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A Case of Bilateral Vocal Cord Paralysis Due to Subglottic Pressure Injury after Endotracheal Intubation: A Case Report.

Gyu Sik CHOI ; Sang Hoon KIM ; Jae Hyung LEE ; You Lim KIM ; Ji Hyun LEE ; Young Woo JANG ; Eun Sun CHEONG ; Jong Kwan JUNG ; Byoung Hoon LEE

The Korean Journal of Critical Care Medicine.2011;26(3):191-195. doi:10.4266/kjccm.2011.26.3.191

Bilateral vocal cord paralysis may occur as a result of mechanical injury during neck surgery, nerve compression by endotracheal intubation or mass, trauma, and neuromuscular diseases. However, only a few cases of bilateral vocal cord paralysis have occurred following short-term endotracheal intubation. We report a case of bilateral vocal cord paralysis subsequent to extubation after endotracheal intubation and mechanical ventilation due to severe pneumonia for 2 days.
Intubation, Intratracheal ; Neck ; Neuromuscular Diseases ; Pneumonia ; Respiration, Artificial ; Vocal Cord Paralysis ; Vocal Cords

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A Case of Parainfluenza Virus Related Acute Respiratory Distress Syndrome in Immune Competent Adult Patient: A Case Report.

Jae Hee LEE ; In Won PARK ; Jae Yeol KIM ; Jong Wook SHIN ; Byoung Whui CHOI ; Jae Chol CHOI

The Korean Journal of Critical Care Medicine.2011;26(3):188-190. doi:10.4266/kjccm.2011.26.3.188

ParaiParainfluenza virus is a common cause of respiratory illness among infants and young children. Although it causes severe pneumonia in immunocompromised patients, it seldom does this in immunocompetent adults. We report the case of a 51-year-old woman with no significant past medical history who presented acute respiratory distress syndrome caused by parainfluenza virus. The diagnosis was made based on reverse transcriptase-polymerase chain reaction (RT-PCR) of a respiratory specimen. The patient was successfully treated with antiviral agent combined with steroids.
Adult ; Child ; Female ; Humans ; Immunocompromised Host ; Infant ; Middle Aged ; Paramyxoviridae Infections ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Steroids ; Viruses

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A Case of Acute Lung Injury after Transfusion during Cesarean Section: A Case Report.

Hee Jong LEE ; Mi Ae JEONG ; Ji Seon JEONG ; Min Kyu HAN ; Jong Hun JUN

The Korean Journal of Critical Care Medicine.2011;26(3):184-187. doi:10.4266/kjccm.2011.26.3.184

Transfusion-related acute lung injury (TRALI) is a serious complication following the transfusion of blood products. TRALI is under-diagnosed and under-reported because of a lack of awareness. TRALI occurs within 6 hours of transfusion in the majority of cases and its presentation is similar to other forms of acute lung injury. We report on the case of a 34-year-old pregnant woman who suffered from TRALI after transfusion during Cesarean section.
Acute Lung Injury ; Adult ; Blood Transfusion ; Cesarean Section ; Female ; Humans ; Pregnancy ; Pregnant Women

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Transient Hypoglycemia-induced Hemiparesis Mimicking Stroke: A Case Report.

Seong Hwa LEE ; Ji Ho RYU ; Yong In KIM ; Maeng Real PARK ; Mun Ki MIN ; Sun Min HWANG

The Korean Journal of Critical Care Medicine.2011;26(3):181-183. doi:10.4266/kjccm.2011.26.3.181

Hypoglycemia is caused by poor oral intake, excessive exercise, alcohol abuse and inaccurate use of a hypoglycemic agent or insulin in patients that have history of diabetes mellitus (DM), especially in the elderly. Severe hypoglycemia has a variety of different symptoms or signs from focal neurologic deficits to severe coma, or death. It can be difficult to differentiate hypoglycemia-induced symptoms or signs, and stroke or cardiovascular disease in acute setting. Transient hypoglycemic hemiparesis is an infrequent case in the emergency department (ED), which is frequently misdiagnosed for stroke. When patients with decreased mental status or hemiparesis are admitted to the ED, a routine blood sugar test is essential. Hypoglycemic hemiparesis if unrecognized can result in permanent neurological damage. Therefore, it is important to detect hypoglycemia early and treat it appropriately.
Aged ; Alcoholism ; Blood Glucose ; Cardiovascular Diseases ; Coma ; Diabetes Mellitus ; Emergencies ; Humans ; Hypoglycemia ; Insulin ; Neurologic Manifestations ; Paresis ; Stroke

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A Case of Acute on Chronic Salicylate Poisoned Elderly Patient with Early Utilization of Continuous Venovenous Hemodiafiltration: A Case Report.

