Korean Journal of Critical Care Medicine最新文献_第3页

Status Epilepticus and Beyond: A Clinical Review of Status Epilepticus and an Update on Current Management Strategies in Super-refractory Status Epilepticus 癫痫状态及其后：癫痫状态的临床回顾和超难治性癫痫当前管理策略的更新

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2017.00252

R. Poblete, G. Sung

引用次数: 6

Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation 体外膜氧合期间气管切开术的安全性

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2017.00059

H. Yeo, S. Yoon, Seung Eun Lee, D. Jeon, Yun-Seong Kim, W. Cho, Dohyung Kim

{"title":"Safety of Surgical Tracheostomy during Extracorporeal Membrane Oxygenation","authors":"H. Yeo, S. Yoon, Seung Eun Lee, D. Jeon, Yun-Seong Kim, W. Cho, Dohyung Kim","doi":"10.4266/kjccm.2017.00059","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00059","url":null,"abstract":"Background The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. Methods From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. Results Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 × 109/L (range, 46 to 434 × 109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. Conclusions The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"197 - 204"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43387092","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}

引用次数: 7

Is It Essential to Consider Respiratory Dynamics? 考虑呼吸动力学有必要吗？

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 Epub Date: 2017-05-31 DOI: 10.4266/kjccm.2017.00276

Youngjoon Kang

{"title":"Is It Essential to Consider Respiratory Dynamics?","authors":"Youngjoon Kang","doi":"10.4266/kjccm.2017.00276","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00276","url":null,"abstract":"Chronic obstructive pulmonary disease (COPD), which is marked by a fixed obstruction of the airway, is a progressive disease including emphysema and chronic bronchitis. According to data from the fourth Korea National Health and Nutrition Survey, the prevalence of COPD is 13.4% in South Korea [1]. Intensive care unit (ICU) admission is required in more than 25% of patients with COPD [2]. ICU stays of patients with lung hyperinflation are longer compared to patients without lung hyperinflation [3]. In an acute exacerbation of COPD, airway resistance rises, positive end expiratory pressure (PEEP) rises, and hyperinflation of lungs occurs. Increased lung volume by hyperinflation compresses inferior vena cava and right ventricle, therefore decreases cardiac output and blood pressure. Moreover, asymmetric lung compliance aggravates unilateral lung hyperinflation which is found in unilateral lung transplantation, fibrosis or pneumonia of a single lung [4,5]. Severe obstruction increases work of breathing and fatigue of respiratory muscles [6]. With the understanding about respiratory dynamics, the better strategies will be discussed. The uneven distribution of volume could be reduced by reducing the diameter of the airway [7]. Measurement of lung hyperinflation is integral to the assessment of physiological impairment in individuals with COPD and can effectively be targeted for treatment [8]. Recognition and successful management of the unilateral lung hyperinflation may avoid complications such as barotrauma and hypotension associated with the presence of intrinsic PEEP [9].","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 2","pages":"223-224"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/57/kjccm-2017-00276.PMC6786716.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41214697","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}

引用次数: 0

The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores 少尿和缺乏液体管理和平衡信息在疾病严重程度评分中的作用

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2017.00192

N. Glassford, R. Bellomo

{"title":"The Role of Oliguria and the Absence of Fluid Administration and Balance Information in Illness Severity Scores","authors":"N. Glassford, R. Bellomo","doi":"10.4266/kjccm.2017.00192","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00192","url":null,"abstract":"Urinary examination has formed part of patient assessment since the earliest days of medicine. Current definitions of oliguria are essentially arbitrary, but duration and intensity of oliguria have been associated with an increased risk of mortality, and this risk is not completely attributable to the development of concomitant acute kidney injury (AKI) as defined by changes in serum creatinine concentration. The increased risk of death associated with the development of AKI itself may be modified by directly or indirectly by progressive fluid accumulation, due to reduced elimination and increased fluid administration. None of the currently extant major illness severity scoring systems or outcome prediction models use modern definitions of AKI or oliguria, or any values representative of fluid volumes variables. Even if a direct relationship with mortality is not observed, then it is possible that fluid balance or fluid volume variables mediate the relationship between illness severity and mortality in the renal and respiratory physiological domains. Fluid administration and fluid balance may then be an important, easily modifiable therapeutic target for future investigation. These relationships require exploration in large datasets before being prospectively validated in groups of critically ill patients from differing jurisdictions to improve prognostication and mortality prediction.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"106 - 123"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43282826","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}

