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Original Article
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
  • 451 View
  • 41 Download
AbstractAbstract PDFSupplementary 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.
Images in Critical Care
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
  • 2,964 View
  • 143 Download
PDFSupplementary Material
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
  • 1,780 View
  • 32 Download
PDFSupplementary Material
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
  • 1,780 View
  • 32 Download
PDFSupplementary Material
Review Articles
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
  • 7,066 View
  • 652 Download
AbstractAbstract PDFSupplementary 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
  • 7,066 View
  • 652 Download
AbstractAbstract PDFSupplementary 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
  • 7,066 View
  • 652 Download
AbstractAbstract PDFSupplementary 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
  • 7,066 View
  • 652 Download
AbstractAbstract PDFSupplementary 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
  • 7,066 View
  • 652 Download
AbstractAbstract PDFSupplementary 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.
Case Reports
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
  • 5,485 View
  • 253 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary 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
  • 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
  • 5,485 View
  • 253 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary 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
  • 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
Letter to the editor
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
  • 4,872 View
  • 93 Download
  • 1 Web of Science
  • 1 Crossref
PDFSupplementary 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
Original Articles
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
  • 6,110 View
  • 141 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary 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
  • 6,110 View
  • 141 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary 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
Case Report
CPR/Resuscitation
Acute aortic dissection developed after cardiopulmonary resuscitation: transesophageal echocardiographic observations and proposed mechanism of injury
Dong Keon Lee, Kyung Sik Kang, Yong Sung Cha, Kyoung-Chul Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang
Acute Crit Care. 2019;34(3):228-231.   Published online April 26, 2018
DOI: https://doi.org/10.4266/acc.2015.00633
  • 7,852 View
  • 153 Download
  • 7 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
There has been no report about aortic dissection due to cardiopulmonary resuscitation (CPR). We present here a case of acute aortic dissection as a rare complication of CPR and propose the potential mechanism of injury on the basis of transesophageal echocardiographic observations. A 54-year-old man presented with cardiac arrest after choking and received 19 minutes of CPR in the emergency department. Transesophageal echocardiography (TEE) during CPR revealed a focal separation of the intimal layer at the descending thoracic aorta without evidence of aortic dissection. After restoration of spontaneous circulation, hemorrhagic cardiac tamponade developed. Follow-up TEE to investigate the cause of cardiac tamponade revealed aortic dissection of the descending thoracic aorta. Hemorrhagic cardiac tamponade was thought to be caused by myocardial hemorrhage from CPR.

Citations

Citations to this article as recorded by  
  • Thoracic Aortic Rupture Post Cardiopulmonary Resuscitation in a Patient With Previous Thoracic Aneurysm Repair
    Aniekeme S Etuk, Olanrewaju F Adeniran , Bernard I Nkwocha, Nformbuh Asangmbeng, Mina Jacob
    Cureus.2023;[Epub]     CrossRef
  • Cardiac Arrest as an Uncommon Manifestation of Late Type A Aortic Dissection Associated with Transcatheter Aortic Valve Replacement
    Jan Naar, Dagmar Vondrakova, Andreas Kruger, Marek Janotka, Iva Zemanova, Martin Syrucek, Petr Neuzil, Petr Ostadal
    Journal of Clinical Medicine.2023; 12(16): 5318.     CrossRef
  • Blunt Thoracic Aortic Injury and Contemporary Management Strategy
    Ranjan Dahal, Yogesh Acharya, Alan H. Tyroch, Debabrata Mukherjee
    Angiology.2022; 73(6): 497.     CrossRef
  • Resuscitative endovascular occlusion of the aorta (REBOA) as a mechanical method for increasing the coronary perfusion pressure in non-traumatic out-of-hospital cardiac arrest patients
    Dong-Hyun Jang, Dong Keon Lee, You Hwan Jo, Seung Min Park, Young Taeck Oh, Chang Woo Im
    Resuscitation.2022; 179: 277.     CrossRef
  • Blunt traumatic aortic dissection death by falling: an autopsy case report
    Gentaro Yamasaki, Marie Sugimoto, Takeshi Kondo, Motonori Takahashi, Mai Morichika, Azumi Kuse, Kanako Nakagawa, Yasuhiro Ueno, Migiwa Asano
    Forensic Science, Medicine and Pathology.2022; 19(3): 388.     CrossRef
  • Intra-arrest transesophageal echocardiography during cardiopulmonary resuscitation
    Sung Oh Hwang, Woo Jin Jung, Young-Il Roh, Kyoung-Chul Cha
    Clinical and Experimental Emergency Medicine.2022; 9(4): 271.     CrossRef
  • Intra-arrest transoesophageal echocardiographic findings and resuscitation outcomes
    Woo Jin Jung, Kyoung-Chul Cha, Yong Won Kim, Yoon Seop Kim, Young-Il Roh, Sun Ju Kim, Hye Sim Kim, Sung Oh Hwang
    Resuscitation.2020; 154: 31.     CrossRef
  • Aortic Rupture as a Complication of Cardiopulmonary Resuscitation
    Prashanth Venkatesh, Edward J. Schenck
    JACC: Case Reports.2020; 2(8): 1150.     CrossRef

ACC : Acute and Critical Care