Hongyeul Lee - Academia.edu (original) (raw)

Papers by Hongyeul Lee

Research paper thumbnail of Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

Tuberculosis and Respiratory Diseases, 2014

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These condit... more Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in lifethreatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

Research paper thumbnail of Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia

Journal of Thoracic Disease, Feb 1, 2018

Background: Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been... more Background: Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been introduced for hypoxic respiratory failure. However, it has not been well-evaluated for acute respiratory failure with hypercapnia. Methods: This retrospective study included acute respiratory failure patients with hypercapnia in the medical intensive care unit (MICU) from April 2011 to February 2013, who required HFNC oxygen therapy for hypoxemia. Respiratory parameters were recorded and arterial blood gas analyses conducted before, and at 1 and 24 h after initiation of HFNC oxygen therapy. Results: Thirty-three patients were studied [median age, 72 years; range, 17-85 years; men, 24 (72.7%)]. Pneumonia (36.4%) and acute exacerbation of chronic obstructive pulmonary disease (33.4%) were the most common reasons for oxygen therapy. Most patients (60.6%) received oxygen therapy via nasal prong before HFNC application. The mean fraction of inspired oxygen (FiO 2) and HFNC flow rate were 0.45±0.2 and 41.1±7.1 L/min, respectively; mean duration of application was 3.6±4.1 days. The partial pressure of arterial carbon dioxide (PaCO 2) was 55.0±12.2 mmHg at admission, and increased by approximately 1.0±7.7 mmHg with conventional oxygen therapy. In contrast, with HFNC therapy, PaCO 2 decreased by 4.2±5.5 and 3.7±10.8 mmHg in 1 and 24 h, respectively, resulting in significant improvement in hypercapnia (P=0.006 and 0.062, respectively). Conclusions: HFNC oxygen therapy with sufficient FiO 2 to maintain a normal partial pressure of arterial oxygen (PaO 2) significantly reduced PaCO 2 in acute respiratory failure with hypercapnia.

Research paper thumbnail of Cardiac troponin I as a prognostic factor in critically ill pneumonia patients in the absence of acute coronary syndrome

Journal of Critical Care, Apr 1, 2015

Purpose: Elevated cardiac troponin (cTn) has been associated with worse outcomes in critically il... more Purpose: Elevated cardiac troponin (cTn) has been associated with worse outcomes in critically ill patients, but few studies have focused on whether these markers are related to outcomes in patients with severe pneumonia. We investigated the levels of cTnI in critically ill patients hospitalized for severe pneumonia and whether elevated levels of cTnI correlated with the clinical outcome of this patient group. Materials and methods: We conducted a retrospective study of patients admitted to the medical intensive care unit (ICU) with severe pneumonia with levels of cTnI obtained within 24 hours of admittance. Patients with evidence of acute coronary syndrome were excluded. A cTnI level greater than 0.034 ng/mL was considered positive. P value b .05 was considered significant. Results: A total of 152 patients (community-acquired pneumonia [39.5%], health care-associated pneumonia [40.8%], and hospital-acquired pneumonia [19.7%]) were included in the study. Eighty-eight (58%) patients had detectable cTnI levels (median, 0.049 ng/mL). Patients with increased cTnI levels showed higher in-ICU mortality (38.6% vs 21.9%, P = .028). The association between elevated cTnI levels and mortality remained significant after adjustment using a multivariate model (adjusted hazard ratio = 1.398; 95% confidence interval, 1.005-1.945; P = .047). Conclusions: Increased levels of cTnI are an independent predictor of ICU mortality in patients hospitalized with severe pneumonia without evidence of acute coronary syndrome.

Research paper thumbnail of Significance of fractional exhaled nitric oxide in chronic eosinophilic pneumonia: a retrospective cohort study

