The Role of Neutrophil Gelatinase-associated Lipocalin (NGAL) as Outcome Prediction in Severe Acute Respiratory Failure: A Pilot Study

( Eunjeong Son ),( Hye Ju Yeo ),( Woo Hyun Cho ),( Taehwa Kim ),( Seung Eun Lee ),( Doosoo Jeon ),( Yun Seong Kim ),( Jin Ook Jang ),( Jin Ho Jang ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Purpose Plasma neutrophil gelatinase-associated lipocalin (NGAL) is released from activated human neutrophil granules. Its concentration raises in many acute inflammatory state such as chronic obstructive pulmonary disease-acute exacerbation, low respiratory tract infection and acute kidney injury. But, the usefulness of plasma NGAL concentration for predicting the outcome of severe acute respiratory failure is unknown. In this study, we evaluated plasma NGAL as a potential prognostic biomarker in patients with severe acute respiratory failure. Method We prospectively collected blood samples from acute respiratory failure patients admitted to the intensive care unit (ICU) between March 2016 and June 2020. Plasma NGAL and inflammatory markers such as TNF-α, IL-1β levels of patients were measured on days 1, 3, 7 of hospitalization. We retrospectively reviewed patient medical records and analyzed correlations between the plasma NGAL concentration and hospital outcomes. Result A total of 46 severe acute respiratory failure patients were included in this study; 32 (69.6%) patients are survivors and 14 (30.4%) patients are non-survivors. In the survivor group, the concentration of plasma NGAL on days 7 of hospitalization decreased compared to the day 1 plasma NGAL concentration (p=0.002), but there was no significant decrease in the non-survivor group (p=0.794). The day 7 plasma NGAL concentration was associated with hospital mortality (p=0.042). Conclusion Acute respiratory failure patients with high plasma NGAL levels on days 7 of hospitalization have a high mortality rate. Therefore, plasma NGAL is useful for predicting outcomes of severe acute respiratory failure.

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.

Efficacy of direct hemoperfusion using polymyxin B-immobilized fiber column in acute respiratory failure patients

박소영,강다현,이윤경,박동일,정재욱,박희선,정성수,김주옥,이정은 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Introduction: Direct hemoperfusion using polymyxin B-immobilized fiber column(PMX-DHP) therapy has been used for critical ill patients, but its efficacy for acute respiratory failure is unclear. We evaluated efficacy and prognostic factor of the PMX-DHP in patients with acute respiratory failure. Methods: This study evaluated retrospectively our experience with PMX-DHP between March 2017 and september 2018 in Kyunghee university and Chungnam national university hostpial. PMX-DHP was implemented patients from multiple etiologies with acute respiratory failure. Laboratory parameters include arterial blood gas analysis, ventilator parameters, hemodynamic parameter and adverse events were recorded serially. Our primary outcome was ICU mortality. Results: Between March 2013 and August 2016, we enrolled 9 patients with severe respiratory failure, Median age was 63.5±8.2 and 6 patients was male. Eight patients had mechanical ventilator, one patient underwent high flow nasal cannula and 2 patients had interventional lung assis. Causes of respiratory failure were pneumonia (3 patients), extrapulmonary ARDS (2 patients), IPF exacerbation (2 patients) and RA-ILD(2patients). ICU mortality was 28.5% and 28d days mortality was 33.3%. 2 IPF exacerbation patients survived in ICU. Surivival patients lead to an acute and moderate increase in arterial oxygenation (PaO2/FiO2 ratio 2hr after initiation of PMX-DHP (150 ±25 mmHg) compared with pre PMX-DHP (110±20.2 mmHg) and rapid shock recovery. Ground glass opacity group showed higher survival group than consolidation group. Conclusion: PMX-DHP therapy may be effective in respiratory failure and is expected to reduce mortality rates.

Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure

Türkay Akbaş,Harun Güneş 대한중환자의학회 2023 Acute and Critical Care Vol.38 No.1

Background The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. Methods This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020. Results One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients’ mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0±7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/FiO2 ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II scores (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017–1.317; P=0.026), admission PaO2/FiO2 ratio (OR, 0.989; 95% CI, 0.978–0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650–47.215; P=0.011) as predictors of ICU mortality. APACHE II scores (OR, 1.099; 95% CI, 1.021–1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056–0.514; P=0.002) emerged as predictors of 90-day mortality. Conclusions APACHE II scores, the PaO2/FiO2 ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.