引用次数: 4

A Retrospective Study Investigating Risks of Acute Respiratory Distress Syndrome and Mortality Following Human Metapneumovirus Infection in Hospitalized Adults 一项调查住院成人急性呼吸窘迫综合征风险和人类偏肺病毒感染后死亡率的回顾性研究

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2017.00038

Hyunjung Hwang, Yujin Kim, Jeong-Woong Park, S. Jeong, S. Kyung

{"title":"A Retrospective Study Investigating Risks of Acute Respiratory Distress Syndrome and Mortality Following Human Metapneumovirus Infection in Hospitalized Adults","authors":"Hyunjung Hwang, Yujin Kim, Jeong-Woong Park, S. Jeong, S. Kyung","doi":"10.4266/kjccm.2017.00038","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00038","url":null,"abstract":"Background Human metapneumovirus (hMPV) is a relatively recently identified respiratory virus that induces respiratory symptoms similar to those of respiratory syncytial virus infection in children. The characteristics of hMPV-infected adults are unclear because few cases have been reported. Methods We conducted a retrospective review of hospitalized adult patients with a positive multiplex real-time polymerase chain reaction assay result from 2012 to 2016 at a single tertiary referral hospital in South Korea. We analyzed clinical characteristics of the enrolled patients and divided patients into an acute respiratory distress syndrome (ARDS) group and a non-ARDS group. Results In total, 110 adults were reviewed in this study. Their mean age was 61.4 years, and the majority (n = 105, 95.5%) had comorbidities or were immunocompromised. Most of the patients had pneumonia on chest X-ray (n = 88, 93.6%), 22 (20.0%) had ARDS, and 12 (10.9%) expired during hospitalization. The mortality rate for patients with ARDS was higher than that of the other patients (36.4% vs. 5.7%, P = 0.001). The risk factor for hMPV-associated ARDS was heart failure (odds ratio, 5.24; P = 0.044) and laboratory values were increased blood urea nitrogen and increased C-reactive protein. The acquisition site of infection was divided into community vs. nosocomial; 43 patients (39.1%) had a nosocomial infection. The risk factors for nosocomial infection were an immunocompromised state, malignancy and immunosuppressive treatment. Conclusions These data suggest that hMPV is one of the important respiratory pathogens important respiratory pathogen that causes pneumonia/ARDS in elderly, immunocompromised individuals and that it may be transmitted via the nosocomial route.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"182 - 189"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49404019","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}

引用次数: 2

Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study 肾素-血管紧张素系统阻塞对急性呼吸窘迫综合征患者的影响:回顾性病例对照研究

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2016.00976

Joohae Kim, S. Choi, Jinwoo Lee, Y. Park, Chang-Hoon Lee, J. Yim, C. Yoo, Young Whan Kim, S. Han, Sang-Min Lee

