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ABSTRACT: Background:To investigate the clinical outcomes of witnessed and/or monitored cases of in-hospital cardiac arrest (IHCA) that occurred on the general ward of a university hospital in Korea.Methods:We prospectively gathered data on all IHCA events that occurred on the general ward of the Asan Medical Center (Seoul, South Korea) and were recorded by medical emergency team records between March 2008 and February 2010. The main outcomes included survival to hospital discharge, incidence of IHCA, and prognostic factors related to hospital mortality. In addition, we also investigated preventable cases.Results:In total, 238 index cases of IHCA were identified. The average estimated incidence of IHCA was 0.145 events per 1000 patient admissions. Survival to hospital discharge was 19% (46 cases). Of these IHCA cases, 66% were due to non-cardiac causes, and 77% were due to medical illnesses. Besides the most common first documented rhythm was pulseless electrical activity (38%). Two hundred and three cases (85.3%) of IHCA were witnessed at the event; 135 cases (56.7%) were monitored at the event. Non-witnessed cases, monitored cases, night onset, medical illness, metastatic cancer, intubation, and long duration of cardiopulmonary resuscitation were significantly associated with hospital mortality according to logistic regression model. We identified 91 preventable cases (38%) in this study. Respiratory insufficiency (37 cases; 41%) was one of major causes of preventable cases.Conclusions:Witnessed cases of IHCA that occur on the general ward demonstrate a higher rate of survival to hospital discharge; however, monitored cases demonstrate a lower rate of survival to hospital discharge. Respiratory insufficiency was a major preventable cause leading to cardiac arrest. In consideration of the preventable cases of IHCA, further studies should be performed on the monitoring practices that are implemented on general wards.
Respiratory care 04/2013; · 2.01 Impact Factor
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ABSTRACT: PURPOSE OF REVIEW: To describe the newly introduced ventilation parameters that are used at the bedside to estimate cardiopulmonary function during positive pressure ventilation (PPV). RECENT FINDINGS: PPV induces right atrial pressure changes over the ventilator cycle. Positive end-expiratory pressure-induced central venous pressure changes and pulse pressure variation have been introduced as parameters that predict fluid responsiveness. Pulse pressure variation seems to be valid even at low tidal volume ventilation. A capnometer can be used to measure low perfusion lung area and to monitor the continuous breath-by-breath cardiac output of ventilated patients. Ultrasound evaluation of the lung parenchyma and diaphragm status is likely to become more popular. To evaluate ventilator settings, functional residual capacity (FRC) measurement and visual lung recruitment estimation via electric impedance tomography (EIT) have been introduced. SUMMARY: The utility of lung ultrasound is expanding. Although the clinical implications of FRC measurement and lung monitoring with imaging tools such as EIT are starting to be realized, their efficacy in severe hypoxic respiratory failure should be evaluated further in well designed clinical trials. To improve the preemptive management of impending respiratory failure, an alarm index that integrates noninvasive cardiopulmonary function parameters should be developed.
Current opinion in critical care 04/2013; · 2.67 Impact Factor
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Jae Yeol Kim,
So Yeon Lim,
Kyeongman Jeon, Younsuck Koh,
Chae-Man Lim,
Shin Ok Koh,
Sungwon Na,
Kyoung Min Lee,
Byung Ho Lee,
Jae-Young Kwon,
Kook Hyun Lee,
Seok-Hwa Yoon,
Jisook Park,
Gee Young Suh
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ABSTRACT: Purpose: This study was designed to validate the usefulness of the Acute Physiology and Chronic Health Evaluation (APACHE) II for predicting hospital mortality of critically ill Korean patients. Materials and Methods: We analyzed data on 826 patients who had been admitted to nine intensive care units and were included in the Fever and Antipyretics in Critical Illness Evaluation study cohort. Results: Among the patients enrolled, 62% (512/826) were medical and 38% (314/826) were surgical patients. The median APACHE II score was 17 (11 to 23 interquartile range), and the hospital mortality rate was 19.5%. Age, underlying diseases, medical patients, mechanical ventilation, and renal replacement therapy were independently associated with hospital mortality. The calibration of APACHE II was poor (H=57.54, p<0.0001; C=55.99, p<0.0001), and the discrimination was modest [area under the receiver operating characteristic (aROC)=0.729]. Calibration was poor for both medical and surgical patients (H=63.56, p<0.0001; C=73.83, p<0.0001, and H=33.92, p<0.0001; C=33.34, p=0.0001, respectively), while discrimination was poor for medical patients (aROC=0.651) and modest for surgical patients (aROC=0.704). At the predicted risk of 50%, APACHE II had a sensitivity of 36.6% and a specificity of 87.4% for hospital mortality. Conclusion: For Koreans, the APACHE II exhibits poor calibration and modest discrimination for hospital mortality. Therefore, a new model is needed to accurately predict mortality in critically ill Korean patients.
