Acute and Critical Care

Original Articles

Pulmonary
The role of nafamostat mesilate as a regional anticoagulant during extracorporeal membrane oxygenation: Jae Ha Lee, Jin Han Park, Ji Hoon Jang, Se Hun Kim, Sung Yong Hong, Woon Heo, Dong-Hwan Lee, Hye Sook Choi, Ki Hoon Kim, Hang-Jea Jang; Acute Crit Care. 2022;37(2):177-184. Published online April 20, 2022; DOI: https://doi.org/10.4266/acc.2021.01312

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Background
Anticoagulation during extracorporeal membrane oxygenation (ECMO) usually is required to prevent thrombosis. The aim of this study was to investigate the usefulness of nafamostat mesilate (NM) as a regional anticoagulant during veno-arterial ECMO (VA-ECMO) treatment. Methods: We retrospectively reviewed the medical records of 16 patients receiving VA-ECMO and NM from January 2017 to June 2020 at Haeundae Paik Hospital. We compared clinical and laboratory data, including activated partial thromboplastin time (aPTT), which was measured simultaneously in patients and the ECMO site, to estimate the efficacy of regional anticoagulation. Results: The median patient age was 68.5 years, and 56.3% of patients were men. Cardiovascular disease was the most common primary disease (75.0%) requiring ECMO treatment, followed by respiratory disease (12.5%). The median duration of ECMO treatment was 7.5 days. Among 16 patients, seven were switched to NM after first using heparin as an anticoagulation agent, and nine received only NM. When comparing aPTT values in the NM group between patients and the ECMO site, that in patients was significantly lower than that at the ECMO site (73.57 vs. 79.25 seconds; P=0.010); in contrast, no difference was observed in the heparin group. Conclusions: NM showed efficacy as a regional anticoagulation method by sustaining a lower aPTT value compared to that measured at the ECMO site. NM should be considered as a safer regional anticoagulation method in VA-ECMO for patients at high risk of bleeding.

Citations

Citations to this article as recorded by

Approach to Decompensated Right Heart Failure in the Acute Setting
Catherine V. Levitt, Caitlin A. Williams, Jalil Ahari, Ali Pourmand
Journal of Clinical Medicine.2024; 13(3): 869. CrossRef
Critical Care Management of Severe Asthma Exacerbations
Shameek Gayen, Stephen Dachert, Bilal Lashari, Matthew Gordon, Parag Desai, Gerard Criner, Juan Cardet, Kartik Shenoy
Journal of Clinical Medicine.2024; 13(3): 859. CrossRef
Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock
Jan-Sören Padberg, Jannik Feld, Leonie Padberg, Jeanette Köppe, Lena Makowski, Joachim Gerß, Patrik Dröge, Thomas Ruhnke, Christian Günster, Stefan Andreas Lange, Holger Reinecke
Journal of Clinical Medicine.2024; 13(4): 1167. CrossRef
Extra-Corporeal Membrane Oxygenation in Pregnancy
Tatsiana Romenskaya, Yaroslava Longhitano, Aman Mahajan, Gabriele Savioli, Antonio Voza, Manfredi Tesauro, Christian Zanza
Journal of Clinical Medicine.2024; 13(6): 1634. CrossRef
Anticoagulants in adult extracorporeal membrane oxygenation: alternatives to standardized anticoagulation with unfractionated heparin
Shu Tang, Liqing Xu, Hui Li, Zhanshen Wu, Qiang Wen
European Journal of Clinical Pharmacology.2023; 79(12): 1583. CrossRef
Management of cardiopulmonary bypass in patients with ischemic and hemorrhagic strokes in surgery for active infective endocarditis
Takahiro Yamazato, Hiroshi Munakata, Yutaka Okita
Indian Journal of Thoracic and Cardiovascular Surgery.2023;[Epub] CrossRef

Pulmonary
The effects of direct hemoperfusion with polymyxin B-immobilized fiber in patients with acute exacerbation of interstitial lung disease: Jae Ha Lee, Jin Han Park, Hyo-Jung Kim, Hyun Kuk Kim, Ji Hoon Jang, Yong Kyun Kim, Bong Soo Park, Si Hyung Park, Il Hwan Kim, Se Hun Kim, Woon Heo, Hang-Jea Jang; Acute Crit Care. 2021;36(2):126-132. Published online April 15, 2021; DOI: https://doi.org/10.4266/acc.2021.00073

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Abstract PDF

Background
Acute exacerbation of interstitial lung disease (AE-ILD) causes clinically significant deterioration and has an extremely poor prognosis with high mortality. Recently, several studies reported the effectiveness of direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) in patients with AE-ILD as a potential therapy. This study describes the clinical effectiveness and safety of PMX-DHP in patients with AE-ILD.
Methods
We retrospectively reviewed the medical records of 10 patients (11 episodes) with AE-ILD treated with PMX-DHP from January 2018 to June 2019. We compared laboratory and physiologic data of the ratio of partial pressure arterial oxygen to fraction of inspired oxygen (P/F ratio) and level of inflammatory markers before and after implementation of PMX-DHP.
Results
Ten patients were included according to the 2016 revised definition of acute exacerbation of idiopathic pulmonary fibrosis (IPF). Nine patients had IPF and one patient had fibrotic nonspecific interstitial pneumonia. Most patients (90.9%) were treated with a steroid pulse, and four patients (36.4%) were treated with an immunosuppressant. The median number of PMX-DHP cycles was 2, and the median duration of each cycle was 6 hours. After PMX-DHP, the mean P/F ratio improved (86 [range, 63–106] vs. 145 [86–260], P=0.030) and interleukin-6 and c-reactive protein decreased (79 [35–640] vs. 10 [5–25], P=0.018 and 14 [4–21] vs. 5 [2–6], P=0.019, respectively). The 30-day mortality rate was 27.3% and the 90-day mortality rate was 72.7%.
Conclusions
PMX-DHP treatment improved P/F ratio and reduced inflammatory markers in AE-ILD patients.

Citations

Citations to this article as recorded by

Polymyxin B-immobilised fibre column treatment for acute exacerbation of idiopathic pulmonary fibrosis patients with mechanical ventilation: a nationwide observational study
Nobuyasu Awano, Taisuke Jo, Takehiro Izumo, Minoru Inomata, Yu Ito, Kojiro Morita, Hiroki Matsui, Kiyohide Fushimi, Hirokazu Urushiyama, Takahide Nagase, Hideo Yasunaga
Journal of Intensive Care.2023;[Epub] CrossRef
Changes in Oxygenation and Serological Markers in Acute Exacerbation of Interstitial Lung Disease Treated with Polymyxin B Hemoperfusion
Song-I Lee, Chaeuk Chung, Dongil Park, Da Hyun Kang, Jeong Eun Lee
Journal of Clinical Medicine.2022; 11(9): 2485. CrossRef

Case Reports

Toxicology
Methidathion Poisoning: Ki Hoon Kim, Se Hun Kim, Charles Her; Korean J Crit Care Med. 2017;32(4):363-369. Published online January 17, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00073

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Abstract PDF

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion’s effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient’s splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.

Citations

Citations to this article as recorded by

A case report of acute kidney injury following organophosphate methidathion poisoning
Bilel Chefirat, Anissa Zergui, Haciba Rezk-Kallah
Toxicologie Analytique et Clinique.2022; 34(2): 121. CrossRef

Pulmonary
Central Venous Catheter-Related Hydrothorax: Se Hun Kim, Charles Her; Korean J Crit Care Med. 2015;30(4):343-348. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.343

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Abstract PDF: This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right sub-clavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

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