Acute and Critical Care

Original Article

Basic science and research
Flecainide Improve Sepsis Induced Acute Lung Injury by Controlling Inflammatory Response: Jia Song, Young joong Suh, Hyun jung Lee, Eun a Jang, Hong-beom Bae, Sang-Hyun Kwak; Korean J Crit Care Med. 2016;31(3):194-201. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00157

Abstract PDF: Background
Flecainide is an antiarrhythmic agent that is used primarily in the treatment of cardiac arrhythmias. Some evidences also suggest that flecainide can participate in alveolar fluid clearance and inflammatory responses. This experiment was aimed to evaluate the effects of flecainide on sepsis induced acute lung injury in a rat model.
Methods
Rats were treated with subcutaneous infusion of saline or flecainide (0.1 or 0.2 mg/kg/hr) by a mini-osmotic pump. Subcutaneous infusion was started 3 hours before and continued until 8 hours after intraperitoneal injection of saline or endotoxin. Animals were sacrificed for analyses of severity of acute lung injury with wet to dry (W/D) ratio and lung injury score (LIS) in lung and inflammatory responses with level of leukocyte, polymorphonuclear neutrophils (PMNs) and inteleukin-8 (IL-8) in bronchoalveolar lavages fluid (BALF).
Results
Flecainide markedly improved dose dependently sepsis induced acute lung injury as analysed by W/D ratio (from 2.24 ± 0.11 to 1.76 ± 0.09, p < 0.05) and LIS (from 3 to 1, p < 0.05), and inflammatory response as determined by leukocyte (from 443 ± 127 to 229 ± 95, p < 0.05), PMNs (from 41.43 ± 17.63 to 2.43 ± 2.61, p < 0.05) and IL-8 (from 95.00 ± 15.28 to 40.00 ± 10.21, p < 0.05) in BALF.
Conclusions
Flecanide improve sepsis induced acute lung injury in rats by controlling inflammatory responses.

Case Reports

Pharmacology/Anesthesiology
Lipid Emulsion in the Successful Resuscitation of Local Anesthetic Toxicity after Ankle Block: Sang Hee Park, Sang Hyun Kwak, Kyung Yeon Yoo, Hyun Jung Lee, Keun Bae Yook, Seok Jai Kim; Korean J Crit Care Med. 2014;29(3):234-236. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.234

Abstract PDF: Unexpected occurrence of local anesthetic toxicity is not rare and can cause fatal complications that do not respond to any known drug of intervention. Recently, the successful use of lipid emulsion for local anesthetic toxicity has been reported and recommended as a rescue method for cardiac or neurologic complications. We report a case of seizure attack and respiratory arrest successfully recovered with the use of intravenous lipid emulsion. Clinicians must be aware of the beneficial role of lipid emulsion in cases of local anesthetic toxicity.

A Case of Hemoperitoneum due to Spontaneous Rupture of Visceral Artery Aneurysm after Ingestion of Puffer Fish: Do Won Lee, Hae Kyu Kim, Hyun Jung Lee, Jung Min Hong, Jae Young Kwon; Korean J Crit Care Med. 2013;28(3):210-213.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.210

Abstract PDF: Ingestion of puffer fish can cause intoxication, which produces a wide range of symptoms due to the presence of neurotoxins, such as tetrodotoxin, in puffer fish. Abdominal pain is just one of the symptoms that should be treated with symptomatic and supportive therapy. This study reports a case of a 56-year-old male patient with abdominal pain, who was admitted to the emergency room with a diagnosis of puffer fish poisoning. In this case, the abdominal pain did not improve, but rather, the symptoms worsened. Finally, the cause of the abdominal pain was found to be hemoperitoneum due to active bleeding at the greater omentum, as observed on abdominal computed tomography; the source of bleeding was the right colic artery branch. Embolization was performed successfully, and the post-intervention course was uneventful. The patient was discharged without any complications within 13 days after admission.

Reexpansion Pulmonary Edema Following the Early Decompression of Pneumothorax Occurred after Anesthetic Induction in a Patient with Lung Bulla: A Case Report: Hye Jin Jeung, Hyun Jung Lee, Seok Jai Kim, Sang Hyun Kwak; Korean J Crit Care Med. 2010;25(3):159-162.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.159

Abstract PDF: When a rapidly re-expanding lung has been in a state of collapse for more than several days, pulmonary edema sometimes occurs. This is called reexpansion pulmonary edema. In general, it most commonly occurs in patients with a large pneumothorax of long duration. In this case, a 15 year old female patient with a 2.3 cm sized bulla in the right lung developed right pneumothorax after anesthetic induction. Although early drainage by closed thoracostomy was performed, right pulmonary edema eventually occurred. It is unusual that vigorous reexpansion pulmonary edema developed even though early decompression was performed within one hour after development of pneumothorax.

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