Yonsei medical journal 03/2013; 54(2):425-31. · 0.77 Impact Factor
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ABSTRACT: PURPOSE: The study aimed to determine whether improvements in intensive care unit (ICU) structural environment affect the incidence of ICU-acquired infections (IAIs), particularly those caused by multidrug-resistant pathogens. METHODS: The incidence of IAI and the number of infections caused by organisms during the 6 months immediately before ICU renovation and during the 6 months immediately after ICU renovation were compared. The observational duration was prolonged for an additional 1 year after recruiting the after-renovation data to observe if the found effect of ICU structural renovation is maintained. The relevant data were prospectively gathered. RESULTS: The overall IAI incidence and distribution of infection site showed no difference in both periods. In IAI-causing pathogens, no considerable difference was found between before and after renovation, except for Acinetobacter baumannii. In comparison of the major pathogens' identification rate between the entire hospital and the renovated ICU during the study periods, only A baumannii cases in the renovated ICU significantly decreased. However, the reduction of the IAI cases by A baumannii was not sustained for more than 1 year. CONCLUSIONS: These results suggest that structural ICU renovations only may not improve overall IAI incidence, except for transient decrease in IAI by A baumannii.
Journal of critical care 02/2013; · 2.13 Impact Factor
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ABSTRACT: BACKGROUND: The Surviving Sepsis Campaign (SSC) to improve patient outcomes in severe sepsis and septic shock contains recommendations for protocolised resuscitation including early goal-directed therapy (EGDT) resuscitation. In EGDT, central venous oxygen saturation (ScvO(2)) is measured as the target monitoring value. The objective of this study was to determine whether intermittent measurement of ScvO(2) is as clinically effective as continuous monitoring in EGDT implementation. METHODS: This prospective, observational, pilot study was performed at an emergency room and general ward in ASAN Medical Centre, a 2680-bed teaching hospital. One hundred and six patients with severe sepsis or septic shock were enrolled and assigned to an intermittent monitoring group (n=53) or continuous monitoring group (n=53). RESULTS: Within 6 h of the EGDT, interventions by the treating physicians were assessed, including intravenous fluid administration, use of vasopressors and compliance with SSC bundles. After 6 h of the EGDT, 41.5% of all goals (primary outcome) were achieved in the intermittent group and 35.8% in the continuous group (p=0.550). Intensive Care Unit (ICU) mortality, hospital mortality and length of ICU stay did not differ between groups. CONCLUSIONS: During EGDT, intermittent ScvO(2) monitoring was not inferior to continuous ScvO(2) monitoring when delivered within the first 6 h of intervention.
Emergency Medicine Journal 11/2012; · 1.44 Impact Factor
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ABSTRACT: Although cardiac troponin I (cTnI) elevations during acute pulmonary embolism (PE) are predictive of in-hospital death, it is not clear whether cTnI measurements at emergency department (ED) admission are predictive of the occurrence of hypotension. The study subjects included all consecutive patients with acute PE (diagnosed by chest computed tomography angiography) in the ED between January, 2006 and December, 2011. All underwent cTnI tests at ED admission and were divided into two groups based on the occurrence of hypotension within 24 h. Of 457 stable patients with acute PE who were admitted to the ED during the study period, 301 patients were included. Within 24 h of hospitalization, 27 (9.0%) developed hypotension. The patients who developed hypotension had a significantly higher mean cTnI concentration than the remaining patients (1.01 vs. 0.14 ng/mL, P<0.00). They were also more likely to be treated with thrombolytic therapy and had higher 28-day and 6-month mortality rates. cTnI elevation (>0.05 ng/mL) at ED admission was a strong predictor of the development of hypotension within 24 h (odds ratio 8.2, 95% CI 2.6-26.1, p = 0.00). The sensitivity, specificity, positive predictive value, and negative predictive value of elevated cTnI were 85%, 66%, 20%, and 98%, respectively. This study suggests that a normal cTnI nearly rules out subsequent development of hypotension within 24 h. This may help to select those patients who would benefit most from intensive clinical surveillance and escalated treatment.
