Pub Date : 2015-11-30DOI: 10.4266/KJCCM.2015.30.4.249
Seung-Young Oh, Songhee Cho, Hannah Lee, E. Chang, S. Min, H. Ryu
Background: The aim of this study is to evaluate the influence of immunosuppressants on in-hospital mortality from sepsis. Methods: Using data of the Health Insurance Review & Assessment Service, we collected data from patients who were admitted to the hospital due to sepsis from 2009 to 2013. Based on drugs commonly used for immunosuppression caused by various diseases, patients were divided into three groups; immunosuppressant group, steroid-only group, and control group. Patients with no history of immunosuppressants or steroids were assigned to the control group. To identify risk factors of in-hospital mortality in sepsis, we compared differences in patient characteristics, comorbidities, intensive care unit (ICU) care requirements, and immunodeficiency profiles. Subgroup analysis according to age was also performed. Results: Of the 185,671 included patients, 13,935 (7.5%) were in the steroid-only group and 2,771 patients (1.5%) were in the immunosuppressant group. The overall in-hospital mortality was 38.9% and showed an increasing trend with age. The steroid-only group showed the lowest in-hospital mortality among the three groups except the patients younger than 30 years. The steroid-only group and immunosuppressant group received ICU treatment more frequently (p < 0.001), stayed longer in the hospital (p < 0.001), and showed higher medical expenditure (p < 0.001) compared to the normal group. Univariate and multivariate analyses revealed that age, male gender, comorbidities (especially malignancy), and ICU treatment had a significant effect on in-hospital mortality. Conclusions: Despite longer hospital length of stay and more frequent need for ICU care, the in-hospital mortality was lower in patients taking immunosuppressive drugs than in patients not taking immunosuppressive drugs.
{"title":"Sepsis in Patients Receiving Immunosuppressive Drugs in Korea: Analysis of the National Insurance Database from 2009 to 2013","authors":"Seung-Young Oh, Songhee Cho, Hannah Lee, E. Chang, S. Min, H. Ryu","doi":"10.4266/KJCCM.2015.30.4.249","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.249","url":null,"abstract":"Background: The aim of this study is to evaluate the influence of immunosuppressants on in-hospital mortality from sepsis. Methods: Using data of the Health Insurance Review & Assessment Service, we collected data from patients who were admitted to the hospital due to sepsis from 2009 to 2013. Based on drugs commonly used for immunosuppression caused by various diseases, patients were divided into three groups; immunosuppressant group, steroid-only group, and control group. Patients with no history of immunosuppressants or steroids were assigned to the control group. To identify risk factors of in-hospital mortality in sepsis, we compared differences in patient characteristics, comorbidities, intensive care unit (ICU) care requirements, and immunodeficiency profiles. Subgroup analysis according to age was also performed. Results: Of the 185,671 included patients, 13,935 (7.5%) were in the steroid-only group and 2,771 patients (1.5%) were in the immunosuppressant group. The overall in-hospital mortality was 38.9% and showed an increasing trend with age. The steroid-only group showed the lowest in-hospital mortality among the three groups except the patients younger than 30 years. The steroid-only group and immunosuppressant group received ICU treatment more frequently (p < 0.001), stayed longer in the hospital (p < 0.001), and showed higher medical expenditure (p < 0.001) compared to the normal group. Univariate and multivariate analyses revealed that age, male gender, comorbidities (especially malignancy), and ICU treatment had a significant effect on in-hospital mortality. Conclusions: Despite longer hospital length of stay and more frequent need for ICU care, the in-hospital mortality was lower in patients taking immunosuppressive drugs than in patients not taking immunosuppressive drugs.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"42 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":"124060668","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 : 2015-11-01DOI: 10.4266/KJCCM.2015.30.4.313
S. Yoon, Jong-Man Kang
Aspiration pneumonia rarely occurs during general anesthesia; however, it can result in fatal pulmonary complications. To reduce aspiration pneumonia, a preoperative fasting time of 8 hours is recommended. A 4-year-old boy with ankyloglossia was scheduled for frenotomy. He completed preoperative fasting time and had no digestive symptoms. Pulmonary aspiration due to unexpected massive vomiting occurred during anesthesia induction. The patient’s airway was immediately secured by endotracheal tube. The vomitus in the airway tract was removed by fiberoptic bronchoscopy. Abdomen radiograph taken after this event showed paralytic ileus which can cause aspiration of gastric contents. We describe a case of pneumonia caused by aspiration of gastric contents in a pediatric patient who followed fasting instructions and who was scheduled for outpatient surgery.
