Acute and Critical Care

Thoracic Surgery
Catheter detection by transthoracic echocardiography during placement of peripherally inserted central catheters: a real-time method for eliminating misplacement: Yong Chae Jung, Man-shik Shim, Hee Sun Park, Min-Woong Kang; Acute Crit Care. 2024;39(2):266-274. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00150

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Abstract PDF Supplementary Material: Background
Although guidelines and protocols are available for central venous access, existing methods lack specificity and sensitivity, especially when placing peripherally inserted central catheters (PICCs). We evaluated the feasibility of catheter detection in the right atrial cavity using transthoracic echocardiography (TTE) during PICC placement. Methods: This single-center, retrospective study included consecutive patients who underwent PICC placement between January 2022 and March 2023. TTE was performed to detect the arrival of the catheter in the right atrial cavity. Catheter misplacement was defined as an aberrant catheter position on chest x-ray (CXR). The primary endpoint was predicting catheter misplacement based on catheter detection in the right atrial cavity. The secondary endpoint was optimizing catheter placement and examining catheter-associated complications. Results: Of the 110 patients identified, 10 were excluded because of poor echogenicity and vein access failure. The remaining 100 patients underwent PICC placement with TTE. The catheter was visualized in the right atrial cavity in 90 patients. CXR exams revealed catheter misplacement in seven cases. Eight patients with catheter misplacement underwent the same procedure in the other arm. In two patients, PICC placement failed due to anatomical reasons. Catheter misplacement was detected using TTE with sensitivity, specificity, positive predictive value, and negative predictive value of 97% confidence interval (CI; 91.31%–99.36%), 90% CI (55.50%–99.75%), 99%, and 75%, respectively. Conclusions: TTE is a reliable tool for detecting catheter misplacement and optimizing catheter tip positioning during PICC placement.

Thoracic Surgery
Transjugular central venous catheter guidewire embolism to venoarterial extracorporeal membrane oxygenation cannula: Nilesh Anand Devanand, Sophie Dohnt, Michael Farquharson; Acute Crit Care. 2024;39(1):199-200. Published online December 26, 2023; DOI: https://doi.org/10.4266/acc.2023.01270

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Cardiology
Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report: Sangshin Park, Min Kim, Dae In Lee, Ju-Hee Lee, Sangmin Kim, Sang Yeub Lee, Jang-Whan Bae, Kyung-Kuk Hwang, Dong-Woon Kim, Myeong-Chan Cho, Dae-Hwan Bae; Acute Crit Care. 2024;39(1):194-198. Published online May 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01158

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Abstract PDF Supplementary Material

The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.

Citations

Citations to this article as recorded by

Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review
Johanna K. R. von Mackensen, Vanessa I. T. Zwaans, Ahmed El Shazly, Karel M. Van Praet, Roland Heck, Christoph T. Starck, Felix Schoenrath, Evgenij V. Potapov, Joerg Kempfert, Stephan Jacobs, Volkmar Falk, Leonhard Wert
Journal of Clinical Medicine.2024; 13(2): 473. CrossRef

Infection
Right-sided infective endocarditis of a native valve with multiple embolus lesions: Miyeon Kim, Ki Yung Boo, Jeong Rae Yoo; Acute Crit Care. 2023;38(4):513-514. Published online November 24, 2023; DOI: https://doi.org/10.4266/acc.2023.01228

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Infection
Right-sided infective endocarditis of a native valve with multiple embolus lesions: Miyeon Kim, Ki Yung Boo, Jeong Rae Yoo; Acute Crit Care. 2023;38(4):513-514. Published online November 24, 2023; DOI: https://doi.org/10.4266/acc.2023.01228

2,658 View
38 Download

PDF Supplementary Material

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

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746 Download

Abstract PDF Supplementary Material: Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

8,448 View
746 Download

Abstract PDF Supplementary Material: Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

8,448 View
746 Download

Abstract PDF Supplementary Material: Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

8,448 View
746 Download

Abstract PDF Supplementary Material: Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