Shock (Augusta, Ga.) 11/2012; · 2.87 Impact Factor
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Byung Ho Lee,
Daisuke Inui,
Gee Young Suh,
Jae Yeol Kim,
Jae Young Kwon,
Jisook Park,
Keiichi Tada,
Keiji Tanaka,
Kenichi Ietsugu,
Kenji Uehara, [......],
Shinhiro Takeda,
Shinsuke Saito,
Sung Jin Hong,
Takeshi Yamamoto,
Takeshi Yokoyama,
Takuhiro Yamaguchi,
Tomoki Nishiyama,
Toshiko Igarashi,
Yasuyuki Kakihana, Younsuck Koh
Critical care (London, England) 10/2012; 16(5):450. · 4.61 Impact Factor
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ABSTRACT: Introduction: Ceftazidime is a third-generation cephalosporin that has activity against Gram-negative bacilli, including Pseudomonas aeruginosa. The increasing prevalence of antimicrobial resistance and the limited number of antimicrobial agents in development have necessitated a review of the current status of treatments involving ceftazidime. Areas covered: This review focuses on studies examining the in vitro antibacterial activity of ceftazidime against recent clinical isolates and recent randomized controlled trials studying the clinical efficacy of ceftazidime, and discusses strategies for the optimal use of ceftazidime for treating respiratory tract infections, mainly hospital-acquired pneumonia (HAP). Expert opinion: Although ceftazidime remains an important option for HAP treatment, its role as an effective antimicrobial agent has been compromised by the sharp increase in resistance rates over the last decade, especially in P. aeruginosa and Acinetobacter baumannii. To maintain or improve the clinical use of ceftazidime in patients with severe HAP, it will be essential to gain a thorough understanding of local resistance patterns, reserve ceftazidime use when pathogens are susceptible to other third-generation cephalosporins, optimize ceftazidime therapy using prolonged or continuous infusion, determine the effectiveness of the combination of ceftazidime with inhibitors of broad-spectrum β-lactamases and role of combination therapy for P. aeruginosa infections, and judiciously use antimicrobial agents through individualization of antimicrobial therapy for HAP.
Expert Opinion on Pharmacotherapy 09/2012; 13(14):2097-109. · 3.20 Impact Factor
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ABSTRACT: We hypothesized that the time from sepsis to inception of continuous renal replacement therapy (CRRT) can be used to predict survival rates in patients with septic acute kidney injury (AKI). The survival predictability of CRRT inception time was compared with that of RIFLE criteria, which were previously used in clinical practice. We retrospectively analyzed outcomes in 55 patients with septic AKI admitted to the medical intensive care unit at Asan Medical Center (Seoul, Korea) between April 2009 and October 2010. These patients were stratified by the time of inception of CRRT from sepsis (early: ≤ 24 h and late: >24 h) and also by the RIFLE criteria (RIFLE-I and RIFLE-F). The primary outcome was 28-day mortality. Of the 55 patients, 38 (69.1%) were male. Patients' mean age was 62.6 years, the most common infection site was the lung (32, 58.2%), and 47 patients (85.5%) were on mechanical ventilation. Thirty patients (54.5%) were in the RIFLE-I, and the others were in the RIFLE-F. Twenty-eight-day mortality rates were lower in the early group than in the late group (19.4% vs. 47.4%; P = 0.03), but did not differ between RIFLE-I and RIFLE-F. Ventilator-free day at day 28 was longer in the early group than that in the late group (7.5 vs. 0 d; P = 0.033). After adjustment for covariates, we found that the late group (hazard ratio, 3.106; 95% confidence interval, 1.066-9.047) and Sequential Organ Failure Assessment at sepsis (hazard ratio, 1.410; 95% confidence interval, 1.108-1.796) were independent factors associated with 28-day mortality. This study suggests that the time interval from sepsis to CRRT inception may be a more useful predictor of 28-day mortality than RIFLE criteria in patients with septic AKI.
