Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.308
Hea Yon Lee, Y. Joo, Y. Oh, Yoorim Seo, H. Joo, S. Kim, C. Rhee
A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxygenation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.
{"title":"Barotrauma after Manual Ventilation in a Patient with Life-Threatening Massive Hemoptysis","authors":"Hea Yon Lee, Y. Joo, Y. Oh, Yoorim Seo, H. Joo, S. Kim, C. Rhee","doi":"10.4266/KJCCM.2015.30.4.308","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.308","url":null,"abstract":"A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxygenation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123060640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.354
D. H. Kim, Young-Wook Kim, K. Park
Superior mesenteric artery (SMA) injuries remain a challenge to most trauma surgeons and continue to result in significant mortality despite aggressive management. We report successful management of a proximal SMA injury through endovascular treatment in a 56-year-old man. The patient presented with hypotension due to a stab wound after the epigastrium. He underwent emergency laparotomy and repair of the penetrated wall of the stomach. Right retroperitoneal hematoma at the initial laparotomy expanded and ruptured, requiring a massive transfusion. At the second laparotomy, we performed lateral arteriorrhaphy of the proximal SMA. Follow-up abdominal computed tomography angiography on post-injury day 7 showed a pseudoaneurysm on the left side of the SMA trunk. The patient was treated successfully with an endovascular stent graft.
{"title":"Endovascular Treatment of Proximal Superior Mesenteric Artery Pseudoaneurysm after Stab Injury","authors":"D. H. Kim, Young-Wook Kim, K. Park","doi":"10.4266/KJCCM.2015.30.4.354","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.354","url":null,"abstract":"Superior mesenteric artery (SMA) injuries remain a challenge to most trauma surgeons and continue to result in significant mortality despite aggressive management. We report successful management of a proximal SMA injury through endovascular treatment in a 56-year-old man. The patient presented with hypotension due to a stab wound after the epigastrium. He underwent emergency laparotomy and repair of the penetrated wall of the stomach. Right retroperitoneal hematoma at the initial laparotomy expanded and ruptured, requiring a massive transfusion. At the second laparotomy, we performed lateral arteriorrhaphy of the proximal SMA. Follow-up abdominal computed tomography angiography on post-injury day 7 showed a pseudoaneurysm on the left side of the SMA trunk. The patient was treated successfully with an endovascular stent graft.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115360810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.239
Kwangha Lee
Severely immunocompromised patients have increased risk of infection by common pathogens, as well as opportunistic infections by less virulent microorganisms of little concern to immunocompetent hosts. This highly developing risk of infection predisposes such individuals to increased risk of sepsis and septic shock.[1,2] The most common cause of severe, prolonged, immune compromise is systemic chemotherapy as a treatment for some forms of hematologic malignancies (e.g., induction chemotherapy for acute leukemia and lymphoreticular malignancies), delayed bone marrow recovery following allogenic hematopoietic stem cell transplantation, and solid organ transplantation. Less intensive chemotherapeutic regimens can cause a low incidence of neutropenia and short duration of bone marrow suppression, such as those regimens used for many solid organ malignancies. Also, the steroids used to treat various rheumatologic diseases and human immunodeficiency virus (HIV) infection contribute to immunosuppressive states. In addition, chronic medical illnesses, such as diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, liver cirrhosis, and heart failure, are often associated with immune abnormalities that increase the susceptibility of affected patients to specific life-threatening infections.[3] The frequency of community and hospitalized patients with immunocompromised host defenses has increased dramatically over recent decades such that it is common for intensive care unit (ICU) care physicians to routinely encounter immunocompromised hosts. Despite significant advances in the prevention, diagnosis, and treatment of infection in immunocompromised hosts, infection remains a major cause of morbidity, increased hospital stay, and increased total costs.[4] As a result, the mortality of these patients can be higher because of higher incidence of infection severity. However, the superimposition of compromised host defenses and acute catastrophic illness complicates the detection and management of infection in such patients. Moreover, while there is a rapidly increasing evidence base in critical care medicine, there are no documented management guidelines for sepsis in immunocompromised patients.[5] In Korea, there is no reported data about current status for sepsis in immunocompromised patients. In this issue of the Journal, Oh et al[6] reported the influence of immunosuppressants on in-hospital mortality from sepsis. The authors retrospectively collected data on patients with sepsis from data of Health Insurance Review & Assessment (HIRA) Service over a period of five years (from 2009 to 2013). In their study,