{"title":"Effect of Renin-Angiotensin System Blockage in Patients with Acute Respiratory Distress Syndrome: A Retrospective Case Control Study","authors":"Joohae Kim, S. Choi, Jinwoo Lee, Y. Park, Chang-Hoon Lee, J. Yim, C. Yoo, Young Whan Kim, S. Han, Sang-Min Lee","doi":"10.4266/kjccm.2016.00976","DOIUrl":"https://doi.org/10.4266/kjccm.2016.00976","url":null,"abstract":"Background Acute respiratory distress syndrome (ARDS) remains a life-threatening disease. Many patients with ARDS do not recover fully, and progress to terminal lung fibrosis. Angiotensin-converting enzyme (ACE) inhibitor is known to modulate the neurohormonal system to reduce inflammation and to prevent tissue fibrosis. However, the role of ACE inhibitor in the lungs is not well understood. We therefore conducted this study to elucidate the effect of renin-angiotensin system (RAS) blockage on the prognosis of patients with ARDS. Methods We analyzed medical records of patients who were admitted to the medical intensive care unit (ICU) at a tertiary care hospital from January 2005 to December 2010. ARDS was determined using the Berlin definition. The primary outcome was the mortality rate of ICU. Survival analysis was performed after adjustment using propensity score matching. Results A total of 182 patients were included in the study. Thirty-seven patients (20.3%) took ACE inhibitor or angiotensin receptor blocker (ARB) during ICU admission, and 145 (79.7%) did not; both groups showed similar severity scores. In the ICU, mortality was 45.9% in the RAS inhibitor group and 58.6% in the non-RAS inhibitor group (P = 0.166). The RAS inhibitor group required a longer duration of mechanical ventilation (29.5 vs. 19.5, P = 0.013) and longer ICU stay (32.1 vs. 20.2 days, P < 0.001). In survival analysis, the RAS inhibitor group showed better survival rates than the non-RAS group (P < 0.001). Conclusions ACE inhibitor or ARB may have beneficial effect on ARDS patients.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"154 - 163"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45255366","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}

引用次数: 37

Refractory Ventricular Arrhythmia Induced by Aconite Intoxication and Its Treatment with Extracorporeal Cardiopulmonary Resuscitation 附子中毒致顽固性室性心律失常及体外心肺复苏治疗

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2017.00017

M. Hong, Jeong Hoon Yang, C. Chung, Jinkyeong Park, G. Suh, K. Sung, Y. Cho

{"title":"Refractory Ventricular Arrhythmia Induced by Aconite Intoxication and Its Treatment with Extracorporeal Cardiopulmonary Resuscitation","authors":"M. Hong, Jeong Hoon Yang, C. Chung, Jinkyeong Park, G. Suh, K. Sung, Y. Cho","doi":"10.4266/kjccm.2017.00017","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00017","url":null,"abstract":"A kind of herbs, aconite is known for cardiac toxicity [1,2]. Hemodynamic support using extracorporeal life support (ECLS) may be good method if failed conventional resuscitation. We report two experiences using ECLS in aconite intoxication. A 47-year-old man, who had taken 20 herbal tablets containing aconite, visited the emergency room because of chest discomfort. An initial electrocardiography (ECG) showed persistent multifocal ventricular tachycardia (Figure 1). He repeatedly became pulseless and unconscious. All conventional resuscitation methods including antiarrhythmic medicines, chest compression, and electric cardioversion failed to maintain a stable condition. After 10 minutes of resuscitation, extracorporeal membrane oxygenation (ECMO) was inserted immediately. A 15-F arterial and 22-F venous catheter were percutaneously inserted into the right femoral vessels. The initial flow rate was set at 2 L/min. Although ventricular tachyarrhythmia occurred frequently on the first hospital day, soon after, the vital signs were stabilized. ECG showed a normal sinus rhythm after 33 hours of ECLS. The ECLS was removed on hospital day 2. He was discharged on hospital day 10. Other case, a 31-year-old man, ingested an unknown number of tablets containing aconite and had difficulty in moving and chest discomfort, was referred to Samsung Medical Center. The initial ECG showed an irregular rhythm with a narrow QRS (Figure 2). Despite conventional resuscitation, the ventricular tachycardia was sustained. After a few minutes, a 15-F arterial and 22-F venous catheter were inserted. The patient’s vital signs were stabilized and ECG rhythm regained normal sinus rhythm after 9 hours of ECLS support. The ECLS was removed on hospital day 2. He was discharged on hospital day 7. Aconite induces refractory ventricular arrhythmia. The symptoms of poisoning appear 10 minutes to 3 hours after aconite is ingested [3,4]. When cardiogenic shock","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"228 - 230"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47278990","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}