BMC Pulmonary Medicine, May 12, 2014

Background: Chronic eosinophilic pneumonia (CEP) is characterized by chronic eosinophilic infiltr... more Background: Chronic eosinophilic pneumonia (CEP) is characterized by chronic eosinophilic infiltration of the lung. It is dramatically responsive to corticosteroid treatment, but symptoms and radiopacities recur frequently after tapering or discontinuing the medication. Fractional exhaled nitric oxide (FeNO) is a well-known noninvasive marker of eosinophilic airway inflammation. The aim of this retrospective cohort study was to investigate the relationships of FeNO with peripheral eosinophilia and the clinical state of CEP and its validity for predicting exacerbation of CEP. Methods: Standard clinical and laboratory parameters, peripheral eosinophil percentage and count, and FeNO level were measured in 18 patients with CEP at several assessment points over 1 year. Results: FeNO level was positively correlated with peripheral eosinophil count (r = 0.341, P = 0.005) and percentage (r = 0.362, P = 0.003). The median (IQR) FeNO levels were 79 (41-88) and 35 (26-49) ppb in uncontrolled (13/74 measurements) and controlled (61/74 measurements) CEP, respectively (P = 0.010). The FeNO level of 66.0 ppb showed the largest area under the curve (0.835) for predicting exacerbation of CEP (sensitivity = 0.80, specificity = 0.84). Conclusion: FeNO may be useful for monitoring eosinophilic parenchymal inflammation and determining the appropriate corticosteroid dose in CEP.

Research paper thumbnail of Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia

The Korean Journal of Internal Medicine, May 1, 2016

Background/Aims: Healthcare-associated pneumonia (HCAP) was proposed as a new pneumonia category ... more Background/Aims: Healthcare-associated pneumonia (HCAP) was proposed as a new pneumonia category in 2005, and treatment recommendations include broad-spectrum antibiotics directed at multidrug-resistant (MDR) pathogens. However, this concept continues to be controversial, and microbiological data are lacking for HCAP patients in the intensive care unit (ICU). This study was conducted to determine the rate and type of antibiotic-resistant organisms and the clinical outcomes in patients with HCAP in the ICU, compared to patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). Methods: We conducted a retrospective cohort analysis of patients with pneumonia (n = 195) who admitted to medical ICU in tertiary teaching hospital from March 2011 to February 2013. Clinical characteristics, microbiological distributions, treatment outcomes, and prognosis of HCAP (n = 74) were compared to those of CAP (n = 75) and HAP (n = 46). Results: MDR pathogens were significantly higher in HCAP patients (39.1%) than in CAP (13.5%) and lower than in HAP (79.3%, p < 0.001). The initial use of inappropriate antibiotic treatment occurred more frequently in the HCAP (32.6%) and HAP (51.7%) groups than in the CAP group (11.8%, p = 0.006). There were no differences in clinical outcomes. The significant prognostic factors were pneumonia severity and treatment response. Conclusions: MDR pathogens were isolated in HCAP patients requiring ICU admission at intermediate rates between those of CAP and HAP.

Research paper thumbnail of Extravasation of TPN following central venous catheter migration

Respiratory medicine case reports, Feb 1, 2022

Central venous catheterization is a preferred method for intensive care patients who require tota... more Central venous catheterization is a preferred method for intensive care patients who require total parenteral nutrition (TPN). TPN can cause tissue damage due to osmotic effects and the presence of ions. We report a case of TPN extravasation into the pleural cavity due to a shift in position of a subclavian central vein catheter. In this report, we discuss the importance of serial follow up of chest X-ray examination in patients with central vein catheterization.

Research paper thumbnail of JCAT_210140 294..299

Objective: The aim of the study was to retrospectively evaluate the safety and accuracy of comput... more Objective: The aim of the study was to retrospectively evaluate the safety and accuracy of computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions during quiet breathing. Methods: We investigated the diagnostic performance and complication rate of 585 procedures in 563 patients (357 men; mean age, 67.7 years), who underwent CT-guided PTNBs during quiet breathing, aided by a respiratory targeting technique fromMay 2017 to July 2019. Differences between the cases with and without respiratory targeting were analyzed. Logistic regression analyses were performed to examine the development of pneumothorax and hemoptysis. Results: Percutaneous transthoracic needle biopsy samples were successfully obtained in 574 of 585 procedures (98.1%). Final diagnoses included: 410 malignant cases, 119 benign cases, and 45 indeterminate cases. The sensitivity, specificity, and accuracy of diagnosis were 94.4%, 100%, and 95.7%, respectively. Use of respiratory targ...