{"title":"Aspiration Pneumonia in a Pediatric Patient under General Anesthesia despite Adequate Preoperative Fasting","authors":"S. Yoon, Jong-Man Kang","doi":"10.4266/KJCCM.2015.30.4.313","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.4.313","url":null,"abstract":"Aspiration pneumonia rarely occurs during general anesthesia; however, it can result in fatal pulmonary complications. To reduce aspiration pneumonia, a preoperative fasting time of 8 hours is recommended. A 4-year-old boy with ankyloglossia was scheduled for frenotomy. He completed preoperative fasting time and had no digestive symptoms. Pulmonary aspiration due to unexpected massive vomiting occurred during anesthesia induction. The patient’s airway was immediately secured by endotracheal tube. The vomitus in the airway tract was removed by fiberoptic bronchoscopy. Abdomen radiograph taken after this event showed paralytic ileus which can cause aspiration of gastric contents. We describe a case of pneumonia caused by aspiration of gastric contents in a pediatric patient who followed fasting instructions and who was scheduled for outpatient surgery.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114420599","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 : 2015-08-31DOI: 10.4266/KJCCM.2015.30.3.151
Jisoo Park, E. Eo, Kyoung-Hee Lee, Jong-Sun Park, Jae Ho Lee, C. Yoo, C. Lee, Y. Cho
Division of Pulmonology, Department of Internal Medicine, Bundang CHA Hospital, Department of Internal Medicine, Respiratory Center, Seoul National University Bundang Hospital, Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
{"title":"The Anti-Inflammatory Effect of Arginine-Vasopressin on Lipopolysaccharide-Induced IκBα/Nuclear Factor-κB Cascade","authors":"Jisoo Park, E. Eo, Kyoung-Hee Lee, Jong-Sun Park, Jae Ho Lee, C. Yoo, C. Lee, Y. Cho","doi":"10.4266/KJCCM.2015.30.3.151","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.151","url":null,"abstract":"Division of Pulmonology, Department of Internal Medicine, Bundang CHA Hospital, Department of Internal Medicine, Respiratory Center, Seoul National University Bundang Hospital, Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Lung Institute, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122526203","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 : 2015-08-31DOI: 10.4266/KJCCM.2015.30.3.234
Y. Hwang, Hyun Joo Lee, Y. T. Kim
Embolism of peripheral arteries originating from malignant tumors is considered a rare manifestation of cancer.[1] Although uncommon, during the pulmonary resection, a fragment of tumor that has invaded a pulmonary vein can embolize and result in arterial occlusion.[2] Symptoms are related to the location of emboli and the most common events are lower extremity, cerebral, myocardial, and limb ischemic events. Here, we present the case of a 70-year-old woman with tumor embolism of the both lower extremities after left pneumonectomy for lung cancer, which was treated successfully with surgical intervention.