Ji Sook LEE ; Woo Chan JEON ; Young Gi MIN ; Won Hyun RYU ; Yoon Seok JUNG ; Sang Cheon CHOI

The Korean Journal of Critical Care Medicine.2011;26(3):177-180. doi:10.4266/kjccm.2011.26.3.177

Salicylate poisonings are divided into acute and chronic syndromes. The most challenging aspect of the management of aspirin-poisoning may be recognition of subtle signs and symptoms of chronic, unintentional overdose. Chronic poisoning typically occurs in elderly as a result of unintentional overdosing on salicylates used to treat chronic conditions. Treatment is directed toward preventing intestinal absorption of the drugs and enhanced elimination. After the first-line treatments, aspirin overdose with its complications of hemodynamic, electrolyte and acid-base issues, is best managed by prompt hemodialysis. We report a case of a 87-year-old woman, who presented with acute on chronic salicylate poisoning. After early continuous venovenous hemodiafiltration, old woman made a good recovery from the salicylism but suffered paralytic ileus caused by aspirin enteroliths. Physician can decide a prompt hemodialysis for salicylate-poisoned patients, who worsen clinical courses despite of first-line therapies.
Aged ; Aged, 80 and over ; Aspirin ; Female ; Hemodiafiltration ; Hemodynamics ; Humans ; Intestinal Absorption ; Intestinal Pseudo-Obstruction ; Renal Dialysis ; Salicylates

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Clinical Features of Hospitalized Patients with Community Acquired Pneumonia during 2009 Influenza A (H1N1) Pandemic.

Myung Jae YUN ; Seong Tae LEE ; Hye Jin OH ; Seung June LEE ; Sook Hee SONG ; In SOHN ; Jae Phil CHOI ; Su Hyun KIM

The Korean Journal of Critical Care Medicine.2011;26(3):162-170. doi:10.4266/kjccm.2011.26.3.162

BACKGROUND: A new influenza A(H1N1) virus emerged and spread globally in 2009, and the rapid progression of pneumonia often required ICU care. We describe the cause analysis and clinical aspects of community acquired pneumonia during the period of the pandemic H1N1 influenza A. METHODS: We reviewed the medical records of 48 adult cases of community acquired pneumonia in which patients were admitted to a public health hospital in Seoul from August to November in 2009. The patients had confirmed H1N1 influenza A based on RT-PCR assay. RESULTS: Thirteen cases of the 48 (27.1%) were 2009 H1N1 RT-PCR positive patients and three (6.3%) of these cases were mixed viral and bacterial pneumonia patients. The mean age was younger and the PSI score was lower in H1N1 patients. Chest radiographic findings of ground glass opacity and interstitial marking were remarkable in H1N1 patients. Major complication events with ICU care or death occurred in 23.1% of the H1N1 positive group and 48.6% of the H1N1 negative group (p=0.202). The major complication group of H1N1 patients had a higher PSI score, lower platelet count, higher CRP and higher mixed bacterial co-infection. CONCLUSIONS: If patients were younger and showed a radiologic finding of interstitial marking or ground glass opacity, we could consider H1N1 influenza as the cause of community acquired pneumonia. A high PSI score, thrombocytopenia, increased CRP and bacterial co-infection were predictable factors of major complication.
Adult ; Coinfection ; Glass ; Humans ; Influenza, Human ; Medical Records ; Pandemics ; Platelet Count ; Pneumonia ; Pneumonia, Bacterial ; Public Health ; Thorax ; Thrombocytopenia ; Viruses

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Predictors of Mortality and Complication in Pediatric Patients Who Require Continuous Renal Replacement Therapy in Pediatric Intensive Care Unit.