Research paper thumbnail of Is Free Breathing Possible During Computed Tomography–Guided Percutaneous Transthoracic Lung Biopsy? The Clinical Experience in 585 Cases

Journal of Computer Assisted Tomography, 2022

Objective The aim of the study was to retrospectively evaluate the safety and accuracy of compute... more Objective The aim of the study was to retrospectively evaluate the safety and accuracy of computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions during quiet breathing. Methods We investigated the diagnostic performance and complication rate of 585 procedures in 563 patients (357 men; mean age, 67.7 years), who underwent CT-guided PTNBs during quiet breathing, aided by a respiratory targeting technique from May 2017 to July 2019. Differences between the cases with and without respiratory targeting were analyzed. Logistic regression analyses were performed to examine the development of pneumothorax and hemoptysis. Results Percutaneous transthoracic needle biopsy samples were successfully obtained in 574 of 585 procedures (98.1%). Final diagnoses included: 410 malignant cases, 119 benign cases, and 45 indeterminate cases. The sensitivity, specificity, and accuracy of diagnosis were 94.4%, 100%, and 95.7%, respectively. Use of respiratory target...

Research paper thumbnail of Extravasation of TPN following central venous catheter migration

Respiratory Medicine Case Reports, 2022

Central venous catheterization is a preferred method for intensive care patients who require tota... more Central venous catheterization is a preferred method for intensive care patients who require total parenteral nutrition (TPN). TPN can cause tissue damage due to osmotic effects and the presence of ions. We report a case of TPN extravasation into the pleural cavity due to a shift in position of a subclavian central vein catheter. In this report, we discuss the importance of serial follow up of chest X-ray examination in patients with central vein catheterization.

Research paper thumbnail of CT Follow-Up of Postoperative Bronchopleural Fistula: Risk Factors for Progression to Chronic Complicated Infection

Journal of the Korean Society of Radiology, 2021

Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistu... more Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistula (BPF) after pulmonary resection using follow-up CT. Materials and Methods We retrospectively reviewed 45 cases with BPF that had undergone pulmonary resection during 2010-2018. We compared the clinical and radiological characteristics of those with complicated BPF (n = 24) and those without complicated (sterilized) BPF (n = 21). The clinical and radiological risk factors for progression to chronic complicated BPF were examined by logistic regression analysis. Results The thickness of the pleural cavity wall (p = 0.022), the size of the pleural cavity (p = 0.029), and the size increase of BPF on follow-up (p = 0.012) were significantly different between the two groups. The risk factors for progression to chronic complicated BPF were age > 70 years (odds ratio, 6.43; 95% confidence interval, 1.2-33.7), the thickness of the cavity wall > 5 mm (odds ratio, 52.5; 95% confidence interval, 5.1-545.4), and an increase in the size of the pleural cavity on follow-up CT (odds ratio, 12.5; 95% confidence interval, 2.1-73.5), only in the univariate analysis. Conclusion The risk factors for progression to chronic complicated BPF can be evaluated using follow-up CT.

Research paper thumbnail of CT Follow-Up of Postoperative Bronchopleural Fistula: Risk Factors for Progression to Chronic Complicated Infection

Journal of the Korean Society of Radiology, 2021

Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistu... more Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistula (BPF) after pulmonary resection using follow-up CT. Materials and Methods We retrospectively reviewed 45 cases with BPF that had undergone pulmonary resection during 2010-2018. We compared the clinical and radiological characteristics of those with complicated BPF (n = 24) and those without complicated (sterilized) BPF (n = 21). The clinical and radiological risk factors for progression to chronic complicated BPF were examined by logistic regression analysis. Results The thickness of the pleural cavity wall (p = 0.022), the size of the pleural cavity (p = 0.029), and the size increase of BPF on follow-up (p = 0.012) were significantly different between the two groups. The risk factors for progression to chronic complicated BPF were age > 70 years (odds ratio, 6.43; 95% confidence interval, 1.2-33.7), the thickness of the cavity wall > 5 mm (odds ratio, 52.5; 95% confidence interval, 5.1-545.4), and an increase in the size of the pleural cavity on follow-up CT (odds ratio, 12.5; 95% confidence interval, 2.1-73.5), only in the univariate analysis. Conclusion The risk factors for progression to chronic complicated BPF can be evaluated using follow-up CT.