{"title":"Acute Peripheral Arterial Tumorous Embolism after Lung Cancer Surgery","authors":"Y. Hwang, Hyun Joo Lee, Y. T. Kim","doi":"10.4266/KJCCM.2015.30.3.234","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.234","url":null,"abstract":"Embolism of peripheral arteries originating from malignant tumors is considered a rare manifestation of cancer.[1] Although uncommon, during the pulmonary resection, a fragment of tumor that has invaded a pulmonary vein can embolize and result in arterial occlusion.[2] Symptoms are related to the location of emboli and the most common events are lower extremity, cerebral, myocardial, and limb ischemic events. Here, we present the case of a 70-year-old woman with tumor embolism of the both lower extremities after left pneumonectomy for lung cancer, which was treated successfully with surgical intervention.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121909310","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 : 2015-08-31DOI: 10.4266/KJCCM.2015.30.3.164
A. L. Lee, C. Chung, Jeong Hoon Yang, K. Jeon, C. Park, G. Suh
Background: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. Methods: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. Results: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. Conclusions: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.
背景:重症监护病房(ICU)需要机械通气的患者的计划外拔管(UE)与患者和组织的不良预后相关。本研究旨在评估UE患者的临床特征，并确定影响ICU UE术后再插管的危险因素。方法:选取2011年1月至2013年12月间我院ICU收治的所有需要机械通气的成年患者，将有UE的患者纳入研究。数据根据UE后的无创或有创处理进行分类。结果:UE率为0.78%(每100 d机械通气UE数)。自行拔管的发生率为97.2%，其余患者均为意外拔管。报告2例UE后心脏骤停合并呼吸骤停。在214例病例中，54.7%的患者在UE后需要有创治疗。机械通气持续时间长(优势比[OR] 1.52;95%置信区间[CI] 1.32-1.75;p = 0.000)和高ICU死亡率(OR 4.39;95% ci 1.33-14.50;p = 0.015)与UE后有创治疗的相关性最为显著。在多变量分析中，年龄越小(OR 0.96;95% ci 0.93-0.99;p = 0.005)，内科患者(OR 4.36;95% ci 1.95-9.75;p = 0.000)，使用镇静药物(OR 4.95;95% ci 1.97-12.41;p = 0.001)，分泌量大(OR 2.66;95% ci 1.01-7.02;p = 0.049)，低PaO2/FiO2比值(OR 0.99;95% ci 0.98-0.99;p = 0.000)是UE术后有创治疗的独立危险因素。结论:对于有危险因素且需要有创处理的患者，应密切关注并给予适当的通气支持，以预防不良的临床结果。
{"title":"Factors Affecting Invasive Management after Unplanned Extubation in an Intensive Care Unit","authors":"A. L. Lee, C. Chung, Jeong Hoon Yang, K. Jeon, C. Park, G. Suh","doi":"10.4266/KJCCM.2015.30.3.164","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.164","url":null,"abstract":"Background: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. Methods: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. Results: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. Conclusions: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127076613","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 : 2015-08-31DOI: 10.4266/KJCCM.2015.30.3.207
Sung-Hwa Lee, Sung Wook Park, S. Han, S. Park
Colchicine poisoning is rare but can cause potentially life-threatening toxic complications such as hypovolemic shock, cardiovascular collapse and multiple organ failure. In this case report, we describe a case of a 20-year-old female who presented to the emergency department after suicidal ingestion of a toxic dose of colchicine. She developed thrombocytopenia, neutropenia and acute respiratory distress syndrome that required blood transfusion and administration of granulocyte colony stimulating factor for the prevention of infectious complications. With regard to the clinical manifestations of colchicine toxicity, we discussed suggested mechanisms.