Jae Wook CHOI ; Woo Jin CHUNG ; Young Joo HAN ; Ju Kyung LEE ; Dong In SUH ; June Dong PARK ; Young Yull KOH

The Korean Journal of Critical Care Medicine.2011;26(3):171-176. doi:10.4266/kjccm.2011.26.3.171

BACKGROUND: The objective of this study is to analyze the factors associated with mortality and complication in children requiring continuous renal replacement therapy (CRRT) in a pediatric intensive care unit. METHODS: We retrospectively analyzed 96 patients who required CRRT at a pediatric intensive care unit in Seoul National University Hospital between April 2005 and April 2011. We evaluated the clinical features, diagnosis, mortality risk factors and complications related to CRRT. RESULTS: Univariate and multivariate analyses were performed to analyze the mortality risk factors of patients requiring CRRT. The overall mortality was 56.3%, the median age was 8 years, and the ages ranged from 4 days to 22 years. The median weight of the patients was 7.9 kg, and the weights ranged from 3.6-72.9 kg. 16 patients were diagnosed with primary renal disease, and the remainder with other underlying diseases. Mortality was higher in children who received stem cell transplantation and in children with a diagnosis of imunologic disease and neurologic disease. The Pediatric Risk of Mortality (PRISM) III score at initiating CRRT was 17.8 +/- 8.9 and the degree of fluid overload at CRRT (FO%) was 12.9 +/- 16.0. The PRISM III score at the start of CRRT and low uric acid level were the factors associated with an increased risk of mortality. Of the 96 children, 13 (13.53%) presented problems of venous catheterization. Hypotension during connection to CRRT was detected in 28 patients (29.2%). Clinically significant hemorrhage occurred in 10 patients (10.4%). CONCLUSIONS: Children who require CRRT have a high mortality rate. The higher score of PRISM III at the starting time of CRRT and the lower uric acid level are the factors associated with a higher mortality. The most frequent complication of CRRT was hypotension on connection to CRRT.
Acute Kidney Injury ; Catheterization ; Catheters ; Child ; Hemorrhage ; Humans ; Hypotension ; Critical Care ; Intensive Care Units ; Multivariate Analysis ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Stem Cell Transplantation ; Uric Acid ; Weights and Measures

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Thyroid Hormonal Changes in Brain Death Donors.

Jae Myeong LEE ; Young Joo LEE

The Korean Journal of Critical Care Medicine.2011;26(3):157-161. doi:10.4266/kjccm.2011.26.3.157

BACKGROUND: We analyzed thyroid hormone values in brain death patients to determine the need for thyroid hormone replacement therapy. METHODS: We analyzed 111 brain death donors (77 males and 34 females, mean age, 41.1 years (range; 8 months -72 years) in Ajou University Hospital from 2000 to 2010. RESULTS: The mean values of thyroid hormones were T3; 72.5 ng/dl (normal range [NR] 60-181 ng/dl), T4; 5.0 microg/dl (NR 4.5-10.9 microg/dl), free T4 1.0 ng/dl (NR 0.8-1.5 ng/dl), and TSH 1.5 microIU/ml (NR 0.35-5.5 microIU/ml), respectively. However, the values of T4 (correlation coefficient -0.264, p = 0.005), free T4 (correlation coefficient -0.305, p = 0.001) and TSH (correlation -0.206, p = 0.031) significantly decreased based on the increase of interval from the brain death-inducing event to the evaluation time (hereafter, interval). The patients with greater than 8 days of interval (N = 30) showed significantly low thyroid hormone values compared to patients with less than 8 days of interval (N = 81); T3 (70.3 ng/dl vs. 77.0 ng/dl, p = 0.242), T4 (4.7 ng/dl vs. 5.3 ng/dl, p = 0.015), free T4 (0.8 ng/dl vs. 1.2 ng/dl, p = 0.006) and TSH (1.0 microIU/ml vs. 2.0 microIU/ml, p = 0.000), respectively. CONCLUSIONS: As the intervals from the brain death-inducing events increased, all thyroid hormone values of brain death donors except T3 significantly decreased. Therefore, we recommend that careful consideration should be given to the interval from brain death-inducing event for the evaluation of thyroid hormone status of brain death patients.
Brain ; Brain Death ; Female ; Humans ; Male ; Thyroid Gland ; Thyroid Hormones ; Tissue Donors

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A Retrospective Study about Characteristics of Out-of-hospital Cardiac Arrest Caused by Non-traumatic Subarachnoid Hemorrhage.

