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Ventricular Fibrillation Soon after Endobronchial Epinephrine Application in a Young Man: A Case Report.

Young Min SHIN ; Jong Hyung KIM ; Hyung Wook KIM ; Bo Sik CHOI ; Jin Gyu JEONG ; Jung Won HWANG ; Kwang Won SEO ; Jong Joon AHN ; Seung Won RA

The Korean Journal of Critical Care Medicine.2011;26(4):276-280. doi:10.4266/kjccm.2011.26.4.276

Ventricular fibrillation and cardiac arrest rarely occur after local application of epinephrine. Local and superficial application of epinephrine is a common hemostatic method during bronchoscopy, especially after biopsies. Although high plasma levels following endobronchial application of epinephrine have been observed in previous animal studies, there is no report of ventricular fibrillation after a usual dose of endobronchial application of epinephrine during bronchoscopy. We present a case of endobronchial epinephrine-induced ventricular fibrillation and cardiac arrest in a 31-year-old man with no previous history of cardiac disease.
Adult ; Animals ; Biopsy ; Bronchoscopy ; Epinephrine ; Heart Arrest ; Heart Diseases ; Humans ; Plasma ; Ventricular Fibrillation

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A Case of Massive Pulmonary Thromboembolism Associated with Ramsay Hunt Syndrome: A Case Report.

Jong Hoo LEE ; Seong Joo KOH ; Gil Myeong SEONG ; Miok KIM ; Jae Chun LEE ; Sang Hoon HAN ; Jay Chol CHOI ; Yee Hyung KIM

The Korean Journal of Critical Care Medicine.2011;26(4):267-271. doi:10.4266/kjccm.2011.26.4.267

Ramsay Hunt syndrome associated with the Varicella zoster virus (VZV) infection is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. Although significant complications from VZV infection are increasing, thrombosis associated with VZV infection is one of the rare complications in adults. The VZV itself could cause endothelial damage in the various organs. Subsequently, the thrombosis might be complicated. A previously healthy 84 year-old female patient was diagnosed with Ramsay Hunt syndrome. On the 7th day of antiviral treatment, she complained of sudden breathlessness. She was hypoxemic with an elevated alveolar-arterial oxygen difference and needed to be supported by mechanical ventilation. Massive pulmonary thrombosis was documented by computerized tomography and she successfully underwent thrombolytic therapy. We report a case of massive pulmonary thromboembolism associated with VZV infection, treated with thrombolytic therapy.
Adult ; Earache ; Facial Nerve ; Female ; Hearing Loss, Sensorineural ; Herpes Zoster ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Humans ; Oxygen ; Paralysis ; Parkinsonian Disorders ; Pulmonary Embolism ; Respiration, Artificial ; Thrombolytic Therapy ; Thrombosis

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High-frequency Chest Wall Oscillation Therapy: Clinical Effectiveness in the Patients with Pulmonary Contusion.

Dae Sup LEE ; Sung Wook PARK ; Suk Ran YEOM ; Sang Kyoon HAN ; Sung Hwa LEE ; Ji Ho RYU

The Korean Journal of Critical Care Medicine.2011;26(4):256-260. doi:10.4266/kjccm.2011.26.4.256

BACKGROUND: Pulmonary contusion is the most common pulmonary parenchymal injury in blunt chest trauma and may constitute a life-threatening thoracic injury. In this study, we evaluated the usefulness of high-frequency chest wall oscillation (HFCWO) therapy in patients with pulmonary contusion. METHODS: Patients with lung contusion either received HFCWO therapy using the Vest system (Vest group; n = 18) or received conventional chest physiotherapy (non-Vest group; n = 23). The physiological parameters of the patients, length of stay in hospital and ICU, and the duration of mechanical ventilation were compared between the two groups. Variables, including pulmonary contusion score, percentage of patients receiving mechanical ventilation therapy, and PaO2/FiO2 ratio, were also analyzed. RESULTS: The pulmonary contusion score was higher in the Vest group (p < 0.01), and mechanical ventilation was used more frequently in the Vest group (p = 0.027). Improvement in the PaO2/FiO2 ratio over the first 48 h did not differ between the Vest and Non-Vest groups. No significant differences in the physiological parameters, hospital and ICU stays, and duration of mechanical ventilation were observed between the two groups. CONCLUSIONS: The therapeutic effect of the Vest system in patients with pulmonary contusion was similar to that of conventional chest physiotherapy. Therefore, the Vest system could be considered as an airway clearance technique in the management of patients with pulmonary contusion.
Chest Wall Oscillation ; Contusions ; Humans ; Length of Stay ; Lung ; Lung Injury ; Respiration, Artificial ; Thoracic Injuries ; Thorax

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Central Venous Catheter-related Infection in Major Burn Patients: Comparison of Subclavian Vein and Femoral Vein.