引用次数: 2

Epidemiology and Clinical Characteristics of Rapid Response Team Activations 快速反应小组激活的流行病学和临床特征

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2017.00199

S. Kim, H. Lee, Mi-ra Han, Yong Suk Lee, E. H. Kang, E. Jang, Keum Sook Jeun, S. Kim

{"title":"Epidemiology and Clinical Characteristics of Rapid Response Team Activations","authors":"S. Kim, H. Lee, Mi-ra Han, Yong Suk Lee, E. H. Kang, E. Jang, Keum Sook Jeun, S. Kim","doi":"10.4266/kjccm.2017.00199","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00199","url":null,"abstract":"Background To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available. Methods In Seoul St. Mary’s Hospital, the St. Mary’s Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016. Results The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation. Conclusions Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"124 - 132"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46041181","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}

引用次数: 4

Difficult Airway and Cannot Intubate, Cannot Ventilate Situations in Korea: What Can We Do in the Future? 韩国出现气管困难、无法插管、无法呼吸的情况:未来该怎么办?

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2017.00066

T. Oh

{"title":"Difficult Airway and Cannot Intubate, Cannot Ventilate Situations in Korea: What Can We Do in the Future?","authors":"T. Oh","doi":"10.4266/kjccm.2017.00066","DOIUrl":"https://doi.org/10.4266/kjccm.2017.00066","url":null,"abstract":"I have read the article entitled “A Pilot Survey of Difficult Intubation and Cannot Intubate, Cannot Ventilate Situations in Korea” published by Kim et al. [1] in the Korean Journal of Critical Care Medicine in August 2016, with great interest. An official survey on difficult intubations is still a very meaningful pilot study in Korea. The authors suggested that the video laryngoscope is the most preferred modality among Korean anesthesiologists and intensivists for “Cannot Intubate, Cannot Ventilate (CICV)” and difficult intubation conditions. This preference reflects the results from a 2013 report of a survey performed in Canada [2]. I believe that these findings are valuable and should be actively applied in special conditions, such as in the intensive care unit (ICU). In general, patients in the ICU exhibit signs and symptoms of acute respiratory distress syndrome and sepsis. These patients lack a physiologic reserve when compared to other patients, and are often facing life-threatening conditions. Moreover, a difficult airway occurs more often outside the operating room, while the rate of incidence is 11% to 22% in critically ill patients [3,4]. Therefore, when compared to patients who undergo tracheal intubation for elective surgery in the operating room [1], it is more important to accurately predict a difficult airway and be successful on the first attempt at intubation in ICU patients [5]. Thus, if a difficult airway condition is predicted in ICU patients, it is necessary to proactively use the video laryngoscope on the first intubation attempt [6]. A prior prospective study reports that the use of the C-MAC video laryngoscope (Karl Storz, Tuttlingen, Germany), over the Macintosh blade, has increased the success rate of the first attempt at tracheal intubation in ICU patients suspected of having a difficult airway from 55% to 79% [7]. In light of these trends, intensive care staff in Korea should consider proactively assessing for difficult airways and using a video laryngoscope before a CICV situation ensues.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"225 - 227"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44087388","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}

引用次数: 0

Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage 急性胆囊炎是动脉瘤性蛛网膜下腔出血发热的原因

Korean Journal of Critical Care Medicine Pub Date : 2017-05-01 DOI: 10.4266/kjccm.2016.00857

N. Yang, K. Hong, E. Seo

{"title":"Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage","authors":"N. Yang, K. Hong, E. Seo","doi":"10.4266/kjccm.2016.00857","DOIUrl":"https://doi.org/10.4266/kjccm.2016.00857","url":null,"abstract":"Background Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. Methods We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. Results Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024). Conclusions AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.","PeriodicalId":31220,"journal":{"name":"Korean Journal of Critical Care Medicine","volume":"32 1","pages":"190 - 196"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44567801","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}

引用次数: 3