1.Massive Hemoptysis due to Acute Mitral Regurgitation with Sporadic Primary Mitral Valve Prolapse.
Won Young CHAE ; Sun Jin PARK ; Chi Woo SONG ; Byoung Hoon LEE ; Sang Hoon KIM ; Jae Hyung LEE
Korean Journal of Critical Care Medicine 2015;30(3):202-206
The most common cardiac cause of massive hemoptysis is mitral stenosis. Mitral regurgitation is rarely complicated by massive hemoptysis. A 48-year-old man with no significant medical history was admitted to our hospital with hemoptysis and production of 500 mL of blood within 24 hours. A pan-systolic murmur was found on chest examination. A chest computed tomography showed airspace consolidation in the right upper and middle lobes, with faint bilateral ground glass opacity. Echocardiography revealed mitral valve prolapse and grade IV mitral regurgitation. The patient was diagnosed with sporadic primary mitral valve prolapse. After mitral valve repair surgery, the patient recovered fully.
Echocardiography
;
Glass
;
Hemoptysis*
;
Humans
;
Middle Aged
;
Mitral Valve Insufficiency*
;
Mitral Valve Prolapse*
;
Mitral Valve Stenosis
;
Mitral Valve*
;
Thorax
2.Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia.
Youjin CHANG ; Sang Oh LEE ; Tae Sun SHIM ; Sae Hoon CHOI ; Hyung Ryul KIM ; Yong Hee KIM ; Dong Kwan KIM ; Seung Il PARK ; Sang Bum HONG
Korean Journal of Critical Care Medicine 2015;30(3):196-201
Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO) made it possible to consider lung transplantation (LTPL) in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.
Extracorporeal Membrane Oxygenation
;
Humans
;
Influenza, Human*
;
Lung Diseases
;
Lung Transplantation*
;
Lung*
;
Middle Aged
;
Mortality
;
Pneumonia*
;
Respiratory Distress Syndrome, Adult*
3.Fixed Pupillary Light Reflex due to Peripheral Neuropathy after Liver Transplantation.
Kwan Hyung KIM ; Namo KIM ; Sungwon NA ; Jaewon JANG ; Jeongmin KIM
Korean Journal of Critical Care Medicine 2015;30(3):191-195
A 46-year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.
Adie Syndrome
;
Emergencies
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Female
;
Hepatic Encephalopathy
;
Humans
;
Intensive Care Units
;
Intracranial Hemorrhages
;
Liver Transplantation*
;
Liver*
;
Middle Aged
;
Nervous System Diseases
;
Peripheral Nervous System Diseases*
;
Pupil
;
Reflex*
;
Reflex, Pupillary
;
Thromboembolism
4.Toxic Shock Syndrome following Tattooing.
Ki Young JEONG ; Kyung Su KIM ; Gil Joon SUH ; Woon Yong KWON
Korean Journal of Critical Care Medicine 2015;30(3):184-190
Toxic shock syndrome (TSS) is a rare but life-threatening illness that is mainly caused by toxigenic strains of Staphylococcus aureus. Although TSS is classically known to be associated with tampon use, the number of TSS cases with non-menstrual causes such as skin and soft tissue infection has been increasing. Tattooing can result in several complications such as localized and systemic infections, inflammatory skin eruptions and neoplasms. We recently experienced a 26-year-old man diagnosed with typical TSS following tattooing. He complained of fever, chills and erythematous rash at tattoo site. Subsequently, the patient developed sign of shock. The skin cultures on the tattoo site were positive for methicillin-sensitive Staphylococcus aureus. The patient was successfully treated with vasopressor infusion and intravenous antibiotics and was discharged without complications. On discharge from the hospital 7 days later, desquamations on the tattoo site, fingers and toes were observed.
Adult
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Anti-Bacterial Agents
;
Chills
;
Exanthema
;
Fever
;
Fingers
;
Humans
;
Shock
;
Shock, Septic*
;
Skin
;
Soft Tissue Infections
;
Staphylococcus aureus
;
Tattooing*
;
Toes
5.Septic Shock due to Unusual Pathogens, Comamonas testosteroni and Acinetobacter guillouiae in an Immune Competent Patient.
Hyun Jung KIM ; Yunkyoung LEE ; Kyunghwan OH ; Sang Ho CHOI ; Heungsup SUNG ; Jin Won HUH
Korean Journal of Critical Care Medicine 2015;30(3):180-183
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.
Acinetobacter*
;
Bacteremia
;
Comamonas testosteroni*
;
Comamonas*
;
Communicable Diseases
;
Female
;
Humans
;
Korea
;
Renal Replacement Therapy
;
RNA, Ribosomal, 16S
;
Shock, Septic*
;
Testosterone
;
Ventilators, Mechanical
;
Virulence
6.Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation.