Young Ho JANG ; Yong Hoon SON ; Sang Kyu KIM ; Joon Mo PARK ; Mi Young LEE ; Jin Mo KIM

The Korean Journal of Critical Care Medicine.2011;26(4):245-249. doi:10.4266/kjccm.2011.26.4.245

BACKGROUND: A central venous catheter (CVC) is usually inserted in patients with severe burns and the selection of the CVC is often difficult due to widespread burned skin. We investigated the incidences of colonization and catheter-related blood stream infection (CRBSI) according to the insertion site of the CVC in major burn patients METHODS: In 63 adult massive burn patients in the intensive care unit, 93 CVCs (47 polyurethane standard CVCs and 46 Oligon anti-mocrobial CVCs) were randomly inserted via the subclavian vein (SCV group, n = 66) or femoral vein (FEV group, n = 27). All catheter tips removed were routinely cultured. Bacterial findings from the burn wound and peripheral blood were also monitored in all patients RESULTS: There was no significant difference in the average insertion length of the CVC (14.3 +/- 6.8 days in SCV and 13.6 +/- 3.8 days in FEV) between the two groups. There were no significant differences in CVC colonization (48.5% in SCV and 63.0% in FEV) and CRBSI (7.6% in SCV and 11.1% in FEV) between the two groups. Logistic analysis found that the use of polyurethane standard CVC is significantly associated with increased risk of CVC colonization (odds ratio = 2.68) CONCLUSIONS: The placement of the CVC via the femoral vein does not increase the incidence of CVC colonization in massive burn patients. The use of Oligon anti-microbial CVC may be helpful to reduce CVC colonization in major burn patients.
Adult ; Bacteremia ; Burns ; Catheter-Related Infections ; Catheters ; Central Venous Catheters ; Colon ; Femoral Vein ; Humans ; Incidence ; Intensive Care Units ; Polyurethanes ; Rivers ; Skin ; Subclavian Vein

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Prediction of Prognosis for Children Cared in Intensive Care Unit (ICU) after Hematopoietic Stem Cell Transplantation (HSCT).

Hye Sun CHOI ; Eun Jung LEE ; Jae Wook LEE ; Pil Sang JANG ; Nack Gyun CHUNG ; Bin CHO ; Hack Ki KIM ; Dae Chul JEONG

The Korean Journal of Critical Care Medicine.2011;26(4):226-231. doi:10.4266/kjccm.2011.26.4.226

BACKGROUND: Pediatric Index of Mortality 2 (PIM2) is a useful scoring system for the prediction of prognosis, and Oncological Pediatric Risk of Mortality (O-PRISM) for ICU support in children with HSCT. We investigated prognostic prediction and risk factors for survival through early detection of admission to ICU after HSCT. METHODS: We reviewed retrospectively medical records of children cared for in ICU after HSCT between 2004 and 2010. Patients who died within 2 hours after admittance to ICU were excluded. We analyzed the worst parameters in ICU by a t-test, Cox-regression, multiple logistic regression and a receiver operating characteristics curve (ROC). RESULTS: 54 children, with fifty-five disease events, were admitted to ICU after HSCT. Sixteen children were diagnosed with high-risk disease status and 8 with non-malignant diseases. Stem cells were sourced from 14 matched siblings, 22 unrelated donors and 19 cord bloods. The median duration in ICU was 8.5 days (0.5-110). The reasons for admission to ICU were 32 pulmonary, 14 neurologic, and 9 hemodynamic events. Six patients (11.1%) survived after intensive care. The factor indicating discharge with survival was mental status (p = 0.04), although other factors included FiO2, prothrombin time, potassium, and pupil reflex in univariate analysis. In multiple logistic regression, there were significant factors of PaCO2 (p = 0.028), O-PRISM (p = 0.039), and PIM2 (p = 0.004) for prognosis. For prediction of prognosis, O-PRISM (p = 0.019) was superior to PIM2 (p = 0.435) in intensive care children after HSCT. CONCLUSIONS: O-PRISM might be a predictable scoring system for children with ICU support, and the Glasgow coma scale and PaCO2 were more reliable prognostic factors in the post-HSCT period.
Child ; Fetal Blood ; Glasgow Coma Scale ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Hemodynamics ; Humans ; Critical Care ; Intensive Care Units ; Logistic Models ; Medical Records ; Potassium ; Prognosis ; Prothrombin Time ; Pupil ; Reflex ; Retrospective Studies ; Risk Factors ; ROC Curve ; Siblings ; Stem Cells ; Unrelated Donors

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Prediction of Mortality in Patients with Acute Paraquat Intoxication Using Simplified Acute Physiology Score II.

