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논문검색은 역시 페이퍼서치

대한중환자의학회지검색

The Korean Journal of Critical Care Medicine


  • - 주제 : 의약학분야 > 기타(의약학)
  • - 성격 : 학술지
  • - 간기: 계간
  • - 국내 등재 : KCI 등재
  • - 해외 등재 : -
  • - ISSN : 2383-4870
  • - 간행물명 변경 사항 :
논문제목
수록 범위 : 28권 1호 (2013)

종설 : 중환자실 전담전문의 제도

박성훈 ( Sung Hoon Park ) , 서지영 ( Gee Young Suh )
4,000
초록보기
Despite a shortage of intensivists, there is an increased need for intensivist staffing in intensive care units (ICUs). Western studies showed that the survival rate of critically ill patients improved and the length of ICU stay decreased in "closed" or "high-intensity" ICU, where intensivists dedicated themselves to the ICU and were primary physicians. This system was also associated with an increased compliance of evidence-based medicine and a decreased medical error. The Leapfrog Group and American College of Critical Care Medicine recommend the implementation of intensivist staffing system in the ICU. Although there are still barriers to implement this system, such as the economic burden to hospitals and conflicts among medical staff, intensivist staffing in the ICU is important in terms of timely diagnosis and treatment and multidisciplinary team approach. The presence of intensivists may also increase the efficacy of ICU systems and save treatment cost. Although the "24 hours/7 days intensivist staffing" system may be ideal, recent data showed that high-intensity ICU system during daytime is not inferior to 24-hour intensivist staffing system in terms of hospital mortality. It is especially important to large-scale academic hospitals, where many severely ill patients are treated. However, few ICUs have intensivists who are committed to caring for ICU patients in Korea. Therefore, we have to try to expand this system throughout the whole country. Additionally, the definition of ICU standard, the role of intensivists, and the policy of financial reward also need to be clarified more clearly.

종설 : 급성호흡곤란증후군의 새로운 정의

김제형 ( Je Hyeong Kim )
4,000
초록보기
Acute respiratory distress syndrome (ARDS) is a common disorder associated with significant mortality and morbidity. The American-European Consensus Conference (AECC) definition of ARDS, established in 1994, has advanced the knowledge of ARDS by allowing the acquisition of clinical and epidemiological data, which in turn have led to improvements in care for patients with ARDS. However, after 18 years of applied research, a number of issues regarding various criteria of AECC definition have emerged. For these reason, and because all disease definitions should be reviewed periodically, the European Society of Intensive Care Medicine convened an international expert panel to revise the ARDS definition from September 30 to October 2, 2011, Berlin, Germany, with endorsement from American Thoracic Society and the Society of Critical Care Medicine. This consensus discussion, following empirical evaluation and consensus revision, addressed some of the limitations of the AECC definition by incorporating current data, physiologic concepts, and clinical trials to develop a new definition of ARDS (Berlin definition). The Berlin definition should facilitate case recognition and better match treatment options to severity in both the research trials and clinical practice.

원저 : 외과계중환자실 담당약사의 약물유해반응 예방에 대한 처방중재효과

강민경 ( Min Kyong Kang ) , 김아정 ( Ah Jeong Kim ) , 조윤숙 ( Yoon Sook Cho ) , 김향숙 ( Hyang Sook Kim ) , 이혜숙 ( Hye Sook Lee ) , 유용재 ( Yong Jae Yu ) , 이한나 ( Han Nah Lee ) , 박규주 ( Kyu Joo Park ) , 박희평 ( Hee Pyoung Park )
4,000
초록보기
Background: A pharmacist`s participation in medical rounds in intensive care unit (ICU) is becoming popular nowadays. In this study, we investigated the effect of pharmacologic intervention by a pharmacist`s participation in medical round in ICU on prevention of adverse drug events (ADEs). Methods: From March 2011 to July 2011, the intervention data were obtained by participating in medical round two or three times a week, and by reviewing electronic medical records of patients admitted to surgical ICU. The incidence, cause, and type of ADEs were noted, respectively. Expected cost avoidance was calculated from interventions, which were considered to be preventive of ADEs. The acceptance rate of pharmacologic interventions was noted. Results: Among 2781 patients, a total of 159 intervention data were collected in 90 patients. Recommendation for drug dosage adjustment or monitoring in patients with potential overdose and sub-therapeutic dose made up 82% of the total interventions. In 8% of interventions, initiation of drug therapy was recommended. 83% of the interventions were accepted and the acceptance rate of interventions within 24 hrs was 58%. The rate of the interventions, which were considered to be preventive of ADEs was 62%. Expected cost reduction obtained by preventing ADEs was 25,867,083₩ during a 5-month period. Conclusions: A pharmacist`s participation in physician rounds in ICU was associated with prevention of ADEs and subsequent reduction of the cost in drug therapy.