Young Kun LEE ; Jeong Am RYU ; Jeong Hoon YANG ; Chi Min PARK ; Gee Young SUH ; Kyeongman JEON ; Chi Ryang CHUNG
Korean Journal of Critical Care Medicine 2015;30(3):176-179
Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Adult
;
Aged
;
Emergency Service, Hospital
;
Endotoxins
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Extracorporeal Membrane Oxygenation*
;
Hemodynamics
;
Hemoperfusion
;
Humans
;
Nephrectomy*
;
Polymyxin B
;
Pyelonephritis
;
Shock, Septic*
7.Polymyxin B Hemoperfusion in Pneumonic Septic Shock Caused by Gram-Negative Bacteria.
Jung Wan YOO ; Su Yeon PARK ; Jin JEON ; Jin Won HUH ; Chae Man LIM ; Younsuck KOH ; Sang Bum HONG
Korean Journal of Critical Care Medicine 2015;30(3):171-175
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.
Cause of Death
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Critical Illness
;
Gram-Negative Bacteria*
;
Hemoperfusion*
;
Humans
;
Middle Aged
;
Polymyxin B*
;
Polymyxins*
;
Pseudomonas aeruginosa
;
Sepsis
;
Shock, Septic*
8.Factors Affecting Invasive Management after Unplanned Extubation in an Intensive Care Unit.
A Lan LEE ; Chi Ryang CHUNG ; Jeong Hoon YANG ; Kyeongman JEON ; Chi Min PARK ; Gee Young SUH
Korean Journal of Critical Care Medicine 2015;30(3):164-170
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.
Adult
;
Heart Arrest
;
Humans
;
Incidence
;
Intensive Care Units*
;
Critical Care*
;
Mortality
;
Multivariate Analysis
;
Respiration, Artificial
;
Risk Factors
9.The Effect of the Valsalva Maneuver on the External Jugular Vein.
Ho Sik MOON ; Sung Hoon JUNG ; Sie Hyeon YOO ; Jae Young JI ; Hae Jin LEE
Korean Journal of Critical Care Medicine 2015;30(3):158-163
BACKGROUND: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. METHODS: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. RESULTS: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. CONCLUSIONS: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
Anesthesia
;
Body Mass Index
;
Catheterization
;
Humans
;
Jugular Veins*
;
Observational Study
;
Palpation
;
Prospective Studies
;
Skin
;
Ultrasonography
;
Valsalva Maneuver*
;
Veins
10.The Anti-Inflammatory Effect of Arginine-Vasopressin on Lipopolysaccharide-Induced IkappaBalpha/Nuclear Factor-kappaB Cascade.
Jisoo PARK ; Eun Young EO ; Kyoung Hee LEE ; Jong Sun PARK ; Jae Ho LEE ; Chul Gyu YOO ; Choon Taek LEE ; Young Jae CHO
Korean Journal of Critical Care Medicine 2015;30(3):151-157
BACKGROUND: Arginine vasopressin (AVP) is widely used as a vasopressor agent. Some recent studies have suggested that AVP may exert an immunomodulatory effect. However, the mechanism about the anti-inflammatory effect of AVP is not well known. We investigated the effect of AVP on the ihibitor of kappa B (IkappaBalpha)/nuclear factor-kappa B (NF-kappaB) pathway in RAW 264.7 cells. METHODS: Cultured RAW 264.7 cells were pretreated with AVP and stimulated with lipopolysaccharide (LPS). To evaluate the effect of AVP on inflammatory cytokines, the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were assessed by an enzyme-linked immunosorbent assay technique. The expression of IkappaBalpha and nuclear translocation of NF-kappaB p65 were measured by Western blotting, and IkappaB kinase (IKK) activity was analyzed by an in vitro immune complex kinase assay. To confirm the AVP effect on IkappaBalpha/NF-kappaB cascade and via V2 receptor, we added tolvaptan (V2 receptor antagonist) after AVP pretreatment. RESULTS: The increase of IL-6 and TNF-alpha in LPS-stimulated RAW 264.7 cells was suppressed by a treatment with AVP. Pretreatment of AVP inhibited increasing of IKK activity and IkappaBalpha degradation induced by LPS in RAW 264.7 cells. Furthermore, LPS induced and NF-kappaB transcription was inhibited by AVP pretreatment. The observed changes in IKK activity, IkappaBalpha degradation and NF-kappaB transcription by AVP was abolished by tolvaptan treatment. CONCLUSIONS: Our results suggest that AVP showed anti-inflammatory effect on LPS-induced IkappaBalpha/NF-kappaB cascade in mouse macrophages via V2 receptors.
Animals
;
Antigen-Antibody Complex
;
Arginine Vasopressin
;
Blotting, Western
;
Cytokines
;
Enzyme-Linked Immunosorbent Assay
;
I-kappa B Kinase
;
Interleukin-6
;
Macrophages
;
Mice
;
NF-kappa B
;
Phosphotransferases
;
Receptors, Vasopressin
;
Tumor Necrosis Factor-alpha