Shock (Augusta, Ga.) 07/2012; 38(1):30-6. · 2.87 Impact Factor
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Sang-Ho Choi,
Sang-Bum Hong,
Gwang-Beom Ko,
Yumi Lee,
Hyun Jung Park,
So-Youn Park,
Song Mi Moon,
Oh-Hyun Cho,
Ki-Ho Park,
Yong Pil Chong, [......],
Jin Won Huh,
Heungsup Sung,
Kyung-Hyun Do,
Sang-Oh Lee,
Mi-Na Kim,
Jin-Yong Jeong,
Chae-Man Lim,
Yang Soo Kim,
Jun Hee Woo, Younsuck Koh
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ABSTRACT: The role of viruses in pneumonia in adults and the impact of viral infection on mortality have not been elucidated. Previous studies have significant limitations in that they relied predominantly on upper respiratory specimens.
To investigate the role of viral infection in adult patients with pneumonia requiring intensive care unit (ICU) admission.
A retrospective analysis of a prospective cohort was conducted in a 28-bed medical ICU. Patients with severe community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) were included in the study.
A total of 198 patients (64 with CAP, 134 with HCAP) were included for analysis. Of these, 115 patients (58.1%) underwent bronchoscopic bronchoalveolar lavage (BAL), 104 of whom were tested for respiratory viruses by BAL fluid reverse-transcription polymerase chain reaction (RT-PCR). Nasopharyngeal specimen RT-PCR was performed in 159 patients (84.1%). Seventy-one patients (35.9%) had a bacterial infection, and 72 patients (36.4%) had a viral infection. Rhinovirus was the most common identified virus (23.6%), followed by parainfluenza virus (20.8%), human metapneumovirus (18.1%), influenza virus (16.7%), and respiratory syncytial virus (13.9%). Respiratory syncytial virus was significantly more common in the CAP group (CAP, 10.9%; HCAP, 2.2%; P = 0.01). The mortalities of patients with bacterial infections, viral infections, and bacterial-viral coinfections were not significantly different (25.5, 26.5, and 33.3%, respectively; P = 0.82).
Viruses are frequently found in the airway of patients with pneumonia requiring ICU admission and may cause severe forms of pneumonia. Patients with viral infection and bacterial infection had comparable mortality rates.
American Journal of Respiratory and Critical Care Medicine 06/2012; 186(4):325-32. · 11.08 Impact Factor
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Je Hyeong Kim,
Suk-Kyung Hong,
Kyung Chan Kim,
Myung-Goo Lee,
Ki Man Lee,
Sung Soo Jung,
Hye Sook Choi,
Jin Hwa Lee,
Ki-Suk Jung,
Sung-Soon Lee,
Jae Hwa Cho,
Shin Ok Koh,
Moo Suk Park,
Kwang Won Seo, Younsuck Koh
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ABSTRACT: The reported actual compliance for severe sepsis bundles was very low, suggesting the presence of barriers to their implementation. The purpose of this study was to assess the influence of full-time intensivist and nurse-to-patient ratio in Korean intensive care units (ICUs) on the implementation of the severe sepsis bundles and clinical outcome.
A total of 251 patients with severe sepsis were enrolled from 28 adult ICUs during the July, 2009. We recorded the organizational characteristics of ICUs, patients' characteristics and clinical outcomes, and the compliance for severe sepsis bundles.
Complete compliance with the resuscitation bundle and totally complete compliance with all element targets for resuscitation and management bundles were significantly higher in the ICU with full-time intensivist and a nurse-to-patient ratio of 1:2 (P < .05). The hazard ratio (HR) for hospital mortality was independently reduced by the presence of full-time intensivist (HR, 0.456; 95% confidence interval, 0.223-0.932), and a nurse-to-patient ratio of 1:2 was independently associated with a lower 28-day mortality (HR, 0.459; 95% confidence interval, 0.211-0.998).
The full-time intensivist and the nurse-to-patient ratio had a substantial influence on the implementation of severe sepsis bundles and the mortalities of patients with severe sepsis.