Young yeol YOU ; Younggi MIN ; Junghwan AHN ; Sang Cheon CHOI ; Yeonho SHIN ; Yoonseok JUNG ; Eunjung PARK

The Korean Journal of Critical Care Medicine.2011;26(4):221-225. doi:10.4266/kjccm.2011.26.4.221

BACKGROUND: The prognosis of paraquat intoxication patients is poor and this makes the prediction of mortality important in administering aggressive treatment and admission. This article investigates the usefulness of simplified acute physiology score II (SAPS II), as a predictor of the mortality in paraquat intoxication. METHODS: We retrospectively reviewed 65 patients who were admitted in one hospital between January in 2005 and December in 2010. We calculated their SAPS II, serum paraquat level, and severity index of paraquat poisoning (SIPP) at the time of intensive care unit (ICU) admission. We investigated the relationship between each systems and the mortality. RESULTS: Overall mortality was 73.8%: 48 out of 65 patients died. Non-survived group (n = 48) had a higher SAPS II score (30.44 +/- 15.99) than survived group (n = 17 [15.7 +/- 6.26], p < 0.001). Serum paraquat level and SIPP were significantly higher in non-survived group than in survived group (p < 0.05, in all comparisons). By using the area under receiver operating characteristic curves (AUC), the SAPS II system yielded equal discriminative power (AUC = 0.82) with serum paraquat level (AUC = 0.896) and SIPP (AUC = 0.865). Hosmer-Lemeshow goodness-of-fit test C indicated SAPS II score validated well in paraquat intoxication group (p = 0.33). CONCLUSIONS: Serum paraquat level is the best way for prediction of mortality in patients with acute paraquat intoxication. If checking serum paraquat level is impossible or delayed, SAPS II score can be an alternative tool for evaluating the prognosis in paraquat intoxication.
Humans ; Intensive Care Units ; Paraquat ; Prognosis ; Research Design ; Retrospective Studies ; ROC Curve

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A Study on Estimating the Blood Pressure by Using the Pulse Wave Transit Time in Shock Patients Who Received Vasopressor Drugs.

Gyeong Nam PARK ; Won Young SUNG ; Sang Won SEO ; Sung Youp HONG ; Young Mo YANG ; Jang Young LEE ; Nak Jin SUNG ; Hee Bum YANG

The Korean Journal of Critical Care Medicine.2009;24(1):11-16. doi:10.4266/kjccm.2009.24.1.11

BACKGROUND: Blood pressure is clinically used for monitoring shock patients and as a therapeutic indicator for them. Non-invasive blood pressure measurement has weak points such as the use of a cuff and it is a discontinuous measurement. A method of measuring the blood pressure by using the PWTT (pulse wave transit time) has been studied to make up for those weak points. If blood pressure monitoring can be done by using the difference of the PWTT between different points in the body, then this method will be a quite useful to monitor the BP of seriously ill patients. This study aimed to verify whether or not the PWTT has a significant correlation with the blood pressure of shock patients who received vasopressor infusion and whether this method is clinically applicable. METHODS: The study subjects were 20 shock patients who were hospitalized in intensive care units and they had received vasopressor, and we measured the PWTT and we analyzed its correlation with the SBP (systolic blood pressure) and DBP (diastolic blood pressure), as measured by non-invasive monitoring. We then determined the effects of the PWTT on the SBP and DBP. RESULTS: From the results of correlation analysis between the PWTT and the SBP and DBP, the SBP displayed a statistically significant negative correlation with the PWTT of 18 patients, while no significant correlation between the PWTT and DBP was observed. At the same time, from the results of the regression analysis of the blood pressures and the PWTT of each patient, it was found that the PWTT had a negative effect on the SBP of all the patients, except two. CONCLUSIONS: The PWTT has a negative correlation with the SBP of the patients who received vasopressor infusion.
Blood Pressure ; Blood Pressure Monitors ; Humans ; Intensive Care Units ; Organothiophosphorus Compounds ; Pulse Wave Analysis ; Shock

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Management of Brain Injury after Post-cardiac Arrest Syndrome.