원저 : 일개 응급센터에서 소아 병원 밖 심정지 환자에 대한 치료적 저체온 요법의 적용

김우진 ( Woo Jin Kim ) , 김진주 ( Jin Joo Kim ) , 장재호 ( Jae Ho Jang ) , 현성열 ( Sung Youl Hyun ) , 양혁준 ( Hyuk Jun Yang ) , 이근 ( Gun Lee )
4,000
초록보기
Background: Cardiac arrest in infants and children is rare than adults yet, it is critical. The efficacy and feasibility of therapeutic hypothermia after cardiac arrest in adults is proved through many studies however, there are few data on pediatric out-of hospital cardiac arrest. We analyzed several variables in pediatric therapeutic hypothermia after out-of hospital cardiac arrest. Methods: Infants and children (1 to 17 years old), who were admitted to our emergency intensive care units following the return of spontaneous circulation after out-of hospital cardiac arrest from Jan 2008 to Apr 2012, were included in this study. Basal patients` characteristics and variables about therapeutic hypothermia were analyzed. Results: A total of seventy-six patients visited our emergency center after a pediatric cardiac arrest during the study period. Among this, sixty-three patients received pediatric advanced life support, twenty one patients were admitted to intensive care units and nine patients received therapeutic hypothermia. Overall, the survival discharge was 7.9% (5 of 63). Among the admitted patients, 3 patients (14.3%) had a good Cerebral Performance Category (CPC). Two patients received endovascular cooling and seven patients received surface cooling. The mean time from the induction of therapeutic hypothermia to reaching the temperature with in the therapeutic range was 193.9 minutes. There were no critical adverse events during induction, maintenance and the rewarming period of therapeutic hypothermia. Conclusions: Therapeutic hypothermia after pediatric out-of hospital cardiac arrest was performed safely and effectively in one emergency center. The standardized pediatric therapeutic hypothermia protocol should be established in order to be used widely in pediatric intensive care units. Further, larger studies are needed on the subject of pediatric therapeutic hypothermia.

Original Articles : Blood Gases during Cardiopulmonary Resuscitation in Predicting Arrest Cause between Primary Cardiac Arrest and Asphyxial Arrest

( Sei Jong Bae ) , ( Byung Kook Lee ) , ( Ki Tae Kim ) , ( Kyung Woon Jeung ) , ( Hyoung Youn Lee ) , ( Yong Hun Jung ) , ( Geo Sung Lee ) , ( Sun Pyo Kim ) , ( Seung Joon Lee )
4,000
초록보기
Background: If acid-base status and electrolytes on blood gases during cardiopulmonary resuscitation (CPR) differ between the arrest causes, this difference may aid in differentiating the arrest cause. We sought to assess the ability of blood gases during CPR to predict the arrest cause between primary cardiac arrest and asphyxial arrest. Methods: A retrospective study was conducted on adult out-of-hospital cardiac arrest patients for whom blood gas analysis was performed during CPR on emergency department arrival. Patients were divided into two groups according to the arrest cause: a primary cardiac arrest group and an asphyxial arrest group. Acid-base status and electrolytes during CPR were compared between the two groups. Results: Presumed arterial samples showed higher potassium in the asphyxial arrest group (p < 0.001). On the other hand, presumed venous samples showed higher potassium (p = 0.001) and PCO2 (p < 0.001) and lower pH (p = 0.008) and oxygen saturation (p = 0.01) in the asphyxial arrest group. Multiple logistic regression analyses revealed that arterial potassium (OR 5.207, 95% CI 1.430-18.964, p = 0.012) and venous PCO2 (OR 1.049, 95% CI 1.021-1.078, p < 0.001) were independent predictors of asphyxial arrest. Receiver operating characteristic curve analyses indicated an optimal cut-off value for arterial potassium of 6.1 mEq/L (sensitivity 100% and specificity 86.4%) and for venous PCO2 of 70.9 mmHg (sensitivity 84.6% and specificity 65.9%). Conclusions: The present study indicates that blood gases during CPR can be used to predict the arrest cause. These findings should be confirmed through further studies.

Case Reports : Endocarditis Caused by Community-Acquired Klebsiella pneumoniae Infection

( Ji Ae Hwang ) , ( Charles Her ) , ( Yang Wook Kim )
4,000
초록보기
In community-acquired Klebsiella pneumoniae infection, pyogenic liver abscess is common as a primary site of infection, particularly in Asia, that can progress to bacteremia. Diabetes mellitus is a usual predisposing factor. Pneumonia as primary site of infection by community-acquired Klebsiella pneumoniae infection is not common but carries a poor outcome. Early administration of appropriate antibiotics is extremely important to avoid the development of bacteremia and septicemia. An infective endocarditis caused by community-acquired Klebsiella pneumoniae infection is very rare; particularly, such a case of endocarditis in which pneumonia was the primary site of infection has never been reported previously. In this report we described a case of community-acquired Klebsiella pneumoniae infection that started with pneumonia and progressed to bacteremia, leading to endocarditis, liver abscess, and other systemic septic complications. Delayed administration of appropriate antibiotics may have played a role in this case.