Research paper thumbnail of Significance of baseline computed tomography assessment for predicting the pulmonary fibrosis during the course of chemotherapy‐induced pneumonitis

Asia-Pacific Journal of Clinical Oncology, 2019

BackgroundThe purpose of our study is to evaluate risk factors for the development of pulmonary f... more BackgroundThe purpose of our study is to evaluate risk factors for the development of pulmonary fibrosis in the baseline computed tomography (CT) during the course of chemotherapy‐induced pneumonitis (CIP).MethodsWe retrospectively identified 80 cases of CIP by clinical, radiological, and pathological findings. When fibrosis developed during the follow‐up, the extent of pulmonary fibrosis was evaluated at final follow‐up CT in terms of a 5% volumetric score for six zones. Univariate and multivariate analyses were performed to identify the clinical and radiological risk factors for the development of fibrosis and severe fibrosis over 11% in extent.ResultsFibrosis occurred in 26 of the 80 total patients (32.5%) during a mean 5.6 months of follow up. Risk factors for developing fibrosis were revealed as preexisting interstitial lung disease (ILD) and moderate to severe emphysema in multivariate analysis (OR = 10.12, 95% CI = 2.35‐43.66, and OR = 12.85, 95% CI = 2.81‐58.82, respectively...

Research paper thumbnail of Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia

Journal of thoracic disease, 2018

Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been introduced ... more Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been introduced for hypoxic respiratory failure. However, it has not been well-evaluated for acute respiratory failure with hypercapnia. This retrospective study included acute respiratory failure patients with hypercapnia in the medical intensive care unit (MICU) from April 2011 to February 2013, who required HFNC oxygen therapy for hypoxemia. Respiratory parameters were recorded and arterial blood gas analyses conducted before, and at 1 and 24 h after initiation of HFNC oxygen therapy. Thirty-three patients were studied [median age, 72 years; range, 17-85 years; men, 24 (72.7%)]. Pneumonia (36.4%) and acute exacerbation of chronic obstructive pulmonary disease (33.4%) were the most common reasons for oxygen therapy. Most patients (60.6%) received oxygen therapy via nasal prong before HFNC application. The mean fraction of inspired oxygen (FiO) and HFNC flow rate were 0.45±0.2 and 41.1±7.1 L/min, respe...

Research paper thumbnail of Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents

Korean Journal of Critical Care Medicine, 2014

Background: Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to... more Background: Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to surgical tracheostomy in intensive care units (ICU), and is widely used for critically ill patients who need prolonged mechanical ventilation. Few studies have reported on PDT performed in critically ill patients taking antiplatelet agents. Our goals are to assess not only the feasibility and safety of PDT, but also bleeding complications in the patients receiving such therapy. Methods: In a single institution, PDTs were performed by pulmonologists at the medical ICU bedside using the single tapered dilator technique and assisted by flexible bronchoscopy to confirm a secure puncture site. From March 2011 to February 2013, the patients' demographic and clinical data, procedural parameters, outcomes and complications were analyzed and compared complications between patients taking antiplatelet agents and those not. Results: PDTs were performed for 138 patients; the median age was 72 years, mean body mass index was 20.3 ± 4.8 kg/m 2 , and mean acute physiology and chronic health evaluation II score was 24.4 ± 9.4. Overall, the procedural success rate was 100% and the total procedural time was 25 ± 8.5 min. There were no periprocedural life-threatening complications, and no statistical difference in the incidence of bleeding complications between patients who had taken antiplatelet agents and those had not (p = 0.657). Conclusions: PDT performed in critically ill patients taking antiplatelet agents was a feasible procedure and was implemented without additional bleeding complications.

Research paper thumbnail of Successful removal of endobronchial blood clots using bronchoscopic cryotherapy at bedside in the intensive care unit

Tuberculosis and respiratory diseases, 2014

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These condit... more Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit...

Research paper thumbnail of A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy

Korean Journal of Critical Care Medicine, 2013

Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in t... more Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in the critical care medicine for patients who need prolonged mechanical ventilation. Traditionally, PDT has been facilitated by bronchoscopy via the endotracheal tube. However, there are risks for blocking the view of correct puncture site on the trachea or being extubated unintentionally, which lead to loss of the airway. These complications are possibly due to insufficient bronchoscopic visualizations via endotracheal tube during the procedure. Using laryngeal mask airways (LMA) during PDT may overcome these problems and could provide a safer alternative method with superior visualizations of the trachea and larynx. We report a case of percutaneous tracheostomy being performed successfully under bronchoscopy with LMA in the intensive care unit.

