Acute and Critical Care

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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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

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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

Delayed Anaphylactic Shock to Intravenous Cefotetan in a Pregnant Woman: A Case Report: Ah Reum Cho, Hyeon Jeong Lee, Hye Kyung Park, Young Jae Oh; Korean J Crit Care Med. 2012;27(2):126-129.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.126

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Abstract PDF

Anaphylactic reactions to agents administered intravenously usually occur within minutes. We present an unusual case of a delayed onset anaphylactic shock to intravenous cefotetan in a pregnant woman who underwent an epidural cesarean section. She sustained hypotension, tachycardia, bronchospasm, and rash 90 min after administering intravenous cefotetan. The possibilities of high epidural blocks or amnionic fluid embolisms were excluded by the height of sensory blocks or different presenting symptoms and signs, respectively. Allergic skin tests for exposed materials were performed 6 weeks after discharge and no immediate reactions occurred. However, delayed systemic allergic reactions, such as urticaria, rash, and edema on her face, neck, back, and abdomen, occurred 3 h after skin test to cefotetan.

Citations

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LC-MS/MS method for the quantitation of cefotetan in human plasma and its application to pharmacokinetic study
Meiyun Shi, Lei Yin, Lanlan Cai, Can Wang, Xidong Liu, Sen Zhao, Yantong Sun, Paul J. Fawcett, Limei Zhao, Yan Yang, Jingkai Gu
Chemical Research in Chinese Universities.2014; 30(6): 900. CrossRef

Central Venous Catheter Misplaced in the Innominate Vein after Penetrating the Left Subclavian Vein in a Neonate: A Case Report: Sang Wook Shin, Ji Uk Yoon, Hyeon Jeong Lee, O Sun Kwon, Hyun Mok Kim; Korean J Crit Care Med. 2012;27(1):49-51.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.49

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Abstract PDF: In the pediatric ICU and operating room, a central venous catheter (CVC) provides accurate hemodynamic information and serves as a reliable route for the administration of vasoactive drugs, fluids and allogeneic blood products. The placement of CVC is associated with a complication rate of 0.4% to 20%, including hemothorax, pneumothorax, thrombosis, infection and cardiac tamponade. We describe a case of CVC being misplaced in the innominate vein after penetrating the subclavian vein during anesthesia induction for arterial switch operation. Our report discusses the mechanisms by which this mishap took place, and reviews the proper positions of the head, arm, thorax and safe depth of venipuncture for the placement of a CVC in neonates.

Bronchospasm during Minimally Invasive Cardiac Surgery in a Patient with a Mosaic Attenuation Pattern on Lung Computed Tomography: A Case Report: Eun Soo Kim, Hyeon Jeong Lee, Sung Chun Park, Hee Young Kim, Hyung Gon Je, Jung Min Hong; Korean J Crit Care Med. 2010;25(1):48-51.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.48

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Abstract PDF

Severe bronchospasm during cardiac surgery is an uncommon, but serious problem. A 52-year-old woman with a mosaic attenuation pattern on the whole lung field was scheduled for repair of an atrial septal defect under minimally invasive cardiac surgery. Bronchospasm developed intraoperatively, but the underlying ventilatory impairment, poor performance of one-lung ventilation and initiation of cardiopulmonary bypass delayed diagnosing and treating the bronchospasm. The bronchospasm induced severe pulmonary edema that required postoperative ventilatory care.

Citations

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Pulmonary Edema in Severe Bronchospasm
Charles Her
The Korean Journal of Critical Care Medicine.2010; 25(3): 203. CrossRef

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