증례 : 두개인두종 수술 말기에 급격히 발생한 심각한 고나트륨혈증

박준범 ( Jun Bum Park ) , 박세훈 ( Se Hun Park ) , 서은희 ( Eun Hui Seo ) , 박현석 ( Hyun Seok Park ) , 정진규 ( Jin Kyu Jeong )
4,000
초록보기
Hypernatremia, defined as a rise in the serum sodium concentration to a value exceeding 145 mM/L, is a common electrolyte disorder. Diabetes insipidus is a common cause of hypernatremia, caused by impaired production or reduced responses to vasopressin. The resultant morbidity may be inconsequential, serious, or even life-threatening. However, hypernatremia rarely occurs during anesthesia and surgery. A 45-year-old female patient with craniopharyngioma was scheduled for tumor resection. Hypernatremia (serum sodium, 170 mM/L) occurred suddenly at the end of the surgery. To treat hypernatremia, 0.45% normal saline was used. Although serum sodium concentration was reduced faster than expected, the patient did not have any complications.

증례 : 폐렴간균(Klebsiella pneumoniae) 패혈증의 합병증으로 발생한 화농성 심장막염

정병호 ( Byeong Ho Jeong ) , 정승민 ( Seung Min Chung ) , 권희진 ( Hee Jin Kwon ) , 전경만 ( Kyeong Man Jeon )
4,000
초록보기
Although the incidence of purulent pericarditis has decreased significantly in the modern antibiotic era, purulent pericarditis remains a life-threatening disease. Therefore, a high index of clinical suspicion should be maintained to diagnose this life-threatening illness at an early stage. We report an extraordinary case of purulent pericarditis, caused by Klebsiella pneumoniae bacteremia, which developed during the recovery of septic shock with urinary tract infection. Despite of early diagnosis and pericardial drainage, in addition to adequate antibiotics, the patient subsequently developed multiple organ failure leading to death. The case highlights that purulent pericarditis is a rare yet possible disorder complicated from septic shock with bacteremia in the antibiotic era. Therefore, purulent pericarditis should always be considered as a possible complication, especially in patients with K. pneumoniae bacteremia and progressive cardiomegaly.

증례 : 관상동맥우회술후 대동맥내풍선펌프 사용으로 발생한 미세색전증에 의한 횡문근융해증

민선경 ( Sun Kyung Min ) , 황은구 ( Eun Gu Hwang ) , 김용인 ( Yong In Kim )
1,000
초록보기
A fifty seven-year-old man visited the outpatient department with chest pain and claudication. Coronary angiogram showed coronary artery diseases (3-vessel diseases) and CABG was planned. However, lower extremity angiogram showed stenosis of both common iliac arteries and stent implantation of both iliac arteries were done before CABG. He underwent CABG and IABP was inserted for weaning from cardiopulmonary bypass. After CABG, ischemic change on ends of feet was noted with red-brown colored urine and hyperkalemia. Blood myoglobin level was over 3,000 ng/ml. Microembolism of his lower body was revealed by multiple uptakes on the whole body bone scan study. After management by massive hydration and alkalization of urine with sodium bicarbonate, he was recovered without renal replacement therapy and discharged in good condition.

Case Reports : Management of Upper Extremity Deep Vein Thrombosis with a Superior Vena Cava Filter

( Woo Il Kwon ) , ( Ho Geol Ryu ) , ( Hann Ah Lee ) , ( Yong Jae Yoo )
4,000
초록보기
Upper extremity deep vein thrombosis (UEDVT) is relatively uncommon and superior vena cava (SVC) filter placements are not often encountered due to strict indication. A 33-year old male with underlying protein C/S deficiency and secondary liver cirrhosis was admitted because of hematemesis. The patient was conservatively managed, but underwent elective splenectomy to prevent aggravation of gastric varix. During postoperative care, the patient underwent cholecystectomy for acalculous cholecystitis. During the postoperative course, UEDVT was detected and heparinization was initiated. The patient experienced repeated attacks of severe dyspnea, which was accompanied by chest pain that lasted for 3 to 10 minutes. Repeated episodes of pulmonary thromboembolism were suspected and SVC filter was placed. Warfarin treatment was initiated and the SVC filter was removed about one month later. The case highlights the clinical significance of UEDVT and reports rare case of SVC filter placement. Intensivists should have comprehensive understanding of UEDVT and its management.
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