The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 435
Slide Session
OS-092 Miscellaneous
Clinical Characteristics of Patients with Bronchiectasis
Chan Kwon Park1, Soon Seog Kwon2, Joong Hyun Ahn3, Chi Hong Kim4, Sook Young Lee5, Sang Hak Lee6, Seung Su Kim7, Jin Kook Lee5, Hyoung Kyu Yoon1
The Catholic University of Korea, Yeouido St. Mary’s Hospital, Korea1, The Catholic University of Korea, Bucheon St. Mary’s Hospital, Korea2, University of Korea, Incheon St. Mary’s Hospital, Korea3, University of Korea, St. Vincent’s Hospital, Korea4, University of Korea, Seoul St. Mary’s Hospital, Korea5, University of Korea, St. Paul’s Hospital, Korea6, University of Korea, Daejeon St. Mary’s Hospital, Korea7 Background: The prevalence of bronchiectasis has increased in recent decades. Bron- chiectasis present the similarities and differences between airway diseases. We are to defi ne the clinical characteristics of patients with bronchiectasis due to any cause Methods: We reviewed patients with bronchiectasis between May 2005 and June 2013 on the base of multicentre study setting. A total of 158 patients from 5 hospitals were enrolled.
Results: The mean age was 64.0±0.9 (mean±standard error); 61% were male. Never smoker was 58.2%. Most common involved lobe was left low lobe and cystic type was 75% in chest CT scan. Mean forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV1/FVC, and number of exerbations per year less than 1 were respectively 2.4±0.7, 1.6±0.1, 65.3%±1.2, 5.70%± 0.34, and 84.4%. FEV1/FVC<70% was 57.6%.
The number of exacerbation per year was signifi cantly correlated with FVC and FEV1.
Conclusions: Decreased lung function with exacerbation was observed in patients with bronchiectasis. Increased acute exacerbation and admission rate was identifi ed in airway obstruction.
OS-093 Pulmonary Infection
Microbiology of Parapneumonic Effusion and Predictive Factors for Mortality in South Korea
Cheolkyu Park1, Yongsoo Kwon1, Hongjoon Shin1, Boram Lee1, Heejung Ban1, Injae Oh1, Kyusik Kim1, Yuil Kim1, Sungchul Lim1, Youngchul Kim1
Chonnam National University Hospital, Korea1
Background: Understanding of the bacteriology is critical in treatment of pleural in- fection. However, there are few studies about pathogens of pleural infection in Korea.
This study aimed to determine microbiologic characteristics of pleural infection and identify predictive factors associated with mortality.
Methods: We performed a retrospective study analyzing 114 cases of parapneumonic effusion with 134 micro-organisms. We examined pleural fl uid cultures using two cul- ture systems, BACTEC blood culture and conventional method.
Results: Of all isolated organisms, the most frequent pathogen was streptococcal species (35.8%) followed by staphylococci (19.4%), anaerobes (15.7%) and gram negatives (9.0%). In 73 specimens using both culture systems, BACTEC blood culture showed higher culture-positive rate (94.5%) than conventional method (35.6%).
Streptococci were main organisms in conventional culture (48.4%), community-ac- quired infection (58.7%) and all susceptible, whereas staphylococci were major isolates in BACTEC blood culture (28.0%), hospital-acquired infection (33.8%) and drug-resist- ant organisms (58.8%). Smoking, interventions (pigtail, tube thoracostomy, intrapleural fi brinolytics, surgery), and severity score (CURB-65) were signifi cantly associated with 30-day mortality in univariate analysis. In multivariate analysis, tube thoracostomy (aOR 0.158, 95% CI 0.051 – 0.489, p=0.001), smoking (aOR 6.958, 95% CI 1.882 – 25.720, p=0.004) and CURB-65 =2 (aOR 4.204, 95% CI 1.345 – 13.136, p=0.014) were signifi cant predictive factors for mortality.
Conclusions: Common pathogens of pleural infection in Korea were streptococcal species, staphylococci, and anaerobes. Tube thoracostomy, smoking, and CURB-65 =2 could be predictive factors for death in pleural infection.
