Korean Journal of Critical Care Medicine最新文献

{"title":"Patient-Ventilator Dyssynchrony","authors":"E. Antonogiannaki, D. Georgopoulos, E. Akoumianaki","doi":"10.4266/kjccm.2017.00535","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00535","url":null,"abstract":"In mechanically ventilated patients, assisted mechanical ventilation (MV) is employed early, following the acute phase of critical illness, in order to eliminate the detrimental effects of controlled MV, most notably the development of ventilator-induced diaphragmatic dysfunction. Nevertheless, the benefits of assisted MV are often counteracted by the development of patient-ventilator dyssynchrony. Patient-ventilator dyssynchrony occurs when either the initiation and/or termination of mechanical breath is not in time agreement with the initiation and termination of neural inspiration, respectively, or if the magnitude of mechanical assist does not respond to the patient’s respiratory demand. As patient-ventilator dyssynchrony has been associated with several adverse effects and can adversely influence patient outcome, every effort should be made to recognize and correct this occurrence at bedside. To detect patient-ventilator dyssynchronies, the physician should assess patient comfort and carefully inspect the pressure- and flow-time waveforms, available on the ventilator screen of all modern ventilators. Modern ventilators offer several modifiable settings to improve patient-ventilator interaction. New proportional modes of ventilation are also very helpful in improving patient-ventilator interaction.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"307 - 322"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44636729","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}

{"title":"Should Very Old Patients Be Admitted to the Intensive Care Units?","authors":"Jun Kwon Cha, In-Ae Song","doi":"10.4266/kjccm.2017.00521","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00521","url":null,"abstract":"I read with great interest the article “Demographic Changes in Intensive Care Units in Korea over the Last Decade and Outcomes of Elderly Patients: A SingleCenter Retrospective Study” published in the Korean Journal of Critical Care Medicine in May 2017 [1]. The results indicated that the proportion of inpatients aged 65–79 years admitted to an intensive care unit (ICU) increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of ICU-hospitalized patients older than 80 years increased from 12.8% in 2005 to 20.7% in 2014. However, the overall mortality rate did not increase despite a higher mortality rate in the elderly than in the younger patients. These results are worthy and impressively demonstrate the recent changing trends in demographic data of ICU patients in Korea. However, I would like to comment on the following two points. First, the authors might have shown a slightly lower sepsis prevalence, not greater than 1% for each subgroup in the ICU. The study conducted by Oh et al. [2], using the Health Insurance Review & Assessment Service database, revealed that the inhospital mortality of patients with sepsis was as high as 38.9%, and the proportion of sepsis increased with age. In addition, in the United States, sepsis was ranked 11 in the top primary diagnoses in 1996 among patients older than 65 years who were admitted to the ICU, but in 2010, sepsis was ranked 1 among the primary diagnoses in older patients admitted to the ICU [3]. In Korea, where the proportion of elderly population is rapidly increasing, it is expected that the rate of primary diagnosis of sepsis in the elderly patients who are admitted to the ICU would be higher. It is considered to be a limitation due to single-center studies, and nationwide demographic studies of ICU patients are required. Second, there had been questions regarding the appropriateness of ICU hospitalization of very old patients (VOPs) aged greater than 80 years with chronic illnesses. Roch et al. [4] reported that among patients older than 80 years, the ICU","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 4","pages":"376-377"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/86/kjccm-2017-00521.PMC6786686.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41214696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage","authors":"S. Park, S. Yeom, S. Han, Y. Jo, H. Kim","doi":"10.4266/kjccm.2016.00787","DOIUrl":"https://doi.org/10.4266/kjccm.2016.00787","url":null,"abstract":"Background Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients. Methods A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher. Results Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016). Conclusions This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"333 - 339"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46225443","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}