수은 증기 흡입에 의한 급성 호흡부전증 및 급성 신부전증 1 예

이상헌(Sang Heon Lee),김석헌(Seok Heon Kim),김영균(Young Kyoon Kim),우제영(Je Young Woo),한석원(Sok Won Han),박인수(In Soo Park),박성학(Sung Hak Park),강성구(Sung Koo Kang) 대한내과학회 1991 대한내과학회지 Vol.40 No.5

Mercury is a commonly found substance in the environment. Nowadays the incidence of mercurey poisining is increasing, especially in developed cauntries. In contrast to extensive literature addressing long- term exposure, to our knowledge there are relatively few reports regarding acute toxicity with mercury. Rare cases have been reported of very high exposure to metallic mercury vapor. We report a case of acute mercury poisoning after exposure to metallic mercury vapor, which occured in a home by spontaneous inhalation of mercury vapor. Severe life-threatening respiratory symptoms developed due to acute chemical pneumonitis, Therefore, prompt treatment with oxygen, penicillamine, corticosteroid and antibiotics was instituted, but the patient died of acute respiratory failure and acute renal failure.

P-6 Predicting factors for the failure of high flow nasal cannula therapy in patients with acute respiratory failure

고유미,김신영,김성경,송소향,김치홍 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.0

Background: The clinical outcome of some patients with acute respiratory failure (ARF) treated with high flow nasal cannula (HFNC) may be favorable, but in others, ARF deteriorates and requires mechanical ventilation (MV). However, little is known about the factors affecting this difference. The aim of this study was to investigate the predicting factors for HFNC failure in patients with ARF treated with HFNC. Methods: A cohort of consecutive patients with ARF treated with HFNC was studied. HFNC failure was defined as MV or death following HFNC. Results: 112 patients were enrolled, of whom 72 (64.3%) required MV or died (HFNC failure). In univariate analysis, the significant factors associated with HFNC outcome were PaCO2, PaO2, P/F ratio, platelet count, CRP level, APACHE II score, P/F ratio difference (difference of P/F ratio before and after HFNC), and lung infiltration extent (P<0.05). Multivariate analysis identified APACHE II score and P/F ratio difference as independent predicting factors for HFNC failure, with odds ratio of 1.224 (p=0.021) and 0.979 (p=0.027), respectively. Receiver operating characteristic curve analysis determined cutoff values of 16.5 for APACHE II score and 41.72 for P/F ratio difference. Conclusion: We demonstrated that APACHE II score over 16.5 and oxygenation improvement (P/F ratio difference below 41.72) were independent predicting factors for HFNC failure. This suggests their role as evaluate criteria in setting indication for early MV in patients with ARF treated with HFNC. A larger, prospective study is required to confirm these finding.

Meaningful of Pneumothorax in Pneumocystis Pneumonia Patients with Respiratory Failure

( Ji Soo Choi ),( Su Hwan Lee ),( Eun Hye Lee ),( Chang Hwan Seol ),( Sung Ryeol Kim ),( Byung Hoon Park ),( Ah Young Leem ),( Kyung Soo Chung ),( Moo Suk Park ),( Young Sam Kim ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Purpose Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can increase the development of pneumothorax during treatment. This study aims to identify the incidence and related factors of pneumothorax in PCP patients with acute respiratory failure and to analyze their prognosis. Method We retrospectively reviewed the occurrence of pneumothorax including clinical characteristics and Results of other examinations in 119 patients with PCP pneumonia and respiratory failure requiring the mechanical ventilator treatment in medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019. Result The 28-day survival rate was 62.2% (N=74). Twenty-two patients (18.5%) developed the pneumothorax during ventilator treatment, and 45 patients (37.8%) were required the tracheostomy due to weaning failure. The cytomegalovirus co-infection (odds ratio 13.9; p = 0.013) were related with the occurrence of pneumothorax. Of 74 patients with 28-day survival, 15 patients (20.3%) were underwent the pneumothorax. In those patients, 5 patients survived (p = 0.048), and only 2 patients finally succeeded to wean from the ventilator (p = 0.037). Conclusion PCP patients with acute respiratory failure who developed pneumothorax were not associated with 28-day mortality, but might have related to difficult and prolonged weaning from the mechanical ventilator.

