1.Acute Respiratory Failure due to Alveolar Hemorrhage after Exposure to Organic Dust.
Sun Mi CHOI ; Jiwon KOH ; Sang Min LEE ; Jinwoo LEE
Korean Journal of Critical Care Medicine 2016;31(2):173-177
Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.
Adrenal Cortex Hormones
;
Adult
;
Anti-Bacterial Agents
;
Biopsy
;
Bronchoalveolar Lavage
;
Diagnosis, Differential
;
Dust*
;
Fibroblasts
;
Hemoptysis
;
Hemorrhage*
;
Humans
;
Intensive Care Units
;
Lung
;
Macrophages
;
Respiration, Artificial
;
Respiratory Insufficiency*
2.Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination.
Sung Wook CHANG ; Sun HAN ; Jung Ho KO ; Jae Wook RYU
Korean Journal of Critical Care Medicine 2016;31(2):169-172
The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.
Brain Death*
;
Brain Injuries*
;
Brain*
;
Extracorporeal Membrane Oxygenation*
;
Humans
;
Kidney
;
Liver
;
Tissue and Organ Procurement
;
Tissue Donors*
3.Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumocystis jirovecii Pneumonia: Case Report and Literature Review.
Dong Won PARK ; Dae Hyun LIM ; Bongyoung KIM ; Ji Young YHI ; Ji Yong MOON ; Sang Heon KIM ; Tae Hyung KIM ; Jang Won SHON ; Ho Joo YOON ; Dong Ho SHIN ; Hyunjoo PAI
Korean Journal of Critical Care Medicine 2016;31(2):162-168
Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active*
;
Extracorporeal Membrane Oxygenation*
;
HIV
;
Humans
;
Mortality
;
Pneumocystis jirovecii*
;
Pneumocystis*
;
Pneumonia*
;
Respiration, Artificial
;
Respiratory Distress Syndrome, Adult*
;
Respiratory Insufficiency
;
Salvage Therapy
4.Extracorporeal Membrane Oxygenation Therapy for Aspiration Pneumonia in a Patient following Left Pneumonectomy for Lung Cancer.
Korean Journal of Critical Care Medicine 2016;31(2):156-161
A patient had undergone left pneumonectomy for lung cancer and had an increased risk of fatal complications such as pneumonia, including acute respiratory distress syndrome (ARDS). The treatment effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for ARDS of postpneumonectomy patient are uncertain. A 74-year-old man with one lung experienced aspiration pneumonia while swallowing pills after the operation, and his condition progressed to ARDS within a day. He was successfully treated with VV-ECMO support and intensive care unit care.
Aged
;
Deglutition
;
Extracorporeal Membrane Oxygenation*
;
Humans
;
Intensive Care Units
;
Lung Neoplasms*
;
Lung*
;
Pneumonectomy*
;
Pneumonia
;
Pneumonia, Aspiration*
;
Respiratory Distress Syndrome, Adult
5.Extracorporeal Membrane Oxygenation Cannula Malposition in the Azygos Vein in a Neonate with Right-Sided Congenital Diaphragmatic Hernia.
Seung Jun CHOI ; Chun Soo PARK ; Won Kyoung JHANG ; Seong Jong PARK
Korean Journal of Critical Care Medicine 2016;31(2):152-155
Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
Azygos Vein*
;
Catheters*
;
Extracorporeal Membrane Oxygenation*
;
Heart
;
Hernias, Diaphragmatic, Congenital*
;
Humans
;
Infant, Newborn*
;
Oxygen
;
Radiography, Thoracic
6.Lung Transplantation for Chronic Humidifier Disinfectant-Associated Lung Injury.
Won Young KIM ; So Woon KIM ; Kyung Wook JO ; Sae Hoon CHOI ; Hyung Ryul KIM ; Yong Hee KIM ; Dong Kwan KIM ; Seung Il PARK ; Sang Bum HONG
Korean Journal of Critical Care Medicine 2016;31(2):146-151
In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient's clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.