Journal of critical care 05/2012; 27(4):414.e11-21. · 2.13 Impact Factor
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Mycoses 03/2012; 55(2):189-92. · 2.25 Impact Factor
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Byung Ho Lee,
Daisuke Inui,
Gee Young Suh,
Jae Yeol Kim,
Jae Young Kwon,
Jisook Park,
Keiichi Tada,
Keiji Tanaka,
Kenichi Ietsugu,
Kenji Uehara, [......],
Shinhiro Takeda,
Shinsuke Saito,
Sung Jin Hong,
Takeshi Yamamoto,
Takeshi Yokoyama,
Takuhiro Yamaguchi,
Tomoki Nishiyama,
Toshiko Igarashi,
Yasuyuki Kakihana, Younsuck Koh
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ABSTRACT: Fever is frequently observed in critically ill patients. An independent association of fever with increased mortality has been observed in non-neurological critically ill patients with mixed febrile etiology. The association of fever and antipyretics with mortality, however, may be different between infective and non-infective illness.
We designed a prospective observational study to investigate the independent association of fever and the use of antipyretic treatments with mortality in critically ill patients with and without sepsis. We included 1,425 consecutive adult critically ill patients (without neurological injury) requiring >48 hours intensive care admitted in 25 ICUs. We recorded four-hourly body temperature and all antipyretic treatments until ICU discharge or 28 days after ICU admission, whichever occurred first. For septic and non-septic patients, we separately assessed the association of maximum body temperature during ICU stay (MAXICU) and the use of antipyretic treatments with 28-day mortality.
We recorded body temperature 63,441 times. Antipyretic treatment was given 4,863 times to 737 patients (51.7%). We found that treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen independently increased 28-day mortality for septic patients (adjusted odds ratio: NSAIDs: 2.61, P=0.028, acetaminophen: 2.05, P=0.01), but not for non-septic patients (adjusted odds ratio: NSAIDs: 0.22, P=0.15, acetaminophen: 0.58, P=0.63). Application of physical cooling did not associate with mortality in either group. Relative to the reference range (MAXICU 36.5°C to 37.4°C), MAXICU≥39.5°C increased risk of 28-day mortality in septic patients (adjusted odds ratio 8.14, P=0.01), but not in non-septic patients (adjusted odds ratio 0.47, P=0.11).
In non-septic patients, high fever (≥39.5°C) independently associated with mortality, without association of administration of NSAIDs or acetaminophen with mortality. In contrast, in septic patients, administration of NSAIDs or acetaminophen independently associated with 28-day mortality, without association of fever with mortality. These findings suggest that fever and antipyretics may have different biological or clinical or both implications for patients with and without sepsis.
ClinicalTrials.gov: NCT00940654.
Critical care (London, England) 02/2012; 16(1):R33. · 4.61 Impact Factor
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ABSTRACT: Although early use of broad-spectrum antimicrobials in critically ill patients may increase antimicrobial adequacy, uncontrolled use of these agents may select for more-resistant organisms. This study investigated the effects of early use of broad-spectrum antimicrobials in critically ill patients with hospital-acquired pneumonia.
We compared the early use of broad-spectrum antimicrobials plus subsequent de-escalation (DE) with conventional antimicrobial treatment (non-de-escalation, NDE) in critically ill patients with hospital-acquired pneumonia (HAP). This open-label, randomized clinical trial was performed in patients in a tertiary-care center medical intensive care unit (MICU) in Korea. Patients (n=54) randomized to the DE group received initial imipenem/cilastatin plus vancomycin with subsequent de-escalation according to culture results, whereas patients randomized to the NDE group (n=55) received noncarbapenem, nonvancomycin empiric antimicrobials.
Between November 2004 and October 2006, 109 MICU patients with HAP were enrolled. Initial antimicrobial adequacy was significantly higher in the DE than in the NDE group for Gram-positive organisms (100% versus 14.3%; P<0.001), but not for Gram-negative organisms (64.3% versus 85.7%; P=0.190). Mean intensive care unit (ICU) stay, and 14-day, 28-day, and overall mortality rates did not differ in the two groups. Among culture-positive patients, mortality from methicillin-resistant Staphylococcus aureus (MRSA) pneumonia was higher in the DE group, even after early administration of vancomycin. Multidrug-resistant organisms, especially MRSA, were more likely to emerge in the DE group (adjusted hazard ratio for emergence of MRSA, 3.84; 95% confidence interval, 1.06 to 13.91).