{"title":"Lung Ultrasound in the Critically Ill.","authors":"Jin Sun Cho","doi":"10.4266/kjccm.2017.00556","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00556","url":null,"abstract":"Until recently, the lung was considered “forbidden territory” for ultrasound. With lung ultrasound, however, the amount of lung consolidation and pleural effusion can be assessed semiquantitatively. Lung ultrasound consists of the identification of 10 signs, and there are several well-established protocols such as the BLUE (Bedside Lung Ultrasonography in Emergency) protocol for diagnosing acute respiratory failure and the FALLS (Fluid Administration Limited by Lung Sonography) protocol for managing acute circulatory failure. The BLUE protocol is a fast protocol that defines eight profiles, correlated with six diseases seen in 97% of patients admitted to the intensive care unit (ICU). With this protocol, it becomes possible to differentiate between pulmonary edema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax [1]. The FALLS protocol uses the potential of lung ultrasound for the early demonstration of fluid overload at an infra-clinical level [2]. It is used in patients with acute respiratory failure, allowing a sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography in combination with lung ultrasound, with the appearance of B lines considered to be the endpoint of fluid therapy. In addition, ultrasound can help to guide airway management in a patient with acute respiratory distress who needs to be intubated and mechanically ventilated (PINK protocol). In a patient with acute respiratory distress who is often ventilated and difficult to transport, computed tomography (CT) is not an easy option, and lung ultrasound can help to predict difficult airway and proper endotracheal tube size, or to confirm proper endotracheal tube placement with avoidance of desaturation during CT [3]. In addition, lung ultrasound can be used to determine the cause of fever distinguishing pneumonia from atelectasis [4], and to rule out pneumothorax, hypovolemia, pulmonary embolism and pericardial tamponade in cardiac arrest (SESAME protocol) [5]. In the critical care setting, lung ultrasound is increasingly used, as it allows bedside visualization of the lungs. Critical care ultrasound is a combination of simple protocols, with lung ultrasound being a basic application, allowing the assessment","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 4","pages":"356-358"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/00/kjccm-2017-00556.PMC6786685.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41214695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Albumin as a Biomarker of Poor Prognosis in the Pediatric Patients in Intensive Care Unit","authors":"Young Suh Kim, I. Sol, Min Jung Kim, Soo-Yeon Kim, Jong Deok Kim, Y. Kim, K. Kim, M. Sohn, Kyu-Earn Kim","doi":"10.4266/KJCCM.2017.00437","DOIUrl":"https://doi.org/10.4266/KJCCM.2017.00437","url":null,"abstract":"Background Serum albumin as an indicator of the disease severity and mortality is suggested in adult patients, but its role in pediatric patients has not been established. The objectives of this study are to investigate the albumin level as a biomarker of poor prognosis and to compare it with other mortality predictive indices in children in intensive care unit (ICU). Methods Medical records of 431 children admitted to the ICU at Severance Hospital from January 1, 2012 to December 31, 2015 were retrospectively analyzed. Children who expired within 24 hours after ICU admission, children with hepatic or renal failure, and those who received albumin replacement before ICU admission were excluded. Results The children with hypoalbuminemia had higher 28-day mortality rate (24.60% vs. 9.28%, P < 0.001), Pediatric Index of Mortality (PIM) 3 score (9.23 vs. 8.36, P < 0.001), Pediatric Risk of Mortality (PRISM) III score (7.0 vs. 5.0, P < 0.001), incidence of septic shock (12% vs. 3%, P < 0.001), C-reactive protein (33.0 mg/L vs. 5.8 mg/L, P < 0.001), delta neutrophil index (2.0% vs. 0.6%, P < 0.001), lactate level (1.6 mmol/L vs. 1.2 mmol/L, P < 0.001) and lower platelet level (206,000/μl vs. 341,000/μl, P < 0.001) compared to the children with normal albumin level. PIM 3 (r = 0.219, P < 0.001) and PRISM III (r = 0.375, P < 0.001) were negatively correlated with serum albumin level, respectively. Conclusions Our results highlight that hypoalbuminemia can be a biomarker of poor prognosis including mortality in the children in ICU.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"347 - 355"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48722925","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}

{"title":"The Authors Reply","authors":"Jeong Uk Lim, Jongmin Lee, J. Ha, H. Kang, S. H. Lee, H. Moon","doi":"10.4266/kjccm.2017.00521.r1","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00521.r1","url":null,"abstract":"","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"377 - 379"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45543289","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}

{"title":"A Pleural Catheter Malposition through Diaphragm to Abdominal Cavity","authors":"W. Jung, Sue In Choi, E. Lee, Sang Yeub Lee, K. In","doi":"10.4266/KJCCM.2017.00290","DOIUrl":"https://doi.org/10.4266/KJCCM.2017.00290","url":null,"abstract":"A 78-old-man with history of diabetes mellitus and cerebral infarction was transferred to intensive care unit of Korea University Anam Hospital from nursing hospital. He presented with acute respiratory failure requiring mechanical ventilation caused by pneumonia and empyema. We inserted chest tube for empyema on the right side. A few days later, pleural effusion occurred on the left side. Thus, pleural catheter was inserted into left seventh intercostal space at the mid axillary line after marking of site using ultrasound. Chest simple radiography showed that the catheter direction had been inserted too downward (Figure 1A). A subsequent computed tomography scan revealed that the catheter first entered into the pleural space, passed through diaphragm, and the tip was located in the abdominal cavity (Figure 1B). The catheter was removed immediately with a close monitoring. After catheter removal, the patient was still stable and showed no signs or symptoms of any complication. The rate of chest tube malposition is less than 3% and 0.6% especially for small drain [1,2]. Pleural catheter malposition was very rarely reported [3]. Pleural catheter into the abdominal cavity through diaphragm is an exceptional complication. Various complications from chest tube misplacement into the abdominal cavity","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"370 - 371"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47266693","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}