{"title":"Acute Colchicine Poisoning Treated with Granulocyte Colony Stimulating Factor and Transfusion","authors":"Sung-Hwa Lee, Sung Wook Park, S. Han, S. Park","doi":"10.4266/KJCCM.2015.30.3.207","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.207","url":null,"abstract":"Colchicine poisoning is rare but can cause potentially life-threatening toxic complications such as hypovolemic shock, cardiovascular collapse and multiple organ failure. In this case report, we describe a case of a 20-year-old female who presented to the emergency department after suicidal ingestion of a toxic dose of colchicine. She developed thrombocytopenia, neutropenia and acute respiratory distress syndrome that required blood transfusion and administration of granulocyte colony stimulating factor for the prevention of infectious complications. With regard to the clinical manifestations of colchicine toxicity, we discussed suggested mechanisms.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132406819","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 : 2015-08-31DOI: 10.4266/KJCCM.2015.30.3.180
Hyun-Jung Kim, Yunkyoung Lee, K. Oh, S. Choi, H. Sung, J. Huh
Comamonas testosteroni and Acinetobacter guillouiae are gram-negative bacilli of low virulence that are widely distributed in nature and normal flora. Despite their common occurrence in environments, they rarely cause infectious disease. We experienced a case of septic shock by C. testosterone and A. guillouiae, and isolated them by 16S ribosomal RNA sequencing method from the blood cultures of a previous healthy female during postoperative supportive care. This is the first case of septic shock required ventilator care and continuous renal replacement therapy due to these organisms in Korea.
{"title":"Septic Shock due to Unusual Pathogens, Comamonas testosteroni and Acinetobacter guillouiae in an Immune Competent Patient","authors":"Hyun-Jung Kim, Yunkyoung Lee, K. Oh, S. Choi, H. Sung, J. Huh","doi":"10.4266/KJCCM.2015.30.3.180","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.180","url":null,"abstract":"Comamonas testosteroni and Acinetobacter guillouiae are gram-negative bacilli of low virulence that are widely distributed in nature and normal flora. Despite their common occurrence in environments, they rarely cause infectious disease. We experienced a case of septic shock by C. testosterone and A. guillouiae, and isolated them by 16S ribosomal RNA sequencing method from the blood cultures of a previous healthy female during postoperative supportive care. This is the first case of septic shock required ventilator care and continuous renal replacement therapy due to these organisms in Korea.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129076591","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 : 2015-08-31DOI: 10.4266/KJCCM.2015.30.3.139
Y. Kim
Since red blood cell (RBC) transfusion was first performed by English obstetrician James Blundell 200 years ago,[1] it has become one of the most commonly used lifesaving therapies. Historically, RBC transfusion have been viewed as a safe and effective means of treating anemia and improving oxygen delivery to tissues. However, in the early 1980s, transfusion practice began to come under systematic scrutiny.[2,3] The early concern about the safety of blood transfusion revolved around transfusion-related infection. However, the concern about risks of blood transfusion have become diverse and complicated over the last three decades, according to research findings. In the recent literature, blood transfusion has been confirmed as an independent risk factor for mortality, perioperative infection, postinjury multiple organ failure, systemic inflammatory response syndrome, and admission to the intensive care unit(ICU).[4-7] Problems about blood transfusion are particularly important in the critically ill patients. Many data suggest that critically ill patients can tolerate hemoglobin levels as low as 7 g/dL and that a “liberal” RBC transfusion strategy may in fact lead to worse clinical outcomes.[8] Actually, RBC transfusion impairs physiologic control of regional vascular tone, induces coagulopathy and negatively impacts immune function and antioxidant system.[9] The 2012 Cochrane analysis reported that restrictive transfusion strategies were more effective than liberal transfusion strategies in reducing hospital mortality significantly among 6,264 patients from 1986 to 2011.[10,11] As such, newer “restrictive” hematocrit threshold for transfusion (e.g., 21%) are now appreciated to be at least noninferior to more “liberal” hematocrit thresholds (e.g., 30%) for broad array of conditions.[9] The efficacy of transfusion in critically ill pediatric patients has been also questioned as is still uncertain for adult critically ill patients. Lacroix et al. suggested, based on their TRIPICU study, that there was no difference in outcomes of stable critically ill children between restrictive (hemoglobin threshold of 7 g/dL) and liberal (hemoglobin threshold of 9.5 g/dL) transfusion strategies.[12] Subgroup analysis of postsurgical and postcardiac surgical patients from the TRIPICU study revealed similar findings. Among pediatric cardiac surgical patients, greater RBC transfusion volumes are associated with prolonged duration of mechanical ventilation, an increase in nosocomial infection rates and duration of hospitalization.[13,14]
