricular Thrombus and Apical Ballooning associated with Recurrent Massive Strokes in a Septic Shock Patient","authors":"H. J. Lee, Hack‐Lyoung Kim, D. Hwang, Chan-Soon Park, Jae-Sung Lim, E. Kang, J. Zo","doi":"10.4266/KJCCM.2016.31.1.39","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.39","url":null,"abstract":"The most feared complication of left ventricular thrombus (LVT) is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"46 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":"125366874","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.2016.31.1.17
S. Kim, Jung Kyu Lee, D. Kim, Jonghwan Shin, Kijeong Hong, E. Heo
Background: Infectious complications are frequent after cardiac arrest and a few reports have demonstrated that infections may be even more frequent after therapeutic hypothermia. Pneumonia is the most frequent infectious complication in these patient. Objectives: We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia. Methods: We retrospectively reviewed medical records of patients who admitted for therapeutic hypothermia after resuscitation of out-of-hospital cardiac arrest between January 2010 and December 2011. Patients dying within the first 72 hours were excluded. Results: Of the 46 patients admitted after cardiac arrest, 31 patients were analyzed and 24 patients (77%) were treated with prophylactic antibiotics within the 24 hours. The frequency of pneumonia in the first three days (early pneumonia) and after the third day (late pneumonia) was not significantly different between the prophylactic antibiotics group and the control group(33.3% vs 11.1% for early pneumonia, P=0.639; 50% vs 18.6% for late pneumonia, P=0.412). And the antibiotic prophylaxis did not also influence the length of ICU stay (19. 4 days in the prophylactic antibiotics group vs 16.4 days in the control group, P=0.659) and of mechanical ventilator (17.3 days in the prophylactic antibiotics group vs 12.7 days in the control group, P=0.372). Conclusion: Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.
背景:感染并发症在心脏骤停后很常见，一些报道表明，治疗性低温后感染可能更频繁。肺炎是这些患者中最常见的感染性并发症。目的:探讨抗生素预防对治疗性低温治疗的心脏骤停患者发生肺炎的影响。方法:回顾性分析2010年1月至2011年12月院外心脏骤停复苏后因治疗性低温入院的患者病历。在最初72小时内死亡的患者被排除在外。结果:46例心脏骤停后入院的患者中，分析31例，24小时内预防性抗生素治疗24例(77%)。预防性抗生素治疗组前3天(早期肺炎)和后3天(晚期肺炎)肺炎发生频率与对照组比较差异无统计学意义(早期肺炎33.3% vs 11.1%， P=0.639;晚期肺炎50% vs 18.6%， P=0.412)。抗生素预防也不影响ICU住院时间(19。预防性抗生素组为4天，对照组为16.4天，P=0.659);机械呼吸机组为17.3天，对照组为12.7天，P=0.372)。结论:治疗性低温治疗的心脏骤停患者抗生素预防并不能降低肺炎的发生频率。
{"title":"Effect of Antibiotic Prophylaxis on Early-Onset Pneumonia in Cardiac Arrest Patients Treated with Therapeutic Hypothermia","authors":"S. Kim, Jung Kyu Lee, D. Kim, Jonghwan Shin, Kijeong Hong, E. Heo","doi":"10.4266/KJCCM.2016.31.1.17","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.17","url":null,"abstract":"Background: Infectious complications are frequent after cardiac arrest and a few reports have demonstrated that infections may be even more frequent after therapeutic hypothermia. Pneumonia is the most frequent infectious complication in these patient. Objectives: We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia. Methods: We retrospectively reviewed medical records of patients who admitted for therapeutic hypothermia after resuscitation of out-of-hospital cardiac arrest between January 2010 and December 2011. Patients dying within the first 72 hours were excluded. Results: Of the 46 patients admitted after cardiac arrest, 31 patients were analyzed and 24 patients (77%) were treated with prophylactic antibiotics within the 24 hours. The frequency of pneumonia in the first three days (early pneumonia) and after the third day (late pneumonia) was not significantly different between the prophylactic antibiotics group and the control group(33.3% vs 11.1% for early pneumonia, P=0.639; 50% vs 18.6% for late pneumonia, P=0.412). And the antibiotic prophylaxis did not also influence the length of ICU stay (19. 4 days in the prophylactic antibiotics group vs 16.4 days in the control group, P=0.659) and of mechanical ventilator (17.3 days in the prophylactic antibiotics group vs 12.7 days in the control group, P=0.372). Conclusion: Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"48 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":"130773192","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.2016.31.1.63
Haemi Lee, Jong-Yun Baek, Sang-Yool Park, D. Jee
A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
{"title":"Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?","authors":"Haemi Lee, Jong-Yun Baek, Sang-Yool Park, D. Jee","doi":"10.4266/KJCCM.2016.31.1.63","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.63","url":null,"abstract":"A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"280 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":"116561697","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.2016.31.1.54
Ju-Hee Park, Junghyeon Lim, Jaejin Lee, H. Lee
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang; Department of Thoracic and Cardiovascular Surgery, Sahmyook Medical Center, Seoul; Department of Thoracic and Cardiovascular Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
{"title":"The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture","authors":"Ju-Hee Park, Junghyeon Lim, Jaejin Lee, H. Lee","doi":"10.4266/KJCCM.2016.31.1.54","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.54","url":null,"abstract":"Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang; Department of Thoracic and Cardiovascular Surgery, Sahmyook Medical Center, Seoul; Department of Thoracic and Cardiovascular Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"26 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":"132669222","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.2016.31.1.34
Jae Meen Lee, S. Paek, Hyeyoung Park, Kangyoon Lee, Chaewon Shin, H. Park, Hee Pyoung Park, D. Kim, B. Jeon
Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.
{"title":"Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy","authors":"Jae Meen Lee, S. Paek, Hyeyoung Park, Kangyoon Lee, Chaewon Shin, H. Park, Hee Pyoung Park, D. Kim, B. Jeon","doi":"10.4266/KJCCM.2016.31.1.34","DOIUrl":"https://doi.org/10.4266/KJCCM.2016.31.1.34","url":null,"abstract":"Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"12 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":"131001154","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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