Min Seob SIM ; Ki Dong SUNG ; Mun Ju KANG ; Ji Ung NA ; Tae Gun SHIN ; Ik Joon JO ; Hyoung Gon SONG ; Keun Jeong SONG ; Yeon Kwon JEONG

The Korean Journal of Critical Care Medicine.2011;26(3):151-156. doi:10.4266/kjccm.2011.26.3.151

BACKGROUND: Subarachnoid hemorrhage is a fatal disease relatively common in the East Asian population. It can lead to cardiac arrest in several pathologic processes. We attempted to elucidate the characteristics of out-of-hospital cardiac arrest caused by non-traumatic subarachnoid hemorrhage. METHODS: We conducted a retrospective, observational study in which patients who had visited Samsung medical center emergency room for out-of-hospital cardiac arrest from January, 1999 to December 2008 were enrolled. A total of 218 OHCA patients who had achieved ROSC were investigated by review of medical charts. Excluding those who had worn trauma, we analyzed 22 patients who had been diagnosed for SAH by brain non-contrast CT scan. RESULTS: Median age of aneurysmal SAH-induced OHCA patients was 61 (IQR 54-67) years. Fourteen patients (64%) were female and 15 patients (68%) were witnessed. Besides, 7 patients (32%) had complained of headache before collapse. We also found 11 patients (50%) had been diagnosed with hypertension previously. All of them showed unshockable rhythm (asystole 60%, PEA 40%) initially. Their median duration of ACLS was 10 minutes. Majority of patients died within 24 hours and survivors showed poor neurologic outcome. CONCLUSIONS: Subarachnoid hemorrhage is a relatively uncommon cause of cardiac arrest, and the outcome of OHCA induced by SAH is very poor. However, emergency physicians have to consider the possibility of SAH when trying to determine the cause of arrest, especially when treating patients who have the characteristics described above.
Aneurysm ; Asian Continental Ancestry Group ; Brain ; Emergencies ; Female ; Headache ; Heart Arrest ; Humans ; Hypertension ; Out-of-Hospital Cardiac Arrest ; Pathologic Processes ; Peas ; Retrospective Studies ; Subarachnoid Hemorrhage ; Survivors ; Wit and Humor as Topic

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The Clinical Significance of Weight Change in Mechanical Ventilated, Critically Ill Patients of ICU.

Young Sun SEO ; You Eun KIM ; Seung Jun LEE ; Yu Ji CHO ; Yi Yeong JEONG ; Ho Cheol KIM ; Jong Deok LEE ; Young Sil HWANG

The Korean Journal of Critical Care Medicine.2011;26(3):139-144. doi:10.4266/kjccm.2011.26.3.139

BACKGROUND: Critically ill patients may show significant weight change in their course of disease during ICU stay. However, what weight changes occur and their effects on patient outcome have not yet been reported to our knowledge. Therefore, we evaluated weight change in critically ill patients in the medical ICU and the effect this may have on clinical outcome. METHODS: We measured body weight in patients admitted to the medical ICU daily and evaluated their clinical characteristics and outcome. RESULTS: Thirty-eight patients (M:F = 30:8, mean age = 65.7 +/- 12.5) were enrolled. Thirteen patients (34.2%) showed weight gain and the mean change was 12.8 +/- 4.2%. In contrast, 25 patients (65.8%) showed weight loss and the mean change was 6.3 +/- 6.9%. Patients who showed weight change over 5% or 10% were 26 (68.4%), and 12 (31.6%), respectively, and their mortality rates were 61.5% and 75%, respectively, showing no statistical significance (p > 0.05). However, when the degree of weight change was stratified with < 5%, 5-10% and > 10%, it was associated with death (p = 0.002). Factors like ICU stay, day of mechanical ventilation, initial APACHE II and SOFA score, body mass index (BMI) and serum albumin were not associated with more than 5% change of weight. BMI at admission was only associated with > 10% change of weight (p < 0.05). CONCLUSIONS: The majority of critically ill patients showed a significant weight change during their ICU stay and these patients may have a tendency to have worse clinical outcome.
APACHE ; Body Mass Index ; Body Weight ; Critical Illness ; Humans ; Respiration, Artificial ; Serum Albumin ; Weight Gain ; Weight Loss

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