{"title":"Acute Physiology and Chronic Health Evaluation II Score and Sequential Organ Failure Assessment Score as Predictors for Severe Trauma Patients in the Intensive Care Unit","authors":"Min A Lee, K. Choi, B. Yu, Jae Jeong Park, Youngeun Park, Jihun Gwak, Jungnam Lee, Y. Jeon, D. Ma, G. Lee","doi":"10.4266/kjccm.2017.00255","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00255","url":null,"abstract":"Background The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Sequential Organ Failure Assessment (SOFA) scoring system are widely used for critically ill patients. We evaluated whether APACHE II score and SOFA score predict the outcome for trauma patients in the intensive care unit (ICU). Methods We retrospectively analyzed trauma patients admitted to the ICU in a single trauma center between January 2014 and December 2015. The APACHE II score was figured out based on the data acquired from the first 24 hours of admission; the SOFA score was evaluated based on the first 3 days in the ICU. A total of 241 patients were available for analysis. Injury Severity score, APACHE II score, and SOFA score were evaluated. Results The overall survival rate was 83.4%. The non-survival group had a significantly high APACHE II score (24.1 ± 8.1 vs. 12.3 ± 7.2, P < 0.001) and SOFA score (7.7 ± 1.7 vs. 4.3 ± 1.9, P < 0.001) at admission. SOFA score had the highest areas under the curve (0.904). During the first 3 days, SOFA score remained high in the non-survival group. In the non-survival group, cardiovascular system, neurological system, renal system, and coagulation system scores were significantly higher. Conclusions In ICU trauma patients, both SOFA and APACHE II scores were good predictors of outcome, with the SOFA score being the most effective. In trauma ICU patients, the trauma scoring system should be complemented, recognizing that multi-organ failure is an important factor for mortality.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"340 - 346"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47175979","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}

{"title":"The Use of Lung Ultrasound in a Surgical Intensive Care Unit","authors":"Hyung Koo Kang, Hyojyo So, Deok Hee Kim, H. Koo, Hye Kyeong Park, Sung-Soon Lee, Hoon Jung","doi":"10.4266/kjccm.2017.00318","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00318","url":null,"abstract":"Background Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). Methods This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. Results The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. Conclusions LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"323 - 332"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49562548","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}

{"title":"Spontaneous Echo Contrast Mistaken for Left Ventricular Thrombus during Venoarterial Extracorporeal Membrane Oxygenation","authors":"S. Lee, So Young Lee, C. Choi, K. Park, C. Park","doi":"10.4266/kjccm.2017.00220","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00220","url":null,"abstract":"Spontaneous echo contrast (SEC) is often observed in patients with mitral stenosis, atrial fibrillation, cardiomyopathy, or a ventricular aneurysm [1]. SEC is a smoke-like echo density observed on echocardiograms, and is caused by increased red blood cell aggregation during low-flow states. It is also a risk factor of thromboembolism [2]. SEC can be observed in patients with severe ventricular dysfunction receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO). We present a case in which left ventricular-SEC (LV-SEC) was mistaken for a LV thrombus during VA-ECMO for severe LV dysfunction. A 36-year-old female patient diagnosed with acute fulminant myocarditis was provided VA-ECMO support on hospital day (HD) 1. Briefly, VA-ECMO (RotaFlow; Maquet Inc., Hirrlingen, Germany) was implanted in the right femoral artery (15-French arterial cannula) and the left femoral vein (20-French venous cannula). Her height and body weight are 163 cm and 52 kg (body surface area, 1.53 m). VAECMO was initiated with a circuit flow of 3.5 L/min (cardiac index, 2.3 2L/min/m). Her creatine kinase-myocardial band and troponin-I levels at admission were 188.03 ng/ml (normal range, 0 to 5 ng/ml) and >50.0 ng/ml (normal range, 0 to 0.78 ng/ml), respectively. Impaired ventricular function (ejection fraction, 22%) suspected as acute fulminant myocarditis was detected by transthoracic echocardiography (TTE) at admission. TTE revealed decreased LV function (ejection fraction, 10%) with mild mitral regurgitation (grade II) immediately after VA-ECMO. Opening of the aortic valve and arterial pulsatility were not observed. Pulmonary edema was aggravated on HD 4. Left atrial (LA) decompression was achieved using a LA catheter (20-French femoral venous cannula) by balloon atrial septostomy through the right femoral","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"372 - 375"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46846396","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}