Research paper thumbnail of Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

Tuberculosis and Respiratory Diseases, 2014

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These condit... more Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in lifethreatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

Research paper thumbnail of Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia

Journal of Thoracic Disease, Feb 1, 2018

Background: Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been... more Background: Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been introduced for hypoxic respiratory failure. However, it has not been well-evaluated for acute respiratory failure with hypercapnia. Methods: This retrospective study included acute respiratory failure patients with hypercapnia in the medical intensive care unit (MICU) from April 2011 to February 2013, who required HFNC oxygen therapy for hypoxemia. Respiratory parameters were recorded and arterial blood gas analyses conducted before, and at 1 and 24 h after initiation of HFNC oxygen therapy. Results: Thirty-three patients were studied [median age, 72 years; range, 17-85 years; men, 24 (72.7%)]. Pneumonia (36.4%) and acute exacerbation of chronic obstructive pulmonary disease (33.4%) were the most common reasons for oxygen therapy. Most patients (60.6%) received oxygen therapy via nasal prong before HFNC application. The mean fraction of inspired oxygen (FiO 2) and HFNC flow rate were 0.45±0.2 and 41.1±7.1 L/min, respectively; mean duration of application was 3.6±4.1 days. The partial pressure of arterial carbon dioxide (PaCO 2) was 55.0±12.2 mmHg at admission, and increased by approximately 1.0±7.7 mmHg with conventional oxygen therapy. In contrast, with HFNC therapy, PaCO 2 decreased by 4.2±5.5 and 3.7±10.8 mmHg in 1 and 24 h, respectively, resulting in significant improvement in hypercapnia (P=0.006 and 0.062, respectively). Conclusions: HFNC oxygen therapy with sufficient FiO 2 to maintain a normal partial pressure of arterial oxygen (PaO 2) significantly reduced PaCO 2 in acute respiratory failure with hypercapnia.

Research paper thumbnail of Cardiac troponin I as a prognostic factor in critically ill pneumonia patients in the absence of acute coronary syndrome

Journal of Critical Care, Apr 1, 2015

Purpose: Elevated cardiac troponin (cTn) has been associated with worse outcomes in critically il... more Purpose: Elevated cardiac troponin (cTn) has been associated with worse outcomes in critically ill patients, but few studies have focused on whether these markers are related to outcomes in patients with severe pneumonia. We investigated the levels of cTnI in critically ill patients hospitalized for severe pneumonia and whether elevated levels of cTnI correlated with the clinical outcome of this patient group. Materials and methods: We conducted a retrospective study of patients admitted to the medical intensive care unit (ICU) with severe pneumonia with levels of cTnI obtained within 24 hours of admittance. Patients with evidence of acute coronary syndrome were excluded. A cTnI level greater than 0.034 ng/mL was considered positive. P value b .05 was considered significant. Results: A total of 152 patients (community-acquired pneumonia [39.5%], health care-associated pneumonia [40.8%], and hospital-acquired pneumonia [19.7%]) were included in the study. Eighty-eight (58%) patients had detectable cTnI levels (median, 0.049 ng/mL). Patients with increased cTnI levels showed higher in-ICU mortality (38.6% vs 21.9%, P = .028). The association between elevated cTnI levels and mortality remained significant after adjustment using a multivariate model (adjusted hazard ratio = 1.398; 95% confidence interval, 1.005-1.945; P = .047). Conclusions: Increased levels of cTnI are an independent predictor of ICU mortality in patients hospitalized with severe pneumonia without evidence of acute coronary syndrome.

Research paper thumbnail of Significance of fractional exhaled nitric oxide in chronic eosinophilic pneumonia: a retrospective cohort study

