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Case Report
Multiple Bilateral Perfusion Defects in the Infant with Acute Viral Bronchiolitis: A Case Report
Woo Jin Chung, Jae Wook Choi, Young Ju Han, June Dong Park
Korean J Crit Care Med. 2011;26(4):272-275.
DOI: https://doi.org/10.4266/kjccm.2011.26.4.272
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AbstractAbstract PDF
Acute viral bronchiolitis (AVB) is an obstructive lung disease which frequently develops in infants and the most common functional involvement is a V/Q ratio change caused by small airway obstruction. We report a case showing the redistribution of pulmonary blood flow by multiple perfusion scan defects in an infant with AVB. A 15 month-old male infant visited ER due to respiratory difficulty. He manifested decreased lung sound in the left lung field, hyperinflation of the left lung on chest x-ray, and metabolic acidosis in blood gas analysis. A perfusion scan showed multiple perfusion defects of both lungs without the evidence of pulmonary embolism on a following cardiac CT and echocardiography. Human Rhinovirus PCR in a nasopharyngeal aspirate was positive. With supportive care, the symptom was resolved in 4 days. AVB can show multiple perfusion defects by the redistribution of pulmonary blood flow of which the direction is opposite to the usual distribution of pulmonary blood flow in children.
Original Articles
The Changes of Regional Cerebral Blood Flow according to Inhalational Anesthetic Agents after Transient Bilateral Carotid Artery Occlusion in the Rabbit
Hyeong Geun Joo, Hae Kyu Kim
Korean J Crit Care Med. 2005;20(2):121-130.
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AbstractAbstract PDF
BACKGROUND
Cerebral hyperperfusion syndrome is a recognized complication of carotid endarterectomy, with a reported incidence of 0.3 to 1.2%. Monitoring of regional cerebral blood flow (rCBF) may limit neurological damage. This study was planned to investigate the changes of rCBF according to inhalational anesthetic agents. METHODS: 2.40+/-0.04 kg weighed New Zealand White Rabbits were undergone transient brain ischemia by bilateral carotid artery ligation for 20 minutes. The rCBF was measured by Bowman Perfusion Monitor.
RESULTS
The value of rCBF in pre-ligation state was not significantly different among the three groups. rCBF in sevoflurane group was decreased to 46% of baseline value during ischemia and increased to 143% just after reperfusion. rCBFs in isoflurane and enflurane groups were abruptly increased instead of decrease like sevoflurane group. The values of rCBF was more increasing after reperfusion in isoflurane and enflurane groups. rCBFs in all groups were return to baseline value 10 minutes after reperfusion. CONCLUSIONS: This results was suggested that sevoflurane might be contributed to create a neurologic damage during ischemia and the hyperperfusion was seen in all three anesthetic agents. The clinical investigation may be needed to establish the value of this experiment.
The Effect of Low-dose Dopamine on Splanchnic and Renal Blood Flow in Patients with Septic Shock under the Treatment of Norepinephrine
Jong Joon Ahn, Tae Hyung Kim, Ki Man Lee, Tae Sun Shim, Chae Man Lim, Sang Do Lee, Woo Sung Kim, Dong Soon Kim, Won Dong Kim, Younsuck Koh
Korean J Crit Care Med. 2001;16(1):36-41.
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AbstractAbstract PDF
BACKGROUND
Norepinephrine, which is frequently administered as a vasopressor to the patients with septic shock, can decrease splanchnic and renal blood flows and aggravate splanchnic and renal ischemia. The low-dose dopamine (LDD) has been frequently combined with norepinephrine to ameliorate renal and splanchnic hypoperfusion in patients with septic shock. However, the effect of the LDD on the splanchnic and renal blood flow has not been fully elucidated. This investigation was carried out to determine the effect of the LDD on the splanchnic and renal blood flow in the patients with septic shock under the treatment of norepinephrine.
METHODS
Eleven patients with septic shock were included in this study. All of them were under the norepinephrine treatment as the mean arterial pressure (MAP) was less than 70 mm Hg in spite of the adequate fluid resuscitation. With stabilization of MAP, the LDD (2 g/kg/min) was administered for two hours in each patients. Hemodynamics, gastric intramucosal pH (pHi), gastric regional PCO2 (rPCO2), rPCO2 - PaCO2, urine volume, urine sodium excretion and creatinine clearance were compared between with and without the LDD infusion. Diuretics was not used during the study period.
RESULTS
Age of patients (n=11) was 64 12 and the APACHE III score was 84 17. The mortality rate of the subjects was 64%. Dosage of norepinephrine was 0.55 0.63 g/kg/min during the study period. There were no significant differences in hemodynamics (central venous pressure, cardiac output, pulmonary artery occlusion pressure, mixed venous gas), pHi, rPCO2, rPCO2 - PaCO2 depending on the concomitant infusion of the LDD. The volume of urine tended to increase (P=0.074) after concomitant LDD, but the changes in urine sodium excretion and creatinine clearance were not significantly different.
CONCLUSIONS
The combined infusion of the LDD with norepinephrine did not improve splanchnic and renal blood flow in the patients with septic shock.

ACC : Acute and Critical Care