Jungyoup Lee

Comparison of propofol and the combination of propofol and alfentanil during bronchoscopy: a randomized study

Background: Propofol is an excellent sedative agent for use in patients undergoing bronchoscopy. The addition of an opioid to propofol can be advantageous because of the antitussive effect of the opioid and the possible improvement in sedation quality. However, it may increase the risk of hypoxaemia. To investigate the effect of the addition of alfentanil to propofol, we performed a prospective study to compare propofol‐only sedation with propofol–alfentanil combination sedation in patients undergoing bronchoscopy.

Bacteremia prediction model using a common clinical test in patients with community-acquired pneumonia.

PURPOSE The aim of this study was to construct a bacteremia prediction model using commonly available clinical variables in hospitalized patients with community-acquired pneumonia (CAP). BASIC PROCEDURES A prospective database including patients who were diagnosed with CAP in the emergency department was analyzed. Independent risk factors were investigated by using multivariable analysis in 60% of the cohort. We assigned a weighted value to predictive factor and made a prediction rule. This model was validated both internally and externally with the remaining 40% of the cohort and a cohort from an independent hospital. The low-risk group for bacteremia was defined as patients who have a risk of bacteremia less than 3%. MAIN FINDINGS A total of 2422 patients were included in this study. The overall rate of bacteremia was 5.7% in the cohort. The significant factors for predicting bacteremia were the following 7 variables: systolic blood pressure less than 90 mm Hg, heart rate greater than 125 beats per minute, body temperature less than 35 °C or greater than 40 °C, white blood cell less than 4000 or 12,000 cells per microliter, platelets less than 130,000 cells per microliter, albumin less than 3.3 g/dL, and C-reactive protein greater than 17 mg/dL. After using our prediction rule for the validation cohorts, 78.7% and 74.8% of the internal and external validation cohorts were classified as low-risk bacteremia groups. The areas under the receiver operating characteristic curves were 0.75 and 0.79 for the internal and external validation cohorts. PRINCIPAL CONCLUSIONS This model could provide guidelines for whether to perform blood cultures for hospitalized CAP patients with the goal of reducing the number of blood cultures.

Low-dose diltiazem in atrial fibrillation with rapid ventricular response

OBJECTIVES Diltiazem is one of the most commonly used medications to control the rapid ventricular response in atrial fibrillation (AF). The recommended starting dose is an intravenous bolus of 0.25 mg/kg over 2 minutes. To avoid hypotension, we have empirically used a lower dose of diltiazem. We compared the efficacy and safety of different doses of diltiazem in rapid AF. METHODS A retrospective chart review was undertaken in patients who presented to the emergency department with rapid AF. Patients were divided into 3 groups according to diltiazem dosage: low dose (≤ 0.2 mg/kg), standard dose (> 0.2 and ≤ 0.3 mg/kg), and high dose (> 0.3 mg/kg). We compared the rates of therapeutic response (adequate rate control) and complications (such as hypotension). Multivariate regression analysis was used to determine the effect of diltiazem dose on the occurrence of complications. RESULTS A total of 180 patients were included in the analysis. There were no significant differences in the rates of therapeutic response for the low-, standard-, and high-dose groups (70.5%, 77.1%, and 77.8%; P = .605). The rates of hypotension in the low-, standard-, and high-dose groups were 18%, 34.9%, and 41.7%, respectively. After adjusting confounding variables, the rate of hypotension was significantly lower in the low-dose group in comparison with the standard-dose group (adjusted odds ratio, 0.39; 95% confidence interval, 0.16-0.94). CONCLUSIONS Low-dose diltiazem might be as effective as the standard dose in controlling rapid AF and reduce the risk of hypotension.

Different fates of excessive daytime sleepiness: survival analysis for remission.

Excessive daytime sleepiness (EDS) is a symptom frequently presented in sleep clinics. Only a paucity of data has addressed clinical courses of sleep disorders with EDS. Therefore, we sought to compare clinical outcomes of patients presenting EDS.

Factors associated with residual symptoms after recompression in type I decompression sickness.

PURPOSE The aim of this study is to investigate factors associated with residual symptoms after hyperbaric oxygen therapy (HBOT) in type I decompression sickness (DCS). BASIC PROCEDURES An HBOT registry, which includes patients with type I DCS, was analyzed retrospectively. We divided enrolled patients into two groups; complete resolution group and residual symptom (RS) group after a single HBOT session. We investigated factors associated with residual symptoms at discharge with univariable and multivariable analyses. Restrictive cubic spline curve and a test for trend analysis were used to show the trend of therapeutic response after HBOT based on time from symptom onset to HBOT. MAIN FINDINGS In a total of 195 patients, 131 (67.2%) patients were included in the RS group after single HBOT. Prolonged time from symptom onset to recompression was independently associated with residual symptoms (P = .004). When patients who underwent recompression within 24 hours from symptom were included in the reference group, the adjusted odds ratios (AOR) (95% confidence interval) of residual symptoms after HBOT were the following: 24 to 96 hours, 2.24 (0.75-6.65); 96 to 240 hours, 3.31 (1.08-10.13); more than 240 hours, 22.83 (2.45-231.43). In terms of sort of diving, commercial and recreational divers had higher probability of residual symptoms than military divers (AOR, 4.78 and 33.36, respectively). PRINCIPAL CONCLUSIONS Early HBOT is associated with rapid symptom elimination after treatment in type I DCS. Military divers showed a more immediate response after recompression in comparison with commercial and recreational divers.

Use of resuscitative endovascular balloon occlusion of the aorta in a patient with gastrointestinal bleeding

Resuscitative endovascular balloon occlusion of the aorta (REBOA) was developed for controlling intra-abdominal arterial bleeding before definitive bleeding control, and is commonly used in patients with ruptured abdominal aortic aneurysms. Although there is limited evidence for other uses of REBOA, we used REBOA in a patient with massive gastrointestinal bleeding. A 53-year-old man with hematochezia was admitted to our emergency department with an initial systolic blood pressure (SBP) of 83 mmHg. His SBP decreased to 40 mmHg in 10 minutes despite rapid fluid infusion. We decided to resuscitate the patient with REBOA in the emergency department and then move him to an intervention room after stabilization. After aortic occlusion, SBP abruptly increased from 57 to 108 mmHg, and the patient could be transferred to an intervention room. The patient was admitted to intensive care, but died of massive rebleeding 24 hours after admission to the emergency department.

Underweight is associated with mortality in patients with severe sepsis and septic shock

It is well known that obesity is associate with improved mortality in severe sepsis in western countries. However, the prognosis of the patients with sepsis in Asian countries might be different from that of western countries.

Association of C-Reactive Protein and Outcome in Patients With Community-Acquired Pneumonia

Physicians tend to think that high C-reactive protein (CRP) and increase of CRP are associated with bad outcome in infectious disease. However there were little evidences about clinical interpretation of C-reactive protein (CRP) value in patient with community-acquired pneumonia (CAP). We investigated association of CRP values and 30-day mortality in patients with community-acquired pneumonia who were admitted to emergency department (ED).