BMC Pulmonary Medicine, May 12, 2014

Background: Chronic eosinophilic pneumonia (CEP) is characterized by chronic eosinophilic infiltr... more Background: Chronic eosinophilic pneumonia (CEP) is characterized by chronic eosinophilic infiltration of the lung. It is dramatically responsive to corticosteroid treatment, but symptoms and radiopacities recur frequently after tapering or discontinuing the medication. Fractional exhaled nitric oxide (FeNO) is a well-known noninvasive marker of eosinophilic airway inflammation. The aim of this retrospective cohort study was to investigate the relationships of FeNO with peripheral eosinophilia and the clinical state of CEP and its validity for predicting exacerbation of CEP. Methods: Standard clinical and laboratory parameters, peripheral eosinophil percentage and count, and FeNO level were measured in 18 patients with CEP at several assessment points over 1 year. Results: FeNO level was positively correlated with peripheral eosinophil count (r = 0.341, P = 0.005) and percentage (r = 0.362, P = 0.003). The median (IQR) FeNO levels were 79 (41-88) and 35 (26-49) ppb in uncontrolled (13/74 measurements) and controlled (61/74 measurements) CEP, respectively (P = 0.010). The FeNO level of 66.0 ppb showed the largest area under the curve (0.835) for predicting exacerbation of CEP (sensitivity = 0.80, specificity = 0.84). Conclusion: FeNO may be useful for monitoring eosinophilic parenchymal inflammation and determining the appropriate corticosteroid dose in CEP.

Research paper thumbnail of Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia

The Korean Journal of Internal Medicine, May 1, 2016

Background/Aims: Healthcare-associated pneumonia (HCAP) was proposed as a new pneumonia category ... more Background/Aims: Healthcare-associated pneumonia (HCAP) was proposed as a new pneumonia category in 2005, and treatment recommendations include broad-spectrum antibiotics directed at multidrug-resistant (MDR) pathogens. However, this concept continues to be controversial, and microbiological data are lacking for HCAP patients in the intensive care unit (ICU). This study was conducted to determine the rate and type of antibiotic-resistant organisms and the clinical outcomes in patients with HCAP in the ICU, compared to patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). Methods: We conducted a retrospective cohort analysis of patients with pneumonia (n = 195) who admitted to medical ICU in tertiary teaching hospital from March 2011 to February 2013. Clinical characteristics, microbiological distributions, treatment outcomes, and prognosis of HCAP (n = 74) were compared to those of CAP (n = 75) and HAP (n = 46). Results: MDR pathogens were significantly higher in HCAP patients (39.1%) than in CAP (13.5%) and lower than in HAP (79.3%, p < 0.001). The initial use of inappropriate antibiotic treatment occurred more frequently in the HCAP (32.6%) and HAP (51.7%) groups than in the CAP group (11.8%, p = 0.006). There were no differences in clinical outcomes. The significant prognostic factors were pneumonia severity and treatment response. Conclusions: MDR pathogens were isolated in HCAP patients requiring ICU admission at intermediate rates between those of CAP and HAP.

Research paper thumbnail of Extravasation of TPN following central venous catheter migration

Respiratory medicine case reports, Feb 1, 2022

Central venous catheterization is a preferred method for intensive care patients who require tota... more Central venous catheterization is a preferred method for intensive care patients who require total parenteral nutrition (TPN). TPN can cause tissue damage due to osmotic effects and the presence of ions. We report a case of TPN extravasation into the pleural cavity due to a shift in position of a subclavian central vein catheter. In this report, we discuss the importance of serial follow up of chest X-ray examination in patients with central vein catheterization.

Research paper thumbnail of JCAT_210140 294..299

Objective: The aim of the study was to retrospectively evaluate the safety and accuracy of comput... more Objective: The aim of the study was to retrospectively evaluate the safety and accuracy of computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions during quiet breathing. Methods: We investigated the diagnostic performance and complication rate of 585 procedures in 563 patients (357 men; mean age, 67.7 years), who underwent CT-guided PTNBs during quiet breathing, aided by a respiratory targeting technique fromMay 2017 to July 2019. Differences between the cases with and without respiratory targeting were analyzed. Logistic regression analyses were performed to examine the development of pneumothorax and hemoptysis. Results: Percutaneous transthoracic needle biopsy samples were successfully obtained in 574 of 585 procedures (98.1%). Final diagnoses included: 410 malignant cases, 119 benign cases, and 45 indeterminate cases. The sensitivity, specificity, and accuracy of diagnosis were 94.4%, 100%, and 95.7%, respectively. Use of respiratory targ...

