Neurologic evaluation in ICU patients

고상배 대한내과학회 2019 대한내과학회 춘계학술대회 Vol.2019 No.-

Neurological complication is common in patients who are treated in the medical or surgical intensive care unit (ICU). Therefore, an accurate assessment and interpretation of neurological status is very important in intensivists, however, it may not be so easy to identify neurological abnormality among the patients who are under a lot of sedative agents. The most common neurological complications are ischemic stroke, hemorrhagic stroke, or seizures. Here, we will review the process how neurologists assess the patients with altered mental status, and will show the tips for neurologic assessment. Detailed brainstem examinations, brain imaging, and electroencephalography will be discussed.

Perioperative stroke: pathophysiology and management

고상배 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.1

Although perioperative stroke is uncommon during low-risk non-vascular surgery, if it occurs, it can negatively impact recovery from the surgery and functional outcome. Based on the Society for Neuroscience in Anesthesiology and Critical Care Consensus Statement, perioperative stroke includes intraoperative stroke, as well as postoperative stroke developing within 30 days after surgery. Factors related to perioperative stroke include age, sex, a history of stroke or transient ischemic attack, cardiac surgery (aortic surgery, mitral valve surgery, or coronary artery bypass graft surgery), and neurosurgery (external carotid-internal carotid bypass surgery, carotid endarterectomy, or aneurysm clipping). Concomitant carotid and cardiac surgery may further increase the risk of perioperative stroke. Preventive strategies should be individualized based on patient factors, including cerebrovascular reserve capacity and the time interval since the previous stroke.

2019 급성 허혈뇌졸중 환자에서 혈관내재개통치료 진료지침 개정

고상배,박홍균,김병문,허지회,나정호,권순억,김종성,이병철,서상현,정철규,정해웅,강동훈,배희준,윤병우,홍근식 대한신경과학회 2020 대한신경과학회지 Vol.38 No.2

Endovascular recanalization therapy (ERT) has been a standard of care for patients with acute ischemic stroke due to large artery occlusion (LAO) within 6 hours after onset since the five landmark ERT trials up to 2015 demonstrated its clinical benefit. Recently, two randomized clinical trials demonstrated that ERT, even in the late time window up to 16 hours or 24 hours after last known normal time, improved the outcome of patients who had a target mismatch defined as either clinical-core mismatch or perfusion-core mismatch, which prompted the update of national guidelines in several countries. Accordingly, to provide evidence-based and up-to-date recommendations for ERT in patients with acute LAO in Korea, the Clinical Practice Guidelines Committee of the Korean Stroke Society decided to revise the previous Korean Clinical Practice Guidelines of Stroke for ERT. For this update, the members of the writing group were appointed by the Korean Stroke Society and the Korean Society of Interventional Neuroradiology. After thorough reviewing the updated evidence from two recent trials and relevant literature, the writing members revised recommendations, for which formal consensus was achieved by convening an expert panel composed of 45 experts from the participating academic societies. The current guidelines are intended to help healthcare providers, patients, and their caregivers make their well-informed decisions and to improve the quality of care regarding ERT. The ultimate decision for ERT in a particular patient must be made in light of circumstances specific to that patient. J Korean Neurol Assoc 38(2

중력주조 공법에서 주조해석 시뮬레이션을 이용한 압탕설계 사례 연구

고상배,한기원,김형준,한태수,한성렬,김경아,최계광,윤재웅,이춘규,Ko, Sang-Bae,Han, Ki-Won,Kim, Hyung-Jun,Han, Tae-Soo,Han, Seong-Ryeol,Kim, kyung-A,Choi, Kye-Kwang,Yun, Jae-Woong,Lee, Chun-Kyu 한국금형공학회 2021 한국금형공학회지 Vol.15 No.2

The casting method uses a mold to solidify a liquid metal to make a solid metal. Since it uses a liquid metal with the least deformation resistance, it has the characteristic that it can easily manufacture even a complex shape. However, the process of solidifying a liquid metal into a solid metal inevitably involves a volume change and contains internal defects such as shrinkage holes. Therefore, in the design of the casting plan, an excess volume called a pressurization compensates for the volume shrinkage. in the product, and it induces the shrinkage hole defects to occur in parts other than the product1). In this study, casting analysis was performed using casting analysis software (anycasting) in order to optimize the design of the tilting gravity casting method for automobile brackets. In particular, the filling and solidification analysis according to the shape and volume of the pressurized metal was conducted, and applied to the actual product to study the effect of the pressurized metal on the shrinkage defect. Through this study, it is possible to understand the effect of the pressure metal on shrinkage defects in the actual product and propose a design of the pressure metal that improves reliability and productivity.