Jong Ho CHOI

The Korean Journal of Critical Care Medicine.2009;24(1):1-3. doi:10.4266/kjccm.2009.24.1.1

In spite of improvement in cardiopulmonary resuscitation (CPR) techniques, post-CPR mortality and brain injury rates have not changed significantly. The post-cardiac arrest syndrome has been suggested to be the major reason for the high mortality rate after CPR. Post-cardiac arrest syndrome, including brain injury, myocardial dysfunction, and septic shock-like syndrome after CPR, result in complicated multiple organ failure. Physicians who work in the ICU should have a good understanding of thepathophysiology of post-cardiac arrest syndrome. Recently, therapeutic hypothermia treatment for protection of brain injuries has been applied as a therapeutic regimen in spite of various side effects during the hypothermic procedure. Finally, therapeutic hypothermic treatment to reduce brain injury in post-cardiac arrest syndrome patients is strongly recommended to physiciansmanaging CPR. I would like to briefly review the therapeutic hypothermic procedure for the management of post-cardiac arrest syndrome.
Brain ; Brain Injuries ; Cardiopulmonary Resuscitation ; Humans ; Hypothermia ; Multiple Organ Failure

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The S100B Protein Could Be Used as Adjuvant Diagnostic Tool in Acute Ischemic Stroke.

Min Hee JUNG ; Dong Hoon LEE ; Chan Woong KIM

The Korean Journal of Critical Care Medicine.2011;26(4):217-220. doi:10.4266/kjccm.2011.26.4.217

BACKGROUND: In the emergency department, the diagnosis of ischemic stroke is difficult because the diagnostic modalities are limited to non-contrast brain CT and neurologic examination. Serum S100B protein, a bio-marker for ischemic stroke, is needed as an additional diagnostic aid in acute ischemic stroke. METHODS: We retrospectively reviewed 50 patients diagnosed with ischemic stroke between August 2007 and December 2008 by brain MRI after brain CT and serum S100B measurement in the emergency department. The serum levels of S100B protein were analyzed and the diagnostic sensitivity of non-contrast brain CT combined with abnormal elevation of S100B protein was compared with that of non-contrast brain CT alone. RESULTS: The overall sensitivity of non-contrast brain CT in the diagnosis of ischemia was 54%. S100B protein in early ischemia had a sensitivity of 58%. However, combining non-contrast brain CT and S100B increased the sensitivity to 74%. CONCLUSIONS: A biomarker-based diagnostic test would not replace the necessity for CT or other early imaging studies, and before contemplating any reperfusion strategy, neuro-imaging must be performed to rule out intracranial hemorrhage. However, S100B protein, a serum bio-marker, is able to help emergency physicians evaluate patients with suspected ischemic stroke and decide on treatment.
Brain ; Diagnostic Tests, Routine ; Early Diagnosis ; Emergencies ; Humans ; Intracranial Hemorrhages ; Ischemia ; Nerve Growth Factors ; Neurologic Examination ; Reperfusion ; Retrospective Studies ; S100 Proteins ; Stroke

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The Analgesic Effect of Remifentanil on Propofol Injection Pain.

Younghoon JEON ; Min Je CHOI ; Choon Hak LIM

The Korean Journal of Critical Care Medicine.2011;26(4):212-216. doi:10.4266/kjccm.2011.26.4.212

BACKGROUND: Pain is a common side-effect of propofol injection. A remifentanil pretreatment has been reported to decrease the incidence and intensity of pain during a propofol injection and has been suggested to act through a central or peripheral effect. This trial was designed to explore the action site of remifentanil on reducing propofol injection pain, using the venous occlusion technique and a time interval between the applications of remifentanil and propofol. METHODS: This randomized, double-blind study was designed to explore the action site of remifentanil on reducing propofol injection pain in 200 patients scheduled for elective surgery. The peripheral properties were examined using the venous occlusion technique for 30 s while a 1 min time interval between remifentanil and propofol injections was allowed for the central effect. Before the propofol injection, group A was pretreated with remifentanil (0.5 microg/ kg) with a venous occlusion, group B with remifentanil and a 1 min interval, and group C with remifentanil with a venous occlusion and a 1 min interval. Pain severity was assessed using a four-point scale. RESULTS: 40 patients (80%) complained of pain in the placebo group compared with 35 (70%) in group A, 20 (40%) in group B (p < 0.05) and 17 (34%) in group C (p < 0.05). The incidence and severity of propofol injection pain were lower in groups B and C than in group A (p < 0.05). However, there was no significant difference between groups B and C. CONCLUSIONS: The remifentanil mediated analgesic effect occurs mainly through the central effect.
Double-Blind Method ; Humans ; Incidence ; Piperidines ; Propofol

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