Research paper thumbnail of Is Free Breathing Possible During Computed Tomography–Guided Percutaneous Transthoracic Lung Biopsy? The Clinical Experience in 585 Cases

Journal of Computer Assisted Tomography, 2022

Objective The aim of the study was to retrospectively evaluate the safety and accuracy of compute... more Objective The aim of the study was to retrospectively evaluate the safety and accuracy of computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions during quiet breathing. Methods We investigated the diagnostic performance and complication rate of 585 procedures in 563 patients (357 men; mean age, 67.7 years), who underwent CT-guided PTNBs during quiet breathing, aided by a respiratory targeting technique from May 2017 to July 2019. Differences between the cases with and without respiratory targeting were analyzed. Logistic regression analyses were performed to examine the development of pneumothorax and hemoptysis. Results Percutaneous transthoracic needle biopsy samples were successfully obtained in 574 of 585 procedures (98.1%). Final diagnoses included: 410 malignant cases, 119 benign cases, and 45 indeterminate cases. The sensitivity, specificity, and accuracy of diagnosis were 94.4%, 100%, and 95.7%, respectively. Use of respiratory target...

Research paper thumbnail of Extravasation of TPN following central venous catheter migration

Respiratory Medicine Case Reports, 2022

Central venous catheterization is a preferred method for intensive care patients who require tota... more Central venous catheterization is a preferred method for intensive care patients who require total parenteral nutrition (TPN). TPN can cause tissue damage due to osmotic effects and the presence of ions. We report a case of TPN extravasation into the pleural cavity due to a shift in position of a subclavian central vein catheter. In this report, we discuss the importance of serial follow up of chest X-ray examination in patients with central vein catheterization.

Research paper thumbnail of CT Follow-Up of Postoperative Bronchopleural Fistula: Risk Factors for Progression to Chronic Complicated Infection

Journal of the Korean Society of Radiology, 2021

Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistu... more Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistula (BPF) after pulmonary resection using follow-up CT. Materials and Methods We retrospectively reviewed 45 cases with BPF that had undergone pulmonary resection during 2010-2018. We compared the clinical and radiological characteristics of those with complicated BPF (n = 24) and those without complicated (sterilized) BPF (n = 21). The clinical and radiological risk factors for progression to chronic complicated BPF were examined by logistic regression analysis. Results The thickness of the pleural cavity wall (p = 0.022), the size of the pleural cavity (p = 0.029), and the size increase of BPF on follow-up (p = 0.012) were significantly different between the two groups. The risk factors for progression to chronic complicated BPF were age > 70 years (odds ratio, 6.43; 95% confidence interval, 1.2-33.7), the thickness of the cavity wall > 5 mm (odds ratio, 52.5; 95% confidence interval, 5.1-545.4), and an increase in the size of the pleural cavity on follow-up CT (odds ratio, 12.5; 95% confidence interval, 2.1-73.5), only in the univariate analysis. Conclusion The risk factors for progression to chronic complicated BPF can be evaluated using follow-up CT.

Research paper thumbnail of CT Follow-Up of Postoperative Bronchopleural Fistula: Risk Factors for Progression to Chronic Complicated Infection

Journal of the Korean Society of Radiology, 2021

Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistu... more Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistula (BPF) after pulmonary resection using follow-up CT. Materials and Methods We retrospectively reviewed 45 cases with BPF that had undergone pulmonary resection during 2010-2018. We compared the clinical and radiological characteristics of those with complicated BPF (n = 24) and those without complicated (sterilized) BPF (n = 21). The clinical and radiological risk factors for progression to chronic complicated BPF were examined by logistic regression analysis. Results The thickness of the pleural cavity wall (p = 0.022), the size of the pleural cavity (p = 0.029), and the size increase of BPF on follow-up (p = 0.012) were significantly different between the two groups. The risk factors for progression to chronic complicated BPF were age > 70 years (odds ratio, 6.43; 95% confidence interval, 1.2-33.7), the thickness of the cavity wall > 5 mm (odds ratio, 52.5; 95% confidence interval, 5.1-545.4), and an increase in the size of the pleural cavity on follow-up CT (odds ratio, 12.5; 95% confidence interval, 2.1-73.5), only in the univariate analysis. Conclusion The risk factors for progression to chronic complicated BPF can be evaluated using follow-up CT.