The therapeutic advantage of early administration of broad-spectrum antimicrobials, especially with vancomycin, was not evident in this study.
Critical care (London, England) 02/2012; 16(1):R28. · 4.61 Impact Factor
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ABSTRACT: : Acute kidney injury (AKI) is a common and serious complication in patients with severe sepsis and septic shock. AKI can be classified using the RIFLE (Risk, Injury, Failure, Loss and End-stage) and/or the Acute Kidney Injury Network (AKIN) criteria. The aim of this study was to determine which of the 2 systems better predicted 28-day mortality in patients with severe sepsis and septic shock.
: We retrospectively examined the medical records of all patients with severe sepsis and septic shock who were admitted to our medical intensive care unit (ICU) between January 2005 and December 2006 and compared the ability of the RIFLE and AKIN criteria to predict mortality.
: Of the 326 patients admitted during the study period, 291 were included. AKI 48 and 72 hours after ICU admission was observed in 62.9% and 55.5% of patients, respectively, according to RIFLE criteria and in 65.6% and 59.2%, respectively, according to AKIN criteria. The overall 28-day mortality rate was 48.5%, and mortality was significantly associated with the severity of AKI, by both RIFLE and AKIN criteria. Both criteria had a similar ability to predict 28-day mortality 48 hours (0.65-69, P < 0.01) and 72 hours (0.66-70, P < 0.01) after ICU admission.
: The incidence of AKI in patients with sepsis and septic shock was slightly higher using AKIN than RIFLE criteria. However, using the AKIN criteria did not enhance the ability of AKI to predict 28-day mortality in such patients.
The American Journal of the Medical Sciences 01/2012; 344(5):350-6. · 1.39 Impact Factor
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ABSTRACT: PURPOSE: The primary objective of this clinical trial of patients on mechanical ventilation was to determine if a weaning protocol implemented solely by nurses could reduce the weaning time relative to usual care (UC). MATERIALS AND METHODS: This study is a prospective, randomized, controlled trial conducted from January 2007 to January 2009 that compared protocol-based weaning (PBW) with UC. A total of 122 patients who received invasive ventilation in the medical ICU of the Asan Medical Center were examined. Nurses operated the mechanical ventilators according to a predesigned ventilator-weaning protocol for the PBW group (n = 61), and intensive care unit (ICU) physicians managed weaning in the UC group (n = 61). RESULTS: There were no significant differences in the 2 groups at baseline. The number of patients who successfully discontinued mechanical ventilation was similar in the 2 groups (PBW, 46 patients, 75.4%; UC, 47 patients, 77.0%; P = .832). The weaning time was 47 hours (interquartile range, 24-168 hours) in the UC group and 25 hours (interquartile range, 5.75-134 hours) in the PBW group (P = .010). CONCLUSIONS: The weaning protocol administered by the nurses was safe and reduced the weaning time from mechanical ventilation in patients who were recovering from respiratory failure.
Journal of critical care 01/2012; · 2.13 Impact Factor
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ABSTRACT: Interventional lung assist (iLA) effectively reduces CO(2) tension and permits protective lung ventilation in patients with acute respiratory distress syndrome. However, there is little experience in using iLA in acute respiratory failure from various causes and no experience for small body sizes such as Asian patients. We evaluated the physiologic effect and safety of the iLA device in patients with acute respiratory failure from various causes. We enrolled 11 consecutive patients with severe respiratory failure from various causes. Wire-enforced cannulae (13-15 Fr) were inserted under ultrasound guidance and connected to iLA. Arterial blood gas analysis, ventilator parameters, hemodynamic parameter, and adverse events were recorded serially. During the first 24h of iLA use, mean blood flow was 1.08±0.15L/min, PaCO(2) decreased from 83.9±23.4mmHg to 40.7±10.2mmHg, and PaO(2) /FiO(2) ratio increased from 110±37 to 141±74. Minute ventilation decreased from 9.4±2.5 to 6.3±1.5L/min, and peak inspiratory pressure decreased from 30.3±7.1cm H(2) O to 28.8±9.4cm H(2) O. No serious adverse events were observed during iLA use. iLA showed effective CO(2) removal, allowed for reducing the invasiveness of mechanical ventilation in patients with severe respiratory failure from various causes even using a small-sized catheter and was safe in small body-sized patients.
