Clinical significance of intra-abdominal hypertension in critically ill surgical patients A prospective, Multicenter, observational cohort study

Kyu-Hyouck Kyoung,Tae-Ui Lee,Chi-Min Park,Jung Chul Kim,Jae-Gil Lee,Suk-Kyung Hong 대한외과학회 2011 대한외과학회 학술대회 초록집 Vol.2011 No.11

Successful Treatment of Accidental Hypothermia with Injury - A Case Report -

Kyu Hyouck Kyoung,Young Hwan Kim,Suk-Kyung Hong 대한중환자의학회 2011 Acute and Critical Care Vol.26 No.2

Accidental hypothermia is an uncommon health issue that can cause fatal problems. Mortality related to hypothermia has been reported to be up to 50%. Prognosis of hypothermia depends on the grade of hypothermia, interval of re-warming from the accident and the re-warming rate. Hypothermic patients with injury show worse prognosis. A 66 year-old man with history of cerebrovascular accident was rescued in the mountains. His Glasgow coma scale (GCS) was 3, core temperature was 25.2℃ and he had a right lateral malleolar fracture. The second patient was a 45 year-old man whose GCS was 8 and core temperature 17.2℃. Blood pressure was unmeasurable with only palpable pulse and showed Osborn J wave on electrocardiography for both patients. Active re-warming was performed with forced warm air, warm saline infusion and bladder irrigation. Patient core temperature raised by 1.5℃/hour and 3.3℃/hour, respectively. The two patients were discharged without any other sequelae and disability.

둔상에 의한 외상성 좌심실 파열환자를 성공적으로 치료한 예

경규혁 ( Kyu Hyouck Kyoung ),정성호 ( Sung Ho Jung ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.2

Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.

Non-invasive ventilation for surgical patients with acute respiratory failure

Byoung Chul Lee,Kyu Hyouck Kyoung,Young Hwan Kim,Suk-Kyung Hong 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.6

Purpose: Acute respiratory failure is a relatively common complication in surgical patients, especially after abdominal surgery. Non-invasive ventilation (NIV) is increasingly used in the treatment of acute respiratory failure. We have assessed the usefulness of NIV in surgical patients with acute respiratory failure. Methods: We retrospectively reviewed the medical charts of patients who were admitted to a surgical intensive care unit between March 2007 and February 2008 with acute respiratory failure. The patients who have got respiratory care for secondary reason such as sepsis and encephalopathy were excluded from this study. Results: Of the 74 patients who were treated with mechanical ventilation, 15 underwent NIV and 59 underwent invasive ventilation. The causes of acute respiratory failure in the NIV group were atelectasis in 5 patients, pneumonia in 5, acute lung injury in 4, and pulmonary edema in 1, this group included 3 patients with acute respiratory failure after extubation. Overall success rate of NIV was 66.7%. Conclusion: NIV may be an alternative to conventional ventilation in surgical patients with acute respiratory failure. Use of NIV may avoid re-intubation in patients who develop respiratory failure after intubation.

Current status of initial antibiotic therapy and analysis of infections in patients with solitary abdominal trauma: a multicenter trial in Korea

Gil Jae Lee,Kyu-Hyouck Kyoung,Ki Hoon Kim,Namryeol Kim,Young Hoon Sul,Kyoung Hoon Lim,Suk-Kyung Hong,Hangjoo Cho 대한외과학회 2021 Annals of Surgical Treatment and Research(ASRT) Vol.100 No.2