Pulmonary
Lung ultrasound for evaluation of dyspnea: a pictorial review: Aparna Murali, Anjali Prakash, Rashmi Dixit, Monica Juneja, Naresh Kumar; Acute Crit Care. 2022;37(4):502-515. Published online November 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00780

8,448 View
746 Download

Abstract PDF Supplementary Material: Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency (BLUE) protocol which can be utilized to diagnose the cause of acute dyspnea at the bedside. We attempt to provide a simplified approach to understanding the physics behind the artifacts used in lung ultrasound, the imaging techniques, and the application of the BLUE protocol to diagnose the commonly presenting causes of acute dyspnea.

Cardiology
Acute perimyocarditis mimicking acute myocardial infarction in a 12-year-old boy with duchenne muscular dystrophy: Ho Jung Choi, Hye Won Kwon, Kyung Jin Oh, Mi Kyoung Song; Acute Crit Care. 2022;37(2):258-262. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00290

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262 Download
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Abstract PDF Supplementary Material

Differential diagnosis of chest pain in the pediatric population is important but can be challenging. A 12-year-old boy with Duchenne muscular dystrophy presented with chest pain, cardiac enzyme elevation, and convex ST elevations in the inferior leads with reciprocal ST depression in the anterior leads on electrocardiogram. Echocardiography on admission revealed normal left ventricular function. Suspecting acute myocardial infarction, we performed invasive coronary angiography, which revealed normal coronary arteries. A follow-up electrocardiogram showed an acute pericarditis pattern with concave ST elevations in most leads and PR depression, and follow-up echocardiography revealed global left ventricular dysfunction, suggestive of acute perimyocarditis. Ibuprofen was administered for acute pericarditis, and a continuous milrinone infusion was commenced for myocardial dysfunction. The chest pain improved by the next day, and the ST segment elevations normalized on day 4. Echocardiography on day 9 revealed improved left ventricular function. The patient was discharged on day 11, and he is doing well without chest pain through 12 months of follow-up. The last electrocardiogram showed normal sinus rhythm without ST change. Differential diagnosis of acute myocardial infarction and acute perimyocarditis is important for proper treatment strategies and the different prognoses of these two conditions.

Citations

Citations to this article as recorded by

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department
Szu-Wei Huang, Ying-Kuo Liu
Diagnostics.2024; 14(5): 526. CrossRef
Case Report: Acute myocarditis in a patient with Duchenne muscular dystrophy
Xinyuan Zhang, Yingkun Guo, Huayan Xu
Frontiers in Cardiovascular Medicine.2024;[Epub] CrossRef
Successful treatment of acute myocardial injury of Duchenne muscular dystrophy with steroids: a case report
Merve Oğuz, Dolunay Gürses, Furkan Ufuk, Münevver Yılmaz, Olcay Güngör
Journal of Cardiothoracic Surgery.2023;[Epub] CrossRef
Comprehensive cardiac magnetic resonance T1, T2, and extracellular volume mapping to define Duchenne cardiomyopathy
Sudeep D. Sunthankar, Kristen George-Durrett, Kimberly Crum, James C. Slaughter, Jennifer Kasten, Frank J. Raucci, Larry W. Markham, Jonathan H. Soslow
Journal of Cardiovascular Magnetic Resonance.2023; 25(1): 44. CrossRef

Cardiology
Acute perimyocarditis mimicking acute myocardial infarction in a 12-year-old boy with duchenne muscular dystrophy: Ho Jung Choi, Hye Won Kwon, Kyung Jin Oh, Mi Kyoung Song; Acute Crit Care. 2022;37(2):258-262. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00290