OS-094 Miscellaneous
Risk Factors and Outcome of Primary Graft Dysfunction After Lung Transplantation in Korea
Sung Woo Moon1, Ji Ye Jung1, Young Ae Kang1, Moo Suk Park1, Young Sam Kim1, Se Kyu Kim1, Joon Chang1, Hyo Chae Park2, Chang Young Lee2, Song Yee Kim1 Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseas- es, Yonsei University College of Medicine, Korea1, Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Korea2
Background: Primary graft dysfunction (PGD) is a severe type of acute lung injury after lung transplantation and is reported to be associated with early morbidity and mortality.
We were to investigate donor, recipient, and perioperative risk factors and outcome of PGD.
Methods: We performed a retrospective study using data collected in one tertiary care hospital in South Korea. The patients who underwent lung transplantation between Jan- uary 2010 and March 2014 were enrolled. The primary outcome was grade 3 PGD (PaO2/
FiO2 < 200 and presence of diffuse infi ltrates on chest radiograph of allograft at 48 or 72 hours after transplant) and PGD grade was defi ned according to International Society for Heart and Lung Transplantation criteria.
Results: A total of 61 patients were enrolled and 16 subjects (26.2%) developed grade 3 PGD. In univariate study, higher body mass index (BMI) in recipients, any history of recip- ient smoking, extracorporeal membrane oxygenation usage before transplantation in re- cipients, and ischemic time during operation were associated with PGD. Primary recipient diagnosis, transplant type, mean pulmonary artery pressure, donor-smoking history were not related with PGD. In multivariate model, independent risk factors for PGD were BMI in recipients (Odds ratio [OR], 1.290; P=0.048) and total ischemic time during operation (OR, 1.013; P=0.009). PGD was signifi cantly associated with higher re-operation rate (OR, 3.500; P=0.042), longer days of ventilator apply (median 6 days vs.14.5 days; P=0.044), longer intensive care unit stay (median 9 days vs. 17 days; P=0.041) and higher rate of renal replacement therapy (OR, 7.708; P=0.002) after transplantation.
Conclusions: We identifi ed risk factors and outcome of grade 3 PGD after lung trans- plantation. Our fi ndings can be used to develop predictive models for PGD that may allow for modifi cation of risk factors.
OS-095 Critical Care
Unplanned Extubation in Mechanically Ventilated Patients in the Medical Intensive Care Unit: Experience in a Single Tertiary Hospital
Tae Won Lee1, Ho Cheol Kim1, Young Sil Hwang1, Jong Deog Lee1, Yi Yeong Jeong1, Yu Ji Cho1, Seung Jun Lee1, Seung Hun Lee1, Sunmi Ju1, Jeong Woo Hong1
Gyeongsang National University Hospital, Korea1
Background: Unplanned extubation (UE) can occur in patients with mechanical ven- tilation (MV) in the intensive care unit (ICU) and can be harmful. This study aimed to evaluate the clinical characteristics of UE and its impact on outcomes in patients on MV in the medical ICU (MICU).
Methods: We retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014 at Gyeongsang National University Hospital.
Results: A total of 468 patients were admitted to the MICU, of which, 435 were on MV. Of these, 30 patients (6.9%) experienced UE. Fourteen of these patients (56.7%) needed reintubation after UE and 16 (43.7%) did not need reintubation. Continuous positive airway pressure or spontaneous breathing with a T-piece was applied at the time of UE in 20 patients (66.7%). Further, 4 patients (13.4%) received sedative agents. Of the 14 reintubated patients, 9 (64.2%) were reintubated within 48 hours.
Patients who needed reintubation had a signifi cantly longer MV duration and ICU stay than those who did not need reintubation (16.9 ± 14.1 vs. 5.6 ± 5.9 days and 6.6 ± 6.4 vs. 16.2 ± 13.1 days, respectively; p < 0.05). In addition, ICU mortality was signifi - cantly higher among patients who needed reintubation than among those who did not need reintubation (6.3% vs. 57.1%, p < 0.05). However, these two groups of patients showed no signifi cant differences in FiO2, blood pressure, heart rate, respiratory rate, and pH after UE.
Conclusions: UE can occur in patients on MV in the ICU. Although reintubation may not always be required in patients with UE, it is associated with poor outcomes in re- intubated patients after UE.
