Factors associated with mortality after asthma admission in the intensive care unit of a tertiary referral hospital

PURPOSE: Asthma is a global health concern involving 300 million people, and mortality due to asthma still accounts for a significant proportion of deaths. The purpose of this study was to define risk factors for the mortality of patients admitted to the intensive care unit because of asthma exacerbation. METHODS: A retrospective analysis of 163 severe asthma patients, who were admitted to Ewha Womans University Mokdong Hospital from January 1997 to December 2011 with the need for intensive medical care, was performed. The medical history and laboratory workup at initial visit to hospital were collected by reviewing medical records. To identify risk factors for mortality, data was compared between the survivors (survivor group) and the dead (death group). RESULTS: As a result, mortality rate was 30.7%. The number of patients 65 years or older was larger in the death group. The number of patients on mechanical ventilation was larger in the death group compared to the survivor group. In arterial blood gas analysis, the levels of pH and PaO2 were higher and the PCO2 levels were lower in the death group. In multivariate analysis, the risk of death was higher in patients on mechanical ventilation (odds ratio [OR], 5.327). PCO2 and O2 saturation were protective factors for mortality (OR, 0.90 and 0.915, respectively). CONCLUSION: Use of mechanical ventilator, low PCO2, and O2 saturation are the most important factors for mortality while admitted to the intensive care unit in severe asthma patients. We should pay attention to patients who are on mechanical ventilation and have low PCO2 and O2 saturation levels.

A Case of Persistent Hiccup in a Patient with Non-small Cell Lung Cancer / 결핵및호흡기질환

A hiccup is caused by involuntary, intermittent, and spasmodic contractions of the diaphragm and intercostal muscles. It starts with a sudden inspiration and ends with an abrupt closure of the glottis. Even though a hiccup is thought to develop through the hiccup reflex arc, its exact pathophysiology is still unclear. The etiologies include gastrointestinal disorders, respiratory abnormalities, psychogenic factors, toxic-metabolic disorders, central nervous system dysfunctions and irritation of the vagus and phrenic nerves. Most benign hiccups can be controlled by traditional empirical therapy such as breath holding and swallowing water. However, though rare, a persistent hiccup longer than 48 hours can lead to significant adverse effects including malnutrition, dehydration, insomnia, electrolyte imbalance, and cardiac arrhythmia. An intractable hiccup can sometimes even cause death. We herein describe a patient with non-small cell lung cancer who was severely distressed by a persistent hiccup.