5,900 View
262 Download
4 Web of Science
4 Crossref

Abstract PDF Supplementary Material

Differential diagnosis of chest pain in the pediatric population is important but can be challenging. A 12-year-old boy with Duchenne muscular dystrophy presented with chest pain, cardiac enzyme elevation, and convex ST elevations in the inferior leads with reciprocal ST depression in the anterior leads on electrocardiogram. Echocardiography on admission revealed normal left ventricular function. Suspecting acute myocardial infarction, we performed invasive coronary angiography, which revealed normal coronary arteries. A follow-up electrocardiogram showed an acute pericarditis pattern with concave ST elevations in most leads and PR depression, and follow-up echocardiography revealed global left ventricular dysfunction, suggestive of acute perimyocarditis. Ibuprofen was administered for acute pericarditis, and a continuous milrinone infusion was commenced for myocardial dysfunction. The chest pain improved by the next day, and the ST segment elevations normalized on day 4. Echocardiography on day 9 revealed improved left ventricular function. The patient was discharged on day 11, and he is doing well without chest pain through 12 months of follow-up. The last electrocardiogram showed normal sinus rhythm without ST change. Differential diagnosis of acute myocardial infarction and acute perimyocarditis is important for proper treatment strategies and the different prognoses of these two conditions.

Citations

Citations to this article as recorded by

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department
Szu-Wei Huang, Ying-Kuo Liu
Diagnostics.2024; 14(5): 526. CrossRef
Case Report: Acute myocarditis in a patient with Duchenne muscular dystrophy
Xinyuan Zhang, Yingkun Guo, Huayan Xu
Frontiers in Cardiovascular Medicine.2024;[Epub] CrossRef
Successful treatment of acute myocardial injury of Duchenne muscular dystrophy with steroids: a case report
Merve Oğuz, Dolunay Gürses, Furkan Ufuk, Münevver Yılmaz, Olcay Güngör
Journal of Cardiothoracic Surgery.2023;[Epub] CrossRef
Comprehensive cardiac magnetic resonance T1, T2, and extracellular volume mapping to define Duchenne cardiomyopathy
Sudeep D. Sunthankar, Kristen George-Durrett, Kimberly Crum, James C. Slaughter, Jennifer Kasten, Frank J. Raucci, Larry W. Markham, Jonathan H. Soslow
Journal of Cardiovascular Magnetic Resonance.2023; 25(1): 44. CrossRef

Pulmonary
Retrieval of a tracheobronchial blood clot with a Yankauer suction catheter in complete airway obstruction: Sharad Kaushik, Gaurav Jain, Namrata Gupta, Lokesh Kumar Saini, Girish Sindhwani; Acute Crit Care. 2021;36(1):78-80. Published online January 13, 2021; DOI: https://doi.org/10.4266/acc.2020.00675

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98 Download
1 Web of Science
1 Crossref

PDF Supplementary Material

Citations

Citations to this article as recorded by

Determining Obstruction in Endotracheal Tubes Using Physical Respiratory Signals
Hyunkyoo Kang, Jin-Kyung Park, Jinsu An, Jeong-Han Yi, Hyung-Sik Kim
Applied Sciences.2023; 13(7): 4183. CrossRef

Basic science and research
Feasibility study of incident dark-field video microscope for measuring microcirculatory variables in the mouse dorsal skinfold chamber model: Christine Kang, Ah-Reum Cho, Hyeon Jeong Lee, Hyae Jin Kim, Eun-Jung Kim, Soeun Jeo, Jeong-Min Hong, Daehoan Moon; Acute Crit Care. 2021;36(1):29-36. Published online February 26, 2021; DOI: https://doi.org/10.4266/acc.2020.00969

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148 Download
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1 Crossref