{"title":"Blood Transfusion Strategies in Patients Supported by Extracorporeal Membrane Oxygenation","authors":"Y. Kim","doi":"10.4266/KJCCM.2015.30.3.139","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.139","url":null,"abstract":"Since red blood cell (RBC) transfusion was first performed by English obstetrician James Blundell 200 years ago,[1] it has become one of the most commonly used lifesaving therapies. Historically, RBC transfusion have been viewed as a safe and effective means of treating anemia and improving oxygen delivery to tissues. However, in the early 1980s, transfusion practice began to come under systematic scrutiny.[2,3] The early concern about the safety of blood transfusion revolved around transfusion-related infection. However, the concern about risks of blood transfusion have become diverse and complicated over the last three decades, according to research findings. In the recent literature, blood transfusion has been confirmed as an independent risk factor for mortality, perioperative infection, postinjury multiple organ failure, systemic inflammatory response syndrome, and admission to the intensive care unit(ICU).[4-7] Problems about blood transfusion are particularly important in the critically ill patients. Many data suggest that critically ill patients can tolerate hemoglobin levels as low as 7 g/dL and that a “liberal” RBC transfusion strategy may in fact lead to worse clinical outcomes.[8] Actually, RBC transfusion impairs physiologic control of regional vascular tone, induces coagulopathy and negatively impacts immune function and antioxidant system.[9] The 2012 Cochrane analysis reported that restrictive transfusion strategies were more effective than liberal transfusion strategies in reducing hospital mortality significantly among 6,264 patients from 1986 to 2011.[10,11] As such, newer “restrictive” hematocrit threshold for transfusion (e.g., 21%) are now appreciated to be at least noninferior to more “liberal” hematocrit thresholds (e.g., 30%) for broad array of conditions.[9] The efficacy of transfusion in critically ill pediatric patients has been also questioned as is still uncertain for adult critically ill patients. Lacroix et al. suggested, based on their TRIPICU study, that there was no difference in outcomes of stable critically ill children between restrictive (hemoglobin threshold of 7 g/dL) and liberal (hemoglobin threshold of 9.5 g/dL) transfusion strategies.[12] Subgroup analysis of postsurgical and postcardiac surgical patients from the TRIPICU study revealed similar findings. Among pediatric cardiac surgical patients, greater RBC transfusion volumes are associated with prolonged duration of mechanical ventilation, an increase in nosocomial infection rates and duration of hospitalization.[13,14]","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127912266","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 : 2015-08-31DOI: 10.4266/KJCCM.2015.30.3.171
Jung-Wan Yoo, Su Yeon Park, J. Jeon, J. Huh, C. Lim, Y. Koh, Sang-Bum Hong
Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.
{"title":"Polymyxin B Hemoperfusion in Pneumonic Septic Shock Caused by Gram-Negative Bacteria","authors":"Jung-Wan Yoo, Su Yeon Park, J. Jeon, J. Huh, C. Lim, Y. Koh, Sang-Bum Hong","doi":"10.4266/KJCCM.2015.30.3.171","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.171","url":null,"abstract":"Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130423548","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 : 2015-08-31DOI: 10.4266/KJCCM.2015.30.3.227
Sung Wook Park, S. Han, S. Yeom, S. Park, Sung-Hwa Lee
Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.
{"title":"Unexpected Multiple Organ Infarctions in a Poisoned Patient","authors":"Sung Wook Park, S. Han, S. Yeom, S. Park, Sung-Hwa Lee","doi":"10.4266/KJCCM.2015.30.3.227","DOIUrl":"https://doi.org/10.4266/KJCCM.2015.30.3.227","url":null,"abstract":"Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.","PeriodicalId":255255,"journal":{"name":"The Korean Journal of Critical Care Medicine","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127474075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：