{"title":"Sepsis in Immunocompromised Patients: Current Status in Korea","authors":"Kwangha Lee","doi":"10.4266/KJCCM.2015.30.4.239","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.239","url":null,"abstract":"Severely immunocompromised patients have increased risk of infection by common pathogens, as well as opportunistic infections by less virulent microorganisms of little concern to immunocompetent hosts. This highly developing risk of infection predisposes such individuals to increased risk of sepsis and septic shock.[1,2] The most common cause of severe, prolonged, immune compromise is systemic chemotherapy as a treatment for some forms of hematologic malignancies (e.g., induction chemotherapy for acute leukemia and lymphoreticular malignancies), delayed bone marrow recovery following allogenic hematopoietic stem cell transplantation, and solid organ transplantation. Less intensive chemotherapeutic regimens can cause a low incidence of neutropenia and short duration of bone marrow suppression, such as those regimens used for many solid organ malignancies. Also, the steroids used to treat various rheumatologic diseases and human immunodeficiency virus (HIV) infection contribute to immunosuppressive states. In addition, chronic medical illnesses, such as diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, liver cirrhosis, and heart failure, are often associated with immune abnormalities that increase the susceptibility of affected patients to specific life-threatening infections.[3] The frequency of community and hospitalized patients with immunocompromised host defenses has increased dramatically over recent decades such that it is common for intensive care unit (ICU) care physicians to routinely encounter immunocompromised hosts. Despite significant advances in the prevention, diagnosis, and treatment of infection in immunocompromised hosts, infection remains a major cause of morbidity, increased hospital stay, and increased total costs.[4] As a result, the mortality of these patients can be higher because of higher incidence of infection severity. However, the superimposition of compromised host defenses and acute catastrophic illness complicates the detection and management of infection in such patients. Moreover, while there is a rapidly increasing evidence base in critical care medicine, there are no documented management guidelines for sepsis in immunocompromised patients.[5] In Korea, there is no reported data about current status for sepsis in immunocompromised patients. In this issue of the Journal, Oh et al[6] reported the influence of immunosuppressants on in-hospital mortality from sepsis. The authors retrospectively collected data on patients with sepsis from data of Health Insurance Review & Assessment (HIRA) Service over a period of five years (from 2009 to 2013). In their study,","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130059153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.303
H. Kang, Hwa Young Lee, Hea Yon Lee, S. Kim
Amniotic fluid embolism (AFE) is a rare but potentially fatal complication that occurs acutely during pregnancy or within 12 h of delivery. The management of AFE focuses initially on supportive measures for cardiopulmonary stabilization. Extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical treatment in order to prevent additional hypoxia and subsequent organ failure. We present a 41-year-old woman with clinical AFE who developed acute respiratory distress syndrome and was treated successfully with extracorporeal membrane oxygenation.
{"title":"Successful Application of Extracorporeal Membrane Oxygenation for a Patient with Clinical Amniotic Fluid Embolism","authors":"H. Kang, Hwa Young Lee, Hea Yon Lee, S. Kim","doi":"10.4266/KJCCM.2015.30.4.303","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.303","url":null,"abstract":"Amniotic fluid embolism (AFE) is a rare but potentially fatal complication that occurs acutely during pregnancy or within 12 h of delivery. The management of AFE focuses initially on supportive measures for cardiopulmonary stabilization. Extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical treatment in order to prevent additional hypoxia and subsequent organ failure. We present a 41-year-old woman with clinical AFE who developed acute respiratory distress syndrome and was treated successfully with extracorporeal membrane oxygenation.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122382390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.336
J. Oh, W. Lee, J. Jang, P. Y. Jung, Sohyun Kim, Jong Yeon Kim, Pyen Js, K. Whang, Sungmin Cho
The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multipletrauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and antithrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.