Purpose: Proper use of antibiotics during emergency abdominal surgery is essential in reducing the incidence of surgical site infection. However, no studies have investigated the type of antibiotics and duration of therapy in individuals with abdominal trauma in Korea. We aimed to investigate the status of initial antibiotic therapy in patients with solitary abdominal trauma. Methods: From January 2015 to December 2015, we retrospectively analyzed the medical records of patients with solitary abdominal trauma from 17 institutions including regional trauma centers in South Korea. Both blunt and penetrating abdominal injuries were included. Time from arrival to initial antibiotic therapy, rate of antibiotic use upon injury mechanism, injured organ, type, and duration of antibiotic use, and postoperative infection were investigated. Results: Data of the 311 patients were collected. The use of antibiotic was initiated in 96.4% of patients with penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. The mean day of using antibiotics was 6 days in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 36 cases. Infection was related to injury severity (Abbreviated Injury Scale of >3), hollow viscus injury, operation, open abdomen, colon perforation, and RBC transfusion. There was no infection in cases with laparoscopic operation. Duration of antibiotics did not affect the infection rate. Conclusion: Antibiotics are used extensively (84.2%) and for long duration (6.2 days) in patients with abdominal injury in Korea.

Enteral nutrition associated non-occlusive bowel ischemia

Jun-Gyo Gwon,Young-Ju Lee,Kyu-Hyouck Kyoung,Young-Hwan Kim,Suk-Kyung Hong 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.3

We describe two patients, with no previous history of vascular problems but poor lung function, who experienced septic shock due to bowel ischemia. Both were fed an enteral formula rich in fiber using a feeding tube and experienced septic shock with regular enteral feeding. Surgical finding showed hemorrhagic ischemia in the bowel. The pathologic finding suggests these changes may have been due to inspissations of bowel contents, which may put direct pressure on the mucosa of the bowel wall, leading to local impairment of mucosal and submucosal blood flow with subsequent bowel necrosis. Bowel ischemia may have been precipitated by an increased mesenteric blood flow requirement in combination with a metabolically stressed bowel. Patients in the intensive care unit fed a fiber-rich enteral formula may have inspissated bowel contents, leading to bowel ischemia, suggesting that the use of fiber-rich formula should be limited in patients at high-risk of bowel ischemia.

혈역학적으로 불안정한 골반 골절 환자에 있어서 외상팀 유무에 따른 생존율 비교

김지완(Ji Wan Kim),홍석경(Suk-Kyung Hong),경규혁(Kyu Hyouck Kyoung),최지호(Ji Ho Choi),김정재(Jung Jae Kim) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.3

목적: 혈역학적으로 불안정한 골반 골절 환자에 있어서 외상팀 치료를 시행한 시점을 전후로 시기를 나누어 각 시기별 치료 결과의 차이를 알아보고자 한다. 대상 및 방법: 혈역학적으로 불안정한 골반 골절 환자를 대상으로 외상팀 가동 시작인 2009년 3월 이전을 1기, 가동 이후를 2기로 하여 구분하였다. 의료진의 진료 시작까지 소요된 시간, 지혈을 위해 시행한 치료 방법 및 소요 시간, 수혈량, 사망률을 조사하였다. 결과: 진료 시작까지 소요된 시간은 1기의 경우 5시간 48분, 2기의 경우 57분으로 줄어들었으며, 환자가 응급실에 도착한 이후 지혈을 위한 처치 시행까지 소요된 시간은 1기의 경우 14.4시간, 2기의 경우 4.2시간이었다. 수혈량은 1기의 경우 41.1 unit인 반면, 2기의 경우 13.2 unit로 1/3 수준으로 감소되었다. 1기에서 7명의 환자 중 4명(57.1%)이 사망하였던 반면, 2기에는 7명 중 1명(14.3%)만이 사망하였다. 결론: 혈역학적으로 불안전한 골반 골절이 있는 외상 환자의 경우 외상팀의 진료는 환자의 치료 방침을 결정하는 데 시간을 단축시키고 적극적인 지혈 치료를 통해 수혈량을 감소시켜 사망률을 현저히 감소시킬 수 있었다. Purpose: To compare the clinical results of hemodynamically unstable patients diagnosed with pelvic ring injury according to the presence of a trauma team. Materials and Methods: Patients with hemodynamically unstable pelvic fracture were enrolled in the study and were divided into two groups: Group Ⅰ, patients who were managed before March 2009, when there was no trauma team; and Group Ⅱ, patients who were managed after March 2009, when emergent trauma team began to work. Data were collected regarding the time the trauma team began patient management, the treatment modality used to control bleeding, transfusion requirement, and patient mortality. Results: The time when the trauma team began patient management was fi ve hours and 48 minutes in Group Ⅰ and 57 minutes in Group Ⅱ. The time to definitive treatment in order to control bleeding in Group Ⅰ and Group Ⅱ was 14.4 hours and 4.2 hours, respectively. The amount of the transfusion was 41.1 unit in Group Ⅰ and 13.2 unit in Group Ⅱ patients. In Group Ⅰ, four patients (57.1%) died, although only one of the seven patients in Group Ⅱ (14.3%) died. Conclusion: Using a multidisciplinary approach, the trauma team has only a short amount of time to determine their treatment strategy and to achieve prompt management of bleeding, with the fi nal objective to decrease the mortality rate in patients with hemodynamically unstable pelvic fractures.

Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study

( Chan-hee Park ),( Hak-jae Lee ),( Suk-kyung Hong ),( Yang-hee Jun ),( Jeong-woo Lee ),( Nak-jun Choi ),( Kyu-hyouck Kyoung ) 한국정맥경장영양학회 2022 한국정맥경장영양학회지 Vol.14 No.2

Purpose: Timely enteral nutrition (EN) is important in critically ill patients. However, use of EN with critically ill surgical patients has many limitations. This study aimed to analyze the current status of EN in surgical intensive care units (ICUs) in South Korea. Materials and Methods: A multicenter, prospective, observational study was conducted on patients who received EN in surgical ICUs at four university hospitals between August 2021 and January 2022. Results: This study included 125 patients. The mean time to start EN after admission to the surgical ICU was 6.2±4.6 days. EN was provided to 34 (27.2%) patients within 3 days after ICU admission. At 15.7±15.9 days, the target caloric requirement was achieved by 74 (59.2%) patients through EN alone. Furthermore, 104 (83.2%) patients received supplemental parenteral nutrition after a mean of 3.5±2.1 days. Only one of the four hospitals regularly used enteral feeding tubes and post-pyloric feeding tubes. Conclusion: Establishing EN guidelines for critically ill surgical patients and setting an appropriate insurance fee for EN-related devices, such as the feeding pump and enteral feeding tube, are necessary.

Efficacy of Serum Antithrombin III Rest in Patients With Severe Traumatic Brain Injury

Hee Seung Noh,Sun Geon Yoon,Kyunghak Choi,Kyu-Hyouck Kyung,Min Soo Kim 대한신경손상학회 2023 Korean Journal of Neurotrauma Vol.19 No.2

Immune reactions following traumatic brain injury (TBI) cause many complications, including intravascular dissemination. Antithrombin III (AT-III) plays an important role in suppressing abnormal clot formation and ensuring hemostasis. Therefore, we investigated the efficacy of serum AT-III in patients with severe TBI.

Successful Management of Potential Non-Heart-Beating Donor with Extracorporeal Membrane Oxygenation -A Case Report-

Young Hwan Kim,Gui Yun Sohn,Yooun Joong Jung,Kyu Hyouck Kyoung,Suk-Kyung Hong 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.4

Hemodynamics of a brain-dead donor can change rapidly during management. It frequently leads to loss of the donor or deterioration of organ functions. Various efforts have been made not to lose potential donors. Extracorporeal membrane oxygenation (ECMO) and non-heart-beating donation (NHBD) are good examples of such efforts. A 47 year-old woman with a history of hypertension, diabetes mellitus and atrial fibrillation was diagnosed with cerebral infarction and hemorrhage. Cardiopulmonary resuscitation was performed three times before transfer to our hospital. Her family agreed to organ donation. ECMO was applied due to her unstable vital signs, which made the first declaration of brain death possible. However, considering the deteriorating vital signs and expected cardiac arrest, it was decided to switch to NHBD under the family’s consent. All life-support devices including ECMO were turned off in the operation room. After cardiac death was declared, the harvesting of liver and kidneys was performed with perfusion through an ECMO catheter. The liver and kidneys were successfully transplanted to three recipients.