급성기 뇌졸중의 일반적 치료

고상배 대한의사협회 2009 대한의사협회지 Vol.52 No.4

Prompt diagnosis and appropriate treatment is most important process in managing patients with acute stroke. The acute stroke treatment can be categorized as a specific treatment and general management. Specific treatment, including antithrombotic treatment or thrombolysis therapy, needs to be modified in individual patients. However, general management deals with common problems such as elevated blood pressure, high glucose level, respiratory difficulty, or fever, and those problems are commonly encountered in treating patients with acute stroke. This paper presents up-to-date recommendations for treating acute stroke with review of literatures.

손상과 결근

고상배,Go, Sang-Bae 대한산업보건협회 2007 산업보건 Vol.232 No.-

면역조직화학적으로 확진된 산발성 크로이츠펠트-야콥병의 임상 특성

고상배,김용선,정병훈,김동규,김상윤 대한신경과학회 2001 대한신경과학회지 Vol.19 No.5

뇌부종과 두개내압 상승의 기본치료원칙

고상배 대한의사협회 2023 대한의사협회지 Vol.66 No.5

Background: Brain edema is a well-recognized pathophysiological secondary change after primary brain injury. The mechanism of brain edema may differ based on the types of brain edema. However, numerous ion channels are involved in its development and are therefore currently a hot target for anti-edema therapy. Here, this paper reviews the clinically important differences among the types of brain edema and a step-wise management strategy for brain edema and elevated intracranial pressure (ICP). Current Concepts: Brain edema can be classified as cytotoxic, ionic, vasogenic, and interstitial edema. Although the underlying mechanisms may differ among the various types of brain edema, multiple ion channels and the integrity of tight junctions are associated with the development of brain edema. If brain edema aggravates, the intracranial volume expands and leads to an elevation of ICP. A basic principle in the management of ICP includes proper positioning, screening for a need for extraventricular drainage, proper sedation, transient hyperventilation, assessing the intracranial water status with the serum sodium level, optimization of cerebral perfusion pressure, hyperosmolar therapy, targeted temperature management, and induction of a pharmacological coma with sedatives. Discussion and Conclusion: Stepwise treatment strategies are recommended in the management of patients with ICP crisis. Based on the principle, detailed management plans need to be adjusted based on the status of an individual patient.

뇌손상 환자에서 두개내압 상승의 평가

박진,고상배 대한의사협회 2023 대한의사협회지 Vol.66 No.5

Background: Monitoring and managing elevated intracranial pressure (ICP) is one of the core topics in neurocritical care. Although invasive methods are regarded as standard means, the recent development of non-invasive monitoring devices help clinicians handle ICP issues without additional risks of device-related complications. Current Concepts: According to the Monro–Kellie hypothesis, any brain injury that can cause a mass effect will lead to ICP elevation. Therefore, an ICP surge beyond the capacity of a compensatory reserve will decrease cerebral blood flow and may end up causing secondary brain damage. Indications for invasive ICP monitoring may vary according to the underlying conditions or the severity of brain damage. Regardless, ICP monitoring is considered when there is a risk of ICP elevation. In addition to pressure monitoring, external ventricular drainage catheters are used therapeutically to drain cerebrospinal fluid to reduce ICP. Several ICP monitoring probes are available based on pressure measurement types. Recently, non-invasive ICP monitoring methods have been developed and are increasingly used in patients with severe brain injuries. Pulsatility index from transcranial Doppler ultrasonography, quantitative pupillary light reflex from an automated pupillometer, and optic nerve sheath diameter using ultrasonography are commonly used surrogates for ICP surges in neurointensive care units. Discussion and Conclusion: ICP monitoring is essential for managing patients with severe brain injuries. Understanding the differences among the ICP monitors and determining the appropriate methods for ICP monitoring is necessary for optimizing patients’ care in the neurocritical care unit.

한국 뇌졸중 진료지침 급성기 치료 중 혈전용해술에 대한 내용의 부분개정

조경희,고상배,김대현,박희권,조아현,홍근식,유경호,허지회,권순억,배희준,오창완,권오기,이병철,윤병우,나정호 대한뇌졸중학회 2012 Journal of stroke Vol.14 No.3

Since the release of first Korean Clinical Practice Guideline of Stroke in 2009, many important new evidences have emerged in the field of thrombolytic therapy. Among the recent developments are the extended therapeutic time window of intravenous (IV)tissue plasminogen activator (tPA) up to 4.5 hours after onset, and the efforts for the wider application of IV thrombolysis to patients with minor stroke and elderly patients over 80 years old. Debates about the optimal dose of IV tPA according to the ethnic population is still ongoing. Further evidences for the efficacy of intra-arterial thrombolysis have also accumulated, including the application of various novel mechanical devices with promising results. Thus update of guideline became necessary and we revise the acute stroke management guideline, focusing on the thrombolytic therapy.