{"title":"Delayed Traumatic Subarachnoid Hemorrhage in a Polytraumatized Patient with Disseminated Intravascular Coagulation","authors":"J. Oh, W. Lee, J. Jang, P. Y. Jung, Sohyun Kim, Jong Yeon Kim, Pyen Js, K. Whang, Sungmin Cho","doi":"10.4266/KJCCM.2015.30.4.336","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.336","url":null,"abstract":"The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multipletrauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and antithrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"240 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131749309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.280
Byeong jun Ahn, S. Cho, W. Jeong, Yeonho You, S. Ryu, Jin Woong Lee, I. Yoo, Y. Cho
Background: We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. Methods: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downwarddirected group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. Results: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the Jtip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). Conclusions: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.
{"title":"Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter","authors":"Byeong jun Ahn, S. Cho, W. Jeong, Yeonho You, S. Ryu, Jin Woong Lee, I. Yoo, Y. Cho","doi":"10.4266/KJCCM.2015.30.4.280","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.280","url":null,"abstract":"Background: We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. Methods: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downwarddirected group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. Results: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the Jtip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). Conclusions: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133868340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.258
Jong Won Kim, Jin Joo Kim, Hyuk-Jun Yang, Y. Lim, J. Cho, I. Hwang, Sang Hyun Han
Background: Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department. Methods: From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined. Results: Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35–4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01–1.08), leukopenia (OR, 3.63; 95% CI, 1.48–8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41–4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30–6.38). Conclusions: A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.
{"title":"The Prognostic Factors of Pneumonia with Septic Shock in Patients Presenting to the Emergency Department","authors":"Jong Won Kim, Jin Joo Kim, Hyuk-Jun Yang, Y. Lim, J. Cho, I. Hwang, Sang Hyun Han","doi":"10.4266/KJCCM.2015.30.4.258","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.258","url":null,"abstract":"Background: Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department. Methods: From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined. Results: Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35–4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01–1.08), leukopenia (OR, 3.63; 95% CI, 1.48–8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41–4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30–6.38). Conclusions: A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116154126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.286
Ha Yeon Kim, S. Na, H. Paik, J. Ha, Jeongmin Kim
Background: Extracorporeal membrane oxygenation (ECMO) is administered for a few days after lung transplantation (LTx) in recipients who are expected to have early graft dysfunction. Despite its life-saving potential, immediate postoperative ECMO has lifethreatening complications such as postoperative bleeding. We investigated the risk factors related to the use of immediate postoperative ECMO. Methods: We retrospectively reviewed the records of 60 LTx patients who were at our institution from October 2012 to May 2015. Perioperative variables associated with postoperative ECMO were compared between the two groups. Results: There were 26 patients who received postoperative ECMO (ECMO group) and 34 patients who did not (control group). Multivariate regression analysis revealed preoperative ECMO (odds ratio [OR] 12.55, 95% confidence intervals [CI] 1.34 – 117.24, p = 0.027) and lower peripheral pulse oxymetry saturation (SpO2) at the end of surgery (OR 0.71, 95% CI 0.54 – 0.95, p = 0.019) were independent risk factors for postoperative ECMO in LTx patients. The incidences of complications, such as re-operation, tracheostomy, renal failure and postoperative atrial fibrillation, were higher in the ECMO group. There was no difference in the duration of postoperative intensive care unit stay or postoperative 30-day mortality between the two groups. Conclusions: The preoperative ECMO and lower SpO2 at the end of surgery were associated with postoperative ECMO. Further, postoperative adverse events were higher in the ECMO group compared with the control group. This study suggests that determination of postoperative ECMO requires careful consideration because of the risks of postoperative ECMO in LTx patients.