Abstract PDF Supplementary Material

Background
Despite the importance of microcirculation in organ function, monitoring microcirculation is not a routine practice. With developments in microscopic technology, incident dark field (IDF) microscopy (Cytocam) has allowed visualization of the microcirculation. Dorsal skinfold chamber (DSC) mouse model has been used to investigate microcirculation physiology. By employing Cytocam-IDF imaging with DSC model to assess microcirculatory alteration in lipopolysaccharide (LPS)-induced endotoxemia, we attempted to validate availability of Cytocam-IDF imaging of microcirculation.
Methods
DSC was implanted in eight BALB/c mice for each group; control and sepsis. Both groups were given 72 hours to recover from surgery. The sepsis group had an additional 24-hour period of recovery post-LPS injection (4 mg/kg). Subsequently, a video of the microcirculation was recorded using Cytocam. Data on microcirculatory variables were obtained. Electron microscopy was implemented using lanthanum fixation to detect endothelial glycocalyx degradation.
Results
The microcirculatory flow index was significantly lower (control, 2.8±0.3; sepsis, 2.1±0.8; P=0.033) and heterogeneity index was considerably higher (control, 0.10±0.15; sepsis, 0.53±0.48; P=0.044) in the sepsis group than in the control group. Electron microscopy revealed glycocalyx demolishment in the sepsis group.
Conclusions
Cytocam showed reliable ability for observing changes in the microcirculation under septic conditions in the DSC model. The convenience and good imaging quality and the automatic analysis software available for Cytocam-IDF imaging, along with the ability to perform real-time in vivo experiments in the DSC model, are expected to be helpful in future microcirculation investigations.

Citations

Citations to this article as recorded by

Sedation with propofol and isoflurane differs in terms of microcirculatory parameters: A randomized animal study using dorsal skinfold chamber mouse model
Christine Kang, Ah-Reum Cho, Haekyu Kim, Jae-Young Kwon, Hyeon Jeong Lee, Eunsoo Kim
Microvascular Research.2024; 153: 104655. CrossRef

Basic science and research
Feasibility study of incident dark-field video microscope for measuring microcirculatory variables in the mouse dorsal skinfold chamber model: Christine Kang, Ah-Reum Cho, Hyeon Jeong Lee, Hyae Jin Kim, Eun-Jung Kim, Soeun Jeo, Jeong-Min Hong, Daehoan Moon; Acute Crit Care. 2021;36(1):29-36. Published online February 26, 2021; DOI: https://doi.org/10.4266/acc.2020.00969

6,501 View
148 Download
2 Web of Science
1 Crossref

Abstract PDF Supplementary Material

Background
Despite the importance of microcirculation in organ function, monitoring microcirculation is not a routine practice. With developments in microscopic technology, incident dark field (IDF) microscopy (Cytocam) has allowed visualization of the microcirculation. Dorsal skinfold chamber (DSC) mouse model has been used to investigate microcirculation physiology. By employing Cytocam-IDF imaging with DSC model to assess microcirculatory alteration in lipopolysaccharide (LPS)-induced endotoxemia, we attempted to validate availability of Cytocam-IDF imaging of microcirculation.
Methods
DSC was implanted in eight BALB/c mice for each group; control and sepsis. Both groups were given 72 hours to recover from surgery. The sepsis group had an additional 24-hour period of recovery post-LPS injection (4 mg/kg). Subsequently, a video of the microcirculation was recorded using Cytocam. Data on microcirculatory variables were obtained. Electron microscopy was implemented using lanthanum fixation to detect endothelial glycocalyx degradation.
Results
The microcirculatory flow index was significantly lower (control, 2.8±0.3; sepsis, 2.1±0.8; P=0.033) and heterogeneity index was considerably higher (control, 0.10±0.15; sepsis, 0.53±0.48; P=0.044) in the sepsis group than in the control group. Electron microscopy revealed glycocalyx demolishment in the sepsis group.
Conclusions
Cytocam showed reliable ability for observing changes in the microcirculation under septic conditions in the DSC model. The convenience and good imaging quality and the automatic analysis software available for Cytocam-IDF imaging, along with the ability to perform real-time in vivo experiments in the DSC model, are expected to be helpful in future microcirculation investigations.

Citations

Citations to this article as recorded by

Sedation with propofol and isoflurane differs in terms of microcirculatory parameters: A randomized animal study using dorsal skinfold chamber mouse model
Christine Kang, Ah-Reum Cho, Haekyu Kim, Jae-Young Kwon, Hyeon Jeong Lee, Eunsoo Kim
Microvascular Research.2024; 153: 104655. CrossRef

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