Adult
;
Catheters
;
Disinfectants
;
Extracorporeal Membrane Oxygenation
;
Female
;
Fibrosis
;
Humans
;
Humidifiers*
;
Inhalation
;
Inhalation Exposure
;
Intensive Care Units
;
Korea
;
Lung Injury*
;
Lung Transplantation*
;
Lung*
;
Oxygen Inhalation Therapy
;
Respiration, Artificial
;
Survivors
7.Lethal Hyperammonemia due to Ornithine Transcarbamylase Deficiency in a Patient with Severe Septic Shock.
Ji An HWANG ; Joo Han SONG ; Young Seok LEE ; Kyung Soo CHUNG ; Song Yee KIM ; Eun Young KIM ; Ji Ye JUNG ; Young Ae KANG ; Young Sam KIM ; Joon CHANG ; Moo Suk PARK
Korean Journal of Critical Care Medicine 2016;31(2):140-145
Severe hyperammonemia can occur as a result of inherited or acquired liver enzyme defects in the urea cycle, among which ornithine transcarbamylase deficiency (OTCD) is the most common form. We report a very rare case of a 45-year-old Korean male who was admitted to the intensive care unit (ICU) due to severe septic shock with acute respiratory failure caused by Pneumocystis jiroveci pneumonia. During his ICU stay with ventilator care, the patient suffered from marked hyperammonemia (>1,700 µg/dL) with abrupt mental change leading to life-threatening cerebral edema. Despite every effort including continuous renal replacement therapy and use of a molecular adsorbent recirculating system (extracorporeal liver support-albumin dialysis) to lower his serum ammonia level, the patient was not recovered. The lethal hyperammonemia in the patient was later proven to be a manifestation of acquired liver enzyme defect known as OTCD, which is triggered by serious catabolic conditions, such as severe septic shock with acute respiratory failure.
Ammonia
;
Brain Edema
;
Humans
;
Hyperammonemia*
;
Intensive Care Units
;
Liver
;
Male
;
Middle Aged
;
Ornithine Carbamoyltransferase Deficiency Disease*
;
Ornithine Carbamoyltransferase*
;
Ornithine*
;
Pneumocystis jirovecii
;
Pneumonia
;
Renal Replacement Therapy
;
Respiratory Insufficiency
;
Shock, Septic*
;
Urea
;
Ventilators, Mechanical
8.Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis.
Hyun Jin BAEK ; Doo Hyuk LEE ; Kyu Hyung HAN ; Young Min KIM ; Hyunbeom KIM ; Byeongwook CHO ; Inkuk LEE ; Kanghyun CHOI ; Hojin YONG ; Goohyeon HONG
Korean Journal of Critical Care Medicine 2016;31(2):134-139
In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.
Blood Platelets
;
Critical Illness
;
Dacarbazine
;
Disseminated Intravascular Coagulation*
;
Ecchymosis
;
Gastrointestinal Tract
;
Hemorrhage
;
Humans
;
Intracranial Hemorrhages*
;
Male
;
Middle Aged
;
Mortality
;
Plasma
;
Sepsis*
9.Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient.
Eunmi GIL ; Tae Sun HA ; Gee Young SUH ; Chi Ryang CHUNG ; Chi Min PARK
Korean Journal of Critical Care Medicine 2016;31(2):129-133
Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.
Acquired Immunodeficiency Syndrome
;
Adrenal Cortex Hormones
;
Aspergillosis*
;
Critical Illness
;
Diagnosis
;
Drug Therapy
;
Gastrointestinal Diseases
;
Humans
;
Immune System Diseases
;
Immunocompromised Host*
;
Intensive Care Units
;
Male
;
Middle Aged
;
Neutropenia
;
Respiratory System
;
Risk Factors
;
Shock, Septic
10.Successful Management of Airway Emergency in a Patient with Esophageal Cancer.
Samina PARK ; Hyun Joo LEE ; Chang Hyun KANG ; Young Tae KIM
Korean Journal of Critical Care Medicine 2015;30(2):135-138
A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient's respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.
Acidosis, Respiratory
;
Airway Management
;
Airway Obstruction
;
Chemoradiotherapy
;
Dyspnea
;
Edema
;
Emergencies*
;
Esophageal Neoplasms*
;
Extracorporeal Membrane Oxygenation
;
Humans
;
Intubation
;
Jejunostomy
;
Middle Aged
;
Respiration, Artificial
;
Respiratory Insufficiency
;
Stents
;
Trachea
;
Tracheal Stenosis