Artificial Organs 11/2011; 36(4):434-8. · 2.00 Impact Factor
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ABSTRACT: Right ventricular dysfunction (RVD) has been found to have a negative impact on the short-term prognosis of patients with pulmonary embolism (PE). However, the long-term prognosis of such patients has not been well defined. We evaluated the effect of RVD on short- and long-term mortality in Korean patients with PE.
We retrospectively assessed 180 patients with PE who underwent transthoracic echocardiography to evaluate RVD between January 2004 and December 2008. Patients were categorized as hemodynamically stable without RVD (stable without RVD, n = 70), hemodynamically stable with RVD (stable with RVD, n = 74), or hemodynamically unstable with RVD (unstable with RVD, n = 36). The clinical courses of all patients were followed up in-hospital and after discharge.
Nineteen patients (10.5%) died during hospitalization, with the unstable with RVD group showing the highest rate of in-hospital mortality (27.8%, P < .05) and PE-related deaths (16.7%, P < .05), but no difference in these parameters was noted between the other 2 groups. Multivariate analysis showed that older age and hemodynamic instability were independent risk factors for poor in-hospital outcomes. Eleven patients died after discharge. Multivariate analysis showed that older age, immobilization, and malignancy were independent predictors of long-term mortality.
Right ventricular dysfunction without hemodynamic instability was not associated with short- or long-term mortality of patients with PE.
Journal of critical care 10/2011; 27(3):325.e1-6. · 2.13 Impact Factor
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ABSTRACT: Although there is controversy regarding the benefit of low-dose corticosteroid therapy in patients with septic shock, the Surviving Sepsis Campaign has advocated that low-dose intravenous hydrocortisone be used to treat adult septic shock patients. This study investigated the effect of the duration of a stress dose of hydrocortisone on survival of septic shock patients with relative adrenal insufficiency.
One hundred and thirty consecutive patients who met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock were included in the study. An additional inclusion criterion was vasopressor support after fluid resuscitation. The primary end-point was 28-day mortality, and the secondary end-points were shock reversal and mortality in the intensive care unit and hospital. All eligible patients were prospectively randomized to receive hydrocortisone treatment for 3 or 7days. Hydrocortisone treatment was started at a dose of 50mg every 6h.
Baseline data at recruitment did not differ between the two groups. After 28days, mortality did not differ between the 3- and 7-day treatment groups (33.8% vs 36.9%, P=0.629). Mortality rates in the intensive care unit and hospital did not differ significantly between the two groups. The median time to withdrawal of vasopressor therapy was 5.0days in the 3-day treatment group and 6.4days in the 7-day treatment group (P=0.102).
This pilot study showed that in patients with septic shock and relative adrenal insufficiency, 28-day mortality did not differ between those treated with low-dose hydrocortisone for 3 or 7days.
Respirology 07/2011; 16(7):1088-95. · 2.42 Impact Factor
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ABSTRACT: It is difficult to differentiate pathogens responsible for pneumonia or colonization in patients with an endotracheal tube or in patients that have undergone tracheostomy. We evaluated the clinical usefulness of quantitative endotracheal aspirates cultures and sought to determine the result threshold level for positivity. The authors performed this retrospective cohort study between December 1, 2004 and January 31, 2006. Forty-five suspected pneumonia patients admitted to an intensive care unit (ICU) with quantitative bronchoalveolar lavage (BAL) and endotracheal aspirate (EA) culture results were enrolled. Using a threshold of 10(5) cfu/mL, 10 of the 45 (22.2%) quantitative EA cultures were positive, as compared with 7 (15.6%) BAL cultures. When BAL culture findings were used as the reference, the sensitivity and specificity of quantitative EA cultures were 85.7% and 89.5%, respectively, at a threshold of 10(5) cfu/mL, and 85.7% and 94.7%, respectively, at a threshold of 10(6) cfu/mL. Of the 10 EA culture positive patients, 2 patients with a result of -10(5) cfu/mL were BAL culture negative. The quantitative EA culture is a useful non-invasive tool for the diagnosis of pneumonia pathogens. It is suggested that a threshold level of 10(6) cfu/mL is appropriate.
Journal of Korean medical science 07/2011; 26(7):865-9. · 0.84 Impact Factor