호흡부전과 신경학적 이상을 동반한 Acute Intermittent Porphyria

전대원(Dae Won Jun),최춘식(Choon Shik Choi),최호순(Ho Soon Choi),전용철(Yong Chul Jung),손주현(Joo Hyun Sohn),한동수(Dong Soo Han),윤병철(Byung Chul Yoon),함준수(Joon Soo Hahm),이민호(Min Ho Lee),이동후(Dong Hoo Lee),기춘석(Choon Shu 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3

The acute intermittent porphyria (AIP) is characterized biochemically by increased excretion of porphyrins and porphyrin precursors, S-aminolevulinic acid (ALA) and porphobilinogen (PBG). AIP presents with abdominal pain, mental disturbances and neurologic dysfunction. A 24-year-old woman with a medical history of AIP was admitted to our hospital because of abdominal pain and proximal muscle weakness. She was treated by carbohydrate loading with intravenous glucose. Twenty five days later, she developed tachycardia, fluctuation of blood pressure and syndrome of inappropriate secretion of antidiuretic hormore (SIADH). On 90th day, intubation was required to control her breathing. Complete flaccid paralysis developed, and the patient became comatose. The neurologic effects of acute porphyria are generally reversible, but the clinical course of severe case is complicated with respiratory failure, fluid electrolyte imbalance. AIP should be considered in differential diagnosis of patient with unexplained respiratory failure. (Kor J Gastroenterol 2000;36:413 - 418)

급성호흡부전 호전 후 기관지폐포세척에서 지방과립구가 확인된 지방색전증후군

박송리 ( Song Ree Park ),김현수 ( Hyun Soo Kim ),이재형 ( Jae Hyung Lee ),김상헌 ( Sang Heon Kim ),김태형 ( Tae Hyung Kim ),윤호주 ( Ho Joo Yoon ),박성수 ( Sung Soo Park ),신동호 ( Dong Ho Shin ),박찬금 ( Chan Kum Park ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.6

Fat embolism syndrome is a rare clinical diagnosis of dyspnea with acute respiratory failure and neurological signs caused by a traumatic long bone fracture. We report a case of fat embolism in a 22 year-old man after a traffic accident. Dyspnea and stuporous mental changes developed on the 1st day after the external fixation operation of a left metaphyseal femur fracture. On the following day, he was transferred from a hospital to this one because of acute respiratory failure. After recovery, macrophages with fat droplets were found in the bronchoalveolar lavage fluid 1. It is important to diagnose a fat embolism as the correct cause of acute respiratory failure through the BAL in the acute state of fat embolism syndrome It is believed that clinically apparent or sometimes hidden fat embolism syndrome can be diagnosed from the BAL during the recovery state. (Tuberc Respir Dis 2006; 61: 562-566)

Imidacloprid 음독 후 저혈압과 호흡부전 1례

하민석,박정수,민진홍,김훈,이석우 대한응급의학회 2011 대한응급의학회지 Vol.22 No.2

Imidacloprid belongs to a relatively new class of insecticides,chloronicotinyl neonicotinoid compounds that are agonists of insect postsynaptic nicotinic acetylcholine receptors (nAChrs). Imidacloprid insecticides have been believed to be of low toxicity to humans causing only mild symptoms such as vomiting, abdominal pain and headache in the majority of cases due to nicotinic receptor resistance. Despite the original belief that imidacloprid has low mammalian toxicity, evidence is increasing evidence that imidacloprid may cause heart, kidney and other organ damages and even death, besides gastrointestinal irritation and neurological symptoms. We report a case of acute ingestion of an imidacloprid-containing insecticide. Clinical manifestrations included hypotension and respiratory failure. A literature review is included