Research paper thumbnail of Significance of baseline computed tomography assessment for predicting the pulmonary fibrosis during the course of chemotherapy‐induced pneumonitis

Asia-Pacific Journal of Clinical Oncology, 2019

BackgroundThe purpose of our study is to evaluate risk factors for the development of pulmonary f... more BackgroundThe purpose of our study is to evaluate risk factors for the development of pulmonary fibrosis in the baseline computed tomography (CT) during the course of chemotherapy‐induced pneumonitis (CIP).MethodsWe retrospectively identified 80 cases of CIP by clinical, radiological, and pathological findings. When fibrosis developed during the follow‐up, the extent of pulmonary fibrosis was evaluated at final follow‐up CT in terms of a 5% volumetric score for six zones. Univariate and multivariate analyses were performed to identify the clinical and radiological risk factors for the development of fibrosis and severe fibrosis over 11% in extent.ResultsFibrosis occurred in 26 of the 80 total patients (32.5%) during a mean 5.6 months of follow up. Risk factors for developing fibrosis were revealed as preexisting interstitial lung disease (ILD) and moderate to severe emphysema in multivariate analysis (OR = 10.12, 95% CI = 2.35‐43.66, and OR = 12.85, 95% CI = 2.81‐58.82, respectively...

Research paper thumbnail of Effectiveness of high-flow nasal cannula oxygen therapy for acute respiratory failure with hypercapnia

Journal of thoracic disease, 2018

Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been introduced ... more Heated and humidified high-flow nasal cannula (HFNC) oxygen therapy has recently been introduced for hypoxic respiratory failure. However, it has not been well-evaluated for acute respiratory failure with hypercapnia. This retrospective study included acute respiratory failure patients with hypercapnia in the medical intensive care unit (MICU) from April 2011 to February 2013, who required HFNC oxygen therapy for hypoxemia. Respiratory parameters were recorded and arterial blood gas analyses conducted before, and at 1 and 24 h after initiation of HFNC oxygen therapy. Thirty-three patients were studied [median age, 72 years; range, 17-85 years; men, 24 (72.7%)]. Pneumonia (36.4%) and acute exacerbation of chronic obstructive pulmonary disease (33.4%) were the most common reasons for oxygen therapy. Most patients (60.6%) received oxygen therapy via nasal prong before HFNC application. The mean fraction of inspired oxygen (FiO) and HFNC flow rate were 0.45±0.2 and 41.1±7.1 L/min, respe...

Research paper thumbnail of Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents

Korean Journal of Critical Care Medicine, 2014

Background: Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to... more Background: Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to surgical tracheostomy in intensive care units (ICU), and is widely used for critically ill patients who need prolonged mechanical ventilation. Few studies have reported on PDT performed in critically ill patients taking antiplatelet agents. Our goals are to assess not only the feasibility and safety of PDT, but also bleeding complications in the patients receiving such therapy. Methods: In a single institution, PDTs were performed by pulmonologists at the medical ICU bedside using the single tapered dilator technique and assisted by flexible bronchoscopy to confirm a secure puncture site. From March 2011 to February 2013, the patients' demographic and clinical data, procedural parameters, outcomes and complications were analyzed and compared complications between patients taking antiplatelet agents and those not. Results: PDTs were performed for 138 patients; the median age was 72 years, mean body mass index was 20.3 ± 4.8 kg/m 2 , and mean acute physiology and chronic health evaluation II score was 24.4 ± 9.4. Overall, the procedural success rate was 100% and the total procedural time was 25 ± 8.5 min. There were no periprocedural life-threatening complications, and no statistical difference in the incidence of bleeding complications between patients who had taken antiplatelet agents and those had not (p = 0.657). Conclusions: PDT performed in critically ill patients taking antiplatelet agents was a feasible procedure and was implemented without additional bleeding complications.

Research paper thumbnail of Successful removal of endobronchial blood clots using bronchoscopic cryotherapy at bedside in the intensive care unit

Tuberculosis and respiratory diseases, 2014

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These condit... more Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit...

Research paper thumbnail of A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy

Korean Journal of Critical Care Medicine, 2013

Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in t... more Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in the critical care medicine for patients who need prolonged mechanical ventilation. Traditionally, PDT has been facilitated by bronchoscopy via the endotracheal tube. However, there are risks for blocking the view of correct puncture site on the trachea or being extubated unintentionally, which lead to loss of the airway. These complications are possibly due to insufficient bronchoscopic visualizations via endotracheal tube during the procedure. Using laryngeal mask airways (LMA) during PDT may overcome these problems and could provide a safer alternative method with superior visualizations of the trachea and larynx. We report a case of percutaneous tracheostomy being performed successfully under bronchoscopy with LMA in the intensive care unit.