背景:体外膜氧合(ECMO)在肺移植(LTx)后的几天内给予预期有早期移植物功能障碍的受者。尽管具有挽救生命的潜力，但术后立即ECMO有危及生命的并发症，如术后出血。我们调查了与术后立即ECMO使用相关的危险因素。方法:回顾性分析我院2012年10月至2015年5月收治的60例LTx患者的临床资料。比较两组之间与术后ECMO相关的围手术期变量。结果:26例患者术后接受ECMO (ECMO组)，34例患者未接受ECMO(对照组)。多因素回归分析显示，术前ECMO(优势比[OR] 12.55, 95%可信区间[CI] 1.34 ~ 117.24, p = 0.027)和手术结束时外周脉搏血氧饱和度(SpO2) (OR 0.71, 95% CI 0.54 ~ 0.95, p = 0.019)是LTx患者术后ECMO的独立危险因素。再手术、气管切开术、肾功能衰竭、术后房颤等并发症发生率均高于ECMO组。两组患者术后重症监护病房住院时间和术后30天死亡率均无差异。结论:术前ECMO及术末SpO2降低与术后ECMO相关。此外，与对照组相比，ECMO组的术后不良事件更高。本研究提示，考虑到LTx患者术后ECMO的风险，术后ECMO的确定需要慎重考虑。
{"title":"Perioperative Risk Factors associated with Immediate Postoperative Extracorporeal Membrane Oxygenation in Lung Transplants","authors":"Ha Yeon Kim, S. Na, H. Paik, J. Ha, Jeongmin Kim","doi":"10.4266/KJCCM.2015.30.4.286","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.286","url":null,"abstract":"Background: Extracorporeal membrane oxygenation (ECMO) is administered for a few days after lung transplantation (LTx) in recipients who are expected to have early graft dysfunction. Despite its life-saving potential, immediate postoperative ECMO has lifethreatening complications such as postoperative bleeding. We investigated the risk factors related to the use of immediate postoperative ECMO. Methods: We retrospectively reviewed the records of 60 LTx patients who were at our institution from October 2012 to May 2015. Perioperative variables associated with postoperative ECMO were compared between the two groups. Results: There were 26 patients who received postoperative ECMO (ECMO group) and 34 patients who did not (control group). Multivariate regression analysis revealed preoperative ECMO (odds ratio [OR] 12.55, 95% confidence intervals [CI] 1.34 – 117.24, p = 0.027) and lower peripheral pulse oxymetry saturation (SpO2) at the end of surgery (OR 0.71, 95% CI 0.54 – 0.95, p = 0.019) were independent risk factors for postoperative ECMO in LTx patients. The incidences of complications, such as re-operation, tracheostomy, renal failure and postoperative atrial fibrillation, were higher in the ECMO group. There was no difference in the duration of postoperative intensive care unit stay or postoperative 30-day mortality between the two groups. Conclusions: The preoperative ECMO and lower SpO2 at the end of surgery were associated with postoperative ECMO. Further, postoperative adverse events were higher in the ECMO group compared with the control group. This study suggests that determination of postoperative ECMO requires careful consideration because of the risks of postoperative ECMO in LTx patients.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122179917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.349
Sanghyun Lee, Hyunggoo Kang, T. Lim, Jaehoon Oh, Chiwon Ahn, J. Lee, Changsun Kim
The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33°C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.
{"title":"Recurrent Pulseless Ventricular Tachycardia Induced by Commotio Cordis Treated with Therapeutic Hypothermia","authors":"Sanghyun Lee, Hyunggoo Kang, T. Lim, Jaehoon Oh, Chiwon Ahn, J. Lee, Changsun Kim","doi":"10.4266/KJCCM.2015.30.4.349","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.349","url":null,"abstract":"The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33°C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131022516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.299
Junggu Yi, Si-Oh Kim, Jun-Mo Park, S. Byun, Hoon Jung, S. Hong
Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamineinduced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
{"title":"Catecholamine-Induced Cardiomyopathy associated with Neuroblastoma and Treated with Extracorporeal Membrane Oxygenation as a Bridge to Recovery","authors":"Junggu Yi, Si-Oh Kim, Jun-Mo Park, S. Byun, Hoon Jung, S. Hong","doi":"10.4266/KJCCM.2015.30.4.299","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.299","url":null,"abstract":"Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamineinduced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124954326","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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